World J Radiol
· 2026 Jun · PMID 42395102
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BACKGROUND: While next-generation dual-energy computed tomography (DECT) has demonstrated utility for fat quantification in various clinical applications, its potential to characterize intestinal creeping fat (CrF) and t...BACKGROUND: While next-generation dual-energy computed tomography (DECT) has demonstrated utility for fat quantification in various clinical applications, its potential to characterize intestinal creeping fat (CrF) and to correlate these imaging finding with specific molecular pathways in Crohn's disease (CD) remains poorly studied. AIM: To assess the value of DECT with the material decomposition (MMD) algorithm in quantifying CrF in patients with CD, and to explore the impact of CrF on intestinal inflammation, fibrosis, adipogenesis, and expression of mucosal barrier-related genes. METHODS: Patients with active or quiescent CD and healthy controls were included for clinical, endoscopic, and DECT imaging assessments. The MMD algorithm was used to quantify CrF. Inflammatory and fibrotic changes were scored histologically. Expression of tumor necrosis factor-α, transforming growth factor-β, peroxisome proliferator-activated receptor gamma 2, and occludin was measured by immunohistochemistry and quantitative real-time polymerase chain reaction. RESULTS: DECT provided high-quality images and allowed quantification of CrF. CrF volume was significantly higher in active CD patients than in healthy controls (104.67 ± 26.51 17.24 ± 5.16, < 0.05). In quiescent CD, CrF volume decreased compared with active CD (32.69 ± 11.42 104.67 ± 26.51, < 0.05) but remained above control levels ( < 0.05). These changes correlated strongly with clinical and pathological indicators, including CDAI ( = 0.927), endoscopic score ( = 0.904), histologic inflammation score ( = 0.917), and fibrosis score ( = 0.932). Furthermore, CrF volume was positively correlated with peroxisome proliferator-activated receptor gamma 2 expression ( = 0.917) and negatively correlated with occludin expression ( = -0.926). CONCLUSION: DECT with the MMD algorithm can effectively quantify intestinal CrF in CD. The quantified CrF correlates well with clinical, endoscopic, histopathological, and molecular indicators of disease activity and intestinal barrier dysfunction. This approach may serve as a useful noninvasive tool for assessing CD.
Alcohol use disorder (AUD) can progress to alcohol-associated liver disease (ALD), yet early-stage ALD (eALD) remains poorly defined at the molecular level. We performed plasma proteomic and peptidomic analysis in 42 adu...Alcohol use disorder (AUD) can progress to alcohol-associated liver disease (ALD), yet early-stage ALD (eALD) remains poorly defined at the molecular level. We performed plasma proteomic and peptidomic analysis in 42 adults (AUD = 10, eALD = 26, healthy volunteers = 6) using LC-MS/MS and pathway enrichment. Individuals with eALD exhibited greater alcohol burden, elevated liver injury markers (AST and ALT), and increased gut-immune dysfunction markers, including lipopolysaccharide, TNF-α, and K18M65, compared with AUD. Proteomic profiling identified 23 dysregulated peptides, with fibrinogen alpha (FIBA), fibrinogen beta (FIBB), COL1A1, and ITIH4 as key candidates. FIBB and COL1A1 were associated with AST, while FIBA and COL1A1 distinguished eALD from AUD. These findings identify circulating peptide biomarkers reflecting gut-immune-liver axis dysfunction and support their potential utility for non-invasive detection of early alcohol-associated liver disease.
