Digestion最新文献

{"title":"Epidemiology of Barrett's Neoplasia in Japan.","authors":"Katsunori Iijima","doi":"10.1159/000548362","DOIUrl":"10.1159/000548362","url":null,"abstract":"<p><strong>Background: </strong>With a 50-year delay compared to Europe and the USA, esophageal adenocarcinoma (EAC) began to increase in Japan around 2010, and it is expected to continue rising over the next few decades. This 50-year discrepancy is primarily attributable to variations in the timing of the decline in Helicobacter pylori infection rates across the two regions, with the extent of obesity in Japan also exerting an influence on the projected increase in EAC. Currently, the incidence of EAC in Japan is approximately one-tenth to one-twentieth that observed in Europe and the USA. However, ongoing monitoring is essential to assess the potential for escalation of this cancer. Accurate estimation of the incidence of EAC in Barrett's esophagus (BE), a precancerous condition of EAC, is imperative for the establishment of appropriate endoscopic surveillance for early cancer detection.</p><p><strong>Summary: </strong>The incidence of EAC in BE is largely determined by its length. In the Japanese population, BE with a length greater than 3 centimeters exhibits a high incidence of EAC and necessitates surveillance, while BE with a length less than 1 centimeter exhibits an exceptionally low incidence of EAC and is considered to require no surveillance. The challenge lies in determining the optimal approach for addressing BE with a length of 1-3 cm, which is observed in 5-15 percent of endoscopic examinees, necessitating careful consideration due to its significance.</p><p><strong>Key message: </strong>Since the EAC risk of BE varies greatly depending on its length, the need for surveillance and inspection intervals for BE in Japan should be defined by its length.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052397","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":"Magnifying Endoscopic Classification for Early Barrett's Neoplasia.","authors":"Yohei Ikenoyama, Aiji Hattori, Yasuko Fujiwara, Misaki Nakamura, Yasuhiko Hamada, Noriyuki Horiki, Hayato Nakagawa","doi":"10.1159/000548227","DOIUrl":"10.1159/000548227","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is becoming increasingly prevalent in both Western countries and Japan. Early diagnosis of Barrett's neoplasia remains challenging. Traditionally, the Seattle protocol, a four-quadrant random biopsy method, has been recommended in Western guidelines. However, this approach has several limitations, including sampling errors, poor adherence, and a high procedural burden. Therefore, magnifying endoscopy has gained attention as a valuable tool for detecting and characterizing neoplastic lesions in patients with BE.</p><p><strong>Summary: </strong>This review outlines historical and current developments in magnifying endoscopic classification systems for BE, with a focus on narrow-band imaging (NBI) and acetic acid chromoendoscopy in both Western countries and Japan. Although various NBI-based classifications have been proposed, their complexity and poor reproducibility have limited their widespread clinical adoption. Recently, simplified and standardized classification systems, including the Barrett's International NBI Group classification in the West and the Japan Esophageal Society-Barrett's esophagus classification in Japan, have been introduced. These systems adopt a binary framework, categorizing mucosal and vascular patterns as \"regular\" (non-neoplastic) or \"irregular\" (neoplastic). They are easy to apply and have demonstrated high diagnostic accuracy and substantial interobserver agreement. Further simplification and practical refinement are required for broader clinical implementation.</p><p><strong>Key messages: </strong>Compared with other gastrointestinal cancers, the magnifying endoscopic diagnosis of Barrett's neoplasia remains technically demanding. However, based on a growing body of evidence, endoscopists should be encouraged to actively challenge this area. Continued efforts to simplify and validate the classification systems are essential for their widespread clinical use in BE surveillance.