Journal of Gastroenterology and Hepatology最新文献

{"title":"Comparative Validation of Prediction Models for HCC Outcomes in Living Donor Liver Transplantation: Superiority of Tumor Markers to Imaging Study","authors":"Hwa-Hee Koh,&nbsp;Minyu Kang,&nbsp;Deok-Gie Kim,&nbsp;Jae Hyon Park,&nbsp;Eun-Ki Min,&nbsp;Jae Geun Lee,&nbsp;Myoung Soo Kim,&nbsp;Dong Jin Joo","doi":"10.1111/jgh.16857","DOIUrl":"10.1111/jgh.16857","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Living donor liver transplantation (LDLT) offers timely curative treatment for unresectable hepatocellular carcinoma (HCC). This study aims to validate and compare previous prediction models for HCC outcomes in 488 LDLT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For 488 patients who underwent LDLT for HCC, pretransplant imaging studies assessed by modified RECSIT criteria, tumor markers such as alpha feto-protein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA II), and explant pathology were recruited. C-index of models for the HCC outcomes was compared, followed by further investigation for the predictive performances of the best model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found MoRAL (11√PIVKA-II + 2√AFP) demonstrated a higher C-index for HCC recurrence than other models that included radiologically viable tumor number and/or size (MoRAL: 0.709, Milan: 0.537, UCSF: 0.575, Up-to-7: 0.572, French AFP: 0.634, Pre-MORAL: 0.637, HALT-HCC: 0.626, Metroticket2.0: 0.629) and also had the highest C-index for HCC-specific deaths (0.706). Five-year HCC recurrence was well stratified upon dividing the patients into three groups by MoRAL cutoffs (11.9% for MoRAL &lt; 100, 29.6% for MoRAL 100–200, and 48.6% for MoRAL &gt; 200, <i>p</i> &lt; 0.001). However, patients with major vessel invasion or portal vein tumor thrombus showed similarly high HCC recurrence regardless of this grouping (<i>p</i> = 0.612).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The MoRAL, based on tumor markers, showed the best predictive performance for HCC recurrence and HCC-specific death among the validated models, except in cases with major vessel invasion or portal vein tumor thrombus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"626-634"},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895156","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":"Long-Term Prognostic Factors for Patients Aged 80 and Older With Superficial Esophageal Squamous Cell Carcinoma Undergoing Endoscopic Submucosal Dissection","authors":"Yugo Suzuki,&nbsp;Daisuke Kikuchi,&nbsp;Kenichi Ohashi,&nbsp;Shu Hoteya","doi":"10.1111/jgh.16859","DOIUrl":"10.1111/jgh.16859","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection (ESD) is an acceptable treatment for superficial esophageal squamous cell carcinoma (ESCC) even in elderly patients. However, studies on the prognostic factors in very elderly patients are limited. Therefore, we aimed to explore the prognostic factors affecting overall survival (OS) in patients aged ≥ 80 with superficial ESCC who underwent ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 155 patients aged ≥ 80 who underwent ESD for superficial ESCC. Clinicopathological findings and long-term outcomes were examined. The prognostic nutritional index (PNI) and geriatric nutritional index (GNRI) were used to assess pre-treatment nutritional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine patients (18.7%) were aged ≥ 85. Thirty-five (22.6%) and 61 (39.4%) patients had a GNRI &lt; 92 and PNI &lt; 45, respectively. Metastatic relapse was observed in five cases, four (80%) of which resulted in death due to the primary disease. The median OS of all patients was 86 months. Although factors specifically associated with disease-specific survival were not identified, GNRI, PNI, comorbidity, and physical status were associated with OS. In multivariate analysis, age ≥ 85 years (<i>p</i> = 0.03), GNRI (<i>p</i> &lt; 0.01), and PNI (<i>p</i> &lt; 0.01) remained factors associated with OS. Patients aged ≥ 85 with either GNRI ≥ 92 or PNI ≥ 45 had a median OS of 106 months, whereas those aged ≥ 85 with GNRI &lt; 92 had a median OS of 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GNRI and PNI are important indicators for assessing the suitability of ESD in elderly patients aged ≥ 80. These indices can help predict OS and guide clinical decision-making for this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"635-644"},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895194","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":"Asia-Pacific Survey on the Management of Helicobacter pylori Infection.","authors":"Koji Otani, Dao Viet Hang, Rapat Pittayanon, Henry Liu, Kee Huat Chuah, John Hsiang, Ning Zhang, Akira Higashimori, Yasuhiro Fujiwara","doi":"10.1111/jgh.16862","DOIUrl":"https://doi.org/10.1111/jgh.16862","url":null,"abstract":"<p><strong>Background and aim: </strong>Gastric cancer (GC)-related incidence and mortality rates remain high owing to Helicobacter pylori infection in Asia, and the importance of primary and secondary prevention of GC has been well recognized. We aimed to investigate the extent of overall agreement among clinicians in the Asia-Pacific region regarding the management of H. pylori infection.