Digestion最新文献

{"title":"Treatment Outcomes of Endoscopic Submucosal Dissection for Lesions Adjacent to the Dentate Line: A Post Hoc Analysis from the Hiroshima GI Endoscopy Research Group Study.","authors":"Megumi Miyahara, Hidenori Tanaka, Toshio Kuwai, Naoki Asayama, Shinji Nagata, Masaki Kunihiro, Yuko Hiraga, Yuzuru Tamaru, Shigeto Yoshida, Tomohiko Kohno, Hideharu Okanobu, Koki Nakamura, Kenta Nagai, Shosuke Kitamura, Seiji Onogawa, Shiro Oka","doi":"10.1159/dig/acmag006","DOIUrl":"10.1159/dig/acmag006","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) of rectal lesions adjacent to the dentate line is technically challenging. This study aimed to evaluate the short- and long-term outcomes of ESD for these lesions, identify factors associated with prolonged procedure time, and assess optimal device selection to increase dissection speed.</p><p><strong>Methods: </strong>From a prospective multicenter observational study conducted by the Hiroshima GI Endoscopy Research Group, lesions adjacent to the dentate line resected using ESD were recruited. Treatment outcomes and those stratified by the presence of hemorrhoids and the degree of circumferential involvement were evaluated. Factors associated with prolonged procedure time were analyzed using multivariate analysis. Optimal device selection for achieving faster dissection speed was investigated using decision tree analysis.</p><p><strong>Results: </strong>Seventy-three lesions were enrolled. Overall en bloc and complete resection rates were 97.3% and 90.4%, respectively, which were not associated with the presence of hemorrhoids or circumferential involvement. No local recurrence occurred with a median follow-up of 40 months. Larger tumor size and severe intraoperative bleeding were significant predictors of prolonged procedure time. Decision tree analysis demonstrated higher dissection speed with the ITknife nano (Olympus) or SB Knife Jr (Sumitomo Bakelite) than with the DualKnife J (Olympus) for lesions ≥30 mm. For lesions measuring ≥20 mm and <30 mm with hemorrhoids, the ITknife nano achieved the highest dissection speed.</p><p><strong>Conclusion: </strong>ESD for rectal lesions adjacent to the dentate line yields favorable short- and long-term outcomes. Although large lesions and intraoperative bleeding prolong procedure time, appropriate device selection can mitigate these challenges.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148826287","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":"Risk Stratification Using the Asia-Pacific Colorectal Screening Score in Asymptomatic and Fecal Immunochemical Test-Positive Individuals in Japan.","authors":"Satoru Mizutani, Masau Sekiguchi, Yasuhiko Mizuguchi, Ryoji Ichijima, Naoya Toyoshima, Hiroyuki Takamaru, Masayoshi Yamada, Nozomu Kobayashi, Mitsuhiro Fujishiro, Yutaka Saito","doi":"10.1159/dig/acmag003","DOIUrl":"10.1159/dig/acmag003","url":null,"abstract":"<p><strong>Introduction: </strong>Currently, most colorectal cancer (CRC) screening programs, such as fecal immunochemical test (FIT)-based, adopt a one-size-fits-all approach; however, the limited colonoscopy capacity necessitates risk stratification in CRC screening. In this study, we evaluated whether the Asia-Pacific Colorectal Screening (APCS) score can be applied for risk stratification in both asymptomatic individuals undergoing screening colonoscopy and those with a positive FIT in Japan.</p><p><strong>Methods: </strong>We retrospectively analyzed individuals aged ≥40 years who underwent their first colonoscopy between January 2015 and April 2025. Individuals were classified into average-, moderate-, and high-risk groups according to their APCS scores. The detection rates of advanced colorectal neoplasia (ACN) and the area under the receiver operating characteristic curve of the score for ACN detection were evaluated separately in asymptomatic individuals undergoing screening colonoscopy and those with a positive FIT.</p><p><strong>Results: </strong>A total of 1,366 asymptomatic individuals were included. In the 825 individuals undergoing screening colonoscopy, ACN detection rates increased across APCS risk categories (average: 1.6%, moderate: 6.7%, high: 16.0%; p < 0.001). In the 541 FIT-positive individuals, ACN detection rates also increased across APCS risk categories (average: 7.1%, moderate: 17.8%, high: 28.8%; p < 0.001). The area under the receiver operating characteristic curve of the score for ACN detection was 0.68 and 0.63 in individuals undergoing screening colonoscopy and FIT-positive individuals, respectively.