Translational gastroenterology and hepatology最新文献

Background: Pancreatic cancer and other solid pancreatic lesions present significant diagnostic challenges owing to their deep anatomical location and nonspecific symptoms. Endoscopic ultrasound (EUS) has emerged as a critical modality for high-resolution imaging and tissue sampling of pancreatic lesions. However, comprehensive data on its utilization and findings in Gulf Cooperation Council (GCC) countries remain scarce. This study aimed to evaluate the demographic characteristics, clinical presentations, and diagnostic outcomes of solid pancreatic lesions assessed via EUS in GCC countries.

Methods: A retrospective, descriptive analysis was conducted on 551 patients who underwent EUS for the evaluation of solid pancreatic lesions between 2020 and 2024 across multiple healthcare institutions in the GCC countries. Demographic data, clinical symptoms, imaging findings, and diagnostic outcomes were also collected. Statistical analyses included descriptive statistics, Chi-squared tests for categorical variables, and Mann-Whitney U tests for non-normally distributed continuous variables.

Results: A total of 551 patients (mean age 61.5±13.7 years; n=330 males, 59.9%) were included. Most were symptomatic (n=499, 90.6%), with abdominal pain (n=354, 64.2%) being the most common symptom. Computed tomography was the initial diagnostic modality in the majority (n=469, 85.1%). Lesions were most frequently located in the pancreatic head/uncinate on imaging (n=329, 59.7%) and EUS (n=361, 65.6%). Vascular involvement was observed in 260 (47.2%) radiologically and 226 (41.1%) on EUS. Lesion size was smaller on EUS (34 vs. 37 mm, P=0.008), while side branch dilation was more often detected (P<0.001). The most common diagnosis was pancreatic ductal adenocarcinoma (n=417, 80.1%), followed by neuroendocrine tumors (n=49, 9.4%).

Conclusions: EUS plays a pivotal role in diagnosing solid pancreatic lesions in the GCC countries, offering safe and effective lesion characterization and tissue sampling. Standardized protocols and further molecular research are warranted to enhance diagnostic precision and outcomes in pancreatic adenocarcinoma.

Background: Esophageal variceal bleeding (EVB) is a common gastrointestinal (GI) emergency associated with a high risk of morbidity and mortality. Esophageal varices are a result of portal hypertension, commonly caused by cirrhosis. When these varices rupture, they cause rapid exsanguination if not intervened on quickly. Hospital admissions during the weekend are associated with worse outcomes in many categories of emergent GI pathology, including upper GI hemorrhage. However, the relationship between weekend admission and hospital outcomes for EVB patients remains controversial. Our study aims to investigate this potential disparity further using a large nationwide sample.

Methods: The National Inpatient Sample (NIS) [2008-2020] was used, patients over 18 with a primary EVB diagnosis using ICD-9/10 codes were selected. Patients were grouped by weekend or weekday admission. Baseline characteristics (age, gender, race, insurance, comorbidities) were compared. Outcomes included mortality, shock, acute myocardial infarction (AMI), acute kidney injury (AKI), composite outcome, length of stay (LOS), hospital charges, endoscopy/TIPS performance, and procedure timeliness. Weighted logistic regression calculated odds ratios (ORs), adjusted for age, gender, race, hospital characteristics, region, and Charlson Comorbidity Index (CCI).

Results: Of 322,155 EVB patients, 82,293 were weekend admissions, and 239,862 were weekday admissions. Baseline characteristics [age (P=0.07), gender (P=0.71), race (P>0.05), insurance (P>0.05)) were similar. Patients admitted on weekends had lower rates of anemia but higher smoking (P=0.005), alcohol use disorder (P=0.002), more medically complex (CCI 5.30 vs. 5.25, P=0.03). The two groups had similar rates of mortality (P=0.14), AMI (P=0.18), and AKI (P=0.14). Weekends had higher odds of shock (OR 1.14, CI 1.08-1.21, P<0.001) and composite outcome (OR 1.08, CI 1.04-1.13, P<0.001). Weekends had lower odds of receiving an endoscopic intervention on hospital day 0 [OR 0.90, 95% confidence interval (CI) 0.86-0.94, P<0.001) or TIPS before day four (OR 0.778, 95% CI 0.65-0.94, P=0.009). The following outcomes of mortality (OR 0.962, 95% CI: 0.867-1.068, P=0.47), AMI (OR 1.214, 95% CI: 0.983-1.499, P=0.07), AKI (OR 1.03, 95% CI: 0.975-1.089, P=0.29), composite (OR 1.034, 95% CI: 0.982-1.089, P=0.20), endoscopy (OR 1.015, 95% CI: 0.960-1.073, P=0.60), and total charges (OR 1,102, 95% CI: -89,717 to 2,295.41, P=0.07) between the two groups.

Conclusions: The increased risk of shock in these patients, but no difference in hospital mortality, could be explained by the lower odds of having an endoscopy done on the day of admission and TIPS before day four, compared to patients admitted on weekdays. Thus, more research is needed to determine how the weekend effect can be mitigated in admitted EVB patients.

