Digestive Diseases and Sciences最新文献

{"title":"The Cystem Works-Bridging Guideline Intent and Real-World Practice in Pancreatic Cyst Surveillance.","authors":"Arjun Chatterjee","doi":"10.1007/s10620-026-10096-4","DOIUrl":"10.1007/s10620-026-10096-4","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5289-5291"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419560","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":"Comparative Diagnostic Accuracy of Cholangioscopy-Based Modalities for Indeterminate Biliary Strictures: A Systematic Review and Network Meta-Analysis.","authors":"Abdul Subhan Talpur, Kainat Urooj, Fawad Talat, Sadia Tabassum, Khandokar Talib, Ahmed Shehadah, Minhaz Ahmad, Abdelhamid Ben-Selma, Toseef Javaid","doi":"10.1007/s10620-026-10106-5","DOIUrl":"10.1007/s10620-026-10106-5","url":null,"abstract":"<p><strong>Background and aims: </strong>Indeterminate biliary strictures present a diagnostic challenge with a differential ranging from benign conditions such as IgG4-related disease to cholangiocarcinoma. ERCP-guided brush cytology has been the long-standing tissue-sampling strategy, but its reported sensitivity for malignancy is limited, frequently falling below 50% in published series. Complementary and alternative approaches have been developed, including fluorescence in situ hybridization (FISH) of biliary brushings, intraductal biopsy (IDB), and single-operator cholangioscopy (SOC) with the SpyGlass DS platform. These modalities have been evaluated individually, but a unified comparative synthesis has not previously been undertaken. This network meta-analysis (NMA) was conducted to synthesize the available evidence across these five strategies and to provide comparative rankings of their diagnostic performance.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, the Cochrane Library, and Scopus from inception through 31 December 2024, without language restriction. Eligible studies enrolled adult patients with indeterminate biliary strictures and evaluated at least one diagnostic modality against a histopathological or follow-up reference standard. Reporting followed methodological guidance for network meta-analyses of diagnostic test accuracy, with relevant items from the PRISMA-NMA and PRISMA-DTA extensions used to structure the review. A Bayesian hierarchical random-effects model was used to pool diagnostic accuracy data. Primary endpoints were sensitivity and specificity for malignancy. Secondary endpoints included diagnostic odds ratio (DOR), area under the ROC curve (AUROC), tissue adequacy, and adverse events. Surface under the cumulative ranking curve (SUCRA) values were calculated to rank modalities. Heterogeneity, network consistency, publication bias, and pre-specified sensitivity analyses (including restriction to SpyGlass DS-era data and to studies with a uniform reference standard) were formally assessed.</p><p><strong>Results: </strong>Thirty-eight studies enrolling 4,912 unique patients met our criteria, contributing 6,570 per-modality observations across five diagnostic strategies: brush cytology, FISH, intraductal biopsy, SOC (SpyGlass DS), and combined FISH + brush cytology. SOC achieved the highest pooled sensitivity at 82% (95% CrI: 76%-88%; SUCRA 92%), and brush cytology had the lowest at 45% (95% CrI: 38%-52%; SUCRA 30%). The pattern was inverted for specificity: brush cytology was highest at 97% (95% CrI: 94%-99%) and SOC was lowest at 89% (95% CrI: 84%-93%). For overall diagnostic accuracy, SOC ranked first (SUCRA 88%), followed by FISH + brush cytology (SUCRA 80%). Pairwise comparison showed SOC was statistically superior in sensitivity to brush cytology, FISH alone, and intraductal biopsy; the comparison between SOC and FISH + brush cytology did not reach statistical significance (OR 1.43; 95% CrI: 0.97-2","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5480-5495"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419433","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":"Intestinal Fibrosis in IBD: Rethinking the Inflammatory Paradigm and Emerging Therapeutic Opportunities.","authors":"Weihao Wang, Yili Sun, Jia Li","doi":"10.1007/s10620-026-10105-6","DOIUrl":"10.1007/s10620-026-10105-6","url":null,"abstract":"<p><p>Intestinal fibrosis is a common and severe complication in the progression of inflammatory bowel disease (IBD). Its pathological essence lies in the excessive synthesis and abnormal deposition of extracellular matrix (ECM) components within the intestinal tissue, leading to structural remodeling and dysfunction of the intestinal wall. As the disease progresses, fibrosis is primarily characterized by the pathological thickening of the muscularis propria, which subsequently triggers irreversible structural damage, such as intestinal strictures, severely impacting patients' quality of life and prognosis. Currently, clinical interventions for intestinal fibrosis are relatively limited, mainly relying on pharmacotherapy and surgical resection. However, existing drugs primarily focus on controlling the inflammatory response in IBD rather than directly targeting the fibrotic process, making it difficult to