Digestion[JOURNAL]
Sun
200 papers
Comparative Evaluation of Endoscopic Closure Techniques for Mucosal and Full-Thickness Defects: An ex vivo Study.
Nakagome S, Goto O, Matsui T … +8 more , Nishiyama N, Habu T, Koizumi E, Higuchi K, Omori J, Akimoto N, Kobara H, Iwakiri K
Digestion · 2026 Feb · PMID 41678429 · Publisher ↗
INTRODUCTION: Reliable closure of mucosal/full-thickness defects after endoscopic treatment is crucial to prevent complications. Although various techniques have been clinically introduced, a direct comparison of these t...
INTRODUCTION: Reliable closure of mucosal/full-thickness defects after endoscopic treatment is crucial to prevent complications. Although various techniques have been clinically introduced, a direct comparison of these techniques has not been conducted. Thus, the present ex vivo study aimed to evaluate the closure strength of these methods. METHODS: Using a porcine stomach, 4 × 2.5-cm mucosal and full-thickness defects were prepared. Each closure was performed for three specimens. For the mucosal defects, the following methods were performed in the mucosal (group M) and muscular-mediated mucosal (group MM) closures: simple clipping (clip-M), loop-assisted closure (loop-M), line-assisted closure (line-M), and endoscopic hand suturing (EHS-M); clip-MM, line-MM, and EHS-MM. For the full-thickness defects, a single-layered closure (group F) was performed by loop-assisted closure (loop-F), line-assisted clip closure (line-F), and EHS (EHS-F). The maximum tension (N) was measured using a mechanical traction device by mechanically pulling both ends of the specimen. RESULTS: In the closure of mucosal defects, among the techniques in group M, EHS-M (11.32 ± 2.1 N) demonstrated the highest strength as compared to the other three methods. For group MM, EHS-MM (13.1 ± 5.3 N) showed the highest strength, significantly outperforming clip-MM (p = 0.03). Among the full-thickness defect closure methods, EHS-F (9.5 ± 0.73 N) had the significantly highest strength among the three methods. CONCLUSIONS: Our ex vivo data showed that EHS has superior closure strength in both mucosal and full-thickness defects. Surgery-oriented endoscopic closure appears to be a reliable method for artificially created intraluminal defects.
Identifying Post-Surgical Recurrence Subtype of T1-Stage Colorectal Cancer by Machine Learning.
Zhou X, Togashi K, Zhu X … +26 more , Zhang T, Kajiwara Y, Oka S, Tanaka S, Nakamura T, Takamatsu M, Hotta K, Yamada M, Ikematsu H, Nagata S, Yamada K, Konishi J, Ishihara S, Saitoh Y, Matsuda K, Komori K, Ishiguro M, Tamaru Y, Okuyama T, Ohuchi A, Ohnuma S, Sakamoto K, Sugai T, Ajioka Y, Sugihara K, Ueno H
Digestion · 2026 Feb · PMID 41666137 · Publisher ↗
INTRODUCTION: Traditional risk stratification heavily relies on expert judgment and manually established thresholds. This study aims to automatically identify subtypes in the patients of T1-stage colorectal cancer with d...
INTRODUCTION: Traditional risk stratification heavily relies on expert judgment and manually established thresholds. This study aims to automatically identify subtypes in the patients of T1-stage colorectal cancer with distinct clinicopathologic characteristics and recurrence risk profiles, using machine learning. METHODS: We analyzed data from 3,367 patients (mean follow-up, 1,281 days) with T1 colorectal cancer who underwent surgical resection between 2009 and 2016 across 27 high-volume core Japanese institutions. Patients were split into derivation and test datasets (4:1 ratio). Hierarchical clustering was employed to identify recurrence subtypes in the derivation dataset. Machine learning classifiers were developed and validated on the test dataset. Co-occurrence and Bayesian network analyses aided interpretation. RESULTS: Three distinct subtypes were identified: two high-risk (subtypes 1 and 2) and one low-risk (subtype 3). Subtype 1 was predominantly associated with polypoid morphology (94.8%), whereas subtype 2 was characterized by flat morphology (89.4%). Subtype 2 showed a relatively consistent presence across most factors, with comparable levels of lymphatic invasion, vascular invasion, and tumor budding. Subtype 3 shared similarities with subtype 1 in polypoid morphology (76.5%) but differed in other factors. These findings showed similar trend on the test dataset. Subtype-specific risk factors included lymphovascular invasion and nodal metastasis in both high-risk subtypes, while rectal location was unique to subtype 1 and polypoid morphology and large size were specific to subtype 2. CONCLUSION: This machine learning approach identified three distinct recurrence subtypes of T1 colorectal cancer, each with unique characteristics and risk profiles, indicating the potential value of subtype-specific clinical strategies.
Therapeutic Efficacy of Risankizumab for Small-Intestinal Lesions in Crohn's Disease: A Retrospective Study Using Double-Balloon Endoscopy.
Yamamura T, Sawada T, Ishikawa E … +12 more , Maeda K, Murate K, Furukawa K, Hirose T, Iida T, Mizutani Y, Yamao K, Ishizu Y, Ishikawa T, Honda T, Nakamura M, Kawashima H
Digestion · 2026 Feb · PMID 41662301 · Publisher ↗
INTRODUCTION: Risankizumab (RZB), an IL-23p19 monoclonal antibody, has demonstrated clinical efficacy in Crohn's disease (CD), yet evidence regarding its effectiveness for deep small-intestinal lesions remains scarce. Th...
