Gut and Liver最新文献

{"title":"Fibrin Glue in Gastric Endoscopic Submucosal Dissection: A Seal for the Acute, Not the Chronic Bleeding?","authors":"Chen-Shuan Chung","doi":"10.5009/gnl250390","DOIUrl":"10.5009/gnl250390","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"19 5","pages":"631-632"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064634","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":"Prevalence, Clinical Characteristics, and Treatment Status of Hepatitis C Virus Infection among People Who Use Drugs in South Korea: A Prospective Multicenter Study.","authors":"Gwang Hyeon Choi, Young-Hoon Chon, Do Hoon Kwon, Sung Nam Jo, Og-Jin Jang, Kyung-Ah Kim, Dahye Baik, Eun Sun Jang, Sook-Hyang Jeong","doi":"10.5009/gnl240451","DOIUrl":"10.5009/gnl240451","url":null,"abstract":"<p><strong>Background/aims: </strong>Data on hepatitis C virus (HCV) infection among people who use drugs (PWUD) in South Korea is limited. This study investigated the prevalence, clinical characteristics, and treatment rates of HCV infection among PWUD.</p><p><strong>Methods: </strong>From August 2022 to May 2024, 342 PWUD were prospectively enrolled in four hospitals covering 95% of PWUD care in Korea. Blood tests and questionnaires were conducted. If the anti-HCV antibody test was positive, a reflex test for HCV RNA was performed. The clinical characteristics were compared according to anti-HCV or HCV RNA positivity.</p><p><strong>Results: </strong>Among these patients (median age, 46 years; men, 76%; injection drug user, 92%; syringe sharing, 56%), the prevalence of anti-HCV and HCV RNA was 31.3% and 10.5%, respectively. Abnormal aspartate aminotransferase or alanine aminotransferase levels were found in 24.6% of patients, and fibrosis-4 >3.25 was detected in 4.4% of patients. Anti-HCV positivity was independently associated with age (odds ratio [OR], 1.074), duration of injection drug use (OR, 1.060), sharing of syringes (OR, 3.510), and very low monthly income (OR, 2.598). Among anti-HCV positive patients, the treatment rate was significantly higher in the HCV RNA negative group (71.8%) than in the RNA positive group (16.7%). The only independent factor related to treatment uptake was having Medical Aid, which reimbursed 100% of the antiviral treatment (OR, 10.912; 95% confidence interval, 2.024 to 58.848; p=0.005).</p><p><strong>Conclusions: </strong>Among PWUD in South Korea, the anti-HCV and HCV RNA prevalence rates were 31.3% and 10.5%, respectively. Only half of the anti-HCV positive PWUD received antiviral treatment. Treatment uptake was related to direct-acting antiviral affordability, suggesting a need for public support.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"725-734"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181529","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":"Misclassification of Alcohol Use Disorder in MASLD and MetALD: Prevalence, Clinical Characteristics, and Outcomes.","authors":"Jun-Hyuk Lee, Sung-Ho Ahn, Jimin Park, So Young Jeon, Eileen L Yoon, Hye Sun Lee, Dae Won Jun","doi":"10.5009/gnl250072","DOIUrl":"10.5009/gnl250072","url":null,"abstract":"<p><strong>Background/aims: </strong>Within metabolic dysfunction and alcohol-associated liver disease (MetALD), there exists a continuum where the condition can conceptually shift between being metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic liver disease. However, alcohol use disorder (AUD) can be included in these diagnoses. The aim of this study was to investigate the prevalence and clinical characteristics of misclassified AUD among patients with MASLD and MetALD.</p><p><strong>Methods: </strong>The study included a total of 3,362,552 participants from the 2011 to 2012 National Health Screening Program. Steatotic liver disease was defined as having a hepatic steatosis index score of 36 or higher. Significant alcohol intake was calculated on the basis of self-report questionnaire responses. AUD was defined as having received medical care for an alcohol-related condition at least once during the study period. The mean follow-up period for participants was 9.8 years.</p><p><strong>Results: </strong>MASLD and MetALD prevalence were 23.8% and 1.9%, respectively. AUD was identified in 1.1% (8,481 individuals) of MASLD and 4.7% (2,989 individuals) of MetALD cases. Misclassified AUD was associated with significantly higher all-cause and liver-related mortality. Adjusted hazard ratios for liver-related mortality were 6.53 for AUD misclassified as MASLD and 6.98 for AUD misclassified as MetALD. Extrahepatic cancer mortality risk was also elevated (adjusted hazard ratio: 1.33 in MASLD and 1.44 in MetALD).</p><p><strong>Conclusions: </strong>A significant number of AUD cases were misclassified as MASLD and MetALD in cross-sectional assessment of alcohol consumption. Patients with AUD misclassified as MASLD or MetALD had higher liver-related mortality than the pure MASLD and MetALD groups.