Introduction

H. pylori infection has affected approximately 50% of the world’s population with the rates being higher in developing countries than in developed ones. Conventional proton-pump inhibitors (PPIs) have been used as first-line treatment for this condition. However, potassium competitive acid blockers (PCABs) were recently developed which may offer beneficial effects than PPIs.

Aims & Methods

This meta-analysis aims to assess the effectiveness of Potassium competitive acid-blocker against Proton pump inhibitors for the eradication of H. pylori among adults with H. pylori infection.
Electronic search of randomized controlled trials comparing H pylori eradication rate of P-CAB and PPI-based therapy was done. Quality assessment used the Modified Cochrane risk-of-bias tool, and statistical analysis was performed using ReviewManager 5.4.1

Results

Fifteen RCTs with 4129 participants who received H pylori eradication therapy comparing potassium competitive acid blockers (Tegoprazan, Vonoprazan, and YH808) with proton pump inhibitors were analyzed. H. pylori eradication rate of potassium competitive acid blocker-based therapy was higher than that of PPI-based triple therapy RR 1.04, CI 1.10-1.18, P < 0.05. Subgroup analysis showed that PCABs based regimens had significantly higher eradication rates than PPI in treatment naive patients (RR 1.14, 95% CI 1.1-1.18, pP < 0.05 ) and that Vonoprazan based regimen in particular had superior eradication rates compared to PPI based regiments (RR 1.16 95% CI 1.12-1.20 P < 0.05). No significant differences were seen between the Tegoprazan and YH4808 groups compared to the PPI group. Adverse events were also lower in the PCAB group compared to the PPI group.

Conclusion

A significant challenge that is being faced by current PPIs include nocturnal acid reflux despite treatment with twice daily PPI, and additional dosage of H2-receptor blocker at bedtime which deters successful control of gastritis under PPI treatment.Our study shows that potassium competitive acid blockers are effective and have significantly higher eradication rates compared to PPI, with lower incidence of adverse events.

References

Yu, K. et al. (2020). Randomized clinical trial: tegoprazan, a novel potassium competitive acid blocker or lansoprazole in the treatment of gastric ulcer. Aliment PHarmacol Ther. 2020 Sept;52 (5);789-797
Tan, N. et al. (2023). Efficacy and safety of keverprazan compared with lansoprazole win the treatment of duodenal ulcer: a phase III, randomized double blind multicenter trial. Clinical and Translational Gastroenterology. 2023 Jul; 14(7)
Kim, J. et al. (2023). Efficacy of tegoprazan-based bismuth quadruple therapy compared with bismuth quadruple therapy for Helicobacter pylori infection: A randomized, double-blind, active-controlled study. Helicobacter. 2023 June; 28(3)
Zhou, S. et al. (2023). Keverprazan, a novel potassium-competitive acid blocker: Single ascending dose safety, tolerability, pharmacokinetics, pharmacodynamics and food effect in healthy subjects. European Journal of Pharmacetucial Sciences 190(1)2023;2-12
Zhou, B. et al. (2023). Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: A systematic review and meta-analysis of randomized controlled trials. Saudi J Gastroenterol.2023 Nov-Dec; 29(6): 347–357.
Yang, C. et al. (2022). Effectiveness and safety of vonoprazan-based regimen for Helicobacter pylori eradication: A meta-analysis of randomized clinical trials. J Clin Pharm Ther. 2022 Jul;47(7):897-904

Disclosure

authors have no conflict of interest

Introduction

Gallbladder cancer (GBC) has a poor prognosis due to its aggressive nature and limited treatment options. Although early diagnosis through imaging is critical, it remains difficult—particularly in cases of focal gallbladder wall thickening (FGWT), which can mimic benign conditions such as adenomyomatosis or chronic cholecystitis.

