Advances in Digestive Medicine最新文献

{"title":"Safety of transcatheter arterial chemoembolization for hepatocellular carcinoma in older adults aged ≥ 85 years: A single-institution retrospective preliminary study","authors":"Atsushi Saiga,&nbsp;Takeshi Aramaki,&nbsp;Rui Sato","doi":"10.1002/aid2.13438","DOIUrl":"https://doi.org/10.1002/aid2.13438","url":null,"abstract":"<p>This study aims to evaluate the safety of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in elderly patients (aged ≥ 85 years). This study examined 20 consecutive TACE procedures performed in 20 treatment-naïve patients aged ≥ 85 years for HCC between May 2010 and February 2023. Patient and TACE procedure data were retrospectively obtained. The patients were followed up during their hospital stay for the clinical symptoms of postembolization syndrome (PES), including fever, pain, nausea, and vomiting. In addition, their length of hospital stay, TACE-related complications, objective response rate (ORR), time to TACE progression (TTTP), and overall survival (OS) were reviewed. In five, two, 10, and three procedures, TACE was performed using powdered cisplatin without lipiodol, epirubicin–lipiodol emulsion, miriplatin–lipiodol suspension, and drug-eluting beads, respectively. The main baseline characteristics of the patients and TACE procedures were as follows: age, 86.0 (interquartile range [IQR], 85.0–86.0) years; sex, male/female (14/6); Child–Pugh classification, A/B (19/1); and maximum tumor size, 5.0 (IQR, 3.9–6.6 cm). The incidence of PES was 55% (11/20). No severe PES was observed. Furthermore, procedure-related complications did not occur, and the TACE-related mortality rate was 0%. The median length of hospital stay was 6 days, and the ORR was 70% (14/20). The median TTTP and survival time were 3.3 (IQR, 2.3–5.5) months and 22.1 (IQR, 11.0–37.1) months, respectively. The OS rates at 1, 3, and 5 years were 70% (14/20), 25% (5/20), and 5% (1/20), respectively. In conclusion, TACE for HCC in elderly patients aged ≥ 85 years has the possibility of being safe and acceptable.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment in noncirrhotic and low-viral-load chronic hepatitis B","authors":"Chao-Hung Hung","doi":"10.1002/aid2.70011","DOIUrl":"https://doi.org/10.1002/aid2.70011","url":null,"abstract":"&lt;p&gt;Chronic hepatitis B virus (HBV) infection is a leading global cause of cirrhosis, liver-related mortality, and hepatocellular carcinoma (HCC).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Current first-line treatments for chronic hepatitis B (CHB) include nucleoside/nucleotide analogs (NAs) and pegylated interferon alpha. Previous studies have demonstrated that NAs can effectively suppress viral replication, achieve biochemical remission, improve liver histology, and lower the risk of HCC.&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The decision to initiate NAs therapy is based on the severity of liver disease and inflammation status as well as viremia level.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; In patients with cirrhosis or advanced fibrosis, treatment is generally recommended regardless of HBV DNA levels or serum alanine aminotransferase (ALT) levels. For non-cirrhotic patients, treatment is typically indicated when HBV DNA exceeds 2000 international units (IU)/mL and ALT levels are above the upper limit of normal.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Conversely, in non-cirrhotic, hepatitis B e antigen (HBeAg)-negative patients with low viral loads (&lt;2000 IU/mL) and normal ALT, antiviral therapy is usually not recommended.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; However, the recent study by Jang and Dai offers the evidence that challenges long-standing thresholds for initiating antiviral therapy in CHB patients.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; This study retrospectively evaluated the impact of NAs on HCC incidence in non-cirrhotic, HBeAg-negative CHB patients with low viral loads.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Among 63 patients aged over 50 years, those treated with NAs had a significantly lower risk of developing HCC compared to untreated counterparts, despite having higher baseline HBV DNA levels. These results underscore the oncogenic potential of even low-level viremia and suggest that current treatment guidelines may underestimate long-term cancer risk in this subgroup. Notably, post-treatment ALT levels decreased significantly (21.3 vs. 29.2 U/L), indicating that some of these patients may fall into the “gray zone,” characterized by borderline HBV DNA and ALT levels between inactive and immune-active HBeAg-negative CHB phases.&lt;/p&gt;&lt;p&gt;Although the study's relatively small sample size and retrospective design warrant cautious interpretation, its clinical implications are still noteworthy. Some guidelines recommend considering treatment even when full treatment criteria are not met, particularly in special scenarios, such as patients over 40 years of age, those with significant fibrosis or moderate liver necroinflammation, individuals with coinfections or extrahepatic HBV manifestations, or those with a family history of HCC.