Jaho J, Balilaj L, Bulla A
… +3 more, Capraro Y, Lamfu L, Baiocchi L
World J Virol
· 2026 Jun · PMID 42395040
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BACKGROUND: Hepatitis B virus remains an important occupational risk for healthcare trainees. Objective serology can verify protection and inform pre-placement clearance policies. AIM: To assess hepatitis B vaccination s...BACKGROUND: Hepatitis B virus remains an important occupational risk for healthcare trainees. Objective serology can verify protection and inform pre-placement clearance policies. AIM: To assess hepatitis B vaccination status, occupational exposure, and serological protection among health sciences students in Albania. METHODS: Cross-sectional study (April-June 2024) at the University of Vlore. Students completed a structured questionnaire ( = 152); a consenting subset provided blood samples for hepatitis B surface antigen and anti-hepatitis B surface antibody (HBs) testing ( = 134). Group comparisons used /Fisher's exact tests and multivariable logistic regression for seroprotection (anti-HBs ≥ 10 IU/L). RESULTS: All tested participants were hepatitis B surface antigen negative ( = 134). Overall, 86.6% had protective anti-HBs (≥ 10 IU/L), including 76.2% with titers > 100 IU/L; 13.4% had anti-HBs < 10 IU/L. Needlestick/sharps injuries were reported during training, supporting the need for standardized clearance and reporting pathways. CONCLUSION: Most students had serological protection, but a meaningful minority lacked protective titers. Universities and training sites should implement pre-placement HB clearance with documented vaccination, mandatory anti-HBs testing, and structured catch-up/booster pathways.
Bandara D, Joshi K, Singh C
… +3 more, Sohal A, Al-Qaisi M, Najafian N
World J Virol
· 2026 Jun · PMID 42395037
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Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) have emerged as increasingly important sources of morbidity among people living...Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) have emerged as increasingly important sources of morbidity among people living with human immunodeficiency virus (HIV). Advances in antiretroviral therapy have substantially improved life expectancy in people living with HIV (PLWH), but have also unmasked a growing burden of metabolic comorbidities which contribute to steatotic liver disease. Recent shifts in nomenclature and the introduction of MetALD emphasize metabolic dysfunction and graded alcohol exposure as central drivers of disease and are particularly relevant to PLWH, a population in whom overlapping metabolic and behavioral risk factors are common. Epidemiologic studies demonstrate that MASLD affects approximately one-third to one-half of PLWH worldwide, often occurring at younger ages and lower body mass index thresholds than in HIV-negative individuals. Emerging data further highlight the synergistic contribution of metabolic dysfunction and alcohol use to accelerated fibrosis progression in PLWH. Pathophysiologic mechanisms linking HIV infection to MASLD and MetALD include chronic immune activation and systemic inflammation, antiretroviral therapy-associated metabolic effects, altered adipose tissue distribution, gut-liver axis dysregulation, and alcohol-metabolic synergy. This review synthesizes contemporary evidence on the definitions, epidemiology, pathogenesis, clinical assessment, and management of MASLD and MetALD in PLWH.
Li X, Zhao Y, Liu N
… +5 more, Zhang Y, Liu R, Shan W, Zhang J, Chen T
J Ginseng Res
· 2026 Jul · PMID 42395019
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C.A. Meyer, a renowned medicinal herb, exerts many of its systemic effects through intricate interactions with the gut microbiota, a relationship that also addresses the challenge of its own limited oral bioavailability....C.A. Meyer, a renowned medicinal herb, exerts many of its systemic effects through intricate interactions with the gut microbiota, a relationship that also addresses the challenge of its own limited oral bioavailability. This review comprehensively examines the role of ginseng and its bioactive constituents in modulating gut microbiota and their subsequent influence on host health through key gut-organ axes. Based on an in-depth analysis of literature, we summarize how ginseng intervention is associated with a modulated gut microbial ecology-characterized by enriched beneficial taxa and suppressed pathogens-and is further linked to enhanced barrier integrity, regulated microbial metabolites, and reduced inflammation and oxidative stress. These mechanisms underlie its protective effects across multiple organ systems, including the gut-brain, gut-liver, gut-lung, gut-heart, and gut-kidney axes, ameliorating conditions such as cognitive decline, hepatic inflammation, pulmonary fibrosis, atherosclerosis, and renal injury. Clinical evidence further associates ginseng with improved metabolic and cognitive parameters correlated to microbial changes. We conclude that the therapeutic activity of ginseng appears to involve, and is likely modulated by, its prebiotic-like influence on the gut microbiota. However, the degree to which its efficacy is microbiota-dependent varies across different organ systems, as established by current evidence. Further mechanistic and clinical studies, particularly those employing causal models, are essential to definitively validate its potential in treating chronic diseases via microbiota-based strategies.
