Digestion最新文献

{"title":"E3 Ubiquitin Ligase NEDD4L Regulates TGF-β1/Smad Signaling Pathway to Mediate High-glucose and High-fat-induced Ferroptosis of Hepatocytes.","authors":"Fang Li, Jiayi Yao, Jianhua Yao, Yusen Mou, Dan Li, Limin Wei","doi":"10.1159/000547407","DOIUrl":"https://doi.org/10.1159/000547407","url":null,"abstract":"<p><strong>Objective: </strong>To explore the molecular mechanism of E3 ubiquitin ligase neural precursor cell-expressed developmentally down-regulated 4-like (NEDD4L) regulating high-glucose and high-fat-induced ferroptosis in hepatocytes via modulation of transforming growth factor (TGF)-β1/Smad signaling pathway.</p><p><strong>Methods: </strong>Hepatocytes THLE-2 were cultured in high-glucose and high-fat medium to establish an in vitro non-alcoholic fatty liver disease (NAFLD) model. This study detected cellular lipid deposition, cell viability, cellular superoxide dismutase (SOD) activity, glutathione (GSH), malondialdehyde (MDA), ferrous iron (Fe2+), reactive oxygen species (ROS) levels, and cellular mitochondrial membrane potential (MMP). Meanwhile, cellular NEDD4L, GPX4, ACSL4, SLC7A11, TGF-β1, TβRII and p-Smad2/3 levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot. In addition, TGF-β1-TβRII and NEDD4L-TβRII interactions were evaluated by Co-immunoprecipitation.</p><p><strong>Results: </strong>High-glucose and high-fat treatment led to ferroptosis in hepatocytes, manifested by decreased cell viability, SOD activity and GSH level, increased MDA, Fe2+ and ROS levels, and reduced MMP. High-glucose and high-fat treatment downregulated NEDD4L expression in hepatocytes; by contrast, overexpression of NEDD4L alleviated ferroptosis in hepatocytes. NEDD4L inhibited TGF-β1 signaling by mediating TβRII ubiquitination and degradation. Besides, suppressed TGF-β1/Smad signaling pathway alleviated ferroptosis in hepatocytes, and NEDD4L could regulate hepatocyte ferroptosis by mediating TGF-β1/Smad signaling pathway.</p><p><strong>Conclusion: </strong>NEDD4L can inhibit high-glucose and high-fat-induced ferroptosis in hepatocytes through suppressing the TGF-β1/Smad signaling pathway via mediating TβRII ubiquitination and degradation.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-20"},"PeriodicalIF":3.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759453","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":"Endoscopic management of Barrett's esophagus-related neoplasia in Japan.","authors":"Yuto Shimamura, Yugo Iwaya","doi":"10.1159/000547645","DOIUrl":"https://doi.org/10.1159/000547645","url":null,"abstract":"<p><p>Background Barrett's esophagus (BE)-related neoplasia remains less prevalent in Japan than in Western countries; however, its incidence is steadily rising. While multimodal treatment - typically endoscopic resection followed by ablation - is the standard of care, endoscopic resection alone remains the primary treatment strategy in Japan, largely due to the limited availability of ablation devices. With advances in endoscopic techniques, endoscopic submucosal dissection (ESD) has become the mainstay for managing BE-related neoplasia. This review outlines the current Japanese approach, focusing on indications, preoperative assessment, treatment outcomes, and post-resection surveillance practices within the Japanese clinical context. Summary Accurate endoscopic assessment, including the use of magnifying endoscopy with image-enhanced modalities, is central to Japanese practice due to the importance of complete resection of neoplasia in the absence of ablative therapy. While data on BE-related neoplasia remain relatively limited in Japan, several multicenter studies have demonstrated favorable outcomes for ESD in terms of resection quality, safety, and long-term survival, particularly in low-risk patients. However, challenges remain, including the lack of standardized surveillance protocols, limited access to ablation, and considerable heterogeneity in clinical practice across institutions. Surveillance strategies in Japan typically rely on targeted biopsies rather than systematic random biopsies. The establishment of unified clinical pathways and evidence-based strategies will be essential to address the increasing burden of BE-related neoplasia in Japan. Key Messages ・ The incidence of BE and esophageal adenocarcinoma (EAC) is increasing in Japan, although still significantly lower than in Western countries. ・ Unlike the Western standard of combining endoscopic resection with radiofrequency ablation (RFA), Japanese practice relies primarily on ESD as the main curative modality. ・ RFA is not widely available in Japan, leading to a reliance on complete resection and more aggressive endoscopic resection strategies. ・ Surveillance strategies remain inconsistent, largely due to the lower disease prevalence and limited Japan-specific clinical evidence.