BACKGROUND: Nowadays, Endoscopic Muscularis Dissection (EMD) and Endoscopic Cap External Snare Resection (ECESR) are utilized as effective techniques for removing small submucosal tumors. Herein, We aimed to clarify the...BACKGROUND: Nowadays, Endoscopic Muscularis Dissection (EMD) and Endoscopic Cap External Snare Resection (ECESR) are utilized as effective techniques for removing small submucosal tumors. Herein, We aimed to clarify the efficacy and outcomes of ECESR vs EMD to determine the optimal minimally invasive approaches for managing small (≤ 12 mm) Gastric Submucosal Tumors (sGSMT) arising from the muscularis propria (MP) layer. METHODS: This study retrospectively included data from patients who underwent ECESR or EMD to excise sGSMT of 12 mm or less. The propensity score matching (PSM) algorithm mitigated selection bias using age, gender, tumor size, location, and growth patterns for one-to-one matching. Finally, 96 patients were divided into ECESR (48) and EMD (48) groups. Clinicopathologic characteristics, procedural outcomes (procedure time, tumor resection time, and R0 resection), adverse events, length of hospital stay, and costs were compared between the two groups. RESULTS: After PSM, the ECESR group experienced significantly shorter procedure time and tumor resection time (23 [21, 22] vs 47 [40-56] min; 5 [5, 6] vs 27 [26-30] min, P < 0.001). The ECESR group exhibited significantly shorter hospital stays (P < 0.001) and lower operation costs (P < 0.001) compared to the EMD group. Both groups achieved high rates of complete (R0) resection, with no statistically significant difference observed. Importantly, no recurrence or metastasis was observed in either group during follow-up. The incidence of adverse events, including perforation and postoperative complications, was comparable between groups, and no statistically significant differences were identified.. CONCLUSIONS: For sGSMT (≤ 12 mm), ECESR exhibits shorter procedure and tumor resection times, speedier recovery, lower operating costs, and shorter hospital stays compared to EMD.
Ingabire CG, Battat R, Rex DK
… +14 more, Daoud DC, Bernard EJ, Orlicka K, Leduc R, D'Aoust L, Kiow JLC, Michal V, Oleksiw M, Djinbachian R, Deslandres E, Bouin M, Panzini B, Bouchard S, von Renteln D
BACKGROUND: In colorectal cancer (CRC) screening, colonoscopy quality is assessed by sporadic adenoma detection and withdrawal time (WT). In inflammatory bowel disease (IBD), withdrawal is more complex due to IBD-specifi...BACKGROUND: In colorectal cancer (CRC) screening, colonoscopy quality is assessed by sporadic adenoma detection and withdrawal time (WT). In inflammatory bowel disease (IBD), withdrawal is more complex due to IBD-specific tasks, such as targeted biopsies, dysplasia surveillance, and segmental inflammatory activity assessment. We hypothesized that in screening-age IBD patients in endoscopic remission, the yield of sporadic adenomas would be similar to that observed in non-IBD patients. We aimed to test this hypothesis recognizing that current quality benchmarks are extrapolated from non-IBD screening despite higher CRC risk in IBD. METHODS: We conducted a secondary analysis of prospectively collected colonoscopy data from a tertiary academic center. Our primary outcome was sporadic adenoma detection rate (ADR) in IBD, using non-IBD patients as a reference group. Secondary outcomes were mean WT, polyp detection rate, adenomas and polyps per colonoscopy, advanced adenoma detection rate, and sessile serrated lesion detection rate. RESULTS: We analyzed 1366 colonoscopies (155 IBD;1211 non-IBD). When adjusting for WT and other potential confounders, ADR was significantly lower in IBD than in non-IBD (18.6% vs 43.0%). The increase in detection per additional WT minute was markedly attenuated in IBD: the odds of detecting an adenoma increased by 16.6% per additional minute in non-IBD versus 2.7% in IBD. Achieving a 26% ADR required an estimated WT of 6.8 min in non-IBD versus 28.2 min in IBD. CONCLUSIONS: In a screening-age cohort without endoscopic IBD activity, our findings suggest that IBD-specific procedural demands limit effective inspection time, and other intrinsic characteristics of the surveillance context influence adenoma detection dynamics. Non-IBD quality thresholds may not be directly applicable to IBD, supporting the development of IBD-specific quality metrics.
