Gut and Liver最新文献

{"title":"Precision Strategy for Hepatocellular Carcinoma Surveillance after Hepatitis C Cure: Debates across Guidelines.","authors":"Masaaki Mino, Eiji Kakazu, Tatsuya Kanto","doi":"10.5009/gnl250187","DOIUrl":"https://doi.org/10.5009/gnl250187","url":null,"abstract":"<p><p>Hepatitis C virus (HCV) clearance markedly reduces the risk of hepatocellular carcinoma (HCC); however, HCC continues to develop in a subset of patients, particularly in those with advanced fibrosis or cirrhosis. Leading hepatology societies, including Asian Pacific Association for the Study of the Liver, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, Korean Association for the Study of the Liver, Taiwan Association for the Study of the Liver, and Japan Society of Hepatology, have issued divergent guidelines for HCC surveillance after sustained virologic response, which reflects variations in regional patient populations, healthcare infrastructure, and policy priorities. While traditional risk stratification primarily centers on histological staging of fibrosis, an array of additional host-related factors, including age, sex, alcohol use, metabolic comorbidities, and genetic and epigenetic profiles, further influence individual HCC risks. Recently developed predictive models aim to improve risk discrimination and inform tailored surveillance intervals. Concurrently, health economic analyses support the continuation of surveillance in high-risk populations. Nonetheless, the optimal surveillance frequency and criteria for patient selection remain matters of ongoing debates. This review synthesizes current controversies across international guidelines, presents an evaluation of the supporting evidence for varied surveillance strategies, highlights emerging tools for individualized risk assessment, and discusses cost-effectiveness considerations to inform personalized, evidence-based HCC surveillance in the post-HCV cure landscape.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015018","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":"Nationwide Survey on Endoscopic Papillectomy for Ampullary Adenoma: Current Practices and Variability.","authors":"Hyung Ku Chon, Ik Hyun Jo, Sungjo Bang, Kihyun Ryu, Dong Wook Lee, Eaum Seok Lee, Yoon Suk Lee, Jonghyun Lee, Huapyong Kang, Tae Joo Jeon, Chang Hwan Park","doi":"10.5009/gnl250252","DOIUrl":"https://doi.org/10.5009/gnl250252","url":null,"abstract":"<p><strong>Background/aims: </strong>Ampullary adenomas are precancerous lesions requiring accurate diagnosis and timely intervention to prevent malignant transformation. Endoscopic papillectomy (EP) has emerged as a less invasive alternative to surgery; however, technical variations in practice remain. This study evaluated contemporary real-world approaches to the diagnosis, treatment, and surveillance of ampullary adenomas among pancreatobiliary endoscopists.</p><p><strong>Methods: </strong>A nationwide cross-sectional survey was conducted among pancreatobiliary endoscopists certified by the Korean Pancreatobiliary Association between January 19 and March 2, 2025. A 29-item questionnaire assessed diagnostic methods, procedural techniques, and follow-up strategies. Of 231 invitations sent, 85 responses (36.8%) were analyzed. Respondents were stratified by EP experience: ≤10 years (n=40) and >10 years (n=45).</p><p><strong>Results: </strong>Diagnostic and procedural strategies were largely comparable across the two experience groups. No significant differences were observed in the histologic reassessment, endoscopic ultrasound test, or cross-sectional images. Single pigtail plastic stents were the most preferred type for prophylactic pancreatic stenting, with a significantly higher preference among endoscopists with ≤10 years of experience compared to those with >10 years (92.5% vs 66.7%, p=0.008). For post-procedural bleeding management, fully covered self-expandable metal stents were more frequently used by endoscopists with ≤10 years of experience (47.5% vs 11.1%, p=0.001). Surveillance intervals, follow-up modalities, and timing of stent removal showed substantial heterogeneity, with no standardized patterns.</p><p><strong>Conclusions: </strong>Although general clinical practices appear standardized, significant variability remains in specific procedural and post-procedural approaches. These findings highlight the need for refined guidelines to support a more consistent and comprehensive approach to EP.