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The natural history of symptomatic uncomplicated gallstone disease is largely unknown. We examined the risk of progressing from symptomatic uncomplicated to complicated gallstone disease in a large regional cohort of patients, where disruptions in elective surgical capacities have led to the indefinite postponement of surgery for benign conditions, including cholecystectomies. Patients with radiologically diagnosed incident symptomatic and uncomplicated gallstone disease were identified from outpatient clinics and emergency departments on the Island of Funen, Denmark. The absolute risk of complications (cholecystitis, cholangitis, pancreatitis, acute cholecystectomy for unremitting pain) was calculated using death and elective cholecystectomies as competing risks using the Aalen-Johansen method. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) of gallstone complications associated with patient and gallstone characteristics. Two hundred eighty-six patients diagnosed with incident symptomatic, uncomplicated gallstone disease from 1 January 2020 to 1 July 2023 were identified. During 79,170 person-years of observation, 176 (61.5%) patients developed a gallstone-related complication. The 6-, 12- and 24-month risk of developing gallstone-related complications were 36%, 55% and 81%. The risk of developing complications related to common bile duct stones was lowest with larger stones (aHR per millimeter increase = 0.89 (0.82–0.97), p < 0.01), while no covariates were statistically significantly associated with the risk of cholecystitis. Eighty-five (30%) patients underwent elective laparoscopic cholecystectomy, with one patient (1.2%) developing a gallstone-related complication afterward. The risk of developing complications to symptomatic gallstones in a general Scandinavian population is high, and prophylactic cholecystectomy should be considered. [ABSTRACT FROM AUTHOR]

There is growing evidence to support a role of the gut microbiome in the development of chronic inflammatory and autoimmune disease (IAD). We used total colectomy (TC) for ulcerative colitis (UC) as a model for a significant disruption in gut microbiome to explore an association with subsequent risk of IAD. We identified all patients with UC and no diagnosis of IAD prior to their UC diagnosis in Denmark from 1988 to 2015. Patients were followed from the date of UC to a diagnosis of IAD, death or end of follow-up, whichever occurred first. We used Cox regression to estimate hazard ratios (HRs) of IAD associated with TC, adjusting for age, sex, Charlson Comorbidity Index, and calendar year of UC diagnosis. 30,507 patients with UC (3,155 with TC and 27,352 without) were identified from the Danish National Patient Registry. During 43,266 person-years of follow-up, 2733 patients were diagnosed with an IAD. The risk of any IAD was higher for patients with TC compared to patients without (adjusted HR [aHR] 1.39 (95% CI: 1.24–1.57)). When the analyses were adjusted for exposure to antibiotics, immunomodulatory medicine and biologics (covering 2005–2018), the risk of IAD was still higher for patients with total colectomy (aHR = 1.41 (95% CI: 1.09;1.83)). Disease-specific analyses were weakened by a low number of outcomes. The risk of IAD was higher for patients who underwent TC for UC compared to patients who did not. What is already known? o The gut microbiome plays an important role in host immune homeostasis, and changes in gut bacterial diversity and composition may change the individual's risk of inflammatory and autoimmune disease (IAD). What is new here? o Patients with ulcerative colitis who undergo total colectomy have a higher risk of being diagnosed with IAD, compared to patients with ulcerative colitis who do not undergo total colectomy. How can this study help patient care? o Future research can help uncover the mechanisms responsible for the higher risk of certain IADs after total colectomy. If the microbiome plays a role, modifying the gut microbiome could prove a viable therapeutic strategy to reduce the risk of developing IADs. In this nationwide Danish cohort study of all Danish UC patients diagnosed in the period from 1988 to 2015, the risk of being diagnosed with inflammatory and autoimmune disease is higher for patients who underwent total colectomy compared to UC patients without total colectomy. [ABSTRACT FROM AUTHOR]

Background Patients with inflammatory bowel disease are at increased risk of extracolonic cancers. Little is known regarding this risk following total colectomy [TC]. Methods Patients who underwent TC for inflammatory bowel disease in Denmark during 1977–2013 were identified from the Danish National Patient Registry. Incidence rates of extracolonic cancers were determined through record linkage to the Danish Cancer Registry and compared with expected incidence rates in the general population. Standardized incidence ratios [SIRs] were calculated as the observed vs expected cancer incidence. Results In total, 4430 patients (3441 with ulcerative colitis [UC]; 989 with Crohn's disease [CD]) were followed for 54,183 person-years after TC. Following their surgery, 372 patients were diagnosed with extracolonic cancer compared to 331 expected [SIR = 1.1 (95% confidence interval {CI}: 1.0–1.2)]. The risk of extracolonic cancer overall was increased among patients with CD and TC (SIR = 1.5 [95% CI: 1.2–1.8]), but not among patients with UC and TC (SIR = 1.0 [95% CI: 0.9–1.2]). Patients with UC and TC had a higher risk of intestinal extracolonic cancer (SIR = 2.0 [95% CI: 1.4–2.7]). Patients with CD and TC had a higher risk of smoking-related cancers (SIR = 1.9 [95% CI: 1.2–2.9]), intestinal extracolonic cancer (SIR = 3.1 [95% CI: 1.6–5.5]) and immune-mediated cancers (SIR = 1.5 [95% CI: 1.0–2.1]). Conclusion Patients with CD and TC had a higher risk of extracolonic cancer overall compared to the general population, while patients with UC and TC did not. Site-specific cancer risk varied according to inflammatory bowel disease type. [ABSTRACT FROM AUTHOR]

Background and study aims: The use of magnetic endoscopic imaging (MEI) to visualize scope configuration in three dimensions is thought to increase procedural efficiency and diminish discomfort associated with colonoscopy. The aim of this systematic review and meta-analysis was to evaluate the performance of MEI in colonoscopy. Methods: The electronic databases Medline, EMBASE, and the Cochrane Library of Randomized Trials were searched. Methodological quality was assessed using the Jadad score. Odds ratios (OR) or risk differences for dichotomous variables and mean differences for continuous outcomes were calculated with 95% confidence intervals (CIs). Results: A total of 13 randomized studies met eligibility criteria and were included in qualitative and quantitative synthesis. MEI was associated with a significantly lower risk of failed cecal intubation (risk difference 4%, 95%CI 0%-7%; P= 0.03), lower cecal intubation time (mean difference 0.58 minutes, 95%CI 0.28-0.88; P<0.001), and lower pain scores as estimated by visual analog scales (mean difference 0.45cm, 95%CI 0.03- 0.86; P=0.03) compared with conventional colonoscopy. On subgroup stratification of outcome according to endoscopist experience, failure rates were unaffected, but experienced colonoscopists reduced intubation times with MEI (mean difference 0.78 minutes, 95%CI 0.12-1.43; P=0.02). Sensitivity analyses of high-quality studies (Jadad score⩾3) showed no significant difference in failure rate (risk difference 4%, 95%CI 0%-8%; P= 0.07) or intubation time (mean difference 0.56 minutes, 95%CI-0.15 to 1.28; P=0.12). Conclusion: Adjuvant MEI is associated with a lower failure risk and shorter time to cecal intubation during elective colonoscopy compared with conventional colonoscopy. [ABSTRACT FROM AUTHOR]