American Journal of Gastroenterology最新文献

{"title":"HE guidelines in practice.","authors":"Sofia S Jakab, Nancy Reau, Jasmohan S Bajaj","doi":"10.14309/ajg.0000000000004206","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004206","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes After Endoscopic Resection for pMM/SM1 Esophageal Cancer: A Multicenter Prospective Cohort Study.","authors":"Ryu Ishihara, Hiroaki Takahashi, Seiichiro Abe, Toshiyuki Yoshio, Tomonori Yano, Yugo Suzuki, Katsunori Matsueda, Yoichiro Ono, Yoshinobu Yamamoto, Hiroyuki Ono, Noboru Kawata, Waku Hatta, Akiko Takahashi, Ichiro Oda, Yuji Amano, Hideki Ishikawa, Tsuneo Oyama","doi":"10.14309/ajg.0000000000004209","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004209","url":null,"abstract":"<p><strong>Background aims: </strong>The optimal management of esophageal cancer with muscularis mucosae or shallow submucosal invasion (post-endoscopic resection [ER] pMM/SM1 cancer) remains controversial. Evidence is largely retrospective, and prospective data are lacking.</p><p><strong>Methods: </strong>This study enrolled patients with squamous cell carcinoma (SCC) or esophageal adenocarcinoma (EAC) diagnosed as post-ER pMM/SM1 cancer. Outcomes included overall survival, metastatic recurrence, local recurrence, and second primary esophageal cancer.</p><p><strong>Results: </strong>Overall, 385 patients were enrolled, including 315 with SCC and 70 with EAC. Five-year overall survival was 92.3% (95% Confidence interval [CI], 88.8%-94.8%) for SCC and 94.2% (95% CI, 85.4%-97.8%) for EAC. Among post-ER lymphovascular invasion (LVI)-negative patients managed without additional treatment, 5-year survival rates were 94.0% (95% CI, 90.2%-96.4%) for SCC and 93.3% (95% CI, 83.5%-97.5%) for EAC. Cumulative metastatic recurrence rates for LVI-negative SCC were 6.3% (95% CI, 3.0%-12.6%) for pMM and 10.5% (95% CI, 2.6%-33.7%) for pSM1 disease, whereas corresponding rates for EAC were 2.2% (95% CI, 0.3%-13.9%) and 0.0% (95% CI could not be calculated). In LVI-negative SCC, lesion size and macroscopic appearance were independent predictors of metastatic recurrence: type 0-II lesions ≤30 mm had a low cumulative metastatic recurrence rate of 2.9% (95%CI, 1.1%-7.5%). The 5-year cumulative incidence of second primary esophageal cancer was 25.8% for SCC and 3.6% for EAC.</p><p><strong>Conclusions: </strong>Post-ER pMM/SM1 esophageal cancer is associated with excellent long-term survival. Surveillance is a reasonable option for many LVI-negative cases, although additional treatment may be considered for selected higher-risk patients.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline characteristics of a prospective, multi-center study on the natural history of compensated cirrhosis: the Liver Cirrhosis Network.","authors":"Kara Wegermann, Abigail R Smith, Srinivasan Dasarathy, Nicole Welch, Elizabeth C Verna, Robert S Brown, Cynthia A Moylan, Patrick Kamath, Vijay H Shah, Elliott B Tapper, Patricia D Jones, Rohit C Loomba, Claude Sirlin, Bilal Hameed, Andrew Stolz, Arun J Sanyal, Jasmohan S Bajaj, Daniela P Ladner, Mandana Khalili, Norah A Terrault, Neehar D Parikh, David Goldberg","doi":"10.14309/ajg.0000000000004211","DOIUrl":"10.14309/ajg.0000000000004211","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Prediction of Clinically Significant Portal Hypertension in Hepatocellular Carcinoma: A Tumor-Adjusted Model.","authors":"Coskun O Demirtas, Catherine Mezzacappa, Riccardo Sartoris, Pierre-Emmanuel Rautou, Mario Romero-Cristóbal, Rafael Bañares, Cosmina Sutac, Bogdan Procopet, Manon Allaire, Dominique Thabut, Elba Llop, Juan C García-Pagan, Muthukumarassamy Rajakannu, Eric Vibert, Tamar Taddei, Guadalupe Garcia-Tsao","doi":"10.14309/ajg.0000000000004204","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004204","url":null,"abstract":"<p><strong>Introduction: </strong>Noninvasive assessment of clinically significant portal hypertension (CSPH) using liver stiffness measurement (LSM) and platelet count (per Baveno VII criteria) may be influenced by tumor-related factors in patients with hepatocellular carcinoma (HCC). We evaluated the relationship between LSM and hepatic venous pressure gradient (HVPG) and developed a tumor-adjusted model for CSPH prediction in HCC.