Gut and Liver最新文献

Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure for pancreaticobiliary diseases. However, its relatively invasive nature necessitates a thorough understanding of potential adverse events and appropriate preventive strategies. Post-ERCP pancreatitis (PEP), the most common ERCP-related adverse event, occurs in approximately 10% of cases. While often mild, severe cases can rapidly progress and lead to clinical deterioration and mortality. The pathogenesis of PEP involves direct tissue injury, impaired ductal drainage, inflammatory mediator release, and individual susceptibility. These insights have informed the currently employed prevention and management strategies. PEP risk factors include both patient- and procedure-related variables, underscoring the need for precise risk stratification and individualized procedural planning. Evidence-based preventive strategies-such as rectal nonsteroidal anti-inflammatory drugs, prophylactic pancreatic stent placement, aggressive intravenous hydration, guidewire-assisted cannulation, and other pharmacologic agents-have demonstrated efficacy in reducing PEP incidence. Future developments, including optimal combination strategies and machine learning-based risk prediction models, may further improve outcomes. Significantly reducing the burden of PEP requires integrating mechanistic insight and risk stratification with timely, evidence-based prevention and management.

Background/aims: To assess the safety and efficacy of early oral refeeding (ERF) versus delayed refeeding (DRF) in patients with mild post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

Methods: Eligible patients were randomly assigned in a 1:1 ratio to the ERF or DRF group. Eligible patients were randomly assigned in a 1:1 ratio to the ERF or DRF group. In the ERF group, feeding began 24 hours after the diagnosis of PEP; in the DRF group, feeding commenced once normal bowel sounds returned and pain had decreased to a visual analog scale score of <2. The diet was advanced from clear fluids to soft foods according to patient tolerance. Refeeding was temporarily halted if the visual analog scale score reached ≥5 points or if intake was refused due to pain. Resumption required normal amylase/lipase levels, pain relief, and bowel movement restoration. Discharge criteria included patient well-being >24 hours post-diet. The primary outcome was PEP hospitalization duration, and secondary outcomes were the incidence of severe acute pancreatitis, readmission rate (<30 days), and PEP-related mortality rate.

Results: A total of 80 patients (40 in each ERF and DRF group) were enrolled across nine referral centers. Baseline characteristics, procedural parameters and initial PEP severity were not significantly different between the two groups. Four ERF and three DRF patients had refeeding interruptions. ERF significantly reduced PEP hospitalization duration compared to DRF (2.93±1.59 days vs 3.78±1.97 days: relative risk, 0.75; 95% confidence interval, 0.59 to 0.97; p=0.026). Rates of severe acute pancreatitis, readmission, and mortality/morbidity related to PEP were similar between the two groups.

Conclusions: ERF effectively shortens hospitalization in mild PEP patients without increasing safety risks (ClinicalTrials.gov identifier NCT04750044).

The gut microbiota has emerged as a key factor in the pathophysiology of inflammatory bowel disease (IBD), providing novel opportunities for diagnostic innovation. Traditional biomarkers, such as C-reactive protein and fecal calprotectin, are widely used in clinical practice; however, their ability to reflect disease complexity and microbial dysregulation remains limited. Recent advances in metagenomics and multi-omics integration have enabled high-resolution profiling of microbial communities and their functional capacities and associated metabolites. Differential abundance analysis and machine learning models have been used to identify microbial biomarkers that can distinguish patients with IBD from healthy individuals. Multicohort studies integrating microbiome and metabolomic data have further improved diagnostic accuracy and generalizability. Transcriptomic and proteomic analyses provide complementary insights into host-microbe interactions and disease mechanisms. In this review, we explored the potential of metagenomic biodata as diagnostic markers for IBD, with an emphasis on a multidimensional analytical approach. We highlight the recent developments in sequencing technologies, computational pipelines for microbial feature selection, and machine learning strategies applied to biomarker discovery. The integration of multi-omics data deepens our understanding of host-microbe interactions and facilitates the development of microbiota-informed diagnostic tools. As multidimensional microbial profiling evolves, its clinical utility for the diagnosis and stratification of IBD requires further investigation.

Background/aims: Although atezolizumab plus bevacizumab has significantly improved the life expectancy of patients with unresectable hepatocellular carcinoma (HCC), it also increases bleeding risks. This study aimed to identify factors associated with bleeding events and evaluate their impact on prognosis.

Methods: Patients treated with atezolizumab plus bevacizumab as first-line therapy for unresectable HCC were retrospectively reviewed. Patients with high-risk varices were treated before therapy initiation. The primary endpoint was the incidence of bleeding events and secondary endpoints were overall survival (OS) and disease control rate (DCR).

Results: Among 123 patients, 81 had varices detected via esophagogastroduodenoscopy or computed tomography (varices group) while 42 did not (non-varices group). During a median follow-up of 11.1 months, bleeding events occurred in 15 patients, with 14 of occurring in the varices group. The cumulative incidence of bleeding in the varices group was 7.7%, 21.3%, or 32.6% at 6, 12, or 18 months, respectively, significantly higher than that (0.0%) in the non-varices group (p=0.001). No significant difference in OS was observed between the groups after inverse probability of treatment weighting (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.49 to 1.46; p=0.54). Bleeding events were not significantly associated with OS after inverse probability of treatment weighting (HR, 0.68; 95% CI, 0.35 to 1.33; p=0.26). However, the DCR was significantly higher in the varices group than in the non-varices group (80.2% vs 54.8%; p=0.006).

