Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease. N-acetylcysteine (NAC) has demonstrated antioxidant and hepatoprotective effects in non-alcoholic steatohepatitis. This study evaluated the impact of high-dose NAC on oxidative stress, insulin resistance, and liver-related outcomes in non-diabetic MASLD patients.

Our study aimed to compare remimazolam, midazolam, and no sedative on postoperative delirium (POD) incidence, cognitive function, inflammation, and recovery in elderly colorectal cancer (CRC) laparoscopic radical resection patients.

Prolonged immobilization in patients with severe acute pancreatitis (SAP) leads to profound physical deconditioning, yet structured rehabilitation protocols remain underexplored in this population.

Sufficient cleansing of the colonic mucosa is of great importance during colonoscopy emphasizing the need for effective preparation agents. Studies evaluating the efficacy of a novel 1 L polyethylene glycol with ascorbate (1 L-PEG-Asc), Plenvu®, versus standard 2 L polyethylene glycol with ascorbate (2 L-PEG-Asc), Moviprep®, have shown promising results regarding bowel cleansing. Nonetheless superiority of 1 L-PEG-Asc has not been shown.

BACKGROUND: High-volume polyethylene glycol (PEG) offers a safe bowel preparation but is often poorly tolerated, whereas low-volume hyperosmotic agents like sodium phosphate (NaP) may improve tolerability but pose safety risks from fluid and electrolyte shifts. We therefore aimed to compare a 1.6-L NaP powder regimen with a standard 4.0-L PEG regimen for bowel preparation efficacy, patient compliance, tolerability, safety in individuals aged 50–70. METHODS: In this multicenter, randomized, single-blind, non-inferiority trial, patients aged 50 to 70 years were randomly assigned to NaP group and PEG group. The primary outcome was the rate of adequate bowel preparation assessed using the Boston Bowel Preparation Scale (BBPS). RESULTS: Between November 2023 and January 2025, 728 patients from 8 tertiary hospitals in China were recruited and 713 patients were randomly assigned to either the NaP group (n = 362) or the PEG group (n = 351). The adequate preparations rate (BBPS ≥ 6 score) was 93.37% in the NaP group and 93.73% in the PEG group (absolute difference − 0.36%, 95% CI -3.97% to 3.24%; Pnon−inferiority < 0.001). The incidence of adverse events, withdrawal time, cecal intubation rate, polyp detection rate, and adenoma detection rate showed no statistical difference. The NaP group exhibited more pronounced changes in blood electrolytes than the PEG group, including potassium (-0.28 ± 0.39 vs. -0.04 ± 0.36, P < 0.001), calcium (-0.11 ± 0.14 vs. -0.04 ± 0.12, P < 0.001), and sodium (1.03 ± 2.79 vs. 0.44 ± 2.62, P < 0.001). However, the alterations in serum creatinine were comparable between the two groups (-0.88 ± 8.57 vs. -1.00 ± 9.58, P = 0.152). No serious adverse events occurred between two groups. Notably, patients in the NaP group reported significantly higher satisfaction scores than those in the PEG group (8.74 ± 1.28 vs. 7.09 ± 1.58, P < 0.001). CONCLUSION: NaP is an effective low-volume purgative that is non-inferior to PEG in Chinese individuals aged 50–70 years with normal renal function. NaP results in greater patient satisfaction. TRIAL REGISTRATION: The study was approved by the research ethic boards from all sites and was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR) (registration number: ChiCTR2500095664) on January 10, 2025.

BACKGROUND AND AIMS: This randomized controlled trial (RCT) sought to investigate whether Saccharomyces boulardii (S. boulardii) can improve the Helicobacter pylori (H. pylori) eradication rate and reduce adverse events when added to the vonoprazan–amoxicillin dual therapy—a first-line treatment. METHODS: This is a single-center, prospective RCT. For the VA (vonoprazan 20 mg twice daily, amoxicillin 750 mg three times daily for 10 days) and VAS (vonoprazan 20 mg twice daily, amoxicillin 750 mg three times daily, and S. boulardii 250 mg twice daily for 10 days) groups, 150 eligible patients were recruited between February 2024 and December 2024. The two groups were compared in terms of eradication rates, adverse events, safety, compliance, and eradication rate-related factors. RESULTS: The eradication rates of the VA and VAS therapies were 89.3% and 93.3% based on intention-to-treat analysis (P = 0.384) and 93.1% and 94.6% based on per-protocol analysis (P = 0.966), respectively. The incidence of adverse events was significantly lower in the VAS group (5.3%) than in the VA group (21.3%; P = 0.004), particularly with regard to abdominal pain (P = 0.020). There was no significant difference in compliance between the VA (96.0%) and VAS groups (98.7%, P = 0.612). Body surface area (BSA) was an influencing factor for the eradication rate in both groups. Liver and kidney functions in both groups before and after the therapy did not change significantly. CONCLUSION: Adding S. boulardii to the VA-dual therapy may reduce the occurrence of adverse effects but may not improve the eradication rate. Low-BSA patients are more suitable candidates for this regimen. TRIAL REGISTRATION: The study protocol received approval and was subsequently registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2300075347). The registration was completed on 1 September 2023, and the publicly accessible record can be found at https://www.chictr.org.cn/ .

