Postprandial gastrin-17 level is a useful dynamic marker for atrophic gastritis

Atrophic gastritis and intestinal metaplasia may progress to gastric malignancy. Non-invasive serum biomarkers have been extensively studied and proven to be useful as a screening tool to stratify risk and identify patients for endoscopy to detect early gastric cancer. These non-invasive biomarkers have been endorsed and recommended by many international consensus guidelines. In this letter, we reviewed the literature and evidence supporting the use of serum biomarkers as a dynamic test to monitor the status of atrophic gastritis.

Treatment of choice for malignant gastric outlet obstruction: More than clearing the road

In this editorial, we comment on the in-press article in the World Journal of Gastrointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction (mGOO). The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage. Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients, with substantial morbidity and a considerable rate of delayed gastric emptying. Endoscopic stenting was introduced as an alternative minimally invasive procedure with less procedural morbidity and rapid clinical improvement; however, it presented a high rate of long-term recurrence. Therefore, challenges remain in the treatment of mGOO patients to improve clinical outcomes. Endoscopic ultrasound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy, whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical procedure to reduce the rate of delayed gastric emptying. In decision-making regarding the treatment of choice, it should be taken into account that mGOO might be accompanied by a variety of pathological conditions, including cancer cachexia, anorexia, malabsorption, and etc., all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO. The treatment plan should consider comprehensive aspects of patients to achieve practical improvements in prognosis and the quality of life.

Limited validity of Mayo endoscopic subscore in ulcerative colitis with concomitant primary sclerosing cholangitis

BACKGROUND

Ulcerative colitis (UC) with concomitant primary sclerosing cholangitis (PSC) represents a distinct disease entity (PSC-UC). Mayo endoscopic subscore (MES) is a standard tool for assessing disease activity in UC but its relevance in PSC-UC remains unclear.

AIM

To assess the accuracy of MES in UC and PSC-UC patients, we performed histological scoring using Nancy histological index (NHI).

METHODS

MES was assessed in 30 PSC-UC and 29 UC adult patients during endoscopy. NHI and inflammation were evaluated in biopsies from the cecum, rectum, and terminal ileum. In addition, perinuclear anti-neutrophil cytoplasmic antibodies, fecal calprotectin, body mass index, and other relevant clinical characteristics were collected.

RESULTS

The median MES and NHI were similar for UC patients (MES grade 2 and NHI grade 2 in the rectum) but were different for PSC-UC patients (MES grade 0 and NHI grade 2 in the cecum). There was a correlation between MES and NHI for UC patients (Spearman's r = 0.40, P = 0.029) but not for PSC-UC patients. Histopathological examination revealed persistent microscopic inflammation in 88% of PSC-UC patients with MES grade 0 (46% of all PSC-UC patients). Moreover, MES overestimated the severity of active inflammation in an additional 11% of PSC-UC patients.

CONCLUSION

MES insufficiently identifies microscopic inflammation in PSC-UC. This indicates that histological evaluation should become a routine procedure of the diagnostic and grading system in both PSC-UC and PSC.

Motorized spiral enteroscopy: A cautious step forward in technological innovation

With the continuous advancement in medical technology, endoscopy has gained significant attention as a crucial diagnostic tool. The introduction of motorized spiral enteroscopy (MSE) represents a significant advancement in the diagnosis and treatment of small bowel diseases. While there are safety concerns and a high reliance on the operator’s skills, MSE should not be disregarded entirely. Instead, it should be considered as a supplementary endoscopic technique, particularly in situations where conventional endoscopy proves ineffective. Through continuous research and technical optimization, MSE has the potential to become an important addition to the endoscopy toolbox in the future. We call on colleagues in the industry to work together to promote the improvement of MSE technology through continuous research and practice, with the aim to bring out its unique value in endoscopy while ensuring patient safety.

Role of macroscopic on-site evaluation of endoscopic ultrasound-guided fine-needle aspiration/biopsy: Results of a multicentric prospective study

BACKGROUND

The concept of macroscopic on-site evaluation (MOSE) was introduced in 2015 when the endoscopist observed better diagnostic yield when the macroscopically visible core on MOSE was superior to 4 mm. Recent studies suggest that MOSE by the endoscopist may be an excellent alternative to rapid on-site evaluation, and some classifications have been published. Few studies have assessed the adequacy of histologic cores in MOSE during endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB).

AIM

To evaluate the performance of MOSE during EUS-FNA/FNB.

