Journal of Gastroenterology and Hepatology最新文献

{"title":"Management of Tunnel Infection Following Upper Gastrointestinal Endoscopic Submucosal Tunneling Procedures.","authors":"Shao-Bin Luo, Li Wang, Zu-Qiang Liu, Yi-Qun Zhang, Wei-Feng Chen, Li-Li Ma, Jian-Wei Hu, Ming-Yan Cai, Quan-Lin Li, Ping-Hong Zhou","doi":"10.1111/jgh.17004","DOIUrl":"https://doi.org/10.1111/jgh.17004","url":null,"abstract":"<p><strong>Objectives: </strong>Tunnel infection is a rare but major adverse event after endoscopic submucosal tunneling procedures (ESTPs), which is scarcely reported. This study aims to offer a comprehensive analysis of the evaluation and management of tunnel infection following ESTP.</p><p><strong>Method: </strong>From August 2010 to December 2023, we retrospectively analyzed 4398 patients with achalasia receiving peroral endoscopic myotomy (POEM) and 2214 patients with upper gastrointestinal tumors receiving submucosal tunneling endoscopic resection (STER). Patients diagnosed with postoperative tunnel infection were included, and the various treatments utilized for managing these infections and outcomes were documented.</p><p><strong>Results: </strong>There were 17 cases of ESTP tunnel infection in patients (10 men; median age 47 years). Among the patients, nine underwent POEM and eight underwent STER. With similar baseline characteristics between two groups after PSM, the tunnel infection group of POEM showed higher rate of mucosal injury (44.4% vs. 11.1%, p = 0.029) and the tunnel infection group of STER showed larger tumor size (3.3 cm vs. 2.3 cm, p = 0.036). The treatment of tunnel infection included insertion of a gastric tube into the tunnel for drainage (nine cases), tunnel mucosal incision (eight cases), and tunnel flushing (seven cases), and no patient required surgical intervention. All patients received broad-spectrum antibiotics to control the infection. A total of three individuals required thoracic drainage for reactive pleural effusion. The median post-infection hospital stay was 18 days (range 5-38).</p><p><strong>Conclusions: </strong>This comprehensive management approach demonstrated its effectiveness, and tunnel infection was successfully treated without requiring subsequent surgical interventions.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275073","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":"Modulation of Lipid Metabolism and Keap1-Nrf2 Pathway Activation in Macrophages by Targeting PPARγ Affects NAFLD Progression.","authors":"Yu-Xin Chen, Yan-Ping Wu, Yi Zhang, Pei-Xuan Ji, Jing Hua","doi":"10.1111/jgh.17033","DOIUrl":"https://doi.org/10.1111/jgh.17033","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lipid metabolism reprogramming regulates cellular inflammatory and immune functions in macrophages. The effects of macrophage-specific PPARγ on lipid metabolism and oxidative stress remain unclear. This study aimed to elucidate the impact of the modulation of macrophage PPARγ expression on lipid metabolism, oxidative stress, inflammation, and the progression of nonalcoholic fatty liver disease.</p><p><strong>Methods: </strong>RAW264.7 cells, Kupffer cells, and bone marrow-derived macrophages were exposed to saturated fatty acids to establish a NAFLD macrophage model. Techniques, including use of PPARγ agonists/antagonists, gene knockout, and gene overexpression, were applied to modulate PPARγ expression in macrophages. NAFLD mouse models were established by feeding PPARγ^fl/fl and PPARγ^Lyz2cre mice a high-fat diet for 16 weeks. Changes in lipid metabolism, oxidative stress, and inflammation were assessed. Primary hepatocytes were incubated with conditioned medium from RAW264.7 cells to establish conditional coculture systems.</p><p><strong>Results: </strong>Saturated fatty acid stimulation increased fatty acid oxidation while reducing de novo lipogenesis in RAW264.7 cells, concurrently increasing PPARγ expression. Upregulation of PPARγ in macrophages under high-fat conditions further increased fatty acid oxidation, decreased ROS production, and inhibited inflammation. Downregulation of PPARγ had the opposite effect. Moreover, PPARγ increased the transcription of the Nrf2 gene and activated the Keap1-Nrf2 pathway. PPARγ overexpression inhibited cytokine secretion in PA-incubated macrophages, subsequently affecting hepatocyte inflammation. In vivo, macrophage-specific PPARγ knockout exacerbated liver inflammation and injury in NAFLD mice.</p><p><strong>Conclusion: </strong>Modulating PPARγ expression affected lipid metabolism, reduced oxidative stress, and suppressed inflammation in macrophages. The modulation of macrophage-specific PPARγ activity may represent a potential therapeutic target for NAFLD treatment.