BACKGROUND AND AIMS: Underwater endoscopic mucosal resection (UEMR) has been widely adopted for the treatment of superficial nonampullary duodenal epithelial tumors (SNADETs). The aim of this study was to identify predic...BACKGROUND AND AIMS: Underwater endoscopic mucosal resection (UEMR) has been widely adopted for the treatment of superficial nonampullary duodenal epithelial tumors (SNADETs). The aim of this study was to identify predictors of local recurrence and piecemeal resection in UEMR for SNADETs. METHODS: This is a retrospective single-center study. Patients who underwent UEMR for SNADETs between November 2017 and October 2024 were included. We documented clinicopathologic characteristics of patients and lesions, noted procedure-related outcomes, and evaluated local recurrence. Kaplan-Meier analysis was used to assess recurrence-free survival, and logistic regression analysis was performed to identify the predictors of piecemeal resection. RESULTS: Among the 367 patients, the rate of piecemeal resection was 11.2%, and the rate of en bloc resection with histologically tumor-free horizontal and vertical margins (R0) was 65.1%. No intraoperative perforations occurred; intraoperative bleeding was observed in 1.9%. Kaplan-Meier analysis of recurrence-free survival showed significantly poorer outcomes in the piecemeal resection group than the en bloc resection group (log-rank test, < .001; Wilcoxon test, < .001). According to multivariate logistic regression analysis, each 1-mm increase in lesion size (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.11-1.31; < .001) and a flat macroscopic type (OR, 12.49; 95% CI, 1.45-107.98; = .02) were significant independent predictors of piecemeal resection. CONCLUSIONS: Piecemeal resection was a risk factor for local recurrence in UEMR for SNADETs. In addition, each 1-mm increase in lesion size and a flat macroscopic type were significant independent predictors of piecemeal resection.
BACKGROUND AND AIMS: Management of rectal neuroendocrine tumors (NETs) with positive/indeterminate vertical margins (VM1/VMX) after endoscopic resection (ER) remains unestablished. We aimed to evaluate the outcomes of su...BACKGROUND AND AIMS: Management of rectal neuroendocrine tumors (NETs) with positive/indeterminate vertical margins (VM1/VMX) after endoscopic resection (ER) remains unestablished. We aimed to evaluate the outcomes of subsequent ER for rectal NETs after initial ER with VM1/VMX. METHODS: We conducted a retrospective analysis of rectal NET cases undergoing subsequent ER at a high-volume center, where such cases were frequently referred and subsequent ER was the principal management strategy, except when the risk of metastasis was considered especially high. We assessed the presence of a residual tumor based on lesion characteristics as well as initial ER techniques and outcomes. Additionally, we assessed subsequent ER outcomes, including en bloc and R0 (en bloc with negative cut margins) resection and adverse events. For patients with follow-up longer than 1 year, we examined recurrence. RESULTS: Among 54 lesions in 51 patients undergoing subsequent ER, a residual tumor was found histologically in 20.4%, despite no endoscopic evidence of residual on the initial resection site. Subsequent ER, mainly endoscopic submucosal resection with a ligation device and endoscopic submucosal dissection, achieved en bloc resection in all and R0 resection in 10 of 11 residual cases without any adverse events. No recurrences were observed during a median follow-up period of 40 months. CONCLUSIONS: A residual tumor was present in a nonnegligible proportion of rectal NETs undergoing subsequent ER after initial ER with VM1/VMX. ER of residual rectal NET in patients with VM1/VMX was successful with no recurrence. Our findings suggest the potential usefulness of subsequent ER for these rectal NET cases.
