INTRODUCTION: The influence of community-level economic distress on outcomes following hepato-pancreato-biliary (HPB) cancer surgery remains poorly characterized. We evaluated the association between the Distressed Commu...INTRODUCTION: The influence of community-level economic distress on outcomes following hepato-pancreato-biliary (HPB) cancer surgery remains poorly characterized. We evaluated the association between the Distressed Communities Index (DCI) and perioperative outcomes among older adults undergoing HPB resection. METHODS: Using 100% Medicare fee-for-service claims (2018-2021), we identified patients ≥66 years undergoing inpatient surgery for pancreatic, hepatic, or biliary cancers. County-level DCI scores were categorized into quintiles (Prosperous to Distressed). The primary outcome was in-hospital mortality; secondary outcomes included prolonged length of stay (>75th percentile), discharge disposition, Index admission Medicare payments, and receipt of perioperative therapy. Multivariable models adjusted for demographic, clinical, regional, and hospital characteristics. RESULTS: Among 15,565 patients, 6,421 (41.3%) resided in Prosperous counties and 831 (5.3%) in Distressed counties. Patients from Distressed communities were more often Black (19.1% vs 4.3%), non-metropolitan (68.0% vs 5.3%), and treated at lower-volume hospitals (31.7% vs 29.8%) (all p<0.001). Overall, in-hospital mortality was 5.4% (n=841), increasing from 5.3% in Prosperous to 7.3% in Distressed counties (p=0.021). After adjustment, residence in At-risk (AOR 1.28, 95% CI 1.12-1.46) and Distressed counties (AOR 1.29, 95% CI 1.09-1.52) was associated with higher odds of in-hospital mortality compared with residence in Prosperous counties. Prolonged LOS occurred more frequently among patients from Distressed communities (26.2% vs 20.6%, p<0.001). Receipt of preoperative radiotherapy was lower in Distressed communities (2.2% vs 4.1%, p=0.006). Index hospitalization Medicare payments were higher among Distressed counties (+$1,994, 95% CI $196-$3,791). CONCLUSION: Community economic distress was associated with modestly worse perioperative outcomes following HPB cancer surgery, supporting its potential role as an area-level risk marker for perioperative vulnerability.
BACKGROUND: Esophagectomy with gastric conduit reconstruction is associated with long-term morbidity; however, the mechanisms underlying postoperative gastric dysfunction remain incompletely understood. This study evalua...BACKGROUND: Esophagectomy with gastric conduit reconstruction is associated with long-term morbidity; however, the mechanisms underlying postoperative gastric dysfunction remain incompletely understood. This study evaluated gastric myoelectrical activity in the reconstructed intrathoracic stomach using noninvasive body surface gastric mapping (BSGM) and examined its relationship with symptoms and delayed gastric conduit emptying (DGCE). METHODS: A total of 30 adults at a median of 50.4 months postesophagectomy were recruited and compared with 30 matched controls. All participants underwent BSGM. Patient-reported outcomes were assessed using the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM), Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QoL), total symptom burden score, and Konradsson's DGCE score. Electrophysiological metrics were compared with those of matched controls. Pearson correlations and analysis of variance with correlation ratio were used to assess associations among electrophysiology, symptoms, and DGCE. RESULTS: Postesophagectomy patients demonstrated significantly impaired gastric electrophysiology, including reduced principal gastric frequency (2.65 ± 0.37 vs controls, 3.11 ± 0.24 cycles per minute, P <.001) and body mass index (BMI)-adjusted amplitude (27.1 ± 11.1 vs 40.5 ± 17.3 µV, P <.001). Notably, 23 (76.7%) patients exhibited abnormal BSGM phenotypes, most commonly low-frequency activity (n = 13). DGCE was present in 23.3% of patients and was associated with a higher symptom burden and reduced quality of life (PAGI-SYM, r = 0.37, P <.05; PAGI-QOL, r = -0.41, P <.05). Principal gastric frequency was found to correlate with nausea (r = 0.49, P <.05), and BMI-adjusted amplitude correlated with symptoms of excessive fullness (r = 0.49, P <.05) and upper gut pain (r = 0.48, P <.05). CONCLUSION: The gastric conduit exhibits persistent electrophysiological abnormalities years after esophagectomy, characterized by low-frequency slow-wave activity and reduced amplitude. Although these abnormalities showed some association with symptom burden, they did not correlate with DGCE, indicating that this condition is multifactorial. BSGM provides insight into postesophagectomy gastric function and could inform therapeutic strategies.
