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Diagnosis, Treatment, and Management of Gastrointestinal Oncology
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Diagnosis, Treatment, and Management of Gastrointestinal Oncology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (30 October 2025) | Viewed by 27705

Special Issue Editors

Dr. Toufic A. Kachaamy

E-Mail Website
Guest Editor
Department of Gastroenterology, City of Hope Phoenix, Goodyear, AZ 85338, USA
Interests: gastroenterology; endoscopic oncology; endoscopy; pancreatic; stomach; esophageal, colon; liver; bile duct cancer
Dr. Madappa N. Kundranda

E-Mail Website
Guest Editor
Gastrointestinal Oncology, Banner MD Anderson Cancer Center, Banner Gateway Medical Center, 2946 East Banner Gateway Drive, Gilbert, AZ 85324, USA
Interests: gastrointestinal oncology; biliary tract cancer; colorectal cancer; esophageal cancer

Special Issue Information

Dear Colleagues,

Gastrointestinal tumors are a common and challenging group of malignancies that have a significant impact on patients' health and quality of life. The aim of this Special Issue is to provide the latest research advances, diagnostic approaches, therapeutic strategies, and management experiences to help the medical community better meet the challenges of gastrointestinal tumors.

This Special Issue covers several aspects, including but not limited to the diagnosis, treatment, and follow-up management of various gastrointestinal tumor types, including gastric, colorectal, esophageal, and pancreatic cancers.

We look forward to your submissions and hope that this Special Issue will provide useful information and inspiration to our readers and contribute positively to the diagnosis, treatment, and management of gastrointestinal tumors.

Dr. Toufic A. Kachaamy
Dr. Madappa N. Kundranda
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal oncology
  • endoscopic oncology
  • biliary tract cancer
  • colorectal cancer
  • esophageal cancer
  • stomach cancer

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Published Papers (9 papers)

