Xuan Huang

Ulcerative colitis (UC) is characterized by gut dysbiosis and impaired mucosal metabolism, positioning short-chain fatty acids (SCFAs) as pivotal mediators. This review moves beyond general mechanisms, offering an in-depth analysis of SCFA metabolic fate, including specific transporters (e.g., monocarboxylate transporter 1 (MCT1) and sodium-coupled monocarboxylate transporter 1 (SMCT1)), the concept of “colon fuel priority,” and their systemic distribution bypassing first-pass hepatic metabolism to reach distant organs. We integrate the established role of SCFAs in modulating immunity and barrier function with their significant but lesser-discussed effects on attenuating oxidative stress and regulating colonic motility. Crucially, we highlight SCFAs’ emergence as dynamic metabolic “fingerprints” with significant diagnostic and prognostic potential, offering advantages over conventional inflammatory markers. The therapeutic section emphasizes novel strategies, from microbiota-targeted approaches to the urgent need for efficient, site-specific delivery systems. By systematically bridging deep mechanistic understanding, biomarker utility, and innovative delivery platforms, this review advances SCFA-centered nutritional strategies toward precise and individualized management of UC.

Background and aims: Non-submucosal injection endoscopic submucosal excavation (NSI-ESE) and mucosal snare resection-assisted endoscopic submucosal excavation (MSR-ESE) are novel techniques for the treatment of gastric submucosal tumors (SMTs). This study aims to evaluate the feasibility, safety, and efficacy differences between these two methods in the management of gastric SMTs. Methods: A retrospective analysis was conducted on 95 eligible patients who underwent endoscopic treatment for gastric SMTs between 01/01/2022 and 31/12/2024, including 41 patients treated with MSR-ESE and 54 with NSI-ESE. Differences in operative time, safety, and cost-effectiveness between the two groups were compared, and multivariate linear regression analysis was performed to investigate the independent impact of the surgical approach on operative time. Results: There were no significant differences between the two groups in baseline characteristics, en bloc resection rate, or incidence of adverse events such as intraoperative perforation and delayed bleeding. However, the MSR-ESE group had significantly longer tumor exposure time (6.37 ± 2.98 min vs. 4.61 ± 2.94 min, p = 0.001), tumor excavation time (29.59 ± 9.09 min vs. 24.09 ± 9.87 min, p = 0.007), and total procedure time (35.95 ± 10.23 min vs. 30.63 ± 11.61 min, p = 0.022) compared with the NSI-ESE group. Multivariate regression analysis confirmed that MSR-ESE was an independent factor associated with prolonged tumor exposure time (β = 1.60, p = 0.005) and total procedure time (β = 5.43, p = 0.012). In addition, the surgery-related cost was significantly higher in the MSR-ESE group than in the NSI-ESE group (US$874.94 ± 106.40 vs. US$731.90 ± 108.98, p < 0.038). Conclusion: In the treatment of gastric SMTs, MSR-ESE did not demonstrate any advantages in efficiency or safety compared with NSI-ESE; instead, it resulted in a significantly longer procedure time, more discomfort and increased economic burden. Therefore, the routine use of snare-assisted mucosal resection during ESE is not recommended in clinical practice.