BACKGROUND: Preoperative prehabilitation has been increasingly incorporated into perioperative care for colorectal cancer (CRC), yet the comparative effectiveness of different prehabilitation modalities remains unclear....BACKGROUND: Preoperative prehabilitation has been increasingly incorporated into perioperative care for colorectal cancer (CRC), yet the comparative effectiveness of different prehabilitation modalities remains unclear. This study aimed to compare the relative effects of major preoperative prehabilitation models on postoperative recovery in patients who undergo surgery for CRC. METHODS: A systematic review and network meta-analysis (NMA) were conducted by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science from inception to March 31, 2026. Randomized controlled trials enrolling adults with CRC scheduled for elective curative surgery were eligible if they evaluated structured preoperative prehabilitation and reported at least 1 relevant postoperative outcome. Interventions were classified as exercise-only prehabilitation (EX), nutrition-only prehabilitation (NU), combined exercise plus nutrition prehabilitation (EX+NU), multimodal prehabilitation combining exercise, nutrition, and psychological support (EX+NU+PSY), or usual care (UC). The primary outcome was postoperative 6-minute walk distance (6MWD). Secondary outcomes included length of hospital stay (LOS), readmission within 30 days, adverse events (AEs), serious AEs (SAEs), quality of life (QoL), anxiety, and depression. Pairwise meta-analyzes were first performed to evaluate the overall effect of prehabilitation vs UC, followed by NMA to compare the relative effects of different prehabilitation modalities. Continuous outcomes were summarized as standardized mean differences (SMDs) with 95% CIs, and dichotomous outcomes were summarized as odds ratios (ORs) with 95% CIs. RESULTS: A total of 22 randomized controlled trials involving 1545 patients were included. In the pairwise meta-analysis, preoperative prehabilitation significantly improved postoperative 6MWD compared with UC (SMD, 0.18; 95% CI, 0.05-0.31; I²= 5.0%). In the NMA, EX+NU+PSY ranked the highest for 6MWD and was superior to UC (SMD, 0.24; 95% CI, 0.02-0.46). No significant overall effects were observed for LOS (SMD, -0.06; 95% CI, -0.28 to 0.16), readmission within 30 days (OR, 0.94; 95% CI, 0.53-1.67), AE (OR, 0.85; 95% CI, 0.67 to 1.06), or SAE (OR, 0.89; 95% CI, 0.53-1.51). Evidence regarding QoL, anxiety, and depression was limited. CONCLUSION: In patients undergoing surgery for CRC, the most consistent benefit of preoperative prehabilitation was improved postoperative functional recovery, with EX+NU+PSY showing the most favorable effect on 6MWD. The current evidence does not support consistent benefits for LOS, readmission, or postoperative complications across prehabilitation modalities.
