Digestive Diseases and Sciences最新文献

{"title":"Paving a Path Forward After an Unsuccessful GI Fellowship Match.","authors":"Kevin Houston, Aimen Farooq, Mariam Naveed, Amy Oxentenko, Mohammad Bilal, Nikki Duong","doi":"10.1007/s10620-025-09413-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09413-0","url":null,"abstract":"<p><p>The gastroenterology (GI) fellowship match is among the most competitive subspecialty matches in internal medicine, with approximately 35% of applicants going unmatched annually. For many trainees, not matching can feel like a significant personal and professional setback. However, this moment can also serve as an inflection point for growth and recalibration. Provided in this manuscript is a practical framework to support unmatched re-applicants in navigating the post-match period and strengthening their candidacy for future application cycles.It is essential to acknowledge the emotional impact of an unsuccessful match and allow time for reflection before re-engaging in the process. While there may be a small number of open slots that do not fill and are open for a scramble-type process, this requires rapid action and access to all application materials to be readily sent, at a time when the unmatched applicant is still going through the disappointment of not matching. Re-applicants should seek mentorship and honest feedback to identify gaps in their applications and set clear goals for the upcoming year(s). Strategies to enhance re-applications include engaging in scholarly activity, pursuing structured research or clinical opportunities, strengthening letters of recommendation, and broadening the scope of program applications.Ultimately, while not matching can be a difficult experience, many successful gastroenterologists have faced this challenge and gone on to excel. By reframing the setback as an opportunity to reflect, rethink, and restart, unmatched re-applicants can re-enter the fellowship match process with improved qualifications and a compelling story of perseverance.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIT Picking-How the Careful Selection of Non-invasive Tools Has Improved the Diagnosis of Portal Hypertension in Patients with Compensated Advanced Chronic Liver Disease.","authors":"Susana G Rodrigues","doi":"10.1007/s10620-025-09440-x","DOIUrl":"https://doi.org/10.1007/s10620-025-09440-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Outcomes of Alcoholic Acute Pancreatitis in Patients with Alcohol Use Disorder Treated with Naltrexone in the United States: Before and After the COVID-19 Pandemic.","authors":"Thai Hau Koo, Alexander Malik, Mohammad Zaahid Sheriff, Rishi Chowdhary, Adrian Lindsey","doi":"10.1007/s10620-025-09411-2","DOIUrl":"https://doi.org/10.1007/s10620-025-09411-2","url":null,"abstract":"<p><strong>Background: </strong>The role of naltrexone in improving acute alcoholic pancreatitis (AAP) outcomes in alcohol use disorder (AUD) patients, remains unclear.</p><p><strong>Aim: </strong>We aimed to assess the temporal trends in AAP incidence and the impact of naltrexone use on clinical outcomes in AUD patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using de-identified patient data from the TriNetX database, including all adults (≥ 18 years) diagnosed with AUD. AAP patients were then identified and stratified by naltrexone exposure. The incidence and prevalence of AAP in AUD patients were assessed pre-(March 2015-2019) and post-COVID-19(March 2020-2025). Propensity score matching (PSM) (1:1) was performed to adjust for confounders. Univariate Cox proportional hazards model was used to assess the outcomes including mortality, chronic pancreatitis, alcoholic hepatitis, cirrhosis, hospital readmission, and emergency department (ED) visits at 1, 6, and 12 months. Standardized mean differences < 0.1 ensured well-matched cohorts.</p><p><strong>Results: </strong>Among 1,331,338 AUD adults, 33,561 (2.52%) developed AAP. The incidence of AAPs increased significantly following the COVID-19 pandemic, with the largest relative rise among younger adults (18-34 years), women, and racial minorities. Of those with AAP, 1,871(5.6%) received naltrexone. Following PSM, naltrexone use was associated with significantly lower odds of mortality at one (OR 0.274, p < 0.0001) and six months (OR 0.571, p = 0.005). Reduced odds were also observed for alcoholic hepatitis at one month and hospital readmissions across all time points. Surprisingly, naltrexone use was associated with increased odds of ED visits.</p><p><strong>Conclusions: </strong>The incidence of AAP has increased since COVID-19 onset. Naltrexone may improve short-term outcomes in patients with AUD and AAP.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Anomaly of Cystic Duct Drainage into a Variant Right Hepatic Duct: Cholangioscopy Diagnosis and Management.","authors":"Guangxuan Tie, Shunzi Shao, Jinquan Shuang, Qibin He","doi":"10.1007/s10620-025-09434-9","DOIUrl":"https://doi.org/10.1007/s10620-025-09434-9","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Risk-Score-Based Surveillance Strategies for Hepatocellular Carcinoma in Patients with Chronic Hepatitis B.","authors":"Ying Chen, Hao Feng, Yun Bao, Mengxia Yan, Kaijie Yao, Bin Wu","doi":"10.1007/s10620-025-09419-8","DOIUrl":"https://doi.org/10.1007/s10620-025-09419-8","url":null,"abstract":"<p><strong>Background: </strong>In China, a significant number of individuals with chronic hepatitis B (CHB) are at risk of developing hepatocellular carcinoma (HCC). Due to low surveillance rates and guidelines that inadequately address resource constraints, this study evaluates the cost-effectiveness of risk-based HCC surveillance strategies in CHB patients in China.