Advances in Digestive Medicine最新文献

Lowering the age for colorectal cancer screening

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2025-03-10 DOI: 10.1002/aid2.70001

Chi-Yang Chang

Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, including in Taiwan, where early detection is crucial for improving outcomes. Recent studies reveal a rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 50, promoting discussions about lowering the recommended age for CRC screening.1, 2 A study by Chang et al. highlights the adenoma detection rate (ADR) in screening colonoscopies among individuals aged 40–75, providing critical insights into the efficacy and implications of early screening.3In Chang's study, the ADR for individuals aged 40–44 years, was 28.0%, compared to 41.5% for those aged 50 and older. Although younger populations showed a lower ADR in, their rates still exceed the current ADR benchmark of 25%, demonstrating the feasibility of initiating screenings earlier. ADR is strongly correlated with reduced CRC incidence and mortality.4, 5 The study's results emphasize the potential of detecting precancerous colon adenomas earlier, which could significantly impact CRC prevention strategies.Historically, CRC screening began at age 50 for average-risk individuals among many countries. However, lifestyle factors such as high consumption of red and processed meats, low intake of fiber-rich foods like fruits and vegetables, physical inactivity, smoking, and rising obesity rates have contributed to the growing burden of CRC among younger populations.1 EOCRC tends to be more aggressive and is often associated with poorer prognosis compared with CRC in older individuals.2 The increasing prevalence of EOCRC has been noted recently. This alarming trend highlights the need to modify current screening guidelines. Early detection through screening colonoscopy could help address this incidence effectively.Chang et al.'s study also identified gender differences in ADR, with males consistently exhibiting higher rates than females across all age groups.3 While the ADR for women aged 40–44 years was slightly below the 20% which is the female ADR benchmark, the overall ADR for younger populations remained robust, supporting the extension of screening to these age groups. One concern with lowering the screening age is the potential impact on the cost-effectiveness and efficiency of CRC screening programs. Chang et al. revealed a slight decrease in overall ADR when younger populations were included, as these groups typically exhibit fewer adenomas. However, the broader benefits of early detection outweigh this challenge. Targeted strategies, such as prioritizing individuals with a family history of CRC or other risk factors, could optimize resource allocation while maintaining high-quality care.6, 7The shift toward earlier CRC screening aligns with updated recommendations by the US Preventive Servic

{"title":"Lowering the age for colorectal cancer screening","authors":"Chi-Yang Chang","doi":"10.1002/aid2.70001","DOIUrl":"https://doi.org/10.1002/aid2.70001","url":null,"abstract":"Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, including in Taiwan, where early detection is crucial for improving outcomes. Recent studies reveal a rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 50, promoting discussions about lowering the recommended age for CRC screening.1, 2 A study by Chang et al. highlights the adenoma detection rate (ADR) in screening colonoscopies among individuals aged 40–75, providing critical insights into the efficacy and implications of early screening.3In Chang's study, the ADR for individuals aged 40–44 years, was 28.0%, compared to 41.5% for those aged 50 and older. Although younger populations showed a lower ADR in, their rates still exceed the current ADR benchmark of 25%, demonstrating the feasibility of initiating screenings earlier. ADR is strongly correlated with reduced CRC incidence and mortality.4, 5 The study's results emphasize the potential of detecting precancerous colon adenomas earlier, which could significantly impact CRC prevention strategies.Historically, CRC screening began at age 50 for average-risk individuals among many countries. However, lifestyle factors such as high consumption of red and processed meats, low intake of fiber-rich foods like fruits and vegetables, physical inactivity, smoking, and rising obesity rates have contributed to the growing burden of CRC among younger populations.1 EOCRC tends to be more aggressive and is often associated with poorer prognosis compared with CRC in older individuals.2 The increasing prevalence of EOCRC has been noted recently. This alarming trend highlights the need to modify current screening guidelines. Early detection through screening colonoscopy could help address this incidence effectively.Chang et al.'s study also identified gender differences in ADR, with males consistently exhibiting higher rates than females across all age groups.3 While the ADR for women aged 40–44 years was slightly below the 20% which is the female ADR benchmark, the overall ADR for younger populations remained robust, supporting the extension of screening to these age groups. One concern with lowering the screening age is the potential impact on the cost-effectiveness and efficiency of CRC screening programs. Chang et al. revealed a slight decrease in overall ADR when younger populations were included, as these groups typically exhibit fewer adenomas. However, the broader benefits of early detection outweigh this challenge. Targeted strategies, such as prioritizing individuals with a family history of CRC or other risk factors, could optimize resource allocation while maintaining high-quality care.6, 7The shift toward earlier CRC screening aligns with updated recommendations by the US Preventive Servic","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2025-03-10 DOI: 10.1002/aid2.13427

Wei-Chih Sun, Wen-Chi Chen, Wei-Lun Tsai, Feng-Woei Tsay, Huay-Min Wang, Yun-Da Li, Tzung-Jiun Tsai

Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; p = .01) and hospital day (18 vs. 6 days; p = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; p = .04), overall biliary cannulation time >10 min (61.9% vs. 38.1%; p = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; p = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (p = .01). Overall biliary cannulation time >10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; p = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; p = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time >10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.

