Issuu

Theme: Breakthroughs and Beyond in Digestive Diseases Date: September 19th (Sat) ~ 20th (Sun), 2026 Venue: NTUH International Convention Center 台大醫院國際會議中心

2026 Taiwan Digestive Disease Week, TDDW Abstract Book INDEX Chairman’s Lecture...................................................................................4 Special Lecture (1)

Balancing Efficacy and Safety in Endoluminal Treatment of Colorectal Neoplasm..................5

(2)

Pancreatobiliary Endoscopy in Patients with Altered Anatomy: ERCP, EUS or a Combined Approach?......................................................................................................................................6

(3)

Restoring Anatomy Without Incisions: POSE-2 and TIF at the Frontiers of Bariatric and Antireflux Endoscopy.......................................................................................................................................7

(4)

Early-Onset Colorectal Cancer: Moving from Correlation to Causation to Prevention............8

(5)

DGBI Mimics You Need to Know: GI Dysautonomia & Small Fiber Neuropathy.........................9

(6)

Translating Clinical Trial Endpoints to Real-World Care in MASLD and MASH......................... 10

(7)

Artificial Intelligence in Gastroenterology: What Has Truly Changed Clinical Practice......... 12

(8)

Navigating Sequencing and Conversion Therapy: Maximizing Long-Term Survival in the Multi-Line Era and The Next Decade of HCC Management............................................... 13

(9)

Toward a Virus-Free World: Over Half a Century of Lessons for the Future............................... 14

Prof. Teh-Hong Wang Memorial Lecture...............................................15 Prof. J uei-Low Sung’s Research Foundation 39th Annual Academic Meeting.........................................................................16 Symposium (1)

Global Gastric and Colorectal Cancer Prevention: From Population Screening to Precision Risk Stratification......................................................................................................................... 20

(2)

Early Detection and Prevention of Pancreatic Cancer: From High-Risk Surveillance to Emerging Population Strategies............................................................................................................... 24

(3)

Breakthroughs and Beyond in IBD........................................................................................................... 28

(4)

Beyond the Incision: Breakthroughs and Evidence-Based Evolution in Digestive Surgery............................................................................................................................................................... 31

(5)

Autoimmune Pancreatitis........................................................................................................................... 35

(6)

Neurogastroenterology and Motility Symposium: Updated Consensus Toward Optimizing Management............................................................................................................................ 38

(7)

Maximal the Effect of Transarterial Chemoembolization (TACE).................................................. 43

(8)

Refresh in Clinical Management of MASLD.......................................................................................... 48

(9)

Prophylactic Clipping After Endoscopic Resection of Colorectal Polyps: Evidence, Size- and Technique-Based Controversies........................................................................ 53

(10)

Next Generation Probiotics and Live Biotherapeutic Products in Clinical Practice................ 57

(11)

Is It Time to Change Practice? Redefining the Algorithm for Primary Biliary Drainage in Unresectable Malignant Distal Biliary Obstruction............................................................................ 59

(12)

Revolutionizing Pediatric Gut Health: Breakthrough Therapies & Research Beyond Medication........................................................................................................................................................ 63

(13)

Breakthroughs and Beyond: A New Era in Intestinal Disorders..................................................... 66

(14)

Precision Pathways in HCC Treatment.................................................................................................... 70

(15)

Updating Progress of Management for Hepatitis B Virus................................................................ 74

(16)

Generative AI in Gastroenterology: From Clinical Documentation to Decision Support.... 78

Young Investigator Award (YIA)............................................................80 Free Paper (1)

HBV...................................................................................................................................................................... 88

(2)

UGI....................................................................................................................................................................... 94

(3)

SLD....................................................................................................................................................................... 99

(4)

Pancreas / Biliary...........................................................................................................................................105

(5)

LGI......................................................................................................................................................................110

(6)

HCC....................................................................................................................................................................115

(7)

IBD.....................................................................................................................................................................121

(8)

HP.......................................................................................................................................................................126

(9)

HCV....................................................................................................................................................................132

Poster Liver.................................................................................................................................................................................139 Gastroenterology........................................................................................................................................................169

2026 TDDW

Chairman’s Lecture Reading the Immune State in Hepatoma A Bedside-to-Bench-and-Back Translational Journey in HCC Chun-Yen Lin Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan Background: Immune checkpoint inhibitor (ICI)–based therapy has become a first-line backbone for advanced hepatocellular carcinoma (HCC), yet most patients do not achieve an objective response. Locoregional–systemic combinations are extending the reach of immunotherapy, but overall-survival benefit and patient selection remain unresolved. Routine clinical parameters can estimate fitness, prognosis, toxicity, and early treatment dynamics; they do not reliably identify the best regimen. Scope and Content: This chairman lecture traces a translational program that begins with clinical uncertainty and asks whether peripheral immune states can provide biologically meaningful, clinically useful readouts of the HCC tumor microenvironment. Real-world Chang Gung cohorts illustrate how locoregional therapy can be integrated with systemic treatment as intensification, salvage, or local control in selected patients, while emphasizing the limits of retrospective evidence. The lecture then follows two complementary immune populations. Peripheral FOXP3-high regulatory T cells are associated with tumorinfiltrating suppressive T-cell states and provide supported prognostic information. Cytokine-driven, bystander-like CD38+HLA-DR+ CD8+ T cells likewise

mirror tumor-associated immune activity and are associated with recurrence risk. Combining effector activation with regulatory restraint produces a baseline CD38+HLA-DR+ CD8+/FOXP3-high Treg ratio that showed encouraging discrimination of response and survival in an atezolizumab/ bevacizumab cohort; this remains a candidate predictive biomarker requiring prospective external validation. Finally, preclinical work explores whether bystander-enriched cytokine-induced killer (CIK) cells can improve effector phenotype and antitumor activity over conventional CIK cells. Conclusion: The most actionable immune readout may be the balance between activation and suppression rather than any single cell population. Peripheral profiling may strengthen risk assessment and generate testable treatment-selection hypotheses, but it is not yet ready to choose therapy. Bystander CIK represents a future translational direction for which clinical efficacy and hepatic safety must still be established. Keywords: hepatocellular carcinoma, immunotherapy, peripheral immune profiling, regulatory T cells, bystander CD8+ T cells, cytokineinduced killer cells

2026 TDDW

Special Lecture (1) Balancing Efficacy and Safety in Endoluminal Treatment of Colorectal Neoplasm Toshio Kuwai Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan Endoscopic treatment has become the standard approach for many colorectal neoplasms because it offers organ-preserving treatment while maintaining excellent oncological outcomes. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) each have distinct advantages, and selecting the appropriate technique based on lesion characteristics is essential to maximize treatment efficacy. In addition, recent evidence indicates that selected patients with T1 colorectal cancer can achieve excellent long-term outcomes following curative endoscopic resection, emphasizing the expanding role of minimally invasive treatment. As endoscopic therapy has evolved, attention has shifted from technical success alone to comprehensive risk management. Delayed bleeding, perforation, and post-ESD coagulation syndrome remain important adverse events

that may compromise patient outcomes. Recent randomized trials and meta-analyses have refined the indications for prophylactic defect closure after EMR, demonstrating that its benefit is largely confined to large proximal colonic lesions rather than routine use after all resections. In contrast, accumulating evidence, including the multicenter randomized EPOC trial, supports prophylactic clip closure after colorectal ESD to reduce delayed bleeding. Emerging adjunctive strategies, such as self-assembling peptide matrices, may further improve post-resection wound management. This lecture will review current evidence on optimizing both oncological efficacy and procedural safety in the endoluminal treatment of colorectal neoplasms, discuss patient selection for preventive interventions, and present practical strategies for achieving safer and more effective endoscopic resection in daily clinical practice.

2026 TDDW

Special Lecture (2) Pancreatobiliary Endoscopy in Patients with Altered Anatomy: ERCP, EUS or a Combined Approach? Raymond S.Y. Tang Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Pancreatobiliary endoscopy in patients with surgically altered anatomy is technically challenging. Modern endoscopic options for such patients include (1) enteroscopy assisted ERCP, (2) EUS guided biliary / pancreatic duct interventions, or (3) combined EUS-ERCP approach. The optimal endoscopic approach for these patients depends on the type of post-surgical anatomy and the nature of pancreatobiliary pathology being treated (eg, benign vs malignant).

(1) Enteroscopy assisted ERCP ‒ Often attempted first in patients with benign pancreatobiliary pathology in which a natural orifice biliary / pancreatic duct access is preferred ‒ Dedicated short-type balloon enteroscope or conventional long-type balloon enteroscope are available ‒ In general, time consuming procedures with variable technical success rates ‒ Anatomy with higher success rates: Billroth II, pancreaticoduodenectomy, Roux-en Y (RY) distal gastrectomy ‒ Anatomy with lower success rates: RY gastric bypass (RYGB), RY hepaticojejunostomy (RYHJ) ‒ Limited ERCP accessories available when long-type balloon enteroscope is used (2) EUS guided biliary / pancreatic duct interventions ‒ Often preferred in patients with recurrent

‒

‒ ‒

malignant pancreatobiliary pathology, anastomotic strictures or complex bile duct stones not amenable to enteroscopy assisted ERCP Biliary drainage can be done in the form of choledochoduodenostomy (EUSCDS), hepaticogastrostomy (EUS-HGS) or antegrade stenting (EUS-AG) Pancreatic drainage can be done in the form of pancreaticogastrostomy (EUS-PGS) or antegrade stenting Higher technical success and reduced adverse event rates can be achieved when dedicated EUS guided drainage accessories and stents are used Cholangiopancreatoscopy via transEUS guided created route (trans-ESCR) is possible EUS guided drainage / anastomosis can be performed for afferent loop obstruction after pancreaticoduodenectomy

(3) Combined EUS-ERCP approach ‒ Particularly helpful for benign conditions such as bile duct stone or HJ stricture in patients after RYGB or RYHJ ‒ Access route created by EUS guided anastomosis using lumen apposing metal stents (LAMS), followed by ERCP using duodenoscope or gastroscope ‒ Growing body of evidence on EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE)

2026 TDDW

Special Lecture (3) Restoring Anatomy Without Incisions: POSE-2 and TIF at the Frontiers of Bariatric and Antireflux Endoscopy Barham Abu Dayyeh Interventional Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA Therapeutic endoscopy is expanding beyond palliation and bridging therapy toward durable, anatomy-directed treatment of obesity and gastroesophageal reflux disease (GERD). Two representative advances: Primary Obesity Surgery Endoluminal 2.0 (POSE-2) and transoral incisionless fundoplication (TIF), illustrate this evolution toward minimally invasive interventions designed to restore function while preserving future therapeutic options. POSE-2 uses full-thickness gastric plication to shorten and remodel the gastric body, targeting the mechanical and neurohormonal pathways that regulate satiation and energy intake. This lecture will review its mechanistic rationale, procedural principles, emerging clinical evidence, safety profile, and appropriate patient selection. POSE-2 will also be positioned within the contemporary obesity-treatment continuum, including lifestyle intervention, anti-obesity pharmacotherapy, endoscopic sleeve gastroplasty, combination therapy, and metabolic-bariatric surgery.

GERD will similarly be considered not solely as a disorder of acid exposure, but as a disease of antireflux-barrier dysfunction. TIF reconstructs the gastroesophageal flap valve through an incisionless approach, while combined hiatal repair and TIF extends this concept to selected patients with clinically significant hiatal hernias. The evidence supporting symptom control, proton-pump inhibitor reduction, objective reflux improvement, safety, and durability will be examined alongside the essential roles of physiologic testing and anatomical phenotyping. Together, POSE-2 and TIF demonstrate a broader paradigm shift: endoscopy can increasingly modify anatomy and physiology rather than merely manage symptoms. Careful patient selection, procedural standardization, multidisciplinary integration, and rigorous comparative and longterm evidence will determine how these therapies are incorporated into future obesity and GERD treatment pathways.

2026 TDDW

Special Lecture (4) Early-Onset Colorectal Cancer: Moving from Correlation to Causation to Prevention Andrew T. Chan Harvard Medical School, Boston, MA, USA Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA The global rise in early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before age 50 years, represents one of the most concerning shifts in contemporary cancer epidemiology. Although efforts to lower the age of screening initiation have become an important public health response, early detection alone is unlikely to reverse this trend, particularly if carcinogenic processes begin decades before clinical diagnosis. Developing effective prevention strategies will require a deeper understanding of the environmental, lifestyle, and biological factors that contribute to EOCRC risk and the identification of individuals most likely to benefit from targeted interventions. This presentation will review the current state of the evidence regarding established and emerging risk factors for EOCRC, with a particular focus on lifestyle and metabolic determinants, including obesity, diet, physical inactivity, and the gut microbiome. The strengths and limitations of the existing epidemiologic and mechanistic evidence

will be examined, highlighting opportunities and challenges in moving from association to causation. The presentation will then discuss how these data begin to inform frameworks for precision prevention. Lifestyle-based risk stratification will be presented as an initial model for identifying individuals at elevated risk and for guiding preventive strategies, while also providing a foundation for future risk prediction models that integrate genetics, circulating and microbial biomarkers, and other multi-omic measures. Finally, emerging approaches to molecular prevention, including anti-inflammatory drugs such as aspirin, metabolic therapies such as GLP-1 receptor agonists, and targeted dietary interventions will be considered within a broader life-course framework aimed at interrupting carcinogenesis before cancer develops. Together, these advances offer a roadmap for shifting EOCRC prevention from reactive early detection toward proactive, individualized risk assessment and prevention.

2026 TDDW

Special Lecture (5) DGBI Mimics: GI Dysautonomia & Small Fiber Neuropathy Kewin Siah Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore Most patients with disorders of gut–brain interaction (DGBI) do not have an underlying neurological disease. However, a small but important subgroup with gastrointestinal dysautonomia or small fiber neuropathy may present with refractory nausea, vomiting, constipation, abdominal pain, bloating, or pan-enteric dysmotility, leading to delayed diagnosis and inappropriate treatment. Using illustrative clinical cases, this practical lecture will highlight the extraintestinal “red flags” that should prompt gastroenterologists to look beyond DGBI, including orthostatic symptoms, palpitations, neuropathic pain, sweating

abnormalities, temperature intolerance, urinary symptoms, and hypermobility. A pragmatic diagnostic approach will be presented, covering targeted history taking, orthostatic vital signs, autonomic symptom assessment, indications for autonomic testing and skin biopsy, and when to involve neurology. Participants will leave with a simple clinical framework to recognize GI dysautonomia and small fiber neuropathy as important DGBI mimics, enabling earlier diagnosis, appropriate investigations, and more personalized multidisciplinary care.

2026 TDDW

Special Lecture (6) Translating Clinical Trial Endpoints to Real-World Care in MASLD and MASH Zobair M. Younossi Chairman, Global NASH/MASH Council Center for Outcomes Research in Liver Disease & Policy Research, Georgetown University School of Medicine, Washington, DC, USA Background and Aims: Regulatory approval of pharmacotherapy for noncirrhotic MASH with F2–F3 fibrosis has rested on histologic endpoints: MASH resolution without worsening fibrosis, and ≥1-stage fibrosis improvement. The field is now moving beyond histology toward patient-centered endpoints, including prevention of cirrhosis, hepatic decompensation, liver transplantation, cardiovascular events, overall survival, healthrelated quality of life (HRQL), and other patientreported outcomes (PROs). In routine care, biopsy is rarely performed before or during therapy, and guideline noninvasive test (NIT) thresholds have varied,¹ creating a gap between the evidence base and the point of care. Methods: This is a synthesis of histologic endpoint definitions, guideline NIT recommendations, consensus-derived thresholds, and published data characterizing determinants of advanced fibrosis, NIT performance, and long-term outcomes.¹-⁴ Results: In the recently published G-MASLD project, fibrosis-based endpoints were anchored to outcomes that matter to patients, demonstrating that fibrosis severity, whether defined histologically or by NIT, independently predicts mortality and liver-related clinical events across diverse populations.² Surrogate performance is not uniform, however. Diagnostic accuracy of blood-based and elastography-based NITs for advanced fibrosis varies by geographic region,³ and by age, type 2 diabetes status, and obesity class, such that fixed thresholds misclassify patients at the extremes of these subgroups.⁴ Consensus recommendations operationalize these surrogates at three decision

points (eligibility, treatment response, and futility) through sequential FIB-4 followed by VCTE or ELF, with cirrhosis excluded by a second concordant NIT.¹ Patient-centered endpoints remain incompletely served: HRQL and PRO scores decline as fibrosis stage advances, yet PROs are seldom captured alongside NITs in practice, and real-world data linking on-treatment surrogate change to decompensation, transplantation, cardiovascular events, and survival remain sparse. Beyond fibrosis stage, portal hypertension offers an endpoint closer to those outcomes. Baveno VII established that clinically significant portal hypertension (CSPH) can be diagnosed noninvasively: liver stiffness measurement (LSM) ≤15 kPa with a platelet count ≥150×109/L rules out CSPH, while LSM ≥25 kPa rules it in with specificity and positive predictive value >90% in viral, alcohol-related, and non-obese MASH-related compensated advanced chronic liver disease.⁵ In obesity, the ≥25 kPa threshold overestimates CSPH, prompting development of the ANTICIPATE-NASH model, which combines LSM, platelet count, and BMI.5 Because CSPH marks the transition to decompensation risk, these thresholds offer a tractable intermediate endpoint linking ontreatment NIT change to cirrhosis-related outcomes. Conclusions: Trial-to-practice translation depends on NIT surrogates whose accuracy varies by age, metabolic phenotype, and region; on CSPH-directed thresholds that account for obesity in MASH; and on prospectively linking those surrogates to cirrhosis prevention, decompensation, transplantation, cardiovascular events, survival, and patient-reported outcomes.

2026 TDDW

References: 1. Younossi ZM, Kalligeros M, Wong VW-S, AlNaamani KM, Tacke F, Tsochatzis E, et al. Updated Global Consensus Recommendations for Risk Stratification, Treatment Initiation, and Response Monitoring in Metabolic Dysfunction-Associated Steatotic Liver Disease. Clin Gastroenterol Hepatol. 2026. doi: 10.1016/j. cgh.2026.03.030. Epub ahead of print. 2. Younossi ZM, de Avila L, Petta S, Hagström H, Kim SU, Nakajima A, et al; Global NASH/ MASH Council (GNC). Predictors of fibrosis, clinical events, and mortality in MASLD: Data from the Global-MASLD study. Hepatology. 2026 Jul 1;84(1):204–215. doi: 10.1097/ HEP.0000000000001617. PMID: 41231627. 3. Younossi ZM, de Avila L, Petta S, Hagström H, Kim SU, Nakajima A, et al; Global NASH/MASH Council (GNC). Global performance of non-invasive

tests in MASLD: Insights from the G-MASLD study. Hepatology. 2026 Jul 1;84(1):161–174. doi: 10.1097/HEP.0000000000001564. PMID: 41100867. Younossi ZM, de Avila L, Petta S, Hagström H, Kim SU, Nakajima A, et al; Global NASH/ MASH Council (GNC). Diagnostic Accuracy of Noninvasive Tests for Metabolic Dysfunctionassociated Steatotic Liver Disease Across Age, Type 2 Diabetes, and Obesity Subgroups: A Multinational Study. Clin Gastroenterol Hepatol. 2026 Jan 29:S1542-3565(26)00044-3. doi: 10.1016/j.cgh.2026.01.016. PMID: 41616900. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII — Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–974. doi: 10.1016/j. jhep.2021.12.022.

2026 TDDW

Special Lecture (7) Artificial Intelligence in Gastroenterology: What Has Truly Changed Clinical Practice Joseph Sung Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Centre of AI in Medicine, Nanyang Technological University, Singapore AI can be a great asset to Gastroenterology and Hepatology, largely because image interpretation is a powerful and mature technology. Endoscopic applications of AI have been developed and tested in various clinical settings, but most evidence is surrounding AI-assisted colonoscopy in polyp detection and characterization, and early detection of cancer in Barrett’s esophagus and gastric intestinal metaplasia. Consensus and guidelines of using such technologies are lacking or conflicting at the moment. The major obstacle is still a lack of clinical outcome improvement i.e. early detection of cancer (instead of pre-malignant lesions), significant impact on treatment strategies and reduction of

cancer mortality. On the other hand, AI has great potential in improving quality of endoscopy (bowel preparation, scope withdrawal time, completeness of examination), clear documentation of endoscopic findings and suggestion of treatment option. These are promising area of AI applications in Gastroenterology and Hepatology but evidence is still weak. Cost evaluation is also preliminary and lack international consensus. Future studies should focus on those low-hanging fruits instead of holding the use of AI because of lacking of significant survival advantage.

2026 TDDW

Special Lecture (8) Navigating Sequencing and Conversion Therapy: Maximizing LongTerm Survival in the Multiline Era and the Next Decade of HCC Management Masatoshi Kudo Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine and University Hospital, Osaka, Japan The therapeutic landscape of unresectable hepatocellular carcinoma (HCC) has rapidly evolved from sequential tyrosine kinase inhibitor (TKI) monotherapy to a multiline era dominated by immune checkpoint inhibitor (ICI)-based combinations. Consequently, the therapeutic objective should extend beyond maximizing the efficacy of an individual regimen toward optimizing the entire treatment sequence while preserving liver function and performance status. After failure of first-line immunotherapy, treatment selection should be individualized according to the pattern of progression, residual liver function, prior toxicity, and biological mechanisms of resistance. TKIs remain central to post-ICI sequencing. Lenvatinib is particularly promising because its potent inhibition of VEGFR and FGFR may overcome VEGF- and FGF-mediated escape and retain activity in immune-cold, Wnt/β-catenin-activated tumors. Furthermore, lenvatinib may reprogram the tumor immune microenvironment toward an immune-hot phenotype, providing a rationale for an “ICI–lenvatinib–ICI” sequence. Regorafenib and cabozantinib also demonstrate clinically meaningful disease control after atezolizumab plus bevacizumab, although prospective comparative evidence remains limited. Conversely, ICI rechallenge may be considered in selected patients, particularly when the initial regimen was discontinued because

of anti-VEGF-related intolerance rather than immunological resistance. Treatment should not necessarily be changed at the first radiological progression. For oligoprogression or newly developed vascular invasion, locoregional therapy—including ablation, superselective transarterial chemoembolization, or stereotactic body radiotherapy—may control resistant lesions and permit continuation of an otherwise effective systemic regimen. Most importantly, systemic therapy should be regarded not only as palliative treatment but also as induction therapy for curative conversion. In TACEunsuitable intermediate-stage HCC, atezolizumab plus bevacizumab followed by resection, ablation, or curative superselective TACE achieved complete response in 35% of patients and drug-free status in 23%. These findings support complete response, cancer-free status, and ultimately drug-free survival as ambitious but achievable therapeutic goals. Over the next decade, HCC management will shift toward biomarker-guided, responseadaptive sequencing with repeated assessment of conversion opportunities. Integrating systemic and locoregional therapies while preserving hepatic reserve will be essential to transform incremental gains across multiple lines into long-term survival and, in selected patients, cure.

2026 TDDW

Special Lecture (9) Toward a Virus-Free World: Over Half a Century of Lessons for the Future Masao Omata President, Yamanashi Prefectural Central and Kita Hospitals, Yamanashi, Japan

Background: Following the discoveries of HBV in 1965 and HCV in 1989, the author has been continuously engaged in clinical and basic research on liver diseases since 1970. Based on over half a century of clinical experience in hepatitis clinics and academic endeavors through APASL, this presentation reflects on past progress and outlines future perspectives for the Asia-Pacific region, which accounts for twothirds of the world’s viral hepatitis population. In HCV management, the advent of direct-acting antivirals (DAAs) in 2013 made viral eradication achievable in nearly all cases. Japan’s experience over the subsequent decade demonstrates a drastic decline in HCV-related cirrhosis and hepatocellular carcinoma.

Conversely, for HBV, universal vaccination programs—pioneered in regions such as Taiwan— have dramatically reduced novel HBV infections. However, complete viral eradication remains hindered by the presence of integrated HBV DNA and cccDNA, posing ongoing therapeutic challenges.

Conclusion: Over 50 years of clinical and academic activity highlight both substantial achievements and remaining hurdles. Building upon the control of HCV and the preventive success against HBV, future efforts must focus on achieving a functional cure for HBV and ensuring equitable treatment access, paving the way toward a truly virus-free world.

2026 TDDW

Prof. Teh-Hong Wang Memorial Lecture Elimination of Helicobacter pylori and Stomach Cancer in Taiwan: National Strategy and Asia-Pacific Consensus Chien-Jen Chen Genomics Research Center, Academia Sinica, Taipei, Taiwan There has been significant decrease in agesex-adjusted incidence of stomach cancer and seroprevalence of Helicobacter pylori (HP) infection and in Taiwan since 1980. Stomach cancer was the third leading cancer in 1980, and the ninth leading cancer in 2023 in Taiwan. The seroprevalence of HP infection increased significantly with age in Taiwan from 27% for children younger than 10 years old and 72% for adults aged more than 40 years old in 1994. Taiwan National Health Insurance Administration started to reimburse diagnosis and antibiotic treatment of HP in 2003. Age-period-cohort (APC) and annual percentage change analyses of noncardia and cardia adenocarcinoma of the stomach from 1984 to 2023 in Taiwan were carried out to assess the effectiveness of environmental sanitation as well as HP diagnosis and antibiotic treatment to reduce stomach cancer incidence. A significant but different birth cohort effect on the incidence of both non-cardia and cardia adenocarcinoma of the stomach was observed. The non-cardia adenocarcinoma incidence was highest for birth cohorts born in 1927–1931 and significantly decreased for birth cohorts born after 1931. The cardia adenocarcinoma incidence was highest for birth cohorts born in 1917–1921, decreased to the lowest for birth cohorts born in 1942–1946, and increased in birth cohorts born after 1946. The findings indicated the environmental sanitation programs including the decreasing usage of night soil in rural farms (>85% in 1945–1953 to 0% after 1990) and increasing coverage of flush toilet (<5%

in 1945–1950s to >85% after 1990) and tap water supply (15% in 1945 to 90% in 1990) effectively reduced the risk of oral-fecal transmission of HP. There was also a significant opposite period effect on non-cardia and cardia adenocarcinoma of the stomach. The non-cardia adenocarcinoma incidence decreased rapidly after 2003 when the national HP diagnosis and treatment program was launched, but there was an increasing trend of cardia adenocarcinoma incidence from 1984 to 2023. The findings indicated the program reduced the incidence of non-cardia adenocarcinoma effectively, but could not reduce the cardia adenocarcinoma risk. A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of HP for prevention of stomach cancer in Taipei in 2020. The consensus was reached in 26 statements. It is recommended that evidence supports the eradication therapy should be offered to all individuals infected with HP. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of HP should be considered in populations at higher risk of stomach cancer. National two-in-one screening program combining stomach and colorectal cancer tests for adults aged 45 to 74 years old was launched on January 1, 2026. It is expected to further decrease both incidence and mortality rates of stomach cancer in Taiwan.

2026 TDDW

Prof. Juei-Low Sung’s Research Foundation 39th Annual Academic Meeting

Fecal Hemoglobin-Guided Precision Postpolypectomy Surveillance within the Current Framework: A Four-Million-Participant Fecal Immunochemical Test-Based Screening Study Mark Pi-Chun Chuang Division of Gastroenterology, Department of Internal Medicine, Biomedical Park Hospital, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan Background & Aims: Defining precision postpolypectomy surveillance intervals is essential to optimize the balance between colonoscopy resource use and colorectal cancer (CRC) risk reduction within population-based fecal immunochemical test (FIT) screening programs. We sought to develop fecal hemoglobin (f-Hb) concentration–guided surveillance intervals and integrate them into the existing surveillance framework. Methods: Between 2010 and 2015, 3,929,387 individuals participated in FIT screening, of whom 89,771 participants aged 50 to 74 years with f-Hb ≥20 μg Hb/g and complete colonoscopy after polypectomy were enrolled and monitored through 2018 for ascertaining incident CRCs. CRC risks across different f-Hb concentrations were estimated using an accelerated failure time model, and surveillance intervals were proportionally adjusted—shortened at higher f-Hb and extended at lower levels. We compared pragmatic, precision-oriented surveillance intervals with current guidelines to evaluate the extent of colonoscopy reduction

without compromising CRC risk. Results: There were 89,771 postpolypectomy individuals stratified as high-risk (49.5%) and lowrisk (50.5%) groups based on the United States surveillance guideline. During a mean 5.5-year followup, CRC incidence was 2.8/1000 personyears (95% confidence interval, 2.7–3.0), increasing stepwise from 2.2/1000 person-years at 20 to 49 μg/g to 4.0/1000 person-years at ≥450 μg/g. Hypothetical f-Hb–guided surveillance intervals were lengthened for low-risk individuals with low f-Hb and shortened for those with elevated f-Hb within both risk categories. If adopting this precision approach, colonoscopy demand could be reduced by 9.8% vs current United States guidelines, while maintaining comparable CRC risk. Conclusions: Precision surveillance intervals guided by f-Hb can complement current guidelinebased strategies by optimizing colonoscopy resource use while preserving the benefits of FITbased CRC screening programs.

2026 TDDW

Prof. Juei-Low Sung’s Research Foundation 39th Annual Academic Meeting

Distinct Gut Microbiota but Common Metabolomic Signatures between Viral and MASLD HCC Contribute to Outcomes of Combination Immunotherapy Pei-Chang Lee Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Immune checkpoint inhibitor (ICI)-based combination therapies have become the firstline standard of care for advanced hepatocellular carcinoma (HCC). However, favorable clinical responses are observed in only about 30% of patients, underscoring an urgent need for precise predictive biomarkers. Globally, viral HCC (V-HCC) and metabolic dysfunction-associated steatotic liver disease-related HCC (MASLD-HCC) represent the major etiologies. Despite distinct molecular profiles and tumor microenvironments, both etiologies can respond to immunotherapy. Given the critical role of gut microbiota and their metabolites in immune regulation, investigating etiology-specific microbial and metabolic features and their impact on clinical outcomes holds high academic and translational value. This prospective study enrolled 102 patients with advanced HCC receiving first-line combination immunotherapy (77 V-HCC, 25 MASLD-HCC) to evaluate the association of baseline fecal microbiota, stool metabolites, and serum cytokines with long-term efficacy. Results showed that although baseline gut microbial compositions

significantly differed between MASLD-HCC and V-HCC cohorts, responders with long-term efficacy in both groups exhibited significantly higher fecal concentrations of short-chain fatty acids (SCFAs), with dominant bacterial species enriched in SCFAproducing metabolic pathways. Notably, fecal acetate concentration served as a robust, shared predictor of objective response rate, progressionfree survival (PFS), and overall survival (OS) across both etiologies. Patients with high fecal acetate demonstrated significantly prolonged median OS (25.2 vs. 11.3 months, p < 0.001) and median PFS (15.3 vs. 4.2 months, p < 0.001). These findings challenge the traditional strain-centric paradigm. Despite the microbial heterogeneity observed between etiologies, the functional downstream output converged on the immunomodulatory metabolite acetic acid. This key discovery of functional redundancy elucidates a potential mechanism underlying successful combination immunotherapy and marks a significant leap in clinical translation, paving the way for etiology-independent, universal biomarkers across diverse patient populations.

2026 TDDW

Prof. Juei-Low Sung’s Research Foundation 39th Annual Academic Meeting

Current Status of Robotic Liver Surgery Yao-Ming Wu Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan Surgery performed by minimal invasive approach had been shown with the benefits of shorter hospital stay, better postoperative recovery and cosmesis of surgical wound. The percentage of major liver resection via minimal invasive approach increased in the past years contributed by both accumulated surgical experience and availability of instruments. Robotic surgical system has the advantages of 3D surgical vision and flexibility which have the potential to overcome these existed laparoscopic limitations, especially for challenging liver resection. We had set up the laparoscopic liver surgery program in NTUH since 2007, and initiated the program of robotic liver resection since the beginning of 2012. We performed over 700 robotic liver resection in the past years, including

challenging right lobe living donor harvested by robotic approach. We got increased percentage of major liver resection performed by minimal invasive approach from 15% to 45% with the assistance of robotic system. And also we successfully performed over 50 living donor harvest procedures by robotic pure minimal invasive approach. The previous experience of laparoscopic liver resection helps us to get used and handle this high technique robotic system quickly. Stimulator training and animal robotic surgical training are helpful to be familiar to operate the robotic surgical system before clinical practice. Also organization of robotic surgical team is important to run a successful robotic surgical program.

2026 TDDW

Prof. Juei-Low Sung’s Research Foundation 39th Annual Academic Meeting

Purinosome Induction by Genotoxic Agents Promotes Chemoresistance and Tumor Immune Evasion Ruey-Hwa Chen Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan Nucleotide availability is essential for DNA repair and chemoresistance, yet how nucleotide biosynthesis is coordinated with the DNA damage response remains incompletely understood. De novo purine synthesis (DNPS) enzymes assemble into purinosomes for enhancing purine biosynthesis. Here, we show that genotoxic agents induce a TRAF6-mediated polyubiquitination of the DNPS enzyme PAICS, thereby facilitating multivalent bindings to p62 and UBAP2L for driving phase separation and purinosome assembly. Blocking DNA damage-induced purinosome assembly decreases purine nucleotide availability to compromise repair

synthesis, replication fork progression, and SLC7A11 expression, which collectively promote apoptosis and ferroptosis to result in chemosensitization. Purinosome deficiency also enhances micronuclei formation and impairs ESCRT-III-dependent micronuclei envelope repair through ROS production, thereby inducing cGAS/STING activation to reshape an anti-tumor immune microenvironment. Our study identifies a mechanism by which tumor cells exploit purinosome for adaption to genotoxic stresses and highlights purinosome as a potential target for sensitizing tumors to chemotherapy and chemoimmunotherapy.

2026 TDDW

Symposium (1) Global Gastric and Colorectal Cancer Prevention: From Population Screening to Precision Risk Stratification

Gastric Cancer Prevention Worldwide: H. pylori Screening and RiskStratified Endoscopy Yi-Chia Lee Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Gastric cancer remains a major global health burden, with approximately 70% of new cases and deaths occurring in Asia and a case fatality rate of about 65%. While upper endoscopic screening in Japan and South Korea has lowered case fatality to roughly 25%, incidence remains high and this approach is resource-intensive. Helicobacter pylori (HP) screening and eradication offers a primaryprevention strategy with broader coverage at lower cost. Robust evidence now supports its efficacy and effectiveness, including a meta-analysis of explanatory randomized trials demonstrating an approximately 40% reduction in gastric cancer risk, a large community cluster randomized trial in China, a pragmatic randomized trial in Taiwan showing benefit from invitation to screening after adjustment for adherence, and a Korean nationwide cohort confirming a 40% reduction in incidence across age groups. Successful implementation should follow the principles of organized screening, with short-, intermediate-, and long-term outcome indicators

to ensure quality and equity. Bismuth quadruple therapy as preferred first-line treatment; confirmation of eradication; and antibiotic stewardship guided by local antibiograms and resistance monitoring. Because eradication cannot fully eliminate gastric cancer risk, risk-stratified endoscopy, informed by premalignant condition assessment, social habits, family history, and clinical symptoms, is needed to identify individuals who require additional upper endoscopy for detection of asymptomatic earlystage gastric cancer. Taiwan’s experience illustrates this pathway: from proof-of-concept programs in the Matsu Islands (HP prevalence reduced from 64% to 6%) and indigenous communities, to the 2026 launch of nationwide HPSA screening as the sixth national cancer screening program, with an overall HP positivity of about 22.4%. Integrating HP screening with existing preventive health infrastructure, alongside targeted endoscopy, provides a scalable and equitable strategy to reduce gastric cancer incidence and mortality.

2026 TDDW

Symposium (1) Global Gastric and Colorectal Cancer Prevention: From Population Screening to Precision Risk Stratification

Optimizing Helicobacter pylori Eradication for Cancer Prevention: Regimens, Resistance, and Long-Term Safety Jyh-Ming Liou Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Helicobacter pylori infection is the most important modifiable risk factor for gastric cancer. Accumulating evidence from randomized trials and population-based studies has shown that eradication of H. pylori can reduce gastric cancer incidence, supporting screening and eradication as an important strategy for gastric cancer prevention. Recent pragmatic randomized evidence from Taiwan further supports the effectiveness of populationbased screening, particularly among individuals who participate in screening and receive treatment. The major challenge is how to achieve consistently high eradication rates in the era of increasing antimicrobial resistance. In the Asia-Pacific region, resistance to clarithromycin, levofloxacin, and metronidazole has increased substantially. Therefore, treatment should follow the principles of antibiotic stewardship, including accurate diagnosis, appropriate drug selection, dose optimization, and

adequate treatment duration. Bismuth quadruple therapy remains an important first-line option, while vonoprazan-based dual and combination therapies provide promising alternatives, particularly in regions with high antibiotic resistance. Rescue therapy should avoid unnecessary reuse of clarithromycin or levofloxacin and should be guided by previous antibiotic exposure, local resistance patterns, or susceptibility testing whenever appropriate. Long-term safety is also important when eradication is applied at the population level. Antibiotic-containing regimens may cause substantial short-term changes in gut microbiota and antimicrobial resistance, although many alterations gradually recover over time. Overall, successful H. pylori eradication for gastric cancer prevention requires a strategy that achieves high efficacy while minimizing unnecessary antibiotic exposure and long-term ecological consequences.

2026 TDDW

Symposium (1) Global Gastric and Colorectal Cancer Prevention: From Population Screening to Precision Risk Stratification

Colorectal Cancer Screening Across Health Systems: Population Programs and Quality Colonoscopy Han-Mo Chiu Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Colorectal cancer (CRC) screening has moved from proving efficacy to delivering it. Across health systems the same evidence base produces very different outcomes, and the difference lies less in the choice of screening test than in how the program is organized and how well the colonoscopy at the end of it performs. This lecture compares population screening programs along two axes — organized versus opportunistic delivery, and stool-based versus endoscopy-first strategy — and uses Taiwan’s nationwide biennial fecal immunochemical test (FIT) program as a worked example. Among those actually screened, FIT substantially reduces CRC mortality, but the effect realized at the population level is governed by coverage. The determinants of program yield are therefore participation, completion of colonoscopy after a positive FIT, and the quality of that colonoscopy — not the sensitivity of the front-end test. Quality is where the residual burden now sits. In a mature FIT-based program, interval cancer arising after a negative colonoscopy far exceeds that

arising after a negative FIT, and risk falls steeply as institutional adenoma detection rate rises. Because underperformance is concentrated in a minority of settings that nonetheless serve most patients, it is targetable: national quality assurance has raised detection rates and reduced post-colonoscopy cancer accordingly. Yet the cancers that persist in high-detection settings are more often proximal and carry worse prognosis, suggesting a ceiling for current colonoscopic technique. Taiwan’s responses include polyp-number-based polypectomy reimbursement, enhanced payment for colonoscopy after a positive FIT, and endoscopist-level quality dashboards. Beyond that ceiling lies precision. Fecal hemoglobin concentration, already measured in every FIT and currently discarded as a binary result, predicts risk continuously and can guide interscreening intervals, age- and sex-specific positivity thresholds, and post-polypectomy surveillance — delivering risk-adapted screening, with meaningful gains in efficiency, entirely within the existing framework.

2026 TDDW

Symposium (1) Global Gastric and Colorectal Cancer Prevention: From Population Screening to Precision Risk Stratification

Precision Colorectal Cancer Prevention: Integrating Lifestyle, Biomarkers, and Molecular Prevention to Personalize Screening and Prevention Andrew T. Chan Harvard Medical School, Boston, MA, USA Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA Colorectal cancer prevention is undergoing a fundamental shift from population-based recommendations toward precision prevention. Current strategies for screening and molecular prevention with aspirin rely largely on age, family history, and a limited number of clinical risk factors. However, advances in epidemiology, molecular biology, and biomarker discovery now offer the opportunity to develop individualized prevention strategies that more accurately identify those most likely to benefit from specific interventions. This presentation will propose a framework for precision colorectal cancer prevention that integrates lifestyle and environmental risk factors with clinical characteristics to develop individualized risk prediction models capable of informing both screening and molecular prevention. Lifestyle-based risk stratification serves as a practical model for this evolving paradigm because these exposures are among the strongest modifiable determinants of colorectal cancer risk and can already be measured at scale. Importantly, this framework establishes the

foundation for future risk models that incorporate germline genetics and other biomarkers to further refine individualized risk assessment. Such integrated risk models have the potential to personalize multiple components of colorectal cancer prevention. Individuals at greatest risk may benefit from earlier or more intensive screening, whereas those at lower risk may require less intensive surveillance. Similarly, molecular preventive strategies, including aspirin and other emerging preventive agents, can be targeted to individuals in whom the expected reduction in colorectal cancer risk outweighs the potential for treatment-related harms. The integration of lifestyle, genetics, and molecular biomarkers into comprehensive risk prediction models has the potential to transform colorectal cancer prevention from age-based recommendations to truly individualized strategies that optimize screening and guide molecular prevention to reduce colorectal cancer incidence and mortality.

2026 TDDW

Symposium (2) Early Detection and Prevention of Pancreatic Cancer: From High-Risk Surveillance to Emerging Population Strategies

Risk Factor–Based Strategies for the Early Detection of Pancreatic Cancer: Insights from Japanese Studies Atsushi Masamune Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan Pancreatic cancer remains one of the deadliest malignancies because nearly half of patients are diagnosed with unresectable disease. Since population-based screening is impractical owing to the low incidence of PC, surveillance of individuals with established risk factors has emerged as a promising strategy for early diagnosis. This lecture will review current evidence from Japan supporting risk factor–based surveillance, focusing on three high-risk populations: chronic pancreatitis (CP), intraductal papillary mucinous neoplasm (IPMN), and diabetes mellitus (DM). A nationwide multicenter cohort of 1,110 patients with CP demonstrated a markedly increased risk of PC (standardized incidence ratio, 6.44), and pancreatic cancer was the strongest determinant of mortality. Importantly, patients who underwent regular surveillance every three months achieved significantly better survival after PC diagnosis, highlighting the value of structured follow-up. For branch duct IPMN (BD-IPMN), a prospective multicenter surveillance study involving 2,104 patients showed cumulative incidences of 1.90% for high-grade dysplasia/invasive carcinoma and 2.11%

for concomitant pancreatic ductal adenocarcinoma (cPDAC) during a median follow-up of 5 years. The significant predictive characteristics of BD-IPMN for progression to high-grade dysplasia/invasive carcinoma were larger cyst size, larger main pancreatic duct size, and mural nodules. Significant predictive characteristics for the development of cPDAC were male sex and older age. The lecture will also present findings from a nationwide survey of 2,291 patients with PC diagnosed among DM patients. Detection triggered by new-onset DM or worsening glycemic control identified significantly more Stage I cancers and fewer Stage IV cancers than symptom-based diagnosis. PC was diagnosed within 6 months of worsening glycemic controls, often accompanied by substantial weight loss and rapid HbA1c elevation. Together, these studies demonstrate that systematic surveillance of individuals with these risk factors can facilitate earlier diagnosis of PC. Future efforts should focus on integrating risk stratification with multidisciplinary surveillance programs to improve the detection of resectable disease and ultimately patient survival.

2026 TDDW

Symposium (2) Early Detection and Prevention of Pancreatic Cancer: From High-Risk Surveillance to Emerging Population Strategies

Pancreatic Cyst Surveillance: Balancing Early Detection and Overtreatment Hsing-Chien Wu Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan Pancreatic cysts are associated with increased risks for pancreatic cancer. As the high-quality crosssectional imaging and sophisticated transabdominal ultrasound become commonly accessible in aging societies, incidental findings of pancreatic cysts are increasing. Among the largest cohorts of pancreatic cysts, the risk of developing pancreatic cancer was 1%–5% over 5–7 years. Many individuals with presumed high-risk cysts underwent surgical resection, though majority of the specimens exhibit no malignancy nor high-grade dysplasia. Surgical resection is associated with 30%–35% morbidity and ~2% peri-operative mortality. Balancing early detection of pancreatic cancer and overtreatment has become imperative. Current indications for surgical resection have limited accuracy in predicting the presence of high-grade dysplasia or invasive pancreatic carcinoma. When worrisome features alone are

used to guide surgical decision-making, the positive predictive value (PPV) for advanced neoplasia is only 1.4%–13%. Emerging molecular biomarkers, artificial intelligence-assisted imaging, and integrated prediction models incorporating multimodal clinical, radiological, and biological features have the potential to improve risk stratification, thereby reducing overtreatment while preserving opportunities for curative intervention. Furthermore, patient-specific competing mortality risks—including age, comorbidity, frailty, and life expectancy—should be incorporated into surveillance and treatment decisions to optimize the balance between benefit and harm. A paradigm shift toward precision diagnosis and surveillance in those with pancreatic cyst is needed to identify the right patient, using the right tools, to deliver the right intervention at the right time.

2026 TDDW

Symposium (2) Early Detection and Prevention of Pancreatic Cancer: From High-Risk Surveillance to Emerging Population Strategies

Biomarkers, Imaging, and AI: New Tools for Early Pancreatic Cancer Detection Wei-Chih Liao Department of internal medicine, National Taiwan University Hospital, Taipei, Taiwan Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies, largely because most patients are diagnosed at an advanced stage. Earlier detection is therefore among the most effective strategies for improving survival. However, the relatively low incidence of PDAC and the lack of a sufficiently accurate, inexpensive screening test preclude population-wide screening. A practical strategy requires identification of individuals at increased risk, followed by application of sensitive molecular and imaging tools. Current international guidelines recommend surveillance of individuals with defined hereditary predisposition or strong familial clustering, primarily using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic ultrasound. Prospective surveillance studies have demonstrated substantial stage migration and encouraging survival among screen-detected patients. Beyond hereditary risk, clinical manifestations of occult PDAC may provide additional opportunities for risk enrichment, including new-onset diabetes and unexplained weight loss and cachexia. Rapid advances in circulating biomarkers offer the possibility of further enriching these at-risk populations. Although CA19-9 alone lacks adequate performance for screening,

combinations incorporating CA19-9 with circulating proteins, microRNAs, methylated cell-free DNA, or metabolomic signatures have demonstrated substantially improved discrimination of earlystage PDAC. Nevertheless, most biomarker studies remain retrospective or case-control in design, and prospective validation is essential before routine implementation. Artificial intelligence (AI) is transforming imaging-based detection. Deep-learning and radiomics models applied to contrast-enhanced CT have been shown to robustly identify small or visually occult PDAC in multicenter and nationwide real-world validation. AI has also been shown to enable diagnosis on prediagnostic CT examinations, while deep learning applied to unenhanced CT raises the possibility of opportunistic detection from imaging performed for unrelated indications. AI analysis of longitudinal electronic health records may further identify individuals at increased risk years before diagnosis. Prospective validation, assessment of falsepositive consequences and cost-effectiveness, and demonstration of meaningful stage migration and survival benefit will determine whether these new tools can ultimately shift PDAC diagnosis toward earlier, surgically curable disease.

2026 TDDW

Symposium (2) Early Detection and Prevention of Pancreatic Cancer: From High-Risk Surveillance to Emerging Population Strategies

Causal Inference & Study Design in Pancreatic Cancer Screening Yu-Kang Tu Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan Pancreatic cancer is diagnosed late and carries high mortality, making earlier detection an appealing goal. Yet population screening is not recommended, and evidence supporting surveillance in high-risk groups remains limited. Existing observational studies report stage shift or longer survival after screen detection, but these findings may reflect lead-time, length, overdiagnosis, selective referral, healthy-adherer effects, and immortal-time bias rather than lives saved. This talk proposes target trial emulation as a framework for estimating the benefits and harms of pancreatic cancer surveillance using real-world data. The trial would compare risk-adapted MRI/MRCP with or without endoscopic ultrasound against no structured surveillance among adults aged 50–75 years exceeding a prespecified three-year absoluterisk threshold. Eligibility, strategy assignment, and

follow-up would begin at a common time zero. A grace period and clone–censor–weight approach would accommodate delayed initiation and evolving adherence. The primary estimand would be the tenyear difference in pancreatic-cancer mortality risk, accounting for competing mortality. Secondary outcomes would include late-stage incidence, resectability, procedures, complications, low-yield surgery, psychological burden, inequitable access, and cost. Target trial emulation cannot recreate randomization or eliminate unmeasured confounding. Its value is to replace vague comparisons of “screened” versus “unscreened” patients with explicit, reproducible strategies, assumptions, diagnostic checks, and interpretable absolute effects.

2026 TDDW

Symposium (3) Breakthroughs and Beyond in IBD

Earlier Is Better? From First Symptoms to Timely, Targeted Treatment Meng-Tzu Weng Departments of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan Inflammatory bowel disease (IBD) is increasingly recognized as a progressive disorder in which delayed diagnosis and treatment can lead to irreversible bowel damage and poorer long-term outcomes. The traditional reactive stepup approach is being replaced by strategies that emphasize early intervention, with the goal of preventing disease progression rather than simply controlling symptoms. Growing evidence supports a therapeutic “window of opportunity,” during which early initiation of advanced therapy may maximize long-term benefit before irreversible structural damage occurs. In Crohn’s disease, multiple studies

have demonstrated that early biologic therapy reduces disease progression, hospitalization, and surgery while improving sustained remission. Although evidence remains less robust in ulcerative colitis, selected patients may also benefit from earlier treatment escalation. However, early intervention should not be applied uniformly, as overtreatment remains a concern. Precision medicine—including earlier diagnosis, predictive biomarkers, genetic and molecular profiling, risk stratification, and treat-totarget strategies—offers an opportunity to identify patients most likely to benefit from timely advanced therapy.

2026 TDDW

Symposium (3) Breakthroughs and Beyond in IBD

Redefining Detection Game-Changing Advances in Early IBD Diagnosis Wei-Chen Lin Endoscopy Diagnosis and Treatment Center, Mackay Memorial Hospital, Taipei, Taiwan Early diagnosis of inflammatory bowel disease (IBD) remains a major unmet need, as delayed recognition is associated with prolonged symptom burden, avoidable complications, and suboptimal treatment outcomes. Conventional diagnostic pathways rely on clinical assessment, inflammatory markers, endoscopy, histology, and cross-sectional imaging; however, these approaches often fail to identify disease at a truly early stage, particularly in patients with nonspecific symptoms or limited disease burden. In recent years, substantial progress has been made in the development of noninvasive and precision-based diagnostic strategies for IBD. Fecal calprotectin remains the most established biomarker for intestinal inflammation and is widely used to triage patients with suspected IBD from functional gastrointestinal disorders. In parallel, advances in magnetic resonance enterography, intestinal ultrasound, and capsule endoscopy have improved the detection of small-bowel and transmural disease, especially in Crohn’s disease. Beyond these conventional innovations, emerging

research has focused on multi-omics approaches, including transcriptomic, proteomic, metabolomic, and microbiome-based signatures, which may allow earlier disease recognition and more accurate phenotyping. Machine learning algorithms that integrate these heterogeneous data sources are also showing promise for improving diagnostic discrimination and risk stratification. Although most molecular and microbiomebased tools remain investigational, they represent an important shift toward proactive, individualized detection of IBD before irreversible intestinal injury occurs. Future diagnostic strategies will likely combine accessible biomarkers with advanced imaging and computational analytics to support earlier diagnosis, refine disease classification, and guide timely therapeutic intervention. This lecture will review current standards, summarize recent diagnostic innovations, and discuss the translational potential of emerging technologies in early IBD detection.

2026 TDDW

Symposium (3) Breakthroughs and Beyond in IBD

The Microbiome Revolution: How Microbiome-Based Diagnostics and Therapies Are Shaping the Future of IBD Siew C. Ng Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong The development and progression of Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, have been associated with altered gut microbiota. However, the field is now moving beyond correlation toward functional application—leveraging the microbiome not only to understand disease but to diagnose, monitor, and treat it. Emerging evidence has established the gut microbiome as a dynamic and actionable target in IBD. In this talk, I will shift the

focus from pathogenesis to clinical utility, reviewing how microbial signatures are being developed as non-invasive diagnostic. I will then discuss the novel approaches by which microbiome-based therapies such as diet, next-generation probiotics, rationally designed live biotherapeutic products and fecal microbiota transplantation can be used to prevent, manage, and eventually cure IBD, and how to bridge the gap between the basic sciences and clinical application.

2026 TDDW

Symposium (4) Beyond the Incision: Breakthroughs and Evidence-Based Evolution in Digestive Surgery

Surgical Treatment of Pancreatic Cancer Ting-Kai Liao Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan Surgical resection remains the cornerstone of curative treatment for pancreatic ductal adenocarcinoma, yet the questions of who to operate on, when, and how have been fundamentally reshaped by evolving multimodal therapy. Five challenges in the surgical management of pancreatic cancer are discussed, integrating current evidence with real-world experience at National Cheng Kung University Hospital: 1. Redefining resectability — anatomical and biological — While arterial involvement is largely dichotomous, the distinction between resectable disease with portal vein–superior mesenteric vein contact and borderline resectable (venous) disease remains inconsistent in real-world practice. Beyond anatomy, biological resectability must be incorporated into surgical decision-making. 2. The evolving role of neoadjuvant chemotherapy — Upfront resection requiring venous resection carries a dismal prognosis, and current evidence and guidelines consistently recommend neoadjuvant chemotherapy for borderline resectable disease. The remaining controversy lies in resectable disease, where randomized trials have yielded conflicting results. We also present our real-world data on improved survival with evolving multimodal therapy, along with predictive factors that identify the patients who benefit most. 3. Maximizing the margin — a systematic approach to en bloc resection — The uncinate margin is the most common site of incomplete resection and local recurrence, demanding a systematic strategy for complete resection

of the tumor with adequate lymph nodes. Surgical technique has evolved from the lateral approach, through the uncinate approach, to the mesenteric approach — adopted for its excellent exposure of the entire mesenteric root, enabling maximal uncinate margin clearance with adequate lymph node yield. Conversion chemotherapy and surgery for locally advanced and metastatic disease — Managing these cases remains the hardest fortress in pancreatic cancer. Institutional outcomes and selection criteria for conversion surgery following induction chemotherapy in locally advanced and selected initially metastatic pancreatic cancer are presented. Vascular complications after surgery — Vascular complications remain a major source of morbidity and mortality in pancreatic cancer surgery. Particular caution is warranted after radiation-based therapy, where dense periarterial fibrosis and increased vascular fragility are frequently encountered. Practical strategies for anticipating and managing these challenges are discussed.

Together, these perspectives argue that modern pancreatic cancer surgery extends far beyond the incision — into imaging review, biological selection, technical refinement, and the expanding but carefully guarded boundaries of resection. With more novel agents for pancreatic cancer expected in the near future, we as surgeons should strive to further refine our practice so that more patients may have the opportunity for cure.

2026 TDDW

Symposium (4) Beyond the Incision: Breakthroughs and Evidence-Based Evolution in Digestive Surgery

Surgical Treatment of T1/T2 Gallbladder Cancer Goro Honda Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University Hospital, Tokyo, Japan We have standardized simple cholecystectomy for benign gallbladder disease based on a layeranatomical understanding of the gallbladder wall, in which the subserosal layer is divided into an inner (SS-inner) and outer (SS-outer) layer, with safe dissection performed along the SS-inner layer. Applying this anatomical knowledge to surgery for T1/T2 gallbladder cancer, we have standardized and proposed “whole-layer cholecystectomy,” in which the boundary between the SS-outer layer and the hepatic parenchyma of the gallbladder bed is dissected without disrupting the SSouter layer. Whole-layer cholecystectomy is now distinguished in Japan from ordinary (narrow-sense) cholecystectomy. When properly performed, wholelayer cholecystectomy can theoretically be applied to gallbladder cancer up to T2 without the need for additional hepatectomy. This presentation describes the technique of

whole-layer dissection of the gallbladder, together with the concept of the appropriate dissection layer at Calot’s triangle, where the gallbladder mesentery is separated from the hepatoduodenal mesentery and hilar plate. Limitations are also discussed, including the difficulty of whole-layer dissection in gallbladders with fibrosis secondary to inflammation. Furthermore, the significance of regional lymphadenectomy for gallbladder cancer is reconsidered in light of the possibility that nodepositive disease may reflect systemic rather than locoregional spread, together with recent advances in effective systemic chemotherapy. In conclusion, a histological understanding of the dissection layers of the gallbladder wall clarifies the challenges of oncologic cholecystectomy and may improve the quality of local control while avoiding unnecessary surgical invasiveness.

2026 TDDW

Symposium (4) Beyond the Incision: Breakthroughs and Evidence-Based Evolution in Digestive Surgery

Evolution in Surgery of HCC Treatment Kun-Ming Chan Department of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan Surgical resection remains the preferred treatment for hepatocellular carcinoma (HCC). Although many patients have underlying cirrhosis, it remains the most effective standard treatment for those suitable for surgery. The advancement in anesthetic and surgical techniques, as well as a thorough understanding of the liver anatomy, and better perioperative care, have contributed dramatically to the safety and effectiveness of liver resection for HCC. As a result, the outcomes of HCC have largely improved after surgical resection in recent years. The application of new technologies and methods for modern liver cancer treatment also brings both opportunities and challenges to liver cancer surgery. Since the proposal of the finger fracture technique for hepatic lobectomy by Prof. Lin in 1953, transection of the hepatic parenchyma has evolved during the last couple decades. There is some troublesome bleeding from the resection line which makes the surgeons fear for the safety

of the finger fracture technique. To overcome this short coming of the finger fracture technique, many special instruments were invented to increase the successful rate and safety of liver resection ever since. Kelly clamp crushing technique had been one of the most widely used techniques for liver resection. Subsequently, ultrasonic dissection using the Cavitron Ultrasonic Surgical Aspirator (CUSA) has become a delicate and optimal approach for liver resection. Today, laparoscopic liver resection has become feasible in experienced centers due to improvement in instruments. Additionally, modern concepts including the use of vascular inflow occlusion, anatomic resection, and low central venous pressure anesthesia, and surgical approaches such as the anterior approach and liver hanging maneuver have been developed along with using more effective instruments for transection of hepatic parenchyma. Hence, liver resections are increasingly being performed and accepted as a safety procedure nowadays.

2026 TDDW

Symposium (4) Beyond the Incision: Breakthroughs and Evidence-Based Evolution in Digestive Surgery

Surgical Treatment in Biliary Cancer: Beyond the Incision Kuo-Hsin Chen Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan Surgery remains the cornerstone of potentially curative treatment for biliary tract cancers, yet its role and technical boundaries are rapidly evolving. Minimally invasive surgery (MIS), initially applied to selected early-stage tumors, has progressively expanded toward complex oncologic procedures for intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), and distal cholangiocarcinoma (dCCA). For iCCA, laparoscopic and robotic liver resection can now incorporate the essential principles of oncologic surgery, including systematic regional lymph-node dissection and major anatomical hepatectomy. With increasing expertise, the boundaries of MIS have further extended to locally advanced tumors requiring en-bloc resection of the diaphragm, adjacent organs, or major vascular structures, with selective vascular resection and reconstruction when necessary to achieve oncologic clearance. Perihilar cholangiocarcinoma represents an even greater frontier. Recent advances in

laparoscopic and particularly robotic surgery have enabled major or extended hepatectomy with caudate lobectomy, regional lymphadenectomy, portal vein resection and reconstruction, and precise hilar bile-duct resection followed by complex bilioenteric reconstruction. Similarly, minimally invasive pancreaticoduodenectomy for distal cholangiocarcinoma has demonstrated increasingly comparable perioperative and oncologic outcomes in experienced centers. The evolution of MIS for biliary cancer therefore represents more than simply replacing a large incision with small ports. The contemporary goal is to reproduce—and potentially refine—the full oncologic principles of open surgery through enhanced visualization, precision dissection, vascular control, lymphadenectomy, and sophisticated reconstruction. Current evidence, technical milestones, appropriate patient selection, and the remaining limitations of laparoscopic and robotic approaches will be critically reviewed.

2026 TDDW

Symposium (5) Autoimmune Pancreatitis

Clinical Diagnosis of Autoimmune Pancreatitis Yu-Ting Chang Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan Division of Gastroenterology/Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Autoimmune pancreatitis (AIP) is a rare, corticosteroid-responsive fibro-inflammatory disease of the pancreas whose central diagnostic challenge is its resemblance to pancreatic cancer. An older patient presenting with painless obstructive jaundice, a pancreatic head mass, and an elevated CA 19-9 may harbor either a lethal malignancy or a condition that resolves with prednisolone — and the two are managed in opposite directions. Accurate diagnosis is therefore paramount. AIP comprises at least two distinct entities. Type 1, the pancreatic manifestation of IgG4-related disease, affects older men, elevates serum IgG4, and involves multiple organs. Type 2 (idiopathic duct-centric pancreatitis) occurs in younger patients, shows normal IgG4, and associates with inflammatory bowel disease. A third, checkpointinhibitor–induced form is increasingly recognized. The diagnostic framework of AIP is built on

five domains — histology, imaging, serology, other organ involvement, and response to steroid therapy (HISORt) — as formalized in the 2011 International Consensus Diagnostic Criteria. Key discriminators are examined: the “sausage-shaped” gland and capsule-like rim on imaging, ductal strictures without upstream dilation, and the caveats of serum IgG4, whose sensitivity and specificity are frequently overestimated. The essential principle throughout is that AIP is a diagnosis of pattern recognition across several domains, requiring confident exclusion of malignancy before any therapeutic steroid trial. The goal is to help clinicians spare appropriate patients unnecessary surgery while never withholding timely treatment from those with malignancy. Keywords: autoimmune pancreatitis, diagnosis, IgG4-related disease, International Consensus Diagnostic Criteria, pancreatic cancer

2026 TDDW

Symposium (5) Autoimmune Pancreatitis

Radiology in Autoimmune Pancreatitis Rheun-Chuan Lee Department of Diagnostic Radiology, West Garden Hospital, Taipei, Taiwan Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan Autoimmune pancreatitis (AIP) is a distinctive form of chronic pancreatitis characterized by immune-mediated pancreatic inflammation and a generally favorable response to corticosteroid therapy. It is increasingly recognized as a systemic fibroinflammatory disorder and may occur in association with other IgG4-related diseases. Because its clinical presentation and imaging appearance can overlap substantially with pancreatic ductal adenocarcinoma, radiologists play a critical role in establishing the diagnosis, guiding further evaluation, and monitoring treatment response. Familiarity with the characteristic multimodality imaging features is therefore essential for avoiding unnecessary surgery and ensuring appropriate management. The radiologic diagnosis of autoimmune pancreatitis requires integration of pancreatic

morphology, enhancement pattern, ductal abnormalities, and extrapancreatic manifestations. CT and MRI, particularly MRCP, provide complementary information that can distinguish typical AIP from other forms of pancreatitis and pancreatic malignancy. Recognition of the “sausageshaped” pancreas, capsule-like rim, delayed enhancement, and long-segment ductal narrowing is particularly valuable. However, because focal AIP may closely mimic pancreatic cancer, imaging findings should always be interpreted together with clinical presentation, serum IgG4 levels, other organ involvement, and, when necessary, histopathologic assessment. A comprehensive multimodality imaging approach can substantially improve diagnostic confidence, prevent unnecessary pancreatic surgery, and facilitate assessment of therapeutic response.

2026 TDDW

Symposium (5) Autoimmune Pancreatitis

Management for Autoimmune Pancreatitis Ying-Jui Chao Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Background: Autoimmune pancreatitis (AIP) is a distinct disease entity characterized by a chronic fibro-inflammatory response in immunemediated pancreatitis. Historically, misdiagnosis with typical pancreatic cancer is significant, with up to 60% of Type 1 AIP and 78% of Type 2 AIP cases retrospectively diagnosed on surgical specimens following pancreatectomy for suspected malignancy. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrating obstructive jaundice with a diffusely enlarged pancreas exhibiting a capsule-rim-like appearance—without low-density mass formation or main pancreatic duct dilation— strongly suggests AIP. In contrast, typical pancreatic adenocarcinoma presents with a localized lowdensity mass, pancreatic duct dilation, and distal parenchymal atrophy. Serological marker elevation alone remains insufficient for a definitive diagnosis. The primary goals of medical management are to relieve clinical symptoms, prevent ongoing organ fibrosis, and improve pancreatic exocrine and endocrine dysfunction. Pharmacological treatment is indicated in symptomatic patients presenting with obstructive jaundice, abdominal or back pain, persistent laboratory or radiological abnormalities, or symptomatic extrapancreatic organ involvement associated with IgG4-related disease. Conversely, watchful waiting is recommended for asymptomatic individuals, as 10% to 25% of patients experience spontaneous improvement. Standard first-line induction therapy consists of oral corticosteroids (prednisone 0.6 to 0.8 mg/kg/day or 30 to 40 mg/ day for 4 weeks), achieving initial remission in approximately 90% of cases. Regional variations exist; Asian practice guidelines advocate initiating oral prednisone at 0.6 mg/kg/day for 2 to 4 weeks,

followed by maintenance therapy at 7.5 mg/day for 6 months to 3 years. Response evaluation by biological and imaging parameters within 1 to 2 weeks is essential, as rapid steroid responsiveness serves as a key diagnostic criterion. Relapse Predictors & Refractory Management: Following steroid tapering (typically by 5 mg every 1 to 2 weeks over 2 to 3 months), disease recurrence occurs in 30% to 50% of patients. Relapse rates are significantly higher in AIP-1 (30% to 60%) than in AIP-2 (under 15%). Primary predictors of relapse include younger age, elevated baseline serum IgG4, persistently high post-treatment IgG4 levels, diffuse pancreatic enlargement, proximal duct involvement, and tissue or circulating eosinophilia. Re-induction with high-dose prednisone achieves over 90% remission in recurrent disease. Long-term refractory options include low-dose maintenance prednisone (7.5 mg/day for 1 to 3 years), steroidsparing immunomodulators (Azathioprine 2.0 to 2.5 mg/kg/day, Mycophenolate Mofetil, or Methotrexate requiring a 6 to 8 weeks steroid overlap), or Rituximab. For severe refractory cases, intravenous methylprednisolone mini-pulse therapy (500 mg/ day for 3 days across 2 courses separated by a 4-day interval) represents an effective alternative. In druginduced AIP-3, immediate discontinuation of the offending immune checkpoint inhibitor is required. Conclusion: Complete clinical remission requires full symptom resolution, normalization of serum IgG and IgG4 levels, and radiological regression of parenchymal enlargement and ductal strictures. Systematic risk stratification and individualized maintenance protocols are critical to preventing long-term complications and optimizing patient outcomes.

2026 TDDW

Symposium (6) Neurogastroenterology and Motility Symposium: Updated Consensus Toward Optimizing Management

Managing Chronic Constipation in Asia: Insights from the Bali Roundtable to the Bangkok Consensus Kewin Siah Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore Chronic constipation remains a common yet challenging disorder across Asia. In this lecture, the lead author of both the Bali Roundtable and the ANMA Asian Consensus on Chronic Constipation (Bangkok Consensus) will provide practical insights into the evolution of the recommendations and the evidence underpinning them. Key updates in diagnosis, physiological

testing, pharmacological and non-pharmacological therapies, and the management of refractory constipation will be highlighted, together with practical algorithms for everyday clinical practice. Participants will gain an evidence-based, Asiafocused approach to managing chronic constipation with confidence.

2026 TDDW

Symposium (6) Neurogastroenterology and Motility Symposium: Updated Consensus Toward Optimizing Management

Multidisciplinary Consensus on the Management of Laryngopharyngeal Reflux Disease (LPRD) in Taiwan Ming-Wun Wong Division of Gastroenterology, Department of Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan Laryngopharyngeal symptoms, including chronic cough, throat clearing, hoarseness, globus, and throat discomfort, are common but inherently nonspecific. A central premise of the Taiwan multidisciplinary consensus is that laryngopharyngeal symptoms should not be equated with laryngopharyngeal reflux disease (LPRD). Rather, LPRD represents the coexistence of compatible symptoms and objective evidence implicating gastroesophageal reflux in symptom generation. This consensus was developed through a modified Delphi process incorporating systematic evidence review, iterative expert voting, and multidisciplinary discussion. The proposed diagnostic framework begins with exclusion of competing laryngeal, airway, and esophageal disorders. Laryngoscopy and upper endoscopy are useful for identifying structural abnormalities but cannot independently establish reflux causality. Similarly, symptom questionnaires and laryngoscopic scoring systems quantify symptom burden and mucosal findings but lack sufficient specificity for diagnosing LPRD. Objective reflux monitoring therefore assumes a central role, particularly in patients with isolated laryngopharyngeal symptoms or an uncertain pretest probability of reflux disease. Prolonged wireless pH monitoring and esophageal impedance-pH monitoring provide complementary assessment of distal acid burden, reflux frequency, proximal reflux extent, and symptom association.

