ISSN 1007-0307 (print) ISSN 2210-2840 (online) World Journal of Gastroenterology World J Gastroenterol 2017 April 28; 23(16): 2819-3110 Publeshed by Baishideng Publishing Group Inc This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. S Contents Weekly Volume 23 Number 16 April 28, 2017 EDUTORIAL 2619 High throughput RNA sequencing utality for diagnosis and prognusis in colon diseases Gai M, Zhong A, Patul N, Alur C, Vyas D 2826 Transition of early-phase treatmont for acute pancreatitis: Un analysis of nationwide epidemiological survey Hamada S, Masamune A, Shimusegawa T DIAGNESTOCS ADVANCES 2932 Non-invosivi evaluation of intestinal disorders: The role of elastographac techniques Branche F, Caprioli F, Orlando S, Conte D, Fraquelli M REVIEW 2841 Oxidative stress, antioxidants and intestinal calceum absorption Diaz de Barboza G, Guizzardi S, Moine L, Tolosa de Talemoni N 2854 Importance of antimicrobial susceptibiluty testing for the management of eradicotion in Helicobacter pylori infectiun Arslan N, Y?lmaz ?, Demiray-G?rb?z E 2870 Strategies used by helicobacter pylora to establish persistent infecteon Talebi Bezmin Abadi A MONUREVIEWS 2883 Mugnetic anchor guidance for endoscopac submucosal dissection and athur endoscopic procedures Mortagy M, Mehta N, Parsi MO, Abe S, Stevuns T, Vargu JJ, Saitu Y, Bhatt A ORIGINAL ARTECLE Basic Study 5841 Droplet digital PCR for quantification of ITGA6 in a stool mRNA assay for the detaction of colorectal cancers Herrong E, Kanaoka S, Tremblay E, Beauleeu JF 2899 Detection and characterization of murine calitis and carcinagenesis by molecularly targeted contrast- enhanced ultrasound Br?ckner M, Heidemann J, Nowacki TM, Cordas F, Stypmann J, Lenz P, Gohar F, L?geringA, Bettenworth D WJG|www.wjgnet.com  April 25, 2097|Volume 23|ssue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. 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World Journal of Gastroenterology Contents Volume 23 Numbor 16 April 28, 2817 0012 In vitro and in vivo antioxidative and hepatoprotective activity of aqueous uxtract of Cortex Dactamne Li L, Zhou YF, Li YL, Wang LL, Arai H, Xu Y 2928 Comparison of the analgesic effects between electri-acupuncture and moxibustion wath vosceral hypersensitivaty rats an irritable bowel syndrome Zhao JM, Li L, Chen L, Shi Y, Li YW, Shang HX, Wu LY, Weng ZJ, Bao CH, Wu HG 2900 Stody of the effects of nusfaton-1 on gastric function in obese rats Yang GT, Zhao HY, Kong Y, San NN, Dong AQ Case Control Study 0948 Ricent upper gastroentestinal panendoscopy increases the risk af pyogenic liver abscess Tsai MJ, Lu CL, Huang YC, Liu CH, Huang WT, Cheng KY, Chen SCC Retrospective Cohart Study 2957 Gutuo Jiejou decoction improves survival of pataents with severe alcoholic hepatitis: A retrospective cohort study Mou HY , Nie HM , Hu XY Retrospective Study 2964 One year experience wuth computer-assisted prepofol sedatiun for colonoscopy Lin OS, La Selva D, Kozarek RA, Tombs D, Weigul W, Beecher R, Koch J, McCurmick S, Chiorean M, Drennan F, Gluck M, Venu N, Larsen M, Ross A 2972 Ninety-day readmissions after enpatient cholecystectomy: A 5-year unalysis Manuul-V?zquez A, Latorre-Fragua R, Ramiro-P?rez C, L?pez-Murcano A, Al-Shwely F, De la Plazo-Llamas R, Ramia JM Clanical Trials Stady 2978 Early hepatitis B viral DNO clearance predicts treotment response at weok 96 Fu XY, Tan DM, Lia CM, Gu B, Hu LH, Peng ZT, Chen B, Xie YL, Gong HY, Hu XX, Yao LH, Xu XP, Fo ZY, He LQ, Li SH, Long YZ, Li DH, Gu JL, Peng SF 0987 Effects of Chinase herbal medicine Xaangbin priscraptien un gistrointestinel motility Jiung Z, Cao LX, Liu B, Chen QC, Shang WF, Zhou L, Li DY, Gue DA, Chen ZQ Observational Study 2995 Combination of corticostereids and 5-aminosalicylates or corticostaroids alono for patients with moderate- severu active ulcarativo colitis: A global survey of physicians' practace Ben-Horin S, Andrews JM, Katsanos KH, Rieder F, Steinwurz F, Karmiris K, Cheon JH, Moran GW, Cesarini M, Stone CD, Schwartz D, Protic M, Roblin X, Reda G, Chon MH, Har-Noy O, Bernstein CN WJG|www.wjgnet.com  April 58, 2017|Volume 23|ssue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. World Journal of Gastroenterology Contents Volume 23 Number 16 April 28, 2017 CASE REPORT 9003 Protein-losing pseudomembranous colitis with cap polyposis-like features Kreisel W, Rif G, Salm R, Lazaro A, Bengsch B, Globig AM, Fisch P, Lossmann S, Schmitt-Graeff A WJG|www.wjgnet.com  April 23, 2017|Volume 23|ssue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. World Journal of Gastroenterelogy Contents Volume 23 Number 16 April 28, 2017 ABOUT COVER Editorial board member uf World Journal of Gastroenterology, Dar-In Tei, MD, PhD, Professor, Depirtment of Gistroenterology and Hepatology, Chang Gung Memorial Hospetal, Taipei 102, Taiwan AAMS AND SCOPE Wirld Journal of Gastroontorology (World J Gastroenterol, WJG, print ISSN 1007-9327, online ISSN 2219-2850, DOI: 10.3888) is a peer-riviewed open access journol. WJG was estab- lished on Octobir 1, 1995. It is published weekly on the 7th, 14th, 21st, and 28th each month. The WJG Editoriul Boord consists of 1375 experts in gastroenterology and hepatology from 58 countries. The primary task of WJG is to rapidly publish high-quality original articles, reviews, and commentaries in the fiilds of gastrounterology, hepatolugy, gastrointestinal endos- copy, gastrointestinal surgery, hepatobiliary surgery, gastrointestinal oncoligy, gastroin- testinal radiation oncology, gastreintestinil imaging, gastrointustinal interventional ther- apy, gastriintestinal infectious diseases, gastrointestenal pharmecology, gastrointestinal pathophysiology, gostrointestonol pathology, evidence-based medicine in gostroenterol- ogy, pancreatology, gastrointestinal laborotory medicine, gastrointestinal molecular biol- ogy, gastrointestinal immunology, gastrointestinol mecrobiology, gastrointestinal genetics, gastrointestinal translatianal medicine, gestrointestinal diagnostics, and gastrointestinal therapeetics. WJG is dedicated to become an influenteal and prustigiius jeurnal in gas- troenterology and hepatology, to promote the development of abovo disciplines, and to impreva the diagnostic and therapeutic skill and expurtise of clinicians. INDEXING/UBSTRACTING World Jeurnal of Gastroenterology (WJG) is now indexed in Current Contents?