Gastroenterology[JOURNAL]
Sun
200 papers
Targeting Oncomucin-driven Immunosuppression Improves the Efficacy of K-ras Inhibition in Pancreatic Cancer.
Bhyravbhatla N, Alsafwani ZW, Thapa I … +14 more , Nallasamy P, Atri P, Moran Segura CM, Park MA, Khan I, Villalobos-Ayala K, Marimuthu S, Cox JL, Centeno BA, Aithal A, Malafa M, Ghersi D, Batra SK, Kumar S
Gastroenterology · 2026 May · PMID 42191046 · Publisher ↗
BACKGROUND & AIMS: Oncogenic de novo mucins (oncoMUCs; MUC4, MUC16, and MUC5AC) are progressively upregulated in pancreatic ductal adenocarcinoma (PDA). Although their individual cell-intrinsic roles have been investigat...
BACKGROUND & AIMS: Oncogenic de novo mucins (oncoMUCs; MUC4, MUC16, and MUC5AC) are progressively upregulated in pancreatic ductal adenocarcinoma (PDA). Although their individual cell-intrinsic roles have been investigated, their collective impact on PDA progression and the tumor microenvironment remains unclear. Evaluating the patient-centric impact of oncoMUCs on the tumor microenvironment will inform diagnostic and therapeutic strategies. METHODS: Integration of single-cell RNA sequencing (n = 34), multiplex/sequential immunostaining, and murine models characterized the oncomucinome. Immune suppression was investigated using NanoString profiling and gene silencing. Pharmacologic oncoMUC targeting (Istradefylline) was evaluated in combination with K-ras inhibitor in a syngeneic murine model. RESULTS: OncoMUCs showed extensive clonal diversity and survival disadvantage (P = .00013) in PDA. OncoMUC4 and oncoMUC16 subpopulations were enriched after stage IIA/B, and their deletion significantly reduced immune checkpoints (ICs) expression (V-domain immunoglobulin suppressor of T-cell activation [VISTA]: P < .0001, .001; T-cell immunoglobulin and mucin domain-containing protein 3: P < .0001, .001), and increased CD8 T-cell (P = .0087) and antigen-presenting cell infiltration (macrophages: P < .004; dendritic cells: P = .021) in tumors of PDA autochthonous models. Mechanistically, these subpopulations potentiate epidermal growth factor receptor and Unc-5 Netrin Receptor B signaling, which collaboratively upregulate ICs, VISTA, and programmed death ligand 1 (P < .0001). As Kras inhibition (MRTX1133) upregulated oncoMuc4 and oncoMuc16 expression, pharmacological targeting of oncoMUCs enhanced the efficacy of MRTX1133, as indicated by reduced tumor burden (P = .034), ICs (local, [P range 0.03-0.009] and systemic VISTA and T-cell immunoglobulin and mucin domain-containing protein 3 [P = .024, .014]), and Unc5b (P = .048) expression. CONCLUSIONS: Transmembrane oncoMUCs promote immune evasion in PDA through epidermal growth factor receptor/Unc-5 Netrin Receptor B signaling, and their targeting enhances the efficacy of K-ras inhibition, suggesting oncoMUCs as novel immune regulators and therapeutic targets in PDA.
Consensus on Irritable Bowel Syndrome-Like Symptoms in Inflammatory Bowel Disease: A Step Toward Advancing Patient-Centered Care.
Burisch J, Marsiglio M, Keszthelyi D
Gastroenterology · 2026 May · PMID 42191045 · Publisher ↗
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Ma Z, Yu X, Shi S
Gastroenterology · 2026 May · PMID 42191044 · Publisher ↗
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Clinical profile and hepatocellular cancer treatment patterns in resource limited settings- a cross-sectional observational study at two tertiary referral teaching hospitals, Addis Ababa, Ethiopia.
Hassen TJ, Nigussie S, Teshome H … +1 more , Seife H
BMC Gastroenterol · 2026 May · PMID 42185963 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) imposes a high global burden. A significant treatment gap exists in low- and middle-income countries (LMICs), where low rates of curative surgical intervention highlight profoun...
