Digestion最新文献

{"title":"Therapeutic Potential of the Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet in Functional Dyspepsia: A Systematic Review.","authors":"Ryo Katsumata, Satoshi Shinozaki, Tadayuki Oshima, Jun Watanabe, Akihiro Asakawa, Takeshi Kamiya, Takaomi Kessoku, Hidekazu Suzuki, Ken Nakamura, Mariko Hojo, Hiroshi Mihara, Hideki Mori, Takatsugu Yamamoto, Fumio Tanaka, Seiji Futagami, Ken Haruma, Takashi Joh, Motoyasu Kusano, Koji Yakabi","doi":"10.1159/000551300","DOIUrl":"10.1159/000551300","url":null,"abstract":"<p><strong>Introduction: </strong>Dietary factors, including fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), have been implicated in symptom generation among patients with functional dyspepsia (FD). Accordingly, a low-FODMAP diet (LFD) has been proposed as a potential therapeutic approach. However, no systematic review has yet been conducted. This study aimed to evaluate the effects of an LFD on gastrointestinal symptoms and quality of life (QoL) in patients with FD.</p><p><strong>Methods: </strong>Following PRISMA guidelines, Medline, Embase, and Central were searched through October 2025. Studies involving adults or children diagnosed with FD and treated with a structured LFD or lower habitual FODMAP intervention were included. Randomized controlled trials (RCTs) and non-RCTs were assessed for methodological quality using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale, respectively.</p><p><strong>Results: </strong>Ten studies involving 4,329 patients (two RCTs and eight non-RCTs) met the inclusion criteria. Both RCTs demonstrated significant improvements in dyspeptic symptoms and QoL following an LFD compared with the control or baseline. Non-RCTs consistently showed symptom relief and improved QoL in adults and children under dietitian supervision, whereas lower habitual FODMAP intake was associated with a higher risk of FD prevalence in cross-sectional studies. Overall, the studies exhibited a predominantly moderate risk of bias.</p><p><strong>Conclusion: </strong>Current evidence suggests that an LFD may alleviate gastrointestinal symptoms and enhance QoL in patients with FD. However, existing studies remain few and heterogeneous. High-quality, adequately powered clinical and mechanistic studies are warranted to confirm its therapeutic efficacy and clarify the underlying physiological mechanisms.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347820","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":"Positive Margins and Lymphovascular Invasion Represent Risk Factors for Remnant Tumor or Late Recurrence in Endoscopic or Local Resection of Duodenal Neuroendocrine Tumors.","authors":"Ilsoo Kim, Yu Kyung Cho, In Hyoung Choi, Donghoon Kang, Jae Myung Park","doi":"10.1159/000551059","DOIUrl":"10.1159/000551059","url":null,"abstract":"<p><strong>Introduction: </strong>Duodenal neuroendocrine tumors (DNETs) are rare neoplasms with malignant potential, and the optimal strategy between endoscopic resection (ER) and surgical resection (SR) remains debated. This study evaluated the clinical outcomes of ER and SR in patients with DNETs at a single tertiary center.</p><p><strong>Methods: </strong>We retrospectively reviewed patients diagnosed with DNETs at Seoul St. Mary's Hospital between 2009 and 2025. The clinical features, treatment modalities, pathology, complications, and long-term outcomes were analyzed. Median follow-up was 4.76 years (0.03-13.70).</p><p><strong>Results: </strong>Sixty-five patients were included (mean age, 62.9 years; 31 men). Fifty patients underwent ER (26 EMR, 9 EMR-L, 11 EMR-P, 1 ESD, 2 ampullectomy, and 1 removal with hot biopsy), while 15 underwent SR (10 wedge resections and 5 pancreatoduodenectomy/Whipple). The en bloc resection rate for ER was 93.9% (46/49), with a histopathologically curative resection rate of 69.4%. Fourteen ER patients had positive margins; one underwent additional surgery with a confirmed residual tumor, but the others showed no recurrence during a median follow-up of 6.8 years. Perforation occurred in three ER cases (6%), all of whom were successfully treated. Among the wedge resections, R1 resection occurred in 3/10 cases. One patient developed lymph node recurrence 12 years after wedge resection, whereas the others remained disease-free. Overall, recurrence was rare in both groups.</p><p><strong>Conclusion: </strong>ER and surgical local resection are effective, minimally invasive treatments for small DNETs, with high resection rates and acceptable safety. However, positive margins and lymphovascular invasion are risk factors for remnant tumors or late recurrence, underscoring the importance of long-term surveillance in high-risk patients.