&lt;span&gt;&lt;sup&gt;6, 7, 9&lt;/sup&gt;&lt;/span&gt; While a strong positive correlation exists between HBV DNA levels and HCC risk,&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; potentially hepatocarcinogenic HBV integrations can occur across all phases of CHB, regardless of hepatitis activity or viremia levels.&lt;span&gt;&lt;sup&gt;11&lt;/sup","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute mechanical intestinal obstruction secondary to malignant melanoma metastasis","authors":"Fatih Yanar,&nbsp;Oğuzhan Şal,&nbsp;Berke Şengün,&nbsp;Nail Ömer,&nbsp;İbrahim Fethi Azamat","doi":"10.1002/aid2.13439","DOIUrl":"https://doi.org/10.1002/aid2.13439","url":null,"abstract":"&lt;p&gt;A 33-year-old male patient was referred to our emergency and trauma unit with abdominal pain that started 3 days ago. On physical examination, widespread abdominal tenderness and rebound were noticed. His medical history consisted of right scrotal malignant melanoma excision 5 years ago. The patient received adjuvant interferon treatment for 7 months and discontinued follow-up. Laboratory tests revealed a leukocyte count of 12  100/mm&lt;sup&gt;3&lt;/sup&gt;, CRP level of 73 mg/L, and blood gas lactate value of 3.2 mmol/L. Air-fluid levels were observed on the standing direct abdominal radiograph. Radiological studies revealed jejuno-jejunal intussusception (Figure 1A,B). What is your diagnosis? Furthermore, what will be the right management strategy?&lt;/p&gt;&lt;p&gt;Diagnostic laparotomy was performed and tumor implants invading small intestine serosa, widespread pigmented lesions on the omentum, and mesentery were observed. (Figure 1C,D). Tumoral lesions blocked the small intestinal lumen at 30th, 90th, and 190th cm from the ligament of Treitz. The mass which was located at 30th cm from Treitz caused intussusception. No other pathology was detected. A total of 60 cm resection, including the invaginated area and aforementioned masses, were performed. Side-to-side and functional end-to-end anastomoses were performed with a stapler. The patient was discharged on post-operative day 6 without any further complications. Macroscopic examination revealed multiple tumor masses with different sizes in the wall of small intestine. Microscopic examination revealed tumor cells, many of which contain dark brown pigment with spindle or ovoid/round morphology containing multiple mitotic figures. The findings were consistent with malignant melanoma metastasis in the present patient with a known history of malignant melanoma. (Figure 2) Follow-up period of 2 years revealed no recurrences of gastrointestinal symptoms and intestinal metastasis. The patient was lost to follow-up after second year of surgery.&lt;/p&gt;&lt;p&gt;Symptomatic small intestine metastasis of malignant melanoma is extremely rare. In autopsy series, intestinal metastasis of malignant melanoma has been shown to be 50% to 58% and symptomatic cases are estimated to be 2% to 5% of all intestinal metastatic cases.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Most of these cases present with abdominal pain, obstructive symptoms, and gastrointestinal bleeding due to the obstructive effect of the polypoid lesions or intussusception of metastatic segments.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Small intestine metastasis should be kept in mind in patients with acute abdomen with a history of malignant melanoma. Acute abdomen may be secondary to intussusception, bleeding, and obstruction. Early surgical intervention is necessary to ensure intestinal continuity and prevention of complications such as perforation. Furthermore, appropriate oncological treatment should be planned as soon as possible to prevent further systemic metastasis.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Fatih Yanar:","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A kiss from the bread: Esophageal ulcer induced by bread impaction in an adult male","authors":"Yoen Young Chuah,&nbsp;Ping-I Hsu,&nbsp;Yeong Yeh Lee,&nbsp;I-Ting Wu","doi":"10.1002/aid2.70002","DOIUrl":"https://doi.org/10.1002/aid2.70002","url":null,"abstract":"<p>A 52-year-old male, a property broker known for his fast-paced lifestyle, presented with a history of severe chest discomfort immediately after consuming a large slice of bread (Figure 1) in his rush to get to work. He exhibited a type A personality, had no comorbidities, and did not take any regular medications. Since then, he has experienced ongoing chest pain accompanied by a sensation of the bread being lodged in his chest. Six hours later, his incarcerated sensation started to decrease after massive water and milk consumption. However, the chest pain still persisted. His gastroduodenoscopy showed a 3.5-cm ulcer in the middle esophagus (Figure 2). His chest symptoms gradually improved after a week treatment with sucralfate 1 g four times daily. The decision to use sucralfate instead of proton pump inhibitors was based on its direct action on the ulcer, forming a protective film that could prevent further deterioration of the esophageal ulcer. A compression ulcer produced by incarcerated bread might occur, possibly due to compression-related ischemia of the mucosa. A bread-related esophageal ulcer tends to occur at middle esophagus, the anatomical narrowing site behind left atrium. Esophageal ulcers can arise from various factors, including reflux esophagitis, viral infections, or medication use.