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"735-745"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707290","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":"Refining the Classification of Steatotic Liver Disease: Beyond Self-Reported Alcohol Intake.","authors":"Won-Mook Choi","doi":"10.5009/gnl250387","DOIUrl":"10.5009/gnl250387","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":"19 5","pages":"639-641"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064669","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":"Novel Risk Score for 30-Day Adverse Events Following Colonoscopy in Older Adults.","authors":"Min-Jae Kim, Seoyoon Choi, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Yuna Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park, Jaeyoung Chun","doi":"10.5009/gnl250010","DOIUrl":"10.5009/gnl250010","url":null,"abstract":"<p><strong>Background/aims: </strong>Physicians are challenged with balancing benefits and risks of performing colonoscopies in older adults. We identified adverse event risk factors in this population and developed a predictive risk score for colonoscopy-related adverse events.</p><p><strong>Methods: </strong>From August 2017 to August 2022, 8,154 patients aged ≥60 years who underwent screening or diagnostic colonoscopies were enrolled at Gangnam Severance Hospital. The primary outcome was 30-day adverse events, defined as emergency room visits or unplanned hospitalizations post-colonoscopy. The frailty index calculated via laboratory findings (FI-LAB) was derived from blood test results and vital signs. A risk score was developed and categorized to predict colonoscopy-related adverse events. Data from 9,154 colonoscopies from September 2022 to December 2023 at two tertiary referral hospitals were used for internal and external validation.</p><p><strong>Results: </strong>The mean age was 67.9 years (range, 60 to 94 years). The 30-day adverse event rate was 1.4%. Adverse events were independently associated with the use of aspirin (adjusted odds ratio [aOR], 2.24), P2Y12 inhibitors (aOR, 1.79), and anticoagulants (aOR, 2.47) and with moderate (aOR, 4.54) and high (aOR, 11.40) FI-LABs. The incidence of adverse events in the low-, moderate-, and high-risk groups were 0.3%, 2.2%, and 10.7%, respectively (p<0.001). The area under the receiver operating characteristic curve for the risk scores were 0.821, 0.856, and 0.757 for the derivation, internal, and external cohorts, respectively.</p><p><strong>Conclusions: </strong>Colonoscopy-related adverse events in older adults were linked to frailty and medication use and were not dependent on age. This novel risk score supports personalized decision-making when performing colonoscopies in older adults.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"706-714"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977370","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 Efficacy of Potassium-Competitive Acid Blocker-Based Triple Therapy with Tegoprazan versus Vonoprazan for <i>Helicobacter pylori</i> Eradication: A Randomized, Double-Blind, Active-Controlled Pilot Study.","authors":"Jae Yong Park, Il Ju Choi, Gwang Ha Kim, Su Jin Hong, Sung Kwan Shin, Seong Woo Jeon, Jae Gyu Kim","doi":"10.5009/gnl250067","DOIUrl":"10.5009/gnl250067","url":null,"abstract":"<p><strong>Background/aims: </strong>Triple therapy with vonoprazan, a potassium-competitive acid blocker, has shown an acceptable eradication rate. The aim of this study was to evaluate the efficacy and safety of tegoprazan-based triple therapy compared with those of vonoprazan-based triple therapy for <i>Helicobacter pylori</i> eradication.</p><p><strong>Methods: </strong>This randomized, double-blind, active-controlled, multicenter pilot study included treatment-naive adults with <i>H. pylori</i> infection. Participants were randomized 1:1:1 to receive tegoprazan 50 mg (TAC 1), tegoprazan 100 mg (TAC 2), or vonoprazan 20 mg (VAC) with amoxicillin 1,000 mg plus clarithromycin 500 mg twice daily for 10 days. The primary outcome was the eradication rate.</p><p><strong>Results: </strong>Of the 102 enrolled participants, 97 completed the study. The eradication rates in the full analysis set were 60.61% (95% confidence interval [CI], 43.93% to 77.28%), 78.79% (95% CI, 64.84% to 92.74%), and 84.85% (95% CI, 72.62% to 97.08%) in TAC 1, TAC 2, and VAC, respectively. The eradication rates in the per-protocol set were 66.67% (95% CI, 49.80% to 83.54%), 86.67% (95% CI, 74.50% to 98.83%), and 87.50% (95% CI, 76.04% to 98.96%) in TAC 1, TAC 2, and VAC, respectively. In the full analysis set, the eradication rate differences were -6.06% (95% CI, -24.61% to 12.49%) between TAC 2 and VAC and -24.24% (95% CI, -44.92% to -3.56%) between TAC 1 and VAC. In the per-protocol set, the eradication rate differences were -0.83% (95% CI, -19.97% to 17.37%) between TAC 2 and VAC and -20.83% (95% CI, -41.23% to -0.44%) between TAC 1 and VAC. All therapies were well tolerated with no notable safety differences.</p><p><strong>Conclusions: </strong>After 10 days, tegoprazan 100 mg showed eradication rates comparable to those of vonoprazan 20 mg, while 50 mg may be insufficient. These findings support future research to optimize tegoprazan dosing in clinical practice (ClinicalTrials.gov; NCT04128917).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"696-705"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215663","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":"15-Year Trends in Hepatocellular Carcinoma: Epidemiology, Treatment, and Outcomes from a Hospital-Based Registry.","authors":"Songgyung Kim, Jina Park, Won-Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Ki-Hun Kim, Jonggi Choi","doi":"10.5009/gnl240599","DOIUrl":"10.5009/gnl240599","url":null,"abstract":"<p><strong>Background/aims: </strong>Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, particularly in Korea. We analyzed trends in the epidemiology, tumor characteristics, treatment modalities, and outcomes of HCC over the past 15 years, using a large-scale hospital-based registry.