BACKGROUND: Vagal nerve injury can cause nonspecific symptoms and is challenging to assess. Pancreatic polypeptide (PP) release after sham feeding is a surrogate marker of vagal function. This study evaluated vagal integ...BACKGROUND: Vagal nerve injury can cause nonspecific symptoms and is challenging to assess. Pancreatic polypeptide (PP) release after sham feeding is a surrogate marker of vagal function. This study evaluated vagal integrity using sham feeding-induced PP measurement and examined associations between symptoms, PP levels, and gastric emptying. METHOD: This was a retrospective study of patients who underwent sham feeding from 2018 to May 2025. We collected demographic and clinical data, sham feeding results, indications for the study, and gastric emptying data. A 50% increase in PP level within 30 min compared to baseline was considered normal. A gastric emptying scan was classified as delayed if > 25% of the material remained at 4 h. RESULTS: 53 patients were included (58.5% women) with a mean age of 57.2 years. The main GI symptoms were nausea and vomiting (21, 40.0%) and diarrhea (14, 26.4%). 36 of 53 patients had a history of abdominal surgery, with Nissen fundoplication, including open and laparoscopic, being the most common surgeries (10, 27.8%). The fold of PP changes between abnormal and normal groups is significantly different (p = 0). In 23 patients with symptoms of nausea and vomiting, symptoms were found to have a robust correlation with a positive sham feeding result (21, 91.3%), compared with gastric emptying scintigraphy (14, 60.9%). CONCLUSION: Sham feeding is consistently abnormal in patients with predominant symptoms of nausea and vomiting, while the correlation between the gastric scintigraphy result and gastroparesis symptoms was not significant. Sham feeding may be a valuable test when assessing patients with symptoms of nausea and vomiting.
PURPOSE: Published reviews of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) have emphasized feasibility and safety. We performed a systematic review and meta-analysis specifically to evaluate how closel...PURPOSE: Published reviews of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) have emphasized feasibility and safety. We performed a systematic review and meta-analysis specifically to evaluate how closely EUS-based portal pressure measurements track invasive comparator measurements in prospective paired studies and to summarize agreement, technical success, and adverse events. METHODS: We searched major databases through January 2026 for prospective cohorts reporting same-patient EUS-based portal pressure measurement and invasive hemodynamic measurements. Correlations were pooled with random-effects models and analyzed separately for studies comparing EUS-PPG with hepatic venous pressure gradient (HVPG) and studies comparing EUS-based portal measurements with direct portal venous pressure. Agreement and threshold discordance were summarized descriptively. RESULTS: Six prospective cohorts (127 attempted procedures) were included. In studies using HVPG as the comparator, the pooled correlation was 0.82 (95% CI, 0.72-0.89; I = 0%). In studies comparing EUS-based portal measurements with direct portal venous pressure, the pooled correlation was 0.86 (95% CI, 0.72-0.93; I = 16.9%). Technical success was 95.3%. EUS-PPG-attributed adverse events occurred in 2.4% of procedures, with no procedure-related deaths. Agreement data were limited. Reported limits of agreement were wide (approximately - 6 to + 7 mmHg), and discrepancies of 5 mmHg or greater occurred in 4 of 30 paired measurements. CONCLUSIONS: EUS-based portal pressure measurement is feasible and shows a strong association with invasive hemodynamic comparators, but the evidence base remains small (six cohorts, 127 attempted procedures). Further study will be necessary to establish patient-level agreement, procedural reproducibility, EUS-specific clinically significant portal hypertension thresholds, and whether HVPG-based decision thresholds can be transferred to EUS-derived measurements.
