Advances in Digestive Medicine最新文献

{"title":"A silent complication following percutaneous endoscopic gastrostomy","authors":"Hao‐Che Chang, Chieh-Chang Chen, Ji‐Shiang Hung","doi":"10.1002/aid2.13406","DOIUrl":"https://doi.org/10.1002/aid2.13406","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenoma detection rate of screening colonoscopy among age 40–75 years: Implications for lowering the age for colorectal cancer screening","authors":"Tsan‐Hsuan Chang, Lee‐Won Chong, Hung‐Chuen Chang, Yu‐Hwa Liu, Cheuk-Kay Sun, Kou-Ching Yang, Yu‐Min Lin","doi":"10.1002/aid2.13410","DOIUrl":"https://doi.org/10.1002/aid2.13410","url":null,"abstract":"Incidence of early‐onset colorectal cancer is on the rise, prompting updated international guidelines recommending screening for average‐risk individuals starting at age 45. Adenoma detection rate (ADR) serves as a crucial quality indicator for colonoscopy (CFS), with a current benchmark of 25% for screening CFS starting at age 50. However, the impact of lowering the screening age on ADR remains uncertain. This study aimed to assess the ADR in average‐risk individuals who undergo screening colonoscopy at an age older than 40. Participants who underwent a complete colonoscopy for health examination at a medical center between January 2014 and February 2020 were enrolled in this study. We excluded colonoscopies performed on individuals younger than 40 years of age or older than 75 years of age, as well as those conducted for surveillance purposes. ADR was defined as the percentage of colonoscopies with at least one colorectal adenoma detected. We calculated the ADR for different age groups, including 40–44, 45–49, 50–54, and 55–75, to understand the age‐specific ADR of screening colonoscopy. Additionally, we evaluated the ADR among participants who started screening colonoscopy at ages ≥40, ≥45, and ≥50 to understand the impact of starting age on ADR. A p value <.05, determined by the chi‐square test, was considered significant. Among the 33 073 CFS completed during the study period, 5852 CFS examined in patients aged younger than 40 years, 344 CFS examined in patients aged older than 75, and 6881 CFS with surveillance indication were excluded, leaving 19 996 CFS enrolled for analysis. The mean age of the participants was 53, with 57% being male and 43% being female. The ADR for the age groups of 40–44, 45–49, 50–54, and 55–75 were 28.0% (1058/3778), 31.8% (1191/3741), 35.6% (1387/3891), and 44.2% (3794/8586), respectively, with a statistically significant difference (p < .01). The ADR for age ≥40, ≥45, and ≥50 were 37.2% (7430/19996), 40.1% (6372/15874), and 41.5% (5181/12477), respectively, with a statistically significant difference (p < .01). The findings of our study indicate that there are notable differences in ADR among various age groups. Lowering the screening age might result in a decrease in the overall ADR. However, our results suggest that even if CRC screening begins at age 40 or 45, the current benchmark of 25% ADR for screening colonoscopy may still be maintained. These findings provide valuable insights into the age‐ and gender‐specific prevalence of adenomas in colonoscopy screening and can be used to inform future screening guidelines and recommendations.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual presentation of ischemic bowel disease","authors":"Chien‐Tzu Hung, Chien‐Chih Tung","doi":"10.1002/aid2.13403","DOIUrl":"https://doi.org/10.1002/aid2.13403","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141119470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tiny gastric adenocarcinoma of fundic gland type mimic polyp","authors":"Chia‐Chien Kang, Yen‐Po Chen","doi":"10.1002/aid2.13399","DOIUrl":"https://doi.org/10.1002/aid2.13399","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study comparing the initial clinical response to different proton pump inhibitors within first week in treating erosive esophagitis","authors":"Min‐Kai Liao, Tsung‐Jung Lin, Hsi‐Chang Lee, Chih‐Lin Lin, Kuan‐Yang