Digestion[JOURNAL]
Sun
200 papers
Directional Bias in Polyp Detection during Colonoscopy: A Prospective Observational Study.
Katagiri A, Mizuno S, Mori D … +12 more , Onishi Y, Yamazaki Y, Higuchi K, Suzuki N, Kikuchi K, Nakatani S, Fujiwara T, Inoki K, Konda K, Tojo M, Wakamura K, Yoshida H
Digestion · 2026 Jul · PMID 42384580 · Publisher ↗
INTRODUCTION: Colonoscopy is essential for colorectal cancer prevention, yet a proportion of lesions remain undetected, contributing to interval cancers. Although adjunctive technologies can improve adenoma detection, th...
INTRODUCTION: Colonoscopy is essential for colorectal cancer prevention, yet a proportion of lesions remain undetected, contributing to interval cancers. Although adjunctive technologies can improve adenoma detection, the role of inherent visibility differences across the endoscopic field has not been fully clarified. This study evaluated whether polyp detection varies according to the short-axis direction of the colonic lumen (SADCO) during colonoscopic withdrawal. METHODS: In this prospective observational study conducted at a tertiary center between June 2024 and February 2025, the short-axis direction of initial lesion visualization was recorded using the short-axis directional classification (SADCO). The primary outcome was the distribution of lesion detection between the upper-left direction (ULD) and lower-right direction (LRD). Subgroup analyses, multivariable logistic regression, and post hoc quadrant analysis were performed to assess factors associated with ULD detection. RESULTS: A total of 1,185 lesions from 432 patients were analyzed. Detection in the ULD was significantly lower than in the LRD (42.4% vs. 57.6%; p < 0.001), and this pattern was consistent across lesion size, bowel segment, macroscopic type, and endoscopist experience. Detection of advanced adenomas tended to be lower in the ULD (41.4% vs. 58.6%; p = 0.071), and detection of advanced neoplasia was significantly reduced (40.7% vs. 59.3%; p = 0.043). On multivariable analysis, a history of colonoscopy within 3 years was independently associated with increased ULD detection (p = 0.040). Quadrant analysis confirmed the lowest detection rate in the upper-left quadrant. CONCLUSION: Polyp detection during colonoscopic withdrawal demonstrates a consistent directional bias, with the ULD functioning as a region of relatively reduced detection frequency. Awareness of this intrinsic limitation and deliberate inspection of the ULD may help optimize visual inspection patterns during colonoscopy.
Prospective validation of magnified endoscopic examination with image-enhanced endoscopy as an optical biopsy for differentiating superficial duodenal epithelial tumor and non-neoplastic lesion in duodenum.
Nakayama A, Kubosawa Y, Minezaki D … +13 more , Morioka K, Iwata K, Miyazaki K, Masunaga T, Hayashi Y, Mizutani M, Akimoto T, Takatori Y, Matsuura N, Sujino T, Takabayashi K, Yahagi N, Kato M
Digestion · 2026 Jun · PMID 42371827 · Publisher ↗
INTRODUCTION: Superficial duodenal epithelial tumors (SDETs) and non-neoplastic lesions (NNLs) often appear similar on conventional endoscopy, complicating real-time differentiation and leading to frequent biopsies. Howe...
INTRODUCTION: Superficial duodenal epithelial tumors (SDETs) and non-neoplastic lesions (NNLs) often appear similar on conventional endoscopy, complicating real-time differentiation and leading to frequent biopsies. However, duodenal biopsy is invasive and may hinder subsequent endoscopic resection. We previously developed a diagnostic algorithm using magnified endoscopic examination with image-enhanced endoscopy (IEE-ME) to distinguish SDETs from NNLs. This study aimed to prospectively validate the diagnostic performance of this algorithm in clinical practice. METHODS: In this single-center prospective observational study, we evaluated an IEE-ME-based diagnostic algorithm for esophagogastroduodenoscopy. Lesions were classified according to predefined criteria, including superficial structure, white opaque substance, demarcation line, and enlarged marginal epithelium. Endoscopic diagnoses were made immediately by 11 endoscopists with varied experience, who were blinded to the final histopathological diagnoses. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS: Among 241 lesions analyzed, 84 and 157 were histologically diagnosed as SDETs and NNLs, respectively. The diagnostic algorithm demonstrated excellent performance, with a sensitivity of 97.6% (95% confidence interval [CI]: 91.7-99.7%), specificity of 95.5% (95% CI: 91.0-98.2%), PPV of 92.1% (95% CI: 85.0-96.0%), NPV of 98.7% (95% CI: 95.0-99.7%), and overall accuracy of 96.3% (95% CI: 93.0-98.3%). CONCLUSION: This prospective validation showed that IEE-ME, applied through a structured algorithm, enables highly accurate and non-invasive differentiation between SDETs and NNLs. Given its excellent NPV and accuracy, this approach may serve as an optical biopsy method that reduces the need for conventional biopsies in clinical practice.
Accurate imaging diagnosis of small pancreatic carcinoma/high-grade pancreatic intraepithelial neoplasia using combined indirect imaging findings.
Sagami R, Mizukami K, Nishikiori H … +20 more , Tsuji H, Sato T, Azuma Y, Hiroshima Y, Tsutsumi K, Fukuda M, Ozaka S, Fukuda K, Arakawa M, Iwao M, Ogawa R, Hirashita Y, Uchida T, Endo M, Kodama M, Horiguchi SI, Daa T, Satoh T, Honda K, Murakami K
Digestion · 2026 Jun · PMID 42340872 · Publisher ↗
INTRODUCTION: Early-stage pancreatic cancer (EPC), including high-grade pancreatic intraepithelial neoplasia (HG-PanIN) and pancreatic cancer ≤ 10 mm, has a favorable prognosis. Indirect imaging findings, such as main pa...