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234274","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":"Iron Quantification Using Spectral CT-Based Material Decomposition Technique for Noninvasive Hepatic Fibrosis Staging: An Experimental Study.","authors":"Lu Wang, Ying Zhao, Bo Duan, Yingli Wang, Li Yang, Hongliang Li, Mengwei Shi, Ruibo Zhang, Yueyang Li, Runyu Miao, Yanling Han, Gang Li, Huarui Zhang, Ailian Liu, Qingyu Ji","doi":"10.1111/jgh.17031","DOIUrl":"https://doi.org/10.1111/jgh.17031","url":null,"abstract":"<p><strong>Background: </strong>Accurate staging is crucial for effective treatment of hepatic fibrosis (HF). This study evaluates whether spectral CT-derived liver iron concentration (LIC) quantification correlates with HF stages and validates its efficacy in diagnostic staging.</p><p><strong>Methods: </strong>One hundred seventy-five New Zealand white rabbits were included in the prospective study (35 normal controls; 140 HF models). Rabbits underwent spectral CT scans before modeling and at 4, 6, 8, 10, and 12 weeks. HF was staged by METAVIR system. Using iodine and water as reference materials paired with iron, the original LIC and the normalized LIC (NIC = LIC/aortic-iron) were measured. The material decomposition (MD) technique of spectral CT was used to quantify LIC and evaluate the correlation between HF stage and LIC. ANOVA, chi-square, and ROC were employed using SPSS, Python, and MedCalc.</p><p><strong>Results: </strong>One hundred fifty rabbits (30-per-stage, F0-F4) were selected. LIC_iron(iodine) and NIC_iron(iodine) in the noncontrast (NC) phase, and LIC_iron(water) and NIC_iron(water) in arterial phases (AP), increased with HF progression (p < 0.05) consistent with pathological results. Multiple LIC parameters exhibited significant differences in 126 comparisons (p < 0.05). ROC showed excellent diagnostic performance of NIC_iron(water)-AP across HF stages (AUC: 0.884-1.000), especially in distinguishing F1 from F0, F2, F3, and F4 (AUC: 0.979, 0.979, 0.918, 0.934). NIC_iron(iodine)-NC exhibited moderate efficacy in F0 versus F1 (AUC = 0.767) but high in other stages (AUC: 0.826-0.994). A multiparameter model achieved a macro-AUC of 0.9917.</p><p><strong>Conclusion: </strong>Spectral CT-based liver iron concentration quantification demonstrates a strong correlation with HF stages, providing precise HF staging and excellent diagnostic performance.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225681","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 Public Attention to Steatotic Liver Disease: A 20-Year Analysis (2004-2024): Surging Steatotic Liver Disease Focus.","authors":"Pojsakorn Danpanichkul, Charat Thongprayoon, Kanokphong Suparan, Donghee Kim, Ornpailin Wanichthanaolan, Phuuwadith Wattanachayakul, Yanfang Pang, Mark D Muthiah, Anand V Kulkarni, Ju Dong Yang, Apichat Kaewdech, Wisit Cheungpasitporn, Karn Wijarnpreecha","doi":"10.1111/jgh.17009","DOIUrl":"https://doi.org/10.1111/jgh.17009","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over one third of the global population and is closely linked to gastrointestinal, oncological, and cardiovascular diseases. As the most common cause of steatotic liver disease (SLD), MASLD is often referred to as \"fatty liver\" in general health information searches. With the Internet becoming a primary source of healthcare information, this study aimed to evaluate global and regional public interest in steatotic liver disease using Google Trends data from January 2004 to December 2024.</p><p><strong>Methods: </strong>A comprehensive analysis was performed using Google Trends with the search term \"fatty liver disease.\" Interest levels were quantified using Google Trends indices, and temporal patterns were evaluated using average annual percent change (AAPC). Regional variations were assessed to identify geographic hotspots of public interest.</p><p><strong>Results: </strong>Global interest in MASLD demonstrated significant growth (AAPC: 6.77%, 95% Confidence interval [CI]: 5.33-8.23), with a 264% increase from 2004 to 2024. Peak interest was observed in August 2024 (index: 100) compared to the lowest point in June 2007. Iran showed the highest country-specific search volume (index: 100), while within the United States, West Virginia demonstrated the greatest relative interest (index: 100). Key topics associated with MASLD included \"liver,\" \"symptoms,\" \"disease,\" and \"therapy.