Clinical Gastroenterology and Hepatology最新文献

{"title":"Artificial Intelligence and Endoscopist Diagnostic Agreement as a Framework for Colorectal Polyp Optical Diagnosis Implementation","authors":"Megan Oleksiw , Roupen Djinbachian , Douglas K. Rex, Cesare Hassan, Heiko Pohl, Daniel von Renteln","doi":"10.1016/j.cgh.2025.06.034","DOIUrl":"10.1016/j.cgh.2025.06.034","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 858-860.e1"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumen-Apposing Stents With or Without Pigtail in Endosonography-Guided Biliary Drainage for Malignant Distal Biliary Obstruction","authors":"Albert Sumalla-Garcia ,&nbsp;Jose R. Aparicio-Tormo ,&nbsp;Rafael Pedraza-Sanz ,&nbsp;Vicente Sanchiz-Soler ,&nbsp;Carlos De-la-Serna Higuera ,&nbsp;Xavi Andujar ,&nbsp;Enrique Vazquez-Sequeiros ,&nbsp;Maria Puigcerver-Mas ,&nbsp;Belen Martinez-Moreno ,&nbsp;Tatiana Barbera ,&nbsp;Maria Capilla-Lozano ,&nbsp;Antonio Martinez-Ortega ,&nbsp;Jose Ramon Foruny-Olcina ,&nbsp;Daniel Luna-Rodriguez ,&nbsp;Esther Garcia-Lerma ,&nbsp;Judith Peñafiel ,&nbsp;Juli Busquets Barenys ,&nbsp;Berta Laquente-Saez ,&nbsp;Manuel Perez-Miranda ,&nbsp;Sebastia Videla ,&nbsp;Joan B. Gornals","doi":"10.1016/j.cgh.2025.05.025","DOIUrl":"10.1016/j.cgh.2025.05.025","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Endoscopic ultrasound–guided biliary drainage, creating a choledochoduodenostomy and using lumen-apposing metal stents (LAMSs), is a promising intervention for the management of malignant distal biliary obstruction (MDBO). But concerns exist regarding its stent patency. Our aim was to determine whether the insertion of an axis-orienting double-pigtail plastic stent (DPS) through LAMS offered a clinical benefit by improving the stent dysfunction rate.</div></div><div><h3>Methods</h3><div>This multicenter randomized controlled trial was carried out in 7 tertiary hospitals. Patients with MDBO secondary to resectable, locally advanced, or unresectable cancers, and indication for biliary drainage, were eligible for inclusion. Patients were randomly assigned (1:1) to either the LAMS group or the LAMS-DPS group. The primary endpoint was the rate of recurrent biliary obstruction (RBO), detected during follow-up. The secondary endpoints were technical and clinical success, safety, time to RBO, reinterventions, and hospitalization.</div></div><div><h3>Results</h3><div>Between November 2020 and October 2022, we screened 123 patients with MDBO, of whom 91 were randomly assigned to LAMS (n = 47) or LAMS-DPS (n = 44). RBO rate was lower in the LAMS-DPS group (14 [30%] of 47 patients vs 4 [9%] of 44 patients; relative risk, 0.31; 95% confidence interval [CI], 0.09–0.78; <em>P =</em> .024). Hospitalization was shorter in the LAMS-DPS group (median difference, 4.5; 95% CI, 0–9; <em>P =</em> .016). The procedure time was longer (21 minutes vs 32 minutes; <em>P =</em> .018) in the LAMS-DPS group. No differences were found among technical, clinical success, and global adverse events (19 vs 27%; relative risk, 1.42; 95% CI, 0.67–3.18; <em>P =</em> .362).</div></div><div><h3>Conclusions</h3><div>In patients with MDBO, endoscopic ultrasound–guided biliary drainage using LAMS with coaxial DPS was superior to LAMS alone. It offered clinical benefits including lower recurrent biliary obstruction rate and shorter hospitalization.</div><div>ClinicalTrials.gov, Number: NCT04595058</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 678-687.e21"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraintestinal Symptoms in Irritable Bowel Syndrome Are Associated With Stress Reactivity and the Gut Microbiome in a Sex-dependent Manner","authors":"Jonathan P. Jacobs,&nbsp;Jennifer S. Labus,&nbsp;Tien S. Dong,&nbsp;Andrea S. Shin,&nbsp;Emeran A. Mayer,&nbsp;Lin Chang","doi":"10.1016/j.cgh.2025.07.026","DOIUrl":"10.1016/j.cgh.2025.07.026","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 854-857"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining