Background: Pre-procedural anxiety is known to impact the quality of upper gastrointestinal endoscopy (esophagogastroduodenoscopy, EGD), particularly in non-sedated patients. Elevated anxiety levels can cause discomfort and reduce procedural success. Objectives: This study aimed to evaluate the effect of pre-procedural anxiety, measured by the State-Trait Anxiety Inventory (STAI), on the quality of EGD and to determine whether anxiety levels can predict the need for sedation. Design: This was a prospective, cross-sectional study conducted at a tertiary care hospital. Methods: This study included 1344 non-sedated patients aged 18–90 years undergoing EGD at Ankara Etlik City Hospital (September 2023–March 2024). Anxiety levels were assessed using STAI before the procedure. Receiver operating characteristic (ROC) analysis determined the optimal STAI-I cutoff for predicting sedation needs. EGD quality was evaluated by examination thoroughness and biopsy adequacy. Logistic regression identified predictors of unsuccessful procedures. Results: The mean participant age was 50.6 years; 47.8% were male. The average STAI-I score was 42.14. ROC analysis identified an STAI-I cutoff of 36, above which unsuccessful procedures were more likely (area under the curve = 0.720, p < 0.001). Higher STAI-I and STAI-II scores were independent predictors of unsuccessful endoscopy, with each unit increase in STAI-I raising the odds by 3.8%. Conclusion: Pre-procedural anxiety, as measured by STAI, significantly affects non-sedated EGD quality. An STAI-I cutoff of 36 predicts the need for sedation. Routine anxiety assessment could enhance sedation strategies, patient satisfaction, and procedure quality. Trial registration : Not applicable.

Traumatic pancreatic injuries (TPI) are rare, critical complications increasingly managed by minimally invasive Endoscopic Retrograde Cholangiopancreatography (ERCP). We systematically reviewed and meta-analyzed ERCP’s efficacy and safety for TPI regarding pancreatic duct integrity and clinical outcomes in diverse populations. PubMed, Scopus, Cochrane Library, and Web of Science were searched (2000–2024) for studies reporting on ERCP for TPI. Primary outcomes were pancreatic duct integrity and complications; secondary outcomes included mortality and hospital stay. Pediatric and adult populations were compared via subgroup analysis. Publication bias was assessed. Fifteen studies comprising 1,823 patients (54% male, 32% pediatric) were included in the meta-analysis. ERCP demonstrated a pooled clinical success rate of 89% (95% CI: 83–93%) and significantly improved pancreatic duct integrity (OR for pancreatic duct integrity: 9.17, 95% CI: 6.73–12.49). Complication rates ranged from 4 to 17%, with pancreatitis and bleeding being the most common adverse events. Mortality rates were low (3–5%), and ERCP significantly reduced hospital stay by an average of 3.1 days compared to surgical interventions. Pediatric patients had slightly lower success rates (OR: 6.73, 95% CI: 4.01–11.31) compared to adults (OR: 10.87, 95% CI: 7.40–15.98). ERCP is an effective and safe modality for managing TPI in both pediatric and adult patients, yielding high success rates in maintaining ductal integrity and reducing complications, although interpretation requires caution due to potential publication bias. Further prospective studies are required to optimize standardized protocols.

Introduction This study aims to identify the demographic, medical, and psychological factors associated with anxiety in patients undergoing non-sedated upper gastrointestinal endoscopy (EGD). By determining high-risk groups and key anxiety triggers, the research seeks to provide insights for improving pre-procedural communication and patient preparation. Methods A total of 1242 patients aged between 18 and 90 years were included in the study. In this cross-sectional and observational study, the anxiety levels of the patients were measured using data collected through face-to-face interviews and the Spielberger State-Trait Anxiety Inventory (STAI). Participants' demographic information, medical history and previous endoscopy experiences were recorded. Results Among the participants, 52.7% (n = 654) reported anxiety related to the procedure. Women (n = 645) exhibited higher anxiety levels than men (STAI-I score: 43.28 ± 13.06 vs. 41.52 ± 12.93, p = 0.017). Chronic conditions, such as COPD (mean STAI-I score: 52.53 ± 9.39, p < 0.001), cardiac disorders (49.68 ± 11.58, p = 0.014), and chronic kidney disease (55.50 ± 10.42, p = 0.004), were associated with significantly elevated anxiety levels. Additionally, patients with depression (50.86 ± 9.19, p < 0.001) and panic disorder (51.12 ± 5.99, p < 0.001) exhibited higher anxiety. Prior experience with endoscopy did not significantly reduce anxiety, with 40% (n = 497) having undergone the procedure before. Notably, 46.7% (n = 580) of participants reported prior knowledge of the procedure, but this did not correspond with significantly lower anxiety levels. Conclusion Anxiety before endoscopic procedures was observed to be common among patients and may directly affect the quality of the procedure. High rates of anxiety in women and individuals with chronic diseases are consistent with the literature. Accurate and comprehensive information of patients prior to the procedure appears to be critical in reducing anxiety levels.

