Search Results (2,865)

Background: Pancreatic cancer (PC) has a very poor 5-year survival and prognosis. Even when CT or MRI shows no metastasis, staging laparoscopy(SL) still detects tiny peritoneal deposits in 20–30% of patients, making them ineligible for surgery. SL is invasive, requiring general anesthesia and substantial resources. Endoscopic ultrasound (EUS) allows the observation of the bile ducts, pancreas, and abdominal cavity, and EUS-guided fine-needle aspiration (EUS-FNA) is essential for pathological diagnosis. Reports on using EUS to perform peritoneal lavage cytology are currently not available. We hypothesized that combining EUS-FNA with peritoneal lavage (EUS-lavage technique; EUS-LT) could enhance staging accuracy and avoid unnecessary surgical procedures. Methods: Ten ex vivo porcine models underwent EUS-LT. Using a 19G FNA needle, 800 mL saline was instilled into the intraperitoneal cavity and then recovered. Two refinements were introduced sequentially: an ENBD catheter with additional side holes and, subsequently, a side-hole introducer (EndoSheather) that eliminated balloon dilation. The primary endpoint was procedural success. Secondary endpoints included safety, complications, recovered volume, duration of endoscopic procedure, and time required to instill 800 mL. Nonparametric tests compared outcomes across iterations. Results: Ten-model porcine ex vivo model series were included, and all procedures were successful. No device malfunctions or unanticipated technical failures; one minor mucosal injury during saline injection resolved after re-puncture. The average procedure time was 31.1 min. Stepwise refinements shortened procedure and infusion times and increased recovered volume. Recovered volume approached the instilled amount in later cases, indicating efficient performance. Conclusions: In this ten-model ex vivo series, EUS-LT demonstrated technical feasibility and short-term safety. Full article

Background: Ulcerative colitis (UC) management relies on accurately assessing disease activity. Fecal calprotectin (FC) is a promising non-invasive biomarker, but method-specific differences in measurement can affect interpretation. Objective: To compare the performance of Calprest ELISA and DiaSorin Liaison CLIA in measuring FC concentrations and their correlation with endoscopic findings in UC. Methods: Stool samples from 40 UC patients were analyzed using both methods, with 138 samples collected across three clinical timepoints. Spearman’s correlation, Wilcoxon test, Bland–Altman analysis, and ROC curves were used to evaluate method agreement and diagnostic performance relative to Mayo endoscopic scores. Results: A total of 135 paired results showed strong correlation (ρ = 0.795, p < 0.001) but significant inter-method differences (p = 0.039). Liaison tended to yield higher FC values. ROC analysis established optimal cut-offs for detecting endoscopic remission and active disease: 47.95/69.55 µg/g (Liaison) and 65/125 µg/g (Calprest). Calprest demonstrated slightly better diagnostic accuracy. Conclusions: Both methods are reliable for monitoring UC activity. Calprest offers greater dynamic range, while Liaison excels in automation and speed. Method-specific thresholds should guide clinical interpretation to ensure accurate disease monitoring. Full article

Objectives: To benchmark the performance of DeepSeek-R1 against three other advanced AI reasoning models (GPT-4o, Qwen3, Grok-3) in automatically extracting T/N staging from esophageal cancer endoscopic ultrasound (EUS) complex medical reports, and to evaluate the impact of language (Chinese/English) and prompting strategy (with/without designed prompt) on model accuracy and robustness. Methods: We retrospectively analyzed 625 EUS reports for T-staging and 579 for N-staging, which were collected from 663 patients at the Sun Yat-sen University Cancer Center between 2018 and 2020. A 2 × 2 factorial design (Language × Prompt) was employed under a zero-shot setting. The performance of the models was evaluated using accuracy, and the odds ratio (OR) was calculated to quantify the comparative performance advantage between models across different scenarios. Results: Performance was evaluated across four scenarios: (1) Chinese with-prompt, (2) Chinese without-prompt, (3) English with-prompt, and (4) English without-prompt. In both T and N-staging tasks, DeepSeek-R1 demonstrated superior overall performance compared to the competitors. For T-staging, the average accuracy was (DeepSeek-R1 vs. GPT-4o vs. Qwen3 vs. Grok-3: 91.4% vs. 84.2% vs. 89.5% vs. 81.3%). For N-staging, the respective average accuracy was 84.2% vs. 65.0% vs. 68.4% vs. 51.9%. Notably, N-staging proved more challenging than T-staging for all models, as indicated by lower accuracy. This superiority was most pronounced in the Chinese without-prompt T-staging scenario, where DeepSeek-R1 achieved significantly higher accuracy than GPT-4o (OR = 7.84, 95% CI [4.62–13.30], p < 0.001), Qwen3 (OR = 5.00, 95% CI [2.85–8.79], p < 0.001), and Grok-3 (OR = 6.47, 95% CI [4.30–9.74], p < 0.001). Conclusions: This study validates the feasibility and effectiveness of large language models (LLMs) for automated T/N staging from EUS reports. Our findings confirm that DeepSeek-R1 possesses strong intrinsic reasoning capabilities, achieving the most robust performance across diverse conditions, with the most pronounced advantage observed in the challenging English without-prompt N-staging task. By establishing a standardized, objective benchmark, DeepSeek-R1 mitigates inter-observer variability, and its deployment provides a reliable foundation for guiding precise, individualized treatment planning for esophageal cancer patients. Full article