INTRODUCTION: Risankizumab (RZB), an IL-23p19 monoclonal antibody, has demonstrated clinical efficacy in Crohn's disease (CD), yet evidence regarding its effectiveness for deep small-intestinal lesions remains scarce. These lesions are often underdiagnosed due to limited accessibility and subtle clinical presentation. METHODS: We retrospectively analyzed 32 patients with moderate-to-severe CD who underwent total small-intestinal evaluation by double-balloon endoscopy (DBE) both before and 8-14 months after RZB initiation in clinical practice. Endoscopic disease activity was assessed using the modified Simple Endoscopic Score for Crohn's Disease (mSES-CD). Clinical response (Crohn's Disease Activity Index [CDAI]), biomarker changes (C-reactive protein, leucine-rich alpha-2 glycoprotein), and endoscopic outcomes were evaluated. RESULTS: Mean mSES-CD significantly decreased from 14.3 to 8.2 (p < 0.001), indicating substantial mucosal improvement, particularly in the jejunum and deep ileum. Endoscopic remission (mSES-CD <2) was achieved in 13.3% of patients. Clinical remission (CDAI <150) occurred in 80% at week 12 and was sustained in 56% at 1 year. Significant biomarker improvements were observed. No progression of strictures was seen during follow-up. CONCLUSION: This study confirms the therapeutic efficacy of RZB for deep small-intestinal involvement in CD based on comprehensive DBE assessment. The results support the clinical utility of RZB in patients with refractory small-intestinal lesions, highlighting its potential to maintain 1 year disease control when ongoing mucosal inflammation is a concern. These findings underscore the importance of deep enteroscopic evaluation to optimize therapeutic strategies.
Paratracheal Air Stripe Sign: A Useful Chest X-Ray Finding for Diagnosis in Patients with Esophageal Achalasia.
Ujiie N, Muranami Y, Sato C … +8 more , Taniyama Y, Okamoto H, Ozawa Y, Ishida H, Ando R, Kunimitsu A, Unno M, Kamei T
Digestion · 2026 Feb · PMID 41642779 · Full text
INTRODUCTION: Esophageal achalasia is a rare motility disorder, and esophagogastroduodenoscopy (EGD) alone has limited diagnostic accuracy, often leading to delayed diagnosis. High-resolution manometry remains the diagno...
INTRODUCTION: Esophageal achalasia is a rare motility disorder, and esophagogastroduodenoscopy (EGD) alone has limited diagnostic accuracy, often leading to delayed diagnosis. High-resolution manometry remains the diagnostic gold standard, but its availability in primary care is limited. Therefore, more accessible diagnostic methods are needed. Given the widespread use of chest X-ray, we investigated whether it reveals distinctive features in achalasia patients. METHODS: In this retrospective cohort study, 215 patients with esophageal achalasia treated between 2015 and 2024 were analyzed. Diagnostic yields of EGD, esophagography, and computed tomography (CT) were evaluated among patients who underwent these examinations in primary care facilities. Chest X-rays were systematically reviewed for paratracheal radiolucency, and a novel radiographic sign - the paratracheal air stripe sign (PASS) - was defined as a paratracheal radiolucent area with a minimum width of ≥5 mm and length of ≥20 mm. To assess specificity, an additional analysis was performed in 210 patients with esophageal cancer as a non-achalasia control cohort. RESULTS: Diagnostic yields in primary care were 41.1% for EGD, 88.4% for esophagography, and 34.8% for CT. PASS was present in 67.0% of achalasia cases and more frequent in patients with type I achalasia, sigmoid-type morphology, and advanced esophageal dilation. Among patients undiagnosed by EGD, 63.9% exhibited PASS. In the non-achalasia control cohort, PASS was observed in 18.0% of cases, predominantly in patients with structural esophageal changes such as tortuosity or dilatation. CONCLUSION: PASS represents a novel and clinically useful chest X-ray feature associated with esophageal achalasia. Its relatively high prevalence, even among cases missed by EGD, and low occurrence in non-achalasia patients suggest that routine assessment of PASS in chest X-rays may aid early detection and timely referral for definitive diagnosis, particularly in primary care settings.
Association between the Gut Microbiota and the Pathophysiology of Irritable Bowel Syndrome: A Narrative Review.
Andoh A, Miwa H
Digestion · 2026 Feb · PMID 41642746 · Publisher ↗
BACKGROUND: Emerging evidence highlights the gut microbiota as a key contributor to the pathophysiology of irritable bowel syndrome (IBS), acting through complex interactions with intestinal motility, immune function, ep...
BACKGROUND: Emerging evidence highlights the gut microbiota as a key contributor to the pathophysiology of irritable bowel syndrome (IBS), acting through complex interactions with intestinal motility, immune function, epithelial barrier integrity, and the gut-brain axis. This narrative review summarizes current knowledge regarding the roles of the gut microbiota and their metabolites in IBS. SUMMARY: We discuss alterations in the gut microbiota in IBS, with particular emphasis on changes in short-chain fatty acid production, bile acid metabolism, serotonin signaling, and gas handling. Special attention is given to microbial metabolites as mediators of visceral hypersensitivity, intestinal permeability, and neuromodulation within the microbiota-gut-brain axis. Major alterations in the gut microbiota of IBS are characterized by a reduction in Bacteroidetes, Bifidobacteria, and Faecalibacterium, accompanied by an increase in Firmicutes. We explain the importance of butyrate metabolism in colonic epithelial cells for maintaining the anaerobic environment of the gut. In addition, we review the impact of diet-microbiota interactions, including FODMAP restriction, resistant starch intake, and protein fermentation, on symptom generation and microbial stability. KEY MESSAGE: Although accumulating evidence supports a link between gut dysbiosis and IBS, establishing causal relationships remains challenging due to disease heterogeneity and dietary influences. Future large-scale, well-phenotyped, multi-omics studies integrating microbiota, metabolomic, and host factors are required to elucidate underlying mechanisms and to guide personalized therapeutic strategies for IBS.
