Introduction

Gastric cancer (GC) is a leading cause of cancer-related deaths worldwide, ranking fourth in terms of mortality and fifth in terms of incidence, according to the 2020 GLOBOCAN report (1). Early detection of preneoplastic conditions such as gastric atrophy and intestinal metaplasia is crucial to reduce GC mortality (2). Moreover, its pathogenesis is a multifactorial process that is influenced by environmental and genetic factors. European guidelines (3) suggest shortening the interval of follow-up in patients with a family history. However, it is a weak recommendation with a low quality of evidence, as evidence regarding familiarity for GC and its related preneoplastic conditions is lacking.

Aims & Methods

To evaluate the risk of GC and preneoplastic conditions and lesions, including gastric atrophy, intestinal metaplasia, and dysplasia, in first-degree relatives for GC patients.
We conducted a systematic review and meta-analysis of case-control studies published on MEDLINE (PubMed and Embase) until November 2022. The primary outcome was the risk of GC in first-degree relatives for GC patients. The secondary findings were the risk of preneoplastic conditions and dysplasia in these patients. Two independent reviewers blindly performed the systematic review and data extraction. The disagreements were resolved through discussion. Homogeneity of effects across studies quantified by I². Odds ratio (OR) and 95% confidence intervals (CIs) were expressed using random effects models.

Results

Of the 1642 studies initially found, 18 studies met the inclusion criteria for GC, and 6 studies were included for preneoplastic conditions. The pooled analysis included a total of 59490 patients for the risk of GC and 4463 patients for the risk of preneoplastic conditions. The results showed a significantly increased risk of GC in first-degree relatives of GC patients (OR = 3.034; 95%CI 2.395 to 3.843; p <.001; I² 85.66%, 95%CI 78.73 to 90.33, p<.001). The risk of gastric atrophy was also significantly increased (OR = 3.812; 95%CI 1.674 to 8.682; p <.001, I² 78,26%, 95%CI 41.41 to 91.93; p = .003). However, the risk of intestinal metaplasia was not significant (OR = 1.207; 95%CI 0.937 to 1.555, p = .15). Furthermore, the risk of gastric dysplasia was found to be significant (OR = 5.480; 95%CI 1.054 to 28.482, p = .043, I² 80.34%, 95%CI 48.18 to 92.55 p = .002).

Conclusion

Our meta-analysis showed that the risk of GC and preneoplastic conditions and lesions, including gastric atrophy and dysplasia, is significantly increased in first-degree relatives for GC patients, even if a significant heterogeneity between studies was found. These findings highlighted the importance of identifying individuals at high risk to facilitate early detection and treatment of preneoplastic conditions, which could potentially reduce the burden of GC.

References

1. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
2. Pimentel-Nunes, P., Libânio, D., Marcos-Pinto, R., Areia, M., Leja, M., Esposito, G., ... & Dinis-Ribeiro, M. (2019). Management of epithelial precancerous conditions and lesions in the stomach (maps II): European Society of gastrointestinal endoscopy (ESGE), European Helicobacter and microbiota Study Group (EHMSG), European Society of pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy, 51(04), 365-388.
3. Yaghoobi, M., Bijarchi, R., & Narod, S. A. (2010). Family history and the risk of gastric cancer. British journal of cancer, 102(2), 237-242.

Introduction

Endoscopic submucosal dissection (ESD) is one of the effective treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs). To avoid postoperative perforation and bleeding, our hospital had introduced D-LECS with ESD for SNADETs. From 2021, D-LECS was divided into D-LECS with FTR, which is a full-thickness resection, and D-LECS with ESD, which is intended for post-ESD reinforcement (1). D-LECS with ESD is considered to be a therapeutic procedure that not only ensures safety but also contributes to the improvement of endoscopic skills.