BACKGROUND: Hepatocellular carcinoma (HCC) imposes a high global burden. A significant treatment gap exists in low- and middle-income countries (LMICs), where low rates of curative surgical intervention highlight profound healthcare inequities. OBJECTIVE: To evaluate the clinical profile and treatment patterns of HCC patients at TASH and SPHMMC Addis Ababa, Ethiopia. METHODS: This hospital-based cross-sectional observational study included 130 HCC patients. Continuous variables were assessed for normality using the Shapiro-Wilk test and described using means and ± SD, while medians and IQR used for skewed data. RESULTS: The mean age was 54.5 ± 16.5 years with a 63.1% male predominance. Although viral hepatitis was common (47.7%; HBV: 72.6%, HCV: 22.6%), a high proportion of patients (37.0%) presented with cryptogenic (unidentified) risk factors. Late-stage presentation was characteristic, evidenced by a mean tumor size of 10.0(± 4.6) cm and 63.8% of patients being BCLC stage C. 50% of cirrhotic patients were Child-Pugh B. These factors limited curative options, with resection performed in only 17.7% of the cohort, while 27.7% received TACE. CONCLUSION: Most HCC patients in this setting present with advanced-stage disease and large tumor burdens, leading to low curative resection rates. Addressing deficiencies in specialized human resources, infrastructure, and policy gaps is critical to improving access to life-saving surgical and loco-regional interventions.
Rare hilar giant cystic cholangiogenic adenoma: a case report and literature review.
Jiang W, Su H, Liang S … +1 more , Wang Z
BMC Gastroenterol · 2026 May · PMID 42185959 · Full text
Laparoscopic resection of giant hilar biliary cystadenoma has been rarely documented in clinical literature. Here, we report a case of a 51-year-old female patient whose laboratory results were unremarkable, while abdomi...
Laparoscopic resection of giant hilar biliary cystadenoma has been rarely documented in clinical literature. Here, we report a case of a 51-year-old female patient whose laboratory results were unremarkable, while abdominal imaging identified a large cystic lesion located in the hepatic hilum. The patient underwent laparoscopic tumor resection under general anesthesia. During surgery, the tumor was noted to significantly compress nearby hilar structures-including the portal vein and gallbladder-and had a communication with the left hepatic duct. The tumor was successfully resected en bloc, and pathological analysis confirmed it to be a hilar biliary cystadenoma. Postoperatively, the patient recovered uneventfully without any complications and was discharged in good condition. No tumor recurrence was detected at the 6-month follow-up visit. This case underscores the potential for misdiagnosis of large hilar biliary cystadenomas and shows that laparoscopic resection is a viable therapeutic option for these lesions.
Machine learning-based preoperative classification of colorectal cancer stage using systemic inflammatory and nutritional biomarkers.
Karacan E, Guven H, Kale H … +2 more , Ersoy ÖF, Uzuncu HB
BMC Gastroenterol · 2026 May · PMID 42185951 · Full text
BACKGROUND: Accurate preoperative staging in colorectal cancer (CRC) is critical for determining the appropriate treatment strategy. This study evaluated whether early-stage (TNM I-II) and advanced-stage (TNM III-IV) CRC...
BACKGROUND: Accurate preoperative staging in colorectal cancer (CRC) is critical for determining the appropriate treatment strategy. This study evaluated whether early-stage (TNM I-II) and advanced-stage (TNM III-IV) CRC could be distinguished using machine learning (ML) models in conjunction with biomarkers reflecting systemic inflammatory and nutritional status. METHODS: We retrospectively analyzed data of 204 patients with CRC. Preoperative variables included tumor size, tumor markers (carcinoembryonic antigen [CEA] and CA 19-9), and inflammation and nutrition-based biomarkers derived from routine laboratory tests. Five supervised machine learning models (random forest, gradient boosting, logistic regression, neural network, and naive Bayes) were developed and evaluated using stratified cross-validation. Model performance was evaluated using the area under the curve (AUC), accuracy, F1 score, and Matthews correlation coefficient (MCC). Model interpretability was examined using SHAP analysis. RESULTS: We evaluated 204 patients (103 early-stage and 101 advanced-stage). Advanced-stage disease was significantly associated with higher inflammatory indices and lower nutritional biomarkers (all p < 0.01). Ensemble-based models showed the strongest performance, whereas the random forest algorithm achieved the highest discriminatory performance (area under the curve [AUC]: 0.91; accuracy: 0.85). SHAP analysis revealed HALP, PLR, and LMR as the most effective predictors and suggested that systemic inflammatory and nutritional status may contribute more to stage differentiation than tumor size. CONCLUSION: Machine learning models incorporating routinely available inflammatory and nutritional biomarkers may help differentiate early-stage from advanced-stage colorectal cancer in the preoperative setting. However, larger multicenter studies with external validation are needed to confirm the generalizability of these findings.
The quality and reliability of short videos about choledocholithiasis on TikTok and Bilibili in China.
