Gastroenterology Report最新文献

Background: Appendicitis imposes a substantial healthcare burden globally, yet comprehensive insights into its disease burden in Europe remain limited. This study assesses regional trends, disparities and high-burden countries for appendicitis in Europe.

Methods: Data on appendicitis-related incidence, mortality and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease 2019 study. Joinpoint regression analyzed temporal trends, while health inequality and quadrant analyses identified socio-demographic disparities and priority countries.

Results: In 2019, Europe's age-standardized incidence rate (ASIR) for appendicitis was 266.47 per 100,000, exceeding the global average (229.86 per 100,000). However, Europe's age-standardized mortality rate and age-standardized DALY rate were lower than the global averages. From 1990 to 2019, the average annual percentage change (AAPC) for the ASIR was 0.50%, whereas the AAPCs for the age-standardized mortality rate and age-standardized DALY rate were -3.02% and -2.20%, respectively. Finland was the sole exception, showing a reduced ASIR (AAPC: -0.20%). Health inequality analysis revealed that the burden of DALYs disproportionately affected less developed European nations. However, there was a notable improvement over the past three decades. The slope index of inequality decreased from -7.32 DALYs per 100,000 in 1990 to -1.02 DALYs per 100,000 in 2019, and the relative concentration index fell from -11.04 to -2.58 during the same period. Among the 43 countries, Bulgaria and Austria had the highest 2019 DALY burdens.

Conclusions: Appendicitis persists as a critical public health challenge in Europe, necessitating targeted resource allocation and policy interventions in high-burden countries to address persistent health inequalities.

Background: Tumor location affects rectal cancer management, but no consensus exists on criteria. The anterior peritoneal reflection (aPR), an anatomical landmark, shows potential for defining tumor location but requires clinical validation. This study evaluated the utility of aPR in guiding neoadjuvant chemoradiotherapy (nCRT) decisions and predicting lateral lymph node (LLN)/distant metastasis patterns.

Methods: This single-center retrospective cohort analyzed data from Peking Union Medical College Hospital (Beijing, China) between January 2016 and August 2022. Magnetic resonance imaging (MRI)-measured aPR parameters were pathologically validated. Patients were stratified by aPR-based definition and tumor height (10 cm). Kaplan-Meier survival curves, log-rank tests, and Cox regression were used for prognostic analysis.

Results: Among 588 patients (439 tumors ≥5 cm from the anal verge), MRI identified aPR with an accuracy of 95.4%. For tumors ≥5 cm, aPR-defined middle-to-low rectal cancer showed lower 3-year disease-free survival (DFS) rate than the upper rectal cancer (P = 0.010), while their 3-year overall survival (OS) rates were comparable. Conversely, 10-cm-defined classification showed no DFS or OS differences (both P > 0.2). Cox regression confirmed aPR-defined classification as an independent DFS predictor (HR = 3.19, P = 0.014), while 10-cm classification was non-predictive. nCRT with tumor regression grade (TRG) 0-1 trended toward improved DFS compared with direct surgery (HR = 0.56, P = 0.072). The independent protective effect of nCRT with TRG 0-1 for DFS was exclusive to the aPR-defined middle-to-low rectal cancer subgroup (HR = 0.45, P = 0.026) and not observed in the 10-cm subgroup. aPR-defined classification was independently associated with LLNs on MRI and postoperative pulmonary metastasis.

Conclusion: aPR may guide nCRT decision-making and predict LLN metastasis and postoperative distant organ metastasis.

Background: Chronic radiation-induced intestinal injury (CRIII) is the most prevalent condition following radiation therapy in patients with pelvic malignancies. More than 15% of patients with severe CRIII require surgery. The histopathological features and their interactions with clinical presentation and outcomes remain largely unknown. The present study proposed a new pathological categorization of CRIII and investigated its relationship with clinical manifestations and outcomes.

Methods: This retrospective study included 111 patients with CRIII who were treated at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 2011 and December 2021. The features of ulcers, collagen fibers, and neoangiogenesis were measured via microscopic scoring, Masson's trichrome staining, and immunohistochemistry for CD34. The K-means method was used for cluster analysis based on these three data groups. The Kaplan-Meier method and log-rank test were used to examine the incidence-time curves of severe complications, including intestinal fistula, intestinal obstruction, and anemia, as endpoint events. Cox proportional hazards regression models were used for multivariate analyses.

Results: Four pathological CRIII subtypes were identified: mixed (48.7%), fibrosis (17.1%), telangiectasia (16.2%), and ulcers (18.0%). Patients with the ulcer subtype had a significant probability of developing a recto-intestinal fistula (P = 0.047) and a pathological pattern of deep serosal ulcers, which manifested as fistulas and thrombosis (75%, 15/20). Patients with the telangiectasia subtype consistently exhibited anemia (P = 0.002) and displayed significant arterial dilatation (72.2%, 13/18). Intestinal obstruction occurred more frequently in the fibrosis subtype due to a severe fibrotic pattern (31.6%, 6/19) and sclerotic collagen (57.9%, 11/19) (P = 0.014).