Test selection should be guided by the clinical phenotype, prior evidence of GERD, and whether evaluation is performed on or off acid-suppressive therapy. Management should be mechanism-based and phenotype-directed. Lifestyle and dietary measures, weight management, and alginate therapy may be considered across relevant phenotypes. Proton pump inhibitor therapy is most appropriate when typical reflux symptoms, abnormal acid exposure, reflux esophagitis, Barrett’s esophagus, or disruption of the antireflux barrier supports reflux-mediated disease. In contrast, routine empiric acid suppression is unlikely to provide durable benefit in patients with isolated laryngopharyngeal symptoms and no objective reflux evidence. Persistent symptoms despite appropriate reflux-directed therapy should prompt reconsideration of the underlying mechanism rather than escalation of acid suppression alone. Laryngeal hypersensitivity, symptom-specific anxiety, hypervigilance, maladaptive cough or throat-clearing behaviors, and disorders of brain– larynx interaction may substantially contribute to symptom persistence. Speech-language pathology interventions, cough suppression, breathing and voice retraining, cognitive recalibration, and selected neuromodulator therapy are therefore integral components of multidisciplinary care. The COuGH RefluX score may further support clinical risk stratification by estimating the probability of concomitant GERD and identifying

2026 TDDW

patients who may proceed directly to treatment, undergo objective reflux testing, or be evaluated for non-reflux mechanisms. Overall, the consensus advocates a shift from symptom-based labeling

and indiscriminate acid suppression toward objective diagnosis, phenotype recognition, and individualized, mechanism-directed management.

2026 TDDW

Symposium (6) Neurogastroenterology and Motility Symposium: Updated Consensus Toward Optimizing Management

What is New in the APAGE-ANMA GERD Consensus? Ping-Huei Tseng Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan The prevalence of gastroesophageal reflux disease (GERD) has increased substantially in Taiwan and worldwide, largely driven by the growing burden of obesity and metabolic syndrome. GERD imposes a significant burden on health-related quality of life and healthcare costs. However, existing international guidelines do not fully address the unique epidemiology, diagnostic resources, therapeutic availability, dietary and cultural diversity, and patient preferences across Asia. To address these gaps, an updated Asia-focused consensus was jointly developed by the Asian Neurogastroenterology and Motility Association (ANMA) and the Asian Pacific Association of Gastroenterology (APAGE). A multinational, multidisciplinary panel of 27 voting experts from 11 Asian countries and regions developed consensus statements using a modified

two-round Delphi process. Clinical questions were formulated according to the PICO (Population, Intervention, Comparator, Outcome) framework. Supporting evidence was identified through systematic literature review and appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. Statements were rated on a six-point Likert scale, and consensus was predefined as ≥80% of panelists selecting either “agree completely” or “agree with minor reservation.” A total of 32 consensus statements were developed across five key domains. This symposium will highlight the major recommendations, including region-specific diagnostic and therapeutic strategies for GERD, as well as the clinical importance of overlap between GERD and disorders of gut–brain interaction (DGBI).

2026 TDDW

Symposium (6) Neurogastroenterology and Motility Symposium: Updated Consensus Toward Optimizing Management

Updated Recommendations from Second Asian Consensus Report on Functional Dyspepsia Yen-Po Wang Division of Endoscopy Diagnosis and Treatment, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Functional dyspepsia (FD) is a prevalent gastrointestinal disorder, increasingly recognized not merely as “functional,” but as a complex gastroduodenal neuromuscular disorder driven by organic micro-changes. Its clinical presentation and optimal management vary between Asian and Western populations. The 2025 Second Asian Consensus Report provides updated recommendations addressing the unique demographic, environmental, and healthcare realities of the Asia-Pacific region. Diagnostically, Asian guidelines emphasize the role of upper endoscopy due to a high regional prevalence of gastric cancer, contrasting with Western guidelines or the updated Rome V criteria. . Epidemiologically, FD prevalence varies dramatically, ranging from 2.4% in Japan to 33% in Singapore, influenced by abnormal body mass index, specific dietary habits, and post-infectious triggers, including COVID-19. These symptoms are often more severe and complex when they co-occur with overlapping disorders of gut-brain interaction, such as irritable

bowel syndrome and gastroesophageal reflux disease. Pathophysiologically, the disorder is driven by factors such as delayed gastric emptying, visceral hypersensitivity, and localized duodenal microinflammation. In management of FD, the “testand-treat” strategy for H. pylori is prioritized in Asia for both symptom relief and gastric cancer prevention. For acid suppression, H2-receptor antagonists are highlighted as highly effective alternatives with a lower risk of inducing enteral dysbiosis to proton pump inhibitors due to generally lower baseline gastric acid in Asian populations. First-line Asian algorithms also include using fundic relaxants (e.g., acotiamide) and prokinetics, and uniquely integrate evidence-based traditional, complementary, and integrative medicine (TCIM). For refractory cases, central neuromodulators such as low-dose tricyclic antidepressants are universally recommended across global guidelines. Ultimately, integrating these culturally and biologically tailored guidelines is warranted to enhance targeted treatment strategies for functional dyspepsia.

2026 TDDW

Symposium (7) Maximal the Effect of Transarterial Chemoembolization (TACE)

Balloon-TACE from Early to Advanced HCCs Chih-Horng Wu Department of Medical Imaging, Shuang Ho Hospital, New Taipei City, Taiwan Transarterial chemoembolization (TACE) remains an important locoregional treatment for hepatocellular carcinoma (HCC). However, conventional TACE may face technical limitations, particularly in large or complex tumors, where progressive occlusion of tumor-feeding arteries during embolic delivery can restrict further therapeutic uptake, promote reflux, and increase non-target embolization. These limitations may contribute to incomplete tumor response and the need for repeated or combined treatments. Balloon-occluded TACE (B-TACE) provides a unique hemodynamic approach to improve the efficiency and selectivity of intra-arterial therapy. Inflation of a microballoon reduces arterial pressure distal to the balloon and creates a pressure gradient that facilitates redistribution of blood flow. Under these low-pressure conditions, flow and embolic agents can be preferentially redirected toward the tumor. The accompanying reduction in intratumoral pressure may further improve access to the tumor

microcirculation, allowing deeper penetration and greater accumulation of therapeutic agents while delaying premature embolization. These effects may enhance tumor uptake while minimizing reflux and undesired embolic burden to the surrounding liver. In this lecture, the technical principles and clinical application of balloon-occluded TACE will be illustrated through representative HCC cases across different disease stages, from localized Stage A disease to intermediate Stage B and advanced Stage C HCC. Particular attention will be given to patient selection, catheter positioning, flow redistribution, embolic delivery, and integration with other treatment modalities in advanced disease. By modifying local hemodynamics rather than simply delivering additional embolic material, balloon-occluded TACE may provide a more precise and efficient approach to transarterial treatment. Understanding its underlying hemodynamic principles and appropriate clinical application may help optimize TACE across a broad spectrum of HCC.

2026 TDDW

Symposium (7) Maximal the Effect of Transarterial Chemoembolization (TACE)

Balloon-Occluded Transarterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma and Liver Metastasis Sung-Hua Chiu Department of Radiology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan Balloon-occluded transarterial chemoembolization (B-TACE) is an evolving technique that temporarily occludes the tumor-feeding artery with a microballoon catheter during embolization, thereby modifying arterial hemodynamics and enhancing selective delivery of embolic agents. Compared with conventional TACE, B-TACE has the potential to improve intratumoral drug retention, increase embolization efficiency, and reduce nontarget embolization. This lecture will provide a practical overview of B-TACE for the treatment of hepatocellular carcinoma (HCC) and selected liver metastases. The technical portion of the lecture will introduce the fundamental principles of B-TACE, including microballoon catheter

preparation, procedural workflow, and characteristic angiographic findings during balloon occlusion. The current clinical evidence supporting B-TACE will then be reviewed, with recent studies suggesting improved local tumor control and higher objective response rates compared with conventional TACE in appropriately selected patients. Finally, the lecture will discuss the emerging role of TACE in the treatment of liver metastases, highlighting its clinical rationale, current evidence, and potential benefits in selected patients. Representative clinical cases will be presented throughout the lecture to illustrate procedural techniques, imaging findings, treatment strategies, and practical decision-making in real-world practice.

2026 TDDW

Symposium (7) Maximal the Effect of Transarterial Chemoembolization (TACE)

DEB-TACE in Treatment of Hepatocellular Carcinoma Chun-Yen Yu Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Transarterial chemoembolization (TACE) remains a key locoregional therapy for hepatocellular carcinoma (HCC). Drug-eluting bead TACE (DEBTACE) has emerged as an effective and safer alternative to conventional TACE (c-TACE), providing higher intratumoral drug concentration with lower systemic exposure and reduced chemotherapyrelated toxicity. This presentation summarizes clinical experience and evidence supporting DEB-TACE in the management of intermediate-stage HCC, guided by the modified Bolondi’s (Kinki) subclassification. Compared with c-TACE, DEB-TACE allows calibrated and distal embolization, achieving deeper tumor penetration while minimizing non-target ischemic injury. Selection of microsphere size is tailored to

tumor vascularity, balancing efficacy and safety; smaller particles may increase local drug delivery but pose higher risk of biliary injury. Our institutional data on 278 patients demonstrated favorable tumor response and survival outcomes, with significant AFP decline correlating with imaging changes. Representative cases illustrate partial and complete responses, including successful down-staging to liver transplantation in 75.9% of candidates. Take-home messages: DEB-TACE is an effective and safe embolization modality that achieves excellent tumor control, enables down-staging for transplantation, and improves survival in advanced HCC. .

2026 TDDW

Symposium (7) Maximal the Effect of Transarterial Chemoembolization (TACE)

Adverse Events in TACE: Clinical Lessons and Prevention Strategies Nai-Wen Chang Division of Interventional Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan Transarterial chemoembolization (TACE) is a cornerstone treatment for intermediate-stage hepatocellular carcinoma (HCC). Although generally safe, major complications such as liver abscess, ischemic biliopathy, and non-target embolization remain clinically significant and may compromise patient outcomes. This presentation reviews the mechanisms, risk factors, and preventive strategies for these complications based on current evidence and representative institutional cases. The differences between conventional TACE (cTACE) and drug-eluting bead TACE (DEB-TACE) are discussed, with emphasis on embolization characteristics and their potential impact on safety. Practical preventive approaches—including careful

patient selection, pre-procedural imaging, conebeam CT or CT hepatic arteriography, superselective catheterization, and identification of non-target vessels—are highlighted. The complementary use of gelatin embolics for flow control, vascular lake management, arterioportal shunts, and protective embolization is also presented. The key message is that most TACErelated complications are preventable through meticulous procedural planning and individualized embolization strategies. Integrating precision imaging, superselective techniques, and appropriate adjunctive embolization can minimize non-target injury while preserving treatment efficacy and improving procedural safety.

2026 TDDW

Symposium (7) Maximal the Effect of Transarterial Chemoembolization (TACE)

The Clinical Value of Combining TACE with Systemic Therapy Pi-Yi Chang Department of Interventional Radiology, Taichung Veterans General Hospital, Taichung, Taiwan Transarterial chemoembolization (TACE) remains a standard treatment for patients with intermediate-stage hepatocellular carcinoma (HCC). However, repeated TACE may provide limited benefit in patients with high tumor burden, bilobar disease, or early TACE refractoriness, while potentially impairing liver function. Combining TACE with systemic therapy offers a complementary strategy: TACE provides rapid local tumor control, while targeted therapy and immunotherapy may suppress residual viable tumors, micrometastases,

and treatment-induced angiogenesis. Emerging evidence suggests that these combinations can improve tumor response and progression-free survival compared with either treatment alone in selected patients. The clinical benefit depends on careful patient selection, treatment timing, and preservation of hepatic reserve. This presentation reviews the rationale and current evidence for combining TACE with systemic therapy and discusses how to integrate this approach into individualized HCC treatment.

2026 TDDW

Symposium (8) Refresh in Clinical Management of MASLD

Implication of Dietary Guidelines for Americans, 2025–2030, for MASLD Meng-Chuan Huang Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately one-third of adults and is a growing cause of chronic liver disease. Because dietary modification remains fundamental to MASLD prevention and management, the Dietary Guidelines for Americans 2025–2030 (DGA-2025) have important implications for liver health. While several recommendations reinforce established principles of healthy eating, others reflect changes from previous guidance whose implications for MASLD warrant further consideration. The DGA-2025 promotes whole and minimally processed foods, fiber-rich whole grains, and avoidance of sugarsweetened beverages, added sugars, and highly processed refined carbohydrates-recommendations broadly consistent with strategies for metabolic and liver health. However, the guidelines increase recommended protein intake to 1.2–1.6 g/kg/ day, emphasize total protein with less distinction between protein sources, and no longer specifically prioritize seafood and plant proteins. Previous explicit quantitative guidance on alcohol consumption has also been removed. These changes are particularly relevant in light of recent NHANES 2017–2023 data examining diet quality and liver outcomes. Higher consumption of fruits, vegetables, greens and

beans, whole grains, and seafood/plant proteins was associated with lower prevalence of steatotic liver disease and/or fibrosis. Conversely, red and processed meats and added sugars were associated with steatotic liver disease, while higher total protein and sodium intake was associated with advanced fibrosis and higher saturated-fat intake with cirrhosis. Notably, some components receiving greater emphasis in DGA-2025, including total protein, were associated with adverse liver outcomes, whereas potentially protective components such as greens and beans and seafood/plant proteins received less specific emphasis. This seminar will critically examine the 2025–2030 DGA through a MASLD lens, distinguishing beneficial recommendations from areas requiring disease-specific interpretation. For MASLD, protein source and overall dietary pattern may matter more than increasing protein quantity. A Mediterranean-style, plant-forward approach emphasizing weight management, minimally processed foods, whole grains, legumes, vegetables, fruits, fish and unsaturated fats, while limiting red/ processed meat, added sugars and saturated fat, may better support hepatic and cardiometabolic health.

2026 TDDW

Symposium (8) Refresh in Clinical Management of MASLD

Outcome and Management of Lean MASLD Patients Ming-Lun Yeh Health Management Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 38% of the global adult population. Although traditionally viewed as a metabolic disorder driven by overweight and obesity, 7% to 20% of affected individuals present with a normal body mass index, a distinct clinical phenotype recognized as Lean MASLD. Far from being a benign variant, Lean MASLD is driven by visceral adiposity, adipose tissue dysfunction, sarcopenia, high-risk genetic predisposition (including PNPLA3 rs738409 and TM6SF2 variants), and alterations in the gut microbiome. Diagnosis is frequently delayed in clinical practice due to low baseline suspicion, normal serum aminotransferase levels, and the inherent failure of BMI to capture ectopic lipid accumulation and unfavorable body composition. Long-term prospective multicohort data reveal a paradoxically severe prognostic trajectory in Lean MASLD compared to obese MASLD, characterized by significantly higher risks for liver-related events,

liver-related mortality, and all-cause mortality. Furthermore, while incident cardiovascular disease (CVD) risk is slightly lower in pure Lean MASLD, CVD-related mortality remains elevated, particularly among individuals with concomitant moderate alcohol use. Management requires a paradigm shift away from aggressive weight-loss targets toward body composition optimization. Nonpharmacological interventions emphasize a modest weight loss target of 3% to 5%, Mediterranean dietary patterns, and resistance training paired with adequate protein intake to preserve skeletal muscle mass. For noncirrhotic fibrotic MASH (F2– F3), weight-neutral liver-directed therapies like resmetirom offer attractive options, whereas GLP1 receptor agonists require careful monitoring to prevent accelerated sarcopenia and excessive loss of lean mass. Ultimately, heightened clinical awareness, early fibrosis risk assessment, and muscle-preserving management strategies are essential to optimize outcomes in this vulnerable patient population.

2026 TDDW

Symposium (8) Refresh in Clinical Management of MASLD

Update of ADA Guideline for Managing Diabetes and MASLD Patients Chih-Yuan Wang Department of Internal Medicine, National Taiwan University Cancer Center, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Metabolic dysfunction associated steatotic liver disease (MASLD) has emerged as one of the most clinically relevant comorbidities in people with type 2 diabetes (T2D). The 2026 American Diabetes Association (ADA) Standards of Care emphasize that MASLD should no longer be regarded simply as an incidental hepatic manifestation of metabolic dysfunction, but rather as an important component of integrated cardiometabolic risk management. A major priority is the early identification of patients at risk for progressive liver fibrosis. Adults with T2D or prediabetes, particularly those with obesity, additional cardiometabolic risk factors, or established cardiovascular diseases, should undergo fibrosis risk assessment using the fibrosis-4 index (FIB-4), even when aminotransferase levels are normal. A FIB-4 value ≥1.3 warrants further evaluation with liver stiffness measurement by transient elastography or, when unavailable, the enhanced liver fibrosis (ELF) test. Patients with evidence suggesting significant or advanced fibrosis should be referred for specialist hepatology assessment. Management should simultaneously address glycemia, adiposity, cardiovascular risk, and liver disease. Lifestyle intervention remains foundational. Structured nutritional therapy and regular physical activity

should aim for meaningful and sustained weight reduction; a weight loss of at least 5% may improve hepatic steatosis, while greater reductions, ideally approaching or exceeding 10%, are generally associated with more substantial histological benefit. Pharmacological selection should increasingly reflect hepatic as well as glycemic outcomes. In patients with T2D, MASLD, and overweight or obesity, GLP1 receptor agonists with demonstrated benefit in metabolic dysfunction–associated steatohepatitis (MASH) are particularly important, while dual GIP/ GLP-1 receptor agonist therapy may also provide substantial metabolic and potential hepatic benefits. For biopsy-proven MASH or patients at high risk of clinically significant fibrosis, GLP-1 receptor agonist therapy is preferred for glycemic management; pioglitazone and dual GIP/GLP-1 receptor agonists may also be considered in appropriately selected patients. The contemporary ADA approach therefore represents a transition from a glucose-centric strategy toward integrated diabetes, obesity, liver, cardiovascular care. For clinicians, the key principle is clear: identify fibrosis early, treat obesity intensively, select glucose-lowering therapies according to organ level benefit, and integrate hepatometabolic risk into routine diabetes management.

2026 TDDW

Symposium (8) Refresh in Clinical Management of MASLD

Surrogates and Strategy for Identifying At-Risk MASLD Patients Zobair M. Younossi Chairman, Global NASH/MASH Council Center for Outcomes Research in Liver Disease & Policy Research, Georgetown University School of Medicine, Washington, DC, USA Background and Aims: Metabolic dysfunctionassociated steatotic liver disease (MASLD) affects approximately one-third of adults worldwide and 60%–70% of those with obesity or type 2 diabetes (T2D).¹ Because fibrosis stage, not steatohepatitis alone, is the most important predictor of liverrelated and all-cause mortality,² case finding must identify the minority with at-risk disease. The following summarizes surrogate markers for adverse outcomes and the sequential strategy endorsed by international consensus, together with the regional and subgroup limitations that constrain its implementation.³-⁴ Methods: Recommendations derive from literature including the global consensus based on a structured Delphi process with international experts, supplemented by multinational data on noninvasive test (NIT) performance and real-world utilization.³-⁹ Results: Screening targets adults with T2D, medically complicated obesity, or persistently elevated aminotransferases. FIB-4 remains the firstline surrogate: <1.3 (<2.0 if aged ≥65) indicates low risk warranting primary care management and retesting in 1–3 years. Higher or indeterminate values prompt second-line testing by vibrationcontrolled transient elastography (VCTE) or the Enhanced Liver Fibrosis (ELF) score. Liver stiffness <8 kPa or ELF <9.2 is reassuring; 10–20 kPa or ELF 9.2– 11.3 identifies probable F2–F3 disease eligible for resmetirom or semaglutide after cirrhosis exclusion; >20 kPa or ELF >11.3 suggests cirrhosis, precluding these agents. The legacy ELF cutoff of 7.7 is no longer valid. Implementation, however, is constrained by availability of NITs in certain regions of the world

or outside large cities and academic centers.⁵-⁶ ELF requires proprietary biomarkers unavailable or cost-prohibitive in many centers, including much of South Asia, while magnetic resonance elastography remains confined to specialized centers. When VCTE is unavailable, ELF, MRI-based methods, or shearwave elastography are reasonable substitutes.⁷ Performance is likewise uneven. In a biopsy-based cohort, accuracy for advanced fibrosis varied appreciably by region for both FIB-4 and ELF, whereas liver stiffness measurement was more consistent.⁸ FIB-4 accuracy declines after age 65 and in complicated T2D — supporting direct second-line testing in that group — and optimal liver stiffness cut-offs rise progressively with BMI class, from lean to class III obesity.⁹ Conclusions: A pragmatic FIB-4–first, VCTE/ELFsecond pathway remains the most scalable strategy for identifying at-risk MASLD. Its thresholds, however, should be applied with attention to patient age, T2D, obesity class, and locally available testing rather than as universal constants, and expanding NIT access in under-resourced regions is as important as refining the cut-offs themselves.

References: 1. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335– 1347. doi: 10.1097/HEP.0000000000000004. PMID: 36626630. 2. Younossi ZM, de Avila L, Petta S, Hagström

2026 TDDW

H, Kim SU, Nakajima A, et al; Global NASH/ MASH Council (GNC). Predictors of fibrosis, clinical events, and mortality in MASLD: Data from the Global-MASLD study. Hepatology. 2026 Jul 1;84(1):204–215. doi: 10.1097/ HEP.0000000000001617. PMID: 41231627. Younossi ZM, Kalligeros M, Wong VW-S, AlNaamani KM, Tacke F, Tsochatzis E, et al. Updated Global Consensus Recommendations for Risk Stratification, Treatment Initiation, and Response Monitoring in Metabolic Dysfunction-Associated Steatotic Liver Disease. Clin Gastroenterol Hepatol. 2026. doi: 10.1016/j. cgh.2026.03.030. Epub ahead of print. Younossi ZM, Zelber-Sagi S, Lazarus JV, Wong VW, Yilmaz Y, Duseja A, et al. Global Consensus Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis. Gastroenterology. 2025 Apr 11:S0016-5085(25)00632-8. doi: 10.1053/j. gastro.2025.02.044. PMID: 40222485. Allen AM, Lazarus JV, Alkhouri N, Noureddin M, Wong VW, Tsochatzis EA, et al. Global patterns of utilization of noninvasive tests for the clinical management of metabolic dysfunctionassociated steatotic liver disease. Hepatol Commun. 2025;9(5):e0678. doi: 10.1097/ HC9.0000000000000678. El-Kassas M, AlNaamani KM, Khalifa R, Yilmaz Y, Labidi A, Almattooq M, et al. Mapping metabolic

dysfunction-associated steatotic liver disease models of care across 17 Middle East and North Africa countries: insights into guidelines, infrastructure, and referral systems. J Clin Transl Hepatol. 2025;13(10):791–808. doi: 10.14218/ JCTH.2025.00286. Vettor R, Petroni ML, Dotan I, Lalazar G, Haluzík M, Spearman CW, et al. Overcoming the barriers in the screening, diagnosis, and follow-up of patients with metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH). Rev Endocr Metab Disord. 2026;27(2):213–235. doi: 10.1007/s11154-026-10027-8. Younossi ZM, de Avila L, Petta S, Hagström H, Kim SU, Nakajima A, et al; Global NASH/MASH Council (GNC). Global performance of non-invasive tests in MASLD: Insights from the G-MASLD study. Hepatology. 2026 Jul 1;84(1):161–174. doi: 10.1097/HEP.0000000000001564. PMID: 41100867. Younossi ZM, de Avila L, Petta S, Hagström H, Kim SU, Nakajima A, et al; Global NASH/ MASH Council (GNC). Diagnostic Accuracy of Noninvasive Tests for Metabolic Dysfunctionassociated Steatotic Liver Disease Across Age, Type 2 Diabetes, and Obesity Subgroups: A Multinational Study. Clin Gastroenterol Hepatol. 2026 Jan 29:S1542-3565(26)00044-3. doi: 10.1016/j.cgh.2026.01.016. PMID: 41616900.

2026 TDDW

Symposium (9) Prophylactic Clipping After Endoscopic Resection of Colorectal Polyps: Evidence, Sizeand Technique-Based Controversies

Prophylactic Clipping Should Be Considered Even after Cold Snare Polypectomy in Selected High-Risk Situations (Proximal Colon, Antithrombotic Use) Chung-Ying Lee Division of Gastroenterology, Department of Internal Medicine, Shuang-Ho Hospital, New Taipei, Taiwan Cold snare polypectomy (CSP) has become the preferred technique for colorectal polyps <10 mm because it is associated with an extremely low risk of delayed bleeding. Consequently, routine prophylactic clipping after CSP is generally considered unnecessary. However, “low risk” should not be interpreted as “no risk,” and a uniform noclipping strategy may overlook selected patients in whom several bleeding risk factors coexist. Post-polypectomy bleeding is determined not only by resection technique and polyp size but also by lesion location, patient-related factors, and antithrombotic therapy. Proximal colonic lesions have traditionally been associated with a greater bleeding tendency, while increasing numbers of patients undergoing colonoscopy

receive antiplatelet or anticoagulant agents that cannot always be safely interrupted. Although CSP substantially reduces delayed bleeding compared with hot snare techniques in these patients, clinically relevant bleeding may still occur. In addition, persistent intraprocedural bleeding, visible vessels, difficult positioning, or multiple resections may further modify the individual risk. Therefore, the key question should not be whether every CSP defect requires closure, but whether there are circumstances in which the consequences and probability of bleeding justify a simple preventive intervention. Selective clipping remains a reasonable option when bleeding risk factors accumulate.

2026 TDDW

Symposium (9) Prophylactic Clipping After Endoscopic Resection of Colorectal Polyps: Evidence, Sizeand Technique-Based Controversies

Prophylactic Clipping Is Unnecessary for Polyps <10 mm after Cold Resection and Should Not Be Routinely Performed Cheng-Hao Tseng Division of Gastroenterology and Hepatology, E-DA Cancer Hospital, Kaohsiung, Taiwan Cold snare polypectomy (CSP) is the preferred technique for removing colorectal polyps smaller than 10 mm because it avoids electrocautery-related deep tissue and vascular injury. Delayed bleeding after CSP is uncommon, generally occurring in fewer than 1% of patients. In the TACOS randomized trial, delayed bleeding occurred in 0.4% after CSP versus 1.5% after hot snare polypectomy, while severe bleeding was exceptionally rare. Evidence supporting prophylactic clipping mainly involves large proximal-colon lesions removed by hot endoscopic mucosal resection. Randomized trials and meta-analyses have not

demonstrated a meaningful benefit from routinely clipping smaller lesions. Current AGA and ESGE guidance also advises against routine closure of small-polyp resection sites. Because the baseline bleeding risk after cold resection of polyps smaller than 10 mm is already very low, routine clipping provides minimal absolute benefit while increasing procedure time and cost. However, clips remain appropriate for persistent bleeding, deep mural injury, suspected perforation, or exceptional patient-specific risks. Therefore, selective clipping based on endoscopic findings is preferable to routine prophylactic closure.

2026 TDDW

Symposium (9) Prophylactic Clipping After Endoscopic Resection of Colorectal Polyps: Evidence, Sizeand Technique-Based Controversies

Prophylactic Clipping Should Be Routinely Performed after EMR or ESD to Prevent Delayed Bleeding and Perforation, Regardless of Lesion Size Toshio Kuwai Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan Delayed bleeding and delayed perforation are important adverse events after colorectal EMR and ESD. Prophylactic clipping is a simple and widely available strategy that can reduce these risks by mechanically protecting the post-resection defect. Although the magnitude of benefit may differ according to lesion size, location, and resection technique, current evidence supports a meaningful preventive role for clipping, particularly in high-risk settings. After colorectal ESD, prophylactic closure has been associated with a significant reduction in delayed bleeding, and complete closure appears to be an important factor in preventing both bleeding

and delayed perforation. After EMR, the benefit is especially evident in larger lesions and in the proximal colon, but routine clipping may still offer practical safety advantages because procedurerelated risk is not determined by lesion size alone. In daily practice, routine prophylactic clipping provides a standardized and preventive approach that may improve outcomes, especially when complete closure can be achieved. This lecture will review the evidence and argue that routine clipping should be considered an important strategy for safer colorectal endoscopic resection.

2026 TDDW

Symposium (9) Prophylactic Clipping After Endoscopic Resection of Colorectal Polyps: Evidence, Sizeand Technique-Based Controversies

Selective, Risk-Guided Closure after Colorectal EMR and ESD Wei-Yuan Chang Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Prophylactic clip closure of every mucosal defect after colorectal EMR and ESD is increasingly promoted, but the evidence for universal application is weaker than it first appears. Meta-analyses and the EPOC randomised trial (delayed bleeding 6.7% vs 20.1%) make a persuasive average-effect case. Averages, however, conceal a benefit that is highly concentrated. In EMR, pooled randomised data show no overall effect (RR 0.69, 95% CI 0.45–1.08); benefit emerges only for lesions ≥20 mm (RR 0.51) and proximal location (OR 0.37 for large proximal versus 0.88 for small proximal lesions). Stratification by histology narrows it further: closure reduced bleeding after large adenomas (3.9% vs 7.6%; P=.030) but not after large serrated lesions, even

proximally (1.7% vs 4.2%; P=.626). Colorectal ESD carries an opposite risk map — rectal rather than right-sided — and stratified meta-analysis confirms significant benefit only for lesions ≥3 cm and in rectal-predominant cohorts. Validated risk scores separate patients across a greater than 20-fold spread in bleeding risk. Cost-effectiveness favours clipping only above a 3.12% baseline bleeding threshold, an assumption never tested in low-risk subgroups, while closure consumes roughly 15 minutes and 15 clips per case. Risk-guided selective closure, alongside cold resection, prophylactic coagulation and perioperative antithrombotic management, is the more defensible strategy.

2026 TDDW

Symposium (10) Next Generation Probiotics and Live Biotherapeutic Products in Clinical Practice

NGP and LBP in Clinical Practice Siew C. Ng Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong The gut microbiota has been established as an indispensable factor in the pathogenesis of inflammatory bowel disease (IBD), paving the way for a new class of therapeutics: next-generation probiotics (NGPs) and live biotherapeutic products (LBPs). Unlike traditional probiotics—which have long relied on food-derived strains with limited evidence—NGPs represent a paradigm shift toward human-derived, rationally selected bacterial strains

with improved colonisation, clinical efficacy, and safety profiles. I am developing a novel LBP to alleviate symptoms of Crohn’s disease, restore gutimmune homeostasis and enhance patient response to existing therapies. This talk will provide a practical overview of how LBPs and NGPs are being developed and their emerging role in the future of personalised IBD care.

2026 TDDW

Symposium (10) Next Generation Probiotics and Live Biotherapeutic Products in Clinical Practice

NGP and LBP in Pseudomembranous Colitis Cheng-Hsun Chiu Chang Gung Microbiota Therapy Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan The human microbiome plays a critical role in colonization resistance, a defense mechanism severely disrupted by broad-spectrum antibiotics. This presentation will summarize how NextGeneration Probiotics (NGPs) and Live Biotherapeutic Products (LBPs) are revolutionizing the treatment of recurrent Clostridioides difficile infection (rCDI). Traditional probiotics offer limited, unregulated efficacy. In contrast, LBPs utilize strictly defined, clinically validated bacterial strains—such as specific Clostridium clusters, Bacteroides species, and targeted microbial consortia—to restore gut homeostasis. I will present their precise mechanisms of action, including the restoration of bile acid metabolism,

competitive exclusion, and direct inhibition of C. difficile toxins. Furthermore, I will mention recent clinical trials and FDA-approved consortia that have demonstrated superior efficacy over standard antibiotic tapering alone. Finally, I will also address the clinical challenges of integrating LBPs into standard care, including manufacturing standardization, positioning within current treatment guidelines, and safety in immunocompromised patients. Ultimately, NGPs and LBPs represent a paradigm shift in rCDI management, transitioning care from continuous antibiotic suppression to definitive, microbiomemediated cures.

2026 TDDW

Symposium (11) Is It Time to Change Practice? Redefining the Algorithm for Primary Biliary Drainage in Unresectable Malignant Distal Biliary Obstruction

Pro ERCP: Why ERCP Should Remain the First-Line Approach for Primary Biliary Drainage Chiung-Yu Chen Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an effective alternative for malignant biliary obstruction, particularly after failed ERCP. As technical outcomes continue to improve, the question of whether EUS-BD should replace ERCP as the universal first-line drainage strategy has become a major topic of debate. This lecture examines the advantages of ERCP that support it as the first-line drainage modality for patients with distal bile duct obstruction. ERCP remains supported by decades of prospective studies, registries, and real-world evidence demonstrating consistently high technical and clinical success across diverse practice settings. Contemporary evidence indicates that ERCP and EUS-BD yield comparable clinical outcomes in appropriately selected patients, while emphasizing that patient anatomy, disease characteristics, and local expertise should guide the choice of drainage modality. A key concept discussed is the distinction between ERCP failure and ERCP inadequacy. Failure to reach the papilla due to surgically altered anatomy, tumor invasion, or anatomical barriers should be recognized as a disease-related access failure rather

than a limitation of the ERCP technique. Conversely, difficult biliary cannulation can often be overcome with evidence-based salvage techniques, thereby improving procedural success. The lecture also reviews the mature safety framework for ERCP, including evidence-based strategies to prevent post-ERCP pancreatitis, standardized management algorithms for procedure-related adverse events, and established quality assurance systems grounded in credentialing, performance indicators, and structured fellowship training. These elements have enabled ERCP to be performed safely and effectively across different levels of healthcare systems, extending well beyond tertiary referral centers. Finally, ERCP preserves native biliary anatomy through a natural-orifice transpapillary approach without creating a transmural fistula, offering potential advantages in selected high-risk patients. Innovation has expanded our therapeutic options, but it has not yet redefined the principles of firstline care. Whenever transpapillary access is feasible, ERCP remains the most evidence-based, physiologic, scalable, and structurally reliable strategy for primary biliary drainage.

2026 TDDW

Symposium (11) Is It Time to Change Practice? Redefining the Algorithm for Primary Biliary Drainage in Unresectable Malignant Distal Biliary Obstruction

Pro EUS-Guided Drainage: The Case for Changing Practice Chen-Shuan Chung Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting has long been considered the standard approach for biliary drainage in patients with unresectable distal malignant biliary obstruction (DMBO). However, ERCP may fail in patients with difficult biliary cannulation, tumor-infiltrated or inaccessible papillae, duodenal obstruction, or surgically altered anatomy, and it remains associated with procedurerelated pancreatitis and the need for re-intervention. Advances in therapeutic endoscopic ultrasound (EUS), particularly electrocautery-enhanced lumenapposing metal stents, have transformed EUSguided biliary drainage (EUS-BD) from a rescue procedure after failed ERCP into a potential first-line treatment for selected patients with DMBO. Recent randomized controlled trials have demonstrated that EUS-guided choledochoduodenostomy (EUS-CDS) provides technical and clinical success comparable or superior to ERCP, while significantly shortening procedural time. Importantly, EUS-BD avoids manipulation of the papilla and pancreatic duct and is associated with a substantially lower risk of post-procedure pancreatitis. Meta-analyses

further support comparable drainage efficacy, with reduced pancreatitis and re-intervention rates. The role of EUS-BD is expanding further in complex clinical scenarios. In patients with concomitant malignant biliary and gastric outlet obstruction, double EUS bypass combining biliary drainage with EUS-guided gastroenterostomy may provide durable internal drainage while reducing recurrent obstruction and re-intervention. EUSguided approaches may also offer advantages in patients with surgically altered anatomy, where conventional enteroscopy-assisted ERCP can be technically challenging. These emerging data suggest that the traditional ERCP-first paradigm deserves reconsideration. For appropriately selected patients with unresectable DMBO, EUS-BD should no longer be regarded solely as rescue therapy, but as a legitimate first-line option when performed by experienced endoscopists. Nevertheless, broader implementation requires appropriate device availability, standardized training, adequate procedural volume, and multidisciplinary support.

2026 TDDW

Symposium (11) Is It Time to Change Practice? Redefining the Algorithm for Primary Biliary Drainage in Unresectable Malignant Distal Biliary Obstruction

Selecting the Optimal EUS-Guided Approach: Choledochoduodenostomy versus Hepaticogastrostomy Raymond S.Y. Tang Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong EUS guided biliary drainage (EUS-BD) is a valuable option for internal biliary drainage when conventional ERCP guided biliary drainage is not feasible or is anticipated to be difficult. EUS guided choledochoduodenostomy (EUS-CDS) and hepaticogastrostomy (EUS-HGS) are examples of transmural internal biliary drainage techniques. Selecting the optimal EUS-BD approach between CDS and HGS depends on the location of biliary obstruction, gastrointestinal tract anatomy, and the presence of duodenal obstruction. In patients with distal malignant biliary obstruction and native upper GI anatomy without duodenal obstruction, both CDS and HGS can be considered. On the other hand, in patients with hilar biliary obstruction, altered upper GI anatomy or duodenal obstruction, HGS would be the preferred

approach. In a recent meta-analysis, the clinical success rates, overall adverse event rates, and re-intervention rates for CDS and HGS are 97.2% vs 92.3%, 11.9% vs 15.5%, and 15.8% vs 20.9%, respectively. Apart from the above, in patients with distal malignant biliary obstruction who are candidates for both CDS and HGS, other considerations to guide the biliary drainage approach would also include availability of suitable devices (eg, dilators, small caliber cautery enhanced lumen apposing metal stents (LAMS), fully covered / partially covered tubular self-expandable metal stents (SEMS) with or without anti-migration flanges, dedicated SEMS for HGS, dedicated plastic stents, etc), device costs and local expertise.

2026 TDDW

Symposium (11) Is It Time to Change Practice? Redefining the Algorithm for Primary Biliary Drainage in Unresectable Malignant Distal Biliary Obstruction

What Is the Optimal Treatment Strategy for Patients with Concomitant Malignant Biliary and Duodenal Obstruction? Yu-Ting Kuo Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University College of Medicine, Taipei, Taiwan Malignant double obstruction, defined as the coexistence of malignant biliary obstruction (MBO) and malignant gastric outlet obstruction (GOO), represents a complex and advanced stage of pancreatobiliary malignancies, particularly pancreatic cancer. Traditionally, management has relied on a combination of ERCP, enteral stenting, and surgical bypass. However, the presence of duodenal obstruction frequently compromises ERCP access, while enteral stents are associated with limited long-term patency. These challenges have driven the evolution of endoscopic ultrasound (EUS) from a diagnostic modality to a comprehensive therapeutic platform. Recent advances in therapeutic EUS have enabled minimally invasive solutions for both biliary and gastrointestinal obstruction. EUSguided gastroenterostomy (EUS-GE) provides durable luminal bypass with superior longterm patency compared with enteral stenting, while EUS-guided biliary drainage (EUS-BD), including choledochoduodenostomy and hepaticogastrostomy, offers effective biliary decompression when ERCP is difficult or impossible.

The ability to combine these interventions has established EUS as a unique modality capable of addressing both components of malignant double obstruction through an integrated endoscopic approach. This presentation will review the rationale for adopting EUS-guided interventions as a first-line treatment strategy for malignant double obstruction. Procedural sequencing, patient selection, technical considerations, and evidence supporting EUS-GEfirst and EUS-BD-first approaches will be discussed. Particular emphasis will be placed on how EUSguided treatment can facilitate durable symptom relief, reduce reintervention rates, improve nutritional recovery, and maintain eligibility for systemic anticancer therapy. Emerging treatment algorithms and future innovations in therapeutic EUS will also be highlighted. As therapeutic EUS continues to evolve, an EUS-first strategy may redefine the management paradigm for patients with malignant double obstruction, offering a minimally invasive, effective, and durable alternative to conventional endoscopic and surgical approaches.

2026 TDDW

Symposium (12) Revolutionizing Pediatric Gut Health: Breakthrough Therapies & Research Beyond Medication

Bioactive Components and Their Implications for Human Health: Inspiration from Human Milk Oligosaccharides Chun-Yan Yeung Department of Pediatric Hepatology, Gastroenterology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan Bioactive components are increasingly recognized as important contributors to human health beyond their traditional nutritional functions. Among these, human milk oligosaccharides (HMOs) provide a remarkable example of how naturally occurring bioactive molecules can influence host biology and inspire new approaches to nutrition and disease prevention. HMOs are structurally diverse, indigestible carbohydrates that are abundant in human milk and interact with the infant intestinal microbiome, intestinal epithelium, and immune system. This lecture will use HMOs as a model to explore the broader biological and translational implications of bioactive components. Particular attention will be given to the multifaceted functions of HMOs, including their ability to selectively promote beneficial microorganisms, inhibit pathogen adhesion, enhance intestinal

barrier function, modulate immune responses, and generate bioactive microbial metabolites. These activities illustrate the complex interactions among diet, the microbiome, intestinal physiology, and systemic health. Beyond infancy, emerging evidence suggests that the principles learned from HMOs may provide inspiration for developing novel functional ingredients, prebiotics, microbiomedirected interventions, and personalized nutritional strategies. Ultimately, HMOs represent more than unique constituents of human milk; they offer a powerful paradigm for understanding how bioactive components can shape host–microbe interactions and promote health. Insights from HMO research may therefore help translate the biological complexity of human milk into innovative strategies for precision nutrition and lifelong health.

2026 TDDW

Symposium (12) Revolutionizing Pediatric Gut Health: Breakthrough Therapies & Research Beyond Medication

Food Allergies: Beyond Avoidance? An Exploration of Emerging Treatments Ching-Feng Huang Division of Pediatric Gastroenterology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan Food allergy (FA), particularly IgE-mediated food allergy, is an increasingly prevalent and potentially life-threatening condition. Recent advances in immunology have led to the development of new therapeutic strategies beyond allergen avoidance and emergency treatment. Currently, oral immunotherapy (OIT), Palforzia, and omalizumab represent major advances in FA management. OIT gradually increases exposure to the allergen to induce desensitization and raise the threshold for allergic reactions, while omalizumab targets IgE to reduce allergic responses. However, these treatments

do not provide a permanent cure, and OIT remains associated with adverse events, treatment burden, frequent clinical visits, and cost. Emerging therapies, including biologics, vaccines, nanoparticles, and JAK and BTK inhibitors, are being investigated to achieve safer and more durable immune tolerance. Overall, the field of FA treatment is shifting from allergen avoidance and temporary desensitization toward precision medicine and long-term immune tolerance, with the ultimate goal of achieving safe, durable, and potentially curative treatment.

2026 TDDW

Symposium (12) Revolutionizing Pediatric Gut Health: Breakthrough Therapies & Research Beyond Medication

Very Early Onset Inflammatory Bowel Disease from Bench to Bedside Pai-Jui Yeh Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Very early-onset inflammatory bowel disease (VEOIBD) represents a clinically distinct subgroup of inflammatory bowel disease (IBD) in which monogenic disorders (monogenic IBD) are disproportionately enriched. Over the past two decades, the identification of more than 100 causative genes has transformed our understanding of intestinal immune homeostasis and established monogenic IBD as a paradigm for precision medicine. This talk will review the evolution of the field from early clinical observations to gene discovery, mechanistic studies, and clinical translation. Using IL-10 signalling defects as a representative example, we will illustrate how genetic diagnosis, functional validation, and immunological investigation have elucidated disease mechanisms and directly

informed therapeutic strategies, including targeted immunomodulation and haematopoietic stem cell transplantation. We will also share a recent systematic study collecting evidence regarding therapeutic efficacy among more 102 monogenic IBD conditions, and the rationale why a standardized disease reporting is needed in the clinical practice. The insights gained from these rare disorders extend beyond paediatric IBD, providing a framework for molecular disease classification and endotypedriven precision medicine in common IBD. Collectively, monogenic IBD exemplifies how rare genetic disorders can reveal fundamental principles of intestinal biology and accelerate the translation of scientific discoveries into improved patient care.

2026 TDDW

Symposium (13) Breakthroughs and Beyond: A New Era in Intestinal Disorders

Breaking the Paradigm: Early and Proactive Strategies in IBD Diagnosis and Management Chen-Wang Chang Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan For years, the standard approach to managing Inflammatory Bowel Disease (IBD) followed a conservative “step-up” strategy—escalating treatment only after a patient experienced a clinical relapse or structural damage. However, waiting for symptoms to flare often means the underlying inflammatory cascade has already caused irreversible bowel damage, leading to strictures, fistulas, and surgery. This lecture challenges the traditional model, presenting a compelling case for a paradigm shift toward early, proactive, and individualized intervention. The presentation will dissect the critical “window of opportunity” in early Crohn’s disease and Ulcerative Colitis, where prompt, top-down

biologic or small-molecule therapy can alter the natural history of the disease. We will discuss the transition from symptom-driven management to proactive monitoring. This includes the routine implementation of objective “treat-to-target” markers—such as fecal calprotectin, point-of-care intestinal ultrasound (IUS), and therapeutic drug monitoring (TDM)—to optimize dosing before clinical symptoms emerge. Finally, the session will explore how integrating genomic and microbial profiling into early riskstratification can help clinicians identify rapid progressors sooner, ultimately paving the way for true precision medicine in IBD.

2026 TDDW

Symposium (13) Breakthroughs and Beyond: A New Era in Intestinal Disorders

Gut Microbiota as a Driver of Intestinal Disease: From Dysbiosis to Therapy Ming-Jung Meng Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan The gut microbiota represents the largest microbial ecosystem in the human body and plays essential roles in metabolism, intestinal barrier maintenance, immune regulation, and colonization resistance. Disruption of this balanced host–microbe symbiosis, known as gut dysbiosis, has been increasingly linked to a wide range of gastrointestinal and liver diseases. With growing understanding of the gut microbiota–health connection, therapeutic strategies targeting dysbiosis, including diet, probiotics, prebiotics, and fecal microbiota transplantation (FMT), have gained increasing attention. FMT aims to restore a healthy microbial community by transferring fecal microbiota from carefully screened healthy donors to patients. Among all current indications, recurrent or refractory Clostridioides difficile infection (CDI) has the strongest evidence supporting FMT. Randomized trials and real-world studies have demonstrated high cure rates, often approaching 90%, with restoration of gut microbial diversity after treatment. In Taiwan, recurrent or refractory CDI remains the only approved indication for FMT. Beyond CDI, FMT has been explored in inflammatory bowel disease (IBD), particularly

ulcerative colitis. Clinical trials and meta-analyses suggest that FMT may improve clinical and endoscopic remission in mild-to-moderate ulcerative colitis, although treatment protocols remain heterogeneous and long-term efficacy requires further validation. Evidence for Crohn’s disease is less conclusive. In patients with IBD complicated by recurrent CDI, FMT may improve CDI outcomes and potentially reduce hospitalization and IBD-related complications. Emerging studies have also investigated FMT in irritable bowel syndrome and liver diseases, including hepatic encephalopathy and metabolic dysfunction-associated steatotic liver disease. While some trials report improvements in symptoms, microbial diversity, hepatic inflammation, or encephalopathy recurrence, current evidence remains insufficient for routine clinical use in most non-CDI conditions. Overall, the gut microbiota is closely connected to human health, and FMT represents a promising microbiota-based therapy. However, standardized protocols, donor selection, disease-specific mechanisms, long-term efficacy, and safety issues require further investigation before broader clinical application.

2026 TDDW

Symposium (13) Breakthroughs and Beyond: A New Era in Intestinal Disorders

Reaching the Unreachable: Breakthroughs in Small Bowel Endoscopy Jen-Wei Chou Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan The small bowel has long been regarded as one of the most challenging regions of the gastrointestinal tract to evaluate because of its length, tortuous anatomy, and limited accessibility using conventional endoscopy. Over the past two decades, however, major technological advances have revolutionized small bowel investigation, transforming previously inaccessible segments into areas that can now be visualized, sampled, and treated. These developments have significantly improved the diagnosis and management of a broad spectrum of small bowel diseases. Capsule endoscopy (CE) has become the preferred first-line, noninvasive modality for evaluating obscure gastrointestinal bleeding, suspected Crohn’s disease, small bowel tumors, polyposis syndromes, and other mucosal disorders. Its ability to visualize the entire small bowel with excellent patient tolerability has greatly enhanced diagnostic yield while avoiding sedation and radiation exposure. However, CE remains limited by its inability to obtain histological specimens or perform therapeutic interventions, and capsule retention remains a concern in patients with significant small bowel strictures. Deep enteroscopy, including double-balloon enteroscopy (DBE), single-balloon enteroscopy, balloon-guided enteroscopy and motorized spiral enteroscopy, complements CE by enabling direct visualization, tissue acquisition, and therapeutic intervention. These techniques facilitate endoscopic

hemostasis, biopsy, polypectomy, foreign body retrieval, balloon dilation of benign strictures, and management of surgically altered anatomy. Among these modalities, DBE remains the reference standard for deep enteroscopy because of its extensive clinical experience and high diagnostic and therapeutic success. MSE has recently emerged as a promising alternative that may shorten procedure time while maintaining comparable clinical performance. The rapid integration of artificial intelligence (AI) into small bowel endoscopy represents the next major breakthrough. AI-assisted image analysis has demonstrated high accuracy in detecting bleeding, ulcers, polyps, tumors, and inflammatory lesions while substantially reducing capsule reading time and interobserver variability. Additional innovations, including robotic capsule systems, enhanced imaging technologies, and improved localization techniques, are expected to further expand the capabilities of small bowel endoscopy. Despite these advances, challenges remain, including limited availability of specialized expertise, procedural complexity, and the need for standardized quality measures and training. Continued technological innovation, combined with AI-assisted diagnosis and increasingly therapeutic endoscopic platforms, is expected to further improve diagnostic accuracy, procedural efficiency, and personalized management, ultimately redefining the future of small bowel disease care.

2026 TDDW

Symposium (13) Breakthroughs and Beyond: A New Era in Intestinal Disorders

Managing Suspected Small Bowel Bleeding in Taiwan: From Evidence to Practice-Based Guidelines Chia-Jung Kuo Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan The small intestine (SB) is a long and tortuous tube in the digestive tract, approximately 6 meters in length. Due to its complex structure, the diagnosis and treatment of SB bleeding have long been clinical challenge. Over recent years, the management of SB bleeding has significantly evolved, driven by advancements in both diagnostic and therapeutic technologies. This practical consensus from the Taiwan Association for the Study of Intestinal Diseases (TASID) integrates local epidemiological data, recent diagnostic advances—particularly the early use of small-bowel capsule endoscopy—and emerging therapeutic strategies for vascular lesions such as angiodysplasia. The consensus is structured

into four major sections: (I) terminology and differential diagnosis of small-bowel bleeding; (II) evaluation of suspected small-bowel bleeding; (III) endoscopic management of small-bowel bleeding; and (IV) medical treatment. The TASID practical consensus providing practice-oriented diagnostic and therapeutic pathways to assist physicians in clinical decisionmaking and thereby optimize the quality of care for SB bleeding. Clinicians would be equipped to identify common causes of SB bleeding, understand the advantages and limitations of various evaluation methods, and apply a stepwise, evidence-based approach in managing these patients.

2026 TDDW

Symposium (14) Precision Pathways in HCC Treatment

Defining Optimal First-Line Immunotherapy for Unresectable HCC Masatoshi Kudo Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine and University Hospital, Osaka, Japan The therapeutic landscape of unresectable hepatocellular carcinoma (HCC) has been transformed by two major classes of combination immunotherapy: immune checkpoint inhibitor plus anti-vascular endothelial growth factor (IO– anti-VEGF) therapy and dual immune checkpoint blockade (IO–IO). However, these regimens exhibit distinctly different response patterns, and optimal first-line treatment should therefore be individualized according to patient characteristics, tumor burden, treatment goals, and anticipated tolerability. IO–anti-VEGF therapy provides rapid and sustained antitumor activity across a broad patient population, resulting in an early survival benefit. By reversing VEGF-mediated immunosuppression, it promotes dendritic-cell maturation, CD8-positive T-cell infiltration, and suppression of regulatory T cells and myeloid-derived suppressor cells. This approach is particularly suitable for patients with locally advanced disease, limited extrahepatic spread, or potential for curative conversion through substantial tumor shrinkage. It may also be preferable in patients considered unable to tolerate severe immune-related adverse events associated with anti-CTLA-4 therapy.

In contrast, IO–IO regimens demonstrate an “all-or-nothing” response pattern. Responders may achieve rapid, deep, and durable tumor regression, leading to a characteristic long-term survival plateau. These regimens may therefore be favored in fit patients with preserved liver function, limited comorbidities, and a very high tumor burden or extensive multiorgan extrahepatic disease, in whom a profound response is urgently required. Nevertheless, their relatively high primary progression rate may expose nonresponders to early mortality. Optimal first-line therapy should thus be selected by integrating performance status, liver function, comorbidities, anti-VEGF eligibility, capacity to tolerate severe immune-related toxicity, tumor distribution, and the therapeutic objective. For patients receiving IO–IO therapy, early monitoring using AFP, PIVKA-II, and AFP-L3 may identify nonresponders before radiological assessment, enabling prompt transition to an antiVEGF-containing regimen. Understanding these regimen-specific response dynamics is essential to deliver the right treatment to the right patient at the right time and maximize both curative conversion and long-term survival.

2026 TDDW

Symposium (14) Precision Pathways in HCC Treatment

Combination External Radiotherapy and Immunotherapy Hee Chul Park Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea The integration of Immune Checkpoint Inhibitors (ICIs) with Radiotherapy (RT) is emerging as a pivotal strategy in oncology, aiming to transform immune-resistant “cold” tumors into immunoresponsive “hot” tumors. While radiotherapy can induce immuno-suppressive effects (e.g., PD-L1 induction, infiltration of Tregs, MDSCs), its immunostimulatory effects—such as dendritic cell (DC) activation, T cell priming, CD8+ T cell recruitment, and the emission of damage-associated molecular patterns (DAMPs)—provide a strong preclinical rationale for synergistic application. Studies demonstrate that the combination of Anti-PD-1 ICIs and RT significantly increases the infiltration of cytotoxic T cells and induces systemic responses, effectively shrinking non-irradiated tumors (the abscopal effect). A critical clinical challenge in advanced hepatocellular carcinoma (HCC) is determining the optimal patient population for combined ICI and RT. Prognosis within the BCLC C stage is highly heterogeneous. Macrovascular invasion (MVI) is not a binary factor. In landmark trials like IMbrave150 (Atezolizumab + Bevacizumab), efficacy notably decreased in high-risk groups (e.g., Vp4, bile duct invasion, >50% liver infiltration), highlighting the need for intensified local control. The NEXTRAH study (concurrent nivolumab and EBRT) and the PORTAL study (atezolizumab/bevacizumab + proton beam therapy) from Samsung Medical Center showed encouraging outcomes for these high-risk cohorts. The PORTAL study, specifically targeting BCLC C patients (100% MVI, 65% high-risk), reported a median progression-free survival (PFS) of 8.5

months and an overall survival (OS) of 15.2 months, demonstrating that high-risk patients derive substantial benefit from the addition of particle therapy to systemic regimens. Traditional fractionated radiotherapy (daily consecutive treatments) may not allow adequate time for the adaptive immune system to recover and mount a robust response. Personalized ultrahypofractionated stereotactic adaptive radiotherapy (PULSAR) introduces a paradigm shift by utilizing “pulses” of RT separated by extended intervals (e.g., weeks). These long intervals facilitate adaptive immunity, acting similarly to an “in-situ cancer vaccine” or a booster shot. This timing allows for sufficient APC activation, T-cell priming, effector phase expansion, and immune recovery between pulses, ultimately crossing the threshold necessary to trigger a systemic abscopal response and overcome resistance in cold tumors. Alongside biological advances, the physical superiority of particle therapy—specifically proton beam therapy and carbon ion beam therapy—plays a crucial role in modern hyper-precision cancer treatment. Particle therapies deposit maximal energy at the end of their path (the bragg peak), sparing surrounding healthy tissues. Furthermore, carbon ion beam therapy possesses a higher relative biological effectiveness (RBE) and a lower oxygen enhancement ratio (OER), making it exceptionally effective against hypoxic, radio-resistant tumors. As the demographic shifts toward an aging population, the incidence of cancer and the utilization of RT (currently roughly 30% in Korea) are accelerating. Facilities like the Samsung Proton Therapy Center

2026 TDDW

have actively integrated advanced technologies. The future trajectory points toward next-generation, compact superconducting accelerators and multiion beam therapy, utilizing a composite of protons, helium, carbon, and oxygen ions to perfectly tailor linear energy transfer (LET) to the tumor core while protecting organs at risk. Combining immune-based systemic therapies with advanced local modalities like radiotherapy

and particle therapy represents a highly promising frontier for advanced HCC. By meticulously selecting candidate patients, optimizing the timing of radiation through the PULSAR approach, and leveraging the precision of proton and carbon ion beams, clinicians can significantly amplify systemic immune responses and improve survival outcomes in challenging clinical scenarios.

2026 TDDW

Symposium (14) Precision Pathways in HCC Treatment

Transarterial Treatment in the Era of Immunotherapy for HCC Chien-Hung Chen Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Transarterial treatment remains central to the management of hepatocellular carcinoma (HCC), particularly in patients with liver-confined disease who are unsuitable for resection, transplantation, or ablation. However, immune checkpoint inhibitor (ICI) based therapies have challenged the traditional paradigm of repeated transarterial treatment and created new opportunities to integrate locoregional and systemic approaches. Transarterial chemoembolization (TACE) remains the standard treatment for selected patients with intermediate-stage HCC. Its efficacy depends on tumor burden, vascular anatomy, treatment selectivity, and hepatic reserve. Patients with extensive bilobar disease, large or infiltrative tumors, or impaired liver function are less likely to benefit and may instead experience further hepatic deterioration. For these “TACE-unsuitable” patients, upfront systemic therapy may be a more appropriate treatment strategy. Transarterial radioembolization (TARE) with yttrium-90 is another important transarterial treatment for HCC. Compared with TACE, TARE generally causes less post-embolization syndrome and may be used for radiation segmentectomy, radiation lobectomy, large tumors, and selected tumors with portal vein invasion. The combination of TARE and immunotherapy is currently under clinical investigation. Hepatic arterial infusion chemotherapy (HAIC) delivers high concentrations of cytotoxic agents

directly to hepatic tumors while limiting systemic exposure. It is used predominantly in Asian countries, particularly for locally advanced HCC with major portal vein tumor thrombosis, bulky intrahepatic disease, or liver-dominant tumor burden. However, HAIC protocols remain heterogeneous, catheterrelated complications may occur, and its international acceptance is limited by geographic variations in the available evidence and clinical practice. Several phase III trials have demonstrated improved progression-free survival when TACE is combined with ICI-based regimens. However, these strategies have not ultimately demonstrated a significant overall survival advantage. Evidence supporting the combination of ICI with TARE or HAIC is currently derived mainly from early-phase trials, retrospective studies, and ongoing randomized studies. Several questions regarding the integration of transarterial treatment and ICI remain unresolved, including whether these modalities should be administered upfront in combination or sequentially. Multidisciplinary assessment is therefore essential to determine whether an individual patient should receive TACE, TARE, HAIC, systemic therapy, or a rational combination of these approaches. In the immunotherapy era, transarterial treatment is not being replaced but repositioned within an integrated therapeutic strategy aimed at maximizing tumor control, preserving liver function, and facilitating conversion to potentially curative treatment.

2026 TDDW

Symposium (15) Updating Progress of Management for Hepatitis B Virus

Precision Prediction of HCC Risk in Untreated HBV Patients Tai-Chung Tseng Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Nucleos(t)ide analogue (NA) therapy reduces but does not eliminate the risk of hepatocellular carcinoma (HCC). Because functional cure remains uncommon, even with HBsAg-targeting agents, prolonged NA therapy is usually required but may not be acceptable or warranted for every viremic patient. A key unmet need is therefore to identify untreated patients who truly carry an increased HCC risk. Beyond traditional parameters, including HBV DNA, alanine aminotransferase (ALT), and liver fibrosis stage, novel viral biomarkers may refine risk stratification in three populations for whom guideline recommendations remain uncertain. Among HBeAg-positive patients in the immunetolerant phase, HBsAg levels may distinguish genuine immune tolerance from immune-tolerant mimickers. Patients with HBsAg levels <10,000 IU/ mL had a 10-year HCC risk of 13.9%, compared with 1.2% among those with levels ≥10,000 IU/mL. This finding, derived in Taiwan and validated in Japan, may help identify patients who could benefit from early NA therapy. Among HBeAg-negative patients in the grey

zone, for whom HBV DNA and ALT provide limited risk discrimination, hepatitis B core-related antigen (HBcrAg) is a superior predictor, with a cutoff of 10 kU/mL distinguishing patients at high and low risk. The derived GZ-HCC (EXPLORE) score, comprising age, sex, platelet count, ALT, and HBcrAg, further stratifies these patients into two risk groups. Patients with scores ≥8 have an HCC risk approaching that of patients with immune-active chronic hepatitis B, whereas those with scores <8 have a risk comparable to that of inactive carriers and may reasonably be observed. Among inactive carriers in the ERADICATE-B and REVEAL-HBV cohorts, HBsAg levels <100 IU/mL identified patients with an annual HCC risk of 0.08% (95% CI, 0.05%–0.13%), below the 0.2% surveillance threshold and comparable to that of individuals without hepatitis B or C. Together, these biomarkers can support both treatment escalation and de-escalation, shifting chronic hepatitis B management beyond conventional phase labels toward individualized, shared decision-making.

2026 TDDW

Symposium (15) Updating Progress of Management for Hepatitis B Virus

Evolutional Definition and Management of “Gray-Zone” Patients Yao-Chun Hsu Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan The natural history of chronic hepatitis B (CHB) has conventionally been divided into five distinct phases defined by viral activities, immune responses, and histological injuries. In routine practice, characteristic patterns of circulatory biomarkers including HBeAg, HBV DNA, and ALT, are used to determine the CHB phases. However, a large proportion, reportedly 30% to 55% depending on the criteria applied, cannot be assigned to any phase and are labeled as “gray zone” or “indeterminate.” The gray zone is best understood not as a distinct biological state but as a residual category created by dichotomizing continuous variables and by discordant thresholds across AASLD, EASL, APASL, and WHO documents. The same patient may be indeterminate under one guideline and actively inflamed under another. The most common profile is HBeAg-negative with ALT within normal limits and HBV DNA above 2,000 IU/mL; smaller subgroups

are defined by discordant HBeAg status, ALT, and viral load. Taking histology into account further complicates the classification uncertainty as biopsy series have shown significant necroinflammation or fibrosis in a substantial proportion despite normal ALT. The major societies have now responded differently. AASLD/IDSA 2025 retains the category, formally adopting “indeterminate phase” with “grey zone” as an alternative term. EASL 2025 moves to a phase-independent treatment algorithm, retaining the construct only as a research classification. The APASL 2026 update does not operationalize the term at all, endorsing instead a simplified treatall approach explicitly framed as overcoming the limitations of phase-based classification. In this talk, the speaker will explain how the residual group acquires a name, and why the name is now disappearing in clinical care.

2026 TDDW

Symposium (15) Updating Progress of Management for Hepatitis B Virus

Crosstalk between Immune Checkpoint Inhibitors and HBV Reactivation I-Cheng Lee Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Immune checkpoint inhibitors (ICIs) have become an essential component of systemic therapy for hepatocellular carcinoma and other malignancies. In patients with chronic hepatitis B virus (HBV) infection, the interaction between ICIs and HBV is complex and bidirectional. Chronic HBV infection is characterized by functional exhaustion of HBV-specific T cells, partly mediated by the programmed cell death protein 1 (PD-1)/PD-ligand 1 pathway. Therefore, immune checkpoint blockade may restore antiviral immune responses, enhance HBV-specific T-cell activity, and potentially suppress HBV replication. Reductions in HBV DNA or HBsAg levels, and even HBsAg loss, have occasionally been observed during ICI treatment. Nevertheless,

HBV reactivation (HBVr) may still occur in patients receiving ICIs, particularly in those with detectable baseline HBV DNA, inadequate antiviral therapy, or treatment interruption. The use of corticosteroids or other immunosuppressive agents for immunerelated adverse events may further increase this risk. HBVr can lead to hepatitis flares, hepatic decompensation, interruption of anticancer therapy, and, rarely, fatal liver failure. This presentation will review the biological mechanisms linking immune checkpoint blockade, antiviral immunity, and HBVr, summarize available clinical evidence, and discuss practical strategies for HBV screening, antiviral prophylaxis, virological monitoring, and management during ICI therapy.

2026 TDDW

Symposium (15) Updating Progress of Management for Hepatitis B Virus

Biomarkers for Guiding HBV Treatment Initiation and Treatment Discontinuation Wen-Juei Jeng Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan The therapeutic landscape of chronic hepatitis B (CHB) is evolving from lifelong viral suppression toward individualized treatment strategies and the pursuit of functional cure. As antiviral agents effectively inhibit HBV replication but rarely eradicate covalently closed circular DNA (cccDNA), accurate biomarkers have become increasingly important for optimizing both treatment initiation and treatment discontinuation. Traditional treatment decisions rely primarily on serum HBV DNA, alanine aminotransferase (ALT), HBeAg status, and the presence of cirrhosis. However, these conventional parameters incompletely reflect the complex interplay between viral activity, host immune responses, and the dynamic natural history of HBV infection. Emerging viral biomarkers, including quantitative hepatitis B surface antigen (qHBsAg), hepatitis B core-related antigen (HBcrAg), and serum HBV RNA, provide complementary information regarding intrahepatic viral transcriptional activity and cccDNA function. In parallel, advances in host-derived biomarkers, such as immune cell phenotyping, cytokine profiles, transcriptomic

signatures, and genetic risk markers, offer new opportunities to characterize immune control and predict treatment outcomes. Increasing evidence suggests that integrating viral and host biomarkers may improve the identification of patients who are most likely to benefit from early antiviral therapy, achieve sustained virological remission after nucleos(t)ide analogue withdrawal, or ultimately attain HBsAg loss. This lecture will review the biological basis, clinical evidence, strengths, and limitations of established and emerging biomarkers for HBV management. Particular emphasis will be placed on biomarker-guided treatment initiation in the era of expanded treatment indications, prediction of clinical relapse and functional cure following nucleos(t)ide analogue discontinuation, and future directions toward precision medicine. The integration of multimodal biomarkers is expected to transform HBV management from guideline-based algorithms to individualized therapeutic decisionmaking, ultimately maximizing patient benefit while minimizing unnecessary treatment.

2026 TDDW

Symposium (16) Generative AI in Gastroenterology: From Clinical Documentation to Decision Support

Generative AI as a GI Co-Pilot: Documentation, Reporting, and Workflow Che-Lun Hung Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan Driven by rapid technological advancements, healthcare AI is transitioning from task-specific tools to comprehensive clinical partners. This presentation

explores the technological trajectory of AI, its current impact on clinical efficiency, and its future role as an intelligent co-pilot for physicians.

2026 TDDW

Symposium (16) Generative AI in Gastroenterology: From Clinical Documentation to Decision Support

From Images to Insights: Integrating Multi-Agentic AI in Gastrointestinal Bleeding Joseph Sung Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Centre of AI in Medicine, Nanyang Technological University, Singapore The use of AI in Gastroenterology has moved from image interpretation alone to using a multimodal model and multi-agentic AI in the decision making process. This talk will use the recent progress in studies focusing on Gastrointestinal Bleeding as an example. Three important topics in the management of upper GIB will be discussed. 1. In patients with peptic ulcer bleeding, how do we predict which patient will have high risk of recurrent bleeding after initial success in hemostasis and which pre-emptive treatment

should be offered. In patients using anti-platelet and anticoagulants, how do we decide on resumption of these agents to balance the risk of recurrent bleeding with the advantage of protecting the cardio/cerebrovascular system. In patients with chronic liver disease, portal hypertension and oesophageal varices, how to choose which patient might be benefit from long-term beta-blocker or pre-emptive endoscopic therapy to prevent bleeding from varices.

2026 TDDW

Young Investigator Award (YIA) ①

DE-ESCALATION OUTCOMES AND STRATEGIES AFTER ADVANCED COMBINATION THERAPY IN DIFFICULT-TO-TREAT INFLAMMATORY BOWEL DISEASE: A REAL-WORLD COHORT STUDY FROM TAIWAN

Ming-Jung Meng1, Puo-Hsien Le1,2,3,4, Chia-Jung Kuo1,2,3,4, Cheng-Tang Chiu1,2,3,4 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 Taiwan Association for the Study of Intestinal Diseases (TASID), Taoyuan, Taiwan 3 Inflammatory Bowel Disease Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 4 Chang Gung Microbiota Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 1

難治型發炎性腸道疾病接受進階合併治療後之降階治療結果與策略：台灣真實世界世代研究孟明蓉1 李柏賢1,2,3,4 郭家榮1,2,3,4 邱正堂1,2,3,4 1

林口長庚紀念醫院胃腸肝膽科系台灣腸道醫學會 3 林口長庚紀念醫院發炎性腸道疾病中心 4 林口長庚紀念醫院長庚微菌治療中心 2

Background: Advanced combination therapy (ACT) is increasingly used for refractory inflammatory bowel disease (IBD). Although ACT can induce rapid clinical and endoscopic remission, optimal post-remission strategies remain unclear. Data on safety, relapse risk, and predictors of successful deescalation are limited, particularly in Asia. Aims: This study aimed to determine the deescalation and subsequent re-escalation rate after ACT- induced remission, and to explore whether certain de-escalation strategies are more successful. Methods: We conducted a retrospective cohort study of refractory IBD patients receiving ACT at a tertiary IBD center in Taiwan between July 2020 and October 2025. Rates of therapy de-escalation after achieving remission and the subsequent need for reescalation were evaluated. Clinical characteristics, remission duration prior to de-escalation, and laboratory markers were collected at baseline and at

3, 6, and 12 months post-de-escalation. Results: Twenty-one patients (11 with Crohn’s disease and 10 with ulcerative colitis) receiving ACT were included. The median disease duration was 5.0 years [IQR 2.5–10.5], and patients had previously failed a median of four biologics [IQR 2.0–4.5]. The median duration of ACT was 12 months [IQR 6.5–14.0]. Eleven patients (52.4%) underwent therapy de-escalation after achieving remission for a median of 4 months [IQR 2.0–7.0]. Among these, only one patient (9.1%) required re-escalation due to clinical relapse, which occurred 6 months after de-escalation. The most common ACT regimen prior to de-escalation was Ustekinumab combined with Upadacitinib (37%). Following de-escalation, Upadacitinib monotherapy was the most frequently used treatment (46%). Hemoglobin levels and albumin levels showed significant increases at 12 months (p = 0.027) and 6 months (p = 0.028) after de- escalation, respectively, while C-reactive protein levels significantly decreased at 6 months (p = 0.036) after de-escalation. Conclusions: This is the first study in Asia to evaluate de-escalation outcomes following ACT-induced remission in difficult-to-treat IBD. Larger prospective studies are needed to define relapse predictors and optimize post-remission ACT strategies.