</p><p><strong>Methods: </strong>In this multicenter study, 452 patients with compensated cirrhosis and HCC who underwent LSM and HVPG within three months were retrospectively analyzed. The correlation between LSM and HVPG was assessed, including stratification by tumor characteristics. A tumor-adjusted predictive model (Baveno-HCC) was developed in a derivation cohort (n=316) and validated in a separate cohort (n=136).</p><p><strong>Results: </strong>LSM correlated moderately with HVPG (r=0.593, p<0.001), with reduced accuracy in patients with large (>5 cm) right-lobe tumors. Baveno VII criteria maintained high sensitivity and negative predictive value (>90%) for ruling out CSPH but showed limited rule-in performance, particularly in patients with larger tumors. The Baveno-HCC model, incorporating LSM, platelet count, spleen size, and tumor burden, improved rule-in performance with higher positive predictive value (PPV) while preserving rule-out accuracy. Improvements were most pronounced in patients with tumor burden >5 cm, with PPV increasing from 46.2% to 84.6% in the derivation cohort and from 56.3% to 100.0% in the validation cohort.</p><p><strong>Discussion: </strong>Tumor burden and location affect LSM-based CSPH assessment. The proposed Baveno-HCC model improves CSPH prediction and supports more accurate risk stratification and clinical decision-making in patients with HCC.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering Surveillance in Non-dysplastic Barrett's Esophagus: When Doing Less Is the Right Choice.","authors":"Sachin Srinivasan, Prateek Sharma","doi":"10.14309/ajg.0000000000004203","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004203","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Data from a Large, Multi-Target Stool DNA Colorectal Cancer Screening Program.","authors":"Sushil Kumar Garg, Carley F Hintz, Hannah J Kolarik, Brayden Mau, Jeffery Hubers, Victor Arce, Derek W Ebner, Suryakanth R Gurudu, Yan Bi, Jason Greenwood, John B Kisiel, Rajeev Chaudhary","doi":"10.14309/ajg.0000000000004196","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004196","url":null,"abstract":"<p><strong>Background aims: </strong>Multi-target stool DNA (mt-sDNA) is an established stool-based colorectal cancer screening test, yet long-term performance is not well-described. We evaluated follow-up colonoscopy rates & quality, neoplasia yield, and repeat-testing adherence over 10 years with an integrated screening program.</p><p><strong>Methods: </strong>We assembled a retrospective cohort of mt-sDNA tests (September 2014-July 2025) within a multi-site health system. A validated large-language-model pipeline extracted colonoscopy, pathology, and quality endpoints from free-text reports. Detection outcomes (adenoma detection rate, advanced neoplasia, modified advanced adenoma, sessile serrated lesion (SSL), and negative exams) were calculated among high-quality exams; adenocarcinoma, bowel preparation adequacy, and cecal intubation rate (CIR) used all screening exams. We assessed colonoscopy completion ≤1 year after positive mt-sDNA, follow-up colonoscopy findings, findings by time-to-colonoscopy, and adherence to repeat mt-sDNA after negative result.</p><p><strong>Results: </strong>Among 148,624 tests in 110,410 individuals, positivity was 13.6%. Of 19,506 positives, 65.1% completed colonoscopy within 12 months (median 82 days). Colonoscopy after a positive mt-sDNA had high yield: advanced adenoma diagnosis was 30.7%; adenocarcinoma was 1.3%. Of patients who had colonoscopy within 3 years of a negative mt-sDNA test, 45.2% had adenoma/serrated lesion, 9.3% had advanced adenoma and 0.5% had colon cancer.Adenoma detection rate after positive mt-sDNA (>50%) exceeded specialty society quality benchmarks and increased over time; Longer intervals (>6 months) to colonoscopy after a positive test were associated with higher advanced adenoma (trend P=0.001).After an initial negative mt-sDNA, only 35.3% were screened again by mt-sDNA testing within 3 years.