BACKGROUND AND AIMS: In this study, we developed an artificial intelligence (AI) system to support the diagnosis of early gastric cancer using magnifying endoscopy with narrow-band imaging (NBI), with the goal of improvi...BACKGROUND AND AIMS: In this study, we developed an artificial intelligence (AI) system to support the diagnosis of early gastric cancer using magnifying endoscopy with narrow-band imaging (NBI), with the goal of improving the diagnostic accuracy of upper gastrointestinal endoscopy. This study aimed to evaluate the diagnostic performance of the AI-based system compared with endoscopists. METHODS: A total of 500 cases, including early gastric cancer and noncancer cases, were used to develop the diagnostic support AI system. We evaluated the AI system with models created using -fold cross-validation. We determined the diagnostic performance of the AI system and 10 endoscopists (5 experts and 5 nonexperts) for detecting early gastric cancer and compared the diagnostic performance between the AI system and endoscopists. Histopathologic diagnosis was used as the reference standard for cancerous lesions, while magnifying endoscopic diagnosis with high confidence served as the reference standard for noncancerous lesions. RESULTS: The median (interquartile range [IQR]) sensitivity for the AI system and all endoscopists was 100% (100%-100%) and 76.8% (65.5%-78.9%), respectively. The sensitivity of the AI system was significantly higher than that of the endoscopists ( = .002). The median (IQR) specificity for the AI system and all endoscopists was 100% (99.0%-100%) and 86.0% (72.0%-91.8%), respectively. The specificity of the AI system was also significantly higher ( = .01). CONCLUSIONS: This study demonstrates the feasibility of applying the diagnostic support AI system during magnified observation with NBI and suggests that it could enhance the diagnostic accuracy of upper gastrointestinal endoscopy for early gastric cancer.
Bouveret syndrome is a rare form of gastric outlet obstruction resulting from gallstone migration through a bilioenteric fistula. Fewer than 300 cases have been reported in the literature, to our knowledge. We present th...Bouveret syndrome is a rare form of gastric outlet obstruction resulting from gallstone migration through a bilioenteric fistula. Fewer than 300 cases have been reported in the literature, to our knowledge. We present the case of a 68-year-old man with severe postprandial pain, recurrent vomiting, and significant weight loss. Laboratory tests revealed severe anemia, metabolic acidosis, and acute kidney injury. Imaging and upper endoscopy identified a large duodenal gallstone associated with a cholecystoduodenal fistula and ischemic gastric ulcers. The patient underwent endoscopic management with laser lithotripsy and fragment extraction, achieving complete resolution of the obstruction. This case highlights the feasibility and effectiveness of endoscopic therapy, particularly laser lithotripsy, as a minimally invasive alternative to surgery in patients with Bouveret syndrome who present with high surgical risk.
Mascarenhas Saraiva M, Mota J, Agudo B
… +19 more, Mendes F, Widmer J, Ribeiro T, Pinto da Costa A, Martins M, Almeida MJ, de la Iglesia D, Esteban C, Garcia de Paredes A, Moris M, de Carvalho MF, Lera M, Ferreira J, Vilas-Boas F, Moutinho-Ribeiro P, Lopes S, Gonzalez-Haba M, De Moura EG, Macedo G
BACKGROUND AND AIMS: Pancreatic cystic lesions (PCLs) are increasingly detected because of the widespread use of imaging techniques. Among them, mucinous PCLs carry a higher malignancy risk, with intraductal papillary mu...BACKGROUND AND AIMS: Pancreatic cystic lesions (PCLs) are increasingly detected because of the widespread use of imaging techniques. Among them, mucinous PCLs carry a higher malignancy risk, with intraductal papillary mucinous neoplasms (IPMNs) being the most frequent subtype. Accurate stratification based on the degree of dysplasia-low-grade dysplasia (LGD) versus high-grade dysplasia or carcinoma (HGD/C)-is essential to guide clinical management and avoid unnecessary surgical interventions. This study aimed to develop and evaluate a deep learning model for stratifying IPMNs into HGD/C and LGD using endoscopic ultrasound (EUS) images. METHODS: This multicenter study included EUS images collected from 5 centers across Spain, Brazil, and the United States. Ground truth classification of IPMNs was established through cytologic and biochemical analysis of cyst fluid, EUS-guided through-the-needle biopsy, or surgical specimens. A deep learning model was trained to distinguish LGD from HGD/C. Model performance was assessed on the basis of sensitivity, specificity, accuracy, and area under the precision-recall curve. RESULTS: A total of 51,046 EUS images were extracted from 30 examinations performed at 5 centers in Portugal, Spain, Brazil, and the United States. The model distinguished IPMNs with HGD/C from those with LGD with a sensitivity of 95.7%, a specificity of 88.7%, and an overall accuracy of 87.2%. The area under the receiver operating characteristic curve was 0.951. CONCLUSIONS: To our knowledge, this is one of the first studies to evaluate the potential of an artificial intelligence model for dysplasia grading of IPMNs. Prospective validation of our model is necessary to ensure clinical benefit.