Background and Aims The uncertainty surrounding the risk of recurrence and metastasis in T1 colorectal cancer (CRC) with solely deep submucosal invasion (DSI, defined as T1b, submucosal invasion exceeding 1000 μm) as a high-risk factor has led to controversial treatment strategies. This meta-analysis aims to assess the risk of lymph node metastasis in T1 CRC patients presenting with a solitary risk factor of DSI. Furthermore, it compares the effectiveness and safety of endoscopic resection, surgery after endoscopic resection, and surgical resection in this context, offering valuable insights for clinical decision-making. Methods PubMed, Embase, and the Cochrane Library electronic databases were searched to identify available studies published up to November 30, 2024. Random- or fixed-effects models were applied in the meta-analyses. Heterogeneity and consistency were evaluated. Results The analysis encompassed 3331 cases of low-risk T1b CRC, pooled from 22 studies. The lymph node metastasis (LNM) rate of low-risk T1b CRC is 2.5% (95% CI 1.3–3.8%). Patients of this kind treated with endoscopic resection, surgery after endoscopic resection, or surgical resection alone do not differ statistically significantly in terms of recurrence rates (P = 0.28) or disease-specific survival (DSS) rate (P = 0.66). In addition, R0 resection could be achieved with endoscopic resection in the majority of patients, without serious adverse events reported in documented cases. Conclusions For patients with early-stage colorectal cancer presenting as DSI and devoid of other risk factors, treatment should be individualized. In such cases, given the low LNM rate, appropriately expanding the indications for endoscopic treatment and implementing rigorous follow-up post-endoscopic resection may represent a feasible strategy for selected patients, especially when balancing risks of unnecessary surgery. Otherwise, surgical resection remains the preferred treatment. Graphical abstract

Gastric cancer (GC) remains one of the most common types of cancer, ranking fifth among cancer-related deaths worldwide. Chemotherapy is an effective treatment for advanced GC. However, the development of chemotherapy resistance, which involves the malfunction of several signaling pathways and is the consequence of numerous variables interacting, seriously affects patient treatment and leads to poor clinical outcomes. Therefore, in order to treat GC, it is imperative to find novel medications that will increase chemotherapy sensitivity and reverse chemotherapy resistance. Traditional Chinese medicine (TCM) has been extensively researched as an adjuvant medication in recent years. It has been shown to have anticancer benefits and to be crucial in enhancing chemotherapy sensitivity and reducing chemotherapy resistance. Given this, the mechanism of treatment resistance in GC is summed up in this work. The theoretical foundation for TCM as a sensitizer in adjuvant treatment of GC is established by introducing the primary signal pathways and possible targets implicated in improving chemotherapy sensitivity and reversing chemotherapy resistance of GC by TCM and active ingredients.

A 21-year-old woman with no underlying medical history was admitted for an esophageal mass. After excluding contraindications, submucosal tunnel endoscopic resection (STER) was performed ([Fig. 1]). On postoperative day 1, the patient developed a fever, chest tightness, shortness of breath, and chest pain. Contrast esophagography demonstrated contrast extravasation, indicative of an esophagothoracic fistula ([Fig. 2]). A left-sided tube thoracostomy was performed for closed drainage of the thoracic cavity, with two chest tubes placed in total, and a large amount of purulent fluid was drained. Subsequent endoscopic evaluation revealed extensive and confluent mucosal denudation with necrosis extending from 35 to 40 cm distal to the incisors, accompanied by necrotic ulceration at the gastroesophageal junction ([Fig. 3] a–c); the retained hemostatic clips were carefully removed under direct visualization, followed by successful closure of the suspected fistula orifice ([Fig. 3] d, [Video 1]). Following endoscopic intervention, antimicrobial therapy combined with enteral and parenteral nutritional support was administered, with no significant adverse events or discomfort observed during the treatment course. Contrast esophagography on postoperative day 7 confirmed the absence of contrast medium leakage into the thoracic cavity. A three-month follow-up endoscopy demonstrated satisfactory mucosal healing at the previous surgical site ([Fig. 4]). Extensive esophageal mucosal necrosis with esophagothoracic fistula represents a rare complication following STER [1]. Postoperative analysis suggested potential contributing factors including extensive submucosal vascular dissection during the procedure, inadequate closure of the tunnel entrance, and suboptimal postoperative nutritional support. The patient ultimately achieved complete recovery through comprehensive endoscopic management combined with adjunctive therapies. These findings indicate that extensive postoperative mucosal necrosis complicated by esophagothoracic fistula could be managed through a combination of endoscopic intervention and enhanced nutritional support therapy. Endoscopy_UCTN_Code_CPL_1AH_2AG Article published online: 10 July 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

