（江宗賢）
National Taiwan University Hospital
Gastric cancer remains a significant global health burden and is largely driven by Helicobacter pylori infection, yet routine endoscopic and histologic risk evaluation is still limited by resource constraints and dependence on specialist expertise. To address these challenges, we develop and deploy a novel end-to-end, cloud-based “rural-to-center” artificial intelligence (AI) platform that analyzes routinely captured whitelight upper endoscopic images to identify active H. pylori infection and premalignant gastric lesions. The platform is designed to integrate with standard clinical workflows and provide decision support where expert interpretation is not always available. Using datasets collected from a tertiary medical center and a resource-limited rural hospital on the Matsu Islands, the multi-step AI pipeline replicates the diagnostic workflow of experienced endoscopists and pathologists. It automatically filters blurred and nongastric images, excludes organic lesions and image-
enhanced modalities, segments stomach regions, and enhances mucosal detail. The system then performs structured classification of H. pylori infection, atrophic gastritis, and intestinal metaplasia, with urea breath testing and histopathologic findings serving as reference standards. To improve clinical applicability, a per-patient voting algorithm aggregates imagelevel predictions and converts them into patientlevel diagnostic outcomes. During real-world rural screening implementation, AI-estimated prevalence rates closely match observed clinical results. The platform achieves diagnostic accuracies of 91% for H. pylori infection, 80% for atrophic gastritis, and 63% for intestinal metaplasia, demonstrating consistent performance in practical settings. The AI system provides a feasible and scalable approach to gastric risk stratification, expands access to expert-level assessment in underserved areas, and supports more effective strategies for gastric cancer prevention.
專題討論（11）
AI 在消化醫學的應用前沿
Cutting-Edge
Applications of AI in Digestive Science
Artificial Intelligence in Endoscopic Images
Hsiu-Chi Cheng（鄭修琦）
National Cheng Kung University Hospital （成功大學醫學院附設醫院
Computational medicine entails the application of computational, mathematical, and data-driven approaches to analyze biomedical data and enhance disease understanding, diagnosis, and personalized treatment. Artificial intelligence (AI) refers to computer systems that can perform intricate tasks typically carried out by human reasoning, decision making, creating, and so on. AI is capable of perceiving its environment and taking actions to achieve goals. In medical images, AI finds application in detection, recognition, and segmentation.
A Convolutional Neural Network (CNN) is a deep learning-based network that enables computers to understand images by automatically learning important features. VGG19 is a deep CNN based on 3 x 3 convolution kernels and is widely used for feature extraction and transfer learning. ResNet uses residual learning and skip connections to enable stable training of very deep neural networks, resulting in
better performance than VGG19 in terms of accuracy, precision, recall, and F1-score. Moreover, different CNN architectures learn various levels of semantic image representation. Consequently, an ensemble of CNNs can extract higher quality features.
CNN has been employed to categorize endoscopic lesions. Our study group has developed a deep ensemble feature network for classifying various gastric sections, a gastric section correlation network to discern the correlations between different gastric sections for comprehensive gastric disease diagnosis, and a mask focal modulation network to segment gastric intestinal metaplasia area in endoscopic images. By integrating these three networks, our AI system can aid in automatically detecting and categorizing lesions and reporting their locations, thereby benefiting endoscopists with heavy workloads or limited experience.
專題討論（11）
AI 在消化醫學的應用前沿
Cutting-Edge
Applications of AI in Digestive Science
An AI-Driven Multi-Parameter Hepatitis Analysis System on the ALOVAS Pathology Platform
Pau-Choo Chung（詹寶珠）
National Cheng Kung University
The diagnosis of hepatitis from pathology images requires extensive feature assessment, involving meticulous examination of tissue details and quantitative measurement of morphological characteristics. Such analysis is both time-consuming and labor-intensive. Advances in artificial intelligence have enabled the development of computational tools that support accurate and efficient quantitative pathology analysis.
In this talk, we will present an AI-based analysis system designed to assist in the quantitative evaluation of hepatitis. The system supports automated measurement of key pathological features, including steatosis (fat droplets), detection of ballooning
hepatocytes, characterization of lymphocyte infiltration, and quantitative assessment of fibrosis. In addition, advanced feature descriptors for tumor analysis—such as trabecular architecture, texture patterns, and nuclear-to-cytoplasmic (N/C) ratio—are integrated into the ALOVAS Pathology Platform.
Clinical application examples of the ALOVAS platform will be showcased to demonstrate how AIassisted quantitative tools can enhance diagnostic accuracy, efficiency, and reproducibility. The talk will highlight how such assistive technologies are transforming pathology practice in the AI era and will invite further discussion on future directions for intelligent pathology systems.
專題討論（11）
AI 在消化醫學的應用前沿
Cutting-Edge
Applications of AI in Digestive Science
Multi-Modal AI in Esophageal Cancer: Diagnosis, Therapy, and Beyond
I-Chen Wu（吳宜珍）
Kaohsiung Medical University Hospital
Esophageal cancer, particularly squamous cell carcinoma, remains a highly lethal disease in which early detection and precise risk stratification are essential. Advances in artificial intelligence (AI), especially multi-modal approaches integrating endoscopic imaging with multi-omics data, are transforming esophageal cancer management across diagnosis, therapy, and follow-up.
In endoscopic practice, deep learning–based computer-aided detection and diagnosis systems have achieved expert-level performance in identifying early esophageal neoplasia using white-light imaging, narrow-band imaging, Lugol chromoendoscopy, and endocytoscopy. These tools improve lesion detection, margin delineation, and real-time histologic prediction, enhancing screening efficiency and diagnostic consistency in high-risk populations. AIassisted endoscopy also supports treatment planning by predicting invasion depth and guiding appropriate selection between endoscopic resection and
multimodal therapy.
Beyond imaging, the integration of multi-omics data—including genomic, proteomic, inflammatory, and microbiome profiles—extends AI applications from visual recognition to biological interpretation. Machine-learning models incorporating targeted sequencing and circulating or tissue-based biomarkers enable molecular subtyping, identification of actionable alterations, and prediction of treatment response and prognosis. When combined with endoscopic phenotypes and clinical variables, these multi-modal models provide a comprehensive view of tumor biology and tumor–host interactions.
In summary, multi-modal AI bridges advanced endoscopic diagnostics with omics-driven precision oncology, offering a unified framework to improve early detection, personalize therapeutic decisionmaking, and enhance long-term outcomes in esophageal cancer.
專題討論（12）
肝硬化的新概念
New Concepts about Liver Cirrhosis
Potential value of GLP1 and SGLT2 in the management of liver cirrhosis.
Hui-Chun Huang（黃惠君）
Taipei Veterans General Hospital
Glucagon-like peptide 1 (GLP-1) is an endogenous hormone released in response to food consumption, lowering blood glucose through insulin secretion and glucagon inhibition, suppressing appetite, and delaying gastric emptying. In the past few years, most studies with GLP-1 agonist had been focused on the control of MASH and MASHrelated liver inflammation and fibrosis. Interestingly, considering its beneficial effects in anti-inflammation and anti-fibrosis, its favorable impacts on liver cirrhosis have gained much attention.
Another rising star in treatment of diabetes and
MASH is sodium-glucose cotransporter-2 (SGLT2) inhibitor. This anti-diabetic agent also exerts pleiotropic and anti-inflammatory effects. Although the application of SGLT-2 in cirrhosis might be potentially feasible, controversial data have been published and more solid evidences are required. Considering the frequent application of GLP-1 agonist and SGLT-2 inhibitor in clinical practice, the remarkable coexistence of diabetes and liver disease, and the significantly increased cases of MASH worldwide, Up-to-date review of the aforementioned aspects will be presented.
專題討論（12）
肝硬化的新概念
New Concepts about Liver Cirrhosis
Diagnosis and management of MASLD-related cirrhosis
Tung-Hung Su（蘇東弘）
National Taiwan University Hospital Hsin-Chu Branch
The diagnosis and management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-related cirrhosis begins with the confirmation of hepatic steatosis via imaging techniques such as ultrasound, CT, or MRI, combined with the presence of at least one of the 5 cardiometabolic risk factors, including obesity, type 2 diabetes, hypertension, hypertriglyceridemia, or low high-density lipoprotein. To accurately stage the disease at the F4 level, several non-invasive tests have been developed and are increasingly used in clinical practice, such as the FIB-4 score and transient elastography or magnetic resonance elastography to measure liver stiffness. Throughout this diagnostic phase, it remains essential to examine secondary causes of chronic liver disease, such as viral hepatitis or alcohol related liver diseases.
Once a diagnosis of MASLD-related cirrhosis is established, the management goal is to prevent decompensation and improve metabolic dysfunction. Because current pharmacotherapies, such as Resmetirom or semaglutide, are primarily
indicated for non-cirrhotic stages, the cornerstone of treatment remains intensive lifestyle modification. Patients are encouraged to achieve a sustainable weight loss of at least 10% through a Mediterranean diet and regular physical activity. Furthermore, absolute alcohol abstinence is mandatory to prevent accelerated liver damage. Medical management focuses heavily on controlling comorbidities, often utilizing GLP-1 agonists to stabilize type 2 diabetes while simultaneously managing dyslipidemia and hypertension to protect the remaining functional liver tissue.
Regular surveillance for hepatocellular carcinoma is recommended every six months using ultrasound, with alpha-fetoprotein and PIVKAII testing. Additionally, the presence of portal hypertension necessitates endoscopic evaluation to screen for esophageal varices. A multidisciplinary care is needed to include hepatologists, dietitians, and endocrinologists to optimize patient outcomes and identify potential candidates for liver transplantation in case of liver decompensation.
專題討論（12）
肝硬化的新概念
New Concepts about Liver Cirrhosis
Involvement of gut microbiota in the pathogenesis and treatment of liver cirrhosis
Shao-Jung Hsu（許劭榮）
Taipei Veterans General Hospital
Liver cirrhosis is a complex, systemic condition in which the intricate relationship between the liver and the gastrointestinal tract—often referred to as the gut-liver axis—plays a central role in disease progression. The gut microbiota is an enormously complex ecosystem comprising tens of trillions of microorganisms that work in concert with the liver to maintain systemic homeostasis. However, this symbiotic relationship is disrupted when intestinal dysbiosis develops, aggravating cirrhosis and portal hypertension via multiple mechanisms. Within the liver, dysbiosis drives inflammation, fibrogenesis, and increased intrahepatic vascular resistance. Simultaneously, in the splanchnic vascular bed, it promotes pathological angiogenesis. The resulting continuous inflammatory influx not only accelerates
hepatic injury and portal hypertension but also precipitates major systemic complications, including hepatic encephalopathy and severe infections. Consequently, correcting this dysbiosis represents a rational therapeutic target for controlling portal hypertension. This review highlights the evolving landscape of microbiome-targeted treatments. While current management relies heavily on nonabsorbable antibiotics and laxatives for symptom control, emerging therapies such as fecal microbiota transplantation (FMT), precision biotherapeutics, and dietary modulation offer promising new therapeutic avenues. Ultimately, targeting the gut microbiome represents a major frontier in hepatology, providing holistic strategies to prevent hepatic decompensation and improve patient outcomes.
專題討論（12）
肝硬化的新概念
New Concepts about Liver Cirrhosis
Albumin treatment in liver cirrhosis: a mixed friend and foe
Ming-Hung Tsai（蔡銘鴻）
Chang Gung Memorial Hospital, Linkou
Human albumin has long been a cornerstone therapy in patients with decompensated liver cirrhosis, owing to its potent oncotic properties and pleiotropic non-oncotic effects, including antioxidant, immunomodulatory, and endothelialstabilizing functions. Clinically, albumin infusion is recommended for the prevention of post–largevolume paracentesis circulatory dysfunction and as an adjunct to vasoconstrictors in hepatorenal syndrome, where plasma volume expansion and improvement in effective arterial blood volume are beneficial Emerging data further suggest that long-term albumin administration may reduce complications, hospitalizations, and mortality in selected cirrhotic populations.
However, albumin therapy is a double-edged sword. Patients with cirrhosis are intrinsically prone to sodium and water retention, cirrhotic cardiomyopathy, and volume overload, rendering them particularly susceptible to pulmonary edema during albumin infusion. Beyond hydrostatic mechanisms, increasing evidence indicates that cirrhosis is characterized by enhanced pulmonary vascular permeability, driven by systemic inflammation, nitric oxide overproduction, and dysregulated endothelial signaling. Hemodynamic studies using transpulmonary thermodilution have demonstrated elevated pulmonary vascular
permeability index (PVPI) and extravascular lung water index (EVLWI) in cirrhotic patients, especially in the setting of sepsis or septic shock, and these abnormalities are independently associated with poor outcomes
The risk appears to be further amplified in the presence of pneumonia, where infectioninduced endothelial injury and alveolocapillary barrier disruption coexist with the hyperpermeable pulmonary vasculature of cirrhosis. In this context, albumin-induced plasma volume expansion may preferentially leak into the interstitial and alveolar spaces, precipitating or worsening non-cardiogenic pulmonary edema and respiratory failure rather than improving effective circulation.
In summary, albumin remains a “friend” when judiciously used in clearly defined indications and carefully selected patients with liver cirrhosis. Yet, it may become a “foe” in those with limited cardiac reserve, active pulmonary infection, or heightened pulmonary vascular permeability. A more individualized approach—integrating clinical assessment, infection status, and, where available, advanced hemodynamic monitoring such as PVPI and EVLWI—may help optimize the benefits of albumin while minimizing its pulmonary complications in this vulnerable population.
專題討論（13）
幽門螺旋桿菌治療之新紀元
A New Era in the Treatment of Helicobacter pylori Infection
Update on the first-line anti-H. pylori therapy – present and future
Chih-An Shih（石志安）
Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital
The effectiveness of clarithromycin-based standard triple therapy for Helicobacter pylori infection has declined markedly due to increasing clarithromycin resistance, with eradication rates now falling below 80% in most countries. Although bismuth quadruple therapy and non-bismuth quadruple regimens (e.g., concomitant or hybrid therapy) are recommended by most international guidelines— particularly in regions with high clarithromycin resistance—these strategies require the use of two or three antibiotics and are frequently associated with adverse events.
Mono-antibiotic therapy for H. pylori infection offers several theoretical advantages, including minimizing unnecessary antibiotic exposure, reducing disruption of the gut microbiota, and lowering the risk of multidrug resistance. However, despite persistently low global resistance of H. pylori to amoxicillin (<3%), regular-dose amoxicillin monotherapy achieves eradication rates of less than 30%. Strategies to enhance the efficacy of amoxicillin-based monoantibiotic regimens include potent acid suppression to elevate intragastric pH, escalation of the amoxicillin dose, and the addition of bismuth salts.
Recent randomized controlled trials have demonstrated progressively improved eradication rates with these approaches. The pooled per-protocol eradication rates for regular-dose amoxicillin/ high-dose proton pump inhibitor (PPI), high-dose amoxicillin/high-dose PPI, high-dose amoxicillin/ high-dose vonoprazan, and bismuth/high-dose
amoxicillin/high-dose vonoprazan regimens were 84.7%, 89.9%, 93.5%, and 98.4%, respectively. A multicenter randomized controlled trial involving 390 patients showed that bismuth/high-dose amoxicillin/ high-dose vonoprazan triple therapy achieved significantly higher eradication rates than both highdose amoxicillin/high-dose vonoprazan dual therapy and standard triple therapy as first-line treatment in Taiwan. In addition, a retrospective cohort study demonstrated that this triple regimen was superior to bismuth quadruple therapy and was associated with fewer adverse events. For patients with penicillin allergy, tetracycline-based mono-antibiotic therapy has also shown promise; 14-day tetracycline/vonoprazan dual therapy achieved a per-protocol eradication rate of 95.1%.
In conclusion, potent acid inhibition, escalation of amoxicillin dosage, and incorporation of bismuth can transform amoxicillin mono-antibiotic therapy from an ineffective strategy into a highly effective eradication regimen for H. pylori infection. First-line treatment options may therefore include 14-day monoantibiotic regimens such as high-dose amoxicillin/ vonoprazan dual therapy or amoxicillin/vonoprazan/ bismuth triple therapy in patients without penicillin allergy. In patients with penicillin allergy, tetracycline/ vonoprazan dual therapy represents an effective alternative.
專題討論（13）
幽門螺旋桿菌治療之新紀元
A New Era in the Treatment of Helicobacter pylori Infection
Beyond first-line
failure: Practical Strategies for H. Pylori rescue therapy
Jiunn-Wei Wang（王俊偉）
Kaohsiung Medical University Hospital
The management of Helicobacter pylori infection has entered a critical phase where the diminishing efficacy of empirical first-line regimens necessitates a paradigm shift toward rigorous, optimized rescue strategies, particularly in regions with evolving antibiotic resistance patterns like Taiwan. Recent surveillance of 1,408 treatmentnaïve isolates in Taiwan between 2019 and 2024 reveals a statistically significant rise in tetracycline resistance to 3.5% alongside the emergence of dual-resistance phenotypes (tetracycline plus clarithromycin/metronidazole), threatening the longterm durability of the standard bismuth quadruple therapy (BQT) as a salvage backbone. Conversely, a paradoxical decline in metronidazole resistance offers a window of opportunity for optimized BQT, provided that strict adherence to 14-day durations and high-dose pharmacological protocols is maintained to overcome partial resistance. This lecture will comprehensively delineate evidence-based algorithms for rescue therapy, positioning High-Dose Dual
Therapy (HDDT) and novel Potassium-Competitive Acid Blocker (P-CAB, vonoprazan)-based regimens as superior, safety-enhanced alternatives for patients intolerant to BQT or those exhibiting complex multidrug resistance. We will examine the pharmacological superiority of P-CABs in achieving the rapid, sustained intragastric pH > 6 required to maximize the time-dependent bactericidal activity of amoxicillin, presenting recent clinical trial data from Taiwan and Japan that demonstrates the noninferiority and potential superiority of susceptibilityguided vonoprazan regimens in third-line refractory settings. Furthermore, the role of molecular testing (including stool antigen PCR for gyrA and 23S rRNA mutations) will be emphasized as the new standard of care for guiding third-line therapy, marking a decisive transition from empirical “try-and-see” approaches to precision medicine stewardship, ultimately aiming to reduce the burden of refractory infection and gastric cancer through successful, definitive eradication.
專題討論（13）
幽門螺旋桿菌治療之新紀元
A New Era in the Treatment of Helicobacter pylori Infection
Screening and treatment of H. pylori infection to prevent gastric cancer in Taiwan
Jyh-Ming Liou
National Taiwan University Hospital
Gastric cancer remains a major cause of cancer mortality worldwide, with the highest burden in East Asia. Helicobacter pylori infection is the principal modifiable cause of gastric cancer and represents a target for primary prevention. Taiwan has been at the forefront of translating this biological insight into population-based strategies for gastric cancer prevention through systematic screening and eradication of H. pylori.
Accumulating epidemiological and clinical evidence shows that eradication therapy reduces gastric cancer risk by approximately 40–55%. Recent large-scale community and pragmatic randomized trials further demonstrate that screening and eradication programmes can reduce gastric cancer incidence and mortality at the population level. These programmes typically rely on accurate noninvasive diagnostic tests, such as the ^13C-urea breath test and monoclonal stool antigen test, followed by timely eradication therapy for infected individuals. Integration of H. pylori testing into existing public
health programmes may improve participation and cost-effectiveness.
However, the effectiveness of eradication strategies is increasingly challenged by rising antibiotic resistance, particularly to clarithromycin and fluoroquinolones. Current evidence supports bismuth quadruple therapy as the preferred first-line regimen in regions with high resistance, while susceptibilityguided or molecular resistance–guided therapy may optimise rescue treatment after eradication failure. Risk stratification also remains essential, as individuals with advanced gastric atrophy, intestinal metaplasia, or a family history of gastric cancer continue to require endoscopic surveillance even after successful eradication.
Taken together, the evidence supports a paradigm shift from treatment of infection alone to populationbased gastric cancer prevention. Future strategies should integrate risk stratification, antimicrobial stewardship, and precision screening approaches to maximise long-term impact.
專題討論（13）
幽門螺旋桿菌治療之新紀元
A New Era in the Treatment of Helicobacter pylori Infection
Current status and future perspective of H. pylori screening and treatment in Japan
Chika Kusano（草野央）
Department of Gastroenterology Kitasato University School of Medicine, Japan
H. pylori eradication is an established approach for gastric cancer prevention, and its use expanded markedly in Japan after insurance coverage was extended in 2013.However, rising antibiotic resistance is reshaping practice, making first-line regimen optimization and avoidance of unnecessary antibiotic exposure increasingly important. This lecture highlights a school-based screening-anderadication program for second-year junior high school students in Akita Prefecture (2015–2024), including high participation, a declining prevalence
trend, test performance considerations, and real world implementation of vonoprazan-based therapy. We also discuss short term, partially reversible gut microbiome perturbations after eradication as a safety perspective. Finally, we connect these findings to contemporary adult management, where resistance aware regimen selection and susceptibility informed strategies are increasingly emphasized, and propose a life-course framework that bridges population based adolescent interventions with individualized adult optimization.
The New Insight and Future Direction of HBV Infection
The impact of steatotic liver disease on the outcomes of chronic hepatitis B
Shang-Chin Huang
The rising global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has established MASLD-chronic hepatitis B (CHB) as a dominant phenotype in modern hepatology. While traditional paradigms suggest a synergistic double hit regarding liver injury, accumulating evidence reveals a nuanced, and often paradoxical, interaction between hepatic lipid metabolism and the HBV life cycle.
Large-scale clinical observations demonstrate an inverse association between hepatic steatosis and viral activity. Patients with significant steatosis exhibit lower quantitative HBsAg levels and HBV DNA loads, and higher probability of function cure. Crucially, when disentangled from the deleterious effects of systemic metabolic dysfunction, such as diabetes and obesity, hepatic steatosis per se appears to exert a protective effect on hepatocellular carcinoma (HCC) risks. This phenomenon challenges the conventional understanding of disease progression and suggests that lipid accumulation creates a metabolically unfavorable environment for viral persistence.
Mechanistically, this viral suppression extends beyond simple hepatocyte injury. Emerging translational data point towards lipid-induced metabolic reprogramming, including the modulation of PGC-1alpha, adiponectin, autophagy, or ER stress, as potential drivers interfering with HBV replication. Despite these insights, critical knowledge gaps remain. The divergent impact of steatosis (viral suppression) versus metabolic dysfunction (fibrosis and carcinogenesis) complicates clinical risk stratification. Current unresolved issues include defining the optimal antiviral treatment thresholds for such patients and determining the exact pathways. Integrating these clinical phenotypes with molecular mechanisms is essential for developing precision management strategies for this growing patient population.
The New Insight and Future Direction of HBV Infection
The impact of integrated HBV DNA on carcinogenesis and antiviral therapy of chronic hepatitis B
Shiou-Hwei Yeh（葉秀慧）
National Taiwan University
Integration of hepatitis B virus (HBV) DNA into the host genome is a pivotal molecular event in chronic hepatitis B (CHB) and HBV-related hepatocellular carcinoma (HCC). Unlike covalently closed circular DNA (cccDNA), integrated HBV DNA arises from double-stranded linear intermediates that are aberrantly inserted into host chromosomes via DNA repair pathways. Integration occurs rapidly after infection, persists throughout all phases of chronic infection, and has been detected in both early HBeAg(+) and late HBeAg(–) stages. Although integration occurs in fewer than 1% of infected hepatocytes, it is present in the genomes of approximately 90% of HBV-associated HCCs. In CHB liver, integration sites are generally random, whereas in HCC they frequently occur at hotspot genes such as TERT and MLL4. In addition to activating the transcription of flanking host genes, most integrated HBV sequences undergo extensive
recombination, producing truncated or chimeric viral products rather than replicative transcripts. These events suggest a co-evolution of HBV and flanking host genes in HCC, contributing to immune evasion and hepatocyte proliferation, ultimately leading to tumor development. Studying these mechanisms in immunocompetent animal models may provide critical insights into HBV-driven tumor biology and help identify novel therapeutic targets. Clinically, integrated HBV DNA represents a major challenge to antiviral therapy. While nucleos(t)ide analogues effectively suppress viral replication, they do not eliminate integrated sequences, which may sustain oncogenic signaling and residual HCC risk. Emerging therapeutic strategies targeting integrated HBV— including gene-editing technologies, transcriptional silencing, and molecularly targeted approaches aimed at reducing tumor progression and improving HCC outcomes—are worthy of further investigation.
The New Insight and Future Direction of HBV Infection
A Community-Based Roadmap for HBV Elimination in Taiwan
Yen-Po Yeh
Changhua County Public Health Bureau
Despite the success of universal hepatitis B virus (HBV) vaccination programs, hepatocellular carcinoma (HCC) remains a substantial health burden in Taiwan. In Changhua, more than 70% of HCCrelated deaths occur in individuals older than 65 years, while the overall HCC mortality rate remains high, reaching 36.0 per 100,000. Although hepatitis C virus (HCV) elimination has been achieved following the introduction of direct-acting antiviral (DAA) therapy, persistent gaps across the HBV care cascade continue to impede progress toward elimination targets.
We examined data from 14,811 participants enrolled in the 2024 Changhua Community-Based Integrated Screening (CHCIS) program to characterize the distribution of HBV-related biomarkers. The prevalence of HBsAg positivity was 13.0%, with HBeAg positivity observed in 3.4% of carriers. Among individuals with chronic HBV infection (CHB), 91.6% had detectable HBV DNA, 16.4% showed elevated ALT levels, and 8.8% had a fibrosis stage F2 or higher. Overall, only 4.1% of CHB participants met Taiwan National Health Insurance (NHI) reimbursement criteria for antiviral therapy. Prior to screening, the treatment rate was only 11.1%
of eligible individuals; this proportion increased to 56.1% following case-management intervention. These findings reflect a broader global challenge, where only 10.5% of individuals with CHB were diagnosed and 17% of those receive treatment, while fewer than 25% of at-risk populations undergo regular HCC surveillance.
To address these gaps, we propose a CommunityBased Roadmap for HBV elimination. This conceptual roadmap includes six interconnected components: simplified community-based HBV care, personalized surveillance, integration with cardio–kidney–metabolic (CKM) syndrome management, community liver care management centers supported by nurse case managers, digital “Liver Toolkits” to facilitate risk assessment and care navigation, and collaboration between GI doctors, primary care, and other specialists. By strengthening linkage to care and embedding HBV management within community health systems, this approach may provide a scalable strategy to enhance continuous surveillance and potentially reduce liver cancer burden in the context of evolving metabolic risk.
The New Insight and Future Direction of HBV Infection
Updated HBV guideline in AASLD 2025
Wen-Juei Jeng（鄭文睿）
Chang Gung Memorial Hospital, Linkou
The 2025 update of the AASLD hepatitis B virus (HBV) clinical practice guideline provides refined, evidence-based recommendations for the management of chronic hepatitis B. Rather than introducing a major paradigm shift, the updated guidance reflects incremental adjustments informed by recent systematic reviews and accumulating real-world data by PICO manner.
Key updates address prevention of HBV transmission, considerations for antiviral treatment in selected patient populations, and risk-based strategies for hepatocellular carcinoma surveillance. The guideline places particular emphasis on individualized shared clinical decision-making for patients in immune-tolerant or indeterminate disease
phases, incorporating factors such as age, fibrosis stage, and overall risk profile. Recommendations on preferred first-line nucleos(t)ide analogue therapies remain largely consistent, while emerging areas— such as finite therapy strategies and post-treatment outcomes—are discussed with acknowledgment of persistent evidence gaps.
This lecture will summarize the major updates in the 2025 AASLD HBV guideline, highlight areas of continuity and change, and discuss their practical implications for daily clinical practice. Comparisons with other international guidelines will be briefly addressed to provide broader context for clinicians managing patients with chronic hepatitis B.
專題討論（15）
肝癌治療的新進展
Treatment of Hepatocellular Carcinoma
Biomarkes of immunotherapy for HCC
Wei Teng
Chang Gung Memorial Hospital, Linkou
Immunotherapy has reshaped the management of hepatocellular carcinoma (HCC); however, durable benefits are confined to a subset of patients. This presentation summarizes emerging biomarkers that can guide patient selection, enable early response assessment, and clarify the mechanisms of primary and acquired resistance to immune checkpoint blockade and combination regimens. We will review tumor-intrinsic markers, including PD-L1 expression, tumor mutational burden, and pathway alterations, such as WNT/β-catenin signaling, that can drive immune exclusion. Microenvironmental biomarkers include immune cell phenotypes, T-cell receptor clonality, interferon-γ gene signatures, myeloidderived suppressor cells, and angiogenic profiles
relevant to anti-VEGF combinations. We will discuss minimally invasive approaches, including circulating tumor DNA, AFP kinetics, cytokines, and peripheral immune repertoires, as well as radiomics and digital pathology, to capture spatial heterogeneity. Finally, host factors such as liver disease etiology, microbiome composition, and baseline hepatic reserve will be considered alongside predictors of immune-related adverse events. We highlight the analytical challenges, assay standardization, and the need for prospective biomarker-enriched trials integrating multi-omics with meaningful endpoints. A pragmatic framework for translating biomarker strategies into routine HCC care and future research is proposed.
專題討論（15）
肝癌治療的新進展
Treatment of Hepatocellular Carcinoma
New progress in the treatment of BCLC B HCC
Shih-Jer Hsu（徐士哲）
National Taiwan University Hospital
Recent advances in the management of intermediate-stage (BCLC stage B) hepatocellular carcinoma (HCC) reflect a shift away from the traditional “one-size-fits-all” approach. Although transarterial chemoembolization (TACE) was historically the standard treatment, the marked heterogeneity in tumor burden and liver function among patients has prompted increasing emphasis on individualized treatment strategies, refined subclassification, and integration of systemic and surgical therapies. Treatment decisions are now guided more by a patient’s suitability for specific therapies rather than strict tumor stage, a concept known as “therapeutic hierarchy.” In selected patients with preserved liver function and limited tumor burden, curative-intent options such as liver resection, liver transplantation, or percutaneous ablation may provide superior survival outcomes compared with TACE. Conversely, TACE may impair liver function without clear survival benefit in patients with high tumor burden or diffuse disease. For these “TACEunsuitable” patients, systemic therapies—including immune checkpoint inhibitors and targeted agents—
have demonstrated higher response rates and improved progression-free survival compared with TACE. Another major focus of current research is conversion therapy (or downstaging), which employs combination treatment strategies to shrink initially unresectable tumors and enable subsequent curative interventions. This strategy facilitates upward “treatment stage migration,” whereby patients achieving substantial tumor regression may become eligible for curative liver resection, ablation, or transplantation. Furthermore, other locoregional therapies are gaining an increasingly important role in the management of BCLC stage B HCC. External beam radiotherapy, transarterial radioembolization, and hepatic arterial infusion chemotherapy have demonstrated survival outcomes comparable to established treatment modalities and are being incorporated more frequently into treatment algorithms. Overall, the management of BCLC stage B HCC requires a multidisciplinary approach to develop patient-tailored treatment strategies, particularly in complex or ambiguous clinical scenarios where high-level clinical trial evidence remains limited.
專題討論（15）
肝癌治療的新進展
Treatment of Hepatocellular Carcinoma
First-line and 2L systemic therapy for HCC
Teng-Yu Lee（李騰裕）
Taichung Veterans General Hospital
Systemic therapy for hepatocellular carcinoma (HCC) has evolved substantially over the past decade, shifting from single-agent tyrosine kinase inhibitors (TKIs) to combination immunotherapybased strategies. In the first-line setting, drug choice is primarily driven by liver function, performance status, tumor burden, and bleeding risk, alongside patient comorbidities. Immune checkpoint inhibitor (ICI)-based combinations have emerged as the preferred first-line option for most patients with preserved liver function, owing to superior overall survival, higher response rates, and improved qualityof-life outcomes compared with earlier standards. However, not all patients are suitable candidates for immunotherapy, and molecularly targeted agents remain important alternatives, particularly in the presence of contraindications such as autoimmune disease or high bleeding risk. Second-line therapy selection is increasingly influenced by prior treatment exposure and patterns of resistance. After failure of immunotherapy-based regimens, multikinase inhibitors and selective antiangiogenic agents continue to play a central role, offering modest but
clinically meaningful survival benefits. Conversely, in patients initially treated with targeted therapies, ICIs, either alone or in combination, remain viable options, although optimal sequencing is not yet clearly defined. Biomarker-guided treatment selection remains an unmet need, as no validated predictive markers are currently available to guide individualized therapy in routine practice. Looking forward, treatment perspectives in HCC are shaped by ongoing efforts to refine therapeutic sequencing, identify predictive biomarkers, and expand combination strategies that integrate immunotherapy with targeted agents or locoregional treatments. Real-world data and translational research will be critical to optimizing drug choice across lines of therapy, particularly in patients with impaired liver function who are underrepresented in clinical trials. Ultimately, a personalized, multidisciplinary approach is essential to maximize therapeutic benefit while minimizing toxicity in this heterogeneous disease. This talk will focus on decision-making regarding the choice of systemic therapy.
專題討論（15）
肝癌治療的新進展
Treatment of Hepatocellular Carcinoma
Novel ongoing clinical trials for HCC
I-Cheng Lee（李懿宬）
Taipei Veterans General Hospital
The therapeutic landscape of hepatocellular carcinoma (HCC) is rapidly evolving, driven by a growing number of ongoing clinical trials exploring novel immunotherapeutic strategies across disease stages. Beyond their established role in advanced HCC, immune checkpoint inhibitors (ICIs) are now being actively investigated to expand indications into early- and intermediate-stage disease. Current trials are evaluating ICIs as neoadjuvant or adjuvant therapy in combination with curative treatments, as well as in combination with locoregional therapies to enhance antitumor immunity and improve long-term disease control.
In parallel, novel immunotherapy targets are under active investigation, including alternative immune checkpoints beyond PD-1/PD-L1 and CTLA4, as well as pathways involving cytokines and innate
immunity that modulate the tumor microenvironment. These approaches aim to overcome primary and acquired resistance to existing ICIs. Advances in immunotherapy drug design have further broadened therapeutic possibilities, with bispecific antibodies and bispecific T-cell engagers (BiTEs) enabling simultaneous targeting of tumor antigens and immune effector cells to enhance specificity and cytotoxicity. Cell-based therapies also represent an emerging frontier in HCC treatment. Ongoing trials are assessing adoptive cell therapies, including chimeric antigen receptor T-cell (CAR-T) approaches targeting liver cancer–associated antigens, as well as other engineered immune cell platforms. Collectively, these innovative clinical trials underscore a paradigm shift toward earlier intervention, immune modulation, and personalized immunotherapy in HCC.
內視鏡肝病學（Endohepatology）在多團隊肝病照護的臨床應用
Integrating Endohepatology into Multidisplicinary Liver
Care
EUS in Liver Lesion Evaluation: Integrating Imaging and Pathologic Diagnosis
Szu-Chia Liao（廖思嘉）
Taichung Veterans General Hospital
Accurate characterization of liver lesions is essential for determining appropriate management and prognosis. While conventional imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) provide much information, some hepatic lesions remain indeterminate. Endoscopic ultrasound (EUS) has emerged as a powerful complementary tool for the evaluation of liver lesions, offering high-resolution imaging and the ability to get tissue during the procedure.
In my presentation, we will focus on the role of EUS in the assessment of focal liver lesions, emphasizing the integration of advanced imaging techniques with pathologic diagnosis. EUS allows evaluation of both lobes of the liver, particularly lesions that are small or difficult to detect using transabdominal imaging. In addition, EUS-guided fine-needle aspiration (EUS-FNA) and fine-needle
biopsy (EUS-FNB) enable real-time tissue acquisition for cytologic and histologic evaluation, improving diagnostic accuracy.
We will discuss about the indications, procedural techniques, diagnostic yield, and safety profile of EUS-guided tissue sampling for hepatic lesions. Clinical cases will illustrate how combining EUS imaging characteristics with pathological findings can make differential diagnosis between benign lesions, primary hepatic malignancies, and metastatic disease. The evolving role of contrast-enhanced EUS in liver lesion characterization will also be briefly discussed. By integrating high-resolution imaging with targeted tissue acquisition, EUS provides a comprehensive role for liver lesion evaluation. This strategy enhances diagnostic confidence, guides clinical decision-making, and supports the development of personalized management plans for patients with hepatic lesions.
專題討論（16）
內視鏡肝病學（Endohepatology）在多團隊肝病照護的臨床應用
Integrating Endohepatology into Multidisplicinary Liver Care
EUS Applications in Chronic Liver Disease: Fibrosis Assessment and Portal Venous Evaluation
Meng-Ying
Lin
（林孟穎）
National Cheng Kung University Hospital
Chronic liver disease (CLD) requires accurate assessment of fibrosis severity and portal hypertension to guide prognosis and management. Although transabdominal ultrasound (TAUS), transient elastography, and cross-sectional imaging remain first-line modalities, their diagnostic performance may be limited by obesity, ascites, narrow intercostal windows, and reduced sensitivity for deep vascular or collateral structures. Endoscopic ultrasound (EUS) offers distinct advantages by positioning the transducer in close proximity to the liver and portal vasculature, thereby providing higher spatial resolution and improved visualization of the left lobe, caudate lobe, and periportal region.
Compared with TAUS, EUS enables more detailed characterization of liver surface nodularity, parenchymal heterogeneity, and small-volume ascites. EUS-guided liver biopsy allows targeted tissue
acquisition under direct visualization, often with higher specimen adequacy and fewer passes. In portal venous evaluation, EUS facilitates precise assessment of the portal vein, left gastric vein, and collateral pathways that may be suboptimally visualized transabdominally. Doppler interrogation from an intraluminal vantage point enhances hemodynamic analysis, and emerging EUS-guided portal pressure gradient measurement provides a minimally invasive alternative to traditional transjugular approaches in selected centers.
By overcoming acoustic window limitations and integrating structural, hemodynamic, and interventional capabilities in a single session, EUS represents a complementary and potentially superior modality for selected patients with CLD, particularly when transabdominal evaluation is inconclusive or technically challenging.
專題討論（16）
內視鏡肝病學（Endohepatology）在多團隊肝病照護的臨床應用
Integrating Endohepatology into Multidisplicinary Liver Care
EUS-Guided Management of Gastroesophageal Varices: Diagnostic and Therapeutic Strategies
Mu-Hsien Lee
（李沐憲）
Chang Gung Memorial Hospital, Linkou
Gastroesophageal varices is a common and severe complication of portal hypertension and pancreatic disease, mostly induced by liver cirrhosis and chronic pancreatitis. Varices bleeding is the most serious complication with high mortality. Transitionally endoscopic approach can provide effective diagnosis and treatment with glue injection, but clinical limitation also noted. Even in patients undergoing emergency endoscopic treatment such as emergency ligation, rebleeding and mortality rates are still non-negligible
EUS combined endoscopic treatment and Doppler ultrasound observation, offer more accurate and effective treatment than conventional endoscopy. Ultra-sound can accurately identify varices size, perforating vessels, needle position and evaluate treatment effect; endoscopy provides different treatment policy, including coils placement, glue/gelfoam/thrombin injection or EUS-guided intrahepatic portosystemic shunt (EIPS) creation and
partial spleen embolization (PSE). With increased applications in Varices management, EUS has demonstrated diagnostic and therapeutical benefits and enriches originally limited options.
Coils -based embolization by EUS develop in recent years. Combined coils and tissue adhesive documents with higher technical success rate, fewer endoscopies, and a lower complication rate and reintervention rate but the evidence of optimal coil numbers, kinds of tissue adhesive and mid-long term complication lacks; More prospective and long-term studies need to be done.
In conclusion, EUS-guided diagnoses and treatments have recently emerged as convenient diagnostic procedures and promising hemostatic interventions for Gastroesophageal Varices and worthy of further research and promotion; Standard treatment policy and protocol of post treatment following up need to be established
專題討論（16）
內視鏡肝病學（Endohepatology）在多團隊肝病照護的臨床應用
Integrating Endohepatology into Multidisplicinary Liver Care
EUS-Guided Tumor Ablation in the Liver
Jiann-Hwa Chen（陳建華）
Taipei Tzu Chi Hospital
Introduction
Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) are the two most common malignant tumors affecting the liver. Liver directed therapies, such as ablation, have become integral to multidisciplinary treatment approaches, despite limited supporting data. Conventional percutaneous radiofrequency ablation (RFA) is a well-established treatment for HCC. However, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged a promising technique, particularly for small and left hepatic lesions that are challenging to access percutaneously. With significant advancements in onco-chemotherapy, primary malignant tumors can sometimes regress completely, yet liver metastases often remain difficult to control. In such cases, RFA serves as a crucial local treatment for managing metastatic liver lesions.
EUS guided RFA treatment for HCC
EUS-guided RFA was conducted with the patient under deep sedation for a total duration of five minutes. A 19-gauge needle with a 10-mm monopolar active electrode (Starmed, TaeWoong Medical, Seoul, South Korea) was positioned along the distal edge of the caudate or left lobe lesion. Multiple overlapping ablations were performed sequentially at an energy setting of 20-30W, progressing proximally until the entire lesion, along with an approximately 5 mm margin of surrounding normal liver tissue, was encompassed under direct EUS visualization.
RFA leads to the formation of vapor bubbles in the treated tissue and was noted to appear as increased echogenicity on EUS.
EUS guided RFA treatment for colorectal liver metastasis
Improved clinical outcomes are seen when treatment approaches for individual metastatic colorectal cancer (mCRC) patients are discussed within a multidisciplinary team (MDT) of experts who meet regularly to review mCRC cases. The MDT has an ongoing role throughout the mCRC patient pathway, initially to review the diagnostic work-up to define whether a patient has clearly resectable or unresectable metastatic disease and to consider management of the primary tumor. A complete eradication of tumor can be obtained using thermo-ablation (evidence of ablation margins and no evidence of disease at follow-up imaging). For patients with one to five metastatic lesions confined to a single organ (most frequently liver or lung), a potentially curative approach exists. In this setting, long-term survival or even cure can be attained in 20%-45% of patients who undergo complete thermal ablation of their metastases.
Conclusions
RFA is a well-established treatment for HCC. EUS-RFA has emerged as a promising technique, particularlyfor small and left hepatic lesions that are challenging to access percutaneously. Metastatic
liver tumors (MLT) are considered a systemic disease and should integrate local and systemic therapies. Thermal ablation is one of locoregional treatment
methods for MLT.
Keywords : EUS, RFA, hepatic malignancy
專題討論（17）
腸胃道金屬支架的演進、臨床應用與未來展望
The Evolution, Clinical Applications, and Future Perspectives of Gastrointestinal Metallic Stents
Introduction to Self-Expandable Metal Stents (SEMS): History, evolution, and technical aspects
Yung-Kuan Tsou
（鄒永寬）
Chang Gung Memorial Hospital, Linkou
Self-expandable metal stents (SEMS) have revolutionized interventional medicine, particularly in the treatment of gastrointestinal (malignant) obstructive diseases. The development of SEMS stemmed from a response to the limitations of rigid plastic prostheses. In the late 20th century, early pioneers sought a solution that could be delivered through a low-profile system while providing excellent radial support and flexibility. The evolution is marked by material science, design refinement, and covering technology. Technically, the efficacy of a SEMS is determined by a balance of radial force and axial force. An ideal SEMS should have high
radial force and low axial force. Modern technology has further improved delivery systems, enabling minimally invasive deployment under endoscopic or fluoroscopic guidance using “over-the-wire” or “through-the-scope” methods. In addition, shortening (the degree to which a stent decreases in length upon expansion) is a critical factor for precise placement. Understanding the evolution and technical nuances of SEMS is essential for optimizing clinical outcomes. This presentation will explore the historical trajectory, technological evolution, and fundamental technical aspects of modern SEMS applications.
專題討論（17）
腸胃道金屬支架的演進、臨床應用與未來展望
The Evolution, Clinical Applications, and Future Perspectives of Gastrointestinal Metallic Stents
Esophageal Stenting: Patient selection, indications, and complication management
Wei-Lun Chang（張維倫）
National Cheng Kung University Hospital
Esophageal stenting has undergone a significant technological transformation, evolving from early rigid polyethylene tubes to sophisticated self-expandable metal stents (SEMS), plastic stents (SEPS), and most recently, biodegradable stents (BDS). The primary clinical indication for stenting in malignant disease is the palliative relief of dysphagia caused by primary or metastatic esophageal cancer, for which partially or fully covered SEMS are currently the recommended standard. Additionally, SEMS are the preferred intervention for sealing malignant tracheoesophageal or bronchoesophageal fistulae. In benign conditions, stenting is indicated for refractory benign esophageal strictures (RBES), which are defined by an inability to maintain a luminal diameter of at least 14 mm after repeated dilations. Other benign applications include the temporary management of anastomotic leaks, perforations, and refractory variceal bleeding, where large-diameter covered stents can serve as a bridge to definitive therapy like TIPS.
Patient selection is critical to optimizing clinical outcomes and requires a multidisciplinary evaluation of expected survival, nutritional status, and anatomical lesion characteristics. For malignant disease, stenting
is prioritized for patients with a short life expectancy (less than 3 months), while brachytherapy may be considered for those expected to survive longer. Anatomical assessment is vital; lesions within 2 cm of the upper esophageal sphincter or above the C7 level are often contraindications due to increased risks of aspiration, globus sensation, and respiratory compromise. Stenting should generally be avoided in asymptomatic patients or those with potentially curable disease.
Management of stent-related complications remains a cornerstone of clinical practice, with common adverse events including migration, tissue ingrowth/overgrowth, severe chest pain, and perforation. Stent migration is particularly prevalent in benign conditions and may require anchoring techniques such as endoscopic suturing or the application of over-the-scope clips. Recurrent dysphagia due to tissue ingrowth is often managed through “stent-in-stent” placement or thermal ablative therapies. Immediate post-procedural pain occurs in roughly 9% to 14% of cases and is typically managed with analgesics, though persistent severe pain may necessitate stent removal.
專題討論（17）
腸胃道金屬支架的演進、臨床應用與未來展望
The Evolution, Clinical Applications, and Future Perspectives of Gastrointestinal Metallic Stents
Gastric and Duodenal Stenting: Endoscopic management of malignant obstruction and comparison with surgery and EUS-guided approaches
Kuei-Chuan Lee
Taipei Veterans General Hospital
Open surgical gastrojejunostomy (SGJ) has long been the standard treatment for malignant gastric outlet obstruction (MGOO), but it carries high complication (up to 27.7%) and mortality rates (up to 8.2%). To improve outcomes, minimally invasive surgical methods such as laparoscopic and robotic SGJ were introduced. More recently, endoscopic approaches have become increasingly favored—especially for patients with limited life expectancy or poor surgical fitness—because they offer quicker recovery. Among these, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) has emerged as a key palliative option.
A large retrospective study of 436 patients compared EUS-GE with SGJ and found that EUS-GE had higher clinical success (98.3% vs. 90.4%) and lower reintervention rates (0.9% vs. 13.7%). Notably,
patients undergoing SGJ generally had better baseline status, including lower ECOG scores and fewer symptoms.
Another multicenter study of 310 patients reported similar technical and clinical success rates and mortality between EUS-GE and SGJ. However, EUS-GE resulted in fewer adverse events, faster return to chemotherapy, quicker recovery of oral intake, and shorter hospitalization. In contrast, EUS-GE showed higher reintervention rates and was used more often in older patients with poorer nutritional status and more ascites.
Overall, EUS - GE provides high technical and clinical success with low complication rates and favorable short-term outcomes, making it an effective option for managing MGOO.
專題討論（17）
腸胃道金屬支架的演進、臨床應用與未來展望
The Evolution, Clinical Applications, and Future Perspectives of Gastrointestinal Metallic Stents
Colonic Stenting: Palliative applications and bridge-to-surgery strategies in malignant obstruction
Cheuk-Kay Sun（孫灼基）
Shin Kong Wu Ho-Su Memorial Hospital
Malignant colonic obstruction is a frequent complication of advanced colorectal cancer, occurring in approximately 8–13% of patients at presentation. Traditionally, emergency surgery has been the standard treatment; however, it is associated with high morbidity, mortality, and a substantial risk of permanent stoma formation. Endoscopic placement of self-expandable metal stents (SEMS) has emerged as an important minimally invasive alternative for both palliative decompression and as a bridge to surgery (BTS) in selected patients.
In the palliative setting, colonic stenting offers rapid relief of obstructive symptoms and restoration of bowel function, improving patient comfort and quality of life. Technical success rates typically exceed 90%, with clinical success reported in approximately 80–90% of cases. Compared with emergent surgical intervention, SEMS placement is associated with shorter hospital stays, earlier resumption of oral intake, lower immediate procedural risk, and reduced rates of permanent stoma formation. Nevertheless, potential complications—including perforation, stent migration, and tumor ingrowth causing reobstruction—must be considered, particularly in
patients receiving systemic chemotherapy or antiangiogenic therapy.
For patients with potentially resectable disease, SEMS placement as a bridge to surgery allows decompression of the obstructed colon, enabling conversion of an emergency situation into an elective surgical procedure. This interval permits optimization of the patient’s physiological status, completion of staging workup, and consideration of minimally invasive surgical approaches. Several studies have demonstrated that BTS strategies may reduce temporary and permanent stoma rates and facilitate single-stage surgical resection. However, concerns remain regarding oncologic safety, especially in cases of stent-related perforation, which may increase the risk of tumor dissemination.
Overall, colonic SEMS placement has become an important therapeutic option in the management of malignant large bowel obstruction. When performed by experienced endoscopists and within a multidisciplinary framework, stenting provides effective palliation and may serve as a valuable bridge to definitive surgical treatment in carefully selected patients.
專題討論（18）
胃腸道疾病的深度營養支持
Advanced Nutritional Support in Gastrointestinal Disorders
Integrative Nutritional Strategies in Cancer Patients Undergoing Chemo-/ Immunotherapy and Surgery
Jaw-Yuan Wang （王照元）
Kaohsiung Medical University Hospital
Malnutrition affects approximately 30–80% of patients with cancer and is strongly associated with reduced treatment tolerance, increased toxicity, and inferior survival. With the growing integration of chemotherapy, immunotherapy, and surgery, nutritional care should no longer be regarded as supportive only, but as a critical therapeutic component that shapes host metabolism, immune competence, and clinical outcomes. This talk highlights metabolic reprogramming in cancer, including the Warburg effect and the detrimental impact of hyperglycemia and insulin resistance on oncologic prognosis and immunotherapy efficacy.
We further discuss the nutrient–immune axis and how targeted nutritional strategies may modulate antitumor immunity. Key interventions include omega-3 polyunsaturated fatty acids, immune-relevant amino acids (arginine and glutamine), micronutrients (vitamin D, zinc, and selenium), dietary fiber, and microbiota-derived short-chain fatty acids, which
collectively influence inflammatory balance, T-cell function, and gastrointestinal integrity. Practical nutritional targets recommended by ESPEN (25–30 kcal/kg/day and 1.2–2.0 g/kg/day protein) will be translated into clinical pathways using oral nutritional supplements, immunonutrition formulas, and timely enteral/parenteral nutrition when oral intake is inadequate.
Finally, we share the Kaohsiung Medical University Hospital experience in implementing home parenteral nutrition (HPN), emphasizing its benefits in improving quality of life, minimizing hospitalization, reducing catheter-related complications through structured education and SOPs, and alleviating healthcare expenditure. From a health-system perspective, integrated nutritional care represents a “win–win–win” model for patients, hospitals, and national payers. Precision oncology cannot be achieved without precision nutrition.
專題討論（18）
胃腸道疾病的深度營養支持
Advanced Nutritional Support in Gastrointestinal Disorders
Nutritional Approaches to Improve Gastrointestinal Cancer Outcomes
Ming-Jen Chen（陳銘仁）
MacKay Memorial Hospital
Nutritional approaches for gastrointestinal (GI) cancer, including personalized dietary counseling, oral nutrition supplements (ONS), and enteral/parenteral feeding, are critical to reduce malnutrition, manage treatment side effects, and improve survival. Key strategies involve maintaining high-protein, energydense diets, managing symptoms, and incorporating immune-modulating nutrients.
1. Key Nutritional Strategies to Improve Outcomes
Early Nutritional Intervention: Regular screening for malnutrition (e.g., using PatientGenerated Subjective Global Assessment (PGSGA) by Registered Dietitians (RD) is essential to develop personalized treatment plans. Oral Nutrition Supplements (ONS): Using ONS effectively increases nutrient density, helps maintain body weight, and reduces delays in cancer treatment. ImmuneEnhancing Nutrients: Supplements such as glutamine and W-3 fatty acids help reduce inflammatory responses and postoperative complications.
2. Medical Nutrition Therapy (MNT)
For patients unable to eat, enteral (tube) or parenteral (IV) nutrition is recommended to meet protein and caloric needs, which can prolong survival in advanced cases.
3. Targeted Approaches for Specific Conditions
Gastric/Upper GI Cancer: Focusing on managing early satiety, nausea, and weight loss, and utilizing enteral nutrition to maintain weight. Colorectal Cancer: Reducing red and processed meat intake while increasing fiber. Radiotherapy/Chemotherapy Support: Combined counseling and supplements improve quality of life and treatment tolerance.
4. Multidisciplinary Care
Effective nutritional management requires coordination between oncologists, dietitians, and nurses to address dietary preferences, physical limitations, and functional changes in the gastrointestinal tract.
專題討論（18）
胃腸道疾病的深度營養支持
Advanced Nutritional Support in Gastrointestinal Disorders
Micronutrient Deficiency in Gastrointestinal Disorders: Clinical Relevance and Supplementation Strategies
Yin-Yi Han（韓吟宜）
National Taiwan University Hospital
Micronutrient deficiency is a common yet frequently overlooked complication in patients with gastrointestinal (GI) disorders and represents a critical component of advanced nutritional therapy. A wide spectrum of GI diseases—including inflammatory bowel disease, chronic liver disease, pancreatic exocrine insufficiency, celiac disease, short bowel syndrome, and post-surgical GI conditions—predispose patients to deficiencies through mechanisms such as malabsorption, impaired digestion, chronic inflammation, altered metabolism, and increased nutrient losses.
Clinically significant deficiencies of iron, zinc, selenium, magnesium, vitamin B12, folate, thiamine, and fat-soluble vitamins are associated with anemia, sarcopenia, immune dysfunction, neurocognitive impairment, poor wound healing, and increased disease-related morbidity. In advanced or critically ill GI patients, conventional biochemical markers may
be confounded by inflammation or organ dysfunction, posing challenges to accurate assessment and timely intervention.
This lecture reviews the pathophysiology, prevalence, and clinical consequences of micronutrient deficiencies in major GI disorders, with emphasis on patient populations at high nutritional risk. Evidencebased supplementation strategies are discussed, including indications for oral, enteral, and parenteral replacement, dosing considerations, monitoring of response, and prevention of toxicity. Practical algorithms integrating micronutrient assessment into routine GI and nutritional care are proposed.
Optimizing micronutrient management is an essential and often modifiable aspect of advanced nutritional support, with the potential to improve functional outcomes, reduce complications, and enhance quality of life in patients with gastrointestinal disorders.
專題討論（18）
胃腸道疾病的深度營養支持
Advanced Nutritional Support in Gastrointestinal Disorders
Nutritional Management of Acute and Chronic Pancreatitis
Chen-Shuan Chung（鍾承軒）
Far Eastern Memorial Hospital
This lecture provides a comprehensive overview of the nutritional management of acute pancreatitis (AP) and chronic pancreatitis (CP), emphasizing the critical role of early and individualized nutritional interventions in improving clinical outcomes. Pancreatitis remains a major global health burden, with rising incidence, mortality, and disabilityadjusted life years. Malnutrition is highly prevalent in both AP and CP, affecting approximately 40–60% of patients with CP and a significant proportion of those with AP, and is strongly associated with increased complications, prolonged hospitalization, higher mortality, impaired pancreatic function, and reduced quality of life
In acute pancreatitis, prolonged fasting exacerbates hypercatabolism, oxidative stress, gut barrier dysfunction, and systemic inflammation. The lecture highlights strong evidence supporting early enteral nutrition (EEN), defined as initiation within 48 hours of hospital admission. EEN preserves intestinal integrity, modulates immune responses, reduces infectious complications, multiorgan dysfunction, mortality, and healthcare costs when compared with delayed feeding or total parenteral nutrition (TPN). Enteral nutrition is generally preferred, while parenteral nutrition should be reserved for selected
patients who cannot tolerate enteral feeding or fail to meet at least 60% of their nutritional requirements. Practical guidance on protein targets, lipid formulations, and prevention of refeeding syndrome is discussed.
Emerging adjunctive nutritional therapies in AP, including omega-3 fatty acids, antioxidants, curcumin, glutamine, and gut microbiota modulation, are reviewed with evidence from randomized controlled trials suggesting potential benefits in selected patient populations.
For chronic pancreatitis, the lecture addresses the multifactorial mechanisms driving malnutrition, including maldigestion, malabsorption, chronic inflammation, endocrine dysfunction, and reduced oral intake. Long-term management requires a comprehensive and individualized approach, incorporating adequate caloric and protein intake, pancreatic enzyme replacement therapy, correction of micronutrient deficiencies, avoidance of alcohol and tobacco, and regular monitoring for sarcopenia and bone disease.
Overall, the lecture underscores nutrition as a cornerstone of pancreatitis management across disease stages, advocating early assessment and tailored nutritional strategies to optimize outcomes
消化系基層醫療論壇
Over 30 Years of Compassionate Medical Care: A journey of Service
三十餘年仁心醫路：一段奉獻之旅
Yung-Feng Liu（劉永豐）
Yung-Feng Liu Clinic
（劉永豐診所）
消化系基層醫療論壇
Self-Paid Clinic Operation 2.0
我的自費經營 2.0
Hui-Hsiung Liu（劉輝雄）
Imperial Clinic
（輝雄診所）
消化系基層醫療論壇
Forum on the Reimbursement of NHI in Primary Gastroenterology Clinic
消化系基層醫師健保實務論壇
Hsih-Hsi Wang（王世晞）
e-com clinic
（宜康診所）
一般演講
主題：上消化道疾病（一） ①
孤立性咽喉逆流症狀患者之食道過度警覺降 低與活動性胃食道逆流症的低度辨識相關 ESOPHAGEAL HYPERVIGILANCE IS ASSOCIATED WITH UNDERRECOGNITION OF ACTIONABLE GERD IN PATIENTS WITH ISOLATED LARYNGOPHARYNGEAL SYMPTOMS
洪睿勝1 翁銘彣1 王仁宏2 劉作財1 易志勳1 雷尉毅1
簡錫淵1 陳健麟1
1 佛教慈濟醫療財團法人花蓮慈濟醫院 消化系中心
2 佛教慈濟醫療財團法人花蓮慈濟醫院 研究醫學部
Background: Isolated laryngopharyngeal symptoms (LPS), including chronic cough, throat clearing, dysphonia, and globus, are often presumed functional when classical gastroesophageal reflux disease (GERD) symptoms are absent. Consequently, objective reflux testing is often deferred. Nevertheless, clinically significant GERD may underlie a subset of these presentations, including Barrett’s esophagus (BE), a premalignant condition that may manifest with reduced symptom perception. Cognitive–affective factors may further influence symptom perception, yet their role in isolated LPS has not been established. The Esophageal Hypervigilance and Anxiety Scale (EHAS) assesses attentional and emotional responses to esophageal sensations.
Aims: This study evaluated EHAS across GERD phenotypes in isolated LPS and determined whether patients with actionable GERD were present.
Methods: Adults presenting with isolated LPS for at least three months were prospectively enrolled. Participants completed the Reflux Symptom Index (RSI) and the EHAS. Upper endoscopy identified BE and erosive esophagitis (EE). Patients without mucosal breaks subsequently underwent 24-hour impedance-pH monitoring for classification into non-erosive reflux disease (NERD), reflux hypersensitivity (RH), or functional heartburn (FH). Clinical characteristics and patient-reported outcomes were compared across phenotypes.
Results: Among 225 patients with isolated LPS (mean age 51.8 years, 63.1% female), 32.4% had actionable GERD, including BE (6.2%), EE (13.3%), and NERD (12.9%). BE patients had the highest prevalence of hiatal hernia (14.3% vs. 9.1%, 4.1%, 2.7%, 5.1% across other phenotypes) and fatty liver disease (78.6% vs. 43.3%, 27.6%, 16.2%, 29.5%) (all p < 0.05). BE demonstrated the lowest
hypervigilance subscale scores (10.6 vs 19.0, 18.1, 20.5; p = 0.004). Total EHAS scores, EHAS-anxiety subscale scores, and RSI scores were similar across phenotypes, with no significant differences (p > 0.05). Across individual LPS, hoarseness, throat clearing, postnasal drip, and cough showed no significant differences between actionable and functional GERD. Globus was significantly more frequent in functional GERD (78.1% vs 60.7%, p = 0.007).
Conclusions: Nearly one-third of patients with isolated LPS exhibited actionable GERD, emphasizing that LPS should not be presumed functional in the absence of typical reflux symptoms. Among LPS symptoms, globus is a negative marker for actionable GERD. BE was characterized by markedly reduced esophageal hypervigilance, which may contribute to the attenuation of symptom perception despite the presence of mucosal injury. Objective diagnostic evaluation, particularly in individuals with low EHAS scores, may enhance identification of occult GERD and support earlier detection of BE.
②
表型分類不確定型非胃食道逆流症可辨識逆 流樣特徵並預測氫離子幫浦抑制劑治療反應 PHENOTYPING INCONCLUSIVE NONGERD TO IDENTIFY REFLUX-LIKE FEATURES AND PREDICT PROTON PUMP INHIBITOR RESPONSE
雷尉毅1 謝名宗2 王仁宏3 翁銘彣1 洪睿勝1 簡錫淵1 劉作財1 易志勳1 陳健麟1
1 佛教慈濟醫療財團法人花蓮慈濟醫院 消化系中心
2 國立成功大學醫學院附設醫院 內科部 胃腸肝膽科
3 佛教慈濟醫療財團法人花蓮慈濟醫院 研究醫學部
Background: Many symptomatic patients demonstrate normal acid exposure time (AET) on pH-impedance monitoring, yet a subset responds to proton pump inhibitors (PPIs), raising suspicion for occult gastro-esophageal reflux disease (GERD).
Aims: We evaluated whether phenotyping inconclusive non-GERD (AET<4%) could unmask reflux-like pathophysiology and predict PPI response in symptomatic patients with normal acid burden.
Methods: Adults with AET <4% who completed highresolution manometry, pH-impedance monitoring off therapy, and an 8-week standard-dose PPI trial were included (n=281). Validated questionnaire data collected for this study consisted of GERDQ, Reflux Symptom Index (RSI), Dominant Symptom Intensity (DSI), Global Symptom Severity (GSS), and Esophageal Hypervigilance and Anxiety Score (EHAS). Conclusive non-GERD was defined as AET <4%, total reflux episodes <40/day, and mean nocturnal baseline impedance (MNBI) >2500 Ω.
Inconclusive non-GERD was subdivided into reflux-like phenotype (≥1 abnormal reflux metric: total reflux episodes >80/day and/or MNBI <1500 Ω), indeterminate phenotype (both metrics borderline: total reflux episodes 40-80, MNBI 1500-2500 Ω), and non-reflux-like phenotype (one borderline and one normal metric). PPI response was defined as ≥50% reduction in GSS. Clinical, manometric, and reflux metrics were compared, and multivariate logistic regression identified independent predictors of response. Results: Despite similar symptom burden, the inconclusive non-GERD phenotype demonstrated higher reflux burden and impaired mucosal integrity compared to conclusive non-GERD, including more total reflux episodes (56.2±44.5 vs 20.8±9.8, p<0.001) and lower MNBI (2309.2±672.6 vs 3135.2±472.2 Ω, p<0.001). Compared with the indeterminate and non-reflux-like phenotypes, the reflux-
like phenotype also demonstrated the highest reflux burden, lowest MNBI, and most impaired motility (all p<0.001). Clinically meaningful PPI response was highest in refluxlike phenotype (51.1%), followed by indeterminate (28.2%) and non-reflux-like phenotypes (29.5%), and lowest in conclusive non-GERD (24.4%) (p=0.025). In multivariate analysis, the reflux-like phenotype remained an independent predictor of PPI response (OR 2.59–4.13, p ≤ 0.040). Lower baseline GSS (OR 0.97, 95% CI 0.95–0.98, p<0.001) and lower EHAS scores (OR 0.98, 95% CI 0.97–0.99, p=0.025) were also associated with a greater likelihood of response.
Conclusions: Among symptomatic patients with normal AET, phenotyping inconclusive non-GERD uncovers a reflux-like subgroup with clear physiologic evidence of reflux and a markedly higher likelihood of PPI response. These findings demonstrate that AET alone is insufficient; integrating MNBI and reflux burden provides superior diagnostic discrimination and directly informs treatment decisions in normal-AET populations.
③
咽喉逆流相關症狀與夜間副交感神經功能失 調之關聯：獨立於阻塞型睡眠呼吸中止症 LARYNGOPHARYNGEAL SYMPTOMS ARE ASSOCIATED WITH NOCTURNAL PARASYMPATHETIC DYSFUNCTION INDEPENDENT OF OBSTRUCTIVE SLEEP APNEA
翁銘彣1 王仁宏2 洪睿勝1 劉作財1 易志勳1 雷尉毅1
簡錫淵1 陳健麟1
1 佛教慈濟醫療財團法人花蓮慈濟醫院 消化系中心
2 佛教慈濟醫療財團法人花蓮慈濟醫院 研究醫學部
Background: Laryngopharyngeal symptoms (LPS) often persist for months and substantially impair quality of life. Although LPS has been increasingly associated with sleep disturbance, it remains unclear whether LPS can be mediated by obstructive sleep apnea (OSA) or arise from abnormalities in autonomic regulation during sleep.
Aims: Our study aimed to evaluate the hypothesis that LPS could be influenced by nocturnal autonomic dysregulation and OSA.
Methods: A prospective case-control study was conducted, including adults with LPS lasting more than three months and age-matched healthy controls. All participants completed validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Taiwanese Depression Questionnaire (TDQ), the State Trait Anxiety Inventory (STAI), the Perceived Stress Scale 10-item version (PSS 10), the Esophageal Hypervigilance and Anxiety Scale (EHAS), and the Laryngopharyngeal Hypervigilance and Anxiety Scale (LHAS). Overnight monitoring using the Leadtek wearable oximeter screened for OSA based on oxygen saturation (SpO2), the 3% oxygen desaturation indices (ODI 3%), and cumulative time with SpO2 below 90% (CT90), with ODI classified by the 3% desaturation criterion as normal (ODI < 5), mild (5 ≤ ODI < 10), moderate (10 ≤ ODI < 30), or severe (ODI ≥ 30). Autonomic function was evaluated through heart rate variability indices, with the root mean square of successive differences (RMSSD) and high-frequency power (lnHF) reflecting parasympathetic activity, and the standard deviation of normal-to-normal intervals (SDNN) and lowfrequency power (lnLF) indicating overall and sympathetic influences.
Results: Sixty-one subjects were included, consisting of 22 patients with LPS and 39 healthy controls. LPS patients demonstrated significantly worse sleep quality, with higher
PSQI scores (P = 0.002). Psychological burden was also higher in the LPS group, including TDQ, EHAS, and LHAS (all P < 0.005). OSA-related physiologic markers (SpO2, ODI 3%, CT90) did not differ between groups (all P > 0.05). HRV analysis revealed significant impairment of nocturnal parasympathetic function among LPS patients. Compared with controls, LPS patients exhibited lower SDNN (P = 0.030), lower RMSSD (P = 0.025), and lower lnHF (P = 0.025), indicating diminished vagal modulation during sleep.
Conclusions: Although LPS are associated with marked deterioration in subjective sleep quality, these symptoms are not mediated by OSA severity. Instead, LPS are characterized by reduced parasympathetic tone during sleep, indicating nocturnal autonomic dysregulation as a primary pathophysiological mechanism linking LPS with sleep disturbance. These findings support the role of nighttime autonomic dysregulation as a mechanistic contributor to LPS, suggesting its clinical relevance in managing patients with LPS.
④
內視鏡氰基丙烯酸酯注射與普萘洛爾用於預 防胃靜脈曲張出血的療效比較：一項開放標 籤、雙中心、隨機對照試驗 ENDOSCOPIC CYANOACRYLATE INJECTION VERSUS PROPRANOLOL FOR THE PRIMARY PREVENTION OF GASTRIC VARICEAL BLEEDING: AN OPEN-LABEL, TWO-CENTER, RANDOMIZED CONTROLLED TRIAL
陳宥任1,2 侯明志1,2
1 臺北榮民總醫院 內科部胃腸肝膽科
2 國立陽明交通大學醫學系
Background: Clinically significant portal hypertension (CSPH) is a major predictor of liver related events, such as hepatic decompensation, hepatocellular carcinoma (HCC) and mortality. Previous study has already established the benefits of non-selective beta blockers (NSBB) in patients with CSPH, yet the clinical application in different subgroups is not investigated. The prevalence of gastric varices (GV) is about 20% in cirrhotic patients. The risk of bleeding is lower in GV than esophageal varices (EV) but usually accompanied with more severe and fetal bleeding episodes.
Aims: This randomized trial aimed to address whether endoscopic cyanoacrylate injection (ECI) or propranolol (PPL) is more effective in primary prevention of gastric variceal bleeding (GVB) in cirrhotic patients
Methods: Patients with cirrhosis and medium to large gastric varices (GVs) without previous GVB were randomized to receive ECI (every 3-4 weeks until eradication) or PPL (titrate from 40mg up to 320mg daily) at a 1:1 ratio. The primary endpoint was esophagogastric variceal bleeding free survival (EGVBFS), secondary endpoints were decompensation free survival (DFS), overall survival (OS) and adverse events (AEs). Followup data in 5 years were analyzed using competing risk regression.
Results: Between April 2010 and December 2023, 120 patients were randomized to receive ECI (n=59) or PPL (n=61). EGVBFS and OS were not different between ECI and PPL group (p=0.612 and 0.804, respectively). For patients with compensated liver cirrhosis, the PPL group had a better DFS than ECI group, with adjust hazard ratio (aHR)=2.137 (95%CI 1.030-4.434, p=0.042). OS was not different between ECI and PPL group even in compensated cirrhotic patients (p=0.357). In the multivariate analysis,
active hepatocellular carcinoma (HCC) (aHR=2.837, p=0.011), decompensated status (aHR=2.554, p=0.006) and higher aspartate aminotransferase (aHR=1.003, p=0.026) were independent risk factors of worse EGVBFS. For compensated subgroup, active HCC (aHR=2.624, p=0.023), higher Model For End-Stage Liver Disease (MELD) score (aHR=1.163, p=0.005), location of GV (GOV vs. IGV, aHR=2.161, p=0.045) and ECI (aHR=2.137, p=0.042) were independent risk factors of worse DFS in the multivariate analysis.
Conclusions: ECI and PPL are equal in preventing first EGVB in cirrhotic patients, active HCC and decompensated status were independent risk factors of worse EGVBFS. For patients with compensated cirrhosis, PPL can delay first hepatic decompensation events. Active HCC, higher MELD score, location of GV and ECI were independent risk factors of worse DFS.
⑤
精緻化酸暴露時間閾值以提升亞洲人群胃食 道逆流症之表型分類 REFINING ACID EXPOSURE TIME THRESHOLDS TO IMPROVE GERD PHENOTYPING IN ASIAN PATIENTS
簡錫淵1 雷尉毅1 謝名宗2 王仁宏3 劉作財1 易志勳1
翁銘彣1 洪睿勝1 陳健麟1
1 佛教慈濟醫療財團法人花蓮慈濟醫院 消化系中心
2 國立成功大學醫學院附設醫院 內科部 胃腸肝膽科
3 佛教慈濟醫療財團法人花蓮慈濟醫院 研究醫學部
Background: The Lyon Consensus 2.0 defines acid exposure time (AET) >6% as conclusive gastroesophageal reflux disease (GERD), yet physiologic acid exposure in Asian populations is substantially lower. Although AET >4% has been widely adopted as the diagnostic threshold for conclusive GERD in Asia, the lower threshold that defines the conclusive absence of GERD—and the intermediate range representing borderline GERD— remains unestablished.
Aims: This study aimed to identify a physiologic lower AET threshold that reliably defines the conclusive absence of GERD and, together with the established >4% threshold, develop a region-appropriate AET framework for GERD phenotyping in Asian patients.
Methods: Patients undergoing upper endoscopy, highresolution manometry, and ambulatory pH-impedance monitoring off therapy were enrolled. A stringent nonGERD reference group was defined using mean nocturnal baseline impedance (MNBI) >2500 Ω and total reflux episodes <40 to reflect physiologic reflux burden. Patients with AET >4% were classified as conclusive GERD, whereas those not meeting the stringent non-GERD criteria were considered borderline GERD. Receiver operating characteristic (ROC) analysis identified the optimal AET threshold distinguishing the stringent non-GERD group. Patients were reclassified using these thresholds, and physiologic characteristics were compared.
Results: Among 373 patients, AET <2.0% demonstrated optimal sensitivity (93%) and specificity (63%) for identifying the conclusive absence of GERD (AUC 0.82). Across AET-defined groups, clear physiologic gradients were observed. Patients with AET >4% had the highest reflux burden (AET 9.23±6.73%; DeMeester 28.28±19.10) and the lowest impedance (MNBI 1676±925 Ω), whereas those with AET <2% showed physiologic acid exposure (0.53±0.52%), preserved mucosal integrity (MNBI
2848±846 Ω), and fewer reflux episodes (26.27±16.64).
The AET 2–4% group demonstrated intermediate acid burden and impedance (MNBI 1941±641 Ω), consistent with a borderline phenotype. Esophagogastric junction (EGJ) barrier metrics improved stepwise, with LES resting pressure and EGJ contractile integral increasing from conclusive GERD to borderline and conclusive absence, paralleling reductions in reflux burden. Esophageal body motility also varied consistently, with ineffective peristalsis (52.5%→43.4%→30.1%, p<0.001) and failed peristalsis (27.4%→21.1%→12.0%, p<0.001) decreasing across groups.
Conclusions: AET <2% reliably identifies the conclusive absence of GERD in Asian patients. Combined with the established >4% diagnostic threshold, the resulting AET framework—conclusive GERD (>4%), borderline GERD (2–4%), and conclusive absence (<2%)—demonstrates clear physiologic and manometric gradients and provides an evidence-based, region-appropriate approach for GERD phenotyping in Asian populations.
⑥
在腎上腺素注射術後，比較併用氬氣電漿凝 固術或併用止血夾兩者對於消化性潰瘍出血 的止血療效之隨機控制試驗 A RANDOMIZED, CONTROLLED TRIAL COMPARING DILUTED EPINEPHRINE INJECTION COMBINED WITH EITHER ARGON PLASMA COAGULATION OR HEMOCLIPPING FOR TREATMENT OF HIGH–RISK PEPTIC ULCER BLEEDING: AN INTERIM REPORT.