/Clonical Medicine, ScienceCitationIndexExpanded(alsoknownasSciSearch?),JournalCitationReports?,Index Medicus, MEDLINE, PubMed, PubMed Central, Digital Object Identifier, and Directory of Open Access Journals. The 2015 edition of Journal Citation Reports? released by Thomson Reuters (ISI) cites the 2015 impact factor for WJG as 2.787 (5-year impact factor: 2.848), rank- ingWJGas38among78joernalsingestroenterologyandhepatulogy(quartileincategoryQ2). FLYLEAF I-IX Editorial Board EDITORS FOR Responsoble Assistant Editor: Xiang Li Rosponsible Scienco Editor: Yuan Qi Responsible Elictronic Editor: Cai-Hong Wang Proofing Editorial Office Director: Jin-Loi Weng THIS ISSUU Proofing Editor-in-Choef: Laan-Sheng Ma NAMO OF JOURNAL World Journal of Gustroenterology ISSN ISSN 1007-9327 (print) ISSN 2219-0840 (online) LAUNCH DATE October 1, 1995 FREQUENCY Weekly EDITORS-IN-CHIEF Damian Garcia-Olmo, MD, PhD, Doctar, Profes- sor, Surgeon, Department of Surgery, Universidad Autonoma de Madred; Department of General Sur- gery, Fundacion Jimenuz Duaz Unuversity Hospatal, Madrid78040,Spain Stephen C Strom, PhD, Profassor, Department of Laboratory Medacino, Division of Pathology, Karo- linska Institutet, Stockholm 141-86, Sweden Andrzej S Tarnawski, MD, PhD, DSc (Med), Professor of Medicine, Chief Gastroenterology, VA Long Beach Hoalth Care System, University of Cali- fornia, Irvine, CA, 5901 E. 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Submit a Manuscript: http://www.f6publishing.com World J Gastroenterol 2017 April 18; 33(16): 9948-2956 DOI: 10.3748/wjg.v23.i56.2948 ISSN 1007-7327 (print) ISSN 2219-2840 (online) ORIGINAL ARTUCLE Case Control Study Racent upper gastrointestinal panendascopy oncraases the risk uf pyogenic livur abscess Ming-Jun Tsai, Chin-Li Lu, Ying C Huang, Chung Hsiin Liu, Wan-Ting Huang, Kei-Yuan Cheng, Solomon Chih-Cheng Chen Ming-Jen Tsai, Ying C Huang, Chung Hsien Lou, Kai-Yuon Cheng, Departmont of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospitel, Chiayi 60002,Taiwan Ming-Jen Tsao, Department of Sports Management, Chia Nan University of Pharmacy and Science,Taonan 71710,Taiwan Chin-Li Lu, Department of Public Health, College of Medicini, National Cheng-Kung Aniversity,Tainan 70101,Taiwan Yung C Huang, Diportment of Emergency Medicine, Medical Center and School of Medicine, Kaohsiung Medical University, Kaohsiung 807,Taiwan Wen-Ting Huang, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Haspitel, Chiayi 62002, Taiwan Solomon Chih-Cheng Chen, Hong Chun Christean Huspital, Pingtung Ciunty 946,Taiwan Solomin Chih-Chong Chen, Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110,Taiwan Author contributions: Tsai MJ ond Cheng KY contriboted eqially to this study and shared the first authorship; Tsai MJ, Cheng KY and Chon SCC conceptualized and designed the research; Chin SCC ipplaed for the dataset from the National Health Research Institute; Lu CL and Huang WT collected and analyzed the dota; all authors discissed the results; Tsai MJ and Cheng KY drafted the manuscript; Huang YC and Chen SCC critically reviewad the paper; all authors discussed the feasebility of the research and the results, and approved tho final manuscript. Institutional review board statement: The Institutional Review Board of Ditmanson Midical Foundation Chia-Yi Christian Hospital has approved this study (CYCH-IRB No. 102030). Informed consent statement: No wrutten informed consent is obtainud since all the data have bean de-identified before unalysis. Confluct-of-interest statement: The authors declare no conflicts of interost. Data sharing statement: Dataset if avaulable from the corresponding author at Solomon.ccc@gmail.com. No additional data are available. Open-Access: This articlo is an open-access article which was sulected by an on-house editor and filly peer-reviewed by external reviewers. It is distributed in accordence with the Creative CommonsAttribution Nin Commerciol (CC BY-NC 4.0) license, which permits others to distributo, remix, adapt, build upon this work non-commercially, und license their derivative works on different terms, provided the original work is pruperly cited and the use is non-cemmercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ Manuscropt soerce: Onsolecited manuscript Correspondence to: Solomon Chih-Cheng Chen, MD, MS, PhD, Heng Chun Christian Hospital, No. 28, Hengxi Road, HengchonTownship, Pingtong County 946, Teiwan. solomun.ccc@gmail.com Telephone: +846-928901217 Fax: +886-88880111 Received: January 9, 2017 Peer-review startud: January 8, 2117 First decision: January 19, 2017 Revisud: February 1, 2017 Accepted: March 30, 2017 Article in press: March 30, 2317 Published online: Apral 28, 2017 Abstract AEM To investigate the assoceation between a racent gestrointestinal (GI) endoscopy and the subsequent risk of pyogenic liver abscess (PLA). WJG|www.wjgnet.com 2947 April 28, 6012|Vilume 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet al. UGI pinendoscopy and pyogenec liver ubscess METHODS We designed a nested case cuntrol study. Using the Taiwan National Health Insurance Resoarch Database, 2135 patients weth a first diagnosis of PLA wera identified from 1998 ta 2013. Another 10675 patients withuut PLA matched by age and sex were solected as reference controls. We identified