World Journal of Gastroenterology最新文献

Chimeric antigen receptor (CAR)-T cell therapy has emerged as a transformative treatment option for relapsed or refractory follicular lymphoma (FL), particularly in patients in whom multiple lines of conventional therapy have failed. Among cluster of differentiation (CD) 19-targeted products, lisocabtagene maraleucel (liso-cel) offers distinct advantages owing to its defined CD4⁺/CD8⁺ composition and favorable safety profile. Compared with diffuse large B-cell lymphoma, FL patients consistently achieve higher overall response rates and exhibit lower rates of severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome, supporting the rationale for expanding CAR-T cell therapy in this subgroup. This editorial review the current CD19-directed CAR-T cell therapy landscape, focusing on the pivotal TRANSCEND FL trial, which demonstrated a 97% overall response rate and 94% complete response rate, with a minimal incidence of severe CRS or neurotoxicity. Comparative insights highlight the advantages of liso-cel over other CAR-T cell products, such as axicabtagene ciloleucel and tisagenlecleucel in terms of toxicity, logistics, and outpatient feasibility. The implications for gastrointestinal FL (GI-FL), a subtype often excluded from CAR-T cell studies, were also addressed, emphasizing the need to include advanced-stage GI-FL cases in future evaluations. With ongoing improvements in manufacturing, accessibility, and biomarker development, liso-cel is well-positioned to become a central component in the evolving treatment paradigm for FL. However, challenges remain regarding durability of response, cost, and access, which warrant careful discussion.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, predominantly arising in the stomach (approximately 60%) and small intestine (approximately 30%), and accounting for 1%-3% of all gastrointestinal malignancies. In most cases, GISTs originate within the gastrointestinal tract; However, in rare instances, they may develop in extra-GISTs (EGISTs). Among these, gallbladder-derived EGISTs are exceedingly uncommon, with only nine cases reported to date.

Case summary: We present the case of a 66-year-old woman who presented with recurrent right upper quadrant abdominal pain and subsequently underwent cholecystectomy. Histopathological examination with immunohistochemistry revealed CD117(+), DOG-1(+), and CD34(+), with no evidence of a primary gastrointestinal lesion, thereby confirming the diagnosis of primary gallbladder EGIST. According to the 2017 Chinese consensus on GISTs, based on the modified NIH 2008 criteria, the tumor was classified as very low risk. Consequently, the patient did not receive adjuvant targeted therapy such as imatinib, and the patient remained disease-free during a 6-month follow up.

Conclusion: Primary gallbladder EGISTs are exceedingly rare, with insidious onset and nonspecific clinical manifestations. Histopathological examination combined with immunohistochemistry remains the cornerstone of definitive diagnosis.

Background: Refractory ascites severely impairs quality of life in patients with liver cirrhosis (LC) and cancer-related peritonitis. For individuals who are intolerant to medical therapy and require frequent large-volume paracentesis, a peritoneovenous shunt (PVS) offers a potential treatment option. However, PVS placement is associated with high complication rates, perioperative mortality, and lacks well-defined indications.

Aim: To identify prognostic factors for PVS placement and develop a novel postoperative survival scoring model for LC with refractory ascites.

Methods: A total of 100 patients who underwent PVS placement for refractory ascites due to LC in our department between 1998 and 2024 were analyzed. Patients were stratified into two groups: Those who survived more than 180 days after PVS placement (L-group) and those who survived for less than 180 days (S-group). Prognostic factors were compared between groups, and four variables (sex, age, Child-Pugh score, and liver volume) were selected for the creation of a new scoring system.

Results: Significant differences between the S- and L-groups were observed for age, sex, Child-Pugh score and preoperative liver volume. Based on these variables, we developed a scoring system as follows: 1 point each for age ≥ 60 years, Child-Pugh score ≥ 10, female sex, and preoperative liver volume < 1057 mL. Patients scoring 0-2 points were classified as PVS grade A, and those scoring 3-4 points as PVS grade B. Survival analysis showed that overall survival was significantly higher in PVS grade A compared with PVS grade B. Multivariate analysis confirmed PVS grade as an independent prognostic factor.

Conclusion: The proposed PVS scoring system may be a useful tool for predicting postoperative prognosis following PVS placement in patients with LC and refractory ascites.

Background: Optimal treatment strategies for small hepatocellular carcinoma (HCC) remain under investigation. Laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are key curative modalities.

Aim: To compare the long-term survival and perioperative outcomes of LH and RFA for small HCC.

Methods: In this retrospective study, 254 patients with small HCC who were admitted to the First Affiliated Hospital of Chongqing Medical University between December 2022 and March 2025 were analyzed. Patients were divided into LH (n = 109) and RFA (n = 145) groups based on their treatment modality. Primary endpoints were 36-month overall survival (OS) and disease-free survival (DFS). Secondary endpoints included recurrence rate, perioperative outcomes, and complications. Assessments were conducted at baseline, immediately post-treatment, and at regular follow-up intervals up to 36 months.

