-
-
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang1 , Chung Hyun Tae2 , Chang Seok Bang3 , Cheol Min Shin4 , Young-Hoon Jeong5 , Miyoung Choi6 , Joo Ha Hwang7 , Yutaka Saito8 , Philip Wai Yan Chiu9 , Rungsun Rerknimitr10 , Christopher Khor11 , Vu Van Khien12 , Kee Don Choi13 , Ki-Nam Shim2 , Geun Am Song14 , Oh Young Lee15 , the Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines
Gut Liver 2024;18(5):764-780https://doi.org/10.5009/gnl240176Abstract : Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.
-
Abstract : Endoscopic resection (ER)–a minimal invasive procedure, compared to surgical gastrectomy, with the advantage of preserving the entire stomach and maintaining the patient’s quality of life–is a widely used curative treatment for early gastric cancers (EGCs). Despite its advantages, such as the preservation of the whole stomach, a large area of the gastric mucosa with histologic changes such as atrophy and intestinal metaplasia remains after ER, and so does the risk of metachronous gastric cancers (MGCs). Therefore, regular surveillance endoscopy after curative ER of EGCs is important so that MGCs are detected early and so minimally invasive ER remains a treatment option. To date, the optimal interval for surveillance endoscopy after curative ER of EGCs has not been established. Therefore, this review summarizes the results of the published studies on this topic with the aim of establishing the optimal surveillance interval for early identification of MGCs. Based on my review, the median timing of MGC occurrence is within 3 years, and reports suggest biannual endoscopy during the first 3 years; however, the evidence suggests that individual patient characteristics may influence the risk of MGCs. Therefore, stratified endoscopic strategies for surveillance based on patient characteristics, such as age, family history of gastric cancer, synchronous gastric lesions, and corpus intestinal metaplasia, should be applied.
-
Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association
Seungchul Han1 , Pil Soo Sung2 , Soo Young Park3 , Jin Woong Kim4 , Hyun Pyo Hong5 , Jung-Hee Yoon6 , Dong Jin Chung7 , Joon Ho Kwon8 , Sanghyeok Lim9 , Jae Hyun Kim10 , Seung Kak Shin11 , Tae Hyung Kim12 , Dong Ho Lee10 , Jong Young Choi2 , Research Committee of the Korean Liver Cancer Association
Gut Liver 2024;18(5):789-802https://doi.org/10.5009/gnl240350Abstract : Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
-
Accuracy Goals in Predicting Preoperative Lymph Node Metastasis for T1 Colorectal Cancer Resected Endoscopically
Katsuro Ichimasa1,2 , Shin-ei Kudo1 , Masashi Misawa1 , Khay Guan Yeoh2 , Tetsuo Nemoto3 , Yuta Kouyama1 , Yuki Takashina1 , Hideyuki Miyachi1
Gut Liver 2024;18(5):803-806https://doi.org/10.5009/gnl240081Abstract : Submucosal invasive (T1) colorectal cancer is a significant clinical management challenge, with an estimated 10% of patients developing extraintestinal lymph node metastasis. This condition necessitates surgical resection along with lymph node dissection to achieve a curative outcome. Thus, the precise preoperative assessment of lymph node metastasis risk is crucial to guide treatment decisions after endoscopic resection. Contemporary clinical guidelines strive to identify a low-risk cohort for whom endoscopic resection will suffice, applying stringent criteria to maximize patient safety. Those failing to meet these criteria are often recommended for surgical resection, with its associated mortality risks although it may still include patients with a low risk of metastasis. In the quest to enhance the precision of preoperative lymph node metastasis risk prediction, innovative models leveraging artificial intelligence or nomograms are being developed. Nevertheless, the debate over the ideal sensitivity and specificity for such models persists, with no consensus on target metrics. This review puts forth postoperative mortality rates as a practical benchmark for the sensitivity of predictive models. We underscore the importance of this method and advocate for research to amass data on surgical mortality in T1 colorectal cancer. Establishing specific benchmarks for predictive accuracy in lymph node metastasis risk assessment will hopefully optimize the treatment of T1 colorectal cancer.
