Gut and Liver最新文献

Background/aims: Accurate diagnosis of and timely eradication therapy for Helicobacter pylori are crucial for managing and preventing adverse clinical outcomes associated with H. pylori infection. H. pylori infection is typically diagnosed using endoscopic biopsy-based tests such as the rapid urease test (RUT). In this study, we investigated the usefulness of mucosal brush sampling for H. pylori detection using the RUT and culture.

Methods: Twenty patients with H. pylori infection underwent endoscopy, and specimens were collected from the greater curvature of the gastric corpus via both mucosal brush and biopsy sampling methods. Brushing was performed using a disposable cytology brush, and the brush specimen was used for the RUT (brush-RUT) and then for culture. Two biopsies were obtained for the RUT (biopsy-RUT) and culture. H. pylori detection rates using RUT and culture yields from brush and biopsy samples were compared.

Results: The H. pylori detection rate was 100% with the brush-RUT, whereas it was 75% with the biopsy-RUT. Notably, among patients taking acid-suppressive agents, the sensitivity of the biopsy-RUT decreased to 66.7%, whereas that of the brush-RUT remained at 100%. The biopsy-RUT yield was also associated with the delta over baseline value determined by the urea breath test. H. pylori was successfully isolated from all the biopsy specimens and 95% of the brush samples, and all H. pylori isolates were tested for antimicrobial susceptibility. No significant procedure-related adverse events occurred with either sampling method.

Conclusions: Mucosal brushing is a simple, effective, and highly sensitive diagnostic method for H. pylori infection. The mucosal brush method is a practical alternative to biopsy, expanding the diagnostic capabilities while minimizing invasiveness.

Background/aims: Data on outcomes of superficial nonampullary duodenal tumors (SNADETs) are limited. We evaluated clinical features, outcomes, and complications of endoscopic resection (ER) in a large single-center cohort.

Methods: Patients who underwent ER for SNADETs between 2008 and 2023 were retrospectively reviewed. Clinicopathologic features, resection outcomes, adverse events, and recurrence were analyzed.

Results: A total of 176 SNADETs from 163 patients (mean age, 57±13 years; 56.4% male) were included. The median follow-up duration was 22 months. The mean lesion size was 9.8±5.4 mm. ER methods were cold snare polypectomy (CSP) (n=29), cold endoscopic mucosal resection (EMR) (n=42), hot EMR (n=83), endoscopic submucosal dissection (ESD) (n=13), and underwater EMR (n=8). En bloc and histologic curative resection rates were 85.7% and 91.5%, respectively. Bleeding occurred in nine patients (5.1%), and perforation occurred in three patients (1.7%); both were mostly managed endoscopically. Bleeding was more common in the second portion of duodenum, and with hot EMR and ESD, whereas no bleeding occurred after CSP or underwater EMR. CSP and underwater EMR showed the shortest procedure times, whereas cold EMR and hot EMR had longer procedure times; ESD had the longest procedure time. Local recurrence occurred after en bloc curative ESD in one patient (0.6%).

Conclusions: ER is effective and safe for SNADETs, achieving high curative resection rates, low recurrence, and acceptable complication risks. Selection of resection method should be individualized, with cold EMR and underwater EMR offering safe and efficient alternatives for the treatment of smaller lesions, while ESD may be reserved for the treatment of larger lesions or complex cases.

Background/aims: Advances in gastric cancer treatment have improved survival rates, which has led to a growing interest in the risk of non-cancer-related conditions, particularly cardiovascular diseases. This study aimed to investigate the risk of heart failure in patients with gastric cancer according to their initial cancer stage.

Methods: We conducted a nationwide, population-based, retrospective cohort study using the Cancer Public Library Database of Korea. Patients diagnosed with gastric cancer between 2012 and 2019 were enrolled and followed until the end of 2020. Heart failure development was defined as a new diagnosis of heart failure that required hospitalization. Based on the Surveillance, Epidemiology, and End Results Program staging for gastric cancer, patients were classified into three groups: localized, regional, and distant stages.

Results: Of the 202,347 patients in the study, 16,004 (7.9%) developed heart failure during a median follow-up period of 3.6 years. The cumulative incidence of heart failure significantly increased with worsening gastric cancer stage (log-rank, p<0.001). After adjusting for age, sex, diabetes status, hypertension status, dyslipidemia status, income, residential area, and initial treatment modality, with the localized stage as the reference group, the hazard ratio for heart failure was 1.52 (95% confidence interval [CI], 1.46 to 1.58) for patients in the regional stage group and 2.87 (95% CI, 2.69 to 3.07) for those in the distant stage group.

Conclusions: In patients with gastric cancer, the risk of heart failure requiring hospitalization increased with worsening cancer stage. Even in young patients and those without metabolic risk factors, close monitoring for heart failure development following cancer treatment is essential.

Background/aims: Traction-assisted endoscopic submucosal dissection (TA-ESD) using dental floss substantially reduces procedural times without increasing adverse event rates. However, few studies have described the clinical outcomes following TA-ESD for prepyloric and pyloric neoplasms. Therefore, this study aimed to investigate the clinical outcomes of patients treated with TA-ESD for prepyloric and pyloric neoplasms.

