Establishment of predictive models and determinants of preoperative gastric retention in endoscopic retrograde cholangiopancreatography

BACKGROUND Study on influencing factors of gastric retention before endoscopic retrograde cholangiopancreatography(ERCP)background:With the wide application of ERCP,the risk of preoperative gastric retention affects the smooth progress of the operation.The study found that female,biliary and pancreatic malignant tumor,digestive tract obstruction and other factors are closely related to gastric retention,so the establishment of predictive model is very important to reduce the risk of operation.METHODS A retrospective analysis was conducted on 190 patients admitted to our hospital for ERCP preparation between January 2020 and February 2024.Patient baseline clinical data were collected using an electronic medical record system.Patients were randomly matched in a 1:4 ratio with data from 190 patients during the same period to establish a validation group(n=38)and a modeling group(n=152).Patients in the modeling group were divided into the gastric retention group(n=52)and non-gastric retention group(n=100)based on whether gastric retention occurred preoperatively.General data of patients in the validation group and identify factors influencing preoperative gastric retention in ERCP patients.A predictive model for preoperative gastric retention in ERCP patients was constructed,and calibration curves were used for validation.The receiver operating characteristic(ROC)curve was analyzed to evaluate the predictive value of the model.RESULTS We found no statistically significant difference in general data between the validation group and modeling group(P>0.05).The comparison of age,body mass index,hypertension,and diabetes between the two groups showed no statistically significant difference(P>0.05).However,we noted statistically significant differences in gender,primary disease,jaundice,opioid use,and gastrointestinal obstruction between the two groups(P<0.05).Mul-tivariate logistic regression analysis showed that gender,primary disease,jaundice,opioid use,and gastrointestinal obstruction were independent factors influencing preoperative gastric retention in ERCP patients(P<0.05).The results of logistic regression analysis revealed that gender,primary disease,jaundice,opioid use,and gastroin-testinal obstruction were included in the predictive model for preoperative gastric retention in ERCP patients.The calibration curves in the training set and validation set showed a slope close to 1,indicating good consistency between the predicted risk and actual risk.The ROC analysis results showed that the area under the curve(AUC)of the predictive model for preoperative gastric retention in ERCP patients in the training set was 0.901 with a standard error of 0.023(95%CI:0.8264-0.9567),and the optimal cutoff value was 0.71,with a sensitivity of 87.5 and specificity of 84.2.In the validation set,the AUC of the predictive model was 0.842 with a standard error of 0.013(95%CI:0.8061-0.9216),and the optimal cutoff value was 0.56,with a sensitivity of 56.2 and specificity of 100.0.CONCLUSION Gender,primary disease,jaundice,opioid use,and gastrointestinal obstruction are factors influencing preoperative gastric retention in ERCP patients.A predictive model established based on these factors has high predictive value.

Preoperative gastric retention in endoscopic retrograde cholangiopancreatography

We comment on the article by Jia et al,in the World Journal of Gastrointestinal Surgery.We focus mainly on the factors that impair gastric motility and cause gastric retention in the pre-operative setting of endoscopic retrograde cholan-giopancreatography(ERCP).ERCP is a complex endoscopic therapeutic proce-dure,which demands great skill from the endoscopist but also has recognized complications.Gastric retention impairs the endoscopist’s visibility but also increases the risk of complications,such as aspiration pneumonia.Therefore,identifying the factors that predispose to gastric retention alerts the endoscopists of the possible risks and enables them to take evasive action.The authors in the current study by Jia et al developed and validated a predictive model,which in-corporates five different factors,i.e.,gender,primary disease,jaundice,opioid use,and gastrointestinal obstruction,which were found to influence gastric retention.This model was shown to have a high predictive value to accurately identify pa-tients at risk for gastric retention before a therapeutic ERCP.

“Jianpi Tongwei Prescription”Acupoint Application Combined with Moxibustion for Gastric Retention in Elderly Patients with Nasal Feeding

Objective:To explore the effect of“Jianpi Tongwei Prescription”acupoint application combined with moxibustion in the treatment of gastric retention in elderly patients with nasal feeding.Method:60 cases elderly patients with nasogastric gastric retention in our hospital were selected as the research object from March 1,2019 to on October 31,2019,and were randomly divided into treatment group and control group.Patients in the control group received the nasal feeding of domperidone,10 mg/time,3 times/d,for 21 days or until gastric retention<100 mL.On the basis of the control group,patients in the treatment group was treated with traditional Chinese medicine(TCM)characteristic nursing“Jianpi Tongwei Prescription”acupoint application combined with moxibustion on Zusanli.Results:The effective rate of Jianpi Tongwei Prescription combined with moxibustion in the treatment of gastric retention in elderly patients with nasal feeding was higher than that of conventional treatment(51.2%vs.23.3%,P<0.05),and the rate of gastrointestinal reaction in the treatment group was significantly lower than that in the control group(P<0.05),moderate and severe gastrointestinal reactions were significantly lower than the control group(P<0.05).Conclusion:“Jianpi Tongwei Prescription”acupoint application combined with moxibustion is effective in the treatment of early clinical symptoms of gastric retention in elderly patients with nasal feeding,no adverse reactions,worthy of clinical promotion and application.

Twenty Cases of Diabetic Gastric Retention Treated by Dachengqi Decoction

Objective: To study the effect of Dachengqi Decoction in Treating diabetic gastric retention.Methods: Twenty Patients of diabetic gastric retention were treated with Dachengqi Decoction with their electrogastrogram, urinary glucose and clinical symptoms observed. Results: After treatment, the parameters of electrogastrogram and urinary glucose lowered significantly, and the symptoms relieved. The effect of the treated group was significantly better than that of the control group who were treated with metoclopramide. Conclusion: Dachengqi Decoction is an effective recipe in treating diabetic gastric retention.

Formulation development and evaluation of gastroretentive floating beads with Brucea javanica oil using ionotropic gelation technology

In the present study, a gastric retention floating system for Brucea javanica oil, composed of alginate and carrageenan, was prepared using ionotropic gelation. Parameters for floatability, drug load, encapsulation efficiency, bead morphology, in vitro release, and in vivo gastric retention were evaluated. The optimized formulation via Box–Behnken design consisted of 1.7% alginate(W/V), 1.02% carrageenan(W/V), 1.4% CaCO_3(W/V), and a gelling bath of pH 0.8. The alginate–carrageenan–Brucea javanica oil beads had a porous structure and exhibited up to 24 h of in vitro floatability with a load capacity of 45%–55% and an encapsulation efficiency of 70%–80%. A 6-h sustained release was observed in vitro. The beads had a prolonged gastric retention(> 60% at 6 h) in fasted rats, compared to non-floating beads(15% at 6 h), as measured by gamma scintigraphy with single-photon emission tomography/computed tomography(SPET/CT). In conclusion, the alginate–carrageenan–Brucea javanica oil system showed enhanced oil encapsulation efficiency, excellent floating and gastric retention abilities, and a favorable release behavior.