Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial.

BACKGROUND: Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9 mm polyps in terms of complete resection and adverse events. METHODS: This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5-9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without < 5 mm or > 9 mm polyps. RESULTS: 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval -1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01). CONCLUSIONS: We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.

Histopathological differences in patients with biopsy-proven non-alcoholic fatty liver disease with and without type 2 diabetes / Diferencias histopatológicas en pacientes con diabetes mellitus tipo 2 y no diabéticos con enfermedad hepática grasa no alcohólica diagnosticada con biopsia

Background and aims: Prevalence of non-alcoholic fatty liver disease (NAFLD) in developed countries is 30% in the general population and 50% in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to compare the severity of NAFLD, as assessed by liver biopsy and using the non-invasive index NAFLD Fibrosis Score (NFS), in subjects with and without T2DM. Patients and methods: The study sample consisted of 217 patients with biopsy-proven NAFLD. Anthropometric assessments, laboratory tests, histological criteria established by the Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN), and the NFS were recorded. Results: Patients with T2DM (n=36; 16.5%) had higher HOMA-IR values (6.3±3.6 vs. 3.3±2.4; p<0.0001), GGT levels (125.2±102.3 vs. 82.5±70.6IU/l; p<005), and NFS index (−0.6±0.2 vs. −1.8±0.1; p<0.001) than subjects with no T2DM. Patients with T2DM were found higher rates of NASH (72.2% vs. 48.6%; p<0.05), advanced steatosis (80.6% vs. 63%; p<0.05), and liver fibrosis (75% vs. 43.1%, p<0.05) than patients with no T2DM. Patients with T2DM also had higher NFS values (−0.6±1.2 vs. −1.8±1.8: p=0.01). A logistic regression analysis adjusting for age, gender and BMI showed a significant independent association between NASH and presence of T2DM (OR=4.2: 95% CI: 1.4-12.1; p=0.007). A second model adjusting for the same covariates showed T2DM to be an independent factor associated to advanced fibrosis (OR=4.1; 95% CI: 1.7-9.7). Conclusion: Patients with T2DM have more advanced degrees of NAFLD and advanced fibrosis as assessed by liver biopsy and the NFS index. Particular attention should be paid to the study and monitoring of NASH in patients with T2DM

Antecedentes y objetivos: La prevalencia de la enfermedad hepática grasa no alcohólica (NAFLD) en los países desarrollados es del 30% de la población general y del 50% de los pacientes con diabetes mellitus tipo 2 (DM2). El objetivo de este estudio fue comparar la gravedad de NAFLD evaluado por biopsia hepática y con un índice no invasivo NAFLD Fibrosis Score (NFS) en sujetos con DM2 frente a pacientes no diabéticos. Pacientes y métodos: Este estudio se llevó a cabo entre 217 pacientes con diagnostico mediante biopsia de NAFLD. Se registraron la valoración antropométrica, pruebas de laboratorio, criterios histológicos establecidos por la Red de Investigación Clínica de Esteatohepatitis No Alcohólica (NASH) y NFS. Resultados: Los pacientes con DM2 (n=36; 16,5%) tuvieron más HOMA-IR (6,3±3,6 vs. 3,3±2,4; p<0,0001), GGT (125,2±102,3 vs. 82,5±70,6UI/L); p<0,05) e índice NFS (−0,6±0,2 vs. −1,8±0,1; p<0,001) que los sujetos sin DM2. Los pacientes con DM2 presentaron mayor porcentaje de EHNA (72,2 vs. 48,6%; p<0,05), grado avanzado de esteatosis (80,6 vs. 63%; p<0,05) y fibrosis hepática (75 vs. 43,1%; p<0,05) que los pacientes sin DM2. Los pacientes con DM2 presentaron también valores más altos de NFS (−0,6±1,2 vs. −1,8±1,8; p=0,01). El análisis de regresión logística ajustado por edad, sexo e IMC mostró asociación significativa independiente entre la esteatohepatitis y la presencia de DM2 (OR=4,2; IC 95%: 1,4-12,1; p=0,007). Un segundo modelo ajustado por las mismas covariables mostró que la DM2 fue un factor independiente asociado a la fibrosis avanzada (OR=4,1; IC 95%: 1,7-9,7). Conclusión: Los pacientes con DM2 tienen grados más avanzados de NAFLD y fibrosis avanzada evaluados mediante biopsia hepática y el índice NFS. Debe prestarse especial atención al estudio y seguimiento de la esteatohepatitis en pacientes con DM2

Histopathological differences in patients with biopsy-proven non-alcoholic fatty liver disease with and without type 2 diabetes.

BACKGROUND AND AIMS: Prevalence of non-alcoholic fatty liver disease (NAFLD) in developed countries is 30% in the general population and 50% in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to compare the severity of NAFLD, as assessed by liver biopsy and using the non-invasive index NAFLD Fibrosis Score (NFS), in subjects with and without T2DM. PATIENTS AND METHODS: The study sample consisted of 217 patients with biopsy-proven NAFLD. Anthropometric assessments, laboratory tests, histological criteria established by the Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN), and the NFS were recorded. RESULTS: Patients with T2DM (n=36; 16.5%) had higher HOMA-IR values (6.3±3.6 vs. 3.3±2.4; p<0.0001), GGT levels (125.2±102.3 vs. 82.5±70.6IU/l; p<005), and NFS index (-0.6±0.2 vs. -1.8±0.1; p<0.001) than subjects with no T2DM. Patients with T2DM were found higher rates of NASH (72.2% vs. 48.6%; p<0.05), advanced steatosis (80.6% vs. 63%; p<0.05), and liver fibrosis (75% vs. 43.1%, p<0.05) than patients with no T2DM. Patients with T2DM also had higher NFS values (-0.6±1.2 vs. -1.8±1.8: p=0.01). A logistic regression analysis adjusting for age, gender and BMI showed a significant independent association between NASH and presence of T2DM (OR=4.2: 95% CI: 1.4-12.1; p=0.007). A second model adjusting for the same covariates showed T2DM to be an independent factor associated to advanced fibrosis (OR=4.1; 95% CI: 1.7-9.7). CONCLUSION: Patients with T2DM have more advanced degrees of NAFLD and advanced fibrosis as assessed by liver biopsy and the NFS index. Particular attention should be paid to the study and monitoring of NASH in patients with T2DM.