INTRODUCTION: Early-stage pancreatic cancer (EPC), including high-grade pancreatic intraepithelial neoplasia (HG-PanIN) and pancreatic cancer ≤ 10 mm, has a favorable prognosis. Indirect imaging findings, such as main pancreatic duct (MPD) irregularities, branch pancreatic duct (BPD) dilation, and focal pancreatic parenchymal atrophy (FPPA), may aid in diagnosis. This study aimed to evaluate their diagnostic performance and assess intermodality agreement. METHODS: Patients with an irregular MPD caliber were included. Indirect imaging findings, including MPD dilation/stenosis, BPD dilation, and FPPA, were evaluated. Positive findings were defined as those detected on computed tomography (CT) or magnetic resonance imaging (MRI). Concordance rates between modalities were also assessed. RESULTS: Among 49 patients (22 malignant [17 with HG-PanIN]), BPD dilation adjacent to an irregular MPD and FPPA were significantly associated with malignancy (P = .013 and .002, respectively) with moderate-to-substantial interobserver agreement. MPD stenosis with FPPA and the combination of all three findings showed the highest specificity (85.2%). The combination of BPD dilation and FPPA achieved the highest diagnostic accuracy (77.6%), although the accuracy based on FPPA alone did not significantly differ. Intermodality agreement ranged from moderate to almost perfect. CONCLUSION: FPPA was a significant indirect imaging finding for diagnosing EPC using CT, MRI, and endoscopic retrograde pancreatography, whereas BPD dilation around an irregular MPD caliber was associated with EPC only in univariate analysis. The combination of characteristic indirect imaging findings may improve diagnostic performance, particularly specificity. This imaging-based diagnostic approach may facilitate early detection of EPC.
Restoration of gut microbiota dysbiosis by a probiotic Lactobacillus paragasseri OLL2716 in patients being treated with low-dose aspirin and acid-suppressive agents.
Teramura E, Fujiwara S, Koga Y … +11 more , Matsushima M, Cho T, Itoh H, Hirose S, Nagata J, Yamamoto S, Imai J, Hozumi K, Takeda M, Kimura K, Suzuki T
Digestion · 2026 Jun · PMID 42334976 · Publisher ↗
Introduction Low-dose aspirin (LDA)-associated small intestinal injury has been suggested to be associated with gut microbiota dysbiosis. The probiotic Lactobacillus paragasseri OLL2716 (LG21) mitigates LDA-induced injur...
Introduction Low-dose aspirin (LDA)-associated small intestinal injury has been suggested to be associated with gut microbiota dysbiosis. The probiotic Lactobacillus paragasseri OLL2716 (LG21) mitigates LDA-induced injury; however, its mechanisms of action on gut microbiota remain unclear. Methods Participants were assigned to the control, acid-suppressive agents (ASAs)-, and ASAs+LDA-treated groups. All subjects consumed yogurt containing LG21 twice daily for 6 weeks. Ileal lavage and fecal microbiota were analyzed once (at the baseline), and twice (at the baseline and post-intervention), respectively. Results In ileal lavage at the baseline, the family Enterobacteriaceae showed a higher abundance in the ASAs+LDA group than in the control and ASAs groups. A tendency toward increased Enterobacteriaceae abundance was also observed in the feces of the ASAs group; however, it was completely restored to the levels comparable to the control group after LG21 treatment. At the baseline in the fecal microbiota, beta diversity differed significantly between the control and ASAs groups, and between the control and ASAs+LDA groups; whereas, no significant differences were observed among the groups after LG21 intervention. Increased Streptococcaceae and Bacteroidaceae abundances in the ASAs-treated groups at the baseline were also restored after LG21 intervention. Conclusion Increased Enterobacteriaceae abundance was found in both ileal lavage of the ASAs+LDA group and feces of the ASAs group. This increase in the abundance of potentially pathogenic bacteria was restored by a probiotic LG21 strain. These findings suggest that LG21 may modulate gut microbiota, particularly Enterobacteriaceae, which could be associated with its beneficial effects on LDA-induced small bowel injury.
Adverse Events after Colorectal Polypectomy in Patients with Amyloidosis: Risk Assessment Using Propensity Score Matching.
Sawaguchi H, Nagaya T, Nakajima T … +6 more , Okamura T, Iwaya M, Uehara T, Katoh N, Sekijima Y, Iwaya Y
Digestion · 2026 Jun · PMID 42328983 · Publisher ↗
INTRODUCTION: Amyloidosis may increase the risk of post-polypectomy bleeding due to mucosal and vascular fragility. We compared adverse events after colorectal polypectomy between patients with and without amyloidosis an...