BACKGROUND: Despite the ongoing discussion around complete mesocolic excision (CME) during right colectomy, it remains a poorly defined concept, and its oncologic role in the treatment of right-sided colon cancer remains...BACKGROUND: Despite the ongoing discussion around complete mesocolic excision (CME) during right colectomy, it remains a poorly defined concept, and its oncologic role in the treatment of right-sided colon cancer remains unclear. Since its original description, CME has been interpreted inconsistently, with multiple techniques and definitions used across studies. This heterogeneity, combined with a reliance on retrospective and observational data, has limited the meaningful assessment of efficacy. METHODS: This narrative literature review aimed to summarize recent data evaluating the oncologic efficacy of CME for right-sided colon cancer. Relevant literature was identified through PubMed/MEDLINE searches using combinations of keywords including "complete mesocolic excision," "central vascular ligation," "D3 lymphadenectomy," and "right hemicolectomy." Particular emphasis was placed on prospective randomized trials. RESULTS: Most studies reporting improved outcomes after CME have compared it with inadequately defined "conventional" colectomy, often using historical controls in whom the quality of mesocolic dissection, vascular ligation, and lymphadenectomy was unclear. Consequently, it is difficult to determine whether the observed benefits are attributable to more radical central (D3) lymphadenectomy or, perhaps more plausibly, to improved standardization and overall surgical quality in a procedure that traditionally has not been centralized to specialized colorectal units. The Radical Extent of Lymphadenectomy of Laparoscopic Right Colectomy (RELARC) trial for colon cancer provides the first high-quality randomized evidence addressing this issue. With standardized, high-quality surgery in both arms, RELARC demonstrated no significant difference in disease-free or overall survival at either 3 or 5 years between D2 dissection and D3/CME dissection. CONCLUSION: Contemporary data support moving away from imprecise terminology, such as "CME," and toward explicit descriptions of lymphadenectomy extent. High-quality D2 dissection should be regarded as the standard of care for routine right colectomy, with future efforts prioritizing standardization, training, and quality improvement, while refining indications for selective D3 dissection in selected patients.
Lal T, Liu F, Cabulong A
… +4 more, Kang CO, Hoehn RS, Rose J, Koroukian SM
J Gastrointest Surg
· 2026 Jun · PMID 42263377
·
Full text
BACKGROUND: Emergency colorectal cancer resection (ECCR) is associated with worse perioperative and oncologic outcomes than elective surgery. As the incidence of colorectal cancer rises among younger adults and dispariti...BACKGROUND: Emergency colorectal cancer resection (ECCR) is associated with worse perioperative and oncologic outcomes than elective surgery. As the incidence of colorectal cancer rises among younger adults and disparities persist across the life course, we examined how clinical and sociodemographic factors intersect to shape ECCR risk across age groups. METHODS: We conducted a retrospective cohort study of adult colorectal cancer resection admissions in the National Inpatient Sample between 2018 and 2022. Multivariable logistic regression and classification and regression tree (CART) analyzes were used to identify independent predictors of ECCR and age-specific high-risk phenotypes. RESULTS: Among 510,135 resection admissions, 64,175 (12.6%) were ECCR. ECCR admissions more often involved patients with compromised health (weight loss, anemia, coagulopathy, and electrolyte disorders), metastatic disease, and ≥3 comorbidities across all ages. Among younger and middle-aged adults, ECCR disproportionately involved patients who were on Medicaid or who were uninsured and those from lower-income communities. In multivariable models, female sex and higher income were associated with protection across most age groups, whereas being on Medicaid or uninsured status, having a higher comorbidity burden, and admission during the COVID-19 pandemic era were more frequently associated with higher odds of ECCR. CART analysis identified age-specific phenotypes, with insurance status predominating in patients younger than 75 years, and clinical complexity and pandemic-era timing predominating in those aged 76 years or older. CONCLUSION: ECCR risk reflects different dominant mechanisms across age groups, suggesting that a one-size-fits-all approach is unlikely to reduce emergency presentations. Age-tailored strategies that address access barriers and optimize management of medically complex older adults may improve timely, equitable colorectal cancer care.
