Clinical decision-making in patients with pancreatic neuroendocrine tumors is complex. The absence of effective biomarkers and the reliance on morphological criteria underlying current predictive models expose patients to a substantial risk of overdiagnosis and overtreatment. The implementation of non-invasive tools that improve the precision of prognostic estimates remains an unmet clinical need.
The PRIVIDIGEST survey is an initiative of the Spanish Society of Digestive Pathology (SEPD) designed to analyse the reality of private practice in our specialty in Spain. It describes a sector undergoing profound change, where the traditional model of isolated consultation is disappearing in favour of a mixed practice, mainly integrated into more complex hospital and clinic structures. In the clinical and technological sphere, there are striking contrasts, as although specialists have modern, high-definition equipment, there is insufficient adherence to the monitoring of internationally required quality indicators. Similarly, there is a large gap between expectations and the actual use of artificial intelligence, as although it is considered a tool with great potential, its daily use is still minimal due to economic and organisational barriers. Finally, the analysis highlights significant gaps in non-clinical training. Specialists acknowledge a general lack of knowledge in the areas of business management, taxation and legal liability, and call on the SEPD to take a leading role in providing specific advice.
Obesity is a major global health challenge. Conventional lifestyle interventions or emerging anti-obesity medications often fail to achieve sustained long-term results. Metabolic and bariatric surgery (MBS) remains the gold-standard treatment for moderate-to-severe obesity and its comorbidities. However, concerns regarding operative risk, irreversibility, high cost, and patient refusing surgical option limit broader adoption. Endoscopic bariatric therapies (EBT) have emerged as a minimally invasive alternative bridging medical and surgical approaches. Endoscopic sleeve gastroplasty (ESG) has become the most widely adopted. First described in 2013, ESG has demonstrated feasibility, safety, and efficacy in obesity management. Large case series and meta-analyses report 15-20% total weight loss up to 24 months, emerging 5-year data, and 50-80% improvement in obesity-related comorbidities. Serious adverse events occur in less than 2.5% of cases. ESG is highly cost-effective compared with lifestyle intervention alone. Relative to laparoscopic sleeve gastrectomy, ESG offers lower procedural risk, faster recovery, and anatomical preservation, making it suitable for patients with mild-to-moderate obesity or elevated surgical risk. Emerging innovations in EBT include ESG technical improvements, robotic-assisted ESG, new suturing devices, combination therapy with GLP-1RAs, small-intestine metabolic interventions, and AI-assisted navigation. With ongoing advancements and expanding indications, ESG is poised to become a cornerstone of modern obesity management. This semi-systematic review summarizes recent global ESG evidence from 2020 to 2025, highlighting mechanisms and technical aspects, indications, efficacy in weight loss and metabolic improvement, special populations, safety, cost-effectiveness, and comparisons with diet alone, pharmacotherapy, and bariatric surgery.
Dysphagia is a debilitating consequence for patients with esophageal cancer. Recanalization of the obstruction with esophageal stents is one of the palliative measures that can most improve the quality of life in these patients. Among patients with dysphagia due to obstructing esophageal cancer, stent insertion has a high technical and clinical success with rapid relief of dysphagia. Interventional radiologists typically insert esophageal stents under fluoroscopic guidance only, whereas endoscopists insert them exclusively under endoscopic monitoring or by endoscopy and fluoroscopy. In this editorial we discuss the study by Relvas, which compares endoscopic-only insertion with fluoroscopy-guided insertion in obstructive esophageal tumors. The difficulties encountered by endoscopists in using proper radiological facilities is probably the main reason for not employing fluoroscopy in esophageal stenting. Proper placement of a guidewire beyond the esophageal stricture is often the first and most critical step in esophageal stenting. The undeployed stent is then slid over the guidewire. Fluoroscopy offers a high degree of certainty that the guidewire has successfully passed through the stenosis, but it is generally assumed that it is not necessary for esophageal stent placement if the stenosis can be passed through with an endoscope. When fluoroscopy is not available, several endoscopic methods can be used for the insertion of esophageal stents. The study by Relvas confirms that the results of endoscopic and fluoroscopic guided insertion are similar. However, ideally, endoscopists should have their own high-quality radiological facilities, such as those available to interventional cardiologists.
