Scandinavian Journal of Gastroenterology最新文献

Objective: Current guidelines recommend using the presence of alarm features to help determine if an upper endoscopy is appropriate as an initial diagnostic tool in young adults with dyspepsia. The study aimed to assess whether young adults without alarm features had clinically significant findings on gastroscopy.

Methods: This was a retrospective study on patients 18-50 years who underwent their first gastroscopy at Landspitali University Hospital 2018-2022. Data was collected on symptoms and endoscopic findings. American Society for Gastrointestinal Endocopy (ASGE) from 2015 were used to determine adequate indication for gastroscopy. The following were considered adequate indications: suspected gastrointestinal bleeding and/or iron deficiency anemia, dysphagia, persistent vomiting, unintentional weight loss, a family history of upper gastrointestinal cancer, or suspicious findings on imaging.

Results: Among 748 patients, 515/748 (69%) had an adequate indication, 52% males and 233/748 (31%) without. Endoscopic findings in the group with adequate indications were: esophagitis (20%), gastric ulcers (4.1%), duodenal ulcers (4.1%), esophageal ulcers (2.1%), gastric cancer (1.0%) and esophageal cancer (0.2%). Clinically relevant findings were rare in the group without an adequate indication and only 4/233 (1.7%) had a duodenal ulcer, all due to an H.pylori infection and only 1 gastric ulcer (0.4%). No cancers were diagnosed among those without an adequate indication.

Conclusions: Patients without alarm features were less frequently diagnosed with clinically significant diseases on gastroscopy compared to patients presenting with alarm features. No cancers were diagnosed in those without an adequate indication and clinically significant findings were rare in that group.

Objectives: The number of advanced therapies for inflammatory bowel disease (IBD) has increased in recent years. Ustekinumab, an inhibitor of interleukin -12 and -23, was mostly used for later-line treatment, where its efficacy may be reduced. Recent expiration of its patent and the introduction of affordable biosimilars introduced interest of using ustekinumab earlier as a first-line option. However, data on the effectiveness in the first-line setting remain limited. The aim was to evaluate the efficacy and treatment persistence of ustekinumab when used as a first-line treatment in IBD.

Materials and methods: This retrospective longitudinal cohortstudy included 71 naïve patients to advanced therapy who initiated first-line treatment with ustekinumab. Data on demographics, patient clinical characteristics, treatment persistence, serum concentrations of ustekinumab, and clinical, biochemical, and endoscopic outcomes, were collected. A Kaplan-Meier curve was performed to assess treatment persistence.

Results: Median follow-up was 20.8 months (interquartile range 11.3-48.5). One-year treatment persistence with ustekinumab was 88%, with a rate of 92% in Crohn's disease (CD), and 82% in ulcerative colitis (UC). Biochemical remission was achieved in 77.6% of patients based on C-reactive protein (≤5 mg/ml) and in 71.1% based on fecal calprotectin (<100 mg/kg). Endoscopic remission (absence of ulcers in CD and endoscopic Mayo ≤1 in UC) was observed in 58.3% of patients.

Conclusions: First-line treatment with ustekinumab demonstrates high treatment-persistence and is associated with substantial rates of clinical, biochemical, and endoscopic remission in patients with IBD.

Background and aims: Data are limited on how histology and noninvasive tests (NITs) for fibrosis severity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) can predict future events. We aimed to confirm the prognostic capacity of liver fibrosis to predict major adverse liver outcomes (MALO), and to confirm previous findings of similar prognostic capacity between invasive and noninvasive fibrosis tests on long-term outcomes.

Methods: This longitudinal observational cohort study (1974-2020) used data from adults with biopsy-defined MASLD from three Swedish university hospitals linked to national registers. Risks for MALO and major adverse cardiovascular events (MACE) were estimated using multivariable adjusted Cox regression models.

Results: Median (mean) follow-up for the overall population (N = 959) was 11 (15) years; 103 (10.7%) developed MALO and 245/867 patients without baseline cardiovascular disease (28.3%) developed MACE. The risk of long-term MALO was significantly lower in patients at fibrosis stage F0, F1 and F2, compared with F4, but not between stages F3 and F4. No significant associations were observed between other histological features and incident MALO. Neither fibrosis stage nor histological features were significantly associated with incident MACE. Biopsy-defined fibrosis staging and Fibrosis-4 Index (FIB-4) scoring had similar predictive performance with unadjusted C-index (95% confidence interval) values for MALO of 0.77 (0.71-0.82) and 0.75 (0.69-0.80) and for cardiovascular-related outcomes 0.58 (0.53-0.60) and 0.65 (0.61-0.68), respectively.

