2024 TDDW摘要手冊

Theme: The Cutting Edge of Digestive Medicine Date: October 5th (Sat) ~ 6th (Sun), 2024 Venue: Kaohsiung Marriott Hotel 高雄萬豪酒店

2024 Taiwan Digestive Disease Week, TDDW Abstract Book INDEX Chairman’s Lecture...................................................................................4 Special Lecture (2)

Updates in the Management of Laryngopharyngeal Reflux.............................................................5

(7)

Frontiers in Modern Hepatology.................................................................................................................6

(8)

The Role of Endoscopy in IBD.......................................................................................................................7

(9)

Current Japanese Clinical Practice and Future Developments in Chemotherapy Sequence for Patients with Metastatic Biliary Tract Cancers and Pancreatic Cancer...............8

(10)

Post-Polypectomy Surveillance Intervals and It’s Effects on Long-Term Colorectal Cancer Risk: The Japan Polyp Study Workgroup...................................................................................................9

Prof. Teh-Hong Wang Memorial Lecture...............................................10 Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting..........................................................................................11 Symposium (1)

Cutting Edge Knowledge of Pancreatology......................................................................................... 16

(2)

HBV...................................................................................................................................................................... 19

(3)

Emerging Issues and Unmet Needs in Colonoscopy Practice........................................................ 23

(4)

New Perspectives on the Treatment of Helicobacter pylori............................................................. 27

(5)

Advances in Neurogastroenterology and Motility Symposium: Optimization of Clinical Management.................................................................................................................................... 30

(6)

Controversial Issues in Colonoscopy Practice...................................................................................... 34

(7)

IASL/TDDW Symposium: Cutting Edge for Liver Disease................................................................ 40

(8)

Cutting Edge of Digestive Diseases......................................................................................................... 43

(9)

Cutting-Edge Advances in Interventional Radiology for the Digestive System...................... 47

(10)

MASLD................................................................................................................................................................ 52

(11)

How Can We Improve the Standard of Care in IBD............................................................................ 56

(12)

Cutting Edge Treatment for Liver Cancer.............................................................................................. 60

(13)

Microbiota and Cancer................................................................................................................................. 62

(14)

Breakthroughs in Innovative EUS-Guided Therapies for GI Diseases.......................................... 65

Gastroenterology Debrief: DDW & WEO 2024.....................................69 Global & Taiwanese Guideline (1)

Chronic Hepatitis B, C and D...................................................................................................................... 70

(2)

Fatty Liver and Metabolic Disorder.......................................................................................................... 71

(3)

Practical Guideline for Evaluation and Management of Small Bowel Bleeding...................... 72

(4)

HCC...................................................................................................................................................................... 73

(5)

HP......................................................................................................................................................................... 74

Young Investigator Award (YIA)............................................................75 Free Paper (1)

HBV...................................................................................................................................................................... 83

(2)

UGI....................................................................................................................................................................... 89

(3)

HCV...................................................................................................................................................................... 95

(4)

Pancreas / Biliary...........................................................................................................................................101

(5)

SLD.....................................................................................................................................................................107

(6)

Cirrhosis & Portal..........................................................................................................................................113

(7)

HCC....................................................................................................................................................................119

(8)

LGI......................................................................................................................................................................125

Poster Liver.................................................................................................................................................................................131 GI......................................................................................................................................................................................209

2024 TDDW

Chairman’s Lecture A Great Journey: Last Mile for the Elimination of CHC in Taiwan Chia-Yen Dai Hepatology Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Since the discovery of hepatitis C virus (HCV), studies on the epidemiology, disease course, treatments and outcomes have rapidly undergone.

The goal of treatment of hepatitis C virus (HCV) infection which results in long-term liver outcomes including cirrhosis or hepatocellular carcinoma is to reduce all-cause mortality and liver related health adverse consequences, including end-stage liver disease and hepatocellular carcinoma (HCC), by the achievement of virologic cure as evidenced by a sustained virologic response (SVR). With developed regimens for CHC, a high SVR rate was achieved by the major progress and advance in treating CHC by all oral DAA therapy achieving very high SVR rates with fewer adverse effects than IFN-based therapy.

The 2016 World Health Organization (WHO) 2030 global elimination targets for hepatitis C virus (HCV) are: 80% of those with chronic HCV treated, 90% reduction in incidence and 65% reduction in liver‐related mortality. The goal for elimination of HCV and HBV by 2025 is set by the Ministry of Welfare and Health of Taiwan and all the non-government organizations (NGOs) have to make efforts to achieve this goal. The management of HCV infection is based on the cooperation of the works on the screening,

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definite diagnosis of active infection (viremia), accessibility of the health care system for treatment, and follow-up for the patients with or without SVR. To identify all HCV patients, epidemiological studies are important for estimating the disease burden, exploring the endemic communities where the prevalence of anti-HCV is high, and increasing the awareness of patients by the effective screening project to identify the patients who have been exposed to HCV infection before are mandatory. To overcome the cost of the tests and the medication, expend the treaters, and increase the accessibility of medication and follow-up systems such as the outreaching OPD or the specificity OPD provided by the hepatologists are very important to achieve completed cascade of care. The last stage of HCV elimination is to accelerate the universal HCV screening program of populations and to resolve the unawareness issue of HCV infection.

There are some unmet needs. After treatment, the follow-up of patients to identify the development of HCC, even if the risk of HCC occurrence decreased significantly after cure of HCV infection, and to discover the predictors for HCC development is also important.

2024 TDDW

Special Lecture (2) Updates in the Management of Laryngopharyngeal Reflux Justin Wu Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong Laryngopharyngeal reflux (LPR) refers to the retrograde flow of gastric contents proximal to the upper esophageal sphincter leading to laryngeal symptoms such as cough, throat clearing, mucus in throat, dysphonia, globus and sore throat. On the other hand, laryngopharyngeal symptoms (LPS) can be related to a variety of non-GERD conditions, and the pathophysiology is highly heterogeneous.

To date, there is a still a lack of objective diagnostic criteria for LPR. Symptom questionnaires and laryngoscopy have limited specificity and sensitivity.

It has been advocated that objective reflux testing should be used as the initial diagnostic tool for suspected LPR. However, the most appropriate test and diagnostic criteria of reflux testing have not been defined yet. Recently, risk prediction model based on various metrics have been developed for patient selection for reflux testing. Salivary biomarkers, such as pepsin and bile acid, have also been evaluated but their diagnostic values in LPR remain the be defined.

Owing to the heterogeneity of the mechanisms, a multidisciplinary approach is needed for the management of LPR. Dietary modification with the use of a plant-based, low fat Mediterranean diet has been shown to be superior to proton pump inhibitors. Weight reduction is recommended for GERD but there is no clinical trial data specifically for LPR management. Therapeutic trial of proton pump inhibitor remains a pragmatic first line

medical therapy suspected LPR, but most studies did not observe superiority of PPI over placebo in patients with no typical GERD symptoms. Alginates have also been evaluated with some benefits in symptom reduction. In addition to acid peptic mechanism, laryngeal hypersensitivity has been implicated as a major contributor to LPR symptoms.

Hypervigilance and symptom-related anxiety have been reported in patients with LPR. Pharmacological neuromodulation has been recommended for LPR patients who do not respond well to PPI. Most of the clinical evidence for neuromodulators, notably gabapentin and pregabalin, focus on the treatment of chronic cough. Tricyclic antidepressant, which is another class of neuromodulator commonly used for the treatment of functional GI disorders, should be used with caution because of its anticholinergic effect, which may cause dry mouth and aggravates the LPS. Speech therapy is effective in several chronic laryngeal symptoms as laryngeal irritation can lead to maladaptive sensory responses and chronic motor behaviors which are modifiable by behavioral retraining. Laryngeal recalibration therapy is an evolving treatment modality that combines altering mechanical patterns, desensitizing laryngeal tissues, and providing symptom-specific cognitive restructuring.

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2024 TDDW

Special Lecture (7) Frontiers in Modern Hepatology Ming-Lung Yu Hepatitis Research Center and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Recent research has enhanced our understanding of various liver diseases, including viral hepatitis B and C (HBV/HCV), non-alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC). The advent of life cycle in viral infections leads to great breakthrough development in the therapeutic agents for liver diseases.

HBV cure can be classified into three types: Partial Cure, where HBsAg remains low but detectable; Functional Cure, characterized by longterm HBsAg loss and undetectable HBV DNA; and Complete Cure, which aims to eliminate cccDNA and integrated HBV DNA, though currently unachievable.

Achieving functional cure improves quality of life and reduces liver complications. Current strategies focus on inhibiting HBV replication, reducing HBsAg secretion, and enhancing immune responses.

Future approaches include combining therapies and targeting viral transcription. Ongoing trials are exploring how to achieve a 30% functional cure rate.

The remarkable advance in artificial intelligence (AI) also advances its application in liver diseases, including 1) Diagnostic Assistance: AI analyzes medical images (ultrasound, CT, MRI) to detect abnormalities like tumors or cirrhosis; 2) Predictive Models: Machine learning helps assess liver disease risk, enabling early intervention; 3) Personalized Medicine: AI tailors treatment plans by predicting individual responses to medications. 4) Remote Monitoring: AI monitors chronic liver disease patients via wearable devices for timely treatment adjustments. Future trends include improving accuracy, interdisciplinary collaboration, addressing ethical concerns, and further automation of clinical processes to provide better prevention, diagnosis,

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and treatment in liver disease.

Recent advances in gut microbiome research emphasize its vital role in the pathogenesis and treatment of liver diseases, particularly in NAFLD, cirrhosis, and HCC. The gut-liver axis allows microbial products like lipopolysaccharides (LPS) to enter the liver through portal vein, promoting inflammation, fibrosis, and HCC. Dysbiosis (imbalanced microbiota) can worsen liver conditions. By contrast, ShortChain Fatty Acids (SCFAs), produced by gut bacteria, have anti-inflammatory properties, potentially slowing liver disease progression. Several clinical evidence shows probiotics (e.g., Lactobacillus, Bifidobacterium) help reduce liver fat and improve insulin sensitivity in NAFLD by restoring a healthy gut microbiome. Transplantation of Fecal Microbiota shows promise in advanced liver disease by restoring microbial diversity, reducing inflammation, and alleviating hepatic encephalopathy. Accumulating data demonstrated that microbiota signatures might serve as non-invasive markers for diagnosis and personalized treatment strategies. Future perspectives included Precision Medicine, Microbiome-Modulating Drugs, and integrating microbiome-targeted treatments with existing liver therapies.

In conclusion, the frontiers in modern hepatology reflect a dynamic interplay of research and clinical practice. As our understanding of liver diseases deepens and technological innovations continue to emerge, the field is poised for growth. Future research should build on these advancements, further elucidating the complexities of liver health and disease to continue evolving the field of hepatology.

2024 TDDW

Special Lecture (8) The Role of Endoscopy in IBD Jeong-Sik Byeon Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Inflammatory bowel disease (IBD) encompasses a variety of conditions, including idiopathic IBD such as ulcerative colitis (UC), Crohn's disease (CD), and Behcet's disease (BD), as well as infectious enterocolitis like tuberculosis, amebic colitis, and CMV colitis. It also includes various forms of drug-associated enterocolitis caused by NSAIDs, antibiotics, and immune-checkpoint inhibitors, along with eosinophilic colitis and many other diseases.

Colonoscopy and small bowel endoscopy methods, such as capsule endoscopy and balloon enteroscopy, play a crucial role in the differential diagnosis of these various IBDs. For differential diagnosis, it is essential to examine the characteristics of ulcers associated with inflammation, including their shape, location, direction, and number.

Additionally, it is important to look for inflammatory sequelae such as fistulas and strictures. Endoscopy is also vital for assessing disease activity in UC and

CD, which is crucial for determining the type and course of medical treatment. Furthermore, it is an important diagnostic tool for detecting colitisassociated dysplasia and/or cancer. Recently, researches have been exploring the integration of artificial intelligence into endoscopy to improve diagnostic performance for IBD. Endoscopy is not only essential for the diagnosis and treatment planning of various IBDs but also for therapeutic interventions. For example, endoscopically resectable colitis-associated dysplasia can be treated through endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). CD-related intestinal strictures and postoperative intestinal strictures in IBD patients can be managed with endoscopic balloon dilation.

In this lecture, we will explore the role of endoscopy in the diagnosis and treatment of various IBDs.

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2024 TDDW

Special Lecture (9) Current Japanese Clinical Practice and Future Developments in Chemotherapy Sequence for Patients with Metastatic Biliary Tract Cancers and Pancreatic Cancer Akihiro Ohba Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan Recently, immune checkpoint inhibitors have been shown to be effective in biliary tract cancer, and we, Japanese institutions, have participated in their development. In addition, the efficacy of various targeted therapies has been reported, and we have reported the results of a clinical trial for HER2-positive biliary tract cancers.

The efficacy of immune checkpoint inhibitors

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and targeted therapies in pancreatic cancer is limited, and cytotoxic anticancer drugs are still the mainstay of treatment. We report the results of a clinical trial comparing FOLFIRINOX with GnP, a debate that has been ongoing for the past decade.

I would like to introduce the current status and efforts in Japan for biliary tract cancers and pancreatic cancer.

2024 TDDW

Special Lecture (10) Post-Polypectomy Surveillance Intervals and It's Effects on Long-Term Colorectal Cancer Risk: The Japan Polyp Study Workgroup Yasushi Sano Kansai Medical University, Osaka, Japan Gastrointestinal Center, Sano Hospital, Kobe, Japan The Asian Novel Bio-Imaging and Intervention Group (ANBIIG) Colorectal cancer (CRC) is the third most common cancer worldwide, with rising incidence and mortality rates in Japan and Asia. There is an urgent need for population-based CRC screening programs and guidelines for post-polypectomy surveillance in these regions. However, there is no long-term evidence of CRC risk after removing premalignant lesions in Asian countries. The National Polyp Study in the US showed a lower-than-expected CRC incidence after removing adenomatous polyps, supporting the adenoma-carcinoma progression concept. Recent studies also highlight the serrated pathway in CRC development. Colonoscopic resection of adenomas and serrated polyps effectively reduces long-term CRC incidence. Despite high-quality colonoscopies, post-colonoscopy colorectal cancer (PCCRC) still occurs due to overlooked lesions, rapid tumor progression, or inadequate polyp resection. The risk

factors for PCCRC, including technical issues, patient characteristics, and polyp/tumor features, are still debated.

The Japan Polyp Study (JPS) began in 2003 to determine the optimal surveillance colonoscopy intervals after tumor resection and its impact on reducing colorectal cancer (CRC) incidence and mortality. Recent findings highlight the importance of non-polypoid colorectal neoplasms (NP-CRNs) as precursors to post-colonoscopy colorectal cancer (PCCRC). The ongoing cohort study involves resecting all neoplastic lesions, including NP-CRNs, to assess their long-term impact on CRC incidence and to identify characteristics of metachronous advanced neoplasia (AN).

This presentation will focus on the surveillance interval after polypectomy and its impact on longterm colorectal cancer risk as seen in the JPS results.

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2024 TDDW

Prof. Teh-Hong Wang Memorial Lecture Use of Microbial Transplantation for Recurrent Clostridium difficile Infection: Where Do We Stand?

Francis Chan Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Microbiota I-Center (MagIC), Hong Kong The diagnosis of Clostridioides difficile infection (CDI) is based on a 2-step testing: initial screening test for glutamate dehydrogenase antigen in C. diff isolates and confirmation of all positive cases by toxigenic culture or PCR. Recurrent CDI is defined as clinically significant diarrhea with a confirmatory positive test within 8 weeks of completing antibiotics.

In immunocompetent adults with recurrent C difficile infection (i.e., after the second recurrence), current guidelines recommend the use of fecal microbiota–based therapies upon completion of standard of care antibiotics. Fecal microbiota–based therapies include conventional fecal microbiota transplantation (FMT), fecal microbiota live-jslm, and fecal microbiota spores live-brpk. Conventional FMT can be delivered via multiple routes. Antibiotics for CDI should be stopped 1–3 days before conventional FMT. Using an AI-driven platform (MOZAIC™) to

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optimize the donor-recipient matching for FMT, our team has achieved a cure of >90%, shortened hospital stay, and prolonged survival. Current guidelines also recommend the use of conventional FMT for severe or fulminant C difficile infection not responding to antimicrobial therapy. Severe CDI is defined as patients with CDI and a leukocyte count ≥15 × 109 cells/L and/or creatinine ≥1.5 mg/dL. Fulminant CDI presents as severe disease with shock, ileus, or megacolon. FMT should be considered if these patients not responding to standard of care antibiotics, generally within 2–5 days after initiating CDI treatment. Trials are needed to assess fecal microbiota–based therapies as primary prevention in patients at high risk of CDI, as first-line treatment after short course of anti-CDI therapy, as treatment for CDI (not prevention), and in combination with bezlotoxumab.

2024 TDDW

Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting Standardize the Surgical Technique and Clarify the Oncologic Significance of Robotic D3-D4 Lymphadenectomy for Upper Rectum and Sigmoid Colon Cancer with Clinically More than N2 Lymph Node Metastasis Tzu-Chun Chen Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan Background: The territory of D3-D4 lymphadenectomy for upper rectal and sigmoid colon cancer varies, and its oncological efficacy is unclear. This prospective study aimed to standardize the surgical technique of robotic D3D4 lymphadenectomy and clarify its oncologic significance.

Methods: Patients with upper rectal or sigmoid colon cancer with clinically suspected more than N2 lymph node metastasis were prospectively recruited to undergo standardized robotic D3-D4 lymphadenectomy. Immediately postsurgery, the retrieved lymph nodes were mapped to five N3N4 nodal stations: the inferior mesenteric artery, para-aorta, inferior vena cava, infra-renal vein, and common iliac vessels. Patients were stratified according to their nodal metastasis status to compare their clinicopathological data and overall survival. Univariate and multivariate analyses were performed to determine the relative prognostic significance of the five specific nodal stations.

Surgical outcomes and functional recovery of the patients were assessed using the appropriate variables.

Results: A total of 104 patients who successfully completed the treatment protocol were assessed. The standardized D3-D4 lymph node dissection harvested sufficient lymph nodes (34.4±7.2) for a precise pathologic staging. Based on histopathological analysis, 28 patients were included in the N3-N4 nodal metastasis-negative

group and 33, 34, and nine patients in the singlestation, double-station, and triple-station nodal metastasis-positive groups, respectively. Survival analysis indicated no significant difference between the single-station nodal metastasis-positive and N3-N4 nodal metastasis-negative groups in the estimated 5-year survival rate [53.6% (95% CI: 0.3353-0.7000) vs. 71.18% (95% CI: 0.4863-0.8518), P = 0.563], whereas patients with double-station or triple-station nodal metastatic disease had poor 5-year survival rates (24.76 and 22.22%), which were comparable to those of AJCC/UICC stage IV disease than those with single-station metastasispositive disease. Univariate analysis showed that the metastatic status of the five nodal stations was comparable in predicting the overall survival; in contrast, multivariate analysis indicated that common iliac vessels and infra-renal vein were the only two statistically significant predictors (P < 0.05) for overall survival.

Conclusions: Using a robotic approach, D3-D4 lymph node dissection could be safely performed in a standardized manner to remove the relevant N3-N4 lymphatic basin en bloc, thereby providing significant survival benefits and precise pathological staging for patients. This study encourages further international prospective clinical trials to provide more solid evidence that would facilitate the optimization of surgery and revision of the current treatment guidelines for such a clinical conundrum.

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2024 TDDW

Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting Endoscopic Variceal Ligation versus Propranolol for the Primary Prevention of Oesophageal Variceal Bleeding in Patients with Hepatocellular Carcinoma: An Open-Label, Two-Centre, Randomised Controlled Trial Tsung-Chieh Yang Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Objective: This randomised trial aimed to address whether endoscopic variceal ligation (EVL) or propranolol (PPL) is more effective at preventing initial oesophageal variceal bleeding (EVB) in patients with hepatocellular carcinoma (HCC).

Design: Patients with HCC and medium-tolarge oesophageal varices (EVs) but without previous EVB were randomised to receive EVL (every 3-4 weeks until variceal eradication) or PPL (up to 320 mg daily) at a 1:1 ratio. Long-term follow-up data on EVB, other upper gastrointestinal bleeding (UGIB), nonbleeding liver decompensation, overall survival (OS), and adverse events (AEs) were analysed using competing risk regression.

Results: Between June 2011 and April 2021, 144 patients were randomised to receive EVL (n = 72) or PPL (n = 72). In the EVL group, 7 patients experienced EVB, and 30 died; in the PPL group, 19 patients had EVB, and 40 died. The EVL group had a lower cumulative incidence of EVB (Gray’s test,

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p = 0.009) than its counterpart, with no mortality difference (Gray’s test, p = 0.085). For patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B, EVL was better than PPL in reducing EVB (p < 0.001) and mortality (p = 0.003). For patients beyond BCLC stage B, between-group outcomes were similar.

Other UGIB, nonbleeding liver decompensation, and AEs did not differ between groups. A competing risk regression model confirmed the prognostic value of EVL. Conclusion: EVL is superior to PPL in preventing initial EVB in patients with HCC. The benefits of EVL on EVB and OS may be limited to patients with BCLC stage A/B and not to those with BCLC stage C/D. Trial registration number: NCT01970748.

Keywords: Hepatocellular carcinoma, Oesophageal varices, Portal hypertension

2024 TDDW

Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting TYRO3: The Nuclear Weapon Driving Colorectal Cancer Progression Pei-Ling Hsu Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. To prevent the development of CRC, it is crucial to thoroughly understand the mechanisms underlying its pathogenesis. Our previous research demonstrated that the overexpression of TYRO3, a member of the TAM (TYRO3, AXL and MERTK) receptor tyrosine kinase family, plays an oncogenic role in CRC. Surprisingly, we discovered a strong nuclear TYRO3 immunoreactive signal in pathological tissues from patients with advanced CRC. Therefore, in this study, we aimed to investigate the function of nuclear TYRO3 in CRC progression and its downstream molecular signaling. We found that nuclear translocation of TYRO3 is positively correlated with the malignancy of CRC and negatively correlated with patient survival. The formation of nuclear TYRO3 is a result of the cleavage of TYRO3 by matrix metalloproteinase (MMP)-2, producing the intracellular domain of TYRO3 (ICD-TYRO3), which then translocates to the nucleus. ICD-TYRO3 promotes the transformation

of normal colon cells, epithelial-mesenchymal transition in CRC cells, and liver and lymph node metastasis in an orthotopic mouse model of CRC. Proteomic analysis identified bromodomaincontaining protein 3 (BRD3), an epigenetic regulator that reads acetyl-lysine, as a downstream effector of nuclear TYRO3. Chromatin immunoprecipitationnext generation sequencing data revealed that ICDTYRO3-mediated phosphorylation of BRD3 regulates the expression of genes involved in anti-apoptosis and the promotion of epithelial-mesenchymal transition. The use of selective inhibitors to inhibit the activity of MMP-2 or BRD3 also demonstrated a reduction in ICD-TYRO3-induced drug resistance and metastasis in CRC organoid cultures and orthotopic mouse models. These findings suggest that the MMP-2/TYRO3/BRD3 signaling pathway promotes the malignancy of CRC, and blocking this signaling pathway could be a novel strategy for slowing the progression of CRC.

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2024 TDDW

Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting The Microbiome Revolution: State of the Art and Future Outlook Emad M El-Omar Microbiome Research Centre, St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia The microbiome field continues to grow at an exponential rate with sophisticated approaches that are pushing the frontiers of science and translating fast into clinical practice. The past year has witnessed sustained progress in microbiome research with a shift towards high quality mechanistic studies, Artificial Intelligence-Machine Learning approaches and clinical trials with microbiome therapeutics.

One particular area that has seen exciting recent progress is the microbiome at the crossroads of cardiovascular, renal and metabolic diseases. The finding that species from the Oscillibacter genus are associated with decreased faecal and plasma cholesterol levels is noteworthy and offers the prospect of potential benefits for lipid homeostasis and cardiovascular, renal and metabolic health. This is the more exciting with the very recent discovery of the hormone Cholesin, which is capable of inhibiting cholesterol synthesis in the liver, leading to a

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reduction in circulating cholesterol levels. Hopefully, these two fields will converge in the near future and offer a comprehensive understanding of the role of the gut microbiome in cholesterol metabolism. In the cancer field there have been very noteworthy developments including the identification and mechanistic work up of certain microbiota such as Streptococcus Anginosus, which plays a key role in gastric carcinogenesis, and Lactobacillus plantarumderived indole-3-lactic acid, which ameliorates colorectal tumorigenesis via epigenetic regulation of CD8+ T cell immunity. Recently, there has also been great progress in understating the role of the gut microbiota in modulating barriers, which could be key to understanding the aetiology of gastrointestinal and neurological disorders. The advances in microbiome science over the past year are too numerous to mention and this lecture will offer an update on the most exciting stories so far!

2024 TDDW

Prof. Juei-Low Sung’s Research Foundation 37th Annual Academic Meeting Human Liver Immunology Research Using Liver Specimens Hideki Ueno Department of Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan The immune system is fundamentally involved in the pathogenesis of liver diseases. While blood samples have often been used to gain insights into their pathogenesis, recent studies show that analyses of liver-resident immune cells are fundamental for the elucidation of pathogenesis.

In addition to Kupffer cells in the sinusoids, the liver contains a number of liver-resident memory (RM) T cells (CD4+ TRM and CD8+ TRM cells) and B cells (BRM cells). Classically defined as non-immune cells, including hepatocytes, cholangiocytes, liver sinusoidal endothelial cells (LSEC), and hepatic stellate cells (HSC), also contribute to the immune responses in the liver.

To establish the biology of immune cells in the healthy human liver and to gain direct insights into human liver diseases, my laboratory has been collecting donor liver tissues, donor liver perfusate,

recipient (diseased) liver and its perfusate, and liver needle biopsy specimens. We analyze liver-resident immune cells at a single-cell scale using multiple approaches, including multi-color flow cytometry, single-cell RNA sequence (scRNAseq), and spatial transcriptomics. Our study shows that liver perfusate contains various tissue-resident immune cells and thus represents a great resource for the research of the human liver. We found that liver TRM cells comprise more diverse cell populations than previously reported. Liver perfusate contained not only T, B, and Kupffer cells, but also neutrophils and eosinophils, and the composition and phenotype of these immune cells were different between cirrhotic and normal livers. In my seminar, I will talk about our recent studies, including single-cell spatial transcriptomics of liver specimens.

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2024 TDDW

Symposium (1) Cutting Edge Knowledge of Pancreatology

Diagnosis and Pretreatment Evaluation in Pancreatic Cancer.

Taiwan Pancreas Society Recommendation Meng-Ying Lin Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Pancreatic cancer, due to the lack of effective screening tools and the absence of obvious symptoms, has long been one of the most lethal cancers. Along with its gradually increasing incidence, pancreatic cancer ranked 10th in the top ten most common cancers in Taiwan in 2021 and 7th among the top ten causes of cancer-related deaths. The Taiwan Pancreas Society has long been committed to supporting the treatment of pancreatic diseases. The rising number of pancreatic cancer cases prompted the society’s president, Professor Jaw-Town Lin, to set a goal of establishing treatment guidelines specifically tailored for the Taiwanese population. He assembled experts from

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various specialties to collaboratively develop these national guidelines for pancreatic cancer treatment.

I had the privilege of participating in the development of the guidelines for diagnosis and pretreatment evaluation. This involved consolidating input from specialists across different fields required for pancreatic cancer care at this stage, supported by evidence-based validation, to produce clear and accessible recommendations for diagnosis and pre-treatment assessment. Through these recommendations, we hope to enable Taiwanese physicians to manage pancreatic cancer patients more efficiently and with stronger evidence-based approaches

2024 TDDW

Symposium (1) Cutting Edge Knowledge of Pancreatology

The Guideline for Surgical Management of Pancreatic Cancer.

Taiwan Pancreas Society Recommendation Yan-Shen Shan Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan Institute of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Pancreatic cancer is a formidable disease with poor survival. Most patients were diagnosed late with high morbidities, including obstructive jaundice, pain, and cachexia. Therefore, we discussed and established Taiwan guideline for surgical management of pancreatic cancer based on the clinical staging first. The treatment guideline was divided into three parts. The first part is the preoperative management; the second part is about the criteria for evaluation of resectablity, and

palliative procedure; the third part is the requirement of surgery procedure of pancreatic cancer, including surgery procedure, requirement of surgical margin.

In addition to the Taiwan guideline of pancreatic cancer, I will also describe about the algorithm for treatment of pancreatic cancer in National Cheng Kung University Hospital. Our results showed well multidiscipline team approach is necessary to improve survival pancreatic cancer.

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2024 TDDW

Symposium (1) Cutting Edge Knowledge of Pancreatology

The Current Status of Systemic Treatments in Advanced Pancreatic Cancer Jen-Shi Chen President, Taiwan Oncology Society Division of Hematology and Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Pancreatic cancer is one of the cancers with the poorest prognosis, primarily due to late-stage diagnosis and low sensitivity to treatment. Statistics from the 2020 Taiwan Cancer Registry Annual Report highlight the severity of this disease in Taiwan.

Pancreatic cancer accounts for 4.88% of all new cancer cases in Taiwan. It ranks 12th in incidence among men and 13th among women. However, in terms of mortality, it ranks 8th among men and 5th among women. Most cases are diagnosed at an advanced stage, making curative surgery impossible, thus requiring chemotherapy to control the disease.

Since 1997, Gemcitabine has been the standard treatment, but its effectiveness is limited.

FOLFIRINOX or Gemcitabine combined with nabpaclitaxel are currently the first-line treatments for metastatic pancreatic cancer. Oral S-1 is an alternative treatment option in East Asia and Taiwan.

Liposome CPT-11 (Onivyde) combined with 5-FU/LV is currently the second-line standard treatment after Gemcitabine failure. A phase III study published in The Lancet in 2023 showed that Liposome CPT-11 as a first-line treatment had better survival rates

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than Gemcitabine combined with nab-paclitaxel.

With the development of these drugs, the median survival for advanced pancreatic cancer is now about 10-11 months. Therefore, chemotherapy is also used as adjuvant therapy after curative surgery, showing better survival benefits. Additionally, the use of induction chemotherapy for locally advanced pancreatic cancer, followed by local radiotherapy or conversion surgery, is being further explored.

In recent years, advancements in nextgeneration sequencing (NGS) have allowed for a better understanding of genetic changes in tumor cells, leading to the discovery of targeted drugs.

New drug trials targeting driver mutations such as HER2, BRAF, BRCA1/2, and mismatch repair genes are being launched and developed. Additionally, promising antibody-drug conjugates (ADCs) are being developed for pancreatic cancer, bringing hope to patients with advanced pancreatic cancer.

Given the numerous treatment options, clinical oncologists must carefully evaluate patients and understand the various drugs to make informed decisions and provide the best patient care.

2024 TDDW

Symposium (2) HBV

Conflicting Data about the Impact of MAFLD on HBV, What’s the Truth? And Why? Tung-Hung Su Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan After the new definitions of Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), we started to have the chance to investigate the interaction and impact between liver steatosis, metabolic dysfunction, and chronic hepatitis B infection.

According to our recent studies, concurrent MAFLD reduces the risk of HCC development, specifically, concurrent hepatic steatosis is independently associated with a lower risk of HCC, whereas the increasing burden of metabolic dysfunction aggravates the risk of HCC in untreated CHB patients. Concurrent and new-onset metabolic dysfunctions increase the risks of cirrhosis and cirrhotic complications in patients with CHB, independent of hepatic steatosis. Furthermore, in untreated HBeAg-negative CHB patients, concurrent MASLD is associated with higher rates of HBsAg

seroclearance and seroconversion. Metabolic dysfunctions have additive effects on the functional cure of CHB. We reasoned steatosis’s beneficial effect is suppressing viral replication or immune responses.

However, other studies showed that concurrent NAFLD or MAFLD may increase the risk of liver inflammation, fibrosis, or even HCC. Variations in patient populations, diagnostic criteria for steatosis (by pathology or ultrasound), and different stages of HBV infection or hepatic steatosis in studies contribute to the mixed results. Genetic predispositions across populations may lead to different outcomes. The adjustment of steatosis or metabolic dysfunction in statistical analysis also contributed to the inconsistent results.

More studies are needed to investigate the mechanisms of and interactions between hepatic steatosis and HBV viral replication.

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2024 TDDW

Symposium (2) HBV

Current Status of HDV/HBV Co-Infection in Taiwan Tsung-Hui Hu Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan For people diagnosed with chronic and active HDV infection, effective treatments for hepatitis D virus infection have been limited to high-dose interferon alfa. Most of the guidelines recommend treatment with peginterferon alfa for at least 48 weeks or longer. However, the response rates are suboptimal, with virologic response rates of 17–47% with high rates of HDV relapse after stopping therapy.

Only a few patients could get a sustained virologic response. Furthermore, interferon-based therapies cannot be used in patients with decompensated liver disease. Therefore, patients have to receive liver transplantation to reduce morbidity and mortality.

HDV DNA decline and ALT normalization became important points for clinical benefit in patients treated with interferon-alfa for HDV. For the present HBV targeting, short-interfering RNAs (siRNAs), VIR-2218 and JNJ-73763989, are being investigated in combination with nucleos(t)ide analog HBV polymerase inhibitor for the treatment of HDV-HBV coinfection. Recently, bulevirtide and Lonafarnib have demonstrated anti-HDV activity in phase 3 clinical trials. The European Regulatory

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Agency has approved Bulevirtide in July 2020 based on evidence according to more than 2 log decline in HDV RNA and ALT normalization in phase 2 clinical trials. Further phase 3 clinical trial and realworld evidence have demonstrated clinical benefit in patients with advanced liver disease. Bulevirtide is under consideration by the United States FDA. Lonafarnib also demonstrated interfering on HDV assembly and secretion. In the phase 3 D-LVR randomized controlled trial, patients with active HDV infection treated with Lonafarnib alone (10.1%) or combined with interferon (19.2%) for 48 weeks achieved significantly higher end-of- treatment responses (defined as ≥2 log HDV RNA plus ALT normalization) than those treated with placebo (1.9%). However, the treatment discontinuation occurred in 8–9% of patients due to gastrointestinal side effects (e.g. nausea, vomiting and diarrhea).

Right now, we are still looking forward to seeing additional research to identify more agents targeting HBV and HDV viral replication and augmenting host immune response for HDV cure.

2024 TDDW

Symposium (2) HBV

HCC Risk Stratification of the HBV Patients in Grey Zones Yao-Chun Hsu Center for Liver Diseases, E-Da Hospital, Kaohsiung, Taiwan School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis B virus (HBV) infection. While standardized risk factors for HCC, such as serum viral loads and alanine aminotransferase (ALT) levels, aid in stratifying HCC risk and guiding clinical management in many patients, a significant proportion of HBV-infected individuals fall outside of these traditional parameters. These “grey-zone” patients are characterized by atypical or fluctuating disease patterns, making HCC risk stratification and management particularly challenging.

The term “grey zone” does not refer to a specific disease status or a homogenous group of patients with shared biological features or clinical manifestations. Instead, patients in grey zones are remarkably heterogeneous, with varying definitions across studies or clinical contexts. This heterogeneity complicates both the prediction of HCC risk and the determination of antiviral therapy indications.

Dynamic changes in host, viral, and environmental factors further obscure the ability to classify and manage these patients using standardized procedures recommended in clinical guidelines.

This presentation will review the latest advancements in risk stratification models designed to address this complexity. Special focus will be placed on emerging biomarkers, liver stiffness measurements, and the potential application of artificial intelligence tools to personalize risk assessments. Rather than offering a one-size-fits-all scoring system, the presentation will emphasize the intricate and multifaceted nature of HBV infection and offer practical suggestions to refine risk management. The importance of patient-centered care and shared decision-making will be highlighted, especially in light of the inherent uncertainties surrounding HCC risk prediction in those patients classified within grey zones.

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2024 TDDW

Symposium (2) HBV

HCC Risk Stratification of CHB Patients on Antivirals Sang Hoon Ahn Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Yonsei Liver Center, Severance Hospital, Seoul, Korea Chronic hepatitis B virus (HBV) infection remains a substantial global health burden, often progressing to liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Despite the implementation of antiviral therapy (AVT) with potent oral nucleos(t)ide analogs (NUCs) that possess high genetic barriers, the risk of HCC development persists. Consequently, biannual surveillance for HCC using abdominal ultrasonography, with or without tumor markers, is recommended for at-risk populations.

To enhance individualized prediction of HCC risk, several predictive models have been developed during the era of potent AVT, yielding promising results. These models facilitate stratification of patients into low, intermediate, or high-risk categories, with many offering the benefit of high negative predictive values, potentially exempting low-risk individuals from biannual HCC screening.

Recent advancements have incorporated noninvasive surrogate markers of liver fibrosis, such as vibration-controlled transient elastography, into predictive equations, improving overall predictive accuracy.

Moreover, beyond traditional statistical methods, which largely rely on multivariable Cox regression analyses informed by existing literature, emerging artificial intelligence techniques have been integrated into the development of HCC prediction models. In this presentation, we aim to examine the various HCC risk prediction models established in the era of potent AVT, critically appraise their

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validation across independent cohorts, and discuss future directions for refining individual HCC risk assessment.

References: 1. Kim BK, Ahn SH. Prediction model of hepatitis B virus-related hepatocellular carcinoma in patients receiving antiviral therapy. J Formos Med Assoc 2023;122:1238-1246.

2. Kim MN, Lee JS, Lee HW, Kim BK, Park JY, Kim DY, Ahn SH, et al. ALT Is Not Associated With Achieving Subcirrhotic Liver Stiffness and HCC During Entecavir Therapy in HBVRelated Cirrhosis. Clin Gastroenterol Hepatol 2023;21:2278-2287.e2275.

3. Chun HS, Papatheodoridis GV, Lee M, Lee HA, Kim YH, Kim SH, Oh YS, et al. PAGE-B incorporating moderate HBV DNA levels predicts risk of HCC among patients entering into HBeAg-positive chronic hepatitis B. J Hepatol 2024;80:20-30.

4. Chon HY, Lee JS, Lee HW, Chun HS, Kim BK, Tak WY, Park JY, et al. Predictive Performance of CAGE-B and SAGE-B Models in Asian TreatmentNaive Patients Who Started Entecavir for Chronic Hepatitis B. Clin Gastroenterol Hepatol 2022;20:e794-e807.

5. Wu S, Zhou J, Wu X, Sun Y, Wang B, Kong Y, Zhan S, et al. Comparative Performance of 14 HCC Prediction Models in CHB: A Dynamic Validation at Serial On-Treatment Timepoints.

Am J Gastroenterol 2022;117:1444-1453.

2024 TDDW

Symposium (3) Emerging Issues and Unmet Needs in Colonoscopy Practice

Application of AI for Improving Colonoscopy Quality Chen-Ming Hsu Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Colonoscopy is a valuable tool for preventing and reducing the incidence and mortality of colorectal cancer. High quality colonoscopy includes adequate bowel preparation, safe colonoscope insertion to cecum, detailed examination with detection of all precancerous lesions, and complete and curative resection of these lesions. The protective effect of colonoscopy is likely to be compromised by a poor quality examination, hence increasing the risk of post-colonoscopy colorectal cancer. Zhu et al established a smartphone app that assessed bowel preparation status according to the appearance of feces in the toilet using an artificial intelligence (AI)based prediction system to provide personalized instructions. Adequate preparation is significantly higher in the AI-driven app group compared with conventional methods. Several AI-based bowel preparation scoring systems are also developed to classify the bowel preparation status. AI bowel preparation assessment may improve the objectivity

of bowel preparation evaluation and standardize clinical practice for colonoscopy surveillance interval.

AI-based colonoscopy inspection quality system is developed to evaluate the skill of colonoscopists.

Intra-procedure alert system for colonoscopy examination can notify colonoscopists if low quality images is detected to improve the inspection quality. Computer-aided polyp detection (CADe) systems may increase the adenoma detection rate and adenoma per colonoscopy and reduce the adenoma miss rate and sessile serrated lesion miss rate. The increase health-care costs by detecting more adenomas may be balanced by savings in costs related to cancer treatment due to CADe-related cancer prevention. An automatic surveillance system is developed to inform patients and endoscopists at crucial times by analyzing the data of colonoscopy and based on the current guidelines. Application of these new AI systems can significant improve the quality of colonoscopy.

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2024 TDDW

Symposium (3) Emerging Issues and Unmet Needs in Colonoscopy Practice

Advances in Dysplasia Detection in Inflammatory Bowel Disease Chen-Shuan Chung Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan Inflammatory bowel disease (IBD) has rapidly increasing incidence and prevalence worldwide, particularly in Asian countries. Patients with IBD including those with ulcerative colitis (UC) and Crohn’s disease have a higher risk of colorectal cancer (CRC) compared to the general population.

Several risk factors for CRC in patients with IBD could be identified, including long disease duration, extensive colitis, severe endoscopic and histological inflammatory activities, primary sclerosing cholangitis, family history of CRC, stricture, prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring

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accordingly. In terms of surveillance colonoscopy methods, the current surveillance techniques are based on several international guidelines. Dye chromoendoscopy (DCE) with targeted biopsy is being recommended increasingly, and highdefinition (HD) colonoscopy is gradually replacing standard-definition colonoscopy. However, due to advanced technologies in optical-based imageenhanced endoscopy, it remains unclear whether DCE, virtual chromoendoscopy (VCE), or HD-whitelight endoscopy has superior efficiency. Herein, I will review the current evidences and future developments for detecting colonic neoplasia among IBD patients.

2024 TDDW

Symposium (3) Emerging Issues and Unmet Needs in Colonoscopy Practice

Risk Stratification of T1 CRC Metastasis to Lymph Nodes: Current Status and Perspectives Wen-Feng Hsu Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan The prevalence of early-invasive colorectal cancer (T1 CRC) has seen a steady increase, attributed in part to the enhanced population of colorectal cancer screening. Concurrently, there has been a significant rise in the adoption of endoluminal treatment as a non-invasive curative treatment strategy, propelled by technological advancements in endoscopic technologies. Despite the popularity of ET, there is a significant gap in the understanding of the long-term outcomes and recurrence patterns associated with these treatments. Existing literature suggests a recurrence rate of 3% for T1 CRCs treated

with endoscopic resection alone, with a 40% mortality rate following recurrence. From the Taiwan Cancer Registry Database, T1 CRC patients treated only with endoluminal treatment had a higher risk of recurrence compared to T1N0 patients who underwent surgical resection, indicating potential undertreatment of deeply invasive lesions that might require surgical intervention. These findings underscore the need for precise colonoscopic diagnostic assessment of invasion depth and accurate pathological analysis to identify patients at risk of lymph node metastasis.

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2024 TDDW

Symposium (3) Emerging Issues and Unmet Needs in Colonoscopy Practice

Is Characterization of Colorectal Neoplasia Still Essential before Resection?

Yasushi Sano Kansai Medical University, Osaka, Japan Gastrointestinal Center, Sano Hospital, Kobe, Japan The Asian Novel Bio-Imaging and Intervention Group (ANBIIG) Narrow-band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed

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images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer-aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other.

This presentation discuss why characterization of colorectal neoplasms prior to resection remains essential.

2024 TDDW

Symposium (4) New Perspectives on the Treatment of Helicobacter pylori

Impact of H. pylori eradication on Antibiotic Resistance Jyh-Ming Liou Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan Department of Internal Medicine, Ntional Taiwan University Hospital, Taipei, Taiwan Recent studies on the impact of H. pylori eradication therapies provide critical insights into antibiotic resistance trends and the resistome’s transient changes following treatment. The rising rates of primary resistance to clarithromycin, metronidazole, and levofloxacin in H. pylori highlight the need for updated treatment guidelines. Region-specific adaptations, particularly in the Asia-Pacific, where resistance is significantly higher, are crucial. From the multicenter randomized trials involving T14, C10, and BQ10, recent studies indicate that while resistance in E. coli and Klebsiella pneumoniae increased shortly after treatment, these changes were mostly transient, returning to baseline within eight weeks to one year. These results provide reassurance regarding the long-term safety of H. pylori eradication therapy on the antibiotic resistome and gut microbiota. Recent studies show the restoration of gut microbiota diversity and resistome composition following eradication

therapies. Despite initial disruptions, the return of microbial diversity and resistome to pre-treatment levels by eight weeks to one year reinforces the concept that H. pylori eradication can be safely integrated into clinical practice without long-lasting negative impacts on the microbiota. However, the variation in recovery timelines between different treatment regimens (e.g., triple vs. concomitant and quadruple therapy) indicates the need for further research to refine eradication strategies for optimal outcomes. These studies collectively emphasize the importance of ongoing monitoring of antibiotic resistance and the development of global strategies to mitigate the rising resistance observed in H. pylori and also support the longterm safety of H. pylori eradication on the diversity, composition, and antibiotic resistome. Yet, more well-designed randomized controlled studies from other populations are warranted to confirm these findings.

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2024 TDDW

Symposium (4) New Perspectives on the Treatment of Helicobacter pylori

Antibiotic Stewardship – Infectious Disease Expert Perspectives Un-In Wu Division of Infection Control, Center for Quality Management and Infection Control, National Taiwan University Cancer Center, Taipei, Taiwan Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Antibiotic stewardship plays a crucial role in optimizing treatment outcomes and minimizing both the development of resistance and the occurrence of adverse effects in the management of infectious diseases. This presentation will explore the application of the “5 D’s” of antibiotic stewardship—Diagnosis, Drug, Dose, Duration, and De-escalation—in the context of Helicobacter pylori therapy from an infectious diseases physician perspective.

Accurate diagnosis, supported by appropriate diagnostic tools and informed by local resistance patterns, forms the foundation of effective treatment. Tailored antibiotic selection is crucial

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not only for successful eradication but also for minimizing unnecessary antibiotic exposure. We will examine how optimizing dose and duration can enhance eradication rates while minimizing potential adverse effects. De-escalation, though less common in H. pylori therapy, remains an important concept in broader stewardship principles, ensuring that treatment is continually reassessed for efficacy and necessity. By applying these stewardship principles, we can ensure more effective and responsible management of H. pylori infections, leading to improved patient care and contributing to global efforts in combating antibiotic resistance.

2024 TDDW

Symposium (4) New Perspectives on the Treatment of Helicobacter pylori

Individual vs Family Therapy Yi-Chia Lee Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan Screening and eradicating Helicobacter pylori may help reduce the risk of gastric cancer. In Taiwan, the acceptability and feasibility of such a program have been confirmed through several steps. The first step is to identify the appropriate population for intervention based on their burden of stomach diseases. Second, the accuracy of screening tests should also be optimized, including the processes for specimen transportation and laboratory quality.

Third, the treatment protocol should be standardized to ensure the best therapy for those who test positive.

Fourth, it is crucial to raise awareness about H. pylori and emphasize its significance for stomach health.

There are two distinct approaches for implementing this program. The first, known as the usual approach, involves screening individuals, with those who test positive receiving antibiotic treatment. The second approach includes outreach to family members

of individuals who test positive after the initial screening. This strategy acknowledges that H. pylori is an infectious disease and that intrafamilial transmission is common, leveraging this connection to increase the detection rates. Four key questions may arise regarding the family approach. The first concerns its applicability in real-world settings.

The second addresses its potential impact and the magnitude on increasing the detection rate of H. pylori. Third, theoretically, this approach may also improve treatment outcomes, as family members can encourage those who test positive to seek treatment and adhere to it. Ultimately, this could lead to a reduction in transmission within families.

In this presentation, these four questions will be discussed based on the H. pylori screening program in Taiwan.

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2024 TDDW

Symposium (5) Advances in Neurogastroenterology and Motility Symposium: Optimization of Clinical Management

Irritable Bowel Syndrome: Patient-centered Strategies for Effective Management Justin Wu Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong Irritable bowel syndrome (IBS) is one of the commonest entities of Disorder of Gut-Brain Interaction (DGBI). IBS is caused by an interplay of various pathophysiological mechanisms, which include visceral hypersensitivity, motility dysfunction, psychiatric comorbidity, immune activation, and dysbiosis, etc. Because of the heterogeneity in the respective roles of these processes among individuals, clinical phenotypes of IBS are highly variable. The heterogeneous pathophysiology and clinical profile imply that the management of IBS cannot adopt a reductionistic approach, and there is no one single “magic bullet” drug that can treat all IBS symptoms. A patient-centered approach is essential to achieve good clinical outcomes. The initial step of management should begin with personalized evaluation of symptomatology, co-morbidity and functional impairment. In addition to symptom control, the objectives should also be targeted at the treatment of comorbidity, elimination of avoidance behaviour, and restoration of social functioning.

Therapeutic relationship is the foundation of effective IBS management. IBS is strongly associated with stressors and psychiatric morbidities such as anxiety, and early detection and intervention of these comorbidities are important.

Dietary modification has been advocated for the management of IBS. Low FODMAP diet has been

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shown effective for alleviation of IBS symptoms.

However, its clinical usefulness is limited by the poor long-term compliance. A pragmatic and agile approach should be used in the prescription of low FODMAP diet. For medical therapy, antispasmodic remains the first line treatment and side effect profile is the key factor of consideration. For patients with stress or meal-related IBS symptoms, prophylactic antispasmodic treatment is a reasonable strategy for patients with less frequent symptoms. Nonanticholinergic antispasmodics, such as otilonium and duspatalin, should be considered for patients who need regular medical therapy for frequent symptoms. Despites the extensive use, probiotics lack consistent and high quality data to substantiate its routine use for IBS management.

For patients with comorbid anxiety, selective serotonin reuptake inhibitor (SSRI) should be considered. Although the use of SSRI has been discouraged in the recent AGA guidelines, the therapeutic efficacy of SSRI as the rescue therapy has been well reported in RCTs and meta-analyses.

Off-label use of SSRI should remain a viable option for non-depressive patients with refractory IBS symptoms. Therapist-based psychotherapy is an important adjunct to patients who have stressors or maladaptive behaviour to IBS.

2024 TDDW

Symposium (5) Advances in Neurogastroenterology and Motility Symposium: Optimization of Clinical Management

Achalasia: Novel Insights into Pathophysiology and Implications for the Management Ping-Huei Tseng Division of Endoscopy, Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Achalasia is a rare primary esophageal motility disorder involving smooth muscle of esophageal body and lower esophageal sphincter (LES). The main symptoms include dysphagia, typically to solids and liquids, regurgitation, chest pain and weight loss.

Without adequate treatment, achalasia may progress to sigmoid-type esophagus with remarkably dilated and tortuous esophagus and have higher chances of developing esophageal cancer. Both barium swallow and esophagogastroduodenoscopy (EGD) may be normal in early stage of achalasia. High resolution esophageal manometry (HRM) is the diagnostic gold standard, which classify achalasia into 3 subtypes, and is considered mandatory before planning achalasia therapy. The exact etiology and pathophysiology of achalasia remains unclear.

Lines of evidence show that an initial insult, such as HSV-1 viral infections, to the esophagus and esophagogastric junction (EGJ) might trigger the inflammatory process in the myenteric plexus,

which may be followed by autoimmune responses, resulting in the neurodegeneration with loss of inhibitory neurons in conjunction with a genetically susceptible host. Per-oral endoscopic myotomy (POEM) is a revolutionizing therapy with the advantages of minimal risk and excellent short-term outcomes in the management of achalasia and has become the mainstream of achalasia treatment.

Recent studies have found that eosinophilic infiltration of the esophagus might have damaged esophageal myenteric plexus and caused loss of ganglion cells and thus resulted in esophageal motility dysfunction. In addition, muscle biopsy during POEM have shown severe fibrosis was only observed in type I achalasia but not in other types of achalasia, suggesting different disease stage or pathophysiology in different achalasia subtypes. We will present the update studies on the pathophysiology of achalasia and its implications on the management of achalasia.

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2024 TDDW

Symposium (5) Advances in Neurogastroenterology and Motility Symposium: Optimization of Clinical Management

Modern GERD Diagnosis, Lyon 2.0: Implications for Clinical Management Wei-Yi Lei Division of Gastroenterology & Hepatology, Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan The Lyon Consensus 2.0 marks a significant advancement in the clinical management of gastroesophageal reflux disease (GERD), providing updated and precise criteria for diagnosis and treatment. The consensus emphasizes the importance of identifying “ctionable GERD,” which refers to cases where conclusive evidence from esophageal testing informs the need for therapeutic intervention. One of the key updates is the recognition of Los Angeles (LA) Grade B esophagitis as definitive evidence of GERD, a shift from the previous focus on only Grades C and D. This change reflects new research demonstrating that patients with LA Grade B esophagitis exhibit similar acid exposure times and proton pump inhibitor response rates as those with more severe esophagitis. The consensus also introduces specific recommendations for the use of prolonged wireless pH monitoring, particularly in patients with unproven GERD. This method, which allows for up to 96 hours of monitoring, is preferred for its ability to capture day-to-day variations in acid exposure, thereby improving diagnostic accuracy.

Additionally, pH-impedance monitoring has been refined, with new metrics and thresholds provided

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for both on-therapy and off-therapy testing, which are particularly useful in diagnosing refractory GERD in patients who continue to experience symptoms despite optimized acid suppression. Another important update is the differentiation between proven and unproven GERD, guiding the selection of diagnostic tests and therapeutic approaches.

For patients with no prior conclusive evidence of GERD, the consensus recommends testing off therapy to determine the presence of GERD. Conversely, for patients with established GERD who exhibit persistent symptoms, on-therapy testing is advised to assess the need for treatment escalation, including surgical or endoscopic interventions.

The Lyon Consensus 2.0 also retires certain criteria that have been found less effective, such as routine histopathological scoring, and underscores the importance of personalized management strategies.

By aligning diagnostic criteria with the latest research, the consensus aims to optimize GERD management, reduce unnecessary treatments, and improve patient outcomes. This comprehensive update is expected to play a pivotal role in shaping the future of GERD diagnosis and treatment.

2024 TDDW

Symposium (5) Advances in Neurogastroenterology and Motility Symposium: Optimization of Clinical Management

Updates in the Management of Abdominal Distension and Bloating Yen-Po Wang Department of Internal Medicine, Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan Abdominal distension and bloating are common gastrointestinal symptoms that can significantly impact an individual’s quality of life. These symptoms, characterized by a feeling of fullness or tightness in the abdomen, can be acute or chronic, and may be associated with underlying organic or functional GI diseases. Although prevalent and disruptive, the underlying mechanisms of bloating and abdominal distension remain less understood, particularly in patients with ascites or malignancy who may also present with these symptoms. For patients with worsening symptoms and warning signs, radiologic imaging or endoscopy should be considered. The Rome IV diagnostic criteria recognize abdominal bloating and distension as a distinct functional gastrointestinal disorder, separate from other digestive conditions. Furthermore, a comprehensive global epidemiological study reported a prevalence rate of up to 3.5% for functional bloating and distension. However, these symptoms are significantly more common when they co-occur with other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), constipation, and functional dyspepsia FD).

Proposed pathophysiological mechanisms for abdominal distension and bloating include altered gastrointestinal motility, visceral hypersensitivity, and changes in intestinal gas production and clearance.

Given the diverse causes of these symptoms, diagnostic testing should follow an algorithmic

approach based on the suspected underlying factors. Food intolerance and hypersensitivity have been identified as potential drivers of bloating and distension in a subset of patients. Small intestinal bacterial overgrowth and other intestinal dysbiosis may also contribute to symptoms. Patients with celiac disease can also experience bloating and abdominal distension. Functional defecation disorders and constipation can be associated with abdominal distension and bloating. Digital rectal examination, defecography, and anorectal physiology testing combined with balloon expulsion can be considered in patients with defecation-related symptoms.

Biofeedback therapy and/or laxatives may be further management options. Food may also trigger bloating and abdominal distension. A low FODMAP diet has been shown to improve these symptoms in patients with IBS or functional dyspepsia. Central neuromodulators may also relieve bloating resulting from visceral hypersensitivity. Finally, biofeedback therapy targeting abdominophrenic dyssynergia was shown to relieve bloating and distension in a recent randomized controlled study. To date, limited studies focusing on management of abdominal distention and bloating exists. Further research is warranted to enhance our understanding of the underlying mechanisms and to develop targeted, evidence-based treatment strategies for these debilitating gastrointestinal symptoms.

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2024 TDDW

Symposium (6) Controversial Issues in Colonoscopy Practice

Optimal Surveillance Interval after Colorectal ESD for Large Colorectal Neoplasm Dong-Hoon Yang Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Recent guidelines suggest optimal postpolypectomy surveillance colonoscopy intervals based on the risk of metachronous advanced adenoma or colorectal cancer. The size, number, and histology of the index polyps are associated with the risk of metachronous advanced neoplasia and determine the surveillance colonoscopy intervals.

However, endoscopic resection techniques were not considered as a factor influencing on the surveillance interval in these guidelines. Endoscopic submucosal dissection (ESD) has advantage in the higher en bloc

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and complete resection rates for large colorectal neoplasia, compared to conventional endoscopic resection methods. Given that lesions removed by ESD are mostly larger than 2 cm and more probable to be early colon cancer than those removed by conventional endoscopic resection methods, the surveillance strategy after ESD should be developed in a different viewpoint. In this lecture, let me review the current guidelines and introduce evidence that can provide clues for surveillance strategy after ESD of early colorectal epithelial neoplasia.

2024 TDDW

Symposium (6) Controversial Issues in Colonoscopy Practice

Surveillance after Negative Colonoscopy: Is the Recommendation from Guideline Applicable in FIT Screening Setting?

Wei-Yuan Chang Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Colorectal cancer (CRC) is the third most common malignancies worldwide and it also costs a second highest cancer-related mortality to its victim. Therefore, intervention to reduce the global CRC burden is critical. Nowadays, colonoscopy with polypectomy has become the most effective intervention to prevent CRC incidence and mortality. After index colonoscopy, a subsequent colonoscopy surveillance is also necessary to capture metachronous colorectal neoplasm, especially metachronous advanced colorectal neoplasm, a more clinical proxy to CRC, during the surveillance period. According to current guideline, the length of surveillance interval should be tailored

by the individual’s risk of metachronous advanced colorectal neoplasm and for those without any neoplasm at index colonoscopy, their risk is though to be low. Therefore, a 10-years surveillance interval for them is accepted by US and European surveillance guideline. However, in countries using fecal immunochemical test (FIT) as first-line screening tool, like Taiwan, whether or not this 10year surveillance interval is feasible for those with positive FIT but negative confirmatory colonoscopy is unknown. The talk today will introduce current evidence of this issue and try to make a proper surveillance suggestion for this special population.

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2024 TDDW

Symposium (6) Controversial Issues in Colonoscopy Practice

Cold or Hot Polypectomy for Small Pedunculated Polyps?

Cheng-Hao Tseng Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, Kaohsiung, Taiwan Cold snare polypectomy (CSP) has been adopted as the standard of care for patients with small colorectal polyps. However, concerns remain about troublesome bleeding for cutting small pedunculated (0-Ip) polyps without coagulating the feeding vessel inside the stalk. This concern has led to the exclusion of pedunculated lesions in certain randomized trials of CSP for small colorectal polyps.

There are differing recommendations between societies, with the US Multi-Society Task Force on Colorectal Cancer recommending CSP for polyps ≤ 9

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mm, regardless of morphology, while the European Society of Gastrointestinal Endoscopy suggests hot snare polypectomy (HSP) for all pedunculated lesions Notably, these recommendations for 0-Ip polyps are primarily derived from studies that focus on larger lesions.

In the wave of cold revolution, recent studies have explored the application of CSP in small pedunculated polyps and yielded favorable results.

Therefore, this presentation will review current literature for this issue.

2024 TDDW

Symposium (6) Controversial Issues in Colonoscopy Practice

Cold Snare Polypectomy or EMR for Large Flat Lesions: Weighting between Complication and Efficacy of Treatment Yun Ho Jung Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

Introduction Cold snare polypectomy, a method that mechanically removes polyps using a snare without electrocautery, is increasingly used worldwide due to its safety and convenience, offering advantages such as shortened procedure time, reduced delayed bleeding risk, and lower treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm compared to conventional hot snare polypectomy. Due to these advantages, the US Multi-Society Task Force on Colorectal Cancer1 and the European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline recommend cold snare polypectomy2 as the standard treatment method for colorectal lesions ≤ 9 mm. Indications, particularly as CSP is being attempted for larger polyps.

CSP for intermediate polyp (10-19 mm) Several theoretical shortcomings exist for CSP in polyps ≥ 10 mm, including a superficial resection plane, difficulty in transecting thick tissue, and the risk of residual pathological tissue at the border due to the absence of an ablation effect. Despite these concerns, a prospective multicenter study involving 350 nonpedunculated colorectal polyps (10-19 mm) found that CSP or cold-EMR resulted in an incomplete resection rate of 2%, a recurrence rate of 1.7%, and no serious adverse events, demonstrating their effectiveness and safety for intermediatesized polyps.3 In another RCT conducted across four hospitals, the en bloc resection rate for colorectal

polyps (6-15 mm) was lower with CSP (58.8%) and Cs-EMR (61.7%) compared to HSP (78.9%) and Hot EMR (84.6%) (P = 0.011), though there were no significant differences in residual polyps or intraprocedural bleeding among the methods.4 A further prospective RCT comparing CSP, CS-EMR, and EMR for approximately 800 polyps (5-20 mm) found no statistically significant differences in the complete resection rate for polyps sized 6-15 mm.

However, for polyps sized 16-20 mm, CSP had a significantly lower complete resection rate (46.5%) compared to CS-EMR (85.7%) and EMR (91.1%).5 A meta-analysis of 23 studies on CSP for polyps less than 20 mm found no significant differences in complete resection rate, en bloc resection rate, and immediate bleeding rate between CSP and HSP, although delayed bleeding was significantly lower in the CSP group.6 In summary, while CSP or C-EMR for 10-15 mm lesions shows reliable results and is worth trying, CSP or C-EMR for 16-20 mm lesions may carry a risk of incomplete resection and should be attempted selectively. Further research is needed due to still insufficient data for polyps sized 10-20 mm.

CSP for large polyps (≥20 mm) According to a meta-analysis of eight studies on CSP for large polyps (≥ 10 mm) involving 522 large colorectal polyps, the technically complete resection rate was 99.3%. However, over a 6.2-month period, adenomas larger than 20 mm exhibited a high recurrence rate of more than 20%. Interestingly,

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sessile serrated lesions (SSL) showed a low recurrence rate of about 1%, regardless of size. Additionally, a retrospective study of cold snare EMR for polyps ≥ 20 mm demonstrated that as the size of adenomatous polyps increased, the recurrence rate significantly rose (20-30 mm: 26.7% vs. 31-41 mm: 47.7%, 41-50 mm: 63.6%, > 50 mm: 76.9%). A prospective RCT conducted across 18 centers compared CS-EMR and HS-EMR for colon polyps ≥ 20 mm. Major adverse events were significantly lower with CS-EMR (1%) compared to HS-EMR (8%). However, the residual or recurrent adenoma rate at the first follow-up was significantly higher with CS-EMR (approximately 24%) than with HS-EMR (14%).

In summary, CSP or cold-EMR for adenomas ≥ 20 mm is safe, with nearly no major adverse events, but it is not recommended due to the higher rate of residual or recurrent adenoma at the first endoscopic follow-up.

CSP for SSL (≥10 mm) A retrospective single-center study was conducted on 566 sessile SSLs ≥ 10 mm using cold EMR. The mean polyp size was 17.2 mm, and the procedure was mostly technically successful, with a residual lesion rate of 8% per polyp.7 A meta-analysis that included 14 studies with 1,139 SSLs ≥ 10 mm in size compared cold EMR with hot EMR, although only 2-3 studies on cold EMR were included. The results showed that the residual SSL rate was lower in the cold EMR group at 0.9%, compared to 5% in the hot EMR group. In the cold EMR group, immediate bleeding (0.7%), delayed bleeding (0%), and perforation (0%) were almost negligible.8 Recent studies on piecemeal CSP or cold snare EMR have primarily focused on large SSL lesions, mostly greater than 10 mm or 20-30 mm in size, with a recurrence rate generally low, at 5% or less.

Additionally, delayed post-polypectomy bleeding and perforation were almost non-existent.9 In summary, CSP or cold-EMR for SSLs ≥ 10 mm can be considered safe, with a relatively lower recurrence rate compared to hot EMR. According to recent expert opinion, substantial literature supports the preferential use of cold resection techniques (CSP or cold-EMR) for SSLs ≥ 10 mm, with practically no upper size limit.10 The updated ESGE guideline also recommends piecemeal CSP for SSLs

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without dysplasia of all sizes. For lesions ≥ 10–15 mm, it is advisable to consider submucosal injection to demarcate margins before polypectomy.2

Conclusions Data on CSP or cold-EMR for colorectal polyps ≥ 10 mm are gradually accumulating through various studies. For SSLs, CSP or cold-EMR can be considered regardless of size due to the low risk of residual or recurrent disease, provided there is no suspicion of dysplasia. However, careful observation is essential to rule out dysplasia before proceeding.

For adenomatous lesions, CSP or cold-EMR is not recommended for polyps ≥ 20 mm due to the very high recurrence or residual rate, and even for polyps ≥ 15 mm, the relatively high recurrence rate suggests that the procedure should be performed with caution.

References: 1. Kaltenbach T, Anderson JC, Burke CA, et al.

Endoscopic Removal of Colorectal LesionsRecommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020;91(3):486-519. DOI: 10.1016/j. gie.2020.01.029.

2. Ferlitsch M, Hassan C, Bisschops R, et al.

Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Update 2024. Endoscopy 2024;56(7):516-545.

DOI: 10.1055/a-2304-3219.

3. Motchum L, Djinbachian R, Rahme E, et al.

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection. Endosc Int Open 2023;11(5):E480-E489. DOI: 10.1055/a-20292392.

4. Rex DK, Anderson JC, Pohl H, et al. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022;96(2):330-338. DOI: 10.1016/j. gie.2022.03.006.

5. Li D, Wang W, Xie J, et al. Efficacy and safety of three different endoscopic methods in treatment of 6-20 mm colorectal polyps.

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6.

7.

8.

Scand J Gastroenterol 2020;55(3):362-370. DOI: 10.1080/00365521.2020.1732456.

Niu C, Bapaye J, Zhang J, et al. Systematic review and meta-analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps.

J Gastroenterol Hepatol 2023;38(9):1458-1467.

DOI: 10.1111/jgh.16312.

McWhinney CD, Vemulapalli KC, El Rahyel A, Abdullah N, Rex DK. Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >/=10 mm. Gastrointest Endosc 2021;93(3):654-659.

DOI: 10.1016/j.gie.2020.08.032.

Thoguluva Chandrasekar V, Aziz M, Patel HK, et al. Efficacy and Safety of Endoscopic Resection

of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020;18(11):2448-2455 e3. DOI: 10.1016/j.cgh.2019.11.041.

9. Kimoto Y, Sakai E, Inamoto R, et al. Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study. Clin Gastroenterol Hepatol 2022;20(2):e132-e138. DOI: 10.1016/j. cgh.2020.10.053.

10. Copland AP, Kahi CJ, Ko CW, Ginsberg GG. AGA Clinical Practice Update on Appropriate and Tailored Polypectomy: Expert Review. Clin Gastroenterol Hepatol 2024;22(3):470-479 e5.

DOI: 10.1016/j.cgh.2023.10.012.

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2024 TDDW

Symposium (7) IASL/TDDW Symposium: Cutting Edge for Liver Disease

HBV Management in Asia Pacific – IASL Perspectives Kwang-Hyub Han Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Hepatitis B virus (HBV) infection remains a significant global health problem and cause of chronic liver disease that led to an estimated 820,000 deaths in 2019, mainly due to cirrhosis and liver cancer. In 2019, WHO estimated that 296 million people were chronically infected and living with hepatitis B, with a disproportionately high burden in low- and middle-income countries. Hepatitis B prevalence is still highest in the Asia Pacific (AP) region.

The main goal of therapy for patients with chronic HBV infection is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The likelihood of achieving these goals depends on the timing of therapy during the natural course of the infection.

Evidence-based guidelines are needed to help providers determine when treatment should be initiated, which medication is most appropriate, and when treatment can safely be stopped.

For people with CHB infection, nucleoside analogue treatment with currently recommended is highly effective and can delay the progression of cirrhosis, reduce the incidence of hepatocellular carcinoma (HCC) and improve long-term survival.

However, a major testing and treatment gap remains. In 2019, only 10% of the estimated 296 million people with CHB had been diagnosed and

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2% had been treated. Since untreated patients must have poor clinical outcomes, an effort to increase in diagnosis rate and linkage to care should be extremely important.

In 2015, WHO issued the first comprehensive guidelines on prevention, care and treatment for people with CHB. Several significant developments have occurred since the 2015 guidelines were published. WHO is working to support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030: such as 1) raising awareness, promoting partnerships and mobilizing resources, 2) formulating evidencebased policy and data for action, 3) increase health equities within the hepatitis response, 3) preventing transmission, 4) scaling up screening, care and treatment services. However, the journey to eliminate viral hepatitis in AP will not be easy until 2030.

IASL set out its long journey since 1958 with the mission of fostering the training of experts in hepatology, encouraging basic and clinical research on the liver and its diseases and facilitating the prevention, recognition and treatment of liver diseases. IASL will continue to work together with the continental societies to support countries in AP for eliminating viral hepatitis in the near future.

2024 TDDW

Symposium (7) IASL/TDDW Symposium: Cutting Edge for Liver Disease

Rationale and Molecular Basis for a Functional Cure of Hepatitis B Ming-Lung Yu Hepatitis Research Center and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Hepatitis B virus (HBV) infection remains a significant global health challenge, with chronic infection affecting over 290 million people worldwide and leading to end-stage liver diseases, including cirrhosis and hepatocellular carcinoma with an annual death of 820,000. The concept of achieving a functional cure—defined as loss of HBV surface antigen (HBsAg)—has gained traction as it offers a viable alternative to lifelong antiviral treatment.

A functional cure could be achieved by eliminating the viral reservoir, such as the covalently closed circular DNA (cccDNA) in hepatocytes or by silencing HBV gene expression. Clinical benefits of attaining a functional cure extend beyond reducing viral load, including decreased risk of hepatic decompensation and HCC, improved quality of life, and potential reduction in transmission rates.

The molecular basis for this involves enhancing the host’s immune response while targeting viral replication, which could lead to HBV antigen clearance and restoration of exhausted immune systems. Numerous agents that target various stages of the HBV viral lifecycle and mechanisms are currently in development. These agents can inhibit the translation of pgRNA and mRNA transcribed

from cccDNA, while also suppressing the translation of integrated HBV DNA. Capsid assembly modulators (CAMs) can interfere with capsid assembly, resulting in the formation of empty or aberrant capsids, which decreases the packaging of pregenomic RNA and HBV DNA replication. Nucleic acid polymers (NAPs) can inhibit the release of HBsAg into the extracellular space. Vaccine antibodies may bind to and neutralize circulating HBsAg, potentially restoring the previously exhausted HBV-specific immune response.

Emerging therapeutic approaches adopt a multi-faceted strategy involving combination therapies, such as immune modulators, RNAtargeted therapies, and therapeutic vaccines. These focus on reactivating the immune system, targeting viral reservoirs, and promoting sustainable antiviral responses.

In conclusion, the rationale for pursuing a functional cure for hepatitis B is compelling, with potential for transformative impact on global health.

Continued research into the intricate pathogenesis of HBV and innovative therapeutic techniques is crucial to realize this goal, ultimately aiming to eradicate the burden of chronic HBV infection and improve patient outcomes worldwide.

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2024 TDDW

Symposium (7) IASL/TDDW Symposium: Cutting Edge for Liver Disease

Clinical Approach to Functional Cure – Is NA Needed?

Henry Chan Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Department of Internal Medicine, Union Hospital, Hong Kong Functional cure of hepatitis B virus (HBV) infection is defined as seroclearance of HBsAg, which is sustained after cessation after antiviral therapy. Experience in nucleos(t)ide analogue (NA) therapy leading to functional cure is disappointing.

To achieve functional cure, immune clearance of cccDNA and intrahepatic HBV DNA is needed.

Clinical studies using peginterferon in NA treated patients have revealed a low serum HBsAg level is a favorable factor for HBsAg seroclearance. RNA interference using siRNA can bring down HBsAg, but is insufficient for functional cure even in NA treated patients. The best chance of functional cure is by combination of siRNA with both peginterferon and

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NA. Anti-sense oligonucleotide has a dual mode of action to activate TLR8 in addition to interfere HBV mRNA. Phase 2 study of bepirovisen, an anti-sense oligonucleotide, showed that HBsAg seroclearance rate was similar among NA treated versus untreated patients. However, NA treated patients tend to have fewer adverse events. A new generation capsid assembly inhibitor, ALG-000184, has been shown in early phase clinical trial to demonstrate more potent HBV DNA suppression than NA, and it may also lead to a gradual decline in HBsAg level. Whether capsid assembly inhibitor can be a substitute of NA in the functional cure regime awaits further clinical studies.

2024 TDDW

Symposium (8) Cutting Edge of Digestive Diseases

Current Status and Future Perspectives of Liver Transplantation in the Surgical Treatment of Intrahepatic and Perihilar Cholangiocarcinoma Taizo Hibi Department of Pediatric Surgery and Transplantation, Kumamoto University, Kumadai, Japan Perihilar cholangiocarcinoma (phCCA) and intrahepatic cholangiocarcinoma (iCCA) are both well-known intractable hepatobiliary malignancies that are often deemed unresectable at the time of presentation. To save the patients with these devastating diseases, “transplant oncology,” an emerging concept defined as “any application of transplant medicine and surgery to the treatment of cancer aimed at improving patients’ survival and quality of life (Ann Surg. 2021;273:483-493),” is expected to play a critical role. Transplant oncology is composed of four pillars (4 E’s): i) Evolution of multidisciplinary cancer management by incorporating liver transplantation for conventionally nontransplantable diseases, ii) Extension of the limits of conventional cancer surgery (e.g., ante-situm resection, Rex-shunt procedure for invasion to the umbilical portion of the portal vein), iii) Elucidation of self- and non-self recognition by linking tumor and transplant immunology (e.g., immune checkpoint

inhibitors), and iv) Exploration of molecular mechanisms of carcinogenesis, invasion, and metastasis by immunogenomic approaches. In the U.S., neoadjuvant chemoradiation therapy followed by liver transplantation for unresectable phCCA was approved in 2009 as a standard MELD exception.

In Japan, we launched a phase I/II multicenter, prospective study in 2022 to evaluate the safety and efficacy of neoadjuvant treatment followed by living donor liver transplantation for unresectable phCCA, defined as either one of 4 conditions: poor hepatic reserve, extensive vascular invasion, extensive biliary spread, and in the setting of PSC. For iCCA, European Association for the Study of the Liver and International Liver Cancer Association has issued clinical practice guidelines in 2023 for early-stage disease in the setting of cirrhosis and for locally advanced disease. Under the concept of transplant oncology, resection and transplantation are mutually exclusive and collectively exhaustive.

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2024 TDDW

Symposium (8) Cutting Edge of Digestive Diseases

Modern Therapeutic Approaches for Perihilar Cholangiocarcinoma Chun-Yi Tsai Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan Chang Gung University, Taoyuan, Taiwan The prevalence of cholangiocarcinoma is increasing globally, yet the prognosis remains devastating stemming from tumor biology and the lack of specific signs for early diagnoses. Cholangiocarcinoma is categorized into intrahepatic, extrahepatic, and perihilar cholangiocarcinoma based on its anatomical location, which also determines the fashion of surgical management ranging from hepatectomy to pancreaticoduodenectomy (PD). Curative resection remains the most promising modality to provide long-term survival for cholangiocarcinoma; however, less than 40% of patients diagnosed of perihilar cholangiocarcioma (pCC) were feasible for curative resection owing to disseminated disease at diagnosis, unrelieved jaundice, insufficient future liver remnant (FLR), and invasion of the vital vessels.

To expand the resectability of pCCs, or, to optimize the preoperative conditions, various interventions were applied including aggressive

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biliary drainages, augmentation of FLR by percutaneous transhepatic portal vein embolization (PTPE), thorough review of perihilar anatomy, and administration of neoadjuvant chemotherapy (conversion chemotherapy) in selective clinical scenarios. Above all, a multi-disciplined team is warranted. The surgical procedures were also standardized and integrated based on the primal Bismuth classification. For the laterally extended tumors, combined PD is warranted to achieve R0 resection. In the past 7 years, we performed 46 curative-intent resections for pCCs based on our established settings. We would like to share our surgical experiences, and your precious comments are welcomed to make the treatment to perfection in the future. As the era of immunochemotherapy arrived, further therapeutic approaches are available as weapons to turn unresectable disease into resectable and to provide possible long-term survival.

2024 TDDW

Symposium (8) Cutting Edge of Digestive Diseases

Surgical Strategy for Advanced HCC in the Era of New Drug Akio Saiura Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan Surgery is the cornerstone of curative treatment for many gastrointestinal solid tumors. On the other hand, surgery, a local treatment, has limited efficacy in the treatment of advanced systemic cancer. In recent years, with the evolution of systemic drug therapy, advanced cancers that were not initially indicated for resection are now being resected after successful drug therapy, and this is called conversion surgery. In hepatocellular carcinoma, rapid progress has been made in drug therapy in the

past decade with the advent of molecular-targeted agents and ICIs. In Japan, oncological classification of resectability has recently been defined and is expected to be an effective tool as a common language for future surgical treatment strategies for hepatocellular carcinoma, including conversion.

Conversion therapy for hepatocellular carcinoma has only just begun, and various clinical studies will clarify better patient selection and the optimal type and duration of drug therapy.

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2024 TDDW

Symposium (8) Cutting Edge of Digestive Diseases

Integrated Approaches in the Treatment of Hepatocellular Carcinoma: A Multimodal Strategy Teng-Wei Chen Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan The treatment landscape for hepatocellular carcinoma (HCC) is evolving and has changed significantly in the last few years with new treatment options. Recent advancements in systemic therapies have greatly improved oncological outcomes for intermediate and advanced stage HCC. Integration of systemic and locoregional therapies further facilitates downstaging of tumors and increases the likelihood of surgical resection for initially

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unresectable cases. The optimal approach may involve multi-modal treatments and requires a multi-disciplinary team to take care of the HCC patients. Although lots of controversies need to be settled, in this review, I will provide a brief overview of the current treatment options, combinations of treatments, efficacy and their impacts on conversion surgery.

2024 TDDW

Symposium (9) Cutting-Edge Advances in Interventional Radiology for the Digestive System

Image Targeted Therapies and Minimally Invasive Techniques for Hepatocellular Carcinoma Te-Cheng Su Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan Hepatocellular carcinoma (HCC) is a common malignancy, with high incidence worldwide due to infection with hepatitis B and C virus and alcoholic liver disease. RFA has been proven to be a curative treatment for HCC in addition to surgery.

Accurate positioning of the RFA needle has an impact on prognosis and recurrence after local ablation. In previous literature and clinical practice, traditional two-dimensional ultrasound has a low recognition rate for small HCC, especially those smaller than 1 cm. In addition, in patients with HBV-related macronodular cirrhosis, multiple pseudolesions will appear under ultrasound, which will also affect the recognition rate. When traditional

ultrasound cannot detect tumors, CT guidance can perform treatment according to the anatomical location, but it has the disadvantage of radiation.

From a radiologist’s perspective, we can consider some ways to improve the situation. First, RFA can be performed by CT guidance combined with ultrasound fusion image for hepatic tumors to improve the effectiveness & efficiency of treatment and reduce radiation dosage of CT scans. Second, combination with TACE and RFA can facilitate needle placement to difficult ablated location and improved treatment response by decrease heat sink effect.

In this talk, I will share some practical cases and share some preliminary experience.

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2024 TDDW

Symposium (9) Cutting-Edge Advances in Interventional Radiology for the Digestive System

HAIC Combines Immunotherapy for HCC Treatment Jing-Wei Kang Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan Systemic therapies including molecular targeting agents (MTAs) and immune checkpoint inhibitors (ICIs) have modified the treatment strategy of advanced HCC. Recently, immune-based combination therapies such as MTAs combined with ICIs, dual ICIs and ICIs combined with local therapy have been shown stronger antitumor activity and better survival outcome than systemic monotherapy.

Hepatic arterial infusion chemotherapy (HAIC), as one of the effective locoregional interventional

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therapy for patients with intermediate to advanced HCC, can enhance treatment response rate and reduce systemic toxicity by increasing local chemotherapeutic drug concentrations within tumor. Some studies demonstrated that HAIC may have a synergistic and positive effect in combination with MTAs or ICIs. In this section, I will review the HAIC-combined therapy for HCC and present the NTUH experience in HAIC-based combination treatment for intermediate to advanced HCC.

2024 TDDW

Symposium (9) Cutting-Edge Advances in Interventional Radiology for the Digestive System

Advances in Embolization Techniques and Imaging Technologies for Gastrointestinal Bleeding Chia-Ling Chiang Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Gastrointestinal bleeding is one of the major causes of hospitalization, accounting for 1-2% of admissions, as well as high death rate up to 25%.

Gastrointestinal bleeding can complicate clinical course of critically ill patients. The definition of upper GI bleeding is the bleeding source proximal to the ligament of Treitz, more frequent than lower GI bleeding, commonly caused by peptic ulcer disease.

The definition of lower GI bleeding is the bleeding location downstream of duodenum-jejunal junction, accounting 20-25% of all GI bleeds, in which CTA is the gold standard for diagnosis, commonly caused

by diverticular bleeding, angiodysplasia, chronic IBD or malignancy. Trans-arterial embolization plays an important role in both upper and lower GI bleeding hemostasis procedure as a primary or salvage management in critically ill status. The indications, timing of treatment, techniques and embolic agent choice are variable in different institutions, which depends on the available interventional radiologists and devices. Eventually, a well-trained, wellestablished teamwork is the key to achieve better results.

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2024 TDDW

Symposium (9) Cutting-Edge Advances in Interventional Radiology for the Digestive System

Innovative Interventions in Biliary Tract and Portal Vein Management Hsuen-En Hwang Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan There are multiple radiological interventions related to biliary system and portal system. I’d like to share my experience and cases in Taipei Veteran General Hospital. My topics were as follow: Biliary system related procedure • PTBD assisted biliary stent implantation • Percutaneous transhepatic common bile duct stone removal

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• Neo-anastomosis creation • Intra-ductal tumor treatment Portal veins related procedure • Pre-operative portal vein embolization • Embolization for other portosystemic shunts/ variceal bleeding • Portal vein stenting • Endovascular interventions for PVT

2024 TDDW

Symposium (9) Cutting-Edge Advances in Interventional Radiology for the Digestive System

Role of Interventional Radiology in Pancreatic Cancer Yi-Sheng Liu Division of Interventional Radiology, Department of Medical Imaging, National Cheng Kung University Hospital, Tainan, Taiwan Pancreatic cancer is a leading cause of cancer death worldwide. Pancreatic ductal adenocarcinoma (PDAC), which accounts for more than 85% of pancreatic malignancies, and 85-90% of patients presenting with locally advanced or metastatic diseases upon diagnosis, which precluding curative surgery.

Although endoscopic, ultrasound-guided tissue acquisition (EUS-TA) is the first choice for pancreatic tumor, CT-guided pancreas biopsy is commonly applicable and widely available. Sometimes there is no conclusion after EUS-TA, CT-guided biopsy still

show high yield rate, due to more tissue could be obtained.

For liver metastatic disease from pancreatic cancer, hepatic arterial infusion chemotherapy (HAIC) shows some benefit. And for pancreatic cancer patients received surgery, some complications might occur, such as fluid collection, bleeding, and vascular stenosis. Interval radiologists also can performed image-guided drainage, transarterial embolization (TAE), and angioplasty to treat kinds of complications. The role of interventional radiology in pancreatic cancer is very important.

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2024 TDDW

Symposium (10) MASLD

From NASH, NAFLD, to MASLD Chia-Chi Wang Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan Non-Alcoholic Fatty Liver Disease (NAFLD) was first named in 1980 and characterized by the accumulation of fat in the liver without significant alcohol consumption or other known causes of liver disease. It has become increasingly prevalent over the decades. In 2023, a landmark change was instituted by the American Association Study of Liver Disease, renaming NAFLD to Metabolic-Associated Steatotic Liver Disease (MASLD). Along with the new name, the diagnostic criteria have been updated to include

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metabolic dysfunction using cardiometabolic criteria. This shift in diagnostic criteria means that the population affected by MAFLD may differ from those previously diagnosed under the NAFLD framework.

Today’s presentation will focus on comparing the new MASLD diagnosis with the old NAFLD criteria, highlighting the differences and what they mean for patients and clinicians alike. We will also review the latest research findings that have emerged since the redefinition.

2024 TDDW

Symposium (10) MASLD

Disease Burden and Identification of SLD with Advanced Liver Fibrosis Ming-Ling Chang Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan Steatotic liver disease (SLD) displays a dynamic and complex disease phenotype, it is an overarching term encompassing the various etiologies of fatty liver disease, including metabolic dysfunctionassociated steatotic liver disease (MASLD), alcoholic liver disease (ALD), and metabolic dysfunction and alcohol-related steatotic liver disease (MetALD).

MASLD, formerly nonalcoholic fatty liver disease (NAFLD), is the most common chronic liver disease affecting 30% of the global population. The burden of MASLD is growing with the obesity epidemic, yet disease awareness and diagnosis is low. The main causes of death in patients with MASLD have been identified and include cardiovascular events, extrahepatic cancer and hepatic complications such as liver cirrhosis and hepatocellular carcinoma (HCC). Liver fibrosis is associated the aforelemtioned

outcomes of patients with MASLD. Identification of patients with advanced liver fibrosis is necessary to timely offer interventions and appropriate care. Liver biopsy is currently considered the gold standard for the diagnosis and staging of liver fibrosis, but it has associated risks and limitations. This has spurred the exploration of non-invasive diagnostics for liver fibrosis. The non-invasive tests (NITs) mostly include biomarkers and algorithms derived from anthropometric measurements, serum tests, imaging or stool metagenome profiling. However, they still need rigorous and widespread clinical validation for the diagnostic performance. The current expert guidelines and clinical practice implications will be highlighted to provide insight into the utility of NITs for liver fibrosis assessment.

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2024 TDDW

Symposium (10) MASLD

Value and Applications of NITs Jee-Fu Huang Hepatitis Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Accurate determination of the presence and extent of liver fibrosis is essential for prognosis and for treatment planning in patients with chronic liver diseases such as viral hepatitis infections and steatotic liver disease (SLD). There are lots of unmet needs for the exploration of non-invasive tests (NITs) of evaluating fibrosis. Such unmet needs include potential bleeding risk for liver biopsy, sampling error and interpretation discordance between pathologists in histopathology, and the reluctance of repeated biopsies in most patients. These methods of evaluating fibrosis have been developed to reduce the need for biopsy for the past decade.

Many serum biomarkers have been evaluated for their ability to determine stage of liver fibrosis in patients with SLD. Among the proposed markers, the so– called direct markers reflect the deposition or removal of extracellular matrix in the liver. These include serum hyaluronate, laminin, and collagenases, and their inhibitors such as matrix metalloproteases and tissue inhibitory metalloprotease-1. Indirect markers include factors that can be measured in routine blood tests, such as

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the prothrombin index, platelet count, APRI, and FIB4 index, etc.

Meanwhile, liver stiffness measurement (LSM) has become a promising tool for the purpose.

Combination with biomarker panels and LSM has extended their clinical application into a more accurate level. There is a promising trend toward non-invasive assessment of liver fibrosis in terms of diagnostic and prognostic implications at present.

Further works of clinical validation regarding various methods are needed to improve the accuracy of the non-invasive methods in various liver diseases.

In patients with SLD, the following NITs such as LSM by TE <8 kPa, FIB-4 <1.3 or NFS < -1.455 are recommended to rule-out advanced fibrosis in clinical practice. MRE is the most accurate noninvasive method for staging liver fibrosis. However, it is only marginally better than other NITs for F3–F4 fibrosis and it is not recommended as a first-line NIT given its cost and limited availability. Results from measurements of direct and indirect markers can be combined and used in complementary fashion.

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Symposium (10) MASLD

Is Resmetirom the Answer to NASH Vincent Wong Division of Gastroenterology and Hepatology, The Chinese University of Hong Kong, Hong Kong The recent approval of resmetirom by the US Food and Drug Administration represents a landmark advancement in the treatment of metabolic dysfunction-associated steatohepatitis (MASH). Resmetirom, a thyroid hormone receptorbeta agonist, selectively targets liver receptors to improve metabolic function while minimizing systemic cardiovascular side effects.

In the pivotal phase 3 MAESTRO-NASH study, resmetirom demonstrated significant efficacy, with 29.9% of patients receiving 100 mg daily achieving MASH resolution without worsening fibrosis after 52 weeks, compared to 9.7% in the placebo group.

Additionally, 25.9% of patients on resmetirom showed fibrosis improvement without worsening MASH, versus 14.2% in the placebo cohort. This trial met both registrational histological endpoints, establishing a new standard for treatment.

Resmetirom was well tolerated, with only a minority of patients experiencing mild to moderate

gastrointestinal side effects such as diarrhoea or nausea. However, it is contraindicated in patients with decompensated cirrhosis, and caution is advised for those on concomitant lipid-lowering medications.

As the field moves forward with the introduction of resmetirom, there is an urgent need to develop robust strategies for monitoring treatment response and determining when to discontinue therapy.

Several drug classes are currently in phase 3 development, notably incretin therapies, which simultaneously improve body weight and glycaemic control, positioning them as potential cornerstones of MASH treatment. Additionally, fibroblast growth factor-21 analogues have shown promising results in MASH resolution and fibrosis improvement, particularly for patients with advanced liver disease.

This lecture will explore these advancements, their clinical implications, and future directions in MASH management.

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2024 TDDW

Symposium (11) How Can We Improve the Standard of Care in IBD

Opportunistic Infection in Inflammatory Bowel Disease: What You Need to Know Chen-Wang Chang Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan Opportunistic infections are infections caused by organisms that typically don’t cause illness in people with healthy immune systems. However, in individuals with weakened immune systems, these organisms can become harmful.

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, often involves inflammation of the digestive tract. This inflammation can weaken the immune system, making individuals more susceptible to infections. Additionally, many IBD treatments, such as immunosuppressants and biologics, can further suppress the immune system, increasing the risk of opportunistic infections.

Opportunistic Infections in IBD Common opportunistic infections associated with IBD include Clostridium difficile, Mycobacterium tuberculosis, influenza, virus hepatitis, Herpes simplex virus, Cytomegalovirus (CMV), and EpsteinBarr virus, et al.

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Signs and Symptoms The symptoms of opportunistic infections can vary depending on the type of infection. However, common signs and symptoms may include: fever, fatigue, weight loss, abdominal pain, diarrhea, vomiting, et al.

Prevention and Management 1. Regular monitoring: monitor immune system function and screen for infections.

2. Vaccinations: Stay up-to-date on vaccinations, including those for influenza, pneumonia, and hepatitis B. 3. Medication management: adequate IBD medications and minimize the risk of side effects.

4. Hygiene practices: Practice good hygiene, such as washing hands frequently and avoiding contact with sick individuals.

2024 TDDW

Symposium (11) How Can We Improve the Standard of Care in IBD

Update on Acute Severe Ulcerative Colitis: From Pathophysiology to Latest Evidence of Medical Treatment Chia-Hung Tu Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Distinguished from common clinical flares of inflammatory bowel disease, acute severe ulcerative colitis (ASUC) manifests as a medical emergency that the disease rapidly worsens from a chronic stable state to the extreme severe form of colitis, which could lead to dire consequences in a matter of days if not being appropriately treated. ASUC, even when timely treated, is associated with significant risks of major complications such as sepsis, fulminant colitis, colectomy, or even fatality.

About one in every four patients with ulcerative colitis (UC) would experience at least one episode of ASUC during their disease course, the fact the underscores the importance of keeping up with the most updated management protocol and being prepped for immediate action on the condition in

everyday primary care. A swift diagnostic evaluation and urgent infusion of high-potency corticosteroid are the keys to successful initial stabilization. The more challenging part is the administering of recue therapy for the steroid-refractory cases before the window of opportunity is closed, which occurs as frequent as one-third of the times. This is the particular field where most research interests rest on in the era of advanced medical therapy (biologic and small-molecule agents), and also the focus of most development of new medical therapeutic agents and revisions of management guidelines.

The presentation will briefly review on the current standards of therapy, and will cover more on the latest advancement, the unmet therapeutic needs, and also the directions of future researches.

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2024 TDDW

Symposium (11) How Can We Improve the Standard of Care in IBD

Cutting Edge Endoscopic Treatment of IBD-Associated Dysplasia Jeong-Sik Byeon Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Longstanding inflammatory bowel disease (IBD) carries a risk of dysplasia, particularly in the colorectum with ulcerative colitis (UC) and Crohn’s colitis. Risk factors for IBD-associated dysplasia include the extent and duration of disease, the activity of inflammation, concomitant primary sclerosing cholangitis, post-inflammatory polyps, and a family history of colorectal cancer. Consequently, strategic colonoscopy surveillance is recommended based on risk stratification using these risk factors starting 6-8 years after the initial manifestation of symptoms, especially in UC. Chromoendoscopy with targeted biopsy has traditionally been the preferred method for surveillance endoscopy. Image-enhanced highdefinition endoscopy is now tried as an alternative to chromoendoscopy. The surveillance interval is determined by the risk of IBD-associated dysplasia.

IBD-associated dysplasia warrants endoscopic resection if the lesion margins are distinct. En bloc

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resection should be attempted for endoscopically resectable IBD-associated dysplasia to reduce recurrence risk and facilitate histological assessment.

