Digestive and Liver Disease最新文献

{"title":"Outcomes of device assisted endoscopic full thickness resection in gastroduodenal submucosal lesions: A large, multicentre study (with videos).","authors":"Zaheer Nabi, Gaurav Patil, Rajesh Puri, Truptesh Kothari, Sukrit Sud, Radhika Chavan, Sridhar Sundaram, Nikhil Sonthalia, Jimmy Narayana, Jayanta Samanta, Jahnvi Dhar, Sanjay Rajput, Vikas Singla, Jeff George, Pankaj Dhawan, Rajesh Goud, Pradev Inavolu, Amit P Maydeo, Randhir Sud, Mahesh Goenka, Santosh Darisetty, D Nageshwar Reddy","doi":"10.1016/j.dld.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.014","url":null,"abstract":"<p><strong>Background and aim: </strong>Device-assisted full-thickness resection (DA-EFTR) has emerged as a promising therapeutic modality for challenging colorectal neoplasms. More recently, the development of a dedicated full-thickness resection device has expanded its application to upper gastrointestinal (GI) lesions. This study aims to evaluate the clinical outcomes of DA-EFTR for subepithelial lesions (SELs) localized in the stomach and duodenum.</p><p><strong>Methods: </strong>This study was a multicenter, retrospective analysis conducted across 14 centers in India. Consecutive cases with gastroduodenal SELs who underwent EFTR using a dedicated full thickness resection device from April 2021 to Aug 2024 were enrolled in the study. The main outcome was rate of technical success (macroscopically complete resection). Additional outcomes included histologically complete (R0) resection, procedure time and adverse events.</p><p><strong>Results: </strong>131 cases (58y, 82 males) underwent DA-EFTR during the study period. Majority of the SELs were located in duodenum (79.1 %) followed by stomach (20.9 %). Median size of the SELs was 12 mm (IQR 10-16) and majority (60.2 %) were submucosal in origin. Technical success was achieved in 123 (94 %) cases. Overall, histologically complete resection (R0) was achieved in 77.9 % cases. In duodenal neuroendocrine tumors, R0 resection was achieved in 87.2 % cases. On multivariate analysis, increased procedure duration was an independent predictor of histological incomplete resection. Adverse events included mild or moderate in 13 (9.9 %) patients and severe (massive bleeding) in one case.</p><p><strong>Conclusion: </strong>DA-EFTR is a safe and effective treatment modality for upper GI SELs especially duodenal neuroendocrine tumors. Prospective studies are required to confirm its role in minimally invasive management strategies for SELs in the upper GI tract.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244014","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":"Anal neoplasm: Streamline follow-up of low-grade dysplasia.","authors":"Aurore Carlo, Laurent Siproudhis, Amandine Landemaine, Claire Gouriou, Claire Grolhier, Astrid Lièvre, Sébastien Henno, Charlène Brochard","doi":"10.1016/j.dld.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.013","url":null,"abstract":"<p><strong>Background: </strong>Screening strategies for anal cancer are based on repeated assessments in targeted populations. Low-grade lesions are frequently diagnosed, but the progression to invasive cancer is not the rule. The aim of the present study was to identify risk levels in these patients to refine screening strategies.</p><p><strong>Methods: </strong>The data of consecutive patients referred for screening of anal intraepithelial lesions were collected prospectively. Patients with low-grade intraepithelial lesions (LSILs) at referral and at least two clinical evaluations, including cytology and virology, were included. HPV DNA screening, high-grade lesion (HSIL) and invasive cancer incidence data were extracted.</p><p><strong>Results: </strong>From April 2010 to December 2020, 194 patients with LSILs were included, with a median follow-up of 48 months. The cumulative probabilities of HSILs were 13.7% [9.5-19.4] at 1 year and 44.4% [35.9-53.3] at 5 years. Past history of HIV, HPV lesions, HPV subtypes (except HPV16), tobacco consumption and body mass index were not significantly related to HSILs. HPV16 status and age older than 44 years at baseline were associated with a greater risk of HSIL.