Aims & Methods

The aim of this study is to evaluate the impact of D-LECS with ESD on the skill development of endoscopists. The subjects were 17 cases in which D-LECS was performed among 79cases diagnosed with SNADA by biopsy at our hospital between January 2000 and October 2023. 5 cases in which D-LECS with ESD was performed. The ESD assessment score was defined using a ladder chart based on muscle layer exposure, perforation, ESD time, and pathological examination results. The scoring for points each item is as follows. (Exposure of muscle layer none: 0, <3mm: 1pt, 3~10mm: 2pt, 10mm<: 3pt, Perforation of the muscle none: 0, <3mm: 1pt, 3~10mm: 5pt, 10mm<: 10pt, ESD time <60min.: 0pt, 60~120min.: 5pt, 120min.<: 10pt, Pathological examination result pR0: 0pt, cR0+pRX: 5pt, pR1:10pt) Images and videos were used in combination to evaluate the muscle layer.

Results

ESD assessment scores of cases undergoing D-LECS with ESD were presented. The state of exposure of the muscle layer had a median of 5 (1-7), a mean of 4.8, and a standard deviation (SD) of 2.3. The state of perforation of the muscle layer had a median of 0 (0-10), a mean of 2.6, and a SD of 4.3. The median ESD time was 170 minutes, the mean was 146 minutes (41-198). The state of pathological examination had a median of 0 (0-10), a mean of 2.0, and a SD of 4.5. The ESD assessment scores are presented as follows: (Exposure of muscle layer, Perforation of muscles layer, ESD, Pathological examination result). The results of each score are as shown on the right, Case1: (7, 0,10, 0), Case2: (5,10, 10, 0), Case3: (5, 0, 10, 0), Case4: (6, 3, 10, 10), Case5: (1, 0, 1, 0). Although the number of cases was small, the time required for ESD was shortened and the degree of perforation tended to improve with experience. 2 examples revealed some important points. Case 1: This case had many blood vessels, and the ST hood was needed because it is difficult to perform ESD. When the endoscope was extended, perforation occurred. Once the perforation was made, it was difficult to move the patient to other bed, so the muscle layer was sutured with OTSC, and a PGA sheet. Case 2: The endoscopic strategy and device were improved, and the lesion could be dissected within 1 hour. ESD was performed with Dual Knife J 1.5. Pulling the lesion with an S-O clip. The RDI function was used during hemostasis to avoid the burn effect on the muscle layer.

Conclusion

D-LECS with ESD will lead to improvements of duodenal ESD techniques. But to ensure safety, laparoscopic closure is preferable until reliable suturing via endoscope becomes possible.

References

(1) Souya Nunobe, Motonari Ri, Naoki Hiki et al: Safety and Feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study. Endoscopy 53: 1065-1068, 2021

Introduction

Aims & Methods

Results

Conclusion

Introduction

Genetic predisposition to accumulate fat by carrying risk alleles of PNPLA3, TM6SF2 and HSD17B13, has been shown to influence the probability of developing cirrhosis and hepatocellular carcinoma (HCC) in several liver diseases characterized by hepatic steatosis including non-alcoholic steatohepatitis, chronic hepatitis C and alcoholic liver disease. Whether these variants have any role in the progression of chronic hepatitis B (CHB) disease, without hepatic steatosis, remains unknown.

Aims & Methods

In this cross-sectional case-control study, we determined PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs72613567 variants in a cohort of 148 healthy controls, 91 CHB (57 cirrhotic and 34 non-cirrhotic), and 84 CHB-related HCC patients from a tertiary center. Associations between control and case groups with the alleles and genotypes were investigated using logistic regression analyses, and adjustment for age and sex was applied. Survival analyses were performed using Kaplan-Meier Curves with the log-rank test in the CHB-related HCC cohort.

Results

The genotype and allelic distribution of PNPLA3, TM6SF2 and HSD17B13 were not different between healthy controls, CHB, cirrhosis and HCC groups. No genotype or allele, including the haplotype analysis, was found to be associated with susceptibility to CHB and increased risk for cirrhosis or HCC. Survival analysis revealed that none of the three variants has any influence on overall survival in patients with CHB-related HCC.

Conclusion

Our findings demonstrated that PNPLA3, TM6SF2, and HSD17B13 genetic variants, known for modulating liver fat and disease progression in hepatic steatosis, have no association with disease progression in patients with CHB and survival in CHB-related HCC.