{"title":"Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography","authors":"Wei-Chih Sun, Wen-Chi Chen, Wei-Lun Tsai, Feng-Woei Tsay, Huay-Min Wang, Yun-Da Li, Tzung-Jiun Tsai","doi":"10.1002/aid2.13427","DOIUrl":"https://doi.org/10.1002/aid2.13427","url":null,"abstract":"Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; p = .01) and hospital day (18 vs. 6 days; p = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; p = .04), overall biliary cannulation time >10 min (61.9% vs. 38.1%; p = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; p = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (p = .01). Overall biliary cannulation time >10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; p = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; p = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time >10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2025-03-10 DOI: 10.1002/aid2.13423

Kuan-Ming Lai, Chien-Yu Tsai, Sheng-Lei Yan

Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (p = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (p = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (p < .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (p < .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (p < .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (p = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR <5.3 (p = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR >5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.

{"title":"Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma","authors":"Kuan-Ming Lai, Chien-Yu Tsai, Sheng-Lei Yan","doi":"10.1002/aid2.13423","DOIUrl":"https://doi.org/10.1002/aid2.13423","url":null,"abstract":"Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (p = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (p = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (p < .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (p < .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (p < .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (p = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR <5.3 (p = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR >5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating short-term efficacy of proton pump inhibitors in GERD management

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2025-02-24 DOI: 10.1002/aid2.70000

Chih-Ming Liang, Wei-Chen Tai, Shih-Cheng Yang, Pao-Yuan Huang, Chih-Chien Yao, Yu-Chi Lee, Seng-Kee Chuah

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition characterized by symptoms, such as heartburn and acid regurgitation. Proton pump inhibitors (PPIs) have long been the cornerstone of GERD treatment due to their superior acid-suppressive properties. However, variations in the short-term efficacy of different PPIs remain a clinical challenge. The recent study by Liao et al.1 explored the comparative short-term effects of lansoprazole and rabeprazole in patients with erosive esophagitis (EE) over a one-week period, offering new insights into the pharmacodynamic responses of these drugs. This editorial aims to highlight key points of the study, discuss the implications of GERD in diagnosis and treatment, and emphasize the role of psychological factors in mild GERD cases.Lansoprazole and rabeprazole share a common mechanism of action by covalently binding to the gastric H+/K+-ATPase enzyme, thereby inhibiting gastric acid secretion. However, their pharmacokinetic profiles diverge, significantly impacting their onset and consistency of acid suppression. Lansoprazole has a time to peak plasma concentration (Tmax) of approximately 1.2–2.1 h, with a half-life (t½) of 0.9–2.1 h. It is primarily metabolized by the CYP2C19 and CYP3A4 enzymes, making its efficacy susceptible to genetic polymorphisms in CYP2C19.2, 3 Individuals with rapid metabolism (extensive metabolizers) may experience reduced acid suppression due to faster drug clearance, whereas poor metabolizers benefit from prolonged drug exposure. Rabeprazole exhibits a slightly delayed Tmax of 3–5 h and a shorter half-life of 0.6–1.4 h.2, 3 Unlike lansoprazole, rabeprazole undergoes mainly non-enzymatic metabolism and has minimal dependence on CYP2C19 metabolism. This property ensures more consistent acid suppression across different genetic profiles, offering a pharmacokinetic advantage, particularly in populations with high CYP2C19 variability.4 PPIs are prodrugs activated in the acidic environment of the parietal cell's secretory canaliculus. Rabeprazole, with a higher pKa (~5.0) compared to lansoprazole (~4.0), undergoes faster acid activation. This rapid activation facilitates more immediate binding to the gastric proton pump, potentially leading to quicker symptom relief. Studies indicate that rabeprazole achieves more consistent intragastric pH control due to its stable metabolism and rapid activation.5 The study by Liang et al. evaluated the short-term efficacy of dexlansoprazole (60 mg) and esomeprazole (40 mg) in 175 GERD patients with LA Grades A/B erosive esophagitis.6 The complete symptom resolution (CSR) rates were similar between the two drugs: Day 1: 25.9% vs. 28.4%, Day 3: 33.3% vs. 32.1%, and Day 7: 51.9% vs. 48.1%. Similarly, Liao et al.