Aims & Methods

This study aimed to identify lesions that progressed to GBC (precancerous lesions of GBC; PLGBC) by evaluating prior imaging and to describe their clinical characteristics and outcomes. Patients diagnosed with GBC at Iwata City Hospital between 2014 and 2024 were retrospectively reviewed. Those who had prior imaging—defined as abdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) performed more than three months before GBC diagnosis—were included for analysis. PLGBC was defined as a lesion identifiable on prior imaging but not diagnosed as GBC, and corresponding to the site of subsequently diagnosed GBC. Imaging features and clinical outcomes were compared between patients with and without PLGBCs.

Results

Among 140 patients diagnosed with GBC, 66 (47%) had prior imaging available for review and were included in the analysis. The median age at GBC diagnosis was 80 years (interquartile range [IQR]: 71–86), with 33 male patients (50%). The median interval between prior imaging and GBC diagnosis was 753 days (IQR: 404–1796). The modalities of prior imaging included CT only in 42 patients, US only in 7, MRI only in 1, US and CT in 6, CT and MRI in 6, US and MRI in 3, and all three modalities in 1 patient.
PLGBCs were identified in 32 patients (48%). Regarding lesion morphology, 28 patients presented with FGWT, 2 patients with diffuse gallbladder wall thickening (DGWT), and 2 patients with gallbladder polyps. Lesion locations were the neck in 5 patients, the body/fundus in 25 patients, and the entire gallbladder in 2 patients. Features such as intramural stones or Rokitansky–Aschoff sinuses (RAS) were observed in 15 patients, and gallstones in 7 patients.
No significant differences were found between patients with and without PLGBCs regarding resectability (36% vs. 35%, P = 1.00), radical resection rates (13% vs. 13%, P = 1.00), or survival from diagnosis (median: 640 vs. 791 days, P = 0.96). Six patients with PLGBC were diagnosed with GBC during observation of gallbladder lesions (median follow-up: 406 days, range: 350–552 days), and all underwent successful radical resection of GBC.

Conclusion

PLGBCs were identified in approximately half of the patients who had undergone imaging before their GBC diagnosis, with FGWT being the predominant imaging feature. Recognizing PLGBCs and ensuring appropriate follow-up may enable timely surgical intervention, offering a potential opportunity to improve outcomes in patients with GBC.

Introduction

Colorectal cancer (CRC) screening is well established worldwide. However, the suboptimal sensitivity of the Fecal Immunochemical Test (FIT) for precancerous lesions justifies the search for new tools, namely microRNAs (miRs). In recent years, the detection of these molecules in liquid biopsies has gained increasing interest, as they reflect CRC progression and enable the early detection of precancerous lesions. Moreover, using miRs as a blood-based screening test could potentially increase patient adherence.

Aims & Methods

In this context, we aimed to identify circulating miR profiles for the early detection of CRC. Based on our previous literature review, we selected four miRs (miR-21-5p, miR-92a-3p, miR-451a and miR-199a-5p) with the best performance for the detection of CRC and high-grade dysplasia lesions (HGD). MiR expression was evaluated using RT-qPCR in plasma samples from 80 individuals who underwent colonoscopy with different clinical outcomes, namely, individuals without lesions found on colonoscopy, low-grade dysplasia lesions, high-grade dysplasia lesions, and patients diagnosed with CRC.

Results

Our findings demonstrate a decreased expression of all miRs in CRC and HGD lesions. Regarding HGD identification, miR-21-5p demonstrate a sensitivity of 68% (95% CI: 46 – 85%) and a specificity of 100% (95% CI: 84 – 100). Moreover, miR-92a-3p, miR-451a and miR-199a-5p demonstrated a sensitivity higher than 85% for HGD lesions detection, despite low sensitivity (around 70%). Concerning CRC detection, miR-92a-3p and miR-199a-5p demonstrated sensitivity of approximately 65%, with specificities of 70%, for miR-92a-3p (95% CI: 48 – 85%), and 80% for miR-199a-5p (95% CI: 58 – 92%). Furthermore, miR-21-5p showed outstanding performance in CRC identification with a sensitivity of 95% (95% CI: 75 – 100%), for an AUC of 0.900 (95% CI: 0.807 – 0.993). Moreover, when a negative result was obtained for one of these miRs, the presence of colorectal cancer lesions could be accurately excluded (negative predictive value: 98%).

