Journal of Gastroenterology and Hepatology最新文献

Background and aim: Women are underrepresented in gastroenterology (GI), and few studies have evaluated gender differences in the authorship of GI clinical practice guidelines. This study aimed to assess gender disparities in the authorship of GI guidelines and their cited articles over time.

Methods: We reviewed luminal GI guidelines from three major GI societies to compare authorship of current guidelines (defined as published from 2019 to 2022) to their retired guidelines (defined as the previous guideline replaced by the current guideline). Several characteristics of the author and article including gender, faculty rank, study type, and strength of recommendation supported by the cited article were collected to evaluate factors associated with female authorship.

Results: We reviewed 13 current guidelines, 12 retired guidelines, and 4328 cited articles. There was no significant change in female authorship of guidelines from 2010 to 2022. Proportions of female first (p-value < 0.0001) and senior (p-value < 0.0001) authors of cited articles increased over time. Women were less often first authors of cited randomized control trials, systematic reviews, and meta-analyses than observational studies (35% vs. 65%, p < 0.0001). Cited articles that supported a "strong" guideline recommendation were less often first-authored (19% vs. 81%, p = 0.003) and senior-authored (10% vs. 90%, p = 0.006) by women.

Conclusions: Female authorship increased over time, but a gender disparity remains. Female authors less commonly authored higher level of evidence studies. Further studies are needed to assess if the proportional increase in female authorship is due to a small subset of prolific authors or representative of the number of women practicing in gastroenterology.

Background: The efficacy of primary tumor resection (PTR) for colorectal cancer lung metastases (CRLM) is unclear. This study used the SEER database to investigate if PTR improves prognosis in CRLM patients and developed a nomogram to predict the likelihood of benefiting from PTR.

Methods: Patients with CRLM from the SEER database (2010-2019) were included. Propensity score matching (PSM) balanced PTR and non-PTR groups. Kaplan-Meier analysis compared overall and cancer-specific survival. Cox regression identified survival factors. The PTR group was divided into training and validation sets (7:3 ratio) for nomogram development using logistic regression. Nomogram performance was validated using ROC curves, calibration curves, and decision curve analysis.

Results: A total of 3264 CRLM patients were included (2459 with PTR, 805 without). After 1:1 PSM, each group had 484 patients. PTR significantly improved survival (p < 0.001). Logistic regression identified age, race, T-stage, chemotherapy, and metastases to the liver, brain, and bone as risk factors. The nomogram showed excellent predictive performance and clinical utility.

Conclusion: PTR improves survival in CRLM patients, and the nomogram effectively predicts the benefit of PTR.

Background and aim: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer whose incidence is increasing globally. However, the high tumor heterogeneity of ICC restricts the efficacy of available systematic therapies. We aim to dissect the tumor heterogeneity of ICC utilizing high-resolution single-cell RNA sequencing to identify novel therapeutic targets.

Methods: We performed single-cell RNA sequencing (scRNA-seq) of 26 tumor samples from 23 ICC patients and spatial transcriptomic sequencing of six tumor sections from six ICC patients. Bulk RNA-seq data from two public datasets were used for validation. Additionally, immunohistochemical staining and multiplex immunofluorescence staining were conducted to validate the infiltration and distribution of cells in the tumor microenvironment.

Results: We discovered that malignant cells in ICC samples exhibited a remarkably high degree of tumor heterogeneity. We identified a basal-like tumor cell subpopulation characterized by the expression of basal epithelial related genes including KRT5, KRT6A, and KRT17. The basal-like tumor subpopulation was characterized by activation of MET signaling and extracellular matrix organization associated with tumor invasion and correlated with poor prognosis. Cell-cell communication analysis further showed significant HGF-MET interaction between inflammatory cancer-associated fibroblasts (iCAFs) and basal-like tumor cells. We found that iCAFs were the major source of HGF in tumor environment and contributed to the basal-like phenotype formation of tumor cells by HGF-MET axis.

