Gut and Liver最新文献

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: 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: 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).

Background/aims: Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction.

Methods: We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events.

Results: A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%).

Conclusions: Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.

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: Few studies have compared the outcomes of catheter angiography and colonoscopy after positive computed tomography angiography (CTA) results in patients with severe lower gastrointestinal bleeding. This study aimed to evaluate differences in clinical outcomes between these approaches.

Methods: We analyzed data from 254 patients with positive CTA results of the lower gastrointestinal tract at Severance Hospital, South Korea (2014-2024). Clinical outcomes were compared between the catheter angiography group (n=108) and the colonoscopy group (n=146), and the predictive risk factors for rebleeding were examined.

Results: There were no significant differences in the confirmation yield (59.3% vs 47.9%), therapeutic yield (64.8% vs 56.2%), and mean hospitalization duration (20.1 days vs 21.3 days) between groups. However, the mean time to procedure (12.3 hours vs 19.2 hours) and rebleeding rate (36.1% vs 48.6%) were lower in the catheter angiography group. Logistic regression revealed that time to procedure predicted higher confirmation and therapeutic yields. Multivariate Cox regression showed that risk factors for rebleeding included receiving >5 units of packed red blood cells (hazard ratio [HR], 1.711; 95% confidence interval [CI], 1.025 to 2.857, p=0.040) and undergoing colonoscopy instead of catheter angiography (HR, 1.922; 95% CI, 1.242 to 2.974, p=0.003).

Conclusions: Following a positive CTA result, colonoscopy (compared to catheter angiography) and the need for more than 5 units of packed red blood cell transfusion were significant risk factors for rebleeding.

Background/aims: Stratifying patients for gastric neoplasm risk before screening esophagogastroduodenoscopy (EGD) is challenging. The aim of this study was to develop a prediction model for assessing gastric neoplasm risk in a screening setting.

Methods: This retrospective cross-sectional study included 21,586 EGD patients from Seoul St. Mary's Hospital, Korea (2009 to 2019). Logistic regression analyses identified risk factors, and score-based prediction models were developed on the basis of these risk factors. These models were evaluated using the area under the curve (AUC) and the Hosmer?Lemeshow goodness of fit test. Internal validation was performed using bootstrapping (1,000 resamples) and a validation cohort.

Results: The study included 10,414 patients in the derivation cohort and 11,172 in the validation cohort. Gastric dysplasia and cancer were identified in 49 (0.47%) and 35 (0.34%) patients, respectively. Four models were developed, with Model 4 including age, sex, pepsinogen I/II ratio, anti-Helicobacter pylori immunoglobulin G antibody, smoking, body mass index, alcohol use, and family history of gastric cancer. Model 4 had the highest AUC (0.827) in the derivation cohort, while Model 2 achieved the highest AUC (0.788) after risk scores were assigned. Observed prevalence rates were 0.24%, 1.05%, and 4.08% for low-, medium-, and high-risk groups, respectively (p<0.001). In internal validation, Model 3 demonstrated the highest AUC (0.802), with consistent performance in the validation cohort, and all models passed the Hosmer-Lemeshow test (p>0.8).

Conclusions: The predictive models achieved an AUC of approximately 0.8. Further improvements with additional stratification factors are needed for better diagnostic performance in prescreening.

Background/aims: Antioxidants may offer protection against colorectal cancer, but their association with colorectal adenomas remains unclear due to variations in study design, population, and dietary factors. We investigated the relationship between dietary intake of β-carotene, vitamin A, and retinol and the prevalence of colorectal adenoma using food frequency questionnaires (FFQs) and colonoscopy data.

Methods: We recruited participants undergoing elective colonoscopy across eight medical institutions. FFQs were administered prior to colonoscopy, and nutrient intakes were categorized into quartiles. Multivariate logistic regression was used to estimate odds ratios (ORs) adjusting for potential cofounders. A meta-analysis of 11 observational studies, including our own, was also conducted.

Results: Among 720 eligible participants (mean age 52.44±14.30 years; body mass index 23.82±3.46 kg/m²), colorectal adenoma was identified in 266 (36.9%). Higher intake of β-carotene and vitamin A was associated with a significantly lower prevalence of colorectal adenoma (p for trend <0.05). Adjusted ORs for the highest versus lowest quartile were 0.43 (95% confidence interval [CI], 0.20 to 0.91) for β-carotene and 0.34 (95% CI, 0.15 to 0.76) for vitamin A. Conversely, higher retinol intake was linked to increased adenoma prevalence (OR, 2.16; 95% CI, 1.09 to 4.29), particularly among individuals with high-fat diets. Meta-analysis confirmed a protective association for β-carotene (OR, 0.60; 95% CI, 0.46 to 0.78), but not for vitamin A or retinol.

Conclusions: We demonstrated an inverse association between β-carotene and colorectal adenoma prevalence, whereas the effects of vitamin A and retinol appeared to vary depending on dietary context. These findings highlight the complex influence of dietary pattern and nutrient sources on colorectal adenoma risk.