Wen Wang

Introduction: The progression of metabolic dysfunction-associated steatotic liver disease (MASLD) involves lipotoxicity and inflammation from disordered cholesterol metabolism. Macrostemonoside I (MI), an Allium saponin monomer, may regulate cholesterol metabolism, but its role in MASLD is unclear. Methods: MASLD was induced in mice by a 6-week choline-deficient high-fat diet (CDAHFD) (1-week gradual transition to CDAHFD and 5 weeks of continuous CDAHFD feeding), followed by treatment with MI (2, 4, 8 mg/kg/d), atorvastatin, or vehicle for 30 days. Body weight, liver index, serum levels of HDL-C, ALT, AST and inflammatory cytokines were measured. Hepatic cholesterol content, histopathology (H&E, Oil Red O, Sirius red, Immunofluorescent staining), oxidative stress markers, transcriptome and the expression of genes/proteins related to cholesterol metabolism and fibrosis were analyzed. Results: MI reduced liver index, ameliorated hepatic ballooning and steatosis, and decreased hepatic total cholesterol and free cholesterol, as well as serum ALT/AST levels, but had no significant effect on HDL-C. It reduced hepatic CD11b⁺ infiltration and serum IL-1β, IL-6, TNF-α levels. Liver fibrosis area, and the fibrosis markers COL1A1 and α-SMA, were downregulated. MI also decreased hepatic ROS and MDA, and increased SOD activity. Furthermore, MI treatment was associated with changes in the cholesterol transcriptome and with significant reductions in both the mRNA and protein levels of the cholesterol metabolism-related molecules SCAP and SREBP2. Discussion: MI might alleviate MASLD by reducing cholesterol accumulation, suppressing inflammation, ameliorating fibrosis, and mitigating oxidative stress, potentially via SCAP/SREBP2 pathway. However, causality remains to be determined.

Background and study aims: Map-like redness (MLR) is a characteristic feature of gastritis after Helicobacter pylori ( H. pylori ) eradication and independent risk factor of gastric cancer after H. pylori eradication. The present study investigated the endoscopic manifestations and histopathological features of MLR to further investigate the relationship between MLR and gastric cancer after Helicobacter pylori eradication. Patients and methods: We enrolled 56 consecutive MLR patients between January 2023 and July 2023. Endoscopic signs and histopathological characteristics were compared among the reddish area, transition zone, and background mucosa (areas R, T, and B, respectively). Results: The histopathological analysis showed significantly greater atrophy, gastric intestinal metaplasia (GIM), and dysplasia in area R compared to other areas ( p < 0.05). Incomplete GIM predominated in area R, while complete GIM predominated in areas T and B. Area R had a higher microvascular density compared to areas T and B. Intervening parts width for area T was greater than that for area B, which was greater than that for area R ( p < 0.05). Crypt opening sizes in area R were greater than those in area T, which were greater than those in area B ( p < 0.05). Conclusion: Gastric MLR, particularly the central reddish area, was associated with localized high-risk mucosal changes, including advanced atrophy, GIM, incomplete GIM, increased microvessel density, and dysplasia in some cases. MLR may serve as an endoscopic marker of high-risk mucosal changes after successful H. pylori eradication.

Background: Successful biliary cannulation is critical to the success of ERCP. While various devices and auxiliary techniques have been developed to manage difficult cannulation in patients with periampullary diverticulum (PAD), however, comparative studies on different traction methods remain understudied. This study aims to compare the safety and efficacy of clip-assisted ERCP (C-ERCP) versus clip combined with rubber band-assisted ERCP (CRB-ERCP) for difficult biliary cannulation in patients with PAD. Methods: This study was a single-center retrospective analysis including 193 patients with difficult biliary cannulation and concomitant PAD. Using propensity score matching based on age, gender, and diverticulum type, 120 patients (60 per group) were selected for comparison. The primary outcomes assessed were cannulation success rate, procedure time and incidence of procedure-related complications. Results: The cannulation success rate was significantly higher in the CRB-ERCP group than in the C-ERCP group (96.7% vs. 73.3%, p p p =0.003). The overall incidence of adverse events was comparable between the two groups ( p= 0.632), all of which resolved with conservative management. No serious adverse events occurred in either group. Conclusion: Both CRB-ERCP and C-ERCP are viable options for difficult biliary cannulation in PAD. However, CRB-ERCP shows superior advantages in shortening cannulation time, improving success rates,and reducing the need for additional rescue techniques, making it a safe, feasible, and highly effective approach.