Inflammatory bowel diseases (IBD) are increasingly acknowledged not merely as confined gastrointestinal disorders but as systemic immunometabolic syndromes. Central to this paradigm is the gut microbiota including non-bacterial components such as the virome, whose functional disruption marked by reduced short-chain fatty acids (SCFAs), increasingly implicated in pathogenic processes extending beyond intestinal mucosa. This review outlines how these alternations compromise the epithelial barrier and immune regulation, increasing the risk of recurrent Clostridioides difficile infections to anemia, neuropsychiatric comorbidities, and extraintestinal manifestations. We critically evaluate emerging microbiota-targeted strategies, including fecal microbiota transplantation (FMT), live biotherapeutic products (LBPs), and precision postbiotics, positioning them as potential adjuncts to conventional immunosuppression. Finally, we discuss the current barriers to clinical translation, such as safety and heterogeneity, and propose a future framework for personalized, functionally integrated IBD care aimed at restoring long-term microbiota homeostasis. Full article

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article

Background/Objectives: Compensated advanced chronic liver disease (cACLD) affects millions and carries risk for portal hypertension, large varices, and clinical decompensation. The HepQuant DuO^® test provides a blood-based assessment of liver function and physiology, generating a disease severity index (DSI) validated for risk stratification. A retrospective, real-world, observational analysis was conducted to evaluate the utility of HepQuant DuO’s DSI cutpoint (18.3) in guiding endoscopy and clinical management decisions for patients with cACLD in the United States. Methods: De-identified data from 87 cases with cACLD were extracted from physician-provided Statements of Medical Necessity documenting the reasons for the HepQuant DuO test. The primary endpoint was concordance of endoscopy decisions with DSI ≤ 18.3 (avoid) or >18.3 (proceed). The secondary endpoint was concordance of clinical management intensity with the same cutpoint. Results: Among the 55 cases analyzed for endoscopy decisions, overall concordance with DSI 18.3 was 93% (p < 0.001 by Fisher’s exact test): 96% of cases with DSI ≤ 18.3 avoided endoscopy, and 90% with DSI > 18.3 underwent endoscopy. For the 45 cases assessing management intensity, overall concordance was 89% (p < 0.001): 90% of cases with DSI ≤ 18.3 had reduced follow-up, and 89% with DSI > 18.3 had intensified management. The cohort exhibited broad functional heterogeneity not captured by standard labs or elastography. Conclusions: HepQuant DuO’s DSI cutpoint 18.3 demonstrated strong concordance with real-world clinical decisions, supporting its utility for risk stratification, optimizing endoscopy use, and tailoring management in cACLD. Full article

Background: Food allergy is a growing public health concern, and oral immunotherapy (OIT) has emerged as a promising approach to induce desensitization and potentially sustained unresponsiveness to allergenic foods. Changes in humoral immunity, particularly in allergen-specific immunoglobulin levels, play a central role in the immunological mechanisms underlying OIT. This review aims to summarize the current evidence on how OIT modulates allergen-specific immunoglobulin E (IgE), G (IgG) and A (IgA) responses in individuals with food allergy. Methods: We conducted a review of original research articles reporting longitudinal data on allergen-specific IgE, IgG, and/or IgA in patients undergoing OIT for common food allergens. Results: OIT was consistently associated with a transient increase in allergen-specific IgE levels during early phases, followed by a gradual decline. In contrast, Allergen-specific IgG4 levels showed a robust and sustained increase, correlating with desensitization and proposed to function as blocking antibodies. Several studies also reported an increase in allergen-specific IgA, particularly secretory IgA at mucosal sites, suggesting a potential role in enhancing mucosal tolerance and immune exclusion of allergens. Conclusions: Humoral immune responses during OIT are characterized by distinct and dynamic changes in immunoglobulin patterns. In particular, the rise in IgG4 and, in some cases, IgA suggests a role in promoting tolerance. Monitoring these biomarkers may offer insights into treatment efficacy and support individualized approaches to OIT. Full article