</p><p><strong>Methods: </strong>The Upper Gastrointestinal (GI) Focus Group of the Asian Pacific Association of Gastroenterology-Emerging Leaders Committee developed an international survey, which was distributed to 98 clinicians in the Asia-Pacific region, compromising an online questionnaire focusing on the management of H. pylori infection.</p><p><strong>Results: </strong>Participants responded from Japan (15, 15.3%), Hong Kong (15, 15.3%), Thailand (33, 33.7%), Vietnam (23, 23.5%), Malaysia (4, 4.1%), Singapore (3, 3.1%), and others (5, 5.1%). The most common first-line eradication regimen was clarithromycin (CAM) triple therapy, including proton pump inhibitor (PPI), amoxicillin (AMPC), and CAM (64.3%) for 14 days (70.4%). The most common second-line eradication regimen was levofloxacin (LVX) triple therapy, including PPI, AMPC, and LVX (22.4%) for 14 days (67.3%). Eradication therapy was deemed necessary for all asymptomatic adults and minors (aged ≤ 17 years) currently infected with H. pylori by 81.6% and 64.3% of respondents, respectively, with 82.7% considering upper GI endoscopy for GC screening useful in the secondary prevention of GC.</p><p><strong>Conclusion: </strong>There appears to be a growing consensus among clinicians, acknowledging the necessity of eradication therapy. We anticipate that this study will establish a new benchmark in preventive medicine aimed at eradicating GC in the Asia-Pacific region.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895152","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":"Exploring the Association Between Food Insecurity, Bowel Health, and All-Cause Mortality in the United States: Insights from NHANES 2005–2010","authors":"Yunlong Li,&nbsp;Yang Chen,&nbsp;Ziqing Yu,&nbsp;Xiaoyin Bai,&nbsp;Gechong Ruan,&nbsp;Yinghao Sun,&nbsp;Wei Han,&nbsp;Hong Yang,&nbsp;Xiaoqing Li","doi":"10.1111/jgh.16861","DOIUrl":"10.1111/jgh.16861","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Functional gastrointestinal disorders such as chronic constipation (CC) and chronic diarrhea (CD) impose a significant burden on global healthcare resources. Food insecurity, a crucial social determinant of health, remains unclearly associated with CC and CD. We aim to explore the association between food insecurity and CC and CD, and its impact on all-cause mortality among participants with abnormal bowel health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from National Health and Nutrition Survey 2005–2010. We assessed food insecurity using the Household Food Security Survey Module, and bowel health, including CD and CC, was evaluated using fecal characteristics and bowel movement frequency from the Bowel Health Questionnaire. Finally, 13 199 participants were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15.26% (2014) participants experienced food insecurity. Multivariate analysis revealed that food insecurity was associated with a higher proportion of CD (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.02–1.52, <i>p</i> = 0.03), especially in women. CC did not exhibit a significant association with food insecurity (OR: 1.10, CI: 0.86–1.40, <i>p</i> = 0.41). Furthermore, food insecurity was significantly linked to higher all-cause mortality in patients with CD (OR: 1.59, CI: 1.01–2.50, <i>p</i> = 0.046) and CC (OR: 2.01, CI: 1.20–3.46, <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Assessing food insecurity's impact on bowel health is crucial for policy formulation and risk identification. Research should explore links between food insecurity and CD or CC severity, treatment, and psychosocial aspects to improve patient quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"653-665"},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895174","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":"Efficacy of a Novel Adjustable Snare Technique Versus the Conventional Technique for Converting the Orobiliary Catheter to a Nasobiliary Catheter","authors":"Xianglin Li,&nbsp;Yumei Ning,&nbsp;Yue Zhu,&nbsp;Wei Li,&nbsp;Pengcheng Yang,&nbsp;Jing Wang,&nbsp;Xiaojun He,&nbsp;Qiu Zhao,&nbsp;Lingling Duan,&nbsp;Xiaodan Zhang","doi":"10.1111/jgh.16860","DOIUrl":"10.1111/jgh.16860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Object</h3>\u0000 \u0000 <p>It is a challenging step to guide a nasobiliary catheter from the mouth to the nasal cavity in endoscopic nasobiliary drainage (ENBD), and new methods are always being explored to improve the procedure. We have developed a novel device which is composed of a dedicated adjustable snare and a tongue depressor–like handle, for completing oral–nasal conversion of the ENBD tube. In this study, we aim to assess the utility of our new technique in repositioning the ENBD catheter by comparing it with conventional