Visceral Medicine最新文献

Background: Proctological diseases are highly prevalent during pregnancy, with reported incidence rates ranging from 45% to 68%. The true prevalence is likely higher due to underreporting. These conditions frequently persist into the postpartum period, causing significant discomfort and emotional distress. Physiological changes in the maternal body - including hormonal, metabolic, immunological, and cardiovascular alterations - play a central role in the development of these disorders. The enlargement of the uterus, increased blood volume, and elevated pressure in the pelvic veins contribute to venous stasis in the hemorrhoidal plexus, thereby predisposing pregnant individuals to symptomatic hemorrhoids and perianal thromboses.

Summary: The most frequently reported symptoms are anal pain and constipation. Anal pain, which is often intense, is commonly associated with constipation and is due to the high density of sensory nerve endings in the anal canal. Constipation affects more than 60% of pregnant women, primarily as a result of hormonal changes, decreased physical activity, and iron supplementation. Straining during defecation further aggravates proctological conditions, facilitating the development of hemorrhoids, anal fissures, and perianal thrombosis. Diagnosis should include a thorough medical history, physical examination, and proctoscopy. In selected cases, additional imaging may be warranted. Conservative treatment is the mainstay of management, with a focus on symptom control and regulation of bowel habits. Hemorrhoidal disease is particularly common during pregnancy. Conservative treatment includes increased fluid intake, the use of stool softeners, and local cooling measures. Surgical interventions should be reserved for refractory cases and only considered when absolutely necessary. Anal fissures, the second most prevalent condition after hemorrhoids, are primarily caused by constipation. First-line treatment involves stool regulation, analgesic therapy, and the application of topical ointments. While chronic fissures may occasionally require surgical intervention, noninvasive approaches are strongly preferred to minimize risks. Perianal thrombosis, often misdiagnosed as thrombosed external hemorrhoids, typically occurs in the third trimester or shortly after delivery. Conservative therapy is generally effective, focusing on pain control. In selected cases, surgical excision of thrombosed nodules may be indicated.

Key messages: In summary, proctological conditions during pregnancy are common but usually manageable through accurate diagnosis, conservative treatment, and empathetic patient support. Prioritizing symptom relief and avoiding unnecessary surgical interventions are essential to achieving favorable outcomes.

Introduction: The prediction of occurrence and form of a postoperative pancreatic fistula (POPF) could decrease the risk after pancreatic resections. We developed a score based on histomorphological criteria to predict POPF earlier on. In this study, we test the scoring system to differentiate between patients developing grades B and C POPF.

Methods: We analysed 92 patients who underwent pancreatic head resection and developed a grade B or C POPF postoperatively. There were no exclusion criteria. Pancreatic resection margins were analysed histologically and pancreatic duct size, fibrosis, fat content, and signs of inflammation were transformed into a scoring system.

Results: Patients with a grade B fistula (n = 48) were compared to patients with grade C fistula (n = 44). The grade C group was characterized by higher mortality (0 vs. 22, p < 0.001), postpancreatectomy haemorrhage (3 vs. 24, p < 0.001), longer stays in intensive care unit (2.6 vs. 21.1, p < 0.001) and in hospital (29.8 vs. 44.6, p < 0.001). The scoring system was unable to predict grade C fistula. We calculated receiver operator characteristics for all assessed characteristics, which revealed an area under the curve of 0.561. The strongest predictors of POPF grade C were pancreatic fat and soft pancreatic tissue. A combination of only these two items led to a statistically significant difference (p < 0.001) and an AUC of 0.771.

Conclusion: Establishing a score to differentiate between grade B and grade C POPF is a difficult task. Pancreatic fat seems to be the most relevant histomorphological feature to be used in any scoring system, and it should be combined with other clinical features to enhance its precision and validity.

Background: The functional lumen imaging probe (EndoFLIP), which utilizes impedance planimetry, has emerged as a valuable tool for a more comprehensive evaluation of esophageal physiology and pathophysiology beyond traditional high-resolution manometry.

Summary: EndoFLIP, including its variations EndoFLIP and EsoFLIP, measures intraluminal distensibility and compliance by assessing diameter and distension pressure using balloon catheters.

Key messages: This technology is applicable to various organs such as the esophagus, stomach, and anorectal region, and serves in both diagnostic and therapeutic contexts, especially in ambiguous clinical cases.

Background: Pancreatic cancer continues to retain the highest mortality rate among all major organ cancers. New strategies for early detection are being proposed to increase long-term survival. A plethora of molecular markers are discovered yearly, but so far none have demonstrated screening utility.

Summary: Promising discovery technologies include affinity-based proteomics and ddPCR. In the validation phase, researchers must decide on key benchmark criteria, what type of pancreatic lesions are desirable to find early through molecular screening, and when to terminate the biomarker study and return to the discovery phase. If the biomarkers meet set benchmarks, retrospective analysis should be conducted in relevant cohorts based on intended use, followed by prospective real-world evaluation. Lastly, regulatory approval, incorporation into clinical practice guidelines, and thorough health economic evaluations must be completed before the screening markers can be fully implemented.

Key messages: In this review, important strategies and phases for molecular biomarker development in pancreatic cancer have been outlined.

