Clinical and Translational Gastroenterology最新文献

{"title":"Quality Indicators of Endoscopists for Both Index and Surveillance Colonoscopy are Associated With Risk of Metachronous Colorectal Neoplasia.","authors":"Aasma Shaukat, Jennifer Holub, Peter Liang, Mohammad Bilal, Seth Gross, Mark Pochapin","doi":"10.14309/ctg.0000000000001016","DOIUrl":"10.14309/ctg.0000000000001016","url":null,"abstract":"<p><strong>Introduction: </strong>An association between higher adenoma detection rate (ADR) at index screening colonoscopy and lower risk of metachronous advanced neoplasia (AN, defined as colorectal cancer [CRC] or advanced adenoma [AA]) has been reported. However, the relationship between ADR at both index and surveillance colonoscopy and subsequent AN is unknown. We examined the association between ADR and withdrawal time (WT) at index and surveillance colonoscopy and risk of metachronous AN at surveillance colonoscopy.</p><p><strong>Methods: </strong>We used GIQuIC, a repository of colonoscopies across the United States. Each patient has a unique ID at a participating site. Endoscopist national provider identifiers are associated with each examination. We included patients with 2 colonoscopies at least 3 years apart (index and surveillance) between 2011 and 2022 and calculated the ADR and average WT for the endoscopist performing the index and surveillance colonoscopies, respectively. We built a multivariable logistic regression model with metachronous AN as the outcome and ADR and WT as independent variables, controlling for patient age, sex, and race.</p><p><strong>Results: </strong>We included 768,274 patients and 3,425 endoscopists. Mean patient age was 61 years and 48% were men; 66% were White, and 3% were Hispanic. Indication for index colonoscopy were screening (43.4%), surveillance (39.0%), and diagnostic (17.6%). ADR quartiles were ≤29.7%, >29.7%-37.2%, >37.2%-45.0%, and >45%. WT quartiles were ≤7.1 minutes, >7.1-8.2 minutes, >8.2-9.7 minutes, and >9.7 minutes. AN detection was lowest when low ADR endoscopists performed both index and surveillance examinations (5.4%, Table 1) and high ADR index examinations were followed by low ADR surveillance examinations (4.0%). Compared with low ADR endoscopists for both index and surveillance examinations, advanced neoplasia detection was significantly higher when both examinations performed by a high ADR endoscopist (AA 7.4%; OR [odds ratio] for AN 1.10 [1.05-1.16]) or low ADR index examinations were followed by high ADR surveillance examinations (AA 13.3%; OR for AN 1.448 [1.37-1.51]). Compared with short WT endoscopists for both examinations (AA 7.2%; CRC 0.3%), AN detection was higher when both examinations were performed by a long WT endoscopist or short WT index examinations were followed by long WT surveillance examinations (AA 7.0% P = 0.53 and 9.9%, P < 0.001) but similar CRC detection of 0.2% and 0.2% ( P 0.14). Other factors associated with finding of metachronous AN were older age (76 years and older vs 45-55 years OR 1.64; 95% CI 1.48, 1.82), male sex (Male vs female OR 1.15; 95% CI 1.10-1.19), White race compared with non-White (OR 1.10; 95% CI 1.06, 1.14), 7-10 years between examinations compared with 3-5 years between examinations (OR 1.24; 95% CI 1.11, 1.37), indication of surveillance vs screening for the index examination (OR 1.1.7; 95% CI 1.13, 1.22), AA or sessile serrated ","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Prevalence of Functional Constipation Across All Age Groups According to Rome II-IV Criteria, 1999-2025: A Systematic Review and Meta-Analysis.","authors":"Ji Won Youn, Hajung Joo, Soeun Kim, Jeongseon Oh, Hyunyi Yoo, Jae Sung Ko, Jin Soo Moon, Jong Woo Hahn, Dong Keon Yon","doi":"10.14309/ctg.0000000000001029","DOIUrl":"10.14309/ctg.0000000000001029","url":null,"abstract":"<p><strong>Introduction: </strong>The most recent global estimates of functional constipation (FC) were reported in 2020 for adults and in 2017 for children; however, no comprehensive update encompassing all age groups has been published since then. Thus, we aimed to provide an updated, standardized global estimate of FC prevalence across all age groups using the Rome criteria.