Lancet Gastroenterology & Hepatology最新文献

{"title":"Transanal total mesorectal excision in the era of robotic surgery","authors":"Patricia Sylla","doi":"10.1016/s2468-1253(26)00075-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00075-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term progression of steatotic liver disease: multiple drivers of the same disease?","authors":"Helena Cortez-Pinto","doi":"10.1016/s2468-1253(26)00086-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00086-5","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"57 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transanal total mesorectal excision versus laparoscopic total mesorectal excision for mid and low rectal cancer (COLOR III): short-term outcomes of an international, multicentre, phase 3, randomised, controlled, non-inferiority trial","authors":"Jurriaan B Tuynman, Hongwei Yao, Laura R Moolenaar, Colin Sietses, Roel Hompes, Felix Aigner, Antonio Caycedo–Marulanda, Chien-Chih Chen, Muneer Deeb, Pascal G Doornebosch, Bo Feng, Chi-Chung Foo, Alois Fürst, Masaaki Ito, Francisco B de Lacy, Pedro Leão, Justin A Maykel, Andrea Muratore, Stefan E van Oostendorp, Sung Chan Park, Michał Pędziwiatr, MingYang Ren, Gerald Seitinger, Hein B A C Stockmann, Aaldert K Talsma, Andreas Türler, Weidong Tong, Quan Wang, Qing Xu, Hongyu Zhang, Jan-Hein T M van Waesberghe, Mahsoem Ali, Jos W R Twisk, Zhongtao Zhang, Antonio M de Lacy, George B Hanna, Hendrik J Bonjer, Muneer Deeb, Mahsoem Ali, Jaap Bonjer, Charlotte Deijen, Roel Hompes, Thomas Koedam, Wytze Lameris, Annabel van Lieshout, Linda Mol, Laura Moolenaar, Stefan van Oostendorp, Jurriaan Tuynman, Jos Twisk, Jan-Hein van Waesberghe, Bin Huang, Feifei Huang, Zhigang Ke, Fan Li, Xiaoli Ran, Yue Tian, Weidong Tong, Li Wang, Xiangfeng Wang, Guodong Xiao, Liyang Yao, Jingwang Ye, Huichao Zheng, Yongbo An, Jiale Gao, Jianning Song, Pengyu Wei, Guocong Wu, Zhengyang Yang, Hongwei Yao, Zhongtao Zhang, Pedro Leão, Maria Sousa, Marion Brunner, Arthur Heiligensetzer, Peter Sauer, Alois Fürst, Vinzenz Völkel, Matthias Biebl, Luca Dittrich, Rosa Schmuck, Robbert Bosker, Koen Talsma, Andrea Muratore, Patrizia Marsanic, Gabie de Jong, Guusje Vughs, Colin Sietses, Antonio Caycedo-Marulanda, Sanjiv Mathur, Pamela Leduc, Raquel Bravo, Marlene Caldera, Yoelimar Guzmán, Francisco Borja de Lacy, Antonio María de Lacy, Ana Otero, Miguel Pera, Pascal Doornebosch, Maarten Vermaas, Michal Pędziwiatr, Andreas Türler, Haug-Lambert Loriz, Chien-Chih Chen, Chun-Ho Chu, Felix Aigner, Gabriele Moitzi, Richard Stadler, Gerald Seitinger, Qing Guo, MingYang Ren, Qing Teng, Dongbing Zhou, Sung Chan Park, Masaaki Ito, Hiro Hasegawa, Chi Chung Foo, Abraham Man, Lei Gu, Qing Xu, Batuer Aikemu, Bo Feng, Zhenghao Cai, Haiqin Song, Minhua Zheng, Ronald Vuylsteke, Hein Stockmann, Hou-Hsuan Cheng, Jeng-Kai Jiang, Chung-Chi Lin, Hung-Hsin Lin, Yinggang Ge, Xingye Wu, Xiang Xu, Hongyu Zhang, Liang He, Yuchen Guo, Yang Gong, Quan Wang, Karim Alavi, Justin Maykel, Paul Sturrock, Jingjing He","doi":"10.1016/s2468-1253(26)00022-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00022-1","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"1 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Binge drinking, metabolic dysfunction, and the spectrum of steatotic liver disease in the USA: a cross-sectional and longitudinal analysis","authors":"Zobair M Younossi, Aleksander Krag, Shira Zelber-Sagi, Markos Kalligeros, Marco Arrese, Luis Antonio Diaz, Juan Pablo Arab, Ashwani K Singal, Mario G Pessoa, Robert J Wong, Javier Crespo, Maja Thiele, Ajay Duseja, C Wendy Spearman, Mohamed El-Kassas, Yusuf Yilmaz, Jiangao Fan, Laurent Castera, Frank Tacke, Vincent Wai-Sun Wong, Michael Betel, Andrei Racila, Ariana Nader, Gabriella Y Paik, Dana Ivancovsky Wajcman, Laura Sol Grinshpan, Linda Henry, Yuchiro Eguichi, Janus P Ong, Fatema Nader, Saleh A Alqahtani, James M Paik","doi":"10.1016/s2468-1253(25)00376-0","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00376-0","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"14 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green fluorescence angiography