ABSTRACT Introduction Argon plasma coagulation (APC) is a non‐contact electrocoagulation technique widely used for hemostasis in gastrointestinal endoscopy. Despite its safety, rare but catastrophic complications such as colonic explosions have been reported. This systematic review aimed to synthesize available evidence on APC‐associated colonic explosions, identify risk factors, and highlight preventive and management strategies. Methods Following PRISMA guidelines, PubMed, Embase, Web of Science, and Cochrane CENTRAL were searched through August 2025 for studies reporting colonic explosions during APC. Eligible studies included clinical reports describing APC use in gastrointestinal procedures with outcomes of explosion or perforation. Data were extracted on patient demographics, procedural context, bowel preparation, and clinical outcomes. Results Ten studies, comprising 12 cases, were included. Explosions most frequently occurred during APC for radiation proctitis, adenoma, or angiodysplasia, predominantly after inadequate bowel preparation or use of enemas alone. Combustible gases—chiefly hydrogen and methane—were identified as the principal mediators. Perforation occurred in half of the cases, all of which were surgically repaired, with no reported fatalities. Conclusion Although rare, colonic explosion during APC remains a preventable event. Complete bowel cleansing with oral polyethylene glycol‐based agents, avoidance of air insufflation, and adherence to safety protocols are essential to minimize risk. Standardized preparation guidelines and further research are warranted.
ABSTRACT Aims Atezolizumab combined with bevacizumab (AB therapy) is a standard first‐line treatment for advanced hepatocellular carcinoma (HCC). However, clinically useful biomarkers for predicting therapeutic efficacy and severe adverse events (AEs) remain limited. Beyond its role in thrombosis, ADAMTS13–von Willebrand factor (VWF) axis is increasingly recognized for its involvement in angiogenesis and immune modulation. This study aimed to investigate the clinical significance of the ADAMTS13–VWF axis in patients receiving AB therapy. Methods A total of 58 patients with advanced HCC treated with AB therapy were enrolled. Plasma VWF antigen (VWF:Ag) and ADAMTS13 activity (ADAMTS13:AC) were measured before treatment initiation. Therapeutic efficacy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and modified RECIST (mRECIST), while safety was assessed according to Common Terminology Criteria for AEs version 5.0. Results Multivariate analyses identified lower baseline VWF:Ag (< 180%) and ADAMTS13:AC (≤ 60%) as independent predictors of superior therapeutic efficacy according to both RECIST and mRECIST criteria. Patients with low VWF:Ag (< 180%) and ADAMTS13:AC (≤ 60%) exhibited significantly prolonged overall survival. Lower baseline VWF:Ag to ADAMTS13:AC (VWF/ADAMTS13) ratios (< 3) were independently associated with severe AEs (Grade ≥ 3). Plasma VWF:Ag and ADAMTS13:AC levels did not significantly change after AB therapy. Conclusion Baseline VWF:Ag and ADAMTS13:AC independently predict therapeutic efficacy, whereas the baseline VWF/ADAMTS13 ratio independently predicts severe AEs in patients with HCC receiving AB therapy. These biomarkers may help optimize patient selection and manage treatment‐related toxicities by reflecting tumor angiogenic activity and host immune status.
ABSTRACT Background and Aims Crohn's disease (CD) is rapidly emerging in Asia, yet endoscopic and histopathological characteristics at diagnosis remain poorly described in Southeast Asia. We aimed to describe baseline endoscopic and histologic features in Vietnamese adults with newly diagnosed CD. Methods We conducted a descriptive cross‐sectional study of consecutive adults newly diagnosed with CD from June 2019 to June 2024 at a tertiary inflammatory bowel disease (IBD) center in Vietnam. Ileocolonoscopy with segmental biopsies was performed in all patients. Endoscopic findings, histopathology, and Montreal classification were systematically recorded. Results Eighty patients (median age 34.5 years, 62.5% male) were included. The median time from symptom onset to diagnosis was 12 months (IQR 2–24); 78.8% had ≥ 1 prior inconclusive colonoscopy, and 25% had undergone intestinal resection before confirmed diagnosis. Ileocolonic disease (L3) predominated (71.3%). At diagnosis, 28.8% of patients had stricturing and 28.8% had penetrating disease behavior. Endoscopically, terminal ileal involvement was observed in 77.6%, cecal involvement in 56.6%, and skip lesions in 72.4%. Aphthous ulcers were seen in 13.2%, longitudinal ulcers in 14.5%, and cobblestoning in 6.6%. Luminal narrowing and fistulous openings were seen in 32.9% and 5.3%, respectively. The overall endoscopic impression was consistent with CD in 46.1%, non‐specific in 35.5%, suggestive of colorectal cancer (CRC) in 13.2%, and suggestive of intestinal tuberculosis in 3.9%. Histologically, chronic inflammation was universal and non‐caseating epithelioid granulomas were identified in 31.6%. The pathologist's conclusion was consistent with CD in 67.1% and non‐specific in 30.4%. Conclusions In this tertiary‐center cohort of Vietnamese adults with newly diagnosed CD, the median time from symptom onset to diagnosis was 12 months. At diagnosis, 57.5% had stricturing or penetrating behavior, and 25.0% had already undergone intestinal resection. Longitudinal ulcers, cobblestoning, and epithelioid granulomas were each found in a minority of patients, and histopathology was nonspecific in 30.4%. These descriptive data provide a baseline for future comparative studies and for evaluating standardized diagnostic criteria in Vietnam.