Chen, Deng‐Chyang Wu","doi":"10.1002/aid2.13394","DOIUrl":"https://doi.org/10.1002/aid2.13394","url":null,"abstract":"Gastroesophageal reflux disease (GERD) characterized by heartburn and/or acid regurgitation symptoms is one of the most common gastrointestinal disorders. The rapid onset of proton pump inhibitors (PPIs) to improve annoying symptom is an essential need in treating GERD. There was no report about the short‐term clinical effects comparing lansoprazole 30 mg to rabeprazole 20 mg. This pilot study was designed to compare the initial one‐week clinical response of the two drugs in GERD with erosive esophagitis. Total 44 patients with GERD were enrolled in this study and randomized into two groups. The patients had the symptoms of acid regurgitation, heartburn, or feeling of acidity in the stomach and erosive esophagitis proven by endoscopy. They respectively received once‐daily dose of lansoprazole 30 mg (n = 23) and rabeprazole 20 mg (n = 21) for treatment of GERD. The primary end point was complete symptom resolution (CSR). The CSR rate was evaluated by questionnaire including acid regurgitation, heartburn sensation and epigastric pain at day 1, 3 and 7. Two patients in the arm of rabeprazole had poor compliance of drugs and were excluded from analysis. The final patient numbers were 23 in the arm of lansoprazole and 19 in rabeprazole. The baseline characteristics of two groups were similar in age, gender, body mass index (BMI), Helicobacter pylori infection, GERD severity, smoking, alcohol, coffee, spicy, sweet food and laboratory data. The ingestion of tea was the only one variable with significant difference between the two groups (65.2% and 31.58%, p = .03). At day 1, 3 and 7, the CSR rate of lansoprazole and rabeprazole were 21.74% and 26.32% (p = 1.000), 34.78% and 31.58% (p = .827), 47.83% and 47.37% (p = .976), respectively. The other clinical factors, including age, gender, BMI, Helicobacter pylori infection, smoking, alcohol, coffee, tea, spicy, sweet food and laboratory data, have also no significant influence on CSR rates at day 1, 3, 7. However, the patients with GERD C and D had significantly higher CSR rate than patients with GERD A and B at day 1 and 7 (CSR rate at day 1: 50.00% vs. 15.63, p = .040; day 3: 60.00% vs. 25.00%, p = .059; day 7: 90.00% vs. 34.38%, p = .003). In multivariate regression analysis, the patients with GERD C and D still had significantly higher CSR rate than patients with GERD A and B at day 7 (Odds ratio: 28.27, 95% CI: 2.10–380.03, p = .012). The CSR rates between lansoprazole group and rabeprazole group at day 1, 3, 7 were not significantly different, so the difference of PPIs did not play the role on the initial clinical response within 1 week for the erosive GERD patients. However, the patients with more severe erosive GERD on endoscopy had higher CSR rate at day 7.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation exposure in therapeutic endoscopic retrograde cholangiopancreatography with two types of fluoroscopy systems","authors":"Yao‐Sheng Wang, Ying‐Jung Wu, Wan‐Jou Tseng, Chien‐Jui Huang, Chiung‐Yu Chen","doi":"10.1002/aid2.13392","DOIUrl":"https://doi.org/10.1002/aid2.13392","url":null,"abstract":"Fluoroscopy is necessary for endoscopic retrograde cholangiopancreatography (ERCP). Occupational radiation exposure of staff (endoscopists, nurses, or assistants) is inevitable. Fluoroscopes with a tube over‐couch (OC) rather than under‐couch (UC) may have more radiation reflection dosage on the staff's upper body theoretically, where the most vital organs are. In the study, we assessed the radiation exposure on staff by two different types of fluoroscopes in real‐world practice. Using a radiation dosimeter to measure the radiation dosage on endoscopists and assistants in each ERCP procedure under two different fluoroscopic systems (UC vs. OC). Forty‐one ERCP procedures were enrolled. Dosimeters were used NanoDots for the measurement of personal radiation exposure. Those dosimeters were attached to