Journal of Gastroenterology and Hepatology最新文献

{"title":"Incidentalomas in Gastroenterology and Hepatology: A Narrative Review of Guideline-Based Management, Ethical Considerations, and a Proposed Framework for Practice.","authors":"Samarth Ram Raghavendra, Hareesha Rishab Bharadwaj, Sajjad Ahmed Khan, Ashish Sharma, Arkadeep Dhali, Hassam Ali, Dushyant Singh Dahiya","doi":"10.1111/jgh.70824","DOIUrl":"https://doi.org/10.1111/jgh.70824","url":null,"abstract":"<p><strong>Background and aim: </strong>Major advancements in medical imaging have led to higher rates of detection of incidental findings unrelated to the presenting complaint, termed incidentalomas. Despite their rising prevalence in gastroenterology and hepatology, there is a paucity of understanding regarding their clinical management and the ethical problems they entail. We aimed to synthesize the latest guidelines for managing these incidentalomas and review the ethical dilemmas they pose, with a view to formulating a management framework to assist clinicians.</p><p><strong>Methods: </strong>We undertook a narrative review by searching MEDLINE (via PubMed) and Embase (January 2010-May 2026) using key search terms. We prioritized recent guidelines and key consensus statements from international societies. We also identified additional ethical literature through targeted searches.</p><p><strong>Results: </strong>Management guidelines for incidentalomas in gastroenterology and hepatology share several commonalities. These include characterization using the least invasive tests, size-based triage, emphasis on growth and morphology, reserve tissue sampling, and referral of indeterminate lesions. However, they differ in intervention thresholds, second-line tests, and surveillance duration. The principal ethical issues identified include conflicts regarding disclosure and autonomy, care cascades and overdetection, distributive justice and equitable care, and medicolegal accountability. Based on this literature, the authors propose a six-step framework for managing incidentalomas: anticipate and contextualize, characterize, risk-stratify, seek multidisciplinary review when required, engage in shared decision-making, and finally, close the loop.</p><p><strong>Conclusion: </strong>Incidentaloma management should follow relevant guidelines and be complemented by a patient-centered approach, particularly regarding the course of investigation and the duration of follow-up.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220427","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":"Impact of Physical Activity on Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Donghee Kim, Pojsakorn Danpanichkul, Do Han Kim, Donghyun Ko, Karn Wijarnpreecha, Aijaz Ahmed","doi":"10.1111/jgh.70826","DOIUrl":"https://doi.org/10.1111/jgh.70826","url":null,"abstract":"<p><strong>Aim: </strong>We investigated whether accelerometer-assessed moderate-to-vigorous physical activity (MVPA) is associated with cardiovascular mortality among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) in the United States.</p><p><strong>Methods: </strong>We performed a longitudinal analysis using the 2003-2006 US National Health and Nutrition Examination Survey data among adults, with mortality follow-up through December 2019. We defined MASLD primarily using the Hepatic Steatosis Index (HSI), followed by current cardiometabolic criteria; we used the US Fatty Liver Index (USFLI) in sensitivity analyses. We classified accelerometer-assessed PA as MVPA, total PA, and sedentary behavior.</p><p><strong>Results: </strong>Among 2785 individuals with HSI-defined MASLD, 584 deaths occurred, including 198 cardiovascular deaths, over a median follow-up of 14.7 years. A higher level of PA is associated with a more favorable predicted cardiovascular risk profile at baseline. Among individuals with MASLD, increasing MVPA was nonlinearly associated with reduced all-cause mortality in a multivariable model (hazard ratio [HR]: 0.80, 95% CI: 0.71-0.91 per 10-min increase; P for trend < 0.001). Furthermore, higher MVPA was nonlinearly associated with a lower risk of cardiovascular mortality in MASLD (HR: 0.72, 95% CI: 0.53-0.99 per 10-min increase; P for trend = 0.009). Although higher total PA was also associated with reduced mortality, the point estimate was substantially weaker than that observed for MVPA. Sensitivity analyses using the USFLI definition showed directionally similar but attenuated associations. Increased sedentary behavior did not impact mortality in the MASLD group.</p><p><strong>Conclusions: </strong>Higher MVPA is nonlinearly associated with cardiovascular mortality in individuals with MASLD.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220471","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":"SPEED-EMR Score: A Simple Predictive Model for Estimating Colorectal Endoscopic Mucosal Resection Duration.","authors":"Mariana Souto, Rui Vieira, Inês Abreu Marques, Vítor Macedo Silva, Francisca Dias de Castro, Joana Magalhães, José Cotter","doi":"10.1111/jgh.70836","DOIUrl":"https://doi.org/10.1111/jgh.70836","url":null,"abstract":"<p><strong>Introduction: </strong>EMR is widely used for large and complex nonpedunculated superficial colorectal lesions, but objective tools to predict procedure duration are lacking. We aimed to develop a simple clinical model to estimate EMR duration: the SPEED-EMR Score.