IBD-associated dysplasia less than 20 mm can be resected en bloc using conventional endoscopic mucosal resection if there is sufficient submucosal lifting. IBD-associated dysplasia greater than 20 mm may be resected en bloc by endoscopic submucosal dissection by skillful endoscopists. Due to the risk of recurrence and metachronous IBDassociated dysplasia, surveillance endoscopy should be performed within 3-6 months, and annually thereafter if no residual disease or local recurrence is detected.

In this lecture, we will review the role of endoscopy in the diagnosis of IBD-associated dysplasia and cutting edge endoscopic treatment method for IBD-associated dysplasia.

2024 TDDW

Symposium (11) How Can We Improve the Standard of Care in IBD

Stricturing Crohn’s Disease: Current Practice and Future Avenues Tien-Yu Huang Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) characterized by transmural inflammation that can lead to various complications, including the development of strictures. Strictures, which result from fibrosis and chronic inflammation, significantly contribute to morbidity in patients with Crohn’s disease. These can manifest as bowel obstructions, necessitating surgical interventions or endoscopic management. The management of stricturing CD remains challenging, with a focus on mitigating inflammation, preventing progression, and addressing established strictures. Current practice for stricturing CD includes a combination of medical, endoscopic, and surgical strategies.

Anti-inflammatory and imunosuppressive therapies, particularly biologics such as anti-TNF agents, have

been integral in controlling inflammation and reducing the formation of strictures. Endoscopic interventions, including balloon dilation and stricturotomy, offer minimally invasive options for certain patients, while surgical resection is often reserved for cases of refractory strictures or those with complex fistulizing disease.

Looking forward, the future management of stricturing Crohn’s disease is likely to be shaped by advancements in personalized medicine, including the identification of biomarkers to predict fibrosis and stricture formation. Anti-fibrotic therapies are under investigation, aiming to directly target fibrogenesis, which has been poorly addressed by current treatments.

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2024 TDDW

Symposium (12) Cutting Edge Treatment for Liver Cancer

Management of HCC with High Tumor Burden Sadahisa Ogasawara Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan Hepatocellular carcinoma (HCC) remains a major global healthcare challenge, particularly in Asia, where a significant proportion of cases are diagnosed at advanced stages despite ongoing surveillance efforts in high-risk populations. The high recurrence rate of the disease further complicates clinical management, often leading to progression to advanced stages. Over the past two decades, the landscape of systemic therapy for advanced HCC has undergone a remarkable transformation. The initial reliance on tyrosine kinase inhibitors (TKIs) with VEGF inhibition has given way to combination immunotherapy as the new standard of care, supported by evidence from global phase III trials.

However, these clinical trials have predominantly enrolled patients with relatively less advanced disease within the spectrum of advanced HCC, often excluding those with high tumor burden.

Such patient selection criteria are inherent and necessary in the controlled environment of clinical trials to ensure homogeneity and safety for rigorous scientific evaluation. However, this methodological necessity creates a gap between trial populations and real-world patients. As a result, efficacy data derived from these trials may not accurately reflect outcomes in real-world clinical settings, where patients often present with more extensive disease progression. This discrepancy underscores the critical need for real-world data to evaluate the true efficacy of current systemic therapy regimens in advanced HCC, particularly in patients with high tumor burden who are underrepresented in clinical trials. By supplementing clinical trial data with

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real-world evidence, we can gain a more complete understanding of treatment efficacy across the spectrum of advanced HCC disease.

A noteworthy phenotype of high-tumorburden advanced hepatocellular carcinoma (HCC) is macrovascular invasion (MVI), a progression pattern exclusive to HCC and recognized as a poor prognostic factor. Despite its clinical significance, the conventional RECIST criteria lack standardized evaluation methods for MVI. This limitation underscores the urgent need to develop robust methods for assessing MVI, which is crucial for accurately determining the effectiveness of systemic therapy in high-tumor-burden advanced HCC. As cancer treatment continues to evolve, the ultimate goal remains achieving a cure. Recent advancements in systemic therapy and other treatment modalities have made it increasingly feasible to achieve a complete response, defined as the total disappearance of cancer on imaging and attaining a “cancer-free” status, even in cases of high tumor burden advanced HCC. However, the heterogeneity of advanced-stage HCC patients leads to significant variability in cancer-free rates based on individual disease characteristics.

A more profound comprehension of high tumor burden advanced HCC is imperative for the advancement of treatment strategies. Future research that bridges the gap between clinical trials and real-world scenarios has the potential to significantly improve outcomes, thereby bringing us closer to transforming this formidable disease into a more manageable and potentially curable condition.

2024 TDDW

Symposium (12) Cutting Edge Treatment for Liver Cancer

Can Immunotherapy Become the Standard of Care for Intermediate Stage HCC? I-Cheng Lee Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan The management of intermediate-stage hepatocellular carcinoma (HCC) continues to pose significant challenges, with current standard therapies like transarterial chemoembolization (TACE) offering limited long-term efficacy for many patients. However, recent advancements in immunotherapy have opened new pathways in HCC treatment, showing promising outcomes, particularly in advanced stages of the disease.

This raises the important question of whether immunotherapy could become the new standard of care for intermediate-stage HCC. In this presentation, we will explore the potential of immunotherapy to reshape treatment strategies

for this patient population. We will examine the latest evidence, including the biological basis for the use of immunotherapy in intermediate-stage HCC, target populations, and updated clinical trial data on combining TACE with immunotherapy.

Additionally, we will address the challenges in integrating immunotherapy into existing treatment frameworks, focusing on identifying TACE-suitable and TACE-unsuitable patients, determining optimal timing, and exploring combination approaches. By evaluating the expanding role of immunotherapy in intermediate-stage HCC, this presentation aims to shed light on its potential to become the future standard of care.

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2024 TDDW

Symposium (13) Microbiota and Cancer

Microbiota and Esophageal Cancer I-Chen Wu Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Studies on microbiota in esophageal cancer has revealed some insights into the mechanisms of carcinogenesis and potential therapeutic strategies.

Dysbiosis in the microbiota, particularly involving Fusobacterium nucleatum, has been implicated in the pathogenesis of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). F. nucleatum is associated with poor prognosis in ESCC, contributing to tumor invasion, enhanced senescence-associated secretory phenotype, and disrupted polyamine metabolism, which collectively promote tumor progression and chemoresistance. In addition to the direct involvement of specific pathogens, the influence of systemic factors such as antibiotic exposure has been linked to increased EAC risk, emphasizing the importance of maintaining microbiota balance.

Antibiotic-induced dysbiosis appears to exacerbate carcinogenesis through immune modulation and a pro-inflammatory milieu. Emerging therapeutic approaches targeting the microbiota, including

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synbiotics combined with enteral nutrition, have shown promise in improving treatment outcomes by mitigating the adverse effects of chemotherapy and preserving microbial diversity. Our ongoing research at focuses on exploring the differences in fecal microbiota between patients with favorable and poor responses following immune checkpoint inhibitor therapy. Preliminary results from this study, involving 29 patients, have identified significant differences in rare microbial taxa between those with partial response and those with progressive disease. Although the current sample size limits the identification of taxa to the Order and Family levels, future studies with larger cohorts are planned to evaluate the correlations between these taxa, progression-free survival, and overall survival. The integration of microbiome profiles into cancer diagnostics and treatment is poised to enhance the prediction of disease risk and the personalization of therapeutic interventions.

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Symposium (13) Microbiota and Cancer

Microbiota and Stomach Cancer Chieh-Chang Chen Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Gastric cancer (GC) is a prevalent malignancy and a leading cause of cancer-related deaths globally.

A unique feature of GC is its close relationship with the commensal microbial community. While Helicobacter pylori is well-known for initiating gastric carcinogenesis, growing evidence suggests that other microbes in the gastric mucosa significantly contribute to disease progression.

Dysregulation of gastric microbiota appears to play crucial roles throughout the carcinogenic process, from the formation of precancerous lesions to

the development of gastric malignancy. We will summarize the current understanding of the role of gastric microbiota in GC development. It also explores the potential clinical applications of gastric microbes in diagnosing, prognosing, and treating GC, while addressing existing conceptual ambiguities and limitations. Finally, the review emphasizes that modulating the microbial community represents a promising new approach for preventing and managing GC, warranting further in-depth research.

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Symposium (13) Microbiota and Cancer

Microbiota and Colon Cancer Deng-Chyang Wu Division of Gastroenterology, Department of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan The gut microbiota, composed of a complex community of microorganisms including bacteria, viruses, fungi, and archaea, plays a crucial role in maintaining intestinal homeostasis and overall health. Recent studies have revealed a strong correlation between alterations in the gut microbiota and the development of colorectal cancer (CRC). The composition and diversity of the gut microbiota can influence host metabolism, immune responses, and the intestinal microenvironment, which are all critical in the pathogenesis of colorectal cancer.

In a healthy gut, the microbiota exists in a balanced state, supporting normal physiological functions. However, dysbiosis, or microbial imbalance, can occur, allowing certain pathogenic strains to thrive and promote carcinogenesis. For instance, Fusobacterium nucleatum and Bacteroides fragilis have been identified as key players in CRC. Fusobacterium nucleatum is known to promote tumorigenesis by inducing inflammatory responses and modulating immune cells, while Bacteroides fragilis produces a toxin that can disrupt cell signaling pathways, leading to cancerous growths.

Moreover, gut microbiota contributes to shaping the tumor microenvironment and can affect the immune system’s ability to recognize and eliminate cancer cells. Short-chain fatty acids (SCFAs), such

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as butyrate, produced by beneficial bacteria, have protective effects against cancer by promoting apoptosis and inhibiting cell proliferation. Conversely, a lack of SCFAs can lead to chronic inflammation, which is a known risk factor for CRC. While the exact mechanisms by which microbiota influence colorectal cancer are still under investigation, current evidence suggests that modifying the gut microbiota may offer potential therapeutic and preventive strategies. Interventions such as probiotics, prebiotics, or fecal microbiota transplantation (FMT) are being explored to restore microbial balance and reduce CRC risk. Further research into personalized microbiota-based treatments holds promise for improving therapeutic outcomes and minimizing side effects in colorectal cancer patients.

Conclusion: Gut microbiota plays a significant role in the initiation, progression, and treatment response of colorectal cancer. Understanding the complex interactions between microbiota and host cells could lead to innovative approaches in cancer prevention and therapy, with a focus on modulating the gut microbiome to maintain intestinal health and reduce cancer risk.

2024 TDDW

Symposium (14) Breakthroughs in Innovative EUS-Guided Therapies for GI Diseases

Revolutionizing Gallbladder Drainage: Advanced EUS Techniques and Patient Selection Akio Katanuma Center for Gastroenterology, Teine-Keijinkai hospital, Sapporo, Japan EUS-guided gallbladder drainage is the alternative treatment for gallbladder decompression.

EUS-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of surgery. In addition, in patients who cannot undergo cholecystectomy, EUS-GBD has been successfully described as both definitive therapy and a bridge to surgery. The procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events, making it a safe and effective option for appropriate candidates. Endoscopic transpapillary gallbladder drainage (ET-GBD) has comparable efficacy with percutaneous drainage and shorter hospitalization periods. However, this procedure can be technically challenging or fail since cystic duct

obstruction by either inflammation, or a stone is common. There is still a lot of controversy regarding the indications and techniques.

The early complication rate was relatively high mainly due to biliary peritonitis and delayed perforation, and the late complication due to duodenal ulcer and gallbladder bleeding. Although, the success rate was the same, the procedure time was significantly shorter when these cases were compared with trans-papillary drainage of the gallbladder using propensity score matching. EUSGBD may be a useful procedure, but the selection of indication, deploying the stent, and even the safety of the procedure will need to be discussed in the future.

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2024 TDDW

Symposium (14) Breakthroughs in Innovative EUS-Guided Therapies for GI Diseases

Cutting-Edge EUS-Guided Gastroenterostomy: A Contemporary Approach to Gastric Outlet Obstruction Management Yu-Ting Kuo Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University College of Medicine, Taipei, Taiwan In recent years, endoscopic enteral stenting have provided an attractive alternative to surgery for palliation of malignant gastric outlet obstruction (GOO). Several studies have assessed the clinical and technical success rates of endoscopic enteral stenting for malignant gastroduodenal obstruction.

Technical success rates of 90% to 100% and clinical success of 80% to 95% was achieved. The procedure was associated with quicker recovery and reduced morbidities as compared to surgical gastrojejunostomies. However, the long-term patency of uncovered stent is limited by the risk of tumor ingrowth that would lead to subsequent re-stenosis of the stents requiring re-intervention.

Thus, to palliate malignant gastric outlet obstruction, surgical gastrojejunostomy is preferred in patients that are fit for surgery with prolonged life expectancy whilst insertion of enteral stent is preferred in patients that are associated with highrisk for surgery and short life expectancy.

A recent advancement, endoscopic ultrasonography-guided gastroenterostomies (EUSGE), utilizing a lumen-apposing self-expandable metal stent (LAMS), offers a durable and minimally invasive solution for GOO. EUS-GE was initially hypothesized and tested in animal models by Fritscher-Ravens in 2002. This technique has progressively evolved; it involves the creation of a bypass between the stomach and a small bowel limb placed distal to the obstruction, through the insertion of a lumen-apposing metal stent (LAMS) under EUS and fluoroscopic guidance. EUS-GE creates a food

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pathway shortcut akin to surgical bypass, providing longer stent patency compared to standard duodenal stenting; furthermore, EUS-GE is theoretically less invasive than surgical gastroenterostomy (SGE).

The EUS-GE technique’s evolution from clinical trials and animal experiments, yielding three main techniques: (1) the direct technique; (2) deviceassisted techniques; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. In the general principle, the small intestinal tract intended for stent deployment should be adjacent to the stomach. A preprocedural computed tomography scan in both transverse and coronal view is helpful in deciding on the puncture site as a preoperative roadmap. It should be cautious to perform EUS-GE in the presence of a large amount of ascites, which interferes with the adherence and fixation of the bowel loops. This procedure remains unoptimized, with some limitations that need to be overcome.

All reports of EUS-GE have been published only by experts of the procedure because the currently followed procedure is technically difficult and must be improved and simplified further to facilitate its use in clinical practice. LAMS design must also be improved because the currently available LAMSs have a maximum diameter that does not appear to be appropriate for EUS-GE, which usually requires a bigger anastomosis and minimal risk of stent obstruction and migration.

References: 1. Carbajo AY, Kahaleh M, Tyberg A. Clinical Review

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2.

3.

4.

5.

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of EUS-guided Gastroenterostomy (EUS-GE). J Clin Gastroenterol. 2020;54(1):1-7.

Ly J, O’Grady G, Mittal A, et al. A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc. 2010;24:290-7.

Binmoeller KF, Shah J. A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy.

2011;43:337-342.

Khashab MA, Kumbhari V, Grimm IS et al. EUSguided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc.

2015;82:932-938.

Iqbal U, Khara HS, Hu Y, Kumar V, Tufail K, Confer B, Diehl DL. EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis. Endosc Ultrasound. 2020 Jan-Feb;9(1):16-23.

Bronswijk M, Vanella G, van Malenstein

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H, Laleman W, Jaekers J, Topal B, Daams F, Besselink MG, Arcidiacono PG, Voermans RP, Fockens P, Larghi A, van Wanrooij RLJ, Van der Merwe SW. Laparoscopic versus EUSguided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score-matched comparison (with video). Gastrointest Endosc. 2021 Sep;94(3):526536. van Wanrooij RLJ, Bronswijk M, Kunda R, Everett SM, Lakhtakia S, Rimbas M, Hucl T, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, PérezMiranda M, van Hooft JE, van der Merwe SW. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. 2022 Mar;54(3):310-332.

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2024 TDDW

Symposium (14) Breakthroughs in Innovative EUS-Guided Therapies for GI Diseases

Elite EUS-Guided Pancreatic Drainage: Solving Complex Cases Beyond Conventional Methods Cheuk-Kay Sun Department of Hepato-Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan In the management of symptomatic pancreatic duct obstruction or leakage, conventional approaches like endoscopic or surgical drainage have long been established. Endoscopic transpapillary (or trans-anastomotic) drainage is typically preferred as a first-line intervention due to its minimally invasive nature. However, this method can pose significant technical and anatomical challenges in complex scenarios, such as complete pancreatic duct obstruction in chronic pancreatitis, disconnected duct syndrome following severe acute pancreatitis or trauma, duodenal strictures, or surgically altered anatomy. In such cases, surgical or, more rarely, percutaneous pancreatic duct drainage (PD) becomes necessary as an alternative.

Recent innovations in interventional endoscopic ultrasound (EUS) have dramatically expanded the scope of pancreatic drainage. EUS now allows access to critical structures like the biliary system, pancreatic fluid collections, abdominal abscesses, and even the pancreatic duct in situations where conventional endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. First pioneered in 1995

by Harada et al., EUS-guided pancreatography opened the door to more advanced techniques.

By 2002, EUS-guided pancreatic duct drainage (EUS-PD) was introduced, combining rendezvous

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and transmural drainage techniques. Since then, despite its complexity, EUS-PD has gained traction in managing challenging pancreatic conditions, though the majority of research remains in the form of case reports and series.

EUS-PD is now recognized as a highly effective option for conditions such as pancreatic duct obstruction, pancreatic leakage, and disconnected duct syndrome. It is often employed following a failed ERCP, especially in cases where normal anatomy is present. However, in patients with anatomical challenges—such as duodenal obstruction or surgically altered anatomy—EUSPD may be considered as a first-line intervention.

Contraindications for EUS-PD include the inability to visualize the pancreatic duct using EUS, the presence of intervening vessels, severe coagulopathy, or an unstable general condition precluding endoscopic procedures. Additionally, EUS-PD carries risks, such as pancreatic fistula or peritonitis, particularly in patients with significant ascites, and careful evaluation of these risks is crucial.

This presentation will explore the application of EUS-PD in resolving complex pancreatic duct cases where traditional methods fall short, highlighting the technical advances and clinical outcomes of this cutting-edge procedure.

2024 TDDW

Gastroenterology Debrief Gastroenterology Debrief: DDW & WEO 2024 Wei-Chen Tai Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Digestive Disease Week (DDW) and the World Endoscopy Organization (WEO) conference in 2024.

DDW (Digestive Disease Week) is one of the most significant annual conferences for professionals in gastroenterology, hepatology, endoscopy, and related fields. It serves as a platform for presenting new research, discussing clinical practices, and sharing advances in diagnostics and treatment. WEO (World Endoscopy Organization) is a global body focused on advancing endoscopic

practices. Its conferences often include updates on the latest techniques, technologies, and guidelines in endoscopy, as well as initiatives for global health improvement through endoscopy. This debrief would typically cover: Major research findings presented at both events. Innovations in diagnostic and therapeutic endoscopy. Updates on treatment guidelines for gastrointestinal diseases (e.g., IBD, gastroenterology, endoscopy).

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2024 TDDW

Global & Taiwanese Guideline Chronic Hepatitis B, C and D Pin-Nan Cheng Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan The criteria of treatment for chronic hepatitis B tends to broaden in order to include more patients receiving oral nucleos(t)ide analogue (NA) and aiming to achievie viral suppression. However, debate remains and new evidence are needed.

Hepatitis B virus (HBV) viral load, ALT, and liver fibrosis stage are the three most important factors to initiate antiviral treatment. Besides, NA treatment also could apply to various population of HBV infection, such as HBV prophylaxis for immunosuppressive therapy and vertical transmission, long-term treatment for cirrhosis, second prevention following curative treatment of hepatocellular carcinoma, and so on.

As the advent of direct acting antivirals (DAA), more than 95% of hepatitis C virus (HCV) infected subjects can achieve viral clearance. Currently, recommended guidelines from various societies are quite similar. All of HCV viremic patients, regardless of their comorbidities, should be treated with

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pan-genotypic DAAs. Nowadays, treatment and prevention of HCV re-infection for special groups of patient and post-sustained virologic response monitoring are the issues should be focused on.

Currently, only one guideline/statement of hepatitis D virus (HDV) infection is launched. It recommends that all HBsAg-positive subjects should be screened for HDV infection. Surveillance strategy is similar to that of HBV infection. A 48-week pegylated interferon is recommended for patients with compensated liver disease including cirrhosis.

Bulevirtide, only approved by EMA in Europe, is indicated for patients with compensated liver disease and is an alternative treatment option for those who are contraindicated or intolerable to pegylated interferon. Bulevirtide also can be an option for long-term suppression of HDV. However, more data is necessary to define its role in decompensated liver disease and long-term treatment.

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Global & Taiwanese Guideline Fatty Liver and Metabolic Disorder Jee-Fu Huang Hepatitis Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Steatotic liver disease (SLD) is now the major cause of chronic liver disease, and also leading to the main etiology for liver-related outcomes. NAFLD per se is associated with extrahepatic manifestations such as chronic kidney disease, cardiovascular disease and sleep apnea. In 2022, metabolic dysfunction-associated steatotic liver disease (MASLD) has been proposed as a new definition for patients with NAFLD, which was endorsed by the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) and other major societies. The new nomenclature is based on an affirmative and non-stigmatizing approach. SLD was chosen as an overarching term to encompass the various etiologies of steatosis. NAFLD was renamed MASLD, encompassing patients who have hepatic steatosis and have at least one cardiometabolic risk factor. All the above-mentioned efforts for the precise definition of the metabolic liver disease imply not only the clinical importance but also the heterogenicity of the complex metabolic disease.

Metabolic dysfunction-associated steatohepatitis (MASH), an extreme form of MASLD had higher overall mortality compared with controls, and most deaths were due to cardiovascular events.

MASH has been a histologically defined disease, characterized by hepatic steatosis, ballooning, and lobular inflammation with variable fibrosis. MASH is also a potentially progressive liver disease that can lead to cirrhosis, hepatocellular carcinoma, liver transplantation, and death. It’s commonly associated with related metabolic diseases, leading to cardiovascular events as its leading cause of death.

The metabolic disorders include abdominal obesity, hypertension, dyslipidemia and insulin resistance (IR) and further increase the risk of cardiovascular disease (CVD), T2DM and chronic kidney disease. The scenario of a higher overall mortality due to CVD as compared with controls has made it a critical global issue.

The surveillance strategy, risk stratification of management, and current therapeutic achievements of metabolic liver disease remain the major pillars in a clinical care setting. Therefore, the Taiwan Association for the Study of the Liver (TASL), Taiwanese Association of Diabetes Educators, Taiwan Society of Cardiology (TSOC), and Diabetes Association of Taiwan collaboratively completed the first two guidance papers in MASLD patients with T2DM or CVD, which provides practical recommendations for patient care.

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2024 TDDW

Global & Taiwanese Guideline Practical Guideline for Evaluation and Management of Small Bowel Bleeding Chia-Jung Kuo Department of Gastroenterology and Hepatology.

Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan Gastrointestinal (GI) bleeding is a common clinical problem encountered in both the inpatient and outpatient settings. Although the evaluation of upper and lower GI bleeding is often straightforward, bleeding from the small bowel may pose a clinical challenge. Bleeding from the small bowel remains a relatively uncommon event, accounting for 5–10% of all patients presenting with GI bleeding.

In order to provide a practical guideline to evaluation and management of suspected small bowel bleeding, Taiwan Association for the Study of Small Intestinal Diseases (TASSID) conduct face-toface meetings to review the most current information and evidence. The statements of recommendation

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were formulated after discussion and voting by committee members. In this practical guideline, we will review the terminology regarding small bowel bleeding and differential diagnosis, modalities for evaluation of presumed of small bowel bleeding, endoscopy for small bowel bleeding and medical treatment.

Clinicians should be able to identify common causes of small bowel bleeding, understand the advantages and disadvantages of the modalities used to evaluate small bowel bleeding, and enact a stepwise management approach to the patient with presumed small bowel bleeding.

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Global & Taiwanese Guideline HCC I-Cheng Lee Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Hepatocellular carcinoma (HCC) remains a critical global health challenge, necessitating ongoing refinement of clinical guidelines and international collaboration to improve patient outcomes. Both global and region-specific guidelines play pivotal roles in shaping HCC management strategies. The Taiwan Liver Cancer Association (TLCA), a leader in the field, has developed comprehensive, evidencebased recommendations tailored to the unique healthcare landscape. This presentation explores the recent updates to both global and TLCA HCC guidelines, focusing on key revisions and novel

insights aimed at optimizing patient care. These updates address various facets of HCC management, including surveillance, diagnosis, staging, and treatment modalities. By integrating cutting-edge advancements in diagnostic technology, prognostic markers, and therapeutic approaches, the updated TLCA guidelines seek to enhance the precision and effectiveness of HCC management. Through an in-depth review of these guideline revisions, this speech aims to equip hepatologists with the latest evidence-based strategies to advance HCC care, both in Taiwan and globally.

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Global & Taiwanese Guideline Screening and Eradication of H. pylori Infection for Gastric Cancer Prevention – The Taiwan Consensus Report Jyh-Ming Liou Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan Department of Internal Medicine, Ntional Taiwan University Hospital, Taipei, Taiwan Gastric cancer remains one of the top ten causes of cancer-related deaths in Taiwan. Despite a decline in age-standardized mortality rates, the incidence of new cases has not decreased due to the aging population, Non-invasive detection methods for H. pylori include the carbon-13 urea breath test, stool antigen test, and serological testing. Invasive procedures that require gastric endoscopy and biopsy, such as histological examination, rapid urease test, and H. pylori culture, are also commonly used.

Eeradication of H. pylori after endoscopic resection of early-stage gastric cancer patients can prevent the development of metachronous gastric cancer.

Eradication therapy also lowers future gastric cancer risks in individuals with a family history of the disease and reduces incidence rates in high-risk regions.

Community-level H. pylori screening and eradication strategies for moderate- to high-risk populations can be considered as part of healthcare policy.

However, the success of these programs depends on factors like invitation methods, participation rates, test accuracy, and eradication success. Since H. pylori is transmitted orally, often through family members during childhood, screening and treating entire families can improve detection, treatment adherence, and lower reinfection risk.

In Taiwan, antibiotic resistance to clarithromycin and levofloxacin in H. pylori is about 15–20%.

As a result, first-line treatment typically involves

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quadruple therapy: either 10-14 days of bismuthbased therapy or 14 days of non-bismuth therapy.

In areas with lower clarithromycin resistance, 14day triple therapy is an acceptable alternative.

For patients allergic to penicillin, bismuth-based quadruple therapy is recommended. Antibiotic susceptibility testing can help tailor the treatment plan, especially in cases of resistant infections. After H. pylori treatment, confirming the eradication’s success is essential. For second-line therapy, bismuth-based quadruple or levofloxacin-containing therapies are viable options. For penicillin-allergic patients, antibiotic selection based on susceptibility results is advised when possible. Empiric treatments involving levofloxacin combinations are also recommended.

For patients who do not respond to two rounds of treatment, further antibiotic choices should be guided by susceptibility tests or high-dose proton pump inhibitor-based quadruple therapy for 14 days. For individuals with a family history of gastric cancer, abnormal serum pepsinogen levels, or clinical warning signs, regular endoscopic monitoring is advised to track gastric mucosal changes. Patients with precancerous lesions such as atrophic gastritis, intestinal metaplasia, or post-gastrectomy conditions should also undergo regular endoscopic surveillance following H. pylori eradication to reduce the risk of progression to gastric cancer.

2024 TDDW

Young Investigator Award (YIA) ①

THE IMPACT OF METABOLIC DYSFUNCTION BURDEN ON METACHRONOUS COLORECTAL NEOPLASM AMONG MASLD PATIENTS

Wei-Yuan Chang1, Husan-Ho Lin2, Hao-Yu Wu3, Li-Chun Chang1, Wen-Feng Hsu1, Ming-Shiang Wu1, Han-Mo Chiu1 Department of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Gastroenterology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan 3 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

代謝異常程度於代謝性脂肪肝（MASLD） 族群對於異時性大腸直腸腫瘤生成之影 響 張為淵1 林宣合2 吳浩宇3 張立群1 許文峰1 吳明賢1 邱瀚模1 1

國立臺灣大學醫學院附設醫院消化內科 國立臺灣大學醫學院附設醫院新竹臺大分院消化內 科 3 國立臺灣大學醫學院附設醫院癌醫中心分院綜合內 科 2

Background: Metachronous colorectal neoplasms (meta-CRN) and advanced neoplasms (meta-ACRN) occur more frequently in subjects with metabolic dysfunction after polypectomy, and exercise has been associated with a reduced risk (Chang et al., Dig Endosc 2022). The new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) comprises patients with varying degrees of metabolic dysfunction, whereas its association with meta-CRN is unknown.

Aims: To examine the association between the degree of metabolic dyncfuntion burden of MASLD patients and the risk of meta-CRN and whether a primary prevention against meta-ACRN could be achieved by treating the metaboluc dysfunction for MASLD patients Methods: Average-risk subjects aged ≥ 40 years who underwent screening and surveillance colonoscopy between January 2009 and December 2021 were retrospectively enrolled. The baseline and follow-up statuses of metabolic profiles of each subject were obtained on the date of screening and surveillance

colonoscopy, respectively. Hepatic steatosis was diagnosed by abdominal ultrasound on the date of colonoscopy. MASLD was defined according to the current guideline (Hepatic steatosis plus at least one of five metabolic factors, Rinella ME et al., Hepatology 2023). The degree of baseline metabolic dysfunction burden was defined by the number of factors each subject had on the date of screening, and the improvement of such dysfunction was defined as those who had a reduced number of factors at the surveillance day. The risk of meta-CRN was analyzed

by Kaplan-Meier analysis. Cox regression models were constructed for multivariate analysis.

Results: A total of 2,331 subjects fulfilling the definition of MASLD and having at least one adenoma on screening colonoscopy were enrolled in this study. Another 942 subjects with hepatic steatosis but none of metabolic factor was defined as simple hepatic steatosis group and served as reference group. There were 1067 subjects with mild (score 1-3) and 1264 subjects with marked (score 4-5) metabolic dysfunction. Among MASLD subjects, 723 and 393 subjects achieved a reduced/improved metabolic dysfunction with one and ≥2 score reduction, whereas the remaining 1215 subjects showed no metabolic dysfunction improvement.

In the multivariable analysis, each one metabolic factor increment was associated with a 7% increase in meta-CRN risk (adjusted hazard ratio (aHR): 1.07; 95% confidence interval (CI) = 1.03-1.10). On the other hand, ≥2 metabolic dysfunction burden score reduction after surveillance interval was associated with 33% and 51% risk reduction of meta-CRN and meta-ACRN. Among all these metabolic factors, abnormal serum triglyceride (TG) level served as the strongest predictive factor for meta-CRN (aHR: 1.17; 95% CI = 1.04-1.32) and a success TG control was associated with a significant reduction of meta-CRN (aHR: 0.80, 95% CI: 0.67-0.96) and meta-ACRN (aHR: 0.44, 95% CI: 0.23-0.84) risk.

Conclusions: The severity of metabolic dysfunction burden in MASLD patients is positively associated with the risk of meta-CRN after polypectomy.

An improved metabolic dysfunction during the surveillance interval is associated with a reduced risk of meta-CRN and meta-ACRN and treating abnormal serum triglyceride level is the most effective prevention strategy against metachronous neoplasm among MASLD patients.

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TOPOGRAPHICAL PROFILING OF HELICOBACTER PYLORIC PATHOGENIC PATHWAYS: SEMI-QUANTIFIED ANALYSIS OF INFLAMMATION AND PREMALIGNANT CHANGES IN GASTRIC TISSUE

Tzu-Chan Hong1,3, Chen-Tu Wu2, Yih-Leong Chang2, Yen-Lin Huang2, Yu-Ting Chen2, Chan-Yi Lin3, Jyh-Ming Liou1,3, Ming-Shiang Wu3 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

描繪幽門螺旋桿菌致病途徑的空間分析： 胃組織中炎症和癌前變化的半定量研究 洪子瞻1,3 吳振都2 張逸良2 黃彥霖2 陳毓婷2 林展毅3 劉志銘1,3 吳明賢3 1

台大醫院癌醫分院綜合內科部 台大醫院癌醫分院病理部 3 台大醫院內科部 2

Background: The Correa sequence describes the progression of gastric pathogenesis, beginning with Helicobacter pylori infection and advancing through stages of acute and chronic inflammation, atrophic gastritis, and intestinal metaplasia.

Endoscopic evaluations and mapping biopsies are recommended for high-risk individuals, guided by the updated Sydney protocol. While previous studies have focused on the severity of pre-malignant lesions, the interactions between various histopathological characteristics within this sequence remain underexplored.

Aims: This study aims to utilize topographical profiling of updated Sydney gastric mapping protocol to semi-quantify these relationships and to enhance our understanding of the pathological progression of Correa sequence.

Methods: This retrospective cohort study included patients undergoing routine endoscopic evaluations at National Taiwan University Cancer Center from April 2022 to August 2023. Using the updated Sydney protocol, targeted biopsies from

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the antrum and body were analyzed for H. pylori infection, neutrophils, mononuclear cells, atrophy, and intestinal metaplasia. Data analysis involved K-means clustering, Multiple Correspondence Analysis, Spearman correlation, and Structural Equation Modeling.

Results: Our study analyzed 406 patients, with an average age of 64, revealing a detailed landscape of gastric pathology. We identified three distinct histopathological subtypes in the antrum: chronic gastritis, inflammatory, and premalignant. The chronic gastritis subtype exhibited minimal H. pylori infection and low inflammation levels. The inflammatory subtype showed high H. pylori activity, severe acute and chronic inflammation, and mild atrophy. The premalignant subtype was characterized by higher degrees of chronic inflammation and intestinal metaplasia, despite mild atrophy. In the gastric body, similar subtypes emerged, though with fewer cases in the inflammatory group. Age adjusted correlation analyses showed strong correlations between H. pylori levels and both acute and chronic inflammation in the antrum. Chronic inflammation correlated weakly with atrophic gastritis, and atrophic gastritis correlated weakly with intestinal metaplasia. Interestingly, in the gastric body, atrophic gastritis and intestinal metaplasia exhibited a stronger correlation. We further constructed a two layered correlation network antrum and body pathologies connected through inflammations but not premalignant lesions. To further highlight the strength of each pathway in the Correa sequence, categorical structural equation modeling analyses delineated the causal relationships and their magnitudes, tracing the progression from infection to acute and chronic inflammation, atrophic gastritis, and ultimately intestinal metaplasia.

Conclusions: This study provides the first comprehensive spatial analysis of H. pyloriinduced gastric pathology, revealing distinct histopathological subtypes and their interrelationships. The topographical profiling approach offers valuable insights into the progression of gastric lesions, potentially guiding future diagnostic and therapeutic strategies.

2024 TDDW

③

INTESTINAL INTEGRITY, METABOLIC SWITCHING, AND HOSTMICROBIOTA INTERACTION IN THE EARLY STAGE OF ALCOHOL-INDUCED INJURY

Cheng-Hao Kuo1,2, Hsiao-Ping Chen3,4,5,6, Chi-Yu Lai3,4, Li-Ling Wu3,4,7, Chun-Ying Wu2,3,4,5,6 Ph.D. Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 2 School of Medicine, National Yang Ming Chiao Tung University, Taiwan 3 Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan 6 Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan 7 Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

探討酒精性病變前期腸道完整性、代謝 轉換、宿主腸道菌叢交互作用之變化 郭正浩1,2 陳筱萍3,4,5,6 賴麒宇3,4 吳莉玲3,4,7 吳俊穎2,3,4,5,6 1

國國立陽明交通大學跨領域醫學博士學位學程 國立陽明交通大學醫學系 3 國立陽明交通大學健康創新中心 4 國立陽明交通大學微菌叢研究中心 5 國立陽明交通大學生物醫學資訊研究所 6 臺北榮民總醫院醫學研究部轉譯研究科 7 國立陽明交通大學生理學科暨研究所 2

Background: Evidence has pinpointed the role of gut microbiota in alcohol-associated liver disease (ALD), as susceptibility to alcohol-induced liver injury could be transmitted from ALD patients to mice via fecal microbiota transplantation (FMT). Changes in the microbial composition of ALD-associated dysbiosis could not fully explain the mechanism of liver injury and bacterial translocation present in ALD patients and animal models. We hypothesize that alcohol causes a second hit on the gut-epithelial barrier to allow an influx of dysbiotic content, leading to ALD development.

Aims: We emphasize the metabolic effects of

alcohol on intestinal host-microbiota interface.

Alcohol induces metabolic stress and alters the metabolome in the gut, and metabolic switching has been demonstrated to disrupt gut integrity and the epithelial barrier’s ability to regulate gut microbiota.

Here, we investigate the metabolic effects of alcohol on epithelial homeostasis and the dynamics of gut microbiota.

Methods: Ad libitum alcohol was made available to mice in drinking water for 3-7 days. Body weight, drinking volume, and serum markers were assessed to monitor systemic effects. After sacrifice, gut length and organ weight were measured, and intestinal tissue was collected to analyze the metabolic status and cell population. The expression of genes involved in gut integrity, proliferation/ differentiation, and cell metabolism was evaluated.

Ileal luminal and mucosal samples were collected for microbial analysis.

Results: Alcohol- and pair-fed mice had similar gut length and organ weight, suggesting no significant systemic effect of alcohol. Serum ALT and AST levels did not differ between two groups after three days of alcohol feeding but were increased in the alcoholfed group after one week. We observed increased epithelial proliferation without a corresponding increase in apoptosis after alcohol feeding, indicating alcohol-induced proliferation rather than a compensation for cell turnover. Differential gene expression analysis demonstrated disrupted intestinal metabolism of fatty acids after alcohol exposure. Expression of genes involved in microbial regulation of specialized cells was downregulated in alcohol-fed groups. Compositional change was shown in both luminal and mucosal microbiota, as α-diversity of mucosal microbiota decreased more significantly than luminal microbiota after alcohol exposure. The gut microbiota of alcoholfed mice also showed a stronger similarity, with a more significant alcohol-associated signature in the luminal microbiota.

Conclusions: Alcohol-induced injury is accompanied by metabolic alterations in the gut epithelium, leading to induced proliferation and impaired differentiation that compromise mucosal defense.

We showed that alcohol is a strong determinant of the microbiota, which may stem from the disrupted mucosal defense and gut integrity after alcohol exposure. These results imply that alcohol causes a second hit on the gut-epithelial barrier through metabolic effects, potentially contributing to ALD.

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④

ASSOCIATION OF THE SLC30A8 RS13266634 VARIANT WITH THE COLORECTAL CANCER RISK IN THE TAIWANESE POPULATION

Chun-Kang Lee1, I-Chieh Chen2, Yin-Cheng Lin1, Yi-Ming Chen2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan 3 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 1

SLC30A8 rs13266634 變異與台灣族群大 腸直腸癌風險的關聯 李俊康1 陳怡潔2 林穎正1 陳一銘2,3 1

臺中榮民總醫院胃腸肝膽科 臺中榮民總醫院醫學研究部 3 臺中榮民總醫院過敏免疫風濕科 2

Background: Metabolic syndrome (MetS) is linked to an increased risk of colorectal cancer (CRC), with various single-nucleotide polymorphisms (SNPs) associated with MetS. However, whether SNPs related to MetS are also associated with CRC risk has not been systematically addressed.

Aims: To explore the relationship of MetS-associated SNPs and CRC risk.

Methods: This cross-sectional study enrolled a total of 58,091 Taiwanese participants, including 1,206 patients with CRC, using data from the Taiwan Precision Medicine Initiative (TPMI) database at Taichung Veterans General Hospital.

The study collected genotyping information using the Affymetrix TWB 2.0 genome-wide SNP Array. Selected 2129 MetS-associated SNPs from previous GWAS databases were compared with TPMI data. Subsequently, 43 SNPs were chosen for a case-control study, and unadjusted analyses were performed. Three SNPs (rs4923461, rs7395662, and rs13266634) showed significance. A total of 1,206 CRC subjects and 4,824 age-gender matched controls were assessed the association between SNPs and the risk of CRC was evaluated using logistic regression models.

Results: Among the 58,091 participants, 26,655

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had no diagnosis of cancer or MetS, while 1,206 participants were diagnosed with CRC. The carrier ratios of the MADD-FOLH1 rs7395662 and SLC30A8 rs13266634 variants were significantly higher in CRC patients, at 72.5% and 73.37% respectively (p = 0.015 and p = 0.002). In contrast, the carrier frequency of BDNF-AS rs4923461 was significantly higher in participants without cancer or MetS (72.04%, p = 0.010). Among these three SNPs, participants carrying the SLC30A8 rs13266634 G allele showed a significantly higher CRC risk (OR: 1.01, 95% CI: 1.0041.195, p = 0.040) compared to those with the A allele.

No significant differences were found in terms of age, gender, smoking, alcohol consumption, tumor markers, tumor location, pathology, clinical staging, or mortality.

Conclusions: In this cohort study, we confirmed the importance of the SLC30A8 rs13266634 G allele with an increased risk of CRC. The pleiotropic effects of this SNP on both MetS and CRC risk offer valuable insights for precision health strategies.

2024 TDDW

⑤

CONVENTIONAL AND MACHINELEARNING BASED RISK SCORE ON SURVIVAL FOR PATIENTS WITH HEPATOCELLULAR CARCINOMA

Yu-Fu Chen1, Chien-Wei Su2,3,4, Chun-Ting Ho1, Elise Chia-Hui Tan5, Yi-Hsiang Huang1,3,4, Ming-Chih Hou1,3, Jiing-Chyuan Luo1,3, Jaw-Ching Wu4 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Department of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 3 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 Department of Health Service Administration, College of Public Health, China Medical University, Taichung, Taiwan 1

機器學習發展之風險評分對肝細胞癌患 者存活的預測 陳昱甫1 蘇建維2,3,4 何俊廷1 譚家惠5 黃怡翔1,3,4 侯明志1,3 羅景全1,3 吳肇卿4 1

臺北榮民總醫院胃腸肝膽科 臺北榮民總醫院一般內科 3 國立陽明交通大學醫學系 4 國立陽明交通大學臨床醫學研究所 5 中國醫藥大學醫務管理學系 2

Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver with a high mortality rate. Accurate prognostic assessment is crucial for guiding treatment decisions and improving patient outcomes. Non-invasive biomarkers, easily obtainable from blood samples and imaging at diagnosis, offer a promising alternative for prognostic evaluation. Recent advancements in machine learning (ML) have shown potential in enhancing the predictive accuracy of these biomarkers.

Aims: To evaluate the prognostic predictability of non-invasive biomarkers and develop a machinelearning (ML)-based risk score using conventional methods and machine-learning (ML) to categorize HCC patients into distinct prognostic groups.

Methods: A total of 4038 HCC patients from BCLC stage 0 to D diagnosed at Taipei Veterans General Hospital from 2012 to 2023 were retrospectively enrolled in the study. The patients were divided into training cohort (n = 2827) and validating cohort (n = 1211) randomly. The primary endpoint was overall survival (OS). Non-invasive biomarkers, obtained through blood sample and image at diagnosis, were analyzed by both conventional method (Cox proportional hazards model) and ML-based method (LASSO Cox regression) to determine their prognostic predictability. In the training cohort, factors showing significance in both conventional method and ML-based method were enrolled in the ML- based risk score. The risk score was computed by utilizing coefficients from the Multivariate Cox proportional hazard model and were standardized to a score ranging from 0 to 100. Patients were than categorized into three risk groups (high, medium, and low risk) based on the 33rd and 66th percentiles.

The risk score’s efficacy was subsequently validated in the validation cohort.

Results: After a median follow-up of 42.0 months (interquartile range IQR 33.6-50.4 months), 1931 patients died, and the 5-year OS rate was 26.0%. Both conventional and ML-based method identified the same 11 factors as significant predictors (Age, curative treatment, extrahepatic metastasis, maximum tumor size, serum albumin, serum creatinine, serum bilirubin, serum aspartate aminotransferase (AST), Lymphocyte-to-monocyte ratio (LMR), albumin bilirubin (ALBI) grade and alpha fetoprotein (AFP) level). The risk score developed accordingly demonstrated excellent predictive ability for patients’ overall survival (AUC = 0.800) and showed outstanding predictability for survival within the first five years post-diagnosis (AUC: 0.873 to 0.890). Furthermore, the ML-based risk score can efficiently stratify patients into three different risk groups with significant difference on overall survival (p < 0.001).

Conclusions: The ML-based risk score, derived from non-invasive biomarkers through conventional and ML-based methods, can effectively stratify HCC patients into different prognostic groups and aid clinicians in personalized disease management.

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ANALYSIS OF PROTEOMICS OF HEPATOCYTE EXOSOMES IN THE PROGRESSION OF NAFLD

En-Sheng Lin1, Shu-Chi Wang1,2,3,4,5 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 4 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 5 Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan 1

對於肝細胞外泌體在非酒精性脂肪肝疾 病的進展的蛋白質體學分析 林恩陞1 王述綺1,2,3,4,5 1

高雄醫學大學醫學檢驗生物技術學系 高雄醫學大學液態檢測中心 3 高雄醫學大學醫學研究所 4 高雄醫學大學附設醫院醫學研究部 5 國立中山大學代謝異常脂肪肝卓越研究中心 2

Background: Non-alcoholic fatty liver disease (NAFLD) has complex etiological factors, and to date, no effective diagnostic and therapeutic strategies have been developed. Without proper detection and proactive treatment, there is a high likelihood that NAFLD will progress to non-alcoholic steatohepatitis (NASH), causing inflammation and necrosis of hepatocytes. If NASH remains untreated, it can become an irreversible condition, further developing into fatal liver diseases such as cirrhosis and liver cancer. Therefore, by analyzing serum exosome proteins, we hope to identify biomarkers for the early diagnosis of NAFLD. Aims: In order to develop new non invasive biomarkers for diagnosing and predicting the diseases.

Methods: (1) Animal Model: C57BL/6J mice (scientific name: Mus musculus) were used as the experimental animals. These mice were divided into two groups, with the first group being fed for normal diet and the second group for western diet. (2) Dietary Groups: Normal Diet Group (ND): These mice were fed the Altromin 1310 diet and provided with double-distilled H₂O as their daily drinking water.

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Western Diet Group (WD): These mice were fed a specific diet (TD.120528), which is known to induce non-alcoholic fatty liver disease (NAFLD/NASH), and were provided with a syrup containing fructose and glucose as their drinking water. 3. Protein Analysis: Protein analysis was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The digested protein peptides were diluted in buffer A containing 0.1% formic acid and then loaded onto a reverse-phase column for further separation. The desalted peptides were separated on a homemade column using a multi-step gradient of buffer B (99.9% acetonitrile/0.1% formic acid).

Mass spectrometry analysis was conducted using an Orbitrap Elite ETD mass spectrometer, which included both full-scan and MS/MS analysis. Internal mass calibration was performed, and dynamic exclusion of certain ion signals was applied. 4.Protein data were analyzed using the STRING database to compare the levels of proteins related to cancer, inflammation, and lipid metabolism between WD and ND mice.

Results: Through histological analysis of mouse liver tissue, we observed the presence of ballooning hepatocytes in the liver tissue of WD mice, with higher degrees of fibrosis, and lipid degeneration compared to mice on a ND mice. Subsequently, we classified the serum exosome proteins of WD mice and ND mice, and used a Venn diagram to distinguish proteins unique to ND mice and those unique to WD mice. The unique proteins of both groups were then analyzed using the STRING, focusing on the protein’s cellular localization, KEGG pathways, and Uniprot analysis.

Conclusions: Through histological analysis of mouse liver tissue, we observed the presence of ballooning hepatocytes in the liver tissue of WD mice, with higher degrees of fibrosis, and lipid degeneration compared to mice on a ND mice. Subsequently, we classified the serum exosome proteins of WD mice and ND mice, and used a Venn diagram to distinguish proteins unique to ND mice and those unique to WD mice. The unique proteins of both groups were then analyzed using the STRING, focusing on the protein’s cellular localization, KEGG pathways, and Uniprot analysis. Integrating the findings from these analyses, our future research will focus on investigating serum exosome proteins to identify potential biomarkers for early diagnosis of non-alcoholic fatty liver disease (NAFLD), aiming to improve the survival rate of patients with liver diseases. We will continue our research based on the analyzed serum exosome proteins.

2024 TDDW

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MITOCHONDRIAL MEMBRANE PROTEIN SAMM50 IN HEPATIC STEATOSIS PROGRESSION

Wei-Shiun Chen1, Jee-Fu Huang2, Chia-Yen Dai2, Wan-Long Chuang2, Ming-Lung Yu2, Shu-Chi Wang1 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 1

粒線體表面穿膜蛋白 SAMM50 在代謝性 脂肪肝變性進程中的保護角色 陳韋勳1 黃志富2 戴嘉言2 莊萬龍2 余明隆2 王述綺1 1 2

高雄醫學大學醫學檢驗生物技術學系 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: The prevalence of nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) has increased due to high-fat and high-sugar western diets. These diseases have a high potential for developing into complications like fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Mitochondrial dynamics regulate energy balance, which influences mitochondrial function.

Sorting and Assembly Machinery Component 50 homolog (SAMM50) is a mitochondrial outer membrane protein that regulates mitochondria dynamics.

Aims: Study the role of mitochondrial outer membrane protein-SAMM50 in the regulation of mitochondrial dynamic balance.

Methods: An NAFLD/NASH animal model using a high-fat western diet and a high-sugar drinking (HFSD) for 7 months. The cell model used AML-12 hepatocytes cocultured with 3T3-L1 adipocytes conditioned medium (Adipo-CM) to stimulate pre-injury hepatic steatosis and Adipo-CM + H2O2 to mimic advanced hepatic steatosis with oxidative stress environment. The shRNA was used to knockdown SAMM50 expression to explore the differences in mitochondrial function and morphology. We verified single nucleotide polymorphisms (SNPs) associated with NAFLD/ NASH through databases and their correlation with HCC overall survival (OS) using the GEPIA system.

Results: The HFSD-induced NAFLD/NASH animal model showed differential effects on SAMM50 regulation and expression in the early and late stage of hepatic steatosis. In the cell model, the synergistic effect of Adipo-CM + H2O2 decreased ATP synthesis, increased mtDNA, and mitochondria ROS, but not found in Adipo-CM. Knockdown of SAMM50 by shSAMM50 can further investigate the decreasing of mitochondrial biogenesis protein (PGC-1α) and mitochondrial dynamics fusion/ fission-associated protein (OPA1, FIS1, Drp1) expression in the synergistic effect of Adipo-CM + H2O2. Furthermore, the reduction in SAMM50 expression caused a decrease in cellular ATP synthesis and a compensatory increase in mtDNA via the downregulation of the expression of mitochondrial biogenesis protein (PGC-1α) and the upregulation of the expression of fission-related proteins (FIS1, Drp1) in the early effect of Adipo-CMinduced hepatocyte steatosis injury. Consequently, this caused a decrease in mitochondrial membrane potential and made the mitochondrial morphology tend to increase the unhealthy type of globe. The database analysis results validating the SAMM50 SNPs were significantly related to the occurrence and progression of NAFLD/NASH diseases and correlated with hepatocellular carcinoma (HCC) prognosis.

Conclusions: SAMM50 plays a protective role in hepatocyte steatosis injury by regulating mitochondrial biogenesis and fission-related protein expression to maintain mitochondrial function and morphology. This study provides the possibility of developing related drugs targeted at SAMM50 to protect mitochondrial function for the treatment of NAFLD/NASH and monitoring SAMM50 expression for the evaluation of clinical prognosis for precise health in the future.

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INITIAL EXPERIENCE WITH DURVALUMAB PLUS GEMCITABINE AND CISPLATIN FOR INTRAHEPATIC CHOLANGIOCARCINOMA IN CLINICAL PRACTICE AT OUR INSTITUTION

Mikoto Fujihara, Tatsuya Kakegawa, Kento Shionoya, Yuki Yamamoto, Mari Hayashi, Keisuke Nakajima, Shunsuke Nakamura, Mayuka Masuda, Hiroshi Takahashi, Takuya Wada, Yoshiya Yamauchi, Hirohito Takeuchi, Shuntaro Mukai, Katsutoshi Sugimoto, Atsushi Sofuni, Takao Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan Background: The efficacy of Durvalumab as an add-on therapy to Gemcitabine/Cisplatin, which has been the standard treatment for intrahepatic cholangiocarcinoma (ICC), has been reported. Its use has become available in Japan since 2022.

However, there is a lack of clinical data on the use of Durvalumab after second-line treatment or postoperative recurrence.

Aims: To evaluate the efficacy of Durvalumab for ICC in clinical practice, we report our early experience with its use.

Methods: We retrospectively evaluated the outcomes of 19 patients with advanced or recurrent ICC who were histologically diagnosed between Jan. 2023 and Mar. 2024 and treated with the combination of Gemcitabine/Cisplatin, and Durvalumab (GCD) at our institution.

Results: The median age of patients was 60 (46-81) years, male/female: 9/10. 12 patients (63.1%) were treated with GCD as primary therapy, 4 patients (21.1%) as secondary therapy, and 3 patients (15.8%) as tertiary therapy or later. The median number of Durvalumab doses was 5 (1-18). The best radiological responses were CR/PR/SD/PD: 1/2/12/4 with response rate of 15.8% and disease control rate of 78.9%. Factors related to prognosis and disease control rate were examined, but no statistically significant differences were identified. This may be due to the fact that the observation period after the introduction of GCD is still young, and patients who used GCD as the first-line treatment did not progress to the second-line treatment or later because they maintained disease control. Grade 3 or higher

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adverse events were observed in 9 cases (47.3%), with neutropenia in 5 cases, cholangitis in 2 cases, and thrombocytopenia in 1 case. There was one case of Grade 2 infusion reaction classified as an immunerelated adverse event.

Conclusions: This study confirms that Durvalumab for ICC is well-tolerated and achieves a high disease control rate. Further accumulation of cases and investigation of biomarkers for prognosis and prediction of treatment response are warranted.

2024 TDDW

Free Paper Section：HBV ①

HIGH FIB-4 INDEX PREDICTS LIVER DECOMPENSATION IN CHRONIC HEPATITIS B PATIENTS WHO DEVELOP CLINICAL RELAPSE AFTER ANTIVIRAL THERAPY CESSATION

Chun-Hsun Liao1, Tung-Hung Su1,2, Chun-Jen Liu1,2, Hung-Chih Yang1, Jyh-Ming Liou1, Chun-Ming Hong1, Tai-Chung Tseng2,4, Chen-Hua Liu1,2, Jia-Horng Kao1,2,3,4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 1

較高 FIB-4 肝纖維化指數可預測慢性 B 型 肝炎患者停藥後臨床復發時之肝失償風 險 廖俊勛1 蘇東弘1,2 劉俊人1,2 楊宏志1 劉志銘1 洪俊銘1 曾岱宗2,4 劉振驊1,2 高嘉宏1,2,3,4 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院肝炎研究中心 3 國立臺灣大學臨床醫學研究所 4 國立臺灣大學醫學院附設醫院醫學研究部

follow-up. Clinical parameters and the Fib-4 index (a surrogate marker for liver fibrosis) were analyzed.

Results: Overall, 320 patients were included, and 144 (45%) developed CR. These patients received entecavir (56%) and tenofovir (31%) for a median of 37 months before NA cessation. Of 144 patients, 98 (68%) fulfilled the APASL stopping rule, and 124 (86%) received retreatment. Liver decompensation developed in 12 patients (8.3%) who had comparable pretreatment HBeAg status, HBV DNA, ALT, NA regimens, end-of-therapy (EOT) HBsAg level, and fulfillment of stopping rule compared to those without decompensation. Decompensated patients had a longer consolidation duration (31.5 vs. 16.5 months, P = 0.026) and higher EOT Fib-4 index (1.79 vs. 1.10, P < 0.001). Multivariable Cox regression analysis showed that EOT Fib-4 index >1.5 (vs. ≤1.5) increased subsequent liver decompensation risk (adjusted HR: 31, 95% CI: 4-242, P = 0.001).

Moreover, higher ALT level and Fib-4 index > 4.4 (vs. ≤4.4) at CR significantly increased the risk of liver decompensation (adjusted HR: 10, 95% CI: 2-51, P = 0.005).

Conclusions: The EOT Fib-4 index > 1.5 helps stratify a higher risk of developing liver decompensation in CHB patients who had CR after NA discontinuation.

These patients should be monitored closely after NA discontinuation. Fib-4 index > 4.4 at CR indicates an even greater risk, warranting prompt retreatment consideration.

2

Background: Finite nucleos(t)ide analogues (NA) therapy may facilitate HBsAg seroclearance to achieve a functional cure. However, clinical relapse (CR, HBV DNA > 2000 IU/mL and ALT > 2-fold elevation) developed in over 30% of patients who discontinued NA therapy, and liver decompensation may occur.

Aims: To identify predictors of liver decompensation (total bilirubin level > 3 mg/dL or prolonged prothrombin time > 18 seconds) after stopping NA therapy.

Methods: We conducted a prospective study to consecutively enroll noncirrhotic chronic hepatitis B (CHB) patients who discontinued NA therapy at a tertiary medical center since 2012. Patients developing CR were included and monitored for liver decompensation or censored at retreatment or last

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②

IMPROVEMENT IN LIVER HISTOLOGY IS OBSERVED IN MOST PATIENTS WITH CHRONIC HEPATITIS DELTA AFTER 48 WEEKS OF BULEVIRTIDE MONOTHERAPY

Pietro Lampertico1,2, Soo Aleman3, Pavel Bogomolov4, Tatyana Stepanova5, Markus Cornberg6, Sandra Ciesek7, Annemarie Berger7, Dmitry Manuilov8, Mingyang Li8, Audrey H. Lau8, Ben L. Da8, Grace M. Chee8, Maurizia Brunetto9,10, Stefan Zeuzem11, Heiner Wedemeyer6 Division of Gastroenterology and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 2 CRC “A. M. and A. Migliavacca” Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy 3 Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden 4 M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russian 5 LLC Clinic of Modern Medicine, Moscow, Russian 6 Clinic for Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany 7 Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany 8 Gilead Sciences, Inc., Foster City, CA, USA 9 Hepatology Unit, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy 10 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 11 Department of Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany 1

Background: Bulevirtide (BLV) is a first-in-class entry inhibitor approved in Europe for chronic hepatitis delta (CHD) treatment.

Aims: This Phase 3 study (NCT03852719) examined virologic, biochemical, and histologic effects of BLV (2mg and 10mg) in CHD patients; results at 48 weeks (W) are presented.

Methods: Patients (N = 150) were randomized 1:1:1 to BLV 2 mg, BLV 10 mg, or control. Liver biopsy

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was performed at baseline and 48W. Viral response categories included virologic response (VR), partial response (PR), or non-response (NR). Histology parameters included histologic activity index (HAI; 0–18), HAI category (0–4), and Ishak fibrosis score (IFS; 0–6). Improvement in HAI or fibrosis was ≥1 point from baseline; histology improvement: ≥2 points from baseline without worsened fibrosis.

Results: Eighty-three patients had paired biopsy data (BLV 2 mg, n = 25; BLV 10 mg, n = 31; control, n = 27). Baseline characteristics: mean age, 42 years; male, 52%; white, 84%; compensated cirrhosis, 33%; concomitant nucleos(t)ide analogue therapy, 61%; mean hepatitis delta virus (HDV) RNA, 5.1 log10 IU/ mL; median alanine aminotransferase (ALT), 92 U/L; median HAI, 9; median IFS, 2. At 48W, 80%, 11%, and 9% of BLV-treated patients achieved VR, PR, and NR; no controls achieved VR. Median change in ALT U/L was similar across viral response groups (−51 to −64) but greater vs control (−11). Most patients experienced ALT normalization: VR (69%), PR (67%), NR (20%), and controls (7%). In 89% of BLV-treated patients, ALT decreased; in 80%, HAI improved. HAI category improvement and HAI decrease occurred in VR (−4; 69%), PR (−3; 83%) vs NR (0; 20%) and control (−1; 30%). In VR, PR, NR, and controls, fibrosis improved 58%, 33%, 25%, and 30%; histology improved 69%, 83%, 25%, and 33%.

Conclusions: Liver histology improved in most CHD patients after 48W of BLV monotherapy.

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③

ALL-CAUSE AND CAUSE-SPECIFIC MORTALITY IN NON-STEATOTIC CHRONIC HEPATITIS B PATIENTS WITH CARDIOMETABOLIC RISK FACTORS

Shang-Chin Huang1,2,3,4, Tung-Hung Su1,2, Tai-Chung Tseng2,5, Shih-Jer Hsu1,2, Chun-Ming Hong6, Ting-Yuan Lan7, Chen-Hua Liu1,2, Hung-Chih Yang1,2, Chun-Jen Liu1,2,3, Pei-Jer Chen1,2,3, Jia-Horng Kao1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 5 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 6 Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 7 Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan 1

非脂肪肝之 B 肝患者合併代謝異常之全 因及各別原因死亡風險 黃上秦1,2,3,4 蘇東弘1,2 曾岱宗2,5 徐士哲1,2 洪俊銘6 藍鼎淵7 劉振驊1,2 楊宏志1,2 劉俊人1,2,3 陳培哲1,2,3 高嘉宏1,2,3 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院肝炎研究中心 3 國立臺灣大學醫學院臨床醫學研究所 4 國立臺灣大學醫學院附設醫院北護分院胃腸肝膽科 5 國立臺灣大學醫學院附設醫院醫學研究部 6 國立臺灣大學醫學院附設醫院整合醫學科 7 國立臺灣大學醫學院附設醫院新竹臺大分院風濕免 疫科 2

with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the impacts of CMRF on the long-term mortality risks of non-steatotic CHB patients remain unknown.

Aims: We aimed to investigate the impacts of preexisting and new-onset CMRF on the all-cause and cause-specific mortality of non-steatotic CHB patients.

Methods: Non-steatotic CHB patients were consecutively enrolled at National Taiwan University Hospital with longitudinal follow-up. The CMRF was defined according to the MASLD criteria, including hyperglycemia, hypertension, high BMI, and dyslipidemia. The metabolic burden was calculated by the number of fulfilled CMRF. Cumulative incidences of all-cause and cause-specific mortality were compared after adjustment for competing risks.

Results: From 2006 to 2021, 13226 non-steatotic CHB patients were included. At baseline, CHB patients with CMRF (n = 7,255) were older and had a lower proportion of HBeAg positivity and lower HBV DNA levels than non-CMRF patients (n = 5,971). After a median follow-up time of 8.9 years, patients with CMRF had a higher risk of all-cause mortality than those without CMRF after adjustment for age, sex, cirrhosis, HBeAg, ALT levels, and anti-viral therapy (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [CI]: 1.48–2.06, p < 0.001). Furthermore, cumulative CMRF increased the risks of all-cause, liver-related, and cardiovascular mortality in a dosedependent manner (all p < 0.001). During the study period, new-onset diabetes mellitus (aHR: 2.31, 95% CI: 1.91–2.79) and new-onset hypertension (aHR: 1.79, 95% CI: 1.49–2.16) further aggravates the risks of all-cause and liver-related mortality (all p < 0.001).

Conclusions: Cumulative metabolic burden increases the risks of all-cause, liver-related, and cardiovascular mortality in non-steatotic CHB patients, and new-onset CMRF further aggravates the risks. Routine monitoring CMRF in CHB patients, even for those without concurrent MASLD, is required for risk stratification and early intervention.

Background: Cardiometabolic risk factors (CMRF) have been reported to increase the risks of adverse liver outcomes in chronic hepatitis B (CHB) patients

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④

TENOFOVIR DISOPROXIL FUMARATE FOR PATIENTS WITH CHRONIC HEPATITIS B AND MINIMALLY RAISED ALANINE AMINOTRANSFERASE: A ROLLOVER STUDY FROM THE TORCH-B TRIAL

Yao-Chun Hsu1,2, Chi-Yi Chen3, Cheng-Hao Tseng2,4, Chieh-Chang Chen5, Teng-Yu Lee6,7, Ming-Jong Bair8,9, Jyh-Jou Chen10, Yen-Tsung Huang11, I-Wei Chang12,13, Chi-Yang Chang14,15, Chun-Ying Wu16,17, Ming-Shiang Wu5, Lein-Ray Mo18, Jaw-Town Lin1 Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan; 2School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan; 3Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chiayi, Taiwan; 4Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, Kaohsiung, Taiwan; 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 6Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 7School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung, Taiwan; 9Mackay Medical College, New Taipei City, Taiwan; 10Department of Internal Medicine, Chi-Mei Medical Center, Liouying Branch, Tainan, Taiwan; 11Institute of Statistical Science, Academia Sinica, Taipei, Taiwan; 12Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 13Department of Clinical Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 14School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 15 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan; 16Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 17Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; 1

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Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan 18

替諾福韋（Tenofovir）用於血清轉胺酶 輕微上升的慢性 B 型肝炎患者：TORCH-B 試驗的延續研究 許耀峻1,2 陳啟益3 曾政豪2,4 陳介章5 李騰裕6,7 白明忠8,9 陳志州10 黃彥棕11 張宜崴12,13 張吉仰14,15 吳俊穎16,17 吳明賢5 牟聯瑞18 林肇堂1 1

義大醫院胃腸肝膽科；2 義守大學醫學系暨醫學研 究所；3 嘉義基督教醫院胃腸肝膽科；4 義大癌治療 醫院胃腸肝膽科；5 台大醫院內科部；6 臺中榮民總 醫院內科部；7 中山醫學大學醫學系；8 台東馬偕紀 念醫院胃腸肝膽科；9 馬偕醫學院；10 柳營奇美醫院 內科部；11 中央研究院統計科學所；12 臺北醫學大學 醫學系病理學科；13 臺北市立萬芳醫院臨床病理部； 14 天主教輔仁大學醫學系；15 天主教輔仁大學附設醫 院胃腸肝膽科；16 國立陽明交通大學生物醫學資訊 研究所；17 臺北榮民總醫院醫學研究部轉譯醫學科； 18 台南市立醫院內科部

Background: Treatment indications for patients with chronic hepatitis B (CHB) remain contentious, particularly for patients whose serum alanine aminotransferase (ALT) levels were minimally raised.

Aims: We aimed to evaluate treatment effects in this patient population.

Methods: This rollover study extended a placebocontrolled trial that enrolled patients with CHB and ALT levels below two times the upper limit of normal, excluding those with cirrhosis or conditions that required antiviral prophylaxis. Following 3 years of randomized intervention with either tenofovir disoproxil fumarate (TDF) or placebo, participants were recruited to receive open-label TDF for 3 years.

Liver biopsies were performed at the beginning and the end of this open-label study to evaluate histopathological changes. Virological, biochemical, and serological outcomes were also assessed (NCT02463019).

Results: Of 146 enrolled patients (median age 47 years, 80.8% male), 123 completed the study with paired liver biopsies. After 3 years of open-label TDF, the Ishak fibrosis score decreased in 74 (60.2%), remained unchanged in 32 (26.0%), and increased in 17 (13.8%) patients (p < 0.0001). The Knodell necroinflammation score decreased in 58 (47.2%), remained unchanged in 29 (23.6%), and increased in 36 (29.3%) patients (p = 0.0038). The proportion

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of patients with an Ishak score ≥3 significantly decreased from 26.8% (n = 33) to 9.8% (n = 12) (p = 0.0002). Histological improvements were more pronounced in patients switching from placebo.

Virological and biochemical outcomes also improved in placebo switchers and remained stable in patients with continued TDF. However, serum HBsAg levels did not change and no patient cleared HBsAg. Conclusions: In CHB patients with minimally raised ALT, favorable histopathological, biochemical, and virological outcomes were observed following 3-year TDF treatment, for both treatment-naïve patients and those who continued the antiviral therapy.

⑤

HIGHER SUSTAINED RESPONSE RATE AND PARTIAL CURE IN OFFPEGYLATED INTERFERON-TREATED PATIENTS PREVIOUSLY ON FINITE NUC THERAPY COMPARED TO NAÏVE PATIENTS

Wen-Juei Jeng1,2, Yu-Ting Kao1, Yen-Chun Liu1,2, Rong-Nan Chien1,2,3 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Liver research unit, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 1

E 抗原陰性慢性 B 型肝炎患者在面臨口服 抗病毒藥物停藥後復發時接受長效性干 擾素治療比初次使用長效性干擾素患者 有更高的持續穩定率與部分治癒率 鄭文睿1,2 高毓婷1 劉彥君1,2 簡榮南1,2,3 1

林口長庚紀念醫院胃腸肝膽科系 長庚大學醫學院 3 林口長庚紀念醫院肝臟研究中心 2

Background: Our previous study showed that patients with off-Nuc CR retreated with Peg-IFN also had a higher functional cure rate than Peg-IFNnaïve patients (10-year: 49.2% vs. 0.1%). It is unclear if this due to off-Peg-IFN sustained response prior to HBsAg loss.

Aims: This study aims to clarify this by comparing propensity score-matched finite therapy experienced off-Peg-IFN patients (Rx-Peg-IFN) to naive off-Peg-IFN patients (naive-Peg-IFN).

Methods: From the CGMH off-Nuc cohort, 25 HBeAg-negative CHB patients with CR retreated with Peg-IFN were included. Only HBeAg-negative CHB patients treated with Peg-IFN monotherapy for 48-52 weeks were included in the naive-PegIFN arm. Propensity score matching (PSM) based on age, gender, ALT, HBV DNA, and HBsAg levels at the start of Peg-IFN treatment was performed at a 1:1 ratio. Events after 1 year of Peg-IFN treatment were compared. Sustained response was defined as normal ALT levels (<36 U/L) after stopping Peg-IFN until the end of follow-up. Partial cure was defined

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as normal ALT levels with HBsAg levels < 100 IU/ mL. Chi-square or Fisher’s exact test compared categorical outcomes. A two-tailed P < 0.05 was considered statistically significant.

Results: After PSM, each group had 25 patients.

Baseline characteristics were comparable: mean age (49.8 vs. 49.9 years, P = 0.97), median ALT (156 vs.

130 U/L, P = 0.14), HBV DNA (5.68 vs. 5.3 log10 IU/ mL, P = 0.13), and HBsAg levels (2.78 vs. 3.1 log10 IU/mL, P = 0.13). Follow-up duration was longer in the naive-Peg-IFN group (130 vs. 82 months, P < 0.001). HBsAg reduction was greater in the RxPeg-IFN group (median: -1.14 vs. -0.13 log10 IU/ mL, P < 0.001), resulting in lower end-of-treatment HBsAg levels (1.58 vs. 2.72 log10 IU/mL, P < 0.001).

Sustained response rates were higher in the Rx-PegIFN group (48% vs. 8%, P = 0.003). More naive-PegIFN patients required retreatment (72% vs. 40%, P = 0.02). By the end of follow-up, 68% and 52% of the Rx-Peg-IFN group achieved HBsAg <100 and <50 IU/ mL (Partial cure), respectively, versus 32% and 12% in the naive-Peg-IFN group (P = 0.001 and 0.002).

Among 12 patients with HBsAg loss, 83.3% did not experience clinical relapse before HBsAg loss.

Conclusions: The higher sustained response, partial cure, and functional cure rates in Rx-Peg-IFN patients compared to naïve-Peg-IFN patients suggest that previous finite therapy significantly influences the host immune response rather than Peg-IFN itself.

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⑥

FORTY-EIGHT-WEEK OFF-THERAPY EFFICACY AND SAFETY OF BULEVIRTIDE IN COMBINATION WITH PEGYLATED INTERFERON ALFA-2A IN PATIENTS WITH CHRONIC HEPATITIS DELTA: FINAL RESULTS FROM THE PHASE 2B, OPEN-LABEL, RANDOMIZED, MULTICENTER STUDY MYR204

Tarik Asselah1, Vladimir Chulanov2, Pietro Lampertico3,4, Heiner Wedemeyer5, Adrian Streinu-Cercel6,9, Victor Pantea7, Stefan Lazar8, Gheorghe Placinta7, George Sebastian Gherlan9,10, Pavel Bogomolov11, Tatyana Stepanova12, Viacheslav Morozov13, Vladimir Syutkin14, Olga Sagalova15, Vladimir Gorodin16, Dmitry Manuilov17, Renee-Claude Mercier17, Lei Ye17, Grace M. Chee17, Ben L. Da17, Audrey H. Lau17, Anu Osinusi17, Marc Bourliere18, Vlad Ratziu19, Stanilas Pol20, Marie-Noëlle Hilleret21, Fabien Zoulim22 Hôpital Beaujon APHP, Université de ParisCité, INSERM UMR1149, Clichy, France; 2 Sechenov University, Moscow, Russian; 3 Division of Gastroenterology and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 4CRC “A. M. and A. Migliavacca” Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 5Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany; 6 Matei Bals National Institute of Infectious Diseases; 7Infectious Clinical Hospital; 8Dr. Victor Babes Foundation, Infectious and Tropical Diseases Hospital, Bucharest, Romania; 9 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 10Dr. Victor Babes Foundation, Bucharest, Romania; 11M. F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russian; 12LLC Clinic of Modern Medicine, Moscow, Russian; 13 LLC Medical Company “Hepatolog”, Samara, Russian; 14Institute of Emergency Medicine n.a. NV Sklifosovsky, Moscow, Russian; 15South Ural State Medical University, Chelyabinsk, 1

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Section：UGI Russian; 16”Specialized Clinical Infectious Diseases Hospital”, Krasnodar, Russian; 17Gilead Sciences Inc., Foster City, CA, USA; 18Hôpital Saint Joseph, Marseille, France; 19CH PitiéSalpêtrière, Paris, France; 20Hôpital Cochin, Paris, France; 21Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; 22Hospital Croix Rousse, Lyon, France Background: Bulevirtide (BLV) is approved in Europe for chronic hepatitis delta (CHD) treatment.

Aims: This Phase 2b study evaluated the safety and efficacy of BLV (2mg and 10mg) ± pegylated interferon alfa-2a (PegIFN) in patients with CHD. Here we present results at 48 weeks (W) post–end of treatment (EOT).

Methods: Patients with CHD (N = 174) were randomized (1:2:2:2) and stratified by compensated cirrhosis status to receive (A) PegIFN for 48W; (B) BLV 2 mg + PegIFN for 48W then BLV 2 mg monotherapy for 48W, (C) BLV 10 mg + PegIFN for 48W then BLV 10 mg monotherapy for 48W; or (D) BLV 10 mg for 96W. All patients were followed for up to 48W post-EOT (FU-48). The primary endpoint was the proportion achieving undetectable hepatitis delta virus (HDV) RNA at W24 post-EOT (FU-24). Composite response was defined as undetectable HDV RNA and alanine aminotransferase (ALT) normalization.

Results: Overall, 34% had compensated cirrhosis with mean (standard deviation) HDV RNA of 5.3 (1.2) log10 IU/mL and ALT of 114 (94.8) U/L; 48% were on nucleos(t)ide analogue therapy; 48% were interferon-experienced. At FU-48, 25% of (A) achieved undetectable HDV RNA; (B), 26%; (C), 46%; and (D), 12% (C vs D, P = 0.0003). At FU-24, 17% of (A) achieved undetectable HDV RNA; (B), 32%; (C), 46%; and (D), 12% (C vs D, C vs A, B vs D; P < 0.05 each). At FU-48, ALT normalization and composite endpoint for (A) were 42%, 25%; (B), 38%, 22%; (C), 46%, 40%; and (D), 22%, 8% (C vs D, P < 0.05), respectively. One participant discontinued BLV due to a BLV-related adverse event; 3 participants experienced BLVrelated serious adverse events posttreatment.

Conclusions: BLV 10mg + PegIFN resulted in the highest rates of undetectable HDV RNA at EOT and FU-24 and was sustained through FU-48, providing a viable finite treatment option for patients with CHD.

⑦

COMPARISON OF THE EFFICACIES OF A NEW VONOPRAZAN-BASED, MONO-ANTIBIOTIC THERAPY AND HIGH-DOSE DUAL THERAPY IN THE FIRST-LINE TREATMENT OF H. PYLORI INFECTION

Ping-I Hsu1,7, Chih-An Shih2,7, Chien-Lin Chen3,7, Chang-Bih Shie1,7, Wei-Yi Lei3,7, Feng-Woei Tsay4,7, Ming-Jen Sheu5,7, Deng-Chyang Wu6,7 Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 Division of Gastroenterology and Hepatology, Department of Medicine, Chi-Mei Hospital, Tainan, Taiwan 6 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan 7 Acid-related Disease-Microbiota (TARD-M) Consortium 1

比較一「Vonoprazan 為基礎之單一抗生 素療法」與「高劑量二合療法」於幽門 螺旋桿菌第一線治療之療效 許秉毅1,7 石志安2,7 陳健麟3,7 施長碧1,7 雷尉毅3,7 蔡峯偉4,7 許銘仁5,7 吳登強6,7 1

中國醫藥大學臺南市立安南醫院胃腸科 安泰醫院胃腸肝膽科 3 花蓮慈濟醫院肝膽胃腸科 4 高雄榮民總醫院胃腸肝膽科 5 奇美醫院胃腸肝膽科 6 高雄醫學大學附設中和紀念醫院胃腸內科 7 台灣胃酸相關疾病暨微菌叢聯盟 2

Background: Evidences have shown that the

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efficacies of high-dose amoxicillin/proton pump inhibitor (PPI) dual therapy and high-dose amoxicillin/potassium competitive acid blocker (PCAB) dual therapy in the treatment of H. pylori infection vary in different countries. Whether a new mono-antibiotic therapy combining high-dose amoxicillin, PCAB and bismuth can reliably achieve an eradication rate ≥90% remains unknown.

Aims: To compare the efficacies and safety of a new mono-antibiotic therapy combining bismuth, high-dose amoxicillin and PCAB (high-dose Bap therapy) and high-dose dual therapy in the first-line treatment of H. pylori infection.

Methods: In the retrospective cohort study, we included 224 patients with H. pylori infection who were treated with a 14-day high-dose Bap therapy (tripotassium dicitrato bismuthate 300 mg four times daily, amoxicillin 750 mg four times daily, and vonoprazan 20 mg twice daily) or a 14-day high-dose amoxicillin-rabeprazole therapy (amoxicillin750 mg four times daily, and rabeprazole 20 mg four times daily) in our hospitals from January 2021 to June 2024. Patients returned at the second week to assess drug adherence and adverse events. Post-treatment H. pylori status was assessed at least four weeks following treatments.

Results: Eighty patients receiving high-dose Bap therapy and 144 receiving high-dose amoxicillinrabeprazole therapy were included. Intention-totreat (ITT) analysis demonstrated a significantly higher eradication rate for the 14-day high-dose Bap therapy group than for the 14-day high-dose dual therapy group (96.3% vs 78.5%, P < 0.001). Perprotocol (PP) analysis also yielded similar results (100.0% vs 84.3%, P < 0.001). The two patient groups had similar frequencies of adverse events (6.3% vs 11.1%, P = 0.339). There were only two patients in the high-dose Bap group failing to eradicate H. pylori infection. Both had poor drug compliance during initial treatment, and their H. pylori infections were ultimately cured by a repeated course of high-dose Bap therapy.

Conclusions: 14-day high-dose Bap therapy demonstrates a very high efficacy in the treatment of H. pylori infection, and is superior to high-dose amoxicillin-PPI dual therapy in first-line therapy.

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FAVORABLE LONG-TERM OUTCOMES OF EARLY ESOPHAGEAL SQUAMOUS NEOPLASIA WITH MUSCULARIS MUCOSA INVOLVEMENT AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Chen-Huan Yu1, Yueh-Hung Chou2, Tze-Yu Shieh3, Chao-Yu Liu4, Jiann-Ming Wu5, Chen-Hsi Hsieh6,7,8, Tzong-Hsi Lee1, Chen-Shuan Chung1,9,10 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2 Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 3Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 4Division of Thoracic Surgery, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan; 5Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 6Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 7School of Nursing, Yuan Ze University, Taoyuan, Taiwan Chen-Hsi Hsieh, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 8Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 9Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan, Taiwan; 10College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 1

Background: Ambiguity exists over treatment and surveillance strategies after endoscopic submucosal dissection (ESD) for esophageal squamous cell neoplasia (ESCN) with unfavorable histologic features.

Aims: This study aimed to investigate the long-term outcomes after ESD for expanded indications among high risk patients with ESCN. Methods: We retrospectively included early ESCN patients treated with ESD at two medical centers in Taiwan between August 2010 and December 2023.

Demographic, endoscopic, and pathological data were collected. Outcome measurements including

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overall survival (OS), disease-specific survival (DSS), and disease recurrence were analyzed.

Results: Among 146 patients (mean age 59.17 years) with 183 lesions, 73 (50%) had a history of head and neck cancer (HNC). En bloc and R0 resection were achieved in 100% and 95.6% of the lesions, respectively. The 5-year OS, DSS and local recurrence rates were 42.7%, 94.7% and 11% respectively. R0 resection was significantly associated with recurrence in univariate analysis (P = 0.05), but tumor size (P = 0.41), lesion involving more than three-fourths of the circumference (P = 0.93), cell differentiation degree (P = 0.21), HNC (P = 0.68) and lymphovascular invasion (P = 0.15) were not. Alcohol abstinence was independently associated with lower recurrence (adjusted OR: 0.20, 95% CI: 0.08-0.48, P < 0.001). Patients with pT1a-MM (invading the muscularis mucosa) had comparable OS (P = 0.82), DSS (P = 0.617) and recurrence (P = 0.63) rates to those with pT1a-EP/LPM (invading the epithelium/lamina propria).

Conclusions: The long-term outcomes of patients with ESCN after ESD for expanded indications were satisfactory in this study. ESD could be considered in selected patients with ESCN involving the muscularis mucosa, notably among high-risk HNC patients.

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COMPARISON OF EMPIRICAL THERAPY VERSUS SUSCEPTIBILITY TESTING-GUIDED THERAPY FOR REFRACTORY HELICOBACTER PYLORI INFECTION: A MULTICENTER, OPENLABEL, RANDOMIZED CONTROLLED, NON-INFERIORITY TRIAL

Mei-Jyh Chen1,2, Yu-Jen Fang3, Po-Yueh Chen4, Chieh-Chang Chen1,2, Ming-Shiang Wu1,2, Jyh-Ming Liou1,2,5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan 4 Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan 5 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

經驗療法與藥物敏感性檢測引導療法在 難治性幽門桿菌感染治療的比較：一個 多中心、開放標籤、隨機對照、非劣效 性試驗 陳美志1,2 方佑仁3 陳柏岳4 陳介章1,2 吳明賢1,2 劉志銘1,2,5 1

台大醫院消化內科 台大醫學院內科 3 台大醫院雲林分院內科部 4 嘉義基督教醫院內科部 5 台大醫院癌醫中心分院內科部 2

Background: The evidence supporting the use of optimized empirical therapy as an alternative to susceptibility-guided therapy for patients with refractory Helicobacter pylori (H. pylori) infection— defined as failure after two or more eradication attempts—is limited.

Aims: This study aims to evaluate whether optimized empirical therapy, involving early use of rifabutin, potent acid inhibitors, and quadruple therapy, is non-inferior to susceptibility-guided therapy in

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treating refractory H. pylori infection.

Methods: We conducted a multicenter, open-label, randomized controlled trial in Taiwan. Eligible patients were allocated in a 1:1 ratio to receive either empirical guided therapy or susceptibility testing guided therapy. The minimum inhibitory concentrations (MICs) of levofloxacin, metronidazole, tetracycline, rifabutin, and clarithromycin were determined using the agar dilution test. Study participants received levofloxacin-based quadruple therapy, bismuth quadruple therapy, rifabutinbased therapy, or clarithromycin-based concomitant therapy based on their previous medication history or susceptibility testing results. The status of H. pylori was determined using the 13C-urea breath test at least 6 weeks after completing eradication therapy.

Eradication rates were analyzed according to both intent-to-treat (ITT) and per-protocol (PP) analyses.

The pre-specified margin for non-inferiority was set at 9%.

Results: Among the 233 patients with refractory H. pylori infection who were randomly assigned and underwent post-eradication evaluation, the eradication rates for the empirical guided therapy group and the susceptibility testing guided therapy group were 82.6% (95% CI: 75.7%-89.5%) and 85.6% (95% CI: 79.3%-91.9%) in the ITT analysis (p = 0.533), respectively. In the PP analysis, the eradication rates were 82.5% (95% CI: 75.5%-89.4%) versus 87.1% (95% CI: 81.0%-93.2%) (p = 0.330). The difference in eradication rates between the empirical guided therapy and susceptibility testing guided therapy groups was -3.0% (95% CI: -11.0% to 5.0%, noninferiority p = 0.107) in the ITT analysis, and -4.6% (95% CI: -12.5% to 3.0%, non-inferiority p = 0.179) in the PP analysis.

Conclusions: Optimized empirical therapy demonstrated comparable efficacy to susceptibility testing guided therapy for treating refractory H. pylori infection.

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DETERMINING THE NEED FOR IHC STAINING IN THE HISTOLOGICAL DIAGNOSIS OF H. PYLORI INFECTION: A STUDY USING THE KYOTO CLASSIFICATION OF GASTRITIS

Shu-Wei Huang1, Sey-En Lin2, Hao-Tsai Cheng1,3, Yen-Chin Chen3, Ming-Yao Su1 Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan 2 Department of Anatomic Pathology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan 3 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan 1

幽門螺旋桿菌組織學診斷中是否有免疫 組織化學染色的需求：運用京都胃炎分 類的研究 黃書偉1 林賜恩2 鄭浩材1,3 陳彥瑾3 蘇銘堯1 1

新北市立土城醫院（委託長庚醫療財團法人興建經 營）胃腸肝膽科 2 新北市立土城醫院（委託長庚醫療財團法人興建經 營）解剖病理科 3 長庚大學臨床醫學研究所

Background: The Kyoto Classification of Gastritis can be used to detect Helicobacter pylori (H. pylori) infection. Histological examination of gastric biopsies using histochemical stains is one of the standard invasive methods for diagnosing H. pylori. However, it remains unclear when immunohistochemical testing for H. pylori should be additionally used.

Aims: To determine whether the Kyoto Classification of Gastritis can help indicate the need for additional immunohistochemical staining in histological examinations for the diagnosis of H. pylori infection.

Methods: Patients who underwent upper gastrointestinal endoscopy with biopsies and both histochemical (Hematoxylin and Eosin (HE)) and immunohistochemical (IHC) staining at New Taipei Municipal Tucheng Hospital (built and operated by Chang Gung Medical Foundation) from January 2022 to July 2022 were included. Exclusion criteria were: use of proton pump inhibitors or antibiotics within one month, previous gastric surgery, and insufficient or poor-quality images. Eight endoscopists performed the endoscopic examinations, and all

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images were interpreted by one endoscopist who was blinded to the H. pylori test results. Endoscopic findings indicating H. pylori infection included spotty redness, mucosal swelling, diffuse redness, and nodularity. Histological results are based on pathology reports, which include results from both HE staining and IHC staining. IHC staining serves as the gold standard for diagnosing H. pylori infection.

Results: A total of 230 patients were included in the analysis, with an average age of 59.24 years. Of these, 46.09% were male, 44.78% had peptic ulcers, and 33.91% tested were positive for H. pylori infection.

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of HE staining were: 78.21%, 98.68%, 96.83%, 89.82% and 91.74% respectively. The sensitivity, specificity, PPV, NPV and accuracy of endoscopic interpretation were: 94.87%, 89.47%, 82.02%, 97.14% and 91.30% respectively. When endoscopic interpretation and HE staining results were consistent, the accuracy of HE staining was 98.48% (194/197). However, when results were inconsistent, the accuracy of HE staining dropped to 51.52% (17/33). Compared to consistent results, HE staining demonstrated significantly lower accuracy when inconsistent with endoscopic interpretation (odds ratio 0.016, 95% CI 0.004-0.062, p < 0.0001).

Conclusions: The Kyoto Classification of Gastritis and HE staining are both effective diagnostic methods for detecting H. pylori infection. Using the Kyoto Classification of Gastritis for endoscopic interpretation of H. pylori infection can help determine whether additional IHC staining is needed in routine histological HE staining.

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THE SURVIVAL ANALYSIS AND CORRELATION OF BODY COMPONENTS AT T12 AND L3 LEVELS OF COMPUTED TOMOGRAPHY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS UNDERGOING CHEMORADIOTHERAPY

I-Ting Chou1,2, Chi-Chi Wu1,2, Yu-Ling Huang3, I-Chen Wu1,2,4 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 3 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 4 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 1

分析接受同步化學放射治療的食道鱗狀 細胞癌患者身體組成在電腦斷層 T12 與 L3 的相關性與生存分析 周奕廷1,2 吳季錡1,2 黃郁玲3 吳宜珍1,2,4 1

高雄醫學大學附設中和紀念醫院內科部 高雄醫學大學附設中和紀念醫院胃腸內科 3 高雄醫學大學附設中和紀念醫院影像醫學部 4 高雄醫學大學醫學系 2

Background: Esophageal cancer is the seventh most common cause of cancer death worldwide. In Taiwan, esophageal squamous cell carcinoma (ESCC) has also increased substantially during the past three decades. However, weight loss and low body mass index are more prevalent in ESCC patients than in those with other malignancies. Malnutrition is a factor that induces sarcopenia, being considered to be a promising predictor of worse progression free survival and overall survival in ESCC undergoing chemoradiotherapy (CRT).

Aims: The purpose of our study was to determine whether the skeletal muscle and fat component measured at the T12 level from chest computed tomography scan can be a substitute for that at the conventional L3 level. Such findings would help us to diagnose sarcopenia and predict the survival outcome in patients of thoracic cancers, especially in ESCC.

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Methods: This study adopts a prospective data collection approach complemented by retrospective analysis. A total of 78 individuals newly diagnosed with stage II-IV esophageal cancer were recruited between March 2017 and December 2021 at Kaohsiung Medical University Hospital. Patients ≥20 years old with pathologically confirmed ESCC were enrolled between March 2017 and December 2021.

All patients underwent computed tomography of the chest before and 4 to 6 weeks after the completion of chemoradiotherapy were recruited. We collected their clinicopathological as well as the sarcopenia and nutrition-related parameters, including skeletal muscle index (SMI), skeletal muscle area radiodensity (SMA), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR) measured at the level of T12 and L3 to examine for their correlation and the association with survival outcome.

Results: Of the total 78 patients (99 person-times) undergoing CRT in the study, 75 (96.15%) were male and the mean age was 59 year-old (range, 44–71 years). 82.05% of the patients had stage III-IV diseases and 80.77% of them had the Eastern Cooperative Oncology Group performance status scored 1. In the analysis of 99 person-times, we found significant correlations of the four parameters of body component measured at T12 and L3 vertebra. The Spearman’s correlation coefficients (p values) were 0.64 (<0.01) for SMI, 0.69 (<0.01) for SMA radiodensity, 0.48 (<0.01) for IMAC and 0.57 (<0.01) for VSR. For the analysis of T12 vertebra muscle mass quality and the survival rate of patients, we found patients with a lower baseline T12 SMI and SMA radiodensity had a non-significant trend of lower overall survival rate. Moreover, low T12 SMI after CRT was a significant predictor for worse overall survival rate while low T12 SMA radiodensity had a non-significant trend for predicting the lower overall survival. After adjustment for confounding factors, including age, gender and tumor stage, low T12 SMI after CRT remained a significant predictor for lower overall survival rate (Adjusted hazard ratio 2.43, p = 0.02) Conclusions: Our study suggested we can estimate the SMI, SMA, IMAC and VSR at L3 by computed tomography images from T12, which will be used to calculate clinical indexes of sarcopenia. These parameters will be helpful in ESCC patients who underwent chest computed tomography, not always covering the L3 level. Moreover, we found low T12 SMI after chemoradiotherapy was a significant predictor for worse overall survival rate.

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COMPARISON OF SURVIVAL RATES FOR ESOPHAGEAL LESIONS IN PATIENTS WITH CONCURRENT HEAD AND NECK CANCER AND EARLY SUPERFICIAL ESOPHAGEAL CANCER TREATED WITH ENDOSCOPIC SUBMUCOSAL DISSECTION, SYNCHRONOUS CHEMORADIOTHERAPY, OR SURGERY: A RETROSPECTIVE STUDY AT A SINGLE MEDICAL CENTER IN SOUTHERN TAIWAN

Yu-Chieh Tsai, Chih-Chien Yao, Yu-Chi Lee, Cheng-Kun Wu, Chih-Ming Liang, Seng-Kee Chuah, Wei-Chen Tai Diversion of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

南台灣單一醫療中心回顧性研究：比較 頭頸癌合併早期表層食道癌的病人之食 道病灶接受內視鏡黏膜下剝離術、同步 放化療或手術的存活率 蔡雨潔 姚志謙 李育騏 吳鎮琨 梁志明 蔡成枝 戴維震 高雄長庚紀念醫院胃腸肝膽科

Background: Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. In Japan, endoscopic submucosal dissection (ESD) for superficial esophageal cancer is the mainstay of endoscopic treatment for superficial esophageal cancer. However, treatment for patients with synchronous head and neck cancer and superficial esophageal squamous cell neoplasm (SHNSESCN) has not been studied.

Aims: We compared treatment effect of SHNSESCN with endoscopic submucosal dissection, concurrent chemoradiotherapy, or surgery in synchronous head and neck cancer patients.

Methods: This is a retrospective study at Kaohsiung Chang Gung Memorial Hospital from January 2013 to December 2022. In total, there were 294 cases of synchronous head and neck cancer and early superficial esophageal cancer. Among these, 49 cases received complete endoscopic

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Section：HCV submucosal dissection (ESD), 183 cases received chemoradiotherapy (CCRT), and 62 cases underwent esophagectomy Results: Among these patients, 49 received complete endoscopic submucosal dissection, 183 received chemoradiotherapy, and 62 underwent esophagectomy. The total median survival time for all patients was 42 months: 39 months in the ESD group, 18 months in the CCRT group, and 69 months in the esophagectomy group. The total mean survival time for all patients was 47 months: 53 months in the ESD group, 30 months in the CCRT group, and 61 months in the esophagectomy group. The overall survival (OS) rates were 52.9% in the ESD group, 29.9% in the CCRT group, and 61% in the esophagectomy group. The first-year survival rates were 91.3% in the ESD group, 53.1% in the CCRT group, and 95.5% in the esophagectomy group. The three-year survival rates were 69.2% in the ESD group, 31% in the CCRT group, and 54.2% in the esophagectomy group.