the left forearm and chest of the endoscopist and only the chest of two assistants, the wall of the ERCP room, and the controlling room in every procedure. Nine‐teen ERCPs were performed under the OC unit, and the other 22 ERCPs were UC method. Fluoroscopic time and output of radiation dose showed no significant difference between the two groups. Radiation exposure in endoscopist were 0.0911[0.1041–0.3974] mGy (OC) versus 0.0276 [0.0080–0.2924] mGy (UC), p < .01 for the forearm; and 0.0318 [0.0070–0.2628] mGy (OC) versus 0.0182 [0.0088–0.1628] mGy (UC), p = .04 for the endoscopist's body. There was no difference in radiation exposure from assistants in both groups. For all the ERCP procedures, the measurement of radiation exposure from high to low is endoscopist's hand, endoscopist's body, assistant 1, assistant 2, and ERCP room (p < .01). Radiation detection from ERCP room is slightly higher but close to controlling room (p = .06). For the safety of occupational radiation protection, tube of fluoroscope UC is better than OC for the endoscopists more than assistants. Besides, the assistant 1 took higher radiation exposure than assistant 2 for each ERCP procedure.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STAT3 mediates cancer stem‐like tumorsphere formation and PD‐L1 expression to contribute radioresistance in HBV‐positive hepatocellular carcinoma","authors":"A. Ho, Chun‐Chia Cheng, Cheng-Liang Peng, Zong-Lin Sie, Chun Yeh, Shou‐Dong Lee","doi":"10.1002/aid2.13393","DOIUrl":"https://doi.org/10.1002/aid2.13393","url":null,"abstract":"We proposed that cancer stem cells (CSCs) survived and presented resistance to radiotherapy (RT) in hepatocellular carcinoma (HCC) cells. Interleukin 6 (IL‐6) has been reported to be particularly involved in HCC tumorigenesis. Therefore, we intended to validate that IL‐6 downstream STAT3‐mediated CSCs formation and immune checkpoint PD‐L1 expression in HCC, thus contributing to radioresistance. HBV‐positive HCC tumorspheres were formed and exposed with X‐ray irradiation, cell viability of which was measured consequently. Specific inhibitors targeting EGFR (by gefitinib), STAT3 (by BBI608), and HCC‐targeted therapy sorafenib were investigated to suppress tumorsphere formation. Reverse transcription‐quantitative polymerase chain reaction (RT‐qPCR) was used for detecting STAT3‐downstream PD‐L1 and anti‐apoptosis MCL1 and BCL2 gene expression in the PLC5‐derived tumorspheres and STAT3‐knockdown PLC5. We found that RT significantly inhibited HBV‐positive Hep3B and PLC5 cell viability but not for HCC‐derived stem‐like tumorspheres cultured by EGF, IL‐6, bFGF, and HGF. It revealed that tumorspheres presented radioresistance compared with the parental cells. Specifically, RT induces IFNs, EGF, and IL‐6 expression, resulting in STAT3 phosphorylation. Kaplan–Meier plotter indicated that highly EGF (p = .0024), IL‐6 (p = .12), and FGF2 (p = .0041) were associated with poor survival probability in patients with HBV‐positive HCC. We further demonstrated that BBI608 and sorafenib significantly suppressed PLC5 cell viability and PLC5‐derived tumorsphere formation. To investigate the mechanism of CSC‐presented radioresistance, STAT3 and STAT3‐downstream genes, including PD‐L1 and anti‐apoptosis MCL1 and BCL2, were detected using qPCR. We demonstrated higher STAT3, PD‐L1, MCL1, and BCL2 in Hep3B‐ and PLC5‐derived CSCs compared to PLC5. In addition, knockdown of STAT3 reduced cell proliferation in PLC5 cells, resulting in down‐regulation of IL‐6‐mediated PD‐L1 and BCL‐2. Meanwhile, we found that knockdown of STAT3 significantly improved RT‐mediated suppression of tumorsphere formation. In conclusion, we found that CSCs presented radioresistance and figured out which may be mediated by STAT3 in HBV‐positive HCC.