</p><p><strong>Conclusion: </strong>Risk stratification was demonstrated using the APCS score in asymptomatic Japanese individuals undergoing screening colonoscopy and in FIT-positive individuals, supporting the potential for more efficient use of limited colonoscopy capacity.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148826289","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 of Fexuprazan-Based Concomitant Therapy for <i>Helicobacter pylori</i> Infection.","authors":"Seokin Kang, Nam-Hoon Kim, Jong Wook Kim, Jun Hyuk Son","doi":"10.1159/dig/acmag007","DOIUrl":"10.1159/dig/acmag007","url":null,"abstract":"<p><strong>Introduction: </strong>Fexuprazan is a novel potassium-competitive acid blocker that provides rapid and potent acid suppression and may serve as an alternative to proton pump inhibitors for Helicobacter pylori eradication. We prospectively evaluated the efficacy and safety of a 10-day fexuprazan-based non-bismuth quadruple (concomitant) therapy regimen as first-line treatment for H. pylori eradication.</p><p><strong>Methods: </strong>This prospective, single-center, single-arm exploratory study enrolled H. pylori eradication-naïve patients. Participants received fexuprazan 40 mg, clarithromycin 500 mg, amoxicillin 1,000 mg, and metronidazole 500 mg twice daily for 10 days. Clarithromycin resistance was assessed by dual-priming oligonucleotide-based multiplex polymerase chain reaction for 23S rRNA point mutations, and cytochrome P450 2C19 genotyping was performed for subgroup analysis.</p><p><strong>Results: </strong>A total of 93 patients were enrolled, and 88 completed the eradication therapy. The eradication rates were 90.3% (84/93) in the intention-to-treat analysis and 92.0% (81/88) in the per-protocol analysis. Among the 89 patients who underwent dual-priming oligonucleotide-based multiplex polymerase chain reaction, point mutations were identified in 25 patients, of whom 80.0% (20/25) achieved successful eradication. Eradication rates did not differ significantly according to cytochrome P450 2C19 genotype (p = 0.686). No severe adverse events occurred, and no liver function abnormalities were observed during the study.</p><p><strong>Conclusions: </strong>Ten-day fexuprazan-based concomitant therapy showed favorable efficacy and tolerability as first-line treatment for H. pylori eradication. As this is the first clinical study to evaluate fexuprazan for H. pylori eradication, further comparative studies are needed to confirm these findings.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148826298","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 Intervention Strategies for Collateral Circulation Formation and Splenomegaly in Portal Hypertension due to Cirrhosis.","authors":"Yanping Sun, Yuling Zhao, Bo Zhao, Yongbo Xu, Haibo Chu","doi":"10.1159/dig/acmag008","DOIUrl":"10.1159/dig/acmag008","url":null,"abstract":"<p><strong>Background: </strong>Portal hypertension (PH) is a common clinical syndrome characterized by a pathologic increase in portal venous pressure. Nevertheless, an ideal therapeutic approach remains to be established in clinical practice.</p><p><strong>Summary: </strong>In cirrhosis, PH occurs owing to extensive fibrosis within the liver parenchyma, causing increased vascular resistance. As PH develops, collateral vessel formation and arterial vasodilation progress, enhancing the blood flow to the portal circulation. Increased levels of circulatory vasodilators are believed to be caused by portosystemic shunting and bacterial translocation, leading to the redistribution of the blood volume with central hypovolemia. Esophagogastric varices and splenomegaly develop as a result of hyperdynamic circulatory syndrome. Cirrhosis-induced blood flow obstruction leads to long-term congestion of the splenic sinus, hyperplasia of fibrous tissue, and proliferation of splenic myeloid cells, culminating in splenomegaly. This condition is a marker of advanced chronic liver disease and PH. Angiogenesis plays a pivotal role in forming portosystemic shunts and splenomegaly. As both jointly reflect the hemodynamic abnormalities in PH, they have become key diagnostic and therapeutic targets. However, significant challenges remain.</p><p><strong>Key messages: </strong>This review focuses on our current understanding of the pathophysiology of collateral circulation and splenomegaly and novel therapeutic approaches for cirrhosis. Interventions targeting these vascular alterations are expected to exert beneficial effects in managing PH in the future.