黃士軒 陳文誌 蔡峯偉 蔡騌圳 李昀達 王惠民 高雄榮民總醫院胃腸肝膽科
Background: Endoscopic treatment is recommended as the primary modality for hemostasis in patients with nonvariceal upper gastrointestinal bleeding. Various endoscopic modalities have demonstrated efficacy in the management of peptic ulcer bleeding. However, the additional hemostatic efficacy of argon plasma coagulation (APC) following endoscopic injection therapy has not been well investigated.
Aims: This study aimed to compare the efficacy of argon plasma coagulation plus diluted epinephrine injection (APC group) versus hemoclipping plus diluted epinephrine injection (Clip group) for the treatment of high-risk peptic ulcer bleeding.
Methods: Between January 2019 and January 2025, consecutive patients admitted to our hospital with high-risk bleeding ulcers—defined as active bleeding, non-bleeding visible vessels, or adherent clots—were prospectively enrolled. Patients were randomly assigned to receive diluted epinephrine injection (1:10,000) combined with argon plasma coagulation (APC) or hemoclipping. All patients received intravenous pantoprazole during the postendoscopic fasting period, followed by oral pantoprazole for 8 weeks to facilitate ulcer healing. In cases of rebleeding, repeat endoscopic combination therapy was performed. Patients who were refractory to endoscopic retreatment subsequently underwent emergency surgery or arterial embolization. Statistical analyses were conducted using SPSS software (SPSS Inc., Chicago, IL, USA). Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test, while categorical variables were analyzed using the chi-square test or Fisher’s exact test, as appropriate. Outcomes assessed included bleeding lesion location, initial hemostasis, rebleeding, need for emergency surgery, and mortality. All statistical tests were
two-sided, and a p value < 0.05 was considered statistically significant.
Results: A total of 163 eligible patients were included in the analysis. 78 patients received argon plasma coagulation combined with diluted epinephrine injection (APC group), and 85 patients received hemoclipping combined with diluted epinephrine injection (Clip group). Baseline demographic and clinical characteristics were comparable between the two groups. Initial hemostasis was successfully achieved in 77 patients in the APC group and 84 patients in the Clip group (98.7% vs. 98.8%, p = 1.000). Rebleeding occurred in 6 patients (7.7%) in the APC group and in 8 patients (9.4%) in the Clip group (p = 0.784). There were no significant differences between the two groups in the rates of surgery (1.3% vs. 1.2%, p = 1.000), transarterial embolization (1.3% vs. 2.4%, p = 1.000), or mortality (1.3% vs. 1.2%, p = 1.000). In addition, length of hospital stay and transfusion requirements were similar between the two groups.
Conclusions: In patients with high-risk peptic ulcer bleeding, argon plasma coagulation combined with diluted epinephrine injection achieved comparable hemostatic efficacy and clinical outcomes to hemoclipping combined with diluted epinephrine injection. Both treatment modalities demonstrated similarly high rates of initial hemostasis and low rates of rebleeding, surgery, transarterial embolization, and mortality. APC combined with epinephrine injection may represent an effective alternative endoscopic hemostatic strategy for high-risk peptic ulcer bleeding.
主題：肝腫瘤（一） ⑦
BCLC B 期肝癌之結果導向次分期：協助臨 床最佳治療選擇
OUTCOME-ORIENTED SUBCLASSIFICATION OF PATIENTS WITH BCLC STAGE B HEPATOCELLULAR CARCINOMA FOR OPTIMIZING SELECTION
温修平1 黃惠玲1,2 丁元捷1,3 盧勝男1,2,4 張德生1
1 長庚醫療財團法人嘉義長庚紀念醫院胃腸肝膽科
2 長庚醫療財團法人嘉義長庚紀念醫院護理部
3 仁愛醫療財團法人大里仁愛醫院胃腸肝膽科
4 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科
Background: BCLC stage B hepatocellular carcinoma (HCC) is highly heterogeneous, and current sub-staging systems offer limited guidance for treatment selection, especially regarding TACE versus surgery or ablation.
Aims: To develop a treatment-oriented sub-classification (BA, BB, BC, BD) to assist clinicians in therapy selection and outcome prediction, focusing on TACE suitability.
Methods: We retrospectively analyzed 442 BCLC-B patients treated at Chiayi Chang Gung Memorial Hospital (CGMH) (2011–2020). Patients were first classified by Child–Pugh score and tumor features: single tumors >5 cm undergoing resection as BA, Child–Pugh >B7 as BD. For the remaining cohort, tumor-burden cutoffs (up-to-7 vs upto-11) and infiltrative morphology were evaluated. Kaplan–Meier curves and log-rank tests compared survival across sub-groups and treatments.
Results: Only the up-to-11 threshold with infiltrative morphology clearly distinguished TACE-suitable (BB) from TACE-unsuitable (BC). Median survival for BA, BB, BC, and BD was 127, 35, 25, and 6 months (P < 0.0001). BB–BC differences were significant only in TACE-treated patients; outcomes were similar for resection or ablation.
Conclusions: (1) Single tumors >5 cm resected were BA; (2) Child–Pugh >B7 were BD due to limited tolerance; (3) TACE-unsuitable (BC) were defined by infiltrative morphology or exceeding up-to-11; (4) BB and BC had similar survival with resection or ablation, showing this classification mainly predicts TACE outcomes. This practical sub-classification can guide therapy selection and identify patients most likely to benefit from TACE.
⑧
自體免疫疾病對肝細胞癌患者預後的影響： 單一醫學中心回溯性研究
IMPACT OF AUTOIMMUNE
DISEASES ON THE PROGNOSIS OF PATIENTS WITH HEPATOCELLULAR CARCINOMA: A SINGLE-CENTER RETROSPECTIVE STUDY
廖健宏 陳威廷 謝顯森 張明鈴
Background: Autoimmune diseases (AIDs) are increasingly recognized among patients with hepatocellular carcinoma (HCC), either as coexisting conditions or as contributors to chronic inflammation and immune dysregulation. However, the prognostic significance of AIDs in HCC remains unclear, particularly in the context of modern immunotherapy.
Aims: To evaluate the impact of AIDs on the prognosis of patients with HCC, compare clinical characteristics between patients with and without AIDs, and assess differences in survival and treatment patterns, with a focus on immunotherapy.
Methods: We retrospectively reviewed medical records of patients diagnosed with HCC from 2000 to 2020 at Chang Gung Memorial Hospital, Linkou. Patients were categorized according to the presence or absence of documented AIDs. More than 20 autoimmune conditions were included, defined by established clinical and serologic criteria. Data on demographics, lifestyle factors, tumor stage, liver function, treatment modalities, and survival were collected. The primary endpoint was overall survival (OS). Group differences were analyzed using t-tests and chi-square tests, and prognostic factors were examined using Kaplan–Meier curves and multivariable Cox regression.
Results: Among 16,371 patients with HCC, 771 (4.7%) had coexisting AIDs. Compared with the non-AID group, patients with AIDs were more often female and older, and were more likely to have cirrhosis or fatty liver. They had lower rates of alcohol consumption and smoking, a lower prevalence of hepatitis B virus (HBV) infection, and a higher prevalence of hepatitis C virus (HCV) infection. Immunotherapy was less frequently administered to patients with high-risk AIDs. Mean OS was significantly longer in the AID group (5.25 ± 4.78 years) than in the non-AID group (3.69 ± 4.31 years; p < 0.0001). In multivariable Cox regression, the presence of an AID
remained independently associated with improved OS (HR = 0.715, 95% CI: 0.61–0.84; p < 0.0001), after adjusting for age, sex, cirrhosis, fatty liver, alcohol use, smoking status, HBV/HCV infection, and TNM stage.
Conclusions: Coexisting AIDs are independently associated with better overall survival in patients with HCC. Enhanced baseline immune activation or increased medical surveillance may contribute to this survival advantage. Larger multicenter and disease-specific studies are warranted to validate these findings and clarify underlying mechanisms.
⑨
肝細胞癌手術切除後之復發型態與復發後存 活：以米蘭準則為基礎之分層分析 RECURRENCE PATTERNS AND POST-RECURRENCE SURVIVAL AFTER CURATIVE RESECTION FOR HEPATOCELLULAR CARCINOMA: A MILAN CRITERIA–BASED STRATIFICATION
談啟蘋1 李懿宬1, 2 胡果正1, 3 周嘉揚4 羅景全1, 2
黃怡翔1, 2, 5, 6
1 臺北榮民總醫院內科部胃腸肝膽科
2 國立陽明交通大學醫學院醫學系
3 衛生福利部基隆醫院內科部胃腸肝膽科
4 臺北榮民總醫院外科部
5 國立陽明交通大學臨床醫學研究所
6 臺北榮民總醫院醫學研究部
Background: Despite curative resection, hepatocellular carcinoma (HCC) is associated with a high recurrence rate. However, recurrence patterns and long-term post-recurrence survival (PRS) remain incompletely characterized.
Aims: This study aimed to delineate recurrence patterns and identify prognostic factors influencing PRS following curative resection for HCC.
Methods: We retrospectively analyzed 1,813 patients who underwent curative resection for HCC between 2007 and 2023. Recurrence patterns, post-recurrence treatments, and factors associated with PRS were evaluated, with stratification according to recurrence within or beyond the Milan criteria.
Results: During a median follow-up of 63.3 months, 906 patients developed HCC recurrence, of whom 61.0% and 39.0% experienced recurrence within and beyond the Milan criteria, respectively. Among patients with recurrence within the Milan criteria, independent predictors of poorer PRS included early recurrence (hazard ratio [HR] = 2.103, p < 0.001), recurrent tumor size > 2 cm (HR = 1.497, p = 0.011), multiple recurrent tumors (HR = 2.110, p < 0.001), AFP > 20 ng/mL (HR = 1.677, p = 0.001), and ALBI grade 2–3 (HR = 1.850, p < 0.001). For patients with recurrence beyond the Milan criteria, baseline microvascular invasion (HR = 2.348, p = 0.004), recurrent macrovascular invasion (HR = 1.620, p = 0.042), confluent multinodular or infiltrative-type recurrent tumor morphology (HR = 3.281, p < 0.001), AFP > 400 ng/mL (HR = 1.867, p = 0.001), ALBI grade 2–3 (HR = 2.130, p < 0.001), and diabetes mellitus (HR = 2.016, p < 0.001) were independently
associated with PRS. Risk scores derived from PRS predictors stratified patients with recurrence within the Milan criteria into three risk groups, with median PRS of 149.6, 68.8, and 33.4 months, respectively (p < 0.001). Similarly, patients with recurrence beyond the Milan criteria were stratified into three risk groups with median PRS of 44.8, 18.8, and 4.7 months, respectively (p < 0.001).
Conclusions: Post-recurrence survival following curative resection for HCC is strongly influenced by recurrence patterns as well as tumor- and host-related factors. These findings may facilitate individualized post-recurrence management, optimize the timing of referral for salvage liver transplantation, and inform the design of future clinical trials.
⑩
晚期肝細胞癌患者經癌自禦合併癌思停治療 後接受根治性治療存活預後 SURVIVAL OUTCOMES OF CONVERSION CURATIVE THERAPY FOLLOWING ATEZOLIZUMAB–BEVACIZUMAB IN ADVANCED HEPATOCELLULAR CARCINOMA
陳瑩芯1 李韋鋒2 陳彥豪3 王景弘1 王植熙2 洪肇宏1 1 高雄長庚紀念醫院胃腸肝膽科系 2 高雄長庚紀念醫院一般外科
3 高雄長庚紀念醫院血液腫瘤科
Background: The prognostic impact of curative therapies—including liver transplantation, hepatectomy, and local ablation—in patients with advanced hepatocellular carcinoma (HCC) following atezolizumab plus bevacizumab (Atezo/Bev) treatment remains uncertain.
Aims: This study aimed to evaluate the feasibility of downstaging curative therapy and to compare survival outcomes between patients who did and did not undergo curative therapy following Atezo/Bev therapy using a propensity score–matched analysis.
Methods: This retrospective study included 318 consecutive patients with advanced HCC who received Atezo/Bev therapy between 2020 and 2024. The primary endpoints were overall survival (OS) and progression-free survival (PFS), which were estimated by the Kaplan-Meier method and evaluated with multivariate Cox proportional hazards regression analysis.
Results: The objective response (OR) rate to Atezo/ Bev therapy was 34.6%, including complete response in 7.2%, partial response in 27.4%, stable disease in 28.6%, and progressive disease in 36.8% of patients. Thirty-six (11%) patients underwent curative therapy after Atezo/ Bev treatment, including liver transplantation in 8 (2.5%), hepatectomy in 11 (3.5%), and local ablation in 17 (5.3%).
Patients who received curative therapy demonstrated significantly improved OS (p<0.001) and PFS (p<0.001) compared with those who did not, and these benefits remained consistent after propensity score matching. Multivariate Cox regression analysis identified curative therapy (hazard ratio [HR] 0.204; 95% confidence interval [CI] 0.094–0.444; p<0.001), OR (HR 0.359; 95% CI 0.237–0.542; p<0.001), albumin–bilirubin grade II/III (HR 1.795; 95% CI 1.249–2.579; p=0.002), tumor burden≥12 (HR 1.580; 95% CI 1.127–2.216; p=0.008), alphafetoprotein≥400 ng/mL (HR 1.575; 95% CI 1.116–2.221;
p = 0.010), Child–Pugh class A (HR 0.583; 95% CI 0.359–0.945; p=0.029), and macrovascular invasion (HR 1.142; 95% CI 1.021–2.038; p=0.038) as independent factors associated with OS.
Conclusions: Curative therapy following Atezo/Bev treatment confers significant survival benefits in selected patients with advanced HCC.
⑪
探討公衛介入的因果關係於台灣肝癌發生率 預測之研究
CAUSAL INTERVENTION CHAINS FOR PREDICTING THE INCIDENCE OF LIVER CANCER IN TAIWAN
廖思涵 立全診所
Background: To combat liver cancer, three change points of interventions have been implemented in Taiwan, including hepatitis B vaccination from 1984, universal health care from 1995, and antiviral therapy from 2004. However, the causal relationship between interventions and whether the heterogeneities of liver cancer disease burden existed across different age groups and geographic areas is still elusive.
Aims: The aims of this study are to assess the effects of three change points according to the time to initiate each intervention on trend changes of liver cancer incidence and to predict the time trend of liver cancer incidence until 2045.
Methods: A causal chain of interventions based on Bayesian hierarchical change-point analysis is proposed to model a cascade of the impacts from baseline values (intercepts), annual changes (slopes), and change points on liver cancer with respect to age groups and geographic areas in Taiwan. The predicted trend of liver cancer incidence until 2045 estimated by integrating parameters under the Bayesian hierarchical change-point model.
Results: The mediated benefit of antiviral therapy through the change of time trend contributing the reduction of liver cancer incidence by 46% for males (RR, 0.54; 95% CI, 0.32 to 0.88) and 45% for females (RR, 0.55; 95% CI, 0.26 to 1.12). The benefit of antiviral therapy was significantly augmented through universal health care leading to 64% reduction of liver cancer incidence for men (RR, 0.36; 95% CI, 0.20 to 0.63), and 62% reduction for women (RR, 0.38; 95% CI, 0.22 to 0.62). The geographic disparity of liver cancer incidence on baseline value, time trend, and the effects of three change points were significant. The predicted incidence of liver cancer until 2045 will be 13.01 per 100,000.
Conclusions: The causal inference on serial interventions for liver cancer prevention in different age groups and geographic areas is drawn from Taiwan’s experience to provide state-of-the-art evidence-based estimate on the elimination of liver cancer globally.
⑫
利用機器學習模型整合臨床資料與大型語言 模型結構化之病理特徵預測肝癌術後早期復 發風險
PREDICTING EARLY RECURRENCE OF HEPATOCELLULAR CARCINOMA AFTER RESECTION: A MACHINE
LEARNING MODEL INTEGRATING
CLINICAL DATA AND LLMSTRUCTURED PATHOLOGICAL FEATURES
孫煜崴1 蘇東弘1,2,3 董鴻甯4 許晏寧5 陳芬芳2 溫家昶6
李少武7 霍德義8 李建璋9 高嘉宏1,3,10,11
1 國立臺灣大學醫學院附設醫院內科部胃腸肝膽科；2 國
立臺灣大學醫學院附設醫院新竹分院醫學研究部；3 國
立臺灣大學醫學院附設醫院肝炎研究中心；4 國立臺灣 大學醫學院附設醫院新竹分院內科部；5 國立臺灣大學 醫學院附設醫院智慧醫療中心；6 國立臺灣大學醫學院 附設醫院資訊室；7 台中榮民總醫院內科部胃腸肝膽科； 8 臺北榮民總醫院醫學研究部；9 衛生福利部資訊處；10 國立臺灣大學醫學院臨床醫學研究所；11 國立臺灣大學 醫學院附設醫院醫學研究部
Background: Hepatocellular carcinoma (HCC) remains one of the most deadly cancers worldwide. Surgical resection is the mainstay of curative treatment for earlystage HCC; however, postoperative recurrence is not uncommon and significantly compromises long-term prognosis.
Aims: We aimed to develop a model integrating clinical and pathological features to predict early (2-year) recurrence after resection.
Methods: We established a retrospective cohort of HCC patients who underwent curative resection using data from the Integrated Medical Database (iMED) of National Taiwan University Hospital. Clinical, laboratory, and imaging data were curated and standardized. The pathologic features—including tumor size, number, differentiation, microvascular invasion, satellite nodules, capsule invasion, location, and fibrosis stage were converted into structured variables using the Meta Llama 3.3 multilingual large language model (LLM). Six machine learning algorithms (Logistic Regression, XGBoost, LightGBM, CatBoost, SVM, and Random Forest) were trained on 80% of cases and tested on the remaining 20%.
Results: A total of 1061 HCC patients and 59 clinicopathologic features were included for modeling. Among the tested models, the CatBoost classifier
demonstrated the best predictive performance, with an AUROC of 0.791 and an accuracy of 0.756. Using a threshold of 0.476, the sensitivity, specificity, and positive predictive value, and F1-score were 0.674, 0.822, 0.753, and 0.711, respectively. Key predictors of early recurrence included trabecular histologic subtype, BCLC staging, microvascular invasion, tumor volume, and integrated clinicopathologic stage.
Conclusions: By leveraging an LLM to structure pathological features, we developed a machine learning model that integrates clinicopathological data to predict early postoperative recurrence in HCC. Future work will expand the model by incorporating preoperative CT imaging and deep learning techniques to have a comprehensive multimodal framework.
主題：病毒性肝炎（一）
⑬
靶向傳送 B 肝表面抗原（HBSAG）至 CEA 陽性的大腸癌以利用 B 肝疫苗產生的免疫 力來抑制腫瘤生長
UTILIZATION OF HBV-VACCINATED IMMUNITY TO SUPPRESS TUMOR PROGRESSION VIA TARGETED DELIVERY OF HBSAG TO CEAPOSITIVE COLORECTAL CANCER
程俊嘉1,2 謝宗霖1 蕭永晉3,4 王智亮2 彭正良5 王俊懿6 張榮善7 何愛生8 張君照9
1 長庚大學 放射醫學研究中心
2 林口長庚醫院 肺腫瘤及內視鏡科
3 長庚大學 生物醫學研究所
4 長庚大學 分子醫學研究中心
5 國家原子能研究院 同位素所
6 中國醫藥大學 醫學系生化學科
7 台北醫學大學 醫學科學究所
8 台北振興醫院 胃腸肝膽科
9 台北醫學大學附設醫院 消化內科
Background: Limited antigen recognition in tumors hinders the CD8⁺ T cells-mediated anti-tumor efficacy. We hypothesized that vaccinated immunity against the hepatitis B virus (HBV) in individuals could be harnessed to target hepatitis B surface antigen (HBsAg)-carrying tumor cells, thereby to suppress tumor progression.
Aims: We aimed to validate the proposed concept and to develop a tumor-targeting approach that delivers HBsAg to colorectal tumor cells via carcinoembryonic antigen (CEA)-specific antibodies.
Methods: We generated HBsAg-overexpressed CT26 and MC38 colorectal tumor cells and utilized HBV-vaccinated mice to evaluate the proposed concept. A fusion protein comprising a fragment of HBsAg (fHBs, amino acids 103170) and a single-chain variable fragment (scFv) against CEACAM5 (CEA), linked to a Fc domain (fHBs-T84scFvFc), was constructed to deliver HBsAg into tumor cells for immune CD8+ T cell recognition and tumor suppression.
Results: We found that HBV-vaccinated mice included anti-HBsAg CD8+ T cells and exhibited strong anti-tumor responses to significantly suppress HBsAg-overexpressed tumors, which were accompanied by increased CD3⁺ and CD8⁺ T cell infiltration. CEACAM5 was identified as a colorectal tumor-specific receptor exhibiting internalization. We consequently demonstrated that the created antitumor reagent, fHBs-T84scFv-Fc, effectively inhibited the growth of CEACAM5-positive MC38 tumors in the HBV-
vaccinated mice. Meanwhile, enhanced infiltration of CD3⁺ and CD8⁺ T cells was observed in the tumor tissues under fHBs-T84scFv-Fc treatment.
Conclusions: In conclusion, we demonstrated a novel strategy by utilizing HBV-vaccinated immunity for colorectal tumor suppression via CEA-targeted HBsAg delivery. This study suggests that the anti-HBV immunity containing anti-HBsAg CD8+ T cells can be utilized to suppress a range of tumors using HBsAg-antibody conjugates by targeting the tumor-specific internalizing receptors.
⑭
慢性 B 型肝炎停用核苷（酸）類似物後， 治療結束時的 HBSAG 濃度可預測功能性治 癒與臨床復發，但無法預測嚴重急性發作風 險
END-OF-TREATMENT HBSAG TO STRATIFIES RISK OF RELAPSE AND HBSAG LOSS, BUT NOT SEVERE FLARES, IN CHRONIC HEPATITIS B PATIENTS
林歆哲1 劉彥君1,2 鄭文睿1 簡榮南1,2 廖運範1
1 林口長庚紀念醫院
2 長庚大學醫學院
Background: Previous studies have demonstrated that lower end-of-treatment (EOT) HBsAg levels, especially <100 IU/mL, is associate with lower clinical relapse (CR) and higher HBsAg loss rate. A recent study involving 108 patients reported that an only EOT qHBsAg <10 IU/mL, not 100 IU/mL, was significantly associated with low CR and higher HBsAg loss (Hume SJ et al Aliment Pharmacol Ther. 2025 Aug 21. doi: 10.1111/apt.70332).
Aims: This study aimed to test this unique finding in large HBeAg-negative patients in our off Nucleos(t)ide Analogue (Nuc) cohort HBeAg-negative participants.
Methods: We included 1,245 HBeAg-negative CHB patients who had stopped therapy according to APASL guidelines and were stratified by EOT qHBsAg levels. Clinical relapse (CR) was defined as HBV DNA ≥2000 IU/mL with ALT > 2x the upper limit of normal (ULN). Hepatitis flare was defined as virological relapse (HBV DNA ≥2,000 IU/mL) with ALT ≥5x ULN. Severe hepatitis flare was defined as ALT ≥1,000 U/L or flare with ALT <1,000 U/L with total bilirubin ≥3.5 mg/dL and/or INR ≥1.5. Kaplan-Meier analysis and log-rank tests were used to compare outcomes across groups.
Results: Among 1,245 patients, 1,041 (84%) were male and 501 (40%) had cirrhosis. EOT qHBSAg <10 IU/mL were seen in only 39 patients (3%), 10–100 IU/mL in 175 patients (14%), 101–1000 IU/mL in 762 patients (61%), and >1000 IU/mL in 269 patients (22%). Compared with those with EOT HBsAg 10–100 IU/mL, patients with EOT HBsAg <10 IU/mL had a lower proportion with pretreatment HBsAg <1,000IU/mL (56% vs 73%, p=0.039) and a higher proportion of genotype C infection (23% vs 8%, p=0.007). Age, sex, cirrhosis prevalence, pre-treatment
HBV DNA level, treatment duration, and consolidation time were comparable between the two lowest HBsAg groups (all p>0.05). The 5-year cumulative incidence of CR and hepatitis flare decreased progressively with lower EOT HBsAg levels [CR: 21% vs 43% vs 66% vs 73%, p<0.05; flare: 19% vs 25% vs 47% vs 56%, p<0.001]. The 5-year cumulative incidence of HBsAg loss was markedly higher in the <10 IU/mL group (59% vs 18% vs 12% vs 0%, p<0.001). Importantly, the 5-year cumulative incidence of severe HBV flare (6% vs 6% vs 10% vs 8%, p=0.323) and severity (median peak ALT: 260 vs 593 vs 420 vs 394 U/L, p=0.209) were comparable across all EOT HBsAg groups. Conclusions: Lower EOT HBsAg levels are associated with a lower rate of off-therapy flare and a higher likelihood of HBsAg clearance. However, only 3% and 14% of patients achieved qHBsAg <10 IU/mL and 11–100 IU/mL, respectively, and the incidence of severe flare was comparable across all EOT HBsAg levels. Therefore, EOT qHBsAg alone is not a practical indicator for deciding Nuc cessation, particularly due to its limited ability to discriminate severe flares.
⑮
HBEAG 陰性慢性 B 型肝炎患者自行停用核 苷（酸）類似物治療後之肝相關死亡與肝臟 移植風險
LIVER-RELATED MORTALITY AND TRANSPLANTATION RISK ASSOCIATED WITH SELF-DISCONTINUATION OF NUCLEOS(T)IDE ANALOGUE THERAPY IN HBEAG-NEGATIVE CHRONIC HEPATITIS B
鄭文睿1,2 劉彥君1,2 吳佳玲4 徐正二1,2 蘇崇維1,2 簡榮南1,2,3 廖運範1,2,3
1 林口長庚紀念醫院胃腸肝膽科系
2 長庚大學醫學院
3 林口長庚紀念醫院肝臟研究中心
4 林口長庚紀念醫院巨量資料中心
Background: Self-discontinuation of nucleos(t)ide analogue (Nuc) therapy without appropriate monitoring and loss to follow-up (LTFU) occur in real-world practice. In our previous AASLD 2023 report, the 10-year cumulative incidence of self-discontinuation/LTFU among HBeAgnegative chronic hepatitis B (CHB) patients approached 20%. However, the long-term outcomes such as liverrelated mortality and/or transplantation, have not been well defined. We aimed to evaluate the association between selfdiscontinuation and liver-related mortality/transplantation using a large multi-center cohort with complete mortality ascertainment.
Aims: -
Methods: We conducted a retrospective cohort study using the Chang Gung Research Database (CGRD), including HBeAg-negative CHB patients who received entecavir or tenofovir (TDF or TAF) for ≥3 months between January 2004 and November 2021 at Chang Gung Memorial Hospital branches in Taipei, Linkou, and Taoyuan. Patients receiving antiviral prophylaxis for chemotherapy or immunosuppression, those with hepatitis C, hepatitis D, or HIV coinfection, or those diagnosed with hepatocellular carcinoma within 5 years prior to antiviral initiation were excluded. Time zero was defined as the date of first Nuc initiation. Self-discontinuation/ LTFU was defined as failure to refill antiviral therapy for ≥2 consecutive months and was confirmed by medical chart review. To avoid immortal time bias, self-discontinuation was modelled as a time-varying exposure. Marginal structural models with stabilized inverse probability weighting were applied to account for
time-varying confounders, including antiviral regimen, cirrhosis status, alanine aminotransferase, and HBV DNA levels over time. Liver-related mortality and transplantation were ascertained through linkage with the national Cause of Death Registry. Competing risk analyses were performed to account for non–liver-related death.
Results: A total of 1897 HBeAg-negative CHB patients with 2211 treatment courses were included (ETV: 1686; TDF/TAF: 525). During a median follow-up of 2.17 years (IQR 1.22–3.01), 399 self-discontinuation or loss-to-follow-up events were identified, and 57 patients (cirrhosis: 51; non-cirrhosis: 6) experienced liver-related death or underwent liver transplantation. The annual incidence of liver-related mortality was substantially higher in self-discontinuation compared with physician-guided treatment strategies (3.32% vs. 0.46%), with consistently higher risks observed in both cirrhotic (4.68% vs. 1.80%) and non-cirrhotic patients (1.39% vs. 0.03%)(All log-rank test, P<0.01). In IPW-MSM analyses, self-discontinuation/ LTFU was independently associated with an increased risk of liver-related mortality or transplantation (subdistribution HR 3.47, 95% CI 1.99–6.06; P<0.001). A dose–response relationship was observed, with a higher times of self-discontinuation or loss-to-follow-up events associated with progressively increased risk (subdistribution HR 2.91, 95% CI 1.86–4.56; P<0.001).
Conclusions: In HBeAg-negative CHB patients receiving long-term Nuc therapy, self-discontinuation without appropriate monitoring was independently associated with a markedly increased risk of liver-related mortality and transplantation, demonstrating a dose–response relationship with increasing numbers of self-discontinuation or lossto-follow-up events. These findings highlight the critical importance of maintaining continuous linkage to care during long-term antiviral treatment. Structured and physician-guided discontinuation after finite therapy offers a much safer strategy when finite therapy is considered.
⑯
慢性 B 型肝炎停用核苷（酸）類似物治療 後達成功能性治癒的機率：惡性腫瘤及化學 治療暴露的影響
PROBABILITY OF FUNCTIONAL CURE AFTER NUCLEOS(T)IDE ANALOGUE
WITHDRAWAL IN CHRONIC HEPATITIS
B: THE IMPACT OF MALIGNANCY AND CHEMOTHERAPY EXPOSURE
劉彥君1,2 林歆哲1 施昱嘉2 許朝偉1,2 鄭文睿1,2 簡榮南1,2
1 林口長庚紀念醫院胃腸肝膽科系
2 長庚大學醫學院
Background: Functional cure of chronic hepatitis B (CHB), defined by HBsAg seroclearance, is increasingly achieved after nucleos(t)ide analogue (NUC) withdrawal in immunecompetent patients. CHB patients with malignancy commonly receive NUC therapy as prophylaxis during chemotherapy, representing a distinct immunological context in which post-NUC HBsAg clearance remains insufficiently characterized. Both malignancy itself and chemotherapy exposure may influence host immune function, and the relative impact of specific agents such as rituximab, compared with chemotherapy without rituximab and immune-competent non-cancer CHB, remains unclear. We therefore aimed to compare the probability of HBsAg loss after NUC withdrawal across three clinically relevant contexts: (1) rituximab-containing chemotherapy, (2) chemotherapy without rituximab, and (3) immunecompetent non-cancer CHB.
Aims: -
Methods: We conducted a retrospective cohort study of non-cirrhotic, HBeAg-negative CHB patients. The cancer-CHB group included 248 patients who received prophylactic NUC therapy ≥12 weeks beyond chemotherapy completion, categorized into non-rituximabtreated (n=131) and rituximab-treated lymphoma (n=117) subgroups. The reference cohort consisted of 939 HBeAgnegative CHB patients who discontinued NUC per APASL criteria (off-NUC cohort). Inverse probability of treatment weighting (IPTW) balanced baseline covariates (age, sex, HBV DNA, end-of-treatment (EOT) HBsAg) across groups. Cumulative HBsAg loss was estimated using Kaplan–Meier methods and compared by weighted log-rank tests. Multivariate Cox regression identified independent predictors of functional cure.
Results: Compared to off-NUC CHB patients, cancerCHB patients treated with rituximab were older (57 vs 52
years) and less often male (53% vs 82%), with markedly lower baseline HBV DNA (median 3.2 vs 6.3 log10 IU/ mL). Before IPTW, the 5-year cumulative HBsAg loss was 11% in the off-NUC cohort (group A), 6% in cancerCHB without rituximab (group B), and 9% in rituximabtreated lymphoma-CHB (group C) (overall p=0.100). Pairwise comparison showed significantly higher HBsAg loss in off-NUC CHB (Group A) compared to cancer-CHB without rituximab (Group B) (p=0.035), but no significant difference between off-NUC CHB and rituximab-treated patients (Group C) (p=0.710). After IPTW adjustment, the 5-year cumulative HBsAg loss was 11% vs 2% vs 4% for groups A, B, and C, respectively (overall p<0.001). OffNUC CHB patients showed significantly higher HBsAg loss probability than both cancer-CHB subgroups [(A) vs (B), p<0.001; (A) vs (C), p=0.026], while no significant difference was observed between the two cancer-CHB subgroups (p=0.13). In multivariate Cox regression, qHBsAg at EOT <2 log10 IU/mL independently predicted HBsAg loss, whereas cancer-CHB status without rituximab was associated with lower probability of HBsAg loss.
Conclusions: After covariate adjustment, cancer-CHB patients showed substantially lower HBsAg loss rates regardless of rituximab exposure, suggesting that cancerassociated immune dysfunction—rather than B-cell depletion alone—is the predominant barrier to functional cure.
⑰
TENOFOVIR ALAFENAMIDE 與
ENTECAVIR 於 B 型肝炎急性肝失代償非 肝硬化病人之治療效果比較 COMPARATIVE EFFECTIVENESS OF TENOFOVIR ALAFENAMIDE AND ENTECAVIR IN HEPATITIS B–RELATED ACUTE HEPATIC DECOMPENSATION WITHOUT CIRRHOSIS
楊芳琦1 黃稚雯1, 2 蘇培元1 陳洋源1 1 彰化基督教醫院肝膽腸胃科 2 國立台灣大學臨床醫學研究所
Background: Tenofovir alafenamide (TAF) has been recommended as a first-line nucleos(t)ide analogue for patients with hepatitis B virus (HBV)–related decompensated liver disease. However, comparative data regarding the therapeutic effectiveness of TAF versus entecavir (ETV) in this clinical setting remain limited.
Aims: We aimed to compare short-term biochemical recovery, virological suppression, and all-cause mortality between TAF and ETV in patients with HBV-related decompensated liver disease without cirrhosis.
Methods: This retrospective cohort study included patients with acute hepatic decompensation related to chronic hepatitis B without cirrhosis who received either ETV or TAF as initial nucleos(t)ide analogue therapy at Changhua Christian Hospital between 2021 and November 30, 2024. Outcomes included all-cause mortality, alanine aminotransferase (ALT) and total bilirubin normalization at 30 and 90 days after treatment initiation, and time to HBV DNA undetectability. Time-to-event outcomes were analyzed using Kaplan–Meier methods, and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.
Results: A total of 165 patients were included (ETV, n = 78; TAF, n = 87). Baseline demographic characteristics, laboratory parameters, HBV DNA levels, and MELD scores were generally comparable between the two groups, although ascites and hepatic encephalopathy were more frequently observed in the TAF group. At 30 days after treatment initiation, ALT normalization occurred in 29.5% of patients receiving ETV and 28.7% of those receiving TAF (HR 0.996, 95% CI 0.50–1.99; p = 0.996), while total bilirubin normalization was observed in 48.7% and 43.7%, respectively (HR 1.220, 95% CI 0.70–2.12; p = 0.482). At 90 days, ALT normalization rates increased to 80.8% in the ETV group and 75.9% in the TAF group (HR
0.934, 95% CI 0.60–1.45; p = 0.893), and total bilirubin normalization rates were 84.6% and 87.4%, respectively (HR 1.217, 95% CI 0.66–2.47; p = 0.925). Kaplan–Meier analysis demonstrated no significant difference in time to HBV DNA undetectability between the two treatment groups (log-rank p = 0.90). Similarly, cumulative all-cause mortality during follow-up did not differ significantly between patients treated with ETV and those treated with TAF (log-rank p = 0.29).
Conclusions: In patients with acute hepatic decompensation due to chronic hepatitis B without cirrhosis, TAF and ETV demonstrated comparable short-term biochemical recovery, virological suppression, and all-cause mortality. These findings suggest that both agents are similarly effective treatment options in this clinical setting.
⑱
拒絕口服抗病毒藥物治療是社區篩檢所發現 的慢性 C 肝病人因肝病死亡之決定因素： 前瞻研究
REFUSAL OF DIRECT-ACTING ANTIVIRAL (DAA) THERAPY AS THE KEY DETERMINANT OF LIVERRELATED MORTALITY FOLLOWING COMMUNITY-BASED DETECTION OF CHRONIC HEPATITIS C: A PROSPECTIVE STUDY
邱紹銘1 王景弘1 張德生2 丁元捷2,3 林芷芸4 林裕珍5
趙紋華5 盧勝男1
1 高雄長庚紀念醫院胃腸肝膽科
2 嘉義長庚紀念醫院胃腸肝膽科
3 仁愛長庚合作聯盟醫院胃腸肝膽科
4 高雄長庚紀念醫院生物統計中心
5 嘉義縣政府衛生局
Background: To elimination chronic hepatitis C virus (HCV) infection, we conducted hepatitis B virus (HBV) and HCV screening in HCV endemic areas around 2018. More than 90% of residents who were detected to both antiHCV and HCV Ag positive have been treated by directacting antiviral (DAA).
Aims: To investigate the impact of HBV and HCV infections on all-cause and liver-related mortality in the era after HCV elimination.
Methods: In 2018, a large-scale community screening program for hepatitis B surface antigen (HBsAg), anti-HCV reflex HCV Ag test were conducted in 5 rural townships of Taiwan. Vital status and causes of death were tracked through June 2024 by death certificates. We separated 6433 participants as three groups: Group B (HBV and HBV combined HCV), Group C (HCV and HBV combined HCV) and Group NBNC (non-HBV and non-HCV) by HBsAg and anti-HCV. Survival outcomes—specifically allcause and liver-related mortality—were evaluated. Virusspecific survival was analyzed using Kaplan–Meier curves with the log-rank test and Cox proportional hazard models. Results: Initial pairwise comparisons revealed that Group C exhibited significantly poor all-cause survival and higher all-cause mortality than Group B (p = 0.018) and Group NBNC (p = 0.007), though this difference became nonsignificant after age adjustment. Regarding liver-related outcomes, Group C demonstrated markedly poor liverrelated survival compared to Group B (p = 0.032) and Group NBNC (p < 0.001). There are total 9 cases of liver-
related death, 5 patients with HCV, 1 patient with HBV and 3 patients without HBV nor HCV infection. Notably, none of the HCV-infected individuals who succumbed to liverrelated death had received DAA therapy.
Conclusions: Although more than 90% of patients diagnosed with chronic hepatitis C received appropriate treatment, HCV infection was still associated with high liver-related mortality in HCV-endemic areas. All of the 5 HCV-infected patients died due to liver-related problems refused DAA. Thus, this prospective study identified refusal of DAA therapy as the key contributing factor of liver-related mortality in HCV-infected patients.
主題：脂肪肝相關疾病 ⑲
腹部超音波與控制衰減參數彈性成像在脂肪 肝診斷上的不一致性分析
DISCORDANCE IN THE DIAGNOSIS OF STEATOTIC LIVER DISEASE BETWEEN ABDOMINAL ULTRASONOGRAPHY AND CAP-BASED TRANSIENT ELASTOGRAPHY
郭世恩1 黃釧峰1,2,3 葉明倫1,2 王志文1,2,4 梁博程1 魏鈺儒1,5 張庭遠1,2 黃志富1,2 戴嘉言1,2 莊萬龍1,2 余明隆1,2,6
1 高雄醫學大學附設中和紀念醫院 肝膽胰內科
2 高雄醫學大學醫學院 肝炎研究中心
3 高雄醫學大學醫學院轉譯醫學博士學位學程
4 高雄市立小港醫院內科
5 高雄市立大同醫院內科
6 國立中山大學醫學院醫學系暨臨床與實驗醫學博士學 位學程 代謝相關脂肪肝病卓越研究中心
Background: Abdominal ultrasonography is widely used for screening steatotic liver disease (SLD), but its diagnostic accuracy may be limited. Quantitative imaging using controlled attenuation parameter (CAP) provides an alternative non-invasive assessment of hepatic steatosis.
Aims: To evaluate the discordance between abdominal ultrasonography and CAP-based transient elastography in the diagnosis of SLD and to identify clinical factors associated with discrepant findings in a community-based cohort.
Methods: A total of 3,376 adults undergoing health examinations with laboratory tests, abdominal ultrasonography, and transient elastography were retrospectively analyzed. Hepatic steatosis was assessed using CAP (<238, 238–275, and ≥275 dB/m). Sonographic underestimation was defined as CAP ≥275 dB/m without sonographic SLD, while overestimation was defined as CAP <238 dB/m with sonographic moderate-to-severe SLD. Multivariate logistic regression analyses were performed to identify associated factors.
Results: Among subjects with CAP ≥275 dB/m, 28.4% showed no sonographic evidence of SLD. Underestimation was associated with lower body mass index (BMI) and fewer metabolic abnormalities. In contrast, among subjects with CAP <238 dB/m, 6.3% were classified as having moderate-to-severe SLD by ultrasonography. Overestimation was associated with higher BMI, adverse lipid profiles, and impaired glucose metabolism. Subjects with sonographic SLD exhibited higher CAP values despite remaining below diagnostic thresholds.
Conclusions: Significant discordance exists between abdominal ultrasonography and CAP-based assessment of hepatic steatosis in community screening. These findings highlight the limitations of ultrasonography alone and support the complementary use of quantitative imaging in the evaluation of SLD.
FIB-4 在代謝性脂肪肝病分類上的侷限
MISCLASSIFICATION OF MAFLD BY THE FIB-4 INDEX
李昀諭
國立成功大學醫學院附設醫院胃腸肝膽科
Background: International guidelines recommend the fibrosis-4 (FIB-4) index as a first-line, non-invasive tool for screening advanced liver fibrosis in patients with metabolic dysfunction–associated steatotic liver disease (MASLD). For patients at intermediate risk, a two-step strategy incorporating vibration-controlled transient elastography (VCTE) is suggested. However, the real-world diagnostic performance of this stepwise screening approach remains unclear.
Aims: To validate the real-world diagnostic performance of the FIB-4 index and VCTE-based stepwise screening strategy, and to identify their limitations.
Methods: We retrospectively reviewed liver histology from patients with and without MASLD to evaluate the utility of FIB-4 scores and VCTE-derived liver stiffness measurements in fibrosis staging. Discrepancies between non-invasive assessments (FIB-4 and VCTE) and liver biopsy findings were analyzed. Clinical characteristics of patients with histologically confirmed advanced fibrosis who were misclassified as low risk by FIB-4 and/or VCTE were further examined.
Results: A total of 182 patients were included, comprising individuals with steatohepatitis (n = 130), steatosis without steatohepatitis (n = 17), and controls (n = 35). Among patients classified as low risk by FIB-4 (<1.3), 8 (8.2%) had advanced fibrosis (F3) on histology. In patients with intermediate FIB-4 scores (1.3–2.6) and low VCTE liver stiffness (<8 kPa), 5 (25%) had advanced fibrosis (F3) and 2 (10%) had cirrhosis (F4). Patients with advanced fibrosis who were misclassified as low risk by FIB-4 were significantly older, had higher serum liver enzyme levels, and exhibited a greater burden of cardiometabolic risk factors.
Conclusions: A low FIB-4 score does not reliably exclude the presence of advanced fibrosis in patients with MASLD. This limitation is particularly evident in elderly patients and those with abnormal liver enzymes or increased cardiometabolic risk. In these populations, consideration of invasive diagnostic modalities or closer clinical follow-up may be warranted.
㉑
大學生健康篩檢族群中代謝性心血管危險因 子與脂肪肝疾病之盛行率分析 PREVALENCE OF CARDIOMETABOLIC RISK FACTORS AND STEATOTIC LIVER DISEASE IN A COLLEGE STUDENT SCREENING COHORT
吳季錡 葉明倫 黃釧峰 王志文 梁博程 魏鈺儒 張庭遠 戴嘉言 黃志富 莊萬龍 余明隆 高雄醫學大學附設中和紀念醫院 肝膽胰內科
Background: Steatotic liver disease (SLD) is closely associated with metabolic dysfunction and increased cardiovascular risk. With the recent adoption of the metabolic dysfunction–associated steatotic liver disease (MASLD) nomenclature, the role of cardiometabolic risk factors in the early development of hepatic steatosis has gained increasing attention. However, data regarding the prevalence of MASLD in young adults, particularly college students, remain limited.
Aims: To investigate the prevalence of cardiometabolic risk factors and steatotic liver disease in a college student screening cohort and to evaluate sex-specific differences.
Methods: In this cross-sectional study, we analyzed data derived from a college-based health screening program conducted in Taiwan. College students voluntarily participating in routine health examinations were enrolled. Data collected included demographic characteristics, anthropometric measurements, blood pressure, biochemical profiles, and liver transient elastography. Hepatic steatosis was assessed using the controlled attenuation parameter (CAP), with SLD defined as a CAP value greater than 238 dB/m, in accordance with established validation studies and current clinical guidance. Cardiometabolic risk factors included overweight or obesity, elevated blood pressure, impaired glucose metabolism, hypertriglyceridemia, and low high-density lipoprotein cholesterol. MASLD was defined as SLD accompanied by at least one cardiometabolic risk factor, according to recent international consensus and guidance endorsed by major liver societies, including the American Association for the Study of Liver Diseases.
Results: A total of 621 students were included; the mean age was 19.0±1.4 years, and 61.0% were female. Overall, 319 participants (51.4%) had at least one cardiometabolic risk factor. Hepatic steatosis was identified in 93 students (15.0%), and MASLD was present in 84 students (13.5%). Male students had significantly higher prevalences of
overweight, obesity, elevated systolic blood pressure, hypertriglyceridemia, and hepatic steatosis than female students (P<0.05 for all comparisons). Mean CAP values were higher in males than in females (210±48 dB/m vs. 193±38 dB/m, P<0.001). Advanced liver fibrosis was rare in this cohort.
Conclusions: Cardiometabolic risk factors and MASLD are already prevalent among college students, particularly among males, indicating that metabolic dysfunction and hepatic steatosis may develop early in adulthood.
㉒結合腸道微菌相及 IGG 糖化形式的差異分 數於 MASLD 病患偵測脂肪肝及肝臟纖維化 的嚴重度
MICROBIAL CONSORTIA-IGG
GLYCOSYLATION COMBINATION
SCORES IDENTIFY SEVERE HEPATIC STEATOSIS AND SIGNIFICANT FIBROSIS IN MASLD PATIENTS
黎子豪 新光吳火獅紀念醫院內科部
Background: Severe hepatic steatosis (HS) and significant hepatic fibrosis indicate severity of MASLD, and the models for early detection are important. Recent studies suggest IgG glycosylation and microbial consortia may involve in the development of MASLD.
Aims: This study investigates the utility of IgG glycosylation and microbial consortia in early detection models.
Methods: A total of 111 MASLD patients categorized into high versus low CAP (for HS) or high versus low FIB-4 (for fibrosis). We analyzed differences in microbial consortia and IgG1/IgG2 glycosylation features, creating scores for identifying severe HS and significant hepatic fibrosis. The combination scores for identifying severe HS and significant hepatic fibrosis in MASLD patients were derived based on the microbial consortia and IgG1/IgG2 glycosylation features accordingly.
Results: Megamonas was linked to severe HS, and Christensenellaceae R-7, UCG-005, CAG-56, and Lachnospira were associated with significant hepatic fibrosis in MASLD patients. The AUCs of severe HS- and significant hepatic fibrosis-microbial scores were 0.731 and 0.773 respectively. The ratios of IgG2-N4H5F1/IgG1-N4H5F1 and bisected-IgG2/bisected-IgG1 predicted severe HS, while IgG2-N4H3F1/IgG1-N4H3F1, bisected-IgG1/bisectedIgG2, and IgG1-galactosylation/IgG2-galactosylation index identified significant hepatic fibrosis in MASLD. The combination scores including microbial consortia and glycosylation features achieved AUCs of 0.776 and 0.810, showing comparable performance to established indices like hepatic steatosis index and FibroAST score.
Conclusions: The study highlights the effectiveness of combining fecal microbiota and serum IgG glycosylation features in identifying MASLD severity, which are noninferior to the current regularly-used models, and suggests the intervention of glycosylation as a promising therapeutic approach for MASLD.
㉓
已清除 B 型肝炎病毒感染之代謝功能異常 相關脂肪肝疾病患者心血管風險：一個族群 研究分析
CARDIOVASCULAR RISK IN METABOLIC DYSFUNCTIONASSOCIATED STEATOTIC LIVER DISEASE PATIENTS WITH RESOLVED HEPATITIS B VIRUS INFECTION : INSIGHTS FROM A POPULATION STUDY
范景涵
台北醫學大學附設醫院
Background: The cardiovascular risks associated with resolved hepatitis B virus (HBV) infection in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have not been well characterized. Understanding these risks is crucial for improving clinical care and outcomes.
Aims: These findings suggest integrating HBV vaccination and cardiovascular assessments into MASLD care to improve long-term outcomes.
Methods: We conducted a cross-sectional populationbased study utilizing data from the Taiwan Biobank (20092019) using 22,373 participants with liver imaging who were categorized by HBV infection status (no infection, resolved, or current) and MASLD presence. Logistic regression models were used to assess associations between HBV status, MASLD, and CVD risk.
Results: Resolved HBV infection was more common in MASLD patients than non-MASLD individuals (p < 0.001). MASLD patients with resolved HBV infection had a higher prevalence of CVD (25.7%) than those with current infection (20.7%).
Resolved HBV infection was associated with an increased risk of atherosclerosis (adjusted OR [aOR] = 1.614, p<0.001). Current HBV infection was not significantly associated with atherosclerosis (aOR = 1.217, p = 0.084).
No significant combined effect of MASLD and resolved HBV infection on CVD risk (aOR = 1.090, p = 0.555).
Conclusions: Resolved HBV infection increases the risk of MASLD and CVD, particularly atherosclerosis, highlighting the need for routine cardiovascular monitoring in MASLD patients with resolved infection. These findings suggest integrating HBV vaccination and cardiovascular assessments into MASLD care to improve long-term outcomes.
㉔
瘦型代謝功能障礙相關脂肪性肝病 （MASLD）不同表型之臨床預後：回溯性 世代研究
CLINICAL OUTCOMES OF LEAN METABOLIC DYSFUNCTIONASSOCIATED STEATOTIC LIVER DISEASE BY PHENOTYPIC SUBTYPES: A RETROSPECTIVE COHORT STUDY
郭加智1 郭行道1,2 1 財團法人奇美醫學中心 肝膽腸胃內科
2 國立中山大學學士後醫學系
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) occurs in individuals without overweight/obesity (“lean MASLD”), yet lean MASLD is clinically heterogeneous. The prognostic implications of low body mass index (BMI) and cardiometabolic phenotypes within lean MASLD remain incompletely characterized.
Aims: To evaluate clinical outcomes of lean MASLD according to BMI-defined subgroups (underweight vs normal-weight) and to further characterize risk across cardiometabolic phenotypic subtypes within normal-weight lean MASLD.
Methods: We conducted a retrospective cohort study using a large multicenter electronic health record network (2005–2024). Adults (≥18 years) with MASLD were identified using steatotic liver disease diagnostic codes plus ≥1 cardiometabolic risk factor. Lean MASLD was defined by BMI <25 kg/m² without evidence of BMI ≥25 within −1 year to +1 month of the index date. Lean MASLD patients were stratified as underweight versus normalweight. We performed 1:1 propensity score matching (PSM) and assessed time-to-event outcomes using Kaplan–Meier analyses and Cox proportional hazards models. Primary outcomes were all-cause mortality, major adverse liver outcomes (MALO), major adverse cardiovascular events (MACE), and extrahepatic cancer. Secondary analyses evaluated outcomes across normal-weight lean MASLD phenotypes (HTN-only, T2D-only, dyslipidemia-only, 2 cardiometabolic risk factors [CMRF], 3 CMRF).
Results: Among the included 40,456 lean MASLD patients, 38,335 were normal-weight and 2,121 underweight individuals. After PSM, 2,115 matched pairs were analyzed. Compared with normal-weight lean MASLD, underweight lean MASLD had higher risks of all-cause mortality (318 vs 172 events; adjusted hazard
ratio [aHR] 2.03, 95% CI 1.68–2.44), MALO (121 vs 69; aHR 2.01, 95% CI 1.49–2.70), and MACE (148 vs 122; aHR 1.30, 95% CI 1.02–1.66), while extrahepatic cancer risk was not significantly different (92 vs 87; aHR 1.14, 95% CI 0.85–1.52). Within normal-weight lean MASLD (reference: HTN-only), increasing cardiometabolic burden (2–3 CMRF) was associated with graded higher risks of mortality (aHR 1.28–1.45), MALO (aHR 1.66–1.68), and MACE (aHR 1.76–1.88).
Conclusions: In lean MASLD, underweight status identifies a high-risk subgroup with substantially increased mortality and liver and cardiovascular events. Among normal-weight lean MASLD, cardiometabolic clustering further stratifies risk, supporting phenotype-based surveillance and preventive strategies.
主題：膽胰疾病（一） ㉕
以一站式 ERCP-LC 優化膽結石合併總膽管 結石之處置：對住院天數與醫療費用之影響 OPTIMIZING THE MANAGEMENT OF CONCOMITANT CHOLECYSTOLITHIASIS AND CHOLEDOCHOLITHIASIS VIA ONESTAGE ERCP-LC: IMPACT ON LENGTH OF STAY AND MEDICAL COSTS
鄭照霖 臺北市立萬芳醫院
Background: The prevalence of cholelithiasis in Taiwan ranges from 4.3% to 14.4%, frequently leading to complications such as acute cholecystitis, cholangitis, and pancreatitis. When stones migrate from gallbladder into the common bile duct (CBD) causing obstruction, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is required. However, the removal of CBD stones alone is associated with a recurrent rate exceeding 50% within one year; therefore, subsequent cholecystectomy is strongly recommended. Traditionally, ERCP and laparoscopic cholecystectomy (LC) are performed during separate hospital admissions. Recent studies have demonstrated that a “one-stage” approach—integrating both procedures under a single anesthetic session—enhances therapeutic efficacy, minimizes complications, and conserves medical resources.
Aims: Following the implementation of this protocol at Wanfang Hospital, this study aims to evaluate its effectiveness in reducing both the Length of Stay (LOS) and National Health Insurance (NHI) expenditures.
Methods: In June 2024, Wanfang Hospital implemented an integrated one-stage ERCP-LC protocol involving the Departments of Gastroenterology and General Surgery. The workflow begins with indication confirmation by either specialty, followed by coordinated scheduling and preoperative preparation. The procedures are performed in a C-arm-equipped operating room by a multidisciplinary team, sequentially performing ERCP followed by LC. To evaluate this model, we conducted a retrospective study on patients with concomitant gallstones and CBD stones treated between June 2024 and January 2025. Patients were categorized into three groups: Group A (One-stage ERCPLC under single anesthesia), Group B (Sequential ERCPLC on separate days within the same admission), and Group C (Delayed LC in separate admissions). Outcomes including age, gender, length of stay (LOS), and NHI costs
were analyzed to assess the comparative effectiveness of these management strategies.
Results: Between June 2024 and January 2025, a total of 39 patients with concomitant cholecystolithiasis and choledocholithiasis undergoing ERCP and LC were enrolled. The study population comprised 12 patients in Group A, 9 in Group B, and 18 in Group C. The mean ages for the three groups were 60.8, 61.5, and 68.6 years, respectively, while the proportion of female patients was 41.7%, 44.4%, and 55.6%, respectively. Regarding the primary outcomes, the mean length of stay (LOS) was 4.4 days for Group A, 7.6 days for Group B, and 10.1 days for Group C. The mean National Health Insurance (NHI) expenditures were 111,091 NTD, 134,894 NTD, and 141,488 NTD, respectively. Statistical analysis revealed a significant difference in LOS among the three groups (p < 0.05). However, the difference in NHI costs did not reach statistical significance (p = 0.077).
Conclusions: The one-stage ERCP-LC model significantly shortens the length of stay (LOS) for patients with concomitant cholecystolithiasis and choledocholithiasis, while demonstrating a trend toward lower NHI expenditures. This integrated medical-surgical care protocol not only enhances treatment efficiency but also shows potential in conserving medical resources. Consequently, it warrants further promotion as a future standard of care.
㉖
膽道內射頻燒灼術在膽道狹窄治療中的應用 與成效
THE EFFECT OF ENDOBILIARY RADIOFREQUENCY ABLATION IN THE TREAMTENT OF PATIENTS WITH BILIARY STRICTRUE
饒名光1 王堯生2 陳炯瑜2 黃千睿2 1 國立成功大學醫學院附設醫院內科部
2 國立成功大學醫學院附設醫院內科部消化內科
Background: Biliary tract-related diseases, specifically malignancies such as cholangiocarcinoma, carry a poor prognosis. To date, the only curative treatment is surgical resection, which is only feasible during the early stages of the disease. However, many patients present with unresectable lesions and can only receive adjunctive treatments such as chemotherapy or radiation, both of which have historically shown poor survival rates. Endobiliary radiofrequency ablation (RFA) has recently emerged as a viable alternative for the local treatment of unresectable malignant biliary obstruction. Endobiliary RFA is a procedure that utilizes high-frequency alternating current to generate high temperatures, causing coagulation necrosis in the target area during endoscopic retrograde cholangiopancreatography (ERCP). Given the promising results shown in recent years, we aim to study its therapeutic effects within the patient population at a teritiary center
Aims: We aim to investigate the therapeutic effects and prognosis of patients with malignant biliary obstruction who undergo endobiliary radiofrequency ablation.
Methods: Patients with cholangiocarcinoma in NCKU hospital, who received Endobiliary RFA from 2020-2025 were collected and studied. Through the hospital electronic medical records, we recorded the overall survival rates of theses population. After dividing the patients into whether the patient underwent RFA only or RFA combined with chemotherapy, we used Kaplan-Meier chart to show the survival months between different group as our primary outcome. For secondary outcome, we divided the population based on initial staging and compare their survival months again.
Results: There was a total of 32 patients with cholangiocarcinoma and malignant bile duct obstruction, who underwent endobiliary RFA. 7 of the patients were either transferred to other hospital due to patient’s preference or suddenly had missing records without
mention of death. The median survival time was 17.6 months. The overall survivor rate at 1-year and 3-year was 64.2% and 22.3%, respectively. There as no statistically significant difference between patients who only underwent RFA and patients who underwent RFA combined with chemotherapy (Log-rank p value 0.8586). However, a statistically significant difference can be observed when the population was divided based on initial staging (Logrank p value 0.0229). Further pairwise comparison between each group showed Stage 1 shows a statistically significant survival advantage when compared directly to Stage 2 (P = 0.0078) and Stage 3 (P = 0.0203). Although there was no significant difference between stage 1 and stage 4 (P = 0.0892), it suggests a trend toward better survival in stage 1.
Conclusions: Endobiliary RFA is a feasible and safe trematent choice in patients with bilairy stricture. It could also prolong the survival in patint with malignant stricture in the combine use of chemotherapy. However, due to low number of patient populations, it may affect the accuracy of the result. Longer follow up duration, higher population number and further study on subgroups might provide better insights on the efficacy of endobiliary RFA.
㉗
比較彎頭與直頭 0.025 吋導線在選擇性膽管 插管的成效
COMPARISON OF ANGLED-TIP AND STRAIGHT-TIP 0.025-INCH GUIDEWIRES FOR SELECTIVE BILIARY CANNULATION
孫煒智1,4 呂家名1 李昀達1 蔡騌圳1,3 蔡維倫1,2,3 蔡峯偉1,3
1 高雄榮民總醫院內科部胃腸肝膽科
2 高雄榮民總醫院內科部一般內科
3 國立陽明交通大學醫學院醫學系
4 國立中山大學生物醫學研究所
Background: Guidewire-assisted biliary cannulation has been demonstrated to improve the success rate with a reduced risk of post-ERCP pancreatitis (PEP). The caliber of the guidewire does not appear to affect the clinical outcome, but the impact of the shape of the guidewire tip has not been fully investigated.
Aims: This study aimed to compare the performance of an angled-tip guidewire (AGW) with a straight-tip guidewire (SGW) in achieving successful biliary cannulation.
Methods: A prospective randomized trial was conducted at our institute between January 2022 and November 2024. We enrolled patients with an intact papilla of Vater and normal anatomy who underwent ERCP by using a sphincterotome and 0.025-inch guidewire for selective biliary cannulation. Patients were randomly assigned to either AGW or SGW. The primary outcome measurement was cannulation success rate. For patients with successful biliary cannulation, the time for successful cannulation, the number of cannulation attempts, the incidence of pancreatic guidewire passage, and the rate of PEP were compared between the two groups.
Results: A total of 113 patients were randomly allocated to two groups: the AGW group (n = 56) and the SGW group (n = 57). The cannulation success rates were 98.2% (55/56) for the AGW and 96.5% (55/57) for the SGW, respectively (p=1.00). For patients with successful biliary cannulation, the baseline characteristics of both groups were similar. The median cannulation time was shorter with the AGW compared with the SGW (69 vs 188 sec., p=0.04). There was no significant difference regarding the median cannulation attempts (2 vs 5, P=0.08), the incidence of pancreatic guidewire passage (30.9% vs 34.5%, P=0.84), and the rate of PEP (7.3% vs 7.3%, P=1.00) between the AGW and the SGW.
Conclusions: An angled-tip 0.025-inch guidewire may facilitate selective biliary cannulation.
㉘
應用胰管導絲引導小球囊擴張於第二型小乳 頭：提升選擇性膽管插管成功率之新穎內視 鏡技術
PANCREATIC DUCT WIRE–GUIDED SMALL-BALLOON PAPILLARY DILATION FOR TYPE 2 SMALL
PAPILLAE: A NOVEL TECHNIQUE TO FACILITATE SELECTIVE BILIARY CANNULATION
柳硯文 盧龍生 梁志明 郭仲謀 黃寳源 蘇輝明 邱紹銘 邱逸群 吳鎮琨
長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨長 庚大學醫學系
Background: Selective biliary cannulation in patients with type 2 small papillae (≤3 mm) is technically challenging, as this papillary phenotype is characterized by a small, often flat papillary orifice and has been associated with a higher likelihood of difficult biliary cannulation and inadvertent pancreatic duct (PD) access. Repeated unintended PD cannulation/guidewire passage is a wellrecognized procedure-related risk factor for post-ERCP pancreatitis (PEP). In this anatomically challenging setting, conventional rescue techniques (e.g.,double-guidewire cannulation, transpancreatic sphincterotomy, and needleknife precut) may be technically demanding and have been associated with increased adverse-event concerns, particularly PEP, in some studies.
Aims: To evaluate the feasibility, efficacy, and safety of pancreatic duct–guided small-balloon papillary dilation with prophylactic pancreatic stenting (PD-GPD) for selective biliary cannulation in patients with type 2 small papillae.
Methods: This single-center retrospective cohort study enrolled consecutive patients with type 2 small papillae undergoing ERCP between January 1, 2010, and December 1, 2025. When standard cannulation failed after ≥2 unintended PD cannulations or ≥5 minutes, PD-GPD was performed. The technique involved advancing a 4–6 mm dilation balloon over a PD guidewire, inflating at low pressure (≤3 ATM) for 5–10 seconds, followed by placement of a 3–5 Fr prophylactic PD stent. Outcomes were compared between the PD-GPD and non-PDGPD groups. The primary outcome was selective biliary cannulation success. Secondary outcomes included ERCP-related adverse events and clinical outcomes. In multivariate analyses, only variables with a p-value <0.05
were considered statistically significant.
Results: A total of 111 patients were included (PD-GPD, n=90; non-PD-GPD, n=21 [transpapillary sphincterotomy, TPS]). Selective biliary cannulation success rates were comparable between the PD-GPD and non-PD-GPD groups (93.3% vs. 85.7%, p=0.367). The incidence of PEP did not differ significantly between groups (10.0% vs. 9.5%, p=1.0). No perforation occurred in either group, and bleeding was infrequent. ERCP procedure time was significantly shorter in the PD-GPD group (23.38 ± 8.27 vs. 32.29 ± 8.81 minutes; p=0.0002). Multivariate analyses showed that younger age and higher pre-ERCP amylase levels were independently associated with PEP, while malignancy and total bilirubin levels were independently associated with in-hospital mortality (all p < 0.05).
Conclusions: In patients with type 2 small papillae, PD-GPD is a feasible and safe technique for selective biliary cannulation and is associated with a shorter ERCP procedure time while maintaining comparable cannulation success and adverse event rates. PD-GPD may represent a practical alternative for biliary access in anatomically challenging small papillae when standard cannulation attempts are unsuccessful.
㉙
膽管結石病患於逆行性膽胰管攝影術後的無 症狀性澱粉酶與脂肪酶升高之相關性分析 ASYMPTOMATIC ELEVATIONS OF AMYLASE AND LIPASE IN BILE DUCT STONE PATIENTS AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
王芃惟 莊棠惟 張凱郁 李佩倫 董宏達 陳志州 鄭俊達
鍾焜明 彭美杰 黃婷儀
奇美醫療財團法人柳營奇美醫院肝膽胃腸科
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently associated with postprocedural elevation of pancreatic enzymes. Although post-ERCP pancreatitis (PEP) is a well-recognized adverse event, asymptomatic hyperamylasemia or hyperlipasemia is far more common and remains clinically ambiguous. Current guidelines emphasize symptom-based diagnosis of PEP; however, limited evidence is available regarding the clinical significance and determinants of marked enzyme elevation in the absence of abdominal pain, particularly among ERCP-naïve patients with common bile duct (CBD) stones. This knowledge gap often leads to uncertainty in post-procedural monitoring and management.
Aims: Aim of the study was to evaluate factors associated with asymptomatic high lipase or amylase levels in common bile duct (CBD) stone patients post ERCP procedure.
Methods: We retrospectively analyzed 208 ERCP-naïve patients with CBD stones who underwent successful stone extraction between January 1, 2019, and January 31, 2024. Patients who developed symptomatic PEP were excluded to focus specifically on asymptomatic biochemical responses. According to post-ERCP pancreatic enzyme levels, patients were categorized into three groups: normal enzyme levels (Group A), mild asymptomatic elevation (<3 times the upper limit of normal [ULN], Group B), and high asymptomatic elevation (≥3x ULN, Group C).
Results: Clinical characteristics and procedural factors were compared, and multivariable logistic regression analysis was performed to identify independent predictors of enzyme elevation. High asymptomatic enzyme elevation (Group C) occurred in 26 patients (12.5%). Multivariable analysis demonstrated that female sex was independently associated with a lower likelihood of remaining in the normal enzyme group (adjusted odds ratio [aOR] 0.26; 95% confidence interval [CI] 0.09–0.80; p = 0.019), indicating
a higher susceptibility to enzyme elevation. In contrast, the use of the double-guidewire (DGW) technique emerged as a strong independent risk factor for marked enzyme elevation (aOR 19.95; 95% CI 1.25–317.47; p = 0.034). Prophylactic pancreatic duct stenting showed a protective tendency (aOR 0.20), although statistical significance was not reached. Importantly, despite substantial biochemical surges, patients in the high-elevation group remained asymptomatic and did not progress to clinical pancreatitis. Conclusions: In conclusion, asymptomatic pancreatic enzyme elevation ≥3× ULN after ERCP is strongly associated with procedural pancreatic duct manipulation, particularly the DGW technique, and is more frequently observed in female patients. Nevertheless, such biochemical changes rarely translate into clinically significant pancreatitis. These findings suggest that marked enzyme elevation in the absence of abdominal pain likely represents a benign physiological response rather than pathological pancreatic injury. Post-ERCP management should therefore prioritize clinical symptoms over isolated biochemical abnormalities, and close observation without aggressive intervention appears appropriate for asymptomatic patients, even when enzyme levels are markedly elevated.
㉚
十二指腸壺腹形態與內視鏡逆行性膽胰管造 影術後胰臟炎之關聯：一項觀察性研究
IMPACT OF DUODENAL MAJOR PAPILLA MORPHOLOGY ON POST ERCP PANREATITIS: AN OBSERVATIONAL STUDY
林碩邦 廖苡君 彭彥儒 童春芳 蔡炘儒 陳家昌 台中榮民總醫院胃腸肝膽科
Background: Duodenal major papilla morphology has been proposed as a potential determinant of procedural difficulty and adverse events during endoscopic retrograde cholangiopancreatography (ERCP). However, its association with post-ERCP pancreatitis has not been fully elucidated.
Aims: This study aimed to evaluate whether duodenal major papilla morphology is associated with an increased risk of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP).
Methods: This was a retrospective observational study. Patients were included if they underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and had a naïve major duodenal papilla. Duodenal papilla morphology was classified according to Haraldsson’s classification as regular (type 1), small (type 2), protruding or pendulous (type 3), or creased or ridged (type 4). Multivariable analysis was performed to identify risk factors associated with PEP.
Results: A total of 442 cases were included. Age, gender, indications were not different among the four types of papillae. The post-ERCP pancreatitis(PEP) rate of Type 1 papilla, Type 2 papilla, Type 3 papilla and Type 4 papilla were 4.3%, 14.3%, 1.1% and 6.4%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 3.38, p = 0.040) were associated with greater PEP rate compared with Type 1 papilla. Precut (odd ratio 4.58, p = 0.025) were also risk factors for PEP. Other variables, including indication for ERCP, age, gender, pancreatic duct cannulation attempts, and therapeutic techniques, were not significantly associated with PEP.
Conclusions: Small papilla and the use of precut sphincterotomy were identified as independent risk factors for post-ERCP pancreatitis.
主題：上消化道疾病（二） ㉛
高解析度食道壓力檢查辨識難治性胃食道逆 流中內視鏡未偵測之「隱性」裂孔疝氣：精 準識別抗逆流黏膜介入治療的理想對象 HIGH-RESOLUTION MANOMETRY UNVEILS
徐善維1 甘育安1,2 高偉育1,3,4,5 張君照1,3,4
1 臺北醫學大學附設醫院內科部消化內科
2 臺北醫學大學醫學院醫學系內科學科
3 臺北醫學大學醫學院醫學系消化內科學科
4 臺北醫學大學消化醫學研究中心
5 臺北癌症中心
Background: Persistent symptoms despite standard proton pump inhibitor (PPI) therapy remain a major challenge in managing gastroesophageal reflux disease (GERD). While anti-reflux mucosal intervention (ARMI) has emerged as a promising treatment for restoring the anti-reflux barrier, identifying the ideal candidates—specifically those with compromised esophagogastric junction (EGJ) integrity but without large hiatal hernias (HH)—relies heavily on accurate morphological assessment.
Aims: This study aimed to evaluate the diagnostic value of high-resolution manometry (HRM) in detecting “occult” EGJ disruption missed by esophagogastroduodenoscopy (EGD) and to characterize the physiological profile of these patients.
Methods: We retrospectively analyzed 107 patients with GERD symptoms who underwent HRM. Patients were categorized based on Chicago Classification v4.0 into intact EGJ (Type I) and disrupted EGJ (Type II [sliding] and Type III [HH]). Clinical characteristics, including PPI responsiveness (>8 weeks), endoscopic findings (Los Angeles grade, HH presence), and impedance-pH (MII-pH) metrics were compared. The diagnostic concordance for hiatal hernia between EGD and HRM was assessed.
Results: Among 107 patients, 44.9% (n=48) presented with disrupted EGJ morphology (Type II/III). While HRM identified structural disruption in these patients (mean hernia size 2.43 cm), EGD failed to diagnose hiatal hernia in 63.0% of this group (detection rate: 37.0% vs. 97.9%, p < 0.001). Patients with disrupted EGJ had a higher prevalence of PPI non-response (77.1%) compared to the intact group (63.9%), suggesting mechanical failure as a key driver for drug refractoriness. The disrupted group exhibited higher BMI (p=0.047) and significantly increased EGJ outflow resistance (IRP 12.3 vs. 10.3 mmHg, p=0.047), indicating a distinct phenotype of “mechanical
incompetence” rather than pure acid hypersecretion. Conclusions: Standard endoscopy significantly underestimates the prevalence of EGJ disruption, missing nearly two-thirds of hiatal hernias detected by HRM in this cohort. HRM is essential in the workup of refractory GERD to unmask these “occult” mechanical defects. These patients, characterized by medication-refractory symptoms and small-to-moderate sliding hernias (Type II), represent the optimal candidates for endoscopic tightening procedures (ARMI) rather than continued medical therapy.
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非阻塞性吞嚥困難中食道蠕動、過度警覺與 症狀嚴重度之關聯性分析 RELATIONSHIPS BETWEEN DYSPHAGIA SYMPTOM, ESOPHAGEAL MOTILITY, AND ESOPHAGEAL HYPERVIGILANCE AND ANXIETY IN PATIENTS WITH NON-OBSTRUCTIVE DYSPHAGIA
劉作財 易志勳 雷尉毅 翁銘彣 洪睿勝 簡錫淵 陳健麟 佛教慈濟醫療財團法人花蓮慈濟醫院 消化系中心
Background: Impaired secondary peristalsis has been demonstrated in non-obstructive dysphagia (NOD). We hypothesized that while secondary peristalsis will be impaired in NOD, esophageal hypervigilance may significantly contribute to symptoms.
Aims: We assessed whether dysphagia symptom severity correlated with primary or secondary peristalsis using high-resolution manometry (HRM) as well as esophageal hypervigilance and anxiety in NOD patients.
Methods: Nineteen healthy adults (mean age 31 years, 10 male) and 11 NOD patients (normal endoscopy and HRM) (mean age 54 years, 6 male) were prospectively evaluated using validated questionnaires [Brief Esophageal Dysphagia Questionnaire (BEDQ), Esophageal Hypervigilance and Anxiety Scale (EHAS)], and HRM using a prototype catheter with one mid-esophageal injection port. Primary peristalsis was evaluated using 10 water swallows, while distension-induced secondary peristalsis was generated with slow and rapid air injections. Frequency of primary and secondary peristalsis, as well as relevant HRM parameters, was compared between NOD patients and healthy adults.
Results: When compared to healthy adults, NOD patients exhibited higher BEDQ score when compared with healthy adults (5.8±1.7 vs 0, p = 0.006), higher total EHAS (40.0±5.4 vs 4.0±1.7, p < 0.001), as well as higher hypervigilance (16.5±2.1 vs 2.6±1.2, p < 0.001) and anxiety scores (23.6±3.4 vs 1.4±0.6, p < 0.001). BEDQ correlated with EHAS hypervigilance (r = 0.50, p = 0.005), anxiety (r = 0.52, p = 0.003), and total score (r = 0.52, p = 0.004). Secondary peristalsis was triggered significantly less often in NOD patients with slow air injections compared with healthy adults (18% vs 82%, p = 0.023); no difference was found with rapid air injections (35% vs 65%, p = 0.51). Proximal contractile integral was lower in NOD patients (p = 0.026); other HRM parameters of primary peristalsis
were similar. Although the distal contractile integral during slow air injections was lower in NOD patients than in healthy adults ( p = 0.003), secondary peristaltic parameters were comparable between NOD patients and healthy adults. The BEDQ score was negatively correlated with the frequency of secondary peristalsis during rapid air injections (r = -0.45, p = 0.013); however, other peristaltic parameters showed no correlation.