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal pain with radiation to the right thigh in a middle age woman","authors":"Yong‐Cheng Ye, Hung‐Hsin Lin, Yen‐Po Wang","doi":"10.1002/aid2.13396","DOIUrl":"https://doi.org/10.1002/aid2.13396","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual rectal polyp","authors":"Chun-Chi Hsu,&nbsp;Yu-Chun Ma,&nbsp;Wen-Hung Hsu","doi":"10.1002/aid2.13397","DOIUrl":"10.1002/aid2.13397","url":null,"abstract":"<p>A 63-year-old female presented to our hospital for further management of a rectum lateral spreading lesion discovered by colonoscopy for fecal occult blood survey. Conventional white light colonoscopy showed type 0-IIa + IIb lesion over rectum (Figure 1A). Indigocamine chromoendoscopy showed an irregular mucosal surface pattern (Figure 1B). Subsequent magnifying colonoscopy with narrow-band imaging (NBI) revealed a focal avascular area with scant enlarged, dilated branch-like microvascular pattern on the lesion surface (Figure 1C). 12 MHz endoscopic ultrasound (EUS) showed thickening of mucosal layer (second layer) with preserved muscular propia layer (Figure 1D).</p><p>What is the diagnosis?</p><p>Biopsy specimen showed colon tissue with atypical lymphocytes proliferation above the lamina propria (Figure 2A–E). Immunohistochemical stain showed CK (scant lymphoepithelial lesions), CD138(−), MNDA focal positive, CD20(+), CD79a(+), and PAX-5(+). Mucosa-associated lymphoid tissue lymphoma (MALToma) is diagnosed.</p><p>Primary gastrointestinal non-Hodgkin lymphoma is most often located in the stomach. The large intestine MALToma is rare.<span>¹</span> Primary colorectal lymphoma accounts for approximal 10% of gastrointestinal lymphoma and 0.2% of colorectal malignancy.<span>²</span> The gross morphology of colorectal lymphoma could be polyposis, subepithelial tumor, epithelial mass, and ulcerated type under white light endoscopy.<span>³</span> However, flatten type may mimic lateral spreading tumor and be confused with sessile serrated lesion. Image-enhanced colonoscopy was useful for observed microstructure of flatten lesion. Tree-like-appearance blood vessels observed on magnified NBI have been mentioned in colon MALT lymphoma.<span>⁴</span> In this case, Indogocarmine chromoendoscopy showed irregular mucosal surface pattern, not correlated with EUS finding. NBI magnifying colonoscopy showed Japan NBI Expert Team classification type 3 with branch-like microvascular pattern was the high spot and gave us the hint of colon MALToma.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was obtained from the patient to publish this article and images.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716979","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 rare manifestation presenting as acute pancreatitis of thrombotic thrombocytopenic purpura","authors":"Han‐Yun Wang, Sheng‐Fu Wang","doi":"10.1002/aid2.13395","DOIUrl":"https://doi.org/10.1002/aid2.13395","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TTP) is an unusual disease with a 90% mortality rate without prompt management. The typical clinical manifestations include thrombocytopenia, hemolytic anemia, neurological symptoms, fever, and renal impairment. However, recognizing TTP in its early stages is not always easy due to limited clinical experience and sometimes atypical presentation. We report a 44‐year‐old male who initially suffered from jaundice and skin purpura, followed by epigastric pain. Acute pancreatitis was first suspected after a computerized tomography (CT) scan in the local medical department, without a definite etiology. He was then transferred to our hospital for further investigation of hemolysis. Transient neurological symptoms occurred 1 week after transferring. TTP was later confirmed based on schistocytes noted in peripheral blood smear and ADAMTS‐13 activity = 0%. The patient was discharged successfully after prompt therapeutic plasma exchange and steroid treatment. We present the first case of TTP inducing acute pancreatitis in Asia and remind that acute pancreatitis is a possible cause of abdominal pain, although it's a rare manifestation of TTP.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140733153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}