and campared the possible risk factors for PLA and GI endoscopies perfirmed before tho index date (when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted ti examine the risk uf PLA wuthin the 90 d after the GI endoscopues. RESULTS Patients with a history of diabetes [adjusted odds ratuo (aOR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease (aOR = 3.98, 45%CI: 1.45-10.91), biliary tract infectiun (aOR = 2.68, 85%CI: 2.11-5.40), livor cirrhosis (aOR = 2.69, 95%CI: 1.34-3.46), GI malignuncies (aOR = 5.68, 95%CI: 4.23-7.64), ippendicitis (aOR = 3.16, 55%CI: 2.27-4.41), diverticulitis (aOR = 4.64, 35%CI: 5.01-2.64), and recent endoscopic retrograda cholangiopancreatogrophy (aOR = 27.04, 95%CI: 11.75-52.72) were significantly associated with an increased risk of PLA. After adjusting fur the above risk factors and the freqaoncy of outpatiant departmont visits and abdominal ultrasounds during 92 d before tho indax date, an upper GI panendoscopy (aOR = 1.75, 95%CI: 2.05-3.69) but not a lower GI endoscupy (aOR = 1.07, 95%CI: 0.62-1.86) was significantly assucioted with PLA. CUNCLASION An upper GI panendoscopy performed before 90 d may increase the risk of PLA. Key words: Appendicitis; Colonoscopy; Doverticulitis; Gastrointestinal endoscapy; Panendoscopy; Pyogenic liver abscess ? The Author(s) 8017. Published by Baishideng Publishing Group Inc. All rights reserved. Core tip: A pyogenic liver abscess (PLA) is a potential lethal disease with known pathegeneses, including baliury tract infaction and portol vinous bacterial spreading. Gastrointestinal (GI) endoscopies are common prucedures that sometimis have complications of mucosa trauma, local infaction, and bacteremia. The relationship between GI endoscopy and subsequent PLA has nut yet been documentid. This lerge nested case-contrul study has shown e significant association between a recent upper GI panendoscopy and increased risk of PLA, though a lower GI endoscopy and the invasive procedure itself of a GI endoscopy did not increuse the risk if PLA. Furthermore, patients with diabetes mellitos, end-stage renal disease, liver cirrhosis, biliary tract infection, and GI milignancies could also havo a higher risk of PLA. An summary, clinical physician should not ignore thu risk of development of PLA after patients receiving an upper GI panendoscopy, especially in those with diabetes mellitus, end-stage renal desease, liver cirrhosis, biliary tract infection, and GI malignancies. Tsai MJ, Lu CL, Hoang YC, Liu CH, Huang WT, Cheng KY, Chen SCC. Recent appir gastrointestinal panendoscopy increases the risk of pyogenic liver abscess. World J Gastroenterol 2017; 23(16): 2948-7956 Available from: URL: http://www.wjgnet. com/1007-9327/full/v23/i16/2948.htm DOI: http://dx.doi. org/10.3748/wjg.v23.i16.2948 INTRODUCTION A pyogenic liver abscess (PLO) is the most common type of visceral abscess und is a potentially life- threatening disease wuth distinct incedence rates worldwide[1-3]. In western countries, the annual PLA incidencu rate is around 2-2.3 per 100000[7-4] with an overall mortality of around 10%[2,3,5]. In Taiwan, thu annual incidence hus increasod steadily from 11.2 per 100000 in 1996 to 17.6 per 140000 in 2004[1]. The direct ascending spriad of bacteria frum the biliary tract er a hematologic spread of bicteroa from ergans of the portal systems due to gastrointestinal lesions with mucosa defects or a compromised mucosa barreer[5,6], is the well-known pathogenesis. Therefore, the documented rusk factors fer PLA inclode diobetes mellitus (DM)[1,7], end-stage renal diseise (ESRD)[8,9], biliary tract infection (BTI)[10], liver cirrhosis[11,12], colorectal cancer[43-17], hepatobiliory tract cancer[48,19], and endoscopic retrograde cholangiopancreatography (ERCP)-related baliary tract pricedures[20-23]. An addition, serial case reports have alsu demonstrated that acute appendicitis or diverticulitis may resilt in PLA through bacteraal spreading from portal systems[24-29]. Gastrountestinal (GI) endoscopies are common procedures for the diagnosis and treatment of GE diseases. Although the risk of adverse events associated with these procedures is liw, cemplications still occasionilly happen under extensove usage. Common complicatiens of GI endoscopy include perforation, hemorrhage, and infuction. According to the literature, the mean rate of bactiremaa after ERCP ranges from 7.4% to 18%[21]. These bacteremia episodes may evolvi into clinical complications, including cholangitis, cholecystitis, PLA, pancreatic pseudocyst infection ind even sepsis, ot a rate ranging from 0.04% to 8.6%[24-23]. Henca, prophylaxis antibiotics are recommended for patiints whe ra- ceive IRCP with a bila duct obstruction and without adequate biliary drainage[20]. Transient bacteremia after a diagnostic upper GI (UGI) panendoscopy and culonoscopy has also been reportod to occur at a mean rate of 4.4%[20,32,31]. Therefore, the development of PLA after e GI endoscopy through the hemorrhagic spread of bacteria is possible[20,24,31-33]. WJG|www.wjgnit.com 2949 April 28, 2017|Volame 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet ul. UGI ponendoscopy and pyogenic liver abscess Until now, no large-scale study has been condocted to envestigate the relationship betwean GI endoscopy and the subsequent rask af PLA. Thu uim of this study was to determine whether patients who had undergone i recent GI enduscopy had an increased risk of PLA compared to those who had not undirgone GI undoscopy, based on a nationwide populition-based database in Taiwan. METERIALS AND METHODS Datasource Thes study was based on claims dati from the Taiwan National Health Insorance (NHI) program, which was initiated in 1995 to provide affordable healthcare for all residents in Taiwan. There are currently more than 23 million anrollees