Background and aim: malnutrition, caused by malabsorption and maldigestion, affects nutrient intake and utilization. Early detection and interventions, such as oligomeric enteral formulas, are key to improving outcomes. This study explored healthcare professionals' experiences with oligomeric supplements in Spain's public healthcare system, focusing on clinical practices, patient adherence, tolerability, and benefits.
Methods: the S-QUEST study was an observational, multicenter, cross-sectional investigation conducted in real-world clinical settings. Healthcare providers, mainly physicians from various specialties, were surveyed electronically using an ad hoc questionnaire on nutritional screening practices for malnourished patients prescribed oligomeric supplements. Data were analyzed using SPSS® (version 25.0), with significance set at p < 0.05.
Results: a total of 259 healthcare providers from 41 Spanish hospitals completed the survey. Nutritional screening was reportedly performed by 75 % of respondents, with endocrinologists and gastroenterologists indicating more frequent use (p < 0.001) and a broader range of methods. Oligomeric formulas were prescribed by 67.6 % of participants, mainly in cases involving oncology, inflammatory bowel disease, and diarrhea-related malnutrition. A self-reported adherence rate of 85 % was noted, with higher compliance perceived by endocrinologists and gastroenterologists. Additionally, 95 % of participants perceived oligomeric formulas as beneficial, particularly in relation to weight, stool consistency, and albumin levels.
Conclusions: this study explored healthcare providers' perceptions of oligomeric formulas in malnutrition management. Respondents, particularly endocrinologists and gastroenterologists, reported frequent use and perceived patient benefits. High self-reported adherence suggests good acceptance. Further research is needed to objectively assess outcomes and guide clinical practice and training.
Background: Small bowel capsule endoscopy (SBCE) is widely recognized as a key diagnostic tool for Crohn's disease (CD). While several scores assess disease activity, a validated scoring system specifically designed for diagnosis was lacking. The Capsule Endoscopy Scoring System for Crohn's Disease (CESS-CD) was introduced in 2025 to address this gap in early CD diagnosis.
Methods: To externally validate the diagnostic performance and clinical utility of the CESS-CD in an independent, single-center cohort, clinical and SBCE data from 135 patients were retrospectively analyzed. The CESS-CD score was calculated based on age ≤30 years (3 points), presence of linear erosion (4 points), and circumferential alignment (4 points). Final diagnosis of CD was established by experienced gastroenterologists. Diagnostic performance was assessed via ROC curve analysis, with accuracy metrics calculated at the predefined cut-off of ≥7 points. Group differences were evaluated using the Mann-Whitney U test.
Results: The CESS-CD showed excellent diagnostic discrimination, with an AUC of 0.973 (vs. 0.925 in the original study). At the 7-point cut-off, sensitivity was 96.8% (vs. 83.3%), specificity 90.4% (vs. 80.0%), PPV 75.0% (vs. 83.3%), NPV 98.9% (vs. 80.0%), and overall accuracy 91.9%. CESS-CD scores were significantly higher in patients with CD compared to those without (p < 0.001).
Conclusion: This external validation confirms the CESS-CD as a highly accurate and robust diagnostic tool for early CD. Its strong sensitivity, NPV, and discriminative ability support its integration into clinical practice to enhance diagnostic precision and guide timely management.
Objectives: The objective of this review is to identify key clinical lessons and highlight diagnostic and therapeutic strategies derived from case reports and recent literature. Particular attention is given to recognising overlapping presentations, optimising multimodal imaging and endoscopic evaluation, and promoting multidisciplinary collaboration between gastroenterologists, gynaecologists, radiologists, and pathologists to enhance diagnostic accuracy and guide patient-centred management.
Methods: A case series was conducted at Hospital Universitari Germans Trias i Pujol (2019-2024), including patients with confirmed inflammatory bowel disease and histologically or radiologically verified endometriosis. A literature review was performed using PubMed and Scopus databases (1990-2024) with search terms: "endometriosis," "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis," "diagnosis," and "multidisciplinary management.