INTRODUCTION: Amyloidosis may increase the risk of post-polypectomy bleeding due to mucosal and vascular fragility. We compared adverse events after colorectal polypectomy between patients with and without amyloidosis and explored risk factors for immediate post-polypectomy bleeding (IPPB). METHODS: This retrospective investigation included 21 amyloidosis patients (71 polyps) and 110 non-amyloidosis patients (298 polyps) who underwent cold snare polypectomy (CSP) or endoscopic mucosal resection (EMR) between 2005 and 2024. Propensity score matching compared IPPB, delayed bleeding, and perforation. In the matched cohort, risk factors for IPPB were evaluated using generalized estimating equation (GEE) logistic regression clustered by patient ID. In the amyloidosis group, histological predictors (amyloid deposition and location) were assessed, and receiver operating characteristic (ROC) analysis evaluated polyp size. RESULTS: IPPB occurred significantly more frequently in the amyloidosis group than in the matched non-amyloidosis group (p = 0.008). In multivariable GEE analysis, amyloidosis remained independently associated with IPPB (adjusted OR 3.20, 95% CI: 1.14-8.99; p = 0.027). In amyloidosis patients, muscularis mucosae deposition was associated with IPPB (p = 0.017); multivariate analysis suggested muscularis mucosae deposition (OR 6.55, 95% CI: 1.59-27.00; p = 0.009) and EMR (OR 8.26, 95% CI: 1.41-48.60; p = 0.020) as predictors. ROC analysis yielded an area under the ROC curve of 0.66 with a 6-mm cutoff. CONCLUSIONS: Amyloidosis was independently associated with increased IPPB risk after colorectal polypectomy. Muscularis mucosae deposition and EMR may help identify higher-risk lesions in amyloidosis, and CSP may be considered when feasible to reduce bleeding risk.
Prognostic effect of MES 1 inflammatory extent on remission maintenance in ulcerative colitis.
Kanazawa M, Tominaga K, Tanaka T … +9 more , Yamazaki Y, Kojimahara S, Masuyama S, Watanabe S, Yamamiya A, Sugaya T, Goda K, Haruyama Y, Irisawa A
Digestion · 2026 Jun · PMID 42284236 · Publisher ↗
INTRODUCTION: Ulcerative colitis (UC) is characterized by continuous inflammation extending from the rectum. Even mild inflammation can present prognostic implications when the disease is extensive. Mayo Endoscopic Score...
INTRODUCTION: Ulcerative colitis (UC) is characterized by continuous inflammation extending from the rectum. Even mild inflammation can present prognostic implications when the disease is extensive. Mayo Endoscopic Score (MES) 1 represents increased risk of relapse, hospitalization, and treatment modification, but it is based solely on inflammation intensity, incorporating consideration of neither extent nor localization. METHODS: Patients with UC in clinical remission with MES 0 or 1 at the initial endoscopic assessment after induction therapy were enrolled retrospectively and were followed for 2 years. Effects of the inflammation extent on remission maintenance were analyzed retrospectively for patients evaluated as MES 1. We investigated whether all MES 1 inflammation should be treated equally. RESULTS: For the 301 included patients, the remission maintenance rate was significantly higher in the MES 0 group than in the MES 1 group (88.9% vs. 67.3%, P < 0.001). Moreover, MES 1 patients with 1-2 inflamed segments had higher remission maintenance rates than those with 3-6 inflamed segments (78.4% vs. 45.6%, P < 0.001). A significantly higher remission maintenance rate was found for the MES 0 group than for the MES 1 group with 1-2 inflamed segments (88.9% vs. 78.4%, P = 0.037). No significant difference was found between rectal and non-rectal involvement (80.7% vs. 76.5%, P = 0.685). CONCLUSION: The remission maintenance rate decreases as the extent of MES 1 inflammation increases in patients in remission. Even mild but extensive inflammation may increase the risk of relapse. Treatment strategies should incorporate consideration of the inflammation extent.
Cold Sensation and Gastric Accommodation in Functional Dyspepsia: An Exploratory Study of Autonomic Function.
Mori H, Masaoka T, Matsuzaki J … +4 more , Sato M, Ando H, Yoshino T, Kanai T
Digestion · 2026 Jun · PMID 42275274 · Publisher ↗
BACKGROUND: Functional dyspepsia (FD) is a heterogeneous disorder characterized by impaired gastric accommodation and autonomic dysfunction as key pathophysiological features. Cold sensation (Hie), a commonly recognized...
BACKGROUND: Functional dyspepsia (FD) is a heterogeneous disorder characterized by impaired gastric accommodation and autonomic dysfunction as key pathophysiological features. Cold sensation (Hie), a commonly recognized subjective bodily sensation in East Asia, reflects autonomic instability. However, its association with gastric accommodation in FD remains unclear. METHODS: This single-center prospective observational study enrolled healthy volunteers and patients with FD. Cold sensation was assessed using a validated questionnaire. Gastric accommodation was evaluated using a standardized nutrient drink test, with drinking time as indices of postprandial tolerance. Autonomic nervous system activity was examined using heart rate variability during the test. RESULTS: Patients with FD had significantly shorter drinking times and lower completion rates than the healthy volunteers. In the combined cohort, cold sensation showed a weak inverse association with drinking time; however, this relationship did not reach statistical significance. In multivariable analysis adjusting for FD status and medication use, cold sensation was not independently associated with drinking time. Cold sensation was significantly inversely correlated with baseline coefficient of variation of R-R intervals, reflecting overall autonomic nervous system activity, but was not associated with nutrient load-induced autonomic responses. CONCLUSION: Cold sensation was more prevalent in patients with FD and was associated with reduced baseline autonomic activity. However, its association with gastric accommodation was attenuated after accounting for FD status, suggesting that cold sensation may represent a disease-related phenotype rather than an independent determinant of postprandial tolerance.
Fully automated detection of pancreaticobiliary maljunction based on 3D magnetic resonance cholangiopancreatography using deep learning.
Zhang X, Liu W, Chang Z … +2 more , Chai C, Lu W
Digestion · 2026 Jun · PMID 42263040 · Publisher ↗
INTRODUCTION: Pancreaticobiliary maljunction (PBM) is closely related to biliary tract cancer. The early detection of PBM is crucial but challenging. We aim to develop and validate a deep learning model for fully automat...