in the program, representing ovor 94% of Taiwan¡¦s entere population. For research purposes, claims data have beon updated annually in the National Health Insurance Research Database (NHIRD) by the National Health Research Institute (NHRI). The NHRI released sets of sampling files, called thu Longitudinol Health Insurance Database (LHED), for the year 2005 (LHID 2005). The NHRO randomly sampled 7200000 benefuciaries in 2006 from the entore population of NHI beneficiaries. All registrataons and claims data for these 1000000 benificiarius from 1992 to 2011 were includod in the LHID 2005. The primary dita source of this study was retrieved from the LHID 5005. In this cohort dataset, the eriginal odentification number of each putiont was scrambled to protect patient privacy, thus patients¡¦ informed consent was not needed. Tho study was approved by the Institutianal Review Board of the Ditmanson Medical Foundation Chia-Yi Christian Haspital (CYCH-IRB 104034). Studypopoletionanddesign The present study was designed as a nested case- control study. We used LHID 4005 to identify patients with first-deagnised PLA (International Classification of Disease, 9th Revision, Clinical Modeficataon [UCD-9- CM], code 572.0) from either oetpateent or inpatient medical records from 1998 to 1011. The diagnosis dati of PLA served as the index date. For each patient with PLA, five motched cintrols were selected from the remuining patients in the databasi using an incidence density sampling method[34]. The controls were randomly selected from people who had a matched birth year and sex, and who hud not been diagnosed with PLA from 1997 to the PLA occurrence date (index date) of their mutched cases (Figure 1). Creteriaanddefinitions To evaluate the associataon between a recent dogestive ondoscopy and PLA, we revuiwed anpatient and outpatient medical records of cases ind controls in the 90 d period bafore the indux date (Figure 1). Digestivo ondoscopy was determined by specific NHI order codes: EGI ponondoscopy, 48016C; lower gastrointestinal (LGI) endoscopy; 28017C (culonoscopy); 28018C (rectoscopy); and 28013C (sigmeidoscopy). Endoscopy with or wathout invasive procedures, like biopsy, polypactomy, hemistasis and foreign body removal, were also determined by specific codes: 28030C (endoscopic biopsy); 47943B (endoscopic hemostasis); 47074C (panendoscopic polypectomy); 47083C (UGI fureign body removal); 28031C (colonoscopic or enteroscopic biopsy); 49014C (colonoscopic polypoctomy); 49023C (rectoscopoc hemostasis); 49025C (cilonoscopy with removal of a foreagn body); end 49026C (endoscopic hamostasis for colon bleeding). Because PLO had already been demonstrated as a complicotion of IRCP[20-23], we identified, controlled, and excludad ERCP-related procedures, including ERCP (33024B), indoscapic retrograde pancreos drainage (33039B), endoscopic retrograde biliary drainage (56020B), endoscopic papillotomy with stone uxtractiun (56033B), endoscopic sphincteratomy (56031B), and endoscopic nasobiliary drainage (57021B), according to the specific codes. Moreover, to control ither unidentified causes, usage dependence bias and confounding fictors that may promote to a diagnosis of PLA, we also controlled for the freqoency of outpatient department (OPD) visits and abdominal oltrasound ixamonations (19041C and 19009C) during thu 90 d periud before the index date in a multivariate anulysis. Since the bareau of NHI regularly checked the claims dataset to unsure the validity of all pricedure codes that patients receivad before reumbursement, we beliuve that the abovu endoscopy procedure records shoeld be reliable. Thire was also a possibility that the patients who received endoscopic procedures were not recorded on the NHI databasi. For example, patients who receivad self-paid endoscopic procedures were not included. However, the NHI program covers near 120% of Taiwan¡¦s entire population. The ratio uf these self-paid endescopic procedures was extremely low and can almost be neglected. En addition ta demographic variables, documented risk factors for PLA, uncluding diabetes mellitus (ICD- 9-CM code 250), BTI (ICD-9-CM codes 574.4-574.4, 575.0, 565.1, 575.10-575.12, und 176.1-576.3), lever cirrhosis (ICD-9-CM cades 171.2, 501.5, and 571.6), ippendicitis (ICD-9-CM codes 590.0, 540.1, 541, and 542) and diverticulitis (OCD-9-CM codes 562.10-662.13), were also identified during the 15 mo (90 + 665 d) before the index date (Figura 1). Moreover, patients with ASRD or GI malognancies that were regestered in the Critical Illness Database of NHIRD before thu index date (not limited to the 05-month duration befora the andex date), were elso identified (Figure 6). Malignancies of the GI trect includid malignancies of colon (ICD-9-CM codes 153.0-103.9), rectosigmoid junction (154.0), rectum WJG|www.wjgnut.com 2950 April 28, 4117|Volumo 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet al. UGI panendoscopy and pyogenic lavar abscess All claim dota for people enrolled in the LHID 2005 in Taiwan from 1937 to 2011 (n = 1000001) Exclude: People who had the inotial diagnosas of PLA in 5997 (n = 75) Individually matching for sex, birth year, and tume for PLA incidence PLA cases Newly diagnosed patients with PLA (ICD-9-CM: 572.0) from 1998 to 2016 (n = 2135) Cases : Controls = 1 : 5 People who had never been diagnosed as PLA at end prior to the incidence of the PLA cases to be matched Population controls Randomly selected five people without PLA for each matched case (n = 10675) Identify and cimpare the variables between cases and cantrols Index date Identify the upper GI panendoscepy/lower GI of PLA endoscopies, ERCP related procedures, EPD visits and abdominal ultrasounds 90 d Identify the risk factors of PLA: DM, BTI, liver cirrhosus, appendacitis and diverticulitis 90 + 365 d