{"title":"Evaluating short-term efficacy of proton pump inhibitors in GERD management","authors":"Chih-Ming Liang, Wei-Chen Tai, Shih-Cheng Yang, Pao-Yuan Huang, Chih-Chien Yao, Yu-Chi Lee, Seng-Kee Chuah","doi":"10.1002/aid2.70000","DOIUrl":"https://doi.org/10.1002/aid2.70000","url":null,"abstract":"Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition characterized by symptoms, such as heartburn and acid regurgitation. Proton pump inhibitors (PPIs) have long been the cornerstone of GERD treatment due to their superior acid-suppressive properties. However, variations in the short-term efficacy of different PPIs remain a clinical challenge. The recent study by Liao et al.1 explored the comparative short-term effects of lansoprazole and rabeprazole in patients with erosive esophagitis (EE) over a one-week period, offering new insights into the pharmacodynamic responses of these drugs. This editorial aims to highlight key points of the study, discuss the implications of GERD in diagnosis and treatment, and emphasize the role of psychological factors in mild GERD cases.Lansoprazole and rabeprazole share a common mechanism of action by covalently binding to the gastric H+/K+-ATPase enzyme, thereby inhibiting gastric acid secretion. However, their pharmacokinetic profiles diverge, significantly impacting their onset and consistency of acid suppression. Lansoprazole has a time to peak plasma concentration (Tmax) of approximately 1.2–2.1 h, with a half-life (t½) of 0.9–2.1 h. It is primarily metabolized by the CYP2C19 and CYP3A4 enzymes, making its efficacy susceptible to genetic polymorphisms in CYP2C19.2, 3 Individuals with rapid metabolism (extensive metabolizers) may experience reduced acid suppression due to faster drug clearance, whereas poor metabolizers benefit from prolonged drug exposure. Rabeprazole exhibits a slightly delayed Tmax of 3–5 h and a shorter half-life of 0.6–1.4 h.2, 3 Unlike lansoprazole, rabeprazole undergoes mainly non-enzymatic metabolism and has minimal dependence on CYP2C19 metabolism. This property ensures more consistent acid suppression across different genetic profiles, offering a pharmacokinetic advantage, particularly in populations with high CYP2C19 variability.4 PPIs are prodrugs activated in the acidic environment of the parietal cell's secretory canaliculus. Rabeprazole, with a higher pKa (~5.0) compared to lansoprazole (~4.0), undergoes faster acid activation. This rapid activation facilitates more immediate binding to the gastric proton pump, potentially leading to quicker symptom relief. Studies indicate that rabeprazole achieves more consistent intragastric pH control due to its stable metabolism and rapid activation.5 The study by Liang et al. evaluated the short-term efficacy of dexlansoprazole (60 mg) and esomeprazole (40 mg) in 175 GERD patients with LA Grades A/B erosive esophagitis.6 The complete symptom resolution (CSR) rates were similar between the two drugs: Day 1: 25.9% vs. 28.4%, Day 3: 33.3% vs. 32.1%, and Day 7: 51.9% vs. 48.1%. Similarly, Liao et al.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Colonoscopic diagnosis of early acute appendicitis

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-12-12 DOI: 10.1002/aid2.13412

Jun-Liang Pan, Sheng-Wei Chang, Chun-Chao Chang, Wei-Yu Kao

A 62-year-old man with medical history of (1) morbid obesity status post Roun-en Y gastric bypass, (2) chronic obstructive pulmonary disease, (3) cardiac arrest status post pacemaker placement.

Due to postprandial diarrhea, general malaise, blood-tinged stool for 1 to 2 weeks, the patient went to our gastroenterology clinic. He denied symptoms of fever, abdominal pain, nausea, vomiting. On initial evaluation, his vital signs were within normal limits, and his abdominal examination was soft, nontender, normal active bowel sound and without signs of peritonitis. A complete blood count and basic biochemical tests were unremarkable. Colonoscopy revealed swollen of appendiceal aperture and a moderate amount of fecalith and purulent discharge from the appendiceal orifice. (Figure 1) Further abdominal computed tomography showed swelling of appendix with perifocal fatty stranding, favor acute appendicitis (Figure 2, arrowhead). He was then admitted for a laparoscopic appendectomy where her appendix and adjacent tissues appeared mildly hyperemic. The appendix was evaluated by an experienced pathologist. Grossly, the external surface of appendix is congested, with pus coating on the serosa. On section, the lumen is filled up with fecal and purulent material. No perforation is found. Microscopically, it shows a picture of acute appendicitis with marked transmural acute inflammation of appendix and peri-appendiceal fat.

Acute appendicitis is one of the most common abdominal surgical emergency worldwide. Although advances in imaging modalities, diagnosis of acute appendicitis still has false-negative rate.¹ Endoscopy is not the standard for diagnosis and treatment of appendicitis, but there are few reported cases of silent appendicitis diagnosed at the time of colonoscopy. From case reports in recent 2 years, we found purulent discharge,² bulging, erythematous, edematous of appendiceal orifice were rare endoscopic finding but related to appendicitis. Thus we perform colonoscopy when insert to cecum, we need to take notice of the appendiceal orifice.