BACKGROUND: The diagnosis of autoimmune pancreatitis (AIP) is multidisciplinary. Pathological diagnosis is pivotal when distinguishing AIP from malignancies. In this study, we aim to compare the diagnostic performance and sample adequacy of 19-gauge endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) needles with 20-gauge endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needles in patients with suspected AIP. METHODS: We conducted a single-centre, parallel-group, prospective, randomized controlled trial at Peking Union Medical College Hospital (Beijing, China). Patients with suspected AIP were enrolled between October 2018 and August 2023 and were randomly assigned to undergo tissue specimen collection using either a 19-gauge EUS-FNA needle or a 20-gauge EUS-FNB needle. The primary endpoint was the diagnostic accuracy against International Consensus Diagnostic Criteria, with secondary endpoints including histologic sensitivity, technical success rate, tissue adequacy, and adverse event rate. RESULTS: 46 patients were enrolled and 45 underwent EUS (FNB n = 23, FNA n = 22), amongst 42 had a final diagnosis of AIP. Diagnostic accuracy, as the primary endpoint, was 52.2% (95% CI 33.0–70.8) with 20-G FNB versus 47.8% (95% CI 29.2–67.0) with 19-G FNA (P = 1.00). Sensitivity for histologic diagnosis of AIP was 47.6% (95% CI 28.3–67.6) in both groups (P = 1.00). Core tissue (≥ 500 μm) was obtained in 65.2% vs. 68.2% (P = 0.83). Adverse events were infrequent and similar (4.3%; both mild; P = 1.00). CONCLUSIONS: We did not observe a statistically significant difference in diagnostic efficacy or core tissue acquisition between 19G FNA and 20G forward-bevelled FNB needles for patients with AIP; however, confidence intervals were wide and smaller clinically important differences could not be excluded. The 19-G FNA needle might serve as an alternative in centres where FNB needles are unavailable. TRIAL REGISTRATION: This study was retrospectively registered on 22 November 2018 at ClinicalTrials.gov (NCT03753815); first participant enrolled in October 2018.

BACKGROUND: The probiotic may help restore treatment-impaired gut microbiota and promote beneficial bacterial colonization, but its specific impact on Helicobacter pylori (H. pylori) eradication efficacy and safety remains unclear. This study aimed to evaluate the role of Bacillus subtilis dual viable bacteria capsules (Medilac-S) as an adjunct to dual therapy, focusing on its impact on treatment safety and H. pylori eradication efficacy. METHODS: From April 1 to August 1, 2024, 220 H. pylori-positive patients were enrolled. They were randomly assigned to two treatment groups: the Probiotics Group (receiving Medilac-S, two capsules three times daily; vonoprazan 20 mg twice daily; amoxicillin 1000 mg three times daily) and the Dual Therapy Group (vonoprazan 20 mg twice daily; amoxicillin 1000 mg three times daily). Both groups underwent a 14-day treatment course. At least four weeks after treatment completion, a 13C-urea breath test was performed. H. pylori eradication rates, adverse event incidence, and medication compliance were compared between the two groups. RESULTS: Eradication rates did not differ significantly between groups in intention-to-treat (91.8% vs. 90.9%, P = 0.810), modified intention-to-treat (96.2% vs. 94.3%, P = 0.527), or per-protocol analyses (96.1% vs. 95.1%, P = 0.722). However, the Probiotics Group had significantly fewer adverse events (11.4% vs. 23.6%, P = 0.020). Medication compliance showed no significant difference between the groups (P = 0.414). The occurrence of adverse events was identified as a risk factor for eradication failure (OR = 12.000, P = 0.001). CONCLUSION: Adding Medilac-S as an adjunct to vonoprazan-amoxicillin dual therapy resulted in satisfactory H. pylori eradication. Although the difference in eradication rates between the Probiotics Group and the Dual Therapy Group was not statistically significant, the Probiotics Group showed numerically higher, but not statistically significant, success rates across PP, mITT, and ITT analyses, along with a significant reduction in treatment-related adverse events. Patients experiencing adverse events were more likely to have eradication failure. TRIAL REGISTRATION: https://www.medicalresearch.org.cn/ , identifier ChiCTR2400082446. Registered on March 29, 2024.