METHODS

This multicentric prospective study was conducted in 16 centers in 3 countries (Egypt, Iraq, and Morocco) and included 1108 patients with pancreatic, biliary, or gastrointestinal pathology who were referred for EUS examination. We prospectively analyzed the MOSE in 1008 patients with available histopathological reports according to 2 classifications to determine the adequacy of the histological core samples. Data management and analysis were performed using a Statistical Package for Social Sciences (SPSS) version 27.

RESULTS

A total of 1074 solid lesions were biopsied in 1008 patients with available cytopathological reports. Mean age was 59 years, and 509 patients (50.5%) were male. The mean lesion size was 38 mm. The most frequently utilized needles were FNB-Franseen (74.5%) and 22 G (93.4%), with a median of 2 passes. According to 2 classifications, 618 non-bloody cores (61.3%) and 964 good samples (95.6%) were adequate for histological evaluation. The overall diagnostic yield of cytopathology was 95.5%. The cytological examination confirmed the diagnosis of malignancy in 861 patients (85.4%), while 45 samples (4.5%) were inconclusive. Post-procedural adverse events occurred in 33 patients (3.3%). Statistical analysis showed a difference between needle types (P = 0.035) with a high sensitivity of FNB (97%). The analysis of the relationship between the MOSE-score and the final diagnosis showed a significant difference between the different scores of the MOSE (P < 0.001).

CONCLUSION

MOSE is a simple method that allows endoscopists to increase needle passes to improve sample quality. There is significantly higher FNB sensitivity and cytopathology diagnostic yield with good MOSE cores.

Systemic air embolism associated with endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a key procedure for diagnosing and treating biliary and pancreatic disorders. Although effective, it carries risks, including rare but severe complications such as air embolism.

CASE SUMMARY

We report a case of a 58-year-old man who developed extensive air embolism during ERCP. He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness. Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery. Imaging confirmed widespread air embolism, which resolved with continued treatment.

CONCLUSION

Air embolism is a rare, critical complication of ERCP, especially in patients with prior surgery such as pancreaticoduodenectomy. Early detection and prompt treatment, including hyperbaric oxygen therapy, are crucial for favorable outcomes.

Endoscopic “calabash” ligation and resection for small gastric mesenchymal tumors

BACKGROUND

Gastric mesenchymal tumors (GMT) are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract. GMT primarily encompass gastric stromal tumors (GST), gastric leiomyomas, and gastric schwannomas. Although most GMT are benign, there are still potential malignant changes, especially GST. Thus, early surgical intervention is the primary treatment for GMT. We have designed a simple endoscopic “calabash” ligation and resection (ECLR) procedure to treat GMT. Its efficacy and safety need to be compared with those of traditional endoscopic techniques, such as endoscopic submucosal excavation (ESE).

AIM

To assess the safety and effectiveness of ECLR in managing small GMT (sGMT) with a maximum diameter ≤ 20 mm by comparing to ESE.

METHODS

This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023, underwent endoscopic resection, and received a pathological diagnosis of GMT. Cases with a tumor diameter ≤ 20 mm were chosen and categorized into two cohorts: Study and control groups. The study group was composed of patients treated with ECLR, whereas the control group was composed of those treated with ESE. Data on general clinical characteristics (gender, age, tumor diameter, tumor growth direction, tumor pathological type, and risk grade), surgery-related information (complete tumor resection rate, operation duration, hospitalization duration, hospitalization cost, and surgical complications), and postoperative follow-up were collected for both groups. The aforementioned data were subsequently analyzed and compared.

RESULTS

Five hundred and eighty-nine individuals were included, with 297 cases in the control group and 292 in the study group. After propensity score matching, the final analysis incorporated 260 subjects in each cohort. The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group. Furthermore, the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group. There were no substantial variations observed in other parameters among the two cohorts.

CONCLUSION

ECLR is a viable and effective approach for managing sGMT.

Gastric fundoplication with endoscopic technique: A novel approach for gastroesophageal reflux disease treatment

BACKGROUND

Gastric fundoplication with endoscopic technique (GFET) is an innovative approach to managing gastroesophageal reflux disease (GERD). This minimally invasive procedure utilizes the GEN-2 Apollo endosuture device and Olympus H2T180 gastroscope to perform partial fundoplication by strategically placing Prolene 2-0 sutures at the 11, 7, 5, 1, and 3 o’clock positions around the gastroesophageal junction.

AIM

To evaluate whether GFET enhances the lower esophageal sphincter function by creating comprehensive plication to improve the barrier against reflux.

