Digestion最新文献

{"title":"Retraction Statement.","authors":"Marta Raposo","doi":"10.1159/000548053","DOIUrl":"10.1159/000548053","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091393","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":"Long-term outcomes and clinical factors associated with conventional therapy failure in intestinal Behçet's disease: A retrospective cohort study in Japan.","authors":"Keita Murakami, Junya Arai, Sozaburo Ihara, Yumi Tsuchida, Haruka Tsuchiya, Mayo Tsuboi, Ken Kurokawa, Nobumi Suzuki, Hiroto Kinoshita, Yoku Hayakawa, Keishi Fujio, Mitsuhiro Fujishiro","doi":"10.1159/000548559","DOIUrl":"https://doi.org/10.1159/000548559","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify the long-term outcomes and predictive factors for failure of conventional therapy (CT), including 5-aminosalicylic acid, azathioprine, and glucocorticoid, in patients with intestinal Behçet's disease (i-BD).</p><p><strong>Methods: </strong>This retrospective study included 63 patients with i-BD receiving CT at the University of Tokyo Hospital between April 2005 and July 2024. Patients requiring anti-tumor necrosis factor-alpha (TNF-α) agents due to CT failure were categorized into the advanced therapy (AT) group, whereas those controlled with CT were classified as the CT group. Risk factors for CT failure were analyzed using Cox proportional hazards regression, and cumulative failure rates were using the Kaplan-Meier method.</p><p><strong>Results: </strong>Twenty-eight patients (44.8%) required AT during a median follow-up of 93 months. The cumulative 1-, 3-, 5-, and 10-year failure rates of CT were 22.6%, 35.9%, 40.0%, and 50.8%, respectively. Multivariate analysis identified maximum ulcer size ≥3 cm (hazard ratio [HR]: 2.68, 95% confidence interval [CI]: 1.05-6.84, p=0.030), concomitant proton-pump inhibitor (PPI) use (HR: 2.65, 95%CI: 1.06-6.58, p=0.036), C-reactive protein (CRP) ≥4 mg/dL (HR: 2.56, 95%CI: 1.04-6.31, p=0.042), and hematochezia (HR: 2.40, 95%CI: 1.05-5.46, p=0.037) as independent predictors of CT failure. A predictive model using all four factors demonstrated good accuracy (AUC=0.877) for predicting AT requirement. Regarding AT efficacy, 22 patients (78.6%) in the AT group continued AT for at least 1 year, with most achieving clinical and endoscopic remission. Concomitant glucocorticoid use significantly decreased from 12.7±11.7 mg/day at baseline to 2.4±2.5 mg/day at 1 year (p<0.001).</p><p><strong>Conclusions: </strong>Large ulcer size, PPI use, high CRP, and hematochezia are risk factors for CT failure. Anti-TNF-α agents are effective in patients with CT failure, and risk-based treatment strategies may improve disease control in patients with i-BD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-26"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091317","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":"Prognostic Effect of Impaired Skeletal Muscle Assessed with Computed Tomography Images in Patients with Endoscopic Resection for Esophageal Squamous Cell Carcinoma.","authors":"Naotaro Tanno, Waku Hatta, Yohei Ogata, Kimiko Kayada, Makoto Kawabe, Yutaka Hatayama, Masahiro Saito, Akira Imatani, Tomoyuki Koike, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune","doi":"10.1159/000548090","DOIUrl":"10.1159/000548090","url":null,"abstract":"<p><strong>Introduction: </strong>No studies have investigated the prognostic effect of skeletal muscle mass and quality and adipose tissue distribution in patients who undergo endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to evaluate their association.</p><p><strong>Methods: </strong>We retrospectively collected data from patients who underwent ER for ESCC at our institution between 2005 and 2020. Multivariate Cox analysis was performed to investigate the association of 17 candidate factors, including indices for skeletal muscle mass and quality and adipose tissue distribution assessed with computed tomography (CT) images, with prognosis. Further, we evaluated the association of impaired skeletal muscle, characterized by the combination of low skeletal mass index (SMI) and high intramuscular adipose tissue content (IMAC), with prognosis and early and late mortality.</p><p><strong>Results: </strong>Among 450 patients, 116 (25.8%) died during the median follow-up of 111.6 months. Multivariate analyses revealed low SMI (hazard ratio [HR], 1.65) and high visceral adipose index (HR, 0.48) showed significant association with mortality, in addition to male sex, performance status, Charlson comorbidity index, American Society of Anesthesiologists physical status, and prognostic nutrition index. Conversely, no significant association was revealed in other indices. Impaired skeletal muscle was a risk factor for mortality (HR, 2.87) but not the combination of low SMI and low IMAC. It was significantly associated with late mortality (HR, 4.53) but not with early mortality.