Conclusions: These data confirm the importance of liver fibrosis as the main predictor of long-term MALO. FIB-4 may aid in risk assessment and in predicting outcomes in MASLD.

Background: Endoscopic biopsies are insufficient for the correct diagnosis of gastric lesions since there has been described a discrepancy rate between endoscopy biopsies and endoscopic resection specimens of 25-32%. The aim of this study was to evaluate factors associated with upstaging and downstaging of biopsy results following gastric endoscopic submucosal dissection (ESD).

Methods: Retrospective, cohort study including consecutive patients who underwent gastric ESD after an initial upper endoscopy with the diagnosis of a gastric lesion harboring dysplasia or adenocarcinoma, confirmed by forceps biopsy.

Results: A total of 215 patients were included, most patients were male (66.0%), with a mean age of 68 ± 8 years. Most lesions were located in the antrum (62.3%). Upstaging was observed in 70 patients (32.6%): 43 patients from low-grade dysplasia (LGD) to high-grade dysplasia (HGD); 9 from LGD to adenocarcinoma; and 18 patients from HGD to adenocarcinoma. Patients with upstaging had significantly larger lesions (18 vs 15 mm, p < 0.001) and had more frequently ulcerated lesions (10.0% vs 2.9%, OR 3.778, p = 0.045). Five patients (2.3%) had downstaging, from HGD to LGD. Patients with downstaging were significantly younger (61 ± 8 vs 68 ± 8 years, p = 0.035) and were more frequently active smokers (60.0% vs 14.3%, OR 9.000, p = 0.028).

Conclusion: The diagnostic discrepancy rate between the initial forceps biopsy and the ESD specimen was 34.9%. Patients with larger or ulcerated lesions were more likely to have an upstaging pathological result. Therefore, it is essential to perform a thorough evaluation of the lesions, including chromoendoscopy and magnification.

Background: This study aimed to identify tumor lesion-related factors associated with possible missed gastric cancer (PMGC) during screening endoscopy, with particular focus on cases following Helicobacter pylori (HP) eradication.

Methods: We analyzed consecutive gastric cancer (GC) cases detected at 11 health check-up institutions in Akita prefecture, Japan. The study focused on 171 GC cases with at least one negative endoscopy within the preceding 2 years. Based on histological assessment, GCs with pT1b or deeper invasion were classified as PMGCs. Their clinical characteristics were compared with those of the remaining pT1a GCs. A backward stepwise logistic regression analysis was performed to identify tumor lesion-related factors associated with PMGC.

Results: Among 171 GC cases, 39 (22.8%) were classified as PMGC, while the remaining 132 served as controls. Overall, 108 cases (63.2%) occurred in individuals with prior HP eradication, and eradication status was not statistically associated with PMGC. Multivariable regression analysis limited to post-eradication cases revealed that upper third location and undifferentiated histology were significantly associated with PMGC, with odds ratios (95% confidence intervals) of 5.65 (1.88-16.90) and 8.35 (2.22-31.40), respectively.

Conclusions: Undifferentiated histology and upper third location were associated with missed diagnoses of GC during screening endoscopy in individuals with prior HP eradication. These findings are clinically relevant for improving the quality of endoscopic examinations in health check-up settings, especially given the increasing prevalence of post-eradication GC.

Background: Endoscopic papillectomy (EP) is a minimally invasive alternative to surgical resection for early ampullary neoplasia. While its use is increasing, outcomes and complication rates vary, and reliable data on hospital mortality in Germany remain scarce.

Methods: We analyzed clinical trends and hospital mortality of EP in Germany from 2018 to 2022 using standardized hospital discharge data from the Federal Statistical Office.

Results: Between 2018 and 2022, 3366 EPs were performed in Germany. Annual procedures rose from 557 in 2018 to 750 in 2022. Median hospital stay was 8.71 days. Overall hospital mortality was 1.75%, higher among women (2.0%) and patients >70 years (2.2%). Bleeding (16.8%) and post-EP pancreatitis (PEPP, 13.2%) were the most common complications. Key factors associated with increased mortality included mechanical ventilation (42.5%), acute renal failure (21.5%), and biliary or duodenal perforations (17.6%/13.5%). Stenting of the main pancreatic duct (MPD) did not affect PEPP rates (13.31% vs. 13.12%) but showed a non-significant trend toward lower mortality (1.40% vs. 1.95%, p = 0.236).

Conclusion: EP is increasingly used in Germany and remains a minimally invasive, organ-preserving procedure with a low hospital mortality of 1.75%, slightly higher than previously reported but still favorable compared to surgery. Identified complications may support better patient selection and improve peri- and post-interventional management to reduce risks and enhance outcomes.