\"</p><p><strong>Conclusions: </strong>Substantial growth in global public interest in MASLD, with distinct temporal and geographical patterns, provides insights to develop targeted awareness campaigns and educational interventions, particularly in regions with low search volumes. Future research should examine the relationship between online search patterns and clinical outcomes in MASLD.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216039","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":"Genome-Scale CRISPR-Cas9 Analysis Reveals Tumor Heterogeneity and Identifies NDC80 as Novel Biomarker in HCC.","authors":"Zhipu Liu, Long Liu, Shutong Liu, Yuhao Ba, Anning Zuo, Hui Xu, Yuyuan Zhang, Senyan Wang, Libo Wang, Xinwei Han","doi":"10.1111/jgh.17016","DOIUrl":"https://doi.org/10.1111/jgh.17016","url":null,"abstract":"<p><strong>Background and aims: </strong>Hepatocellular carcinoma (HCC) is a malignant tumor with a poor prognosis and is characterized by severe intratumoral heterogeneity. Identifying key genomic features and more reliable classifications is helpful for clinical management.</p><p><strong>Methods: </strong>Cancer essential genes (CEGs) were identified using genome-scale CRISPR-Cas9 and univariate Cox regression analyses. Based on gene expression, nonnegative matrix factorization (NMF) was used to generate distinct molecular subtypes. The nearest template prediction (NTP) algorithm was used to validate the accuracy and robust classifications among three independent cohorts, including GSE14520, GSE54236, and ICGC-LIRI. Specifically, potential biomarkers were screened for clinical transformation based on their prognostic characteristics and biological function features. EdU, colony formation, and Transwell assays were utilized to confirm the effect of biomarkers in vitro.</p><p><strong>Results: </strong>The C1 subtype had the worst prognosis and was characterized by advanced AJCC stages and high genomic instability. The NTP approach confirmed that the molecular subtypes were practical, robust, and reproducible. We further identified NDC80 as a gene specifically expressed in C1 subtype, indicative of prognosis solely for this subtype. Based on overrepresentation analysis (ORA), it was found that the biological function of NDC80 was mainly enriched in proliferation. In vitro cellular assays verified that promoted tumor growth and migration.</p><p><strong>Conclusions: </strong>Our study identified three robust molecular subtypes and revealed tumor heterogeneity. Meanwhile, the potential biomarker NDC80 served as a characteristic gene of the C1 subtype, correlating with poor prognosis and promoting tumor growth and migration, providing new insights for prognostic treatment strategies in HCC.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216040","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":"National Insights Into Epidemiological Trends and Outcomes of Malignant Neoplasms of the Small Intestine: A Big Data Analysis.","authors":"Jung Rock Moon, Joo Hye Song, Jihyoun Lee, So-My Koo, Hyun Gun Kim, Jin-Oh Kim, Seong Ran Jeon, Ji Sung Lee","doi":"10.1111/jgh.17014","DOIUrl":"https://doi.org/10.1111/jgh.17014","url":null,"abstract":"<p><strong>Background: </strong>Few large-scale studies exist on within-country variations in the incidence, diagnosis, and mortality of small intestine malignancies. This study examined the epidemiological trends and outcomes of these cancers in South Korea.</p><p><strong>Methods: </strong>We analyzed National Health Insurance Service claims data from 2005 to 2022 to identify newly diagnosed small intestine malignancies (ICD-10 code C17) and evaluated treatment modalities and diagnostic test usage. Kaplan-Meier curves and Cox proportional hazards models assessed survival outcomes and prognostic factors.</p><p><strong>Results: </strong>We identified 20 395 newly diagnosed patients with small intestine malignancies. Incidence rose over the study period, with a temporary decline during COVID-19 in 2019-2020, followed by a sharp increase in 2021. The highest incidence was among individuals aged 60-69, particularly in regions with larger elderly populations. Diagnostic procedures increased from 3.27 per person in 2005 to 6.23 in 2022. Patients with advanced adenocarcinoma treated with chemotherapy had a 5-year survival rate of 23.8% (95% CI 21.7-25.8), while those with advanced gastrointestinal stromal tumor treated with imatinib had a rate of 75.5% (95% CI 73.4-77.6). Older age and lack of surgery were linked to poorer outcomes in both groups.