BACKGROUND: Paraconduit hernia is a challenging complication after esophagectomy, with the potential to compromise the neo-esophagus and risk of bowel incarceration or strangulation. This study aimed to assess the incide...BACKGROUND: Paraconduit hernia is a challenging complication after esophagectomy, with the potential to compromise the neo-esophagus and risk of bowel incarceration or strangulation. This study aimed to assess the incidence and risk factors associated with paraconduit hernia after esophagectomy and to evaluate its surgical management, recurrence rates, and contributing factors. METHODS: A single-institution retrospective cohort study was conducted on patients who underwent esophagectomy between 2008 and 2024. Freedom from paraconduit hernia was estimated using the Kaplan-Meier method, and Cox regression analysis was employed to determine the associated risk factors. RESULTS: Of 349 patients, 27 (7.4%) developed a paraconduit hernia (Ivor Lewis, 66.7% vs McKeown approach, 22.2%; transhiatal, 11.1%). The median time between esophagectomy and its clinical manifestation was 1.38 years (IQR, 0.13-4.89). The cumulative incidence of paraconduit hernia was 11.9% at the 5-year follow-up. Notably, 21 patients presented with symptoms, including abdominal pain in 51.9%, nausea and vomiting in 59.3%, and dysphagia and chest pain in 44.4%. Approximately 33% of patients required emergency surgical repair because of conduit distension and delayed conduit emptying. Risk factors associated with a higher risk of development of paraconduit hernia were the presence of hiatal hernia (hazard ratio [HR]: 3.0) during esophagectomy and a prior history of hiatal hernia repair with antireflux procedures (HR: 3.68). Extreme body mass index (BMI) was also associated; a lower BMI (<18.5 kg/m) was associated with a higher risk (HR: 4.39), whereas obesity was a protective factor (HR: 0.26). Recurrence of paraconduit hernia occurred in approximately 38% of patients, necessitating reoperation at a median of 1.25 years from the initial presentation. CONCLUSION: Paraconduit hernia is an uncommon but clinically significant complication after esophagectomy, with an 11.9% incidence at 5 years. Its development is influenced by intraoperative factors, such as hiatal hernia repair, as well as low BMI and prior hiatal hernia surgery. Prompt surgical intervention with hernia reduction and cruroplasty is essential because delayed treatment increases morbidity.
BACKGROUND: After polypectomy, patients with adenomas containing high-grade dysplasia (HGD) are recommended to undergo surveillance at 3 years because of an increased risk of metachronous neoplasia. Although proximal col...BACKGROUND: After polypectomy, patients with adenomas containing high-grade dysplasia (HGD) are recommended to undergo surveillance at 3 years because of an increased risk of metachronous neoplasia. Although proximal colon cancers are associated with a worse prognosis compared with distal tumors, limited data exist regarding how the laterality of an initial HGD adenoma influences the subsequent risk of colon cancer. This study aimed to analyze the role of the laterality of HGD adenoma on the incidence of metachronous colon cancer. METHODS: The Surveillance, Epidemiology, and End Results-Medicare linked database was queried for adults aged ≥65 years who underwent endoscopic polypectomy for HGD adenoma in the proximal or distal colon, defined relative to the splenic flexure (2006-2019). Cox regression assessed the effect of adenoma location on metachronous malignancy. Survival was assessed using a Kaplan-Meier model. RESULTS: In a cohort of 523 patients, 41% had proximal HGD adenomas. The 10-year cumulative incidence of postpolypectomy colon cancer was 33% for proximal and 8% for distal adenomas (P <.01). The median time to diagnosis of colon cancer was 2.8 years for proximal adenomas compared with 4.1 years for distal adenomas. Proximal HGD location was significantly associated with an increased incidence of metachronous cancer (hazard ratio, 4.19; 95% CI, 1.90-9.26) after adjusting for age and sex. Patients with proximal HGD had worse 10-year overall survival than that of patients with distal adenomas (49% vs 57%). CONCLUSION: The proximal location of an HGD adenoma was associated with a 4-fold increased incidence of and a shorter interval to metachronous colon cancer diagnosis. The location of an HGD adenoma may be taken into consideration when determining clinical management and surveillance.
