Gut and Liver最新文献

Background/aims: Gastrointestinal amyloidosis (GIA) is a common condition that presents with a variety of endoscopic features. However, the classification of these endoscopic features of GIA and its clinical implications have not been investigated.

Methods: The endoscopic findings of 127 patients with GIA were reviewed and classified by three experienced endoscopists. The relationships of the endoscopic classification of GIA with clinical amyloidosis entities, symptoms, and patient outcomes were evaluated.

Results: Five distinct types of endoscopic lesion features were identified in GIA patients: protruding, granular, hemorrhagic, ulcerative, and nonspecific. The hemorrhagic type was most common (n=32, 25.2%), followed the by protruding (n=30, 23.6%), ulcerative (n=28, 22.0%), granular (n=20, 15.7%), and nonspecific types (n=17, 13.4%). The protruding type was significantly prevalent in patients with localized amyloidosis (23/49, 71.4%), whereas the hemorrhagic type was the most common in patients with immunoglobulin light chain amyloidosis (20/47, 42.6%), and the ulcerative type was the most common in patients with amyloid A amyloidosis (8/17, 47.1%) (p<0.001). The granular type was related to dysmotility symptoms (p=0.018). Among 30 GIA patients with the protruding type, two died, whereas 36.1% of patients with the other endoscopic types (35/97) died during a median follow-up of 95.5 months (interquartile range, 65.8 to 132.0 months) (p=0.007).

Conclusions: Five types of GIA lesions were identified, and on this basis, an endoscopic classification system was proposed. This system may be of diagnostic and prognostic value.

Background/aims: The presence of individual cancer cells at the invasive tumor front is referred to as tumor budding (TB). The purpose of this study was to assess the clinicopathological significance of TB in patients with early gastric cancer (EGC).

Methods: A total of 939 patients who received radical surgery for EGC were included in this retrospective study. We assessed clinicopathological features in relation to TB including the grade of histologic differentiation, the extent of invasion depth, the width of submucosal (SM) invasion, and the presence of lymphovascular invasion (LVI), lymph node metastasis (LNM) and perineural invasion (PNI).

Results: TB was identified in 59.5% of the patients with EGC, 38.7% of the patients with mucosal invasive cancer, and 80.4% of the patients with SM invasive cancers. TB showed significant association with male sex, undifferentiated tumor types, SM invasion, LVI, PNI, and LNM. The presence of SM invasion (odds ratio [OR], 8.750; p<0.001), TB (OR, 5.586; p<0.001), and an undifferentiated-type histology (OR, 2.648; p=0.0005) were found to be significantly associated with LNM/LVI. TB was the sole significant risk factor for LNM/LVI (OR, 7.181; p=0.0016) among the mucosal invasive cancers. In SM invasive cancers, three independent risk factors for LNM/LVI were identified: a tumor located in the lower third of the stomach (OR, 3.425; p=0.0061), an undifferentiated-type histology (OR, 2.320; p=0.0177), and an SM invasion width greater than 4,000 μm (OR, 2.849; p=0.0041).

Conclusions: TB may be an important factor associated with LNM, particularly in mucosal gastric cancer.

Background/aims: Colorectal cancer (CRC) is the third most prevalent malignancy and the second leading cause of cancer-associated death worldwide. Ferroptosis is a form of regulated cell death that has been linked to the treatment of CRC. Tribbles homolog 3 (TRIB3) and TEA domain transcription factor (TEAD4) are linked with the progression of various cancers, but their role in ferroptosis remains unclear.

Methods: We analyzed TRIB3 and TEAD4 expression in CRC tissues using bioinformatics and examined the TRIB3-ferroptosis association. Immunohistochemistry was employed to determine the expression levels of TRIB3 and glutathione peroxidase 4 (GPX4). Real-time quantitative polymerase chain reaction was utilized to measure the mRNA levels of TRIB3 and TEAD4. Western blot was performed to assess the changes in the levels of proteins related to ferroptosis and MEK/ERK pathway. Dual luciferase assays and chromatin immunoprecipitation assays were employed to detect TEAD4TRIB3-TEAD4 targeting. We also employed colony formation assays to analyze cell proliferation, flow cytometry to measure reactive oxygen species levels, and detection kits to measure Fe2 +, glutathione and NADPH levels.

Results: TRIB3 was upregulated in CRC cells and tissues and was implicated in the ferroptosis pathway, demonstrating a positive association with GPX4. TRIB3 positively modulated ferroptosis proteins and the MEK/ERK signaling pathway, increasing the ferroptosis resistance of CRC cells. Overexpression of TRIB3 in TEAD4-knockdown cells significantly increased the ferroptosis resistance of CRC cells.