Controversies in Computer-Assisted Detection in Colonoscopy.
Putera M, Koh FHX, Li JW
Digestion · 2026 Feb · PMID 41642745 · Publisher ↗
BACKGROUND: Artificial intelligence (AI) applications in endoscopy, particularly computer-aided detection (CADe), have shown consistent benefit in randomized controlled trials (RCTs), with improvements in adenoma detecti...
BACKGROUND: Artificial intelligence (AI) applications in endoscopy, particularly computer-aided detection (CADe), have shown consistent benefit in randomized controlled trials (RCTs), with improvements in adenoma detection rate (ADR) and reductions in adenoma miss rate (AMR). Despite these findings, adoption of CADe in routine colonoscopy remains controversial, with international guidelines issuing divergent recommendations. SUMMARY: Evidence from RCTs demonstrates that CADe increases ADR, predominantly through detection of diminutive adenomas, while its effect on advanced adenomas is limited. Real-world implementation studies show comparatively diminished benefits, likely explained by factors which are difficult to measure, such as the absence of Hawthorne effect in real-world practice, the quality of mucosal exposure and decision-making regarding diminutive polyps. Cost-effectiveness analyses generally favour CADe even with varying assumptions across healthcare systems, although these are based on the high degree of improvement in ADR seen in RCTs with CADe. Potential harms include increased polypectomy of non-neoplastic lesions, higher lifetime colonoscopy burden, and the risk of deskilling among endoscopists. Concerns remain about bridging the gap between trial efficacy and real-world effectiveness, optimizing surveillance intervals, and mitigating deskilling and human-AI interaction issues. KEY MESSAGES: (1) CADe improves ADR in RCTs, but real-world effectiveness is inconsistent and often lacklustre. (2) Gains in ADR are largely derived from diminutive adenomas, and less with advanced adenomas, with uncertain impact on clinically significant outcomes such as colorectal cancer incidence and mortality. (3) Cost-effectiveness analyses are generally favourable, but dependent on assumptions about ADR improvement, CADe cost, and surveillance policies. (4) Deskilling and altered endoscopist behaviour represent important considerations that require further study. (5) Future integration of CADe with computer-aided diagnosis (CADx) and quality-assurance (CAQ) tools may maximize clinical benefit and cost-effectiveness, but evidence gaps must be addressed before widespread implementation.
Electroacupuncture-Regulated Bile Acid Metabolism and Farnesoid X Receptor Expression in Constipation-Predominant Irritable Bowel Syndrome Rat: A Preclinical Study.
Jiang S, Wang X, Qu Z … +6 more , Guo J, Liu X, Su Y, Jing X, Sun J, Pei L
Digestion · 2026 Feb · PMID 41642735 · Publisher ↗
INTRODUCTION: The efficacy of electroacupuncture (EA) treatment in alleviating visceral hypersensitivity with irritable bowel syndrome (IBS) has been established. Abnormal bile acid metabolism and farnesoid X receptor (F...
INTRODUCTION: The efficacy of electroacupuncture (EA) treatment in alleviating visceral hypersensitivity with irritable bowel syndrome (IBS) has been established. Abnormal bile acid metabolism and farnesoid X receptor (FXR) expression are recognized as potential contributors to visceral hypersensitivity in IBS. This study as a preclinical study of IBS visceral hypersensitivity explored the potential of EA to reduce visceral hypersensitivity in rats with IBS by improving bile acid metabolism and FXR expression. METHODS: Heterotypic intermittent stress (HIS) for 9 days was used to induce visceral hypersensitivity in constipation-predominant irritable bowel syndrome (IBS-C). EA/sham EA bilateral ST36 and LR3 acupoints began on the 5th day of HIS. Electromyography of the abdominal external oblique muscle and calcitonin gene-related peptide were used to assess colonic hypersensitivity. Colonoscopy and histopathological examination were used to evaluate pathological changes in the colon. Bile acid composition was analyzed using high-performance liquid chromatography-mass spectrometry, while FXR expression in colon tissue was quantified through immunofluorescence and Western blot. RESULTS: HIS induced visceral hypersensitivity in IBS-C rats. EA not only regulated bile acid levels in the feces of IBS-C rats, but also had a downregulatory effect on the overexpression of FXR in the colon tissue of rats with IBS-C. The therapeutic effects were better than those of the sham EA. EA treatment alleviated visceral hypersensitivity in the colon of IBS-C rats. CONCLUSION: Our data suggested that EA normalized colonic bile acid signaling and FXR protein expression in an IBS-C rat model, offering a mechanistic hypothesis for future clinical evaluation.
What Is the Optimal Endoscopic Resection Method for Intermediate-Sized (10-20 mm) Superficial Non-Ampullary Duodenal Epithelial Tumors? A Systematic Review.
Yamasaki Y, Iwagami H, Matsueda K … +13 more , Takizawa K, Kurahara K, Kakushima N, Abe N, Dohi O, Nonaka S, Fukuhara S, Yoshimizu S, Hirose T, Hoteya S, Kushima R, Kato M, Yahagi N
Digestion · 2026 Jan · PMID 41615866 · Publisher ↗
INTRODUCTION: For intermediate-sized (10-20 mm) superficial non-ampullary duodenal epithelial tumors (SNADETs), various endoscopic resection (ER) techniques are available, including conventional endoscopic mucosal resect...