for anastomotic perfusion assessment in colorectal surgery: a systematic review with meta-analysis, meta-regression, and trial sequential analyses","authors":"Éanna J Ryan, Odhrán K Ryan, Neil Corrigan, Gemma Ainsworth, Denise E Hilling, Alexander L Vahrmeijer, Jyrki Kössi, Jun Watanabe, David Jayne, Ronan A Cahill","doi":"10.1016/s2468-1253(25)00373-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00373-5","url":null,"abstract":"<h3>Background</h3>Anastomotic leak is a serious complication in colorectal surgery. Indocyanine green fluorescence angiography (ICGFA) is an adjunctive digital method of assessing bowel perfusion intraoperatively. We assessed whether ICGFA use during surgery reduces postoperative anastomotic leak exclusively using data from randomised controlled trials (RCTs).<h3>Methods</h3>In this systematic review and meta-analysis, we searched PubMed, ScienceDirect, Scopus, Web of Science, Embase, and the Cochrane Collaboration databases from inception to July 19, 2025, for English-language RCTs comparing additive intraoperative ICGFA with standard surgeon perfusion assessment alone in patients undergoing colorectal resection with primary anastomosis according to prespecified criteria and PRISMA guidelines. Summary-level data were extracted by two reviewers. The primary outcome was overall anastomotic leak rate. The Jadad scale (Oxford quality scoring system) was used to assess trial quality, the Cochrane Risk of Bias (RoB 2) tool for RCTs was used to assess risk of bias, and GRADE was used to assess strength of evidence. Meta-regression and trial sequential analyses were performed. This study is registered with PROSPERO, CRD420250652639.<h3>Findings</h3>719 records were initially identified, with 387 remaining after screening and 184 sought for full eligibility screening, of which nine were eligible RCTs (with 4754 patients) for analysis. ICGFA significantly reduced overall anastomotic leak (risk ratio 0·66 [95% CI 0·56–0·78], p<0·0001; number needed to treat [NNT]=24), with trial sequential analysis showing that the required information size (2183) was exceeded overall. ICGFA reduced both anastomotic leak requiring intervention (risk ratio 0·73 [95% CI 0·60–0·89], p=0·0020; NNT=39) and anastomotic leak not requiring intervention (0·48 [0·31–0·72], p=0·0004, NNT=35). Significant benefit was observed for left-sided resections (risk ratio 0·62 [95% CI 0·51–0·74], p<0·0001; NNT=19), rectal resections (0·62 [0·51–0·76], p<0·0001; NNT=19), and low anterior resections (0·62 [0·48–0·79], p<0·0001; NNT=13), in which the required information size was also exceeded, but not for right-sided resections. In the meta-regression analysis, among all tested covariates, only patient BMI significantly modified the ICGFA treatment effect, with an increasing protective effect with increasing BMI (coefficient –0·0153 [95% CI –0·0251 to –0·0056], p=0·0020). Evidence was graded as high certainty for overall, left-sided, rectal, asymptomatic, and 30-day anastomotic leaks, and moderate certainty for clinically significant anastomotic leak.<h3>Interpretation</h3>Intraoperative use of ICGFA reduces anastomotic leak rates in left-sided and rectal colorectal resections. Given the evidence available now, further general efficacy trials are no longer required and research should shift to implementation and defined targeted subgroup ICGFA role definition (ie, in non-rectal left","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"22 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green works: redefining research priorities in colorectal surgery","authors":"Zoe Garoufalia","doi":"10.1016/s2468-1253(26)00009-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00009-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"16 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to test for hepatitis D virus infection: evidence and rationale to inform policy recommendations and future directions","authors":"Emi E Okamoto, Robia Islam, Sahar Bajis, Niklas Luhmann, Ashley Kallarakal, Frédéric Le Gal, Philippa Easterbrook","doi":"10.1016/s2468-1253(25)00265-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00265-1","url":null,"abstract":"Chronic