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Research

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12 pages, 588 KB  
Article
The Impact of Neoadjuvant Chemoradiation Therapy on Non-Tumorous Barrett’s Dysplasia of the Esophagus: A Multicenter Cohort Study
by Vismaya S. Bachu, Jay M. Lee, Hanlin L. Wang, Phillip Kozan, Melanie Ramirez, Jose Garcia-Corella, Kevin A. Ghassemi, Venkataraman Muthusamy and Danny Issa
J. Clin. Med. 2026, 15(1), 285; https://doi.org/10.3390/jcm15010285 - 30 Dec 2025
Viewed by 506
Abstract
Background/Objectives: Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC), and neoadjuvant chemoradiation therapy (NCRT) is commonly used in the treatment of EAC. However, the impact of NCRT on non-tumorous BE and dysplasia is poorly understood. Our study aims to evaluate [...] Read more.
Background/Objectives: Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC), and neoadjuvant chemoradiation therapy (NCRT) is commonly used in the treatment of EAC. However, the impact of NCRT on non-tumorous BE and dysplasia is poorly understood. Our study aims to evaluate the effects of NCRT on BE segment length and dysplasia in patients undergoing esophagectomy for EAC. Methods: This multicenter, retrospective cohort study includes EAC patients who underwent esophagectomy with or without NCRT between 2014 and 2020. Patients with histologically confirmed BE and dysplasia (low- or high-grade) were analyzed. Preoperative and postoperative pathology were compared to assess BE regression, dysplastic changes, and segment length. Statistical analyses included chi-square and t-tests, with p < 0.05 considered significant. Results: Of 101 patients who were diagnosed with EAC, 28 patients were found to have BE, with 18 receiving NCRT in addition to surgery and 10 undergoing surgery alone. The NCRT group showed significantly higher BE regression than the control group (77.8% versus 10%, p < 0.001). Regression of dysplasia occurred in 66.7% of the NCRT group versus 20% of the control group (p = 0.079) and residual dysplasia was lower in the NCRT group (33.3%) compared to the control group (80%) (p = 0.018). Conclusions: NCRT significantly reduces BE and dysplasia, suggesting it may improve surgical outcomes by minimizing residual disease. These findings support the potential of NCRT to enhance surgical precision in EAC treatment, though further research is needed to explore underlying mechanisms and refine treatment strategies. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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13 pages, 1650 KB  
Article
A 20-Year Real-World Study of Small Bowel Cancers: Histologic Subtypes, Clinical Features, and Survival Implications
by Jirapat Wonglhow, Patrapim Sunpaweravong, Chirawadee Sathitruangsak, Arunee Dechaphunkul and Panu Wetwittayakhlang
J. Clin. Med. 2025, 14(19), 6962; https://doi.org/10.3390/jcm14196962 - 1 Oct 2025
Cited by 2 | Viewed by 1303
Abstract
Background: Small-bowel cancers (SBCs) are rare, histologically diverse malignancies with limited data from Asian populations. This study aimed to describe histological subtype distribution, clinical features, survival outcomes, and prognostic factors in SBCs over a 20-year period. Methods: We retrospectively reviewed patients diagnosed with [...] Read more.
Background: Small-bowel cancers (SBCs) are rare, histologically diverse malignancies with limited data from Asian populations. This study aimed to describe histological subtype distribution, clinical features, survival outcomes, and prognostic factors in SBCs over a 20-year period. Methods: We retrospectively reviewed patients diagnosed with SBC at a tertiary referral center in Southern Thailand (2005–2024). Clinical, pathological, and radiological data were analyzed by histologic subtype. Results: A total of 158 patients were included: adenocarcinoma (81.0%), gastrointestinal stromal tumor (GIST, 5.7%), well-differentiated neuroendocrine tumor (NET, 5.7%), other sarcomas (5.1%), and poorly differentiated neuroendocrine carcinoma (NEC, 2.5%). Adenocarcinoma predominantly affected older patients and frequently presented with advanced-stage disease and poor performance status, whereas NET and NEC occurred in younger patients typically at early NET and metastatic NEC stages. Median overall survival (OS) varied by subtype: adenocarcinoma (8.3 months), GIST (63.6 months), NEC (8.9 months), NET (not reached), and other sarcomas (9.8 months). Five-year OS rates were 14.0%, 55.6%, 0%, 88.9%, and 18.8%, respectively. Eastern Cooperative Oncology Group performance status ≥2, duodenal location, and metastatic disease were independently associated with worse OS. Conclusions: SBCs display distinct clinical and prognostic profiles by subtype. Overall prognosis remained poor, underscoring the need for earlier detection and subtype-specific management. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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16 pages, 629 KB  
Article
Palliative Luminal Treatment of Colorectal Cancer Using Endoscopic Calcium-Electroporation: First Case Series from United Kingdom
by Ademola Adeyeye, Olaolu Olabintan, Homira Ayubi, Hao Gao, Aman Saini, Andrew Emmanuel, Bu’Hussain Hayee and Amyn Haji
J. Clin. Med. 2025, 14(12), 4138; https://doi.org/10.3390/jcm14124138 - 11 Jun 2025
Cited by 4 | Viewed by 2024
Abstract
Background/Objectives: Colorectal cancer (CRC) is the most common gastrointestinal (GI) malignancy, the second leading cause of cancer-related mortality, and the third most prevalent tumor. Around 20% of cases are metastatic or inoperable at diagnosis, often requiring palliative treatment, which may not be feasible [...] Read more.
Background/Objectives: Colorectal cancer (CRC) is the most common gastrointestinal (GI) malignancy, the second leading cause of cancer-related mortality, and the third most prevalent tumor. Around 20% of cases are metastatic or inoperable at diagnosis, often requiring palliative treatment, which may not be feasible in frail patients. Calcium-electroporation, a less invasive alternative, induces cell death via apoptosis, necrosis, and pyroptosis. This study is the first in the United Kingdom to evaluate the efficacy and safety of endoscopic calcium-electroporation in palliating distal CRC. Methods: Frail patients with inoperable left-sided CRC were included. The diagnosis and staging followed standard guidelines, while frailty was assessed using the performance status (PFS), Charlson comorbidity index (CCI), and American Society of Anesthesiologists (ASA) score. Calcium electroporation was performed via a flexible endoscopy usually under sedation, with symptom relief, quality of life (QoL), survival, and adverse events (AE) monitored. Results: Sixteen patients (median age 84.5) underwent 36 treatments with electroporation over 28 months (November 2022 to March 2025). The incidence of common symptoms was rectal bleeding (75%), constipation (25%), and pain (75%). Nine patients had metastases and three had failed conventional treatments. Symptomatic relief and an improved QoL occurred in 86.7%, with transfusion/iron infusion needs reduced by 91.7%. The median cancer-specific survival was 10 months, with a 94% survival rate. No device-related AE was recorded. One patient died after 11 months due to disease progression while two patients passed away from other medical conditions. Conclusions: Endoscopic calcium electroporation is a safe, palliative option effective for tumor reduction and symptomatic relief in frail CRC patients unfit for conventional therapies. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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Review

