Gastroenterology Insights

12 pages, 704 KB

Open AccessArticle

Vitamin D Insufficiency and Deficiency in Chronic Pancreatitis: Association with Disease Progression and Cardiovascular Risk

by Mila Kovacheva-Slavova, Plamen Gecov, Neli Georgieva, Victor Dimitrov, Nikolay Penkov and Borislav Vladimirov

Gastroenterol. Insights 2025, 16(4), 49; https://doi.org/10.3390/gastroent16040049 - 16 Dec 2025

Viewed by 934

Abstract

Background: Vitamin D (VD) insufficiency is present in chronic pancreatitis (CP), leading to increased cardiovascular risk, bone complications, impaired quality of life, and increased mortality. This study aimed to determine the prevalence of VD deficiency in patients with CP and to assess its [...] Read more.

Background: Vitamin D (VD) insufficiency is present in chronic pancreatitis (CP), leading to increased cardiovascular risk, bone complications, impaired quality of life, and increased mortality. This study aimed to determine the prevalence of VD deficiency in patients with CP and to assess its relationship to CP progression and associated cardiovascular complications. Methods: Seventy patients were enrolled and evaluated for pancreatic exocrine insufficiency by fecal elastase-1, CP severity by M-ANNHEIM classification, cardiovascular risk by 10-year risk mortality scores (SCORE and FRS), and for arterial stiffness using pulse wave velocity (PWV) at a. carotis and a. femoralis. Determination of 25-hydroxyvitamin D was performed by an LC-MS/MS method. Resting energy expenditure was calculated using the Harris–Benedict formula. Results: Mean VD levels were 37.86 ± 24.36 nmol/L (range 3.854–99.874 nmol/L); only five patients were in sufficiency status. VD levels correlated significantly with body mass index (BMI) and resting energy expenditure. In patients with severe structural changes, we observed lower VD levels regardless of etiology (p < 0.01). VD levels were lower in patients with pancreatic exocrine insufficiency (PEI), p < 0.05. Patients with mild CP by M-ANNHEIM had lower levels of VD compared to moderate and advanced CP, p < 0.05. At a cut-off of VD 11.95 nmol/L, we verified pancreatic lithiasis with 89.4% sensitivity, 83.3% specificity, and AUC of 0.826 ± 0.113 (95% CI, 0.61–1). VD status worsened with the increase in the 10-year risk mortality by both SCORE and FRS and PWV, p < 0.05. Conclusions: Most of our patients with CP were VD insufficient. Monitoring of nutritional status in patients with CP is mandatory to prevent the development of malnutrition complications and the associated morbidity and mortality. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 783 KB

Open AccessArticle

Clinical and Endoscopic Features of Upper Gastrointestinal Bleeding Associated with Helicobacter pylori Infection: A Retrospective Cohort Study in the Colombian Caribbean (2021–2023)

by Lizeth Garzón-Guerron, Carlos Jiménez-Lacouture, Andrés Cadena Bonfanti, Alex Dominguez Vargas and Henry J. González-Torres

Gastroenterol. Insights 2025, 16(4), 48; https://doi.org/10.3390/gastroent16040048 - 4 Dec 2025

Viewed by 825

Abstract

Background/Objectives: Helicobacter pylori infection is a key etiological factor in upper gastrointestinal bleeding (UGIB) due to its role in mucosal injury and ulcer formation. Despite its clinical relevance, data from the Colombian Caribbean are limited. This study aimed to describe the incidence [...] Read more.