</p><p><strong>Conclusions: </strong>Patients with LSIL have a low risk of HSILs, except those with HPV16 subtype at baseline. After a first-year a reasonable recommendation may be a 4-year interval between two screening visits.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243975","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 and histological characteristics of gastric \"crawling-type\" adenocarcinoma.","authors":"Bacui Zhang, Wei Gao, Kai Liu, Yusheng Yang, Jing Wang","doi":"10.1016/j.dld.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.017","url":null,"abstract":"<p><strong>Background: </strong>Crawling-type adenocarcinoma (CTA) is an uncommon and poorly characterised subtype of early gastric cancer, primarily reported in isolated case and series studies.</p><p><strong>Aims: </strong>To investigate the clinicopathological and endoscopic features of CTA.</p><p><strong>Methods: </strong>We retrospectively analysed 17 patients with histologically confirmed CTA. Clinical characteristics, endoscopic findings, including magnifying endoscopy with narrow-band imaging (ME-NBI) and computed tomography (CT) imaging, were evaluated. Histological features were assessed using hematoxylin-eosin (H&E) staining, and immunohistochemistry was performed to study the clinical features.</p><p><strong>Result: </strong>The mean age was 68.7 years; 64.7 % were male. Most patients were asymptomatic. Endoscopically, CTA appeared as flat or slightly elevated lesions with indistinct margins and brownish discolouration. ME-NBI revealed dilated, tortuous microvessels and mild microsurface irregularity, while CT showed no metastasis. Histologically, 82.4 % of tumors were confined to the mucosa, consisting of moderately differentiated tubular glands with horizontal spread, mild to moderate atypia, and preserved polarity. Characteristic \"shaking-hand\" or \"WHY × \" patterns were observed. Immunohistochemically, cytokeratin was positive in all cases. MUC5AC and MUC6 were aberrantly expressed in 70.6 % of cases, and most showed p53 overexpression.</p><p><strong>Conclusion: </strong>CTA is a histologically indolent but diagnostically challenging subtype of early gastric cancer. Recognition of its endoscopic and pathological features is essential for accurate diagnosis and management.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231888","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":"Recompensation after acute decompensation in alcohol-related cirrhosis is rare and likely unrelated to platelet-poor plasma thrombin generation and fibrinolysis.","authors":"Alberto Zanetto, Dario Saltini, Elena Campello, Cristiana Bulato, Sabrina Gavasso, Patrizia Burra, Paolo Simioni, Marco Senzolo","doi":"10.1016/j.dld.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.018","url":null,"abstract":"<p><strong>Background: </strong>Hemostasis may be involved in cirrhosis progression. However, its potential involvement in hepatic recompensation is unknown.</p><p><strong>Objective: </strong>We investigated predictors of recompensation, including coagulation and fibrinolysis, in acutely decompensated, alcohol-related cirrhosis.</p><p><strong>Methods: </strong>Clinical and laboratory data were collected at hospitalization. Coagulation was assessed via factor VIII, natural anticoagulants, and thrombin generation assay. Fibrinolysis was assessed via pro and anti-fibrinolytic factors and plasmin-antiplasmin complexes. Patients were prospectively followed up for recompensation according to Baveno VII criteria.</p><p><strong>Results: </strong>We included 224 patients (Child-Pugh B/C 46/54 %). Cumulative rate of recompensation was 5.4 % (median follow-up: 450 days). Patients who achieved recompensation had lower MELD (12 vs. 17, p = 0.02), Child-Pugh C (25 % vs 56 %, p = 0.04), and higher platelet count (106 × 10⁹/L vs. 83 × 10⁹/L) than those who did not, without differences in coagulation and fibrinolysis. In Cox-regression analysis, Child-Pugh was the only predictor of recompensation (HR: 0.26; p = 0.02). Same results were observed with the \"expanded\" Baveno VII criteria for recompensation. A competing risk analysis considering ACLF/liver-related death, transplantation, and TIPS as competing risks showed comparable results.