INTRODUCTION: Pancreaticobiliary maljunction (PBM) is closely related to biliary tract cancer. The early detection of PBM is crucial but challenging. We aim to develop and validate a deep learning model for fully automatically detection of PBM using magnetic resonance cholangiopancreatography (MRCP) images. METHODS: Clinical and imaging data from patients who underwent MRCP examinations from January 2020 to December 2021 were retrospectively collected. A total of 200 patients (100 with confirmed PBM and 100 non-PBM controls) were enrolled. The dataset was randomly divided into training, validation, and test sets in a 6:2:2 ratio. The training and validation sets were used to train YOLOv5 and Inception-ResNetV2. The test set was used to evaluate the accuracy of the model. RESULTS: The PBM group had a higher proportion of females (62% vs. 42%, P = .01) and biliary tract cancer (11% vs. 3%, P = .03) than controls. The optimal model achieved a mean absolute error (MAE) of 6.2% and an F1 score of 93.0%, with sensitivity, specificity, positive predictive value, and negative predictive value of 95.0%, 92.5%, 92.7%, and 94.9%, respectively. CONCLUSION: The proposed deep learning model demonstrates high accuracy in automated PBM detection on MRCP images, offering potential to improve diagnostic efficiency and reduce interobserver variability.
Comparative Effectiveness of Hangeshashinto and Ramosetron for the Treatment of Irritable Bowel Syndrome with Diarrhea.
Nishida K, Hirata Y, Murano M … +8 more , Mitooka H, Sugishima S, Nakazawa K, Koshiba R, Kakimoto K, Miyazaki T, Nakamura S, Nishikawa H
Digestion · 2026 Jun · PMID 42224387 · Publisher ↗
Background/Aims Evidence-based pharmacological options for irritable bowel syndrome with diarrhea (IBS-D) remain limited, and complementary approaches are of interest. We evaluated the real-world effectiveness of hangesh...
Background/Aims Evidence-based pharmacological options for irritable bowel syndrome with diarrhea (IBS-D) remain limited, and complementary approaches are of interest. We evaluated the real-world effectiveness of hangeshashinto (TJ-14), ramosetron, and their combination in patients with IBS-D or mixed-type IBS (IBS-M). METHODS This retrospective observational pilot study included 56 patients with IBS-D/IBS-M treated for 4 weeks with ramosetron (n=12), hangeshashinto (n=31), or combination therapy (n=13). Symptoms were assessed at baseline and week 4 using the Izumo scale. Within-group changes were examined using nonparametric tests. To address baseline imbalances, pairwise propensity score analyses were performed using Average Treatment effect on the Treated (ATT) weighting with weighted outcome regression adjusting for pretreatment Izumo scores and prespecified covariates. RESULTS All groups showed improvement in Izumo symptom scores over 4 weeks. In ATT-weighted analyses, follow-up Izumo scores were comparable between hangeshashinto and ramosetron (adjusted mean difference [Hangeshashinto - Ramosetron] -0.269, 95% CI -1.402 to 0.863). Combination therapy was associated with lower follow-up scores than ramosetron alone (adjusted mean difference [Combination - Ramosetron] -1.849, 95% CI -3.571 to -0.127), while the comparison with hangeshashinto alone did not reach statistical significance (adjusted mean difference [Combination - Hangeshashinto] -0.845, 95% CI -1.763 to 0.074). Higher pretreatment Izumo scores were independently associated with greater improvement. CONCLUSION In this exploratory real-world analysis, hangeshashinto showed short-term symptom improvement comparable to ramosetron, and adding hangeshashinto to ramosetron was associated with lower follow-up symptom scores than ramosetron monotherapy. Prospective studies are warranted to confirm comparative effectiveness and identify patients most likely to benefit.
Association between maternal and paternal history of chronic constipation and its development: A brief report.
Vu NTH, Quach DT, Miyauchi S … +7 more , Ishiuchi N, Yoshino A, Miyake Y, Okamoto Y, Kuwai T, Oka S, Hiyama T
Digestion · 2026 May · PMID 42213606 · Publisher ↗
INTRODUCTION: A family history of chronic constipation (CC) is considered an important predisposing factor for developing CC. This study aimed to compare the associations of maternal and paternal histories of CC with con...
INTRODUCTION: A family history of chronic constipation (CC) is considered an important predisposing factor for developing CC. This study aimed to compare the associations of maternal and paternal histories of CC with constipation in offspring. METHODS: Students at Hiroshima University completed a web-based health checkup questionnaire between April and June 2025. Data included baseline characteristics, lifestyle factors, family history of CC, Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26, and Bulimic Investigatory Test (BITE). CC was diagnosed using the Rome IV criteria. Multivariate logistic regression analysis was performed to identify associated factors. RESULTS: Among 5,518 participants, both maternal and paternal histories of CC were significantly associated with CC, showing similar strength of association (maternal: odds ratio [OR] = 3.47, 95% confidence interval [CI] = 2.82-4.27; paternal: OR = 3.41, 95% CI = 2.16-5.40; both p < 0.001). Other significant factors included higher EAT-26 score (OR: 4.27, 95% CI: 2.31-7.87, p<0.004), female sex (OR: 2.74, 95% CI: 2.28-3.28, p<0.001), lack of physical exercise (OR: 1.67, 95% CI: 1.40-1.98, p<0.001), and short sleep duration (OR: 1.45, 95% CI: 1.22-1.71, p=0.001). CONCLUSION: Both maternal and paternal histories of CC were similarly associated with CC. However, this association may be largely driven by unmeasured shared environmental factors and should be interpreted cautiously.