Background/Objectives: Helicobacter pylori infection is a key etiological factor in upper gastrointestinal bleeding (UGIB) due to its role in mucosal injury and ulcer formation. Despite its clinical relevance, data from the Colombian Caribbean are limited. This study aimed to describe the incidence and clinical–endoscopic features of H. pylori-associated UGIB in a high-complexity hospital in Barranquilla, Colombia. Methods: A retrospective cohort study was conducted including adults (≥18 years) admitted for UGIB between 2021 and 2023. Demographic, clinical, and endoscopic variables were obtained from institutional records. Non-parametric tests (Fisher’s exact, Wilcoxon rank-sum) were applied to compare sex and admission diagnosis. Multiple-correspondence analysis explored associations among clinical and pathological parameters. Significance was set at p < 0.05. Results: Among 329 patients with UGIB, 44 (13%) tested positive for H. pylori. The median age was 60 years, and 57% were male. Melena (48%) and hematemesis (45%) were the main presenting symptoms. Hypertension was significantly more frequent in men (45% vs. 15%, p = 0.04), while chronic gastritis was the most common histopathological finding (75%), followed by gastrointestinal ulcer (23%) and intestinal adenocarcinoma (16%). The majority of ulcers were Forrest IIA (50%), followed by III (40%) and IB (10%), with no sex differences (p > 0.92). Multiple correspondence analysis revealed that male patients tended to present melena and chronic gastritis, whereas females and older adults were more likely to exhibit hematemesis. Conclusions: H. pylori-associated UGIB in this cohort primarily affected older adults with chronic gastritis and hypertension. Recognition of these clinical–pathological profiles may guide early detection, targeted therapy, and prevention strategies in similar regional contexts. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 2650 KB

Open AccessArticle

Clinical Value of Ultrasound Fat Fraction in Grading Hepatic Steatosis: Preliminary Cut-Off Values in Obese Patients

by Francesca Ibba, Carlo Airola, Tommaso Rozera, Lucrezia Petrucci, Giorgio Carlino, Simone Varca, Chiara Cavallaro, Nicoletta De Matthaeis and Fabrizio Pizzolante

Gastroenterol. Insights 2025, 16(4), 47; https://doi.org/10.3390/gastroent16040047 - 1 Dec 2025

Viewed by 1668

Abstract

Objectives: Liver steatosis is one of the main causes of liver disease with several clinical implications, such as steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. It is associated with increased cardiovascular risk. Reliable, non-invasive methods to classify and evaluate improvement or worsening of [...] Read more.

Objectives: Liver steatosis is one of the main causes of liver disease with several clinical implications, such as steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. It is associated with increased cardiovascular risk. Reliable, non-invasive methods to classify and evaluate improvement or worsening of liver steatosis at the diagnosis and during follow-up are therefore essential. This study aims to evaluate the accuracy of ultrasound fat fraction (USFF) in a population of patients with moderate to morbid obesity. Method: A total of 95 obese patients were evaluated for liver steatosis with ultrasound visual assessment and USFF measurement using the Samsung RS85 Prestige system. 84 patients were included (exclusion criteria were morphological features of advanced liver disease or cirrhosis, active viral hepatitis, alcohol use disorder, liver enzymes alteration and heart failure) Based on the visual assessment, patients were classified into four categories: absent, mild, moderate, and severe steatosis. The distribution of USFF values across groups was analyzed using one-way ANOVA with post-hoc comparisons. Receiver Operating Characteristic (ROC) curves were generated, and the Youden index was applied to determine optimal USFF cut-off points for each steatosis grade. Results: Mean USFF values increased progressively across the severity spectrum and significant differences in mean USFF values were observed across all four steatosis grades groups (p < 0.001). Based on the Youden index, the following cut-offs have been proposed: no steatosis USFF < 7.33, mild steatosis USFF < 11.66, moderate steatosis USFF < 16.30. Conclusions: Our findings suggest that USFF may offer a valuable tool for objectively quantifying liver fat content with a more easily comparable parameter, improving the accuracy of steatosis grading and follow-up. Full article

(This article belongs to the Section Liver)

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39 pages, 43744 KB

Open AccessReview

Frozen Section Studies of Gastrointestinal and Hepatobiliary Systems: A Review Article

by Abed M. Zaitoun and Sayed Ali Almahari

Gastroenterol. Insights 2025, 16(4), 46; https://doi.org/10.3390/gastroent16040046 - 27 Nov 2025

Viewed by 2055

Abstract

Frozen section (FS) analysis is a rapid intraoperative tool that provides real-time pathological assessment, guiding surgical decisions in gastrointestinal and hepatobiliary disease. Its main applications include confirming diagnoses, assessing resection margins, staging lymph nodes, and evaluating unexpected intraoperative findings. Drawing on a 14-year [...] Read more.