-
Clinicopathological Characteristics and Lymph Node Metastasis Rates in Early Gastric Lymphoepithelioma-Like Carcinoma: Implications for Endoscopic Resection
Tae-Se Kim1 , Ji Yeong An2 , Min Gew Choi2 , Jun Ho Lee2 , Tae Sung Sohn2 , Jae Moon Bae2 , Yang Won Min1 , Hyuk Lee1 , Jun Haeng Lee1 , Poong-Lyul Rhee1 , Jae J. Kim1 , Kyoung-Mee Kim3 , Byung-Hoon Min1
Gut Liver 2024;18(5):807-813https://doi.org/10.5009/gnl240006Abstract : Background/Aims: Lymphoepithelioma-like carcinoma (LELC) is a rare subtype of gastric cancer. We aimed to identify the clinicopathological features and rate of lymph node metastasis (LNM) to investigate the feasibility of endoscopic submucosal dissection for early gastric LELC confined to the mucosa or submucosa.Methods: We compared the clinicopathological characteristics of 116 early gastric LELC patients and 5,753 early gastric well- or moderately differentiated (WD or MD) tubular adenocarcinoma patients treated by gastrectomy.Results: Compared to WD or MD early gastric cancer (EGC) patients, early LELC patients were younger and had a higher prevalence of proximally located tumors. Despite more frequent deep submucosal invasion (86.2% vs 29.8%), lymphatic invasion was less frequent (6.0% vs 16.2%) in early LELC patients than in WD or MD EGC patients. Among tumors with deep submucosal invasion, the tumor size was smaller, lymphatic invasion was less frequent (6.0% vs 40.2%) and the rate of LNM was lower (10.0% vs 19.4%) in patients with LELC than in those with WD or MD EGC. The overall rate of LNM in early LELC patients was 8.6% (10/116). The risk of LNM in patients with mucosal, shallow submucosal invasive, or deep submucosal invasive LELC was 0% (0/6), 0% (0/10), and 10% (10/100), respectively.Conclusions: Early LELC is a distinct subtype of EGC with more frequent deep submucosal invasion but less lymphatic invasion and LNM than WD or MD EGCs. Endoscopic submucosal dissection may be considered curative for patients with early LELC confined to the mucosa or shallow submucosa, given its negligible rate of LNM.
-
Real-World Risk of Gastrointestinal Bleeding for Direct Oral Anticoagulants and Warfarin Users: A Distributed Network Analysis Using a Common Data Model
Jae Myung Cha1 , Myoungsuk Kim1 , Hyeong Ho Jo2 , Won-Woo Seo3 , Sang Youl Rhee4 , Ji Hyun Kim5 , Gwang Ha Kim6 , Junseok Park7
Gut Liver 2024;18(5):814-823https://doi.org/10.5009/gnl230406Abstract : Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods: Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results: The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions: In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.
-
Abstract : Background/Aims: The incidence of acute gastrointestinal bleeding (GIB) increases with the utilization of anticoagulant and nonsteroidal anti-inflammatory drugs (NSAIDs). This study aimed to compare the risk of GIB between anticoagulant and NSAIDs combotherapy and anticoagulant monotherapy in real-world practice. Methods: We investigated the relative risk of GIB in individuals newly prescribed anticoagulant and NSAIDs combination therapy and that in individuals newly prescribed anticoagulant monotherapy at three hospitals using “common data model.” Cox proportional hazard models and Kaplan-Meier estimation were employed for risk comparison after propensity score matching. Results: A comprehensive analysis of 2,951 matched pairs showed that patients who received anticoagulant and NSAIDs combousers exhibited a significantly higher risk of GIB than those who received anticoagulant monousers (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.30 to 2.12; p65 years (HR, 1.53; 95% CI, 1.15 to 2.03; p=0.003) and >75 years (HR, 1.89; 95% CI, 1.23 to 2.90; p=0.003). We also found that the risk of GIB was significantly higher in the patients who received anticoagulant and NSAIDs combousers than that in patients who received anticoagulant monousers in both male (p=0.016) and female cohorts (p=0.010). Conclusions: The risk of GIB is significantly higher in patients who receive anticoagulant and NSAIDs combotherapy than that in patients who receive anticoagulant monotherapy. In addition, the risk of GIB associated with anticoagulant and NSAIDs combotherapy was much higher in individuals aged >75 years. Therefore, physicians should be more aware of pay more attention to the risk of GIB when they prescribe anticoagulant and NSAIDs.