Conclusions: TEAD4 increases the expression level of TRIB3 through transcriptional activation, thereby controlling the MEK/ERK signaling pathway and inducing ferroptosis resistance in CRC cells.

Background/aims: The MiroCam MC2000 (MC2000) is a double-tip capsule with a camera on each side. It is designed to provide more extensive visualization of the small bowel mucosa, potentially reducing the chance of missing lesions. This study aimed to compare the detection rates for lesions in the ampulla of Vater (AoV) and the small bowel of the MC2000 and the PillCam SB3 (SB3) for patients with suspected small bowel bleeding.

Methods: This prospective, multicenter, randomized crossover trial compared the lesion detection capabilities of the MC2000 and SB3 capsules, ingested one hour apart by patients with suspected small bowel bleeding. The primary outcome was the detection of lesions in the AoV, while the secondary outcome was the assessment of the detection of P1 and P2 lesions, known underlying causes of small bowel bleeding.

Results: There was no significant difference in AoV lesion detection rates between the devices. However, MC2000 demonstrated significantly greater detection of red spots in patients with visible bleeding (p=0.018) and tended to detect a greater number of small bowel lesions, including P2 lesions. Minor complications included device stasis, with fewer incidents with the MC2000 than with the SB3, and one instance of small bowel retention due to ulcers.

Conclusions: The MC2000's dual-camera system appears to enhance the detection of small bowel lesions over the SB3, especially for more important lesions. These findings suggest that the MC2000 may offer superior diagnostic capabilities for patients with suspected small bowel bleeding, potentially leading to better clinical outcomes (this trial registered KCT0005591).

Background/aims: Magnetic resonance imaging (MRI) with a proton density fat fraction (PDFF) sequence is the most accurate, noninvasive method for assessing hepatic steatosis. However, manual measurement on the PDFF map is time-consuming. This study aimed to validate automated whole-liver fat quantification for assessing hepatic steatosis with MRI-PDFF.

Methods: In this prospective study, 80 patients were enrolled from August 2020 to January 2023. Baseline MRI-PDFF and magnetic resonance spectroscopy (MRS) data were collected. The analysis of MRI-PDFF included values from automated whole-liver segmentation (autoPDFF) and the average value from measurements taken from eight segments (avePDFF). Twenty patients with ≥10% autoPDFF values who received 24 weeks of exercise training were also collected for the chronologic evaluation. The correlation and concordance coefficients (r and ρ) among the values and differences were calculated.

Results: There were strong correlations between autoPDFF versus avePDFF, autoPDFF versus MRS, and avePDFF versus MRS (r=0.963, r=0.955, and r=0.977, all p<0.001). The autoPDFF values were also highly concordant with the avePDFF and MRS values (ρ=0.941 and ρ=0.942). The autoPDFF, avePDFF, and MRS values consistently decreased after 24 weeks of exercise. The change in autoPDFF was also highly correlated with the changes in avePDFF and MRS (r=0.961 and r=0.870, all p<0.001).

Conclusions: Automated whole-liver fat quantification might be feasible for clinical trials and practice, yielding values with high correlations and concordance with the time-consuming manual measurements from the PDFF map and the values from the highly complex processing of MRS (ClinicalTrials.gov identifier: NCT04463667).

Endoscopic submucosal dissection (ESD) enables en-bloc resection of large lesions more than 20 mm in size. Therefore, the use of ESD has gained broader acceptance for clinical applications globally. Previous reports on long-term outcomes after ESD, when followed by additional surgery, have also reported favorable results, positioning ESD as a crucial tool in providing minimally invasive treatment for T1 colorectal cancer (CRC). However, a lack of clear evidence regarding optimal surveillance strategies for T1 CRC following endoscopic treatments such as ESD remains. In some cases of T1 CRC, the need for additional surgery to address the risk of lymph node metastasis (LNM) remains a significant concern in daily practice. This narrative review aimed to examine the evidence on surveillance and additional surgery following the endoscopic treatment of T1 CRC by evaluating the criteria for intervention and associated risk factors. In cases where there are no unfavorable pathological features or risk factors for LNM, the risk of LNM is extremely low, and endoscopic techniques alone are typically sufficient in achieving curative resection for these patients. However, when risk factors for LNM are present, additional surgery should be considered. Several current guidelines recommend determining whether to pursue additional surgery or surveillance based on these risk factors, which must be carefully assessed according to individual patient conditions. Further studies are required to clarify the long-term prognosis, risk of lymph node or distant metastasis, and appropriate surveillance strategies, which may include salvage treatment such as additional surgery.