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321466","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":"A Comprehensive Literature-Based Analysis of Prognosis in Patients with Cronkhite-Canada Syndrome.","authors":"Yuki Imazu, Maiko Ono, Yugo Takeda, Mariko Ishii, Nobuko Matsuoka, Hiromi Nakajima, Akira Toyoda, Yoshinori Takahara, Hiromasa Harada, Yoshitaka Ogata","doi":"10.1159/000551291","DOIUrl":"10.1159/000551291","url":null,"abstract":"<p><strong>Introduction: </strong>Cronkhite-Canada syndrome (CCS) is a rare, nonhereditary gastrointestinal disorder with unclear etiology and limited treatment consensus. Given the scarcity of data, we aimed to construct a pooled literature-based cohort to analyze survival outcomes and identify prognostic factors to inform future therapeutic strategies.</p><p><strong>Methods: </strong>We developed a literature-based cohort of CCS by extracting individual patient data from published case reports and two in-house cases. Articles were selected through a systematic screening process based on relevance and data availability. Information collected included age, sex, clinical symptoms, laboratory findings, endoscopic and histological features, treatment approaches, and outcomes. The compiled dataset was used to explore clinical characteristics, treatment patterns, and survival trends across reported cases.</p><p><strong>Results: </strong>A total of 200 CCS patients were analyzed, including 198 from literature and 2 in-house cases. Most patients presented with diarrhea, weight loss, skin pigmentation, and alopecia. Polyps were commonly found in the stomach and colon. Survival analysis showed a 1-year survival rate of 92.3% and a 3-year survival rate of 79.9%. Male sex was associated with poor prognosis. However, multivariate analysis showed no significant predictors. Treatment with corticosteroids significantly improved survival, especially with high doses (≥40 mg/day). Surgical intervention tended to correlate with poorer outcomes. These findings suggest that appropriately dosed corticosteroid therapy may enhance long-term prognosis in CCS.</p><p><strong>Conclusion: </strong>Using a comprehensive analysis of literature-based Cronkhite-Canada syndrome cases and our in-house cases, this study demonstrated the clinical characteristics of CCS. Our data showed the prognostic value of sex and surgical intervention, and the significance of high-dose corticosteroid therapy on the treatment of CCS.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321377","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 Transpapillary Gallbladder Drainage Reduces the Frequency of Biliopancreatic Events in the Waiting Period for Surgery, Even in Patients without Comorbid Diseases.","authors":"Yavuz Emre Parlar, Bengi Öztürk, Onur Keskin, Taylan Kav, Erkan Parlak","doi":"10.1159/000551128","DOIUrl":"10.1159/000551128","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with acute cholecystitis and choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) followed by interval cholecystectomy (6 weeks-3 months), preoperative biliopancreatic events are reported in 18.3-41.8%. Endoscopic transpapillary gallbladder drainage (ET-GBD) is indicated in this patient group if there are comorbidities preventing surgery. This study compared biliopancreatic events during the interval to cholecystectomy in patients who underwent ET-GBD despite being surgically fit versus those treated with ERCP alone.</p><p><strong>Methods: </strong>In this retrospective study conducted between 2018 and 2023, 121 patients with cholecystitis secondary to choledocholithiasis underwent ERCP. Surgical candidates expected to undergo delayed cholecystectomy were divided into two groups: those who received ET-GBD (study group) and those who did not (control group, from the first half of the study period).</p><p><strong>Results: </strong>The ET-GBD group had a mean age of 54.54 (56.7% female), while the non-ET-GBD group had a mean age of 63.18 (50% female). During the waiting period, biliopancreatic events occurred in 1/34 (2.9%) of ET-GBD patients versus 18/34 (52.9%) of controls (absolute risk reduction: 50.0%, 95% confidence interval [CI]: 21.8-68.0; relative risk: 0.056, 95% CI: 0.0079-0.39; p < 0.001). Specifically, biliary colic (2.9% vs. 47.1%; p < 0.001), cholecystitis (0% vs. 17.6%; p = 0.009), and choledocholithiasis (0% vs. 26.4%; p = 0.001) were significantly less frequent in the ET-GBD group.</p><p><strong>Conclusion: </strong>ET-GBD was associated with significantly lower biliopancreatic complications during the interval to surgery in operable patients with acute cholecystitis and choledocholithiasis.