</p><p><strong>Conclusions: </strong>The incidence of malignant neoplasms of the small intestine has risen over time, likely due to enhanced diagnostic efforts, with regional variations highlighting the influence of demographic factors such as age. Improving survival outcomes requires a better understanding of these demographic factors and a stronger focus on early detection.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199349","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":"Comparison Analysis of Lenvatinib Plus Transcatheter Arterial Chemoembolization Versus Atezolizumab Plus Bevacizumab as First-Line Therapy for Intermediate-Stage Hepatocellular Carcinoma Beyond the Up-to-Seven Criteria.","authors":"Takashi Niizeki, Seiichi Mawatari, Michihiko Shibata, Ryu Sasaki, Shinji Itoh, Satoshi Shakado, Rie Sugimoto, Yusuke Morita, Takuya Kuwashiro, Mizuki Endo, Masao Iwao, Yasuhide Motoyoshi, Masahito Nakano, Shigeo Shimose, Hirokazu Takahashi, Hiroshi Yatsuhashi, Fumihito Hirai, Tomoharu Yoshizumi, Hisamitsu Miyaaki, Takumi Kawaguchi, Akio Ido, Masaru Harada","doi":"10.1111/jgh.17024","DOIUrl":"https://doi.org/10.1111/jgh.17024","url":null,"abstract":"<p><strong>Background and aim: </strong>This study aimed to compare the therapeutic effects and safety of lenvatinib (LEN) plus transcatheter arterial chemoembolization (LEN-TACE) and atezolizumab plus bevacizumab (Atez/Bev) as the first-line therapies in patients with intermediate-stage hepatocellular carcinoma (HCC) beyond the up-to-seven criteria.</p><p><strong>Methods: </strong>We enrolled 768 patients with HCC treated with first-line systemic therapy, and 154 patients were enrolled and categorized into either the LEN-TACE therapy (n = 42) or Atez/Bev (n = 112) groups. After propensity score matching (PSM), 72 patients (LEN-TACE group, n = 36; Atez/Bev group, n = 36) were analyzed.</p><p><strong>Results: </strong>After PSM, the median progression-free survival showed no significant differences between the LEN-TACE and Atez/Bev groups (8.5 [95% confidence interval (CI): 6.1-10.7] months vs. 8.6 (95% CI: 5.3-12.1) months, respectively; p = 0.973). Regarding median overall survival (OS), no significant differences were noted between the LEN-TACE and Atez/Bev groups (37.3 [95% CI: 31.2-60.2] months vs. 32.4 (95% CI: 19.5-NE) months, respectively; p = 0.183). Regarding adverse events (AEs) of grade ≥ 3, no significant difference was observed between the two groups. Multivariate analysis revealed that the ALBI grade 1 and low AFP levels were independent factors for OS.</p><p><strong>Conclusion: </strong>LEN-TACE therapy may be one of the effective treatment strategies in intermediate-stage HCC patients beyond the up-to-seven criteria.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191886","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":"Differences in Clinical Characteristics Between Missed and Detected Laryngopharyngeal Cancers.","authors":"Yusuke Kumazawa, Yohei Ikenoyama, Manabu Takamatsu, Koyo Kido, Ken Namikawa, Yoshitaka Tokai, Shoichi Yoshimizu, Yusuke Horiuchi, Akiyoshi Ishiyama, Toshiyuki Yoshio, Toshiaki Hirasawa, Akira Seto, Takashi Toshiyasu, Shunji Takahashi, Junko Fujisaki","doi":"10.1111/jgh.17023","DOIUrl":"https://doi.org/10.1111/jgh.17023","url":null,"abstract":"<p><strong>Background and aim: </strong>Laryngopharyngeal cancers are often overlooked during endoscopy because of their anatomical complexity and the gag reflex. However, the characteristics of these cancers remain poorly understood. We studied the differences in clinical characteristics and endoscopic procedures between missed and detected cancers.</p><p><strong>Methods: </strong>Newly diagnosed laryngopharyngeal squamous cell carcinomas identified during esophagogastroduodenoscopy at our hospital between January 2016 and December 2020 were analyzed. A total of 179 lesions were categorized into two groups: missed (n = 74) and detected (n = 105). Missed cancer was defined as a lesion identified within 18 months of preceding esophagogastroduodenoscopy at our hospital, while detected cancer was defined as a lesion not included in the missed group.</p><p><strong>Results: </strong>The miss rate of laryngopharyngeal cancers on esophagogastroduodenoscopy was 41.3%. Multivariate analysis showed that the non-use rate of pethidine hydrochloride (odds ratio 4.1, 95% confidence interval 2.0-8.6, p < 0.01), ratio of white-light imaging ≥ narrow-band imaging through observation of laryngopharynx (odds ratio 31.8, 95% confidence interval 3.9-258.0, p < 0.01), and number of \"comprehensiveness of laryngopharyngeal observation\" negatives (odds ratio 2.6, 95% confidence interval 1.3-5.4, p = 0.01) were significantly larger in the missed group. Univariate analysis showed that the number of tumors located on the epiglottis (p = 0.02) was significantly larger in the missed group.