Methods: We retrospectively analyzed the data of 208 patients who underwent ESD for prepyloric and pyloric neoplasms between 2016 and 2021 at Pusan National University Hospital. The patients were categorized into the conventional ESD (C-ESD) (n=173) and TA-ESD (n=35) groups. One-to-two propensity score matching (PSM) was performed between both groups.

Results: In the unmatched cohort, compared with the C-ESD group, the TA-ESD group had a significantly greater rate of resection defects exceeding half of the circumference of the pylorus (45.7% vs 27.2%, p=0.048), a lower complete resection rate (85.7% vs 97.1%, p=0.014), a higher positive vertical margin rate (5.7% vs 0.0%, p=0.028), and a longer procedural time (34.2±26.1 minutes vs 25.3±22.0 minutes, p=0.036). After PSM, the TA-ESD group required a significantly shorter procedural time than did the C-ESD group (30.1±18.1 minutes vs 40.4±23.7 minutes, p=0.031). No statistically significant differences were observed in other variables between the two groups.

Conclusions: Compared to C-ESD, TA-ESD significantly shortened the procedural time for treating prepyloric and pyloric neoplasms. However, no significant differences were observed in the complete resection rate or in adverse events between the two groups.

Background/aims: Familial adenomatous polyposis (FAP), a hereditary colorectal cancer syndrome caused by APC gene mutations, is characterized by the development of numerous colorectal polyps and cancer at young age. To determine an effective chemopreventive strategy, we investigated the combined effects of varying doses of niclosamide and metformin in Apc^Min/+ mice.

Methods: Apc^Min/+ mice were treated with metformin, niclosamide, or their combination at three doses (50, 100, and 200 mg/kg) for 16 weeks. The polyp burden was analyzed, and drug interactions were assessed by using the Bliss independence model to evaluate pharmacodynamic synergy and a physiologically based pharmacokinetic (PBPK) model to quantify the contribution of known pharmacokinetic interactions.

Results: Low-dose metformin (50 mg/kg), niclosamide (50 mg/kg), and their combination showed no significant effects on the total polyp numbers compared with those in the control group. Higher doses (100 and 200 mg/kg) of both agents and their combination significantly reduced the total polyp numbers. The Bliss independence model showed a significant additive effect at the 100 mg/kg combination dose, whereas at the 200 mg/kg combination dose, an antagonistic interaction was observed. PBPK modeling predicted that coadministration of niclosamide increased exposure to metformin. Notably, the predicted metformin plasma Cmax remained within a safe therapeutic window at the 100 mg/kg combination dose but exceeded a safety threshold at 200 mg/kg.

Conclusions: By integrating in vivo efficacy testing with quantitative modeling, our study identified the 100 mg/kg combination of niclosamide and metformin as the optimal dose for chemoprevention in a murine FAP model, providing a strong rationale for future clinical translation in FAP management.

Background/aims: Intestinal Behçet's disease (BD) is a rare, chronic intestinal vascular disorder often refractory to conventional therapy. We aimed to assess the effectiveness and tolerability of anti-tumor necrosis factor alpha (anti-TNF-α) therapy in patients with moderate to severe refractory intestinal BD.

Methods: Clinical remission, clinical response, and biological response rates at 4, 12, and 24 months, as well as the adverse effects of anti-TNF-α therapy were investigated at the Inflammatory Bowel Disease Center of Severance Hospital, Seoul, Korea. We also examined the relapse rates and predictive factors for disease relapse.

Results: Of the 119 patients, 15 (12.6%) were bio-exposed, 68 (57.1%) received concomitant immunomodulators, and 56 (47.1%) received concomitant corticosteroids at anti-TNF-α treatment induction. At 4, 12, and 24 months, clinical remission rates were 23.5%, 40.3%, and 42.0%; clinical response rates were 84.0%, 62.2%, and 62.2%; and biological response rates were 61.3%, 68.9%, and 58.8%, respectively. Sixty-three patients (52.9%) relapsed, with a mean relapse time of 2.8 years. Higher initial C-reactive protein levels (hazards ratio [HR], 1.013; 95% confidence interval [CI], 1.008 to 1.018; p<0.001), history of previous intestinal surgery (HR, 4.282; 95% CI, 2.379 to 7.709; p<0.001), concomitant immunomodulator use (HR, 0.455; 95% CI, 0.267 to 0.775; p=0.004), and clinical response at 4 months (HR, 0.353; 95% CI, 0.181 to 0.687; p=0.002) were independent factors associated with the disease relapse. No mortality was observed during the study period; 26 (21.8%) and three patients (2.5%) experienced mild infection and infusion reactions, respectively.

Conclusions: Anti-TNF-α therapy could be an effective and tolerable option for refractory intestinal BD.