A Comprehensive Analysis of Prevalence, Risk Stratification, and Early Post-Procedure Predictive Scoring for Post-endoscopic Submucosal Dissection Coagulation Syndrome.
Ghoneem E, Yoshida N, Hirose R … +10 more , Kobayashi R, Iwai N, Inoue K, Dohi O, Konishi H, Itoh Y, Inagaki Y, Inada Y, Morinaga Y, Kojima M
Digestion · 2026 May · PMID 42166385 · Publisher ↗
BACKGROUND AND STUDY AIMS: Post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) is defined as abdominal pain with inflammatory responses, requiring careful differentiation from delayed perforation (DP)...
BACKGROUND AND STUDY AIMS: Post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) is defined as abdominal pain with inflammatory responses, requiring careful differentiation from delayed perforation (DP). This study aimed to evaluate clinical and biochemical characteristics associated with PECS and DP following ESD, and to develop a scoring system for predicting PECS. PATIENTS AND METHODS: We retrospectively analyzed 318 consecutive patients who underwent colorectal ESD at our institution between January 2022 and June 2024. Patients were classified into three groups: PECS (n=32), DP (n=7), and no-PECS/no-DP (NPD) (n=279). Multivariate analysis was performed to identify predictors of PECS for clinical factors and values such as C-reactive protein (CRP), white blood cell (WBC) count, and body temperature. Based on significant predictors, we constructed a five-variable PECS-predictive scoring system (FPSS) for early post-procedure prediction of PECS. RESULTS: Among 318 patients, the incidence of PECS and DP was 10.1% and 2.2%, respectively. DP cases demonstrated greater CRP elevation (p<0.001) and higher leukocytosis (p=0.011) compared with PECS, while PECS cases showed significantly higher WBC (p<0.001) and CRP (p<0.001) than the NPD group. Multivariate analysis identified five independent predictors of PECS: right colon (OR=3.54; p=0.004), female gender (OR=2.10; p=0.018), body temperature ≥37.6°C (OR=16.70; p<0.001), WBC >8,000/µL on day 1 (OR=13.78; p<0.001), and lesion size >24 mm (OR=3.03; p=0.003). The FPSS (range 0-9) achieved an AUC of 0.881, with high negative predictive value (97.4%). CONCLUSION: The characteristics of PECS were clarified in comparison with NPD and DP, and the newly developed FPSS demonstrated excellent diagnostic performance of PECS.
Association between antithrombotic drug management and bleeding during high-risk endoscopic procedures: A multi-center retrospective observational study.
Imai M, Aoki T, Niikura R … +21 more , Furukawa K, Toda N, Kim Y, Ogura K, Okamura T, Hasatani K, Yoshida N, Sumiyoshi T, Nishida T, Kiyotoki S, Arai M, Ikeda T, Motomura Y, Yamada S, Kurasawa M, Otsuka E, Iwata T, Komatsu K, Suzuki N, Hayakawa Y, Fujishiro M
Digestion · 2026 May · PMID 42154660 · Publisher ↗
BACKGROUND & AIMS: Optimal management of antithrombotic drugs (ATDs) is essential to minimize bleeding during high-risk endoscopic procedures. This study aimed to investigate peri-procedural ATD strategies to reduce 30-d...
BACKGROUND & AIMS: Optimal management of antithrombotic drugs (ATDs) is essential to minimize bleeding during high-risk endoscopic procedures. This study aimed to investigate peri-procedural ATD strategies to reduce 30-day post-procedural bleeding. METHODS: We performed a multicenter, retrospective cohort study on high-risk endoscopic procedures. The primary outcome was 30-day bleeding requiring endoscopic hemostasis. We categorized the peri-procedure management of ATDs into continuation, discontinuation, and replacement. We evaluated the risk differences in 30-day bleeding among ATD management groups, as compared to patients who did not take ATDs (nonusers). RESULTS: High-risk upper-GI procedures included 1365 esophageal ESDs, 788 elective EVLs, 5391 gastric ESDs, and 2562 PEGs; lower-GI procedures included 23326 colonic polypectomy/EMRs and 2769 colonic ESDs. ATDs management included aspirin continuation (n=818) and discontinuation (n=62); thienopyridine discontinuation (n=188) and replacement (n=97); warfarin continuation (n=97) and discontinuation (n=20); DOAC discontinuation (n=487). Thirty-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures. Bleeding risk differed according to antithrombotic drug management. In upper-GI procedures, numerically higher bleeding rates were observed in some antithrombotic management groups, particularly aspirin continuation and thienopyridine discontinuation during gastric ESD, compared with nonusers; however, the absolute risk differences were within 10%. In contrast, bleeding risk differences in lower-GI procedures were smaller overall and within 5%. CONCLUSIONS: This multicenter study describes differential bleeding risk patterns across high-risk endoscopic procedures among patients receiving antithrombotic therapy.
Family History and Clinical Severity of Functional Constipation: Sex-Stratified Findings From the FAMI-CON+ Multicenter Retrospective Study.
Oka A, Kozuka K, Matsuo K … +12 more , Okanobu H, Mouri R, Onogawa S, Tanaka S, Miwata T, Vu NTH, Quach DT, Kuwai T, Kobara H, Ishihara S, Oka S, Hiyama T
Digestion · 2026 May · PMID 42149790 · Publisher ↗
INTRODUCTION: Functional constipation (FC) is one of the most prevalent disorders of gut-brain interaction (DGBIs), associated with reduced quality of life and increased morbidity and mortality. Although several studies...