Donor Selection for FMT in UC: The Role of Chromobacteriaceae and Other Underrecognized Pro-inflammatory Taxa","authors":"Hong Zhang ,&nbsp;Jiaxin Li ,&nbsp;Hu Zhang","doi":"10.1016/j.cgh.2025.04.019","DOIUrl":"10.1016/j.cgh.2025.04.019","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Page 870"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the Relationship Between Early Post Transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy and Mortality: Are We Still Missing Something?","authors":"Dario Saltini ,&nbsp;Silvia Nardelli ,&nbsp;Filippo Schepis","doi":"10.1016/j.cgh.2025.04.020","DOIUrl":"10.1016/j.cgh.2025.04.020","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 870-872"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing an Endobariatric Practice: Steps, Challenges, and Considerations Within a Private Practice Model","authors":"Aryan Jain ,&nbsp;Dharma Ayer ,&nbsp;Bora Gumustop ,&nbsp;Joseph Choma ,&nbsp;Rohit Dhingra","doi":"10.1016/j.cgh.2025.10.014","DOIUrl":"10.1016/j.cgh.2025.10.014","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 579-582"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AGA Clinical Practice Update on the Role of Therapeutic Endoscopy in Inflammatory Bowel Disease: Commentary","authors":"Gursimran S. Kochhar ,&nbsp;Nayantara Coelho-Prabhu ,&nbsp;Jana G. Hashash ,&nbsp;Bo Shen","doi":"10.1016/j.cgh.2025.11.007","DOIUrl":"10.1016/j.cgh.2025.11.007","url":null,"abstract":"<div><h3>Description</h3><div>The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) Commentary is to discuss the different scenarios in which advanced therapeutic endoscopic procedures can be used for patients with inflammatory bowel diseases. The CPU will also inform clinical practice on when such procedures should and should not be considered.</div></div><div><h3>Methods</h3><div>This CPU was commissioned and approved by the AGA Institute CPU committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This communication incorporates important and recently published studies in the field, reflecting the experiences of the authors.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 595-601"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of the GOLDEN Model for Predicting HBsAg Loss in Noncirrhotic Chronic Hepatitis B Patients With Interferon-Alpha-Based Therapy","authors":"Xingmei Liao ,&nbsp;Qing Xie ,&nbsp;Xiaoguang Dou ,&nbsp;Junqi Niu ,&nbsp;Hong Ma ,&nbsp;Yali Liu ,&nbsp;Shumei Lin ,&nbsp;Huiying Rao ,&nbsp;Song Yang ,&nbsp;Jianping Xie ,&nbsp;Mingxiang Zhang ,&nbsp;Qiang Li ,&nbsp;Yanyan Yu ,&nbsp;Qin Ning ,&nbsp;Wu Li ,&nbsp;Chengzhong Li ,&nbsp;Liaoyun Zhang ,&nbsp;Zhengang Zhang ,&nbsp;Tao Han ,&nbsp;Jian Sun ,&nbsp;Rong Fan","doi":"10.1016/j.cgh.2025.06.005","DOIUrl":"10.1016/j.cgh.2025.06.005","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>GOLDEN model is designed to predict hepatitis B surface antigen (HBsAg) loss based on patients with chronic hepatitis B (CHB) receiving nucleos(t)ide analogues therapy. We aimed to validate GOLDEN model's effectiveness in predicting HBsAg loss or decline in interferon-α-treated patients with CHB.</div></div><div><h3>Methods</h3><div>Interferon-α-treated patients were enrolled from EXCEL study, a randomized controlled trial that included hepatitis B e antigen–positive, noncirrhotic, treatment-naive patients with CHB, and Search-B cohort, a prospective real-world observational cohort of CHB. Using multiple quantitative HBsAg (qHBsAg) measurements, GOLDEN model was used to calculate a patient's probability of achieving HBsAg loss or decline.