INTRODUCTION: Postacute care services (PACS) are one of the fastest-growing programs funded by the Centers for Medicare and Medicaid (CMS), with potential promise to rural communities. Emergency general surgery (EGS) is...INTRODUCTION: Postacute care services (PACS) are one of the fastest-growing programs funded by the Centers for Medicare and Medicaid (CMS), with potential promise to rural communities. Emergency general surgery (EGS) is essential to many hospitals. Yet little is known about post-EGS PACS utilization, especially among rural communities, which have longstanding barriers to healthcare access and greater travel distances. This study seeks to uncover drivers of PACS utilization after EGS among rural patients. METHODS: Using the 2016 to 2022 National Inpatient Sample, we conducted a retrospective cohort study identifying hospitalizations of adult patients from rural areas, using the National Center for Health Statistics urban-rural classification scheme, who underwent selected EGS procedures. Factors associated with PACS utilization, defined as discharge to home healthcare or other intermediate care facilities (including intermediate care facilities and skilled nursing facilities), were evaluated. Adjusted multinomial logistic regression models were estimated, controlling for demographic and clinical characteristics. RESULTS: There were more than 1,148,000 EGS hospitalizations in the United States for rural patients, of which 28.9% used PACS. CMS was the primary payer for 82% of the hospitalizations using PACS. Factors that were significantly predictive of higher use of any type of PACS utilization included older age, greater comorbidities, increased length of stay, Medicare or Medicaid payer, large-bowel procedures, hospital location in the Northeast or South, operative complications, and transferred-in status. CONCLUSION: In one of the largest evaluations of PACS utilization after EGS, approximately one-third of hospitalizations of rural patients received PACS after EGS. Surgeons, healthcare systems, and CMS can leverage these results to accurately predict which patients will require PACS and how best to improve its utilization for rural patients.
BACKGROUND: Emergency abdominal surgeries comprise most of emergencies and are high-risk procedures owing to their urgency and the limited time for optimization of comorbidities. Enhanced recovery after surgery (ERAS) pr...BACKGROUND: Emergency abdominal surgeries comprise most of emergencies and are high-risk procedures owing to their urgency and the limited time for optimization of comorbidities. Enhanced recovery after surgery (ERAS) protocols, in an adapted form, can potentially improve patient outcomes in emergency settings. The present study aimed to evaluate the safety, efficacy, and feasibility of adapted ERAS protocols in emergency abdominal operations. METHODS: This open-label, single-center, superiority, randomized controlled trial was conducted over 18 months. Patients with acute abdomen planned for surgery were randomized preoperatively to an adapted ERAS or standard care group in a 1:1 ratio. Patients with refractory shock, coagulopathy, age < 18 years, American Society of Anesthesiologists class 4E, polytrauma, and pregnancy were excluded. The primary outcome was the length of hospitalization (LOH), whereas the secondary outcomes were functional recovery parameters and 30-day morbidity and mortality. RESULTS: A total of 50 patients were analyzed in each group, showing comparable demographic and clinicopathological characteristics. The adapted ERAS group had a 6-day shorter LOH (10 [7-17] vs 16 [11-22] days, P <.001); early functional recovery in terms of reduction in time (in days) to first flatus (2.48 vs 3.14, P =.001), start of solid diet (3 vs 4, P =.035), and first stool (4 vs 5, P =.001); and a reduction in pulmonary complications (risk ratio [RR] = 0.47, P =.011). Postoperative nausea and vomiting (RR = 0.62, P =.372), surgical site infections (RR = 0.73, P =.067), and urinary tract infections (RR = 0.25, P =.092) were similar in both groups. CONCLUSION: Adapted ERAS pathways are safe and feasible and reduce the LOH in patients undergoing emergency abdominal operations.
