departmental bulletin paper

Background: Less aggressive rectal neuroendocrine tumors (NETs) are mainly located in the submucosal layer. We analyze our clinical experience of endoscopic submucosal dissection (ESD) for rectal NETs. Methods: We experienced 27 consecutive rectal neuroendocrine neoplasms (NENs). In these cases, we retrospectively analyzed our selections and the therapeutic results of endoscopic mucosal resection (EMR) and ESD. Results: We initially used EMR for rectal NETs. However, there was one case of local recurrence with adjacent lymph-node metastasis. This was initially treated by EMR at another hospital 12 years earlier. We changed the resection modality from EMR to ESD, which has been useful for en bloc resection. Thereafter, we performed ESD for 16 cases. En bloc resection was performed in 15 cases. The vertical margin was positive in one case but there was no local residue. In one ESD case, detailed examination of the ESD en bloc specimen clarified lymphovascular invasion and was useful for the decision of additional surgical operation. Conclusions: Based on our experience of this case series of rectal NETs, en bloc resection using ESD is a　promising treatment modality.

This study examined the association between non-invasive liver fibrosis biomarkers and non-alcoholic fatty liver disease (NAFLD) in an apparently healthy population. A matched case-control design was used to analyze 145 pairs of participants with and without NAFLD. Six liver fibrosis indexes were evaluated: Aspartate Aminotransferase to Alanine Aminotransferase Ratio (AAR), Aspartate Aminotransferase to Platelet Ratio Index (APRI), fibrosis index based on four factors (FIB-4), modified FIB-4 (mFIB-4), Forns Index, and Gamma-Glutamyl Transpeptidase to Platelet Ratio (GPR). Adjusted logistic regression analyses showed significant associations between mFIB-4 and Forns Index with NAFLD, highlighting their potential as tools for early detection. These markers demonstrated consistency across multiple analyses, supporting their potential use for screening asymptomatic individuals, especially in resource-limited settings. However, traditional markers like APRI and GPR showed limited utility in this cohort, emphasizing the need for contextual biomarker selection. Future studies should validate these findings across diverse populations and investigate their diagnostic capabilities in prospective cohort studies to improve early NAFLD detection and intervention.