Conclusion

These findings suggest that circulating miRs have the potential to improve the detection of precancerous lesions, surpassing the performance of FIT. Moreover, given their accuracy in identifying individuals without lesions, they could serve as effective confirmatory screening tools, reducing the number of unnecessary colonoscopies.
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Introduction

The use of lumen-apposing metal stents (LAMS) in therapeutic endoscopy has significantly increased in recent years due to their expanding role in a variety of procedures, such as drainage of pancreatic fluid collections, endoscopic ultrasound (EUS)-guided choledochoduodenostomy, EUS-guided gallbladder drainage, gastro-enteric anastomoses, or abscess drainage.

Aims & Methods

This study aims to analyze the spectrum of indications and complication rates between 2016 and 2024. It includes a retrospective analysis of all patients who received LAMS at our center during this period.

Results

A total of 201 LAMS placements were performed: 82 for biliary drainage, 69 for peripancreatic collections, 41 for gastric outlet obstruction, 8 for abscesses, and 1 for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE). Initially, LAMS were primarily used for the drainage of collections; however, in recent years, anastomoses have become the predominant indication. Overall, we performed 124 anastomoses (61.7%) over the observation period. Among the patients, 86 (42.8%) had malignancies necessitating LAMS placement.
The overall complication rate was 7.5% (15 cases): 6 cases of primary stent maldeployment, 5 bleeds, 2 infections related to walled-off necrosis (WON)/LAMS obstruction, and 2 buried stents. Three patients required surgery, and one underwent radiological embolization for a leak from a splenic artery pseudoaneurysm. No 30-day mortality was observed, although one patient died 65 days post-drainage, 36 days after LAMS extraction, due to splenic artery bleeding.

Conclusion

LAMS use has evolved substantially at our institution, shifting from drainage to anastomotic applications, with EUS-guided gallbladder drainage now being the most common procedure.
Despite the broad spectrum of indications, the complication rate remained low (7.5%) and was managed non-surgically in 80% of cases.
These findings support continued expansion of LAMS in therapeutic endoscopy.

Introduction

Management of poscholecystectomy complications has been variably discussed. Various options exist but the recent trend has been towards the endoscopic retrograde approach favoring a simultaneous diagnostic and therapeutic potential.

Aims & Methods

Objetive: A single institution retrospective analysis of 203 with bile duct injuries (BDI) after laparoscopic cholecystectomy (LC). We studied the various endoscopic modalities to evaluate the efficacy of the approach.
Patients and Methods: From January 2005 to January 2025, a retrospective analysis was conducted of 5528 patients referred to the endoscopy department. During this period, 434 were referred after related BDI. These 434 (7,8%) are BDI. 231(53,2%) after open cholecystectomy and 203 (46,8%) after LC, formed the basis for this study. 154 (75,8%) were female and 49 (24,2%) were male, with an average age of 49,1years (range,13-88 years). The clinical presentation of the BDI: jaundice 134 (66,0%); pain 47 (23,1%); fever 79 (38,9%); persistent drainage 75 (36,9%); pruritus 74 (36,4%) and acute biliary pancreatitis 18 (8,8%). ERCP was used in all cases.