Frozen section (FS) analysis is a rapid intraoperative tool that provides real-time pathological assessment, guiding surgical decisions in gastrointestinal and hepatobiliary disease. Its main applications include confirming diagnoses, assessing resection margins, staging lymph nodes, and evaluating unexpected intraoperative findings. Drawing on a 14-year experience at Queen’s Medical Centre, Nottingham, this review highlights the strengths and limitations of FS in gastrointestinal and hepatopancreato-biliary surgery. Concordance with final paraffin diagnoses exceeded 97%, underscoring its reliability when performed under optimal conditions. FS is particularly valuable in complex scenarios such as distinguishing benign from malignant hepatic or pancreatic lesions, identifying metastatic disease, and evaluating conditions like Hirschsprung disease. Although interpretive artefacts and sampling errors remain challenges, careful technique and close clinical–pathological communication mitigate these issues. Beyond diagnosis, FS also supports molecular applications through targeted tissue selection for genomic testing. Overall, FS remains an essential adjunct to modern surgical pathology, enhancing intraoperative decision-making and contributing to precision oncology. Looking ahead, the integration of FS with artificial intelligence, telepathology, and minimally invasive surgical platforms is poised to expand its accuracy, accessibility, and impact in real-time precision surgery. Full article

(This article belongs to the Section Gastrointestinal Disease)

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8 pages, 239 KB

Open AccessArticle

Beyond H. pylori: Streptococcal Co-Infections and Their Hidden Impact on Gastric Lesions in Vietnam

by Nghiem Xuan Hoan, Dao Phuong Giang, Nguyen Minh Trang, Nguyen Thi Loan, Le Huu Song and Mai Thanh Binh

Gastroenterol. Insights 2025, 16(4), 45; https://doi.org/10.3390/gastroent16040045 - 24 Nov 2025

Viewed by 946

Abstract

Background/Objectives: Helicobacter pylori (H. pylori) is a well-established pathogen associated with chronic gastritis and gastric malignancies. Recent studies suggest that members of the Streptococcus anginosus group (SAG), particularly S. anginosus and S. constellatus, may also contribute to gastric mucosal damage, [...] Read more.

Background/Objectives: Helicobacter pylori (H. pylori) is a well-established pathogen associated with chronic gastritis and gastric malignancies. Recent studies suggest that members of the Streptococcus anginosus group (SAG), particularly S. anginosus and S. constellatus, may also contribute to gastric mucosal damage, especially when co-infecting with H. pylori. This study aimed to evaluate the prevalence of these three bacterial species and their associations with gastric lesions in Vietnamese patients. Methods: A cross-sectional study was conducted on 200 adult patients with gastritis diagnosed by endoscopy and biopsy. PCR analysed gastric tissue samples from the antrum and corpus for H. pylori, S. anginosus, and S. constellatus. Gastric lesions were classified histologically, and associations with bacterial infections were assessed using odds ratios (OR) and 95% confidence intervals. Results: Infection rates were 62.5% for H. pylori, 62% for S. constellatus, and 48.5% for S. anginosus. Coinfections were frequent, with 25% of patients infected by all three bacteria. Atrophic gastritis was the most common lesion (80%) and was significantly associated with all three bacteria, particularly H. pylori (OR = 7.7), and in co-infections (e.g., H. pylori + S. constellatus, OR = 7.4, p < 0.0001). Triple infection was strongly linked to both atrophy (OR = 5.1) and intestinal metaplasia/dysplasia (OR = 3.4, p = 0.007). Conclusions: Polymicrobial infections involving H. pylori and SAG bacteria are common in Vietnamese patients with gastritis and are significantly associated with more severe gastric lesions. These findings highlight the need for broader microbial screening and integrated management strategies to improve gastritis treatment and gastric cancer prevention in high-prevalence settings. Full article

(This article belongs to the Section Gastrointestinal Disease)