Conclusions: NOD patients have lower esophageal peristaltic response to slow air injections. Dysphagia symptom severity is associated with greater esophageal hypervigilance and anxiety, as well as lower frequency of secondary peristalsis during rapid air injections. This study reemphasizes impaired distension-mediated modulation of secondary peristalsis in NOD, but esophageal hypervigilance and anxiety may be of higher pathophysiological relevance to symptom generation than esophageal dysmotility.
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功能性火燒心作為一種異質性疾病：以食道 蠕動障礙為特徵的生理表型 FUNCTIONAL HEARTBURN AS A HETEROGENEOUS DISORDER: A PHYSIOLOGIC PHENOTYPE CHARACTERIZED BY ESOPHAGEAL MOTILITY DISORDER
黃稚雯1 曾屏輝2 周昆慶1 柯純芬1
1 彰化基督教醫院肝膽腸胃科
2 台灣大學附設醫院肝膽腸胃科
Background: Functional heartburn (FH) is characterized by typical reflux symptoms in the absence of objective gastroesophageal reflux. A subset of FH patients may have concomitant ineffective esophageal motility (IEM), which could influence their clinical or physiologic profile.
Aims: This study aimed to compare clinical characteristics, reflux metrics, mean nocturnal baseline impedance (MNBI) and symptom questionnaires between FH patients with and without IEM.
Methods: A total of 28 patients diagnosed with FH were enrolled, including 10 patients with IEM and 18 with normal esophageal motility. Demographic variables, lifestyle factors, high-resolution manometry and pHimpedance metrics, and symptom questionnaires (GAD-7, GERDQ, RSI, and PSQI) were compared between the two groups.
Results: FH patients with IEM exhibited several significant differences compared with those without IEM. The IEM group had higher proportions of male sex (80% vs. 33.3%, p=0.018), hiatus hernia (50% vs. 5.6%, p=0.006), nocturnal symptoms (100% vs. 66.7%, p=0.039), and MNBI <2292 Ω (80% vs. 33.3%, p=0.018). Despite these physiological and demographic differences, all symptom questionnaire scores—including GAD-7, GERDQ, RSI, and PSQI—were comparable between the two groups.
Conclusions: Among patients with FH, approximately onethird had concomitant IEM. These patients demonstrated distinct demographic and physiological features, including higher rates of hiatus hernia, nocturnal symptoms, and impaired mucosal integrity. However, symptom severity and psychological or sleep-related scores did not differ between groups. These findings suggest that IEM may represent a physiological phenotype within FH without necessarily influencing patient-perceived symptom burden.
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藉由粒線體移植調控胃癌惡性潛能 MODULATING THE MALIGNANT POTENTIAL OF GASTRIC CANCER THROUGH MITOCHONDRIAL TRANSPLANTATION
朱能生1 沈群勝1 黃斌2 林明瑋3 許文鴻4,5 郭昭宏5,6
1 高雄巿立小港醫院胃腸內科
2 高雄醫學大學生物醫學暨環境生物學系
3 義大醫療財團法人義大醫院 醫學研究部
4 高雄醫學大學附中和紀念醫院胃腸內科
5 高雄醫學大學醫學系
6 高雄秀傳紀念醫院腸胃內科
Background: Mitochondria are essential for cancer cell metabolism and energy homeostasis. Modifying mitochondrial function may influence tumor behavior.
Aims: This study explored whether mitochondria transplantation could reduce the malignancy of gastric cancer (GC) cells.
Methods: Mitochondrial membrane potential (MMP) was compared among GES-1 (normal gastric), EAhy 926 (endothelial), and AGS (gastric cancer) cells. GES1 mitochondria were isolated and transplanted into AGS cells, confirmed by confocal microscopy and flow cytometry. Migration, invasion, viability, apoptosis, EMTand cell cycle–related proteins were analyzed, and tumor growth was assessed in mice.
Results: AGS cells receiving GES-1 mitochondria showed reduced migration and invasion, while viability and apoptosis were unchanged. Mesenchymal markers (α-SMA, MMP-9, Snail, Vimentin, N-cadherin) decreased, whereas E-cadherin and Claudin-1 remained stable. Cyclin B1 and D1 were downregulated. In vivo, tumor size was smaller in mice injected with mitochondria-transplanted AGS cells.
GES-1 mitochondria were stably maintained with lower MMP, ATP production, and mitochondrial mass, alongside increased LC3 II and PINK1 expression.
Conclusions: Transplanting normal gastric mitochondria into cancer cells suppressed GC malignancy by reducing migration, invasion, and tumor growth through EMT and cell cycle modulation. Low-efficiency mitochondria transplantation may offer a new therapeutic strategy against gastric cancer.
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胃癌相關粒線體之蛋白質體學與代謝體學探 討
PROTEOMICS AND METABOLOMICS OF GASTRIC CANCER-RELATED MITOCHONDRIA
楊啓昇1 王俊偉2,3 黃斌4 劉忠榮2 吳登強2,3 郭昭宏2,4
1 高雄巿立旗津醫院內科
2 高雄醫學大學附設中和紀念醫院胃腸內科
3 高雄醫學大學醫學系
4 高雄秀傳紀念醫院腸胃內科
Background: Mitochondria are essential for energy metabolism, apoptosis, and redox regulation. Previous work showed that mitochondria from normal gastric cells (GES1) reduce the malignancy of gastric cancer cells (AGS).
Aims: This study investigated the proteomic and metabolomic mechanisms underlying this effect.
Methods: TMT-based quantitative proteomics and Ingenuity Pathway Analysis (IPA) were used to identify altered proteins and pathways in AGS cells after GES-1 mitochondrial transplantation. Key proteins were validated by Western blot. Metabolomic profiling examined changes in glycolysis, the TCA cycle, PPP, and ATP production, with specific assays for pyruvate, lactate, and related enzymes and transporters.
Results: Proteomics identified 257 upregulated and 34 downregulated proteins in 14 pathways, including mitochondrial dysfunction. Western blot confirmed increased p53, Bax, p-Akt, and p-mTOR, and decreased Sirt3, p-NRF2, and HO-1. Metabolomics revealed altered energy metabolism, with decreased glycolytic and TCA intermediates, elevated cytosolic pyruvate, reduced extracellular lactate, and changes in MCT1, MCT4, LDHB, and MPC expression. Accumulated pyruvate inhibited AGS cell migration, indicating metabolic reprogramming.
Conclusions: GES-1 mitochondrial transplantation reprograms mitochondrial signaling and metabolism in AGS cells, leading to pyruvate accumulation and reduced migration. These results elucidate how healthy mitochondria suppress gastric cancer progression and support their potential in metabolic therapy.
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HOXA9-IGFBP2 軸透過上調細胞因子受體 促進胃癌的進展
THE HOXA9-IGFBP2 AXIS PROMOTES GASTRIC CANCER PROGRESSION BY UPREGULATING CHEMOKINE RECEPTORS
胡晃鳴1,2 林楷傑1 劉忠榮3 王崧維3 許文鴻2,3 郭昭宏2,4
1 高雄醫學大學附設高醫岡山醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄醫學大學附設中和紀念醫院胃腸內科
4 高雄秀傳紀念醫院腸胃內科
Background: Gastric cancer is one of the most common cancers worldwide, and is also the third leading cause of cancer-related mortality. The poor prognosis of gastric cancer may be partly attributed to the complicated molecular networks operating the aggressiveness of gastric cancer. The interaction between gastric cancer cells and the tumor microenvironment, particularly human bone marrow mesenchymal stem cells (HBMMSCs), plays a critical role in cancer progression.
Aims: The HOXA9–IGFBP2 signaling axis may regulate the recruitment of HBMMSCs and influence cytokine secretion that promotes gastric cancer cell migration. Methods: Western blotting was used to detect HOXA9 and IGFBP2 expression. Transwell migration assays assessed HBMMSC and gastric cancer cell migration. Cytokine arrays measured IL-6, IL-8, CXCL-1, and CCL5 secretion. The effects of recombinant IGFBP2, cytokines, and neutralizing antibodies on gastric cancer AGS cell migration were analyzed.
Results: HOXA9 overexpression increased IGFBP2 secretion, enhancing HBMMSC migration toward gastric cancer cells. IGFBP2 upregulated cytokine receptor expression (IL-6R, IL-8RA/B (CXCR1/2), CCR5) in AGS cells. HBMMSCs significantly secreted IL-6, IL-8, CXCL-1, and CCL-5, which promoted AGS cell migration. Neutralizing antibodies against these cytokines reduced the HBMMSC-induced migration of gastric cancer cells.
Conclusions: The HOXA9–IGFBP2 axis enhances the recruitment of HBMMSCs, which secrete cytokines (IL6, IL-8, CXCL-1, CCL-5) that promote gastric cancer cell migration. Targeting this paracrine signaling may represent a potential therapeutic strategy to inhibit gastric cancer progression.
主題：肝硬化及其他肝病
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LIVERRISK SCORE 在肝硬化患者中與門 靜脈壓之關聯
LIVERRISK SCORE CORRELATED WITH PORTAL VEIN PRESSURE IN LIVER
CIRRHOSIS
賴信樺 臺北榮民總醫院內科部胃腸肝膽科
Background: Portal hypertension is a major complication of liver cirrhosis and is associated with cirrhosis-related adverse events. Accurate assessment of portal vein pressure (PVP) is essential for risk stratification in cirrhosis yet requiring invasive measurement. LiverRisk Score (LRS) is a recently proposed scoring system that has been shown to correlate with liver stiffness and to predict liver-related complications in the general population. Investigating the relationship between LRS and PVP provides insight into its clinical utility for identifying patients at high risk of portal hypertension.
Aims: This study aimed to investigate the correlation between LRS and PVP in patients with liver cirrhosis. In addition, we evaluated the predictive ability of LRS across different levels of portal hypertension.
Methods: Patients with cirrhosis were prospectively enrolled from March, 2011 to November, 2024. Hepatic venous pressure gradient (HVPG) or direct PVP measurements obtained during liver transplantation were collected. Clinical and laboratory parameters required to calculate LiverRisk Score, MELD score, Child–Pugh score, ALBI, APRI, and FIB-4 were also recorded.
Results: A total of 221 patients with cirrhosis were analyzed (mean age 57.4 ± 11.0 years; 76.0% male) with major etiologies of hepatitis B (47.5%). Seventysix patients received HVPG measurement (mean HVPG=17.42 ± 5.00 mmHg) and 145 patients underwent direct PVP measurement intraoperatively (mean direct PVP=22.03 ± 5.17 mmHg). The overall mean LRS was 8.76 ± 2.26. (8.68 ± 2.35 in the HVPG group and 8.80 ± 2.22 in the direct measurement group) LRS correlated positively with HVPG in univariate linear regression (p=0.031). Furthermore, LRS was the only parameter that correlated positively with HVPG in multivariable analysis (p=0.029). In patients with HVPG ≥16 mmHg, LRS is the only parameter that demonstrated significant predictive ability. (AUC 0.68, p=0.04). Although LRS did not show correlation with direct PVP in univariate linear regression, it stood out as the only variable
that correlated with direct PVP in multivariable analysis (p=0.009).
Conclusions: LRS was independently correlated with both direct PVP and HVPG. Also, it showed significant predictive ability for patients with HVPG ≥16 mmHg, suggesting its potential utility in identifying patients at high risk of portal hypertension.
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整合腸道菌和臨床參數以預測肝硬化患者之 乙型受體阻斷劑反應與肝門靜脈壓力 INTEGRATING GUT MICROBIOTA AND CLINICAL PARAMETERS TO PREDICT BETA-BLOCKER RESPONSE AND PORTAL PRESSURE IN CIRRHOTIC PATIENTS
吳佩珊1,3 林宥成3 謝昀蓁2,3 吳詩韻3,4
2,3,5
2,3 李癸汌2,3 侯明志1,2,3
1 臺北榮總內科部內視鏡診斷暨治療科
2 臺北榮總內科部胃腸肝膽科
3 國立陽明交通大學
4 臺北榮總口腔醫學部
5 臺北榮總醫學研究部
Background: Non-selective beta-blockers (NSBBs) are central for preventing esophageal variceal bleeding in cirrhosis. Growing evidence links portal hemodynamics with the gut microbiota, but their combined relevance to NSBB response remains unclear.
Aims: We aimed to identify clinical and microbial features associated with portal pressure and response to NSBBs.
Methods: Patients with cirrhosis requiring NSBB therapy were enrolled. Hepatic venous pressure gradient (HVPG) and hemodynamic parameters were measured before and after NSBB treatment. Stool samples were collected from patients and healthy controls for microbiota analysis. Predictors of HVPG and hemodynamic response were evaluated.
Results: Thirty patients with cirrhosis were enrolled, including 15 responders and 15 non-responders. Baseline HVPG was similar between groups; however, responders had higher baseline cardiac output (CO) than non-responders, which persisted after NSBB therapy (8.1 ± 2.5 vs. 6.0 ± 1.3 L/min and 6.4 ± 1.3 vs. 4.9 ± 0.8 L/min, respectively; both p < 0.05). NSBBs did not alter gut microbiota composition; however, responders showed higher relative abundances of Enterococcus sp. and Escherichia–Shigella, while nonresponders were enriched in potential gut barrier-supporting taxa. Post-treatment CO was the only independent predictor of hemodynamic response. Liver stiffness showed a weak but consistent association with HVPG, and incorporating Weissella confusa improved the prediction of HVPG.
Conclusions: Higher cardiac output was associated with a favorable response to NSBBs, while liver stiffness and specific microbial features provided additional information for estimating portal pressure.
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細胞激素及尿液生物標記可預測膽汁鬱積性 肝硬化大鼠使用 PROPRANOLOL 後腎臟 之不良反應
CYTOKINES AND URINARY BIOMARKERS PREDICT ADVERSE RENAL IMPACTS OF PROPRANOLOL IN BILIARY CIRRHOTIC RATS
劉家甫1 莊喬琳2,3 黃惠君1,3,4,5 許劭榮1,3,5 羅景全1,3,5 侯明志1,3,5 李發耀1,3,5
1 臺北榮民總醫院內科部胃腸肝膽科
2 臺北榮民總醫院內科部一般內科
3 國立陽明交通大學醫學系內科學科
4 臺北榮民總醫院內科部內視鏡診斷暨治療中心
5 臺北榮民總醫院肝硬化與門脈高壓治療暨研究中心
Background: Non-selective beta-blockers (NSBBs) are the mainstay of treatment for variceal hemorrhage in cirrhotic patients. However, the safety of NSBBs in decompensated cirrhosis has been questioned due to concerns about triggering hemodynamic derangement, including hypotension and renal hypoperfusion, which could adversely affect renal function
Aims: To investigate the thorough hemodynamics of rats with common bile duct ligation (CBDL)-induced liver cirrhosis receiving propranolol treatment. The diagnostic utility of several urinary biomarkers for early detection of renal hypoperfusion in propranolol-treated CBDL rats was also evaluated.
Methods: Four weeks after CBDL, Sprague-Dawley rats developed liver cirrhosis and were randomized to receive oral distill water (DW) or propranolol (30 mg/kg/day).
After 2 weeks of treatment, all rats were placed individually in the polycarbonate metabolic cages to collect 24-hour urine on the 15th day. On the 16th day post treatment, blood was drawn for analyses following measurement of systemic and renal hemodynamics.
Results: Propranolol treatment led to significant decreases in mean arterial pressure (MAP), heart rate, portal pressure (PP), and renal blood flow (RBF) in CBDL rats (p < 0.05). Both MAP and PP significantly correlated with RBF, while RBF inversely correlated with urinary liver-type fatty acidbinding protein (L-FABP) and the combination of tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein-7 ([TIMP-2]x[IGFBP7]) levels in propranolol-treated CBDL rats (p < 0.05). Propranololtreated CBDL rats with severe hypotension (MAP < 65 mmHg) showed significantly higher IL-1β, but lower IL-6
levels than those with MAP ≥ 65 mmHg (p < 0.05). Conclusions: Propranolol treatment led to significant decreases in mean arterial pressure (MAP), heart rate, portal pressure (PP), and renal blood flow (RBF) in CBDL rats (p < 0.05). Both MAP and PP significantly correlated with RBF, while RBF inversely correlated with urinary liver-type fatty acid-binding protein (L-FABP) and the combination of tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein-7 ([TIMP2]x[IGFBP7]) levels in propranolol-treated CBDL rats (p < 0.05). Propranolol-treated CBDL rats with severe hypotension (MAP < 65 mmHg) showed significantly higher IL-1β, but lower IL-6 levels than those with MAP ≥ 65 mmHg (p < 0.05).
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THE LIVERRISK SCORE 預測肝移植患者 圍術期預後
THE LIVERRISK SCORE PREDICTS PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING LIVER TRANSPLANTATION
高士勛1 吳佩珊2,6 張天恩2,6 郭芳成3,6 雷浩然4,6 林釀呈3,6 李癸汌1,6 蔡昕霖5,6 劉君恕3,6
1 臺北榮民總醫院內科部胃腸肝膽科
2 臺北榮民總醫院內科部內視鏡診斷暨治療中心
3 臺北榮民總醫院外科部移植外科
4 臺北榮民總醫院外科部一般外科
5 臺北榮民總醫院外科部兒童外科
6 國立陽明交通大學醫學院醫學系
Background: The LiverRisk score has been proposed as a novel tool for predicting future liver-related outcomes; however, its prognostic performance in liver transplant recipients remains unclear.
Aims: To evaluate the prognostic value of the LiverRisk score for predicting perioperative outcomes in patients undergoing liver transplantation.
Methods: This single-center, retrospective cohort study enrolled adult patients who underwent liver transplantation at Taipei Veterans General Hospital between August 2017 and January 2024. Patients younger than 18 years were excluded. The prognostic performance of the LiverRisk score was compared with that of the Model for End-Stage Liver Disease (MELD) score and the Child–Pugh score for perioperative complications.
Results: A total of 240 patients were enrolled. The median MELD score was 20 (IQR, 13–34), the median Child–Pugh score was 10 (IQR, 8–12), the median LiverRisk score was 8.46 (IQR, 7.42–10.00), and the median graft-torecipient weight ratio (GRWR) was 1.07 (IQR, 0.87–1.24).
In univariate analyses, a higher LiverRisk score was associated with increased risks of overall complications (odds ratio [OR], 1.135; 95% confidence interval [CI], 1.013–1.271; p = 0.029) and biliary events (OR, 1.235; 95% CI, 1.054–1.447; p = 0.010). These associations remained significant in multivariate analyses for overall complications (OR, 1.129; 95% CI, 1.001–1.274; p = 0.048) and biliary events (OR, 1.235; 95% CI, 1.048–1.456; p = 0.012). Receiver operating characteristic (ROC) analysis demonstrated superior prognostic performance of the LiverRisk score for overall complications (area under the curve [AUC], 0.615) compared with the MELD (AUC,
0.526) and Child–Pugh scores (AUC, 0.495). For biliary events, the LiverRisk score showed better discrimination (AUC, 0.649) than GRWR (AUC, 0.504), whereas GRWR showed superior performance for predicting graft failure (AUC, 0.746).
Conclusions: The LiverRisk score demonstrated superior prognostic performance compared with the MELD and Child–Pugh scores for predicting postoperative complications and biliary events after liver transplantation. It may serve as a useful adjunct to preoperative risk assessment.
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台灣肝硬化與慢性肝病死亡患者之性別差 異：全國代表性的哨兵醫院研究
SEX DIFFERENCES AMONG PATIENTS WHO DIED FROM LIVER CIRRHOSIS AND CHRONIC LIVER DISEASES IN TAIWAN: A NATIONALLY REPRESENTATIVE SENTINEL CENTER STUDY
楊承燁1 陳彥均2 簡榮南3 林俊彥3 盧勝男1 曾國枝2 1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系 2 佛教慈濟醫療財團法人大林慈濟醫院胃腸肝膽科系
3 長庚醫療財團法人林口長庚紀念醫院胃腸肝膽科系
Background: The characteristics of patients who died from liver cirrhosis and chronic liver disease (LC/CLD), particularly differences between men and women, remain insufficiently described.
Aims: This sentinel center study compared sex-specific characteristics and secular trends among LC/CLD deaths in Taiwan, focusing on age distribution and etiologic composition of hepatitis B virus (HBV), hepatitis C virus (HCV), and non-B non-C (NBNC) disease.
Methods: Between 2015 and 2022, LC/CLD deaths were identified from national mortality statistics using ICD-10 codes K70, K73, and K74. Individual-level viral serology data were obtained from the Chang Gung Research Database (CGRD) and the Buddhist Tzu Chi Medical Foundation (TCMF), comprising 16 hospitals across Taiwan. After cross-system deduplication, patients with available HBsAg and anti-HCV results were included. Analyses were stratified by sex to compare age and viral etiology. National etiology-specific LC/CLD mortality was estimated using direct standardization based on sentinelderived distributions.
Results: A total of 35,413 patients died from LC/CLD nationally, of whom 6,619 (18.7%) had complete viral serology available in the combined CGRD and TCMF datasets. The sex distribution in the study sample was consistent with national mortality statistics (male:female ≈ 7:3). Men died younger than women (57±14 vs. 70±14 years, p<0.001). Etiologic patterns differed by sex: among HBV-related deaths, 73.8% occurred in men (1,077/1,460) and 26.2% in women (383/1,460), whereas HCVrelated deaths showed a more balanced sex distribution, with 53.4% in men (807/1,512) and 46.6% in women (705/1,512). After direct standardization, estimated national HCV-related mortality declined by 51%, with a greater
reduction in women than in men (58% vs. 43%).
Conclusions: Among patients who died from LC/CLD in Taiwan, men and women exhibited distinct etiologic compositions and secular trends. HBV predominated among male deaths, whereas HCV accounted for a larger proportion of female deaths. From 2015 to 2022, HCVrelated mortality declined substantially, with a significantly greater reduction in women than in men (58% vs. 43%).
主題：下消化道疾病（一）
水下與傳統內鏡黏膜下剝離術治療大腸非蒂 狀病灶：一項單醫學中心回顧性研究 UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LARGE NON-PEDUNCULATED COLORECTAL LESIONS: A SINGLECENTER RETROSPECTIVE STUDY.
李政諱1 李宗頴1,2,3
1 衛生福利部雙和醫院內科部消化內科
2 臺北醫學大學醫學院內科部消化內科
3 臺北醫學大學消化醫學研究中心
Background: Endoscopic submucosal dissection (ESD) is an established technique for the en bloc resection of large colorectal lesions. However, conventional ESD (CESD) can be technically demanding, often associated with prolonged procedure times and increased risks in challenging cases. Underwater ESD (UESD) has emerged as a promising approach that may facilitate flap creation, improve visualization, and offer thermal protection. Despite its potential, clinical evidence comparing UESD and CESD remains limited.
Aims: This study aimed to compare the clinical outcomes and efficiency of UESD versus CESD for large nonpedunculated colorectal lesions.
Methods: We conducted a retrospective analysis of prospectively collected data from January 2023 to July 2025 at Shuang-Ho Hospital. Adult patients (age ≥20) with non-pedunculated colorectal neoplasms ≥20 mm in size who underwent colorectal ESD performed by a single experienced operator (CYL) were included. A total of 71 patients (UESD: n = 45; CESD: n = 26) were analyzed. Primary outcomes were en bloc and R0 resection rates, resection time, resection speed, and adverse events. Secondary outcomes included traction method usage and hemostatic device requirements. Categorical variables were compared using chi-square or Fisher’s exact tests, and continuous variables were analyzed using the Mann–Whitney U test.
Results: Baseline characteristics, including median lesion size (35 mm for both groups), morphology, and location, were comparable. UESD achieved a faster resection speed (18.3 mm²/min vs 14.3 mm²/min, P=0.02), shorter timeto-flap creation time (4 vs. 7 mins, P<0.001) and higher en bloc resection rate (100% vs 84.6%, P=0.01). Hemostatic forceps were used less frequently in UESD (26.7% vs.
46.2%), though this did not reach statistical significance (P=0.1). No delayed bleeding or perforations occurred in either group.
Conclusions: UESD is a highly efficient technique for the resection of large non-pedunculated colorectal lesions. Compared to CESD, UESD significantly reduces the time required for flap creation, increases resection speed, and achieves a superior en bloc resection rate. Further multicenter prospective studies are warranted to validate these findings and assess the generalizability of the technique.
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真實世界臨床實務中 P4P 實施前後大腸鏡 品質指標之評估
EVALUATING COLONOSCOPY QUALITY METRICS BEFORE AND AFTER IMPLEMENTATION OF A PAYFOR-PERFORMANCE PROGRAM IN REAL-WORLD PRACTICE
陳奕孝1,2,3 李家睿1,2,3 吳冠輝1,2,3 吳宛臻1,2,3 張麗文1,2,3
孫灼基1,2,3 楊國卿1,2,3 林裕民1,2,3
1 新光吳火獅紀念醫院內科部
2 新光吳火獅紀念醫院胃腸肝膽科
3 天主教輔仁大學醫學院醫學系
Background: Colorectal cancer (CRC) remains a major public health burden and the third leading cause of cancerrelated mortality in Taiwan. Colonoscopy is central to CRC screening and prevention. In April 2024, Taiwan’s Ministry of Health and Welfare implemented a pay-for-performance (P4P) program that reimburses colonoscopy based on polypectomy volume (1–3, 4–9, ≥10 polyps) to incentivize quality and adenoma detection. This study evaluated realworld changes in colonoscopy quality metrics before and after P4P implementation.
Aims: This study aimed to evaluate real-world changes in colonoscopy quality metrics, including adenoma detection rate (ADR), adenomas per colonoscopy (APC), and adenomas per positive colonoscopy (APP), before and after implementation of a polypectomy volume–based P4P program.
Methods: We conducted a retrospective, single-center study using institutional colonoscopy reports. The preP4P period was April 2023–March 2024, and the postP4P period was May 2024–April 2025. All adult patients undergoing screening, surveillance, or diagnostic colonoscopy were included. Colonoscopy quality metrics included ADR, APC, and APP. Differences in ADR were assessed using the chi-square test, whereas APC and APP were compared using t-tests. Distributions across P4P reimbursement tiers were assessed using the chi-square test.
A P value < 0.05 was considered statistically significant. Results: A total of 6,681 colonoscopies were analyzed in the pre-P4P period and 6,283 in the post-P4P period. The proportion of male patients was 51.7% before and 49.5% after P4P implementation, with mean ages of 59.7 and 60.0 years, respectively. Compared with the pre-P4P period, the post-P4P period was associated with higher ADR (45.2% vs. 47.0%, P < 0.05) and APC (0.93 vs. 0.99, P <
0.05), while APP did not differ significantly (2.06 vs. 2.10, P = 0.23). The distribution of colonoscopies across P4P reimbursement tiers differed significantly between periods (P < 0.01), driven primarily by a higher-than-expected proportion of examinations yielding ≥10 adenomas after policy implementation.
Conclusions: Implementation of a polypectomy volume–based P4P program was associated with higher ADR and APC, suggesting improved adenoma detection. The unchanged APP may reflect high baseline performance and warrants further evaluation. The increased proportion of high–adenoma-yield examinations indicates a systematic shift in polypectomy volume, supporting a potential role for P4P programs in improving colonoscopy quality in realworld practice.
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PLGA 奈米載體緩釋 SN38 在腸炎引發癌症 模型具持續抗腫瘤作用並減輕腸炎嚴重度
PLGA-BASED SUSTAINED DELIVERY OF SN38 PRESERVES ANTITUMOR EFFICACY AND MITIGATES COLITIS IN A COLITIS-ASSOCIATED CANCER MODEL.
翁孟慈1,2 劉心雲3 熊佳悅4 林本仁5 陳韻晶4,6 魏淑鉁2
1 國立臺灣大學醫學院附設醫院新竹臺大分院醫學研究部
2 國立臺灣大學醫學院附設醫院內科部
3 肝病防治學術基金會
4 國立清華大學生物醫學工程研究所
5 國立臺灣大學醫學院附設醫院外科部
6 國立清華大學化學系
Background: Irinotecan is widely used in colorectal cancer, but its active metabolite SN38 is limited by poor solubility, instability, and gastrointestinal toxicity. PLGAbased nanoparticle delivery may improve drug stability and reduce treatment-related intestinal injury through sustained release.
Aims: This study aimed to develop SN38-loaded PLGA nanoparticles and evaluate their antitumor efficacy and safety in colon cancer cells and a murine model of colitisassociated colorectal cancer.
Methods: SN38-loaded PLGA nanoparticles were synthesized and characterized for particle size and polydispersity using dynamic light scattering. In vitro cytotoxicity was assessed by MTT assay in HCT116 colorectal cancer cells and non-cancerous HEK293T cells. Drug release kinetics were examined to determine sustained release properties. Therapeutic efficacy and safety were evaluated using an azoxymethane (AOM)/ dextran sodium sulfate (DSS)-induced CAC mouse model. Antitumor activity was assessed by tumor number and tumor area, while colitis severity was evaluated by colon length, disease activity index (DAI), and histological colitis scores. Systemic toxicity was further assessed by body weight changes and histopathological examination of major organs.
Results: SN38-loaded PLGA nanoparticles exhibited a mean diameter of 170.7 ± 0.95 nm with a polydispersity index of 0.18 ± 0.04 and demonstrated sustained SN38 release over 48 hours. In vitro, PLGA-SN38 preserved potent cytotoxicity against HCT116 cells while exhibiting reduced toxicity toward HEK293T cells compared with free SN38. In vivo, administration of PLGA-SN38 or free SN38
five times per week in combination with bevacizumab significantly reduced tumor number and tumor burden in the AOM/DSS-induced CAC model. Notably, reducing the dosing frequency of PLGA-SN38 from five to three injections per week did not compromise antitumor efficacy. Importantly, PLGA-SN38 markedly attenuated treatmentassociated colitis, as evidenced by improved body weight maintenance, longer colon length, lower DAI scores, and reduced histological inflammation compared with free SN38 or saline-treated controls. Among treatment regimens, PLGA-SN38 administered three times weekly conferred the greatest protection against colitis severity. No significant histopathological abnormalities were observed in major organs, indicating a favorable safety profile.
Conclusions: PLGA-mediated encapsulation of SN38 enables sustained drug delivery that maintains antitumor efficacy while significantly reducing gastrointestinal toxicity in colitis-associated colorectal cancer. This nanotherapeutic strategy offers a promising platform for improving the therapeutic index of SN38, with the added benefits of reduced dosing frequency and enhanced tolerability.
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華碩 ENDOAIM 人工智慧大腸鏡病灶輔助 系統於 OLYMPUS CV-1500 內視鏡之跨機 型臨床效能驗證研究
CLINICAL PERFORMANCE
VALIDATION OF THE ASUS ENDOAIM
AI-ASSISTED COLONOSCOPIC LESION
DETECTION AND CLASSIFICATION
SYSTEM ON THE OLYMPUS CV-1500 PLATFORM
莊世杰 黃文信 楊其穎 鄭幸弘 謝宗霖 黃秉淳 張育誠 張晋維 彭成元 中國醫藥大學附設醫院消化醫學中心
Background: Missed polyps during colonoscopy remain a major limitation in colorectal cancer prevention, particularly for small or flat lesions. Artificial intelligence–assisted computer-aided detection and diagnosis (CADe/ CADx) systems have demonstrated improved detection rates; however, most systems are validated on a single endoscopy platform. EndoAim (ASUS) is an AI-based colonoscopic lesion detection and classification system previously approved for use on Olympus CV-290. Its performance on other optical endoscopy platforms has not been fully evaluated.
Aims: To validate the clinical performance and crossplatform applicability of the EndoAim system on the Olympus CV-1500 endoscopy platform by assessing polyp detection sensitivity and adenoma classification accuracy using non-inferiority testing.
Methods: This retrospective study analyzed deidentified colonoscopy videos obtained using Olympus CV-1500 systems at a tertiary referral center. Three experienced gastroenterologists independently annotated polyp presence, size, morphology, and classification, with consensus adjudication serving as ground truth.
Study A evaluated lesion-based polyp detection sensitivity as the primary endpoint, with frame-based specificity as an observational metric. Stratified analyses were performed according to polyp size (<5 mm) and morphology.
Study B assessed adenoma versus non-adenoma classification using a balanced 1:1 polyp sample, with area under the receiver operating characteristic curve (AUC) as the primary classification metric. Predefined non-inferiority thresholds were sensitivity ≥90% and AUC ≥85%.
Results: A total of 252 patients with 533 polyps were included for detection analysis. Overall lesion-based sensitivity was 94.93% (95% CI: 92.73–96.50%),
exceeding the non-inferiority threshold. Sensitivity remained high for polyps <5 mm (94.79%), protruding lesions (97.55%), and flat/depressed lesions (91.77%). Frame-based specificity was 98.33%. For classification analysis, 274 polyps (142 adenomas, 132 non-adenomas) were evaluated. The adenoma classification AUC was 89.55% (95% CI: 85.93–93.17%), meeting noninferiority criteria. No device-related adverse events were observed.
Conclusions: EndoAim demonstrated high polyp detection sensitivity and robust adenoma classification performance on the Olympus CV-1500 platform, supporting its crossplatform applicability and stable performance across different endoscopic optical systems.
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牽引輔助內視鏡黏膜下剝離術與傳統內視鏡 黏膜下剝離術於表淺型大腸腫瘤之比較：多 中心回溯性研究
TRACTION-ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION VERSUS CONVENTIONAL ESD FOR SUPERFICIAL COLORECTAL NEOPLASMS: A MULTIPLE-CENTER RETROSPECTIVE STUDY
鄭旭恩 台中榮民總醫院
Background: Endoscopic submucosal dissection (ESD) is an established treatment for superficial colorectal neoplasms (SCNs) but remains technically challenging, particularly in the colon, due to limited visualization and unstable traction. Traction-assisted ESD (T-ESD) has been introduced to improve exposure of the submucosal plane and procedural efficiency; however, traction devices have only recently been adopted in Taiwan, and prior studies have reported inconsistent results regarding its clinical benefits.
Aims: This study aimed to compare the outcomes of traction-assisted and conventional ESD (C-ESD) for SCNs in real-world practice.
Methods: In this multiple-center retrospective study, patients with superficial colorectal neoplasms who underwent ESD between January 2020 and December 2025 were enrolled. Primary outcomes were procedure time and dissection speed. Secondary outcomes included en bloc resection, R0 resection, and procedure-related complications.
Results: A total of 214 superficial colorectal neoplasms were analyzed, including 191 lesions (89.3%) treated with conventional ESD and 23 lesions (10.7%) treated with traction-assisted ESD. Median tumor surface area (7.1 [4.1–11.6] vs 8.3 [5.0–13.9] cm², p = 0.28) and median procedure time (57 [32–101] vs 49 [28–83] min, p = 0.21) were comparable between groups. However, traction-assisted ESD achieved a significantly higher dissection speed than conventional ESD (19 [11–31] vs 13 [7–23] mm²/min, p = 0.018). Location-specific analysis demonstrated significantly faster dissection with traction-assisted ESD in rectal lesions (24 [14–36] vs 15 [8–26] mm²/min, p = 0.012) and transverse colon lesions (17 [9–30] vs 10 [5–18] mm²/min, p = 0.021), with non-significant trends favoring traction-assisted
ESD in other colonic segments. En-bloc resection (90.1% vs 91.3%, p = 0.88), R0 resection (89.5% vs 95.7%, p = 0.31), and overall complication rates (19.4% vs 26.1%, p = 0.43) were comparable between groups. Resection time and dissection speed differed significantly by lesion morphology (Kruskal–Wallis p < 0.001). LST-NG pseudodepressed lesions showed the longest resection time and slowest dissection speed, whereas polypoid and LST-G homogeneous lesions were resected more efficiently. In multivariable analysis, lesion size was the strongest predictor of prolonged resection time (β = 0.62, 95% CI 0.55–0.69). Additionally, lesion morphology and location were independently associated. Specifically, rectal lesions were associated with shorter procedures, whereas rightsided colonic lesions tended to require longer resection times.
Conclusions: Traction-assisted ESD was associated with faster dissection speed, particularly for rectal and transverse colon lesions, with favorable technical success, oncologic outcomes, or safety.
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腸道超音波對臨床穩定的潰瘍性大腸炎病人 全層癒合的評估
INTESTINAL ULTRASOUND TO ASSESS TRANSMURAL REMISSION FOR ULCERATVE COLITIS PATIENTS IN CLINICAL REMISSION
吳心耘1,2 陳知澈1,2 林弘堯2,3 陳韻竹2 翁孟慈2,4 王雋穎4 魏淑鉁2
1 台大醫院金山分院 內科部
2 台大醫院 肝膽腸胃內科
3 台大醫院新竹分院 內科部
4 台大醫院新竹分院 醫學研究部
Background: Endoscopic remission (ER) is the formal long-term treatment target for ulcerative colitis (UC). With wider use of intestinal ultrasound (IUS), UC as a purely mucosal disease is being challenged. Yet, data on transmural remission (TR) remained limited.
Aims: We aimed to characterize IUS findings, TR prevalence, and concordance with other remission domains in UC patients in clinical remission (CR).
Methods: From October 2024 to November 2025, we prospectively enrolled UC patients in CR, defined as partial Mayo score <3 and no subscore >1 for over 3 months. Proctitis-only disease was excluded. Patients received colonoscopy, IUS and took inflammatory bowel disease (IBD) disk questionnaire within a month. Biochemical remission (BR) was defined as fecal calprotectin (FC) <100 µg/g; ER as Mayo endoscopic subscore ≤1; histologic remission (HR) as Nancy index ≤1 in those with ER. IUS variables included bowel wall thickness (BWT), bowel wall flow (BWF), bowel wall stratification (BWS), haustration, inflammatory fat (iFat), and lymph nodes. Submucosal index (SMI) was the percentage of the submucosal layer thickness in BWT. We predefined hierarchical TR categories (simple, standard, complete, extensive, ultra) based on progressive normalization of the parameters. Correlations between TR and BR, ER, HR were assessed using chi-square test and Kendall’s tau-b correlation.
Results: 56 patients were enrolled (median age 53, 53.6% male). Median disease duration was 11 years, and extensive colitis was present in 91.1%. Exposure to ≥2 advanced therapies composed of 17.9%. Median fecal calprotectin (FC) was 47 µg/g (range: 0-2804). Median IBD disk score 7 (range: 0-46), indicating low burden on quality of life. Overall, 69.6% achieved BR and also 69.6% attained ER. Among ER, 79.5% achieved HR. TR prevalence decreased
stepwise with increasing stringency, simple TR (BWT <3 mm) 73.2%; standard TR (simple TR plus normal BWF) 57.1%; complete TR (standard TR plus preserved BWS and absent iFat) 55.4%; extensive TR (complete TR plus no lymphadenopathy, preserved haustra, and SMI <50%) 48.2%; ultra TR (extensive TR with SMI 0%) 37.5%. Among HR patients, 77.4% reached simple TR. Across definitions, correlations between TR and biochemical remission, ER, or HR were weak (all correlation coefficients <0.3). Segmentally, median BWT ranged from 2 mm in sigmoid to 1.3 mm in ascending colon. Structural abnormalities were most frequent in sigmoid colon. Presence of BWF, iFat, loss of BWS and haustra were seen in 14.3%, 14.3%, 7.2%, and 16.1% of sigmoid segments; SMI >50% occurred in 8.9%.
Conclusions: Among UC patients in CR with low symptom burden, IUS depicted residual transmural abnormalities. TR was achievable but less common when strict IUS criteria were applied. IUS-based TR may serve as a complementary remission dimension, not redundant with ER or HR.
主題：幽門螺旋桿菌
14 天鉍劑／高劑量阿莫西林／福星定療法 之療效與安全性更優於其他三種一線幽門螺 旋桿菌根除方案
SUPERIOR EFFICACY AND SAFETY OF 14-DAY BISMUTH/HIGH-DOSE
AMOXICILLIN/VONOPRAZAN
THERAPY COMPARED WITH OTHER THREE FIRST-LINE REGIMENS FOR HELICOBACTER PYLORI
ERADICATION: A MULTICENTER
REAL-WORLD STUDY IN TAIWAN
蔡峯偉1 吳登強2 蔡成枝3 楊智欽4 石志安5 許銘仁6 陳健麟7 陳冠仰8 李嘉龍9 劉玉華10 許斯淵11 施長碧12 雷尉毅7 戴維震3 高崧碩13 蔡騌圳1 李熹昌8 許秉毅12
1 高雄榮民總醫院；2 高雄醫學大學附設醫院；3 高雄長 庚紀念醫院；4 國立台灣大學醫學院附設醫院；5 安泰醫 院；6 奇美醫院；7 花蓮慈濟醫院；8 臺北市立聯合醫院； 9 國泰綜合醫院；10 新光吳火獅紀念醫院；11 台中榮民
總醫院；12 台南市立安南醫院；13 屏東榮民總醫院
Background: The effectiveness of clarithromycin-based standard triple therapy for Helicobacter pylori (H. pylori) infection has declined because of increasing clarithromycin resistance, with eradication rates falling below 80% in most countries. Several alternative strategies—including bismuth quadruple therapy, potassium-competitive acid blocker (PCAB)–based triple therapy, and bismuth/high-dose amoxicillin/PCAB (BAP) therapy—have been proposed to improve first-line H. pylori eradication.
Aims: To compare the efficacy and safety of 14-day BAP therapy, bismuth quadruple therapy, rabeprazole-based triple therapy, and vonoprazan-based triple therapy as firstline treatments for H. pylori infection in Taiwan.
Methods: This retrospective cohort study included patients with H. pylori infection who received one of the following 14-day regimens between August 2018 and June 2025 at 12 hospitals in Taiwan: BAP therapy (tripotassiumdicitrato bismuthate 300 mg qid, amoxicillin 750 mg qid, and vonoprazan 20 mg bid), bismuth quadruple therapy (tripotassiumdicitrato bismuthate 300 mg qid, rabeprazole 20 mg bid, tetracycline 500 mg qid, and metronidazole 250 mg qid), rabeprazole-based triple therapy (rabeprazole 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1 g bid), or vonoprazan-based triple therapy (vonoprazan 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1 g bid). H. pylori status was assessed at least four weeks after completion of therapy.
Results: A total of 222, 292, 138, and 292 patients received BAP, bismuth quadruple, rabeprazole triple, and vonoprazan triple therapies, respectively. In the modified intention-to-treat analysis, BAP therapy achieved a significantly higher eradication rate than bismuth quadruple therapy, rabeprazole triple therapy, and vonoprazan triple therapy (98.2% vs. 94.2%, 87.7%, and 93.2%; P = 0.024, <0.001, and 0.010, respectively). Bismuth quadruple therapy also resulted in a higher eradication rate than rabeprazole triple therapy (94.2% vs. 87.7%; P = 0.020). Regarding safety, bismuth quadruple therapy was associated with a significantly higher incidence of adverse events compared with BAP, rabeprazole triple, and vonoprazan triple therapies (31.8% vs. 9.5%, 15.2%, and 15.8%, respectively; all P< 0.001).
Conclusions: Fourteen-day BAP triple therapy provides superior eradication efficacy with fewer adverse events compared with bismuth quadruple, rabeprazole triple, and vonoprazan triple therapies. It represents an effective and well-tolerated first-line treatment option for H. pylori infection in Taiwan.
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BISMUTH ／ AMOXICILLIN ／ VONOPRAZAN 三合療法與標準三合療法 在幽門螺旋桿菌根除治療中之根除率、全民 健康保險醫療支出與碳排放量之比較 COMPARISON OF ERADICATION RATES, NATIONAL HEALTH INSURANCE EXPENDITURES, AND CARBON EMISSIONS BETWEEN BISMUTH/ AMOXICILLIN/ VONOPRAZAN TRIPLE THERAPY AND STANDARD TRIPLE THERAPY FOR HELICOBACTER PYLORI ERADICATION
標彥岑1,5 吳登強2,5 蔡成枝3,5 施長碧1,5 許銘仁4,5 許秉毅1,5
1 中國醫藥大學台南市立安南醫院消化內科
2 高雄醫學大學附設醫院胃腸內科
3 高雄長庚紀念醫院胃腸肝膽科
4 奇美醫院胃腸肝膽科
5 台灣胃酸相關疾病暨微菌叢聯盟
Background: Owing to rising clarithromycin resistance, the eradication rate of standard triple therapy for Helicobacter pylori infection has declined to below 90% in most countries. A recent randomized controlled trial demonstrated eradication rates of 98% for bismuth/ amoxicillin/vonoprazan (BAV) triple therapy and 88% for standard triple therapy in Taiwan.
Aims: To compare eradication rates, medical expenditures reimbursed by Taiwan’s National Health Insurance (NHI), and carbon emissions associated with H. pylori eradication using a 14-day BAV triple therapy versus a 14-day standard triple therapy as first-line treatment, followed by 14-day bismuth quadruple therapy as rescue treatment in Taiwan.
Methods: Assuming a unit cost of vonoprazan of 40 New Taiwan Dollars (NTD), we calculated the cumulative eradication rates and NHI medical expenditures for H. pylori eradication in 100 patients treated with either 14day BAV triple therapy or 14-day standard triple therapy as first-line treatment, followed by 14-day bismuth quadruple therapy as rescue therapy. Differences between the two strategies were compared. In addition, carbon emissions associated with each treatment strategy were estimated for 1,000 patients, and differences in carbon dioxide equivalent (CO₂e) emissions between groups were analyzed.
Results: The expected cumulative eradication rates of the two treatment strategies were 100% and 99%, respectively. The total NHI medical expenditures per 100 patients were NTD 416,838 for the BAV-based strategy and NTD
432,460 for the standard triple therapy–based strategy. The BAV-based strategy was associated with lower carbon emissions than the standard triple therapy–based strategy (15,970 kg CO₂e per 1,000 patients vs. 20,320 kg CO₂e per 1,000 patients).
Conclusions: An H. pylori eradication strategy using bismuth/amoxicillin/vonoprazan triple therapy as firstline treatment followed by bismuth quadruple therapy as second-line treatment achieves comparable eradication efficacy to a strategy using standard triple therapy followed by bismuth quadruple therapy, while resulting in lower National Health Insurance expenditures. Moreover, the BAV-based strategy is associated with substantially lower carbon emissions, supporting its role as a clinically effective and environmentally sustainable treatment approach.
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「BISMUTH/HIGH-DOSE AMOXICILLIN/ VONOPRAZAN 三合療 法」與「標準鉍劑四合療法」在第二線幽門 螺旋桿菌除菌治療的療效與安全性之比較一項台灣多中心真實世界研究
EFFICACY AND SAFETY OF BISMUTH/ HIGH-DOSE AMOXICILLIN/ VONOPRAZAN TRIPLE THERAPY AND STANDARD BISMUTH QUADRUPLE THERAPY IN THE SECOND-LINE TREATMENT OF HELICOBACTER
PYLORI INFECTION - A MULTICENTER REAL-WORLD STUDY IN TAIWAN
許斯淵1,8 許秉毅2,8 石志安3,8 許銘仁4,8 陳健麟5,8 施長碧2,8
鄭旭恩1,8 吳佩叡4,8 雷尉毅5,8 蔡峯偉6,8 蔡騌圳6,8 郭昭宏7,8
吳登強7,8
1 臺中榮民總醫院 胃腸肝膽科
2 臺南市立安南醫院 消化內科 中國醫藥大學
3 安泰醫院 胃腸肝膽科
4 奇美醫院 胃腸肝膽科
5 花蓮慈濟醫院 胃腸肝膽科
6 高雄榮民總醫院 胃腸肝膽科
7 高雄醫學大學附設醫院 胃腸內科
8 臺灣胃酸相關疾病暨微菌叢聯盟
Background: Standard bismuth quadruple therapy (BQT) and proton pump inhibitor (PPI)–amoxicillin–fluoroquinolone triple therapy are recommended secondline treatments for Helicobacter pylori infection by the Maastricht/Florence VI Consensus Report. Recently, we developed a novel regimen comprising bismuth, high-dose amoxicillin, and a potassium-competitive acid blocker (PCAB) for second-line H. pylori eradication. A pilot study demonstrated that bismuth/high-dose amoxicillin/PCAB (BAP) triple therapy achieved an eradication rate exceeding 90% as salvage treatment.
Aims: To compare the efficacy and safety of 14-day BAP triple therapy with 14-day standard BQT as second-line treatment for H. pylori infection in Taiwan.
Methods: This retrospective cohort study included consecutive H. pylori -infected patients who failed firstline therapy and subsequently received either 14-day BAP triple therapy (tripotassium dicitrato bismuthate 300 mg qid, amoxicillin 750 mg qid, and vonoprazan 20 mg bid) or BQT (tripotassium dicitrato bismuthate 300 mg qid, rabeprazole 20 mg bid, tetracycline 500 mg qid, and metronidazole 250 mg qid) between July 2020 and October
2025 at five hospitals in Taiwan. Patients returned at week 2 to assess treatment adherence and adverse events. H. pylori eradication status was evaluated at least four weeks after completion of rescue therapy.
Results: A total of 52 patients received 14-day BAP triple therapy, and 52 received 14-day BQT. Resistance rates of H. pylori to amoxicillin, tetracycline, metronidazole, clarithromycin, and levofloxacin were 0%, 0%, 59%, 79%, and 52%, respectively. The modified intention-totreat eradication rates were 94.2% (49/52; 95% confidence interval [CI], 87.8-100.0%) in the BAP group and 86.5% (45/52; 95% CI, 77.2-95.8%) in the BQT group, with no significant difference between treatments (p = 0.319). The incidence of adverse events (15.4% vs. 21.1%) and treatment adherence (98.1% vs. 96.2%) were also comparable between groups.
Conclusions: Fourteen-day BAP triple therapy demonstrates efficacy and tolerability comparable to 14day standard bismuth quadruple therapy as second-line treatment for H. pylori infection in Taiwan.
糞便抗原篩檢在成人族群中檢測幽門螺旋桿 菌感染的有效性
THE EFFECTIVENESS OF STOOL ANTIGEN SCREENING FOR HELICOBACTER PYLORI INFECTION IN AN ADULT POPULATION
林維良
臺北市立萬芳醫院 消化内科
Background: Helicobacter pylori infection remains a major global health concern and is associated with chronic gastritis, peptic ulcer disease, and gastric malignancy. The stool antigen test is a widely used noninvasive tool for detecting active H. pylori infection because of its low cost and suitability for population-based screening. Previous studies have demonstrated acceptable diagnostic performance under controlled conditions, and a recent Taiwanese study reported a reduced incidence of gastric cancer following screening with H. pylori stool antigen testing [1,2]. However, in real-world clinical practice, confirmatory gastric biopsy is often performed selectively rather than universally, particularly when screening results directly guide treatment decisions.
Aims: This study aimed to evaluate the association between stool antigen screening results and biopsy-confirmed H. pylori infection in a real-world clinical cohort.
Methods: This retrospective study included patients who underwent H. pylori stool antigen screening between March and June 2025. Patients with positive stool antigen results received eradication therapy either directly or after confirmatory gastric biopsy. Among patients who underwent biopsy, a 2 × 2 contingency table was constructed to assess the association between stool antigen results (positive vs negative) and biopsy-confirmed H. pylori infection (positive vs negative). Fisher’s exact test was used because of potential small cell counts. All tests were two-sided, and a P value < 0.05 was considered statistically significant. Statistical analyses were performed using SPSS version 19.0 (IBM Corp., Armonk, NY, USA).
Results: A total of 109 patients underwent H. pylori stool antigen screening between March and June 2025.
Baseline characteristics are summarized in Table 1. The mean ages of stool antigen–positive and –negative patients were 62.9 and 61.0 years, respectively, and the proportions of male patients were 36.4% and 39.1%. Among the 109 patients, 22 underwent confirmatory gastric biopsy via esophagogastroduodenoscopy. Of the 8 stool
antigen–positive patients, 7 (87.5%) had biopsy-confirmed H. pylori infection, whereas 1 (12.5%) had a negative biopsy result. Among the 14 stool antigen–negative patients who underwent biopsy, 11 (78.6%) had negative biopsy results and 3 (21.4%) were biopsy positive. In patients who underwent confirmatory biopsy, stool antigen test results were significantly associated with biopsyconfirmed H. pylori infection (Fisher’s exact test, twosided p = 0.006), (Table 2). Apparent sensitivity, specificity, positive predictive value, and negative predictive value in this subgroup were 70.0%, 91.7%, 87.5%, and 78.6%, respectively.
Conclusions: In this real-world clinical cohort, H. pylori stool antigen results were significantly associated with biopsy-confirmed infection among patients who underwent confirmatory testing. While false-negative results were observed, the stool antigen test demonstrated reasonable performance as a noninvasive screening tool in routine clinical practice. The relatively lower apparent sensitivity comparing to previous studies [3] should be interpreted with caution given the limited number of patients who underwent confirmatory biopsy. These findings support the use of stool antigen testing for H. pylori screening, while highlighting the importance of confirmatory evaluation in selected cases.
RIFABUTIN 合併 METRONIDAZOLE 作
為 PENICILLIN 過敏患者的幽門螺旋桿菌 救援療法之療效分析
RIFABUTIN COMBINATIONS WITH METRONIDAZOLE AS RESCUE
HELICOBACTER PYLORI THERAPY FOR PENICILLIN-ALLERGIC PATIENTS
莊至鈞1 郭家榮1,2 林正祐1,2 陳俊瑋1,2 林蔚然1,2 邱正堂1,2
1 林口長庚紀念醫院胃腸肝膽科
2 長庚大學醫學院
Background: The global rise in antibiotic resistance among Helicobacter pylori strains has led to increasing eradication failures, making rescue therapies particularly challenging. Rifabutin, with its low intrinsic resistance rates and potent bactericidal activity, emerges as a promising option. For penicillin-allergic patients, metronidazole is used to replace amoxicillin in clarithromycin based triple therapy. Rifabutin is generally used in combination with amoxicillin. However, there is paucity of data about the efficacy of rifabutin in patients with penicillin-allergy.
Aims: This study aimed to evaluate the efficacy rifabutinmetronidazole combination as rescue Helicobacter pylori therapy in patients with penicillin-allergy.
Methods: We retrospectively reviewed the medical records of 111 patients who received rifabutin-based Helicobacter pylori therapy as second- or third-line treatment. Helicobacter pylori infection was confirmed by rapid urease test, urea breath test, stool antigen test, or histology. Eradication status was assessed using the urea breath test or rapid urease test at least 4 weeks after completion of therapy.
Results: Overall, the mean age of the patients was 57.8 years, and 56.7% were female. Peptic ulcer disease was present in 41.4% of patients at the time of Helicobacter pylori diagnosis. For 6 cases of refractory Helicobacter pylori infection with penicillin allergy, rifabutin 150 mg twice daily, amoxicillin 1.0 g twice daily, and esomeprazole 40 mg twice daily were prescribed for 7-10 days, yielding an eradication rate of 33.3%. For 101 cases of refractory Helicobacter pylori infection without penicillin allergy, rifabutin 150 mg twice daily, combined with amoxicillin 1.0 g twice daily and a proton pump inhibitor twice daily for 7–10 days, yielded an eradication rate of 78.2%.
Conclusions: Rifabutin-based regimens are effective and well tolerated as rescue therapy for H. pylori eradication. However, for patients with penicillin-allergy, rifabutin combinations with metronidazole have demonstrated poor eradication rates. This may reflect either antagonistic effects between these antibiotics or the high prevalence of H. pylori resistance to metronidazole.
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「鉀離子競爭性酸阻斷劑 / 共伴療法」與「質 子幫浦抑制劑 / 反轉式混合療法」在第一線 幽門螺旋桿菌除菌治療之療效比較 EFFICACY OF POTASSIUMCOMPETITIVE ACID BLOCKERBASED CONCOMITANT THERAPY, AND PROTON PUMP INHIBITOR-BASED REVERSE HYBRID THERAPY IN FIRSTLINE ANTI-H PYLORI TREATMENT
陳奕全 高雄榮民總醫院 胃腸肝膽科
Background: The increasing antibiotic resistance of Helicobacter pylori (H. pylori) has challenged the efficacy of conventional therapies. While 14-day reverse hybrid therapy is an effective first-line strategy, its long duration and complex dosing schedule may compromise patient compliance. Vonoprazan, a novel potassium-competitive acid blocker (P-CAB), provides more potent and durable acid suppression than proton pump inhibitors (PPIs), potentially allowing for shortened treatment durations without compromising efficacy.
Aims: This study aimed to compare the eradication rate, safety, and compliance of a 7-day Vonoprazanbased concomitant therapy against the standard 14-day Pantoprazole-based reverse hybrid therapy in first-line anti-H. pylori treatment.
Methods: In this retrospective comparative study (2023/01~2025/12), 148 H. pylori-infected treatment-naive patients were included and divided into two groups (n=74 per group). The Vonoprazam-Concomitant group received a 7-day regimen of Vonoprazan 20 mg, Amoxicillin 1 g, Clarithromycin 500 mg, and Metronidazole 500 mg, all twice daily. The Pantoprazole-Reverse Hybrid group received a 14-day regimen consisting of a 7-day quadruple therapy (Pantoprazole 40 mg, Amoxicillin 1 g, Clarithromycin 500 mg, and Metronidazole 500 mg, twice daily) followed by a 7-day dual therapy (Pantoprazole 40 mg and Amoxicillin 1 g, twice daily). H. pylori status was reassessed 6 weeks after treatment using the Urea Breath Test. Efficacy was analyzed by intention-to-treat (ITT) and per-protocol (PP) analyses.
Results: Baseline demographics showed differences between groups, the Vonoprazam-Concomitant group was older (60.7+/-10.4 vs. 54.8 +/-13.5 years, P=0.003) and had a higher prevalence of gastritis (P<0.001).The eradication rates in the V-Concomitant group were numerically higher
than those in the P-Reverse Hybrid group.Intention-totreat (ITT) analysis: 98.6% (73/74) vs. 90.5% (67/74), respectively (P=0.063).Per-protocol (PP) analysis: 98.6% (70/71) vs. 91.4% (64/70), respectively (P=0.063).While the difference showed marginal statistical significance, the V-Concomitant group demonstrated a strong trend toward superior efficacy. Adverse event rates were similar between groups (20.3% vs. 21.6%, P=1.000), with abnormal taste being the most common complaint. Both regimens achieved high compliance (>94%).
Conclusions: The 7-day Vonoprazan-based concomitant therapy achieved an exceptionally high eradication rate (98.6%) and demonstrated a trend of superiority over the 14-day PPI-based reverse hybrid therapy. Given its significantly shorter duration, simplified regimen, and comparable safety profile, the 7-day Vonoprazan-based concomitant therapy is a highly promising candidate for first-line H. pylori eradication. However, this study is limited by its retrospective design and single-center nature. Future large-scale prospective randomized trials are warranted to validate these findings.
主題：其他消化道疾病（一）
臨床緩解期潰瘍性結腸炎患者中，NANCY 組織學指數與活檢策略對臨床預後之影響： 前瞻性研究
PROSPECTIVE EVALUATION OF THE NANCY INDEX AND OPTIMAL BIOPSY STRATEGIES FOR PREDICTING OUTCOMES IN ULCERATIVE COLITIS
PATIENTS WITH CLINICAL REMISSION
葉星佑
國立臺灣大學醫學院附設醫院內科部
Background: STRIDE-II highlights clinical, biochemical, and endoscopic remission as time-bound treatment targets, with quality of life as a long-term goal. Although histologic remission (HR) is linked to improved outcomes, its clinical utility remains limited by uncertainty regarding its relationship with outcomes and the optimal biopsy strategy. Among available histologic scores, Nancy Histological Index (NHI) is the most simple and pathologist-friendly design but no prospective study has demonstrated the prognostic value of NHI in clinical remission status. Aims: This study aimed to clarify the role of NHI and determine optimal biopsy locations for consistent histologic assessment in ulcerative colitis (UC) in clinical remission. Methods: Adult UC patients in clinical remission—partial Mayo score <3 with no subscore >1 for ≥ 3 months—were prospectively enrolled between February and November 2024 across three hospitals. Biochemical remission was defined as fecal calprotectin <100 μg/g and C-reactive protein <1 mg/dL. Endoscopic remission (ER) was defined as MES ≤1 in all segments, and strict ER (ERs) as MES = 0. Patients achieving ER received two biopsies per segment of colon, targeting MES 1 lesions when present, scar tissue when MES 0, or random sites otherwise. Six blinded pathologists independently graded all specimens using NHI. HR was defined as NHI ≤1 and strict HR (HRs) as NHI = 0. Composite adverse events included treatment escalation, corticosteroid use, early/emergency visits, hospitalization, or surgery. ROC analysis compared 4 biopsy strategies: sigmoid–rectal biopsies only (NHI-SR), ascending–sigmoid–rectal biopsies (NHI-ASR), worst NHI across segments (NHI-worst) and the segment with highest MES (NHI-MES).
Results: Among 78 enrolled patients, 77 underwent colonoscopy; 59 (76.6%) achieved ER, including 29 (37.7%) with ERs. Of those with ER, HR was present in 49 (83.1%) and HRs in 10 (16.9%). Median follow-up was
17.5 months. Patients with ER had fewer adverse events, with clear separation among MES 0, MES 1, and MES >1 (P = 0.028). HR was also associated with improved outcomes, demonstrating longer event-free duration (P = 0.045). When combining endoscopic and histologic features, ER+/HR–and ER– groups showed higher adverse event rates than those achieving HR (P = 0.023). ROC analysis showed that NHI-worst and NHI-MES provided the best discrimination, NHI-ASR performed modestly, and NHI-SR was poorest (P = 0.005). Using only sigmoid–rectal biopsies yielded ~10% misclassification (6/59).
Conclusions: To our knowledge, this is the first prospective study to demonstrate that NHI-based histological remission was associated with favorable outcomes in UC patients with clinical remission. Distal-only biopsy strategies were inadequate, supporting the need for comprehensive sampling to accurately assess histologic activity.
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胃腸道基質瘤中腫瘤大小相關之風險分層與 部位別效應差異：單一中心癌症登錄研究 (2009–2025)
TUMOR SIZE–DEPENDENT RISK STRATIFICATION AND SITESPECIFIC EFFECT MODIFICATION IN GASTROINTESTINAL STROMAL TUMORS: A SINGLE-CENTER CANCER REGISTRY STUDY (2009–2025)
鍾事達1,2 鍾悦仁1 梁志明1 邱紹銘1 蘇輝明1 吳鎮琨1 邱逸群1 1 長庚醫療財團法人高雄長庚紀念醫院 胃腸肝膽科系 2 高雄市立鳳山醫院（委託長庚醫療財團法人經營）
Background: Surveillance and treatment decisions for gastrointestinal stromal tumors (GISTs) are frequently guided by tumor size and anatomic origin, yet realworld data describing how these factors jointly relate to pathologic stage are limited.
Aims: The aim of our study is to investigate the associations of tumor size group and primary tumor site with advanced pathologic stage, and evaluated whether the site effect varies across tumor size strata.
Methods: We performed a retrospective analysis of the Kaohsiung Chang Gung Memorial Hospital cancer registry (2009–2025). Among 525 registry-identified patients, 129 were excluded due to incomplete clinical data, leaving 396 eligible cases. Tumor size groups were defined as G1 (≤2.0 cm), G2 (2.1–5.0 cm), G3 (5.1–10.0 cm), and G4 (≥10.1 cm). Advanced pathologic stage was defined as stage 3A/3B/4 (binary outcome). Primary site was categorized as stomach (ICD-O-3 C16x; C168 recoded to C169), small intestine (C17x), rectum (C20x/C209), and peritoneum/ retroperitoneum (C48x). We compared clinicopathologic characteristics across tumor size groups. Multivariable logistic regression was used to identify factors associated with advanced stage, including tumor size group, primary site, age, and sex. Effect modification by primary site was assessed using tumor size group–by–site interaction models and stratified adjusted odds ratios (aORs).
Results: Of 396 patients, tumor size distribution was G1: 94 (23.7%), G2: 141 (35.6%), G3: 101 (25.5%), and G4: 60 (15.2%). Advanced stage prevalence increased stepwise with tumor size (G1: 3.2%; G2: 9.9%; G3: 55.4%; G4: 90.0%; p<0.001). Primary site distribution differed by tumor size group (p<0.001), with decreasing gastric predominance as size increased (G1: 88.3% stomach vs
G4: 55.0% stomach) and higher representation of nongastric sites in larger tumors. In multivariable analysis, tumor size remained the dominant predictor of advanced stage: compared with G1, G3 had aOR 52.25 (95% CI 11.88–229.74; p<0.001) and G4 had aOR 317.33 (95% CI 60.19–1673.11; p<0.001); G2 showed a non-significant increase (aOR 3.44; p=0.115). Small-intestinal origin was independently associated with advanced stage versus stomach (aOR 3.34; 95% CI 1.53–7.32; p=0.003), whereas age and sex were not significant. Interaction analyses demonstrated significant effect modification for small intestine versus stomach across tumor size groups (p for interaction <0.001), while interactions for rectum and peritoneum/retroperitoneum were not significant; estimates for rarer sites were imprecise due to sparse strata.
Conclusions: In this large single-center registry cohort, tumor size showed a strong, graded association with advanced pathologic stage, and small-intestinal origin conferred additional risk independent of size. The site effect differed by tumor size for small intestine versus stomach, supporting a size-dependent, site-aware approach to risk stratification and clinical decision-making in GIST.
發炎性腸道疾病患者的帶狀疱疹風險與藥物 治療：一項全國性世代研究 HERPES ZOSTER RISK AND PHARMACOLOGIC TREATMENT IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A NATIONWIDE COHORT STUDY
蔡孟蓉1 郭泰宏2 周仁偉3 賴香君1 吳宜樺3 黃柏儒3 鄭庚申3 1 中國醫藥大學中醫學系 2 中國醫藥大學附設醫院教學部 3 中國醫藥大學附設醫院消化醫學中心
Background: Patients with inflammatory bowel disease (IBD) are known to have an increased risk of herpes zoster (HZ), largely attributed to immune dysregulation and the use of immunosuppressive therapies. With the expanding use of immunomodulators, biologic agents, and combination treatment strategies, the clinical landscape of IBD management has evolved substantially. However, how the risk of HZ changes over time following IBD diagnosis, and how different contemporary treatment regimens influence this risk, remains incompletely understood. A clearer understanding of these temporal patterns and medication-specific effects is essential to inform preventive strategies and optimize clinical care.
Aims: This study aimed to quantify the time-dependent risk of herpes zoster following a diagnosis of inflammatory bowel disease and to evaluate the associations between HZ risk and commonly used immunosuppressive treatments. We specifically sought to examine how the risk of HZ varies across different follow-up periods after IBD diagnosis and to assess the independent and combined effects of corticosteroids, immunomodulators, biologic agents, and combination therapy. By identifying high-risk periods and treatment-related risk factors, we aimed to provide evidence to support targeted prevention strategies, including early vaccination, in patients with IBD.
Methods: We conducted a nationwide, population-based cohort study using data from Taiwan’s National Health Insurance Research Database spanning 2000 to 2021. Patients newly diagnosed with inflammatory bowel disease were identified and propensity score–matched at a 1:4 ratio with individuals without IBD based on sex, age, and index year. Participants were followed from the index date until the occurrence of herpes zoster, death, withdrawal from insurance, or the end of the study period. Cox proportional
hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals for the association between IBD and HZ. Time-dependent analyses were performed to evaluate changes in risk across different follow-up intervals. Medication exposures, including 5-aminosalicylic acids, corticosteroids, immunomodulators, biologic agents, and combination therapy, were treated as time-varying covariates. Corticosteroid exposure was further categorized by average annual dose to explore dose–response relationships. Models were adjusted for demographic factors, comorbidity burden, and geographic region.
Results: The final matched cohort consisted of 51,132 patients with IBD and 204,528 non-IBD controls. Overall, IBD was associated with a significantly increased risk of herpes zoster (aHR 1.53, 95% CI 1.38–1.70). The excess risk was time-dependent, with the highest incidence observed within the first three years following IBD diagnosis. Use of immunomodulators, biologic agents— particularly anti–tumor necrosis factor–α therapies— high-dose corticosteroids, and combination therapy independently increased the risk of HZ, with combination regimens conferring the greatest hazard. A dose–response relationship was observed for corticosteroids: high-dose exposure (≥135 mg/year of prednisolone equivalent) significantly increased HZ risk, whereas low-to-moderate doses were associated with a lower observed risk, likely reflecting confounding by indication. Additional factors associated with increased HZ risk included advanced age, higher comorbidity burden, and residence in eastern Taiwan and offshore islands.
Conclusions: Patients with inflammatory bowel disease face a substantially elevated and dynamic risk of herpes zoster, particularly during the early period following diagnosis. Immunosuppressive treatments, especially combination therapy and high-dose corticosteroid use, further amplify this risk. These findings highlight the importance of early risk stratification and proactive prevention strategies in IBD management. Integrating herpes zoster vaccination at or shortly after IBD diagnosis, particularly for patients anticipated to receive intensive immunosuppression, may represent a critical step toward reducing preventable infectious complications in this vulnerable population.
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發炎性腸道疾病患者治療後活動性結核病之 發生率：一項全國性回溯性世代研究 INCIDENCE OF ACTIVE TUBERCULOSIS AFTER TREATMENT IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A NATIONWIDE RETROSPECTIVE COHORT STUDY IN TAIWAN
陳季襄1 賴香君2 吳美瑤1 陳子力1,3 林恒君4 呂冠恩5 吳宜樺6 黃柏儒6 鄭庚申6 周仁偉2.6*
1 中國醫藥大學附設醫院中醫部
2 中國醫藥大學中醫學系
3 中國醫藥大學附設醫院身心介面研究與健康中心
4 中國醫藥大學附設醫院臨床試驗中心統計分析組 5 秀傳醫療財團法人彰濱秀傳紀念醫院中醫部 6 中國醫藥大學附設醫院消化醫學中心
Background: Inflammatory bowel disease (IBD) is associated with an increased risk of tuberculosis (TB), which may be influenced by medications used in IBD treatment.
Aims: This study aimed to investigate the association between IBD and the risk of active TB, and to evaluate how this risk is affected by IBD medications.
Methods: We conducted an observational study using population-based insurance claims data from the Taiwan National Health Insurance Research Database (2001–2020). The study included 38,444 patients with IBD and 38,444 matched controls without IBD. Exploratory analyses were performed to assess the association between IBD and active TB risk, as well as the impact of prescribed medications on TB risk in IBD patients.
Results: The incidence of active TB was higher in IBD patients than in matched non-IBD controls (336 vs. 239 per 1000 person-years). The adjusted hazard ratio for TB in IBD patients compared to non-IBD controls was 1.28 (95% CI: 1.09-1.52).
Among IBD patients, adalimumab use was associated with an increased risk of active TB compared to untreated IBD patients (adjusted HR 2.52, 95% CI: 1.19-5.36). In contrast, methylprednisolone and dexamethasone use were associated with a reduced risk of active TB compared to untreated IBD patients (adjusted HR 0.63, 95% CI: 0.43-0.95 and 0.58, 95% CI: 0.39-0.85, respectively).
Conclusions: Our findings suggest that IBD is associated with an elevated risk of active TB, particularly among patients treated with adalimumab. Conversely, corticosteroid use, specifically methylprednisolone and dexamethasone, was associated with a significantly lower risk of active TB in this population.
GLP-1 受體促效劑與 DPP-4 抑制劑在接受
胃造瘻術的第二型糖尿病患者的胃腸道安全 性比較：一項多中心世代研究
GASTROINTESTINAL SAFETY OF GLP1 RECEPTOR AGONISTS VERSUS DPP4 INHIBITORS IN PATIENTS WITH TYPE 2 DIABETES UNDERGOING GASTROSTOMY: A MULTIINSTITUTIONAL COHORT STUDY
陳忠宏 彰濱秀傳紀念醫院
Background: GLP-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising safety concerns regarding ulcers and motility in frail patients undergoing percutaneous endoscopic gastrostomy (PEG). Comparative evidence in this population remains limited.
Aims: To compare the risks of gastric ulcer, ileus, and constipation associated with GLP-1 RAs versus DPP4 inhibitors in a real-world cohort of patients with gastrostomy.
Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network spanning 2015–2024. Adult patients with type 2 diabetes who underwent PEG placement were propensity score–matched 1:1 to new users of DPP-4 inhibitors based on demographics, comorbidities, medications, and laboratory values. Kaplan–Meier analyses and Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for gastrointestinal outcomes.
Results: After matching, 337 patients were retained in each group with well-balanced baseline characteristics. GLP1 RA use was not associated with a significantly increased risk of gastric ulcer (HR 1.06, 95% CI 0.48–2.32) compared with DPP-4 inhibitors. Regarding motility outcomes, the GLP-1 RA group showed a non-significant trend toward lower risks for ileus/gastroparesis (HR 0.65, 95% CI 0.40–1.06) and constipation (HR 0.87, 95% CI 0.64–1.16), suggesting no signal of harm regarding gastrointestinal motility.
Conclusions: Among complex patients with gastrostomy requiring glucose-lowering therapy, GLP-1 RAs demonstrated a gastrointestinal safety profile comparable to DPP-4 inhibitors. These findings suggest that the gastric slowing effects of GLP-1 RAs do not translate into increased adverse events, supporting their use as a reasonable option in this high-risk population.
主題：病毒性肝炎（二）
與貝樂克相比，慢性 B 型肝炎 E 抗原陽性 患者在停用韋立得後的復發率較高；但與惠 立妥相比則無此差異
HIGHER RELAPSE RATE IN HBEAGPOSITIVE PATIENTS AFTER CESSATION OF TENOFOVIR ALAFENAMIDE COMPARED TO ENTECAVIR, BUT NOT TENOFOVIR DISOPROXIL FUMARATE
萬冠宏1 陳建宏1 彭成元2 胡琮輝1 王景弘1 洪肇宏1 盧勝男1
1 高雄長庚紀念醫院 胃腸肝膽科系
2 中國醫藥大學附設醫院 消化內科
Background: There is limited information comparing the off-therapy relapse rates of patients discontinued tenofovir alafenamide (TAF) to those stopping entecavir or tenofovir disoproxil fumarate (TDF) in HBeAg-positive patients.
Aims: To compare the rate of HBV relapse after cessation of entecavir, TDF or TAF therapy in HBeAg-positive patients.
Methods: A total of 408 HBeAg-positive patients without cirrhosis receiving entecavir (n=200), TDF (n=126) or TAF (n=82) were enrolled. All patients underwent post-treatment follow-up for at least 6 months and fulfilled Taiwan’s National Health Plan stopping criteria for antiviral therapy, which are HBeAg loss or seroconversion with undetectable HBV DNA maintained for at least 12 months. Propensityscore (PS) matching method was applied to eliminate the significant differences in clinical characteristics.
