Gut and Liver最新文献

Background/aims: Effective implementation of population-based esophagogastroduodenoscopy (EGD) screening requires careful evaluation of its diagnostic performance and potential harms. This study aimed to assess the diagnostic performance and potential harms of EGD for gastric cancer screening under the National Cancer Screening Program.

Methods: In this retrospective study, asymptomatic individuals aged ≥40 years who underwent screening EGD between 2017 and 2023 were included. Diagnostic yield and potential harms were compared between middle-aged and older adults. Univariable and multivariable Poisson regression analyses were used to identify factors associated with detection of high-risk gastric lesions.

Results: Among 12,413 participants, a mean of 35.4 endoscopic images per examination was obtained, with a mean procedure time of 4.2 minutes. Precancerous conditions and high-risk gastric lesions were identified in 64.3% and 0.7% of participants, respectively, both of which were more prevalent in older adults (p<0.001 and p=0.043, respectively). Procedure-related adverse events (1.1%) and false-positive findings (2.8%) were comparable between age groups. However, false-negative results were significantly higher among older adults than middle-aged individuals (3.4% vs 1.1%, p<0.001). In multivariable analysis, older age (≥65 years), male sex, more EGD images, and longer procedure time were independently associated with the detection of high-risk lesions.

Conclusions: In population-based EGD screening, older age, male sex, and high-quality procedural metrics (e.g., more images and longer examination time) were independently associated with the detection of high-risk gastric lesions. These findings may inform risk-stratified screening strategies and quality benchmarks for EGD screening programs.

Endoscopic retrograde cholangiopancreatography (ERCP) is important for the therapeutic management of pancreatobiliary diseases, but it carries a risk of perforation, an infrequent yet life-threatening adverse event. We summarize contemporary evidence on the prevention and management of ERCP-related perforation, aligning with current society guidelines (European Society of Gastrointestinal Endoscopy 2020, American Society for Gastrointestinal Endoscopy 2017, and Japan Gastroenterological Endoscopy Society 2018). We conducted a comprehensive narrative review by searching the PubMed, EMBASE, and Cochrane Library databases for articles published between January 2010 and October 2025. We prioritized current society guidelines, recent systematic reviews and meta-analyses, and landmark original studies, focusing on incidence, classification, risk factors, prevention strategies, and outcomes. Evidence was narratively synthesized to provide guideline-aligned recommendations. Perforation occurs in approximately 0.1% to 1.8% of ERCPs and is associated with substantial morbidity and mortality. The Stapfer system can be used to stratify injury severity and guide management. Most periampullary (Stapfer type II) and ductal (type III) injuries can be managed nonoperatively with endoscopic closure and/or diversion (e.g., fully covered self-expandable metal stents), whereas large, free-wall duodenal perforations (type I) often require early surgery. Early recognition, the use of CO₂insufflation, careful sphincterotomy and dilation, and multidisciplinary care are associated with improved outcomes. Prevention through meticulous technique and appropriate case selection is important. When a perforation does occur, prompt classification and a stratified intervention approach (conservative, endoscopic, or surgical) can optimize treatment outcomes. Advances in endoscopic closure and diversion have significantly reduced the need for surgical intervention in many patients. However, prompt surgical management remains critical in select cases.

Background/aims: This study examined sex differences in the effect of changes in body mass index (BMI) on the development of gastric cancer (GC) in South Korea.

Methods: Using data from the National Health Insurance Service-Health Screening Cohort, a retrospective cohort study involving 333,169 Koreans with a median follow-up of 12 years was conducted. BMI was categorized into five groups (<18.5, 18.5-22.9, 23.0-24.9 [reference], 25.0-29.9, and ≥30.0 kg/m²) and the risk of developing GC was evaluated according to changes in BMI by calculating the hazard ratio (HR) using Cox proportional hazard regression.

Results: Among males, BMI ≥30.0 kg/m² was associated with a 1.27-fold higher overall risk of developing GC (95% confidence interval [CI], 1.02 to 1.57), but not in females. For non-cardia GC, a U-shaped association between BMI and risk of developing GC was observed in males, although statistical significance was observed only for BMI 18.5-22.9 kg/m². Additionally, an increase in BMI to 23.0-24.9 kg/m² was associated with a decreased non-cardia GC risk among males. In females, the largest waist circumference category was significantly associated with an increased risk of developing overall GC (HR, 1.37; 95% CI, 1.07 to 1.74).

Conclusions: This study demonstrated that maintaining a BMI in the range of 23.0-24.9 kg/m² is optimal for minimizing the risk of non-cardia GC, particularly in males. In females, visceral obesity, represented by a large waist circumference as a proxy, was associated with an increased risk of developing GC.

Background/aims: Colorectal cancer (CRC) risk is approximately 0.1% according to registry data, and fecal immunochemical tests (FITs) identify approximately 5% of screened individuals as positive. We evaluated whether a negative FIT result is reassuring regarding CRC risk.

Methods: In this retrospective cohort study, 141,982 Taiwanese individuals aged ≥50 who underwent self-paid medical screening from 1994 to 2008 were enrolled. CRC cases and all-cause deaths were identified through the National Cancer Registry and National Death File. A negative FIT was defined as <20 μg Hb/g.

Results: There were 987 CRC patients with a negative FIT and 713 with a positive FIT. Among the 133,369 individuals with one negative FIT, 113 CRC patients were registered within 2 years and 803 within 10 years; only 15% of the CRC cases were identified within the first 2 years after testing. The overall incidence was 1.27/1,000 person-years, decreasing by 63% to 0.80/1,000 person-years after one negative FIT. With repeated biennial negative FITs, CRC risk declined to 63%, 53%, 33%, 23%, and 10% over 10 years. All-cause mortality decreased from 1,106/100,000 person-years to 511/100,000 person-years. Notably, 84% of the cohort had consistently negative FIT results across all five rounds.

Conclusions: Two-thirds of the 10-year CRC risk remained in individuals following one negative FIT. The risk after a negative FIT result reemerged 2 years after testing, highlighting the importance of continuing biennial FIT screening. Consistently negative FITs were associated with reduced CRC risk and a lower all-cause mortality. This study is limited by the lack of confirmatory colonoscopy in FIT-negative individuals, which may lead to an underestimation of CRC incidence.

Gastric cancer (GC) remains a significant concern worldwide, with a very high incidence in Japan, South Korea, and China. Early diagnosis of GC is important for reducing its mortality; to achieve this, screening of individuals at a high risk for developing GC should include frequent esophagogastroduodenoscopy. Currently, various population-based GC screening strategies are being implemented in South Korea, Japan, and the Matsu region of Taiwan. Many studies have suggested that serum pepsinogens (sPGs) can be used as GC biomarkers in South Korea, China, Europe, and other countries; indeed, Japan first included the sPG test in GC screening prior to 1990. However, while the role of sPGs (particularly type 1) as a marker of atrophic gastritis is well known, studies on the association between sPG levels and GC have mainly focused on the association with intestinal-type GC. Recent studies have demonstrated that sPGII is associated with severe inflammation and proliferation. Specifically, high sPGII levels and Helicobacter pylori positivity are associated with an increased risk of early diffuse-type GC, particularly in young females. In this review, the physiology of sPGs and the usefulness of sPG levels in the detection of intestinal- or diffuse-type GC are discussed in terms of sex and age.