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Aims/Introduction Previous studies have reported that the glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) delays gastric emptying, and gastric emptying was assessed by the 13C breath test or paracetamol absorption technique. However, neither of them is clinically familiar in real‐world clinical practice. The purpose of the present study was to investigate the association between GLP‐1RA treatment and gastric residue in an esophagogastroduodenoscopy. Materials and Methods This study was a matched pair case–control study. The study population consisted of 1,128 individuals with diabetes who had esophagogastroduodenoscopy at our clinic between July 2020 and June 2022. To account for differences in characteristics, such as age, sex, insulin treatment and glycated hemoglobin, we carried out a one‐to‐one nearest neighbor propensity score matching analysis between diabetes patients with and without GLP‐1RA treatment. After matching, we compared the presence of gastric residue in an esophagogastroduodenoscopy by the McNemar test between patients with and without GLP‐1RA treatment. Results After the propensity score matching, we selected 205 pairs. In the propensity score‐matched comparison, the proportion of gastric residue was statistically significantly higher in the GLP‐1RA treatment group (0.49% vs 5.4%, P = 0.004). The details of GLP‐1RA prescribed for the 11 patients with gastric residue were liraglutide once daily 1.8 mg (n = 2), dulaglutide once weekly 0.75 mg (n = 5), semaglutide once weekly 0.5 mg (n = 2) and semaglutide once weekly 1.0 mg (n = 2). Conclusion GLP‐1RA treatment is associated with gastric residue in an esophagogastroduodenoscopy in patients with diabetes. The purpose of the present study was to investigate whether glucagon‐like peptide‐1 receptor agonist treatment is associated with gastric residue in an esophagogastroduodenoscopy. To account for differences in characteristics, such as age, sex, insulin treatment and glycated hemoglobin, we carried out a one‐to‐one nearest neighbor propensity score matching analysis between diabetes patients with and without glucagon‐like peptide‐1 receptor agonist treatment. This matched pair case–control study shows for the first time that taking glucagon‐like peptide‐1 receptor agonist treatment is associated with gastric residue in an esophagogastroduodenoscopy in patients with diabetes.

In a prospective study involving 50 patients with severe aortic stenosis and anemia, 94% had angiodysplasia, of whom 69% had lesions in the small intestine. After TAVR, the number and size of angiodysplastic lesions were reduced.

Background: Submucosal fibrosis is a known risk factor for adverse outcomes in colorectal endoscopic submucosal dissection (ESD). However, evidence regarding the presence and impact of fibrosis in colorectal serrated lesions (CSLs) remains limited. Objectives: This study aimed to evaluate the association between CSLs and submucosal fibrosis, and to assess the impact of fibrosis presence on therapeutic outcomes of colorectal ESD. Design: Retrospective cohort study. Methods: We retrospectively reviewed consecutive colorectal ESD cases performed between 2020 and 2024. Only lesions ⩾20 mm were included; cases were classified as CSLs and adenoma + T1 cancer according to histological diagnosis. CSLs included sessile serrated lesions (SSL), traditional serrated adenomas, SSL with dysplasia, and unclassified serrated adenomas. Patient/lesion characteristics, presence of fibrosis, severe fibrosis, and ESD outcomes were assessed. Multivariate analyses, including CSLs’ histology, were performed to identify factors associated with the presence of submucosal fibrosis and severe fibrosis. Results: A total of 445 colorectal ESD cases were included, comprising 72 CSLs and 373 adenoma + T1 cancer. CSLs were significantly associated with a lower presence of fibrosis (34.7% and 48.5%, p = 0.04) and severe fibrosis (6.9% vs 18.2%; p = 0.03) compared to adenoma + T1 cancer. In multivariate analysis, CSLs’ histology (odds ratio (OR): 0.58; p = 0.04), lesion size ⩾40 mm (OR: 2.03; p < 0.01), and rectal location (OR: 0.40; p < 0.01) were significantly related to fibrosis presence. Lesion size ⩾40 mm (OR: 2.45; p < 0.01) and polypoid morphology (OR: 3.42; p < 0.01) were significantly related to severe fibrosis. Conclusion: CSLs’ histology was negatively correlated with submucosal fibrosis in colorectal ESD.