</p><p><strong>Methods: </strong>We systematically searched PubMed/MEDLINE, Embase, CINAHL, and Cochrane Library, from inception to March 28, 2025, for population-based observational studies reporting FC prevalence according to Rome II, III, or IV criteria. Eligible studies included cross-sectional or prospective designs involving children, adults, or older population. Studies without Rome-based definitions, extractable prevalence data, or population-based sampling were excluded. The primary outcome was pooled prevalence of FC. Subgroup analyses were performed by Rome version, diagnostic method, geographic region, age, sex, and behavioral factors.</p><p><strong>Results: </strong>From 12,574 identified records, a total of 128 studies from 44 countries comprising 459,061 participants met inclusion criteria. The global pooled prevalence of FC was 12.14% (95% CI, 11.14-13.23; I 2 = 98.99%). Prevalence was higher in female patients (14.60% [12.50-17.04]; I 2 = 99.01%) than male patients (10.62% [8.84-12.75]; I 2 = 98.74%). By age, prevalence was highest in older population (19.89% [95% CI, 14.67-26.97]; I 2 = 98.77%), followed by children (12.06% [11.05-13.16]; I 2 = 97.85%) and adults (9.50% [8.11-11.14]; I 2 = 99.12%). The pooled prevalence was highest with Rome II (12.68% [95% CI, 8.02-20.04]; I 2 = 99.31%) and lowest with Rome IV (10.34% [9.11-11.75]; I 2 = 98.79%).</p><p><strong>Discussion: </strong>FC is a highly prevalent global disorder, with substantial variation by age, sex, diagnostic criteria, country, and region. Standardized population-based assessments using validated Rome criteria are essential to inform clinical practice and public health strategies.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Validation of AI-Assisted Evaluation of Indeterminate Biliary Strictures in Digital-Single Operator Cholangioscopy: A Transcontinental Multicentric Study.","authors":"Miguel Mascarenhas, Jessica Widmer, Francisco Mendes, Tiago Ribeiro, Antonio Pinto da Costa, Belén Agudo, Miguel Martins, João Afonso, Joana Mota, Maria João Almeida, Pedro Cardoso, Joana Frias, Catarina Araújo, Hélder Cardoso, Maria Plaza González, Ana Pérez-González, Marcos Eduardo Lera Dos Santos, Maria Moris, Ana Garcia Garcia de Paredes, José Foruny, Luiza Bicudo de Oliveira, Matheus Ferreira de Carvalho, Fauze Maluf-Filho, Maria Clara Ferreira, Tomazo Prince, Andrea Velasquez, Ivan Enrique González, João Ferreira, Grace E Kim, Uzma D Siddiqui, Laleh R Omrani, Naif Alrossais, Mathew Keegan, Perveen Aslam, Vipul Aggarwal, Filipe Vilas-Boas, Pedro Pereira, Luis Carlos Sabbagh, Aymen Almuhaidb, Eduardo Guimarães Hourneaux De Moura, Guilherme Macedo, Mariano González-Haba","doi":"10.14309/ctg.0000000000001015","DOIUrl":"10.14309/ctg.0000000000001015","url":null,"abstract":"<p><strong>Introduction: </strong>Biliary strictures (BS) are a significant challenge, with malignant strictures frequently diagnosed at advanced stages, limiting curative options. Digital single-operator cholangioscopy (D-SOC) enables high-resolution, direct visualization of the bile duct, yet with suboptimal accuracy. Artificial intelligence (AI) has shown promise for detection and differentiation of BS in frame-level analysis and small clinical series. This study aimed to validate a deep learning model for AI-assisted D-SOC image analysis.</p><p><strong>Methods: </strong>This multicenter study included 135 D-SOC examinations from 129 patients (61 with malignant BS) across 14 centers in the United States, Brazil, Spain, Colombia, Australia, and Saudi Arabia. For each examination, up to 25 clinically relevant frames were selected and uploaded to a web-based platform for AI analysis. The model performed both detection and differentiation of BS: Detection was assessed by comparing AI-generated bounding boxes with expert-defined annotations using intersection-over-union (IoU), while differentiation was benchmarked against histopathology. Performance metrics included accuracy, sensitivity, specificity, and positive and negative predictive values.