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21 pages, 5237 KB  
Review
Candida Esophagitis in Patients with Solid Organ Cancers
by Ahmed Telbany, Hannah Farfour, Krista Gomez, Youssef Soliman and Toufic A. Kachaamy
J. Clin. Med. 2026, 15(4), 1474; https://doi.org/10.3390/jcm15041474 - 13 Feb 2026
Cited by 2 | Viewed by 1294
Abstract
Candida esophagitis (CE) is the most common fungal infection of the esophagus and an increasingly recognized complication in patients with solid organ malignancies. Once primarily associated with advanced HIV/AIDS and hematologic malignancies, the epidemiology has shifted in the modern era of antiretroviral therapy [...] Read more.
Candida esophagitis (CE) is the most common fungal infection of the esophagus and an increasingly recognized complication in patients with solid organ malignancies. Once primarily associated with advanced HIV/AIDS and hematologic malignancies, the epidemiology has shifted in the modern era of antiretroviral therapy and intensive cancer treatments. Patients with solid tumors receiving chemotherapy, corticosteroids, broad-spectrum antibiotics, and proton pump inhibitors (PPIs) are at a heightened risk for CE due to synergistic immunosuppressive and mucosal barrier-disrupting effects. Clinically, CE in cancer patients often present with odynophagia, dysphagia, or chest pain, but a considerable proportion of cases are asymptomatic or non-specific, complicating diagnosis and needing a high index of suspicion. Endoscopic evaluation with characteristic white plaques and histopathologic confirmation remains the diagnostic gold standard, as symptoms as oropharyngeal findings are unreliable indicators of esophageal infection. Disease management centers on systemic antifungal therapy. Fluconazole is the first-line treatment, achieving high cure rates, while echinocandins and posaconazole are reserved for refractory cases or non-albicans infections. Prompt therapy is crucial, as untreated CE can lead to malnutrition, interruptions in cancer therapy, and rare but serious complications (e.g., necrotizing esophagitis or perforation). We provide a comprehensive review of the epidemiology, risk factors, clinical manifestations, pathogenesis, diagnosis, and management of CE in solid organ cancer patients. Gaps in knowledge are highlighted, including the need for better non-invasive diagnostics, antifungal resistance surveillance, and tailored prophylactic strategies. A high index of suspicion and early recognition and treatment of CE in oncology patients can improve nutritional status, quality of life, and continuity of cancer care. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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29 pages, 2077 KB  
Review
KRAS Inhibition in Pancreatic Ductal Adenocarcinoma
by Roshini Pradeep, Nooredeen Jamal Isbeih, Freya F. Abraham, Ehsan Noori, Zachary P. Yeung and Madappa N. Kundranda
J. Clin. Med. 2026, 15(2), 873; https://doi.org/10.3390/jcm15020873 - 21 Jan 2026
Cited by 2 | Viewed by 2290
Abstract
KRAS alterations are a hallmark of pancreatic ductal adenocarcinoma (PDAC) found in >90% of tumors. This review examines the historical evolution of the understanding of RAS and its central role in PDAC biology. We summarize the various downstream effectors, feedback loops, and resistance [...] Read more.
KRAS alterations are a hallmark of pancreatic ductal adenocarcinoma (PDAC) found in >90% of tumors. This review examines the historical evolution of the understanding of RAS and its central role in PDAC biology. We summarize the various downstream effectors, feedback loops, and resistance mechanisms that play a pivotal role in PDAC oncogenesis. Our review explores the early development of covalent inhibitors of KRAS G12C and efforts at specific inhibition of other codons and newer approaches of targeted protein degradation. We subsequently summarize the development of panRAS inhibitors and allosteric and switch-region targeting before focusing on rational therapeutic blockade of crosstalk and upstream signaling, with attention to synthetic lethality approaches transitioning from preclinical to early-phase in-human clinical trials. This review elaborates on ongoing KRAS-specific siRNA research and evolving KRAS-directed immunotherapies. We conclude by outlining the current KRAS clinical trial landscape and future areas of investigation. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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19 pages, 489 KB  
Review
Role of Endoscopy in the Diagnosis and Management of Esophageal Cancer
by Jennifer Ma, Sharon Pan, Rachel Mortan, Faisal Shaukat Ali, Nirav Thosani and Vaibhav Wadhwa
J. Clin. Med. 2025, 14(22), 8169; https://doi.org/10.3390/jcm14228169 - 18 Nov 2025
Viewed by 2256
Abstract
Esophageal cancer cases are predicted to reach 957,000 by 2040. Prior mortality rates average 6.5% in men and 2.2% in women, with a poor 5-year prognosis of 20%. A deficiency in screening guidelines, an incomplete understanding of pathophysiology, and limited treatment options contributed [...] Read more.