ABSTRACT Aims Zinc deficiency is common in patients with Crohn's disease (CD) and has been associated with adverse clinical outcomes. However, the relationship between zinc status and intestinal barrier integrity remains unclear. We investigated the association between serum zinc levels and the expression of tight junction (TJ) proteins and proinflammatory cytokines using paired intestinal biopsies from patients with CD. Methods and Results This retrospective observational study included patients with CD who underwent colonoscopic biopsies under both low zinc (< 80 μg/dL) and normal zinc (≥ 80 μg/dL) conditions between March 2017 and December 2023. Immunohistochemical staining was performed to assess TJ proteins (E‐cadherin, zonula occludens‐1 [ZO‐1], occludin, and claudin‐1) and proinflammatory cytokines (tumor necrosis factor‐α, interleukin [IL]‐17, IL‐12, and IL‐23). Twelve patients were included in the main analysis, while eight who did not receive treatment intensification were included in the sub‐analysis. In the main analysis, E‐cadherin, ZO‐1, and claudin‐1 expression levels were significantly lower during the low zinc state, whereas IL‐17 expression was significantly higher. Similar trends were observed in the sub‐analysis. Additionally, the CD Activity Index was significantly higher, and hemoglobin and albumin levels were significantly lower during the low zinc state. Conclusion Low zinc status was associated with altered expression of TJ proteins and IL‐17 in the intestinal mucosa of patients with CD. These findings suggest that zinc status may be linked to epithelial barrier integrity and mucosal immune responses in CD. Although further validation is required, zinc supplementation may represent a simple and accessible adjunct to current therapies.
ABSTRACT Background Choosing an effective Helicobacter pylori eradication regimen for patients with penicillin allergy remains a clinical challenge. Although vonoprazan‐based regimens yield excellent outcomes in standard populations, we still lack sufficient evidence regarding penicillin‐allergic patients. To address this gap, we investigated how a 1‐week triple therapy (vonoprazan, clarithromycin [CAM], and metronidazole [MNZ]) performs in this specific cohort, particularly considering the influence of antimicrobial resistance. Methods This exploratory, single‐arm, open‐label interventional study was conducted at Yokohama City University Hospital (jRCTs031200171). Patients with H. pylori infection and confirmed penicillin allergy were enrolled. The treatment regimen consisted of vonoprazan (20 mg), CAM (200 mg), and MNZ (250 mg), each administered twice daily for 7 days. The primary endpoint was the eradication success rate. Secondary endpoints included safety and the association between eradication success and antimicrobial susceptibility. Results Thirty patients completed the intervention. The overall eradication rate was 90.0% (27/30; 95% confidence interval [CI], 73.5%–97.9%) in per‐protocol and intention‐to‐treat analyses. Adherence was high (99.7%). According to resistance profiles, eradication rates were 100% (15/15; 95% CI, 78.2%–100%) in CAM‐susceptible strains, 78.6% (11/14; 95% CI, 49.2%–95.3%) in CAM‐resistant strains, 92.0% (23/25; 95% CI, 74.0%–99.0%) in MNZ‐susceptible strains, 75.0% (3/4; 95% CI, 19.4%–99.4%) in MNZ‐resistant strains, and 50.0% (1/2) in dual‐resistant strains. No serious adverse events were documented. Conclusions A 1‐week triple therapy with vonoprazan, CAM, and MNZ is an effective and safe treatment option for H. pylori eradication in patients with penicillin allergy. While the regimen achieved excellent results in CAM‐susceptible strains, further optimization may be required for cases involving dual antibiotic resistance.