Results: The cumulative incidences of virological relapse, clinical relapse and retreatment at 96 weeks were higher in the off-TAF group (88.3%, 69.1% and 67.7%, respectively) than that in the off-entecavir group (52%, 41.6% and 33.9%, respectively) (all: p<0.001) and that in the off-TDF group (71.8%, 59.1% and 51.9%, respectively) (p=0.124, p=0.037, p=0.006, respectively). The median time to clinical relapse was much earlier for off-TAF patients than for off-entecavir or off-TDF (median: 17, 43 and 24 weeks, respectively). Multivariate analysis indicated that TAF therapy was an independent risk factor for virological relapse, clinical relapse and retreatment when compared to entecavir, but not TDF therapy, and and these findings persisted even after PS matching. HBsAg level at EOT was an independent factor of virological and HBV genotype C and HBsAg level at EOT were independent factors of clinical relapse, in the off-TAF group. There was no significant difference in the severity of ALT flare
and hepatic decompensation rate upon clinical relapse among the entecavir, TDF and TAF groups. However, among patients with clinical relapse, the off-TAF group had a higher rate of HBeAg reversion (80%) than the offentecavir group (51.0%, p = 0.003) and the off-TDF group (57.0%, p = 0.018.)
Conclusions: There is an earlier and higher HBV relapse rate in patients who discontinue TAF therapy than in comparable patients discontinuing entecavir, but not TDF therapy. Close monitoring is necessary after TAF or TDF withdrawal, particularly in the first 3 months in HBeAgpositive patients.
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慢性 B 型肝炎治療中肝細胞癌的治療期預 測因子：在 APA-B 分數之外，代謝功能障 礙相關脂肪性肝病、脂肪性肝病與糖代謝異 常的獨立影響有限 ON-TREATMENT PREDICTORS OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS B: LIMITED INDEPENDENT IMPACT OF MASLD, STEATOTIC LIVER DISEASE, AND DYSGLYCEMIA BEYOND THE APA-B SCORE
王鴻偉1,2 賴學洲1,3 許偉帆1,3 陳昇弘1,2 張育瑞1 顏子皓1 彭成元1,2
1 中國醫藥大學附設醫院內科部消化醫學中心
2 中國醫藥大學醫學系
3 中國醫藥大學中醫學系
Background: Chronic hepatitis B (CHB) continues to drive hepatocellular carcinoma (HCC) risk despite nucleos(t) ide analogue (NA) therapy. The on-treatment APA-B score (age, platelets, AFP at 12 months of treatment) predicts HCC in entecavir-treated Asian cohorts, but MASLD and dysglycemia may alter this risk. We investigated whether MASLD, SLD, and prediabetes/diabetes add prognostic value beyond APA-B in real-world CHB patients.
Aims: To evaluate the role of MASLD, SLD and dysglycemia in predicting HCC development in patients with CHB on NA treatment.
Methods: We analyzed 1,012 CHB patients with data at baseline and 12 months of treatment. MASLD, SLD, and prediabetes/diabetes status were recorded. Baseline and 12-month clinical profiles were compared by MASLD status. Incident HCC was the outcome. Cox proportional hazards models evaluated baseline and 12-month predictors with multivariable adjustment, reporting hazard ratios (HRs) with 95% confidence intervals (CIs) and p values.
Results: Among 1,012 patients, 561 had MASLD and 451 did not. Patients with MASLD were more often male (74.9% vs 63.6%, p <0.001) and more frequently had prediabetes/diabetes (39.4% vs 17.7%, p <0.001); HBeAg status, age, and HBV DNA levels were comparable. At baseline, MASLD was associated with lower AST (63 vs 76 U/L, p = 0.001), higher platelet count (173 vs 164 ×103/ µL, p = 0.011), and lower AFP (4.92 vs 5.44 ng/mL, p = 0.036). At 12 months of treatment, ALT (28 vs 24 U/L, p <0.001) and platelet count (181 vs 164 ×103/µL, p <0.001) were higher in the MASLD group. During a median
treatment duration of 60 months, HCC occurred in 3.3% of patients with MASLD versus 8.9% without MASLD (p = 0.086). Age and platelet count were independent predictors of HCC both at baseline (aHR 1.037 per year; aHR 0.990 per 103/µL) and 12 months of treatment (aHR 1.048 per year; aHR 0.985 per 103/µL). AFP was an independent predictor of HCC at 12 months of treatment (aHR 1.015, p <0.001). MASLD was not independently associated with HCC at baseline (adjusted HR [aHR] 0.688; p = 0.123) or at 12 months of treatment (aHR 0.787; p = 0.443). In the baseline model, prediabetes/diabetes increased HCC risk (aHR 1.616, p = 0.045) whereas SLD reduced HCC risk (aHR 0.591, p = 0.036). However, neither factor was an independent predictor of HCC in the 12-month model. APA-B demonstrated significantly higher discrimination than the baseline model (AUC 0.824 vs 0.757, p = 0.004), indicating its superior discriminatory performance for predicting HCC.
Conclusions: In this CHB cohort, MASLD was common and associated with distinct metabolic and laboratory profiles, yet it was not independently linked to incident HCC in the baseline or 12-month multivariable model. HCC risk was driven primarily by age and platelet count with 12-month AFP providing additional prognostic value. Prediabetes/diabetes and SLD showed baseline associations that attenuated after on-treatment reassessment.
61
血清 HBV RNA 與 HBCRAG 作為慢性 B 型
肝炎治療起始需求及停藥後預後之預測因子 SERUM HBV RNA AND HBCRAG AS PREDICTORS OF TREATMENT INITIATION REQUIREMENTS AND POST-CESSATION OUTCOMES IN CHRONIC HEPATITIS B
齊振達1,2 李懿宬1 李沛璋1 李杰如1,2 黃怡翔1,2,3
1 臺北榮民總醫院胃腸肝膽科
2 國立陽明交通大學臨床醫學研究所
3 臺北榮民總醫院醫學研究部
Background: Hepatitis B core-related antigen (HBcrAg) and serum HBV RNA are emerging biomarkers for hepatitis B virus (HBV) infection. However, the clinical utility of these markers in predicting the necessity of nucleos(t)ide analogue (NUCs) therapy and the risk of relapse following treatment discontinuation remains to be validated within the Taiwanese population.
Aims: We aimed to evaluate the utility of these novel biomarkers in predicting both the requirement for NUCs initiation and the risk of clinical relapse following treatment discontinuation.
Methods: Between November 2020 and September 2023, we prospectively enrolled 133 treatment-naïve patients with CHB (Cohort 1) and 45 NA-treated patients who met the Taiwan National Health Insurance criteria for treatment cessation (Cohort 2). We evaluated the correlations between various biomarkers, including qHBsAg, HBcrAg, and HBV RNA, and analyzed the predictors for treatment eligibility within two years for Cohort 1 and off-therapy relapse for Cohort 2. HBV RNA was measured using the Roche cobas® assay (detection limit: >10 cp/mL).
Results: The mean age was 53.4 years in Cohort 1 and 58.9 years in Cohort 2. Regarding HBeAg status, 132 of 133 (99.2%) patients in Cohort 1 were HBeAg-negative, whereas 13 of 45 (28.9%) patients in Cohort 2 were HBeAg-positive. In patients without antiviral therapy (Cohort 1), HBV RNA was strongly correlated with HBV DNA (r = 0.785, p < 0.001) and moderately correlated with HBcrAg (r = 0.625, p < 0.001) and qHBsAg (r = 0.480, p < 0.001). Conversely, in Cohort 2 at the end of treatment (EOT), HBV RNA showed no significant correlation with other biomarkers (HBV DNA, HBcrAg, qHBsAg), likely due to viral suppression. During a median followup of 37.7 months, 11 (8.3%) HBeAg-negative patients in Cohort 1 met the criteria for antiviral therapy within 2
years. Baseline HBV RNA ≥ 2 log copies/mL and HBcrAg ≥ 4 log U/mL were identified as independent risk factors for requiring NUCs treatment. In Cohort 2, during a median follow-up of 21.2 months post-discontinuation, 36 (80%) patients experienced virological relapse and 31 (68.9%) experienced clinical relapse. Virological relapse was associated with HBV RNA ≥ 2 log copies/mL at EOT and off-treatment month 3) and HBcrAg ≥ 4 log U/mL at month 3. Clinical relapse was associated with HBcrAg ≥ 4 log U/mL at EOT and month 3, and HBV RNA ≥ 2 log copies/mL at month 3, both performed better than qHBsAg. Longitudinal analysis showed that in patients who experienced virological or clinical relapse, HBV RNA and HBcrAg levels rebounded rapidly and substantially after cessation.
Conclusions: Serum HBV RNA and HBcrAg represent critical biomarkers for predicting the necessity of antiviral therapy in treatment-naïve patients and the risk of relapse following NUCs cessation. While elevated HBV RNA levels at the end of treatment (EOT) serve as a superior predictor of virological relapse, HBcrAg demonstrates higher predictive value for clinical relapse. These findings highlight the complementary roles of these biomarkers in the optimized management of CHB.
62
慢性 C 肝患者其 BMI 與預後之關聯性分析
ASSOCIATION
BETWEEN BODY MASS INDEX AND PROGNOSIS
IN PATIENTS WITH CHRONIC HEPATITIS C
江偉廷 江祉毅 黃彼得 童綜合醫院胃腸肝膽科
Background: The advent of direct-acting antivirals (DAAs) has dramatically improved sustained virologic response (SVR) rates in patients with chronic hepatitis C virus (HCV) infection. Nevertheless, long-term prognosis after viral eradication remains heterogeneous. While advanced fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) are well-established predictors of adverse outcomes, the role of body mass index (BMI) in long-term prognosis after HCV diagnosis or treatment remains controversial. Obesity and metabolic dysfunction are increasingly recognized as contributors to liver disease progression and hepatocarcinogenesis. However, BMI may act as a surrogate marker rather than an independent risk factor, and its prognostic impact may be confounded by age, malignancy, and baseline liver disease severity. Real-world data examining BMI and long-term outcomes in HCV populations, particularly in Asian cohorts, remain limited. Aims: To evaluate whether baseline body mass index is independently associated with long-term prognosis— defined as all-cause mortality or terminal discharge—in patients diagnosed with chronic hepatitis C.
Methods: This retrospective cohort study included patients diagnosed with chronic hepatitis C between January 1, 2017, and December 31, 2024, using an institutional clinical database. Patients were included if baseline BMI data were available.The primary outcome was a composite endpoint of in-hospital mortality or terminal discharge. Patients without events were censored at December 31, 2024. Time-to-event analyses were performed using Cox proportional hazards regression. Hazard ratios (HRs) with 95% confidence intervals (CIs) were reported. Statistical significance was defined as a two-sided p value <0.05.
Results: A total of 853 patients were included, with 95 composite events (11.1%) over a median follow-up of 1,495 days. In multivariable analysis, BMI was not independently associated with the composite outcome (HR per 5 kg/ m² increase: 0.994; 95% CI 0.770–1.283; p=0.962). Similarly, categorical BMI analyses demonstrated no significant differences across BMI strata.
In contrast, age, liver cirrhosis, baseline hepatocellular carcinoma, and baseline extrahepatic malignancy were strongly associated with adverse outcomes, supporting the internal validity of the model. These findings suggest that BMI alone does not independently predict long-term mortality or terminal discharge in patients with chronic hepatitis C. The prognostic impact of BMI may be mediated through metabolic comorbidities or liver disease severity rather than acting as a direct risk factor. Furthermore, the composite outcome used in this study may be driven predominantly by malignancy and advanced liver disease, potentially attenuating BMI-related effects.
Conclusions: In this real-world cohort of patients with chronic hepatitis C, baseline BMI was not independently associated with long-term prognosis as defined by inhospital mortality or terminal discharge. Age, liver cirrhosis, and pre-existing malignancies were the primary determinants of adverse outcomes. Future studies should focus on liver-specific endpoints and metabolic phenotypes to better delineate the role of obesity in post-HCV prognosis.
63
經篩檢檢出慢性 BC 肝病患之全縣可近性定 期追蹤門診：第一年成果 COUNTYWIDE ACCESSIBLE PERIODIC HEPATOLOGY SURVEILLANCE
CLINICS FOR PATIENTS WITH CHRONIC HEPATITIS B AND C IDENTIFIED THROUGH NATIONAL SCREENING: FIRST-YEAR OUTCOMES
張善涵1 呂思妮2 陳伊君2 曾春美2 盧勝男3
1 台大醫院雲林分院 胃腸肝膽科
2 雲林縣政府衛生局
3 高雄長庚紀念醫院 胃腸肝膽科系
Background: Regular surveillance is essential for individuals with chronic hepatitis B or C to enable early detection of hepatitis flares and hepatocellular carcinoma (HCC). Although a national hepatitis B and C screening program has been in place since 2011 and further expanded in 2020, a standardized approach for long-term viral activity monitoring and HCC surveillance has not been established.
Aims: To assess the feasibility and first-year outcomes of a countywide accessible hepatology surveillance clinic model in Yunlin County.
Methods: Nineteen of 20 townships participated. The Yunlin Public Health Bureau obtained a registry of individuals positive for HBsAg or anti-HCV from the Health Promotion Administration. Public health nurses contacted eligible individuals and invited those not undergoing regular surveillance to annual communitybased clinics. Participants received blood testing (AST, ALT, AFP, and PIVKA-II) and non-fasting abdominal ultrasonography. HCV RNA testing was performed for anti-HCV–positive participants without prior confirmation. Referrals were arranged for those with detectable HCV RNA, HBsAg positivity with ALT >80 IU/mL, or suspected focal liver lesions.
Results: A total of 522 individuals enrolled (215 men, 307 women); 44.3% were aged 50–64 years. Among 153 antiHCV-positive participants, 4 (2.5%) had HCV viremia. Among 394 HBsAg carriers, 6 (1.5%) had elevated ALT >80 IU/ml. Focal liver lesions were detected in 19 individuals; 4 (0.76%) were diagnosed as HCC. The sensitivity & specificity of AFP (>9 ng/ml) and PIVKA II (>40 mAU/ml) were 25.0% & 99.6% and 50.0% and 98.1%, respectively. Two were diagnosed at early stage and underwent local ablation, one intermediate-stage
case received transcatheter arterial embolization, and one advanced-stage case received palliative care.
Conclusions: This countywide community-based hepatology surveillance model demonstrated feasibility and facilitated meaningful early detection, supporting its potential as a framework for national long-term postscreening surveillance.
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在 C 型肝炎流行區域，以盛行率導向的抗 HCV 篩檢結合反射式 HCV 抗原檢測於慢性 C 型肝炎患者
PREVALENCE-GUIDED ANTI-HCV AND REFLEX HCV AG TESTING IN THE DETECTION OF PATIENTS WITH CHRONIC HEPATITIS C IN HEPATITIS C ENDEMIC AREAS
陳聖學1,2 丁元捷3,4 許念慈5 張德生3 林裕珍6 趙紋華6 盧勝男7
1 高雄長庚紀念醫院 醫學教育委員會
2 桃園長庚大學 醫學院
3 嘉義長庚紀念醫院 胃腸肝膽科
4 台中大里仁愛醫院 胃腸肝膽科
5 高雄長庚紀念醫院 生物統計暨生物資訊中心
6 嘉義縣政府 衛生局
7 高雄長庚紀念醫院 胃腸肝膽科
Background: Chronic hepatitis C virus (HCV) remains a major public health concern in Taiwan, particularly in southern regions with high endemicity. While HCV elimination is a national priority, resources are often limited. Relying solely on broad, township-level prevalence rates is inefficient, as the true disease burden can vary dramatically at the village level. Therefore, identifying local hotspots through fine-scale mapping is critical for efficient resource allocation and targeted intervention.
Aims: This study aimed to validate village-level prevalence estimates and evaluate the efficiency of a communitybased, targeted screening approach utilizing this detailed prevalence data in Chiayi County.
Methods: We integrated data from the Chiayi Health Bureau and Chiayi Chang Gung Memorial Hospital (2000–2015) to generate village-level risk maps for five townships: Lioujiao (LJ), Yijhu (YH), Dongshih (DS), Taibao (TB), and Lucao (LC). Between 2018 and 2021, we conducted door-to-door community screening using antiHCV testing with reflex HCV antigen (Ag) testing. AntiHCV/HCV Ag prevalence, number needed to test (NNT), and linkage-to-care rates were calculated to validate prevalence estimates and assess screening efficiency.
Results: Among 3910 participants, anti-HCV prevalence ranged from 5.4% (TB) to 8.7% (DS). Estimated and observed village-level prevalence showed moderate-tostrong correlation (r = 0.696–0.830, p < 0.001). Screening efficiency was highest in DS (NNT = 21) and lowest in TB (NNT = 42). Of 132 antigen-positive individuals, 131
(99.2%) initiated direct-acting antiviral therapy. Conclusions: The village-level risk maps accurately predicted local HCV burden, enabling targeted screening with high diagnostic yield and near-complete treatment uptake. This approach maximizes resource efficiency and may serve as a scalable model for advancing Taiwan and the WHO’s 2030 HCV elimination goals.
主題：其他消化道疾病（二）
耐性乳酸菌對於氫離子阻斷劑所致腸道症狀 的影響
THE EFFECTS OF ANTIBIOTICSRESISTANT LACTIC ACID BACTERIAE IN PPI RELATIVE GASTROINTESTINAL SYMPTOM
許文鴻1,2 翁碧娟1 李易諶1 郭昭宏2,3
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄秀傳紀念醫院腸胃內科
Background: Helicobacter pylori is one of the important causes of digestive diseases. Lactic acid bacteria (LACBs) are among the earliest and most extensively studied probiotics used in medicine. They help metabolize carbohydrates and produce lactic acid to maintain a slightly acidic intestinal environment, thereby promoting gut microbiota balance and health, and helping to maintain digestive function. Antibiotic-resistant lactic acid bacteria (Biofermin-R) exhibit high resistance to various antibiotics and are expected to increase the colonization rate after probiotic use, thus enhancing the efficacy of LACBs.
Aims: Evaluate the effects of antibiotics-Resistant Lactic acid Bacteriae in proton-pump-inhibitor and Helicobacter pylori eradication associated gastrointestinal dysbiosis, diarrhea and gastrointestinal dysfunction.
Methods: Fifty-seven participants were recruited and randomly selected from those assessed by a gastroenterologist as needing treatment for Helicobacter pylori eradication therapy (amoxicillin, clarithromycin, metronidazole) and proton pump inhibitors for conditions such as acid reflux and peptic ulcers. Forty-two patients received Biofermin-R treatment as the experimental group, taking three packets (1g/packet) daily at 8 AM, 12 AM, and 6 PM for four consecutive months. Another 15 patients did not receive Biofermin-R treatment as the observation group, receiving no additional medication (including other probiotics). During the fourmonth follow-up, disease improvement, stool pattern (Bristol stool score), and bowel movement frequency were recorded in both groups. After completing the four-month treatment, Helicobacter pylori eradication was assessed using gastroscopy or a carbon-13 breath test.
Results: The side effects of the medication were recorded throughout the trial. The percentage of patients experiencing side effects was 11.9% (5/42) in the experimental group and 80% (12/15) in the control group. The side effects
of antibiotics in the control group were more than 6.5 times higher than those in the experimental group. This means that taking Bifidobacterium-R concurrently with antibacterial drugs can significantly reduce the side effects of antibiotics. The UBT test is commonly used in clinical practice as the basis for determining whether sterilization is successful. The final UBT negative rate in the experimental group was 95.2% (40/42), while the final UBT negative rate in the control group was 73.3% (11/15). The experimental group had a higher sterilization effect than the control group.
Conclusions: Bifemin R can alleviate diarrhea or gastrointestinal discomfort caused by antibiotic treatment for Helicobacter pylori and improve the eradication rate. This significant reduction in side effects can indirectly improve patient compliance in clinical practice. Future similar studies should include antibiotic susceptibility analysis of the strain in the testing program, which may further enhance the analysis of the reasons for eradication failure in a small number of patients.
66
跨物種粒線體轉移對黑色素瘤惡性表型的調 節作用之研究
MODULATING MELANOMA
AGGRESSIVENESS VIA INTERSPECIES MITOCHONDRIAL TRANSPLANTATION
郭晟銘1 郭富珍2 施翔耀1 劉忠榮1 黃斌3 吳登強1,4
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 義守大學學士後醫學系
3 高雄醫學大學生物醫學暨環境生物學系
4 高雄醫學大學醫學系
Background: Mitochondrial transplantation is an emerging therapy for cancer and tissue repair, yet sourcing sufficient healthy mitochondria remains a significant challenge. This study investigates the viability of interspecies mitochondrial transplantation to address this limitation, specifically within the context of melanoma. Recognizing the metabolic influence of the tumor microenvironment, researchers transplanted mitochondria isolated from healthy keratinocytes and endothelial cells (both human and mouse) into human and mouse melanoma cell lines.
Aims: The study evaluates how these cross-species transplants affect malignancy by analyzing changes in mitochondrial morphology, ATP production, epithelialmesenchymal transition (EMT), and invasive capability, offering new insights into cancer regulation.
Methods: Human (A375) and mouse (B16F10) melanoma cells received mitochondria isolated from healthy human and mouse keratinocytes and endothelial cells. Transplantation efficiency was verified using flow cytometry and confocal microscopy. To assess the therapeutic impact, the study employed wound healing and transwell assays for migration and invasion, alongside MTT assays for viability. Physiological changes were measured via ATP levels, ROS generation, and mitochondrial membrane potential. Additionally, Western blotting analyzed protein markers related to epithelial-mesenchymal transition (EMT), signaling pathways, and mitochondrial dynamics to elucidate underlying molecular mechanisms.
Results: We successfully transplanted mitochondria from four donor cell types into human (A375) and mouse (B16F10) melanoma cells. Notably, mitochondria from human endothelial cells (HUVEC) uniquely retarded migration in B16F10 cells. Once internalized, HUVEC mitochondria altered B16F10 mitochondrial morphology to a dysfunctional globular state, significantly reducing ATP production, membrane potential, and fission
proteins. Furthermore, this transplantation suppressed key malignancy and invasion markers (TGF-β, NANOG, N-cadherin) while elevating ROS levels and cell death. Thus, HUVEC-derived mitochondria effectively impaired the bioenergetics and tumorigenicity of mouse melanoma cells.
Conclusions: Validating interspecies transplantation, this study demonstrates that human endothelial (HUVEC) mitochondria effectively suppress mouse melanoma (B16F10) malignancy via endocytosis. This transfer disrupted mitochondrial dynamics and downregulated the TGF-β/EMT signaling pathway. Consequently, tumor invasion was inhibited and ROS-mediated cell death increased, highlighting the therapeutic potential of crossspecies mitochondrial donation in restricting metastasis.
67
台灣 IBD 患者於第一線 VEDOLIZUMAB 治療失效後之臨床預後研究
CLINICAL OUTCOMES AFTER FAILURE OF VEDOLIZUMAB AS FIRST LINE TREATMENT IN INFLAMMATORY BOWEL DISEASE PATIENTS IN TAIWAN.
邱正堂1,2,3,4,6
1 林口長庚醫院 肝膽胃腸科
2 長庚大學醫學系
3 長庚微菌中心
4 林口長庚紀念醫院發炎性腸道疾病中心
5 新北市立土城醫院 肝膽胃腸科
6 台灣腸道醫學會
Background: Vedolizumab (VDZ), a gut-selective antiintegrin biologic, has been increasingly utilized as first-line therapy for moderate-to-severe inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD).
Aims: This study aimed to assess real-world outcomes and clinical effectiveness of first-line VDZ and second-line biologics following VDZ failure in Taiwan.
Methods: This retrospective cohort study included 121 biologic-naïve IBD patients treated with VDZ as the first-line therapy between 2017 and 2023. Patients with VDZ failure were analyzed for outcomes of second-line biologics, including anti-TNFα agents and ustekinumab (UST). Clinical response (CRS), clinical remission (CRM), and drug persistence were assessed.
Results: For first-line VDZ treatment, 74.7% of UC and 73.9% of CD patients achieved CRS, whereas 61.3% of UC and 54.3% of CD patients achieved CRM at 30-week. The 52-week drug persistence rates were 70.7% and 69.6% for UC and CD, respectively. Among VDZ non-responders, no significant differences in CRS, CRM, safety profile, or drug persistence were observed between anti-TNFα and UST as second-line treatment.
Conclusions: VDZ demonstrated high efficacy and persistence as a first-line biologic for IBD. Both anti-TNFα and UST were effective second-line options following VDZ failure, with comparable clinical outcomes, safety profiles, and treatment persistence.
臺灣潰瘍性結腸炎患者於疾病活動期與緩解 期之個體內腸道微生物相變化
INTRA-INDIVIDUAL GUT MICROBIOME SHIFTS BETWEEN FLARE AND REMISSION IN TAIWANESE PATIENTS WITH ULCERATIVE COLITIS
陳韻竹1 凃佳宏1 陳彥年3 郭雨庭2 韓明倫2 曾屏輝1
邱瀚模1 吳明賢1 陳介章1
1 台大醫院內科部
2 台大醫院綜合診療部
3 台大醫院癌醫分院內科部
Background: Gut microbial dysbiosis has been linked to inflammatory bowel disease (IBD), but most evidence is based on cross-sectional comparisons that cannot account for high inter-individual variability. Longitudinal data tracking individuals through flare and remission remain limited, particularly in Asian populations. We evaluated intra-individual microbiome dynamics across flare, remission, and long-term remission in ulcerative colitis (UC).
Aims: This study aims to characterize intra-individual gut microbiome dynamics across flare, remission, and longterm remission in Taiwanese patients with ulcerative colitis using longitudinal paired sampling.
Methods: We prospectively enrolled adults with ulcerative colitis (UC) and non-IBD controls at National Taiwan University Hospital between 2018-2023. Baseline demographics, disease extent, medications, and laboratory data were collected, and UC patients were followed longitudinally. Fecal samples were obtained during clinical flare and remission, stored at −80 °C, and used for fecal calprotectin (fCal) and microbiome analysis. UC patients were categorized into flare–remission (FR) and longterm remission (LTR) groups. Flare was defined as new or worsening UC symptoms requiring treatment escalation and/or partial Mayo ≥5; clinical remission as partial Mayo ≤2 with no subscore >1 and no rectal bleeding; LTR as remission maintained ≥12 months without systemic steroids. Fecal DNA underwent 16S rRNA gene sequencing, and reads were processed by QIIME2/ DADA2 with taxonomic assignment using the GTDB database. Alpha/beta diversity and differential abundance analyses were performed in R using MaAsLin3 with FDR correction.
Results: Shannon alpha diversity tended to be higher in controls than in FR and LTR, but without
statistical significance (Kruskal–Wallis p = 0.15). Within FR, diversity trended to increase from flare to remission (Wilcoxon p = 0.53), while LTR remained stable across the two time points. Principal coordinates analysis (PCoA) of Bray–Curtis distances showed distinct community structure among controls, FR and LRT (PERMANOVA p = 0.001). Within FR, paired samples shifted from flare to remission (PERMANOVA p = 0.002), trending toward the control composition. Multivariable linear modeling (MaAsLin3) demonstrated marked disease-activity–associated restructuring of the gut microbiota. In longitudinal modeling of patients transitioning between flare and remission (N=40, with paired samples), remission showed marked increases in SCFA-producing genera (e.g., Blautia (β +8.86) and Monoglobus (β +7.68, p < 0.01), while genus Allisonella remained enriched during flare (β −7.30, p<0.01). Collectively, remission involved selective re-colonization of functional metabolic guilds rather than uniform reversal of flare-associated dysbiosis.
Conclusions: Paired longitudinal sampling reveals intra-individual gut microbiome shifts from flare to remission in UC that are not captured by cross-sectional analysis. Long-term remission showed temporal stability. Microbiota profiles during remission partially converge toward controls, suggesting incomplete restoration of a healthy microbial state. Paired sampling may improve identification of microbiome-based markers of disease activity in UC.
利用自然語言處理與機器學習之多模態電子 病歷資料進行高風險發炎性腸道疾病患者之 自動辨識
AUTOMATED IDENTIFICATION OF HIGH-RISK INFLAMMATORY
BOWEL DISEASE PATIENTS
MULTIMODAL
USING
EMR DATA WITH NLP AND MACHINE LEARNING
陳健良1 陳彥伶2 陳冠至1 鍾承軒1
1 亞東紀念醫院肝膽胃腸科
2 國立陽明交通大學生物醫學資訊研究所
Background: Diagnosing inflammatory bowel disease (IBD) is difficult because no accepted gold standard exists. Prior work using artificial intelligence (AI) and natural language processing (NLP) has largely focused on Western populations and single data modalities.
Aims: We developed a multimodal pipeline to identify patients at high risk of IBD before diagnosis.
Methods: We analyzed pre-diagnostic electronic medical record data from a 1,000-bed university-affiliated medical center in Taiwan, including 821 patients with IBD. A bidirectional encoder representation from transformers–based model extracted clinically relevant terms from narrative visit notes, endoscopy reports, and linked pathology reports. Pathology reports were included only when generated within two weeks after the corresponding endoscopic procedure and were treated as part of the endoscopy encounter. NLP features were combined with one-year cumulative laboratory values and exposure to anti-laxatives. All variables were encoded with positive and negative scoring. We trained an extreme gradient boosting decision tree model using 90 features with an 80/20 train–test split to generate risk scores from 0 to 100. High-risk cases were adjudicated by physicians and considered true positives when referral to gastroenterology or intensified monitoring was warranted.
Results: Before diagnosis, common laboratory testing included hemoglobin (HGB, 36.4%) and white blood cell count (WBC, 32.2%). The most frequent visit-note terms were “colitis” (28.8%), “ulcer” (28.8%), and “mucosa” (23.7%). In pathology reports, “infection” (23.7%) was typically used to exclude IBD (negative score), whereas “inflammation” (23.7%) supported IBD (positive score). Endoscopy reports most often mentioned “ulcer” (21.2%) and “ulcer scar” (10.2%) among predicted high-risk cases. The final model achieved an area under the receiver
operating characteristic (ROC) curve of 0.918 and a specificity of 0.972. In an external cohort of 1,916 patients, 118 were classified as high risk. In pilot deployment, approximately five IBD cases were confirmed monthly, while the model flagged 7–11 patients per month with scores above 90 from October to December; more than 80% were judged clinically actionable by reviewers.
Conclusions: We developed a robust electronic medical record (EMR)–based multimodal NLP and machine learning framework that identifies patients at high risk of IBD before diagnosis, enabling earlier referral and targeted surveillance.
有限療程進階療法對發炎性腸道疾病控制與 復發的影響：台灣單中心研究
IMPACT OF LIMITED-DURATION ADVANCED THERAPY ON DISEASE CONTROL AND RELAPSE IN INFLAMMATORY BOWEL DISEASE: INSIGHTS FROM A TAIWANESE SINGLE-CENTER COHORT
羅際竹1 陳冠至1 蔡建誠3 鍾承軒1,2
1 亞東紀念醫院 腸胃肝膽科
2 元智大學
3 亞東紀念醫院 解剖病理科
Background: Advanced therapies have markedly improved the management of inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), by helping patients achieve and sustain treat-to-targets. However, under Taiwan’s National Health Insurance (NHI) program, these treatments are often required to be discontinued after a fixed duration of one year. The consequences of this time-limited policy on disease relapse remain insufficiently understood.
Aims: This study aimed to assess clinical outcomes and identify predictors of relapse in patients with moderate to severe IBD following the mandated one-year cessation of advanced therapy.
Methods: Adult patients with IBD who received advanced therapy and subsequently discontinued treatment after a limited duration of up to one year, in accordance with NHI regulations, were retrospectively enrolled from a single center in Taiwan between 2014 and 2025. Prior to initiating advanced therapy, all patients were required to complete a 6-month course of conventional treatment. Collected clinical data included demographics, comorbidities, IBD subtype and disease severity, type of advanced therapy used, and details of relapse events and their timing. Treat-to-target outcomes were recorded following each discontinuation of advanced therapy. Predictors of clinical relapses were analyzed using univariate and multivariate Cox regression models, with statistical significance set at p < 0.05.
Results: A total of 64 patients were included in the study (34 with CD and 30 with UC). The mean time to relapse was 11.41 months in CD (relapse rate: 66.9% per personyear) and 12.17 months in UC (relapse rate: 42.4% per person-year). In CD, univariate regression analysis identified both primary (HR 31.65, 95%CI 2.88–347.45;
P=0.005) and secondary (HR 3.00, 95%CI 1.07–8.43; P=0.037) non-response as significant predictors of earlier relapse, whereas achieving an endoscopic response (HR 0.40, 95%CI 0.17–0.91; P=0.028) and mucosal healing (HR 0.25, 95%CI 0.01–0.62; P= 0.003) was associated with a lower relapse risk. Multivariate analysis further confirmed that primary (HR 31.85, 95%CI 1.03–984.30; P=0.048) and secondary (HR 13.00, 95%CI 1.12–150.78; P=0.040) non-response were independently associated with earlier relapse. In UC, univariate analysis showed that secondary (HR 23.01 , 95%CI 3.18–166.58; P=0.002) non-response increased the risk of relapse, while achieving steroidfree remission (HR 0.23, 95%CI 0.06–0.82; P=0.023) was linked to a reduced relapse risk. Multivariate analysis confirmed secondary non-response (HR 39.19, 95%CI 4.19–366.91; P=0.001) as an independent predictor of earlier relapses.
Conclusions: Mandatory discontinuation of advanced therapy after one year was associated with high relapse rates in both CD and UC. Patients who demonstrated primary or secondary non-response to advanced therapies were at substantially greater risk of clinical relapse, indicating that extended maintenance therapy may be warranted for this subgroup.
主題：下消化道疾病（二）
以 POWER BI 即時視覺化績效監測提升胃 腸專科醫師大腸鏡訓練成效 ENHANCING COLONOSCOPY TRAINING IN GASTROENTEROLOGY FELLOWSHIP THROUGH REALTIME VISUALIZED PERFORMANCE MONITORING USING POWER BI
黃奕軒 陳培慈 周益霆 林榮鈞 陳鵬仁 黃天祐 三軍總醫院胃腸科
Background: Colonoscopy is a core competency in gastroenterology (GI) fellowship training. Traditional feedback mechanisms are often retrospective and lack specificity. Power BI, a data visualization tool, was implemented to provide GI fellows with real-time feedback on colonoscopy quality indicators, supporting data-driven, competency-based learning.
Aims: To assess whether a customized Power BI dashboard provides effective realtime feedback that enhances gastroenterology fellows’ understanding of colonoscopy performance and supports competencybased training.
Methods: Seven GI fellows at a tertiary care unit used a customized Power BI dashboard to monitor colonoscopy performance. The dashboard tracked cecal intubation rate, adenoma detection rate (ADR), withdrawal time and bowel preparation quality. Fellows completed a 5-item satisfaction questionnaire using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), including: (1) understanding of performance, (2) identification of learning needs, (3) motivation for self-directed learning, (4) clarity of visual feedback, and (5) likelihood of recommending the tool to others. One open-ended item captured the most helpful dashboard feature. Descriptive statistics analysis was applied.
Results: A total of 1,808 colonoscopy procedures were performed by gastroenterology fellows under the direct supervision of experienced endoscopists from August 2024 to June 2025. The average cecal intubation rate was 97.2%, and the overall adenoma detection rate (ADR) was 51.5%. Regarding bowel preparation quality, 62% of procedures were rated as Good, 5% as Excellent. The overall mean satisfaction score for the Power BI dashboard was 4.63 ± 0.59. The highest-rated item was “Power BI helps me understand my performance” (mean: 4.86 ± 0.38). In openended responses, fellows most frequently cited withdrawal time and ADR visualization as the most useful dashboard features contributing to their learning and performance
improvement.
Conclusions: The Power BI dashboard was well-received, especially on withdrawal time and ADR, supporting datadriven, competency-based endoscopy training.
簡化症狀指標於潰瘍性結腸炎內視鏡緩解之 預測價值
A SIMPLE SYMPTOM-BASED APPROACH TO IDENTIFY ENDOSCOPIC REMISSION IN ULCERATIVE COLITIS
黃稚雯1,2 顏旭亨1 陳洋源1
1 彰化基督教醫院肝膽腸胃科
2 國立台灣大學臨床醫學研究所
Background: Mucosal healing, reflected by endoscopic remission, is a key therapeutic target in ulcerative colitis (UC). However, repeated colonoscopy is invasive, costly, and often impractical in routine clinical practice. Symptombased indices are widely used to guide disease monitoring, but their correlation with true endoscopic remission remains uncertain.
Aims: This study aimed to systematically evaluate the predictive value of symptom scores for endoscopic remission and to construct a simplified nomogram to support clinical decision-making.
Methods: We prospectively analyzed 96 UC patients who underwent a total of 156 colonoscopies with Mayo endoscopic subscore (MES) assessment. Endoscopic remission was defined as MES = 0 (n = 45, 28.8%).
Symptom variables included stool frequency (SF), rectal bleeding (RB), urgency (UD), physician’s global assessment (PGA), and SCCAI. Receiver operating characteristic (ROC) curves were generated to assess discriminative ability, while sensitivity, specificity, and accuracy were calculated for each symptom threshold. Logistic regression identified the most robust predictors, which were incorporated into a simplified heatmap for clinical use.
Results: ROC analysis demonstrated that RB (AUC = 0.743) and PGA (AUC = 0.742) were the most reliable individual predictors of remission, followed by SCCAI (AUC = 0.727). In contrast, SF (AUC = 0.652), UD (AUC = 0.646), and night-time SF (AUC = 0.607) showed limited discriminative performance (Figure 1). Diagnostic accuracy analysis confirmed RB (68.6%) and PGA (66.0%) as the strongest predictors, with high sensitivities of 0.778 and 0.911, respectively, but only moderate specificities (0.56–0.65) (Table 1). Based on these findings, we developed a simplified heatmap incorporating RB and PGA (Figure 2).
The model demonstrated that patients with any positive RB or PGA score had a substantially reduced probability of remission, whereas the likelihood of remission exceeded
50% only when both RB and PGA were absent. This finding indicates that even mild symptom activity is strongly associated with a high likelihood of persistent endoscopic disease activity.
Conclusions: Symptom-based indices correlate with endoscopic findings, but RB and PGA emerge as the most clinically meaningful predictors of mucosal healing. The RB–PGA heatmap offers a simple, noninvasive method to estimate the probability of endoscopic remission in UC patients during outpatient visits. This approach may help clinicians prioritize patients for endoscopic reassessment, reducing unnecessary procedures while ensuring timely evaluation of those at risk of active disease. By integrating symptom assessment with a validated predictive model, patient care and resource allocation in UC management may be optimized.
換水大腸鏡檢查合併腸鏡末端接合器材對大 腸腺瘤偵測的影響：一項單中心前瞻性隨機 分組試驗分析
A SINGLE-CENTER RANDOMIZED COMPARISON OF ADENOMA DETECTION USING WATER EXCHANGE COLONOSCOPY WITH AND WITHOUT DISTAL ATTACHMENT DEVICES
鄭吉良1 郭彥麟1 蘇怡佳1 林慧婷1 李百萍1 崔怡寧1
Felix W. Leung2,3
1 中壢長榮醫院胃腸科
2 美國退伍軍人事務部大洛杉磯醫療保健系統 Sepulveda 門診照護中心胃腸科
3 美國加州大學洛杉磯分校 David Geffen 醫學院
Background: Higher adenomas per colonoscopy (APC) are associated with a reduced risk of postcolonoscopy colorectal cancer. Water exchange (WE) colonoscopy improves bowel cleansing and increases adenoma detection. Distal attachment devices may further enhance mucosal visualization and lesion detection; however, comparative evidence evaluating different attachment designs during WE colonoscopy remains limited.
Aims: To compare APC among WE colonoscopy performed without a distal attachment, with a transparent cap, or with Endocuff Vision®
Methods: To compare APC among WE colonoscopy performed without a distal attachment, with a transparent cap, or with Endocuff Vision®
Results: Baseline demographic and clinical characteristics, including colonoscopy indications, were well balanced across groups (men: 48.4%; mean age: 61.7 ± 7.6 years; screening: 29.5%; surveillance: 61.8%; positive FIT: 8.8%). WE combined with Endocuff Vision ® achieved a significantly higher overall APC than WE alone (1.8 ± 2.4 vs. 1.4 ± 0.9, P = 0.003), primarily driven by increased distal colon yield (0.4 vs. 0.1, P < 0.001), with a nonsignificant trend toward increased proximal colon APC (0.9 vs. 0.5, P = 0.071). WE with a transparent cap did not significantly improve APC. WE combined with Endocuff Vision ® also achieved a significantly higher overall ADR than WE alone (71.1% vs. 47.9%; P = 0.014), with significantly higher polypoid, small-size, and distal colon ADRs (all P < 0.05). SSL detection rate, bowel preparation quality, and overall withdrawal time were similar across groups. Limitations included the unblinded design and single-center setting.
Conclusions: In this single-center randomized study, Endocuff Vision®–assisted WE colonoscopy significantly improved APC and ADR compared with WE alone, whereas a transparent cap conferred no additional benefit. These findings support further multicenter evaluation of Endocuff Vision ® combined with WE to assess generalizability.
宮入菌對於大腸腺瘤復發預防之潛在角色
THE POTENTIAL ROLE OF CBM588 IN THE PREVENTION OF COLORECTAL ADENOMA RECURRENCE
王俊偉1,2,3 許文鴻2,3 余方榮2,3 劉忠榮3,4 郭昭宏1,2,3,5
王照元6,7 林明宏8 吳登強1,2,3
1 高雄醫學大學 醫學院 臨床醫學研究所
2 高雄醫學大學 醫學院 醫學系 內科學科
3 高醫附設中和紀念醫院 內科部 胃腸內科
4 高雄醫學大學 再生醫學與細胞治療研究中心
5 高雄秀傳紀念醫院 內科部 胃腸內科
6 高雄醫學大學 醫學院 醫學系 外科學科
7 高醫附設中和紀念醫院 外科部 大腸直腸外科
8 高雄醫學大學 醫學院 醫學系 微生物暨免疫學科
Background: Colorectal adenomatous polyps are precursors to colorectal cancer and exhibit a high rate of recurrence post-polypectomy. Dysbiosis of the gut microbiota is implicated in tumorigenesis, suggesting that microbiota modulation may be a preventive avenue. This study evaluated the efficacy of Clostridium butyricum MIYAIRI 588 (CBM588), a butyrate-producing probiotic, in preventing colorectal adenoma recurrence in high-risk patients.
Aims: The primary aim of this study was to evaluate the efficacy of CBM588 in reducing the recurrence rate of colorectal adenomatous polyps in high-risk patients. Secondary objectives included assessing the impact of CBM588 on the number of recurrent polyps and evaluating the safety and tolerability of long-term administration.
Methods: We conducted a randomized, single-blind, crossover trial enrolling 398 patients with a history of endoscopic adenoma resection. Participants were randomized to receive CBM588 for the first year followed by observation (Group A), or observation first followed by CBM588 (Group B). All patients underwent annual surveillance colonoscopies. The primary outcomes were adenoma recurrence rates and mean polyp counts, analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches.
Results: In the first-year analysis, the CBM588-treated group showed a reduction in adenoma recurrence compared to controls. While the ITT analysis showed a non-significant trend (30.00% vs. 35.35%, P=0.26), the PP analysis demonstrated a statistically significant reduction in recurrence (29.76% vs. 44.71%, P<0.05) and mean polyp count (0.80 vs. 1.25, P<0.05). Following the crossover,
Group B (initiating CBM588 in year 2) experienced similar preventive benefits, while Group A maintained lower recurrence rates. The number needed to treat (NNT) to prevent one recurrence in the PP population was 7. No serious adverse events were reported.
Conclusions: CBM588 demonstrated a significant potential to reduce colorectal adenoma recurrence, particularly in the per-protocol analysis. These findings support the role of CBM588 as a feasible, safe, and non-invasive chemopreventive strategy for patients at high risk of recurrent colorectal polyps.
『VITABOX® LP28 HYPERBIOTICS PRO300』之腸道 有益菌及排便狀況評估試驗 執
行機構：臺北醫學大學代謝與肥胖科學研究 所 執行
CLINICAL EVALUATION OF VITABOX®
LP28 HYPERBIOTICS PRO-300 ON INTESTINAL PROBIOTICS AND DEFECATION PATTERNS
陳文昭1 黃惠宇2
1 台北醫學大學附設醫院
2 臺北醫學大學
Background: Lactobacillus is recognized as one of the most abundant microbial groups within the human gastrointestinal (GI) tract and is closely associated with optimal intestinal health (Heeney, Gareau, & Marco, 2018). There is a growing consensus regarding the use of lactic acid bacteria (LAB) as primary probiotics in fermented foods and dietary supplements for health maintenance, as well as the prevention and treatment of various diseases (Hill et al., 2014; Marco et al., 2017).In recent years, the incidence of colorectal cancer (CRC) has risen significantly. Research indicates a strong correlation between the composition of the gut microbiota and the development of CRC (Chiang, Chen, Chen, You, & Lai, 2010). Modern dietary habits often lead to dysbiosis— an imbalance in the intestinal flora characterized by an increased proportion of pathogenic bacteria. These harmful microorganisms compromise intestinal integrity and increase the risk of gastrointestinal diseases (Derrien, Vaughan, Plugge, & de Vos, 2004). Consequently, the maintenance of gastrointestinal health has become a critical emerging issue.
Aims: Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO 2002). The human GI tract harbors a diverse range of microbial communities, with the large intestine being the most densely populated region, containing approximately 500 distinct species. This microbiota primarily consists of obligate anaerobes. While certain genera such as Clostridium, Staphylococcus, and Veillonella are potentially pathogenic, Bifidobacterium and Lactobacillus are known for their health-promoting properties. Other organisms, such as Escherichia coli, Bacteroides, and Streptococcus, may become harmful if their populations expand excessively, though they are generally commensal under normal conditions.
Specifically, the physiological benefits of Bifidobacterium include:Reduction of blood ammonia levels.Lowering of plasma cholesterol concentrations.Modulation of gastrointestinal immune function and enhancement of resistance to infections.Synthesis of B-complex vitamins during fermentation.Production of short-chain fatty acids (SCFAs), such as acetate and butyrate, which lower luminal pH and inhibit the proliferation of pathogens. Anticarcinogenic effects and the inhibition of tumor development.The large intestine represents the most stable and concentrated microbial environment, with bacterial counts reaching $10^{11}$–$10^{12}$ CFU/ mL (Colony-Forming Units). Given that approximately one-third of fecal matter consists of live bacteria, fecal microbial analysis serves as a reliable proxy for colonic microbiota status. It is well-established that shifts in the gut microbiota are intimately linked to the host’s physiology, diet, and nutritional status. Extensive literature suggests that the consumption of probiotics or prebiotics (such as oligosaccharides) can significantly increase the abundance of beneficial bacteria while suppressing harmful strains. Therefore, this study aims to investigate whether the intervention of VITABOX ® LP28 Hyperbiotics Pro-300 can effectively modulate the gut microbiota by increasing beneficial bacteria and improving defecation patterns.
Methods: Study Design and Methodology The trial was conducted as a randomized, doubleblind, parallel-controlled study. Participants were assigned to either Group Y (Test Product: VITABOX ® LP28 Hyperbiotics Pro-300) or Group P (Placebo). A total of 20 participants were recruited and allocated into two groups of 10, balanced for gender ratio, age distribution, and body weight. The total study duration was 12 weeks (Weeks 0–12), consisting of: Run-in Period: A 2-week adjustment phase (Weeks 0–2). Intervention Period: A 10-week supplementation phase (Weeks 2–12). During the intervention, participants consumed one sachet of lactic acid bacteria (Group Y) or placebo (Group P) daily. Fecal samples were collected and anthropometric measurements were recorded at three intervals: Weeks 2, 7, and 12.
Results: Results The findings indicated that after 10 consecutive weeks of supplementation, VITABOX ® LP28 Hyperbiotics Pro-300 significantly increased the counts of Lactobacillus and Bifidobacterium in human feces compared to the placebo group. Specifically: Lactobacillus counts increased approximately 2-fold. Bifidobacterium counts increased approximately 2.5-fold.
These results suggest that the product effectively modulates and improves the gut microbiota composition.
Conclusions: Conclusion and Recommendation : Based on these clinical findings, a daily intake of two capsules (provided by Focus International Co., Ltd.) of VITABOX® LP28 Hyperbiotics Pro-300 can significantly enhance the abundance of probiotics within the human intestinal tract.
76
小腸轉移性腫瘤：以小腸鏡為基礎之臺灣多 中心流行病學研究
SMALL BOWEL METASTATIC TUMORS: A MULTICENTER ENTEROSCOPYBASED EPIDEMIOLOGIC STUDY IN TAIWAN
陳怡廷1,2,3 黃天祐4,5 顏旭亨5,6 林偉彬5,7,8 李柏賢5,7,8 許文鴻5,9 戴啟明5,10,11 鍾承軒5,12,13 林敬斌5,14 廖竟妤1,2,3,5 翁鼎淳1,2,3 章振旺1,2,3,5 1 馬偕紀念醫院內科部消化科系；2 馬偕醫護管理專科學 校；3 馬偕醫學大學醫學院醫學系；4 三軍總醫院胃腸肝 膽科；5 台灣腸道醫學會；6 彰化基督教醫院胃腸肝膽科； 7 林口長庚紀念醫院胃腸肝膽科；8 長庚大學醫學院；9 高雄醫學大學附設中和紀念醫院 肝膽胰內科；10 義大醫 院內科部；11 義守大學醫學院醫學系；12 亞東紀念醫院 內科部肝膽胃腸科；13 輔仁大學醫學院；14 中山醫學大 學附設醫院
Background: Small bowel tumors are an uncommon cause of gastrointestinal symptoms and small bowel obstruction. While primary small bowel neoplasms such as adenocarcinoma, carcinoid tumors, lymphoma, sarcoma, and gastrointestinal stromal tumors have been well described, metastatic tumors involving the small bowel are rare and often underrecognized. In patients with advanced malignancy, small bowel metastasis may present with gastrointestinal bleeding, small bowel obstruction, or nonspecific abdominal symptoms, posing diagnostic challenges even with modern imaging modalities. Data regarding the epidemiology, clinical presentation, and endoscopic characteristics of metastatic small bowel tumors remain limited.
Aims: This study aimed to investigate the real-world clinical characteristics of metastatic small bowel tumors in Taiwan.
Methods: In this multicenter retrospective study conducted across eight medical centers in Taiwan, medical records from November 2007 to October 2025 were reviewed. A total of 28 patients diagnosed with metastatic small bowel tumors were included. All diagnoses were confirmed by endoscopic, radiological, and pathological examinations. Collected variables included baseline demographic characteristics, primary malignancy origin, interval between primary cancer diagnosis and small bowel metastasis, presence of isolated versus multi-organ metastasis, clinical presentation (gastrointestinal bleeding or obstruction), radiologic findings, and endoscopic
features. Continuous variables were expressed as mean ± standard deviation and compared using the Mann–Whitney U test. Categorical variables were presented as percentages and compared using the chi-square test or Fisher’s exact test, as appropriate.
Results: Among the 28 patients with metastatic small bowel tumors, 14 had isolated small bowel metastasis and 14 had multi-organ metastases. The mean age was 60.4 ± 13.3 years, and 78.6% of patients were male. No significant differences were observed between the two groups regarding age, sex, smoking status, alcohol consumption, body mass index, duration of metastasis, survival time, or primary tumor origin. Lung cancer was the most common primary malignancy (25%). The mean diagnostic interval was longer in patients with multi-organ metastases than in those with isolated small bowel metastasis (155.2 ± 288.2 weeks vs. 39.5 ± 53.7 weeks). The mean survival was shorter in patients with multi-organ metastases than in those with isolated small bowel metastasis (65.27±31.7 weeks vs. 131.2±53.8 weeks). Jejunal involvement was significantly more frequent in the multi-organ metastasis group (71%, p = 0.042). Gastrointestinal bleeding was the predominant clinical presentation (64%), followed by small bowel obstruction (18%). Computed tomography failed to provide a definitive diagnosis in 35.7% of cases. On enteroscopy, ulceration (64%) and luminal stricture (46%) were common findings, and polypoid lesions were more frequently observed in the multi-organ metastasis group (57%, p = 0.046).
Conclusions: Metastatic small bowel tumors are rare and commonly present with gastrointestinal bleeding, with the jejunum being the most frequent site, particularly in patients with multi-organ metastases. Given the limited diagnostic yield of computed tomography, enteroscopy is essential for accurate diagnosis and should be considered early in patients with unexplained gastrointestinal symptoms.
主題：膽胰疾病（二） 77
單一醫學中心以內視鏡經乳頭膽囊引流作為 替代手術之姑息治療：臨床經驗回顧 CLINICAL EXPERIENCE WITH ENDOSCOPIC TRANSPAPILLARY GALLBLADDER DRAINAGE AS AN ALTERNATIVE PALLIATIVE TREATMENT
IN A SINGLE MEDICAL CENTER
吳宛臻 孫灼基 新光吳火獅紀念醫院 胃腸肝膽科
Background: Endoscopic transpapillary gallbladder drainage (ETGBD) has been used as a minimally invasive approach for symptom relief in patients with gallbladder disease who are not suitable for surgery; however, its role as a long-term management strategy compared to surgery remains unclear. It is uncertain which clinical or laboratory characteristics may identify patients who can relieve symptoms with prolonged ETGBD, and whether stentrelated factors can influence the likelihood of requiring subsequent surgical intervention.
Aims: To identify clinical and laboratory factors associated with symptom control using long-term ETGBD in patients at high surgical risk, and to evaluate whether stent-related characteristics—including stent type, number, and length— are associated with a reduced need for subsequent surgical intervention.
Methods: This retrospective cohort study included 34 adult patients who underwent ERCP with ETGBD at a single medical center between January 1 st , 2019 and December 31 th , 2025. Patients were categorized according to whether they subsequently underwent surgery. Demographic characteristics, laboratory parameters, and procedural factors—including type and number of stents, and presence of acute cholecystitis—were compared. Categorical variables were analyzed using Fisher’s exact test, and continuous variables were analyzed using the Mann–Whitney U test.
Results: Among 34 patients, 29 didn’t need subsequent surgical intervention (85.3%). Gender, presence of acute cholecystitis, stent type, and number of stents were not significantly associated with surgery (all p >0.05). Platelet count was significantly higher in patients who underwent surgery (median [IQR]: 304 [262–360] vs. 157 [123–208] ×10³/μL, p = 0.019). Other clinical and laboratory variables showed no statistical differences. r-GT levels were numerically higher in the surgery group but did not reach
statistical significance (p = 0.053).
Conclusions: In this single-center cohort of high-risk surgical patients, 85.3% of patients undergoing ETGBD did not require subsequent surgical intervention. These findings support the role of ETGBD as a palliative alternative to surgery for symptom control in selected patients. While platelet count differed significantly between groups and r-GT levels were numerically higher in patients who underwent surgery, most baseline clinical, laboratory, and stent-related factors were not significantly associated with subsequent surgical intervention. Larger studies are warranted to further define patient selection criteria for long-term ETGBD. 78
膽道引流之時機對於急性膽管炎病患臨床預 後的影響 - 台灣多中心的回朔性研究 IMPACT OF TIMING AND MODALITY OF BILIARY DRAINAGE ON CLINICAL OUTCOMES IN ACUTE CHOLANGITIS: A MULTICENTER RETROSPECTIVE STUDY
謝宗霖 中國醫藥大學附設醫院內科部消化醫學中心
Background: Acute cholangitis is a bacterial infection caused by biliary obstruction, allowing bacteria and endotoxins to enter the systemic circulation and trigger systemic inflammation and organ dysfunction. Despite advances in management, the mortality rate of acute cholangitis remains substantial. The Tokyo Guidelines 2018 recommend severity-based, individualized treatment strategies: antibiotics alone are considered sufficient for mild acute cholangitis, with biliary drainage reserved for patients with poor response; early biliary drainage via endoscopic or percutaneous approaches is recommended for moderate cases; and for severe acute cholangitis, initial stabilization of respiratory and circulatory function is mandatory, followed by biliary drainage as soon as the patient’s condition permits. However, the optimal timing of biliary drainage remains controversial.
Aims: This study aimed to evaluate the optimal timing of biliary drainage associated with the greatest clinical benefit in patients with acute cholangitis. In addition, we analyzed other clinical parameters potentially influencing prognosis. Methods: This was a retrospective, multicenter study conducted in Taiwan. We enrolled 527 patients with acute cholangitis, defined according to the Tokyo Guidelines 2018, from nine hospitals between August 2022 and July 2024. Clinical data, including laboratory results, microbiological cultures, vital signs, drainage modalities, and clinical outcomes, were collected from patients treated with a single antibiotic regimen of cefoperazone/sulbactam (Brosym). After exclusion, 202 patients were included in the final analysis. Patients were categorized into three groups according to the timing of biliary drainage: Day 1 (D1, the day of hospital presentation), Day 2 (D2), and Day ≥3 (≥D3). The primary outcomes were clinical recovery and microbiological outcomes.
Results: Initial Kaplan–Meier analysis demonstrated significant differences in time to clinical cure among the three intervention groups (D1, D2, and ≥D3; p
= 0.022). Post hoc pairwise comparisons showed no significant difference between the D2 and ≥D3 groups (p = 0.562). Accordingly, patients were regrouped into early intervention (D1) and delayed intervention (≥D2). The refined Kaplan–Meier analysis revealed significantly faster recovery in the early intervention group (p = 0.0067). Univariable Cox regression analysis identified sex, intervention timing, length of hospital stay, clinical diagnosis, drainage modality, and baseline laboratory parameters (hemoglobin, neutrophil count, prothrombin time, and alkaline phosphatase) as prognostic factors. In the multivariable Cox proportional hazards model using stepwise selection, intervention timing and drainage modality remained independent predictors of time to cure. Patients in the early intervention group were 2.12 times more likely to achieve earlier recovery than those in the delayed group (adjusted hazard ratio [HR]: 2.12; 95% confidence interval [CI]: 1.39–3.23; p = 0.001).
Radiological decompression was associated with a significantly prolonged recovery compared with endoscopic decompression (HR: 0.46; 95% CI: 0.27–0.78; p = 0.004).
Conclusions: Biliary drainage performed on the first day of hospital presentation is associated with faster recovery in patients with acute cholangitis. Endoscopic biliary decompression appears to be superior to radiological drainage in terms of clinical recovery.
吉西他濱化療後轉移性胰臟腺癌患者接受安 能得微脂體注射劑治療的臨床療效：單一中 心回顧性研究
CLINICAL OUTCOMES OF LIPOSOMAL IRINOTECAN IN PATIENTS WITH METASTATIC PANCREATIC ADENOCARCINOMA AFTER GEMCITABINE-BASED THERAPY: A SINGLE-CENTER RETROSPECTIVE STUDY
林子鈞1 孫煒智1,4 蔡騌圳1,3 王國強2 陳玉佳2,3 陳文誌1,3 蔡峯偉1,3
1 高雄榮民總醫院內科部胃腸肝膽科
2 高雄榮民總醫院外科部一般外科
3 國立陽明交通大學醫學院醫學系
4
Background: In the NAPOLI-1 study, the combination of liposomal irinotecan (Onivyde), 5-fluorouracil and folinic acid (Nal-IRI+5-FU/LV) has shown survival benefits in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) who have previously received gemcitabinebased treatment. However, due to other chemotherapeutic regimens used in this setting and the lack of real-world data on the efficacy of Nal-IRI-based therapy, no consensus could be achieved on the optimal treatment sequence.
Aims: To investigate the clinical efficacy of Nal-IRI-based treatment for mPDAC patients following progression after gemcitabine-based therapy.
Methods: From August 1, 2018 to August 31, 2025, medical data of patients with mPDAC who were treated with Nal-IRI-based regimens after gemcitabine-based therapy in our hospital were retrospectively collected. The outcome measures included objective response rate (ORR), median overall survival (mOS), and median progressionfree survival (mPFS). According to the time interval between regimen switch from disease progression after gemcitabine-based therapy to Nal-IRI-based treatment, a comparison of outcome measures was performed in patients with a prompt ( ≦ 28days) and deferred (>28 days) switch.
Results: A total of 37 patients (median age at diagnosis: 62 years, 48.6% male) were enrolled. Before Nal-IRI-based treatment, all patients received a median of 12 sessions of chemotherapy, with the most common three regimens being GA (54.1%), SLOG (51.4%), and GAS (32.4%).The ORR was 21.6%. The mOS and mPFS were 5.1 months
and 2.7 months. The overall survival rates were 45.5% at 6 months and 29.9% at 12 months. Since the start of firstline chemotherapy, mOS was 14.9 months. The baseline characteristics were comparable between patients with a prompt (n=17) and deferred (n=20) regimen switch, except for a different gender proportion. The patients receiving a prompt regimen switch had better ORR (41.2% & 5.0%, p=0.03) and longer mOS (6.9 months & 3.1 months, p=0.05) than those with deferred switching. Patients with a prompt regimen switch had estimated 6- and 12-month overall survival rates of 51.8% and 41.4%, respectively, whereas those with deferred switching had rates of 29.2% and 5.0% (p=0.05). In the multivariate Cox regression analysis, prompt regimen switch was found to be predictive of overall survival (HR, 0.35; 95%CI: 0.12-1.01; p=0.05).
Conclusions: Nal-IRI-based regimen is an effective treatment option following gemcitabine-based therapy in patients with mPDAC. Prompt regimen switch is associated with improved survival.
80
年輕發病之肝內膽管癌具有獨特的臨床特徵 與較佳的可切除性：單一中心經驗 DISTINCT CLINICAL FEATURES AND FAVORABLE RESECTABILITY IN YOUNG-ONSET INTRAHEPATIC CHOLANGIOCARCINOMA: A SINGLECENTER EXPERIENCE
林其寬1 李騏宇
1 馬偕學校財團法人馬偕醫學大學
2 馬偕紀念醫院消化科系
3 財團法人馬偕醫護管理專科學校
4 馬偕紀念醫院外科部
5 馬偕紀念醫院醫研部
Background: Intrahepatic cholangiocarcinoma (iCCA) is conventionally associated with advanced age and poor prognosis. However, the incidence of iCCA in younger adults (≤50 years) is gradually increasing. The clinical characteristics, risk profiles, and therapeutic outcomes of this specific demographic remain under-investigated in Taiwan.
Aims: This study aims to delineate the clinical presentation, disease stage at diagnosis, and treatment outcomes of young-onset iCCA patients in a real-world Taiwanese cohort.
Methods: We conducted a retrospective review of patients aged ≤50 years newly diagnosed with iCCA at MacKay Memorial Hospital between May 2020 and September 2025. Diagnosis of fatty liver and cirrhosis were established by abdominal ultrasonography. Patient demographics, tumor staging (AJCC 8th edition), liver-associated risk factors, and treatment modalities were analyzed. Primary outcomes included resectability rates and short-term survival. Overall survival was defined from diagnosis to death or last follow-up and analyzed descriptively using the Kaplan–Meier method.
Results: A total of 14 young-onset iCCA patients were enrolled (median age: 46 years; male: 64.3%). Regarding risk factors, sonographic fatty liver was highly prevalent (78.6%), followed by chronic hepatitis B virus infection (35.7%) and cirrhosis (35.7%). Five patients (35.7%) were asymptomatic at diagnosis. Notably, the majority of patients presented with early-stage disease (AJCC Stage I/II: 71.4%), leading to a high curative resection rate of 71.4% (10/14). During follow-up, two mortality events were recorded, highlighting the impact of tumor biology
and liver reserve: one patient suffered from postoperative recurrence with portal vein invasion and succumbed to infectious complications, while another presented with advanced-stage disease combined with decompensated cirrhosis, receiving only best supportive care. However, due to the high proportion of early-stage diagnoses in the overall cohort, the median overall survival was not reached.
Conclusions: Young-onset iCCA patients in this cohort presented with distinct clinical features, characterized predominantly by early-stage disease and high resectability rates. Unlike the traditional elderly iCCA population, younger patients may benefit from more aggressive surveillance or incidental detection, leading to curative surgical interventions and favorable short-term prognosis. These findings align with the emerging phenotype of young-onset iCCA and warrant further validation in larger cohorts. 81
保守型內視鏡醫師的階段式膽管插管策略胰管支架置入後經胰預切開術的臨床影響 A STEPWISE CANNULATION STRATEGY FOR CONSERVATIVE ENDOSCOPISTS: THE CLINICAL IMPACT OF TRANSPANCREATIC PRECUT AFTER PANCREATIC STENTING
曾子瀚1 蘇偉志1 陳建華1 徐榮源1 趙有誠1 1 佛教慈濟醫療財團法人台北慈濟醫院胃腸肝膽科 2 慈濟大學醫學院
Background: Pancreatic stenting reduces post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and aids in cannulation in difficult cases. However, conservative endoscopists may stop at this step, resulting in suboptimal outcomes.
Aims: To assess the efficacy of transpancreatic precut sphincterotomy (TPS) as a rescue procedure following pancreatic stenting.
Methods: Between March 2013 and November 2018, 82 patients underwent pancreatic stenting at our institution prior to successful biliary cannulation. TPS was introduced in April 2016, and patients were divided into “Before TPS” and “After TPS” groups. The outcomes included cannulation success, PEP incidence, and predictors of TPS conversion.
Results: There were 43 and 39 patients in the “Before TPS” and “After TPS” groups, respectively. Twenty-two patients (56.4%) underwent conversion to TPS in the “After TPS” group. The “After TPS” group had a higher bile duct cannulation rate (89.7% vs. 72.1%) than the “Before TPS” group, but this difference was not statistically significant (P = 0.054). Multivariate analysis showed that age >50 years (odds ratio [OR] = 0.181, P = 0.021) and being in the “After TPS” group (OR = 0.712, P = 0.039) were independently associated with reduced PEP risk. Haraldsson Type 2 and Type 4 papillae carried a relatively high TPS conversion rate.
Conclusions: A stepwise cannulation strategy that incorporates TPS after pancreatic stenting minimizes the need for advanced techniques and improves PEP outcomes.
透過 ALPHAFOLD3 的構形性狀預測解析
與膽結石相關的遺傳變異
DISENTANGLING GENETIC VARIANTS ASSOCIATED WITH CHOLELITHIASIS THROUGH CONFORMATIONAL TRAIT
PREDICTION BY ALPHAFOLD3
蕭又中
臺南市立醫院（秀傳醫療社團法人經營）肝膽腸胃科
Background: The ATP-binding cassette G5/G8 (ABCG5/ G8) heterodimer regulates biliary cholesterol secretion. Disruption of this transport function predisposes individuals to gallstone disease, as association studies connect genetic variants with disease phenotypes. Yet the specific variants that modulate protein function through stereoconformation remain only partially understood, underscoring challenges in causal interpretation.
Aims: This study examined the causal variant’s influence on protein conformation through structure-function relationships, calculating the mechanical properties of ABCG8 polymorphism and dimerization with ABCG5..
Methods: Using meta-analysis confirms a causal variant of ABCG8, translated into the protein sequences and implicated in conformational accessibility by AlphaFold3, elucidating loss-of-function phenotypes associated with cholelithiasis and contributing to genotypic correlations.
Results: Meta-analytic pooling identified the ABCG8 D19H variant (rs11887534; G>C) as a prevalent genetic determinant, yielding a fixed-effect allelic odds ratio of 2.06 (95% CI: 1.76–2.41, p<0.0001). The D19H substitution (aspartic acid to histidine) alters hydrophilicity across nine residues (positions 15–23), modifying local biophysical properties. AlphaFold3 structural predictions revealed that D19H truncates an alpha-helix turn; however, the nucleotide-binding sites (NBS) within the ABCG8 α-helical subdomain remain unaffected. FINCHES analysis showed no detectable differences in IDRs or sequence-specific interactions between wild-type and variant heterodimers. Intermolecular interaction maps similarly revealed no distinguishable differences.
Conclusions: While the D19H variant demonstrates strong genetic association with cholelithiasis, subtle conformational changes do not directly impact canonical binding sites. The functional mechanisms by which this single amino acid substitution impairs ABCG8 activity require further characterization, including dynamic cellular interaction studies. This framework informs targeted mechanistic research and potential therapeutic development strategies for gallstone disease.
主題：病毒性肝炎（三）
醫學中心 B 型 C 型肝炎篩檢服務替代模式 ALTERNATIVE SCREENING SERVICES
MODEL FOR HEPATITIS B AND C AT A MEDICAL CENTER
劉怡伶 楊芳琦 黃稚雯 蘇培元 林靜君 彰化基督教醫院
Background: Liver disease has been a major public health issue in Taiwan. According to data released by the Ministry of Health and Welfare in 2023, approximately 13,000 people die each year from chronic liver disease, liver cirrhosis and liver cancer. Liver cancer is the second leading cause of cancer-related mortality. Hepatitis B and C are the major causes of liver cirrhosis and liver cancer. Since 2020, the Health Promotion Administration has provided a once-in-a-lifetime hepatitis B and C screening program for adults aged 45 to 79 years. In August 2025, eligibility was expanded to individuals born before 1986 (aged 39–79 years) to early identify hepatitis-positive cases. While most patients with liver disease often presents few or no symptoms in its early stages, many people are unaware of the availability and the importance of this screening services. This could gradually decrease the annual screening rate for hepatitis B and C. There was an apparently decline in the total number of screenings from 2937 to 1318 from January to September in 2024, as compared to the same period in 2023. Previous nursing research had indicated that accessibility and convenience are key factors for effective disease screening strategy. Therefore, the Department of Gastroenterology at our hospital introduced an alternative screening model “fixedsite mobile screening unit” in January 2025, allowing screening services to “go out” and the public to “step in.” This initiative promoted convenience and accessibility.
Aims: The purpose of this report is to see the efficacy of the fixed-site mobile screening model. To improve accessibility and participation of screening services for hepatitis B and C.
Methods: The target population is eligible individuals aged 39–79 years for free hepatitis B and C screening. The fixed-site mobile screening unit is located next to the blood collection check-in machine on the second floor of our hospital where is also nearby outpatient clinics area. Being available for our target population during daily scheduled hours. This fixed-site mobile screening unit is further supported by the integration of the hospital’s information management system, and is equipped with inquiry and laboratory order entry functions. The data of screening
rate and total case numbers will be analyzed before and after the implementation of this alternative screen service model, and compare the change of the data from January to September in 2023, 2024 and 2025.
Results: The results showed a significantly increase in total case numbers following the launch of the fixed-site mobile screening unit by 130 from January to September in 2025, as compared to the same period in 2024. The overall screening service rate increased from 56.5% to 59.2% between 2024 and 2025, representing a growth rate of 2.7%.
Conclusions: The results confirm that a fixed-site mobile screening model can be effective to promote screening program, leading to a reversal of the declining trend in screening number. It could also facilitate early diagnosis of liver disease. This intervention successfully addressed and overcome barriers to screening that related to time constraints and inconvenient procedures.
84
接受化學治療患者中預防 B 型肝炎病毒再 活化之抗病毒預防治療的比較療效與安全 性：一項真實世界研究 COMPARATIVE EFFECTIVENESS AND SAFETY OF ANTIVIRAL PROPHYLAXIS FOR PREVENTING HEPATITIS B VIRUS REACTIVATION IN PATIENTS UNDERGOING CHEMOTHERAPY: A REAL-WORLD STUDY
楊芳琦 蘇培元 林婉瑜 顏旭亨 蘇維文 陳洋源 彰化基督教醫院胃腸肝膽科
Background: Patients with chronic hepatitis B are at risk of HBV reactivation during cytotoxic chemotherapy. Current guidelines recommend prophylactic nucleos(t)ide analogue therapy in this setting. However, data comparing the virological efficacy, hepatic biochemical response, and renal safety among different nucleos(t)ide analogues remain limited.
Aims: This study aimed to compare laboratory changes among three antiviral agents used to prevent HBV reactivation during chemotherapy.
Methods: This retrospective cohort study was conducted at a medical center in central Taiwan and included patients with chronic hepatitis B who received cytotoxic chemotherapy between January 2020 and June 2024. Patients received prophylactic antiviral therapy with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), or entecavir (ETV). Only patients with paired laboratory data at baseline (T0) and week 48 (T48) were included in the analysis.
Results: A total of 1,401 patients were included in the study; among them, 874 had paired alanine aminotransferase (ALT) data, 833 had paired serum creatinine data, and 512 had paired HBV DNA data. All three antiviral agents achieved significant reductions in log₁₀ HBV DNA from baseline to week 48 (all within-group P < 0.001). Adjusted analyses demonstrated significant differences in HBV DNA reduction among treatment groups, with post-hoc comparisons showing a greater decline in the ETV group than in the TAF group, whereas differences involving TDF were not statistically significant after correction. ALT levels declined significantly only in the TAF group; however, adjusted between-group differences were not significant. Serum creatinine increased modestly in all groups, with no significant differences among antiviral agents in adjusted analyses.
Conclusions: Although ETV achieved a greater reduction in continuous HBV DNA levels than TAF in patients with chronic hepatitis B undergoing chemotherapy, changes in liver enzymes and renal function did not differ significantly among the three agents. These findings indicate that prophylactic antiviral therapy with TDF, TAF, and ETV effectively suppressed HBV replication and was associated with stable hepatic and renal biochemical profiles over 48 weeks.
85
不同核苷（酸）類似物治療結束時表面抗原 最佳截點值可預測慢性 B 型肝炎 E 抗原陰 性患者 B 型肝炎復發 OPTIMAL NUCLEOS(T)IDE
ANALOGUE–SPECIFIC HBSAG
THRESHOLDS AT END OF TREATMENT
PREDICT HBV RELAPSE IN HBEAGNEGATIVE PATIENTS
陳建宏 郭垣宏 顏毅豪 胡琮輝 王景弘 洪肇宏 盧勝男 高雄長庚紀念醫院 胃腸肝膽科系
Background: Recent studies showed that HBsAg<100 IU/ mL at end of treatment (EOT) is not a good predictor of HBV relapse after NA cessation.
Aims: To find the optimal value of HBsAg at EOT to predict HBV relapse according to different NA therapy in HBeAg-negative patients.
Methods: A total of 910 HBeAg-negative patients without cirrhosis receiving entecavir (n=449), TDF (n=276) or TAF (n=185) were enrolled. All patients underwent posttreatment follow-up for at least 6 months and fulfilled stopping criteria of antiviral therapy in 2012 APASL.