BACKGROUND: Dolichocolon (DC), or colonic redundancy, is an elongated and tortuous colon described as early as 1820, yet it remains underrecognized in clinical gastroenterology. Advances in imaging and motility assessmen...BACKGROUND: Dolichocolon (DC), or colonic redundancy, is an elongated and tortuous colon described as early as 1820, yet it remains underrecognized in clinical gastroenterology. Advances in imaging and motility assessment offer new insights into its prevalence, mechanisms, and clinical implications. AIMS: To summarize current evidence on the anatomy, epidemiology, and potential clinical significance of DC and to explore possible pathophysiological mechanisms linking this variant to gastrointestinal disorders. METHODS: A targeted literature review of studies published between 1900 and 2024 was conducted using PubMed and Scopus with search terms including dolichocolon, colonic redundancy, and redundant colon. Publications addressing anatomy, motility, symptom associations, and disease relevance were included. RESULTS: Though epidemiological data are limited, it has been estimated that DC affects 10-20% of the population and is associated with constipation, volvulus, and, possibly, inflammatory bowel disease. Proposed mechanisms include segmental stasis and ischemia in redundant loops, altered neuromuscular signaling, and increased mucosal surface area promoting immune-microbiota interactions. Despite its potential importance, DC is rarely noted in modern radiology reports, contributing to under-recognition in clinical practice. CONCLUSIONS: Colonic redundancy represents a common anatomic variant with potentially overlooked clinical implications. Standardized radiologic characterization and prospective studies are needed to clarify its role in gastrointestinal disorders and to guide future diagnostic and therapeutic approaches.
BACKGROUND AND AIMS: Current guidelines recommend early surveillance following piecemeal polypectomy due to recurrence risk; however, this contributes substantially to colonoscopy burden. We aimed to identify subgroups i...BACKGROUND AND AIMS: Current guidelines recommend early surveillance following piecemeal polypectomy due to recurrence risk; however, this contributes substantially to colonoscopy burden. We aimed to identify subgroups in which surveillance can be safely deferred beyond current guideline intervals. METHODS: We performed a two-center retrospective study of consecutive patients undergoing first (SC1) and second (SC2) surveillance colonoscopy following piecemeal resection. Primary outcome was histological recurrence; secondary outcome was detection of additional high-risk polyps. RESULTS: A total of 221 lesions, 130 conventional adenomas (CA) and 91 serrated lesions (SL), were resected piecemeal in 202 patients, with 76% removed using cold snare technique. Recurrence following cold resection occurred in 11% of CA ≥ 20 mm and 15% of CA < 20 mm, while recurrence in SL was low (5% for < 20 mm; 0% for ≥ 20 mm). Hot snare resection was predominantly used for larger CA (79% ≥ 20 mm) and was associated with a recurrence rate of 14%. At SC1, additional high-risk polyps were detected in 27% of patients, particularly following resection of larger index lesions. No advanced neoplasia was detected at SC2 in patients with serrated lesions without recurrence at SC1. CONCLUSIONS: In this real-world study, most piecemeal polypectomy was performed using cold snare technique. There was a clinically significant risk of recurrence in CA including those < 20 mm supporting current recommendations of surveillance at 6 months unless technical advances can be shown to reduce recurrence. Our findings suggest a lower risk of recurrence in SL of all sizes and if confirmed on further studies, surveillance intervals may be able to safely lengthen in these cases.