<span>^1-3</span> In this case, the mechanical obstruction caused by the bread likely contributed to the development of the ulcer given the sequence of events.</p><p>In the literature, there have been reports of fatality and laceration caused by bread crust and bagel, respectively.<span>^{4, 5}</span> The autopsy of the former case revealed perforation at the upper end of the esophagus with a mediastinal abscess.<span>⁴</span> In the latter case, a barium-swallow exam indicated a 4-cm mucosal tear extending from the upper esophagus to the cricopharyngeal muscle.<span>⁵</span> However, the patient survived with conservative medical treatment involving narcotic analgesics, antacids, and intravenous hydration.</p><p>All authors contributed equally to the review of data, drafting of manuscript, and approval of final version.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was taken from patient for clinical image submission.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose ursodeoxycholic acid successfully treats overlap syndrome","authors":"Tzu-Rong Peng,&nbsp;Ta-Wei Wu,&nbsp;You-Chen Chao","doi":"10.1002/aid2.13441","DOIUrl":"https://doi.org/10.1002/aid2.13441","url":null,"abstract":"&lt;p&gt;The first-line treatment regimen of overlap syndrome includes both ursodeoxycholic acid (UDCA) and corticosteroids, with or without azathioprine (AZA).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Herein, we present a high-dose ursodeoxycholic acid successful treatment in a patient with overlap syndrome (primary biliary cholangitis [PBC] with or without autoimmune hepatitis [AIH]).&lt;/p&gt;&lt;p&gt;This is a 45-year-old female, weighing ~60 kg, with a lengthy history of dyslipidemia and liver cirrhosis, presenting with abnormal transaminase levels managed by an endocrinologist. She was referred to a gastroenterologist due to elevated levels of gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), and anti-mitochondria antibody (AMA), measuring 2243 U/L, 854 U/L, 153 U/L, 330 U/L, and positive; 1:160, respectively. However, its antinuclear antibody (ANA), and anti-smooth muscle antibody (ASMA) were all negative, which could not significantly prove the diagnosis of AIH. And the client refused to undergo liver biopsy. However, an ultrasound scan of the patient's liver, gallbladder, pancreas, and spleen revealed mild parenchymal liver disease (acoustic radiation force impulse: 1.61 m/s [F1]). Therefore we diagnosed her with PBC with or without AIH.&lt;/p&gt;&lt;p&gt;The initial therapeutic approach involved UDCA at 200 mg thrice daily (10 mg/kg), and prednisolone at 20 mg thrice daily, leading to a reduction in GGT and ALP to 972 and 296 U/L, respectively. Attempts to discontinue medications resulted in a rebound effect, with GGT and ALP peaking at 1993 and 707 U/L. Subsequently, UDCA was reintroduced at 300 mg thrice daily, omitting prednisolone or immune compression, as the patient declined such interventions due to concerns regarding drug adverse reactions and concurrent polypharmacy. Therefore, we continue to treat patients with UDCA.&lt;/p&gt;&lt;p&gt;Within a month, her GGT and ALP decreased by around half to 783 and 325 U/L, maintaining stability over the subsequent 3 months. Progressing the therapeutic strategy, the UDCA dose was increased to 400 mg thrice daily, leading to a further decrease in GGT and ALP to 399 and 206 U/L in 2 months. To achieve sustained disease control, a consistent upward titration of UDCA was implemented, reaching 600 mg thrice daily, resulting in a GGT and ALP reduction to 148 and 108 U/L (Figure 1). Although her ALP and GGT had significantly decreased, these levels remained abnormal, and her HRF1 was 1.05. As a result, subsequent UDCA titration to 35 mg/kg divided into 700 mg thrice daily produced a rapid decline in GGT and ALP to 130 and 94 U/L within 2 weeks, marking the lowest levels observed in recent years. However, the patient did not complain of any side effects.