This study aimed to assess the impact of adding pancreatin (a pancreatic enzyme derivative) to standard treatment on patients diagnosed with Irritable Bowel Syndrome (IBS) and Type 2 Diabetes Mellitus (T2DM). IBS and T2DM frequently coexist, leading to significant gastrointestinal symptoms and a decrease in quality of life. Gastrointestinal symptoms arising in T2DM patients present challenges in management for both clinicians and patients. Standard treatments may not fully address these symptoms. Recent studies suggest that pancreatic enzyme replacement therapy may offer additional benefits. This study investigates whether adding pancreatin to standard treatment can improve gastrointestinal outcomes in this patient population. Conducted as a prospective observational study, the research involved patients diagnosed with IBS according to Rome IV criteria and having concomitant T2DM. The patients were divided into two groups: one receiving standard dual treatment (otilinium bromide + simethicone) and the other receiving a triple therapy including a pancreatin derivative in addition to the standard treatment. Various clinical scores and measurements, including Visual Analog Scale (VAS), Bristol Stool Chart (BSC), Irritable Bowel Syndrome-Severity Scoring System (IBS-SSS), and Irritable Bowel Syndrome Quality of Life Instrument (IBS-QOL), were assessed before and after treatment. The study comprised 121 patients, with a median age of 41 years (interquartile range [IQR] 38–48), of whom approximately 70.2% were female. Fifty-eight patients (47.9%) received dual therapy, while sixty-three patients (52.1%) received triple therapy. Before treatment, both groups exhibited similar pre-treatment Bristol stool scale results: normal (39.7% and 49.2%) and constipation (37.9% and 31.7%) in the dual and triple therapy subgroups, respectively (p > 0.05). Post-treatment, the triple therapy group showed a significantly higher proportion of normal cases on the Bristol stool scale (82.5%) compared to the dual therapy group (44.8%) (p < 0.001). After treatment, the triple therapy group demonstrated statistically significant improvements in VAS score (p < 0.001), IBS-SSS (p < 0.001), and IBS-QOL (p < 0.001) compared to the dual therapy group. There were no significant differences between groups in BMI, HbA1c levels, duration of diabetes, or diabetes treatment at baseline (p > 0.05 for all parameters). The findings suggest that adding pancreatin to standard therapies significantly enhanced the quality of life for patients with both IBS and T2DM, demonstrating improvements across various symptom measurements and indicating the potential benefits of this supplementary therapy in managing gastrointestinal symptoms in this population. Further studies are warranted to explore its broader clinical implications and mechanisms of action.

Aims: This study aimed to determine the factors predicting the development of hepatorenal syndrome (HRS) in cirrhotic patients presenting with acute kidney injury (AKI). Methods: We retrospectively analyzed 263 cirrhotic patients diagnosed with AKI between September 2022 and March 2024. Demographic characteristics, clinical findings, and laboratory results were analyzed. We diagnosed HRS using the 2019 International Club of Ascites criteria. We used bivariate and multivariate logistic regression models in our statistical analysis. Results: HRS developed in 31 patients (11.8%). MELD-Na scores were significantly higher in the HRS group (28 vs. 18, p2.5 mg/dl (OR 2.5, 95% CI 1.2-5.5), albumin 2 mg/dl (OR 7.9, 95% CI 3.7-17.0), and presence of spontaneous bacterial peritonitis (OR 5.5, 95% CI 1.4-12.2). Hemodialysis requirement (61.3% vs. 8.6%, p