JGH Open最新文献

Background: Hybrid endoscopic submucosal dissection (h-ESD) has emerged as a modified approach to overcome the technical challenges associated with conventional ESD (c-ESD). However, evidence comparing their safety and efficacy in colorectal neoplasia remains limited.

Methods: A comprehensive search was conducted in PubMed, Cochrane Library, and Embase up to April 2025 for randomized and propensity-matched studies comparing h-ESD with c-ESD for colorectal neoplasia. The primary outcome was en bloc resection, with secondary outcomes including procedure time, adverse events, bleeding, and perforation. Data synthesis was performed using a random-effects model in RevMan.

Results: Five studies (three RCTs and two propensity-matched cohorts) involving 1047 participants were included. The pooled analysis demonstrated no significant differences in en bloc resection rates (OR = 0.64, 95% CI = 0.26-1.56; p = 0.33; I ² = 69%) or R0 resection rates (OR = 0.70, 95% CI = 0.44-1.11; p = 0.13; I ² = 24%). h-ESD was associated with significantly shorter procedure duration (WMD = -10.65 min, 95% CI: -14.90 to -6.39; p < 0.01; I ² = 5%). No significant differences were observed for overall adverse events (OR = 1.14, 95% CI: 0.70-1.84), bleeding episodes (OR = 1.28, 95% CI: 0.45-3.65), or bowel perforation (OR = 0.97, 95% CI: 0.54-1.73).

Conclusion: Hybrid ESD demonstrated equivalent safety and efficacy to c-ESD for colorectal neoplasia, with the added advantage of significantly shorter procedure times. Further high-quality RCTs are needed to validate its role in clinical practice.

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurs in up to 10% of cases. Prophylactic pancreatic stenting reduces PEP risk; however, plastic stents frequently require an additional procedure for removal, increasing cost and patient burden. Biodegradable pancreatic stents negate the need for retrieval, but data on cost-effectiveness and clinical outcomes remain limited.

Methods: We conducted a two-center retrospective cohort study of adults undergoing ERCP with biodegradable pancreatic stent placement for PEP prophylaxis between January 2021 and August 2025. Demographic, procedural, and clinical data were collected. The primary outcome was per-patient cost difference between patient journeys utilizing biodegradable and plastic stenting. Secondary outcomes included PEP incidence, technical success, and stent usability data.

Results: A total of 5086 ERPCs were performed during the study period, and 111 ERCPs with biodegradable stents inserted were analyzed (mean age 62 years; 57% female; 39% rural). Technical success was 98%. The mean cost difference per patient favored biodegradable stents by AUD$393 (95% CI 149-63, p = 0.002). PEP occurred in 11% (12/111), all of which were mild. Higher rates of PEP were noted in patients on anticoagulation (36% vs. 8%, p = 0.02), with a history of prior PEP (67% vs. 8%, p = 0.02), or with failed pancreatic stent placement (100% vs. 9%, p = 0.01). Endoscopists rated ease of use comparable to plastic stents.

Conclusion: Biodegradable pancreatic stent placement is technically safe, effective, and associated with significant cost savings and reduced patient/healthcare burden by negating the need for further procedures. Observed PEP rates were consistent with those reported in high-risk cohorts.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disorder worldwide. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucose-lowering agents with cardiovascular benefits, have shown hepatoprotective potential. Their comparative effects on steatosis and fibrosis, their interrelationship, and the role of treatment duration remain uncertain.

Objectives: To compare the effects of individual SGLT2 inhibitors on hepatic steatosis and fibrosis, and to assess correlations between controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as the impact of treatment duration.

Methods: Randomized controlled trials of SGLT2 inhibitors in MASLD were synthesized using Bayesian network meta-analysis. Hepatic steatosis (CAP) and fibrosis (LSM) were analyzed separately as mean differences (MDs) with 95% credible intervals (CrIs). Prespecified study-level effect modifiers were evaluated using Bayesian network meta-regression. Comparative rankings were derived using the surface under the cumulative ranking curve (SUCRA). Trial-level concordance between CAP and LSM was assessed using bivariate Bayesian meta-analysis.

