The significant contribution of greenhouse gas (GHG) emissions to global warming and the resultant negative impact on health is well established. Within the hospital setting, the endoscopy center has been ranked third–after the operating theater complex and intensive care unit–in terms of the volume of hazardous medical waste generated. Such regulated medical waste cannot be recycled, and the disposal process results in higher costs and a larger carbon footprint. There have been clarion calls to reduce the number of endoscopic procedures as a means of reducing GHG emissions. Previous studies have demonstrated the carbon footprint of inappropriate endoscopic procedures. However, endoscopy is an important diagnostic and therapeutic tool that has been shown to be cost-effective. A focus simply on reduction in procedural case volume alone raises the unintended consequences of inequitable access to endoscopy for those in need. A more nuanced approach that is aligned with the innate sense of healthcare professional aspirations and pride, in terms of seeking quality and clinical excellence, should be considered. An evidence-based approach, with a focus on quality and efficiency, as well as appropriate and timely use of new technology, will serve as a catalyst for positive behavioral change toward quality procedures and excellence. This will improve patient satisfaction, increase professional expertise and pride, and reduce carbon footprint through minimization of inappropriate and avoidable repeat procedures.

Objectives: Sarcopenia increases the risk of nonalcoholic steatohepatitis (NASH) and cirrhosis in patients with nonalcoholic fatty liver disease (NAFLD). Subsequently, poorly managed NAFLD can result in adverse health outcomes. Lifestyle interventions are effective for both NAFLD and sarcopenia; however, diagnosis of sarcopenia in this population is not well defined. This review aimed to examine current methods to diagnose sarcopenia in NAFLD patients.

Methods: MEDLINE, EMBASE, and CINAHL databases were searched for articles published until July 2023 using the terms “Non-alcoholic fatty liver disease, ” “NAFLD, ” “fatty liver, ” “sarcopenia, ” and “myoatrophy.” Studies were excluded if they included pediatric populations, did not diagnose both sarcopenia and NAFLD, or included patients with alternate causes of liver disease.

Results: Twenty studies, predominantly from Asian countries (14 [70.0%]), involving 68 848 participants (45.5% females) were included. In 15 studies, most participants had a BMI > 25 kg/m². Heterogeneity in the tools used to diagnose NAFLD was identified, with abdominal ultrasound being the most commonly used. European, Asian, and Australasian Sarcopenia Working Groups had differing diagnostic definitions of sarcopenia. Of the three potential diagnostic elements of sarcopenia (muscle mass, strength, function), all studies measured muscle mass, commonly through bioelectrical impedance analysis (12 [60.0%]). Seven studies (35.0%) measured muscle strength, with the majority (n = 6) utilizing hand grip strength. Four (20.0%) measured muscle function, through gait speed or a timed up-and-go test.

Conclusions: The lack of standardization in sarcopenia diagnosis for NAFLD patients is concerning. A consistent definition is necessary to prevent this comorbidity from being overlooked, improve care, and outcomes.

Objectives: Immunotherapy-based regimens (IMBs), compared with tyrosine-kinase inhibitors (TKIs), improve the overall survival (OS) of patients with advanced hepatocellular carcinoma (aHCC). The aim of the study was to explore the interaction of prognostic factors with survival in study cohorts receiving IMB or TKI.

Methods: A systematic search was performed and single arms of phase III trials including IMB or TKI were selected. Analysis of IMB and TKI cohorts was performed, and the relationship between progression-free survival (PFS) with OS was assessed. Finally, 13 variables were extracted, and their relationships with survival in the two groups were evaluated.

Results: Thirty-three study cohorts were selected. Longer OS and post-progression survival (PPS) were evident in the group of IMB, while the relationship of PFS with OS was significant only in the TKI cohorts (β = 0.527,p = 0.007). Prognostic factors in the IMB cohorts did not report any significant relationship with OS, while among patients receiving TKIs, longer OS was documented with elder age (β = 0.577,p = 0.003) and good performance status (β = 0.500,p = 0.011). Conversely, in the IMB cohorts, PPS increased with hepatitis B virus (HBV) (β = 0.756,p = 0.030) and Barcelona Clinic Liver Classification (BCLC) stage (β = 0.898,p = 0.002).

Conclusion: In contrast to TKIs, IMBs improved the outcome of patients with aHCC by increasing PPS, particularly in patients with BCLC stage C and HBV-related hepatopathy, but the outcome improvement was lost in patients with hepatitis C virus-related liver disease.

Objectives: Inflammatory bowel disease (IBD) is a group of chronic diseases with adverse events such as disease flare, progression, drug escalation, hospitalization, and surgery. Meanwhile, patients with IBD often have sleep disorders. We performed this systematic review and meta-analysis aiming to investigate the relationship between sleep quality of patients with IBD and their prognosis.

Methods: MEDLINE and Web of Science Core Collection databases were searched for articles published up to November 2024. We pooled the hazard ratio (HR) and odds ratio (OR) with the corresponding 95% confidence interval (CI) for adverse outcome events during the follow-up period in patients with poor sleep quality at baseline compared with those with normal sleep quality.