</p><p><strong>Methods: </strong>We examined Asan Medical Center HCC registry data on 21,699 treatment-naïve patients with HCC diagnosed between 2009 and 2023. Patients were categorized into four periods based on their year of diagnosis: period 1 (2009-2011), period 2 (2012-2015), period 3 (2016-2019), and period 4 (2020-2023). HCC staging followed the Barcelona Clinic Liver Cancer (BCLC) system.</p><p><strong>Results: </strong>The prevalence of hepatitis B virus declined continuously from 74.9% to 61.2%, with an increase in nonviral etiologies. The median age at diagnosis increased from 56 years in period 1 to 62 years in period 4, with increased comorbidities such as diabetes and hypertension. Early-stage HCC detection improved, with more patients diagnosed at BCLC stage 0 or A. The use of systemic therapy, particularly atezolizumab-bevacizumab treatment, increased from 2020, especially among patients with BCLC stage C. The 5-year survival rate improved significantly from 44.0% in period 1 to 65.2% in period 3, with overall survival rates increasing across all stages except BCLC stage D. Patients with hepatitis B virus-related HCC experienced the best outcomes. Recurrence rates after curative treatment gradually decreased over time.</p><p><strong>Conclusions: </strong>Over the past 15 years, significant advancements in the early detection and treatment of HCC in Korea have led to improved survival outcomes. These findings underscore the need for ongoing clinical strategy evolution to address the changing landscape of HCC.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"746-757"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077706","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":"Comparing the Efficacy and Safety of Fexuprazan and Lansoprazole for the Prevention of Nonsteroidal Anti-inflammatory Drug-Induced Peptic Ulcer.","authors":"Seokchan Hong, Ji Hyeon Ju, Sang-Heon Lee, Seung-Jae Hong, Sang-Hyon Kim, Ga Young Ahn, Jae Hyun Jung, Jin-Wuk Hur, You-Jung Ha, Jin Kyun Park, Hyun-Sook Kim, Sung Won Lee, Yong-Beom Park, Mie Jin Lim, Yun Sung Kim, Jung Soo Song, Chan-Bum Choi, Seong-Ho Kim, In Ah Choi, Kee Don Choi, Tae Hee Lee, Young Sin Cho, Yong Chan Lee, Kye Sook Kwon, Hyejung Lee, Mihee Park, Junga Heo, Song Baek, Chang-Keun Lee","doi":"10.5009/gnl250019","DOIUrl":"10.5009/gnl250019","url":null,"abstract":"<p><strong>Background/aims: </strong>To compare the efficacy and safety of fexuprazan and lansoprazole for preventing peptic ulcers (PUs) induced by nonsteroidal anti-inflammatory drugs (NSAIDs).</p><p><strong>Methods: </strong>This multicenter, double-blind, randomized, active-controlled study was conducted across 32 hospitals in South Korea. Patients with musculoskeletal disease requiring long-term treatment with celecoxib, naproxen, or meloxicam were randomized to receive either fexuprazan 20 mg/day (n=212) or lansoprazole 15 mg/day (n=211) for 24 weeks. The primary endpoint was the occurrence of PUs, which were confirmed via esophagogastroduodenoscopy (EGD), with a non-inferiority margin of 8.3%. Only ulcers that developed during the treatment period were examined in the analysis. The occurrence of gastroduodenal bleeding was also monitored via EGD, and symptoms were assessed by using the Patient Assessment of Upper Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM). Adverse events were recorded during the study.</p><p><strong>Results: </strong>The incidence rate of EGD-confirmed PUs at week 24 was 1.16% in the fexuprazan group and 2.76% in the lansoprazole group, with a between-group difference of -1.64% (95% confidence interval, -4.52% to 1.25%), demonstrating non-inferiority. No patients presented with gastroduodenal bleeding. No significant between-group differences were found in the PAGI-SYM scores (leastsquare mean difference in the total score at week 24, -0.42; 95% confidence interval, -2.48 to 1.64; p=0.69). There were low rates of adverse drug reactions in the fexuprazan and lansoprazole groups (8.57% vs 4.78%, respectively p=0.12).</p><p><strong>Conclusions: </strong>Given its non-inferiority to lansoprazole and similar safety profile, fexuprazan is a promising alternative for the prevention of NSAID-induced PUs (ClinicalTrials.gov identifier NCT04784910).</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"685-695"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495887","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":"Clinical Application of Lyon Consensus 2.0 in Asia: An Overview.","authors":"Ming-Wun Wong, Chien-Lin Chen","doi":"10.5009/gnl250183","DOIUrl":"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":"642-650"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436056/pdf/","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":"OA","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":"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":"665-676"},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436058/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}