Results: Fourteen RCTs (n = 855) were included. Compared with standard care, SGLT2 inhibitors reduced CAP (MD 10.48 dB/m; 95% CrI 0.53 to 18.72) and LSM (MD 0.57 kPa; 95% CrI 0.02 to 1.12). Dapagliflozin showed the most consistently favorable estimates across both outcomes. Trial-level treatment effects on CAP and LSM were highly concordant. Treatment duration was not significantly associated with treatment effects; most trials lasted ≤ 24 weeks.

Conclusions: SGLT2 inhibitors, particularly dapagliflozin, were associated with improvements in non-invasive markers of steatosis and fibrosis in MASLD. CAP and LSM show aligned trends but remain biologically distinct, underscoring the need for longer, histology-driven, multiethnic trials to confirm true antifibrotic efficacy.

Registration: PROSPERO CRD420251146413.

Aims: To test whether water exchange improves advanced neoplasia detection rate (ANDR) by pooling data from four randomized controlled trials (RCTs) conducted in Taiwan with similar designs, patient populations, and endoscopists.

Background: Water exchange colonoscopy has been shown to improve adenoma detection rate (ADR) compared to air insufflation. However, its effect on ANDR, a surrogate marker for colorectal cancer risk, remains unclear due to small sample sizes in individual studies.

Methods: Patient demographics, procedural outcomes, ADR, and ANDR from four RCTs comparing water exchange and air insufflation were pooled and analyzed.

Results: A total of 1048 patients were included. Baseline characteristics were similar between groups. Water exchange significantly increased overall ADR (54.0% vs. 45.7%, p = 0.007) and overall ANDR (17.9% vs. 13.4%, p = 0.047) compared to air insufflation. The difference in ANDR was mainly observed in the proximal colon (8.7% vs. 4.6%, p = 0.007). Water exchange also resulted in a shorter mean withdrawal time (12.3 vs. 12.7 min, p = 0.023) and better bowel preparation scores. Adequate water exchange technique was confirmed by a cecal aspirated-to-infused water volume ratio of 106%.

Conclusions: Pooled analysis of four comparable RCTs showed that water exchange colonoscopy significantly improves overall and proximal colon ANDR compared to air insufflation. Further studies are needed to determine whether this translates into a reduced risk of interval colorectal cancer.

Clostridioides difficile infection (CDI) is recognized as the leading cause of antibiotic-associated diarrhea. There are several case reports of C. difficile enteritis in patients who have undergone colectomy and end ileostomy or ileal pouch-anal anastomosis. This case report describes a unique case of recurrent C. difficile enteritis following proctocolectomy and ileoanal pouch, treated successfully with faecal microbiota transplantation (FMT) via anterograde and retrograde delivery into the small bowel.

Background and aim: Endoscopic closure in gastric endoscopic submucosal dissection (ESD) is useful to prevent delayed bleeding. Although several closure methods have been reported, their cost remains a significant issue. In this pilot study, we developed a low-cost endoscopic closure (LoCC) method and evaluated its feasibility and cost-effectiveness.

Methods: We retrospectively analyzed 20 gastric lesions in 18 patients who underwent ESD between September 2024 and July 2025. Mucosal defect closure was performed using the LoCC method, which involves the application of conventional clips and threads to approximate mucosal edges. The primary outcome was the complete closure rate. The secondary outcomes were closure time, number of clips used and their cost, sustained closure rate on postoperative day (POD) 1, and incidence of delayed bleeding.

Results: Complete closure was achieved in 90.0% (18/20) of the lesions, with sustained closure on POD1 in 85.0% (17/20). The median closure time was 17.5 min (interquartile range [IQR]: 12.3-24.0), using a median of 20 clips (IQR: 15-23), at a median cost of 131.8 United States dollars (IQR: 98.8-151.5). No cases of delayed bleeding occurred.

Conclusions: The LoCC method showed favorable technical feasibility and enabled cost-efficient closure of post-ESD ulcers compared with other closure methods. This technique achieved a high closure success rate and sustained closure rate without the need for expensive devices, suggesting that it may serve as a practical and feasible closure method in routine clinical practice.

Background and aims: We investigated the clinical utility of the apolipoprotein A2 isoform index (apoA2-i index), a novel tumor marker for pancreatic cancer, in clinical practice, particularly for CA19-9-negative pancreatic cancer.