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015101","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":"Transplantation of Autologous Bone Marrow-Derived Mesenchymal Stem Cells for the Treatment of Decompensated Liver Cirrhosis: A Real-World Evidence Study in a Population-Based Cohort.","authors":"Seul Ki Han, Sung Hwa Kim, Sang Baek Koh, Moon Young Kim","doi":"10.5009/gnl250016","DOIUrl":"https://doi.org/10.5009/gnl250016","url":null,"abstract":"<p><strong>Background/aims: </strong>Despite medical advances in recent decades, the mortality rate of advanced liver cirrhosis remains high. Although liver transplantation remains the most effective treatment, candidate selection is limited by donor availability and alcohol abstinence requirements. Bone marrow-derived mesenchymal stem cell (BM-MSC) transplantation has shown promise for the treatment of advanced cirrhosis. However, trials tend to involve small patient samples, and long-term follow-up studies are lacking. In this study, BM-MSC transplantation outcomes were assessed using real-world evidence (RWE) along with dynamic matching to reduce bias.</p><p><strong>Methods: </strong>A control group was selected using exposure density sampling to reduce immortal time bias. Mortality rates were compared using Kaplan-Meier survival analysis and Cox proportional-hazard regression models, with adjustments for baseline characteristics.</p><p><strong>Results: </strong>The cumulative incidences of 5-year mortality were 0%, 5.0%, and 11.3% at 1, 3, and 5 years in the BM-MSC group, compared with 7.0%, 10.9%, and 42.1% in the control group, respectively. Kaplan-Meier analysis revealed no significant difference in 1-year mortality between the BM-MSC and control groups (p=0.140). However, 3- and 5-year mortalities were significantly lower in the BM-MSC group (p<0.001). The adjusted hazard ratios for 5-year mortality in the BM-MSC group were 0.18 (95% confidence interval [CI], 0.04 to 0.87) and 0.14 (95% CI, 0.02 to 0.82) under the two models, indicating a lower mortality risk than in controls.</p><p><strong>Conclusions: </strong>This study highlights the potential of BM-MSC transplantation in reducing long-term mortality in patients with alcoholic cirrhosis. The use of RWE provides a valuable framework for evaluating treatment efficacy and overcoming randomized controlled trial limitations, setting a precedent for future clinical research.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015097","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":"Superior Efficacy of Bismuth-Containing Rifabutin Quadruple Therapy over Rifabutin Triple Therapy as Salvage Treatment.","authors":"Hannah Lee, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Jung Ho Kim","doi":"10.5009/gnl250211","DOIUrl":"https://doi.org/10.5009/gnl250211","url":null,"abstract":"<p><strong>Background/aims: </strong>Helicobacter pylori is a pathogen that causes chronic gastritis and peptic ulcer diseases and is a carcinogen responsible for the development of malignancies, including gastric cancer. In the current era of high antimicrobial resistance, rifabutin-based triple therapy is recommended as a salvage therapy. Bismuth has not only a strong bacteriostatic effect but also a synergic effect when combined with antibiotics. Our study aimed to compare and evaluate the eradication rates between rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy as salvage treatments.</p><p><strong>Methods: </strong>In this single-center study, patients who received rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy after failure of conventional therapy, including first- and second-line treatment, between January 2016 and July 2024, were retrospectively investigated. A total of 53 patients who received rifabutin-based triple therapy and 50 who received bismuth-containing quadruple therapy were included.</p><p><strong>Results: </strong>In the rifabutin-based triple therapy group, eradication was achieved in 32 out of 53 patients (60.4%; 95% confidence interval [CI], 46.8% to 74.0%). In the bismuth-containing quadruple therapy group, eradication was achieved in 40 out of 50 patients (80.0%; 95% CI, 68.5% to 91.5%), demonstrating significant therapeutic benefit (p=0.030). Adverse events, including nausea, epigastric discomfort, and lethargy, were significantly more frequent in the bismuth-containing quadruple therapy group (p=0.007), but they were mild and tolerable enough not to affect compliance (p=0.329).