BACKGROUND: Chronic intestinal inflammation is a well-established driver of colorectal dysplasia in inflammatory bowel disease (IBD). However, the role of metabolic factors such as obesity remains poorly understood. We e...BACKGROUND: Chronic intestinal inflammation is a well-established driver of colorectal dysplasia in inflammatory bowel disease (IBD). However, the role of metabolic factors such as obesity remains poorly understood. We evaluated whether chronic obesity, measured using five-year longitudinal body mass index (BMI), is independently associated with colorectal dysplasia in patients with IBD. METHODS: We conducted a retrospective 1:1 matched case-control study at a tertiary academic center. Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent surveillance colonoscopy between 2019 and 2025 were included. Cases had biopsy-confirmed colorectal dysplasia (indefinite, low grade, or high grade). Controls were dysplasia-free and matched by age (± 5 years), sex, and IBD subtype. Obesity was defined as a mean body mass index (BMI) ≥ 30 kg/m using all outpatient measurements over a five-year period prior to the index colonoscopy. Multivariable conditional logistic regression was used to evaluate the association between obesity and dysplasia, adjusting for established dysplasia risk factors and surveillance-related variables. RESULTS: A total of 312 patients were included (156 dysplasia cases and 156 matched controls). Dysplasia cases had significantly longer IBD duration compared with controls (median 12.1 vs. 8.0 years, p < 0.01) and were more likely to have a history of prior colorectal dysplasia (16.0% vs. 3.8%, p < 0.01). In multivariable analysis, obesity was independently associated with colorectal dysplasia (adjusted odds ratio [aOR] 2.23, 95% CI 1.08-4.57). Longer disease duration (aOR 1.05 per year, 95% CI 1.02-1.08) and prior dysplasia (aOR 4.88, 95% CI 1.69-14.06) were also independently associated with dysplasia. In a secondary model adjusting for additional surveillance-related and structural colonic factors, obesity remained significantly associated with dysplasia (aOR 2.11, 95% CI 1.05-4.24). CONCLUSIONS: Obesity is independently associated with colorectal dysplasia in patients with IBD, suggesting that metabolic factors contribute to neoplastic risk beyond traditional inflammation-driven pathways. Incorporation of metabolic risk into dysplasia risk stratification may improve CRC prevention strategies in IBD.
BACKGROUND: Bowel preparation quality is critical for effective colonoscopy. We aimed to evaluate seasonal variation in bowel preparation adequacy and to determine whether season modifies the association between preparat...BACKGROUND: Bowel preparation quality is critical for effective colonoscopy. We aimed to evaluate seasonal variation in bowel preparation adequacy and to determine whether season modifies the association between preparation regimen and inadequate bowel preparation. METHODS: This single-center retrospective study included 853 patients undergoing health-screening colonoscopy in 2024 who received either a split-dose regimen (SPD, n = 388) or same-day dosing (SDD, n = 465) of polyethylene glycol-based preparation. Multivariable logistic regression was used, with effect modification tested via a Season × Regimen interaction term (likelihood ratio test [LRT], df = 3). Bootstrap resampling (5,000 replicates) and parametric-bootstrap empirical power analyses were performed to evaluate interaction robustness. RESULTS: Inadequate preparation was most frequent in winter (20.9%) and least frequent in autumn (9.8%). Without the interaction term, winter was associated with higher odds of inadequate preparation versus spring (odds ratio [OR] = 2.17, 95% confidence interval [CI] 1.23-3.90). A significant Season × Regimen interaction was observed (P = 0.047). In winter, SDD versus SPD was associated with lower odds of inadequate preparation (adjusted OR = 0.43, 95% CI 0.21-0.87), whereas no significant association was seen in other seasons. Higher body weight, anxiety, and constipation were independently associated with inadequate preparation. Bootstrap re-estimation showed wide CIs for interaction terms (e.g., winter × SDD OR = 0.25, 95% CI 0.07-0.86), and empirical power for detecting the interaction was 0.65. CONCLUSIONS: This study identified seasonal variation in bowel preparation quality and a potential season-by-regimen interaction. In winter, SDD was associated with lower odds of inadequate preparation compared with SPD; however, this finding requires confirmation in larger prospective studies.