Background: Colorectal cancer (CRC) poses a significant health challenge, being a leading cause of cancer-related mortality in the United States. Despite the effectiveness of colonoscopy in early detection and prevention, a substantial number of adenomas remain undetected, contributing to interval CRC cases. This systematic review and meta-analysis evaluate the efficacy of Endocuff Vision (ECV), an advanced colonoscopy attachment, compared to standard colonoscopy (SC) in enhancing adenoma detection rates (ADR) and other relevant outcomes.

Methodology: Systematic search was performed in PubMed, Web of Science, Scopus, and Embase from inception to June 2025. Risk of bias assesment was performed by using ROB2. Data-analysis was conducted using R version 4.2.2 (2022-10-31) and RStudio version 2022.07.2 (2009-2022, RStudio, Inc.).

Results: We included 18 randomized controlled trials involving 17,734 patients. ECV significantly improves ADR (RR: 1.13, 95% CI: 1.07-1.20; p < 0.0001), advanced adenoma detection rate (AADR) (RR: 1.11, 95% CI: 1.01-1.21; p = 0.0282), polyp detection rate (PDR), sessile serrated lesion detection rate (SLDR), and left side lesion detection rate (LSLDR), while also reducing withdrawal and cecal intubation times. Subgroup analyses suggest that ECV is particularly beneficial in screening and surveillance populations. However, evidence quality varied, with some outcomes exhibiting moderate certainty.

Conclusion: Our results underscore ECV's potential as a valuable tool in CRC screening, aiming to enhance detection rates and ultimately reduce interval cancer risks. Future research should focus on long-term clinical implications, cost-effectiveness, and comparative studies with other detection-enhancing technologies to further substantiate ECV's role in clinical practice.

Background: The role of cytomegalovirus (CMV) in ulcerative colitis (UC) remains controversial. This study aimed to evaluate the association between mucosal CMV load and disease severity and to identify predictive risk factors for CMV infection in active UC.

Methods: Mucosal CMV DNA load was quantified by real-time PCR in 231 patients with active UC. Disease activity was assessed using the Truelove & Witts clinical score, Mayo endoscopic subscore, and a modified Geboes score for histologic evaluation. Multivariate logistic regression was used to identify independent risk factors.

Results: CMV was detected in the colonic mucosa of 91 patients (39.4%). Patients with CMV infection showed significantly higher clinical (p < 0.001) and endoscopic severity (p = 0.002). The prevalence of CMV infection showed a positive trend with higher clinical disease activity (p < 0.001) and was also associated with more severe endoscopic (p = 0.002) and histologic inflammation (p = 0.004). Mucosal CMV load strongly correlated with clinical severity (ρ = 0.498, p < 0.001) and histologic grade (ρ = 0.735, p < 0.001). ROC analysis indicated that CMV load effectively predicted severe clinical (AUC = 0.796), endoscopic (AUC = 0.697), and histologic disease (AUC = 0.905; all p < 0.01). Multivariate analysis identified cobblestone-like appearance, punched-out ulcers, spontaneous bleeding, and decreased absolute lymphocyte count as independent predictors of CMV infection.

Conclusion: Mucosal CMV load is closely associated with inflammatory severity in UC. Characteristic endoscopic features and lymphopenia may serve as valuable predictors for CMV infection.

Aim: The purpose of this study was to assess the long-term risk of biliary cancer in patients diagnosed with choledochal malformations (CMs).

Methods: The patient population was collected from the Helsinki University Hospital registers including all consecutive patients from 1987 to 2020. This data were complemented with the population-based register data from the Finnish Register of Congenital Malformations (FRM) and the Finnish Care Register for Health Care (1987-2020). Patient population was cross-linked with data from the Finnish Cancer Register data and the Cause-of-Death Register.

Results: There were 209 patients with CM (142 females and 67 males). Most patients (n = 110, 53%) underwent biliary diversion surgery, 18 patients (8.6%) were treated endoscopically, and 57 patients (27%) were managed with observation only. Three patients (1.4%) were diagnosed with biliary cancer at a mean age of 60.3 years, and all of them died of their disease at a mean age of 65.4 years. Cholangitis was diagnosed in 33 patients (16%). Risk of inflammatory bowel diseases (IBDs) appeared higher in CM patients than in general Finnish population as IBD was diagnosed in 10 patients (4.8%) with relative risk (RR) of 4.9 (95% confidence interval [CI] 2.7-9.0).

Conclusions: CM seemed to be associated with an increased risk of biliary cancer although the prevalence was lower than in previous reports.