Conclusions: We identified an aggressive basal-like tumor cell subpopulation, which correlated with poor prognosis in ICC. The MET pathway contributes to the aggressiveness of basal-like tumor cells and serves as a novel therapeutic target for ICC.

Objective: This study aims to evaluate the real-world effectiveness and safety of sequential treatment with regorafenib and trifluridine/tipiracil (FTD-TPI) in patients with metastatic colorectal cancer (mCRC) in Taiwan.

Methods: Data were obtained from Taiwan's National Health Insurance Research Database (NHIRD) to assess clinical outcomes in mCRC patients who were treated with both drugs in either sequential order from 2016 to 2019. Overall survival (OS) was analyzed using Kaplan-Meier curves and Cox's proportional hazard models, with adjustments made for age, gender, Quan-CCI score, presence of liver metastases, number of metastatic sites, and the use of anti-epidermal growth factor receptor medications. Additionally, age-stratified subgroups and sensitivity analyses were conducted to examine the robustness of our findings.

Results: Five hundred and twenty-eight patients receiving both study drugs were included. The regorafenib/FTD-TPI group demonstrated a longer median OS of 14.1 months compared with 10.2 months in the FTD-TPI/regorafenib group (p = 0.007). The survival benefit for the regorafenib/FTD-TPI sequence remained significant after adjustment (adjusted HR, 1.49; p = 0.002). The mean treatment duration was also longer for regorafenib/FTD-TPI than FTD-TPI/regorafenib (337 vs. 214 days; p < 0.01). No significant difference between the sequential treatment groups was observed in any adverse event of interest. Both subgroup and sensitivity analyses yielded outcomes consistent with the main analysis.

Conclusion: The findings indicated that initiating treatment with regorafenib followed by FTD-TPI had superior clinical outcomes compared with the reverse sequence among mCRC patients. This study offers real-world evidence for clinical decision-making and treatment optimization.

Although iron is a vital component in the body, excessive iron leads to iron toxicity, which affects vital organs. In particular, the liver is considerably affected by iron toxicity because it stores the highest amount of iron in the body. Nonetheless, the relationship between iron overload and aging in the liver has not yet been clearly identified. This study aimed to observe the effects of aging on iron overload in the liver. Female C57BL/6J mice were randomly divided into vehicle control and iron overload groups (n = 7-22 per group). The iron overload group was injected with iron-dextran (Fe-dextran, ferric hydroxide dextran complex) (0.5 g/kg) for 4 weeks. After the experimental period, liver and blood samples were obtained from 2-, 15-, and 22-month-old mice. Liver weight, iron deposition, structural changes, cell death, extracellular matrix deposition, and fenestration of sinusoidal vessels were analyzed and compared between the groups. Additionally, biochemical analyses (aspartate aminotransferase, alanine aminotransferase, and serum total iron levels) were performed. The iron overload group exhibited significant differences compared with the control group with age. In the elderly iron overload model, iron deposition, inflammatory cell infiltration, and cell death were significantly increased (p < 0.0001). Moreover, deposition of the extracellular matrix and defenestration of sinusoidal fenestrae were observed among 22-month-old mice in the iron overload group. These results suggest that aging is a risk factor for iron-induced liver injury. Therefore, caution should be exercised when performing iron-related treatments in the elderly.

Background and aim: A novel 11-Fr digital cholangioscope (eyeMAX) has recently become available. However, a prospective comparative study of the diagnostic yield of the eyeMAX and of a conventional cholangioscope (SpyGlass DS II) has not been reported. Therefore, the aim of this study was to prospectively compare the diagnostic yield of the eyeMAX and of the SpyGlass DS II for indeterminate biliary disease.

Patients and method: Forceps biopsy was repeated until visible core tissue was obtained. The primary outcome of this study was the diagnostic accuracy of the biopsy specimens obtained by the eyeMAX. The secondary outcomes were comparisons of the diagnostic yield of visual findings, tissue size, number of forceps biopsies until MOSE positivity, and adverse events.