INTRODUCTION: Functional constipation (FC) is one of the most prevalent disorders of gut-brain interaction (DGBIs), associated with reduced quality of life and increased morbidity and mortality. Although several studies have examined risk factors in children, research focusing on adult populations is considerably limited. The present study investigated the association between family history and the clinical phenotype of FC using an adult cohort and a standardized constipation scoring system, building on prior population-based findings suggesting familial influences on disease prevalence and severity. METHODS: A retrospective multicenter study of adults diagnosed with FC according to the Rome IV criteria was conducted at 9 Japanese centers. Collected data included family history, demographic characteristics, age at symptom onset, modified Constipation Scoring System (mCSS) scores before and after treatment, and prescribed medications, with onset age and mCSS selected to evaluate potential familial associations with earlier disease onset and greater symptom severity. RESULTS: Data from 266 patients were analyzed. A family history was present in 30.1% of patients and was more common in women (34.5%) than in men (22.1%) (OR 1.86, 95% CI 1.04-3.31; p = 0.037). Among the women, a positive family history was associated with earlier onset (median 30 vs. 40 years, p = 0.043) and higher baseline mCSS scores (median 11 vs. 8, p = 0.039), whereas no significant associations were observed in men. Subscore analyses showed higher ratings for "feeling of incomplete evacuation" and "minutes in lavatory per attempt" in women with a family history. Although women with a family history required more medications, treatment response, as measured by improvement in mCSS, was comparable to those without such history. CONCLUSION: Family history is associated with sex-specific differences in the clinical presentation of FC. This pattern may reflect interactions between genetic susceptibility, hormonal factors, and shared familial environments.
Body mass index and mucosal healing in Japanese patients with ulcerative colitis: A cross-sectional study.
Hanayama M, Furukawa S, Miyake T … +16 more , Yoshida O, Nakaguchi H, Kanamoto A, Miyazaki M, Murakami Y, Horiuchi K, Tange K, Kitahata S, Ninomiya T, Suzuki S, Ohashi K, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y
Digestion · 2026 May · PMID 42118697 · Publisher ↗
PURPOSE: Ulcerative colitis (UC) is a chronic inflammatory bowel disease, and obesity is thought to exacerbate disease activity via chronic low-grade inflammation and related metabolic and cytokine dysregulation. However...
PURPOSE: Ulcerative colitis (UC) is a chronic inflammatory bowel disease, and obesity is thought to exacerbate disease activity via chronic low-grade inflammation and related metabolic and cytokine dysregulation. However, evidence on the relationship between obesity and UC remains limited and inconsistent. As mucosal healing (MH) is an established therapeutic goal in UC, we aimed to investigate the association between body mass index (BMI) and MH in Japanese patients with UC. METHODS: This study included 292 Japanese UC patients. One endoscopist evaluated complete mucosal healing (CMH), defined as Mayo endoscopic sub-scores of 0. Underweight and obesity were defined as BMI <18.5 and ≥25 kg/m2, respectively. For detailed analysis, BMI was divided into quartiles: low: <19.70 kg/m2, lower-middle: 19.70-21.82 kg/m2, upper-middle: 21.83-24.60 kg/m2, and high: ≥24.61 kg/m2. Multivariable logistic regression models were used to adjust for potential confounders and to evaluate the associations of BMI categories with MH. RESULTS: The mean age, male ratio, CMH rate, and clinical remission rate were 50.3 years, 57.9%, 25.0%, and 59.6%, respectively. No clear association between underweight, normal weight, or obesity and CMH was observed; however, in the quartile analysis, the highest BMI was independently and positively associated with CMH in the younger group, but not in the older group (adjusted OR: 0.29, 95% CI: 0.07-0.97). CONCLUSION: BMI was independently and inversely associated with CMH in Japanese younger patients with UC, but this association was not observed in older patients.
Comparison of linked color imaging and narrow-band imaging for detection and miss rates during right-sided colonoscopy: a multicenter tandem randomized controlled trial.
Ono S, Yoshida N, Matsumoto M … +11 more , Hayasaka S, Inoue M, Inoue K, Tsuda M, Kobayashi R, Takagi R, Nishimura Y, Kato S, Yagi N, Sakamoto N, Kato M
Digestion · 2026 May · PMID 42113709 · Publisher ↗
INTRODUCTION: Right-sided lesions are frequently missed during colonoscopy, and the diagnostic performance of image-enhanced endoscopy (IEE) modalities remains debated. This multicenter randomized controlled trial compar...
INTRODUCTION: Right-sided lesions are frequently missed during colonoscopy, and the diagnostic performance of image-enhanced endoscopy (IEE) modalities remains debated. This multicenter randomized controlled trial compared linked color imaging (LCI) with second-generation narrow-band imaging (2G-NBI) for adenoma detection and miss rates in the right colon. METHODS: Patients undergoing colonoscopy at six centers in Japan between November 2020 and November 2023 were randomly assigned (1:1) to primary right-colon observation with LCI or 2G-NBI, followed by secondary white-light imaging (WLI). The primary outcome was adenoma detection rate (ADR) in the right-sided colon during primary IEE observation. Secondary outcomes included polyp detection rate (PDR) and miss rates of adenomas and polyps. RESULTS: A total of 1,528 patients were analyzed (LCI, n = 776; 2G-NBI, n = 752). ADR did not significantly differ between the LCI group and the 2G-NBI group (26.7% vs 23.4%, P = 0.14). PDR was also comparable (32.6% vs 28.9%, P = 0.12). However, secondary WLI identified fewer additional polyps after LCI than after 2G-NBI (12.4% vs 16.4%, P = 0.026). Per-lesion miss rates were significantly lower with LCI for both adenomas (19.9% vs 31.4%) and polyps (21.5% vs 31.9%) (both P < 0.001). Multivariable analyses confirmed the association between LCI and a reduced risk of missed lesions, with more pronounced associations observed in cases of poor bowel preparation, procedures by expert endoscopists, and observation times ≤70 seconds. CONCLUSION: Although ADR did not differ significantly between modalities, lower miss rates in the right-sided colon were observed with LCI.