</p><p><strong>Results: </strong>At the patient level, malignant BS were identified with 86.0% accuracy, 84.1% sensitivity, and 85.7% specificity, with an area under the curve of 0.904. The model demonstrated robust detection performance, achieving a mean IoU of 70.3%. Performance was maintained across demographic variables and centers.</p><p><strong>Discussion: </strong>This first multicentric validation study demonstrates real-world performance of AI-assisted D-SOC analysis across multiples continents and devices, with robust accuracy for BS detection and differentiation. These findings support AI as an adjunctive tool in D-SOC, enhancing a more accurate evaluation of patients with indeterminate BS.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted confocal laser endomicroscopy for predicting invasion depth of superficial esophageal mucosal lesions: a cohort study.","authors":"Yue Xu, Renquan Luo, Jiali Tang, Lu Liu, Haideng Yang, Jinbang Peng, Zhenzhen Wang, Xiuxiu Jin, Lingyan Shen, Lingling Yan, Jiacheng Li, Binbin Gu, Jun Wang, Xiang Jin, Xianbin Zhou, Ying Zhou, Jiaxiu Ying, Congni Zhu, Siyan Yan, Shaowei Li, Yu Zhang, Xinli Mao","doi":"10.14309/ctg.0000000000001044","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001044","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate assessment of invasion depth in esophageal squamous cell carcinoma (ESCC) is essential for optimal treatment. Probe-based confocal laser endomicroscopy (pCLE) enables real-time in vivo imaging, but its interpretation depends heavily on endoscopist expertise. This study aimed to develop and validate an artificial intelligence-assisted pCLE (AI-pCLE) system for the differential diagnosis of low-grade intraepithelial neoplasia (LGIN) from high-grade intraepithelial neoplasia with submucosal invasion (HGIN-SM1).</p><p><strong>Methods: </strong>In this retrospective single-center study, 1234 pCLE images were used to develop and validate the AI model. Histopathology from resected specimens served as the reference standard. Six deep learning algorithms were evaluated using accuracy, sensitivity, specificity, area under the curve, positive predictive value (PPV), and negative predictive value (NPV). The best-performing model was selected and compared with 10 endoscopists.</p><p><strong>Results: </strong>For the differentiation between LGIN and HGIN-SM1 lesions, the AI-pCLE system exhibited a sensitivity of 97.4%, specificity of 92.6%, accuracy of 95.3%, PPV of 94.17%, and NPV of 96.70%, respectively. In comparison, the mean sensitivity, specificity, accuracy, PPV, and NPV of the endoscopists were 83.79%, 85.26%, 84.46%, 88.14%, and 82.61%, respectively. With AI-pCLE assistance, the accuracy, sensitivity, and NPV of the endoscopists increased to 94.41% (P=0.001), 96.98% (P=0.006), and 96.24% (P=0.001), respectively. The diagnostic performance of the AI-assisted system was comparable to that of expert endoscopists.</p><p><strong>Conclusions: </strong>The AI-pCLE system demonstrated robust diagnostic performance in differentiating LGIN from HGIN-SM1 lesions, indicating its potential as a reliable tool for evaluating the invasion depth of ESCC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Long-Term Treatment With Budesonide Orodispersible Tablets in Patients With Eosinophilic Esophagitis.","authors":"Gaia Pellegatta, Francesca Paola Giugliano, Valeria Poletti, Giacomo Marcozzi, Emanuela Morenghi, Francesca Racca, Enrico Heffler, Marco Spadaccini, Davide Massimi, Roberta Maselli, Cesare Hassan, Alessandro Repici","doi":"10.14309/ctg.0000000000001024","DOIUrl":"10.14309/ctg.0000000000001024","url":null,"abstract":"<p><strong>Introduction: </strong>Budesonide orodispersible tablets (BOT) has improved eosinophilic esophagitis (EoE) outcomes. This study aimed to evaluate in real-life the efficacy of BOT and adverse events in induction and maintenance therapy.</p><p><strong>Methods: </strong>Patients with EoE receiving BOT (2 mg/day induction, 1 mg/day maintenance) were retrospectively analyzed over a 1-year follow-up. Clinical (Straumann Dysphagia Index [SDI]), endoscopic (Endoscopic Reference Score [EREFS]), and histological (eosinophils <15/HPF) responses were assessed at 12 weeks (T1) and 52 weeks (T2).