BACKGROUND AND AIMS: Artificial intelligence (AI)-assisted colonoscopy for polyp detection is designed to improve colonoscopy quality. Although surveys have assessed staff gastroenterologists' attitudes toward AI, less i...BACKGROUND AND AIMS: Artificial intelligence (AI)-assisted colonoscopy for polyp detection is designed to improve colonoscopy quality. Although surveys have assessed staff gastroenterologists' attitudes toward AI, less is known about the views of gastroenterology (GE) fellows regarding AI during training. METHODS: We conducted a nationwide survey of GE fellows from August 2024 to November 2024 to assess (1) exposure to and experience with AI in fellowship, (2) perceptions of AI's impact on colonoscopy quality, and (3) attitudes toward implementing AI into training. The survey included Likert scale questions with branching logic to tailor questions based on AI availability at the fellows' institutions. RESULTS: A total of 126 fellows started the survey, and 88 (69.8%) completed it. AI was available at least at 1 training site for 69.3% of respondents. In addition, 81.8% of fellows believed AI should be available during fellowship. Many fellows (43.2%) thought AI should be incorporated in the second year of training. Most fellows (60.7%) believed early exposure to AI-enhanced polyp detection skills. However, 52.5% felt neutral that AI made them better endoscopists overall. Despite this, 62.5% preferred to pursue a job with AI if they had trained with it. CONCLUSIONS: Our nationwide survey found that GE fellows are generally supportive of integrating AI into their training, with most advocating for its incorporation in the second year. These results should be considered by fellowship program leadership and GE practices recruiting fellows trained with AI. Further studies are required to assess the impact of training GE fellows with AI on their polyp detection competency.
BACKGROUND AND AIMS: Traditional endoscopic self-expandable metal stent (SEMS) placement necessitates fluoroscopy guidance when treating gastrointestinal obstruction. This study was performed to report the safety and eff...BACKGROUND AND AIMS: Traditional endoscopic self-expandable metal stent (SEMS) placement necessitates fluoroscopy guidance when treating gastrointestinal obstruction. This study was performed to report the safety and efficacy of radiation-free peroral cholangioscopy-guided SEMS placement in the treatment of 2 cases with gastrointestinal obstruction. METHODS: This study included 2 patients with gastrointestinal obstruction due to cholangiocarcinoma and sigmoid colon cancer. Peroral cholangioscopy was applied for radiation-free guidewire insertion and SEMS placement. RESULTS: The guidewire insertion and SEMS placement were successfully accomplished by radiation-free peroral cholangioscopy in both cases. It resulted in significant relief of gastrointestinal obstruction symptoms. In addition, no adverse events such as bleeding or perforation were observed intraoperatively and postoperatively. CONCLUSIONS: Radiation-free peroral cholangioscopy may safely and effectively assist SEMS placement to relieve the symptoms of obstruction caused by gastrointestinal tumors.