The five-year survival rates were 36.1% in the ESD group, 23.6% in the CCRT group, and 27.1% in the esophagectomy group. The Kaplan-Meier survival analysis revealed no significant difference in overall survival rate between the ESD and esophagectomy groups (p = 0.013). However, both the ESD and esophagectomy groups had significantly better overall survival rates compared to the CCRT group (p < 0.01).

Conclusions: In summary, our present analysis has shown that curative treatment with complete endoscopic submucosal dissection or esophagectomy for early esophageal lesions in patients with synchronous head and neck cancer resulted in better survival rates compared to the traditional concurrent chemoradiotherapy group.

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ASSOCIATION OF CHRONIC HEPATITIS C VIRUS INFECTION WITH COGNITIVE IMPAIRMENT AMONG ELDERLY IN TAIWAN

Chia-Ling Wu1, Chih-Ching Yeh2, Yi-Chien Lai2, Fu-Hsiung Su1,3 School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 2 School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan 3 Department of Family Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan 1

台灣年長者慢性 C 型肝炎與認知功能障 礙相關性研究 吳佳凌1 葉志清2 賴怡芊2 蘇富雄1,3 1

天主教輔仁大學醫學系 臺北醫學大學公共衛生學系 3 天主教耕莘醫院家庭醫學科 2

Background: Several studies have suggested an association between chronic hepatitis C virus (HCV) infection and cognitive impairment (CI).

Aims: This population-based cohort study aimed to assess the risk of CI among the elderly with chronic HCV infection in Taiwan.

Methods: Our cohort study recruited 9,079 elderly Taiwanese aged over 60 (326 HCV-positive individuals and 8,753 HCV-negative counterparts) identified with cognitive impairment (CI) by Mini Mental State Examination (MMSE) during year 20082019 from the Taiwan Biobank. CI was defined based on MMSE scores: <16 for participants without formal education; <21 for participants whose highest education level was elementary school; and <24 for participants with an education level of at least junior high school. HCV infection status was determined based on HCV antibody titers (<1: negative; >1: positive). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for determining the association between HCV infection and CI development among the elderly.

Results: The CI incidence rates during follow-up in 2008–2019 was compared between the HCV groups. HCV carriers were significantly associated with CI risk increasing by 76% (adjusted hazard ratio (aHR), 1.76; 95% confidence interval (CI): 1.09–2.83; P = 0.021) after multivariate analysis. Significant

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association was also observed between APOE ε4 alleles and the risk of CI. Relative to the participants without an ε4 allele, aHR was 1.67 (95% CI: 1.27–2.19, P = 0.0002) among participants with one or two ε4 alleles. The association between HCV infection and CI was marginally significant among subjects with the APOE ε4 allele (aHR: 2.58, 95% CI: 0.95–7.00, P = 0.0633) compared to those non-HCV counterparts without the APOE ε4 allele.

Conclusions: Our findings suggest that elderly Taiwanese with chronic HCV infection are at an increased risk of cognitive impairment.

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HEPATITIS C VIRUS INFECTION INCREASES RISK OF PERIPHERAL ARTERIAL DISEASE IN ENDSTAGE RENAL DISEASE PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS THERAPY

Chih-Wen Wang1,2, Chung-Feng Huang1, Tyng-Yuan Jang1, Ming-Lun Yeh1, Po-Cheng Liang1, Yi-Hung Lin1,2, Jee-Fu Huang1, Chia-Yen Dai1, Ming‐Lung Yu1, Wan-Long Chuang1 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 1

C 型肝炎病毒感染會增加接受血液透析治 療的末期腎臟病患者發生週邊動脈疾病 的風險 王志文1,2 黃釧峰1 張庭遠1 葉明倫1 梁博程1 林宜竑1,2 黃志富1 戴嘉言1 余明隆1 莊萬龍1 1 2

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄市立小港醫院內科部

Background: Both hepatitis C virus (HCV) infection and end-stage renal disease are associated with an increased risk of developing peripheral arterial disease (PAD).

Aims: Our objective was to explore the relationship between HCV infection and PAD in hemodialysis patients, using brachial-ankle pulse wave velocity (baPWV) as the assessment method.

Methods: Since 2016, we have actively been recruiting patients undergoing regular hemodialysis three times a week. All baPWV assessments for our patients were performed before the implementation of direct-acting antiviral treatment. Furthermore, none of the uremic patients with HCV infection had received interferon-based treatment in the past.

An elevated baPWV measurement surpassing 2100 cm/sec is indicative of an increased susceptibility to potential PAD. Our analysis utilized multivariate linear and logistic regression analysis.

Results: Individuals with HCV infection exhibited higher baPWV levels compared to those without HCV infection (2006.0 ± 687.4 vs. 1809.3 ± 466.1 cm/sec, p

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= 0.039). The presence of HCV infection (β = 199.56, 95% CI: 10.56 ~ 388.56, p = 0.039) demonstrated a significantly positive correlation with baPWV levels.

In the multivariate logistic regression analysis, HCV infection (OR = 2.67, 95% CI: 1.07 ~ 6.68, p = 0.036) significantly associated with baPWV > 2100 cm/sec.

Furthermore, individuals with a higher viral load (HCV RNA > 60 x103 IU/mL) (OR = 4.45, 95% CI: 1.12 ~ 17.68, p = 0.034) demonstrated a significant association with baPWV > 2100 cm/sec when compared to nonHCV infection 6patients. Additionally, patients with genotype I exhibited a significant association with baPWV > 2100 cm/sec (OR = 8.13, 95% CI: 2.04 ~ 32.42, p = 0.003) in comparison to non-HCV patients.

Conclusions: The presence of HCV infection has been demonstrated to markedly increase baPWV levels. Particularly, HCV infection with higher viral load and genotype I is significantly linked to an elevated risk of PAD. It emphasizes the importance of HCV elimination in the specific population.

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PREDICTION MODEL FOR RISK OF HEPATOCELLULAR CARCINOMA AND LIVER-RELATED EVENTS AFTER HEPATITIS C VIRAL ERADICATION

Wei-Fan Hsu1,2,3, Ching-Chu Lo4, Hsueh-Chou Lai1,3, Kuo-Chih Tseng5,6, Chi-Yi Chen7, Cheng-Yuan Peng1,8 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan 3 School of Chinese Medicine, China Medical University, Taichung, Taiwan 4 Department of Internal Medicine, St. Martin De Porres Hospital-Daya, Chiayi, Taiwan 5 Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 6 School of Medicine, Tzuchi University, Hualien, Taiwan 7 Department of Internal Medicine, Chiayi Christian Hospital, Chiayi, Taiwan 8 School of Medicine, China Medical University, Taichung, Taiwan 1

C 型肝炎根除患者罹患肝細胞癌和肝臟相 關併發症的預測模型 許偉帆1,2,3 羅清池4 賴學洲1,3 曾國枝5,6 陳啟益7 彭成元1,8 1

中國醫藥大學附設醫院消化醫學中心 中國醫藥大學生物醫學研究所 3 中國醫藥大學中醫系 4 聖馬爾定醫院內科部 5 大林慈濟醫院內科部 6 慈濟大學醫學系 7 嘉義基督教醫院內科部 8 中國醫藥大學醫學系 2

Background: The predictors of hepatocellular carcinoma (HCC) and liver-related events (LREs) in patients with chronic hepatitis C (CHC) and a sustained virologic response (SVR) after direct-acting antiviral therapy (DAA) are not well known.

Aims: We proposed a risk prediction model for the risk of HCC or LRE in patients with CHC with SVR after DAA therapy.

Methods: Between September 2012 and March

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2022, this retrospective study enrolled 4454 consecutive patients from 4 hospitals in Taiwan. The patients were divided into derivation (n = 2614) and validation (n = 1840) groups.

Results: In the derivation group, age, diabetes mellitus, platelet count, albumin, and alphafetoprotein levels at 12 weeks after antiviral therapy were independent predictors of hepatocellular carcinoma. We incorporated these predictors into a novel risk prediction model called the AAAPD-C score, with total risk scores ranging from 0 to 13. The AAAPD-C score had C-statistics of 0.860 and 0.827 for the derivation and validation groups, respectively.

The risk score accurately classified patients in both groups into those with low, medium, and high risks.

The model also effectively classified patients in the derivation and validation groups on the basis of their risk of liver-related events into 3 subgroups. Patients in the low-risk groups had a low annual incidence of incident hepatocellular carcinoma (1.413 per 1000 person-years).

Conclusions: The AAAPD-C score can predict the risk of hepatocellular carcinoma and liver-related events in patients with chronic hepatitis C and a sustained virologic response after direct-acting antiviral therapy. The tool is accurate and inexpensive, and clinicians can use it to identify patients with chronic hepatitis C at risk of hepatocellular carcinoma or liver-related events following viral eradication.

⑯

LONG-TERM DYNAMIC CHANGES OF INSULIN RESISTANCE AND LIPID PROFILES IN PATIENTS WITH HEPATITIS C VIRAL ERADICATION

Wei-Fan Hsu1,2,3, Hsueh-Chou Lai1,3, Hung-Wei Wang1,4, Sheng-Hung Chen1,4, Wen-Pang Su1, Guan-Tarn Huang1,4, Cheng-Yuan Peng1,4 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan 3 School of Chinese Medicine, China Medical University, Taichung, Taiwan 4 School of Medicine, China Medical University, Taichung, Taiwan 1

C 型肝炎病毒根除患者胰島素抗性和血脂 肪的長期變化 許偉帆1,2,3 賴學洲1,3 王鴻偉1,4 陳昇弘1,4 蘇文邦1 黃冠棠1,4 彭成元1,4 1

中國醫藥大學附設醫院消化醫學中心 中國醫藥大學生物醫學研究所 3 中國醫藥大學中醫學系 4 中國醫藥大學醫學系 2

Background: The hepatitis C virus (HCV) disrupts glucose hemostasis through several direct and indirect mechanisms, resulting in hepatic and extrahepatic insulin resistance (IR). Cardiometabolic criteria (CMC) increase the risk of liver-related events in patients with chronic hepatitis C (CHC). Thus, HCV and CMCs have a complex bidirectional relationship.

However, the dynamic changes of metabolic profiles in CHC patients with viral eradication by directacting antiviral agents are unclear.

Aims: We aimed to investigate the dynamic changes of metabolic profiles in CHC patients with viral eradication.

Methods: From September 2012 to April 2023, 1080 patients with cured CHC and available body mass index (BMI) data were enrolled in this retrospective study. The CMC was defined accordingly. The atherogenic index of plasma (AIP) was calculated to define low (<0.11), intermediate (0.11–0.21), and high (>0.21) risks of cardiovascular diseases.

The demographic and virologic characteristics

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were recorded at baseline and 12 or 24 weeks after antiviral therapy (PW12), and posttreatment glycohemoglobin, IR, and lipid profiles were recorded at the end of therapy, PW12, and then every year until 3 years after the therapy.

Results: Of 1080 patients, 480 (44.4%) patients were male, and 296 (27.4%), 202 (18.7%), and 373 (34.5%) patients had hypertension, DM, and liver cirrhosis, respectively. The median age was 59 (50–67) years (first quartile–third quartile), and the median BMI was 24.03 (21.77–26.68) kg/m². The median triglyceride (TG), total cholesterol (Chol), highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and AIP were 86 (65– 116) mg/dL, 167 (145–186) mg/dL, 47.6 (37.7–58.5) mg/dL, 94.4 (75.5–115.6) mg/dL, and 0.236 (0.069– 0.445), respectively. The median glycohemoglobin (HbA1c) and IR were 5.6 (5.3–6.0) and 2.09 (1.23– 3.25), respectively. In total, 671 (62.1%), 293 (27.1%), 19 (1.8%), 92 (8.5%), and 4 (0.3%) patients had HCV genotypes 1, 2, 3, 6, and mixed infection. The univariate logistic regression analysis showed that sex, BMI ≥23 kg/m², prediabetes or DM, low HDL, total bilirubin, and estimated glomerular filtration were associated with improved AIP grade at year 2.

Multivariable logistic regression analysis revealed that BMI ≥23 kg/m² (0.383 (0.168–0.874), p = 0.023) was independently associated with improved AIP grade at year 2. The levels of TG, Chol, LDL-C, HDL-C, AIP, and HbA1c significantly increased at PW12, Years 1, 2, and 3 compared to the baseline, and IR significantly decreased at Year 1, 2, and 3 compared to the baseline. Patients with and without BMI ≥23 kg/m² had different dynamic patterns of TG, HDL-C, IR, and AIP levels.

Conclusions: TG, Chol, LDL-C, HDL-C, AIP, and HbA1c levels significantly increased, and IR gradually decreased after HCV eradication. Patients with and without BMI ≥23 kg/m² had different dynamic patterns of TG, HDL-C, IR, and AIP levels.

⑰

WHAT KINDS OF LIVER DISEASES WILL WE FACE IN THE POST-HEPATITIS C VIRUS (HCV) ELIMINATION ERA: A COMPREHENSIVE FOLLOWUP STUDY IN AN HCV-ENDEMIC TOWNSHIP

Sheng-Nan Lu1, Jing-Houng Wang1, Shu-Feng Hung1, Yu-Ling Chen1, Yu-Chen Lin2, Wen-Hua Chao2 Division of Hepato-gastroenterology, Department off Inteernal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2 Chiayi County Health Bureau, Chiayi, Taiwan 1

C 型肝炎根除之後我們將面對那些肝病： 某 C 肝盛行鄉的追蹤研究 盧勝男1 王景弘1 洪淑芬1 陳柚陵1 林裕珍2 趙紋華2 1 2

高雄長庚紀念醫院內科部胃腸肝膽科系 嘉義縣衛生局

Background: The National HCV elimination program has been conducted for 7 year and showed promising results.

Aims: To realize status of liver diseases after HCV elimination.

Methods: A follow-up health examination was conducted in an HCV-endemic township, where hepatitis B virus and HCV has been screened 5 years ago. Health examination included questionnaire of habitual alcoholic drinking, laboratory tests of liver and metabolic diseases, Fibroscan®, and upper abdominal ultrasonography.

Results: A total of 240 residents (M/F = 112/128, Age 57.3 ± 14.4 years) responded, including 161 followup and 79 examination naïve cases. Among naïve cases, 11 (13.9%) were HBsAg-positive, 9 (11.4%) anti-HCV-positive, and 2 (2.5%) both-positive. Two of 11 (18.2%) newly detected anti-HCV positive cases were positive for HCV RNA, but none of 29 follow-up subjects. Two previous anti-HCV(-) subjects (1.5%, 2/132) were detected as low titer anti-HCV-positive without viremia. Among 42 HBsAg(+) subjects, including 29 follow-up and 13 newly detected, 21 (50%) were <250 IU/ml. There was no incident HBsAg case. Comparing 33 paired HBsAg concentration, 4 (12.1%) were negative conversion, 9 (27.3%) were

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with >50% decrease, and 4 (12.1%) were with >50% increase. Questionnaires showed habitual alcoholic drinking in 20 (8.3%) subjects, and men (18/112 = 16.1%) were significantly prevalent than women (2/128 = 1.6%) (p < 0.001). Twenty-three subjects (9.6%) with abnormal GGT. Positive questionnaire significantly correlated to GGT elevation (p = 0.001).

Forty-six (19.2%) subjects were with ALT >30 IU/ ml. Based on univariate consideration, rates were 26.2% (11/42) in HBsAg carriers, 16.7% (7/42) in anti-HCV-positive subjects, 40% (8/20) in habitual drinkers, 17.4% (4/23) in DM patients and 38.2% (13/34) in metabolic syndrome status. Seventeen subjects (7.1%) showed significant hepatic fibrosis. i.e. liver stiffness measurement (LSM) > 8 Kpa. There were 19.0% (8/42) in HBsAg carriers, 4.8% (2/42) in anti-HCV-positive subjects, 20% (4/20) in habitual drinkers, 13.0% (3/23) in DM patients and 8.8% (3/34) in metabolic syndrome status. The distributions were 142 (59.2%), 83 (34.6%) and 15 (6.3%) in FIB4 groups cutting by 1.33 and 2.67, respectively. The rates of LSM > 8 KPa in these 3 groups were 5.6% (8/142), 9.6% (8/83) and 6.7% (1/15).

Conclusions: This pilot community-based study pointed out status of hepatitis B and C, alcoholic liver disease, and metabolic-associate fatty liver diseases after HCV elimination.

⑱

IMPACT OF HCV ERADICATION ON RECURRENCE PATTERN AND LONGTERM OUTCOMES IN PATIENTS WITH HCV-RELATED HEPATOCELLULAR CARCINOMA UNDERGOING RADIOFREQUENCY ABLATION

Kuo-Cheng Wu1,2,3, I-Cheng Lee1,2, Chen-Ta Chi1,2,4, Chien-An Liu4,5, Nai-Chi Chiu4,5, Shao-Jung Hsu1,2, Pei-Chang Lee1,2, Chi-Jung Wu1,2, Jiing-Chyuan Luo1,2, Ming-Chih Hou1,2, Yi-Hsiang Huang1,2,4,6 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan 4 Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan 6 Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan 1

根除 C 型肝炎對肝癌接受射頻消融術後 復發模式和長期預後的影響 胡果正1,2,3 李懿宬1,2 齊振達1,2,4 柳建安4,5 邱乃祈4,5 許劭榮1,2 李沛璋1,2 吳啟榮1,2 羅景全1,2 侯明志1,2 黃怡翔1,2,4,6 1

臺北榮民總醫院胃腸肝膽科 國立陽明交通大學醫學系 3 衛生福利部基隆醫院胃腸肝膽科 4 國立陽明交通大學臨床醫學研究所 5 臺北榮民總醫院放射線部 6 臺北榮民總醫院健康管理中心 2

Background: The benefits of HCV eradication on distinct recurrence patterns and long-term hepatic outcomes in patients with hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA) remain uncertain.

Aims: This study aims to assess the impact of HCV eradication on HCC recurrence patterns and longterm hepatic outcomes after RFA and to identify predictors of recurrence in patients achieving sustained virologic response (SVR).

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Section：Pancreas / Biliary Methods: We retrospectively enrolled 274 patients receiving RFA for HCV-related HCC, including 73 and 88 patients treated with interferon-based (IFN) and direct-acting antivirals (DAA) therapy, respectively.

We analyzed factors associated with local tumor progression (LTP), distant recurrence, overall survival, and hepatic decompensation.

Results: SVR was achieved in 49.3% of patients undergoing IFN therapy and 93.2% of patients undergoing DAA therapy. HCV eradication was not associated with LTP but significantly correlated with reduced risk of distant recurrence (by DAA: hazard ratio (HR) = 0.449, p = 0.006), overall survival (by IFN: HR = 0.242, p < 0.001; by DAA: HR = 0.274, p < 0.001), and hepatic decompensation (by IFN: HR = 0.313, p = 0.004; by DAA: HR = 0.281, p < 0.001). The benefits of achieving SVR in terms of overall survival and hepatic decompensation remained significant in subgroups of patients with and without recurrence.

Patients with SVR showed a significant decline in FIB-4 score and a higher proportion of ALBI grade improvement. Among SVR patients, the IMbrave050 criteria predicted LTP but not distant recurrence, whereas the FIB-4 score after SVR, rather than the baseline FIB-4, predicted distant recurrence.

Conclusions: HCV eradication was associated with a significant reduction in distant recurrence, mortality, and hepatic decompensation following RFA in patients with HCV-related HCC.

⑲

THE THERAPEUTIC ROLE OF NPS1034 IN PANCREATIC DUCTAL ADENOCARCINOMA Yu-Kai Huang1, Chi-Chih Wang1,2,3, Wen-Wei Sung2,3, Chun-Che Lin1,2,3, Ming-Chang Tsai1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan 3 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 1

NPS-1034 對胰臟癌細胞的治療效果 黃裕凱1 汪奇志1,2,3 宋文瑋2,3 林俊哲1,2,3 蔡明璋1,2,3 1

中山醫學大學附設醫院肝膽腸胃科 中山醫學大學醫學研究所 3 中山醫學大學醫學系 2

Background: Pancreatic ductal adenocarcinoma (PDAC) is a challenging disease, which is hard to diagnosis in the early stage and has poor response to current chemotherapy and immunotherapy.

Aims: This study explored the potential therapeutic role of NPS-1034, a kinase inhibitor targeting MET and AXL, in PDAC. Methods: We investigate monotherapy with NPS1034 and its combination with the commonly prescribed chemotherapy agents, fluorouracil and oxaliplatin. We used cell culture BxPC-3 and MIAPaCa-2, human PDAC cells, were purchased from the JCRB cell bank. MTT assays were applied to test the cytotoxicity of NPS-1034. To detect the distribution of the cell cycle and the percentage of apoptotic cells in each group, flow cytometry was performed using a FACSCanto™ II Cell Analyzer (BD Biosciences, Franklin Lakes, NJ, USA). Western blotting was used to extract the proteins. IBM SPSS software (version 20.0) (Armonk, NY, USA) was utilized for the statistical analysis. Data are demonstrated as mean ± standard deviation (SD). For continuous or discrete data analysis, Student’s t-test was applied.

Results: Our study revealed that NPS-1034 induces cell death and reduces the viability and clonogenicity of PDAC cells in a dose-dependent manner. Furthermore, the combination of NPS1034 with fluorouracil or oxaliplatin demonstrated a synergistic effect, significantly reducing cell viability

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and inducing tumor cell apoptosis compared to monotherapies. Figure 1 showed (E) flow cytometry revealed increasing proportions of the sub-G1 group after NPS-1034 treatment on PDAC cells. (F) The columns illustrate the increasing proportions of the sub-G1 group after NPS-1034 treatment on PDAC cells. (G) Cell cycle distributions of PDAC cells after NPS-1034 treatment are shown. Data are shown in mean ± SD (*p < 0.05; **p < 0.01; ***p < 0.001). Figure 2 showed the viability of PDAC cells reduced more drastically after combined treatment with NPS-1034 + 5-fu/oxaliplatin. (A–B) MTT assay showed reduced viability of PDAC cells after treatment with NPS1034 + fluorouracil (5-FU). (C–D) MTT assay showed reduced viability of PDAC cells after treatment with NPS-1034 + oxaliplatin.

Conclusions: Our results highlight the anticancer potential of NPS-1034 in PDAC treatment, both as a monotherapy and in combination with traditional chemotherapy, offering a promising opportunity for further clinical exploration.

⑳

NOVEL ROLE OF THE SNARE-TIP FISTULOTOMY AS AN ALTERNATIVE TO NEEDLE-KNIFE IN DIFFICULT BILE DUCT CANNULATION: A SINGLE CENTER EXPERIENCE IN TAIWAN

Te-Jung Chuang1, Hsuan-Jen Hung1,2, Chih-Wei Yang1, Tien-Yu Huang1, Jung-Chun Lin1, Wei-Kuo Chang1, Peng-Jen Chen1 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan 1

線圈尖端瘺管切開術在困難膽管插管中 替代針刀的新角色：台灣的單一中心經 驗 莊得榮1 洪宣任1,2 楊志偉1 黃天祐1 林榮鈞1 張維國1 陳鵬仁1 1 2

三軍總醫院腸胃內科 國軍左營總醫院腸胃內科

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used to diagnose and treat pancreaticobiliary diseases. However, ERCP is a technically challenging procedure, and successful biliary cannulation is essential for the procedure. Needle knife papillotomy (NKP) is the most extensively used precut technique.

Aims: However, due to the increased incidence of complications associated with these techniques including pancreatitis, hemorrhage, and perforation, we aimed to compare the effectiveness of precut technique with conventional NKP to the new precutting method called snare-tip fistulotomy (STF).

Methods: In this study, 56 patients with difficult bile duct cannulation underwent precut papillotomy in one single hospital from January 2013 to June 2022. Among the 56 patients with difficult bile duct cannulation, 27 patients (48.2%) received STF and 29 patients (51.7%) received NKP. Main outcome measures were success rates of biliary cannulation, incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications (perforation, hemorrhage), and post-

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ERCP pancreatitis rate.

Results: The cannulation success rate was 96.2% in 27 patients receiving STF, which was much higher than that of 55% in the 29 patients with NKP (OR 12.12, 95% CI 1.69–86.3, p = 0.001).

Conclusions: STF is a good alternative method to conventional NKP. This is an effective and safe procedure to reach selective biliary cannulation in patients with failure of standard cannulation.

㉑

PREVENTION OF POSTSPHINCTEROTOMY BLEEDING BY ENDOSCOPIC TRANEXAMIC ACID AND SUCRALFATE ADMINISTRATION: AN INTERIM STUDY OF A RANDOMIZED CONTROLLED TRIAL

Hsueh-Chien Chiang, Jui-Wen Kang, Chien-Ming Chiang, Chiung-Yu Chen, Xi-Zhang Lin, Meng-Ying Lin Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

經內視鏡投予傳明酸與蘇克拉非藥物粉 末以預防膽道乳頭切開術後出血之隨機 分派臨床試驗期中分析 姜學謙 康瑞文 江健銘 陳炯瑜 林錫璋 林孟穎 國立成功大學醫學院附設醫院消化內科

Background: Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (EST) are standard treatments for choledocholithiasis and cholangitis. ERCP is associated with a higher rate of complications than other endoscopic procedures, including post-ERCP pancreatitis (PEP), post-EST bleeding, perforation, and biliary tract infection. The incidence rate of post-EST bleeding was 5 – 10%.

Post-EST bleeding results in Tarry-bloody stool and anemia, increasing the mortality rate and hospital stay. Currently, there are no effective methods or medications for the prevention of post-EST bleeding. Tranexamic acid is an antifibrinolytic agent that inhibits fibrin degradation by binding to tissue plasminogen. Sucralfate can promote mucosal healing and protect the wound as a barrier.

Aims: This study aimed to investigate whether the local administration of tranexamic acid and sucralfate can reduce the post-EST bleeding event.

Methods: This is a multi-center prospective randomized controlled trial. Patients with choledocholithiasis scheduled for ERCP with EST at National Cheng Kung University Hospital and Siriraj Hospital were enrolled. The study will recruit 120 patients. After randomization, 60 patients will be classified into the intervention group and 60 into the standard group. The participants will receive standard ERCP and EST for common bile duct stone

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removal. If immediate polypectomy bleeding occurs, we will apply standard endoscopic therapy by either local injection of diluted epinephrine or heater probe coagulation. After CBD stone removal, the operator will spray 0.5 g of sucralfate powder and 0.5 g of tranexamic acid powder through the side-view duodenoscope precisely on the post-EST wound in patients among the intervention group. Blood tests of liver enzymes, bilirubin, and hemoglobin will be obtained 2 days after the ERCP. All enrolled patients will be monitored for post-EST bleeding, post-ERCP pancreatitis, perforation, and biliary tract infection for 14 days after the ERCP. The primary outcome is the incidence rate of post-EST bleeding, which is defined as overt GI bleeding with a drop in hemoglobin by >2 g/dL. Results: From 2024/01/15 to 2024/05/31, forty patients were enrolled and analyzed. After randomization, 19 patients were in the intervention group, and 21 were in the standard group. The baseline characteristics and the CBD stone size were balanced between the groups. Two patients (9.5%) in the standard group had post-EST bleeding, and no patients (0%) in the intervention group had post-EST bleeding. The event rate of post-ERCP pancreatitis was similar between the intervention group and the standard group (10.2% vs 9.5%, P = 0.916). No patient had duodenal perforation or mortality.

Conclusions: Endoscopic spray of an optimal dose of tranexamic acid and sucralfate after EST is a safe procedure and seems to have the potential to prevent post-EST bleeding. This clinical trial will be continued.

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SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS: COMPARISON OF DIFFERENT THERAPEUTIC TECHNIQUES FOR MALIGNANT BILIARY OBSTRUCTION

Li-An Wang1,2, Jyun-Hao Wang1, Sz-Iuan Shiu1,2 Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 1

惡性腫瘤膽道阻塞治療之系統性回顧與 網絡統合分析 王立安1,2 王俊皓1 許斯淵1,2 1 2

臺中榮民總醫院胃腸肝膽科 臺中榮民總醫院內科部

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the preliminary intervention for malignant biliary obstruction (MBO).

Percutaneous transhepatic biliary drainage (PTCD), endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS), and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) are alternative therapies after failure of ERCP. However, the optimum choice among these approaches remains inconclusive.

Aims: We conducted a network meta-analysis to compare the different techniques for MBO. Methods: Three major bibliographic databases were reviewed for enrollment of comparative trials which took place prior to August 23, 2023. We included adults with MBO after failure of preliminary ERCP and compared two or more of four interventions, including controlled group of performing secondtime ERCP, PTCD, EUS-HGS and EUS-CDS. We focus on the outcomes of technical success and postoperative complications including pancreatitis, biliary tract infection, bleeding, perforation, and death.

Results: Five studies involving a total of 340 participants were used in the analyses. When compared with the control group, EUS-HGS (OR 7.47, 95% CI: 1.48~37.75) and EUS-CDS (OR 4.50, 95% CI: 1.85~10.95) were significantly superior to the other techniques in technical success, and EUS-CDS (OR 0.59, 95% CI: 0.20~1.69) and PTCD (OR 0.70, 95% CI: 0.25~1.94) were found to be associated with a lower complication rate without significance.

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Conclusions: For MBO, only EUS-CDS achieved both better technical success and lower postoperative complications while EUS-HGS only showed higher technical success when compared to second-time ERCP.

㉓

ENDOSCOPIC ULTRASOUND GUIDED HEPATICOGASTROSTOMY WITH OR WITHOUT ANTEGRADE STENTING: A RETROSPECTIVE COHORT STUDY

Hung-Yao Lin1,2, Tung-Yen Lin1,2, Chi Ko1,2, Jia-Kuo Chen4, Sheng-Jie Chang1,2, Yu-Ting Kuo1,2,3, Hsiu-Po Wang1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan 3 Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan 4 Internal Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan 1

內視鏡超音波導引之肝胃造廔膽管引流 術有無合併內視鏡超音波導引之順行經 乳突或吻合處之膽道引流術之比較 林弘堯1,2 林東彥1,2 葛齊1,2 陳嘉國4 張勝傑1,2 郭雨庭1,2,3 王秀伯1,2 1

國立臺灣大學醫學院附設醫院消化內科 國立臺灣大學醫學院內科 3 國立臺灣大學醫學院附設醫院綜合診療部內視鏡科 4 衛生福利部金門醫院內科部 2

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can serve as a rescue procedure when endoscopic retrograde cholangiopancreatography (ERCP) fails. EUS-HGS with antegrade stenting (EUS-HGAS) may prolong the time to recurrent biliary obstruction (TRBO), but concerns have been raised regarding potentially increased adverse events (AEs), such as cholangitis and pancreatitis. To date, no Taiwan-based data on these issues have been published.

Aims: This study aims to compare the outcomes of EUS-HGS and EUS-HGAS in a Taiwan-based cohort.

Methods: A total of 125 procedures conducted between December 2020 and May 2024 at the National Taiwan University Hospital were included for retrospective analysis. The primary endpoint was the comparison between EUS-HGS and EUSHGAS regarding TRBO. Early (<4 weeks) and late (>4 weeks) complications were also analyzed. One

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patient with failed antegrade stenting but successful HGS stenting was included in the EUS-HGS group for outcome analysis.

Results: Of the 125 procedures, 88 out of 94 (93.6%) in the EUS-HGS group and 30 out of 31 (96.8%) in the EUS-HGAS group achieved technical success. The mean follow-up period was 204 days for the EUS-HGS group and 99 days for the EUS-HGAS group (P = 0.03).

EUS-HGAS was associated with significantly less recurrent biliary obstruction (RBO, 48.3% vs. 13.3%, P < .001) and longer TRBO (76 days vs. 151 days, logrank P < .01). There was no significant difference in terms of procedure time, technical success rate, or early and late complication rates between the EUSHGS and EUS-HGAS groups. Patients with ascites had a lower technical success rate for HGS (98.6% vs. 90.6%, P = 0.038) and a lower clinical success rate (94.4% vs. 73.6%, P = 0.001). Additionally, patients with an intrahepatic duct (IHD) diameter of less than 5 mm also had a lower clinical success rate.

Finally, there were no differences in TRBO whether the patient had gastric outlet obstruction (GOO, log-rank P = 0.06) or not, or between patients with different types of GOO (log-rank P = 0.813).

Conclusions: EUS-HGAS lengthens TRBO and decreases RBO compared to EUS-HGS, without differences in overall success rate and AEs other than RBO. EUS-HGAS can be conducted safely on patients with GOO and may enhance jaundice alleviation in patients with preprocedural ascites and small IHD.

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BLEEDING AFTER ENDOSCOPIC PAPILLECTOMY AND ITS RISK FACTORS: TWENTY YEARS EXPERIENCE OF A SINGLE MEDICAL CENTER

Hsing-Hung Cheng, Wen-Hsin Huang, Chi-Ying Yang, Shih-Chieh Chuang, Tsung-Lin Hsieh, Pin-Chun Huang, Cheng-Yuan Peng Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan

內視鏡壺腹腫瘤切除術後出血及風險因 子，一醫學中心二十年之經驗 鄭幸弘 黃文信 楊其穎 莊世杰 謝宗霖 黃秉淳 彭成元 中國醫藥大學附設醫院消化醫學中心

Background: Adenomas of the major duodenal papilla are considered rare occurrences. Previous research has highlighted the adenoma-carcinoma sequence leading to ampulla of Vater cancer, with reported malignant transformation rates of ampulla of Vater adenomas ranging between 26% to 65%. As a result, prompt removal of this precancerous lesion is deemed crucial. While surgical resection is typically the definitive treatment, it comes with increased risks of morbidity and mortality. Endoscopic papillectomy (EP) offers an alternative endoscopic approach in specific cases. Despite its benefits, EP is associated with various documented adverse events, with post-EP bleeding standing out as one of the most frequent and severe complications. This retrospective study especially focused on evaluating the risk factors of post-EP bleeding.

Aims: This study aims to assess the clinical outcomes, management strategies related to post-EP bleeding, with a particular focus on identifying its risk factors.

Methods: A retrospective study was conducted at our hospital from 2004 to 2024. Ninety-seven patients diagnosed with adenomas of the major duodenal papilla underwent EP. The clinical data of these patients was thoroughly reviewed.

Results: Ninety-seven patients who underwent EP were included in the study. The average age of the patients was 65 years, with 42.2% being male. The mean tumor size measured 19.4 mm. Post-EP bleeding occurred in 21.6% of the patients (21 out of 97). Of

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Section：SLD those who experienced post-EP bleeding, 66.7% (14 out of 21) encountered immediate bleeding, while 23.8% (5 out of 21) experienced delayed bleeding.

Two patient (9.5%) had both immediate and delayed bleeding episodes. Treatment methods employed included epinephrine injection (16 cases), heater probe electrocoagulation (9 cases), hemoclips (9 cases), and hot biopsy forceps electrocoagulation (4 cases). We conducted a comparative analysis between patients who experienced immediate post-EP bleeding and those who did not, aiming to identify predictive factors for bleeding. Multivariate analysis revealed that tumor size (P = 0.03), elevated direct bilirubin level (P = 0.006), and stage 3a chronic kidney disease (P = 0.02) were potential predictors of immediate post-EP bleeding. Other clinical factors, such as age, medical history, other laboratory tests, and length of hospital stay, were not significantly associated with the occurrence of immediate postEP bleeding. Endoscopic hemostasis was effective in all cases, with no instances requiring surgical intervention or angiography. Importantly, there were no fatalities recorded in this study.

Conclusions: Endoscopic papillectomy for adenomas of the major duodenal papilla was demonstrated to be both highly effective and safe.

The risk of immediate post-EP delayed bleeding was increased in patients with larger tumor size, higher direct bilirubin level and stage 3a chronic kidney disease. Nonetheless, a more expansive prospective study is deemed necessary to provide further insights and clarification on this matter.

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MULTIPLE GENETIC POLYMORPHISMS ARE ASSOCIATED WITH THE RISK OF METABOLIC SYNDROME, FATTY LIVER, AND AIRFLOW LIMITATION: A TAIWAN BIOBANK STUDY

Ying-Ying Yang1,2, Hwai-I Yang3,4, Hsiao-Chin Shen1,2, Mei-Hung Pan3,4, Chih-Jen Huang3,4, Hsiao-Yun Yeh1,2, Kuei-Chuan Lee2,5, Han-Chieh Lin2,5, Ming-Chih Hou1,2,5 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan 2 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 3 Genomics Research Center, Academia Sinica, Taipei, Taiwan 4 Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan 5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 1

多種基因多態性與代謝症候群、脂肪肝 和氣流受限的風險有關：Taiwan Biobank 研究 楊盈盈1,2 楊懷壹3,4 沈曉津1,2 潘眉紅3,4 黃志仁3,4 葉筱芸1,2 李癸汌2,5 林漢傑2,5 侯明志1,2,5 1

臺北榮民總醫院教學部 國立陽明交通大學醫學系 3 中央研究院基因體中心 4 國立中山大學臨床醫學科學博士學位學程 5 臺北榮民總醫院胃腸肝膽科 2

Background: Links have been reported between the airflow limitation and both metabolic syndrome (MetS) and fatty liver (FL). Additionally, associations between genetic factors and risks of MetS, FL, and airflow limitation have been identified separately in different studies.

Aims: Our study aims to simultaneously explore the association between specific single nucleotide polymorphisms (SNPs) of certain genes and the risk of the three associated diseases Methods: In this retrospective cross-sectional nationwide study, 150,709 participants from the

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Taiwan Biobank (TWB) were enrolled. We conducted a genotype–phenotype association analysis of nine SNPs on seven genes (ApoE-rs429358, MBOAT7rs641738, LEPR-rs1805096, APOC3-rs2854116, APOC3-rs2854117, PPP1R3B-rs4240624, PPP1R3Brs4841132, TM6SF2-rs58542926, and IFNL4rs368234815) using data from the TWB1.0 and TWB2.0 genotype dataset. Participants underwent a series of assessments including questionnaires, blood examinations, abdominal ultrasounds, and spirometry examinations.

Results: MetS was associated with FL and airflow limitation. ApoE-rs429358, LEPR-rs1805096, APOC3rs2854116, APOC3-rs2854117, PPP1R3B-rs4240624, PPP1R3B-rs4841132, and TM6SF2-rs58542926 were significantly associated with the risk of MetS. The cumulative impact of T alleles of ApoE-rs429358 and TM6SF2-rs58542926 on the risk of FL was observed (p for trend <0.001). Individuals without MetS and airflow limitation carrying LEPR-rs1805096 G_G genotype exhibited a reduction in the forced expiratory volume in 1 second percentage prediction (Coefficient -35, 95% confidence interval (CI) -69.7 – -0.4), low forced vital capacity percentage prediction (Coefficient -41.6, 95% CI -82.6 – -0.6), and low vital capacity percentage prediction (Coefficient -42.2, 95% CI -84.2 – -0.1).

Conclusions: MetS significantly correlated with FL and airflow limitation. Multiple SNPs were notably associated with MetS. Specifically, T alleles of ApoErs429358 and TM6SF2-rs58542926 cumulatively increased the risk of FL. LEPR-rs1805096 shows a trend-wise association with pulmonary function, which is significant in patients without MetS or airflow limitation.

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TO INVESTIGATE THE FIBROSIS, INFLAMMATION AND LIPOGENESIS EFFECTS BY ENVIRONMENTAL TOXICANT WITH LIPID-ENRICHED CONDITIONS ON NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) TO HEPATOCELLULAR CARCINOMA (HCC)

Saptarshi Bhattacharyya1, Jee-Fu Huang2, Ming-Lung Yu2, Shu-Chi Wang1, Chia-Yen Dai2 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 1

研究富含脂質的環境毒物對非酒精性脂 肪肝病（NAFLD）至肝細胞癌（HCC）的 纖維化、發炎和脂肪生成的影響 Saptarshi Bhattacharyya1 黃志富2 余明隆2 王述綺1 戴嘉言2 1 2

高雄醫學大學醫學檢驗生物技術學系 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: The liver, a highly specialized organ, comprises multiple cell types in a threedimensional architecture. To mimic the in-vivo liver conditions, spherical or irregularly shaped 3-D structures, called spheroids, are developed by coculturing distinct liver cells. Particularly relevant to research is their utility in investigating the effects of environmental toxicants, such as Bisphenol-A (BPA), on Non-Alcoholic Fatty Liver Disease (NAFLD) and Hepatocellular Carcinoma (HCC). BPA, commonly found in consumer goods, disrupts lipid metabolism, but the detail of the abnormal lipogenesis, steatosis, fibrosis and even HCC by the genetic alternation need to further investigation.

Aims: To prove that BPA can exacerbate fatty liver diseases.

Methods: We established a three-dimensional invitro spheroid model by co-cultured hepatocyte cell line (Huh-7), Liver Sinusoidal Endothelial Cell line (SK-HEP-1) and hepatic stellate cell line (LX-2) to develop a 3-D in-vitro spheroid model to mimic the in-vivo liver environment. The cell groups were prepared as LX-2, Huh-7, Sk-Hep-1, Huh-7+LX-2 and

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Huh-7+Sk-Hep-1 co-culture. Next, we compared their proliferation rate and spheroid formation effect under lipid-free, lipid-enriched (Oleic acid/ Palmitic acid) and lipid plus BPA enriched conditions to analyze the ratio of Triglyceride (TG) formation using Triglyceride Assay.

Results: The XTT cytotoxicity and cell proliferation data provides the BPA cytotoxicity with lipid enriched on the 3-D spheroids. Gene expression analysis using RT-PCR revealed alterations in inflammation (TNF-α, TGF-β), fibrosis (COL1A1, TIMP-1), lipogenesis (SREBP-1, FASN) and HCC (β-catenin, AKT-1, SREBP-c) genes under lipid-free, lipid-/lipid + BPA-enriched conditions to prove that environmental toxicant can lead to steatosis and fatty-liver disease. The NGS may provide for the further investigate comprehensive genetic networks alternation under the environmental toxicant with lipid-enriched condition.

Conclusions: This comparative analysis enhances our understanding of how lipid with environmental toxicant influence the behavior of the threedimensional liver tissue model. By elucidating mechanisms underlying spheroid formation, cell proliferation, and lipid-mediated effects.

This study contributes valuable insights into liver pathophysiology and aids in developing preventive strategies against NAFLD and HCC with environmental toxicant.

㉗

THE ASSOCIATIONS BETWEEN DYSBIOTIC MICROBIOTA AND PRESENCE OF MASLD IN INDIVIDUALS RECEIVING HEALTH CHECK-UP IN SOUTHERN TAIWAN

Kung-Hung Lin1,2, Chi-Shen Chen1, Chiao-Lin Hsu1, Wei-Chin Huang1, Pin-Chieh Wu1, Kuang-Chieh Hsueh1,3, Jui-Ho Wang1,4, I-Shu Chen1,5, Hsien-Chung Yu1,2 Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 3 Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 4 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 1

在南臺灣接受健康檢查者中，失調性微 菌叢與代謝功能障礙相關脂肪肝病之相 關性 林恭弘1,2 陳己升1 許喬琳1 黃偉晋1 吳品潔1 薛光傑1,3 王瑞和1,4 陳以書1,5 余憲忠1,2 1

高雄榮民總醫院健康管理中心 高雄榮民總醫院胃腸肝膽科 3 高雄榮民總醫院家庭醫學部 4 高雄榮民總醫院大腸直腸外科 5 高雄榮民總醫院一般外科 2

Background: Metabolic-dysfunction associated steatotic liver disease (MASLD), a term encompassing patients having hepatic steatosis and one of five cardiometabolic risk factorsis, is replacing “nonalcoholic fatty liver disease (NAFLD)”. There are increasing evidence indicating the involvement of gut microbiota in the development and progression of NAFLD. Aims: We design this study to explore the association between dysbiotic microbiota and MASLD assessed by both image and laboratory parameters.

Methods: We enrolled consecutive adults receiving comprehensive health check-ups including fasting blood tests, fecal microbiota analysis using 16S

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rRNA sequencing, hepatobiliary ultrasound (US), and CT scans in our Health Management Center.

The presence and severity of steatosis on US was determined by radiologists according to increased hepatic echogenicity in contrast to kidney or spleen, visualization of portal sheath, and fatty attenuation, and reappraised by a single gastroenterologist. CT liver-to-spleen ratio (LSR) was measured by taking average Hounsfield unit (HU) of three region-ofinterests over both hepatic lobes, and dividing it by the spleen HU value. Fatty Liver Index (FLI) and fibrosis-4 (FIB-4) score were calculated according to the formulas proposed by Bedogni G et al and Sterling RK et al, respectively. Previous CT images and laboratory reports were reviewed to elucidate the interval changes of aforementioned parameters.

Results: A total of 200 individuals were enrolled for analysis, including 109 (54.5%) male and 29 (14.5%) with type 2 DM, with a median age, 59.8 years (IQR 52.1 – 67.1) and BMI, 24.0 (21.8 – 26.4). Sixty eight (34%) individuals were diagnosed as MASLD, including 17 with moderate or severe steatosis by ultrasound appearance. FLI > 60 and CT LSR < 1 were correlated with presence of steatosis on US, as well as LSR < 0.8 with moderate or more steatosis (P < 0.001 for all comparison). Decreased abundance of Firmicutes was significantly associated with MASLD (P = 0.009), LSR < 0.8 (P = 0.025) and higher value of FLI (P = 0.04), while scarceness of Ruminococcus correlated with FLI ≥ 60 (P = 0.045) and higher FLI (P = 0.005). On the contrary, enrichment of Fusobacterium was significantly associated with higher FLI (P = 0.008). Neither Proteobacterium nor Bifidobacterium correlated with steatosis. None of these microbiota was associated with FIB-4 scores, as well as the interval changes (median 4.4 years) of LSR, FLI values, and FIB-4 scores.

Conclusions: Our findings highlighted the correlations of Firmicutes, Ruminococcus, and Fusobacterium, with the diagnosis of MASLD and parameters of steatosis. In contrast to the literature, the opposite directions of some correlations, however, warranted further studies to discriminate.

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COMPARED THE EFFICACY OF DIFFERENT STATIN BASE MEDICINE IN REDUCING THE LIVER INFLAMMATION AMONG THE PATIENTS WITH METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE – A SINGLE HOSPITAL RETROSPECTIVE COHORT STUDY

Yi-Tseng Tsai1, Chu-Kuang Chou2, Li-Fu Kuo1, I-Ting Wu1, Ping-I Hsu1, Kun-Feng Tsai1 Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chiayi Christian Hospital, Chiayi, Taiwan 1

比較以不同 Statin 為基礎的藥物改善代 謝性肝臟疾病之病人肝臟發炎之療效改 善差異 — 一回溯性研究 蔡宜蓁1 周莒光2 郭立夫1 吳奕霆1 許秉毅1 蔡坤峰1 1

臺南市立安南醫院—委託中國醫藥大學興建經營消 化內科 2 戴德森醫療財團法人嘉義基督教醫院胃腸肝膽科

Background: There is increasing evidence that metabolic associated steatotic liver disease is associated with obesity and metabolic syndrome.

Previous research suggests that statins (HMG-CoA reductase inhibitors) can be used to treat MASLD (metabolic associated steatotic liver disease) due to their anti-inflammatory, antithrombotic, and antifibrotic properties, which might help delay or prevent the progression of MASLD to cirrhosis and liver cancer. Another lipid-lowering drug, niacin, has shown promising results in reversing cirrhosis in preclinical trials, but the combination of niacin with statins has not yielded consistent results in studies.

This study aims to evaluate the effectiveness of the treatment in MASLD. Aims: This study aims to evaluate the effects of three different treatment regimens (Lovastatin/niacin, Rosuvastatin, and Atovastatin) on the patient with metabolic fatty liver disease. The goal is to assess the treatment effectiveness of the differ in reducing the liver inflammation for patients with MASLD. Methods: Since 2021 Jan-2024 March, we retrospective enrolled 984 participants who

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were assigned to one of three treatment groups: Lovastatin/niacin group (n = 396), rosuvastatin group (n = 264), and atorvastatin group (n = 324).

Liver function was assessed at baseline, visit 1 (post-treatment for three months), and visit 2 (post-treatment for 6 months). Statistical analyses, including one-way ANOVA, chi-square test, and Kruskal-Wallis test, were used to compare the liver function parameters among these groups.

Results: The study revealed that the Lovastatin/ niacin group showed significant improvements in liver enzyme levels compared to the Rosuvastatin group and the Atorvastatin groups. At the 3-month post-treatment visit, the mean AST levels for the Lovastatin/niacin group were 29.41 ± 14.75, showing a significant decrease from baseline (33.55 ± 21.67) with a p-value of 0.0077. Similarly, ALT levels decreased significantly in the Lovastatin/ niacin group (36.18 ± 27.09 from 41.81 ± 36.16) with a p-value of 0.0418.

Conclusions: These findings were not as pronounced in the other treatment groups, suggesting that the combination of Lovastatin and niacin may offer superior benefits in reducing liver inflammation in MASLD patients.

㉙

METABOLIC DYSFUNCTIONASSOCIATED STEATOTIC LIVER DISEASE IS ASSOCIATED WITH INCREASED RISKS OF HEART FAILURE

Kai-Chun Chang1, Tung-Hung Su2,3, Cho-Kai Wu1, Shang-Chin Huang4,5, Tai-Chung Tseng2,3,6, Chun-Ming Hong2, Shih-Jer Hsu2,3, Chen-Hua Liu2,3, Hung-Chih Yang2,3, Chun-Jen Liu2,3, Jia-Horng Kao2,3,5,6 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 5 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 6 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 1

代謝相關性脂肪肝病與心衰竭風險 張凱鈞1 蘇東弘2,3 吳卓鍇1 黃上秦4,5 曾岱宗2,3,6 洪俊銘2 徐士哲2,3 劉振驊2,3 楊宏志2,3 劉俊人2,3 高嘉宏2,3,5,6 1

國立臺灣大學醫學院附設醫院心臟內科 國立臺灣大學醫學院附設醫院胃腸肝膽科 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北護分院內科部 5 國立臺灣大學醫學院臨床醫學研究所 6 國立臺灣大學醫學院附設醫院醫學研究部 2

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), defined by steatotic liver disease (SLD) and cardiometabolic factors, is increasing in prevalence, but its association with heart failure (HF) is unclear.

Aims: We aim to clarify the association between MASLD with new onset HF. Methods: Patients with SLD without a history of HF from 2006 to 2021 were retrospectively included and were classified into MASLD and non-MASLD groups

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that were followed longitudinally. The primary outcome was the new development of HF, which was sub-classified by echocardiography. Multivariable and propensity score matching analyses were conducted to adjust for confounding factors.

Results: Overall, 26,676 patients with SLD were included, with a median age of 51 and 71% classified as MASLD. During a median follow-up of 6 years, 429 (1.61%) patients developed HF, and 76% were HF with preserved ejection fraction (HFpEF). The risk of HF was significantly higher in patients with MASLD than in those without (sub-distributional hazard ratio (SHR): 2.59, 95% confidence interval (CI): 1.84-3.64) after adjustment of competing mortality.

There is a dose-dependent increase in HF risks in patients with more cardiometabolic risk factors (SHR:1.17, 95% CI: 1.09-1.27). Specifically, MASLD increased the risks of HFpEF (SHR: 1.91, 95% CI: 1.272.86). In propensity score-matched cohorts, MASLD increased 2.52-fold risk of HF. The MASLD definition identifies significantly more at-risk patients for HF compared with the definition of non-alcoholic fatty liver disease.

Conclusions: In patients with SLD, the risk of HF, specifically HFpEF, was significantly increased in those with MASLD. Patients with MASLD with more cardiometabolic risk factors should be monitored for the development of HF.

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HYDROXYCHLOROQUINE FOR THE TREATMENT OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS

Hsu-Hua Tseng1, Chung-Jui Huang2, Chih-Kai Chen3, Kuan-Yu Lin3, Hung-Chih Yang1,4, Feng-Chiao Tsai1,2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan 3 School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan 1

以羥氯奎寧治療脂肪性肝炎 曾旭華1 黃崇睿2 陳至楷3 林冠宇3 楊宏志1,4 蔡丰喬1,2 1

國立臺灣大學醫學院附設醫院內科部 國立臺灣大學藥理學研究所 3 國立臺灣大學醫學系 4 國立臺灣大學微生物學研究所 2

Background: The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) is on the rise, posing risks of fibrosis, cirrhosis, and even hepatocellular carcinoma. Despite these potential complications, there are currently no approved medications for MASH treatment.

Aims: Considering hydroxychloroquine’s (HCQ) pleiotropic effects, including inflammation reduction, glucose homeostasis, and lipid metabolism, we administered HCQ to MASH patients.

The investigation revealed a swift reduction in serum alanine aminotransferase (ALT) levels. Our goal was to substantiate HCQ’s potential efficacy and possible mechanisms in MASH treatment.

Methods: We retrospectively enrolled patients meeting the following criteria from National Taiwan University Hospital from 2017 to 2022: (1) age above 18, (2) ALT level > 41 U/L, (3) diagnosed with MASH, and (4) received HCQ treatment. Therapeutic effects were assessed using a case-control strategy, matching HCQ-treated patients with a prospective MASH cohort undergoing lifestyle modification

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Section：Cirrhosis & Portal only. ALT level changes were reviewed for both groups. Filamentous actin structures in LX-2 human hepatic stellate cells and the sizes and amounts of lipid droplets in the HepG2 cell line were employed to assess HCQ’s effects.

Results: Among 26 HCQ-treated patients matched with 26 lifestyle-modification patients, a significant reduction in ALT levels occurred with HCQ treatment.

At 3 months, the proportion of patients with persistent ALT levels > 41 U/L was 34.62% (HCQ) and 84.62% (control); at 12 months, it was 11.54% (HCQ) and 53.85% (control). (Figure 1A) We further analyzed patients with HCQ discontinuation followed by re-administration. One year after discontinuation, ALT level rebounds were observed in 86% of the patients. (Figure 1B) After re-administration, 56% of the patients exhibited normalized ALT levels within three months; and 89% in one year. (Figure 1C) Significant alteration of actin structures in activated LX2 cells by HCQ was noted in a concentrationdependent manner. (Figure 2) The number of lipid droplets in HepG2 cells were significantly decreased

by HCQ in a concentration-dependent manner.

(Figure 3) Besides, in contrast to control cells containing lipid droplets of variable sizes, remaining lipid droplets in cells under HCQ were mostly large in size, indicating that HCQ blocked the initiation rather than enlargement of lipid droplets.

Conclusions: HCQ significantly decreased serum ALT levels in MASH patients. The causal relationship was further confirmed by ALT rebound and renormalization during discontinuation and readministration. HCQ suppressed activities of stellate cells and reduced liver steatosis. These results suggest the promise of HCQ in resolving liver inflammation and its potential as a treatment for MASH.

㉛

RISK STRATIFICATION OF LIVER-RELATED EVENTS AND HEPATOCELLULAR CARCINOMA AFTER ANTIVIRAL TREATMENT USING BASELINE AND POSTTREATMENT LIVER STIFFNESS

Sheng-Hung Chen1,2, Hsueh-Chou Lai1,3, Yi-Chun Kuo1, Wei-Fan Hsu1,3, Hung-Wei Wang1,2, Cheng-Yuan Peng1,2 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 School of Medicine, China Medical University, Taichung, Taiwan 3 School of Chinese Medicine, China Medical University, Taichung, Taiwan 1

利用治療前後肝臟硬度值進行抗病毒治 療後的肝臟相關事件和肝細胞癌風險分 層 陳昇弘1,2 賴學洲1,3 郭亦純1 許偉帆1,2 王鴻偉 彭成元1,2 1

中國醫藥大學附設醫院消化醫學中心 中國醫藥大學醫學系 3 中國醫藥大學中醫學系 2

Background: The residual burden of liver fibrosis and metabolic dysfunction cannot be completely abolished after antiviral treatment in patients with chronic hepatitis B (CHB) or chronic hepatitis C (CHC).

Liver stiffness (LS) measurement, a non-invasive technique using point shear wave elastography, can track disease severity over time in patients with chronic liver disease. This technique is valuable as it reflects both liver fibrosis and necroinflammation, key factors in the development of liver-related events (LREs) and hepatocellular carcinoma (HCC).

Aims: This study investigated the association between LS kinetics and the risk of LREs and HCC in patients with CHB or CHC using baseline and posttreatment LS values. The study also aimed to identify both baseline and post-treatment cutoff values of LS for identifying low-risk subgroups in terms of developing LREs and HCC events.

Methods: This was a retrospective longitudinal cohort study conducted at a single medical center.

The study population comprised consecutive patients with CHB or CHC who initiated antiviral therapy between May 2015 and May 2024.

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Demographic data, medical history, and laboratory values were collected at baseline and at one year after treatment initiation. The primary outcomes were the occurrence of incident LREs and HCC after one year of treatment initiation. Cox proportional hazards regression analysis was employed to identify predictors of LREs and HCC. Predictors with a p-value of <0.2 in univariate analysis were included in stepwise backward multivariable analysis.

The Kaplan-Meier method was used to estimate cumulative incidence rates and identify cutoffs for distinct risk groups, and log-rank tests were used to assess differences between groups.

Results: This study included 897 patients, with 47 (5.2%) experiencing LREs and 39 (4.3%) HCC over a median follow-up of 48 months (maximum 72 months). The median age was 56 years, and 50% (n = 451) were male. The etiologies of liver disease were CHC (64%, n = 573) and CHB (36%, n = 324).

Other prevalent conditions included fatty liver (65%, n = 586), hypertension (27%, n = 243), and diabetes mellitus (17%, n = 152). Multivariable Cox regression analyses identified diabetes (adjusted hazard [aHR] = 1.985, 95% confidence interval = 1.086-3.627, p = 0.0258), fatty liver (aHR 0.451, 0.247-0.822, p = 0.0093), platelet (<150 × 103/μL, aHR 2.450, 1.223-4.911, p = 0.0115), and LS (≥1.70 m/s, aHR 4.387, 2.038-9.442, p = 0.0002) at baseline as the independent predictors of incident LREs after one year of treatment initiation. At one year after treatment initiation, diabetes (aHR 2.164, 1.180-3.969, p = 0.0126), fatty liver (aHR 0.479, 0.262-0.876, p = 0.0168), albumin (aHR 0.378, 0.219-0.653, p = 0.0005), platelet (<140 ×103/μL, aHR 2.207, 1.117-4.361, p = 0.0226), AFP (≥2.7 ng/mL, aHR 2.994, 1.246-7.193, p = 0.0142), LS (≥1.50 m/s, aHR 2.538, 1.293-4.981, p = 0.0068), and LS decline (≥0.3 m/s, aHR 2.245, 1.218-4.138, p = 0.0095) were independent predictors of LREs. For HCC prediction, baseline diabetes (aHR 2.224, 1.154-4.287, p = 0.0170), fatty liver (aHR 0.403, 0.2060.788, p = 0.0079), platelet (<150 ×103/μL, aHR 2.143, 1.015-4.527, p = 0.0457), and LS (≥1.70 m/s, aHR 3.415, 1.542-7.563, p = 0.0025) were independent predictors. At one year after treatment initiation, predictors for HCC included diabetes (aHR 2.185, 1.132-4.220, p = 0.0199), fatty liver (aHR 0.436, 0.2230.855, p = 0.0157), platelet (<150 ×103/μL, aHR 2.225, 1.039-4.765, p = 0.0396), AFP (≥2.7 ng/mL, aHR 3.890, 1.351-11.199, p = 0.0118), LS (≥1.50 m/s, aHR 2.085, 1.048-4.150, p = 0.0364), and LS decline (≥0.3 m/s, aHR 2.314, 1.167-4.588, p = 0.0163). LS cutoff

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values of 1.30 m/s (area under the receiver operating characteristic curve [AUC] = 0.822) for LRE and 1.25 m/s (AUC = 0.800) for HCC at baseline, and 1.20 m/s for both LRE (AUC = 0.827) and HCC (AUC = 0.803) at one year after treatment initiation, identified subgroups of patients with a 5-year cumulative incidence rate of less than 1% for each outcome, respectively.

Conclusions: In patients with CHB or CHC, LS values at baseline and one year after treatment initiation are independent predictors of LREs and HCC. Lower LS values alone at both time points identify a subgroup of patients with an extremely low risk of developing these events. The findings of this study may help clinicians stratify the risks of LREs and HCC and thereby optimize the surveillance program for these events.

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TOCILIZUMAB TREATMENT IMPROVES LIPOPOLYSACCHARIDEINDUCED ACUTE LUNG INJURY IN BILIARY CIRRHOTIC RATS

Ching-Chih Chang1,2, Kuang-Yao Yang1,2, Hui-Chun Huang1,2, Chiao-Lin Chuang1,2, Ming-Chih Hou1,2, Fa-Yauh Lee1,2

pulmonary inflammatory protein expressions.

Conclusions: LPS administration induced acute lung injury in biliary cirrhotic rats. Tocilizumab treatment ameliorated lung damage and hypoxia, possibly by downregulating inflammatory proteins and reducing IL-6, TNF-α and CD68-positive macrophage infiltration in the lung.

Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

Tocilizumab 治療可改善肝硬化大鼠急性 肺部損傷 張景智1,2 陽光耀1,2 黃惠君1,2 莊喬琳1,2 侯明志1,2 李發耀1,2 1 2

臺北榮民總醫院內科部 國立陽明交通大學醫學系

Background: Infection-related lipopolysaccharide (LPS) release causes cytokine storm and acute lung injury. Emerging data show that the interleukin 6 (IL6) inhibitor tocilizumab can improve lung damage in patients with sepsis.

Aims: This study aimed to investigate the therapeutic effect of tocilizumab on acute lung injury in cirrhotic rats.

Methods: Biliary cirrhosis was induced in SpragueDawley rats with common bile duct ligation (BDL).

Sham-operated rats served as surgical controls.

Tocilizumab was administered on post-operative day 21, and LPS was injected intraperitoneally on day 29. Three hours after LPS injection, hemodynamic parameters, biochemistry data, and arterial blood gas analysis were evaluated, along with measurements of IL-6 and tumor necrosis factor-α (TNF-α). Liver and lung histology was examined, and protein levels were analyzed.

Results: LPS administration did not affect mortality, but it reduced portal pressure, portal venous flow and cardiac index in the BDL rats. In addition, LPS administration induced acute lung injury, hypoxia and elevated TNF-α and IL-6 levels. Pre-treatment with tocilizumab did not affect hemodynamic and biochemistry data, but it ameliorated lung injury and decreased TNF-α, IL-6, and CD68-positive macrophage infiltration. Moreover, tocilizumab administration improved hypoxia and gas exchange in the BDL rats, and downregulated hepatic and

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ENHANCING THE DETECTION OF FOCAL LIVER LESIONS THROUGH DEEP-LEARNING SIGNATURE

BY INTEGRATING OUTCOMES FROM MULTI-SEQUENCE MRI IN INDIVIDUALS WITH AND WITHOUT CIRRHOSIS

Sulagna Mohapatra1,2, Chun-Ying Wu2,3,4,5,6, Yao-Chun Hsu7,8, Teng-Yu Lee1,9, Che-Lun Hung2,3, Yuan-Chia Chu10,11, Chia-Sheng Chu12,13, Pushpanjali Gupta2,3,4 Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan; 2Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; 5Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan; 6Department of Public Health, China Medical University, Taichung, Taiwan; 7 Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan; 8School of Medicine, I-Shou University, Kaohsiung, Taiwan; 9 School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 10Information Management Office & Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; 11 Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 12Division of Gastroenterology and Hepatology, Taipei City Hospital Yang Ming Branch, Taipei, Taiwan; 13 Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

Background: Manual identification of focal liver lesions (FLLs) using multi-sequence MRI is challenging, time-consuming, and error-prone due to variability in their intensity, size, location, and appearance, often influenced by the observer’s subjective experience.

Aims: To design a dual-phase deep learning approach, DualDeep-LLD, to automatically locate liver and corresponding FLLs in both cirrhotic and non-cirrhotic patients, using multi-sequence MRI

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features.

Methods: This retrospective study involved 271 patients, 60 with cirrhosis and 211 without, from January 2010 to December 2014. It analyzed various imaging characteristics from contrast-enhanced (arterial, venous, and delayed phases) and nonenhanced (T1, T2, T1 Dual Echo, and T1/T2 ratio) MRI. The collected data comprised 144 cirrhotic and 560 non-cirrhotic nodules, respectively. Initially, the DualDeep-LLD focused on precise localization of the liver, followed by an automated system to detect FLLs. Additionally, an advanced voting method was introduced, combining the individual outcome from multiple MRI sequences to conclude the location of FLL accurately.

Results: In its initial phase, the DualDeep-LLD system showed high accuracy in localizing livers, achieving a mean average precision (mAP) of 0.96 for cirrhotic livers and 0.98 for non-cirrhotic ones.

For FLL detection, it reached an average precision of 0.96 and a recall of 0.88 in non-cirrhotic cases, and an average precision of 0.73 with a recall of 0.86 in cirrhotic cases. The system scored F1-score of 0.80 for cirrhotic and 0.87 for non-cirrhotic fatty liver cases.

In terms of lesion size, DualDeep-LLD achieved true positive rates (TPR) of 0.53 and 0.83 for lesions ≤ 1.5 cm, and 0.81 and 0.87 for lesions sized 1.5 cm-3 cm, across both case types. Notably, it localized larger lesions (>3 cm) with 100% accuracy.

Conclusions: The advanced DualDeep-LLD system can automatically detect Focal Liver Lesions (FLLs) larger than 0.3 cm using multi-sequence MRI inputs, reducing workload, errors, and diagnosis time.

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㉞

RECONSIDERING PROPHYLACTIC ANTIBIOTIC USE IN CHILD-PUGH A CIRRHOTIC PATIENTS WITH UPPER GI BLEEDING

additional randomized controlled trials are necessary to further confirm the result and potentially inform guideline updates.

Chien-Hao Huang, Ya-Ting Cheng, Ming-Hung Tsai, Chun-Yen Lin, Rong-Nan Chien Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

重新考量在上消化道出血的 Child-Pugh A 肝硬化患者中使用預防性抗生素 黃建豪 鄭雅婷 蔡銘鴻 林俊彥 簡榮南 林口長庚紀念醫院胃腸肝膽科系肝臟科

Background: Patients with liver cirrhosis presenting with upper gastrointestinal bleeding (UGIB) are commonly administered prophylactic antibiotics, preferably before endoscopy, as recommended by the Baveno VII and EASL guidelines. However, the risk of bacterial infection and mortality is notably low in patients with Child-Pugh A cirrhosis, warranting further investigation into the necessity of antibiotic prophylaxis in this subgroup.

Aims: This study investigated whether prophylactic antibiotic use is beneficial in Child-Pugh A cirrhotic patients with UGIB. Methods: In this retrospective cohort study conducted between 2016 and 2023, data from 3,520 cirrhotic patients with UGIB were analyzed. Patients were categorized into two groups: those receiving prophylactic antibiotics and those who did not.

Participants with Child-Pugh B or C scores, or lacking available Child or MELD scores, were excluded. The primary endpoint was the incidence of infection within one month, and the secondary endpoint was mortality within three months.

Results: After exclusions, 266 patients in the antibiotic group and 1,117 in the non-antibiotic group were included. Cox multivariate regression analysis revealed no significant difference in the incidence of infection between patients receiving prophylactic antibiotics and those who did not.

Mortality rates were borderline significantly higher in the prophylactic antibiotic group.

Conclusions: These findings suggest that prophylactic antibiotic use may be unnecessary in Child-Pugh A cirrhotic patients with UGIB. However,

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㉟

MAC-2-BINDING PROTEIN GLYCOSYLATION ISOMER IMPROVES THE PREDICTION OF SUBSEQUENT HCC RISK IN PATIENTS WITH INTERMEDIATE FIB-4 SCORES

Ze-Min Ling1, Tung-Hung Su1,2, Mei-Hsuan Lee3, Chun-Jen Liu1,2, Pei-Jer Chen1,2,4,5, Hung-Chih Yang1,2, Chen-Hua Liu1,2, Chi-Ling Chen4, Tai-Chung Tseng1,2, Chien-Hung Chen6, Hsuan-Shu Lee1, Chien-Jen Chen7, Jia-Horng Kao1,2,4,5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 3 Institute of Clinical Medicine, National Yang‐ Ming Chiao Tung University, Taipei, Taiwan 4 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 5 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan 7 Genomics Research Center, Academia Sinica, Taipei, Taiwan 1

MAC-2 結合蛋白糖基化異構體改善中度 FIB-4 指數患者的後續肝細胞癌風險預測 凌澤民1 蘇東弘1,2 李美璇3 劉俊人1,2 陳培哲1,2,4,5 楊宏志1,2 劉振驊1,2 陳祈玲4 曾岱宗1,2 陳健弘6 李宣書1 陳建仁7 高嘉宏1,2,4,5 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院肝炎研究中心 3 國立陽明交大臨床醫學研究所 4 國立臺灣大學臨床醫學研究所 5 國立臺灣大學醫學院附設醫院醫學研究部 6 國立臺灣大學醫學院附設醫院雲林分院 7 中央研究院基因體研究中心 2

Background: The Fibrosis-4 (FIB-4) index and serum Mac-2-binding protein glycosylation isomer (M2BPGi) have been individually demonstrated to be predictive for hepatocellular carcinoma (HCC) development in chronic hepatitis C (CHC) patients.

Aims: This study aims to investigate the predictive

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value of serum M2BPGi for HCC development in treatment-naïve hepatitis C virus (HCV) patients following stratification by the FIB-4 index.

Methods: We conducted a retrospective ERADICATE-C cohort study to include untreated HCV patients who received longitudinal follow-ups at the liver clinic of the National Taiwan University Hospital from 1986 to 2014. Patients were enrolled if they had positive anti-HCV antibody, HCV RNA, or a diagnosis of CHC by ICD-codes. Patients with incomplete medical records, coinfection of HBV or HIV, history of HCC or HCC development in the first year, antiviral therapy initiation within 1 year of enrollment, or a follow-up duration of less than 3 years were excluded. The Receiver characteristics curve was used to determine the cut-off value for the M2BPGi level. Patients were stratified by FIB-4 index into low (<1.45), intermediate (1.45-3.25), and high (≥3.25) risk groups, and the Cox proportional hazards model was conducted to identify potential predictors of HCC development.

Results: A total of 772 patients were included in this study. The mean age was 55 years, 286 patients (37%) were male, and 80 (10.4%) patients had baseline cirrhosis. The median M2BPGi level was 1.2 C.O.I, and the FIB-4 level was 2.25. After a median follow-up of 12 years, 159 (20.6%) patients newly developed HCC. The 5-year cumulative risks of HCC were 0.9%, 4.3%, and 11.9% in the respective low, intermediate, and high-risk groups of the FIB4 index. The univariate and multivariable analysis both revealed that M2BPGi level is a significant predictor of HCC development. Because the HCC risks were very low in the low FIB-4 group and high in the high FIB-4 group, FIB-4 should be sufficient to assess the HCC risks. We, therefore, focused on the intermediate FIB-4 group. The M2BPGi level predicts the 5-year HCC risks with an AUROC of 0.70 in this group. After adjustment of confounding factors, M2BPGi level > 2.0 C.O.I. can stratify the 5-year risks of HCC development in these patients (hazard ratio: 6.57, 95% confidence interval: 1.77-24.33).

Conclusions: In treatment-naïve HCV patients with intermediate FIB-4 level, M2BPGi > 2.0 C.O.I. can help predict the subsequent development of HCC.

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Section：HCC ㊱

HIGH SAFE SCORES STRATIFY RISKS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC LIVER DISEASES REGARDLESS OF ETIOLOGIES

Tung-Hung Su1, Sheng-Shun Yang2, Wei-Yu Kao3, Shang-Chin Huang4, Fen-Fang Chen1, Francis SK Poon2, Lung-Wen Tsai3, Che Lin5, Weichung Wang6, Jia-Horng Kao1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Division of Gastroenterology & Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 5 Department of Electrical Engineering & Graduate Institute of Communication, National Taiwan University, Taipei, Taiwan 6 Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan 1

with various CLD etiology were included from tertiary medical centers in Taiwan. The SAFE score, consisting of age, BMI, diabetes, and laboratory data, was calculated at baseline, and patients were traced for new development of HCC. The predictability of the SAFE score for HCC was analyzed using the subdistribution hazard model with adjustments for competing risks.

Results: We included 12,963 CLD patients with a median follow-up of 4 years, during which 258 developed HCC. The SAFE score classifies 1, 3, and 5-year HCC risk regardless of CLD etiologies, which outperformed the Fibrosis-4 index. High (≥100) and intermediate (0-100) SAFE scores increased HCC risks by 11 and 2 folds, respectively, compared to low (<0) SAFE scores. Combining two lower risk tiers (SAFE < 100), a high SAFE score (≥100) was associated with a 7.5-fold risk of HCC (adjusted sub-distributional hazard ratio [aSHR]: 7.54, 95% confidence interval (CI): 5.38-10.60). A high SAFE score increased the risks of HCC in subgroups of viral hepatitis and nonviral hepatitis (aSHR: 11.10, 95% CI: 3.97-31.30). In the external cohort of 8,103 CLD patients, a high SAFE score (≥100 vs. <100) significantly increased 7.13-fold HCC risks.

Conclusions: The SAFE score stratifies high risks for HCC in CLD patients regardless of etiologies and helps to select at-risk candidates for HCC surveillance.

高 SAFE 分數可區別各種原因慢性肝病患 者的肝癌風險 蘇東弘1 楊勝舜2 高偉育3 黃上秦4 陳芬芳1 潘錫光2 蔡龍文3 林澤5 王偉仲6 高嘉宏1 1

台大醫院胃腸肝膽科 臺中榮民總醫院胃腸肝膽科 3 臺北醫學大學附設醫院胃腸肝膽科 4 台大醫院北護分院內科部 5 國立臺灣大學電機系及電信所 6 國立臺灣大學應用數學所 2

Background: There are no hepatocellular carcinoma (HCC) surveillance recommendations for chronic liver diseases (CLD) with non-viral etiologies, such as non-alcoholic fatty liver disease (NAFLD). The Steatosis-Associated Fibrosis Estimator (SAFE) score correlates with liver fibrosis in NAFLD. Aims: We aim to explore the SAFE score as a universal predictor for HCC in NAFLD and other CLD etiologies.

Methods: In this retrospective cohort study, patients

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㊲

TUMOR-INTRINSIC IFNΑ AND CXCL10 ARE CRITICAL FOR IMMUNOTHERAPEUTIC EFFICACY

BY RECRUITING AND ACTIVATING T LYMPHOCYTES IN TUMOR MICROENVIRONMENT

Chun-Chia Cheng1,2, Jungshan Chang3, Ai-Sheng Ho4, Zong-Lin Sie2, Cheng-Liang Peng5, ChihLiang Wang6, Kapil Dev2, Chun-Chao Chang1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan 2 Research Center of Radiation Medicine, Chang Gung University, Taoyuan, Taiwan 3 Graduate Institute of Medical Sciences, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 4 Division of Gastroenterology, Cheng Hsin General Hospital, Taipei, Taiwan 5 Department of isotope application research, National Atomic Research Institute, Taoyuan, Taiwan 6 Division of Pulmonary Oncology and Interventional Bronchoscopy, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 1

腫瘤表現內生性 IFNα 及 CXCL10 可聚集 及活化腫瘤微環境的 T 細胞並對免疫治 療療效具關鍵因素 程俊嘉1,2 張榮善3 何愛生4 謝宗霖2 彭正良5 王智亮6 Kapil Dev2 張君照1 1

臺北醫學大學附設醫院消化內科 長庚大學放射醫學研究中心 3 臺北醫學大學醫學科學研究所 4 振興醫院胃腸肝膽科 5 國家原子能科學研究院同位素所 6 林口長庚紀念醫院肺腫瘤及內視鏡科 2

Background: Tumor immunotherapies targeting PD-(L)1 exhibit anti-tumor efficacy in only 10-30% of patients with various cancers. Literature has demonstrated that a “hot tumor” which contains high T lymphocytes in the tumor microenvironment exhibits a better response to immunotherapies than a “cold tumor”.

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Aims: This study aimed to investigate whether tumor-intrinsic IFNα and CXCL10 determine the recruitment and activation of CD8+ T cells to become “hot tumor”.

Methods: GEPIA, cBioPortal, and Kaplan-Meier Plotter were used to investigate the gene expression, co-expression, and immunotherapeutic association for CD274 (PD-L1), ICAM1, and CXCL10 in lung, colon, and liver cancers. qPCR and flow cytometry were used to detect the gene expression in tumor cells and T lymphocytes. CD8+ T cell transwell assay was used to measure the CD8+ T cell migration.

In addition, immunotherapy-sensitive CT26 and immunotherapy-resistant LL/2 were used to demonstrate that tumor-intrinsic IFNα and CXCL10 determine the recruitment and activation of CD8+ T cells to become “hot tumor” characteristic of sensitizing αPD-L1 immunotherapies.

Results: In this study, we found that CXCL10 overexpressed in a variety of tumors, including lung, colon, and liver tumors with a correlation with PD-L1. High PD-L1 and CXCL10 are associated with better survival rates in tumor patients receiving immunotherapies. IFNs-downstream transcriptional factor IRF-1 and STAT1 were correlated with PD-L1 and CXCL10 expression. We demonstrated that IRF-1 and STAT1 were both bound with the promoters of PDL1 and CXCL10, sharing the same signaling pathway and determining IFNs-mediated PD-L1 and CXCL10 expression. In addition, IFNα significantly increased activation marker IFNγ in PBMCs, promoting M1 type monocyte differentiation, CD4+ T, and CD8+ T cell activation. Particularly, we found that CD8+ T lymphocytes abundantly expressed high CXCR3, a receptor of CXCL10, by flow cytometry, indicating that tumor-intrinsic CXCL10 potentially recruited CD8+ T in tumor microenvironment. To demonstrate the hypothesis, immunotherapy-sensitive CT26 and immunotherapy-resistant LL/2 were used, and we found that CT26 cells exhibited higher IFNα, IFNγ, CXCL10, and PD-L1 levels compared to LL/2, leading to higher IFNγ expression in mouse splenocytes.

Moreover, we found that CD8+ T cells were recruited

by CXCL10 in vitro, whereas SCH546738, an inhibitor of CXCR3, inhibited T cell migration and splenocytes-mediated anti-tumor effect. We then confirmed that CT26-derived tumor was sensitive to αPD-L1 immunotherapy and LL/2-tumor was resistant, whereas αPD-L1 significantly increased T lymphocyte activation marker CD107a in CT26derived BALB/c mice.

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Conclusions: In conclusion, this study revealed that CXCL10 expression is correlated with PD-L1 in tumors, sharing the same signaling pathway and associating with better immunotherapeutic efficacy. Further evidence in the syngeneic tumor models demonstrated that immunotherapysensitive CT26 intrinsically exhibited higher IFNα and CXCL10 compared to immunotherapyresistant LL/2 to recruit and activate CD8+ T cells in the tumor microenvironment, exhibiting “hot tumor” characteristic of sensitizing αPD-L1 immunotherapies.

㊳

IMMUNE-RELATED LIVER INJURY IS A GOOD PROGNOSTIC FACTOR IN PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDER ATEZOLIZUMAB PLUS BEVACIZUMAB THERAPY

Tai-Chi Wu1, Wei Teng1,2,3, Po-Ting Lin1,2, Yi-Liang Shen5, Chung-Wei Su1,2, Yi-Chung Hsieh1,2, Wei-Ting Chen1,2, Tsung-Han Wu2,4, Chen-Chun Lin1,2, Chun-Yen Lin1,2, Shi-Ming Lin1,2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Liver Research Unit, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 4 Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 5 Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan 1

免疫相關肝臟損傷在接受癌自癒合併癌 思停治療的肝細胞癌患者中是一個良好 的預後因子 吳泰錡1 滕威1,2,3 林伯庭1,2 沈奕良5 蘇崇維1,2 謝彝中1,2 陳威廷1,2 吳宗翰2,4 林成俊1,2 林俊彥1,2 林錫銘1,2 1

林口長庚紀念醫院胃腸肝膽科系 長庚大學醫學系 3 林口長庚紀念醫院肝臟研究中心 4 林口長庚紀念醫院一般外科系 5 林口長庚紀念醫院放射腫瘤科 2

Background: Atezolizumab plus bevacizumab therapy is the standard first-line therapy for unresectable hepatocellular carcinoma (HCC), and immune-related liver injury (IrLI) is commonly observed in these treated patients, especially with underlying chronic liver disease. However, the association between IrLI and clinical outcome remains unknown.

Aims: This study aimed to investigate the prognostic value of IrLI on patients with HCC undergoing atezolizumab plus bevacizumab therapy.

Methods: One hundred and sixteen patients

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who received atezolizumab plus bevacizumab and fulfilled the IMBrave150 inclusion criteria for unresectable HCC in Chang Gung Memorial Hospital, Linkou Medical Center from 2020 to 2023 were enrolled for analyses. Radiologic evaluation was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Treatment-related adverse event (TrAE) was graded according to the National Cancer Institute CTCAE v5.0. IrLI was defined as an increase in ALT or AST serum levels attributed to the treatment.

Results: Of the 116 patients, the best objective response rate (ORR) and disease control rate (DCR) were 38.8% and 67.2%, respectively. Forty-eight patients (41.4%) died during the median follow-up of 9.8 months. The overall occurrence rate of any grade of TrAE was 69.0%, and that of grades 3 and 4 was 15.5%. IrLI was the most common AE among these patients (52.6%), and the median time to the onset was 1.7 months. The development of grade ≥2 IrLI was associated with longer OS (19.7 vs. 11.0 months; log-rank p = 0.039) and PFS (6.7 vs. 3.5 months; log-rank p = 0.027). However, patients with grade ≥ 2 elevated bilirubin had shorter OS (4.5 vs.

16.7 months; log-rank p < 0.001) and PFS (2.3 vs.

5.0 months; log-rank p < 0.001). Prior loco-regional therapy is the only predictor of the occurrence of grade ≥ 2 IrLI (OR 2.667; 95% CI: 1.022-7.710, p = 0.040).

Conclusions: In patients with HCC who receive atezolizumab plus bevacizumab, the development of grade ≥ 2 IrLI correlates with improved outcomes, while prior loco-regional therapy may be associated with the occurrence of grade ≥ 2 IrLI.

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A SINGLE NUCLEOTIDE POLYMORPHISM GALNT14 RS6752303 AS AN EFFECTIVE PREDICTOR OF THERAPEUTIC SIDE EFFECTS AND SURVIVAL AFTER IMMUNE CHECKPOINT INHIBITORS THERAPY IN PATIENTS WITH HEPATOCELLULAR CARCINOMA

Po-Ting Lin1, Wei Teng1, Wei-Ting Chen1, Yu-De Chu2, Chung-Wei Su1, Yi-Chung Hsieh1, Chen-Chun Lin1, Yung-Chang Lin3, Chun-Yen Lin1, Chau-Ting Yeh1, Shi-Ming Lin1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 2 Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 3 Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 1

單核苷酸多態性 GALNT14 rs6752303 作 為在肝細胞癌患者接受免疫檢查點抑制 劑治療後預測治療副作用和存活率的有 效指標 林伯庭1 滕威1 陳威廷1 朱育德2 蘇崇維1 謝彞中1 林成俊1 林永昌3 林俊彥1 葉昭廷1 林錫銘1 1

林口長庚紀念醫院胃腸肝膽科 林口長庚念醫院肝臟研究中心 3 林口長庚念醫院血液腫瘤科 2

Background: Genomic alterations have been reported to define patients’ response to immune checkpoint inhibitors (ICIs) therapy for hepatocellular carcinoma (HCC).

Aims: The present study aimed to determine associations between single nucleotide polymorphism (SNP) GALNT14-rs6752303 and ICI treatment-related side effects and survival in patients with HCC (HBV infection).

Methods: This study analyzed retrospective data from a prospectively collected database of 96 patients with HCC receiving ICIs (atezolizumab plus bevazizumab) therapy between 2020 and 2023. The treatment response, overall survival (OS), progression-free survival (PFS) and side effects of the two GALNT14-rs6752303 genotypes were compared,

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and factors associated with side-effects, OS and PFS were identified in this patient population.

Results: Genotypes among included patients were, 23 (24.0%) GALNT14-rs6752303 “TT” and 73 “nonTT”. Median post-treatment PFS grade was 19.7 vs.

4.3 months (p = 0.056), while the proportion of posttreatment AST grade with low grade (grade 0) (“TT” vs. “non-TT”) was 65.2% vs. 39.7% (p = 0.031). After propensity score matching, patients with GALNT14rs6752303 “TT” genotype (p = 0.028), low posttreatment hand-foot skin reaction (HFSR) (p = 0.019) or low post-treatment aspartate aminotransferase (AST) (p = 0.067) was associated with longer posttreatment PFS. Rs6752303 “TT” genotype was associated with decreased risk of post-treatment AST with high-grade (odds ratio [OR] = 0.192, 95% CI: 0.048-0.771; p = 0.020). After stratifying the two genotypes by AST grade, GALNT14-rs6752303 “TT” genotype among patients with low post-treatment AST grade (grade 0) or low post-treatment HFSR grade (grade 0) had higher post-treatment PFS than did GALNT14-rs6752303 “non-TT” genotype (all p < 0.05). However, this association was not observed among patients with high post-treatment AST grade (grade ≥1) or high post-treatment HFSR grade (grade ≥1) (all p > 0.05).

Conclusions: Genetic variants of SNP GALNT14rs6752303 may affect post-treatment PFS in HCC patients (HBV infection) receiving ICIs therapy via a side effect-mediated manner. However, further studies are required to confirm these findings.

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THE GAAD SCORE PREDICTS HCC IN HBV-RELATED CIRRHOSIS PATIENTS AFTER 6-YEAR ANTIVIRAL THERAPY

Hung-Ning Tung1, Tung-Hung Su1, Chun-Che Lin2, Chia-Chi Wang3, Wan-Long Chuang4, Cheng-Yuan Peng5, Wei-Wen Su6, Sheng-Shun Yang7, Chih-Lin Lin8, Kuo-Chih Tseng9, Shih-Jer Hsu1, Fat-Moon Suk10, Tsung-Ming Chen11, Ming-Jong Bair12, Cheng-Kuan Lin13, Yao-Chun Hsu14, Tai-Chung Tseng1, Jia-Horng Kao1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2 Division of Gastroenterology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 3Division of Gastroenterology, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Taipei, Taiwan; 4 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 6Department of Gastroenterology and Hepatology, Changhua Christian Hospital, Changhua, Taiwan; 7 Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 8Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan; 9Department of Hepatology, Buddhist Tzu Chi General Hospital, Da-Lin Branch, Chiayi, Taiwan; 10 Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 11 Division of Hepato-Gastroenterology, Department of Internal Medicine, and Department of Medical Research, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan; 12Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan; 13 Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan; 14Division of Gastroenterology and Hepatology, E-Da 1

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Hospital, Kaohsiung, Taiwan

使用 GAAD 評分預測 B 型肝炎肝硬化患 者抗病毒治療 6 年後的肝細胞癌發生率 董鴻甯1 蘇東弘1 林俊哲2 王嘉齊3 莊萬龍4 彭成元5 蘇維文6 楊勝舜7 林志陵8 曾國枝9 徐士哲1 粟發滿10 陳宗勉11 白明忠12 林政寬13 許耀峻14 曾岱宗1 高嘉宏1 1

國立臺灣大學醫學院附設醫院胃腸肝膽科；2 中山 醫學大學附設醫院肝膽腸胃科；3 台北慈濟醫院胃腸 肝膽科；4 高雄醫學大學附設中和紀念醫院內科部； 5 中國醫藥大學附設醫院腸胃肝膽科；6 彰化基督教 醫院胃腸肝膽科；7 臺中榮民總醫院胃腸肝膽科； 8 臺北市立聯合醫院仁愛院區消化內科；9 佛教慈濟 醫療財團法人大林慈濟醫院腸胃內科；10 臺北市立 萬芳醫院—委託財團法人臺北醫學大學辦理消化內 科；11 童綜合醫院胃腸肝膽科暨醫學研究部；12 台東 馬偕紀念醫院胃腸肝膽科；13 亞東紀念醫院內科部； 14 義大醫院胃腸肝膽科

Background: In CHB-related cirrhosis patients on long-term antiviral therapy, hepatocellular carcinoma (HCC) risk persists, motivating the need for risk stratification. The GAAD score, encompassing gender, age, alpha-fetoprotein, and des-gamma carboxyprothrombin (DCP) measurements, is designed for early-stage HCC detection.

Aims: This study investigates the predictive role of the GAAD score in HCC development in CHB-related cirrhosis patients on antiviral therapy.

Methods: We conducted a retrospective cohort study to include HBV-related cirrhotic patients undergoing long-term antiviral therapy with regular HCC surveillance. The on-treatment plasma samples were retrieved for alpha-fetoprotein and DCP measurements by the Roche Elecsys® system to calculate the GAAD score. Cox proportional hazard regression analysis identified risk predictors for HCC. Results: A total of 499 patients were included and categorized into “prior HCC” (n = 47), “HCC” (n = 56), and “no HCC” (n = 396) groups with a median GAAD score of 1.12, 0.84, and 0.54, respectively (< 0.001).

Among the 452 patients without prior HCC, their median age was 60, and they received a median of 6.2 years of antiviral therapy. After a median of 3.3 years of follow-up, 56 patients developed HCC. A GAAD score of 0.71, and 1.64 significantly stratified the risk of HCC (logrank < 0.0001). After adjusting for age, sex, and FIB-4 index, a GAAD score ≥ 1.64, 0.711.64 significantly increased the risks of HCC by 8.68fold (95% CI: 3.50-21.55) and 2.25-fold (0.96-5.25)

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compared with a GAAD score < 0.71.

Conclusions: After 6 years of antiviral therapy, a high GAAD score significantly stratified the development of HCC and should receive intensive HCC surveillance.

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Section：LGI ㊶

ENHANCING A COMPUTERASSISTED POLYP DETECTION AND CLASSIFICATION SYSTEM BY INTEGRATING THE YOLOV7 OBJECT DETECTION ALGORITHM WITH HISTOGRAM EQUALIZATION AND MOSAIC DATA AUGMENTATION

Meng-Yun Shih1, Chia-Pei Tang2,3, Hong-Yi Chang4, Wei-Xuan Hu4, Chia-Hsin Cheng5 Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 3 School of Medicine, Tzu Chi University, Hualien City, Taiwan 4 Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan 5 Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 1

通過整合 YOLOv7 物件偵測演算法與直 方圖均衡化及馬賽克數據增強技術以增 強電腦輔助息肉偵測與分類系統 施孟芸1 唐家沛2,3 張宏義4 胡濰瑄4 鄭佳欣5 1

大林慈濟醫院內科部 大林慈濟醫院肝膽腸胃內科 3 慈濟大學醫學院 4 國立嘉義大學資訊管理學系 5 大林慈濟醫院研究部 2

Background: Colonoscopy plays a crucial role in reducing the occurrence of colorectal cancer by detecting and removing colon polyps early. Despite this, the miss detection rate for colon polyps during conventional colonoscopy can be as high as 26%.

Therefore, finding ways to reduce the missed polyps has become a top priority in the present day.

Development of an effective and efficient polyp detection and classification system is crucial to reduce colon cancer incidence.

Aims: The objective of this study is to strengthen

training data by employing techniques such as image cropping, histogram equalization and adjusting the quantity of Mosaic data augmentation. These efforts are aimed at improving the model’s learning ability of polyp features, thereby enhancing the classification accuracy of CADe/x in detecting and classifying colon polyps. This enhancement focuses on assisting endoscopists in more effectively identifying polyps and promptly managing them.

Methods: This study was conducted in Dalin TzuChi Hospital (IRB Number: B11101011) to obtain still images and videos of colorectal polyps. For the videos, the frames were initially segmented and polyp images were extracted. These polyp images were obtained from white light and narrow-band imaging (NBI) endoscopy. Our study preprocessed the raw data, including cropping images to remove non-polyp regions and annotating classes based on their positions. SRGAN was then used to enhance the quality of input images and augment features.

Subsequently, the YOLOv7 object detection model was trained, focusing on the lowest-performing classes, which are subjected to histogram equalization. Subsequently, adjustments were made to the network architecture’s Mosaic data augmentation, increasing from 2x2 to 3x3 images per augmentation. As the lack of the SSA images, the final approach involved cropping images with conventional endoscope to simulate polyp images captured with magnifying endoscopy. To simulate the actual magnifying endoscopy images, the manual cropping process centered polyps as much as possible while preserving the surrounding area.

Histogram equalization was applied for contrast enhancement to accentuate the image features.

This enabled the utilization of more images during training, thus enhancing the model’s ability to generalize across various sizes and angles. Finally, all improvements were integrated into the YOLOv7 model, completing a computer-aided detection and classification system. A comparative analysis of the model’s performance was conducted.

Results: After integrating the aforementioned adjustments, the model demonstrates significantly superior performance. The performance across all categories improves from a mAP@0.5 of 0.729 to 0.904. However, in terms of Recall, the performance is slightly inferior compared to the model without data augmentation, indicating that some correct polyps might be overlooked. For the SSA class, the model without data augmentation also performs

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slightly better except for Precision. The model may encounter flickering issues, leading to false positives in the absence of polyps.