</p><p><strong>Conclusions: </strong>Over a decade,mt-sDNA screening achieved high colonoscopy qualitybut revealed critical gaps in the care cascade. One-third of positive tests lacked timely follow-up and nearly two-thirds of negative tests were not repeated on schedule, suggesting opportunities for system-level interventions.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Baseline Synchronous Adenoma Burden on the Risk of Metachronous Advanced Neoplasia.","authors":"Wei-Yuan Chang, Li-Chun Chang, Chu-Kuang Chou, Cheng-Hao Tseng, Chi-Yang Chang, Chi-Yi Chen, Wen-Feng Hsu, Yen-Nien Chen, Chieh-Chang Chen, Chia-Hung Tu, Mei-Jyh Chen, Ching-Tai Lee, Po-Yueh Chen, Ming-Shiang Wu, Han-Mo Chiu","doi":"10.14309/ajg.0000000000004197","DOIUrl":"10.14309/ajg.0000000000004197","url":null,"abstract":"<p><strong>Introduction: </strong>and study aim: Individuals classified as high-risk at initial colonoscopy face an elevated risk of metachronous advanced colorectal neoplasms (meta-ACRN), but risk heterogeneity within this group remains unclear. We aimed to stratify meta-ACRN risk among high-risk individuals based on their synchronous neoplastic burden.</p><p><strong>Methods: </strong>This prospective cohort study used data from a Taiwanese multicenter trial (NCT03373136). We included participants with conventional high-risk findings (3-10 low-risk adenomas [LRAs] or any high-risk adenoma [HRA]). The primary outcome was meta-ACRN incidence. Adjusted incidence rate ratios (aIRRs) were calculated using multivariable Poisson regression, stratifying patients by baseline synchronous burden, with the 3-4 LRAs group as reference.</p><p><strong>Results: </strong>Among 730 participants undergoing surveillance (mean follow-up 2.4 years), 81 (11.1%) developed meta-ACRN. A single HRA did not significantly increase meta-ACRN risk compared with 3-4 LRAs (aIRR 2.02; 95% confidence interval (CI) 0.83-4.90). However, risk escalated significantly when the index HRA was accompanied by synchronous LRA(s) (aIRR 2.56; 95% CI 1.24-5.39) or synchronous HRA(s) (aIRR 3.93; 95% CI 1.77-8.73) ( P for trend = 0.001). Furthermore, applying a more severe modified advanced adenoma criteria, an identical dose-response pattern emerged, culminating in a >5-fold increased risk of severe metachronous outcomes (aIRR 5.23; 95% CI 1.50-18.22) when accompanied by synchronous HRA(s).</p><p><strong>Discussion: </strong>Meta-ACRN risk within the conventional high-risk population is highly heterogeneous and driven primarily by baseline synchronous neoplastic burden. Surveillance intervals should be personalized, reserving shorter intervals for patients with advanced lesions accompanied by synchronous adenomas.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescuing the Unretrievable: A W(hole) New Approach for an Embedded Biliary Stent.","authors":"Sanil Parekh, Amit Maydeo, Sehajad Vora, Nagesh Kamat, Biswa Ranjan Patra, Sidharth Harindranath, Priyansh Bhayani","doi":"10.14309/ajg.0000000000004199","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004199","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Nutrition Into Gastroenterology Practice: A Practical Guide for Clinicians.","authors":"Jennifer Katz","doi":"10.14309/ajg.0000000000004200","DOIUrl":"10.14309/ajg.0000000000004200","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuing Medical Education Questions: September 2026.","authors":"Sean Bhalla","doi":"10.14309/ajg.0000000000004161","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004161","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 9","pages":"2085"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}