2026 TDDW

②

SPATIAL AND SIGNALING DYNAMICS OF CLDN18.2 IN GASTRIC CANCER

Tzu-Chan Hong1,2,3, Szu-Hua Pan4, Min-Shu Hsieh5, Yu-Ju Chen6, Ming-Shiang Wu3 Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Department & Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 4 Graduate Institue of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan 5 Department of Pathology, National Taiwan University Cancer Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 6 Institute of Chemistry, Academia Sinica, Taipei, Taiwan 1

CLDN18.2 在胃癌中之空間分布與訊息傳遞變化

evaluating over 2.38 million single cells for objective, threshold free evaluation. Results: In the 154 patient cohort, 37.9% met standard IHC positivity criteria, yet this classification yielded no overall survival prognostic value (HR 1.00) and correlated poorly with actual protein abundance (Spearman rho 0.120). Phosphoproteomic mapping revealed that rapidly proliferating tumors dismantle their cellular architecture to hide the target (driven by mitotic kinases like Aurora A, correlation -0.466), whereas differentiated tumors maintain stable structures that keep CLDN18.2 exposed (supported by homeostasis kinases like CDK14, correlation 0.443). Spatially, positive tumor cells cluster into 5-7 mm domains comprising 46% of the epithelium. These accessible domains exhibit selective loss of ZO1 tight junctions and active CD8 positive T cell infiltration, whereas negative zones show fibrotic encapsulation that completely excludes immune effectors. Conclusions: CLDN18.2 expression is a spatially and functionally coordinated phenotype. Combining spatial immune proximity with kinase activity profiles offers a robust framework to identify true therapeutic responders and guide precision oncology.

洪子瞻1,2,3 潘思樺4 謝明書5 陳玉如6 吳明賢3 1

台大醫院癌醫分院綜合內科部國立臺灣大學醫學教育暨生醫倫理學科暨研究所 3 國立臺灣大學醫學院及台大醫院內科部 4 國立臺灣大學基因體暨蛋白體醫學研究所 5 國立臺灣大學醫學院、台大醫院及台大醫院癌醫分院病理部 6 中央研究院化學研究所 2

Background: Claudin 18.2 (CLDN18.2) is a highly relevant therapeutic target in advanced gastric cancer. Clinical trials demonstrate unpredictable response rates among immunohistochemistry positive patients, suggesting current bulk testing fails to resolve tumor spatial structure and true therapeutic accessibility. Aims: We aimed to map the spatial and signaling heterogeneity of CLDN18.2 to identify functional tumor states and improve clinical stratification for targeted therapies. Methods: We integrated comprehensive molecular profiling, including quantitative proteomics and phosphoproteomics, from a 154 patient clinical cohort. Subsequently, we applied a 40-marker spatial multiplex immunofluorescence workflow,

2026 TDDW

③

GENOME-WIDE META-ANALYSIS IDENTIFIES NOVEL ASIAN-SPECIFIC VARIANTS AND ENHANCES RISK STRATIFICATION OF GALLSTONE DISEASE

Feng-Pai Tsai1,2,3, Yen-Cheng Anne Feng3,4,5, Yi-Syuan Ke4, Mu-Yi Shih4, Yu-Jen Fang6, Chieh-Chang Chen2, Ming-Shiang Wu2, Jyh-Ming Liou1,2 Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan 4 Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan 5 Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan 1

Background: Gallstones are common and clinically important, yet genetic risk prediction remains insufficient in Asian populations. Aims: To perform an updated gallstone genomewide association study (GWAS), construct polygenic risk score (PRS) models, and integrate genetic and non-genetic factors in a Taiwanese population. Methods: We conducted a large-scale GWAS using data from the Taiwan Precision Medicine Initiative (TPMI) and Taiwan Biobank, including 462,548 Taiwanese participants (35,709 gallstone cases and 426,839 controls). PRS models were developed using Taiwan-only, East Asian, and cross-ancestry approaches, with external validation in 27,352 TPMI participants from National Taiwan University Hospital. Results: GWAS identified 532 genome-wide significant variants, with the strongest signal at chromosome 3:149492656 (P = 4.54 × 10-²¹). Finemapping identified 19 candidate causal variants, of which seven were novel. Among these, an Asianspecific missense variant, rs2296651, in Solute Carrier Family 10 Member 1 (SLC10A1) showed the strongest evidence of being a causal variant. SLC10A1

encodes the sodium taurocholate co-transporting polypeptide (NTCP), an entry receptor for hepatitis B and D viruses (HBV/HDV) that is inhibited by bulevirtide, a recently FDA-approved anti-HDV drug. In external validation, the cross-ancestry PRS performed best. Participants in the highest PRS quintile had a two-fold higher risk of symptomatic gallstones than those in the lowest quintile (OR 2.06, 95% confidence interval, 1.76–2.40). Integration of PRS with modifiable factors, past medical history, and drug history further improved risk stratification. Conclusions: This study identified novel Asian-specific gallstone-susceptibility loci and demonstrated the potential of cross-ancestry PRS for precision prevention of symptomatic gallstone disease.

2026 TDDW

④

EFFECTIVENESS AND COSTEFFECTIVENESS OF INITIATING FECAL IMMUNOCHEMICAL TESTBASED COLORECTAL CANCER SCREENING AT AGE 45 INSTEAD OF 50 IN TAIWAN Hsu-Hua Tseng1, Ajitha Mannalithara2, Wen-Feng Hsu3, Uri Ladabaum2, Han-Mo Chiu3 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

台灣免疫法大腸癌篩檢：45 歲起始相較於 50 歲起始之臨床成效與成本效益評估曾旭華1 Ajitha Mannalithara2 許文峰3 Uri Ladabaum2 邱瀚模3 1

國立臺灣大學醫學院附設醫院癌醫中心分院內科部史丹佛大學醫學系消化內科 3 國立臺灣大學醫學院附設醫院內科部 2

Background: Early-onset colorectal cancer (EOCRC) incidence is rising worldwide. In response, U.S. guidelines recommend initiating average-risk screening at age 45 based on cost-effectiveness analyses. Taiwan has one of the highest CRC incidence rates globally among adults aged 40–49, likely due to the rising prevalence of precancerous lesions. Long-term cohort data further support earlier screening with fecal immunochemical test (FIT), showing lower CRC incidence and mortality. In 2025, Taiwan lowered the starting age for national screening to 45 years with biennial FIT. Given the relatively low cost of colonoscopy in Taiwan, primary colonoscopy also warrants evaluation. We therefore assessed the clinical and economic implications of these approaches using the validated MOSAIC model calibrated to Taiwanese data. Aims: To evaluate the clinical effectiveness and cost-effectiveness of lowering the CRC screening initiation age from 50 to 45 years in Taiwan using a validated decision-analytic model comparing various FIT-based and colonoscopy-based strategies. Methods: MOSAIC was adapted to Taiwan, including age- and sex-specific CRC incidence, stage distribution, adenoma and advanced adenoma

prevalence, CRC-related mortality, life tables, and costs. Screening strategies included: No screening; Annual or Biennial FIT from ages 50–74 or 45–74; and Colonoscopy every 10 years from ages 50–74 or 45–74. Model outcomes included CRC cases (screen vs. symptom-detected), CRC-related deaths, costs, quality-adjusted life years (QALYs), incremental costeffectiveness ratios (ICERs), and numbers of FIT and colonoscopies required. Results: All screening strategies improved health outcomes vs. no screening, and all FIT-based strategies were cost-saving. Screening decreased CRC incidence primarily at ages 60+, with 32%– 34% of cases detected by screening rather than symptoms under biennial FIT. Biennial FIT at ages 50– 74 reduced CRC incidence and mortality by 53% and 63% vs. no screening. Lowering the start age to 45 prevented an additional 464 CRC cases (6%) and 174 deaths (5%) per 100,000, yielding overall reductions of 59% and 68%, respectively, with a minimal incremental cost of USD7.76/person. Programmatic demand rose moderately, with FIT increasing by 27% (11.7 vs. 9.2/person) and colonoscopies by 20% (1.5 vs. 1.2/person). Shortening the screening interval to annual FIT provided greater incremental benefit but required substantially more screening capacity, with 9.3 additional FIT kits (79% increase) and 0.7 additional colonoscopies (47% increase) per person. Colonoscopy every 10 years achieved the lowest CRC burden but at the highest ICER (approximately USD5,600/QALY gained) and would require >175% additional colonoscopy capacity. Conclusions: Initiating FIT screening at age 45 in Taiwan provides meaningful benefit at minimal incremental cost and requires only modest capacity increases. Under current epidemiologic and healthcare economic conditions, biennial FIT from ages 45–74 is highly cost-effective, supporting the 2025 policy change. In contrast, colonoscopy-based screening is limited by higher cost and an over 1.7fold increase in colonoscopy demand as compared with FIT screening.

2026 TDDW

⑤

CIRCULATING CD38+HLA-DR+ CD8+ T CELLS COMBINED WITH FIB4 PREDICT EARLY RECURRENCE AND REFINE RISK STRATIFICATION AFTER CURATIVE THERAPY IN HEPATOCELLULAR CARCINOMA Wei-Ting Ku1, Chien-Hao Huang1,2, Wei Teng1,2, Cheng-Heng Wu1, Jian-He Fang1, Tsung-Han Wu2,3, Po-Ting Lin1,2, Chan-Keng Yang2,4, Yen-Chun Liu1,2, Eric Yi-Liang Shen5, Wen-Juei Jeng1,2, Yung-Chang Lin2,4, Chun-Yen Lin1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 4 Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 5 Radiation Oncology and Proton Therapy Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 1

循環 CD38+HLA-DR+ CD8+ T 細胞聯合 FIB-4 預測肝細胞癌根治性治療後早期復發古唯鼎1 黃建豪1,2 滕威1,2 吳承衡1 方健合1 吳宗翰2,3 林伯庭1,2 楊展庚2,4 劉彥君1,2 沈奕良5 鄭文睿1,2 林永昌2,4 林俊彥1,2 1

林口長庚紀念醫院胃腸肝膽科系長庚大學醫學院 3 林口長庚紀念醫院一般外科 4 林口長庚紀念醫院血液腫瘤科 5 林口長庚紀念醫院放射腫瘤科暨質子中心 2

Background: Early recurrence remains a critical challenge in hepatocellular carcinoma (HCC) after curative resection or ablation, yet reliable bloodbased biomarkers for postoperative risk stratification are lacking. CD8+ T cell infiltration does not reliably predict tumor control, suggesting antigenindependent immune programs confound standard

immune infiltration signals. Aims: To characterize CD38+HLA-DR+ CD8+ T cells as a cytokine-driven immune population in HCC and evaluate their utility as a practical blood-based biomarker for early recurrence after curative therapy. Methods: Mechanistic characterization employed ex vivo interleukin (IL)-12/IL-15/IL-18 perturbation, bulk RNA sequencing, and single-cell cellular indexing of transcriptomes and epitopes by sequencing with paired T cell receptor (TCR) sequencing. Findings were validated in The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) dataset. Clinical validation was performed in a prospective HCC cohort with preoperative flow cytometry measurement of circulating CD38+HLA-DR+ CD8+ T cells. Results: IL-12/IL-15/IL-18 induced a CD38+HLA-DR+ CD8+ T cell phenotype with NK-like cytotoxicity, high proliferative activity, and reduced canonical exhaustion checkpoint expression. TCR profiling confirmed clonal trafficking across the circulationto-tumor axis, establishing the biological rationale for its clinical evaluation. In TCGA-LIHC, the CD38+HLA-DR+ signature co-segregated with immunosuppressive Treg and myeloid-derived suppressor cell programs and was associated with inferior recurrence-free survival, contrasting with a neoantigen-associated CD8+ signature that was linked to a favorable outcome. In the prospective cohort, preoperative circulating CD38+HLADR+ CD8+ T cells independently predicted early recurrence (adjusted HR 2.49, 95% CI 1.14–5.43, p = 0.022); combined with the Fibrosis-4 (FIB-4) index, a routinely available clinical parameter, discriminative performance was substantially enhanced (area under the curve [AUC] 0.81; ΔAUC 0.12, p = 0.004; C-statistic 0.80). Conclusions: Circulating CD38+HLA-DR+ CD8+ T cells mark a maladaptive, cytokine-driven immune program linked to HCC early recurrence. Combined with FIB-4, they constitute a practical blood-based tool for postoperative risk stratification.

2026 TDDW

⑥

IMPACT OF SUBJECTIVE AND OBJECTIVE SLEEP DISTURBANCE ON GASTROINTESTINAL SYMPTOMS RELATED TO DISORDERS OF GUT-BRAIN INTERACTION IN A TAIWANESE GENERAL POPULATION

Kai-Yu Hu1, Wei-Chung Hsu2,3, Chien-Chuan Chen1, Chia-Hung Tu1, Han-Mo Chiu1, Ming-Shiang Wu1, Ping-Huei Tseng1,4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan 3 Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan 4 Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan 1

主觀與客觀睡眠障礙對台灣一般族群腸腦軸失調相關腸胃道症狀之影響胡凱毓1 許巍鐘2,3 陳建全1 凃佳宏1 邱瀚模1 吳明賢1 曾屏輝1,4 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附設醫院耳鼻喉部 3 國立臺灣大學醫學院附設醫院睡眠中心 4 國立臺灣大學醫學院附設醫院綜合診療部內視鏡科 2

Background: Impaired sleep quality is frequently reported in patients with disorders of gut-brain interaction (DGBI) with bi-directional interactions. However, studies examining the complex relationship between sleep disturbance severity and gastrointestinal symptom burden based on the general population remain limited. Aims: This study aimed to investigate the impact of subjective and objective sleep disturbances on various DGBI-associated symptoms in a Taiwanese general population. Methods: We prospectively recruited adults who underwent their periodic health check-ups at National Taiwan University Hospital. Subjective sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI), defined as a score >5. Objective sleep disturbance was evaluated by validated electrocardiogram-based cardiopulmonary coupling (CPC), with a cut-off value of apnea– hypopnea index (AHI) >15. Various upper and lower

gastrointestinal symptoms were assessed based on standardized questionnaires, including Reflux Disease Questionnaire (RDQ) and Rome IV Diagnostic Questionnaires. Individuals with clinically significant endoscopic findings such as reflux esophagitis of Los Angeles grade B or higher, peptic ulcer disease, or inflammatory bowel disease were excluded. Clinical characteristics and gastrointestinal symptom odds were compared between participants with and without subjective and objective sleep disturbance. Results: A total of 391 subjects were analyzed (mean age 49.8 years; 57.0% male). The mean total RDQ score was 4.2 ± 6.8, and the prevalence of gastrointestinal symptoms ranged from 3.1% to 22.0%, with abdominal bloating being the most common. Subjective sleep disturbance was identified in 209 (53.5%) participants. Individuals with subjective sleep disturbance showed a female predominance (51.2% vs. 33.5%, P < 0.001) and a greater burden of upper gastrointestinal symptoms, reflected by higher total RDQ scores (5.6 ± 8.3 vs. 2.6 ± 3.7, P < 0.001). After adjustment for sex, subjective sleep disturbance was independently associated with increased odds of esophageal and gastroduodenal symptoms, including dysphagia, heartburn, epigastric pain and burning, easy satiety. PSQI scores correlated positively with total RDQ scores (ρ = 0.155, P = 0.002). In contrast, no significant differences in DGBI-associated symptoms were observed between participants with CPC-AHI >15 and those without. Conclusions: Subjective sleep disturbance was associated with greater esophageal DGBI symptom burden, whereas objective sleep disturbance showed no such association. These findings highlight a close interaction between subjective sleep quality and DGBI-associated symptoms. Further studies are warranted to elucidate underlying mechanisms and to determine whether gastrointestinal or sleepdirected interventions may modify this relationship.

2026 TDDW

⑦

ENDOSCOPIC PREDICTORS OF CONTRAST EXTRAVASATION ON COMPUTED TOMOGRAPHY IN PATIENTS WITH REFRACTORY OR RECURRENT PEPTIC ULCER BLEEDING

Yang-Ting Huang1, Shih-Chi Hu2, Kao-Lang Liu2, Ping-Hui Tseng1, Li-Chun Chang1 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

難治性或復發性消化性潰瘍出血患者電腦斷層血管攝影顯影劑外滲之內視鏡預測因子分析黃揚庭1 胡士麒2 劉高郎2 曾屏輝1 張立群1 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癌醫中心分院胃腸肝膽科 2

Background: Acute upper gastrointestinal bleeding is one of the most common gastrointestinal emergencies, with peptic ulcer disease accounting for approximately 40%–50% of cases. Although upper gastrointestinal endoscopy is the cornerstone of diagnosis and treatment, recurrent or refractory bleeding still occurs in 10%–15% of patients, leading to increased transfusion requirements, prolonged hospitalization, higher healthcare costs, and greater mortality. Current clinical guidelines primarily recommend CTA after failed endoscopic therapy or when ongoing bleeding is suspected, yet they provide limited guidance regarding which patients are most likely to benefit from CTA. Identifying clinical and endoscopic predictors of CTA positivity could improve patient selection, optimize the timing of imaging, and facilitate earlier radiological intervention. Aims: This study aimed to identify endoscopic factors of CTA positivity in patients with recurrent or refractory upper gastrointestinal bleeding. Methods: This retrospective cohort study included patients with upper gastrointestinal bleeding who underwent upper GI endoscopy at National Taiwan University Hospital between January 2023 and July 2025. Patients were eligible if the bleeding source

was confirmed to be peptic ulcer bleeding by upper GI endoscopy and if they subsequently underwent CTA within seven days because of refractory or recurrent bleeding. We analyzed endoscopic findings, including Forrest classification, ulcer size, and ulcer location to determine their association with contrast extravasation on CTA. Results: Among 1,947 patients who underwent upper GI endoscopy for upper gastrointestinal bleeding, 1,366 were diagnosed with peptic ulcer bleeding. Ultimately, 140 patients (67.9% male; median age, 74 years) underwent CTA because of refractory or recurrent bleeding and were included in the analysis. Contrast extravasation was identified in 33 patients (23.6%). Among those with active contrast extravasation, 27 (81.8%) had duodenal ulcers, whereas 6 (18.2%) had gastric ulcers. Upper GI endoscopy demonstrated that high-risk endoscopic stigmata (Forrest classification Ia, Ib, or IIa) (75.8% vs. 39.3%; P < 0.001), large ulcers (≥2 cm) (63.6% vs. 32.7%; P = 0.0030), and duodenal ulcer location (81.8% vs. 53.3%, P = 0.0065) were each significantly more common in the CTA-positive group than in the CTA-negative group. In multivariable analysis, high-risk endoscopic stigmata (adjusted odds ratio [aOR], 2.931), large ulcer size (aOR, 2.891), and duodenal ulcer location (aOR, 3.359) were identified as independent predictors of contrast extravasation. Conclusions: In patients with refractory or recurrent peptic ulcer bleeding, high-risk endoscopic stigmata (Forrest classification Ia, Ib, or IIa), large ulcer size (≥2 cm), and duodenal ulcer location are strong independent predictors of contrast extravasation on CT angiography (CTA). These findings may help clinicians identify patients who are most likely to benefit from urgent radiologic intervention.

2026 TDDW

⑧

LIGHTWEIGHT HISTOLOGYBASED MICROSATELLITE INSTABILITY PREDICTION IN COLORECTAL CANCER: INTERNAL REPRODUCIBILITY VERSUS EXTERNAL CALIBRATION SHIFT ON CPTAC-COAD

Conclusions: The lightweight model was computationally feasible and internally discriminative, but sealed CPTAC validation demonstrated marked calibration and generalization shift. Internal benchmark performance alone is insufficient to support fixed-threshold MSI-H screening; independent external validation and domain adaptation are required.

Minh Thu Phung1,2,4, Nguyen Quoc Khanh Le3,4 International Master Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 2 Department of Embryology – Pathology – Forensic Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam 3 In-Service Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 4 AIBioMed Research Group, Taipei Medical University, Taipei, Taiwan 1

Background: Deep learning may support low-cost MSI-H prescreening from routine H&E slides, but models are often validated only on internal data. External reliability and probability calibration are essential before clinical screening claims. Aims: To evaluate whether a lightweight MSI/MSS classifier reproducible on consumer hardware retains performance under sealed external validation. Methods: A three-seed EfficientNet-B0 ensemble was trained on 80,979 TCGA-derived patches, with patient-level validation and test splits from a 192,312-patch dataset. External validation used 221 CPTAC-COAD whole-slide images from 105 patients (81 MSS, 24 MSI-H), with labels from cBioPortal. CPTAC was not used for training, tuning, threshold selection, or calibration. Whole-slide inference used a fixed tumor gate (MobileNetV3-Small, Kather100K) without saving patch datasets. Patient probability was the unweighted mean of slide probabilities. Threshold was fixed at 0.5. Results: Internal test (n = 100): ensemble AUC 0.850 (95% CI 0.744–0.936); sensitivity 0.346, specificity 0.986 at threshold 0.5. Three-seed AUC SD was 0.015, supporting reproducibility. CPTAC external (n = 105): AUC 0.601 (95% CI 0.467–0.730); sensitivity 0.000, specificity 0.988 at threshold 0.5. All 24 MSI-H patients were classified below threshold despite weak residual ranking signal (MSI-H mean probability 0.28 vs MSS 0.23).

2026 TDDW

Free Paper Section：HBV ①

CLINICAL OUTCOMES FOLLOWING SECOND FINITE NUCLEOS(T)IDE ANALOGUE THERAPY: COMPARISON WITH FIRST TREATMENT CESSATION

Chien-Hung Chen1, Yuan-Hung Kuo1, Yi-Hao Yen1, Jing-Houng Wang1, Tsung-Hui Hu1, Chao-Hung Hung1, Sheng-Nan Lu2 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jen-Ai Hospital, Taichung, Taiwan 1

HBeAg 陰性慢性 B 型肝炎患者第二次有限核苷（酸）類似物治療停藥後的臨床結果：與第一次停藥的比較陳建宏1 郭垣宏1 顏毅豪1 王景弘1 胡琮輝1 洪肇宏1 盧勝男2 1

長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨長庚大學醫學系 2 仁愛醫療財團法人大里仁愛醫院胃腸肝膽科

Background: The rates of HBV relapse and HBsAg seroclearance after cessation of a second finite nucleos(t)ide analogue (NA) therapy remain unclear in HBeAg-negative patients. Aims: To compare the rates of HBV relapse and HBsAg seroclearance following cessation of first and second finite NA therapies. Methods: A total of 759 and 175 non-cirrhotic HBeAg-negative patients who discontinued entecavir, tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF) after first and second finite therapy, respectively, were retrospectively analyzed. Results: Patients who underwent second finite therapy had significantly higher cumulative incidences of virological and clinical relapse than those who underwent first finite therapy in both the overall cohort (both p < 0.001) and the propensity score-matched (PSM) cohort (p = 0.002 and p = 0.006, respectively). However, HBsAg seroclearance rates did not differ significantly between the first and second finite therapy groups in either the overall cohort (p = 0.315) or the PSM cohort (p = 0.180).

Nevertheless, multivariable analysis identified second finite therapy as an independent predictor of HBsAg seroclearance after adjusting other factors. Among patients receiving first finite therapy, the TAF group had higher virological and clinical relapse rates than the TDF and entecavir groups. In contrast, among patients receiving second finite therapy, virological and clinical relapse rates were comparable among the entecavir, TDF, and TAF groups. After PSM, patients who received entecavir during second finite therapy had significantly higher virological relapse (p = 0.006), clinical relapse (p = 0.002), and HBsAg seroclearance (p = 0.004) rates than those who received entecavir during first finite therapy. This finding was not observed in the TDF or TAF groups. Conclusions: Although overall HBsAg seroclearance rates were comparable between first and second finite therapy, second finite therapy was independently associated with HBsAg seroclearance. Moreover, HBsAg seroclearance appeared to be more frequent after second finite therapy among patients treated with entecavir during both treatment courses.

2026 TDDW

②

COMPARATIVE PERFORMANCE OF HCC PREDICTION MODELS IN NUCTREATED CHRONIC HEPATITIS B STRATIFIED BY MASLD STATUS

Hung-Wei Wang1,2, Wei-Fan Hsu1,3, Sheng-Hung Chen1,2, Tzu-Hao Yen1, Hsueh-Chou Lai1,3, 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

依代謝功能障礙相關脂肪性肝病狀態分層之核苷（酸）類似物治療慢性 B 型肝炎患者肝癌預測模型比較表現王鴻偉1,2 許偉帆1,3 陳昇弘1,2 顏子皓1 賴學洲1,3 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: Chronic hepatitis B (CHB) remains a major cause of hepatocellular carcinoma (HCC), cirrhosis-related complications, and liver-related mortality. In nucleos(t)ide analogue (NUC)-treated HBV patients, viral suppression reduces but does not eliminate residual HCC risk. Metabolic comorbidities, including obesity, diabetes, hypertension, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease (MASLD), may further modify this risk. Therefore, validation of existing HCC risk scores in NUC-treated HBV patients with metabolic dysfunction is important for risk stratification and individualized HCC surveillance. Aims: This study aimed to evaluate the performance of HCC risk scores for predicting incident HCC in patients with NUC-treated CHB and MASLD. Methods: Adult patients with CHB receiving NUC therapy were retrospectively enrolled if complete clinical and laboratory data were available for HCC risk-score calculation. Patients were stratified according to MASLD status. Baseline demographics, metabolic comorbidities, cirrhosis status, liver biochemistry, platelet count, AFP, FIB-4, and ALBI score were collected. PAGE-B, mPAGE-B, APA-B, HCC-

RESCUE, CAMD, AASL-HCC, REAL-B, and aMAP scores were calculated. The primary outcome was incident HCC. Discriminatory performance was assessed using Harrell’s C-index and 3-, 5-, and 10-year timedependent AUCs, with 95% confidence intervals estimated using 1,000 bootstrap replications. Results: Among the 626 NUC-treated HBV patients, the median follow-up duration was 4.89 years (IQR, 2.95–7.78 years); 338 patients had MASLD, whereas 288 did not. Compared with non-MASLD patients, those with MASLD were more frequently male and had higher proportions of diabetes or prediabetes and hypertension, while showing relatively preserved liver function and lower fibrosis-related indices, including higher platelet counts and lower FIB-4 and ALBI scores. The MASLD group had a significantly lower incidence of HCC than the nonMASLD group (5.3% vs. 12.2%, p = 0.002), whereas time to HCC among patients who developed HCC did not differ significantly between groups. Baseline HCC risk scores were generally comparable between groups, except that APA-B and aMAP scores were significantly lower in MASLD patients. In the overall cohort, Harrell’s C-index was highest for APA-B (0.834), followed by CAMD (0.829), AASLHCC (0.827), HCC-RESCUE (0.813), REAL-B (0.808), mPAGE-B (0.795), aMAP (0.778), and PAGE-B (0.702). Time-dependent AUC analyses at 3, 5, and 10 years confirmed the consistently strong performance of APA-B across all time points. In subgroup analyses, model performance varied by MASLD status. Among MASLD patients, Harrell’s C-index was highest for CAMD (0.833), followed by AASL-HCC (0.831), HCC-RESCUE (0.807), APA-B (0.798), REAL-B (0.790), mPAGE-B (0.699), aMAP (0.694), and PAGE-B (0.625). Among non-MASLD patients, APA-B had the highest C-index (0.834), followed by CAMD (0.827), mPAGE-B (0.827), REAL-B (0.817), AASL-HCC (0.815), HCCRESCUE (0.811), aMAP (0.791), and PAGE-B (0.742). For time-dependent AUCs, CAMD performed best among MASLD patients, whereas mPAGE-B performed best at 3 and 5 years and CAMD at 10 years among non-MASLD patients. Conclusions: In NUC-treated HBV patients, HCC riskscore performance varied according to MASLD status. APA-B provided the strongest overall discrimination, whereas CAMD and AASL-HCC showed robust performance among MASLD patients, supporting tailored HCC surveillance strategies. Further validation in larger external cohorts is warranted.

2026 TDDW

③

END-OF-TREATMENT HBCRAG OUTPERFORMS QHBSAG IN PREDICTING CLINICAL RELAPSE AFTER NUCLEOS(T)IDE ANALOGUE CESSATION IN HBEAG-POSITIVE CHRONIC HEPATITIS B

Yen-Chun Liu1,2, Chien-Wei Peng1,2, Wen-Juei Jeng1,2, Rong-Nan Chien1,2, Yun-Fan Liaw1,3 College of Medicine, Chang Gung University, Taoyuan, Taiwan 2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 3 Liver Research Unit, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 1

治療結束時 HBcrAg 對 HBeAg 陽性慢性 B 型肝炎患者停用核苷（酸）類似物後臨床復發之預測價值優於 qHBsAg 劉彥君1,2 彭建維1,2 鄭文睿1,2 簡榮南1,2 廖運範1,3 1

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

Background: Most studies of HBV viral biomarkers for predicting outcomes after nucleos(t)ide analogue cessation have included mixed pretreatment HBeAg-positive and HBeAg-negative populations. Data remain limited for patients with pretreatment HBeAg-positive chronic hepatitis B. Aims: We therefore evaluated the relative predictive value of end-of-treatment quantitative HBsAg and hepatitis B core-related antigen for off-therapy clinical relapse after Nuc cessation in this population. Methods: HBeAg-positive patients who stopped Nuc therapy per APASL criteria (HBV DNA undetectable ≥1 year; HBeAg loss for ≥1 year) with available EOT qHBsAg and HBcrAg data were analyzed. were analyzed. Clinical relapse (CR) was defined as ALT ≥2 times upper limit of normal and HBV DNA ≥2000 IU/ mL. Time-dependent AUCs, cumulative incidence functions, Fine-Gray regression, and smoothed hazard functions evaluated predictive performance and biomarker-outcome associations; retreatment was treated as a competing risk. Results: Among 159 HBeAg-positive CHB patients who discontinued Nuc therapy, the mean age

was 45 years, 74% were male, 22%had cirrhosis, and the median follow-up was 5.4 years. Median EOT qHBsAg and HBcrAg levels were 2.9 log10 IU/ mL and 4.6 log10 U/mL, respectively. EOT HBcrAg outperformed qHBsAg for 2-year CR prediction, with AUCs of 0.63 versus 0.37, respectively; p < 0.001. Adding qHBsAg to HBcrAg did not significantly improve discrimination beyond HBcrAg alone. In multivariable Fine-Gray analysis, EOT HBcrAg ≥4.5 log10 U/mL independently predicted CR, with an adjusted SHR of2.71; 95% CI, 1.59–4.63; p < 0.001, whereas EOT qHBsAg ≥3log 10 IU/mL did not. Patients with EOT HBcrAg ≥4.5 log10 U/mL had higher 2-year cumulative CR incidence than those with HBcrAg <4.5 log10 U/mL: 73% versus 48%; Gray’s p = 0.004. Smoothed hazard curves showed sustained late CR hazard beyond 6 months in patients with HBcrAg ≥4.5 log10 U/mL, and HBeAg seroreversion further identified the highest-risk subgroup. Conclusions: In HBeAg-positive CHB patients stopping Nuc therapy, EOT HBcrAg outperformed qHBsAg in predicting off-therapy clinical relapse and identified sustained late relapse risk beyond6 months. Patients with EOT HBcrAg ≥4.5 log10 U/ mL may warrant intensified off-therapy surveillance, particularly if HBeAg seroreversion occurs during follow-up.

2026 TDDW

④

RISK OF HEPATOCELLULAR CARCINOMA STRATIFIED BY THE COMBINATION OF ON-TREATMENT CHANGES IN APRI AND FIB-4 VALUES IN PATIENTS WITH CHRONIC HEPATITIS B RECEIVING ENTECAVIR OR TENOFOVIR THERAPY – PINGTUNG COUNTY EXPERIENCE

Shi-Chi Wen1, Wu-Hsien Kuo2, Chao-Wen Hsueh1, Hsin-Yeh Chen1, Kai-Yao Yang3, Chou-Yuan Ko3, Jyan-Wei Huang4, Pei-Yu Lee1, Hsin-Yi Shen5, Ji-Xuan Zhuo5, Kai-Ting Chang5, Yu-Tong Wei5 Division of Gastroenterology, Department of Internal Medicine, Pao-Chien Hospital, Pingtung, Taiwan 2 Division of Gastroenterology & Hepatology, Department of Internal Medicine, Yuan Rung Hospital Yuan Sheng Branch, Changhua, Taiwan 3 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan 4 Division of Gastroenterology, Department of Internal Medicine, Pingtung Branch of Kaohsiung Armed Forces General Hospital, Pingtung, Taiwan 5 Endoscopy Room, Nursing Department, PaoChien Hospital, Pingtung, Taiwan 1

慢性 B 型肝炎患者接受核苷酸類似物治療後利用 APRI 和 FIB-4 合併組合套裝值評估其纖維化差異性可預測肝癌發生風險 — 屏東地區經驗文士祺1 郭武憲2 薛肇文1 陳興曄1 楊凱堯3 柯朝元3 黃健維4 李珮育1 沈欣怡5 卓季萱5 張凱婷5 魏宇彤5 1

to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) index are popular noninvasive indices to predict liver fibrosis. Furthermore, baseline FIB-4 has higher predictive performance for HCC. Aims: Limited reports have addressed however ontreatment dynamic change or on-treatment value of noninvasive indices affects HCC development. We aimed to find out risk of HCC development according to on-treatment changes in APRI and FIB-4 in patients with CHB receiving Tenofovir or Entecavir, particular in the subgroup of patient with cirrhosis. Methods: We retrospectively enrolled 129 patients with CHB who received tenofovir or entecavir therapy in Ping-Tung County between Nov 2013 and Nov 2023. We investigated the risk of HCC according to prognostic performance with APRI and fibrosis-4 (FIB-4) prognostic scores and calculated by Received operating curves (ROCs) to assess. A combination of APRI and FIB-4 values was use to stratified the cumulative risk of HCC into four subgroups each in the total population and cirrhotic subgroups. Results: Cirrhosis was present in 76 (58.9%) patients. Total population with CHB who had APRI levels ≥0.7455/FIB-4 levels ≥4.3925 (HR: 5.050, 95% CI:1.758–14.504, P = 0.003) and APRI <0.7455/FIB-4 ≥4.3925 (HR:11.192, 95% CI: 3.249–38.557, P < 0.001) exhibit the high risk for HCC occurrence. In the subgroup of patient with cirrhosis, APRI ≥0.7455/ FIB-4 ≥4.3925 (HR: 6.156, 95% CI: 1.583–23.944, P = 0.009) and APRI <0.7455/FIB-4 ≥4.3925 (HR: 9.039, 95% CI: 9.039, 95% CI: 2.570–31.791, P = 0.001) were independently associated with development of HCC. Conclusions: A research using a combination of ontreatment change in APRI ≥0.7455/FIB-4 ≥4.3925 or APRI <0.7455/FIB-4 ≥4.3925 values may provide independent predictive indices for occurrence of HCC after Tenofovir or Entecavir therapy in patients with CHB particular in the subgroup with cirrhosis.

屏東寶建醫院胃腸肝膽科員榮醫院員生院區胃腸肝膽科 3 國軍高雄總醫院腸胃科 4 國軍高雄總醫院屏東分院腸胃科 5 屏東寶建醫院護理部胃鏡室 2

Background: Liver cirrhosis and hepatocellular carcinoma (HCC) are the major complication of chronic hepatitis B virus (CHB). Long-term nucleos(t) ide analogue (NUC) therapy leads to the regression of liver fibrosis and reduces the incidence of HCC. The severity of liver fibrosis has been known to be a crucial risk factor for HCC. The aminotransferase-

2026 TDDW

⑤

T-CELL IMMUNE STATUS AND SEROCONVERSION IN PATIENTS WITH CHRONIC HEPATITIS B RECEIVING NUCLEOS(T)IDE ANALOGUE THERAPY: A SINGLE HOSPITAL EXPERIENCE IN TAIWAN

Ai-Sheng Ho1,2, Zong-Lin Sie3, Chun Yeh1, Shou-Dong Lee1, Chun-Chia Cheng3 Division of Gastroenterology, Cheng Hsin General Hospital, Taipei, Taiwan 2 School of Medicine, National Defense Medical University, Taipei, Taiwan 3 Research Center of Radiation Medicine, Chang Gung University, Taoyuan, Taiwan 1

接受核苷（酸）類似物治療的慢性 B 型肝炎患者的 T 細胞免疫狀態與血清抗體轉換：台灣單一醫院的臨床經驗何愛生1,2 謝宗霖3 葉淳1 李壽東1 程俊嘉3 1

振興醫院胃腸科國防醫學大學醫學系 3 長庚大學放射醫學研究中心 2

Background: Chronic hepatitis B (CHB) causes liver inflammation and dysfunction, which can progress to liver fibrosis and eventually lead to liver cancer. Nucleos(t)ide analogues (NAs) are antiviral agents that specifically target and inhibit hepatitis B virus (HBV) replication. Although liver inflammation is known to be associated with immune cell activation, the immune status of CHB patients treated with NAs remains unclear. Aims: We intended to investigate the T cell status in CHB patients treated with NAs. Methods: HBV-related markers, including HBV DNA, HBsAg, HBeAg, and HBsAb, were routinely measured in clinical practice. Seroconversion was also evaluated in enrolled CHB patients treated with NAs (n = 128; male/female: 82/46; mean age: 58.7 years). In addition, T-cell subsets were analyzed by flow cytometry. Results: Administration of NAs for at least 6 months significantly suppressed HBV DNA levels in CHB patients (n = 78, p < 0.001). Approximately 27% (21/78) of CHB patients became HBeAb- or HBsAbpositive after NA therapy or through spontaneous seroconversion. NA therapy resulted in an HBeAg seroconversion rate of 37.1% (13/35; HBeAg-positive

to HBeAb-positive; mean age: 54 years), which was higher than the reported rate in untreated CHB patients (n = 21,022; 1.15% HBeAb-positive). Interestingly, 11 cases of HBsAg seroconversion (HBsAg-positive to HBsAb-positive; mean age: 62 years) were observed, all of which occurred spontaneously. Furthermore, CD4+ T-cell levels were significantly higher in patients with HBsAg seroconversion (p < 0.05) and tended to be higher in those with HBeAg seroconversion (p = 0.20) than in CHB patients without seroconversion. CD8+ T-cell levels were lower, and the CD4+/CD8+ ratio was higher, in the seroconversion groups than in HBVinfected patients without seroconversion, although these differences were not statistically significant. Conclusions: NA therapy significantly suppressed HBV DNA levels in CHB patients. We observed spontaneous HBsAg seroconversion and a relatively high HBeAg seroconversion rate in HBeAg-positive CHB patients treated with NAs. In addition, CD4+ T-cell levels were higher in CHB patients with seroconversion. These findings provide insights into seroconversion and T-cell immune status in CHB patients receiving NA therapy.

2026 TDDW

⑥

REGRESSION OF LIVER FIBROSIS EVALUATED BY NON-INVASIVE MARKERS IN PATIENTS WITH CHRONIC HEPATITIS B CIRRHOSIS UNDERGOING ENTECAVIR AND TENOFOVIR ALAFENAMIDE THERAPY

Yong-Jhih Lin1, Te-Sheng Chang1,2, Shui-Yi Tung1,2, Chen-Heng Shen1, Kuo-Liang Wei1,2, Yung-Yu Hsieh1,2, Yi-Hsing Chen1, Chun-Hsien Chen1, Wei-Lin Tung1, Chih-Wei Yen1, Kuan-Chen Pan1, Wei-Ming Chen1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

應用非侵入性標記評估 Entecavir 與 Tenofovir Alafenamide 治療慢性 B 型肝炎肝硬化之肝纖維化改善成效林永智1 張德生1,2 董水義1,2 沈建亨1 魏國良1,2 謝詠諭1,2 陳奕行1 陳俊憲1 童威霖1 顏志維1 潘冠塵1 陳慰明1,2 1 2

was evaluated longitudinally using the aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis index based on four factors (FIB-4). Liver function and disease severity were assessed using the Albumin-Bilirubin (ALBI) score and the Model for End-Stage Liver Disease (MELD) score. Results: A total of 112 patients were evaluated over a 2-year AVT period. Baseline characteristics were comparable between the ETV (n = 38) and TAF (n = 74) groups, except for higher baseline serum creatinine in the TAF group (P = 0.044). Significant regression of liver fibrosis was observed in the overall cohort. The mean APRI score decreased from 1.28 at baseline to 0.98 at year 1 (P < 0.05) and further to 0.64 at year 2 (P < 0.05). Similarly, the mean FIB-4 index decreased from 4.71 at baseline to 3.94 at year 1 (P < 0.05) and significantly dropped to 2.71 at year 2 (P < 0.05). Although both ALBI and MELD scores showed numerical improvements over the 2 years, these functional changes did not reach statistical significance. Conclusions: Antiviral therapy achieved substantial and continuous regression of liver fibrosis over 2 years in CHB patients with cirrhosis, as evidenced by significant declines in non-invasive markers (APRI and FIB-4), while preserving stable liver function profiles.

嘉義長庚紀念醫院胃腸肝膽科長庚大學醫學院

Background: Numerous studies have evaluated the clinical efficacy and liver fibrosis regression between tenofovir disoproxil fumarate (TDF) and entecavir (ETV) in patients with chronic hepatitis B (CHB). However, because many historical studies generalize TDF findings to tenofovir alafenamide (TAF), literature specifically addressing the impact of TAF on fibrotic burden remains limited, particularly in patients with established liver cirrhosis. Real-world longitudinal data monitoring the chronological changes in fibrosis under these modern first-line therapies are needed. Aims: This study aimed to investigate and characterize the chronological changes in fibrotic load and liver function over a 2-year period in cirrhotic CHB patients undergoing antiviral therapy with either ETV or TAF. Methods: We retrospectively enrolled CHB patients with liver cirrhosis undergoing first-line AVT (either ETV 0.5 mg/day or TAF 25 mg/day) at a regional medical center in Taiwan. Fibrotic burden

2026 TDDW

Section：UGI ⑦

ENDOSCOPIC RESECTION OF GASTRIC SUBEPITHELIAL TUMORS: A 14-YEAR SINGLE-CLINIC EXPERIENCE AND THE PREDICTIVE VALUE OF FUNDIC LOCATION I-Lin Lee Dr. Lee Gastroenterology Clinics, Taipei, Taiwan

內視鏡切除胃黏膜下腫瘤：單一診所 14 年經驗與腫瘤位於胃底之臨床意義李宜霖李宜霖診所

Background: Gastric subepithelial tumors (SETs) are not uncommon, yet their management remains clinically challenging. Preoperative biopsy frequently fails to yield an accurate histologic diagnosis, and endoscopic resection of these lesions—particularly those arising from the muscularis propria—carries considerable technical difficulty and risk. Because a substantial proportion prove to be gastrointestinal stromal tumors (GISTs) with malignant potential, the optimal approach to these lesions remains unsettled. Aims: This study aimed to evaluate the safety and efficacy of endoscopic resection for gastric SETs based on a 14-year single-clinic experience, and to characterize the clinical significance of fundic tumor location—particularly its association with perforation risk and GIST histology. Methods: We retrospectively reviewed consecutive patients treated at a single gastroenterology clinic between June 2012 and June 2026. Eligible lesions were gastric SETs smaller than 5 cm, originating from the muscularis propria, without prominent extraluminal growth on endoscopic ultrasound. Resection was performed mainly by endoscopic subepithelial tumor resection (ESTD), with overthe-scope clip (OTSC)–assisted resection in selected cases. Results: Seventy-seven patients (28 men, 49 women; mean age 54.07 years) underwent resection of 87 tumors; 10 patients had two synchronous SETs. En-bloc resection was achieved in 83 of 87 lesions (95.4%); 3 underwent piecemeal but complete resection and 1 was incompletely resected. ESTD was used in 82 cases and OTSC in 4; one patient required subsequent surgery. Histology revealed leiomyoma in 59 (67.8%), GIST in 27 (31.0%), and schwannoma in 1. Notably, 9 of 10 fundic tumors were GISTs.

Perforation occurred in 10 cases (11.6%), all successfully closed intraoperatively with hemoclips without immediate surgical repair. Perforation was strongly associated with fundic location (6/10, 60% vs. 4/77, 5.2% for non-fundic lesions), and 7 of the 10 perforated lesions were GISTs. Conclusions: Endoscopic resection of gastric SETs achieved a >95% success rate, and although perforation occurred in 11.6%, no patient required surgical repair, supporting the safety and appropriateness of this approach. Fundic location carried both the highest perforation risk—owing to a thin gastric wall and difficult endoscopic access—and the highest likelihood of GIST. We therefore recommend heightened vigilance and consideration of active endoscopic treatment for fundic SETs, alongside thorough patient counseling, periprocedural precautions such as general anesthesia with endotracheal intubation to limit intra-abdominal pressure, and operator readiness to manage perforation and evacuate excess intraperitoneal air.

2026 TDDW

⑧

OPTIMIZING AI-ASSISTED DETECTION OF SUPRAGASTRIC BELCHING TO REFINE GASTROESOPHAGEAL REFLUX DISEASE PHENOTYPING ON 24HOUR IMPEDANCE-PH MONITORING

Ming-Wun Wong1, Yen-Jhu Chen2, Wen-Cheng Lin2, Hsin-Chieh Li2, Jen-Hung Wang3, Hsi-Yuan Chien1, Chih-Hsun Yi1, Tso-Tsai Liu1, Wei-Yi Lei1, Jui-Sheng Hung1, Chien-Lin Chen1 Digestive Health Center, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 2 Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan 3 Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 1

以人工智慧輔助優化酸鹼阻抗檢查中胃上噯氣之偵測：應用於胃食道逆流疾病精準分型

events, including 1,657 confirmed SGB events and 861 suspected events. YOLOv12n and Real-Time Detection Transformer (RT-DETR) were compared using precision, recall, F1-score, mean average precision at an intersection-over-union threshold of 0.5, sensitivity, and specificity. Results: In the single-class SGB detection task, YOLOv12n achieved higher mean average precision than RT-DETR (0.950 vs 0.885; P < 0.001), with higher F1-score (0.906 vs 0.885; P = 0.018) and precision (0.905 vs 0.855; P = 0.004). Recall was comparable between models (0.906 vs 0.915; P = 0.42). YOLOv12n also showed higher sensitivity and specificity for confirmed SGB detection than RT-DETR (96.05% and 90.51% vs 93.02% and 88.59%; both P < 0.05). In the mixed-class dataset, YOLOv12n maintained superior overall performance, with higher mean average precision (0.857 vs 0.700; P < 0.001) and F1-score (0.787 vs 0.767; P = 0.032). Conclusions: AI-assisted object detection can efficiently localize SGB events in 24-hour impedancepH recordings. YOLOv12n demonstrated better overall performance than RT-DETR and may facilitate SGB screening, physician-assisted interpretation, and mechanism-based GERD phenotyping.

翁銘彣1 陳嬿竹2 林紋正2 李信頡2 王仁宏3 簡錫淵1 易志勳1 劉作財1 雷尉毅1 洪睿勝1 陳健麟1 1

佛教慈濟醫療財團法人花蓮慈濟醫院消化系中心慈濟大學醫學資訊學系 3 佛教慈濟醫療財團法人花蓮慈濟醫院研究醫學部 2

Background: Supragastric belching (SGB) is increasingly recognized as a behavioral mechanism in gastroesophageal reflux disease (GERD). Although 24-hour multichannel intraluminal impedance-pH monitoring is required to identify SGB, commercial software does not provide reliable automated detection, and manual review is time-consuming. Aims: To develop and evaluate an artificial intelligence-assisted computer-aided detection workflow for event-level localization of SGB in 24hour impedance-pH tracings, and to compare two real-time object detection models. Methods: Fifty-five subjects who underwent 24hour impedance-pH monitoring were included. Raw six-channel impedance signals were exported at 50 Hz and converted into 20-second 640 × 640 pixel signal images using temporal-to-spatial mapping. The dataset comprised 2,518 annotated

2026 TDDW

⑨

CLINICAL OUTCOMES OF X-TACK AND OVERSTITCH SUTURING FOR GASTROINTESTINAL DEFECT CLOSURE AFTER ADVANCED ENDOSCOPIC RESECTION: A MULTICENTER RETROSPECTIVE STUDY IN TAIWAN

Wei-Wei Lee1, Tze-Yu Shieh2, Chung-Ying Lee3, Chao-Wen Hsu4, Wei-Chen Tai5, Hsu-En Cheng6, Chih-Wei Yang7, I-Ching Cheng8, Chen-Shuan Chung1,9 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 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan 4 Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal Ta-tung Hospital, Kaohsiung, Taiwan 6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan 8 Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan 9 Taiwan Association for the Study of Intestinal Diseases (TASID) 1

X-Tack 與 OverStitch 縫合系統用於進階內視鏡切除術後胃腸道傷口閉合之臨床療效：臺灣多中心回溯性研究李瑋瑋1 謝子鈺2 李宗頴3 許詔文4 戴維震5 鄭旭恩6 楊志偉7 鄭以勤8 鍾承軒1,9 1

亞東紀念醫院肝膽腸胃科馬偕紀念醫院胃腸內科 3 衛生福利部雙和醫院消化內科 2

高雄榮民總醫院外科部高雄市立大同醫院胃腸肝膽科 6 臺中榮民總醫院胃腸肝膽科 7 三軍總醫院胃腸肝膽科 8 臺安醫院胃腸肝膽科 9 台灣腸道醫學會 5

Background: Advanced endoscopic resection (ER) frequently creates gastrointestinal wall defects for which conventional hemoclips may be insufficient. Recently introduced non-traditional closure devices, including X-Tack and OverStitch, offer alternative options, but comparative data remain limited, particularly in Taiwan. Aims: This study compared their outcomes and evaluated the role of the Sydney deep mural injury classification in guiding device selection. Methods: This retrospective multicenter study enrolled 48 patients from eight tertiary centers in Taiwan (December 2023–February 2026) who underwent endoscopic resection followed by wound closure using X-Tack or OverStitch. Technical success, clinical success, complications, procedural time, and wound size were compared. Defect depth was categorized using the Sydney deep mural injury (DMI) classification. Results: Technical success rates were 93.1% for X-Tack (n = 29) and 100% for OverStitch (n = 19) (p = 0.512); clinical success rates were 86.2% and 89.5%, respectively (p = 1.000). Wound closure time (19.62 ± 12.85 vs. 21.16 ± 10.06 min, p = 0.662) and complication rates (10.3% vs. 15.8%, p = 0.669) were comparable, with no mortality in either group. X-Tack was predominantly used for ESD defects in the colorectum and for Sydney Type I–II injuries, whereas OverStitch was exclusively used for Sydney Type III–IV defects, primarily following ER beyond submucosa layer for gastric subepithelial lesions. Conclusions: Both devices demonstrated high efficacy and safety profiles. X-Tack is well suited for mucosal-level defects across diverse anatomical locations, while OverStitch provides reliable fullthickness closure for deep gastric defects. Sydney DMI classification offers a practical framework for evidence-based closure device selection.

2026 TDDW

⑩

THE EASTERN PHENOTYPE OF AUTOIMMUNE GASTRITIS IS INDEPENDENTLY ASSOCIATED WITH GASTRIC MALIGNANCIES: A 15-YEAR AGE- AND SEX-MATCHED COHORT STUDY

Cheng-Yu Lin1,2, Ming-Ling Chang1,2, Chung-Guei Huang3, Chia-Jung Kuo1,2, Yung-Lin Chang3, Wei-Pin Lin1,2, Kai-Feng Sung1,2, Wei-Ting Chen1,2, Tsung-Hsing Chen1,2, Chung-Wei Su1,2, Puo-Hsien Le1,2, Yi-Chung Hsieh1,2, Cheng-Jen Chen1,2, Chi-Huan Wu1,2, Chia-Hung Tai1,2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 1

自體免疫性胃炎東方表型與胃惡性腫瘤之獨立相關性：15 年配對世代研究林正祐1,2 張明鈴1,2 黃瓊瑰3 郭家榮1,2 張永麟3 林偉彬1,2 宋皚峰1,2 陳威廷1,2 陳聰興1,2 蘇崇維1,2 李柏賢1,2 謝彝中1,2 陳正仁1,2 吳季桓1,2 戴佳虹1,2 1

林口長庚紀念醫院胃腸肝膽科系長庚大學醫學院 3 林口長庚紀念醫院檢驗醫學部 2

negative controls (N = 1,295). Multiple imputationsupported multivariable regression models assessed clinical predictors and long-term oncogenic risks. Results: AIG presented with a balanced male-tofemale ratio and was independently associated with baseline autoimmune thyroid disease (adjusted odds ratio [aOR] 4.58), previous gallbladder disease (aOR 2.34), progressive Vitamin B12 depletion (aOR 0.90), and iron deficiency (aOR 1.81). Longitudinally, AIG emerged as a major independent risk factor for GAC, conferring a more than 6-fold increased risk (adjusted hazard ratio [aHR] 6.42, 95% confidence interval [CI]: 2.82–14.65; P < 0.001). Type 1 gNET events occurred exclusively within the AIG subcohort. For gNETs, baseline serum creatinine was a significant independent predictor (aHR 1.27 per 1 mg/dL increase; P < 0.001), highlighting a clinically relevant renal-gastrin link. Despite significantly elevated neoplastic risks, AIG did not independently compromise 15-year overall survival (aHR 0.66; P = 0.065). Mortality was dictated primarily by extra-gastric systemic frailty, including diminished hemoglobin, elevated transaminases, and systemic autoimmunity. Conclusions: The Eastern phenotype of AIG is an independent risk factor for both gNETs and GAC, demonstrating a significant oncogenic trajectory. Despite elevated tumor risks, 15-year overall survival remains uncompromised. Integrating baseline renal function and gastric metaplasia into clinical surveillance strategies can guide personalized monitoring.

Background: Autoimmune gastritis (AIG) in East Asia presents with a distinct clinical profile and higher gastric cancer burden compared to Western cohorts. However, the intrinsic oncogenic trajectory of this Eastern phenotype remains poorly defined in endemic areas. Aims: We aimed to identify early diagnostic markers for AIG and evaluate its independent longitudinal risks for Type 1 gastric neuroendocrine tumors (gNETs), gastric adenocarcinoma (GAC), and allcause mortality. Methods: This 15-year retrospective cohort study utilized a multi-institutional Taiwanese database (2009–2024). We identified 259 AIG patients using the 2023 Japan Gastroenterological Endoscopy Society (JGES) diagnostic criteria, matched 1:4 with 1,036 anti-gastric parietal cell antibody (GPCA)-

2026 TDDW

⑪

THE CORREA CASCADE IS NOT THE MALTOMA CASCADE: INTESTINAL METAPLASIA IS INVERSELY ASSOCIATED WITH GASTRIC MALT LYMPHOMA

Chun-Hao Wang1, Chu-Po Chou2, Shih-Chi Hu2, Chan-Yi Lin2, Jyh-Ming Liou1,2, Ming-Shiang Wu1, Tzu-Chan Hong2 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 2 Department of Medicine, National Taiwan University Cancer Center, National Taiwan U niversity College of Medicine, Taipei, Taiwan 1

Correa 級聯反應並非胃黏膜相關淋巴組織淋巴瘤之致病機轉王俊皓1 周主博2 胡士麒2 林展毅2 劉志銘1,2 吳明賢1 洪子瞻2 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: Helicobacter pylori drives two distinct gastric neoplastic pathways: the Correa cascade toward adenocarcinoma via epithelial progression, and chronic antigenic stimulation toward gastric mucosa-associa ted lymphoid tissue lymphoma (MALToma). Whether intestinal metaplasia (IM), a hallmark of the Correa cascade, also marks MALToma risk remains unclear. Aims: To examine whether endoscopic IM burden, assessed by the Endoscopic Grading of Gastric Intestina l Metaplasia (EGGIM) score, is associated with gastric MALToma risk. Methods: We conducted a retrospective 1:4 matched case-control study including 54 gastric MALToma cases and 216 non-MALToma controls from a screening cohort (2022–2025). Controls were matched by age, sex, and H. pylori history. Exposures included binary IM positivity and graded EGGIM severity (score 0–10). Conditional logistic regression estimated matched adjusted odds ratios (aORs). Effect modification by H. pylori eradication status was assessed via interaction terms. Results: IM positivity was less frequent among MALToma cases than matched controls (37.0% vs. 61.1%). Binary IM positivity was inversely associated with MALToma (aOR 0.34, 95% CI 0.18–0.66, p =

0.001). Continuous EGGIM severity showed no significant association (aOR 0.97 per point, 95% CI 0.87–1.08, p = 0.605). H. pylori eradication status did not modify either association (p-interaction 0.827 and 0.676, respectively). Conclusions: IM was inversely associated with gastric MALToma risk and was not a shared marker across H. pylori-driven neoplastic pathways. These findings support mechanistically distinct epithelial and lymphoid oncogenic cascades.

2026 TDDW

Section：SLD ⑫

LIVER FIBROSIS SEVERITY INDEPENDENTLY PREDICTS LONGTERM CARDIOVASCULAR RISK IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE

Pin-Han Lin1, Shih-Han Weng2, Hsiao-Yun Hu2, Hui‐Fen Chen1, Tsung-Jung Lin1, Chih-Lin Lin1 Department of Gastroenterology, Taipei City Hospital Renai Branch, Taipei, Taiwan 2 Department of Education and Research, Taipei City Hospital Renai Branch, Taipei, Taiwan 1

肝纖維化嚴重程度可獨立預測代謝功能異常相關脂肪性肝病患者的長期心血管風險林品瀚1 王詩涵2 胡曉雲2 陳蕙芬1 林聰蓉1 林志陵1 1 2

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

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide. MASLD is associated with increased morbidity and mortality, and cardiovascular disease (CVD), rather than liver-related complications, is the leading cause of death in affected patients. Consequently, the concept of cardiovascular–liver–metabolic health has gained increasing attention recently. Liver fibrosis, a major consequence of MASLD, has been associated with adverse cardiovascular outcomes. However, conflicting evidence exists regarding whether liver fibrosis is an independent risk factor for CVD beyond traditional cardiometabolic risk factors or just a marker of underlying metabolic dysfunction. Clarifying this relationship may help refine cardiovascular risk stratification and identify patients with MASLD at increased cardiometabolic risk. Aims: To determine whether liver fibrosis severity is independently associated with long-term cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This prospective cross-sectional study enrolled consecutive patients with MASLD between January 2024 and October 2025. Clinical characteristics, anthropometric measurements,

laboratory parameters, and transient elastography (FibroScan®) were collected. Liver fibrosis severity was assessed by liver stiffness measurement (LSM). Long-term cardiovascular risk was estimated using the 30-year Framingham Risk Score (FS30). High cardiovascular risk was defined as FS30 ≥20%. Results: Among 285 patients with MASLD, 129 (45.3%) had high cardiovascular risk (Framingham risk score ≥20%). Compared with the low-risk group, patients with high cardiovascular risk were older and exhibited higher LSM and FIB-4 values, together with a greater prevalence of smoking, hypertension, diabetes mellitus, and metabolic risk factors (all P < 0.05). Liver stiffness increased across Framingham risk stages, with median (IQR) values of 4.35 (3.6–5.3), 4.15 (3.5–5.2), 4.80 (4.1–6.0), and 4.80 (4.2–6.3) kPa for stages 1–4, respectively (Kruskal–Wallis P = 0.0088). Restricted cubic spline analysis demonstrated a significant association between LSM and high cardiovascular risk, with no evidence of nonlinearity (overall P = 0.0039; P for nonlinearity = 0.8415), supporting a linear relationship. LSM was also positively correlated with Framingham total score (Pearson r = 0.175, 95% CI 0.060–0.286, P = 0.003). In multivariable logistic regression adjusting for age, BMI, LDL, diabetes mellitus, and hypertension, LSM remained independently associated with high cardiovascular risk (adjusted OR 1.22 per kPa increase, 95% CI 1.04–1.46, P = 0.020). Conclusions: In patients with MASLD, increasing liver fibrosis severity was independently associated with a higher predicted long-term cardiovascular risk, beyond the contribution of traditional cardiometabolic risk factors. These findings support the emerging role of liver fibrosis as a key extrahepatic marker of systemic cardiometabolic disease burden and underscore the importance of incorporating fibrosis assessment into comprehensive cardiovascular risk stratification.

2026 TDDW

⑬

HIERARCHICAL ANALYSIS OF METABOLIC PHENOTYPE REVEALS DISTINCT MICROBIOTA AND CIRCULATORY TRANSCRIPTOME IN METABOLIC DYSFUNCTION– ASSOCIATED STEATOTIC LIVER DISEASE

Tzu-Hao Li1, Chien-Yi Tung2,3, Yi-Hsuan Lin4, Ya-Yuan Chang2,3, Jhen-Wei Ruan3,5, Pei-Chen Chen3,5, Chian-Feng Chen5, Chien-Wei Su6,7, Ying-Ying Yang4,6,7, Ming-Chih Hou6 Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan 2 Cancer and Immunology Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 3 Genomics Center for Clinical and Biotechnological Applications, Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan 5 Department of Medical Laboratory Science and Biotechnology, Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan 6 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 7 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

透過代謝表型的階層分析揭示代謝功能障礙相關脂肪性肝病中獨特的微生物相與循環轉錄組黎子豪1 董建憶2,3 林宜璇4 張雅媛2,3 阮振維3,5 陳沛臻3,5 陳建鋒5 蘇建維6,7 楊盈盈4,6,7 侯明志6 1

新光吳火獅紀念醫院內科部國立陽明交通大學腫瘤免疫中心 3 國立陽明交通大學臨床與生技應用基因體中心 4 臺北榮民總醫院教學部 5 國立成功大學醫學檢驗生物技術學系 6 臺北榮民總醫院胃腸肝膽科 7 國立陽明交通大學醫學系 2

100

Background: Visceral adipose tissue (VAT) accumulation constitutes a central pathogenic mechanism in metabolic dysfunction-associated steatotic liver disease (MASLD). Among various adipose depots, VAT is uniquely active in promoting inflammation and metabolic derangement via direct drainage into the portal circulation, increased release of and pro-inflammatory mediators and contributes to systemic insulin resistance and type 2 diabetes pathogenesis. The interaction between visceral fat, hepatic steatosis, insulin sensitivity, and lifestyle factors highlights the need for integrative phenotyping approaches to metabolic disease. Aims: To investigate how visceral adiposity and insulin resistance, defined respectively by visceral adiposity index (VAI) and triglyceride–glucose (TyG) index, jointly influence gut microbiota composition and immune transcriptomes in metabolic dysfunction–associated steatotic liver disease (MASLD), and to explore potential mechanistic pathways. Methods: We enrolled 169 adults stratified by VAI, controlled attenuation parameter (CAP), TyG index, and physical activity. Gut microbiota and immune transcriptomes were profiled using 16S rRNA and RNA sequencing, respectively. Differentially expressed genes (DEGs) were identified across subgroups. Functional annotation and upstream regulatory networks were analyzed using DAVID and Ingenuity Pathway Analysis (IPA). Results: Higher VAI correlated with obesity, inflammation, and steatosis, while the TyG index independently predicted fibrosis risk. Specific taxa, including TM7x, Acidaminococcus, and Dielma, were consistently enriched in adverse metabolic phenotypes. Transcriptomic analysis of circulating immune cells identified 348 TyG-associated DEGs significantly enriched in mitochondrial and cytokine signaling pathways. IPA highlighted IL6, SREBF1, PTGS1 and SNCA as central regulators linking metabolic stress to mitochondrial dysfunction. Conclusions: Gut microbiota shifts and immune transcriptome alterations jointly mediate the interplay between insulin resistance and visceral adiposity in MASLD. The identified insulin resistance– associated genes suggest that mitochondrial dysfunction and cytokine dysregulation contribute to obesity-related hepatic pathology, supporting precision strategies targeting VAI and metabolic dysregulation.

2026 TDDW

⑭

IMPAIRED FECAL SECONDARY BILE ACID FORMATION IN ADVANCED LIVER FIBROSIS: MODULATION BY URSODEOXYCHOLIC ACID AND STATIN THERAPY

Cheng-Ying Hsieh1, Chih-Ming Liang1, Chang-Chun Hsiao2, Hung Su3, Jentaie Shiea4, Seng-Kee Chuah1, Tsung-Hui Hu1, Chien-Hung Chen1, Ming-Chao Tsai1, Yuan-Hung Kuo1 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Department of Chemistry, National Kaohsiung Normal University, Kaohsiung, Taiwan 4 Department of Chemistry, National Sun YatSen University, Kaohsiung, Taiwan 1

進階肝纖維化患者糞便次級膽酸生成受損及熊去氧膽酸與 Statin 治療之調節作用謝承穎1 梁志明1 蕭長春2 蘇鴻3 謝建台4 蔡成枝1 胡琮輝1 陳建宏1 蔡明釗1 郭垣宏1 1

長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨長庚大學醫學系 2 長庚大學臨床醫學研究所 3 國立高雄師範大學化學系 4 國立中山大學化學系

Background: Patients with advanced liver fibrosis remain at risk of persistent hepatic inflammation and disease progression despite effective hepatitis B virus suppression or hepatitis C virus eradication. The gut–liver axis, particularly microbiota-mediated bile acid transformation, may contribute to ongoing fibrogenesis. Impaired conversion of primary bile acids to secondary bile acids may reflect intestinal dysbiosis and altered microbial 7α-dehydroxylation. Ursodeoxycholic acid (UDCA) and statins may modulate bile acid metabolism, intestinal microbiota, inflammation, and fibrosis-related pathways. Aims: This exploratory pilot study aimed to characterize fecal primary and secondary bile acid

profiles in patients with advanced liver fibrosis and to evaluate the effects of UDCA, statin therapy, and combined statin plus UDCA therapy on fecal bile acid composition. Methods: This randomized, open-label, exploratory pilot study enrolled patients with advanced liver fibrosis after sustained hepatitis B viral suppression or hepatitis C sustained virologic response. Patients with advanced liver fibrosis were randomized to observation control, UDCA 300 mg twice daily, simvastatin 40 mg once daily, or combined simvastatin plus UDCA therapy, with three patients in each group. Six participants without advanced fibrosis served as controls. Fecal bile acids, including cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), lithocholic acid (LCA), glycocholic acid, glycodeoxycholic acid, glycoursodeoxycholic acid, and UDCA, were quantified using liquid chromatography–tandem mass spectrometry. Non-detectable values were treated as zero for exploratory analysis. Continuous variables are presented as median [interquartile range]. Results: A total of 18 evaluable participants were included, comprising 12 patients with advanced liver fibrosis and 6 controls. Compared with controls, patients with advanced liver fibrosis had significantly higher INR (1.09 [1.07–1.14] vs. 1.01 [1.00–1.02]; p = 0.004), lower platelet counts (120.5 [85.5–166.3] vs. 246.5 [230.3–292.8] ×10³/μL; p = 0.001), lower LDL-C levels (96.0 [73.0–109.5] vs. 135.0 [117.8–153.0] mg/dL; p = 0.048), and higher FibroScan values (12.2 [10.2–17.8] vs. 4.9 [4.4–5.8] kPa; p < 0.001). At baseline, total fecal bile acid levels were numerically lower in advanced liver fibrosis than in controls (12.34 [0.29–42.90] vs. 31.10 [12.08– 73.44] ppm; p = 0.280). CA levels were numerically higher in advanced liver fibrosis (1.99 [0.00–19.74] vs. 0.00 [0.00–8.83] ppm; p = 0.441), whereas CDCA levels were similarly low between groups (0.00 [0.00–0.12] vs. 0.00 [0.00–0.00] ppm; p = 0.898). Among secondary bile acids, DCA was numerically lower in advanced liver fibrosis than in controls (0.00 [0.00–0.14] vs. 17.70 [0.01–35.38] ppm; p = 0.165), while LCA was largely undetectable in both groups (0.00 [0.00–0.00] vs. 0.00 [0.00–0.00] ppm; p = 0.195). Exploratory aggregate conversion indices showed lower DCA/CA ratio in advanced liver fibrosis than in controls (0.214 vs. 6.151) and lower secondaryto-primary bile acid ratio, defined as (LCA + DCA)/ (CDCA + CA), (0.201 vs. 2.074). Formal statistical

101

2026 TDDW

testing was not performed for these ratios because individual-level estimates were unstable due to sparse detection and frequent zero denominators. In paired treatment analyses, UDCA increased total fecal bile acids and fecal UDCA levels in all three treated patients, but the secondary-to-primary bile acid ratio remained low. Statin therapy produced heterogeneous changes, with total fecal bile acids decreasing in two patients and increasing in one. Combined statin plus UDCA therapy increased total fecal bile acids in two of three patients, but did not consistently increase the secondary-to-primary bile acid ratio. Conclusions: Patients with advanced liver fibrosis showed numerically reduced total fecal bile acids, lower DCA levels, and diminished aggregate secondary-to-primary bile acid conversion indices compared with controls. These findings suggest impaired microbiota-mediated primary-tosecondary bile acid transformation in advanced liver fibrosis. UDCA-containing therapy appeared to remodel the fecal bile acid pool primarily by increasing total bile acid abundance and UDCArelated composition, rather than by restoring classical secondary bile acid generation. Given the small sample size, sparse bile acid detection, and exploratory design, these findings should be interpreted as hypothesis-generating and require validation in larger prospective studies.