</p><p><strong>Results: </strong>Among 104 patients enrolled, at T1 97.8% of patients achieved histologic remission and 70.3% maintained remission at T2 with a significant improvement of EREFS and SDI. Higher SDI during induction (odds ratio [OR]: 0.72; 95% CI: 0.56-0.93) and maintenance (OR: 0.65; 95% CI: 0.52-0.82) predicted loss of histologic remission at T2. BOT-proton pump inhibitor (PPI) coadministration during maintenance therapy increased the probability for histological response at T2 (OR: 7.8; 95% CI: 2.4-25.4). After induction, significant increase in incidence of erosive esophagitis was observed (2.2% vs 13.0%, P = 0.013), with BOT-PPI coadministration being protective toward it (OR: 0.14; 95% CI: 0.03-0.54). Local candidiasis was the most common adverse events at T1 and T2. Risk factors of candidiasis included a history of gastroesophageal reflux disease (OR: 3.71; 95% CI: 1.14-12.09), EoE family history (OR: 16.94; 95% CI: 1.78-161.4), oral allergy syndrome (OR: 3.53; 95% CI: 1.29-9.66).</p><p><strong>Discussion: </strong>BOT is effective and overall safe in inducing and maintaining EoE remission. Erosive esophagitis incidence is higher during BOT therapy, supporting BOT-PPI combination in select cases. Clinical monitoring with SDI may help guide maintenance therapy and follow-up timing.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Architecture Screening in Hospitalized Patients With Inflammatory Bowel Diseases: A Prospective Propensity Score-Matched Analysis.","authors":"Xiu'e Zhou, Xiaoliang Wang","doi":"10.14309/ctg.0000000000000964","DOIUrl":"10.14309/ctg.0000000000000964","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the effectiveness of sleep architecture screening in hospitalized patients with inflammatory bowel diseases (IBD) from the viewpoint of long-term survival from IBDs worsening.</p><p><strong>Methods: </strong>A total of 1,024 patients were prospectively enrolled and stratified into screening cohort, receiving sleep architecture screening through the polysomnography approach, and control cohort matched by a 1:1 propensity score method. Primary endpoint was survival from disease progression including treatment escalation, severe infection, rehospitalization, emergency visit, or surgeries within 12 months after discharge. Secondary outcomes included complications and quality-adjusted life years.</p><p><strong>Results: </strong>The screening cohort identified that 53.5% of patients experienced sleep deprivation. N1, N2, N3, and rapid eye movement sleep accounted for 6.8%, 62.0%, 14.9%, and 16.3% of their total sleep time. During a mean follow-up of 8.6 ± 4.5 months, 26.8% and 46.6% of cases reported an IBD-related events in screening and control cohorts ( P = 0.005). The mean survival time from disease worsening was significantly longer in patients receiving screening than those in control cohort (11.68 [95% CI: 11.03-12.32] vs 9.46 [95% CI: 8.86-10.06] months, log-rank test P < 0.001), yielding a hazard ratio of 0.684 (95% CI: 0.554-0.746). Superiority was met because the 95% CI fell within the predefined superiority margin of 0.75. The means quality-adjusted life years across all time points were significantly higher in screening cohort compared with controls (all P < 0.05). No serious complications were observed.</p><p><strong>Discussion: </strong>Sleep architecture screening combined with specialized interventions in patients with IBD provided a better long-term survival from disease progression, resulting in a significant improvement in patients' quality of life within a 12-month follow-up.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse endoscopic full-thickness resection (R-EFTR) for gastric submucosal tumors with a predominant extraluminal growth pattern.","authors":"Ziyi Li, Zhukai Chen, Weikun Zhang, Lingnan He, Guang Yu, Ajun Gu, Shuxi Liu, Haibin Zhang, Jingjing Lian, Meidong Xu, Tao Chen","doi":"10.14309/ctg.0000000000001047","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001047","url":null,"abstract":"<p><strong>Background: </strong>Large gastrointestinal stromal tumors (GISTs) exhibiting a predominantly extraluminal growth pattern are characterized by a rich vascular supply and close proximity to adjacent organs, which pose significant challenges for endoscopic full-thickness resection (EFTR). This study aims to evaluate the feasibility and therapeutic outcomes of R-EFTR for gastric GISTs with a predominantly extraluminal growth pattern.