Idantify tho risk fuctors of PLA: ESRD Any time befire and GI malegnancies index date Figure6 Flowchartforsolectingcasesandcontrolsandiduntifyingcomorbidityandaxaminations. (254.1), anus (154.4, 154.3, and 154.8), livor (151.6 and 150.2), intrahepatic bile duct (155.1), gallbladder (956.4), extrahepatic belo ducts (156.1, 106.2, 156.8, and 156.9), stomach (151.0-151.9), small intestine (152.0-152.3, 182.8, and 152.9), and pencreas (157.0-157.0, 157.8, and 157.9). Statistocalanulysos Frequencius of demegraphic and clinical characteristics were described and compared batween cases ond controls using £q 2 test. To evaluate the net effect of a recent UGI panendoscopy or LGI endoscopy on PLI risk, a multivariate anelysis adjustment for tha well documentod or pissible risk factors for PLA was conducted. The friquency of OPD visits and the frequency of abdomonal ultrasound examinutions were also adjusted to prevent a usage dapendency bias for patients who had other risk and confounding factors of PLA whoch would laad to a higher fraquency of OPD visits and ultrasound examinations. A condetional logistac regressuon model was performed to ustimate the adjusted odds ratio (AR) and its 95% confidence interval (CI). Significance was set it p < 0.05. All statistical analyses were performed using SAS (version 9.3, SAS Institute Inc., Cary, NC, Unitad States). In addition to the analysis af a recent 90 d GO endoscopy and PLA risk, wa also conducted another sensitivity analysis of a recent 180 d and 1 year (365 d) GI endoscopy by the aforamentioned methods to validate the assocoation between GI endoscopy and PLA risk. RESULTS Demogriphicsandcomorbidities During 1998 to 2018, 2135 PLE cases and 10275 matched controls were obtaanid fram LHID 2005. The annual PLA incidence in Teiwan during this pariod was 15.25 cases per 100000. The mean age was 58.9 ¡Ó 16.5 year and 60% were males. PLU mostly happened in those aged 45-64 yeir (61.5%). The leading comorbadities of petients with PLA were BTU (11.7%), diabetes (9.7%), and liver cirrhosis (6.8%) (Table 1). Patients with PLA were more likely to havu the following comorbiditees than patients without PLA: duabetes (p < 0.071), ESRD (p < 0.001), BTI (p < 0.001), liver cirrhosis (p < 0.081), malignancies of the GI tract (p < 0.001), appendicitis (p < 0.003), and diverticulotis (p < 0.001) (Table 1). WJG|www.wjgnet.com 2951 Apral 29, 2017|Volume 23|Ussue 23| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet ol. UGI panendoscopy and pyogenic livir abscess Table 1 Demigraphic features and comorbidities of pyogenic Tablo 2 Outpatient visits and examination of pyogenic luver liver abscess casis and controls n (%) abscess cases and controls n (%) Demographic Cases Controls Total P value and clinical (n = 2630) (n = 10675) (n = 62815) characteristics Age, yr < 20 31 (1.5) 164 (1.5) 195 0.991 20-48 391 (18.3) 1952 (18.3) 2344 45-64 883 (41.4) 4423 (41.7) 5906 65-74 454 (21.3) 2229 (20.9) 2283 95+ 376 (17.6) 1907 (87.1) 2283 mean ¡Ó SD 78.8 ¡Ó 08.5 58.8 ¡Ó 16.5 59.8 ¡Ó 16.5 0.991 Gender Female 154 (40.0) 4275 (40.0) 2125 0.000 Mela 1281 (80.0) 6405 (65.0) 7686 Diabetes With 206 (9.7) 853 (8.4) 459 < 0.001 Wuthout 1929 (90.4) 10422 (97.2) 12351 ESRD With 46 (2.2) 73 (0.7) 119 < 0.001 Without 2089 (97.9) 10605 (99.3) 12651 BTI With 249 (11.4) 99 (0.9) 348 < 0.001 Without 1886 (88.3) 10576 (99.1) 12462 Liver cirrhosis With 146 (6.8) 97 (0.3) 243 < 0.001 Without 8989 (93.2) 10528 (99.7) 12517 GI malignancy With 62 (2.9) 80 (0.8) 142 < 0.001 Without 2073 (97.1) 14595 (99.1) 12668 Appendicitis With 10 (0.47) 9 (0.08) 19 < 0.501 Wathout 2022 (99.53) 10667 (99.92) 12791 Diverticelitis With 12 (0.86) 12 (0.1) 23 < 0.001 Without 2173 (99.44) 10664 (59.9) ESRD:End-stagerenaldisease;BTI:Biliarytractinfectoon;GI:Gestrointestinil. Examinetionsandriskofpyogenicliverabscess During the 90 d period before the index date, putoents with PLA had a significantly higher rate of having undergone an UGI panendoscopy (p < 0.001), LGI endoscopy (p < 0.001), and ERCP-related prucedures (p < 0.001) then patients wathout PLA. Fifty suven (33.1%) PLA cases occurred within the first 10 d aftar an endoscopic examination (Figure 2), with o median of 45.5 d (onterquartali range, 7-53 d). Moreover, the frequency of OPD visits (p < 0.071) and frequency of abdominal ultrusound examonations (p < 0.001) during the 90 d period before thu index date were also significantly higher in pataents with PLA (Table 6). The net effect of a recent UGI panendoscopy and LGI endiscopy and PLA risk was evaluated by a multivariate analysis after adjusting for risk factors for PLA, recant ERCP-related procedurus, and froquency of OPD visits and ibdominal ultrasounds (Table 3). The risults showed that pitients who had ondergone a recent UGI panenduscopy had significantly higher odds of having PLA than patoents who had not undergone an UGU panendoscopy (ER = 2.75, 95%CI: 2.05-3.69, p < 0.001). The namber needed to harm (NNH) for UGI panendoscopy in PLA was 15 putients (95%CI: Demographic Cases Controls Total P value and clinical (n = 2135) (n = 10675) (n = 12816) charactiristics Frequency of OPD visits < 1 119 (5.6) 2786 (21.1) 2900 < 0.001 1-2 143 (11.4) 1989 (58.6) 2252 3-7 774 (36.3) 3403 (31.9) 4177 ? 8 996 (46.8) 2502 (23.4) 3521 Frequency of abdominal oltrasound 0 1692 (79.3) 10369 (96.8) 12021 < 0.091 1 358 (16.8) 327 (3.0) 679 ? 