A radioiodine-refractory differentiated thyroid cancer patient with rising serum thyroglobulin (Tg) levels underwent ¹⁸F-FDG PET/CT scan, which showed a hypermetabolic region in the proximal segment of esophagus, leading to ambiguity in diagnosis. MRI was immediately added, and PET/MRI fusion image localized an air-containing lesion interlinked with esophagus with enhanced T2 hyperintense mucosal signal, indicating an inflammatory esophageal diverticulum, which was subsequently verified by endoscopy. This case highlights the added value of PET/MRI image fusion in cases with inconclusive ¹⁸F-FDG PET/CT findings, requiring no additional tests and utilizing existing software, thereby minimizing the need for invasive procedures. Full article

Background/Objectives: Although vonoprazan-based triple therapy has improved the first- and second-line Helicobacter pylori eradication rates, a subset of patients still require third-line or later treatments. The present study aimed to evaluate the efficacy and safety of susceptibility-guided eradication strategies from third-line or later treatments in a multicenter setting. Methods: This retrospective multicenter study (2019–2024) enrolled 94 patients who had failed second-line eradication therapy and underwent H. pylori isolation and susceptibility testing. Based on sitafloxacin sensitivity, patients received vonoprazan, amoxicillin, and sitafloxacin (VAS) if sensitive, or vonoprazan, amoxicillin, and rifabutin (VAR) if resistant. Altogether, 75 patients received treatment according to this protocol. Results: Among the 75 patients, 61.3% were sitafloxacin-sensitive (VAS group), and 38.7% were resistant (VAR group). All strains were rifabutin-sensitive. The overall eradication rates were 92.0% and 95.8% in the intention-to-treat and per-protocol analyses, respectively. Adverse events occurred in 17.3% of cases. One patient in the VAR group discontinued therapy due to dizziness, whereas all other adverse events were mild and did not require treatment cessation. Subgroup analysis showed eradication rates of 93.5% (43/46) and 89.7% (26/29) for the VAS and VAR groups, respectively. The eradication rate for third-line therapy was 96.2% (50/52), whereas that for fourth-line therapy was 85.7% (18/21). Fifth-line therapy showed an eradication rate of 50.0% (1/2). Conclusions: Susceptibility-guided vonoprazan-based regimens from the third-line treatment onward achieved high eradication and tolerability in a multicenter cohort. This approach may offer a valuable treatment option for patients with refractory H. pylori infections. Full article

Background: Transjugular intrahepatic portosystemic shunt (TIPSS) outcomes in patients with moderate-to-severe pre-existing kidney disease (PKD, stages G3a–G4) remain poorly characterized. This study aimed to identify potential predictors of mortality specifically in patients with an eGFR 15–59 mL/min/1.73 m². Methods: We retrospectively analyzed 68 cirrhosis patients with PKD (eGFR < 60 mL/min/1.73 m²) undergoing a TIPSS between April 2021 and April 2024. Clinical outcomes, renal function changes, and 12-month survival were assessed. Statistical analyses included paired t-tests with false discovery rate adjustment and Kaplan–Meier survival analysis to identify potential predictors of mortality. Results: The cohort (mean age 61.0 ± 8.3 years, 83.8% male, 79.4% with PKD G3a–G3b) showed modest improvement in renal function (creatinine 1.93 to 1.75 mg/dL, p = 0.031), though this biochemical change did not predict survival. Overall mortality was 36.8% (95% CI: 25.4–49.5%) at mean follow-up of 6.7 months. Traditional severity scores (MELD, Child–Turcotte–Pugh) showed no significant association with survival (p > 0.05 for all comparisons). In exploratory analyses, mortality was significantly higher in patients with the following: (1) uncontrolled diabetes before a TIPSS (55.2% vs. 25.9%; RR 2.35, 95% CI: 1.08–5.15, p = 0.032); (2) post-TIPSS infection (70.0% vs. 31.0%; HR 5.44, 95% CI: 1.54–19.23, p = 0.009); and (3) post-procedural cardiac events (85.7% vs. 31.1%; p = 0.005). These associations persisted after false-discovery rate adjustment but require prospective validation given the modest sample size and wide confidence intervals. Conclusions: In this exploratory single-center study of patients with moderate PKD undergoing a TIPSS, we observed associations between mortality and pre-TIPSS poorly controlled diabetes, infections, and cardiac events. These hypothesis-generating findings suggest potential areas for future research. Prospective multi-center studies are needed to validate these associations and determine whether interventions targeting these factors improve outcomes. Full article