BACKGROUND: Dye-based chromoendoscopy is recommended for dysplasia surveillance in inflammatory bowel disease (IBD), but virtual chromoendoscopy systems are increasingly used as practical alternatives. Prospective data directly comparing these techniques on a single imaging platform remain limited. This study aimed to compare dysplasia detection using methylene blue dye-based chromoendoscopy (MB-CE) and Fujifilm virtual chromoendoscopy (blue light imaging [BLI] and linked color imaging [LCI]) during IBD surveillance colonoscopy. METHODS: This was a prospective, randomized, single-center study conducted at Al Adan Hospital, Kuwait. Three hundred adult patients with ulcerative colitis or Crohn’s colitis scheduled for surveillance colonoscopy were randomized 1:1 to MB-CE or BLI/LCI (150 per group). All procedures were performed on Fujifilm ELUXEO systems by a single experienced endoscopist. Targeted biopsies were obtained from all visible lesions, with additional random biopsies every 10 cm. Multivariable logistic regression identified independent predictors of dysplasia detection. RESULTS: Dysplasia was detected in 30 of 300 patients (10.0%). The MB-CE group had a significantly higher per-patient dysplasia detection rate than the BLI/LCI group (12% vs. 8%; p = 0.04). Lesions detected by MB-CE were more frequently flat and located in the proximal colon. On multivariable analysis, MB-CE, disease duration ≥ 10 years, pancolitis, primary sclerosing cholangitis, and exposure to biologic or immunosuppressive therapy were independently associated with dysplasia detection. CONCLUSIONS: Within the Fujifilm ELUXEO platform, MB-CE detected more dysplasia than BLI/LCI, particularly flat and right-sided lesions in high-risk patients. Dye-based chromoendoscopy should remain the preferred surveillance technique in high-risk IBD populations, while virtual chromoendoscopy may be considered in selected lower-risk settings. TRIAL REGISTRATION: ISRCTN, ISRCTN10174296. Registered 9 March 2026, https://www.isrctn.com/ISRCTN10174296 .

Celiac disease is an immune-mediated enteropathy triggered by gluten ingestion. The effect of very small gluten exposures remains uncertain, contributing to international variations in food-labeling standards. Interleukin 2 (IL2) rises rapidly after gluten ingestion, serving as a biomarker of immune activation. We aimed to identify the lowest gluten dose that elicits a measurable IL2 response and accompanying symptoms in treated celiac disease.

OBJECTIVE: White light endoscopy (WLE) is an important method for upper gastrointestinal cancer screening. However, studies have demonstrated that magnifying endoscopy with image-enhanced endoscopy (ME-IEE) achieves a significantly higher detection rate of early cancer compared with WLE. Current research has primarily focused on evaluating the diagnostic performance of ME-IEE, while evidence regarding its feasibility as a routine opportunistic screening mode for early upper gastrointestinal cancer in daily clinical practice remains limited. METHODS: A prospective, single-center, randomized controlled trial was conducted between October 15, 2023, and October 7, 2024. Patients aged ≥ 18 years who underwent painless anesthesia esophagogastroduodenoscopy(EGD) at our endoscopy center were enrolled. Recruited patients were randomly assigned to either the routine magnifying endoscopy group (r-ME group) or the white light endoscopy group (WLE group). All suspicious lesions were biopsied. The primary endpoint was the detection rate of early neoplasms; secondary endpoints included biopsy implementation rate, biopsy positivity rate, mean screening time, and mean number of biopsies. RESULTS: A total of 3,000 patients were randomized (1:1). The detection rate of early neoplasms and biopsy positivity rate were significantly higher in the r-ME group than the WLE group (3.87% vs. 2.27% and 6.34% vs. 3.58%, respectively; both P < 0.05). However, the mean screening time was slightly longer in the r-ME group, by less than a minute (643s vs. 600s, P < 0.05). Among expert endoscopists, the detection rate of early neoplasms was significantly higher than that of non-expert endoscopists (4.54% vs. 2.50%, P < 0.05), while the biopsy submission rate was significantly lower (56.5% vs. 64.4%, P < 0.05). For non-expert endoscopists, both the detection rate of early neoplasms and biopsy positivity rate were significantly higher in the r-ME group than in the WLE group (3.32% vs. 1.67% and 5.29% vs. 2.53%, respectively; both P < 0.05). In contrast, no significant differences were observed of the above endpoints between the two groups for expert endoscopists (5.28% vs. 3.81% and 9.36% vs. 6.72%, both P > 0.05). The detection rate of early cancer using WLE mode was significantly lower for non-expert endoscopists compared with expert endoscopists (1.67% vs. 3.81%, P < 0.05). Notably, when r-ME mode was used, the detection rate achieved by non-expert endoscopists did not differ significantly from that of expert endoscopists (3.32% vs. 5.28%, P > 0.05), nor from that of expert endoscopists using WLE mode (3.32% vs. 3.81%, P > 0.05). CONCLUSION: The r-ME model enhances diagnostic accuracy and consistency in opportunistic screening for early upper gastrointestinal cancer, offering particular value for non-expert endoscopists. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry on 03/10/2023 (clinical trial registration number: ChiCTR2300076327).