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812461","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":"Incomplete Intestinal Metaplasia as a High-Risk Clinical Phenotype in Gastric Carcinogenesis: Implications for Surveillance and Management.","authors":"Hongfa Wei, Weidong Chen, Xun Chen, Rongjie Zheng, Hao Chen, Yanpeng Huang, Dianzuo Cai, Chanshan Ma, Yang Zheng, Feiran Zhang, Suihong Qiu","doi":"10.1159/000553633","DOIUrl":"10.1159/000553633","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer remains a leading cause of cancer-related mortality worldwide, underscoring the critical need for effective prevention through the management of precancerous lesions. Gastric intestinal metaplasia is a key precursor, with its incomplete subtype (incomplete intestinal metaplasia [IIM]) conferring a substantially higher risk of malignant progression compared to complete intestinal metaplasia (CIM). However, IIM is not merely a static histological variant but represents a dynamic, transitional epithelial state of mixed gastric and intestinal differentiation, driven by chronic inflammation. Its accurate identification and clinical management pose significant challenges.</p><p><strong>Summary: </strong>This review synthesizes current evidence on IIM as a high-risk transitional phenotype in gastric carcinogenesis. We detail its cellular origins, primarily from spasmolytic polypeptide-expressing metaplasia via chief cell reprogramming (paligenosis), and its characteristic hybrid molecular signature. Diagnostically, definitive subtyping relies on histochemical staining (e.g., AB-PAS), as conventional endoscopy and histology lack sufficient precision, highlighting a barrier to routine risk stratification. Epidemiologically, IIM is associated with a 4- to 11-fold increased risk of gastric cancer compared to CIM. While Helicobacter pylori eradication may induce partial regression, patients with IIM retain a significant residual cancer risk, necessitating ongoing surveillance. Emerging endoscopic techniques (e.g., narrow-band imaging) and molecular biomarkers (including DMBT1, AQP5, TROP2, and OLFM4) show promise for improving in vivo detection and risk assessment, with combinatorial biomarker strategies potentially better capturing IIMs hybrid phenotype. Current classification systems have limitations, including the frequent coexistence of subtypes and a lack of validated biomarkers for precise risk stratification.</p><p><strong>Key messages: </strong>(1) IIM is a biologically unstable, transitional lesion with a markedly elevated risk of progression to gastric adenocarcinoma, warranting its distinction from CIM in clinical practice. (2) Reliance on specialized pathology for diagnosis limits widespread risk stratification, creating an urgent need for reliable endoscopic predictors and validated molecular biomarkers. (3) Even after successful H. pylori eradication, patients with IIM require long-term endoscopic surveillance due to persistent cancer risk. Future strategies must integrate IIM subtyping into personalized surveillance protocols to enhance gastric cancer prevention.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789365","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":"Clinicopathological Characteristics of Endoscopically Detected and Undetected Lesions in Hereditary Diffuse Gastric Cancer.","authors":"Takahiro Uda, Yuji Urabe, Tomoyuki Gurita, Yoshiki Hatsushika, Satoshi Masuda, Yukiko Sako, Takeo Nakamura, Kazuki Ishibashi, Hirona Konishi, Takeshi Mizumoto, Yuichi Hiyama, Akira Ishikawa, Junko Fujiwara, Toshio Kuwai, Shigeto Yoshida, Masahiro Nakagawa, Takao Hinoi, Shinji Mii, Shiro Oka","doi":"10.1159/000553272","DOIUrl":"10.1159/000553272","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary diffuse gastric cancer (HDGC), caused by germline mutations in CDH1, is associated with a high risk of diffuse gastric cancer. In HDGC, gastric cancer lesions are often poorly visualized during endoscopy, increasing the likelihood of missed lesions. We aimed to investigate the clinicopathological characteristics of endoscopically detected and undetected lesions in patients with HDGC.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients diagnosed with HDGC between January 2017 and October 2024 at 4 institutions. Patients who underwent prophylactic or therapeutic total gastrectomy with detailed preoperative endoscopic evaluation were included.</p><p><strong>Results: </strong>Among 7 patients diagnosed during the study period, 5 underwent gastrectomy and were included in the analysis. Histopathological examination identified 146 lesions, of which 39 (27%) were detected endoscopically. No significant clinicopathological differences were observed between detected and undetected lesions, except for tumor size and anatomical location. Detection rates were significantly lower in the upper (U) region (1%) than in the middle (M) (81%) and lower (L) (68%) gastric regions (p < 0.01). Lesions in the U region were significantly smaller, and in a subgroup analysis of lesions measuring ≥4 mm, the detection rate was lower in the U region than in the M/L regions (17% vs. 95%, p < 0.01), although lesion size still differed between regions.