hepatitis D virus (HDV) coinfection in people with chronic hepatitis B is associated with rapid progression to liver cirrhosis and high mortality. In 2020, the estimated global HDV burden among people with chronic hepatitis B was 12 million people, with a seroprevalence of 4·5%. Treatment options are now evolving with the introduction of bulevirtide; however, testing for HDV remains very low. In 2024, WHO published comprehensive guidelines on the management of people with chronic hepatitis B, including recommendations for the first time on who to test and how to test for HDV infection. WHO recommends an anti-HDV serological assay for those with chronic hepatitis B, and if reactive, an HDV RNA test to confirm active infection and, where available, reflex laboratory-based testing for anti-HDV in those who are HBsAg positive and an HDV RNA test in those who are anti-HDV positive. WHO also recommended universal anti-HDV testing among all individuals who are HBsAg positive, or a risk-based approach among populations at high risk when this is not feasible. We present two complementary Reviews—one on who to test and one on how to test for HDV infection. This Review on how to test provides a comprehensive landscape and performance review of available serological and molecular diagnostic assays, as well as the evidence and rationale for the adoption of reflex testing both for anti-HDV in individuals who are HBsAg positive, and HDV RNA testing in those who are anti-HDV positive. Key implementation considerations and research priorities include the need for countries to incorporate HDV testing into their national policies and guidelines for chronic hepatitis B, expand laboratory capacity and training that leverages existing networks and infrastructure, promote access to quality diagnostics, including anti-HDV rapid diagnostic tests, and conduct evaluations of quality-assured assays using all HDV genotypes.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"130 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who to test and reflex testing for hepatitis D virus infection: evidence and rationale to inform policy recommendations and future directions","authors":"Sahar Bajis, Niklas Luhmann, Emi Okamoto, Robia Islam, Olufunmilayo Lesi, Philippa Easterbrook","doi":"10.1016/s2468-1253(25)00266-3","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00266-3","url":null,"abstract":"Chronic hepatitis D coinfection affects an estimated 12 million people globally, with higher prevalence in low-income and middle-income countries, especially the African and Western Pacific regions. It leads to accelerated progression to liver cirrhosis, hepatocellular carcinoma, and increased mortality. The treatment landscape is evolving with the introduction of bulevirtide, but hepatitis D virus (HDV) testing uptake and case-finding remain low. The 2024 WHO guidelines on the management of chronic hepatitis B provide recommendations for the first time on who to test and how to test for HDV infection. WHO recommends universal anti-HDV testing among all HBsAg-positive individuals, and where this is not feasible, a complementary focused (risk-based) testing approach among higher-risk populations. We present two complementary Reviews—one on who to test and one on how to test for HDV infection. This Review on who to test summarises the evidence base and rationale for the two recommendations regarding the universal and risk-based testing approaches, as well as the recommendation for the laboratory-based reflex HDV testing both for anti-HDV and HDR RNA. Key implementation considerations include the need for countries to incorporate HDV testing into their national policies and guidelines, education and training of health-care providers in counselling and linkage to care, community awareness raising and demand creation, and the establishment of clinical care pathways for HDV infection. Research priorities include the development of HDV rapid diagnostic tests to facilitate decentralisation of HDV testing, the generation of improved epidemiological data across different populations and settings