&lt;/p&gt;&lt;p&gt;Treatment of PBC with UDCA has been shown to have a beneficial effect and highly safe effect on the disease progression. Regarding the dose of UDCA in patients with PBC, 14–16 mg/kg/day of UDCA for at least 2 years has demonstr","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased incidence of hepatocellular carcinoma in non-cirrhotic and low-viral-load chronic hepatitis B patients treated with nucleotide/nucleoside analogs","authors":"Tyng-Yuan Jang,&nbsp;Chia-Yen Dai","doi":"10.1002/aid2.13424","DOIUrl":"https://doi.org/10.1002/aid2.13424","url":null,"abstract":"<p>Nucleotide analogs (NAs) reduced hepatocellular carcinoma (HCC) incidence in chronic hepatitis B (CHB) patients. Among low-viral-load (DNA of hepatitis B virus [HBV] were &lt;2000 IU/mL) and non-cirrhotic CHB patients, the efficacy of NAs in the prevention of HCC remained elusive. The retrospective study recruited non-cirrhotic CHB patients with hepatitis B e-antigen (HBeAg) negative who were older than 50 years. Patients treated with or without NAs (2:1 age and sex match). HCC survey was performed during regular follow-up. A total of 63 patients were recruited for the current study (mean age, 63.5 years; 61.9% male). All patients were non-cirrhotic and with HBeAg negative. 68.3% of patients had fatty liver. Mean value of fibrosis-4 index (FIB-4) was 1.8. Overall, 65.1% of patients (41/63) were treated with potent NAs during the follow-up period. Compared to patients without NAs therapy, those with NAs therapy had higher HBV DNA levels (416.0 IU/mL vs. 212.0 IU/mL; <i>p</i> = .01). The HCC development was substantially lower in patients with NAs therapy, compared to those without NAs therapy (0% vs. 9.1%; log-rank <i>p</i> &lt; .001). There was no HCC development in patients with NAs therapy, whereas two patients developed HCC within 2 years of follow-up in patients without NAs therapy. NAs could reduce the incidence of HCC in older (more than 50 years), non-cirrhotic, HBeAg-negative patients with low viral load.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic argon plasma coagulation ablation of cervical inlet patch improves proton-pump inhibitor-refractory laryngopharyngeal symptoms","authors":"Yoen Young Chuah,&nbsp;Yeong Yeh Lee,&nbsp;Shih-Peng Hsieh,&nbsp;Chu-Kuang Chou","doi":"10.1002/aid2.70004","DOIUrl":"https://doi.org/10.1002/aid2.70004","url":null,"abstract":"&lt;p&gt;Cervical inlet patch (CIP) is an islet of heterotopic gastric mucosa found at upper esophagus with the incidence ranging between 0.1% and 10% in conventional diagnostic esophagogastroduodenoscopy. CIP has been associated with common troublesome laryngopharyngeal symptoms, such as globus sensation, hoarseness, odynophagia, and dysphagia. Medical treatment for symptomatic CIP usually begins with strong acid suppressive agents, such as proton-pump inhibitors (PPIs), but the response remains unsatisfactory. Endoscopic therapy with argon plasm coagulation (APC) has been increasing shown to be effective in alleviating the laryngopharyngeal symptoms in patients with CIP in a few Western studies.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Long-term effect up to 27 months of follow-up has also been reported.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, no relevant study regarding the application of APC in CIP patients has been conducted in Taiwan and other Asian countries. We would like to present a CIP patient with PPI-refractory laryngopharyngeal symptoms, who was successfully treated with endoscopic APC ablation. This case shed light on the possible application of APC for Taiwanese patients with symptomatic CIP.&lt;/p&gt;&lt;p&gt;A 52-year-old female patient presented with persistent symptoms of burning and lumpy sensation in the throat for over 6 months. Initial treatment with standard dose of PPI for 8 weeks showed only minimal improvement, and the symptoms worsened upon PPI discontinuation. Esophagogastroduodenoscopy (EGD) revealed an area of salmon-colored mucosa, approximately 0.8 cm in size, located in the inlet of the upper esophagus (Figure 1A). Endoscopic biopsy demonstrated the presence of mature gastric body mucosa in the lamina propria of esophagus that confirmed the diagnosis of CIP (Figure 1B). After shared decision-making with the patient, endoscopic APC was applied (60 W, 2 L/min) to ablate the CIP completely in two sessions (Figure 1C). No adverse event, such as odynophagia or bleeding, developed after ablation. A follow-up EGD 2 months later revealed neither residual CIP nor complications, such as stricture or ulcers (Figure 1D).&lt;/p&gt;&lt;p&gt;The visual analog scores (from 0 to 10; the higher the score, the more severe the symptoms) for symptoms of dry throat, burning throat, globus sensation, and hoarseness before APC were 8, 10, 8, 6 (without PPI therapy), 7, 5, 5, 7 (with PPI therapy), and the scores improved significantly, that is, 2, 1, 1, 1 after ablation&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; (Figure 1D). Throughout the 1-year follow-up after the procedure, the patient did not experience any recurrence of laryngopharyngeal reflux symptoms and was free from PPI therapy, evidenced by 1, 0, 0, 1 in dry throat, burning throat, globus sensation, and hoarseness.