A 63-year-old man underwent a colonoscopy due to abdominal distension, during which signs of cat scratch colon were found ([Fig. 1] a, b), accompanied by 10 colon tumors (3 in the cecum, 4 in the descending colon, and 3 in the sigmoid colon). Carbon dioxide was used for insufflation, and the patient did not feel discomfort during the colonoscopy. Initially, cat scratch colon was visible only in the cecum. During endoscopic mucosal resection (EMR) for colon tumors with submucosal injection (a mixture of methylene blue and physiological saline), this condition appeared again in the descending colon ([Fig. 1] c) but not in the sigmoid colon ([Fig. 1] d). Three months after EMR, the patient underwent a retest colonoscopy. Multiple white scars were visible in the cecum. After three minutes of observation, no signs of cat scratch colon were observed ([Fig. 1] e, f, [Video 1]). Cat scratch colon was first described by McDonnell et al. in 2007 [1], and reports have been rare to date. The exact cause is not clear. At first, it was believed to be caused by air pressure injury due to insufflated air. Benjamin et al. described the first case of cat scratch colon identified using carbon dioxide insufflation in 2013 [2]. Afterwards, other reasons were reported, such as collagenous colitis [3], diversion colitis [4], and chronic cholestasis [5]. Here, we report a case of cat scratch colon in a patient with multiple colon tumors. It is unusual that the patient did not show these signs again after EMR for the colon tumors, with white scars appearing instead. In existing case reports, this condition mainly occurs in middle-aged and elderly people, mostly aged 60 and above [1] [2] [3] [4] [5]. Therefore, we believe cat scratch colon is related to intestinal elasticity. The majority of patients experience no discomfort when experiencing colonic mucosal tears, which can heal on their own. Endoscopy_UCTN_Code_TTT_1AQ_2AB Article published online: 16 October 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Hiatal hernia (HH) is an important cause of refractory gastroesophageal reflux disease (GERD) [1]. Repair of hiatal hernias primarily relies on surgical intervention, with a lack of robust options for endoscopic treatments [2]. Here, we report a case in which a hiatal hernia combined with refractory GERD was successfully treated by gastric fundal and esophageal mucosal ligation combined with titanium clips (GEML-C). A 69-year-old woman came to our hospital with a 20-year history of refractory GERD. Despite being on twice-daily proton pump inhibitor (PPI) therapy, she continued to experience symptoms, primarily acid reflux. The gastroscopic report suggested grade C erosive esophagitis and presence of a hiatal hernia ([Fig. 1] a, b). Esophageal manometry confirmed a grade III hiatal hernia ([Fig. 2]). The patient opted for GEML-C after the discussion of the options. A therapeutic endoscope was used throughout the whole process. With use of the inverted mirror condition, ligatures were placed with a multiring ligator (MBL-U-10; Cook Medical, USA) in a direction that was parallel to the angle of His. Six ligature rings were placed on the fundal side of the hernia sac ([Fig. 3] a). Two ligation rings were placed in the lower esophagus on the sides of the greater and lesser curvatures, and two large titanium clips (ROCC-D-26-195; MT, China) were placed at the base of the ligations ([Fig. 3] b). The lack of active resection in GEML-C is speculated to increase its safety profile, with a reduced risk of bleeding and perforation. In addition by ligating both the stomach and esophagus at the same time, it plays a better role in repairing the hernia sac and improving antireflux ([Video 1]). The patient was discharged 1 day after the procedure. By 2 weeks later, she had reduced her dosage of PPI from twice daily to twice a week. After 3 months of follow-up, her clinical symptoms, gastroscopy, and esophageal manometry results all showed significant improvement ([Fig. 4] and [Fig. 5]; [Table 1]). This case suggests that this new type of minimally invasive endoscopic interventional therapy may be safer and faster for the treatment of hiatal hernia combined with refractory GERD. Endoscopy_UCTN_Code_TTT_1AO_2AJ Article published online: 03 June 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany