Journal of Digestive Diseases最新文献

Gastric cardiac carcinoma (GCC), also known as gastroesophageal junction (GEJ) carcinoma, is a slow-growing fatal cancer that arises in gastric cardiac mucosa in a region of about 2 cm above and 3 cm below the GEJ line. This carcinoma shows clinicopathologic and genomic features similar, but not identical, to gastric noncardiac carcinoma (GNCC). In contrast, GCC is much more complicated than esophageal adenocarcinoma (EA) in clinicopathology, genomics, and prognosis. GCC is heterogeneous geographically, accounting for 20%-50% of all gastric carcinomas in endemic regions in China. Compared with EA, GCC shows a much broader histopathologic spectrum and worse prognosis. Although detailed mechanisms of GCC pathogenesis remain elusive, advanced age, Helicobacter pylori infection, and gastroesophageal reflux disease are key risk factors. Intriguingly, goblet cell intestinal metaplasia may not be an essential initial step toward carcinogenesis in all GCC cases. At present, an accurate diagnosis of early GCC with prompt curative resection is the only realistic hope for dramatically improving patient outcomes. The recently developed liquid biopsy technology for serum cell-free DNA is a promising tool for the detection of early GCC, though many challenges remain and an in-depth investigation is required. Given the recent rapid advances in artificial intelligence, endoscopic technology, and a better understanding of endoscopists for subtle mucosal/vascular changes in early GCC, accurate detection of early GCC in a high proportion of cases would be possible.

Objectives: Double-balloon enteroscopy (DBE) is effective for managing small bowel (SB) diseases. We aimed to evaluate the patient outcomes of DBE polypectomy in Peutz-Jeghers syndrome (PJS) with large SB polyps at surveillance imaging studies and to identify the risk factors for SB surgery.

Methods: Forty-five PJS patients who underwent regular SB surveillance imaging studies from 2005 to 2023 were retrospectively included. DBE was performed for polyps > 15 mm detected by imaging studies, and DBE polypectomy was conducted for those > 10 mm or symptomatic ones.

Results: Patients' average age at PJS diagnosis and surveillance initiation was 19.9 and 27.8 years, respectively. Thirty-one (68.9%) patients had laparotomy before surveillance. Each patient underwent 2.7 DBE procedures at a 31.0-month interval. An average of 7.8 and 4.4 polyps were removed during the first and second DBE procedures (p = 0.070). During 9 (8.2%) DBE procedures, complications, including two perforations requiring surgery, occurred. During the follow-up period, 11 patients required SB surgery, with a median time to surgery of 155 months. Patients with ≥ 5 polyps removed at initial DBE had a higher cumulative probability of SB surgery than those with < 5 polyps (hazard ratio [HR] 9.65, p = 0.031). Patients with ≥ 3 laparotomies before surveillance tended to have an increased surgery risk (HR 9.98, p = 0.078).

Conclusions: DBE polypectomy effectively manages large SB polyps detected by imaging surveillance in PJS over the long term. Early initiation of surveillance should be emphasized to minimize the risk of SB surgery.

Pancreaticobiliary endoscopy is an essential tool for diagnosing and treating pancreaticobiliary diseases. However, it does not fully meet clinical needs, which presents challenges such as significant difficulty in operation and risks of missed diagnosis or misdiagnosis. In recent years, artificial intelligence (AI) has enhanced the diagnostic and treatment efficiency and quality of pancreaticobiliary endoscopy. Diagnosis and differential diagnosis based on endoscopic ultrasound (EUS) images, pathology of EUS-guided fine-needle aspiration or biopsy, need for endoscopic retrograde cholangiopancreatography (ERCP) and assessment of operational difficulty, postoperative complications and prediction of patient prognosis, and real-time procedure guidance. This review provides an overview of AI applications in pancreaticobiliary endoscopy and proposes future development directions in aspects such as data quality and algorithmic interpretability, aiming to provide new insights for the integration of AI technology with pancreaticobiliary endoscopy.

The median age of patients at diagnosis of mitochondrial neurogastrointestinal encephalomyopathy was 25 years. The most common neurological symptoms were leukoencephalopathy (83.1%), polyneuropathy (68.5%), and ptosis/ophthalmoparesis (61.8%). And the most common digestive symptoms were weight loss/cachexia (71.9%), abdominal pain (58.4%), diarrhea (57.3%), vomiting (53.9%), and constipation (13.5%).

Objectives: Immunotherapy-based regimens (IMBs), compared with tyrosine-kinase inhibitors (TKIs), improve the overall survival (OS) of patients with advanced hepatocellular carcinoma (aHCC). The aim of the study was to explore the interaction of prognostic factors with survival in study cohorts receiving IMB or TKI.

Methods: A systematic search was performed and single arms of phase III trials including IMB or TKI were selected. Analysis of IMB and TKI cohorts was performed, and the relationship between progression-free survival (PFS) with OS was assessed. Finally, 13 variables were extracted, and their relationships with survival in the two groups were evaluated.

Results: Thirty-three study cohorts were selected. Longer OS and post-progression survival (PPS) were evident in the group of IMB, while the relationship of PFS with OS was significant only in the TKI cohorts (β = 0.527, p = 0.007). Prognostic factors in the IMB cohorts did not report any significant relationship with OS, while among patients receiving TKIs, longer OS was documented with elder age (β = 0.577, p = 0.003) and good performance status (β = 0.500, p = 0.011). Conversely, in the IMB cohorts, PPS increased with hepatitis B virus (HBV) (β = 0.756, p = 0.030) and Barcelona Clinic Liver Classification (BCLC) stage (β = 0.898, p = 0.002).

Conclusion: In contrast to TKIs, IMBs improved the outcome of patients with aHCC by increasing PPS, particularly in patients with BCLC stage C and HBV-related hepatopathy, but the outcome improvement was lost in patients with hepatitis C virus-related liver disease.