Lu X, Fang Y, Chen D
BMC Gastroenterol · 2026 May · PMID 42185762 · Full text
BACKGROUND: Choledocholithiasis, a disease with a rising incidence and potential for severe complications, has prompted many to seek health information online. TikTok and Bilibili have emerged as key platforms for dissem...
BACKGROUND: Choledocholithiasis, a disease with a rising incidence and potential for severe complications, has prompted many to seek health information online. TikTok and Bilibili have emerged as key platforms for disseminating such information. This study evaluates the quality and reliability of short videos on choledocholithiasis on these platforms. METHODS: This study analyzed the top 100 choledocholithiasis-related videos from TikTok and Bilibili. The Global Quality Score (GQS), modified DISCERN (mDISCERN) tool, and the Journal of the American Medical Association (JAMA) criteria were employed to assess video quality. Cohen's Kappa coefficient is used to assess inter-rater agreement.Group comparisons were conducted using Mann-Whitney U and Kruskal-Wallis H tests, while Spearman's correlation was utilized for correlation analysis. RESULTS: A total of 170 videos were included, predominantly uploaded by hepatobiliary surgeons. The content of these videos mainly focuses on treatment (81.76%), with limited coverage of etiology and diagnosis. The overall video quality was mediocre, with median scores of 3 for GQS (IQR: 3.00-4.00), 2 for mDISCERN (IQR: 2.00-2.00), and 2 for JAMA (IQR: 2.00-2.00). Videos from hepatobiliary surgeons generally exhibited superior quality. Notably, video quality showed no correlation with engagement metrics. CONCLUSIONS: The content of choledocholithiasis-related videos is structurally deficient. The videos' quality, reliability, and transparency are relatively poor, though those uploaded by hepatobiliary surgeons stand out for their superior quality and reliability. Importantly, video quality is independent of engagement metrics.
Combined preoperative PNI and APRI for risk stratification after curative hepatectomy for hepatocellular carcinoma.
Takahashi D, Maeda A, Aoyama H … +2 more , Takahashi T, Takayama Y
BMC Gastroenterol · 2026 May · PMID 42185759 · Full text
BACKGROUND: Long-term outcomes after curative hepatectomy for hepatocellular carcinoma (HCC) remain heterogeneous, yet simple preoperative tools for postoperative risk stratification are limited. We investigated whether...
BACKGROUND: Long-term outcomes after curative hepatectomy for hepatocellular carcinoma (HCC) remain heterogeneous, yet simple preoperative tools for postoperative risk stratification are limited. We investigated whether combining representative inflammation/nutrition- and fibrosis-related markers could improve pragmatic risk stratification after hepatectomy. METHODS: We retrospectively analyzed 343 consecutive patients who underwent curative hepatectomy for primary HCC between June 2010 and November 2020 at a single tertiary center. Preoperative laboratory data obtained within 4 weeks before surgery were used to calculate candidate inflammation-based scores and fibrosis markers. Cut-offs were derived using receiver operating characteristic analysis for 5-year mortality. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods and Cox proportional hazards models adjusted for a prespecified clinical covariate set. Discrimination, calibration, and bootstrap internal validation were also evaluated. RESULTS: In separate multivariable models using the same clinical adjustment set, low prognostic nutritional index (PNI) and high aspartate aminotransferase-to-platelet ratio index (APRI) were independently associated with worse OS and RFS. A combined PNI-APRI classification stratified patients into low-, intermediate-, and high-risk groups with 5-year OS rates of 82.5%, 74.5%, and 49.7%, respectively, and 5-year RFS rates of 47.7%, 38.2%, and 18.6%, respectively. Compared with the low-risk group, the adjusted hazard ratio for the high-risk group was 2.72 for OS and 2.12 for RFS. Adding the composite classification to the base clinical model improved the C-index from 0.703 to 0.722 for OS and from 0.634 to 0.648 for RFS. Calibration was acceptable, and optimism-corrected C-index values after bootstrap internal validation were 0.705 for OS and 0.633 for RFS. CONCLUSIONS: Preoperative PNI and APRI captured complementary host domains and, when combined, provided a simple classification associated with both OS and RFS after curative hepatectomy for HCC. Pending external validation, this routine laboratory-based approach may serve as a simple adjunct to existing clinical assessment when planning perioperative optimization and postoperative follow-up.
The impact of gastric adenocarcinoma location and clinical and socioeconomic determinants on survival: a retrospective population-based cohort study using SEER data (1975-2016).