Conclusions: The use of super-resolution image enhancement along with histogram equalization to increase image contrast has been demonstrated.

This study confirmed that applying histogram equalization on the SSA class yielded superior results compared to processing all classes. The CLAHE not only performs worse than models processing the SSA class, but it also underperformed compared to the original model. By combining these approaches, which include adjusting the number of images used per batch in mosaic data augmentation from the original four to nine images, the model’s generalization capability is enhanced. This leads to improved predictions under various lighting conditions or angles. In the integrated model, the mAP of 0.5 increased to 90.4%, with a precision of 0.860 and a recall of 0.883. There is an approximate 16% improvement in accuracy compared to the initial model without any processing.

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SYSTEMATIC REVIEW ON MOLECULAR FEATURES OF POSTCOLONOSCOPY COLORECTAL CANCER: MORE SERRATED THAN SPORADIC

Jen-Hao Yeh1, Wen-Shuo Yeh1, Po-Jen Hsiao1, Kuo-Tung Hung1, Chuan-Pin Lin1, Tzu-Ning Tseng1, Jaw-Yuan Wang2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA DaChang Hospital/I-Shou University, Kaohsiung, Taiwan 2 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University ChungHo Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 1

鋸齒樣癌變之分子特徵於腸鏡後間隔癌 更為常見：系統回顧研究 葉人豪1 葉文碩1 蕭博仁1 洪國棟1 林詮斌1 曾子寧1 王照元2 1 2

義大大昌醫院胃腸肝膽科 高雄醫學大學附設中和紀念醫院大腸直腸外科

Background: Post-colonoscopy colorectal cancer (PCCRC) is an adverse outcome associated with missed lesions and incomplete polypectomy.

However, its molecular features have not been systematically reviewed.

Aims: Investigating the distinct molecular features of PCCRC. Methods: We searched PubMed, Embase, and Cochrane Library databases from inception to April 2024. Studies examining the molecular characteristics of PCCRCs, including microsatellite instability (MSI), CpG island methylator phenotype (CIMP), genetic mutations, and chromosomal mutations, were considered eligible.

Results: Fifteen studies, encompassing eleven cohorts with 2,143 PCCRCs and 19,036 sporadic CRCs, were included. Compared to sporadic CRCs, PCCRCs were associated with older age (standardized mean difference 0.29, 95% confidence interval [CI] 0.20– 0.38) and more proximal lesions (odds ratio [OR] 2.08, 95% CI 1.91–3.63). Molecularly, PCCRCs were more likely to exhibit MSI (OR 2.28, 95% CI 1.69– 3.08), CIMP (OR 2.10, 95% CI 1.39–3.18), and BRAF mutations (OR 1.74, 95% CI 1.22–2.49), but were less

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likely to have K-ras mutations (OR 0.63, 95% CI 0.45– 0.87). There were trends toward more early-stage diseases (stage I + II, OR 1.24, 95% CI 0.98–1.56) and mucinous carcinoma (OR 2.20, 95% CI 0.94–5.14) among PCCRCs. The pooled 5-year overall survival was similar between PCCRCs and sporadic CRCs (hazard ratio [HR] 1.04, 95% CI 0.64–1.69), though PCCRCs had worse survival compared to screeningdetected CRCs (HR 1.65, 95% CI 1.46–1.86).

Conclusions: PCCRCs are more likely associated with the serrated pathway than sporadic CRCs based on clinical and molecular features. Enhanced detection of clinically significant serrated lesions may improve CRC screening efficacy.

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THE REAL-WORLD OUTCOME AFTER FAILURE OF VEDOLIZUMAB FOR MODERATE TO SEVERE INFLAMMATORY BOWEL DISEASE IN TAIWAN

Yao-Wei Kuo1,2, Chia-Jung Kuo1,2,3, Puo-Hsien Le1,2,3, Cheng-Yu Lin1,2, Ming-Yao Su1,2,4, Cheng-Tang Chiu1,2,3 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Chang Gung Microbiota Therapy Center, Taoyuan, Taiwan 4 Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan 1

台灣中重度炎症性腸病患者使用 Vedolizumab 治療失敗後的預後結果 郭曜瑋1,2 郭家榮1,2,3 李柏賢1,2,3 林正祐1,2 蘇銘堯1,2,4 邱正堂1,2,3 1

林口長庚紀念醫院胃腸肝膽科 長庚大學醫學院 3 長庚微菌治療中心 4 新北市立土城醫院 2

Background: The use of biologic agents have become the cornerstone of therapy for moderateto-severe active inflammatory bowel disease (IBD). Vedolizumab (VDZ), an anti-a4β7 integrin monoclonal antibody approved for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC), has been increasingly used as a first-line biologic therapy in biologic-naïve patients with IBD who require more aggressive therapy. Second-line therapy after failure of VZD induction primary nonresponse has not yet been established.

Aims: To evaluate the real-world outcomes after failure of PNR to VZD Induction forin bio-naïve IBD patients in Taiwan. A and to assess the treatment response of IBD patients treated with anti-TNF agents or ustekinumab (UST) following VDZ discontinuation.

Methods: This was a single-center retrospective observational study. Adults with moderate-to-severe active IBD treated with VDZ between October 2017

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and May 2022 were enrolled in this study. Crohn’s Disease Activity Index (CDAI) and Mayo score were used to evaluate the efficacy of induction therapy.

Results: A total of 138 patients who received VDZ as induction therapy were included in this study.

More than half of the patients (78.3%, 108/138) were biologic-naïvebiologic-naive. For Among the biologic-naïve IBD patients, the PNR during VZD induction therapy was (25% (, 27/108). Among the patients who had no response to VZD induction, 14 cases were diagnosed with CD, and 13 cases were diagnosed with UC. Upon After VDZ discontinuation, 57.1% (8/14) and 21.4% (3/14) of CD patients were switched to adalimumab (ADA) and ustekinumab (UST) as second-line therapies, respectively. The response and remission rates were 12.5% (1/8) and 50% (4/8), respectively, in patients who received ADA. All three CD patients who receivtreated with UST as second-line therapy achieved clinical remission.

Conclusions: In a real-world experience in Taiwan, among bio-naïve IBD patients, failure of VZD as firstline biologic did not decrease the clinical response rates of second-line biologic therapy in CD patients.

However, ADA shows unsatisfactory treatment efficacy in patients with UC.

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COMPARISON OF THE ADENOMA DETECTION RATE IN SCREENING COLONOSCOPY WITH MUCOSAL EXPOSURE DEVICES AND A COMPUTER-AIDED DETECTION SYSTEM

Chun-Wei Chen, Wey-Ran Lin, Chia-Jung Kuo, Wei-Pin Lin, Chen-Ming Hsu, Chun-Jung Lin, Cheng-Tang Chiu Department of Gastroenterology and Hepatogloy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

比較黏膜暴露裝置及電腦輔助偵測系統 在篩檢性大腸鏡的瘜肉偵測率 陳俊瑋 林蔚然 郭家榮 林偉彬 許振銘 林淳榮 邱正堂 林口長庚紀念醫院胃腸肝膽科

Background: Colorectal cancer (CRC) is a leading cause of gastrointestinal cancer worldwide.

Colonoscopy can effectively lower the mortality and morbidity of CRC by facilitating detection and removal of precancerous lesions. The adenoma detection rate (ADR) plays an important role in the quality of colonoscopy. Several measures including mucosal exposure attachable devices and computeraided detection (CADe) systems on endoscopic monitors have been developed to increase the ADR. However, few studies have accessed the ADR between groups with mucosal exposure devices and the CADe systems.

Aims: The aim of the study was to compare the ADR and other indicators in patients for screening colonoscopy between mucosal exposure devices and CADe systems.

Methods: This study was a prospective randomized control trial performed in Linkou Chang Gang Memorial Hospital from Sep, 2020 to Nov, 2022.

Patients underwent screening colonoscopy were included. Patients screened with Endocuff Vision (Olympus, Japan) on conventional colonoscopy were included in the EV group and those screened with CADe (EndoBRAIN-EYE, Olympus, Japan) were included in the CADe group. The demography of patients and polyp characteristics, including polyp pathological findings, size, location and morphology were collected. The polyp detection rate (PDR) and ADR were also recorded. Descriptive statistics and frequencies were calculated. Comparisons of

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continuous data were performed using the MannWhitney U test, and comparisons of discrete variables were conducted with the Chi-square test. Statistical significance was defined as a p value < 0.05.

Results: A total of 195 patients were enrolled in this study. 92 patients were in the EV group, and 103 patients were in the CADe group. Table 1 shows the demographics of the patients and polyps. The polyp detection rate was 60.9% in the EV group and 30.1% in the CADe group respectively (p = 0.18). The total number and size of detected polyps in the EV group were significantly greater than those in the CADe group (87 vs. 42, p < 0.001 5.15 ± 3.42 mm vs. 4.5 ± 5.19 mm, p = 0.004). The adenoma detection rate was 39.1% in the EV group and 21.3% in the CADe group (p = 0.08). The total number and size of detected adenomas in the EV group were significantly greater than those in the CADe group (59 vs. 29, p = 0.002; 5.49 ± 3.09 vs. 5.21 ± 6.12, p = 0.004).

Conclusions: Our data demonstrated that the PDR and ADR were comparable in the EV and CADe groups. Total adenoma and polyp numbers were greater in the EV group than in the CADe group.

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CLINICOPATHOLOGICAL STUDY OF PRIMARY SMALL BOWEL ADENOCARCINOMA: THE EXPERIENCE IN A SINGLE INSTITUTION IN TAIWAN

Po-Ju Huang1,3, Ken-Sheng Cheng1,2, Yi-Hua Wu1,3, Jen-Wei Chou1,2,3 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University Hospital, Taichung, Taiwan 2 School of Medicine, China Medical University, Taichung, Taiwan 3 Taiwan Association for the Study of Small Intestinal Diseases (TASSID) 1

原發性小腸腺癌的臨床病理學研究：台 灣單一機構的經驗 黃柏儒1,3 鄭庚申1,2 吳宜樺1,3 周仁偉1,2,3 1

中國醫藥大學附設醫院消化系 中國醫藥大學醫學院 3 台灣小腸醫學會 2

Background: Adenocarcinoma of small bowel is a relative rare malignancy of the gastrointestinal tract and which are 50 times less common than colonic carcinoma. Around 50% of small bowel adenocarcinomas are found in the duodenum, especially near the ampulla. In the remaining cases, the jejunum is more commonly involved than the ileum. Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment.

Aims: The aim of the study was to investigate the clinicopathological features of patient whom underwent deep enteroscopy and were diagnosed as primary small bowel adenocarcinoma in a single institution in Taiwan.

Methods: From January 2008 to December 2024, we retrospectively reviewed the medical charts at China Medical University Hospital. Patients who were diagnosed as primary small bowel adenocarcinoma via double balloon enteroscopy (DBE) were included into this study. Clinical data were obtained from the medical records and from the physicians responsible for patient care. Clinical data abstracted included age, gender, symptoms, tumor location, co-mobidity, treatment methods, and outcomes.

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Results: A total of 14 patients with primary small bowel adenocarcinoma were enrolled into this study.

There were 9 males and 5 females, with a male-tofemale ratio of 1.8:1. The mean age was 64.92 years (range, 37-84 years). In our present study, as regards clinical symptoms, all 14 patients were symptomatic.

They most commonly presented with ileus (6 patients, 42.8%). Followed by GI bleeding in three (21.4%), weight loss in three (21.4%), abdominal pain in two (14.2%). In terms of co-morbidities, 8 of 14 patients (57.1%) had hypertensive disease and cardiovascular disease, three (21.4%) had diabetes mellitus, one (7.1%) had iron deficiency anemia, one (7.1%) had end-stage renal disease (ESRD) and two (14.2%) had malignancy history, including one prostate cancer and one sigmoid colon adenocarcinoma.

Primary small bowel adenocarcinoma involved the duodenum in 7 (50%) of 14 patient, the and the jejunum in 7 (50%) of 14 patient. The tumors ranged in size from 1.5 to 8.5 cm (mean, 4.2 cm). 9 patients receive surgical operation for tumor resection and 5 cases receive palliative care due to old age.

Four patients have good prognosis after surgical operation and still regular follow up at GI OPD. These four pateints all involved in duodenum. Another 10 patients died of disease progression, five of these ten cases ever receive surgical operation and adjuvant therapy. And five patients of these ten cases choice palliative care in whole disease course.

Conclusions: In conclusion, the results of our present study showed primary small bowel adenocarcinoma are poor prognosis in Taiwan and their initially symptom and sign were usually vague.

Hence, delay diagnosis and treatment is common, especially located in jejunum and ileum are needs deep more time. These patients who suffered from primaly small bowel adenocarcinoma usually old age and have co-mobidity disease. Compared with those reported in other countries, primary small bowel adenocarcinoma in Taiwan have the similar clinicopathologic feature.

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Poster Section：Liver P.001

CARDIO-METABOLIC RISKS AND CARDIOVASCULAR OUTCOMES POST-HCV ERADICATION: INSIGHTS FROM TAIWANESE COHORTS Pei-Chien Tsai, Chung-Feng Huang, Jee-Fu Huang, Ming-Lung Yu, T-ACR Study Group

SLD groups confirmed similar results. Subgroup analysis highlighted increased MACE risk with CMRF in non-cirrhotic or normal renal function patients.

Conclusions: Our findings underscore the need for targeted cardiovascular risk management in MASLD patients post-SVR, especially those without cirrhosis or with normal renal function.

Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

C 肝根除後代謝相關因子與心血管疾病之 相關：一個大型台灣世代研究 蔡佩倩 黃釧峰 黃志富 余明隆 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: Chronic hepatitis C (CHC) patients with steatoic liver disease (SLD) and cardio-metabolic risk factors (CMRF) face unclear cardiovascular disease (CVD) risks post-sustained virological response (SVR).

Aims: This study uniquely assesses the impact of SLD and CMRF on CVD post-SVR in the context of HCV eradication.

Methods: Among 17,836 SVR-CHC patients, which enrolled from two nationwide cohorts: an interferon-based (T-COACH) and a directly acting antiviral (TACR) cohorts in Taiwan. 8,755 (49.1%) had SLD, SLD was identified using a combination of ultrasonography and a hepatic steatosis index (HSI) >36. Metabolic dysfunction-associated steatotic liver disease (MASLD) was defined when SLD with at least one of five CMRFs. After considering death and liver transplant as competing risks, Gray’s cumulative incidence method and Cox subdistribution hazards were analyzed CVD risk post-SVR. Results: Over 3.4 years, 6.7% developed MACE. MASLD patients exhibited a MACE incidence rate of 190.2 per 10,000 person-years, significantly higher than that of simple SLD patients at 84.0. Adjusted hazard ratios showed increased MACE risk with higher CMRF grades in MASLD (aHR: 1.74 for grade 1-2, P = 0.009 and 2.25 for grade ≥3, P < 0.001, respectively), particularly with BMI >23 kg/m² or diabetes (aHR: 1.69 for BMI >23 kg/m², P = 0.022 and 2.29 for DM, P = 0.018, respectively), but not in preDM. No additive effect in MACE risk was found for BMI >23 kg/m² and diabetes combined. Sensitivity analysis using 1:1 propensity matching for age, sex, fibrosis, and renal function between SLD and non-

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ESTABLISH THE PREDICTION MODEL OF CLINICAL RELAPSE AND HBSAG LOSS IN HBEAG-NEGATIVE PATIENTS WITHOUT CIRRHOSIS WHO DISCONTINUED ENTECAVIR OR TENOFOVIRTHERAPY Chien-Hung Chen, Kwong-Ming Kee, Jing-Houng Wang, Tsung-Hui Hu, Chao-Hung Hung, Sheng-Nan Lu Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

建立 B 型肝炎 e 抗原陰性無肝硬化患者 在貝樂克或惠立妥停藥後發生臨床復發 及 B 型肝炎表面抗原消失的預測模式 陳建宏 紀廣明 王景弘 胡琮輝 洪肇宏 盧勝男 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: HBV relapse are common aftercessation of nuclot(s)ideanaloges (NA) therapy.

However, HBsAg loss rate was higher in patients who discontinued NA therapy compared to patients who continued NA therapy.

Aims: To establish the useful prediction model predict clinical relapse and HBsAg loss after NA cessation.

Methods: A total of 709HBeAg-negative patients without cirrhosis who received entecavir (n = 437) ortenofovirdisoproxilfumarate (TDF) (n = 272) therapy previously and had post-treatment followup for at least 12 months were included in this study.

Results: In the entire cohort, the cumulative incidences of virological relapse, clinical relapse and HBsAg loss were 76%, 65.8% and 34.1%. All enrolled patients were randomly assigned to the models of development or validation group in a 2:1 ratio to construct prediction model of clinical relapse and HBsAg loss.Cox regression analysis identified age, HBV genotypes, TDF used, NA-naïve statusand HBsAg levels at end of treatment (EOT) were independent risk factors of clinical relapse, and age, HBV genotype, consolidation time and HBsAg level at EOT were independent risk factors of HBsAg loss in the development group. We developed the

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prediction model of clinical relapse, based on age, HBV genotypes, NA-naïve status, TDF used and HBsAg levels at EOT, with the total scores ranging of 0 to 10.This risk model accurately classified patients intolow (0–2), medium (2–6), and high (>6) risks in the development and validation groups (p < 0.001).

The areas under the receiver operating characteristic curve (AUROC) of 3-, 5- and 10-year risks of HCC were 0.751, 0.722and 0.701, respectively in the development cohort.We developed the prediction model of HBAs loss based on age, HBV genotypes, consolidation time, and HBsAg levels at EOT, with the total scores ranging of 0 to 12.This risk model accurately classified patients intolow (0–2), medium (2–10), and high (>10) risks in the development and validation groups (p < 0.001). The areas under the receiver operating characteristic curve (AUROC) of 3-, 5- and 10-year risks of HBsAg loss were 0.937, 0.914 and 0.713, respectively in the development cohort.

Conclusions: Establish prediction model exhibited good discriminant function in predicting clinical relapse and HBsAg loss in HBeAg-negative patients without cirrhosis after cessation of entecavir or TDF therapy. External validation is needed for further verification.

2024 TDDW

P.003

SIGNIFICANT PREDICTORS OF CLINICAL OUTCOMES IN METABOLIC ASSOCIATED FATTY LIVER DISEASERELATED HEPATOCELLULAR CARCINOMA FOLLOWING HEPATECTOMY Chih-Wen Lin1,2, Yu-Wei Huang2,3,4, Wen-Lung Wang1,2, Po-Jen Hsiao5, Szu-Ying Chen2,3,4,6, Pei-Min Hsieh2,7,8, Yaw-Sen Chen2 Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 3 Division of Surgical Intensive Care, Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 4 Department of Nursing, Fooyin University, Kaohsiung, Taiwan 5 Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan 6 Division of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 7 Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 8 Department of Surgery, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan 1

代謝性脂肪肝引起的肝癌經肝切除術後 的臨床結果的重要預測因素 林志文1,2 黃煜為2,3,4 王文𤦎1,2 蕭博仁5 陳思穎2,3,4,6 謝沛民2,7,8 陳耀森2 1

義大醫院胃腸肝膽科2 義守大學醫學系 義大醫院外科加護病房及急重症部 4 輔英大學護理部 5 義大大昌醫院胃腸肝膽科 6 義大醫院職業醫學科 7 義大醫院一般外科 8 義大大昌醫院一般外科 3

remains unknown in this population.

Aims: This study aimed to identify the risk factors for HCC recurrence and overall mortality in patients with MAFLD-related HCC who underwent surgery.

We also examined the association between ALDH2 rs671 polymorphism and HCC recurrence and mortality in this population.

Methods: This prospective cohort study enrolled 70 patients with MAFLD-related HCC who underwent hepatectomy between 2011 and 2022 at E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. The data analysis was completed in October 2023. The proposed criteria for the diagnosis of MAFLD are based on evidence of hepatic steatosis (>5%) and one of the following three criteria: overweight/ obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. The end points were HCC recurrence and overall mortality.

Results: Of the 70 patients enrolled, 55 (78.6%) were men, and the mean (SD) age was 67.4 (8.0) years. HCC recurrence occurred in 19 patients, and 20 died. The 10-year cumulative HCC recurrence and mortality rates after resection were 55.4% and 43.9%, respectively. In Cox proportional analyses, patients with ALDH2 rs671 genotypes GA/AA had the highest HCC recurrence rate (hazard ratio [HR]: 3.48, 95% confidence interval [CI]: 1.08-12.4, P = 0.045), followed by those with multiple tumors (HR: 3.06, 95% CI: 1.11-10.9, P = 0.039). Moreover, patients with Barcelona Clinic Liver Cancer (BCLC) stage B/C had the highest mortality rate (HR: 3.94, 95% CI: 1.34-11.6, P = 0.012), followed by those with hypertension (HR, 3.47; 95% CI: 1.28-9.40, P = 0.015).

Conclusions: ALDH2 rs671 polymorphism and multiple liver tumors were strongly associated with HCC recurrence. Furthermore, BCLC stage and hypertension were significantly associated with mortality in MAFLD-related HCC patients after hepatectomy.

Background: The risk factors for the clinical outcomes of hepatocellular carcinoma (HCC) associated with metabolic-associated fatty liver disease (MAFLD) following hepatectomy remain uncertain. The association between ALDH2 rs671 polymorphism and HCC recurrence and mortality

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P.004

THE IMPACT OF BACTEROIDES OVATUS IN THE GUT ON FATTY LIVER IN DIET-INDUCED OBESE MICE AND CHILDREN WITH OBESITY Yu-Cheng Lin1, Chun-Liang Chen1, Hsueh-Fang Lin1, Yen-Hsuan Ni2 Division of Pediatric Gastroenterology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan 2 Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan 1

腸道中卵形擬桿菌對飲食誘導肥胖小鼠 和肥胖兒童脂肪肝的影響 林裕誠1 陳俊良1 林雪芳1 倪衍玄2 1 2

臺北榮民總醫院兒童胃腸科 台大醫院小兒部

Background: Although the key role of gut dysbiosis in metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized, it remains unclear which specific microbes are responsible and might be used as therapeutic targets.

Aims: This study aims to (1) identify the microbes that modify the risk of MASLD in children with obesity and (2) investigate the effects of the identified microbe, B. ovatus, on the severity of MASLD in an obese mouse model.

Methods: First, we analyzed differences in gut microbiome signatures using age-, sex-, and body mass index (BMI)-matched pairs of obese children with MASLD and without MASLD. Their fecal microbiomes, identified through full-length 16S rRNA sequencing using the PacBio Sequel IIe platform, were correlated with the presence of fatty liver. Second, high-fat diet (HFD)-induced obese mice were administered with the identified bacterium, B. ovatus. Histopathological changes in the liver and ileum were analyzed.

Results: Gut microbiome analysis from 80 age-, sex-, and BMI-matched pairs of obese children with and without NAFLD (totaling 160 subjects) revealed a significant difference in the relative abundances of B. ovatus (1.01% in obese children with MASLD compared to 3.15% in obese children without MASLD). We then administered B. ovatus and observed improved hepatic steatosis and fibrosis in HFD-fed mice. Specifically, B. ovatus administration decreased liver weight by 23.0%, liver steatosis by

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56.4%, and liver fibrosis by 42.1%. Furthermore, HFD-fed mice gavaged with B. ovatus exhibited significant increases in villus length, crypt depth, and the number of goblet cells per villus in the ileum tissue. The serum FITC-dextran levels decreased by 66.4% in the B. ovatus-treated HFD group compared to the HFD control group. In addition, the serum level of IL-22 increased two-fold after B. ovatus treatment.

Conclusions: Our findings provide novel insights into the role of B. ovatus in the pathogenesis of MASLD. The potential mechanisms linking B. ovatus to MASLD include improved intestinal permeability and elevated serum IL-22 levels. Supplementation with B. ovatus could be a promising therapeutic target for the treatment of MASLD.

2024 TDDW

P.005

TARGETING PPP1R15B AND ATF4 AXIS IN HEPATOCELLULAR CARCINOMA: A NOVEL STRATEGY FOR OVERCOMING LENVATINIBTOLERANT PERSISTER CELLS THROUGH GPX4-MEDIATED FERROPTOSIS INDUCTION Ming-Yao Chen1,2, Vijesh Kumar Yadav1,2, Chi-Tai Yeh3,4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, New Taipei City, Taiwan 3 Department of Medical Research, Shuang Ho Hospital, New Taipei City, Taiwan 4 Continuing Education Program of Food Biotechnology Applications, College of Science and Engineering, National Taitung University, Taitung, Taiwan 1

靶向 PPP1R15B 和 ATF4 軸在肝細胞癌中 的應用：通過 GPX4 介導的鐵死亡誘導 克服樂衛瑪引發之頑固型耐藥肝癌的治 療策略 陳明堯1,2 魏吉世1,2 葉淇臺3,4 1

臺北醫學大學醫學系消化內科 衛生福利部雙和醫院消化內科 3 衛生福利部雙和醫院研究部 4 國立臺東大學食品生物技術應用二年制在職學位學 程 2

Background: Background: Lenvatinib is the standard treatment for advanced hepatocellular carcinoma (HCC). However, the development of lenvatinib tolerance in persister cancer cells (LTPCs) has led to major challenges, including therapy resistance and cancer relapse.

Aims: Aims: This study aimed to explore the role of the Protein Phosphatase 1 Regulatory Subunit 15B (PPP1R15B)-ATF4 signaling pathway in mediating lenvatinib tolerance in HCC and to identify effective strategies for mitigating this resistance.

Methods: Methods: We characterized LTPCs in HCC cell lines and used RNA sequencing to identify the

upregulation of the PPP1R15B-ATF4-GPX4 signaling axis. Mechanistic investigations examined how this axis enhances the drug-tolerant persister (DTP) phenotype and modulates redox homeostasis, promoting ferroptosis resistance through GPX4 upregulation. The functional impact of this pathway was assessed using gene knockdown and pharmacological inhibition.

Results: Results: Inhibiting PPP1R15B disrupted the signaling cascade, compromised redox balance, and increased ferroptosis, thus diminishing LTPC survival and resensitizing the cells to lenvatinib. Knocking down PPP1R15B expression through shRNA led to a marked reduction in ATF4 and GPX4 protein levels, impairing antioxidant defense mechanisms and causing an accumulation of reactive oxygen species (ROS) and lipid peroxidation products, which are hallmarks of ferroptosis. Pharmacological inhibition of PPP1R15B mirrored these effects, confirming its pivotal role. In vivo experiments using an LTPC mouse model further supported these findings. Mice treated with the PPP1R15B inhibitor showed a significant decrease in tumor growth and elevated markers of oxidative stress and ferroptosis, indicating that PPP1R15B inhibition sensitized the LTPCs to lenvatinib by disrupting redox homeostasis.

Additionally, a potential feedback loop was identified where increased oxidative stress due to PPP1R15B inhibition further suppressed ATF4 expression, amplifying the ferroptotic response. This feedback mechanism highlights the targeting the PPP1R15BATF4-GPX4 axis as a therapeutic strategy.

Conclusions: Conclusions: Overall, our research elucidated the crucial role of the PPP1R15B-ATF4GPX4 axis in lenvatinib tolerance in HCC and identified it as a promising therapeutic target.

Inhibiting this pathway can overcome lenvatinib resistance and enhance treatment outcomes in HCC. These findings provide a novel approach for improving therapeutic strategies against lenvatinibresistant HCC, potentially leading to better patient outcomes and reduced cancer relapse rates. Future research should focus on further validating these results in clinical settings and exploring additional molecular mechanisms involved in lenvatinib resistance.

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P.006

HIGHER LEVEL OF HEPATITIS B SURFACE ANTIGEN ASSOCIATED WITH DELAYED DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN IMMUNE-TOLERANT PATIENTS Tai-Chung Tseng1,2,3, Chun-Jen Liu1,2, Chien-Jen Chen4, Tung-Hung Su1,2, Wan-Ting Yang2, Hung-Chih Yang1,5,6, Chen-Hua Liu1,2, Pei-Jer Chen1,2,3,5,6, Hwai-I Yang4,7,8,9,10, Jia-Horng Kao1,2,3,4 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan; 4Genomics Research Center, Academia Sinica, Taipei, Taiwan; 5Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; 6 Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan; 7 Institute of Clinical Medicine, National YangMing Chiao Tung University, Taipei, Taiwan; 8 Graduate Institue of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 9Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan; 10Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan 1

對於免疫耐受期之慢性 B 型肝炎患者， 較高 B 型肝炎表面抗原濃度與肝癌的延 遲發生有關 曾岱宗1,2,3 劉俊人1,2 陳建仁4 蘇東弘1,2 楊菀婷2 楊宏志1,5,6 劉振驊1,2 陳培哲1,2,3,5,6 楊懷壹4,7,8,9,10 高嘉宏1,2,3,4 1

台大醫院胃腸肝膽科；2 台大醫院肝炎研究中心； 台大醫院醫學研究部；4 中央研究院基因體研究中 心；5 台大醫學院臨床醫學研究所；6 台大醫學院微 生物學系；7 國立陽明交通大學臨床醫學研究所；8 高雄醫學大學醫學研究所；9 中央研究院生醫轉譯研 究中心；10 國立中山大學臨床醫學科學博士學位學 程 3

Background: Chronic hepatitis B (CHB) patients

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with active viral replication are at significant risk of developing hepatocellular carcinoma (HCC).

However, the HCC risk in highly viremic patients, such as immune-tolerant patients, remains unclear.

Aims: This study aimed to investigate the relationship between viral factors and HCC risk in CHB patients, focusing on immune-tolerant patients.

Methods: A total of 6,139 non-cirrhotic Taiwanese patients with chronic HBV infection were enrolled, comprising 2,666 patients from ERADICATE study and 3,473 patients from REVEAL-HBV study. The primary endpoint was HCC development. The relationships between viral factors and HCC risk in HBeAg-positive and HBeAg-negative patients were analyzed separately.

Results: Over a median 21.7-year follow-up, 547 patients developed HCC. Distinct relationships between viral factors and HCC risk were found based on different HBeAg statuses. HBV DNA levels were shown to be positively associated with HCC risk up to ≥10 million IU/mL in HBeAg-negative patients, but not in HBeAg-positive patients. HBsAg levels were positively associated with HCC risk in HBeAgnegative patients but negatively correlated with HCC risk in HBeAg-positive patients. Further investigation focusing on AASLD- or EASL-defined immunetolerant patients showed that HBsAg levels ≥10,000 IU/mL (vs. <10,000 IU/mL) were associated with delayed HCC development, which was validated in an independent cohort from Japan.

Conclusions: Predictive roles of HBV DNA and HBsAg levels in HCC development differ between HBeAgnegative and HBeAg-positive patients. Particularly, among immune-tolerant patients, HBsAg levels ≥10,000 IU/mL showed delayed development of HCC, suggesting HBsAg as a biomarker to define genuine immune-tolerant patients.

2024 TDDW

P.007

UNLOCKING THE POWER OF GENERATIVE ARTIFICIAL INTELLIGENCE: TRANSFORMING LIVER LESION DIAGNOSIS IN CT SCANS Pushpanjali Gupta1,2,3, Chun-Ying Wu1,2,3,4,5, Che-Lun Hung2,3, Yao-Chun Hsu6,7, Yuan-Chia Chu8,9, Chia-Sheng Chu10,11, Teng-Yu Lee12,13, Sulagna Mohapatra2,13 Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; 2Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan; 5Department of Public Health, China Medical University, Taichung, Taiwan; 6Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan; 7 School of Medicine, I-Shou University, Kaohsiung, Taiwan; 8Information Management Office & Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; 9Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 10Division of Gastroenterology and Hepatology, Taipei City Hospital Yang Ming Branch, Taipei, Taiwan; 11Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 12Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan; 13 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 1

finalize the best models. The derived models were externally validated using CT images from the Medical Segmentation Decathlon (MSD) and The Cancer Imaging Archive (TCIA) datasets. In addition, the performances of AI models were observed with varying sizes of FLL and with physicians during external validation.

Results: The training set included 1272 patients (malignant: 589, male: 776, mean age 62 ± 10.9), and the test set included 317 patients (malignant: 147, male: 228, mean age 57 ± 11.8). The DLLC system achieved a precision of 0.81 for localization and an accuracy of 0.98 (95% CI: 0.98, 1.00) and 0.97 (95% CI: 0.95, 0.99) for binary and multiclass classifications, respectively. When externally validated, the system achieved 85% accuracy for localization in MSD and 95% and 98% accuracy for localization and classification, respectively, in the TCIA dataset.

Conclusions: The DLLC system, developed with only arterial phase and venous phase CT images, can be an effective assistant that can assist inexperienced radiologists and hepatologists in faster and more robust diagnosis of FLLs. Furthermore, reducing the number of CT phases required for FLL diagnoses may reduce exposure time and the time required for CT examination.

Background: Computed tomography of the abdomen exhibits subtle and complex features of liver lesions, subjectively interpreted by physicians.

Aims: To develop a deep learning-based localization and classification (DLLC) system for Focal Liver Lesions (FLLs) that could assist physicians in more robust clinical decision-making.

Methods: The retrospective study included 1,589 patients containing 17,335 slices with 3,195 FLLs found by contrast-enhanced CT collected from January 2004 to December 2020. Several detection and classification models were compared to

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P.008

FORECASTED CHANGES IN TUMOR CHARACTERISTICS AND SURVIVAL OF PATIENTS WITH NONVIRAL HEPATOCELLULAR CARCINOMA IN THE UNITED STATES: A MODELING STUDY BASED ON THE SEERMEDICARE DATABASE Joanne Kimiko Liu1, Nicholas Chien1, Curtis Chong2, Scott Barnett1, Ramsey Cheung1,4, Mindie H. Nguyen1,4,5 Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA 2 Division of Oncology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA 3 Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA 4 Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA 5 Stanford Cancer Institute, Stanford University Medical Center, Palo Alto, CA, USA 1

Background: Nonviral hepatocellular carcinoma (HCC) incidence is increasing, however, U.S. population-based data are limited.

Aims: Using a national U.S. database, we determined and forecasted characteristics and survival rates of nonviral HCC, overall and in subgroups of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD).

Methods: We included adult HCC patients with nonviral liver disease from the SEER-Medicare database (2000-2017) and excluded those with non-liver cancer or HIV infection. We used linear regression to model data from 2000-2017 and forecasted these trends up to 2035.

Results: We analyzed 23,926 patients with HCC (18,266 MASLD, 5,660 ALD). Between 2013-2017, 69.1% were male. The proportion of patients with a history of HCC surveillance remained low over the years (13% in 2000-2003 vs. 12% in 2013-2017, P = 0.15). Using linear modeling, we estimated an increase in 5-year survival rates from 4.79% in 2000 to 22.0% in 2027 (P < 0.001) and in median survival from 0.28 years in 2000 and to 1.31 years by 2035

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(P < 0.001, Figure). Additionally, while there was significant increase in the 5-year and median survival for the MASLD subgroup between 2000-2027 (5.68% to 23.2% and 0.33 to 1.4 years, both P < 0.001, respectively), there was significant improvement only in the median survival (0.23 to 1.09 years, P < 0.001) but not 5-year survival rates (7.32% to 11.2%, P = 0.16) for ALD-related HCC. The proportion of patients diagnosed with HCC at TNM stage I is predicted to increase to 49.9% in 2027, with stage IV decreasing to 8.56% in 2027 (both P < 0.001).

Conclusions: Though there have been improvements in early-stage detection, the proportion of nonviral HCC diagnosed via surveillance remains dismally low (13%), 5-year survival rates remain <25% by 2027, and median survival remains <1.5 years by 2035.

More effort is needed to improve HCC surveillance and therapeutic strategies.

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P.009

DIFFERENCE IN CLINICAL PATTERNS OF HEPATOCELLULAR CARCINOMA IN NONALCOHOLIC FATTY LIVER DISEASE BETWEEN PATIENTS WITH AND WITHOUT CIRRHOSIS Wei-Kang Tu, Tsung-Jung Lin Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan

有肝硬化和沒有肝硬化之非酒精性脂肪 肝肝癌的臨床差異 杜維剛 林聰蓉 臺北市立聯合醫院仁愛院區消化內科

Background: Nonalcoholic fatty liver disease (NAFLD) has been an emerging role that could lead to chronic liver disease, nonalcoholic steatohepatitis, cirrhosis, and eventually hepatocellular carcinoma (HCC). According to our previous study, NAFLDrelated HCC patients were older, heavier, and more susceptible to DM than HBV-related HCC patients.

Aims: The aim of our study is to compare the clinical patterns between NAFLD-related HCC patients with and without cirrhosis, including age, gender, body mass index, diabetes mellitus, tobacco use, biochemistry tests, liver function and tumor characteristics including Barcelona clinic liver cancer (BCLC) stage, largest tumor size and alphafetoprotein.

Methods: Most of our HCC patients were recruited from the data base of Cancer Registries in Taipei City Hospital, Ren-Ai Branch, from 2011 to 2017; and the other patients consecutively from the HCC multidisciplinary conference between January, 2018 and October, 2019. NAFLD was defined as non-viral hepatitis B (either positive anti-HBs or negative anti-HBc), non-viral hepatitis C (negative anti-HCV), nonalcoholic (alcohol consumption less than 30 g/ day) liver disease and if present or past histological or ultrasonographic evidences of fatty liver. Cirrhosis was diagnosed based either on histology or on ultrasound, endoscopic, laboratory, and clinical evidence.

Results: Total 23 NAFLD-related HCC patients were included in our study and only 8 patients were cirrhotic. The demographic data and tumor characteristics of the patients were showed in Table 1 and Table 2, respectively. NAFLD-related HCC patients without cirrhosis had significantly lower

ALT level (27.5 [10-65] U/L vs. 39.6 [22-65] U/L; p = 0.047) and larger largest tumor size (5.5 [1.8-13] cm vs. 3.2 [1.2-8.1] cm; p = 0.047) than NAFLD-related HCC patients with cirrhosis. However, there were no significant differences in age (70.6 [43-88] years vs.

69 [60-79] years; p = 0.548), male gender (12 [80.0%] vs. 5 [62.5%]; p = 0.621), body mass index (29.56 [19.88-33.20] kg/m² vs. 28.26 [18.51-35.01] kg/m²; p = 0.36), diabetes mellitus (10 [66.7%] vs. 4 [50%]; p = 0.657), tobacco use (12 [80%] vs. 7 [87.5%]; p = 1.000), AST levels (33.6 [15-114] U/L vs. 44 [22-79] U/L; p = 0.056), total bilirubin levels (0.82 [0.3-3.6] mg/dL vs. 0.90 [0.36-1.70] mg/dL; p = 0.265), international normalized ration levels (0.98 [0.9-1.09] vs. 1.03 [0.96-1.10]; p = 0.149), albumin levels (4.2 [3.9-4.4] g/dl vs. 4.1 [3.6-4.6] g/dl; p = 0.548), platelet levels (209 [112-321] 10^3/ul vs. 163 [20-282] 10^3/ul; p = 0.169), creatinine levels (2.09 [0.6-9.2] mg/dl vs.

0.88 [0.6-1.1] mg/dl; p = 0.149), Child-Pugh score (A: 14 [93.3%] vs. 8 [100%], B: 1 [4.3%] vs. 0 [0%], C: 0 [0%] vs. 0 [0%]; p = 1.000), BCLC stage (0: 1 [6.7%] vs. 2 [25%], A: 7 [46.7%] vs. 4 [50%], B: 6 [40.0%] vs.

1 [12.5%], C: 0 [0.0%] vs. 1 [12.5%], D: 1 [4.4%] vs. 0 [0%]; p = 0.281) and alpha-fetoprotein (2606.4 [0.936373] ng/mL vs. 10.4 [3.1-27.0] ng/mL; p = 0.19) between the two groups.

Conclusions: In conclusion, our study showed NAFLD-related HCC patients without cirrhosis have lower ALT levels and larger largest tumor size than patients with cirrhosis. The other factors, including age, gender, body mass index, diabetes mellitus, tobacco use, liver function, BCLC stage and alphafetoprotein were not significantly different between the two groups.

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P.010

P.011

HEPATITIS B SURFACE ANTIGEN LOSS IN CHRONIC HEPATITIS B PATIENTS WITH LOW-VIRAL-LOAD

ROLE OF AIR POLLUTION IN DEVELOPMENT OF HEPATOCELLULAR CARCINOMA AMONG CHRONIC HEPATITIS B PATIENTS TREATED WITH NUCLEOTIDE/NUCLEOSIDE ANALOGUES

Tyng-Yuan Jang, Chia-Yen Dai Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

B 型肝炎低病毒量病人表面抗原消失

Tyng-Yuan Jang1, Chia-Yen Dai1, Pau-Chung Chen2, Ming-Lung Yu1

張庭遠 戴嘉言

1

高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: Among low viral load (DNA of hepatitis B virus (HBV) was <2,000 IU/mL), the factor of the loss of hepatitis B surface antigen (HBsAg) remained elusive.

Aims: To know the factors of the loss of HBsAg. Methods: The retrospective study recruited patients with chronic hepatitis B (CHB) who were negative low for hepatitis B e-antigen (HBeAg), had a low viral load, and experienced HBsAg loss during followup. CHB patients with low-viral load but without consequent HBsAg loss were also enrolled at the ratio of 1:4. The factors contributing to HBsAg loss were analysed.

Results: A total of 80 patients were recruited for the current study, with a mean age of 63.9 years and 61.3% being male. Among them 62.5% patients (50/80) were treated with potent nucleoside/ nucleotide analogues (NAs) during the follow-up period. Additionally, 12.5% patients (10/80) had a prior history of NAs treatment before enrolment.

During the follow-up, HBsAg loss occurred in 17 patients (21.3%). Compared to patients without HBsAg loss, those with HBsAg loss were younger (57.9 years vs 65.5 years; P = 0.01), had lower HBV DNA levels (1.3 log10 IU/mL vs 2.3 log10 IU/mL; P = 0.003) and higher proportion of prior NAs-treated history. Logistic regression analysis revealed that the factors associated with factors associated with HBsAg loss were age < 60 years (OR/CI: 3.95/1.15– 13.60, P = 0.03), prior NAs-treated history (OR/CI: 7.59/1.42–40.51, P = 0.01) and current NAs-treated (OR/CI: 0.19/0.05–0.71, P = 0.01).

Conclusions: In the study, older age and prior NAs were positively associated with HBsAg loss, and current NAs was negatively associated with HBsAg loss. Additionally, some patients experienced HBsAg loss during the NAs therapy.

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Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Public Health, National Taiwan University, Taipei, Taiwan

空氣污染在 B 型肝炎使用口服抗病毒用 藥病人產生肝癌的影響 張庭遠1 戴嘉言1 陳保中2 余明隆1 1 2

高雄醫學大學附設中和紀念醫院肝膽胰內科 國立臺灣大學公共衛生學系

Background: Role of air pollution in development of hepatocellular carcinoma among chronic hepatitis B patients treated with nucleotide/nucleoside analogues remain elusive.

Aims: We aimed to investigate the association between air pollution and hepatocellular carcinoma (HCC) among patients with infection of chronic hepatitis B (CHB) virus treated by nucleotide/ nucleoside analogues (NAs).

Methods: 1,298 CHB patients treated with NAs were enrolled and the incidence and risk factors of HCC development were analyzed. Daily estimates of air pollutants (particulate matter ≤2.5 µm in diameter (PM2.5)), (particulate matter ≤10 µm in diameter (PM10), nitrogen dioxide (NO2) and ozone (O3)) were estimated since the previous year based on the date of enrolment.

Results: The annual incidence of HCC was 2.1 per 100 person-years after a follow-up period of over 4840.5 person-years. Factors with the strongest association with HCC development were liver cirrhosis (hazard ratio [HR]/95% confidence interval [CI]: 3.00/1.55– 5.81, P = 0.001), followed by male gender (2.98/1.51– 5.90, P = 0.02), BMI (HR: 1.11, CI: 1.04–1.18, P = 0.002) and age (HR: 1.06, CI: 1.04–1.09, P < 0.001). Among cirrhotic patients, the factors associated with HCC development were male gender (2.10/1.00–4.25, P

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P.012 = 0.04) and NO2 (per one-unit increment, ppb) (HR: 1.07, CI: 1.01–1.13, P = 0.01). Compared to patients with lowest quartile level of annual NO2 exposure, those with highest quartile level of annual NO2 exposure had more than three-fold risk (HR: 3.26, CI: 1.34–7.93, P = 0.01) of HCC development in cirrhotic patients. Among non-cirrhotic patients, the strongest factors associated with HCC development was male gender (HR/CI: 5.86/1.79–19.23, P = 0.004), followed by age (HR/CI: 1.12/1.07–1.17, P < 0.001) and platelet count (HR/CI: 0.99/ 0.98–1.00, P = 0.04).

Conclusions: Air pollution played a potential role in HCC development in CHB patients who underwent NA therapy. Long-term NO2 exposure might accelerated HCC development in CHB cirrhotic patients receiving NAs treatment.

THE CHANGING OF PERCUTANEOUS TUMOR ABLATION METHODS FOR HEPATOCELLULAR CARCINOMA IN A SINGLE MEDICAL CENTER Ying-Chi Chiang1, Ching-Wei Chang1,2,3, Chi-Yu Lee1, Ming-Jen Chen1,2,3, Chen-Wang Chang1,2,3 Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 3 Department of Medicine, MacKay Medical College, New Taipei City, Taiwan 1

肝癌患者接受經皮腫瘤治療在一家醫學 中心之趨勢改變 江英吉1 張經緯1,2,3 李騏宇1 陳銘仁1,2,3 章振旺1,2,3 1

馬偕紀念醫院胃腸肝膽科 馬偕醫護管理專科學校 3 馬偕醫學院 2

Background: Percutaneous Tumor Ablation Methods such as Radiofrequency ablation (RFA) and percutaneous ethanol injection therapy (PEIT) are important for hepatocellular carcinoma (HCC).

Previous studies indicate that RFA is better than PEIT. Aims: Our study aims to emphasize the trend of percutaneous tumor ablation methods for HCC in recent 15 years and reform the treatment outcome in different treatment groups.

Methods: The medical records of patients who underwent RFA or PEIT in MacKay Memorial Hospital from Jan. 1st, 2009 to Dec. 31th, 2023 were reviewed retrospectively. The patients with HCC and received percutaneous tumor ablation as first line treatment were enrolled. Exclusion criteria encompass cases of HCC classified as BCLC stage C or D, TNM stage IV and patients without receiving a follow up image.

We analyzed the trend of percutaneous tumor ablation. These patients are categorized by the first line treatment modality, the RFA group and PEIT group. We analyzed the trend of percutaneous tumor ablation in HCC patients. These patients are categorized by the date of first time percutaneous tumor ablation. The conventional clinical characteristics of patients with different treatment groups were analyzed using the Fisher exact test and Mann-whitney U test. Survival analysis was

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P.013 calculated by using the Kaplan-Meier method. P values of <0.05 were considered significant.

Results: A total of 339 patients newly diagnosed with Hepatocellular Carcinoma (HCC) were included in this study. These patients were divided into two groups based on their initial treatment approach: the Radiofrequency Ablation (RFA) group (n = 276, 83.63%) and the Percutaneous Ethanol Injection Therapy (PEIT) group (n = 54, 16.37%).

The demographic and clinical characteristics of the patients are summarized in Table 1. The two groups showed similarities in terms of age, gender distribution, etiologies of chronic liver disease, Eastern Cooperative Oncology Group (ECOG) Performance status, Child-Pugh classification grade, Barcelona Clinic Liver Cancer (BCLC) stage, and initial Alpha-Fetoprotein (AFP) level. Over the past 15 years, there has been a notable shift in the primary treatment approach for HCC patients. The proportion of patients receiving PEIT has declined while those undergoing RFA has increased, as illustrated in Figure 1. 143 patientes (51.81%) need second treatment in RFA group and 41 patients (75.93%) need second treatment in PEIT group. The median time from first RFA to second treatment is 376 days (167-847.5). The median time from first PEIT to second treatment is 97 days (73.75-311.25). Table 2 provides a summary of the distribution of treatment modalities and the time intervals between treatments.

Conclusions: The real-world data from our study indicate a decreasing trend in the utilization of percutaneous ethanol injection therapy as the initial treatment for HCC, with a corresponding increase in the proportion of patients undergoing RFA. Additionally, our findings suggest that patients in the RFA group tend to require a second treatment less frequently and have longer intervals between treatments compared to those in the PEIT group.

INNOVATIVE MEASURES TOWARDS ELIMINATION OF HEPATITIS C IN RURAL VILLAGES BY PREVALENCEBASED SCREENING BY ANTI-HCV REFLEX HCV ANTIGEN TEST AND ACCESSIBLE POST-SCREENING CARE Kuan-Chen Pan1, Nien-Tzu Hsu2, Ying-Mei Tang3, Yu-Chen Lee4, Hsiu-Ling Kuo5, Tung-Jung Huang6,7,8, Chun-Mei Tseng9, Sheng-Nan Lu8,10, Te-Sheng Chang1,3,8 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Biostatistics and Bioinformatics Center of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan; 4 Sihu Township Public Health Center, Yunlin County, Yunlin, Taiwan; 5Beigang Township Public Health Center, Yunlin County, Yunlin, Taiwan; 6Division of Pulmonary Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan; 7 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Branch, Chiayi, Taiwan; 8College of Medicine, Chang Gung University, Taoyuan, Taiwan; 9 Public Health Bureau, Yunlin County, Yunlin, Taiwan; 10Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 1

基於盛行率的篩檢與 Anti-HCV 與 HCV 抗原檢測和可及的篩檢後照護，消除農 村 C 型肝炎的措施 潘冠塵1 徐念慈2 唐英梅3 李育真4 郭秀玲5 黃東榮6,7,8 曾春美9 盧勝男8,10 張德生1,3,8 1

嘉義長庚紀念醫院胃腸肝膽科；2 高雄長庚紀念醫 院生物統計中心；3 雲林長庚紀念醫院胃腸肝膽科； 4 四湖鄉衛生所；5 北港鎮衛生所；6 雲林長庚紀念醫 院胸腔科；7 嘉義長庚紀念醫院呼吸照護中心；8 長 庚大學醫學院；9 雲林縣衛生局；10 高雄長庚紀念醫 院胃腸肝膽科

Background: One major barrier to the goals of

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P.014 hepatitis C virus (HCV) elimination is identification and linkage-to-care for those with HCV infection.

Aims: The aim of this research was to develop a strategy to help achieve HCV elimination in remote rural villages.

Methods: According to the maps of the townshipand village-specific testing rates and prevalence rates of anti-HCV produced by the Public Health Bureau of Yunlin County, a high anti-HCV prevalent township Sihhu and four nearby villages were selected for an intensive screening with anti-HCV reflex HCV antigen test. A temporary outreach hepatology clinic was set in Sihhu Township Health Center to enhance accessibility for post-screening care of those positive for HCV antigen.

Results: The population aged > 40 years of the included villages at time of survey was 18,018 with 5,343 (29.7%, range 18.8% to 39.7%) having ever been previously screened, and 1503 responded to this screening. The crude screening coverage rate increased to 38.0% (range 27.6% to 47.2%) after this screening campaign. The prevalence rates of anti-HCV and HCV antigen were 17.3% and 8.3% respectively, with the rate of antigenemia (HCV antigen/anti-HCV) being 48.1%. Numbers needed to test (NNT) to find a candidate for anti-viral treatment were 12. All the 75 antigenic patients evaluated at the outreach clinic received direct-acting antiviral treatment, 70 at the outreach clinic and 5 at other hospitals. Evaluable sustained virological response rate for the 70 patients was 97%.

Conclusions: Prevalence-based screening and accessible outreach clinic can help accelerate HCV elimination in rural villages.

THE INFLUENCE OF LIVER RESECTION FOR ADVANCED RECURRENT HEPATOCELLULAR CARCINOMA TREATED WITH MULTITARGETED AGENTS Guan-Hua Li1, Pi-Teh Huang1, Kuan-Chun Hsueh2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tung’s Taichung MetroHarbor Hospital, Taichung, Taiwan 2 Division of General Surgery, Department of Surgery, Tung’s Taichung MetroHarbor Hospital, Taichung, Taiwan 3 Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan 1

肝臟切除對於使用標靶治療的復發晚期 肝癌患者的影響 李冠華1 黃彼得1 薛冠群2,3 1

童綜合醫院胃腸肝膽科 童綜合醫院一般外科 3 國立中興大學學士後醫學系 2

Background: Liver resection (LR) has been used as radical treatment for hepatocellular carcinoma (HCC) patients, but the recurrence rate is still very high. The recurrent HCC may develope metastasis or vascular invasion, and tyrosine kinase inhibitors (TKIs) were administered as subsequent therapy.

Aims: This study aimed to evaluate the influence of LR on recurrent advanced-stage HCC patients who received sorafenib or lenvatinib as systemic treatment.

Methods: This retrospective cohort study enrolled 72 patients with advanced recurrent HCC, who had previously received LR, and then treated with sorafenib or lenvatinib between June 2016 and August 2022. All data were retrospectively retrieved from medical documents. TKIs were used for at least one month, and patients were follow-up up to December, 2023 or until death, whether which comes first. The primary outcome was overall survival (OS). The secondary outcome was progression-free survival (PFS). The impact factors related to the risk of HCC survival were also analyzed.

Results: Study results showed median OS of the

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P.015 study group was 15 months (95% confidence interval [CI]: 4.37-25.63). All patients were then divided into two groups on basis of two different TKIs (sorafenib, n = 35; lenvatinib, n = 37). The median OS of sorafenib group was 12 months, and the median OS of lenvatinib group was 29 months. There was a significant difference in median OS between the two groups (p = 0.012). The PFS of sorafenib group was 3 months. The PFS of lenvatinib group was 8 months, with a significant difference (p = 0.026). Multivariate analysis showed that the administration of lenvatinib for patient who had experienced LR is associated with better OS (p = 0.008) and PFS (p = 0.003).

Univariate Cox regression analyses showed viral hepatitis (hepatitis B and hepatitis C) and portal vein thrombosis were predictors for death. Subsequent multivariate analyses revealed that extrahepatic spread (p = 0.03) and portal vein thrombosis (p = 0.001) were independently predictive of death.

Although age ≥ 65 years had tendency to related to PFS, but multivariate analysis showed no statistical significance.

Conclusions: When using systemic therapy in treating patients of advanced recurrent HCC with prior operation history, lenvatinib had better efficacy than sorafenib. Furthermore, portal vein thrombosis and extrahepatic spread were related to HCC overall survival.

RISK FACTORS OF ADVANCED FIBROSIS IN HISTOLOGY-PROVEN STEATOTIC LIVER DISEASE Chen-Te Huang1, Shang-Chin Huang1,2,3,4, Chia-Lin Kang1, Tan Sia Wang1, Hau-Jyun Su5, Tung-Hung Su1,2, Tai-Chung Tseng2,6, Shih-Jer Hsu1,2, Chun-Ming Hong7, Chen-Hua Liu1,2, Hung-Chih Yang1,2, Pei-Jer Chen1,2,3, Jia-Horng Kao1,2,3, Chun-Jen Liu1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 6 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 7 Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

病理證實之脂肪肝病中嚴重纖維化的臨 床風險因子 黃禎德1 黃上秦1,2,3,4 康家綾1 陳聲旺1 蘇浩俊5 蘇東弘1,2 曾岱宗2,6 徐士哲1,2 洪俊銘7 劉振驊1,2 楊宏志1,2 陳培哲1,2,3 高嘉宏1,2,3 劉俊人1,2,3 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院肝炎研究中心 3 國立臺灣大學醫學院臨床醫學研究所 4 國立臺灣大學醫學院附設醫院北護分院胃腸肝膽內 科 5 中山醫學大學附設醫院肝膽腸胃科 6 國立臺灣大學醫學院附設醫院醫學研究部 7 國立臺灣大學醫學院附設醫院整合醫學科 2

Background: Steatotic liver disease (SLD) is a major cause of liver fibrosis with increasing prevalence globally. Identifying the risk factors of advanced fibrosis facilitates risk stratification and early

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P.016 intervention among these patients.

Aims: We aimed to investigate the risk factors and predictive scores of advanced fibrosis within patients with histology-proven SLD. Methods: Patients with histology-proven SLD were consecutively recruited at National Taiwan University Hospital from 2008 to 2023. Advanced fibrosis was defined as F2 to F4 based on histology. Clinical risk factors and proposed predictive scores, including NAFLD Fibrosis Score (NFS), Fibrosis-4 (FIB-4) index and others, were examined in the whole cohort and subgroups.

Results: Two hundred twenty-three histologyproven SLD patients were included for analysis.

Among these patients, 143 patients had concurrent metabolic dysfunction-associated steatotic liver disease (MASLD). In the whole cohort, older age (odds ratio [OR]: 1.04 per year older, 95% confidence interval [CI]: 1.01-1.06), alcohol consumption (OR: 5.77, 95% CI: 1.41-23.68), diabetes mellitus (OR: 2.13, 95% CI: 1.09-4.14), chronic hepatitis B (OR: 2.52, 95% CI: 1.24-5.14), and obesity (OR: 2.64, 95% CI: 1.275.09) were the risk factors of advanced fibrosis after adjustment for clinical parameters and comorbidities (all p < 0.05). In the MASLD subgroup, older age, hypertension, diabetes mellitus, and chronic hepatitis B were associated with an increased risk of advanced fibrosis. Among young patients (<50 years), older age and obesity were the risk factors after adjustment. NFS performed better in the whole cohort (AUROC = 0.724 versus 0.693) and the MASLD subgroup (AUROC = 0.782 versus 0.707) than FIB-4 index, whereas FIB-4 index was superior to NFS in young patients (AUROC = 0.786 versus 0.765) for predicting advanced fibrosis.

Conclusions: Among patients with histologyproven SLD, older age, alcohol consumption, diabetes mellitus, chronic hepatitis B, and obesity are associated with advanced fibrosis. NFS and FIB-4 index have distinct performances in different patient subgroups.

THE IMPACTS OF MAFLD VERSUS MASLD ON LONG-TERM SURVIVAL OF CHRONIC HEPATITIS B PATIENTS Shang-Chin Huang1,2,3,4, Tung-Hung Su1,2, Tai-Chung Tseng2,5, Shih-Jer Hsu1,2, Chun-Ming Hong6, Ting-Yuan Lan7, Chen-Hua Liu1,2, Hung-Chih Yang1,2, Chun-Jen Liu1,2,3, Pei-Jer Chen1,2,3,5, Jia-Horng Kao1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 5 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 6 Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 7 Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan 1

代謝異常脂肪肝病對慢性 B 肝患者長期 存活影響之比較 黃上秦1,2,3,4 蘇東弘1,2 曾岱宗2,5 徐士哲1,2 洪俊銘6 藍鼎淵7 劉振驊1,2 楊宏志1,2 劉俊人1,2,3 陳培哲1,2,3,5 高嘉宏1,2,3 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院肝炎研究中心 3 國立臺灣大學醫學院臨床醫學研究所 4 國立臺灣大學醫學院附設醫院北護分院胃腸肝膽內 科 5 國立臺灣大學醫學院附設醫院醫學研究部 6 國立臺灣大學醫學院附設醫院整合醫學科 7 國立臺灣大學醫學院附設醫院新竹臺大分院風濕免 疫科 2

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are the new criteria for steatotic liver

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P.017 disease (SLD). However, the comparative impacts of these criteria on prognosis of chronic hepatitis B (CHB) patients remains unknown.

Aims: We aimed to investigate the impacts of MAFLD versus MASLD criteria on long-term survival of CHB patients.

Methods: From 2006 to 2021, consecutive CHB patients with SLD were recruited from National Taiwan University Hospital. Diagnosis of MAFLD, MASLD, or alcohol-associated liver disease (ALD) was made according to the proposed criteria. The metabolic burden was quantified by the number of fulfilled metabolic factors defined by MAFLD and MASLD criteria, respectively. The all-cause and cause-specific mortality was compared between groups.

Results: A total of 8773 CHB patients with SLD were enrolled. At baseline, 67.3%, 8.0%, 0.1%, and 24.6% of patients presented with “both MAFLD and MASLD”, “MASLD only”, “MAFLD only”, and “SLD from other etiologies”, respectively. With a median follow-up of 9.1 years, patients with “both MAFLD and MASLD” had the highest all-cause, liver-related, cancer-related, and cardiovascular mortality rates, followed by those with “MASLD only”, “SLD from other etiologies”, and “MAFLD only” after adjustment for age, sex, cirrhosis, HBeAg and ALT levels (all p < 0.001). Greater metabolic burden, by MAFLD criteria (3 versus 0 factors, adjusted hazard ratio [aHR] 2.54, 95% confidence interval [CI] 1.68–3.83, p < 0.001) or by MASLD criteria (≥3 versus 0 factors, aHR 2.16, 95% CI 1.45–3.22, p < 0.001), satisfactorily stratified mortality risks in a dose-dependent manner.

Furthermore, ALD patients exhibited a significantly higher mortality risk (aHR 11.80, 95% CI 5.89–23.60, p < 0.001) than those without ALD. Conclusions: MASLD criteria encompass most MAFLD patients within the CHB population.

However, the metabolic burden, rather than the specific criteria for MAFLD or MASLD, determines the mortality risks. Differentiating ALD from the SLD spectrum is clinically important for CHB patients.

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FACTORS THAT PREDICT RESPONSE OF CHRONIC HEPATITIS B PATIENTS WITH HEPATITIS B E ANTIGEN POSITIVE TO TENOFOVIR ALAFENAMIDE IN PING-TUNG COUNTY Shi-Chi Wen1, Wu-Hsien Kuo2, Chao-Wen Hsueh1, Hsin-Yeh Chen1, Tzu-Ming Ou3, Chou-Yuan Ko3, Jyan-Wei Huang3, Chieh-Yu Wang4, Hsin-Yi Shen5, Yu-Fen Chen5, Yi-Ting Chen5, Chia-Yao Wang5 Division of Gastroenterology, Department of Internal Medicine, Pao-Chien Hospital, Pingtung, Taiwan 2 Yuan-Sheng Branch, Yuan-Zuong Hospital, Changhua, Taiwan 3 Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan 4 Case Manager, Nursing Department, PaoChien Hospital, Pingtung, Taiwan 5 Endoscopy Room, Nursing Department, PaoChien Hospital, Pingtung, Taiwan 1

屏東地區以核苷酸類似物韋立得治療慢 性 B 型肝炎 e 抗原陽性患者 e 抗原成功 消失之預測因素分析 文士祺1 郭武憲2 薛肇文1 陳興曄1 歐子銘3 柯朝元3 黃健維3 王潔瑜4 沈欣怡5 陳郁棻5 陳怡婷5 王嘉耀5 1

寶建醫院肝膽胰內科 員榮醫院肝膽胰內科 3 國軍高雄總醫院肝膽胰內科 4 寶建醫院護理部個管師 5 寶建醫院護理部內視鏡室 2

Background: Tenofovir alafenamide (TAF), a novel prodrug of tenofovir (TFV) diphosphate, an acyclic analogue of adenosine phosphonoamidate, has been approved for treatment of chronic hepatitis B (CHB) infection. TAF has been shown to be a potent inhibition of HBV replication at a low dose with high intracellular concentration and more than 90% lower systemic TFV concentration than tenofovir disoproxil fumarate (TDF) with less renal toxicity and mineral bone density loss. Predictor of treatment response to interferon-base therapy has shown that HBV genotype A/B, wide type pre-core or basal core promoter sequences, lower HBV DNA,

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higher ALT levels and younger had better response.

However, maintained HBV DNA suppression to an undetectable level is the appropriate surrogate outcome for nucleos(t)ide analogues.

Aims: We aimed to determinate the longer term follow-up and real-world data in viral/ biochemical and serological response treated with TAF and assessment of predictive factors associated with e antigen loss, which is regarded as a desirable outcome.

Methods: A retrospective cohort study, a total of 23 consecutive CHB patients treatment naïve with e antigen positive treated with TAF between Jan 2016 and Jul 2022, in Ping-Tung County, was recruited.

The primary end points including a reduction in the serum HBV level to undetectable, HBeAg loss and normalization of the alanine aminotrasferase (ALT) level which were followed up for 12-24 weeks were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors that were independently related to HBeAg loss.

Results: The follow-up and treatment period for each patient was calculated as 9.81 ± 6.71 years and 2.67 ± 1.68 years. Of the 23 patients enrolled, the male 65.2%, non cirrhosis 87% was predominant.

The mean age was 47.7 ± 10.6 years. The baseline mean HBV DNA level was 7.11 ± 1.51 (log10 IU/ mL). The ALT (IU/L) (ULN x times) was 6.85 ± 7.67.

A cumulative rate of virological response with an undetectable HBV DNA level at year 0.5, 1, 2 and 3 was 34.8%, 69.6%, 82.6% and 87.0%, respectively. A cumulative rate of biochemical response with ALT normalization at year 1, 2 and 3 was 78.3%, 87.0%, and 91.3%, respectively. A serological response obtained with e antigen loss rate 56.5%, mean time (year)1.70 ± 1.28; and with seroconversion rate 43.5%, mean time (year)1.65 ± 1.26. A cumulative serological response with e antigen loss had 26.1%, 34.8%, 47.8% and 56.5% at year 1, 2, 3 and 4; and a seroconversion had 17.4%, 30.4%, 34.8% and 43.8% at year 1, 2, 3, and 4, respectively. Base on Cox proportional hazard univaiate analysis, factors with female gender (HR: 5.449; 95% CI: 1.349-22.012; P = 0.017), cumulative undetectable HBV DNA at year 3 (HR: 5.859; 95% CI: 1.265-27.133; P = 0.024) and cumulative ALT normalization at year 2 (HR: 6.446; 95% CI: 1.170-35.505; P = 0.032) were associated with e antigen loss in univariate analysis. Multivariate analysis indicated that cumulative undetectable HBV DNA at year 3 (HR: 11.411; 95% CI: 1.610-80.860;

P = 0.015) was an independent predictive factor for e antigen loss.

Conclusions: This study has presented chronic hepatitis B with e antigen positive has a good response to TAF for the end point. Among patients, significant predictors including female sex, undetectable HBV DNA level, and normalization of ALT have an increase in e loss. The good response to TAF for these end points including undetectable HBV DNA and ALT normalization is maintained throughout the extension period.

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P.018

P.019

CORRELATION OF CDKN2BAS1 SINGLE NUCLEOTIDE POLYMORPHISMS WITH HEPATOCELLULAR CARCINOMA

IMPACT OF ALDH2 POLYMORPHISMS AND DRINKING BEHAVIORS: INSIGHTS FROM THE NORTHEASTERN TAIWAN COMMUNITY MEDICINE RESEARCH COHORT (NTCMRC)

Kuan-Chun Hsueh1,2,3, Shun-Fa Yang3,4 Division of General Surgery, Department of Surgery, Tungs’ Taichung MetroHarbour Hospital, Taichung, Taiwan 2 Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan 3 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan 4 Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan 1

CDKN2B-AS1 單核苷酸基因多型性與肝 細胞癌的關聯探討 薛冠群1,2,3 楊順發3,4 1

童綜合醫療社團法人童綜合醫院一般外科 國立中興大學學士後醫學系 3 中山醫學大學醫學研究所 4 中山醫學大學附設醫院臨床研究中心 2

Background: Hepatocellular carcinoma (HCC) is a liver malignancy and a major cause of cancer mortality worldwide. Mounting evidence has demonstrated that cyclin dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1) can exhibit both promotive and inhibitory effects on cancer development, revealing a dual role in tumorigenesis.

Aims: We aimed to assess the effect of CDKN2BAS1 single-nucleotide polymorphisms (SNPs) on the susceptibility to HCC. Methods: Real-time polymerase chain reaction was used to analyze five SNPs of CDKN2B-AS1 (rs564398, rs1333048, rs1537373, rs2151280 and rs8181047) in 810 patients with HCC and 1190 cancer-free controls.

Results: No significant association of these five SNPs with the risk of developing HCC was detected between the case and control group. However, patients who bear at least one variant allele (heterozygote or homozygote) of CDKN2B-AS1 rs1537373 were less prone to develop large tumor size tumors (OR, 0.717; 95% CI, 0.522-0.984; p = 0.039).

Conclusions: Our results indicate an association of CDKN2B-AS1 rs1537373 gene polymorphisms with the progression of liver cancer.

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Chun Kai Wang1, Chih-Lang Lin1,2, Li-Wei Chen1, Rong-Nan Chien1,2,3, Jia-Jang Chang1, Shuo-Wei Chen1, Ching-Chih Hu1, Cheng-Hung Chien1, Tien -Shin Chou1, Tsuo-Hsuan Chien1, Xiu-Wei Li1, Kuang-Chen Huang1, Cheng-Han Xie1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Keelung, Taiwan 2 Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 3 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Linkou, Taoyuan, Taiwan 1

ALDH2 基因變異與飲酒行為之影響：台 灣東北部社區世代醫學研究之發現 王俊凱1 林志郎1,2 陳立偉1 簡榮南1,2,3 張家昌1 陳碩為1 胡瀞之1 錢政弘1 鄒騰信1 簡佐軒1 李修維1 黃冠程1 謝承翰1 1

基隆長庚紀念醫院胃腸肝膽科 基隆長庚紀念醫院社區醫學研究中心 3 林口長庚紀念醫院胃腸肝膽科 2

Background: The Aldehyde dehydrogenase 2 (ALDH2) enzyme plays a critical role in detoxifying acetaldehyde, a harmful byproduct of alcohol metabolism. However, mutations in the ALDH2 gene, particularly the ALDH2*2 allele common among East Asians, decrease the enzyme’s efficiency. This leads to the accumulation of acetaldehyde, which not only causes ‘Asian flush syndrome’ but also increases the risk of liver diseases and various cancers.

Aims: The objective of this study is to investigate the effects of ALDH2 polymorphisms on liver function and metabolic health in the Northeastern Taiwan Community Medicine Research Cohort (NTCMRC). It specifically focuses on assessing how interventions within the community that aim to modify drinking behaviors interact genetically with alcohol consumption.

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P.020 Methods: Using the Alcohol Use Disorder Identification Test (AUDIT), we assessed the alcohol consumption of 1,540 participants. We identified the ALDH2 rs671 polymorphism and collected data on various laboratory parameters as well as demographics and lifestyle habits through questionnaires. Subsequent analyses explored the relationships between ALDH2 genotypes, drinking habits, and liver function.

Results: Of the patients included, 46% (708 individuals) were men with an average age of 46.4 years. The AUDIT test revealed that 731 participants (47.47%) reported no alcohol use, 599 (38.9%) were classified as low-risk drinkers, and 210 (13.64%) displayed hazardous drinking behavior. Regarding ALDH2 genotypes, 52.21% (804 participants) had the ‘GG’ genotype (wild type), 39.87% (614 participants) had the ‘GA’ genotype (one defect), and 7.92% (122 participants) had the ‘AA’ genotype (two defects). Statistically significant differences among the ALDH2 genotypes were noted in sex (p = 0.006), waist circumference (p = 0.038), triglycerides (p = 0.024), very low-density lipoprotein cholesterol (p = 0.01), uric acid (p = 0.002), creatinine (p = 0.034), gamma-glutamyl transferase (GGT) (p < 0.001), albumin (p = 0.013), and the fatty liver index (p = 0.002). Subsequent univariate and following multivariate analyses were performed. Individuals with the ‘GG’ and ‘AA’ genotypes exhibited lower levels of rGT and albumin compared to those with the ‘GG’G genotype, regardless of their drinking habits. Additionally, hazardous drinking habits were strongly associated with higher GGT levels.

Conclusions: This landmark community study in Taiwan explores the relationship between ALDH2 variants and liver function. The findings confirm that ALDH2 polymorphisms significantly impact liver health, especially in populations where the ALDH2*2 allele is common. Individuals with GA and AA genotypes exhibit lower levels of GGT and albumin, regardless of their alcohol consumption.

Moreover, hazardous drinking is strongly linked to increased GGT levels, highlighting the complex interplay between genetic factors and lifestyle in affecting liver function.

COMPARATIVE EFFECTIVENESS OF SGLT2 VS DPP4 INHIBITORS ON LONG-TERM OUTCOMES IN CHB PATIENTS WITH LIVER CIRRHOSIS: A RETROSPECTIVE COHORT STUDY USING THE CHANG GUNG RESEARCH DATABASE Yen-Hao Chen1, Chih-Lang Lin1,2, Li-Wei Chen1, Rong-Nan Chien1,3, Jia-Jang Chang1, Shuo-Wei Chen1, Ching-Chih Hu1, Cheng-Hung Chien1, Tien -Shin Chou1, Tsuo-Hsuan Chien1, Xiu-Wei Li1, Kuang-Chen Huang1, Cheng-Han Xie1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Keelung, Taiwan 2 Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 3 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Linkou, Taoyuan, Taiwan 1

比較 SGLT2 與 DPP4 抑制劑於慢性 B 型 肝炎肝硬化患者長期療效之研究：一個 長庚醫學資料庫之回顧性世代研究 陳彥豪1 林志郎1,2 陳立偉1 簡榮南1,3 張家昌1 陳碩為1 胡瀞之1 錢政弘1 鄒騰信1 簡佐軒1 李修維1 黃冠程1 謝承翰1 1

基隆長庚紀念醫院胃腸肝膽科 基隆長庚紀念醫院社區醫學研究中心 3 林口長庚紀念醫院胃腸肝膽科 2

Background: In Taiwan, Hepatitis B virus (HBV) affects between 2.5 and 3 million individuals, significantly escalating the risk of liver cirrhosis and hepatocellular carcinoma (HCC). Concurrent diabetes mellitus in patients with chronic hepatitis B (CHB) further exacerbates liver disease progression, enhances oncogenic potential, and reduces survival rates. While dipeptidyl peptidase-4 (DPP4) inhibitors have shown potential protective effects against HCC in animal studies, human studies yield inconsistent results. Additionally, previous studies indicate that sodium-glucose cotransporter 2 (SGLT2) inhibitors may also have protective effects against HCC. However, little is known about how SGLT2 inhibitors compare to DPP4 inhibitors in preventing HCC

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P.021 among CHB patients with liver cirrhosis.

Aims: This retrospective cohort study aims to explore how SGLT2 inhibitors compare to DPP4 inhibitors in preventing HCC among CHB patients with liver cirrhosis, by analyzing data from the Chang Gung Research Database (CGRD).

Methods: Between January 2008 and December 2022, a total of 4156 DPP4 inhibitor users and 689 SGLT2 inhibitor users were enrolled for analysis and correlation with outcomes.

Results: Of the patients included, demographic analysis revealed that SGLT2 inhibitor users were predominantly male (76.3% vs 66.3%, P = 0.001) and younger (61.3 ± 11.1 vs 65.7 ± 11.8, P = 0.001).

These users had higher platelet counts, elevated TG levels, and lower HbA1c levels, with fewer occurrences of ascites, hepatorenal syndrome, and bacterial peritonitis, and lower rates of end-stage renal disease and heart failure. However, they had higher rates of fatty liver, dyslipidemia, and obesity.

In terms of liver cirrhosis development, there was no significant difference between SGLT2 and DPP4 inhibitor users in CHB patients without antiviral therapy. Conversely, among those on antiviral therapy, SGLT2 inhibitor users experienced less liver cirrhosis development compared to DPP4 inhibitor users (P = 0.013). Although there were no significant differences in HCC development between the two groups, HBV patients undergoing antiviral therapy had markedly lower HCC development than those not on therapy. Notably, regardless of HBV antiviral therapy, SGLT2 inhibitor users showed better 5-year survival rates than DPP4 inhibitor users.

Conclusions: In conclusion, this study demonstrates that SGLT2 inhibitors are associated with better clinical outcomes compared to DPP4 inhibitors in CHB patients with liver cirrhosis, particularly those receiving antiviral therapy. These benefits include reduced rates of liver cirrhosis development and improved 5-year survival rates, highlighting the potential advantages of SGLT2 inhibitors for managing CHB patients with diabetes and liver cirrhosis. Therefore, further large-scale studies are warranted to investigate the mechanisms and verify these results.

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MICRO-ELIMINATION OF CHRONIC HEPATITIS C BY UNIVERSAL SCREENING WITH RAPID DIAGNOSTIC TEST PLUS DIRECTACTING ANTIVIRALS (DAA) FOR INCARCERATED PERSONS IN HUALIEN Mu-Liang Cheng1, Kai-Wen Chen2, Hui-Lee Chen3 Department of Gastroenterology, Mennonite Christian Hospital, Hualien, Taiwan 2 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan 3 Sanitation and Health Section, Hualien Prison, Agency of Corrections, Ministry of Justice, Hualien, Taiwan 1

矯正機關以快速診斷檢驗法普遍篩檢合 併直接作用抗病毒藥物微消除慢性 C 型 肝炎 — 花蓮經驗 鄭穆良1 陳楷文2 陳惠琍3 1

基督教門諾會醫院腸胃內科 國軍花蓮總醫院腸胃內科 3 法務部矯正署花蓮監獄 2

Background: In Taiwan, incarcerated people are a special population with a high prevalence of Hepatitis C virus (HCV), micro-elimination should be prioritized. In July 2022, the National Office for the Elimination of HCV released the progress of HCV treatment and elimination nationwide, with an average positive rate of 27.4% for HCV antibodies, an average coverage rate of 39.2% (5.0%–86.6%) for HCV testing, and an average diagnostic rate (WHO) of 33.8% (3.2%–72.7%).

Aims: For increased the HCV antibodies an average coverage rate and increased an average diagnostic rate by change the screening process and use rapid diagnostic test (RDT), the main goal of achieving the WHO goal of HCV elimination – diagnostic rate (>90%) and treatment rate (>80%).

Methods: Through a pre-consensus meeting, Mennonite Christian Hospital (responsible for HCV anti-body screen), Hualien Armed Forces General Hospital (responsible for HCV-RNA testing and Hepatitis C treatment), we use rapid diagnostic test (RDT) universal screening plus HCV reflex testing, followed by direct-acting antiviral (DAA) medicines.

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P.022 Results: From May 2 to May 25, 2023, a total of 7 half-day sessions, among the 1459 incarcerated people, we used the RDT of blood drops, a total of 1410 people completed the rapid screening of HCV antibody, 265 people were positive for RDT screening.

As of August 1, 2023, the positive rate of rapid screening of HCV antibody was 18.8%, the positive rate of serum HCV antibody was 18.7%, the positive rate of HCV RNA detection was 69.9%, the coverage rate of HCV testing was 96.6%, the diagnostic rate of HCV screening was 96.6%, and the proportion of HCV receiving antiviral treatment was 93.9%, which has achieved the goal of HCV elimination (WHO) in a correction institution in Hualien.

Conclusions: Rapid diagnostic test (RDT; Referred to as rapid screening) refers to a screening tool that can obtain results within 30 minutes, and most of them can collect microvascular whole blood for analysis through fingertip sampling, and quickly obtain the test results. Rapid screening tests have been recognized by the World Health Organization (WHO) as a diagnostic tool that can improve access to and proximity to care for hepatitis C.

THE COMPARISONS OF EFFICACY AND SAFETY OF DIRECT-ACTING ANTIVIRAL TREATMENT FOR CHRONIC HEPATITIS C PATIENTS WITH AND WITHOUT CANCER: EXPERIENCE FROM SINGLE MEDICAL CENTER Chen-Ta Yang, I-Ling Liu, Fang-Chi Yang, Yang-Yuan Chen, Siou-Ping Huang, Hsu-Heng Yen Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan

比較直接作用抗病毒藥物於慢性 C 型肝 炎的癌症患者與非癌症患者的效果與副 作用 楊承達 劉怡伶 楊芳琦 陳洋源 黃秀萍 顏旭亨 彰化基督教醫院胃腸肝膽科

Background: Hepatitis C virus (HCV) infection and reactivation carry a negative impact in cancer patients because of risks of liver failure or the need to stop chemotherapy temporarily. However, data about efficacy and safety of direct-acting antiviral (DAA) treatment in cancer patients are lack.

Aims: This study aims to evaluate and compare the efficacy and safety of DAA treatment in patients with and without cancer.

Methods: This is a retrospective study of 926 HCV viremic patients receiving DAA treatment, inclusive of 149 patients with cancer and 777 patients without cancer. Demographic, laboratory data, and treatment response were recorded in all patients.

Results: The mean age is 62.9 years-old and gender distribution is equal (49.9% male). Sustained virologic response (SVR) was achieved in 869 of 926 patients (93.8% of all patients, intention-to-treat analysis), including 130 of 149 patients with cancer (87.2%) and 739 of 777 patients without cancers (95.1%). The percentage of patients achieving SVR is significantly lower among patients with cancer than patients without cancer (87.2% vs. 95.1%, p value < 0.001). The main reason for failed SVR is expire for patients with cancer (17 of 149, 11.4%) and refusal to follow up or discontinuing medication for patients without cancer (20 of 777, 2.6%). Virologic failure is rare and only 6 patients have virologic failure (none in patients with cancer and 6 in patients without

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P.023 cancer).

Conclusions: Although SVR rate of DAA treatment is lower in patients with cancer than those without cancer, virologic response is excellent in both groups.

The main etiology of failed SVR is different in both groups that high mortality is found among patients with cancer and higher rate of refusal to follow up or discontinuing medication among patients without cancer.

THE CLINICAL CHARACTERISTICS AND FIBROSIS SEVERITY IN SUBGROUPS OF MASLD Yi-Jhong Luo1, Shih-Han Weng2, Tsung-Jung Lin1, Kuan-Yang Chen3, Chih-Lin Lin1 Department of Gastroenterology, Taipei City Hospital, Renai Branch, Taipei, Taiwan 2 Department of Education and Research, Taipei City Hospital, Taipei, Taiwan 3 Department of Gastroenterology, Taipei City Hospital, Yangming Branch, Taipei, Taiwan 1

代謝功能障礙相關脂肪性肝病次族群的 臨床表徵與肝纖維化嚴重程度研究 羅一鐘1 翁詩涵2 林聰蓉1 陳冠仰3 林志陵1 1

臺北市立聯合醫院仁愛院區消化內科 臺北市立聯合醫院教學研究部 3 臺北市立聯合醫院陽明院區消化內科 2

Background: Metabolic Associated Steatotic Liver Disease (MASLD) is the new nomenclature for Steatotic liver disease (SLD). According to the diagnostic criteria, MASLD can be further divided into three subgroups: (1) Pure MASLD (2) Metabolic dysfunction and alcohol associated steatotic liver disease (MetALD) (3) MASLD combined other etiologies. As the prevalence of MASLD is increasing in Taiwan. However, the difference of clinical characteristics between MASLD subgroups needs further clarification.

Aims: In this study, we sought to comparatively investigate the prevalence and characteristics of different subgroups of MASLD among Taiwanese population.

Methods: We enrolled participants with SLD which was evaluated by abdominal ultrasound.

The clinical features, including anthropometric parameters, clinical and biochemical characteristics were collected. Alcohol intake was self-reported through a questionnaire. Then the participants who diagnosed with MASLD were categorized into three subtypes according to diagnostic criteria. Statistical analyses were performed by chi-square test and Fisher’s exact test, Student’s t test and multivariate logistic regression.

Results: A total of 294 patients with MASLD were recruited. The prevalence of pure MASLD, MetALD, and MASLD combined with other etiologies was

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P.024 55% (162/294), 8% (25/294), and 36% (107/294), respectively. Compared to pure MASLD and MASLD combined with other etiologies, patients with MetALD had significantly higher ratio of male gender (96% vs. 61.7% and 65.4% P < 0.0001) highest aspartate aminotransferase levels (45.71 ± 50.21 mg/dl vs. 33.86 ± 25.13 and 28.33 ± 13.92 mg/ dl, P = 0.007), highest gamma-glutamyl transferase levels (125.55 ± 169.14 mg/dl vs. 44.97 ± 56.82 and 30.07 ± 26.83 mg/dl, P < 0.0001) and highest AC sugar level (123.30 ± 90.15 mg/dl vs. 101.18 ± 17.09 and 104.58 ± 28.83 mg/dl, P = 0.012). Regarding the severity of fibrosis, patients with MetALD had higher NFLD fibrosis score (P = 0.031) and FIB-4 index (P = 0.001). In subgroup analysis, there were 137 patients received hepatic stiffness and Controlled Attenuation Parameter (CAP) measurement by Fibroscan. There was no significant difference in CAP measurement between 3 subgroups. However, patients with MetALD had higher elastrography stiffness (8.78 ± 6.12 kPa vs. 5.10 ± 2.19 kPa vs. 5.03 ± 2.78 kPa, P = 0.006).

Conclusions: The majority of MASLD patients is pure MASLD. Although the proportion of metALD is small, the hepatic fibrosis is the more severe than pure MASLD and MASLD combined with other etiologies. The long-term clinical outcomes of MASLD subgroups still needed further study.

SHOULD ENDOSCOPIC ULTRASONOGRAPHY-GUIDED FINE NEEDLE BIOPSY BE PERFORMED IN PATIENTS WITH RESECTABLE PANCREATIC MALIGNANCIES? – A SINGLE-CENTER EXPERIENCE Ming-Sheng Chien1, Ching-Chung Lin1,2, Jian-Han Lai1,2,3 Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Medical College, Taipei, Taiwan 3 MacKay Junior College of Medicine Nursing and Management, Taipei, Taiwan 1

可切除的胰臟惡性腫瘤患者是否應進行 超音波內視鏡引導下的細針切片檢查？ — 單醫學中心經驗 簡銘陞1 林慶忠1,2 賴建翰1,2,3 1

台北馬偕紀念醫院胃腸肝膽科 馬偕醫學院 3 馬偕醫護管理專科學校 2

Background: Pancreatic cancer is a leading cause of cancer-related deaths, with surgery being the only curative option for resectable cases. CT and MRI help assess tumor resectability but cannot distinguish between primary and metastatic tumors.

Histological examination is necessary for definitive identification. For unresectable tumors, tissue confirmation guides systemic treatment. During EUS, deciding to perform FNA or FNB is crucial. For resectable tumors, surgery is usually recommended without pre-operative tissue confirmation unless imaging results are uncertain. Pre-operative FNB can prevent unnecessary surgeries by identifying metastatic tumors, emphasizing careful diagnostic decision-making.

Aims: The objective of this study was to determine whether pre-operative tissue confirmation using FNA or FNB influenced the subsequent treatment plan, specifically the choice between surgical intervention and systemic therapy.

Methods: This retrospective cohort study was conducted at a medical center in Taiwan, analyzing patients with pancreatic tumors who underwent EUS-FNA and FNB between January 1, 2020, and February 28, 2023. Patients with benign tumors or unresectable malignancies beyond stage III (per the

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P.025 American Joint Committee on Cancer 8th edition) were excluded. Diagnosis was based on both cytopathological and imaging findings. We collected data on age, sex, chronic pancreatitis presentation, EUS findings (tumor location, size, number of passes), cytopathological results, CT imaging, and history of other cancers.

Results: A total of 182 patients with pathologically confirmed pancreatic tumors were retrospectively reviewed. Among them, 114 patients were excluded from the analysis because they were diagnosed with either benign (n = 6) or unresectable (n = 108) tumors. A flow diagram of the participant selection is presented in Figure 1. The clinical characteristics of the patients are shown in Table 1. The cohort of patients diagnosed with resectable malignant pancreatic tumors and undergoing EUS-FNB comprised 27 men and 41 women, with a mean age of 64.53 ± 13.5 years. Seventeen patients had a history of cancer, accounting for 25% of all cases.

The most frequent histological types of pancreatic malignancies were pancreatic adenocarcinoma (n = 42, 61.8%), neuroendocrine tumors (n = 22, 32.3%), and metastases (n = 4, 5.9%). The patients were divided into two groups: those with a history of cancer (n = 17) and those without (n = 51), as shown in Table 2. Of the patients with a history of cancer, three had lung cancer, seven had breast cancer, one had esophageal cancer, and six had other types of cancer, such as hepatocellular carcinoma, endometrial carcinoma, pheochromocytoma, and carcinoid tumors of the mediastinum. The diagnosis of pancreatic metastatic tumors was confirmed by tissue proof via EUS-FNB/A and pathohistology. The mean size of primary pancreatic tumors was 2.25 ± 0.86 cm, compared with secondary cases, which had a mean size of 3.2 ± 2.60 cm (P = 0.07). In our study, the incidence of metastatic pancreatic tumors tended to be higher in patients with a history of malignancy (23.5%) than in those with no cancer history (P < 0.001). Notably, all patients without a history of cancer were diagnosed with primary pancreatic cancer.

Conclusions: Metastases to the pancreas can occur at various stages of different solid tumors, sometimes long after the initial diagnosis. Distinguishing between primary and secondary pancreatic tumors using imaging alone is challenging. EUS, combined with FNB, is essential for identifying pancreatic tumor features and obtaining tissue samples for a definitive diagnosis. This approach helps initiate appropriate treatment and prevent unnecessary pancreatic surgeries.

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IS LENVATINIB-RADIOFREQUENCY ABLATION (RFA) FEASIBLE IN ADVANCED STAGE HEPATOCELLULAR CARCINOMA (HCC)?

Yuan-Sheng Chang, Kwong-Ming Kee, Ming-Chao Tsai, Chao-Hung Hung, Jing-Houng Wang, Yuan-Hung Kuo, Chien-Hung Chen, Sheng-Nan Lu Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

樂衛瑪續接射頻灼燒術在晚期肝癌病人 可行嗎？ 張源升 紀廣明 蔡明釗 洪肇宏 王景弘 郭垣宏 陳建宏 盧勝男 高雄長庚紀念醫院胃腸肝膽科

Background: Before immunotherapy was introduced, target therapy is a standard treatment for advanced hepatocellular carcinoma (HCC).

Patients with a partial response may become candidates for locoregional therapy. To elucidate the proportion of patients who become candidates for curative ablation following Lenvatinib treatment, we conducted this retrospective study.

Aims: We aim to find out the proportion of patients under Lenvatinib who are candidates for radiofrequency ablation (RFA) in Kaohsiung Chang Gung Memorial Hospital (KCGMH).

Methods: All patients with advanced HCC who met the reimbursement criteria for Lenvatinib and received treatment with Lenvatinib for at least five months were enrolled from January 2020 to January 2024 in KCGMH. Patients combining with radiotherapy initially were excluded. Candidates for curative ablation were defined as patients with fewer than five tumors, the largest tumor diameter less than 10 cm, no viable tumor thrombus in the main portal vein or its first branch, and for whom tumor ablation was technically feasible. Experienced physicians who perform ablation reviewed the imaging of each patient to determine technical feasibility.

Results: From January 2020 to January 2024, 284

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P.026 patients were treated by Lenvatinib, 48 (16.9%) were treated for five months or more and only 9 (3.2%) met criteria of curative ablation. Among 9 candidates, 2 underwent radiofrequency ablation (RFA) and 3 were treated by transcatheter arterial embolization (TACE). One post-RFA case survived for more than 3 years in a tumor-free and drug-free status.

Conclusions: For patients with advanced HCC underwent Lenvatinib treatment, only 3.2% met criteria of curative ablation. Only 22.2% (2/9) were further treated by tumor ablation, and one achieved complete response. Since there is a chance of achieving a complete response, we highly recommend the limited group of patients should be treated by curative ablation. Currently, there is an urgent need for similar analysis of immunotherapy followed by curative ablation in patients with advanced HCC.

EFFICACY AND SAFETY OF 144 WEEKS OF BULEVIRTIDE 2 MG OR 10 MG MONOTHERAPY FROM THE ONGOING PHASE 3 STUDY, MYR301 Pietro Lampertico1,2, Soo Aleman3, Maurizia Brunetto4,5, Antje Blank6, Pietro Andreone7, Pavel Bogomolov8, Vladimir Chulanov9, Nina Mamonova9, Natalia Geyvandova10, Morozov Viacheslav11, Olga Sagalova12, Tatyana Stepanova13, Grace M. Chee14, Dmitry Manuilov14, Mingyang Li14, Audrey H. Lau14, Anu Osinusi14, Julian Schulze zur Wiesch15, Markus Cornberg16, Stefan Zeuzem17, Heiner Wedemeyer16 Division of Gastroenterology and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2CRC “A. M. and A. Migliavacca” Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3Karolinska University Hospital/ Karolinska Institutet, Department of Infectious Diseases, Stockholm, Sweden; 4 University Hospital of Pisa, Hepatology Unit, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, Pisa, Italy; 5 University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy; 6 Heidelberg University Hospital, Medical Faculty Heidelberg/Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany; 7University of Modena and Reggio Emilia, Internal Medicine, Baggiovara Hospital, Modena, Italy; 8M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russian; 9FSBI National Research Medical Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation, Moscow, Russian; 10Stavropol Regional Hospital, Stavropol, Russian; 11LLC Medical Company “Hepatolog,” Samara, Russian; 12Southern Ural State Medical University of Ministry of Health of the Russian Federation, Chelyabinsk, Russian; 13LLC Clinic of Modern Medicine, Moscow, Russian; 14Gilead Sciences, Inc., Foster City, CA, USA; 15Hepatology Outpatient 1

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Medical Clinic, University Hospital HamburgEppendorf, Hamburg, Germany; 16Clinic for Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; 17Department of Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany Background: Bulevirtide (BLV) is a first-in-class entry inhibitor approved in Europe for chronic hepatitis delta (CHD).

Aims: In a Phase 3 study over 96 weeks (W), BLV 2mg or 10mg monotherapy was effective and safe. Here, we present W144 results.