-
A New Risk Prediction Model for Detecting Endoscopic Activity of Ulcerative Colitis
Guoyu Guan1 , Sangdan Zhuoga1 , Songbai Zheng1 , Kangqiao Xu2 , Tingwen Weng3 , Wensi Qian4 , Danian Ji5 , Xiaofeng Yu6
Gut Liver 2024;18(5):834-844https://doi.org/10.5009/gnl230370Abstract : Background/Aims: Ulcerative colitis (UC) is an incurable, relapsing-remitting inflammatory disease that increases steadily. Mucosal healing has become the primary therapeutic objective for UC. Nevertheless, endoscopic assessments are invasive, expensive, time-consuming, and inconvenient. Therefore, it is crucial to develop a noninvasive predictive model to monitor endoscopic activity in patients with UC. Methods: Clinical data of 198 adult patients with UC were collected from January 2016 to August 2022 at Huadong Hospital, China. Results: Patients with UC were randomly divided into the training cohort (70%, n=138) and the validation cohort (30%, n=60). The receiver operating characteristic curve value for the training group was 0.858 (95% confidence interval [CI], 0.781 to 0.936), whereas it was 0.845 (95% CI, 0.731 to 0.960) for the validation group. The calibration curve employed the Hosmer-Lemeshow test (p>0.05) to demonstrate the consistency between the predicted and the actual probabilities in the nomogram of these two groups. The decision curve analysis validated that the nomogram had clinical usefulness. Conclusions: The nomogram, which incorporated activated partial thromboplastin time, fecal occult blood test, β2-globulin level, and fibrinogen degradation products, served as a prospective tool for evaluating UC activity in clinical practices.
-
Risk of Hematologic Malignancies in Patients with Inflammatory Bowel Disease: A Meta-Analysis of Cohort Studies
Xiaoshuai Zhou1 , Qiufeng Zhang2 , Dongying Wang2 , Zhiyi Xiang2 , Jiale Ruan2 , Linlin Tang3
Gut Liver 2024;18(5):845-856https://doi.org/10.5009/gnl240119Abstract : Background/Aims: Inflammatory bowel disease (IBD) may contribute to the development of hematologic malignancies. In this study, the potential relationship between IBD and hematologic malignancies was investigated. Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for all cohort studies comparing the incidence of hematologic malignancies in non-IBD populations with that in IBD patients, and we extracted relevant data from January 2000 to June 2023 for meta-analysis. Results: Twenty cohort studies involving 756,377 participants were included in this study. The results showed that compared with the non-IBD cohort, the incidence of hematologic malignancies in the IBD cohort was higher (standardized incidence ratio [SIR]=3.05, p
-
Impact of User’s Background Knowledge and Polyp Characteristics in Colonoscopy with Computer-Aided Detection
Jooyoung Lee1 , Woo Sang Cho2 , Byeong Soo Kim2 , Dan Yoon2 , Jung Kim1 , Ji Hyun Song1 , Sun Young Yang1 , Seon Hee Lim1 , Goh Eun Chung1 , Ji Min Choi1 , Yoo Min Han1 , Hyoun-Joong Kong3,4,5,6 , Jung Chan Lee3,7,8 , Sungwan Kim3,7,8 , Jung Ho Bae1
Gut Liver 2024;18(5):857-866https://doi.org/10.5009/gnl240068Abstract : Background/Aims: We investigated how interactions between humans and computer-aided detection (CADe) systems are influenced by the user’s experience and polyp characteristics.Methods: We developed a CADe system using YOLOv4, trained on 16,996 polyp images from 1,914 patients and 1,800 synthesized sessile serrated lesion (SSL) images. The performance of polyp detection with CADe assistance was evaluated using a computerized test module. Eighteen participants were grouped by colonoscopy experience (nurses, fellows, and experts). The value added by CADe based on the histopathology and detection difficulty of polyps were analyzed.Results: The area under the curve for CADe was 0.87 (95% confidence interval [CI], 0.83 to 0.91). CADe assistance increased overall polyp detection accuracy from 69.7% to 77.7% (odds ratio [OR], 1.88; 95% CI, 1.69 to 2.09). However, accuracy decreased when CADe inaccurately detected a polyp (OR, 0.72; 95% CI, 0.58 to 0.87). The impact of CADe assistance was most and least prominent in the nurses (OR, 1.97; 95% CI, 1.71 to 2.27) and the experts (OR, 1.42; 95% CI, 1.15 to 1.74), respectively. Participants demonstrated better sensitivity with CADe assistance, achieving 81.7% for adenomas and 92.4% for easy-to-detect polyps, surpassing the standalone CADe performance of 79.7% and 89.8%, respectively. For SSLs and difficult-to-detect polyps, participants' sensitivities with CADe assistance (66.5% and 71.5%, respectively) were below those of standalone CADe (81.1% and 74.4%). Compared to the other two groups (56.1% and 61.7%), the expert group showed sensitivity closest to that of standalone CADe in detecting SSLs (79.7% vs 81.1%, respectively).Conclusions: CADe assistance boosts polyp detection significantly, but its effectiveness depends on the user’s experience, particularly for challenging lesions.