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303629","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":"Diagnosis of Gastric Intestinal Metaplasia: Histology, Endoscopy, and Artificial Intelligence.","authors":"Byeong Yun Ahn, Ji Yoon Kim, Hyunsoo Chung","doi":"10.1159/000551238","DOIUrl":"10.1159/000551238","url":null,"abstract":"<p><strong>Background: </strong>Gastric intestinal metaplasia (GIM) is a well-established precancerous lesion and key biomarker for assessing the risk of gastric cancer. Histological classification into complete and incomplete types, along with the Operative Link on Gastric Intestinal Metaplasia, provides valuable prognostic information, with stages III-IV strongly associated with cancer development. Therefore, an accurate diagnosis and appropriate surveillance of GIM are essential.</p><p><strong>Summary: </strong>This review highlights the epidemiology, histological subtypes, and staging systems of GIM, and evaluates the performance of endoscopic modalities, including conventional white-light endoscopy (WLE), chromoendoscopy, and image-enhanced endoscopy (IEE). Conventional WLE has limited sensitivity and specificity for detecting GIM. In contrast, IEE techniques and scoring systems, such as the Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM), improve detection, demonstrate a strong correlation with histology, and enable endoscopic risk stratification. Although these methods increase the diagnostic yield, their accuracy remains dependent on operator experience and training. To address this limitation, artificial intelligence (AI) has attracted significant attention. Recent studies have reported that AI-assisted endoscopy achieves sensitivities and specificities exceeding 90%, often outperforming human endoscopists. AI applications extend beyond detection to real-time segmentation, automated EGGIM scoring, and pathological image analyses. However, challenges remain, including the need for external validation, management of data heterogeneity, generalizability beyond Asian cohorts, and development of explainable AI.</p><p><strong>Key messages: </strong>(i) GIM is a critical biomarker for gastric cancer prevention that requires accurate diagnosis and surveillance. (ii) IEE techniques substantially improve endoscopic detection compared to WLE, although interobserver variability remains. (iii) AI demonstrates excellent diagnostic accuracy for GIM and may help overcome the human limitations in detection and grading. (iv) Future directions include prospective multicenter validation, real-time video-based AI, and integration of explainable and ethically sound AI systems into clinical practice.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303610","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":"Disturbance of Lymphatic Function by Prox1 Contributes to Mesenteric Lesions and the Composition of Microbiota in Crohn's Disease.","authors":"Weisong Shen, Chenyang Li, Ruiqing Liu, Xiaohui Huang, Yi Li, Weiming Zhu","doi":"10.1159/000551237","DOIUrl":"10.1159/000551237","url":null,"abstract":"<p><strong>Introduction: </strong>The main aim of the current study was to investigate the potential role of Prox1 in lymphatic function and analyze Prox1-dependent stimulation of lymphatic function in experimental Crohn's disease (CD).</p><p><strong>Methods: </strong>Prox1flox/+, Tie2-CreERT2, and IL-10 KO mice were included. Lymphatic vessel density and lymphatic function were analyzed using immunohistochemistry and lymphangiography. The effects of lymphatic function on mesenteric adipose tissue (MAT) and the composition of microbiota were evaluated. Disease activity and enterocolitis inflammation were assessed using a grading system.</p><p><strong>Results: </strong>For lymphatic vessel, IL-10 KO+Prox1 KO mice showed lower lymphatic vessel density and less functional lymphatic vessels. IL-10 KO+AAV-Prox1 mice showed significantly increased lymphatic vessel density. Delivery of AAV-Prox1 also promoted lymphatic drainage function. Additionally, Prox1-dependent stimulation of lymphatic function reduced hypertrophy of MAT in IL-10 KO mice. Delivery of AAV-Prox1 also modified the composition of microbiota; the proportion of Firmicutes increased and Bacteroidetes decreased in IL-10 KO+AAV-Prox1 mice compared with IL-10 KO mice. An increase in the diversity of gut microbiota in IL-10 KO+AAV-Prox1 mice was observed. Systemic delivery of AAV-Prox1 ameliorated disease activity index and the severity of gut inflammation in IL-10 KO mice. Without the compensatory response of Prox1, IL-10 KO+Prox1 KO mice developed serious inflammation in the colon.