102

⑮

FIB-4 INDEX COMBINED WITH INTRAVENOUS TREATMENT INTENSITY IDENTIFIES A HIGHMORTALITY RISK PHENOTYPE IN PATIENTS WITH HEART FAILURE

Bi-Ling Yang1, Shou-Dong Lee1,2,3, Chun Yeh1, Hung-Yu Chang3,4, Kai-Hsi Lu4 Division of Gastroenterology, Department of Medicine, Cheng Hsin 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, Taipei, Taiwan 4 Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan 1

FIB-4 指數結合注射型治療強度可辨識心臟衰竭患者之高死亡風險族群楊必玲1 李壽東1,2,3 葉淳1 張鴻猷3,4 盧凱熙4 1

振興醫療財團法人振興醫院腸胃科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 振興醫療財團法人振興醫院心臟醫學中心 2

Background: Heart failure is frequently associated with hepatic congestion, impaired hepatic perfusion, and congestive hepatopathy. The Fibrosis-4 index (FIB-4), a non-invasive marker derived from age, AST, ALT, and platelet count, may reflect cardio-hepatic interaction and hepatic vulnerability in patients with heart failure. Intravenous treatment of intensity may further represent acute decompensation and advanced clinical severity. Aims: To evaluate whether FIB-4 combined with intravenous treatment intensity can identify a high-mortality risk phenotype among patients hospitalized for heart failure. Methods: We conducted a single-center retrospective cohort study including 6,154 adult patients hospitalized for heart failure between 2013 and 2021. FIB-4 was calculated at index admission and categorized as low/intermediate or high, with high FIB-4 defined as ≥3.01. Intravenous treatment intensity was assessed using total injection counts, and high intravenous treatment intensity was defined as ≥8 injections, corresponding to the 75th

2026 TDDW

percentile. Patients were stratified into four groups: neither high FIB-4 nor high intravenous treatment intensity, high FIB-4 only, high intravenous treatment intensity only, and both high FIB-4 and high intravenous treatment intensity. The primary outcome was all-cause mortality. Multivariable logistic regression and Cox proportional hazards models were performed with adjustment for sex, body mass index, severe heart failure, oral medication burden, and comorbidities. Results: Among 6,154 patients, 715 deaths occurred, with an overall mortality rate of 11.6%. Mortality increased progressively across the four risk strata: 8.1% in patients with neither high FIB-4 nor high intravenous treatment intensity, 12.4% in those with high FIB-4 only, 14.9% in those with high intravenous treatment intensity only, and 19.0% in those with both high FIB-4 and high intravenous treatment intensity. Compared with the reference group, patients with both high FIB-4 and high intravenous treatment intensity had the highest unadjusted mortality risk (risk ratio 2.35). After multivariable adjustment, this combined high-risk phenotype remained significantly associated with all-cause mortality in logistic regression (adjusted odds ratio 2.07, 95% confidence interval 1.56–2.75) and Cox regression (adjusted hazard ratio 2.08, 95% confidence interval 1.61–2.70). This group also had the highest prevalence of severe heart failure (65.3%). Conclusions: FIB-4 combined with intravenous treatment intensity identifies a distinct high-risk phenotype among patients hospitalized for heart failure. Elevated FIB-4 may reflect cardio-hepatic congestion, hepatic vulnerability, and systemic frailty, while high intravenous treatment intensity may indicate acute decompensation and greater therapeutic demand. This combined assessment may serve as a simple and clinically applicable risk stratification tool to identify patients requiring closer cardio-hepatic surveillance and intensive multidisciplinary care.

⑯

EFFICACY OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY ON LIVER STEATOSIS AND INSULIN RESISTANCE IN FATTY LIVER PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A 4-YEAR FOLLOW-UP COHORT STUDY

Hsiao-Chin Shen1,2,3, Yen-Hsun Huang1, Tzu-Hao Li4, Hsiao-Yun Yeh1,3, Hung-Cheng Tsai3,5, Chien-Wei Su3,6,7, Kun-Ta Chou2,8, Ying-Ying Yang1,3,6,7, Ming-Chih Hou7 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan 2 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 3 School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 4 Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan 5 Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 6 Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 7 Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 8 Ceneter of OSA, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 1

連續正壓呼吸器治療對阻塞性睡眠呼吸中止症合併脂肪肝患者之肝脂肪變性與胰島素阻抗的療效：一項四年追蹤世代研究沈曉津1,2,3 黃彥勛1 黎子豪4 葉筱芸1,3 蔡弘正3,5 蘇建維3,6,7 周昆達2,8 楊盈盈1,3,6,7 侯明志7 1

臺北榮民總醫院教學部臺北榮民總醫院胸腔部 3 國立陽明交通大學醫學系 4 新光吳火獅紀念醫院風濕免疫科 2

103

2026 TDDW

臺北榮民總醫院風濕免疫科 6 臺北榮民總醫院一般內科 7 臺北榮民總醫院胃腸肝膽科 8 臺北榮民總醫院睡眠醫學中心

Background: Fatty liver disease and obstructive sleep apnea (OSA) are comorbid conditions that synergistically increase cardiovascular risk through systemic inflammation and insulin resistance. While continuous positive airway pressure (CPAP) is the standard treatment for OSA, its efficacy in improving hepatic steatosis and insulin resistance in patients with concurrent fatty liver disease remains unclear. Aims: This study aimed to characterize metabolic profiles in fatty liver patients stratified by OSA severity and evaluate the longitudinal effects of CPAP therapy on hepatic steatosis and insulin resistance. Methods: This retrospective cohort study screened 2,429 adults and analyzed 321 patients with CTconfirmed fatty liver disease who underwent polysomnography (PSG) at a tertiary center. Participants were stratified by OSA severity using the Apnea-Hypopnea Index (AHI). We evaluated the 4-year longitudinal trajectories of hepatic steatosis by HSI and insulin resistance by the TG/HDL and TyG index, and assessed the impact of CPAP therapy on these metabolic indicators. Results: Patients with severe OSA (AHI ≥ 30) exhibited a significantly higher prevalence of elevated HSI at baseline (p < 0.001) and consistently higher longitudinal levels of HSI, TG/HDL, and TyG over the 4-year follow-up. In the severe OSA cohort, CPAP therapy significantly attenuated insulin resistance, reflected by a lower prevalence of elevated TyG compared to non-users (27.4% vs. 31.9%, p = 0.043). Longitudinal assessment further identified that CPAP users maintained significantly lower TyG-BMI values during the 1st-2nd year (135.7 vs. 146.6, p = 0.025) and 2nd-3rd year (133.6 vs. 146.0, p = 0.036) intervals, indicating a sustained metabolic benefit. Conclusions: Severe OSA significantly exacerbates metabolic dysfunction in fatty liver patients, necessitating PSG for accurate diagnosis. Long-term CPAP therapy effectively improves insulin resistance specifically in severe OSA cases. Therefore, routine OSA screening and CPAP intervention based on OSA severity are strategies for improving metabolic prognosis in fatty liver patients.

104

⑰

COMPARING RISK-FACTOR PROFILES FOR ALL-CAUSE VERSUS LIVER-RELATED MORTALITY IN A TAIWANESE HEALTH CHECKUP COHORT FOCUSING ON FIBROTIC METABOLIC DYSFUNCTION– ASSOCIATED STEATOTIC LIVER DISEASE

Wei-Chun Cheng1,2,3, Shih-Chieh Chien1, Hung-Chih Chiu1, Ming-Hsuan Wu1, Meng-Hsuan Lu1, Yen-Cheng Chiu1, Pin-Nan Cheng1, Chiung-Yi Li3 Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2 Department of Gastroenterology and Hepatology, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan 3 Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan 1

比較台灣健檢世代中全因死亡率與肝臟相關死亡率之危險因子特徵：以纖維化代謝功能障礙相關脂肪性肝病為焦點鄭維鈞1,2,3 簡世杰1 邱宏智1 吳銘軒1 呂孟璇1 邱彥程1 鄭斌男1 李中一3 1

國立成功大學醫學系內科學科衛生福利部台南醫院胃腸肝膽科 3 國立成功大學公共衛生學系 2

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent worldwide, and advanced fibrosis is a recognized predictor of adverse clinical outcomes; however, the actual risk—and the risk factors driving overall versus liver-specific mortality—remain poorly defined. Aims: To compare risk-factor profiles for all-cause versus liver-related mortality in a large Taiwanese health-checkup cohort. Methods: We followed 195,221 adults in the Taiwanese MJ health-checkup program (2010– 2022), excluding baseline cirrhosis or hepatocellular carcinoma. At each repeat checkup, ultrasonographic steatosis plus metabolic criteria classified participants as no steatosis, non-MASLD steatosis, or MASLD, with MASLD subdivided by advanced fibrosis (FIB-4 >2.67). We fitted Cox proportional

2026 TDDW

Section：Pancreas / Biliary hazards models with time-varying (time-updated) covariates, updating both the exposure (steatosis/ fibrosis category) and adjustment covariates at each checkup. Models estimated adjusted hazard ratios (aHR) for all-cause and liver-related (multiple-cause) mortality, treating other deaths as competing risk events and adjusting for demographics, lifestyle, comorbidity medication history, and hepatitis B. Results: Over a median 11–12 years, 4,272 all-cause and 219 liver-related deaths occurred. MASLD without advanced fibrosis conferred no excess risk, whereas MASLD with advanced fibrosis carried markedly higher risk—far greater for liver-related (4.04, 2.46–6.64) than all-cause mortality (1.25, 1.05–1.48). Risk-factor profiles diverged. All-cause mortality was associated with vascular comorbidities (stroke 1.69, 1.44–2.00; coronary disease 1.21, 1.10– 1.33), chronic kidney disease (1.38, 1.28–1.49), and hypertension with medication treatment (1.25, 1.16– 1.35). However, these factors were not statistically significant for liver-related death. Conversely, liverrelated death was dominated by hepatitis B (4.31, 3.24–5.74), diabetes (2.93, 2.01–4.26), advanced fibrosis, and heavy alcohol use (2.77, 1.62–4.76). Older age, current smoking and diabetes increased hazard for both endpoints; female sex was protective for both. Conclusions: All-cause mortality reflects cardiometabolic-vascular burden, whereas liverrelated death is governed by hepatitis B, diabetes, and advanced hepatic fibrosis. Steatosis without fibrosis carries no excess risk; fibrosis stage, not steatosis itself, should guide MASLD risk stratification.

⑱

SAFETY AND EFFICACY OF EUS GUIDED RADIOFREQUENCY ABLATION OF PANCREATIC NEUROENDOCRINE TUMOR

Yi-Yeh Chang Division of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Taipei, Taiwan

內視鏡超音波導引射頻消融治療胰臟神經內分泌腫瘤的安全性與療效張以業台北慈濟醫院肝膽腸胃科

Background: Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option for pancreatic neuroendocrine tumors (PNETs), particularly in patients who are poor surgical candidates or decline surgery. Aims: This study aimed to evaluate the safety and efficacy of EUS-guided RFA for the treatment of pancreatic neuroendocrine tumors. Methods: This is multi center retrospective study. Between December 2023 and June 2026, nine patients with histologically confirmed grade 1 PNETs underwent EUS-guided RFA at National Taiwan University Hospital (NTUH) and Taipei Tzu Chi Hospital (TTCH). The cohort included six patients with pancreatic insulinomas and three with nonfunctioning PNETs (NF-PNETs). The diagnosis and tumor grading were established by EUS-guided fine-needle biopsy (FNB) according to the 2022 WHO classification. Following regulatory approval of the EUSRA® catheter (StarMed, Korea) in Taiwan, EUS-guided RFA was performed using a 19-gauge electrode with a 5- or 10-mm active tip, selected according to tumor size. Radiofrequency energy was delivered at 30 W for 20 seconds per application, with the total ablation time determined by real-time tissue impedance. Contrast-enhanced EUS using Sonazoid® was performed before and after ablation to assess treatment efficacy. Complete ablation was defined as hypo-enhancement or absence of enhancement within the treated lesion. Follow-up imaging consisted of contrast-enhanced computed tomography (CECT), contrast-enhanced magnetic resonance imaging, or EUS at 1–2 months after treatment.

105

2026 TDDW

Results: The study included four men and five women, with a mean tumor diameter of 13.9 ± 3.5 mm. The technical and clinical sucessful rate are 100%, resepctively. All six patients with pancreatic insulinoma achieved complete resolution of hypoglycemic symptoms and normalization of blood glucose levels after RFA. One patient experienced recurrence of hypoglycemia one year later and underwent repeat EUS-guided RFA, resulting in successful symptom resolution. All three patients with NF-PNETs demonstrated complete radiologic response on one-month follow-up CECT. Procedurerelated adverse events occurred in one patient who developed a pancreatic pseudocyst, which resolved completely with conservative management. The mean follow-up duration was 25.5 months (range, 7–38 months). Conclusions: EUS-guided RFA is a safe and effective minimally invasive treatment for selected patients with pancreatic neuroendocrine tumors, providing excellent clinical outcomes for insulinomas and encouraging radiologic responses for small NFPNETs. Standardization of ablation protocols, including optimal power settings and treatment duration, remains necessary. Larger prospective studies with long-term follow-up are warranted to determine the durability of treatment, particularly for non-functioning PNETs.

⑲

IMPACT OF FOREGOING A NASOGASTRIC TUBE IN ROBOTIC PANCREATICODUODENECTOMY: A PROPENSITY SCORE-MATCHED STUDY

Tun-Chieh Yu1, Bor-Shiuan Shyr1,2,3, Shin-E Wang1,2,3, Shih-Chin Chen1,2,3, Yi-Ming Shyr1,2,3, Bor-Uei Shyr1,2,3 Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan 2 Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan 3 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

達文西機器手臂輔助胰十二指腸切除手術術後不置放鼻胃管對預後影響之傾向分數配對研究游敦傑1 石柏軒1,2,3 王心儀1,2,3 陳世欽1,2,3 石宜銘1,2,3 石柏威1,2,3 1

臺北榮民總醫院一般外科臺北榮民總醫院胰臟癌治療暨研究中心 3 國立陽明交通大學醫學系 2

Background: The use of nasogastric tube (NGT) decompression after a pancreatoduodenectomy has been traditionally thought to reduce postoperative complications, such as vomiting, wound dehiscence, and anastomotic leaks, but the efficacy was also questioned. Aims: This study aimed to evaluate the feasibility and safety of not using an NGT after a pancreatoduodenectomy. Methods: A total of 906 patients undergoing robotic pancreatoduodenectomy (RPD) or open pancreatoduodenectomy (OPD) were included in this study for propensity score matching. The surgical outcomes of RPD without an NG tube (RPD(-)NGT) were compared with those of RPD with an NG tube (RPD(+)NGT) and OPD with an NG tube (OPD(+)NGT). Results: Each group comprised 100 patients. The RPD groups without and with NGT had less intraoperative blood loss compared to the OPD group, with a median of 155 vs. 200 vs. 500 cc (p < 0.001) and a higher lymph node yield, with a median

106

2026 TDDW

number of 18 vs. 15 vs. 12 (p < 0.001). The surgical outcomes were comparable among the RPD(-) NGT, RPD(+)NGT, and RPD(+)NGT groups, except for delayed gastric emptying (DGE) and length of stay (LOS). The incidence of DGE was significantly lower in the RPD without and with NGT groups than in the OPD(+)NGT group (3% vs. 4% vs. 18%, p < 0.001). The LOS was also shorter in the RPD(-)NGT group, with a median of 17 days, compared to the other two groups with NGT, 22 days and 26 days (p < 0.001). Only the operation type, OPD, remained an independent risk factor for DGE. Conclusions: RPD without NGT was associated with lower incidence of DGE and shorter LOS. It is feasible to forego an NGT in RPD cases without negatively impacting safety.

⑳

COMPARISON OF ENDOSCOPIC ULTRASOUND, COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN STAGING NEOPLASM OF PANCREAS

Chia-Che Wu, Te-Jung Chuang, Jung-Chun Lin, Hsuan-Wei Chen Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan

內視鏡超音波、電腦斷層掃描和磁振造影在胰臟腫瘤分期中的比較吳嘉哲莊得榮林榮鈞陳宣位國防醫學大學三軍總醫院胃腸科

Background: Current imagingbased staging of pancreatic cancer relies primarily on computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS). However, discrepancies are frequently observed between tumor size reported on CT or MRI and the actual size measured after surgery. Aims: Tumor size directly determines T staging and lesions staged above T3 generally warrant neoadjuvant chemotherapy as part of modern treatment guidelines. Thus, accurate preoperative size assessment is clinically essential. As EUS has emerged as a powerful modality in pancreatic tumor detection, its potential to improve the precision of preoperative tumor size estimation warrants investigation. This study aimed to compare the accuracy of EUS with that of CT and MRI in evaluating pancreatic tumor size. Methods: This retrospective single center study included 68 patients with confirmed pancreatic malignancy who underwent surgical intervention, endoscopic ultrasound (EUS), computed tomography or magnetic resonance imaging. Tumor size measured by total en block resection was regarded as the reference standard. Measurements obtained from EUS were compared with those from CT and MRI to evaluate relative precision. The primary outcome was accuracy of evaluating tumor size by different image techniques. Secondary outcomes included size deviation stratified by tumor location: head/uncinate process versus neck/body, and neck/ body versus tail.

107

2026 TDDW

Results: Among patients with tumor size <40 mm, EUS demonstrated significantly lower tumor size deviation (6.008 mm) compared with CT (8.048 mm; p = 0.0192). In secondary analyses, EUS showed significantly smaller deviation in the head/uncinate process group (6.313 mm) compared with the neck/ body group (11.76 mm; p = 0.0246) and tail group (7.214 mm; p = 0.03). Conclusions: EUS provides more accurate tumor size measurements than CT in patients with pancreatic cancer, particularly for tumors <4 cm and those located in the pancreatic head or uncinate process.

㉑

OVERALL SURVIVAL AND STENT PATENCY PERIODS IN MALIGNANT BILIARY OBSTRUCTION: A 20-YEAR REAL-WORLD COMPARISON OF ANATOMICAL SUBSITES, STENT DESIGNS, AND TUMOR BIOLOGY

Chien-Yu Lin1, Kuo-Liang Wei1,2, Yi-Hsing Chen1, Wei-Ming Chen1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

惡性膽道狹窄病患之整體存活與支架暢通：解剖部位、支架設計與腫瘤生物特性之 20 年真實世界對比研究林千友1 魏國良1,2 陳奕行1 陳慰明1,2 1 2

嘉義長庚紀念醫院胃腸肝膽科長庚大學醫學院

Background: In the palliative management of malignant biliary obstruction (MBO), achieving a durable stent patency period that outlasts the patient’s overall survival (OS) is the definitive goal of interventional endoscopy. However, real-world data tracking these twin temporal endpoints across decades remain scarce. It remains unclear whether anatomical stricture locations (extra-hepatic vs. hilar) or synthetic modifications (covered vs. noncovered SEMS) translate into statistically meaningful extensions of patency duration and patient survival, or if these outcomes are ultimately governed by the baseline virulence of the underlying malignancy. Aims: This study aimed to analyze the long-term, real-world durations of OS and stent patency periods in patients receiving metallic biliary stents over a 20-year timeline, explicitly evaluating how these two chronological outcomes are affected by: (1) anatomical stricture location, (2) covered (cSEMS) versus non-covered (ucSEMS) stent designs in extrahepatic obstructions, and (3) specific primary tumor biology. Methods: A retrospective cohort analysis was conducted on patients undergoing metallic biliary stenting for MBO between March 30, 2005, and May 28, 2024, at Chiayi Chang Gung Memorial Hospital. Out of 131 patients, 23 with benign strictures were

108

2026 TDDW

excluded. To prevent early procedural confounding of time-to-event data, patients lost to followup (n = 6), deceased within two weeks (n = 4), or who underwent surgery (n = 1) were excluded, leaving 97 patients for final survival and patency analysis. Chronological endpoints—median OS and cumulative stent patency periods—were calculated using the Kaplan-Meier method and evaluated via the log-rank test. Patients dying with an intact, functional stent were statistically censored at the date of death to ensure precise patency period tracking. Results: The final cohort comprised 97 patients (56.7% male; mean age 70.9 ± 12.9 years) primarily diagnosed with pancreatic (38.1%), biliary (24.7%), and ampullary (22.7%) malignancies, demonstrating an overall cohort mean stent patency period of 34.9±31.1 weeks and a mean survival of 45.7 ± 42.5 weeks. When evaluating anatomical subsites, extra-hepatic strictures demonstrated longer numerical durations for both endpoints compared to hilar strictures, though neither reached statistical significance, with a median OS of 40.0 vs. 25.0 weeks (P = 0.10) and a median stent patency period of 40.0 vs. 25.0 weeks (P = 0.23). Regarding stent design in the extra-hepatic subgroup, pre-recurrent biliary obstruction (RBO) mortality occurred in 61.1% (n = 44) of cSEMS and 76.9% (n = 10) of ucSEMS patients. While membrane covering provided a distinct numerical extension in patency duration (median 285.0 days for cSEMS vs. 185.0 days for ucSEMS; P = 0.417), it failed to influence patient longevity, with nearly identical median OS between the two designs (cSEMS: 267.0 days vs. ucSEMS: 248.0 days; P = 0.812). Crucially, inherent tumor biology acted as the primary driver for both temporal endpoints, as patients with pancreatic cancer suffered significantly shorter median OS (247.0 vs. 357.0 days; P = 0.01) and a severely abbreviated median stent patency period (268.0 vs. 836.0 days; P = 0.013) compared to those with cholangiocarcinoma. Conclusions: This 20-year real-world experience confirms that palliative metallic stenting provides robust and highly comparable timelines for overall survival and stent patency, maintaining an overall median patency of 38 weeks. From a prognostic standpoint, inherent tumor biology dictates both patient survival and stent patency periods far more decisively than anatomical location or stent design. While covered SEMS offer a substantial numerical prolongation of the stent patency period by 100

days over non-covered designs, they do not extend overall patient survival. Ultimately, the aggressive nature of pancreatic cancer rapidly truncates both patency and survival timelines, underscoring that mechanical interventions must be tightly coupled with aggressive oncological therapies to achieve true clinical longevity.

109

2026 TDDW

Section：LGI ㉒

ARTIFICIAL INTELLIGENCE– ASSISTED COLONOSCOPY WITH AND WITHOUT ENDOCUFF VERSUS STANDARD COLONOSCOPY: A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Wei-Chung Tsai1, Ying-Nan Tsai2,3, Ming-Hung Hsu1,3, Cheng-Hao Tseng2,3, Ching-Tai Lee1,3, Chi-Chih Wang4,5, Ming-Chang Tsai4,5, Jaw-Town Lin1, Wen-Lun Wang1,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan 3 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 5 School of Medical, Chung Shan Medical University, Taichung, Taiwan 1

人工智慧輔助結合與不結合內視鏡袖套對比標準大腸鏡：多中心隨機對照試驗蔡韙仲1 蔡英楠2,3 徐銘宏1,3 曾政豪2,3 李青泰1,3 汪奇志4,5 蔡明璋4,5 林肇堂1 王文𤦎1,3 1

義大醫院胃腸肝膽科義大癌治療醫院胃腸肝膽科 3 義守大學醫學系 4 中山醫學大學附設醫院胃腸肝膽科 5 中山醫學大學醫學系 2

Background: While artificial intelligence (AI)assisted colonoscopy reduces recognition failures through real-time alerts, the Endocuff (EC) physically flattens mucosal folds to enhance the visualization of concealed polyps. However, despite the distinct mechanisms of these complementary technologies, a knowledge gap remains as to whether their combined use provides an additive benefit to the adenoma detection rate (ADR). Aims: We aimed to evaluate the effect of adding EC to AI-assisted colonoscopy on adenoma detection. Methods: This study was conducted as a prospective, multicenter, single-blind randomized controlled trial

110

(RCT). Eligible patients were randomized in a 1:1:1 ratio into three study arms: AI-assisted colonoscopy combined with Endocuff (EC), AI-assisted colonoscopy alone, or standard colonoscopy. The primary outcome was the adenoma detection rate (ADR). Secondary outcomes included the advanced ADR, polyp detection rate (PDR), sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), polyps per colonoscopy (PPC), and the incidence of adverse events. Results: A total of 1,015 patients were analyzed, with baseline characteristics well-balanced across all groups. The primary outcome, adenoma detection rate (ADR), was significantly higher in both the AI + EC group (49.9%) and the AI-alone group (47.5%) compared to the standard colonoscopy group (36.4%; p < 0.01); however, no significant difference was observed between the AI+EC and AI-alone groups (p = 0.54). Regarding secondary outcomes, APC, PDR, and PPC were significantly higher in both AI-assisted groups than in the standard group. Subgroup analyses revealed that AI intervention improved the detection of diminutive and small (<10 mm) adenomas across both the right and left colon. In contrast, there were no significant differences in the detection of large adenomas (>10 mm), advanced ADR, or SSLDR among the three groups. Finally, no procedure-related adverse events were observed, demonstrating a comparable safety profile. Conclusions: In conclusion, AI-assisted colonoscopy significantly improves adenoma and polyp detection rates (ADR and PDR) compared to standard colonoscopy, driven primarily by enhanced detection of diminutive and small lesions throughout the colon. However, the addition of Endocuff (EC) to AI-assisted colonoscopy provides no cumulative or further clinical benefit over AI alone. These findings suggest that AI assistance is the dominant factor in optimizing mucosal inspection, rendering the routine combination of EC unnecessary for the primary purpose of increasing detection rates.

2026 TDDW

㉓

BEYOND ADR: COMBINATION COLONOSCOPY STRATEGIES IMPROVE ADVANCED ADENOMA DETECTION AND ADENOMA YIELD

Yu-Hsi Hsieh1,2, Yen-Chun Chen1,2 Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Tzu Chi Medical Foundation, Chiayi, Taiwan 2 School of Medicine, Tzu Chi University, Hualien, Taiwan 1

超越 ADR：組合式大腸鏡策略可提高 AADR 與 APC 謝毓錫1,2 陳彥均1,2 1 2

大林慈濟醫院腸胃內科慈濟大學醫學系

Background: Combination colonoscopy strategies may improve lesion detection by integrating complementary technologies such as computeraided detection, image-enhanced endoscopy, mucosal exposure devices, water exchange, chromoendoscopy, or computer-aided quality assessment. Although many individual strategies improve adenoma detection rate (ADR), whether combination strategies improve clinically meaningful outcomes beyond an already active comparator remains uncertain. Aims: To evaluated the effects of A+B combination strategies compared with active comparators on ADR, advanced adenoma detection rate (AADR), and adenomas per colonoscopy (APC). Methods: We performed a meta-analysis of randomized trials comparing a protocolized combination colonoscopy strategy, A+B, with an active comparator representing one component of the combination. The primary outcome for this abstract was AADR. Supporting outcomes were ADR and APC. Random-effects meta-analysis was performed using risk difference (RD) and risk ratio (RR) for binary outcomes and mean difference (MD) for APC. When binary outcomes were reported as percentages with arm denominators but without event counts, event counts were reconstructed by rounding the reported percentage multiplied by the corresponding denominator. Reconstructed-count contrasts were flagged and evaluated in sensitivity analyses. Results: The final ADR analysis included 18 contrasts

from 16 studies, all weightable. Combination strategies significantly improved ADR compared with active comparators, with a pooled RD of 5.37 percentage points (95% CI, 2.92 to 7.82; I² = 34.9%) and pooled RR of 1.11 (95% CI, 1.05 to 1.16; I² = 39.3%). For AADR, 12 contrasts from 10 studies were included. Combination strategies significantly improved AADR, with a pooled RD of 1.86 percentage points (95% CI, 0.55 to 3.17; I² = 0.0%) and pooled RR of 1.16 (95% CI, 1.01 to 1.32; I² = 1.1%). For APC, 9 weightable contrasts were included. Combination strategies increased adenoma yield, with a pooled MD of 0.18 adenomas per colonoscopy (95% CI, 0.15 to 0.22; I² = 0.0%). Clean withdrawal-time analysis was limited to compatible workbook-prespecified definitions. Serrated lesion detection and regional ADR outcomes were treated as exploratory because of definition heterogeneity. Conclusions: Compared with active comparators, combination colonoscopy strategies significantly improve ADR, AADR, and APC. The improvement in AADR suggests that the benefit of combining colonoscopy enhancement strategies extends beyond detection of any adenoma alone and may include more clinically relevant neoplasia. Future trials should standardize reporting of advanced adenoma, serrated lesion, regional detection, and withdrawal-time outcomes to better define the clinical value of combination strategies.

111

2026 TDDW

㉔

OUTCOMES OF T1 COLORECTAL ADENOCARCINOMA AFTER ENDOSCOPIC AND SURGICAL MANAGEMENT: A FIVE-YEAR REALWORLD EXPERIENCE

Kuan-Ju Chen, I-Hong Harn, Yu-Jou Tsai, Ching-Yang Tsai Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan

T1 期大腸直腸腺癌內視鏡與外科治療之臨床預後：五年真實世界經驗陳冠儒韓逸宏蔡毓洲蔡青陽阮綜合醫院肝膽腸胃科

Background: T1 colorectal adenocarcinoma may be treated by endoscopic resection in selected patients, whereas radical surgery remains important for lesions with high-risk pathological features. Realworld outcomes of different treatment strategies, including additional surgery after endoscopic resection, remain clinically relevant. Aims: To evaluate the real-world oncologic outcomes of patients with T1 colorectal adenocarcinoma managed with endoscopic or surgical treatment and to assess the impact of additional surgery following endoscopic resection on recurrence and survival. Methods: We retrospectively reviewed 146 patients with T1 colorectal adenocarcinoma treated between 2020 and 2024. Treatment was classified as endoscopic/local excision or surgical colectomy. A secondary analysis categorized patients into primary surgery, endoscopic treatment only, and endoscopic treatment followed by additional surgery. Patients with unknown recurrence status were excluded from recurrence and disease-free survival analyses. Disease-free survival was estimated using Kaplan– Meier analysis and compared with the log-rank test. Results: Among 146 patients, the mean age was 65.7 years and 61.6% were male. Tumors were located in the colon in 68.5%, rectosigmoid junction in 5.5%, and rectum in 26.0%. In the primary analysis, 83 patients underwent endoscopic/local excision and 63 underwent surgical colectomy. Recurrence occurred in 4.9% of the endoscopic/local excision group and 1.6% of the surgical group (P = 0.388). Five-year DFS was 94.5% and 98.3%, respectively (log-rank P = 0.257). In the secondary analysis,

112

recurrence occurred in 1.8% of primary surgery, 5.1% of endoscopic treatment only, and 2.2% of endoscopic treatment followed by additional surgery (P = 0.594). Five-year DFS was 98.1%, 94.2%, and 97.6%, respectively (log-rank P = 0.572). Conclusions: In this five-year real-world cohort of T1 colorectal adenocarcinoma, recurrence was uncommon across all treatment strategies. Endoscopic treatment only showed numerically higher recurrence than primary surgery or endoscopic treatment followed by additional surgery, but the differences were not statistically significant. Selective additional surgery after endoscopic resection may provide favorable oncologic outcomes in appropriately selected patients.

2026 TDDW

㉕

IS THERE STILL ROOM TO IMPROVE? INCREMENTAL ADR GAIN BEYOND ACTIVE COLONOSCOPY STRATEGIES

Yen-Chun Chen1,2, Yu-Hsi Hsieh1,2 Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 2 School of Medicine, Tzu Chi University, Hualien, Taiwan 1

是否仍有提升空間？超越既有積極大腸鏡操作策略後，腺瘤偵測率的進一步提升陳彥均1,2 謝毓錫1,2 1 2

大林慈濟醫院慈濟大學醫學系

Background: Several colonoscopy enhancement strategies improve adenoma detection, but the residual benefit of adding a second strategy to an already active comparator remains uncertain. Aims: We evaluated incremental adenoma detection rate (ADR) gain from combination strategies and explored whether this gain was attenuated when active-comparator ADR was already high. Methods: We performed an exploratory contrastlevel analysis of randomized trials comparing a protocolized combination strategy, A+B, with an active comparator representing one component of the combination. Incremental ADR gain was defined as ADR in the combination arm minus ADR in the active-comparator arm. Contrasts were categorized by active-comparator domain and added-component domain using prespecified categories: computer-aided detection (CADe), water exchange, mucosal exposure, image-enhanced endoscopy, chromoendoscopy, and computeraided quality assessment. Weighted summaries were calculated using inverse-variance weights. Weighted regression examined the association between active-comparator ADR and incremental ADR gain. Results: Eighteen main A+B versus activecomparator ADR contrasts from 16 study IDs were included. Overall mean incremental ADR gain was 5.36 percentage points, median gain was 4.60 percentage points, and weighted mean gain was 5.45 percentage points (95% CI, 3.53 to 7.37). Incremental ADR gain was positive in 16 of 18 contrasts.

Incremental gains were generally positive across active-comparator and added-component domains. In exploratory domain-level summaries, gains were most consistently observed when mucosal exposure or CADe was the added component, while sparse categories were interpreted descriptively. These domain-level summaries were not treated as formal evidence of between-domain superiority. In weighted regression, higher active-comparator ADR was associated with smaller incremental ADR gain. Each 10-percentage-point higher active-comparator ADR was associated with a 2.79-percentage-point smaller incremental ADR gain (95% CI, −5.22 to −0.36; p = 0.024). The negative direction was retained in sensitivity analyses excluding reconstructed-count contrasts, duplicate-aware analysis, unweighted regression, and leave-one-study-out analysis. Conclusions: Combination colonoscopy strategies usually provided additional ADR gain beyond active comparators, but the magnitude of benefit appeared smaller when active-comparator ADR was higher. These findings suggest possible attenuation of residual incremental benefit and are hypothesisgenerating rather than proof of a ceiling effect or definitive superiority of one component domain.

113

2026 TDDW

㉖

FROZEN PATHOLOGY FOUNDATION MODELS ENABLE ACCURATE PREDICTION OF MICROSATELLITE INSTABILITY FROM ROUTINE H&E HISTOPATHOLOGY IN COLORECTAL CANCER

Ngoc Huyen Nguyen1,2, Kim Ngan Ly1,2, Nguyen Quoc Khanh Le1,2 Fulbright University Vietnam, Vietnam Taipei Medical University, Taiwan

1 2

Background: Microsatellite instability (MSI) is an established biomarker for prognosis and selection of immune checkpoint inhibitors in colorectal cancer (CRC). However, confirmatory molecular testing using immunohistochemistry (IHC), polymerase chain reaction (PCR), or next-generation sequencing (NGS) may not be readily available in all clinical settings. Recent pathology foundation models trained on large-scale histopathology datasets have demonstrated strong generalizable image representations and may enable AI-assisted MSI prescreening directly from routine hematoxylin and eosin (H&E)-stained slides. Aims: To evaluate the feasibility of frozen pathology foundation model embeddings for predicting MSI status from routine H&E histopathology images in colorectal cancer and to compare the performance of two representative pathology foundation models using simple downstream classifiers. Methods: Tumor-only H&E image tiles from TCGACOAD and TCGA-READ were linked to MANTISderived MSI labels obtained from the TCGA PanCancer Atlas. Patients were classified as MSI-high (MSI-H; MANTIS ≥0.4) or microsatellite stable (MSS; MANTIS <0.4), while MSI-low and incomplete cases were excluded. A total of 206 patients (82 MSI-H and 124 MSS) represented by 210 diagnostic slides were included. Frozen UNI and CONCH pathology foundation models were used to extract tile-level image embeddings without model fine-tuning. Patient-level representations were generated by hierarchical mean pooling, and logistic regression, support vector machine (SVM), and XGBoost classifiers were trained using patient-level stratified five-fold cross-validation. Model performance was evaluated using pooled out-of-fold AUROC, AUPRC, sensitivity, specificity, accuracy, and 95% confidence intervals obtained by patient-level bootstrap resampling (2,000 replicates).

114

Results: Both pathology foundation models successfully captured discriminative histomorphologic features associated with MSI. Among all evaluated models, frozen UNI embeddings combined with logistic regression achieved the best overall performance, with an AUROC of 0.855 (95% CI, 0.799–0.906), AUPRC of 0.788 (95% CI, 0.690–0.881), sensitivity of 72.0%, specificity of 80.6%, accuracy of 77.2%, and F1-score of 0.715. SVM achieved comparable discrimination (AUROC 0.853), while XGBoost yielded the highest specificity (83.9%). Interestingly, UNI achieved optimal performance using a simple linear classifier, whereas CONCH required the more flexible XGBoost classifier to achieve comparable discrimination (AUROC 0.856, 95% CI 0.801–0.903). Visualization of patient-level embedding space demonstrated clear separation between MSI-H and MSS cases, supporting the biological relevance of the learned representations. Conclusions: Frozen pathology foundation models enable accurate prediction of MSI status from routine H&E histopathology without task-specific model fine-tuning. The comparable performance achieved by two independent foundation models, together with the strong results obtained using a simple linear classifier, suggests that pretrained pathology representations encode clinically meaningful MSI-associated morphologic features. These findings support further development of pathology foundation models as practical AI-assisted prescreening tools for colorectal cancer, with future validation in external multicenter cohorts.

2026 TDDW

Section：HCC ㉗

FIRST-LINE ATEZOLIZUMABBEVACIZUMAB VERSUS DURVALUMAB-TREMELIMUMAB IN UNRESECTABLE HEPATOCELLULAR CARCINOMA: A REAL-WORLD, PROPENSITY SCORE-MATCHED ANALYSIS FROM TAIWAN

Ming-Feng Chiang1, Wei Teng1,2,3, Po-Ting Lin1,2,3, Yi-Chung Hsieh1,2, Tsung-Han Wu2,4, Wei-Ting Chen1,2, Chen-Chun Lin1,5, Shi-Ming Lin1,2, Chun-Yen Lin1,2 Division 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 Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 4 Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 5 Division of Gastroenterology and Hepatology, New Taipei Municipal City Tucheng Hospital, New Taipei City, Taiwan 1

第一線 Atezolizumab-Bevacizumab 與 Durvalumab-Tremelimumab 治療不可切除肝細胞癌之比較：台灣真實世界傾向分數配對分析江明峰1 滕威1,2,3 林伯庭1,2,3 謝彝中1,2 吳宗翰2,4 陳威廷1,2 林成俊1,5 林錫銘1,2 林俊彥1,2 1

林口長庚紀念醫院胃腸肝膽科長庚大學醫學院 3 林口長庚紀念醫院肝臟研究中心 4 林口長庚紀念醫院外科部 5 新北市立土城醫院胃腸肝膽科 2

Background: Atezolizumab plus bevacizumab (A+B) and durvalumab plus tremelimumab (D+T) are established immunotherapy-based combinations that are the first-line standard of care for unresectable hepatocellular carcinoma (uHCC). However, in the absence of a head-to-head randomized trial, the comparative effectiveness of these mechanistically distinct regimens remains undefined, particularly in Asian hepatitis B-predominant cohorts that are underrepresented in pivotal phase III trials.

Aims: This study aimed to compare the real-world effectiveness and safety of A+B versus D+T as firstline treatment for uHCC in a Taiwanese cohort, and to identify clinical factors associated with survival outcomes. Methods: We conducted a single-center retrospective cohort study of patients with uHCC receiving first-line A+B or D+T. To emulate target trial conditions, variable-ratio propensity score matching was performed using age, sex, tumor size, extrahepatic spread, and prior locoregional therapy. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR) according to mRECIST, and treatment-related adverse events graded by CTCAE v5.0. Prognostic factors were evaluated using Cox proportional hazards models. Results: The matched cohort included 152 patients, comprising 109 treated with A+B and 43 treated with D+T. Baseline characteristics were generally balanced between groups. D+T showed a numerical trend toward improved OS compared with A+B, but this did not reach conventional statistical significance in Cox analysis (HR 0.41, 95% CI 0.16–1.04; p = 0.060). PFS was not significantly different between regimens (HR 1.37, 95% CI 0.87–2.15; p = 0.171). Treatment response was also comparable, with ORR of 33.0% for A+B and 37.2% for D+T, and DCR of 67.9% and 58.1%, respectively. In multivariate analysis, immunerelated liver injury was independently associated with improved OS (HR 0.47, 95% CI 0.27–0.82; p = 0.008), whereas younger age and prior locoregional therapy were independently associated with longer PFS (age per 10 years: HR 0.79, 95% CI 0.67–0.94; p = 0.009; prior locoregional therapy: HR 0.61, 95% CI 0.39–0.93; p = 0.023). Toxicity profiles were regimenspecific. D+T was associated with a higher rate of grade ≥3 rash (9.3% vs. 0.9%; p = 0.023), whereas A+B showed numerically more VEGF-related events such as proteinuria, hypertension, and gastrointestinal bleeding, although these differences were not statistically significant. Conclusions: In this propensity score-matched realworld Asian cohort, A+B and D+T demonstrated comparable OS, PFS and response outcomes. Prognosis appeared to be influenced more by treatment-related immune activation and prior locoregional therapy than by regimen selection alone. These findings support individualized firstline treatment selection based on clinical context and toxicity considerations.

115

2026 TDDW

㉘

FROM VIRAL SUPPRESSION TO METABOLIC SURGE: THE CHANGING EPIDEMIOLOGICAL LANDSCAPE AND AGING TRENDS OF HEPATOCELLULAR CARCINOMA OVER 38 YEARS IN TAIWAN

You-Sheng Fang1, Jing-Houng Wang2, Kwong-Ming Kee2, Chao-Hung Hung2, Chien-Hung Chen2, Sheng-Nan Lu3 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jen-Ai Hospital, Taichung, Taiwan 1

從病毒控制到代謝激增：銜接台灣肝癌 38 年流行病學轉變與高齡化趨勢方友聖1 王景弘2 紀廣明2 洪肇宏2 陳建宏2 盧勝男3 1

長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系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 3 仁愛醫療財團法人大里仁愛醫院胃腸肝膽科 2

Background: Over the past four decades, Taiwan’s medical interventions—such as the universal hepatitis B virus (HBV) vaccination, serum biomarkers for hepatitis viruses and expanding antiviral therapies—have significantly transformed the epidemiological landscape of hepatocellular carcinoma (HCC). However, despite the decline in viral hepatitis, the overall HCC burden remains substantial, likely driven by emerging metabolic and lifestyle-related risks. Previous nationwide multicenter studies only provided fragmented historical periods (1981–2001 and 2011–2019), leaving a critical temporal gap in the comprehensive longitudinal narrative of HCC evolution in Taiwan. Aims: This study utilizes a large, 38-year single-center database to investigate the long-term secular trends of HCC etiologies in Taiwan. By comparing findings during overlapping periods with prior nationwide

116

multicenter studies, we aim to validate our singlecenter data as representative of the national landscape, bridge the historical temporal gaps, and clarify the shifting epidemiological trajectories post2019. Methods: This longitudinal single-center study included 20,048 patients diagnosed with HCC at Kaohsiung Chang Gung Memorial Hospital between the years 1986 and 2023. Annual proportions of HBsAg positivity were evaluated across the entire 38-year span. For detailed viral etiology distribution, 19,140 patients diagnosed from 1994 to 2023 were stratified into four groups: HBV-related (B-HCC), HCV-related (C-HCC), HBV plus HCV-related (B+CHCC), and non-HBV/non-HCV-related (NBNC-HCC). Secular trends in etiological proportions, mean age at diagnosis, male-to-female (M:F) ratios and segmented trend were analyzed. Results: Between 1986 and 2023, overall HBsAg prevalence among HCC patients declined significantly from 75.9% to 50.6%, driven by a sharp decrease in male patients from 79.7% to 54.4% (both p < 0.001). Segmented analysis showed that this decline was significant from 1986 to 2011 (p < 0.001) but leveled off into a stable plateau during 2012–2023 for both overall (p = 0.887) and male populations (p = 0.468). From 1994 to 2023, C-HCC overall exhibited an initial rise followed by a subsequent decline. Conversely, B+C-HCC declined and NBNC-HCC increased significantly across all three groups (all p < 0.001). From 1994 to 2023, the mean age at HCC diagnosis increased significantly across all populations and etiologies (p < 0.001), with female patients consistently older than males, and B-HCC patients remaining the youngest. Segmented analysis using the 2006 National Health Insurance reimbursement expansion for antiviral therapies as a landmark cutoff revealed a profound shift: prior to 2006, the diagnostic age remained statistically unchanged for the majority of subgroups. In sharp contrast, a significant and sustained upward aging trend emerged post-2006 across all viral etiologies and both genders (all p < 0.05). The overall male-tofemale ratio of HCC patients decreased significantly (p < 0.001). B-HCC consistently exhibited the highest male predominance but showed a marked decline in its sex ratio from 8.61 to 4.02 (p < 0.001). C-HCC consistently maintained the lowest sex ratio among all groups. Conclusions: Our large-scale single-center data mirrors prior nationwide trends during overlapping

2026 TDDW

periods, validating its national representativeness, bridging historical gaps, and clarifying post-2019 trajectories. The 38-year etiological evolution reflects shifting policies and lifestyles: B-HCC has entered a stable plateau, C-HCC exhibited an initial rise before decreasing, while NBNC-HCC experienced a sustained surge. Furthermore, a significant aging trend emerged across all etiologies, turning particularly pronounced after the 2006 NHI antiviral reimbursement expansion. These shifting paradigms highlight an urgent need for public health strategies to pivot toward prevention, targeting metabolic and lifestyle-related risks to reduce future HCC development.

㉙

EFFICACY OF CARBON-ION RADIATION THERAPY FOR HEPATOCELLULAR CARCINOMA ACROSS DIFFERENT BCLC STAGES: A SINGLE-CENTER EXPERIENCE

Min-Chi Chang1, Keng-Hsin Lan1,2 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 1

重粒子放射治療於不同 BCLC 分期肝細胞癌之療效：單中心經驗張閔期1 藍耿欣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: Carbon-ion radiotherapy (CIRT) combines highly conformal dose delivery with enhanced biological effectiveness and may offer therapeutic advantages over conventional photon radiotherapy. Although CIRT is increasingly recognized as a noninvasive treatment option for hepatocellular carcinoma (HCC), stage-specific evidence in HCC remains limited, particularly in Taiwan. Aims: This study evaluated the effectiveness and safety of CIRT across Barcelona Clinic Liver Cancer (BCLC) stages in patients with HCC treated at Taipei Veterans General Hospital. Methods: We retrospectively evaluated 62 patients with treatment-naïve, residual, or recurrent HCC who underwent CIRT between August 2022 and September 2025. Patients were stratified according to imaging-based BCLC stage at CIRT initiation into an early-stage group (BCLC A) and an intermediateto-advanced-stage group (BCLC B/C). Outcomes included all-cause mortality, objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS). Survival outcomes were estimated using the Kaplan–Meier method and compared using the log-rank test. Categorical variables were compared using the chisquare test. Results: Of the 62 enrolled patients, 55 had more than 6 months of follow-up and were included in the final analysis: 31 with BCLC A disease and 24 with BCLC B/C disease. The median follow-up duration was

117

2026 TDDW

20.0 months. ORR was 81% in the BCLC A group and 77% in the BCLC B/C group (p = 0.556), whereas DCR was 97% and 100%, respectively (p = 0.395). Death occurred in 10% and 25% of patients, respectively (p = 0.128). Median OS was not reached in either group, and OS did not differ significantly between groups (log-rank p = 0.158). Median PFS was 17.8 months in the BCLC A group and 15.7 months in the BCLC B/C group (log-rank p = 0.338). Conclusions: CIRT achieved favorable tumor response and disease control across BCLC stages. ORR, DCR, OS, and PFS did not differ significantly between patients with BCLC A and BCLC B/C disease. Although limited by its retrospective design, small sample size, and relatively short follow-up, this study supports CIRT as a potentially effective local treatment option for selected patients with HCC.

㉚

COMPARATIVE EFFECTIVENESS AND SAFETY OF ATEZOLIZUMAB– BEVACIZUMAB AND DURVALUMAB– TREMELIMUMAB AS FIRSTLINE SYSTEMIC THERAPY FOR HEPATOCELLULAR CARCINOMA: A REAL-WORLD STUDY

Jia-Jie Zhong1, Shu Hsien Lin2, Jia-Ling Wu3, Ying-Nan Tsai4, Cheng-Hao Tseng4,5,6, Chi-Yang Chang7, Po-Yueh Chen2, Yao-Chun Hsu3,5,6 Division of Gastroenterology and Hepatology, E-DA Hospital, Kaohsiung, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan 3 Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 4 Division of Gastroenterology and Hepatology, E-DA Cancer Hospital, Kaohsiung, Taiwan 5 Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan 6 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan 7 Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan 1

比較 Atezolizumab–Bevacizumab 與 Durvalumab–Tremelimumab 作為肝細胞癌第一線全身性治療之療效與安全性：真實世界研究鍾佳劼1 林淑賢2 吳嘉玲3 蔡英楠4 曾政豪4,5,6 張吉仰7 陳柏岳2 許耀峻3,5,6 1

義大醫院胃腸肝膽科嘉義基督教醫院胃腸肝膽科 3 義大醫院醫學研究部 4 義大癌治療醫院胃腸肝膽科 5 義守大學醫學研究所 6 義守大學醫學系 7 天主教輔仁大學附設醫院內科部 2

Background: Atezolizumab plus bevacizumab (Atezo/Bev) and durvalumab plus tremelimumab (Durva/Treme) are established first-line therapies for advanced hepatocellular carcinoma (HCC). However, direct comparisons between these regimens remain

118

2026 TDDW

limited. Aims: This study aimed to evaluate their comparative effectiveness and safety. Methods: We conducted a retrospective cohort study within the TriNetX Global Collaborative Network, including adults with HCC who initiated Atezo/Bev or Durva/Treme as first-line systemic therapy between October 1, 2022, and October 31, 2025. Outcomes were defined using standardized diagnostic, procedural, and medication codes. Propensity score matching (1:1) was applied to minimize baseline differences between groups. Results: Among 3,362 eligible patients, 765 matched pairs were included in the final analysis. Over a median follow-up of 14.8 months for Atezo/Bev and 17.5 months for Durva/Treme, overall survival was comparable between the regimens (median 14.6 vs. 17.3 months; aHR 0.96; 95% CI 0.83–1.12). Safety outcomes were broadly similar, including gastrointestinal bleeding (aHR 0.88; 95% CI 0.68– 1.13), and non-gastrointestinal bleeding (aHR 1.06; 95% CI 0.60–1.89). Treatment-requiring immunerelated adverse events (irAEs) occurred significantly less frequently with Atezo/Bev (aHR 0.61; 95% CI 0.48–0.77), with curve separation evident early after treatment initiation. Incident hypertension was numerically more frequent with Atezo/Bev but was not statistically significant (aHR 1.24; 95% CI 0.87– 1.76). Conclusions: Atezo/Bev and Durva/Treme demonstrated similar overall survival in patients with HCC, with largely comparable safety profiles. The lower rate of treatment-requiring immunerelated adverse events observed with Atezo/Bev may assist clinicians in tailoring regimen selection for individuals with advanced HCC.

㉛

ARID1A DEFICIENCY SENSITIZES ANTI-PD-L1 THERAPY IN HEPATOCELLULAR CARCINOMA VIA CHEMOTAXIS REPROGRAMMING

Hsin-Yu Kuo1,2,3, Chun-Yuan Chen1,2, Huang-Pin Chen1,2, Hung-Tsung Wu2,3, 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 Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan 3 Tong-Yuan Diabetes Center, College of Medicine, National Cheng Kung University, Tainan, Taiwan 1

AT-Rich Interaction Domain 1A 缺失透過趨化性重編程增強肝細胞癌對抗 PD-L1 免疫治療之敏感性郭欣瑜1,2,3 陳俊元1,2 陳煌斌1,2 吳泓璁2,3 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系內科 3 國立成功大學醫學院東原糖尿病研究中心 2

Background: AT-rich interactive domaincontaining protein 1A (ARID1A) mutations occur in approximately 15% of hepatocellular carcinomas (HCC), yet the role of ARID1A in the tumor immune microenvironment remains uncharacterized. Aims: This study investigated the effects of ARID1A on responses to anti-PD-L1 immunotherapy through underlying metabolic and chemotaxis reprogramming. Methods: We measured ARID1A expression by real-time PCR, and retrospectively analyzed the relationship among ARID1A levels, overall survival and tumor-infiltrating lymphocytes (TIL). A lentiviral vector containing short hairpin RNA targeted to ARID1A was used to knockdown ARID1A expression in Mus musculus Hepa1-6 cell line. Syngeneic mouse tumor models were further established to evaluate the in vivo therapeutic synergy of ARID1A deficiency combined with anti-PD-L1 blockade (Atezolizumab). Results: Clinically, HCC patients with lower ARID1A expressins exhibited significantly prolonged overall survival and markedly elevated CD8+

119

2026 TDDW

TIL infiltration than those of higher expressions. Deletion of ARID1A downregulates Arginase-1 (Arg1) expression, leading to intracellular arginine depletion. This unique metabolic stress condition triggers a profound, compensatory transcriptional activation and secretion of T-cell recruiting chemokines, including CXCL9, CXCL10, and CXCL11. ARID1A-knockdown desensitized to anti-PD-L1 therapy, resulting in dramatic, synergistic tumor progression and a decreased influx of active T cells in an HCC-bearing mice model. This observation was significantly reversed by arginine supplement. Conclusions: ARID1A deficiency drives intrinsic arginine metabolic reprogramming to foster an inflamed microenvironment. Consequently, ARID1A levels possibly serve as a predictive clinical biomarker for anti-PD-L1 efficacy in patients with HCC.

㉜

DETECTION OF T CELL INFILTRATION IN TUMOR TISSUES IS A POTENTIALLY PHARMACODYNAMIC MARKER ASSOCIATED WITH RESPONSE OF ΑPD-L1 IMMUNOTHERAPEUTIC EFFICACY

Chun-Chia Cheng1, Hua-Ching Lin2,3, Zong-Lin Sie1, Ai-Sheng Ho4,5 Research Center of Radiation Medicine, Chang Gung University, Taoyuan, Taiwan 2 Division of Colorectal Surgery, Chen-Hsin General Hospital, Taipei, Taiwan 3 Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan 4 Division of Gastroenterology, Cheng Hsin General Hospital, Taipei, Taiwan 5 School of Medicine, National Defense Medical University, Taipei, Taiwan 1

測定腫瘤組織中 T 細胞浸潤做為 αPD-L1 免疫治療的藥物動態反應生物標記程俊嘉1 林華卿2,3 謝宗霖1 何愛生4,5 1

長庚大學放射醫學研究中心振興醫院大腸直腸外科 3 銘傳大學醫療資訊與管理學系 4 振興醫院腸胃科 5 國防醫學大學醫學系 2

Background: Programmed death-ligand 1 (PD-L1) detection is widely used as a biomarker for guiding anti-PD-(L)1 immunotherapy. However, its predictive value for therapeutic response remains inconsistent, and reliable markers for identifying dynamic responders are still needed in clinical practice. We propose that direct detection of T cell infiltration within the tumor microenvironment may be a potential pharmacodynamic marker in determining anti-PD-(L)1 immunotherapeutic efficacy. Aims: This study aimed to evaluate whether detection of T cell infiltration serves as a pharmacodynamic marker for anti-PD-(L)1 immunotherapy efficacy and to characterize the therapeutic potential of a newly engineered anti-PD-L1 (scFv-Fc) in different tumor mouse models. Methods: Murine colorectal cancer CT26 (MSS/ pMMR,“hot tumor”with anti-PD-(L)1-responsive) and Lewis lung carcinoma LL/2 (“cold tumor” with non-

120

2026 TDDW

Section：IBD responsive) tumor models were utilized. Expression levels of PD-L1, IFNG, IRF1, CXCL9, and CXCL10 were analyzed by qPCR. An anti-PD-L1 (scFv-Fc) fusion protein was generated, and its tumor accumulation was assessed using nuclear imaging techniques. Therapeutic efficacy was evaluated by tumor growth inhibition assays. Immunohistochemistry (IHC) was performed to assess CD3+ and CD8+ T cell infiltration following treatment. Results: We found that CT26 tumors exhibited higher expression of PD-L1, IFNG, IRF1, CXCL9, and CXCL10, consistent with a T-cell-inflamed tumor microenvironment. Nevertheless, flow cytometry revealed that surface PD-L1 expressed highly in both LL/2 and CT26 tumor cells. Nuclear imaging assay confirmed a preferential accumulation of antiPD-L1 (scFv-Fc) in PD-L1-positive tumor tissues. The anti-PD-L1 (scFv-Fc) treatment significantly suppressed tumor growth in CT26-derived tumors but showed no effect in LL/2-derived tumors. IHC analysis demonstrated increased CD3+ and CD8+ T cell infiltration in CT26 tumors following treatment, whereas LL/2 tumors showed no apparent change. Conclusions: These findings demonstrate that T cellinflamed CT26 tumors (“hot tumor”) are responsive to anti-PD-L1 therapy and support the use of T cell infiltration as a pharmacodynamic biomarker of anti-PD-L1 immunotherapeutic efficacy.

㉝

INCREASING TRENDS AND SOCIODEMOGRAPHIC DISPARITIES IN THE PREVALENCE AND INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN TAIWAN: A NATIONWIDE POPULATION-BASED STUDY OVER A TEN-YEAR PERIOD

Yi-Hua Wu1,2,3,4, Tsai-Chung Li2,5, Cheng-Chieh Lin2,5 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan 3 Taiwan Association for the Study of Intestinal Diseases (TASID) 4 Taiwan Society of Inflammatory Bowel Disease (TSIBD) 5 Preventive Medicine Center, China Medical University Hospital, Taichung, Taiwan 1

台灣發炎性腸道疾病（IBD）盛行率與發生率的變化趨勢及社會人口學因素對疾病負擔的影響吳宜樺1,2,3,4 李采娟2,5 林正介2,5 1

中國醫藥大學附設醫院消化內科中國醫藥大學醫學系 3 台灣腸道醫學會 4 台灣發炎性腸道疾病學會 5 中國醫藥大學附設醫院預防醫學中心 2

Background: The prevalence of inflammatory bowel disease (IBD) has increased substantially in Asian countries over recent decades, potentially driven by rapid industrialization, westernized dietary patterns, and lifestyle transitions. However, comprehensive nationwide epidemiological data regarding temporal trends and sociodemographic disparities in Taiwan remain limited. Aims: This study aimed to investigate annual trends in the prevalence and incidence of IBD and evaluate associated sociodemographic factors in Taiwan from 2011 to 2021. Methods: A nationwide population-based study was conducted using data from Taiwan’s National Health Insurance (NHI) program and the Catastrophic Illness Patient Database. Patients diagnosed with IBD were identified using the International

121

2026 TDDW

Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) codes. Annual prevalence and incidence rates were calculated and stratified by age, sex, insurance premium level, and degree of urbanization. Logistic regression analyses were performed to estimate associations between sociodemographic characteristics and IBD burden. Joinpoint regression analyses were used to evaluate temporal trends in age-standardized prevalence and incidence rates from 2011 to 2021. Results: The age-standardized prevalence of IBD increased from 9.56 per 100,000 population in 2011 to 19.54 per 100,000 population in 2021, representing an annual percent change (APC) of 7.35%. During the same period, the incidence rate increased from 0.89 to 2.46 per 100,000 population, with an APC of 11.04%. Males consistently exhibited higher prevalence and incidence rates than females throughout the study period. The highest prevalence was observed among individuals aged 50–60 years, those with higher income levels, and residents of highly urbanized areas. Incidence peaked among individuals aged 40–50 years and was also significantly elevated in higher-income populations. Temporal analyses demonstrated a persistent upward trend across most sociodemographic strata. Conclusions: The prevalence and incidence of IBD in Taiwan increased markedly between 2011 and 2021. The disease burden was disproportionately higher among males, middle-aged adults, higherincome groups, and residents of highly urbanized regions. These findings highlight the growing public health impact of IBD in Taiwan and underscore the importance of targeted prevention strategies and healthcare resource allocation for high-risk populations.

122

㉞

SHORT-TERM OUTCOMES OF RISANKIZUMAB AND MIRIKIZUMAB TREATMENT FOR ULCERATIVE COLITIS

Tadashi Ichimiya¹, Masakatsu Fukuzawa¹, Naoki Yoshimura¹,², Takao Itoi¹ ¹Department of Gastroenterology and Hepatology, Clinical Medicine, Tokyo Medical University Hospital, Tokyo, Japan ²Ohori IBD Clinic, Tokyo, Japan Background: The anti-interleukin-23p19 (IL-23p19) monoclonal antibodies risankizumab (RIS) and mirikizumab (MIRI) are new therapeutic options for moderate-to-severe ulcerative colitis (UC). Aims: This study evaluated the short-term outcomes of RIS and MIRI up to 12 weeks in UC patients at our institution. Methods: This study included 21 UC patients who initiated RIS (n = 7) or MIRI (n = 14) by September 2025. Disease activity up to 12 weeks was evaluated using the Partial Mayo Score (PMS). Clinical response was defined as a PMS decrease of ≥2 points. Clinical remission was defined as PMS ≤1 with a rectal bleeding subscore of 0. Results: The male/female distribution was 4/3 (RIS) and 8/6 (MIRI). Median age at induction was 46 (range: 25–66) years for RIS and 49 (30–67) years for MIRI. Median disease duration was 17 (7–29) years for RIS and 10 (4–27) years for MIRI. Disease phenotypes (RIS/MIRI) were pancolitis in 5/8 patients, left-sided colitis in 2/4, and proctitis in 0/2. Prior to induction, 5/9 patients had a molecular-targeted therapy history, and 2/5 were bio-naive (prior exposures included IFX: 3/0, ADA: 2/4, GLM: 2/5, UST: 1/5, VDZ: 1/1, FIL: 1/1, TFZ: 1/0, UPA: 0/1; overlapping cases included). Median baseline PMS was 3 (1–6) for RIS and 5 (3–7) for MIRI. At 12 weeks, clinical remission rates were 100% (7/7) for RIS and 64% (9/14) for MIRI. Clinical response rates were 71% (5/7) for RIS and 86% (12/14) for MIRI. Primary non-response occurred in two patients in the MIRI group. No adverse events were reported at 8 weeks. Conclusions: At 12 weeks, clinical remission and response rates showed no significant differences between the RIS and MIRI groups (p = 0.123 and p = 0.574, respectively). Both RIS and MIRI are effective for remission induction in UC patients.

2026 TDDW

㉟

REAL-WORLD EFFECTIVENESS OF RISANKIZUMAB IN FISTULIZING CROHN’S DISEASE

Ching-Huang Su1, Puo-Hsien Le1,2,3,4, Ming-Yao Su2,4,5, Cheng-Tang Chiu1,2,3,4, Chen-Ming Hsu1,2,4, Yi-Cheng Chen1,2, Chia-Jung Kuo1,2,3,4 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Inflammatory Bowel Diseases Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 4 Taiwan Association for the Study of Intestinal Disease, Taoyuan, Taiwan 5 Department of Gastroenterology and Hepatology, New Taipei Municipal Tu Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan 1

Risankizumab 治療廔管型克隆氏症之真實世界療效蘇璟煌1 李柏賢1,2,3,4 蘇銘堯2,4,5 邱正堂1,2,3,4 許振銘1,2,4 陳益程1,2 郭家榮1,2,3,4

therapy. Baseline characteristics, previous biologic exposures, and clinical outcomes were retrieved. Clinical response was defined as documented fistula improvement or healing based on radiological or physician assessment. Results: Within the cohort, 80.0% (12/15) of patients were refractory to other biologic agents. With a mean (±SD) follow-up of 28.3 ± 18.2 weeks, RZB achieved an overall clinical response rate of 46.7% (7/15). In the extended follow-up cohort (≥ 6 months), durable effectiveness was higher, with overall response rates 66.7% (6/9) and 75.0% (3/4) in the perianal fistula subgroup. For the patients with clinical response, the mean (±SD) time to documented clinical response was 36.9 ± 11.6 weeks. Regarding safety profile, mild adverse events were observed in 40.0% (6/15) of patients. No case of latent tuberculosis reactivation or severe adverse event was reported during the follow-up period. Conclusions: The escalating incidence of inflammatory bowel disease in Asian populations is accompanied by a uniquely higher burden of perianal complications when compared to Western population. Our real-world cohort study demonstrates that RZB serves as a highly effective and safe therapeutic option for fistulizing CD. Future large-scale, prospective, and multicenter studies are warranted to validate our findings.

林口長庚紀念醫院胃腸肝膽科長庚大學醫學院 3 林口長庚紀念醫院發炎性腸道疾病中心 4 台灣腸道醫學會 5 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

Background: Fistulizing Crohn’s disease (CD) represents a long-term clinical challenge that substantially impairs patients’quality of life. Although risankizumab (RZB), a selective interleukin-23 p19 inhibitor, is highly effective for moderate-to-severe CD, real-world data regarding its efficacy and safety for fistulizing CD within Asian populations remains scarce. Aims: We aim to provide real-world effectiveness data regarding the efficacy of Risankizumab in patients with fistulizing Crohn’s disease in Taiwan. Methods: We conducted a retrospective cohort study at Linkou Chang Gung Memorial Hospital, Taiwan, enrolling 15 adult CD patients complicated with perianal or other types of fistulas receiving RZB

123

2026 TDDW

㊱

CLINICAL OUTCOMES OF DUAL ADVANCED THERAPY IN REFRACTORY INFLAMMATORY BOWEL DISEASE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER

Tzu-Wen Chen1, Chen-Wang Chang1, Ching-Wei Chang1, Tzu-Chi Hsu2, Horng-Yang Wang1, Wei-Chen Lin1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan 2 Division of Colon and Rectal Surgery, Mackay Memorial Hospital, Taipei, Taiwan 1

難治性發炎性腸道疾病雙重先進療法的臨床療效：單一醫學中心的經驗陳咨彣1 章振旺1 張經緯1 許自齊2 王鴻源1 林煒晟1 1 2

馬偕紀念醫院消化科系馬偕紀念醫院大腸直腸外科

Background: Preliminary data suggest that dual advanced therapy (DAT) improves response rates in patients with inflammatory bowel disease (IBD) who fail targeted monotherapy and may represent a novel therapeutic option for refractory disease or extraintestinal manifestations. However, data regarding the optimal treatment combinations, duration, and safety of DAT remain limited. A 2026 ECCO abstract from Taiwan reported that the most frequently used DAT combinations were a Janus kinase (JAK) inhibitor with ustekinumab or vedolizumab. Aims: To evaluate the real-world efficacy and safety of DAT, consisting of either two biologics or a biologic combined with a small-molecule agent, in patients with refractory IBD. Methods: A retrospective analysis was performed in patients with IBD who had received at least one course of advanced therapy between December 2011 and April 2025 at a tertiary referral center in Taipei, Taiwan. Results: A total of 144 patients with IBD, including 71 with Crohn’s disease (CD) and 73 with ulcerative colitis (UC), had received at least one biologic agent. Among them, eight patients with CD and one patient with UC received DAT. The mean age was 39 years, and five patients (55.6%) were male. Six patients (66.7%) had a history of IBD-related surgery. Six patients (66.7%) had previously failed

124

at least two advanced therapies, while one patient received DAT for severe acute UC. Upadacitinibbased combinations were the most common DAT regimen (44.4%), followed by infliximab-based (33.3%) and ustekinumab-based combinations (11.1%). Two patients discontinued DAT within one month, one because of adverse events and the other because of primary non-response. Overall, seven patients (77.8%) achieved a clinical response after a mean treatment duration of 3.1 months (range, 2–6 months). Following DAT, only one patient (11.1%) continued the initial advanced therapy. Conclusions: DAT appears to be a promising strategy for patients with IBD who have an incomplete response to targeted monotherapy. In this cohort, DAT was primarily used as a short-term treatment because of limited supporting evidence and financial constraints. Small-molecule agents were the most commonly used components of DAT. Larger studies with longer follow-up are needed to establish the optimal use and long-term safety of DAT in clinical practice.