-
Precirrhotic Primary Biliary Cholangitis with Portal Hypertension: Bile Duct Injury Correlate
Yi-Fan Hu1 , Shun-Xin Li1 , Hong-Li Liu2 , Zhi-Xiang Du1 , Shuang-Shuang Wang3 , Miao-Yang Chen1 , Li Wang1 , Qing-Fang Xiong1 , Yan-Dan Zhong1 , Du-Xian Liu4 , Yong-Feng Yang1
Gut Liver 2024;18(5):867-876https://doi.org/10.5009/gnl230468Abstract : Background/Aims: The histological characteristics and natural history of precirrhotic primary biliary cholangitis (PBC) with portal hypertension (PH) are unclear. Our aim was to clarify the prevalence, risk factors, and histological characteristics of precirrhotic PBC patients with PH. Methods: This retrospective study compared the clinical features, histological characteristics, and response to ursodeoxycholic acid (UDCA) between the PH and non-PH groups of precirrhotic PBC patients. Results: Out of 165 precirrhotic PBC patients, 40 (24.2%) also had PH. According to histological stage 1, 2 and 3 disease, 5.3% (1/19), 17.3% (17/98), and 45.8% (22/48) of patients also had PH, respectively. Precirrhotic PBC with PH was significantly positively correlated with bile duct loss, degree of cytokeratin 7 positivity, and degree of fibrosis in the portal area, but significantly negatively correlated with lymphoid follicular aggregation. Compared to the non-PH group, patients in the PH group showed a higher prevalence of obliterative portal venopathy, incomplete septal fibrosis, portal tract abnormalities and non-zonal sinusoidal dilatation (p
-
Effect of Biliary Drainage on the Prognosis of Patients with Hepatocellular Carcinoma and Bile Duct Invasion
Keungmo Yang , Hyun Yang , Chang Wook Kim , Hee Chul Nam , Ji Hoon Kim , Ahlim Lee , U Im Chang , Jin Mo Yang , Hae Lim Lee , Jung Hyun Kwon , Soon Woo Nam , Soon Kyu Lee , Pil Soo Sung , Ji Won Han , Jeong Won Jang , Si Hyun Bae , Jong Young Choi , Seung Kew Yoon , Hee Yeon Kim
Gut Liver 2024;18(5):877-887https://doi.org/10.5009/gnl240032Abstract : Background/Aims: Bile duct invasion (BDI) is rarely observed in patients with advanced hepatocellular carcinoma (HCC), leading to hyperbilirubinemia. However, the efficacy of pretreatment biliary drainage for HCC patients with BDI and obstructive jaundice is currently unclear. Thus, the aim of this study was to assess the effect of biliary drainage on the prognosis of these patients. Methods: We retrospectively enrolled a total of 200 HCC patients with BDI from multicenter cohorts. Patients without obstructive jaundice (n=99) and those who did not undergo HCC treatment (n=37) were excluded from further analysis. Finally, 64 patients with obstructive jaundice (43 subjected to drainage and 21 not subjected to drainage) were included. Propensity score matching was then conducted. Results: The biliary drainage group showed longer overall survival (median 10.13 months vs 4.43 months, p=0.004) and progression-free survival durations (median 7.00 months vs 1.97 months, p
-
Impact of Korean Military Service on the Prevalence of Steatotic Liver Disease: A Longitudinal Study of Pre-enlistment and In-Service Health Check-Ups
Jaejun Lee1,2 , Jae Hyeop Jung3 , Sung Jun Choi4 , Beomman Ha3 , Hyun Yang1,5 , Pil Soo Sung1,2 , Si Hyun Bae1,5 , Jeong-A Yu3
Gut Liver 2024;18(5):888-896https://doi.org/10.5009/gnl240077Abstract : Background/Aims: Young Korean men are obligated to serve in the military for 18 to 21 months. We investigated the effects of military service on steatotic liver disease (SLD) and other metabolic parameters. Methods: Pre-enlistment health check-up performed from 2019 to 2022 and in-service health check-up performed from 2020 to 2022 were merged as paired data. SLD was defined as a hepatic steatosis index of 36 or higher. Hypertension (HTN) and hypertriglyceridemia were also included in the analysis. Results: A total of 503,136 paired cases were included in the analysis. Comparing pre-enlistment and in-service health check-ups, the prevalence of SLD (22.2% vs 17.6%, p
-
Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey
Eui Joo Kim1,2 , Sang Hyub Lee3 , Min Kyu Jung4 , Dong Kee Jang5 , Jung Hyun Jo6 , Jae Min Lee7 , Jung Wan Choe8 , Sung Yong Han9 , Young Hoon Choi10 , Seong-Hun Kim11 , Jin Myung Park12 , Kyu-Hyun Paik13
Gut Liver 2024;18(5):897-905https://doi.org/10.5009/gnl230350Abstract : Background/Aims: Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods: The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results: In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. Conclusions: This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.