Tsay C, Chen K, Sahyoun L … +1 more , Protiva P
BMC Gastroenterol · 2026 May · PMID 42178521 · Full text
BACKGROUND: Despite the decreasing incidence of gastric cancer in the United States, cancers of the stomach remain one of the leading causes of cancer related death in globally. Most patients are asymptomatic and have ad...
BACKGROUND: Despite the decreasing incidence of gastric cancer in the United States, cancers of the stomach remain one of the leading causes of cancer related death in globally. Most patients are asymptomatic and have advanced disease when diagnosed. Studies have shown similar prognosis for proximal and distal tumors, although most studies exclude lesions in the cardia given overlap with esophageal cancers. Distal tumors involving the pylorus often leads to symptoms, such as gastric outlet obstruction presenting with nausea and emesis, which may lead to earlier diagnosis; therefore, we compared the adjusted survival with gastric adenocarcinomas based on location. METHODS: Using SEER*Stat software, we performed a retrospective cohort study by extracting U.S. survival data from the Surveillance, Epidemiology and End Results Database for all gastric adenocarcinomas based on location (antrum, body, fundus, pylorus) for the period between 1975 and 2016 for individuals aged > 30 years of age. Survival was compared by calculating relative hazard ratios (HRs) for cancer-specific death in the 5-year period following diagnosis with Cox proportional hazards models, adjusted for covariates, with significance set at p < 0.05. Data were analyzed using SAS 9.4 software and R. RESULTS: Survival analysis included 31,158 patients and showed no survival benefit comparing adenocarcinomas of the pylorus with those in the antrum (HR 1.02, 95% CI 0.97-1.07), body (HR 1.03, 95% CI 0.97-1.09). However, lower survival was seen for those in the fundus (HR 1.19, 95% CI 1.12-1.27). Male sex (HR 1.13, 95% CI 1.10-1.27), older age (HR 1.26, 95% CI 1.21-1.30), lack of chemotherapy (HR 1.06, 95% CI 1.02-1.10) and absence of surgery (HR 1.45, 95% CI 1.38-1.53) were associated with higher mortality. There were also statistically significant differences across higher stage and grade tumors, racial groups, and marital status. CONCLUSONS: Despite early presentation of symptoms, our study corroborated data suggesting no difference in prognosis between pyloric gastric adenocarcinomas and proximal tumors, except those in the fundus. While involvement of the pylorus often leads to clear clinical manifestations including weight loss, early satiety, nausea, and emesis, earlier identification of malignancy compared to adenocarcinomas in more indolent locations does not necessarily improve survival outcomes.
Precision Xenogenomics: A Major Milestone in Bridging the Organ Gap.
Malhi H, DeBosch BJ
Gastroenterology · 2026 May · PMID 42178030 · Publisher ↗
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Feasibility, safety and accuracy of a novel robotic navigation system for cone-beam CT-guided and TACE-assisted radiofrequency ablation of hepatocellular carcinoma, a preliminary study.
Liu Z, Lyu T, Hu L … +8 more , Fan S, Zhou S, Sun Y, Deng W, Song L, Tong X, Zou Y, Wang J
BMC Gastroenterol · 2026 May · PMID 42177414 · Full text
PURPOSE: To evaluate the technical feasibility, targeting accuracy and short-term safety of a novel integrated system of the robot-navigated, cone-beam CT (CBCT)-guided and transarterial chemoembolization (TACE)-assisted...
PURPOSE: To evaluate the technical feasibility, targeting accuracy and short-term safety of a novel integrated system of the robot-navigated, cone-beam CT (CBCT)-guided and transarterial chemoembolization (TACE)-assisted radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in high-risk locations. MATERIALS AND METHODS: This retrospective, single-center study enrolled 11 participants with HCC lesions in high-risk locations. All participants underwent TACE followed by RFA navigated by a novel robotic system. Trajectory planning was based on respiratory-gated CBCT images and the subsequent needle insertion was guided by real-time fluoroscopy. The evaluated outcomes included the first placement accuracy, the adequate placement accuracy, targeting time, repositioning times, radiation exposure dose, complications and the 1-month complete ablation rate. RESULTS: The cohort included 10 males and 1 female. Technical success was achieved in 100% (11/11) of cases. The median tumor diameter was 16.20 mm and the mean tumor depth was 79.37 mm. Seven tumors were located in the subdiaphragmatic position, three tumors were situated adjacent to major vascular structures and one tumor was located adjacent to extrahepatic organs. The median Euclidean error and angle error of the first placement were 6.2 mm and 3.0 degrees, respectively. The median Euclidean error and angle error of the adequate placement was 2.2 mm and 1.3 degrees. The median targeting time was 6.70 min (range, 1.55-29.52 min) and the median number of repositioning adjustments was 2. The mean cumulative air kerma was 216.34 mGy. The 1-month complete ablation rate was 81.8% (9/11) following adjunctive ablation in 2 patients. No major complications were reported. CONCLUSION: The integrated platform of robotic-navigated, real-time CBCT-guided, and TACE-assisted RFA is technically feasible and demonstrates short-term safety. In this cohort, it achieves preliminary targeting accuracy for the ablation of HCC in high-risk locations.