This study presents a magnetically actuated soft robot inspired by the peristaltic locomotion of flatworms, designed to replicate the biological locomotion of worms to achieve robust maneuverability. Fabricated entirely from photocurable soft resin, the robot features a flexible elastomeric body and two webbed fins with embedded soft magnets. By applying a vertically oscillating magnetic field, the robot achieves forward crawling through the coordinated bending and lifting of fins, converting oscillating magnetic fields into continuous undulatory motion that mimics the gait of flatworms. The experimental results demonstrate that the system maintains consistent bidirectional velocities in the range of 4–7 mm/s on flat surfaces. Beyond linear locomotion, the robot demonstrates effective terrain adaptability, navigating complex topographies, including curved obstacles up to 16 times its body thickness, by autonomously adopting a high-lifting kinematic strategy to overcome gravitational resistance. Furthermore, load-carrying tests reveal that the robot can transport a 6 g payload without velocity degradation. These findings underscore the robot’s efficacy in overcoming mobility constraints, highlighting promising applications in fields requiring non-invasive intervention, such as biomedical capsule endoscopy and industrial pipeline inspection. Full article

A 57-year-old man presented with fever and progressive odynophagia three days after a suspected fish bone impaction. Laboratory tests revealed leukocytosis (17,400/µL) and an elevated C-reactive protein level (8.93 mg/dL). Initial chest radiography was unremarkable, ruling out pneumomediastinum. Contrast-enhanced computed tomography (CT) of the neck revealed focal thickening of the cervical esophageal wall, along with a low-attenuation collection and mild fat stranding surrounding the esophagus. Also, extraluminal air was absent. These findings supported the diagnosis of intramural abscess rather than free perforation. Upper endoscopy revealed a submucosal bulging lesion with a pinpoint mucosal defect that was actively draining pus, consistent with a contained intramural collection. Water-soluble contrast esophagogram confirmed smooth passage without extravasation, obstruction, or the double-lumen sign. The patient received bowel rest, intravenous piperacillin/tazobactam, and close observation. Symptoms and inflammatory markers improved, and follow-up CT confirmed the resolution of the intramural collection. Esophageal intramural abscesses develop when an infection spreads within the submucosa after a mucosal breach. In East Asia, this often occurs due to fish bone impaction. Early CT enables the differentiation of esophageal intramural abscess from perforation or dissection and guides the selection of conservative, rather than interventional, management. Full article

Background/Objectives: The prevalence of gastric subepithelial lesions (SELs) is rising. Endoscopic resection (ER) technique provides a minimally invasive alternative to manage gastric SELs. This study aims to evaluate the effectiveness and safety of ER for gastric myogenic tumors, and examine predictors for gastrointestinal stromal tumors (GISTs). Methods: The retrospective study was conducted between 2012 and 2024 at nine tertiary centers in Taiwan. We enrolled patients with endoscopic ultrasound (EUS)-documented gastric myogenic tumors managed by endoscopic muscular dissection (EMD), endoscopic subserosal dissection (ESSD), submucosal tunneling endoscopic resection (STER), and endoscopic full-thickness resection (EFTR). Clinical manifestation, endoscopic features, and outcomes were analyzed. Results: We enrolled 325 patients with 332 lesions [mean EUS size 14.5 mm, 153 (46.1%) leiomyoma, 152 (45.8%) GISTs, 27 (8.1%) other histology]. ER techniques were 193 (58.1%) EMD, 46 (13.9%) ESSD, 28 (8.4%) STER, and 65 (19.6%) EFTR. Technical success, en bloc, and R0 resection rates were 97.0%, 94.3%, and 88.9%, respectively. Twenty-four (9.0%) procedures were shifted to unintentional EFTR, and 21 (6.3%) patients had complications. No recurrence occurred during mean follow-up period of 921.4 days. Two (0.6%) patients died of non-procedure related reasons. Old age, fundus location, heterogeneous echotexture, and exophytic growth pattern were independent risk factors for GIST (all with p < 0.05). Using the above factors, we built a prediction model with sensitivity of 77.0%, specificity of 85.6%, and AUC of 0.8771. Conclusions: ER is an efficient and safe management for gastric myogenic tumors. The histological type could be predicted by demographic characteristics and EUS features. Full article