Journal of Gastroenterology and Hepatology最新文献

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.

Gastric cancer (GC) has become a serious threat to global health with escalating incidence and mortality. There is a lack of effective approach to evaluate prognostic survival and stratify high-risk patients due to the highly heterogeneous characteristics of GC. In this study, we integrated N6-methyladenosine (m⁶A) RNA modification, ferroptosis gene sets, and lncRNA transcriptomic data together, established and validated a novel six-lncRNA profile associating with the survival of GC. The m⁶A-ferroptosis lncRNA signature could identify high-risk GC patients and characterize the immunosuppressive tumor microenvironment (TME). In our GC cohort, the 3- and 5-year survival rates of the high-risk compared with low-risk subgroup were 27.8% versus 54.8% and 22.2% versus 50.0%, respectively. Multiplex immunofluorescence assays indicated that high-risk GC samples frequently had less infiltration of CD8⁺ T cells but exhibited abundant immunosuppressive M2-polarized macrophages and Tregs. The differentially expressed genes were primarily enriched in oxidative stress response, reactive oxygen species, RNA metabolic processes, the PI3K-Akt signaling axis, and leukocyte transendothelial migration pathways. Accordingly, high-risk patients might be sensitive to inhibitors targeted at PDK1, tyrosine kinase, PI3K, and HIF-proly1 hydroxylase, whereas the low-risk subgroup might benefit from blockade of ErbB, TrkA, PARP, and Ribosomal S6 kinase. Moreover, we demonstrated that the high-risk factor AC129507.1 in the lncRNA signature was a novel target of the m⁶A regulatory axis WTAP/YTHDF3/ALKBH5, and depletion of AC129507.1 could markedly induce ferroptosis in GC. Collectively, these findings provide a candidate strategy for risk classification and better clinical management of GC and shed new insight into the underlying mechanism of AC129507.1 in GC development.

Background and aim: The effectiveness of standard endoscopic treatment (SET) for non-variceal upper gastrointestinal bleeding (NVUGIB) may vary, particularly depending on the bleeding site, lesion size, and etiology. Recent studies suggest that hemostatic powder (HP) may effectively control bleeding secondary to malignant upper gastrointestinal lesions, but its efficacy in benign etiology for NVUGIB remains uncertain. This systematic review and meta-analysis aimed to compare the effectiveness of HP versus SET as first-line therapy for patients with non-malignant causes of NVUGIB.

Methods: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) from inception to January 2025. We used risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes with their corresponding 95% confidence intervals (CIs).

Results: We included 5 RCTs (708 patients). Compared to SET, HP was associated with marginally lower risk of further bleeding during esophagogastroduodenoscopy (EGD) (RR 1.04; 95% CI [1.001, 1.084]; p = 0.04) and similar rebleeding rate within 1, 3, 7, 15, and 30 days. The need for a second endoscopic treatment and the mean procedure time were similar between the groups. Subgroup analyses showed that HP has a lower risk of further bleeding during EGD only when analyzing Forrest IIa lesions, but not in active bleeding.

Conclusions: In patients with non-malignant NVUGIB, HP demonstrated lower risk of further bleeding during EGD in cases with non-bleeding visible vessels. There was no statistically significant difference in further bleeding during EGD for active bleeding, nor in rebleeding risk at 1, 3, 7, 15, or 30 days.

A 62-year-old man presented with neurological symptoms, and head computed tomography revealed multiple brain metastases. Subsequent evaluation identified a 30-mm Type 2 ulcerative lesion in the lower gastric body, diagnosed as moderately differentiated tubular adenocarcinoma. In addition, numerous small, patchy white lesions with a large “white globe appearance (WGA)–like” appearance were observed endoscopically throughout the stomach. Histological analysis confirmed lymphatic invasion of adenocarcinoma in these areas. These findings suggest that a large WGA-like appearance may reflect lymphatic dissemination and could serve as endoscopic markers for evaluating tumor invasion depth and metastatic potential in gastric cancer.