Spengler J, Ramalingam G, Hang Y
… +13 more, Yang R, Healey M, Smirnova E, Asgharpour A, Patel V, Lee H, Matherly SC, Luketic VA, Siddiqui MS, Wedd JP, Sanyal A, Verdugo JPA, Sterling RK
OBJECTIVES: Acute alcohol-associated hepatitis (AAH) is a severe inflammatory liver condition with high morbidity and mortality. Many patients with AAH exhibit features of the Systemic Inflammatory Response Syndrome (SIR...OBJECTIVES: Acute alcohol-associated hepatitis (AAH) is a severe inflammatory liver condition with high morbidity and mortality. Many patients with AAH exhibit features of the Systemic Inflammatory Response Syndrome (SIRS). While Maddrey's Discriminant Function (MDF) and Model for End-Stage Liver Disease (MELD) are established tools used to assess severity and guide treatment, the prognostic utility of SIRS criteria remains unclear. We hypothesized that AAH patients with more SIRS criteria would show greater illness severity, reduced steroid responsiveness, and worse 30-day survival. METHODS: Retrospective analysis was conducted on 531 AAH patients hospitalized between 2012 and 2019. Patients were stratified into ≥ 2 SIRS criteria (n = 243) and < 2 criteria (n = 288). Demographics, laboratory parameters, and scoring system measures (MDF, MELD) were collected. The primary outcome was 30-day (30-d) survival. Secondary outcomes were disease severity (MELD) and response to steroids. RESULTS: The mean age was 47; the majority were male (56%) and White (66%). Several baseline characteristics differed between groups. Patients with ≥ 2 SIRS criteria had significantly lower albumin (2.86 vs 2.97 g/dL, p = 0.035), higher MDF (40.1 vs 36.1, p = 0.004), higher admission MELD scores (20.9 vs 20.1, p = 0.04), and similar response to steroids (68% vs 64%). Thirty-day survival was numerically lower in the ≥ 2 SIRS group (86.9%) vs the < 2 group (91.5%) (p = 0.18), suggesting a trend toward worse outcomes with higher SIRS burden. CONCLUSION: Higher SIRS criteria are associated with greater disease severity, similar biochemical and prognostic scoring abnormalities, as well as a non-significant trend toward worse 30-day survival. Further prospective studies are warranted to clarify prognostic value of SIRS, guide treatment and risk stratification in AAH.
BACKGROUND: The pancreatic guidewire (PGW) technique is widely used as a salvage method for difficult biliary cannulation; however, risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP)...BACKGROUND: The pancreatic guidewire (PGW) technique is widely used as a salvage method for difficult biliary cannulation; however, risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in PGW cases remain unclear. Specifically, the role of detailed intraprocedural and morphological factors remains underexplored. AIM: To identify risk factors for PEP in PGW-assisted biliary cannulation using a retrospective video-based analysis. METHODS: We retrospectively reviewed patients who underwent ERCP with PGW-assisted biliary cannulation for naïve papillae at our institution between August 2017 and January 2023. Previously recorded endoscopic and fluoroscopic videos were analyzed to extract papillary morphology and intraprocedural variables. Multivariable logistic regression was used to identify factors associated with PEP. RESULTS: The PGW technique was used in 215 of 862 ERCP procedures for naïve papillae; 178 cases with available video recordings were included in the analysis. The cannulation success rate was 96.1%, and PEP occurred in 20 patients (11.2%). In multivariable analysis, cannulation time ≥ 20 min (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.14-11.0) and short oral protrusion of the papilla (< 10 mm vs. ≥ 10 mm; OR 3.01, 95% CI 1.11-8.15) were independently associated with PEP. Guidewire insertion into a pancreatic side branch tended to increase PEP risk (OR 2.48, 95% CI 0.89-6.93). CONCLUSION: In PGW-assisted biliary cannulation, prolonged cannulation time, a short oral protrusion, and pancreatic side-branch guidewire insertion are important risk factors for PEP. These findings may help refine risk stratification and inform technical decision-making and prophylactic strategies in cases of difficult biliary cannulation.
BACKGROUND: Colorectal cancer (CRC) exhibits extensive cellular heterogeneity and complex tumor microenvironment (TME) interactions, which influence tumor progression and treatment response. However, the precise interpla...BACKGROUND: Colorectal cancer (CRC) exhibits extensive cellular heterogeneity and complex tumor microenvironment (TME) interactions, which influence tumor progression and treatment response. However, the precise interplay between epithelial cells and cancer-associated fibroblasts and its prognostic relevance remain incompletely understood. METHODS: We performed single-cell RNA sequencing on CRC and matched normal tissues, integrating the data with spatial transcriptomics. Cellular heterogeneity, developmental trajectories, and intercellular communication were analyzed to identify key epithelial and fibroblast subpopulations. RESULTS: Nine epithelial and nine fibroblast subpopulations were identified, with FGGY + epithelial cells and COL11A1 + fibroblasts markedly enriched in tumors. Intercellular communication analysis revealed a tumor-specific epithelial-CAF axis mediated by PPIA-BSG signaling, accompanied by strong spatial co-localization. Trajectory and copy number variation (CNV) analyses indicated progenitor-like PLK1 + epithelial cells contribute to tumor plasticity. The FGCS score, derived from six genes from these two subsets, stratified patients by stage and survival, acting as an independent prognostic factor. CONCLUSION: This study provides a comprehensive, high-resolution view of CRC cellular and microenvironmental organization, revealing how epithelial-fibroblast interactions shape tumor progression and spatial niches, offering insights into CRC biology and potential therapeutic targets.