Methods: 150 patients with CHD were randomized: Arm A, observed for 48W then BLV 10 mg/d for 96W (n = 51); Arm B, BLV 2 mg/d for 144W (n = 49); Arm C, BLV 10 mg/d for 144W (n = 50). All patients were followed for 96W posttreatment. W144 efficacy endpoints included virologic response (VR; undetectable hepatitis delta virus (HDV) RNA or ≥2 log10 IU/mL decline from baseline), alanine aminotransferase (ALT) normalization, combined response (CR; VR and ALT normalization), and undetectable HDV RNA (target not detected).

Results: At W144, 96%, 92%, and 88% in Arms A, B, and C remained in study. Arms B and C had similar rates of CR, VR, and ALT normalization; rates increased through W96 and were maintained through W144. At W144, 57%, 73%, 59% (Arm B) and 54%, 76%, 60% (Arm C) of patients achieved CR, VR, and ALT normalization. Undetectable HDV RNA rates were 29% (Arm B) and 50% (Arm C) at W144.

Time to VR (mean [standard deviation] W) was faster in Arm C (69.3 [41.2]) vs Arm B (77.3 [44.5]). At W144 in Arm A, rates of CR, VR, ALT normalization, and undetectable HDV RNA were 56%, 92%, 58%, and 52%. No progression to liver-related outcomes occurred over 144W except for 1 case of mild ascites in Arm A (patient with baseline cirrhosis). Through 144W of BLV therapy, no drug discontinuations, serious adverse events, or deaths attributed to BLV occurred; the safety profiles were similar for BLV 2 mg and 10 mg.

Conclusions: Long-term BLV therapy over 144W remains safe and effective. Improvements in biochemical, fibrosis, and virologic markers support the potential clinical benefits of long-term BLV therapy.

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A MACHINE LEARNING MODEL FOR PREDICTING HEPATOCELLULAR CARCINOMA OCCURRENCE IN PATIENTS WITH HEPATITIS B VIRUS RELATED CIRRHOSIS Pao-Yuan Huang1, Heng-Syu Lin2, Cheng-Yuan Peng3,4, Ruei-Hau Hsu2, Chien-Hung Chen1 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Department of Computer Science and Engineering, National Sun Yat-sen University Kaohsiung, Taiwan 3 Center of Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 4 School of Medicine, China Medical University, Taichung, Taiwan 1

用於預測 B 型肝炎病毒相關肝硬化患者 發生肝細胞癌的機器學習模型 黃寳源1 林恒旭2 彭成元3,4 徐瑞壕2 陳建宏1 1

高雄長庚紀念醫院肝膽胃腸科系暨長庚大學醫學院 國立中山大學資訊工程學系 3 中國醫藥大學附設醫院消化醫學中心 4 中國醫藥大學醫學院 2

Background: Patients with chronic hepatitis B (CHB) and cirrhosis have a high risk of developing hepatocellular carcinoma (HCC). However, there are few predictive models specifically designed to evaluate this risk in these patients.

Aims: This study aimed to develop a prediction model to assess the risk of HCC in patients with hepatitis B virus (HBV) related cirrhosis undergoing antiviral therapy.

Methods: The cohort study included 1,592 patients with HBV related cirrhosis from two hospitals in Taiwan. These patients had been undergoing treatment with nucleos(t)ide analogues (NA) such as entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide for at least one year. Patients diagnosed with hepatocellular carcinoma (HCC) within the first 12 months of NA therapy were excluded from the study. These patients were randomly assigned

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P.028 to either the derivation or the validation group in a 2:1 ratio. A machine learning method, eXtreme Gradient Boosting (XGBoost), was used to develop the prediction model. We calculated the area under the receiver operating characteristic curve (AUROC) and compared with extant prediction models.

Results: The cumulative incidences of HCC in all patients were 15.2% at 5 years, 22.7% at 8 years, and 25.7% at 10 years. The patients’ demographics and baseline characteristics in the derivation and validation groups did not show significant differences. Our model incorporated six parameters: baseline serum albumin level and platelet count, as well as age, platelet count, and serum AST and AFP levels at 12 months after initiating NA therapy. The AUROCs of our model in the validation group ranged from 0.79 to 0.80 over a period of 3 to 10 years. This demonstrated superior predictive performance for HCC development, surpassing previous models such as APA-B, PLAN-B, PLAN-B retrain, PAGE-B, mPAGE-B, REACH-B, and CU-HCC (AUROC ranging from 0.61 to 0.73; all p < 0.05). Patients were stratified into three distinct risk categories based on the risk scores computed by our model. In the validation cohort, the 10-year cumulative incidence rates of HCC development were 9% for the low-risk group (0-0.15), 26% for the intermediate-risk group (0.150.30), and 67% for the high-risk group (0.30-1).

Conclusions: The proposed machine learning model for predicting HCC development exhibited good predictive accuracy in CHB patients with cirrhosis undergoing NA therapy.

DIAGNOSTIC PERFORMANCE OF PIVKA-II AND ITS DYNAMIC CHANGE IN IDENTIFYING RECURRENCE OR PROGRESSION OF HEPATOCELLULAR CARCINOMA (HCC): A SINGLE-CENTER, RETROSPECTIVE STUDY Ding-Fong Wu1, Hsin-yi Chen1, Chih-Sheng Hung1,2, Chia-Long Lee1,2,3, Sien-Sing Yang1,2, Jui-Ting Hu1,2,3 Division of Digestive Medicine, Cathay General Hospital, Taipei, Taiwan 2 School of Medicine, College of Medicine, FuJen Catholic University, New Taipei City, Taiwan 3 School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 1

PIVKA-II 以及其數值變化對肝細胞癌的復 發與疾病進展的診斷表現：單一醫學中 心的回朔性研究 巫定峰1 陳信宜1 洪志聖1,2 李嘉龍1,2,3 楊賢馨1,2 胡瑞庭1,2,3 1

國泰綜合醫院消化內科 天主教輔仁大學醫學系 3 臺北醫學大學醫學系 2

Background: Prothrombin induced by vitamin K absence II (PIVKAII), also known as des-γ-carboxy prothrombin, was firstly described in 1984 as a biomarker specific for hepatocellular carcinoma (HCC). PIVKA-II cumulative in HCC patients due to the deficiency of vitamin K-dependent carboxylase in malignant hepatocytes results in insufficient carboxylation of the prothrombin precursor.

Previous studies showed that PIVKAII plays a critical role in the diagnosis of HCC, and also in progression prediction and treatment monitoring. However, studies on its efficacy in diagnosing HCC recurrence or progression were rarely found.

Aims: To evaluate the diagnostic performance of PIVKA-II and its dynamic change in identifying recurrence or progression of hepatocellular carcinoma (HCC) determining by CT/MRI. Methods: We retrospectively enrolled patients with HCC and received regular follow-up in Cathay general hospital between January 2022 and December 2023. The inclusion criteria were as follows: (1) received regular measurements of

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P.029 PIVKA-II in every 6 months; (2) received regular CT/ MRI studies in every 3-12 months; (3) the interval between PIVKA-II measurement and CT/MRI study was less than 3 months; exclusion criteria: (1) received antitumor treatment (Radiofrequency ablation (RFA), transarterial chemoembolization (TACE), transarterial embolization (TAE)) within 6 months before PIVKA-II measurements, (2) use of anticoagulant within 2 weeks before examination of PIVKA-II; (3) died during the follow-up period. Finally, 73 patients were enrolled in the present study.

Results: A total of 73 HCC patients were enrolled, with 21 patients having recurrence or progression and 52 patients having no recurrence or progression.

Both mean levels of PIVKA-II and AFP were higher in patients with recurrence or progression. ROC curves were plotted in order to compare diagnostic performance of PIVKA-II with AFP and combination of PIVKA-II and AFP in identifying HCC recurrence or progression. PIVKA-II showed similar accuracy comparing with AFP (AUC 0.783; 95% CI 0.664-0.902 vs. AUC 0.737; 95% CI 0.611-0.863, p = 0.602). The combination of PIVKA-II and AFP showed trend of better accuracy than PIVKA-II or AFP alone but was not statistically significant (AUC 0.871; 95% CI 0.7790.962; p = 0.255 and 0.095, respectively). In the 73 patients, 24 patients had increased level of PIVKAII in serial measurements and 14 out of 24 patients (58.3%) experienced HCC recurrence or progression.

Explorative analysis of the patients with increased level of PIVKA-II in serial measurements was done.

The PIVKA-II showed similar accuracy comparing with percent increase in PIVKA-II (AUC 0.886; 95% CI 0.729-1 vs. AUC 0.786; 95% CI 0.505-0.938, p = 0.235) Conclusions: In conclusion, our study revealed moderate accuracy of PIVKA-II and AFP in identifying HCC recurrence or progression with no statistical significance. The combination of PIVKA-II and AFP showed trend of better accuracy than PIVKA-II or AFP alone but was not statistically significant. The dynamic change of the PIVKA-II may have better accuracy but further study with larger sample size is required.

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GAAD SCORE AS A PROGNOSTIC MODEL FOR RECURRENCE OF HEPATOCELLULAR CARCINOMA AFTER CURATIVE RESECTION Yueh-Jen Chung1, Chih-Chi Wang2, Chao-Hung Hung3, Yuan-Hung Kuo3, Tsung-Hui Hu3, Chien-Hung Chen3, Sheng-Nan Lu3, Ming-Chao Tsai3,4 Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2 Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 3 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 4 School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan 1

GAAD 可預測肝細胞癌術後的復發

鍾悦仁1 王植熙2 洪肇宏3 郭垣宏3 胡琮輝3 陳建宏3 盧勝男3 蔡明釗3,4 1

高雄長庚紀念醫院內科部 高雄長庚紀念醫院一般外科 3 高雄長庚紀念醫院胃腸肝膽科 4 國立中山大學醫學系 2

Background: The high recurrence rate of hepatocellular carcinoma (HCC) remains a significant challenge, even after curative treatment. The novel GAAD algorithm, which combines gender, age, alpha-fetoprotein (AFP), and protein induced by vitamin K absence or antagonist II (PIVKA-II), was developed as a diagnostic model for HCC. However, the utility of the GAAD score for predicting HCC recurrence is still unknown.

Aims: This study aims to assess the role of the GAAD score in predicting outcomes for HCC patients after curative resection.

Methods: This study included 294 HCC patients who underwent curative resection at Kaohsiung Chang Gung Hospital from January 1, 2010, to December 31, 2022. Serum AFP, PIVKA-II levels and GAAD scores

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P.030 (range 0-10) were measured using Elecsys® assays on the cobas® e 601 analyzer. The Kaplan-Meier (KM) curve and log-rank test were used to compare prognosis between two groups classified by GALAD score. Additionally, the association between the GAAD score and microvascular invasion (MVI) was analyzed.

Results: The optimal cutoff value of the GAAD score for predicting HCC recurrence was 2. By KaplanMeier analysis, a GAAD score >2 was associated with significantly shorter recurrence-free survival (p = 0.006) and overall survival (p = 0.039). The multivariate Cox proportional hazards model revealed that a GAAD score >2 (HR = 1.46, 95% CI = 1.003-2.125; p = 0.048), the presence of MVI (HR = 1.65, 95% CI = 1.184-2.287; p = 0.003), and satellite nodules (HR = 1.89, 95% CI = 1.036-3.472; p = 0.038) were independent risk factors for HCC recurrence.

Furthermore, we found that a GAAD score >2 shows a strong positive correlation with MVI (p < 0.001).

Conclusions: The pre-operative GAAD score can be used as a predictor for recurrence in HCC patients after curative resection. The GAAD score also shows a strong positive correlation with MVI.

CHARACTERISTIC OF CONTRAST ENHANCED HARMONIC EUS OF METASTATIC LIVER MALIGNANCY Chung-Hsiang Wu1, Jiann-Hwa Chen1,2, Wei-Chih Su1, Tsung-Hsien Hsiao1, Lung-Yuan Hsu1,2, You-Chen Chao1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan 2 School of Medicine, Tzu Chi University, Hualien, Taiwan 1

轉移惡性肝腫瘤在對比劑內視鏡超音波 的特徵 吳仲翔1 陳建華1,2 蘇偉志1 蕭宗賢1 徐榮源1,2 趙有誠1,2 1 2

佛教慈濟醫療財團法人台北慈濟醫院胃腸肝膽科 慈濟大學醫學院

Background: Contrast-enhanced computed tomography (CE-CT) has been widely used as a standard imaging modality to determine the stage of malignancy. Contrast-enhanced harmonic EUS (CHEUS) has emerged as a useful imaging modality to differentiate primary or metastatic liver malignancy according to different enhancement pattern.

Aims: To investigate the different enhancement pattern of metastatic liver tumors using Sonazoid contrast agent.

Methods: A total of 33 tumors from 9 patients with hepatic metastasis from other sites underwent CEHEUS before histological evaluation. Four patients are lung cancer (NSCLC), three patients, colorectal cancers; two patients, pancreatic cancer. These patients received Sonazoid 0.015ml/Kg for contrastenhanced hormonic EUS assessment. All contrast images examination is observed for more than 5 minutes until the Kuffer phase present about 5-6 minutes. All patients received EUS guided fine needle biopsy (FNB). The puncture needle used is Acquire 22G, Boston Co., Boston, USA. The enhancement pattern was assessed according to the Wilson, et al classification system. The B mode EUS and CEH-EUS images characteristics were recorded.

Results: The gender ratio of male to female is 7:2.

The tumor size is 37.6 ± 14.7 mm in diameter. Hypoenhancement with rim vascular pattern is observed in the lung and pancreatic cancer patients. Hyperenhancement in vascular pattern and early washout

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P.031 are observed in CRC patients with liver metastasis.

Heterogeneous echogenicity in perfusion phase was observed in all tumors.

Conclusions: Hypo-enhancement and transient rim enhancement followed with rapid washout are the most common CEUS manifestation of liver metastases. Small metastases prone to show diffuse hypo-enhancement pattern, and hyper-vascular metastases had a significantly longer washout time than hypo-vascular metastases.

SIGNIFICANT DIFFERENCES IN IN THE OVERALL AND CAUSESPECIFIC SURVIVAL RATES ACROSS SUBGROUPS OF PATIENTS WITH CIRRHOSIS Ashley Fong1, Joanne Kimiko Liu1, Mayumi Maeda1, Vy H. Nguyen1, Isaac Le1, Annie Fung1, Surya Teja Gudapati1, Sally Tran1, Angela Chau1, Xinrong Zhang1, Jung Eun Park1, Ramsey Cheung1, Dr. Changqing Zhao2, Minjuan Jin3, Mindie H. Nguyen1 Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA 2 Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, China 3 Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hang Zhou, China 1

Background: Cirrhosis is the end stage of chronic liver disease. Real-world U.S. data on sex differences for cirrhosis presentation and mortality are currently limited.

Aims: We aimed to evaluate differences in 10-year survival and risk factors associated with mortality of male and female patients with cirrhosis.

Methods: We analyzed 15,882 consecutive patients with cirrhosis diagnosed between 2000-2022 at a U.S. university medical center. Cirrhosis was diagnosed by imaging, histology, noninvasive test showing stage 4 fibrosis or signs of portal hypertension in the presence of an underlying chronic liver disease.

We used Kaplan-Meier curves to analyze cumulative survival rates and Cox proportional hazard regression to analyze variables associated with overall (OS), liver related, and nonliver related mortality.

Results: This cohort included 59.1% males (N = 9383) and 40.9% females (N = 6499). Males had a significantly lower 10-year cumulative OS compared to females (42.3% vs. 50.3%, P < 0.0001) overall as well as in subgroup of patients with decompensated (29.2% vs. 34.7%, P < 0.0001) and compensated (53.7% vs. 60.2%, P < 0.0001) cirrhosis. Among patients without HCC at baseline, males had a significantly lower 10-year OS (46.5% vs. 52.1%, P < 0.0001), but no significant sex disparity was

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P.032 observed among those with baseline HCC (28.6% vs. 28.2%, P = 0.141). Across CTP classes, males had significantly lower 10-year OS than females (class A: 63.7% vs. 71%, class B: 35.4% vs. 40.8%, class C: 33.7% vs. 39.2%, P < 0.0001 for all), and the same trend was observed across MELD-3.0 ranges (<15: 53.3% vs. 60.1%, 15-20: 33.8% vs. 39.6%, >20: 34.5% vs. 40.1%, P < 0.001 for all). By cause of death, liverrelated cumulative survival rates were significantly lower for male compared to female patients (P < 0.0001 for both), but not for nonliver-related survival (P = 0.578). In multivariable Cox regression adjusting for sex, diagnosis period, age, race and ethnicity, liver disease etiology, MELD-3.0 score, baseline HCC, and Charlson Comorbidity Index (CCI), significant predictors for both liver and nonliver-related mortality included cirrhosis diagnosed after 2010, older age, nonviral etiology, higher MELD-3.0 score, baseline HCC, and higher CCI (P < 0.001 for all).

Conclusions: Significant sex disparities in the survival of patients with cirrhosis were found across cirrhosis decompensation and HCC status, CTP class, and MELD-3.0 score. Further evaluation of risk factors associated with male vs. female mortality is needed to reduce the sex disparity in cirrhosis survival.

SWITCHING FROM TENOFOVIR DISOPROXIL FUMARATE TO TENOFOVIR ALAFENAMIDE OR ENTECAVIR IN PATIENTS WITH CHRONIC HEPATITIS B Yu-Sheng Lin, Cheng-Hao Wu, Hsin-Ju Tsai, Chia-Chang Chen, Ying-Cheng Lin, Shou-Wu Lee, Yen-Chun Peng, Sheng-Shun Yang, Teng-Yu Lee Division of Gastroenterology & Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

將 慢 性 B 型 肝 炎 病 人 由 Te n o f o v i r Disoproxil Fumarate 轉換成 Tenofovir Alafenamide 或 Entecavir 的比較 林侑昇 吳晟浩 蔡炘儒 陳家昌 林穎正 李少武 彭彥鈞 楊勝舜 李騰裕 臺中榮民總醫院胃腸肝膽科

Background: Tenofovir alafenamide (TAF) and entecavir (ETV) are both options to replace tenofovir disoproxil fumarate (TDF) during the treatment course of chronic hepatitis B; however, their relative safety remains uncertain.

Aims: We aimed to compare the renal safety of switching from TDF to either TAF or ETV in chronic hepatitis B patients.

Methods: We retrospectively recruited consecutive patients who switched from TDF to TAF or ETV in Taichung Veterans General Hospital from January 1, 2012, to December 31, 2021. The exclusion criteria included (1) End stage renal disease (eGFR < 15 mL/min/1.73 m²); (2) Decompensated liver cirrhosis; (3) Co-infected with hepatitis C virus and human immunodeficiency virus; (4) Concurrent malignancies; (5) TDF use for less than 6 months; (6) ETV or TAF use for less than 1 year; (7) Missing data.

After the switch from TDF, we compared changes in renal function, liver function, and virological parameters between the two groups. A generalized linear mixed-effect model was used to evaluate the changes in estimated glomerular filtration rate (eGFR).

Results: A total of 236 TDF users who received switch therapy (168 TAF and 67 ETV) were included in the analysis. After adjusting for age, gender, baseline eGFR, HBeAg status, pre-existing chronic kidney

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P.033 disease (CKD), diabetes and hypertension, the mean decline in eGFR over 36 months was similar between the two study groups (TAF vs. ETV: −4.2 ml/ min/1.73 m², 95% confidence interval [CI]: −3.7 to −4.6 vs. −4.4 ml/min/1.73 m², 95% CI: −3.8 to −4.9; p = 0.857). In multivariable analysis, the estimated slope coefficient differences revealed that baseline lower eGFR (−0.86 per 1 mL/min/1.73 m² decrease; 95% CI: −0.81 to −0.90; p < 0.001) and pre-existing CKD (−7.38; 95% CI −13.6 to −1.13; p < 0.001) were the independent risk factors for affecting changes of eGFR after switch therapy. The 3-year cumulative incidence of CKD stage downgrade was also not significantly different (TAF vs. ETV: 12.0%, 95% CI: 9.4-14.6 vs. 10.4%, 95% CI: 6.4-14.5; p = 0.889). The patient proportions of ALT normalization (TAF vs.

ETV: 81% vs. 79%; p = 0.891) and undetectable HBV DNA (TAF vs. ETV: 97.6% vs. 97.2%; p = 0.958) were similar between the TAF and ETV groups after three years of follow-up.

Conclusions: Both TAF and ETV are safe and effective options for switch therapy in TDF users.

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SIMPLIFIED CT-BASED HEPATIC EXTRACELLULAR VOLUME FRACTION MEASUREMENT: A NONINVASIVE METHOD FOR ASSESSING LIVER FIBROSIS AND CIRRHOSIS Yu-Kuang Kang, Hsuan-Hwai Lin Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

簡化電腦斷層肝臟細胞外容積分數測量 法：一種非侵入性評估肝纖維化和肝硬 化的方法 康有光 林煊淮

三軍總醫院胃腸科

Background: Chronic liver disease is a significant public health issue. Sustained liver injury leads to diffuse fibrosis and extracellular space expansion, impairing hepatic function and marking cirrhosis.

Evaluating hepatic fibrosis is crucial for disease management, aiding prognosis and guiding therapies such as antiviral agents that can reverse fibrosis. While histopathologic evaluation of biopsy samples is the standard for assessing hepatic fibrosis, its invasive nature, risk of complications, and susceptibility to sampling error highlight the importance of non-invasive methods. Non-invasive evaluation is essential for safer, more comprehensive fibrosis assessment, improving patient care and outcomes.

Aims: This retrospective study evaluates a simplified CT method for measuring hepatic extracellular volume (ECV) fraction in patients with malignant liver tumors. We aim to: (1) Assess the correlation between CT-measured ECV fraction and histological fibrosis staging. (2) Compare ECV fraction with other non-invasive indicators, such as FIB-4, in predicting cirrhosis. (3) Determine the optimal ECV threshold for cirrhosis prediction. (4) Explore the clinical potential of this non-invasive CT method in assessing liver fibrosis and cirrhosis.

Methods: This retrospective case-control study used the cancer center’s database to identify 447 patients who had abdominal CT scans and blood tests prior to surgical resection of malignant liver tumors. Liver tissue samples were taken from the

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P.034 non-tumor portion during hepatic tumor surgeries.

Experienced hepatopathologists assessed the fibrosis stage using the Ishak and Batts-Ludwig staging systems. A hepatologist and a trainee reviewed images from all studies, recording four CT attenuation measurements of the liver and the aorta during each enhancement phase. Mean attenuation values (in Hounsfield units) for liver parenchyma and blood were derived, and liver ECV was calculated.

The findings were correlated with each patient’s Ishak staging, Batts-Ludwig staging and FIB-4 level.

Results: Complete Ishak, Batts-Ludwig staging, and ECV data were available for 398 patients. The ECV was significantly greater in patients with cirrhosis compared to those without cirrhosis (0.3473 versus 0.3187, p < 0.05). Both ECV and FIB-4 levels were predictive of cirrhosis, with areas under the receiver operating characteristic curve of 0.5953 (p < 0.05) and 0.617 (p < 0.0001), respectively. The sensitivity and specificity of ECV greater than 0.3450 the threshold for predicting cirrhosis were 46% and 69%, respectively.

Conclusions: Noninvasive contrast-enhanced CT quantification of the fractional ECS correlates with the Ishak and Batts-Ludwig staging, an indicator of the severity of liver disease, and merits further study.

HISTOLOGIC AND CLINICAL FEATURES OF A SOLITARY LARGE HEPATOCELLULAR CARCINOMA WITHOUT MACROVASCULAR INVASION IN A TERTIARY MEDICAL CENTER Yi-Hsuan Liu1,2,3, Tsang-En Wang1,2,3, Ching-Wei Chang1,2,3, Ming-Jen Chen1,2,3, Jiunn-Chang Lin1,2,3, Chia-Chi Tsai1,2,3 Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 3 MacKay Medical College, New Taipei City, Taiwan 1

醫學中心大型單一顆無大血管侵犯的肝 臟腫瘤之組織學和臨床特徵 劉嬑玹1,2,3 王蒼恩1,2,3 張經緯1,2,3 陳銘仁1,2,3 林俊昌1,2,3 蔡家騏1,2,3 1

馬偕紀念醫院胃腸肝膽科 馬偕醫護管理專科學校 3 馬偕醫學院 2

Background: Solitary hepatocellular carcinoma (HCC) larger than 5 cm without macrovascular invasion have widely variable outcomes. It is classified as BCLC B in Taiwan and as BCLC class A in the West world. Many factors affect the prognosis of cancer, such as viral infection, tumor size, number, nodal metastasis, vascular invasion, and liver function [1].

Histological grading reflects the biological behavior of solid tumors and provides valuable prognostic information. This is also expected in large solitary HCC. Evaluation of gross and histological features of these HCC specimens obtained through surgical resection aids in identifying critical histopathological characteristics of HCC. Aims: This study aims to review the clinical and histological features of patients with solitary large HCC (>5 cm) without macrovascular invasion in a tertiary medical center, with a focus on predicting prognosis based on tumor size and histological grading.

Methods: We conducted a retrospective study involving 98 cases of surgically resected HCC >5 cm without macrovascular invasion diagnosed at

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P.035 our hospital between 2007 and 2018. Patients were categorized into two groups based on tumor size: 5-10 cm and ≥10 cm. We collected data on clinical features including age, gender, presence of HBV, HCV, alcohol use, and Child-Pugh score, and analyzed overall survival and recurrence rate. Histological grading was performed according to the WHO three-stage system using H&E staining. There are well-differentiated (G1), moderately differentiated (G2), and poorly differentiated (G3) HCCs. Results: Table 1 summarizes the clinical and histological characteristics of the study population and subgroups based on tumor size (5-10 cm vs. ≥10 cm). In the 5-10 cm group (n = 74, 75.5%), 55 (74.32%) patients were men and 19 (25.68%) were women, with a mean age of 60.3 years. Most patients had viral hepatitis, predominantly HBV (75.68%). Nine (12.16%) patients had hepatitis C. Alcohol use was noted in 9.46% of patients. The majority (97.3%) had Child-Pugh class A and two patients (2.7%) had Child-Pugh class B cirrhosis.

Histologically, 8.11% were well-differentiated, 62.16% were moderately differentiated, and 29.73% were poorly differentiated. In the ≥10 cm group (n = 24, 24.5%), 20 (83.33%) patients were men and 4 (16.67%) were women with a mean age of 56 years.

HBV infection was present in 75% of patients, HCV in 8.33%, and alcohol use in 4.17%. All patients had Child-Pugh class A cirrhosis. Histologically, 12.5% were well-differentiated, 62.5% were moderately differentiated, and 25% were poorly differentiated.

Overall survival of 15 years was 32.43% in the 5-10 cm group and 45.83% in the ≥10 cm group, not statistically significant (p = 0.176). The recurrence rate was 48.65% in the 5-10 cm group and 62.5% in the ≥10 cm group, not statistically significant (p = 0.12). Additionally, histological differentiation also impacted prognosis: overall survival was 66.7% in patients with well-differentiated HCC, 70.5% in moderately differentiated, and 50% in poorly differentiated, not statistically significant (p = 0.37).

The corresponding recurrence rates were 33.3%, 47.5%, and 70.37% respectively, not statistically significant (p = 0.059).

Conclusions: In conclusion, this study emphasizes that tumor size and histological differentiation may not significantly affect overall survival or recurrence in HCC patients who receive tumor resection. This outcome could be attributed to the study’s small sample size and potential selection bias among surgically resected patients.

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TARGETING THE GUT-LIVERIMMUNE AXIS TO TREAT METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE BY FUCOIDAN Ming Shun Wu1,2,3, Sheng-Jie Shiue1,3, Chun-Nan Chen1,3, Chao-Ling Cheng1,3, Tze-Sian Chan1,3, Gi-Shih Lien1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3 TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan 1

探討小分子褐藻醣膠對代謝功能障礙相 關脂肪肝病的腸道 - 肝臟 - 免疫軸影響 吳明順1,2,3 薛聖潔1,3 陳俊男1,3 鄭照霖1,3 張智翔1,3 連吉時1 1

臺北市立萬芳醫院—委託財團法人臺北醫學大學辦 理消化內科 2 臺北醫學大學醫學系內科 3 臺北醫學大學消化醫學研究中心

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) stands as an unrestrained peril for end-stage hepatic ailments, despite the availability of therapeutic interventions.

Dysregulated immune responses and microbiota dysbiosis assume cardinal roles in the pathogenesis of MASLD, yet persistently elude routine clinical scrutiny.

Aims: We delved into the safety and impact of fucoidan on the gut-liver-immune axis in individuals afflicted with MASLD. Methods: Fifteen individuals afflicted with MASLD, stratified by the varying degrees of obesity according to BMI-mild, -moderate, and -severe were each allocated to one of five distinct groups receiving different fucoidan dosages: 1.2g, 2.4g, 4.8g, 9.6g, and 14.4g. The safety, immune profile, and gut microbiota data of patients were monitored approximately one month before and after the administration of fucoidan.

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P.036 Results: Throughout the clinical trial, there were no reported incidents of adverse reactions, and both liver and renal functions remained unimpaired.

Following one month of fucoidan consumption, there was a reduction in the severity of hepatic steatosis in individuals with severe fatty liver disease.

The immune profile exhibited an augmentation in B, T, Th, Tc, and DC cells, with an increase in NK cells observed in the high-dosage groups. Moreover, the NLR ratio experienced a decrease in the highdosage cohort. After one month of fucoidan intake, the microbial diversity of the gut microbiota demonstrated an elevation.

Conclusions: Fucoidan may ameliorate hepatic steatosis in individuals with MASLD, enhancing both specific and nonspecific immunity and enriching the microbial diversity of the gut microbiota.

Furthermore, it is postulated to modulate the gutliver-immune axis.

THE IMPACT OF MODERATE ALCOHOL CONSUMPTION AND ASSOCIATED RISK FACTORS ON SURVIVAL OUTCOMES IN HEPATOCELLULAR CARCINOMA PATIENTS: A RETROSPECTIVE COHORT STUDY IN EASTERN TAIWAN Meng-chen Hsieh1, Ping-Jen Hu1,2, Ming-Yao Chen1,2, Ming-Jong Bai3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan 2 TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan 3 Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan 1

中度飲酒及相關風險因子對肝細胞癌患 者生存結果之影響：東台灣單中心回顧 性研究 謝孟辰1 胡炳任1,2 陳明堯1,2 白明忠3 1

衛生福利部雙和醫院消化內科 臺北醫學大學消化醫學研究中心 3 台東馬偕紀念醫院胃腸肝膽科 2

Background: Hepatocellular carcinoma (HCC) is a significant global health issue, ranking as the seventh most common cancer worldwide and the fourth leading cause of cancer-related death.

In Taiwan, HCC ranks second in cancer mortality.

Heavy alcohol consumption has been identified as an independent risk factor for the development of HCC, however, there are few studies that explore the relationship between alcohol consumption and survival outcome in HCC patients.

Aims: This study aims to investigate the relationship between moderate alcohol consumption and survival outcomes in HCC patients in Eastern Taiwan, and to evaluate the impact of potential risk factors on survival.

Methods: A retrospective cohort study was conducted at Taitung MacKay Memorial Hospital, including 513 patients diagnosed with HCC between February 2006 and December 2016. Patients were

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P.037 classified based on their alcohol consumption status and the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Clinical data, including age, gender, body mass index (BMI), and laboratory data such as albumin, total bilirubin (Bil.T), prothrombin time international normalized ratio (PT INR), hemoglobin (Hb), and platelet count, were collected and analyzed. Logistic regression analysis was used to explore the relationship between these factors and survival rates.

Results: Among the study population, 74.1% reported moderate alcohol consumption, 25.5% were infected with HBV, and 32.9% with HCV. Alcohol consumption was associated with worse survival outcomes at 2, 3, and 5 years. Our findings highlight a progressive worsening of prognosis in HCC associated with alcoholic liver disease (ALD) over time. Additionally, hypoalbuminemia, elevated platelet count, and prolonged international normalized ratio (INR) emerged as robust markers for predicting both short- and long-term survival outcomes in HCC patients. Hypoalbuminemia seems to have very strong association to poor survival outcome in HCC patients, with survival-6 month (OR, 2.334; 95% CI, 1.364-3.995), Survival-2 year (OR, 2.343; 95% CI, 1.422-3.861), and survival-5 year (OR, 1.701; 95% CI, 1.056-2.739). The elevated counts of platelet are also thought to be related to poor survival outcome, with survival-6 month (OR, 0.996; 95% CI, 0.993-0.999), survival-2 year (OR, 0.996; 95% CI, 0.993-0.999) and survival-5 year (OR, 0.997; 95% CI, 0.994-1.000). The elevated INR was significantly associated with poor survival outcomes at 1 year (odds ratio [OR] 0.118, 95% confidence interval [CI] 0.016-0.876), 2 year (OR 0.123, 95% CI 0.016-0.964), and 5 year (OR 0.122, 95% CI 0.015-0.984). Age demonstrated a significant correlation with 5-year survival, with male patients showing a higher risk of HCC than females.

Conclusions: Moderate alcohol consumption significantly worsens survival outcomes in HCC patients in Eastern Taiwan. Key prognostic factors such as hypoalbuminemia, elevated platelet count, and prolonged INR are valuable in predicting patient survival. These findings can enhance clinical management and treatment strategies for HCC patients, particularly those with alcohol-related liver disease. Further research is needed to explore the mechanisms underlying these associations and to develop effective interventions.

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THE RISK STRATIFICATION OF LIVER FIBROSIS REMAINS MOSTLY UNCHANGED OVER SHORT-TERM FOLLOW-UP IN DIABETIC PATIENTS Yu-Ting Chen1, Miaw-Jene Liou2, Chih-Yiu Tsai2, Chia-Hung Lin2,3, Yi-Cheng Chen1,4,5 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 3 Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 4 College of Medicine, Chang Gung University, Taoyuan, Taiwan 5 School of Medicine, National Tsing Hua University, Taoyuan, Taiwan 1

多數糖尿病患者在短期追蹤期間肝纖維 化風險分層保持不變 陳昱廷1 劉妙真2 蔡之祐2 林嘉鴻2,3 陳益程1,4,5 1

林口長庚紀念醫院胃腸肝膽科 林口長庚紀念醫院內分泌暨新陳代謝科 3 長庚大學中醫學系 4 長庚大學醫學院 5 清華大學醫學系 2

Background: Type 2 diabetes is a recognized risk factor for metabolic dysfunction-associated fatty liver disease (MASLD) and significant or advanced liver fibrosis. High risk diabetic patients can be identified using fibrosis risk stratification with twostep noninvasive assessments of fibrosis 4 index (FIB-4) and liver stiffness measurement (LSM). The direction of non-high risk or high risk stratification during follow-up is not well-known.

Aims: To investigate the changes of risk stratification grades over short-term follow-up in diabetic patients.

Methods: Patients with baseline and subsequent (1-, 2- or 3-year) liver fibrosis assessments of FIB4 and LSM were retrieved from a cohort of type 2 diabetes in our previous study. The laboratory tests of albumin, AST, ALT, platelet, lipid and sugar profiles and LSM by vibration-controlled transient

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P.038 elastography (VCTE) were retrospectively reviewed using electrical medical records from 2015 April to 2022 March. Body mass index (BMI), insulin resistance (IR), FIB-4, and the history of chronic viral hepatitis and hypertension were recorded. Liver fibrosis risk stratification was performed using FIB4 and LSM. High risk subjects for significant fibrosis (stage ≥ 2) were determined by FIB-4 >2.67 or LSM >12 kPa according to the guidelines.

Results: Eight-three diabetic patients with serial assessments of FIB-4 and LSM were recruited. All patients had at least two assessments (including baseline) in three-year follow-up. There were 57 (68.7%) males, 37 (44.6%) HBV infection, 9 (10.8%) HCV infection and 43 (51.8%) hypertension. The median (IQR) age was 61 (54-67) years. The median levels of BMI, LSM and FIB-4 were 26.3 (23.6-29.7) kg/m², 6.6 (5.3-10.2) kPa, and 1.61 (1.10-2.38), respectively. High-risk stratification for significant fibrosis was identified in 17 (20.5%) patients. One, two-, and three-year assessment were available in 53, 60 and 49 patients, respectively. Among the 43 non-high risk and 10 high-risk patients, 36 and 7 remained the same risk stratification at one year (43 of 53, 81.1%), respectively. Of the 48 non-high risk and 12 high-risk patients, risk stratification unchanged in 45 and 8 at 2 year (53 of 60, 88.3%), respectively. Thirty-seven of 40 non-high-risk and 5 of 9 high-risk patients remained unchanged in risk stratification at three year (42 of 49, 85.7%). Overall, 65 of 83 (78.3%) patients remained unchanged in risk stratification grade in three-year follow-up. The age and BMI at baseline were not associated with the risk stratification changes (p = 0.125 and p = 0.818, respectively).

Conclusions: Most of the risk stratification grade of liver fibrosis remains unchanged in short-term follow-up. Longer follow-up period is needed to figure out the progression of liver fibrosis in diabetic patients.

THE USEFULNESS OF BLOOD GAMMA-GLUTAMYLTRANSFERASE IN SCREENING FOR UNHEALTHY ALCOHOL USE IN INDIGENOUS COMMUNITY Hui-Min Tien1, Hsiao-Chu Lien1, Pei-Lin Chou2, Yu-Ling Chen3,4, Nien-Tzu Hsu3,4, Sheng-Nan Lu3,4, Jing-Houng Wang3,4 Laiyi Primary Health Center, Kaohsiung, Taiwan Mudan Primary Health Center, Kaohsiung, Taiwan 3 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 4 Kaohsiung Research Association for the Control of the Liver Diseases 1 2

血液丙麩胺醯氨轉酸酶於原民社區篩檢 不健康飲酒的效用 田惠民1 連筱筑1 周培麟2 陳柚陵3,4 許念慈3,4 盧勝男3,4 王景弘3,4 1

來義鄉衛生所 牡丹鄉衛生所 3 高雄長庚紀念醫院胃腸肝膽科 4 高雄市肝病防治協會 2

Background: To facilitate early detection of patient with alcohol use problem for intervention, the public health approach begins with screening for unhealthy alcohol use (UAU).

Aims: This study aimed to evaluate the usefulness of blood gamma-glutamyltransferase (GGT) as screening tool of UAU in community.

Methods: Liver disease screening programs with blood tests including GGT, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) had been conducted at two indigenous communities between 2020 and 2021. At the time of screening, public health nurses in community health center performed alcohol use disorders identification test (AUDIT) questionnaires to identify UAU. With AUDIT score ≥8 and ≥4 as the criteria of UAU for male and female, the performances of GGT and aminotransferase in the detection of UAU were analyzed. We determined the cutoffs and their diagnostic validities.

Results: A total of 1755 residents (male/female:

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P.039 792/963, median age: 57 years) with available GGT, AST, ALT and ADUIT questionnaires were enrolled. The UAU prevalence was 7.4% and 46.1% respectively in these two communities. The prevalence of UAU was 26.2%, 26.3% and 26.1% in all, male and female. The median AST and ALT level were 24IU/L and 21IU/L. The prevalence of GGT ≥ upper normal limit (UNL) was 35.3%. The performance of GGT in detection of UAU was 0.767, 0.723 and 0.804 for all, male and female. However, the performance of AST and AST/ALT was 0.66 and 0.549 for all residents. With the cutoff of GGT ≥ UNL in the detection of UAU, the sensitivity, specificity, accuracy, positive and negative predictive value was 62.5%, 75.5%, 72.1%, 47.4% and 85.0%. The specificity and negative predictive value was 91% and 80% with the cutoff of GGT ≥2 times UNL. Conclusions: Blood GGT test was useful for screening of UAU in indigenous community. There were high specificity and negative predictive value with the cutoff of GGT ≥2 times UNL.

RELAPSE IN HBV CANCER PATIENTS RECEIVING CHEMOTHERAPY AFTER CESSATION OF NUCLEOS(T)IDES ANALOGUES INCREASED OVERALL MORTALITY RISK Chih-Wen Wang1,2, Chung-Feng Huang1, Ming-Lun Yeh1, Po-Cheng Liang1, Tyng-Yuan Jang1, Yu-Ju Wei1,3, Ming-Yen Hsieh1,3, Yi-Hung Lin1,2, Jee-Fu Huang1, Chia-Yen Dai1, Wan-Long Chuang1, Ming‐Lung Yu1 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 3 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan 1

停止使用核苷（酸）類似物後接受化療 的 B 型肝炎患者產生復發會增加整體死 亡率風險 王志文1,2 黃釧峰1 葉明倫1 梁博程1 張庭遠1 魏鈺儒1,3 謝明彥1,3 林宜竑1,2 黃志富1 戴嘉言1 莊萬龍1 余明隆1 1

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄市立小港醫院內科部 3 高雄市立大同醫院內科部 2

Background: Hepatitis B virus (HBV) reactivation is common in patients with solid organ or hematological cancer who received cytotoxic or immunosuppressive agents and the current guidelines recommended prophylactic nucleos(t) ides analogues (NUCs) therapy for HBV carriers before anticancer treatment.

Aims: We aimed to explore the risk factors associated with virological and clinical relapse, as well as their impact on overall mortality, in hepatitis B virus (HBV) infected patients receiving nucleos(t)ide analogues (NUCs) therapy prior to chemotherapy initiation.

Methods: From 2010 to 2020, we conducted a prospective cohort study involving patients with HBV infection undergoing cytotoxic chemotherapy.

We utilized the Kaplan-Meier method and Cox proportional hazard regression models to assess risk factors.

Results: We observed that TDF or TAF (HR: 2.16, 95%

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P.040 CI 1.06–4.41; p = 0.034), anthracycline (HR: 1.73, 95% CI 1.10–2.73; p = 0.018), baseline HBV DNA (HR: 1.55, 95% CI 1.33–1.81; p < 0.001), and end-of-treatment HBsAg titer >100 IU/mL (HR: 7.81, 95% CI 1.94–31.51; p = 0.004) were associated with increased risk of virological relapse. Additionally, TDF or TAF (HR: 4.91, 95% CI 1.45–16.64; p = 0.011), baseline HBV DNA (HR: 1.48, 95% CI 1.10–1.99; p = 0.009), and end-of-treatment HBsAg titer >100 IU/mL (HR: 6.09, 95% CI 0.95-38.87; p = 0.056) were associated with increased risk of clinical relapse. Furthermore, we found that virological relapse (HR: 3.32, 95% CI 1.33– 8.32; p = 0.010) and clinical relapse (HR: 3.59, 95% CI 1.47–8.80; p = 0.005) significantly correlated with allcause mortality in HBV patients receiving cytotoxic chemotherapy with prophylactic NUCs therapy.

Conclusions: The risk of virological and clinical relapse was linked to baseline HBV DNA, endof-treatment HBsAg levels, and TDF or TAF for prophylaxis; additionally, experiencing relapse heightens the risk of all-cause mortality. Further research is warranted to explore potential strategies for preventing virological and clinical relapse in high-risk patients.

HEPATITIS C VIRUS INFECTION ASSOCIATED WITH CORONARY AND THORACIC AORTIC ATHEROSCLEROSIS Chih-Wen Wang1,2, Chung-Feng Huang1, Ming-Lun Yeh1, Po-Cheng Liang1, Tyng-Yuan Jang1, Yu-Ju Wei1,3, Ming-Yen Hsieh1,3, Yi-Hung Lin1,2, Jee-Fu Huang1, Chia-Yen Dai1, Wan-Long Chuang1, Ming‐Lung Yu1 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 3 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan 1

C 型肝炎病毒感染與冠狀動脈和胸主動脈 粥樣硬化有關 王志文1,2 黃釧峰1 葉明倫1 梁博程1 張庭遠1 魏鈺儒1,3 謝明彥1,3 林宜竑1,2 黃志富1 戴嘉言1 莊萬龍1 余明隆1 1

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄市立小港醫院內科部 3 高雄市立大同醫院內科部 2

Background: Coronary and thoracic aortic calcification was associated with stroke, coronary heart, and peripheral vascular disease. Hepatitis C virus (HCV) infection is significantly associated with insulin resistance, diabetes mellitus and hepatic steatosis.

Aims: We aimed to investigate the relationship between HCV infection and coronary, thoracic aortic atherosclerosis.

Methods: Calcification was detected by chest computed tomography and defined as any Agatston score greater than zero. Metabolic syndrome was based on the modified Adult Treatment Panel III criteria. Fibrosis-4 (FIB-4) and AST-to-platelet ratio (APRI) was calculated. The anti-HCV signal-to-cutoff (S/CO) ratio was determined by the third generation ELISA kit. Atherosclerosis risk was estimated by using multiple logistic regression modeling.

Results: Being positive for both metabolic syndrome and HCV infection (OR = 2.65, 95% CI: 1.26–5.59, p = 0.007), negative for metabolic syndrome and positive

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P.041 for HCV infection (OR = 2.75, 95% CI: 1.48–5.30, p = 0.001), and positive for metabolic syndrome and negative for HCV infection (OR = 2.42, 95% CI: 1.92– 3.07, p < 0.001) were associated with atherosclerosis compared with being negative for both metabolic syndrome and HCV infection (Ptrend < 0.001). HCV infection with liver fibrosis (HCVFIB4 > 1.4; OR = 2.16, 95% CI: 1.22–3.82, p = 0.008), or (HCVAPRI > 0.5; OR = 3.40, 95% CI: 1.28–9.06, p = 0.014) and elevated anti-HCV S/CO ratio (anti-HCVS/CO > 10.0; OR = 1.72, 95% CI: 1.01–2.93, p = 0.045) was associated with atherosclerosis.

Conclusions: HCV infection with metabolic syndrome, liver fibrosis and elevated anti-HCV S/CO ratio was associated with atherosclerosis.

IMPACT OF DIABETES MELLITUS ON RECURRENCE PATTERN AND SURVIVAL IN PATIENTS WITH HBV-RELATED HEPATOCELLULAR CARCINOMA UNDERGOING THERMAL ABLATION Kuo-Cheng Wu1,2, I-Cheng Lee1,3, Chien-An Liu4,5, Nai-Chi Chiu3,5, Shao-Jung Hsu1,3, Pei-Chang Lee1,3, Chi-Jung Wu1,3,4, Chen-Ta Chi1,3,4, Jiing-Chyuan Luo1,3, Ming-Chih Hou1,3, Yi-Hsiang Huang1,3,4,6 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan 3 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan 6 Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan 1

糖尿病對 B 型肝炎相關肝癌接受熱消融 術後復發模式和存活的影響 胡果正1,2 李懿宬1,3 柳建安4,5 邱乃祈3,5 許劭榮1,3 李沛璋1,3 吳啟榮1,3,4 齊振達1,3,4 羅景全1,3 侯明志1,3 黃怡翔1,3,4,6 1

臺北榮民總醫院胃腸肝膽科 衛生福利部基隆醫院胃腸肝膽科 3 國立陽明交通大學醫學系 4 國立陽明交通大學臨床醫學研究所 5 臺北榮民總醫院放射線部 6 臺北榮民總醫院健康管理中心 2

Background: Diabetes mellitus (DM) negatively impacts patients with chronic hepatitis B, but its role in those with HBV-related hepatocellular carcinoma (HCC) undergoing thermal ablation remains unclear.

Aims: This study aims to evaluate the influence of DM on recurrence patterns and overall survival (OS) among patients with HBV-related HCC undergoing ablation.

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P.042 Methods: We retrospectively enrolled 372 patients receiving thermal ablation for HBV-related HCC, including 96 (25.8%) patients with DM. Factors associated with local tumor progression (LTP), distant recurrence, and OS were analyzed. The prognostic value of DM in IMbrave050-defined highrisk population was validated.

Results: DM did not correlate with LTP, whereas patients with DM had significantly higher risk of distant recurrence (median time to recurrence 23.7 versus 46.2 months, p = 0.032), poorer OS (median OS 75.6 versus 106 months, p = 0.011), and poorer post-recurrence survival (70.7 versus 106 months, p = 0.009). In multivariate analysis, DM (hazard ratio (HR) = 1.466, p = 0.012), FIB-4 score, multiple tumors, and AFP level were independent predictors of distant recurrence, while DM (HR = 1.424, p = 0.028), ALBI score, tumor size, AFP and creatinine levels were significantly associated with OS. A DM-based risk score effectively discriminated the risk of distant recurrence. The IMbrave050 criteria could stratify the risk of LTP but not distant recurrence. DM status further discriminated the risk of distant recurrence and mortality in the IMbrave050-defined high-risk population.

Conclusions: Patients with DM had an increased risk of distant recurrence and mortality after thermal ablation for HBV-related HCC, highlighting the importance of increasing awareness of DM and implementing rigorous post-ablation monitoring for diabetic HCC patients.

CHARACTERISTICS AND DYNAMICS OF HEPATITIS D VIRUS IN HEPATITIS B AND C DUALLY INFECTED PATIENTS AFTER HEPATITIS C ANTIVIRAL THERAPY Ming-Lun Yeh1,2, Po-Cheng Liang1, Po-Yau Hsu1,2, Tyng-Yuan Jang1,2, Yu-Ju Wei1,2, Chung-Feng Huang1,2, Jee-Fu Huang1,2, Chia-Yen Dai1,2, Wan-Long Chuang1,2, Ming-Lung Yu1,2 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 1

B 型 C 型肝炎合併感染病患接受 C 型肝 炎抗病毒藥物治療後 D 型肝炎病毒表徵 及病毒動力學 葉明倫1,2 梁博程1 許博堯1,2 張庭遠1,2 魏鈺儒1,2 黃釧峰1,2 黃志富1,2 戴嘉言1,2 莊萬龍1,2 余明隆1,2 1 2

高雄醫學大學附設醫院肝膽胰內科 高雄醫學大學醫學系

Background: Triple infection of hepatitis B (HBV), hepatitis C (HCV) and hepatitis D virus (HDV) was seldom investigated.

Aims: We aimed to investigate the HDV’s characteristics and viral dynamics in triple viruses infected patients.

Methods: Four hundred and eleven HBV and HCV dually infected patients who received interferon (IFN) (n = 150) or direct acting antivirals (DAA) (n = 261) therapy for HCV were enrolled. HDV antibody (Anti-HDV) and HDV RNA (in patients with positive Anti-HDV) were measured before and after treatment. Another 2310 HBV mono-infected patients were included as the control group. The endpoints included HDV’s prevalence, characters, and viral dynamics after HCV antiviral therapy.

Results: Forty-four (10.7%) of the 411 HBV/HCV dual infected patients tested positive for AntiHDV, and the Anti-HDV positivity rate was 4.7% of the IFN cohort, 14.2% of the DAA cohort. The HDV RNA positivity rate was 38.6% in Anti-HDV positive patients with a median HDV RNA level of 4.1 log10 copies/mL. HBV/HCV dual-infected patients had a

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P.043 non-statistically higher rate of positive Anti-HDV (9.5% vs. 5.4%, p = 0.147) as compared to HBV monoinfected patients after propensity score matching.

We further found patients of positive Anti-HDV were more male gender, had a history of injecting drugs, and HCV genotype 6. Patients who had a history of injecting drugs were at a significantly higher risk of positive Anti-HDV (51.1% vs. 6.5%, p < 0.001), but similar risk of positive HDV RNA (30.4% vs. 35.7%, p = 1.000). In IFN cohort, there was no difference of characters between patients of positive and negative Anti-HDV. However, a lower rate of detectable HBV DNA was observed in DAA cohort patients of positive Anti-HDV (37.8% vs. 57.5%, p = 0.032). Regarding the viral dynamics, no significantly changes of positive HDV RNA and viral load were found in DAA cohort patients. However, a decline of HDV RNA at end of treatment but rebound later was observed in IFN cohort patients.

Conclusions: HDV coinfection was not uncommon in HBV/HCV dual-infected patients, especially highrisk patients. DAA therapy did not affect the HDV viral dynamics. Further studies remain necessary to identify the viral interactions.

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DEVELOPING A PERSONALIZED HCC TREATMENT STRATEGY BY AN EX VIVO CANCER CELL MODEL Ming-Lun Yeh1,2, Yi-Shan Tsai1, Chung-Feng Huang1,2, Jee-Fu Huang1,2, Chia-Yen Dai1,2, Wan-Long Chuang1,2, Ming-Lung Yu1,2 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 1

以一體外腫瘤細胞模式發展個人化肝癌 治療策略 葉明倫1,2 蔡易珊1 黃釧峰1,2 黃志富1,2 戴嘉言1,2 莊萬龍1,2 余明隆1,2 1 2

高雄醫學大學附設醫院肝膽胰內科 高雄醫學大學醫學院醫學系

Background: Hepatocellular carcinoma (HCC) remained one of the leading cancer deaths in Taiwan.

The delayed diagnosis and lack of an effective treatment resulted in the poor survival of patients with advanced HCC. In addition, there was also no effective biomarker to predict treatment response to current immune and target therapies.

Aims: We aim to develop a personalized treatment strategy for HCC patient.

Methods: We had developed an ex vivo primary hepatoma cell culture model for HCC patients who received ultrasound guide fine needle aspiration.

The method to harvest and culture primary hepatoma cells had been reported previously.

Primary hepatoma cells were cultured with 10% FBS/ DMEM medium. The culture medium was replaced every 3-4 days. The clinical profiles including patients and tumor characteristics, treatment, and outcomes were collected, too.

Results: We observed that the different cell growth pattern correlated with the tumor size, stage, and overall survival. After a period of cell growth, three types of tumor cell morphology, epithelial cell, cancer associated fibroblast (CAF), and mixed cell types, were identified. We further found CAF type hepatoma cells exhibited higher gene expression levels of IL6, ACTA2, PDGFRB, MMP14, and THY1 than epithelial cell type. We found a lower survival

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P.044 in HCC patients of high PDFGRB, THY1, and CCNB1 expression in TCGA-LIHC database. And HCC tissues with high ACTA2 expression (CAF type) showed higher CTLA4, CXCL12, CCL2, CCL5, IL6, as well as Treg (TNFRSF18), NK cells (LILRB1, KLRK1), TAM (MRC1, MSR1) than HCC with low ACTA2 expression. The properties and immunomodulatory capabilities of CAF type implicated CAF as a potential biomarker for immune and target therapy. We further performed the three-dimensional tumor spheroid assay and identified its effect in the evaluation of response to HCC target therapy individually.

Conclusions: Our ex vivo cancer cell model can be potentially used as a personalized treatment strategy for HCC patients. Further investigation is needed to confirm our findings.

FROM LIVER TO PANCREAS: WHY DOES HEPATOCELLULAR CARCINOMA CAUSE ACUTE PANCREATITIS? – A CASE REPORT AND MINI-REVIEW Wei-Liang Lin, Po-Cheng Liang, Ming-Lun Yeh, Chung-Feng Huang, Zu-Yau Lin, Jee-Fu Huang, Ming-Lung Yu, Wan-Long Chuang, Chia-Yen Dai Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

從肝到胰：為何肝細胞癌會引起急性胰 腺炎？ — 病例報告與迷你文獻綜述 林威良 梁博程 葉明倫 黃釧峰 林子堯 黃志富 余明隆 莊萬龍 戴嘉言 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: Acute pancreatitis (AP) is a common cause of emergency admissions and hospitalizations. Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer. Previous literature has primarily discussed how HCC may lead to AP by invading distant bile ducts or as a complication of HCC treatments such as transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), or targeted therapies.

Aims: This case report is unique in describing AP induced by hypercalcemia resulting from HCC metastasis to the bone.

Methods: We present the detailed clinical course of this case and explore the mechanisms by which hypercalcemia induces pancreatitis. A literature review examines the clinical features of other malignancies that cause hypercalcemia-induced pancreatitis (HCIP). Additionally, we summarize previous cases that have reported an association between HCC and pancreatitis.

Results: The review indicates that malignancies can lead to hypercalcemia through various mechanisms, such as parathyroid hormone-related protein (PTHrP) secretion or osteolytic activity. Because HCIP caused by malignancy is relatively rare in liver cancer, the treatment of such pancreatitis should include not only supportive care with hydration but also aggressive calcium-lowering therapy. This report emphasizes the importance of recognizing and managing these conditions in patients with advanced HCC.

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P.045 Conclusions: HCC can cause pancreatitis through direct tumor invasion, treatment complications, or, as demonstrated in this case, bone metastasis leading to hypercalcemia. It is crucial to monitor for bone metastasis and hypercalcemia in advanced HCC patients. Future research should investigate the clinical presentation and prognosis of pancreatitis caused by different cancers, the efficacy of various hypocalcemic agents in preventing pancreatitis complications, and risk factors for pancreatitis in patients with bone metastases from various cancers.

THE INFLUENCES OF 5-HYDROXYTRYPTAMINE RECEPTOR RELEVANT AGENTS ON PORTAL HYPERTENSION-RELATED DERANGEMENTS IN CIRRHOTIC RATS Chia-Jui Tsai1, Shao-Jung Hsu1,2, Hui-Chun Huang1,2, Ming-Chih Hou1,2, Fa-Yauh Lee1,2 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan 2 Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

5-Hydroxytryptamine（5-HT）接受器相 關物質對肝硬化大鼠之門脈高壓相關表 現的效應 蔡佳叡1 許劭榮1,2 黃惠君1,2 侯明志1,2 李發耀1,2 1 2

臺北榮民總醫院胃腸肝膽科 國立陽明交通大學醫學系

Background: Liver cirrhosis and portal hypertension is a dreadful illness in Taiwan. The major presentations include liver fibrogenesis, pathological abdominal angiogenesis and formation of portosystemic collateral vessels. They may result in severe complications such as gastroesophageal variceal hemorrhage and hepatic encephalopathy. Therefore, it would be beneficial for cirrhotic patients if both abnormal angiogenesis and severity of shunting can be alleviated. Serotonin (5-hydroxytryptamine, 5-HT) is secreted from gut enterochromaffin cell and responsible for many physiological reactions. The recent studies found that it influences angiogenesis and vascular tone. The mechanism includes the modulation of Akt, ERK, MMP, nitric oxide (NO), and vascular endothelial growth factor (VEGF). However, the relevant actions in liver cirrhosis and portal hypertension have not been surveyed.

Aims: This study investigated the influences of serotonin and different serotonin receptor antagonists on the derangement of liver cirrhosis and portal hypertension.

Methods: Common bile duct ligation (BDL) was performed to induce liver cirrhosis in SpragueDawley rats, sham-operated rats were surgical controls. BDL rats received vehicle, serotonin

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P.046 precursor, HT receptor 1 (HTR1) antagonist or HTR2 antagonist since the 15th day after BDL for 2 weeks. On the 29th day after BDL, experiments like hemodynamic measurement, portosystemic shunting degree analysis and immunofluorescent study for the mesenteric vascular density were performed by using independent groups were performed.

Results: HTR2 antagonist was found to increase systemic vascular resistance and decrease cardiac index. It ameliorated splanchnic abnormal high blood flow. It is worth noted that 5-HT attenuated collateral shunting. HTR1 antagonist or HTR2 antagonist further decreased shunting severity. In addition, HTR1 antagonist significantly decreased mesenteric angiogenesis while HTR2 antagonist had no effect on it. Mesentery protein expression were evaluated. HTR1 antagonist or HTR2 antagonist treatment significantly attenuated peNOS protein expression. On the other hand, HTR2 antagonist upregulated pAkt or pErk expression compared to vehicle treated BDL group.

Conclusions: In conclusion, 5-HT is a possible treatment target in liver cirrhosis and portal hypertension. Treatment based on 5-HT and related receptors in cirrhotic patients deserves further survey.

THE ASSOCIATED BETWEEN ALDH2 RS671 POLYMORPHISM AND CLINICAL PROGNOSIS IN ALCOHOLRELATED HEPATOCELLULAR CARCINOMA AFTER CURATIVE RESECTION I-Hsun Lin1, Wen-Lung Wang1,2, Pei-Min Hsieh3,4, Yaw-Sen Chen3, Yu-Wei Huang5,6, Chih-Wen Lin1,2 Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 3 Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 4 Department of Surgery, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan 5 Department of Anesthesiology, Emergency and Critical Care Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 6 Department of Nursing, Fooyin University, Kaohsiung, Taiwan 1

ALDH2 rs671 基因多型性與接受根治性 切除後的酒精引起的肝癌的臨床預後的 相關性 林逸勳1 王文𤦎1,2 謝沛民3,4 陳耀森3 黃煜為5,6 林志文1,2 1

義大醫院胃腸肝膽科 義守大學醫學系 3 義大醫院一般外科 4 義大大昌醫院一般外科 5 義大醫院麻醉部及加護病房中心 6 輔英大學護理部 2

Background: Whether ALDH2 rs671 polymorphism predicts clinical prognosis in alcoholic liver disease (ALD)-related hepatocellular carcinoma (HCC) after hepatectomy remains unclear.

Aims: This study aims to investigate the association between ALDH2 rs671 polymorphism and HCC recurrence and mortality in patients with ALDrelated HCC who underwent hepatectomy. We also explored the risk factors for HCC recurrence and mortality in this population of patients.

Methods: This prospective cohort study enrolled 238 ALD-related HCC patients underwent hepatectomy

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P.047 from 2011 to 2022 at the E-Da Hospital, I-Shou University. Data analyses were finalized on October, 2023. Alcoholism was defined as consuming over 20 g of ethanol each day for at least 5 years. Patients with HBsAg-positive or/and HCV-positive status were excluded. ALDH2 rs671 polymorphism was analyzed. The endpoint was HCC recurrence and overall mortality.

Results: Of the 238 patients enrolled, 196 (82.4%) were men, and the mean (SD) age was 62.3 (10.2) years. HCC recurrence occurred in 70 patients, and 64 patients died. ALDH2 rs671 polymorphism was significantly associated with HCC recurrence and mortality. The 10-year cumulative HCC recurrence and mortality rates were significantly higher in patients with the ALDH2 rs671 genotype GA/AA relative to those with the ALDH2 rs671 genotype GG. In the Cox proportional analyses, the ALDH2 rs671 genotypes GA/AA (hazard ratio [HR]: 2.66, 95% confidence interval [CI]: 1.59-4.43, P < 0.001) and AST ≥ 40 IU/L (HR: 1.93, 95% CI: 1.18-3.17, P = 0.009) were significantly associated with increased HCC recurrence. Furthermore, the ALDH2 rs671 genotype GA/AA (HR: 2.02, 95% CI: 1.17-3.49, P = 0.012) and age ≥ 65 years (HR: 1.67, 95% CI: 1.01-2.78, P = 0.048) were significantly associated with increased mortality.

Conclusions: The ALDH2 rs671 genotype GA/AA is significantly associated with unfavorable clinical prognosis in ALD-related HCC after hepatectomy.

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AGE ISN’T JUST A NUMBER: EXPLORING TREATMENT OUTCOMES ACROSS GENERATIONAL DIVIDES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC) Pei-Lin Chuang1,2, Yao-Kuang Wang1,2,3, I-Chen Wu1,2,3 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 3 Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 1

年齡不僅是一個數字：探索食道鱗狀細 胞癌跨年齡層的治療結果 莊沛霖1,2 王耀廣1,2,3 吳宜珍1,2,3 1

高雄醫學大學附設中和紀念醫院內科部 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 2

Background: Esophageal squamous cell carcinoma (ESCC) predominantly occurs in middle-aged and elderly people. Chemoradiotherapy (CRT) and esophagectomy are the mainstay treatment for ESCC. Numerous patients aged 65 or older are traditionally excluded from clinical trials and receive sub-standard treatment, considering the increased comorbidities associated with age. Management of the elderly became therapeutically challenging.

Aims: The aim of this study was to investigate the prognosis in elderly patients with ESCC. Methods: A retrospective study of 474 patients with pathologically confirmed ESCC in the divisions of Gastroenterology at Kaohsiung Medical University Hospital between 2011 and 2022 was conducted.

Patients were divided into 3 age groups (<50, 50–65, and >65 years). We analyzed the association of age groups with clinicopathologic factors and 2 quality of life questionnaires of the European Organization for Research and Treatment of Cancer (EORTC).

The impact of the factors on overall survival and progression-free survival were analyzed using the IBM SPSS Statistics 25.

Results: Among the 474 cases, 110 (23.2%) were older than 65 years old. Compared with other

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P.048 two groups, group >65 years was exposed to less risk factors including alcohol, smoking and betel nuts use (p < 0.001) and has no different Eastern Cooperative Oncology Group (ECOG) (p = 0.46) or quality of life status (p = 0.41 and 0.23, respectively), however, receiving less standard treatment (82.4% vs. 90% vs. 80%; p = 0.02, respectively). There was no significant difference in overall survival (p = 0.32) and progression-free survival rate (p = 0.08) between the 3 age groups.

Conclusions: Chronological age was not predictive of poorer outcomes in patients with ESCC.

SERIAL CHANGES IN STEATOTIC LIVER DISEASE (SLD) AFTER SLEEVE GASTRECTOMY (SG) AND ITS ASSOCIATION WITH ABDOMINAL ADIPOSITY Bing-Jie Lee1, Chung-Yi Yang2, Jian-Han Chen3, Shiu-Feng Huang4, Ming-Lung Yu5, Chi-Ming Tai1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 2 Department of Medical imaging, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan 3 Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan 4 Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan 5 Center of Hepatitis Research, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan 1

袖狀胃切除術後脂肪肝病的系列變化及 其與腹部脂肪的關聯 呂秉杰1 楊中宜2 陳建翰3 黃秀芬4 余明隆5 戴啟明1 1

義大醫療財團法人義大醫院胃腸肝膽科 義大醫療財團法人義大醫院醫學影像科 3 義大醫療財團法人義大醫院一般外科 4 國家衛生研究院分子與基因醫學研究所 5 高雄醫學大學液態生物檢體暨世代研究中心和醫學 院肝炎研究中心 2

Background: Steatotic liver disease (SLD) is a new nomenclature for fatty liver disease.

Aims: We aimed to evaluate the serial changes in SLD and abdominal adiposity following sleeve gastrectomy (SG) in two SLD subgroups.

Methods: Patients who underwent SG and intraoperative liver biopsy were enrolled in this prospective study. Magnetic resonance imaging (MRI) was performed for the assessment of liver fat fraction (LFF), visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area. Hepatic steatosis was quantified by measuring the LFF. The fibrosis-4 index (FIB-4) was used to estimate the severity of liver fibrosis. LFF, VAT area, VAT area, and FIB-4 were obtained at baseline and at the 6th and

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P.049 12th months after SG. Results: Seventy-six SLD patients were enrolled, including patients with metabolic dysfunctionassociated steatotic liver disease (MASLD) (n = 67) and patients with coexisting MASLD and other liver diseases (n = 9). Twelve months after SG, all MRI measurements significantly improved (all P < 0.001) with no significant differences between the two groups. The FIB-4 score ​​after SG was significantly greater than the baseline FIB-4 score (0.61 vs. 0.71, P = 0.012), and 68.2% of patients had increased FIB4 scores. The median LFF decreased from 17.3% at baseline to 4.2% and 3.7% at the 6th and 12th postoperative months, respectively, and complete resolution of steatosis was achieved in 76.1% and 97.8% of patients at the 6th and 12th postoperative months, respectively. Changes in LFF did not significantly correlate with changes in VAT (P = 0.192) or SAT area (P = 0.055).

Conclusions: SG resulted in a significant decrease in body mass index and abdominal adiposity in SLD patients, but two-thirds of patients had increased FIB-4 scores. Hepatic steatosis resolved in almost all patients 12 months after SG, which was not correlated with changes in VAT or SAT area.

CIRCULATING LET-7 PREDICTS HEPATIC FIBROGENESIS OF 12-MONTH POST-NUCLEOS(T)IDE ANALOG TREATMENT IN PATIENTS WITH HEPATITIS B VIRUS Yi-ShanTsai, Po-Cheng Liang, Yi-Hung Lin, Tyng-Yuan Jang, Yu-Ju Wei, Po-Han Chen, Jia-Ning Hsu, Meng-Hsuan Hsieh, Ming-Yen Hsieh, Chih-Wen Wang, Zu-Yau Lin, Ming-Lun Yeh, Chung-Feng Huang, Jee-Fu Huang, Ming-Lung Yu, Wan-Long Chuang, Chia-Yen Dai Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

血中 Let-7 可預測 B 型肝炎病毒患者接受 核（酸）類似物治療 12 個月後發生纖維 化 蔡易珊 梁博程 林宜竑 張庭遠 魏鈺儒 諶柏翰 許家寧 謝孟軒 謝明彥 王志文 林子堯 葉明倫 黃釧峰 黃志富 余明隆 莊萬龍 戴嘉言 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: Chronic hepatitis B virus (HBV) infection is associated with potential complications of liver cirrhosis and hepatocellular carcinoma. To date, there are no effective and noninvasive clinical markers that can predict the risk of liver fibrosis early and accurately in chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogs (NAs).

Aims: This study aimed to investigate the association of circulating let-7b/c/g levels with the severity of hepatic fibrosis with a FIB-4 index of 1.5 to 2.9 in CHB patients.

Methods: We conducted a retrospective longitudinal study in patients with CHB after 6 months of antiNAs therapy to investigate whether serum let-7b/ c/g levels can be monitored as an early biomarker for liver fibrogenesis based on multivariate logistic regression analyses. We also used the hepatic stellate cell line LX-2 treated with transforming growth factor-β (TGF-β) to evaluate the suppression effect of let-7b/c/g on hepatic fibrogenesis.

Results: The study showed that circulating let-7b/ c/g could predict 12 months of antiviral treatment for HBV-related cirrhosis (FIB-4 index ≥2.9) at baseline

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P.050 and was significantly negatively correlated with the FIB-4 score. Moreover, let-7b/c/g could directly target the TGF-βR1- 3’ untranslated region (3’UTR) and inhibit TGF-β induced p-SMAD2 phosphorylation to reduce α-smooth muscle actin levels, a fibrogenesis marker in LX-2 cells.

Conclusions: These results confirm that let-7b/c/g could be a biomarker for monitoring HBV-induced fibrogenesis.

COMPARATIVE EVALUATION OF PEDIATRIC FATTY LIVER DISEASE CRITERIA: MASLD, ESPGHAN, NASPGHAN, AND NAFLD IN TAIWAN Chih-Wen Wang1,2, Po-Chin Huang3, Chia‐Yen Dai1, Jee‐Fu Huang1, Ming‐Lung Yu1 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 3 National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan 1

台灣兒童脂肪肝病標準的比較評估： MASLD、ESPGHAN、NASPGHAN 和 NAFLD 王志文1,2 黃柏菁3 戴嘉言1 黃志富1 余明隆1 1

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄市立小港醫院內科部 3 國家衛生研究院國家環境醫學研究所 2

Background: The currently recommended screening test for pediatric fatty liver disease was suggested by The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The NASPGHAN advises alanine aminotransferase (ALT), with recommended threshold values set at 22 U/L for girls and 26 U/L for boys. The ESPGHAN recommends the combined use of ALT and liver ultrasonography as indicators for fatty liver disease.

Aims: We aim to compare the criteria of fatty liver in children including MASLD, ESPGHAN, NASPGHAN, and NAFLD. Methods: We utilized a well-established cohort, the Taiwan Petrochemical Complex Cohort for Children (TPE3C), consisting of school-aged children (6–13 years old) central Taiwan. A total of 343 children were selected from five elementary schools. Each student was randomly matched by sex using their school identification number. The participants were students in grades 1–6 who had resided locally for at least one year and were at least 6 years old.

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P.051 Ultrasonography was performed for each child.

Results: In our dataset, it was observed that NAFLD exhibited significantly lower levels of cardiometabolic risk factors (HOMA-IR, BMI-SDS, triglycerides) compared to MASLD, ESPGHAN, and NAPGHAN. Nevertheless, among children with obesity, the distinctions in levels of cardiometabolic risk factors among NAFLD, MASLD, ESPGHAN, and NASPGHAN became statistically non-significant.

Furthermore, it was noted that 9 (30.0%) children in ESPGHAN, 7 (28.0%) children in NASPGHAN and 48 (61.5%) children in NAFLD had zero cardiometabolic risk factor. Furthermore, our findings revealed that NASPGHAN exhibited significantly higher levels of AST (p = 0.003) and ALT (p = 0.004) compared to MASLD Conclusions: It’s noteworthy that NASPGHAN and ESPGHAN primarily emphasize liver function in the screening of fatty liver disease, while MASLD concentrates on liver steatosis and cardiometabolic risk factors. The variations in methods used to categorize pediatric fatty liver disease raise the question of whether cardiometabolic risk factors, liver inflammation, or fibrosis holds greater significance for the long-term outcomes of children.

Further studies are recommended to identify the most suitable pediatric label.

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TO INVESTIGATE THE EFFECT OF ADIPOCYTES ON LIVER FIBROSIS TO METABOLIC ASSOCIATED FATTY LIVER DISEASE (MAFLD) Ting-Wei Chang1, Chia-Yen Dai2,3, Jee-Fu Huang2,3, Wan-Long Chuang2, Ming-Lung Yu2, Shu-Chi Wang1 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 3 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan 1

研究脂肪細胞對肝纖維化及代謝相關性 脂肪肝病（MAFLD）的影響 張庭瑋1 戴嘉言2,3 黃志富2,3 莊萬龍2 余明隆2 王述綺1 1

高雄醫學大學醫學檢驗暨生物技術學系 高雄醫學大學附設中和紀念醫院肝膽胰內科 3 高雄市立小港醫院內科部 2

Background: With the changes in today’s dietary habits and the increasing popularity of Western diets, obesity has gradually become one of the prominent issues in medical treatment nowadays. Among these issues, metabolic fatty liver disease (MAFLD) stands out as a liver disease closely associated with obesity. Previous literature has highlighted that inflammation of adipose tissues and elevated levels of free fatty acids in the blood increase the risk of metabolic diseases accompanied by inflammation.

Therefore, understanding adipocyte biosynthesis and its regulatory mechanisms on liver fibrosis may enhance the treatment of MAFLD. Aims: We used different free fatty acids: triglyceride (TG), trans-oleic acid (EA) and oleic acid (OA)/ palmitic acid (PA) to induce the differentiation of 3T3-L1 white adipocytes into brown adipocytes. Oil red staining was used to confirm the degree of oil droplet accumulation in adipocytes, and qPCR was used to identify the key genes that regulate this transformation.

Methods: In this study, we differentiated 3T3-L1 adipocytes. We used different oils: Triglyceride, Elaidic acid, and OA/PA to induce the transformation

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P.052 of white adipocytes into brown adipocytes. Key factors regulating this transformation were identified using q-PCR and oil red stain.

Results: We induced adipocyte differentiation from white adipocytes to brown adipocytes for 3 days. We utilized insulin at 10 μg/ml, IBMX (3-Isobutyl-1-methylxanthine) at 0.5 mM, and DEX (Dexamethasone) at 1 μM to differentiate white adipocytes. Additionally, for the differentiation of brown adipocytes, we supplemented the above with Triglyceride (TG) at 100 μg/ml, Eelaidic acid (EA) at 50 μM, and a mixture of oleic acid (OA) and palmitic acid (PA) at 100 μM. Our findings indicate that CTBP1 is the most significant gene in distinguishing white adipocytes treated with TG, while TCF21 is prominent in those treated with EA and those treated with OA/PA. Furthermore, in distinguishing brown adipocytes, SMAD3 stands out in those treated with TG, while LHX8 is notable in those treated with EA and OA/PA. To further investigate, we treated AML12 cells with supernatant from differentiated 3T3-L1 cells, supplemented with TG and OA/PA condition media, to validate the factors associated with liver fibrosis using q-PCR. Conclusions: Our results may highlight significant critical points and elucidate the complexities of these processes, aiding in a better understanding of the metabolic derangements resulting from their imbalance.

SARCOPENIA AND MYOSTEATOSIS ARE ASSOCIATED WITH SURVIVAL IN PATIENTS RECEIVING LENVATINIB FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA Pei-Jui Luo1, Kai-I Chuang2, Cheng-Fu Ni2, Wei-Yu Kao3, Chih-Horng Wu1 Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan 2 Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan 1

肌少症和肌肉脂肪變性與接受樂威瑪治 療不可切除肝細胞癌患者的存活有關 羅培瑞1 莊凱壹2 倪承賦2 高偉育3 吳志宏1 1

台大醫院影像醫學部 臺北醫學大學附設醫院影像醫學部 3 臺北醫學大學附設醫院內消化內科 2

Background: The association between sarcopenia and myosteatosis and mortality in Lenvatinib (LEN)treated hepatocellular carcinoma (HCC) patients is lacking.

Aims: To investigate the association of skeletal muscle quantity and quality with survival outcomes among patients with advanced HCC treated with LEN. Methods: In this retrospective study, LEN-treated HCC patients were enrolled. Sarcopenia and myosteatosis were evaluated on pretreatment computed tomography (CT) at the L3 level by skeletal muscle index and mean muscle attenuation. Low skeletal muscle quantity (LSMT) was determined according to the index, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined based on the mean Hounsfield unit (HU) and used predefined cutoff values. The log-rank test and the Cox proportional hazards model were used to compare overall survival (OS) and progressionfree survival (PFS).

Results: A total of 82 patients were included.

Patients with LSMT exhibited significantly poorer PFS (p = 0.003) and OS (p = 0.010) than patients without LSMT. Patients with myosteatosis exhibited

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P.053 significantly poorer PFS (p = 0.013) and OS (p < 0.001) than patients without myosteatosis. In multivariate analysis adjusting for tumor extent and liver function reserve, LSMT remained an independent predictor of poor PFS (p = 0.011) and OS (p = 0.027); myosteatosis remained an independent predictor of poor PFS (p = 0.014) and OS (p = 0.001). Patient mortality was significantly higher in the group with two or more risk factors than in the group with fewer risk factors.

Conclusions: Low skeletal muscle mass and myosteatosis are independent prognostic factors in patients who received LEN for advanced HCC and may exhibit synergistic effects.

THE OBESITY-RELATED GENETIC MUTATIONS ON NONALCOHOLIC FATTY LIVER DISEASE Wei-Chen Chiang1, Yen-Yu Chen2, Jee-Fu Huang3,4,5,6, Wan-Long Chuang4,5,6, Ming-Lung Yu4,5,7,8, Shu-Chi Wang1,3,8,9,10 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan; 2School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 7School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 8Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan; 9Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 10Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 1

非酒精性脂肪肝與肥胖相關的基因突變 江為宸1 陳彥渝2 黃志富3,4,5,6 莊萬龍4,5,6 余明隆4,5,7,8 王述綺1,3,8,9,10 1

高雄醫學大學醫學檢驗生物技術系；2 高雄醫學大 學醫學院；3 高雄醫學大學液體切片中心；4 高雄醫 學大學附設醫院肝膽胰內科；5 高雄醫學大學臨床醫 學研究所；6 高雄醫學大學醫學院內科學系；7 國立 中山大學臨床與實驗醫學系博士班；8 國立中山大學 代謝性脂肪肝卓越研究中心；9 高雄醫學大學醫學研 究所；10 高雄醫學大學附設醫院醫學研究部

Background: The prevalence of overweight and obesity is increasing, leading to metabolicassociated fatty liver disease (MAFLD) characterized by excessive accumulation of liver fat and a risk of developing hepatocellular carcinoma (HCC).

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P.054 The driver gene mutations may play the roles of passengers that occur in single ‘hotspots’ and can promote tumorigenesis from benign to malignant lesions.

Aims: This study investigates the correlation between obesity-induced hepatic cell damage and carcinogenesis-associated significant mutated genes, aiming to explore the role of obesity-related gene mutations in the progression from NAFLD to HCC. Methods: We investigated the impact of high body weight and BMI on HCC survival using the Cancer Genome Atlas Liver (TCGA-LIHC) dataset. To explore the effects of obesity-related gene mutations on HCC, we collected driver mutation genes in 34 TCGA patients with obese BMI ≥ 27 and 23 TCGA patients with BMI < 27. The digital PCR validate the PBMC and exosome samples for the variant rate by 96 NAFLD patients.

Results: Our analysis showed that obesity leads to significantly worse survival outcomes in HCC. Using cbioportal, we identified 414 driver mutation genes in patients with obesity and 127 driver mutation genes in non-obese patients. Functional analysis showed that obese-related genes significantly enriched the regulated lipid and insulin pathways in HCC. The insulin secretion pathway in obese patients with HCC-specific survival identified ABCC8 and PRKCB as significant genes (p < 0.001). It revealed significant differences in gene mutation and gene expression profiles compared to non-obese patients.

The digital PCR test ABCC8 variants were detected in PBMC samples and caused a 14.5% variant rate, significantly higher than that of non-obese NAFLD patients.

Conclusions: The study findings showed that the gene ABCC8 was an obesity-related gene in NAFLD patients, which provides the probability that ABCC8 mutation contributes to the pre-cancer lesion biomarker for HCC.

THE EFFECTS OF ADRENOCORTICAL AND ANDROGEN SUPPLEMENT IN CIRRHOTIC RATS WITH ACUTE HEMORRHAGE Chien-Lin Chang1, Hui-Chun Huang1,2, Shao-Jung Hsu1,2, Ching-Chih Chang1,2, Fa-Yauh Lee1,2, Ming-Chih Hou1,2 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

補充腎上腺皮質素及雄性素對急性出血 之肝硬化大鼠的影響 張建林1 黃惠君1,2 許劭榮1,2 張景智1,2 李發耀1,2 侯明志1,2 1 2

臺北榮民總醫院胃腸肝膽科 國立陽明交通大學醫學系

Background: Gastroesophageal hemorrhage is detrimental in cirrhotic patients with portal hypertension. Vasoconstrictors, such as glypressin, remain the mainstay of pharmacological treatment.

Unfortunately, the therapeutic effects are usually limited by nitric oxide (NO)-associated poorer vasoresponsiveness to vasoconstrictors and endothelin-1 (ET-1)-related increased intrahepatic resistance during hemorrhage. This may be further adversely influenced by a relative adrenal insufficiency in this setting. We have found previously that high-dose dexamethasone reversed systemic and splanchnic hyporesponsiveness to glypressin in bleeding adrenalectomized portal hypertensive rats, suggesting the importance of adequate adrenocorticoid supplement in portal hypertension with hemorrhage. On the other hand, dehydroepiandrosterone (DHEA) is an adrenal androgen precursor that influences NO and endothelin-1 syntheses and the potential to reverse shock has been noticed. However, the relevant effects of dexamethasone plus DHEA in cirrhotic animals with acute hemorrhage have not been surveyed.

Aims: The aim of this study was to evaluate the effects adrenocortical and androgen supplement in cirrhotic rats with acute hemorrhage.

Methods: Cirrhosis was induced by common bile

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P.055 duct ligation (BDL) in Spraque-Dawley rats. Sham rats served as controls. Experiments were performed on the 29th day post BDL or Sham operation, with or without hemorrhage, to survey the systemic and splanchnic hemodynamic responses to glypressin (mean arterial pressure (MAP), heart rate (HR), systemic vascular resistance (SVR), portal pressure (PP), superior mesenteric artery (SMA) flow, SMA resistance (SMAR)) in rats injected with (a) distilled water (DW, vehicle), (b) dexamethasone 5 mg/kg, or (c) dexamethasone plus DHEA (10 mg/kg). In situ liver perfusion technique was applied to evaluate the perfusion pressure changes. Then hepatic thromboxane synthase, COX1, COX2, iNOS, eNOS protein expressions were determined.

Results: In sham rats with bleeding, those with dexamethasone and DHEA injections showed higher MAP elevation and a tendency to increase SVR. In BDL rats with bleeding, those with dexamethasone and DHEA injections exerted higher SVR, increased SMAR, reduced PP, and upregulated hepatic eNOS protein expression.

Conclusions: The combination use of dexamethasone and DHEA increased systemic and SMA vascular resistance, which may be responsible for the elevation of MAP during hemorrhage. The hepatic eNOS upregulation may provide liver circulatory benefit but further study is required.

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ON-DEMAND LOCOREGIONAL THERAPY BENEFITS SURVIVAL IN UNRESECTABLE HEPATOCELLULAR CARCINOMA PATIENTS UNDERGOING SORAFENIB OR LENVATINIB TREATMENT Yu-Jui Chang, Hung-Wei Wang, Hsueh-Chou Lai, Wei-Fan Hsu, Che-Wei Chang, Cheng-Yuan Peng Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

需求導向的局部區域治療有助於提高接 受蕾莎瓦或樂衛瑪治療之不可切除肝細 胞癌患者的生存率 張育瑞 王鴻偉 賴學洲 許偉帆 張哲維 彭成元 中國醫藥大學附設醫院消化醫學中心

Background: Locoregional therapy (LRT) and tyrosine kinase inhibitors (TKIs) have been fundamental in treating patients with hepatocellular carcinoma (HCC). However, the effects of combining or sequencing LRT with TKIs in these patients remain unclear.

Aims: This study aimed to determine whether ondemand LRT improves survival in HCC patients treated with sorafenib or lenvatinib.

Methods: From June 2019 to April 2023, a total of 134 unresectable HCC patients treated with sorafenib (n = 75) or lenvatinib (n = 59) were recruited. The response to treatment was assessed using dynamic imaging based on the modified RECIST criteria. Documentation included whether patients undergoing first-line TKI treatment received on-demand LRT. Predictors for progression-free survival (PFS) and overall survival (OS) were analyzed after propensity score matching between patients with and without LRT. Results: Among the 134 patients receiving first-line TKI treatment, the median age was 65 years, 77.6% were male, the median PFS was 6 months (95% CI: 4.5–7.5), and median OS was not reached. Compared to those without LRT, patients who received ondemand LRT had significantly longer PFS (7 months vs. 4 months, log-rank P = 0.025) and better OS (firstyear cumulative survival rate 90.2% vs. 74.6%, logrank P = 0.021). After propensity score matching, LRT

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P.056 (adjusted HR: 0.592, 95% CI: 0.374–0.939, P = 0.026) was an independent predictive factor for PFS; while AFP >9 ng/mL (adjusted HR: 3.827, 95% CI: 1.110– 13.19, P = 0.034), NLR >5 (adjusted HR: 9.435, 95% CI: 2.528–35.21, P = 0.001), and LRT (adjusted HR: 0.229, 95% CI: 0.086–0.610, P = 0.003) were independent predictive factors for OS in the multivariable Cox regression analysis. In the subgroup analysis, LRT was an independent predictive factor for OS among patients with AFP levels greater than 9 ng/mL (not reached vs. 20 months, P = 0.017) and among patients with a NLR <5 (not reached vs. 21 months, P = 0.010).

Conclusions: LRT independently predicts both PFS and OS. Furthermore, LRT significantly benefits patients by extending overall survival, particularly in those with AFP levels greater than 9 ng/mL or NLR less than 5.

MONITORING ADHERENCE AND RENAL SAFETY OF NUCLEOS(T)IDE ANALOGUES FOR PATIENTS WITH CHRONIC HEPATITIS B Ying-fan Chen1, Chia-Chen Hsu2,3, Zih-Er Chen2,3, Jiing-Chyuan Luo1,4, Ming-Chih Hou1,4, Chien-Wei Su4,5,6 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan 3 Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 Institute of Clinical medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 6 Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 1

慢性 B 型肝炎病人使用口服核苷酸抗病 毒藥物之安全性監測與腎功能之影響 陳膺帆1 許家禎2,3 陳姿而2,3 羅景全1,4 侯明志1,4 蘇建維4,5,6 1

臺北榮民總醫院胃腸肝膽科 臺北榮民總醫院藥學部 3 國立陽明交通大學藥學系 4 國立陽明交通大學醫學系 5 國立陽明交通大學臨床醫學研究所 6 臺北榮民總醫院一般內科 2

Background: Potent nucleos(t)ide analogues (NAs) for treating chronic hepatitis B (CHB) include entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF); however, information about monitoring practices for these drugs is limited. The effects of NAs on renal safety have remained inconclusive.

Aims: To investigate monitoring practices and compare the risk of renal dysfunction among different NAs used to treat CHB. Methods: We included patients with CHB who received ETV, TDF or TAF between 2012 and 2022.

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P.057 Levels of serum alanine aminotransferase (ALT), total bilirubin, albumin and serum creatinine, hepatitis B viral load, and abdominal sonograms, were evaluated every six months during 36 months of NA treatment. The rates and hazard ratios (HRs) of renal dysfunction after NAs treatment were analyzed.

Results: Of 2,155 patients enrolled, 65.8% received ETV; 23.1%, TDF; and 11.1%, TAF. Although ALT levels were monitored adequately in more than 90% of patients taking each drug, other important laboratory values were monitored in only 20–80%.

After adjustment, TDF (HR 1.41, 95% confidence interval [CI] 0.95–2.08) and TAF (HR 0.91, 95% CI 0.52–2.18) exhibited comparable risks of renal dysfunction in comparison with ETV. Factors such as older age, comorbidities, high fibrosis-4 score and diuretic use were linked to a higher risk of renal dysfunction, whereas elevated serum albumin levels were associated with a lower risk.

Conclusions: This real-world study revealed that monitoring of patients with CHB who receive NAs is suboptimal. ETV, TDF and TAF had comparable renal safety.

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EVALUATION OF INHIBITORY EFFECT AND MECHANISM OF AMENTOFLAVONE COMBINES WITH REGORAFENIB IN HEPATOCELLULAR CARCINOMA Chien-Hua Chen Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan

評估穗花雙黃酮結合癌瑞格對肝細胞癌 的抑制作用與機制 陳建華 秀傳醫療社團法人秀傳紀念醫院消化系中心

Background: Oral multikinase inhibitors such as sorafenib, regorafenib, and lenvatinib are used for the treatment of hepatocellular carcinoma (HCC).

Amentoflavone, a bioactive compound isolated from medicinal plants, elicits tumor suppression through the induction of apoptosis, cell cycle arrest, and inhibition of oncogenic signaling pathways.

Additionally, amentoflavone has been shown to enhance the anti-HCC efficacy of sorafenib or lenvatinib. However, whether amentoflavone sensitizes HCC cells to regorafenib remains unclear.

Aims: The main goal of the present study was to verify the inhibitory effect and mechanism of amentoflavone combined with regorafenib in HCC cells.

Methods: Huh7 HCC cells was used in this study. The cells were treated with amentoflavone, regorafenib, or a combination of both for 48 hours. Changes in cell proliferation, apoptotic signaling, cell invasion, NF-κB signaling, and invasion-associated proteins will be determined using MTT assay, flow cytometry, cell invasion assay, and Western blotting.

Results: The results showed that amentoflavone effectively enhances the anti-HCC properties of regorafenib, including growth inhibition, induction of apoptosis, reduction of invasion ability, and suppression of NF-κB signaling and invasionassociated proteins.

Conclusions: Based on our data, we suggest that amentoflavone enhances the inhibitory effects of regorafenib against HCC, including growth inhibition, induction of apoptosis, reduction of invasion capability, and suppression of NF-κB signaling and invasion-associated proteins.

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P.059

EVALUATION OF INHIBITORY EFFICACY AND MECHANISM OF FLUOXETINE IN COMBINATION WITH RADIATION ON HEPATOCELLULAR CARCINOMA

INSIGHTS FROM A PRELIMINARY COMMUNITY-BASED HCC SCREENING STUDY USING AFP, PIVKA-II, AND ULTRASONOGRAPHY

Chien-Hua Chen Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan

評估百憂解合併放射線對於肝細胞癌的 抑制效益與機制 陳建華 秀傳醫療社團法人秀傳紀念醫院消化系中心

Background: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat mood and anxiety disorders, has also been reported to possess inhibitory potential against hepatocellular carcinoma (HCC). The potential of fluoxetine in the treatment of HCC is worth further investigation.

Aims: The main purpose of the present study is to investigate the inhibitory efficacy of fluoxetine combined with radiation in HCC. Methods: HCC Huh7 and Hep55.1 cells were used for this study. Cells and mice were treated with fluoxetine, radiation, or a combination of both for different durations. Changes in tumor cell growth, apoptotic signaling, invasion ability, and the expression of oncogenic proteins involved in epithelial-mesenchymal transition were evaluated using colony formation, invasion assays, and western blotting.

Results: The results showed that fluoxetine effectively enhances the therapeutic effectiveness of radiation on tumor cell growth, apoptosis, invasion inhibition, and suppression of EMT. Conclusions: Fluoxetine, as a potential radiosensitizer, enhances the effectiveness of radiation on proliferation, apoptosis, DNA repair, invasion ability, and EMT-related proteins in HCC cells.

Tsu-Zong Yuan1, Jing-Houng Wang1, Yu-Chen Lin2, Wen-Hua Chao2, Sheng-Nan Lu1 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2 Public Health Bureau, Chiayi County, Chiayi, Taiwan 1

併用甲型胎兒蛋白（AFP）、異常凝血酶 原（PIVKA-II）及超音波作為肝癌社區篩 檢的工具 阮致榮1 王景弘1 林裕珍2 趙紋華2 盧勝男1 1 2

高雄長庚紀念醫院胃腸肝膽科 嘉義縣衛生局

Background: Protein induced by vitamin K absence or antagonists (PIVKA)- II, a tumor marker of hepatocellular carcinoma (HCC), has been reimbursed in Japan since 1989. PIVKA-II was also reimbursed with restricted criteria and an unreasonable expense in Taiwan 31 years later.

Aims: Investigate the efficacy of Protein Induced

by Vitamin K Absence or Antagonists-II (PIVKA-II) in community-based Hepatocellular Carcinoma (HCC) Screening.

Methods: In this cross-sectional study, adult residents from two rural townships were recruited to participate in the HCC screening program. The screening tools included serological markers, AFP and PIVKA-II, and abdominal ultrasonography (US).

The cutoff values were set at 9 ng/ml for AFP and 40 mAU/ml for PIVKA-II. Values exceeding these cutoffs were defined as positive. Participants with positive results were further evaluated through confirmatory diagnostic procedures.