Results: The cumulative incidences of virological and clinical relapse at 144 weeks were higher in the off-TAF group (88% and 70.7%, respectively) than that in the offentecavir group (71.3% and 51.7%, respectively) and that in the off-TDF group (77.3% and 59.7%, respectively) (both p<0.001). The median time to clinical relapse was much earlier for off-TAF patients than for off-entecavir or off-TDF (median: 16, 56 and 27 weeks, respectively). Multivariate analysis indicated that TAF therapy was an independent risk factor for virological and clinical relapse when compared to entecavir and TDF therapy, and these findings persisted even after PS matching. HBsAg level at EOT was an independent factor of virological and clinical relapses in off-ETV, off-TDF and off-TAF therapy. To identify NA–specific HBsAg thresholds corresponding to similar HBV relapse risk across treatment groups, we applied a risk-equivalent threshold approach. The HBsAg level of 40 IU/mL was the optimal value to predict HBV relapse in entecavir group with HBsAg at EOT<100 IU/ mL. The 5-year cumulative rates of viroloigcal and clinical relapse were 26% and 12.2%, respectively. HBsAg levels of 20 and 2 IU/mL were the optimal values in TDF and TAF groups, respectively. The 5-year cumulative rates of viroloigcal and clinical relapse were 20% and 15%, respectively in TDF group and 3-year rates were 33.3% and
16.7%, respectively in TAF group.
Conclusions: There is an earlier and higher HBV relapse rate in patients who discontinue TAF therapy than in comparable patients discontinuing entecavir and TDF therapy in HBeAg-negative patients. HBsAg cutoffs at EOT should be NA-specific, as TAF shows higher relapse risk requiring very low threshold to achieve low HBV relapse after stopping TAF therapy.
86
C 型肝炎患者以抗病毒藥物成功治療後，丙 胺酸轉氨酶水平波動的相關因素 FACTORS ASSOCIATED WITH ALANINE TRANSAMINASE LEVEL FLUCTUATIONS AFTER SUCCESSFUL HEPATITIS C TREATMENT WITH DIRECT-ACTING ANTIVIRALS
施孟芸1 陳彥均2
1 大林慈濟醫院內科部
2 大林慈濟醫院 肝膽胰內科
Background: Although most patients with chronic hepatitis C (CHC) achieve normalization of alanine aminotransferase (ALT) levels after attaining a sustained virologic response (SVR), a proportion continues to exhibit ALT abnormalities.
Aims: Identifying factors associated with ALT fluctuations may help clinicians better determine the underlying causes of liver injury following direct-acting antiviral (DAA) therapy.
Methods: This retrospective study included CHC patients who received DAA therapy at Dalin Tzu Chi Hospital between 2017 and 2022. Patients were excluded if they had treatment interruption, incomplete ALT data, unknown SVR12 status, incomplete baseline information, active malignancy, hepatitis B virus coinfection, or missed followup. A total of 1,109 patients were enrolled. Normal ALT levels were defined as 30 U/L for males and 19 U/L for females, and analyses were stratified by sex. Persistently normal ALT was defined as values within the normal range on at least three occasions over six months. ALT fluctuation was defined as any abnormal ALT value during followup. Multivariable logistic regression was used to identify predictors of ALT fluctuation.
Results: The mean age was 64.6 ± 12.0 years, with 463 men (41.7%) and 646 women (58.3%). At baseline, 975 patients (87.9%) had abnormal ALT levels. During the twoyear follow-up, ALT fluctuations occurred in 751 patients (67.7%). In multivariate analysis, liver cirrhosis (OR 2.707; 95% CI 1.738–4.216 for fluctuation) and higher baseline ALT levels (OR 1.007; 95% CI 1.004–1.010 for fluctuation) were significant predictors in both sexes. In males, fatty liver (OR 1.763; 95% CI 1.149–2.707) and higher BMI (OR 1.088; 95% CI 1.029–1.152) were additional predictors of ALT fluctuation.
Conclusions: Among CHC patients who achieved SVR after DAA therapy, liver cirrhosis, elevated baseline ALT,
fatty liver disease, and higher BMI were associated with ALT fluctuations. These findings underscore the importance of managing metabolic and liver-related comorbidities to optimize long-term hepatic outcomes after hepatitis C virus eradication.
87
慢性
C 型肝炎基因型 3 的患者合併代謝功
能障礙相關脂肪性肝病 (MASLD) 臨床特徵 CLINICAL CHARACTERISTICS OF METABOLIC DYSFUNCTIONASSOCIATED STEATOTIC LIVER DISEASE IN CHRONIC HEPATITIS C PATIENTS WITH GENOTYPE 3 INFECTION
許恩齊1 黃釧峰1,2,3 葉明倫1,2 王志文1,2,4 梁博程1 魏鈺儒1 張庭遠1,2 黃志富1,2 戴嘉言1,2 莊萬龍1,2 余明隆1,2,5
1 高雄醫學大學附設中和紀念醫院內科部肝膽胃腸科
2 高雄醫學大學醫學院肝病研究中心
3 高雄醫學大學轉譯醫學博士學位學程
4 高雄市立小港醫院內科部肝膽胃腸科
5 國立中山大學醫學院醫學系暨臨床與實驗醫學博士班 代謝異常脂肪肝卓越研究中心
Background: Steatotic liver disease (SLD) is a common manifestation in chronic hepatitis C (CHC). Metabolic alterations in CHC are associated with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to elucidate whether hepatitis C virus (HCV) eradication mitigates MASLD occurrence or resolution. Aims: To realize more aspects of CHC genotype 3 infection causing metabolic dysfunction. And to compare the metabolism before and after eradication.
Methods: We included 31,254 patients with chronic hepatitis C from a nationwide HCV registry, among whom 649 patients had genotype 3 infection and achieved sustained virological response after treatment with directacting antivirals. Metabolic dysfunction–associated steatotic liver disease (MASLD) and cardiometabolic risk factors (CMRFs) were assessed at baseline and 6 months after HCV eradication.
Results: Based on nationwide data (n = 31,254), hepatitis C virus genotype 3 accounted for 2.1% of all chronic hepatitis C cases (n = 649). Among patients with genotype 3 infection, 49.9% had steatotic liver disease (SLD) (n = 324), 78.4% had at least one cardiometabolic risk factor (CMRF) (n = 509), and 45.3% met the criteria for metabolic dysfunction–associated steatotic liver disease (MASLD) (n = 294).
Conclusions: In this study, SLD and CMRF status appeared to remain largely unchanged before and after SVR in patients with hepatitis C virus genotype 3. The limited follow-up duration and the presence of multiple metabolic comorbidities in this cohort may have influenced these findings.
ENTECAVIR 與 TENOFOVIR 在非肝硬化 慢性 B 型肝炎患者中對肝細胞癌與肝相關 預後之療效比較：一項多中心傾向分數配對 之競爭風險分析研究 COMPARATIVE EFFECTIVENESS OF ENTECAVIR AND TENOFOVIR ON HEPATOCELLULAR CARCINOMA AND LIVER-RELATED OUTCOMES IN NONCIRRHOTIC PATIENTS WITH CHRONIC HEPATITIS B: A MULTICENTER PROPENSITY SCORE–MATCHED COMPETING RISK ANALYSIS
于洪元1,2 胡琮輝3 余明隆4 洪肇宏3 鄭斌男5 彭成元6 劉俊人7,8 陳志洲9 簡榮南10 黃怡翔11,12 1 台北榮民總醫院內科部胃腸肝膽科；2 國立陽明交通大 學醫學院醫學系；3 高雄長庚紀念醫院內科部胃腸肝膽 科；4 高雄醫學大學附設中和紀念醫院內科部肝膽胰內 科；5 國立成功大學醫學院附設醫院內科部胃腸肝膽科； 6 中國醫藥大學附設醫院內科部消化內科；7 台灣大學臨 床醫學研究所；8 台灣大學附設醫院胃腸肝膽科；9 柳營 奇美醫院胃腸肝膽科；10 林口長庚紀念醫院內科部胃腸 肝膽科；11 台北榮民總醫院醫學研究部；12 陽明交通大 學臨床醫學研究所
Background: Chronic hepatitis B (CHB) infection is a major risk factor for hepatocellular carcinoma (HCC) and liver-related mortality or liver transplantation. Entecavir (ETV) and tenofovir (TDF) are first-line nucleos(t)ide analogs (NUCs) that effectively suppress viral replication, normalize liver function, and reduce the risk of HCC. However, the comparative effectiveness of ETV and TDF in non-cirrhotic patients remains inconclusive.
Aims: This study aimed to compare the effectiveness of ETV and TDF in preventing HCC and liver-related death or liver transplantation in non-cirrhotic CHB patients.
Methods: This multicenter retrospective cohort study included non-cirrhotic CHB patients who initiated ETV or TDF therapy between January 2004 and March 2019 at 10 institutions in Taiwan. Propensity score matching (PSM) was performed to balance baseline characteristics and minimize confounding. Competing risk analysis was applied to account for death as a competing event. The primary outcome was HCC occurrence, and the secondary outcomes were liver-related death and liver transplantation.
Results: A total of 4,849 patients were enrolled, among whom 2,256 were included after PSM. In the overall cohort, ETV therapy was associated with a higher
incidence of HCC compared with TDF (TDF vs. ETV: hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.32–0.84, p = 0.008), and this difference remained significant in the matched cohort (HR 0.56, 95% CI 0.31–0.99, p = 0.048). However, after competing risk adjustment, the difference in HCC incidence between the two groups was no longer significant in either the overall cohort (HR 0.69, 95% CI 0.43–1.11, p = 0.13) or the matched cohort (HR 0.43, 95% CI 0.43–1.34, p = 0.34).
No significant difference was observed in liverrelated death or liver transplantation between the TDF and ETV groups in both the overall cohort (HR 1.95, 95% CI 0.99–3.84, p = 0.053) and the matched cohort (HR 2.01, 95% CI 0.81–5.01, p = 0.132).
Multivariate analysis identified older age, male sex, and the presence of ascites as independent risk factors for HCC development, whereas a history of hypertension, the presence of ascites, and elevated alpha-fetoprotein levels were associated with liver-related death or liver transplantation.
Conclusions: After adjustment using propensity score matching and competing risk analysis, no significant difference was observed between entecavir and tenofovir in the risks of HCC development or liver-related death and liver transplantation among non-cirrhotic patients with chronic hepatitis B.
主題：肝腫瘤（二）
合併脂肪肝疾病與慢性 B 型肝炎相關肝細 胞癌根除性切除後整體存活率較佳之關聯 CONCURRENT STEATOTIC LIVER DISEASE IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL AFTER CURATIVE RESECTION FOR CHRONIC HEPATITIS B–RELATED HEPATOCELLULAR CARCINOMA
柳硯文1 王植熙2 劉約維2 李韋鋒2 顏毅豪1 郭垣宏1
王心明3 蔡明釗1,3,4
1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨 長庚大學醫學系
2 長庚醫療財團法人高雄長庚紀念醫院一般外科系暨長 庚大學醫學系
3 高雄市立鳳山醫院（委託長庚醫療財團法人經營）
4 國立中山大學醫學院
Background: Steatotic liver disease (SLD) is increasingly recognized among patients with chronic hepatitis B–related hepatocellular carcinoma (CHB-HCC). Although SLD has been associated with improved overall survival after curative resection, the clinical basis for this favorable outcome remains incompletely defined.
Aims: To evaluate the impact of concurrent SLD on recurrence-free survival (RFS) and overall survival (OS) following curative hepatic resection in patients with CHBHCC, and to determine whether differences in baseline nutritional status, assessed by the preoperative prognostic nutritional index (PNI), account for the observed survival advantage.
Methods: This retrospective cohort study included patients with CHB-HCC who underwent curative hepatic resection between 2009 and 2023. SLD was defined histologically as hepatic steatosis involving ≥5% of hepatocytes in nontumorous liver tissue. The primary outcomes were RFS and OS. Secondary analyses incorporated nutritional stratification using preoperative baseline PNI (≥50 vs. <50), survival analyses within the recurrence subgroup, and comparisons of post-recurrence treatment modalities.
Results: Among the 733 eligible patients, 389 (53%) were diagnosed with concurrent SLD. Patients with SLD had a significantly higher prevalence of PNI ≥50 compared to those without SLD (p < 0.001). After a median followup of 53 months, patients with concurrent SLD exhibited a lower risk of death (HR: 0.60; 95% CI: 0.40–0.91; p = 0.015), while no significant difference in HCC recurrence rates was observed between the two groups. In a subgroup
analysis of patients who experienced tumor recurrence (n = 204), overall survival (OS) did not differ according to PNI status (p = 0.919); however, the presence of SLD remained significantly associated with prolonged OS (p = 0.003). Notably, patients with SLD received more locoregional therapies following recurrence, including radiofrequency ablation and transarterial chemoembolization.
Conclusions: These findings indicate that the superior prognosis observed in CHB-HCC patients with concurrent SLD after curative resection is not solely attributable to better preoperative nutritional status. Rather, the presence of SLD appears to be associated with a preserved capacity to tolerate more locoregional therapies following recurrence, thereby contributing to improved overall survival.
ATEZOLIZUMAB 合併 BEVACIZUMAB
治療不可切除性肝細胞癌之出血風險：多中 心研究
BLEEDING RISK WITH ATEZOLIZUMAB PLUS BEVACIZUMAB IN UNRESECTABLE HEPATOCELLULAR CARCINOMA: A MULTICENTER EXPERIENCE
陳胤禎1 高偉育1-4 謝曜宇5-6 王嘉齊7 吳明順2,3,8 吳志宏9-11
丁偉義12 吳善加13,14 莊凱壹15 蘇建維16-19 張君照1-3
陳三奇17,20
1 臺北醫學大學附設醫院 胃腸肝膽科；2 臺北醫學大學 醫學系 胃腸肝膽科；3 臺北醫學大學 消 化醫學研究中 心；4 臺北醫學大學 代謝與肥胖科學研究所；5 臺北醫 學大學雙和醫院 血液腫瘤科；6 臺北醫學大學醫學系 血 液腫瘤科；7 佛教慈濟醫療財團法人臺北慈濟醫院 胃腸 科；8 臺北醫學大學萬芳醫院 胃腸肝膽科；9 國立臺灣 大學醫學院附設醫院 影像醫學暨放射科；10 國立臺灣大 學醫學院附設醫院 微創介入放射治療中心；11 國立臺灣 大學醫學院附設醫院 肝炎研究中心；12 臺北醫學大學雙 和醫院影像醫學科；13 臺北醫學大學萬芳醫院 放射科； 14 臺北醫學大學醫學系 放射科；15 臺北醫學大學附設醫 院 影像醫學科；16 臺北榮民總醫院 胃腸肝膽科；17 國立 陽明交通大學 醫學系；18 國立陽明交通大學 臨床醫學 研究所；19 臺北榮民總醫院 一般醫學科；20 臺北榮民總 醫院 腫瘤醫學部
Background: Atezolizumab plus bevacizumab (ate/bev) has become the standard first-line therapy for unresectable hepatocellular carcinoma (uHCC). However, bleeding complications remain a clinical concern, particularly in patients with pre-existing esophageal varices (EV) or peptic ulcer disease. The differential bleeding risks associated with baseline EV and ulcer lesions have not been fully characterized.
Aims: This multicenter study aimed to evaluate the incidence, severity, and risk factors of variceal and ulcerrelated bleeding in uHCC patients treated with ate/bev, with a particular focus on baseline endoscopic findings.
Methods: We retrospectively analyzed 262 consecutive uHCC patients who received ate/bev across eight hospitals in Taiwan. Baseline clinical characteristics and endoscopic findings were collected. Bleeding events were classified as variceal or ulcer-related and graded according to the Common Terminology Criteria for Adverse Events (CTCAE). Cumulative incidence was estimated, and Cox proportional hazards models were applied to identify
factors associated with bleeding risk.
Results: During follow-up, bleeding events occurred in 21 patients (8.0%), including 13 cases (5.0%) of variceal bleeding and 8 cases (3.1%) of ulcer-related bleeding. Patients with baseline endoscopic lesions (esophageal varices or ulcers) had a significantly higher bleeding risk than those without baseline lesions (22.4% vs. 7.9%, logrank p < 0.02). Similarly, baseline esophageal varices were associated with a markedly increased bleeding risk compared with the absence of baseline varices (19.4% vs. 5.1%, log-rank p < 0.01). In contrast, baseline ulcer status was not associated with a significant difference in bleeding risk (13.7% vs. 3.8%, log-rank p = 0.75).
In multivariable Cox regression analysis, baseline esophageal varices remained an independent risk factor for variceal bleeding during ate/bev therapy (HR 7.76, 95% CI 1.76–34.24; p < 0.01), whereas macrovascular invasion showed a trend toward an increased bleeding risk (HR 3.51, 95% CI 0.87–14.14; p = 0.08). By contrast, baseline ulcer presence was not significantly associated with ulcer-related bleeding (HR 1.79, 95% CI 0.33–9.82; p = 0.50), although macrovascular invasion showed a trend toward an increased risk of ulcer bleeding (HR 8.85, 95% CI 0.97–80.92; p = 0.053). High-grade bleeding events (CTCAE grade ≥ 3) accounted for 75.0% of ulcer related bleeding cases and 76.9% of variceal bleeding cases.
Conclusions: In uHCC patients treated with ate/bev, baseline esophageal varices are a major determinant of variceal bleeding risk, whereas baseline ulcer disease is not associated with an increased risk of ulcer-related bleeding. Patients without baseline endoscopic lesions have a low overall bleeding risk, supporting the safety of ate/bev in this population.
以 UP-TO-7 腫瘤負荷作為中期肝細胞癌在 肝動脈化學栓塞術失敗後接受一線酪胺酸激 酶抑制劑治療的務實預後分層指標 UP-TO-7 TUMOR BURDEN AS A PRAGMATIC PROGNOSTIC STRATIFIER FOR FIRST-LINE TYROSINE KINASE INHIBITOR THERAPY AFTER TACE FAILURE IN INTERMEDIATE-STAGE HEPATOCELLULAR CARCINOMA
林于智1 王鴻偉1,2 賴學洲1,3 許偉帆1,3 陳昇弘1,2 張育瑞1 顏子皓1 彭成元1,2
1 中國醫藥大學附設醫院內科部消化醫學中心
2 中國醫藥大學醫學系
3 中國醫藥大學中醫學系
Background: Intermediate-stage hepatocellular carcinoma (HCC) is clinically heterogeneous, and outcomes after transarterial chemoembolization (TACE) failure vary widely once systemic therapy is initiated. A simple, bedside-applicable stratification tool is needed to counsel patients and support risk-adapted management at the transition to first-line tyrosine kinase inhibitors (TKIs).
Aims: We investigated whether tumor burden, defined by the up-to-7 criteria, provides robust prognostic stratification for survival after TKI initiation, and whether on-demand TACE exposure offers additional prognostic information beyond tumor burden.
Methods: We retrospectively identified 47 patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who received first-line sorafenib or lenvatinib between February 2020 and January 2023 at China Medical University Hospital. Tumor burden was categorized as within versus beyond the up-to-7 criteria. Overall survival (OS) and progression-free survival (PFS) were measured from the date of TKI initiation. Kaplan–Meier methods and log-rank tests were used for survival comparisons. Multivariable Cox proportional hazards models were applied to evaluate the independent prognostic value of up-to-7 status and the incremental contribution of on-demand TACE exposure.
Results: Up-to-7 tumor burden demonstrated strong and consistent prognostic discrimination. Patients within the up-to-7 criteria had significantly better PFS (multivariable HR, 0.438; 95% CI, 0.215–0.892; p=0.023) and markedly improved OS (multivariable HR, 0.102; 95% CI, 0.018–0.565; p=0.009). In contrast, TACE exposure was not independently associated with PFS (multivariable HR,
0.722; p=0.368) or OS (p=0.455) after adjustment. AFP >9 ng/mL showed a nonsignificant trend toward shorter PFS (multivariable HR, 1.705; p=0.140). In an exploratory combined categorization, the “within up-to-7 with TACE exposure” subgroup showed improved PFS compared with all other patients (multivariable HR, 0.340; 95% CI, 0.137–0.841; p=0.020), whereas the OS signal was not significant (multivariable HR, 0.434; p=0.388).
Conclusions: Among intermediate-stage HCC patients initiating first-line TKIs after TACE failure, the up-to-7 criteria provide a pragmatic and powerful prognostic stratifier for both PFS and OS. TACE exposure does not add independent prognostic value overall, although an exploratory analysis suggests potential PFS benefit in selected patients with lower tumor burden. Prospective validation is warranted to determine how tumor-burden–based stratification can be adopted for risk-adapted management and treatment sequencing.
LENVATINIB 治療前四周的相對劑量強度 是不可切除肝細胞癌患者無進展生存期獲益 的影響因素：一項多中心真實世界研究 RELATIVE DOSE INTENSITY OVER THE FIRST FOUR WEEKS OF LENVATINIB THERAPY IS A FACTOR OF FAVORABLE PROGRESSION FREE SURVIVAL IN PATIENTS WITH UNRESECTABLE HEPATOCELLULAR CARCINOMA-A MULTICENTER, REAL WORLD STUDY
段思丞1 吳明順1, 3, 4 呂建宏2 高偉育2, 3, 4, 5 陳三奇6, 7
謝燿宇8, 9
1 臺北市立萬芳醫院 內科部 消化內科
2 臺北醫學大學附設醫院 內科部 消化內科
3 臺北醫學大學醫學院醫學系 內科學科 消化內科
4 臺北醫學大學消化醫學研究中心
5 臺北癌症中心
6 臺北榮民總醫院 腫瘤醫學部 腫瘤內科
7 國立陽明交通大學醫學院 醫學系
8 衛生福利部雙和醫院 內科部 血液腫瘤科
9 臺北醫學大學醫學院醫學系 內科學科 血液腫瘤學科
Background: Lenvatinib is an approved first-line therapy for unresectable hepatocellular carcinoma (HCC). Previous studies suggest that early treatment exposure, measured by 4-week relative dose intensity (4W-RDI) ≥70%, correlates with improved radiological response and overall survival (OS). However, real-world evidence linking 4W-RDI to progression-free survival (PFS) remains limited
Aims: To investigate the impact of early treatment exposure, assessed by 4-week relative dose intensity (4W-RDI), on progression-free survival and overall survival in patients with unresectable hepatocellular carcinoma receiving first-line lenvatinib in a real-world setting.
Methods: This multicenter retrospective study evaluated the association between 4W-RDI and treatment outcomes in 205 patients with unresectable HCC receiving first-line lenvatinib for ≥4 weeks. The 4W-RDI was calculated as the cumulative dose delivered during the first 4 weeks divided by the weight-based standard dose. Patients were stratified into high (≥80%) and low (<80%) 4W-RDI groups. The primary endpoint was PFS, and the secondary endpoint was OS. Survival outcomes were compared using Kaplan–Meier analysis and log-rank tests
Results: Median PFS was significantly longer in the high 4W-RDI group compared with the low 4W-RDI group (8.9 vs. 8.6 months; p = 0.038), indicating improved disease
control with higher early dose intensity. However, median OS did not differ significantly between groups (16.5 vs. 14.0 months; p = 0.10).
Conclusions: In this real-world study, maintaining a 4W-RDI ≥80% during lenvatinib initiation is associated with improved PFS but not OS. These findings support careful early dose management and timely post-progression strategies to optimize long-term outcomes.
肝細胞癌達到完全緩解之患者僅發生肝外復 發之臨床特性
CLINICAL CHARACTERISTICS FOR PATIENTS WITH HEPATOCELLULAR CARCINOMA WHO ACHIEVED COMPLETE RESPONSE WITH ONLY EXTRAHEPATIC RECURRENCE DURING FOLLOW-UP
黃顯鈞
高雄榮民總醫院內科部胃腸肝膽科
Background: Hepatocellular carcinoma (HCC) is a major health burden in Taiwan, ranking fourth in incidence and second in cancer-related mortality. Although some patients achieve complete response (CR) after curative or locoregional therapies, a small subgroup develops extrahepatic recurrence (EHR) without intrahepatic recurrence (IHR) during follow-up. Early identification of this pattern is challenging but clinically relevant for prognosis and therapeutic planning.
Aims: This study compared the clinical characteristics of patients with EHR only versus those with both IHR and EHR.
Methods: We retrospectively analyzed 4,161 HCC patients treated at Kaohsiung Veterans General Hospital from 2005 to 2022. Patients who achieved CR after surgical resection, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), transarterial chemoembolization (TACE), transarterial embolization (TAE), hepatic arterial infusion chemotherapy (HAIC), chemotherapy, radiotherapy, targeted therapy, or immuno-oncology (IO) therapy were included. Surveillance consisted of CT or MRI and serum tumor markers every 3–4 months; additional imaging, such as chest CT, brain scans, or bone scintigraphy, was performed when clinically indicated. Clinical parameters were assessed at diagnosis and at recurrence.
Results: Among patients with CR, 72 developed EHR. Of these, 10 (13.9%) had EHR only, and 62 (86.1%) had both EHR and IHR. All EHR-only patients (100%) underwent surgical resection, while subsets received chemotherapy (10%), HAIC (20%), TAE (10%), or IO therapy (20%).
Compared with the EHR+IHR group, the EHR-only group exhibited higher rates of BCLC stage ≥ B (90.0% vs. 43.5%, p = 0.014), larger tumor size (11.09 ± 4.43 vs. 5.07 ± 3.92 cm, p < 0.001), and AFP ≥ 200 ng/mL (50.0% vs. 16.1%, p = 0.045). Surgical resection (100% vs. 61.3%, p = 0.025) and IO therapy (20.0% vs. 0%, p = 0.018) were
also more common in the EHR-only group. No significant differences were observed at recurrence detection.
Conclusions: Patients with EHR only had distinct clinical profiles, including higher BCLC stage, larger tumor burden, and elevated AFP at baseline. They were also more likely to receive surgical resection and IO therapy. Recognition of these features may facilitate early identification and inform surveillance strategies for this unique subgroup.
驗證 UP7-ALBI 分數於不可切除肝 細胞癌接受 ATEZOLIZUMAB 合併 BEVACIZUMAB 治療之預後預測價值
VALIDATION OF THE UP7-ALBI SCORE FOR PROGNOSTICATION IN UNRESECTABLE HEPATOCELLULAR CARCINOMA TREATED WITH ATEZOLIZUMAB PLUS BEVACIZUMAB
黃柏叡2 呂建宏2 高偉育2-5 謝曜宇6,7 王嘉齊8 吳明順3,4,9
吳志宏10-12 丁偉義13 吳善加14,15 莊凱壹16 蘇建維17-20
張君照2-4 陳三奇1,18
1 臺北榮民總醫院 腫瘤醫學部；2 臺北醫學大學附設醫 院 內科部 消化內科；3 臺北醫學大學 醫學院 醫學系 內 科學科 消化內科學科；4 臺北醫學大學 消化醫學研究中 心；5 臺北醫學大學 代謝與肥胖科學研究所；6 臺北醫 學大學 衛生福利部雙和醫院 血液腫瘤科；7 臺北醫學大 學 醫學院 醫學系 內科學科 血液腫瘤學科；8 佛教慈濟 醫療財團法人台北慈濟醫院 胃腸肝膽科 及 慈濟大學醫 學院；9 臺北醫學大學 萬芳醫院 內科部 消化內科；10 國 立臺灣大學醫學院附設醫院 影像醫學部 及 國立臺灣大 學醫學院；11 國立臺灣大學醫學院附設醫院 微創介入放 射治療中心；12 國立臺灣大學醫學院附設醫院 肝炎研究 中心；13 臺北醫學大學 衛生福利部雙和醫院 影像醫學 部；14 臺北醫學大學 萬芳醫院 放射科；15 臺北醫學大 學 醫學院 醫學系 放射線學科；16 臺北醫學大學附設醫 院 影像醫學部；17 臺北榮民總醫院 內科部 胃腸肝膽科； 18 國立陽明交通大學 醫學院 醫學系；19 國立陽明交通大 學 醫學院 臨床醫學研究所；20 臺北榮民總醫院 內科部 一般內科
Background: A well-established prognostic scoring system for unresectable hepatocellular carcinoma (uHCC) receiving systemic therapy is lacking. The Up7-ALBI score has shown prognostic value for lenvatinib.
Aims: This study aimed to validate its prognostic value in uHCC treated with atezolizumab plus bevacizumab (ate/ bev).
Methods: This retrospective multicenter study included 225 patients with uHCC who received first-line ate/bev in Taiwan between 2020 and 2025. The Up7-ALBI score (0–2), combining tumor burden (within vs. beyond up-to-7) and ALBI grade (1 vs. 2–3), categorized patients into low-, intermediate-, and high-risk groups. The score was used to stratify overall survival (OS) and progression-free survival (PFS), with multivariate analysis performed to adjust for potential confounding.
Results: The objective response rate (ORR) and disease
control rate were 44.4% and 60.4%, respectively, and the median OS and PFS were 23.8 and 7.0 months. The Up7ALBI score significantly stratified outcomes, with OS not reached, 36.0 months, and 9.2 months for scores 0, 1, and 2 (p < 0.01); PFS of 13.4, 7.9, and 5.8 months; and ORR of 66.7%, 52.2%, and 32.9%, respectively (p < 0.01).
Multivariate analysis showed that Up7-ALBI scores 1 and 2, along with macrovascular invasion, were independent risk factors for OS. However, it was not associated with gastrointestinal bleeding risk.
Conclusions: This study validated the Up7-ALBI score for uHCC receiving ate/bev. Its consistent prognostic performance across systemic therapies supports its potential as a simple, clinically applicable risk-stratification tool.
電子壁報展示
第一部分：肝
P.001
屏東地區慢性 B 型肝炎肝硬化患者經核苷 酸類似物治療後以 APRI FIB-4 評估肝纖維 化其差異性預測肝癌發生風險之次分析研究 DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN CIRRHOTIC PATIENTS WITH CHRONIC HEPATITIS
B RECEIVING NUCLEOS(T)IDE
ANALOGUE THERAPY USING ONTREATMENT CHANGE IN APRI AND FIB-4 VALUES- PING-TUNG COUNTY EXPERIENCE
文士祺 屏東寶建醫院內科部胃腸肝膽科
Background: Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related deaths on a global scale. Chronic hepatitis B virus (HBV) infection is one of the leading causes of HCC worldwide. The identification of HCC risk factors and development of prognostic risk scores are essential for early diagnosis and prognosis in patients with chronic hepatitis B (CHB) related cirrhosis receiving nucleos(t)ide analogue (NUC) therapy.
Aims: We aimed to find out possible factors that could predict HCC development in patients with CHB receiving Tenofovir or Entecavir, particular in the subgroup of patient with cirrhosis, as well as to compare the predictive performance of various well known risk scoring model systems between cirrhosis and chronic hepatitis.
Methods: We retrospectively enrolled 129 patients with CHB who received tenofovir or entecavir therapy in Ping-Tung County between Nov 2013 and Nov 2023. We conducted this study to investigate the risk of HCC according to prognostic performance with APRI and fibrosis-4 (FIB-4) prognostic scores and calculated by received operating curves (ROCs) to assess. We compared the laboratory variables and noninvasive fibrosis indices at baseline and after treatment between patients with cirrhosis and CHB. We used the Cox proportional hazard model to perform a time to event analysis in order to assess probable factors associated with development of HCC. Kaplan-Meier analysis and log-rank test were performed to estimate and compare free curve between low and high risk in this realworld setting.
Results: Cirrhosis was present in 76 (58.9%) patients. Of the cirrhotic patients, the median age at baseline was 64.1±10.7 years. Fifty-nine (45.7%) were male, 29 (22.5%)
were diabetic, 45 (34.9%) were Tenofovir, 31(24.0%) were Entecavir. Eleven (8.5%) had HBeAg (+), and 22 (17.1%) had varices. In cirrhotic patients, there were 19 (14.7%) who developed HCC during treatment duration of 6.37±3.38 years and follow-up period 9.20±4.39 years. Cirrhotic patients had achieved a time to virological response (VR) of 8.49±5.22 months and VR (12M) 64 (49.6%). Compared with none cirrhotic patients, those cirrhotic had higher proportion of diabetic 29 (22.5%), lower proportion of HBeAg (+), lower albumin levels (3.81±0.57 gm/dL), lower AST levels (93.4±96.7 U/ L), lower ALT levels (98.4±119.9 U/L), lower platelet levels (133.8±54.8 x103/uL), lower HBV DNA levels (5.01±1.63 log IU/mL), high APRI levels (0.98±1.24) after treatment, higher APRI levels ≧ 0.7455 (optimal cutoff value change) after treatment 28 (21.7%), higher FIB4 levels after treatment (5.45±4.96), higher proportion FIB-4 levels ≧ 3.8575 before treatment 42(32.6%), higher proportion FIB-4 levels ≧ 4.3925 after treatment 21(16.3%) and high proportion △ FIB-4 ≧ 0 (median value on-treatment change) 10 (7.8%). Unadjusted univariate Cox regression analysis revealed that six factors associated with HCC were AFP before treatment (HR:1.001, 95% CI:1.000-1.001, P=0.001), APRI after treatment (HR:1.35 95% CI:1.140-1.601, P=0.001), △ APRI ≧ 0 (HR:3.961, 95% CI:1.543-10.167, P=0.004), APRI ≧ 0.7455 (HR:6.148, 95% CI:2.101-17.992, P=0.001), FIB-4 after treatment (HR:1.138, 95% CI:1.069-1.210, P<0.001) and FIB4 ≧ 4.3925 (HR:5.248, 95% CI: 2.027-13.586, P=0.001).
Base on adjusted multivariate Cox proportional hazard model, a factor with APRI ≧ 0.7455 (aHR:5.371, 95% CI:1.038-27.802, P=0.045) was determined to be an independent predictor of HCC development.
Conclusions: APRI and FIB-4 kinetics during NUC therapy showed discriminatory performance to assess the risk of HCC development in cirrhotic patients. Further research using a combination of on treatment change in APRI ≧ 0.7455 and FIB-4 ≧ 4.3925 values may help identify the highest risk of HCC.
P.002
台灣接受化學治療患者中血清陽性隱性 B 型肝炎病毒感染之盛行率 PREVALENCE OF SEROPOSITIVE OCCULT HEPATITIS B VIRUS INFECTION IN TAIWANESE PATIENTS UNDERGOING CHEMOTHERAPY
蘇培元1,2 黃稚雯1,2,3 顏旭亨1,2,4 陳洋源1 楊采旻1
1 彰化基督教醫院 胃腸肝膽科
2 國立中興大學醫學院 學士後醫學系
3 國立臺灣大學醫學院臨床醫學研究所
4 彰化基督教醫院人工智慧發展中心
Background: Occult hepatitis B virus (HBV) infection (OBI), defined by detectable HBV DNA in the absence of hepatitis B surface antigen (HBsAg), is associated with an increased risk of viral reactivation during cancer therapy. Despite the high endemicity of HBV in Taiwan, data on the prevalence and clinical predictors of OBI among patients with cancer remain limited.
Aims: To investigate the prevalence of occult hepatitis B virus infection (OBI) among Taiwanese patients with cancer and to identify associated clinical factors.
Methods: We conducted a retrospective study of patients with cancer treated at Changhua Christian Hospital between January 2021 and May 2025. Patients with positive antiHBc IgG and negative HBsAg were included. OBI was defined by detectable HBV DNA. Clinical characteristics were analyzed using univariate and multivariate logistic regression to identify factors associated with OBI.
Results: Among 1,935 patients, 65 (3.4%) had OBI. Patients with OBI were older and more likely to have hematologic malignancies. On multivariate analysis, age (OR 1.03; 95% CI 1.01–1.06) and hematologic malignancies (OR 2.47; 95% CI 1.34–4.55) were independently associated with OBI. The prevalence of OBI was significantly higher in patients without anti-HBs than in those with anti-HBs (6.9% vs. 1.6%).
Conclusions: Occult hepatitis B virus infection was not uncommon among Taiwanese patients with cancer, particularly in older patients and those with hematologic malignancies, highlighting the importance of vigilant HBV assessment in this high-risk population.
P.003
慢性 B 型肝炎患者 FIB-4 評分與
FIBROSCAN 肝臟硬度測量值的相關性：單 中心經驗
CORRELATION BETWEEN FIB-4 SCORE AND FIBROSCAN LIVER STIFFNESS MEASUREMENT IN CHRONIC HEPATITIS B: A SINGLE-CENTER EXPERIENCE
林煒晟 連梓亞 林揚笙 王鴻源 張經緯 台北馬偕紀念醫院 消化科系
Background: In patients with chronic hepatitis B (HBV), accurate staging of liver fibrosis is a vital predictor of disease progression and an important indicator for initiating antiviral therapy. The fibrosis index based on four factors (FIB-4) score is a widely used non-invasive tool for assessing liver fibrosis. FibroScan is considered one of the most reliable non-invasive tools; however, its high cost and limited availability restrict its use in some settings.
Aims: This study aimed to compare FIB-4 results with liver stiffness measurements (LSM) obtained via FibroScan to determine their correlation and effectiveness in diagnosing advanced fibrosis in real-world clinical practice.
Methods: This was a retrospective study conducted at a tertiary care center in Taipei, Taiwan, between May 2025 and October 2025. During the study period, both FIB-4 and FibroScan assessments were performed in all enrolled patients with HBV. FIB-4 scores were calculated using standard formulas, and LSM was measured using FibroScan. A low FIB-4 score was defined as <1.30, and a high score as >2.67. Correlation analysis was performed, and results were stratified by fibrosis stages (F0–F4).
Results: Among the 69 patients, 32 (46.4%) were male, and the mean age was 60.4 years. The mean body mass index was 26.1 kg/m². Thirty-three patients had low FIB4 scores, 26 had indeterminate scores, and 10 had high scores. Among patients with low FIB-4 scores, 30.1% had advanced fibrosis (F2–F4, defined by an LSM >8 kPa), which would have been missed if relying solely on FIB-4. Among those with high FIB-4 scores, 60% had no fibrosis (F0, defined by an LSM <7 kPa). The correlation coefficient between FIB-4 and FibroScan results was 0.273 (p = 0.023), indicating a weak but statistically significant correlation.
Conclusions: This study demonstrates a weak correlation between FIB-4 scores and LSM measurements, with a significant proportion of patients with advanced fibrosis being missed when relying on FIB-4 alone. These findings
highlight the importance of evaluating the complete clinical context and considering additional diagnostic tools to appropriately risk-stratify patients, particularly when clinical suspicion of fibrosis remains high despite a low FIB-4 score.
P.004
心臟血管代謝相關風險因子對於完治慢性 C 型肝炎患者之末期慢性肝病與肝細胞癌的影 響
IMPACT OF CARDIOMETABOLIC RISK FACTORS ON ADVANCED CHRONIC LIVER DISEASE AND HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CURED CHRONIC HEPATITIS C
Background: Despite hepatitis C virus eradication, patients with advanced fibrosis or cirrhosis remain at persistent risk for hepatocellular carcinoma (HCC) and liver-related events (LREs). The association between metabolic dysfunction-associated steatotic liver disease (MASLD) or cardiometabolic risk factors (CMRFs) and advanced chronic liver disease (ACLD) in patients with cured chronic hepatitis C (CHC) is unknown.
Aims: The aim of this study is to evaluate whether MASLD or CMRFs are associated with the development of ACLD among patients with a sustained virologic response to hepatitis C treatment.
Methods: This retrospective study enrolled 1086 patients with cured CHC without alcohol consumption between September 2012 and November 2024. The CMRFs were defined in accordance with the guidelines. Variables and fibrosis-4 (FIB-4) obtained at 12 or 24 weeks after DAA therapy (PW12) were used to identify the predictors of ACLD, HCC, and LREs. Patients with liver cirrhosis (LC) or an FIB-4 >3.25 at baseline were defined as patients with ACLD. LC was diagnosed based on liver histology, clinical, endoscopic, or laboratory evidence of LC at baseline. LREs included ascites, high-risk esophageal or bleeding gastric varices, hepatic encephalopathy, hepatorenal syndrome, and HCC. The variables with a P-value of <0.157 in the univariate analysis were included in the logistic (for ACLD) or multivariable Cox regression (for HCC and LREs) analyses.
Results: Of 1086 patients, 549 patients (50.6%) fulfilled the diagnostic criteria for MASLD at PW12. The median FIB-4 declined from 4.39 at baseline to 2.90 at the end of therapy and 2.83 at PW12 in patients with baseline
advanced liver fibrosis or cirrhosis. FIB-4 >2.83 at PW12 was used to define ACLD after viral eradication. A multivariable logistic regression analysis of the variable at PW12 identified hypertension, in addition to aspartate aminotransferase and platelet count, as significant predictors of ACLD. Multivariable Cox regression analyses indicated that per CMRF (hazard ratio [HR]: 1.279, 95% confidence interval [CI]: 1.004–1.631), and FIB-4 >2.83 (HR: 4.178; 95% CI: 1.948–8.961) were risk factors for HCC development, and that per CMRF (HR: 1.336, 95% CI: 1.089–1.639) and FIB-4 >2.83 (HR: 3.976, 95% CI: 2.062–7.665) were also risk factors for LREs.
Conclusions: Among the individual CMRF, hypertension was an independent predictor of ACLD. The ACLD and number of CMRFs were risk factors for incident HCC and LREs in patients with cured CHC.
P.005
比較年輕和老年慢性 B 型肝炎患者對核苷 ( 酸 ) 類似物的抗病毒免疫反應
COMPARATIVE ANALYSIS OF ANTIVIRAL IMMUNE RESPONSES TO NUCLEOS(T)IDE ANALOGUES IN YOUNGER AND OLDER PATIENTS WITH CHRONIC HEPATITIS B
陳俞宏1,4 黃文彥2 樊修龍3 施宇隆1 謝財源1 鄭揚5 黃瑋琛1,4
1 三軍總醫院胃腸肝膽科
2 三軍總醫院放射腫瘤部
3 三軍總醫院移植外科
4 國防醫學大學臨床免疫學實驗室
5 中研院生物醫學研究所
Background: Chronic hepatitis B (CHB) remains a major global health challenge, affecting an estimated 254 million people worldwide and causing 1.3 million deaths annually. Although Taiwan’s nationwide universal vaccination program has markedly reduced new infections among younger generations, a substantial population of chronically infected older patients persists, contributing to rising rates of cirrhosis and hepatocellular carcinoma (HCC). Current first-line therapies suppress viral replication but rarely achieve functional cure, and age-related immune differences are not adequately addressed in existing treatment guidelines.
Aims: To investigate age-dependent antiviral immune responses to therapeutic intervention in patients with CHB. Methods: Patients were analyzed across age groups to assess functional responses of key antiviral effectors, including Natural Killer (NK) cells and HBV-specific T cells, in the context of antiviral therapy.
Results: Younger patients exhibited Th1-skewed antiviral immune responses, whereas older patients demonstrated progressive immune exhaustion following decades of persistent antigenic stimulation.
Conclusions: Age critically shapes the host–virus immune landscape in CHB. Defining age-specific immune signatures may guide personalized treatment strategies, optimize emerging immunotherapies, and improve clinical outcomes toward the goal of HBV elimination.
P.006
長期使用口服核苷酸類似物治療之非肝硬化 E 抗原陰性慢性 B 型肝炎患者其血液 B 型 肝炎表面抗原定量濃度分析研究 ANALYSIS OF THE SERUM QUANTITATIVE HEPATITIS B SURFACE ANTIGEN LEVELS IN NON-CIRRHOTIC HBEAG-NEGATIVE CHRONIC HEPATITIS B PATIENTS TREATED BY LONG-TERM ORAL NUCLEOS(T)IDE ANALOGUES
朱啟仁1,2 林泰谷1 欒志軒1 林崇棋2,3 蘇建維1,2 李發耀1,2 羅景全1,2 黃怡翔1,2 侯明志1,2
1 臺北榮民總醫院內科部胃腸肝膽科
2 國立陽明交通大學醫學院醫學糸內科
3 臺北榮民總醫院健康管理中心
Background: Nucleos(t)ide analogues (NAs) therapy is the mainstay treatment of chronic hepatitis B (CHB) infection, effectively reducing the risks of advanced liver disease and hepatocellular carcinoma (HCC) development. For patients with hepatitis B e antigen (HBeAg)-negative CHB, the phenomenon of disease flare is quite common when NAs was discontinued before hepatitis B surface antigen (HBsAg) loss. Quantitative HBsAg level is an important and useful tool to predict post-therapy virological or clinical relapse after NAs withdrawal. Previous studies demonstrated that if HBsAg level can be lowered to < 100 IU/mL at the time point of NAs discontinuation, the expected 2-year clinical relapse rate after NAs withdrawal was less than 20%.
Aims: To analyze the quantitative HBsAg levels of noncirrhotic HBeAg (-) CHB patients under long-term therapy of NAs with sustained viral suppression.
Methods: The eligible candidates were patients who diagnosed to have HBeAg (-) CHB, and under long-term (≥3 years) NAs treatment by the investigators with at least two years of viral suppression (i.e. undetectable HBV DNA < 10 IU/mL by real-time PCR) till last visit. Patients had the following condition were excluded including: 1).
History of HCC, 2). Diagnosed to have compensated or decompensated liver cirrhosis, 3). Co-infected with HCV, HDV or HIV, 4). Post-organ transplantation, and 5). Under cancer chemotherapy or immunosuppressant therapy. Quantitative HBsAg level was measured by commercially available kit with a lower limit of detection of 0.05 IU/ mL. Patient characteristics were presented as means and standard deviations or as percentages when appropriate. A
statistically significant result was defined as P<0.05. Results: A total of 90 patients were enrolled for analyze, the mean age of study population was 60.8±10.5 years and 59 (65.6%) of them was male. Forty-five (50%) of them have been treated with NAs before with disease relapse, 75 (83.3%) of study population was currently treated by entecavir and others were treated by tenofovir disoproxil fumarate/ tenofovir alafenamide. Patients were categorized into two groups according to treatment duration: group 1 (n=46, NAs duration: 3-8 years), and group 2 (n=44, NAs duration: 8-15 years). The distribution of last available quantitative HBsAg level is quite variable, the percentages to have HBsAg level < 100 IU/mL, 100-200 IU/mL, 200500 IU/mL, 500-1000 IU/mL and > 1000 IU/ml were 28.3%, 17.4%, 26.1%, 15.2%, and 13.0% in group 1; and 54.5%, 20.5%, 9.1%, 11.4%, and 4.5% in group 2, respectively. Longer NAs treatment duration tended to have a lower HBsAg level but baseline HBsAg is the most important determinant. The decline of HBsAg level is slow, the mean decline of HBsAg in recent 1-year period was 0.123±0.020 log10 IU/mL for group 1 and 0.110±0.016 log10 IU/mL for group 2 patients, respectively (P=0.898).
Conclusions: Our study demonstrated that for HBeAg (-) CHB patients treated by long-term NAs, the distribution of quantitative HBsAg levels is variable and the decline of HBsAg level is slow. Using NAs therapy alone to reach the proposed HBsAg threshold for safely discontinuation of oral antiviral therapy need very long-term and incorporating other strategies to facilitate HBsAg decline is in urgent need. Optimal endpoint for NAs discontinuation in HBeAg (-) CHB and accurate predictors of post-treatment course by including novel viral or immunological biomarkers remains to be defined.
P.007
體能表現與慢性肝病患者的嚴重肝纖維化的 相關性
PHYSICAL PERFORMANCE IS ASSOCIATED WITH SEVERE LIVER FIBROSIS IN PATIENTS WITH CHRONIC LIVER DISEASE
許景盛1,2,5 林志明2,4 蔡佳勳2,4 洪宗興3,4 柯秉宏3,4 曾國枝3,4
1 台中慈濟醫院研究部
2 台中慈濟醫院消化醫學中心
3 大林慈濟醫院腸胃科
4 慈濟大學醫學系
5 慈濟大學學士後中醫學系
Background: Physical activity is a key lifestyle factor that influences the development of chronic liver disease (CLD). However, the impact of physical performance on the severity of liver fibrosis in CLD patients remains unclear.
Aims: This study aimed to investigate the association between physical performance and liver fibrosis by analyzing the relationship between noninvasive fibrosis markers and various assessments of physical performance in individuals with CLD.
Methods: This retrospective study included 200 patients with various chronic liver conditions who underwent physical performance evaluations at Dalin and Taipei Tzu Chi Hospital between July 2020 and June 2023. The evaluations included handgrip strength, the Short Physical Performance Battery, the Five Times Sit-to-Stand Test, the 4-meter usual walking speed test, and the 6-minute walking test. Liver fibrosis was assessed using the Fibrosis-4 Index (FIB-4), with scores ≥2.67 indicating advanced fibrosis and <1.3 indicating its absence. Clinical data, FIB-4 scores and physical performance measures were analyzed for associations.
Results: The cohort included 100 patients with chronic hepatitis B, 16 with hepatitis C, 56 with liver cirrhosis, 20 with alcoholic liver disease, and 123 with steatotic liver disease. All participants were nutritionally stable. Among them, 23 were identified with advanced liver fibrosis.
Multivariate analysis showed that older age and lower handgrip strength were significantly associated with FIB4 scores ≥2.67. On the contrary, steatotic liver disease was significantly associated with FIB-4 scores <1.3.
Conclusions: Reduced handgrip strength and the presence of steatotic liver disease may serve as potential indicators for screening advanced liver fibrosis in patients with CLD.
P.008
TENOFOVIR DISOPROXIL FUMARATE 可降低慢性 B 型肝炎患者之血清 APO-B100
，並提升膽固醇負載能力
TENOFOVIR DISOPROXIL FUMARATE LOWERS SERUM APO-B100 AND INCREASES CHOLESTEROL LOADING CAPACITY IN CHRONIC HEPATITIS B PATIENTS
陸冠廷1 孫宏羽2 楊孔嘉3 邱宏智1 邱彥程1 簡世杰1
鄭斌男1
1 國立成功大學醫學院附設醫院 內科部
2 國立成功大學醫學院 生理學研究所
3 國立成功大學醫學院 醫學檢驗生物技術學系
Background: Tenofovir disoproxil fumarate (TDF) has been shown to have lipid-lowering effects in chronic hepatitis B (CHB) patients. Our previous study in hepatitis C patients demonstrated that lipoprotein loading capacity reflects antiviral-associated lipid changes. However, the features of loading capacity in TDF-treated CHB patients remain unknown.
Aims: This study aimed to compare lipoprotein lipid loading capacity and apolipoprotein B-100 levels between CHB patients receiving TDF versus entecavir (ETV).
Methods: Thirty-six CHB patients who were later switched to tenofovir alafenamide (TAF) were enrolled (30 from TDF, 6 from ETV). Baseline characteristics before switching were analyzed for this cross-sectional comparison. VLDL and LDL were isolated by iodixanol density gradient ultracentrifugation. Triglyceride (TG), cholesterol (Chol), and apolipoprotein B-100 (apoB-100) were quantified. Lipid loading capacities were calculated as lipid-to-apoB-100 ratios.
Results: Compared to ETV-treated patients, TDF-treated patients were younger (53.7±9.4 vs. 64.2±11.1 years, p=0.021) and had lower total cholesterol (152.6±23.6 vs. 182.3±32.4 mg/dL, p=0.011) and LDL-C (98.2±23.6 vs. 123.3±27.7 mg/dL, p=0.027), while HDL-C and TG were similar. Notably, TDF patients had markedly reduced LDL apoB-100 (17.10±8.48 vs. 31.89±10.07 mg/dL, p=0.001), representing 46% fewer LDL particles, while VLDL apoB100 remained similar. Despite fewer LDL particles, TDF patients demonstrated higher cholesterol loading capacity in both VLDL (4.15±1.09 vs. 2.59±0.75, p=0.002) and LDL (7.14±3.65 vs. 3.07±0.31, p<0.001). TG loading capacity was similar between groups in both lipoprotein fractions. Conclusions: TDF treatment is associated with significantly
reduced LDL ApoB-100 level suggesting enhanced hepatic clearance, while cholesterol loading capacity increases instead. These findings provide mechanistic insights into TDF’s lipid-lowering effects and long-term effects warrant further evaluation.
P.009
慢性 B 型肝炎患者由 TENOFOVIR DISOPROXIL FUMARATE 或
ENTECAVIR 轉換為 TENOFOVIR ALAFENAMIDE 後脂蛋白脂質承載能力之 變化
CHANGES IN LIPID LOADING CAPACITY OF LIPOPROTEINS IN CHRONIC HEPATITIS B PATIENTS SWITCHING FROM TENOFOVIR DISOPROXIL FUMARATE OR ENTECAVIR TO TENOFOVIR ALAFENAMIDE
吳銘軒1 孫宏羽2 楊孔嘉3 邱宏智1 邱彥程1 簡世杰1 鄭斌男1 1 國立成功大學醫學院附設醫院內科部胃腸肝膽科 2 國立成功大學醫學院醫學系生理學科暨研究所 3 國立成功大學醫學院醫學檢驗生物技術學系
Background: Previous studies have shown increased lipid profiles when chronic hepatitis B (CHB) patients switch from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF), but the underlying mechanisms remain unclear.
Aims: We investigated changes in lipoprotein lipid loading capacities and apolipoprotein B-100 (apoB-100) levels to elucidate the mechanisms underlying lipid profile changes during antiviral drug switching.
Methods: Thirty-six CHB patients switching to TAF (30 from TDF and six from entecavir [ETV]) were enrolled. Plasma samples were collected at baseline and at week 48 post-switch. Very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) were isolated by iodixanol density gradient ultracentrifugation. Triglyceride (TG), cholesterol (Chol), and apoB-100 were quantified. Lipid loading capacities were calculated as lipid-to-apoB-100 ratios.
Results: Following the switch from TDF to TAF, all lipid profiles increased significantly in TDF-switch patients, accompanied by increased LDL apoB-100 (17.10 ± 8.48 to 34.38 ± 9.42 mg/dL, p < 0.001), decreased VLDL apoB100 (34.21 ± 14.83 to 21.09 ± 5.25 mg/dL, p < 0.001), decreased Chol loading capacity of LDL (7.14 ± 3.65 to 3.70 ± 0.84, p < 0.001), decreased TG loading capacity of LDL (1.45 ± 1.28 to 0.71 ± 0.28, p = 0.002), and increased TG loading capacity of VLDL (1.58 ± 1.04 to 2.75 ± 1.22, p < 0.001). In contrast, all lipid profiles, apoB-100, and Chol and TG loading capacities remained stable in ETV-
switch patients. At week 48, despite similar apoB-100 levels in both lipoproteins, TDF-switch patients maintained higher Chol and TG loading capacities in VLDL and higher Chol loading capacity in LDL compared to ETV-switch patients (all p < 0.05).
Conclusions: Switching from TDF to TAF results in decreased VLDL apoB-100 with increased Chol and TG loading capacities, indicating greater lipid delivery from the liver. Normalization of LDL apoB-100 results in decreased Chol and TG loading capacities, indicating more lipid in blood circulation. These metabolic changes mechanistically explain the elevation in lipid profiles and warrant assessment of cardiovascular outcomes.
P.010
接受生物製劑治療之發炎性腸道疾病患者， 其 B 型肝炎病毒復發之風險
RISK OF HEPATITIS B VIRUS
REACTIVATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE RECEIVING BIOLOGIC THERAPY
郭程瑋1 戴維震1,2 蔡雨潔1 梁志明1 蔡明釗1 吳鎮琨1 蔡成枝1 吳耿良3 姚志謙1
1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系 暨 長庚大學醫學系
2 高雄市立大同醫院
3 吳耿良胃腸肝膽專科診所
Background: Taiwan remains an endemic area for hepatitis B virus (HBV), with a significantly higher prevalence than Western countries. While biologic agents have become a cornerstone in the management of inflammatory bowel disease (IBD), the risk of HBV reactivation associated with these therapies remains insufficiently characterized in clinical practice.
Aims: This study aimed to evaluate the incidence of HBV reactivation and the efficacy of prophylactic antiviral therapy in IBD patients undergoing biologic treatment.
Methods: This retrospective cohort study included 81 patients with IBD (47 with Crohn’s disease [CD] and 34 with ulcerative colitis [UC]) who received biologic agents at Kaohsiung Chang Gung Memorial Hospital between January 2017 and December 2025. All patients were screened for HBV serological markers, including HBsAg and anti-HBc, prior to the initiation of biologics. The clinical course, use of prophylactic antiviral medications, and serial HBV DNA levels were analyzed.
Results: The study population comprised 37 females and 44 males, with a median age of 56 years (range: 18–81). At baseline, 7 patients were HBsAg-positive (5 CD; 2 UC), six of whom received prophylactic antiviral therapy and 26 patients exhibited isolated anti-HBc positivity (16 CD; 10 UC). HBV reactivation occurred in three HBsAgpositive patients, all of whom had CD. Two of these cases experienced reactivation: one at month 8 of adalimumab treatment despite receiving prophylactic antiviral therapy (HBV DNA increased from 340698 to 1,360,000 IU/ ml) and another at month 6 of ustekinumab treatment (HBV DNA increased from 10 to 450,000 IU/ml) without prophylactic antiviral therapy. The third reactivation event occurred at month 9 in a patient receiving adalimumab without prophylaxis (HBV DNA increased from 10
to 801,000 IU/ml). In contrast, among the 26 patients with isolated anti-HBc positivity, none received HBV prophylaxis, and no HBV reactivation were observed during the study period.
Conclusions: Our findings suggest that HBsAg-positive IBD patients remain at considerable risk for HBV reactivation even when receiving prophylactic antiviral therapy. However, for patients with isolated anti-HBc positivity, the risk of reactivation appears minimal, suggesting that routine prophylaxis may not be necessary in this subgroup.
P.011
FIBROSIS-4 指數可預測心衰竭患者的死亡 率
LIVER STIFFNESS ASSESSED BY FIBROSIS-4 INDEX PREDICTS
MORTALITY IN PATIENTS WITH HEART FAILURE
楊必玲1 葉淳1 李壽東2 張鴻猷3 1 振興醫療財團法人振興醫院腸胃科主治醫師 2 振興醫療財團法人振興醫院腸胃科主治醫師．台北榮 民總醫院醫療顧問．國立陽明交通大學醫學院榮譽教授 3 振興醫院心臟醫學中心心臟血管內科主治醫師 國立陽 明交通大學醫學系副教授
Background: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and independently affects the development of cardiovascular (CV) disease. We investigated whether hepatic steatosis and/or fibrosis are associated with the development of hospitalized heart failure (HF) mortality, and CV death in HF patients. Liver dysfunction due to HF is known as congestive hepatopathy. The Fibrosis-4 (FIB4) index calculated by (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is useful for evaluating liver stiffness in patients with NAFLD. Liver fibrosis indices (e.g., FIB-4) reflect systemic congestion and hepatic injury in HF.
Aims: We investigated whether higher FIB-4 is associated with (1) nutritional status (BMI), (2) hospitalization frequency, (3)Distinct Comorbidity and (4) specific causes of death.
Methods: We conducted a single-center retrospective cohort study of consecutive 6154 adults hospitalized for HF from Cheng Hsin General Hospital, Taipei between January, 2013 and December 2021. FIB-4 was calculated at index admission from age, AST, ALT, and platelet count, and categorized as [low: < 1.72, n=2,095], [intermediate: 1.72–3.01, n=1,932], and [high: ≥3.01, n=2,127].
Differences between groups were analyzed using KruskalWallis tests for continuous variables and Chi-square tests for categorical variables
Results: Among 6,154 patients (41.2% women), higher FIB-4 was associated with:
● Lower BMI: Mean BMI significantly decreased as FIB-4 increased (Group Low: 25.7 vs. Group High: 24.0 kg/m², P < 0.001).
● Higher Hospitalization Frequency: Patients with high
FIB-4 had a significantly higher mean number of total hospitalizations (4.81 vs. 4.74, P = 0.047).
● Distinct Comorbidity Profile: High FIB-4 patients had more severe heart failure (53.5% vs. 48.3%, P = 0.003). Conversely, the prevalence of hyperlipidemia significantly decreased as FIB-4 increased (Group 1: 4.1% vs. Group 2: 2.7% vs. Group 3: 2.4%, P = 0.003).
● Lower Survival: All-cause mortality was significantly higher in the high FIB-4 group (14.3% vs. 8.6%, P < 0.001).
● Causes of Death Analysis: Among non-survivors, the leading causes were Infection (33–34%) and severity of Heart Failure (21–24%). Notably, deaths attributed to Liver/Biliary Disease were higher in Group 3 (3.6%) compared to Group 1 (1.6%) and Group 2 (1.3%), highlighting the clinical relevance of elevated fibrosis markers to liver-related mortality.
Conclusions: Elevated FIB-4 at HF admission identifies a high-risk phenotype characterized by lower BMI, increased hospitalization, and reduced survival. The inverse association with hyperlipidemia, combined with lower BMI, suggests that high FIB-4 in this population may reflect impaired hepatic synthetic function and poor nutritional status rather than typical metabolic risk profiles. FIB-4 serves as a valuable marker for identifying vulnerable patients requiring closer surveillance. Clinical Perspective: Beyond predicting mortality, FIB-4 signals nutritional risk and potential hepatic vulnerability. Routine assessment could flag patients who benefit from nutritional evaluation and monitoring for both cardiac and hepatic complications.
P.012
黃酮類化合物 CALYCOSIN 於肝細胞模型 中之氧化傷害效應：對肝臟氧化還原失衡之 潛在意涵
OXIDATIVE CYTOTOXICITY OF CALYCOSIN IN LIVER CELL MODELS: IMPLICATIONS FOR HEPATIC REDOX DISORDERS
孫煒智1,2 梁維哲3
1 國立中山大學生物醫學研究所
2 高雄榮民總醫院內科部胃腸肝膽科
3 高雄榮民總醫院教學研究部
Background: Calycosin (7-hydroxy isoflavone), a naturally occurring flavonoid found in citrus fruits and Astragalus species, exhibits notable antioxidant, anti-inflammatory, and anticancer properties. While its cytotoxicity has been demonstrated in various cancer cell models, its impact on redox homeostasis in hepatic systems remains largely unexplored. Given that oxidative imbalance plays a pivotal role in modulating cellular processes, such as metabolism, proliferation, and programmed cell death, understanding its modulation is essential for therapeutic development.
Aims: This study aimed to investigate the oxidative response induced by calycosin in human hepatic cell models, through a three-phase evaluation in WRL68 cells: (1) Assess dose-dependent effects of calycosin on cell viability. (2) Evaluate morphological alterations following treatment. (3) Explore the interplay between oxidative stress markers and cytotoxicity.
Methods: Cell viability was measured using the Cell Counting Kit-8 (CCK-8). Intracellular reactive oxygen species (ROS) and glutathione (GSH) levels were quantified via DCFH-DA and CMF fluorescence assays, respectively, and analyzed with a microplate reader. Apoptotic activity was determined through flow cytometric analysis.
Results: Calycosin treatment led to a concentrationdependent reduction in cell viability, elevation of intracellular ROS, and depletion of GSH content— indicative of oxidative stress. Notably, pretreatment with vitamin E (5 μM) significantly mitigated these effects, supporting a redox-related mechanism of toxicity.
Conclusions: Our findings indicate that calycosin induces oxidative damage as a key mediator of cytotoxicity in liver cell models. The attenuation of these effects by antioxidant suggests potential therapeutic targets for modulating calycosin-induced stress responses.
P.013
腸道上皮 PPARγ 缺失在高脂速食誘導之 MASH 模型中加劇腸道屏障功能障礙與菌 相失衡
INTESTINAL EPITHELIAL PPARγ DEFICIENCY EXACERBATES GUT BARRIER DYSFUNCTION AND DYSBIOSIS IN A FAST FOOD DIETINDUCED MASH MODEL
謝昀蓁 黃怡翔 侯明志 林漢傑 李癸汌 台北榮民總醫院內科部胃腸肝膽科
Background: Metabolic dysfunction-associated steatohepatitis (MASH) is closely linked to gut-liver axis disturbances. Peroxisome proliferator-activated receptor gamma (PPARγ) plays a crucial role in maintaining intestinal homeostasis.
Aims: This study aimed to investigate the impact of intestinal epithelial PPARγ deficiency on gut microbiota, intestinal inflammation, barrier function, and bacterial translocation in a fast food diet (FFD)-induced MASH model.
Methods: Mice with intestinal epithelial cell-specific PPARγ deficiency (PPARγΔIEC) were generated using a villin-Cre transgene and floxed Pparg allele. Littermate mice carrying only the floxed Pparg allele without the Cre transgene (PPARγf/f), served as controls. MASH was induced by feeding a fast food diet (FFD) for 24 weeks.
Results: Intestinal epithelial PPARγ deficiency significantly exacerbated FFD-induced intestinal inflammation and downregulated the expression of tight junction proteins (occludin, claudin-1, and claudin-2) in both the ileum and colon. These changes were accompanied by increased gut permeability and enhanced bacterial translocation, evidenced by higher circulating lipopolysaccharide (LPS) levels in PPARγΔIEC-FFD mice. Microbiota analysis revealed that while diet was the primary driver of microbial community separation (PCoA), and FFD increased Firmicutes across genotypes, the loss of intestinal PPARγ specifically facilitated the expansion of pro-inflammatory taxa. LEfSe analysis identified a significant enrichment of Desulfovibrio and Streptococcaceae in PPARγΔIEC-FFD mice. Heatmap correlations further demonstrated that this specific microbial shift was closely aligned with impaired barrier function and systemic endotoxemia.
Conclusions: Our findings suggest that intestinal epithelial PPARγ is essential for maintaining the gut barrier during metabolic stress. Its deficiency promotes the expansion
of barrier-disrupting microbiota such as Desulfovibrio, leading to increased bacterial translocation and systemic inflammation.
P.014
12-79 歲美國人口中代謝功能障礙相關脂肪 性肝病的盛行率、趨勢與特徵 PREVALENCE, TRENDS, AND CHARACTERISTICS OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE AMONG THE US POPULATION AGED 12–79 YEARS
甄沛勤1 張君照1, 2
1 臺北醫學大學附設醫院內科部消化內科
2 臺北醫學大學消化醫學研究中心
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has emerged as a major global health concern. It is the most common liver disorder in Western countries and is frequently comorbid with metabolic conditions such as obesity, type 2 diabetes, and hypertension. The rising rates of these metabolic syndromes have led to increased economic burdens and long-term health threats. While prevalence has historically risen, recent trends in specific demographic subgroups remain unclear. Furthermore, the surge in childhood obesity suggests MASLD is becoming an urgent challenge among adolescents and young adults (AYA), necessitating updated epidemiological data.
Aims: The primary objective of this study was to report and update the prevalence and temporal trends of MASLD among the United States population over a twentyyear period. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, the authors aimed to analyze these trends specifically within adult (aged 20-79) and adolescent and young adult (AYA, aged 12-19) populations.
Methods: This cross-sectional study utilized data from ten cycles of the NHANES (1999–2018), including adults aged 20–79 and AYA aged 12–19. MASLD in adults was defined using the US Fatty Liver Index (US-FLI) with a cutoff of >= 30. For the AYA population, MASLD was defined by elevated alanine aminotransferase (ALT) levels combined with obesity or overweight status, as the US-FLI is not valid for this age group. The researchers employed joinpoint regression analysis to evaluate prevalence trends and calculate the average annual percentage change (AAPC). Additionally, multivariable logistic regression models were used to determine characteristics associated with MASLD.
Results: Overall, MASLD prevalence increased among US adults in the past two decades. Particularly, the prevalence increased from 30.8% in 1999–2000 to 37.7% in 2017–2018. Furthermore, the increase was observed in female participants, age groups 20–45 and 61–79 years, and nonHispanic white individuals. In terms of characteristics, adults with MASLD were often >50 years old, men, Mexican American, and unmarried, and had a low family income, poor general health, obesity or overweight, and chronic conditions. Additionally, AYA with MASLD were Mexican American boys, and they had a low family income and did not have kindergarten to high school education.
Conclusions: In this nationally representative survey, significant increases in MASLD prevalence were found in the overall adult population and in subgroups. Healthcare providers should raise awareness regarding the increasing trend of MASLD and the characteristics associated with MASLD to prevent and treat conditions associated with MASLD.
P.015
持續高脂飲食攝取對肥胖大鼠減重手術後肝 臟脂質自噬與代謝適應的調節效果有差異 SUSTAINED HIGH-FAT DIET INTAKE DIFFERENTIALLY REGULATES HEPATIC LIPOPHAGY AND 1 METABOLIC ADAPTATION AFTER BARIATRIC SURGERY IN OBESE RATS
黃士懿1,2,3 廖晨妤1 張瀞文1,4 吳沁穎2 姜品聿1 張君照4,5,6
高偉育1,4,5,6
1 台北醫學大學代謝與肥胖科學研究所
2 台北醫學大學營養學院
3 台北醫學大學附設醫院營養研究中心
4 台北醫學大學消化醫學研究中心
5 台北醫學大學附設醫院內科部消化內科
6 台北醫學大學醫學院內科學科消化內科
Background: The global rise in obesity has been paralleled by an increasing burden of metabolic dysfunctionassociated steatotic liver disease (MASLD).
Aims: This study examined how metabolic bariatric surgery, sleeve gastrectomy (SG), under continued exposure to an high-fat diet (HFD), affects hepatic pathology, lipid metabolism, autophagy, and liver lipidomic profiles in dietinduced obese Wistar rats.
Methods: A total of 25 male Wistar rats aged 6 weeks were used in this study. These animals were randomly divided into the following groups to undergo the first phase of dietary induction: (1) a control group and (2) an high-fat diet (HFD) group. The control group was fed a standard chow diet (Laboratory Rodent Diet 5001), whereas the HFD group received an HFD for 8 weeks, followed by a choline-deficient, L-amino-acid-defined HFD (CDAHFD) for another 6 weeks to establish a rat model of morbid obesity and MASLD. At 22 weeks, the HFD group underwent a sleeve gastrectomy (SG).Tthe rats that were maintained on an HFD for 6 weeks were assigned to an HPO-6 group (fed an HFD at 6 weeks postoperatively), whereas those that were maintained on the same diet for 12 weeks were assigned to an HPO-12 group (fed an HFD at 12 weeks postoperatively). The control group was consistently fed a chow diet and did not undergo any surgical intervention throughout the experimental period.
Results: After 14 weeks of HFD feeding, 25 male Wistar rats (n=5 per group) underwent SG or control procedures and were maintained on an HFD for up to 12 additional weeks. SG reduced the rats’ serum alanine aminotransferase and aspartate aminotransferase levels and mitigated hepatic
lipid accumulation. Immunohistochemistry demonstrated reduced PLIN2 expression; therefore, it is recommended that the time-dependent changes in lipophagic activity be studied after surgery. Lipidomic analysis also revealed changes in hepatic free fatty acid composition after SG, with reduced levels of prosteatotic fatty acids and improved lipid metabolic balance. Multivariate partial least squares discriminant analysis further revealed distinct metabolic states between the groups. Such results indicate that even with sustained HFD intake after surgery, the expression of lipid-synthesis-related enzymes in the liver remained upregulated, indicating enhanced postoperative hepatic metabolic activity. However, the physiological stress induced by the surgical procedure appeared to activate lipophagy, promoting the reprogramming of lipid metabolic pathways.
Conclusions: These findings indicate that SG alleviates hepatic steatosis and reprograms lipid metabolism despite ongoing HFD exposure, and that lipidomic signatures may serve as informative biomarkers for monitoring liver recovery in MASLD.
P.016
乙肝病毒感染對 MASLD 族群纖維化風險的 影響
EFFECT OF HBV INFECTION ON FIBROSIS RISK IN MASLD POPULATIONS
連梓亞1 林揚笙1, 2, 3 張經緯1, 2 林煒晟1, 2 李騏宇1, 2
1 馬偕紀念醫院內科部胃腸肝膽科
2 馬偕醫學大學
3 台北醫學大學醫學院臨床醫學研究所
Background: MASLD(Metabolic dysfunction-associated steatotic liver disease) and Chronic Hepatitis B (CHB) are major causes of chronic liver disease worldwide, especially in Asia. The interaction between HBV and metabolic dysfunction remains complex. While metabolic factors drive fibrosis in MASLD, the specific impact of concomitant HBV infection on Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) in the MASLD population requires clarification.
Aims: Our Aim is to investigate the differences in baseline characteristics, steatosis, and fibrosis burden between MASLD patients with and without HBV infection.
Methods: This is a Single-center(MacKay Memorial Hospital), retrospective cross-sectional study. Ultrasound identified MASLD with grading of hepatic steatosis and chronic liver disease was enrolled, and total 202 paitents meet cardiometabolic criteria clinically who are performed Fibroscan in the period from April, 2025, to September, 2025. All the patients had anthropometric and metabolic profiling. The study participants were stratified into two groups, MASLD-only group(n=129) and HBV co-infection group(n=73). All statistical analyses were performed using R software version 4.5.2. Continuous variables were expressed as mean ± standard deviation (SD) and compared using the Student’s t-test or Mann-Whitney U test, depending on the normality of distribution. Categorical variables were presented as frequencies (percentages) and analyzed using the Chi-square test or Fisher’s exact test. A two-sided p-value < 0.05 was considered statistically significant.
Results: A total 202 MASLD patients were analyzed in the study, with 129 calssified to the MASLD-only group and 73 to the HBV co-infection group. In table 1, the HBV coinfection group (n=73) was significantly older (61.0 vs. 57.0, p=0.021) and had lower platelet counts (210.23 vs. 231.98, p=0.046) compared to the MASLD-only group (n=129). Renal function (CrCl) was also significantly
lower in the HBV group (96.99 vs. 114.66, p=0.008). Despite meeting MASLD criteria, HBV patients exhibited a significantly lower steatosis burden and better metabolic profile: lower CAP (260.08 vs. 285.08, p=0.002), lower FLI (14.93 vs. 30.26, p=0.003), and lower HOMA-IR (1.02 vs. 2.66, p=0.009). Crucially, the lower metabolic burden in the HBV group did not translate to a lower fibrosis risk. There was no significant difference in Liver Stiffness Measurement (LSM) between the two groups (8.21 vs. 7.94 kPa, p=0.758), and The proportion of patients with significant fibrosis (LSM ≥ 8 kPa) was nearly identical (32.9% vs. 31.8%, p=0.998).
Conclusions: In conclusion, for MASLD patients with HBV, low levels of steatosis biomarkers (such as CAP, Fatty Liver Index, and HOMA-IR) may not fully reflect the underlying fibrosis risk. Therefore, clinicians should be cautious when relying on scores driven primarily by liver fat. Direct assessment of liver stiffness (via FibroScan) appears to be a reliable method for fibrosis staging in this specific population.
P.017
代謝功能障礙相關脂肪性肝病的心血管疾病 風險評估
THE RISK OF CARDIOVASCULAR DISEASE IN METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE
林品瀚1 杜維剛1 翁詩涵2 陳蕙芬1 林聰蓉1 林志陵1 1 臺北市立聯合醫院仁愛院區 2 臺北市立聯合醫院教學研究部
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common cause of chronic liver disease worldwide with the estimated global prevalence of up to 38% in adult population. MASLD may progress over time and lead to serious complications such as fibrosis, cirrhosis, or hepatocellular carcinoma. In particular, MASLD is associated with multisystem disease. Insulin resistance and cardiometabolic risk factors play a key pathogenic role in the development of MASLDrelated liver diseases (including cirrhosis, liver failure and hepatocellular carcinoma) and extrahepatic complications such as cardiovascular disease (CVD), diabetes mellitus (T2DM) and chronic kidney disease (CKD). The impact of fibrosis on the risk of CVD in patients with MASLD remains to be clarified.
