Application of endoscopic submucosal dissection (ESD) for treating undifferentiated-type early gastric cancers (EGCs) remains controversial. Therefore, we aimed to compare long-term outcomes of ESD with those of surgery for patients with undifferentiated-type EGCs by a retrospective study. We retrospectively reviewed data of patients who underwent curative ESD or gastrectomy for undifferentiated-type EGCs between 2010 and 2017. Gastric cancers were undifferentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Demographics, complications, recurrence cancer rates, and survival data were collected and compared. Forty patients who underwent curative ESD and 52 patients who underwent surgery were included. The median follow-up duration was 74.6 months. There was no significant difference of metachronous gastric cancer rate (5.0% vs 3.8%, P = .75) or total cancer recurrence rate (10.0% vs 3.8%, P = .33) between the 2 groups. The 5-year overall survival, disease-free survival, recurrence-free survival rates did not significantly differ between the 2 groups (P = .72, .26, .27 respectively). There were no gastric cancer-related deaths in either group. Long-term outcomes after curative ESD for undifferentiated-type EGCs that met the expanded indication were comparable to that achieved with surgery. ESD without additional surgery is an acceptable choice to treat undifferentiated-type EGCs that meet the curative criteria.

INTRODUCTION: Ectopic embolism caused by cyanoacrylate migration is a severe complication. We aimed to test the hypothesis that prior clipping can reduce ectopic embolism secondary to endoscopic cyanoacrylate injection (ECI) in gastric varices with a gastrorenal shunt. METHODS: In this multicenter, open-label, parallel, randomized controlled trial, patients with fundal gastric varices and gastrorenal shunts from 10 tertiary hospitals were randomly assigned to clip-assisted ECI (Clip-ECI, n = 35) and conventional ECI groups (Con-ECI, n = 35). The primary outcome was the occurrence of ectopic embolism. Computed tomography was performed within 48 hours of the initial injection to screen for cyanoacrylate (marked with lipiodol) migration. RESULTS: The technical success rate was 100% in both groups. The Clip-ECI group had a significantly lower incidence of cyanoacrylate embolism than the Con-ECI group (11.4% vs 42.9%, P = 0.003). Symptomatic pulmonary embolism occurred in 4 patients in the Con-ECI group, of which 1 patient died. By contrast, no symptomatic embolism event was observed in the Clip-ECI group (11.4% vs 0%, P = 0.114). No clip-related bleeding was reported. No significant differences were observed in the total rebleeding rate (14.3% vs 14.3%) and survival rate (97.1% vs 93.9%) between the Clip-ECI and Con-ECI groups during a median follow-up of 10.1 (interquartile range 7.7–12.9) and 9.9 (interquartile range 6.3–12.6) months, respectively. DISCUSSION: Clipping before ECI reduces the risk of ectopic embolism in patients with fundal varices with a portal-systemic shunt, without compromising safety or efficacy.

Liver fibrosis is a reversible condition that occurs in the early stages of chronic liver disease. To develop effective treatments for liver fibrosis, understanding the underlying mechanism is crucial. The NOD-like receptor protein 3 (NLRP3) inflammasome, which is a part of the innate immune system, plays a crucial role in the progression of various inflammatory diseases. NLRP3 activation is also important in the development of various liver diseases, including viral hepatitis, alcoholic or nonalcoholic liver disease, and autoimmune liver disease. This review discusses the role of NLRP3 and its associated molecules in the development of liver fibrosis. It also highlights the signal pathways involved in NLRP3 activation, their downstream effects on liver disease progression, and potential therapeutic targets in liver fibrosis. Further research is encouraged to develop effective treatments for liver fibrosis.

To identify risk factors of hepatocellular carcinoma (HCC) in cirrhotic patients with chronic hepatitis B (CHB). A total of 715 cirrhotic patients with CHB were recruited from the Zhongshan Hospital Affiliated to Fudan University and enrolled in this case-control study between January 2009 and September 2014. All participants were Chinese Han residing in Shanghai and the surrounding areas. The patients were divided into a cirrhosis group (n =281) and a HCC group (n=434). History of hepatitis B infection and HCC, as well as clinical data from serological, imaging and pathological examinations were collected for analysis.SPSS software, version 19.0, was used for all statistical comparisons. Single factor analysis indicated that development of HCC in cirrhotic patients with CHB was significantly associated with male sex, age of 50 years or more, family history of HCC, alcohol consumption,fatty liver, detectable levels of hepatitis B virus (HBV) DNA, and history of HBV infection without effective antiviral treatment. Multivariate logistic regression analysis indicated that age of 50 years or more (P =0.005, odds ratio [OR] =1.766), history of alcohol consumption (P =0.002, Or = 2.570), family history of HCC (P =0.014, Or = 2.268), fatty liver (P =0.023, Or = 3.390), and history of HBV infection without effective antiviral treatment (P < 0.001,Or = 5.389) were risk factors of HCC.The risk factors for development of HCC in cirrhotic patients with hepatitis B after achieving sustained virologic suppression (SVS) were family history of HBV infection (P =0.014, Or = 2.537), family history of HCC (P =0.037,Or = 3.339) and fatty liver (P =0.018, Or = 11.646). Risk factors of HCC in cirrhotic patients with CHB include age,drinking history,family history of HCC, fatty liver, and ineffective antiviral treatment of CHB.Family history of HBV infection or HCC, and fatty liver disease, were significantly associated with HCC development after SVS in patients with hepatitis B-related cirrhosis.

Background: Hepatic sinusoidal obstruction syndrome (HSOS) is a rare but life-threatening liver condition. The clinical utility of transjugular intrahepatic portosystemic shunt (TIPS) for HSOS remains unclear.Methods: A systematic review and meta-analysis was performed across five databases (up to November 2024) to evaluate the efficacy and safety of TIPS in HSOS patients. Key outcomes included technical success, clinical response, portal pressure changes, survival, and complications.Results: Nineteen studies involving 465 patients were included. Pooled technical success and clinical response rates were 100 and 94.2%, respectively. TIPS significantly reduced portal pressure (mean PPG: −13.5 mmHg; PVP: −12.3 mmHg). The 3-month and 1-year survival rates were both 91.6%. Hepatic encephalopathy occurred in 13.2% of patients.Conclusion: TIPS is a feasible and relatively safe treatment for HSOS, particularly in patients with pyrrolizidine alkaloid–induced HSOS (PA-HSOS). Further research is warranted to confirm its long-term benefits.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024620323, identifier CRD42024620323.