13 pages, 356 KB

Open AccessArticle

Cytopenias in Compensated Versus Decompensated Liver Function: Is There a Difference?

by Elda Victoria Rodríguez-Negrete, Lourdes Andrea Arriaga Pizano, Karina Sánchez-Reyes, Liliana Anguiano-Robledo, Ángel Morales-González, Raúl Rojas-Martínez, Eduardo Osiris Madrigal-Santillán and José Antonio Morales-González

Gastroenterol. Insights 2025, 16(4), 44; https://doi.org/10.3390/gastroent16040044 - 20 Nov 2025

Viewed by 673

Abstract

Background/Objectives: Patients with liver cirrhosis (LC) present hematological abnormalities with multiple etiologies. As liver function deteriorates, these abnormalities become more evident, conferring a higher risk of morbidity and mortality. The objective of this study was to determine the hematological alterations present in [...] Read more.

Background/Objectives: Patients with liver cirrhosis (LC) present hematological abnormalities with multiple etiologies. As liver function deteriorates, these abnormalities become more evident, conferring a higher risk of morbidity and mortality. The objective of this study was to determine the hematological alterations present in patients with compensated vs. decompensated liver cirrhosis. Methods: This study is a prospective study conducted in a tertiary hospital with patients diagnosed with compensated liver cirrhosis monitored by the Gastroenterology Department, in addition to patients hospitalized for decompensated liver cirrhosis. Serum samples were taken after an informed consent form was signed, and clinical and biochemical data were recorded. Results: Seventy-three percent of patients with decompensated liver cirrhosis (DLC) suffered from anemia and thrombocytopenia at the start of the study. Patients with LC are at greater risk of developing leukopenia/lymphopenia if they are in a more advanced stage of the disease, and the erythrocyte sedimentation rate (ESR) and C-reactive protein levels are higher in this group than in patients with compensated LC. Twenty-eight percent (4/14) of patients with DLC were admitted due to evidence of acute gastrointestinal bleeding; the remaining 18 patients suffering from CLC and DLC were recorded as having an average hemoglobin level of 11 g/dL with no evidence of bleeding. Conclusions: Hematological abnormalities are common in patients with LC, particularly in the advanced stages of the disease, and these abnormalities increase the risk of morbidity and mortality. The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised in accordance. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 960 KB

Open AccessSystematic Review

The New Horizon for Non-Metastatic dMMR Colorectal Cancer: A Systematic Review of the Adjuvant Chemoimmunotherapy and Neoadjuvant Immunotherapy Revolution

by Nabil Ismaili

Gastroenterol. Insights 2025, 16(4), 43; https://doi.org/10.3390/gastroent16040043 - 16 Nov 2025

Viewed by 2807

Abstract

Background: The management of resected stage III colorectal cancer (CRC) has long been reliant on fluoropyrimidine-based adjuvant chemotherapy. However, the 10–15% of patients with mismatch repair-deficient (dMMR) tumors derive limited benefit from this approach. While immunotherapy has revolutionized the treatment of metastatic dMMR [...] Read more.

Background: The management of resected stage III colorectal cancer (CRC) has long been reliant on fluoropyrimidine-based adjuvant chemotherapy. However, the 10–15% of patients with mismatch repair-deficient (dMMR) tumors derive limited benefit from this approach. While immunotherapy has revolutionized the treatment of metastatic dMMR CRC, its role in the early-stage setting is rapidly evolving, creating a paradigm shift. Methods: A systematic literature review was conducted to identify pivotal clinical trials evaluating therapeutic strategies for non-metastatic dMMR CRC. Databases including PubMed/MEDLINE and conference proceedings from the American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) were searched up to June 2025. The review focused on phase II and III trials reporting on disease-free survival (DFS), pathological complete response (pCR), and safety. Study selection followed PRISMA guidelines. Results: The systematic review identified 14 key studies that were included for narrative synthesis. The evidence base encompassed three areas: (1) Foundational adjuvant chemotherapy trials (e.g., MOSAIC, IDEA); (2) Pivotal metastatic trials (e.g., KEYNOTE-177) validating immunotherapy efficacy in dMMR CRC; and (3) Modern trials in non-metastatic disease. The phase III ATOMIC trial demonstrated that adding atezolizumab to mFOLFOX significantly improved 3-year DFS versus chemotherapy alone (86.4% vs. 76.6%; Hazard Ratio [HR] 0.50, 95% Confidence Interval [CI] 0.34–0.72; p < 0.001). Concurrently, phase II neoadjuvant immunotherapy trials (e.g., NICHE-2) reported remarkable pCR rates of 68% and a 3-year DFS of 100%, with a more favorable safety profile compared to chemoimmunotherapy. Conclusions: The landscape for non-metastatic dMMR CRC is shifting from a chemotherapy-based model to an immunotherapy paradigm. The ATOMIC trial establishes adjuvant chemoimmunotherapy as a new standard, while robust neoadjuvant data suggest a potential future where short-course, chemotherapy-free immunotherapy could become a preferred strategy. Ongoing trials directly comparing these approaches are awaited. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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29 pages, 1739 KB