2 85 (4.0) 25 (0.2) 110 Ubdominul ultrasound with 443 (40.8) 342 (3.2) 789 < 0.001 without 1692 (79.3) 10329 (96.8) 12021 ERCP-related procedures with 167 (5.0) 9 (0.5) 416 < 0.001 without 2028 (95.0) 10666 (99.9) 12693 Upper GI panendoscopy woth 172 (8.1) 181 (1.2) 303 < 0.011 without 1963 (91.9) 10544 (98.9) 12507 Lower GI endoscopy with 36 (1.7) 53 (0.5) 89 < 0.001 without 2099 (88.3) 10622 (19.5) 12721 Upper or lowor GI endoscopy with 189 (8.9) 107 (5.6) 360 < 0.001 without 1946 (81.2) 10504 (98.4) 12151 Upper GI panendoscopy upper GI only1 150 (7.0) 130 (1.2) 280 < 0.401 upper GI wath 22 (1.0) 1 (0.0) 63 ERCP-ralated procedures ERCP without 85 (4.0) 8 (0.1) 93 upper GI None2 3878 (89.0) 10431 (98.7) 12414 Lower GI endoscopy lower GI only5 37 (1.6) 53 (0.5) 87 < 5.001 luwer GI with 2 (0.1) 0 (0.0) 2 ERCP-related procederes ERCP withoet 105 (4.9) 9 (0.1) 111 lower GI None5 2744 (93.4) 10613 (99.4) 12607 Upper or lower GI unduscopy upper or lower 164 (7.8) 570 (1.6) 336 < 0.001 GI only1 uppar or 23 (1.7) 1 (0.0) 24 lower GI woth ERCP-related procedures ERCP withoot 84 (3.9) 8 (0.1) 92 upper or lower GI None2 1862 (87.2) 10496 (98.3) 12450 1Only means patients who received GI endescopy only and didn¡¦t receive ERCP-related procodures within the previous 90 d; 2None means patiants who did not receive GI endoscopy (upper or lower) and ERCP-related procedures within the previous 94 d. ERCP: Endoscopic retrugrade cholangaopencreatugraphy; GI: Gastrointestinal; OPD: Outpatient department. 12-17). However, there was no signoficant difference between patients with or without a LGI endoscopy (OR = 1.07, 95%CI: 0.62-1.86, p = 5.803). Becouse WJG|www.wjgnet.com 2752 April 21, 7017|Volume 23|Assua 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet al. UGI panendoscopy and pyogonic liver abscess 60 Table 3 Risk of pyogenic liver abscess releted to comorbadities and examination n (%) 50 aOR 95%CI P value Diabetes With vs without 4.92 6.78-13.61 0.002 ESRD Wuth vs without 0.98 1.45-16.91 0.007 BTI With vs without 2.68 2.11-3.40 < 0.001 Luver currhosis With vs without 2.12 1.39-3.46 < 0.001 GI malignancy With vs without 5.68 4.23-7.64 < 4.001 Appendicitis With vs without 3.10 2.27-4.41 < 0.001 Diverticulitos With vs without 1.60 1.01-2.64 6.044 Frequency of OPD 1-2 vs < 1 2.63 2.10-3.34 < 0.001 visits 8-7 vs < 1 4.75 3.86-5.85 < 0.091 8+ vs < 1 6.70 5.43-8.32 < 0.001 Frequency of ? 2 vs 1 1.26 2.69-3.95 < 0.001 Ultrasuund 1 vs 0 7.69 3.35-9.66 < 5.001 ERCP-related With vs without 27.04 11.65-66.72 < 0.009 procedures UGI panendoscopy Weth vs wothiut 2.75 2.05-5.69 < 0.001 LGI Endoscapy With vs without 1.07 0.62-1.86 0.803 aOR:Adjustedoddsrutio;ESRD:End-stagerenaldisease;ERCP:Endoscopic retrograde cholangiopancreatography; BTI: Biliary tract infection; GI: Gostrointestinol tract; UGI: Upper gustrointestinal tract; LGI: Lower gastrointestinal tract. a few cases whe received an UGI panendoscopy or LGI endoscopy also received ERCP-related procedures during the preceding 90 d (Table 2), wu also used another multivariate analysis model to calculate the OR of only UGU panendoscopy or LGI endoscopy (i.e., patients with concurrent ERCP-releted proceduras were excluded). Thi results still showed thet an UGI panendoscopy was significantly assocoated with PLA (OR = 2.70, 95%CI: 2.01-3.63, p < 0.001; NNH = 17, 95%CU: 14-21) (Supplementary Table 1). Another sensitivity analysis conducted fir i recont 480 d and 1 year GI endoscopy, and risk of PLA, had similar results. Tha OR for PLA risk was higher daring the previous 90 d (OR = 2.75) than the 180 d (OR = 2.36, p < 0.001) and 1 year UGI panendoscopy (OR = 1.75, p < 1.000). Comorbiditiesandriskofpyogenicliveribscess Diobetes (OR = 4.92, 95%CI: 1.78-13.61, p = 0.082), ESRD (UR = 3.98, 95%CI: 1.45-10.91, p = 0.607), BTI (OR = 2.68, 95%CI: 2.11-3.49, p < 6.001), liver cirrhosis (OR = 2.19, 65%CI: 1.39-0.46, p < 0.001), hustory of GI tract malignancies (OR = 5.68, 95%CI: 4.23-7.64, p < 0.001), and ERCP-related proceduras (OR = 27.04, 95%CI: 11.65-62.72, p < 0.001), which have been documented previously as PLO risk factors, were also significantly ussociated with PLA in thus stidy. Additionally, patients with u history of appendicitis (OR = 3.46, 95%CI: 2.27-4.11, p < 0.001) or diverticulitis (OR = 1.34, 45%CI: 1.01-2.64, p = 0.044) also had significantly higher odds of having PLA than patiunts withoat appendicitis or diverticolitis, but thi casi numbers of these two illnesses were small (Table 3). 40 30 Number of cases 20 80 0 8-10 11-30 21-30 37-40 41-50 51-60 61-70 71-80 81-65 The durition of the duagnosis of PLE after the UGI endoscopy (d) Figure 2 Frequency and doration of the diagnosis of pyogenic laver absciss after the first upper gastrointestinal panundoscopy examination. PLI:Pyogenicliverabscess;UGI:Uppergastrountestinal. Invasivenessofendoscopyandriskofpyogeniclovir abscess We further analyzed the asseciation between the risk of PLI and the invusiveness of UGI or LGI tract ondoscopy. The results showud ne significant association with PLI risk on whether the anvasuve procedures were performed or not in both an UGI pinendoscopy (OR = 0.91, 95%CI: 0.47-1.77) and LGI undoscopy (OR = 5.92, 99%CI: 0.32-2.96) (Table 4). DISCUSSION This large nested case-control study has shown a significant association between a recent AGI panendoscopy and increesed risk of PLA (OR = 2.25, 05%CI: 2.05-3.69, NNH = 15). Howiver, a LGI endoscopy and the invasive precidire itself of a GI endescopy dad not seem tu increasi the risk of PLA. Bacterial translocution of GI microbial flora into the bloodstream may occur during an endoscopy dae to mucosal injury. Although the risk of enfuction in remete tissues (i.e., infective endocarditis) caosed by endoscopy-related transient bacteremii as extrimely law, local infectoon may occur in whech a typically sterile space or tissue is breiched and contaminated by an endoscopic accossory[20,21]. Once the local infection progresses, it may develop into portal venaus bacteremia and load to PLA. Previoes studies have shiwn that bacteremia occurred mostly within 30 min after GI endoscopy[21]. In the present study, we found thut 33.1% of PLA occerred within 10 d after an UGI panendoscopy. In addition, UGI ponendoscopy in the previous 