The authors declare no conflicts of interest.

Written informed consent was obtained from the patients.

{"title":"Colonoscopic diagnosis of early acute appendicitis","authors":"Jun-Liang Pan, Sheng-Wei Chang, Chun-Chao Chang, Wei-Yu Kao","doi":"10.1002/aid2.13412","DOIUrl":"https://doi.org/10.1002/aid2.13412","url":null,"abstract":"A 62-year-old man with medical history of (1) morbid obesity status post Roun-en Y gastric bypass, (2) chronic obstructive pulmonary disease, (3) cardiac arrest status post pacemaker placement.Due to postprandial diarrhea, general malaise, blood-tinged stool for 1 to 2 weeks, the patient went to our gastroenterology clinic. He denied symptoms of fever, abdominal pain, nausea, vomiting. On initial evaluation, his vital signs were within normal limits, and his abdominal examination was soft, nontender, normal active bowel sound and without signs of peritonitis. A complete blood count and basic biochemical tests were unremarkable. Colonoscopy revealed swollen of appendiceal aperture and a moderate amount of fecalith and purulent discharge from the appendiceal orifice. (Figure 1) Further abdominal computed tomography showed swelling of appendix with perifocal fatty stranding, favor acute appendicitis (Figure 2, arrowhead). He was then admitted for a laparoscopic appendectomy where her appendix and adjacent tissues appeared mildly hyperemic. The appendix was evaluated by an experienced pathologist. Grossly, the external surface of appendix is congested, with pus coating on the serosa. On section, the lumen is filled up with fecal and purulent material. No perforation is found. Microscopically, it shows a picture of acute appendicitis with marked transmural acute inflammation of appendix and peri-appendiceal fat.Acute appendicitis is one of the most common abdominal surgical emergency worldwide. Although advances in imaging modalities, diagnosis of acute appendicitis still has false-negative rate.1 Endoscopy is not the standard for diagnosis and treatment of appendicitis, but there are few reported cases of silent appendicitis diagnosed at the time of colonoscopy. From case reports in recent 2 years, we found purulent discharge,2 bulging, erythematous, edematous of appendiceal orifice were rare endoscopic finding but related to appendicitis. Thus we perform colonoscopy when insert to cecum, we need to take notice of the appendiceal orifice.The authors declare no conflicts of interest.Written informed consent was obtained from the patients.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Proton pump inhibitors use and risk of liver cancer: Concerns to be addressed 质子泵抑制剂的使用和肝癌的风险：需要解决的问题

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-12-02 DOI: 10.1002/aid2.13434

Wei-Yu Kao, Chien-Wei Su

Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for managing gastroesophageal reflux disease, peptic ulcer disease, and the eradication of Helicobacter pylori infection.1 However, the association between PPIs use and an increased risk of developing cancer remains unclear, particularly for cancers of the gastrointestinal tract and liver.2-6 One proposed mechanism for the potential carcinogenicity of PPIs is their potent suppression of gastric acid production, which could lead to hypergastrinemia. Hypergastrinemia may promote carcinogenesis in the digestive system due to the pro-growth effects of gastrin on tissues such as the pancreas, stomach, colon, and esophageal mucosa.7 In addition, long-term use of PPIs may alter gut microbiome diversity and increase the risk of enteric infection and hepatic inflammation, which could contribute to the development of liver fibrosis, a critical factor in hepatic carcinogenesis.8, 9Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-related deaths worldwide. Several risk factors for HCC have been identified, including hepatitis B or C virus infection, fatty liver disease, and liver cirrhosis.10 Our previous study in a Taiwanese population-based cohort, using a propensity score matching analysis, demonstrated that PPIs use is not associated with an increased risk of developing HCC among patients with chronic hepatitis B or C.4 Similarly, another study from a nationally representative Korean cohort found no increased risk of HCC associated with PPIs use in selected population, such as those with obesity, older age, or chronic liver diseases.5 However, two previous meta-analyses have reported conflicting results regarding the relationship between PPIs use and HCC risk.11, 12 Furthermore, our recent Taiwanese population-based cohort study showed that long-term PPIs use in HCC patients after hepatectomy might be associated with longer recurrence-free survival.13In Advances in Digestive Medicine, Yi and colleagues investigated the association between PPIs use and the risk of hepatobiliary cancer, presenting newly available evidence.14 Their meta-analysis revealed a significant association between PPIs use and an increased risk of hepatobiliary cancer (95% confidence interval 1.44–1.98, p < .001). However, the association observed in this and previous studies was weak, lacked a dose-dependent effect, and the reported odds ratios were less than 3, suggesting that residual confounding rather than causality might be responsible for the findings.15In conclusion, the relationship between PPI use and the risk of liver cancer rem