2026 TDDW

㊲

COLITIS-ASSOCIATED COLORECTAL CANCER IN TAIWANESE PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SINGLE-CENTER EPIDEMIOLOGICAL STUDY

Po-Ju Huang1,3,4, Shih-Chieh Chuang1, Wang-De Hsiao1, Cheng-Hsing Hung1, Tsung-Lin Hsieh1, Ken-Sheng Cheng1,2, Jen-Wei Chou1,2,3,4 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 School of Medicine, China Medical University, Taichung, Taiwan 3 Taiwan Association for the Study of Intestinal Diseases (TASID) 4 Taiwan Society of Inflammatory Bowel Disease (TSIBD) 1

台灣發炎性腸道疾病患者之結腸炎相關大腸直腸癌：單一中心流行病學研究

incidence rate were 4/215 = 1.8% among ulcerative colitis care and 1/115 = 0.9% in Crhon’s disease. These five CAC patient all ever had extensive colitis, and 80% had Mayo endoscopic subscores of ≥2. The disease duration of CAC incidence among ulcerative case within 10 years: 1/93 = 1.07% and 20 years: 3/122 = 3.27%. And Crohn’s disease were 10 years: 0/54 = 0% and 20 years: 1/61 = 1.6%. Among the CAC, the histological type of five cases were all adenocarcinoma. And 4/5 = 80% were early stage, and 1/5 = 20% were late stage. Four patient with early stage underwent surgical intervention with disease free. And one patient (UC) with liver metastasis receive chemotherpay and mortality in 13 months later. All patient with CAC were poor complicance with surveillance colonoscopy and medicine. The colorectal cancer was disgnosed with colonoscopy during these five patient suffered from lower GI tract symptom including small caliber stool passage, tensmus and bloody tingle stool. Conclusions: Our study showed importance of patient with IBD regularly surveillance colonoscopy and good complicance with medicine.

黃柏儒1,3,4 莊世杰1 蕭望德1 鄭幸弘1 謝宗霖1 鄭庚申1,2 周仁偉1,2,3,4 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院 3 台灣腸道醫學會 4 台灣發炎性腸道疾病學會 2

Background: As far as we know, Inflammatory bowel disease (IBD) is a significantly risk of colitis-associated colorectal cancer. Risk factors that increase the risk of colitis-associated colorectal cancer include disease duration, extent and severity. Aims: The aim of our study was to investigate the incidence, disease duration and severity of colitisassociated colorectal cancer (CAC) in a single institute experience in Taiwan. Methods: From January 1997 to Novermber 2025, we retrospectively reviewed the medical charts at China Medical University Hospital. Patients with IBD who were diagnosed as colorectal cancer were enrolled in study. Clinical data were obtained from the medical records. Epidemiological data included disease duration IBD subtype and severity. Results: 330 patients with IBD were enrolled into study. There were 215 pateint with ulcerative colitis and 115 pateint with Crohn’s disease. The incidence of total IBD case was 5/330 = 1.5%. Subgroup

125

2026 TDDW

Section：HP ㊳

EFFICACY AND SAFETY OF BISMUTHAMOXICILLIN-VONOPRAZAN TRIPLE THERAPY AND LEVOFLOXACIN QUADRUPLE THERAPY IN THE SECOND-LINE TREATMENT OF H. PYLORI INFECTION — A MULTICENTER STUDY IN TAIWAN

Jiunn-Wei Wang1,2,10, Ping-I Hsu3,10, Chih-An Shih4,10, Ming-Jen Sheu5,10, Chien-Lin Chen6,10, Sz-Iuan Shiu7,10, Chang-Bih Shie3,10, Pei-Jui Wu5,10, Wei-Yi Lei6,10, Feng-Woei Tsay8,10, Tzung-Jiun Tsai8,10, Chao-Hung Kuo1,2,9, Deng-Chyang Wu1,2,10 Division of Gastroenterology, Department of Internal medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 2 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai TianSheng Memorial Hospital, Antai Medical Care Corporation, Pingtung, Taiwan 5 Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan 6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan 7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 8 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 9 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Show Chwan Memorial Hospital, Kaohsiung, Taiwan 10 Taiwan Acid-related Disease & Microbiota (TARD-M) Consortium 1

「Bismuth-Amoxicillin-Vonoprazan 三合療法」與「Levofloxacin 四合療法」在第二線幽門螺旋桿菌除菌治療的療效與安 126

全性之比較 — 一項台灣多中心研究王俊偉1,2,10 許秉毅3,10 石志安4,10 許銘仁5,10 陳健麟6,10 許斯淵7,10 施長碧3,10 吳佩叡5,10 雷尉毅6,10 蔡峯偉8,10 蔡騌圳8,10 郭昭宏1,2,9 吳登強1,2,10 1

高雄醫學大學附設中和紀念醫院胃腸內科高雄醫學醫學大學醫學系 3 臺南市立安南醫院暨中國醫藥大學消化內科 4 安泰醫院胃腸肝膽科 5 奇美醫院胃腸肝膽科 6 花蓮慈濟醫院胃腸肝膽科 7 臺中榮民總醫院胃腸肝膽科 8 高雄榮民總醫院胃腸肝膽科 9 高雄秀傳紀念醫院腸胃內科 10 臺灣胃酸相關疾病暨微菌叢聯盟 2

Background: After failure of bismuth quadruple therapy or standard triple therapy, the Maastricht VI/Florence Consensus Report recommends a fluoroquinolone-containing quadruple (or triple) regimen as second-line treatment for Helicobacter pylori infection. Recently, we developed a novel regimen consisting of bismuth, high-dose amoxicillin, and a potassium-competitive acid blocker (PCAB) for second-line H. pylori eradication. A pilot study demonstrated that this bismuth–amoxicillin–PCAB (BAP) triple therapy achieved an eradication rate exceeding 90% as salvage treatment. Aims: To compare the efficacy and safety of 14-day BAP triple therapy with those of 14-day levofloxacincontaining quadruple therapy as second-line treatment for H. pylori infection in Taiwan. Methods: This retrospective cohort study included consecutive patients with H. pylori infection who had failed first-line eradication therapy and subsequently received either 14-day BAP triple therapy (tripotassium dicitrato bismuthate 300 mg four times daily, amoxicillin 750 mg four times daily, and vonoprazan 20 mg twice daily) or 14day levofloxacin-containing quadruple therapy (tripotassium dicitrato bismuthate 300 mg four times daily, amoxicillin 1 g twice daily, levofloxacin 500 mg once daily, and esomeprazole 40 mg twice daily) between July 2020 and March 2026 at six hospitals in Taiwan. Patients returned at week 2 to assess treatment adherence and adverse events. H. pylori eradication was assessed at least 4 weeks after completion of therapy. Results: A total of 65 patients received BAP triple therapy, and 56 received levofloxacin-

2026 TDDW

containing quadruple therapy. The intention-totreat eradication rates were 93.8% (61/65) in the BAP group and 69.6% (39/56) in the levofloxacin group. BAP triple therapy achieved a significantly higher eradication rate than levofloxacin-containing quadruple therapy (P < 0.001). The incidence of adverse events was comparable between the two groups (12.3% vs. 21.4%, P = 0.178). Drug adherence was also similar (98.4% vs. 94.6%, P = 0.335). Conclusions: Fourteen-day BAP triple therapy was significantly more effective than levofloxacincontaining quadruple therapy as second-line treatment for H. pylori infection in Taiwan, while demonstrating comparable safety and treatment adherence. These findings suggest that BAP triple therapy may serve as an effective empirical rescue regimen for H. pylori eradication.

㊴

BISMUTH–VONOPRAZAN– TETRACYCLINE TRIPLE THERAPY VERSUS BISMUTH QUADRUPLE THERAPY FOR FIRSTLINE HELICOBACTER PYLORI ERADICATION: A MULTICENTER PILOT STUDY

Pei-Jui Wu1, Deng-Chyang Wu2, Ming-Jen Sheu1, Chien-Lin Chen3, Chih-An Shih4,5, Chang-Bih Shie6, Wei-Yi Lei3, I-Ting Wu6, Jiunn-Wei Wang2, Pin-Yi Wang1, Hsuan-Yuan Chang1, Ping-I Hsu6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, 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, Antai TianSheng Memorial Hospital, Antai Medical Care Corporation, Pingtung, Taiwan 5 Department of Nursing, Meiho University, Pingtung, Taiwan 6 Division of Gastroenterology, Department of Medicine, Tainan Municipal An Nan Hospital, China Medical University, Tainan, Taiwan 1

Bismuth–Vonoprazan–Tetracycline 三合一療法與鉍劑四合一療法為第一線幽門桿菌根除治療之比較：一項多中心先導研究吳佩叡1 吳登強2 許銘仁1 陳健麟3 石志安4,5 施長碧6 雷尉毅3 吳奕霆6 王俊偉2 王品貽1 張瑄元1 許秉毅6 1

奇美醫院胃腸肝膽科高雄醫學大學附設中和紀念醫院胃腸內科 3 花蓮慈濟醫院肝膽胃腸科 4 安泰醫院胃腸肝膽科 5 美和科技大學護理系 6 臺南市立安南醫院暨中國醫藥大學消化內科 2

Background: Most international guidelines currently recommend 14-day bismuth quadruple

127

2026 TDDW

therapy as the first-line treatment for Helicobacter pylori (H. pylori) infection. However, this regimen is limited by its complexity and high incidence of adverse events. Potassium-competitive acid blockers (PCABs) provide more potent acid suppression than proton pump inhibitors and may enhance the antibacterial activity of tetracycline against H. pylori. Whether a mono-antibiotic regimen combining tetracycline with vonoprazan and bismuth can achieve eradication rates comparable to those of conventional bismuth quadruple therapy remains unknown. Aims: To compare the efficacy and safety of 14day bismuth-vonoprazan-tetracycline (BVT) triple therapy with 14-day bismuth-rabeprazoletetracycline-metronidazole quadruple therapy as first-line treatment for H. pylori infection in Taiwan. Methods: We conducted a retrospective cohort study of patients with H. pylori infection who received either 14-day BVT triple therapy (tripotassium dicitrato bismuthate 300 mg four times daily, vonoprazan 20 mg twice daily, and tetracycline 500 mg four times daily) or 14-day bismuth quadruple therapy (tripotassium dicitrato bismuthate 300 mg four times daily, rabeprazole 20 mg twice daily, tetracycline 500 mg four times daily, and metronidazole 250 mg four times daily) with complete follow-up between January 2024 and March 2026 at five hospitals in Taiwan. H. pylori status was assessed at least four weeks after completion of eradication therapy. Results: A total of 64 patients received BVT triple therapy and 74 received bismuth quadruple therapy. In the modified intention-to-treat analysis, the eradication rates were comparable between the BVT and bismuth quadruple therapy groups (89.1% vs. 94.6%, P = 0.346). The incidence of adverse events was significantly lower in the BVT group than in the bismuth quadruple therapy group (12.5% vs. 31.1%, P = 0.009). Drug adherence was similarly high in both groups (93.8% vs. 94.6%, P = 1.000). Conclusions: In this pilot study, 14-day BVT triple therapy achieved an eradication rate comparable to that of conventional bismuth quadruple therapy while significantly reducing adverse events. These findings support further evaluation of this simplified mono-antibiotic regimen in a large-scale randomized controlled trial.

128

㊵

EFFICACY AND SAFETY OF BAP THERAPY COMPARED WITH AMOXICILLIN-VONOPRAZAN, AMOXICILLIN-RABEPRAZOLE AND HYBRID THERAPIES FOR HELICOBACTER PYLORI ERADICATION IN TAIWAN

Hung Liang1,14, Deng-Chyang Wu2,14, Feng-Woei Tsay3, Chih-An Shih4, Ming-Jen Sheu5, Chien-Lin Chen6, Seng-Kee Chuah7,14, Jyh-Chin Yang8, Kuan-Yang Chen9, Chia-Long Lee10, Yu-Hwa Liu11, Sz-Iuan Shiu12, Chang-Bih Shie1, Wei-Yi Le6, Wei-Chen Tai7,14, Sung-Shuo Kao13, Tzung-Jiun Tsai3, Hsi-Chang Lee9, Ping-I Hsu1,14 Division of Gastroenterology, Department of Medicine, Tainan Municipal An Nan Hospital, China Medical University, Tainan, Taiwan; 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai TianSheng Memorial Hospital, Antai Medical Care Corporation, Pingtung, Taiwan; 5Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 6Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hualien Tzu Chi Hospital, Hualien, Taiwan; 7Division of Hepatogastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 8 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; 9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan; 10Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan; 11Division of Gastroenterology, Department of Internal Medicine Shin Kong Wu Huo-Shih Memorial Hospital, Taipei, Taiwan; 1

2026 TDDW

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 13 Division of Gastroenterology, Department of Internal medicine, Pingtung Veterans General Hospital, Pingtung, Taiwan; 14Taiwan Acid-related Disease-Microbiota (TARD-M) Consortium 12

BAP 療法與 Amoxicillin-Vonoprazan、 Amoxicillin-Rabeprazole 及混合療法在台灣根除幽門螺旋桿菌之療效與安全性比較梁弘1,14 吳登強2,14 蔡峯偉3 石志安4 許銘仁5 陳健麟6 蔡成枝7,14 楊智欽8 陳冠仰9 李嘉龍10 劉玉華11 許斯淵12 施長碧1 雷尉毅6 戴維震7,14 高崧碩13 蔡騌圳3 李熹昌9 許秉毅1,14 1

臺南市立安南醫院消化內科；2 高雄醫學大學附設醫院胃腸內科；3 高雄榮民總醫院胃腸肝膽科；4 安泰醫院胃腸肝膽科；5 奇美醫院胃腸肝膽科；6 花蓮慈濟醫院肝膽胃腸科；7 高雄長庚紀念醫院胃腸肝膽科；8 國立台灣大學醫學院附設醫院胃腸肝膽科； 9 臺北市立聯合醫院仁愛院區消化內科；10 國泰綜合醫院腸胃內科；11 新光吳火獅紀念醫院胃腸肝膽科； 12 臺中榮民總醫院胃腸肝膽科；13 屏東榮民總醫院胃腸肝膽科；14 台灣胃酸相關疾病暨微菌叢聯盟

Background: The global eradication rate of standard triple therapy for Helicobacter pylori (H. pylori) infection has declined to below 80% because of increasing antimicrobial resistance. Vonoprazan, a novel potassium-competitive acid blocker (PCAB), provides more potent and sustained acid suppression than conventional proton pump inhibitors (PPIs). In our recent pilot study, a regimen combining bismuth, amoxicillin, and vonoprazan (BAP therapy) achieved a 98% eradication rate with a low incidence of adverse events (7%) in Taiwan. These findings suggest that this novel monoantibiotic regimen has strong potential to become a new standard first-line therapy for H. pylori infection. Aims: To compare the efficacy and safety of 14day BAP therapy, amoxicillin-vonoprazan therapy, amoxicillin-rabeprazole therapy, and hybrid therapy as first-line treatments for H. pylori infection in Taiwan. Methods: This retrospective multicenter cohort study included patients with H. pylori infection who received one of four 14-day regimens between

August 2018 and March 2026 at 11 hospitals in Taiwan: BAP therapy (tripotassium dicitrato bismuthate 300 mg qid, amoxicillin 750 mg qid, and vonoprazan 20 mg bid); amoxicillin-vonoprazan therapy (amoxicillin 750 mg qid and vonoprazan 20 mg bid); amoxicillin-rabeprazole therapy (amoxicillin 750 mg qid and rabeprazole 20 mg qid); or hybrid therapy (rabeprazole 20 mg bid plus amoxicillin 1 g bid for the first 7 days, followed by rabeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid, and metronidazole 500 mg bid for the final 7 days). H. pylori eradication was assessed at least four weeks after completion of therapy. Results: A total of 198, 416, 296, and 297 patients received BAP, amoxicillin-vonoprazan, amoxicillinrabeprazole, and hybrid therapies, respectively. In the modified intention-to-treat analysis, the eradication rates were 96.0%, 86.1%, 93.2%, and 94.3%, respectively. BAP therapy achieved significantly higher eradication rates than both amoxicillin-vonoprazan and amoxicillin-rabeprazole dual therapies (both P < 0.001), whereas its efficacy was comparable to that of hybrid therapy. The incidences of adverse events were significantly lower with BAP, amoxicillin-vonoprazan, and amoxicillinrabeprazole therapies than with hybrid therapy (10.6%, 9.7%, and 13.2% vs. 26.9%, respectively; all P < 0.001). Conclusions: BAP therapy demonstrated superior eradication efficacy compared with amoxicillinvonoprazan and amoxicillin-rabeprazole dual therapies for first-line treatment of H. pylori infection in Taiwan. It achieved eradication rate comparable to that of hybrid therapy while causing significantly fewer adverse events, supporting its potential as an effective, safe, and simplified first-line treatment.

129

2026 TDDW

㊶

ACTIVE HELICOBACTER PYLORI INFECTION IS LINKED TO PATTERNSPECIFIC ANTINUCLEAR ANTIBODY PROFILES IN AN AGE- AND SEXDEPENDENT MANNER

Chan-Yi Lin1, Chun-Hao Wang2, Yi-Min Huang1, Ming-Shiang Wu2, Jyh-Ming Liou1,2, Tzu-Chan Hong1,2,3 Department of Medicine, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan 3 Department of Medical Education and Bioethics, Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan 1

活動性幽門螺旋桿菌感染與特定抗核抗體型態相關，且其關聯受年齡與性別影響林展毅1 王俊皓2 黃逸閔1 吳明賢2 劉志銘1,2 洪子瞻1,2,3 1

台大醫院癌醫分院內科部台大醫院內科部 3 台大醫學院醫學教育暨生命倫理學研究所 2

Background: The relationship between Helicobacter pylori infection and systemic autoimmunity remains controversial. Prior studies usually analyzed antinuclear antibody (ANA) positivity as a binary outcome, which may overlook heterogeneity in ANA immunofluorescence patterns and their potential biological significance. Aims: We investigated whether active H. pylori infection is associated with ICAP-defined ANA patterns and whether these associations vary by age and sex. Methods: We analyzed 2,182 adults who underwent concurrent ¹³C-urea breath testing and HEp-2 indirect immunofluorescence ANA testing in a health-examination program from September 2021 to August 2024. ANA patterns were classified according to International Consensus on ANA Patterns nomenclature. Pattern-specific associations were estimated using Firth-penalized logistic regression. Age was modeled continuously, with testing for nonlinear age modification and H. pylori

130

× age × sex interaction. Results: Active H. pylori infection was present in 292 participants (13.4%) and not associated with overall ANA positivity (30.8% vs 28.1%; p = 0.376). In contrast, pattern-level analysis identified a significant association with fine speckled AC-4 ANA positivity (18.5% vs 11.6%; OR 1.72, p < 0.001), which remained significant after multiple testing correction. The H. pylori–AC-4 association was nonlinear across age, with peak risk around age 50 in men (OR 2.88, 95% CI 1.37–5.79). A three-way H. pylori × age × sex interaction was significant for AC-4 (p = 0.0001), AC-19 (p = 0.0001), AC-27 (p = 0.0004), and overall ANA positivity (p < 0.0001), indicating that active infection shapes autoreactive profiles differently across demographic contexts. Conclusions: Active H. pylori infection is linked to selective ANA pattern positivity. Pattern-specific ANA analysis may uncover age- and sex-dependent host–microbe immune phenotypes missed by binary ANA assessment.

2026 TDDW

㊷

H. PYLORI BURDEN BEFORE ERADICATION PREDICTS SHORT-TERM ENDOSCOPIC AND HISTOLOGIC INTESTINAL METAPLASIA EVOLUTION

Chu-Po Chou1, Chen-Tu Wu2, Yih-Leong Chang2, Feng-Pai Tsai3,4, Shih-Chi Hu1, Tzu-Min Yu1, Chan-Yi Lin4, Jyh-Ming Liou1,3,4, Ming-Shiang Wu1,3, Tzu-Chan Hong1,3,4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 1

幽門螺旋桿菌除菌前菌量可預測胃腸化生短期內視鏡及組織學演變

or regression. Associations were assessed using modified Poisson regression. Results: Among 322 patients (mean follow-up 15.3 months), higher baseline H. pylori burden was associated with a dose-dependent increase in endoscopic progression. The adjusted relative risks were 2.24 (95% CI, 1.50–3.34) for intermediate burden and 2.67 (95% CI, 1.73–4.12) for high burden (Ptrend <0.001). Similar patterns were observed for composite histologic IM score, whereas OLGIM did not reach significance. Notably, these findings remained consistent in a sensitivity analysis restricted to patients with confirmed eradication success. Conclusions: Baseline H. pylori burden is a dose-dependent determinant of short-term IM progression, persisting regardless of eradication success. This “legacy effect” in intermediate-tohigh burden groups highlights the importance of quantifying bacterial density before eradication to risk-stratify patients.

周主博1 吳振督2 張逸良2 蔡豐百3,4 胡士麒1 游子民1 林展毅4 劉志銘1,3,4 吳明賢1,3 洪子瞻1,3,4 1

台大醫院內科部台大醫院癌醫分院病理部 3 台大醫學院內科部 4 台大醫院癌醫分院綜合內科部 2

Background: The impact of Helicobacter pylori (H. pylori) eradication on gastric intestinal metaplasia (IM) evolution remains uncertain. Aims: We hypothesized that baseline bacterial burden, rather than eradication status alone, determines longitudinal IM evolution. Methods: In this retrospective longitudinal cohort, patients underwent paired endoscopy with Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) scoring and systematic biopsies. Baseline histologic H. pylori burden (antrum + body; range 0–6) was categorized as negative (0), low (1–2), intermediate (3–4), or high (5–6). The primary outcome was endoscopic IM progression, defined as an increase in the EGGIM score (ΔEGGIM >0). Secondary outcomes included endoscopic IM regression, progression from low-risk to high-risk EGGIM categories (score 0–4 to 5–10), histologic IM progression (increase in a composite histologic IM score) or regression, and OLGIM progression

131

2026 TDDW

Section：HCV ㊸

IMPACT OF HANDHELD ABDOMINAL POINT OF CARE ULTRASOUND ON IMAGING TIMELINESS, HOSPITAL STAY AND CLINICAL DECISIONS IN INPATIENT GASTROINTESTINAL AND HEPATOLOGY CONSULTATIONS: A CLUSTER-RANDOMIZED CONTROLLED TRIAL

Mark Pi-Chun Chuang1, Chun-Hsun Liao2, Che-Yu Rau2, Te-Yao Hsueh2, Wen-Feng Hsu2, Chun-Jen Liu2, Han-Mo Chiu2 Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

手持式腹部焦點式超音波對住院病人胃腸肝膽科照會中影像時效、住院天數與臨床決策之影響：一項叢集隨機對照試驗莊弼鈞1 廖俊勛2 饒哲宇2 薛德曜2 許文峰2 劉俊人2 邱瀚模2 1 2

國立臺灣大學醫學院附設醫院新竹臺大分院內科部國立臺灣大學醫學院附設醫院內科部

Background: Handheld ultrasound (HUD) has emerged as a valuable tool, offering diagnostic performance comparable to conventional ultrasound in select scenarios. While point-of-care ultrasound (POCUS) is increasingly adopted in internal medicine, data regarding its impact on system efficiency and effectiveness in gastrointestinal (GI) and hepatology consultations remain limited. Aims: To investigate whether integrating abdominal POCUS with HUD into the GI and hepatology consultation process and clinical algorithm can improve hospital care quality by reducing time to diagnosis, shortening hospital length of stay (LOS), and facilitating timely changes in clinical management without compromising diagnostic accuracy. Methods: In this single-center, time-stratified, cluster randomized controlled trial (NCT07497490), we enrolled 232 inpatients referred for nonendoscopic GI or hepatology consultation over a one-year period (December 2024 to November 2025). Participants were allocated according to odd/

132

even-numbered calendar days to either the POCUS group (abdominal POCUS with HUD plus standard care) or the control group (standard care alone). The primary outcome was the time from consultation to acquisition of diagnostic imaging. Secondary outcomes included post-consultation LOS, clinical decision changes and image-based diagnostic accuracy. Results: Of 232 enrolled patients, 114 were assigned to the POCUS group and 118 to the control group, with 112 in the study group and 113 in the control group eligible for analysis. Median time to diagnostic imaging was 112.5 minutes in the POCUS group and 308.0 minutes in the control group (adjusted rate ratio [aRR], 0.255; 95% CI, 0.119-0.543; P = 0.004). Overall, post-consultation LOS showed a downward trend (aRR, 0.830), and a significant reduction was observed in the abnormal liver profile subgroup (n = 146; aRR, 0.715; 95% CI, 0.527–0.968; P = 0.030). Clinical decision change occurred in 12.5% (95% CI, 7.0%–20.1%) of POCUS cases. Abdominal POCUS demonstrated 86.4% (95% CI, 78.3%–92.4%) diagnostic accuracy compared with formal imaging as reference standard. 30-day readmission and inhospital mortality rates were comparable between groups. Conclusions: Handheld abdominal POCUS may expedite diagnostic imaging in hospitalized patients undergoing GI and hepatology consultation and shorten post-consultation LOS, particularly in those with abnormal liver profiles. It may represent a practical approach to enhance workflow efficiency and optimize resource use in in-patient settings.

2026 TDDW

㊹

COMPARISON OF MACHINE LEARNING MODELS AND LONGITUDINAL CLINICAL PARAMETERS FOR PREDICTING HEPATOCELLULAR CARCINOMA AFTER DIRECT-ACTING ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C

Wei-Fan Hsu1,2, Ching-Chu Lo3, Kuo-Chih Tseng4,5, Hsueh-Chou Lai1,2, Chi-Yi Chen6, Wilson Wen Bin Goh7,8, Cheng-Yuan Peng1,9 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 School of Chinese Medicine, China Medical University, Taichung, Taiwan 3 Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan 4 Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan 5 School of Medicine, Tzuchi University, Hualien, Taiwan 6 Department of Internal Medicine, Chiayi Christian Hospital, Chiayi, Taiwan 7 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore 8 Center of AI in Medicine, Nanyang Technological University, Singapore, Singapore 9 School of Medicine, China Medical University, Taichung, Taiwan 1

機器學習模型與時序性臨床參數在預測慢性 C 型肝炎接受口服抗病毒藥物治療後罹患肝細胞癌風險之比較許偉帆1,2 羅清池3 曾國枝4,5 賴學洲1,2 陳啟益6 Wilson Wen Bin Goh7,8 彭成元1,9 1

中國醫藥大學附設醫院消化醫學中心中國醫藥大學中醫學系 3 聖馬爾定醫院內科部 4 大林慈濟醫院內科部 5 慈濟大學醫學系 6 嘉義基督教醫院內科部 7 南洋理工大學李光前醫學院 8 南洋理工大學人工智能醫學中心 9 中國醫藥大學醫學系

Background: We previously developed the AAAPD-C score to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC) who achieved a sustained virologic response to direct-acting antiviral (DAA) therapy. Aims: This study aims to optimize HCC prediction using advanced machine learning (ML) algorithms and longitudinal data. Methods: Utilizing a multicenter cohort of 4,426 consecutive CHC patients (derivation: 1,248; validation: 3,178), missing data were handled using multivariate imputation by chained equations. Baseline demographics and comorbidities, alongside longitudinal clinical features, including complete blood counts, biochemical, and virological data, collected at baseline, at the end of therapy (EOT), and at 12 weeks post-treatment (PW12), were analyzed. Three ML models, gradient boosting, random survival forest (RSF), and deep survival neural network, were constructed and compared with the AAAPD-C score for predicting incident HCC. 95% confidence intervals (CIs) were computed using 1,500 bootstrapping repetitions. Results: Predictive performance across all models peaked with PW12 parameters, outperforming the baseline and EOT data. In the validation group, the RSF model achieved the best performance, with a Harrell’s C-index of 0.9063 (95% CI: 0.8490–0.9535) and an Uno’s C-index of 0.8968 (95% CI: 0.8478– 0.9406). The RSF model consistently outperformed other approaches in AUROC, AUPRC (0.3196; 95% CI: 0.16–0.49), accuracy, sensitivity, specificity, and F1score (0.2857). Conclusions: In this preliminary study, the RSF model utilizing PW12 data emerged as the optimal tool for post-SVR HCC risk stratification, exhibiting superior predictive performance compared with the AAAPD-C score and other ML models. Further investigations with extended follow-up are warranted to refine this ML-driven approach.

133

2026 TDDW

㊺

EVALUATION OF PATIENTS TREATED WITH DIRECT-ACTING ANTIVIRALS FOR CHRONIC HEPATITIS C AND THEIR RISK OF HEPATOCELLULAR CARCINOMA IN PING-TUNG

屏東地區慢性 C 型肝炎患者以 DAA 治療其發生肝癌風險預測分析文士祺1 郭武憲2 薛肇文1 陳興曄1 楊凱堯3 柯朝元3 黃健維4 李珮育1 沈欣怡5 卓季萱5 張凱婷5 魏宇彤5 1

寶建醫院胃腸肝膽科員榮醫院員生院區胃腸肝膽科 3 國軍高雄總醫院腸胃科 4 國軍高雄總醫院屏東分院腸胃科 5 屏東寶建醫院護理部胃鏡室 2

Background: Hepatocellular carcinoma (HCC) is currently the fourth cause of liver related death worldwide. Hepatitis C virus (HCV) is a significant risk factor for liver cirrhosis and HCC. The achievement of sustained virological response (SVR) to antiviral treatment was demonstrated to reduce incidence of HCC. Following SVR to DAA-based regimen, reported rates of de-novo HCC was estimated nearly 2%–2.5%. Aims: Current literature efforts aim at deeply investigation predictors of HCC in HCV cured through SVR with ultimately goal of personalized

134

risk stratified individualized surveillance polices. To evaluate the risk of HCC in CHC treated with directacting antivirals (DAA) in Ping Tung, as it has not been studied before in this locality. Methods: One hundred and eighty-one consecutive patients with CHC treated with DAA in Ping-Tung County between Aug 2016 and Mar 2023 were identified. We compared variables and noninvasive fibrosis indices at baseline and after treatment between patients with HCC occurrence and without ones. Cox proportional hazard model was used to identify factors associated with HCC development. Results: A total of 24 (13.3%) developed HCC during median treatment duration of 2.92 ± 0.58 months and follow-up period 41.6 ± 43.6 months. Most of the patients had achieved sustained virological response 178 (98.3%). The cumulative HCC incidence rates were 8.3%, 9.4%, 11.6%, and 13.5% at 1, 3, 5 and >5 years, respectively. Univariate analysis showed that significant factors associated with HCC after DAA were: older age, cirrhosis, history of treated experience, higher AFP at the start or end of DAA therapy, high FIB-4 at the start or end of DAA therapy. Multivariate analysis revealed that age (HR = 1.058, 95% CI = 1.005–1.114, P = 0.032) and cirrhosis (HR = 0.029, 95% CI = 0.005–0.149, P < 0.001) were independent factors associated with the development of HCC in patients with CHC. Conclusions: DAA-based therapies provided evidence that HCV eradication halts the progression in patients with advanced fibrosis/cirrhosis. Here we summarize the main findings: older age, history of treated experience, cirrhosis are independent predictors of increased risk of HCC development. Moreover, non-invasive tests for hepatic fibrosis, namely FIB4, measured before and after treatment and their post-therapy change, contribute to better stratifying the risk of HCC occurrence.

2026 TDDW

㊻

CIRRHOSIS VS. MALIGNANCY: DEVELOPING CLINICAL SCORING SYSTEMS FOR PROGNOSIS PREDICTION IN PATIENTS WITH VARICEAL BLEEDING

Tai-Hui Kuo1, Yu-Jen Chen1,2,3, 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 3 Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan 1

從肝硬化到惡性腫瘤：靜脈曲張出血病人預後評分之比較郭泰輝1 陳宥任1,2,3 侯明志1,2 1

臺北榮民總醫院胃腸肝膽科國立陽明交通大學醫學院醫學系 3 國立陽明交通大學公共衛生研究所 2

Background: Variceal bleeding in portal hypertension carries high mortality, and outcomes may differ by etiology. Malignancy-related portal hypertension causing by hepatobiliary or metastatic tumors may further compromise both bleeding control and survival. Several prognostic scores are widely applied to predict survival in patients with portal hypertension. However, their predictive performance in cirrhotic versus malignancy-related disease remains insufficiently characterized. Aims: We compared the prognostic accuracy of nine clinical scores for survival after acute esophageal (EV) or gastric variceal (GV) bleeding, stratified by cirrhotic versus malignancy-related etiology, to define an etiology-specific scoring approach. Methods: This single-center retrospective cohort study enrolled 528 patients at Taipei Veterans General Hospital (January 2016–August 2025), stratified into cirrhosis (n = 183) and malignancyrelated (n = 345) groups. Nine scores: MELD, MELDNa, MELD-3.0, Child-Pugh, albumin-bilirubin (ALBI), lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), AST-to-platelet ratio index (APRI), and FIB-4 were calculated at the time of endoscopy. Discrimination for 6-week, 1-year, and 3-year mortality was assessed by the area

under the receiver-operating-characteristic curve (AUROC). Pairwise score differences were tested by the DeLong method. A two-sided p < 0.05 was considered significant. Results: Mortality was higher in the malignancyrelated than cirrhosis group at every timepoint (6-week 32.6% vs. 11.6%; 1-year 66.4% vs. 34.7%; 3-year 82.8% vs. 52.6%). Overall, MELD showed the strongest 6-week discrimination (AUROC 0.804), whereas MELD-Na was statistically superior to MELD at 1-year (ΔAUROC +0.020, p = 0.012) and 3-year (ΔAUROC +0.031, p < 0.001) by DeLong testing. In the cirrhosis subgroup, LMR showed strong 6-week discrimination (AUROC 0.820) and was not significantly different from MELD (AUROC 0.862, ΔAUROC +0.042, p = 0.443) or Child-Pugh (AUROC 0.868, ΔAUROC +0.048, p = 0.918) by DeLong testing. In the malignancy-related subgroup, MELDNa was the best-performing score at all timepoints (AUROC 0.808, 0.713, and 0.672 at 6 weeks, 1 year, and 3 years) and was statistically superior to MELD at 1-year (ΔAUROC +0.034, p < 0.001) and 3-year (ΔAUROC +0.040, p < 0.001) by DeLong testing. Conclusions: Prognostic score performance after variceal bleeding varies by etiology and time horizon. MELD and Child-Pugh reliably predict shortterm mortality in both groups, whereas MELD-Na provides better long-term discrimination, especially in malignancy-related disease.

135

2026 TDDW

㊼

REAL-WORLD EFFECTIVENESS AND SAFETY OF 8-WEEK GLECAPREVIR/ PIBRENTASVIR FOR PERSONS WHO INJECT DRUGS AND WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION PATIENTS FROM TAIWAN NATIONWIDE HCV REGISTRY

Cheng-Li Cheng1, Ming-Lung Yu2,3,4, Chung-Feng Huang2, Wan-Long Chuang2, Jee-Fu Huang2, Ming-Lun Yeh2, Chia-Yen Dai2, Pei-Chien Tsai2, Lein-Ray Mo5, Chi-Ming Tai6, Chien-Yu Cheng7, Hsing-Tao Kuo8, Szu-Jen Wang9, Chih-Lin Lin10, Ying-Chieh Chen11, Ming-Jong Bair12,13, Chi-Yi Chen14, Chi-Chieh Yang15, Sheng-Shun Yang16, Chun-Ting Chen17, Ming-Chang Tsai18, Chien-Hung Chen19, Te-Sheng Chang20, Tsai-Yuan Hsieh21, Pin-Nan Cheng22, Chih-Lang Lin23, Lee-Won Chong24 Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan; 5 Department of Hepatogastroenterology, Tainan Municipal Hospital, Tainan, Taiwan; 6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; 7 Division of Infectious Diseases, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 9 Division of Gastroenterology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan; 10Department of Gastroenterology, Taipei City Hospital Renai 1

136

Branch, Taipei, Taiwan; 11Department of Internal Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan; 12 Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan; 13Mackay Medical College, New Taipei City, Taiwan; 14Division of Gastroenterology and Hepatology, Department of Medicine, Chiayi Christian Hospital, Ditmanson Medical Foundation, Chiayi, Taiwan; 15Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan; 16 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 17 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Penghu, Taiwan; 18Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 19Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 20Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Chiayi, Taiwan; 21Division of Gastroenterology, Department of Internal Medicine, TriService General Hospital, National Defense Medical Center, Taipei, Taiwan; 22Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 23Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 24 Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

臺灣全國 HCV 登錄資料庫中注射藥物者及 HIV 感染者接受 8 週 Glecaprevir/

2026 TDDW

Pibrentasvir 治療之真實世界療效與安全性研究鄭丞利1 余明隆2,3,4 黃釧峰2 莊萬龍2 黃志富2 葉明倫2 戴嘉言2 蔡佩倩2 牟聯瑞5 戴啟明6 鄭健禹7 郭行道8 王嗣仁9 林志陵10 陳英傑11 白明忠12,13 陳啟益14 楊基滐15 楊勝舜16 陳軍廷17 蔡明璋18 陳建宏19 張德生20 謝財源21 鄭斌男22 林志郎23 張麗文24 1

高雄醫學大學附設中和紀念醫院內科部；2 高雄醫學大學附設中和紀念醫院肝膽胰內科；3 高雄醫學大學肝炎研究中心；4 國立中山大學代謝異常脂肪肝卓越研究中心；5 台南市立醫院腸胃內科；6 義大醫院胃腸肝膽科；7 衛生福利部桃園醫院感染科；8 奇美醫院胃腸肝膽科；9 阮綜合醫院胃腸科；10 臺北市立聯合醫院仁愛院區消化內科；11 衛生福利部金門醫院內科部；12 台東馬偕紀念醫院胃腸科；13 馬偕醫學大學；14 戴德森醫療財團法人嘉義基督教醫院胃腸肝膽科；15 秀傳紀念醫院胃腸科；16 臺中榮民總醫院胃腸肝膽科；17 國防醫學中心三軍總醫院澎湖分院胃腸科；18 中山醫學大學附設醫院胃腸肝膽科；19 高雄長庚紀念醫院胃腸肝膽科；20 嘉義長庚紀念醫院胃腸肝膽科；21 國防醫學中心三軍總醫院胃腸科； 22 國立成功大學醫學院附設醫院胃腸肝膽科；23 基隆長庚紀念醫院胃腸肝膽科暨社區醫學研究中心；24 新光吳火獅紀念醫院胃腸肝膽科

excluding those lost to follow-up or without SVR12 data. The safety profile was analyzed in the intentionto-treat (ITT) population. Results: Among 894 chronic HCV patients initiated on GLE/PIB, 580 presented with PWID only, 163 with HIV infection only, and 151 with PWID/HIV coinfection. In the mITT population, the overall SVR12 rate was 97.0%, with subgroup SVR12 rates 98.4% (PWID only), 97.4% (HIV only), and 91.4% (PWID/ HIV coinfection) respectively. Optimal treatment adherence (≥80%) was high, exceeding 92.1% in all subgroups. Adverse events occurred in 10.3% of patients, primarily fatigue (6.4%) and pruritus (3.0%). Serious adverse events were rare (0.3%), with none attributed to DAA therapy. Furthermore, hepatic biochemistries improved significantly posttreatment. The 1-year HCV reinfection rate was 5.1% overall, peaking at 7.1% among coinfected patients. Conclusions: In this real-world Taiwanese cohort, 8-week GLE/PIB therapy was highly effective and well-tolerated, demonstrating excellent adherence among PWID and HIV patients. Furthermore, the benefits of HCV cure in achieving short-term liver function improvement were observed across all patient subgroups.

Background: Chronic hepatitis C (CHC) virus infection is one of the leading causes of liver cirrhosis worldwide, including in Taiwan. According to National Taiwan HCV office, the person who inject drugs (PWID) and who are infected with human immunodeficiency virus (HIV) are special populations with high HCV prevalence. Some Taiwan local studies have identified direct-acting antivirals (DAA) as efficacious, well-tolerated among PWID and HIV-infected patients. However, the evidence of efficacy and safety for 8-week GLE/PIB in all genotypes of PWID and HIV patients is currently limited in Taiwan population. Aims: This study aimed to provide real-world evidence on the use of 8-week GLE/PIB in PWID and HIV by using data from the Taiwan Association for the Study of the Liver HCV Registry (TACR). Methods: Data of CHC patients treated with an 8-week regimen of GLE/PIB were extracted from the TACR, managed by the Taiwan Association for the Study of the Liver (TASL). Treatment efficacy, measured as sustained virologic response at 12 weeks post-treatment (SVR12), was evaluated in the modified intention-to-treat (mITT) population,

137

2026 TDDW

㊽

ENHANCING HEPATOCELLULAR CARCINOMA RISK STRATIFICATION AFTER VIRAL HEPATITIS TREATMENT UTILIZING LIVER STIFFNESS TRAJECTORY: A 1,221-PATIENT DYNAMIC COHORT STUDY

Sheng-Hung Chen1,2, Hsueh-Chou Lai1,3, 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

以縱向肝硬度軌跡優化病毒性肝炎治療後肝癌風險分層陳昇弘1,2 賴學洲1,3 許偉帆1,3 王鴻偉1,2 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: Static liver stiffness (LS) measurements represent cross-sectional snapshots that do not capture longitudinal structural biographies. This potentially leads to risk misallocation for hepatocellular carcinoma (HCC) after viral hepatitis treatment. Aims: To evaluate the feasibility and dynamic net benefit of integrating longitudinal LS trajectories to address the diagnostic limitations of static elastography. Methods: We analyzed 1,221 chronic viral hepatitis patients (hepatitis B: 31.4%, hepatitis C: 64.0%, B+C coinfection: 4.6%; 48.5% male, median age 57 years) who achieved treatment landmark milestone. Missing dynamic LS metrics across 5 multi-temporal points were restored via parallel multivariate imputation by chained equations (MICE, m = 10). Unsupervised, HCC-unaware latent class mixed models (LCMM) characterized longitudinal trajectories at a permanent 48-week post-treatment landmark, eliminating the need for iterative computational updates. Results: During median post-landmark follow-up periods ranging from 40.9 to 56.0 months across

138

trajectory classes (overall median ~46 months, IQR: 26–68), 58 patients developed incident HCC. Unsupervised LCMM segregated 4 distinct phenotypes: Class 1 (stable low, 64.9% of 1221; HCC incidence 1.9%), Class 2 (declining moderate, 18.1%; HCC incidence 7.2%, Rubin’s pooling HR = 3.26, 95% CI: 1.33–7.98, P = 0.011), Class 3 (steep-decline parsimonious residual, 3.6%; HCC incidence 11.4%, HR = 4.19, 95% CI: 1.09–16.18, P = 0.038), and Class 4 (persistently high, 13.4%; HCC incidence 13.40%, HR = 5.60, 95% CI: 2.34–13.43, P < 0.001). Surveillance frameworks were benchmarked using Youdenoptimized thresholds (LS0 ≥ 1.51 m/s at baseline; LS48 ≥ 1.18 m/s at week 48). Cross-tabulation demonstrated a severe bidirectional discordance in static elastography: static LS48 ≥ 1.18 m/s falsely overestimated risk in 178 Class 1 true nonprogressors (relative risk = 13.4), while systematically underestimating and leaking 17 Class 4 progressors into the “safe pool” (absolute incidence = 5.9%, relative risk = 11.8). A trajectory-integrated singlestage union consensus (Strategy A: LS48 ≥ 1.18 m/s OR LCMM Classes 3 OR 4) captured the structural leakage, driving the screening sensitivity to a toptier peak of 94.8% (55/58) with an actionable positive predictive value of 10.4% and a number needed to screen of 9.6, while saving surveillance burdens for 56.7% (692/1,221) of the healthy population. Compared with single-point snapshotting LS48 Only (sensitivity 93.1%, burden saved 59.2%), the integrated consensus required a negligible increase in operational surveillance expansion (+2.5%, 529 vs. 498 patients) to rescue critical missed oncogenic events. Stage A rescued the 55th HCC event precisely through the identification of the Class 4 high-plateau trajectory. Conclusions: Cross-sectional single-point snapshots suffer from structural signal distortion. Deploying a trajectory-integrated single-stage union consensus at the 48-week post-treatment landmark potentially eliminates historical risk leakage. This maximizes diagnostic sensitivity with minimal burden inflation for post-viral treatment programming.

2026 TDDW

Poster Section：Liver P.01

BYSTANDER CD38+HLADR+PD1+CD8+ T CELLS FACILITATE HBSAG REDUCTION BY SHAPING THE IMMUNOMODULATORY MICROENVIRONMENT IN CHRONIC HEPATITIS B Hsiang-Wei Huang1,2, Rachel Wen-Juei Jeng1,2, Chia-Wei Lin2, Yen-Chun Liu2, Jian-He Fan1,2, Wei-Ting Ku1,2, Thi Kim Duyen Nguyen2,3, Chun-Yen Lin2,4,5 School of Medicine, Chang Gung University, Taoyuan, Taiwan 2 Division of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 3 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan 4 Institute of Immunology and Translational Medicine, Chang Gung University, Taoyuan, Taiwan 5 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

旁觀者 CD38+HLADR+PD1+CD8+ T 細胞藉由塑造免疫調節微環境促進慢性 B 型肝炎之 HBsAg 下降黃祥瑋1,2 鄭文睿1,2 林家緯2 劉彥君2 方健合1,2 古唯鼎1,2 阮金緣2,3 林俊彥2,4,5 1

長庚大學醫學系林口長庚紀念醫院胃腸肝膽科 3 長庚大學臨床醫學研究所 4 長庚大學免疫轉譯醫學研究所 5 長庚大學醫學院 2

Background: We previously identified that activated CD38+HLADR+PD1+CD8+ T cells correlate with ontreatment HBsAg reduction velocity and baseline HBV-specific IFN-γ ELISpot responses in chronic hepatitis B (CHB) patients. Aims: This study investigated the underlying mechanisms connecting this subset to baseline HBV-specific immune responses. Methods: We performed scRNA-seq and CITEseq dextramer analysis on peripheral CD8+ T cells from CHB patients. Linear regression, mediation analysis, pseudotime trajectory, and public gene signature validation evaluated clinical impacts and

differentiation paths. Results: Regression analysis confirmed that CD38+HLADR+PD1+CD8+ T cell frequency at treatment-free timepoint significantly correlated with HBsAg reduction and baseline IFN-γ ELISpot responses. Mediation analysis revealed that this subset influenced HBsAg reduction through independent pathways beyond mere ALT-reflected liver injury. Notably, scRNA-seq showed that HBVspecific CD8+ T cells were segregated from the CD38+HLADR+PD1+CD8+ cluster, demonstrating they did not predominantly concentrate within this population. To rule out whether both populations were simply co-driven by the same inflammatory milieu, we evaluated pro-inflammatory cytokine receptors. While the CD38+HLADR+PD1+CD8+ cluster strongly expressed these receptors and downstream pathways, baseline HBV-specific CD8+T cells remained dormant, enriching Naive and KIR signatures with low receptor and downstream expression, arguing against a simple co-regulated inflammatory mechanism. Instead, the CD38+HLADR+PD1+CD8+ cluster exhibited enrichment of cytokine-related transcripts and programs, including IL2, IFNG, and TNF. Furthermore, pseudotime analysis and GSEA revealed distinct functional states, with early CD38+HLADR+PD1+CD8+ cluster enriched in proliferation and cytokine production modules, whereas later CD38+HLADR+PD1-CD8+ cluster exhibited cytotoxic features. Finally, following nucleos(t)ide analogue (NUC) therapy, the proportion of these quiescent HBV-specific CD8+ T cells increased. Conclusions: CD38+HLADR+PD1+CD8+ T cells represent an inflammation-induced, cytokineproducing bystander CD8+ T cell state rather than the main HBV-specific effectors. While associated with hepatocyte injury, they may establish a favorable immune environment for HBV-specific CD8+ T cell responses via IL2/IFNG/TNF production, serving as a biomarker of subsequent HBsAg reduction.

139

2026 TDDW

P.02

A NOVEL CLUSTER OF CYTOLYTIC ALPHA/BETA TCR+CD4-CD8-T CELLS ORIGINATING FROM CD8+ T CELLS WITH POTENT INNATE-LIKE T CELL KILLING ABILITY: IMPLICATING ADOPTIVE T CELL TRANSFER THERAPY FOR HEPATOCELLULAR CARCINOMA Cheng-Heng Wu1, Te-Wei Tseng2, Chen-Yang Huang3, Ping-Hsun Ou4, Yi-Chen Lin4, Pin-Jung Chen1, Po-Ting Lin4, Chan-Keng Yang3, Wei Teng4, Tsung-Han Wu5, Yung-Chang Lin3, Chun-Yen Lin6 School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 2 Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 3 Division of Hematology and Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 4 Division of Gastroenterology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 5 General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 6 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

源自 CD8+ T 細胞之新型溶胞性 αβ TCR+ 雙陰性 T 細胞具強效類先天性殺傷力：在肝癌中過繼性 T 細胞療法之應用啟示吳承衡1 曾德維2 黃振洋3 歐秉勳4 林沂蓁4 陳品蓉1 林伯庭4 楊展庚3 滕威4 吳宗翰5 林永昌3 林俊彥6 1

長庚大學醫學系林口長庚紀念醫院內科部 3 林口長庚紀念醫院血液腫瘤科 4 林口長庚紀念醫院胃腸肝膽科 5 林口長庚紀念醫院血一般外科 6 長庚大學醫學院 2

Background: Tumor immunotherapies represent promising strategies for treating various cancers, including hepatocellular carcinoma. In this context, immune cells, including the adoptive T cell transfer treatment, become the focus of interests. Notably,

140

alpha/beta TCR+CD4-CD8-T (DNT) cells is a subgroup of T cells that is ignored for a long time but was refocused recently. These DNT cells are a group of cells with opposite functions in different condition, including pro-inflammatory or suppressive functions and possibly originated from over-stimulation of peripheral CD4+ T cells/CD8+ T cells or a special group of T cells formed in thymus. Aims: (1) Identification of cytotoxic DNT cells in tumor site by transcriptome profile. (2) Investigate the key factors that determine DNT development. (3) In vitro expansion of cytotoxic DNT cells and study the therapeutic role of DNT cells. Methods: (1) Animal model establishment. Established an orthotopic murine hepatoma model. BALB/c mice received intrahepatic inoculation of 3 × 10⁵ BNL hepatoma cells on Day 0 to establish an orthotopic liver tumor. On Day 21, leukocytes were isolated from the liver, spleen, lymph nodes (LN), and draining lymph nodes (DLN) for downstream analysis. (2) Quantification and activation profiling of DNT cells by flow cytometry. Compared the proportion and T cell activation marker expression of DNT cells in the tumor microenvironment (TME) versus other compartments to characterize the phenotype of tumor-infiltrating DNT cells. (3) Functional cytotoxicity assay. Isolated DNT cells from the TME of murine hepatoma and performed in vitro tumor-killing assays to validate their tumor-cytotoxic capacity. (4) Single-cell transcriptomic profiling (scRNA-seq / CITE-seq). Performed CITE-seq to simultaneously profile the single-cell transcriptome and surface proteome of TME-infiltrating T cells. Applied unsupervised clustering to resolve DNT cells into distinct T cell clusters, and assessed exhaustion markers, cytolytic molecules, and metabolismrelated factors to define the signature of the cytolytic DNT subset. Used trajectory analysis to infer the developmental origin of these cytolytic DNT cells. Results: In our research results, we have found these DNT cells increased in murine hepatoma model, especially in the tumor microenvironment. In addition, these DNT cells from tumor microenvironment of murine hepatoma possessed potent tumor-killing ability. Furthermore, we analyzed the transcriptome profile of T cells in tumor microenvironment by single cell RNAseq approach (CITE-seq). We found DNT cells could be categorized into two main clusters, one is cytolytic DNT cells, resemble the potent CD8+ T cells, and another is the CD4+ T cell-like DNT cells. These cytolytic DNT cells are

2026 TDDW

P.03 not exhausted but with high expression of cytolytic molecule and low hypoxia-inducible factor-1alpha (HIF-1a) expression. By trajectory analysis, cytolytic DNT cells come from the conventional CD8+ T cells but following a unique developmental pathway that is different from the CD8+ T cells. Interesting, these cytolytic DNT cells also expressed high level of Fcer1g molecule, a marker of innate CD8+ T cells. In addition, these DNT cells could be generated and expanded in-vitro by IL-15 without TCR activation. In conclusion, we identified a cluster of cytolytic DNT cells, originated from CD8+ T cells, exhibits innate T cells behavior and potent killing ability. In addition, these cytolytic DNT cells could be generated and expanded in-vitro for the adoptive T cell transfer treatment of hepatoma. Conclusions: In conclusion, we identified a cluster of cytolytic DNT cells, originated from CD8+ T cells, exhibits innate T cells behavior and potent killing ability. In addition, these cytolytic DNT cells could be generated and expanded in-vitro for the adoptive T cell transfer treatment of hepatoma.

STATIN AND URSODEOXYCHOLIC ACID MODULATE THE GUT–BILE ACID–MICROBIOTA–IMMUNE AXIS IN ADVANCED LIVER FIBROSIS: A RANDOMIZED PILOT AND EXPERIMENTAL MOUSE STUDY Chih-Ming Liang1,2, Seng-Kee Chuah1,2, Chang-Chun Hsiao2, Wei-Shiung Lian3,4, Tsung-Hui Hu1,2, Chien-Hung Chen1,2, Ming-Chao Tsai1,2, Yuan-Hung Kuo1,2 Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Core Laboratory for Phenomics and Diagnostics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 4 Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 1

他汀類藥物與熊去氧膽酸對進階肝纖維化腸道 — 膽酸 — 菌相 — 免疫軸之調節作用：隨機先導研究與實驗小鼠研究梁志明1,2 蔡成枝1,2 蕭長春2 連韋雄3,4 胡琮輝1,2 陳建宏1,2 蔡明釗1,2 郭垣宏1,2 1

長庚醫療財團法人高雄長庚紀念醫院胃腸肝膽科系暨長庚大學醫學系 2 長庚大學臨床醫學研究所 3 長庚醫療財團法人高雄長庚紀念醫院實驗動物型態鑑定暨診斷核心實驗室 4 高雄長庚紀念醫院醫學研究部

Background: Patients with advanced liver fibrosis may continue to exhibit persistent inflammatory and fibrogenic activity even after successful hepatitis B viral suppression or hepatitis C viral eradication. Disturbance of the gut–bile acid– microbiota–immune axis has been implicated in this residual disease activity, but therapeutic strategies targeting this axis remain insufficiently defined. Ursodeoxycholic acid (UDCA) may modify bile acid homeostasis and gut microbial ecology,

141

2026 TDDW

whereas statins have potential anti-inflammatory and antifibrotic properties. Whether statin and UDCA, alone or in combination, can modulate gut microbiota and gut-derived inflammatory–fibrotic signaling in advanced liver fibrosis remains unclear. Aims: To investigate whether statin, UDCA, or their combination is associated with modulation of gut microbiota, inflammatory cytokines, and fibrosisrelated biomarkers in patients with advanced liver fibrosis after viral control, and to integrate these findings with a thioacetamide-induced mouse model incorporating human cirrhotic fecal microbiota transplantation. Methods: The human component was a randomized, open-label, exploratory pilot study enrolling patients with advanced liver fibrosis, defined as bridging fibrosis or cirrhosis corresponding to F3–F4 disease, after hepatitis B viral suppression or hepatitis C sustained virologic response. A total of 19 participants were initially enrolled; one was excluded for not meeting the definition of advanced liver fibrosis, leaving 18 evaluable participants. Twelve patients with advanced liver fibrosis were randomized to control, UDCA, statin, or statin plus UDCA groups, with three patients per arm, and a non-fibrosis comparison group was enrolled concurrently (n = 6). Stool microbiota was analyzed using 16S rRNA gene sequencing, and fibrosis- and inflammationrelated biomarkers were measured before and after treatment. The experimental component included 40 male C57BL/6 mice allocated to six groups: PBSFMT control, cirrhotic FMT control, cirrhotic FMT plus statin, cirrhotic FMT plus UDCA, cirrhotic FMT plus statin plus UDCA, and healthy non-induced control. Mice underwent thioacetamide-induced chronic liver fibrosis for 12 weeks, followed by human cirrhotic fecal microbiota transplantation and drug intervention for 8 weeks. Two mice in the cirrhotic FMT control group died during the intervention period, and endpoint analyses were performed using available samples. Results: In the human pilot cohort, patients with advanced liver fibrosis showed biochemical and elastographic features consistent with more advanced liver injury compared with non-fibrosis controls, including higher international normalized ratio, lower platelet count, lower low-density lipoprotein cholesterol, higher FibroScan values, and significantly elevated type IV collagen (p = 0.001, q = 0.008). Global gut microbiome structure was not significantly different between advanced fibrosis

142

and non-fibrosis groups, and paired treatment analyses did not demonstrate consistent changes in alpha- or beta-diversity. However, exploratory taxa-level analysis identified a consistent reduction in Klebsiella after statin plus UDCA treatment, with genus-level significance by LEfSe analysis (adjusted p = 0.046). Detected Klebsiella-related species, including K. pneumoniae, showed directionally lower post-treatment abundance, although specieslevel comparisons did not remain significant after multiple-testing correction. Predicted functional pathway analysis showed directional increases in bile acid-, short-chain fatty acid/carbohydrate-, transport-, and signaling-related pathways after treatment, but these findings were not statistically significant after false discovery rate correction. In the mouse model, human cirrhotic fecal microbiota transplantation aggravated liver and intestinal phenotypes beyond thioacetamide-induced background injury. The cirrhotic FMT control group showed the most severe hepatic fibrosis, with higher Ishak stage, increased Collagen I expression (overall p < 0.001), increased TGF-β expression (overall p < 0.001), elevated serum IL-6 (overall p = 0.0014) and IL-1 (overall p < 0.001), and the most severe ileal PAS-defined mucosal injury. In contrast, UDCAcontaining regimens were associated with lower hepatic profibrotic marker expression, reduced systemic inflammatory cytokines, and more favorable intestinal mucosal findings. The statin plus UDCA group showed a favorable integrated profile, including lower Collagen I, TGF-β, IL-6, and IL-1, and the highest claudin-1 immunoreactivity among thioacetamide-exposed groups. Conclusions: This integrated randomized pilot and experimental mouse study supports the feasibility of targeting the gut–bile acid–microbiota–immune axis in advanced liver fibrosis. In humans, statin plus UDCA was associated with an unexpected exploratory reduction in Klebsiella without broad global microbiome restructuring. In mice, human cirrhotic FMT aggravated hepatic inflammatory– fibrotic signaling and intestinal mucosal injury, whereas UDCA-containing regimens, particularly statin plus UDCA, were associated with attenuation of profibrotic and inflammatory phenotypes. These findings suggest that statin plus UDCA may act as a host–microbiome ecological modulator. Trial registration: ClinicalTrials.gov NCT07102979/IRB: IRB202201398A3.

2026 TDDW

P.04

PD-1 DEFINES A CONTINUUM OF ATYPICAL MEMORY B-CELL REMODELING LINKED TO HBSAGSPECIFIC DYSFUNCTION AND IMPAIRED HBSAG REDUCTION IN CHRONIC HEPATITIS B Nguyen Thi Kim Duyen1,2, Yen-Chun Liu1, Hsiang-Wei Huang1, Chia-Wei Lin1, Wei-Ting Ku1, Jian-He Fang1, Wen-Juei Jeng1,3, Chun-Yen Lin1,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

PD-1 界定慢性 B 肝非典型記憶 B 細胞重塑連續譜及其與 HBsAg 下降受損之關聯阮金緣1,2 劉彥君1 黃祥瑋1 林家緯1 古唯鼎1 方健合1 鄭文睿1,3 林俊彥1,3 1

林口長庚醫院胃腸肝膽科系長庚大學臨床醫學研究所 3 長庚大學醫學院 2

programs, alongside a progressive loss of IFNresponse and lymphoid homing programs. Notably, PD-1+ atMBCs retained somatic hypermutation levels comparable to classical memory B cells, suggesting antigen-driven maturation. In flow cytometry validation cohort, PD-1+/atMBC frequency negatively correlated with HBsAg reduction (r = -0.574, p = 0.032). At the antigen-specific level, HBsAg-specific B cells displayed significant lower classical memory phenotypes, enrichment of PD-1+ atypical phenotypes and increased IL-10 receptor expression compared with HBcAg-specific B cells (p = 0.002, p = 0.0085 and p = 0. p = 0.0017, respectively). Notably, PD-1+/atMBC positively correlated with enrichment of PD-1+ atypical phenotype among HBsAg-specific B cells (r = 0.7099, p = 0.0058). In contrast, HBcAg-specific B cells retained classical memory features, increased with ALT elevation (p = 0.0186) and showed no association between their PD-1+ atypical phenotype and PD-1+/atMBC. Conclusions: Progressive PD-1 acquisition marks a terminal atypical B-cell state associated with selective remodeling of HBsAg-specific B-cell immunity and poorer HBsAg decline. These findings support a model in which chronic HBsAg exposure drives divergent specific B-cell differentiation trajectories, linking atypical B-cell heterogeneity to barriers against functional cure in chronic hepatitis B.

Background: Atypical memory B cells (atMBCs) and HBV-specific memory B cells undergo dysfunction during chronic hepatitis B (CHB). Whether this defect represents a uniform exhaustion or antigen-specific divergent differentiation remains unclear. Aims: We investigated the remodeling of HBsAgand HBcAg-specific B cells and the role of the PD-1 axis in shaping HBsAg-specific B-cell fate. Methods: Single-cell multi-omics (scRNA/CITE/ BCR-seq) was performed on peripheral B cells from 17 HBeAg-negative CHB patients. Flow cytometry validated B-cell subsets and HBV-specific B cells using fluorescent antigen baits. Correlations were assessed using Spearman and Jonckheere–Terpstra analyses. Results: Unsupervised analysis identified two distinct atMBC states connected by a progressive PD-1 differentiation trajectory. Increasing PD-1 protein expression is associated with upregulation of inhibitory receptors, UPR/ER-stress, and ASC-priming

143

2026 TDDW

P.05

CLINICAL APPLICATION OF PHOSPHATIDYLETHANOL IN ALCOHOL-ASSOCIATED LIVER DISEASE IN TAIWAN Chun-Ming Hong1, Ching-Hua Lee2,3, Ching-Hua Kuo2,3, Tung-Hung Su4, Shih-Jer Hsu4, Tai-Chung Tseng4, Hung-Chih Yang4, Shang-Chin Huang5, Jia-Horng Kao4, Chun-Jen Liu4, Pei-Jer Chen4 Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan 3 The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan 4 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 5 Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan 1

臺灣酒精相關肝病中磷脂醇乙醇（Phosphatidylethanol, PEth）的臨床應用洪俊銘1 李京樺2,3 郭錦樺2,3 蘇東弘4 徐士哲4 曾岱宗4 楊宏志4 黃上秦5 高嘉宏4 劉俊人4 陳培哲4 1

台大醫院整合醫學科國立臺灣大學藥學系 3 國立臺灣大學基因體暨精準醫學研究中心 4 台大醫院胃腸肝膽科 5 台大醫院北護分院內科部 2

Background: Alcohol-associated liver disease (ALD) has become a serious issue worldwide in recent years and the most common cause of advanced liver disease and leading indication for liver transplantation. It is essential to recognize ALD patients. Acquiring the information of alcohol intake is essential though challenging. Under-reporting may happen and some patients may not be able to report the accurate amount of alcohol intake or cannot be interviewed due to encephalopathy or alcohol intoxication. Therefore, a biomarker with the ability to detect recent alcohol intake is helpful. Phosphatidylethanol (PEth), an ethanol metabolite,

144

can be used as a biomarker for alcohol use in recent 1-4 weeks. There is a consensus that a cut-off value for PEth (16:0/18:1) over 20ng/mL indicates excessive alcohol use. However, usage of PEth is limited in most countries. Aims: Our study tried to investigate clinical application of PEth in ALD patients in Taiwan. Methods: We conducted a prospective study in National Taiwan University Hospital from May 2025 to March 2026. Upon recruitment, clinical information, AUDIT (Alcohol Use Disorders Identification Test) questionnaire, laboratory tests, and blood were obtained. PEth (16:0/18:1) was measured by liquid chromatography-tandem mass spectrometry from whole blood samples. Testing for PEth was conducted with an Agilent (Santa Clara, USA) 1290 UHPLC system coupled with an Agilent 6460 triple quadrupole LC/MS system. Results: Forty-one patients were recruited. Thirtyseven (90.2%) were male. Average age was 58 years old. 22 patients (53.7%) had HBV infection and one had positive anti-HCV Ab. Nine patients (22%) were cirrhotic. Average total bilirubin was 1.2 mg/dL, average AST was 41.5 U/L, average ALT was 36 U/L, and average GGT was 184.9 U/L. 21 patients (51.2%) had AUDIT scores more than 8 points. Average PEth (16:0/18:1) was 256.6 ng/mL. Pearson correlation coefficient between AUDIT score and PEth (16:0/18:1) concentration was 0.692. Conclusions: PEth proves to be a reliable biomarker for recent alcohol exposure and its levels correlate with AUDIT scores. Despite its cost and limited accessibility, measurement of PEth should be implemented in the workup of ALD in Taiwan.

2026 TDDW

P.06

EARLY POST-CESSATION HBV DNA PREDICTS HEPATITIS FLARES AFTER TENOFOVIR DISCONTINUATION IN HBEAG-NEGATIVE CHRONIC HEPATITIS B Yen-Chun Liu1,2, Wen-Juei Jeng1,2, Rong-Nan Chien1,2, Yun-Fan Liaw1,3 College of Medicine, Chang Gung University, Taoyuan, Taiwan 2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 3 Liver Research Unit, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 1

停用 Tenofovir 後早期 HBV DNA 可預測 HBeAg 陰性慢性 B 型肝炎患者之肝炎發作劉彥君1,2 鄭文睿1,2 簡榮南1,2 廖運範1,3 1

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

Background: Hepatitis flares after discontinuation of tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) may occur rapidly, predominantly within the first 6 months after treatment cessation. Early identification of patients at risk for imminent flare is critical for safe off-therapy monitoring. Aims: We evaluated whether HBV DNA measured at 1 and 3 months after TDF/TAF cessation predicts subsequent hepatitis flare in HBeAg-negative chronic hepatitis B (CHB). Methods: HBeAg-negative CHB patients who discontinued TDF or TAF after sustained virological suppression, defined as consecutive undetectable HBV DNA measurements at least 6 months apart, were included. After treatment cessation, patients underwent monthly monitoring during the first 3 months and every 3months thereafter during the first year. Off-therapy hepatitis flare was defined as ALT ≥5× ULN with HBV DNA ≥2000 IU/mL. Predictive performance of month 1 and month 3 HBV DNA after cessation and end-of-treatment (EOT) HBsAg, was assessed using AUROC analysis. Kaplan-Meier analysis compared cumulative flare incidence by Youden index-derived HBV DNA cutoffs. Results: Among 83 HBeAg-negative CHB patients

who discontinued TDF or TAF, median age was 55 years, 84% were male, and 78% had genotype B. Median pretreatment HBV DNA and EOT HBsAg levels were 6.6 and 2.4 log10 IU/mL, respectively. During a median follow-up of 5.0 years, 48 patients (56%) developed off-therapy hepatitis flare, with a median time to flare of 14 weeks. Flares clustered early after cessation: 17, 32, 38 patients flared within 3, 6, 12 months, respectively, and 84% of the first-year flares occurred within the first 6 months. Month-1 HBV DNA outperformed EOT HBsAg in predicting 3-month flare, with AUROCs of 0.825 versus 0.474, respectively; p = 0.007. Month-1 HBV DNA also predicted 6-month flare, with an AUROC of 0.716, compared with 0.460 for EOT HBsAg. Using 2.5 log10 IU/mL as the optimal month-1 HBV DNA cutoff, cumulative flare incidence was higher in patients with HBV DNA ≥2.5 versus <2.5 log10 IU/ mL at 3 months and 6months: 31% versus 0% and 52% versus 14%, respectively; log-rank p < 0.01. For predicting 3-month flare, this cutoff identified all flare cases, yielding a sensitivity and NPV of 100%, with a specificity of 43.9% and PPV of 31.5%. Month-3 HBV DNA further improved prediction of 6and 12-month flare, with AUROCs of 0.888 and 0.876, respectively. Conclusions: In HBeAg-negative CHB patients after TDF/TAF cessation, month-1 HBV DNA outperformed EOT HBsAg in predicting early off-therapy hepatitis flare. A month-1 HBV DNA level <2.5 log10 IU/ mL identified patients at low risk for imminent 3-month flare, while levels ≥2.5 log10 IU/mL may warrant closer early monitoring. Month-3 HBV DNA further refined prediction of 6- and 12-month flare, supporting individualized post-cessation surveillance.