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728741","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":"Future Perspective of AI Diagnostics for Early Barrett's Neoplasia.","authors":"David A Roser, Alanna Ebigbo","doi":"10.1159/000547635","DOIUrl":"https://doi.org/10.1159/000547635","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) represents the only established precursor to esophageal adenocarcinoma. While endoscopic surveillance is a cornerstone of early detection, it remains limited by interobserver variability, sampling error, and variability in diagnostic yield. In recent years, artificial intelligence (AI) has emerged as a promising tool to improve the detection and characterization of neoplastic lesions in BE.</p><p><strong>Summary: </strong>This review outlines the current landscape and future potential of AI applications in the endoscopic management of BE. Diagnostic systems employing convolutional neural networks and transformer-based architectures have achieved high performance for both lesion detection (CADe) and characterization (CADx), with several models externally validated in multicenter cohorts. The first CE-certified commercial system, CADU, has further marked the entry of AI into clinical use. Emerging developments include AI tools for infiltration depth estimation, vessel detection during endoscopic submucosal dissection, post-therapeutic surveillance, and procedural quality assessment. Challenges related to generalizability, human-AI interaction, ethical implementation, and regulatory compliance are discussed in the context of clinical translation.</p><p><strong>Key messages: </strong>• AI systems demonstrate high diagnostic accuracy and enable real-time assistance in BE surveillance. • In-domain pretrained models and transformer-based systems may improve robustness and adaptability. • Clinical applications are expanding beyond diagnostics to therapeutic guidance and post-treatment monitoring. • Successful implementation depends on rigorous validation, explainability, and integration into clinical workflows.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-21"},"PeriodicalIF":3.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728742","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":"Characteristics of magnifying endoscopy with narrow-band imaging findings in gastric cancer after Helicobacter pylori eradication.","authors":"Yusuke Horiuchi, Noriko Yamamoto","doi":"10.1159/000547574","DOIUrl":"https://doi.org/10.1159/000547574","url":null,"abstract":"<p><p>Background Helicobacter pylori eradication reduces the risk of gastric cancer development and is effective in patients with chronic atrophic gastritis. Recently, an increase in gastric cancer incidence has been observed in daily clinical practice in patients who have undergone H. pylori eradication. Therefore, continuous surveillance endoscopy is important for detecting gastric cancer after H. pylori eradication. In addition, endoscopic findings may differ between noneradication and posteradication gastric cancer. Magnifying endoscopy with narrow-band imaging (ME-NBI) has been useful for the diagnosis of posteradication gastric cancer, regardless of the histological type. However, there have been no comprehensive reports in this regard. Here, we aimed to clarify the characteristics of ME-NBI findings in gastric cancer following H. pylori eradication. Summary In differentiated- and mixed-type cancers (a mixture of differentiated and undifferentiated), the cancer may be covered by noncancerous epithelium following H. pylori eradication; however, abnormalities can still be detected using ME-NBI. Therefore, ME-NBI is suitable for the diagnosis of posteradication gastric cancer. In undifferentiated-type cancer, ME-NBI is more useful in diagnosing posteradication gastric cancer than noneradicated gastric cancer because of the clear contrast between cancerous and noncancerous areas following eradication. In addition, when noneradicated gastric cancer is detected, rather than performing endoscopic submucosal dissection (ESD) or gastrectomy without eradication, it is beneficial to start patients on eradication therapy immediately and diagnose the disease extent with ME-NBI without awaiting the results of the eradication assessment and performing ESD or gastrectomy. This approach is expected to prevent misdiagnosis of the tumor size and reduce the positivity of the horizontal margin in ESD or gastrectomy. Key messages The number of posteradication gastric cancer cases is expected to increase in comparison to noneradicated gastric cancer cases, as H. pylori eradication is being widely used in chronic atrophic gastritis cases. Therefore, the diagnosis of posteradication gastric cancer using ME-NBI is expected to gain importance in daily clinical practice.