Gao A, Beran A, Bick BL
… +13 more, Saleem N, Gromski MA, Fogel EL, Gutta A, Obaitan I, Watkins JL, House MG, Zyromski NJ, Ellis RJ, Ceppa EP, Roch AM, Easler JJ, Yadlapati S
INTRODUCTION: Laparoscopic subtotal cholecystectomy (STC) is an established approach for difficult cholecystectomy (CCY) and a well-recognized strategy to mitigate complications such as bile duct injury. The incidence of...INTRODUCTION: Laparoscopic subtotal cholecystectomy (STC) is an established approach for difficult cholecystectomy (CCY) and a well-recognized strategy to mitigate complications such as bile duct injury. The incidence of post-CCY bile leak is higher following STC compared with total cholecystectomy (TC). Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and bile duct stent placement is the standard, effective therapy for bile leaks after CCY. With the increasing adoption of STC as a strategy for complex CCY, a comprehensive understanding of the effectiveness of ERCP for a bile leak after STC is imperative. We offer a comparative analysis of patient characteristics, peri-procedure details, and clinical outcomes for patients managed with ERCP for bile leak after STC versus TC. METHODS: Data on patients referred for ERCP at Indiana University Health (IUH) Hospital between 2011-21 were collected within a retrospective database. Patients with Strasberg Type A bile leaks and/or leak from the gallbladder remnant were included in the analysis. Bile leaks with etiologies other than CCY (e.g. hepatectomy, trauma) or additional CCY related complications (e.g. common bile duct injury) were excluded. Operative reports, ERCP cholangiogram findings, and post-CCY cross-sectional imaging were reviewed to verify a TC or STC status. High-grade bile leaks were defined as evidence of contrast extravasation before opacification of the intrahepatic ducts on retrograde cholangiogram. Outcomes evaluated included resolution of bile leak at the first post-intervention (biliary sphincterotomy or stent insertion) follow-up ERCP, total number of ERCP procedures required for resolution, and overall success of ERCP for leak resolution. RESULTS: Among bile leak patients, 301 met study criteria. STC patients were older, had a higher BMI and were more often male. STC patients more frequently had a drain in place at the time of the first ERCP (p<0.001) and less often had a biloma (p=0.009). STC patients were more frequently treated with placement of self-expanding metal biliary stents (SEMS) (p=0.001) and with a longer stent dwell time after the index ERCP (41 vs 35 days, p=0.02). Overall success rate for leak resolution was high with ERCP (98%). While there was a trend for higher rate of leak resolution at first follow-up ERCP for TC patients (p=0.07), total number of ERCP procedures and overall success of ERCP for managing post-CCY bile leak was no different between the two groups. CONCLUSION: ERCP remains an effective strategy for resolution of bile leak after CCY, including in patients experiencing bile leak as a complication of STC. In our cohort, strategies such as SEMS placement and extended stent dwell time were more frequently employed in patients with STC at the discretion of the endoscopist. Despite this, no differences in ERCP procedure burden or rates of bile leak resolution were observed between TC and STC patients.
BACKGROUND: This video demonstrates a robotic approach for the repair of bilateral levator ani eventration with associated perineal hernia and obstructive defecation symptoms, including pelvic floor reinforcement and con...BACKGROUND: This video demonstrates a robotic approach for the repair of bilateral levator ani eventration with associated perineal hernia and obstructive defecation symptoms, including pelvic floor reinforcement and concomitant ventral mesh rectopexy. METHODS: A surgical video (available online at XXX) demonstrates the technique step by step. A 71-year-old woman with a remote history of pelvic trauma and 4 prior vaginal deliveries presented with progressive bilateral perineal bulging and obstructive defecation. Computed tomography showed a chronic right pubic/superior ramus fracture with persistent fracture lines, bowel-containing bilateral levator ani eventration (right greater than left), and a 1.5-cm left levator plate defect. RESULTS: A robotic repair using a 4-arm configuration was performed. Key operative steps included: (i) abdominal access and pelvic exposure with identification of the ureters; (ii) dissection from the sacral promontory to the anterior reflection with preservation of the hypogastric nerves and development of the rectovaginal plane to the perineal body; (iii) bilateral levator plate dissection and identification of an approximately 1-cm left levator defect; (iv) bilateral onlay synthetic mesh reinforcement secured with sutures and fibrin glue; (v) ventral mesh rectopexy using bioresorbable mesh secured to the anterior rectum with partial-thickness absorbable sutures and to the sacral promontory with permanent sutures; (vi) intraoperative flexible sigmoidoscopy to exclude mucosal injury; and (vii) peritoneal closure with a running barbed absorbable suture, transversus abdominis plane block, and port-site closure. CONCLUSION: Robotic pelvic floor reinforcement with concomitant ventral mesh rectopexy is a feasible approach for symptomatic levator ani eventration with perineal hernia, enabling precise pelvic dissection, restoration of levator plate integrity, and correction of associated posterior compartment dysfunction.