Background: Endoscopic submucosal dissection (ESD) enables en bloc resection of large colorectal lesions, but it remains challenging due to thin walls and poor operability. Traction devices like SureClip traction band (SCTB, Micro-tech) and SO clip (SO-C, Zeon Medical Inc.) are used to address this. This study compared the differences in ESD outcomes between SCTB and SO-C. Objective: Comparative analysis of the efficacy of SO-C and SCTB for various therapeutic results, including procedure time in colorectal ESD. Design: A single-center retrospective study reviewed 982 colorectal ESD procedures for lesions 20–49 mm performed at Kyoto Prefectural University of Medicine from January 2015 to November 2024. Methods: Patients were categorized into no-traction, SCTB, and SO-C groups. Propensity score matching was performed to minimize baseline differences. The primary outcome was ESD procedure time, and secondary outcomes assessed various therapeutic results. Results: After matching, there were no differences in procedure time (56.0 ± 31.2 vs 59.8 ± 30.6 min, p = 0.206), en bloc resection (97.7% vs 98.3%, p = 0.589), and perioperative perforation (0.3% vs 1.4%, p = 0.101) between the traction (SCTB + SO-C) and no-traction groups. Regarding the comparison between the SCTB and SO-C groups after matching, there were no significant differences regarding ESD procedure time (58.7 ± 37.4 vs 59.1 ± 31.9 min, p = 0.469), en bloc resection (97.4% vs 97.4%, p = 1.000), and perioperative perforation (0% vs 0.9%, p = 0.316). The SCTB deployment was significantly faster than the SO-C (6.3 ± 3.8 vs 9.3 ± 5.9 min, p = 0.004). Conclusion: There were no significant differences in ESD therapeutic results between SCTB and SO-C, while the SCTB had a faster deployment time.

INTRODUCTION:The efficacy of texture and color enhancement imaging (TXI) in the novel light-emitting diode endoscopic system for polyp detection has not been examined. We aimed to evaluate the noninferiority of the additional 30-second (Add-30-s) observation of the right-sided colon (cecum/ascending colon) with TXI compared with narrow band imaging (NBI) for detecting missed polyps.METHODS:We enrolled 381 patients ≥40 years old who underwent colonoscopy from September 2021 to June 2022 in 3 institutions and randomly assigned them to either the TXI or NBI groups. The right-sided colon was first observed with white light imaging in both groups. Second, after reinsertion from hepatic flexure to the cecum, the right-sided colon was observed with Add-30-s observation of either TXI or NBI. The primary endpoint was to examine the noninferiority of TXI to NBI using the mean number of adenomas and sessile serrated lesions per patient. The secondary ones were to examine adenoma detection rate, adenoma and sessile serrated lesions detection rates, and polyp detection rates in both groups.RESULTS:The TXI and NBI groups consisted of 177 and 181 patients, respectively, and the noninferiorities of the mean number of adenomas and sessile serrated lesions per patients in the second observation were significant (TXI 0.29 [51/177] vs NBI 0.30 [54/181], P < 0.01). The change in adenoma detection rate, adenoma and sessile serrated lesions detection rate, and polyp detection rate for the right-sided colon between the TXI and NBI groups were not different (10.2%/10.5% [P = 0.81], 13.0%/12.7% [P = 0.71], and 15.3%/13.8% [P = 0.71]), respectively.DISCUSSION:Regarding Add-30-s observation of the right-sided colon, TXI was noninferior to NBI.