</p><p><strong>Conclusions: </strong>Rifabutin with bismuth-containing quadruple regimen as a salvage treatment achieved significantly superior eradication efficacy over the rifabutin-based triple regimen. Further multicenter prospective studies are needed to provide additional supporting evidence.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Global, Regional, and National Burden of Inflammatory Bowel Disease among Children and Adolescents from 1990 to 2021 and Trend Projections up to 2036.","authors":"Yue Chen, Juan Yu, Jin-Yan Zhang, Xue-Qin Chen, Wei-Feng Huang","doi":"10.5009/gnl250261","DOIUrl":"https://doi.org/10.5009/gnl250261","url":null,"abstract":"<p><strong>Background/aims: </strong>Early-onset inflammatory bowel disease (EO-IBD) poses a global health challenge with its distinct clinical manifestations and complex progression.</p><p><strong>Methods: </strong>In this study, IBD cases occurring before age 20 were defined as EO-IBD. Data were extracted from the Global Burden of Disease 2021 database. Temporal trends were assessed using Joinpoint regression analysis, and future epidemiological trends were projected using the Bayesian age-period-cohort (BAPC) model. Health disparities across various sociodemographic index (SDI) regions were quantified using the slope index of inequality and concentration index.</p><p><strong>Results: </strong>From 1990 to 2021, the global number of EO-IBD cases increased, while the incidence rates showed minimal change. Mortality and disability-adjusted life years (DALYs) rates briefly increased before a rapid decline after 1992. In 2021, males had higher mortality and DALYs rates due to EO-IBD than females. The highest mortality and DALYs rates were observed in the <5 years and 15 to 19 years age groups. Geographically, high SDI regions had the highest incidence, prevalence, and DALYs rates, while low SDI regions had the highest mortality rates. BAPC projections indicate that by 2036, the age-standardized incidence rate and prevalence rate will increase, whereas the age-standardized mortality rate and DALYs rates will continue to decline.</p><p><strong>Conclusions: </strong>The incidence of EO-IBD is projected to exhibit an increasing trend in the future. Although the global mortality and DALYs rates of EO-IBD have decreased, significant disparities persist across age groups and regions. Targeted prevention and control strategies are needed to address the needs of high-risk populations and regions.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000448","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":"Alternative Surveillance Improves Outcomes by Detecting Early-Stage Hepatocellular Carcinoma in Chronic Hepatitis B Patients.","authors":"Dong Ho Lee, Heejin Cho, Su Jong Yu, Min Kyung Park, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, Yoon Jun Kim, Jung-Hwan Yoon","doi":"10.5009/gnl240602","DOIUrl":"https://doi.org/10.5009/gnl240602","url":null,"abstract":"<p><strong>Background/aims: </strong>Current guidelines recommend biannual ultrasound for hepatocellular carcinoma (HCC) surveillance in chronic hepatitis B (CHB) patients. However, computed tomography (CT) or magnetic resonance imaging (MRI) may be used when ultrasound is inadequate. The clinical impact of these alternative modalities remains unclear.</p><p><strong>Methods: </strong>CHB patients undergoing regular HCC surveillance were classified into two groups: ultrasound-only and alternative surveillance (CT/MRI). Patients were stratified into high- and low-risk groups using the Risk Estimation for HCC in CHB (REACH-B) score. Outcomes included 10-year overall survival (OS), HCC tumor size, Barcelona Clinic Liver Cancer (BCLC) stage at diagnosis, and OS after HCC diagnosis. Propensity score matching was applied to balance baseline characteristics.</p><p><strong>Results: </strong>A total of 2,024 patients were included after propensity score matching to ensure balanced baseline characteristics, with 1,012 patients in each group. OS was similar (ultrasound-only 96.0% vs alternative 96.8%; p=0.379). HCC occurred in 66 patients in each group. Alternative surveillance detected smaller HCC tumors (1.6 cm vs 2.1 cm; p<0.001) and more BCLC stage 0 cases (alternative 71.2% vs ultrasound-only 42.4%; p=0.003). The OS after HCC diagnosis was higher with alternative surveillance (83.0% vs 67.0%; p=0.025). In high-risk patients (n=970), alternative surveillance increased the OS (97.3% vs 93.6%; p=0.029) and the OS after HCC diagnosis (83.0% vs 60.6%; p=0.010). No significant differences were observed in low-risk patients.