质子泵抑制剂（PPIs）是治疗胃食管反流病、消化性溃疡疾病和根除幽门螺杆菌感染最常用的处方药之一然而，PPIs的使用与癌症风险增加之间的关系仍不清楚，特别是胃肠道和肝脏癌症。2-6 PPIs潜在致癌性的一个被提出的机制是它们对胃酸产生的有效抑制，这可能导致高胃素血症。由于胃泌素对胰腺、胃、结肠和食管粘膜等组织的促生长作用，高胃泌素血症可促进消化系统的癌变此外，长期使用PPIs可能会改变肠道微生物群多样性，增加肠道感染和肝脏炎症的风险，这可能会导致肝纤维化的发展，而肝纤维化是肝癌发生的关键因素。8,9肝细胞癌（HCC）是最常见的原发性肝癌，也是全球癌症相关死亡的第四大原因。HCC的几个危险因素已被确定，包括乙型或丙型肝炎病毒感染、脂肪肝疾病和肝硬化我们之前在台湾人群中进行的一项研究，使用倾向评分匹配分析，证明PPIs的使用与慢性乙型肝炎或丙型肝炎患者发生HCC的风险增加无关。同样，另一项来自全国代表性的韩国队列的研究发现，在选定的人群中，如肥胖、老年或慢性肝病患者，PPIs的使用没有增加HCC的风险然而，之前的两项荟萃分析报告了关于PPIs使用与HCC风险之间关系的相互矛盾的结果。此外，我们最近基于台湾人群的队列研究显示，肝切除术后HCC患者长期使用PPIs可能与更长的无复发生存期相关。在《消化医学进展》中，Yi和他的同事调查了PPIs使用与肝癌风险之间的关系，提出了新的证据他们的荟萃分析显示PPIs使用与肝癌风险增加之间存在显著关联（95%可信区间1.44-1.98,p < .001）。然而，在本研究和以往的研究中观察到的相关性很弱，缺乏剂量依赖效应，并且报道的比值比小于3，这表明残留的混杂而不是因果关系可能是导致这些发现的原因。总之，使用PPI与肝癌风险之间的关系仍然存在争议。避免不适当的长期使用ppi是至关重要的。然而，对这些研究的过度解读和耸人听闻导致了公众的错误信息。因此，需要更多的前瞻性、大规模、长期随访的随机对照临床试验来进一步研究PPI使用与肝癌的关系。作者声明无利益冲突。

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引用次数: 0

2024 Reviewer Acknowledgment 2024审稿人致谢

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-12-02 DOI: 10.1002/aid2.13435

Consistent high-quality of papers published in Advances in Digestive Medicine (AIDM) can only be maintained with the cooperation and dedication of a number of expert referees. The Editors would like to thank all those who have donated the hours necessary to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the journal to maintain its tradition of excellence. We are grateful to the following reviewers for their contributions during 2024.