</p><p><strong>Conclusion: </strong>Impaired skeletal muscle assessed with CT images was a risk factor for late mortality in patients who underwent ER for ESCC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Statement.","authors":"Marta Raposo","doi":"10.1159/000548054","DOIUrl":"10.1159/000548054","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091382","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 Application of Confocal Laser Endomicroscopy in the Diagnosis of Gastrointestinal Diseases.","authors":"Wenli Ruan, Jianfeng Yang, Yingdong Hou, Aiyv Yv, Qi Ding, Yifeng Zhou","doi":"10.1159/000548414","DOIUrl":"10.1159/000548414","url":null,"abstract":"<p><strong>Background: </strong>Confocal laser endomicroscopy (CLE) is a real-time microscopic imaging technique based on laser scanning technology. It enables subcellular histological visualization in vivo with a resolution of up to 1 μm and demonstrates over 90% sensitivity for detecting early gastrointestinal cancers and precancerous lesions. In recent years, the integration of CLE with fluorescence staining and artificial intelligence (AI) has further improved its image interpretation capabilities in identifying gastrointestinal inflammation and early cancer.</p><p><strong>Summary: </strong>This review provides an overview of CLE's clinical applications in gastric and intestinal diseases. It also discusses the synergistic role of AI in enhancing CLE and highlights the clinical relevance of CLE in the detection of digestive tract disorders.</p><p><strong>Key messages: </strong>CLE is a high-resolution real-time imaging technology that can identify early gastrointestinal cancers and precancerous lesions with high sensitivity, providing important basis for diagnosis and treatment. The integration of CLE with fluorescent staining and AI significantly improves its real time in vivo interpretation of inflammation and early cancerous lesions in the gastrointestinal tract. CLE is valuable in the auxiliary diagnosis and dynamic monitoring of gastrointestinal diseases, and the integration of AI further expands its clinical application potential.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085376","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":"Erratum.","authors":"Marta Raposo","doi":"10.1159/000548007","DOIUrl":"https://doi.org/10.1159/000548007","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074679","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":"Underwater Clip Closure versus Conventional Clip Closure following Endoscopic Submucosal Dissection in Colorectal Lesions: A First Comparative Study.","authors":"Hirotaka Oura, Daisuke Murakami, Harutoshi Sugiyama, Takayoshi Nishino, Makoto Arai","doi":"10.1159/000548463","DOIUrl":"https://doi.org/10.1159/000548463","url":null,"abstract":"<p><p>Introduction This single-center retrospective study compared underwater clip closure (UCC) with conventional clip closure (CCC) under routine gas insufflation for post-endoscopic submucosal dissection (ESD) ulcers of colorectal lesions measuring ≤5 cm. Methods Between May 2021 and June 2023, 89 patients were enrolled. Since March 2022, all cases underwent UCC. Patients were divided into the UCC group (n = 52) and the CCC group (n = 37). Primary outcomes were complete closure rate and incidence of post-ESD coagulation syndrome (PECS), delayed bleeding, and perforation. Secondary outcomes included closure time and number of clips used. Results Complete closure was achieved in all cases, with no PECS, delayed bleeding, or perforation in either group. Median closure time was significantly shorter in the UCC group (10 min [IQR, 7-14]) than in the CCC group (11 min [IQR, 8.5-19]; p = 0.044). The number of clips used was similar (median 10 in both groups; p = 0.290). Multiple regression analysis identified both resection area (p < 0.001) and closure method (p = 0.002) as independent factors affecting closure time. Conclusion UCC may decrease the time required for post-ESD closure of colorectal lesions measuring ≤5 cm, while using a comparable number of clips to CCC, with no serious complications.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069316","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":"Etiology and Pathophysiology of Barrett's Esophagus/Neoplasia.","authors":"Naoki Asano, Tomoyuki Koike, Masahiro Saito, Yutaka Hatayama, Yohei Ogata, Xiaoyi Jin, Takeshi Kanno, Waku Hatta, Kaname Uno, Akira Imatani, Atsushi Masamune","doi":"10.1159/000548413","DOIUrl":"10.1159/000548413","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus and its malignant progression to Barrett's adenocarcinoma are becoming increasingly prevalent worldwide, yet their underlying mechanisms remain incompletely understood.</p><p><strong>Summary: </strong>The pathogenesis of Barrett's esophagus and Barrett's adenocarcinoma is multifactorial, involving environmental, genetic, and cellular factors. Chronic acid and bile reflux are well-established contributors, promoting cellular transformation in the esophageal epithelium. Obesity further exacerbates this risk, both indirectly by increasing reflux and directly via proinflammatory adipokines. Recent genetic studies have identified several genetic risk variants, with loss of p53 recognized as critical event in malignant progression. Moreover, the origin of Barrett's esophagus remains under investigation, with proposed sources including cells of esophageal submucosal glands, cells of gastric cardia, and circulating bone marrow-derived cells.