Increased Extracolonic Cancer Incidence and Mortality in Patients with Serrated Polyposis Syndrome with a History of Colorectal Cancer: A Comparative Cohort Study.
Shimohara Y, Takigawa H, Urabe Y … +9 more , Kishida Y, Nagao A, Kitadai Y, Sako Y, Tanaka H, Yamashita K, Hiyama Y, Kuwai T, Oka S
Digestion · 2026 May · PMID 42096362 · Publisher ↗
INTRODUCTION: Serrated polyposis syndrome (SPS) is a high-risk factor for colorectal cancer (CRC); however, prognostic differences based on patient characteristics are poorly understood. This exploratory study investigat...
INTRODUCTION: Serrated polyposis syndrome (SPS) is a high-risk factor for colorectal cancer (CRC); however, prognostic differences based on patient characteristics are poorly understood. This exploratory study investigated the impact of concomitant or a history of CRC at the time of SPS diagnosis on long-term prognosis. METHODS: Of the 70 patients diagnosed with SPS between 2009 and 2023, 55 with a 1-year follow-up were included in this single-center retrospective cohort study. Patients with a history of CRC were assigned to the CRC (+) (n = 16) group and those without a history of CRC were assigned to the CRC (-) group (n = 39). We compared the baseline characteristics, surveillance findings, and long-term outcomes, including new extracolonic cancer incidence and overall survival, between the groups. RESULTS: The CRC (+) group had a significantly higher prevalence of personal history of other cancers (38% vs. 10%, p = 0.024) and family history of cancer (69% vs. 38%, p = 0.048). The incidence of new extracolonic cancers during follow-up after the diagnosis of SPS was significantly higher in the CRC (+) group (25%; 4/16) than in the CRC (-) group (3%; 1/39) (p = 0.012). Overall survival was also significantly poorer in the CRC (+) group (two deaths, 13%) than in the CRC (-) group (p = 0.044). CONCLUSION: A history of CRC in patients with SPS is associated with a higher incidence of new extracolonic cancer and poorer overall survival. These findings suggest that management strategies should extend beyond standard colorectal surveillance to comprehensive systemic monitoring. Therefore, the validation of these results in larger prospective cohorts is warranted.
Impact of Constipation on Quality of Life, Work Productivity, and Treatment Practices: Findings from the CONNECT Web-Based Survey.
Takagi T, Shin T, Yoneda S … +4 more , Higashikawa M, Shimada Y, Umeyama M, Ueno M
Digestion · 2026 Apr · PMID 42060565 · Full text
INTRODUCTION: Constipation is a common gastrointestinal disorder that negatively affects quality of life (QOL), work productivity, and long-term prognosis. The aim of this study was to examine the associations between co...
INTRODUCTION: Constipation is a common gastrointestinal disorder that negatively affects quality of life (QOL), work productivity, and long-term prognosis. The aim of this study was to examine the associations between constipation severity and Short Form-8 Health Survey (SF-8) and Work Productivity and Activity Impairment Questionnaire (WPAI) scores, as well as treatment status and patient preferences, through a large-scale survey of the general population. METHODS: A web-based questionnaire was administered to 2,300 Japanese adults with constipation symptoms using a large survey panel. The survey assessed the Constipation Scoring System (CSS), Bristol Stool Form Scale (BSFS), SF-8, WPAI, treatment status, and preferences for treatment methods. RESULTS: CSS scores showed significant negative correlations with the SF-8 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and significant positive correlations with WPAI scores (p < 0.05). Both SF-8 and WPAI scores differed significantly across BSFS categories, with normal stool forms associated with better outcomes (p < 0.05). Only 22.0% of participants received prescription medication for constipation. The most common reason for not seeking medical care was "inconvenience of visiting a medical institution" (65.6%). Regarding treatment preferences, 80.8% preferred tablet formulations, and once-daily administration at bedtime was the most favored dosing schedule (56.7%), followed by before breakfast (30.0%). CONCLUSION: Constipation severity and stool form are associated with QOL and work productivity, underscoring the importance of appropriate treatment strategies. Patient preference should also be considered when selecting therapeutic options.
Endoscopic Management of Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from Single-Balloon Enteroscopy.
Tanisaka Y, Ryozawa S, Mizuide M … +5 more , Fujita A, Ito S, Watanabe R, Hamamura R, Matsuno Y
Digestion · 2026 Apr · PMID 42048285 · Publisher ↗
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has long been established as a standard procedure with a high success rate and an acceptable incidence of adverse events. However, performing ERCP in pati...