INTRODUCTION: For intermediate-sized (10-20 mm) superficial non-ampullary duodenal epithelial tumors (SNADETs), various endoscopic resection (ER) techniques are available, including conventional endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD). However, the optimal method remains uncertain. METHODS: We conducted a systematic review of studies published from January 2013 to August 2023 using PubMed and the Japan Medical Abstracts Society database. Eligible studies reported ER outcomes for SNADETs of ≤20 mm. Data were extracted from 14 cohort studies (3 multicenter lesions 10-20 mm in size and 11 single-center lesions less than 20 mm), including en bloc and R0 resection rates, delayed bleeding, intraoperative and delayed perforations, and recurrence. RESULTS: In the multicenter studies, the pooled en bloc resection rates for EMR, UEMR, and ESD of intermediate-sized SNADETs were 82.7%, 74.8%, and 94.6%, respectively. The corresponding R0 resection rates were 54.2%, 50.6%, and 80.9%. Delayed bleeding rates were similar across methods (3.3% for EMR, 3.2% for UEMR, and 5.4% for ESD). However, intraoperative and delayed perforations were more frequent with ESD (7.9% and 3.0%) than with EMR (1.1% and 0.3%) and UEMR (0.0% and 0.0%). Single-center studies showed consistent trends, with ESD achieving higher resection rates but also showing greater variability in adverse events. Recurrence rates were about 5% for EMR and UEMR, with no recurrences reported after ESD. CONCLUSION: While ESD provides superior resection quality, EMR and UEMR offer favorable outcomes with fewer adverse events. Given their safety and efficacy profiles, EMR and UEMR should be considered appropriate first-line treatment options for intermediate-sized SNADETs.
Newly Developed Evaluation of Esophageal Wall Motion Using Endoscopic Ultrasonography via Transnasal Endoscopy: Clinical Application in Esophageal Achalasia.
Bukeo E, Manabe N, Etani T … +3 more , Ayaki M, Fujita M, Haruma K
Digestion · 2026 Jan · PMID 41591958 · Publisher ↗
INTRODUCTION: A new minimally invasive method is needed to evaluate both esophageal muscle contraction and esophageal wall distensibility under physiological conditions. The primary objective of this study was to establi...
INTRODUCTION: A new minimally invasive method is needed to evaluate both esophageal muscle contraction and esophageal wall distensibility under physiological conditions. The primary objective of this study was to establish a novel examination method for evaluating esophageal wall motion using a transnasal endoscope with an endoscopic ultrasonography (EUS) probe. The secondary objective was to apply this method to gain new pathophysiological insights into the clinical subtypes of achalasia diagnosed by high-resolution manometry. METHODS: The study included 20 patients with dysphagia. Patients were instructed to swallow 20 mL of oral rehydration solution, while a transnasal endoscope and a 20-MHz EUS probe were used to record the swallowing motion. The esophageal lumen area and muscle layer thickness were measured on still images from recorded videos. The reproducibility of the method was evaluated for both internal and external consistency. The study also analyzed differences in esophageal wall motion among achalasia subtypes using two new parameters: the muscle layer contraction rate and the esophageal wall distension rate. RESULTS: The new transnasal EUS method was safely performed in all 20 patients without complications, and the images were sufficient for analysis. The reproducibility evaluation showed significant positive correlations for both internal and external reproducibility. The esophageal wall distensibility and muscle layer contraction rates differed between esophageal achalasia subtypes. CONCLUSION: This pilot study successfully established a new, safe, and reproducible method for evaluating esophageal wall motion using transnasal EUS. This method will lead to a deeper understanding of the pathophysiology of esophageal motility disorders and potentially to the development of new treatment strategies.
Identification of LGR5 and TFF2 as Biomarkers in High-Risk Chronic Atrophic Gastritis: From Multi-Omics Mining to Clinical Validation.
Zhang Q, Wu D, Guo F … +4 more , Yang S, Bao L, Zhang R, Wang P
Digestion · 2026 Jan · PMID 41579392 · Publisher ↗
INTRODUCTION: High-risk chronic atrophic gastritis (CAG; OLGA/OLGIM Ⅲ-Ⅳ) carries significant gastric cancer (GC) risk yet lacks reliable gastric stem cell (GSC)-based biomarkers. We evaluated GSC markers LGR5 (proliferat...
INTRODUCTION: High-risk chronic atrophic gastritis (CAG; OLGA/OLGIM Ⅲ-Ⅳ) carries significant gastric cancer (GC) risk yet lacks reliable gastric stem cell (GSC)-based biomarkers. We evaluated GSC markers LGR5 (proliferative) and TFF2 (protective) for risk stratification. METHODS: TCGA/GEO bioinformatics analysis preceded immunohistochemical validation in 60 clinical samples. Protein co-expression (Wnt/β-catenin, Ki67, Bax) was assessed. Diagnostic/prognostic power was tested via ROC and Kaplan-Meier analyses. Functional networks were deciphered through GO/KEGG enrichment. RESULTS: High-risk CAG and GC tissues showed LGR5 upregulation and TFF2 downregulation (p < 0.001). IHC confirmed these patterns, with concurrent Wnt activation (β-catenin↑, cyclin D1↑) and proliferation-apoptosis imbalance (Ki67↑, Bax↓). TFF2 outperformed LGR5 in diagnosing high-risk CAG (AUC: 0.842 vs. 0.681). Poor GC prognosis correlated with high LGR5/low TFF2 (p < 0.05). Co-expression networks linked LGR5 to metabolic genes (CPS1, ADH6) and TFF2 to mucosal defense (GKN1, PGC). CONCLUSION: The coordinated assessment of LGR5 and TFF2 offers a promising approach to identifying high-risk CAG. This biomarker pair captures a homeostatic imbalance in GSCs linked to Wnt/β-catenin signaling, establishing a novel molecular framework for early detection and future targeted strategies.
<italic>Helicobacter pylori</italic>-Naïve Gastric Neoplasms: Clinicopathological and Molecular Features and Diagnostic Challenges.