IntroductionAn endoscopic system using 5-color light-emitting diodes (LEDs) (EVIS X1; Olympus Co., Tokyo, Japan), which includes texture and color enhancement imaging (TXI), has been released. In this study, we analyzed the effects of TXI on the visibility of non-polypoid colorectal lesions and its diagnostic accuracy.MethodsWe reviewed 101 non-polypoid lesions from 26 patients observed with white light imaging (WLI), narrow band imaging (NBI), and TXI. One representative image of each mode was evaluated by 6 endoscopists using a polyp visibility score of 4 (excellent) to 1 (poor). We calculated the color difference (CD) values for each lesion in the three modes. For tumor characteristics, one representative image of TXI and NBI magnification was evaluated by 3 experts according to a NBI classification.ResultsThe least squares means [95% confidence interval] of polyp visibility score of TXI (3.42 [3.06–3.77]) was significantly higher than that of WLI (2.85 [2.49–3.20], p < 0.001) but not that of NBI (3.33 [2.98–3.69], p = 0.258). The CD value of TXI (13.3 ± 6.3) was higher than that of WLI (9.7 ± 6.0, p < 0.001) but not that of NBI (13.1 ± 6.8, p = 0.81). For sessile serrated lesions, the CD value of TXI (11.1 ± 4.4) tended to be lower than that of NBI (12.6 ± 6.0, p = 0.07). The diagnostic accuracy and confidence level of magnification for NBI were significantly better than those for TXI (87.1 vs. 80.5%, p = 0.027, 87.5 vs. 62.7%, p < 0.001, respectively).ConclusionTXI showed better visibility than WLI in terms of the endoscopist’s score and CD value and may improve polyp detection.

Objectives We aimed to conduct a systematic review and meta‐analysis to assess the value of image‐enhanced endoscopy including blue laser imaging (BLI), linked color imaging, narrow‐band imaging (NBI), and texture and color enhancement imaging to detect and diagnose gastric cancer (GC) compared to that of white‐light imaging (WLI). Methods Studies meeting the inclusion criteria were identified through PubMed, Cochrane Library, and Japan Medical s Society databases searches. The pooled risk ratio for dichotomous variables was calculated using the random‐effects model to assess the GC detection between WLI and image‐enhanced endoscopy. A random‐effects model was used to calculate the overall diagnostic performance of WLI and magnifying image‐enhanced endoscopy for GC. Results Sixteen studies met the inclusion criteria. The detection rate of GC was significantly improved in linked color imaging compared with that in WLI (risk ratio, 2.20; 95% confidence interval [CI], 1.39–3.25; p < 0.01) with mild heterogeneity. Magnifying endoscopy with NBI (ME‐NBI) obtained a pooled sensitivity, specificity, and area under the summary receiver operating curve of 0.84 (95 % CI, 0.80–0.88), 0.96 (95 % CI, 0.94–0.97), and 0.92, respectively. Similarly, ME‐BLI showed a pooled sensitivity, specificity, and area under the curve of 0.81 (95 % CI, 0.77–0.85), 0.85 (95 % CI, 0.82–0.88), and 0.95, respectively. The diagnostic efficacy of ME‐NBI/BLI for GC was evidently high compared to that of WLI, However, significant heterogeneity among the NBI studies still existed. Conclusions Our meta‐analysis showed a high detection rate for linked color imaging and a high diagnostic performance of ME‐NBI/BLI for GC compared to that with WLI.

Objective Prevalence of colonoscopy (CS) is an important countermeasure against colorectal cancer (CRC). In this study, we used large-scale data for a comparison of CS with esophagogastroduodenoscopy (EGD) in Japan. Methods This was a retrospective descriptive study. Commercially anonymized patient data were collected from various health insurance societies (JMDC, Inc. Tokyo, Japan) generated from the insurance registry, receipts (inpatient, outpatient, and prescription), and health checkup data. The data also included healthy subjects who had never been examined in a hospital. The data of 2,760,048 persons who were 50–75 years old during January 2012–December 2019 were extracted from the original data source. The annual rate, the prevalence rate (frequency of those undergoing at least one endoscopy during the period), and the percentage of repeaters (undergoing endoscopy at least twice during the period) of CS were calculated and compared to those of EGD. Results The annual rates in 2012/2015/2019 were 3.4%/4.5%/5.3% for CS, respectively, and increased gradually from 2012 to 2019. Those rates were 7.0%/7.9%/7.4% for EGD, respectively, and did not increase. The prevalence rates of CS and EGD were 25.3% and 36.2%, respectively, among the 137,246 participants over 8 years. The prevalence rates of individuals in their 50 s/60 s/70 s were 23.0%/25.9%/31.4% for CS and 33.0%/37.6%/40.7% for EGD, respectively. The proportions of males/females were 27.9%/20.7% for CS, and 36.4%/35.8% for EGD, respectively. The repeat rates of CS and EGD were 40.3% and 44.8%, respectively, over 8 years. Conclusions Using large-scale data, we determined the status of CS and EGD in Japan.