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 43 consecutive patients who underwent R-EFTR for gastric GISTs exhibiting a predominant extraluminal growth pattern between March 2019 and December 2024. Data on clinicopathologic characteristics, surgical parameters, and follow-up outcomes were collected and analyzed.</p><p><strong>Results: </strong>Tumor sizes ranged from 2.0 to 5.0 cm, and en bloc resection by R-EFTR was successfully achieved in 41 tumors (95.3%). Notably, tumors larger than 3 cm significantly prolonged operative times (P < 0.001). Successful closure of gastric wall defects was accomplished using through-the-scope twin clips in 41.9% of cases, while 58.1% were closed using endoloop-clips. Closure with endoloop-clips was associated with longer procedure time (P = 0.037). The postoperative follow-up completion rate was 100%, achieved through clinic visits combined with endoscopic ultrasound and computed tomography. During the follow-up period, no patients experienced recurrence or metastasis.</p><p><strong>Conclusions: </strong>The findings of our study suggest that R-EFTR is a viable and effective treatment option for GISTs that exhibit a predominantly extraluminal growth pattern and measure between 2 and 5 cm. Tumor size greater than 3 cm was associated with increased procedural complexity, whereas the association with endoloop-clip closure should be interpreted cautiously.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Clip Closure to Prevent Bleeding After Colorectal Endoscopic Submucosal Dissection: A Cost-Effectiveness Study.","authors":"Daryl Ramai, Abdulrahman Qatomah, Patrick Magahis, Kobina Essilfie-Quaye, John Fang, Hiroyuki Aihara","doi":"10.14309/ctg.0000000000001043","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001043","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic submucosal dissection (ESD) enables en-bloc resection of large and complex colorectal neoplasms but is associated with a clinically significant risk of delayed bleeding. Prophylactic clip closure of post-ESD mucosal defects reduces bleeding risk; however, its routine use remains unclear. We evaluated the cost-effectiveness of prophylactic clipping following colorectal ESD.</p><p><strong>Methods: </strong>We developed a decision-analytic Markov model comparing colorectal ESD with prophylactic clip closure versus ESD without closure. The model incorporated probabilities of delayed bleeding, subsequent management pathways, costs, and health utilities. The primary outcome was the incremental cost-effectiveness ratio (ICER), evaluated against a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted life-year (QALY). Deterministic (one-way, two-way, and threshold) and probabilistic sensitivity analyses (10,000 Monte Carlo simulations) were performed.</p><p><strong>Results: </strong>In the base-case analysis, prophylactic clipping was more effective and more costly than no clipping, yielding an ICER of $88,843/QALY. The incremental cost was $1,102 with a QALY gain of 0.01. One-way sensitivity analyses demonstrated robust findings; clipping remained cost-effective provided total costs were below $8,943, and no clipping was favored only if delayed bleeding risk without clips fell below 3.12%. Probabilistic sensitivity analysis showed prophylactic clipping was the preferred strategy in 83.8% of simulations at a WTP of $100,000/QALY.</p><p><strong>Conclusions: </strong>Prophylactic clip closure following colorectal ESD appears to be a cost-effective strategy, with the potential to reduce delayed bleeding at an acceptable incremental cost. However, these findings are based on model assumptions and should be interpreted in the context of these parameters.