Shibagaki K, Kotani S, Takahashi Y … +7 more , Suemitsu S, Nagase M, Araki A, Kawabata S, Niino D, Ishimura N, Ishihara S
Digestion · 2026 Jan · PMID 41579391 · Full text
BACKGROUND: With the increasing proportion of the Helicobacter pylori (Hp)-naïve population in Japan, conventional Hp-infected gastric neoplasms (HpIGNs) have decreased, whereas Hp-naïve gastric neoplasms (HpNGNs) are be...
BACKGROUND: With the increasing proportion of the Helicobacter pylori (Hp)-naïve population in Japan, conventional Hp-infected gastric neoplasms (HpIGNs) have decreased, whereas Hp-naïve gastric neoplasms (HpNGNs) are being detected more frequently. SUMMARY: Hp infection remodels the gastric mucosa and promotes tumorigenesis through a high mutational burden and epigenetic dysregulation, contributing to the histologically diverse and aggressive nature of HpIGNs. In contrast, HpNGNs arise with few genetic and epigenetic alterations, resulting in limited morphological diversity determined by the type of their background mucosa. Most HpNGNs arise in the fundic gland mucosa and exhibit a gastric phenotype, whereas those arising from the pyloric gland mucosa or gastric cardia show a variable phenotype. Regardless of histologic subtype, HpNGNs are generally biologically indolent, except for a subset arising in the gastric cardia. The histological classification of HpNGNs does not always fit conventional diagnostic frameworks for gastric neoplasms. In particular, foveolar-type adenomas (FGAs) need to be subclassified into flat and raspberry types, which represent distinct molecular entities. Furthermore, HpNGNs with a MUC6-dominant gastric phenotype, including gastric adenocarcinomas of fundic gland or fundic gland mucosa type and some flat-type FGAs with partial MUC6-dominant components, and pyloric gland adenomas form a morphological and molecular continuum, occasionally making histological distinction difficult. A comprehensive disease concept integrating these lesions may help resolve this diagnostic issue. KEY MESSAGES: As the prevalence of Hp infection continues to decline worldwide, HpNGNs are expected to emerge as a distinct disease entity, highlighting the need for refined diagnostic frameworks and risk-based surveillance strategies in the post-Hp era.
High Correlation between Fecal Immunochemical Test and Fecal Calprotectin in the Evaluation of Activity in Patients with Inflammatory Bowel Disease.
Torres-Díaz JA, Díaz-Espaillat O, Yamamoto-Furusho JK
Digestion · 2026 Jan · PMID 41575902 · Publisher ↗
INTRODUCTION: The fecal immunochemical test (FIT) is a wide available fecal biomarker that could evaluate the disease activity in inflammatory bowel disease (IBD). The aim was to assess the correlation between the FIT an...
INTRODUCTION: The fecal immunochemical test (FIT) is a wide available fecal biomarker that could evaluate the disease activity in inflammatory bowel disease (IBD). The aim was to assess the correlation between the FIT and fecal calprotectin (FC) for evaluating IBD activity. METHODS: This was a unicentric, transversal cohort study. Consecutive patients with IBD were included and FIT and FC were determined. The clinical activity was assessed with Truelove-Witts and Yamamoto-Furusho index for UC patients while Harvey-Bradshaw and CDAI for CD patients. Spearman's rank correlation test was used to assess the correlation between FIT and FC. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPVs) for FIT and FC were calculated. Receiver operator curves were constructed. RESULTS: A total of 206 patients were included. One hundred forty-eight (72%) patients had diagnosis of UC and 58 (28%) with CD. The median of FIT was 2.8 μg/g (range, 2.6-2,394 μg/g) and the median for FC level was 265.5 μg/g (range, 22-6,285 μg/g). There was a very good correlation between FIT with and FC in UC patients (r = 0.745, p < 0.01) and moderate in CD patients (r = 0.574, p < 0.01). A FIT cutoff of 2.6 μg/g identified endoscopic activity in UC patients with a sensitivity of 78%, specificity of 86%, PPV of 91% and NPV of 67% with an area under the curve (AUC) of 0.852 (95% CI: 0.758-0.946). CONCLUSION: FIT can be an alternative fecal biomarker to assess the disease activity in UC patients.
Quality of Care and Burden in Patients with Celiac Disease: Results from the German Celiac Registry.
Koletzko S, Sobotzki C, Blömacher M … +5 more , Plachta-Danielzik S, Schumann M, Baas S, Bokemeyer B, Schuppan D
Digestion · 2026 Jan · PMID 41575898 · Publisher ↗
INTRODUCTION: European and National Celiac Disease (CeD) guidelines offer an easy pathway to diagnose CeD. The German CeD Registry aimed to assess symptoms and clinical findings before diagnosis, diagnostic delay, care d...