</p><p><strong>Conclusion: </strong>Prox1 played the critical role in lymphatic function. Additionally, Prox1-dependent stimulation of lymphatic function could reduce hypertrophy of MAT, modify the composition of microbiota, and ameliorate gut inflammation. Our findings demonstrated that correction of lymphatic function with Prox1 may lead to improved treatments for CD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289756","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":"Gastric Cancer in the Post-<italic>Helicobacter pylori</italic> Era: Non-<italic>H</italic>. <italic>pylori</italic>-Related Gastric Microbiota, Non-<italic>H</italic>. <italic>pylori-</italic>Related and Post-<italic>H. pylori</italic> Eradication Gastric Cancer.","authors":"Andrew Xia Huang Tan, Nicholas Chin Hock Tee, Tiing Leong Ang","doi":"10.1159/000551095","DOIUrl":"10.1159/000551095","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori-negative gastric cancer (GC) occurs in individuals with specific risk factors. This narrative review will evaluate the role of non-H. pylori gastric microbiota in gastric carcinogenesis and summarize the clinical aspects of non-H. pylori-related GC.</p><p><strong>Summary: </strong>Epstein-Barr virus is the only other infection conclusively proven to be causative of GC. Case-control studies have reported a dysbiotic GC-associated gastric microbiome, with greater abundance of Fusobacterium nucleatum, Streptococcus anginosus, Prevotella, and Veillonella. Mice model mechanistic studies have demonstrated the role of non-H. pylori microbiota in gastric carcinogenesis. Current data support their role as promotive factors, with H. pylori infection being the initiating event. In hereditary GC, inherited germline mutations initiate a genetically programmed pathway to gastric carcinogenesis. Autoimmune atrophic gastritis and Ménétrier's disease are associated with increased GC risk. Oxyntic gland adenoma/gastric adenocarcinoma of fundic gland type and foveolar-type gastric adenoma are distinct histological subtypes of gastric neoplasia. Chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) persist even after H. pylori eradication, increasing GC risk.</p><p><strong>Key messages: </strong>There must be greater awareness of H pylori-negative GC as a diagnostic possibility due to the impact on management. There is significant potential for translational application of gastric microbiome as predictive or prognostic biomarkers or even to shape treatment outcomes. Endoscopic surveillance is indicated in the case of extensive CAG or GIM, even after successful H. pylori eradication.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225900","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":"Childhood-Onset Celiac Disease Autoimmunity and Risk of Depression and Anxiety across the Lifespan: A Longitudinal Analysis of a Large Real-World Cohort.","authors":"Yotam Elimeleh, Matan Buchris, Halim Awadie, Firas Abu Hanna, Orit Rozenberg, Firas Rinawi","doi":"10.1159/000550906","DOIUrl":"10.1159/000550906","url":null,"abstract":"<p><strong>Introduction: </strong>Celiac disease is associated with various extraintestinal manifestations, including psychiatric and psychological comorbidities. We evaluated the risk of developing depression and anxiety among patients diagnosed with celiac disease autoimmunity (CDA).</p><p><strong>Methods: </strong>This retrospective case-control cohort study was conducted using the Clalit Healthcare Services population-based electronic database (∼4.5 million individuals). Between January 1, 2008, and December 31, 2022, we identified subjects aged 1-80 years with a positive IgA anti-tissue transglutaminase test and a repeat measurement within 6-36 months. Depression and anxiety were identified over follow-up using ICD-9 diagnostic codes or by documented regular use of antidepressants or anxiolytics.</p><p><strong>Results: </strong>We identified 3,797 patients with CDA, and the cohort was matched in a 1:3 ratio with 11,387 healthy controls having a negative anti-tTG2 serology. Over a median 60-month follow-up duration, 5.9% of CDA patients developed depression or anxiety, compared to 1.7% of the control group (HR 2.89, 95% CI 2.2-3.8, p < 0.001), and 67% of anxiety and depression cases among CDA patients were developed during childhood. On multivariate analysis, very high baseline anti-tTG2 level (>10× ULN), older age at diagnosis, and female sex were independently associated with the risk of developing anxiety and depression among CDA patients (HR 1.82, 1.03, and 1.38; p values 0.029, 0.018, and 0.038, respectively).</p><p><strong>Conclusions: </strong>CDA appears to increase the risk for anxiety and depression, particularly with very high baseline anti-tTG2 levels, advanced age at diagnosis, and in females.