Allen, Jacqui

Chang, Chen-Wang

Chang, Li-Chun

Chang, Wei-Kuo

Chang, Wei-Lun

Chang, Wei-Yuan

Chen, Hsuan-Wei

Chen, Jiann-Hwa

Chen, Kuan-Chih

Chen, Kuan-Yang

Chen, Mei-Jyh

Chen, Ming-Jen

Chen, Ming-Yao

Chen, Peng-Jen

Chen, Po-Yueh

Cheng, Pin-Nan

Chien, Hsi-Yuan

Chien, Shih-Chieh

Chou, Chu-Kuang

Chou, Jen-Wei

Chu, Cheng-Hsin

Chu, Yin-Yi

Chuah, Seng-Kee

Chuah, Yoen Young

Chung, Chen-Shuan

Feng, I-Che

Han, Ming-Lun

Hsieh, Ming-Tsung

Hsu, Chao-Wei

Hsu, Ching-Sheng

Hsu, Ping-I

Hsu, Wei-Fan

Hsu, Wen-Feng

Hsu, Wen-Hung

Hsu, Yao-Chun

Huang, Jee-Fu

Huang, Tien-Yu

Huang, Wei-Chen

Hung, Chao-Hung

Hung, Jui-Sheng

Kao, Sung-Shuo

Kao, Wei-Yu

Kitagawa, Koh

Kuo, Chia-Jung

Kuo, Hsin-Yu

Kuo, Kuang-Tai

Kuo, Yuan-Hung

Kuo, Yu-Ting

Lai, Hsueh-Chou

Le, Puo-Hsien

Lee, Ching-Tai

Lee, Chung-Ying

Lee, I-Cheng

Lee, Kuei-Chuan

Lee, Tsung-Chun

Lee, Tzong-Hsi

Lei, Wei-Yi

Liang, Chih-Ming

Liao, Szu-Chia

Liao, Wei-Chih

Lien, Gi-Shih

Lin, Cheng-Kuan

Lin, Chih-Lin

Lin, Chih-Wen

Lin, Ching-Pin

Lin, Jung-Chun

Lin, Meng-Ying

Lin, Tsung-Jung

Lin, Yu-Min

Liou, Jyh-Ming

Liu, Chen-Hua

Liu, Nai-Jen

Luo, Jiing-Chyuan

Moon, Jong Ho

Peng, Cheng-Yuan

Shieh, Tze-Yu

Shih, Yu-Lueng

Shiu, Sz-Iuan

Su, Chien-Wei

Sun, Meng-Shun

Tai, Chi-Ming

Tsai, Kun-Feng

Tsai, Ming-Chao

Tsai, Ming-Hung

Tsai, Tzung-Jiun

Tseng, Cheng-Hao

Tseng, Chih-Wei

Tseng, Kuo-Chih

Tseng, Ping-Huei

Tseng, Tai-Chung

Tsou, Yung-Kuan

Tu, Chia-Hung

Wang, Chia-Chi

Wang, Yao-Sheng

Wang, Yen-Po

Wong, Ming-Wun

Wu, I-Chen

Yang, Hung-Chih

Yang, Tzu-Wei

Yang, Yao-Jong

Yeh, Hsing-Jung

Yeh, Jen-Hao

Yen, Hsu-Heng

在《Advances in Digestive Medicine》（AIDM）上发表的论文，只有在众多专家审稿人的合作和奉献下才能保持一致的高质量。编辑们要感谢所有花时间审阅、评价和评论稿件的人；他们兢兢业业的努力使杂志保持了精益求精的传统。我们感谢以下审稿人在2024年所做的贡献。Allen, jacquchang，陈望chang，李春chang，张伟国，张伟伦，陈伟元，陈宣伟，陈建华，陈宽之，陈宽洋，陈美杰，陈明珍，陈明珍，陈明耀，陈鹏珍，郑宝岳，陈品南，陈锡远，周世杰，周楚光，陈振伟，朱成新，尹一桦，宋可桦，尹永钟，陈双峰，韩奕彻，谢明伦，苏明忠，徐超伟，徐清胜，徐平一，徐伟凡，徐文峰，徐文宏，黄耀春，黄洁福，黄天宇，洪伟臣，洪朝宏，高瑞生，高圣硕，北川唯幸，郭郭，郭嘉中，郭新宇，郭光泰，郭元鸿，赖玉婷，lesueh - chooule，李国贤，Ching-TaiLee, Chung-YingLee, I-ChengLee，桂传李，宗春，Tzong-HsiLei, weichihhliang，廖志明，Szu-ChiaLiao, weichihhlien, ching - shihlin, cheng - kwan, lin chihlin, chihwenlin, Ching-PinLin, Jung-ChunLin, mengying lin, Jung-ChunLin, liyu - minou, Jyh-MingLiu，陈华柳、骆乃珍、月景川、钟合鹏、郑元石、子玉石、玉銮石、思元苏、建伟孙、孟顺泰、蔡志明、蔡坤峰、蔡明超、蔡明洪、曾宗俊、郑浩森、志伟森、郭志诚、平辉辉、太忠祖、永宽图、王家鸿、王家赤、王耀胜、颜宝通、吴明武、杨奕晨、杨宏哲、杨成贤、邢俊杰、颜仁浩、徐恒

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引用次数: 0

The nursing roles in caring for patients with inflammatory bowel disease 护理炎症性肠病患者的护理角色

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-09-26 DOI: 10.1002/aid2.13430