BACKGROUND AND AIMS: This study surveyed Canadian inflammatory bowel disease (IBD) specialists to understand their perceptions, preferences, and practices regarding image-enhancement modalities (including dye-spray chrom...BACKGROUND AND AIMS: This study surveyed Canadian inflammatory bowel disease (IBD) specialists to understand their perceptions, preferences, and practices regarding image-enhancement modalities (including dye-spray chromoendoscopy [DCE], virtual chromoendoscopy [VCE], and artificial intelligence [AI]-aided endoscopy) for colorectal neoplasia (CRN) detection in IBD, to inform future studies and recommendations. METHODS: Developed collaboratively by IBD experts and methodologists, the survey assessed physicians' attitudes toward colonoscopy image-enhancement modalities for CRN surveillance in IBD, evaluating 5 domains: current practices, familiarity with advanced techniques, perceptions of AI-assisted endoscopy, barriers to adoption, and research priorities. It was distributed to IBD specialists affiliated with the Canadian IBD Research Consortium and conducted per The Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS: Of 82 specialists invited, 33 responded (40.2%). Most worked in academic centers (90%); 39.4% managed large IBD practices. VCE was the most used advanced imaging modality (84.8%), followed by DCE (33.3%), high-definition white-light endoscopy (HD-WLE) plus nontargeted biopsies (33.3%), AI-assisted colonoscopy (18.2%), and HD-WLE alone (6.1%). Although 60.6% considered DCE and VCE similarly effective, drawbacks included bowel preparation (VCE: 26.6%; DCE: 24.1%) and poor visualization with inflammation (VCE: 26.6%; DCE: 12%). AI-assisted colonoscopy was seen as promising for CRN detection; 78.8% agreed randomized controlled trials are needed, and 39.4% would adopt AI if it improved CRN detection by 5% over HD-WLE. CONCLUSIONS: This survey highlights a shift toward VCE over DCE, perceived drawbacks of chromoendoscopy, limited availability and uncertainty about AI-assisted colonoscopy, and a desire for research to demonstrate AI's utility for CRN detection in IBD.
BACKGROUND AND AIMS: After Roux-en-Y gastric bypass (RYGB), accessing the excluded or remnant stomach (RS) is difficult using standard endoscopy, and double-balloon enteroscopy (DBE) is often used when pathology is suspe...BACKGROUND AND AIMS: After Roux-en-Y gastric bypass (RYGB), accessing the excluded or remnant stomach (RS) is difficult using standard endoscopy, and double-balloon enteroscopy (DBE) is often used when pathology is suspected. Data on the use of DBE for this purpose are limited. We investigated the success rate, technical factors, and findings when using DBE to access the RS after RYGB. METHODS: This was a retrospective analysis of adult patients with RYGB who underwent DBE to access the RS between January 2018 and July 2023 across 3 academic medical centers. Primary aims were identifying the technical success rate of accessing the RS and associated endoscopic findings. Secondary aims were identifying patient characteristics, procedure indications, factors behind technical failures, studies preceding DBE, endoscopic therapies performed, and procedural adverse events. RESULTS: Eighty-nine patients underwent DBE to access the RS after RYGB for anemia/bleeding (56.2%), abdominal pain (32.6%), and abnormal imaging (44.9%). The RS was successfully accessed in 71.9% of cases. The most common reasons the RS was not accessed were proximal pathology (40%), anastomotic angulation (32%), and limb length (16%). Many (40.4%) examination results were normal. The most common findings were inflammatory (30.3%) or vascular (15.7%), 6.7% had polyps, and 5.6% had malignant neoplasm. Biopsy (50.6%) and hemostatic maneuvers (20.2%) were commonly performed. Accessing the RS was not associated with patient age, procedural indication, or time from RYGB. DBE served as definitive management in 29.2% of cases, and no procedural adverse events occurred. CONCLUSIONS: The RS in RYGB can be successfully and safely accessed with DBE.