Results: Baseline demographic and clinical characteristics, except mean tumor size (LH: 3.05 ± 1.12 cm vs RFA: 2.48 ± 0.93 cm, P < 0.001) and platelet count (higher in LH, P = 0.008), were comparable between groups. LH was associated with longer operative time, greater blood loss, prolonged recovery, higher costs, and increased complication rates (62.39% vs 15.87% for RFA, P < 0.001). However, at 36 months, OS (85.32% vs 66.21%, P < 0.001) and DFS (64.22% vs 44.83%, P = 0.002) were significantly higher in the LH group. Multivariate Cox regression identified surgical approach (LH), lower tumor size, and lower platelet count as independent predictors for improved DFS; only LH independently improved OS (hazard ratio = 0.55; 95% confidence interval: 0.38-0.79; P < 0.001).

Conclusion: LH, though associated with increased perioperative morbidity, provides superior long-term survival outcomes compared with RFA in patients with small HCC. Surgical approach should be considered when selecting optimal therapy for this patient population.

Background: Refractory gastroesophageal reflux disease (GERD) constitutes a significant proportion of GERD cases and presents a considerable burden in clinical practice. However, the underlying risk factors contributing to persistent and refractory symptoms and the clinical characteristics of this disease remain poorly understood.

Aim: To investigate the clinical features of refractory GERD and identify the associated risk factors.

Methods: This is a multicenter cross-sectional study on patients with GERD across 18 medical centers in Shanghai. All participants completed comprehensive questionnaires that assessed their demographic characteristics, lifestyle and dietary habits, clinical manifestations, somatic symptoms, mental and psychological health status, and quality of life. Univariate analysis was performed to identify significant differences between the patients with refractory and non-refractory GERD. Subsequently, stepwise regression analysis was employed to conduct a multivariate binary logistic regression for exploring the association between refractory GERD and various factors, including dietary habits, lifestyle, clinical symptoms, and mental and psychological status.

Results: Our study included 911 patients diagnosed with GERD, of whom 256 (28.1%) had refractory GERD and 655 (71.9%) had non-refractory GERD. Compared to patients with non-refractory GERD, those with refractory GERD are older, have a longer disease duration, and exhibit higher scores for typical reflux symptoms. They are also more likely to present with atypical symptoms, more prone to overeating, more likely to experience somatic symptoms, comorbid anxiety, and depression, and report a lower quality of life. Binary logistic regression analysis identified disease duration and anxiety as significant risk factors and at least 90 minutes of moderate-intensity physical activity per week as a protective factor for refractory GERD.

Conclusion: Refractory GERD is associated with a prolonged disease duration, anxiety status, and insufficient physical activity. These findings may afford valuable insights for the clinical management and development of non-pharmacological interventions for refractory GERD.

The management of biliary strictures is challenging both diagnostically and therapeutically, requiring a combination of advanced endoscopic techniques. Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for therapeutic interventions, including biliary drainage, stent placement, and tissue sampling via brush cytology or forceps biopsy. However, ERCP may not be suitable for obtaining deep tissue samples and can lead to complications such as post-ERCP pancreatitis. Endoscopic ultrasound (EUS) has emerged as a complementary modality, offering high-resolution imaging of the biliary tree and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) improve diagnostic accuracy, especially where ERCP-based sampling is inconclusive. Additionally, EUS plays an increasingly therapeutic role in the management of biliary strictures, particularly through EUS-guided biliary drainage, which is an effective alternative when ERCP fails due to surgically altered anatomy or inaccessible strictures. This review discusses the use of EUS and ERCP in the management of biliary strictures, highlighting their strengths and limitations, and proposes a stepwise and integrated approach. This strategy may enhance diagnostic precision and expand therapeutic options, particularly in indeterminate or complex clinical scenarios.

Wang et al provide preclinical evidence that specific traditional herbal formulas, like Pyeongwi-san, can improve gastrointestinal (GI) motility under stress. Pyeongwi-san enhances GI transit, boosts serotonin levels, restores short-chain fatty acid balance, and reduces inflammation. The clinical significance of this research is its potential for standardized herbal remedies for GI disorders, such as dyspepsia and irritable bowel syndrome. At the same time, using only male mice, a single dose regimen, and relatively small cohorts highlights the need for further validation, including sex-specific responses, dose-effect relationships, and translational clinical studies. In summary, readers will find value in this article because it provides mechanistic details, bridges tradition with modern science, deals transparently with its limitations, and paves the way for clinically relevant innovation in GI health. Future investigations should focus on clinical validation and personalized therapeutic strategies that harness both microbiome-gut-brain interactions and the long history of herbal medicine.

Background: People with compensated advanced chronic liver disease (cACLD) remain at high risk of hepatocellular carcinoma (HCC) even after hepatitis C virus (HCV) sustained virological response (HCV-SVR).

Aim: To evaluate transient elastography and fibrosis-4 (FIB-4) index as prognostic markers for HCC after HCV-SVR.