Results: Out of 481 participants, the distribution of AFP(+)/PIVKA-II(+), AFP(+)/PIVKA-II(-), AFP(-)/PIVKAII(+), and AFP(-)/PIVKA-II(-) was 1 (0.2%), 2 (0.4%), 8 (1.7%), and 470 (97.7%), respectively. The sole AFP(+)/PIVKA-II(+) individual was diagnosed with HCC, presenting AFP and PIVKA-II levels of 15.96 ng/ ml and 7430 mAU/ml, respectively. The two AFP(+)/ PIVKA-II(-) cases had AFP levels of 13.56 and 10.39

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P.060 ng/ml, both exhibiting abnormal liver function tests, elevated GGT, and advanced fibrosis (LSM ~12 Kpa).

PIVKA-II(+)/AFP(-) cases were categorized into high (5769 and 30,000 mAU/ml, n = 2), intermediate (88 and 236 mAU/ml, n = 2), and low (41-54 mAU/ml, n = 4) groups. High group subjects were on Warfarin therapy with prolonged prothrombin time (PT).

Intermediate group subjects showed no abdominal tumors on CT and had reduced PIVKA-II levels (15.7 and 41.8 ng/ml) upon re-evaluation. Four low group subjects will undergo follow-up every three months. US detected two intrahepatic malignancies, confirmed by a regional hospital as HCC and cholangiocarcinoma. The HCC case was AFP and PIVKA-II positive, while the cholangiocarcinoma case was negative for both markers.

Conclusions: Based on the small-scale preliminary study, we observed several key findings regarding HCC screening. Firstly, in screening for low-incidence diseases, minimizing false positives is crucial. In our study, the false positive rate was 0.4% for AFP and 1.7% for PIVKA-II, underscoring the importance of accurate cutoff values and diagnostic criteria.

Secondly, given the effective control of hepatitis B and C viral activity, the consensus AFP cutoff for HCC screening should not remain at 20 ng/ml. In this study, elevated AFP levels were found to be below 16 ng/ml, suggesting that a lower cutoff value is more appropriate for current screening programs. Thirdly, warfarin use was identified as a common cause of elevated PIVKA-II levels.

Therefore, it is essential to consider medication history and prolonged prothrombin time (PT) as useful references when interpreting PIVKA-II results. Fourthly, laboratory variations may account for intermediate PIVKA-II elevations. However, it is critical to rule out intraabdominal tumors, whether hepatic or extrahepatic, using CT scans to ensure accurate diagnosis and appropriate follow-up.

Finally, due to the lack of a consensus cutoff for PIVKA-II, follow-up testing with the same or different reagents is advisable for individuals with low PIVKAII elevations. This approach ensures continuous monitoring and timely detection of potential HCC development.

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COMPARATIVE ANALYSIS OF ULTRASOUND-GUIDED VERSUS CT-GUIDED RADIOFREQUENCY ABLATION IN EARLY-STAGE HEPATOCELLULAR CARCINOMA: A SINGLE HOSPITAL EXPERIENCE Yueh-An Lee, Pei-Yuan Su, Yu-Chun Hsu, Wei-Wen Su, Yang-Yuan Chen Division of Gastroenterology and Hepatology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan

超音波引導與 CT 引導射頻消融在早期肝 細胞癌中的比較分析：單一醫院經驗研 究 李約鞍 蘇培元 徐友春 蘇維文 陳洋源 彰化基督教醫院胃腸肝膽科

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, presenting significant treatment challenges. For early-stage HCC, curative therapies include ablation, surgical resection, and liver transplantation. Radiofrequency ablation (RFA) is favored for its efficacy, minimal invasiveness, and shorter hospital stays compared to surgery.

Aims: This retrospective study aims to evaluate and compare outcomes of ultrasound-guided versus CTguided RFA in patients with treatment-naïve HCC. Methods: Data from the Cancer Registry Center of Changhua Christian Hospital were analyzed for patients who underwent RFA for early-stage treatment-naïve HCC between January 2018 and December 2020. Inclusion criteria were treatmentnaïve HCC, BCLC stage 0 to stage A, and TNM stage T1a to T1b, with at least two years of follow-up.

Patients with recurrent HCC or other malignancies were excluded. Primary outcomes were the complete ablation rate, complication rate, and recurrence rate.

Results: A total of 81 patients were included, with an average age of 66.69 years (range: 36-89); 48 males and 33 females. Twelve patients underwent CT-guided RFA (average age 63.0 years, female ratio 0.25) and 69 patients underwent ultrasound-guided RFA (average age 67.38 years, female ratio 0.43). The complete ablation rate was 91.7% for CT-guided RFA and 89.86% for ultrasound-guided RFA (p-value: >0.99). CT-guided RFA had a higher complication

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P.061 rate of 25% (primarily fever) compared to 5.8% for ultrasound-guided RFA (p-value: 0.0627). Recurrence rates were 54.5% for CT-guided RFA and 59.68% for ultrasound-guided RFA (p-value: 0.7518).

Conclusions: Both CT-guided and ultrasoundguided RFA are effective for early-stage HCC. Ultrasound-guided RFA shows a trend towards fewer complications, though this difference was not statistically significant. These findings suggest a potential preference for ultrasound-guided RFA due to its lower complication rate. Further prospective studies are needed to confirm these results and optimize patient outcomes.

EVALUATION OF CLINICAL OUTCOMES FOR FIRST-LINE LENVATINIB TREATMENT IN PATIENTS WITH NON-VIRAL HEPATOCELLULAR CARCINOMA Ju-Yung Tso1, Chi-Yu Lee1, Tsang-En Wang1,2,3, Shih-Ting Huang1, Chia-Yuan Liu1,2,3,4, Ming-Jen Chen1,2,3, Horng-Yuan Wang1,2,3, Ching-Wei Chang1,2,3,4 Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 3 MacKay Medical College, New Taipei City, Taiwan 4 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan 1

非病毒性肝細胞癌患者使用 Lenvatinib 作為第一線治療的臨床效果評估 左如永1 李騏宇1 王蒼恩1,2,3 黃詩婷1 劉家源1,2,3,4 陳銘仁1,2,3 王鴻源1,2,3 張經緯1,2,3,4 1

馬偕紀念醫院胃腸肝膽科 馬偕醫護管理專科學校 3 馬偕醫學院 4 馬偕紀念醫院醫學研究部 2

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide. The rising prevalence of non-viral HCC etiologies, such as alcohol-related liver disease and non-alcoholic fatty liver disease, poses unique therapeutic challenges due to limited treatment options.Current systemic therapies for advanced HCC do not show significantly different efficacy between non-viral and viral HCC. Tyrosine kinase inhibitors (TKIs), including lenvatinib, have been established as first-line therapy for advanced HCC. Nonetheless, the clinical outcomes of lenvatinib treatment in patients with non-viral HCC remain underexplored.

Aims: This study aimed to evaluate the clinical efficacy of first-line lenvatinib therapy in patients with non-viral hepatocellular carcinoma (HCC), comparing outcomes with viral HCC counterparts.

We assessed progression-free survival (PFS), overall survival (OS), objective response rates (ORR), and

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P.062 disease control rates (DCR) retrospectively from March 2021 to April 2024 at MacKay Memorial Hospital. While PFS and OS were comparable between non-viral and viral HCC groups, nuances in ORR and DCR underscored differences in treatment response. These findings emphasize the importance of tailored treatment approaches for non-viral HCC, warranting further prospective studies to optimize therapeutic strategies.

Methods: In this retrospective cohort study, we evaluated the clinical outcomes of first-line lenvatinib therapy in patients with non-viral and viral HCC. Data were retrospectively collected from medical records of patients treated with first-line lenvatinib between March 2021 and April 2024 at MacKay Memorial Hospital. The non-viral HCC patients were defined as patients who tested negative for serum HBsAg and serum anti-HCV Ab. The viral HCC patients were defined as patients who tested positive for serum HBsAg and serum anti-HCV Ab. We compared clinical characteristics, treatment response rates, progression-free survival (PFS), overall survival (OS), objective response rates (ORR), and disease control rates (DCR) between the nonviral and viral HCC cohorts.

Results: A total of 91 patients were included, comprising 24 patient swith non-viral HCC and 67 with viral HCC. Table 1 presents the baseline characteristics of both cohorts. Radiological best overall responses are detailed in Table 2. KaplanMeier survival curves demonstrated no statistically significant differences in PFS (p = 0.500) and OS (p = 0.715) between the two groups (Figures 1 and 2). Notably, patients with non-viral HCC exhibited a trend towards longer PFS (8.5 months vs. 7.6 months) but shorter OS (16.0 months vs. 16.8 months), alongside lower ORR (12.5% vs. 13.4%) and DCR (33.3% vs. 44.8%) compared to those with viral HCC. Conclusions: First-line lenvatinib treatment yielded comparable PFS and OS outcomes in nonviral and viral HCC patients. However, the nuanced differences in response rates highlight the need for further prospective investigations to elucidate these findings and optimize treatment strategies for nonviral HCC.

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EVALUATION OF THE SECONDLINE IMMUNOTHERAPY FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA PATIENTS: REALWORLD EXPERIENCE FROM A MEDICAL CENTER IN TAIWAN Ting-Churn Wong1, Chi-Yu Lee1, Tsang-En Wang1,2,3, Chia-Yuan Liu1,2,3,4, Ming-Jen Chen1,2,3, Horng-Yuan Wang1,2,3, Ching-Wei Chang1,2,3,4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 3 MacKay Medical College, New Taipei City, Taiwan 4 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan 1

不可切除肝細胞癌患者的二線免疫治療 評估：台灣某醫療中心的實際經驗 翁鼎淳1 李騏宇1 王蒼恩1,2,3 劉家源1,2,3,4 陳銘仁1,2,3 王鴻源1,2,3 張經緯1,2,3,4 1

馬偕紀念醫院胃腸肝膽科 馬偕醫護管理專科學校 3 馬偕醫學院 4 馬偕紀念醫院臨床試驗管理中心 2

Background: Currently, the combination of atezolizumab with bevacizumab is used in unresectable Hepatocellular carcinoma (HCC) due to its superior survival benefit than sorafenib.

While first-line treatments have been well studied in unresectable HCC, the availability of effective second-line systemic therapies is still limited.

Pembrolizumab has emerged as a promising option for second-line therapy. However, there is a lack of comprehensive data comparing its effectiveness with other immunotherapy-based treatments.

Aims: This study evaluates pembrolizumab and other immunotherapies as second-line treatments for patients with unresectable HCC. Methods: In this retrospective study, we reviewed the medical records of patients with unresectable HCC in MacKay Memorial Hospital from Jan. 1st, 2020, to Jul. 31st, 2023. The patients who received immunotherapy-based second-line systemic therapy

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P.063 were enrolled. Clinical characteristics, objective response rates (ORR), disease control rates (DCR), progression-free survival (PFS), and overall survival (OS) were compared between patients received the immunotherapy-based second-line therapy with pembrolizumab and non-pembrolizumab.

Results: The patients with unresectable HCC (n = 25) were enrolled and divided into two groups: the pembrolizumab group (n = 8) and the nonpembrolizumab group (n = 17). The mean age was 56.4±14.8 years and 84% of patients were male.

Among these patients (Table 1), no significant differences were found in the two groups regarding age, sex, BCLC stage, liver cirrhosis, total-bilirubin level, and extra-hepatic spread number. Radiological best overall responses are detailed in Table 2. The two groups had no significant difference in ORR, DCR, PFS, and OS (Table 2, Figure 1). Non-pembrolizumab groups exhibited a trend toward longer median OS compared with pembrolizumab groups (33.3 months vs. 27.9 months).

Conclusions: Our real-world data showed no significant difference in treatment response and survival between HCC patients treated with secondline pembrolizumab and those receiving other second-line immunotherapies. Further prospective studies are needed to draw definitive conclusions.

PERSISTENT HCV-INDUCED MIRNA EXPRESSION IN THE PROGRESSION OF HEPATOCELLULAR CARCINOMA Wen-Hsiu Su1, Ciniso Sylvester Shabangu2, Jee-Fu Huang3, Chia-Yen Dai3, Wan-Long Chuang3, Ming-Lung Yu3, Shu-Chi Wang1,2 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 1

長期 HCV 誘導的肝癌過程中其 miRNA 的表達 蘇玟秀1 辛仁碩2 黃志富3 戴嘉言3 莊萬龍3 余明隆3 王述綺1,2 1

高雄醫學大學醫學檢驗生物技術學系 高雄醫學大學醫學研究所 3 高雄醫學大學附設中和紀念醫院肝膽胰內科 2

Background: Chronic hepatitis C is one of the leading chronic infectious factors that cause liver cancer. In the liver biopsy of chronic hepatitis C, it has been observed that not all hepatocytes are infected with HCV, and only about 40% of the cells can be detected the expression of hepatitis C protein.

Although there are effective treatments for hepatitis C and the eradication of the HCV rate has reached more than 95%, there are still a certain proportion of patients with long-term infection but undiagnosed or untreated. Clinical studies have confirmed that long-term HCV-infected patients respond poorly to ledipasvir and daclatasvir, NS5A inhibitors. The sensitivity of the detection will also ignore the inability of host immunity to clear the virus, resulting in the persistence of low viral load and the change of epigenetic genes to induce virus-related liver cancer.

Aims: It is essential to study the gene regulation in hepatocytes for long-term infection with viruses to cause cancerization, which can further provide the mechanism and possibility of the subsequent development of liver cancer. To explore the regulation between persistent HCV-infected and gene expression. We hope that it can provide a new strategy for preventing liver cancer caused by chronic

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P.064 hepatitis C in the future, reduce the incidence of liver cancer caused by chronic HCV-infected and achieve the purpose of precision medicine.

Methods: We utilized the Huh751 cell line and infected it with the long-term JFH1 replicon of lowviral load HCV (L-HCV), S2 cells. We initially identified potential miRNA candidates using an HCV miRNA array and analyzed their associated KEGG pathways through DIANA. Subsequently, we identified miRNA-mRNA targets using three databases (miRDB, miRPathDB, and TargetScan) and analyzed these targets for KEGG pathways using ShinyGO. To integrate miRNA-mRNA data, we compared the target miRNA-mRNA candidate genes with L-HCV NGS mRNA data. The identified genes were then analyzed in The Cancer Genome Atlas (TCGA) for survival, biological processes, and expression in liver hepatocellular carcinoma (LIHC) Big Data.

Results: Our analysis revealed that hsa-miR-2155p, hsa-mir-10b-5p, and has-let-7a-5p, belonging to the L-HCV miRNAs group, showed significant associations with overall survival in LIHC, with a hazard ratio greater than 1.0. Notably, these miRNAs were LIHC-specific and not observed in other cancers. Through systematic integration of these findings, we identified HMOX1 and BMF genes as being specifically associated with HCC and regulated by hsa-miR-215-5p, hsa-miR-10b-5p, and hsa-miR7a-5p.

Conclusions: miRNAs are known to play a role in cancer pathways by regulating RNA degradation and acting as tumor suppressors. The negative correlation between miRNA expression and their target mRNA suggests that HCV and target genes suppress miRNA expression. The suppression of miRNA is associated with decreased survival. Silencing miRNA expression leads to the overexpression of cancer in LIHC, creating a microenvironment that favors cancer growth. Therefore, miRNA may function as a tumor suppressor that is suppressed in persistent HCV infection, ultimately contributing to the progression of HCC. Consequently, the miRNA may be a potential treatment target for preventing the progression of HCC in individuals with persistent HCV infection.

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INVESTIGATING THE IMPACT OF FERROPTOSIS IN A HIGH- FAT/HIGHROS MAFLD ENVIRONMENT Chi-Sheng Chen1, Jee-Fu Huang2, Chia-Yen Dai2, Wan-Long Chuang2, Ming-Lung Yu2, Shu-Chi Wang1 Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 1

研究在高脂和高氧化壓力的環境下鐵依 賴性細胞凋亡對代謝性脂肪肝疾病的影 響 陳祺聖1 黃志富2 戴嘉言2 莊萬龍2 余明隆2 王述綺1 1 2

高雄醫學大學醫學檢驗生物技術學系 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: An iron-dependent mechanism of cell death, ferroptosis, occurs with intracellular iron accumulation and is associated with lipid peroxidation. Previous studies have shown that lipid peroxidation-induced ROS promotes the progression of steatosis.

Aims: Therefore, we aim to study the ferroptosis effect in the Metabolic dysfunction-associated fatty liver disease (MAFLD) in vivo model and highfat/high ROS cell model with ACM (Adipocyteconditioned medium) with low dose H2O2 in vitro.

Methods: Analysis of gene expression in a 9-month Western diet with high fructose/glucose-containing sugar drinking water (WFSD) mouse livers compared with the ND mice (fold change > 1.5, FDR and p-value < 0.05).

Results: Bioinformatic analyses by Partek Flow and IPA revealed pronounced differences in lipid metabolism, inflammatory response, and ion-related pathways. To further study the ferroptosis effect, the high-fat and high-ROS with a low dose of carbon tetrachloride WFSD murine model demonstrated notable lipid deposition, fibrosis, and iron accumulation in livers from both WFSD and WFSD + CCl4 groups, with significant upregulation of IRP1, IRP2, ferroportin, and DMT1 expression observed in hepatocytes. Moreover, ACM with low dose H2O2 in AML12 hepatocytes upregulated iron-related and

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P.065 inflammatory genes after 48 hours. Then, Erastin, a ferroptosis inducer, increased AML12 sensitivity to ROS-induced cytotoxicity in XTT assays. Further, using the ferroptosis inhibitor of UAMC-3203 in the WFSD mice, the iron-related and antioxidant protein expression was reversed by the administration of UAMC-3203.

Conclusions: These data collectively implicate ferroptosis in the pathogenesis of high- fat and highROS-associated hepatic injury, with the potential to facilitate the development of precise health prevention strategies by modulating the ferroptosis pathway to prevent MAFLD progression.

A HIGHER PERCENTAGE OF M2 MACROPHAGES IN NON-TUMOR PART PREDICT THE TUMOR RECURRENCE IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AFTER SURGICAL RESECTION Po-Ting Lin1, Wei-Ting Ku2, Tsung-Han Wu3, Cheng-Heng Wu1, Chan-Keng Yang4, Teng Wei1, Yung-Chang Lin4, Chun-Yen Lin1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 2 Chang Gung University, Taoyuan, Taiwan 3 Department of General surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 4 Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 1

非腫瘤部分中較高比例的 M2 巨噬細胞 可預測肝細胞癌患者手術切除後的腫瘤 復發 林伯庭1 古唯鼎2 吳宗翰3 吳承衡1 楊展庚4 滕威1 林永昌4 林俊彥1 1

林口長庚紀念醫院胃腸肝膽科 長庚大學 3 林口長庚紀念醫院一般外科 4 林口長庚紀念醫院血液腫瘤科 2

Background: The primary hurdle in improving outcomes for hepatocellular carcinoma (HCC) patients after curative treatment is the high early recurrence rate. The existing literature indicates the presence of type 2 macrophages (M2), renowned for their immunosuppressive capabilities, has been implicated in creating a microenvironment conducive to tumor growth and recurrence. However, the intricate interplay involving M2 macrophages and the recurrence of HCC is underexplored.

Aims: To identify the key cells responsible for tumor recurrence in HCC patients after hepatectomy.

Methods: Therefore, we conducted an analysis involving HCC patients who underwent hepatectomy at our hospital between 2013 and 2017. We collected samples from both the tumor and non-tumor regions and subjected them to bulk RNA sequencing for comprehensive molecular profiling. The proportion

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P.066 of immune cells was calculated by CIBERSORTx. Results: In our study, we enrolled fifty patients, with sixty percent presenting with cirrhosis and seventythree percent having viral hepatitis. Twenty-three patients experienced tumor recurrence, with a median time to recurrence of 12.6 months. First, we found no correlation between five TIMR subtypes defined by TIMELASER (Xue R, Nature, 2022) and recurrence. However, as for the proportions of immune cell, a significantly lower NK/Treg ratio (p = 0.0163) and high within the resected tumor section in recurrent group was found. On the other hand, the ratio of M2 macrophages to total macrophages (M2/M) was significantly higher within the non-tumor region in patients experiencing tumor recurrence after hepatectomy (p = 0.0357).

Furthermore, the expression of the ACGT2 gene in non-tumor part, which strongly correlates with Treg function, was significantly higher (p = 0.0056) in recurrent group. In addition, the innate T cells score was increased in non-tumor pat in recurrent group but with borderline significance (p = 0.0628).

However, in multivariable analysis, only a higher M2/M ratio within the non-tumor region (HR 3.756, p = 0.0072) were identified as independent risk factors for tumor recurrence. We also found that patients with a higher M2/M ratio had a lower percentage of cirrhotic patients (p = 0.0049) and less association with TIME-IA (immune activation) subtype of HCC by TIMELASER classification (p = 0.0030).

Conclusions: In conclusion, a higher M2/M ratio within the non-tumor region predict the tumor recurrence in patients with hepatocellular carcinoma.

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EPIDEMIOLOGICAL TRENDS AND RISK ANALYSIS OF NAFLD IN SOUTHERN TAIWAN Tzu-Chun Lin1, Po-Cheng Liang1, Pei-Chien Tsai1, Chung-Feng Huang1,2, Tyng-Yuan Jang1, Yi-Hung Lin1, Chih-Wen Wang1,2, Ming-Lun Yeh1,2, Jee-Fu Huang1,2, Wan-Long Chuang1,2, Ming-Lung Yu1,2, Chia-Yen Dai1,2 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 1

台灣南部非酒精性脂肪肝流行病學趨勢 及風險分析 林姿君1 梁博程1 蔡佩倩1 黃釧峰1,2 張庭遠1 林宜竑1 王志文1,2 葉明倫1,2 黃志富1,2 莊萬龍1,2 余明隆1,2 戴嘉言1,2 1 2

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄醫學大學醫學系

Background: With the advent of the hepatitis B vaccine and effective treatments for hepatitis C, nonalcoholic fatty liver disease (NAFLD) has gradually become the leading cause of chronic liver disease.

In Taiwan, the prevalence of NAFLD is approximately 11.4-41% and shows an increasing trend. However, further evaluation regarding the characteristics and risk analysis of NAFLD in a community environment is needed.

Aims: This study aims to explore the prevalence and risk factors of NAFLD in the southern Taiwan community.

Methods: The present retrospective study included subjects selected from community health screenings in southern Taiwan between 2001 and 2020. Each individual has undergone basic anthropometric measurements and biochemical tests during the assessment period. They also received ultrasound examinations to monitor the status of hepatic steatosis. To determine the presence or absence of NAFLD, multivariate analysis was used to test the independent relationships between the studied markers.

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P.067 Results: A total of 6,096 subjects were enrolled in the study, and 3,004 (49.3%) subjects had NAFLD. Compared to the non-NAFLD group, patients with NAFLD are older, have a higher proportion of males, higher BMI and waist circumference values, a higher rate of diabetes, hypertension, hyperlipidemia, and elevated biochemical measurement levels. The prevalence of NAFLD was found to be 49.3%, with an increase from 46.3% in the 2001-2010 period to 55.7% in the 2011-2020 period. In the multivariate regression analysis, the significant factors influencing NAFLD included gender, BMI, waist circumference, diabetes, ALT, TG, TC, LDL-C, and the period (2001-2010 vs. 2011-2020). The NAFLD group was further stratified according to the severity of steatosis. We found that subjects with the moderate to severe NAFLD group were mostly male, and had significant obesity, chronic diseases, elevated liver function index, and dyslipidemia. The proportion of individuals with moderate to severe NAFLD also increased from 40.2% in the first decade to 46.1% in the second decade.

Conclusions: This study reveals a significant and growing NAFLD in the southern Taiwan community over 20 years. Emphasis should be placed on early detection, lifestyle modifications, and the management of associated risk factors such as obesity, diabetes, hypertension, and dyslipidemia to mitigate the progression and impact of NAFLD in the community.

EFFECTIVENESS OF IMMUNOTHERAPY FOR ADVANCED HEPATOCELLULAR CARCINOMA WITH OR WITHOUT PERITONEAL CARCINOMATOSIS Tzu-Chun Hong, Juei-Seng Wu, Wei-Ting Chen, Ting-Tsung Chang, Chiung-Yu Chen, Chiao-Hsiung Chuang, Po-Jun Chen, Ming-Tsung Hsieh, Hsin-Yu Kuo Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

免疫療法對於有或無腹膜轉移之晚期肝 細胞癌的療效比較 洪子鈞 吳叡森 陳威廷 張定宗 陳炯瑜 莊喬雄 陳柏潤 謝名宗 郭欣瑜 國立成功大學醫學院附設醫院內科部

Background: Patients with advanced hepatocellular carcinoma (HCC), which was associated with high tumor burden, distal metastasis or portal vein thrombosis, have unfavorable prognosis, and systemic therapy is the mainstream treatment for this population. Immune checkpoint inhibitor (ICI) is an effective systemic therapy for patients with advanced HCC. In HCC patients with distal metastasis, peritoneal carcinomatosis (PC) is relative uncommon. Moreover, it was still unclear whether the effectiveness of ICI is similar between patient group with or without PC. Aims: We aimed to investigate the efficacy of ICI by comparing the clinical outcomes between advanced HCC patients with or without peritoneal carcinomatosis.

Methods: We retrospectively included 198 patients with unresectable HCC who underwent ICI treatment at National Cheng Kung University Hospital, Tainan, Taiwan. Patients were further categorized into two groups, which were with or without peritoneal carcinomatosis, respectively. Treatment response was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria.

Results: The baseline characteristics were not significantly different between patients with and without peritoneal carcinomatosis (PC). On enrollment, 13 patients (6.6%) were with PC and 185

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P.068 (93.4%) were without PC. Ten patients (76.9%) with PC and 140 (75.7%) without PC were classified as ChildPugh class A (p = 1.000). Additionally, combination therapy of ICIs and a tyrosine kinase inhibitor was administered to 9 (69.2%) patients with PC and 118 (63.8%) without PC. Five (38.5%) patient with PC and 96 (51.9%) without PC received ICIs as first-line systemic therapy, respectively. The overall response rate (ORR, the percentage of patients with complete response, partial response) of ICIs was lesser in the patient group with peritoneal carcinomatosis (30.7%) compared with the patient group without peritoneal carcinomatosis (34.3%). The disease control rate (DCR, the percentage of patients with complete response, partial response and stable disease) of ICIs was greater in the patient group with peritoneal carcinomatosis (69.2%) compared with the patient group without peritoneal carcinomatosis (55.9%). In both groups, the most common adverse events were skin rash, fatigue, and increase in the aspartate aminotransferase level. No significant increase in the risk of grade 3/4 adverse events was observed between these two groups.

Conclusions: Immune checkpoint inhibitors (ICIs) demonstrate clinical benefits for HCC patients with peritoneal carcinomatosis, reflected in the overall response rate, without a significant increase in adverse effects. Despite a slightly lower overall response rate in patients with peritoneal carcinomatosis compared to those without it, ICIs remain an effective treatment option. These findings highlight the potential of ICIs in managing advanced HCC, including cases with peritoneal carcinomatosis, supporting the use of ICIs in this subset of patients.

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THE IMPACT OF PD-1+ INNATE-LIKE T CELLS ON THE HBSAG REDUCTION IN ACTIVE CHRONIC HEPATITIS B PATIENTS RECEIVING NUCLEOS(T) IDE ANALOGUE THERAPY Hsiang-Wei Huang1, Wen-Juei Jeng1,2, Chia-Wei Lin1, Jian-He Fan1, Yen-Chun Liu1,2, Wei-Ting Ku1, Cheng-Heng Wu1, Chien-Hao Huang1,2, Chun-Yen Lin1,2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

PD-1+ 類先天性 T 細胞對發炎狀態的慢性 B 型肝炎患者接受核苷（酸）類藥物治療 後 B 型肝炎表面抗原定量減少程度的影 響 黃祥瑋1 鄭文睿1,2 林家緯1 方健合1 劉彥君1,2 古唯鼎1 吳承衡1 黃建豪1,2 林俊彥1,2 1 2

林口長庚紀念醫院胃腸肝膽科系 長庚大學醫學院

Background: Hepatitis B surface antigen quantification levels (HBsAg) kinetics during Nuc treatment in CHB patients is essential for achieving a functional cure.

Aims: This study investigates factors affecting ontreatment HBsAg reduction and the role of PD-1 positive and negative innate-like CD8+ T cells in active CHB patients undergoing Nuc treatment.

Methods: CHB patients with active hepatitis [ALT ≥ 2 times (x) ULN) were analyzed. Flow cytometry assessed innate-like T cells (CD38+HLADR+CD8+ T cells, Huang CH, Hepatology, 2022), PD-1+CD8+ T cells, PD-1+ innate-like T cells, PD-1-innate-like T cells, activated regulatory T cells (CD45RA-Foxp3highCD4+T cells). Spearman correlation explored relationships between pretherapy factors, innatelike CD8+ T cells, and on-treatment HBsAg kinetics.

Logistic regression identified predictors for rapid HBsAg decline (>0.5 log10 IU/mL/year), while linear regression analyzed factors associated with HBsAg reduction (log10 IU/mL/year) during treatment.

Results: Out of 43 CHB patients, with median age 54, 79% male, and 74% genotype B, 26% genotype C. Median HBV DNA, HBsAg, and ALT levels were

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P.069 6.67 log10 IU/mL, 3.35 log10 IU/mL, and 146 U/L, respectively. Hepatitis flare (ALT ≥ 5 x ULN) and rapid HBsAg decline occurred in 16 and 23 patients, respectively. Multivariate analysis identified pretherapy ALT levels as independent factors for rapid HBsAg decline or reduction magnitude (aOR: 1.015, P = 00108; Estimate: 0.018, P = 0.0005).

Pretherapy HBsAg levels were associated with HBsAg reduction, with AUROC of 0.909 (P < 0.0001).

An HBsAg level ≥ 3.6 log10 IU/mL indicated higher rapid decline in both ALT ≥ 5X (100% vs. 40%, P = 0.0179) and 2-5X ULN (66.7% vs. 12.5%, P = 0.0786).

As for the immunological aspect of these patients, PD-1+innate-like T cells proportion was positively correlated with pretherapy ALT levels (r = 0.324, P = 0.034), but not with HBsAg (P = 0.901) or HBV DNA (P = 0.561) levels. Among patients with pretherapy HBsAg < 3.6 log10 IU/mL, PD-1+ innate-like T cells showed significant association with HBsAg decline (estimate: 0.0198, P = 0.0230).

Conclusions: In Nuc-treated active CHB patients, pretherapy ALT level is the main independent factor for HBsAg reduction. As for immunologic aspect, PD1+innate-like T cells showed positive correlation with pretherapy ALT levels. Its significant association with HBsAg decline only show in patients with pretherapy HBsAg < 3.6 log10 IU/mL.

A POINT-OF-CARE MODEL FOR HEPATITIS C SCREENING IN REMOTE ISLANDS OF TAIWAN Tzu-Chun Lin1, Pei-Chien Tsai1, Chung-Feng Huang1,2, Ming-Lun Yeh1,2, Chia-Yen Dai1,2, Ming-Lung Yu1,2, Wan-Long Chuang1,2, Jee-Fu Huang1,2,3 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan 3 Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 1

台灣偏遠離島 C 型肝炎篩檢之定點照護 模式 林姿君1 蔡佩倩1 黃釧峰1,2 葉明倫1,2 戴嘉言1,2 余明隆1,2 莊萬龍1,2 黃志富1,2,3 1

高雄醫學大學附設中和紀念醫院肝膽胰內科 國立中山大學代謝相關脂肪肝疾病卓越中心 3 高雄醫學大學附設中和紀念醫院肝炎中心 2

Background: Timely and accurate diagnosis of hepatitis C virus (HCV) infection in a point-of-care (POC) manner remains to be the effective approach for subsequent care cascade of HCV treatment. The strategy is of importance in under-resourced areas, particularly in the remote islands.

Aims: The study aimed to assess the feasibility of a point-of-care model by a rapid diagnostic test (RDT) and subsequent confirmational HCVRNA test for those anti-HCV+ patients in the remote islands of Taiwan.

Methods: We conducted a mass screening program in 3 small outlying islands in Taiwan, including A. Liuqiu (6.8 km2, 12,000 residents), B. Green (15.1 km2, 4,280 residents), and C. Lanyu (48.4 km2, 5,230 residents) islands. We used the qualitative assays for detecting HCV antibody, based on immunochromatography technology. Serum HCV RNA levels were measured among those who were seropositive for rapid anti-HCV test. They also received sonography for liver cancer surveillance.

Results: There were 756, 175, and 194 adult residents

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P.070 receiving rapid tests in island A, B, and C, respectively, yielding the response rates of 38.8%, 19.8%, and 18.5%, respectively. The prevalence of anti-HCV+ in island A, B, and C were 0.7% (n = 14), 0.3% (n = 3), and 0, respectively. Only one of the two anti-HCV+ patients in island B was HCVRNA-. The other 16 HCVRNA+ patients were then referred for anti-viral treatment. The mean performing time for rapid test was 20 seconds, which was significantly shorter than vacuum tube test (120 seconds). Meanwhile, the cost of manpower for each HCVRNA+ patient identified was USD 156.3, which was significantly lower than USD 218.8 of traditional approach.

Conclusions: The study demonstrated the effectiveness of the POC model in the remote islands with limited resources.

COMPARATIVE ANALYSIS OF FIBROSCAN AND ULTRASOUND FOR ASSESSING LIVER ENZYME CORRELATION IN TEENAGERS WITH FATTY LIVER DISEASE Po-Cheng Liang, Chung-Feng Huang, Ming-Lun Yeh, Jee-Fu Huang, Ming-Lung Yu, Wan-Long Chuang, Chia-Yen Dai Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

脂肪肝青少年的肝功能相關性評估中 Fibroscan 纖維化掃描與超音波的比較分 析 梁博程 黃釧峰 葉明倫 黃志富 余明隆 莊萬龍 戴嘉言 高雄醫學大學附設中和紀念醫院肝膽胰內科

Background: Fatty liver disease (FLD) is becoming increasingly common among teenagers, necessitating accurate diagnostic methods for early detection and management.

Aims: This study aims to compare the correlation of liver enzyme levels (GOT and GPT) with two diagnostic methods, Fibroscan and ultrasound, in evaluating FLD among teenagers.

Methods: This study involved 156 students from Liouguei Senior High School and Namasia Junior High School. Participants underwent evaluations for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), anti-hepatitis C virus (antiHCV), and liver function tests, including GOT and GPT levels. Both Fibroscan and ultrasound examinations were performed to assess liver steatosis and fibrosis.

Results: The study population had a mean age of 15.47 ± 1.89 years, with 48.1% being male. HBsAg positivity was found in 0.64%, while 36.5% were HBsAb positive. No participants tested positive for anti-HCV. The mean GOT and GPT levels were 21.74 ± 11.05 IU/L and 19.24 ± 25.51 IU/L, respectively.

Among the 136 participants who underwent ultrasound, 72.1% had no fatty liver, 15.4% had mild fatty liver, 6.6% had moderate fatty liver, and 5.9% had severe fatty liver. For the 66 participants who underwent both Fibroscan and ultrasound, CAP values also increased significantly with FL severity (p < 0.001), indicating that Fibroscan is a more reliable tool than ultrasound for assessing fatty liver in

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P.071 adolescents.

Conclusions: This study provides an overview of the prevalence and severity of fatty liver disease among teenagers and compares the diagnostic effectiveness of Fibroscan and ultrasound. The data suggest that both methods are useful in assessing liver health, but further analysis is needed to determine which method correlates better with liver enzyme levels. These findings can inform the selection of appropriate diagnostic tools for early detection and management of FLD in the adolescent population. Further studies with larger sample sizes and more detailed statistical analyses are warranted to validate these results.

CRISPR/CAS9-MEDIATED TLR4 KNOCKOUT ATTENUATES HEPATOCELLULAR CARCINOMA PROGRESSION IN MICE VIA THE KINETICS OF MYELOID-DERIVED SUPPRESSOR CELL SUBSETS Chi-Chen Cheng1, Hsiao-Ping Chen2,3,4, He-Yu Kuo5, Pei-Han Fan5, Jie-Lun Ku1, Cheng-Hao Kuo1,6, Li-Ling Wu3,4,5, Chun-Ying Wu3,4,7 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 2 Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan 3 Microbiota Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 5 National Yang Ming Chiao Tung University, Department and Institute of physiology, Taipei, Taiwan 6 Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taiwan, Taipei, Taiwan 7 Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

CRISPR/Cas9 敲除 TLR4 小鼠透過調節骨 髓衍生抑制細胞（MDSC）亞群減緩肝癌 進展 鄭祺臻1 陳筱萍2,3,4 郭賀喻5 范沛涵5 古杰倫1 郭正浩1,6 吳莉玲3,4,5 吳俊穎3,4,7 1

國立陽明交通大學醫學系 臺北榮民總醫院轉譯研究科 3 國立陽明交通大學微菌叢研究中心 4 國立陽明交通大學健康創新中心 5 國立陽明交通大學生理學科暨研究所 6 國立陽明交通大學臨床醫學研究所 7 國立陽明交通大學生物資訊及系統生物研究所 2

Background: Hepatocellular carcinoma (HCC) significantly contributes to global cancer mortality, highlighting the urgent need for new treatments.

Toll-like receptor 4 (TLR4) is linked to metabolic dysfunction associated steatotic liver disease

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(MASLD)-related HCC, while MDSCs (myeloidderived suppressor cell) suppress the immune system in the tumor microenvironment.

Aims: This study investigates how TLR4 ablation using CRISPR/Cas9 technology influences HCC progression in mice with MASLD-associated HCC by examining MDSC subset dynamics.

Methods: CRISPR/Cas9 TLR4 mutant mice (CCT #712 to CAT) (CTLR4), global TLR4 knockout (TLR4), and wild-type (WT) HCC models with or without HFD were used. HDI was used to transfect C3H/HeN mice with surrogate tumor antigens, NRAS, ShP53, and ORFs. Mice were examined at two, four, six, and eight weeks after HCC induction. Mouse gut microbiota (GM) was explored through germ-free (GF) to specific pathogen-free (SPF) environment shift mice and GF mice. Comprehensive studies include metabolic profile, serum analysis, hepatotoxicity assessment, and immune cell flow cytometry.

The GM composition was analyzed by TTGE and 16SrDNA NGS. HCC was verified by histology and immunohistochemistry.

Results: Histological evaluation of NAFLD features indicated that HFD diet in combination with addition to hydrodynamic injections of oncogenes created a new MASLD-HCC model. Both CTLR4 and TLR4 mice demonstrated a substantial decrease in the progression of HCC in this model when compared to WT mice. CTLR4 and TLR4 mice exhibited decreased levels of AST and ALT. Flow cytometry analysis of CTLR4 and TLR4 mice reveals fewer pankeratin Ki67 cells, indicating a deceleration in tumor growth. The livers of WT mice contained a greater quantity of monocytic MDSCs (mMDSC) compared to mice lacking CTLR4 and TLR4. In contrast to WT mice, CTLR4 and TLR4 mice exhibit a reduction in granulocytic MDSCs (gMDSCs) during the final phases (6-8 weeks) of HCC progression. Suggesting that mMDSCs may foster immunological tolerance in the initial microenvironment of HCC tumors, whereas gMDSCs become more abundant during the intermediate and terminal phases. Hepatic tumor MDSC infiltration appears to be TLR4-regulated.

SPF mice were outlived by GF mice subsequent to GM modifications. Significantly, GF mice that were transplanted into SPF conditions exhibited a greater abundance of myeloid cell TLR4s than both GF and WT mice.

Conclusions: This study provides an HFD-induced MASLD-HCC model with accelerated carcinogenesis.

CRISPR/Cas9-mediated TLR4 deletion prevents

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mouse HCC progression. Early mMDSCs decrease and late gMDSCs decrease was observed in both CTLR4 and TLR4 mice, along with attenuated HCC progression. The findings suggest TLR4 regulation could reverse HCC and highlight immune cell-cancer interactions.

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COMPARING LENVATINIB/ PEMBROLIZUMAB VS. ATEZOLIZUMAB/BEVACIZUMAB IN UNRESECTABLE HEPATOCELLULAR CARCINOMA: A REAL-WORLD EXPERIENCE Yu-Chun Hsu1, Po-Ting Lin1, Wei Teng1, Yi-Chung Hsieh1, Wei-Ting Chen1, Chung-Wei Su1, Ching-Ting Wang2, Pei-Mei Chai2, Chen-Chun Lin3, Chun-Yen Lin1, Shi-Ming Lin1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 2 Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 3 Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan 1

2022. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) by modified RECIST were compared.

Results: 121 patients were recruited with 37 receiving L+P and 84 receiving A+B. Among them, 95 (78.5%) patients were BCLC stage C and 99 (81.8%) patients had viral etiology for HCC, predominantly chronic HBV (68.6%). Both the L+P and the A+B groups demonstrated comparable OS (18.2 months versus 14.6 months, p = 0.35) and PFS (7.3 months versus 8.9 months, p = 0.75). The ORR and DCR were similar. After propensity score matching, the results remained consistent between the matched patients. Treatment-related adverse events of any grade occurred in 28 (75.7%) in the L+P group and 53 (63.1%) in the A+B group.

Conclusions: Our findings suggest that L+P and A+B exhibit comparable efficacy and safety profiles in real-world settings.

比較樂衛瑪合併吉舒達與癌自禦合併癌 思停在不可切除肝細胞癌的真實世界經 驗 徐毓均1 林伯庭1 滕威1 謝彝中1 陳威廷1 蘇崇維1 王靜婷2 柴佩鎂2 林成俊3 林俊彥1 林錫銘1 1

林口長庚紀念醫院胃腸肝膽科 林口長庚紀念醫院護理部 3 新北市立土城醫院胃腸肝膽科 2

Background: The combination of anti-angiogenic therapy and immune checkpoint inhibitors has revolutionized the management of unresectable hepatocellular carcinoma (uHCC). While an earlyphase study demonstrated promising outcomes for lenvatinib plus pembrolizumab (L+P) in treating uHCC, the LEAP-002 trial did not meet its primary endpoint. However, the comparative efficacy between L+P and atezolizumab plus bevacizumab (A+B) as first-line treatment remains a topic of uncertainty.

Aims: This study aimed to assess the effectiveness and safety of L+P in contrast to A+B among patients diagnosed with uHCC. Methods: We conducted a retrospective analysis enrolled patients with uHCC who received L+P or A+B as initial systemic treatment at Chang Gung Memorial Hospital from June 2019 to December

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P.073

IN-HOSPITAL HCV-FREE ENDOSCOPE PROCEDURES PROJECT (CEPP): A SINGLE CENTER STUDY IN TAIWAN Benjamin Lih-Ren Hsieh1, Yen-Ting Kuo2, Ming-Yen Hsieh1,3, Yu‑Ju Wei1,3,4, Ming-Lun Yeh1,4,6, Chung-Feng Huang1,4, Chia-Yen Dai1,4,6, Jee-Fu Huang1,4,5,6, Ming-Lung Yu1,4,5,6, Wan-Long Chuang1,4 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 2 Department of Administration, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 4 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 5 Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 6 Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan 1

院內內視鏡檢查 C 型肝炎根除計畫 謝礪仁1 郭嫣婷2 謝明彥3,4 魏鈺儒1,3,4 葉明倫1,3 黃釧峰1,3 戴嘉言1,3,5 余明隆1,3,5,6 莊萬龍1,3 黃志富1,3,5,6 1

高雄醫學大學附設中和紀念醫院肝膽胰內科 高雄市立大同醫院行政部門 3 高雄醫學大學附設中和紀念醫院肝膽胰內科 4 高雄市立大同醫院內科部 5 國立中山大學代謝異常脂肪肝卓越研究中心 6 高雄醫學大學附設中和紀念醫院肝炎防治中心 2

Background: Since iatrogenic route is the major transmission vehicle for HCV infection, it is important to scrutinize the risks of medical treatments.

Although a complete disinfection for endoscopy devices should be able to eliminate the risk of HCV transmission, a new HCV infection could occur during the invasive procedures. Hence, preventing the risk of endoscopy-related HCV transmission is still impactful in a clinical setting. Previous studies

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show that a higher HBsAg (Hepatitis B serum antigen) screening rate, can be achieved with a proper reminder system. Similarly, studies have suggested that strategies such as call back system or mandatory testing for cancer patient significantly increase the HCV screening rate. Hepatitis C virus (HCV) elimination in the care cascades for patients receiving invasive procedures remains elusive.

This prospective study evaluated the efficacy of an elimination strategy implemented in a single center in Taiwan.

Aims: This study aimed to evaluate the efficacy of mandatory HCV screening for patients receiving endoscopy procedures. The screening rates before and during the project were compared. We also compared the screening rates between procedures of different departments.

Methods: The study was conducted in Kaohsiung Municipal Ta-Tung Hospital, which is a regional hospital in Kaohsiung City, Taiwan. The in-hospital HCV-free Endoscope Procedures Project (CEPP) was prospectively implemented in Jan 2021. All patients receiving an endoscopy were recommended for anti-HCV screening without anti-HCV screening record on electronic medical record (EMR) within the past 5 years. The screening measurement was further noticed by a pop out reminding signal prior to the endoscopic procedures. We retrospectively collected the data before CEPP from 2020 Jan to 2020 Dec for comparison. The screening rate of phase A (2020 Jan – 2020 Dec) and phase B (2021 Jan – 2022 Sep) was compared to evaluate the efficacy of the screening reminder system. Furthermore, the eligible CEPP patients were divided into those from Department of Internal Medicine (DOM) and those who are not from Department of Internal Medicine (non-DOM) to compare the screening rates between different departments. We perform anti-HCV tests with third-generation commercially available enzyme-linked immunosorbent assay kit (AxSYM 3.0; Abbott Laboratories, North Chicago, IL, USA), with reactive samples tested in triplicate and confirmed via HCV RNA assay. We detected serum HCV RNA with a standardized, automated qualitative reverse-transcription PCR assay (COBAS AMPLICOR Hepatitis C Virus Test, version 2.0; Roche, Branchburg, NJ, USA). Previous tests were performed in duplicate with a detection limit of 50 IU/ml. The difference between groups was analyzed using One-way ANOVA followed by a post-hoc test using Scheffe’s method. A two-sided hypothesis test with a

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P.074 significance level of p < 0.05 was implemented on all analyses. All data processing and statistical analysis were performed in IBM SPSS Statistic 20.

Results: The project was divided into two phases: before (2020 Jan – 2020 Dec, phase A) and during (2021 Jan – 2022 Sep, phase B) the screening electronic remind system. We examined the rate of screening, anti-HCV (+), HCVRNA (+), treatment, and sustained virological response (SVR) for both phases. Comparison between Phase A and Phase B: The anti-HCV screening rate was 18.7% (899/4812) during Phase A, with an anti-HCV+ rate of 4.0% (36/899). Four (11.1%, 4/36) HCVRNA+ patients were identified and three of them received DAA treatment. The screening rate in phase B was 64.2% (1857/2893), and anti-HCV+ rate 5.2% (97/1857).

There were 15.4% (15/97) patients with HCVRNA+, and 6 of them received DAA treatment. All nine of the HCVRNA+ patients (3 of phase A and 6 of phase B) who received the DAA treatment have achieved sustainable virological response (SVR). The screening rate of Phase B 64.2% (1857/2893) is significantly higher than that of Phase A 18.7% (899/4812) (p < 0.01). There is no significant difference between the anti-HCV+ rate and HCVRNA+ rate of both phases. Furthermore, all patients who received DAA treatment had reached SVR. Comparison of DOM vs. non-DOM: We further divided all endoscopy patients into 2 categories: patients from Department of Internal (DOM) and non-DOM. DOM patients have a screening rate of 41.6% (2107/5071), antiHCV+ rate of 4.4% (93/2107), HCVRNA+ rate of 9.7% (9/93), and a DAA treatment rate of 55.5% (5/9).

Whereas non-DOM patients have a screening rate of 28.2% (649/2299), antiHCV+ rate of 6.2% (40/649), HCVRNA+ rate of 25.0% (10/40), and a DAA treatment rate of 40.0% (4/10). All the patients who received DAA treatment have achieved SVR. The screening rate for DOM and non-DOM during two phases: During Phase A, there is no significant difference between the screening rate of DOM patients 21.1% (751/3553) and non-DOM patients 11.8% (148/1259) (p = 0.07). During Phase B, the screening rate of DOM 89.3% (1356/1518) is significantly higher than that of non-DOM 48.2% (501/1040) (p < 0.05).

Conclusions: The EMR-based project significantly increased the HCV screening rate for patients receiving endoscopy procedures. The increase in screening rate was more significant in DOM patients.

PHASE 1 STUDY FOR THE EVALUATION OF SAFETY AND EFFICACY OF T-ACE OIL USED IN TAE/TACE FOR HCC TREATMENT Hung-Chih Chiu1, Yi-Sheng Liu2, Huei-Lung Liang3, Wei-Lun Tsai4, Tung-Hung Su5, Po-Chin Liang6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2 Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 3 Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 4 Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 6 Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan 1

一項使用大員油（T-ACE Oil）以肝動脈 栓塞或肝動脈栓塞化學療法用於肝細胞 癌 病人之第一期試驗 邱宏智1 劉益勝2 梁慧隆3 蔡維倫4 蘇東弘5 梁博欽6 1

國立成功大學醫學院附設醫院胃腸肝膽科 國立成功大學醫學院附設醫院影像醫學部 3 高雄榮民總醫院放射線部 4 高雄榮民總醫院內科部 5 國立臺灣大學醫學院附設醫院胃腸肝膽科 6 國立臺灣大學醫學院附設醫院影像醫學部 2

Background: Transcatheter embolization/ chemoembolization (TAE/TACE) is a common treatment strategy for hepatocellular carcinoma (HCC). Lipiodol serves as both an embolic agent and a carrier for chemotherapeutic agents in TAE/TACE. T-ACE oil, a derivative of sunflower oil modified through ethylation and iodization, shares similar chemical properties to lipiodol.

Aims: This phase 1 study aims to evaluate the safety

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P.075 and efficacy of T-ACE oil in HCC patients undergoing TAE/TACE. Methods: We enrolled 12 patients with HCC (stage 0-B) to receive TAE/TACE. Exclusion criteria included poor liver function (Child-Pugh score ≥9), tumor number >10, or tumor size >15 cm. The initial three patient received TAE, the subsequent three underwent TACE, and the last six received either TAE or TACE at the investigator’s discretion. The procedure mirrored conventional TAE/TACE, except lipiodol was substituted with 1.5-15 mL of T-ACE oil, based on the tumor diameter. Contrast MRI assessments were conducted before and four weeks post-procedure to evaluate treatment responses according to mRECIST criteria. Adverse events (AEs) were graded using CTCAE v5.0.

Results: Of the 12 patients, 11 were evaluable for response and safety outcomes. Five underwent TAE and six received TACE. The median largest tumor size was 24.3 mm (range: 12-70 mm). Treatment responses included four complete remissions, four partial responses, and three cases of stable disease, resulting in an overall objective response rate (ORR) of 72.7% (8/11). Common AEs were hepatitis, fever, and abdominal pain, with 72% of AEs being mild. One severe adverse event (SAE) of septic shock occurred, which was not related to the investigational drug.

The patient with SAE fully recovered.

Conclusions: The safety and efficacy profile of T-ACE oil in TAE/TACE was comparable to that reported for lipiodol in similar settings. Based on these phase 1 results, a phase 2 randomized, double-blind trial comparing T-ACE oil and lipiodol in TACE is planned.

POST-TREATMENT OCCURRENCE OF SERUM CRYOGLOBULINEMIA IN CHRONIC HEPATITIS C PATIENTS Gantogtokh Dashjamts1, Amin-Erdene Ganzorig1, Yumchinsuren Tsedendorj1, Dolgion Daramjav1, Ganchimeg Dondov1, Otgongerel Nergui1, Tegshjargal Badamjav1, Chung-Feng Huang2, Po-Cheng Liang2, Tulgaa Lonjid1, Batbold Batsaikhan1,3, Chia-Yen Dai2,4,5 Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia 2 Department of Internal Medicine and Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Department of Health Research, Graduate School, Mongolian National University of medical Sciences, Ulaanbaatar, Mongolia 4 Ph.D. Program in Environmental and Occupational Medicine, and Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan 5 College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan 1

Background: Hepatitis C virus infection is highly prevalent worldwide and is known to be associated with extrahepatic manifestations. One of the most commonly reported clinical extrahepatic symptoms is mixed cryoglobulinemia (MC). Clinical manifestation of MC is referred to by the following syndromes including arthralgia, fatigue, and/ or myalgia, as well as small and medium vessel vasculitis. Antiviral therapy’s clearance of HCV is suggested to reduce the clinical manifestations of cryoglobulinemia and decrease cryoglobulin production. However, persistent cryoglobulinemia symptoms may arise even after achieving SVR through pegylated interferon alpha plus ribavirin treatment. Persistent cryoglobulinemia after completion of antiviral treatment is an important consideration of clinical management in chronic

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P.076 hepatitis C patients.

Aims: We aimed to investigate the occurrence of serum cryoglobulinemia in chronic hepatitis C patients without cryoglobulinemia at the initiation of antiviral treatment.

Methods: Totally 776 patients without cryoglobulinemia were assessed for serum cryoglobulinemia after completion of anti-HCV treatment. Serum cryoglobulinemia precipitation was assessed both initiation and completion of the treatment and analyzed for the clinical, laboratory factors associated with chronic hepatitis C. Results: One hundred eighteen (118) patients were checked for serum cryo-precipitation after completion of the treatment and 8 patients (4.6%) were positive for serum cryoglobulinemia. Patients who become positive cryoglobulinemia had a higher proportion of liver cirrhosis patients (4/50%, p = 0.033) and other organ cancer patients (5/62.5%, p = 0.006) than patients who remained no sign of cryoglobulinemia after treatment. In multivariate analysis, liver cirrhosis (Odds Ratio [OR]–17.86, 95% Confidence Interval [95% CI]: 1.79–177.35, p = 0.014) and other organ cancer (OR: 25.17, 95% CI: 2.59–244.23, p = 0.005) were independently and significantly associated with positive cryoglobulinemia 3 months after antiviral treatment.

Conclusions: Three months after the antiviral DAA therapy had concluded, eight patients checked positive for cryoglobulinemia, representing a 6.7% prevalence. Liver cirrhosis and other organ cancer were independently and significantly associated with positive cryoglobulinemia after antiviral treatment. Further investigation into the causes of positive cryoglobulinemia after DAA antiviral therapy is warranted.

CLINICAL OUTCOMES OF ALCOHOLASSOCIATED LIVER DISEASE IN A MEDICAL CENTER IN TAIWAN Chun-Ming Hong1, Tung-Hung Su2, Shih-Jer Hsu2, Tai-Chung Tseng3, Chen-Hua Liu2, Hung-Chih Yang2, Shang-Chin Huang4, Jia-Horng Kao2, Chun-Jen Liu2, Pei-Jer Chen2 Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 4 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 1

Background: Alcohol use disorder (AUD) is becoming increasingly important and has caused liver-related disease and death globally. This issue has become even more serious after the COVID-19 pandemic. Public awareness of and managements towards major liver diseases including viral hepatitis or metabolic dysfunction-associated steatotic liver disease (MASLD) have been improving over the decades. In contrast to other etiologies of liver diseases, studies for alcohol-associated liver disease (ALD) are not easily conducted in Taiwan because of lack of effective therapies and of patient compliance.

Aims: To explore current epidemiology of ALD in Taiwan.

Methods: We conducted a retrospective study by looking into Integrative Medical Database in National Taiwan University Hospital (NTUH-iMD) from 2006 to 2021. ICD-9 (International Classification of Diseases, ninth edition) and ICD-10 were used for disease coding. The inclusion criteria are patients whose diagnosis was made once at outpatient or inpatient and over 20 years old, while the exclusion criteria are those who had hepatocellular carcinoma (HCC), liver transplantation, or death before the index date. The index date was the first time when the patient was diagnosed inpatient or outpatient.

Results: From 2006 to 2021, 4403 patients were recruited from NTUH-iMD. 4001 patients were diagnosed at outpatient while 1330 patients were diagnosed when hospitalized. 3757 (85.33%)

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P.077 patients were male. However, the percentage of female patients in 20-30s (35.96%) was increasing than other age groups (10.53% to 19.20%). Mean total bilirubin was 2.69 mg/dL, mean ALT was 66.68 U/L, and the mean GGT was 277.19 U/L. The average of FIB-4 index was 5.43. 328 patients (7.45%) had HBV infection while 138 patients (3.13%) had HCV infection. 819 patients were ALBI grade 1, 915 patients were ALBI grade 2, and 410 patients were ALBI grade 3. 402 patients (9.13%) had psychiatric or neurologic comorbidity. 79 patients (1.79%) received liver transplantation, 162 patients (3.68%) developed HCC, and 1584 patients (35.98%) died.

Conclusions: Our single-center retrospective study presents a preliminary epidemiology of ALD in urban areas in northern Taiwan. While over 85 percent of ALD patients were male, the percentage of young female ALD patients was increasing. Moreover, a high mortality suggested ALD awareness and managements as an important unmet need to be addressed.

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THE RAPID REDUCTION RATE WAS SIGNIFICANTLY LOWER IN GREY ZONE HBEAG-NEGATIVE PATIENTS WHO STARTED ANTIVIRAL THERAPY COMPARED TO THOSE WITH ACTIVE HEPATITIS Yen-Chun Liu1,2, Wen-Juei Jeng1,2, Rong-Nan Chien1,2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

Background: HBsAg seroclearance in active hepatitis B treatment may take >3-4 decades. Little is known about HBsAg kinetics during treatment in grey zone HBeAg-negative patients (GZ), crucial due to longer treatments leading to adherence and follow-up challenges.

Aims: This study compares on-treatment HBsAg kinetics in GZ HBeAg-negative CHB patients (GZ group) to those with active HBeAg-negative hepatitis (Active CHB group) receiving Nuc treatment.

Methods: Non-cirrhotic HBeAg-negative CHB patients on Nuc therapy >1 year with consecutive HBsAg assessments were enrolled, excluding those on prophylactic Nuc therapy for cancer or immunosuppressive agents, or with HCV, HDV, or HIV coinfection. The grey zone was defined as HBV DNA <2000 IU/mL + ALT ≥ 1 time (x) upper limit of normal (ULN) or HBV DNA ≥ 2000 IU/mL + ALT < 2x ULN. The active CHB group was defined as HBV DNA ≥ 2000 IU/mL + ALT ≥ 2x ULN. Phenotype was based on ≥2 consecutive assessment. HBsAg kinetics was calculated as the average reduction per year: (log reduction of last HBsAg level pretherapy HBsAg level)/(assessment interval in years). Rapid HBsAg decline was defined as a reduction > 0.5 log10 IU/ mL per year. A 2:1 Propensity Score Matching (PSM) adjusted age, gender, Nuc types, pretherapy HBsAg level was used for sensitivity analysis.

Results: Among 1793 HBeAg-negative patients, 115 were in GZ group. The GZ group had lower pretherapy HBV DNA (4.8 vs. 6.3 log10 IU/mL), HBsAg (2.9 vs. 3.1 log10 IU/mL) and ALT levels (44 vs. 177 U/L) compared to the active CHB group (all P < 0.01). The proportion treated with high genetic barrier Nucs (ETV or TDF) was comparable. The treatment duration was longer in the active CHB

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P.078 group (median: 3 vs. 2.7 years, P < 0.01). The annual HBsAg reduction was less in GZ group (median: -0.15 vs. -0.06 log10 IU/mL/year, P < 0.01). In the active CHB group, 13% achieved rapid HBsAg reduction while none in GZ group (figure, P < 0.01). After PSM, there were 230 in active CHB and 115 in GZ group.

Annual HBsAg reduction remained lower in the GZ group (median: -0.13 vs. -0.06 log10 IU/mL/year, P < 0.001), with 12% of the active CHB group achieving rapid HBsAg decline compared to none in GZ group (P < 0.01).

Conclusions: The significantly lower HBsAg reduction in the GZ group suggests they need much longer treatment compared to the active CHB group to achieve HBsAg loss. This raises concerns about the potential need for lifelong therapy in GZ HBeAgnegative patients, given the debatable benefits.

PREVALENCE OF METABOLIC DYSFUNCTION–ASSOCIATED FATTY LIVER DISEASE AMONG ADULTS IN ULAANBAATAR, MONGOLIA Dolgion Daramjav, Yumchinsuren Tsedendorj, Ganchimeg Dondov, Tegshjargal Badamjav, Batbold Batsaikhan, Lonjid Tulgaa Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia Background: Introduction: The global prevalence of MAFLD among adults is 25-30%, and it is increasing.

MAFLD may lead to chronic liver disease and liver cirrhosis. However, there is no data on the prevalence of MAFLD in Mongolia.

Aims: In this study, we aimed to estimate the prevalence of MAFLD among adults in the urban population (Ulaanbaatar city) in Mongolia.

Methods: Methods: A cross-sectional study was conducted among Mongolian adults who received health care services at referral hospitals in Ulaanbaatar from January 2023 to February 2024.

MAFLD was diagnosed in subjects who have both hepatic steatosis and metabolic disorders according to the new international expert consensus. All participants were seronegative for HBsAg and anti-HCV and had limited alcohol assumption.

Data was collected using a developed structured questionnaire consisting of 76 questions covering 4 categories. The total prevalence of MAFLD and prevalence by sex and age was estimated.

Results: Results: A total of 600 participants (mean age: 52.5 ± 9.3 years, 52.9% women) were included.

The overall prevalence of MAFLD in Mongolian adults was 34.3% (n = 205). In participants diagnosed with MAFLD, the prevalence of overweight/obesity was up to 87.1%, type 2 diabetes (T2DM) and hypertension were 42.6% and 29.9%, respectively. Among patients with smoking, hyperlipidemia, and family history of liver steatosis, the prevalence of МAFLD was 14.4%, 33.8%, and 38.5%, respectively. Also, liver steatosis by severity for mild, moderate, and severe was 25.4%, 43.9%, and 30.7%, respectively. In all participants, BMI, SBP, TG, TC and ALT, AST were associated with MAFLD (all p < 0.001).

Conclusions: Conclusions: The urban population of Ulaanbaatar, Mongolia is 34.3% prevalence of MAFLD. BMI, SBP, TG, TC and ALT, AST were associated with MAFLD.

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P.079

ASSOCIATED FACTORS TO INCREASE ON ESTIMATED GLOMERULAR FILTRATION RATE IN CHRONIC HEPATITIS C PATIENTS Gantsetseg Gantumur1, Dolgion Daramjav1, Yumchinsuren Tsedendorj1, Amin-Erdene Ganzorig1, Enkhmend Khayankhyarvaa1, Gantogtokh Dashjamts1, Tegshjargal Badamjav1, Tulgaa Lonjid1, Batbold Batsaikhan1,2 Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia 2 Department of Health Research, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia 1

Background: Globally, an estimated 50 million people have chronic hepatitis C virus infection, with about 1.0 million new infections occurring per year. Direct-acting antivirals (DAAs) have improved the treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD).

Aims: We aimed to estimate the effect of DAA treatment on renal function in chronic hepatitis C patients.

Methods: An estimated 3529 patients with HCV infection were enrolled in this study between. We used the modification of diet in renal diseases to calculate estimated glomerular filtration rate (eGFR). eGFR assessed and evaluated at the initiation of the treatment and 6 months after completion of the treatment. Demographic and laboratory parameters were assessed, and appropriate statistical methods were performed for the analysis.

Results: The mean age of the patients was 61.89 ± 12.45 years, 54.7% were male. The mean of eGFR in baseline and after treatment groups were similar.

Liver fibrosis score (FIB4), liver function tests were significantly reduced after DAA treatment (p < 0.0001). However, lipid profiles increased after treatment group (p < 0.0001). We have found that older patients (over 60 years old) with advanced fibrosis (FIB4 > 3.25) were decreased eGFR level after treatment compared with baseline (n = 967, 79.45 ± 27.61 vs 77.26 ± 27.68; p < 0.001). Nevertheless, younger patients (below 60 years old) with mild

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fibrosis (FIB4 < 3.25) were increased eGFR level after treatment compared with baseline (n = 1022, 93.00 ± 26.03 vs 94.47 ± 28.76; p = 0.018).

Conclusions: Younger age and mild fibrosis score are the factors to increase renal function after DAA treatment in chronic hepatitis C patients. Early diagnosis and treatment are suggested in chronic hepatitis C to recover renal function.

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Section：GI P.080

THE ASSOCIATION BETWEEN HEPATITIS B, C VIRUS INFECTION AND RENAL FUNCTION Gantsetseg Gantumur1, Amin-Erdene Ganzorig1, Enkhmend Khayankhyarvaa1, Gantogtokh Dashjamts1, Batbold Batsaikhan1,2 Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia 2 Department of Health Research, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia 1

Background: The association between hepatitis C virus (HCV) and hepatitis B virus (HBV) infection and chronic kidney disease (CKD) still remains controversial.

Aims: We aimed to investigate whether HCV and HBV really affect renal function, and to analyze the association between clinical effects of CHC and decreased kidney function (assessed by glomerular filtration rate (eGFR) level).

Methods: Totally 3114 patients enrolled in this study and 1038 age- and sex-matched communitybased control individuals, 1038 HBV and 1038 HCV infected individuals were assessed (1:1:1, cases and control ratio). We used the modification of diet in renal diseases to calculate eGFR. Demographic and laboratory parameters were assessed, and appropriate statistical methods were performed for the analysis.

Results: The mean eGFR were lower in HCV group (85.8 ± 24.3; p < 0.0001) compared with HBV and control groups (95.6 ± 20.8 and 95.4 ± 7.3; p = 0.795).

Number of patients with eGFR < 90 were higher in HCV (59.3%), HBV (33.9%) compared with control group (11.8%). Also, the number of patients with eGFR < 60 were higher in HCV and HBV groups (9.5% and 5.2% vs 0%; both p < 0.0001). Multivariate logistic regression analysis showed that HCV infection (OR 0.1; 95% CI-0.08-0.13; p < 0.0001), HBV infection (OR 0.3; 95% CI-0.24-0.39; p < 0.0001), liver fibrosis (OR 0.6; 95% CI-0.51-0.75; p < 0.0001), male gender (OR 0.5; 95% CI-0.46-0.65; p < 0.0001), BMI (OR 0.9; 95% CI0.95-0.99; p < 0.037) were associated with lower eGFR (<90).

Conclusions: Our study found that HBV, HCV infection and gender, liver fibrosis, BMI are associated with a low eGFR. FIB4 score and eGFR were negatively correlated in our cohort.

P.081

ENDOSCOPIC ULTRASOUNDGUIDED COIL INJECTION FOR GASTRIC VARICES: INITIAL EXPERIENCE IN A TAIWANESE MEDICAL CENTER Jung-Chun Lin1, Hsing-Hao Ho2, Tien-Yu Huang1, Peng-Jen Chen1, Tsai-Yuan Hsieh1, Wei-Kuo Chang1 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 2 Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 1

內視鏡超音波引導下栓塞線圈注射治療 胃靜脈曲張：台灣醫學中心初步經驗 林榮鈞1 何幸豪2 黃天祐1 陳鵬仁1 謝財源1 張維國1 1 2

國防醫學院三軍總醫院胃腸科 國防醫學院三軍總醫院放射診斷部

Background: Gastric varices (GV) are a catastrophic complication of portal hypertension with significant morbidity and mortality. However, high-quality data on optimal management of GV bleeding is lacking.

Endoscopic ultrasound (EUS)-guided coil therapy has emerged as a promising procedure for treating GV, especially compared to conventional direct endoscopic glue injection.

Aims: To describe our initial experience with EUSguided therapy for GV in Taiwan, as no data on its feasibility and safety in the Taiwanese population is currently available.

Methods: We retrospectively analyzed patients with bleeding GV or GV at risk of bleeding who underwent EUS-guided coil injection therapy at a tertiary care center between 2021 and 2023. Baseline patient and procedure-related information was collected.

The procedure involved injecting 0.018 or 0.035inch hemostatic coils using a 19-gauge fine needle aspiration needle. Primary outcomes included technical success (successful coil deployment with diminished Doppler flow) and clinical success (cessation of bleeding). Intra-procedural and postprocedural adverse events were also assessed.

Results: Five patients (mean age 68 ± 11.9 years; 60% female) were included. Cirrhosis was the most common cause of GV (80%). Eighty percent

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P.082 presented with acute GV bleeding requiring intensive care and/or blood transfusion. Isolated GV type 1 was the most common (80%). A mean of 2.8 ± 1.8 coils were injected with a total mean length of 37.6 ± 25.1 cm. Both technical and clinical success rates were 100%. No major adverse events occurred.

Conclusions: This single-center study in Taiwan demonstrates high technical and clinical success rates for EUS-guided coil injection therapy in GV management. Further prospective studies comparing this modality with other common interventions for GV are warranted.

THE EFFECTIVENESS OF ENDOSCOPIC ARGON PLASMA COAGULATION ABLATION V.S. PROTON PUMP INHIBITORS FOR THE LARYNGOPHARYNGEAL SYMPTOMS IN SYMPTOMATIC CERVICAL INLET PATCHES: A FIRST CASE SERIES IN ASIA-PACIFIC REGION Yoen-Young Chuah1,2, Lian-Feng Lin1, Chia-Jung Kuo1, Seng-Howe Nguang1, Yi-Chun Chan1, Chung-Fong Lin1, Lin-Suei Jhang1, Yeong Yeh Lee3, Chu-Kuang Chou4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Pingtung, Taiwan 2 Department of Nursing, Mei Ho University, Pingtung, Taiwan 3 Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan 1

內視鏡氬氣電漿凝固消融術與質子泵抑 制劑對有症狀食道入口斑塊患者咽喉症 狀的療效比較：亞太地區首例病例系列 研究 蔡元榮1,2 林連豐1 郭志榮1 阮盛豪1 詹益群1 林群峰1 張琳遂1 李永葉3 周莒光4 1

屏東基督教醫院胃腸肝膽科 美和科技大學護理系 3 馬來西亞理科大學醫學院 4 嘉義基督教醫院胃腸肝膽科 2

Background: Cervical inlet patch (CIP), an islet of heterotopic gastric mucosa seen in the upper esophagus with the presentation as salmon colored patch in conventional esophagogastroduodenoscopy.

Its incidence runs from 0.1% to 10%. Commonly seen laryngopharyngeal symptoms like globus feeling, hoarseness, odynophagia, and dysphagia have been reported to be related to CIP. Usually, the first step of medical care for symptomatic CIP starts with the use

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of strong acid suppression drugs, including protonpump inhibitors (PPI); nonetheless, the effectiveness of these proton-pump inhibitors is limited and durability of these medications remains unknown. A few Western studies have shown that in individuals with CIP, endoscopic treatment with argon plasma coagulation (APC) is progressively successful in reducing laryngopharyngeal symptoms. One study showed that long-term effects spanning up to 27 months of follow-up after the APC ablation treatment. However, there are not any relevant studies comparing the efficacy of APC ablation versus proton-pump inhibitors in Asia-Pacific nations. We retrospectively reviewed a cohort conducted in our hospital including six symptomatic CIP patients gathered for comparison of the APC ablation treatment against proton-pump inhibitors. This case series serves as the first case series in Asia-Pacific region and might further clarifies the probable use of APC ablation for Asian-Pacific nations’ symptomatic CIP patients.

Aims: To evaluate the efficacy of Argon plasma coagulation ablation versus proton pump inhibitors for laryngopharyngeal symptoms in symptomatic CIP patients.

Methods: From May 22, 2022, to June 30, 2024, we gathered six symptomatic patients overall, verified to be CIP endoscopically and pathologically.

Patients less than 20 and those who declined argon plasma coagulation ablation were eliminated. Every enrolled patient had endoscopic ablation at pulsed force, 60 W and 2 L/min in one session in order to reduce the CIP. Visual analog score (from 0 to 10) based questionnaires with the higher the score, more severe the symptoms for symptoms of dry throat, burning throat, globus sensation, hoarseness and clearing throat were distributed to patients at the time points of before the use of proton pump inhibitors, after the use of proton pump inhibitors and one month after the endoscopic ablation with APC to evaluate the efficacy endoscopic procedure.

With more than five out of ten of a pain score, we defined symptomatic CIP with at least one of the above -described symptoms. Efficiency of APC and proton-pump inhibitors was then compared in these individuals.

Results: The current study recruited a total of six patients. Majority of patients were female (67%) in gender and had an average age of 41 years (ranging from 27 years old to 50 years old). The CIP was located in the upper esophagus at 16.7 cm in

average from the incisors (15–18 cm), and two-thirds of the patients had more than one CIP. The average size of CIP was about 0.6 cm (ranging from 0.3 cm to 0.8 cm). If compared the use of PPI, the APC ablation improved the five parameters (dry throat (2, 4, P = 0.16), burning sensation (0, 3, P = 0.03), foreign body sensation (1, 4, P = 0.01), hoarseness (1,4, P = 0.05) and clearing throat (1,2, P = 0.12). Foreign body sensation showed the most prominent improvement with APC ablation if compared to other symptoms.

There were no complications, such as perforation, infection, ulcers, or stricture, after the procedure. No residual CIP in all recruited patients was seen one month after the APC procedure in the follow-up EGD. Conclusions: APC ablation significantly improved symptomatic CIP patients with laryngopharyngeal symptoms of burning sensation, foreign body sensation and hoarseness if compared to protonpump inhibitors treatment in Asia-Pacific population.

To confirm the significance of APC in symptomatic CIP patients, nonetheless, more prospective randomized trials with a bigger sample size are required.

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P.083

MULTIPLE DRAINAGE APPROACHES TO DRAIN A MAXIMUM OF LIVER SEGMENTS DID NOT IMPROVE CLINICAL OUTCOMES IN PALLIATIVE DRAINAGE OF MALIGNANT HIGH GRADE BILIARY STRICTURES Tung-Yen Lin1,2, Yu-Ting Kuo1,2,3, Jia-Kuo Chen4, Hung-Yao Lin1,2, Sheng-Jie Chang1,2, Chi Ko1,2, Hsiu-Po Wang1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan 4 Department of Internal Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan 1

最大限度姑息性膽道引流對於高度惡性 膽道狹窄無法增加顯著預後 林東彥1,2 郭雨庭1,2,3 陳嘉國4 林弘堯1,2 張勝傑1,2 葛齊1,2 王秀伯1,2 1

國立臺灣大學醫學院附設醫院胃腸肝膽科 國立臺灣大學醫學院附設醫院內科部 3 國立臺灣大學醫學院附設醫院內視鏡科 4 衛生福利部金門醫院內科部 2

Background: According to previous literature, achieving optimal treatment for biliary strictures includes ensuring drainage of more than 50% of the liver volume, which is linked to improved median survival. Recently, there has been significant progress in endoscopic devices and new biliary drainage modalities, such as endoscopic ultrasoundguided biliary drainage (EUS-BD). Therefore, it remains unclear the clinical impact of using multiple drainage approaches to drain a maximum of liver segments Aims: To evaluate the percentage of liver drained and its correlation on survival whatever the drainage technique used in unresectable malignant high grade biliary strictures.

Methods: This study retrospectively reviewed the patients with high grade biliary strictures (at least

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Bismuth type II) with diagnosis of unresectable malignancy, who underwent biliary drainage using different modalities, including endoscopic retrograde cholangiography, EUS-guided, or percutaneous methods at National Taiwan University Hospital. The study evaluated drainage efficacy based on the proportion of successfully drained liver segments. Our primary endpoint was overall survival, while secondary endpoints included technical success, clinical success, reintervention rate, stent patency duration, and complications.

Results: Total 95 patients were included from January 2014 to January 2024. The percentage of liver segments drained was dichotomized based on a threshold value of 85%, resulting in two groups (between 50% and 85%; and ≥85%). The median duration of follow-up was 105 days (interquartile range, 58.5–314) for the biliary drainage between 50 and 85% group and 192 days (interquartile range, 88–386) for the biliary drainage ≥85% group (P = .111). Biliary drainage ≥85% did not prolong the overall survival in Kaplan-Meier analysis, comparing to drainage between 50 and 85% (P = .557). There was no significant difference between patients receiving biliary drainage between 50% and 85% and ≥85% in technical success rates (95% vs 88.6%, P = .193), clinical success rates (88.3% vs 91.1%, P = .264), reintervention rate (59.2% vs 67.4%, P = .561), and overall complication rate (20.4% vs 13%, P = .663).

Conclusions: Multiple drainage approaches to drain a maximum of liver segments did not improve clinical outcomes and adequate drainage (≥50%) may be enough for palliative drainage of malignant high grade biliary stricture.

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P.084

IMPACT OF PERIOD AND BIRTHCOHORT ON THE TEMPORAL TREND OF ADVANCED NEOPLASMS PREVALENCE IN THE 40–49 AVERAGE-RISK SCREENING POPULATION Hsu-Hua Tseng1, Chiu-Wen Su1, Wen-Chen Chang1, Wei-Yuan Chang2, Wen-Feng Hsu1, Li-Chun Chang1, Ming-Shiang Wu1, Han-Mo Chiu1

(0.83–1.41)] and [2015–2019: aOR = 0.76 (0.56–1.03)] when compared with age 45–49.

Conclusions: The prevalence of AN in age 40–54 increased in Taiwanese population with a later birth cohort harbored a higher prevalence of AN. However, the prevalence of AN in age 45–49 increased more remarkably and approximated those in age 50–54, which may justify earlier initiation of colorectal cancer screening at age 45.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

不同年代與出生世代對 40–49 歲一般風 險篩檢族群大腸進行性腺瘤盛行率歷年 變化之影響 曾旭華1 蘇秋文1 張文禎1 張為淵2 許文峰1 張立群1 吳明賢1 邱瀚模1 1 2

國立臺灣大學醫學院附設醫院內科部 國立臺灣大學醫學院附設醫院癌醫中心分院內科部

Background: Early-onset colorectal cancer (CRC) is increasing globally. While the United States has lowered the initiation age of screening to 45, current practices in other countries still commence screening at 50. In Taiwan, the incidence of CRC declined in 55– 74 after the initiation of screening, but still increased in 50–54, which potentially resulted from the rising precancerous lesions in 40–49.

Aims: This study aimed to explore the chronological trend of the prevalence of colorectal advanced neoplasm (AN) in the screening population aged 40–54.

Methods: We retrospectively analyzed the screening colonoscopy cohort for prevalence of AN in averagerisk subjects aged 40–54 from 2003 to 2019. Logistic regression was used to distinguish a cohort effect from a time-period effect on the prevalence of AN. Results: Totally, 27,805 subjects, 14,500 (52.1%) men and 13,305 (47.9%) women, were enrolled.

Remarkable increases in prevalence of AN were noted in all three age groups during this 17-year span, but more rapidly in age 40–44 (0.99% to 3.22%) and 45–49 (2.50% to 4.19%). Age 50–54 harbored higher risk of AN [aOR = 1.62 (1.19–2.19)] in 2003– 2008 but not in later periods [2009–2014: aOR = 1.08

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P.085

TIMING IN ENDOSCOPIC INTERVENTION FOR ESOPHAGEAL SHARP-POINTED FOREIGN BODY REMOVAL: BALANCING SWIFTNESS AND EFFICIENCY Po-Han Huang1,2, Ming-Jen Chen1,2,3 Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 Department of Medicine, MacKay Medical College, New Taipei City, Taiwan 3 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 1

食道尖銳異物的內視鏡介入時機：速與 效的平衡 黃柏翰1,2 陳銘仁1,2,3 1

馬偕紀念醫院胃腸肝膽科 馬偕醫學院醫學系 3 馬偕醫護管理專科學校 2

Background: Foreign body ingestion, especially of sharp objects, is a common medical emergency.

Often, these objects naturally pass through the gastrointestinal tract within a week, provided they are not trapped in the esophagus. However, they can cause serious complications such as mucosal inflammation, deep neck abscess, mediastinitis, and even esophageal perforation. Complication rates from some studies are reported to be as high as 20%, with major complications occurring in around 10% of cases. A recent study highlighted risk factors contributing to complications, including older age at presentation, fewer underlying gastrointestinal diseases, and a longer duration of foreign body impaction prior to endoscopic management (over 24 hours).The timing of endoscopic intervention is a key aspect of patient management. Both the European Society of Gastrointestinal Endoscopy (ESGE) and the American Society of Gastrointestinal Endoscopy (ASGE) recommend performing an emergent endoscopic procedure within 6 hours for esophageal obstruction or sharp-pointed objects in the esophagus.

Aims: Despite the clinical benefits of emergency endoscopy, it poses a significant burden on medical practitioners and requires a greater financial investment from the healthcare system. As such, our research is focused on reevaluating the optimal

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timing for endoscopic removal of sharp esophageal foreign bodies and identifying the primary risk factors that lead to complications.

Methods: This retrospective study, conducted from 2021 to 2023, enrolled emergency department patients diagnosed with esophageal sharp-pointed FB ingestion via EGD. Endoscopic intervention timing was categorized as emergent, urgent, or nonurgent. Complications were assessed postprocedure, ranging from minor mucosal injuries to severe issues like deep lacerations, perforations, or bleeding requiring further procedures for hemostasis. Logistic regression analyses assessed uni- and multivariate factors predicting overall and major complications. We used the Trend Chi-Square test to evaluate the association between impaction duration and complications, and the Chi-Square test for major complications to compare emergent and urgent groups.

Results: Our study involved 112 out of 168 patients presenting with sharp-pointed FB ingestion, primarily females (69.8%) with a median age of 59 (21-99). The most common FBs were fish bones (n = 70, 66.0%), followed by medication foil (n = 18, 17.0%) and poultry bones (n = 16, 15.1%). The cervical esophagus was the most frequent lodgment site (n = 48, 45.3%). Interventions were categorized as emergency (n = 32, 30.2%), urgent (n = 59, 55.6%), and nonurgent (n = 15, 14.2%). Successful FB removal was achieved in 94.3% of cases. Complications were reported in 69 of patients (65.1%), with minor complications including mucosal erosions or abrasions (43.4%) and lacerations (10.4%).

Major complications included deep lacerations with bleeding (4.7%), deep ulceration (4.7%), and perforation (1.9%). Non-emergent endoscopy (P = 0.02) and longer FBs (P = 0.005) were associated with higher complications. Major complications were only associated with non-urgent endoscopy (P = 0.02). The longer duration of impaction had the trend with higher major complication (P = 0.02). and the weak correlation between duration of impaction and major complications was found (Spearman correlation coefficient = 0.22, P = 0.03). No significant difference in major complication rates was observed between emergent and urgent endoscopy groups.

Conclusions: Our study highlights the importance of prompt intervention in managing esophageal sharp-pointed FB ingestion. We found that emergency endoscopy significantly lowers overall complications, aligning with ESGE and ASGE

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P.086 guidelines. However, our findings also suggest that urgent endoscopy could be adequate to minimize major complications, presenting a more pragmatic and resource-effective strategy. We discovered that larger FBs and non-emergent endoscopy correlate with higher complications, emphasizing the need for early intervention. Further comprehensive studies are needed to determine the optimal intervention timing.

A MULTICENTER STUDY OF ENDOSCOPIC RESECTION FOR GASTRIC MYOGENIC TUMORS Chih-Tsung Fan1, Tze-Yu Shieh2, Wen-Hung Hsu3, Hsi-Yuan Chien4, Ching-Tai Lee5, Wei-Chen Tai6, Sz-Iuan Shiu7,8,9, I-Ching Cheng10, Chen-Shuan Chung1,11 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2 Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 3Division of Gastroenterology, Kaohsiung Medical University ChungHo Memorial Hospital, Kaohsiung, Taiwan; 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; 5 Department of Endoscopy, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan; 6 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 8Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 9Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan; 10Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan; 11School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 1

以內視鏡切除胃肌肉層腫瘤：一個多中 心研究 范之仲1 謝子鈺2 許文鴻3 簡錫淵4 李青泰5 戴維震6 許斯淵7,8,9 鄭以勤10 鍾承軒1,11 1

亞東紀念醫院肝膽胃腸科；2 馬偕紀念醫院胃腸肝 膽科；3 高雄醫學大學附設中和紀念醫院胃腸內科； 4 臺北醫學大學附設醫院消化內科；5 義大醫療財團 法人義大醫院；6 高雄長庚紀念醫院胃腸肝膽科；7 臺中榮民總醫院胃腸肝膽科；8 臺中榮民總醫院重症 醫學部；9 國立陽明交通大學內科學系；10 基督復臨 安息日會醫療財團法人臺安醫院胃腸肝膽科；11 天

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P.087 主教輔仁大學醫學系

Background: The prevalence of gastric subepithelial lesions (SELs) is rising. Endoscopic resection (ER) provides minimally invasive alternatives for resection of gastric myogenic tumor.

Aims: This study aims to evaluate the effectiveness and safety of endoscopic dissection of gastric myogenic tumors as well as the endoscopic ultrasound (EUS) predictors for gastrointestinal stromal tumors (GISTs).

Methods: The study was conducted between January 2012 and April 2024 at eight tertiary-care referral centers in Taiwan. We consecutively enrolled patients with EUS documented myogenic origin of stomach which were managed by endoscopic muscular dissection (EMD), endoscopic subserosal dissection (ESSD), submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR). The primary outcomes were technical success and en-bloc rates. The secondary outcomes included R0 resection rate, procedure time, complications, rate of shifting to unintentional EFTR, hospital stay, tumor recurrence, and mortality.

Results: In total, 310 patients with 317 lesions [146 (46.1%) leiomyoma, 146 (46.1%) GISTs and 25 (7.8%) SELs with other histology] were enrolled. ER technique included 188 (59.3%) EMD, 43 (13.6%) ESSD, 28 (8.8%) STER and 58 (18.3%) EFTR. The technical success rate, en-bloc rate and R0 resection rates were 96.5%, 94.3% and 89.3%, respectively, whereas mean (range) EUS tumor size and procedure time were 14.5 (3~45) mm and 60.4 (7~315) minutes.

Twenty-two (6.9%) procedures were shifted to unintentional EFTR within the patients with GIST. Two (0.6%) patients had recurrence during mean follow-up period of 944.1 days. 20 (6.3%) patients had complication including 15 (4.7%) intra-procedure inadvertent perforation, 1 (0.3%) delay perforation, 2 (0.6%) delayed bleeding and 2 (0.6%) others.

Two (0.6%) patients died of non-procedure related reasons. Male gender, elderly age, larger EUS tumor size, heterogeneous echotexture and exophytic growth pattern under EUS were independent risk factors for GIST. Conclusions: ER appeared to be an efficient and safe method for the management of gastric myogenic tumors. Additionally, the malignant potential could be predicted by EUS features.

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EVALUATION OF EFFECT OF LENVATINIB ON NF-KB SIGNALINGMEDIATED SURVIVAL AND INVASION IN COLORECTAL CANCER CELLS Chien-Hua Chen Digestive Disease Center, Show Chwan Memorial Hospital, Changhua, Taiwan

評估樂衛瑪對 NF-KB 訊號介導大腸直腸 癌細胞存活和侵襲的影響 陳建華 秀傳醫療社團法人秀傳紀念醫院消化系中心

Background: Constitutive nuclear factor-kappaB (NF-kB) activation upregulates anti-apoptotic and invasion ability in colorectal cancer (CRC). Inhibition of NF-kB signaling downregulates survival and invasion of CRC. Lenvatinib, an oral multikinase inhibitor, presents promising clinical activity in metastatic CRC patients. In addition, lenvatinib has been shown to reduce NF-kB signaling in liver and lung cancer. However, whether lenvatinib inhibits NF-kB signaling in CRC cells is ambiguous.

Aims: The main goal of present study is to evaluate effect of lenvatinib on NF-kB signaling-mediated survival and invasion in CRC cells.

Methods: CRC HT-29 and HCT-116 cells will be treated with different concentration of lenvatinib for 48 h.

Effects of lenvatinib on cell proliferation, apoptotic signaling, and extracellular signal-regulated kinase (ERK)/NF-kB signaling were evaluated by using cell viability assay, flow cytometry, and western blotting.

Results: The results showed that lenvatinib reduces ERK/NF-kB signaling and significantly inhibits cell growth. Furthermore, lenvatinib effectively induces apoptosis through extrinsic and intrinsic pathways in CRC cells.

Conclusions: Based on our results, we suggest that suppression of ERK/NF-kB signaling and induction of apoptosis are associated with lenvatinib-inhibited growth of CRC cells.

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P.088

THE FACTORS ASSOCIATED WITH ESOPHAGEAL STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUB-CIRCUMFERENTIAL OR CIRCUMFERENTIAL SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA Kazuki Yamamoto, Masakatsu Fukuzawa, Takahiro Muramatsu, Midori Mizumachi, Satoshi Shimai, Miki Wada, Tomohiro Ida, Haruki Kaizuka, Kenichi Tadokoro, Fumito Yamanishi, Yasuyuki Kagawa, Takashi Morise, Yoshiya Yamauchi, Shin Kono, Sakiko Naito, Takao Itoi

oral steroid administration alone in 17 cases (36.2%), a combination of steroid injections and oral steroid administration in 17 cases (36.2%), and no measure in 6 cases (12.8%). Postoperative strictures occurred in 17 cases. Univariate analysis revealed that muscular layer exposure was significantly associated with strictures (p = 0.043). Furthermore, among the muscular layer exposure group, the stricture rate was compared between those with clip suturing and those without, showing rates of 64.2% vs. 20% (p = 0.031), indicating a higher tendency for strictures in the clip suturing group.

Conclusions: During sub-circumferential or circumferential ESD for ESCC, intraoperative muscular layer exposure was suggested to be a potential factor associated with postoperative strictures.

Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan Background: Endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (ESCC) is a minimally invasive and highly curative treatment method. However, extensive resection cases often develop postoperative stricture. To prevent stricture after ESD, the cases that resect more than 75% of the circumference of the lumen commonly need local steroid injections for mucosal defects or oral steroid administration.

Despite these measures, some patients develop severe strictures.

Aims: To investigate the associated factors of esophageal stricture after sub-circumferential or circumferential ESD for superficial ESCC. Methods: Consecutive patients with superficial ESCC who underwent sub-circumferential or circumferential ESD between January 2016 and September 2022 were retrospectively analyzed.

Results: Forty-seven patients were evaluated.

The median patient age was 68 (range, 44-90) years. Sub-circumferential and circumferential resections were performed in 44 and 3 cases, with a median resection length of 33.5 (range, 2-65) mm, and all cases achieved en-bloc resection. The pathological depth of invasion was EP/LPM/MM/ SM1 in 5/26/12/4 cases. Intraoperative muscular layer exposure was observed in 24 cases (51.1%), and 14 of these (29.8%) underwent muscle layer suturing using clips. Stricture prevention measures were local steroid injections alone in 7 cases (14.9%),

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P.089

PERIAMPULLARY DIVERTICULUM DID NOT INCREASE THE PROCEDURE TIME OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Yi-Chia Chen, Chun-Chi Yang, Su-Hung Wang, I-Che Feng Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

壺腹旁憩室並不增加經內視鏡逆行性膽 胰管攝影術的手術時間 陳奕嘉 楊畯棋 王宿鴻 馮意哲 奇美醫院胃腸肝膽科

Background: Periampullary diverticulum (PAD) is a common anatomical anomaly, observed in up to 30% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Traditionally, PAD has been thought to decrease biliary cannulation rates and may potentially increase postoperative complications. However, past literature lacks a consistent conclusion on this matter. Additionally, studies on different types of PAD have yet to reach a unified consensus. A variety of new cannulation methods (such as needle-knife fistulotomy, transpancreatic biliary sphincterotomy, and pre-cut techniques) are increasingly available to enhance our success rates. Therefore, assessing the impact of PAD on ERCP difficulty based on procedural duration may provide a more objective measure compared to biliary cannulation rates.

Aims: We aim to compare whether the presence of PAD, different types of PAD, and various cannulation methods affect the procedure time of ERCP and its associated complications. Additionally, we explore whether other variables also influence the procedure time of ERCP. Methods: The individuals included in the analysis are categorized based on the indication for ERCP (excluding cancer), common bile duct diameter, presence of PAD, PAD size and Li-Tanaka classification, cannulation method, and the bilirubin level. Additionally, the experience of the operator is divided into three groups for comparison. We designate procedure time as the primary outcome.

Cannulation success rate and postoperative complications are designated as secondary outcomes.

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Results: From January 2022 to July 2022, a total of 162 individuals were included, comprising cases with PAD (N = 103) and those without PAD (N = 59).

There was no significant difference in procedure time (32.76 vs. 31.32 minutes; p = 0.631) and cannulation success rate (88.3% vs. 96.6%; p = 0.072) between the two groups. Significant differences were observed in procedure time among different PAD types (p = 0.036), with Type III having the shortest procedure time (23.8 minutes). The use of trans-pancreatic biliary sphincterotomy (37.9 minutes) and precut techniques (43.0 minutes) resulted in longer procedure times compared to normal wire-guided cannulation (27.7 minutes) (p < 0.001), but there was no difference between trans-pancreatic biliary sphincterotomy and pre-cut techniques (p = 0.638).

The experience of the operator was significantly correlated with procedure time (p < 0.001), but there was no significant difference between operators with more than 2 years of experience.

Conclusions: The presence of PAD does not seem to affect procedure time, but there are differences among different types of PAD. Various cannulation methods can effectively increase the cannulation success rate, but advanced cannulation methods also tend to increase procedure time. As the experience of the operator matures, procedure time also tends to decrease.