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023081","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":"Family History as a Dominant Risk Factor for Uninvestigated Dyspepsia and Chronic Constipation: A Rome IV-Based Study among Japanese University Students.","authors":"Nhu Thi Hanh Vu, Duc Trong Quach, Mai Ngoc Luu, Shunsuke Miyauchi, Naoki Ishiuchi, Doan Thi Nha Nguyen, Atsuo Yoshino, Yoshie Miyake, Yuri Okamoto, Shiro Oka, Toru Hiyama","doi":"10.1159/000548363","DOIUrl":"10.1159/000548363","url":null,"abstract":"<p><strong>Introduction: </strong>Uninvestigated dyspepsia (UD) and chronic constipation (CC) are common disorders of gut-brain interaction. However, limited research has assessed their risk factors in young adults, particularly the influence of family history. This study investigated the associated factors for UD and CC, focusing on family history among Japanese university students.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at Hiroshima University. UD and CC were diagnosed using the Rome IV criteria. Multivariate logistic regression was performed to identify associated factors of UD and CC.</p><p><strong>Results: </strong>Among 10,500 individuals participating in the annual health checkup, 7,496 responded to the web-based questionnaire, and 5,386 completed it. The mean age of the participants was 21.1 ± 4.1 years, with a male-to-female ratio of 1:1.17. The prevalence of UD and CC was 7.3% and 13.7%, respectively. Family history was associated with both UD (odds ratio [OR]: 4.29; 95% confidence interval [CI]: 3.17-5.79) and CC (OR: 2.77; 95% CI: 2.31-3.31). Depression and physical inactivity were shared associated factors. Alcohol consumption (OR = 2.36; 95% CI: 1.15-4.83) and smoking (OR = 1.59; 95% CI: 1.02-2.49) were identified as associated factors for UD, while female sex (OR = 2.00; 95% CI: 1.69-2.36) and short sleep duration (OR = 1.28; 95% CI: 1.09-1.50) were associated with CC.</p><p><strong>Conclusions: </strong>Family history was found to be a predominant factor associated with both UD and CC, with a relatively stronger association for UD. Our finding highlights the need to consider familial factors in future prevention and intervention strategies for UD and CC in young adults.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023091","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":"Volatile Organic Compounds in Irritable Bowel Syndrome: Microbial Insights into Gut-Brain Dynamics and Clinical Applications.","authors":"Dinh Chuong Nguyen, Sutep Gonlachanvit, Thanikan Sukaram, Tanisa Patcharatrakul","doi":"10.1159/000548310","DOIUrl":"10.1159/000548310","url":null,"abstract":"<p><strong>Background: </strong>Irritable bowel syndrome (IBS) affects 4.1% of the global population, posing a significant healthcare challenge due to its complex pathophysiology and limited treatment options. Gut microbiota-derived volatile organic compounds (VOCs) are increasingly recognized as key players in IBS, with the potential for noninvasive diagnostics and personalized management.</p><p><strong>Summary: </strong>This review examines VOCs - such as short-chain fatty acids, hydrocarbons, and alcohols - as microbial metabolites influencing IBS through gut barrier function, inflammation, motility, and gut-brain signaling. Cross-sectional studies highlight the diagnostic accuracy of VOCs (area under the curve 0.76-0.99) in distinguishing IBS from healthy controls and conditions like inflammatory bowel disease, while longitudinal studies underscore their utility in predicting and reflecting microbial changes to microbiota-targeted therapies. Despite this promise, variability in study designs, methodological inconsistencies, and confounding factors hinder clinical translation.</p><p><strong>Key messages: </strong>VOCs illuminate the microbial underpinnings of IBS and its gut-brain interactions, offering a pathway to precise diagnosis and treatment stratification. However, their full potential awaits standardized sampling, analytical protocols, and robust clinical trials to ensure reliability and applicability in IBS care.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999979","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":"Comparative Efficacy of Mycophenolate Mofetil vs. Azathioprine in Autoimmune Hepatitis: A Systematic Review and Meta-Analysis.","authors":"Momen Mohamed Ibrahim, Bisher Sawaf, Noheir Ashraf Ibrahem Fathy Hassan, Momen Hassan Moussa, Mayar Ibrahim, Karam R Motawea, Muhammed Elhadi, Yaseen Alastal","doi":"10.1159/000548140","DOIUrl":"10.1159/000548140","url":null,"abstract":"<p><strong>Background: </strong>Azathioprine (AZA) is the standard treatment for both induction and maintenance of response in autoimmune hepatitis (AIH). However, lifelong administration is often required, and the combination therapy of prednisolone and azathioprine raises significant concerns regarding efficacy and tolerability, especially given the high relapse rates following AZA cessation. Consequently, there is a need to explore alternative treatment options. This systematic review and meta-analysis compared the efficacy and safety of mycophenolate mofetil (MMF) versus AZA, combined with prednisolone, for treating AIH.