to inform testing approaches, and evaluating the cost-effectiveness and feasibility of both universal and risk-based HDV testing approaches, alongside reflex HDV serology and HDV RNA testing.","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"197 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Africa must not be left out of the hepatitis B cure era","authors":"Mohamed El-Kassas, Hend Shousha, Asgeir Johannessen","doi":"10.1016/s2468-1253(26)00024-5","DOIUrl":"https://doi.org/10.1016/s2468-1253(26)00024-5","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"12 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of antiviral therapy in adults with chronic hepatitis B according to baseline hepatitis B virus DNA and alanine aminotransferase concentrations: a systematic review and meta-analysis","authors":"Yu Ri Im, Si Emma Chen, Rukmini Jagdish, Daniela Yucuma, Arthur Rakover, Zakary Ismail Warsop, Roger Chou, Philippa Easterbrook, Yusuke Shimakawa","doi":"10.1016/s2468-1253(25)00301-2","DOIUrl":"https://doi.org/10.1016/s2468-1253(25)00301-2","url":null,"abstract":"<h3>Background</h3>In the 2015 WHO guidelines for chronic hepatitis B (CHB), antiviral therapy was recommended for individuals with cirrhosis and individuals without cirrhosis with persistently elevated alanine aminotransferase (ALT) concentrations and hepatitis B virus (HBV) DNA >20 000 IU/mL, whereas treatment was deferred for individuals with persistently normal ALT concentrations and HBV DNA <2000 IU/mL. To inform 2024 WHO guidelines on CHB and the potential expansion of treatment threshold recommendations, we conducted two linked systematic reviews and meta-analyses; this analysis examines the efficacy of antiviral therapy in adults with non-cirrhotic CHB according to baseline HBV DNA and ALT concentrations.<h3>Methods</h3>In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, and the Cochrane Library for randomised controlled trials (RCTs) and non-randomised (prospective or retrospective) confounder-controlled cohort studies of antiviral therapy versus placebo or no treatment in people with CHB, published in any language between Jan 1, 2000, and Feb 6, 2023. We also reviewed the reference lists of included studies and systematic reviews to identify RCTs published before 2000. Eligible studies reported baseline HBV DNA and ALT concentrations of adults with CHB, had less than 30% of participants with cirrhosis at baseline, and reported on at least one of our predefined outcomes. We excluded studies focused exclusively on pregnant women, individuals co-infected with HIV, hepatitis C virus, or hepatitis D virus, or individuals with primary conditions other than CHB, and studies that included participants who had received anti-HBV therapy in the 6 months before study enrolment. We extracted aggregate data to examine clinical outcomes (ie, hepatocellular carcinoma, cirrhosis, all-cause mortality, and liver-related mortality) and intermediate outcomes (ie, liver fibrosis, liver necroinflammation, ALT normalisation, HBsAg and HBeAg seroclearance and seroconversion, and HBV DNA suppression) stratified by baseline HBV DNA concentration (<2000 IU/mL, 2000–19 999 IU/mL, 20 000–199 999 IU/mL, 200 000–1 999 999 IU/mL, 2 000 000–19 999 999 IU/mL, and ≥20 000 000 IU/mL) and ALT (less than the upper limit of normal [ULN], 1·0–1·9 × ULN, and ≥2·0 × ULN). We used random-effects meta-analysis to pool unadjusted risk ratios (RRs) from RCTs and adjusted or unadjusted hazard ratios (aHRs or HRs) or unadjusted RRs for non-randomised studies. We estimated the number needed to treat (NNT) to prevent one case of hepatocellular carcinoma with nucleoside or nucleotide (nucleos[t]ide) analogue treatment. The study was registered with PROSPERO (CRD42023437560).<h3>Findings</h3>Of 13 224 articles screened, 24 met the inclusion criteria, including 16 studies on nucleos(t)ide analogues (12 RCTs and four non-randomised studies) and eight studies on interferon alfa-2-based therapy (four RCTs and four non-randomised studies). In adult","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"45 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}