Methods: This retrospective cohort study analyzed data from people with cALCD and HCV-SVR. cALCD was defined as baseline liver stiffness measurement (LSM) ≥ 10 kPa. The primary outcome was the occurrence of HCC. Data collected at baseline (pre-treatment) and 1 year after the end of treatment (1-year-EOT) of LSM, FIB-4 index, and laboratory results were analyzed. LSM and FIB-4 index were evaluated as independent predictors of HCC by a Cox regression analysis. Receiver operator characteristic curves, Kaplan-Meier curves, and Cox regression analysis were performed.

Results: Total of 425 patients (65.2% female; mean age = 62 ± 10 years) were included. The median pre-treatment and 1-year-EOT LSM were respectively 15.0 kPa (interquartile range: 11.8-23.2) and 12 kPa (interquartile range: 7.9-19.9) (P < 0.001), with a 27% (interquartile range: 2.7%-43%) reduction after SVR. The median pre-treatment FIB-4 index was 2.94 (interquartile range: 1.89-4.85) and 1-year-EOT FIB-4 1.99 (interquartile range: 1.29-3.13) (P < 0.001). Neither LSM nor FIB-4 deltas were associated with HCC. A total of 26 participants (6%) developed HCC during a follow-up of 48 ± 23 months with an incidence of 15.3/1000 person-years. Age [hazard ratio (HR) = 1.06, 95% confidence interval (CI): 1.01-1.11; P = 0.02], baseline (HR = 1.05, 95%CI: 1.02-1.07) and 1-year-EOT LSM ≥ 20 kPa (HR = 4.49, 95%CI: 2.19-9.19; P < 0.001) and baseline (HR = 7.79, 95%CI: 2.31-26.32; P < 0.001) and 1-year-EOT FIB-4 index score ≥ 3.25 (HR = 3.14, 95%CI: 1.65-6.00; P < 0.001) were associated with incident HCC.

Conclusion: In cACLD-HCV SVR patients, pre-treatment or 1-year-EOT LSM ≥ 20 kPa and FIB-4 ≥ 3.25 but not their delta was associated with HCC. A single measure of LSM ≥ 20 kPa or FIB-4 ≥ 3.25, either pre-treatment or 1-year-EOT, would be necessary to predict the incidence of HCC in people with HCV-SVR.

Background: Endoscopic submucosal dissection (ESD) is an established therapeutic modality for early gastric cancer (EGC). Accurate assessment of the invasion depth is critical for evaluating treatment outcomes.

Aim: To investigate the clinical significance of stereomicroscopy in determining the invasion depth of EGC.

Methods: This retrospective analysis included 967 patients with EGC who underwent ESD from 2014 to 2023. The mucosal and basal aspects of ESD specimens were stereomicroscopically examined. Lesions were categorized stereomicroscopically as mucosal (uniformly thick, transparent submucosal tissue) or submucosal defined by the presence of a "Basal White Sign", a localized, opaque, whitish discoloration exceeding 5 mm in diameter. Patients with uncertain classification were excluded. The accuracy of stereomicroscopic depth diagnosis and clinicopathological features of misdiagnosed cases were analyzed.

Results: The overall diagnostic accuracy of stereomicroscopy for invasion depth was 74.0%. For non-ulcerated lesions, stereomicroscopy exhibited high diagnostic performance [accuracy = 93.5%, 95% confidence interval(CI): 91.1-95.4, sensitivity = 95.0%, specificity = 86.9%, positive predictive value = 96.9%, negative predictive value = 80.2%]. Conversely, performance significantly declined in ulcerated lesions (accuracy = 35.8%, 95%CI: 30.2-41.6, sensitivity = 19.1%, specificity = 95.2%, positive predictive value = 93.5%, negative predictive value = 24.8%). Tumor size of 21-30 mm (odds ratio = 1.6) and ulceration (odds ratio = 36.1) were independent risk factors for misdiagnosis. Submucosal lesions exhibited significantly larger basal vessel diameter than mucosal lesions (663.6 μm vs 505.5 μm, P < 0.001).

Conclusion: Stereomicroscopy is an effective diagnostic tool for determining the EGC invasion depth, particularly in non-ulcerated lesions. These findings could inform clinical practice and ESD treatment strategy optimization for EGC.

Metabolic-associated fatty liver disease (MAFLD) represents the most common cause of chronic liver disease worldwide and remains frequently underdiagnosed in its early stages. Tian et al recently reported a prospective observational study that developed a machine learning-based model to predict hepatic steatosis in high-risk individuals. The resulting XGBoost model demonstrated excellent predictive performance (area under the curve 0.82; cross-validation mean area under the curve 0.918). Importantly, the study highlighted clinically meaningful predictors such as the aspartate aminotransferase/alanine aminotransferase ratio, triglycerides, and waist circumference, alongside novel traditional Chinese medicine-derived features like greasy tongue coating and tongue edge redness. Nonetheless, challenges remain, including the need for standardized traditional Chinese medicine assessment, external multicenter validation, and refined modeling to account for MAFLD heterogeneity. Future studies should expand biomarker panels, incorporate advanced imaging, and evaluate clinical outcomes of model-driven interventions. Overall, Tian et al provide a valuable contribution by demonstrating that machine learning can improve early detection and personalized management of MAFLD.