-
Immune-Enhancing Treatment among Acute Necrotizing Pancreatitis Patients with Metabolic Abnormalities: A Post Hoc Analysis of a Randomized Clinical Trial
Xiaofei Huang1,2 , Wenjian Mao3 , Xingxing Hu1,2 , Fengxia Qin1,2,4 , Hui Zhao1,2 , Aiping Zhang1,2 , Xinyu Wang3 , Christian Stoppe5,6 , Dandan Zhou1,2 , Lu Ke3,7 , Haibin Ni1,2 , Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG)
Gut Liver 2024;18(5):906-914https://doi.org/10.5009/gnl230326Abstract : Background/Aims: Metabolic syndrome is common in patients with acute pancreatitis and its components have been reported to be associated with infectious complications. In this post hoc analysis, we aimed to evaluate whether metabolic abnormalities impact the effect of immune-enhancing thymosin alpha-1 (Tα1) therapy in acute necrotizing pancreatitis (ANP) patients. Methods: All data were obtained from the database for a multicenter randomized clinical trial that evaluated the efficacy of Tα1 in ANP patients. Patients who discontinued the Tα1 treatment prematurely were excluded. The primary outcome was 90-day infected pancreatic necrosis (IPN) after randomization. Three post hoc subgroups were defined based on the presence of hyperglycemia, hypertriglyceridemia, or both at the time of randomization. In each subgroup, the correlation between Tα1 and 90-day IPN was assessed using the Cox proportional-hazards regression model. Multivariable propensity-score methods were used to control potential bias. Results: Overall, 502 participants were included in this post hoc analysis (248 received Tα1 treatment and 254 received matching placebo treatment). Among them, 271 (54.0%) had hyperglycemia, 371 (73.9%) had hypertriglyceridemia and 229 (45.6%) had both. Tα1 therapy was associated with reduced incidence of IPN among patients with hyperglycemia (18.8% vs 29.7%: hazard ratio, 0.80; 95% confidence interval, 0.37 to 0.97; p=0.03), but not in the other subgroups. Additional multivariate regression models using three propensity-score methods yielded similar results. Conclusions: Among ANP patients with hyperglycemia, immune-enhancing Tα1 treatment was associated with a reduced risk of IPN (ClinicalTrials.gov, Registry number: NCT02473406).
-
Development of a Nomogram to Predict the Risk for Acute Necrotizing Pancreatitis
Gut Liver 2024;18(5):915-923https://doi.org/10.5009/gnl230403Abstract : Background/Aims: Necrotizing pancreatitis (NP) presents a more severe clinical trajectory and increased mortality compared to edematous pancreatitis. Prompt identification of NP is vital for patient prognosis. A risk prediction model for NP among Chinese patients has been developed and validated to aid in early detection. Methods: A retrospective analysis was performed on 218 patients with acute pancreatitis (AP) to examine the association of various clinical variables with NP. The least absolute shrinkage and selection operator (LASSO) regression was utilized to refine variables and select predictors. Subsequently, a multivariate logistic regression was employed to construct a predictive nomogram. The model's accuracy was validated using bootstrap resampling (n=500) and its calibration assessed via a calibration curve. The model's clinical utility was evaluated through decision curve analysis. Results: Of the 28 potential predictors analyzed in 218 AP patients, the incidence of NP was 25.2%. LASSO regression identified 14 variables, with procalcitonin, triglyceride, white blood cell count at 48 hours post-admission, calcium at 48 hours post-admission, and hematocrit at 48 hours post-admission emerging as independent risk factors for NP. The resulting nomogram accurately predicted NP risk with an area under the curve of 0.822, sensitivity of 82.8%, and specificity of 76.4%. The bootstrap-validated area under the curve remained at 0.822 (95% confidence interval, 0.737 to 0.892). This model exhibited excellent calibration and demonstrated greater predictive efficacy and clinical utility for NP than APACHE II, Ranson, and BISAP. Conclusions: We have developed a prediction nomogram of NP that is of great value in guiding clinical decision.