BACKGROUND: Hepatitis B virus (HBV) reactivation is a potentially severe and preventable complication of immunosuppressive therapy, particularly with anti-CD20 agents such as rituximab, underscoring the need for effectiv...BACKGROUND: Hepatitis B virus (HBV) reactivation is a potentially severe and preventable complication of immunosuppressive therapy, particularly with anti-CD20 agents such as rituximab, underscoring the need for effective screening and prophylaxis to reduce adverse outcomes. METHODS: We conducted a retrospective population-based cohort study using the Clalit Health Services database in northern Israel. Adult patients aged ≥ 18 years who received rituximab between 2005 and 2022 were included. HBV screening (HBsAg and anti-HBc), antiviral prophylaxis, and HBV reactivation events were evaluated. Timely screening was defined as testing performed within 90 days before rituximab initiation. Temporal trends were analyzed using the Cochran-Armitage test, and predictors of reactivation were evaluated using Cox proportional hazards models, with the per-patient analysis considered the primary model. RESULTS: After exclusion of patients younger than 18 years, a total of 11,888 adult patients received rituximab during the study period (mean age 61.6 ± 15.6 years; 54.7% female). Only 10.5% of patients underwent timely HBV screening before treatment initiation, while 47.4% were never screened without time restriction and 89.5% had no HBV serology within 90 days before rituximab initiation. Among screened patients, approximately 6.0% had evidence of current or prior HBV infection. Screening rates improved significantly over time (P < 0.0001) but remained suboptimal across clinical settings. Antiviral prophylaxis increased over the study period but plateaued at approximately 50% among eligible patients. A total of 159 HBV reactivation events were identified, corresponding to an incidence of 1.06% per treatment event and approximately 1.3% per patient. Reactivation occurred predominantly among patients who had not undergone HBV screening. Multivariable analysis identified male sex as an independent predictor of HBV reactivation. CONCLUSIONS: Despite gradual improvement over nearly two decades, HBV screening before rituximab therapy remains insufficient in real-world clinical practice. Given that HBV reactivation is largely preventable with appropriate screening and antiviral prophylaxis, system-level interventions are needed to improve adherence to guideline-recommended care.
BACKGROUND AND AIMS: Dual-targeted therapy (DTT) combines medications with different anti-inflammatory mechanisms to manage immune-mediated conditions. We describe our experience of adding guselkumab (GUS) to upadacitini...BACKGROUND AND AIMS: Dual-targeted therapy (DTT) combines medications with different anti-inflammatory mechanisms to manage immune-mediated conditions. We describe our experience of adding guselkumab (GUS) to upadacitinib (UPA) in complex inflammatory bowel disease (IBD). METHODS: We reviewed our real-world registry of adult patients with IBD who had GUS added to UPA. Prospectively collected outcomes included clinical remission (Harvey-Bradshaw Index (HBI) < 5 or Simple Clinical Colitis Activity Index (SCCAI) < 3), biochemical remission (normalization of fecal calprotectin (FCP)/CRP), corticosteroid-free remission, and adverse events (AEs). Patient-reported activity of extraintestinal manifestations (EIMs) was retrospectively reviewed. RESULTS: We identified 11 patients with Crohn's disease (CD) and 4 with ulcerative colitis (UC) who added GUS to UPA for luminal inflammation (n = 12) and/or EIMs (n = 5). Five of nine patients with active CD achieved biochemical remission. Of the four with symptomatic CD (HBI > 5), two achieved clinical remission. Four patients received DTT for CD-associated EIMs and two had partial improvement of symptoms after GUS. All 3 patients who started DTT for active UC achieved clinical remission and one with active enteropathic arthropathy had partial improvement of symptoms after DTT. AEs included minor skin irritation, fatigue, and headaches. 14/15 patients remain on DTT after median 6 months' follow-up. CONCLUSION: The addition of GUS to UPA led to clinical remission in 50% and 100% of patients with CD and UC, and biochemical remission in 55.6% and 66.7% of patients with CD and UC, respectively. 60% noted improvement of their EIMs after adding GUS. No serious AEs were reported highlighting the safety of this DTT strategy.
