Advances in Digestive Medicine最新文献

The significant reduction in global colorectal cancer screenings due to the COVID-19 pandemic, which led to an increase in the diagnosis of advanced cases rate in short periods, prompted this comprehensive retrospective study at Chi Mei Medical Center (CMMC) in Southern Taiwan. Conducted from January 2017 to December 2022, the study aimed to understand the impacts of these disruptions on the healthcare system, particularly focusing on emergency department (ED) visits, hospitalizations, and mortality rates. Utilizing statistical methodologies such as Pearson's chi-square and Fisher's exact tests for categorical data, alongside the t-test and Wilcoxon rank-sum test for continuous data, this research compared the epidemiological and clinical outcomes across pre-pandemic and pandemic periods. Kaplan–Meier plots, coupled with log-rank tests, were employed to analyze mortality trends effectively. Among 3373 individuals who tested positive via fecal immunochemical tests (FIT), 96 patients were diagnosed with colorectal cancer before the COVID-19 pandemic, and 89 during it. The pathological staging indicated a consistent early-stage diagnosis rate of around 65% (p = .876). In addition, it revealed no significant changes in the frequency of ED visits and hospitalizations. Despite the pandemic's challenges and its extended duration, the median time to death and one-year mortality remained stable, underscoring the effectiveness of robust healthcare strategies in maintaining high-quality cancer screenings and managing patient care during public health crises. This research highlights the critical need for ongoing evaluations of healthcare protocols to mitigate the impacts of global health emergencies on diagnostic processes.

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.

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, 9}

Hepatocellular 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.¹³

In 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.¹⁵

In conclusion, the relationship between PPI use and the risk of liver cancer rem

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

Both hepatitis C virus (HCV) infection and end-stage renal disease are associated with an increased risk of developing peripheral arterial disease (PAD). Our objective was to explore the relationship between HCV infection and PAD in hemodialysis patients, using brachial-ankle pulse wave velocity (baPWV) as the assessment method. Since 2016, we have actively been recruiting patients undergoing regular hemodialysis three times a week. All baPWV assessments for our patients were performed before the implementation of direct-acting antiviral treatment. Furthermore, none of the uremic patients with HCV infection had received interferon-based treatment in the past. An elevated baPWV measurement surpassing 2100 cm/s is indicative of an increased susceptibility to potential PAD. Our analysis utilized multivariate linear and logistic regression analysis. Individuals with HCV infection exhibited higher baPWV levels compared with those without HCV infection (2006.0 ± 687.4 vs. 1809.3 ± 466.1 cm/s, p = .039). The presence of HCV infection (β = 199.56, 95% CI: 10.56–388.56, p = .039) demonstrated a significantly positive correlation with baPWV levels. In the multivariate logistic regression analysis, HCV infection (OR = 2.67, 95% CI: 1.07–6.68, p = .036) significantly associated with baPWV >2100 cm/s. Furthermore, individuals with a higher viral load (HCV RNA ≥60 × 10³ IU/mL) (OR = 4.45, 95% CI: 1.12–17.68, p = .034) demonstrated a significant association with baPWV ≥2100 cm/s when compared with non-HCV infection patients. Additionally, patients with genotype I exhibited a significant association with baPWV ≥2100 cm/s (OR = 8.13, 95% CI: 2.04–32.42, p = .003) in comparison to non-HCV patients. The presence of HCV infection has been demonstrated to markedly increase baPWV levels. Particularly, HCV infection with higher viral load and genotype I is significantly linked to an elevated risk of PAD. It emphasizes the importance of HCV elimination in the specific population.

The incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.

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

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

Currently, reports comparing radiation exposure associated with endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for acute cholecystitis are lacking. Therefore, we aimed to evaluate the radiation exposure during ETGBD and EUS-GBD. We retrospectively investigated patients with acute cholecystitis who underwent ETGBD or EUS-GBD between January 2020 and September 2023. All procedures were performed using the same fluoroscopy device with an overcouch x-ray tube. Parameters such as fluoroscopy time, number of radiographs, and estimated entrance surface dose were assessed for radiation exposure. After excluding patients with choledocholithiasis or acute cholangitis, a comparative analysis of patient characteristics and procedural outcomes was performed between the ETGBD and EUS-GBD groups. Forty-four patients (21 and 23 in the ETGBD and EUS-GBD groups, respectively) were assessed. Although there was no significant difference in patients with an American Society of Anesthesiologists physical status ≥3 between the groups, the EUS-GBD group had a higher proportion of older patients than the ETGBD group. The EUS-GBD group demonstrated a shorter procedure time (38 vs. 59 min, p < .001), shorter fluoroscopy time (964 vs. 1829 s, p < .001), fewer radiographs (22.9 vs. 28.4 images, p < .001), and lower estimated entrance surface dose (85.2 vs. 149.3 mGy, p < .001) compared to the ETGBD group. The EUS-GBD group had a higher procedural success rate than the ETGBD group (100% vs. 57.1%, p < .001), with no significant difference in the incidence of early adverse events (17.4% vs. 9.5%, p = .67). In patients with permanent stenting, the 1-year cumulative incidence of symptomatic late adverse events (recurrence of acute cholecystitis and other adverse events) was significantly lower in the EUS-GBD group than in the ETGBD group (p = .045). In patients without concurrent bile duct stones or cholangitis, EUS-GBD demonstrated shorter procedure and fluoroscopy times, required fewer radiographs, and had a significantly higher procedural success rate than ETGBD.