</p><p><strong>Methods: </strong>PubMed, Cochrane, Scopus, and Web of Science were searched to identify randomized clinical trials and cohort studies comparing AZA and MMF for treating AIH. Four studies compared steroid withdrawal and complete biochemical response (CBR) between the MMF and AZA groups. Subgroup analyses were performed based on age (above and below 50 years) and IgG levels (above and below 2400 mg/dL). RevMan (version 5.4) software was used for meta-analysis.</p><p><strong>Results: </strong>Four studies (three cohort studies and one RCT) comprising 505 patients were included in the final analysis. The pooled analysis showed a statistically significant association between the MMF group and increased CBR compared with the AZA group (RR = 1.44, 95% CI = 1.03 to 2.01, p-value = 0.03), with no significant difference between the two groups regarding steroid withdrawal. Subgroup analysis by age revealed a significant association between the MMF group and increased CBR in patients over 50 years (RR = 1.63, 95% CI = 1.00-2.64, p-value = 0.05). IgG subgroup analysis revealed a significant association between the MMF group and increased biochemical remission compared with the AZA group in patients with IgG levels of less than 2400 mg/dL (RR = 1.63, 95% CI = 1.00-2.64, p-value = 0.05).</p><p><strong>Conclusion: </strong>The use of MMF was significantly associated with increased CBR compared to AZA in patients with AIH. Additionally, there was no significant association between the two groups regarding steroid withdrawal. Further research is needed to fully elucidate the optimal treatment strategy for AIH patients across different subpopulations.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946436","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":"Dialysis, Antithrombotics, and Lesion Location: Who Benefits Most from Gel Immersion Endoscopy in Gastric Endoscopic Submucosal Dissection?","authors":"Hiroki Hayashi, Takeshi Kanno, Tomonori Yano, Kazuaki Akahoshi, Jun Owada, Hiromi Sekiguchi, Takashi Ueno, Yoshie Nomoto, Hisashi Fukuda, Haruo Takahashi, Yuji Ino, Hironori Yamamoto","doi":"10.1159/000548018","DOIUrl":"10.1159/000548018","url":null,"abstract":"<p><strong>Introduction: </strong>Gel immersion endoscopy (GIE) is a technique used to maintain a clear view during gastric endoscopic submucosal dissection. We aimed to identify cases most likely to benefit from GIE for ESD bleeding by reviewing our clinical experience and determining the associated factors.</p><p><strong>Methods: </strong>We retrospectively analyzed 470 lesions in 380 patients who underwent gastric ESD between October 2020 and March 2023. The patients were divided into conventional method (n = 433) and GIE groups (n = 37). We compared the clinical and pathological characteristics between the groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with GIE use. Among the GIE group, hemostasis times under gas, water, and gel conditions were compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>Multivariate analysis revealed that dialysis (odds ratio [OR]: 15.3), concurrent antiplatelet and anticoagulant use (OR: 9.5), and tumor location in the middle third (OR: 3.5), upper third (OR: 5.7), or remnant stomach (OR: 9.3) were independently associated with GIE use. No significant differences in overall hemostasis time were observed between gas, water, or gel. Of the nine bleeding events exceeding 300 s under gas immersion, seven achieved successful hemostasis by switching to GIE, with a median of 32 s to locate the source and 140 s to complete hemostasis.</p><p><strong>Conclusion: </strong>Dialysis, combined antithrombotic use, and certain tumor locations were key factors influencing GIE for ESD bleeding. Although the overall hemostasis times did not differ, GIE may be particularly beneficial in high-risk scenarios.