</p><p><strong>Conclusions: </strong>CT/MRI-based alternative surveillance led to earlier HCC detection and improved post-diagnosis survival, particularly in high-risk CHB patients, supporting its potential role as an alternative to ultrasound in selected populations.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Metabolic Dysfunction-Associated Steatotic Liver Disease and Body Mass Index on the Incidence of Alzheimer Disease: A Nationwide Cohort Study.","authors":"Tae Seop Lim, Seok Jong Chung, Jimin Jeon, Ja Kyung Kim, Jinkwon Kim","doi":"10.5009/gnl250079","DOIUrl":"https://doi.org/10.5009/gnl250079","url":null,"abstract":"<p><strong>Background/aims: </strong>This study aimed to investigate the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) and body mass index (BMI) on the incidence of Alzheimer disease (AD) in the general South Korean population.</p><p><strong>Methods: </strong>The National Screening Program for Transitional Ages collected data from 66-year-old dementia-free Koreans in 2010 and 2011. MASLD was diagnosed based on the fatty liver index (≥30) and the presence of metabolic components, and overweight/obese status was defined as a BMI ≥23 kg/m². The primary outcome was the development of AD up to December 2021. Multivariable Cox analyses were performed to evaluate whether the presence of MASLD or overweight/obese status influenced the risk of developing AD.</p><p><strong>Results: </strong>A total of 376,902 dementia-free individuals aged 66 years were included in this cohort. The participants were categorized into four groups: overweight/obese non-MASLD (30.4%, n=114,528), overweight/obese MASLD (37.0%, n=139,551), lean non-MASLD (29.9%, n=126,692), and lean MASLD (2.7%, n=10,131). During a mean follow-up period of 10.38±1.90 years, 23,874 individuals (6.3%) were newly diagnosed with AD. Compared to the overweight/obese non-MASLD group, the adjusted hazard ratios (95% confidence interval) for AD in the lean MASLD, lean non-MASLD, and overweight/obese MASLD groups were 1.34 (1.24 to 1.45), 1.08 (1.04 to 1.13), and 1.13 (1.09 to 1.17), respectively.</p><p><strong>Conclusions: </strong>A normal/underweight BMI and the presence of MASLD synergistically increased the risk of AD. The lean MASLD group had a higher risk of developing AD than the overweight/obese MASLD group, suggesting that the clinical relevance of MASLD for incident AD differs based on the BMI.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992360","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 Lyon Consensus 2.0 in Asia: An Overview.","authors":"Ming-Wun Wong, Chien-Lin Chen","doi":"10.5009/gnl250183","DOIUrl":"https://doi.org/10.5009/gnl250183","url":null,"abstract":"<p><p>The Lyon Consensus 2.0, published in 2023, provides an updated diagnostic framework for gastroesophageal reflux disease (GERD), emphasizing objective physiological testing and introducing the concept of \"actionable GERD\" to guide individualized therapy. This review evaluates the clinical applicability of this framework in Asia, where normative values require regional adaptation. Given limited access to physiological testing in primary care, an endoscopy-based strategy may be considered due to its greater availability, helping overcome diagnostic barriers. Key updates include recognizing Los Angeles grade B esophagitis as conclusive GERD evidence, adoption of prolonged wireless pH monitoring, and revised thresholds for pH-impedance studies, including mean nocturnal baseline impedance. High-resolution manometry and impedance remain important for evaluating refractory symptoms and regurgitation-predominant presentations. Challenges in Asian contexts include the limited predictive performance of Western-derived tools, such as the Lyon score, and the need for lower acid exposure thresholds. The Milan score, a novel manometry-based index, provides an assessment of anti-reflux barrier integrity and may guide selection of candidates for endoscopic anti-reflux therapies. The COuGH RefluX score, based on symptoms and risk factors, estimates GERD probability in patients with laryngeal complaints. Incorporating psychophysiological assessments, such as esophageal hypervigilance and symptom-related anxiety, can further enhance diagnostic precision and improve outcomes. Successful implementation of Lyon Consensus 2.0 in Asia will depend on contextual adaptation of diagnostic criteria and integration of accessible clinical and psychological tools.