PURPOSE: A patulous anus is often associated with prior anal sphincter injury and fecal incontinence (FI). We aimed to understand the clinical and functional significance of a patulous anus as identified on MRI defecogra...PURPOSE: A patulous anus is often associated with prior anal sphincter injury and fecal incontinence (FI). We aimed to understand the clinical and functional significance of a patulous anus as identified on MRI defecography (MRD). METHODS: We conducted a retrospective review of the clinical characteristics, high-definition anorectal manometry, MRD, and symptom severity scores from a prospectively maintained registry of patients with or without patulous anus. RESULTS: Of the 161 patients (86.3% women), who presented with various anorectal symptoms, 47 (29%) exhibited a patulous anus. Ninety-five percent of patients with a patulous anus were women (p = 0.018), older (66 ± 12.7 vs. 56 ± 15.1 y, p = 0.0003), and had a history of pelvic surgery (39% vs. 22%, p = 0.038). Patients with a patulous anus were more likely to report FI with higher Wexner scores (p < 0.05), associated with a shorter anal high-pressure zone, reduced resting tone and squeeze pressures (p < 0.01), independent of age, gender, and previous surgeries. MRD revealed higher Oxford grades of rectal intussusception (p < 0.0001), longer levator hiatus length (p = 0.002), greater perineal descent (p = 0.006), and a wider anorectal angle at rest (p < 0.001). After adjusting for age, gender, and history of previous pelvic surgeries, such differences remained significant. Stepwise logistic regression identified higher Oxford grade, lower resting tone, and wider anorectal angle at rest as independent predictors of a patulous anus. CONCLUSION: A patulous anus on MRD indicates clinically important underlying anorectal anatomical and functional abnormalities and warrants screening for FI and/or advanced rectal intussusception.
BACKGROUND: Circulating tumor DNA (ctDNA)-based minimal residual disease (MRD) is an emerging biomarker, but its utility in resectable gastric cancer remains incompletely characterized. METHODS: We conducted a systematic...BACKGROUND: Circulating tumor DNA (ctDNA)-based minimal residual disease (MRD) is an emerging biomarker, but its utility in resectable gastric cancer remains incompletely characterized. METHODS: We conducted a systematic review and meta-analysis of eight studies (520 patients) to evaluate the prognostic value of ctDNA-based MRD for recurrence-free survival (RFS) and overall survival (OS) in resectable gastric cancer. RESULTS: In localized resectable gastric cancer (Stage I-III), the setting in which postoperative ctDNA most coherently represents true molecular residual disease after curative-intent surgery, postoperative ctDNA positivity was associated with diminished recurrence-free survival (RFS: HR 12.26, 95% CI 3.30-45.52) and overall survival (OS: HR 8.57, 95% CI 3.06-23.98). The test for subgroup differences between localized and mixed-stage cohorts was not statistically significant (P = 0.57), and the numerically higher HR in the localized subgroup should therefore not be interpreted as evidence of a quantitatively stronger prognostic effect. Postoperative ctDNA detection demonstrated substantially stronger prognostic value (overall RFS: HR 10.00, 95% CI 4.53-22.10) compared to preoperative assessment (HR 2.17, 95% CI 1.10-4.28). Both tumor-informed and tumor-agnostic strategies effectively stratified high-risk patients. However, these effect sizes should be interpreted cautiously given the small number of studies and substantial heterogeneity (I = 65-72%). Results from mixed-stage cohorts including Stage IV disease are supportive but should not be considered equivalent to localized-disease findings, as ctDNA in metastatic disease reflects persistent systemic burden rather than minimal residual disease in the postoperative sense. CONCLUSIONS: Postoperative ctDNA-based MRD shows a consistent adverse prognostic association in resectable gastric cancer, with localized disease (Stage I-III) representing the most biologically and clinically coherent setting for interpretation. However, the large pooled hazard ratios (HR 10.00-12.26) should be interpreted as a directionally consistent signal rather than precise quantitative estimates, given the small number of studies, wide confidence intervals, and substantial heterogeneity (I = 65-73%). This heterogeneity is largely driven by substantial variation in postoperative sampling timing (4 days to 16 weeks) and ctDNA assay characteristics (platform, sensitivity, coverage, variant filtering, and positivity thresholds), which require standardization in future studies. While ctDNA is prognostically valuable, its clinical utility remains unestablished. Prospective randomized trials are needed to determine whether ctDNA-guided strategies improve patient outcomes before routine clinical implementation can be recommended.