-
A New Korean Nomenclature for Steatotic Liver Disease
Nonalcoholic Fatty Liver Disease (NAFLD) Nomenclature Revision Consensus Task Force on behalf of the Korean Association for the Study of the Liver (KASL)
Gut Liver 2024;18(5):924-925https://doi.org/10.5009/gnl240278 -
Corrigendum to: The Association between Educational Attainment and the Risk of Nonalcoholic Fatty Liver Disease among Chinese Adults: Findings from the REACTION Study
Yuanyue Zhu1,2, Long Wang1,2, Lin Lin1,2, Yanan Huo3, Qin Wan4, Yingfen Qin5, Ruying Hu6, Lixin Shi7, Qing Su8, Xuefeng Yu9, Li Yan10, Guijun Qin11, Xulei Tang12, Gang Chen13, Shuangyuan Wang1,2, Hong Lin1,2, Xueyan Wu1,2, Chunyan Hu1,2, Mian Li1,2, Min Xu1,2, Yu Xu1,2, Tiange Wang1,2, Zhiyun Zhao1,2, Zhengnan Gao14, Guixia Wang15, Feixia Shen16, Xuejiang Gu16, Zuojie Luo5, Li Chen17, Qiang Li18, Zhen Ye6, Yinfei Zhang19, Chao Liu20, Youmin Wang21, Shengli Wu22, Tao Yang23, Huacong Deng24, Lulu Chen25, Tianshu Zeng25, Jiajun Zhao26, Yiming Mu27, Weiqing Wang1,2, Guang Ning1,2, Yufang Bi1,2, Yuhong Chen1,2, Jieli Lu1,2
Gut Liver 2024;18(5):926-927https://doi.org/10.5009/gnl230220.e
-
Correlation between White Globe Appearance and Clinicopathologic Characteristics in Early Gastric Cancer
Dae Jin Jung1 , Gwang Ha Kim1 , Kyungbin Kim2 , Hye Kyung Jeon1 , Dong Chan Joo1 , Moon Won Lee1 , Bong Eun Lee1
Published online October 8, 2024https://doi.org/10.5009/gnl240097 -
Association of Intensive Endoscopic Burden with Esophageal Cancer Detection: A Nationwide Cohort Study
Yeunji Lee1,2 , Eunyoung Lee3 , Bumhee Park4 , Gil Ho Lee2 , Sun Gyo Lim2 , Sung Jae Shin2 , Choong-Kyun Noh2 , Kee Myung Lee2
Published online September 27, 2024https://doi.org/10.5009/gnl240111 -
Short-term and Long-term Clinical Outcomes of Combined Caudate Lobectomy for Intrahepatic Cholangiocarcinoma Involving the Hepatic Hilus: A Propensity Score Analysis
Di Zeng1,2 , Yaoqun Wang1,2 , Ningyuan Wen1,2 , Bei Li1,2 , Nansheng Cheng1,2 , Jiong Lu1,2
Published online September 27, 2024https://doi.org/10.5009/gnl240158 -
Effect of Probiotics on Improving Intestinal Mucosal Permeability and Inflammation after Surgery
Min-Jae Kim , Young Ju Lee , Zahid Hussain , Hyojin Park
Published online September 27, 2024https://doi.org/10.5009/gnl240170 -
Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Published online September 4, 2024https://doi.org/10.5009/gnl240245 -
Pharmacological Interventions for Cirrhotic Ascites: From Challenges to Emerging Therapeutic Horizons
Yuan Gao1 , Xin Liu2 , Yunyi Gao3 , Meili Duan4 , Bing Hou5 , Yu Chen1
Published online August 29, 2024https://doi.org/10.5009/gnl240038 -
Cognitive Impairment and Insomnia in Celiac Disease: A Systematic Review and Meta-Analysis
Renato Beas1 , Ambar Godoy1 , Dalton A. Norwood2 , Ysaith Orellana Ascencio3 , Diego Izquierdo-Veraza1 , Eleazar E. Montalvan-Sanchez1 , Mirian Ramirez4 , Satya Kurada5
Published online August 1, 2024https://doi.org/10.5009/gnl240063 -
Cellular Plasticity in Gut and Liver Regeneration