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992352","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":"Evolving Strategies for the Optimal Management of Common Bile Duct Stones.","authors":"Hyung Ku Chon, Ik Hyun Jo, Chang Hwan Park","doi":"10.5009/gnl250251","DOIUrl":"https://doi.org/10.5009/gnl250251","url":null,"abstract":"<p><p>Management of common bile duct (CBD) stones has evolved substantially with the advent of endoscopic techniques and dedicated high-end devices. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widespread essential technique for managing CBD stones, with high success rates in standard cases. However, for patients with large stones, stones in an impacted state, and stones in anatomically challenging regions, advanced strategies using various dedicated devices may be needed. Although mechanical lithotripsy and endoscopic papillary large balloon dilation are effective techniques for managing giant stones, temporary biliary stenting with interval stone extraction, commonly referred to as two-stage ERCP, is a valuable approach, particularly in patients with sepsis or significant comorbidities. Digital single-operator cholangioscopy (DSOC) combined with electrohydraulic or laser lithotripsy has significantly transformed the endoscopic treatment strategy for managing difficult-to-extract stones by enabling direct visualization of stones and real-time targeted fragmentation. In very difficult situations where conventional ERCP is unsuccessful, percutaneous transhepatic cholangioscopy may be an effective solution, with DSOC enhancing both efficacy and safety. Advances in endoscopic technology, including integrated laser systems and next-generation retrieval devices, are expected to further improve procedural outcomes. Artificial intelligence is also gaining traction, with potential applications in diagnostic imaging interpretation, intraprocedural decision support, and prediction of stone recurrence. In conclusion, optimal management of CBD stones requires a patient specific, resource-sensitive approach. The integration of cutting-edge technologies and data-driven strategies is expected to improve the precision, efficiency, and overall quality of endoscopic CBD stone management.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992368","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 Randomized Controlled Trial to Evaluate the Effect of Fibrin Glue on Bleeding after Gastric Endoscopic Submucosal Dissection.","authors":"Tae-Se Kim, Tae-Jun Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim","doi":"10.5009/gnl250113","DOIUrl":"https://doi.org/10.5009/gnl250113","url":null,"abstract":"<p><strong>Background/aims: </strong>This study aimed to evaluate the effectiveness of fibrin glue application in reducing bleeding after endoscopic submucosal dissection (ESD) in the general patient population.</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 262 patients who underwent ESD for gastric neoplasms. The participants were randomized into the fibrin glue group (n=133) or the control group (n=129). The primary outcome was the post-ESD bleeding rate, which was compared between the two groups. Additionally, exploratory subgroup analyses were conducted for high-risk patients, which included patients taking antithrombotic agents (ATAs) and patients with resected specimens measuring 4 cm or greater.</p><p><strong>Results: </strong>In the modified intention-to-treat population (n=252), the overall bleeding rate occurred in 10.7% of cases, including 10.3% of patients in the fibrin glue group and 11.1% of patients in the control group (p=0.839). In the per-protocol population (n=248), the bleeding rates were 10.3% in the fibrin glue group and 10.7% in the control group (p=1.000). Among ATA users, the overall bleeding rate was 18.0%, including 9.5% of patients in the fibrin glue group and 24.1% of patients in the control group (p=0.271). Among ATA users with specimens measuring 4 cm or larger, the overall bleeding rate was 18.4%, including 12.5% of patients in the fibrin glue group and 22.7% of patients in the control group (p=0.675).</p><p><strong>Conclusions: </strong>Routine application of fibrin glue after ESD did not significantly reduce postoperative bleeding. Although the results of subgroup analyses suggested a potential reduction in early bleeding among high-risk patients, these findings warrant further investigation.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951698","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}