Results: Five studies were included with a total of 2333 patients with IBD. Poor sleep quality in patients with IBD was significantly correlated with the occurrence of adverse outcome events at follow-up (OR 1.63, 95% CI 1.14–2.33). Patients with Crohn’s disease (CD) with poor sleep quality had a significantly higher risk of adverse outcome events at follow-up (OR 1.58, 95% CI 1.26–1.99), whereas those with ulcerative colitis (UC) did not (OR 1.10, 95% CI 0.76–1.60).

Conclusion: Early identification of poor sleep quality in patients with IBD, especially CD, has a predictive effect on their prognosis.

Objectives: To investigate the correlation between gastric xanthoma (GX) and precancerous lesions (PCL) and gastric cancer (GC), and to explore other potential risk factors for PCL and GC in northwest China.

Methods: A case–control study was conducted from September 2022 to September 2023 at Xijing Hospital, Air Force Medical University (Xi’an, Shaanxi Province, China). The patients who underwent gastroscopy were enrolled and divided into the chronic gastritis (CG) group (n = 423), PCL group (n = 422), and GC group (n = 415). The variables were selected through univariate analysis, including demographic information, dietary habits, lifestyle, gastroscopic findings, and Helicobacter pylori (H. pylori) infection. Multivariate logistic regression analysis was performed to analyze the factors associated with PCL and GC, and odds ratio (OR) and 95% confidence interval (CI) were calculated.

Results: GX was more prevalent in the PCL group (14.93%) and the GC group (19.76%) than in the CG group (6.15%). Multivariate analysis revealed that age ≥ 50 years, male gender, rural residence,H. pylori infection, family history of GC, GX, and hypertension were independent risk factors for GC and PCL. Furthermore, a diet high in salt and spice, coupled with daily intake of less than 100 g of fresh fruits, might be associated with the occurrence of GC.

Conclusion: Age ≥ 50 years, male gender, rural residence, family history of GC and H. pylori infection, presence of GX, and a history of hypertension may be risk factors for PCL and GC.

Objectives: To identify the diagnostic criteria for metabolic dysfunction–associated steatotic liver disease (MASLD) related to liver fibrosis and to characterize patients with cryptogenic steatotic liver disease (SLD) (non-MASLD) among those previously diagnosed with nonalcoholic fatty liver disease (NAFLD).

Methods: This multicenter retrospective study included 511 patients diagnosed with NAFLD via liver biopsy, and the prevalence of MASLD was assessed based on the diagnostic criteria. Patients were divided into those who met the MASLD criteria and those who did not, and the characteristics of advanced fibrosis and associated cardiometabolic factors were evaluated.

Results: Of the 475 patients with NAFLD, 458 (96.4%) met the criteria for MASLD, showing a high overlap between classical NAFLD and MASLD populations. Severe fibrosis was observed, regardless of the number of cardiometabolic factors. Hypertension and diabetes mellitus significantly contributed to advanced fibrosis (≥ F3), with odds ratio of 1.92 and 2.00 (95% confidence interval of 1.17–3.16 and 1.22–3.28, respectively; both p < 0.01) on multivariate analysis. The other seventeen (3.6%) patients did not meet the diagnostic criteria for MASLD. Among them, seven had significant fibrosis and a high fibrosis-4 index.

Conclusions: Diabetes mellitus and hypertension are key metabolic factors associated with advanced fibrosis. Some cases, classified as cryptogenic SLD, also exhibit significant fibrosis. Consequently, identifying high-risk patients, including those undergoing noninvasive tests for fibrosis, is crucial.

Objective: We aimed to evaluate the differences in clinical features and lifestyle between Han and ethnic minority populations in Guangdong Province, China and their impacts on the ever-growing burden of metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: In this cross-sectional investigation in Guangdong Province, China, one of the most densely populated areas with imbalanced development, multistage stratified random sampling was used. Demographic, socioeconomic, and lifestyle data of participants were collected. Assessment of hepatic steatosis and liver stiffness measurement were performed.

Results: A total of 7287 individuals were recruited, including 7076 Han and 211 ethnic minority individuals, with similar MASLD prevalence between the two groups (35.8% vs 34.6%,p = 0.771). More ethnic minority individuals presented advanced fibrosis (≥ F3) overall and in subgroups of overweight/obesity, lean/normal weight, and males, but less advanced fibrosis in females and age of 30–34 years (all p < 0.05) than the Han Chinese. Proper physical activity was associated with a reduced risk of MASLD (Han: odds ratio [OR] 0.64,p = 0.021; ethnic minority: OR 0.06,p = 0.017). Sufficient sleep, drinking tea, and dietary fiber intake were protective factors for MASLD, while long sedentary duration, midnight snacks, dining out, and excessive intake of salt, red meat, and sugar were associated with a higher risk of MASLD in Han Chinese only.

Conclusions: There was a strikigly high burden of MASLD in the ethnic minority in Guangdong Province, China, and their lifestyle differences compared with Han Chinese may contribute to the epidemic surge of MASLD.