</p><p><strong>Conclusion: </strong>In acutely decompensated, alcohol-related cirrhosis, recompensation is rare and linked to the baseline severity of liver disease. Coagulation and fibrinolysis seem not to be involved in cirrhosis recompensation.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228515","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":"The last embrace: A CT scout image of love and loss.","authors":"Junyuan You, Shuyue Yang, Xiaochen Geng","doi":"10.1016/j.dld.2025.09.016","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.016","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211879","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":"Focus on esophagus: What is boiling in in the pot.","authors":"Nicola de Bortoli, Pierfrancesco Visaggi, Edoardo V Savarino","doi":"10.1016/j.dld.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.008","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198572","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":"Therapeutic adherence and self-care in IBD: A new behavioral paradigm.","authors":"Daniele Napolitano, Piergiorgio Martella, Franco Scaldaferri","doi":"10.1016/j.dld.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.012","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185019","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":"The indolent nature of type 1 gastric neuroendocrine tumors under 1 cm.","authors":"Elisabetta Dell'Unto, Dalvinder Mandair, George Riding, Alessandro Rimondi, Maria Rinzivillo, Gianluca Esposito, Tu Vinh Luong, Edith Lahner, Jennifer Watkins, Bruno Annibale, Alberto Murino, Edward John Despott, Martyn Caplin, Marco Marini, Francesco Panzuto, Christos Toumpanakis","doi":"10.1016/j.dld.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.011","url":null,"abstract":"<p><strong>Background: </strong>Type 1 gastric neuroendocrine tumors (T1-gNETs) are typically indolent. Current guidelines suggest endoscopic surveillance for lesions ≤10 mm, mainly based on expert consensus.</p><p><strong>Aim: </strong>To evaluate outcomes in patients with T1-gNETs ≤10 mm managed by endoscopic surveillance.</p><p><strong>Methods: </strong>This dual-center retrospective study (2000-2023) included patients from two Western ENETS Centers of Excellence with T1-gNETs ≤10 mm under surveillance. Primary endpoints were disease progression rate and progression-free survival (PFS); p < 0.05 was considered significant.</p><p><strong>Results: </strong>A total of 125 patients (66.4 % female; median age 59.5 years) with a median tumor size of 3 mm were analyzed. Most tumors were G1 (92.8 %), and 75.2 % had ≤5 lesions. Over a median follow-up of 72 months, progression occurred in 5 patients (4 %), with no metastases. Low-grade dysplasia was found in 2.4 % and early gastric cancer in 1.6 %. Eleven patients (8.8 %) died, none from tumor-related causes. Restricted mean survival time was 266.5 months. The 5-year PFS rate was 97.8 %. Having ≤5 lesions was significantly associated with lower progression risk (HR = 0.14, 95 % CI: 0.014-0.76, p = 0.022).</p><p><strong>Conclusions: </strong>T1-gNETs ≤10 mm show low progression risk and can be safely managed with lifelong surveillance. In patients with solitary or few lesions, extended intervals may be appropriate.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184939","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":"Exploring the role of tofacitinib in managing chronic pouchitis: A systematic review and meta-analysis.","authors":"Archit Garg, Vishali Moond, Mehak Bassi, Aadhithyaraman Santharaman, Luisa Recinos-Arenas, Arkady Broder","doi":"10.1016/j.dld.