&lt;/p&gt;&lt;p&gt;Our case demonstrated that APC ablation may be a promising treatment with a durable effect for CIP patients with PPI-refractory laryngopharyngeal symptoms in Taiwanese population. Future prospective randomized studies wit","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lowering the age for colorectal cancer screening","authors":"Chi-Yang Chang","doi":"10.1002/aid2.70001","DOIUrl":"https://doi.org/10.1002/aid2.70001","url":null,"abstract":"&lt;p&gt;Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, including in Taiwan, where early detection is crucial for improving outcomes. Recent studies reveal a rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 50, promoting discussions about lowering the recommended age for CRC screening.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; A study by Chang et al. highlights the adenoma detection rate (ADR) in screening colonoscopies among individuals aged 40–75, providing critical insights into the efficacy and implications of early screening.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In Chang's study, the ADR for individuals aged 40–44 years, was 28.0%, compared to 41.5% for those aged 50 and older. Although younger populations showed a lower ADR in, their rates still exceed the current ADR benchmark of 25%, demonstrating the feasibility of initiating screenings earlier. ADR is strongly correlated with reduced CRC incidence and mortality.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; The study's results emphasize the potential of detecting precancerous colon adenomas earlier, which could significantly impact CRC prevention strategies.&lt;/p&gt;&lt;p&gt;Historically, CRC screening began at age 50 for average-risk individuals among many countries. However, lifestyle factors such as high consumption of red and processed meats, low intake of fiber-rich foods like fruits and vegetables, physical inactivity, smoking, and rising obesity rates have contributed to the growing burden of CRC among younger populations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; EOCRC tends to be more aggressive and is often associated with poorer prognosis compared with CRC in older individuals.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The increasing prevalence of EOCRC has been noted recently. This alarming trend highlights the need to modify current screening guidelines. Early detection through screening colonoscopy could help address this incidence effectively.&lt;/p&gt;&lt;p&gt;Chang et al.'s study also identified gender differences in ADR, with males consistently exhibiting higher rates than females across all age groups.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; While the ADR for women aged 40–44 years was slightly below the 20% which is the female ADR benchmark, the overall ADR for younger populations remained robust, supporting the extension of screening to these age groups. One concern with lowering the screening age is the potential impact on the cost-effectiveness and efficiency of CRC screening programs. Chang et al. revealed a slight decrease in overall ADR when younger populations were included, as these groups typically exhibit fewer adenomas. However, the broader benefits of early detection outweigh this challenge. Targeted strategies, such as prioritizing individuals with a family history of CRC or other risk factors, could optimize resource allocation while maintaining high-quality care.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The shift toward earlier CRC screening aligns with updated recommendations by the US Preventive Servic","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography","authors":"Wei-Chih Sun,&nbsp;Wen-Chi Chen,&nbsp;Wei-Lun Tsai,&nbsp;Feng-Woei Tsay,&nbsp;Huay-Min Wang,&nbsp;Yun-Da Li,&nbsp;Tzung-Jiun Tsai","doi":"10.1002/aid2.13427","DOIUrl":"https://doi.org/10.1002/aid2.13427","url":null,"abstract":"<p>Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; <i>p</i> = .01) and hospital day (18 vs. 6 days; <i>p</i> = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; <i>p</i> = .04), overall biliary cannulation time &gt;10 min (61.9% vs. 38.1%; <i>p</i> = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; <i>p</i> = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (<i>p</i> = .01). Overall biliary cannulation time &gt;10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; <i>p</i> = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; <i>p</i> = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time &gt;10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma","authors":"Kuan-Ming Lai,&nbsp;Chien-Yu Tsai,&nbsp;Sheng-Lei Yan","doi":"10.1002/aid2.13423","DOIUrl":"https://doi.org/10.1002/aid2.13423","url":null,"abstract":"<p>Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (<i>p</i> = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (<i>p</i> = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (<i>p</i> &lt; .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (<i>p</i> = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR &lt;5.3 (<i>p</i> = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR &gt;5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}