Background Endoscopic band ligation (EBL) and radiofrequency ablation (RFA) have emerged as alternative therapies of gastric antral vascular ectasia (GAVE) in addition to endoscopic thermal therapy (ETT), but the optimum choice remains inconclusive. Aim We conducted a meta-analysis in order to compare these three treatments for GAVE. Methods We searched the electronic databases of PubMed, Embase and Cochrane Central Register of Controlled Trials without any language restrictions and also performed a manual literature search of bibliographies located in both retrieved articles and published reviews for eligible publications prior to December 8, 2021. We included comparative trials which had evaluated the efficacy and safety of interventions in adults (aged ≥ 18 years) diagnosed with symptomatic GAVE and was confirmed according to clinical backgrounds and upper gastrointestinal endoscopy. We included reports that compared three interventions, ETT, EBL, and RFA. The study was comprised of adults diagnosed with GAVE and focused on overall mortality, bleeding cessation, endoscopic improvement, complications, hospitalization, hemoglobin improvement, number of sessions and transfusion requirements. Results Twelve studies were performed involving a total of 571 participants for analysis. When compared with ETT, EBL achieved better bleeding cessation (OR 4.48, 95% CI 1.36–14.77, p = 0.01), higher hemoglobin improvement (MD 0.57, 95% CI 0.31–0.83, p < 0.01) and lower number of sessions (MD − 1.44, 95% CI − 2.54 to − 0.34, p = 0.01). Additionally, EBL was superior to ETT in endoscopic improvement (OR 6.00, 95% CI 2.26–15.97, p < 0.01), hospitalization (MD − 1.32, 95% CI − 1.91 to − 0.74, p < 0.01) and transfusion requirement (MD − 2.66, 95% CI − 4.67 to − 0.65, p = 0.01) with statistical significance, with the exception of mortality (OR 0.58, 95% CI 0.19–1.77, p = 0.34) and complication rate (OR 5.33, 95% CI 0.58–48.84, p = 0.14). Conclusion For GAVE, we suggest that EBL be initially recommended, and APC and RFA be used as alternative treatment choices based upon a very low quality of evidence.

The incidence of IBD is increasing in Eastern countries. The anti-TNF-alpha biological agents are available in patients with severely active IBD. Recently, the vedolizumab was approved by Taiwan Food and Drug Administration (TFDA). The efficacy and safety of vedolizumab in real-world practice for Asia regions is uncertain. Our primary endpoint is to evaluate the efficacy of vedolizumab for TNF-alpha exposure and naive patients during induction phase. The secondary endpoints are adverse events, infection, and emergent surgery during induction. We conducted a retrospective observational cohort study from November 2017 to April 2019 in our hospital. We enrolled patients receiving vedolizumab with or without previous anti-TNF-alpha agent exposure. The study results of continuous and categorical variables are presented as median (interquartile range [IQR]), with the IQR presented as 25th percentile to 75th percentile, and number (percentage), respectively. Categorical variables were compared with Fisher's exact test or Pearson's chi-square test, and continuous variables were compared with a Mann-WhitneyUtest. Twenty-four patients received vedolizumab from November 2017 to April 2019. Sixteen patients had finished the postinduction phase of the clinical evaluation. None of the patients discontinued vedolizumab due to an adverse drug reaction. The study group all fulfilled the criteria for clinical response and two of them achieved clinical remission. 50% of the patients could successfully discontinue systemic and topical steroid treatment. Three patients from CD group had endoscopic remission. Compare CD to UC patients, the efficacy of vedolizumab is comparable to both groups, but endoscopic response is slightly better in CD group. One patient developed systemic infection (urinary tract infection). None of tuberculosis complex infection or hepatitis B flare up observed during follow-up period. In this study, we offer our real-world experience of vedolizumab and suggest that the use of vedolizumanb is safe and effective. Moreover, 50% of steroid-dependent patients can discontinue steroid after vedolizumab induction. This can be addressed in the future study.

Hepatic events can occur after discontinuing antiviral therapy. We investigated factors associated with hepatitis flares and hepatic decompensation after discontinuing tenofovir disoproxil fumarate (TDF) and entecavir (ETV). Hepatitis flares within 6 months and hepatic decompensation were compared between non-cirrhotic hepatitis B e antigen-negative patients after discontinuing TDF or ETV by using the Cox proportional hazard model. The cumulative rates of hepatitis flare at 6 months after discontinuing ETV and TDF were 2% and 19%, respectively (p < 0.001). The respective rates of hepatic decompensation at 6 months were 0% and 7% (p = 0.009). Higher alanine aminotransferase (ALT) (AASLD criteria) at the end of treatment (EOT) (HR = 4.93; p = 0.001), an off-therapy dynamic change in HBV DNA (rapid rebound of HBV DNA from the nadir, ≥1 log₁₀ IU/mL per month) (HR = 10.7; p < 0.001), and the discontinuation of TDF (HR = 6.44; p = 0.006) were independently associated with hepatitis flares within 6 months. Older age (HR = 1.06; p < 0.001) and an off-therapy dynamic change in HBV DNA (HR = 3.26; p = 0.028) were independently associated with hepatic decompensation after the discontinuation of antiviral therapy. In summary, we demonstrated several factors associated with hepatitis flares and hepatic decompensation after discontinuing antiviral therapy in non-cirrhotic hepatitis B e antigen-negative patients.