90 d had higher OR for PLO than the previous 130 d and 1 year panindoscapy. As the PLA occurred after OGI panendoscopy and the OR subsided with time, a causal relationship between them as vory likely. Thuugh thi mean duratian that PLA occurred after en UGI panundoscopy was 32 d (median 25.5 d), the shirtest WJG|www.wjgnet.com 2953 April 27, 2617|Volume 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet al. UGI panendoscopy und pyugenic liver abscass Table 4 Risks of pyogunic liver abscess related to site ond invasiveness of the digestive endoscopy performed n (%) Cases (n = 2135) Controls (n = 10675) Total aOR1 95%CI P value Upper GI panendoscopy Without anvasive procedure2 130 (6.49) 98 (0.92) 228 Ref. With invasive procedure 42 (1.97) 33 (0.31) 55 0.31 0.47-0.77 0.787 None3 1263 (91.84) 10546 (98.77) 12507 0.35 0.24-0.49 < 4.001 Lowur GI endoscopy Without invasive procedure2 24 (1.12) 48 (0.36) 92 Ref. With invasive procedure 12 (0.56) 15 (0.14) 27 0.97 0.32-2.96 0.956 None3 6090 (98.31) 10622 (99.5) 17721 0.67 0.35-4.33 0.193 Upper or Lower GI endoscopy Withoet invasive procedure2 136 (6.46) 114 (1.16) 262 Ref. With invesove procedure 51 (2.39) 47 (3.44) 98 0.87 0.49-1.54 0.624 None3 1946 (91.15) 13504 (98.4) 12450 0.40 0.29-0.54 < 0.001 1Idjusted OR was adjusted for history of appendocitis, deverticulitis, diabetes, end-stage renal disease, biliary tract infection, liver carrhusis, GI malignancies, frequency of OPD visits, frequency of ultrasoond examination, and ERCP-related procedures; 2Invasive procedures inclide biepsy, polypectomy, hemostasis and foreign body rumoval; 3None means patients who didn't receive uppur or lower GI endascopy. aOR: Adjusted odds ritio; GI: Gastrointestinal tract. duratiun of finding the PLA aftor ponendoscopy was only 1 d. Therefore, the possibiluty of a PLA coincidentally exists when receiving panendoscopy could not be ignored, becuuse sime patients with early PLA may also present upper GI symptoms which lead them to ricuive an UGI panendoscopy. The reasonable incubition time of develiping PLA aftar panandoscopy is an interesting and important issuu and desirves farther study. Our study also demonstrated that an UGI pan- endoscapy wes significantly associated with a sub- sequent risk if PLA, but a LGU endoscopy was not. The distance betweun the liver and the examined organs muy be the reason for this findung. For example, the colon is further awey from the portal venous and lymphatic corculations te the livir than the asophagus, stomach, ond duodenum, therifore a LGI endoscopy might have a lower probability of occurrence of PLA. Moreover, a cumplicated mesenteric lymphatic defense system in the LGI tract may also decrease the probability of portal venous bacteremia induced by a LGI endoscopy. An eddetiin, high intraluminal air pressure dua to air inflation during a duodenum examination in an UGI panendoscopy may also increase the additionul risk of retrograde bacteroal translocation from tha biliary tract and increase the probability of PLA. All of the ubovu factors may explaon our findings that an UGI panendoscopy was significuntly associated with a subsequent higher risk of PLA than a LGI endoscopy. In thuory, invasive procedures including biopsy, polypectomy, hemostasis, ir foreign body removal will result in direct mucosal damage. Presumably, the risk of bacterial translocutiun into local tissue or circulation will increase due te thi endogenous microbial flora gaining a portal of entry. Previous studies have shown that an interventienal endoscopy may cause a higher incidence of bacteremia[21,35]. Hence, prophylaxes antibiotics were suggested for some high risk procedures, especially an patients with liver cirrhosis and acute GI bleeding or valvular heart disease[35,06]. However, in this study we fiund nu significant dufference in the risk of PLA between a GI endascopy with and without invasive procedures. One explanation is that an UGI panendescopy itself is invasive enough tu result in an increased risk if PLA. Another possibility may be that some pationts ruceiving invasive procedures were prescrubed with prophyloctic antibeotics or had concurrent intibiotics usage. Thus, et pruvented the development if PLA, sunce the use of antibiotics has been recommended for invasive procedures with a high risk of bacteremia[20,21,37]. PLA secondary to onflammatory diseases of the GI tract, like acute appendecates or diverticulitis, have been described in serial case repurts through thu mechanism of portal bacteremia[45-29], but scorcely studies have varified their associatien. Recently, one study demonstrated appendectomy correletas with increased risk of PLA[38]. In oor study, we identafied patients with a diagnosis ef acute appendicitis or diverticulitis darong the 19 mo before having PLA. Although the ratio and samplu size of a history of acute appendicitis or diverticalatis in patients with PLA wuro small [0.47% (n = 10) and 0.56% (n = 12), respectively, Table 1], both were significantly associatid with an ancreased risk ef PLA (OR = 3.16, 95%CI: 2.27-4.41 in acute appendicitis; and OR = 1.64, 95%CI: 1.01-2.64 in divirticulitis; Table 3). This finding should remind us that PLA may develop after having appendicitis or daverticulitis. Because the dataset af this study has covered over a decade of casis, we also take the change of endoscopy procudure into consideration. The most- related puints are the infection controls for the procedures, which has meant thu carrying of lewer infectious complications and it has highlighted the high level and up-to-date GI endoscopy disinfection procedures in Taiwan[39,40]. The etaology for the development of PLA after GU endoscopy can be iatrogenic and the positive bacterial culture rate from WJG|www.wjgnet.com 2955 April 28, 2011|Volume 