Methods: Between May 2024 and July 2025, patients who underwent abdominal computed tomography (CT) for the differential diagnosis of pancreatic diseases had their CEA, CA19-9, and apoA2-i indexes measured. We evaluated the sensitivity and specificity for pancreatic cancer and analyzed the relationship between the apoA2-i index and pancreatic atrophy or main pancreatic duct dilatation on CT.

Results: A total of 115 patients were included: 38 with pancreatic cancer, 47 with intraductal papillary mucinous neoplasms (IPMNs), and 30 with other conditions. The median age was 72.0 years, and 55 patients (47.8%) were male. The sensitivity of apoA2-i index for pancreatic cancer was 65.8%, while the specificity was 85.7%. The combined use of CA19-9 and the apoA2-i index increased sensitivity to 78.9% (specificity, 81.8%). Among 17 patients with CA19-9-negative pancreatic cancer, 9 (52.9%) tested positive for the apoA2-i index. The positive rates for stage 0/I pancreatic cancer were 12.5% for CA19-9 and 62.5% for the apoA2-i index. Regarding CT findings, the apoA2-i index significantly decreased with the progression of pancreatic atrophy (p = 0.027) and was also significantly lower in patients with pancreatic duct dilatation (p = 0.016).

Conclusions: The apoA2-i index can detect CA19-9-negative pancreatic cancer, and the combination of the apoA2-i index with CA19-9 enhances diagnostic performance in clinical practice.

Background and aims: The impact of computer-aided detection (CADe)-assisted colonoscopy on gastroenterology fellow trainees remains incompletely defined. In this study, adenoma detection rates (ADR) with and without CADe were assessed among gastroenterology fellows.

Methods: This quality improvement study compared 1580 colonoscopies performed with and without CADe. The primary outcome was the ADR in fellow-assisted colonoscopies, with and without CADe, stratified by fellowship year. ADRs were compared among procedures assisted by first-year fellows; those assisted by second- and third-year fellows (combined); and those performed by faculty without a fellow.

Results: Age, birth sex, race, body mass index, procedure indication, non-neoplastic resection rate, and withdrawal time were similar. CADe-assisted colonoscopy significantly improved the ADR for first-year fellows (66.2% vs. 48.6%, p < 0.001). However, for colonoscopies assisted by second- and third-year fellows, the ADR was not significantly different (61.5% vs. 58.7%, p = 0.39). Although there was an upward trend in ADR for CADe-assisted colonoscopies performed by faculty without fellow participation (61% vs. 50%), it was not statistically significant (p = 0.24).

Conclusion: CADe-assisted colonoscopy improved ADR in first-year fellow-assisted procedures. The bounding box created by the system's artificial intelligence may enhance polyp detection by improving peripheral gaze patterns in novice endoscopists. Further studies are needed to validate this hypothesis.

Aims: Frailty predisposes patients with cirrhosis to hepatic encephalopathy (HE). This study aimed to evaluate the effect of frailty on risk stratification for covert HE (CHE) and overt HE (OHE) in patients with cirrhosis.

Methods: Hospitalized patients with cirrhosis and without history of OHE were retrospectively included. Frailty was assessed using the Clinical Frailty Scale (CFS). Factors associated with CHE and OHE development were evaluated using the logistic regression and Fine-Gray competing risk regression models, respectively.

Results: Among 262 patients (median [interquartile range] age, 65 [55-74] years; 154 [58.8%] female), frailty and CHE were identified in 25 (9.5%) and 82 (31.3%) patients, respectively. The prevalence of CHE was higher in patients with frailty than in those without frailty (84.0% vs. 25.7%; p < 0.001). During a median follow-up of 2.9 years, 40 patients (15.3%) developed OHE and 20 (7.6%) died. The incidence of OHE was higher in patients with frailty than in those without (incidence rates at 1, 3, and 5 years; 25%, 33%, and 36% vs. 5%, 11%, and 18%; p = 0.009). Multivariable analyses showed that CFS was an independent factor for CHE (odds ratio, 2.13; 95% confidence interval, 1.41-3.37; p < 0.001) and OHE development (subdistribution hazard ratio, 1.38; 95% confidence interval, 1.02-1.87; p = 0.037).

Conclusion: Frailty assessed using the CFS is a robust factor to stratify the risk of CHE and OHE development in patients with cirrhosis. Patients with frailty should be screened and carefully monitored for HE.