Scandinavian Journal of Gastroenterology最新文献

Background/objectives: Robust evidence regarding the management after endoscopic resection of malignant colorectal polyps (MCP) is lacking. Inconsistencies in reporting on potential prognostic factors hinder the decision process. To address these issues, the Scottish Screen-detected Polyp Cancer Study (SSPoCS) introduced an algorithm based in two easily obtainable variables: resection margin and lymphovascular invasion. This study aims to assess the applicability of the SSPoCS algorithm in a Portuguese multicentric cohort.

Methods: Endoscopically resected MCP in five centers were included. The main outcome was residual/recurrent malignancy (RRM), defined as any of the following: (1) residual intramural or lymph node malignancy in the surgical specimen after completion surgery; (2) local or systemic recurrent disease in conservatively managed patients.

Results: Two-hundred and eleven patients were included (mean age: 68.6 ± 10.4 years; male participants: 65.4%); 121 underwent completion surgery while 90 remained in surveillance. Thirty-two patients (15.2%) experienced RRM: 27 displayed residual malignancy in the surgical specimen and five developed recurrent disease. According to the SSPoCS algorithm: 120 patients were classified as having low-risk of residual disease, six of whom displayed RRM (5.0%); 10 as medium-risk, with one having RRM (10.0%); and 81 as high-risk, 25 of whom experienced RRM (30.9%). Lesions classified as low risk showed a negative predictive value (NPV) of 95.0% to exclude RRM. The algorithm demonstrated good accuracy in predicting RRM in a Receiver Operating Characteristic curve analysis (AUC: 0.74; 95% CI: 0.65-0.83; p < 0.001).

Conclusions: The SSPoCS algorithm revealed good accuracy in predicting residual/recurrent malignancy with a NPV of 95.0% to exclude RRM in low-risk lesions.

Background: High-quality bowel preparation is paramount for a successful colonoscopy. This study aimed to explore the effect of artificial intelligence-driven smartphone software on the quality of bowel preparation.

Methods: Firstly, we utilized 3305 valid liquid dung images collected via mobile phones as training data. the most effective model was employed on mobile phones to evaluate the quality of bowel preparation. Secondly, From May 2023 to September 2023, colonoscopy patients were randomly assigned to two groups - the AI group (n = 116) and the control group (n = 116) - using a randomized, controlled, endoscopist-blinded method. We compared the two groups in terms of Boston Bowel Preparation Scale (BBPS) scores, polyp detection rate, adverse reaction rate, and factors related to bowel preparation quality. The primary endpoint was the percentage of patients who achieved a BBPS ≥6 among those who effectively utilized the smartphone software.

Results: EfficientNetV2 exhibited the highest performance, with an accuracy of 87%, a sensitivity of 83%, and an AUC of 0.86. In the patient validation experiment, the AI group had higher BBPS scores than the control group (6.78 ± 1.41 vs. 5.35 ± 2.01, p = 0.001) and showed an improvement in the detection rate (71.55% vs. 56.90%, p = 0.020) for polyps. Multifactor logistic analysis indicated that compliance with enema solution usage rules (OR: 5.850, 95% confidence interval: 2.022-16.923), total water intake (OR: 1.001, 95% confidence interval: 1.001-1.002), and AI software reminders (OR: 2.316, 95% confidence interval: 1.096-4.893) were independently associated with BBPS scores ≥6.

Conclusion: Compared with traditional methods, the use of artificial intelligence combined with software to send reminders can lead to more accurate assessments of bowel preparation quality and an improved detection rate for polyps, thus demonstrating promising clinical value.

Objectives: Concurrent type 1 diabetes (T1D) and celiac disease (CeD) pose challenges in insulin dosage adjustments and gluten-free dietary adherence. Urine testing for gluten immunogenic peptides (GIP) is a new method to detect gluten exposure within the last 3-12 h. Our aims were to compare gluten-free dietary adherence between T1D + CeD and CeD individuals and evaluate urinary GIP testing in an outpatient setting.

Materials and methods: This observational cross-sectional study included three adult groups: (1) T1D and CeD, (2) CeD only, and (3) T1D only. T1D participants were recruited from outpatient clinics, the CeD group via social media. One urine sample (12 pm-7 pm) was analyzed using a qualitative immunographic GIP test. CeD participants completed 'Celiac Dietary Adherence Test' (CDAT) and 'Celiac Symptom Index' (CSI) questionnaires. IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin (IgG-DGP) serology were also analyzed.

Results: 197 participants, mean (SD) age 43 (15) years, were included. Female percentages were: CeD: 90%, T1D + CeD: 64%, and T1D: 47%. Positive urinary GIP was found in 15% (14/96) of T1D + CeD and 0% (0/50) of CeD (p = 0.002). As expected, most T1D only participants had positive urinary GIP (86%, 44/51). CDAT and CSI scores did not differ between T1D + CeD and CeD groups. Positive IgA-TG2 and/or IgG-DGP levels were found in 12% of T1D + CeD and 6% of CeD participants (p = 0.38).