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P.090

P.091

ASSOCIATION BETWEEN MULTIPLE DIMINUTIVE VERSUS SMALL ADENOMAS AND THE RISK OF METACHRONOUS ADVANCED ADENOMAS

LONG-TERM EFFECT OF CHOLECYSTECTOMY ON ALZHEIMER’S DISEASE’S RISK – A RETROSPECTIVE STUDY BASED ON TRINETX DATABASE

Tsan-Hsuan Chang, Lee-Won Chong, Hung-Chuen Chang, Yu-Hwa Liu, Cheuk-Kay Sun, Kou-Ching Yang, Yu-Min Lin

Kun-Ta Wu1, Shu-Shien Lin2, Yi-Ju Chen1, Wei-Hsin Chen1, Jian-Jhou Liao1, Feng-Hsu Wu1, Shao-Ciao Luo1, Hui-Chen Lin1, Kuei-Heng Chang1, Yi-Ju Tsai1, Peng-Yu Ku1

Division of Gastroenterology and Hepatology, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan

多發性微小腺瘤與小腺瘤與復發進階性 腺瘤風險之間的關聯 張璨璿 張麗文 張鴻俊 劉玉華 孫灼基 楊國卿 林裕民 新光醫療財團法人新光吳火獅紀念醫院肝膽腸胃科

Background: Patients with previous multiple (≥3) non-advanced (1-9 mm) adenomas are at higher risk for metachronous advanced adenoma (>1 cm) and consequently have an increased risk of colorectal cancer. There is ongoing debate about whether multiple diminutive (<5 mm) adenomas significantly increase the risk.

Aims: We aim to examine the risk of developing metachronous advanced adenomas from small (6-9 mm) versus diminutive (1-5 mm) adenomas.

Methods: Focused on participants who underwent health examinations with two colonoscopies between 2014 to 2020. Adenoma detection rate (ADR) at the initial colonoscopy was 44.31% (2074/4681). 169 patients with metachronous advanced adenoma were categorized into 4 groups based on initial colonoscopy findings.

Results: Age and sex have a strong correlation with metachronous advanced adenoma. Multiple small adenomas and advanced adenomas were significant for developing metachronous advanced adenoma.

Multiple diminutive adenomas was not significant for developing metachronous advanced adenoma.

Multiple small adenomas had a significantly higher risk of metachronous advanced adenoma compared to multiple diminutive adenomas.

Conclusions: The strength of our study is that the endoscopists in our group had ADRs well above the recommended benchmark (35%). Current guidelines for post-polypectomy surveillance in 3-5 years for multiple non-advanced (1-9 mm). Our findings suggest to extended the current recommended surveillance interval to 5-7 years for patients with multiple diminutive (<5 mm) adenoma.

Division of General Surgery, Department of Surgery, Taichung Veteran General Hospital, Taichung, Taiwan 2 Division of Hepato-Gastroenterology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan 1

評估膽囊切除術後之長期阿茲海默症風 險 — 使用 TriNetX 資料庫之回溯性分析 吳坤達1 林淑賢2 陳怡如1 陳維信1 廖建洲1 吳峯旭1 羅少喬1 林卉晨1 張奎亨1 蔡易儒1 古朋育1 1 2

臺中榮民總醫院一般外科 戴德森醫療財團法人嘉義基督教醫院腸胃肝膽科

Background: Alzheimer’s disease (AD), known to be the leading cause of dementia that contributes up to 60–80% of all dementia. With the growing evidence on alternation of bile acid composition and enterohepatic cycle connect with neurodegeneration disease, the real world evidence on the association between cholelithiasis, cholecystectomy and AD are lacking.

Aims: Given the lacking of both basic and clinical studies relevant to the association between AD and post-cholecystectomy, our study aimed to elucidate the association of post-cholecystectomy status (PC) and the long term risk of AD in patients presented with cholelithiasis, which there is still lacking a large scale retrospective cohort study.

Methods: Utilizing the TriNetX network database, 134,956 cholelithiasis patients were enrolled each in cholecystectomy and observation group. After selection and propensity score matching by age, sex and ethnicity, the risk of AD were compared and analyzed after 19 years of maximum follow up interval.

Results: The incidence of AD were significantly lower within the first decade after cholecystectomy

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P.092 in cholelithiasis patients (Overall risk: 0.259% v.s 0.327%; Risk difference: -0.068%, p = 0.0011; Risk ratio: 0.792; 95% CI: 0.688 – 0.911). No significance were observed between two groups when postcholecystectomy duration beyond 10 years (Overall risk: 0.047% v.s 0.041%; Risk difference: 0.006%, p = 0.4614; Risk ratio: 1.145; 95% CI: 0.798 – 1.644). There are no statistical significance between different sex (p = 0.683).

Conclusions: In conclusion, under real-world evidence under TriNetX database, the overall risk of AD decreases within 10 years after cholecystectomy.

The protective effect diminishes when the post cholecystectomy time interval beyond 10 years.

THE IMPACT OF ESOPHAGEAL VARICES ON THE PROGNOSIS OF PATIENTS WITH CHOLANGIOCARCINOMA: A SINGLE CENTER RETROSPECTIVE STUDY Yu-Jen Chen1,2,3, Tze-Han Ma3, Chien-Wei Su1,3, Ming-Chih Hou1,3 Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan 3 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

食道靜脈曲張對膽管癌病人的預後影響 陳宥任1,2,3 馬子涵3 蘇建維1,3 侯明志1,3 1

臺北榮民總醫院胃腸肝膽科 國立陽明交通大學公衛所 3 國立陽明交通大學醫學系 2

Background: Whether esophageal varices (EV) could determine the outcomes of patients with cholangiocarcinoma (CCA) is still debated.

Aims: We aimed to assess the impact of EV on the prognosis of CCA patients.

Methods: We enrolled 254 treatmentnaïve CCA patients who received esophagogastroduodenoscopy at the time of CCA diagnosis from 2013 to 2022. The factors in terms of EV formation were analyzed by Logistic regression model. The factors in terms of prognosis were analyzed by Cox proportional hazards model.

Results: A total of 42 (16.5%) patients had EV. By multivariate analysis, male (hazard ratio HR 2.764, 95% confidence interval CI 1.239-6.165, p = 0.013) and platelet <150 K/cumm (HR 3.215, 95% CI 1.5396.719) were risk factors of EV formation. After a median follow-up of 363 days, 200 patients died. The median overall survivals (mOS) of patients with or without EV were 292 and 379 days, respectively (p = 0.035) (Figure 1). By multivariate analysis, age > 65 (HR 1.453, CI 1.051-2.007), serum albumin level < 3.5 g/dL (HR 1.540, 95% CI 1.111-2.135, p = 0.010), CA199 level > 100 U/mL (HR 1.894, 95% CI 1.367-2.624, p = 0.001), advanced cancer stage (HR 2.516, 95% CI 1.647-3.845) and the presence of EV (HR 1.449, 95% CI 1.005-2.221, p = 0.047), were independent risk

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P.093 factors associated with poor OS. Conclusions: Among CCA patients, male gender and low platelet count were the risk factors of EV formation. EV was an independent risk factor predicting poor prognosis for the patients with CCA by multivariate analysis.

ENDOSCOPIC SLEEVE GASTROPLASTY COMBINED WITH ORAL SEMAGLUTIDE IMPROVES WEIGHT CONTROL IN OBESE PATIENTS Chen-Shuan Chung1,2,3, Hua-Fen Chen3, Jiann-Ming Wu4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan 2 School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 3 Division of Endocrinology & Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan 4 Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan 1

利用內視鏡袖狀縮胃減重術合併口服 Semaglutide 可增進體肥胖患者之體重控 制 鍾承軒1,2,3 陳華芬3 吳建明4 1

亞東紀念醫院肝膽胃腸科 天主教輔仁大學醫學系 3 亞東紀念醫院新陳代謝科 4 亞東紀念醫院一般外科 2

Background: Multidisciplinary and multimodality management is crucial for obesity management.

Endoscopic bariatric and metabolic therapies are emerging minimally invasive options for weight control.

Aims: This study aimed to evaluate the efficacy and safety of combining endoscopic sleeve gastroplasty (ESG) and anti-obesity medication (AOM) for obesity therapy.

Methods: It was a retrospective study between February 2022 and March 2024 in a tertiary center in Taiwan. Obese patients who underwent ESG alone and combination of ESG and oral rybelsus, a glucagon-like-1 peptide (GLP-1) analogue, were enrolled for analysis.

Results: In total, 18 (10 female and 8 male) patients with median age and body-mass index (BMI) of 43.5-year-old and 34.19 kg/m² were enrolled. Before ESG, thirteen (72.22%), three (16.67%), one (5.56%) and one (5.56%) patient failed to lifestyle/dietary

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P.094 modification, AOM, intragastric botox injection and gastric banding surgery, respectively. Technically success rate was 100% with median procedure time of 70 minutes. Endoscopically manageable intraprocedural bleeding occurred to one (5.56%) patient. BMI (median 29.51 kg/m², p = 0.005) as well as metabolic dysfunction improved at 6-month after ESG, particularly for hemoglobin A1c level (p = 0.04).

Total and excess weight loss at 1-month, 3-month and 6-month were all higher in combination therapy with delta mean value of 4.03% (p = 0.005) and 8.63% (p = 0.023), 4.71% (p = 0.013) and 12.21% (p = 0.024), and 4.95% (p = 0.015) and 9.99% (p = 0.034), respectively. There were no differences in adverse effects between ESG alone and combination therapy.

Conclusions: Combining ESG with AOM results in superior efficacy in weight control without additional adverse effects for obese patients. Further studies are warranted to define the predictors for those who benefit from combination therapy.

CHARACTERISTICS OF SYMPTOM PROFILES AND ESOPHAGEAL MOTILITY IN PATIENTS WITH GASTRIC CARDIAC SUBMUCOSAL TUMOR AND ASSOCIATED CHANGES AFTER ENDOSCOPIC RESECTION: A STUDY BASED ON HIGH-RESOLUTION IMPEDANCE MANOMETRY Kuang-Fang Lin, Chien-Chuan Chen, Chieh-Chang Chen, Ming-Lun Han, Hsiu-Po Wang, Ping-Huei Tseng Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

以高解析度食道壓力阻抗檢測探討胃賁 門黏膜下腫瘤之病患臨床特性與食道蠕 動功能及經內視鏡切除後的相關變化 林鑛紡 陳建全 陳介章 韓明倫 王秀伯 曾屏輝 國立臺灣大學醫學院附設醫院內科部

Background: Gastric cardiac submucosal tumors (SMTs) mostly originate from the muscular layer of esophagogastric junction (EGJ), but the influence of these SMTs on esophageal motility and EGJ barrier function remains unclear.

Aims: This study aimed to investigate the clinical characteristics in patients with gastric cardiac SMTs and associated changes after endoscopic resection based on high-resolution impedance manometry (HRIM).

Methods: We identified consecutive patients referred to our motility laboratory for pre-operative evaluation of gastric cardiac SMT between 2015 and 2023 from our electronic database. All patients have undergone comprehensive evaluation including standardized symptom questionnaires, endoscopic ultrasonography (EUS), and HRIM. Endoscopic resection via submucosal dissection (ESD) or submucosal tunneling (STER) were performed.

Follow-up esophagogastroduodenoscopy and HRIM were performed 3 months thereafter. Data on the baseline characteristics and clinical outcomes were collected. Esophageal motility was compared based on updated Chicago classification version 4.0.

Results: Thirty patients (mean age, 47.4±12.8 years; male, 50%) with gastric cardiac SMT were analyzed.

Most patients were asymptomatic (43.3%), while

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P.095 others presented with epigastralgia (30%) and regurgitation (23.3%). On EUS, the average tumor size was 16.7±4.5 mm (range, 10.0-30.0 mm), and all SMTs appeared hypoechoic and mostly originated from 4th layer (80%). On HRIM, 22 patients (73.3%) were classified as normal motility, while 8 (26.7%) were abnormal, including 5 with ineffective esophageal motility (IEM), and 3 with esophagogastric junction outflow obstruction. Among the 27 patients undergoing endoscopic treatment (12 ESD, 15 STER), complete resection was achieved in 25 (92.6%), and pathology revealed predominantly leiomyoma (96%). No significant differences of symptom profiles, endoscopic findings, and HRIM parameters were observed after resection. However, three patients with pre-operative IEM exhibited normal motility on follow-up HRIM. Conclusions: Up to 26.7% of patients with gastric cardiac SMTs had abnormal esophageal motility.

Endoscopic resection of these SMTs were effective and safe, and appeared to improve esophageal motility in patients with IEM.

INDOCYANINE GREEN FLUORESCENT CHOLANGIOGRAPHY ASSURES THE SURGICAL SAFTY OF LAPAROSCOPIC CHOLECYSTECTOMY King-Teh Lee Department of Surgery, Park One International Hospital, Kaohsiung, Taiwan

靛氰綠螢光膽管攝影提升了腹腔鏡膽囊 切除術的手術成果 李金德 博田國際醫院肝膽胰外科

Background: Laparoscopic cholecystectomy (LC) is one of the common surgical procedure in hepatobiliary surgery. Despite advances in laparoscopic techniques, iatrogenic injury to the bile duct still occurs at a rate of 0.08-1.5%, and conversion to open occurs at a rate of 3-15%.

Recently, a novel indocyanine green (ICG) fluorescent cholangiography (ICG-FC) was used to visualize the biliary tract and be used with an critical view of the safety technique. The ICG is injected intravenously before surgery, excreted exclusively into bile juice, and illuminated with near-infra-red (NIR) light. The surgeon can detect the biliary tract when switching on NIR fluoroscopy.

Aims: Using ICG-FC, surgeons can achieve improved visualization of the biliary tract during LC, potentially decreasing the rate of bile duct injury and conversion to open surgery.

Methods: ICG-FC was performed routinely in 350 cases during LC from Sept. 2020 to May 2024 in Park One Hospital Kaohsiung. For intra-operative ICG-FC, 0.1 mg/kg of indocyanine green was administrated intravenously 25 minutes before starting LC. Near infra-red ICG-FC was conducted using an OTV-S 200-2D imaging system with IR telescope (Olympus, Tokyo). The data of demographic characteristics, clinical diagnosis, operation time, length of hospital stay, the success rate of delineating biliary tract, and postoperative complications were collected prospectively and analyzed retrospectively. The collected data were compared to those of 367 LC cases without ICG-FC. Results: Data of surgical outcomes after LC were collected in 350 cases with ICG-FC and 367 without ICG-FC. The success rate of visualization of biliary

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P.096 tract by ICG-FC is: common hepatic bile duct 100%, common bile duct 100% and cystic duct 95%. The surgical outcomes were shown in the following: ICG-FC group had shorter operation time; it was ICG(+) 52.2 ± 13.7 min vs. ICG(-) 4.7 ± 30.61 min (p < 0.005). ICG(+) group had fewer post-operative complications; it was Clavian-Dindo grade Ⅲ in ICG(+) 0.28% vs. ICG(-) 3.0%. There was no case of conversion to open cholecystectomy in the ICG(+) group. Rate of conversion to open, ICG(+) 0% vs. ICG() 1.9%. Length of stay is comparable in two groups, ICG(+) 3.21 ± 1.3 days vs. ICG(-) 3.73±1.77 days. No bile duct injury was found in the two groups.

Conclusions: The current evidence of surgical outcomes showed ICG-FC during LC is a feasible procedure that could be routinely used in LC to improve surgical outcomes.

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SAFETY AND FEASIBILITY OF SINGLE-INCISION LAPAROSCOPIC DISTAL PANCREATECTOMY Wei-Hsin Lin, Ching-Yao Yang Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan

單切口腹腔鏡遠端胰臟切除術的安全性 和可行性 林瑋信 楊卿堯 國立臺灣大學醫學附設醫院外科部

Background: Single-incision laparoscopic distal pancreatectomy (SILS-DP) has emerged as a potential alternative to conventional laparoscopic distal pancreatectomy (C-LDP), offering improved cosmetic outcomes and potential benefits. However, its safety and feasibility remain contentious due to technical challenges and limited evidence.

Aims: To promote the introduction of this technique, a comparative study between SILSDP and C-LDP is needed. This study aimed to retrospectively assess the surgical outcomes in patients who underwent SILS-DP under strict indication criteria.

Methods: The study analyzed data from 12 SILS-DP and 31 C-LDP cases at National Taiwan University Hospital (NTU), with 17 of C-LDP from Nara Medical University (NMU) for comparison. We retrospectively reviewed the patient characteristics and surgical outcomes of those who underwent either SILS-DP or C-LDP at National Taiwan University (NTU) and C-LDP at Nara Medical University (NMU) between 2009 and 2019. SILS-DP was indicated for benign or low-grade malignant pancreatic tail tumors and was performed along with splenectomy.

Results: Patients in the SILS-DP group had significantly less blood loss than the C-LDP group at NTU (P = 0.028). Postoperative outcomes, including the postoperative hospital stay and clinically relevant pancreatic fistula, were not significantly different between the 2 groups. Although SILS-DP was performed by a surgeon who was well-experienced with laparoscopic surgeries, the first few cases had a larger amount of blood loss, longer operation time, and a higher rate of complications. Such unfavorable outcomes were likely to be resolved shortly. No reoperations and deaths were noted.

Conclusions: SILS-DP is deemed safe and feasible when performed by experienced surgeons in carefully selected patients.

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IMPLEMENTATION OF THE NOVEL AI-BASED CECAL RECOGNITION SYSTEM IMPROVED ADENOMA DETECTION IN A SCREENING COLONOSCOPY SETTING Mark Pi-Chun Chuang1, Wen-Feng Hsu1,2, Wei-Yuan Chang2,3, Chen-Ya Kuo4, Hsuan-Ho Lin5, Li-Chun Chang1,2, Ming-Shiang Wu1,2, Han-Mo Chiu1,2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 College of Medicine, National Taiwan University, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 4 Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan 5 Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan 1

Quality metrics, including cecal intubation rate (CIR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and sessile serrated adenoma detection rate (SSADR) were compared. Multivariate analyses assessed the impact of implementing the system and the quality metrics.

Results: The CIRs were the same before and after the implementation of AI-CRS (99.5% vs. 99.5%, p = 0.91), but ADR significantly increased. The most significant increase in ADR was in the cecum, while the most significant increase in AADR was in the proximal colon. The adjusted odds ratio (aOR) was 1.35 for adenoma detection (95% CI = 1.26–1.45), 1.23 for advanced adenoma detection (95% CI = 1.07–1.41), and 1.80 for sessile serrated adenoma detection (95% CI = 1.49–2.18) in the period after implementation compared to the period before.

Conclusions: Implementing a post hoc verification and audit of cecal intubation using an AI-based cecal recognition system significantly improved neoplasm detection in screening colonoscopy.

在篩檢大腸鏡中置入人工智慧盲腸辨識 系統對腺瘤偵測的幫助 莊弼鈞1 許文峰1,2 張為淵2,3 郭震亞4 林宣合5 張立群1,2 吳明賢1,2 邱瀚模1,2 1

國立臺灣大學醫學院附設醫院內科部 國立臺灣大學醫學院 3 國立臺灣大學醫學院附設醫院癌醫中心分院內科部 4 天主教輔仁大學附設醫院內科部 5 國立臺灣大學醫學院附設醫院新竹臺大分院 2

Background: Cecal intubation is a critical quality indicator for verifying completeness of colonoscopy but relies on self-reporting. Manual verification of cecal intubation through photographic documentation is labor-intensive and impractical.

An artificial intelligence-based cecum recognition system (AI-CRS) for post hoc verification of cecal intubation may offer help.

Aims: The objective of this study is to assess the change in adenoma related metrics following the implementation of AI-based cecum recognition system.

Methods: For this retrospective analysis, we collected first screening colonoscopy reports from January 2015 to December 2022, to cover both before and after the AI-CRS was implemented in March 2018.

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P.098

DOES AN ABDOMINAL COMPRESSION DEVICE REDUCE THE NEED FOR MANUAL ASSISTANCE

BY ENDOSCOPY STAFF DURING CO2 INSUFFLATION COLONOSCOPY? A PILOT OBSERVATIONAL STUDY Chi-Liang Cheng1, Jen-Hao Yeh2, Ming-Yao Su3,4, Yen-Lin Kuo1, I-Chia Su1, Yi-Ning Tsui1, Bai-Ping Lee1, Hui-Ting Lin1, Yan-Lun Syu1, Chia-Yu Jan1, Ke-Yun Zou5, Yun-Shien Lee5, Felix W. Leung6,7 Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da DaChang Hospital, I-Shou University, Kaohsiung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan 4 School of Medicine, Chang Gung University, Taoyuan, Taiwan 5 Department of Biotechnology, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan 6 Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA 7 David Geffen School of Medicine at UCLA, Los Angeles, California, USA 1

二氧化碳灌氣大腸鏡併用腹部加壓器材 是否可以降低內視鏡技術師施行人工徒 手輔助術式的頻率？一項先導觀察性研 究 鄭吉良1 葉人豪2 蘇銘堯3,4 郭彥麟1 蘇怡佳1 崔怡寧1 李百萍1 林慧婷1 許晏綸1 冉家瑜1 鄒可芸5 李御賢5 Felix W. Leung6,7 1

中壢長榮醫院胃腸科 義大大昌醫院胃腸肝膽科 3 新北市立土城醫院胃腸肝膽科 4 長庚大學醫學系 5 銘傳大學健康科技學院生物科技學系 6 Sepulveda Ambulatory Care Center, Veterans Affairs 2

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Greater Los Angeles Healthcare System, North Hills, California, USA 7 美國加州大學洛杉磯分校醫學院

Background: Manual assistance in the form of abdominal pressure and repositioning is frequently used to overcome looping during colonoscopy.

These maneuvers pose ergonomic challenges to endoscopy staff. Both ColoWrap (LLC, Durham, NC, USA) and Maxbelt (Nippon Sigmax Co., Tokyo, Japan), which are external abdominal compression devices, have shown conflicting results in terms of procedural outcomes in previous randomized controlled trials (RCTs) (CGH 2016;14:850; JGH Open 2020;4:441.). Water exchange (WE) colonoscopy has been shown to reduce the need for manual assistance during insertion in previous RCTs (CGH 2015;13:1972; GIE 2017;86:192).

Aims: We aimed to assess the efficacy of abdominal compression devices and WE in terms of reducing the need for manual assistance during colonoscopy and other procedural outcomes.

Methods: We performed a retrospective study comparing four groups: the CO2 insufflation alone group, the CO2 with ColoWrap group, the CO2 with Maxbelt group, and the WE group. The patients were aged ≥20 years, had routine indications and had an intact colon. ColoWrap was used from November 2023 through January 2024, and Maxbelt was used from January through May 2024. The data for the CO2 alone and WE groups were derived from our previous RCT (CTG 2023;14:e00594). The primary outcome was the proportion of patients requiring manual pressure or repositioning during colonoscopic insertion.

Results: A total of 245 patients were included in this study (73 in the CO2 group, 76 in the WE group, 44 in the ColoWrap group, and 52 in the Maxbelt group).

The baseline demographics and colonoscopy indications were similar between groups, except that the patients in the Maxbelt group were significantly younger. Compared with CO2, WE and the use of compression devices significantly decreased the proportion of patients requiring any manual assistance during insertion (55% [WE], 30% [ColoWrap], 29% [Maxbelt] vs. 85% [CO2]; all P < 0.001).

The cecal intubation time (CIT) was significantly shorter in the ColoWrap group than in the CO2 group (7.5 ± 5.5 vs. 10.0 ± 6.0 min, P = 0.023), and the CIT was significantly longer in the WE group than in the CO2 group (18.4 ± 7.1 vs. 10.0 ± 6.0 min, P < 0.001).

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P.099 The withdrawal time was significantly shorter in the WE group (22.4 ± 8.5 vs. 27.7 ± 9.7 min [CO2], P < 0.001). Compared with CO2, the total procedure time was not different for the WE and ColoWrap groups, but it was significantly shorter in the Maxbelt group.

There was no significant difference in the adenoma detection rate or clinically significant serrated polyp detection rate between the groups.

Conclusions: Both WE and the use of an abdominal compression device significantly reduced the frequency of ancillary manual assistance during colonoscopic insertion. The potential benefits of reducing the ergonomic risks among the endoscopy staff deserves further study.

SINGLE-CENTER RETROSPECTIVE STUDY ON THE OUTCOMES OF ENDOSCOPIC RADIOFREQUENCY ABLATION FOR HIGH RISK BARRETT’S ESOPHAGUS Li-Han Weng1, Hau-Jyun Su1, Ming-Hseng Tseng2, Chun-Che Lin1.3.4, Ming-Chang Tsai1.3.4, Chi-Chih Wang1.3.4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taiwan 2 Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan 3 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 4 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan 1

單中心回顧性研究高風險 Barrett 食道接 受內視鏡射頻消融術的治療結果 翁立翰1 蘇浩俊1 曾銘性2 林俊哲1.3.4 蔡明璋1.3.4 汪奇志1.3.4 1

中山醫學大學附設醫院肝膽腸胃科 中山醫學大學醫學資訊學系 3 中山醫學大學醫學系 4 中山醫學大學醫學研究所 2

Background: Barrett’s esophagus is a condition where the mucosa at the gastroesophageal junction had repeated stimulation by Gastroesophageal Reflux Disease (GERD), leading to intestinal metaplasia and goblet cell formation under the microscope. It is typically classified into short or long segments. Some cases progress to low-grade or even high-grade dysplasia, potentially advancing to esophageal adenocarcinoma, which has a fiveyear survival rate of approximately 20%. For patients with low-grade dysplasia and risk factors (such as a family history of esophageal adenocarcinoma, long segment, multifocal low-grade dysplasia, or confirmation on subsequent endoscopy), as well as those with high-grade dysplasia or early esophageal adenocarcinoma, endoscopic therapy is recommended. This includes endoscopic mucosal resection, submucosal dissection, or endoscopic ablative therapy. The complete eradication of intestinal metaplasia was achieved in 78% of patients3 using esophageal radiofrequency ablation

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P.100 (RFA) for Barrett’s esophagus. The most common adverse event, esophageal stricture, occurred in around 5% of patients in literature.

Aims: We report the outcomes of esophageal RFA treatment for Barrett’s esophagus at a single medical center in Taiwan Methods: From November 2022 to June 2024, we collected data on 55 patients diagnosed with high risk Barrett’s esophagus at a our center who received esophageal RFA treatment using the Medtronic Barrx™ channel RFA endoscopic catheter (TTS-1100) and the Medtronic Barrx™ 360 Express RFA Balloon Catheter (Balloon 360). After excluding the patients, who lost follow-up, 49 patients was included in this retrospective study. These patients underwent endoscopic follow-up one month post-treatment with continued proton pump inhibitor therapy. If residual Barrett’s epithelium was suspected under narrow band imaging during follow-up endoscopy, targeted biopsies were performed (Figure 1) (Figure 2). Annual follow-ups were conducted thereafter.

Results: Among the 49 patients, there are 30 males and 19 females, with an average age of approximately 56 years. The average weight was 66.3 kg, and the mean BMI was 24.1 kg/m². Ten patients had a smoking history of more than 10 pack-years. The mean Prague C score was 1.2, and nearly 40 patients had long segment Barrett’s esophagus (Prague M ≥3 cm). Eighteen patients had dysplasia, 26 patients had GERD grade C or D, and 4 partients had hiatal hernia (Hill grade III and IV). Forty-four patients were treated using the TTS-1100 catheter, while five were treated using Balloon 360 probe. Only 3 patients had pathologic residual Barrett’s epithelium, resulting in a curative rate of approximately 94%. There were no cases of major bleeding or perforation, and only one patient developed post treatment stricture (Table 1).

Conclusions: Our data, previous systematic reviews and meta-analyses on the efficacy of RFA for Barrett’s esophagus3 have demonstrated that esophageal RFA is an effective treatment method with an acceptable complication risk.

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COMPARATIVE CARDIOVASCULAR SAFETY OF CETUXIMAB AND PANITUMUMAB IN COLORECTAL CANCER: A RETROSPECTIVE COHORT STUDY UTILIZING THE TRINETX DATABASE Mitsuhiro Koseki1, Po-Yu Huang1, Yi-Chen Chen2, I-Che Feng1, Hsing-Tao Kuo1, Ming-Jen Sheu1 Division of Gastroenterology and Hepatology, Department of internal Medicine, Chi Mei Medical Center, Tainan, Taiwan 2 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan 1

大腸直腸癌患者中 Cetuximab 與 Panitumumab 心血管安全性之比較：應 用 TriNetX 資料庫進行之回溯性世代研究 古關光浩1 黃博裕1 陳怡蓁2 馮意哲1 郭行道1 許銘仁1 1 2

奇美醫學中心胃腸肝膽科 奇美醫學中心醫學研究部

Background: Colorectal cancer (CRC) treatment has advanced with the use of targeted therapies such as cetuximab and panitumumab. These drugs are integral to national insurance guidelines in Taiwan for treating CRC, particularly in patients without KRAS mutations. Although hypomagnesemia incidence is higher in CRC patients treated with panitumumab compared to cetuximab, the cardiovascular outcomes remain unclear. This study aims to compare the cardiovascular safety profiles of cetuximab and panitumumab in clinical practice using data from the TriNetX database.

Aims: The primary aim of this study is to compare the cardiovascular safety outcomes and overall clinical outcomes of CRC patients treated with cetuximab versus panitumumab.

Methods: A retrospective cohort study was conducted using the TriNetX database, which included data from 117 healthcare organizations across 14 countries. Patients diagnosed with CRC between January 1, 2007, and December 31, 2023, who received either cetuximab or panitumumab were included. We excluded patients susceptible to pre-study period effects, such as KRAS mutation, underlying disease related to the outcomes, and medications used predominantly by one group.

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P.101 Propensity score matching (1:1) was employed to minimize selection bias, resulting in 1,382 patients in each treatment group. Baseline characteristics and cardiovascular outcomes were compared using standardized differences, and risk differences.

Results: Prior to the application of propensity score matching, notable differences were observed in several baseline characteristics between the cetuximab cohort (N = 2,787) and the panitumumab cohort (N = 1,431). Post-matching, these groups exhibited balanced characteristics. As the result, the incidence of hypomagnesemia was significantly lower in the cetuximab group (92 patients, 6.7%) compared to the panitumumab group (121 patients, 8.8%) (Risk Difference -0.021, 95% CI: -0.041 to -0.001, p = 0.039). The incidence of atrial fibrillation was marginally lower in the cetuximab group (26 patients, 1.9%) compared to the panitumumab group (40 patients, 2.9%), though this difference did not achieve statistical significance (Risk Difference -0.010, 95% CI: -0.022 to 0.001, p = 0.081). Conversely, the incidence of tachycardia was significantly reduced in the cetuximab group (73 patients, 5.3%) relative to the panitumumab group (114 patients, 8.2%) (Risk Difference -0.030, 95% CI: -0.048 to -0.011, p = 0.002). No significant differences were observed between the two cohorts concerning other cardiovascular events such as ventricular arrhythmia and heart failure.

Conclusions: Both cetuximab and panitumumab are effective in the treatment of CRC without KRAS mutations, with no significant difference in overall cardiovascular safety profiles. However, cetuximab is associated with a lower risk of tachycardia. These findings provide valuable insights for clinicians in selecting the appropriate therapy for CRC patients, considering the efficacy and potential side effects, particularly cardiovascular risks, of each treatment.

Further studies are warranted to explore the longterm cardiovascular outcomes and quality of life of patients receiving these therapies.

MULTI-OMICS SYSTEMIC APPROACH FOR BIOMARKER DISCOVERY IN CHOLANGIOCARCINOMA Jin-Chiao Lee1, Li-chieh Julie Chu2, Chia-Jung Tsai2, Jau-Song Yu2, Ta-Sen Yeh1 Department of General Surgery, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan 2 Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan 1

運用多體學系統性開發膽道癌之生物標 誌 李勁樵1 朱俐潔2 蔡佳蓉2 余兆松2 葉大森1 1 2

林口長庚紀念醫院一般外科 長庚大學分子醫學研究中心

Background: Cholangiocarcinoma presents a pressing challenge globally due to its rising incidence and persistently dismal prognosis, largely attributed to early intra-hepatic and/or extra-hepatic metastasis. Despite advancements in healthcare, early detection remains elusive, necessitating the identification of reliable and applicable biomarkers.

Currently, serum CA19.9 serves as the standard biomarker, albeit with limitations.

Aims: This study aims to identify supplementary biomarkers to enhance diagnostic accuracy in cholangiocarcinoma.

Methods: A literature review spanning from 2005 to 2018 was conducted, focusing on the keyword “cholangiocarcinoma biomarker” to identify existing protein biomarkers. Three datasets (GSE26556, GSE33327, and GSE32879) sourced from the Gene Expression Omnibus (GEO) database were analyzed to ascertain differentially expressed genes in cholangiocarcinoma. Proteome profiling of pooled bile samples from cholangiocarcinoma (n = 6) and gallstones (n = 5) was performed via 2D LC-MS/ MS. Biomarkers identified through these platforms were selected and subjected to assessment of diagnostic accuracy using ELISA in a training set (34 cholangiocarcinoma vs 44 gallstones) with paired bile and plasma, and in a test set (152 cholangiocarcinoma vs 68 gallstones) utilizing plasma alone.

Results: A literature review of 219 relevant publications yielded 85 potential protein biomarkers of cholangiocarcinoma across diverse sample types,

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P.102 including tissue (46), serum (35), bile (11), and plasma (8). Data from the three aforementioned GEO datasets revealed 47 up-regulated and 111 down-regulated genes consistently expressed in cholangiocarcinoma. Our bile proteomic profiling identified 46 up-regulated and 73 down-regulated proteins in cholangiocarcinoma compared to gallstones. Convergence of the above omics analyses highlighted POSTN (periostin) and MMP-9 as promising biomarkers. In the training set, elevated bile MMP-9 levels (3.1-fold, p < 0.0001) and plasma POSTN levels (2.11-fold, p < 0.0001), respectively, distinguished cholangiocarcinoma from gallstones.

In the test set, plasma POSTN emerged as a robust biomarker (2.18-fold, AUC 0.85; sensitivity 77%, specificity 85%). From a clinical perspective, combining plasma CA19.9 and POSTN enhanced diagnostic performance (AUC 0.94, sensitivity 0.87, specificity 0.91).

Conclusions: The integrated multi-omics systemic approach paves the ground for searching eligible tissue and/or liquid biomarkers of cholangiocarcinoma. MMP-9 levels in bile and POSTN levels in plasma are new potential biomarkers for cholangiocarcinoma. Combining plasma CA19.9 and POSTN provides good diagnostic value with AUC 0.94.

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EVALUATION OF PERCUTANEOUS BILIARY STONE REMOVAL (PBSR) FOR MANAGEMENT OF BILE DUCT STONES Liu-Han Lin1, Yang-Yuan Chen1, Hsu-Heng Yen1, Yung-Fang Chen2 Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan 2 Department of Radiology, China Medical University Hospital, Taichung, Taiwan 1

經皮膽道系統結石移除評估 林柳含1 陳洋源1 顏旭亨1 陳永芳2 1 2

彰化基督教醫院胃腸科 中國醫藥大學附設醫院放射診療科

Background: Gallstone disease, including both gallbladder and bile duct stones, remains a prevalent global health issue, particularly impacting East Asian populations where primary bile duct stones are more frequent than in Western countries. While cholecystectomy has been the primary treatment for symptomatic gallstones. However, management of bile duct stones, which pose significant health risks, has evolved towards less invasive procedures like percutaneous biliary stone removal (PBSR).

Aims: This study aims to evaluate the prevalence, clinical implications, and the transition from traditional cholecystectomy to PBSR in managing bile duct stones. We focus on the success rates of stone clearance among patients undergoing PBSR. Methods: This retrospective case series study analyzes cases of PBSR performed between 1999 and 2019. The 772 patients were collected from Medical Center of Mid-Taiwan electronic medical records system. Exclusion criteria includes cases with incomplete data or those undergoing alternative procedures for stone removal. Relevant data were extracted from medical records, including patient demographics, stone characteristics (size, location), surgical details, postoperative outcomes, and complications. Primary outcomes assessed were stone removal success rate, defined as complete stone clearance or clinically insignificant residual fragments, and occurrence of complications postPBSR. Results: The gender distribution of the 772 patients was nearly equal, with males comprising 51% and females 49%. The age distribution revealed that

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P.103 more than half of the patients were between 50 and 80 years old, with the majority falling within the 70-80 age group. The distribution of bile duct stones varied significantly with the common bile duct (CBD) accounted for the majority of 39%, followed by the gallbladder of 22%. Stones were also found in the left and right intrahepatic ducts, and in some cases, stones were present in multiple locations simultaneously. The overall success rate of percutaneous biliary stone removal (PBSR) was exceptionally high, achieving 96%. However, some complications were observed during the study with 10% of patients developed chills and fever after undergoing PBSR. Two patients experienced intrahepatic arterial injury during the procedure. The morbidity and mortality rates compare favorably with those of surgery.

Conclusions: PBSR represents a significant advancement in the management of bile duct stones, offering high success rates in stone clearance while minimizing the invasiveness and recovery times associated with traditional surgical approaches.

LONG-TERM OUTCOMES AND RECURRENCE RATES OF ACUTE CHOLANGITIS POSTCHOLECYSTECTOMY: A NATIONWIDE COHORT STUDY IN TAIWAN Po-Cheng Yang1, Chih-Lang Lin1,2, Li-Wei Chen1, Rong-Nan Chien1,3, Jia-Jang Chang1, Shuo-Wei Chen1, Ching-Chih Hu1, Cheng-Hung Chien1, Tien -Shin Chou1, Tsuo-Hsuan Chien1, Xiu-Wei Li1, Kuang-Chen Huang1, Cheng-Han Xie1 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Keelung, Taiwan 2 Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 3 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and University, Linkou, Taoyuan, Taiwan 1

膽囊切除術後急性膽管炎的長期預後與 復發率：一個台灣全國性之世代研究 楊博程1 林志郎1,2 陳立偉1 簡榮南1,3 張家昌1 陳碩為1 胡瀞之1 錢政弘1 鄒騰信1 簡佐軒1 李修維1 黃冠程1 謝承翰1 1

基隆長庚紀念醫院胃腸肝膽科 基隆長庚紀念醫院社區醫學研究中心 3 林口長庚紀念醫院胃腸肝膽科 2

Background: Acute cholangitis (AC), a lifethreatening condition affecting the extrahepatic biliary system, manifests with symptoms such as abdominal pain, fever, and jaundice, indicative of biliary infection and obstruction. Recent advancements in diagnostic and therapeutic techniques, including improved bile duct decompression and new antibiotics from microbiological studies, have significantly lowered mortality rates. Despite these advances, AC remains a critical medical emergency, with untreated cases swiftly progressing to sepsis. However, to date, there remains limited clinical data on the longterm recurrence rates and prognosis following cholecystectomy for AC. Aims: This retrospective cohort study was conducted to explore these issues by analyzing data from the

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P.104 Taiwanese National Health Insurance Research Database.

Methods: From January 2000 to December 2013, a total of 18,061 AC patients were enrolled as the control group, and 5,671 AC patients from a total of 41,511 post-cholecystectomy individuals were selected as the study group through screening for study eligibility.

Results: Of the patients included in the study group, the cumulative incidences of 1, 3, 5, 10 years of AC were 1.97%, 5.75%, 10.16%, and 24.51%, respectively. Statistical analyses using univariate and following multivariate approaches were conducted to predict AC risk factors indicated significant predictors of AC, including male gender, older age, and several comorbid conditions such as cerebrovascular disease, chronic pulmonary disease, peptic ulcer disease and renal disease, with P-values below 0.001 for all except renal disease (P = 0.015). In comparisons of AC-related mortality between both groups, the control group exhibited significantly higher mortality rates (P = 0.003) than the study group. Predictors for AC-related mortality in the control group included older age, peptic ulcer disease, and liver disease of varying severity. In the study group, significant associations were found with male gender (P = 0.041), older age, and severe liver disease. Regarding overall mortality, the control group demonstrated worse survival (P < 0.001) compared to the study group. Predictors for overall mortality in the control group included male gender, older age, myocardial infarction, congestive heart failure, cerebrovascular disease, dementia, peptic ulcer disease, mild to severe liver disease, both types of diabetes, hemiplegia, and renal disease.

Similarly, in the study group, significant predictors for overall mortality included male gender, older age, myocardial infarction, congestive heart failure, cerebrovascular disease, dementia, peptic ulcer disease, mild to severe liver disease, uncomplicated diabetes, and renal disease.

Conclusions: This study reveals that the long-term risk of AC recurrence following cholecystectomy remains considerable, with significant implications for patient mortality and overall health. The identification of key predictors such as age, gender, and specific comorbidities is critical for developing personalized treatment protocols. Effective postoperative monitoring and tailored therapeutic approaches are essential for improving patient outcomes in this at-risk patient group.

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EFFECTIVENESS AND PERSISTENCY OF USTEKINUMAB TREATMENT FOR INFLAMMATORY BOWEL DISEASE : A SINGLE CENTER STUDY Wei-Chen Lin1, Chen-Wang Chang1, Ming-Jen Chen1, Ching-Wei Chang1, Horng-Yang Wang1, Tzu-Chi Hsu2 Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan 2 Division of Colon and Rectal Surgery, Mackay Memorial Hospital, Taipei, Taiwan 1

喜達諾 ® 治療發炎性腸道疾病的有效性 和持久性：單中心研究 林煒晟1 章振旺1 陳銘仁1 張經緯1 王鴻源1 許自齊2 1 2

馬偕紀念醫院肝膽腸胃內科 馬偕紀念醫院大腸直腸外科

Background: There is an urgent need to understand the real-world effectiveness of ustekinumab (UST) in the treatment of Crohn’s disease (CD) and ulcerative colitis (UC). Persistence on treatment is commonly used as a surrogate measure of treatment response.

Aims: This study aims to estimate the real-world efficacy and persistence of UST in patients with inflammatory bowel disease (IBD).

Methods: A retrospective analysis was conducted on IBD patients who had received at least one course of UST therapy from March 2021 to January 2024, retrieved from a single center in Taipei, Taiwan. The clinical efficacy of UST was assessed from weeks 8 to 56. Persistence to UST was defined as the absence of a therapy exposure gap of more than 120 days between days of supply or end of follow-up.

Results: Nineteen IBD patients received UST therapy (median age 46 years, 42.1% men), of whom 12 had CD. The biologic-naïve rate was 58.3% in CD patients and 14.3% in UC patients. The response and remission rates for CD patients were 83.3% and 25.0% at week 8, and 87.5% and 75.0% at week 56, respectively. For UC patients, the response and remission rates were 57.1% and 42.9% at week 8, and 75.0% and 66.7% at week 56, respectively. No significant differences in clinical remission were noted between bio-naïve and bio-experienced patients. Adverse event incidence was notably low at 5.2%. The 6- and 12-month cumulative persistence rates were 100% and 81.8% in CD patients, and 100% and 67.3% in UC patients.

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P.105 Conclusions: Among difficult-to-treat patients with IBD, UST was effective in the majority, with high drug persistence at 12 and 24 months, combined with a favorable safety profile.

MORTALITY AND ADVERSE EFFECT PROFILES OF METRONIDAZOLE VERSUS ORAL VANCOMYCIN IN CLOSTRIDIOIDES DIFFICILE INFECTION: INSIGHTS FROM A POPULATION-BASED COHORT STUDY USING TRINETX DATABASE Po-Yu Huang1, Mitsuhiro Koseki2, Su-Hong Wang2, I-Che Feng2, Hsing-Tao Kuo2, Ming-Jen Sheu2 Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan 2 Division of Gastroenterology and Hepatology, Department of internal Medicine, Chi Mei Medical Center, Tainan, Taiwan 1

Metronidazole 與口服 Vancomycin 在困 難梭狀桿菌感染的死亡率和不良反應分 析：應用 TriNetX 資料庫進行的世代研究 分析 黃博裕1 古關光浩2 王宿鴻2 馮意哲2 郭行道2 許銘仁2 1 2

奇美醫學中心內科部 奇美醫學中心胃腸肝膽科

Background: Metronidazole has been a mainstay in the treatment of mild-to-moderate Clostridioides difficile infection (CDI) due to its cost-effectiveness and favorable safety profile. However, recent studies have raised concerns about its efficacy, particularly in severe cases and with the emergence of hypervirulent strains of Clostridioides difficile.

The IDSA recommends oral vancomycin as the initial treatment for severe CDI patients, which are characterized by a white blood cell count of 15,000 cells/µL or higher and a serum creatinine level greater than 1.5 mg/dL. However, to date, there is still no other consensus on the criteria of substituting metronidazole for oral vancomycin, including those based on age or comorbidities.

Aims: This study aims to explore the efficacy variations between metronidazole and oral vancomycin in CDI patients.

Methods: We conducted a retrospective cohort study using TriNetX, a global research database with data collected from multiple centers. The US Collaborative Network was used to study patients diagnosed with CDI to evaluate the effects of different treatments on clinical outcomes, especially

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P.106 mortality, within a 1-month follow-up timeframe.

Kaplan-Meier analysis was used to compare the mortality rates between the metronidazole and oral vancomycin groups after propensity score matching.

Furthermore, age-specific subgroup analyses were performed to assess its effect on the mortality.

Results: The metronidazole group exhibited higher mortality (hazard ratio [HR], 1.204; 95% confidence interval [95% CI], 1.09-1.331), diarrhea rate (HR, 1.217; 95% CI, 1.041-1.424), symptoms of nausea or vomiting (HR, 1.697; 95% CI, 1.378-2.09) compared to the oral vancomycin group during the 1-month follow-up period. Further age-specific subgroup analyses indicated that for patients under 60 years old, there is no significant difference in mortality rates between the two groups (HR, 1.147; 95% CI, 0.895-1.47).

Conclusions: Oral vancomycin is superior to metronidazole for CDI patients, irrespective of the severity of their condition. However, metronidazole might be a viable alternative for patients under 60 years old.

PREFERENCES TOWARDS TREATMENT ATTRIBUTES AMONG PATIENTS WITH CROHN’S DISEASE AND ULCERATIVE COLITIS IN ARGENTINA, AUSTRALIA, BRAZIL, SAUDI ARABIA AND TAIWAN: A DISCRETE CHOICE EXPERIMENT M. Argollo1, Y. K. An2, D. C. Balderramo3, N. Azzam4, C. J. Kuo5, O. Fadeeva6, E. Uy6, J. Chen7 Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil 2 Mater Hospital Brisbane, Brisbane, Australia 3 Servicio de Gastroenterología y Endoscopia Digestiva, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina 4 Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia 5 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 6 Takeda Pharmaceuticals International AG, Singapore 7 Takeda Pharmaceuticals Taiwan, Ltd. 1

Background: Advanced therapies (ATs) with different mechanisms of action and routes of administration (RoA) are used for inflammatory bowel disease (IBD: Crohn’s disease [CD] and ulcerative colitis [UC]), and patients (pts) play an increasing role in the decisionmaking process.

Aims: Pts’ preferences for treatment attributes from 7 European countries have been reported previously; however, evidence from non-European countries is lacking.

Methods: Adult pts with CD or UC on treatment for ≥6 months from Argentina, Australia, Brazil, Saudi Arabia and Taiwan were enrolled in this crosssectional, self-administered online survey (Oct 2022 to May 2023). Pts’ preferences for IBD treatment attributes are described. In a discrete choice experiment, the relative importance of treatment attributes was estimated using conditional logit models.

Results: Overall, 706 pts with CD and UC (n = 353 each) completed the survey. Mean (standard deviation [SD]) ages (years [y]) were 36.8 (9.9) and

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P.107 37.7 (10.2), 47.9% and 47.6% were female, and mean (SD) disease durations (y) were 4.5 (6.0) and 4.6 (6.7) for CD and UC, respectively; 58.1% (CD) and 56.1% (UC) were exposed to ATs. For pts with CD, the rate of long-term remission on maintenance therapy (MT) was the most important attribute for treatment choice (32.5%), followed by the rate of 1-y remission (25.7%), RoA (24.6%) and risk of serious adverse events (AEs, 11.5%) and mild AEs (5.8%). For pts with UC, the rate of corticosteroid-free remission after 1 y was the most important attribute (30.8%), followed by RoA (27.4%), rate of mucosal healing after 1 y (16.1%), long-term remission on MT (14.9%) and risk of serious AEs (10.0%) and mild AEs (0.8%).

Country-specific results are shown in the Table.

Compared with intravenous administration every 4–8 weeks, pts with CD preferred subcutaneous (SC) administration every 1–2 weeks (odds ratio [95% confidence interval]: 1.41 [1.27–1.56], P < 0.001) or every 4–12 weeks (1.22 [1.08–1.39, P = 0.002]), and pts with UC preferred taking a tablet (1.41 [1.25– 1.59], P < 0.001) or SC administration every 4–12 weeks (1.30 [1.14–1.48], P < 0.001) or every 1–2 weeks (1.20 [1.07–1.35], P = 0.002). Pts exposed to ATs ranked the importance of RoA lower than that of effectiveness compared with AT-naïve pts, and 49.3% of pts with CD and 50.5% with UC indicated that they wanted ATs to start earlier.

Conclusions: This study highlights the importance of treatment effectiveness, RoA and safety for pts with IBD. Personalised care is crucial given that preferences for treatment attributes may vary across countries and among pts. Patient–physician shared decision-making discussions regarding therapy choice and timing should happen throughout the treatment journey.

THE APPLIANCE OF LAPAROSCOPIC SLEEVE GASTRECTOMY WITH CONCOMITANT HIATAL HERNIA REPAIR ON GASTROESOPHAGEAL REFLUX DISEASE IN THE MORBIDLY OBESE Jiun-Wei Hsu, Po-Chun Wang Division of General Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan

腹腔鏡袖狀胃切除術合併食道裂孔疝氣 修補術在治療肥胖合併胃食道逆流症的 應用 許君瑋 王柏鈞 馬偕紀念醫院一般外科

Background: Hiatal hernias are common among bariatric surgery candidates and resulting gastroesophageal reflux disease (GERD). Hiatal hernia may be diagnosed before metabolic and bariatric surgery (MBS) by panendoscopy. With the increase risk of reflux before weight loss surgery as well as after Laparoscopic sleeve gastrectomy (LSG), patients with hiatal hernia identified pre-operative and intra-operatively should be considered undergo repairment. Based on our data, LSG with concomitant HHR appears to be effective and safe treatment in patients with morbid obesity and GERD. Aims: The aim of this study was to investigate the outcomes between concurrent hiatal hernia repair (HHR) and different bariatric surgery methods.

Methods: We will perform preoperative endoscopy in the evaluation reflux-induced esophageal injury and diagnosis of esophagitis. GERD Q questionnaire used for the evaluation of postoperative symptoms of GERD. Patient demographics, symptoms, and postoperative outcomes were collected and univariate analysis was performed to assess the association between preoperative and postoperative symptoms.

Results: Patients who received Laparoscopic sleeve gastrectomy (LSG) alone with short-term weight loss may experience the symptoms of GERD. Recently, we performed LSG+HHR in patients who was diagnosis with GERD by endoscopy. In our experience, concurrent LSG+HHR with non-absorbable barbed suture to repair the crus of diaphragm then fix with esophagus can achieve remission of the symptoms.

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P.108 Conclusions: Substantial weight loss in postMBS (Metabolic and bariatric surgery) patient, the hiatus hernia can be observed to enlarge attribute to fat loss around the gastro-oesophageal junction (GOJ). Based on the available literature, laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective surgical treatment for morbid obesity and is known to effectively control symptoms of gastroesophageal reflux (GERD). But LRYGB has the risk of long term comorbidity including internal herniation, malnutrition and Micronutrient and mineral nutritional deficiencies. Concurrent HHR with Laparoscopic sleeve gastrectomy (LSG) appears to be effective and safe procedure. In our opinion, each size of hiatus hernia should be repaired during the time of MBS to prevent further complication.

PRIMARY SMALL BOWEL GASTROINTESTINAL STROMAL TUMORS FINDING IN DOUBLE BALLOON ENTEROSCOPY: THE EXPERIENCE IN A SINGLE INSTITUTION IN TAIWAN Yu-Lin Chen1, Po-Ju Huang1,3, Chu-Ping Wang1, Yi-Hua Wu1,3, Ken-Sheng Cheng1,2, Jen-Wei Chou1,2,3 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University Hospital, Taichung, Taiwan 2 School of Medicine, China Medical University, Taichung, Taiwan 3 Taiwan Association for the Study of Small Intestinal Diseases (TASSID) 1

雙氣囊小腸鏡發現原發性小腸胃腸道間 質瘤：台灣單一醫學中心的經驗 陳宥霖1 黃柏儒1,3 王楚評1 吳宜樺1,3 鄭庚申1,2 周仁偉1,2,3 1

中國醫藥大學附設醫院消化系 中國醫藥大學附設醫院醫學系 3 台灣小腸醫學會 2

Background: Gastrointestinal stromal tumors are common mesenchymal tumors, usually occurring in the gastrointestinal tract, from the esophagus to the rectum. GISTs are most occur in the stomach (60– 70%), followed by small intestine (20%–30%), colon and rectum (5%) and esophagus (<5%). Primary small intestine gastrointestinal stromal tumors are difficult to diagnose preoperatively because of endoscopic inaccessibility.

Aims: The aim of the study was to investigate the clinicopathological features of patient whom underwent deep enteroscopy and were diagnosed as primary small intestine gastrointestinal stromal tumors in a single institution in Taiwan.

Methods: From January 2009 to December 2023, we retrospectively reviewed the medical charts at China Medical University Hospital. Patients who were diagnosed as primary small intestine gastrointestinal stromal tumors via double balloon enteroscopy (DBE) were included into this study. Clinical data were obtained from the medical records and from the physicians responsible for patient care. Clinical

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P.109 data abstracted included age, gender, symptoms, tumor location, co-mobidity, treatment methods, and outcomes.

Results: A total of 32 patients with primary small intestine gastrointestinal stromal tumors were enrolled into this study. There were 17 males and 15 females, with a male-to-female ratio of 1.13:1. The mean age was 57.9 years (range, 31-86 years). In our present study, as regards clinical symptoms, all 32 patients were symptomatic. They most commonly presented with GI bleeding (28 patients, 87.5%).

Followed by abdominal pain in seventeen, diarrhea in eight, weight loss in four, and ileus in two patient.

In terms of co-morbidities, 10 of 32 patients (31.2%) had hypertensive disease and cardiovascular disease, six (18.8%) had diabetes mellitus, four (12.5%) had iron deficiency anemia, three (9.4%) had chronic liver disease with or without liver cirrhosis, two (6.3%) had end-stage renal disease (ESRD) and one (3.2%) had lung adenocarcinoma. Primary small intestine gastrointestinal stromal tumor involved the jejunum in 22 (68.8%) of 32 patient, the 3rd to 4th duodenum in 6 (18.8%) of 32 patients, and the ileum in 4 (12.5%) of 32 patient. The tumors ranged in size from 0.9 to 14 cm (mean, 3.6 cm); The immunohistochemistry reveraled CD117 positivity in 31 of 32 patients (96.8%). And CD 34 positive in 28 cases (87.5%), 12 cases (37.5%) were positive for smooth muscle actin, and 2 cases (6.3%) were positive for desmin. 25 patients receive surgical operation and 20 cases of these group receive adjuvant targeted therapy with Imatinib. Another 6 patient receive monotherapy with Imatinib. Another one patient refuse any therapy and ask for palliative care due to old age. Four patients died of disease progression, three of these four case receive surgical operation and adjuvant targeted therapy. And one patient choose palliative care. Another 28 patient still regularly follow up in OPD now.

Conclusions: In conclusion, the results of our present study showed primary small intestine gastrointestinal stromal tumors are most common type of small bowel tumor in Taiwan and their diagnosis are usually needs deep small bowel enteroscopy or operation. These patients who suffered from primaly small intestine GIST usually old age and have co-mobidity disease. Compared with those reported in other countries, primary small intestine GIST in Taiwan have the similar clinicopathologic feature.

INCREASED RISKS OF GASTROINTESTINAL MALIGNANCY IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME BASED ON NATIONAL POPULATION STUDY Chao-Feng Chang, Hsuan-Hwai Lin, Peng-Jen Chen, Wei-Kuo Chang, Tien-Yu Huang Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

健保資料庫分析探討原發性乾燥症患者 發生胃腸道惡性腫瘤的風險性 張肇丰 林煊淮 陳鵬仁 張維國 黃天祐 三軍總醫院胃腸科

Background: Sjögren’s syndrome is a long-lasting autoimmune disorder which happens when the immune system attacks the glands including eyes, mouth, and other parts of the body. It also increased the risk of gastrointestinal malignancy due to the desynchronization of mucosal immune system.

Therefore, Sjögren’s syndrome is hypothesized to be related with gastrointestinal disorder.

Aims: This study aimed to investigate the association between Sjögren’s syndrome and several chronic diseases including gastrointestinal malignancy in a large-scale Taiwan adult population cohort.

Methods: 1246006 participants from Longitudinal Health Insurance Database in Taiwan (2000–2015) were involved in this cross-sectional analysis. The patients in Taiwan were assessed and divided equally into Sjögren’s syndrome group and non- Sjögren’s syndrome group. Cox regression model was used in our study to assess if it had significant findings.

The association between Sjögren’s syndrome and gastrointestinal malignancy was assessed while covariate assessments.

Results: The patients who had been diagnosed as Sjögren’s syndrome were substantially correlated with increased risk of gastrointestinal malignancy (3.14% v.s. 2.70%, P < 0.05). Furthermore, this study also significantly revealed association between Sjögren’s syndrome (P < 0.05) and other chronic diseases including dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, hypertension and cancer.

Conclusions: Patients with Sjögren’s syndrome are

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P.110 highly associated with the risk of gastrointestinal malignancy and many other chronic diseases among the adult population in Taiwan. More research is necessary to bring the bright of pathophysiological mechanisms associated to Sjögren’s syndrome and gastrointestinal malignancy diseases.

OUTCOME AND LEARNING CURVE OF COLORECTAL ESD BY UNSUPERVISED ENDOSCOPIST: INSIGHTS FROM A SINGLE-CENTER EXPERIENCE IN TAIWAN Hao-Ping Hsu1,2, Chung-Ying Lee1,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan 1

新手內視鏡醫師進行結直腸 ESD 的結果 與學習曲線：台灣單一中心經驗的見解 徐昊平1,2 李宗頴1,3 1

衛生福利部雙和醫院肝膽腸胃科 國立臺灣大學醫學院附設醫院肝膽腸胃科 3 臺北醫學大學消化醫學研究中心 2

Background: Early detection of adenomas or early cancers followed by endoscopic resection is crucial for improving colorectal cancer outcomes. For large lesions, ESD is preferred due to its higher en bloc resection rate, enabling precise histopathological diagnosis and reducing unnecessary surgeries.

However, the wider adoption of ESD outside Japan is limited by its technical difficulty, prolonged procedure time, and elevated complication rates.

Japanese experts recommend a stepwise training approach, beginning with gastric ESD followed by esophageal and colorectal ESD (CR-ESD) under expert supervision. Therefore, understanding the learning curve for unsupervised novice endoscopists in CR-ESD is essential in countries outside Japan.

Aims: To evaluate the outcome and learning curve of colorectal ESD(CR-ESD) based on an unsupervised endoscopist’s experience.

Methods: This retrospective study, conducted at Shuang Ho Hospital in Taiwan from July 2019 to July 2023, enrolled consecutive 60 lesions that underwent CR-ESD performed by a single, unsupervised endoscopist. The cases were chronologically divided into two distinct periods: 1st period (case 1-30, from July 2019 to July 2021) and 2nd period (case 31-

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P.111 60, from Aug. 2021 to July 2023). Comprehensive data on baseline case characteristics, procedure parameters, and outcomes were collected between these periods for comparative analysis.

Results: No statistically significant differences were observed in age, gender, or Charlson Comorbidity Index between the two periods. The 2nd period displayed a higher ratio of larger lesions (≥40 mm) (p = 0.007) and technical difficulty score (ZhongShan CR-ESD scores ≥4) (p = 0.005) compared to the 1st period. The median resection speed notably improved, increasing from 6.0 mm²/min to 8.2 mm²/ min (p = 0.044). The trend of median resection speed for sequential blocks of every 15 cases revealed an increase in resection speed after 45 cases of experience. The R0 resection showed enhancements, rising from 76.7% to 86.7%. Hybrid-ESD was more frequently utilized in the 1st period than the 2nd period (p = 0.002). While complications were absent in the 1st period, five minor complications occurred in the 2nd period. Overall, among 37 cases (61.6%) with a median follow-up of 11.7 months, only two encountered local recurrence (5.4%).

Conclusions: We demonstrated the feasibility and learning curve of unsupervised CR-ESD, showing that effective resection speed and optimal en bloc resection rate were achieved after at least 45 cases.

Hybrid-ESD can serve as a balanced strategy to minimize complications during the initial phase.

Additionally, using a difficulty scoring model can assist in case selection, tailoring the technical difficulty to the endoscopist’s evolving competence in CR-ESD.

SM2-3 INVASION AND TUMOR BUDDING WARRANT SURGICAL RESECTION IN T1 COLORECTAL CANCER PATIENTS WHO HAD UNDERGONE ENDOSCOPIC RESECTION: CLINICAL EXPERIENCE SHARING FROM A MEDICAL CENTER IN NORTHERN TAIWAN Wei Chiang1, Tze-Sian Chan1,2, Min-Shung Wu1,2, Fat-Moon Suk1,2, Gi-Shih Lien1,2, I-Ching Cheng3, Chun-Nan Chen1 Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 2 Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3 Division of Gastroenterology, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan 1

經內視鏡下切除後呈現深度黏膜下層侵 犯及腫瘤出芽之 T1 大腸癌仍需外科手術 介入治療：一個北部醫學中心的臨床分 析 江瑋1 張智翔1,2 吳明順1,2 粟發滿1,2 連吉時1,2 鄭以勤3 陳俊男1 1

臺北市立萬芳醫院消化內科 臺北醫學大學醫學系內科學科 3 基督復臨安息日會醫療財團法人臺安醫院消化內科 2

Background: T1 colorectal cancer (T1 CRC) is defined as a colorectal malignancy with histologic invasion through the muscularis mucosa and into, but not beyond the submucosa. Endoscopic resection is the treatment of choice for lesions that extend beyond the superficial submucosal level (SM-s). However, if the tumors have invaded more than 1000 µm (deep submucosal invasion, DSI), additional surgical resection with lymph node dissection is warranted.

Surgical over-treatment remains a major issue in T1 CRC. A retrospective study was conducted to investigate the results of the T1 CRC after endoscopic resection followed by surgery and lymph node dissection in a medical center.

Aims: To investigate the outcomes of the T1 CRC patients who received endoscopic resections and

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P.112 surgery intervention with lymph node dissections in a medical center in northern Taiwan.

Methods: The endoscopic and surgical records of patients with T1 CRC were retrieved and analyzed retrospectively at Wan Fang Medical Center from Jan-2018 to Dec-2022. Patients’ demographics, techniques of endoscopic resection such as polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD and surgery were all recorded. Only patients with adenocarcinoma were included in this study.

Furthermore, those who received additional surgical colorectal resection and lymph node dissection were identified and studied. The indications for additional surgery were illustrated and the pathological reports upon lymph node invasion were further evaluated.

Results: A total of 753 patients with the diagnosis of colorectal cancers were registered in Taipei Medical University Municipal Wan Fang Hospital between Jan-2018 to Dec-2022. Among them, 152 were T1 CRCs. There were 33 patients who fit the criteria of both T1 CRC and indications for endoscopic resection. Twenty out of 33 (60.6%) cases received further surgical resection and lymph node dissection.

The reasons for further surgical intervention were: depth of submucosal invasion >1000 µm or SM2–3, tumor budding, and unclear margin to be assessed.

Among these 20 patients, 20.0% of the cases (n = 4) were proved positive with LNM. Conclusions: For the T1 CRCs resected endoscopically possessing risk factors such as deep submucosal invasion >1000 µm, tumor budding, and unclear margins, additional surgical intervention with lymph node dissection are still necessary to avoid potential LNM.

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CHARACTERISTICS AND OUTCOMES OF SMALL BOWEL VASCULAR LESIONS IN PATIENTS WITH OBSCURE GASTROINTESTINAL BLEEDING DETECTED BY DEEP ENTEROSCOPY: A SINGLE-CENTER EXPERIENCE IN TAIWAN Ming-Chun Hsieh1, Chao-Feng Chang1, Peng-Jen Chen1, Yu-Lueng Shih1, Wei-Kuo Chang1,2, Tsai-Yuan Hsieh1, Tien-Yu Huang1,2 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 2 Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan 1

在隱晦性腸胃道出血病人接受深部小腸 鏡檢查呈現小腸血管性病灶的特徵及治 療：單一中心回顧性研究 謝明均1 張肇丰1 陳鵬仁1 施宇隆1 張維國1,2 謝財源1 黃天祐1,2 1 2

三軍總醫院胃腸肝膽科 台灣小腸醫學會

Background: In patients with gastrointestinal bleeding, obscure gastrointestinal bleeding (OGIB) poses a significant challenge in clinical practiceeven standard endoscopic evaluation. Small bowel vascular lesions are a major cause of OGIB. Aims: This study aims to identify the clinical characteristics and endoscopic management of small bowel vascular lesions in OGIB patients undergoing deep enteroscopy.

Methods: From September 2009 to December 2023, 385 patients underwent single-balloon enteroscopy (SBE) (totaling 592 procedures) at Tri-Service General Hospital. Among them, 203 patients with OGIB who underwent SBE (308 procedures) were enrolled.

Clinical characteristics and endoscopic findings were collected, and multiple variables were analyzed to determine the risk factors and clinical outcomes.

Results: Among OGIB patients undergoing SBE, the diagnostic yield was 79% (161 patients). In patients with positive findings, vascular lesions were found in 39.1%, while non-vascular lesions accounted for 60.9%. The most common etiology of OGIB in patients with vascular lesions was angiodysplasia

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P.113 (88.8%). The endoscopic intervention rate was 87.3%, with most patients treated using argon plasma coagulation (73%). Three cases required transcatheter arterial embolization (4.8%), one case received sclerotherapy, and two cases underwent surgical intervention.

Conclusions: In our study, angiodysplasia was the most common vascular lesion in patients with obscure gastrointestinal bleeding. Most patients were successfully treated with endotherapy. In certain situations, surgical or vascular intervention was necessary.

INDEPENDENT RISK FACTORS PREDICTING ERADICATION FAILURE OF VONOPRAZAN HIGH-DOSE DUAL THERAPY FOR THE FIRSTLINE TREATMENT OF HELICOBACTER PYLORI INFECTION Chih-An Shih1,10, Deng-Chyang Wu2,10, Chien-Lin Chen3,10, Kuan-Yang Chen4,10, Seng-Kee Chuah5,10, Chia-Long Lee6,10, Feng-Woei Tsay7,10, Jyh-Chin Yang8,10, Wei-Yi Lei3,10, Chao-Hung Kuo2,10, Chang-Bih Shie9,10, Hsi-Chang Lee4,10, Wei-Chen Tai5,10, Ping-I Hsu9,10 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai TianSheng Memorial Hospital and Department of Nursing, Meiho University, Pingtung, Taiwan; 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan; 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine Taipei City Hospital, Renai Branch, Taipei, Taiwan; 5 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, and Chang Gung University College of Medicine, Taoyuan, Taiwan; 6Division of Gastroenterology and Hepatology, Department of Internal Medicine Cathay General Hospital, Taipei, Taiwan; 7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National YangMing University, Kaohsiung, Taiwan; 8Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 9Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan; 10 Taiwan Acid-related Disease (TARD) Study Group 1

以「Vonoprazan（福星定）為基礎之高 劑量二合療法」治療幽門螺旋桿菌感染 除菌失敗之獨立危險因子 241

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石志安1,10 吳登強2,10 陳健麟3,10 陳冠仰4,10 蔡成枝5,10 李嘉龍6,10 蔡峯偉7,10 楊智欽8,10 郭昭宏2,10 施長碧9,10 李熹昌4,10 戴維震5,10 許秉毅9,10 1

安泰醫院胃腸肝膽科；2 高雄醫學大學附設醫院胃 腸內科；3 花蓮慈濟醫院肝膽胃腸科；4 臺北市立聯 合醫院仁愛院區消化內科；5 高雄長庚紀念醫院胃腸 肝膽科；6 國泰綜合醫院腸胃內科；7 高雄榮民總醫 院胃腸肝膽科；8 國立臺灣大學醫學院附設醫院胃腸 肝膽科；9 臺南市立安南醫院暨中國醫藥大學消化內 科；10 台灣胃酸相關疾病暨微菌叢聯盟

Background: A recent randomized controlled trial demonstrated that both vonoprazan-based highdose dual therapy was superior to proton pump inhibitor–based triple therapy. However, eradication rates of vonoprazan high-dose dual therapy according to intention-to-treat and per-protocol analyses were 83% and 85%, respectively. Currently, the risk factors of eradication failures for vonoprazan high-dose dual or triple therapies remain unclear.

Aims: To investigate the independent risk factors predicting eradication failure of vonoprazan highdose dual therapy for the first-line treatment of H. pylori infection.

Methods: H. pylori-infected patients who received 14-day vonoprazan high-dose dual therapy between Jan 2022 and April 2024 were included for the retrospective cohort study. They received an eradication regimen containing a dual therapy with vonoprazan 20 mg twice daily and amoxicillin 750 mg four times daily. Post-treatment H. pylori status was assessed at least 4 weeks after completion of treatment. The relationships between eradication rate and 12 clinical parameters were analyzed by univariate and multivariate analyses.

Results: In total, 302 H. pylori-infected patients were included. The eradication rates of vonoprazan highdose dual therapy by intention-to-treat, modified intention-to-treat and per-protocol analyses were 83.8%, 86.9% and 87.4%%, respectively. Univariate analysis revealed that the eradication rate in male patients was significantly lower than that in female patients (81.3% vs. 91.1%; p = 0.015). Additionally, patients with poor drug adherence also had a lower eradication rate than those with good drug adherence (60.0% vs. 87.7%; p = 0.017). Although those harboring amoxicillin-resistant strains had a lower eradication rate than those harboring amoxicillin-susceptible strains (66.7% [2/3] vs.

89.2% [181/203]), the difference in eradication

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rates between groups did not reach statistically significant (p = 0.219). Multiple regression analysis showed that male gender and poor drug adherence were significant independent risk factors predicting eradication failure in patients treated with vonoprazan high-dose dual therapy with odds ratios of 2.2 (1.1–4.5) and 8.4 (1.3–53.8), respectively.

Conclusions: 14-day vonoprazan high-dose dual therapy achieve a suboptimal eradication rate for H. pylori infection in Taiwan. Male gender and poor drug adherence are independent risk factors predicting eradication failure of vonoprazan high-dual therapy.

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COMPARISON OF COMPLICATIONS IN PATIENTS WITH BILIARY PLASTIC STENTS REMOVAL WITHIN AND BEYOND THREE MONTHS Yen-Kang Lee, Chao-Ling Cheng, Tze-Sian Chan, Ming-Shun Wu, Fat-Moon Suk, Gi-Shih Lien Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan

比較三個月內或三個月以上進行膽道塑 膠支架移除的患者併發症 李言康 鄭照霖 張智翔 吳明順 粟發滿 連吉時 臺北市立萬芳醫院消化內科

Background: Biliary plastic stents are crucial in managing biliary drainage in cases of benign or malignant biliary stenosis. The primary function of these stents is to maintain smooth passage of bile flow, and to resolve obstructive jaundice and cholangitis. However, retaining these stents beyond the manufacturer- recommended insertion threemonths period can lead to complications such as, recurrent cholangitis, cholecystitis, liver abscess, internal stent migration, or biliary tract injury caused by stent fragmentation. Despite the known risks, retained biliary plastic stents beyond three-months period are encountered in clinical practice, often due to patient follow-up issues or healthcare provider oversight. Understanding the complications associated with stent retention beyond the recommended period is essential for improving patient outcomes and healthcare practices.

Aims: To compare the complications associated with removal of biliary plastic stents in patients within three months versus those with delayed removal beyond three months.

Methods: This research was conducted as a retrospective cohort study. The study population consisted of patients who had biliary plastic stents inserted for bile duct drainage. The patients were divided into two groups: those with stents retained for ≤3 months and those with stents retained for >3 months. Recorded complications included recurrent cholangitis, cholecystitis, liver abscess, internal stent migration, and biliary tract injury caused by stent fragmentation. The primary

outcome was complications in patients with stents retained beyond three months. A chi-square test of independence was performed to determine significant differences in complications between the two groups.

Results: In this five-year retrospective study, from January 2019 to January 2024, we included 113 patients who received internal biliary stent drainage after episodes of obstructive jaundice caused by common bile duct stones. A total of 53 patients experienced delayed biliary stent removal. Among these, 7 patients developed complications. The chisquare test of independence revealed a significant association between delayed stent removal and complications, with a Pearson correlation coefficient of 0.230 and a p-value of 0.014 (p < 0.05).

Conclusions: This study concluded that delayed biliary plastic stents removal beyond the recommended three-month period significantly increases the risk of complications. The results highlight the importance of replacing or removing the stent within this timeframe. Improving patient’s follow-up practices will also enhance patients outcomes.

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FACTORS ASSOCIATED WITH PERSISTENT SYMPTOMS AND CHRONIC USE OF PROTON PUMP INHIBITORS IN PATIENTS WITH SUSPECTED LARYNGOPHARYNGEAL REFLUX Kuan-Chih Chen1,2, Chen-Chi Wang3, Yen-Chun Peng1,2, Han-Chung Lien1,2 Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 3 Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan 1

疑似咽喉逆流患者持續症狀及慢性質子 泵抑制劑使用的相關因素 陳寬智1,2 王仲祺3 彭彥鈞1,2 連漢仲1,2 1

臺中榮民總醫院胃腸肝膽科 臺中榮民總醫院內科部 3 臺中榮民總醫院耳鼻喉科 2

Background: Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease (GERD). Despite frequent use, the evidence regarding the effectiveness of proton pump inhibitors (PPIs) for LPR is weak, and diagnosing it is challenging. Composite pH, defined as the presence of ≥2 pharyngeal acid reflux episodes within 24 hours and/or excessive distal esophageal acid reflux as measured by reflux monitoring, has emerged as a potential predictor for treatment response. However, its long-term predictive value remains unclear.

Besides, long-term data on persistent symptoms and PPI use are scarce. We hypothesized that acidbased parameters on reflux monitoring may predict long-term PPI use.

Aims: To evaluate the prevalence and predictors of persistent symptoms and PPI use in patients with suspected LPR under routine care.

Methods: In this prospective study, 116 subjects with LPR symptoms underwent a 24-hour 3-pH esophagopharyngeal test without therapy, followed by a 12-week esomeprazole treatment and a 9-month PPI tapering period at Taichung Veteran General Hospital. In the second year, laryngeal symptoms and PPI use were tracked by mail and phone. Chronic

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PPI use was defined as receiving at least 120 tablets per year at physician’s discretion. Independent risk factors for PPI use and persistent symptoms were assessed using multivariable logistic regression.

Results: Of the 116 subjects, 11 were excluded due to loss of follow-up (n = 11). Among the remaining 105, 81 (77%) reported persistent symptom including one with newly diagnosed of having laryngeal cancer. Forty subjects (38%) are chronic PPIs users.

Of them, 25%, 25%, and 50% reported taking PPIs for symptomatic relief of larynx, esophagus, and both larynx and esophagus, respectively. Multivariate logistic regression analysis revealed that prior PPI use (aOR: 4.5, 95% CI: 1.3-15.6, P = 0.012), erosive esophagitis (3.9, 1.1-14.0, P = 0.010), composite pH (5.3, 1.6-17.3, P = 0.005), and response to a 12-week esomeprazole treatment (4.9, 1.5-15.6, P = 0.003) were independently associated with chronic PPI use. No predictors of persistent laryngeal symptoms were identified.

Conclusions: Three-fourths of suspected LPR patients remain symptomatic in the second year.

Acid-based parameters from reflux monitoring, rather than typical reflux symptoms, predict longterm PPI use, suggesting their potential diagnostic value.

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INTESTINAL PSEUDOOBSTRUCTION AS THE INITIAL PRESENTION OF SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE SERIES REPORT Tun-Yen You, Yang-Yuan Chen, Hsu-Heng Yen Department of Gastroenterolgy, Changhua Christian Hospital, Changhua, Taiwan

以假性腸阻塞為初期表現的系統性紅斑 狼瘡：病例係列報告 游敦巖 陳洋源 顏旭亨 彰化基督教醫院胃腸肝膽科

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various parts of the body. The immune system, which normally protects the body against infections, mistakenly attacks healthy tissue in individuals with SLE. This abnormal immune response can lead to inflammation and damage in multiple organ systems, including the skin, joints, kidneys, brain, and other organs.

Aims: SLE patients complicated with gastrointestinal complications, such as intestinal pseudo-obstruction (IPO), are extremely rare in clinical practice. Therefore, we report the emergence of these cases in single medical center.

Methods: We conducted a search of laboratory data to identify confirmed SLE patients who underwent long-term follow-up at the Rheumatology and Immunology Department and exhibited suspicion of IPO. Clinical features, symptoms, and autoimmune profiles were collected. Abdominal echography or abdominal computed tomography (CT) scans and gastrointestinal endoscopic examinations were reviewed.

Results: Total five SLE cases (1 male, 4 females, mean age 44.2 years) were enrolled with suspicion of IPO between 2005 to 2024 at Changhua Christian Hospital. All five cases presented with abdominal pain for a period before seeking medical management. CT imaging with enrolled cases showed wall thickening over terminal ileum, ileus without a transitional, mural thickening of the ileum and wall thickness over jejunum. 2 cases had undergone further enteroscopic examination, which both showed no signs of obstruction or inflammation. 1 case presenting with ileus on CT

imaging had previously undergone enteroscopy at another medical center, which also showed no signs of obstruction or inflammation. All cases tested positive for antinuclear antibody. 80% cases (4/5) tested positive for anti-double-strand DNA and 60% cases (3/5) with positive of anti-Sm. 40% cases (2/5) with positive for Anti-SSA, anti-cardiolipin IgG and Anti-RNP. 1 case with positive of Anti-SSB. AntiScl-70 were all negative in all five cases. All cases showed gradual improvement in clinical symptoms after treatment with prednisolone.

Conclusions: While SLE patients complicated by IPO are rare in clinical practice, cases have emerged in recent years with the underlying cause yet to be determined. Notably, the possible relation of emerge of these cases with association of COVID-19 infection linked to autoimmune diseases recurrence yet to be discovered.

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COMPARISON OF GPT-4O AND GPT4 TURBO IN DETECTING POLYPS IN COLONOSCOPY IMAGES Wei-Lun Hsu1,2,3 Division of Gastroenterology and Hepatology, Department of Medical Affairs, Landseed International Hospital, Taoyuan, Taiwan 2 Department of Digital Development, Landseed International Hospital, Taoyuan, Taiwan 3 Institute of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan 1

ChatGPT 4o 與 ChatGPT 4 Turbo 對大腸 息肉偵測的比較 徐偉倫1,2,3 1

聯新國際醫院腸胃肝膽科 聯新國際醫院數位發展部 3 國立中央大學資訊工程研究所 2

Background: Colonoscopy is essential for the early detection and prevention of colorectal cancer.

Accurate identification and classification of colorectal polyps during colonoscopy are crucial for effective patient management. Recently, artificial intelligence (AI) models like GPT-4o and GPT-4 Turbo have emerged, promising improvements in the accuracy of polyp detection and classification. Understanding the comparative performance of these models can significantly impact clinical outcomes.

Aims: This study aims to evaluate and compare the performance of GPT-4o and GPT-4 Turbo in detecting polyps in colonoscopy images. Additionally, the study seeks to understand the influence of the Paris polyp classification, Narrow Band Imaging (NBI), and the polyp area ratio (PI ratio) on the models’ performance. Consistency of model performance across multiple runs is also assessed to ensure reliability.

Methods: A dataset of 3,433 colonoscopy images, each annotated with ground truth labels for polyp classification, was utilized. Each image was processed by both GPT-4o and GPT-4 Turbo models across five runs, generating predictions for each run.

The primary performance metric was the proportion of images in which polyps were detected by each model. The impact of NBI and PI ratio on detection rates was analyzed using t-tests and logistic

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regression. Confusion matrices were generated to visualize classification performance, and standard deviation and statistical tests were employed to evaluate the consistency of the models’ performance across runs.

Results: The results indicated that GPT-4o failed to detect polyps in 19.91% of cases, while GPT-4 Turbo failed in 19.38% of cases. A t-test comparing the detection rates of the two models showed no statistically significant difference, indicating that both models have similar capabilities in detecting polyps. The presence of NBI significantly reduced the rate of missed detections (t-statistic: -3.0181, p < 0.01). Higher PIratio values significantly decreased the probability of missing polyps (coefficient: -2.6693, p < 0.001). Analysis of the Paris polyp classification revealed variations in detection rates across different polyp classes. Polyps classified as Type Ip were the easiest to detect, with both models showing higher detection rates for this class. Conversely, Type IIb polyps were the most challenging to detect, with both models showing higher rates of missed detections for this class. Both models exhibited consistent performance across the five runs, with low standard deviations in detection rates, confirming the reliability of the results.

Conclusions: The study demonstrates that both GPT-4o and GPT-4 Turbo reliably detect polyps in approximately 80% of cases, indicating strong baseline performance with no significant difference between the models. Polyps classified as Type Ip were the easiest to detect, while Type IIb polyps were the most challenging. The presence of NBI and higher PI ratio values significantly enhance polyp detection rates. The models’ consistent performance across runs underscores their reliability, highlighting the potential of AI in gastroenterology and the need for ongoing development to achieve more accurate and dependable diagnostic tools.

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P.119

EMPLOYING COMPUTER-AIDED ORDINAL REGRESSION BASED ON DUAL LOSS FUNCTION TO AUTOMATICALLY DETECT AND CLASSIFY THE L3 VERTEBRA IN CT IMAGES FOR CENTRAL SARCOPENIA EVALUATION Mei-Chuan Liang1, Chia-Pei Tang2,3, Tu-Liang Lin4, Hong-Yi Chang4, Yu-Ming Hsu4, Chia-Hsin Cheng5 Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 3 School of Medicine, Tzu Chi University, Hualien, Taiwan 4 Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan 5 Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 1

基於電腦輔助的雙重損失函數的序數回 歸自動偵測和分類 CT 影像中的 L3 腰椎 應用於中心性肌少症之評估 梁美娟1 唐家沛2,3 林土量4 張宏義4 許育民4 鄭佳欣5 1

大林慈濟醫院內科部 大林慈濟醫院肝膽腸胃內科 3 慈濟大學醫學院 4 國立嘉義大學資訊管理學系 5 大林慈濟醫院研究部 2

Background: Sarcopenia is defined as a significant loss of muscle mass and function and has been recognized as an important independent risk factor for numerous adverse outcomes. CT provides information of muscle quality and specific attenuation depending on the degreed of fat density.

CT images in L3 vertebral is the gold standard to evaluate quantitative and qualitative changes in muscle and fat. To investigate CT in sarcopenia, it requires identification of the L3 vertebral manually.

Computer-aided auto detection of L3 facilitate the diagnosis of sarcopenia.

Aims: There is the need to develop a standardized, reliable and accurate evaluation techniques for the use of CT to obtain recognition of L3 vertebral, muscle metrics, to develop analysis techniques, and to establish diagnostic cut points for sarcopenia.

Computer-aided analysis is a novel method to achieve these goals. The process is involved in two steps, the first is to detect the designated spine (L3) automatically and the second step is the automation to measure the surrounding muscle and fat. Current study is aimed to use computer-aided automation to detect the L3 vertebral.

Methods: This study used a dataset of CT image slices provided by Dalin Tzu Chi Hospital in Chiayi (IRB number: B11102012). The dataset includes a total of 84 patients, each with 4 to 6 CT images of the T12 and the L1 to L4 vertebrae, totaling 2512 CT images. This includes 474 images of the T12, 482 images of the L1, 510 images of the L2, 548 images of the L3, and 498 images of the L4. We divided the dataset by patient count in an 8:2 ratio. In the first experiment, we trained using the pretrained model of EfficientNetV2-S, setting the learning rate to e-5, and using the Adam optimizer. We employed the ordinal residual dual loss function and compared its performance with the use of simple crossentropy loss and methods from previous literature.

Using the EfficientNetV2-S network, the training incorporates various loss functions including crossentropy loss, CORN Loss, CDW-CE Loss, and the ordinal residual dual loss function proposed in this study. The accuracy of each model is compared subsequently. The second experiment utilizes the ResNet-34 network for training, also integrating the four aforementioned loss functions, followed by an evaluation and comparison of the models. We used accuracy and F1-score as performance metrics and employed the Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) to assess whether the distance between the predicted and actual categories has decreased, indicating more accurate predictions.

Results: The application of the ordinal residual dual loss function outperformed simple cross-entropy loss, improving the accuracy from 0.9234 to 0.9312, reducing the Mean Absolute Error (MAE) from 0.0766 to 0.0688, and decreasing the Root Mean Square Error (RMSE) from 0.2768 to 0.2622. The results using cross-entropy loss and CORN Loss showed little difference. We also calculated the accuracy and F1score for each category using EfficientNetV2-S with

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P.120 various methods. It was observed that using CORN loss or CDW-CE loss resulted in better accuracy for the T12 and the L1 compared to using just crossentropy loss. However, there was a downward trend in accuracy for the L2, L3 and L4. Since sarcopenia is primarily assessed using the L3, the methods from previous literature still have their shortcomings.

By utilizing the ordinal residual dual loss function, not only did the accuracy for the T12, L1, L2, and L4 improve, but the accuracy for the L3 was also enhanced. Compared to the cross-entropy loss, the accuracy for the L3 increased slightly from 0.953 to 0.959, showing better results than previous literature. In our second experiment, we trained using the pretrained ResNet-34 model, with the learning rate and optimizer settings identical to those used for EfficientNetV2-S. The results indicate that using the ordinal residual dual loss function indeed performed better than using just the crossentropy loss. The accuracy improved from 0.8939 to 0.9136, the Mean Absolute Error (MAE) decreased from 0.1081 to 0.0864, and the Root Mean Square Error (RMSE) was reduced from 0.3346 to 0.2940.

However, the accuracy when using CORN Loss was slightly lower than that achieved with cross-entropy loss.

Conclusions: The ordinal residual dual loss function has demonstrated superior performance compared to the cross-entropy loss function. With the EfficientNetV2-S model, the training accuracy improved from 0.9234 to 0.9312, and the Root Mean Square Error (RMSE) decreased from 0.2768 to 0.2622. Similarly, using the ResNet-34 model, the training accuracy increased from 0.8939 to 0.9136, and the RMSE was reduced from 0.3346 to 0.2940.

These improvements in both models surpass those documented in previous literature. Sarcopenia assessment primarily relies on the accuracy of detecting the L3. While methods from previous literature generally show overall higher accuracy compared to the cross-entropy loss function, they tend to decrease the accuracy specifically for the L3 vertebra. However, using the ordinal residual dual loss function not only enhances the accuracy of surrounding lumbar vertebrae but also significantly improves the accuracy of the L3. With EfficientNetV2-S, the accuracy reached 0.959, and with ResNet-34, it reached 0.951. These improvements provide better support the accuracy in diagnosing sarcopenia.

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TO ASSESS PUBLIC KNOWLEDGE GAPS ON FECAL MICROBIOTA TRANSPLANTATION (FMT) Kuan-Chih Chen, Chun-Hsing Liao Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

評估大眾對微菌叢植入治療（FMT）的知 識差距 陳冠至 廖俊星 亞東紀念醫院內科部

Background: Fecal microbiota transplantation (FMT) has demonstrated efficacy in treating recurrent or refractory Clostridioides difficile infection (CDI) but faces challenges due to a shortage of fecal donors. As efforts are made to establish a fecal bank, understanding public perception of FMT is crucial.

Aims: This study aims to assess public knowledge regarding FMT. Methods: A 20-question questionnaire in Chinese, utilizing a 5-point Likert Scale, was distributed to the public via QR code posters in specific clinic rooms at Far Eastern Memorial Hospital, New Taipei City, Taiwan.

Results: Of 152 collected questionnaires, 116 were deemed effective. The majority of respondents were female, predominantly aged 40-50 years, and university graduates. Responses indicated a neutral stance in half of the questions (50%). Approximately 52.6% believed FMT has sufficient evidence for treating CDI, while 10% expressed safety concerns.

Interestingly, 57.4% felt individuals with colonic polyps should not be fecal donors even in the status of post-polypectomy. Furthermore, 22.6% believed individuals with tattoos could still be donors.

Conclusions: Knowledge gaps exist among the public, particularly regarding criteria for fecal donor eligibility. Education efforts are needed to increase understanding of FMT, thereby facilitating recruitment of donors to meet future demands.

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EPIDEMIOLOGY OF SMALL BOWEL TUMORS DIAGNOSED BY BALLOON ASSISTED ENTEROSCOPY: A MULTICENTER STUDY IN TAIWAN Kuei-Chang Kuo1, Jen-Wei Chou2, Hsu-Heng Yen3, Wen-Hung Hsu4, Tien-Yu Huang5, Chen-Wang Chang6, Chi-Ming Tai7, Wei-Chen Tai8, Chia-Jung Kuo9, ChenShuan Chung1,10 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 3Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan; 4Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 5Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 6 Department of Gastroenterology, Mackay Memorial Hospital, Taipei, Taiwan; 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; 8Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 9Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 10School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 1

氣囊輔助深部小腸鏡下之小腸腫瘤流行 病學數據：台灣之多中心研究 郭桂彰1 周仁偉2 顏旭亨3 許文鴻4 黃天祐5 章振旺6 戴啟明7 戴維震8 郭家榮9 鍾承軒1,10 1

亞東紀念醫院肝膽胃腸科；2 中國醫藥大學附設醫 院消化系中心；3 彰化基督教醫院消化系中心；4 高 雄醫學大學附設中和紀念醫院胃腸內科；5 三軍總醫 院胃腸肝膽科；6 馬偕紀念醫院胃腸肝膽科；7 義大 醫療財團法人義大醫院胃腸肝膽科；8 高雄長庚紀念 醫院胃腸肝膽科；9 林口長庚紀念醫院胃腸肝膽科； 10 天主教輔仁大學醫學系

Background: Advancements in device-assisted enteroscopy (DAE) have allowed early identification and management of small bowel tumors (SBTs). The epidemiological studies on SBTs in Asia are limited.

Nationwide research is needed to better understand epidemiology and clinical manifestations of SBTs. Aims: We aimed to investigate the epidemiological data and clinical presentation of SBTs in Taiwan, including both benign and malignant lesions, using a multi-center database of deep enteroscopy.

Methods: We conducted a review of electronic medical records of enteroscopy from April 1, 2012, to July 30, 2023, across nine medical centers in Taiwan. The study included patients who underwent deep enteroscopy and were diagnosed with SBTs. Demographic characteristics, clinical data, radiologic findings, enteroscopy results, and pathological reports were collected and analyzed.

Results: A total of 339 patients with SBTs were enrolled, 257 (75.8%) of whom had malignant lesions. The patients with malignant lesions were significantly older (62.52 vs 55.12, p = 0.003) than benign ones. Bleeding (56.0%), abdominal pain (20.9%), and ileus (10.3%) were the most common presentations. 133 (39.2%) of the patients underwent double balloon-assisted enteroscopy (DBE), and 116 (34.2%) underwent single balloon-assisted enteroscopy (SBE), 81 (23.9%) push enteroscopy, 1 (0.3%) spiral enteroscopy and 8 (2.4%) others. Chronic inflammation (24.4%) was the most common benign histology, followed by hamartomatous polyps (18.3%) and adenomatous polyps (13.4%). For malignant lesions, gastrointestinal stromal tumors (GIST) (35.5%), adenocarcinoma (27.2%), lymphoma (17.1%), and metastatic cancer (12.8%) were most common. The enteroscopic exams identified 89.3% of suspected malignant lesions, with no significant difference in diagnostic yield between DBE and SBE (87.9% vs 88.2%, p = 0.94). The accuracy of pathological diagnosis under enteroscopy was only 66.5%, which was significantly higher using DBE (66.4%) compared to SBE (50.0%) (p = 0.027).

Conclusions: The most common malignant SBTs was GIST, followed by adenocarcinoma, lymphoma, and metastatic cancer, which differs from previous studies in the western countries. Furthermore, DBE seems to have better diagnostic accuracy compared to SBE in this study.

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A CASE SERIES OF SKIN ECCHYMOSIS AND ITS CLINICAL IMPLICATION IN A SINGLE INSTITUTION Yoen-Young Chuah1,2, Lian-Feng Lin1, Chia-Jung Kuo1, Seng-Howe Nguang1, Yi-Chun Chan1, Chung-Fong Lin1, Lin-Suei Jhang1, Yeong Yeh Lee3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Pingtung, Taiwan 2 Department of Nursing, Mei Ho University, Pingtung, Taiwan 3 Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 1

單一機構的皮膚瘀斑的臨床意義之病例 系列報告 蔡元榮1,2 林連豐1 郭志榮1 阮盛豪1 詹益群1 林群峰1 張琳遂1 李永葉3 1

屏東基督教醫院胃腸肝膽科 美和科技大學護理系 3 馬來西亞理科大學醫學院 2

Background: Retroperitoneal hemorrhage can result in bruising of the flanks, umbilicus, pubis, and groin. These bruise patterns are commonly referred to as Grey Turner’s sign, Cullen’s sign, and Stabler’s sign, respectively. Cullen’s sign and Grey Turner sign are areas of bruising in the periumbilical region and flank, respectively. These signs are typically seen in individuals with acute pancreatitis, indicating the occurrence of pancreatic necrosis. Cullen’s sign occurs when retroperitoneal bleeding spreads into the falciform ligament and the subcutaneous umbilical tissues through the connective tissue of the round ligament complex. On the other hand, Grey Turner sign is seen when the hemorrhagic fluid spreads into the quadratus lumborum muscle and the surrounding subcutaneous tissues through a defect in the transversalis fascia. Stabler’s sign refers to the presence of non-traumatic bruising on the skin of the inguinal-pubic area, which is related with bleeding inside the abdomen. This sign was initially seen in cases of ectopic pregnancy. The clinical implications of the aforementioned ecchymosis in real-world practice remain unknown, so we reviewed the cases that occurred in our hospital in

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the past five years.