145

2026 TDDW

P.07

BEYOND AGREEMENT: HOW AI ABSTRACTION ERRORS BIAS REAL-WORLD HEPATOCELLULAR CARCINOMA DATA Hung-Kai Chiu1, Wei-Mei Chen2, Chia-Kan Lin3, Lee-Wen Chong1,4,5, Cheuk-Kay Sun1,4,5, Kou-Ching Yang1,4, Yu-Min Lin1,4,5 Department of Internal Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan 2 Cancer Prevention and Management Center, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan 3 Application System Maintenance Section, Information Department, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan 5 School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan 1

AI 資料萃取與真實世界數據的偏差分析 — 以晚期肝癌為例邱泓愷1 陳㻰玫2 林嘉淦3 張麗文1,4,5 孫灼基1,4,5 楊國卿1,4 林裕民1,4,5 1

新光吳火獅紀念醫院內科部新光吳火獅紀念醫院癌症防治中心癌登組 3 新光吳火獅紀念醫院資訊部 4 新光吳火獅紀念醫院腸胃肝膽科 5 輔仁大學醫學系 2

Background: AI-assisted abstraction can accelerate real-world oncology datasets, and overall agreement with clinicians is often high; but whether residual errors are random or systematically biasing is unknown, and only bias threatens real-world evidence. Aims: We aimed to characterize the pattern, direction, and downstream impact of AI abstraction errors in hepatocellular carcinoma (HCC). Methods: In 33 adults with advanced HCC receiving immune checkpoint inhibitor (ICI)–containing therapy, an institutional AI system abstracted 18 variables (594 field-comparisons); clinicians verified every value (reference standard). Discordances were classified by severity and direction, and overall survival (OS) from AI-abstracted versus verified data was compared.

146

Results: Discordances were systematic, not random, concentrating in staging, date-anchored biomarkers, and derived variables (TNM agreement 39%) while static fields were near-perfect, and worsening with time since diagnosis (TNM discordance odds ratio 1.82 per year). Errors were directional but from distinct mechanisms: TNM favored under-staging, while diagnosis-anchored survival was independently underestimated via mis-anchored dates. Bias was anchor-dependent: OS from the ICI-start date was unbiased (14.7 versus 14.9 months), whereas OS from the diagnosis date was underestimated by 7.3 months, driven almost entirely by a few catastrophic date errors (−0.2 months after exclusion). Conclusions: AI abstraction errors are systematic and directional, and a few severe date errors can bias cohort survival. Overall agreement alone cannot certify such data; a human-in-the-loop step— clinician verification of date-anchored and staging variables, with outlier screening—is essential before outcome analysis.

2026 TDDW

P.08

SYMPATHETIC DRIVE ORCHESTRATES THE HEPATOCYTE METABOLIC-TO-STRESS FUNCTIONAL SWITCH AND GUTLIVER-BRAIN AXIS DYSFUNCTION IN ACUTE INJURY: FROM PATHOLOGICAL DRIVE TO NEUROMETABOLIC RESTORATION Yi-Lin Chiu1, Herng-Sheng Lee2,3, Tien-Yu Huang4, Yi-Jen Peng3, Chao-Yang Chen5, I-Hsuan Huang4, Jung-Chun Lin4 Department and Graduate Institute of Biochemistry, College of Biomedical Sciences, National Defense Medical University, Taipei, Taiwan 2 Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 3 Department of Pathology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan 4 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan 5 Division of Colon and Rectal Surgery, TriService General Hospital, National Defense Medical University, Taipei, Taiwan 1

交感神經傳導調控急性損傷中肝細胞「代謝向壓力」功能轉換與腸 - 肝 - 腦軸失調：從病理性驅動到神經 - 代謝修復邱奕霖1 李恒昇2,3 黃天祐4 彭奕仁3 陳昭仰5 黃奕軒4 林榮鈞4 1

國防醫學院生物化學研究所高雄榮民總醫院病理檢驗部 3 三軍總醫院病理部 4 三軍總醫院胃腸肝膽科 5 三軍總醫院大腸直腸外科

Aims: We aimed to investigate how sympathetic drive governs the hepatocyte metabolic-to-stress transition and coordinates the collapse of the gutliver-brain axis during acute toxic challenge. Methods: Acute liver injury (ALI) was induced by carbon tetrachloride (CCl4) in mice. Chemical sympathectomy via 6-hydroxydopamine (6-OHDA) was performed to assess the role of the SNS in hepatic necrosis, intestinal enteropathy, and anorexia-driven weight loss. We integrated public single-cell RNAsequencing (scRNA-seq) data (GSE268846) to map the “SNS Response Module” and model hepatocyte state transitions using ternary plot mapping and CellChat analysis. Results: SNS ablation significantly attenuated CCl4induced alanine aminotransferase (ALT) surges (11,113 ± 3,470 IU/L vs. 25,835 ± 1,117 IU/L in the CCl4 group, p < 0.05) and centrilobular necrosis. 6-OHDA pre-treatment preserved ileal villous architecture, mitigated anorexia, and prevented weight loss, stabilizing the systemic gut-liver axis. Mechanistically, protected mice exhibited lower Heme Oxygenase-1 (HO-1) protein levels (~71% of the CCl4 group) despite robust hepatoprotection, indicating a state of “Metabolic Quiescence” in which blocking upstream neural stress preserves energetic reserves. scRNA-seq confirmed that sympathetic drive forces hepatocytes to switch from a metabolic identity (Cyp2e1) to a stress-responsive state (Adra1b), a process sustained by hepatic stellate cells acting as “neurotrophic hubs” via Ptn and Mdk signaling. Conclusions: Pathological sympathetic drive dictates the hepatocyte metabolic-to-stress switch and gut-liver axis collapse. Targeting the neurometabolic interface represents a novel therapeutic paradigm for acute liver failure and systemic gastroenterological dysfunction.

Background: Drug-induced liver injury (DILI) and acute liver failure represent systemic clinical crises involving the collapse of metabolic homeostasis and gut-liver-brain axis dysfunction. The sympathetic nervous system (SNS) is a primary regulator of visceral physiology, but its systemic neural regulation of hepatocyte states remains poorly defined.

147

2026 TDDW

P.09

HEXA-LACTOSIDE AS A HEPATOCYTE-TARGETING MOLECULE FOR FUNCTIONAL HEPATOCYTE IMAGING AND TRANSTHYRETIN (TTR) SIRNA DELIVERY Mei-Hui Wang, Hung-Wen Yu, Ching-Liang Kuo, Chun-Hung Yang, Kung-Liang Lin, Chen-Hsin Chan, Kai-Hung Cheng, Chung-Li Ho, Min-Hsuan Hsu, Wan-Chi Li, Tse-Zung Liao, Wei-Chuan Hsu National Atomic Research Institute, Taoyuan, Taiwan

六聚乳醣作為肝細胞標靶分子於肝細胞功能影像及甲狀腺素轉運蛋白（TTR） siRNA 傳輸之應用王美惠于鴻文郭璟亮楊浚泓林昆諒詹振勳鄭凱鴻何宗澧徐敏軒李婉綺廖澤蓉徐維荃國家原子能科技研究院

Background: Hepatitis affects approximately 10% of the global population, posing a severe threat to millions through progression into liver fibrosis, cirrhosis, and hepatocellular carcinoma. In managing these chronic liver conditions, precise non-invasive assessment of functional hepatocyte mass is critical; however, clinical practice still lacks a reliable standard for quantifying residual liver function. Concurrently, transthyretin (TTR) amyloidosis—a progressive, debilitating disease—is primarily driven by hepatic TTR production, necessitating liver-targeted gene silencing therapies. Aims: Leveraging the high affinity of Hexa-Lactoside for the asialoglycoprotein receptor (ASGPR) abundantly expressed on functional hepatocytes, we developed a versatile hepatocyte-targeting platform designed for both ASGPR-mediated functional molecular imaging and highly efficient TTR siRNA delivery. Methods: A synthetic Hexa-Lactoside moiety served as the functional targeting chassis. For diagnostic imaging, Hexa-Lactoside was conjugated with NCS-benzyl-NODA-GA and radiolabeled with gallium-68 (⁶⁸Ga) for PET/CT imaging in liver disease animal models. For therapeutic applications, HexaLactoside was conjugated with a cationic NARIpeptide via maleimide chemistry and self-assembled

148

with siRNA via non-covalent interactions to form targeted nanoparticles. In vivo hepatic TTR gene silencing efficiency was validated by quantifying serum TTR protein levels via Western blot analysis, while molecular imaging was employed to track the biodistribution of the delivery system. Results: Preliminary results demonstrated that Ga68 Hexa-Lactoside addresses current bottlenecks in liver function assessment by providing highcontrast, spatially resolved quantitative functional imaging. This imaging agent precisely visualized functional hepatocyte distribution, clearly delineated tumor margins, and mapped residual liver function. On the therapeutic front, the Hexa-Lactoside-NARI peptide complex exhibited prolonged hepatocyte accumulation exceeding 116 hours with minimal background signals in off-target tissues. Furthermore, systemic administration of the Hexa-Lactoside/siRNA nanoparticles achieved a robust reduction in serum TTR protein levels by over 50%. Conclusions: In conclusion, the Hexa-Lactoside platform successfully bridges the gap between precision diagnostics and targeted therapeutics. By offering quantitative functional liver imaging alongside highly potent, cell-specific TTR gene silencing, this liver-targeted approach represents a promising strategy for personalized liver function management and the treatment of liver-centric genetic diseases.

2026 TDDW

P.10

EFFECT OF DIRECT-ACTING ANTIVIRAL THERAPY ON GLYCEMIC CONTROL IN PATIENTS WITH CHRONIC HEPATITIS C AND TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS Jing-Hong Hu1, Ming-Ling Chang2, Ming-Shyan Lin3, Tung-Jung Huang4,5,6, Yung-Yu Hsieh7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yunlin Chang Gung Memorial Hospital, Yunlin, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan 3 Division of Cardiology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan 4 Department of Internal Medicine, Yunlin Chang Gung Memorial Hospital, Yunlin, Taiwan 5 School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 6 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan 7 Division of Gastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan 1

直接作用型抗病毒藥物治療對慢性 C 型肝炎合併第二型糖尿病患者血糖控制之影響：系統性回顧與統合分析胡錦鴻1 張明鈴2 林明賢3 黃東榮4,5,6 謝詠諭7 1

雲林長庚紀念醫院胃腸肝膽科林口長庚紀念醫院胃腸肝膽科暨長庚大學醫學院 3 雲林長庚紀念醫院心臟內科 4 雲林長庚紀念醫院內科部 5 長庚大學醫學系 6 長庚科技大學呼吸照護系 7 嘉義長庚紀念醫院胃腸肝膽科 2

achieves high sustained virological response (SVR) rates, its effect on glycemic control in patients with established T2DM remains uncertain. We conducted a systematic review and meta-analysis to evaluate the impact of DAA therapy on glycemic outcomes in this population. Aims: Chronic hepatitis C virus (HCV) infection is associated with insulin resistance and an increased risk of type 2 diabetes mellitus (T2DM). Although direct-acting antiviral (DAA) therapy achieves high sustained virological response (SVR) rates, its effect on glycemic control in patients with established T2DM remains uncertain. This study aimed to evaluate the impact of DAA therapy on glycemic control using a systematic review and meta-analysis. Methods: A systematic literature search was conducted according to PRISMA 2020 guidelines. Studies enrolling adults with chronic HCV infection and T2DM treated with interferon-free DAA regimens were included. The primary outcome was the change in HbA1c before and after SVR. A random-effects meta-analysis was performed to calculate pooled mean differences. Subgroup and sensitivity analyses were also conducted. Results: Six cohort studies involving more than 2,800 patients were included. DAA therapy significantly improved glycemic control after SVR, with a pooled HbA1c reduction of approximately 0.45%. Greater HbA1c improvement was observed in patients with cirrhosis and those with baseline HbA1c ≥8%. Sensitivity analyses confirmed the robustness of the findings despite moderate-to-high heterogeneity. Conclusions: DAA-induced eradication of HCV is associated with clinically meaningful improvement in glycemic control among patients with chronic HCV infection and T2DM. Successful antiviral therapy provides metabolic benefits beyond viral clearance. Careful glycemic monitoring following SVR is recommended, particularly in patients receiving glucose-lowering medications.

Background: Chronic hepatitis C virus (HCV) infection is associated with insulin resistance and an increased risk of type 2 diabetes mellitus (T2DM). Although direct-acting antiviral (DAA) therapy

149

2026 TDDW

P.11

ANTROQUINONOL ATTENUATES PORTOSYSTEMIC COLLATERAL CIRCULATION AND HEPATIC ENCEPHALOPATHY BY DOWNREGULATING THE VEGFR2/ ERK/ENOS PATHWAY IN CIRRHOTIC RATS Yu-Lun Yang1, Shao-Jung Hsu1,2, Hui-Chun Huang2,3, Jiing-Chyuan Luo1,2, Ming-Chih Hou1,2, Fa-Yauh Lee1,2 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 Endoscopic Center for Diagnosis and Therapy, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 1

牛樟芝藉由調降 VEGFR2/ERK/eNOS 路徑改善肝硬化大鼠之側枝循環及肝腦病變楊宇倫1 許劭榮1,2 黃惠君2,3 羅景全1,2 侯明志1,2 李發耀1,2 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 臺北榮民總醫院內視鏡診斷治療科 2

Background: Liver cirrhosis accompanied by portal hypertension arises from chronic liver injury, leading to life-threatening complications such as hepatic encephalopathy (HE). Extrahepatic angiogenesis, driven by the upregulation of the vascular endothelial growth factor (VEGF) pathway, contributes to pathological neovascularization. This process corporate-exacerbates portosystemic collateral shunting, hyperammonemia, and HE. Extracellular signal-regulated kinase (ERK) and endothelial nitric oxide synthase (eNOS) are activated downstream of VEGF signaling during angiogenic development. Antroquinonol, a bioactive compound isolated from the mycelium of Antrodia camphorata, exhibits anti-tumor effects by inhibiting angiogenesis. However, its specific molecular mechanisms and therapeutic potential regarding angiogenesis, portal hypertension, and HE in cirrhosis remain unexplored. Aims: This study aimed to evaluate the therapeutic potential of antroquinonol in a rat model of experimental cirrhosis with HE.

150

Methods: Male Sprague–Dawley rats underwent bile duct ligation (BDL) to induce liver cirrhosis. Starting one day post-surgery, the rats were randomly assigned to receive either vehicle or antroquinonol for 28 days. Experimental assessments were performed on day 29. Results: Antroquinonol did not alter portal pressure, hepatic hemodynamics, nor splanchnic circulation in cirrhotic rats. Notably, it significantly attenuated the severity of portosystemic collateral shunting (P = 0.009). Mechanistic analyses revealed that antroquinonol suppressed pathological mesenteric angiogenesis (P < 0.001) by decreasing the phosphorylation of VEGFR2 (P < 0.001), phosphorylation of ERK (P = 0.009), and phosphorylation of eNOS (P = 0.004) on Western blot analysis. Concurrently, plasma ammonia levels were significantly reduced (P = 0.002). Locomotor activity testing demonstrated improved neurobehavioral performance, evidenced by a significant increase in ambulatory moving distance (P = 0.016) and total moving duration (P = 0.015), alongside a decrease in total stopping duration (P = 0.018) in the antroquinonol-treated group, indicating attenuation of HE. Conclusions: Antroquinonol alleviates portosystemic collateral shunting, hyperammonemia, and HE in cirrhotic rats, at least in part by suppressing extrahepatic angiogenesis via downregulation of the VEGFR2/ERK/eNOS pathway. These findings suggest that antroquinonol warrants further evaluation as a therapeutic strategy for managing cirrhosis-related HE.

2026 TDDW

P.12

LONG-TERM RISK OF HEPATOCELLULAR CARCINOMA DEVELOPMENT FOR CHRONIC HEPATITIS C PATIENTS WITH LIVER CIRRHOSIS TREATED BY PEGYLATED INTERFERON-BASED THERAPY Tai-Ku Lin1, Chung-Chi Lin2,3, Chi-Jen Chu1,2, Chien-Wei Su1,2, Fa-Yauh Lee1,2, Jiing-Chyuan Luo1,2, Yi-Hsiang Huang1,2, Ming-Chih Hou1,2 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 Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan 1

慢性 C 型肝炎肝硬化病患在接受長效型干擾素治療後長期肝細胞癌發生率之追蹤研究林泰谷1 林崇棋2,3 朱啟仁1,2 蘇建維1,2 李發耀1,2 羅景全1,2 黃怡翔1,2 侯明志1,2 1

臺北榮民總醫院胃腸肝膽科國立陽明交通大學醫學糸 3 臺北榮民總醫院健康管理中心 2

Background: Multiple longitudinal follow-up studies confirmed that advanced fibrotic chronic hepatitis C (CHC) patients who failed to interferonbased therapy had significantly higher rate of allcause mortality, liver-related mortality, liver failure and hepatocellular carcinoma (HCC) as compared to CHC patients who achieved sustained virological response (SVR). Fortunately, the therapeutic landscape of CHC evolved dramatically after the invention of all oral direct-acting antivirals (DAAs). As compared with pegylated interferon (Peg-IFN), all oral DAAs provided shorter treatment period, highly efficacy and excellent tolerability. To date, DAAs became a valuable option for patients who are ineligible or failure to Peg-IFN-based therapy. Aims: To investigate the long-term risk of HCC development for CHC patients with liver cirrhosis after treating with Peg-IFN plus ribavirin (RBV) with or without SVR. Methods: Between January 2011 to June 2018, a total of 79 consecutive CHC patients with liver

cirrhosis who treated with Peg-IFN plus RBV by the investigators were enrolled. History of HCC before the initiation of Peg-IFN, liver transplantation and early terminate antiviral therapy with short followup period (<1 year) were excluded. Liver cirrhosis was defined either by pathological report of biopsy, presence of typically endoscopic/radiological manifestations of cirrhosis, or reliable transient elastography (FibroScan) result with fibrosis degree >14.0 kPa. SVR was defined by undetectable HCV RNA (<15 IU/mL) at the end-of-treatment and 24 weeks after the completion of Peg-IFN therapy. For patients who failed to Peg-IFN plus RBV, DAAs were provided for rescue therapy and treatment responses were recorded. Occurrence of HCC was included as the primary outcome and the cumulative incidence of HCC development was measured by Kaplan-Meier statistical method. Results: Mean age of enrolled patients starting PegIFN was 59.8 ± 9.3 years, 60.8% of them was female, and mean pre-treatment HCV RNA was 5.98 ± 0.91 log10 IU/mL. Genotype distribution was as follows: 1a: 2.5%; 1b: 64.6%; 2: 26.6%; and mixed 1 and 2: 6.3%. After therapy with Peg-IFN plus RBV, responses were as follows: SVR: 50.6%; relapser: 25.3%, partial or null-responder: 10.1%, intolerant and early terminate: 13.9%. The mean follow-up period post first dose Peg-IFN was 114.9 ± 47.3 months (range: 16 to 182 months). 31 of 39 (79.5%) patients who failed Peg-IFN plus RBV received all oral DAAs as rescue and 30 of them (96.8%) achieve SVR. A total of 32 (40.5%) patients developed HCC during study period, 14 in SVR and 18 in Peg-IFN failure group. For cirrhotic patients achieved SVR by Peg-IFN + RBV (n = 40), incidence to develop HCC at 2, 5, 8, 10 and 14 years was 12.6%, 21.5%, 31.1%, 38.2% and 42.3%, respectively. For Peg-IFN failure (n = 39) but majority of them successfully rescued by all-oral DAAs, comparable incidence of HCC development was found as compared to SVR group. The incidence of HCC occurrence at 2, 5, 8, 10 and 14 years was 7.7%, 16.2%, 38.2%, 45.1% and 69.8%, respectively (log rank p value = 0.462). Ultimate antiviral response and thrombocytopenia are important factor associated with HCC occurrence. Conclusions: For cirrhotic CHC patients who failed therapy with Peg-IFN plus RBV, future risk of HCC occurrence can be negatively modified, at least in part, by successful DAAs rescue. Despite viral clearance, the residual risk to develop HCC still existed, especially for patients with

151

2026 TDDW

P.13 thrombocytopenia. Continuing surveillance of HCC should be arranged for patients with risk factors of liver disease progression.

ADVANCED HEPATOCELLULAR CARCINOMA AS THE DOMINANT PREDICTOR OF 6- WEEK MORTALITY AFTER VARICEAL BLEEDING: A REALWORLD COHORT STUDY Han-Hui Lee1, Chung-Ying Lee1,2,3, Tsung-Chun Lee1,2,3 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, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3 TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan 1

晚期肝細胞癌為靜脈曲張出血後六週死亡率最主要的預測因子：一項真實世界世代研究李政諱1 李宗頴1,2,3 李宗錞1,2,3 1

衛生福利部雙和醫院（委託臺北醫學大學興建經營）消化內科 2 臺北醫學大學內科學科消化內科 3 臺北醫學大學消化醫學研究中心

Background: Upper gastrointestinal variceal bleeding remains a life-threatening complication of portal hypertension, with a 6-week mortality of 10–20% despite advances in endoscopic and pharmacological therapy. Existing prognostic tools such as Model for End-stage Liver Disease (MELD) and Child-Pugh scores were not derived from variceal bleeding populations. Aims: We aimed to identify independent predictors of 6-week early mortality and to develop a local prognostic model with improved discriminative performance. Methods: A single-center retrospective cohort study was conducted at Shuang Ho Hospital (SHH) from January 2020 to December 2025. Patients aged ≥18 years who underwent endoscopic variceal ligation (EVL) or injection sclerotherapy (EIS) for esophageal or gastric variceal bleeding were eligible. Duplicate encounters were excluded; only the index endoscopy was analyzed. The primary outcome was all-cause mortality within 6 weeks of the index

152

2026 TDDW

P.14 procedure. Independent predictors were identified by logistic regression, and model discrimination was evaluated by Area Under the Receiver Operating Characteristic (AUROC). Results: Among 288 patients, 52 (18.1%) died within 6 weeks. On multivariate logistic regression, five variables were independently associated with early mortality: age (OR 1.06, 95% CI 1.03–1.10), total bilirubin (OR 1.08, 1.01–1.15), serum albumin (OR 0.43, 0.21–0.86), systolic blood pressure (SBP) (OR 0.98, 0.97–1.00), and advanced hepatocellular carcinoma (HCC) (modified Barcelona Clinic Liver Cancer, BCLC, stage C) (OR 9.99, 1.62–61.61). The proposed model incorporating these five variables achieved an AUROC of 0.811 (95% CI 0.737–0.873), outperforming MELD score (AUROC 0.730) and Child-Pugh score (AUROC 0.733). For 6-week rebleeding (14.9%), independent predictors were serum albumin (OR 0.49, p = 0.040), hepatic encephalopathy (OR 2.84, p = 0.014), and active bleeding at endoscopy (OR 3.22, p =0.003). Conclusions: In a real-world Taiwanese cohort, advanced HCC (modified BCLC stage C) was the strongest single predictor of 6-week mortality after variceal bleeding (OR ~10). A five-variable model — age, total bilirubin, albumin, SBP, and BCLC stage C — provided superior discrimination over established scores and may guide early triage and multidisciplinary escalation in high-risk patients.

LONG-TERM OUTCOMES AND PROGNOSTIC FACTORS OF PERCUTANEOUS RADIOFREQUENCY ABLATION FOR HEPATIC METASTASES: A 9-YEAR SINGLECENTER RETROSPECTIVE COHORT STUDY Andy Lin1, Wei-Ting Chen1, Shi-Ming Lin1, Chen-Chun Lin2, Yi-Chung Hsieh1, Po-Ting Lin1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan 1

經皮射頻消融術治療肝轉移之長期臨床結果與預後因子分析：九年單中心回顧性世代研究林安砥1 陳威廷1 林錫銘1 林成俊2 謝彜中1 林伯庭1 1 2

林口長庚紀念醫院胃腸肝膽科系新北市立土城醫院胃腸肝膽科

Background: Percutaneous RFA effectively treats colorectal liver metastases (CRLM), but real-world data for non-colorectal liver metastases (NCRLM) remains limited. Significant clinical heterogeneity— due to diverse primary tumors, varying tumor burdens, and distinct treatment histories— complicates patient selection and prognostic prediction. Aims: To evaluate the long-term outcomes of RFA for hepatic metastases and compare survival between colorectal and non-colorectal origins. We aimed to identify independent prognostic factors, testing the hypothesis that tumor burden dictates local control while systemic factors dictate survival. Methods: This 9-year retrospective cohort study included patients with solid tumor liver metastases undergoing percutaneous RFA. Primary endpoints were technical success rate and local tumor progression (LTP). Secondary endpoints included intrahepatic distant recurrence (IDR), hepatic progression-free survival (hPFS), and overall survival (OS). Results: We analyzed 183 patients (CRLM: 36.1%;

153

2026 TDDW

P.15 NCRLM: 63.9%) over 282 RFA sessions. The technical success rate was 72.0%, with tumor size >4 cm (P = 0.002) and ≥4 tumors (P = 0.002) as significant predictors of technical failure. Following complete ablation, LTP occurred in 16.7%. Median hPFS and OS were 8.38 and 27.3 months, respectively. Primary origin did not significantly impact OS (P = 0.501). Conversely, pre-ablation progressive disease (PD) under systemic therapy and tumor multiplicity (>3 tumors) independently predicted IDR and worse hPFS. Furthermore, PD (P < 0.001) and extrahepatic metastasis (P = 0.012) were significant poor prognostic factors for OS. Conclusions: RFA is an effective modality offering comparable survival benefits for both CRLM and NCRLM. However, RFA primarily provides local tumor control. Specifically, regarding hepatic progression-free survival (hPFS), progressive disease (PD) under systemic therapy and tumor multiplicity (>3 tumors) are significant poor prognostic factors. Consequently, for patients exhibiting PD, the anticipated survival benefit of RFA is highly limited. Strict patient selection prioritizing systemic disease control and limited tumor burden is essential before considering ablation.

SYSTEMIC TREATMENT VERSUS WITHOUT SYSTEMIC TREATMENT IN ICTERIC HEPATOCELLULAR CARCINOMA AFTER BILIARY DRAINAGE: A RETROSPECTIVE COHORT STUDY Chung-Wei Liu1, Chi-Huan Wu1,2, Yung-Kuan Tsou1,2, Mu-Hsien Lee1,2, Kai-Feng Sung1,2, Cheng-Hui Lin1,2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

膽道引流後黃疸型肝細胞癌患者接受與未接受全身性治療之臨床結果比較：回溯性世代研究劉中偉1 吳季桓1,2 鄒永寬1,2 李沐憲1,2 宋皚峰1,2 林政輝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: Icteric hepatocellular carcinoma (HCC) caused by bile duct invasion or compression is uncommon but difficult to treat. These patients often have advanced tumor burden, jaundice, impaired liver function, and limited treatment options. Biliary drainage may improve jaundice and allow further anti-cancer treatment. However, the clinical benefit of systemic treatment after biliary drainage in patients with icteric HCC remains unclear. Aims: To clarify clinical benefit of systemic treatment after biliary drainage in patients with icteric HCC. Methods: We conducted a retrospective cohort study at a single center. A total of 78 patients with icteric HCC who underwent biliary drainage by endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage were included. Among them, 30 patients received systemic treatment after biliary drainage, while 48 patients did not receive systemic treatment, including supportive care, loco regional treatment. Results: The median age was 61 years, and most patients were male. HBV and HCV infections were present in 59.0% and 20.5% of patients, respectively. Most patients had advanced-stage disease, with 66.7% classified as Barcelona Clinic Liver Cancer

154

2026 TDDW

P.16 stage C. Patients receiving systemic treatment had significantly longer overall survival and progressionfree survival than those without systemic treatment. The median overall survival was 14.6 months in the systemic treatment group and 6.7 months in the without systemic treatment group (p = 0.025). The median progression-free survival was 7.5 months and 3.5 months, respectively (p = 0.005). After 1:1 propensity score match (PSM) with 25 patients in each group, systemic treatment still significantly improved PFS 7.57 vs. 4.61 months (p = 0.044). Conclusions: Systemic treatment after biliary drainage was associated with better outcome survival in selected patients with icteric HCC, which given the opportunity for subsequent systemic therapy and improve outcomes in this difficult-totreat population.

THE SURVIVAL BENEFITS OF PRIOR CURATIVE HEPATECTOMY FOR PATIENTS WITH HEPATOCELLULAR CARCINOMA RECEIVING FIRSTLINE MULTIKINASE INHIBITORS: A PROPENSITY SCORE MATCHING AND INVERSE PROBABILITY OF TREATMENT WEIGHTING STUDY Kuan-Chun Hsueh1,2, Meng-Ju Yu2, 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

既往接受根治性肝切除術對第一線多重激酶抑制劑治療肝細胞癌患者存活之影響：傾向分數配對與逆機率治療加權研究薛冠群1,2 游孟儒2 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醫學研究部 2

Background: Hepatectomy is the treatment of choice for patients with resectable hepatocellular carcinoma (HCC). However, postoperative recurrence rate remains high. Some patients with tumor recurrences even develop macrovascular invasion or extrahepatic spread and require systemic therapy to control tumor growth. Likewise, patients progressing beyond locoregional treatment (LRT) require systemic therapy. Multikinase inhibitors (MKIs) are established first-line options for patients with HCC who are unsuitable for or refractory to LRT, or who have advanced disease. However, whether prior curative resection confers a survival benefit after MKI initiation remains unclear. We employed inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to compare

155

2026 TDDW

P.17 survival outcomes between MKI-treated patients with and without prior hepatectomy. Aims: This study aimed to evaluate and compare the survival outcomes, specifically overall survival (OS) and progression-free survival (PFS), between hepatocellular carcinoma (HCC) patients receiving first-line multikinase inhibitors (MKIs) with and without a history of prior curative hepatectomy. Methods: This retrospective cohort study enrolled 203 patients with unresectable HCC (Barcelona Clinic Liver Cancer [BCLC] stage B with LRT failure, or stage C) receiving first-line sorafenib or lenvatinib at a referral hospital in Taiwan (2018–2023). Patients were classified into recurrent HCC (rHCC, n = 58; with prior curative resection) and primary unresectable HCC (uHCC, n = 145; without prior resection) groups. The primary endpoints, overall survival (OS) and progression-free survival (PFS), were evaluated using stabilized IPTW combined with multivariable Cox regression, and PSM as sensitivity analysis. Results: Over a median follow-up of 13.2 months, the rHCC group demonstrated longer median OS (27.0 vs 11.8 months; P = 0.027). After IPTW-adjusted multivariable analysis, prior curative resection was an independent protective factor for OS (P = 0.003) and PFS (P = 0.010). PSM yielded concordant results (P < 0.001). Exploratory analysis indicated this survival advantage was concentrated in patients with late recurrence (≥24 months from hepatectomy). High tumor burden was an independent adverse prognostic factor for OS (P = 0.017). Conclusions: Among patients with BCLC B-C HCC receiving first-line MKIs, prior curative resection confers longer OS and PFS, persisting after propensity score adjustment. The favorable hepatic reserve and tumor biology associated with prior surgical candidacy may persist during systemic therapy. Future trials may prespecify prior curative resection as a stratification factor in survival analyses.

156

TARGETING KERATIN 23 SUPPRESSES TUMOR METASTASIS, GLYCOLYSIS AND ENHANCES SORAFENIB SENSITIVITY IN HEPATOCELLULAR CARCINOMA VIA THE AK3/AMPKΑ/ SNAIL AXIS Yang-Hsiang Lin1, Chau-Ting Yeh1,2 Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 2 Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 1

Background: Hepatocellular carcinoma (HCC) patients with sorafenib resistance exhibit poor survival outcomes. Metabolic reprogramming, particularly enhanced glycolysis, has been increasingly recognized as a key driver of drug resistance. 2-Deoxyglucose (2-DG), a glucose analog that inhibits glycolysis, has been evaluated in multiple cancers. However, its potential role in antiHCC progression remains unexplored. Aims: The clinical application of the glucose metabolism inhibitor 2-deoxyglucose (2-DG) in keratin 23 (KRT23)-driven HCC progression remains limited. Methods: KRT23, a cytoskeleton-associated protein, was identified from public datasets. Its prognostic value in HCC was analyzed by Kaplan-Meier survival analysis, and its functions and regulatory mechanisms were investigated in vitro, in vivo, and by molecular assays. Results: In this study, we found that KRT23 was upregulated in HCC tissues and correlates with poor survival in both our clinical cohort and publicly available datasets. Functional assays demonstrated that KRT23 overexpression promotes tumor growth, metastasis, enhances glycolysis, and confers resistance to sorafenib both in vitro and in vivo. Metabolomic profiling revealed that KRT23 reduces adenosine monophosphate (AMP) levels, thereby inhibiting the phosphorylation of AMP-activated protein kinase α (AMPKα), a key event required for Snail protein stabilization. Mechanistically, the KRT23-mediated reduction in AMP levels was achieved through the modulation of adenylate kinase 3 (AK3). Notably, the LID, NMP, and P-loop domains of AK3 are important for the modulation of KRT23-mediated oncogenic effects.

2026 TDDW

P.18 Interestingly, AK3 protein stability was regulated by KRT23 through its rod domain. Importantly, pharmacological inhibition of glycolysis using 2-DG reversed the oncogenic effects induced by KRT23. Conclusions: These findings identify KRT23 as a key regulator of sorafenib resistance through modulation of AMP levels and the AK3/AMPKα/ Snail axis, suggesting that targeting this pathway may represent a promising therapeutic strategy for improving outcomes in HCC patients with sorafenib resistance.

ANTIVIRAL THERAPY IS ASSOCIATED WITH ACHIEVEMENT OF STATISTICAL CURE OF PATIENTS UNDERGOING LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA: A RETROSPECTIVE STUDY Yi-Hao Yen1, Sin-Hua Moi2, Chih-Chi Wang3 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3 Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan 1

抗病毒藥物治療和肝細胞癌病患接受手術切除達到統計學上的根治相關：一回溯性研究顏毅豪1 魏芯樺2 王植熙3 1

高雄長庚紀念醫院胃腸肝膽科系高雄醫學大學臨床醫學研究所 3 高雄長庚紀念醫院一般外科 2

Background: Statistical cure occurs when the mortality of a specific population returns to mortality values of the general population. Whether antiviral therapy is associated with achievement of statistical cure of patients with hepatocellular carcinoma (HCC) undergoing liver resection (LR) remains unknown. Aims: We aimed to clarify this issue. Methods: We enrolled 1004 patients with HCC who underwent LR. We evaluated overall survival (OS) as the primary survival measure for estimating cure fractions through a mixture model. Results: The probability of resection enabling patients with HCC to achieve the same life expectancy as that of the general population was 48.6%. The multivariable cure model revealed that age ≤65 years, 7th edition pathological American Joint Committee on Cancer (AJCC) stage 1, no cirrhosis, receipt of antiviral therapy, and a Model for End-Stage Liver Disease (MELD) score of ≤9 were predictors of cure after LR. Conclusions: About five in 10 patients could be considered cured after LR for HCC. In addition

157

2026 TDDW

P.19 to tumor- and liver-related variables, receipt of antiviral therapy was associated with achievement of statistical cure. We highlight the importance of antiviral therapy for maximizing outcomes of resection for HCC.

IMMUNE CHECKPOINT INHIBITOR– BASED THERAPIES DEMONSTRATE SUPERIOR EFFICACY IN PATIENTS WITH HBV-RELATED ADVANCED HEPATOCELLULAR CARCINOMA Ching-Sheng Hsu1,2, Chih-Ming Lin1,2, Chia-Hsun Tsai1,2, Kao-Chi Chang Ou1,2 Center for Digestive Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan 2 College of Medicine, Tzu Chi University, Hualien, Taiwan 1

B 肝晚期肝細胞癌患者接受免疫檢查點抑制劑治療具有較佳療效許景盛1,2 林志明1,2 蔡佳勳1,2 張歐高奇1,2 1 2

台中慈濟醫院消化醫學中心慈濟大學醫學院

Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, particularly in advanced stages with limited therapeutic options. Immune checkpoint inhibitor (ICI)-based therapies and tyrosine kinase inhibitors (TKIs), including sorafenib and lenvatinib, are widely used as first-line treatments in real-world practice. However, direct comparisons between these approaches, particularly according to HCC etiology, remain limited. Aims: To evaluate the comparative efficacy and safety of ICI-based therapies and TKI monotherapy in advanced HCC and the impact of HCC etiology on treatment outcomes. Methods: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO: CRD420251000417). PubMed, Embase, and CENTRAL were searched for studies comparing ICI-based regimens with TKI monotherapy in advanced or unresectable HCC. Randomized controlled trials and high-quality observational studies reporting overall survival (OS), progressionfree survival (PFS), objective response rate (ORR), or disease control rate (DCR) were included. Subgroup analyses were conducted based on hepatitis B virus (HBV)-related, hepatitis C virus (HCV)-related, and non-viral HCC. Hazard ratios (HRs) and risk ratios (RRs) were pooled using random-effects models. Results: Seventeen studies were included.

158

2026 TDDW

P.20 Compared with TKI monotherapy, ICI-based regimens significantly improved OS (HR = 0.76, 95% CI: 0.65–0.88) and PFS (HR = 0.71, 95% CI: 0.62–0.81). ICIs also achieved higher ORR (RR = 1.58, 95% CI: 1.09–2.29) and DCR (RR = 1.10, 95% CI: 1.00–1.20), with lower rates of both any-grade and grade 3–4 adverse events. Subgroup analyses demonstrated a significant survival benefit in HBV-related HCC (HR = 0.70, 95% CI: 0.60–0.82), whereas no significant benefit was observed in HCV-related or non-viral HCC. Conclusions: ICI-based therapies provide superior efficacy and tolerability compared with TKI.

CLINICAL OUTCOMES AND SAFETY OF RADIOFREQUENCY ABLATION FOR EARLY HEPATOCELLULAR CARCINOMA IN HIGH-RISK VERSUS CONVENTIONAL LOCATIONS: EXPERIENCE FROM NEW TAIPEI MUNICIPAL TUCHENG HOSPITAL Min-Yung Chen, Po-Jung Chen, Ying-Cheng Chen, Cheng-Chun Lin Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan

超音波導引無線射頻消融術治療高危險部位與常規部位早期肝細胞癌之臨床療效與安全性：新北市立土城醫院臨床經驗陳敏庸陳柏融陳英正林成俊新北市立土城醫院胃腸肝膽科

Background: Radiofrequency ablation (RFA) is an established curative treatment for early-stage hepatocellular carcinoma (HCC). However, tumors located in anatomically challenging areas—such as adjacent to major intrahepatic vessels, the diaphragm, or adjacent abdominal organs—present significant therapeutic hurdles due to the risk of thermal injury or incomplete ablation. Advances in intraoperative imaging guidance may potentially overcome these anatomical constraints. Aims: This study aimed to evaluate the treatment efficacy, long-term local tumor control, and safety of ultrasound-guided RFA for early-stage HCC located in high-risk areas compared with those in conventional, low-risk areas in a real-world clinical setting. Methods: A retrospective analysis was conducted on 114 consecutive patients with early-stage HCC who underwent ultrasound-guided RFA between 2020 and 2025. Tumors were classified into two groups based on their anatomical location: the Conventional Group (n = 20) and the High-Risk Group (n = 94, including tumors adjacent to major vessels, the diaphragm, or gastrointestinal organs). Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and real-time virtual sonography (RVS), were applied for tumor localization and

159

2026 TDDW

P.21 treatment planning when necessary. The baseline characteristics, initial complete response (CR) rate, major complication rate, and long-term local tumor progression (LTP)-free survival were compared between the two groups. Results: Baseline clinical characteristics, including mean age (66.8 vs. 68.3 years), solitary tumor profile (80.0% vs. 79.8%), mean tumor size (2.51 vs. 2.57 cm), and liver function profiles, were well-balanced and comparable between the Conventional and High-Risk groups. Advanced guidance (CEUS/RVS) was more frequently utilized in the High-Risk group (50.0% vs. 40.0%). The initial CR rate achieved was 100.0% (20/20) in the Conventional group and 93.6% (88/94) in the High-Risk group, showing no statistically significant difference (p = 0.580). Long-term follow-up demonstrated excellent local tumor control, with no significant difference in LTPfree survival between the two groups (Log-rank test, p > 0.05). The overall major complication rate was extremely low at 0.88% (1/114, consisting of 1 manageable case of diaphragm rupture in the highrisk group), with 0% procedure-related mortality. Conclusions: Ultrasound-guided RFA is highly effective and safe for early-stage HCC, even when tumors are located in high-risk anatomical areas. With the assistance of advanced imaging modalities such as CEUS and RVS, RFA achieves initial technical success and long-term local tumor control comparable to tumors in conventional locations without compromising patient safety.

SIX-MONTH ALBI TRAJECTORIES STRATIFY SURVIVAL OUTCOMES IN UNRESECTABLE HEPATOCELLULAR CARCINOMA TREATED WITH IMMUNOTHERAPY Ning-Yuan Yang1, Wei-Fan Hsu1,2, Cheng-Kuo Chen3, Hsueh-Chou Lai1,2, Hung-Wei Wang1,4, Ming-Mo Hou5, Shi-Ming Lin6, Chia-Hsun Hsieh5,7,8, Cheng-Yuan Peng1,4 Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 2 School of Chinese Medicine, China Medical University, Taichung, Taiwan 3 Division of Gastroenterology & Hepatology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan 4 School of Medicine, China Medical University, Taichung, Taiwan 5 Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 6 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan 7 College of Medicine, Chang Gung University, Taoyuan, Taiwan 8 School of Medicine, National Tsing Hua University, Hsinchu, Taiwan 1

六個月 ALBI 軌跡做為接受免疫治療無法切除的肝細胞癌預後進行生存分層楊甯元1 許偉帆1,2 陳政國3 賴學洲1,2 王鴻偉1,4 侯明模5 林錫銘6 謝佳訓5,7,8 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中醫學系 3 亞洲大學附設醫院胃腸肝膽科 4 中國醫藥大學醫學系 5 長庚醫療財團法人林口長庚紀念醫院腫瘤內科 6 長庚醫療財團法人林口長庚紀念醫院胃腸肝膽科 7 長庚大學醫學院 8 清華大學生命科學暨醫學院 2

Background: The Albumin-Bilirubin (ALBI) score is a validated objective tool for assessing liver

160

2026 TDDW

P.22 function. However, the prognostic value of its dynamic evolution during immunotherapy remains inadequately defined. Aims: This study aimed to delineate six-month ALBI trajectories in patients with unresectable hepatocellular carcinoma (uHCC) receiving immune checkpoint inhibitor (ICI)-based therapy and evaluate their associations with clinical outcomes. Methods: We retrospectively analyzed 221 patients with uHCC treated with ICIs at four hospitals. Groupbased trajectory modeling (GBTM) was employed to identify distinct patterns of ALBI score changes within the first 6 months of ICI initiation. Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan-Meier analysis and multivariable Cox regression. Results: Three distinct trajectories were identified: Trajectory Group 1 (T-G1; stable/low score), T-G2 (stable/intermediate), and T-G3 (deteriorating/ high). Median OS was 60.63 months for T-G1, 23.47 months for T-G2, and 10.80 months for T-G3 (P <0.001). Multivariable analysis confirmed that the trajectory group was an independent predictor of OS (hazard ratio [HR] for T-G2 vs. T-G1: 2.313, 95% confidence interval [CI] 1.432-3.735; HR for T-G3 vs. T-G1: 5.070, 95% CI: 2.882-8.918) and PFS. In patients with baseline ALBI grade 1 (n = 104), falling outside T-G1 was associated with significantly worse OS (HR: 2.891). ALBI trajectories provided better prognostic stratification than baseline ALBI grade alone. Conclusions: Longitudinal ALBI trajectories provide superior prognostic discrimination compared to static baseline assessment. Monitoring these dynamics enables personalized risk stratification and therapeutic optimization for uHCC patients in the era of immunotherapy.

PREDICTORS OF SURVIVAL IN ADVANCED HEPATOCELLULAR CARCINOMA PATIENTS WITH FAVORABLE RESPONSE TO FIRSTLINE LENVATINIB: REAL-WORLD EXPERIENCE FROM A TAIWANESE COHORT Ting-Yu Chen1, Te-Sheng Chang1,2, Shui-Yi Tung1,2, Chen-Heng Shen1, Kuo-Liang Wei1,2, Yung-Yu Hsieh1,2, Yi-Hsing Chen1, Chun-Hsien Chen1, Wei-Lin Tung1, Chih-Wei Yen1, Kuan-Chen Pan1, Wei-Ming Chen1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

晚期肝癌第一線 Lenvatinib 反應良好者之生存預測因子：台灣真實世界研究陳亭佑1 張德生1,2 董水義1,2 沈建亨1 魏國良1,2 謝詠諭1,2 陳奕行1 陳俊憲1 童威霖1 顏志維1 潘冠塵1 陳慰明1,2 1 2

嘉義長庚紀念醫院胃腸肝膽科長庚大學醫學院

Background: Currently, most patients with advanced hepatocellular carcinoma (HCC) in Taiwan receive first-line immunotherapies, such as atezolizumab plus bevacizumab or tremelimumab plus durvalumab, which are reimbursed by the Taiwan National Health Insurance (NHI). However, these regimens are often contraindicated in patients with gastrointestinal bleeding, cardiovascular comorbidities, or active autoimmune diseases. In such scenarios, targeted therapies like lenvatinib serve as crucial alternative first-line treatments. This study investigated the real-world efficacy of lenvatinib and identified clinical factors predictive of a favorable prognosis among long-term responders. Aims: To identify the clinical characteristics of ideal candidates who achieve a favorable response to first-line lenvatinib therapy for advanced HCC. Methods: Between January 2020 and April 2024, a total of 108 patients with advanced HCC who received NHI-reimbursed first-line systemic therapy with lenvatinib at Chiayi Chang Gung Memorial Hospital were retrospectively screened, with a

161

2026 TDDW

P.23 minimum follow-up of 2 years. To focus on the favorable response group, patients with a baseline Child-Pugh score of B or C, an ECOG performance status of 2–5, or a lenvatinib treatment duration of less than 5 months were excluded. We evaluated the reasons for treatment discontinuation, tumor response, overall survival (OS), progression-free survival (PFS), longitudinal changes in the FIB-4 index, and independent prognostic factors for OS. Results: Ultimately, 40 patients met the inclusion criteria (30 males, 10 females; mean age: 67.79 years). Regarding viral etiology, 50% had hepatitis C virus (HCV) infection and 35% had hepatitis B virus (HBV) infection. The baseline mean ALBI score and FIB-4 index were -2.75 and 4.31, respectively. After a minimum 2-year follow-up, 13 patients remained alive and 27 had expired. The objective response rate was 50%, with a complete response rate of 17.5%, a partial response rate of 32.5%, and stable disease in 50%. Reasons for the cessation of NHI reimbursement included disease progression (65%), death (20%), adverse events (5%), and deterioration of liver reserve to Child-Pugh class B (5%). The mean FIB-4 index increased from 4.31 at baseline to 6.12 at 3 months, and subsequently settled at 5.82 at 6 months. The median OS was 21.9 months, and the median PFS was 15.3 months. Univariable analysis revealed that being within the Up-to-Seven criteria, having fatty liver, the absence of ascites, and ALBI grade 1 were associated with better OS. Multivariable analysis confirmed that the absence of ascites and a better ALBI grade were independent predictors of significantly prolonged OS. Conclusions: For patients with advanced HCC who are not candidates for immunotherapy, firstline lenvatinib monotherapy yields encouraging real-world efficacy with a median OS of 21.9 months in long-term responders. Baseline liver reserve (ALBI grade) and the absence of ascites are key independent predictors of superior survival, serving as practical clinical markers to identify ideal candidates for this targeted therapy.

162

IMPACT OF BASELINE ALBI GRADE ON THE ADVERSE EVENTS OF FIRSTLINE IMMUNOTHERAPY WITH ATEZOLIZUMAB AND BEVACIZUMAB FOR HEPATOCELLULAR CARCINOMA PATIENTS Huai-Cheng Cheng1, Yen-Po Chen1,2,3, Ching-Wei Chang1,2,3,4, Chia-Yuan Liu1,2,3,4, Tsang-En Wang1,2,3, Horng-Yuan Wang1,2,3, Shen-Yung Wang1,3, Chi-Yu Lee1,3, Ting-Churn Wong1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 2 MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan 3 School of Medicine, College of Medicine, MacKay Medical University, New Taipei, Taiwan 4 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan 1

分析 ALBI Grade 對於肝細胞癌病患接受第一線免疫治療 Atezolizumab 合併 Bevacizumab 產生不良事件的相關性鄭懷誠1 陳彥伯1,2,3 張經緯1,2,3,4 劉家源1,2,3,4 王蒼恩1,2,3 王鴻源1,2,3 王勝永1,3 李騏宇1,3 翁鼎淳1 1

馬偕紀念醫院消化科系馬偕醫護管理專科學校 3 馬偕醫學大學醫學系 4 馬偕紀念醫院醫學研究中心 2

Background: The combination of atezolizumab and bevacizumab (A+B) has become a standard first-line treatment for advanced hepatocellular carcinoma (HCC). However, the impact of baseline liver function, particularly classified by the Albumin-Bilirubin (ALBI) grade, on the safety profile and treatment tolerability in real-world clinical practice remains unclear. Aims: This study aimed to evaluate and compare the incidence, severity, and profiles of adverse events (AEs) between HCC patients with baseline ALBI grade 1 and those with ALBI grade 2–3 receiving first-line A+B therapy in a single tertiary medical center. Methods: This retrospective study reviewed medical records of patients with unresectable HCC who received immunotherapy-based first-line systemic treatment at MacKay Memorial Hospital between January 1, 2020, and November 4, 2025. Patients

2026 TDDW

P.24 treated with A+B more than two courses were enrolled, and were categorized into two groups based on baseline liver function: ALBI grade 1 (ALBI score ≤ -2.60) and ALBI grade 2–3 (ALBI score > -2.60). Clinical characteristics, treatment-related adverse events and individual symptoms were analyzed using the Mann–Whitney U test, Chi-squared Test and Fisher’s exact test. Results: A total of 56 patients with advanced HCC receiving A+B as first-line treatment were included, comprising 21 patients of ALBI grade 1 and 35 patients of ALBI grade 2–3. Baseline characteristics were largely comparable between the two groups, with no significant differences in age, sex, viral hepatitis status, most of the underlying condition, Child–Pugh class, BCLC stage, presence of portal vein thrombosis or extrahepatic spread. Notably, patients with ALBI grade 1 had a significantly higher prevalence of diabetes mellitus (71.4% vs. 31.4%, p = 0.004), whereas patients with ALBI grade 2–3 had a significantly higher proportion of large tumors (71.4% vs. 42.9%, p = 0.034). Regarding safety, the overall incidence of any-grade AEs was similar between the two groups. Severe AEs (≥ Grade 3) occurred exclusively in the ALBI grade 2–3 group, though the difference did not reach statistical significance. Rates of treatment withdrawal due to AEs and steroid use were also comparable. In terms of specific AE profiles, there were no statistically significant differences between ALBI grade 1 and grade 2–3 groups for rash, AST/ALT elevation, amylase/lipase elevation, proteinuria, diarrhea, fatigue, hypertension, or other symptoms including epistaxis, nausea, pyrexia, dizziness, edema or total bilirubin elevation. Conclusions: In this real-world cohort, there was no significant differences in the adverse event profiles between HCC patients with baseline ALBI grade 1 and ALBI grade 2–3 treated with atezolizumab plus bevacizumab. Although severe AEs (≥ Grade 3) and specific symptoms like fatigue and hypertension were only observed in patients with baseline ALBI grade 2–3, there was no statistical significance. Nevertheless, the relatively small sample size and limited follow-up duration might restrict the generalizability of our findings. Therefore, further prospective, large-scale studies are warranted to validate these results.

CURCUMIN ANALOGUE GO-Y030 STIMULATES CELL APOPTOSIS AND CASPASE ACTIVATION VIA ERK AND P38 ACTIVITY IN HEPATOCELLULAR CARCINOMA Kuan-Chun Hsueh1,2, Meng-Ju Yu2, 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

薑黃素類似物 GO-Y030 透過 ERK 與 p38 活性刺激肝細胞癌細胞凋亡及凋亡蛋白酶活化薛冠群1,2 游孟儒2 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醫學研究部 2

Background: Curcumin is a natural phenolic compound with well-documented anti-cancer properties. However, its clinical application is limited by poor solubility and low bioavailability. GO-Y030, a synthetic curcumin analogue, has demonstrated improved bioavailability, although its anti-tumor effects and underlying mechanisms in hepatocellular carcinoma (HCC) remain largely unknown. Aims: This study aimed to investigate the anti-cancer effects of GO-Y030 on HCC cells and to elucidate the molecular mechanisms underlying its anti-tumor activity. Methods: Human HCC cell lines (SK-hep-1 and Huh7) were treated with GO-Y030. Cell viability, apoptosis, and cell-cycle distribution were evaluated using MTT assay and flow cytometry assays. The expression of apoptosis-related proteins was examined by apoptotic proteome profiling and Western blotting. Pharmacological inhibitors of ERK and p38 signaling were used to investigate the involvement of these pathways in GO-Y030-induced apoptosis.

163

2026 TDDW

P.25 Results: GO-Y030 significantly reduced the viability of SK-hep-1 and Huh-7 cells in a dose-dependent manner. Treatment with GO-Y030 induced apoptotic cell death and disrupted cell-cycle progression. Proteome analysis demonstrated increased cleavage of caspases and decreased expression of the apoptosis inhibitors XIAP and cIAP-1. Inhibition of ERK and p38 signaling attenuated GO-Y030induced caspase activation, suggesting that these signaling pathways contribute to GO-Y030-mediated apoptotic responses. Conclusions: GO-Y030 exerts potent anti-tumor effects against HCC by suppressing cell proliferation, inducing apoptosis, and disrupting cell-cycle progression. These effects are associated with activation of the caspase cascade through ERK- and p38-dependent signaling pathways, supporting the therapeutic potential of GO-Y030 as a promising candidate for HCC treatment.

TP53-WILD-TYPE TUMORS EXHIBIT ENHANCED RADIOTHERAPYINDUCED IMMUNOGENIC ACTIVATION THROUGH INTERFERON SIGNALING Chun-Chia Cheng1, Zong-Lin Sie1, Chun Yeh2, Ai-Sheng Ho2,3 Research Center of Radiation Medicine, Chang Gung University, Taoyuan, Taiwan 2 Division of Gastroenterology, Cheng Hsin General Hospital, Taipei, Taiwan 3 School of Medicine, National Defense Medical University, Taipei, Taiwan 1

TP53 野生型腫瘤透過干擾素訊息路徑增加放射治療誘導的免疫細胞活化程俊嘉1 謝宗霖1 葉淳2 何愛生2,3 1

長庚大學放射醫學研究中心振興醫院胃腸科 3 國防醫學大學醫學系 2

Background: Radiotherapy (RT) is widely used to suppress tumor progression and can induce an abscopal effect that enhances anti-tumor immunity, potentially improving the efficacy of immunotherapy. However, the tumor types most likely to exhibit RT-induced immunogenic effects remain unclear. Aims: Given that TP53-wild-type tumors are generally more sensitive to RT, we hypothesized that these tumors are more likely to develop RT-induced immunogenic activation. Methods: Bioinformatic analyses of RNA sequencing (RNA-seq) data were performed to identify differentially expressed genes associated with RT and TP53 status. Quantitative polymerase chain reaction (qPCR) and flow cytometry were subsequently used to investigate the underlying mechanisms in vitro. Results: In liver hepatocellular carcinoma (LIHC), in which approximately 73% of tumors retain wildtype TP53, p53 expression positively correlated with the expression of 15 immunotherapy-associated genes. Consistently, IFNγ-induced genes in TP53wild-type A549 cells were associated with improved immunotherapeutic outcomes. In contrast, RT induced a distinct gene signature enriched in the p53 signaling pathway that correlated with improved overall survival in LIHC but not with immunotherapy

164

2026 TDDW

P.26 response. Functional analyses demonstrated that RT preferentially induced apoptosis in TP53-wildtype HCT116 cells compared with TP53-null HCT116 cells, resulting in significantly enhanced immune cell activation in vitro. Furthermore, RT selectively increased IFNα and IFNγ expression in TP53-wildtype cells, promoting M1 macrophage polarization, whereas these effects were absent in TP53-null models. Conclusions: Our findings demonstrate that TP53wild-type tumors exhibit enhanced sensitivity to RT, leading to increased interferon production and immunogenic activation. RT-induced IFNα and IFNγ may promote M1 macrophage polarization and contribute to the immunogenic effects of RT. These results suggest that TP53-wild-type tumors are promising candidates for combined RT and immunotherapy.

COMBINED ATEZOLIZUMAB PLUS BEVACIZUMAB WITH HEPATIC ARTERIAL INFUSION CHEMOTHERAPY FOR ADVANCED HEPATOCELLULAR CARCINOMA Wei-Chih Sun1,2,3, Ting-Yu Yan1, Kung-Hung Lin1,4, Chia-Ling Chiang5, Yu-Chia Chen6, Wei-Lun Tsai1,7, Feng-Woei Tsay1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 2 Cancer Prevention Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 3 Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan 4 Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 5 Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 6 Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 7 Division of General Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 1

癌自禦合併癌思停加上肝動脈灌注化療對於晚期肝細胞癌之療效孫煒智1,2,3 顏廷宇1 林恭弘1,4 江佳陵5 陳玉佳6 蔡維倫1,7 蔡峯偉1 1

高雄榮民總醫院胃腸肝膽科高雄榮民總醫院癌症防治中心 3 國立中山大學生物醫學研究所 4 高雄榮民總醫院健康管理中心 5 高雄榮民總醫院放射線部 6 高雄榮民總醫院一般外科 7 高雄榮民總醫院一般內科 2

Background: Atezolizumab combined with bevacizumab has demonstrated promising antitumor activity along with a manageable safety profile in patients with unresectable hepatocellular carcinoma (HCC). Hepatic arterial infusion chemotherapy (HAIC) has likewise been associated with high response rates and improved survival outcomes in patients with advanced HCC. Aims: To evaluate the clinical efficacy and safety of combining atezolizumab and bevacizumab with

165

2026 TDDW

P.27 HAIC for advanced HCC. Methods: Between August 2023 and February 2026, patients with advanced HCC who received atezolizumab plus bevacizumab in combination with HAIC were retrospectively reviewed for eligibility. Efficacy was assessed based on tumor response rates and survival outcomes, while safety was evaluated according to the incidence of key adverse events (AEs). Results: A total of 33 eligible patients were included in this study. The objective response rate (ORRs) based on mRECIST criteria was 60.6%. The median progression-free survival (PFS) of patients was 10.4 months, and the overall survival (OS) was 13.3 months. All AEs were controlled and no treatmentrelated deaths occurred. Conclusions: The combination of atezolizumab plus bevacizumab and HAIC demonstrated significant therapeutic efficacy and a manageable safety profile in patients with advanced HCC, suggesting it may represent a promising treatment option for this population.

166

METASTATIC LIVER CANCER ORIGINATING FROM BASAL CELL CARCINOMA OF THE RIGHT AXILLA: A CASE REPORT AND LITERATURE REVIEW Keito Tohori, Hidehito Honda, Mayuka Masuda, Shunsuke Nakamura, Keisuke Nakajima, Hiroshi Takahashi, Tatsuya Kakegawa, Yu Yoshimasu, Hirohito Takeuchi, Takao Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku, Tokyo, Japan Background: A male in his 40s presented with a palm-sized ulcerated tumor in his right axilla, which was diagnosed as basal cell carcinoma (BCC). Despite local invasion into axillary vessels, nerves, and muscles, 11 cycles of intra-arterial cisplatin infusion, radiation therapy, and one cycle of cisplatin and doxorubicin (CA) therapy achieved a complete response (CR) of the primary lesion. However, 2 years later, a 20-mm tumor was detected in liver segment 4, leading to his referral to our department. Aims: We report a rare case of metastatic liver cancer originating from BCC of the right axilla, diagnosed via a percutaneous liver biopsy, along with a literature review. Methods: The clinical course, imaging findings, and histopathological characteristics were retrospectively reviewed. To establish a definitive diagnosis, a percutaneous liver biopsy and subsequent immunohistochemical staining were performed. Results: Gadoxetic acid-disodium (EOB-GD-DTPA)enhanced magnetic resonance imaging and perflubutane (Sonazoid)-enhanced ultrasonography suggested metastatic liver cancer or intrahepatic cholangiocarcinoma. Immunohistochemical staining of the liver specimen demonstrated: p40(+), CK5/6(-), HNF4a(-), CDX2(-), Ber-EP4(+, weak), CD56(+), synaptophysin(-), chromogranin A(-), and INSM1(-). These findings were consistent with liver metastasis from cutaneous BCC, confirming the diagnosis of metastatic liver tumor. Conclusions: BCC is a common cutaneous malignancy, but distant metastasis is extremely rare, with a reported incidence of 0.0028% to 0.1%. Clinicians should maintain a high index of suspicion when new visceral lesions appear

2026 TDDW

P.28 during post-treatment surveillance. Percutaneous liver biopsy combined with comprehensive immunohistochemical profiling is highly useful for distinguishing metastatic BCC from primary hepatic malignancies.

STEATOTIC LIVER DISEASE AND METABOLIC RISK IN PATIENTS WITH HIV/HBV COINFECTION IN TAIWAN Yu-Chun Pan1, Chien-Tzu Hung2, Yu-Shan Huang3, Hsin-Yun Sun3, Tung-Hung Su4,5, Chien-Ching Hung3,6 School of Medicine, National Taiwan University, Taipei, Taiwan 2 Good Liver Clinic, Taipei, Taiwan 3 Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 5 Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan 1

臺灣 HIV/HBV 共同感染者之脂肪性肝病與代謝風險潘祐君1 洪芊慈2 黃于珊3 孫幸筠3 蘇東弘4,5 洪健清3,6 1

國立臺灣大學醫學系好心肝診所 3 國立臺灣大學醫學院附設醫院感染內科 4 國立臺灣大學醫學院附設醫院胃腸肝膽內科 5 國立臺灣大學醫學院附設醫院新竹臺大分院醫學研究部 6 國立臺灣大學醫學院附設醫院雲林分院感染內科 2

Background: As survival has improved among people with human immunodeficiency virus/ hepatitis B virus (HIV/HBV) coinfection after highly active antiretroviral therapy, metabolic risk has become an increasing concern. The disease burden of steatotic liver disease (SLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. Aims: To evaluate the prevalence of SLD, MASLD, and liver fibrosis severity in an HIV/HBV coinfection cohort from a medical center in Taiwan. Methods: We retrospectively analyzed people with HIV/HBV coinfection who underwent abdominal ultrasound between 2022 and 2026. The index date was set at the date of the most recent abdominal

167

2026 TDDW

P.29 ultrasound. The severity of SLD was classified as none, mild, mild-to-moderate, moderate, or severe. MASLD was defined as SLD with at least 1 cardiometabolic risk factor, based on laboratory data, body mass index (BMI), or medication usage. The Hepatic Steatosis Index (HSI) and Fibrosis-4 (FIB4) were used to evaluate the severity of steatosis and liver fibrosis. Results: A cohort of 338 adults was analyzed. Their median age was 50 years (interquartile range 45– 57), median BMI 24.4 kg/m² (22.5–26.9), and 98.2% (332/338) were male. SLD was detected in 47% of participants (159/338). Among all patients, 21% (71/338) had moderate-to-severe SLD, and 46.4% (157/338) had MASLD. In multivariable models, higher BMI (adjusted odds ratio [aOR]: 1.32; 95% confidence interval [CI]: 1.21–1.44), triglycerides (aOR: 1.27; 95% CI: 1.03–1.56), and CD4 count (aOR: 1.24; 95% CI: 1.11–1.40) were associated with SLD. In addition, higher BMI (aOR: 1.46), triglycerides (aOR: 1.37), and CD4 counts (aOR: 1.21) were associated with moderate-to-severe SLD, whereas HIV viral suppression and HBV DNA detectability were not. HSI correlated well with ultrasound-detected SLD, whereas FIB-4 did not discriminate steatosis. Conclusions: SLD was common among Taiwanese people with HIV/HBV coinfection and was closely associated with cardiometabolic risk factors. Routine abdominal ultrasound examination and metabolic assessment should be integrated into long-term HIV/HBV management.

168

COMPARATIVE EFFECTIVENESS OF RESMETIROM VERSUS GLP1 RECEPTOR AGONISTS ON LIVER AND CARDIOVASCULAR OUTCOMES IN METABOLIC DYSFUNCTIONASSOCIATED STEATOTIC LIVER DISEASE Ping-Jou Kuo1, Chia-Chih Kuo1,2, Hsuan-Yuan Chang1,2, I-Che Feng1,2, Hsing-Tao Kuo1,2 Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan 2 Department of Gastroenterology, Chi-Mei Medical Center, Tainan, Taiwan 1

Resmetirom 與 GLP-1 受體促效劑對代謝功能障礙相關脂肪性肝病患者肝臟與心血管事件之比較郭蘋瑈1 郭加智1,2 張瑄元1,2 馮意哲1,2 郭行道1,2 1 2

財團法人奇美醫學中心內科部財團法人奇美醫學中心肝膽腸胃內科

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease. Resmetirom and glucagonlike peptide-1 receptor agonists (GLP-1RAs) have shown therapeutic benefits, but direct real-world comparisons remain limited. Aims: To compare the effectiveness of resmetirom versus GLP-1RAs on liver-related and cardiovascular outcomes in patients with MASLD. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults with MASLD initiating resmetirom or a GLP-1RA between March 14, 2024, and July 11, 2026, were identified. Patients with other chronic liver diseases, prior exposure to the comparator drug, or pre-existing major liver or cardiovascular outcomes were excluded. After 1:1 propensity score matching, outcomes were assessed from 30 days after treatment initiation. The primary outcome was major adverse liver outcomes (MALO); secondary outcomes included decompensated liver cirrhosis (dLC) and major adverse cardiovascular events (MACE). Results: After matching, 2,793 patients were included in each group. Resmetirom showed a numerically lower risk of MALO than GLP-1RAs (0.90%

2026 TDDW

Section：Gastroenterology P.30 vs. 1.43%; OR 0.62, 95% CI 0.38–1.03; P = 0.061). Risks of dLC were also numerically lower (0.79% vs. 1.18%; OR 0.66, 95% CI 0.39–1.14; P = 0.136). Resmetirom was associated with a lower risk of MACE (0.48% vs. 0.94%; OR 0.51, 95% CI 0.26–0.99; P = 0.046). Conclusions: In this real-world propensity score– matched cohort, resmetirom was associated with numerically lower risks of MALO and dLC and a significantly lower risk of MACE compared with GLP-1RAs. Larger studies with longer follow-up are needed to confirm these findings.

EFFECT OF PRE-OPERATIVE CARBOHYDRATE LOADING (COCONUT JUICE) IN ELECTIVE GASTROINTESTINAL (GI) SURGERY Chumpon Wilasrusmee, Chairat Supsamutchai, Jakrapan Jirasiritham, Puvee Punmeechao, Lisa Sangkum, Pattawia Choikrua Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: Preoperative carbohydrate loading is recommended by Enhanced Recovery After Surgery (ERAS) protocols, but inexpensive and widely available alternatives remain of interest. Aims: This study evaluated the impact of preoperative coconut water administration on postoperative outcomes in patients undergoing elective gastrointestinal surgery. Methods: In this randomized controlled trial (COA. MURA2022/567, TCTR20260202009), 63 patients undergoing elective gastrointestinal or colorectal surgery between October 2022 and October 2024 were assigned to either conventional fasting (n = 32; ≥8 hours) or coconut water loading (COCOLOVE®EVERLOVE®, Unicorn Consumer Group Co., Ltd., Thailand) (n = 31; 250 mL at 8 PM before surgery and 250 mL 2–4 hours preoperatively). Primary outcomes included length of hospital stay (LOS), surgical site infection (SSI), aspiration pneumonia, wound complications, and quality of recovery assessed using the QoR-40 questionnaire before surgery and at 24 hours, 72 hours, and 14 days postoperatively. Results: Baseline demographic and perioperative characteristics were comparable between groups. The coconut water group had a significantly shorter LOS than the conventional fasting group (median 3.0 [IQR 2.0–8.0] vs. 6.5 [IQR 2.5–8.0] days; p = 0.038). SSI rates during hospitalization and at postoperative days 14 and 30 were low and did not differ significantly between groups. No aspiration pneumonia occurred in either group. Wound complications requiring intervention were observed only in the conventional fasting group (6.3% vs. 0%, p = 0.492). Rates of other postoperative complications and QoR-40 scores at all assessment time points were similar between groups. Conclusions: Preoperative coconut water administration was safe and associated with a shorter hospital stay without increasing postoperative

169

2026 TDDW

P.31 complications. As a low-cost and readily available carbohydrate-containing beverage, coconut water may be a practical option for preoperative carbohydrate loading. Larger multicenter studies are needed to confirm these findings.

