Gastrointestinal Disorders

Background/Objectives: Variceal size and red wale marks determine hemorrhage risk and guide management in portal hypertension, so a reproducible classification is essential. The most widely used systems are Calès, Japanese Research Society for Portal Hypertension (JRSPH), and American Association for the Study of Liver Diseases (AASLD). We aimed to determine intra- and inter-observer concordance for variceal size using the mentioned classifications, and propose a simplified binary classification system based on the complete disappearance of the variceal relief during air insufflation. Methods: Descriptive cross-sectional study, using videos of esophagogastroduodenoscopy from pediatric and adult patients with esophageal varices, which were evaluated twice by three expert endoscopists. Cohen’s Kappa was used to assess agreement between two measurements, and Fleiss’s Kappa to evaluate the agreement of all three observers. Because some patients contributed more than one recording, confidence intervals were obtained by bootstrap resampling at the patient level. Results: A total of 78 videos were evaluated (58 adult, 20 pediatric). Intra-observer concordance for variceal size classification systems was: Calès κ = 0.41, JRSPH κ = 0.40, AASLD κ = 0.50, and new classification κ = 0.47. Inter-observer agreement was: Calès κ = 0.39, JRSPH κ = 0.24, AASLD κ = 0.31, and new classification κ = 0.47. Conclusions: Agreement for the commonly used variceal size classifications ranged from fair to moderate. Our proposed insufflation-based classification was the only system to achieve moderate agreement both within and between observers, offering a simpler criterion aligned with the treat-versus-observe decision. It should be regarded as a promising proposal rather than a validated tool: prospective multicenter validation against variceal bleeding outcomes is required before clinical use.

Irinotecan-loaded drug-eluting bead transarterial chemoembolization (DEBIRI) has an established but evolving evidence base for colorectal liver metastases, while its use in small-cell lung cancer (SCLC) liver metastases remains poorly characterized. To the best of our knowledge, this is the first published report of DEBIRI use from Indonesia. We describe a single-center case series of patients treated for colorectal liver metastases and small-cell lung cancer liver metastases. Six patients underwent DEBIRI at a tertiary oncology center: five with colorectal liver metastases and one with SCLC liver metastases. Clinical characteristics, procedural details, imaging response, toxicity, and outcomes were retrospectively reviewed. ECOG performance status ranged from 0 to 2. Cumulative irinotecan doses ranged from 40 to 360 mg across one to three sessions. Technical success was achieved in all procedures. Among five patients with evaluable follow-up, four had documented progression between 2.6 and 7.8 months, while one remained progression-free at last follow-up at 3.7 months. Three patients with CRLM demonstrated stable disease followed by documented progression at 3.7, 5.1, and 7.8 months. The SCLC case demonstrated progressive disease approximately 3 months after DEBIRI and subsequently showed a marked metabolic response following systemic chemotherapy. DEBIRI was technically feasible across colorectal liver metastases and SCLC with liver metastases. The colorectal cases were broadly consistent with published evidence, while the SCLC case is hypothesis-generating.

Autoimmune gastritis (AIG) is a chronic disorder involving an immune response that leads to the destruction of the oxyntic glands, which leads to gastric atrophy, intestinal metaplasia, and nutritional deficiencies. It increases the risk of type 1 gastric neuroendocrine tumors and, although the extent of this association is still disputed, also carries a risk of gastric adenocarcinoma. The present review covers the current understanding of AIG from clinical and pathologic points of view, addressing its pathogenesis, clinical and endoscopic manifestations, histopathological characteristics, diagnosis, management, and surveillance. We also point out recent findings regarding the variability in pathology reporting, clinicians’ interpretation of pathology reports, and the emerging uses of artificial intelligence in the diagnosis and surveillance of AIG, as well as what obstacles still exist before these tools can be used in a clinical setting. Improved recognition of the condition and the establishment of a common diagnostic standard would enable earlier diagnosis, more reliable risk stratification, and a form of surveillance that corresponds to the actual neoplasia risk.