</p><p><strong>Methods: </strong>Retrospective cohort study of consecutive conventional EMRs of nonpedunculated colorectal lesions ≥ 15 mm performed at a tertiary referral center between 2020 and 2025. EMR duration was defined from the first lesion image to final post-resection documentation. Predictors of duration were identified using multivariable linear regression and converted into an integer-based score. Model performance and discrimination for predefined time-based complexity categories were evaluated.</p><p><strong>Results: </strong>A total of 1077 EMRs were analyzed. Median lesion size was 20 mm (IQR 15-25), and median EMR duration was 13 min (IQR 7-24). Independent predictors of longer duration were lesion size, flat/depressed morphology, NICE type 2 pattern, difficult anatomical location, and recurrent lesion at a previously treated site (all p ≤ 0.002). These variables composed the SPEED-EMR Score (0-15 points). Predicted duration was calculated as 3.23 + 3.94 × SPEED-EMR score. The final model showed R² = 0.445. Discrimination was good for low-complexity (≤ 20 min; AUC: 0.77) and high-complexity (≥ 40 min; AUC: 0.75) procedures.</p><p><strong>Conclusions: </strong>SPEED-EMR is a novel, bootstrap internally validated tool for objective prediction of colorectal EMR duration. It may support optimized scheduling, workflow efficiency, and resource allocation in therapeutic endoscopy services.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220445","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":"Operational Carbon Footprint of a Gastrointestinal Endoscopy Unit at a Regional Hospital in Japan.","authors":"Shintaro Fujihara, Hideki Kobara, Atsushi Imagawa, Noriko Nishiyama, Haruo Oba","doi":"10.1111/jgh.70827","DOIUrl":"https://doi.org/10.1111/jgh.70827","url":null,"abstract":"<p><strong>Background and aim: </strong>Gastrointestinal endoscopy is resource-intensive, but no carbon footprint data have been reported from a Japanese facility, and published estimates differ widely in system boundary. We quantified the operational carbon footprint of an endoscopy unit at a Japanese regional hospital and identified which emission sources are amenable to unit-level intervention.</p><p><strong>Methods: </strong>In this retrospective single-center study, we analyzed 794 consecutive procedures performed over 5 months at a 150-bed regional public hospital. Emissions from electricity, patient travel, medical waste, consumables, reprocessing chemicals, medical gas, and water were estimated according to the Greenhouse Gas Protocol using Japanese national emission factors and published life-cycle data. Patient travel was aggregated at the procedure level under two scenarios: procedure-day travel only (Scenario A) and visit-count-corrected travel (Scenario B). Sensitivity analyses addressed transport mode, air-conditioning load factor, and waste composition.</p><p><strong>Results: </strong>The operational carbon footprint was 6537.5 kg CO₂e (CO₂e) (8.23 kg CO₂e per procedure) in Scenario A and 8042.1 kg CO₂e (10.13 kg CO₂e per procedure) in Scenario B. In Scenario B, electricity was the largest source (38.8%), followed by patient travel (35.3%) and medical waste (13.5%). Air conditioning accounted for 69.3% of electricity use. Waste generation was 0.80 kg per procedure, of which suction fluid bags represented 36.7%.</p><p><strong>Conclusions: </strong>Electricity, dominated by air conditioning, was the largest operational emission source and is directly modifiable by the unit. Patient travel was of comparable magnitude but reflects healthcare access geography rather than endoscopic practice.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206981","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":"Response to Lohana: Diagnostic and Clinical Performance of Single-Use Versus Reusable Gastrointestinal Endoscopes: A Systematic Review and Meta-Analyses.","authors":"Natalie Tyldesley-Marshall, Yen-Fu Chen, Jefferson Buendia, Anna Brown, Thomas Matthews, Janette Parr, Shivashri Chockalingam, Adel Elfeky, Amy Grove, Lazaros Andronis, Stuart R Coles, Mandana Zanganeh, Bu Hayee, Anjan Dhar, Shaji Sebastian, Ramesh Arasaradnam","doi":"10.1111/jgh.70841","DOIUrl":"https://doi.org/10.1111/jgh.70841","url":null,"abstract":"","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206962","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":"Integrating Plain 2D Ultrasound and Clinical Data for Identification of At-Risk MASH: A Multicenter Proof of Concept Study.","authors":"Vigneshwaran Selvakumar, Jordan Jun Yi Low, Nicole S Tang, Chuan X Lau, Kalpenya D Ganakirthana, Zongchen Li, Yong-Shen Xia, Shun-Ping Chen, Masahito Nakano, Keisuke Amano, Asako Nogami, Satoshi Oeda, Masato Yoneda, Yuya Seko, Minghua Zheng, Takumi Kawaguchi, Hirokazu Takahashi, Cheng Han Ng, Nicholas Syn, Mei Chin Lim, Margaret L P Teng, Daniel Q Huang","doi":"10.1111/jgh.70763","DOIUrl":"https://doi.org/10.1111/jgh.70763","url":null,"abstract":"<p><strong>Background: </strong>Identifying people with at-risk metabolic dysfunction-associated steatohepatitis (MASH) is a major challenge. We aimed to use deep learning to develop a convolutional neural network (CNN) model to facilitate the detection of at-risk MASH.