INTEGRATED MULTI-MODAL DEEP LEARNING FRAMEWORK FOR ULCERATIVE COLITIS ACTIVITY ASSESSMENT: AUTOMATED GRADING OF MAYO ENDOSCOPIC SCORE AND NANCY HISTOLOGICAL INDEX UNDER LINKED COLOR IMAGING Po-Yi Chou1, Hung-Yi Lin1, Duan-Yu Chen2, Chen-Shuan Chung1,2 Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan 2 Program A, Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan 1

整合式多模態深度學習框架用於潰瘍性結腸炎活動度評估：在 Linked Color Imaging 下自動分級 Mayo 內視鏡評分與 Nancy 組織學指數周柏毅1 林宏益1 陳敦裕2 鍾承軒1,2 1 2

亞東紀念醫院肝膽胃腸科元智大學電機工程學系（甲組）

Background: Endoscopy is essential for disease assessment in ulcerative colitis (UC), but subjectivity influenced accuracy and precision. Linked color imaging (LCI) is an image-enhanced endoscopy technique in which color differences are expanded by processing image data to enhance shortwavelength narrow-band light. We aimed to pilot a fully-automated video analysis system for LCI image endoscopic disease grading in UC under LCI. Furthermore, we extended this framework to evaluate the system’s capability in predicting histological activity—traditionally the ‘gold standard’ that requires invasive biopsies and time-consuming microscopic evaluation. Aims: To develop and evaluate an automated deep learning model for assessing ulcerative colitis activity using linked color imaging, with automated grading of both the Mayo Endoscopic Score and the Nancy Histological Index. Methods: A convolutional neural network (YOLOv11s) was trained on a dataset comprising colonoscopy images collected in 2023 from patients diagnosed with ulcerative colitis at Far Eastern

170

2026 TDDW

P.32 Memorial Hospital. (Total 1812 pictures) The imaging data were annotated and graded according to the Mayo (4-tier, 0-3) and Nancy (5-tier, 0-4) scoring systems. Model performance was assessed using clinically relevant metrics, including Sensitivity (Recall) and Positive Predictive Value (Precision). A detailed error analysis was conducted using confusion matrices to identify clinical diagnostic pitfalls, specifically focusing on false negatives (missed lesions) and false positives (misidentifying normal tissue as lesions). Results: The AI model demonstrated high accuracy in differentiating between severity grades once a lesion was correctly localized. For the 5-tier Nancy index, the model achieved an overall positive predictive value (PPV) of 85.3% and a sensitivity of 72.2%. In the 4-tier Mayo score, the overall PPV was 87.7% and sensitivity was 69.1%. However, significant clinical limitations were observed. The model exhibited a high false-positive rate, frequently over diagnosing normal background tissue as active lesions. More critically, the underrepresentation of severe cases in the training data led to profoundly reduced sensitivity for the most severe grades, missing 48.5% of Mayo 3 and 44.0% of Nancy 4 lesions. Conclusions: The AI model shows promising high precision in multi-tier severity classification for both the Mayo and Nancy systems. Future efforts will focus on refining diagnostic specificity to mitigate overdiagnosis while enhancing sensitivity for critical lesions to ensure clinical safety.

TRINETX-BASED ANALYSIS OF TIMING OF CHOLECYSTECTOMY AFTER PTGBD: A COMPARISON OF INTERVALS WITHIN 3 DAYS, 3–7 DAYS, 7–21 DAYS, AND MORE THAN 21 DAYS Chin-Yee Mah1, Chi-En Hung1, Chang-Kuo Wei1, Chun-Hung Lin1,2, Shih-Pin Lin1, Yu-Ting Chiu1, Wen-Yao Yin1,2, Cheng-Hung Lee1,2 Department of General Surgery, Dalin Tzu Chi General Hospital, Chiayi, Taiwan 2 School of Medicine, Tzu Chi University, Hualian, Taiwan 1

基於 TriNetX 的分析：PTGBD 後膽囊切除術時機的比較（3 天內、3–7 天、7–21 天及 21 天以上）馬靜儀1 洪啟恩1 魏昌國1 林俊宏1,2 林世彬1 邱郁婷1 尹文耀1,2 李政鴻1,2 1 2

佛教慈濟醫療財團法人大林慈濟醫院一般外科慈濟學校財團法人慈濟大學醫學系

Background: Percutaneous transhepatic gallbladder drainage (PTGBD) is often used as a bridge to surgery in acute cholecystitis. The optimal timing of subsequent cholecystectomy after PTGBD remains debated. Aims: Using TriNetX, a large federated health database, we analyzed outcomes of patients undergoing cholecystectomy after PTGBD, stratified by timing intervals: within 3 days, 3–7 days, 7–21 days, and more than 21 days. Methods: We identified patients who underwent PTGBD followed by cholecystectomy in the TriNetX network. Patients were categorized into four groups based on the timing of cholecystectomy after PTGBD: within 3 days, 3–7 days, 7–21 days, and more than 21 days. We compared postoperative outcomes, including bile duct injury, major bleeding, and complications, across these groups, adjusting for baseline characteristics. Results: After adjusting for covariates, patients who underwent cholecystectomy within 3 days had significantly lower complication rates and shorter hospital stays compared to those in the longer intervals. The group with surgery within 3–7 days also showed favorable outcomes, though slightly less pronounced. Delays beyond 21 days were

171

2026 TDDW

P.33 associated with increased morbidity and longer stays. Conclusions: Using TriNetX, we identified that early cholecystectomy (within 3 days after PTGBD) was associated with better outcomes, including fewer complications and shorter hospital stays, compared to delayed surgery. These findings emphasize the value of real-world data from TriNetX to optimize surgical timing and improve patient outcomes after PTGBD.

CLINICAL OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED LUMEN-APPOSING METAL STENT DRAINAGE VERSUS SURGICAL MANAGEMENT FOR NECROTIZING PANCREATITIS: A 10-YEAR SINGLECENTER RETROSPECTIVE STUDY Guan-De Li1, Chen-Huan Yu1, Kuan-Chih Chen1,2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan 2 Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan 1

內視鏡超音波導引腔道貼附式金屬支架（LAMS）引流與外科手術治療壞死性胰臟炎之臨床結果比較：單中心十年回溯性研究李冠德1 余臣桓1 陳冠至1,2 1 2

亞東紀念醫院肝膽腸胃科國立臺灣大學生物醫學電子與資訊學研究所

Background: Management of necrotizing pancreatitis has shifted from open surgery toward minimally invasive interventions. Endoscopic ultrasound-guided drainage using lumen-apposing metal stents (LAMS) has emerged as an effective treatment for walled-off necrosis; however, comparative data between LAMS and surgical management in real-world practice remain limited. Aims: To compare the clinical outcomes of patients with necrotizing pancreatitis treated with LAMS versus surgical intervention. Methods: We retrospectively reviewed consecutive patients diagnosed with necrotizing pancreatitis at Far Eastern Memorial Hospital between January 2016 and April 2026. Patients who underwent either endoscopic drainage with LAMS or surgical intervention were included. Baseline characteristics, clinical severity, and treatment outcomes were collected and compared between the two groups. Results: A total of 51 patients with necrotizing pancreatitis were included, of whom 19 underwent endoscopic drainage with LAMS and 32 underwent surgical intervention. Baseline characteristics, including age, sex, Charlson Comorbidity Index, pancreatitis etiology, BISAP score, and CTSI score,

172

2026 TDDW

P.34 were comparable between the two groups. Patients in the surgery group underwent percutaneous drainage more frequently than those in the LAMS group (88% vs. 32%, P < 0.001). Four-week clinical success was achieved in 68% of patients treated with LAMS and 75% of those undergoing surgery (P = 0.61). The LAMS group had a significantly shorter hospital stay than the surgery group (37.1 ± 29.2 vs. 58.3 ± 36.3 days, P = 0.045). Three-month readmission rates (44% vs. 56%, P = 0.45), three-month mortality (16% vs. 22%, P = 0.60), and the incidence of disconnected pancreatic duct syndrome (16% vs. 6%, P = 0.28) were comparable between the two groups. Long-term overall survival also showed no significant difference between patients treated with LAMS and surgery. Conclusions: In this single-center retrospective study, endoscopic management with LAMS achieved clinical outcomes comparable to surgery while significantly reducing hospital stay. LAMS may represent an effective and less invasive alternative to surgery for selected patients with necrotizing pancreatitis. Larger prospective studies are warranted to further validate these findings.

COMPARATIVE EFFECTIVENESS AND SAFETY OF RISANKIZUMAB VS USTEKINUMAB IN CROHN’S DISEASE: A REAL-WORLD RETROSPECTIVE COHORT STUDY FROM TAIWAN Ming-Jung Meng1, Puo-Hsien Le1,2,3,4, Chia-Jung Kuo1,2,3,4, Cheng-Tang Chiu1,2,3,4 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 Taiwan Association for the Study of Intestinal Diseases (TASID), Taoyuan, Taiwan 3 Inflammatory Bowel Disease Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 4 Chang Gung Microbiota Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 1

Risankizumab 與 Ustekinumab 用於克隆氏症之比較療效與安全性：台灣真實世界回溯性世代研究孟明蓉1 李柏賢1,2,3,4 郭家榮1,2,3,4 邱正堂1,2,3,4 1

林口長庚紀念醫院胃腸肝膽科系台灣腸道醫學會 3 林口長庚紀念醫院發炎性腸道疾病中心 4 林口長庚紀念醫院長庚微菌治療中心 2

Background: Direct real-world comparative data on risankizumab and ustekinumab for Crohn’s disease are limited, particularly in Asian populations and in patients with fistulizing disease. These agents are clinically important comparators because both target the IL-23 pathway but differ mechanistically, with ustekinumab blocking the shared IL-12/23 p40 subunit and risankizumab selectively blocking IL-23 p19. Aims: To compare the real-world effectiveness and safety of risankizumab (RZB) versus ustekinumab (UST) in patients with moderate-to-severe Crohn’s disease (CD). Methods: Consecutive adult patients with confirmed CD treated with UST or RZB at the Chang Gung Inflammatory Bowel Disease (IBD) Center were retrospectively included. Patients received standard induction and maintenance regimens of UST or RZB according to routine clinical practice. The primary outcome was steroid-free clinical

173

2026 TDDW

P.35 remission (SFCR) at week 24. Secondary outcomes included clinical remission, changes in hemoglobin, C- reactive protein, and albumin levels; IBD- related hospitalization and surgery; fistula closure; and adverse events (AEs). Results: Among 285 patients, 58 received risankizumab and 227 received ustekinumab. The risankizumab group had more smoking, penetrating disease, extraintestinal manifestations, prior complications, and prior biologic exposure, suggesting a more refractory population. At week 24, steroid-free clinical remission was lower with risankizumab than ustekinumab among patients with available data (46.7% vs 82.4%, P < 0.001). This difference was most evident in biologic-naïve patients (54.5% vs 93.9%, P < 0.001), while no significant difference was observed in biologicexperienced patients. Fistula closure was more frequent with risankizumab (75.0% vs 29.4%, P = 0.002), and reported adverse events were less frequent (0% vs 24.3%, P < 0.001). Hospitalization, surgery, and laboratory changes were similar. Conclusions: In this Taiwanese real-world cohort, ustekinumab was associated with higher week-24 steroid-free remission, particularly in biologic-naïve patients, whereas risankizumab showed higher fistula closure and fewer reported adverse events. Findings require cautious interpretation due to retrospective design, baseline imbalance, and potential confounding.

174

PROTEOMIC MORPHOGENESIS EXPLAINS WHY GASTRIC CANCERS ULCERATE OR DIFFUSELY INFILTRATE Chun-Hao Wang1, Qi-Sheng Hong2, Yu-Ju Chen2, Ming-Shiang Wu1, Tzu-Chan Hong3 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 2 Institute of Chemistry, Academia Sinica, Taipei, Taiwan 3 Department of Medicine, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan 1

蛋白質體形態發生機轉可解釋胃癌表現為潰瘍性病灶或瀰漫性浸潤病灶之差異王俊皓1 洪啟盛2 陳玉如2 吳明賢1 洪子瞻3 1

國立臺灣大學醫學院附設醫院內科部中央研究院化學研究所 3 國立臺灣大學醫學院附設癌醫中心分院內科部 2

Background: Borrmann morphology is clinically intuitive but biologically underexplained. It remains unclear why some gastric cancers form ulcerated masses while others diffusely infiltrate as linitis plastica. Aims: To determine whether tumor proteomics and phosphoproteomics can explain the distinct morphogenetic behaviors underlying Borrmann classification. Methods: We analyzed 124 tumor proteomes and phosphoproteomes from the National Taiwan University Hospital (NTUH) Gastric Cancer cohort, comparing ulcer-forming Borrmann II/III cancers (B2/3, n = 96) with Borrmann IV linitis plastica (B4, n = 28). Differential protein expression, Hallmark gene set enrichment analysis (GSEA), phosphoproteomic interrogation of epithelial-mesenchymal transition (EMT) transcription factors, and kinase-substrate enrichment analysis (KSEA) were integrated with clinicopathologic features. Results: B4 tumors showed enrichment for Lauren diffuse histology (68% vs. 35%, p = 0.018), perineural invasion (81% vs. 49%, p = 0.007), female sex (57% vs. 32%, p = 0.026), and shorter median progressionfree survival (265 vs. 378 days). B2/3 tumors were enriched for proliferation (E2F targets, normalised enrichment score [NES] 2.86; G2/M checkpoint,

2026 TDDW

P.36 NES 2.69; MYC targets) and inflammation (IFN-α/γ, TNF-α/NF-κB, IL-6/JAK/STAT3). B4 tumors showed higher oxidative phosphorylation (NES 2.75), fatty acid metabolism (NES 2.51), and elevated CLDN18, GKN1/2, and SHH. Despite bulk Hallmark EMT scoring higher in B2/3, phosphoproteomics revealed B4-specific ZEB2 activation at S36 (log2FC +0.41, p = 0.001) and S705 (log2FC +0.25, p = 0.005), with coordinated upregulation of SGK1, PDK1, PAK1/4, ROCK1, LATS1, and Src kinase activity. Conclusions: Borrmann morphology reflects distinct proteomic morphogenesis. Ulcer-forming cancers are proliferation-driven and inflamed, whereas linitis plastica is metabolically reprogrammed, ZEB2phospho-activated, and gastric-lineage-retaining. This framework may refine morphology-based risk stratification and CLDN18.2-directed therapeutic strategies.

THE EVOLUTION OF ENDOSCOPIC QUALITY: A 10-YEAR LONGITUDINAL ANALYSIS OF CONTEMPORARY HIGH-DEFINITION IMAGING IN GASTRIC PRECANCEROUS CONDITIONS Shih-Chi Hu1, Chu-Po Chou1, Chan-Yi Lin1, Jyh-Ming Liou1,2,3, Ping-Huei Tseng2,3,4, Tzu-Chan Hong1,2,3 Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan 4 Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University, Taipei, Taiwan 1

內視鏡品質的演進：高畫質影像於胃部癌前病變之十年世代分析胡士麒1 周主博1 林展毅1 劉志銘1,2,3 曾屏輝2,3,4 洪子瞻1,2,3 1

台大醫院癌醫分院綜合內科部台大醫院內科部 3 台大醫學院內科部 4 台大醫院綜合診療部 2

Background: The detection of gastric precancerous conditions (GPC), including intestinal metaplasia (IM) and atrophic gastritis (AG), is critical for gastric cancer prevention and surveillance planning. While international guidelines (MAPS III, ACG, APAGE) have reinforced these quality indicators, their real-world longitudinal diagnostic impact remains uncertain. Aims: We aimed to evaluate the 10-year temporal trends of GPC detection and the impact of advancing endoscopic technology in a large screening cohort. Methods: We analyzed a 10-year multicenter retrospective cohort (2016–2025) of index screening gastroscopies across three hospitals in Taiwan. Data extracted included the presence of AG and IM, and the endoscope generation utilized (PreviousGeneration HD vs. Contemporary HD). Multivariable logistic regression was utilized to calculate adjusted odds ratios (aOR) to evaluate the independent diagnostic impact of Contemporary HD scopes,

175

2026 TDDW

P.37 adjusting for patient demographics, time era, and hospital setting. Results: Of 97,288 patients who underwent index screening gastroscopy (54% female; mean age 57.8 years), overall GPC detection increased significantly from 5.3% in 2016 to 9.5% in 2025 (p < 0.001). Specifically, IM detection rose from 2.2% to 6.0%, and AG from 3.5% to 4.2% (both p < 0.001). After multivariable adjustment, Contemporary HD endoscopy outperformed Previous-Gen HD systems, demonstrating a statistically significant increase in the odds of detecting overall GPC (aOR 1.10, 95% CI 1.03–1.18, p = 0.004) and IM (aOR 1.17, 95% CI 1.08– 1.28, p < 0.001). Conclusions: The detection rates of gastric precancerous conditions have improved significantly over the last decade. Furthermore, the transition to Contemporary HD endoscopy independently enhances the detection of these high-risk mucosal lesions, supporting the ongoing modernization of endoscopic equipment in routine gastric cancer screening programs.

A NOVEL SELF-EXPANDABLE AND REMOVABLE POLYVINYL ALCOHOL HYDROGEL STENT FOR BILIARY DRAINAGE: FROM MATERIAL DESIGN TO LONG-TERM PORCINE EVALUATION Takayoshi Tsuchiya1, Yoshiyasu Nagakawa2, Atsushi Sofuni1, Reina Tanaka1, Ryosuke Tonozuka1, Shuntaro Mukai1, Kazumasa Nagai1, Hiroyuki Kojima1, Hirohito Minami1, Noriyuki Hirakawa1, Kyoko Asano1, Kazuki Hama1, Motoki Sasaki3, Takao Itoi1 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan 2 Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan 3 Division of Research and Development for Minimally Invasive Treatment, Cancer Center Keio University School of Medicine, Tokyo, Japan 1

Background: Plastic biliary stents are removable and inexpensive but are prone to early occlusion, whereas self-expandable metallic stents (SEMSs) provide longer patency but are costly and can be difficult to remove after long-term placement. A hydration-responsive polyvinyl alcohol (PVA) hydrogel stent (HGS) was developed as a first-in-class biliary stent platform to combine self-expandability, removability, and resistance to sludge-related occlusion. Previous endoscopic placement of this novel HGS in a porcine bile duct demonstrated technical feasibility and biliary expansion without disturbing bile flow. Aims: This study aimed to describe the material design and fabrication process of the PVA-HGS and to evaluate its long-term in vivo performance in a porcine gallbladder model. Methods: The PVA-HGS was fabricated using composite PVA hydrogels designed to provide both mechanical strength and hydration-driven expansion. A seamless tubular structure was formed, followed by controlled extension-drying to induce anisotropic swelling. Bismuth trioxide was incorporated to enable fluoroscopic visualization. Long-term bile exposure was assessed by surgically

176

2026 TDDW

P.38 implanting the PVA-HGS into the porcine gallbladder. A SEMS was used as a control. Retrieved stents were evaluated macroscopically and microscopically to assess lumen preservation and adherent materials. Results: The PVA-HGS was successfully implanted and retrieved after long-term gallbladder placement. The HGS maintained its tubular configuration and showed excellent lumen preservation. Macroscopic and microscopic evaluations demonstrated minimal adherent material on the inner surface of the HGS, whereas the control SEMS showed more prominent bile-related deposits. These findings suggest that the hydrophilic, seamless PVA hydrogel surface may reduce sludge accumulation during prolonged exposure to bile. Conclusions: This first-in-class hydration-responsive PVA-HGS demonstrated promising long-term lumen preservation in a bile-rich porcine model. The device may represent a new removable self-expandable platform for biliary drainage that addresses limitations of both plastic and metallic stents.

IN SMALL RECTAL NEUROENDOCRINE TUMOR (RNET <10 MM), MODIFIED ENDOSCOPIC MUCOSAL RESECTION (M-EMR) PROVIDES A SIMILAR COMPLETE RESECTION RATE TO ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) WITH SIGNIFICANTLY SHORTER PROCEDURE TIME: EXPERIENCE FROM A REGIONAL HOSPITAL IN SOUTHERN TAIWAN, A RETROSPECTIVE STUDY I-Hong Harn, Chun-Hao Chen Department of Internal Medicine, Section of Hepatobiliary and Gastroenterology, Yuan’s General Hospital, Kaohsiung, Taiwan

改良式內視鏡黏膜切除術治療小型直腸神經內分泌腫瘤（<10 mm）可達與內視鏡黏膜下剝離術相近之完整切除率並縮短手術時間：南臺灣一區域醫院近五年回溯性分析韓逸宏陳君豪阮綜合醫院肝膽腸胃內科

Background: The optimal endoscopic resection method for small rectal neuroendocrine tumors (rNETs) remains debated. This retrospective study evaluated tumor size, resection method, margin status, and procedure time in rNET cases at a regional hospital in southern Taiwan. The primary comparison focused on rNETs <10 mm treated with EMR-based versus ESD-based procedures. Aims: Primary endpoint: Procedure time in rNET <10 mm treated by EMR-based versus ESD-based resection. Secondary endpoint: Complete resection rate in the same subgroup. Methods: We retrospectively reviewed rectal neuroendocrine tumor cases identified from 2021.01 to 2026.01 at our regional hospital. A total of 51 rNET cases were extracted from the uploaded pathology/ endoscopy dataset. Tumor size, procedure method, margin status, and procedure time were standardized. For the subgroup of rNET <10 mm treated by EMR-based or ESD-based procedures, procedure time was compared using the MannWhitney U test because the sample size was small

177

2026 TDDW

P.39 and the time distribution was skewed. Complete resection was defined as a tumor-free margin in the pathology report. Results: Overall, 51 cases were analyzed. The size distribution was 25 cases <5 mm, 23 cases 5–9 mm, and 3 cases ≥10 mm. Procedure groups were EMRbased (n = 17), ESD-based (n = 17), conventional polypectomy (n = 13), and surgery/local excision (n = 4). In the rNET <10 mm EMR/ESD comparison cohort, complete resection was 100% in both EMRbased and ESD-based groups. Procedure time was shorter with EMR-based procedures than ESD-based procedures: median 10.0 (6.0–14.0) vs 18.0 (14.0– 26.2) minutes; Mann-Whitney U p = 0.0006. Conclusions: In this regional hospital experience, modified EMR/EMR-L for rNET <10 mm achieved a complete resection rate comparable to ESD while significantly reducing procedure time. These findings support EMR-based resection as an efficient first-line endoscopic strategy for carefully selected small rNETs without high-risk features.

CLINICAL OUTCOMES OF ENDOSCOPIC INTERMUSCULAR DISSECTION VERSUS TRANSANAL MINIMALLY INVASIVE SURGERY FOR EARLY RECTAL CANCER: A MULTICENTER RETROSPECTIVE COHORT STUDY Guan-De Li1, Chen-Huan Yu1, Chun-Sheng Shen2, Tai-Chuan Kuan3, Keng-Li Lin3, Chen-Shuan Chung1,4,5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan 2 Gastroenterology Division, Department of Internal Medicine, Kaohsiung Municipal HsiaoKang Hospital, Kaohsiung, Taiwan 3 Division of Colon and Rectal Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan 4 Taiwan Association for the Study of Intestinal Diseases (TASID), Taoyuan, Taiwan 5 Program A, Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan 1

內視鏡肌間層剝離術與經肛門微創手術治療早期直腸癌之臨床療效比較：一項多中心回溯性世代研究李冠德1 余臣桓1 沈群勝2 官泰全3 林耿立3 鍾承軒1,4,5 1

亞東紀念醫院肝膽腸胃科高雄市立小港醫院胃腸內科 3 亞東紀念醫院大腸直腸外科 4 台灣腸道醫學會 5 元智大學電機工程學系（甲組） 2

Background: Endoscopic intermuscular dissection (EID) has recently emerged as a novel anus-preserving endoscopic technique for selected patients with early rectal cancer and deep submucosal invasion. By enabling en bloc resection while preserving the anal sphincter and avoiding radical surgery, EID may reduce treatment-related morbidity without compromising oncologic outcomes. However, comparative evidence between EID and transanal minimally invasive surgery (TAMIS), a wellestablished organ-preserving approach, remains limited.

178

2026 TDDW

P.40 Aims: To compare the clinical outcomes of EID and TAMIS for the treatment of early rectal cancer in a multicenter retrospective study. Methods: We retrospectively reviewed consecutive patients who underwent EID or TAMIS for early rectal neoplasms between January 2018 and June 2026. Baseline demographic characteristics, tumor characteristics, pathological findings, procedural outcomes, adverse events, length of hospital stay, recurrence, and mortality were analyzed and compared between the two groups. Results: A total of 18 patients were included, with 13 undergoing EID and 5 undergoing TAMIS. Baseline characteristics, including age, sex, Charlson Comorbidity Index, ASA classification, clinical stage, and tumor size, were comparable between groups. Tumors treated with EID were more frequently located in the lower rectum than those treated with TAMIS (100% vs. 20%, P < 0.001). Technical success was achieved in all patients. En bloc resection rates were 76.9% for EID and 100% for TAMIS (P = 0.24), while R0 resection rates were similar (84.6% vs. 80.0%, P = 0.81). Procedure time did not differ significantly between groups (111.2 vs. 90.0 minutes, P = 0.40). Adverse events occurred only in the EID group (38.5%), including bleeding (23.1%), perforation (7.7%), and infection (7.7%), without a statistically significant difference. Patients treated with EID had a significantly shorter hospital stay than those undergoing TAMIS (5.1 vs. 8.0 days, P = 0.04). The median follow-up period was 410 days (IQR, 150–722 days). During follow-up, local recurrence occurred in one patient (7.7%) in the EID group and two patients (40.0%) in the TAMIS group (P = 0.17). No nodal or distant recurrence was observed in either group. One patient in the TAMIS group died during follow-up, whereas no mortality occurred in the EID group. Conclusions: EID achieved technical success, R0 resection, and short-term oncological outcomes comparable to TAMIS while offering a significantly shorter hospital stay. Although adverse events were observed only after EID, the overall safety profile remained acceptable. These findings suggest that EID is a feasible organ-preserving alternative to TAMIS for carefully selected patients with early rectal neoplasms. Larger prospective studies with longer follow-up are warranted to validate these results.

COMPARISON OF CLINICOPATHOLOGICAL FINDINGS OF COLORECTAL POLYPS BETWEEN YOUNGER AND OLDER PATIENTS: A PROPENSITY SCORE MATCHING ANALYSIS Chih-Chun Chuang1, Wey-Ran Lin1,2, Chia-Jung Kuo1,2, Chun-Jung Lin1,2, Wei-Pin Lin1,2, Chen-Ming Hsu1,2, Cheng-Tang Chiu1,2, Chun-Wei Chen1,2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan 1

年輕與年長患者大腸息肉臨床病理特徵之比較：傾向分數配對分析莊至鈞1 林蔚然1,2 郭家榮1,2 林淳榮1,2 林偉彬1,2 許振銘1,2 邱正堂1,2 陳俊瑋1,2 1 2

林口長庚紀念醫院胃腸肝膽科長庚大學醫學院

Background: The incidence of young-onset colorectal cancer has been increasing despite a decline in older adults. Colorectal polyps are important precursor lesions of colorectal cancer; however, their clinicopathological characteristics in younger patients remain unclear. Aims: The aim of this study is to compare the clinicopathological findings of colorectal polyps between patients younger than 50 years and those aged 50 years or older. Methods: This retrospective study included patients with colorectal polyps who underwent colonoscopic polypectomy at Linkou Chang Gung Memorial Hospital between 2017 and 2020. Patients were categorized into a younger group (<50 years) and an older group (≥50 years). Clinicopathological variables, including polyp size, location, morphology, and histology, were compared between groups. Propensity score matching was performed to balance sex distribution between the two groups. Results: A total of 3,470 patients were included, comprising 620 patients younger than 50 years and 2,850 patients aged 50 years or older. After propensity score matching, 620 patients were included in each group. The younger group had a significantly

179

2026 TDDW

P.41 higher proportion of distal polyps than the older group (63.5% vs. 52.1%, p < 0.001). Regarding histology, younger patients had significantly higher proportions of hyperplastic polyps (20.6% vs. 9.8%, p < 0.001) and sessile serrated adenomas (6.6% vs. 3.2%, p = 0.041), whereas older patients had a higher proportion of tubular adenomas (67.4% vs. 50.6%, p < 0.001). Regarding advanced polyp features, including tubular adenomas ≥10 mm, adenomas with villous components, and sessile serrated adenomas ≥10 mm, were comparable between the two groups. High-grade dysplasia was rare, occurring in 0 younger patients and 2 older patients. Conclusions: Our results revealed higher proportions of distal polyps and serrated lesions in younger patients. The prevalence of advanced polyps was comparable between the two groups, suggesting that younger individuals may derive significant benefit from colonoscopy screening.

AUTOMATED AUDIT OF COLONOSCOPY QUALITY INDICATORS VIA LARGE LANGUAGE MODELS: A RETROSPECTIVE FEASIBILITY STUDY AT A TAIWANESE TEACHING HOSPITAL Shan-Wei Hsu1, Chien-Hung Lu1, Wei-Yu Kao1,2,3,4, Wei-Cheng Huang1, Hsing-Jung Yeh1,2,3,7,8, Lung-Wen Tsai5,6, Chun-Chao Chang1,2,3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, 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 4 Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan 5 Department of Medicine Research, Taipei Medical University Hospital, Taipei, Taiwan 6 Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan 7 School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan 8 Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan 1

大型語言模型於大腸鏡品質指標自動化評估之應用：一篇台灣教學醫院之回顧性研究徐善維1 呂建宏1 高偉育1,2,3,4 黃唯誠1 葉欣榮1,2,3,7,8 蔡龍文5,6 張君照1,2,3 1

臺北醫學大學附設醫院消化內科臺北醫學大學醫學系消化內科學科 3 臺北醫學大學消化醫學研究中心 4 臺北醫學大學臺北癌症中心 5 臺北醫學大學附設醫院研究部 6 臺北醫學大學大數據科技及管理研究所 7 臺北醫學大學保健營養學系 8 臺北醫學大學營養醫學研究中心 2

180

2026 TDDW

P.42 Background: Colorectal cancer (CRC) poses a significant global health burden. Colonoscopy is established as an effective procedure for CRC screening and mortality reduction, with highquality performance considered essential to achieve these benefits. However, auditing colonoscopy quality indicators requires substantial manual labor. Research on the automated generation of colonoscopy quality metrics remains limited, particularly utilizing large language models (LLMs). Aims: This study aimed to evaluate the feasibility of using LLMs to automatically generate colonoscopy quality indicators. Methods: Patients aged ≥18 years who underwent colonoscopy at Taipei Medical University Hospital between March 1, 2025, and May 31, 2025, were included. Google’s MedGemma-1.5-4B and Meta’s Llama-3.1-8B-Instruct were utilized to generate four primary quality indicators: adequacy of bowel preparation, cecal intubation rate (CIR), adenoma detection rate (ADR), and sessile serrated lesion detection rate (SSLDR). A gastroenterologist independently reviewed the colonoscopy and pathology reports to establish the results as the gold standard. Results: Among 1,153 patients, baseline manual rates for bowel preparation, CIR, ADR, and SSLDR were 59.7%, 97.5%, 40.5%, and 3.7%, respectively. Llama-3-8b demonstrated statistical superiority over MedGemma-1.5-4b across multiple metrics: bowel preparation (95.5% vs. 89.9%, p < 0.001), ADR (95.4% vs. 89.9%, p < 0.001), and SSLDR (99.6% vs. 98.0%, p < 0.001). For CIR, Llama-3-8b achieved a comparable accuracy of 97.7% (with a 2% missing rate) against MedGemma-1.5-4b’s 97.4%. Conclusions: Open-source, lightweight large language models (LLMs) can accurately generate primary colonoscopy quality indicators, with Llama3.1-8B-Instruct outperforming MedGemma-1.54B in this task. These models hold the potential to be integrated into colonoscopy unit workflows to significantly reduce the burden of quality auditing.

ASSOCIATION BETWEEN DIABETES MELLITUS AND COLON CANCER DETECTION AMONG OLDER ADULTS: A HOSPITAL-BASED CROSSSECTIONAL STUDY Chia-Hsun Tsai1,4, Kao-Chi Chang Ou1, Chih-Ming Lin1, Ching-Sheng Hsu1,2,3,4 Center for Digestive Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan 2 School of Medicine, Tzu Chi University, Hualien, Taiwan 3 Department of Medical Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan 4 School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan 1

老年族群糖尿病與大腸癌檢出之相關性：一項醫院型橫斷面研究蔡佳勳1,4 張歐高奇1 林志明1 許景盛1,2,3,4 1

台中慈濟醫院消化醫學中心慈濟大學醫學系 3 台中慈濟醫院研究部 4 慈濟大學學士後中醫學系 2

Background: Diabetes mellitus (DM) has been implicated as a potential risk factor for colon cancer, particularly in the aging population. Aims: This study aimed to evaluate the association between DM, related clinical factors, and colon cancer detection among patients aged ≥65 years undergoing colonoscopy in a hospital-based setting. Methods: A retrospective cross-sectional study was conducted using colonoscopy data from 2,290 patients aged ≥65 years who underwent colonoscopy at Taichung Tzu Chi Hospital between 2015 and 2019. Colon cancer detection rates were compared between patients with and without DM. Multivariable logistic regression analyses were performed to identify factors associated with colon cancer detection after adjustment for age, comorbidities, and medication use. A subgroup analysis was conducted among patients with DM to evaluate the association between antidiabetic medications and colon cancer detection. Results: After excluding patients with a history of colorectal cancer, 476 patients with DM and 1,814

181

2026 TDDW

P.43 patients without DM were included in the analysis. The colon cancer detection rate was significantly higher in patients with DM than in those without DM (6.3% vs. 3.4%, p = 0.008). In the unadjusted analysis, DM was associated with a higher likelihood of colon cancer detection (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.21–2.98; p = 0.005). After adjustment for age and comorbidities, DM remained independently associated with colon cancer detection (adjusted OR, 1.62; 95% CI, 1.02–2.58; p = 0.041). Increasing age was also independently associated with colon cancer detection (adjusted OR, 1.10; 95% CI, 1.07–1.13; p < 0.001). Aspirin and statin use were not significantly associated with colon cancer detection. Among patients with DM, none of the antidiabetic medications, including metformin, insulin, dipeptidyl peptidase-4 (DPP-4) inhibitors, or thiazolidinediones, was significantly associated with colon cancer detection. However, metformin use showed a nonsignificant trend toward a lower likelihood of colon cancer detection (OR, 0.57; 95% CI, 0.27–1.21; p = 0.140). Conclusions: DM was independently associated with an increased likelihood of colon cancer detection in older adults undergoing colonoscopy. However, no individual antidiabetic medication was significantly associated with colon cancer detection among patients with DM. These findings underscore the importance of vigilant colorectal cancer screening in older adults with diabetes. Larger prospective studies are warranted to further elucidate the associations among DM, antidiabetic medications, and colon cancer detection.

182

VERIFICATION OF THE STORAGE STABILITY OF FECAL HEMOGLOBIN IN STOOL SAMPLING BOTTLE USING IMPROVED BUFFER – A PILOT STUDY Masakatsu Fukuzawa1, Sakiko Naito1, Shin Kono1, Yoshiya Yamauchi1, Takashi Morise1, Kumiko Uchida1, Yasuyuki Kagawa1, Takahiro Muramatsu1, Shiori Enomoto2, Shizuka Takehara2, Norimitsu Hosaka2, Takao Itoi1 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan 2 Eiken Chemical Co., Ltd., Tokyo, Japan 1

Background: Postal submission of stool samples has the potential to improve participation in fecal immunochemical test (FIT)-based colorectal cancer screening. However, fecal hemoglobin (Hb) degradation during storage and transport, particularly under high-temperature conditions, may compromise test accuracy. Aims: This study compared an improved stool collection buffer with the conventional buffer in terms of fecal Hb correlation and high-temperature stability, and simultaneously evaluated the stability of fecal transferrin (Tf ) and fecal calprotectin (FC). Methods: From June 2021 to December 2024, 130 stool samples collected from patients with informed consent were analyzed. Fecal Hb, Tf, and FC were measured in samples stored in both buffers, followed by correlation and stability assessments. High-temperature stability was evaluated at 37 °C for 1 week. Results: The improved buffer showed strong correlations with the conventional buffer for three markers (r ≥ 0.95; slope 1.00 ± 0.10). In the hightemperature stability test, residual reactivities were assessed for Hb ≥10 µg/g, Tf ≥10 µg/g, and FC ≥50 µg/g. Hb residual reactivity was significantly higher with the improved buffer (p < 0.01), while Tf maintained high stability (> 90%) in both buffers. FC showed reduced stability in the conventional buffer under prolonged high-temperature exposure, whereas the improved buffer demonstrated better preservation. The improved buffer also maintained higher Hb stability at elevated concentrations (≥30 µg/g). Conclusions: The improved stool collection

2026 TDDW

P.44 buffer effectively addressed the limitations of the conventional buffer by providing better Hb stability under high-temperature and high-concentration conditions, while preserving excellent stability for Tf and FC. These findings support its potential utility for postal stool collection in FIT-based colorectal cancer screening.

BILATERAL POLYP DISTRIBUTION AND IMPAIRED RENAL FUNCTION AS INDEPENDENT PREDICTORS OF HIGH-GRADE COLORECTAL NEOPLASIA Chia-Yu Lee, Si-Hsuan Chen, Jian-Han Lai, Ching-Wei Chang Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan

雙側大腸息肉與腎功能不良是進展性大腸腫瘤的危險因子李嘉宇陳席軒賴建翰張經緯馬偕紀念醫院消化科系

Background: Patients with chronic kidney disease (CKD) carry an elevated risk of colorectal cancer. Patient-level predictors of advanced neoplasia are recognized, but whether impaired renal function and polyp distribution independently determine high-grade neoplasia is unclear. Major guidelines do not modify colorectal screening by renal function. Aims: To identify which factors—renal function, polyp location, colonoscopy indication, and age— are associated with high-grade colorectal neoplasia. Methods: We retrospectively analyzed 154 patients undergoing colonoscopic polypectomy. Worstlesion histology was graded as low-risk, advanced adenoma, or high-grade neoplasia (cancer, carcinoma in situ, or high-grade dysplasia). Polyp location was classified as right-sided, left-sided, or bilateral; renal function by eGFR (<60 vs. ≥60 mL/min/1.73m²). Independent predictors were identified by multivariable logistic regression. Results: High-grade neoplasia occurred in 30/154 patients (19.5%). It was higher with impaired than preserved eGFR (38.7% vs. 14.6%; P = 0.006), and rose from right-sided (8.3%) to left-sided (18.3%) to bilateral polyps (27.6%; P = 0.013). Indication was not associated (P = 0.12). In multivariable analysis, bilateral distribution (aOR 5.72, 95% CI 1.33–24.57), impaired renal function (aOR 3.01, 1.10–8.29), and smoking (aOR 3.12, 1.21–8.08) were independent predictors. Conclusions: Impaired renal function, a bilateral polyp distribution, and smoking were independent predictors of high-grade colorectal neoplasia,

183

2026 TDDW

P.45 whereas colonoscopy indication, multiplicity, and age were not. These findings support proactive, risk-stratified colonoscopic screening and careful inspection for additional lesions when bilateral polyps are found; prospective validation is warranted.

COMPARABLE OUTCOMES OF SELFEXPANDABLE METALLIC STENT PLACEMENT FOR MALIGNANT COLORECTAL OBSTRUCTION BETWEEN A MEDICAL CENTER AND A REGIONAL HOSPITAL: A RETROSPECTIVE COHORT STUDY Liu-Han Lin1,2, Yang-Yuan Chen1,2, Hsu-Heng Yen1,2, Chih-Wen Huang1,2 Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan 1

醫學中心與區域醫院惡性大腸癌阻塞接受自擴式金屬支架置放之治療結果比較：回溯性世代研究林柳含1,2 陳洋源1,2 顏旭亨1,2 黃稚雯1,2 1 2

彰化基督教醫院內科部彰化基督教醫院肝膽腸胃科

Background: Self-expandable metallic stents (SEMS) are widely used for the management of malignant colorectal obstruction as either a bridge to surgery (BTS) or palliative decompression. However, data comparing the outcomes of SEMS placement between medical centers and regional hospitals remain limited. Aims: To compare patient characteristics, procedural patterns, and clinical outcomes of colorectal SEMS placement between a medical center and a regional hospital. Methods: This retrospective cohort study included patients who underwent colorectal SEMS placement for malignant colorectal obstruction secondary to colorectal cancer between March 2017 and December 2025 at Changhua Christian Hospital (CCH) and Yuanlin Christian Hospital (YCH). Patients undergoing duodenal stenting, those without colorectal cancer, and those lacking follow-up information were excluded. Baseline demographics, disease stage, treatment intent, lesion location, stent characteristics, procedural outcomes, and complications were compared between the two hospitals. Results: A total of 227 patients were included, comprising 181 patients from CCH and 46 patients

184

2026 TDDW

P.46 from YCH. Patient age, sex distribution, and disease stage were comparable between the two hospitals. Permanent palliative stenting was performed more frequently in YCH than in CCH (84.8% vs. 57.5%, P < 0.001). Clinical success rates were 90.1% in CCH and 100% in YCH (P = 0.112). Technical success without symptom relief occurred in 4.4% of patients in CCH and none in YCH, while procedural failure occurred in 5.5% and 0%, respectively. Procedure-related complications occurred in four patients (1.8%), all from CCH, with no complications observed in YCH (P = 0.585). Stent duration was significantly longer in YCH (P = 0.007), whereas the rate of stent-in-stent procedures was similar between the two hospitals. Conclusions: Despite differences in treatment intent and stent utilization patterns, both the medical center and the regional hospital achieved favorable clinical outcomes with low complication rates. These findings support the safety and feasibility of colorectal SEMS placement in regional hospitals and demonstrate that outcomes comparable to those of a medical center can be achieved.

LATE RECURRENCE OF SMALL RECTAL NEUROENDOCRINE TUMORS AFTER ENDOSCOPIC RESECTION: A LONG-TERM FOLLOW-UP STUDY Won Jeong Hwang1, Jooyoung Lee2,3, Ji Min Choi2,3, Min-Sun Kwak2,3, Su Jin Chung2,3 College of Nursing, Seoul National University, Seoul, South Korea 2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea 3 Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea 1

Background: Small rectal neuroendocrine tumors (NETs) ≤10 mm are generally considered low-risk lesions with excellent prognosis after endoscopic treatment. Current international guidelines recommend limited or no surveillance following complete resection; however, long-term outcome data extending beyond 10 years remain scarce. Aims: We aimed to evaluate long-term recurrence patterns and clinical outcomes of small rectal NETs during extended follow-up. Methods: We retrospectively analyzed 74 patients with rectal NETs ≤10 mm who underwent endoscopic treatment and achieved at least 5 years of follow-up at Seoul National University Hospital Healthcare System Gangnam Center. Initial treatment consisted of simple excisional biopsy in 17 patients and advanced endoscopic resection in 57 patients. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Results: The mean age at diagnosis was 48.7 ± 9.0 years, and the mean tumor size was 5.1 ± 1.9 mm. The mean follow-up duration was 14.5 ± 4.3 years (range, 5.2–21.5 years). No recurrence was observed within the first 5 years after treatment. During extended follow-up, recurrence occurred in 5 patients (6.8%), all between 6 and 19 years after the initial resection. Recurrent lesions were small (2–5 mm) and were successfully managed with repeat endoscopic resection. RFS rates were 100% at 5 years, 95.9% at 10 years, 92.9% at 15 years, and 81.2% at 20 years. No disease-related deaths were observed throughout follow-up. Conclusions: In this long-term follow-up cohort,

185

2026 TDDW

P.47 late recurrence occurred despite the absence of recurrence within the first 5 years after treatment. Although recurrence was uncommon and no disease-related deaths were observed, all recurrences developed beyond the surveillance periods addressed by current guidelines. These findings provide rare long-term outcome data for small rectal NETs and suggest that current surveillance strategies may not capture a subset of late recurrences.

TRACKING-AUGMENTED TEMPORAL FILTERING FOR REDUCING ALERT BURDEN IN COLONOSCOPY COMPUTER-AIDED DETECTION Kim-Ngan Ly1,3, Dang-Manh Ho3, Nguyen-Quoc-Khanh Le2,3 International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 2 In-Service Master’s Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3 AIBioMed Research Group, Taipei Medical University, Taipei, Taiwan 1

Background: Frame-wise computer-aided detection (CADe) for colonoscopy may generate transient and repetitive alerts during full-procedure video analysis, increasing alert burden and limiting clinical usability. Aims: To evaluate whether timestamp-based temporal persistence and short-gap object tracking could reduce annotation-unmatched alert events while preserving lesion-level detection. Methods: This three-video feasibility pilot used REAL-Colon data from two studies. Development included one training video with one lesion and one validation video with seven lesions from study 001. One 32.06-minute video with nine lesions from study 002 was held out for testing. A preexisting YOLOv8s checkpoint was applied, with a confidence threshold of 0.45 selected on validation data and locked before test inference. Identical detector outputs were processed using three postprocessing systems: frame-only alerts, 0.20-second temporal persistence, and 0.20-second persistence combined with ByteTrack-based short-gap tracking using a 0.50-second gap tolerance. The primary endpoint was annotation-unmatched alert events per evaluable minute, defined using an intersectionover-union (IoU) threshold of 0.30. Safety outcomes were lesion-level sensitivity and detection latency. Results: Frame-only alerts generated 108.92 annotation-unmatched events per minute and detected 9/9 lesions. Temporal persistence alone reduced the event rate to 4.96 events per minute, a 95.4% reduction, but detected only 4/9 lesions. Persistence with short-gap tracking generated 14.88 events per minute, an 86.3% reduction, while detecting 8/9 lesions. Among lesions detected by

186

2026 TDDW

P.48 both frame-only and tracking-based systems, the median paired detection delay was 3.0 seconds. Conclusions: Temporal persistence alone markedly reduced alert burden but excessively suppressed intermittent lesion detections. Adding short-gap tracking recovered most lesions lost by persistence while maintaining substantial alert reduction. This pilot supports the technical feasibility of trackingassisted alert suppression for colonoscopy CADe, but larger multi-video validation with clinical adjudication is required before clinical performance can be inferred.

WILL COLONOSCOPY INDUCE APPENDECTOMY? A MEDICAL CENTER 10 YEARS RETROSPECTIVE STUDY I-Liang Chen, Wen-Hsin Huang, Cheng-Yuan Peng Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

大腸鏡檢查是否會導致急性闌尾炎？國內一醫學中心 10 年之回顧性研究陳宜良黃文信彭成元中國醫藥大學附設醫院消化系內科

Background: Colonoscopy is a useful diagnostic tool for survey colonic lesion such as colon polyp, or colon cancer, etc. However, some complications associated with colonoscopy occur such as bleeding, perforation, splenic laceration, acute appendicitis, etc. Among these complications, the appendicitis post colonoscopy incident rate is very low (0.038%–0.049%). According to other study, post colonoscopy appendicitis can occur during 0–14 days. Some mechanism may explain the etiology of post colonoscopy appendicitis, including barotrauma through intralumen obstruction, direct intubation into the appendix orifice. However, we wonder if some factor will induce appendicitis post colonoscopy. Therefore, we proceed the study for further evaluation. Aims: To evaluated if nay risk factor associated with appendicitis after colonoscopy. Methods: We search the cases with diagnosis as acute appendicitis with individual above 20 years old in 2011 to 2020 in China medical university hospital, Taiwan with electric medical charts. Among these cases, we check if the colonoscopy is arranged before 0–14 days. We don’t exclude any underline disease such as diabetes mellitus, hypertension or malignancy. The age, gender, underline disease, colonoscopy procedure time, intervention during colonoscopy, colon preparation with colonoscopy, the symptom/sign and the white counts when appendicitis onset. Then, we will analysis the cases meeting with the conditions. Results: There are 5944 cases is diagnosed as acute appendicitis among 2011–2020 above 20 years old. Overall 7 cases are diagnosed acute appendicitis

187

2026 TDDW

P.49 after colonoscopy 0–14 days. All cases are treated with antibiotic and receive appendectomy. The fever is defined as above 37.5℃. The intervention mean biopsy or polypectomy during procedure. The abdominal pain mean any abdominal discomfortable such as epigastria, low abdominal pain, abdominal fullness. The colon prepare condition is defined with Aronchick scale. About underline disease: Case 1 with old cerebrovascular disease; Case 2 with bipolar disorder; Case 3 with Hypertention, congestive heart failure, benign prostate hyperplasia; Case 4 with sigmoid cancer post operation; Case 5.6.7 denied any underline disease. Among these 7 cases, the male is predominet (85.7%). The average age is 53.14 years old. Only 3 cases have fever (42.8%). All case show abdominal discomfortable symptom. 4 cases with leukocytosis is noted when appendicitis is diagnosed. The average time of appendicitis after colonoscopy is 8.28 days. The cases of procedure time more than 15 mins occupies 20% (two cases have no available data about procedure time). 3 cases have endoscopic intervention when coloboscopy (endoscopic biopsy is done for these case without appendix orifice approach). 4 cases (57.1%) with inadequate colon preparation is noted. All case with cecal insertion is mentioned. All case received appendectomy after admission and discharge with stable condition. Conclusions: In our study, only 7 case was included so no obvious risk factor was obtained due to low case number. However, the gender may be associated with the result due to predominet case in male. We need more data and further evaluation to get more specific conclusion.

188

ANALYZING THE MALIGNANCY RISK OF SESSILE SERRATED LESIONS AND EXPLORING THE MECHANISMS OF THEIR CARCINOGENESIS PROCESS USING MACHINE LEARNING AND MULTI-OMICS STUDIES Po-Chun Liu1, Joseph T. Tseng1,2 Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan 2 Ph.D. Program in Precision Medicine, National Tsing Hua University, Hsinchu, Taiwan 1

利用機器學習和多體學解析無蒂鋸齒狀病變癌化風險並探討其惡化之機制劉柏均1 曾大千1,2 1 2

國立清華大學生物科技研究所國立清華大學精準博士學位學程

Background: Colorectal cancer (CRC) is a highly fatal and prevalent gastrointestinal cancer that frequently originates from colorectal adenomas or lesions, which acquire critical genetic and epigenetic mutations that drive malignant transformation through conventional adenoma-carcinoma sequence or sessile serrated pathway. Though these precancerous tissues were removed through colonoscopy, the relative risks of these lesions were determined by assessing their size and location, which is error-prone and vulnerable to inter-observer variabilities. Finding a novel way to calculate the relative risks is critical to clinical decision-making for appropriate screening periods of patients. Aims: We aim to provide a comprehensive insight into the malignant risks and specific mechanisms of both pathways from precancerous lesions, namely tubular adenoma (TA) and sessile serrated lesions (SSL). Methods: DNA Methylation array-based sequencing data and high-throughput sequencing mRNA expression data are quantified using openaccess databases and meta-analysis approaches. Subsequently, machine learning techniques such as extreme gradient boosting and support vector machines will also be leveraged to determine the relative malignant risks of lesions. Results: We discovered that SSLs have relatively higher risks of malignancy because of their abilities to methylate BRAF gene, which activated oncogene-

2026 TDDW

P.50 induced senescence (OIS) and senescenceassociated secretory phenotypes (SASP). In addition, the risks of SSLs are also linked to chronic inflammation in cellular microenvironments and enhanced replicative immortality of SSL cells. Conclusions: Our results provided a systematic thought across epigenomics and transcriptomics of precancerous colorectal lesions. By leveraging machine learning and multi-omics data, we showed that SSL may utilize inflammatory microenvironment to quickly accumulate mutations and become CRC.

VALIDATION OF OVERALL ADENOMA DETECTION RATE AS A COLONOSCOPY QUALITY INDICATOR ACROSS ALL INDICATIONS: A PROSPECTIVE MULTICENTER STUDY IN TAIWAN Chi-Liang Cheng1,2,3, Chen-Ming Hsu3,4, Wen-Lun Wang5,6, Shuo-Wei Chen3,7, Jen-Hao Yeh8, Yen-Lin Kuo2, Cesare Hassan9,10, Felix W. Leung11,12 Division of Gastroenterology and Hepatology, Department of Internal Medicine, JenAi Hospital, Taichung, Taiwan; 2Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 5Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; 6School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA DaChang Hospital, I-Shou University, Kaohsiung, Taiwan; 9Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 10Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 11Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), North Hills, CA, USA; 12David Geffen School of Medicine at UCLA, Los Angeles, CA, USA 1

將大腸腺瘤偵測率評估擴展至所有大腸鏡檢查適應症作為品質指標之驗證：一項臺灣前瞻性多中心研究鄭吉良1,2,3 許振銘3,4 王文𤦎5,6 陳碩為3,7 葉人豪8 郭彥麟2 Cesare Hassan9,10, Felix W. Leung11,12

189

2026 TDDW

大里仁愛醫院胃腸肝膽科；2 中壢長榮醫院胃腸科；3 長庚大學醫學院；4 林口長庚紀念醫院胃腸肝膽科系；5 義大醫院胃腸肝膽科；6 義守大學醫學系；7 基隆長庚紀念醫院胃腸肝膽科；8 義大大昌醫院胃腸肝膽科；9Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 10Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 11Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), North Hills, CA, USA; 12 David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Background: The adenoma detection rate (ADR), defined as the proportion of colonoscopies in which at least one conventional adenoma is detected, has been validated as the most important colonoscopy quality indicator for first-time screening colonoscopy. Colonoscopy indications are commonly categorized as screening, surveillance, diagnostic, and fecal immunochemical test-positive (FIT+). Growing evidence suggests that ADR calculated across all indications except FIT+ (overall-non-FIT) closely approximates first-time screening ADR, reduces temporal variability, and provides a more precise measure of endoscopist performance. Accordingly, the 2024 American College of Gastroenterology and American Society for Gastrointestinal Endoscopy Quality Task Force endorsed overall-non-FIT ADR as an acceptable alternative to screening-restricted ADR for quality assessment. However, supporting evidence has been derived predominantly from retrospective database studies conducted in the United States (Endoscopy 2017;49:1069–74; Clin Gastroenterol Hepatol 2021;19:1883–9; Clin Gastroenterol Hepatol 2021;9:1873–82). Whether overall-non-FIT ADR can reliably substitute for firsttime screening ADR when evaluated prospectively in other populations remains uncertain. Aims: To prospectively evaluate whether overallnon-FIT ADR closely approximates first-time screening ADR in an Asian population. Methods: This prospective multicenter study was conducted at five hospitals in Taiwan between November 2021 and March 2026. Consecutive patients aged ≥50 years undergoing colonoscopy for any indication were enrolled. The primary outcome was ADR. For each endoscopist, ADRs were calculated separately for first-time screening, non-first-time screening, surveillance, diagnostic,

190

FIT+, and overall-non-FIT examinations (defined as all screening, surveillance, and diagnostic colonoscopies). Results: A total of 2,695 colonoscopies (mean age, 62.1 ± 7.6 years; 51.5% male) performed by 18 gastroenterologists were analyzed. Colonoscopy indications included first-time screening (13.7%), non-first-time screening (23.5%), surveillance (30.8%), diagnostic (21.3%), and FIT+ (10.6%). The first-time screening ADR (41.4%; 95% confidence interval [CI], 36.4%–46.4%) and overall-non-FIT ADR (41.6%; 95% CI, 39.7%–43.6%) were nearly identical. The 95% CI for overall-non-FIT ADR was substantially narrower than that for first-time screening ADR (3.9 vs. 10.0 percentage points), indicating greater precision. Overall-non-FIT ADR was also strongly correlated with first-time screening ADR across endoscopists (Pearson r = 0.809) and with allscreening ADR (r = 0.765). Compared with first-time screening colonoscopy, ADR was significantly higher in surveillance examinations (odds ratio [OR], 1.58; 95% CI, 1.23–2.03) and FIT+ examinations (OR, 1.71; 95% CI, 1.26–2.34), significantly lower in non-firsttime screening examinations (OR, 0.66; 95% CI, 0.51– 0.87), and lower in diagnostic examinations (OR, 0.81; 95% CI, 0.62–1.06). Conclusions: These findings suggest that inclusion of surveillance and diagnostic examinations does not meaningfully alter assessment of endoscopist ADR performance, supporting the use of overallnon-FIT ADR for routine quality monitoring. Adoption of overall-non-FIT ADR may simplify quality measurement and facilitate broader implementation of colonoscopy quality reporting.

2026 TDDW

P.51

ADDITIONAL CHEMORADIOTHERAPY VERSUS ESOPHAGECTOMY FOR EARLY ESOPHAGEAL CANCER: AN INTEGRATED ANALYSIS OF RECONSTRUCTED TIME-TO-EVENT DATA Chi-Wei Yang1, Po-Feng Huang1,2 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan 1

616 patients were included. Quantitative synthesis revealed no significant difference between CRT and surgery in RFS (HR = 1.020, 95% CI 0.856– 1.214) or OS (HR = 1.031, 95% CI 0.886–1.200). Crucially, subgroup analyses demonstrated that this therapeutic equivalence was robust and not significantly modified by the proportion of pT1b invasion, tumor location, or LVI status. Conclusions: Additional CRT provides longterm survival outcomes comparable to radical esophagectomy for non-curative ESCC, even in high-risk subgroups defined by deep submucosal invasion or LVI. CRT should be considered a potential, organ- preserving alternative to surgery in selected patients.

早期食道癌接受追加放化療或食道切除術之療效比較楊志偉1 黃柏峰1,2 1 2

三軍總醫院腸胃科國軍高雄總醫院腸胃科

Background: Management of early-stage esophageal squamous cell carcinoma (ESCC) following non-curative endoscopic resection remains controversial, particularly for patients with pathological risk factors like deep submucosal invasion (pT1b) or lymphovascular invasion (LVI). While surgery is the standard for ensuring oncological clearance, it carries significant morbidity. Additional chemoradiotherapy (CRT) offers an organ-preserving alternative, yet previous metaanalyses have failed to clarify its efficacy in specific high-risk subgroups. Aims: This study aimed to compare the long-term survival of additional CRT versus esophagectomy using reconstructed time-to-event data. Methods: A systematic review of major databases was conducted from inception to September 2025. Comparative studies evaluating additional CRT versus surgery post-endoscopic resection were included. Individual patient data were reconstructed from published Kaplan–Meier curves to estimate hazard ratios (HRs). Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). Stratified analyses evaluated the modifying effects of pT1b depth and LVI. Results: Seven retrospective studies comprising

191

2026 TDDW

P.52

RESULTS OF ENDOSCOPIC RESECTION FOR GASTRIC SUBEPITHELIAL TUMOR Tze-Yu Shieh1,2, Chen-Wang Chang1,2, Chi-Yu Lee1,2, Shih-Hsi Wang2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan 2 School of Medicine, Mackay Medical University, New Taipei City, Taiwan 1

經內視鏡切除胃黏膜下腫瘤之成果謝子鈺1,2 章振旺1,2 李騏宇1,2 汪士熹2 1 2

馬偕紀念醫院消化科系馬偕醫學大學醫學系

Background: In the past, the only way to treat gastric subepithelial tumors (G-SETs) was open or laparoscopic surgery. With advances in endoscopic equipment and techniques, endoscopic resection (ER) has become an increasingly accepted treatment option for patients with G-SETs. Endoscopic muscularis dissection (EMD), endoscopic subserosal dissection (ESSD) and endoscopic full thickness resection (EFTR) are of its variations, aimed to remove gastric tumors arising below the submucosal layer. Endoscopic resection has many advantages compared to laparoscopic approaches, including shorter procedure time, earlier resumption to oral intake, less blood loss and shorter hospital stay. Aims: This study aimed to evaluate the outcome of endoscopic resection in patients with G-SETs and to assess its feasibility, efficacy, and safety in the treatment of the disease. Methods: We retrospectively reviewed 103 patients with 105 lesions, who underwent 18 EMD, 17 ESSD and 70 EFTR procedures without laparoscopic assistance in Mackay Memorial Hospital, Taipei, Taiwan from July 2016 to October 2025. Primary outcomes included R0 resection rate, en bloc resection rate, days of hospital stay, intra-procedural perforation rate and adverse events including delayed bleeding and delayed perforation. All patients were diagnosed with GSETs with previous diagnostic esophagogastroduodenoscopy and underwent endoscopic ultrasonography (EUS) to locate the tumor and assess its size and layer of origin. All specimens were reviewed by a certified pathologist after the procedure.

192

Results: There were 22 men and 81 women, and the mean age was 57.1 ± 12.0 years old. The mean procedure time was 71.6 ± 42.30 minutes. The mean tumor size was 19.15 ± 11.24 mm. Histopathological diagnoses included 76 gastric gastrointestinal stromal tumors (G-GISTs), 20 leiomyomas, 4 ectopic pancreases, 2 schwannomas, 1 calcifying fibrous tumor, 1 gastritis cystica profunda, and 1 grade 2 neuroendocrine tumor. Regarding tumor location, 57 were located at upper stomach (cardia and fundus) and 48 at lower stomach (gastric body and antrum). We reached an en bloc resection rate of 100% (105/105), and a R0 resection rate of 96.2% (101/105). The patients were hospitalized for 4.81 ± 1.53 days on average. Intentional intraoperative full thickness perforation was created in 66.7% (70/105) of procedures as part of the ER technique, but only 1 case required emergent laparoscopic repair. All remaining defects were successfully closed endoscopically. No delayed bleeding or delayed perforation was observed. Conclusions: Endoscopic resection is a feasible, effective, and safe treatment option for gastric subepithelial tumors. In this single-center series, ER achieved excellent en bloc and R0 resection rates with a low rate of clinically significant adverse events. These findings support the role of ER as a minimally invasive alternative to surgical resection in appropriately selected patients.

2026 TDDW

P.53

EFFICIENT ENDOSCOPE CLEANING: WATER CONSERVATION AND QUALITY ENHANCEMENT REPORT Tao-Chieh Liu, Pei-Chun Tsai, Tien-Yu Huang, Peng-Jen Chen, Wei-Kuo Chang, Yi-Ting Chou, Chao-Feng Chang Division of Gastroenterology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

高效率內視鏡清洗：節水與品質提升報告

establishment, 95% staff training completion, and 90% compliance with daily monitoring. Conclusions: The initiative delivered multi-level benefits by advancing hospital ESG and CQI objectives through reduced resource consumption, enhancing patient safety and procedural efficiency via standardized endoscope reprocessing, and strengthening team capability with internal competency scores improving remarkably. Looking ahead, while water waste was effectively reduced, the next phase will focus on implementing smart monitoring systems to enable automated usage tracking and ensure long-term process consistency and sustainability.

劉導潔蔡佩君黃天祐陳鵬仁張維國周益霆張肇丰國防醫學院三軍總醫院胃腸肝膽科

Background: The initiative was formed in response to the increasing volume of clinical endoscopic procedures, which highlighted structural inefficiencies such as long cleaning times and excessive resource consumption. Aims: Through optimizing endoscope cleaning workflows to reduce resource waste. This project successfully integrates water- saving measures with medical quality enhancements through standardized procedures and equipment recalibration. Methods: The project utilized a problem-solving Quality Control story methodology to identify and address the root causes of water resource waste. The team implemented three primary categories of action including equipment Adjustment, standardization, and personnel training & awareness to improve water saving. The methodology followed the PDCA (Plan-Do-CheckAct) cycle. During a three-month trial period from June to August, the team monitored water usage and conducted microbial cultures to verify that the reduction in water flow did not negatively affect infection control standards, Results: The project exceeded its primary objective of reducing water consumption per endoscope cleaning cycle, achieving a reduction from 20.9 L to 17.1 L (−3.8 L; 18% improvement), corresponding to 126% of the original 3-L target. Infection control and quality safety were fully maintained, with a 0.00% positive microbial culture rate in year 2025 and no observed increase in abnormal bacterial strains or cross-infection risk following implementation. High execution fidelity supported these outcomes, including 100% AER recalibration, 100% SOP

193

2026 TDDW

P.54

IMPACT OF PERORAL ENDOSCOPIC MYOTOMY ON PSYCHOLOGICAL DISTRESS AND SLEEP QUALITY IN ELDERLY PATIENTS WITH ACHALASIA Han-Tse Cheng1, Chien-Chuan Chen2, Ping-Huei Tseng2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1

經口內視鏡肌肉切開術對老年賁門失弛緩症患者心理壓力與睡眠品質的影響鄭翰澤1 陳建全2 曾屏輝2 1 2

戴德森醫療財團法人嘉義基督教醫院胃腸肝膽科台大醫院胃腸肝膽科

Background: Peroral endoscopic myotomy (POEM), a novel minimally invasive treatment for esophageal achalasia, has been shown to be safe and effective in elderly patients. However, studies regarding its application in elderly Taiwanese patients and its impact on psychological distress and sleep quality remains scarce. Aims: This study investigates application of peroral endoscopic myotomy (POEM) in elderly Taiwanese patients with achalasia and its impact on psychological distress and sleep quality. Methods: This retrospective study included consecutive achalasia patients aged ≥75 years who underwent POEM from 2013 to 2025 at a tertiary medical center in Taiwan. All patients underwent a comprehensive work-up before POEM, including symptom questionnaires, esophagogastroduodenoscopy, timed barium esophagogram (TBE), and high-resolution impedance manometry (HRIM), and were reevaluated within 6 months after POEM. Results: A total of 17 patients were analyzed. Mean symptom duration before diagnosis was 29 months. Fourteen were treatment naïve, whereas others had prior treatments. Preoperatively, 29% of patients exhibited psychiatric comorbidity (Brief Symptom Rating Scale [BSRS-5] >5) and 76% reported poor sleep quality (Pittsburgh Sleep Quality Index

194

[PSQI] >5). Mean POEM procedure time was 92.4 min, and clinical success (Eckardt score <3) was achieved in all patients. No severe peri-operative adverse events were observed. At a mean followup of 4.1 months, significant improvements were observed in median Eckardt score (5 vs. 1, p < 0.001), lower esophageal sphincter (LES) resting pressure (25.0 vs. 15.0 mmHg, p = 0.01), LES integrated relaxation pressure in 4 seconds (IRP4s) (21.7 vs. 9.8 mmHg, p = 0.004), Reflux Symptom Index scores (17 vs. 4, p < 0.001), BSRS-5 (3 vs. 1, p = 0.007), and PSQI scores (11 vs. 10, p = 0.038). There was no deterioration on Reflux Disease Questionnaire scores (8 vs. 0, p = 0.08) and Gastroesophageal Reflux Disease Questionnaire scores (6 vs. 6, p = 0.866). Correlation analysis showed that ΔPSQI was moderately correlated with ΔClearing throat (ρ = 0.585, p = 0.014). Conclusions: POEM was effective and safe in elderly Taiwanese achalasia patients with significant improvement of esophageal symptoms as well as psychological distress and sleep quality.

2026 TDDW

P.55

CLINICAL OUTCOMES OF SM1 AND SM2 T1B ESOPHAGEAL CANCER POST-ENDOSCOPIC SUBMUCOSAL DISSECTION: A 10-YEAR SINGLECENTER EXPERIENCE Ching-Reigh Hsieh, Bo-Huan Chen, Yung-Kuan Tsou Division of Gastroenterology & Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

早期食道癌 T1b 黏膜下深層侵犯（SM1 與 SM2）內視鏡黏膜下剝離術後的臨床預後：單一中心十年經驗謝清瑞陳博煥鄒永寬長庚醫療財團法人林口長庚紀念醫院胃腸肝膽科系

Background: Endoscopic submucosal dissection (ESD) is the established gold standard for mucosal esophageal cancer. However, its application in submucosal (T1b) disease remains a subject of clinical debate due to the elevated risk of lymph node metastasis. While T1b-SM1 lesions (invasion depth <200 μm) are often considered relative indications for ESD, T1b-SM2 lesions (>200 μm) are typically deemed investigational. This study aimed to evaluate long-term oncological outcomes and prognostic factors in patients with pathologically confirmed T1b esophageal squamous cell carcinoma treated with ESD, specifically comparing SM1 and SM2 disease in the context of adjuvant therapy. Aims: The first study to compare the long-term oncological outcomes of pT1b-SM1 and pT1b-SM2 post ESD. Methods: We conducted a retrospective cohort study of 63 patients (69 lesions) with T1b esophageal cancer who underwent ESD at Linkou Chang Gung Memorial Hospital between January 2015 and December 2024. Patients were stratified into SM1 (n = 16) and SM2 groups (n = 53) based on post-procedural histopathological invasion depth. The primary endpoint was overall survival (OS). Secondary endpoints included technical ESD outcomes (e.g., resection margins, or post-ESD bleeding, perforation, or stricture), progression-free survival (PFS), and disease-specific survival (DSS). Results: A significantly higher rate of positive deep resection margins was observed in the SM2 group

compared to the SM1 group (34.7% vs. 7.1%, p = 0.028). Consequently, a greater proportion of SM2 patients received post-ESD adjuvant therapy (esophagectomy or chemoradiotherapy, 71.4% vs. 21.4%, p = 0.001), primarily in the form of chemoradiotherapy (57.1% vs. 14.3%, p = 0.005). The SM2 group demonstrated lower all-cause mortality (50.0% vs. 85.7%, p = 0.018) and superior OS in Kaplan–Meier analysis (log-rank p = 0.014). In the multivariable Cox regression analysis, a Charlson Comorbidity Index (CCI, >5) was identified as an independent predictor of poor OS (Hazard Ratio [HR] = 2.203; 95% Confidence Interval [CI], 1.084– 4.478; p = 0.029). Subgroup analysis of the SM2 cohort revealed that adjuvant therapy significantly improved OS compared to ESD alone (log-rank p = 0.014). Conclusions: Although SM2 patients have a higher rate of deep resection margin positivity, cancerspecific prognosis (DSS, PFS) is comparable between SM1/SM2. Comorbidities (Charlson Comorbidity Index >5) are an independent predictor of poor overall survival.