Aims: The aims of the study are to investigate the proportion of MASLD patients at high CVD risk and the risk factors associated with high CVD risk.
Methods: The study population consists of patients with MASLD who had complete clinical data collected between January 2024 and October 2025. The analysis includes anthropometric parameters, laboratory data, body composition, non-invasive liver fibrosis assessment, past medical history and alcohol consumption history. The risk of cardiovascular disease was assessed using the Framingham risk score, which is then converted into a 10year risk category: low risk: <10%, intermedia risk: 1019%, high risk: ≧ 20%.
Results: A total of 410 patients with MAFLD were enrolled. The patients were divided into two group according to the Framingham risk score. Group 1 consisted of patients with low and intermediate CVD risk (Framingham risk score <20%), totaling 252 patients (61.5%). Group 2 included patients with high CVD risk (Framingham risk score ≧ 20%), totaling 158 patients (38.5%). There was no significant difference between two groups in terms of gender, body mass index, alcohol consumption, prevalence
of chronic hepatitis B and C. Compared to group 1 patients, group 2 patients were significantly older age (62.66±9.35 years vs. 49.09±10.68 years, P<0.0001), had a lower platelet count (208.91±56.79x103 U/L vs. 239.10±61.21x103 U/ L，P<0.0001), and a higher serum BUN levels (16.32±8.57 mg/dl vs. 13.75±3.06 mg/dl，P=0.004)、HBA1C levels (6.17±0.87 % vs. 5.88±1.00 %，P=0.006)， FIB-4 index (1.87±1.76 vs. 1.11±0.71，P<0.0001)、NAFLD fibrosis score (-0.35±2.03 vs. -1.75±2.12，P<0.0001). Additionally, there was a higher proportion of smoking (35.59% vs. 9.34%，P<0.0001)、 hypertension (64.56% vs. 17.86%， P<0.0001) 、 DM (50.63% vs. 14.68% ， P<0.0001) 、 ≧ 2 cardiometabolic risk factors (89.87% vs. 69.44%， P<0.0001) as well as significant liver fibrosis (F2-F4, 16.5% vs. 5.78%，P<0.006) in Group 2. After adjusting age, smoking, hypertension and T2DM, multivariate logistic regression analysis revealed FIB-4 index [hazard ration (HR): 2.80, 95% confidence interval (CI): 1.176.72, P<0.021] 、NAFLD fibrosis score (HR:1.47, 95% CI: 1.04-2.09, P=0.03)、 ≧ 2 cardiometabolic risk factors (HR:2.44, 95% CI:1.08-5.51, P=0.032) were independent risk factors associated with high CVD risk. In a subgroup analysis, 276 patients underwent hepatic stiffness and controlled attenuation parameter (CAP) measurement by Fibroscan and bioelectrical impedance analysis (Inbody). Among them, 27 patients (9.78%) had significant liver fibrosis (F2-F4). Compared to patients with liver fibrosis F0-F1, patients with liver fibrosis F2-F4 had significantly higher proportion of ≧ 2 cardiometabolic risk factors (96.30% vs. 72.69%, P=0.007) high CVD risk (62.96% vs. 34.54%, P=0.014).
Conclusions: A significant proportion of patients with MASLD are at high risk of CVD. MASLD patients with high risk of CVD have more cardiometabolic risk factors and severe fibrosis than those with low/intermediate risk. Liver fibrosis is significantly associated with CVD risk. According to our results, early identification of cardiovascular risk in patients with MASLD will provide timely treatment to reduce the risk of cardiovascular mortality in this population.
P.018
多模式健身運動對改善脂肪肝患者嚴重度與 體適能的影響
THE IMPACT OF MULTIMODAL FITNESS EXERCISE ON IMPROVING THE SEVERITY AND PHYSICAL FITNESS OF PATIENTS WITH FATTY LIVER
葉欣榮1,2,3,5 張育愷4 高偉育1,2 趙振瑞2,3,5 張君照1,2 洪辰歆4
1 臺北醫學大學附設醫院內科部消化內科
2 臺北醫學大學消化醫學研究中心
3 臺北醫學大學保健營養學系
4 臺灣師範大學體育與運動學系
5 臺北醫學大學附設醫院營養研究中心
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a prevalent metabolic disorder associated with sedentary lifestyle and metabolic syndrome and may progress to advanced liver disease if untreated. Although exercise is recommended for MASLD management, evidence regarding the effects of multimodal fitness exercise on hepatic steatosis remains limited. This study aimed to examine the effects of a 3-month multimodal fitness exercise program on hepatic steatosis severity and physical fitness in patients with MASLD.
Aims: Under the guidance of professional sports and nutrition experts and gastroenterologists, this study investigated the degree and impact of multimodal fitness exercise on the improvement of fatty liver severity and physical fitness in patients with metabolic fatty liver disease.
Methods: Fifty-six patients with MASLD were enrolled, and forty-eight (24 men, 24 women) completed the study. Participants were assigned to an exercise group (n = 27) or an observation group (n = 21). Baseline and postintervention assessments included liver stiffness (E score) and controlled attenuation parameter (CAP) measured by transient elastography, as well as body composition, muscle strength, and cardiorespiratory fitness. The exercise group participated in a 3-month multimodal fitness program consisting of weekly supervised sessions (90 minutes) and home-based exercise 3–4 times per week, while the observation group maintained their usual lifestyle. No dietary supplements or medications were administered.
Results: The exercise group demonstrated a greater reduction in hepatic steatosis compared with the observation group, as indicated by changes in CAP (−14.5 ± 26.4 vs. +4.1 ± 33.7; t = −2.09, p = 0.044). Significant
between-group differences were also observed for reductions in body fat percentage (−1.4% vs. −0.1%, p = 0.007) and improvements in upper-limb muscle strength (+3.8 vs. +0.003). No significant differences were found for liver stiffness, body weight, BMI, muscle mass, lower-limb strength, or cardiorespiratory fitness.
Conclusions: Multimodal fitness exercise reduced hepatic steatosis and body fat percentage and improved upper-limb muscle strength in patients with MASLD, independent of changes in body weight or BMI, supporting its use as an effective non-pharmacological intervention.
P.019
抗病毒藥物治療和 B 型肝炎以及 C 型肝炎 相關的肝細胞癌病患接受手術切除的 10 年 整體存活率的相關性 THE ASSOCIATION BETWEEN ANTIVIRAL THERAPY AND 10YEAR OVERALL SURVIVAL OF PATIENTS UNDERGOING LIVER RESECTION FOR HEPATITIS C VIRUS OR HEPATITIS B VIRUSRELATED HEPATOCELLULAR CARCINOMA
顏毅豪1 劉約維2 陳建宏1
1 高雄長庚紀念醫院胃腸肝膽科
2 高雄長庚紀念醫院一般外科
Background: The efficacy of antiviral therapy against hepatitis C virus (HCV) and hepatitis B virus (HBV), following liver resection (LR) for hepatocellular carcinoma (HCC), has been studied extensively.
Aims: However, its long-term overall survival (OS) benefit remains to be conclusively demonstrated.
Methods: This retrospective cohort study included 1121 patients (777 with HBV-related HCC and 344 with HCVrelated HCC) who underwent LR. The primary outcome was 10-year OS. The indication for antiviral therapy was serum HBV DNA > 2000 IU/ml in patients with HBVrelated HCC and detectable serum HCV RNA in patients with HCV-related HCC.
Results: After propensity score matching, the 10-year OS of the antiviral-treated group was 58% and that of the untreated group was 25% (p < 0.001) in the HCV-infected cohort. The 10-year OS of the antiviral-treated group was 62% and that of the untreated group was 61% (p = 0.917) in the HBV-infected cohort.
Conclusions: Antiviral therapy was associated with improved 10-year OS of patients with HCV-related HCC and viremia who underwent LR. In contrast, the 10-year OS of patients undergoing LR for HBV-related HCC who were treated with antiviral therapy based on serum HBV-DNA > 2000 IU/ ml was similar to that of untreated patients.
P.020
早期肝細胞癌長期存活的預後決定因素和治 療策略：一項回顧性隊列研究 PROGNOSTIC DETERMINANTS AND TREATMENT STRATEGIES ASSOCIATED WITH LONG-TERM SURVIVAL IN EARLY-STAGE HEPATOCELLULAR CARCINOMA: A RETROSPECTIVE COHORT STUDY
潘冠塵1 黃惠玲1,2 丁元捷1,3 盧勝男1,4 張德生1,5
1 嘉義長庚紀念醫院腸胃科
2 嘉義長庚紀念醫院護理部
3 台中大里仁愛醫院腸胃科
4 高雄長庚紀念醫院腸胃科
5 桃園長庚大學醫學院
Background: Hepatocellular carcinoma (HCC) is commonly diagnosed cancer and the leading cause of cancer death of death in worldwide.1 It is the second cause of cancer-related death and the fourth most common newly diagnosed cancer in Taiwan.2 Despite advances in various treatment modalities, HCC remains a disease that requires close clinical attention. In early-stage HCC, curative treatment is often achievable, and complete tumor eradication can lead to favorable long-term outcomes. Therefore, clinical decision-making and treatment strategies for patients with early-stage HCC must be approached with particular care and precision. Previous studies have extensively explored the prognostic factors associated with HCC, as well as survival and recurrence outcomes related to initial treatment modalities.3-5 However, most prognostic factor analyses have focused on survival within five years of diagnosis.6 Given the increasing availability and efficacy of therapeutic options, many early-stage HCC patients now survive beyond five years. Nevertheless, limited research has investigated long-term prognostic factors (survival beyond five years) and the evolution of treatment strategies in these long-term survivors. Therefore, this study was designed to investigate the prognostic factors and therapeutic strategies associated with long-term survival in patients with early-stage HCC
Aims: This study aims to focused on the following key questions: (1) Do the prognostic factors for early-stage HCC change in patients who survive more than five years, and which of these factors are associated with longterm survival? (2) What are the curative treatment and stage progression rates among early-stage HCC patients who achieve long-term survival? (3) What clinical
characteristics and treatment strategies are associated with higher tumor free status and favorable long-term outcomes?
Methods: Population and Data Collection This retrospective study was conducted using data from the cancer registry of a regional hospital, including patients diagnosed with hepatocellular carcinoma (HCC) between January 2011 and December 2020, with follow-up extending through December 2023. The registry provided comprehensive baseline information, including patient sex, age, tumor stage, viral etiology, liver function reserve (Child-Pugh classification), date and stage at diagnosis, and tumor marker levels. Additional clinical data such as initial treatment type, time to recurrence, subsequent treatments, and date of death or last follow-up were obtained through detailed manual review of individual medical records. Among the 1,144 patients included, 22 (1.9%) had missing Child-Pugh scores. These cases were retained in the overall analysis due to completeness of other key variables, but were excluded from subgroup analyses where liver function classification was essential. Patients were excluded if they had received any prior HCCrelated treatment before the recorded diagnosis, had an uncertain disease stage, were diagnosed with advancedstage HCC (BCLC stage B, C, or D), or had incomplete treatment records due to referral to other institutions. Following the application of these criteria, only patients with early-stage HCC (BCLC stage 0 or A) and complete treatment and follow-up data were included in the analysis. Curative treatments were defined as surgical resection, liver transplantation, or tumor ablation, while non-curative treatments encompassed all other therapeutic modalities. Tumor-free survival (TFS) was defined as the state in which no viable tumor was detected by dynamic contrastenhanced imaging (CT or MRI) for at least 6 months following the last treatment session. Patients who remained within the early-stage classification, achieved complete tumor elimination, and experienced no recurrence within up to three treatment sessions were classified as having achieved TFS. Study Design The study was conducted in two parts. The first part aimed to identify prognostic factors associated with overall survival, with additional focus on factors specifically predictive of survival beyond five years. Seven key variables were selected based on existing literature: age, sex, viral etiology (hepatitis B or C), tumor burden (tumor number), liver function reserve (ChildPugh classification), serum tumor marker (AFP level), and initial treatment modality. A subgroup analysis was conducted on patients who survived more than five years,
applying the same evaluation framework to further explore characteristics associated with long-term survival. The second part of the study focused on long-term survivors, comparing patients who survived beyond ten years with those who survived between five and ten years. Patients who were still alive at the last follow-up but had not yet reached ten years of survival were excluded from this comparison. Baseline characteristics and treatment courses were compared between these two subgroups. In addition, treatment outcomes were analyzed by assessing tumor-free status and stage progression rates. Stage progression was defined as advancement to BCLC stage B or C or D. The proportion of curative treatments relative to total treatment sessions was also examined, particularly in patients who achieved tumor-free status, to evaluate whether curative interventions were associated with better long-term outcomes
Results: Between 2011 and 2020, a total of 3,170 patients with hepatocellular carcinoma (HCC) were registered in the cancer registry and followed up until December 2023. Patients were excluded if they had undergone prior treatment, had an unknown disease stage, were classified as BCLC stage B or later, no available treatment records, or were transferred to other institutions. Ultimately, 1,144 patients with early-stage HCC (BCLC 0 or A) were included in the analysis. These patients were categorized into three groups based on survival or o duration: less than 5 years, 5 to 10 years, and more than 10 years (shown in Figure 1). The median survival of the entire cohort was 81.8 months. Specifically, patients with BCLC stage 0 (n = 260) had a median survival of 17.9 months, while those with stage A (n = 884) had a median survival of 76.2 months (p = 0.0012) (shown in Figure 2). In univariate analysis, the following were identified as poor prognostic factors: age > 65 years, presence of multiple tumors, non-viral etiology, Child-Pugh class B, AFP > 20 ng/mL, and noncurative initial treatment, with hazard ratios (HRs) of 1.54, 1.43, 2.48, 1.85, 1.44, and 2.21, respectively. In contrast, patients with HBV-related HCC who received curative treatment had a significantly lower risk of mortality (HR = 0.44). In multivariate analysis, the variable “multiple tumors” was no longer statistically significant (Table 1) Focusing on the subgroup of 619 patients who survived more than 5 years, both univariate and multivariate analyses showed age > 65 years, Child-Pugh class B and non-curative treatment were poor prognostic factors, while HBV-related HCC were good prognostic factors (Table 2). Summarizing findings in Tables 1 and 2, findings were as
follows. 1. After multiple adjustment, “multiple tumors” was no more significant. 2. Limited patients with longer survival, effect of “AFP >400” disappeared. 3. Comparing to Table 1, proportions of poor prognostic factors decreased in Table 2, i.e. “Age > 65 years” from 52.4% to 46.4% (11.5% decrease), “non-hepatitis B” from 74.2% to 69.8% (5.9% decrease), “Child-Pugh Class B” from 5.6% to 3.1% (44.6% decrease) and “non-curative treatment” from 13.2% to 8.7% (34.1% decrease). 4. “Child-Pugh B” affected small proportion of patients, but with highest HR, highest proportion decrease. 5. “Age > 65 years” and “hepatitis B-related” involved large proportion and with stationary effects. 6. The only modifiable factor “initial treatment” plays significant role of both analyses. During this study period, a total of 123 patients with early HCC lived for more than 10 years and 187 patients died within 5 to 10 years. Patient characteristics about age, gender, hepatitis, AFP, child score, and BCLC stage were demonstrated in Table 3. In survival more than 10 years group, the patient had younger ages, and more hepatitis B carriers compared with survival 5~10 years group. Comparing to Table 2, proportions of poor prognostic factors decreased in patients survived for than 10 years, “Age > 65 years” from 46.4% to 33.3% (28.2% decrease), “non-hepatitis B” from 69.8% to 65.0% (6.9% decrease), and “Child-Pugh Class B” from 3.1% to 1.6% (48.4% decrease) while “non-curative treatment” increased from 8.7% to 13.0% (49.4% increase). Treatment results of not only initial treatment session but also the 2nd and 3rd treatment sessions were shown in Figure 3. In the group of 123 patients who survived for more than 10 years, a treatment flowchart (shown in Figure 3) was created based on the number of treatments and recurrence status. In the initial treatment, 52 (42.3%) out of 123 patients achieved tumor free status (TFS). The 71 recurrent cases, but 2 with stage progression, underwent 2nd treatment, and 35 (35/69=50.7%) achieved TFS. The 34 patients experienced the 2nd recurrence, but one with stage progression, underwent the 3rd treatment, and 13 (13/33=39.4%) achieved TFS. In the 123 patients, 100 (81.3%) achieved TFS within 3 sessions of treatment. The TFS rate per treatment sessions was 44.4% (100 TFS/ 225 sessions). In the group of 187 patients who survived for 5~10 years group, a treatment flowchart (shown in Figure 3) was created based on the number of treatments and recurrence status. In the initial treatment, 61 (32.6%) out of 187 patients achieved tumor free status. The 126 recurrent cases, but 27 with stage progression, underwent 2nd treatment, and 24 (24/99=24.2%) achieved TFS.
75 patients experienced the 2nd recurrence, but 21 with stage progression, underwent the 3rd treatment, and 16 (16/54=29.6%) achieved TFS. In the 187 patients, 101 (54%) achieved TFS within 3 sessions of treatment. The TFS rate per treatment sessions was 29.7% (101 TFS/ 340 sessions). Compared survival over 10 years group with survival 5-10 years group related to their first 3 sessions of treatment (Table 4), after 1st treatment, 52 patients (42.3%) achieved TFS in survival over 10 years group, and 61 patients (32.6%) achieved TFS in survival 5~10 years group. There was no statistical significance (P=0.084). After the 2nd treatment, 70.7% of patients in survival over 10 years compared with 45.5% of patients in survival 5~10 years achieved TFS with statistical significance (P<0.001). 100 patients (81.3%) in survival over 10 years group achieved, and 101 patients (54%) in survival 5~10 years had TFS. There was statistical significance (P<0.001) In cumulating stage progression, after the first three sessions treatment, only 5 patients (4.1%) in the >10year group experienced stage progression compared to 58 patients (31%) in the 5–10-year group (p < 0.001). Similar significant differences were observed after the first and second treatment sessions. In total, there were 225 treatment sessions in the >10-year survival group and 340 sessions in the 5–10-year group, all within early-stage disease. (Table 5). In initial treatment, 107 curative treatment sessions (87%) in survival over 10 years compared to 156 curative treatment sessions (83.4%) in survival 5~10 years were no statistical significance. (P=0.391) In 2nd treatment, curative treatment ratios were 71% (49/69) compared to 61.6% (61/99) with no statistical significance. (P=0.207) There was statistical significance (P=0.092) in 3rd treatment and total first sessions treatment. (P=0.041). Compared curative treatment ratios in the first three treatments, gradually decreased curative treatment ratio was found in two groups. (P of trends 0.002 & <0.001) In survival over 10 years group, there were 100 patients with TFS in total 225 first three sessions treatment. A total of 101 patients achieved TFS in total 340 first three sessions treatment in survival 5~10 years group. Compared to the tumor free status ratio, patients in survival over 10 years group had better ratio (44.4% vs 29.7%) with statistical significance (P<0.001). In the >10-year group, 85 patients achieved TFS with 178 curative sessions, and 15 achieved TFS with 47 noncurative sessions. Curative treatments were significantly associated with better TFS rates (p = 0.044).
Conclusions: The survival outcomes of the study population were generally consistent with those expected
for early-stage hepatocellular carcinoma (HCC). However, our findings indicate that the prognostic factors associated with long-term survival differ in part from those influencing overall survival, particularly in variables that can be modified through clinical intervention. Analysis of subgroup proportions and hazard ratios revealed that younger age and HBV-related HCC were consistently associated with favorable prognosis in both short- and long-term contexts. In contrast, Child-Pugh class B remained a strong negative prognostic factor, albeit with low prevalence. Child-Pugh B was the strongest negative prognostic factor, followed by age >65 years, and noncurative treatment. Notably, the initial presence of multiple tumors (1 vs. 2–3 nodules) and elevated AFP (>400 ng/ mL) appeared to lose prognostic significance in long-term survivors, suggesting that effective treatment may change their adverse impact. In the prognostic factor of curative treatment, this study selected two clinical course indicators for treatment evaluation analysis: achievement of tumorfree status (TFS) within three treatment sessions and the occurrence of stage progression during those sessions. Both indicators showed significant differences between the comparison groups. Furthermore, in patients without stage progression, three curative treatments resulted in a 27.3% improvement in >10-year survival. These findings suggest that, in addition to baseline patient characteristics that are non-modifiable at the time of diagnosis, several modifiable factors—including the choice of treatment modality, therapeutic efficacy, and early detection of recurrence— play a critical role in determining long-term prognosis. These are areas in which clinical decision-making and treatment strategies can meaningfully influence patient outcomes.
P.021
LENVATINIB 與 ATEZOLIZUMAB–BEVACIZUMAB 作為不可切除肝細胞癌一 線治療之比較性預後分析：澄清醫院回溯性 研究
COMPARATIVE OUTCOMES OF LENVATINIB VERSUS ATEZOLIZUMAB–BEVACIZUMAB AS FIRST-LINE THERAPY FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA: A RETROSPECTIVE STUDY IN CHENG CHING GENERAL HOSPITAL
賴俊瑋1 黃仁杰1 許維中2 何士奇1 黃一修3
1 澄清綜合醫院中港院區肝膽腸胃科
2 澄清綜合醫院中港院區放射腫瘤科
3 澄清綜合醫院平等院區肝膽腸胃科
Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer mortality, and systemic therapy plays a key role in unresectable cases. While both lenvatinib and atezolizumab–bevacizumab (A+B) are recommended as first-line therapies, direct comparative evidence is limited. Aims: This retrospective study aims to compare the overall survival (OS) and progression-free survival (PFS) associated with lenvatinib versus atezolizumab–bevacizumab as first-line therapy for unresectable hepatocellular carcinoma.
Methods: This retrospective study analyzed 65 patients with unresectable HCC treated between 2021 and 2025 at two regional hospitals in Taiwan. Patients receiving lenvatinib or A+B as first-line therapy were analyzed. Clinical and biochemical variables (such as age, gender, BCLC, TNM stage, Child–Pugh score, biochemical indicators, overall survival (OS) and progression-free survival(PFS) were collected. Statistical analyses were performed using SPSS version 20.0 (IBM Corp., Armonk, NY, USA), including Pearson correlation coefficients, Kaplan–Meier survival analysis, and Cox proportional hazards regression. Statistical significance was defined as p < 0.05.
Results: OS did not differ significantly between the lenvatinib and A+B groups .However,in HBV-related unresectable HCC, lenvatinib demonstrated significantly longer OS and PFS compared with A+B, especially in T4 disease (p < 0.05). No significant survival differences were observed in T1–T3 stages or by maximum tumor size. Conclusions: In the total population, OS did not differ significantly between the lenvatinib and A+B groups.
However, lenvatinib showed superior outcomes in HBVrelated, vascular-invasive (T4) disease, suggesting that its benefit is invasion-driven rather than size-driven. The findings highlight the potential of etiology- and stagespecific systemic therapy in unresectable HCC.
P.022
晚期肝細胞癌病患第一線免疫治療 之比較： ATEZOLIZUMAB 合併 BEVACIZUMAB 與 DURVALUMAB 合併 TREMELIMUMAB 的療效分析 COMPARATIVE EFFECTIVENESS OF FIRST-LINE ATEZOLIZUMAB PLUS BEVACIZUMAB VERSUS DURVALUMAB PLUS TREMELIMUMAB IN ADVANCED HEPATOCELLULAR CARCINOMA
鄭懷誠1 金彥承1 翁鼎淳1 李騏宇1,3 陳彥伯1,2,3 王勝永1,3 王蒼恩1,2,3 劉家源1,2,3,4
1 台北馬偕醫院腸胃內科 2
4 台北馬偕醫院醫學研究中心
Background: Hepatocellular carcinoma (HCC) remains a major global health burden with high mortality, particularly in patients diagnosed at an advanced stage. Immunotherapybased regimens, including atezolizumab plus bevacizumab (A+B) and durvalumab plus tremelimumab (D+T), have been established as first-line treatments for advanced HCC. However, direct real-world comparisons of clinical outcomes between these two regimens remain limited.
Aims: This study aimed to compare real-world clinical outcomes between atezolizumab plus bevacizumab and durvalumab plus tremelimumab as first-line systemic therapy for advanced HCC in a single tertiary medical center.
Methods: This retrospective study reviewed medical records of patients with unresectable HCC who received immunotherapy-based first-line systemic treatment at MacKay Memorial Hospital between March 1, 2025, and November 4, 2025. Patients treated with either atezolizumab plus bevacizumab (A+B) or durvalumab plus tremelimumab (D+T) were enrolled. Clinical characteristics, objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progressionfree survival (PFS) were analyzed using the Mann–Whitney U test, Fisher’s exact test, and the Kaplan–Meier method.
Results: A total of 30 patients with advanced HCC were included, comprising 13 patients in the A+B group and 17 patients in the D+T group. Baseline characteristics were well balanced between the two groups, with no significant differences in age, sex, viral hepatitis status, underlying liver disease, Child–Pugh class, ALBI grade, BCLC stage, serum bilirubin level, alpha-fetoprotein level
(>200 ng/mL), tumor size (>5 cm), presence of portal vein thrombosis, or extrahepatic spread (Table 1). Radiological best overall responses are summarized in Table 2. No significant differences were observed between the A+B and D+T groups in ORR, DCR, PFS, or OS (Table 2; Figure1). Median OS was not reached in either group. Median PFS was not reached in the A+B group and was approximately 4.0 months in the D+T group.
Conclusions: In this real-world cohort, first-line treatment with atezolizumab plus bevacizumab and durvalumab plus tremelimumab demonstrated comparable overall survival and progression-free survival in patients with advanced HCC. However, the relatively short follow-up duration limited the estimation of median survival outcomes. Larger prospective studies with longer follow-up are warranted to further clarify the comparative effectiveness of these two immunotherapy-based regimens.
P.023
無法切除肝細胞癌之轉換手術：來自 ATEZOLIZUMAB/BEVACIZUMAB 與 LENVATINIB 比較研究的臨床趨勢 CONVERSION SURGERY IN UNRESECTABLE HCC: CLINICAL TRENDS FROM A COMPARATIVE STUDY OF ATEZOLIZUMAB/ BEVACIZUMAB AND LENVATINIB
張智翔1,2,3 吳明順1,2,3 陳永發1,3 陳俊男1,3 黃世斌1,2,3
鄭照霖1,2,3 蔡坤志1,3 杜美玟1 連吉時1,2,3 粟發滿1,2,3
1 臺北醫學大學- 北醫‧萬芳醫院- 內科部- 消化內科
2 臺北醫學大學- 醫學院- 醫學系- 內科學科
3 臺北醫學大學消化醫學研究中心
Background: Hepatocellular carcinoma (HCC) remains highly prevalent in regions where chronic hepatitis B, hepatitis C, or other forms of chronic hepatitis are endemic. Although surveillance has facilitated earlier detection of these conditions, HCC is still frequently diagnosed at advanced stages, which precludes curative surgery—the only definitive option for disease cure. Atezolizumab plus bevacizumab (ATEZO/BEV) and lenvatinib (LEN) have demonstrated efficacy as first-line systemic therapies for unresectable HCC (u-HCC). Conversion surgery (CS) following ATEZO/BEV is emerging as a treatment strategy for u-HCC; however, data on CS remain limited.
Aims: This study aims to evaluate and compare the efficacy of ATEZO/BEV and LEN in patients with u-HCC treated at a medical center in Northern Taiwan.
Methods: Data were retrospectively collected from 57 patients u-HCC who received first-line ATEZO/BEV (n = 25) or LEN (n = 32) between 2023 and 2025 at Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. The primary outcome was conversion surgery (CS) following treatment. Demographic data, clinical predictors (including BCLC stage, ECOG performance status, AFP and PIVKAII levels), liver function tests (bilirubin, albumin, ChildPugh score, ALBI grade), and etiology of HCC (HBV, HCV, cirrhosis status) were retrospectively collected. Univariate and multivariate analyses were performed. Logistic regression was applied, as the study outcome was categorical.
Results: The median patient age was 69 years (SD: 1.61). Most patients were male (77.2%). Forty-two percent had chronic hepatitis B and 17.5% had chronic hepatitis C. The majority were Child-Pugh class A (40, 70.2%), ALBI grade 2 (27, 47.4%), ECOG PS 0 (38, 66.7 %), and BCLC stage
C (32, 56.1%) patients. Median AFP and PIVKA-II levels were 101.6 ng/mL and 354.1 mAU/ml, respectively. Mean albumin and bilirubin levels were 3.3 g/dL and 5.9 mg/dL, respectively. Further analysis showed:
1. Patients with ALBI grade 1 were significantly more likely to achieve CS than those with grade 2 or 3 (p = 0.018).
2. Earlier-stage patients (BCLC A/B) had significantly better CS outcomes compared to BCLC stage C/D (p = 0.047).
3. Although the p-value for the ATEZO/BEV group (p = 0.113) did not reach statistical significance, the odds ratio of 3.97 still suggests a strong clinical trend favoring ATEZO/BEV for conversion.
Conclusions: This clinical analysis demonstrated consistent trends supporting a higher probability of ATEZO/BEV in achieving conversion surgery among patients with u-HCC.
Although the p-value narrowly exceeded the conventional threshold of 0.05, the effect size was substantial given the limited sample size. ALBI grade and BCLC stage were identified as the most significant independent predictors of surgical success in the multivariate model, underscoring the importance of liver functional reserve. Larger patient cohorts are required to further confirm this hypothesis.
P.024
內視鏡超音波導引下惡性肝轉移的射頻治療 ENDOSCOPIC ULTRASOUND–GUIDED RADIOFREQUENCY ABLATION FOR HEPATIC METASTATIC TUMORS
林易霖1 陳建華1,2 蘇偉志1,2 徐榮源1,2 趙有誠1,2
1 台北慈濟醫院
2 慈濟大學醫學院
Background: Endoscopic ultrasound–guided radiofrequency ablation (EUS-RFA) has emerged as a novel, minimally invasive approach for managing primary and hepatic metastatic tumors (HMT), particularly in anatomically challenging regions inaccessible to percutaneous therapy.
Aims: This study evaluate safety and outcomes for EUSRFA in metastatic liver tumors.
Methods: Between February 2023 and October 2025, six consecutive patients with hepatic metastatic tumors who underwent CEH-EUS and endoscopic RFA were included. The ablation purpose is to activate innate immunity for one patient who is small cell lung cancer with multiple liver metastasis. The others are expected to have tumors completely eradicated. The effect of the ablation was monitored by CE-EUS after RFA immediately. These patients received follow-up with contrast enhanced computed tomography or magnetic resonance images at 2 months later after RFA. Additional ethanol injection was performed under CEH-EUS guidance if incomplete response is suspected.
Results: A total of 14 tumors is ablated. Four patients with hepatic metastasis from colorectal cancer have complete response. One of them arrived at the complete ablation effect after additional ethanol injection. Another one patient with hepatic metastasis from esophageal cancer has complete response. The other lung cancer patient with hepatic metastasis has stable disease. The initial burning time of the former two patients is according to the instructions of manufactures; however, the latter four patients received longer burning time. No adverse events occurred among these patients.
Conclusions: EUS-RFA represents a promising adjunct to surgical, percutaneous, and systemic treatment strategies for liver tumors. With further device evolution, prospective studies, and standardized ablation parameters, EUS-RFA may assume a more prominent role in multidisciplinary liver malignancy management.
P.025
應用人工智慧模型預測肝細胞癌手術切除後 之生存率
USING ARTIFICIAL INTELLIGENCE MODEL TO PREDICT SURVIVAL OF HEPATOCELLULAR CARCINOMA AFTER SURGICAL RESECTION
張佳煒1 張廷安2 丁金聰3 林柏任1 林聰蓉1,4
1 臺北市立聯合醫院仁愛分院消化內科
2 臺北市立聯合醫院仁愛分院病理科
3 臺北市立聯合醫院仁愛分院消化外科
4 淡江大學資訊工程學系
Background: Hepatocellular carcinoma (HCC) has been the second leading cause of cancer-related death in Taiwan in recent years. Although surgical resection remains one of the most effective treatments for HCC, long-term survival varies significantly among patients. Therefore, identifying factors associated with survival is crucial for risk stratifications and optimizing postoperative management strategies.
Aims: This study was aimed to provide more accurate survival predictions for patients with HCC and offer a scientific base for clinical decision-making by leveraging artificial intelligence (AI) technologies to process and analyze data.
Methods: Total 233 patients who underwent surgical resection for HCC were recruited consecutively from the database of Cancer Registries between January 2011 and December 2021 in Taipei City Hospital, Renai Branch. Patients were followed for survival status until December 2022. Total fifteen variables including age, gender, body mass index, alcohol consumption history, tumor size, serum creatinine, total bilirubin, international normalized ratio, Child-Pugh classification, alphafetoprotein levels, Barcelona Clinic Liver Cancer stage, liver fibrosis, pathological differentiation, lymphovascular invasion and surgical margin status, were selected from Cancer Registries database. Python was used for model construction. The primary outcomes were the 1-year, 2-year and 3-year overall survival rates. We utilized five AI models including two deep learning-based algorithms (DeepSurv and Neural Multi-Task Logistic Regression [NMTLR]) and three machine learning-based algorithms (Random Survival Forest [RSF], XGBoost and Support Vector Machine [SVM]) for model training. A multivariable Cox Proportional Hazards (CoxPH) model was also constructed for comparison. The dataset was randomly divided into
a training cohort and a test cohort in an 8:2 ratio. The performance of models with different hyperparameter combinations was assessed using the concordance index (C-index), Integrated Brier Score (IBS). To assess the time-dependence, sensitivity, and specificity of the model, Receiver operating characteristic curves were generated, and the Area Under the Curve (AUC) values for 1-year, 2-year, and 3-year survival rates were calculated.
Results: Table 1 presents the performance of each model on the test cohort. In our analysis, we employed the logrank test to compare the C-index across models. The results indicated that five AI models had not demonstrated significantly superior discriminative ability compared to the standard CoxPH model (p > 0.05) as detailed in Table 2. Among the five AI models, DeepSurv had the highest C-index (0.58), demonstrating its superiority in predictive performance and the lowest IBS value (0.11), indicating its best performance in terms of uncertainty in the predictions.
The DeepSurv model achieved an AUC of 0.85 for 1-year survival predictions, 0.86 for 2-year, and 0.61 for 3-year survival rates. The results indicate that, in predicting the survival prognosis of HCC after surgical resection, the deep learning model DeepSurv exhibited the best performance for survival prediction in multiple evaluation metrics.
Table 1. Performance of six survival models.
Models C-index IBS 1-year AUC 2-year AUC 3-year AUC
CoxPH 0.56 0.14 0.61 0.69 0.63
DeepSurv 0.58 0.11 0.85 0.86 0.61
NMTLR 0.54 0.13 0.9 0.71 0.49
RSF 0.58 0.11 0.93 0.72 0.52
XGBoost 0.48 0.16 0.76 0.59 0.55
SVM 0.52 0.11 0.83 0.62 0.50
Table 2. Comparative analysis of discriminative ability (C-index) between CoxPH and artificial intelligence models (DeepSurv, N-MTLR, RSF, XGBoost, SVM).
Model 1 Model 2 p-value
CoxPH DeepSurv 0.64
CoxPH NMTLR 0.55
CoxPH RSF 0.57
CoxPH XGBoost 0.34
CoxPH SVM 0.41
Conclusions: Comparing to the CoxPH model, the five artificial intelligence models had comparable accuracy in predicting the survival of HCC after surgical resection. Among the five AI models, the DeepSurv model may have the most superior predictive capabilities in the survival of HCC after surgical resection.
P.026
DLK-1 蛋白作為肝細胞癌患者臨床預後之 預測因子
DELTA-LIKE 1 HOMOLOGUE (DLK1)
PREDICTS CLINICAL OUTCOMES IN PATIENTS WITH HEPATOCELLULAR CARCINOMA
黃冠輔1 儲天輝2 張國欽1 吳鎮琨1 蔡明釗1 黃昭誠3
胡琮輝1 戴明泓4
1 高雄長庚紀念醫院胃腸肝膽科
2 國軍高雄總醫院教學研究中心
3 高雄長庚紀念醫院病理科
4 國立中山大學生物醫學科學研究所
Background: Delta-like 1 homologue (DLK1), a transmembrane and secreted protein, is a non-canonical Notch ligand. DLK1 is also a hepatic stem/progenitor cell marker in both fetal liver and hepatocellular carcinoma (HCC). However, the role of DLK1 in HCC remains incompletely characterized.
Aims: To clarify the clinical significance of DLK1 expression within hepatoma tissues and its impact on HCC prognosis.
Methods: We examined DLK1 expression patterns in 90 HCC specimens and paired adjacent non-tumorous liver tissues after surgical resection by using immunoblot analysis, and investigated their associations with clinicopathological parameters. The oncogenic functions of DLK1 were also analyzed in vitro.
Results: DLK1 protein levels were significantly upregulated in HCC tissues compared to adjacent normal liver tissues in about 36/90 (40%) of patients, and high DLK1 expression in tumor was associated with shorter overall and disease-free survivals. Moreover, DLK1 expression in HCC tissues positively correlated with advanced BCLC stages and big tumor sizes. Subsequent in vitro experiments demonstrated that recombinant DLK1 (rDLK1) protein, markedly promoted the proliferation of hepatoma cells. Furthermore, genetic manipulation of cellular DLK1 levels regulates the proliferation and colonies formation of HCC cells in vitro.
Conclusions: Our findings suggest that elevated DLK1 expression in HCC is linked to advanced BCLC stages, big tumor sizes and poor prognosis in HCC patients after surgical resection. DLK1 seems to serve as a valuable biomarker and may be a candidate for therapeutic targeting of HCC pending further validation.
P.027
肝細胞癌合併糖尿病接受免疫治療之臨床結 果：血糖控制對治療反應的影響 IMMUNOTHERAPY FOR HEPATOCELLULAR CARCINOMA WITH DIABETES: THE IMPACT OF GLYCEMIC CONTROL ON TREATMENT RESPONSE
林孟緯1 吳泓璁2,3 陳煌斌1 林孟葳1 李俊德1,3 洪子鈞1 吳叡森1 莊喬雄1 歐弘毅2,3,4 郭欣瑜1,3
1 成功大學醫學院附設醫院 消化內科
2 成功大學醫學院附設醫院 內科部
3 成功大學醫學院 東原糖尿病研究中心
4 成功大學醫學院附設醫院 新陳代謝科
Background: Metabolic disorders have emerged as increasingly important contributors to the pathogenesis of hepatocellular carcinoma (HCC). Diabetes mellitus is frequently accompanied by immune dysregulation, characterized by impaired immune cell migration, reduced phagocytic capacity, and hyperglycemia-associated dysfunction of CD8⁺ T cells. Although immune checkpoint inhibitors have transformed the systemic treatment landscape for HCC, the influence of glycemic control and diabetes-related immune dysfunction on immunotherapy outcomes remains incompletely understood.
Aims: To evaluate the prognostic significance of glycemic status in diabetic patients with unresectable hepatocellular carcinoma undergoing immunotherapy, with the aim of informing and optimizing treatment strategies.
Methods: A total of 151 patients with unresectable hepatocellular carcinoma (HCC) who received atezolizumab plus bevacizumab were retrospectively enrolled in this study. Patients were stratified into three groups according to glycemic status: non-diabetic group (n = 83), well-controlled diabetes group (HbA1c < 7.0%; n = 37), and poorly-controlled diabetes group (HbA1c ≥ 7.0%; n = 31). Treatment response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and prognostic factors were assessed using Cox proportional hazards regression models.
Results: The poorly-controlled diabetes group showed significantly inferior treatment response, PFS, and OS compared with both the well-controlled diabetes and nondiabetes groups. In contrast, patients with well-controlled diabetes exhibited survival outcomes comparable to those without diabetes. On multivariate Cox proportional hazards
analysis, poor glycemic control remained independently associated with worse PFS (HR = 3.52; 95% CI, 1.98–6.24; P < 0.001) and OS (HR = 5.16; 95% CI, 2.38–11.18; P < 0.001).
Conclusions: Poor glycemic control independently related to poorer survival and lower treatment response in unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab.
P.028
接受聯合治療後存活超過 1 年之肝細胞癌合 併門靜脈腫瘤血栓患者的影像學特徵 IMAGING FEATURES OF PATIENTS WITH HEPATOCELLULAR CARCINOMA AND PORTAL VEIN TUMOR THROMBOSIS SURVIVING BEYOND 1 YEAR AFTER COMBINED THERAPY
林偉銘1,2 黃惠玲3 盧勝男4 楊哲彥5 王皓正1 許勝榮1
賴家玄6 張德生7
1 嘉義長庚醫院放射線診斷科
2 長庚大學臨床醫學研究所
3 嘉義長庚醫院護理部
4 高雄長庚醫院胃腸肝膽科
5 中國醫藥大學附設醫院醫學研究部
6 嘉義長庚醫院放射線腫瘤科
7 嘉義長庚醫院胃腸肝膽科
Background: Portal vein tumor thrombus (PVTT) is a severe complication of hepatocellular carcinoma (HCC) and is associated with poor outcomes.
Aims: This study aimed to describe the imaging and clinical characteristics observed among HCC patients with PVTT who survived longer than one year following combined systemic therapy and radiotherapy.
Methods: This retrospective, single-center study included 26 consecutive HCC patients with PVTT who survived more than one year after combined treatment. Baseline characteristics included PVTT extent classified according to the Liver Cancer Study Group of Japan VP1 (segmental portal vein invasion), VP2 (second-order portal vein invasion), VP3 (first-order portal vein invasion), and VP4 (main portal trunk or contralateral PV invasion) and liver function assessed by Child–Pugh class and ALBI grade. Contrast-enhanced CT or MRI was evaluated at baseline and 6 months after treatment using RECIST 1.1 criteria. Results: he cohort was predominantly male (69%), and most patients had extensive PVTT (VP3–VP4, n = 19). Preserved liver function was common at baseline (Child–Pugh class A, n = 24; ALBI grade I, n = 14). Tumor response was observed in 23 patients (88%) during followup. Frequently observed post-treatment imaging findings included portal vein recanalization (n = 12), collateral circulation (present in 7 patients at baseline and 6 at followup), and compensatory liver hypertrophy (n = 6).
Conclusions: Among HCC patients with PVTT who survived longer than one year after combined therapy, portal vein recanalization, collateral circulation, and
compensatory liver hypertrophy were commonly observed imaging features. Given the retrospective design and survivor-selection nature of the study, these findings should be interpreted as descriptive observations rather than evidence of treatment efficacy or prognostic determinants.
P.029
老年營養風險指數（GERIATRIC NUTRITIONAL RISK INDEX, GNRI）對 BCLC 第 0 期肝細胞癌患者預後之影響 PROGNOSTIC IMPACT OF GERIATRIC NUTRITIONAL RISK INDEX (GNRI) IN PATIENTS WITH BCLC STAGE 0 HEPATOCELLULAR CARCINOMA
陳立章
1 台北榮民總醫院內科部胃腸肝膽科
2 國立陽明交通大學醫學院醫學系
3 國立陽明交通大學醫學院臨床醫學研究所
4 台北榮民總醫院內科部一般內科
Background: Nutritional status had been recognized as an increasingly important prognostic factor for hepatocellular carcinoma (HCC), but its significance in very early–stage disease remains unclear. The geriatric nutritional risk index (GNRI), calculated using serum albumin and ideal body weight, is a simple and noninvasive marker of nutritional status.
Aims: This study evaluated the prognostic impact of malnutrition assessed by GNRI on overall survival (OS) in HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage 0.
Methods: This retrospective cohort study included 461 consecutive patients diagnosed with BCLC stage 0 HCC at Taipei Veterans General Hospital between January 2012 and July 2024. GNRI was calculated at diagnosis, and patients were classified into high- and low-GNRI groups using an optimal cutoff value of 103 determined by the Youden index for OS. Baseline characteristics were compared between groups. OS was analyzed using the Kaplan–Meier method with log-rank testing, and Cox proportional hazards regression were utilized to identify independent predictors of OS.
Results: Among the 461 patients, 312 (67.7%) had high GNRI and 149 (32.3%) had low GNRI. Patients with low GNRI were older, more often male, less likely to receive curative treatment, and had worse liver functional reserve, while tumor characteristics and viral etiology were similar between groups. After a median follow-up of 37 months (interquartile range: 19–70), 97 patients died, with a 5-year OS of 73.6%. OS was significantly lower in the low-GNRI group than in the high-GNRI group (61.3% vs. 80.4%, p < 0.001). In multivariable analysis, low GNRI (hazard ratio [HR] 1.99, 95% confidence interval [CI] 1.32–2.99, p = 0.001), lower platelet count (HR 2.97, 95% CI 1.78–4.94, p
< 0.001), and elevated serum creatinine (HR 2.62, 95% CI 1.72–3.99, p < 0.001) were independently associated with increased mortality, whereas hepatitis B surface antigen positivity was associated with improved survival. Subgroup analyses showed that GNRI had better prognostic value in younger patients aged ≤65 years (p < 0.001).
Conclusions: Malnutrition, assessed by baseline GNRI, is a strong predictor for OS in patients with very early–stage HCC, particularly among younger individuals, with potential to serve as a practical tool for risk stratification.
P.030
晚期肝細胞癌第一線檢查點抑制後的序列組 合免疫療法：初步報告 SEQUENTIAL COMBINATION IMMUNOTHERAPY FOLLOWING FIRST-LINE CHECKPOINT INHIBITION IN ADVANCED HEPATOCELLULAR CARCINOMA: A PRELIMINARY REPORT
謝明傑1 李沛璋1,2 吳啟榮1 齊振達1,3 柳建安3,4 李懿宬1,2
侯明志1 黃怡翔1,2,3,5
1 台北榮民總醫院內科部胃腸肝膽科
2 國立陽明交通大學醫學院醫學系
3 國立陽明交通大學醫學院臨床醫學研究所
4 台北榮民總醫院放射科
5 台北榮民總醫院醫學研究部
Background: Atezolizumab/bevacizumab (Ate/Bev) and tremelimumab/durvalumab (Tre/Dur) represent the established first-line standards of care for advanced hepatocellular carcinoma (aHCC). However, the efficacy of sequential combination immunotherapy following progression on initial immune checkpoint inhibitor (ICI)based regimens is not yet well-defined. Consequently, the clinical benefit of switching to an alternative immunotherapy combination remains unclear.
Aims: This study aimed to explore the clinical outcomes of second-line ICI-based therapy in patients with advanced HCC after progression on first-line immunotherapy
Methods: We retrospectively reviewed a real-world cohort of 17 patients with aHCC who received secondline combination immunotherapy following the failure of first-line immunotherapy-based regimens. First-line regimens included Ate/Bev (A+B, n=5) and Tre/Dur (T+D, n=12). Only patients with evaluable imaging for response assessment were included in the final analysis. Baseline characteristics were assessed at the time of the 2L initiation. First-line tumor progression was classified as early (≤3 months) or late (>3 months) progression. Secondline treatment response was evaluated using RECIST 1.1 criteria, including objective response rate (ORR) and disease control rate(DCR). Immune-related adverse events (irAEs) during second-line treatment were also analyzed. Results: A total of 11 patients receiving 2L therapy with evaluable imaging studies were included for this analysis. Baseline characteristics at 2L initiation were generally comparable between treatment sequences, although patients in the 1L A+B to 2L T+D group had a longer median
duration of first-line treatment. Among the 11 patients, disease control was achieved in 3 patients(DCR=27.2%).
Patients with late progression on first-line therapy showed a numerically higher rate of disease control on secondline treatment compared with those with early progression (33.3% vs 20.0%). Notably, disease control was observed exclusively among patients who transitioned from T+D to A+B;in contrast, no patients switching from A+B to T+D achieved disease control. During second-line therapy, irAEs occurred in 2 patients (18.2%), both received A+B following T+D. No unexpected safety signals were observed by repeated combination immunotherapy.
Conclusions: Disease progression on first-line ICI-based therapy did not uniformly preclude clinical benefit from subsequent second-line immunotherapy. Disease control was primarily observed when an anti-VEGF agent was incorporated into the second-line regimen, suggesting that bevacizumab may provide additional therapeutic benefit following progression on T+D. However, these findings remain exploratory and necessitate validation in larger, prospective cohorts.
METFORMIN 併用對晚期肝細胞癌免疫治 療療效的影響
IMPACT OF METFORMIN COADMINISTRATION ON THE EFFICACY OF IMMUNOTHERAPY IN ADVANCED HEPATOCELLULAR CARCINOMA
吳啟榮1,2,3 李沛璋1,3 齊振達1,2,3 李懿宬1,3 謝明傑1 李杰如1 侯明志1 黃怡翔1,2,3,4
1 臺北榮民總醫院內科部胃腸肝膽科
2 國立陽明交通大學臨床醫學研究所
3 國立陽明交通大學醫學系
4 臺北榮民總醫院醫學研究部
Background: Preclinical studies have suggested that metformin may enhance T-cell activity and synergize with immunotherapy especially for hepatocellular carcinoma (HCC) with steatotic liver disease (SLD). However, clinical evidence regarding its impact on survival outcomes in patients with advanced HCC receiving first-line immunotherapy remains limited.
Aims: This study tried to evaluate association between metformin use and clinical outcomes in advanced HCC treated with first-line immunotherapy.
Methods: From Oct. 2020 to Sep. 2025, a total of 234 patients with advanced HCC and preserved liver function (Child–Pugh score ≤ B7) who received atezolizumab plus bevacizumab (A+B) or durvalumab plus tremelimumab (STRIDE) as first-line therapy at Taipei Veterans General Hospital were prospectively enrolled. Tumor responses were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST), v1.1.
Results: Of the 234 enrolled patients, 158 (67.5%) received A+B and 76 (32.5%) received STRIDE as first-line therapy. Of them, 61(26.1%) patients had chronic metformin use at baseline. In multivariate analysis, presence of metabolic associated SLD (MASLD), and AFP >100 ng/mL were associated with poor progression-free survival (PFS), Metformin use was not the determinant of RFS or durable tumor response. In the subgroup of patients with nonviral HCC (n=77), metformin use was also not the factors associated with survival.
Conclusions: Contrary to expectations, baseline metformin use was not associated with survivals in advanced HCC patients receiving first-line immunotherapy, even in the subgroup patients with non-viral etiology.
P.031
P.032
非甲狀腺疾病症候群可作為接受 ATEZOLIZUMAB 合併 BEVACIZUMAB 之肝細胞癌患者預後不佳的預測因子 NON-THYROIDAL ILLNESS SYNDROME PREDICTS POOR PROGNOSIS IN HEPATOCELLULAR CARCINOMA
PATIENTS TREATED WITH ATEZOLIZUMAB AND BEVACIZUMAB
陳怡文1,3 林承緯1,3 滕威2,3 林伯庭2,3 蘇崇維2,3 吳宗翰3,4
謝彞中2,3 陳威廷2,3 林成俊3,5 林錫銘2,3 林俊彥2,3
1 林口長庚醫院內分泌新陳代謝科
2 林口長庚醫院胃腸肝膽科系
3 長庚大學醫學院
4 林口長庚醫院一般外科系
5 新北市立土城醫院胃腸肝膽科系
Background: Atezolizumab plus bevacizumab (Ate/ Bev) is the first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). However, the prognostic impact of immune-related thyroid adverse events (irTAEs), particularly non-thyroidal illness syndrome (NTIS), remains unclear.
Aims: This study aimed to evaluate the incidence, clinical features, and prognostic significance of irTAs—particularly NTIS—in patients with unresectable HCC undergoing Ate/ Bev therapy.
Methods: We retrospectively analyzed 70 patients with unresectable HCC treated with Ate/Bev. Thyroid function was monitored at baseline and during the treatment. IrTAEs were classified as NTIS (low T3 and/or free T4 with normal or low TSH levels) or thyroid adverse events (hypothyroidism or thyrotoxicosis). Clinical outcomes, including progression-free survival (PFS) and overall survival (OS), were assessed using Kaplan–Meier and Cox regression analysis. Subgroup analyses were performed to examine the associations between liver function, nutritional status, and HCC etiology.
Results: Among 70 patients (median age, 64 years; 80% male), 24 (34.3%) developed irTAEs: 11 had NTIS and 13 had thyroid AEs. NTIS was independently associated with worse OS (adjusted hazard ratio [HR], 2.51; P = 0.041) and a shorter median OS (5.4 months). In contrast, thyroid AEs were associated with a favorable trend in PFS (adjusted HR, 0.37; P = 0.073) and a higher objective response rate (53.8% vs. 9.1%, P = 0.006). NTIS was correlated with deterioration in albumin level, body mass index, and ALBI grade. Viral HCC was associated with fewer thyroid AEs,
while alcohol-related HCC trended toward NTIS.
Conclusions: Thyroid dysfunction during Ate/Bev therapy is prognostically significant. NTIS reflects systemic deterioration and portends poor survival, whereas thyroid AEs may suggest favorable immune activation. Routine monitoring of thyroid function may aid in risk stratification.
P.033
先天性肝纖維化：台灣單一中心 20 年病例
系列
CONGENITAL HEPATIC FIBROSIS: A 20YEAR SINGLE-CENTER CASE SERIES IN TAIWAN
黃俊宏1 黃秀芬2,3 陳泰迪3 賴明瑋4 謝彝中1
1 林口長庚紀念醫院肝膽胃腸科系
2 國家衛生研究院分子與基因醫學研究所
3 林口長庚紀念醫院解剖病理科
4 林口長庚紀念醫院兒童內科部兒童胃腸科
Background: Congenital hepatic fibrosis (CHF) is a rare autosomal recessive fibrocystic liver disease that often manifests with portal hypertension. Its nonspecific and heterogeneous clinical presentations often result in delayed diagnosis. Long-term institutional experience in Asian cohorts remains limited.
Aims: This study aimed to characterize the clinical features, diagnostic findings, and outcomes of patients with CHF at a tertiary referral center in Taiwan.
Methods: We retrospectively reviewed the clinical, biochemical, radiological, and pathological data of patients diagnosed with CHF based on liver histopathology at Linkou Chang Gung Memorial Hospital over a 20-year period. Clinical presentation, laboratory and radiographic findings, pathological findings, treatment, and long-term outcomes were collected and analyzed.
Results: Ten patients were identified (six males and four females), with a median age at diagnosis of 18 years (range, 2–39 years). Portal hypertension was the predominant clinical feature (9/10, 90%), including varices in 70% of patients and a history of variceal bleeding in 50.0% of patients. Imaging studies frequently showed splenomegaly (100.0%) and cirrhotic-like hepatic morphology. Renal involvement was common, with renal cysts detected in 30.0% of patients by ultrasound and 66.7% by MRI. Liver function was generally preserved, with a median MELD score of 10 (range, 7–23). Four patients required solid organ transplantation (two liver, one kidney, and one combined liver-kidney). Two patients died during the follow-up period.
Conclusions: In this Taiwanese cohort, CHF primarily presented with portal hypertension and variceal complications despite relatively preserved liver function. Imaging commonly revealed splenomegaly and cirrhoticlike hepatic morphology, making differentiation from other chronic liver diseases challenging. Liver biopsy remained
essential for definitive diagnosis, typically showing abnormal bile duct proliferation, portal vein hypoplasia, and periportal fibrosis. Although the small sample size and incomplete follow-up limited comprehensive prognostic assessment, post-transplant outcomes appeared to be favorable. Larger studies are needed to better delineate the long-term outcomes in Asian patients with CHF.
P.034
CHILD–PUGH A 級患者之 ALBI 分級快速 辨識：數學模擬與大型臨床驗證
RECOGNIZING ALBI GRADE IN CHILDPUGH A PATIENTS AT A GLANCE: MATHEMATICAL SIMULATION AND LARGE-SCALE CLINICAL VALIDATION
莊伯恒1 盧勝男2 丁元捷1, 3 林芷芸4
1 仁愛長庚合作聯盟，大里仁愛醫院內科部胃腸肝膽科
2 高雄長庚紀念醫院內科部肝膽胃腸科
3 嘉義長庚紀念醫院內科部胃腸肝膽科
4 高雄長庚紀念醫院生物統計中心
Background: The albumin–bilirubin (ALBI) grade provides an objective assessment of hepatic reserve, but the need for calculation by means of a formula has hampered its use in the bedside.
Aims: This study was to develop simple cut-off values for ALBI grade and validate its per-formance in a large multicenter real-world cohort.
Methods: A mathematical simulation evaluated every possible ALBI pair that falls within the Child–Pugh classification (CP) A range, discretized to 0.1 increments. Cut points for patient stratification without equationbased calculation were derived. Validation was conducted with the Chang Gung Research Database (CGRD), which contains data from 10 hospitals in Taiwan. Patients with same-day albumin and bilirubin measurements in 2024 were included.
Results: Mathematical modeling identified clinically applicable cutoffs—albumin ≥ 4.4 g/dL or ≤ 3.5 g/dL and bilirubin ≥ 2.4 mg/dL—with further refinement at albumin 4.0 g/dL and bilirubin ≥ 1.0 mg/dL. Among 7,583 CP-A patients, 82% were directly classifiable without computation, with consistent applicability across chronic liver disease and hepatocellular carcinoma (HCC) subgroups. Equation dependence increased only slightly in HCC group, confirming robustness across disease severities.
Conclusions: Simplified cutoff rules derived from mathematical modeling and validated in a mul-ti-center cohort enable rapid recognition of ALBI grade in most CP-A patients. This approach enhances the clinical usability of ALBI and supports its integration into pa-tient care, clinical trials, and treatment allocation.
P.035
五種血清肝纖維化評分系統與 FIBROSCAN 之診斷效能比較
COMPARATIVE PERFORMANCE OF FIVE SERUM-BASED FIBROSIS SCORES USING FIBROSCAN
潘沐昀1 林聖峰2,3 張君照1,4,5 高偉育1,4,5 張甄1,4,5
1 臺北醫學大學附設醫院消化內科
2 臺北醫學大學附設醫院急診醫學科
3 臺北醫學大學醫學系公衛學科
4 臺北醫學大學醫學系內科學科
5 臺北醫學大學消化醫學研究中心
Background: Accurate assessment of liver fibrosis is essential for the clinical management of chronic liver diseases. While transient elastography (FibroScan) is a validated non-invasive tool, simple blood-based markers offer a more accessible alternative for large-scale screening. Noninvasive approaches are particularly important given the limitations of liver biopsy for population-based screening and broad clinical application.
Aims: This study aimed to evaluate and compare the diagnostic performance of five serum-based noninvasive fibrosis scores—Fibrosis-4 index (FIB-4), Aspartate Aminotransferase–to–Platelet Ratio Index (APRI),NAFLD Fibrosis Score (NFS), Steatosis-Associated Fibrosis Estimator (SAFE), and Metabolic-Associated Fibrosis score-5 (MAF-5)—using FibroScan-derived fibrosis staging as the reference.
Methods: We retrospectively analyzed 2,356 patients who underwent FibroScan assessment. Five noninvasive fibrosis models were evaluated. Missing data were addressed using multiple imputation. Logistic regression analyses were performed with each fibrosis score entered as an independent variable and FibroScan-defined advanced fibrosis (F3–F4 vs F0–F2) as the binary outcome. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUROC) in the overall cohort and across etiologic subgroups, including hepatitis B virus (HBV), hepatitis C virus (HCV), and nonalcoholic fatty liver disease (NAFLD).
Results: Among 2,356 patients, fibrosis stages were distributed as 79.4% F0, 10.1% F1–2, 3.7% F3, and 6.8% F4. Logistic regression analyses demonstrated that all five fibrosis scores were independently associated with FibroScan-defined advanced fibrosis (F3–F4 vs F0–F2) (all P<0.0001). In the overall cohort, MAF-5 demonstrated the highest diagnostic accuracy (AUROC 0.8396), followed
by APRI (0.8312). In subgroup analyses, MAF-5 showed superior performance in patients with HBV (AUROC 0.8438), whereas APRI demonstrated the highest accuracy in the HCV subgroup (AUROC 0.7977). Among patients with NAFLD, SAFE and MAF-5 exhibited excellent and comparable diagnostic accuracy (AUROC 0.8544 and 0.8542).
Conclusions: While the MAF-5 score demonstrated robust performance across the overall cohort, APRI appeared more suitable for patients with HCV, whereas SAFE and MAF-5 showed optimal performance in NAFLD populations. These findings support the use of etiology-specific noninvasive scoring strategies to enhance liver fibrosis screening and risk stratification.
P.036
探討在肝硬化患者上消化道出血早期（≤12 小時）與常規內視鏡檢查之臨床影響 EARLY (≤12-HOUR) VERSUS REGULAR ENDOSCOPY IN CIRRHOTIC PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING: A RETROSPECTIVE COHORT STUDY
江卓鴻1 韓明倫1,2 吳哲瑋1,2 陳介章1 曾屏輝1,2 劉俊人1 1 臺大醫院內科部胃腸肝膽科 2 臺大醫院綜合診療部
Background: Acute variceal bleeding is a common and life-threatening cause of upper gastrointestinal bleeding in patients with cirrhosis. Current clinical guidelines recommend endoscopic intervention within 12 hours of presentation; however, the clinical benefit of early endoscopy remains uncertain in real-world practice, and concerns persist regarding potential harm related to premature intervention in unstable patients.
Aims: We aimed to compare early (≤12-hour) versus regular endoscopy and their associations with clinical outcomes in this population.
Methods: We conducted a retrospective cohort study of adult patients with cirrhosis who presented to the emergency department with symptoms of upper gastrointestinal bleeding between October 1, 2024, and July 31, 2025. Patients were categorized according to endoscopy timing as early (≤12 hours) or regular (>12 hours) endoscopy. The primary outcome was 5-day treatment failure following index endoscopy, defined as failure to control bleeding or clinically significant rebleeding. Secondary outcomes included length of hospital stay and all-cause mortality. Associations between endoscopy timing and treatment failure were assessed using multivariable logistic regression models, adjusting for liver disease severity and relevant demographic and clinical factors.
Results: A total of 101 patients were included, of whom 34 underwent early endoscopy and 67 underwent regular endoscopy. Most patients had Child–Pugh class A cirrhosis (67%), followed by class B (31%) and class C (3%).
During the study period, all-cause mortality occurred in 2 patients (5.9%) in the early endoscopy group and 9 patients (13.4%) in the regular endoscopy group, with no significant difference between groups (p = 0.43). The median length of hospital stay was 5.5 days (interquartile range [IQR], 4.0–10.0) in the early endoscopy group and 8.0 days (IQR, 4.0–12.0) in the regular endoscopy group (p = 0.198). Five-
day treatment failure occurred in 6 patients (17.6%) in the early endoscopy group and 3 patients (4.5%) in the regular endoscopy group (p = 0.058). In multivariable logistic regression analysis adjusting for age, sex, Child–Pugh class, and MELD score, regular endoscopy (>12 hours) was not significantly associated with a lower risk of 5-day treatment failure compared with early endoscopy (adjusted odds ratio [OR], 0.23; 95% confidence interval [CI], 0.05–1.03; p = 0.055).
Conclusions: In cirrhotic patients with upper gastrointestinal bleeding, early endoscopy was not associated with a lower risk of 5-day treatment failure, allcause mortality, or length of hospital stay compared with regular endoscopy.
P.037
CHILD–PUGH A 亞分級與 ALBI 分級分佈 一致性之數學模擬與實證研究 MATHEMATICAL SIMULATION AND REAL-WORLD VALIDATION OF DISTRIBUTION CONCORDANCE BETWEEN CHILD–PUGH A SUBCLASSIFICATION AND ALBI GRADING
丁元捷1, 3 盧勝男2 林芷芸4 莊伯恒1
1 仁愛長庚合作聯盟，大里仁愛醫院內科部胃腸肝膽科
2 高雄長庚紀念醫院內科部肝膽胃腸科
3 嘉義長庚紀念醫院內科部胃腸肝膽科
4 高雄長庚紀念醫院生物統計中心
Background: Assessment of hepatic functional reserve is critical for hepatocellular carcinoma (HCC) management. The albumin–bilirubin (ALBI) grade, using a continuous formula model, provides better prognostic value despite easier clinical use of the Child–Pugh classification (CP).
Aims: This study aimed to assess the concordance of distributions between CP-A5/6 and ALBI grade 1/2 according to different albumin and bilirubin ranges in patients free from ascites, encephalopathy or coagulopathy.
Methods: A mathematical matrix was developed to divide CP-A into CP-A5 and CP-A6 using serum albumin and bilirubin in 0.1-unit steps. Each grid represents a unique ALBI pair, and the ALBI grade was calculated using the original formula. Theoretical findings were subsequently validated using large-scale real-world data from the Chang Gung Research Database (CGRD) cohort.
Results: Mathematical simulation revealed that 22.6% of CP-A5 grid mapped to ALBI grade 2, while 44.6% of CPA6 grid remained in ALBI grade 1. In real-world validation (n=10,000), 91.8% (n= 6292/6798) of CP-A5 patients were ALBI grade 1, but 8.2% (n=556/6798) were reclassified as ALBI grade 2. Conversely, 92.2% (1147/1244) of CPA6 patients aligned with ALBI grade 2, with only 7.8% (97/1244) remaining in ALBI grade 1.
Conclusions: In the real-world data, a high agreement between CP-A and ALBI was found, with > 90% of CPA5 categorized as ALBI grade 1 and CP-A6 as ALBI grade 2. However, discordant classification in approximately 10 % subgroup represents inherent heterogeneity, reflecting intrinsic differences between these two systems.
P.038
肝硬化合併末期腎病患者之腹膜透析與血液 透析比較
PERITONEAL DIALYSIS VERSUS HEMODIALYSIS IN PATIENTS WITH CIRRHOSIS AND END-STAGE KIDNEY DISEASE
林庭右1,2 林彥仲2,3 莊明蒼4 高偉育1,2,5,6
1 臺北醫學大學附設醫院消化內科
2 臺北醫學大學附設醫院內科部
3 臺北醫學大學附設醫院腎臟內科
4 臺北醫學大學數據處臨床數據中心
5 臺北醫學大學醫學系內科學科消化內科
6 臺北醫學大學消化醫學研究中心
Background: The optimal dialysis modality for patients with liver cirrhosis and end-stage kidney disease (ESKD) remains controversial. While peritoneal dialysis (PD) offers theoretical hemodynamic stability, its safety profile regarding infection and long-term survival in this immunocompromised population is undefined. This study compared the risk of mortality and major complications between PD and hemodialysis (HD) in patients with cirrhosis.
Aims: To evaluate the comparative risks of all-cause mortality and major adverse events associated with peritoneal dialysis versus hemodialysis in patients with cirrhosis.
Methods: Using the TriNetX global health research network, we identified adult patients with cirrhosis and ESKD initiating dialysis. To isolate sustained modality effects, we excluded patients who switched modalities. A 1:1 propensity score matching (PSM) was performed to balance 31 baseline covariates, including liver disease severity surrogates. We employed a 30-day landmark analysis to minimize immortal time bias. The primary outcome was all-cause mortality. Secondary outcomes included sepsis, peritonitis, myocardial infarction (MI), stroke, gastrointestinal bleeding, and hospital admission. Results: The final cohort included 1,651 matched pairs (mean age 62 years; 43% ascites). During the 3-year follow-up, PD was associated with a significantly higher risk of all-cause mortality compared with HD (45.7% vs. 36.2%; Hazard Ratio [HR], 1.38; 95% Confidence Interval [CI], 1.23 to 1.55; P<0.001). PD patients also exhibited a higher risk of sepsis (HR, 1.40; 95% CI, 1.16 to 1.68) and peritonitis (HR, 3.26; 95% CI, 2.45 to 4.33).
Contrary to theoretical expectations, PD was associated
with a higher risk of non-fatal MI (HR, 1.28; 95% CI, 1.00 to 1.64; P=0.047). Risks of gastrointestinal bleeding were comparable between groups. Furthermore, PD was associated with a higher burden of unplanned hospital admissions (HR, 1.57; 95% CI, 1.10 to 2.23).
Conclusions: In patients with cirrhosis and ESKD, PD is associated with inferior survival and a substantially elevated burden of sepsis compared with HD. These findings challenge the prioritization of PD for hemodynamic stability in this population, suggesting that infectious risks may outweigh theoretical cardiovascular benefits in decompensated cirrhosis.
P.039
慢性肝衰竭急性發作之預後因子與臨床結 果 - 台灣南部單一醫學中心回顧性研究
PROGNOSTIC FACTORS AND CLINICAL OUTCOMES OF ACUTE-ON-CHRONIC LIVER FAILURE: A SINGLE-CENTER RETROSPECTIVE STUDY IN SOUTHERN TAIWAN
陳建廷1 黃寳源1 林煜程2 王植熙2 陳建宏1
1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系 暨
長庚大學醫學系
2 長庚醫療財團法人高雄長庚紀念醫院外科部一般外科 暨 長庚大學醫學系
Background: Acute-on-chronic liver failure (ACLF) is characterized by a sudden decline in hepatic function occurring in patients with pre-existing chronic liver disease.
Aims: The study is to analyze the clinical characteristics and identify prognostic factors as well as evaluate predictive models in patients with acute-on-chronic liver failure (ACLF).
Methods: This retrospective cohort study included patients diagnosed with acute-on-chronic liver failure (ACLF) based on the definition provided by the Asian-Pacific Association for the Study of the Liver (APASL). Clinical characteristics, laboratory parameters, and prognostic scores—including the AARC score, CLIF-C ACLF score, MELD-Na, and ChildTurcotte-Pugh (CTP) score—were collected and calculated. The primary outcome was 28-day mortality.
Results: A total of 100 patients diagnosed with ACLF were included in this study, out of which 25 patients underwent liver transplantation (LT). Among LT-free patients, the 28-day mortality rate was observed to be 48.2%. The primary cause of ACLF was acute exacerbation of hepatitis B virus (HBV) in 83.5% of cases, followed by alcohol-related etiology (15.3%). Multivariate analysis identified that older age, higher INR and ammonia levels, and the presence of severe hepatic encephalopathy (grade III/IV) on days 3–6 were independent predictors of 28-day mortality. The AARC score and CLIF-C ACLF score, evaluated on days 3–6, demonstrated the highest predictive performance for 28-day mortality, with AUC values of 0.922 and 0.915, respectively. The optimal cut-off values for the AARC score and CLIF-C ACLF score were determined to be 9 and 46, respectively.
Conclusions: The AARC score and CLIF-C ACLF score, evaluated within one week after treatment, exhibit strong predictive capabilities for short-term mortality in ACLF patients. These models are valuable tools for guiding timely decision-making.
第二部分：消化道及膽胰疾病 P.040
以十二指腸液培養診斷與治療小腸細菌過度 增生
DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH (SIBO) USING DUODENAL FLUID CULTURE
薛文豪1,3 葉欣榮1,3,4 高偉育1,3,4 趙振瑞3,4 張君照1,3 簡睦旼2,3
1 臺北醫學大學附設醫院內科部消化內科
2 臺北醫學大學附設醫院小兒科
3 臺北醫學大學消化醫學研究中心
4 臺北醫學大學保健營養學系
Background: Small intestinal bacterial overgrowth (SIBO) is a condition in which excessive and abnormal bacterial populations colonize the small intestine, disrupting digestion and nutrient absorption. Common causes include impaired gut motility, anatomical abnormalities, and chronic diseases. The gold standard for diagnosis is duodenal or jejunal fluid aspiration. Treatment primarily consists of antibiotics (such as rifaximin or amoxicillin), dietary modifications (such as a low-FODMAP diet), management of underlying conditions, and correction of nutritional deficiencies. Persistent or recurrent cases may require long-term therapy and additional evaluation.
Aims: Our goal is to diagnose small intestinal bacterial overgrowth using intestinal fluid cultures, identify the bacterial species involved, and treat them with appropriate antibiotics.
Methods: After obtaining approval from the TMU-JIRB (Taipei Medical University – Joint Institutional Review Board; case number: N202312107), we enrolled ten patients who had undergone esophagogastroduodenoscopy and colonoscopy without an identifiable cause of abdominal pain, or whose imaging studies showed thickening or distention of the small bowel and were therefore suspected of having SIBO. All the patients agreed to undergo esophagogastroduodenoscopy for intestinal fluid cultures. A Tandem XL cannula was advanced into the duodenum beyond the second portion. Between 0.5 mL and 2.0 mL of duodenal fluid was collected. A cytologic brush was applied ten times to obtain mucosal microbiota, and a biopsy was taken from the second portion of the duodenum. Duodenal fluid was serially diluted and plated onto MacConkey agar (MAC), Blood Agar Plates (aerobic condition only) and Phenylethyl alcohol (PEA) agar (aerobic condition only). According to the North American Consensus criteria, SIBO
was defined as bacterial growth ≥10³ colony-forming units (CFU) per milliliter. All culture procedures were performed by trained personnel in the Clinical Laboratory Department of Taipei Medical University Hospital under sterile conditions.
Results: Regarding the symptoms of these ten patients, abdominal pain (mostly epigastric pain) and abdominal fullness were the most common presentations. Other symptoms included belching, acid regurgitation, changes in bowel habits, nausea, diarrhea, and constipation. A comparison of symptoms between the SIBO and non-SIBO groups is provided in Table 1. Seven out of ten patients were diagnosed with SIBO. Two had no bacterial growth in the culture, and one had a culture result of fewer than 1,000 CFU/mL. Two patients were lost to follow-up after endoscopy. One patient did not respond and continued to have recurrent abdominal pain. He was later diagnosed with a gastrointestinal stromal tumor (GIST) on abdominal CT. We list each of the ten patients’ age and sex, symptoms, culture results, antibiotics used, and treatment outcomes in Table 2.
Conclusions: For patients who have epigastric pain or abdominal fullness but have no identifiable cause on gastroscopy or colonoscopy, SIBO should be considered as a potential diagnosis. In this study, 70% of such patients were diagnosed with SIBO through endoscopy with intestinal fluid cultures. If the response to antibiotic therapy is limited after a diagnosis of SIBO, other possible underlying conditions should be investigated.
P.041
整合遺傳與生活型態因素之臺灣食道鱗狀細 胞癌風險預測模型
INTEGRATING GENETIC AND LIFESTYLE DETERMINANTS IN A RISK PREDICTION MODEL FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN TAIWAN
湯帛翰1 鍾承軒1 陳以勳2 徐銘宏3 余臣桓1 王文 3 王秀伯4 吳明賢4 李建宏5 吳宜珍2 陳哲宏6
1 亞東紀念醫院 肝膽胃腸科
2 高雄醫學大學附設中和紀念醫院 腸胃內科
3 義大醫院 內科部
4 國立臺灣大學醫學院附設醫院 胃腸肝膽科
5 高雄醫學大學 公共衛生學系
6 史丹佛大學 亞裔健康研究與教育中心
Background: In East Asia, esophageal squamous cell carcinoma (ESCC) is strongly influenced by both inherited susceptibility and modifiable lifestyle factors.