guidewire technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The patients who underwent ENBD at Zhongnan Hospital of Wuhan University were enrolled to the study. They were randomly divided into the new and conventional technique groups. The primary outcome was the first-time success rate of operation. The secondary outcome included the procedure time, the comfortable degree, and adverse event rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with using the conventional technique, the first-time success rate of operation using the novel adjustable snare technique to replace the ENBD catheter from the mouth to the nostril was significantly improved (76.19% vs. 51.43%, <i>p</i> &lt; 0.001). The procedure time was significantly shorter using the new device (78.96 s vs. 102.4 s, <i>p</i> &lt; 0.001). In addition, the discomfort scores of patients in the new technique group were lower than those in the conventional group (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our novel adjustable snare technique improved the first-time success rate of the nasobiliary catheter repositioning, shortened the procedure time, and alleviated the patient's discomfort.</p>\u0000 \u0000 <p><b>Trial Registration:</b> Chinese Clinical Trial Registry number: ChiCTR2400085838.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"645-652"},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895170","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":"Editorial: Learning Curve for ESD and Other Advanced Endoscopy Procedures","authors":"Tiing Leong Ang,&nbsp;Osamu Dohi,&nbsp;Han-Mo Chiu","doi":"10.1111/jgh.16864","DOIUrl":"10.1111/jgh.16864","url":null,"abstract":"&lt;p&gt;Endoscopy training has evolved over time, with the current emphasis on structured training programs and focus on the level of competency achieved, and not just numbers of procedures performed. Nonetheless, the concept of threshold numbers, although not absolute, remains important, as trainees progress from novice phase to a level of competency and eventual mastery [&lt;span&gt;1&lt;/span&gt;]. Globally, formal programs are available and well established for basic endoscopy [&lt;span&gt;2, 3&lt;/span&gt;] and advanced procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and endosonography (EUS) [&lt;span&gt;4&lt;/span&gt;]. Although endoscopic submucosal dissection (ESD) was introduced into clinical practice more than two decades ago, outside of East Asia, formal training programs are limited, due to lack of suitable case volume and expertise despite the clinical needs. While it may be possible to undergo a hands-on training fellowship if a temporary medical license is obtained, it may not be logistically feasible or practical for senior advanced endoscopists to spend an entire year or more abroad for further formal fellowship training. Multipronged stepwise strategies have been explored to meet this need [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Journal of Gastroenterology and Hepatology&lt;/i&gt;, Pattarajierapan et al. reported on the learning curve of a single endoscopist for colorectal ESD, using cumulative sum analysis (CUSUM) of the resection speed as the primary outcome [&lt;span&gt;6&lt;/span&gt;]. The endoscopist had prior extensive experience in colonoscopy and endoscopic mucosal resection (EMR). He underwent supervised training in 30 cases of colorectal ESD in Thailand, then went to Japan for 4 months, where he had further cognitive training and hands-on training in four colonic and one gastric ESD. On return to Thailand, he performed a further 70 cases of colorectal ESD. CUSUM of the resection speed revealed that proficiency was achieved after 36 cases. This study demonstrated that such customized training can help attain competency to provide clinical service that can be benchmarked to international standards. The weakness is that this only reflected the experience of a single endoscopist with prior extensive experience in endoscopy and may not be generalizable to less experienced endoscopists who would require a closer level of supervision. Nonetheless, this adds to our knowledge base that more than one playbook is possible for the acquisition of complex skills with a steep learning curve. A study from Japan reported that for Japanese trainees who perform ESD under expert supervision, 30 cases were required to attain competency in gastric ESD [&lt;span&gt;7&lt;/span&gt;], while other Japanese studies that evaluated colorectal ESD without prior gastric ESD experience reported that a higher level of competency was achieved after 21 [&lt;span&gt;8&lt;/span&gt;] to 40 cases [&lt;span&gt;8&lt;/span&gt;]. A study from the United States examined the learning curve of ESD with an untutored prevalence-bas","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 2","pages":"347-348"},"PeriodicalIF":3.7,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895157","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":"Gastrointestinal: Esophageal Achalasia With Unusual Endoscopic Findings","authors":"Kazuya Sumi,&nbsp;Haruhiro Inoue","doi":"10.1111/jgh.16852","DOIUrl":"10.1111/jgh.16852","url":null,"abstract":"&lt;p&gt;A 61-year-old male patient presented to our hospital with dysphagia, chest pain, and weight loss of 4 kg over the past 3 months, with no regurgitation. He had been receiving medical treatment for hypertension, dyslipidemia, and hyperuricemia. He was administered a calcium channel blocker (amlodipine 5 mg) for the management of hypertension. He reported no history of allergies, smoking, surgeries, or endoscopic interventions such as balloon dilation, and he had occasional alcohol consumption.