</p><p><strong>Key messages: </strong>The pathophysiological mechanisms underlying Barrett's esophagus and the development of Barrett's adenocarcinoma are still under active investigation. Understanding these mechanisms is essential for developing effective preventive and therapeutic strategies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069384","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 Cold Snare Polypectomy in Intensive Downstaging Polypectomy for Colorectal Polyps in Patients with Familial Adenomatous Polyposis.","authors":"Kazuki Ishibashi, Yuji Urabe, Takahiro Uda, Yukiko Sako, Tomoyuki Gurita, Satoshi Masuda, Yoshiki Hatsushika, Takeo Nakamura, Hirona Konishi, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yoshihiro Kishida, Yuichi Hiyama, Hidehiko Takigawa, Toshio Kuwai, Shiro Oka","doi":"10.1159/000548434","DOIUrl":"https://doi.org/10.1159/000548434","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive downstaging polypectomy (IDP) has emerged as an alternative strategy for managing colorectal polyps in patients with familial adenomatous polyposis (FAP), aiming to endoscopically control the disease in those who delay or refuse colectomy. This study evaluated the safety and efficacy of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) and hot biopsy (HB) in patients with FAP undergoing IDP.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with FAP who underwent IDP between September 2012 and March 2024 at Hiroshima University Hospital. The patients were divided into two groups: CSP (October 2022 onward) and HOT (HSP and HB; 2012-2022). Outcomes assessed included adverse events, resection time per polyp, total procedure time, number of polyps removed per procedure, and R0 resection rate.</p><p><strong>Results: </strong>A total of 185 treatment sessions were performed in 32 patients. The CSP group had a significantly shorter resection time per lesion and a higher number of polyps removed per procedure compared to the HOT group. The incidence of adverse events was significantly lower in the CSP group. Immediate bleeding occurred in 10 cases in the HOT group, while no such events were observed in the CSP group. Additionally, delayed bleeding and perforation were each observed in two cases in the HOT group, whereas neither event occurred in the CSP group.</p><p><strong>Conclusion: </strong>CSP is a safe and efficacious method for polyp removal in patients with FAP undergoing IDP, offering shorter resection time and fewer adverse events compared to HSP and HB.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069330","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":"Anti-reflux mucosal intervention for gastroesophageal reflux disease: a new horizon of endoscopic anti-reflux therapy.","authors":"Haruhiro Inoue, Mayo Tanabe, Kazuki Yamamoto, Yohei Nishikawa, Kei Ushikubo, Ippei Tanaka, Kaori Owada, Manabu Onimaru, Takayoshi Ito, Noboru Yokoyama, Stefan Seewald","doi":"10.1159/000547947","DOIUrl":"https://doi.org/10.1159/000547947","url":null,"abstract":"<p><p>Anti-reflux mucosal (ARM) interventions have expanded the therapeutic spectrum for gastroesophageal reflux disease beyond pharmacologic therapy and surgery. This narrative review traces the evolution from anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) to the more recently developed anti-reflux mucoplasty (ARMP) and ARMP with valve (ARMPV). Collectively, the available cohort studies and systematic reviews indicate a clinical response rate of 70-82%, with proton-pump inhibitor discontinuation achieved in up to 55% of cases. The most common adverse events are transient dysphagia (~11%) and post-procedural bleeding (~5%), both of which are manageable endoscopically. Direct defect closure in ARMP shortens the interval to symptom relief and virtually eliminates delayed bleeding, while technical refinements such as the angle booster and counter-mucosal incision have improved access and tension management. When selecting among ARM intervention techniques, we propose ARMP as the first-line option in naïve anatomy, reserving ARMA for redo or post-surgical settings where submucosal fibrosis limits application. Ongoing trials are assessing durability beyond five years, the role of full-thickness suturing that incorporates sling- and clasp-muscle fibers, and applications in bariatric or para-esophageal hernia populations. Future research priorities include standardizing ulcer dimensions to optimize shrinkage, refining patient-reported outcome measures, and clarifying cost-effectiveness relative to fundoplication and magnetic sphincter augmentation. In summary, ARM interventions offers a spectrum of flexible, minimally invasive solutions that can be tailored to individual anatomic and physiological profiles, potentially bridging the treatment gap between long-term acid suppression and surgery.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069309","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}