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-20"},"PeriodicalIF":3.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689540","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":"Colorectal Polyp Size Measurement Faces Infinite Possibilities: Artificial Intelligence Is the Key.","authors":"Cheng-Long Wang, Xiang-Yu Sui, Yi Zeng, Jia-Yi Wu, Jun-Jie Xing, Song Zhang, Jia-Hui Wei, Kevin Chang, Yi-Ta Wu, Zhao-Shen Li, Sheng-Bing Zhao, Yu Bai, En-Da Yu","doi":"10.1159/000547299","DOIUrl":"https://doi.org/10.1159/000547299","url":null,"abstract":"<p><strong>Background: </strong>Colorectal neoplasia poses a severe health threat worldwide. The accurate measurement of polyp size is essential for risk stratification, selecting polypectomy techniques, and determining the surveillance interval.</p><p><strong>Summary: </strong>The methods routinely used for measuring polyp size, including objective ex vivo measurement, subjective visual estimation by an endoscopist, and objective precise measurement using endoscopic instruments, all have limitations. Therefore, the integration of artificial intelligence (AI) with endoscopy has been explored as a promising method for measuring the size of colorectal polyps. However, current AI systems are limited to endoscopic reference media or nonprospective real-time measurements. Consequently, AI-assisted endoscopy for precise, real-time automatic measurement of colorectal polyp size holds great promise for the future. Nevertheless, further extensive studies are necessary.</p><p><strong>Key messages: </strong>This review focuses on summarizing the advancements in colorectal polyp size research and further explores the potential of AI-assisted measurements.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682212","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 impact of endoscopic closure treatment on outcomes in patients with esophageal cancer-associated fistula: A retrospective analysis.","authors":"Qijie Dai, Xian Zhao, Weipeng Lu, Yitian Wang, Jiepeng Cen, Heqing Tao, Liang Peng","doi":"10.1159/000547231","DOIUrl":"https://doi.org/10.1159/000547231","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal cancer-associated fistula is strongly linked to elevated mortality. This study aims to investigate the impact of endoscopic closure on outcomes in patients with esophageal cancer-related fistula.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of patients with esophageal cancer-related fistula. These patients were categorized into endoscopic closure group and conservative treatment group. The Clinical Pulmonary Infection Score (CPIS) gap, duration of hospitalization, ICU admission rates, in-hospital mortality rates, and hospitalization costs were compared between endoscopic group and conservative group. Additionally, factors associated with post-fistula survival and healing were assessed.</p><p><strong>Results: </strong>Univariate and multivariate COX regression analyses revealed that endoscopic closure could significantly improve short-term pulmonary infections based on CPIS gap (3 versus 2; P=0.004) but did not influence survival or fistula healing outcomes, and the hospitalization costs were elevated ($6653 versus $3350; P=0.005). Subgroup analysis focusing on esophagotracheal fistulas was also consistent with these results. Protective factors associated with improved survival prognosis included higher albumin levels (HR=0.928, 95%CI: 0.875-0.984, P=0.012), absence of bloodstream infections (positive blood culture (HR=23.055, 95%CI: 5.193-102.357, P<0.001)), non-T4 stage (T4 stage (HR=1.792, 95%CI: 1.052-3.052, P=0.032)) and no distant metastasis (distant metastasis (HR=2.122, 95%CI: 1.127-3.996, P=0.020)). Cervical esophageal fistula (upper (HR=0.154, 95% CI: 0.041-0.570, P=0.005); middle (HR=0.128, 95% CI: 0.027-0.609, P=0.010); lower (HR=0.218, 95% CI: 0.052-0.902, P=0.036)) was significantly associated with improved fistula healing outcomes, while a history of radiotherapy (HR=0.265, 95% CI: 0.089-0.788, P=0.017) was a risk factor for esophageal fistula healing.</p><p><strong>Conclusion: </strong>Our study indicates that multiple factors are significantly associated with the prognosis of patients with esophageal fistula. Endoscopic closure treatment effectively manages short-term infections but it associates with higher hospitalization costs and doesn't significantly enhance long-term healing or survival prognosis.