Background: Polypoid lesions of the gallbladder (PLGs) are common lesions that can be classified as either nonneoplastic or neoplastic polyps. Surgical resection is recommended for neoplastic polyps, and accurate preoperative identification of neoplastic polyps is needed to guide appropriate management. However, accurately distinguishing neoplastic polyps remains challenging. Therefore, the aim of this study is to establish a preoperative prediction model for neoplastic polyps on the basis of a convolutional neural network (CNN) model using ultrasound images and evaluate its reliability.

Methods: This was a multicentre retrospective study. All included cases were divided into a training set, an internal test set, and an external test set. A CNN model was established using the Inception-V3 model, and the ultrasound images from the training set were input into the CNN for feature processing. The internal and external test set images were subsequently used to assess the predictive performance of the CNN model, which was then compared with the diagnostic performance of three sonographers with different levels of experience and an ultrasound feature-based nomogram model.

Results: A total of 380 cases (921 images in total) were retrospectively collected, with 194 cases in the training set (547 images in total), 83 cases in the internal test set (234 images in total), and 103 cases in the external test set (140 images in total). The areas under the curves (AUCs) of the CNN model were 0.896 and 0.852 in the internal and external test sets, respectively. In addition, the CNN model outperformed the three sonographers with varying levels of experience (AUC =0.687, 0.703, and 0.803, respectively), but was comparable to the nomogram model (AUC =0.880) in terms of diagnostic efficacy.

Conclusions: The CNN model, which is based on ultrasound images, has demonstrated relatively good predictive performance in preoperatively identifying neoplastic polyps and is highly important for assisting in the selection of treatment methods for PLG patients.

Background: Although nosocomial diarrhea other than Clostridioides difficile infection (CDI) is common, only limited evidence on antidiarrheal medications has been studied. Probiotics, known for preventing antibiotic-associated diarrhea (AAD) by restoring microbiota and bismuth subsalicylate (BSS), a traditional medication with anti-microbial and anti-secretory effects are interested to be used. We then conducted randomized controlled trial (RCT) to evaluate the use of Saccharomyces boulardii (S. boulardii) versus BSS as an adjunctive treatment for nosocomial diarrhea.

Methods: This is a prospective RCT conducted at Department of Medicine, Siriraj Hospital, Bangkok, Thailand. Patients with new onset nosocomial diarrhea and negative C. difficile toxin in stool were randomly allocated to receive 5 days of either S. boulardii (Sb group) or BSS (BSS group), compared to standard care (SC group). Treatment outcomes including stool weight, frequency and consistency were compared between groups.

Results: Seventy-two eligible patients were recruited from August 2016 to February 2018. Demographic data in these three groups were comparable. The median changes of stool weight from baseline to day 5 of treatment between the groups were not significantly different (Sb 68 vs. BSS 170 vs. SC 156 g, P=0.11). Median change of stool frequency (Sb 0.9 vs. BSS 1.0 vs. SC 1.6 times/day, P=0.14) and consistency were similar (Sb 0.2 vs. BSS 0.4 vs. SC 0.2, P=0.95). No adverse event was reported.

Conclusions: Our study revealed that S. boulardii and BSS added no benefit in treatment of non-CDI nosocomial diarrhea. These were applicable across all outcomes including weight, frequency and consistency of stool. More studies are needed to ascertain a better treatment for nosocomial diarrhea.

Trial registration: Thai Clinical Trials Registry Identifier TCTR20250904004.

Background: Crohn's disease (CD) is a chronic, idiopathic inflammatory bowel condition with increasing incidence globally. For a long time, the treatment for ileal disease relied on surgery for complications or refractoriness to conventional clinical management. With the advent of immunobiological agents, the natural history of the disease has been altered, establishing a new treatment paradigm. This study aimed to perform a systematic review (SR) depicting the role of surgical resection in the post-biological era, especially as initial therapy for limited disease.

Methods: A comprehensive search of PubMed, PubMed PMC, BVS/BIREME, CINAHL, Web of Science, Embase, Cochrane Library, and ProQuest databases was performed, including studies published up to July 2025.

Results: Six retrospective and two prospective studies were included, all developed in Europe, except for one in Canada. Only one included a pediatric population. Of the eight studies, two directly compared ileocolic resection with biological therapy. The remaining studies assessed only surgical outcomes. Five studies evaluated complications after surgical treatment and one after medical treatment, with median rates of 10% and 3%, respectively. Five studies analyzed clinical remission rates, and five assessed endoscopic remission at varying follow-up times. At approximately 1 year of follow-up, endoscopic remission rates ranged from 29% to 79% in the surgical group and from 48% to 84% in the biologics group. Clinical remission was assessed only in the surgical group, with rates of 60%, 83.7%, and 92% at 1 year, and 74% and 88% at 10 years. In the direct comparison of surgery versus biological therapy, only one study evaluated the subsequent need for additional biological treatment during follow-up, and this need was similar among the groups.

Conclusions: Ileocolectomy is an effective and viable therapeutic alternative to primary biological therapy for localized and refractory ileal CD. Early surgery can offer more sustained control for specific phenotypes, reducing the need for long-term treatment. The decision should be individualized, taking into account risks, disease phenotype, and patient preferences. Further randomized trials are needed to refine recommendations.