Evidence about the effect of artificial intelligence (AI) on upper endoscopy in multicenter, randomized controlled trials is lacking. We aimed to explore whether AI can enhance gastric neoplasm detection.

The ADMIRE CD trial demonstrated the efficacy and safety of darvadstrocel in patients with complex perianal fistulas from Europe and Israel. The efficacy and safety of darvadstrocel in an expanded patient population was investigated.

Secondary loss of response to ustekinumab is observed in patients with Crohn's disease (CD). Multiple dose-intensification regimens have been proposed. We aimed to test prospectively 2 different dose-intensification regimens with ustekinumab in patients with CD experiencing secondary loss of response.

The optimal timing for direct endoscopic necrosectomy (DEN) after endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic necrotizing pancreatitis remains unknown. We hypothesized that immediate DEN after EUS-guided drainage might reduce the time to disease resolution compared with a drainage-oriented step-up approach.

OBJECTIVE: Anastomotic stricture (AS) is a common complication following low-level anastomosis of the colon and rectum in rectal cancer (RC) surgery. The aim of this study is to evaluate whether intraoperative stay sutures combined with postoperative anal dilatation reduce the incidence of AS after low anterior resection with defunctioning stoma. METHODS: A total of 240 patients with low RC who underwent treatment at the Ninth Medical Center of the PLA General Hospital between February 2019 and May 2024 were randomly assigned to four groups (n = 60 each): one experimental group and three control groups (A, B, and C). The experimental group underwent intraoperative placement of stay sutures at the anastomotic site under anoscopic guidance during low anterior resection with defunctioning stoma, with 3 to 4 radial transanastomotic sutures placed across the anastomotic line. Postoperative anal dilatation was initiated two weeks after surgery. Control group A received only intraoperative stay sutures; control group B received only postoperative anal dilatation; control group C received neither intervention. The incidence of AS was evaluated 1 to 2 months postoperatively, with follow-up continuing from 2 months to 1 year. RESULTS: The incidence of AS was 0% in the experimental group, 2% in control group A, 7% in control group B, and 48% in control group C. CONCLUSION: The combined use of intraoperative stay suture placement and postoperative anal dilatation was effective in preventing AS following low anterior resection with defunctioning stoma in patients with RC. Intraoperative stay sutures also provided additional benefits in reinforcing anastomosis and achieving hemostasis. Owing to its simplicity, safety and clinical utility, this strategy may be considered for broader application in surgical practice.

Treatment of Helicobacter pylori infection after previous eradication failure remains challenging. This study evaluated the efficacy and safety of a vonoprazan-tetracycline (VT) dual regimen as a potential rescue therapy.

Hepatocellular carcinoma (HCC) surveillance is key to early diagnosis and timely curative treatment. Current strategies are suboptimal with many patients presenting with advanced HCC. This randomized controlled trial compared the combined use of serum biomarker (BM) measurements and abdominal ultrasound (US) with US alone for the diagnosis of early-stage HCC.

Postprocedural pancreatitis is the most common adverse event (AE) associated with endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent is emerging as a promising approach for managing malignant distal biliary obstruction, offering the potential to lower the risk of postprocedural pancreatitis.

The role of low-grade-inflammation in Irritable Bowel Syndrome (IBS) a common disorder of gut-brain interaction is unclear. Association with symptom severity, as well as effects of first line treatments are understudied. In a large cohort of primary care IBS patients (DOMINO trial), a FODMAP-lowering diet application was superior in improving symptoms compared to standard medical therapy (otilonium bromide, OB). We investigated the level of pro-inflammatory markers in this IBS cohort and its changes by the DOMINO application and OB.