&lt;/p&gt;&lt;p&gt;Esophagogastroduodenoscopy revealed circumferential erythematous changes at gastric folds and the squamocolumnar junction (SCJ) of the esophagus with passage resistance through a narrow distal segment and no hiatal hernia (Figure 1a–c). Biopsies of the mucosa revealed no malignant findings. Laboratory examinations, including tumor markers, revealed no apparent abnormalities, and computed tomography (CT) did not reveal any obvious neoplastic lesions. A positron emission tomography (PET) revealed no abnormal accumulation. Proton pump inhibitor was prescribed considering the possibility of gastroesophageal reflux disease (GERD), but symptoms showed no improvement. Barium esophagram revealed a narrow distal segment and dilation of 4 cm in transverse diameter, indicating barium outflow obstruction (Figure 1d). High-resolution manometry (HRM) (Starlet system, Star Medical, Tokyo, Japan) demonstrated an integrated relaxation pressure of 26.2 mmHg with panesophageal pressurization (Figure 1e).&lt;/p&gt;&lt;p&gt;The endoscopic findings showed features not typically seen in classical achalasia. Although there were no elevated tumor markers and CT or PET scans did not reveal any obvious masses, the rapid progression of symptoms necessitated ruling out a malignant tumor that progresses diffusely in the submucosa, known as pseudoachalasia. Bite-on-bite biopsies performed during a subsequent endoscopic examination ruled out malignant pseudoachalasia with negative results. Based on these results, a diagnosis of Type 2 esophageal achalasia (Chicago Classification v3.0), characterized by gastric folds and visible SCJ, was established.&lt;/p&gt;&lt;p&gt;Peroral endoscopic myotomy (POEM) was performed after discussing potential postprocedural complications, such as GERD, with the patient. The POEM was successfully performed without any complications, with myotomy of 3 cm on the gastric side. Two months after POEM, the patient's Eckardt score improved from 7 to 0. Although GERD-related symptoms were very mild, endoscopic examination revealed severe erosions, which were effectively managed with esomeprazole 20 mg daily. The patient has been under continuous follow-up for 7 years and remains in remission, with no recurrence of symptoms to date (Figure 2a–c).&lt;/p&gt;&lt;p&gt;Esophageal achalasia is a rare disorder characterized by impaired relaxation of the lower esophageal sphincter (LES). This case exhibited impaired relaxation at the upper margin of the gastric folds rather than the LES, with a clearly ","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"559-561"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16852","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854322","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 Significance of Lymphatic Involvement in Intramucosal (pT1a) Gastric Cancer Resected by Endoscopic Submucosal Dissection","authors":"Katsunori Matsueda,&nbsp;Yoshiyasu Kono,&nbsp;Koji Miyahara,&nbsp;Masahiro Nakagawa,&nbsp;Hirokazu Mouri,&nbsp;Kazuhiro Matsueda,&nbsp;Kenta Hamada,&nbsp;Masaya Iwamuro,&nbsp;Seiji Kawano,&nbsp;Yoshiro Kawahara,&nbsp;Takehiro Tanaka,&nbsp;Motoyuki Otsuka","doi":"10.1111/jgh.16854","DOIUrl":"10.1111/jgh.16854","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Lymphatic involvement is sometimes detected during routine examination of intramucosal (pT1a) gastric cancer resected endoscopically. However, its clinical significance and association with the risk of metastasis remain unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study of 6797 consecutive patients with pT1a gastric cancers treated by endoscopic submucosal dissection (ESD) at three institutions in Japan from January 2005 to August 2023. Patients with 49 uncommon-type gastric cancer types were excluded. The risk of metastasis for pT1a cancers with lymphatic involvement was quantified by comparing lymph node metastasis and/or metastatic recurrence in patient groups who underwent additional surgery post-ESD or did not undergo surgery but were followed up for &gt; 3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 6748 pT1a cancers treated by ESD, 41 lesions (0.6%) had histologically confirmed lymphatic involvement. Among the 41 patients, 1 was excluded from the analysis of metastasis risk because the follow-up period after ESD without additional surgery was ≤ 3 years. Metastasis was identified in 1 of 40 patients analyzed (2.5%; 95% confidence interval [CI] 0.4%–12.9%), and was not detected in any of the 25 patients with pure differentiated-type lesions (0.0%; 95% CI 0.0%–13.