</div></div><div><h3>Results</h3><div>Among 200 patients in the EXCEL study and 1041 patients from the Search-B cohort, the corresponding cumulative incidence of qHBsAg &lt;100 IU/mL or HBsAg loss was 20.0% and 6.7%, after the median follow-up of 18.0 (interquartile range, 18.0–30.0) and 66.7 (interquartile range, 48.8–84.7) months, respectively. The GOLDEN model achieved an area under the curve of 0.820 (95% confidence interval, 0.737–0.902) for predicting qHBsAg &lt;100 IU/mL in the EXCEL study and 0.964 (95% confidence interval, 0.953–0.974) for predicting HBsAg loss in the Search-B cohort, maintaining robust performance across subgroups. The favorable group showed higher cumulative incidences of qHBsAg &lt;100 IU/mL (42.5% vs 4.6%; <em>P</em> &lt; .001) or HBsAg loss (37.2% vs 0%; <em>P</em> &lt; .001) than the unfavorable group, along with significantly lower qHBsAg levels and faster qHBsAg decline rates. Moreover, the favorable group defined by GOLDEN model and qHBsAg levels at enrollment were confirmed as independent predictors for HBsAg loss or decline.</div></div><div><h3>Conclusions</h3><div>GOLDEN model is a robust tool for predicting HBsAg loss or decline in interferon-α-treated patients with CHB, offering valuable support for clinicians in developing personalized, effective management strategies for patients with CHB.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 743-753.e9"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distension-mediated Obstruction: A Novel Pathophysiology in Functional Dysphagia","authors":"Anand S. Jain,&nbsp;Vani J.A. Konda,&nbsp;Milli Gupta,&nbsp;Rena Yadlapati,&nbsp;Dustin A. Carlson,&nbsp;John E. Pandolfino","doi":"10.1016/j.cgh.2025.06.033","DOIUrl":"10.1016/j.cgh.2025.06.033","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 864-867.e3"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FIB-4-based Referral Pathways Have Suboptimal Accuracy to Identify Increased Liver Stiffness and Incident Advanced Liver Disease","authors":"Laurens A. van Kleef ,&nbsp;Rickard Strandberg ,&nbsp;Jesse Pustjens ,&nbsp;Niklas Hammar ,&nbsp;Harry L.A. Janssen ,&nbsp;Hannes Hagström ,&nbsp;Willem P. Brouwer","doi":"10.1016/j.cgh.2025.06.036","DOIUrl":"10.1016/j.cgh.2025.06.036","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Fibrosis-4 (FIB-4) is the cornerstone of identifying clinically relevant liver disease among low-prevalence populations. However, its diagnostic accuracy is debated.</div></div><div><h3>Methods</h3><div>Participants with metabolic dysfunction from the National Health and Nutrition Examination Survey (NHANES) 2017 to 2020 and Apolipoprotein MOrtality RISk (AMORIS) were used for cross-sectional and longitudinal analysis, respectively. The ability of the FIB-4-based referral pathways to detect individuals with increased liver stiffness (LSM) and/or International Classification of Diseases-based incident advanced liver disease was investigated. Additional analysis included the application of an age-adjusted cutoff.</div></div><div><h3>Results</h3><div>Cross-sectional analysis comprised 6375 participants (age, 52 years [interquartile range, 36–64 years]; 49% male), of whom 10.3% had LSM ≥8, 3.4% LSM ≥12 and 28% FIB-4 ≥1.3. Among those considered to have no clinically relevant liver disease (72%), LSM ≥8, 12, and 15 kPa was still present in 8.5%, 2.3%, and 1.1%, respectively. The FIB-4 had 0.0% sensitivity for increased LSM among participants aged 18 to 35 years and a high referral rate (71%) among participants aged 65 to 80 years or low sensitivity (34%) with the age-adjusted cutoff. However, in the longitudinal analysis (n = 53,766; age, 54 years [interquartile range, 45–61]; male 65%; events 132), FIB-4 detected 74% of 5-year incident cases of advanced liver disease (cirrhosis or hepatocellular carcinoma).</div></div><div><h3>Conclusions</h3><div>FIB-4-based referral pathways to identify liver disease among the general population result in a high referral rate while not detecting approximately 60% of LSM ≥8, 50% of LSM ≥12, 40% of LSM ≥15, and 25% of incident advanced liver disease. Current referral pathways to detect precirrhotic liver disease in low-prevalence populations could benefit from further optimization.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"24 3","pages":"Pages 733-742"},"PeriodicalIF":12.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}