Esophageal cancer cases are predicted to reach 957,000 by 2040. Prior mortality rates average 6.5% in men and 2.2% in women, with a poor 5-year prognosis of 20%. A deficiency in screening guidelines, an incomplete understanding of pathophysiology, and limited treatment options contributed to this poor prognosis. Now, as technology and knowledge evolve, endoscopy serves a primary role in improving morbidity and mortality around esophageal cancer, in which early detection and treatment play a profound role. Advances in diagnostic modalities, including higher frequency ultrasound, acquisition of larger specimens, and nodal characterization, all improve esophageal cancer diagnostic accuracy and treatment planning. This is primarily due to earlier detection of precursor lesions, eradication with complete resection, and more informed surveillance. Prior management with esophagectomy has now evolved to include endoscopic submucosal dissection, mucosal resection, ablation, stent placement, fiducial markers for radiotherapy, sponge vacuum, and more. These endoluminal remedies are curative, palliative, or post-intervention solutions, thereby reducing the surgical risk, morbidity, and mortality associated with esophageal cancer. This review article details the diagnostic and therapeutic role of endoscopy in esophageal cancer. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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19 pages, 333 KB  
Review
Advances in Endoscopic Diagnosis and Management of Cholangiocarcinoma
by Usamah Chaudhary and Shawn L. Shah
J. Clin. Med. 2025, 14(17), 6028; https://doi.org/10.3390/jcm14176028 - 26 Aug 2025
Cited by 3 | Viewed by 2928
Abstract
Cholangiocarcinoma (CCA) is an aggressive malignancy originating from the epithelial lining of the intrahepatic or extrahepatic bile ducts. Although rare globally, its mortality closely mirrors incidence due to late-stage presentation of the disease and limited curative options. While surgical resection and liver transplantation [...] Read more.
Cholangiocarcinoma (CCA) is an aggressive malignancy originating from the epithelial lining of the intrahepatic or extrahepatic bile ducts. Although rare globally, its mortality closely mirrors incidence due to late-stage presentation of the disease and limited curative options. While surgical resection and liver transplantation remain the cornerstone treatments for those with resectable disease, endoscopic techniques have emerged as versatile tools for diagnosis, therapy, and palliation. In recent years, there have been major advancements in endoscopic therapies, including radiofrequency ablation (RFA), intraluminal brachytherapy (ILBT), and photodynamic therapy (PDT). The current narrative review serves to provide an overview of current and emerging endoscopic strategies for CCA, emphasizing diagnostic capabilities, therapeutic approaches, palliative interventions, and future directions. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
21 pages, 1314 KB  
Review
Revolutionizing Gastrointestinal Disorder Management: Cutting-Edge Advances and Future Prospects
by Chahat Suri, Babita Pande, Tarun Sahu, Lakkakula Suhasini Sahithi and Henu Kumar Verma
J. Clin. Med. 2024, 13(13), 3977; https://doi.org/10.3390/jcm13133977 - 8 Jul 2024
Cited by 25 | Viewed by 11667
Abstract
In recent years, remarkable strides have been made in the management of gastrointestinal disorders, transforming the landscape of patient care and outcomes. This article explores the latest breakthroughs in the field, encompassing innovative diagnostic techniques, personalized treatment approaches, and novel therapeutic interventions. Additionally, [...] Read more.
In recent years, remarkable strides have been made in the management of gastrointestinal disorders, transforming the landscape of patient care and outcomes. This article explores the latest breakthroughs in the field, encompassing innovative diagnostic techniques, personalized treatment approaches, and novel therapeutic interventions. Additionally, this article emphasizes the use of precision medicine tailored to individual genetic and microbiome profiles, and the application of artificial intelligence in disease prediction and monitoring. This review highlights the dynamic progress in managing conditions such as inflammatory bowel disease, gastroesophageal reflux disease, irritable bowel syndrome, and gastrointestinal cancers. By delving into these advancements, we offer a glimpse into the promising future of gastroenterology, where multidisciplinary collaborations and cutting-edge technologies converge to provide more effective, patient-centric solutions for individuals grappling with gastrointestinal disorders. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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Other