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.4,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225880","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":"Comparative Evaluation of Endoscopic Closure Techniques for Mucosal and Full-Thickness Defects: An ex vivo Study.","authors":"Shun Nakagome, Osamu Goto, Takanori Matsui, Noriko Nishiyama, Tsugumi Habu, Eriko Koizumi, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Hideki Kobara, Katsuhiko Iwakiri","doi":"10.1159/000550836","DOIUrl":"10.1159/000550836","url":null,"abstract":"<p><strong>Introduction: </strong>Reliable closure of mucosal/full-thickness defects after endoscopic treatment is crucial to prevent complications. Although various techniques have been clinically introduced, a direct comparison of these techniques has not been conducted. Thus, the present ex vivo study aimed to evaluate the closure strength of these methods.</p><p><strong>Methods: </strong>Using a porcine stomach, 4 × 2.5-cm mucosal and full-thickness defects were prepared. Each closure was performed for three specimens. For the mucosal defects, the following methods were performed in the mucosal (group M) and muscular-mediated mucosal (group MM) closures: simple clipping (clip-M), loop-assisted closure (loop-M), line-assisted closure (line-M), and endoscopic hand suturing (EHS-M); clip-MM, line-MM, and EHS-MM. For the full-thickness defects, a single-layered closure (group F) was performed by loop-assisted closure (loop-F), line-assisted clip closure (line-F), and EHS (EHS-F). The maximum tension (N) was measured using a mechanical traction device by mechanically pulling both ends of the specimen.</p><p><strong>Results: </strong>In the closure of mucosal defects, among the techniques in group M, EHS-M (11.32 ± 2.1 N) demonstrated the highest strength as compared to the other three methods. For group MM, EHS-MM (13.1 ± 5.3 N) showed the highest strength, significantly outperforming clip-MM (p = 0.03). Among the full-thickness defect closure methods, EHS-F (9.5 ± 0.73 N) had the significantly highest strength among the three methods.</p><p><strong>Conclusions: </strong>Our ex vivo data showed that EHS has superior closure strength in both mucosal and full-thickness defects. Surgery-oriented endoscopic closure appears to be a reliable method for artificially created intraluminal defects.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178470","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":"Identifying Post-Surgical Recurrence Subtype of T1-Stage Colorectal Cancer by Machine Learning.","authors":"Xue Zhou, Kazutomo Togashi, Xin Zhu, Tuao Zhang, Yoshiki Kajiwara, Shiro Oka, Shinji Tanaka, Takahiro Nakamura, Manabu Takamatsu, Kinichi Hotta, Masayoshi Yamada, Hiroaki Ikematsu, Shinji Nagata, Kazutaka Yamada, Jun Konishi, Soichiro Ishihara, Yusuke Saitoh, Kenji Matsuda, Koji Komori, Megumi Ishiguro, Yuzuru Tamaru, Takashi Okuyama, Akihiro Ohuchi, Shinobu Ohnuma, Kazuhiro Sakamoto, Tamotsu Sugai, Yoichi Ajioka, Kenichi Sugihara, Hideki Ueno","doi":"10.1159/000550959","DOIUrl":"10.1159/000550959","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional risk stratification heavily relies on expert judgment and manually established thresholds. This study aims to automatically identify subtypes in the patients of T1-stage colorectal cancer with distinct clinicopathologic characteristics and recurrence risk profiles, using machine learning.</p><p><strong>Methods: </strong>We analyzed data from 3,367 patients (mean follow-up, 1,281 days) with T1 colorectal cancer who underwent surgical resection between 2009 and 2016 across 27 high-volume core Japanese institutions. Patients were split into derivation and test datasets (4:1 ratio). Hierarchical clustering was employed to identify recurrence subtypes in the derivation dataset. Machine learning classifiers were developed and validated on the test dataset. Co-occurrence and Bayesian network analyses aided interpretation.</p><p><strong>Results: </strong>Three distinct subtypes were identified: two high-risk (subtypes 1 and 2) and one low-risk (subtype 3). Subtype 1 was predominantly associated with polypoid morphology (94.8%), whereas subtype 2 was characterized by flat morphology (89.4%). Subtype 2 showed a relatively consistent presence across most factors, with comparable levels of lymphatic invasion, vascular invasion, and tumor budding. Subtype 3 shared similarities with subtype 1 in polypoid morphology (76.5%) but differed in other factors. These findings showed similar trend on the test dataset. Subtype-specific risk factors included lymphovascular invasion and nodal metastasis in both high-risk subtypes, while rectal location was unique to subtype 1 and polypoid morphology and large size were specific to subtype 2.</p><p><strong>Conclusion: </strong>This machine learning approach identified three distinct recurrence subtypes of T1 colorectal cancer, each with unique characteristics and risk profiles, indicating the potential value of subtype-specific clinical strategies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156374","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}