Chen-Wang Chang

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by recurring inflammation and severe mucosal damage in the intestine. In Taiwan, there has been a rapid increase in the incidence and prevalence of IBD, posing significant challenges for patient care.1 A newly diagnosed patient with IBD may face uncertainty about the future and worry about their prognosis. Unfortunately, IBD is a chronic condition that can vary significantly in terms of its extent, severity, and activity. Some patients may develop disease that is refractory to available treatments, leading to a significant decline in quality of life.1, 2Refractory IBD patients are at increased risk of malnutrition and psychological complications.3 When assessing the reasons for treatment failure, it is essential to rule out any concomitant clinical conditions, evaluate potential disease complications, assess patient adherence to therapy, and explore opportunities for treatment optimization.2 There are numerous factors that can influence medication adherence, including infections, pregnancy, drug delivery methods, and patient concerns about potential complications.1, 4 Among patients with IBD, medication nonadherence rates range from 7% to 72%. This is a significant contributing factor to treatment refractoriness or loss of response.5 According to the study, regarding concerns about adverse reactions, 38.8% of patients reported never or rarely feeling worried, while 40.3% felt sometimes worried, 12.8% often worried, and 6.1% always worried.5 A study revealed that the COVID-19 pandemic led to changes in the medical behavior of IBD patients. However, educational interventions by clinicians and IBD nurses successfully reduced anxiety levels and enhanced medication adherence.4 During pregnancy, clinicians or patients may also change the drug regimen due to concerns about side effects.1A multidisciplinary team (MDT) in IBD care consists of healthcare professionals from various disciplines who collaborate to provide comprehensive patient care. However, nursing roles within MDTs for IBD patients can vary significantly across different regions of the world.3 According to the second N-ECCO consensus statements on European IBD care, nurses working in any setting that involves contact with IBD patients need a fundamental understanding of the diseases, including the distinction between Crohn's disease and ulcerative colitis. They must also recognize the importance of timely therapeutic interventions. Nurses should cultivate empathy and active listening skills, and be able to provide essential IBD-related information and holistic support.6 In Taiwan, the institutionalization of IBD nurse specialists

炎症性肠病（IBD）是一种慢性胃肠道疾病，以反复发作的炎症和严重的肠道黏膜损伤为特征。在台湾，IBD 的发病率和流行率迅速上升，给患者护理带来了巨大挑战。1 新确诊的 IBD 患者可能会面临对未来的不确定性和对预后的担忧。不幸的是，IBD 是一种慢性疾病，其范围、严重程度和活动性都会有很大的不同。3 在评估治疗失败的原因时，必须排除任何并发症，评估潜在的疾病并发症，评估患者对治疗的依从性，并探索优化治疗的机会。影响患者坚持用药的因素有很多，包括感染、妊娠、给药方式以及患者对潜在并发症的担忧。5 一项研究显示，COVID-19 大流行导致了 IBD 患者医疗行为的改变。然而，临床医生和 IBD 护士的教育干预成功地降低了患者的焦虑水平，提高了患者的服药依从性。4 在怀孕期间，临床医生或患者也可能因担心副作用而改变用药方案。1A IBD 护理中的多学科团队（MDT）由来自不同学科的医护人员组成，他们相互协作，为患者提供全面的护理。3 根据 N-ECCO 关于欧洲 IBD 护理的第二份共识声明，在任何与 IBD 患者接触的环境中工作的护士都需要对疾病有基本的了解，包括区分克罗恩病和溃疡性结肠炎。他们还必须认识到及时进行治疗干预的重要性。护士应培养同理心和积极倾听的技能，并能够提供与 IBD 相关的基本信息和整体支持。研究显示，关于 IBD 护理服务在疾病教育、用药教育和门诊时间安排方面的有用性，约有 10.9%-12.5% 的患者认为有用，78.1% 的患者认为非常有用。3 此外，IBD 护士在 IBD MDT 中扮演着至关重要的角色，是连接消化内科医生和结直肠外科医生的桥梁。他们要满足患者广泛的护理需求，从沟通和治疗教育到更复杂问题的处理，如瘘管护理。难治性 IBD 的心理发病率也应得到认可；这是由多次治疗失败的影响、意识到疾病结果可能不理想、频繁接触阿片类药物、以及症状波动或持续不愈造成的巨大痛苦所驱动的。IBD 护士在患者护理中发挥着关键作用，通常包括患者教育、疾病管理、营养咨询和伤口护理。此外，他们还协助患者处理可能影响病程的日常生活问题，如饮食和性生活。7 总之，IBD 护理的作用在包括台湾在内的全球范围内日益得到认可，是有效 IBD 医疗服务的基本组成部分，并已在 MDT 中牢固确立。

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引用次数: 0

Gastric goblet cell adenocarcinoma

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-09-17 DOI: 10.1002/aid2.13431