Background: Pancreatic ductal adenocarcinoma (PDA) is a highly lethal malignancy, often diagnosed at an advanced stage due to its insidious progression and the absence of effective early detection strategies. Accurate diagnosis and staging are critical for optimizing treatment selection and improving patient survival. Contrast-enhanced computed tomography (CT) remains the diagnostic standard for PDA; however, its sensitivity is limited by interobserver variability and the frequent absence of overt morphological abnormalities in early stage disease.

Summary: Artificial intelligence (AI) has emerged as a promising tool for overcoming the inherent limitations of conventional radiologic assessment by leveraging radiomics and deep learning models to extract subtle imaging signatures of PDA that are imperceptible to the human eye. AI-driven models have demonstrated the ability to detect pre-diagnostic PDA on CT scans months to years before clinical presentation by identifying textural and structural changes in the pancreas. Furthermore, automated volumetric pancreas segmentation enhances reproducibility and facilitates the discovery of imaging biomarkers associated with early carcinogenesis. Despite these advances, key challenges remain, including dataset heterogeneity, model interpretability, and prospective validation in real-world clinical settings.

Key messages: AI-driven approaches offer a transformative opportunity to augment CT-based PDA detection, reduce diagnostic uncertainty, and facilitate earlier intervention. However, robust external validation, integration into clinical workflows, and prospective trials are essential to establish AI as a reliable adjunct in PDA diagnosis and staging.

Background: Pediatric surgical complications and their endoscopic treatment approaches share a unique challenge of small anatomy, highly volatile situations and the need to be flexible with instruments which have been designed for older and bigger patients. In the last few decades, endoscopic interventions have emerged as a minimally invasive alternative approach to standard open closure procedures for the treatment of postsurgical complications.

Summary: This review summarizes the most common situations and techniques in pediatric endoscopy taking on postsurgical complications, including opportunities to improve outcome and overcome barriers of individualized therapy as compared to adult strategies.

Key message: Endoscopic management of postsurgical complications is highly effective and associated with high success rates, low mortality, and minimal recurrence of the underlying pathology.

Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with early detection and surgical resection being the only potentially curative treatment option. Despite advancements in diagnostics and surgical techniques, the prognosis of early-stage PDAC remains poor. Understanding the indications, approaches and perioperative management are crucial for improving patient survival.

Summary: Surgical resection remains the only curative treatment for early-stage PDAC. Different surgical procedures are performed depending on tumor location and local extent. Advances in minimally invasive surgery (MIS) yielded promising results regarding postoperative recovery and oncologic outcomes. The implementation of neoadjuvant therapy has improved resection and survival rates. Still, pancreatic surgery is associated with significant morbidity.

Key messages: Surgical resection remains the only curative option for early-stage pancreatic cancer. Neoadjuvant chemotherapy plays a crucial role in improving resection and survival rates. Perioperative care has been refined by MIS, optimized surgical techniques, and structured complication management.

Introduction: Texture analysis can provide quantitative imaging markers and better characterize tumor tissue in oncological imaging. The present analysis investigated the diagnostic benefit of computed tomography (CT)-derived texture analysis to categorize and stage lymph nodes in patients with colon cancer.

Methods: In this study, 85 patients were included (n = 39 females, 45.9%) with a mean age of 70.3 ± 14.8 years. All patients were surgically resected, and the lymph nodes were histopathologically analyzed. All investigated lymph nodes were further investigated with texture analysis using the MaZda package.

Results: Out of a total of 279 extracted CT texture features, 7 parameters independently showed statistically significant differences between lymph node positive to negative ones. For instance, the texture parameter S(1,0)AngScMom showed statistically significant differences regarding lymph node metastasis status (0.007 ± 0.004 for N0 vs. 0.005 ± 0.001 for N1-2, p = 0.001). A multivariate model was developed based on n = 7 independent texture parameters. The diagnostic accuracy reached an area under the curve of 0.79 (95% CI: 0.69-0.89) with a sensitivity of 0.77 and a specificity of 0.70, resulting in an accuracy of 0.73.

Discussion: Texture analysis can improve the diagnostic accuracy for nodal CT staging in patients with colon cancer. Further validation studies are needed to confirm the present results.

Background: Following metabolic and bariatric surgery (MBS), a wide range of symptoms may indicate postoperative complications, all of which can prompt endoscopic inspection and multidisciplinary management of potential complications. Therefore, an anatomical and technical understanding of the previous surgical procedure and its forms of reconstruction especially after MBS is crucial for the attending endoscopist to optimize endoluminal therapy. A selective literature review has been performed. This overview of endoscopic complication management aims to outline the available options after MBS.

Summary: Postoperative complication rates vary widely depending on the antecedent procedure and have been reported to be relevant after specific procedures such as laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass in the context of MBS. There is a timeline of 30 days in the postoperative course that divides early from late complications. While anastomotic leaks or endoluminal bleeding are considered typical early complications, late complications include problems such as strictures and anastomotic ulcers. Management of complications in the immediate postoperative period (very early complications) may require a multidisciplinary approach to optimize the outcome of complication management, involving the surgeon, the endoscopist and the ward physician who manages the patient round-the-clock. This hand-in-hand approach enables the best possible treatment for the patient, with endoscopy playing a crucial role in solving endoluminal problems in a much less invasive way than repeated surgical intervention, thereby contributing significantly to an easier postoperative course.

Key messages: The surgical approach, in cooperation with endoluminal complication management, constitutes comprehensive visceral medicine, as endoscopy is the helping hand of surgery in the context of MBS.