Association of metabolic vulnerability index with various chronic liver diseases and mortality: a large prospective cohort study.
Qin Z, Yang K, Liang Z … +5 more , Gao L, Liu Y, Peng J, Wei H, Zhang S
BMC Gastroenterol · 2026 May · PMID 42177400 · Full text
BACKGROUND: The association between metabolic vulnerability index (MVX), a composite biomarker integrating inflammatory and metabolic pathways, and chronic liver diseases (CLDs) is still unclear. METHODS: This prospectiv...
BACKGROUND: The association between metabolic vulnerability index (MVX), a composite biomarker integrating inflammatory and metabolic pathways, and chronic liver diseases (CLDs) is still unclear. METHODS: This prospective cohort study included 255,171 participants from the UK Biobank, with a median follow-up period of 13.71 years. Multivariable-adjusted cox proportional hazards models, restricted cubic splines (RCS) and sensitivity analyses were used to evaluate the association between MVX and CLDs. RESULTS: This study showed that higher levels of MVX (Q4 vs Q1) significantly increased the risk of CLDs after adjusted by socio-demographic and health status factors (all P < 0.05): cirrhosis (HR = 1.60, 95%CI:1.38-1.86), alcoholic-related liver disease (HR = 1.34, 95%CI:1.07-1.68), autoimmune liver disease (HR = 1.35, 95%CI:1.12-1.62), liver and biliary tract cancer (HR = 1.32, 95%CI:1.05-1.66), liver disease-related death (HR = 2.11, 95%CI:1.59-2.80), and all-cause mortality (HR = 1.17, 95%CI:1.13-1.21). No association was found between MVX and viral hepatitis. RCS and threshold analysis showed a reverse L-shaped association between MVX and cirrhosis and liver-related deaths, a linearly increasing association with AILD and LBC, and a J-shaped association with ALD and all-cause mortality. Subgroups analysis and sensitivity analyses demonstrated stable correlation between MVX and CLDs and death events. CONCLUSION: MVX is a promising indicator for independently predicting CLD events, liver-related mortality, and all-cause mortality. As a marker of metabolic-inflammatory dysregulation, MVX may enable early identification of high-risk individuals for targeted primary prevention of CLDs.
Management of Helicobacter pylori-Associated Disease in a Child: Clinical Considerations Beyond a One-Size-Fits-All Approach.
Bonilla S, Harris P, Homan M
Gastroenterology · 2026 May · PMID 42176869 · Publisher ↗
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A retrospective observational study: are gallstone patients aging, or are the elderly more susceptible to gallstones?
Gu L, Cai J, Wang F … +4 more , Gao X, Huang Y, Zhou Z, Zheng Y
BMC Gastroenterol · 2026 May · PMID 42174457 · Full text
BACKGROUND: Gallstone disease is a common clinical condition worldwide, with a global incidence ranging from less than 10% to over 40% and affecting approximately 3-11% of the population in China. This high and increasin...