Jiaxing Ma, Xingjie Shen, Liang Liu

A 75-year-old man was hospitalized with a 6 months history of intermittent abdominal pain and discomfort. The patient has a long history of hypertension and coronary heart disease. No obvious abnormalities were found in the laboratory and abdominal physical examination. Gastroscopy revealed a superficial concave lesion of approximately 1.5 × 2.0 cm in size on the anterior wall of the gastric antrum, with surrounding mucosal protrusions. We took multiple mucosal biopsies, and the pathological results of the biopsies showed intramucosal carcinoma. According to the Paris classification of early gastric cancer, the lesion is morphologically classified as 0-IIa + IIc.1 The patient requested diagnostic endoscopic submucosal dissection (ESD). Endoscopic ultrasonography showed that the submucosa was slightly thickened and irregular (Figure 1). The lesion had a positive lift sign during the ESD, and there was no adhesion between the lesion base and surrounding tissue (Figure 1). Histologically, the lesion consists of two parts: a moderately to poorly differentiated tubular adenocarcinoma and a tumor composed of goblet mucous cells. The tumor volume ratio was about 4.5:5.5. Goblet mucous cells are arranged in a nested pattern. The nucleus is small and compressed. The cytoplasm is rich in mucin. Most tumor clusters are solid, without lumen formation, typical nuclear atypia is not significant, the nuclear division is rare, and scattered in individual panellian cells. Immunohistochemistry showed that Syn, CgA, MUC-2, MUC-5AC, and MUC-6 were partially positive. In addition, the Ki-67 proliferative index in the goblet-like cells was more than 70%. The postoperative pathology and immunohistochemical results showed goblet cell adenocarcinoma (GCA) (Figure 2). The lesion invaded the submucosal layer by 1200 microns. Subsequently, the patient was transferred to gastrointestinal surgery for additional surgical treatment.In earlier years, this type of tumor was considered to be a mixed glandular neuroendocrine tumor, with a morphology intermediate between carcinoid and adenocarcinoma and characterized by bidirectional differentiation. In 2019, the World Health Organization named this type of tumor as the GCA. GCA mostly occurs in elderly patients and is commonly seen in the appendix,2, 3 as well as in the colon and anus, and is rare to occur in the stomach. GCA has a biological behavior similar to that of conventional adenocarcinoma which with aggressiveness in both histological morphology and biological behavior. Combined with immunohistochemistry helps in the diagnosis and differential diagnosis.Jiaxing Ma contributed to writing of the manuscript. Xingjie Shen contributed to acquisition of data and Liang Liu contributed to drafting the article or revising it critically for important intellectual content.The authors declare no conflicts of interest.Informed consent was obtained from the p

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引用次数: 0

An unusual subepithelial tumor of gastritis cystica profunda 一种不常见的深部胃炎上皮下肿瘤

IF 0.3 Q4 GASTROENTEROLOGY & HEPATOLOGY

Advances in Digestive Medicine

Pub Date : 2024-07-25 DOI: 10.1002/aid2.13411

Kai-Jie Lin, Hsiang-Yao Shih, Yu-Chung Hsu, Yi-Hsun Chen

Gastritis cystica profunda (GCP) is a rare disease characterized by the formation of non-neoplastic cysts that can penetrate deep into the submucosal layer of the stomach.1, 2 We presented two GCP cases without systemic diseases or abdominal operation history that were incidentally found by routine esophagogastroduodenoscopy (EGD) exams. We also shared different strategies for tumor resection according to endoscopic ultrasonography (EUS) evaluation.Case one was a 51-year-old female and was transferred to our hospital due to a 0.8 cm subepithelial lesion (SEL) at gastric body (Figure 1A) found in local clinic. The EUS exam showed one polypoid lesion with mixed echoic, heterogeneous, and suspected cystic pattern originating from the muscularis mucosa layer with 9.0 × 6.0 mm2 in size (Figure 1B). Based on the invasion of the muscularis mucosa layer only and its pedunculated characteristic, we conducted a polypectomy for the tumor. The specimen revealed herniation of cystically dilated glands through the muscularis mucosa into the submucosa (Figure 1C,D).Case two was a 65-year-old female with a 1.0 cm SET at antrum on EGD (Figure 2A). The EUS revealed one 22.1 × 6.5 mm2 isoechoic, heterogeneous, and suspected cystic lesion subepithelial tumor originating from the propria muscularis layer (Figure 2B). We carried out a full-layer endoscopic submucosal dissection (ESD) using a tunnel technique, with complete resection of the tumor. The pathology disclosed dilated cysts with disorganized smooth muscle in the stroma (Figure 2C), and the immunohistochemical study showed positive for CKAE1/AE3 (Figure 2D), which was compatible with the diagnosis of gastric cystica profunda.The pathophysiology of GCP is linked to chronic inflammation and ischemia from different etiologies (such as prior gastric surgery or bacterial infections) and eventually leads to submucosal cysts formation.1, 2 In EUS, most GCP cases showed irregularly heterogeneous, hypo- to anechoic cystic components, and could arise from different subepithelial layers.3 As a result, the differential diagnosis from EUS finding is very challenging due to its heterogenous character and different subepithelial layers origin, and some lesions such as gastrointestinal stroma tumor, leiomyoma or ectopic pancreas should be taken into consideration. Pathology is the gold standard to make diagnosis of GCP. The malignant potential of GCP is still in debate. Treatment options include observation for the relatively small and asymptomatic cysts, and endoscopic resection or surgical excision for symptomatic or large lesions.4, 5 More studies and long-term surveillance is still essential for patients with GCP.Kai-Jie Lin: Case data collection and wrote the manuscript. Hsiang-Yao Shih: Case provider and review of the manuscript. Yu-Chung Hsu: Patholog

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引用次数: 0