Open AccessReview

Effects of Nutrients and Alcoholic Beverages on Gastrointestinal Tract Morphology

by Marta Elizabete Vītola, Rūta Anna Eisāne, Sofija Iļičuka, Krista Anna Kļaviņa, Anna Junga and Māra Pilmane

Gastroenterol. Insights 2025, 16(4), 42; https://doi.org/10.3390/gastroent16040042 - 4 Nov 2025

Viewed by 2391

Abstract

This study aimed to review the effects of simple carbohydrates (SCs), fibre, proteins, fats, and alcoholic beverages on human gastrointestinal tract (GIT) morphology. Additional objectives included describing normal human GIT morphology, the mentioned dietary components, and their connection to GIT pathologies. An extensive [...] Read more.

This study aimed to review the effects of simple carbohydrates (SCs), fibre, proteins, fats, and alcoholic beverages on human gastrointestinal tract (GIT) morphology. Additional objectives included describing normal human GIT morphology, the mentioned dietary components, and their connection to GIT pathologies. An extensive literature review was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar. This study revealed that excessive SC intake can increase intestinal permeability, modify gut microbiota, and cause tooth decay. Dietary fibre, through microbiota modulation, can enhance epithelium proliferation, improve intestinal barrier integrity, and prevent or manage GIT pathologies. Excessive protein consumption can decrease tight junction protein expression and increase inflammation, while insufficient intake can result in villi atrophy and increased permeability. A high-saturated-fat diet can increase intestinal permeability, increase inflammation, and promote gut dysbiosis, whereas omega-3 fatty acids can reduce inflammation and improve epithelial integrity. Immoderate alcohol use damages the GIT epithelium, causing inflammation and increasing the risk of cancer. The reviewed dietary components notably impact GIT morphology and are linked to various GIT pathologies. These findings highlight a balanced diet’s substantial role in preserving GIT health. Full article

(This article belongs to the Section Gastrointestinal Disease)

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14 pages, 494 KB

Open AccessReview

Management of Antithrombotic Therapy in Acute Gastrointestinal Bleeding

by Konstantinos Papantoniou, Christos Michailides, Dimitrios Velissaris and Konstantinos Thomopoulos

Gastroenterol. Insights 2025, 16(4), 41; https://doi.org/10.3390/gastroent16040041 - 23 Oct 2025

Viewed by 5084

Abstract

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising [...] Read more.

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising prevalence of cardiovascular and thromboembolic diseases. Balancing the risk of ongoing hemorrhage against the potentially life-threatening consequences of thrombosis remains a delicate and critical clinical decision. This review provides a practical, evidence-based approach to the periprocedural management of antithrombotic therapy in urgent endoscopy, particularly in the context of acute GI bleeding. We summarize the indications, pharmacokinetics, and reversal strategies for commonly used agents, including warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin, aspirin, and P2Y12 inhibitors. Risk stratification is discussed in detail, considering both the urgency and bleeding risk of endoscopic procedures, as well as the thromboembolic risk associated with temporary drug interruption. Special considerations are given to high-risk patients, such as those with recent coronary stents, mechanical heart valves, or atrial fibrillation with elevated stroke risk scores. Close consultation and collaboration with other specialties, including cardiology and hematology, is often essential to optimize patient outcomes. Recommendations based on real-world clinical experience alongside formal guideline directives aim to support safe and timely endoscopic intervention without compromising systemic thrombotic protection, especially in emergent situations. Full article