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871966","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":"Current Management of Laparoscopic and Endoscopic Cooperative Surgery for Duodenal Neoplasia: Suitable Endoscopic Resection Approaches.","authors":"Hiroyuki Yamamoto, Shoichi Yoshimizu, Masaru Hayami, Kosuke Tanaka, Makoto Tamamushi, Koyo Kido, Wataru Kurihara, Chika Fukuyama, Yusuke Horiuchi, Toshiyuki Yoshio, Toshiaki Hirasawa, Souya Nunobe","doi":"10.1159/000547890","DOIUrl":"10.1159/000547890","url":null,"abstract":"<p><strong>Introduction: </strong>Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is a promising hybrid approach to managing duodenal neoplasia, including superficial non-ampullary duodenal epithelial tumors (SNADETs) and subepithelial lesions (SELs). This approach aims to reduce adverse events (AEs), such as delayed perforation, often associated with endoscopic submucosal dissection (ESD). Combining laparoscopic techniques for duodenal stabilization with precise endoscopic resection, D-LECS may provide safer and more comprehensive treatment. However, few studies have compared the outcomes of D-LECS with those of ESD and full-thickness resection (FTR), and suitable endoscopic resection approaches for D-LECS remain unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed records of 80 patients who underwent D-LECS for duodenal neoplasia at our institution between 2011 and 2024. Fifty-six patients underwent D-LECS with ESD for SNADETs (ESD group), whereas 24 underwent D-LECS with FTR for 16 SELs and 8 SNADETs (FTR group). All patients underwent en bloc resection, showing an overall R0 resection rate of 92.5%.</p><p><strong>Results: </strong>There was no significant difference in overall incidence of Clavien-Dindo grade II or higher AEs between the ESD and FTR groups. However, the ESD group tended to have fewer cases of delayed gastric emptying and higher inflammatory response (p = 0.087 and p = 0.063, respectively). One patient in the FTR group experienced delayed perforation and 2 patients in the ESD group experienced delayed bleeding. However, these events were not significant.</p><p><strong>Conclusions: </strong>Both D-LECS with ESD and FTR were effective and safe. D-LECS with ESD may be a more suitable approach for SNADETs, whereas D-LECS with FTR is preferable for SELs.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-6"},"PeriodicalIF":3.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854848","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":"E3 Ubiquitin Ligase NEDD4L Regulates the 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":"10.1159/000547407","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to explore the molecular mechanism of E3 ubiquitin ligase neural precursor cell-expressed developmentally downregulated 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 nonalcoholic fatty liver disease 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":"1-15"},"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 and Related Neoplasia in Japan.","authors":"Yuto Shimamura, Yugo Iwaya","doi":"10.1159/000547645","DOIUrl":"10.1159/000547645","url":null,"abstract":"<p><strong>Background: </strong>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 (ER) followed by ablation - is the standard of care, ER alone remains the primary treatment strategy in Japan. 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.</p><p><strong>Summary: </strong>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 and considerable heterogeneity in clinical practice across institutions. The establishment of unified clinical pathways and evidence-based strategies will be essential to address the increasing burden of BE-related neoplasia in Japan.</p><p><strong>Key messages: </strong>The incidence of BE and esophageal adenocarcinoma is increasing in Japan, although still significantly lower than in Western countries. Unlike the Western standard of combining ER 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 ER 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":"1-10"},"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 Artificial Intelligence Diagnostics for Early Barrett's Neoplasia.","authors":"David A Roser, Alanna Ebigbo","doi":"10.1159/000547635","DOIUrl":"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>(1) AI systems demonstrate high diagnostic accuracy and enable real-time assistance in BE surveillance. (2) In-domain pretrained models and transformer-based systems may improve robustness and adaptability. (3) Clinical applications are expanding beyond diagnostics to therapeutic guidance and posttreatment monitoring. (4) Successful implementation depends on rigorous validation, explainability, and integration into clinical workflows.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"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}