METHODS

This single-center prospective study included patients undergoing GFET. Before beginning GFET, pH metrics and subsequent manometric measurements were obtained. An analysis of variance was performed to determine statistically significant differences between quality of life (QOL) and DeMeester scores at the time of the procedure and 6 and 12 months postoperatively. Pearson’s χ² test was performed to identify statistically significant differences between categorical variables at the time of the procedure and 6 and 12 months postoperatively.

RESULTS

Eighteen participants were enrolled (11 males and 7 females; mean age, 35 years). More than 70% had an initial Hill grade of IIb. One adverse event was recorded after the procedure. One patient underwent valve reinforcement at 12 months. The mean QOL score was markedly higher at the time of the procedure (39.9 ± 4.0) compared to those at 6 and 12 months postoperatively (P < 0.001). Scores at 12 months were slightly higher than those at 6 months. The highest mean QOL score was observed at the time of the procedure, followed by those at 6 and 12 months postoperatively (P < 0.001). A similar trend was noted for the mean DeMeester scores (P < 0.001).

CONCLUSION

GFET is a minimally invasive alternative to traditional surgical interventions and endoscopic techniques for managing GERD. Further research is warranted to validate its long-term efficacy and effectiveness over existing treatments.

Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients: A meta-analysis

BACKGROUND

As a less invasive technique, peroral endoscopic myotomy (POEM) has recently been widely accepted for treating achalasia with an excellent safety profile, durability, and efficacy in adults. In pediatric and geriatric patients, the treatment is more difficult.

AIM

To discuss the clinical outcomes of POEM in pediatric and geriatric patients with achalasia.

METHODS

We conducted a comprehensive search of PubMed, Embase and Cochrane Library databases from inception to July 2024. The primary outcomes were technical and clinical success. Secondary outcomes of interest included adverse events and gastroesophageal reflux disease (GERD). The pooled event rates were calculated by comprehensive meta-analysis software.

RESULTS

A total of 32 studies with 547 pediatric patients and 810 geriatric patients were included in this study. The pooled event rates of technical success, clinical success, GERD and adverse events of POEM for treating achalasia in pediatric patients were 97.1% [95% confidence interval (CI): 95.0%-98.3%; I² = 0%; P < 0.000], 93.2% (95%CI: 90.5%-95.2%; I² = 0%; P < 0.000), 22.3% (95%CI: 18.4%-26.7%; I² = 43.874%; P < 0.000) and 20.4% (95%CI: 16.6%-24.8%; I² = 67.217%; P < 0.000), respectively. Furthermore, in geriatric patients, the pooled event rates were 97.7% (95%CI: 95.8%-98.7%; I² = 15.200%; P < 0.000), 93.2% (95%CI: 90.3%-95.2%; I² = 0%; P < 0.000), 23.9% (95%CI: 19.4%-29.1%; I² = 75.697%; P < 0.000) and 10.8% (95%CI: 8.3%-14.0%; I² = 62.938%; P < 0.000], respectively.

CONCLUSION

Our findings demonstrated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.

Predictors of stricture after endoscopic submucosal dissection of the esophagus and steroids application

BACKGROUND

Endoscopic submucosal dissection (ESD) is a reliable method to resect early esophageal cancer. Esophageal stricture is one of the major complications after ESD of the esophagus. Steroid prophylaxis for esophageal strictures, particularly local injection of triamcinolone acetonide (TA), is a relatively effective method to prevent esophageal strictures. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.

AIM

To identify the predictors of esophageal strictures after steroids application.

METHODS

Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion- and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study. The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.

RESULTS

A total of 120 patients were included in the analysis. In the oral prednisone and oral prednisone combined with local tretinoin injection groups, the stenosis rates were 44/53 (83.0%) and 56/67 (83.6%), respectively. Among them, univariate analysis showed that the lesion circumference (P = 0.01) and submucosal injection solution (P = 0.04) showed significant correlation with the risk of stenosis formation. Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports, such as additional chemoradiotherapy and tumor location. We identified a lesion circumference < 5/6 (OR = 0.19; P = 0.02) and submucosal injection of sodium hyaluronate (OR = 0.15; P = 0.03) as independent predictors of on esophageal stricture formation.

CONCLUSION

Steroid prophylaxis effectively prevents stenosis. Moreover, the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures. Additional interventions should be considered in high-risk patients.

Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male: A case report

BACKGROUND

Esophagopericardial fistula (EPF) is a rare, life-threatening condition with limited scientific literature and no established management guidelines. This case report highlights a successful multidisciplinary approach and the innovative use of endoscopic vacuum assisted closure (endoVAC) therapy in treating this complex condition.

CASE SUMMARY

A 16-year-old male with a history of esophageal atresia and colon interposition presented with progressive chest pain, fever, and dyspnea. Imaging revealed an EPF with associated pleural and pericardial effusions. Initial management with an esophageal stent failed, prompting the use of an endoVAC system. The patient underwent multiple endoVAC device changes and received broad-spectrum antibiotics and nutritional support. The fistula successfully closed, and the patient recovered, demonstrating no new symptoms at a 6-month follow-up.

CONCLUSION

EndoVAC therapy can effectively manage EPF, providing a minimally invasive treatment option.

Confocal laser endomicroscopy for gastric neoplasm

Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa. CLE has a higher sensitivity, specificity, and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band imaging. It can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit patterns. CLE may have some advantages over the standard biopsy protocol, such as higher diagnostic yield and fewer biopsy requirements. Its diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light endoscopy. Inherent limitations, such as a narrow field of vision, can be surpassed by technological advancements and integration with other detection methods. Artificial intelligence holds promise in automated analysis of histopathological images. Thus, CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies, such as mucosal damage, bleeding, and infection.

Prevalence and resistance of Helicobacter pylori in a predominantly Hispanic population

BACKGROUND

Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans. The risk of acquiring H. pylori is related to socioeconomic status and living conditions early in life. Treatment regimens must consider local antibiotic resistance patterns. Adventist Health White Memorial Hospital serves a predominantly indigent population in east Los Angeles with a large number of immigrants from South and Central America. Data regarding the prevalence and resistance of H. pylori in this population is scant.

AIM

To evaluate the prevalence and resistance of H. pylori and correlate with country of origin.

METHODS

All gastric biopsies were obtained by a single gastroenterologist at the hospital in a consecutive manner from patients with gastritis from 2017 to 2022 and sent to various labs for evaluation.

RESULTS

Two hundred and sixty-six patients are born in the United States, 450, 171, 70, and 30 patients are immigrants from Mexico, Central and South America (CSA), Asia, and other countries respectively. Overall, 14.65% were found to be infected with H. pylori. Rates of infection in United States-born citizens, immigrants from Mexico, CSA, and Asia are 9.02%, 18.67%, 13.45%, and 11.43% respectively, with Mexican immigrants having a relative risk of 2.3889 [95% confidence interval (CI): 1.4789-3.8588, P = 0.0004] compared to those born in United States. No correlation seen between infection and length of time immigrants were in United States. Relative risk of infection in patients with no proton pump inhibitor use within the past 30 days found to be 1.9276 (95%CI: 1.3562-2.7398, P = 0.0003). Rates of resistance for clarithromycin and levofloxacin are 21.43% and 31.11%.

CONCLUSION

H. pylori infection appears to be associated with low socioeconomic status and poor living conditions early in life. Clarithromycin and levofloxacin based treatment regimens should be avoided as first line therapy in this region, particularly in patients of Latin American origin.

Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a variety of adverse events (AEs). One of the most important AEs is post-ERCP pancreatitis (PEP), which is most common in cases of difficult biliary cannulation. Although the precut technique has been reported as a PEP risk factor, recent studies indicate that early precut could reduce PEP, and that precut itself is not a risk factor.

AIM

To evaluate the safety of the precut technique, especially in terms of PEP.

METHODS

We conducted a retrospective study, spanning the period from November 2011 through December 2021. It included 1556 patients, aged ≥ 20 years, who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center. We compared the PEP risk between the early precut and the delayed precut group.

RESULTS

The PEP incidence rate did not significantly differ between the precut and non-precut groups. However, the PEP incidence was significantly lower in the early precut group than the delayed precut group (3.5% vs 10.5%; P = 0.02). The PEP incidence in the delayed precut group without pancreatic stent insertion (17.3%) was significantly higher compared to other cases (P < 0.01).

CONCLUSION

Our findings indicate that early precut may reduce PEP incidence. If the precut decision is delayed, a pancreatic stent should be inserted to prevent PEP.

How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma?