(This article belongs to the Special Issue Advances in the Management of Gastrointestinal and Liver Diseases)

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10 pages, 249 KB

Open AccessArticle

African and Hispanic Americans Have Higher Healthcare-Related Burden Without Higher Mortality When Admitted with Acute Diverticulitis

by Luis M. Nieto, Sharon I. Narvaez, Kenneth J. Vega, Do Han Kim, Donghyun Ko, Frank J. Lukens and Pedro Palacios-Argueta

Gastroenterol. Insights 2025, 16(4), 40; https://doi.org/10.3390/gastroent16040040 - 21 Oct 2025

Viewed by 748

Abstract

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A [...] Read more.

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample of adult patients discharged for AD. Patients were classified into six racial and ethnic groups: Caucasian, African American (AA), Hispanic, Asian, Native American (NA), and other. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for primary and secondary outcomes. Results: A total of 647,119 admissions with acute diverticulitis (AD) were identified. Most patients were Caucasian (about three-quarters), followed by Hispanics (11%), AA (9%), Asians (1%), Native Americans (<1%), and other (2%). Minority groups were generally younger than Caucasians and less likely to undergo colonoscopy or surgical procedures such as partial or total colectomy. In the multivariable analysis, both Hispanics and AA were less likely to present with complicated diverticulitis. Despite this, their hospitalizations were associated with higher overall charges and costs. No significant differences were found across groups in terms of inpatient mortality or the need for percutaneous abscess drainage. Conclusions: Hispanic and AA have higher healthcare- related charges and costs compared to Caucasians when admitted with AD. Further studies are needed to understand the healthcare-related spending variations seen in these groups despite them often having less complicated AD. Full article

(This article belongs to the Section Gastrointestinal Disease)

19 pages, 888 KB

Open AccessReview

Liquid Biopsy in Pancreatic Ductal Adenocarcinoma: Clinical Utility, Trials, and Future Directions

by Ahmed Bendari, Oana Vele, Brett Baskovich, Alaa Bendari, Mona Sebika, Juan Luis Gomez Marti, Kritika Krishnamurthy and Saeed Asiry

Gastroenterol. Insights 2025, 16(4), 39; https://doi.org/10.3390/gastroent16040039 - 19 Oct 2025

Cited by 1 | Viewed by 2490

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such [...] Read more.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, tumor-educated platelets (TEPs), and cell-free RNAs (cfRNAs)—offers dynamic insights into PDAC biology. This review advances beyond the prior literature by offering a unified synthesis that bridges molecular mechanisms, biomarker dynamics, and clinical translation within the context of PDAC. It also summarizes key clinical trials evaluating liquid biopsy in PDAC, underscoring its growing impact on precision oncology. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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11 pages, 230 KB

Open AccessArticle

Outcomes of EUS-Guided Gallbladder Drainage: A Case Series from a Tertiary Referral Center in Ireland

by Mohamed Wael Mohamed, Olufemi Aoko and Danny Cheriyan

Gastroenterol. Insights 2025, 16(4), 38; https://doi.org/10.3390/gastroent16040038 - 16 Oct 2025

Viewed by 2180

Abstract

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage [...] Read more.