Background/aims: Despite technical advancements, various conditions such as bleeding diathesis and altered anatomy challenge the creation of a durable conduit for biliary stone removal in endoscopic retrograde Cholangiopancreatography (ERCP). A fully covered self-expandable metal stent (SEMS) has been used as a robust conduit for drainage in a wide spectrum of pancreatobiliary diseases. However, its primary use for stone removal has not been fully evaluated. This study aimed to evaluate the efficacy and safety of a novel fully covered SEMS that is 3 cm in length and has a wide distal flare as a durable conduit for stone extraction through the papilla.

Methods: Twenty patients with common bile duct stones were enrolled prospectively and underwent ERCP with the novel SEMS. Primary outcomes were technical and therapeutic success rates. Secondary outcomes were the device removal success rate and any adverse events.

Results: The technical and therapeutic success rates were 95% (19/20) and 90% (18/20), respectively. The novel SEMS was removed successfully in all patients (100%). Mild post-ERCP pancreatitis developed in 15% of the patients (3/20), and post-ERCP cholangitis occurred in 5% (1/20). There were no cases of moderate to severe pancreatitis, perforation, bleeding, or procedure-related mortality.

Conclusions: The novel SEMS offers a durable conduit for safe and effective biliary stone extraction without major adverse events. Further studies in larger cohorts are warranted to confirm these findings (CRiS identifier KCT0006185).

Background/aims: Conventional oral sulfate tablets (OSTs) and mini-OSTs have gained popularity for bowel preparation in South Korea. This study aimed to evaluate the efficacy, tolerability, and safety of mini S-OSTs, which have fewer tablets and include simethicone compared to the mini-OSTs.

Methods: This was a prospective, randomized, investigator-blinded, multicenter, and noninferior phase 3 trial conducted between August 2023 and January 2024. The efficacy, safety, and tolerability were compared among a mini S-OST split dose group, mini S-OST non-split dose group and conventional OST group. To evaluate the occurrence of gastric mucosal lesions, gastroscopy was also performed.

Results: High-quality preparation was achieved in the mini S-OST split dose group and conventional OST group according to both the full analysis set and per-protocol set analyses, without significant differences. Tolerability metrics were more favorable in the mini-OST group. The hematin content tended to decrease and the number of erosions was reduced in the mini S-OST split dose group compared with the conventional OST group according to the gastroscopy results. Adverse events were comparable between the conventional OST and mini S-OST split dose groups. The mini S-OST non-split dose group showed no difference in overall successful cleaning, but the proportion of high-quality cleaning in the ascending colon was lower than that in the mini S-OST split dose group and conventional OST group.

Conclusions: Compared with conventional OST, the mini S-OST split dose showed excellent efficacy, comparable safety and tolerability, with less gastric injury (ClinicalTrial.gov identifier NCT06287606).

Gastritis, characterized by gastric mucosal inflammation, is a common gastrointestinal disorder with diverse etiologies, such as Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs use, and autoimmune conditions. Pharmacological treatment aims primarily to heal the mucosa and resolve symptoms, and such treatments include mucoprotective agents, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and potassium-competitive acid blockers (P-CABs). Mucoprotective agents enhance gastric mucosal protection through multiple mechanisms, such as by promoting mucosal regeneration, reducing inflammation, and mitigating oxidative stress. Clinical trials have highlighted the effectiveness of these agents in promoting endoscopic healing and ameliorating symptoms, underscoring the clinical significance of these agents. H2RAs have been extensively used to manage gastritis due to their proven efficacy in reducing gastric acid secretion and promoting mucosal healing. Additionally, PPIs along with newer P-CABs provide robust acid suppression and have shown the ability to rapidly relieve symptoms, thus increasing the number of available treatment options. Since each pharmacological agent offers distinct therapeutic benefits, treatment should be selected based on an individual patient's needs and clinical context.

Background/aims: Helicobacter pylori is a well-known gastric carcinogen, and its eradication is an important therapeutic strategy to prevent the development of metachronous lesions following endoscopic submucosal dissection (ESD). However, the optimal timing for H. pylori eradication following ESD remains unclear.

Methods: In this multicenter, prospective, randomized trial, 191 patients undergoing ESD for gastric neoplasms were randomly assigned to either an early (3 to 5 days) or late (8 to 9 weeks) eradication group after ESD. The primary outcome was the rate of successful H. pylori eradication. Secondary outcomes included the tolerability and side effects of eradication therapy in both groups.

Results: A total of 149 patients were included in the per-protocol analysis (75 in the early eradication group and 74 in the late eradication group) after excluding patients who required surgery or were lost to follow-up. The early eradication group showed a significantly higher eradication rate compared to the late eradication group (early 80.0%, late 64.9%; p=0.045). However, the tolerability and side effects of the eradication therapy did not differ between the groups. In multivariate analysis, early initiation of eradication therapy after ESD was an independent predictor of successful eradication (odds ratio, 2.30; 95% confidence interval, 1.04 to 5.05; p=0.038).

Conclusions: Early attempts to eradicate H. pylori following ESD significantly increased eradication success rates without increasing the incidence of side effects. Therefore, early attempts to eradicate H. pylori after ESD may be the best option for successful eradication. (ClinicalTrials.gov identifier NCT02921399).