</p><p><strong>Methods: </strong>A multi-center cohort study was conducted across five tertiary hospitals in Japan and China. Clinical data and conventional ultrasound images were retrospectively collected. Organ segmentation using YOLO version 11 with quality control was performed, followed by creation of an EfficientNet-B6 CNN regression model, with image-level predictions averaged per patient, to estimate FAST and AGILE 3+ risk categories. Model performance was assessed using agreement across clinically relevant rule-out and rule-in thresholds, R², root mean squared error (RMSE), and area under the receiver operating curve (AUROC).</p><p><strong>Results: </strong>The final dataset comprised 416 patients for training (7643 images), 139 for internal validation (2463 images), and 154 for external testing (3539 images). The CNN model demonstrated good agreement with FAST (R² = 0.684; RMSE = 0.131; category agreement = 0.71) and moderate agreement with AGILE 3+ (R² = 0.445; RMSE = 0.1964; category agreement = 0.63). For FAST, AUROC was 0.974 (95% CI 0.947-0.993) for 0.35 and 0.932 (95% CI 0.884-0.969) for the 0.67 cut-off. For AGILE 3+, AUROC was 0.908 (95% CI 0.854-0.950) for 0.451 and 0.902 (95% CI 0.839-0.953) for the 0.679 cut-off.</p><p><strong>Conclusion: </strong>The CNN model applied to clinical ultrasound images can approximate the accuracy of VCTE-based composite risk scores for detecting at-risk MASH. This may support the detection of at-risk MASH in settings with limited access to transient elastography.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194592","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":"Comment on: \"Diagnostic and Clinical Performance of Single-Use Versus Reusable Gastrointestinal Endoscopes: A Systematic Review and Meta-Analyses\".","authors":"Isheeka Lohana","doi":"10.1111/jgh.70840","DOIUrl":"https://doi.org/10.1111/jgh.70840","url":null,"abstract":"","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194493","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":"HCC Risk Is Not Surveillance Benefit: Interpreting Surveillance Thresholds in Elderly MASLD.","authors":"Onur Can Kılınç","doi":"10.1111/jgh.70843","DOIUrl":"https://doi.org/10.1111/jgh.70843","url":null,"abstract":"","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194546","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":"Multisystem Comorbidity in Idiopathic Gastroparesis: Clarifying Targeted Clinical Assessment.","authors":"Marie-Claire Seeley, Kate L M Anderson, Emma Tippett, Alan J Hakim, Celine Gallagher","doi":"10.1111/jgh.70820","DOIUrl":"https://doi.org/10.1111/jgh.70820","url":null,"abstract":"","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194641","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":"Impact of AI-Assisted Endoscopy on Secondary Review and Referral Decisions in Gastric Cancer Screening: A Multicenter Real-World Study.","authors":"Sachiyo Onishi, Seiji Adachi, Masahito Shimizu","doi":"10.1111/jgh.70823","DOIUrl":"https://doi.org/10.1111/jgh.70823","url":null,"abstract":"<p><strong>Objectives: </strong>Artificial intelligence (AI)-assisted endoscopy may support gastric cancer screening, but its impact on structured secondary human review remains unclear. We evaluated secondary review modifications and referral decisions before and after AI implementation.</p><p><strong>Methods: </strong>This retrospective multicenter study included 5013 screening esophagogastroduodenoscopy examinations performed before (n = 2021) and after (n = 2992) AI implementation. The primary outcome was secondary review modifications. Secondary outcomes included referral for further diagnostic evaluation. Multivariable logistic regression analyses adjusted for age, sex, Helicobacter pylori eradication status, prior-year endoscopy, and endoscopist experience were performed. Interaction analyses according to endoscopist experience and inverse probability of treatment weighting analyses were conducted. No external reference standard was available to verify secondary-review modifications or referral decisions.</p><p><strong>Results: </strong>Secondary review modifications increased from 1.2% in the pre-AI period to 3.7% in the AI period (p < 0.01). A significant interaction was observed between AI implementation and endoscopist experience (p for interaction < 0.01), with increased modifications primarily among nonexpert endoscopists. Cancer-related modifications remained uncommon but increased after AI implementation (0.6% vs. 0.2%, p = 0.04). Referral rates decreased from 4.9% to 2.8% (p < 0.01), and AI implementation was independently associated with lower odds of referral (adjusted OR = 0.53; 95% confidence interval = 0.36-0.77).</p><p><strong>Conclusions: </strong>AI-assisted endoscopy was associated with lower referral rates; however, secondary review modifications persisted after AI implementation, particularly among nonexpert endoscopists. These findings describe workflow changes and do not establish the clinical validity of the modifications or the appropriateness of referral decisions.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194670","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}