Aims: This study aimed to develop a risk assessment model for ESCC prevention by integrating genetic variants of two key alcohol-metabolizing enzymes—ADH1B and ALDH2— with major carcinogenic exposures, including alcohol, tobacco, and betel quid use.
Methods: Genetic and behavioral data were obtained from independent cohorts across five tertiary medical centers in Taiwan. The training cohort consisted of 406 ESCC patients and 656 healthy controls, while the validation cohort included 276 ESCC patients and 276 healthy controls. Genotyping was performed for ADH1B (rs1229984) and ALDH2 (rs671), and detailed questionnaires captured alcohol, tobacco, and betel quid consumption. These five significant genetic and lifestyle predictors were combined into a composite risk score.
Results: The risk score was constructed using the log odds ratios of the five predictors. With a cutoff value of 5 and the inclusion of gender, the model demonstrated a sensitivity of 80.05% and specificity of 86.59% in the training cohort (AUC-ROC = 0.90). In the validation cohort, 83.70% (231/276) of ESCC patients had scores ≥5, resulting in a sensitivity of 83.70%, specificity of 94.20%, a positive predictive value of 93.52%, and a negative predictive value of 85.25%.
Conclusions: This integrated risk assessment model accurately identifies individuals at elevated risk for ESCC and shows strong promise as a precision medicine–oriented screening tool for preventing alcohol-related upper digestive tract cancers in regions where ADH1B and ALDH2 polymorphisms and betel quid chewing are common.
P.042
小於 2 公分上消化道肌肉層下病灶於超音波 內視鏡追蹤下之尺寸變化規律與風險因子分 析
PARADOXICAL SIZE PROGRESSION PATTERNS IN UPPER GASTROINTESTINAL MUSCULAR SUBEPITHELIAL LESIONS ≤2 CM UNDER EUS SURVEILLANCE
鍾悦仁 鍾事達 梁志明 邱紹銘 蘇輝明 吳鎮琨 邱逸群 長庚醫療財團法人高雄長庚紀念醫院 胃腸肝膽科系
Background: Endoscopic ultrasound (EUS) surveillance is widely recommended for small upper gastrointestinal (UGI) muscular subepithelial lesions (SELs), particularly lesions ≤2 cm suspected to be gastrointestinal stromal tumors (GISTs). However, real-world data describing long-term size dynamics and risk factors for progression in this population remain limited, especially in Asian cohorts. Clear evidence guiding surveillance intensity and intervention thresholds is still lacking.
Aims: To analyze EUS findings and identify potential predictors of tumor progression.
Methods: We conducted a retrospective cohort study at Kaohsiung Chang Gung Memorial Hospital, a tertiary referral medical center in Taiwan. Consecutive patients with upper gastrointestinal muscular SELs ≤2 cm who underwent EUS surveillance between 2015 and 2024 were included. Lesions were stratified by baseline EUS size into four groups: G1 (≤0.5 cm), G2 (0.5–1.0 cm), G3 (1.0–1.5 cm), and G4 (1.5–2.0 cm). The primary endpoint was size progression, defined as a >20% increase in maximal diameter from baseline using a RECIST-like criterion. Cumulative progression was visualized using Kaplan–Meier–like curves. Univariable and multivariable analyses were performed using Firth penalized logistic regression to account for sparse events, adjusting for baseline size group, age, sex, and EUS echogenicity.
Results: A total of 248 patients were included (median age 60 years; 30.6% male). Most lesions were located in the stomach, predominantly in the body and fundus. During a median follow-up of 6.0 years (IQR 2.0–9.0), 106 of 245 followed patients (43.3%) met the progression criterion. Progression rates decreased with increasing baseline size: 62.2% in G1, 49.0% in G2, 23.8% in G3, and 0% in G4. No progression events were observed in lesions measuring 1.5–2.0 cm. Median time-to-progression was 1.0 year across progressing groups. In multivariable analysis (reference:
G1), larger baseline size groups were independently associated with a lower likelihood of progression, including G3 (adjusted OR 0.15, 95% CI 0.05–0.42) and G4 (adjusted OR 0.01, 95% CI 0.00–0.24). Male sex was associated with reduced progression risk (adjusted OR 0.44, 95% CI 0.24–0.82), whereas baseline heterogeneous echogenicity on EUS was independently associated with increased progression risk (adjusted OR 3.74, 95% CI 1.16–12.05). Age was not significantly associated with progression.
Conclusions: Larger small SELs (1.5–2.0 cm) did not show increased progression risk in this cohort, indicating that surveillance strategies should incorporate EUS imaging features in addition to baseline size, rather than using size alone as the primary determinant.
P.043
南臺灣一區域醫院早期低分化黏液缺乏型胃 癌（POORLY COHESIVE CARCINOMA） 之診斷困難性與臨床特徵：近兩年回溯性分 析
DIAGNOSTIC CHALLENGES AND CLINICAL CHARACTERISTICS OF EARLY POORLY COHESIVE CARCINOMA: A TWO-YEAR RETROSPECTIVE STUDY FROM A REGIONAL HOSPITAL IN SOUTHERN
TAIWAN
韓逸宏 林成業 阮綜合醫院 消化內科
Background: Gastric cancer incidence in Taiwan has demonstrated a steady decline over recent decades. Population-based data from the Taiwan Cancer Registry have shown that the age-adjusted incidence of gastric cancer decreased significantly and was strongly correlated with the increasing implementation of Helicobacter pylori screening and eradication programs.
Previous large-scale cohort studies and international consensus statements have confirmed that H. pylori eradication effectively reduces gastric cancer risk, particularly for intestinal-type gastric cancer through interruption of the Correa cascade.
Poorly cohesive carcinoma (PCC), a histologic subtype within the diffuse-type gastric cancer spectrum, exhibits a weaker association with H. pylori infection and often lacks recognizable premalignant lesions. As a result, earlystage PCC frequently presents with subtle or nonspecific endoscopic findings, posing substantial diagnostic challenges in routine clinical practice.
Aims: 1. To evaluate the prevalence of poorly cohesive carcinoma among gastric cancers diagnosed over the past two years in a regional hospital in southern Taiwan.
2. To compare the clinical and endoscopic characteristics between early and late PCC.
3. To illustrate the diagnostic challenges associated with early PCC and discuss the clinical implications of endoscopic biopsy strategies.
Methods: Study design: Retrospective pathology-based observational study.
Study setting: A regional hospital located in southern Taiwan.
Study period: January 2024 to November 2025.
Inclusion criteria: All newly diagnosed epithelial gastric
cancers confirmed by histopathology.
Exclusion criteria: Gastric lymphoma, gastrointestinal stromal tumors, and gastric neuroendocrine neoplasms.
Definitions:
- Poorly cohesive carcinoma (PCC): Pathology reports describing “poorly cohesive carcinoma” and/or “signet ring cell carcinoma”.
- Early PCC: Tumors staged as T1 when tumor stage information was available.
- Late PCC: PCC tumors beyond T1 stage.
- Helicobacter pylori status: Recorded as positive or negative based on diagnostic testing at the time of diagnosis; history of prior eradication therapy was not available.
Results: A total of 53 gastric cancer cases were identified during the study period.
Distribution of gastric cancer subtypes:
- Poorly cohesive carcinoma: 21 cases (39.6%).
- Non-poorly cohesive gastric carcinoma: 32 cases (60.4%).
The proportion of PCC in this cohort was numerically higher than that reported in previous large Taiwanese series, suggesting a relative prominence of PCC in contemporary clinical practice.
Association with Helicobacter pylori
At the time of diagnosis, H. pylori positivity was observed in:
- PCC: 14.3% (3 of 21 cases).
- Non-PCC gastric cancers: 6.3% (2 of 32 cases).
These findings support previous observations that PCC demonstrates a weaker association with H. pylori infection. Non-invasive H. pylori tests reflect infection status but do not reliably stratify PCC risk.
Early versus Late PCC
Among the 21 PCC cases:
- Early PCC (T1): 5 cases (23.8%).
- Late PCC: 16 cases (76.2%).
Clinical presentation:
Early PCC cases commonly presented with dyspepsia, epigastric discomfort, or were detected incidentally, whereas late PCC cases more frequently presented with gastrointestinal bleeding, anemia, and unintentional weight loss.
Endoscopic findings under white-light endoscopy:
Early PCC lesions were predominantly located in the distal stomach and appeared as shallow ulcers or subtle pale or whitish mucosa with minimal surface irregularity. In contrast, late PCC commonly showed mass-forming or infiltrative lesions with fold rigidity and, in some cases,
features suggestive of linitis plastica.
Key observation: Early PCC frequently mimicked benign gastric ulcers, increasing the likelihood of under-diagnosis without adequate biopsy sampling.
Diagnostic Challenges of Early PCC
Early PCC lacks reliable non-invasive biomarkers for detection. Routine non-invasive H. pylori tests, including CLO test, urea breath test, and stool antigen testing, cannot diagnose PCC and should not be used as surrogate markers for PCC risk.
Furthermore, the characteristic subepithelial spread and patchy tumor distribution of PCC contribute to a high falsenegative rate when biopsy sampling is limited.
Clinical Implications
Histologic confirmation through endoscopic biopsy remains the cornerstone of PCC diagnosis. Based on our institutional experience, careful and adequate biopsy sampling from suspicious gastric ulcers—including the ulcer edge, base, and adjacent pale or irregular mucosa— may improve diagnostic yield, particularly in cases with subtle endoscopic findings.
Conclusions: 1. Gastric cancer incidence in Taiwan continues to decline, likely related to widespread H. pylori screening and eradication.
2. Poorly cohesive carcinoma, a gastric cancer subtype less dependent on H. pylori, may represent a relatively larger proportion of newly diagnosed gastric cancers.
3. Early PCC presents with subtle clinical and endoscopic features and is easily overlooked.
4. Adequate and targeted endoscopic biopsy is essential for improving early detection of PCC in routine clinical practice.
P.044
早期診斷至關重要：內視鏡醫師視角下的主 動脈 食道瘻管相關大量上消化道出血 THE CRITICAL IMPORTANCE OF EARLY DIAGNOSIS IN AORTOESOPHAGEAL FISTULAINDUCED MASSIVE UPPER GASTROINTESTINAL BLEEDING: AN ENDOSCOPIST’S PERSPECTIVE
張源升1 戴維震1,2 吳鎮琨1 李育騏1 盧龍生1 姚志謙1
1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系 暨 長庚大學醫學系 2 高雄市立大同醫院
Background: Aortoesophageal fistula (AEF) is a rare but fatal cause of upper gastrointestinal bleeding. The disease progression is often rapid if not promptly recognized. The most common etiologies include thoracic aortic aneurysm (TAA) and prior aortic surgery. Early diagnosis remains a challenge due to nonspecific and intermittent symptoms. Aims: This case series aim to highlight the endoscopic features of AEF and the critical role of endoscopists in early detection.
Methods: We report three elderly patients (aged 76–82) who presented to the emergency department with massive hematemesis. One had a history of type B aortic dissection post thoracic endovascular aortic repair (TEVAR); the others had no known thoracic disease. None reported midthoracic pain. Laboratory data showed hemoglobin 5.1 to 6.2 g/dL without coagulopathy. Esophagogastroscopy (EGD) was performed within 1 hour in two patients, and at 9 hours in the third. EGD showed consistent findings in three cases: a subepithelial bulging mass with central blood clot adherent to the left quadrant (6–9 o’clock) of the midesophagus (Figures A-C). CT confirmed AEF secondary to ruptured TAA in two patients (Figure D). Unfortunately, one patient collapsed suddenly in the emergency department; the others underwent emergent surgery but died within 1 and 21 days postoperatively (esophagectomy with or without TEVAR).
Results: Chiari’s triad (mid-thoracic pain, sentinel bleeding, fatal hematemesis) is classically associated with AEF but was absent in half of the patients. In our report, EGD can be a most timely and specific modality for early diagnosis of AEF, especially in patients without clear prior aortic disease. The typical endoscopic feature— subepithelial bulging mass with central blood clot—may serve as a diagnostic clue. In addition, we proposed the
concept of a “hot-zone” of AEF in EGD, located at the left quadrant (six to nine o’clock) of mid-esophagus (Figures E-F), may also be a potential predictor of AEF.
Conclusions: Early recognition of typical features and “hot zone” of AEF on EGD may enable timely diagnosis of AEF and guide life-saving interventions.
P.045
接受窄頻影像導引切片之胃腸化生患者中， 內視鏡表徵與年齡相關之異生風險：南台灣 單一醫學中心研究
ENDOSCOPIC FEATURES AND AGERELATED RISK OF DYSPLASIA IN PATIENTS WITH GASTRIC INTESTINAL METAPLASIA UNDERGOING NBITARGETED BIOPSY: A SINGLE-CENTER STUDY FROM SOUTHERN TAIWAN
黃輝勝 張源升 梁志明 姚志謙 戴維震 蔡成枝
高雄長庚紀念醫院胃腸肝膽科系
Background: Gastric intestinal metaplasia (GIM) is a recognized precancerous condition of the stomach. Accurate risk stratification for dysplasia among patients with GIM remains clinically challenging, particularly in the era of narrow-band imaging (NBI)–targeted biopsy. While individual endoscopic features of gastric atrophy have been proposed as potential markers of neoplastic progression, their combined predictive value and the optimal role of age-based stratification remain uncertain. This study aimed to evaluate the association between predefined endoscopic atrophy features, a composite endoscopic score, and dysplasia in patients with GIM.
Aims: This study aimed to investigate the association between predefined endoscopic atrophy features and the risk of dysplasia in patients with gastric intestinal metaplasia (GIM) undergoing narrow-band imaging (NBI)–targeted biopsy. Specifically, we evaluated both individual atrophic endoscopic features and a composite atrophy feature score for their predictive value in identifying lowgrade dysplasia.
Methods: We conducted a retrospective observational study at a single tertiary medical center in Southern Taiwan, including consecutive patients with histologically confirmed GIM who underwent NBI-targeted biopsy between January and December 2024. The primary endpoint was the presence of low-grade dysplasia (LGD). Four predefined endoscopic atrophy features—loss of regular arrangement of collecting venules (RAC), visible submucosal vessels, loss of gastric folds, and visible atrophic border—were systematically recorded and summed into a composite atrophy feature score (range 0–4). Logistic regression analyses were performed to assess associations with dysplasia, using both univariate and multivariable models adjusted for sex and Kimura–Takemoto classification (closed vs open type). Sensitivity analyses explored different age cut-offs, and the
optimal threshold was identified using receiver operating characteristic analysis and the Youden index.
Results: A total of 102 patients with GIM were included, of whom 34 (33.3%) had LGD. The composite atrophy feature score showed no significant association with LGD when analyzed as a binary variable, ordinal variable, or through trend testing (p for trend >0.80). Individual endoscopic atrophy features were also not independently associated with dysplasia. In contrast, age demonstrated a consistent association with LGD. An age cut-off of ≥69 years provided the most balanced discriminatory performance (sensitivity 0.529, specificity 0.706) and was significantly associated with LGD (univariate OR 2.70, 95% CI 1.15–6.33; p=0.029). This association remained significant after multivariable adjustment for sex, Kimura classification, and composite atrophy score (adjusted OR 2.62, 95% CI 1.08–6.36; p=0.034).
Conclusions: In this single-center cohort from Southern Taiwan, aggregated endoscopic atrophy features did not independently predict dysplasia among patients with GIM undergoing NBI-targeted biopsy. Age emerged as the most informative clinical factor for dysplasia risk stratification. These findings highlight the importance of incorporating age into surveillance and biopsy decision-making, rather than relying solely on composite endoscopic atrophy features.
P.046
PKF118-310 作為一種潛在的小分子抑制 劑，靶向 WNT/β-CATENIN 信號通路以用 於胃癌治療
PKF118-310 AS A POTENTIAL SMALL MOLECULE INHIBITOR TARGETING THE WNT/β-CATENIN PATHWAY FOR GASTRIC CANCER THERAPY
張德生1,2 盧重光1 李沁3 陳慰明1 謝詠諭1 魏國良1,2 江明格3 1 嘉義長庚醫院胃腸肝膽科 2 長庚大學醫學院
3 國立中正大學 生物醫學科學系
Background: While advances in public health have reduced its incidence rate, clinical outcomes of advanced GC remain suboptimal with current standard therapy. The Wnt/ β-catenin signaling pathway is frequently upregulated in GC and promotes tumorigenesis by activating oncogenes via β-catenin and T-cell factor/lymphoid enhancing factor (TCF/ LEF) complexes.
Aims: To examine the effect of PKF118-310, a small molecule inhibitor of the β-catenin -TCF/LEF interaction, on suppressing the downstream oncogenic signaling of GC.
Methods: We investigate the in vitro antitumor potential of PKF118-310 in GC cell lines, patient-derived xenografts and organoids that are miniature forms of tissues cultured in vitro specifically to maintain their three-dimensional architecture and therefore maintain their functions.
Results: Our results showed that PKF118-310 exhibited dose- and time- dependent inhibition of GC cell proliferation. PKF118-310 downregulated Wnt/β-catenin signaling targets, reduced cancer stem cell (CSC) markers, and key epithelial-mesenchymal transition (EMT) marker. PKF118310 also inhibited cell migration, invasion and colony formation. In patient-derived xenograft (PDX) models, PKF118-310 suppress tumor growth without affecting body weight, indicating good tolerability. Transcriptomic analysis of patient-derived organoids (PDOs) revealed a strong correlation between PKF118-310 sensitivity and TCF7 gene expression, with higher TCF7 levels predicting greater sensitivity. Furthermore, bioinformatics analysis showed that elevated TCF7 expression in GC tissues was associated with advanced tumor grade and reduced overall survival.
Conclusions: Certain small molecule inhibitors of Wnt/ β-catenin signaling pathway might be a promising therapeutic agent for GC as they can induce apoptosis via inhibiting proliferation, EMT and CSC feature of cancer cells and are most importantly well-tolerated.
P.047
GRP78 過度表現的人類胃癌細胞透過外泌 體增強抗藥性
GRP78-OVEREXPRESSING GASTRIC CANCER CELLS PROMOTE CHEMORESISTANCE VIA EXTRACELLULAR VESICLES
施翔耀1 蔡忻誼2 林明瑋2 吳政毅1,3 許文鴻1,3 吳登強1,3
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 義大醫療財團法人義大醫院 醫學研究部
3 高雄醫學大學醫學系
Background: Numerous studies have reported that chemotherapeutic resistance in gastric solid tumors results from genetic heterogeneity in cancer cells. Cancer cells with the ability to self-renew and maintain stemness may cause cancer recurrence and contribute to chemoresistance. Glucose-regulated protein 78 (GRP78) is thought to regulate the tumor microenvironment, leading to cancer chemoresistance. Extracellular vesicles (EVs) are small membranous particles secreted by cancer cells may promote cancer stemness. Our previous study revealed that cytosolic GRP78 contributes cancer stemness.
Aims: This study aims to investigate how the GRP78-rich EVs contribute to gastric cancer (GC) chemoresistance.
Methods: GRP78 was overexpressed in human gastric cancer AGS cells. The EVs derived from human gastric cancer cells were isolated and purified from GRP78 overexpressed AGS (OE-GRP78) or vector control cells (NC-CTL) by using qEV size exclusion chromatography. The concentration and size of EVs were measured by nanoparticle tracking (NTA) system. The biomarkers of EVs, including CD63, CD9 and CD81, were identified by Nano flow cytometry (nFCM). The level of GRP78 in EVs were evaluated using an ultrasensitive ELISA. Cancer stemness-related markers were determined by Western blot or flow cytometry. The cell viability was evaluated by Cell Counting Kit-8.
Results: GRP78 level is up-regulated in serum EVs of patients with GC or OE-GRP78 derived EVs. GRP78rich EVs promote cancer stemness markers (CD44, CD24 and LGR5), stemness-related protein (GRP78, ABCG2, SOX2, OCT4, and NANOG) expressions, and enhanced chmoresistance.
Conclusions: The present study points to the importance of GRP78-rich EVs in cancer stemness and chemoresistance in GC, which may be potential targets for anticancer therapy.
P.048
藉由胃上皮細胞粒線體的轉殖改變胃癌抗藥 性及代謝路徑的機轉 MECHANISMS OF ALTERING DRUG RESISTANCE AND METABOLIC PATHWAYS IN GASTRIC CANCER BY TRANSFECTION OF GASTRIC EPITHELIAL CELL MITOCHONDRIA
林楷傑1 陳建誠1 黃斌2 林明瑋3 胡晃鳴1,4 郭昭宏4,5
1 高雄醫學大學附設高醫岡山醫院胃腸內科
2 高雄醫學大學生物醫學暨環境生物學系
3 義大醫療財團法人義大醫院 醫學研究部
4 高雄醫學大學醫學系
5 高雄秀傳紀念醫院腸胃內科
Background: Gastric cancer is highly malignant, with challenges in stemness and chemoresistance. GRP78 regulates cancer stemness and drug resistance. Mitochondrial transplantation from healthy cells may modulate metabolism and reduce malignancy.
Aims: This study investigated the effects of transferring normal gastric epithelial mitochondria into gastric cancer cells.
Methods: Mitochondria from normal gastric epithelial cells were transplanted into MKN45 and AGS cells. Stemness markers, oxidative stress, apoptosis, and mitochondrial metabolism were analyzed via flow cytometry, Western blot, Seahorse assays, and lactate measurement. Chemosensitivity to 5-fluorouracil was assessed by CCK8. Xenograft mice were used to evaluate tumor growth and protein expression in vivo.
Results: Mitochondrial transplantation downregulated mitochondrial biogenesis, glycolysis, and GRP78mediated stemness, increased oxidative stress, enhanced apoptosis under hypoxia, and improved 5-FU sensitivity. In vivo, epithelial mitochondria suppressed tumor growth and altered stemness- and metabolism-related protein expression.
Conclusions: Normal gastric epithelial mitochondria inhibit gastric cancer progression by reducing GRP78mediated stemness, impairing metabolism, and enhancing oxidative stress, apoptosis, and chemosensitivity, suggesting a promising therapeutic strategy to overcome chemoresistance.
P.049
胃癌病人口腔唾液與牙菌斑菌叢變化
ORAL SALIVA AND DENTAL PLAQUE
BIOFILM MICROBIOTA ACROSS THE GASTRIC CANCER SPECTRUM
黃奕翔1 吳如惠2,3 葉于瑄1 林佩蓁3 吳宜珍1,4 郭昭宏4,5
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學口腔醫學院口腔衛生學系
3 高雄醫學大學附設中和紀念醫院牙科部
4 高雄醫學大學醫學系
5 高雄秀傳紀念醫院腸胃內科
Background: Gastric cancer remains one of the most common malignancies and leading causes of cancerrelated mortality worldwide. The oral cavity has the second most diverse microbiome after the gut. Different dental surface and niches serve as multiple microhabitats and contribute to the complexity. Because oral microorganisms are continuously swallowed, the mouth may serve as an upstream reservoir that shapes gastric microbial exposure. Increasing evidence suggests that oral-originating bacteria are associated with digestive tract cancers. For example, Fusobacterium has been reported to be significantly enriched in gastric cancer tissue, and its coexistence with Prevotella has been associated with malignant transformation in colorectal cancer.
Aims: We aimed to investigate the association between the oral microbiome and gastric carcinogenesis.
Methods: We conducted a cross-sectional study including four groups: normal gastric mucosa, intestinal metaplasia, post-treatment gastric cancer, and active gastric cancer. Saliva, anterior dental plaque coating, and posterior plaque coating samples were collected. Three target bacteria, Fusobacterium nucleatum (FN), Prevotella intermedia (PI), and Porphyromonas gingivalis (PG), were quantified using SYBR-based real-time qPCR with total bacterial 16S rRNA as the internal control. Relative bacterial abundance across the gastric carcinogenesis spectrum was analyzed.
Results: A total of 151 participants were included. Baseline characteristics did not differ significantly among groups, except for history of Helicobacter pylori (H.pylori) infection (p= 0.014). Salivary FN, PI, and PG showed no significant differences across groups. In posterior dental plaque, FN significantly increased stepwise from normal mucosa to active gastric cancer (p=0.004; H. pyloriadjusted p=0.009). PG in posterior dental plaque showed a similar gradient with significance (p=0.002; H.pyloriadjusted p=0.008).
Conclusions: Targeted qPCR profiling showed enrichment of FN and PG in posterior dental plaque along the gastric carcinogenesis spectrum, suggesting a potential role in gastric cancer development. Posterior oral biofilm profiling may represent a feasible, noninvasive biomarker candidate for gastric cancer risk stratification and assessment of disease activity.
P.050
胃黏膜相關淋巴組織淋巴癌：單一醫學中心 病歷系列研究
GASTRIC MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT)
LYMPHOMA: A CASE SERIES STUDY IN A SINGLE MEDICAL CENTER
陳永發
臺北醫學大學˙ 臺北市立萬芳醫院 消化內科
Background: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is a non-Hodgkin B-cell lymphoma that frequently involves the stomach and has been reported to be associated with Helicobacter pylori (HP) infection in most cases. So HP eradication is regarded as the first-line therapy in early stage disease. More recent observations have seen a gradual increase in the relative incidence of HP-negative MALT lymphomas.
Aims: Our study aimed to reveal the clinical, endoscopic features and treat strategy of gastric MALT lymphoma by comparing HP-uninfected with current HP-infection cases. Methods: We performed a retrospective analysis using the pathology database of Wanfang medical center to search for primary gastric MALT lymphomas diagnosed from 2003 to 2025. Finally, eighteen cases were collected.
Results: The 18 patient cohort included 8 men and 10 women with a median age of 58.7 (41~85) years old at entry. 9 (50%) were HP-uninfected cases. The same incidence of HP-negative MALT lymphomas was noted, 6 in 12 cases after 2015 and 3 in 6 cases before 2015. All cases were Ann Arbor stage I except one case was stage IV, who combined diffuse large B-cell lymphoma. The clinical symptoms were upper abdominal pain (N:8), and bleeding (N:3). 7 cases had no symptoms and discovered by health checkup. The endoscopic appearances were superficial type (N:8), ulcer(N:2), polyp/mass(N:5) and mixed type(N:3). The location of involved were proximal stomach (N:10), distal stomach(N:7) and multiple regions(N:1). 11 cases had a solitary lesion and 7 cases had multiple lesions. The maximal size of lesion were <1 cm(N:2), 1~3 cm (N:10) and >3 cm (N:6). Unfortunately, the age, gender, symptoms, endoscopic appearances, lesions of location, number and size didn’t have significantly difference between HPuninfected with current HP-infection cases. Excluding one case of stage IV and two cases of loss follow-up, fifteen cases were reviewed for treatment strategy and outcome. All 9 HP-infected cases received HP eradication as first-
line treatment. One of them was treated with radiotherapy 7 months after eradication. Time from effective treatment to complete response was 5 months (3~6). In 6 HP-uninfected cases, four cases received radiotherapy only. Two cases received eradication, then accompanied with radiotherapy and targeted therapy, 3 and 11 months after eradication respectively. Time to complete response for HP-uninfected cases was 2.5 months (1~3). No relapse developed during the following time, 13.33 months(3~31) for HP-infection cases and 28.33 months (6~57) for HP-uninfected cases. Conclusions: From our small limited study, we found that the relative incidence of HP-uninfected gastric MALT lymphoma didn’t increase in recent ten years. Compaired with current HP-infection cases, HP-uninfected cases didn’t have significantly difference about age, gender, symptoms, endoscopic appearances, lesions of location, number and size. Hp eradication may be not suitable for HP-uninfected cases as first-line therapy, unlikey for current HP-infection cases.
P.051
巴瑞特氏食道患者接受燒灼術之臨床成效： 單一中心回顧性分析
CLINICAL OUTCOMES OF RADIOFREQUENCY ABLATION IN PATIENTS WITH LONG SEGMENT BARRETT’S ESOPHAGUS: A SINGLECENTER RETROSPECTIVE ANALYSIS
董帝佑1 翁立翰1 洪心玉1 林俊哲1,2,3 蔡明璋1,2,3 曾明性2,3
汪奇志1,2,3
1 中山醫學大學附設醫院肝膽腸胃科
2 中山醫學大學醫學研究所
3 中山醫學大學醫學系
Background: Radiofrequency ablation (RFA) serves as a cornerstone in the management of Barrett’s esophagus (BE) to mitigate the risk of neoplastic progression.
Aims: This study aimed to analyze real-world clinical data to evaluate the efficacy of RFA in achieving complete eradication and to determine the recurrence rates during a one-year surveillance period.
Methods: We conducted a retrospective review of 90 patients with biopsy-confirmed BE who underwent RFA between 2022 and 2025. Post-procedural assessment included both endoscopic inspection and histological evaluation at one-month and one-year intervals to monitor for residual disease and late-term recurrence.
Results: The study cohort (mean age 56.5±14.3 years) showed a significant male predominance (68.9%). Baseline endoscopic findings revealed a mean Prague C and M of 1.46 and 3.68, respectively. Histologically, 37.8% of patients presented with dysplasia (LGD: 36.7%; HGD: 1.1%). Utilizing primarily the TTS-1100 RFA system (91.0%), we observed a one-month endoscopic clearance rate of 71.3% (57/80), while the pathologic clearance rate was notably higher at 92.4% (73/79). In patients who completed the one-year follow-up (n=33), the recurrence rate was 12.1% (n=4). Complications were minimal, with only a single instance of esophageal stricture (1.4%).
Conclusions: Our findings demonstrate that RFA is a highly effective and safe intervention, achieving over 90% pathologic clearance. While minor endoscopic residues may persist in the immediate short-term, the low recurrence rate at one year underscores the durability of RFA as a long-term therapeutic strategy for BE.
P.052
氬氣電漿凝固術治療症狀性食道入口斑之亞 太地區前瞻性病例系列研究
A PROSPECTIVE CASE SERIES OF ARGON PLASMA COAGULATION FOR SYMPTOMATIC CERVICAL INLET PATCHES IN THE ASIA-PACIFIC REGION
蔡元榮1,2 詹益群1 林連豐1 郭志榮1 阮盛豪1 林群峰1
張琳璲1 薛佑玲2,3 1 屏東基督教醫院內科部胃腸肝膽科
2 國立中山大學生物科學所
3 國立中山大學生物醫學所
Background: Cervical inlet patch (CIP), defined as heterotopic gastric mucosa located in the proximal esophagus, is increasingly recognized as a potential cause of laryngopharyngeal reflux (LPR)-like symptoms, including globus sensation, throat discomfort, hoarseness, and chronic throat clearing. While many cases are incidental, symptomatic CIP can significantly impair quality of life. Proton pump inhibitors (PPIs) are commonly prescribed; however, symptom persistence despite adequate acid suppression is frequently reported. Endoscopic ablation with argon plasma coagulation (APC) has emerged as an effective treatment option, but prospective data from the Asia-Pacific region remain limited.
Aims: This study aimed to evaluate the safety and shortterm efficacy of argon plasma coagulation in patients with symptomatic cervical inlet patches refractory to proton pump inhibitor therapy, and to report the first prospective case series from the Asia-Pacific region.
Methods: This was a prospective case series conducted at a Ping Tung Christian Hospital. Four consecutive adult patients with symptomatic cervical inlet patches were enrolled between January 2025 and September 2025. All patients presented with persistent laryngopharyngeal reflux–like symptoms despite prior proton pump inhibitor therapy. Cervical inlet patches were identified during diagnostic upper endoscopy and documented according to their location from the incisors and maximal diameter. Targeted biopsies were obtained in all patients to confirm the presence of ectopic gastric mucosa. All initial endoscopic examinations were performed without sedation. Symptom severity was assessed using a subjective pain scale scoring system at baseline, after PPI therapy, and at 1 week and 1 month following APC ablation. APC was performed using standard endoscopic technique with the aim of achieving
complete macroscopic ablation of the inlet patch. Patients were followed for one month after the procedure to assess symptom response and procedure-related adverse events, including bleeding, stricture formation, ulceration, infection, or perforation.
Results: A total of four symptomatic patients were recruited for argon plasma coagulation (APC) treatment. Three were male, with ages ranging from 46 to 64 years (mean age: 56 years). Cervical inlet patches (CIPs) were located between 15 cm and 20 cm from the incisors. The patch sizes ranged from 0.2 cm to 0.8 cm, with a mean diameter of 0.4 cm. Three of the four patients had two separate patches. All patients presented with prominent laryngopharyngeal reflux (LPR)-like symptoms, including dry throat, burning sensation, globus sensation, hoarseness, and frequent throat clearing. Each patient underwent biopsy, and ectopic gastric mucosa was pathologically confirmed in three cases. Two patients had concurrent duodenal ulcers, while one had a gastric ulcer. Additionally, two patients were diagnosed with GERD grade A. All initial upper endoscopies were performed without sedation. The severity of laryngopharyngeal symptoms was assessed using a subjective symptom scale(pain scale scoring), scored as follows at baseline: 7, 5, 6, 5, and 7, respectively. Despite treatment with proton pump inhibitors (PPIs), symptoms persisted, with follow-up scores of 8, 4, 6, 5, and 8, indicating minimal to no improvement. Following APC ablation, all patients showed substantial symptomatic improvement. One week after the procedure, scores decreased to 4, 1, 3, 3, and 4; at one month post-ablation, the scores further improved to 3, 1, 2, 2, and 4, respectively (Figure 1). No major complications—such as strictures, ulcers, infections, or perforations—were observed during the one-month follow-up. However, two patients had residual CIPs and were scheduled for a second session of APC.
Conclusions: Argon plasma coagulation ablation appears to be a safe and effective endoscopic treatment for patients with symptomatic cervical inlet patches, providing substantial relief of laryngopharyngeal symptoms. In contrast, PPI therapy alone was ineffective in symptom control. APC should be considered a viable therapeutic option in managing CIP-associated LPR symptoms.
P.053
虛擬染色內視鏡時代下胃體大彎切片的診斷 效益：回溯性研究 DIAGNOSTIC YIELD OF BODY GREATER CURVATURE BIOPSY IN THE ERA OF VIRTUAL CHROMOENDOSCOPY: A RETROSPECTIVE STUDY
胡士麒 國立臺灣大學醫學院附設醫院
Background: The updated Sydney System recommends a multi-site biopsy protocol, including the body greater curvature (BGC), for optimal gastric cancer risk stratification (OLGA/OLGIM staging). However, the BGC is historically considered the site of lowest diagnostic yield. With the advent of high-definition virtual chromoendoscopy (e.g., NBI), endoscopists can increasingly visualize intestinal metaplasia (IM) and atrophy in real-time. It remains unclear whether the BGC biopsy can be safely omitted in patients with an endoscopically normal appearance at this site without compromising risk stratification.
Aims: To evaluate the diagnostic yield of the BGC biopsy and determine the clinical safety of a “Simplified Protocol” (omitting BGC sampling) for detecting high-risk gastritis (Stage III/IV) in patients with no visible IM or atrophy at the BGC.
Methods: This retrospective cohort study analyzed patients undergoing routine upper gastrointestinal endoscopy at the National Taiwan University Cancer Center. Highresolution white-light endoscopy followed by narrow-band imaging was used for assessment. We enrolled patients with a normal-appearing BGC (EGGIM score = 0 and no endoscopic atrophy). We compared a Standard Protocol (using all biopsy data) with a Simplified Protocol (omitting the BGC biopsy and imputing a score of 0 for that site). Primary outcomes included the negative predictive value (NPV) of endoscopy for BGC pathology, staging consistency (Kendall’s tau-b), and the down-staging rate from high-risk (Stage III/IV) to low-risk (Stage 0–II).
Results: Among 307 patients (63% female; median age 63 years) with a normal-appearing BGC, endoscopic assessment demonstrated high accuracy, with an NPV of 96.5% for histological IM and 91.1% for histological atrophy. The Simplified Protocol showed excellent concordance with the Standard Protocol (OLGIM: 97.4% agreement, Kendall’s tau-b = 0.98; OLGA: 95.1%
agreement, Kendall’s tau-b = 0.95). Omitting the BGC biopsy resulted in the down-staging of only 5 high-risk patients (1.6%). The number needed to test (NNT) to detect one additional high-risk patient by biopsying a normalappearing BGC was 61.4.
Conclusions: In patients with a normal-appearing BGC on virtual chromoendoscopy, routine biopsy of this site provides low incremental yield. A simplified biopsy strategy omitting the BGC maintains high agreement with standard staging and successfully identifies the vast majority of high-risk cases. Given the high NNT (~61), this simplified strategy appears feasible and resource-efficient, carrying only a minimal residual risk (<2%) of understaging.
P.054
P.055
大腸瘜肉切除術後 非酒精性脂肪肝疾病與 復發進階性腺瘤風險之間 性別差異之探討 SEX-BASED DIFFERENCES IN THE ASSOCIATION BETWEEN NONALCOHOLIC FATTY LIVER DISEASE AND RISK OF METACHRONOUS ADVANCED COLORECTAL ADENOMA AFTER POLYPECTOMY
張璨璿1 林裕民1,2 張麗文1,2 張鴻俊1,2 劉玉華1 孫灼基1,2 楊國卿1 1 新光吳火獅紀念醫院 胃腸肝膽科
2 天主教輔仁大學 醫學院 醫學系
Background: Because nonalcoholic fatty liver disease (NAFLD) is common and biologically linked to colorectal tumorigenesis, current schemas may overlook metachronous advanced adenoma (mAA) risk. Incorporating metabolic factors can refine stratification. Aims: Our aim is to determine whether the metabolic profile—especially NAFLD—is independently associated with mAA after polypectomy.
Methods: Focused on participants who underwent health examinations with two colonoscopies between 2014 to 2020. Outcome: mAA at surveillance (≥ 10 mm, high grade dysplasia, or tubulovillous/villous). Exposures: age ≥ 45, and metabolic profile: NAFLD; fasting blood glucose (FBG) ≥ 100; abdominal obesity; triglyceride (TG) ≥ 150; low high density lipoprotein (HDL); low density lipoprotein (LDL) ≥ 140; hypertension. Statistics: Sexstratified logistic regression (univariable → multivariable), adjusting for index colonoscopy findings (reference: 1–2 non-advanced adenomas; comparators: ≥ 3 diminutive, ≥ 3 small, advanced).
Results: NAFLD independently predicted mAA in women [Odds ratio (OR) 4.90, 95% CI 3.05–7.87] but not in men (OR 1.28, 0.94–1.76). Age ≥ 45: Men 1.52 (1.18–1.96); Women 1.74 (1.08–2.78). FBG ≥ 100 mg/dL: Women 1.48 (1.09–2.01); Men 1.15 (0.88–1.51). Other metabolic factors (abdominal obesity, TG, HDL, LDL, hypertension): not significant after adjustment. Index findings predict mAA (vs 1–2 non-advanced): ≥ 3 diminutive adenomas: not significant (Men 1.09; Women 1.21). ≥ 3 small adenomas: Men 3.11 (2.21–4.36); Women 3.27 (2.02–5.29). Advanced adenoma: Men 4.71 (3.67–6.05); Women 5.41 (3.73–7.83). Conclusions: NAFLD predicts metachronous advanced adenoma after adenoma removal, with a stronger effect
in women—plausibly due to postmenopausal estrogen decline, dysglycemia-driven inflammatory signaling, and a more fibrotic/inflamed NAFLD phenotype. These sexspecific findings support metabolic risk profiling and position NAFLD as a modifiable target for colorectal cancer prevention.
P.056
非高風險族群之大腸息肉盛行率：回溯觀察 性研究
PREVALENCE OF COLORECTAL POLYPS IN NON-HIGH-RISK GROUP
INDIVIDUALS: A RETROSPECTIVE OBSERVATIONAL STUDY
劉冠緯 黃懷毅 王俊偉 陳忠宏 顏聖烈 葉永祥 黃信彰 秀傳醫療財團法人彰濱秀傳紀念醫院
Background: Colorectal cancer (CRC) is a leading cause of cancer-related death, and colonoscopy examination is crucial for detection of precancerous polyps. However, the prevalence of colonic polyps in the non-high-risk population is not well known.
Aims: The aim of this study was to evaluate the prevalence of colonic polyps in the non-high-risk population.
Methods: From January 1, 2023 to December 31, 2024, individuals undergoing colonoscopy examinations at the health check-up department were included. Exclusion criteria were individuals with gastrointestinal bleeding, positive fecal occult blood test, previous colonic polyp history, and first-degree family history of CRC. The prevalence of adenomas, sessile serrated polyps, advanced neoplasia (AA) (size ≥1 cm, villous pattern, high-grade dysplasia, and CRC), and clinically significant serrated polyps (CSSP) (large (≥1 cm) hyperplastic polyps, sessile serrated polyps, traditional serrated adenomas) were calculated. The prevalence of colorectal neoplasia across different age groups was compared using Pearson’s chisquare test.
Results: Our study initially included 2979 individuals undergoing colonoscopy examinations at the health checkup department. After excluding 1240 participants, a total of 1739 individuals were included in the final analysis. The prevalence of adenoma was as follows: <40 years (17.7%), 40–44 years (34.7%), 45–49 years (40.8%), 50–54 years (41.4%), 55–59 years (49.1%), and ≥60 years (55.1%) (P < 0.001, across all groups). The prevalence of SSL was as follows: <40 years (1.3%), 40–44 years (1.8%), 45–49 years (3.3%), 50–54 years (2.6%), 55–59 years (1.2%), and ≥60 years (2.2%) (P = 0.46, across all groups). The prevalence of AA was as follows: <40 years (2.8%), 40–44 years (6.0%), 45–49 years (7.1%), 50–54 years (10.3%), 55–59 years (10.2%), and ≥60 years (8.7%) (P < 0.001, across all groups). The prevalence of CSSP was as follows: <40 years (1.5%), 40–44 years (2.5%), 45–49 years (5.4%), 50–54 years (4.7%), 55–59 years (3.0%), and ≥60 years
(3.6%) (P =0.040, across all groups).
Conclusions: In the non-high-risk population, the prevalence of adenoma increased significantly with advancing age. In contrast, the prevalence of SSL did not increase significantly with advancing age. The prevalence of AA and CSSP was significantly higher in individuals aged ≥40 years compared with those under 40.
P.057
糞菌移植治療復發性或難治型艱難梭菌感染 之南台灣單中心真實世界研究
REAL-WORLD EXPERIENCE OF FECAL MICROBIOTA TRANSPLANTATION FOR RECURRENT OR REFRACTORY CLOSTRIDIOIDES DIFFICILE INFECTION: A SINGLE-CENTER EXPERIENCE FROM SOUTHERN TAIWAN
柳硯文1 姚志謙1 梁志明1 戴維震1,2 王心明1,3 王植熙4 陳肇隆4 李柏賢5,6 邱政洵6,7 蔡成枝1 蔡明釗1,3,8
1 長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨 長庚大學醫學系
2 高雄市立大同醫院
3 高雄市立鳳山醫院（委託長庚醫療財團法人經營）
4 高雄長庚紀念醫院外科部一般外科與長庚大學醫學系
5 林口長庚紀念醫院胃腸肝膽科系
6 長庚微生物治療中心
7 林口長庚紀念醫院兒童感染科
8 國立中山大學醫學院
Background: Recurrent or refractory Clostridioides difficile infection (rrCDI) poses a significant therapeutic challenge, particularly in high-risk and immunocompromised populations. While fecal microbiota transplantation (FMT) is an established therapy, robust real-world data from Asian cohorts, especially regarding solid organ transplant recipients, remain limited.
Aims: This study aimed to evaluate the real-world clinical outcomes and safety of FMT for rrCDI in a single-center cohort at Kaohsiung Chang Gung Memorial Hospital, with a specific focus on general and high-risk liver transplant populations.
Methods: We conducted a retrospective cohort study evaluating all patients who received FMT for rrCDI between October 2019 and May 2025. FMT materials were processed by a centralized Microbiota Therapy Center and delivered via a cold-chain system. The primary endpoint was clinical success, defined as the resolution of diarrhea within one month post-FMT. Secondary outcomes included sustained clinical success at one year and procedure-related adverse events.
Results: A total of 23 patients underwent 26 FMT procedures. The primary clinical success rate at one month was 92.0% (23/25). Sustained clinical success at one year was 84.2%. Notably, within the immunocompromised subgroup of liver transplant recipients (n=5), both 1-month
and 1-year clinical success rates were 100%. The safety profile was excellent, with no procedure-related adverse events observed
Conclusions: This real-world study demonstrates that FMT is a highly effective and safe therapeutic modality for rrCDI, achieving high rates of both primary and sustained clinical success. Critically, these robust outcomes extend to immunocompromised patients, including liver transplant recipients, supporting the broader implementation of FMT in high-risk Asian populations
P.058
比較吡可硫酸鈉、氧化鎂與檸檬酸組合製劑 及聚乙二醇之病人回報結果與腸道清潔效 果：臺灣前瞻性隨機試驗
PATIENT-REPORTED OUTCOMES AND BOWEL CLEANSING EFFICACY OF SODIUM PICOSULFATE, MAGNESIUM OXIDE AND CITRIC ACID AND POLYETHYLENE GLYCOL: A PROSPECTIVE RANDOMIZED TRIAL IN TAIWAN
劉彥伯1 陳昱宗1,2,3 李輔仁1,2,4 邱毓澤1,2 梁凱舜1,2 吳冠緯
1 輔仁大學附設醫院 內科部 胃腸肝膽科
2 輔仁大學醫學院醫學系
3 國立臺灣大學醫學院臨床醫學研究所
4 中國醫藥大學公共衛生學院公共衛生學
Background: The quality of bowel cleansing significantly affects colonoscopy performance. Patient-reported outcomes (PROs) are critical in optimizing bowel preparation.
Aims: This study aimed to compare the bowel cleansing efficacy, safety, tolerability, and acceptability of sodium picosulfate, magnesium oxide and citric acid (SPMC) and polyethylene glycol (PEG) in Taiwan.
Methods: A single-center, randomized, non-inferiority trial was conducted among outpatient individuals aged 20–75 scheduled for colonoscopy. Participants were randomized to receive either SPMC or PEG. Bowel cleansing efficacy was assessed using the Aronchick scale as the primary outcome. Secondary outcomes included polyp detection rate, adenoma detection rate, safety, compliance, and patient-reported satisfaction.
Results: A total of 440 participants were enrolled. The adherence rate was higher in the SPMC group (100% vs. 92.9%, p < 0.001). Bowel cleansing quality was significantly higher in the SPMC group (79.5% vs. 69.7%, p = 0.030). Adverse events were lower in the SPMC group (18.5% vs. 28.9%, p = 0.013), with nausea being the most common. PROs favored SPMC in ease of use (p<0.001), overall satisfaction (p <0.001), and further willingness for reuse (p=0.062).
Conclusions: SPMC demonstrated better bowel cleansing quality, fewer adverse events, and greater patient-reported satisfaction compared to PEG, supporting its use as a patient-centered alternative to PEG in clinical practice.
P.059
治療策略對大腸直腸癌之影響
THE IMPACT OF TREATMENT STRATEGIES ON COLORECTAL CANCER
王聖文 魏克承 陳沿如 王俊雄 林裕鴻 陳一毅 毛元治 郭振源 林瑞昌 張國寬 郭明正 牟聯瑞 台南市立醫院（委託秀傳醫療社團法人經營）
Background: Colorectal cancer (CRC) is one of the most common malignancies worldwide, with a rising incidence, particularly among younger populations and in low- to middle-income countries. Although early detection and advances in treatment have improved outcomes, the impact of different treatment modalities on prognosis across various tumor sites and stages remains insufficiently studied.
Aims: This retrospective study aimed to evaluate the impact of various treatment strategies on survival and recurrence outcomes in patients with CRC, with a particular emphasis on tumor location and diagnostic stage.
Methods: Data were collected from 925 CRC patients diagnosed between 2015 and 2023 at Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation). Patients were categorized by cancer stage (early-stage: stage I and II vs. advanced-stage: stages III and IV) and tumor location. Statistical analyses included logistic regression, Kaplan–Meier survival curves, and log-rank tests to evaluate associations between treatment approaches and patient outcomes.
Results: Surgical resection was performed in 85.9% of patients and was associated with significantly improved survival (p < 0.001). Among advanced-stage patients, those who underwent surgery followed by systemic therapy demonstrated better outcomes compared to those who did not have surgery. Neoadjuvant chemoradiotherapy, primarily used for advanced rectal cancer, resulted in a lower mortality rate (8.7%) compared to patients who underwent immediate surgery (47.8%, p < 0.001), despite shorter initial survival durations due to limited follow-up. Factors significantly associated with recurrence included perineural invasion (HR = 3.1, p = 0.001), involvement of more than seven lymph nodes (HR = 14.5, p < 0.001), male gender (HR = 2.2, p = 0.047), and obesity (HR = 1.9, p = 0.063).
Conclusions: This study highlights the prognostic importance of treatment strategies, particularly surgical resection and neoadjuvant therapy, in managing CRC.
Tailoring treatment based on tumor stage and location can significantly improve survival outcomes. Further prospective studies are needed to validate these findings and optimize treatment protocols for CRC patients.
P.060
類升糖素胜肽 -1 受體促效劑與重複接受大 腸鏡檢查風險增加之相關性：一項真實世界 回溯性世代研究
GLUCAGON-LIKE PEPTIDE-1
RECEPTOR AGONISTS IS ASSOCIATED WITH AN INCREASED RISK OF REPEAT COLONOSCOPY: A REAL-WORLD RETROSPECTIVE COHORT STUDY
羅紹齊 葉欣榮 台北醫學大學附設醫院內科部消化內科
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for the management of Type 2 Diabetes Mellitus (T2DM) and obesity. However, their pharmacological mechanism involves delaying gastric emptying and inhibiting gastrointestinal motility, which raises concerns regarding the quality of bowel preparation for colonoscopy. Inadequate bowel preparation often necessitates early repeat procedures, increasing healthcare burdens and patient risk. It remains unclear whether the use of GLP-1 RAs is associated with a higher rate of repeat colonoscopies in a real-world setting.
Aims: This study aimed to investigate whether the use of GLP-1 RAs within 3 months prior to a colonoscopy is associated with an increased risk of undergoing a repeat colonoscopy within one year among patients with T2DM.
Methods: We utilized the TriNetX US Collaborative Network to conduct a retrospective cohort study involving adult patients (aged 18-80) with T2DM who underwent a colonoscopy between January 1, 2020, and December 5, 2025. Two cohorts were identified: 1. GLP-1 RA Cohort: Patients with a prescription for a GLP-1 RA (tirzepatide, semaglutide, dulaglutide, liraglutide, lixisenatide, or exenatide) within 3 months prior to the index colonoscopy.
2. Control Cohort: Patients with T2DM undergoing colonoscopy without recent GLP-1 RA exposure. To mitigate confounding bias, 1:1 propensity score matching (PSM) was performed based on demographics (age, sex, race), BMI, comorbidities (e.g., cerebrovascular disease, ESRD), and concurrent use of medications affecting motility (opioids, calcium channel blockers, antipsychotics, tricyclic antidepressants). The primary outcome was the incidence of repeat colonoscopy within the follow-up period. Hazard Ratios (HR) and Risk Ratios (RR) with 95% confidence intervals (CI) were calculated.
Results: After matching, a total of 23,962 patients were included, with 11,981 patients in each cohort. The cohorts
were well-balanced regarding age (mean ~61 years) and relevant comorbidities. The incidence of repeat colonoscopy was significantly higher in the GLP-1 RA cohort (5.56%, n=666) compared to the Control cohort (4.28%, n=513). 1. Risk Ratio (RR): 1.30 (95% CI: 1.16 –1.45, p < 0.001). 2. Kaplan-Meier Analysis: The GLP-1 RA cohort demonstrated a significantly lower probability of avoiding a repeat procedure (Log-Rank test p < 0.001). 3. Hazard Ratio (HR): 1.55 (95% CI: 1.38 – 1.74).
Conclusions: In this large real-world cohort study, recent use of GLP-1 RAs in patients with T2DM was associated with a significantly increased risk of repeating colonoscopy within one year. This finding supports the hypothesis that GLP-1 RA-induced hypomotility may compromise bowel preparation quality, necessitating repeat examinations. Clinicians should consider optimizing bowel preparation protocols or adjusting medication schedules for patients on GLP-1 RAs undergoing colonoscopy.
P.061
大腸鏡檢查的安全性：大腸破裂案例的回顧 性分析
SAFETY OF COLONOSCOPY: A RETROSPECTIVE ANALYSIS OF COLONIC PERFORATION CASES
蕭尚益 張智翔 吳明順 粟發滿 連吉時 陳俊男 臺北市立萬芳醫院- 委託台北醫學大學經營 消化內科
Background: Colonoscopy is a widely used procedure for diagnosing and treating conditions of the colon. While it is generally safe, one of the most serious complications that can arise is colon perforation. This rare but potentially life-threatening event can lead to significant morbidity. Understanding the risk factors and outcomes associated with colon perforation is essential for improving patient safety.
Aims: The primary aim of this study is to investigate risk factors associated with colon perforation following colonoscopy. Additionally, the study seeks to evaluate the clinical presentation and outcomes of patients who experience this complication.
Methods: This retrospective study analyzed patients who underwent colonoscopy at our institution and were diagnosed with colon perforation using discharge diagnosis codes. We identified ten patients from the electronic health records, extracting data on demographics, indications for colonoscopy, presence of diverticulosis, perforation location, time of diagnosis, and treatment received. The analysis aimed to evaluate the relationship between colon diverticulosis and perforation occurrence, as well as the rate of surgical interventions performed in these cases. Statistical methods were applied to assess the significance of findings.
Results: A total of ten patients diagnosed with colon perforation following colonoscopy were identified. The cohort included 6 males and 4 females. The primary indications for colonoscopy among the patients included follow-up for colon cancer (30%), bloody stool (20%), and follow-up for previous polyps (30%), health exam(10%), positive fecal occult blood tests(10%), unknown cause(10%). Of the ten patients, 6 (60%) were found to have diverticulosis. It indicated a potential association between diverticulosis and the occurrence of perforation. The perforations were primarily located in the sigmoid colon (70%). Out of the ten patients, 8 (80%) underwent surgical intervention, which included resection of the affected segment and repair of the perforation. In summary,
the analysis suggests a notable association between the presence of diverticulosis and colon perforation, as well as a high rate of surgical intervention in affected patients. Conclusions: This study highlights the association between colon perforation and the presence of diverticulosis. While colon perforation is often detected promptly, there are instances where it can present with a delayed onset, complicating diagnosis and management. Furthermore, surgical intervention is typically required for patients experiencing colon perforation, underscoring the importance of early recognition and timely treatment. These findings emphasize the need for heightened awareness among clinicians regarding the risks associated with diverticulosis and the potential for both immediate and delayed complications following colonoscopy.
P.062
比較大腸腺性息肉及大腸癌病患有肝膿瘍病 史及沒有肝膿瘍病史糞便微菌叢的不同：著 重在克雷伯氏菌的研究
A COMPARISON OF FECAL MICROBIOTA IN PATIENTS DIAGNOSED TO HAVE DISEASES OF COLON ADENOMA/ADENOCARCINOMA WITH OR WITHOUT A MEDICAL HISTORY OF PYOGENIC LIVER ABSCESS: FOCUS ON KLEBSIELLA PNEUMONIAE
康力元 陳立偉
基隆長庚紀念醫院 胃腸肝膽科
Background: Past studies reported an association between Klebsiella pneumoniae (K. pneumoniae) related pyogenic liver abscess (KpLA) and colorectal neoplasm
Aims: This study aims to verify the association of gastrointestinal colonization of K. pneumoniae, PLA and colon neoplasm
Methods: This study prospectively collected patients’ fecal or liver abscess aspirated pus specimens from whom having a current or a history of KpLA from Jan, 2024 to Dec, 2025 in Keelung Chang-Gung Memorial Hospital. The participants underwent colonoscopy to evaluate if the presence of colon adenoma or adenocarcinoma. Fecal specimens were sent for bacterial genotypes, phylogenetic relationship, antimicrobial resistance (AMR) gene profiles. The virulence genes, such as colorectal cancer-associated genes encoding genotoxin, were determined.
Results: Among 21 patients with a past history of KpLA, colonic neoplasm was found in the 7 (33.3%) patients, including tubular adenoma was detected in 6 patients (6/21, 28.5%). Among the 6 patients with tubular adenoma, high grade dysplasia (premalignancy) was found in 2 patients. Colon adenocarcinoma was found in one patient (1/21, 4.8%). In the 18 patients with current KpLA, 4 (4/18, 22.2%) patients with colon adenocarcinoma, 7 (7/18, 38.9 %) patients with colon tubular adenoma, and 7 (7/18, 38.9 %) patients with negative colon neoplasm were detected. Hence, colon neoplasm was common findings in patients with a history (33.3%) and a current (61.6%) KpLA. Gastrointestinal strains of K. pneumoniae was isolated in 8 stool samples from total 13 specimens (carriage rate 61.5%). Because K. pneumoniae could produce β-lactamase and bacterial biofilm, Ampicillin resistance was found in all isolated K. pneumoniae. Most K. pneumoniae intestinal strains were susceptible to most tested antibiotics. No
ESBL or MDR strain was found. The antibiotic resistance rates of intestinal K. pneumoniae were cefazolin: 16.7% (2/12), trimethoprim/sulfamethoxazole (TMP/SMX): 16.7% (2/12) and ampicillin/sulbactam: 33.2% (4/12).
Conclusions: Colon neoplasm is common in the patients with a history (33.3%) or a current (61.6%) KpLA. Most gastrointestinal strains of K. pneumoniae were susceptible to most antibiotics except ampicillin.
P.063
在抗腫瘤壞死因子與非抗腫瘤壞死因子生物 製劑時代免疫抑制劑於發炎性腸道疾病所扮 演之角色：來自台灣發炎性腸道疾病學會資 料庫的多醫學中心研究 THE ROLE OF IMMUNOSUPPRESSANT AGENTS IN THE ERA OF ANTI-TNF AND NON-ANTI-TNF BIOLOGICS FOR INFLAMMATORY BOWEL DISEASE: MULTICENTER STUDY FROM THE TSIBD REGISTRATION
陳咨彣1 魏淑鉁2 謝銘鈞3 周仁偉4 莊喬雄5 顏旭亨6 吳登強7 黃天祐8 劉玉華9 蔡騌圳10 戴維震11 戴啟明12 鍾承軒13 蔡文司14 張崇信15 林敬斌16 李熹昌17 王鴻源1 章振旺1 林煒晟1 1 馬偕紀念醫院內科部胃腸科；2 國立臺灣大學醫學院附 設醫院；3 國立臺灣大學醫學院附設醫院腫瘤醫學部， 國立臺灣大學醫學院；4 中國醫藥大學附設醫院；中國 醫藥大學中醫學院；5 國立成功大學醫學院附設醫院內 科部，國立成功大學醫學院；6 彰化基督教醫院胃腸肝 膽科；7 高雄醫學大學岡山醫院內科部胃腸科；8 三軍 總醫院內科部胃腸肝膽科，國防醫學院；9 新光吳火獅 紀念醫院內科部胃腸肝膽科；10 高雄榮民總醫院內科部 胃腸肝膽科；11 長庚內科部胃腸肝膽科；12 義大醫院內 科部胃腸肝膽科，義守大學；13 亞東紀念醫院胃腸肝膽 科；亞東紀念醫院超音波暨內視鏡中心；14 長庚紀念醫 院外科部大腸直腸外科；長庚大學醫學院；15 臺中榮民 總醫院內科部胃腸肝膽科；16 中山醫學大學附設醫院內 科部胃腸肝膽科；中山醫學大學醫學研究所；中山醫學 大學醫學院；17 臺北市立聯合醫院仁愛院區內科部胃腸 肝膽科
Background: The therapeutic landscape of inflammatory bowel disease (IBD) has transitioned toward diverse biologic options, yet the optimal role of conventional immunosuppressants (IMMs) remains contentious and the necessity of concomitant IMMs with non-anti-TNF biologics is still debated. In Taiwan, clinical practices— specifically the “step-up” approach and adjunctive IMM use—are uniquely governed by the National Health Insurance (NHI) reimbursement criteria, which may influence the timing of advanced therapy initiation.
Aims: This study aimed to investigate the utilization patterns of IMMs as part of combination therapy during the era of biologics agents in Taiwan.
Methods: We retrospectively analyzed data from a prospective registry established by the Taiwan Society of Inflammatory Bowel Disease (TSIBD) between 2015
and August 2025. A total of 722 IBD patients receiving biologics were enrolled, comprising 360 patients with Crohn’s disease (CD) and 362 with ulcerative colitis (UC). We evaluated patient demographics, surgical and medication histories, and the rates of combination therapy with IMMs to compare anti-TNF and non-anti-TNF cohorts.
Results: Among 722 IBD patients, those with CD demonstrated a higher male predominance (69.6% vs. 60.0%, p=0.009), as well as higher prevalence of eversmoking (18.1% vs. 12.7%, p=0.059) and alcohol consumption (18.1% vs. 12.4%, p=0.046). Notably, prior appendectomy was significantly more frequent in CD than UC (10.1% vs. 2.4%, p<0.001). Regarding treatment patterns, Vedolizumab was the primary biologic for UC (32.7% vs. 50.1%, p<0.001), while Adalimumab predominated in the CD cohort (38.4% vs. 22.3%, p<0.001). CD patients exhibited a more intensive treatment history, with 80.2% receiving IMMs before biologics and a significantly higher rate of concurrent combination therapy (76.2% vs. 64%, p<0.001). Within the anti-TNF group, CD patients were more likely to receive combination therapy than UC patients (84.1% vs. 73.4%, p=0.0161). However, no significant difference in combination therapy rates was observed between CD and UC patients within the non-antiTNF group (70.7% vs. 63.6%, p=0.1010). Furthermore, the interval from diagnosis to biologic initiation was significantly shorter in CD compared to UC (3.14±3.80 vs. 4.23±4.78 years, p<0.001), reflecting a more rapid escalation to advanced therapies in CD.
Conclusions: This study examines real-world biologic utilization in Taiwan, identifying vedolizumab as the primary choice for UC and adalimumab for CD. CD patients had higher concomitant IMM use and a shorter time from diagnosis to biologic initiation. Regarding therapeutic strategies, patients with CD and those receiving anti-TNF agents exhibited a significantly higher propensity for combination therapy.
P.064
台灣的 CRONKHITE–CANADA 症候群： 以病例為基礎的傳統治療回顧與全球新興生 物製劑治療經驗整理 CRONKHITE-CANADA SYNDROME IN TAIWAN: CASEBASED REVIEW OF CONVENTIONAL MANAGEMENT AND EMERGING BIOLOGIC THERAPY FROM GLOBAL EXPERIENCE
陳詩桓1 張若苹1 葉雨霈1 周仁偉2,3 鄭庚申2 黃柏儒2 吳宜樺2
1 中國醫藥大學附設醫院教學部
2 中國醫藥大學附設醫院消化醫學中心
3 中國醫藥大學中醫系
Background: Cronkhite–Canada syndrome (CCS) is a rare, nonhereditary hamartomatous polyposis syndrome characterized by diffuse gastrointestinal polyposis, proteinlosing enteropathy, ectodermal changes, and high mortality. Current treatments for CCS largely rely on corticosteroids, immunosuppressive agents and supportive therapies. However, the management of CCS remains challenging due to its rarity and the lack of standardized guidelines. In global reports, a subset of patients shows an inadequate response to the first-line treatment. Consequently, biologic agents have been considered as an emerging therapeutic approach for CCS patients who are refractory to conventional treatments.
Aims: To describe a CCS case managed in Taiwan, summarize reported Taiwanese CCS cases, and review global experience with biologic therapy in CCS, focusing on indications, treatment strategies, efficacy, and safety. Methods: We retrospectively analyzed the clinical course, treatments, and outcomes of a Taiwanese CCS patient. A narrative literature review was conducted using PubMed, Embase, Cochrane Library, and Airiti Library to identify Taiwanese CCS cases and international reports involving biologic therapies, including anti-TNF-α agents, vedolizumab, and rituximab. Data on prior treatments, biologic regimens, responses, follow-up, and adverse events were extracted.
Results: The patient in our presentation demonstrated only partial and unstable responses to conventional therapy. Internationally, anti-TNF-α therapy (most commonly infliximab), rituximab combined with cyclosporine have been reported to achieve clinical improvement and regression of polyposis in steroid-refractory CCS. The gutselective antiintegrin vedolizumab also induced clinical
and endoscopic remission after anti-TNF failure in selected cases. Although randomized trials are lacking, available case-level evidence suggests acceptable safety and potential efficacy of biologics in refractory CCS.
Conclusions: CCS in Taiwan shares clinical features and therapeutic challenges with international experience, with frequent refractoriness to steroid-based regimens. Accumulating case reports support biologic therapy as a potential steroid-sparing option for refractory or complex CCS.
P.065
大腸瘜肉內視鏡下尺寸與病理報告尺寸的差 異：單一醫學中心於短期間小規模隨機取樣 個案之分析 DISCREPANCY BETWEEN ENDOSCOPIC AND PATHOLOGICAL MEASUREMENTS OF COLORECTAL POLYPS: A SHORT-TERM, SMALLSAMPLE RANDOMIZED ANALYSIS FROM A SINGLE MEDICAL CENTER
潘為昇1 洪志聖1,2,3 黃鼎鈞1,2,3
1 國泰綜合醫院 消化內科
2 天主教輔仁大學醫學院醫學系
3 國立清華大學學士後醫學系
Background: Colorectal polypectomy is a well-established endoscopic procedure. With increasing accessibility to medical records and growing health awareness among patients, discrepancies between endoscopic polyp size estimation and pathological measurements have become a frequent source of clinical concern. However, real-world evidence addressing this discrepancy remains limited.
Aims: To quantify the difference between endoscopic estimates and pathological measurements of colorectal polyp size.
Methods: We conducted a retrospective chart review of patients who underwent colonoscopy with polypectomy at our institution between September and November 2025. A randomized sample of cases was selected, anonymized, and analyzed. Each polypectomy was treated as an independent observation. Cases involving biopsy forceps removal only or lacking pathological measurements were excluded.
Results: A total of 200 polypectomy cases were included in the final analysis. The mean endoscopic polyp size was 0.744 ± 0.419 cm (range: 0.2–3.0 cm), whereas the mean pathological polyp size was 0.543 ± 0.400 cm (range: 0.1–2.9 cm). Overall, endoscopic measurements tended to be larger than corresponding pathological measurements across the observed size spectrum. The mean absolute size difference, defined as endoscopic minus pathological measurement, was 0.201 cm, with a 95% confidence interval of 0.161–0.242 cm. Although the absolute difference appeared modest, relative proportional differences were more pronounced in smaller polyps, suggesting potential amplification of measurement variability at lower size ranges. These findings indicate a systematic tendency toward overestimation of polyp size during endoscopic assessment when compared with
pathological measurements, particularly in diminutive lesions.
Conclusions: In this short-term, small-sample analysis, endoscopic measurements of colorectal polyps were generally larger than pathological measurements. On average, pathological sizes were approximately 37% smaller than endoscopic estimates, with a wide 95% proportional error range (−125% to +51%), particularly in small lesions.
P.066
使用冷圈套瘜肉切除術切除之大腸瘜肉內視 鏡與病理類型分析：台北市一醫學中心於短 期間小規模隨機取樣個案之分析。
COLONOSCOPIC AND PATHOLOGICAL FINDING OF COLORECTAL POLYPS
RESECTED BY COLD SNARE
POLYPECTOMY: A SHORT-TERM, SMALL-SCALE RANDOM SAMPLING STUDY AT A SINGLE MEDICAL CENTER
葉俊廷1 潘為昇1 洪志聖1,2,3 黃鼎鈞1,2,3
1 國泰綜合醫院消化內科
2 天主教輔仁大學醫學院醫學系
3 國立清華大學學士後醫學系
Background: Cold snare polypectomy (CSP) has become a well-established and widely adopted endoscopic technique for the removal of small colorectal polyps. However, the pathological spectrum of polyps resected by CSP in realworld clinical practice has not been fully characterized and warrants further evaluation.
Aims: The aim of this study was to analyze the colonoscopic and histopathological characteristics of colorectal polyps resected by cold snare polypectomy at a single medical center.
Methods: This retrospective study included patients who underwent colonoscopy with cold snare polypectomy (CSP) at our institution between October and November 2025. Cases were randomly selected, and all data were de-identified prior to analysis. Each polypectomy and its corresponding pathological specimen were considered a single analytical unit, and records without available pathological reports were excluded.
Results: During the study period, a total of 158 colorectal polyps resected by cold snare polypectomy (CSP) were randomly selected, and all were successfully linked to their corresponding pathological reports. The mean endoscopic polyp size was 0.603 cm (range, 0.2–1.5 cm). Among these, 65 polyps (41.13%) measured ≤0.5 cm, 90 polyps (56.96%) measured >0.5 cm and <1.0 cm, and only 3 polyps (1.89%) measured ≥1.0 cm. Histopathological analysis showed that tubular adenoma was the most common diagnosis (125/158, 79.11%), followed by hyperplastic polyp (19/158, 12.02%), sessile serrated adenoma (9/158, 5.69%), and adenoma with high-grade dysplasia (5/158, 3.16%).
Conclusions: In this random sampling study, cold snare polypectomy was predominantly applied to colorectal polyps measuring <1 cm, in accordance with current
clinical practice and treatment guidelines. After excluding hyperplastic polyps, nearly 88% of resected lesions were of potential clinical significance, suggesting that CSP was appropriately applied to selected lesions at our medical center.
P.067
台灣某醫學中心克隆氏症病患之表型特徵與 治療負擔： 真實世界數據分析 PHENOTYPIC PROFILE AND TREATMENT BURDEN OF CROHN’S DISEASE IN A TERTIARY REFERRAL CENTER IN TAIWAN: A REAL-WORLD DATA ANALYSIS
謝承穎 姚志謙 李育騏 吳鎮琨 林靜怡 梁志明 蔡成枝 戴維震
長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系 暨 長庚大學醫學系
Background: Crohn’s disease (CD) incidence and prevalence are rising globally, particular in newly industrialized Asian countries, including Taiwan. However, real-world data from Asian tertiary centers on phenotypic progression and treatment burden remain limited compared with Western cohorts.
Aims: The aim of our study was to characterize clinical phenotypes and biologic utilization patterns among CD patients followed at a single tertiary medical center in Taiwan, providing insight into the management challenges of this specific population.
Methods: This retrospective observational cohort study included 73 patients with confirmed CD from the inflammatory bowel disease registry of a Taiwanese tertiary center. Data including demographics, phenotype categorized according to the Montreal Classification, CD related surgical history, and treatment exposure (conventional therapy including 5-aminosalicylates, immunomodulators, and corticosteroids, and/or biologics thearpy).
Results: The cohort (60.3% male, mean age 48 years) predominantly exhibited with stricturing behavior (B2, 59.3%), indicating a complex disease profile typical of a tertiary center. Despite the high prevalence of stricturing disease, prior CD-related abdominal surgery was low (6.8%). Most patients had been exposed to conventional therapies: 5-aminosalicylates (84.9%), corticosteroids (71.2%), and immunomodulators (65.8%). Consequently, 67.1% required escalation to biologic therapy, indicating a highly treatment-refractory population.
Conclusions: In this Taiwanese tertiary cohort, stricturingpredominant CD with low surgical rates despite disease complexity suggests aggressive biologic therapy may effectively target reversible inflammatory strictures, successfully delaying or preventing surgery in this high-
risk group. These findings imply that many patients likely have “inflammatory strictures” rather than established fibrotic scars that are amenable to biologic treatment, highlighting the value of a “window of opportunity” for early and aggressive intervention.
P.068
潰瘍性結腸炎合併闌尾粘液性腫瘤，系列病 例報告
APPENDICEAL MUCINOUS NEOPLASM IN ULCERATIVE COLITIS, A CASE SERIES
張立楷1,2 廖竟妤1,2,3 林煒晟1,2 李騏宇1,2,3 張經緯1,2,3
章振旺1,2,3
1 馬偕紀念醫院消化系
2 馬偕醫學大學醫學院
3 馬偕醫護管理專科學校
Background: Ulcerative colitis (UC) is a well-established risk factor for colorectal malignancy; however, primary appendiceal mucinous neoplasms (AMNs) remain a rare entity in this population. These lesions, ranging from benign cystadenomas to invasive adenocarcinomas, present significant diagnostic challenges as their symptoms often mimic UC flares or acute appendicitis. Given the scarcity of data and lack of standardized treatment guidelines, this systematic review aims to synthesize the clinical characteristics and management outcomes of AMNs in patients with UC.
Aims: This study aims to review the characteristics and management of appendiceal mucinous neoplasm in ulcerative colitis.
Methods: Inclusion criteria were adults with ulcerative colitis that presenting with appendiceal mucinous neoplasm under the histological confirm. Exclusion criteria were patient not affected by ulcerative colitis, not adults, lack of abstracts, articles that is not in English. We screened PubMed, Medline and Cochrane Library databases up to December 2025. Total 20 articles were included.
Results: This systematic review analyzed 29 patients (mean age 52 years; 59% male) with concurrent UC and AMNs. The majority had long-standing UC (mean duration 9.6 years), and 55% exhibited active colonic inflammation at the time of diagnosis. While right lower quadrant pain was the primary symptom (45%), 14% of patients were asymptomatic with incidental findings. All patients underwent surgical resection, with procedures ranging from simple appendectomy (28%) to total proctocolectomy (38%). Histopathologically, benign mucinous cystadenomas were predominant (52%), while LAMN and mucinous adenocarcinomas each accounted for 24%. These findings highlight that while most lesions are benign or low-grade, a significant proportion represents malignancy, necessitating high vigilance and careful surgical planning in UC patients.
Conclusions: Concurrent AMN and UC are rare. Diagnosis is challenging due to overlapping symptoms and nonspecific endoscopic findings. While most lesions are benign cystadenomas, the rate of malignancy (24%) and risk of pseudomyxoma peritonei necessitate rigorous preoperative imaging, and definitive surgical resection to ensure optimal outcomes.rld data in shaping effective health policies.
P.069
INFLIXIMAB 藥物濃度監測在發炎性腸道 疾病的臨床應用價值
CLINICAL UTILITY OF INFLIXIMAB THERAPEUTIC DRUG MONITORING IN INFLAMMATORY BOWEL DISEASE
黃稚雯1,2 顏旭亨1 許翠純1 陳洋源1
1 彰化基督教醫院肝膽腸胃科
2 國立台灣大學臨床醫學研究所
Background: Therapeutic drug monitoring (TDM) of infliximab (IFX) is widely used to support treatment optimization in inflammatory bowel disease (IBD). However, in real-world practice, the relationship between IFX trough levels, clinical symptoms, and objective inflammatory markers remains heterogeneous and incompletely defined.