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Chronic Constipation and Subtypes on Serum Trimethylamine-N-oxide Levels and Their Reduction with Treatment: Multicenter Observational Study.","authors":"Yo Ishihara, Eikichi Ihara, Hidenori Ohkubo, Mayumi Ohira, Naoki Tomita, Kota Takahashi, Shunsuke Oyamada, Takeo Kurihashi, Tomoyuki Iwasaki, Haruki Usuda, Koichiro Wada, Atsushi Nakajima, Takaomi Kessoku","doi":"10.14309/ctg.0000000000001046","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001046","url":null,"abstract":"<p><strong>Background: </strong>Chronic constipation (CC) is associated with increased cardiovascular events, and trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, has been recently shown to correlate with this risk. We examined how constipation status affects serum TMAO and how treatment modifies it.</p><p><strong>Methods: </strong>This prospective observational study (July 2023-September 2024), conducted at three Japanese centers. Healthy controls (HCs) were recruited during health checkups, and patients with CC recruited from outpatient clinics. Serum TMAO was measured using liquid chromatography-tandem mass spectrometry at baseline and at 4 and 12 weeks after treatment with magnesium oxide (MgO) or elobixibat. CC was classified as normal transit constipation (NTC) or slow-transit constipation (STC) by colonic transit time.</p><p><strong>Results: </strong>Overall, 72 HCs and 165 patients with CC (NTC, n = 110; STC, n = 55) were included. Mean serum TMAO levels were 1.8 [± 1.1] µM and 9.0 [± 8.1] µM in the HC and CC groups, respectively (p<0.01). Serum TMAO levels were significantly higher in the STC group than in the NTC group (p<0.01). Constipation treatment reduced serum TMAO levels to 5.5 ± 7.6 µM (n = 165, p<0.01) at 4weeks and 4.5 ± 7.6 µM (n = 165, p<0.01) at 12 weeks. Elobixibat lowered serum TMAO at 4 and 12 weeks in both NTC and STC. Conversely, MgO lowered TMAO only at 12 weeks in NTC and did not affect STC.</p><p><strong>Conclusions: </strong>Constipation status, particularly STC, is associated with elevated serum TMAO levels. MgO or elobixibat significantly reduced serum TMAO, with a greater reduction observed with elobixibat.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replication of endotypes in eosinophilic esophagitis using a curated gene panel compared to bulk sequencing and assessing stability over time.","authors":"Evan S Dellon, Yihsuan S Tsai, Joel S Parker, Siyao Liu","doi":"10.14309/ctg.0000000000001045","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001045","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether eosinophilic esophagitis (EoE) endotypes can be replicated using whole transcriptome data or if endotypes persist after treatment. We investigated endotypes with a curated gene panel and bulk sequencing and assessed endotype stability after topical steroid (tCS) treatment.</p><p><strong>Methods: </strong>We analyzed specimens collected during a randomized trial of tCS for newly diagnosed EoE. Bulk RNA-seq was performed on pre- and post-treatment esophageal biopsies. For pre-treatment samples, we used the EoE diagnostic panel (EDP) to assess previously described endotypes. We then identified endotypes using consensus clustering from the top 1500 most variable genes from bulk sequencing. This process was repeated for post-treatment samples, and pre/post treatment comparisons were made. Clinical characteristics were assessed by endotype.</p><p><strong>Results: </strong>We replicated the three previously reported EDP EoE endotypes. EoEe1 was mild and treatment responsive compared to e2 and e3 (95% histologic response [<15 eos/hpf] vs 59% and 59%; p=0.01), whereas e2/e3 had more severe endoscopic findings. Two endotypes predominated in bulk sequencing data. Compared to cluster 1, cluster 2 trended to more histologic response (76% vs 59%; p=0.08) and endoscopic findings were milder. After treatment, endotypes did not persist; gene expression was dependent on histologic response.</p><p><strong>Conclusions: </strong>We replicated the three EDP-based endotypes in newly diagnosed patients with EoE, though clinical correlations were not as strong as previously reported. Using bulk sequencing data, two endotypes were noted. Post-treatment gene expression changes after tCS therapy suggest that endotype is best assessed at diagnosis and prior to treatment.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}