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-17"},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682214","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":"Current Management of Duodenal Neoplasia. Endoscopic treatment for large SNADET.","authors":"Kurato Miyazaki, Naohisa Yahagi, Motohiko Kato","doi":"10.1159/000547461","DOIUrl":"https://doi.org/10.1159/000547461","url":null,"abstract":"<p><p>Background Superficial non-ampullary duodenal epithelial tumors (SNADETs) were previously considered rare. However, the widespread use of health checkup endoscopy, improvements in endoscopic imaging and heightened awareness of SNADETs among endoscopists have recently led to an increase in their detection rate. Particularly for large SNADETs, the possibility of including cancer must be considered, and thus complete and reliable resection is essential. Although surgical resection has traditionally been the standard treatment, its high invasiveness has led to increased interest in less invasive endoscopic treatments. Nevertheless, due to the unique anatomical and physiological features of the duodenum, endoscopic treatment in the duodenum remains highly challenging and presents many technical difficulties. Summary This review provides a comprehensive overview of current endoscopic treatment options for large SNADETs, including conventional endoscopic mucosal resection (C-EMR), underwater endoscopic mucosal resection (U-EMR), cold snare endoscopic mucosal resection (CS-EMR), endoscopic submucosal dissection (ESD), and laparoscopic-endoscopic cooperative surgery (LECS), incorporating the latest clinical findings. While C-EMR, U-EMR, and CS-EMR are associated with lower technical difficulty and favorable safety, they tend to show lower en bloc resection rates and higher recurrence rates for large SNADETs when compared to ESD. In contrast, ESD offers higher en bloc resection rates but carries a greater risk of complications due to its technical complexity. To overcome these limitations, several techniques have been developed, such as the pocket-creation method, water pressure method, improved closure strategies for mucosal defects, and drainage with endoscopic nasobiliary and pancreatic drainage to prevent exposure to pancreatic juice and bile. Key Messages Multiple endoscopic strategies are available for the treatment of large SNADETs. However, due to the rarity of the disease and variation in institutional expertise, a standardized treatment strategy has not yet been established. Endoscopic treatment for large SNADETs is technically very challenging and carries a high risk. Therefore, careful consideration of the indication for each treatment method, along with a full understanding of their respective advantages and disadvantages, is essential. In recent years, the safety of endoscopic resection has been gradually improving due to various technical innovations and better management of adverse events, making ESD, which offers a high en bloc resection rate, an increasingly reasonable treatment option.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-27"},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682213","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":"PATHOPHYSIOLOGY OF ACHALASIA.","authors":"Arvind Rengarajan, Ahmad Najdat Bazarbashi, C Prakash Gyawali","doi":"10.1159/000547354","DOIUrl":"https://doi.org/10.1159/000547354","url":null,"abstract":"<p><p>Achalasia is a rare primary esophageal motility disorder of the esophageal smooth muscle, characterized by abnormal relaxation of the lower esophageal sphincter (LES), and associated with abnormal, spastic or absent esophageal body peristalsis. The primary pathophysiological defect is abnormal esophageal inhibitory nerve function from neuronal death in the esophageal neuronal plexuses and ganglia that control esophageal smooth muscle peristalsis. This is a consequence of an autoimmune cytotoxic insult from molecular mimicry following an intercurrent viral infection, typically herpes simplex virus, varicella zoster virus, human papilloma virus, measles virus, and even the COVID-19 virus. Neuronal inflammation rather than death can lead to imbalance between excitatory and inhibitory forces, and varying degrees of retained spastic, premature or even normal peristalsis in the smooth muscle esophageal body. Chagas disease caused by trypanosoma cruzi, eosinophilic inflammation, direct infiltration with neoplastic cells from adjacent cancers, or humoral autoimmune destruction from distant cancers can also result in an achalasia-like syndrome. Mechanical obstruction from tight strictures, anti-reflux or bariatric surgery and extrinsic compression can mimic the manometric features of achalasia. Chronic opioid medication usage can result in a clinical and pathophysiological syndrome identical to spastic achalasia. Careful clinical evaluation, and judicious interpretation of esophageal function tests following pathophysiological principles can lead to an accurate diagnosis of achalasia, opening the door to durable permanent disruption of the malfunctioning esophageal smooth muscle, and resulting in symptom relief.