Conclusions: In unresectable HCC patients treated with atezolizumab plus bevacizumab, varices increase bleeding risk. However, proactive management and careful monitoring could mitigate their impact on OS and help increase the DCR.

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.

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.

Background/aims: Although rectal neuroendocrine tumors (NETs) ≤1 cm in size are generally considered low-risk tumors that are suitable for endoscopic resection, the long-term outcomes after histologically complete resection remain unknown.

Methods: We conducted a multicenter retrospective cohort study of patients with rectal NETs who underwent complete endoscopic resection (endoscopic mucosal resection or endoscopic submucosal dissection) between January 2014 and December 2019. A total of 860 patients with ≥6 months of follow-up were included. Recurrence-free survival and its associated risk factors were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results: Among 860 patients, the mean age was 47.7 years, and 57.9% of the patients were male. The overall recurrence rate was 1.4% (n=12). Univariate and multivariate analyses identified histological grade 2 (hazard ratio [HR], 19.13; 95% confidence interval [CI], 3.51 to 104.22) and mitotic count 2-20/10 high-power field (HPF) (HR, 20.88; 95% CI, 1.61 to 270.19) as independent predictors of recurrence, while >20/10 HPF (HR, 7.93; 95% CI, 0.90 to 69.87) showed a marginal association. The pathological tumor size, resection method, endoscopic ultrasonography findings, and Charlson Comorbidity Index were not associated with recurrence. The 5-year and 9-year recurrence-free survival rates were 98.4% and 84.7%, respectively. Supplementary analysis excluding patients with missing data confirmed consistent findings.

Conclusions: Although recurrence is rare after the complete resection of rectal NETs ≤1 cm in size, patients with grade 2 tumors or a mitotic count ≥2/10 HPF are at increased risk. Risk-adapted follow-up based on histological features should be considered.

Background/aims: The World Health Organization aims to eliminate hepatitis C virus (HCV) by 2030; however, linkage to care rates remain suboptimal. To address this, an in-hospital HCV alarm system integrated into electronic medical records (EMRs) was implemented to increase confirmatory testing and referral rates.

Methods: This retrospective study analyzed patients with positive anti-HCV antibody results at a tertiary hospital in Korea, comparing the pre-alarm period (August 2020-July 2022) with the post-alarm period (July 2022-May 2024). HCV RNA testing rates, liver clinic visits, and direct-acting antiviral (DAA) prescriptions were assessed. Multivariate logistic regression was performed to identify factors associated with the lack of HCV RNA testing implementation.

Results: Among 941 patients who tested positive for anti-HCV antibodies, the proportion of patients who underwent HCV RNA testing significantly increased from 49.4% in the pre-alarm period to 67.8% in the post-alarm period (p<0.001). The rate of referral to liver specialists also showed an increasing trend (89.4% vs 93.2%), while DAA initiation rates remained similar (68.4% vs 72.0%). Multivariate analysis revealed that older age, surgical or emergency department admission, and non-liver-related testing indications were independent predictors of the lack of HCV RNA testing implementation.

Conclusions: Implementation of an in-hospital HCV alarm system significantly increased HCV RNA testing rates, enhancing early diagnosis and linkage to care. While referral rates remained high, persistently low testing rates in emergency departments highlight the need for targeted interventions. A cost-effective, EMR-integrated alarm system may be a feasible strategy to support national HCV elimination efforts.

Background/aims: Type 2 diabetes mellitus (T2DM) is linked to an elevated risk of gastrointestinal bleeding (GIB), but the effects of diabetes duration and severity remain unclear. We investigated these associations in a nationwide Korean cohort.

Methods: This retrospective cohort study used the Korean National Health Insurance database from individuals who underwent national health screening between 2009 and 2015. Participants were classified as having normal glucose, impaired fasting glucose (IFG), new-onset diabetes, diabetes <5 years, or diabetes ≥5 years. GIB was defined by fulfilling all three: hospitalization, red blood cell transfusion, and ICD-10 GIB codes. Because hemoglobin A1c data were unavailable, insulin treatment served as a surrogate for diabetes severity. Kaplan-Meier and Cox proportional hazards models were applied to estimate cumulative incidence and adjusted hazard ratios (aHRs), adjusting for medications and comorbidities.

Results: Upper GIB risk increased progressively with diabetes duration: aHR 1.081 (95% confidence interval [CI], 1.008 to 1.159) for IFG; 1.265 (1.128 to 1.418) for new-onset diabetes; 1.561 (1.392 to 1.751) for diabetes <5 years; and 1.738 (1.578 to 1.915) for diabetes ≥5 years. Elevated risk was also observed among those receiving insulin. In contrast, diabetes duration was not significantly related to lower GIB: aHR 0.949 (95% CI, 0.830 to 1.085) for IFG; 1.150 (0.902 to 1.468) for new-onset diabetes; 1.202 (0.944 to 1.531) for diabetes <5 years; and 0.984 (0.792 to 1.224) for diabetes ≥5 years.

Conclusions: Longer duration and greater severity of T2DM are associated with increased risk of upper GIB, whereas no significant association was found for lower GIB.