</p><p><strong>Conclusion: </strong>Endoscopic detection of HDGC-associated gastric cancer lesions remains challenging, particularly for small lesions and those located in the U gastric region. These findings should be interpreted in light of lesion size and may help refine surveillance strategies by clarifying the characteristics of lesions that may be overlooked during HDGC surveillance.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683891","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":"Retraction Statement.","authors":"","doi":"10.1159/000553198","DOIUrl":"10.1159/000553198","url":null,"abstract":"<p><p>The article \"Identification of LGR5 and TFF2 as Biomarkers in High-Risk Chronic Atrophic Gastritis: From Multi-Omics Mining to Clinical Validation\" [Digestion. 2026; https://doi.org/10.1159/000549887] by Qingqing Zhang, Di Wu, Fengyun Guo, Shengnan Yang, Lijing Bao, Ruiying Zhang and Ping Wang has been retracted by the Publisher and the Editor.Post-publication concerns were raised regarding the integrity of the clinical cohort data reported in the article. The data presented in Table 1 shares the same subgroup size, gender distributions and H. pylori infection rates across all three subgroups to those reported in a previously published article by the same research group [1]. Additionally, the images in Figure 4b and d of this article are published as Figure 2a and b in [1]. The previous publication was not cited in this article.When asked about the similarities between the cohorts, the authors stated that they were two independent cohorts and that the similarities were coincidental. The Editors did not find the authors' explanation sufficient to resolve their concerns, and as a result have lost confidence in the reliability and originality of the reported cohort data.The authors did not respond to our correspondence about the retraction of this article within the timeframe specified.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648496","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":"Dynamic Changes in Circulating and Tissue Biomarkers and Therapeutic Response to HER2/PD-1 Dual Blockade in HER2-Positive Gastric Cancer.","authors":"Yueyan Shi, Jie Zhang, Jianmei Gu, Wenjing Zhao, Guoxing Li, Xiaohua He","doi":"10.1159/000553654","DOIUrl":"10.1159/000553654","url":null,"abstract":"<p><strong>Introduction: </strong>HER2-positive gastric adenocarcinoma demonstrates heterogeneous responses to dual HER2/PD-1 blockade therapy. This study investigated integrated circulating tumor DNA (ctDNA), protein biomarkers, and immune cell profiling for predicting treatment outcomes and monitoring therapeutic resistance.</p><p><strong>Methods: </strong>This retrospective analysis included 72 patients with HER2-positive gastric or gastroesophageal junction adenocarcinoma receiving anti-HER2 therapy plus PD-1 inhibitors. Serial blood samples underwent ctDNA sequencing, protein biomarker measurement, and flow cytometric immune cell characterization. Multivariable analysis identified independent predictors and developed an integrated biomarker model for patient stratification.</p><p><strong>Results: </strong>Objective response rate was 40.3% with a median progression-free survival of 11.4 months. Sustained ctDNA suppression in 24 patients correlated with prolonged survival compared to early rebound patterns (p = 0.048). Co-occurring genomic alterations in EGFR, PIK3CA, MYC, and FGFR2 were detected in ctDNA and were associated with shorter progression-free survival. CD8+ T-cell increases and natural killer cell activity patterns differed between responders and nonresponders. Multivariable analysis identified composite immune score (HR: 0.58, p = 0.003), tumor stage (HR: 2.31, p < 0.001), and performance status as independent predictors. An exploratory integrated biomarker model stratified patients into risk categories of differing outcomes, although discrimination was modest (area under the curve: 0.65) and requires prospective validation.</p><p><strong>Conclusion: </strong>Integrated ctDNA and immune biomarker monitoring may provide prognostic information for dual HER2/PD-1 blockade therapy. Serial molecular profiling enables early resistance detection and identifies evolutionary patterns that may inform therapeutic strategies, though prospective validation is required.