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.007","url":null,"abstract":"<p><strong>Background and aims: </strong>Tofacitinib, commonly used for ulcerative colitis, has shown promising results in the management of chronic pouchitis (CP). We performed a pooled analysis of the efficacy and safety of tofacitinib for CP.</p><p><strong>Methods: </strong>We searched multiple databases for articles reporting the outcomes of tofacitinib for the treatment of CP and conducted a meta-analysis.</p><p><strong>Results: </strong>8 studies including 99 subjects (mean age: 37.5 years and 55.6 % males) were analyzed. The pooled clinical and endoscopic response rate was 47.7 % [Cl 33.3-62.6 %; I2= 40 %] and 51.7 % [Cl 37.4-65.7 %; I2=34 %], respectively. The remission rate was 41.2 % [Cl 26.6-57.6 %; I2= 0 %]. Clinical PDAI score improved markedly post-tofacitinib (Pre: 3.35 [Cl 2.9-3.7; I2 = 68 %] vs Post: 2.0 [Cl 1.59-2.4; Cl = 0 %], p-value <0.001). There was a significant reduction in endoscopic PDAI score (Pre: 4.5 [Cl 3.7-5.2; I2 = 84 %] vs Post: 2.5 [Cl 1.7-3.3; Cl = 64 %], p-value < 0.001) and total PDAI score (Pre: 7.4 [Cl 5.3-9.6; I2 = 96 %] vs Post: 4.3 [Cl 2.8-5.9; Cl = 84 %], p-value < 0.001). The pooled adverse events and discontinuation rates were 30.9 % [Cl 17.5-48.5; I2=24 %] and 43 % [Cl 25-63.1; I2=40 %] respectively.</p><p><strong>Conclusion: </strong>Based on this meta-analysis, tofacitinib caused statistically significant changes in PDAI scores with favourable response and remission rates. Although adverse event and discontinuation rates are high, this is similar to or less frequent than those of other biologics. Future studies are required to evaluate the long-term safety profile of tofacitinib before considering it as an effective alternative for the treatment of CP.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184944","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":"Metabolic-associated fatty liver disease and Colorectal Adenoma: A Cross-Sectional Study in a Metabolically Characterized Xinjiang Population, China.","authors":"Shiyu Peng, Xinyi Song, Xiaoyan Ma, Zhigang Chen, Shuxin Tian","doi":"10.1016/j.dld.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.dld.2025.09.010","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between metabolic-associated fatty liver disease (MAFLD) and colorectal adenoma (CRA), providing a theoretical basis for colorectal cancer (CRC) prevention in MAFLD patients. The relationship between MAFLD and CRA risk remains incompletely elucidated.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted at the First Affiliated Hospital of Shihezi University and Altay Prefecture People's Hospital in Xinjiang, China. Participants underwent both hepatic ultrasonography and colonoscopy. Subjects were categorized into MAFLD and non-MAFLD groups based on ultrasonographic findings. Adenomas were classified via colonoscopy and histopathology as: no adenoma, low-risk adenoma (<3 adenomas with diameter <10 mm and low-grade dysplasia), or high-risk adenoma (meeting ≥1 criterion: ≥3 adenomas, diameter ≥10 mm, high-grade dysplasia, or villous features).</p><p><strong>Results: </strong>The detection rates of low-risk and high-risk adenomas were 31.8% and 54.5% in the MAFLD group, compared to 28.9% and 51.6% in the non-MAFLD group, respectively. After multivariate adjustment, young MAFLD patients exhibited significantly higher odds of low-risk adenomas (adjusted β = 2.0, 95% CI: 1.2-2.9, P < 0.05) and high-risk adenomas (adjusted β = 2.7, 95% CI: 1.8-3.5, P < 0.05) compared to non-MAFLD controls. Elderly MAFLD patients also demonstrated elevated detection rates of low-risk adenomas (adjusted β = 1.5, 95% CI: 1.2-1.9, P < 0.05).</p><p><strong>Conclusion: </strong>MAFLD is independently associated with increased detection rates of both low-risk and high-risk colorectal adenomas across age groups in the Xinjiang populations of Shihezi and Altay. These findings position MAFLD as a potential independent risk factor for CRC screening and provide critical evidence for optimizing CRC prevention strategies in MAFLD patients.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181794","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}