A total of 386 patients who underwent complete resection of hepatocellular carcinoma over an 8-year period were assessed retrospectively for tumour recurrence. Some 219 (56.7 per cent) of the patients developed recurrence. Patients with a greater degree of cirrhosis showed a longer interval to recurrence; the median (range) interval until recurrence was 7.9 (1.8-84.2) months in patients with a normal liver, 13.4 (2.0-79.5) months in those with chronic hepatitis and 16.7 (1.5-73.1) months in those with cirrhosis. Intrahepatic recurrence was observed more frequently in either the same (26.4 per cent) or the adjacent (24.8 per cent) Healey segment than in the lobe contralateral to the primary tumour (17.8 per cent). The presence of portal venous invasion and/or intrahepatic metastasis, underlying liver cirrhosis and perioperative blood transfusion were determined to be independent predictors of recurrence by multivariate analysis. Because intrahepatic spread of hepatocellular carcinoma occurs in a segment-by-segment manner, surgeons should use an anatomically wide resection within the hepatic functional reserve.

A total of 386 patients who underwent complete resection of hepatocellular carcinoma over an 8-year period were assessed retrospectively for tumour recurrence. Some 219 (56.7 per cent) of the patients developed recurrence. Patients with a greater degree of cirrhosis showed a longer interval to recurrence; the median (range) interval until recurrence was 7.9 (1.8-84.2) months in patients with a normal liver, 13.4 (2.0-79.5) months in those with chronic hepatitis and 16.7 (1.5-73.1) months in those with cirrhosis. Intrahepatic recurrence was observed more frequently in either the same (26.4 per cent) or the adjacent (24.8 per cent) Healey segment than in the lobe contralateral to the primary tumour (17.8 per cent). The presence of portal venous invasion and/or intrahepatic metastasis, underlying liver cirrhosis and perioperative blood transfusion were determined to be independent predictors of recurrence by multivariate analysis. Because intrahepatic spread of hepatocellular carcinoma occurs in a segment-by-segment manner, surgeons should use an anatomically wide resection within the hepatic functional reserve.

Background/Aims: Phase III study demonstrated that vonoprazan-based Helicobacter pylori eradication therapy achieved higher eradication rate compared with lansoprazole. However, there is no study that evaluated the efficacy of vonoprazan in a large sample in real world. We investigated the eradication rate and safety of vonoprazan-based eradication therapy compared with our randomized control trial using second-generation proton pump inhibitor (PPIs). Methods: (First study) A total of 147 patients who have H. pylori infection were randomly assigned to receive either, esomeprazole (EPZ) group and rabeprazole (RPZ) group. (Second study) 1,688 patients who have H. pylori infection underwent primary eradication with triple therapy involving vonoprazan. In both studies, triple therapy with amoxicillin, clarithromycin, and PPI or vonoprazan was performed, and eradication effect was assessed by an urea breath test. Results: (First study) Eradication rate was 77.5% in the EPZ group and 68.4% in the RPZ group; no significant difference was observed between the 2 groups. (Second study) The successful primary eradication rate was 90.8%. There was no severe adverse effect. Conclusions: The eradication rate of vonoprazan-based triple therapy was remarkably higher compared with second-generation PPIs-based triple therapy in real world. Vonoprazan is very likely to become the first option for future eradication therapy.

Small intestinal mucosal injury caused by low-dose aspirin is a common cause of obscure gastrointestinal bleeding. We aimed to investigate the protective effects and optimal dose of rebamipide for low-dose aspirin-induced gastrointestinal mucosal injury. In this prospective randomized trial, 45 healthy volunteers (aged 20–65 years) were included and divided into three groups. The groups received enteric-coated aspirin 100 mg (low-dose aspirin) plus omeprazole 10 mg (Group A: proton pump inhibitor group), low-dose aspirin plus rebamipide 300 mg (Group B: standard-dose group), or low-dose aspirin plus rebamipide 900 mg (Group C: high-dose group). Esophagogastroduodenoscopy and video capsule endoscopy were performed, and the fecal occult blood reaction and fecal calprotectin levels were measured before and two weeks after drug administration. Although the fecal calprotectin levels increased significantly in Group A, they did not increase in Groups B and C. The esophagogastroduodenoscopic and video capsule endoscopic findings and the fecal occult blood test findings did not differ significantly among the three groups. In conclusion, standard-dose rebamipide is sufficient for preventing mucosal injury of the small intestine induced by low-dose aspirin, indicating that high-dose rebamipide is not necessary.

Although low-dose aspirin (LDA) is known to induce small intestinal mucosal injury, the effect of dual antiplatelet therapy (DAPT; LDA + clopidogrel) on small intestinal mucosa in patients after percutaneous coronary intervention (PCI) for coronary stenosis is unknown. Fifty-one patients with a history of PCI and LDA use were enrolled, and 45 eligible patients were analyzed. Patients were grouped based on DAPT (DAPT: n = 10 and non-DAPT: n = 35) and proton pump inhibitor (PPI) use (PPI user: n = 22 and PPI-free patients: n = 23) to compare small intestinal endoscopic findings. The relationship between LDA-use period and small intestinal endoscopic findings was also examined. Multivariate analysis was performed to identify risk factors for LDA-induced mucosal injury using age, sex, DAPT, PPI, gastric mucoprotective drug, and LDA-use period. The rate of small intestinal mucosal injury incidence did not significantly differ between DAPT and non-DAPT patients (50% vs 51.1%, respectively; p = 0.94), or PPI users and PPI-free patients (50% vs 52.2%, respectively; p = 0.88). Additionally, LDA-use period of ≤24 months (n = 15) yielded a significantly higher rate of small intestinal mucosal injury incidence than LDA-use period >24 months (n = 30) (80% vs 36.7%, respectively; p = 0.006). Multivariate analysis revealed that a LDA-use period of ≤24 months was a significant risk factor for small intestinal mucosal injury (odds ratio: 19.5, 95% confidence interval: 2.48–154.00, p = 0.005). Following PCI for coronary stenosis, neither DAPT nor PPI affected LDA-induced small intestinal mucosal injury. Moreover, patients who used LDA within the last 24 months were at a greater risk of small intestinal mucosal injury.