BACKGROUND: Hybrid endoscopic submucosal dissection combines elements of endoscopic submucosal dissection and endoscopic mucosal resection to overcome the technical challenges of standard colorectal endoscopic submucosal...BACKGROUND: Hybrid endoscopic submucosal dissection combines elements of endoscopic submucosal dissection and endoscopic mucosal resection to overcome the technical challenges of standard colorectal endoscopic submucosal dissection. It serves as a rescue strategy to facilitate en bloc resection or margin-negative resection when conventional endoscopic submucosal dissection is infeasible. Although short-term benefits are established, long-term data on recurrence and organ preservation remain limited. This study aimed to evaluate the long-term outcomes of hybrid endoscopic submucosal dissection in a large, single-center cohort. METHODS: Patients who underwent hybrid endoscopic submucosal dissection for colorectal neoplasms between November 2011 and December 2023 were retrospectively analyzed. The primary outcome was recurrence-free survival. Secondary outcomes included en bloc resection rate, R0 resection rate, perioperative complications, operative time, and the need for additional colon resection. Cox proportional hazards regression was used to identify predictors of recurrence-free survival. RESULTS: A total of 408 lesions from 391 patients were resected using hybrid endoscopic submucosal dissection. The median age was 67 years (IQR, 59-73), and 48.8% were females. The median lesion size was 30 mm (IQR, 20-40); 62.6% were located in the right colon. The en bloc resection rate was 28.9%, and the histologically complete resection rate was 81.4%. Postoperative morbidity occurred in 10.8% of patients. Additional colon resection was required in 4.9% of patients. Among 203 (49.8%) patients who underwent follow-up colonoscopy, the 3-year recurrence-free survival rate was 90.2%. Histologically complete resection was associated with improved recurrence-free survival (hazard ratio [HR], 0.27; 95% CI, 0.11-0.66), whereas older age predicted decreased recurrence-free survival (HR, 1.07; 95% CI, 1.01-1.13). CONCLUSION: Hybrid endoscopic submucosal dissection is a safe and effective option for the management of complex colorectal lesions, achieving favorable long-term outcomes with a low recurrence rate and a minimal need for surgical resection. Margin-negative resection is critical for oncologic success, and careful postprocedural surveillance remains essential.
Abosheisha M, Alqasem M, Nasr E
… +12 more, Asaad A, Kandeel M, Bylapudi S, Kolli VS, Omran MA, Boalot A, Sarsam M, Swealem A, Ismaiel A, Ismaiel M, Wilson J, Magee C
BACKGROUND: Patients with malignant gastric outlet obstruction (GOO) require intervention to restore gastric emptying. Surgical gastrojejunostomy (SGJ) is effective but associated with slower recovery and higher complica...BACKGROUND: Patients with malignant gastric outlet obstruction (GOO) require intervention to restore gastric emptying. Surgical gastrojejunostomy (SGJ) is effective but associated with slower recovery and higher complication rates. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative, but comparative evidence remains limited. METHODS: A systematic review and meta-analysis was conducted including studies comparing EUS-GE and SGJ for malignant GOO. Primary outcomes were technical success, clinical success, and adverse events. Secondary outcomes included procedure duration, time to oral intake, diet tolerance, hospital stay, surgical reintervention, and overall mortality. Pooled analyses were performed using random-effects models, with heterogeneity assessed using I². RESULTS: Twelve studies including 22,118 patients (4,954 EUS-GE; 17,164 SGJ) were included. EUS-GE had lower technical success (OR 0.25; p = 0.0002) but higher clinical success (OR 1.51; p = 0.04). EUS-GE was associated with shorter procedure time (-93.8min; p < 0.0001), earlier oral intake (-2.5 days; p = 0.002), and shorter hospital stay (-4.91 days; p < 0.0001). It required fewer reinterventions (OR 0.39; p = 0.02), had fewer adverse events (OR 0.39; p < 0.0001), and showed lower mortality (OR 0.59; p = 0.05). Diet tolerance was similar between groups. CONCLUSION: Although EUS-GE had lower technical success, likely due to procedural complexity and anatomical challenges, it provides higher clinical success, faster recovery, fewer complications, and reduced need for reintervention compared with SGJ, supporting its role as a safe and effective minimally invasive alternative for malignant GOO.