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548095","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":"Extraintestinal Manifestations Have a Negative Impact on Quality of Life of Patients Living with Inflammatory Bowel Disease.","authors":"Jesus K Yamamoto-Furusho, Fausto Damian Gutierrez-Herrera","doi":"10.1159/000553638","DOIUrl":"10.1159/000553638","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel diseases (IBDs) can produce extraintestinal manifestations (EIMs) in up to 50% of patients with IBD and may have worse quality of life than the general population. In general, IBD patients with activity have worse quality of life than those who are in remission. No previous studies have explored whether EIMs can affect the quality of life in patients with IBD. The aim of this study is to evaluate whether the presence of EIM causes a worse quality of life in patients with IBD.</p><p><strong>Methods: </strong>A case-control study that included 243 patients diagnosed with IBD (132 without EIM and 111 with EIM). The IBDQ-32 questionnaire was administered to all patients in order to measure the quality of life. The cutoff value to consider altered quality of life was <170 points. Statistical analysis was performed using SPSS version 25.</p><p><strong>Results: </strong>Patients with IBD with EIMs had significantly worse quality of life than those without EIMs (p = 0.001; OR = 2.29, 95% CI: 1.3-3.8). In the subgroup analysis by dimensions of the IBDQ-32, we found that all of them, such as social function (p < 0.0001), systemic symptoms (p < 0.0001), intestinal symptoms (p < 0.0001), and emotional (p < 0.0001), were affected in all patients with EIMs.</p><p><strong>Conclusions: </strong>Patients with IBD and EIMs had worse quality of life compared to those without EIMs regardless of IBD activity.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-6"},"PeriodicalIF":3.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497313","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":"Directional Bias in Polyp Detection during Colonoscopy: A Prospective Observational Study.","authors":"Atsushi Katagiri, Sayaka Mizuno, Daichi Mori, Yoshinao Onishi, Yuta Yamazaki, Kensuke Higuchi, Norihiro Suzuki, Kazuo Kikuchi, Shinya Nakatani, Takahisa Fujiwara, Kazuya Inoki, Kenichi Konda, Masayuki Tojo, Kunihiko Wakamura, Hitoshi Yoshida","doi":"10.1159/000552207","DOIUrl":"https://doi.org/10.1159/000552207","url":null,"abstract":"<p><strong>Introduction: </strong>Colonoscopy is essential for colorectal cancer prevention, yet a proportion of lesions remain undetected, contributing to interval cancers. Although adjunctive technologies can improve adenoma detection, the role of inherent visibility differences across the endoscopic field has not been fully clarified. This study evaluated whether polyp detection varies according to the short-axis direction of the colonic lumen (SADCO) during colonoscopic withdrawal.</p><p><strong>Methods: </strong>In this prospective observational study conducted at a tertiary center between June 2024 and February 2025, the short-axis direction of initial lesion visualization was recorded using the short-axis directional classification (SADCO). The primary outcome was the distribution of lesion detection between the upper-left direction (ULD) and lower-right direction (LRD). Subgroup analyses, multivariable logistic regression, and post hoc quadrant analysis were performed to assess factors associated with ULD detection.</p><p><strong>Results: </strong>A total of 1,185 lesions from 432 patients were analyzed. Detection in the ULD was significantly lower than in the LRD (42.4% vs. 57.6%; p < 0.001), and this pattern was consistent across lesion size, bowel segment, macroscopic type, and endoscopist experience. Detection of advanced adenomas tended to be lower in the ULD (41.4% vs. 58.6%; p = 0.071), and detection of advanced neoplasia was significantly reduced (40.7% vs. 59.3%; p = 0.043). On multivariable analysis, a history of colonoscopy within 3 years was independently associated with increased ULD detection (p = 0.040). Quadrant analysis confirmed the lowest detection rate in the upper-left quadrant.</p><p><strong>Conclusion: </strong>Polyp detection during colonoscopic withdrawal demonstrates a consistent directional bias, with the ULD functioning as a region of relatively reduced detection frequency. Awareness of this intrinsic limitation and deliberate inspection of the ULD may help optimize visual inspection patterns during colonoscopy.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367549","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}