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-17"},"PeriodicalIF":3.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607826","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":"Does 5-Aminosalicylic Acid Prevent Colorectal Cancer in Tumour Necrosis Factor: Treated Ulcerative Colitis? A Real-World Study.","authors":"Yu Nishida, Shuhei Hosomi, Koji Fujimoto, Yumie Kobayashi, Rieko Nakata, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Fumio Tanaka, Yasuhiro Fujiwara","doi":"10.1159/000547093","DOIUrl":"10.1159/000547093","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) increases the risk of colorectal cancer (CRC). Although 5-aminosalicylic acid (5-ASA) has long been regarded as chemopreventive, it remains unclear whether 5-ASA therapy still confers this benefit when used concomitantly with tumour necrosis factor (TNF) inhibitors.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the nationwide Japanese Medical Data Vision database. Patients with UC who initiated TNF inhibitors were followed from the first TNF inhibitor prescription until CRC diagnosis or disenrollment. Concomitant 5-ASA use was defined as prescription within 90 days before or after TNF initiation. Cumulative incidence was compared with Kaplan-Meier curves and the log-rank test; hazard ratios (HRs) were estimated with multivariable Cox regression and inverse probability of treatment weighting (IPTW), adjusting for age, sex, primary sclerosing cholangitis (PSC), diabetes, obesity, immunomodulator use, type of TNF agent, and prior advanced therapy exposure.</p><p><strong>Results: </strong>Among 9,919 eligible patients, 8,387 (84.6%) received concomitant 5-ASA. During follow-up (median 3.14 years), 161 CRC events occurred: crude incidence 3.67/1,000 person-years (with 5-ASA use) versus 4.58/1,000 person-years (without 5-ASA use) (p = 0.421). Concomitant 5-ASA was not associated with CRC risk (adjusted HR 1.25, 95% CI 0.76-2.04; IPTW-adjusted HR: 1.28, 95% CI: 0.78-2.11). Independent risk factors were older age, male sex, and PSC.</p><p><strong>Conclusions: </strong>We found no measurable chemopreventive benefit of concomitant 5-ASA in UC patients receiving TNF inhibitors during this treatment phase. Accordingly, 5-ASA need not be prioritised for CRC prevention at this stage. Longer observation is required to clarify any benefit beyond the early years of TNF inhibitors.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583391","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":"Management of adverse events related to endoscopic resection for superficial non-ampullary duodenal epithelial tumors.","authors":"Osamu Dohi, Tomoko Ochiai, Mayuko Seya, Katsuma Yamauchi, Naoto Iwai, Reo Kobayashi, Ryohei Hirose, Elsayed Ghoneem, Ken Inoue, Naohisa Yoshida","doi":"10.1159/000547233","DOIUrl":"https://doi.org/10.1159/000547233","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic resection (ER) is a minimally invasive alternative to surgical resection for superficial non-ampullary duodenal epithelial tumors (SNADETs); however, it carries a high risk of adverse events (AEs) due to the thin duodenal wall and the technical challenges of endoscopic maneuverability. This review discusses the management of intraoperative and delayed postoperative AEs associated with duodenal ER.</p><p><strong>Summary: </strong>Various ER techniques for SNADETs, including cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD), present different risk profiles. CSP has a very low risk of AEs, while EMR and UEMR exhibit moderate AE risks (up to 18.7%) and high recurrence rates, particularly in cases of piecemeal resections. ESD enables high en bloc resection rates but is associated with a considerable risk of AEs (up to 45.5%). Intraoperative AEs can be managed endoscopically using various closure techniques. To prevent intraoperative AEs during ESD, the use of scissor-type knives and specialized methods such as the pocket-creation method and water pressure method may be employed. Delayed AEs require effective closure of mucosal defects to prevent delayed perforation, which poses a high risk of conversion to surgical intervention.</p><p><strong>Key messages: </strong>Careful patient selection and implementation of preventive strategies are essential to minimize AEs and optimize the safety of duodenal ER. A comprehensive understanding of the risk profiles of different ER techniques, along with appropriate preventive measures, is critical for safe and effective treatment. A multidisciplinary approach involving experienced endoscopists, surgeons, and radiologists is crucial to optimizing patient outcomes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575029","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}