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9 pages, 2158 KB  
Technical Note
A Step-By-Step Guide for Robotic Blumgart Pancreaticojejunostomy
by Siyuan Qian, Jeison Carrillo-Peña, Víctor Domínguez-Prieto, Pedro Villarejo-Campos, Montiel Jiménez-Fuertes, Pablo Pastor-Riquelme and Santos Jiménez-Galanes
J. Clin. Med. 2025, 14(13), 4471; https://doi.org/10.3390/jcm14134471 - 24 Jun 2025
Cited by 1 | Viewed by 2252
Abstract
Background: In recent years, the use of minimally invasive approaches in pancreatic surgery has progressively increased. One of the key components of pancreaticoduodenectomy is the creation of a pancreato-enteric anastomosis, due to the high risk of postoperative complications, particularly the development of postoperative [...] Read more.
Background: In recent years, the use of minimally invasive approaches in pancreatic surgery has progressively increased. One of the key components of pancreaticoduodenectomy is the creation of a pancreato-enteric anastomosis, due to the high risk of postoperative complications, particularly the development of postoperative pancreatic fistula. Among the types of anastomoses, the Blumgart technique has gained popularity due to its ease of reproducibility. Methods: In this guide, we summarize and systematize step by step how to perform a feasible, reproductible and safe robotic Blumgart pancreaticojejunostomy, providing some instructions for its successful completion. Results: Despite the heterogeneity of the published data, duct-to-mucosa Blumgart anastomosis seems to be superior in terms of clinically relevant postoperative pancreatic fistula rates compared with other types of pancreato-enteric anastomosis. The advantages of robotic surgery, such as improved precision, greater control, and enhanced visualization, make robotic Blumgart anastomosis a safe, practical, and reproducible technique in the context of robotic pancreaticoduodenectomy. Conclusions: Robotic Blumgart pancreaticojejunostomy is a safe and feasible technique for pancreato-enteric anastomosis following pancreaticoduodenectomy when surgical technique is systematized step by step. Full article
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)
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