Digestion最新文献

Introduction: Intensive downstaging polypectomy (IDP) has emerged as an alternative strategy for managing colorectal polyps in patients with familial adenomatous polyposis (FAP), aiming to endoscopically control the disease in those who delay or refuse colectomy. This study evaluated the effectiveness and safety of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) and hot biopsy (HB) in patients with FAP undergoing IDP.

Methods: This retrospective study included patients diagnosed with FAP who underwent IDP between September 2012 and March 2024 at Hiroshima University Hospital. The patients were divided into two groups: CSP (October 2022 onward) and HOT (HSP and HB; 2012-2022). Outcomes assessed included adverse events, resection time per polyp, total procedure time, number of polyps removed per procedure, and R0 resection rate.

Results: A total of 185 treatment sessions were performed in 32 patients. The CSP group had a significantly shorter resection time per lesion (1.3 vs. 1.8 min, p = 0.01) and a higher number of polyps removed per procedure compared to the HOT group (80.5 vs. 42.1 polyps, p < 0.01). The incidence of adverse events was significantly lower in the CSP group (0% vs. 10.1%, p = 0.03). Immediate bleeding occurred in 10 cases in the HOT group, while no such events were observed in the CSP group. Additionally, delayed bleeding and perforation were each observed in two cases in the HOT group, whereas neither event occurred in the CSP group.

Conclusion: CSP is a safe and effective method for polyp removal in patients with FAP undergoing IDP, offering shorter resection time and fewer adverse events compared to HSP and HB.

Background: Antireflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from antireflux mucosectomy and antireflux mucosal ablation (ARMA) to the more recently developed antireflux mucoplasty (ARMP) and ARMP with valve.

Summary: Cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (∼11%) and post-procedural bleeding (∼5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or postsurgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond 5 years, and the role of full-thickness suturing that incorporates sling and clasp muscle fibers, and applications in bariatric or paraesophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation.

Key messages: In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.

Introduction: Uninvestigated dyspepsia (UD) and chronic constipation (CC) are common disorders of gut-brain interaction. However, limited research has assessed their risk factors in young adults, particularly the influence of family history. This study investigated the associated factors for UD and CC, focusing on family history among Japanese university students.

Methods: A cross-sectional study was conducted at Hiroshima University. UD and CC were diagnosed using the Rome IV criteria. Multivariate logistic regression was performed to identify associated factors of UD and CC.

Results: Among 10,500 individuals participating in the annual health checkup, 7,496 responded to the web-based questionnaire, and 5,386 completed it. The mean age of the participants was 21.1 ± 4.1 years, with a male-to-female ratio of 1:1.17. The prevalence of UD and CC was 7.3% and 13.7%, respectively. Family history was associated with both UD (odds ratio [OR]: 4.29; 95% confidence interval [CI]: 3.17-5.79) and CC (OR: 2.77; 95% CI: 2.31-3.31). Depression and physical inactivity were shared associated factors. Alcohol consumption (OR = 2.36; 95% CI: 1.15-4.83) and smoking (OR = 1.59; 95% CI: 1.02-2.49) were identified as associated factors for UD, while female sex (OR = 2.00; 95% CI: 1.69-2.36) and short sleep duration (OR = 1.28; 95% CI: 1.09-1.50) were associated with CC.

Conclusions: Family history was found to be a predominant factor associated with both UD and CC, with a relatively stronger association for UD. Our finding highlights the need to consider familial factors in future prevention and intervention strategies for UD and CC in young adults.

Background: Irritable bowel syndrome (IBS) affects 4.1% of the global population, posing a significant healthcare challenge due to its complex pathophysiology and limited treatment options. Gut microbiota-derived volatile organic compounds (VOCs) are increasingly recognized as key players in IBS, with the potential for noninvasive diagnostics and personalized management.

Summary: This review examines VOCs - such as short-chain fatty acids, hydrocarbons, and alcohols - as microbial metabolites influencing IBS through gut barrier function, inflammation, motility, and gut-brain signaling. Cross-sectional studies highlight the diagnostic accuracy of VOCs (area under the curve 0.76-0.99) in distinguishing IBS from healthy controls and conditions like inflammatory bowel disease, while longitudinal studies underscore their utility in predicting and reflecting microbial changes to microbiota-targeted therapies. Despite this promise, variability in study designs, methodological inconsistencies, and confounding factors hinder clinical translation.

Key messages: VOCs illuminate the microbial underpinnings of IBS and its gut-brain interactions, offering a pathway to precise diagnosis and treatment stratification. However, their full potential awaits standardized sampling, analytical protocols, and robust clinical trials to ensure reliability and applicability in IBS care.

Background: Azathioprine (AZA) is the standard treatment for both induction and maintenance of response in autoimmune hepatitis (AIH). However, lifelong administration is often required, and the combination therapy of prednisolone and azathioprine raises significant concerns regarding efficacy and tolerability, especially given the high relapse rates following AZA cessation. Consequently, there is a need to explore alternative treatment options. This systematic review and meta-analysis compared the efficacy and safety of mycophenolate mofetil (MMF) versus AZA, combined with prednisolone, for treating AIH.

Methods: PubMed, Cochrane, Scopus, and Web of Science were searched to identify randomized clinical trials and cohort studies comparing AZA and MMF for treating AIH. Four studies compared steroid withdrawal and complete biochemical response (CBR) between the MMF and AZA groups. Subgroup analyses were performed based on age (above and below 50 years) and IgG levels (above and below 2400 mg/dL). RevMan (version 5.4) software was used for meta-analysis.

Results: Four studies (three cohort studies and one RCT) comprising 505 patients were included in the final analysis. The pooled analysis showed a statistically significant association between the MMF group and increased CBR compared with the AZA group (RR = 1.44, 95% CI = 1.03 to 2.01, p-value = 0.03), with no significant difference between the two groups regarding steroid withdrawal. Subgroup analysis by age revealed a significant association between the MMF group and increased CBR in patients over 50 years (RR = 1.63, 95% CI = 1.00-2.64, p-value = 0.05). IgG subgroup analysis revealed a significant association between the MMF group and increased biochemical remission compared with the AZA group in patients with IgG levels of less than 2400 mg/dL (RR = 1.63, 95% CI = 1.00-2.64, p-value = 0.05).

Conclusion: The use of MMF was significantly associated with increased CBR compared to AZA in patients with AIH. Additionally, there was no significant association between the two groups regarding steroid withdrawal. Further research is needed to fully elucidate the optimal treatment strategy for AIH patients across different subpopulations.

Introduction: Gel immersion endoscopy (GIE) is a technique used to maintain a clear view during gastric endoscopic submucosal dissection. We aimed to identify cases most likely to benefit from GIE for ESD bleeding by reviewing our clinical experience and determining the associated factors.

Methods: We retrospectively analyzed 470 lesions in 380 patients who underwent gastric ESD between October 2020 and March 2023. The patients were divided into conventional method (n = 433) and GIE groups (n = 37). We compared the clinical and pathological characteristics between the groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with GIE use. Among the GIE group, hemostasis times under gas, water, and gel conditions were compared using the Kruskal-Wallis test.

Results: Multivariate analysis revealed that dialysis (odds ratio [OR]: 15.3), concurrent antiplatelet and anticoagulant use (OR: 9.5), and tumor location in the middle third (OR: 3.5), upper third (OR: 5.7), or remnant stomach (OR: 9.3) were independently associated with GIE use. No significant differences in overall hemostasis time were observed between gas, water, or gel. Of the nine bleeding events exceeding 300 s under gas immersion, seven achieved successful hemostasis by switching to GIE, with a median of 32 s to locate the source and 140 s to complete hemostasis.

Conclusion: Dialysis, combined antithrombotic use, and certain tumor locations were key factors influencing GIE for ESD bleeding. Although the overall hemostasis times did not differ, GIE may be particularly beneficial in high-risk scenarios.

Introduction: Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is a promising hybrid approach to managing duodenal neoplasia, including superficial non-ampullary duodenal epithelial tumors (SNADETs) and subepithelial lesions (SELs). This approach aims to reduce adverse events (AEs), such as delayed perforation, often associated with endoscopic submucosal dissection (ESD). Combining laparoscopic techniques for duodenal stabilization with precise endoscopic resection, D-LECS may provide safer and more comprehensive treatment. However, few studies have compared the outcomes of D-LECS with those of ESD and full-thickness resection (FTR), and suitable endoscopic resection approaches for D-LECS remain unclear.

Methods: We retrospectively reviewed records of 80 patients who underwent D-LECS for duodenal neoplasia at our institution between 2011 and 2024. Fifty-six patients underwent D-LECS with ESD for SNADETs (ESD group), whereas 24 underwent D-LECS with FTR for 16 SELs and 8 SNADETs (FTR group). All patients underwent en bloc resection, showing an overall R0 resection rate of 92.5%.

Results: There was no significant difference in overall incidence of Clavien-Dindo grade II or higher AEs between the ESD and FTR groups. However, the ESD group tended to have fewer cases of delayed gastric emptying and higher inflammatory response (p = 0.087 and p = 0.063, respectively). One patient in the FTR group experienced delayed perforation and 2 patients in the ESD group experienced delayed bleeding. However, these events were not significant.

Conclusions: Both D-LECS with ESD and FTR were effective and safe. D-LECS with ESD may be a more suitable approach for SNADETs, whereas D-LECS with FTR is preferable for SELs.

Introduction: The aim of the study was to explore the molecular mechanism of E3 ubiquitin ligase neural precursor cell-expressed developmentally downregulated 4-like (NEDD4L) regulating high-glucose and high-fat-induced ferroptosis in hepatocytes via modulation of transforming growth factor (TGF)-β1/Smad signaling pathway.

Methods: Hepatocytes THLE-2 were cultured in high-glucose and high-fat medium to establish an in vitro nonalcoholic fatty liver disease model. This study detected cellular lipid deposition, cell viability, cellular superoxide dismutase (SOD) activity, glutathione (GSH), malondialdehyde (MDA), ferrous iron (Fe2+), reactive oxygen species (ROS) levels, and cellular mitochondrial membrane potential (MMP). Meanwhile, cellular NEDD4L, GPX4, ACSL4, SLC7A11, TGF-β1, TβRII, and p-Smad2/3 levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. In addition, TGF-β1-TβRII and NEDD4L-TβRII interactions were evaluated by co-immunoprecipitation.

Results: High-glucose and high-fat treatment led to ferroptosis in hepatocytes, manifested by decreased cell viability, SOD activity, and GSH level, increased MDA, Fe2+, and ROS levels, and reduced MMP. High-glucose and high-fat treatment downregulated NEDD4L expression in hepatocytes; by contrast, overexpression of NEDD4L alleviated ferroptosis in hepatocytes. NEDD4L inhibited TGF-β1 signaling by mediating TβRII ubiquitination and degradation. Besides, suppressed TGF-β1/Smad signaling pathway alleviated ferroptosis in hepatocytes, and NEDD4L could regulate hepatocyte ferroptosis by mediating TGF-β1/Smad signaling pathway.

Conclusion: NEDD4L can inhibit high-glucose and high-fat-induced ferroptosis in hepatocytes through suppressing the TGF-β1/Smad signaling pathway via mediating TβRII ubiquitination and degradation.

Background: Helicobacter pylori (H. pylori) eradication reduces the risk of gastric cancer development and is effective in patients with chronic atrophic gastritis. Recently, an increase in gastric cancer incidence has been observed in daily clinical practice in patients who have undergone H. pylori eradication. Therefore, continuous surveillance endoscopy is important for detecting gastric cancer after H. pylori eradication. In addition, endoscopic findings may differ between non-eradication and post-eradication gastric cancer. Magnifying endoscopy with narrow band imaging (ME-NBI) has been useful for the diagnosis of post-eradication gastric cancer, regardless of the histological type. However, there have been no comprehensive reports in this regard. Here, we aimed to clarify the characteristics of ME-NBI findings in gastric cancer following H. pylori eradication.

Summary: In differentiated- and mixed-type cancers (a mixture of differentiated and undifferentiated type), the cancer may be covered by noncancerous epithelium following H. pylori eradication; however, abnormalities can still be detected using ME-NBI. Therefore, ME-NBI is suitable for the diagnosis of post-eradication gastric cancer. In undifferentiated-type cancer, ME-NBI is more useful in diagnosing post-eradication gastric cancer than non-eradicated gastric cancer because of the clear contrast between cancerous and noncancerous areas following eradication. In addition, when non-eradicated gastric cancer is detected, rather than performing endoscopic submucosal dissection (ESD) or gastrectomy without eradication, it is beneficial to start patients on eradication therapy immediately and diagnose the disease extent with ME-NBI without awaiting the results of the eradication assessment and performing ESD or gastrectomy. This approach is expected to prevent misdiagnosis of the tumor size and reduce the positivity of the horizontal margin in ESD or gastrectomy.

Key messages: The number of post-eradication gastric cancer cases is expected to increase in comparison to non-eradicated gastric cancer cases, as H. pylori eradication is being widely used in chronic atrophic gastritis cases. Therefore, the diagnosis of post-eradication gastric cancer using ME-NBI is expected to gain importance in daily clinical practice.

Background: Colorectal neoplasia poses a severe health threat worldwide. The accurate measurement of polyp size is essential for risk stratification, selecting polypectomy techniques, and determining the surveillance interval.

Summary: The methods routinely used for measuring polyp size, including objective ex vivo measurement, subjective visual estimation by an endoscopist, and objective precise measurement using endoscopic instruments, all have limitations. Therefore, the integration of artificial intelligence (AI) with endoscopy has been explored as a promising method for measuring the size of colorectal polyps. However, current AI systems are limited to endoscopic reference media or nonprospective real-time measurements. Consequently, AI-assisted endoscopy for precise, real-time automatic measurement of colorectal polyp size holds great promise for the future. Nevertheless, further extensive studies are necessary.

Key messages: This review focuses on summarizing the advancements in colorectal polyp size research and further explores the potential of AI-assisted measurements.