Minwook Kim1,2 , Yoojeong Park1,2 , You Sun Kim1,3 , Sungjin Ko1,2
Published online July 31, 2024https://doi.org/10.5009/gnl240005 -
Impact of Donor Age on Liver Transplant Outcomes in Patients with Acute-on-Chronic Liver Failure: A Cohort Study
Jie Zhou1 , Danni Ye2 , Shenli Ren2 , Jiawei Ding2 , Tao Zhang2 , Siyao Zhang2 , Zheng Chen2 , Fangshen Xu2 , Yu Zhang1 , Huilin Zheng3 , Zhenhua Hu1,2
Published online June 21, 2024https://doi.org/10.5009/gnl230143 -
Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study
Hoonsub So1 , Hyun Don Joo2 , Tae Jun Song3 , Sung Woo Ko4 , Ho Seung Lee3 , Sung Hyun Cho3 , Dongwook Oh3 , Sung Yong Han5 , Dong Uk Kim5 , Dong-Wan Seo3
Published online May 22, 2024https://doi.org/10.5009/gnl240014 -
Gallstone Dissolution Effects of Combination Therapy with n-3 Polyunsaturated Fatty Acids and Ursodeoxycholic Acid: A Randomized, Prospective, Preliminary Clinical Trial
See Young Lee1 , Sung Ill Jang1 , Jae Hee Cho1 , Min Young Do1 , Su Yeon Lee1 , Arong Choi1 , Hye Sun Lee2 , Juyeon Yang2 , Dong Ki Lee1
Published online May 7, 2024https://doi.org/10.5009/gnl230494 -
Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines
Jung Hun Woo1 , Hwanhyi Cho1 , Kihyun Ryu1 , Young Woo Choi1 , Sanghyuk Lee1 , Tae Hee Lee1 , Dae Sung Kim1 , In Seok Choi2 , Ju Ik Moon2 , Seung Jae Lee2
Published online May 7, 2024https://doi.org/10.5009/gnl230534 -
The Circular RNA Circ_0043947 Promoted Gastric Cancer Progression by Sponging miR-384 to Regulate CREB1 Expression
Chongxin Zhang1 , Fan Zhang1 , Yukun Li1 , Pengfei Yang1 , Yang Liu2 , Wenxiao Yang1
Published online April 19, 2024https://doi.org/10.5009/gnl230173 -
Unraveling the Heterogeneity of CD8+ T-Cell Subsets in Liver Cirrhosis: Implications for Disease Progression
Kepu Zheng1 , Leiyang Dai2 , Shengning Zhang1 , Yingpeng Zhao1 , Wang Li1 , Yang Gao1 , Yuanyi Mang1 , Lingfeng Jiao1 , Yu Tang3 , Jianghua Ran1
Published online April 16, 2024https://doi.org/10.5009/gnl230345 -
Risk Assessment of Metachronous Gastric Neoplasm after Endoscopic Resection for Early Gastric Cancer According to Age at Helicobacter pylori Eradication
Seunghan Lee , Soo-Jeong Cho , Hyunsoo Chung , Bokyung Kim , Mi Jin Oh , Yun Suk Na , Jun Hee Lee , Jiyoon Kim , Sang Gyun Kim
Published online March 21, 2024https://doi.org/10.5009/gnl230383 -
Rebamipide Prevents the Hemoglobin Drop Related to Mucosal-Damaging Agents at a Level Comparable to Proton Pump Inhibitors
Ji Eun Kim1 , Yeong Chan Lee2 , Tae Se Kim1 , Eun Ran Kim1 , Sung Noh Hong1 , Young-Ho Kim1 , Kyunga Kim3 , Dong Kyung Chang1
Published online March 12, 2024https://doi.org/10.5009/gnl230372 -
Influence of Cytokine Genetic Polymorphisms in Helicobacter pylori-Associated Gastric Inflammation According to Sex in South Korea
Hee Jin Kim1 , Nayoung Kim2,3,4 , Jae Young Jang2,3,4 , Sihyun Kim2 , Jongchan Lee2 , Hyeon Jeong Oh5
Published online February 23, 2024https://doi.org/10.5009/gnl230359 -
Molecular Activity of Inflammation and Epithelial-Mesenchymal Transition in the Microenvironment of Ulcerative Colitis