Aims: This study aimed to evaluate the association between infliximab TDM results and concurrent clinical symptoms and objective inflammatory biomarkers in patients with IBD.
Methods: We conducted a prospective observational study of IBD patients receiving infliximab with available TDM data in routine clinical care. Clinical symptoms and disease activity indices recorded at the time of TDM included stool frequency (SF), rectal bleeding (RB), physician’s global assessment (PGA), Mayo score and Mayo endoscopic subscore (MES) for ulcerative colitis (UC), and Harvey–Bradshaw Index (HBI) for Crohn’s disease (CD). Laboratory parameters included C-reactive protein (CRP), albumin, and hematologic indices. Clinical activity was defined as UC: Partial Mayo Score score ≥2, or MES ≥2; CD: HBI ≥5. Biochemical activity was defined as CRP >0.5 mg/dL. Receiver operating characteristic (ROC) analysis was used to identify the optimal IFX trough cutoff associated with biochemical activity.
Results: A total of 13 IBD patients (CD 8, UC 5) with available IFX TDM data were included. The median IFX trough level was 3.14 µg/mL. ROC analysis using CRPdefined biochemical activity demonstrated a modest discriminative ability of IFX trough levels (AUC = 0.65), with an optimal cutoff of approximately 3.3 µg/mL. In contrast, IFX trough levels showed limited discrimination for symptom-based clinical activity (AUC ≈ 0.50), reflecting frequent discordance between symptoms and objective inflammation. Several patients exhibited persistent symptoms despite adequate IFX trough levels and normal CRP, while others demonstrated biochemical
activity in the absence of prominent symptoms. In routine practice, TDM results did not consistently lead to immediate treatment modification.
Conclusions: In this real-world IBD cohort, an IFX trough level around 3.3 µg/mL was most closely associated with biochemical inflammation as assessed by CRP, whereas symptom-based activity showed substantial discordance with drug exposure. These findings highlight the importance of integrating TDM with objective biomarkers rather than relying on symptoms alone, and illustrate the complexity of translating TDM results into clinical decision-making in daily practice.
P.070
身體質量指數與性別對大腸直腸癌患者整體 存活率之關聯性
ASSOCIATION OF BODY MASS INDEX AND SEX WITH OVERALL SURVIVAL IN COLORECTAL CANCER PATIENTS
郭子綺 基隆長庚醫院
Background: Colorectal cancer (CRC) represents a growing global health burden. In Taiwan, CRC is a leading cause of cancer-related mortality, with incidence rising alongside increasing obesity. While excess body weight is a well-established risk factor for CRC development, several studies have paradoxically reported lower mortality among patients with a higher body mass index (BMI). Despite evidence suggesting that BMI influences survival outcomes, large-scale contemporary data from Taiwanese populations remain limited. Moreover, potential sexspecific differences in this association have not been fully elucidated.
Aims: The aim of this study was to update the evidence using a large contemporary cohort and to investigate the association between BMI and overall survival, specifically exploring sex- and age-stratified patterns.
Methods: We conducted a nationwide cohort study linking the Taiwan Cancer Registry and National Health Insurance claims data to investigate the association between BMI and overall survival among CRC patients diagnosed between 2011 and 2020. Based on BMI at diagnosis, patients were categorized as underweight (<18.5 kg/m²), normal weight (18.5–23.9 kg/m²), overweight (24.0–26.9 kg/m²), or obese (≥27.0 kg/m²). Multivariable Cox proportional hazards models were adjusted for demographic factors, tumor characteristics, treatment modalities, lifestyle factors, and comorbidities.
Results: The cohort included 96,500 CRC patients (mean age 65.5 years; 57% male). Underweight patients were generally older, more often female, had lower socioeconomic status, and presented with more advanced disease and poorly differentiated tumors; conversely, higher BMI was associated with a greater comorbidity burden. During follow-up, 37,728 deaths (39.1%) occurred. Underweight patients had the highest mortality rate (59%), while obese patients had the lowest (32%). After adjustment, BMI was significantly associated with overall survival. Underweight status conferred a higher mortality risk (adjusted hazard ratio [aHR] = 1.53, 95% CI
= 1.47–1.58), whereas overweight (aHR = 0.83, 95% CI = 0.81–0.85) and obesity (aHR = 0.83, 95% CI = 0.80–0.85) were associated with better survival compared to normal weight. Sex-stratified analyses showed consistent trends: underweight status increased mortality risk in both men (aHR = 1.96) and women (aHR = 1.65), while overweight and obese status provided a survival advantage. Agestratified analyses indicated the association was strongest in patients aged ≥50 years. No significant three-way interaction among BMI, sex, and age was observed (p = 0.58).
Conclusions: Our study confirms the presence of the obesity paradox in a large Asian CRC cohort. Underweight status was associated with increased mortality, while overweight and obesity were associated with improved survival. This pattern persisted across both sexes and was particularly pronounced in patients aged ≥50 years.
P.071
P.072
唾液中咽峽炎鏈球菌與大腸腺瘤及大腸癌之 相關性
ASSOCIATION BETWEEN SALIVARY STREPTOCOCCUS ANGINOSUS AND COLORECTAL ADENOMA AND CANCER
盧俊翰1 余方榮1,2 葉于瑄1 施翔耀1 王耀廣1,2 吳登強1,2
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
Background: Emerging evidence suggests that oral microbiota may be involved in colorectal tumorigenesis. Streptococcus anginosus has been implicated in gastrointestinal malignancies; however, its association with colorectal adenoma and cancer remains unclear.
Aims: This study aimed to investigate the relationship between salivary S. anginosus and colorectal neoplastic diseases.
Methods: A total of 287 patients undergoing colonoscopic evaluation were enrolled. Patients were first categorized into those with colorectal cancer (n = 86) and those without colorectal cancer (n = 191). They were further stratified into patients with colorectal adenoma or cancer (n = 208) and those without adenoma or cancer (n = 79). Salivary S. anginosus was detected and quantified using SYBR Green–based quantitative PCR with absolute quantification based on a standard curve. The presence of S. anginosus was defined by a specific melting curve profile, and bacterial quantity was analyzed as a continuous variable. Comparisons of S. anginosus presence and salivary quantity were performed between groups.
Results: The presence of salivary S. anginosus did not differ significantly between patients with and without colorectal cancer, nor between those with colorectal adenoma or cancer and those without neoplastic disease. In contrast, salivary S. anginosus quantity was significantly higher in patients with colorectal cancer compared with non–colorectal cancer controls (P = 0.023). Similarly, patients with colorectal adenoma or cancer exhibited significantly higher salivary S. anginosus quantities than those without adenoma or cancer (P = 0.018).
Conclusions: While the presence of salivary Streptococcus anginosus was not associated with colorectal neoplasia, increased salivary bacterial quantity was significantly associated with colorectal adenoma and cancer. These findings suggest that the salivary load of S. anginosus, rather than its mere presence, may be relevant to colorectal neoplastic disease and warrants further investigation.
P.073
比較大腸癌與一般大腸鏡檢病人口腔健康指 標之差異
COMPARISON OF ORAL HYGIENE INDICATORS BETWEEN PATIENTS WITH COLORECTAL CANCER AND THOSE UNDERGOING ROUTINE COLONOSCOPY
陳建誠1 許朝欽1 吳如惠2,3 葉于瑄1,4 林佩蓁3 吳登強4,5
1 高雄醫學大學附設高醫岡山醫院胃腸內科
2 高雄醫學大學口腔醫學院口腔衛生學系
3 高雄醫學大學附設中和紀念醫院牙科部
4 高雄醫學大學醫學系
5 高雄醫學大學附設中和紀念醫院胃腸內科
Background: Poor oral hygiene and periodontal inflammation have been linked to systemic diseases, including colorectal cancer (CRC). However, the association between oral hygiene status and different stages of colorectal neoplasia remains unclear.
Aims: This study compared key oral hygiene indicators among healthy individuals, patients with colorectal polyps, adenomas, and colorectal cancer.
Methods: Patients undergoing lower gastrointestinal endoscopy for routine examinations were enrolled and classified into four groups: healthy controls (N = 45), polyp group (N = 26), adenoma group (N = 43), and colorectal cancer group (N = 89). Oral hygiene assessments included Plaque Index, Gingival Index, number of probing depths >5 mm, number of bleeding teeth, and number of missing teeth. Demographic characteristics were also recorded. Group comparisons were performed to evaluate differences in oral health indicators.
Results: Age did not differ significantly among the four groups (p = 0.2296), whereas sex distribution showed significant variation (p = 0.0043). Significant group differences were found in the Plaque Index (Health: 0.55±0.24; Polyps: 0.72±0.35; Adenoma: 0.73±0.36; CRC: 0.97±0.47; p < 0.0001), with the highest plaque accumulation observed in CRC patients. The Gingival Index also differed among groups (p = 0.0496), with CRC patients showing the greatest gingival inflammation (0.40±0.42). No significant differences were found in the number of probing depths >5 mm (p = 0.5836), number of bleeding teeth (p = 0.7629), or number of missing teeth (p = 0.1882).
Conclusions: Among the evaluated oral hygiene indicators, plaque accumulation and gingival inflammation
were significantly worse in colorectal cancer patients compared to other groups. These findings suggest a potential association between deteriorated oral hygiene and colorectal cancer and highlight the importance of oral health monitoring in individuals at risk for colorectal neoplasia.
P.074
比較大腸癌與一般大腸鏡檢病人唾液中牙周 致病菌之差異
COMPARISON OF SALIVARY PERIODONTAL PATHOGENS BETWEEN PATIENTS WITH COLORECTAL CANCER AND THOSE UNDERGOING ROUTINE COLONOSCOPY
許朝欽1 吳如惠2,3 葉于瑄4 林佩蓁3 胡晃鳴1,5 吳登強4,5
1 高雄醫學大學附設高醫岡山醫院胃腸內科
2 高雄醫學大學口腔醫學院口腔衛生學系
3 高雄醫學大學附設中和紀念醫院牙科部
4 高雄醫學大學附設中和紀念醫院胃腸內科
5 高雄醫學大學醫學系
Background: Emerging evidence suggests that oral periodontal pathogens may contribute to colorectal carcinogenesis via the oral–gut axis. However, comparative data on salivary and dental plaque microbiota across different colorectal neoplasia stages remain limited.
Aims: This study aimed to compare the levels of major periodontal pathogens—Fusobacterium nucleatum (FN), Prevotella intermedia (PI), and Porphyromonas gingivalis (PG)—in saliva and dental plaque among healthy individuals, patients with colorectal polyps, adenomas, and colorectal cancer (CRC).
Methods: Patients undergoing lower gastrointestinal endoscopy for routine examinations were enrolled. Prior to endoscopy, unstimulated saliva (1 mL) and dental plaque samples were collected using sterilized specimen bottles. All samples were transported to the laboratory on ice and stored at −20 °C until PCR analysis. The concentrations of FN, PI, and PG were quantified in saliva and dental plaque.
Results: Demographic characteristics and microbial profiles were compared across four groups: healthy controls (N = 45), polyp group (N = 26), adenoma group (N = 43), and CRC group (N = 89). Age did not differ significantly among groups (p = 0.2296), whereas sex distribution showed significant variation (p = 0.0043). In saliva, FN and PI levels did not differ significantly among the four groups (p = 0.1758 and p = 0.2996, respectively). However, PG levels showed significant group differences (p = 0.0002), with the CRC group demonstrating lower salivary PG compared with healthy participants. In dental plaque, FN, PI, and PG levels showed no significant between-group differences (p = 0.4842, 0.2488, and 0.1347, respectively).
Conclusions: Among the major periodontal pathogens analyzed, only salivary PG showed significant variation
across colorectal neoplasia stages, whereas FN and PI levels remained comparable in both saliva and dental plaque. These findings suggest that the salivary presence of PG may have differential associations with colorectal disease status and may warrant further investigation as a potential biomarker in the oral–gut axis.
P.075
小腸隔膜樣疾病：單一醫院病例系列報告
SMALL BOWEL DIAPHRAGM DISEASE: A CASE SERIES FROM A SINGLE HOSPITAL
江偉廷 黃彼得 童綜合醫院胃腸肝膽科
Background: Obscure gastrointestinal bleeding (OGIB) is defined as overt or occult gastrointestinal bleeding that persists or recurs after nondiagnostic esophagogastroduodenoscopy and colonoscopy. In older adults, up to 75% of OGIB originates from the small intestine, and diaphragm disease—characterized by circumferential ulceration and diaphragm-like strictures— is a frequently underdiagnosed cause, particularly among chronic NSAID users.
Aims: To report cases of recurrent OGIB caused by small bowel diaphragm disease, highlighting the diagnostic challenges, the role of capsule endoscopy, and the importance of recognizing NSAID-related small bowel injury in elderly patients with unexplained anemia.
Methods: We retrospectively collected patients diagnosed with small bowel diaphragm disease at our hospital. Clinical data including presenting symptoms, laboratory findings, endoscopic evaluations, imaging studies, capsule endoscopy findings, treatment courses, and clinical outcomes were reviewed and analyzed.
Results: Small bowel diaphragm disease is an underrecognized cause of obscure gastrointestinal bleeding and may affect patients across a broad age range. In this single-hospital case series, patients shared similar clinical backgrounds, including recurrent gastrointestinal bleeding or anemia with nondiagnostic conventional endoscopy, ultimately requiring small bowel evaluation for diagnosis. Capsule endoscopy played a pivotal role in identifying diaphragm-like strictures with associated ulceration; however, the presence of small bowel narrowing also posed a risk of capsule retention, which in one patient necessitated surgical retrieval. These findings underscore that small bowel diaphragm disease may remain clinically silent until complicated by bleeding or obstruction. Careful patient selection and risk assessment prior to capsule endoscopy are essential.
Conclusions: Small bowel diaphragm disease is an important and often overlooked cause of obscure gastrointestinal bleeding in elderly patients, particularly those with chronic NSAID exposure and concurrent
antiplatelet or steroid use. Capsule endoscopy plays a pivotal role in establishing the diagnosis when conventional endoscopic studies are nondiagnostic. Early recognition is essential to prevent recurrent bleeding, repeated transfusions, and delayed diagnosis in this high-risk population.
P.076
人工智慧輔助大腸鏡於真實世界臨床提升每 次檢查腺瘤數：前瞻性單中心研究 ARTIFICIAL INTELLIGENCE–ASSISTED COLONOSCOPY IMPROVES ADENOMAS PER COLONOSCOPY IN REAL-WORLD CLINICAL PRACTICE: A PROSPECTIVE SINGLE-CENTER STUDY
鄭幸弘 黃文信 楊其穎 莊世杰 黃柏儒 蕭望德 謝宗霖
黃秉淳 張育誠 張晋維 彭成元 中國醫藥大學附設醫院消化醫學中心
Background: Colorectal cancer remains a leading cause of cancer-related mortality worldwide. Colonoscopy is the gold standard for colorectal polyp detection and removal; however, missed lesions remain a significant limitation due to operator dependency and procedural complexity. Artificial intelligence (AI)–assisted systems have emerged as a promising tool to improve detection performance. While adenoma detection rate (ADR) has been widely studied, adenomas per colonoscopy (APC) may better reflect comprehensive adenoma detection and removal.
Aims: This study aimed to evaluate the effectiveness of an AI-assisted colonoscopy system (EndoAim) compared with conventional colonoscopy, with APC as the primary endpoint. Secondary outcomes included ADR, polyp detection rate (PDR), and positive predictive value (PPV), as well as subgroup analyses based on bowel preparation quality, endoscopist experience, and polyp location.
Methods: A prospective study was conducted at our hospital in 2025. A total of 556 patients undergoing colonoscopy were assigned to either an AI-assisted group or a conventional colonoscopy group. Comprehensive clinical data were systematically collected and reviewed for analysis.
Results: A total of 371 polyps (200 adenomas) were detected in the AI group, whereas 310 polyps (184 adenomas) were detected in the conventional group. The APC was higher in the AI group (0.73 vs. 0.65), with a P value of 0.03, suggesting a statistically significant difference between groups. Subgroup analyses showed consistently higher APC in the AI group among cases with fair bowel preparation, less-experienced endoscopists, and sigmoid colon lesions. ADR did not differ significantly between groups. The AI group demonstrated a significantly higher adjusted PDR, particularly in patients with good bowel preparation and examinations performed by lessexperienced endoscopists. PPV was comparable between
groups, with a significantly higher PPV observed for cecal polyps in the AI group.
Conclusions: AI-assisted colonoscopy using EndoAim demonstrated a higher number of adenomas per colonoscopy, suggesting that AI may play an important role in improving colorectal polyp detection. Moreover, AI assistance may provide incremental benefits in polyp detection, particularly in challenging settings such as fair bowel preparation, examinations performed by less-experienced endoscopists, and lesions located in anatomically difficult regions.
P.077
南台灣錯配修復功能缺失大腸直腸癌之臨床 病理特徵
CLINICOPATHOLOGICAL FEATURES OF DEFICIENT MISMATCH REPAIR COLORECTAL CANCER IN SOUTHERN TAIWAN
陳彦畯 李佩倫 陳志州 鄭俊達 莊棠惟 彭美杰 鍾焜明 王芃惟 李宜霖 吳庭瑋 蘇暉揚 董宏達 奇美醫療財團法人柳營奇美醫院內科部胃腸肝膽科
Background: Colorectal cancer (CRC) is a major global health challenge and ranks as a leading cause of cancer mortality in Taiwan. The deficient mismatch repair (dMMR) pathway, occurring in 10–15% of cases, leads to unique biological behaviors and a robust immune microenvironment. While Western literature describes a distinct female predominance, regional epidemiological patterns in Southern Taiwan remain less defined.
Aims: To provide a comprehensive characterization of dMMR CRC at a regional medical center in Southern Taiwan. To precisely delineate phenotypic differences by performing an age- and sex-matched comparative analysis (1:1 ratio) with proficient MMR (pMMR) controls.
Methods: A retrospective analysis of 535 CRC patients (2023–2025) was conducted. Forty-six dMMR/MSI-H cases (8.6%) were identified and compared with 46 age- and sexmatched proficient MMR (pMMR) controls in a 1:1 ratio.
Results: Prevalence & Demographics: The dMMR prevalence was 8.6%. The cohort showed a near-equal gender distribution (52.2% male). Anatomy & Pathology: 80.4% of dMMR tumors were located in the proximal colon, accounting for 25.7% of all right-sided cases. Most cases (93.5%) exhibited conventional adenocarcinoma histology.
Stage Discrepancy: Despite larger mean tumor sizes (4.7 cm vs. 4.1 cm), dMMR tumors were significantly more likely to be diagnosed at an earlier stage (Stage I/II: 73.9% vs. 21.7%, p < 0.001) and showed markedly lower serum CEA levels (p = 0.012). Molecular Patterns: MLH1/PMS2 co-loss was the most frequent phenotype (65.9%). Low adherence to clinical criteria (0% Amsterdam II, 30.4% Bethesda) suggests a predominantly sporadic etiology.
Conclusions: dMMR CRC in Southern Taiwan exhibits a unique “stage discrepancy,” characterized by robust local growth but limited metastatic potential. Because traditional family history criteria are insensitive, anatomical location (right-sidedness) serves as a critical clinical surrogate for dMMR screening. Universal IHC testing is essential to guide genetic evaluation for Lynch syndrome and optimize immunotherapy access.
P.078
MICRORNA–YAP/TAZ 軸調控胰臟管腺癌 的腫瘤微環境介導的化療抗藥性
A MICRORNA–YAP/TAZ AXIS GOVERNS TUMOR MICROENVIRONMENTMEDIATED CHEMORESISTANCE IN PANCREATIC DUCTAL ADENOCARCINOMA
張雋威
臺北醫學大學附設醫院消化內科
Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a fibrotic and stiff tumor microenvironment (TME) that promotes chemoresistance by activating YAP/TAZ signaling through suppression of the Hippo pathway.
Aims: Identified a microRNA signature centered on hsa-miR-181c-5p, which directly targets key Hippo kinases—MST1, LATS2, MOB1, and SAV1—leading to sustained YAP/TAZ nuclear localization and activation of downstream pro-survival and epithelial–mesenchymal transition (EMT) programs.
Methods: Functional suppression of miR-181c-5p restores Hippo activity, decreases YAP/TAZ output, and resensitizes PDAC cells to gemcitabine. Supporting this core mechanism, loss of hsa-miR-23a-5p enhances FOXM1 activity, promoting proliferation and ECM remodeling that favor YAP/TAZ activation under biomechanical stress.
Meanwhile, hsa-miR-202-5p, delivered via exosomes from tumor-associated macrophages (TAMs), suppresses PTEN and activates the PI3K/AKT pathway, which cooperates with YAP/TAZ to reinforce drug resistance.
Results: Together, this miRNA network connects extracellular matrix stiffness to intracellular transcriptional reprogramming, defining a coordinated mechanism of biomechanical adaptation and chemoresistance in PDAC.
Conclusions: Targeting this microRNA–YAP/TAZ regulatory axis offers a promising strategy for overcoming TME-driven therapeutic failure.
P.079
兒童極早期發炎性腸道疾病之臨床表現與基 因研究：臺灣單一中心橫斷性研究
VERY EARLY-ONSET INFLAMMATORY BOWEL DISEASE: A TAIWANESE SINGLE-CENTER CROSS-SECTIONAL SURVEY OF GENETIC & PHENOTYPIC SPECTRUM
陳明 國立臺灣大學醫學院附設醫院兒童醫院小兒部
Background: Very early onset inflammatory bowel disease (VEO-IBD) is defined as onset before 6 years of age, and is more likely to be associated with monogenic mutations. In spite of multiple previous cohort studies of VEO-IBD patients, the disease severity and response to therapy of VEO-IBD patients remained inconclusive. Besides, no previous cohort studies of VEO-IBD have been reported in Taiwan to our knowledge. Therefore, we would like to present the first Taiwanese cross-sectional survey of VEOIBD patients.
Aims: To provide the first detailed cross-sectional survey of pediatric patients with VEO-IBD in Taiwan, highlighting the clinical presentations, genetic findings, and therapeutic approaches.
Methods: We conducted a cross-sectional survey of 26 pediatric patients diagnosed with VEO-IBD at National Taiwan University Children’s Hospital (NTUCH) between 2022 and 2025. Whole exome sequencing (WES) results were reviewed to identify associated monogenic mutations. Clinical data were collected on disease onset, phenotype, treatment regimens, and comorbidities.
Results: Among the 26 pediatric patients with VEO-IBD, 11 patients (42.3%) were diagnosed with Crohn’s disease (CD) & 15 (57.7%) patients with ulcerative colitis (UC). The median age of onset was 2.2 years, with a predominance of colonic involvement. WES identified disease-associated monogenic variants in 23.1% (6/26) of patients, with none of these patients sharing the same mutation. Most identified genes involved in immune regulation, including IL10RA, LRBA, PTPRC, etc. Immune-related comorbidities, such as autoimmune sclerosing cholangitis (ASC), autoimmune thyroiditis, and psoriasis, were observed in six of the patients. Eighteen patients (69.2%) received systemic steroids, while advanced therapies such as thiopurine and biologics were used in 16 of the patients (61.5%). Clinical heterogeneity was notable, underscoring the diagnostic and therapeutic challenges in this population.
Conclusions: This single-center study provides the comprehensive portrait of pediatric VEO-IBD in Taiwan, delineating its clinical presentation, genetic association, and treatment regimen. As the understanding of VEOIBD continues to evolve, additional disease-associated genes may be identified, and WES is poised to play an increasingly pivotal role in the diagnosis and management of these patients.
P.080
粒線體移植於不同腫瘤行為調控之作用 THE ROLE OF MITOCHONDRIAL TRANSPLANTATION IN REGULATING THE BEHAVIOR OF DIFFERENT TUMORS
林千傑1 朱能生1 黃斌2 林明瑋3 許文鴻4,5 郭昭宏5,6
1 高雄巿立小港醫院胃腸內科
2 高雄醫學大學生物醫學暨環境生物學系
3 義大醫療財團法人義大醫院 醫學研究部
4 高雄醫學大學附中和紀念醫院胃腸內科
5 高雄醫學大學醫學系
6 高雄秀傳紀念醫院腸胃內科
Background: Melanoma is a highly aggressive cancer with poor prognosis and limited treatment options. Mitochondrial transfer within the tumor microenvironment can influence tumor behavior.
Aims: This study investigated how endothelial cell (EC)derived mitochondria affect melanoma growth and related signaling pathways.
Methods: Mitochondria isolated from ECs were transplanted into murine melanoma B16F10 cells. Posttransplantation, proteins related to tumor growth, oxidative stress, mitochondrial homeostasis, and apoptosis were analyzed. In vivo tumor progression and macrophage polarization were assessed using a xenograft mouse model. Results: EC mitochondrial transplantation enhanced tumor growth–related protein expression, antioxidative capacity, and mitochondrial stability via activation of the Sirt1–PGC-1α–Nrf2–HO-1 pathway, while suppressing caspase-3 expression. In mice, EC mitochondria–enriched melanoma cells formed larger tumors and promoted M2 macrophage polarization through Nrf2/HO-1 activation.
Conclusions: Endothelial mitochondria promote melanoma progression by enhancing mitochondrial function and antioxidative signaling while inhibiting apoptosis. These findings suggest that stromal-to-tumor mitochondrial transfer contributes to melanoma malignancy and may represent a potential therapeutic target.
P.081
臺灣發炎性腸道疾病患者之腸外表現：一項 全國性世代研究探討其發生率與診斷前後之 時間關係
EXTRAINTESTINAL MANIFESTATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN TAIWAN: A NATIONWIDE COHORT STUDY OF INCIDENCE AND TEMPORAL RELATIONSHIP TO DIAGNOSIS
郭泰宏1 蔡孟蓉1 周仁偉2 賴香君3 黃柏儒2
1 中國醫藥大學教學部
2 中國醫藥大學消化內科部
3 中國醫藥大學中醫學院
Background: Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, is a chronic immune-mediated disorder with rising incidence in Taiwan. Extraintestinal manifestations (EIMs) are systemic inflammatory conditions that may involve multiple organ systems and substantially impair quality of life. While EIMs are traditionally considered complications of established IBD, emerging evidence suggests that they may occur before intestinal symptoms. However, populationbased data regarding the prevalence, distribution, and especially the temporal relationship between EIMs and IBD diagnosis in Asian populations remain limited. Clarifying these patterns is essential for improving early recognition and clinical management of IBD.
Aims: This nationwide population-based study aimed to investigate extraintestinal manifestations in Taiwanese patients with inflammatory bowel disease. The specific objectives were: (1) to estimate the incidence of EIMs in patients with IBD compared with non-IBD controls; (2) to characterize the distribution of EIMs across affected organ systems; and (3) to determine the temporal relationship between the onset of EIMs and the formal diagnosis of IBD, with particular emphasis on the occurrence of EIMs preceding intestinal disease.
Methods: We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database from 2008 to 2021. Patients with IBD diagnosed between 2013 and 2019 were identified through possession of a Catastrophic Illness Certificate and corresponding ICD9/10 codes. A five-year look-back period was used to identify EIMs occurring before IBD diagnosis, and a two-year follow-up period was applied to capture EIMs after diagnosis. Extraintestinal manifestations were
confirmed if recorded in at least two outpatient visits or one hospitalization and were categorized into mucocutaneous, ocular, musculoskeletal, hepatobiliary, genitourinary, pulmonary, cardiac, and neurological systems. Ageand sex-matched non-IBD controls were included for comparison. Incidence rates were calculated per 100 person-years. Cox proportional hazards models were used to estimate hazard ratios for EIM risk associated with IBD. Statistical analyses were performed using SAS 9.4, and figures were generated using RStudio 4.2.2.
Results: A total of 1,627 patients with IBD (498 Crohn’s disease and 1,129 ulcerative colitis) and 4,881 nonIBD controls were included. Patients with IBD had a significantly higher risk of developing EIMs compared with controls (hazard ratio 1.76, 95% CI 1.48–2.13).
Overall, the incidence rate of EIMs in the IBD cohort was 2.76 per 100 person-years. Notably, 87.5% of patients developed EIMs before IBD diagnosis, with a mean lead time of 5.69 years, whereas only 12.5% developed EIMs after diagnosis. Musculoskeletal manifestations were most prevalent (29.6%), followed by mucocutaneous (23.8%), genitourinary (22.1%), and ocular (11.5%) involvement. Peripheral arthritis, axial arthritis, cholelithiasis, and oral mucosal lesions were the most common EIM subtypes. Incidence of EIMs increased progressively in the years preceding IBD diagnosis and peaked within the first year after diagnosis. Women aged 40–64 years showed the highest incidence of pre-diagnostic EIMs.
Conclusions: In this nationwide Taiwanese cohort, extraintestinal manifestations frequently preceded the diagnosis of inflammatory bowel disease, often by several years. Musculoskeletal, mucocutaneous, ocular, and genitourinary systems were most commonly affected. This temporal pattern contrasts with Western data and suggests a prolonged pre-clinical systemic phase of IBD in Taiwan. Heightened clinical awareness of EIMs, particularly among non-gastroenterology specialists, may facilitate earlier recognition of IBD and improve patient outcomes.
P.082
大腸癌病人胃液及糞便中咽峽炎鏈球菌菌叢 變化
ALTERED STREPTOCOCCUS
ANGINOSUS STATUS IN GASTRIC JUICE AND STOOL AMONG COLORECTAL CANCER PATIENTS
嚴珮綺1 王崧維1 葉于瑄1 王俊偉1,2 余方榮1,2 吳登強1,2
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
Background: Streptococcus anginosus (SA) is an oral-associated bacterium increasingly implicated in gastrointestinal carcinogenesis. A recent Cell study demonstrated that SA is enriched across the spectrum of human gastric lesions and can drive gastric inflammation, atrophy/metaplasia, and dysplasia/tumorigenesis in vivo, with mechanistic evidence supporting a TMPC–ANXA2–MAPK axis.
Aims: This study aims to figure out that SA abundance in gastric juice and stool differs across nges after colorectal cancer (CRC) treatment
Methods: We conducted an observational cohort study enrolling adults with documented colonoscopy/pathology findings, categorized into: hemorrhoid/benign polyp, adenoma, CRC, and CRC post operation/therapy (post OP/Tx). SA in gastric juice and stool was quantified by SYBR Green quantitative PCR (qPCR) using a standardcurve quantification approach. The qPCR reaction volume was 10 μL with 100 ng DNA input and SYBR Green master mix; positive/negative calls incorporated meltcurve assessment with a single peak near the expected SA melting temperature (≈77–78 °C) and expected amplicon size (103 bp). A serially diluted SA DNA standard curve (10^8 to 10^1) was used (OD600=1 approximated as 1×10^8 cfu/mL), with the provided regression (R²=0.999; y = −3.45x + 40.371) and quantity back-calculation formula. Group comparisons used chi-square/Fisher’s exact tests for positivity rates and ANOVA or independent t-test for quantitative comparisons; statistical results are reported as in the analysis output summary.
Results: A total of 255 participants had colorectal diagnosis classification: hemorrhoid/benign polyp (n=121), adenoma (n=46), CRC (n=38), CRC post OP/Tx (n=50). qPCR availability was 122 gastric juice samples and 218 stool samples. Across hemorrhoid/benign polyp vs adenoma vs CRC, there were no significant differences in SA positivity or quantity in gastric juice or stool (chi-square
p=0.645 and ANOVA p=0.09; chi-square p=0.804 and ANOVA p=0.659). When comparing CRC post OP/Tx vs CRC, SA positivity rates remained similar (Fisher’s exact p=0.553 for gastric juice; chi-square p=0.341 for stool). Notably, gastric juice SA quantity was higher in CRC post OP/Tx (juice qPCR available: n=18) than in CRC (n=3) with a statistically significant difference (independent t-test p=0.02). Stool SA quantity did not differ significantly between CRC post OP/Tx and CRC (p=0.223).
Conclusions: In this cohort, only gastric juice SA quantity differed significantly—being higher in CRC patients after operation/therapy compared with untreated CRC—while stool SA signals were not significantly different. These findings suggest that treatment status may be associated with altered gastric ecological conditions or oral–gastric translocation dynamics. Given the small number of untreated CRC cases with available gastric juice qPCR, larger studies—ideally longitudinal and incorporating broader microbiome profiling—are warranted to validate the association and clarify clinical implications.
P.083
住院病人困難梭狀桿菌感染之風險因子與監 測指標探討
IDENTIFYING RISK FACTORS AND MONITORING INDICATORS FOR CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED PATIENTS
夏竹萱1,2,3 蘇秀悅1,2,3 張君照4,5 簡怡雯1,2,5
1 台北醫學大學附設醫院營養室
2 台北醫學大學保健營養學系
3 台北醫學大學附設醫院營養醫學研究中心
4 台北醫學大學附設醫院消化內科
5 台北醫學大學附設醫院消化醫學研究中心
Background: Clostridium difficile infection (CDI) has emerged as a major healthcare challenge, characterized by high treatment costs, extended lengths of hospital stay, and increased healthcare resource utilization. These impacts are particularly pronounced among hospitalized patients with multiple comorbidities or advanced age. Despite advances in infection control practices, the incidence of CDI continues to rise in many institutions. We identified a consistent annual increase in CDI incidence over the study period, suggesting a growing clinical and epidemiological concern at Taipei Medical University Hospital (TMUH).
Aims: We aimed to identify risk factors for CDI and establish monitoring indicators to guide prevention among hospitalized patients receiving antibiotics.
Methods: A case-control study to identify the risk factors of CDI among inpatients admitted to TMUH who underwent testing for C. difficile between January 1, 2017, and December 31, 2020. Data on patient’s demographics, comorbidities, prior medical and medication history, antibiotic exposure, and relevant laboratory parameters were extracted from electronic medical records. These variables were subsequently analyzed to evaluate their associations with CDI occurrence and to identify potential monitoring indicators for early detection and prevention in hospitalized patients.
Results: Compared with non-CDI patients, those with CDI exhibited significantly lower NRS 2002 scores (3.1 ± 1.7 vs. 3.5 ± 1.6, p=0.02). Tube feeding was less frequently observed in the CDI group (23.0% vs. 36.7%, p=0.01), while parenteral nutrition was more frequently used (8.8% vs. 3.8%, p=0.03).
In multivariate logistic regression, older age, lower NRS 2002 score, comorbid cardiovascular or pulmonary disease, tube feeding, and a higher number of medications were independently associated with CDI.
Conclusions: Nutritional assessment and feeding strategies may serve as important monitoring indicators for CDI prevention in hospitalized patients.
P.084
以三維腸道類器官探討腸道菌群與宿主互 作：肥胖與第二型糖尿病之交互關聯機制研 究
MODELING MICROBIOTA–
HOST INTERACTIONS USING 3D
GASTROINTESTINAL ORGANOIDS: INSIGHTS INTO THE INTERPLAY BETWEEN OBESITY AND TYPE 2 DIABETES
許文鴻1,2 古家禎3,4 吳念吉3,4 楊雅涵3,4 郭昭宏2,5 陳志彥6 橫山一成2,4,7 吳登強1,2,4
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄醫學大學醫學研究所
4 高雄醫學大學再生醫學與細胞治療研究中心
5 高雄秀傳紀念醫院腸胃內科
6 陽明交通大學急重症醫學研究所
7 高雄醫學大學附設中和紀念醫院細胞治療暨研宄中心
Background: Obesity is closely linked to metabolic disorders such as type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Increasing evidence indicates that these conditions are associated with alterations in gut microbiota composition and metabolism. Gut microbes produce bioactive metabolites especially short-chain fatty acids (SCFAs) and secondary bile acids (BAs) that regulate host metabolic, immune, and redox functions.
Aims: This study aims to investigate the mechanisms by which these metabolites influence oxidative stress and redox signaling in obesity-related conditions.
Methods: Three-dimensional (3D) gastrointestinal (GI) organoids were used as a physiologically relevant model to explore host–microbiota interactions. Organoids were exposed to microbiota derived from diabetic environments to assess microbial metabolite secretion and host pathway activation. Analyses focused on the relationship between Selenoprotein P (SePP), a selenium-transporting hepatokine involved in redox regulation, and nuclear factor erythroid 2–related factor 2 (NRF2), a master regulator of antioxidant defense.
Results: Microbiota from diabetic sources altered metabolite secretion profiles and triggered oxidative stress in organoids, evidenced by increased reactive oxygen species (ROS) and disrupted NRF2 pathway activity. SePP expression was also modulated, linking microbial metabolites to host redox imbalance and antioxidant
signaling dysregulation.
Conclusions: This 3D organoid model provides a controlled and physiologically relevant system to study microbiota-driven redox alterations. The results reveal that gut microbial metabolites modulate oxidative stress through SePP–NRF2 signaling under obesity-related metabolic conditions, offering mechanistic insight into the microbiota’s contribution to metabolic dysfunction and redox imbalance.
P.085
尿路結石患者的尿液微菌叢失調：多樣性降 低與菌相組成的改變 DYSBIOSIS OF THE URINARY MICROBIOTA IN UROLITHIASIS: REDUCED DIVERSITY AND ALTERED BACTERIAL COMPOSITION
謝華蓁1 李香瑩2,3 柯宜彣1 王崧維1 吳登強1,2 盧建宇1,2
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄醫學大學附設中和紀念醫院泌尿部
Background: Urolithiasis is a prevalent urological condition characterized by a high recurrence rate. While metabolic and environmental factors are well-known, the role of the urinary microbiota in stone formation remains under-explored compared to the gut microbiota. Dysbiosis, or the imbalance of microbial communities, may disrupt urinary homeostasis and contribute to disease progression.
Aims: This study aims to investigate the association between urinary microbiota dysbiosis and urolithiasis by comprehensively characterizing the microbial composition and diversity in patients with urinary stones compared to a healthy control population.
Methods: We conducted a case-control study enrolling 28 patients diagnosed with urolithiasis and 59 control participants, excluding those with recent antibiotic usage or catheterization. Mid-stream voided urine samples were collected from all subjects and stored at -80°C for genomic DNA extraction. We employed 16S rRNA gene sequencing targeting the V3-V4 variable regions to identify bacterial taxa. The analysis pipeline included Alpha diversity assessment for species richness, Beta diversity analysis using PCoA and NMDS to evaluate community structural differences, and statistical testing via ANOSIM and Welch’s t-test. Linear Discriminant Analysis Effect Size (LEfSe) was further utilized to identify specific microbial biomarkers distinguishing the two groups.
Results: Demographic analysis revealed that patients in the stone group were significantly younger and had a higher Body Mass Index (BMI) than the control group. In terms of microbial ecology, Alpha diversity indices (Chao1, ACE, and Shannon) demonstrated that the urinary microbiota of stone formers had significantly lower species richness and complexity compared to the non-stone controls. Beta diversity analysis, supported by ANOSIM statistics (P=0.004), confirmed a distinct separation in the microbial community structures between the two cohorts. Taxonomic
profiling identified that the control group harbored a significantly higher abundance of specific genera, including Alcaligenes, Bacteroides, Blautia, Ruminococcaceae_UCG, Cutibacterium, Alistipes, and Lachnoclostridium. Notably, the genus Alcaligenes exhibited the most significant depletion in the urolithiasis patients, whereas genera such as Finegoldia and Proteus were more prominent in the stone group.
Conclusions: Our study provides evidence that dysbiosis of the urinary microbiota, characterized by a marked reduction in microbial diversity and the loss of potentially protective genera such as Alcaligenes, is closely associated with the development of urolithiasis. These findings suggest that the urinary microbiome plays a critical role in maintaining urinary health. Further research targeting these specific microbial alterations may lead to the identification of novel diagnostic biomarkers and the development of microbiotamodulation therapies to prevent stone recurrence.
P.086
消化道 - 眼睛微菌叢失衡與眼科重要疾病的 相關分析
THE RELATIONSHIP BETWEEN THE GUT-EYE DYSBIOSIS AND SIGNIFICANT OPHTHALMIC DISEASE UNDER THE DATA OF SOUTHERN TAIWAN MEDICAL CENTER
周奕廷1 林倢伃2 葉于瑄1 許淑娟2,3 許文鴻1,3 吳登強1,3 1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學附設中和紀念醫院眼科
3 高雄醫學大學醫學系
Background: The gut microbiome is a complex ecosystem whose dysregulation has been increasingly implicated in the pathogenesis of diverse systemic diseases. The gut microbiome had much system interaction with its host, such as nutrient metabolism, regulation of immune function, inhibition of pathogens. The translocation of microbes along the epithelial barrier, microbial dysbiosis induces systemic inflammation that may lead to tissue destruction and had impact on many system disease. In recent study, gut-eye axis concept had been advocated and how oral, gut, and ocular-surface microbiota contribute to major blinding eye diseases, such as dry eye disease , non-infectious uveitis, glaucoma, age-related macular degeneration, allergic conjunctivitis and diabetic retinopathy were be emphasized.
Aims: We wish to realized the relationships between guteye dysbiosis and the major eye disease.
Methods: we wish to realize the relationship between oral, gut and eye disease, we collected total 74 patients with intact ophthalmic survey and oral, gut microbiome collection. We collect patient’s saliva with the dental plaques, gastric juice, stool for real time qPCR, especially these species such as Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, Enterococcus faecalis, Bacteroides fragilis, and Streptococcus anginosus. accumulating clinical and basic science evidence suggests that these pathogens may be associated with certain eye diseases. Statistic analysis were with logistic regression with adjusted age, sex, underlying disease analysis , under Software SPSS (significance defined as p-value < 0.05)
Results: From 2023 to 2025, we collected total 74 patients with intact ophthalmic survey and microbiome profiles. Among patients in this study, mean age 64.9 year-old, 29.7% were male patient, 28.4% patients had diabetic mellitus, 16.2% patients had autoimmune disease. The
result showed the Prevotella intermedia had significant relationships with the dry eye disease. (p<0.05) and saliva samples had stronger evidence than the gastric juice and stool samples.
Conclusions: In our study, Prevotella intermedia had significant relationships with the dry eye disease. (p<0.05) and the mechanism be surmised to be systemic immune modulation and inflammation. The cytokines damage the corneal and conjunctival epithelial barriers, disrupt the tear film, and cause goblet cell dysfunction. The gut-eye axis where an imbalance (dysbiosis) may be associated with significant ophthalmic disease, and we will kept this study for more evidence in the future.
P.087
腸道與泌尿道微生物群與前列腺疾病之關 聯：以 16S RRNA 定序分析良性前列腺肥大 與前列腺癌之研究
ASSOCIATION OF GUT AND URINARY MICROBIOTA WITH PROSTATIC DISEASES: A 16S RRNA SEQUENCING STUDY OF BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER
余方榮1,2 李香瑩2,3 沈群勝4 劉忠榮1 吳登強1,2 盧建宇1,2
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄醫學大學附設中和紀念醫院泌尿部
4
Background: Numerous microorganisms residing in the gastrointestinal and genitourinary tracts play important roles in host health and disease. Emerging evidence suggests that alterations in the human microbiota may be associated with prostatic diseases; however, the relationship between microbiota composition and benign prostatic hyperplasia (BPH) or prostate cancer (PC) remains unclear.
Aims: This study aimed to investigate the potential association between human microbiota and prostatic diseases by analyzing stool and urine microbiota profiles in patients with BPH or PC compared with a control group, and to identify microbial taxa potentially involved in prostatic disease pathogenesis.
Methods: Stool and voided urine samples were collected from patients with BPH, patients with PC, and healthy controls. Microbial composition was analyzed using 16S ribosomal RNA (rRNA) gene sequencing. Extracted genomic DNA was amplified, and quality-filtered sequences were used to identify and classify operational taxonomic units (OTUs) based on taxonomic assignment.
Results: No statistically significant differences in microbial composition were observed among the groups in stool samples. In contrast, urine samples demonstrated distinct microbiota compositions across different patient populations. The five genera showing the most significant differences between the BPH and control groups were Alcaligenes, Pseudomonas, Lactobacillus, Akkermansia, and Cetobacterium. When comparing the PC and control groups, the genera with the largest proportional differences were Faecalibacterium, Staphylococcus, Ruminococcaceae_UCG_002, Neisseria, and Agathobacter.
Conclusions: The urine microbiota composition in patients
with BPH and PC differs significantly from that of healthy controls, whereas stool microbiota shows no significant differences. These findings suggest a potential role of urinary microbiota in prostatic diseases, highlighting the need for further studies to identify specific microbial taxa involved in disease development and progression.
P.088
ANTI-INTEGRIN αVβ6 抗體與 ANTI-GMCSF 抗體在台灣發炎性腸道疾病患者之效 用
THE UTILITY OF ANTI-INTEGRIN αVβ6 AND ANTI-GM-CSF ANTIBODIES IN TAIWANESE PATIENTS WITH INFLAMMATORY BOWEL DISEASE
陳知澈1.2 吳心耘1,2 陳韻竹2 翁孟慈2,3 魏淑鉁2
1 台灣大學醫學院附設醫院金山分院
2 台灣大學醫學院附設醫院
3 台灣大學醫學院附設醫院新竹分院
Background: Serological markers such as antiSaccharomyces cerevisiae antibody (ASCA) and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) have been used to distinguish ulcerative colitis (UC) from Crohn’s disease (CD), with limited performance. Emerging anti-integrin αvβ6 and anti-GM-CSF, have shown promise in differentiating disease type and reflecting disease activity in limited Japanese and Western cohorts. Also, no previous reports have examined these antibodies together.
Aims: This study aimed to evaluate the diagnostic and clinical utility of these markers in Taiwanese patients with inflammatory bowel disease (IBD).
Methods: Patients with IBD under proactive tight monitoring were prospectively enrolled at a medical center in Taiwan from 2021 to August 2025. Serum samples were analyzed with ELISA for anti-integrin αvβ6 (MBL, Japan) and anti-GM-CSF (FineTest, China). Fecal calprotectin was obtained within 1 month of blood collection. Colonoscopies within 3 months were reviewed for endoscopic activity by Mayo endoscopic subscore for UC and Simple Endoscopic CD score for CD patients. Group differences were analyzed using the Mann-Whitney U test. Associations between serologic markers and clinical parameters, including disease activity and extent, were examined using Spearman correlation. Analyses were conducted with IBM SPSS Statistics 22.
Results: A total of 159 patients were included (89 UC, 70 CD). The mean age at sampling was 44.7 years, and mean disease duration was 6 years. Systemic steroid exposure within 1 year was noted in 46.9%. Extensive colitis was present in 68.2% of UC patients, while 72.1% of CD patients had ileocolonic disease; 21.9% and 35.9% of CD patients had stenotic and penetrating phenotypes, respectively. Anti-integrin αvβ6 levels were significantly higher in UC than in CD (2245.6 vs. 188.4 U/mL, p <
0.005), whereas there was no difference in the anti-GMCSF levels among the UC and CD patients (86.4 vs. 76.4 U/mL, p = 0.161). At a cutoff value of 217.7 U/mL, anti-integrin αvβ6 can differentiate UC from CD with a sensitivity of 83.1%, a specificity of 84.3%, a positive predictive value of 84.6%, and a negative predictive value of 80.5%. Anti-integrin αvβ6 correlated positively with the Mayo endoscopic subscore in UC (correlation coefficient 0.365, p = 0.014). In CD, both anti-integrin αvβ6 and anti-GM-CSF showed significant correlations with fecal calprotectin (correlation coefficient, -0.571 and -0.490, p = 0.041 and 0.046).
Conclusions: Anti-integrin αvβ6 but not the anti-GM-CSF, effectively differentiates UC from CD in Taiwanese patients with IBD. Anti-integrin αvβ6 reflects endoscopic activity in UC. Anti-integrin αvβ6 and anti-GM-CSF correlate with biochemical disease activity in CD patients. These findings support the value of these serologic markers in disease classification and monitoring within this population.
P.089
UPADACITINIB 於發炎性腸道疾病患者之 治療藥物監測：真實世界前瞻性觀察研究 THERAPEUTIC DRUG MONITORING OF UPADACITINIB FOR INFLAMMATORY BOWEL DISEASE PATIENTS: A REAL-WORLD PROSPECTIVE OBSERVATIONAL STUDY
陳韻竹1 陳知澈2 吳心耘2
台大醫院內科部
2 台大醫院金山分院內科部
3 台大醫院新竹分院內科部
4 國立台灣大學醫學院法醫研究所
Background: Therapeutic drug monitoring (TDM) helps optimize treatment in patients with inflammatory bowel disease (IBD). Patient adherence affects treatment response, especially with oral therapies. Real-world data on serum upadacitinib concentrations are limited.
Aims: This study aimed to evaluate real-world utility of serum upadacitinib measurement.
Methods: We prospectively enrolled patients with IBD receiving upadacitinib between April 2024 and October 2025. Serum samples were obtained every 3–6 months during routine follow-up. Upadacitinib concentrations were quantified using liquid chromatography–mass spectrometry (LC-MS), with each sample analyzed in duplicate for validity. Data on dose, dosing-to-sampling interval, and clinical disease activity were recorded. Clinical remission was defined as partial Mayo score (pMayo) < 3 for ulcerative colitis (UC) and Harvey–Bradshaw Index (HBI) < 2 for Crohn’s disease (CD). Median serum concentrations in controls (IBD patients not receiving upadacitinib) and those receiving 15-mg, 30-mg, and 45-mg daily doses were compared using the Kruskal–Wallis test. Correlations between drug concentration and (1) dosing-to-sampling time and (2) albumin were assessed using Spearman correlation. Factors associated with drug levels were analyzed using univariable and multivariable regression models.
Results: A total of 18 patients (13 male; median age 40.8 years) contributed 75 measurements over 18 months. Most were UC patients (15/18), predominantly extensive colitis (E3: 9/15). Median body mass index was 24.8, and 13 (72.2%) had prior biologic failure. Upadacitinib was used as monotherapy in 58.7% of observations. Clinical remission was observed in 58/61 UC assessments and 10/14
CD assessments. The median dosing-to-sampling interval was 13.5 hours (IQR 8.5–16). The overall median serum concentration was 0.35 ng/mL (IQR 0.16–0.74). Serum concentrations increased significantly with higher doses and were negatively correlated with dosing-to-sampling time, indicating dose- and time-dependent pharmacokinetics (p < 0.05). Serum concentrations were not associated with albumin. Age, sex, BMI, prior biologic exposure, disease phenotype, and combination therapy were not associated with drug levels. Two patients with previously detectable drug levels later became undetectable. After adherence counseling, levels returned to detectable ranges. One representative case showed biochemical and endoscopic flare related to poor adherence, with remission regained after adherence improved.
Conclusions: Serum upadacitinib concentrations were significantly influenced by dose and dosing-to-sampling timing, but not by patient demographics, prior biologic exposure, disease phenotype, combination therapy, or albumin. TDM may help reinforce adherence and maintain therapeutic efficacy of upadacitinib in real-world practice.
2022 至 2025 年幽門螺旋桿菌抗生素抗藥性 連續變化趨勢：台灣南部單一中心報告 SEQUENTIAL CHANGES IN ANTIBIOTIC RESISTANCE IN HELICOBACTER PYLORI FROM 2022 TO 2025: A SINGLECENTER REPORT FROM SOUTHERN TAIWAN
石志安1,2 蘇以哲1 鄭一中1 吳坤輝1 李昶毅3 詹麗珍3 鄭玉紫3 蔡丞家4 周正忠4 張家曦4 吳登強5 許秉毅6
1 屏東安泰醫療社團法人安泰醫院內科部胃腸肝膽科 2 屏東美和科技大學護理系
3 屏東安泰醫療社團法人安泰醫院藥劑科
4 屏東安泰醫療社團法人安泰醫院檢驗科
5 高雄醫學大學附設醫院胃腸內科
6 中國醫藥大學臺南市立安南醫院消化內科
Background: Antibiotic resistance has a significant effect on the rates of treatment failure for Helicobacter pylori (H. pylori) infections.
Aims: To investigate the sequential changes and trends in primary antibiotic resistance of H. pylori in southern Taiwan over the past three years.
Methods: We conducted a retrospective analysis of H. pylori isolates from Taiwanese who had not undergone previous treatments (n=392), collected at a single center in Pingtung County between January 1st, 2022, and August 31st, 2025. Susceptibility of these strains to amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline was tested using the Epsilometer test. We analyzed the trends in resistance profiles throughout the study period and conducted a comparison of antibiotic resistance specifically in southern Taiwan.
Results: In treatment-naïve patients with H. pylori infection receiving first-line eradication therapy, primary resistance trends for clarithromycin (14.6%–32.0%, p=0.14), levofloxacin (24.6%–44.0%, p=0.25), and metronidazole (13.8%–30.0%, p=0.13) were observed. Dual initial resistance to clarithromycin and metronidazole also showed an increasing trend (3.4%–16.0%, p=0.13). In southern Taiwan, primary resistance rates to amoxicillin and tetracycline remained at low levels (1.0% and 1.3%), respectively.
Conclusions: Primary antibiotic resistance to clarithromycin, levofloxacin, and metronidazole for H. pylori has increased in southern Taiwan from 2022 to 2025. Dual resistance to clarithromycin and metronidazole also increased significantly.
P.090
P.091
尿素酶測試陽性但病理檢查陰性：第一線幽 門螺旋桿菌治療成效較差之潛在風險因子
ASSOCIATION BETWEEN HISTOLOGICAL HELICOBACTER
P.092
AMOXICILLIN-VONOPRAZAN 二合一療
法用於治療幽門螺旋桿菌：一篇系統性回顧 與統合分析
AMOXICILLIN-VONOPRAZAN
SINGLE-
PYLORI DETECTION AND FIRST-LINE TREATMENT OUTCOMES IN UREASE TEST-POSITIVE PATIENTS: A
CENTER
STUDY IN SOUTHERN TAIWAN
李沅融 高崧碩 陳彥樺 王志峯 屏東榮民總醫院肝膽胃腸科
Background: In clinical practice, patients with a positive rapid urease test (RUT) are typically treated for Helicobacter pylori (H. pylori) infection, even if histological examination does not reveal the bacteria. However, the clinical significance of this discrepancy remains unclear.
Aims: This study aimed to evaluate the association between histological H. pylori detection and the efficacy of first-line eradication therapy among RUT-positive patients in a single medical center in Southern Taiwan.
Methods: We conducted a retrospective study on 119 H. pylori-infected patients with positive RUT results between November 2024 and October 2025. All patients received first-line eradication therapy, consisting of either 14-day reverse hybrid therapy (n = 91) or 7-day concomitant therapy (n = 28). Eradication status was assessed by a urea breath test at least 4 weeks after therapy completion and 2 weeks after PPI discontinuation.
Results: Among the 119 patients, 79 were histologypositive and 40 were histology-negative. Successful eradication was achieved in 77 of the 79 histologypositive patients (97.4%) and 34 of the 40 histologynegative patients (85.0%). The overall eradication rate was 93.3%. The eradication rate was significantly higher in the histology-positive group compared to the histologynegative group (97.4% vs. 85.0%, P = 0.029).
Conclusions: In patients with positive rapid urease tests (RUT), the presence of H. pylori in histological biopsies is associated with significantly superior first-line eradication rates compared to those with negative histological findings. Histological confirmation may serve as a predictor for treatment success in this population.
DUAL THERAPY IN PATIENTS WITH H. PYLORI INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
鄭宇翔1 李忠憲1 彭姿蓉2
1,3
1,3
1,3
Background: Helicobacter pylori infection remains a global health issue, and various treatment regimens are employed for its eradication. Traditional PPI-based therapies have high failure rates, and newer approaches, such as vonoprazan (VA)-based dual therapy, are being explored.
Aims: To compare VA dual therapy with other H. pylori eradication regimens’ eradication rates, adverse events rates and treatment discontinuation rates.
Methods: This study analyzed the efficacy and safety of VA dual therapy for H. pylori eradication, comparing it with other common therapies, including PPI-based and bismuth based regimens. Data were pooled from multiple clinical trials using intention-to-treat (ITT) analysis.
Results: The pooled eradication rate of H. pylori with VA dual therapy was 83.9%. The efficacy was higher with longer treatment durations (10-day and 14-day regimens), and high-dose amoxicillin showed better results compared to low-dose. VA dual therapy demonstrated superior efficacy over PPI-based therapies (RR = 1.10), but similar efficacy to bismuth-based regimens. The overall adverse event rate was 19.3%, with VA dual therapy showing fewer adverse events compared to bismuth-based regimens.
Conclusions: VA dual therapy is a promising treatment option for H. pylori eradication, showing comparable efficacy to existing therapies, with a favorable safety profile. Further studies, particularly in diverse geographic populations, are needed to refine treatment regimens.
P.093
偶發性胃部 PET 熱點之特徵分析：瀰漫性 高強度攝取與幽門螺旋桿菌感染之關聯 CHARACTERIZING INCIDENTAL GASTRIC FDG UPTAKE: DIFFUSE HIGH-INTENSITY PATTERNS AS A MARKER FOR HELICOBACTER PYLORI INFECTION
林展毅1 莊佩儒2 劉志銘1,3 吳明賢3 洪子瞻1,3
1 臺大醫院癌醫分院綜合內科部
2 臺大醫院癌醫分院核子醫學部
3 臺大醫院內科部
Background: In oncologic 18F-FDG PET/CT, incidental gastric uptake presents a common diagnostic challenge, often requiring differentiation between physiological activity and pathology such as Helicobacter pylori (HP) gastritis or malignancy. While screening studies have linked gastric uptake to HP infection, the clinical significance of these incidental findings in real-world cancer staging remains unclear. Specifically, correlating distinct spatial patterns and metabolic intensity with active infection is difficult, and current standard analysis often lacks the sensitivity to stratify risk in these small, heterogeneous cohorts.
Aims: This study aimed to identify metabolic signatures of HP infection in patients with incidental gastric FDG uptake. Specifically, we sought to determine if the spatial pattern of uptake (diffuse vs. non-diffuse) and metabolic intensity (SUVmax) could serve as predictive markers for active HP infection.
Methods: We conducted a retrospective pilot analysis of 19 patients at the National Taiwan University Cancer Center (October 2024 – December 2025). Patients were included if they presented with incidental gastric FDG uptake and underwent confirmatory HP testing via 13C-UBT or endoscopic biopsy. Cases with confirmed lymphoma or gastric MALT lymphoma were excluded to avoid confounding metabolic signals. Uptake patterns were categorized as “Diffuse/Large Area” or “Non-Diffuse” (localized to Fundus/Antrum). Metabolic intensity was assessed using the maximum standardized uptake value (SUVmax). Statistical analysis employed the MannWhitney U test for continuous variables. To address the limitations of the small sample size (n=19), we utilized Bayesian probability modeling (Monte Carlo simulation) to estimate the probability that Diffuse uptake confers a higher risk of infection than Non-Diffuse uptake.
Results: The diffuse uptake pattern emerged as a distinct hypermetabolic entity, exhibiting significantly higher metabolic intensity compared to non-diffuse patterns (Mean SUVmax: 5.6 vs. 3.5, p = 0.0017, Mann–Whitney U test). Although SUVmax magnitude alone did not strictly differentiate HP -positive from HP-negative cases (p = 0.9), the diffuse pattern was enriched for infection. The HP prevalence was 66.7% (6/9) in the diffuse group versus 30% (3/10) in the non-diffuse group. Bayesian analysis revealed an 93.6% probability that the infection rate is higher in diffuse cases than in non-dffuse cases. The diffuse pattern demonstrated a Positive Likelihood Ratio (LR+) of 2.22 and a Positive Predictive Value (PPV) of 66.7%.
Conclusions: Diffuse gastric FDG uptake represents a distinct high-intensity metabolic state that is significantly more active than focal uptake and carries a two-fold increased likelihood of H. pylori infection. These findings suggest that incidental diffuse uptake should not be dismissed as physiological noise but warrants endoscopic evaluation. The application of Bayesian modeling in this pilot cohort effectively highlights a risk signal that should be tested in future study involving larger sample sizes.
P.094
台灣幽門螺旋桿菌感染第一線治療之真 實世界研究：14 天 VONOPRAZAN–AMOXICILLIN 雙重療法與 14 天混合療法 之比較
REAL-WORLD COMPARISON OF 14DAY VONOPRAZAN–AMOXICILLIN
DUAL THERAPY AND 14-DAY HYBRID THERAPY AS FIRST-LINE TREATMENT FOR HELICOBACTER PYLORI INFECTION IN TAIWAN
張瑄元
奇美醫療財團法人奇美醫院 胃腸肝膽科
Background: Vonoprazan–amoxicillin dual therapy has demonstrated superior efficacy compared with proton pump inhibitor (PPI)–based standard triple therapy for Helicobacter pylori eradication in the United States. However, differences in efficacy and safety between this novel regimen and non-bismuth quadruple therapies—such as concomitant, hybrid, and sequential therapies—remain unclear.
Aims: To compare the efficacy and safety of 14-day vonoprazan–amoxicillin dual therapy and 14-day hybrid therapy as first-line treatment for H. pylori infection in realworld clinical practice in Taiwan.
Methods: This retrospective study included treatmentnaïve patients with H. pylori infection who received either 14-day vonoprazan–amoxicillin (VA) dual therapy (vonoprazan 20 mg twice daily plus amoxicillin 750 mg four times daily for 14 days) or 14-day hybrid therapy (rabeprazole 20 mg twice daily plus amoxicillin 1,000 mg twice daily for 7 days, followed by rabeprazole 20 mg twice daily, amoxicillin 1,000 mg twice daily, clarithromycin 500 mg twice daily, and metronidazole 500 mg twice daily for an additional 7 days) between June 2019 and July 2023 at seven hospitals in Taiwan. Patients returned at week 2 for assessment of treatment adherence and adverse events. H. pylori eradication was evaluated at least four weeks after completion of therapy.
Results: A total of 574 patients were included, with 279 receiving VA dual therapy and 295 receiving hybrid therapy. By intention-to-treat analysis, the eradication rate of VA dual therapy was significantly lower than that of hybrid therapy (87.8% vs. 93.9%, P = 0.011). However, VA dual therapy was associated with a significantly lower incidence of adverse events compared with hybrid therapy (10.8% vs. 24.4%, P < 0.001). Treatment adherence was
high and comparable between the two groups (98.6% vs. 98.3%).
Conclusions: In this Taiwanese real-world cohort, 14day hybrid therapy achieved superior eradication efficacy compared with 14-day VA dual therapy as first-line treatment for H. pylori infection, whereas VA dual therapy was associated with fewer adverse events.
P.095
咽峽炎鏈球菌及幽門螺旋桿菌誰才是胃癌的 主兇
STREPTOCOCCUS ANGINOSUS AND HELICOBACTER PYLORI: WHICH IS THE DOMINANT DRIVER OF GASTRIC CANCER PROGRESSION?
盧俊翰1 王俊偉1,2 陳清元1 吳宜珍1,2 許文鴻1,2 郭昭宏2,3
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄秀傳紀念醫院腸胃內科
Background: Although Helicobacter pylori (H. pylori) is a major risk factor for gastric cancer, disease progression may persist after eradication, suggesting the involvement of other microorganisms. Streptococcus anginosus (S. anginosus) has been increasingly detected in gastric cancer tissues, but its relative role compared with H. pylori remains unclear.
Aims: This study aims to investigate the relative role between Streptococcus anginosus and Helicobacter pylori in gastric cancer
Methods: Gastric cancer tissues were analyzed from 10 S. anginosus–negative and 13 S. anginosus–positive patients. S. anginosus positivity was defined by quantitative PCR detection in stool, gastric juice, saliva, or dental plaque, with positivity in any specimen considered positive. Samples were further stratified by H. pylori status. Tumorto-normal (T/N) expression ratios of claudin-18 (CLDN18), occludin (OCLN), and zonula occludens-1 (ZO-1) were assessed. Transwell migration assays were performed using AGS gastric cancer cells infected with H. pylori or S. anginosus at different multiplicities of infection (MOI), alone or in combination.
Results: In S. anginosus –negative patients, H. pylori infection was associated with a significant reduction in CLDN18 T/N ratios (P = 0.045). In S. anginosus–positive patients, H. pylori infection led to significant downregulation of CLDN18 (P = 0.0001), OCLN (P = 0.011), and ZO-1 (P = 0.015). In contrast, S. anginosus infection alone was associated with a significant decrease only in OCLN expression in H. pylori –negative patients (P = 0.005). Functionally, H. pylori enhanced AGS cell migration at MOI 50 and 100 (P = 0.016 and 0.040), while S. anginosus increased migration at MOI 100 and 200 (P = 0.008 and 0.018). Co-infection produced an additive promigratory effect (P = 0.0004).
Conclusions: H. pylori is the dominant driver of epithelial
barrier disruption and gastric cancer progression, while S. anginosus plays a secondary but contributory role. We hypothesize that S. anginosus may continue to influence gastric carcinogenesis after H. pylori eradication, a possibility that warrants further investigation.
P.096
幽門螺旋桿菌治療後促氧化與抗氧化微量元 素濃度之變化
CHANGES IN PROOXIDANT AND ANTIOXIDANT TRACE ELEMENT LEVELS FOLLOWING HELICOBACTER PYLORI ERADICATION THERAPY
侯灝皚1 林千傑1 郭富珍2 林清江3,4 黃友利5 吳登強6,7
1 高雄巿立小港醫院胃腸內科
2 義守大學學士後醫學系
3 輔英科技大學附設醫院檢驗醫學部
4 輔英科技大學醫學檢驗生物技術系
5 高雄醫學大學醫學檢驗生物技術學系
6 高雄醫學大學附設中和紀念醫院胃腸內科
7 高雄醫學大學醫學系
Background: Helicobacter pylori (H. pylori) is a spiralshaped Gram-negative bacterium strongly associated with chronic gastritis, peptic ulcer disease, and gastric cancer.
The Maastricht V/Florence Consensus Report recommends eradication therapy to prevent these complications. Trace elements play a crucial role in maintaining oxidative balance, and alterations in their levels during proton pump inhibitor (PPI) and antibiotic therapy may provide insight into the metabolic mechanisms of H. pylori and the host cellular response to treatment.
Aims: To evaluate changes in trace elements and malondialdehyde (MDA) following H. pylori eradication therapy.
Methods: Forty patients received standard triple therapy. Blood and urine samples were collected at baseline and one month post-treatment. Trace elements were measured by ICP-MS or AAS, and MDA by HPLC-FLD. Eradication was confirmed by urea breath test.
Results: Most laboratory parameters were unchanged, except for increased BUN (p = 0.007). After therapy, plasma iron, copper, chromium, and MDA increased, while zinc and selenium decreased (p < 0.05). Urinary iron, copper, zinc, and selenium decreased, whereas chromium increased (p < 0.05).
Conclusions: H. pylori eradication therapy altered the average levels of several trace elements and the oxidative stress marker MDA. The observed increase in prooxidantrelated elements and MDA, together with a decrease in antioxidant-related elements, suggests enhanced oxidative stress following treatment. These findings highlight the need for further studies to clarify the clinical significance and longterm implications of these changes after eradication therapy.
P.097
在幽門螺旋桿菌根除後胃病變與咽峽炎鏈球 菌的關聯性
THE RELATIONSHIP BETWEEN GASTRIC DISEASE PROGRESSION AND THE STREPTOCOCCUS ANGINOSUS IN POST HELICOBACTER PYLORI ERADICATION ERA
王崧維1 陳以勳1 葉于瑄1 許文鴻1,2 吳登強1,2 郭昭宏2,3
1 高雄醫學大學附設中和紀念醫院胃腸內科
2 高雄醫學大學醫學系
3 高雄秀傳紀念醫院腸胃內科
Background: Streptococcus anginosus (S. anginosus, S.a) is a common commensal bacterium of the oral cavity known to cause opportunistic infections. While Helicobacter pylori is a well-established carcinogen, recent evidence suggests that non-H. pylori microbiota may also play a important role in gastric carcinogenesis.
Aims: This study aimed to investigate the distribution of S. anginosus across the human gastrointestinal tract (saliva, gastric juice, and stool) and to evaluate the correlation between its presence in gastric juice and the severity of gastric mucosal pathology, including gastritis, intestinal metaplasia (IM), and gastric cancer.
Methods: We conducted a cross-sectional study from May 2023 to April 2025. The cohort included adult patients undergoing upper endoscopy for epigastric discomfort or gastric cancer surveillance. Patients who were pregnant, lactating, or immunocompromised were excluded. Gastric juice samples were collected from all participants (N=230), while a subset (N=64) provided simultaneous saliva and stool samples. The presence of S. anginosus was detected by quantitative PCR (qPCR). Statistical analyses were performed to assess correlations between bacterial presence, intragastric pH, and disease stages.
Results: Among the 230 patients analyzed, S. anginosus infection in gastric juice was significantly associated with elevated intragastric pH (mean pH 4.9 in positive cases vs. 2.1 in negative cases; P<0.001). The detection rate of S. anginosus increased significantly with the severity of gastric disease: 45.4% in gastritis without IM, 60.6% in gastritis with IM, and peaking at 92.3% in newly diagnosed gastric cancer (P<0.001). In patients with intestinal metaplasia, the detection rate showed an increasing trend with severity (55.8% in mild vs. 100% in severe), though this did not reach statistical significance (P=0.213). In the subset analysis (N=64), S. anginosus was detected
in 81.3% of saliva, 53.1% of gastric juice, and 87.5% of stool samples. A significant concordance was observed between S. anginosus presence in saliva and gastric juice (P=0.021), supporting an oral-gastric transmission route. No significant correlation was found between gastric juice and stool positivity (P=0.199).
Conclusions: S. anginosus is highly prevalent in the oral cavity and colon. Its presence in the stomach strongly links to an alkaline environment and the progression of gastric carcinogenesis—particularly in gastric cancer and severe precancerous lesions. The significant correlation between salivary and gastric positivity suggests that the oral cavity serves as the primary reservoir for gastric S. anginosus colonization. These findings indicate that S. anginosus may act as a potential biomarker for gastric disease progression.
P.098
內視鏡特徵分級對活動性幽門螺旋桿菌感染 的預測價值
PREDICTIVE VALUE OF GRADED ENDOSCOPIC FEATURES FOR ACTIVE HELICOBACTER PYLORI INFECTION
吳柏陞1 劉志銘1,2 吳明賢1 洪子瞻1,2
1 臺大醫院內科部
2 臺大醫院癌醫分院綜合內科部
Background: Accurate identification of active Helicobacter pylori infection remains clinically important, as eradication strategies depend on current infection status. With advances in endoscopic technology, various H. pylori -related endoscopic gastric mucosal changes, including atrophic gastritis and intestinal metaplasia, can be better identified and classified using modern endoscopic stratification methods. While these endoscopic features have been reported to be associated with H. pylori infection, their ability to predict active infection remains incompletely defined. Identifying reliable endoscopic predictors of active H. pylori infection may facilitate risk stratification and guide different screening strategies during and after endoscopy.
Aims: To evaluate whether endoscopic gastric mucosal features, particularly atrophic gastritis (classified by the Kimura–Takemoto system) and intestinal metaplasia (graded by the Endoscopic Grading of Gastric Intestinal Metaplasia, EGGIM), can predict active H. pylori infection.
Methods: This was a retrospective cross-sectional analysis of patients who underwent esophagogastroduodenoscopy as part of a larger randomized control trial on H. pylori screening in National Taiwan University Hospital and National Taiwan University Cancer Center. Active H. pylori infection was defined using a strict composite criterion, requiring seropositivity for H. pylori antibodies together with at least one positive functional test, either the urea breath test or the stool antigen test. Atrophic gastritis was classified according to the Kimura–Takemoto system, and intestinal metaplasia was assessed using the EGGIM score. Multivariable logistic regression was performed to evaluate associations of endoscopic features and active H. pylori infection. A composite endoscopic score integrating the Kimura–Takemoto classification and EGGIM score was developed to reflect the overall gastric mucosal severity, and categorized the patients into three groups: healthy mucosa, mild mucosal change, severe mucosal change. Multivariable logistic regression was performed to evaluate
associations of the composite endoscopic score and active H. pylori infection.
Results: A total of 149 patients (59.1 % male, mean age: 61.3 ± 12.7 years) were included in the analysis. Active H. pylori infection rate was higher in patients with atrophic gastritis (86.0% v.s. 54.0%, p < 0.001) and intestinal metaplasia (91.1% v.s. 51.4%, p < 0.001). After adjustment for age (≥50 v.s. <50 years) and sex, patients with closed-type atrophic gastritis (Kimura–Takemoto classification C1–C3) showed a trend toward a higher likelihood of active H. pylori infection compared with those without or with minimal atrophy, although the association did not reach statistical significance (adjusted OR: 2.11, 95% CI: 0.81 – 5.51, p value = 0.126). Opentype atrophic gastritis (Kimura–Takemoto classification O1–O3) was not independently associated with active H. pylori infection compared with those without or with minimal atrophy (adjusted OR: 1.78, 95% CI: 0.1520.86, p value = 0.646). Regarding intestinal metaplasia, increasing EGGIM categories demonstrated a clear dose–response relationship with active H. pylori positivity after adjustment for age and sex. Compared with patients without intestinal metaplasia, those with focal intestinal metaplasia (EGGIM score 1-4) showed a trend toward a higher likelihood of active infection (adjusted OR: 2.80, 95% CI: 0.88–8.91, p = 0.081), whereas patients with extensive intestinal metaplasia (EGGIM score 5-10) had a markedly increased risk of active H. pylori infection (adjusted OR: 20.49, 95% CI: 2.51–167.27, p = 0.0048). When EGGIM classification was treated as an ordinal variable, a significant positive linear trend was observed between increasing severity of intestinal metaplasia and active H. pylori infection (p for trend < 0.001). We further developed a composite endoscopic score integrating the Kimura–Takemoto classification and EGGIM score to reflect the overall severity of gastric mucosal changes, and categorized the patients into three groups: healthy mucosa, mild mucosal change, severe mucosal change. After adjustment with age and sex, patients with mild mucosal change had a significantly higher likelihood of active H. pylori infection compared with those with healthy mucosa (adjusted OR: 4.68, 95% CI: 2.03 – 10.77, p < 0.001), whereas patients with severe mucosal change demonstrated a markedly elevated risk (adjusted OR: 44.32, 95% CI: 5.33 – 368.63, p < 0.001). When the composite score was treated as an ordinal variable, a significant positive linear trend was observed between increasing severity of mucosal change and active H. pylori infection (p for trend < 0.001).
Conclusions: Specific endoscopic gastric mucosal features, particularly extensive intestinal metaplasia, are independently associated with active H. pylori infection after adjustment for age and sex. Our graded composite scoring model combining both the atrophic gastritis and intestinal metaplasia severity evaluation demonstrates a strong predictive value for active H. pylori infection. These findings support the clinical utility of endoscopic assessment in identifying patients with a high probability of active H. pylori infection and may aid risk stratification in endoscopy-based screening settings.
