Saku Central Hospital

ABSTRACT Background The prognostic impact of prior cholecystectomy (CCY) in patients with colorectal cancer (CRC) remains uncertain. The aim of this study was to evaluate the prognostic impact of prior CCY in a large cohort of patients with CRC, with particular attention to tumor location. Methods We retrospectively analyzed all patients diagnosed with colorectal adenocarcinoma between January 2012 and December 2023. Patients were classified into proximal (cecum, ascending, and transverse) and distal (descending, sigmoid, and rectum) groups. Survival outcomes were compared using multivariate Cox proportional hazards regression models, including an interaction term between tumor location and history of CCY. Propensity score matching (PSM) was performed as a sensitivity analysis. Results Among 3487 patients (1375 proximal and 2112 distal CRC), 158 (4.8%) had a history of CCY. Proximal CRC was more frequently associated with female sex, older age, history of CCY, poor differentiation, BRAF mutation, MSI‐high status, and non‐resection initial strategy ( p ≤ 0.005). Among proximal CRC patients, multivariate analysis revealed TNM stage III/IV ( p < 0.001), non‐resection initial strategy ( p < 0.001), and history of CCY ( p = 0.042) were independent predictors of poor overall survival (OS). Prior CCY was associated with worse OS in proximal CRC ( p = 0.004). A significant interaction between tumor location and history of CCY was observed ( p for interaction = 0.025). Conclusions History of CCY was associated with worse prognosis in proximal CRC but not in distal CRC, suggesting a differential impact of CCY on prognosis in CRC. Our findings would provide insight into further research on bile acid metabolism or microbiome modulation in CRC patients.

[Purpose] In this study, we aimed to investigate the effects of stride count on the values, validity, and test-retest reliability ofautocorrelation-based gait variability variables in older adults requiring long-term care. [Participants and Methods] Thirty participantswalked along a 20-meter walkway with a triaxial accelerometer attached to the trunk. The experimental protocol included two walkingsessions, each consisting of two consecutive trials. Autocorrelation coefficients were derived from trunk acceleration signals while varyingthe stride count from 2 to 10 in one-stride increments. We analyzed the influence of stride count on the absolute differences betweenautocorrelation coefficients and their 10-stride reference values. Additionally, for each stride count, we assessed correlations betweenautocorrelation coefficients and age-related outcomes, as well as the test-retest reliability of these coefficients. [Results] Absolutedifferences in autocorrelation coefficients decreased as stride count increased. Variations in stride count influenced age-related outcomesassociated with autocorrelation coefficients. Test-retest reliability improved with increasing stride count. [Conclusion] These findingsindicate that changes in stride count affect the values, validity, and test-retest reliability of autocorrelation-based gait variabilityvariables in older adults requiring long-term care.

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37-91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1-4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5-14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm2) at a rate of 9.3 cm2/h in 121 min. Tutored beginners achieved a 75% [25-100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers.

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Esophageal squamous cell carcinoma (ESCC) in patients with no history of tobacco smoking or alcohol consumption accounts for approximately 5% of all ESCCs. This study aimed to clarify the clinicopathological features of superficial ESCCs in patients with no history of tobacco smoking or alcohol consumption. Clinical data and pathological features of 108 superficial ESCCs in endoscopic submucosal dissection (ESD) specimens obtained from 102 patients with no history of tobacco smoking or alcohol consumption (NTNA group) were reviewed. For comparison, the clinicopathological features of 767 superficial ESCCs in ESD specimens from 544 patients with history of tobacco smoking and alcohol consumption (TA group) were also reviewed. Factors analyzed included age, sex, synchronous/metachronous cancer, gastroesophageal reflux disease (GERD), tumor size, tumor site, macroscopic type, Lugol-voiding lesion (LVL) grade, invasion depth, and lymphovascular invasion. LVLs were graded as A (no lesions), B (1-9 lesions), and C (> 9 lesions). The univariate analysis revealed that female predominance (p < 0.01), absence of synchronous/metachronous cancer (p < 0.01), grade A LVLs (p < 0.01), presence of GERD (p < 0.01), tumor location in the middle thoracic esophagus (p < 0.05), tumor location at the posterior wall (p < 0.05), and 0-IIa macroscopic type (p < 0.01) were significantly more frequently observed in NTNA group than in TA group. Multivariate analysis identified female predominance (OR 68.2, p < 0.001), LVL grade A (OR 50.6, p < 0.001), and 0-IIa macroscopic type (OR 7.2, p < 0.001) as significant features in the NTNA group. This study demonstrated the unique clinicopathological features of ESCCs in patients with NTNA.

ObjectivesAlthough accurate assessment of polyp morphology helps endoscopists select the appropriate management for colorectal polyps, some studies have reported unsatisfactory accuracy in such assessment. This study aimed to clarify the usefulness of a short educational video available on the Internet for accurate polyp morphology assessment.MethodsThis was a multicenter randomized controlled trial. Participants were randomly assigned to the pre‐ or post‐education groups after a pre‐test comprising images of 42 polyps, including 12 laterally spreading tumors. Participants who scored ≥ 80% on the pre‐test were excluded. Only the post‐education group completed the diagnostic test after watching an online educational video. The primary outcome was the difference in diagnostic accuracy between the pre‐test and diagnostic tests for each group.ResultsOf the 296 endoscopists enrolled from 48 institutions, 34 missed the test deadline, and 29 who scored ≥ 80% in the pre‐test were excluded. The primary outcome analysis sets were 117 and 116 in the pre‐ and post‐education groups, respectively. The mean pre‐test accuracies in the pre‐education and post‐education groups were 60.6% and 60.7%, respectively. The difference in diagnostic accuracy between the pre‐test and diagnostic test was significantly higher in the post‐education than the pre‐education group (12.0 points, 95% confidence interval [CI] 9.9–14.1 and 2.3 points, 95% CI 0.9–3.6; p < 0.001).ConclusionThis multicenter randomized controlled trial demonstrated the usefulness of a short educational video for accurate polyp morphology assessment.

Shigeru Nishiyama, Takeshi Hisa, Aki Ego, Shogo Sakata, Yui Ito, Akiharu Kudo, Takahiro Yamada, Shozo Osera, Hideki Fukushima, Shunta Ishizaki, Ryoga Hamura, Masashi Tsunematsu, Kyohei Abe, Yoshihiro Shirai, and Shinji Onda. Int J Gastrointest Interv 2025;14:15-9. https://doi.org/10.18528/ijgii240065