PURPOSE: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the management of pancreaticobiliary disorders and may be associated with systemic oxidative stress. Dynamic thiol-disulfide homeostasis, w...PURPOSE: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the management of pancreaticobiliary disorders and may be associated with systemic oxidative stress. Dynamic thiol-disulfide homeostasis, which reflects the balance between reduced and oxidized thiol groups, has emerged as a sensitive indicator of systemic redox status. This study aimed to evaluate alterations in thiol-disulfide homeostasis in patients undergoing ERCP. METHODS: In this observational study, patients undergoing ERCP and control subjects were included. Serum native thiol, total thiol, disulfide levels, and thiol-based ratios were measured using an automated spectrophotometric assay. Baseline demographic and laboratory characteristics were compared between groups. Age-adjusted analyses were performed using analysis of covariance (ANCOVA), and longitudinal changes were evaluated using mixed-effects models. RESULTS: Compared with controls, patients undergoing ERCP demonstrated significantly lower native thiol and total thiol levels together with higher disulfide concentrations and altered thiol-based ratios. Age-adjusted analyses confirmed significant group effects for native thiol, total thiol, disulfide, and native thiol/total thiol ratio. Longitudinal analyses showed partial increases in reduced thiol parameters after ERCP; however, post-procedural values remained lower than those observed in controls at the 24-h time point. These alterations were observed irrespective of post-ERCP pancreatitis or pancreatic enzyme elevations. CONCLUSION: Patients undergoing ERCP exhibited significant alterations in thiol-disulfide homeostasis, characterized predominantly by depletion of reduced thiol pools. The observed redox imbalance persisted during the early post-procedural period and appeared to be associated with both underlying pancreaticobiliary disease and procedure-related oxidative stress. Further studies are needed to clarify the clinical significance of these findings.
PURPOSE: People with metabolic dysfunction-associated steatotic liver disease (MASLD) or alcohol-related liver disease (ALD) are at increased risk of cardiovascular (CV) events and extrahepatic cancers. However, data on...PURPOSE: People with metabolic dysfunction-associated steatotic liver disease (MASLD) or alcohol-related liver disease (ALD) are at increased risk of cardiovascular (CV) events and extrahepatic cancers. However, data on MASLD with increased alcohol intake (MetALD) are limited. We investigated the incidence of CV events and extrahepatic cancers across SLD subgroups. METHODS: Patients with histologically confirmed SLD were included. Incident CV events (heart failure, ischemic heart disease (IHD), cerebrovascular disease, peripheral vascular disease) and extrahepatic cancers were recorded. Five-year cumulative incidence and sHR were estimated using competing risk regression with death and transplantation as competing events. RESULTS: 739 patients were included: 525 (71%) MASLD, 88 (12%) MetALD and 126 (17%) ALD. Mean age was 51 ± 13 years and 63% were male. Advanced fibrosis (F ≥ 3) was present in 39%. Over a median follow-up of 6.3 (IQR 3.8-8.3) years, 75 (10.1%) patients died, and 60 incident CV events occurred, most commonly IHD (46.6%). Estimated five-year cumulative incidence of CV events was 5.3% in MASLD, 7.4% in MetALD and 3.2% in ALD. Extrahepatic cancers occurred in 55 patients, most frequently skin and prostate. Estimated five-year cumulative incidence of extrahepatic cancers was 3.4% in MASLD, 4.9% in MetALD and 4.3% in ALD. The SLD subgroup was not independently associated with CV events, but MetALD (sHR 2.43, p = 0.021) and ALD (sHR 1.96, p = 0.040) were independently associated with extrahepatic cancer risk. CONCLUSIONS: In this cohort of biopsy-proven SLD, the risk of extrahepatic cancer was higher in patients with MetALD. These findings may reflect synergistic effects of metabolic risk and alcohol exposure.