INTRODUCTION: European and National Celiac Disease (CeD) guidelines offer an easy pathway to diagnose CeD. The German CeD Registry aimed to assess symptoms and clinical findings before diagnosis, diagnostic delay, care during the diagnostic process, and factors associated with persistence of symptoms. METHODS: Individuals with CeD provided demographic, clinical, and healthcare-related information. Participants were divided into four subgroups according to age at diagnosis (>18 or <18 years) and year of diagnosis (before and since 2012). Factors associated with symptoms after at least 1 year on a gluten-free diet (GFD) were assessed using multivariate logistic regression. RESULTS: From 11/2019 to 10/2021, 2,333 participants were enrolled. After exclusion of 169 (7.2%), 2,164 remained for analysis, thereof 796 (36.8%) were diagnosed <18 years, and 1,283 (59.3%) since 2012. Most common symptoms before diagnosis included abdominal pain (83%), bloating (82%), fatigue (78%), and diarrhoea (71%). Diagnostic delay after 2012 was longer in adults than children (median 4.4 years [interquartile range; IQR: 1.2-13.0] versus 1.1 [IQR: 0.5-2.2], respectively) (p < 0.001). Guideline-conform diagnoses increased over time. After diagnosis, only 60% received professional dietary counselling. Factors associated with symptoms despite GFD included female gender (odds ratio [OR]: 1.79 [95% confidence interval: 1.34; 2.40], p < 0.001), same symptom before diagnosis (OR: 3.45 [2.45; 4.96], p < 0.001), insufficient information provided at diagnosis (OR: 1.25 [1.00; 1.57], p = 0.046), and age at diagnosis (per decade) (OR: 1.11 [1.04; 1.18], p < 0.001) but not time since diagnosis. CONCLUSIONS: Our findings revealed deficits in awareness, the diagnostic process, and post-diagnostic care that are linked to decreased clinical improvement over time.
Explainable Artificial Intelligence for the Mayo Endoscopic Score in Ulcerative Colitis.
Zhu J, Zhu S, Ding X … +10 more , Liu L, Xu C, Ni H, Lin J, Liu X, Wang Y, Li Y, Zhao H, Li JW, Li R
Digestion · 2026 Jan · PMID 41569974 · Publisher ↗
INTRODUCTION: The Mayo endoscopic score (MES) is used widely in ulcerative colitis (UC) for severity assessment and therapeutic decision-making. Deep learning (DL) models developed to determine MES currently lack explain...
INTRODUCTION: The Mayo endoscopic score (MES) is used widely in ulcerative colitis (UC) for severity assessment and therapeutic decision-making. Deep learning (DL) models developed to determine MES currently lack explainability. We aimed to develop explainable models for the MES in patients with UC and examine the human-artificial intelligence interactions with the models. METHODS: This was a retrospective multicenter study conducted across four large tertiary institutions in China. A total of 2,600 white light images were used for training. Two approaches were adopted: traditional blackbox or explainable AI (XAI). The trained models were evaluated with three external test datasets (#1 Changshu and Jintan hospitals, n = 100; #2 HyperKvasir, n = 100; #3 Yongding hospital, n = 260), and the performance was compared with endoscopists. The primary outcome was the performance of 4-way classification. For explainability, moreover, Grad-CAM was for computer vision, while local interpretation, variable importance, and partial dependence plots were for the classifier within XAI. RESULTS: In the test #1 dataset, a Xception-backboned XAI showed accuracy of 0.910, Matthew's correlation coefficient 0.880, and Cohen's kappa 0.960 (95% CI, 0.940-0.990). The metrics were better than other models, as well as the two endoscopists. With the AI assistance, the performance of endoscopists were improved (senior's accuracy from 0.890 to 0.930 and junior's accuracy from 0.810 to 0.880). Similar trend was observed in the test #2 and #3 datasets. CONCLUSION: The use of an explainable framework empowers AI models to achieve improved performance with transparency. XAI can also improve endoscopist performance in interpretation of MES in UC.
Characteristics and Prognosis of Esophageal Squamous Cell Carcinoma that Progressed to pT1a-MM or Deeper despite Surveillance Esophagogastroduodenoscopy.
Hatsushika Y, Urabe Y, Masuda S … +16 more , Uda T, Sako Y, Gurita T, Nakamura T, Ishibashi K, Konishi H, Tsuboi A, Tanaka H, Yamashita K, Hiyama Y, Kishida Y, Takigawa H, Ishikawa A, Mii S, Kuwai T, Oka S
Digestion · 2026 Jan · PMID 41543989 · Publisher ↗
INTRODUCTION: In the surveillance of esophageal squamous cell carcinoma (ESCC), advanced lesions may still be detected despite regular screening with esophagogastroduodenoscopy (EGD). In this study, we investigated the e...
INTRODUCTION: In the surveillance of esophageal squamous cell carcinoma (ESCC), advanced lesions may still be detected despite regular screening with esophagogastroduodenoscopy (EGD). In this study, we investigated the endoscopic characteristics and prognosis of ESCC cases that progressed to pT1a-MM or deeper despite undergoing surveillance EGD. METHODS: We retrospectively analyzed 225 consecutive superficial ESCC lesions invading beyond the muscularis mucosa that were resected by endoscopic submucosal dissection (ESD) from 215 patients at Hiroshima University Hospital between April 2010 and March 2023. Among them, 28 patients (29 lesions) were classified as the post-EGD ESCC (PEESCC) group, defined as cases where surveillance EGD performed 24 months before diagnosis did not detect neoplasia or carcinoma. The remaining 188 patients (196 lesions) were the screening group. Subsequently, endoscopic findings and prognosis were compared. RESULTS: From the multivariate analysis, the presence of Lugol-voiding lesions (69.0% vs. 39.3%), cervical esophageal location (17.2% vs. 3.1%), small tumor diameter (21.6 ± 12.3 mm vs. 34.0 ± 18.3 mm), and submucosal tumor (SMT)-like elevation (20.7% vs. 7.7%) were significantly identified as characteristic endoscopic findings of PEESCC. The PEESCC group exhibited lower 5-year disease-specific survival (93.1% vs. 98.5%, p = 0.039) and recurrence-free survival (69.0% vs. 83.7%, p = 0.025). CONCLUSION: PEESCC lesions are associated with distinct endoscopic features and a poorer prognosis than are non-PEESCC lesions.
Gastrointestinal Bleeding after Particle Radiotherapy for Pancreatic Cancer.