</p><p><strong>Methods: </strong>We developed a state-transition model to simulate disease progression in hypothetical CHB cohorts over their lifetimes, considering various HCC risk scores to classify patients into low, intermediate, and high-risk categories. The model assessed the cost-effectiveness of five active surveillance strategies, including biannual monitoring, compared to no surveillance. Key outcomes included life expectancy, quality-adjusted life years (QALYs), total costs, and the incremental cost-effectiveness ratio (ICER), with comparisons to China's willingness-to-pay (WTP) threshold of $37,674 per QALY.</p><p><strong>Results: </strong>For overall and intermediate-risk cohorts, biannual and annual surveillance were cost-effective (ICER < $37,674/QALY). In high-risk groups, all surveillance strategies, except quinquennial, were cost-effective, with ICERs ranging from $28,448 to $36,073 per QALY. No surveillance strategy was cost-effective for the low-risk group. Sensitivity analyses confirmed biannual surveillance had the highest probability of being cost-effective across all risk groups and was most sensitive to changes in mortality rates associated with intermediate to advanced HCC stages.</p><p><strong>Conclusions: </strong>The cost-effectiveness of HCC surveillance in CHB patients varies based on HCC risk. A risk-stratified approach, with biannual surveillance prioritized for high-risk patients and potentially omitted for low-risk patients, could optimize resource allocation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal Postoperative Bleeding After Endoscopic Ultrasound-Guided Gastroenterostomy.","authors":"Jia-Huan Liu, Jin-Lin Yang, Rui Wang","doi":"10.1007/s10620-025-09430-z","DOIUrl":"https://doi.org/10.1007/s10620-025-09430-z","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined \"Double-Tube\" Endoscopic Purse-String Closure for Traumatic Rectovesical Fistula: A Safe and Low-Cost Therapeutic Approach.","authors":"Shiyu Peng, Weigang Chen, Shuxin Tian","doi":"10.1007/s10620-025-09429-6","DOIUrl":"https://doi.org/10.1007/s10620-025-09429-6","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Acid Test - Does Ketoacidosis Affect the Course and Prognosis of Hypertriglyceridemic Acute Pancreatitis?","authors":"Ján Csomor","doi":"10.1007/s10620-025-09435-8","DOIUrl":"https://doi.org/10.1007/s10620-025-09435-8","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Endoscopic Ultrasound (EUS) vs. Magnetic Resonance Cholangiopancreatography (MRCP) in the Etiological Evaluation of Idiopathic Acute Pancreatitis (IAP): A Systematic Review and Meta-Analysis.","authors":"Jahnavi Udaikumar, Rithish Nimmagadda, Vineeth Potluri, Ravi Medarametla, Sameer Garlapati, Nayanika Tummala, Satwik Kuppili, Adam J Goodman, Daniel Marino","doi":"10.1007/s10620-025-09408-x","DOIUrl":"https://doi.org/10.1007/s10620-025-09408-x","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic acute pancreatitis (IAP) accounts for up to 20% of acute pancreatitis cases despite thorough initial evaluation. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are commonly used as second-line imaging modalities when IAP etiologies are unclear, yet their comparative diagnostic performance remains uncertain. We conducted a systematic review and meta-analysis to assess the diagnostic yield of EUS versus MRCP in identifying etiologies of IAP.</p><p><strong>Methods: </strong>A systematic search of PubMed, EMBASE, and Google Scholar (January 2000-April 2025) identified English-language studies comparing EUS and MRCP diagnostic performance in IAP. Two reviewers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale. Pooled relative risks (RR) were calculated using a random-effects model, with subgroup, sensitivity, and publication bias analyses done per PRISMA 2020. Subgroup analyses assessed diagnostic yield by etiology-biliary disease (cholelithiasis, choledocholithiasis, microlithiasis, and sludge), pancreatic divisum, intraductal papillary mucinous neoplasm (IPMN), and malignancy (pancreatic adenocarcinoma and periampullary cancer).</p><p><strong>Results: </strong>Of 4,933 studies screened, 8 met inclusion criteria. Pooled analysis showed that EUS had significantly higher diagnostic yield than MRCP (RR 2.01; 95% CI 1.42-2.85; p < 0.01; I² = 69.1%). EUS was markedly superior for biliary etiologies (RR 3.67; 95% CI 2.08-6.47; p < 0.0001; I² = 37.7%) and trended toward better detection of CP in IAP (RR 2.20; 95% CI 0.87-5.55; p = 0.0955; I² = 15.5%). MRCP favored the detection of pancreatic divisum (RR 0.59; 95% CI 0.31-1.12; p = 0.1078; I² = 0.0%). Both EUS and MRCP performed equally in detecting IPMNs (RR 0.88; 95% CI 0.35-2.22; p = 0.7861; I² = 0.0%). EUS also demonstrated higher cancer detection compared to MRCP (RR 1.98; 95% CI 0.56-7.03; p = 0.2896; I² = 0.0%).</p><p><strong>Conclusion: </strong>EUS surpasses MRCP in diagnosing IAP biliary etiologies and has an overall higher diagnostic yield. Prior studies suggest that EUS may be oversensitive in diagnosing CP, which may be consistent with the increased rate of diagnosis by EUS in our data. There was some signal that EUS had a higher diagnostic yield for cancer, which may highlight a potential role in identifying occult malignancy in IAP evaluation. In practice, choosing EUS vs. MRCP depends on resource availability, but a patient-centered approach that integrates modality strengths with clinical profiles can improve diagnostic accuracy and prognostic outcomes.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Insightful Investigations into the Applications of Immunohistochemistry to Highlight Intraepithelial Lymphocytes in Formalin-Fixed and Frozen Duodenal Biopsies: Comparability of Results and Cut-Off Revision.","authors":"Syeda Aliza Aamir, Ali Karim, Shaan Huss, Osheen Vandana Shahani, Sawera Memon, Karan Kumar","doi":"10.1007/s10620-025-09425-w","DOIUrl":"https://doi.org/10.1007/s10620-025-09425-w","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}