Prado R, Chatterjee A, Sierra L
… +12 more, Kaul R, Vikash FNU, Syed KA, Firkins S, Alkhayyat M, Simon R, Joyce D, Coppa C, Siddiki H, Stevens T, Mohiuddin S, Chahal P
PURPOSE: Chronic pancreatitis is a progressive inflammatory disorder marked by irreversible parenchymal injury, fibrosis, and multifactorial pain. Therapeutic endoscopy plays a central role in managing obstructive phenot...PURPOSE: Chronic pancreatitis is a progressive inflammatory disorder marked by irreversible parenchymal injury, fibrosis, and multifactorial pain. Therapeutic endoscopy plays a central role in managing obstructive phenotypes and selected complications. This review synthesizes contemporary evidence on endoscopic management of pancreatic duct stones, main pancreatic duct strictures, benign biliary strictures (BBS), pancreatic duct leaks, pancreatic pseudocysts, and endoscopic ultrasound-guided celiac plexus block, addressing the role of endoscopy. METHODS: A narrative review was performed, evaluating pain relief, ductal decompression, quality of life, adverse events, and reintervention across ERCP-based therapies, extracorporeal shock wave lithotripsy, pancreatoscopy-guided electrohydraulic or laser lithotripsy, and endoscopic management of pancreatic fluid collections and ductal leaks, and endoscopic ultrasound-guided pain interventions. RESULTS: In painful obstructive chronic pancreatitis, targeted endotherapy can provide symptom relief; however, randomized trials generally favor surgery drainage procedures and/or pancreatic resection over endoscopy for sustained pain control, ductal decompression, and physical quality of life, with comparable safety. ERCP alone is appropriate for small pancreatic duct stones, whereas larger stones are managed with extracorporeal shock wave lithotripsy or pancreatoscopy-guided electrohydraulic or laser lithotripsy to achieve ductal clearance. Main PD strictures are managed with dilation and stenting, with single large-caliber plastic stents preferred; routine use of fully covered self-expandable metal stents is discouraged due to higher adverse events. For chronic pancreatitis-associated BBS, fully covered metal and multiple plastic stents demonstrate similar long-term efficacy, with metal stents reducing procedural burden. Symptomatic PPCs are optimally managed endoscopically based on anatomy and ductal communication. EUS-CPB provides short-term analgesia for refractory pain. CONCLUSION: Endoscopic therapy is integral to multidisciplinary CP management, offering effective, anatomy-driven interventions, while surgery remains preferred for durable pain control in selected patients.
BACKGROUND AND AIM: Detection of intraductal neoplasms of the bile duct (IN-Bs) remains suboptimal despite various diagnostic modalities. We evaluated the efficacy of digital single-operator cholangioscopy (D-SOC) for sc...BACKGROUND AND AIM: Detection of intraductal neoplasms of the bile duct (IN-Bs) remains suboptimal despite various diagnostic modalities. We evaluated the efficacy of digital single-operator cholangioscopy (D-SOC) for screening and surveillance of IN-Bs in patients with bile duct dilatation after stone removal. METHODS: In a prospective cohort of 181 patients with post-stone removal common bile duct dilatation (> 10 mm), screening D-SOC was followed by two rounds of surveillance at 1-year intervals. Outcomes included cumulative incidence of IN-Bs, technical success of D-SOC and D-SOC-guided biopsy, and number needed to screen (NNS) to identify a neoplastic lesion at each round. RESULTS: Technical success of D-SOC was achieved in all patients. Among 181 patients who underwent D-SOC, nine were diagnosed with IN-Bs: cholangiocarcinoma (CCA) (n = 3), intraductal papillary neoplasms of the bile duct (n = 5), and adenoma with dysplasia (n = 1). Curative resection was performed in two patients with CCA. The cumulative incidence of IN-Bs was 6.3% (95% confidence interval, 2.4-10.7%). The NNS values to detect one neoplastic lesion were 29.4, 21.8, and 9.7 at initial screening and 1- and 2-year surveillance. CONCLUSION: D-SOC can be useful for risk-enriched detection and surveillance of IN-Bs in patients with post-stone-removal biliary dilatation, warranting further evaluation in those with additional CCA risk factors (clinical trial registration number: NCT05600803).