</p><p><strong>Conclusions: </strong>This study highlights the importance of precisely observing the laryngopharynx, facilitated by the use of pethidine hydrochloride and narrow-band imaging. In addition, epiglottic lesions are frequently missed. Comprehensive observation of the laryngopharynx using narrow-band imaging and premedication may reduce the frequency of missed cancers.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Metachronous Advanced Neoplasia After Colonoscopy in Patients With Different Index Findings.","authors":"Kai Song, Shengyu Zhang, Jiahui Luo, Bin Lu, Jianing Li, Yueyang Zhou, Yuqing Chen, Yuelun Zhang, Aiming Yang, Hongda Chen, Dong Wu","doi":"10.1111/jgh.17026","DOIUrl":"https://doi.org/10.1111/jgh.17026","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing colonoscopy are at risk of developing metachronous advanced neoplasia (AN). This study explores risk factors of metachronous AN and refines risk stratification based on different index findings.</p><p><strong>Methods: </strong>This retrospective cohort study included patients undergoing multiple colonoscopies performed by experienced endoscopists at a major tertiary hospital in China in 2012-2023. Cox regression, adjusted for covariates, estimated the risk of metachronous AN. Cumulative hazard was determined using Kaplan-Meier estimation. Multiple sensitivity analyses validated the impact of risk factors.</p><p><strong>Results: </strong>A total of 3638 patients was included. In the index nonadvanced adenoma (NAA) group, covariate-adjusted Cox regression showed proximal adenomas (hazard ratio [HR], 2.99; 95% confidence interval [CI], 1.20-7.44), adenomas ≥ 6 mm (HR, 3.29; 95% CI, 1.49-7.26), and ≥ 3 adenomas (stratified by time horizons: HR, 4.05; 95% CI, 1.25-13.10) were associated with increased risk of metachronous AN. In the group with non-significant findings at index colonoscopy, age ≥ 50 years (HR, 2.19; 95% CI: 1.36-3.51), family history of colorectal cancer (HR: 5.55; 95% CI: 2.96-10.44), and male sex (HR: 2.45; 95% CI: 1.61-3.73) were associated with increased risk of metachronous AN. Survival analysis revealed that patients with these risk factors reached reference risk for developing metachronous AN much earlier.</p><p><strong>Conclusions: </strong>Based on a Chinese population, we identified independent risk factors for metachronous AN across different baseline diagnostic subgroups, facilitating personalized risk stratification for high-risk patients. Risk profiles should be considered when defining the optimal surveillance interval for colonoscopy.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173887","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 Efficacy and Safety of Endoscopic Submucosal Dissection (ESD) Combined With Radiofrequency Ablation (RFA) Sequential Therapy for Extensive Esophageal Lesions.","authors":"Yuan Ding, Lu Chen, Xiaochun Yin, Qin Lu, Zhi Wang, Yinnan Zhu, Ruihua Shi","doi":"10.1111/jgh.17022","DOIUrl":"https://doi.org/10.1111/jgh.17022","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the efficacy and safety of a sequential treatment combining endoscopic submucosal dissection (ESD) with radiofrequency ablation (RFA) for extensive esophageal lesions, focusing on reducing esophageal stenosis and improving patients' quality of life.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with extensive esophageal lesions who underwent sequential treatment of ESD and RFA. Lesion characteristics were assessed using Lugol's iodine staining, white-light endoscopy, and ultrasound endoscopy. The non-stained area was treated with ESD, and the remaining lightly stained area was subsequently treated with RFA.</p><p><strong>Results: </strong>A total of 80 patients were enrolled in the study. The sequential therapy significantly reduced the incidence of esophageal stenosis compared to ESD monotherapy. The postoperative adverse events were lower in the sequential therapy group. There was no significant difference in postoperative recurrence rate between the two groups.</p><p><strong>Conclusion: </strong>Sequential ESD-RFA therapy significantly reduces stricture rates (30% vs. 60%, p = 0.02) and improves 12-month quality of life (SF-36: 82.55 vs. 74.40, p = 0.001) compared to ESD monotherapy, while maintaining equivalent complete remission rates (100% vs. 96.7%, p = 0.16). This approach is particularly advantageous for lesions > 10 cm or involving > 3/4 circumference.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173891","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}