Journal of Gastroenterology and Hepatology最新文献

Background/aims: Benefits of the Mediterranean diet (MD) in reducing hepatic steatosis among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) have been well established. This study aims to evaluate the relationship between MD adherence and liver fibrosis among the MASLD population.

Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey 2017 to March 2020. Individuals with MASLD were identified based on the vibration-controlled transient elastography-defined steatosis. Participants' MD adherence was evaluated using the alternate Mediterranean diet (aMED) score, with higher scores indicating greater adherence. Risk of significant liver fibrosis was compared between low, moderate, and high aMED groups.

Results: Of 2672 MASLD participants, 27.2%, 42.3%, and 30.6% were categorized into low, moderate, and high aMED groups, respectively. After adjusting for the number of cardiometabolic risk factors (CMRFs), physical activity, and other covariates, participants in the high aMED group were associated with a lower risk of significant liver fibrosis compared with those in the low aMED group (aMED 5-9 vs. aMED 0-2: OR = 0.662, 95% confidence interval [CI]: 0.660-0.663; p for trend < 0.0001). In the sensitivity analyses, the protective association of higher MD adherence against the risk of significant liver fibrosis weakened with higher cardiometabolic burden (aMED 5-9: aOR 0.582, 95% CI: 0.580-0.584 [4-5 CMRFs] vs. aOR 0.383, 95% CI: 0.380-0.386 [1 CMRF]).

Conclusions: In MASLD patients, higher MD adherence was associated with lower risk of significant liver fibrosis. Our findings support the recommendation of the MD as a crucial lifestyle intervention to lower the risk of liver fibrosis in this population.

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.