Results: Fifty patients were prospectively enrolled in the eyeMAX group. And 47 patients in the SpyGlass DS II group were enrolled as a historical control. The number of biopsies was significantly fewer in the eyeMAX group than in the SpyGlass DS II group (p = 0.001). Tissue size was larger in the eyeMAX group (2.96 ± 0.69 mm²) than in the SpyGlass DS II group (1.80 ± 1.61 mm²). The diagnostic accuracy was also higher in the eyeMAX group (96.0%, 48/50) than in the SpyGlass DS II group (80.9%, 38/47). The diagnostic accuracy for the final diagnosis was slightly higher in the eyeMAX group (93.5%, 47/50) than in the SpyGlass DS II group (89.3%, 42/47).

Conclusions: The eyeMAX has a favorable diagnostic yield in terms of visual findings and the forceps biopsy specimen.

Trial registration: 000049465.

Background and aims: Brush cytology is a widely used diagnostic method in conjunction with intraductal biopsies during endoscopic retrograde cholangiopancreatography, but its diagnostic yield remains a limitation. This study evaluated the efficacy of biliary cytology using a newly developed brush device with rapid on-site cytological evaluation (ROSE) for detecting malignant biliary strictures (MBSs).

Methods: In total, 58 patients with suspected intrinsic MBS identified by intraductal ultrasound were enrolled. After achieving tissue sampling with ROSE through a maximum of two brushing passes, a transpapillary forceps biopsy (TPB) was performed. The primary outcome was diagnostic accuracy, and the secondary outcomes were technical success, sampling adequacy, and procedure-related adverse events.

Results: Biliary cytology with ROSE was technically successful in all patients (58/58), with a sampling adequacy of 96.6% (56/58). The technical success and sampling adequacy of TPB were 94.8% (55/58) and 91.4% (53/58), respectively. Brush cytology with ROSE and TPB yielded sensitivity rates of 91.8% and 85.7%, specificity rates of 88.9% for both, and accuracy rates of 88.9% for both. The receiver operating characteristic curve comparing the diagnostic accuracies of brush cytology with ROSE and TPB combined versus TPB alone showed a significantly higher value for the combined approach (0.93) than TPB alone (0.87) (p = 0.010).

Conclusion: Biliary brush cytology using a novel brush device with ROSE is effective and can be used complementarily to TPB in patients with suspected MBS.

Background and aim: Accurate endoscopic prediction of histology is key to recognition of early gastric neoplasia and selection of appropriate resection techniques. Narrow-band imaging with magnification (M-NBI) has proven to be highly accurate for gastric lesions in eastern countries; however, we sought to examine whether it can be effectively utilized in the west where evidence is scarce.

Methods: This is an analysis of a prospective database of gastric lesions at a single Australian center from 2009 to 2023. All lesions were assessed endoscopically using M-NBI and a determination made whether the lesion was neoplastic or non-neoplastic, as well as prediction of histological subtype. This was then correlated with final histology.

Results: A total of 232 lesions in 183 patients were included: 135 non-neoplastic and 97 neoplastic lesions. Thirty-five were adenomas, 29 early gastric cancers, and 6 advanced adenocarcinomas. For differentiating neoplastic versus non-neoplastic lesions, M-NBI had a sensitivity of 97.9% (CI 92.6%-99.7%) and specificity of 97.1% (CI 92.7%-99.2%). M-NBI was also highly accurate (97.0%, CI 93.9%-98.8%) for identifying lesions suitable for endoscopic resection. The observed agreement between the M-NBI predicted histology and the final pathology was 91.8% with a derived kappa statistic of 0.87, indicating excellent agreement. Comparatively, prior biopsies had an observed agreement of 40.4% with final histology, with a derived kappa statistic of 0.27.

Conclusions: M-NBI can be used with a high degree of accuracy in a western population. M-NBI can effectively differentiate neoplastic from non-neoplastic gastric lesions and delineate histological subtypes with superior accuracy to previous biopsies.