BACKGROUND: Gallstone disease is a common clinical condition worldwide, with a global incidence ranging from less than 10% to over 40% and affecting approximately 3-11% of the population in China. This high and increasing prevalence places a significant burden on healthcare resources due to the costs associated with diagnosis, treatment, and long-term follow-up. More importantly, gallstones can lead to severe complications, such as acute cholecystitis, cholangitis, and pancreatitis, establishing the disease as a major public health concern. Although traditionally associated with a higher incidence in middle-aged women, the number of elderly patients with gallstones is rising as Chinese society ages. However, large-scale epidemiological studies covering the entire adult age spectrum and explicitly exploring the relationship between age and gallstone incidence remain scarce. Furthermore, while numerous studies have investigated risk factors for gallstone formation, few have examined the dynamic changes in individual-level data before and after stone formation-an approach that could offer more valuable insights for personalized prevention. Therefore, this study aims to address these gaps through a retrospective analysis of 10 years of health examination data, to explore the incidence trend and preventable risk factors for gallstones, and ultimately to provide a basis for improving clinical management and prevention strategies. METHODS: Through the retrospective analysis from January 2012 to December 2021 in Xuanwu Hospital, Capital Medical University physical examination center for health examination related data, select those who have no gallstones on baseline data and receive two or more ultrasound examinations. A total of 37,440 subjects were included in the study, Age (44.48 ± 16.06) (range 16-103 years). Gallstones were confirmed by repeated ultrasound examinations. Then, according to the data before and after the formation of gallstones, the subjects were divided into study group and control group. Rank-sum test and χ2 test were used to analyze the data statistically and explored the risk factors for gallstone formation by Logistic regression analysis. RESULTS: 1401 subjects were confirmed the gallstones, 699 men, 702 women, age (59.57 ± 16.12) years (range: 22-103 years old), and the incidence of gallstones was 3.73%. The incidence of gallstones in the elderly aged 65 years and above was significantly higher than that in the young and middle-aged group below 65 [11.88% (553 / 4653): 2.59% (848 / 32788)], and the difference was statistically significant (χ2 = 3183.17, P < 0.001), the incidence of gallstones in men and women increased with age. The incidence was lower in women than in men before age 30. After age 30, it is more common in female than in male. Multivariate logistic-analysis found statistically significant differences in age, waist circumference, aspartate aminotransferase, fasting blood glucose, triglycerides, and high-density lipoprotein. CONCLUSION: The incidence of gallstones in the elderly aged 65 years and above is significantly higher than that in the young and middle-aged people. The incidence of gallstones increases with age, the older the age, the higher the incidence of gallstones, as was seen in both men and women. Age, waist circumference, aspartate aminotransferase and fasting blood glucose are risk factors for gallstone formation, triglycerides and high-density lipoprotein are protective factors for gallstone formation.
Prognostic model for patients with hepatoid adenocarcinoma of the stomach.
Tong S, Xu B, Ye X … +2 more , Yin J, Hu H
BMC Gastroenterol · 2026 May · PMID 42174453 · Full text
INTRODUCTION: Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer. This study assessed the impact of tumor node metastasis (TNM) stage on survival in HAS compared with non-HAS patients, identifi...
INTRODUCTION: Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer. This study assessed the impact of tumor node metastasis (TNM) stage on survival in HAS compared with non-HAS patients, identified prognostic factors, and developed a predictive nomogram. METHODS: Patients diagnosed with HAS between September 2012 and August 2022 were retrospectively analyzed. Clinical characteristics and survival outcomes were compared between HAS and non-HAS groups before and after TNM stage matching. Prognostic factors were determined using Kaplan-Meier and Cox regression analyses, and nomograms were constructed for survival prediction. RESULTS: Without stage matching, HAS patients showed significantly worse survival than non-HAS patients (HR = 3.09, 95% CI: 2.05-4.67, p < 0.001). After TNM stage matching, no significant difference was observed (HR = 1.14, 95% CI: 0.79-1.64, p = 0.476). The nomogram model incorporating Sal-like protein 4 (SALL4), serum iron (Fe), and free prostate-specific antigen (fPSA) accurately predicted overall survival (AUC = 0.946, 95% CI: 0.897-0.994). CONCLUSIONS: These findings suggest that poorer outcomes in HAS are primarily due to advanced TNM stages, and that SALL4, serum Fe, and fPSA serve as key prognostic indicators.
Comparison of early and late drainage interventions in necrotizing pancreatitis: a systematic review and meta-analysis.
Zhang G, Zhao B, Deng T … +4 more , He X, Chen Y, Zhong C, Chen J
BMC Gastroenterol · 2026 May · PMID 42174434 · Full text
OBJECTIVE: This study was designed to evaluate differences in mortality, complication rates, and length of hospital stay between early (≤ 4 weeks) and delayed (> 4 weeks) minimally invasive drainage in patients with necr...