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has long been established as a standard procedure with a high success rate and an acceptable incidence of adverse events. However, performing ERCP in patients with surgically altered anatomy remains technically challenging, not only because of the difficulty in accessing the target site but also in performing subsequent therapeutic interventions. To address these challenges, balloon enteroscopy (BE)-assisted ERCP has been introduced into clinical practice and has demonstrated both efficacy and safety. More recently, the short-type single-balloon enteroscopy (short SBE), with a working length of 152 cm and a 3.2-mm working channel, has been widely adopted, enhancing procedural efficiency. The short SBE allows the use of a wider range of accessories in various therapeutic interventions, such as stone extraction and self-expandable metallic stent placement. SUMMARY: This review provides a comprehensive overview of SBE-assisted ERCP, with a particular focus on short SBE. It summarizes reported procedural success and adverse event rates from previous studies and discusses factors associated with procedural failure. In addition, it highlights key technical tips, various procedural approaches using short SBE-assisted ERCP, and recent advances in relevant technologies and devices. KEY MESSAGES: Despite these advancements, multiple technical challenges still need to be overcome to successfully complete the procedure. Proficiency in alternative treatments, such as endoscopic ultrasound-guided biliary drainage (EUS-BD), is also essential. The decision between BE-assisted ERCP and EUS-BD should be individualized according to the type of postoperative reconstruction, the patient's clinical status, and, importantly, the endoscopist's experience level.
An Epidemiological Study on the Relationship between Gastric Mucosal Atrophy, Exhaled Hydrogen Concentration, and Gut Microbiota.
Sato S, Chinda D, Mikami K … +11 more , Tobinai M, Ishidoya N, Furusawa K, Miyashiro K, Yoshida K, Iino C, Sawada K, Mikami T, Nakaji S, Murashita K, Sakuraba H
Digestion · 2026 Apr · PMID 42048281 · Publisher ↗
INTRODUCTION: This study aimed to conduct an epidemiological investigation of the relationship between gastric mucosal atrophy and exhaled hydrogen gas concentration, including gut microbiota, in residents who participat...
INTRODUCTION: This study aimed to conduct an epidemiological investigation of the relationship between gastric mucosal atrophy and exhaled hydrogen gas concentration, including gut microbiota, in residents who participated in health checkups. METHODS: Based on pepsinogen I <70 ng/mL and PG I/PG II <3 as cutoff values, the participants were divided into a control (n = 903) and atrophy (n = 63) groups. The exhaled hydrogen gas concentrations and gut microbiota were compared in 212 participants from the control group and 53 participants from the atrophy group, selected through propensity score matching. Furthermore, participants were categorized as non-infection, persistent infection, or post-eradication groups based on their Helicobacter pylori (H. pylori) infection status. RESULTS: In the atrophy group, 66.0% were persistent H. pylori carriers, whereas 39.6% of the control group had undergone H. pylori eradication. The atrophy group showed lower exhaled hydrogen concentration than those of the control group. In the gut microbiota of the atrophy group, an increase in Streptococcus, and a decrease in Blautia were observed. Among H. pylori infection statuses, persistent infection group showed reduced exhaled hydrogen gas concentration and increased gut Streptococcus compared to the non-infection group, but no association was observed with the post-eradication group. CONCLUSIONS: Most individuals infected with H. pylori showed evidence of gastric mucosal atrophy, accompanied by decreased breath hydrogen concentrations and alterations in the gut microbiota. Eradication of H. pylori may ameliorate gastric mucosal atrophy, which could subsequently normalize the gut microbial composition and lead to increased levels of exhaled hydrogen.
Comparative Assessment of Diagnostic Accuracy and Puncture Duration of Two Endoscopic Ultrasound Biopsy Needles (22G Franseen versus 20G Antegrade Core Trap) in Patients with Solid Pancreatic Lesions.
Petzold G, Huhnold LS, Knoop RF … +9 more , Raddatz D, Sasse A, Heiduk TR, Todorovic J, Bremmer F, Stroebel P, Ellenrieder V, Neesse A, Amanzada A
Digestion · 2026 Apr · PMID 42048266 · Publisher ↗
INTRODUCTION: Endoscopic ultrasound with fine needle biopsy (EUS-FNB) is the clinical standard for histological confirmation of solid pancreatic lesions. Various types of needles are available. Current guidelines cannot...
INTRODUCTION: Endoscopic ultrasound with fine needle biopsy (EUS-FNB) is the clinical standard for histological confirmation of solid pancreatic lesions. Various types of needles are available. Current guidelines cannot provide recommendations on the type of needle to be used. The aim of the study was to compare the diagnostic accuracy and puncture duration of two EUS-FNB needles (22G Franseen vs. 20G antegrade core trap) in solid pancreatic tumors. METHODS: Between 09/2023 and 02/2025, patients with solid pancreatic masses and indication for histological confirmation by EUS-FNB underwent two puncture procedures at a tertiary hospital, one with a 22G FNB needle and one with a 20G FNB needle. The diagnostic accuracy and puncture duration of both needles were compared. RESULTS: Fifty patients were prospectively included. The mean diameter of the solid lesion was 29.43 mm (±8.69). The final diagnosis was pancreatic adenocarcinoma in 47 patients, neuroendocrine tumor in 2 patients, and pseudotumor in 1 patient. In 86% of cases (43/50), the diagnosis was made with the 22G needle, and in 66% (33/50) with the 20G needle. This difference was statistically significant (p = 0.019). When both needles were used in combination, the diagnostic accuracy was 90% (45/50). The average puncture time with the 22G needle was 166 s (±73) and with the 20G needle 212 s (±93). The difference was significant (p = 0.007). CONCLUSION: The 22G FNB needle was superior to the 20G needle in terms of both diagnostic accuracy and puncture time. The study contributes to improving the available data for selecting the most suitable EUS needle types.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe