European Journal of Gastroenterology & Hepatology最新文献

Objectives: Given the high rate of recurrence in Crohn's disease (CD), postoperative maintenance therapy is crucial for preventing disease recurrence. However, the relationship between infliximab trough levels and postoperative endoscopic recurrence in CD patients has been insufficiently evaluated.

Methods: This study included consecutive postoperative CD patients treated with infliximab for the prevention of postoperative recurrence, with measurement of infliximab serum trough concentrations and colonoscopy performed within 3 months of sampling. Endoscopic recurrence was defined as a Simple Endoscopic Score for Crohn's Disease (SES-CD) score ≥3 or a Rutgeerts' score ≥2.

Results: The final cohort comprised 137 patients, with 70 in the 'no endoscopic recurrence' group and 67 in the 'endoscopic recurrence' group. Infliximab trough levels were significantly lower in patients with recurrence (3.4 vs. 5.9, P  = 0.001), with an area under the curve of 0.69 and an optimal cutoff value of 3.15 μg/ml. In the subgroup of patients who have undergone ileocolonic resection, the nonrecurrence group showed significantly higher infliximab trough levels (5.8 vs. 2.4, P  = 0.001). In addition, patients with a Rutgeerts' score of 0 had significantly higher trough infliximab levels compared with scores of 2 ( P  = 0.001). Multivariate analysis confirmed that infliximab trough levels were inversely associated with endoscopic recurrence in the overall cohort, and this association remained significant in the ileocolonic resection subgroup.

Conclusion: Our study demonstrates that lower infliximab trough levels are associated with postoperative endoscopic recurrence in CD patients, both in the overall surgical cohort and in the subgroup of patients who underwent ileocolonic resection.

A selection of interesting papers that were published in the month before our press date in major journals likely to report important results in gastroenterology and hepatology. Peter Hayes and John Plevris The Royal Infirmary, Edinburgh EH3 9YW, UK.

Purpose: To describe institutional surveillance practices for hepatic neoplasms in people with Fontan circulation and report the number and types of biopsied lesions identified.

Methods: We retrospectively analyzed surveillance liver imaging, serum alpha-fetoprotein (AFP), and histopathology in individuals with Fontan circulation cared for at our hospital between 2013 and 2022. Clinical information and subsequent management were reviewed. Imaging for hepatocellular adenomas (HCAs) and malignant lesions was assessed for key diagnostic features.

Results: A total of 1110 liver imaging studies were performed in 686 individuals. Twenty-eight focal liver lesions (in 23 patients) were biopsied: 10 focal nodular hyperplasia-like lesions, seven HCA, seven hepatocellular carcinomas (HCCs), one cholangiocarcinoma, one hamartoma, one posttransplant lymphoproliferative disorder lesion, and one hemangioma. Two HCAs demonstrated malignant transformation to HCC. Median ages at diagnosis were 17.5 years for HCA and 26.6 years for malignant tumors. Most HCAs (5/7) and HCCs (5/7) were initially detected with MRI. Only three of seven patients with HCC had elevated AFP prebiopsy. Imaging features - including arterial phase hyperenhancement, washout, fat content, and hepatobiliary phase hypointensity - substantially overlapped between HCAs and HCCs. Among patients with malignant neoplasms ( n  = 8), four died, three underwent percutaneous therapy followed by heart-liver transplantation, and one underwent ablation alone.

Conclusion: Surveillance imaging in this cohort of children and adults with Fontan circulation identified hepatocellular neoplasms in patients as young as 15 years old. MRI detected most lesions, AFP was often normal in HCC, and substantial imaging overlap between HCAs and HCCs reinforces the need for multidisciplinary review to guide diagnosis and management.

Objective: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a poor prognosis due to late diagnosis and limited treatment options. The secretome, encompassing proteins, metabolites, and extracellular vesicles secreted by cells, has emerged as a promising tool for early detection, risk stratification, and therapeutic targeting in HCC. Recent studies suggest that secretome-derived biomarkers improve diagnostic accuracy and predict survival outcomes. However, variability in methodologies and findings necessitates a comprehensive synthesis of evidence.

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, and Scopus databases were searched on 2 May 2025 for studies evaluating the diagnostic and prognostic value of the secretome in HCC. Eligibility criteria included original research reporting sensitivity, specificity, or survival outcomes. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. Pooled estimates of sensitivity, specificity, and hazard ratios (HRs) were calculated using random-effects models, with heterogeneity assessed via I² statistics.

Results: Five studies met the inclusion criteria. The secretome demonstrated high diagnostic accuracy, with a pooled sensitivity of 95.9% [95% confidence intervals (CI): 40-100] and specificity of 89.6% (95% CI: 43.1-99). Moderate heterogeneity (I² = 44%) was observed. For survival outcomes, the pooled HR was 2.37 (95% CI: 0.87-6.41), though statistical significance was not reached (P = 0.07).

Conclusions: The secretome shows promise as a diagnostic and prognostic tool in HCC, with high sensitivity and specificity. However, further large-scale, standardized studies are needed to validate these findings and facilitate clinical translation.