OBJECTIVE: This study was designed to evaluate differences in mortality, complication rates, and length of hospital stay between early (≤ 4 weeks) and delayed (> 4 weeks) minimally invasive drainage in patients with necrotizing pancreatitis (NP) through the synthesis of existing evidence. METHODS: Databases including PubMed, Embase, and the Cochrane Library were searched up to November 1, 2025. Eligible randomized controlled trials (RCTs) and cohort studies were included. Literature screening and data extraction were conducted in accordance with the PRISMA guidelines, and a random-effects model was employed for meta-analysis. RESULTS: A total of 11 studies involving 1,697 patients were included. Meta-analysis results demonstrated that the mortality rate in the early drainage intervention group was significantly higher than that in the delayed drainage intervention group (RR = 1.38; 95%CI 1.05-1.81; P = 0.02), though the stability of this finding was poor. The proportion of patients requiring subsequent further debridement was significantly higher in the early drainage intervention group compared with the delayed drainage intervention group (RR = 2.05; 95%CI 1.26-3.31; P = 0.004). No significant differences were detected between the two groups in terms of length of hospital stay (P = 0.17), length of intensive care unit (ICU) stay (P = 0.25), or the incidence of complications (P > 0.05). CONCLUSION: This meta-analysis supports prioritizing delayed drainage in the treatment of NP, as it reduces the need for subsequent invasive debridement procedures; however, early drainage may still hold significant value patients with infection or organ failure.
Comparison of surgical safety among different comprehensive treatment models for adenocarcinoma of esophagogastric junction: a single-center cohort study.
Dai H, Wang Y, Shan F … +8 more , Li S, Jia Y, Xue K, Miao R, Li Z, Xiu X, Li Z, Ji J
BMC Gastroenterol · 2026 May · PMID 42174414 · Full text
BACKGROUND: Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (nCRT) are increasingly used to treat adenocarcinoma of the esophagogastric junction (AEG). However, there is insufficient clinical evidence to...
BACKGROUND: Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (nCRT) are increasingly used to treat adenocarcinoma of the esophagogastric junction (AEG). However, there is insufficient clinical evidence to compare surgical safety among the three comprehensive treatment models, including the surgery‑first model, NAC model, and nCRT model. Therefore, this study was designed to compare surgical safety of the three comprehensive treatment models. METHODS: This is a retrospective cohort study. From January 2012 to December 2018, 276 consecutive patients with Siewert II and III AEG (cT2-4NxM0) in the Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute were enrolled in this study. All these patients underwent surgery and were categorized into three groups: surgery‑first group, NAC group and nCRT group. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the three groups. RESULTS: The overall postoperative complication rate in nCRT groups was 59.6%, which was significantly higher than that in the surgery-first group (42.2%, P = 0.040) and the NAC group (39.3%, P = 0.027). Moreover, the rate of major postoperative complications differed significantly among the three groups (P = 0.011), with the nCRT group showing a notably higher incidence than the surgery-first group (P = 0.008) and the NAC group (P = 0.043). No significant differences in postoperative complication rates were found between the surgery-first group and the NAC group. After IPTW, nCRT was significantly associated with increased postoperative complication (weighed OR = 2.25, 95% CI: 1.13-4.50, P = 0.022), and major postoperative complications (weighed OR:3.27, 95% CI: 1.45-7.39, P = 0.005). Thoracoabdominal approach (weighed OR = 6.47, 95% CI: 1.44-29.13, P = 0.015), combined organ resection (weighed OR = 5.08, 95% CI: 1.66-15.51, P = 0.004), and operative time exceeding 240 min (weighed OR = 2.23, 95% CI: 1.20-4.12, P = 0.011) were also identified as independent risk factors for postoperative complications. CONCLUSIONS: Neoadjuvant chemotherapy did not increase the risk of postoperative complications. In contrast, nCRT was associated with worse postoperative complications. We should pay more attention to AEG patients receiving neoadjuvant chemoradiotherapy.
Promoting High-Quality Palliative Care for Minoritized Sexual and Gender Identity Populations With Advanced Liver Disease.
Nikzad N, Patel AA, Patel P … +3 more , Newman KL, Woodrell CD, Paul S
Gastroenterology · 2026 Jun · PMID 42173621 · Publisher ↗
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Comparative effectiveness of the Clutch Cutter versus Dual knife for esophageal endoscopic submucosal dissection by non-expert endoscopists: a single-center retrospective cohort study.
Terasaki K, Sakai K, Yorioka Y … +15 more , Kimura H, Fujiishi S, Fujinami M, Watanabe K, Amioka S, Nonaka T, Miura T, Okuda K, Oya H, Katayama T, Fukumoto K, Mitsumoto Y, Mizuno C, Shima T, Okanoue T
BMC Gastroenterol · 2026 May · PMID 42168899 · Full text
BACKGROUND: A Clutch Cutter is a grasping scissor forceps device used for endoscopic submucosal dissection (ESD). This device can grasp and incise the target tissue similar to the action of a biopsy forceps. Therefore, E...