Case presentation: Case one involved a 35-year-old pregnant woman with Crohn's disease presenting acute abdominal pain initially considered as appendiceal plastron; endometriosis was subsequently confirmed postpartum following laparoscopic appendectomy. Case two concerned a 68-year-old woman with Crohn's disease and rectovesical fistula complications, where histopathological analysis of resected sigmoid tissue revealed concurrent deep infiltrating endometriosis. Case three presented a 36-year-old woman with ileal Crohn's disease experiencing persistent pelvic pain initially misattributed to inflammatory bowel pathology before definitive endometriosis diagnosis. Case four involved a 43-year-old woman with Crohn's disease and axial spondylitis, whose chronic pelvic symptoms were ultimately attributed to deep infiltrating endometriosis.
Conclusions: The coexistence of endometriosis and IBD presents significant diagnostic and therapeutic challenges requiring multidisciplinary evaluation. Early recognition and targeted imaging strategies are fundamental for preventing delayed diagnoses and optimising patient outcomes.
Introduction: Joint extraintestinal manifestations (EIMs) are a frequent complication in patients with inflammatory bowel disease (IBD). The effectiveness of vedolizumab in this context remains uncertain, with conflicting results reported. Some studies have even suggested a potential worsening of joint manifestations during treatment.
Methods: We conducted a meta-analysis of observational studies reporting joint EIM outcomes in patients with Crohn's disease or ulcerative colitis treated with vedolizumab. New-onset and worsening of existing joint manifestations were analysed separately from improvement or clinical response. A systematic search was performed in EMBASE, PubMed, and MEDLINE in June 2023, with the final search conducted on 15 June 2023. Grey literature, including preprints and conference abstracts, was excluded. The primary outcomes were the pooled incidence of joint EIMs and the rate of clinical response.
Results: Twelve studies including a total of 7,296 patients met the inclusion criteria. The pooled was 8.7% (95% CI, 4.3-13%) for incidence of joint EIMs was and 31.9% for worsening. The pooled clinical response rate was 35% (95% CI, 22-48%), with a response rate of 32% for arthritis/arthralgia and 23% for spondyloarthritis. All analyses demonstrated high heterogeneity.
Conclusions: Vedolizumab treatment appears to be associated with a relatively low incidence of new or worsening joint EIMs. However, its effectiveness in improving joint manifestations is limited.
Polycystic kidney diseases are linked to a myriad of hepatobiliary diseases. Patients with such diseases have a higher risk of admission. Clinical manifestations and complementary testing differ from healthy controls leading to suboptimal care. This review focuses on the different hepatobiliary diseases linked to polycystic kidney diseases, their diagnosis, clinical manifestations and management.
Background and aim of the study: Thiopurines are cornerstone immunosuppressants for maintenance therapy in inflammatory bowel disease, but their use is limited by potentially serious adverse events. The aim of this study is to characterize severe adverse events associated with thiopurine therapy in a cohort of inflammatory bowel disease patients treated at a tertiary care center.
Methods: A retrospective observational study was conducted including adult inflammatory bowel disease patients who developed clinically significant adverse events while on thiopurine therapy. Demographic, disease-related, treatment, and outcome variables were collected. Quantitative variables were expressed as means and standard deviations; categorical variables as percentages with 95% confidence intervals. Statistical significance was defined as p < 0.05.
Main results: Among 722 inflammatory bowel disease patients treated with thiopurines, 81 (11.2%) experienced at least one severe adverse event. Of these, 24 (30%) required hospitalization, and 2 deaths (2.5%) were attributed to thiopurine-associated malignancies. The most frequent adverse events were acute pancreatitis in 31 patients (38.3%), myelotoxicity in 19 (23.4%), malignancies in 13 (16.0%), and hepatotoxicity in 6 (7.4%). Infections and fever of unknown origin were less common, with 3 cases each (3.7%). No statistically significant associations were observed between adverse events occurrence and sex (p = 0.36), IBD subtype (p = 0.21), or thiopurine type (azathioprine vs. 6-mercaptopurine; p = 0.09).
Conclusions: Thiopurine therapy in inflammatory bowel disease is associated with a notable incidence of severe adverse events, particularly acute pancreatitis and myelotoxicity. No consistent demographic or clinical predictors of toxicity were identified, highlighting the importance of universal monitoring strategies during thiopurine treatment.
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