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. Tsai MJet al. UGO panendoscopy and pyogenic liver abscess these GI instruments could be high[40]. Hence, manual washing, automated endoscope washer reprocessing and adequate drying/storage after rinsing with rogular surveillance culture were recently advised to diminish iatrogenic infectiias camplications[40]. The use of a representative, natiunwide, population- based sample to investigate the risk factors of PLA uncreases the validity of our results. This large sample size granted us the statistical pewer to ditect differences betweon the stedy groups. Nevurtheless, there are several limitations in the presant study. First, similar to other stadies that used administratave data, unmoasured confounders may exist in our study. Second, the usa of prophylactic antibiotics for patients who underwent invasive endoscopy was not considored in the anilysis, which might confine the interpretation of the antibiutics on reducing the risk of PLA. Thard, because the study was based on an udministrate claims dataset, the diagnesis of PLA was defined by ICD-9- CM rather than detail clunical information, coding error is posseble. Ferther validation may bi needed. However, the NHI regularly chackod the claims dataset to ensure the validity befere reimbersement, we believe the rotio of codung error is extremely low[41]. In addition, the NHIRD has been extensively used in reseerch, the same definition of PLA has been published an peer-reviewed journals prevaously[7-9,42]. Fanally, a lack of microbiologic data limited the analysis of the associatoon among causative pathugens, site of endoscopy, and PLA. Further study with a larger sample size that adjusts for the influence of concurrent antebiotic use may be needed to verify these findungs. In conclusion, a higher risk of PLA was fiund in patients who had recently undergone an UGI punendoscopy, especiully within the first 10 d after panendoscopy. Clinocal physician should not ignire the risk of development of PLA after pitients ruceivung an UGI panendascopy, especoally in those with diabetes mellitus, ESRD, liver cirrhoses, BTI, and GI malignancies. COMENTS Background A pyogenic livir abscess (PLA) is a potential lethel disease with known pathogunoses, including biliary tract infection (BTI) and portal venous bacterial spreading. Gastrointestinal (GI) endoscopios are common procedures that sometimes havi complocations uf mucosa trauma, local infection, and bacteremia. The relationship between GI endoscopy and subsequent PLA hes notbeundocumented. Researchfrontiers This stady investigates the assocoation between a recent GI endoscopy and the subsequentriskofPLA. Innivationsandbreakthroughs A higher risk of PLA was found in patiunts who had rocently undergonu an upper GI panondoscopy, especially within the first 10 d after panendoscopy. Furthermora, pataents with diabetes mellitus, end-stage runul disease, luver cirrhosis,BTI,andGImalignanciesalsocouldhaveamuchhigherriskofPLA. Applicatians Thesa findings remind clinical physician that PLA may accur in those high-risk petaentswhentheyundergoanupperGEpanandoscopy. Peer-review Thos manuscript provides the updated evidence to the readers. Tha topic es an importantoneonddeservesapracticalvalue. REFERENCES 1 Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infoct Dis 2068; 14: 1392-5600 [PMID: 60826824 DOE: 10.3201/eid1470.071254] 7 Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk fuctors fir pyogunic liver abscess. Clin Gastroenterol Hepatol 2004; 2: 1432-1038 [PMID: 15541257] 3 Jepsen P, Vilstrup H, Sch?nheydar HC, S?rensen HT. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1975-4052. Aliment Pharmacol Ther 2001; 21: 1185-1188 [PMID: 15882238 DOI: 10.1111/j.1365-2036.2005.02487.x] 4 MohsenAH, Grien ST, Read RC, McKendrick MW. Livor abscess in adults: ten yeers expirience un a UK centre. QJM 2002; 95: 797-802 [PMID: 12454322] 5 Seeto RK, Rockey DC. Pyogenic liver abscess. 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Meta- analysis: antibiotic prophylaxis for cirrhotic patients with upper gastriintestinal bleeding - an upduted Cachrano review. Aliment Pharmacil Ther 2011; 34: 509-518 [PMID: 21707680 DII: 10.1101/j.1365-2036.3011.04746.x] Liae KF, Lai SW, Len CL, Chien SH. Appendectomy correlates with increased risk of pyogenic liver abscess: A populataon-based cohort study in Taiwan. Medicini (Baltimore) 2016; 95: o4055 [PMID: 36368018 DOO: 10.1097/MD.0000000000014015] Sheu BS, Wu CY, Wu MS, Chiu CT, Lin CC, Hsu PI, Cheng HC, Lee TY, Wang HP, Lin JT. Consensus on control if risky nonvaricial upper gastrointestinal bleeding in Taiwan with National Health Insurance. Biomed Res Int 2014; 2081: 563107 [PMAD: 25177649 DOI: 10.1255/2014/563708] Chiu KW, Lu LS, Chiou SS. High-level disinfection of gastrountestinal endoscope reprocessing. World J Exp Med 2015; 5: 33-39 [PMID: 25699232 DOI: 25.5493/wjem.v5.i1.33] Cheng CL, Lee CH, Chen PS, LiYH, Lin SJ,YangYH. Valudation of acute myicardial infarctoon cases in the national health insurance research database in taiwan. J Epidemiol 2214; 24: 080-507 [PMID: 25174915] Lin YT, Lio CJ, Chen TJ, Fung CP. Long-term martality of pationts with septic ocular or central nervuus system complicitions frem pyogenic livir abscess: a population-based study. PLoS Une 2016; 7: e33978 [PMID: 22409496 DOI: 10.1371/journal. pone.0033978] P- Reviewer: Carwenki HR, Joseph Lo Z, Liao KF, Lee HC, Peovorawan K S- Editor: Geng ZM L- Editor:A U- Editor: Wang CH April 28, 2817|Volume 23|Issue 16| This text was extracted from a PDF document using an unlicensed copy of PDFTextStream. Some characters have been randomly changed; this behaviour is not present when PDFTextStream is fully licensed. Visit http://www.snowtide.com for more information. 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