Approximately 7% of the polyps resected endoscopically have an adenocarcinoma focus, with no previous endoscopic evidence of malignancy. This raises the question of whether endoscopic resection has been curative. Furthermore, there is no consensus on what the endoscopic and histological criteria for good prognosis are, the appropriate follow-up strategy and what are the long-term results. The aim of the retrospective study by Fábián et al was to evaluate the occurrence of local relapse or distant metastasis in those tumors that were resected endoscopically compared to those that underwent oncologic surgery. They concluded that, regardless of the treatment strategy chosen, there was a higher recurrence rate than described in the literature and that adherence to follow-up was poor. The management approach for an endoscopically benign polyp histologically confirmed as adenocarcinoma depends on the presence of any of the previously described poor prognostic histological factors. If none of these factors are present and the polyp has been completely resected en bloc (R0), active surveillance is considered appropriate as endoscopic resection is deemed curative. These results highlight, once again, the need for further multicentric clinical practice studies to obtain more evidence for the purpose of establishing appropriate treatment and follow-up strategies.

Heterotopic mesenteric ossification caused by trauma: A case report

BACKGROUND

Heterotopic mesenteric ossification (HMO) is a clinically rare condition characterized by the formation of bone tissue in the mesentery. The worldwide reporting of such cases is limited to just over 70 instances in the medical literature. The etiology of HMO remains unclear, but the disease is possibly induced by mechanical trauma, ischemia, or intra-left lower quadrant abdominal infection, leading to the differentiation of mesenchymal stem cells into osteoblasts. Here, we present a rare case of HMO that occurred in a 34-year-old male, who presented with left lower quadrant abdominal pain.

CASE SUMMARY

We report the case of a 34-year-old male patient who presented with left lower abdominal pain following trauma to the left lower abdomen. He subsequently underwent surgical treatment, and the postoperative pathological diagnosis was HMO.

CONCLUSION

We believe that although there is limited literature and research on HMO, when patients with a history of trauma or surgery to the left lower abdomen present with corresponding imaging findings, clinicians should be vigilant in distinguishing this condition and promptly selecting appropriate diagnostic and therapeutic interventions.

Endoscopic ultrasound-guided treatment of isolated gastric varices entwined with arteries: A case report

BACKGROUND

Interventional endoscopic ultrasound is clinically used for the treatment of isolated gastric varices (IGVs) owing to its precise visualization.

CASE SUMMARY

A 39-year-old man was diagnosed with a large IGV during a routine physical examination. Endoscopic ultrasonography showed gastric varices entwined with an artery, which greatly increased the difficulty of treatment. We successfully treated the patient with endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection.

CONCLUSION

Endoscopic ultrasonography-guided coil embolization combined with cyanoacrylate injection was safe and effective for the treatment of an IGV entwined with an artery.

Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer: The puzzle of eCura C1

In this editorial, we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection (ESD), starting from the consideration recently made by Zhu et al. Specifically, we evaluate the management of eCura C1 lesions, where decisions regarding further interventions are pivotal yet contentious. Collaboration among endoscopists, surgeons, and pathologists is underscored to refine risk assessment and personalize therapeutic management. Recent advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 lesions. Moreover, despite needing further clinical validation, molecular biomarkers have emerged as promising tools for enhancing prognostication. This manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options, ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

Cold snare polypectomy: A closer look at the efficacy and limitations for polyps 10-20 mm in size

Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size. Conversely, endoscopic mucosal resection is still the preferred technique for larger polyps. Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection (resulting in piecemeal removal), and the potential for local residual polyp tissue and a high rate of recurrence. On the other hand, cold snare technique has the advantages of shortening procedure time, reducing delayed bleeding risks and lowering cost of treatment. Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm, with the goal of providing clear guidelines in the near future. The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.

Esophageal ulcer and multisystem inflammatory syndrome after COVID-19: A case report

BACKGROUND

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe disease occurring several weeks after severe acute respiratory syndrome coronavirus 2 infection. It develops in adults with inflammation of different organs including the gastrointestinal tract, heart, kidneys, skin and hematopoietic system.

CASE SUMMARY

We present a 58-year-old Chinese man diagnosed with MIS-A. His chief complaints were fever, generalized fatigue and anorexia, accompanied with rashes on his back. Further examination showed cardiac, renal and liver injury. He had melena and gastroscopy indicated esophageal ulcer and severe esophagitis. Repeated blood and sputum culture did not show growth of bacteria or fungi. Antibiotic treatment was stopped due to unsatisfactory performance. His condition improved after prednisone and other supportive treatment.

CONCLUSION

Gastrointestinal involvement in MIS-A is not uncommon. Intestinal involvement predominates, and esophageal involvement is rarely reported. Esophageal ulcer with bleeding could also be a manifestation of MIS-A.