References

1. Abul-Husn NS, Cheng X, Li AH, et al. A Protein-Truncating HSD17B13 Variant and Protection from Chronic Liver Disease. N Engl J Med. 2018 Mar 22;378(12):1096-1106.
2. Gellert-Kristensen H, Richardson TG, Davey Smith G, et al. Combined Effect of PNPLA3, TM6SF2, and HSD17B13 Variants on Risk of Cirrhosis and Hepatocellular Carcinoma in the General Population. Hepatology. 2020 Sep;72(3):845-856.
3. Kang Q, Xu J, Luo H, et al. Evaluation of the association of a variant in PNPLA3 and TM6SF2 with fibrosis progression in patients with chronic hepatitis C infection after eradication: A retrospective study. Gene. 2022 Apr 30;820:146235.
4. Stickel F, Buch S, Nischalke HD, et al. Genetic variants in PNPLA3 and TM6SF2 predispose to the development of hepatocellular carcinoma in individuals with alcohol-related cirrhosis. Am J Gastroenterol. 2018 Oct;113(10):1475-1483.

Introduction

Russia is among the countries with a high prevalence of Helicobacter pylori (H. pylori) infection. The North-Western Federal District, comprising one-tenth of Russia's population, is predominantly urban. As of 2023, its population is over 13 million people. Current information on H. pylori infection prevalence is necessary for the development of clinical guidelines for the prevention of H. pylori-associated disorders.

Aims & Methods

To evaluate the dynamics of H. pylori infection prevalence among patients with dyspepsia between 2015 and 2023 based on ¹³C-urea breath test (¹³C-UBT).
The study was conducted in the North-Western Federal District. Patients with dyspepsia (n=50,884) who underwent ¹³C-UBT between 2015 and 2023 were included in this descriptive study. If Delta Over Baseline (DOB, δ¹³СО2) was less than 2.5‰, the result of the test was considered negative, while δ¹³СО2 value ≥2.5‰ indicated the presence of H. pylori infection. The criteria for the infection grade (IG) were defined as follows: IG I (2.5–3.4‰), IG II (3.5–6.4‰), IG III (6.5–9.4‰), and IG IV (>9.5‰). The database for subsequent statistical analysis included such parameters as the patients’ age, gender, history of prior eradication therapy, and the result of the ¹³C-UBT test.

Results

Among all included individuals (mean age 43.3 years (31.0; 55.0); 57.5% of whom were female), there were 83.6% (n=42,543) of primary “naive” patients (who had had no history of prior eradication therapy) (95% confidence interval (CI) 83.3-83.9). The proportion of treated patients was 16.4% (n=8,341; 95% CI 16.1-16.7). The prevalence of H. pylori infection among the primary patients was 51.4% in 2015 (874/1701 subjects; 95% CI 49.0–53.8) and gradually decreased to 32.2% (1904/5916 subjects; 95% CI 31.0–33.4) in 2022. In 2023 H. pylori-positive was 32.7% (1450/4433 subjects; 95% CI 31.3–34.1). Eradication failure was 39.1% in 2015 (148/379 subjects; 95% CI 34.5-44.3). Eradication rate in 2016 was 80.2% (684/853 subjects; 95% CI 77.4-82.7) and increased to 86.8% (702/809 subjects; 95% CI 84.3-88.9) in 2023.
Naive and unsuccessful treated patients demonstrated a very high IG - 73.0 and 66.5%, respectively. H. pylori was detected more often in young adults (18–44 years old (y.o.)). The infection was less commonly detected among children (1.6% of primary and 1.3% of treatment-failure patients).

Conclusion

Overall, our study highlighted a significant decrease of H. pylori-infection from 2015 to 2023. However, the eradication rates in the North-Western district of Russia remain low and do not reach the threshold value of 95%.

References

1. Li Y., Choi H., Leung K. et al. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis // Lancet Gastroenterol. Hepatol. 2023. Vol. 8, No. 6. P. 553–564. DOI: 10.1016/S2468-1253(23)00070-5
2. Malfertheiner P., Megraud F., Rokkas T. et al; European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report // Gut. 2022:gutjnl-2022-327745. DOI: 10.1136/gutjnl-2022-327745