Aims: To evaluate the underlying causes of the skin ecchymosis, focusing on Grey Turner’s sign, Cullen’s sign, and Stabler’s sign.

Methods: Patients with skin ecchymosis of the aforementioned three signs were recruited and evaluated by a single physician from January 2019 to January 2023, for a total of five years.

Results: A total of five patients were recruited. All the patients were male. Age ranges from 46 years old to 66 years old, with an average of 55 years old.

Two Cullen’s signs were presented in two cases of hepatocellular carcinoma with tumor rupture. Three Grey-Turner’s signs were noted in three cases with hepatocellular carcinoma rupture, alcoholism with liver decompensation, and iatrogenic hemolytic anemia. One stabler’s sign was observed in a case of portal hypertension. None of the abovementioned cases were related to retroperitoneal hemorrhage.

Conclusions: None of the cases of Cullen’s sign, Grey-Turner’s sign, and Stabler’s sign in our institute were associated with retroperitoneal hemorrhage.

Therefore, it is necessary to investigate further underlying causes for the skin ecchymosis.

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RISK FACTORS AND PROGNOSIS OF VENOUS THROMBOEMBOLISM IN PANCREATIC DUCTAL ADENOCARCINOMA: A RETROSPECTIVE COHORT STUDY Hsing-Chien Wu1,2,3, Kuo-Liong Chien2, Shu-Hui Chang2,4, Hsiang-Fong Kao5, Shih-Hsiang Tseng6, Wei-Chih Liao3,7 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan 3 Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Institute of Health Data Analytics and Statistics, National Taiwan University, Taipei, Taiwan 5 Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan 6 National Taiwan University Hospitalintegrative Medical Database, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan 7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

胰管腺癌中靜脈血栓栓塞的危險因素與 預後：一項回顧性世代研究 吳行健1,2,3 簡國龍2 張淑惠2,4 高祥豐5 曾昰翔6 廖偉智3,7

among the entire cohort and within subgroups in Taiwan.

Methods: From January 2013 to December 2019, a retrospective cohort study was conducted involving patients with PDAC at a tertiary center in Taiwan.

The sub-distribution hazard for VTE occurrence, accounting for the competing risk of death, was calculated. The Cox proportional hazard ratio for overall survival was determined by treating VTE as a time-dependent variable, and interactions between predefined factors and VTE were examined.

Results: Among 942 PDAC patients, 247 (26.2%) experienced VTE. Tumor location in the pancreatic body, tail, or overlapping sites, the presence of metastatic disease, and undergoing chemotherapy were identified as independent risk factors for VTE. VTE was independently associated with overall survival, with an adjusted hazard ratio (aHR) of 1.60 (95% CI 1.36–1.89; P < 0.001). Patients with VTE had a median survival of 4.83 months (95% CI, 3.58–6.57), compared to 8.08 months (95% CI, 7.36– 8.71) for those without VTE. Furthermore, after VTE, men showed a marginally poorer overall survival compared to women (aHR for men, 1.85; 95% CI, 1.49–2.29; aHR for women, 1.34; 95% CI, 1.05–1.71; P for interaction = 0.05).

Conclusions: In this single-center retrospective study, the occurrence of VTE accelerated the deterioration of overall survival among Taiwanese patients with PDAC in a sex-specific manner, with men being more susceptible to VTE events than women.

1

國立臺灣大學醫學院附設醫院癌醫中心分院綜合內 科部 2 國立臺灣大學流行病學與預防醫學研究所 3 國立臺灣大學醫學院內科 4 國立臺灣大學健康數據拓析統計研究所 5 國立臺灣大學醫學院附設醫院癌醫中心分院腫瘤內 科 6 臺大醫療體系醫療整合資料庫 7 國立臺灣大學醫學院附設醫院胃腸肝膽科

Background: Pancreatic ductal adenocarcinoma (PDAC) carries a significant risk of venous thromboembolism (VTE), but the influence of thromboembolic events has been poorly described in Taiwan.

Aims: The study aimed to examine whether the presence of VTE events deteriorates overall survival

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MANAGEMENT OF MASSIVE HEMOBILIA DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Pin-Chun Huang, Wen-Hsin Huang, Chi-Ying Yang, Shih-Chieh Chuang, Hsing-Hung Cheng, Tsung-Lin Hsieh, Yu-Chen Chang, Cheng-Yuan Peng Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medial University, Taichung, Taiwan

內視鏡膽胰管攝影中大量膽道內出血之 治療 黃秉淳 黃文信 楊其穎 莊世杰 鄭幸弘 謝宗霖 張育誠 彭成元 中國醫藥大學附設醫院消化醫學中心

Background: Massive hemobilia which is defined as an acute and enormous hemorrhage in bile duct lumens associated with hemodynamic instability during Endoscopic Retrograde Cholangiopancreatography (ERCP) is rare but potentially fatal. Because of difficulty in detecting the definite bleeding site, traditional endoscopic hemostasis methods usually could not be applied for such an emergency situation. After failed endoscopic hemostasis, radiological and/or surgical intervention is regarded as a rescue method.

However, there are few reports published to discuss about the management of massive hemobilia during the ERCP procedures.

Aims: We aimed to evaluate the clinical outcomes of endoscopic hemostasis with metallic stent in patients with massive hemobilia during the ERCP procedures.

Methods: From Nov., 2015 to Dec., 2023, a total of 11 consecutive male patients, 62 (37-86) years old, suffering from massive hemobilia associated with hemodynamic instability and failing in traditional endoscopic hemostasis during ERCP, were retrospectively analyzed in a medical center. Etiology for ERCP, ERCP procedures, hemostasis methods and clinical outcomes were evaluated.

Results: All the 11 patients underwent ERCP due to biliary tract obstruction. The etiologies of biliary obstruction were as follows: cholangiocarcinoma (n = 3), hepatocellular carcinoma (n = 3),

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choledocholithiasis (n = 3), and post-liver transplantation biliary anastomotic stricture (n = 2). Massive hemobilia encountered during the following ERCP procedures: endoscopic papillary balloon dilation (EPBD) (n = 3), wired-guided biliary cannulation (n = 2), retrieval balloon extraction for stone removal (n = 2), removal of biliary plastic stent (n = 2), and endobiliary biopsies (n = 1). The 11th patient underwent ERCP due to obstructive jaundice to find massive hemobilia, which was not associated with ERCP procedure. The hemostasis methods and clinical outcomes were summarized in Table 1.

Seven patients underwent endoscopic hemostasis with self-expandable metallic stent (SEMS), and the hemorrhage was successfully stopped immediately.

However, one patient suffered from recurrent bleeding and finally died despite trans-arterial embolization (TAE) was performed. The success rate of endoscopic hemostasis with metallic stent was 86% (6/7). Three patients initially underwent TAE. The first patient succeeded in hemostasis. For the second patient, extravasation was not detected during angiography, but hemostasis was achieved after medical treatment. The third patient failed to achieve hemostasis with TAE. Therefore, one (25%) among four patients undergoing radiological intervention achieved successful hemostasis. The last patient only underwent CT angiography (CTA) to show no extravasation. Hemostasis was achieved after medical treatment.

Conclusions: In addition to radiological intervention, endoscopic stenting with SEMS provides an immediate and effective non-surgical method for patients with massive hemobilia failed for traditional endoscopic hemostasis during ERCP. Prospective design and more patients are needed to draw definite conclusions in the further study.

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IMPACT OF THE COVID-19 PANDEMIC ON INCIDENCE AND STAGING OF EARLY AND LATE ONSET COLORECTAL CANCER IN TAIWAN Yih-Shiow Chen1, Yu-Min Lin1,2,4, Lee-Won Chong1,2,4, Hung-Chung Chang1,2,3,4, Yu-Hwa Liu1,2, Cheuk-Kay Sun1,2,4, Kuo-Ching Yang1,2 Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan 3 Cancer Prevention and Management Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan 4 School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 1

新冠疫情對台灣早發性與晚發性大腸癌 發生率及分期的影響 陳奕孝1 林裕民1,2,4 張麗文1,2,4 張鴻俊1,2,3,4 劉玉華1,2 孫灼基1,2,4 楊國卿1,2 1

新光吳火獅紀念醫院內科部 新光吳火獅紀念醫院胃腸肝膽科 3 新光吳火獅紀念醫院癌症防治中心 4 天主教輔仁大學醫學系 2

Background: The COVID-19 pandemic disrupted healthcare systems, significantly affecting cancer screening and diagnosis. Colorectal cancer (CRC) is highly prevalent in Taiwan and the third leading cause of cancer-related deaths. Global trends show a decline in late-onset CRC (LOCRC, age ≥50) and a rise in early-onset CRC (EOCRC, age <50). Taiwan’s CRC screening targets individuals aged 50-74, potentially overlooking younger adults.

Aims: This study evaluates the impact of COVID-19 on the incidence and staging of EOCRC and LOCRC in Taiwan by comparing trends before and during the pandemic.

Methods: Data from the Taiwan Cancer Registry Database was analyzed, with incidence rates standardized to the WHO 2000 standard population.

Trends and average annual percent changes (AAPC) with 95% confidence intervals (CI) were recorded for the overall population, LOCRC, and EOCRC from

2000 to 2021. The study compared CRC stages from the pre-pandemic period (2015-2018) with the pandemic period (2019-2021). CRC cases were categorized into non-advanced (stages 0, I, II) and advanced (stages III, IV) stages. Chi-square tests assessed changes in stage distribution before and during the pandemic.

Results: Overall CRC incidence in Taiwan increased slightly from 2000 to 2021, with an AAPC of 0.73% (95% CI: 0.20-1.27). LOCRC declined with an AAPC of 0.53% (95% CI: 0.10-0.96), while EOCRC increased significantly with an AAPC of 2.14% (95% CI: 1.502.78). During the pandemic, overall CRC incidence declined with an AAPC of -6.26% (95% CI: -8.20 to -4.32). LOCRC declined (AAPC -5.84%, 95% CI: -7.45 to -4.23), whereas EOCRC, which had increased prepandemic, declined to an AAPC of -7.80% (95% CI: -9.20 to -6.40). Advanced-stage diagnoses increased during the pandemic across all age groups, with significant increases in advanced EOCRC cases.

Specifically, advanced CRC stages increased from 41.1% pre-pandemic to 44.4% during the pandemic overall (P < 0.01), from 40.4% to 44.1% in LOCRC (P < 0.01), and from 46.5% to 47.9% in EOCRC (P < 0.05).

Conclusions: The COVID-19 pandemic led to a decline in CRC incidence but an increase in advancedstage diagnoses in Taiwan. The significant rise in advanced-stage EOCRC cases compared to LOCRC underscores the need for earlier screening and robust healthcare policies. Additionally, the sharp decline in EOCRC incidence during the pandemic (AAPC -7.80%) suggests potential disruptions in healthcare access for younger populations.

Reevaluating current screening strategies and addressing healthcare disparities are essential to improving CRC outcomes in the post-pandemic era.

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STATIN-INDUCED REGULATION OF MIR-21 AND TIMP-1 EXPRESSION MITIGATES BILE DUCT PROLIFERATION IN A RAT BDL MODEL AND LPS-TREATED HEPG2 CELLS Chi-Yi Peng1, Yi-Chin Yang2, Yi-Wen Hung3, Yen-Chun Peng4 Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan 2 Division of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan 3 Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University, Taichung, Taiwan 4 Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan 1

他汀類藥物對大鼠膽管結紮模型和 LPS 處理的 HepG2 細胞中 miR-21 和 TIMP-1 表達的調控作用及其對膽管增生的緩解 效果 彭啟益1 楊怡津2 洪義文3 彭彥鈞4 1

國立中興大學獸醫系 臺中榮民總醫院神經外科 3 中國醫藥大學轉譯醫學研究中心泰法癌症研究實驗 室 4 臺中榮民總醫院胃腸肝膽科 2

Background: Individuals diagnosed with high cholesterol are typically treated with statins to manage their condition. Beyond lowering cholesterol, statins exhibit pleiotropic effects, including anti-fibrotic properties and an association with reduced cancer risk. The interplay between bile duct proliferation and miR-21 involves complex regulatory mechanisms governing cell proliferation, inflammation, and fibrosis. miR-21’s role in promoting bile duct cell proliferation and its involvement in liver disease pathology highlight its significance as a target for research and therapeutic intervention in hepatology.

Aims: The aim of the study was to investigate the effects of statins on bile duct proliferation and miR21 expression in liver disease models.

Methods: Sixteen-week-old male Sprague-Dawley rats were divided into four groups: sham, sham plus atorvastatin treatment, BDL (bile duct ligation), and

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BDL plus amiodarone treatment. Rats received a daily dose of 10 mg/kg body weight via intragastric gavage, starting 5 days post-BDL. Rat cytokine arrays were utilized to assess the effect of BDL on liver cell expression. After two weeks of BDL, animals were euthanized using 100% carbon dioxide (CO2) gas at a flow rate of 20–30% chamber volume per minute.

Additionally, simvastatin was used in LPS-treated HepG2 cells to observe miR-21 expression.

Results: BDL induced bile duct proliferation, which was reduced by statin treatment. TIMP-1 expression was significantly increased by simvastatin in the BDL model, and miR-21 expression was mildly decreased.

In HepG2 cells, simvastatin reduced LPS-induced miR-21 expression.

Conclusions: Simvastatin may induce TIMP1 expression and decrease miR-21 expression, contributing to the mitigation of bile duct proliferation.

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DEMOGRAPHIC CHARACTERISTICS OF GASTRIC SUBEPITHELIAL LESIONS: A RETROSPECTIVE ANALYSIS FROM A SINGLE CENTER Yu-Fu Wang, Cheuk-Kay Sun Department of Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

胃黏膜下病變的人口學特徵：單中心回 顧性分析 王郁富 孫灼基 新光醫療財團法人新光吳火獅紀念醫院胃腸肝膽科

Background: Mesenchymal tumors of the gastrointestinal tract are often discovered incidentally as firm, protruding submucosal lesions during routine upper gastrointestinal examinations for other conditions. Larger tumors may sometimes cause bleeding. Most of these tumors, from a pathological perspective, are composed of spindle cells that exhibit smooth muscle differentiation.

Gastrointestinal stromal tumors (GISTs) originate from the interstitial cells of Cajal. The stomach is the primary site for these tumors, with 60% to 70% of GISTs occurring there. GISTs have malignant potential and are the most common type of sarcoma found in the gastrointestinal tract. The identification of driver mutations in the KIT or PDGFRA genes and the subsequent development of targeted molecular therapies have transformed the diagnosis and treatment of GISTs, enabling significant advancements in scientific research and the creation of clinical guidelines. The actual incidence of clinical GIST is similar in East Asia and Western regions, estimated at no more than 10 cases per million people annually. In East Asia, small gastric submucosal tumors (SMTs) less than 2 cm without malignant characteristics are monitored through periodic endoscopic ultrasonography. Malignant characteristics include ulceration, irregular margins, heterogeneous parenchyma observed via endoscopy and EUS, and tumor growth during follow-up, all of which necessitate further evaluation and possible surgical removal. Small GISTs, including mini-GISTs and micro-GISTs, are frequently indolent and are more often detected during screenings in East Asia. This leads to a relatively favorable prognosis for Asian GIST patients and supports the endoscopic resection of these small tumors.

Aims: We want to evaluate the endoscopic and ultrasonography features of GISTs as compared with gastric leiomyomas and then to determine the features that could predict GIST from gastric leiomyomas, which would helps the physicians decide whether to perform surgical removal or not.

Furthermore, we seek to determine whether patients with GISTs who undergo surgical resection and opt for “endoscopic resection” as opposed to “traditional surgical resection” experience shorter hospital stays, fewer complications, and whether there is a difference in the recurrence rate in the absence of an R0 resection in “endoscopic resection” group.

Methods: We evaluated 96 patients with gastric mesenchymal tumors, confirmed by histopathologic diagnosis as either GISTs or leiomyomas, from January 2014 to May 2024 at a single medical center.

We collected predictors including gender, age, BMI, gastroscopy findings (tumor location, macroscopic shape, mucosal changes), and endoscopic ultrasonography findings (tumor size, originating layer, echogenicity compared to the surrounding normal muscle layer, homogeneity, regularity of the marginal border, presence of a marginal halo, internal septations, hyperechogenic foci, calcification, intratumoral cystic spaces) to assess for statistical significance. Additionally, we examined 61 patients with a histopathologic diagnosis of GISTs to evaluate their hospital stay (in days), complication rate, and recurrence rate of GISTs, in order to determine the safety and efficacy of “endoscopic resection” compared to “traditional surgical resection.”

Results: Immunohistochemical analyses identified 46 leiomyomas and 47 GISTs. Endoscopic findings indicated that tumors located in the gastric cardia and upper body, compared to the fundus, middle body, and lower body, were more frequently observed in leiomyomas than in GISTs (P-value < 0.05). Furthermore, endoscopic ultrasonography (EUS) comparisons revealed that exophytic growth, isoechoic and hyperechoic echogenicity relative to the surrounding muscle, heterogeneous homogeneity, and hyperechogenic foci were more frequently observed in GISTs (P-value < 0.05).

Regarding the comparison between endoscopic resection and traditional surgical resection, the average hospital stay was significantly shorter for endoscopic resection (5.14 days versus 9.58 days) (P-value < 0.05). The complication rates showed no statistical significance between the two methods.

Additionally, the recurrence rates indicated no

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P.128 statistical significance, suggesting that endoscopic resection does not result in a higher recurrence rate compared to traditional surgical resection.

Conclusions: The location of gastric subepithelial lesions may serve as a predictor of gastric GISTs. Furthermore, endoscopic ultrasonography (EUS) may be valuable in distinguishing gastric GISTs from gastric leiomyomas. Lastly, endoscopic resection for GISTs is both safe and effective compared to traditional surgical resection.

COMPARISON OF P-DUCT STENT AND RECTAL DICLOFENAC TO PREVENT POST-ERCP (ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY) PANCREATITIS: A COHOST STUDY Hao-Tsai Cheng1,2,3,4, Cheng-Hui Lin2,4, Chieh-Han Yu4, Shu-Wei Haung1,4, Sen-Yung Hsieh2,4 Department of Gastroenterology and Hepatology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan 2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 3 Graduate Institute of Clinical Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 4 School of Medicine, Chang Gung University, Taoyuan, Taiwan 1

使用胰管支架或直腸塞入雙氯芬酸來預 防經內視鏡逆行性膽胰管攝影術後所造 成的胰臟炎：世代研究 鄭浩材1,2,3,4 林政輝2,4 游捷涵4 黃書偉1,4 謝森永2,4 1

新北市立土城醫院（委託長庚醫療財團法人興建經 營）胃腸肝膽科 2 林口長庚紀念醫院胃腸肝膽科系 3 長庚大學臨床醫學研究所 4 長庚大學醫學系

Background: Post-ERCP pancreatitis (PEP) is a significant and common complication associated with ERCP, with an incidence rate of approximately 3% to 5%, and its severity typically ranges from mild to moderate. The incidence of PEP is influenced by factors such as operator skill, patient health, procedural complexity, and patient-specific factors like history of pancreatitis, gender, and age.

Preventive measures include prophylactic pancreatic stent placement and the use of pharmacological agents like NSAIDs. Aims: The aim of this study was to evaluate the efficacy of two methods for preventing post-ERCP pancreatitis: rectally administered Diclofenacbased and pancreatic stent-based interventions.

We conducted retrospective statistical analyses to compare the preventive outcomes of using both methods simultaneously, using either method alone,

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P.129 or not using any preventive method. compare the outcomes associated with these methods.

Methods: This retrospective cohort study conducted at Tucheng Hospital (Diclofenac group) and Linkou Chang Gung Hospitals (stent group) in Taiwan. Enrolling 1060 patients over 42 months, from April 2020 to October 2023. Inclusion criteria focused on first-time ERCP patients without prior pancreatic interventions. Exclusion criteria included contraindications to NSAIDs, incomplete records, and prior surgeries, and so on. The study included 645 eligible patients, with 295 in the Diclofenac group and 350 in the stent group. Then, patients were divided into four subgroups: both interventions, only Diclofenac, only stent, and no intervention. PEP was defined and graded based on Cotton criteria, Consensus paper, and Revised Atlanta Classification criteria. The study analyzed the incidence of PEP using contingency tables, odds ratios, relative ratios, and Chi-Square tests to compare preventive methods.

Findings indicated significant differences in PEP incidence among the groups, providing statistical evidence on the relative effectiveness of Diclofenac and stents in PEP prevention.

Results: A total of 645 patients were included in the analysis, with an average age of 61.68 year-old in Diclofenac-based group and 63.72 year-old in pancreatic duct based group. Among the 189 patients who underwent duct cannulation, 6 developed PEP, while 3 patients developed PEP without cannulation.

Results showed that using both Diclofenac and stents (RR 0.70) with pancreatic duct cannulation and Diclofenac alone without pancreatic duct cannulation (RR 0.62) were protective against PEP. However, using only Diclofenac with cannulation (RR 8.06) and only stents (RR 2.91) did not decrease the risk of PEP. Significant risk factors included age under 60, periampullary diverticulum, and pancreatic duct cannulation. The study highlights the importance of tailored preventive strategies to reduce PEP incidence.

Conclusions: Based on our research findings, for every patient undergoing ERCP, even in the absence of cannulation to the pancreatic duct, the routine administration of rectal Diclofenac at the end of the procedure could serve as an effective preventive measure. Additionally, the placement of a p-duct stent during ERCP, especially in cases where cannulation to the pancreatic duct occurs, may effectively contribute to reducing the incidence of post-ERCP pancreatitis. These discoveries hold implications for improving the safety and success rates of ERCP procedures.

FACTORS OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE BIOPSY (EUS-FNB) FOR SUCCESSFUL NEXT-GENERATION SEQUENCING (NGS) IN PANCREATIC DUCTAL ADENOCARCINOMA (PDAC): ONE SINGLE CENTER RETROSPECTIVE STUDY Szu-Chia Liao1, Hong-Zen Yeh2, Yi-Chun Liao1, Hui-Chun Chang1, Chi-Shun Yang3, Yu-Hsuan Shih4 Division of Gastroenterology and Hepatology, Division of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Division of Gastroenterology and Hepatology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan 3 Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 4 Division of Medical Oncology, Department of Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 1

利用內視鏡超音波細針切片成功進行次 世代定序的相關因子：單一中心回溯性 分析 廖思嘉1 葉宏仁2 廖苡君1 張惠郡1 楊啟順3 石宇軒4 1

臺中榮民總醫院胃腸肝膽科 童綜合醫院胃腸肝膽科 3 臺中榮民總醫院病理部 4 臺中榮民總醫院腫瘤科 2

Background: The role of NGS for both the development of new treatments and precision medicine in PDAC is getting more and more attention.

In clinical practice, Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is the primary method to obtain tissue samples from Pancreatic cancer. EUSFNB is considered to superior to EUA-FNA to get adequate tissue. However, there was still few studies focusing on the successful rate of EUS-FNB for NGS checkup.

Aims: This study aims to investigate the factors influencing success rate of EUS-FNB in NGS of PDAC. Methods: This is a retrospective single-centered

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P.130 study. Between March 2022 and February 2024, eighty-three patients with PDAC proved by EUS-FNB procedures were included in the study. 22 gauge (G) FNB needles were used (Acquire, Boston Scientific, Natick, MA and Mediglobe SonoTip TopGain@) with multiple passes until PDAC was used for all EUSFNB. The pathologist chose one pass which was considered as the adequacy of the extracted DNA for NGS. Samples used for NGS were subjected to pathological assessment, and areas including the tumor epithelium were identified via HE staining. The FFPE specimen available for NGS was 10 µm × 3, and the tumor percentage in the hemotoxylin and eosin specimen was defined as 10% or more. F1CDx uses DNA isolated from formalin-fixed paraffin embedded (FFPE) tumor tissue specimens and applies NGS to the detection of point mutations (substitutions, insertions and deletions), copy number alterations and selected gene rearrangements, in 324 genes.

F1CDx also enables the evaluation of genomic signatures including microsatellite instability and tumor mutational burden. We collected baseline demographics, the condition of EUS-FNB including tumor size, location, needle pass number, procedure time, use of contrast-enhanced EUS, the length of tissue obtained by macroscopic on-site evaluation (MOSE), the availability of rapid on-site evaluation (ROSE) and the differentiation of adenocarcinoma.

We compared the parameter between the failed group and success group of NGS. Our data was analyzed by non-parametric method.

Results: Our study included 63.86% male patients, aged 62.54 years (± 11.11 year). The size of pancreatic cancer showed no significant difference between failed and success groups (5.85 ± 12.05cm vs 3.69 ± 1.01, p = 0.357). The trans-duodenal approach and number of needle passes also showed no association with success of NGS. The location of the pancreatic tumor and the level of CEA showed significantly association between failed and success. The location over tail showed lower success rate (OR 0.15, 0.030.75, p = 0.020). However, the availability of ROSE and the length of tissue core recorded by MOSE (OR 0.15, 0.03-0.75) showed no significant difference.

Conclusions: PDCA over pancreatic tail are the factors that influenced the successful rate of NGS during EUS-FNB on PDCA. Due to limited number of cases and retrospective design, further study should be performed to confirm the result.

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USING SEROLOGY TO IDENTIFY TREATMENT-NAÏVE H. PYLORI INFECTION IN YOUNG POPULATIONS Mei-Jyh Chen1,2, Yu-Jen Fang3, Po-Yueh Chen4, Chieh-Chang Chen1,2, Ming-Shiang Wu1,2, Jyh-Ming Liou1,2,5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan 4 Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan 5 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

使用血清學檢測鑑別年輕群體的未經治 療過之幽門桿菌感染 陳美志1,2 方佑仁3 陳柏岳4 陳介章1,2 吳明賢1,2 劉志銘1,2,5 1

台大醫院消化內科 台大醫學院內科部 3 台大醫院雲林分院內科部 4 嘉義基督教醫院內科部 5 台大醫院癌醫分院內科部 2

Background: Accurate diagnosis and effective eradication of Helicobacter pylori (H. pylori) infection are imperative, yet expert opinions vary regarding the suitability of serology test in large-scale screening programs.

Aims: This study aimed to assess the accuracy of serology compared to biopsy-based H. pylori diagnostic tests and identify factors influencing their test performance through subgroup analyses.

Methods: Those adults aged 20 and above without prior H. pylori eradication undergoing endoscopy for abdominal discomfort or other indications who consented to H. pylori screening were eligible for enrollment. Biopsy specimens obtained during endoscopy were utilized for H. pylori detection via rapid urease test (RUT), histology, and culture. Blood

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P.131 samples were collected for serology targeting H. pylori IgG antibodies and serum pepsinogen I/II ratio indicative of gastric mucosal atrophy. Diagnostic accuracy was assessed using sensitivity, specificity, accuracy, positive predictive value (LR+), negative predictive value (LR-), diagnostic odds ratio (DOR) and post-test probability.

Results: A total of 8497 treatment-naïve adult participants were included in the analysis. The sensitivity and specificity of diagnosing H. pylori infection were 94.5% versus 86.0% for serology, 88.6% versus 97.1% for RUT, 92.3% versus 94.3% for histology, and 90.2% versus 98.2% for culture, respectively. Specificity and LR+ of serology were 62.4% versus 2.59 in the atrophic gastritis (AG) group and 87.2% versus 7.33 in the non-AG group, respectively. The diagnostic odds ratios were 106.4 for serology, 260.0 for RUT, 199.1 for histology, and 496.8 for culture. Additionally, serology demonstrated the high sensitivity of 95.2% and DOR of 268.9 among individuals aged ≤45 years, suggesting its utility for mass screening of H. pylori infection in younger population.

Conclusions: Serology alone proved preferable for identifying H. pylori infection in treatment-naïve individuals aged ≤45 years, while employing more than one diagnostic test was recommended for subjects with atrophic gastritis.

ASSOCIATION BETWEEN SUPERFICIAL ESOPHAGEAL CANCER FOLLOWING ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION AND SYNCHRONOUS HEAD AND NECK CANCER: A RETROSPECTIVE STUDY AT A SINGLE MEDICAL CENTER IN SOUTHERN TAIWAN Yu-Chieh Tsai, Chih-Chien Yao, Yu-Chi Lee, Cheng-Kun Wu, Chih-Ming Liang, Chiu Yi-Chun, Seng-Kee Chuah, Wei-Chen Tai Diversion of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

表淺性食道癌經食道接受內視鏡黏膜下 剝離術與同步頭頸癌的關聯：台灣南部 某醫學中心的回顧性研究 蔡雨潔 姚志謙 李育騏 吳鎮坤 梁志明 邱逸群 蔡成枝 戴維震 高雄長庚紀念醫院胃腸肝膽科

Background: Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. In Japan, endoscopic submucosal dissection (ESD) for superficial esophageal cancer is the mainstay of endoscopic treatment for superficial esophageal cancer, with overall en bloc resection and local recurrence rates, reportedly, better than endoscopic mucosal resection (EMR). However, treatment for patients with synchronous head and neck cancer and superficial esophageal squamous cell neoplasm (SHNSESCN) has not been studied.

Aims: We aimed to search outcome and tumor characteristic of endoscopic resection of SESCN in patients with synchronous HNC and SESCN (SHNSESCN).

Methods: This is a retrospective study at Kaohsiung Chang Gung Memorial Hospital from January 2019 to December 2023. In total, we enrolled total 163 cases with early esophageal cancer receiving endoscopic submucosal dissection.

Results: A total of 163 cases of early esophageal cancer received complete esophageal endoscopic submucosal dissection. Among them, 97 cases also

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P.132 had synchronous head and neck cancer, which included 35 cases of pharyngeal cancer, 7 cases of laryngeal cancer, 44 cases of oral cavity cancer, and 11 cases of lingual cancer. Additionally, 6 cases had other types of synchronous head and neck cancer.

All patients with synchronous head and neck cancer and superficial esophageal squamous cell neoplasm (SESCN) were male (100%). Of these patients, 86 were smokers (88.6%), 80 chewed betel nut (82.5%), and 77 were alcoholics (79.3%).Regarding the esophageal lesions, 8 were located in the upper esophagus (8%), 35 in the middle esophagus (36%), and 54 in the lower esophagus (55%). There were 18 lesions classified as high-grade dysplasia, 12 as lowgrade dysplasia, and 67 as esophageal squamous cell carcinoma (ESCC). Among these, 84 lesions were mucosal, and 13 had submucosal invasion, including 5 lesions with invasion less than 500 μm (SM1) and 8 lesions with invasion greater than 500 μm (SM2).

Macroscopic examination revealed that 15 cases had elevated mucosa and 82 cases had flat lesions.

Of those with elevated mucosa, 2 had SM2 invasion, 2 had SM1 invasion, and 11 were mucosal lesions.

Only 5 cases underwent esophagectomy following ESD due to 2 recurrence and 1 margin unclear.

Conclusions: Treatment of superficial esophageal squamous cell neoplasm with ER is the recommended approach for patients with synchronous HNC and SESCN. However, the follow-up period is not long enough to see the outcome. Further prospective randomized controlled trials are needed to confirm the benefit of ER for the treatment of SESCN in patients with SHNSESCN.

AUTOMATED IDENTIFICATION OF MUSCLE LOSS ON COMPUTED TOMOGRAPHY IMAGING PREDICTS POOR SURVIVAL IN ESOPHAGEAL CANCER PATIENTS RECEIVING CHEMORADIOTHERAPY Wei-Chen Lin1, Hsueh-Chien Chiang1, Nan-Tsing Chiu2, Ta-Jung Chung2, Hsing-Yu Lee2, Forn-Chia Lin3, Bor-Shyang Sheu1, Wei-Lun Chang1 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2 Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 3 Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan 1

從電腦斷層影像自動辨別食道癌病人於 化放療期間的肌肉流失可以預測病人存 活 林韋辰1 姜學謙1 邱南津2 鍾達榮2 李星佑2 林逢嘉3 許博翔1 張維倫1 1

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附設醫院影像醫學部 3 國立成功大學醫學院附設醫院腫瘤醫學部 2

Background: Nearly 80% of esophageal cancer patients have malnutrition and sarcopenia. Timely detection of sarcopenia enables healthcare professionals to provide adequate intervention.

Skeletal muscle mass in L3 evaluated by a CT scan has been applied to assess sarcopenia. It emerged as a potential prognostic marker independent of body mass index (BMI), highlighting its relevance in determining nutritional status and predicting outcomes.

Aims: This study aimed to develop a deep learning model for automated segmentation of skeletal muscle area from PET-CT and CT images.

Methods: The study utilized data from the National Cheng Kung University Hospital (NCKUH), including 100 PET-CT images for model training and 30 CT images for external validation. The deep

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P.133 learning model employed a CSP-DenseNet for image segmentation. We compared the accuracy and efficiency of the model to manual methods in assessing muscle mass, and validate its application for automated detection of muscle loss in an esophageal cancer cohort.

Results: After training, our image segmentation model achieved an intersection over union (IOU) of 98% on the training dataset and 96.5% on internal validation. Application to external validation datasets yields IOU of 95% and 97% for PET-CT and CT images, respectively. The deep learning model reduced annotation time significantly, from 63 seconds manually to 0.8 seconds using a Titan GPU, with a 300-fold improvement. In an esophageal cancer cohort (n = 40, all male) initially treated by chemoradiotherapy, the AI model successfully measured the serial change of muscle mass automatedly from the retrieved CT scan images. Patients who had muscle loss (>5%) during chemoradiotherapy evaluated by AI had shorter overall survival (OS, p = 0.03) and progressionfree survival (PFS, p = 0.09). Multi-variate Coxregression analysis confirmed that muscle loss is an independent poor prognostic factor, with hazard ratios of 12.62 for OS (95% CI: 1.35–118.30, p < 0.05) and 3.18 for PFS (95% CI: 1.10–9.18, p < 0.05), after adjusting age, tumor size, staging, BMI, and baseline muscle mass.

Conclusions: This study underscores the feasibility and effectiveness of using deep learning for precise skeletal muscle mass measurement in CT scan images. We also confirmed its application in the automated detection of muscle loss in an esophageal cancer cohort. Further validation in a larger cohort including other diseases is warranted.

COMPARATIVE SHORTTERM COMPLICATIONS OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY VERSUS NASOGASTRIC TUBE NUTRITIONAL SUPPORT: A RETROSPECTIVE COHORT STUDY Chien-Hua Chen1, Chung-Hung, Chen2 Division of Gastroenterology, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan 1

比較經皮內視鏡胃造口術與傳統鼻胃管 短期使用的併發症：一篇回溯性研究評 估 陳建華1 陳忠宏2 1 2

彰化秀傳紀念醫院腸胃科 彰濱秀傳紀念醫院腸胃科

Background: PEG and NG tubes are common nutritional support methods for patients unable to eat orally. However, comparative studies on the risks and complications of these methods are limited.

Aims: This study aims to evaluate and compare the incidence of short-term complications, specifically peritonitis, gastric ulcer, gastrointestinal bleeding, and aspiration pneumonia, in patients receiving percutaneous endoscopic gastrostomy versus nasogastric tube nutritional support.

Methods: The TrinetX network covers 66 healthcare institutions in the United States, with a follow-up period from 2000 to 2024. Each group, PEG and NG, included 14,373 individuals matched by age, sex, race, comorbidities (hypertension, diabetes, chronic kidney disease, osteoporosis, socioeconomic status), and co-medications. The mean age for both groups was 55.4 ± 24.6 years. The demographic composition of the cohorts was 42.8% female, 56.8% male, 63.6% white, 18.3% Black or African American, and 7.7% Asian. The primary outcomes included the incidence of peritonitis, gastric ulcer, gastrointestinal bleeding, and aspiration pneumonia within 1-90 days, analyzed using multivariable Cox regression and Kaplan-Meier survival methods.

Results: Compared to the control group, the PEG

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P.134 group had a significantly lower risk of peritonitis within 90 days (adjusted HR 0.65, 95% CI 0.52-0.82) and a higher risk of aspiration pneumonia (1.53, 1.34-1.75). The risk of gastric ulcer (1.03, 0.79-1.33) and gastrointestinal bleeding (0.89, 0.77-1.03) did not differ significantly between the groups. In the PEG cohort, the 90-day cumulative incidence of peritonitis was 1.1%, compared to 1.7% in the NG cohort (P < 0.001). The incidence of aspiration pneumonia was 5.9% in the PEG group, compared to 3.7% in the NG cohort (P < 0.001).

Conclusions: Among patients requiring tubebased nutritional support, PEG is associated with an increased risk of aspiration pneumonia, indicating a short-term impact of PEG. These findings underscore the need for continuous monitoring and preventive strategies for PEG users.

THE EFFICACY OF PROTON PUMP INHIBITORS FOR LARYNGOPHARYNGEAL SYMPTOMS IN SYMPTOMATIC CERVICAL INLET PATCH PATIENTS: A PILOT STUDY IN TAIWAN Yoen-Young Chuah1,2, Lian-Feng Lin1, Chia-Jung Kuo1, Seng-Howe Nguang1, Yi-Chun Chan1, Chung-Fong Lin1, Lin-Suei Jhang1, Yeong Yeh Lee3, Chu-Kuang Chou4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Pingtung, Taiwan 2 Department of Nursing, Mei Ho University, Pingtung, Taiwan 3 Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan 1

氫離子幫浦抑制劑對有症狀食道入口斑 塊患者的咽喉症狀之療效研究 蔡元榮1,2 林連豐1 郭志榮1 阮盛豪1 詹益群1 林群峰1 張琳遂1 李永葉3 周莒光4 1

屏東基督教醫院胃腸肝膽科 美和科技大學護理系 3 馬來西亞理科大學醫學院 4 嘉義基督教醫院胃腸肝膽科 2

Background: The cervical inlet patch (CIP) is a heterotopic gastric mucosal islet that exists in the upper esophagus and has a roundish salmoncolored appearance during conventional esophagogastroduodenoscopy evaluation. Its incidence ranges from 0.1% to 10%. Laryngopharyngeal symptoms such as globus sensation, hoarseness, odynophagia, and dysphagia have been associated with patients with symptomatic CIP. Medical intervention for symptomatic CIP with the administration of potent acid suppressive agents, such as proton-pump inhibitors (PPI), is usually the first step of management in clinical practice.

However, the efficacy of these agents is very limited in the literature. Furthermore, Asia-Pacific countries

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P.135 including Taiwan have not conducted any relevant research. As a result, we retrospectively reviewed a cohort of 12 symptomatic CIP patients to determine the efficacy of proton pump inhibitors.

Aims: To evaluate the efficacy of proton pump inhibitors for the improvement of laryngopharyngeal symptoms in symptomatic cervical inlet patch patients.

Methods: We recruited a total of 12 symptomatic patients, proven to be CIP endoscopically, from May 22, 2022, to June 30, 2024. We excluded patients who were less than 16 years old or who refused the prescription of a proton pump inhibitor for treatment. The questionnaires were composed of visual analog scores, ranging from 0 to 10. The higher the score, the more severe the symptoms.

We distributed symptoms of dry throat, burning throat, globus sensation, hoarseness, and clearing throat to patients before and after the use of proton pump inhibitors to assess their efficacy. We defined symptomatic CIP as the presence of at least one of the aforementioned symptoms, accompanied by a pain score of at least 5 out of 10 on the pain scale.

Results: The current study enrolled 12 patients.

Two-thirds of patients were female (8/12) in gender and had an average age of 49 years old (ranging from 17 to 83 years old). The CIP was located in the upper esophagus at 16 cm on average from the incisors (15–20 cm), and forty percent (5/12) of the patients had more than one CIP. The average size of CIP was about 0.6 cm (ranging from 0.3 cm to 1.2 cm). The medical treatment with a proton pump inhibitor for at least two weeks improved all five laryngopharyngeal symptoms, such as dry throat (5.8–>5.2), burning sensation (4.9–>3.8), foreign body sensation (5–>3.3), hoarseness (5.8–>4.1), and clearing throat (4.7–>3.8). Foreign body sensation and hoarseness showed the most prominent improvement, decreasing from 5 to 3.8 and from 5.8 to 4.1, respectively.

Conclusions: In the Taiwanese population, proton pump inhibitors improved laryngopharyngeal symptoms for symptomatic CIP patients. However, to validate the effectiveness of proton-pump inhibitors in symptomatic CIP patients, further prospective randomized studies with a larger sample size are necessary.

CHARACTERISTICS OF SMALL BOWEL TUMORS DIAGNOSED BY SINGLE-BALLOON ENTEROSCOPY Chin-Yu Liao1, Chi-Yu Lee1, Wei-Chen Lin1, Ting-Churn Wong1, Ching-Wei Chang1,2,3, Ming-Jen Chen1,2,3, Chen-Wang Chang1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan 3 Department of Medicine, MacKay Medical College, New Taipei City, Taiwan 1

經由單氣囊小腸鏡診斷的小腸腫瘤特徵 廖竟妤1 李騏宇1 林煒晟1 翁鼎淳1 張經緯1,2,3 陳銘仁1,2,3 章振旺1,2,3 1

馬偕紀念醫院胃腸肝膽科 馬偕醫護管理專科學校 3 馬偕醫學院醫學系 2

Background: Small bowel tumors are uncommon among gastrointestinal tumors. In the past, to diagnose small bowel tumors via endoscopic examination has been challenging because of the length of the small bowel. With advancements in endoscopic technology and techniques, more small bowel tumors can now be diagnosed or treated through endoscopy.

Aims: The study aimed to analyze the clinical characteristics, endoscopic presentations, pathological features of small bowel tumors.

Methods: We retrospectively reviewed the medical records of patients with small bowel tumor in MacKay Memorial Hospital from 2009/1/1 to 2023/12/31.

The patients diagnosed with small bowel tumors via endoscopy were enrolled. We investigated the clinical characteristics, endoscopic morphology and pathologic features of small bowel tumors.

Continuous data were represented using means or medians along with standard deviation (SD) and ranges. Categorical data were presented as counts and percentages. Associations between categorical and continuous variables were assessed using either the chi-square test or Fisher’s exact test, as deemed appropriate. Statistical analyses were conducted using “SPSS 25.0”.

Results: A total of 38 patients with small bowel tumors (16 benign lesions, 22 malignant lesions)

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P.136 diagnosed by endoscopy were enrolled. In benign tumors, there were 7 males (43.75%) and 9 females (56.25%). In malignant tumors, there were 16 males (72.73%) and 6 females (27.27%). GI bleeding (47.37%) and abdominal pain (32.58%) were the most common clinical symptoms. Harmatomas (50%) were the most common benign tumors.

Six different histologic types of malignant tumors were identified. Adenocarcinomas were the most common malignancies in small bowel (31.82%), followed by lymphomas (22.73%), metastatic tumors (22.73%), and GISTs (13.64%).

Conclusions: According to our analysis, harmatomas were the most common benign small bowel tumors, while adenocarcinomas were the most common small bowel malignancies, followed by lymphomas and metastatic tumors. More male patients had malignant small bowel tumors than female patients, but there was no significant difference. More sample size and subgroup analysis are needed for further research.

BALLOON ENTEROSCOPY-ASSISTED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR THE TREATMENT OF BILIARY DISEASES IN SURGICALLY ALTERED ANATOMY PATIENTS: A SINGLECENTERED RETROSPECTIVE STUDY Wei-Ming Weng1, Szu-Chia Liao1,2, Chung-Hsin Chang1, Chia-Chang Chen1,2, Sz-Iuan Shiu1, Yi-Chun Liao1,2, Hsin-Ju Tsai1,2, Yen-Chun Peng1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 2 Department of Post-Baccalaureate, College of Medicine, National Chung Hsing University, Taichung, Taiwan 1

球囊內視鏡輔助的內鏡逆行胰膽管造影 術在有外科改道患者中治療膽道疾病： 單中心回顧性研究 翁偉銘1 廖思嘉1,2 張崇信1 陳家昌1,2 許斯淵1 廖苡君1,2 蔡炘儒1,2 彭彥鈞1 1 2

臺中榮民總醫院胃腸肝膽科 國立中興大學學士後醫學系

Background: Balloon enteroscopy-assisted Endoscopic retrograde cholangiopancreatography (BE-ERCP) for biliary disease in patients with surgically altered anatomy remains technically challenging.

Aims: To investigate the outcomes of BE-ERCP performed in our hospital in the past and to explore the factors related to the success of the procedure.

Methods: This is a retrospective study. Forty-seven sessions in twenty-three patients with surgically altered anatomy underwent BE-ERCP between May 2018 and Mar. 2024 in Taichung Veterans General Hospital.

Results: Among these patients, there are two patients with Billroth II gastrojejunostomy, four patients with Whipple’s procedure and seventeen with Roux-en-Y anastomosis. The overall success rate was 89.36% (five sessions failed and 42 sessions succeeded). Among the failure sessions, one patient had undergone Whipple’s procedure and the other four sessions involved patients with Roux-en-Y anastomosis. There was no significant difference

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P.137 in success rates between these difference surgical procedures. A comparison between different types of balloon enteroscopy showed a significant difference in success rates between double-balloon (DB-ERCP) and single-ballon enteroscopy ERCP (SBERCP) (p = 0.044). The mean procedure time for the entire procedure was 167.9 ± 73 minutes. The mean time to reach the opening of bile duct and to complete the biliary procedure (including stone extraction and stent insertion, etc.) were 94.6 ± 63.3 and 74.8 ± 57.0 minutes, respectively. There were no procedure-related major adverse events.

Conclusions: BE-ERCP can be a safe and nonsurgical method for the treatment of biliary diseases in surgically altered patients, but the techniques is difficult and time-consuming. In the future, more data and prospective studies are needed to identify suitable candidates to receive BE-ERCP. If it is relatively difficult in some surgically altered patients, considering alternative methods directly like EUSguided biliary drainage might reduce the procedure time and complications.

THE EFFECT OF BALLOON PRESSURE ON ENDOSCOPIC PAPILLARY BALLOON DILATION FOR COMMON BILE DUCT STONES Wei-Chih Sun1,2, Chia-Ming Lu1, Yun-Da Li1, Tzung-Jiun Tsai1,3, Wei-Lun Tsai1,3,4, Feng-Woei Tsay1,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2 Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan 3 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 1

氣球壓力對於內視鏡乳突氣球擴張術在 總膽管結石治療之影響 孫煒智1,2 呂家名1 李昀達1 蔡騌圳1,3 蔡維倫1,3,4 蔡峯偉1,3 1

高雄榮民總醫院胃腸肝膽科 國立中山大學生物醫學研究所 3 國立陽明交通大學醫學系 4 高雄榮民總醫院一般內科 2

Background: Endoscopic papillary balloon dilation (EPBD) has been considered an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct stones (CBDS). There was plenty of research about the optimal balloon diameter and dilating duration on the efficacy and safety of EPBD, but no study was reported regarding the balloon pressure.

Aims: To compare the effectiveness of EPBD with low and high balloon pressure for CBDS. Methods: We reviewed patients who were diagnosed with CBDS and received EPBD with 3atm (A) and 8atm (B) of 12mm balloons in our hospital from January 2010 to November 2021.

Results: A total of 151 patients, including 78 in group A and 73 in group B, were enrolled for analysis. Both groups had comparable baseline data except that group A had a larger CBD diameter than group B (15.8 mm & 14.5 mm, p = 0.03). Need for mechanical lithotripsy (12.8% & 12.3%), initial stone clearance rates (91.0% & 90.4%), overall stone clearance rates

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P.138 (96.2% & 93.2%), post-ERCP serum amylase levels (229.4 U/L & 320.4 U/L), the incidence of post-ERCP hyperamylasemia (39.7% & 38.4%), and the incidence of post-ERCP pancreatitis (5.1% & 11.1%) were not significantly different between group A and B. Conclusions: Balloon pressure did not affect the treatment outcome of EPBD for CBDS, but there was a trend of increased post-ERCP serum amylase levels and pancreatitis for higher balloon pressure.

COMPARION OF COMMON BILE DUCT STONE INDUCED ACUTE CHOLANGITIS WITH AND WITHOUT PANCREATITIS Kuan-Ting Liu, Yung-Kuan Tsou Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

總膽管結石引起急性膽管炎有無合併胰 臟炎的比較性研究 劉冠廷 鄒永寬 林口長庚紀念醫院胃腸肝膽科

Background: Acute cholangitis (AC) occurs clinically when bile duct obstruction results in a cholangiovenous reflux of pathogenic microorganisms or endotoxins. Common bile duct stones (CBDS) are the most common cause of AC. When CBDS are lodged at the pancreaticobiliary junction, not only AC but also acute pancreatitis (AP) can occur. Therefore, some CBDS patients may experience complications from both AC and pancreatitis. Theoretically, concurrent AP may worsen clinical outcomes in patients with AC, but studies are lacking.

Aims: This study aimed to compare the clinical characteristics and outcomes of patients with common bile duct stones (CBDS)-related AC (acute cholangitis) with and without pancreatitis.

Methods: This single-center retrospective study focused on patients at Chang Gung Memorial Hospital-Linkou Center, who visited the emergency room in 2016–2017, were diagnosed with AC, and underwent ERCP. Collected data included patient demographics, laboratory, and imaging results. AC diagnosis and severity were based on the criteria of the 2013/2018 Tokyo Guidelines, while AP (acute pancreatitis) and its severity followed the 2012 Revised Atlanta Classification. The primary outcome was ICU admissions. Secondary outcomes were 30day mortality, length of hospital stay, and 30-day readmission rate.

Results: 460 patients with native papilla met diagnostic criteria. Among them, 89 patients with AP were divided into AC with AP group, and the remaining 371 patients were divided into AC without AP group. Age, sex, and body temperature did not differ between groups. In terms of laboratory

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P.139 tests, the only significant difference was a higher rate of abnormal WBC count in the AC with AP group (62.9% vs. 48.0%, P = 0.011). Liver biochemical tests, including AST, ALT, alkaline phosphatase, and total bilirubin, did not differ. Regarding ERCP, there were no differences in terms of time to ERCP, ERCP procedural success rate, and incidence of ERCPrelated complications (pancreatitis, cholangitis, or bleeding). However, the perforation rate was significantly higher in AC with AP group (2.2% vs.

0.3%, P = 0.037).AC severity did not differ. Primary and secondary outcomes showed no differences.

Multivariate analysis identified age, organ dysfunction, and AC severity to be factors associated with ICU admission.

Conclusions: Except for abnormal WBC count, AC with AP and without AP have similar clinical manifestations and laboratory results. Our study demonstrates that clinical outcomes in patients with CBDS-induced AC, whether primary or secondary, are not worsened by concurrent AP.

CLINICAL AND PSYCHOPHYSIOLOGICAL CHARACTERISTICS OF REFLUX PATIENTS WITH NORMAL ACID EXPOSURE: THE ROLE OF MEAN NOCTURNAL BASELINE IMPEDANCE Wei-Yi Lei1, Jen-Hung Wang2, Jui-Sheng Hung1, Ming-Wun Wong1, Chih-Hsun Yi1, Tso-Tsai Liu1, Chien-Lin Chen1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 2 Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 1

酸暴露正常逆流患者臨床與生理心理特 徵之表現：平均夜間基礎阻抗之角色 雷尉毅1 王仁宏2 洪睿勝1 翁銘彣1 易志勳1 劉作財1 陳健麟1 1 2

佛教慈濟醫療財團法人花蓮慈濟醫院肝膽腸胃科 佛教慈濟醫療財團法人花蓮慈濟醫院研究醫學部

Background: Management for reflux patients with normal acid exposure from pH-impedance monitoring is complicated by varied factors, and among these, day-to-day variation is an important issue. Mean nocturnal baseline impedance (MNBI) over 2500 ohms indicates mucosal injury and is considered non-pathologic reflux according to current gastroesophageal reflux disease (GERD) consensus. However, there are still scant studies that use MNBI to categorize patients diagnosed with normal acid exposure by pH-impedance.

Aims: This study aimed to compare the clinical and psychophysiological characteristics between patients with normal and abnormal MNBI in the context of normal acid exposure.

Methods: Consecutive patients with chronic reflux symptoms, non-erosive esophagitis on endoscopy, and normal acid exposure on ambulatory pHimpedance monitoring were enrolled in this study. Patients were grouped as “normal MNBI” and “abnormal MNBI” based on an MNBI value of 2500 ohms. Demographic information, GERD and psychological questionnaires, as well as manometric and reflux monitoring profiles, were compared

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Results: Of the 236 eligible patients included (mean age: 48.2 years, female 60%), 98 (41.5%) were identified as having normal MNBI, and 138 (58.5%) as having abnormal MNBI. Patients with normal MNBI had more females (p < 0.001), a lower body mass index (p < 0.001), and higher dominant symptom intensity (p = 0.012). Additionally, the normal MNBI group had higher psychological scores as measured by the Pittsburgh Sleep Quality Index (PSQI) (p = 0.004) and the Taiwanese Depression Questionnaire (TDQ) (p = 0.003). Regarding the results of reflux monitoring testing, patients in the abnormal MNBI group had higher upright (p = 0.001), supine (p = 0.005) and total acid exposure times (p < 0.001), as well as higher total reflux events (p = 0.030), compared to the normal MNBI group. However, there were no significant differences between the groups in terms of manometric profiles, except for the lower mean distal contractile integral (DCI) in the abnormal MNBI group (p = 0.039). Multivariate analysis indicated that body mass index (BMI) was the only factor independently associated with MNBI (β = −46.87, 95% CI = −83.92 to -9.82, p = 0.013).

Conclusions: In conclusion, this study highlights significant differences in clinical and psychophysiological characteristics between patients with normal and abnormal MNBI values in the context of normal acid exposure, with BMI identified as the only independent factor associated with MNBI. These findings suggest that MNBI measurement can be a valuable tool in better stratifying and managing reflux patients, especially those with normal acid exposure.

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COUGH REFLUX SCORE PREDICTS GASTROESOPHAGEAL REFLUX IN PATIENTS WITH LARYNGOPHARYNGEAL SYMPTOMS BUT IS UNRELATED TO SYMPTOM SEVERITY OR PSYCHOLOGICAL DISTRESS Ming-Wun Wong1, Chih-Hsun Yi1, Tso-Tsai Liu1, Wei-Yi Lei1, Jui-Sheng Hung1, Jen-Hung Wang2, Chien-Lin Chen1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 2 Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 1

COuGH RefluX 評分系統能預測咽喉逆流 症狀患者胃食道逆流情況但和身心症狀 嚴重度無關

翁銘彣1 易志勳1 劉作財1 雷尉毅1 洪睿勝1 王仁宏2 陳健麟1 1 2

佛教慈濟醫療財團法人花蓮慈濟醫院肝膽腸胃科 佛教慈濟醫療財團法人花蓮慈濟醫院研究醫學部

Background: The COuGH RefluX score has been validated as a predictive tool for gastroesophageal reflux disease (GERD) in patients presenting with laryngopharyngeal symptoms (LPS), utilizing parameters such as Cough, Overweight, Globus, Hiatal Hernia, Regurgitation, and male sex. The esophageal hypervigilance and anxiety scale (EHAS) assesses cognitive–affective visceral sensitivity and contributes to LPS. However, the interrelationship between psychological distress and the COuGH RefluX score remains undetermined.

Aims: The objective of this study was to evaluate the practical utility of the COuGH RefluX score in predicting GERD in Taiwan and its association with EHAS and sleep disturbance.

Methods: Patients experiencing LPS for more than three months were prospectively enrolled. Those with negative endoscopy results underwent 24-hour impedance-pH monitoring to assess reflux burden and esophageal mucosal integrity, determined by mean nocturnal baseline impedance (MNBI).

Validated patient-reported outcomes, including

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P.141 the GERD questionnaire (GERDQ), reflux symptom index (RSI), EHAS, and Pittsburgh Sleep Quality Index (PSQI), were collected. Patients were classified based on their COuGH RefluX scores as follows: ≤2.5 (unlikely GERD), 3.0−4.5 (inconclusive), and ≥5.0 (likely GERD).

Results: Among 170 participants (mean age 47.6), 102 were classified as unlikely, 54 as inconclusive, and 14 as likely to have GERD. The prevalence of male sex, BMI, and hiatal hernia was highest in the likely GERD group, followed by the inconclusive and unlikely GERD groups (P <0.001). The unlikely GERD group exhibited lower MNBI and fewer confirmed GERD cases compared to the inconclusive and likely GERD groups (P < 0.05). Additionally, the unlikely GERD group had lower upright acid exposure time (AET) compared to the likely GERD group (P < 0.05).

However, symptom severity, EHAS scores, PSQI, and supine and total AET were similar across all groups (P > 0.05).

Conclusions: The COuGH RefluX score effectively predicts GERD in LPS patients without esophagitis.

However, it does not correlate with symptom severity or psychological distress as measured by EHAS and sleep disturbance.

METABOLIC-ASSOCIATED STEATOTIC LIVER DISEASE AND ADENOMATOUS COLON POLYPS: RISK ASSESSMENT USING MACHINE LEARNING Jen Yu1, Ming-Ling Chang1,2, Chia-Yu Lai3, Chieh Lee4, Tsung-Hsing Chen1,2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Department of Management Information Systems, National Pingtung University of Science and Technology, Pingtung, Taiwan 4 Department of Information and Management, National Sun Yat-sen University, Kaohsiung, Taiwan 1

代謝相關脂肪肝病患者腺性結腸息肉的 風險評估及機器學習風險分層分析 游仁1 張明鈴1,2 賴佳瑜3 李捷4 陳聰興1,2 1

林口長庚紀念醫院胃腸肝膽科 長庚大學醫學院 3 國立屏東科技大學資訊管理系 4 國立中山大學資訊管理學系 2

Background: Metabolic-associated steatotic liver disease (MASLD) is increasingly recognized for its association with various extrahepatic conditions, including colorectal neoplasia. This study investigates the risk of adenomatous colon polyps in patients diagnosed with MASLD and employs advanced machine learning techniques to stratify risk factors associated with this condition.

Aims: The primary aim of this study is to assess the prevalence and risk factors for adenomatous colon polyps in a large cohort of MASLD patients, utilizing machine learning models to enhance risk stratification.

Methods: A total of 11,317 patients meeting the MASLD diagnostic criteria were included in the study.

Data were analyzed using both traditional statistical methods and machine learning techniques.

Specifically, Ordinary Least Squares (OLS) stepwise regression and XGBoost algorithms were employed to identify significant predictors and stratify risk factors. Model performance was assessed using

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P.142 standard metrics, and the results were validated through cross-validation techniques.

Results: The analysis revealed several significant predictors of adenomatous colon polyps among MASLD patients. The OLS stepwise regression identified key risk factors, which were further refined and confirmed through the XGBoost model, highlighting the robustness of the findings.

The machine learning models demonstrated superior predictive performance compared to traditional methods, providing a comprehensive risk stratification framework for clinical application.

Conclusions: This study underscores the heightened risk of adenomatous colon polyps in patients with MASLD and demonstrates the efficacy of machine learning techniques in identifying and stratifying risk factors. These findings support the integration of advanced analytical methods in clinical practice to enhance early detection and targeted intervention strategies for colorectal neoplasia in MASLD patients.

EFFECT MODIFICATION OF RISK BEHAVIORS AND POLYMORPHISMS OF ADH1B, ALDH2, AND ALDH3A1 GENES FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN TAIWAN Ming-Hung Hsu1, Sin-Hua Moi2, Ching-Tai Lee1, Wen-Lun Wang1,3, Che-Hong Chen4 Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan 2 Graduate Institute of Clinical Medicine College of Medicine Kaohsiung Medical University, Kaohsiung, Taiwan 3 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 4 Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, USA 1

危險行為與 ADH1B、ALDH2、ALDH3A1 基因多態性對台灣地區食道鱗狀細胞癌 的交互作用修飾效應 徐銘宏1 魏芯樺2 李青泰1 王文𤦎1,3 陳哲宏4 1

義大醫院內科部 高雄醫學大學臨床醫學研究所 3 義守大學醫學系 4 史丹佛大學醫學院化學及系統生物研究所 2

Background: Risk behaviors, including alcohol drinking and cigarette consumption, combined with single nucleotide polymorphisms (SNPs) of alcohol dehydrogenase 1B (ADH1B rs1229984) and aldehyde dehydrogenase 2 (ALDH2 rs671) were reported as increasing the risk of esophageal squamous cell carcinoma (ESCC). However, betel nut consumption, SNP of aldehyde dehydrogenase 3A1 (ALDH3A1 rs3744692), and effect modification among all risk factors have rarely been evaluated for the association risk of ESCC development.

Aims: Assess the joint effects and interactions between these polymorphisms and risk behaviors on ESCC susceptibility.

Methods: We consecutively recruited patients with treated ESCC as the case group and healthy population as the control group between June 2008 and December 2019 at EDA Hospital. The risk behaviors, including alcohol drinking, cigarette consumption, and betel nut, and blood samples

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P.143 for the SNPs genotyping of ADH1B, ALDH2, and ALDH3A1 were collected and then evaluated to determine the associated risk of ESCC and effect modification among all risk factors.

Results: The ADH1B G-allele was positively associated with ESCC regardless of alcohol drinking, besides no statistical interactions between them.

However, the ADH1B G-allele combined with betel nut or cigarette consumption had increased odds of having ESCC, and they also had statistical interaction in additive or even multiplicative scale. The ALDH2 G/A heterozygous combined with alcohol drinking, betel nut, or cigarette consumption had increased odds of having ESCC and all had statistical interactions among them. The combination of ADH1B G/G homozygous and ALDH2 G/A heterozygous in alcohol drinking status had the highest odds of ESCC. We did not observe the association between ADH1C polymorphism or risk behaviors with ESCC. Conclusions: Our findings indicated the joint effect between ADH1B (rs1229984) or ALDH2 (rs671) and alcohol drinking, betel nut, or cigarette consumption status on ESCC susceptibility, except the combination of ADH1B (rs1229984) and alcohol drinking. (EDAHS111016)

SURVIVAL BENEFIT OF PANCREATIC ENZYME REPLACEMENT THERAPY IN PATIENTS WITH UNRESECTED PANCREATIC HEAD CANCER: A RETROSPECTIVE COHORT STUDY Weng-Fai Wong1, Yu-Ting Kuo1, Ming-Lun Han1, Hsiu-Po Wang2 Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

胰臟酵素替代療法對未切除之胰頭癌症 患者的生存益處：一項回溯性世代研究 黃永輝1 郭雨庭1 韓明倫1 王秀伯2 1 2

國立臺灣大學醫學院附設醫院綜合診療部 國立臺灣大學醫學院附設醫院內科部

Background: Malnutrition is common in patients with pancreatic ductal adenocarcinoma, reducing their tolerance to anti-cancer treatments. Cancer arises from the pancreatic head blocks the outflow of pancreatic juice, causing maldigestion and poor nutritional status.

Aims: We aimed to determine whether pancreatic enzyme replacement therapy (PERT) provides survival and nutritional benefits for patients with unresected pancreatic head cancer.

Methods: This retrospective study was conducted at a medical center in Taiwan. Patients with unresected pancreatic head cancer were identified through the cancer registry system between 2007 and 2021.

Clinical information was obtained from electronic medical records, and survival status was retrieved from the Taiwan’s National Health Insurance Research database. The study compared survival and nutritional status between patients with and without PERT. Results: A total of 562 patients were enrolled, with 282 (50%) receiving PERT. The median survival was longer in the PERT group (median [IQR], 303 [184 to 493] vs 147 [85 to 271] days; P < 0.001). The adjusted hazard ratio for PERT was 0.38 (95% CI, 0.27-0.55; P < 0.001). The reduction in serum albumin level was less pronounced in the PERT group three months after diagnosis (median [IQR], -0.4 [-0.8 to -0.1] vs -0.7 [-1.2 to -0.1] g/dL; P = 0.025). The PERT group

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P.144 tended to lose less weight six months after diagnosis (median [IQR], -5.3 [-9.8 to -1.2] vs -7.0 [-12.3 to -2.8] kg; P = 0.067).

Conclusions: PERT prolongs survival in patients with unresected pancreatic head cancer.

CLINICAL CHARACTERITICS OF FUNCTIONAL DYSPEPSIA WITH OVERLAPPING IRRITABLE BOWEL SYNDROME Yen-Po Wang1,2,3, Po-Shan Wu4,5, Pei-Yi Liu1, Ming-Chih Hou1,2,3, Ching-Liang Lu1,2,3,5 Endoscopy Ceter of Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2 Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 3 School of Medicine, National Yang Ming Chiao Tung University Hospital, Taipei, Taiwan 4 Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan 5 Institute of Brain Science, National Yang Ming Chiao Tung University Hospital, Taipei, Taiwan 1

功能性消化不良症合併大腸急躁症患者 之臨床特性 王彥博1,2,3 吳柏姍4,5 劉佩怡1 侯明志1,2,3 盧俊良1,2,3,5 1

臺北榮民總醫院內視鏡診斷與治療中心 臺北榮民總醫院胃腸肝膽科 3 國立陽明交通大學醫學系 4 臺北榮民總醫院營養部 5 國立陽明交通大學腦科學研究所 2

Background: Functional dyspepsia (FD) is one of the most common disorder of the gut brain interaction.

FD patients may also have sympotms overlapped with irritable bowel syndrome (IBS). Diet therapy can be effective for FD or IBS patients. The clinical characteristics and diet pattern in Rome IV-defined FD patients with overlapping IBS (FD-IBS overlap) are less known.

Aims: To investigate the clinical characteristics and diet pattern in FD-IBS overlap patients.

Methods: Rome IV-defined FD patients and healthy controls were prospectively enrolled in a tertiary medical center. Clinical profiles and questionnaires, including the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale (HADS), Nepean Dyspepsia Index questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Food Intolerance Questionnaire, were acquired. Statistical analyses were performed by independent t test or chi-square test as appropriate. Correlation analysis

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P.145 was conducted using Pearson correlation analysis.

A two-sided P value of < 0.05 was considered statistically significant.

Results: 100 FD patients (M 36%, 49.5 years) and 50 controls (M 40%, 48.8 years) were enrolled. A higher portion of FD patients had sleep disorders (55% vs. 28%, p < 0.001), anxiety (62% vs. 20%, p < 0.001) and depression (35% vs. 8%, p < 0.001). 29% FD patients were found to have overlapping IBS. In FD-IBS overlap, dyspepsia symptom severity and quality of life were related to sleep disturbance.

The proportions of patients with sleep disorders, depression and anxiety did not differ between patients with FD-IBS overlap and patients with FD only. FD-IBS overlap patients had more severe abdominal pain (3.34 vs. 2.46, p = 0.003), ingestion (3.83 vs. 3.16, p = 0.008), diarrhea (2.77 vs. 1.99, p = 0.001) and GSRS total score (3.19 vs. 2.55, p < 0.001).

FD-IBS overlap patients also had a higher Nepean dyspepsia index score (66.62 vs. 49.37, p = 0.014) and impaired quality of life in interference daily activities/work (70.93 vs. 78.87, p = 0.05), while the total Nepean dyspepsia index quality of life score did not differ between groups (69.10 vs. 74.77, p = 0.139). The overall diet pattern and food intolerance did not differ between patients with FD-IBS overlap and patients with FD only. In FD-IBS overlap patients, dyspepsia-related quality of life and symptoms were not related to diet intake frequency. The diet intake frequency in FD-IBS overlap patients was negatively related to GI symptoms, severity of impaired sleep quality, anxiety and depression.

Conclusions: (1) FD-IBS overlap patients had more severe gastrointestinal symptoms but similar anxiety, depression, and sleep disturbance compared with patients with FD only. (2) The diet pattern and food intolerance did not differ between patients with FDIBS overlap and patients with FD only.

FEASIBILITY OF NEWLY DESIGNED ROTATABLE SPHINCTEROTOME FOR ENDOSCOPIC SPHINCTEROTOMY Yasuki Hori, Kazuki Hayashi, Itaru Naitoh, Hiromi Kataoka Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Background: Endoscopic sphincterotomy can be challenging especially in patients with surgically altered anatomy. Although a rotatable sphincterotome (r-sphincterotome) may be useful, its rotational function is often inadequate.

Aims: We evaluated the feasibility of a newly designed r-sphincterotome equipped with a wellconceived cutting wire.

Methods: We measured the movement and dynamics of both the newly designed r-sphincterotome and two existing r-sphincterotomes using in-house equipment. Ideally, the rotational force exerted at the proximal end should transmit directly to the distal end. But it is often challenging, particularly within the constraints of a bent endoscope and working channel. We collected data regarding deviation from the ideal value 10 times for each sphincterotome.

Results: The deviation from the ideal value was significantly lower with the newly designed r-sphincterotome than with the conventional r-sphincterotomes (44.9 ± 27.8 vs. 73.7 ± 44.6 and 130.1 ± 71.4 degrees, respectively; P < 0.001). The newly designed r-sphincterotome rotated smoothly and consistently at a constant speed, mirroring the input rotation. We successfully performed sphincterotomy in a patient with Roux-en-Y reconstruction.

Conclusions: The newly designed r-sphincterotome is effective for endoscopic sphincterotomy. We believe that the findings from these experiments and our clinical cases may contribute to easier and more precise sphincterotomies.

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SAFETY OF PERFORMING ENDOSCOPIC ULTRASOUNDGUIDED FINE NEEDLE BIOPSY IN OUTPATIENTS Ryosuke Tonozuka, Kento Shionoya, Takayoshi Tsuchiya, Reina Tanaka, Kazumasa Nagai, Kenjiro Yamamoto, Yukitoshi Matsunami, Hiroyuki Kojima, Hirohito Minami, Noriyuki Hirakawa, Takao Itoi

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IMPACT OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE BIOPSY USING A NOVEL NEEDLE FOR PANCREATIC TUMORS AND PERIDIGESTIVE TRACT LESIONS

Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

Momoko Iina, Kento Shionoya, Shuntaro Mukai, Ryosuke Tonozuka, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Kenjiro Yamamoto, Kazumasa Nagai, Yukitoshi Mastunami, Hiroyuki Kojima, Hirohito Minami, Noriyuki Hirakawa, Takao Itoi

Background: Recently, endoscopic ultrasoundguided fine needle biopsy (EUS-FNB) has been crucial for obtaining pathological specimens in the diagnosis and treatment of pancreatic diseases and perigastric lesions. While rare, complications such as bleeding and pancreatitis have been reported, but their true nature remains insufficiently understood.

At our hospital, EUS-FNB has also been performed in outpatients for its expedited procedure.

Aims: This study aimed to evaluate the safety of EUS-FNB when conducted in an outpatient setting.

Methods: We retrospectively examined complications in 1,232 cases of EUS-FNB performed from August 2016 to November 2023 at our hospital (560 outpatients, 672 inpatients).

Results: The average age of the patients was 66.0 ± 13.1 years. The lesions examined were pancreatic lesions (944 cases), submucosal lesions of the gastrointestinal tract (SELs) (122 cases), and others (166 cases). The adverse events occurred in 1.2% (15/1,232) of cases, including bleeding/hematoma (8 cases), pancreatitis (4 cases), pancreatic fistula (1 case), pancreatitis + bleeding (1 case), and puncture site infection (1 case). The incidence rates were 1.1% in outpatients (6 cases) and 1.3% in inpatients (9 cases), with no significant difference (p = 0.7966). All procedures used a 22G needle, and no differences due to the type of needle were observed. All cases of bleeding were mild and were initially managed with EUS probe compression. Bleeding from the gastric wall was treated with clipping, followed by intestinal rest during hospital admission, which improved all cases. The six cases of pancreatitis and pancreatic fistula (5 mild, 1 severe) all improved with conservative treatment. The one infection case was resolved after 13 days of antibiotic treatment.

Conclusions: EUS-FNB can be safely performed in the outpatient setting with proper management.

Background: Endoscopic ultrasound-guided tissue acquisition is vital for diagnosing pancreatic and peridigestive tract lesions. A new three-prong asymmetry tip needle has been developed for this procedure.

Aims: In this study, we retrospectively assessed the diagnostic ability, tissue collection volume, and procedural adverse events of the threeprong asymmetry tip needle for solid pancreatic, subepithelial, and other organ lesions.

Methods: We analyzed the data of 80 consecutive patients who underwent endoscopic ultrasoundguided tissue acquisition using a three-prong asymmetry tip needle between August 2022 and August 2023 at a single care center. Our specimen processing is characterized using the ultimate simplified macroscopic on-site evaluation (s-MOSE) a method that does not involve additional pathology tests such as rapid on-site evaluation or cytology.

Results: Overall accuracy was 86.3% (69/80) and limited to pancreatic cancer, the diagnosis rate was 91.7% (26/33) with s-MOSE. Although there was a significant difference in the accuracy between benign and malignant diseases, and needle diameter, there was no significant difference in diagnostic performance by target organ, route of puncture, or size of lesion. In a multivariate analysis, the factors for inaccurate diagnosis were benign diseases (odds ratio 0.202, p = 0.040), and use of a 25-gauge needle (odds ratio 0.104, p = 0.012).Using our original assessment method, the average histological core tissue score was 3.04 ± 0.80, whereas the blood contamination volume was 2.45 ± 0.85. Only one of 80 patients (1.3%) developed a pancreatic fistula of

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Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

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P.148 moderate severity as an adverse event.

Conclusions: The three-prong asymmetry tip needle demonstrated good diagnostic capability and adequate sample volume with safety for pancreatic, subepithelial, and other organ lesions.

INTRAPROCEDURAL HOLOGRAM SUPPORT WITH MIXED-REALITY TECHNIQUE IN ERCP FOR THE TREATMENT OF BILE LEAKAGE K. Nagai, H. Minami, A. Sofuni, K. Sugimoto, T. Tsuchiya, R. Tonozuka, S. Mukai, K. Yamamoto, R. Tanaka, Y. Matsunami, H. Kojima N. Hirakawa, K. Shionoya, Yasuhiro Shimizu, Takao Itoi Department of Gastroenterology and Hepatology Tokyo Medical University, Tokyo, Japan Background: Bile leakage is sometimes difficult to treat with ERCP. Recently, virtual extended reality (XR) technology has spread in the medical field.

Holograms, which are computer-generated graphics models, have recently been used with XR techniques as a surgical navigation tool.

Aims: We report the first case in which ERCP supported by XR technology was performed to treat postoperative bile leakage.

Methods: 3D images of the biliary tract were created from magnetic resonance cholangiopancreatography using SYNAPSE VINCENT (Fuji Film Medical Co., Ltd., Tokyo, Japan). Data were converted into 3D polygon data using the Holoeyes XR system (Holoeyes Inc., Tokyo, Japan) installed on a HoloLens head-mounted display (HMD; Microsoft Co., Redmond, WA, USA). The operator, wearing an HMD, performed ERCP while referring to the 3D cholangiogram projected in space.

Results: The patient is a 53-year-old man. Seven days after laparoscopic cholecystectomy for acute cholecystitis, he developed bile leakage. Thus, emergent ERCP was performed to treat the bile leakage. Although the bile duct was thin and complicated, the operator wearing the HMD was able to identify the location of the bile leakage and the drainage tube was successfully placed in the targeted bile duct branch.

Conclusions: This is the first report of ERCP using a 3D hologram. A 3D cholangiogram may make it easier for some to understand the biliary anatomy than a 2D image.

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BARRETT’S ESOPHAGEAL ADENOCARCINOMA DIAGNOSED

BY HEALTH CHECK-UP ESOPHAGOGASTRODUODENOSCOPY AND TREATMENT: A RETROSPECTIVE STUDY Hidetaka Ohta, Atsushi Miwa Gastroenterology and Endoscopy, Kurosawa Hospital, Gunma, Japan General Technical Office, Kurosawa Hospital, Gunma, Japan Background: In recent years, Barrett’s adenocarcinoma (BA) has been increasing in proportion to squamous cell carcinoma (SCC) in esophageal cancer in Asia. This is due to dietary westernization, rising obesity, and Helicobacter pylori (HP) eradication therapy, leading to more gastroesophageal reflux disease (GERD). Early asymptomatic BA, detected via health check-up esophagogastroduodenoscopy (EGD), can be curatively resected with endoscopic submucosal dissection (ESD).

Aims: We investigate the recent detection rates and proportion of BA relative to SCC, examine endoscopic features and treatment outcomes of early BA, and analyze patient characteristics.

Methods: This retrospective analysis was conducted on 10 consecutive cases of BA identified among 174,919 individuals who underwent health checkup EGD in our institution from 2015 to 2022.

Results: Among 174,919 EGD performed during health check-ups, 33 cases of esophageal cancers were identified (10 BA (30%), 23 SCC (70%)), yielding an incidence rate of 0.019% (BA 0.006%, SCC 0.013%).

Ten BA arising from Barrett’s esophagus (BE) were predominantly associated with short-segment BE (SSBE) rather than long-segment BE (LSBE), with a ratio of 9:1. The detection rate of early-stage BA was 80% (8 out of 10 cases). Lesion morphology; 0-Ⅰs:0Ⅱa:0-Ⅱb:0-Ⅱc = 1:2:3:4, lesion size (mm): 7-32 (19), exhibited a reddish coloration. Depth of invasion of the cases were LPM: MM: SM1: SM2 = 2:5:1:2. The characteristics of BA included a male-to-female ratio of 9:1, age range of 50-69 (61) years, BMI 21.5-30 (24.4), high prevalence of daily alcohol consumption (40%), smoking (40%), and a history of HP eradication (not infected: post-eradicated: currently infected = 8:2:0). Two cases (both SM2) underwent surgical intervention. The follow-up period after ESD (8 cases), ranging from 1-7 (5.5) years, showed no

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recurrence in all cases.

Conclusions: BA accounted for 30% of detected esophageal cancers. BA is predominantly observed in obese males with GERD associated with hiatal hernia and SSBE.

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UPPER GASTROINTESTINAL BLEEDING DUE TO RARE CAUSES: LAPAROSCOPIC APPROACH AND MANAGEMENT

CLINICAL EFFICACY OF SNARE TIP PRECUTTING ENDOSCOPIC MUCOSAL RESECTION IN 15-20 MM NON-PEDUNCULATED COLORECTAL NEOPLASMS: A PROSPECTIVE RANDOMIZED MULTICENTER STUDY

Nghe Huynh, Trung Le, Hanh Tran, Luu Le Nguyen Tri Phuong Hospital, Vietnam Ho Chi Minh City University of Medicine and Pharmacy, Vietnam Background: Upper gastrointestinal bleeding is a relatively common and potentially lifethreatening medical emergency. Most cases are related to peptic ulcer disease, gastric cancer, and esophageal varices rupture. In contrast, rare causes of upper gastrointestinal bleeding are often poorly suspected, leading to many challenges in diagnosis and management.

Aims: Describe the clinical scenarios and management of rare cases.

Methods: Case report.

Results: Three cases diagnosed with upper gastrointestinal bleeding due to rare causes including duodenal polyp, duodenal diverticulum, and gastrointestinal stromal tumor at the angle of Treitz, were effectively managed and definitively resolved by laparoscopic surgery.

Conclusions: Under specific circumstances, laparoscopic surgery can be utilized to address uncommon etiologies of upper gastrointestinal bleeding, including gastrointestinal stromal tumors at the angle of Treitz, duodenal polyps and duodenal diverticula. Favorable outcomes can potentially be achieved through the provision of adequate resources, proficient techniques, and multidisciplinary coordination.

Yunho Jung1, Seong-Jung Kim2, Chang Kyo Oh3, Seong Woo Choi1, Tae-Geun Gweon4 Department of Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea 2 Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea 3 Department of Internal Medicine, Hallym University Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea 4 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea 1

Background and Aims: The optimal endoscopic resection technique for non-pedunculated colorectal neoplasms 15-20 mm in size remained unclear. This study therefore aimed to evaluate the efficacy of snare tip precutting endoscopic mucosal resection (STP-EMR) compared to conventional EMR (C-EMR) for these lesions.

Methods: This prospective randomized comparative study recruited 126 patients with 128 colorectal neoplasms of 15-20 mm in size and randomly assigned them in a 1:1 ratio to undergo STP-EMR or C-EMR at four university hospitals from June 2022 to November 2023. The primary outcomes were en bloc resection rate (EBR) and complete resection rate (CRR), determined by gastrointestinal pathologists.

Results: A total of 128 eligible colorectal neoplasms were successfully resected using C-EMR (n = 65) and STP-EMR (n = 63). The overall mean lesion size, EBR, and CRR were 17.2 ± 1.9 mm, 78.9% (101/128), and 67.1% (86/128), respectively. The EBR (87.3% vs.

70.8%, P = 0.022) and CRR (76.2% vs. 58.5%, P = 0.033) were significantly higher in the STP-EMR group compared to that of the C-EMR group. Additionally, the mean total procedure time was significantly longer in the STP-EMR group (8.1 ± 2.5 vs. 5.0 ± 3.9, P < 0.001). There were no significant differences in the post-procedural bleeding rate, perforation rate (1.6% vs. 0%), and hospital stays between the

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P.152 two groups. Univariate analysis revealed that the resection method (STP-EMR vs. C-EMR) was the sole significant factor associated with both EBR (P = 0.022) and CRR (P = 0.033). Pathologic findings and polyp type also significantly influenced CRR. In the multiple logistic regression analysis, the resection method [STP-EMR (vs. C-EMR)] remained the only significant factor of both EBR (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.33-9.34; P = 0.011) and CRR (OR 3.03, 95% CI 1.29-7.07, P = 0.011).

Conclusions: STP-EMR seems to significantly improve en bloc and complete resection compared to C-EMR for non-pedunculated colorectal neoplasms of 15-20 mm, despite a longer procedure time.

Keywords: Colorectal Neoplasms, Mucosal Resection, Perforation

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Endoscopic

TRIGLYCERIDE GLUCOSE INDEX (TYG INDEX) AND RISK OF COLORECTAL ADENOMA: A CHASID MULTICENTER STUDY Dae Sung Kim, Hoon Sup Koo, and Kyu Chan Huh Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea Background and Aims: Insulin resistance is associated with the risk of colorectal adenoma.

Insulin resistance has been constantly associated with high triglyceride (TG) level. TyG index is a useful indicator of insulin resistance calculated by TG and plasma glucose levels. We investigated the association between the risk of colorectal adenoma and various variables including Tyg index.

Methods: This study was performed on 7251 subjects who underwent colonoscopy at university hospitals in Daejeon and Chungcheong province from November 2019 to June 2022. Logistic regression model was used to investigate the relationship between the risk of colorectal adenoma and variables including TyG index.

Results: The mean of age, BMI, fasting glucose level, HbA1C, fasting triglyceride level, and TyG index were all significantly higher in the group with colorectal adenomas (p < 0.001, all). Logistic regression analysis showed that obesity (BMI > 25) [adjusted odds ratio (OR), 1.365; 95% Confidence interval (CI), 1.208– 1.541; p < 0.001], DM (HbA1C ≥ 6.5%) [adjusted OR, 1.375; 95% CI, 1.175–1.609; p < 0.001], metabolic syndrome [adjusted OR, 1.441; 95% CI, 1.294–1.603; p < 0.001] and TyG index [adjusted OR, 1.351; 95% CI, 1.241–1.471; p < 0.001] were positively associated with colorectal adenomas. There was no significant association between high-LDL level (>130 mg/dl) and the risk of colorectal adenomas [adjusted OR, 1.053; 95% CI, 0.948–1.189; p = 0.301].

Conclusions: Lipid profile is related to the risk of developing colorectal adenomas. LDL level, which is considered clinically important, did not have a correlation, but low-HDL level and high-TG level had significant correlation. TyG index can be used to predict the risk of colorectal adenomas. Therefore, TyG index can be a simple and useful indicator for identifying people who are recommended for screening colonoscopy.

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Reference: 1. Ortiz AP, Thompson CL, Chak A, Berger NA, Li L. Insulin resistance, central obesity, and risk of colorectal adenomas. Cancer. 2012;118(7):17741781.

2. Kim JH, Lim YJ, Kim YH, et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol Biomarkers Prev. 2007;16(8):15431546.

3. Milano A, Bianco MA, Buri L, et al. Metabolic syndrome is a risk factor for colorectal adenoma and cancer: A study in a White population

using the harmonized criteria. Therap Adv Gastroenterol. 2019;12:1756284819867839.

4. Kim NH, Suh JY, Park JH, et al. Parameters of Glucose and Lipid Metabolism Affect the Occurrence of Colorectal Adenomas Detected by Surveillance Colonoscopies. Yonsei Med J. 2017;58(2):347-354.

5. Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. Triglyceride-glucose index (TyG index) is a predictor of incident colorectal cancer: a population-based longitudinal study.

BMC Endocr Disord. 2020;20(1):113.

Table 1. Logistic regression analyses for the association between continuous variables and colorectal adenomas.

Fasting glucose HbA1C HDL cholesterol LDL cholesterol Fasting triglyceride TyG index

Adjusted OR (95% CI)* 1.006 (1.004–1.008) 1.139 (1.068–1.214) 0.992 (0.988–0.996) 1.001 (0.999–1.002) 1.002 (1.001–1.002) 1.351 (1.241–1.471)

p value <0.001 <0.001 <0.001 0.211 <0.001 <0.001

*Adjusted for age and sex.

Table 2. Logistic regression analyses for the association between categorical variables and colorectal adenomas.

Metabolic syndrome BMI Overweight (23–24.9) Obesity (≥25) HbA1C IGT (5.7–6.4%) DM (≥6.5%) High-LDL (>130 mg/dl) Low-HDL (men < 40; women < 50 mg/dl) High-triglyceride (≥150 mg/dl)

Adjusted OR (95% CI)* 1.441 (1.294–1.603)

p value <0.001

1.165 (1.013–1.339) 1.365 (1.208–1.541)

0.302 <0.001

1.062 (0.948–1.189) 1.375 (1.175–1.609) 1.053 (0.948–1.169) 1.307 (1.135–1.505) 1.305 (1.164–1.464)

0.301 <0.001 0.338 <0.001 <0.001

*Adjusted for age and sex.

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INCIDENCE OF VENOUS THROMBOEMBOLISM IN ASIAN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS Ju Hye song1, Dae Sung Kim2, Hoon Sup Koo2, Sung Ryul Shim3, Joo Hye Song1 Kyu Chan Huh2 Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea 2 Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea 3 Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea 1

Background and Aims: Although the incidence and prevalence of inflammatory bowel disease (IBD) have been gradually increasing throughout Asia, the incidence of venous thromboembolism (VTE) in Asia is relatively lower than that in Western countries and is not well known. This study aimed to evaluate the incidence of VTE in Asian patients with IBD using a systematic review and meta-analysis.

Methods: Studies were identified through a literature search of the PubMed, Embase, and Cochrane databases (from inception inclusive April 2024) for English studies. The criteria for selecting the participants were as follows: (1) studies including patients with Crohn’s disease (CD) and Ulcerative colitis (UC) in the Asian population; (2) comparisons were specified as with a control group of non-IBD patients for comparative incidence; and (3) outcomes were measured by relative risks (RR) and hazard risk (HR) for VTE incidence in nationwide cohort studies.

Three independent reviewers extracted published data using a standardized procedure in accordance with the reporting guidelines. A fixed-effects model was used to estimate pooled effect sizes. Metaregression analyses were conducted to identify the potential moderating effects of VTE risk in patients with IBD. Results: Five studies met the inclusion criteria. The pooled RR for overall VTE incidence in Asian patients with IBD compared to that in non-IBD patients was 2.065 (95% CI: 1.905–2.238). The heterogeneity test resulted in a p-value of 0.418 for the Cochrane Q statistics, and Higgins’ I2 was 0%. There was no statistical moderating effect of the variables (number

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of patients, mean age, female rate, CD proportion, country, and type of risk) on the outcomes.

Conclusions: In our systematic review and metaanalysis, the VTE incidence in Asian patients with IBD was higher than that in non-IBD patients (RR 2.065).

It seemed reasonable to consider prophylaxis for VTE in hospitalized patients with IBD.

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ENDOSCOPIC ULTRASONOGRAPHY FOR SUBMUCOSAL CUSHION MEASUREMENT TO DETERMINE ELIGIBILITY FOR ENDOSCOPIC SUBMUCOSAL DISSECTION IN ULCERATIVE COLITIS-ASSOCIATED DYSPLASIA: A CASE SERIES

24.5 mm and 16.0 x 12.5 mm, respectively. En bloc resection was achieved in all cases, with an 87.5% (7/8) R0 resection rate. No perforation occurred but delayed bleeding occurred in one patient.

Conclusions: EUS-measured SM cushion thickness provides objective information of the lifting status after submucosal injection and may indicate the resectability of UC-associated dysplasia.

Kyuwon Kim1, Seung Wook Hong2, Sung Wook Hwang2, Sang Hyoung Park2, Byong Duk Ye2, Jeong-Sik Byeon2, Seung-Jae Myung2, Suk-Kyun Yang2, Dong-Hoon Yang2 Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea 2 Department of Gastroenterology, ChungAng University College of Medicine, Internal medicine, Chung-Ang University Hospital, Seoul, Korea 1

Background and Aims: Endoscopic submucosal dissection (ESD) has gained traction as an effective therapy for ulcerative colitis (UC)-associated dysplasia, yet identifying fitting ESD candidates is challenging by substantial submucosal (SM) fibrosis from chronic inflammation. We report our experience utilizing endoscopic ultrasonography (EUS) to assess ESD eligibility by measuring SM cushion thickness.

Methods: Retrospective case-series includes nine patients who were diagnosed with UC-associated dysplasia in surveillance colonoscopies between August 2017 and October 2023. After scanning dysplastic lesions, saline or diluted hyaluronic acid solution was injected into the SM layer. EUS with a mini-probe quantified SM cushion beneath the dysplastic lesion. Shallow (less than 2.0 mm) SM cushion at diffuse area was considered ineligible for ESD. Results: A total of ten lesions from nine patients were evaluated before ESD. Median disease duration was 19 years, and median age at diagnosis of UCassociated dysplasia was 50 years. Median SM cushion thickness of ESD-eligible lesions was 4.2 mm at the thinnest site and 6.9 mm at the thickest site. Eight lesions met the criteria and underwent ESD, while two lesions were regarded as unsuitable for ESD due to insufficient SM cushion thickness.

Median resection time was 50 minutes, and median size of resected specimens and lesions were 31.5 x

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MINI-PROBE ENDOSCOPIC ULTRASOUND FOLLOWED

BY SUBMUCOSAL SALINE INJECTION: POTENTIAL ROLE IN THERAPEUTIC DECISION-MAKING FOR COLORECTAL SUBEPITHELIAL TUMORS Jung-Bin Park1, Ji Eun Baek1, June Hwa Bae1, Seung Wook Hong1, Sung Wook Hwang1,2,3, Sang Hyoung Park1,2, Byong Duk Ye1,2, Jeong-Sik Byeon1, Seung-Jae Myung1,3, Suk-Kyun Yang1,2, Dong-Hoon Yang1,3 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2 Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 3 Digestive Disease Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 1

Background: Colorectal subepithelial lesions (SELs) without proper muscle layer invasion can be treated using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Lifting after submucosal injection is often considered a subjective benchmark for endoscopic resectability, but mini-probe endoscopic ultrasound (mEUS) can provide objective information. We aimed to evaluate the feasibility of mEUS followed by saline submucosal injection (SSI-mEUS) for assessing the endoscopic resectability of colorectal SELs. Methods: From January 2020 to December 2023, mEUS was performed for 174 colorectal SELs in 161 patients before treatment. Among these, SSI-mEUS was applied to 127 lesions to measure the distance between the deepest margin of SELs and the proper muscle layers (thickness of submucosal cushion).

SSI-mEUS was primarily conducted between October 2022 and December 2023. Additionally, we reviewed 217 colorectal SELs in 203 patients who did not undergo pre-procedural EUS during the same study period. We collected data on mEUS findings, thickness of submucosal cushion, and retrospectively reviewed the treatment outcomes, and histological diagnosis from the electronic data records.

Results: The thickness of submucosal cushion after

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saline injection was measured as 5.8 ± 2.1 mm at the thinnest area and 7.1 ± 2.2 mm at the thickest area under mEUS. In the SSI-mEUS group, ESD was performed more frequently (30.4%) than in the no EUS and mEUS only groups (15.9%) (P < 0.001).

The majority of lesions were rectal neuroendocrine tumors, with 81.6% in the SSI-EUS group and 74.7% in the no EUS and mEUS only groups. In five cases, en bloc resection was unattainable due to severe fibrosis, necessitating piecemeal resection. The R0 resection rate of neoplastic lesions was statistically significantly higher in the SSI-mEUS group (97.3% vs.

90.3%, P = 0.046). To identify risk factors associated with a positive or indeterminate deep margin in rectal neuroendocrine tumors, a univariate analysis of potential factors was conducted, and variables with P < 0.15 in the univariate analysis were included in the multivariate logistic regression analysis. In the multivariate analysis, the procedure without EUS or with mEUS only (OR, 6.64; 95% CI, 1.61– 61.07; P = 0.006) was associated with a positive or indeterminate deep margin.

Conclusions: For colorectal SELs, including lesions that look insufficiently elevated on conventional endoscopy, a submucosal cushion created by administering SSI and measurement by mEUS can predict a high likelihood of safe and complete resection. Moreover, this information may become a new endosonographic parameter to determine the feasibility of endoscopic resection.

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