Okamoto T, Mie T, Takeda T … +9 more , Suzuki K, Sato Y, Hirai T, Maegawa Y, Hamada J, Furukawa T, Sasaki T, Ozaka M, Sasahira N
Digestion · 2026 Jan · PMID 41543987 · Publisher ↗
INTRODUCTION: Particle radiotherapy (PRT) is a new option for the treatment of unresectable pancreatic cancer (PC). While gastrointestinal bleeding (GIB) is a feared adverse event, real-world evidence in this setting is...
INTRODUCTION: Particle radiotherapy (PRT) is a new option for the treatment of unresectable pancreatic cancer (PC). While gastrointestinal bleeding (GIB) is a feared adverse event, real-world evidence in this setting is limited. METHODS: We conducted a single-center retrospective study to evaluate the frequency and outcomes of GIB and to elucidate the risk factors for GIB after PRT for PC. RESULTS: Thirty-four patients were included. Twenty-nine received PRT to the pancreatic primary, while five received PRT for metastases. Concurrent chemotherapy was given to 26 patients (76%). Eleven patients (32%) experienced acute GIB symptoms after PRT. Median time from PRT to GIB was 13.2 months. Endoscopic signs of hemorrhage were observed in 8 patients (24%), and endoscopic hemostasis was performed in six (18%). Three cases presented with ruptured pseudoaneurysms, of which two were treated with transarterial embolization. Hemostasis was ultimately achieved in all cases, and no deaths occurred directly as a result of GIB. However, overall survival after GIB was short (median: 1.9 months). Median overall survival after PRT tended to be longer in bleeders than in non-bleeders (26.8 vs. 22.7 months, p = 0.03). Concurrent chemotherapy was associated with a lower risk of GIB in univariate analysis (p = 0.05). CONCLUSION: GIB after PRT may not be as rare as previously believed, particularly in the terminal stages of PC.
Gastric Epithelial Neoplasms in <italic>Helicobacter pylori</italic>-Uninfected Patients.
Ueyama H, Yao T, Nakamura S … +10 more , Uemura Y, Iwano T, Yamamoto M, Abe D, Oki S, Takeda T, Akazawa Y, Ueda K, Hojo M, Nagahara A
Digestion · 2026 Jan · PMID 41525303 · Full text
BACKGROUND: In recent years, several studies have described the clinicopathological characteristics of Helicobacter pylori (H. pylori)-uninfected gastric cancer. This entity is now recognized as one of the major topics i...
BACKGROUND: In recent years, several studies have described the clinicopathological characteristics of Helicobacter pylori (H. pylori)-uninfected gastric cancer. This entity is now recognized as one of the major topics in gastric cancer research and clinical practice. SUMMARY: Currently, H. pylori-uninfected gastric epithelial neoplasms (HpUGENs; excluding adenocarcinomas of the esophagogastric junction and gastric neuroendocrine tumors) are classified into seven subtypes in our research results: raspberry-type gastric epithelial neoplasm (GEN; foveolar-type adenoma), whitish flat elevated-type GEN (GEN with gastric phenotype), gastric adenocarcinoma of fundic gland type (GA-FG), gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM), other GEN with a gastric phenotype (complex type of GEN with gastric phenotype), GEN with an intestinal or gastrointestinal mixed phenotype arising in the pyloric gland region, and signet ring cell carcinoma. KEY MESSAGES: This study outlines our analysis of current cases, detailing the endoscopic and clinicopathological characteristics of HpUGENs, and provides practical insights for their endoscopic and pathological diagnosis. Since many of these neoplasms histologically show low-grade atypia, they are sometimes diagnosed as gastric adenoma or gastric dysplasia rather than adenocarcinoma in the World Health Organization classification, highlighting the need for standardized histopathological diagnostic criteria of GENs with low-grade atypia. Moreover, as no clinical practice guidelines have yet been established for HpUGENs, future research should aim to elucidate the relationship between early and advanced lesions, perform comprehensive analyses of H. pylori-uninfected advanced gastric cancer, and conduct molecular biological studies to achieve a better understanding of the entire disease spectrum and to establish evidence-based clinical guidelines.
Very Early Biologic Therapy within Six Months of Crohn's Disease Diagnosis Improves One-Year Steroid-Free Clinical Remission: A Retrospective Cohort Study.
Chang YC, Lin SH, Chen TD … +8 more , Kuo CJ, Chen CM, Chang CW, Chou JW, Chiu CT, Su MY, Pan YB, Le PH
Digestion · 2026 Jan · PMID 41511901 · Publisher ↗
INTRODUCTION: Early use of biologics improves outcomes for Crohn's disease (CD). Evidence now indicates that initiating therapy within 6 months of diagnosis - the "very early" window - may yield additional benefits over...
INTRODUCTION: Early use of biologics improves outcomes for Crohn's disease (CD). Evidence now indicates that initiating therapy within 6 months of diagnosis - the "very early" window - may yield additional benefits over the traditional ≤2-year target. We therefore compared 1-year outcomes after very early (<6 months) versus early (6-24 months) biologic initiation in routine practice. METHODS: In this retrospective cohort (March 2018 to June 2025), biologic-naïve adults with CD and ≥52 weeks of follow-up were stratified by time from diagnosis to first biologic: very early (<6 months) or early (6-24 months). The primary endpoint was steroid-free clinical remission at week 52. Multivariate logistic regression identified variables independently associated with remission. RESULTS: Ninety-six patients were analyzed (very early = 52; early = 44). Baseline characteristics were comparable except for a higher proportion of corticosteroid use in the very early group (67.3% vs. 43.2%; p = 0.018). At week 52, very early initiation was associated with a lower mean CD Activity Index (64.82 ± 6.79 vs. 96.10 ± 13.03; p = 0.038) and a higher steroid-free clinical remission rate (71.2% vs. 45.5%; p = 0.011). Concomitant corticosteroid use fell to 11.4% in the very early group versus 30.6% in the early group (p = 0.033). Very early initiation remained the strongest independent predictor of steroid-free remission (adjusted OR 3.537, 95% CI: 1.417-8.824; p = 0.007). CONCLUSIONS: Initiating biologic therapy within 6 months of CD diagnosis significantly increases 1-year steroid-free clinical remission and reduces corticosteroid dependence compared with initiation at 6-24 months. These real-world data support adopting a standardized "very early" biologic treatment strategy to optimize clinical outcomes in newly diagnosed, biologic-naïve CD.