Background: Ectopic adrenocorticotropic hormone (ACTH) secretion is commonly associated with neuroendocrine tumors such as bronchial carcinoids. However, hepatoblastoma presenting with ectopic ACTH syndrome in children is exceedingly rare.

Case description: We report a rare case of hepatoblastoma associated with ectopic ACTH secretion in a 3-year-old girl, emphasizing its clinical presentation, pathological features, diagnostic workup, and treatment strategy. The patient presented with rapid weight gain (3 kg over 3 months) and hypertension. Magnetic resonance imaging (MRI) revealed a large mass in the left hepatic lobe, with no abnormalities in the pituitary or adrenal glands. After multidisciplinary consultation, hepatoblastoma with ectopic ACTH syndrome was diagnosed. A retrospective analysis of the clinical data and a literature review were performed to guide treatment. The patient underwent radical resection of the liver tumor. Postoperatively, symptoms including palpitations, excessive sweating, and blood pressure fluctuations gradually resolved, and serum ACTH levels declined. Histopathological examination confirmed mixed-type hepatoblastoma with ectopic ACTH secretion.

Conclusions: Hepatoblastoma with ectopic ACTH syndrome is an exceptionally rare entity in children and may present with a wide range of clinical symptoms, increasing the risk of misdiagnosis or inappropriate treatment. Accurate diagnosis requires a comprehensive assessment incorporating clinical findings, biochemical tests, imaging, and pathology. Surgical resection remains the cornerstone of treatment.

Endoscopic surveillance for patients with compensated advanced chronic liver disease (cACLD) is currently guided by the presence or size of esophageal varices. Current guidelines recommend repeat endoscopy every 2-3 years for patients with no varices and every 1-2 years for those with small varices, but these intervals are based largely on expert opinion rather than objective risk stratification. We evaluated the Disease Severity Index (DSI) from the oral cholate challenge test as a predictor of clinical outcomes in 195 patients from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis (HALT-C) Trial (ClinicalTrials.gov, NCT00006164) with cACLD with no or small esophageal varices. Subjects were stratified into four clinical risk categories based on DSI and platelet count: DSI ≤18.3 (low risk), DSI ≤24 with platelet count >135 nL^-1 (low-to-moderate risk), DSI ≤24 with platelet count ≤135 nL^-1 (moderate-to-high risk), and DSI >24 (high risk). Kaplan-Meier analysis demonstrated a stepwise increase in adverse outcomes (variceal hemorrhage, ascites, encephalopathy, Child-Pugh progression, transplant, and death) across these categories. In multivariable logistic regression, DSI was a highly significant predictor of clinical outcome (P<0.001), while categories of no or small esophageal varices was not (P=0.07). Based on these findings, we recommend integrating DSI into surveillance strategies to guide the timing of repeat endoscopy: later endoscopy (2-3 years) for lower-risk patients and earlier endoscopy (1-2 years) for higher-risk patients. We recommend repeat DSI testing every 2-3 years for low risk, 1.5-2 years for low-to-moderate risk, 1-1.5 years for moderate-to-higher risk, and <1 year for highest risk. These results suggest that DSI is a robust, noninvasive tool for refining timing of repeat endoscopy and optimizing resource utilization in cACLD, regardless of disease etiology.

Pancreatic cancer (PC) is characterized by its aggressive nature and delayed diagnosis, with hepatic metastasis significantly worsening patient prognosis. Recent studies have unveiled multi-layered molecular mechanisms underlying liver metastasis (LM), offering novel perspectives for clinical intervention. Firstly, dysregulation of key genes critically influences metastatic progression. Secondly, metabolic reprogramming fuels metastatic processes, suggesting metabolic targeting as a potential strategy. Additionally, the tumor microenvironment (TME) plays a pivotal role: cancer-associated fibroblasts (CAFs) remodel the niche via extracellular matrix (ECM) and growth factor secretion, while neutrophil extracellular traps (NETs) foster pre-metastatic niches through high-mobility group box 1 (HMGB1) signaling. Immune suppression is further exacerbated by dysfunctional effector T cells and immunosuppressive cells, though targeting insulin-like growth factor I receptor (IGF-IR) or programmed cell death protein 1 (PD-1) may reverse immune tolerance. Key signaling pathways, including aberrant signal transducers and activators of transcription (STAT) family activation, Yes-associated protein (YAP)/transcriptional coactivator (TAZ)-mediated mechanotransduction, and dysregulated phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT) pathways, are intricately linked to metastasis. Epithelial-mesenchymal transition (EMT), a central mechanism, is regulated by p21-activated kinase 2 (PAK2)/transforming growth factor (TGF)-β and sex determining region Y-box 2 (SOX2)/Slug pathways, with combined targeting of metabolism and EMT offering therapeutic promise. Future research should focus on elucidating the spatiotemporal dynamics of these mechanisms and integrating immunotherapy with molecular targeting to improve outcomes for PC patients with hepatic metastasis. This review aims to provide a reference for the mechanism research and therapeutic intervention of hepatic metastasis of pancreatic cancer (HMPC).