Conclusion: We proposed a new pathological classification for CRIII that better associates with clinical presentations and consequences.

Acute mesenteric ischemia (AMI) is a life-threatening vascular disorder that demands greater clinical and research attention due to its significant morbidity and mortality risks. Clinicians should maintain a high index of suspicion for AMI in patients presenting with severe abdominal pain disproportionate to physical findings, particularly those with atrial fibrillation or recent vasoconstrictor use. In such cases, prompt computed tomography angiography is recommended as the initial diagnostic modality, given its high sensitivity, specificity, efficiency, and favorable safety profile. Multi-disciplinary treatment plays a critical role in elucidating disease etiology and guiding therapeutic decision-making. For confirmed cases of intestinal necrosis, open surgical intervention remains the gold standard. Laparoscopic exploration offers a minimally invasive alternative for assessing bowel viability while reducing unnecessary surgical trauma in equivocal presentations. In the pre-necrotic phase of intestinal ischemia, emerging endovascular therapies demonstrate increasing promise due to their minimally invasive nature and improved clinical outcomes, warranting further investigation. Continuous clinical vigilance is essential throughout management. Persistent abdominal pain or signs of peritonitis may indicate disease progression, necessitating urgent reassessment for possible ischemic necrosis and therapeutic strategy adjustments. This review synthesizes current evidence by examining AMI pathophysiology, anatomical considerations, risk factors, and diagnostic-therapeutic advancements, with an emphasis on optimizing clinical decision-making in this critical condition.

Background: Endoscopic ultrasound (EUS)-guided liver biopsy has been an effective method for acquiring liver tissue. However, currently, there is no consensus on the technical details of biopsy sampling. This study aimed to optimize the EUS-guided liver biopsy techniques to improve specimen quality.

Methods: EUS-guided liver biopsies were performed in four porcine subjects with four technical aspects: negative pressure suction, number of actuations, two puncture manipulations, and two types of puncture needles. The primary outcomes were total specimen length (TSL) and complete portal tracts (CPTs), the secondary outcomes included longest specimen length (LSL), number of specimen pieces, specimen fragmentation, blood contamination, and bleeding.

Results: Forty-four biopsy samplings were performed. In Phase I, specimens obtained with 1-mL suction demonstrated significantly superior TSL, CPTs, and LSL compared with other suction techniques according to multiple comparisons. In Phase II, median TSL and CPTs with fewer than three actuations were significantly higher compared with those with at least three actuations (P < 0.05). In Phase III, the modified "click-puncture" yielded superior median CPTs, TSL, and LSL in comparison with conventional puncture (P < 0.05). In Phase IV, a fine-needle aspiration (FNA) needle was effective with a low risk of bleeding and foreign-tissue embedding (P < 0.05).

Conclusions: Optimal techniques for specimen quality in EUS-guided liver biopsy include using 1-mL suction, no more than three actuations, and employing a modified "click-puncture" manipulation. While FNA and fine-needle biopsy needles achieved comparable specimen quality, the FNA needle demonstrated the prevention of bleeding and foreign-tissue embedding.

Background: The association between delayed surgery and survival outcomes in locally advanced rectal cancer patients with a poor response to neoadjuvant chemoradiotherapy (nCRT) remains unclear. This study aimed to determine the optimal timing of surgery following nCRT in these patients and to explore the association between delayed surgery and survival outcomes.

Methods: Restricted cubic spline curves were used to determine the optimal timing of surgery for patients with a poor response to nCRT (ypT2-4N0 or ypTxN+). The patients were divided into two groups: the early surgery group and the delayed surgery group. Propensity score matching (PSM) analysis was employed to reduce the selection bias and survival analysis was conducted to assess the survival differences. Immunostaining of post-operative specimens was performed to investigate whether the difference in survival was associated with the CD8⁺ T-cell density in the tumor.

Results: A total of 583 patients were enrolled in this study. The optimal timing for surgery was determined to be 9 weeks after nCRT. In PSM analysis, delayed surgery was associated with worse disease-free survival (63.0% vs 76.3% at 5 years, 53.0% vs 76.3% at 10 years; P = 0.003) and cancer-specific survival (72.9% vs 85.5% at 5 years, 60.1% vs 81.8% at 10 years; P = 0.001). Immunostaining analysis showed that longer waiting times were associated with decreased CD8⁺ T-cell density in tumors (P = 0.017).

Conclusions: Patients who had a poor tumor response after nCRT, detected by using magnetic resonance imaging restaging or other assessments, need timely radical surgery without delay.