Results

There were 103 patients with stricture (26 total transaction and 77 partial) and 64 (31,6%) patients with leaks and 36 (17,7%) had a combination of leaks and stricture. Endoscopic diagnosis was feasible in all cases. Subsequently, 170 (83, 7% ) patients were considered for endotherapy and endoscopic treatment was interrupted in 17 patients, required surgical intervention, success healing was shown in 90% There 64 biliary fistulae: 40 of the cystic stump, 20 of the common hepatic and 2 of the right hepatic and 2 of the left hepatic; 36 (17,7%) biliary fistulae with stenosis (9 complete transaction and 27 partial transaction) and 103 stenosis (26 total transaction and 77 partial). The 35 total transaction required surgical treatment; however two were treated by endoscopies. There was success in the endoscopic treatment of biliary fistulae, which 64 esphincterotomy transpapilar (ETP) and four stents. 27 patients with biliary fistulae with stenosis were 6 ETP; 11 ETP with stents; 8 ETP, dilatation, stents and two ETP with dilatation and two patients need the surgical treatment. 71/77 (92,2%) patients with stenosis could be treated: 34 ETP, stents; 36 ETP, dilatation, stents; and 3 ETP, dilatation. Complications occurred in 6 (3, 5%), perforation (n = 1), mild pancreatites (n=3), and cholangitis (n=2) and 17 patients failed endoscopic treatment.

Conclusion

The ERCP in biliary complications of LC is feasible and with good results. It firms as coadjuvant treatment of the definitive surgery and in some situations being the method close for the definitive treatment.

Disclosure

No Conflict of Interest

Introduction

Behaviours such as supra-gastric belching, gastric belching, and aerophagia, often identified during oesophageal physiology studies (e.g., 24-hour pH and impedance study), are known to exacerbate symptoms like reflux, bloating, and regurgitation. These behaviours are frequently misunderstood and may lead to unnecessary referrals to specialists or invasive interventions. Upper GI biofeedback (UGI BFB) therapy offers a tailored, non-invasive approach to help patients manage these behaviours. By teaching specific techniques such as diaphragmatic breathing, open-mouth posture, and the multiple rapid swallow technique, patients are empowered to take control of their symptoms, improve their quality of life, and reduce reliance on surgical or gastroenterology pathways.

Aims & Methods

• Participants: Between December 2022 and December 2024, 35 patients were referred for UGI BFB therapy. Most referrals (n=31) came after oesophageal physiology studies, with additional referrals from gastroenterologists for belching and bloating (n=2) and from clinical endoscopists for persistent hiccups and audible wheezing (n=2).
• Intervention: Patients attended a one-hour education session in the Gastrointestinal (GI) Physiology unit. This included a review of diagnostic findings and practical training in diaphragmatic breathing, open-mouth posture, and the multiple rapid swallow technique. A follow-up telephone consultation at 6–8 weeks allowed for monitoring progress. For cases of poor oesophageal clearance, referring clinicians were advised to consider prokinetics. For frequent gastric belching, small intestinal bacterial overgrowth (SIBO) breath testing was recommended to assess any additional contributing factors.

Results

• Supra-gastric belching episodes were reduced by 50% (mean: 24 episodes pre-therapy to 12 post-therapy; p<0.001).
• GERD-HRQL scores improved by 45%, indicating significant quality-of-life improvements (mean: 22 pre-therapy to 12 post-therapy; p<0.001).
• 75% of patients reported substantial reductions in belching, bloating, and reflux-like symptoms.
• Half of the patients (50%) no longer required specialist referrals, as symptoms were successfully managed with therapy or GP-led interventions, including prokinetics or medications for hypersensitivity.
• Stress emerged as a critical factor for most patients. Relaxation techniques, mindfulness, and stress management strategies played an important role in symptom control. One patient, who became a mental health first aider at work, reported long-term symptom relief due to stress reduction efforts.

Conclusion

Upper GI biofeedback therapy is a valuable approach for addressing behavioural contributors to symptoms like air swallowing, belching, and bloating. A multidisciplinary approach, involving cognitive behavioural therapy or hypnotherapy alongside UGI BFB, can be highly beneficial. The GI Physiology team also recognises its limitations and has found that referrals to Speech and Language Therapy can be instrumental when patients are unable to engage fully with the therapy. This collaborative, patient-centred approach ensures that UGI BFB therapy not only reduces the need for invasive procedures and specialist consultations but also empowers patients to adopt long-lasting lifestyle and behavioural changes.