Retraction note to: Association between triglyceride-glucose index and colorectal polyps: A retrospective cross-sectional study

[This retracts the article on p. 55 in vol. 16, PMID: 38464818.].

Effectiveness of serological markers of gastric mucosal atrophy in the gastric precancer screening and in cancer prevention

BACKGROUND

New markers are needed to improve the effectiveness of serological screening for atrophic gastritis.

AIM

To develop a cost-effective method for serological screening of atrophic gastritis with a high level of sensitivity.

METHODS

Of the 169 patients with atrophic gastritis, selected by the visual endoscopic Kimura-Takemoto method, 165 showed histological mucosal atrophy using the updated Kimura-Takemoto method. All 169 patients were examined for postprandial levels of gastrin-17 (G17) and pepsinogen-1 (PG1) using GastroPanel® (Biohit Plc, Helsinki, Finland).

RESULTS

We used the histological standard of five biopsies of the gastric mucosa, in accordance with the Kimura-Takemoto classification system to assess the sensitivity of G17 in detecting gastric mucosal atrophy. We also compared the morpho-functional relationships between the detected histological degree of gastric mucosal atrophy and the serological levels of G17 and PG1, as the markers of atrophic gastritis. The sensitivity of postprandial G17 was 62.2% for serological levels of G17 (range: 0-4 pmol/L) and 100% for serological G17 (range: 0-10 pmol/L) for the detection of monofocal severe atrophic gastritis. No strong correlation was found between the levels of PG1 and degree of histological atrophy determined by the Kimura-Takemoto classification system to identify the severity of mucosal atrophy of the gastric corpus. In the presented clinical case of a 63-year-old man with multifocal atrophic gastritis, there is a pronounced positive long-term dynamics of the serological marker of atrophy - postprandial G17, after five months of rennet replacement therapy.

CONCLUSION

Serological screening of multifocal atrophic gastritis by assessment of postprandial G17 is a cost-effective method with high sensitivity. Postprandial G17 is an earlier marker of regression of atrophic gastritis than a morphological examination of a gastric biopsy in accordance with the Sydney system. Therefore, postprandial G17 is recommended for dynamic monitoring of atrophic gastritis after treatment.

Colonic schistosomiasis mimicking cancer, polyp, and inflammatory bowel disease: Five case reports and review of literature

BACKGROUND

Schistosomiasis, officially named as a neglected tropical disease by The World Health Organization, is a serious parasitic disease caused by trematode flukes of the genus Schistosoma. It is a common infectious disease, endemic in more than 78 countries. The disease can involve various organs and poses far-reaching public health challenges.

CASE SUMMARY

Here, we present a series of five patients with variable presentations: an asymptomatic patient who was diagnosed with colonic schistosomiasis upon screening colonoscopy; 2 patients with clinical suspicion of colonic cancer; and 2 patients with a clinical diagnosis of inflammatory bowel disease. All patients were subsequently confirmed to have colonic schistosomiasis after colonoscopy and histopathologic examination. The clinical manifestations, colonoscopy features and histologic findings of the patients are described. Most of the patients showed significant clinical improvement following administration of oral praziquantel.

CONCLUSION

Intestinal schistosomiasis can present with features mimicking other gastrointestinal conditions. This disease should be a diagnostic consideration in patients who live in or have traveled to endemic areas.

Unveiling hidden outcomes in malignant gastric outlet obstruction research - insights from a "Pancreas 2000" review

Malignant gastric outlet obstruction (mGOO) is a major condition affecting patients with periampullary tumors, including pancreatic cancer. The current treatment options include surgical gastroenterostomy, endoscopic stenting and more recently EUS-guided gastroenterostomy. Most studies comparing the outcomes of the three procedures focus on technical success, clinical success and safety. Several "occult" outcomes relevant to the patient's viewpoints and perspective may ultimately impact on cancer-related and overall survival, such as body mass composition, nutritional biomarkers, chemotherapy tolerance and patient-reported quality of life. The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.

Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding

Non-variceal upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality. Traditionally, through-the-scope (TTS) clips, thermal therapy, and injection therapies are used to treat GI bleeding. In this review, we provide an overview of novel endoscopic treatments that can be used to achieve hemostasis. Specifically, we discuss the efficacy and applicability of over-the-scope clips, hemostatic agents, TTS doppler ultrasound, and endoscopic ultrasound, each of which offer an effective method of reducing rates of GI rebleeding.