Endoscopic resection has become an accepted approach for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), but there are technical challenges, especially during ESD for SNADETs. The aim of this study is to evaluate the efficacy and safety of an innovative traction technique for ESD in the treatment of SNADETs. We sought to evaluate the clinical value of detachable clip combined with rubber band-assisted ESD (DCRB-ESD) in the treatment of SNADETs in a large tertiary center. The patients who underwent DCRB-ESD or conventional endoscopic submucosal dissection (C-ESD) between July 2010 and December 2025 were enrolled in this study. Propensity score matching was applied to match patients with similar baseline characteristics. The clinical characteristics of patients and lesions, submucosal fibrosis, procedural time, therapeutic outcomes, adverse events, and follow-up data were analyzed. One hundred and forty-nine patients were included in this study. Of these patients, 54 patients were matched in each group via propensity score matching. The en bloc resection rate and R0 resection rate of SNADETs in the DCRB-ESD group were superior to those in the C-ESD group [100 vs. 94.4%, P = 0.24; 96.3 vs. 85.2%, P < 0.05]. The procedure time was significantly shorter in the DCRB-ESD group than in the C-ESD group [48.5(28.9-81.2) vs. 57.1(40.1-119.8) min, P < 0.05]. Although there were no statistical differences in postoperative complications (1.9 vs. 5.6%, P = 0.62), the rate of intraoperative complications in the DCRB-ESD group was significantly lower than that in the C-ESD group (7.4 vs. 22.2%, P < 0.05). DCRB-ESD is a safe and effective method for treating superficial duodenal epithelial tumors. It can shorten procedural time, reduce technical difficulty, and may facilitate the management of larger lesions or those with submucosal fibrosis.

Background and aims: While endoscopic resection techniques such as endoscopic submucosal excavation (ESE) or endoscopic full-thickness resection (EFTR) enable the removal of gastrointestinal muscularis propria–originating submucosal tumors (MP-SMTs), these procedures still present certain limitations, including risks of perforation and hemorrhage. Therefore, we developed a novel embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) approach designed to achieve complete resection of MP-SMTs while preserving mucosal integrity. This study evaluated its feasibility in beagle model. Methods: Twelve healthy beagles underwent E-NOTES using a gastric endoscope. Simulated lesions were created on the serosal surface of the gastric anterior wall. The muscularis propria and serosal layers were resected while maintaining mucosal integrity. Simulated lesion size, operative time, intraoperative hemorrhage, intra-/ postoperative complications were recorded and analyzed. Postoperative endoscopy at 60 days and histopathological examination were performed to assess outcomes. Results: All procedures were successfully completed without conversion to laparoscopy. The mean simulated lesion diameter was 28.1 ± 7.7 mm, and mean operative time was 64.3 ± 5.5 min. Minor intraoperative bleeding (< 5 mL) occurred in 7/12 (58.3%) dogs and was controlled endoscopically. No severe complications (perforation, peritonitis, or major bleeding) occurred. All animals resumed oral intake within 24 h. Endoscopy on postoperative day 60 confirmed complete mucosal healing, and histopathology verified the complete excision of the targeted full-thickness muscularis propria and the preservation of mucosal layers. Conclusion: In this preclinical canine model, E-NOTES enabled safe and complete resection of gastric MP-SMTs with intact mucosa in a beagle model, demonstrating minimal invasiveness, low complication rates, and rapid recovery. These findings support further technical refinement and cautious evaluation in subsequent translational studies.

Background: Gastroesophageal reflux disease(GERD) with extraoesophageal symptoms tends to respond poorly to proton pump inhibitors (PPIs). Aims: This study aimed to evaluate the role of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index in predicting PPIs response among GERD patients with extraoesophageal symptoms. Methods: We investigated the predictive significance of clinical, endoscopic, and pre-treatment 24-h impedance-pH monitoring data in determining PPIs response, evaluating both the individual and combined predictive capacities of MNBI and PSPW index. Results: A total of 92 Chinese patients were analyzed, revealing pathological MNBI ( p = 0.013, OR = 4.217, 95%CI: 1.359–13.089), PSPW index ( p = 0.015, OR = 4.026, 95%CI: 1.308–12.396), AET ( p = 0.017, OR = 4.246, 95%CI: 1.290–13.982), and typical GERD symptoms ( p = 0.040, OR = 3.467, 95%CI: 1.057–11.374) as independent predictors of PPIs response. Notably, the combined AUC of MNBI, PSPW index, and AET was significantly higher than that of the individual parameters ( p < 0.05). Among patients with normal AET, the combined AUC of MNBI and PSPW index was significantly higher than that of MNBI alone ( p < 0.001). In patients with only extra-oesophageal symptoms, the AUC of the MNBI and the combined parameters of the three indices were higher than that of the AET ( p < 0.05). Conclusion: MNBI and PSPW index serve as independent predictors of PPI response in GERD patients with extraesophageal symptoms, including those with normal AET. Importantly, their combined use significantly enhances predictive performance. MNBI remains a valuable predictor in patients with only extraesophageal symptoms. This study conducted a preliminary investigation into the predictive role of the combined MNBI-PSPW model in a Chinese population, highlighting the clinical importance of impedance parameter integration in managing extraesophageal GERD.

Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary colorectal cancer syndrome characterized by diffuse adenomatous polyposis of the colon and rectum. Without intervention, aff...