Conclusions: A single GIP urine test revealed higher gluten exposure in T1D + CeD versus CeD only, questioning dietary adherence in this population. Urinary GIP tests can be useful for clinical follow-up.

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that affects the esophagus. Previous studies have indicated a substantial increase of EoE over the last decades. The aim of the current study was to describe the incidence and prevalence of EoE over time and by geographical regions in Sweden, utilizing nationwide population-based registries.

Material and methods: The number of hospital admissions (in-patient and out-patient) for patients were identified using ICD-10-SE code K20.9A from the National Patient Registry between 1st January 2011 and 31st December 2021. Crude incidence and prevalence numbers were presented per 100,000 person years and persons, respectively.

Results: In 2011, no hospital visits of EoE were recorded. A total of 3,243 incident patients (2,379 (73.4%) men and 864 (26.6%) women) had a record of EoE between 2012 and 2021. The incidence increased over calendar year in where the incidence was from 1.59 per 100,000 person years in 2012 to 5.34 per 100,000 person years in 2021. The prevalence was 1.29 per 100,000 person years and 31.02 per 100,000 person years in 2012 and 2021, respectively. Major differences in the prevalence between geographical regions in Sweden were observed, e.g. in 2021, the prevalence was 12.24 in Västernorrland compared to 43.26 in Västra Götaland per 100,000 person years, which is similar to the prevalence in the Stockholm region.

Conclusion: The incidence and prevalence of eosinophilic esophagitis has significantly increased over calendar year but differs between geographical regions in Sweden. These differences should be further investigated.

Background: Perihilar cholangiocarcinoma (pCCA) has a 5-year overall survival (OS) ranging from 10-40%, following resection. However, prognostic models for postoperative outcomes are limited by long study timespan and variations in work-up. We investigated postoperative outcomes in patients resected for pCCA in a high-volume center with standardized work-up.

Method: Patients resected with confirmed pCCA, between 2013 and 2023, were included. Cox-regression investigated association between postoperative factors and OS as well as disease-free survival (DFS).

Results: Totally, 65 patients were resected for pCCA. The 1-, 3- and 5-year OS rates were 86.1%, 56.5% and 32.6% respectively. The 1-, 3- and 5-year DFS rates were 67.7%, 40.0% and 26.8%, respectively. Portal vein embolization (PVE) (HR 4.52 [CI 1.66-12.27], p = 0.003), lymph node metastasis (LNM) (HR 6.37 [CI 2.06-19.67], p = 0.001) and Clavien-Dindo (CD) ≥3a (HR 2.83 [CI 1.43-5.56], p = 0.002) were associated with inferior OS. Clavien-Dindo (CD) ≥3a (HR 2.10 [CI 1.05-4.22], p = 0.03) and T-stage >2 (HR 2.36 [CI 1.01, 5.05], p = 0.04) were associated with inferior and superior DFS, respectively.

Conclusion: PVE, T-stage >2, LNM and CD ≥ III were associated with worse prognosis in resected pCCA. Research is needed to improve pre-operative detection of oncological features and patients with risk of major surgical complications.

Objective: To compare the pocket-creation method (PCM) with the conventional method of endoscopic submucosal dissection (ESD) for cecal and ascending colon lesion resection.

Methods: The data of patients who underwent ESD for cecal or ascending colon lesions were retrospectively analyzed. The patients were divided into the PCM group and the conventional group according to the method of ESD. Baseline data, endoscopic characteristics, dissection speed, pathological results and adverse events were compared between the two groups. Dissection speed was also analyzed.

Results: Overall, 122 patients were included. The dissection speed in the PCM group was higher than in the conventional group (0.20 [0.11, 0.32] cm²/min vs. 0.12 [0.08, 0.20] cm²/min, Z = -2.813, p = 0.005). The proportion of patients with injury to the muscularis propria layer in the PCM group was lower than in the conventional group, though the difference was not significant (19.4% vs. 29.1%, χ² = 1.215, p = 0.270). The univariate analysis showed that low body mass index (BMI), use of the PCM, long lesion diameter, large lesion area, and minimal fibrosis were independent risk factors for fast dissection (all p < 0.05). The logistic regression analysis showed that high dissection speed was associated with the choice to use the PCM, longer lesion diameter, and no fibrosis.

Conclusion: For cecal and ascending colon lesions, the PCM is a better choice than the conventional method, especially in patients with fibrosis, and large lesion area.

Purpose: The aim of this study was to explore the multifaceted ways in which inflammatory bowel disease (IBD) negatively affects working life and studies.

Material and methods: IBD patients were identified by diagnosis codes from the hospital records of a Finnish University Hospital. Patients were sent questionnaires via mail and text messages. Respondents, being 561 patients, formed the sample. Hospital records and data of medications were combined to questionnaire data.

Results: Over a fifth of the patients reported having to change their job due to IBD, whereas a third of the sample had to modify their work due to IBD. On average, they had changed jobs once. Most common modifications were to do fewer hours or work during different hours, decreasing the physical burden of their work and moving their workplace closer to a toilet. Around a fifth of the sample' studies were negatively influenced by IBD. Interestingly, clinical parameters or sex did not affect the probability of job modifications, changes or negative effects on studies.

Conclusions: IBD has a considerable negative impact on many patients' studies and working life that extends beyond commonly studied absenteeism and presenteeism.

Objectives: EUS-guided biliary drainage (EUS-BD) is performed after endoscopic transpapillary biliary drainage fails. Although fistula dilation is one of the most difficult steps of EUS-BD, whether an ultratapered ERCP catheter or a dilator is the best choice for fistula dilation is unclear. In this study, we aimed to identify the optimal device for fistula dilation after guidewire placement.

Materials and methods: Patients who underwent EUS-guided transhepatic biliary drainage between March 2019 and July 2024 were enrolled in this study. The successful fistula dilation rates, patient characteristics, and EUS-BD procedures were compared between patients who underwent fistula dilation with an ultratapered ERCP catheter (Catheter group) and patients who underwent fistula dilation with new dilators (ES dilator or Tornus ES) (Dilator group).

Results: A total of 38 fistula dilation sessions were performed. Among these 38 sessions, 12 involved a catheter, and 26 involved a dilator. The ERCP catheter was specifically intended for use with 0.025 guidewires, and the dilators were specifically intended for use with 0.018 or 0.025 guidewires. Successful fistula dilation was more frequently achieved in the dilator group than in the catheter group (100% (26/26) vs. 50% (6/12), p < 0.01). When the cases were limited to those involving devices specifically intended for use with 0.025 guidewires, the results were similar (dilator group 100% (22/22) vs. catheter group 50% (6/12), p < 0.01). The other outcomes were not significantly different between the two groups.

Conclusions: A dilator is more promising than a tapered ERCP catheter for fistula dilation in EUS-BD.

Background: Alpha-1,3-glucosyltransferase (ALG8), a key enzyme in protein glycosylation, is implicated in the oncogenesis and progression of several human malignancies. This study aimed to define the role of ALG8 in hepatocellular carcinoma (HCC) and uncover its mechanisms of action.

Methods: ALG8 expression in HCC and normal tissues was analyzed using the TCGA and GEO databases, validated by RT-qPCR and western blot. Survival outcomes were evaluated via Cox analyses, and ALG8's impact on HCC behavior was examined through functional assays. GO, KEGG, and GSEA identified ALG8-related pathways, validated by biochemical assays.

Results: In bioinformatics analyses, ALG8 was overexpressed in HCC tissues (p < 0.05 for all comparisons) and correlated with poorer survival (p = 0.006 and p = 0.025, respectively), establishing its role as an independent prognostic factor. In vitro experiments showed that knockdown of ALG8 reduced HCC cell proliferation, migration, and invasion. Using the STRING platform and TCGA-LIHC dataset, we identified ALG8-interacting genes and their associated differentially expressed genes (DEGs). GO and KEGG analyses further linked ALG8 to genes involved in glycosylation, signal release, and other processes, as well as pathways including neuroactive ligand-receptor interaction and N-Glycan biosynthesis. GSEA, corroborated by western blot and immunofluorescence, points to the Wnt/β-catenin signaling cascade as a probable mechanistic pathway through which ALG8 may modulate HCC progression.

Conclusion: Elevated ALG8 expression in HCC is linked to worse outcomes and increased tumor aggressiveness, with silencing ALG8 reducing Wnt/β-catenin signaling, highlighting ALG8 as a potential therapeutic target.

Objective: Colorectal cancer (CRC) is a type of digestive system cancer. At the molecular level, some factors, including genetic and epigenetic factors, as well as various signaling pathways such as oxidative stress and inflammation, play an active role in the onset of CRC. Genetic and epigenetic mutations, particularly in oncogenes and tumor suppressor genes, occur during colorectal adenocarcinoma development as a result of a change in gastrointestinal epithelial cell proliferation and self-renewal rates. This study aimed to determine the genes and molecular mechanisms that play a role in the emergence of this disease by analyzing the CRC data.

Material and methods: Microarray data selected for bioinformatics analysis is Gene Expression data stored with the code GSE110224 in the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database. Gene expression analysis, functional clustering analysis, enrichment analysis, and pathway analysis were performed using this data set.

Results: Analysis of raw transcriptomic data revealed 1770 common DEGs in CRC. While the expression level of 769 of these genes increased, the expression level of 1001 genes decreased. A Protein-protein interaction (PPI) network was created from the first 25 genes with increased expression levels and 11 signature genes were identified. Increased expression of REG1A, MMP3, FOXQ1 and CEMIP genes and decreased expression of AQP8, CA1, CLDN8, PYY, CA4, CEACAM7 and SLC30A10 genes were observed.

Conclusions: This approach revealed a CRC-specific molecular profile and may provide some guidance for further investigation of potential biomarkers for diagnosis and prognosis prediction of CRC patients.