195

2026 TDDW

P.56

ENDOSCOPIC ULTRASOUNDGUIDED COIL-BASED OBLITERATION FOR SECONDARY PREVENTION OF GASTRIC VARICEAL BLEEDING: A SINGLE-CENTER REAL-WORLD EXPERIENCE Pei-Huan Ho, Mu-Hsien Lee, Sheng-Fu Wang, Chi-Huan Wu, Yung-Kuan Tsou, Cheng-Hui Lin, Kai-Feng Sung Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

內視鏡超音波導引線圈栓塞治療於胃靜脈曲張出血二級預防之應用：單中心真實世界經驗何沛桓李沐憲王昇富吳季桓鄒永寬林政輝宋皚峰林口長庚紀念醫院胃腸肝膽科系

Background: Endoscopic ultrasound (EUS)-guided coil-based therapy is increasingly used for gastric varices, but data on adjunctive gelfoam use and longitudinal outcomes remain limited. Aims: To evaluate the safety, technical success, and follow-up outcomes of EUS-guided coil-based gastric variceal obliteration for secondary prevention. Methods: Consecutive patients undergoing EUSguided coil-based treatment for gastric varices with stigmata of recent hemorrhage at a tertiary referral center from December 2022 to February 2026 were retrospectively reviewed. Technical success was defined as successful coil deployment with posttreatment Doppler response. Results: Nineteen patients were included. The median age was 64 years, 12 (63.2%) were male, and 17 (89.5%) had cirrhosis. Child–Pugh class was A, B, and C in 8, 5, and 4 cirrhotic patients, respectively. Gastroesophageal varices type 2 was the predominant varix type (16/19, 84.2%). All patients had pretreatment Doppler-detectable flow. Adjunctive gelfoam, cyanoacrylate, and coil-alone strategies were used in 12 (63.2%), 4 (21.1%), and 3 (15.8%) patients, respectively. Technical success, immediate Doppler flow disappearance, and immediate variceal obliteration were achieved in all patients (19/19, 100%). No procedure-related major adverse event, systemic embolism, procedure-

196

related mortality, or 30-day mortality occurred. During a median follow-up of 326 days, rebleeding occurred in 3 patients (15.8%), all within 19 days after the index procedure, and 5 patients (26.3%) required endoscopic or EUS-guided reintervention. No patient required radiological shunt therapy. Final documented variceal obliteration was observed in 15 patients with available follow-up assessment. Overall mortality was 15.8%, with no bleedingrelated death. Conclusions: In this single-center secondaryprevention experience, EUS-guided coil-based gastric variceal obliteration, most commonly with adjunctive gelfoam, achieved universal technical success, effective immediate obliteration, and favorable safety without major procedure-related complications.

2026 TDDW

P.57

MAPPING GASTRIC CANCER MOLECULAR PROGRAMS REVEALS UNIVERSAL PLASTICITY AND ANCESTRY-SPECIFIC PROGNOSTIC BIOLOGY: A TRANSCRIPTOME-BASED INDIVIDUAL PATIENT DATA METAANALYSIS Tzu-Chan Hong1,2,3, Yu-Ju Chen4, Ming-Shiang Wu3 Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan 2 Department & Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan 3 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 4 Institute of Chemistry, Academia Sinica, Taipei, Taiwan 1

以轉錄體分析胃癌預後相關分子特徵：跨族群一致與族群特異性生物學之個別病人資料統合分析洪子瞻1,2,3 陳玉如4 吳明賢3

Hippo, MYC, and proliferation. Within each cohort, Cox models adjusted for age, sex, and pathological stage were integrated by random-effects metaanalysis. Randomized LASSO-Cox modeling derived a prognostic composite in training cohorts, followed by validation in an independent Korean cohort. Results: YAP/TAZ was the strongest stageindependent adverse prognostic program across cohorts (pooled HR 1.33 per SD, 95% CI 1.23–1.45, q = 3.4 × 10-¹¹, I² = 0%). EMT was also consistently adverse (HR 1.22, 95% CI 1.11–1.33, q = 1.0 × 10-⁴, I² = 20%). LASSO-Cox selected only YAP/TAZ and EMT, with selection frequencies of 97.5% and 86.0%. The resulting Composite Plasticity Index predicted worse survival in the independent Korean validation cohort (HR 1.26 per SD, 95% CI 1.10–1.43, p < 0.001). MYC showed no universal prognostic effect, but demonstrated ancestry-specific prognostic biology, including adverse survival association in non-Asian patients (HR 1.39, 95% CI 1.10–1.76, p = 0.005). Conclusions: Transcriptome-based molecular program mapping identifies a reproducible YAP/ TAZ–EMT plasticity score for gastric cancer prognostic stratification. MYC-related ancestry-specific biology may support future population-aware biomarker development and clinical trial design.

台大醫院癌醫分院綜合內科部國立臺灣大學醫學教育暨生醫倫理學科暨研究所 3 國立臺灣大學醫學院及台大醫院內科部 4 中央研究院化學研究所 2

Background: Gastric cancer outcomes remain heterogeneous even among patients with similar stage or histologic subtype. Current classifications incompletely capture continuous molecular biology that may influence prognosis across different populations. Aims: We aimed to identify reproducible transcriptome-based molecular programs associated with gastric cancer prognosis and to determine whether prognostic biology differs between Asian and non-Asian populations. Methods: We analyzed five gastric cancer cohorts comprising 1,420 patients and 557 overall-survival events, including three East Asian cohorts and two mixed or predominantly Western cohorts. Twentytwo molecular programs were curated from MSigDB HALLMARK pathways, literature-based signatures, and in-house scores, covering gastric and intestinal identity, YAP/TAZ, EMT, WNT, Notch, Hedgehog,

197

2026 TDDW

P.58

EFFICACY AND SAFETY OF REMOVABLE FULLY COVERED METALLIC STENTS IN PRIMARY ACHALASIA I-Lin Lee Dr. Lee Gastroenterology Clinics, Taipei, Taiwan

可移除式全覆膜金屬支架治療原發性賁門弛緩症之療效與安全性李宜霖李宜霖診所

Background: Because fully covered self-expandable metallic stents (FCSEMS) are removable and reusable, they are increasingly being applied to benign esophageal conditions. Primary achalasia has an incidence of about one in 100,000, and its standard treatment is peroral endoscopic myotomy (POEM). Balloon dilation and botulinum toxin injection have high recurrence rates and limited long-term efficacy. Aims: To evaluate the long-term efficacy and safety of FCSEMS dilation in patients with primary achalasia who are unsuitable for, or unwilling to undergo, surgery or POEM. Methods: Under intravenous anesthesia and endoscopic guidance, an esophageal metallic stent (TaeWoong Niti stent or ChooStent, usually 20 × 100 mm) was placed, with position confirmed by chest X-ray. Patients took liquids immediately and soft foods the next day. The stent was usually removed one to two weeks later, or earlier if symptoms were severe. Improvement in dysphagia, vomiting, and gastroesophageal reflux was followed, and the procedure was repeated whenever symptoms recurred. Results: Between January 2017 and June 2026, 25 patients were treated (12 men, 13 women; mean age 56.2 years, range 18–85). The median time from symptom onset to treatment was 2 years (range 0.5– 37). Nineteen patients were treated once, three twice, and three three times; only one, with poor response after three treatments, eventually underwent POEM. Four patients with recurrence after prior surgery or POEM also improved markedly with FCSEMS. Three elderly patients added in the past six months — a 71-year-old man, a 76-year-old man, and an 80-yearold woman — each had a single stent placement, recovered well, and now eat normally; the 80-yearold woman, with a 37-year history and two failed

198

prior operations, also responded well. Mean followup was about 56.9 months (range 1–178.1). Among the 24 non-surgical patients, only five had occasional dysphagia or vomiting (two with symptoms over 30 years); most others improved significantly, and postprocedure reflux was uncommon. Conclusions: FCSEMS dilation is a simple, safe, and effective treatment for primary achalasia, with most patients achieving long-term relief after only one or two treatments. Even patients who have previously undergone surgery can be treated again with this method when symptoms recur.

2026 TDDW

P.59

DRUG-CLASS RATHER THAN DRUG-SPECIFIC AKI RISK IN ACIDSUPPRESSIVE THERAPY: AN ACTIVECOMPARATOR STUDY ACROSS PPIS, H2RAS, AND TEGOPRAZAN IN CKD Ka Young Joanna Hwang¹, Jin Ho Hwang¹, Nak-Hoon Son², Cheal Wung Huh¹ ¹Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea ²Department of Statistics, Keimyung University, Daegu, Republic of Korea Background: Observational studies have consistently reported associations between proton pump inhibitor (PPI) use and acute kidney injury (AKI). However, whether these signals reflect drugspecific nephrotoxicity or a class-level effect remains unresolved. Aims: We leveraged tegoprazan, a pharmacologically distinct potassium-competitive acid blocker (P-CAB), as a third active comparator alongside H2 receptor antagonists (H2RAs) and PPIs to test whether AKI risk elevation in chronic kidney disease (CKD) is specific to PPIs or shared across acid-suppressive drug classes.

previously reported PPI-associated AKI signal was not reproduced under active-comparator design. Conclusions: In patients with pre-existing CKD, numerically higher AKI risk relative to H2RAs was observed across pharmacologically distinct acidsuppressive agents without reaching statistical significance, and the pattern was not specific to any individual drug. The consistent treatment-byCKD interaction across drug classes, combined with non-replication of the PPI-AKI signal under activecomparator design, is consistent with confounding by indication or a class-level effect as alternative explanations for previously reported associations, although causal inference remains limited by the observational study design.

Methods: This retrospective cohort study included new users of an H2RA, a PPI, or tegoprazan at Korean tertiary hospitals (2019– 2024). Pairwise 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), stratified by baseline eGFR (<60 vs ≥60 mL/min/1.73m²), were used to estimate hazard ratios (HRs) for incident AKI and an AKI–kidney replacement therapy (KRT) composite. Treatment-by-CKD interaction terms were tested across all three pairwise comparisons. Results: Of 363,340 screened adults, 58,175 were eligible. In the non-CKD cohort, neither PPIs nor tegoprazan was associated with increased AKI risk relative to H2RAs. In the CKD cohort, numerically higher point estimates relative to H2RAs were observed for both PPIs (HR, 1.27; 95% CI, 0.75–2.17) and tegoprazan (HR, 1.37; 95% CI, 0.81–2.31), without reaching statistical significance. The treatment-byCKD interaction was significant for PPI versus H2RA (P = 0.014) and tegoprazan versus H2RA (P = 0.010), but not for tegoprazan versus PPI (P = 0.086). The

199

2026 TDDW

P.60

ENDOSCOPIC INTERVENTION FOR BREAST-ESOPHAGUS SYNDROME: CLINICAL EXPERIENCE FROM A REGIONAL HOSPITAL IN SOUTHERN TAIWAN Yu-Jou Tsai1, I-Hong Harn1, Ching-Yang Tsai1, Ching-Kung Pan2 Section of Hepatobiliary and Gastroenterology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan 2 Section of Breast Surgery, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan 1

乳房食道症候群之內視鏡介入：南台灣某一區域醫院之臨床經驗蔡毓洲1 韓逸宏1 蔡青陽1 潘慶坤2 1 2

阮綜合醫院消化系內科阮綜合醫院乳房外科

Background: Esophageal metastasis from breast cancer is rare and poses significant diagnostic and therapeutic challenges with a very poor prognosis. While autopsy studies report a prevalence of 4.2%– 5.9%, clinical observation identifies only 0.4%, highlighting the difficulty of early detection. Aims: This study aims to improve the diagnosis and management of this rare condition, often referred to as “Breast-Esophagus Syndrome.” Methods: We conducted a retrospective review of patients diagnosed with esophageal metastasis from breast cancer between 2020 and 2025 at a regional hospital in southern Taiwan. Clinical data—including patient demographics, primary cancer stage, location of esophageal metastasis, presenting symptoms, diagnostic tools, therapeutic approaches, and survival outcomes—were collected and analyzed. Results: Out of 608 breast cancer patients treated between 2020 and 2025 at Yuan’s General Hospital, only 2 (0.33%) were diagnosed with esophageal metastasis. The patients were aged 45 and 83 years. Both initially presented with epigastric fullness, which progressed to dysphagia. Imaging revealed lumen narrowing in the lower and middle thoracic esophagus, respectively. At the time of esophageal diagnosis, both patients had concurrent distant

200

metastases (including liver, pleura, bone, and lymph nodes). The intervals between the initial breast cancer diagnosis and the development of dysphagia were 10 and 23 years, respectively. Their initial cancer stages were T2N3aM0 (Stage IIIC) and T2N0M0 (Stage IIA). Regarding intervention, both patients initially underwent endoscopic balloon dilation. One patient subsequently received a fully covered esophageal stent with an anti-reflux valve (Choostent, M.I.Tech, Korea), resulting in improved dysphagia and a survival of over 6 months. In contrast, the patient who received no further intervention survived less than 3 months following the initial procedure. Conclusions: Our findings suggest that breast cancer patients presenting with dysphagia should be evaluated early for esophageal metastasis. Even in advanced stages, aggressive endoscopic treatments, such as esophageal stenting, should be considered to improve quality of life and survival outcomes. Further large-scale studies are warranted to establish standardized treatment guidelines for this rare syndrome.

2026 TDDW

P.61

COST-EFFECTIVENESS ANALYSIS OF A NOVEL HEMOSTATIC DRUG POWDER SPRAY FOR PREVENTING GASTROINTESTINAL BLEEDING Hsueh-Chien Chiang, Po-Jun Chen, Meng-Hsuan Lu, Chiao-Hsiung Chuang, Xi-Zhang Lin Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

預防胃腸道出血之止血藥粉噴灑的成本效益分析姜學謙陳柏潤呂孟璇莊喬雄林錫璋成大醫院內科部

Background: Gastrointestinal bleeding can be classified into disease-related and procedurerelated origins. Although conventional endoscopic therapy is effective, the incidence of recurrent bleeding ranges from 20% to 30%, depending on the underlying etiology. In contrast, procedure-related bleeding occurs in approximately 2% to 8% of cases, such as delayed post-polypectomy bleeding and post-sphincterotomy bleeding. Both recurrent bleeding and procedure-related bleeding may lead to emergency department visits, hospitalization, blood transfusion, repeat endoscopy, organ damage, and even mortality. These complications not only compromise patient health but also increase healthcare costs. Hemostatic drug powder spray is a novel technique that delivers specific drug powders, such as tranexamic acid and sucralfate, precisely to gastrointestinal lesions via a Functional Powder Spray System (Endo Peace Biomedical Technology Co., Ltd.). From 2022 to 2026, four published clinical trials have demonstrated its effectiveness in preventing recurrent bleeding and procedurerelated bleeding. However, its cost-effectiveness remains unknown. Aims: This study aimed to evaluate the costeffectiveness of hemostatic drug powder spray in preventing gastrointestinal bleeding. Methods: This study was designed as a secondary analysis of four randomized controlled trials evaluating hemostatic drug powder spray for the prevention of gastrointestinal bleeding at National Cheng Kung University Hospital between 2022 and 2026. A total of 400 patients were included in the analysis, comprising 120 patients enrolled for the

prevention of recurrent bleeding and 280 patients enrolled for the prevention of procedure-related bleeding. Patients in the included trials had received either conventional endoscopic treatment only or additional hemostatic drug powder spray. The primary clinical outcome of interest was subsequent bleeding requiring hospitalization. For the economic evaluation, we compared the total costs associated with each treatment strategy, including the intervention cost and the cost of bleeding-related hospitalization. In this analysis, the cost of drug powder spray was estimated at NT$10,000, whereas the average cost of a bleeding-related hospitalization was estimated at NT$80,000. Cost-effectiveness was assessed by comparing the difference in total costs with the difference in hospitalization events between the two groups. Results: Among the 400 patients, 200 were assigned to the conventional treatment group and 200 to the intervention group. In the conventional treatment group, 30 patients subsequently developed bleeding requiring hospitalization, including 20 cases of recurrent bleeding and 10 cases of procedure-related bleeding, corresponding to a hospitalization rate of 15.0%. In the intervention group, only 4 patients developed recurrent bleeding requiring hospitalization, corresponding to a hospitalization rate of 2.0%. Assuming an average cost of NT$80,000 per bleeding-related hospitalization, the hospitalization-related cost in the conventional group was NT$2,400,000. In the intervention group, the preventive intervention cost was NT$2,000,000, and the hospitalization cost was NT$320,000, yielding a total cost of NT$2,320,000. Compared with conventional treatment, the new technique reduced total cost by NT$80,000 while reducing 26 hospitalization events. Conclusions: In conclusion, the additional hemostatic drug powder spray was both more effective and less costly.

201

2026 TDDW

P.62

P.63

A NOVEL TECHNIQUE OF PER-ORAL ENDOSCOPIC MYOTOMY USING A SMALL-CALIBER ENDOSCOPE

EFFICACY AND SAFETY OF MIRIKIZUMAB IN CROHN’S DISEASE: A SYSTEMATIC REVIEW AND METAANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Yasuyuki Kagawa, Masakatsu Fukuzawa, Shin Kono, Takao Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan Background: Per-oral endoscopic myotomy (POEM), originally developed in Japan, has become an established minimally invasive treatment for esophageal achalasia. However, reports describing technical refinements of POEM remain limited. We developed a novel POEM technique using a smallcaliber endoscope to improve procedural efficiency and safety. Aims: To describe the technical feasibility and potential benefits of POEM using a small-caliber endoscope. Methods: POEM was performed using a small-caliber endoscope (EG-L580NW; Fujifilm, Tokyo, Japan), which is typically used for transnasal endoscopy. An Impact Shooter N distal attachment (TOP Corp., Tokyo, Japan) was fitted to the endoscope tip, and mucosal incision and myotomy were performed using a SOUTEN multifunctional knife (Kaneka Medix Corp., Osaka, Japan). Other procedural steps were identical to conventional POEM. The technical characteristics and potential advantages of this modified approach were evaluated. Results: The use of a small-caliber endoscope provided several technical benefits. A smaller mucosal entry could be created, potentially reducing the risk of entry-site dehiscence. The use of a small-caliber endoscope enabled the creation of a narrower submucosal tunnel, minimizing unnecessary tissue dissection and potentially reducing submucosal bleeding. Passage through the tightly constricted lower esophageal sphincter was facilitated by the smaller outer diameter of the endoscope. In addition, interference between endoscopes during double-scope assessment was reduced, improving maneuverability. These features may simplify the procedure and reduce procedurerelated adverse events. Conclusions: POEM using a small-caliber endoscope represents a feasible technical modification that may improve procedural simplicity, maneuverability, and safety. This technique may serve as a useful option for optimizing POEM procedures.

202

Po-Feng Huang1,2, Tien-Yu Huang2, Peng-Jen Chen2, Yu-Lueng Shih2, Hsuan-Hwai Lin2, Jung-Chun Lin2, Wei- Kuo Chang2, Tsai-Yuan Hsi2, Fang-Chen Liu2 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan 1

Mirikizumab 治療克隆氏症之療效與安全性：隨機對照試驗之系統性回顧與統合分析黃柏峰1,2 黃天祐2 陳鵬仁2 施宇隆2 林煊淮2 林榮鈞2 張維國2 謝財源2 劉芳辰2 1 2

國軍高雄總醫院胃腸肝膽科三軍總醫院胃腸肝膽科

Background: Crohn’s disease (CD) is a challenging inflammatory condition, with immunologic agents often used for symptomatic and endoscopic management. Mirikizumab, a humanized IgG4 monoclonal antibody targeting the p19 subunit of interleukin-23, has shown promise in treating moderate-to-severe CD. Aims: This meta-analysis evaluates the efficacy and safety of Mirikizumab in achieving Crohn’s Disease Activity Index (CDAI) clinical remission (CDAI <150) and endoscopic response (≥50% reduction in Simple Endoscopic Score-CD). Methods: Systematic searches were conducted in PubMed, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov through December 31, 2024, following PRISMA 2020 guidelines. Eligible studies included randomized controlled trials (RCTs) comparing Mirikizumab with placebo or standard treatments. Primary outcomes were clinical remission and endoscopic response, measured using Hedges’ g with 95% confidence intervals (CIs), with values of 0.2, 0.5, and 0.8 indicating small, moderate, and

2026 TDDW

P.64 large effect sizes. Odds ratios (ORs) were calculated for adverse events. Heterogeneity was assessed using I² and Cochran’s Q statistics, with I² values of 25%, 50%, and 75% indicating low, moderate, and high heterogeneity. Results: Two RCTs involving 969 participants showed Mirikizumab significantly improved clinical remission (Hedges’ g = 0.710; 95% CI: 0.233–1.186; p = 0.003; I² = 51.2%) and endoscopic response (Hedges’ g = 0.920; 95% CI: 0.400–1.440; p = 0.001; I² = 61.7%). Adverse events, including anemia, arthralgia, headache, upper respiratory infections, and nasopharyngitis, were similar between Mirikizumab and placebo (OR = 1.069; 95% CI: 0.601–1.904; p = 0.819; I² = 60.7%). Conclusions: Mirikizumab is effective and welltolerated in moderate-to-severe CD, significantly improving clinical remission and endoscopic response without increasing adverse events. These findings support its potential as a safe, targeted treatment for IL-23-mediated inflammation in CD.

IMPACT OF EARLY VEDOLIZUMAB INITIATION ON STEROID-FREE REMISSION IN BIOLOGIC-NAÏVE SEVERE ULCERATIVE COLITIS Yu-Han Chen1, Puo-Hsien Le1,2, Chia-Jung Kuo1,2, Cheng-Tang Chiu1,2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 2 Inflammatory Bowel Disease Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan 1

早期開始 Vedolizumab 治療對生物製劑未曾使用之重度潰瘍性結腸炎患者達成無類固醇緩解的影響陳昱翰1 李柏賢1,2 郭家榮1,2 邱正堂1,2 1 2

林口長庚紀念醫院胃腸肝膽科林口長庚紀念醫院發炎性腸道疾病中心

Background: Whether early biologic therapy modifies outcomes in ulcerative colitis (UC) remains controversial, and data in Asian populations— particularly in severe UC—are limited. In Crohn’s disease, the benefit of early biologic therapy had been established. In contrast, it is still remain unknown that early initiation of biologic treatment brings benefits or not. We evaluated the impact of early vedolizumab (VDZ) initiation on steroid-free clinical and endoscopic outcomes in biologic-naïve UC patients. Aims: The primary outcome was Steroid-Free Clinical Remission (SFCR) at week 52 in patients who remained on their initial biologic therapy for the entire 1-year period. SFCR was defined as achieving clinical remission, characterized by a Partial Mayo score <2, without the use of any systemic corticosteroids at the time of assessment. Steriod-Free Endoscopic Remission (SFER) was also evaluated after 52-week period VDZ use. Methods: We conducted a retrospective cohort study of biologic-naïve UC patients treated with VDZ at the Chang Gung IBD Center (2018–2025). All patients are biologics naïve and disease severity are all severe type (Mayo score ≥11). Early VDZ use was defined as initiation within 18 months after diagnosis; later use thereafter. Baseline characteristics and 52-week outcomes were compared. The primary endpoints

203

2026 TDDW

P.65 were steroid-free clinical remission (SFCR) and steroid-free endoscopic remission (SFER) at week 52. Variants such as initiation time of VDZ, Age of biologic initiation, sex, BMI, Montreal classification, disease severity, white count, hemoglobin, CRP level were all analyzed. Multivariable logistic regression identified independent predictors. Results: A total of 55 patients were included (early: n = 36; late: n = 19). There was no statistically significant difference between the two groups. Early VDZ was associated with higher week-52, steroid-free clinical remission rate (56% vs 32%, p = 0.034), and steroid-free endoscopic remission (67% vs 26%, p = 0.012). On multivariable analysis, early VDZ initiation independently predicted SFCR (OR 5.889; 95% CI 1.596–21.726; p = 0.008) and SFER (OR 4.545; 95% CI 1.17–17.661; p = 0.02), after adjusting for age, sex, smoking habit, baseline Mayo endoscopic subscore, baseline BMI. Conclusions: In this retrospective cohort of biologicnaïve patients with severe ulcerative colitis, early initiation of VDZ within 18 months after diagnosis was associated with significantly improved SFCR and SFER at week 52 compared with later initiation. Early VDZ use independently predicted both SFCR and SFER after adjustment for baseline clinical factors. These findings suggest that earlier introduction of VDZ may provide superior disease control and mucosal healing in severe UC, supporting a potential “window of opportunity” for biologic intervention in Asian UC populations.

204

TRANSPANCREATIC PRECUT SPHINCTEROTOMY DURING ERCP: LEARNABILITY AND OUTCOMES ACROSS OPERATOR VOLUMES AND EXPERIENCE Wei-Chih Su1,2, Chih-Hsiang Chen1, Chia-Chi Wang1,2, Tsung-Hsien Hsiao1, Hung-Da Chen1,2, Tzu-Hsiang Kung1, Jiann-Hwa Chen1,2 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

經胰管預切開括約肌切開術之學習性與臨床成效：高低操作量及不同經驗 ERCP 術者之比較蘇偉志1,2 陳至翔1 王嘉齊1,2 蕭宗賢1 陳泓達1,2 龔子翔1 陳建華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系

Background: TPS is an advanced cannulation technique for difficult biliary access during ERCP and is generally considered easier to learn than other advanced cannulation methods. However, evidence regarding its learnability across operators with different levels of experience is limited. Aims: To assess the learnability of TPS by comparing outcomes among endoscopists with different ERCP experience and procedure volumes. Methods: TPS was introduced in April 2016. We retrospectively analyzed ERCPs performed thereafter (April 2016–March 2023) by three endoscopists: high-volume senior (~80/year), low-volume senior (~30/year), and low-volume newly independent (~30/year; since October 2020). Outcomes were successful CBD cannulation after TPS; cannulation/ total ERCP times; and adverse events, including post-ERCP pancreatitis (PEP). Results: Among 539 ERCPs in patients with naïve papillae, TPS was used in 69 procedures (12.8%; 46, 16, and 7 for the high-volume senior, lowvolume senior, and newly independent operators). Cannulation success after TPS was uniformly high (95.7%, 100%, and 100%). PEP occurred in 8.7%,

2026 TDDW

P.66 6.3%, and 28.6%, all mild. The newly independent operator had longer cannulation times (median [IQR] 35 [15] min vs. 22 [17] and 25 [12] min; P = 0.016) and total ERCP times (54 [42] vs. 42 [19] and 49 [32] min; P = 0.013). In multivariable analysis, older age was associated with lower PEP odds (OR 0.936; P = 0.033), whereas end-stage renal disease (OR 47.433; P = 0.024) and procedures performed by the newly independent operator (OR 14.879; P = 0.028) were associated with higher odds. Conclusions: TPS is a readily adoptable advanced option for endoscopists proficient in basic ERCP skills. Newly independent operators can achieve comparable cannulation success but demonstrate early-proficiency patterns that may inform training, supervision, and procedural standardization.

DIAGNOSTIC PERFORMANCE OF ENDOSCOPIC ULTRASONOGRAPHY IN PATIENTS WITH SUSPECTED PANCREATIC LESIONS OR ELEVATED CA19-9 Chiung-Yun Chang1, Jian-Han Lai2, Ching-Wei Chang2, Yi-Heng Chen1, Wei-Chen Lin2, Yen-Po Chen2 Department of Nursing, MacKay Medical University, New Taipei City, Taiwan 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan 1

內視鏡超音波檢查在疑似胰臟病變或 CA19-9 升高患者的診斷效能張瓊云1 賴建翰2 張經緯2 陳怡亨1 林煒晟2 陳彥伯2 1 2

馬偕醫學大學護理學系馬偕紀念醫院消化科系

Background: In clinical practice, patients with unexplained elevation of carbohydrate antigen 19-9 (CA19-9) or abnormal pancreatic findings on ultrasonography are typically evaluated with non-invasive imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI). However, these imaging modalities may have limited sensitivity for detecting small pancreatic lesions, can be time-consuming, and may fail to provide a definitive diagnosis. Endoscopic ultrasonography (EUS) offers high-resolution imaging of the pancreas but is an invasive procedure. The role of EUS in the diagnostic evaluation of these patients remains unclear. Aims: To evaluate the clinical utility of EUS and identify effective screening strategies for pancreatic lesions. Methods: This retrospective study included patients who underwent EUS for pancreatic evaluation between January 2023 and March 2026 at a tertiary referral center in Taipei, Taiwan. Results: A total of 294 patients underwent EUS for pancreatic evaluation. The mean age was 65.1 ± 12.8 years, and 43.5% were male. The most common indications for EUS were abdominal symptoms (67.7%), abnormal ultrasonographic findings (46.6%), and elevated CA19-9 levels (41.2%). Pancreatic abnormalities were detected by EUS

205

2026 TDDW

P.67 in 199 patients (67.7%). The detection rates of CT and MRI were 66.9% (119/178) and 74.0% (57/77), respectively. Lesions detected by EUS were smaller than those identified by CT or MRI, with mean lesion sizes of 19.4 ± 14.9 mm, 24.7 ± 16.9 mm, and 24.5 ± 13.5 mm, respectively. Approximately one-third of patients (31.6%) underwent EUS as the initial pancreatic imaging modality, and 73 patients (24.8%) received a definitive diagnosis based on EUS findings alone without requiring additional imaging studies. Among these patients, approximately half had no significant pancreatic abnormalities, while the remainder had pancreatic lesions identified. Intraductal papillary mucinous neoplasm (IPMN) was the most common lesion detected (28.8%), followed by pancreatic cysts (19.2%). EUS-guided biopsy was performed in 29.3% of patients. Final diagnoses were negative in 63.6% of patients, whereas pancreatic adenocarcinoma was diagnosed in 16.0%. Overall, approximately 20% of patients were diagnosed with malignant or potentially malignant lesions. Conclusions: EUS demonstrated a high diagnostic yield for pancreatic evaluation and identified smaller lesions. Nearly one-third of patients underwent EUS as the initial imaging modality, and one-quarter were diagnosed based on EUS findings alone without additional imaging. These findings support the role of EUS as an effective tool for the early detection and characterization of pancreatic lesions.

PIVKA-II AS A POTENTIAL DIAGNOSTIC BIOMARKER FOR PANCREATIC DUCTAL ADENOCARCINOMA Yun-Sheng Wu1, Tung-Hung Su1,2,3, Chieh-Chang Chen1, Chien-Hui Wu4, Wei-Chih Liao1,5 Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan 2 Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan 3 Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan 4 Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 5 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan 1

PIVKA-II 應用於胰管腺癌生物標記之探討吳澐聖1 蘇東弘1,2,3 陳介章1 吳健暉4 廖偉智1,5 1

國立臺灣大學醫學院附設醫院內科部台大醫院新竹台大分院醫學研究部 3 台大醫院肝炎研究中心 4 國立臺灣大學醫學院附設醫院外科 5 國立臺灣大學醫學院內科 2

Background: Detection of pancreatic ductal adenocarcinoma (PDAC) at an early stage is critical for effective treatment. Prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) is a biomarker for hepatocellular carcinoma. Studies showed serum PIVKA-II levels were elevated in patients with PDAC. Aims: This study evaluates PIVKA-II’s ability to discriminate PDAC from benign pancreatic disease and compares its performance with other markers. Methods: We conducted a retrospective study including patients with PDAC, benign pancreatic disorders, and healthy volunteers from a tertiary medical center in Taiwan. The clinical parameters and serum samples were analyzed. The diagnostic performance of serum PIVKA-II for PDAC was compared with that of CA19-9 and CEA.

206

2026 TDDW

P.68 Results: Between September 2006 and September 2021, 59 patients with PDAC, 29 with benign pancreatic disease, and 90 healthy volunteers were included. PIVKA-II concentrations were higher in PDAC than in benign pancreatic disease or healthy controls (15.8 vs. 14.0 vs. 10.5 ng/mL, p < 0.001, p for trend = 0.0004). PIVKA-II at 31.5 ng/mL showed good diagnostic performance distinguishing PDAC from others (area under the receiver operating characteristic curve [AUROC]: 0.91, 95% confidence interval [CI]: 0.87–0.95). Combining PIVKA-II (cutoff: 31.5 ng/mL) with CA19-9 (cut-off: 37 U/mL) enhanced diagnostic accuracy (AUROC: 0.90, 95% CI: 0.85–0.95; sensitivity 91%, specificity 89%). Multivariable logistic regression analysis, adjusting for CA19-9 and CEA, demonstrated that PIVKA-II was associated with a 1.21-fold increased risk of PDAC (odds ratio: 1.21, 95% CI: 1.07–1.45), and the risk was greater in patients with normal CA19-9 levels (odds ratio: 2.92, 95% CI: 1.57–10.03). Conclusions: PIVKA-II is a promising biomarker for complementing CA19-9 in diagnosing PDAC.

ICG-GUIDED LAPAROSCOPIC CHOLECYSTECTOMY FOR ENHANCING INTRAOPERATIVE IDENTIFICATION OF BILIARY ANATOMICAL VARIATIONS: A CASE SERIES Shao-Ting Tseng1, Kung-Chen Ho2 Division of General Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan 2 Division of General Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan 1

ICG 螢光膽道攝影輔助腹腔鏡膽囊切除術於膽道解剖變異辨識之應用：病例系列報告曾紹庭1 何恭誠2 1 2

新竹馬偕紀念醫院一般外科馬偕紀念醫院一般外科

Background: Laparoscopic cholecystectomy (LC) is among the most common surgical procedures, yet bile duct injury remains a serious complication whose incidence has not declined over the past three decades and carries substantial morbidity and mortality. The considerable variability of extrahepatic biliary anatomy is a major contributing factor, complicating surgical dissection. Indocyanine green fluorescence cholangiography (ICG-FC) is a non-invasive, radiation-free method for real-time intraoperative visualization of biliary anatomy, often before dissection of Calot’s triangle, making it a promising tool for navigating anatomical variations. Aims: To illustrate the clinical utility of ICG-guided LC in the real-time intraoperative identification and preservation of high-risk biliary anatomical variations, and to prevent inadvertent ductal injury and postoperative bile leakage. Methods: Three patients (two men aged 48 and 41 years and one woman aged 76 years) underwent ICG-guided LC for symptomatic chronic cholecystitis with gallbladder sludge, an enlarging gallbladder polyp, and gallstone disease, respectively. Indocyanine green (25 mg/vial) was reconstituted in 10 mL of solvent, and 1 mL (2.5 mg) was administered as a single intravenous push approximately one hour before surgery, followed

207

2026 TDDW

P.69 by maintenance intravenous fluid. Intraoperatively, hepatic excretion of fluorescent ICG into the bile enabled real-time fluorescence cholangiography for delineation of extrahepatic biliary structures during dissection. None of the gallbladders showed acute inflammation at the time of surgery. Results: ICG-FC identified a distinct anatomical variation in each case. In Case 1, an accessory liver lobe attached to the gallbladder wall was identified; a small connecting bile duct revealed by ICG fluorescence was clipped rather than mistaken for a vessel and divided by cautery, avoiding postoperative bile leakage. In Case 2, an accessory hepatic duct was clearly visualized and clipped, preventing an otherwise unrecognized source of bile leakage. In Case 3, ICG fluorescence delineated the course of the cystic duct, preventing misidentification and inadvertent ligation of a possible right anterior sectoral duct (RASD). All procedures were completed laparoscopically without conversion, with operative times of 2 h 19 min, 2 h 17 min, and 1 h 52 min. Cases 1 and 2 were followed for 3 months and Case 3 for 4 months, with no postoperative complications and no common bile duct dilatation on ultrasonography. Conclusions: ICG-guided LC provides real-time, non-invasive, and radiation-free biliary mapping that significantly enhances intraoperative identification of high-risk anatomical variations, helping to prevent complications such as bile leaks and major ductal injuries. Routine integration of ICG fluorescence cholangiography may serve as a valuable safety adjunct, improving anatomical clarity and maximizing patient safety.

208

THE DISCONNECT BETWEEN DEVICE COLONIZATION AND PATIENT INFECTION: A MICROBIOLOGICAL CORRELATION STUDY OF PROCESSED DUODENOSCOPES AND BILE JUICE Chao-Feng Chang1, Tien-Yu Huang1, Hsuan-Hwai Lin1, Wei-Kuo Chang1, Hsin-Hung Huang2, Tao-Chieh Liu1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan 2 Division of Gastroenterology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan 1

臨床處置後十二指腸鏡和膽汁處理後的微生物相關性研究張肇丰1 黃天祐1 林煊淮1 張維國1 黃信閎2 劉導潔1 1 2

三軍總醫院胃腸肝膽科振興醫院胃腸肝膽科

Background: Interventional gastrointestinal endoscopy, particularly Endoscopic Retrograde Cholangiopancreatography (ERCP), is a critical modality for managing pancreatobiliary pathologies. However, due to the complex structural design of side-viewing duodenoscopes—specifically the cantilevered elevator mechanism and wire channels—reprocessing remains highly challenging. Physical degradation, such as channel scratches and fluid/debris retention, increases susceptibility to microbial colonization and biofilm formation. Despite strict regulatory mandates from the FDA, including double reprocessing and “culture and hold” surveillance policies, endoscope-associated infections and outbreaks of antibiotic-resistant strains remain a global concern. Aims: To investigate the microbiological correlation between the accumulating debris/fluids of processed clinical ERCP duodenoscopes (endoscopic cultures) and patient-specific clinical cultures (pre-procedural bile juice and blood cultures) in a clinically enrolled population. Methods: This prospective study enrolled 86 patients undergoing scheduled ERCP. Clinical bile juice samples were routinely aspirated immediately upon biliary cannulation and prior

2026 TDDW

P.70 to therapeutic intervention. Post-procedural endoscopic cultures were obtained by immediately sampling accumulating fluids and debris within the duodenoscope channels following the procedure. Microbiological correlation was defined as positive if identical microbial species grew in both bile juice and endoscope samples. Patients’ baseline characteristics, laboratory data (including bilirubin and liver enzymes), and concomitant bloodstream infections were reviewed and analyzed. Results: Of the 86 patients, 27 (31.4%) had positive bile juice cultures, and 59 (68.6%) were negative. Demographics, underlying comorbidities (diabetes, hypertension), and biliary conditions (cholangitis, cholecystitis) did not differ significantly between the two groups. Interestingly, patients with negative bile juice cultures exhibited significantly higher baseline transaminases compared to those with positive cultures (AST: 112.8 ± 137.2 vs. 46.1 ± 40.4 U/L, p = 0.001; ALT: 169.9 ± 191 vs. 63.7 ± 71 U/L, p < 0.001). Spearman correlation analysis revealed no statistically significant correlation between postprocessing endoscopic cultures and clinical bile juice cultures (r = -0.104, p = 0.339) or blood cultures ($r = 0.098, p = 0.371). Conclusions: Although the complex architecture and physical degradation of patient-ready duodenoscopes present persistent risks for fluid and debris retention, residual device contamination does not directly correlate with or immediately mirror the patient’s acute biliary or systemic microbiological profile during ERCP. The clinical paradox of higher transaminases in culture-negative patients may reflect earlier medical or antibiotic interventions in severe mechanical obstructions. Continued rigorous surveillance is necessary, but a clear disconnect exists between device colonization and immediate patient infection profiles.

COMPARATIVE EFFECTIVENESS, SAFETY, AND AGE-RELATED RISK OF CEFOPERAZONE/SULBACTAM VERSUS OTHER ANTIBIOTIC REGIMENS IN ASIAN PATIENTS WITH ACUTE CHOLANGITIS: A MULTICENTER RETROSPECTIVE COHORT STUDY Jian-Liang Chen1, Chieh-Chang Chen2,3, Hsiu-Po Wang2,3, Jiann-hwa Chen4,5, Wen-Hsin Huang6, Tsung-Lin Hsieh6, Ming-Chang Tsai7,8, Nai-Jen Liu9, Chi-Huan Wu9, Yi-Chun Chiu10, Chih-Ming Liang10, Cheng-Kun Wu10, Wen-Lun Wang11,12, Ching-Tai Lee11, Ming-Hung Hsu11, Li-Wei Chen13, Chen-Shuan Chung1,14 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 4Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan; 5School of Medicine, Tzu Chi University, Hualien, Taiwan; 6Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 8School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 10Division of HepatoGastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 11Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; 12School of Medicine, College of Medicine, I-Shou 1

209

2026 TDDW

University, Kaohsiung, Taiwan; 13Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 14 Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan

亞洲急性膽管炎患者使用 Cefoperazone/ Sulbactam 與其他抗生素治療方案之療效、安全性及年齡相關風險比較：多中心回溯性研究陳健良1 陳介章2,3 王秀伯2,3 陳建華4,5 黃文信6 謝宗霖6 蔡明璋7,8 劉乃仁9 吳季桓9 邱逸群10 梁志明10 吳鎮琨10 王文𤦎11,12 李青泰11 徐銘宏11 陳立偉13 鍾承軒1,14 1

亞東紀念醫院肝膽胃腸科；2 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內科部；4 台北慈濟醫院胃腸肝膽科；5 慈濟大學醫學系；6 中國醫藥大學附設醫院消化內科；7 中山醫學大學附設醫院肝膽腸胃科；8 中山醫學大學醫學系；9 林口長庚紀念醫院胃腸肝膽科；10 高雄長庚紀念醫院胃腸肝膽科；11 義大醫院胃腸肝膽科；12 義守大學醫學系；13 基隆長庚紀念醫院胃腸肝膽科；14 元智大學電機工程學系

Background: Cefoperazone/sulbactam (Brosym) is a beta-lactam/beta-lactamase inhibitor combination widely used in Asia for the treatment of acute cholangitis, a potentially life-threatening biliary infection that requires early antimicrobial intervention. Evidence comparing its efficacy with other antibiotic regimens in cholangitis management remains limited. Aims: This study aimed to evaluate the comparative effectiveness and safety of cefoperazone/sulbactam versus other antibiotic regimens in patients with TG18-defined acute cholangitis across multiple centers in Taiwan. Methods: This multicenter retrospective cohort study enrolled 505 patients with TG18-defined acute cholangitis from nine centers in Taiwan (2022–2024), who received either Brosym (n = 311) or other antibiotics, including flomoxef (n = 121), ceftriaxone (n = 41), piperacillin/tazobactam (n = 20), and ertapenem (n = 12). The primary outcome was clinical response on Day 4. Secondary outcomes included clinical response on Day 7, ICU admission, in-hospital mortality, and adverse events. Statistical analyses were performed using R (version ≥4.0). Firth penalized logistic regression was used to

210

estimate unadjusted and adjusted odds ratios; the adjusted model incorporated TG18 severity grade, age, hospital-acquired infection status, and baseline ALT. Holm correction was applied across five tested outcomes as a conservative multiplicity-adjusted sensitivity analysis. An exploratory subgroup analysis was conducted in patients aged ≥65 years, with a treatment-by-age interaction test in the full cohort. Results: Patients in the Brosym group were older (median 71 vs. 67 years, p = 0.039) and more likely to have hospital-acquired infection (10.0% vs. 4.1%, p = 0.017). Baseline ALT was significantly lower in the Brosym group (median 113 vs. 180 U/L, p = 0.002), and Klebsiella pneumoniae was less frequent among culture-positive patients (12.2% vs. 26.9%, p = 0.006). On Day 4, the Brosym group showed a higher responder rate (98.7% vs. 94.7%; Fisher p = 0.022; unadjusted OR 3.86, 95% CI 1.26–11.85; adjusted OR 4.65, 95% CI 1.52–14.17); however, this finding was attenuated after Holm correction (Holmcorrected p = 0.110). No significant difference was observed in Day 7 clinical response, ICU admission, in-hospital mortality, or adverse events. In the exploratory elderly subgroup (age ≥65 years; n = 321), a numerically higher Day 4 response rate was observed (99.0% vs. 94.5%; Fisher p = 0.024; Holmcorrected p = 0.146); however, the treatment-by-age interaction was not significant (p = 0.498), indicating a descriptive interpretation only. ALT levels were significantly lower in the Brosym group at Day 4 and Day 7 (both p ≤ 0.001). Conclusions: Cefoperazone/sulbactam was associated with a higher Day 4 clinical response rate compared with other antibiotics for acute cholangitis, with a comparable safety profile. This early response signal was attenuated after conservative multiplicity correction, and secondary outcomes did not differ significantly. The elderly subgroup finding was exploratory and should not be interpreted as evidence of preferential efficacy. Prospective comparative studies are needed to confirm these findings.

2026 TDDW

P.71

STEPWISE AND INDIVIDUALIZED MANAGEMENT OF NECROTIZING PANCREATITIS: A CASE SERIES EMPHASIZING TIMING AND SURGICAL ESCALATION Hon Phin Wong1,2, Hsu Yi Pu1, Chao Hsiang Huang1, Ming-Hui Chang3,4, Chi-Chih Wang3,4 Division of Digestive Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan 2 College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 4 College of Medicine, Chung Shan Medical University, Taichung, Taiwan 1

壞死性胰臟炎的分階段與個別化治療：強調介入時機與外科漸進治療之病例系列策略

stabilization and recovered fully. A 56-year-old male with diabetes and chronic kidney disease required percutaneous drainage, delayed necrosectomy, and endoscopic drainage for recurrent infected necrosis, achieving clinical stability. A 79-year-old female with post-ERCP NP improved following delayed abscess drainage and staged necrosectomy. In contrast, a 46-year-old male with hypertriglyceridemia, shock, and multi-organ failure presented with fulminant NP requiring early necrosectomy within 48 hours due to surgical urgency. Subsequent complications, including gastric ischemia and splenic infarction, necessitated multiple staged surgical and interventional procedures, leading to eventual stabilization after a prolonged course. Conclusions: Delayed, step-up management provides favorable outcomes in most NP cases. However, early necrosectomy is sometimes unavoidable in severe, rapidly progressive disease. Individualized, multidisciplinary, and staged management is essential to address evolving complications and optimize outcomes.

黃漢斌1,2 蒲煦宜1 黃兆祥1 張明輝3,4 汪奇志3,4 1

中山醫學大學附設醫院消化外科國立中興大學獸醫學院 3 中山醫學大學附設醫院肝膽腸胃科 4 中山醫學大學醫學院 2

Background: Necrotizing pancreatitis (NP) is a severe condition associated with high morbidity and mortality, often complicated by infection and organ failure. Current guidelines favor a delayed, step-up approach; however, urgent surgical intervention may be required in rapidly deteriorating patients. Aims: To present a case series highlighting individualized management strategies in NP, with emphasis on intervention timing and the role of early surgery in fulminant disease. Methods: We retrospectively reviewed four consecutive NP cases managed at a tertiary center. Data included patient characteristics, etiology, clinical course, interventions, complications, and outcomes. Management was guided by a multidisciplinary team, with treatment escalation tailored to disease severity and clinical urgency. Results: Three patients were managed using a delayed, step-up approach. A 38-year-old male with alcoholic NP underwent delayed necrosectomy after

211

2026 TDDW

P.72

ENDOSCOPIC ULTRASOUND FOR THIN-SECTION CT FALSE-NEGATIVE PANCREATIC HEAD CANCERS: A CASE SERIES OF 3.2-CM AND 1.5-CM TUMORS Lien-Fu Lin1, Meng-Hao Chang2, Ji-Kuen Yu2, Pi-Teh Huang1, Hong-Zen Yeh1, Chi-Sen Chang1 Division of Hepato-Gastroenterology, Department of Internal Medicine, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan 2 Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan 1

內視鏡超音波於細切電腦斷層偽陰性之胰臟頭部癌案例應用：病例系列報告林連福1 張孟浩2 余積琨2 黃彼得1 葉宏仁1 張繼森1 1 2

童綜合醫院胃腸肝膽科童綜合醫院外科部

Background: Computed tomography (CT) can miss or fail to detect pancreatic cancer smaller than 2 cm [Egypt J Hosp Med 2025, Lancet Oncol 2026]. Endoscopic ultrasound (EUS) significantly outperforms CT in pancreatic tumor detection, demonstrating a sensitivity of 87%–100% compared to 53%–91% for CT [Biomed Rep 2024, J Pers Med 2022]. This diagnostic gap widens for pancreatic tumors under 20 mm, where EUS maintains a 94.4% sensitivity while multidetector CT (MDCT) sensitivity drops to approximately 50% [Egypt J Hosp Med 2025, J Pers Med 2022]. In patients with obstructive jaundice, a false-negative thin-section CT—characterized by the absence of a visible mass or main pancreatic duct dilatation—frequently leads to the misdiagnosis of a distal common bile duct (CBD) stricture as benign. Consequently, both EUS and magnetic resonance imaging (MRI) are recommended in these scenarios [ESGE Guidelines 2024]. Aims: To report two cases of pancreatic adenocarcinoma (3.2 cm and 1.5 cm) detected via linear EUS following false-negative CT scans, prompted by an index case where an initial falsenegative CT resulted in a false-negative endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling. Methods: Between October 2024 and June 2026, we

212

retrospectively reviewed three cases of obstructive jaundice secondary to pancreatic cancer presenting with initial false-negative, thin-section computed tomography (CT) scans. A false-negative scan was defined as the absence of both a visible pancreatic mass and main pancreatic duct dilatation on a 3-mm slice thickness CT. In the index case, endoscopic retrograde cholangiopancreatography (ERCP) with tissue acquisition was initially performed, yielding negative results; subsequent magnetic resonance imaging (MRI) raised suspicion of pancreatic cancer. In the two subsequent cases, endoscopic ultrasound (EUS) was utilized as the primary supplementary diagnostic modality following the false-negative thin-section CT, which was then followed by further MRI evaluation. Results: Case 1: A 62-year-old man presented with painless obstructive jaundice without weight loss. Laboratory tests showed elevated GGT (1,060 U/L), AST (287 U/L), ALT (425 U/L), total bilirubin (9.6 mg/dL), and direct bilirubin (6.3 mg/dL). Imaging revealed CBD dilatation (1.8 cm) but a falsenegative thin-section CT (no pancreatic head mass or ductal dilatation). Following negative ERCP tissue sampling, MRI findings suggested a pancreatic malignancy. Pathology ultimately confirmed a 3.2-cm, moderately differentiated pancreatic head adenocarcinoma. Case 2: A 79-year-old man presented with anorexia and obstructive jaundice. Laboratory tests showed elevated GGT (580 U/L), AST (140 U/L), ALT (158 U/L), total bilirubin (7.4 mg/dL), and direct bilirubin (4.0 mg/dL). Initial thin-section CT showed CBD dilatation (1.4 cm) but was negative for a pancreatic mass or main pancreatic duct dilatation. Linear EUS successfully detected a 2.2-cm hypoechoic lesion in the pancreatic head, and MRI findings concurred with a diagnosis of pancreatic head cancer. Surgical pathology confirmed a 1.5-cm, well- to moderately differentiated pancreatic ductal adenocarcinoma. Case 3: A 68-year-old woman presented with epigastric pain, cholelithiasis, and obstructive jaundice. Laboratory tests showed elevated GGT (1,621 U/L), AST (248 U/L), ALT (241 U/L), total bilirubin (13.1 mg/dL), and direct bilirubin (10.3 mg/dL). Abdominal CT revealed no discrete tumor or main pancreatic duct dilatation, demonstrating only CBD dilatation (1.45 cm) and duodenal wall thickening. Linear EUS identified a 2.9-cm mass invading the duodenal wall, a finding later supported by MRI. Post-surgical pathology confirmed a 3.2-cm, moderately differentiated

2026 TDDW

P.73 pancreatic head adenocarcinoma. Conclusions: This case series demonstrates that thin-section CT may miss pancreatic tumors as large as 3.2 cm in biliary obstruction without a detectable mass or main pancreatic duct dilatation. Linear EUS provides diagnostic utility.

TWO CASES OF BILIARY DISEASE SUCCESSFULLY MANAGED USING AN ULTRATHIN 7.8 FR PERORAL CHOLANGIOSCOPE Yuta Uematsu, Kyoko Asano, Kazumasa Nagai, Noriyuki Hirakawa, Takayoshi Tsuchiya Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Kazuki Hama, Takao Itoi Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan Background: Peroral cholangioscopy (POCS) is useful for the diagnosis and treatment of biliary diseases, but advancing a conventional scope through tight strictures or in narrow working spaces can be challenging. An ultrathin 7.8 Fr POCS with four-way tip deflection, an independent irrigation channel, and a 0.9 mm working channel has recently become available. Aims: To describe two biliary disease cases in which an ultrathin 7.8 Fr POCS facilitated procedures that were difficult or impossible with conventional POCS. Methods: We retrospectively reviewed two patients referred to our institution, one with a large common bile duct stone and one with suspected malignant biliary strictures. In both cases, an ultrathin 7.8 Fr POCS (Briview; Shanghai SeeGen Photoelectric Technology Co. Ltd.) was used for direct visualization, therapy, and targeted tissue sampling as needed. Results: Case 1 was a 73 year old man with a 25 mm bile duct stone that could not be removed at the previous hospital. Using the ultrathin POCS, we performed YAG laser lithotripsy under direct vision, followed by basket extraction, achieving complete stone clearance without recurrence of cholangitis. Case 2 was a 75 year old man with distal and hilar biliary strictures. A conventional 9.6 Fr POCS could not traverse the strictures, whereas the 7.8 Fr POCS successfully reached the hepatic hilum. We identified a membranous hilar stricture without obvious malignant features such as irregular vessels and obtained multiple targeted biopsies. Histology showed CD138 positive plasma cells and IgG4 positive cells without malignancy, and the patient remains stable under outpatient follow up. Conclusions: The ultrathin 7.8 Fr POCS enabled

213

2026 TDDW

P.74 access beyond severe strictures and maneuvering in narrow spaces, allowing effective lithotripsy and detailed assessment with tissue sampling. It may represent a valuable diagnostic and therapeutic option in selected biliary disease cases.

ASSOCIATIONS OF PRE- AND POSTDIAGNOSIS DEPRESSION AND ANXIETY WITH MORTALITY AMONG GASTRIC CANCER SURVIVORS: A NATIONWIDE COHORT STUDY Jung Kim1, Jin Ho Choi2 Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea 2 Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea 1

Background: Depression and anxiety are common among cancer survivors and may adversely affect prognosis. However, the impact of psychiatric disorders before and after gastric cancer diagnosis on mortality outcomes remains unclear. Aims: We investigated the associations of depression and anxiety with all-cause, suicide, and circulatory system mortality among gastric cancer survivors. Methods: Using the nationwide Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) database, we identified 234,414 patients aged ≥30 years diagnosed with gastric cancer between 2012 and 2021 who survived at least one year after diagnosis. Depression status was classified according to diagnoses within one year before and after cancer diagnosis (No/No, No/Yes, Yes/No, Yes/ Yes). Multivariable Cox and Fine–Gray competingrisk models were used to estimate adjusted hazard ratios (HRs) and subdistribution hazard ratios. Results: During a median follow-up of 4.0 years, 44,382 all-cause deaths, 746 suicide deaths, and 3,170 circulatory system deaths occurred. Compared with the No/No group, the No/Yes and Yes/Yes groups showed increased risks of all-cause mortality (adjusted HR 1.49 and 1.45), suicide mortality (adjusted HR 2.23 and 4.87), and circulatory mortality (adjusted HR 1.56 and 1.74). (The Yes/No group showed smaller risk increases. Similar but weaker associations were observed for anxiety.) In combined analyses, patients with both depression and anxiety had the highest risks of all-cause mortality (adjusted HR 1.56), suicide mortality (adjusted HR 4.27), and circulatory mortality (adjusted HR 1.53). Associations of depression with mortality were stronger in younger patients and those with localized disease.

214

2026 TDDW

P.75 Conclusions: Depression was associated with increased risks of all-cause, suicide, and circulatory mortality among gastric cancer survivors. (Depression emerging or persisting after diagnosis showed stronger associations than pre-diagnosis depression alone, while) coexisting depression and anxiety conferred the greatest mortality risk. Routine mental health assessment should be considered in survivorship care.

VISCERAL ADIPOSITY AND LONGITUDINAL INCREASE ARE ASSOCIATED WITH INCIDENT GALLBLADDER POLYPS Eun Jeong Kim1,2, Jung Kim3, Jeong Hee Yoon4, Jeong Min Lee4, Su Jin Chung3, In Rae Cho1, Woo Hyun Paik1, Sang Hyub Lee1, Ji Kon Ryu1, Yoo Min Han1,3, Jin Ho Choi1 Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea 2 Department of Internal Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Republic of Korea 3 Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea 4 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea 1

Background: Gallbladder polyps (GBPs) are increasingly detected during routine imaging, with a subset demonstrating malignant potential. Aims: This study aimed to evaluate whether deep learning-quantified visceral adipose tissue (VAT) and its longitudinal changes were associated with clinically significant GBPs. Methods: Adults who underwent same-day abdominal ultrasonography and computed tomography (CT) during routine health check-ups were included; longitudinal analyses were conducted on those with at least one follow-up examination. VAT and subcutaneous fat (SF) were automatically quantified from CT images using a validated U-Netbased platform for body composition analysis. Clinically significant GBPs were defined as polyps measuring 5 mm or larger. Results: Among 7,554 participants, GBPs were identified in 1,316 individuals (17.4%), including 545 (7.2%) with clinically significant GBPs (≥5 mm). A higher baseline VAT index was independently associated with clinically significant GBPs (per 1-standard deviation [SD] increase; adjusted OR [aOR], 1.18; 95% confidence interval [CI], 1.05–1.32; p = 0.005) but not with GBPs of any size regardless of size threshold. Spline analyses showed a progressive

215

2026 TDDW

P.76 increase in the predicted probability of clinically significant GBPs with increasing VAT index. In longitudinal analyses, a ≥1-SD increase in VAT index was associated with an approximately twofold higher risk of incident clinically significant GBPs (aOR, 1.91; 95% CI, 1.07–3.44; p = 0.030), whereas changes in SF index were not. Conclusions: Higher VAT and longitudinal VAT gain were associated with clinically significant GBPs, whereas SF was not. Deep learning-based quantitative assessment of VAT may offer additional value in identifying individuals at risk of clinically significant GBPs.

TELEPHONE RE-ENGAGEMENT WITH INTESTINAL ULTRASOUND– ASSISTED SHARED DECISIONMAKING IMPROVES FOLLOW-UP AMONG FIT-POSITIVE PATIENTS WITH DELAYED COLONOSCOPY Yu-Kuan Tu1, I-Che Feng2, Po-Yu Huang2, Chun-Chia Yang2, Chia-Chi Kuo2, Ya-Ting Ke3,4, Meei-Ren Wang5, Kuei-Min Huang5, Hui-Mei Huang6, Mitsuhiro Koseki2 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 3 Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan 4 Department of Senior Welfare and Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan 5 Health Promotion Team, Chi Mei Medical Center, Tainan, Taiwan 6 Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan 1

電話訪問結合腸道超音波輔助共享決策，可提升糞便免疫化學檢測（FIT）陽性且延遲接受大腸鏡檢查患者的後續追蹤完成率凃育寬1 馮意哲2 黃博裕2 楊峻嘉2 郭加智2 柯雅婷3,4 王美仁5 黃桂敏5 黃惠美6 古關光浩2 1

奇美醫院內科部奇美醫院胃腸肝膽科 3 奇美醫院護理部 4 南臺科技大學高齡福祉服務系 5 奇美醫院健康促進組 6 奇美醫院加護醫學部 2

Background: Timely colonoscopy after a positive fecal immunochemical test (FIT) is essential for colorectal cancer screening; however, delayed follow-up remains common. Aims: We aimed to identify barriers to delayed colonoscopy and evaluate a structured telephone re-engagement pathway incorporating intestinal ultrasound (IUS) as a shared decision-making tool to facilitate patient re-engagement.

216

2026 TDDW

P.77 Methods: We reviewed FIT-positive individuals who had not completed colonoscopy within 90 days after a positive FIT result at a tertiary medical center in 2025. Reasons for delayed follow-up were classified from case management records and structured telephone interviews. A standardized telephone intervention was performed to reassess barriers, provide education regarding FIT-positive significance, and arrange outpatient evaluation. For patients reluctant to undergo colonoscopy, IUS was offered as a point-of-care, non-invasive assessment to facilitate communication and shared decisionmaking. Primary outcomes were successful patient re-engagement and colonoscopy completion. Results: Among 574 FIT-positive individuals, 87 (15.2%) had delayed colonoscopy beyond 90 days. The leading barriers included inability to contact patients (31%), refusal of colonoscopy (17%), self-arranged follow-up (15%), indecision (10%), and competing medical conditions. Telephone intervention successfully re-engaged 12 patients to return for outpatient evaluation; 11 attended clinic visits, and 9 underwent IUS examination. IUS findings facilitated individualized discussions regarding subsequent management. Ultimately, 8 patients completed colonoscopy at our institution, while another 8 arranged colonoscopy at outside hospitals. Overall, 16 additional patients re-entered the diagnostic pathway, increasing institutional colonoscopy completion from approximately 85.0% to 87.6%. Conclusions: A structured telephone reengagement pathway identified modifiable barriers to delayed colonoscopy after positive FIT and improved follow-up completion. Incorporating point-of-care IUS into shared decision-making was feasible in selected patients reluctant to undergo colonoscopy and may facilitate individualized communication. Larger prospective studies are warranted to evaluate its impact on long-term adherence and colorectal neoplasia detection.

THE IMPACT OF EDUCATIONAL INTERVENTIONS ON SERUM VITAMIN D LEVELS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SINGLE-CENTER CROSS-SECTIONAL STUDY Yao-Wei Kuo, Chia-Jung Kuo Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

教育干預對發炎性腸道疾病患者血清維生素 D 濃度的影響：單中心橫斷性研究郭曜瑋郭家榮林口長庚紀念醫院肝膽胃腸科

Background: Patients with inflammatory bowel disease (IBD) are at a higher risk of vitamin D deficiency and bone disorders. Awareness and understanding of the disease are crucial for prevention and early diagnosis. Educational interventions have been shown to improve self-assessment knowledge. The impact on vitamin D levels after education had not been evaluated. Aims: This study aimed to evaluate the impact of education interventions on vitamin D levels in IBD patients. Methods: This single-center cross-sectional study included 59 adult patients. Clinical data, blood tests, bone mineral density (BMD), T-score, Z-score, vitamin D level and questionnaires covering self-assessed knowledge, fracture risks, and physical activity were assessed. Results: Initially, low, insufficient and ideal level of vitamin D were observed in 67.2%, 25.8% and 6.9% of patients. Of all participants, 32.2% were under vitamin D supplements. Six months after education interventions, low, insufficient and ideal level of vitamin D were observed in 61.4%, 29.8% and 8.7% of patients. There was no significant difference in vitamin D level before and after education interventions. Among patients with baseline low or insufficient vitamin D level, only two improved to ideal levels at 6 months. Conclusions: High prevalence of vitamin D deficiency was observed in IBD patients. Education interventions only show limited effectiveness on increasing serum vitamin D levels. Proactive management of vitamin D deficiency in IBD patients should be considered for possible better outcome.

217

2026 TDDW

P.78

EFFICACY OF MODIFIED BISMUTH QUADRUPLE THERAPY FOR MULTIDRUG-RESISTANT HELICOBACTER PYLORI: A SINGLECENTER EXPERIENCE Wei-Kang Tu, Hsi-Chang Lee, Tsung-Jung Lin, Chih-Lin Lin, Kuan-Yang Chen Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan

改良式鉍劑四合一療法治療多重抗藥性幽門螺旋桿菌感染的療效：單一中心經驗杜維剛李熹昌林聰蓉林志陵陳冠仰臺北市立聯合醫院仁愛院區消化內科

Background: The eradication rate of Helicobacter pylori (H. pylori) has steadily declined worldwide because of increasing antibiotic resistance. Modified bismuth quadruple therapy (mBQT) remains an important rescue therapy, achieving eradication rates of 80%–90% despite antimicrobial resistance. Aims: To evaluate the efficacy of modified bismuth quadruple therapy (mBQT) in patients with severe multidrug resistant H. pylori infection (resistant to 3–5 antibiotics) and to analyze the impact of adverse events (AEs) on treatment outcomes. Methods: This single-center study at Taipei City Hospital Renai Branch (January 2023–December 2025) enrolled patients with previously treated H. pylori infection. Among 83 collected specimens, 54 yielded positive H. pylori cultures and subsequently underwent antimicrobial susceptibility testing. Patients with resistance to three or more antibiotics who received modified bismuth quadruple therapy (mBQT) were eligible for further analysis, and 32 patients were ultimately included in the final study cohort. The 14-day mBQT regimen consisted of rabeprazole 20 mg twice daily, bismuth subcitrate 120 mg four times daily, metronidazole 500 mg three times daily, and tetracycline 500 mg four times daily. Eradication outcomes and adverse events (AEs) were continuously recorded and analyzed. Results: The overall eradication rate was 84.4% (27/32), while the incidence of adverse events (AEs) was 62.5% (20/32). Eradication rates according to the degree of antibiotic resistance were 100% in

218

patients with 3-drug resistance (10/10), 66.7% in those with 4-drug resistance (6/9), and 84.6% in those with 5-drug resistance (11/13). One treatment failure in the 4-drug resistance group was attributed to treatment discontinuation due to AEs. The most common AEs were loose stools and black stools. The eradication rate was numerically higher among patients who experienced AEs than among those without AEs (90.0% [18/20] vs. 75.0% [9/12]). Conclusions: mBQT remains a highly reliable rescue therapy, demonstrating an 84.4% eradication rate against severe multidrug-resistant strains. While mBQT causes frequent AEs (62.5%), experiencing side effects does not compromise eradication efficacy. Because severe AEs can trigger treatment withdrawal and subsequent failure, clinicians must closely monitor side effects and provide support to ensure treatment adherence.

2026 TDDW

P.79

EFFICACY OF CONTINUOUS RENAL REPLACEMENT THERAPY IN SEVERE ACUTE PANCREATITIS: A RETROSPECTIVE SINGLE-CENTER STUDY Jin Won Kim, Eun Ae Cho, Chang Hwan Park Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea

lower in the early CRRT group (1/14, 7.1%) compared with the non-early CRRT group (11/19, 57.9%), demonstrating a statistically significant difference (p = 0.003). Conclusions: In patients with severe acute pancreatitis, the initiation of CRRT within 24 hours was associated with a reduced mortality, suggesting that early CRRT represent a potential therapeutic strategy beyond conventional indications.

Background: Acute pancreatitis is a potentially life-threatening condition, particularly in severe cases with systemic inflammation and organ failure. Continuous renal replacement therapy (CRRT) has gained attention not only for renal support but also for possible immunomodulatory effects. However, clinical evidence supporting the optimal timing and therapeutic role of CRRT in acute pancreatitis remains limited. Aims: This study aims to demonstrate the benefit of early initiation of CRRT within 24 hours in patients with severe acute pancreatitis. Methods: This retrospective, single-center observational cohort study included adult patients (aged 18 years and over) diagnosed with severe acute pancreatitis between January 2022 and October 2025. Patients with mild to moderate acute pancreatitis, chronic kidney disease requiring maintenance dialysis, chronic pancreatitis, death within 24 hours of admission, or insufficient records were excluded. Patients were divided into two groups: those receiving early CRRT (initiated within 24 hours of admission) and those receiving non-early CRRT (initiated after 24 hours based on conventional clinical indications). Clinical characteristics and outcomes were compared, with 30-day mortality as the primary outcome. Results: A total of 33 patients were included. The mean age of the overall cohort was 57.75 ± 19.44 years; 25 patients (75.8%) were male, and the mean BMI was 24.22 ± 4.03 kg/m², with no significant differences between groups. Alcohol was the most common etiology (57.6%), followed by hypertriglyceridemia (18.2%), biliary pancreatitis (12.1%), and idiopathic causes (12.1%), without statistically significant differences in distribution between groups. The overall in-hospital mortality rate was 36.4% (12/33). Mortality was significantly

219