Introduction

Type I gastric neuroendocrine tumors (T1-GNETs) are caused by auto-immune gastritis and often occur in multiple lesions. Although endoscopic resection, such as endoscopic submucosal dissection (ESD), is often used for treatment of a small number of T1-GNET, antrectomy is also performed for multiple lesions. However, to date, the efficacy of antrectomy remains unclear.

Aims & Methods

Type I gastric neuroendocrine tumors (T1-GNETs) are caused by auto-immune gastritis and often occur in multiple lesions. Although endoscopic resection, such as endoscopic submucosal dissection (ESD), is often used for treatment of a small number of T1-GNET, antrectomy is also performed for multiple lesions. However, to date, the efficacy of antrectomy remains unclear.

Results

The median age of all patients was 54 years (range, 44–67 years). The ratio of male to female patients was 2:5. The number of tumors preoperatively observed in endoscopy was <10 in two patients, 10–20 in one, and >20 in four. The median size of largest tumor was 6 mm (range, 4–8 mm). Antrectomy was performed in three patients as initial treatment and in four as additional treatment after ESD. The number of tumors pathologically evaluated in resected specimens was <10 in four patients, 10–20 in two, and >20 in one. All tumors were limited to the submucosa. The median diameter of the largest tumor was 5 mm (range, 1.5–8 mm). The median gastrin levels significantly decreased from 3900 pg/mL (range, 2400–8000 pg/mL) to 73 pg/mL (range, 26–120 pg/mL) after antrectomy. Regarding postoperative assessment, tumor regression was observed in one patient and disappearance was observed in six at the follow-up endoscopy. The median period between antrectomy and tumor disappearance was 20 months (range, 5–49 months). No recurrence or cause-specific death occurred in all patients, with a median follow-up period of 48 months (range, 24–60 months).

Conclusion

Based on our findings, antrectomy does not only control local disease but also may lead to prevention of recurrence and regression of tumor persistence. Antrectomy was an effective treatment that could avoid total gastrectomy in patients with multiple T1-GNETs.

References

NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine Tumors Version 2.2016

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

Endoscopic retrograde cholangiopancreatography (ERCP) is now the gold standard for treating biliopancreatic conditions. With growing operator experience and significant advancements in endoscope and instrument design, outcomes have markedly improved. However, the procedure still carries a risk of complications and is not always successful in clearing bile duct stones on the first attempt. In this context, our study aims to evaluate the complication rate of ERCP in the management of common bile duct stones and to explore what factors predict failure to clear these stones during the initial procedure.

Aims & Methods

The aim of this study is to evaluate the predictive factors associated with failure of complete biliary stone clearance during the initial endoscopic retrograde cholangiopancreatography (ERCP) procedure. This is a retrospective, descriptive, and analytical study conducted over a 20-year period, from September 2005 to September 2025. It includes all patients with bile duct stones who underwent ERCP with endoscopic sphincterotomy, followed by stone extraction using standard techniques such as an extraction balloon or Dormia basket.

Results

A total of 1,080 ERCP procedures were performed for the extraction of bile duct stones. The mean age of the patients was 58.9 ± 14.4 years, with a female predominance (59.5%). The average diameter of the common bile duct (CBD) was 13.4 ± 4.31 mm, and biliary strictures were observed in 6.3% of cases. The primary duct clearance rate was 75.1%, while supplementary techniques were required in 22.7% of cases.
On univariate analysis, several factors were significantly associated with failure of stone clearance using standard techniques: younger age (OR: 0.9; 95% CI: -0.03 to -0.01; p < 0.001), male gender (OR: 0.7; 95% CI: -0.5 to -0.02; p = 0.036), history of cholecystectomy (OR: 1.3; 95% CI: 0.02 to 0.6; p = 0.035), presence of cholangitis (OR: 0.4; 95% CI: -1.1 to -0.4; p < 0.001), CBD dilation >15 mm (OR: 0.8; 95% CI: -0.2 to 0.1; p < 0.001), biliary stricture (OR: 0.3; 95% CI: -1.7 to -0.7; p < 0.001), and presence of impacted and/or large stones (OR: 0.1; 95% CI: -2 to -1; p < 0.001).
Multivariate analysis identified four independent predictors of primary clearance failure: presence of cholangitis (OR: 1.9; 95% CI: 0.2 to 1; p = 0.001), impacted and/or large stones (OR: 2.5; 95% CI: 0.5 to 1.3; p < 0.001), CBD dilation >15 mm (OR: 0.88; 95% CI: -0.17 to -0.07; p < 0.001), and biliary stricture (OR: 2.9; 95% CI: 0.4 to 1.7; p = 0.002).
Following the application of supplementary techniques, the overall bile duct clearance rate increased to 92.4%.

Conclusion

In our study, the main predictors of failure to achieve primary common bile duct clearance were cholangitis, the presence of impacted and/or large stones, CBD dilation greater than 15 mm, and biliary strictures.

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

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

Functional diseases of the gastrointestinal tract are a common diagnosis, with the most common manifestations being functional dyspepsia and IBS. The pathophysiological mechanisms and etiology of this group of diseases are not fully understood, but stress is believed to play a key role.

Aims & Methods

This study aims to evaluate the effectiveness of a low-histamine diet in patients with irritable bowel syndrome. Patients who meet the ROME IV criteria were included in the study. The study included 120 patients, divided into three groups: low- histamine diet, FODMAP diet and mediterranian diet.Questionnaires were used to assess stress levels PSS-4, anxiety GAD-7, severity of IBS - IBS Severity Score, and quality of life. The questionnaires were completed three times: both at the beginning of the study, immediately after the end of the 4-week diet, and one month after the end of the diet therapy.

Results

The low-histamine diet led to a statistically significant improvement in IBS symptoms compared to baseline. These findings suggest that the dietary intervention had a positive therapeutic effect ( low- histamine diet : t = 9.6181, p-value < 0.001, low FODMAP diet Z = 22, p-value < 0.001, mediterannian diet Z =119, p-value < 0.001).

Conclusion

Dietary therapy plays a key role in the management of IBS. The low-histamine diet shows promising results and may serve as a viable alternative to the FODMAP diet.

Disclosure

The study was launched after receiving approval from the Research Ethics Committee (REC) at the Medical University "Prof. Dr. Paraskev Stoyanov" – Varna, protocol 111/ 20.01.2022y.Data were processed and analyzed using appropriate statistical methods chosen according to the nature of the variables and research questions. The analysis includes:

• Evaluation of the statistical significance of the main and interactions between the factors (Repeated Measures with Wicolxon and Paired t-test).
• Regression analysis to assess relationships between dependent and independent variables. As well as using heteroskedasticity-robust standard error estimates (HC3) to ensure accuracy of regression analysis results.