BACKGROUND: A Clutch Cutter is a grasping scissor forceps device used for endoscopic submucosal dissection (ESD). This device can grasp and incise the target tissue similar to the action of a biopsy forceps. Therefore, ESD with a Clutch Cutter may be easier and safer than that performed with non-scissor-type knives. This study verified the usefulness of the Clutch Cutter by nonexpert endoscopists during ESD for superficial esophageal cancer. METHODS: This single-center retrospective cohort study enrolled 125 patients who underwent ESD as a first-line therapy for superficial esophageal cancer between January 2016 and June 2023 at Saiseikai Suita Hospital. The patients were divided into groups based on the ESD device: a Clutch Cutter or a non-scissor-type device (dual knife). The clinical characteristics and technical outcomes were compared between the two groups. RESULTS: Among one hundred twenty-five patients, seventy-nine patients underwent nonexpert endoscopic treatment, of which twenty-one patients underwent ESD with a Clutch Cutter and fifty-eight patients with a dual knife. There is a significant difference in sex distribution between the two groups, with a higher percentage of males in the dual knife group (94.8%) compared to the Clutch Cutter group (71.4%) (p = 0.01). Patients in the Clutch Cutter group had shorter procedure times (60 min) than those in the dual knife group (93 min) (p = 0.002). However, en bloc and R0 resection rates were not significantly different between the groups. In the multivariate analysis, procedure time (min) was significantly correlated with device type (coefficient 58.86, 95% confidence interval: 26.99-90.72) and tumor size (coefficient 4.9, 95% confidence interval: 3.58-6.21). CONCLUSION: ESD for superficial esophageal cancer with the Clutch Cutter significantly shortened procedure time compared to that with the dual knife for nonexpert endoscopists. Therefore, the Clutch Cutter may be a preferred-device for nonexpert endoscopists.
Clinicopathological characteristics and stage-adjusted outcomes of sporadic pMMR/MSS early-onset colorectal cancer.
Momma T, Okayama H, Hasegawa M … +9 more , Kawamata T, Takiguchi C, Fukai S, Sato T, Ito M, Ujiie D, Chida S, Saito M, Kono K
BMC Gastroenterol · 2026 May · PMID 42168886 · Full text
BACKGROUND: The global incidence of early-onset colorectal cancer (EOCRC) is increasing. The prognostic impact of EOCRC remains controversial, as it is largely confounded by hereditary syndromes and mismatch repair defic...
BACKGROUND: The global incidence of early-onset colorectal cancer (EOCRC) is increasing. The prognostic impact of EOCRC remains controversial, as it is largely confounded by hereditary syndromes and mismatch repair deficient (dMMR)/microsatellite instability-high (MSI-H) tumors. We aimed to evaluate the clinicopathological features and stage-adjusted outcomes of sporadic, proficient MMR/microsatellite stable (pMMR/MSS) EOCRC. METHODS: We retrospectively reviewed 1,600 consecutive patients who underwent primary tumor resection for Stage 0-IV CRC. After excluding patients with known hereditary cancer syndromes or inflammatory bowel disease (IBD)-related CRC, as well as those with dMMR/MSI-H tumors or unknown MMR/MSI status, 1,218 patients with sporadic pMMR/MSS CRC were analyzed. Patients were stratified into EOCRC (< 50 years, n = 86) and late-onset CRC (LOCRC, ≥ 50 years, n = 1,132) cohorts. Cancer-specific survival (CSS) and time to recurrence (TTR) were evaluated. RESULTS: Patients with EOCRC were more often diagnosed at an advanced stage than those with LOCRC (P < 0.001). Unadjusted CSS was worse in the EOCRC group (P = 0.042); however, multivariable analysis showed that EOCRC was not an independent predictor of worse CSS (adjusted hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.49-1.37, P = 0.512). Among 987 patients with curatively resected Stage I-III disease, the EOCRC group received significantly more intensive perioperative treatments (P < 0.001). Unadjusted TTR did not significantly differ between the age groups (P = 0.510), and multivariable analysis showed a non-significant tendency toward a lower recurrence risk in patients with EOCRC (adjusted HR 0.52, 95% CI 0.23-1.03, P = 0.084). CONCLUSIONS: After exclusion of hereditary syndromes, IBD-related CRC, and dMMR/MSI-H tumors, pMMR/MSS EOCRC more often presented with advanced disease, but its stage-adjusted cancer-specific survival and recurrence outcomes did not significantly differ from those of LOCRC.
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