Background/Objectives: A new LED endoscopy system featuring advanced noise-reduction technology, the EP-8000 with the EC-860ZP colonoscope (Fujifilm), was introduced in 2024. We evaluated the improvements in colonoscopic image quality of this system, comparing it with a previous system/scope (VP-7000/EC-760ZP). Methods: This is a multicenter, observational study. From January 2024 to February 2025, 150 patients undergoing colonoscopy at two institutions were enrolled. Images of the cecum and lesions were captured using white light imaging (WLI), blue light imaging (BLI), and linked color imaging (LCI) under similar conditions. Participants were divided into three groups: Group 1 (EP-8000+EC-860ZP; 50 cases), Group 2 (EP-8000+EC-760ZP; 50 cases), and Group 3 (VP-7000+EC-760ZP; 50 cases). Cecal and lesion images were evaluated for brightness, halation, and visibility using a four-point scale (1 = poor to 4 = excellent) by endoscopists and original values by image-analysis software. Results: In cecal images, the endoscopists’ scores in Group 1 were significantly better than in Group 3 for brightness (WLI: 3.71 ± 0.55 vs. 3.51 ± 0.58, p < 0.001, BLI: 3.15 ± 0.85 vs. 2.23 ± 0.92, p < 0.001; LCI: 3.83 ± 0.42 vs. 3.54 ± 0.58, p < 0.001) and for halation (WLI: 3.60 ± 0.51 vs. 3.18 ± 0.59, p < 0.001, BLI: 2.99 ± 0.69 vs. 2.71 ± 0.78, p < 0.001; LCI: 3.33 ± 0.60 vs. 3.10 ± 0.58, p < 0.001). Software analysis confirmed that Group 1 had superior brightness values compared with Group 3 for WLI, BLI, and LCI, as well as lower halation values for WLI and LCI. Regarding lesion images, brightness, halation, and visibility for WLI, BLI, and LCI were superior in Group 1 than in Group 3. Conclusions: The new LED system provided improvements in brightness, halation, and lesion visibility.

Background Nonalcoholic fatty liver disease is characterized by excessive hepatic fat accumulation. Some individuals frequently present elevated gamma-glutamyl transferase (GGT) levels without fatty liver ultrasound images and other abnormal liver enzymes levels. However, whether these individuals are at an elevated risk for developing fatty liver is unclear. We compared fatty liver change rates and risk factors between individuals with frequently elevated GGT levels and those with normal levels. Methods We designed a retrospective cohort study on the basis of complete medical checkup records. One group of individuals had presented normal serum GGT levels during the observation period (Normal-GGT group, n  = 2713). Another group had had abnormal elevated serum GGT levels frequently (Abnormal-GGT group, n  = 264). We determined the fatty liver change incident rates before and after propensity score matching. We explored confounding factors affecting fatty changes in each group using univariate and multivariate Cox models. Results The change incidence rates were 5.80/1000 and 10.02/1000 person-years in the Normal-GGT and Abnormal-GGT groups, respectively. After propensity score matching, the incidence rates were 3.08/1000 and 10.18/1000 person-years in the Normal-GGT and Abnormal-GGT groups, respectively ( p  = 0.026). The factors associated with fatty liver changes in the Normal-GGT group included body mass index (BMI), hemoglobin, alanine aminotransferase (ALT), albumin, triglyceride (TG), fasting blood sugar, and high-density lipoprotein levels. Those in the Abnormal-GGT group were platelet counts and TG. In our multivariable analysis, BMI, ALT, albumin, and TG levels were independent predictors of fatty changes in the Normal-GGT group, and high TG level was the only independent predictor in the Abnormal-GGT group. Conclusions The incidence rate of fatty liver change in the Abnormal-GGT group was higher than that in the Normal-GGT group. Consecutive elevated GGT levels increase the risk for fatty liver, and high TG levels in those individuals further independently increase the risk.