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The low prevalence of metastasis after ESD for pT1a gastric cancer with lymphatic involvement, particularly in patients with pure differentiated-type lesions, suggests a low risk of metastatic recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"712-719"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846818","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":"Natural History and Prognosis of Chronic Hepatitis B Patients in the Indeterminate Phase","authors":"Hao Jiang,&nbsp;Hongsheng Yu,&nbsp;Yinan Huang,&nbsp;Mingkai Li,&nbsp;Bilan Yang,&nbsp;Xiaoli Xi,&nbsp;Yiming Lei,&nbsp;Bin Wu,&nbsp;Yidong Yang","doi":"10.1111/jgh.16849","DOIUrl":"10.1111/jgh.16849","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>In chronic hepatitis B (CHB), an indeterminate phase exists outside the typical predefined phases. Our study investigates this indeterminate phase's natural history and prognosis, focusing on antiviral treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study to compare the risk of transitioning to immune active phase between inactive and indeterminate CHB and the incidence of hepatocellular carcinoma (HCC) and cirrhosis between untreated patients with indeterminate CHB (at baseline and throughout follow-up) and those who received treatment, following standard AASLD 2018 guidance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The risk of transitioning to the immune active phase over 3, 5, and 10 years was 6.3%, 8.9%, and 14.2%, respectively, for inactive phase patients (<i>n</i> = 104). For HBeAg-negative indeterminate phase patients (<i>n</i> = 194), the risk was significantly higher at 23.0%, 31.9%, and 38.2%, and for HBeAg-positive indeterminate phase patients (<i>n</i> = 140), it was 40.4%, 52.0%, and 55.0% (<i>p</i> &lt; 0.001). Inverse probability of treatment weighting (IPTW) was utilized to balance the groups of treated and untreated indeterminate patients. Following IPTW adjustment, the Kaplan–Meier curve analysis indicates that the risk of HCC and cirrhosis among untreated patients (<i>n</i> = 294) is higher than that among treated patients (<i>n</i> = 76), (<i>p</i> = 0.015 and 0.007, respectively). In the multivariable analysis, antiviral therapy remained an independent predictor of a reduced risk of HCC (aHR 0.128, 95% CI 0.031–0.522, <i>p</i> = 0.005) and cirrhosis (aHR 0.148, 95% CI 0.044–0.496, <i>p =</i> 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The indeterminate phase patients had a high-risk transition to active phase, and antiviral therapy can reduce the incidence of developing HCC and cirrhosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"720-730"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846819","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 Simple Prediction Model for Clostridioides difficile Infection: A Hospital-Based Administrative Database Study","authors":"Kenta Watanabe,&nbsp;Tsuyotoshi Tsuji,&nbsp;Hisanori Matsuzawa,&nbsp;Yohei Saruta,&nbsp;Yosuke Shimodaira,&nbsp;Katsunori Iijima","doi":"10.1111/jgh.16851","DOIUrl":"10.1111/jgh.16851","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Few prediction scores for <i>Clostridioides difficile</i> infection (CDI), a potentially life-threatening nosocomial diarrhea, combine high accuracy with simplicity. A simple prediction score for routine clinical practice is needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of all inpatients aged ≥ 18 at a secondary care hospital in Japan. The derivation and validation cohorts consisted of patients from January 2016 to December 2020 and January 2021 to September 2022, respectively. Demographic and clinical data were retrieved using electronic medical records and an administrative database. The primary outcome was to derive and validate an accurate, simple prediction score for primary hospital-onset CDI. A derived prediction score by logistic regression analysis was calibrated and validated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CDI developed in 102 of 25 517 and 25 of 6259 patients in the derived and validation cohorts (2.7 cases/10 000 patient-days). The derived model for predicting CDI, including antibiotic use, acid suppressant (proton pump inhibitors or vonoprazan) use, Charlson comorbidity index, and Barthel index, yielded <i>c</i>-statistics of 0.89 and 0.82 in the derivation and validation cohort. The model was well calibrated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This simple prediction score enables early medical intervention and modification of treatment plans to reduce the risk of developing primary hospital-onset CDI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"609-617"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846834","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}