Journal of Gastroenterology and Hepatology最新文献

Hepatocellular carcinoma (HCC) remains one of the most prevalent and lethal malignancies worldwide, characterized by late diagnosis, limited therapeutic options, and poor prognosis. Conventional systemic therapies such as sorafenib and its successors provide only modest survival benefits and are frequently complicated by toxicity and drug resistance. In recent years, immunotherapy has emerged as a promising avenue, yet its efficacy is often restricted by the profoundly immunosuppressive tumor microenvironment (TME). Within this landscape, exosomes-nanoscale extracellular vesicles secreted by tumor, stromal, and immune cells-have gained increasing attention for their central role in intercellular communication. They influence immune modulation, metabolic reprogramming, and therapeutic resistance, while also serving as potential biomarkers, nanocarriers, and vaccine platforms. Tumor-derived exosomes (TEXs) contribute to immune evasion by suppressing CD8⁺ T cells, polarizing macrophages toward protumoral phenotypes, and enhancing immune checkpoint resistance. Conversely, engineered exosomes demonstrate significant therapeutic potential by reprogramming TAMs, improving drug delivery, and acting as cancer vaccines. Despite these advances, challenges remain in exosome biogenesis, heterogeneity, large-scale production, and off-target effects, which hinder clinical translation. Furthermore, interactions between exosomes and gut microbiota in modulating hepatic immunity represent an emerging frontier with unexplored therapeutic implications. Continued advances in bioengineering, nanotechnology, and systems biology are expected to refine exosome-based therapies, offering novel, personalized strategies to improve outcomes for HCC patients.

Background and aim: Endoscopic ultrasound (EUS)-guided drainage is widely used for postoperative pancreatic fluid collections (PO-PFCs). However, concerns regarding adverse events persist. We aimed to assess clinical outcomes and identify risk factors for adverse events following endoscopic ultrasound-guided drainage of postoperative pancreatic fluid collections after distal pancreatectomy.

Methods: We retrospectively analyzed 124 patients who underwent EUS-guided drainage for PO-PFCs following distal pancreatectomy. The clinical and procedural data were also evaluated. Risk factors for adverse events and post-procedural bleeding were identified using univariate and multivariate logistic regression analyses. Subgroup analyses were performed before and after the introduction of the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS).

Results: Technical and clinical success rates were 100% and 92.7%, respectively. Adverse events occurred in 25.8% (32/124) of patients. Moderate-to-severe bleeding occurred in 11 patients, of whom 10 required embolization or emergency surgery. Paracolic gutter extension was an independent risk factor for adverse events. Factors associated with post-procedural bleeding included paracolic extension, longer procedure time, antiplatelet or anticoagulant use, and the combined use of electrocautery and mechanical dilators. In the subgroup analysis before and after EC-LAMS introduction, adverse events were less frequent (31.9% vs. 18.2%), but the difference was not statistically significant (p = 0.10).

Conclusions: EUS-guided drainage of PO-PFCs is effective but carries the risk of adverse events. Ongoing refinements in the technique and device design appear to have improved safety over time. Careful case selection and early recognition of adverse events are essential for optimizing patient outcomes.

Background and aim: Endoscopic submucosal dissection (ESD) is widely used to treat superficial Barrett's esophageal adenocarcinoma (sBEA) in Japan. However, ESD for sBEA remains technically challenging because of respiratory motion and esophageal peristalsis. No studies have reported predictive factors for technical difficulty during ESDs for sBEA. This study aimed to identify predictive factors for technical difficulty during ESDs for sBEA.

Methods: This retrospective single-center cohort study included patients who were diagnosed with sBEA and subsequently underwent ESDs between April 2006 and January 2025. Patients with previous esophagectomies, chemoradiotherapy, and who underwent staged circumferential ESDs or simultaneous resections of multiple lesions were excluded. Technical difficulty was defined as resection times ≥ 120 min, perforations, incomplete treatment, or piecemeal resections. Univariate and multivariate logistic regression analyses were performed to identify the predictive factors for technical difficulty.

Results: In total, 188 patients with 199 lesions were analyzed, and 33 (16.6%) lesions met the criteria for technical difficulty. Multivariate analysis identified long-segment Barrett's esophagus (LSBE) (adjusted odds ratio [OR]: 2.380; 95% confidence interval [CI]: 1.010-5.620; p = 0.048) and circumferential involvement of ≥ 1/2 of the esophagus (adjusted OR: 4.460; 95% CI: 1.290-15.400; p = 0.018) as independent predictive factors. These were also associated with lower R0 resection and negative horizontal margin rates and a higher incidence of post-ESD strictures.

Conclusions: LSBE and circumferential involvement of ≥ 1/2 of the esophagus were identified as significant predictors of technical difficulty in ESDs for sBEA. Preoperative recognition of these factors may facilitate appropriate operator assignment and procedural strategies.

Liver diseases represent a major global health challenge, yet current treatment options remain insufficient, highlighting the need for new therapeutic strategies. Recent research underscores the crucial role of the gut microbiota and their metabolites in liver disease progression. Emerging evidence suggests that bacterial extracellular vesicles (BEVs), membrane-bound vesicles secreted by bacteria, play a critical role in hepatic inflammation, fibrosis, metabolic dysregulation, and tumor development, while commensal and probiotic-derived BEVs exhibit protective effects against these pathologies. This review provides a comprehensive overview of BEVs and their diverse roles in liver disease progression and treatment. Additionally, we discuss the current challenges in BEV research and propose future directions to improve our understanding of their effects on liver health and their potential therapeutic applications.

Background and aim: The triglyceride-glucose (TyG) index and alanine aminotransferase (ALT) are emerging biomarkers linked to metabolic disturbances and liver health. Nonetheless, the combined impact of these markers on predicting new-onset steatotic liver disease (SLD) and its metabolic and alcohol-associated subtypes remains unclear. This study aimed to investigate the association of TyG and ALT, individually and combined, in incident SLD in the Korean Genome and Epidemiology Study (KoGES) and UK Biobank cohorts.

Methods: This study utilized data from two large population-based cohorts: KoGES (adults aged 40-69 years from South Korea [2001-2002]) and UK Biobank (participants aged 37-73 years from the United Kingdom [2006-2010]). Participants without baseline SLD were classified into four groups based on TyG index and ALT levels, and the incidence of SLD was compared among these groups to assess risk.

Results: Elevated baseline TyG index and ALT levels were significantly associated with a higher risk of new-onset SLD and its subtypes in both cohorts. The highest HRs and ORs were observed in individuals with both markers elevated (2.39 in KoGES; 3.89 in UK Biobank). Survival analyses confirmed significantly lower survival probabilities in high-risk groups (p < 0.001). Predictive accuracy was highest with the combined TyG index + ALT model, outperforming either marker alone (p < 0.001).

Conclusions: Elevated combined baseline TyG index and ALT levels were significantly associated with increased risk of SLD and its subtypes. Combined use of these markers may be valuable for early identification and risk stratification of individuals at risk for SLD.