Continuous versus Intermittent Midazolam Sedation in Balloon-Assisted Enteroscopy: A Multicenter Randomized Trial.
Sakakibara Y, Mannami T, Kuwai T … +22 more , Kagaya T, Toyokawa T, Katsushima S, Kanda T, Shimada M, Kuramochi M, Hamada S, Fujii H, Watanabe N, Wakatsuki T, Tamaru Y, Esaka N, Sasaki Y, Kubo K, Mabe K, Yamada T, Ishihara A, Uraoka T, Kato M, Kada A, Saito AM, Harada N
Digestion · 2026 Jan · PMID 41493892 · Full text
INTRODUCTION: Sedation protocols for balloon-assisted enteroscopy (BAE) are not yet standardized. The aim of this study was to compare the efficacy and safety between continuous infusion and intermittent bolus administra...
INTRODUCTION: Sedation protocols for balloon-assisted enteroscopy (BAE) are not yet standardized. The aim of this study was to compare the efficacy and safety between continuous infusion and intermittent bolus administration of midazolam for sedation during BAE. The study hypothesis was that continuous infusion would provide a greater proportion of time under conscious sedation than would intermittent bolus administration. METHODS: We conducted a multicenter, prospective, double-blind, randomized controlled trial at 15 institutions of the National Hospital Organization in Japan. Patients scheduled for diagnostic or therapeutic BAE were randomly assigned to receive continuous infusion or intermittent bolus administration of intravenous midazolam. The primary endpoint was the proportion of time under conscious sedation, defined as a Ramsay Sedation Scale score of 3-4. Secondary endpoints included body movements causing procedure interruption, endoscopist and patient satisfaction, total drug dosage, adverse events, and termination of the procedure. RESULTS: Of 76 enrolled patients (39 continuous infusion group, 37 intermittent bolus group), one from each group discontinued before treatment, leaving 74 patients (38 continuous group, 36 intermittent bolus group) for analysis. The proportion of time under conscious sedation was comparable between groups (mean ± SD: 0.637 ± 0.315 vs. 0.609 ± 0.272, p = 0.721). However, the continuous infusion group showed a lower incidence of body movements causing procedure interruption (7.9% vs. 25.0%, p = 0.091). The total midazolam dose was higher in the continuous infusion group, whereas the incidence of adverse events was comparable between the two groups. CONCLUSION: Continuous infusion of midazolam did not demonstrate superiority over intermittent bolus administration with regard to the proportion of time under conscious sedation. However, continuous infusion suppressed body movements during BAE without increasing adverse events; thus, it could be one of the feasible sedation options for BAE in clinical practice.
Comparison of Therapeutic Outcomes between Underwater EMR and Cap-Assisted EMR for Superficial Non-Ampullary Duodenal Epithelial Tumors Measuring 6-20 mm.
Nishikawa E, Yoshizaki T, Abe E … +18 more , Hashimoto H, Yoshiji M, Matsuura S, Wada T, Higasa Y, Tanabe H, Hoki S, Ishida R, Hori R, Nakai T, Ueda C, Urakami S, Abe H, Takao M, Takao T, Morita Y, Toyonaga T, Kodama Y
Digestion · 2025 Dec · PMID 41452797 · Publisher ↗
INTRODUCTION: Conventional endoscopic mucosal resection (EMR) is widely accepted for 6-20 mm superficial non-ampullary duodenal epithelial tumors (SNADETs); however, its en bloc and R0 resection rates remain suboptimal....
INTRODUCTION: Conventional endoscopic mucosal resection (EMR) is widely accepted for 6-20 mm superficial non-ampullary duodenal epithelial tumors (SNADETs); however, its en bloc and R0 resection rates remain suboptimal. Modified techniques, such as underwater EMR (UEMR) and cap-assisted EMR (EMRC), have been introduced to improve outcomes; nevertheless, comparative data are limited despite both techniques being increasingly utilized. METHODS: This retrospective two-center study included patients with 6-20 mm SNADETs treated with either UEMR or EMRC between April 2016 and May 2024 at Kobe University Hospital and the International Clinical Cancer Research Center. Clinicopathologic characteristics, therapeutic outcomes, and adverse events were compared. Multivariate logistic regression analysis was conducted to identify risk factors for non-R0 and piecemeal resection. RESULTS: A total of 155 SNADETs (51 UEMR, 104 EMRC) were included. The EMRC group achieved significantly higher R0 resection rates (86.5% vs. 62.7%; p < 0.001) and en bloc resection rates (94.2% vs. 78.4%; p = 0.003) without increasing adverse events. Multivariate analysis identified UEMR, lesion size ≥10 mm, and anterior or lateral wall involvement as independent risk factors for non-R0 resection. Lesion size ≥10 mm was the only independent risk factor for piecemeal resection. CONCLUSION: In SNADETs measuring 6-20 mm, EMRC demonstrated higher en bloc and R0 resection rates than UEMR with a comparable safety profile, suggesting EMRC may be a useful option for achieving complete resection in selected cases. Prospective studies are needed to refine techniques to minimize complications while maintaining efficacy and to clarify long-term outcomes and recurrence.
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