Ectopic liver tissue (ELT) is a rare congenital anomaly characterized by hepatic parenchyma located outside the native liver. In this systematic review, 55 cases of hepatocellular carcinoma (HCC) arising from ELT were identified through a literature search performed in PubMed, MEDLINE, Scopus, and Web of Science, in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251084866). The median age was 61 years (IQR: 52-68), and 65.5% were male. Hepatitis B and C were present in 26.5% cases. The most common tumor locations were the subphrenic ( n  = 11), peritoneal ( n  = 7), retroperitoneal ( n  = 6), and pancreatic ( n  = 6) regions. Solitary tumors were reported in 78.2% of cases, with a median tumor size of 71 mm (IQR: 36.5-100). AFP was elevated in 74.4% of patients, and AFP-L3 (100%) and PIVKA-II (72.7%) were elevated in most tested cases. Immunohistochemistry frequently showed positivity for HepPar-1 (88.6%), glypican-3 (81.3%), and arginase-1 (87.5%). Surgical resection was the primary treatment modality, and in addition, transarterial chemoembolization, tyrosine kinase inhibitors, and immune checkpoint inhibitors have been used as therapeutic options. The median follow-up was 17 months (IQR: 12-36), during which 85.4% of patients were alive. Distant metastasis occurred in 18.6% of cases, and local recurrence in 6.7%. In conclusion, ectopic HCC is a rare tumor entity with variable clinical presentations. Despite limited classical risk factors, surgical resection remains associated with a favorable prognosis. Histopathological confirmation is essential for diagnosis, and multimodal treatment strategies should be considered for advanced disease.

Objectives: About 30% of the patients with inflammatory bowel disease (IBD) develop malignancies, which constitute the second cause of death, after cardiovascular diseases. This study aimed to investigate the prevalence, risk factors, and outcome of malignancies in IBD patients in Crete.

Methods: This is a retrospective study of prospective longitudinal IBD registries at the University Hospital and Venizelion General Hospital of Heraklion, Crete. IBD patients with malignancies were compared with IBD controls without malignancies [matching 1:3 according to sex, IBD diagnosis (ulcerative colitis, Crohn's disease; CD), age (±5 years)].

Results: From 2.382 IBD patients, 107 (4.5%) were diagnosed with cancer during their follow-up. Among those, 49 (45.8%) were females, and 54 (50.5%) had CD. The majority were extraintestinal malignancies, while 12 (11.2%) had colorectal cancer. In the multivariate analysis, inflammatory CD phenotype (Odds ratio (OR), 0.28; 95% confidence interval (CI), 0.09-0.58) was protective, whereas colonic location (OR, 4.8; 95% CI, 1.81-12.79) remained a risk factor for malignancy. Twelve (11.2%) had a cancer recurrence, 19 (17.8%) died of cancer, whereas the initiation of biologics, immunomodulators (IMMs) or in combination after the cancer diagnosis did not have a negative impact either on the survival or on the possibility of recurrence.

Conclusion: The rate of malignancy in IBD patients in Crete is 4.5%. CD disease location and behavior are associated with the development of malignancies. No association with biologics and/or IMMs previous exposure was found. Moreover, initiation of biologics or IMMs after cancer diagnosis was not associated with an adverse impact either on survival or on cancer recurrence.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-associated death globally. Second-line therapies are crucial for improving survival and quality of life among individuals suffering from advanced HCC who have not responded to first-line therapies. This study sought to evaluate the safety and efficacy of different second-line therapies for advanced HCC by network meta-analysis. A network meta-analysis was carried out on 26 randomized controlled trials comprising 10 368 people suffering from advanced HCC. The treatments evaluated included cabozantinib, pembrolizumab, brivanib, apatinib, and other targeted therapies. The principal results assessed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). The evaluation also encompassed adverse events (AEs) as well as those classified as grade 3-4 AEs. Cabozantinib 60 mg once daily (QD) demonstrated the most significant improvement in OS [mean difference (MD) = 3.36, 95% confidence interval (CI) = 2.01, 4.70] and PFS (MD = 3.26, 95% CI = 2.59, 3.94), ranking highest among the therapies evaluated. Brivanib 800 mg once daily (OD) was most effective in terms of ORR [odds ratio (OR) = 7.13, 95% CI = 1.42, 35.88], while apatinib 750 mg QD ranked highest for DCR (OR = 3.92, 95% CI = 1.76, 8.71). Codrituzumab 1600 mg administered every 2 weeks demonstrated the most advantageous health profile, markedly decreasing AEs and instances of grade 3-4 AEs. Pembrolizumab 200 mg administered every 3 weeks indicated good effectiveness. Alongside a tolerable safety profile, indicating its potential as a reasonable second-line treatment option. Cabozantinib 60 mg QD and pembrolizumab 200 mg Q3W arise as the most suitable second-line therapies alternatives for advanced HCC, offering substantial improvements in survival and disease control with manageable adverse effects. These findings support the integration of both targeted and immune therapies in handling of advanced HCC.

Background: For poorly differentiated early gastric cancer (PDEGC), the oncologic safety and outcomes of endoscopic resection vs. surgical resection remain controversial. This study aimed to evaluate the prognostic difference of endoscopic resection and surgical resection for PDEGCs.

Methods: We retrospectively collected data of PDEGC cases from the Surveillance, Epidemiology, and End Results (SEER) database. A final cohort of 558 PDEGC cases with highly complete clinical and follow-up records available for analysis. Cox multivariate analysis and univariate analysis after propensity score matching (PSM) were used to evaluate the prognostic differences. Cancer-specific survival (CSS) and overall survival (OS) were chosen as the endpoints of this study.

Results: In multivariate analysis of the raw dataset, surgical resection was observed as a relative protective factor for CSS [hazard ratio: 0.61, 95% confidence interval (CI): 0.28-1.33, P  = 0.215] and an independent protective factor for OS (hazard ratio: 0.56, 95% CI: 0.32-0.98, P  = 0.042). Survival curves based on post-PSM dataset exhibited significant differences in analysis on both CSS ( Plog-rank = 0.034) and OS ( Plog-rank = 0.033).

Conclusion: In this retrospective study on PDEGC utilizing the SEER database, our analysis suggests that endoscopic resection for PDEGC was associated with significantly worse CSS and OS compared with surgical resection. These findings reinforce the current guideline recommendations favoring surgical resection as the treatment of choice for PDEGC to achieve optimal oncological safety.