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). EUS-GBD has emerged as a promising minimally invasive option, offering high technical and clinical success with fewer complications and need for reinterventions. The objective of this study was to evaluate the clinical outcomes of EUS-GBD in high-risk surgical patients with acute cholecystitis. Methods: We conducted a single-center retrospective study evaluating outcomes of EUS-GBD in a tertiary referral center in Ireland. Data from ten high-risk patients with acute cholecystitis who underwent EUS-GBD using a 15 mm × 10 mm HOT AXIOS lumen-apposing metal stent (LAMS) between October 2017 and September 2018 were analyzed. Parameters assessed included technical and clinical success, adverse events, and 1-year mortality. Results: The mean age of patients was 79.5 years (range 65–95). Technical success of stent placement was achieved in all patients with no immediate complications. A trans-gastric approach was used in 7 patients while a trans-duodenal route was employed in the remaining 3. 1–year mortality following EUS-GBD was 20%. Stents were not removed in any patient in this series. No patient experienced stent-related adverse events, re-occurrence of cholecystitis, or the need for re-intervention. Conclusions: EUS-GBD has very high technical and clinical success rates, with low risk of complications and need for re-intervention in comparison to other options of GB decompression. It is, however, not widely available, and it requires a skilled endoscopist with experience in interventional EUS. Full article

(This article belongs to the Section Gastrointestinal Disease)

15 pages, 1013 KB

Open AccessArticle

Divergent Trends in Esophageal Adenocarcinoma and Squamous Cell Carcinoma Incidence, 2000–2022

by Vinit H. Majmudar, Kyle Nguyen-Ngo and Michael Tadros

Gastroenterol. Insights 2025, 16(4), 37; https://doi.org/10.3390/gastroent16040037 - 9 Oct 2025

Viewed by 2450

Abstract

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns [...] Read more.

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 1274 KB

Open AccessArticle

Impact of Hypoglycemia on Morbidity, Mortality, and Resource Utilization in Gastrointestinal Stromal Tumor: A Nationwide Analysis

by Manasa Ginjupalli, Jayalekshmi Jayakumar, Arnold Forlemu, Anuj Raj Sharma, Praneeth Bandaru, Vikash Kumar, Kameswara Santosh Dheeraj Nalluri and Madhavi Reddy

Gastroenterol. Insights 2025, 16(4), 36; https://doi.org/10.3390/gastroent16040036 - 25 Sep 2025

Cited by 1 | Viewed by 1340

Abstract

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National [...] Read more.

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National Inpatient Sample (NIS) 2018–2020. Adult GIST discharges were identified by ICD-10-CM codes and stratified by hypoglycemia. Primary outcomes were in-hospital mortality and resource utilization—length of stay (LOS) and total hospital charge. Secondary outcomes included malnutrition, sepsis, ascites, peritonitis, bowel perforation, intestinal obstruction, gastrointestinal bleeding, and iron deficiency anemia. Analyses used survey-weighted logistic regression for binary outcomes and generalized linear models for continuous outcomes. A propensity score-matched sensitivity analysis balanced sepsis and malnutrition. Results: Among 61,725 GIST hospitalizations, 0.72% had hypoglycemia. Mortality was 12.6% with hypoglycemia vs. 3.1% without; adjusted odds of death were higher (aOR 4.16, 95% CI 2.06–8.37; p < 0.001). Hypoglycemia was also associated with malnutrition (aOR 5.63, 3.37–9.40), sepsis (aOR 4.00, 2.24–7.14), ascites (aOR 3.43, 1.63–7.19), and peritonitis (aOR 2.91, 1.17–7.22). LOS was 4.61 days longer on average (not significant; p = 0.185), and total hospital charge was $5218 higher (β = 19,116.8; p = 0.95). In the matched cohort, the mortality association attenuated but persisted (aOR 1.38, 1.27–1.49; p < 0.001); peritonitis remained significant (aOR 1.10, 1.04–1.17), intestinal obstruction (aOR 4.91, 3.44–7.05) and iron deficiency anemia (aOR 3.54, 1.62–7.74) became significant, while ascites and gastrointestinal bleeding were not significant. Conclusions: Hypoglycemia in GIST, although uncommon, marks a higher-risk inpatient trajectory with increased mortality and several complications; these signals largely persist after balancing severity proxies. Resource-use differences were directionally higher but not statistically significant. Recognition of hypoglycemia may aid risk stratification and inpatient management in GIST. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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Gastroenterol. Insights, Volume 16, Issue 4 (December 2025) – 14 articles

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