Yu Kyung Jun1 , Nayoung Kim1,2 , Hyuk Yoon1 , Ji Hyun Park2 , Hyung Kyung Kim3,4 , Yonghoon Choi1 , Ji Ae Lee3 , Cheol Min Shin1 , Young Soo Park1 , Dong Ho Lee1,2
Published online February 22, 2024https://doi.org/10.5009/gnl230283 -
Tumor-Derived Exosomal Circular RNA Pinin Induces FGF13 Expression to Promote Colorectal Cancer Progression through miR-1225-5p
Xianghui Liao1 , Tuhua Li1 , Li Yang1 , Haiwen Li2 , Weiru Li1 , Yuting Liu3 , Zhong Xie1
Published online February 22, 2024https://doi.org/10.5009/gnl230304 -
Differential Diagnosis of Thickened Gastric Wall between Hypertrophic Gastritis and Borrmann Type 4 Advanced Gastric Cancer
Jun-young Seo1,2 , Do Hoon Kim1 , Ji Yong Ahn1 , Kee Don Choi1 , Hwa Jung Kim3 , Hee Kyong Na1 , Jeong Hoon Lee1 , Kee Wook Jung1 , Ho June Song1 , Gin Hyug Lee1 , Hwoon-Yong Jung1
Published online November 28, 2023https://doi.org/10.5009/gnl230307 -
Are the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Prognostic Factors for Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy?
Jiong-Jie Yu1,2, Li-Yang Sun1,2, Bing Quan1,2, Tian Yang1
Published online October 10, 2018https://doi.org/10.5009/gnl18210
Search for
-
Esophageal Reflux Hypersensitivity: A Comprehensive Review
Akinari Sawada1 , Daniel Sifrim2 , Yasuhiro Fujiwara1
Gut Liver 2023;17(6):831-842
-
A New Paradigm Shift in Gastroparesis Management
Parit Mekaroonkamol , Kasenee Tiankanon , Rungsun Rerknimitr
Gut Liver 2022;16(6):825-839
-
Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis
Sang Hyub Lee1 , Jung Wan Choe2 , Young Koog Cheon3 , Miyoung Choi4 , Min Kyu Jung5 , Dong Kee Jang6 , Jung Hyun Jo7 , Jae Min Lee8 , Eui Joo Kim9 , Sung Yong Han10 , Young Hoon Choi11 , Hyung-Il Seo12 , Dong Ho Lee13 , Hong Sik Lee14
Gut Liver 2023;17(1):34-48
-
Triple Therapy-Based on Tegoprazan, a New Potassium-Competitive Acid Blocker, for First-Line Treatment of Helicobacter pylori Infection: A Randomized, Double-Blind, Phase III, Clinical Trial
Yoon Jin Choi1 , Yong Chan Lee1 , Jung Mogg Kim2 , Jin Il Kim3 , Jeong Seop Moon4 , Yun Jeong Lim5 , Gwang Ho Baik6 , Byoung Kwan Son7 , Hang Lak Lee8 , Kyoung Oh Kim9 , Nayoung Kim10 , Kwang Hyun Ko11 , Hye-Kyung Jung12 , Ki-Nam Shim12 , Hoon Jai Chun13 , Byung-Wook Kim14 , Hyuk Lee15 , Jie-Hyun Kim16 , Hyunsoo Chung17 , Sang Gyun Kim17 , Jae Young Jang18
Gut Liver 2022;16(4):535-546
-
Metabolic Dysfunction-Associated Fatty Liver Disease Predicts Long-term Mortality and Cardiovascular Disease
Joon Ho Moon1,2 , Won Kim1,3 , Bo Kyung Koo1,4 , Nam H. Cho5 , on behalf of the Innovative Target Exploration of NAFLD (ITEN) consortium
Gut Liver 2022;16(3):433-442
-
Cardiovascular Risk Is Elevated in Lean Subjects with Nonalcoholic Fatty Liver Disease
Yuna Kim1,2 , Eugene Han3 , Jae Seung Lee1,2,4 , Hye Won Lee1,2,4 , Beom Kyung Kim1,2,4 , Mi Kyung Kim3 , Hye Soon Kim3 , Jun Yong Park1,2,4 , Do Young Kim1,2,4 , Sang Hoon Ahn1,2,4 , Byung-Wan Lee1,5 , Eun Seok Kang1,5 , Bong-Soo Cha1,5 , Yong-ho Lee1,5 , Seung Up Kim1,2,4
Gut Liver 2022;16(2):290-299