effectively block or reverse ECM accumulation. Although surgery can temporarily relieve obstruction, it is associated with a high postoperative recurrence rate and fails to fundamentally intervene in the pathological mechanisms of fibrosis. Therefore, a deeper understanding of the mechanisms underlying the initiation and progression of intestinal fibrosis is of great significance for developing specific anti-fibrotic therapeutic strategies and improving long-term patient outcomes. This review aims to systematically summarize the cellular and molecular mechanisms of intestinal fibrosis, with a focus on the roles of fibroblast activation, epithelial-mesenchymal transition, and immune microenvironment regulation in the fibrotic process. The goal is to provide a theoretical basis and novel research insights for the subsequent development of targeted drugs and the optimization of clinical treatment strategies.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"6009-6019"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419431","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":"Oxidative Stress During ERCP: Biomarker or Bystander?","authors":"Nilanjan Kar, Abhirup Chatterjee","doi":"10.1007/s10620-026-10141-2","DOIUrl":"10.1007/s10620-026-10141-2","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5311-5312"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590842","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":"MELD and the Risk of Mortality Between Black and White Patients with Advanced Fibrosis.","authors":"Michael L Attanasi, Mathew J Gregoski, Don C Rockey","doi":"10.1007/s10620-026-10130-5","DOIUrl":"10.1007/s10620-026-10130-5","url":null,"abstract":"<p><strong>Purpose: </strong>MELD has been well established as the gold standard metric for predicting mortality in patients with cirrhosis. Here, we hypothesized that Black race is an important factor in predicting mortality in patients with cirrhosis when controlling for social determinants of health.</p><p><strong>Methods: </strong>All adults who had a liver biopsy showing F4 fibrosis at our institution from January 1, 2013 through July 1, 2021 were identified. Histology, fibrosis stage, and complete clinical data were abstracted. Patients were propensity matched based on age, gender, Charlson Comorbidity Index, and the CDC/ATSDR Social Vulnerability Index Themes 1, 2, and 4. Cox Proportional Hazard Modeling was used to identify if race was a predictor of 5-year liver-related mortality. Logistic regression analysis was performed comparing race, MELD 3.0, and their interaction on ninety-day liver-related mortality.</p><p><strong>Results: </strong>Of 3572 patients having a liver biopsy, 64 Black and 61 White patients had F4 fibrosis after propensity matching. No significant differences between these groups existed for MELD scores. Liver-related mortality at 5 years was not significantly different between White and Black patients. Logistic regression analysis did not reveal an association between race and liver-related mortality.</p><p><strong>Conclusion: </strong>Black and White patients with similar comorbidities and social vulnerabilities had comparable liver-related mortality at similar MELD 3.0 scores. The data suggest that the MELD 3.0 score is equally predictive of mortality in Black and White patients.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5729-5736"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590926","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":"Risk Carriers: Elevated Risk of Post-ERCP Pancreatitis in Patients Heterozygous for Mutations of the Cystic Firbrosis Transmembrane Regulator (CFTR) Gene.","authors":"Mengruo Jiang, Liqi Sun","doi":"10.1007/s10620-026-10153-y","DOIUrl":"10.1007/s10620-026-10153-y","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5318-5319"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618823","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":"Bile Leak Grade Is Associated with Healing Time and Subsequent Biliary Stricture After Liver Transplantation.","authors":"Delio Stefani Donati, Dario Gambaccini, Arianna Venturini, Gherardo Tapete, Veronica Natali, Valeria Bolognesi, Andrea Pancetti, Antonio Grosso, Pierfrancesco Visaggi, Emanuele Marciano","doi":"10.1007/s10620-026-10167-6","DOIUrl":"10.1007/s10620-026-10167-6","url":null,"abstract":"<p><strong>Background and aims: </strong>Biliary leaks after liver transplantation predispose to strictures, but leak-specific endoscopic strategies remain heterogeneous. We evaluated leak- and procedure-related factors associated with time to closure and 12-month stricture.</p><p><strong>Methods: </strong>Single-center retrospective cohort (Jan 2020-Jun 2024) of adults with radiologically confirmed biliary leaks treated by ERCP within 24 h. Leaks were graded (high vs low) and timed (early ≤ 4 weeks vs late).</p><p><strong>Primary outcome: </strong>days to closure, defined by imaging confirmation of no ongoing extravasation on follow-up ERCP cholangiography (or MRCP when ERCP was not repeated).</p><p><strong>Secondary outcome: </strong>biliary stricture within 12 months.</p><p><strong>Results: </strong>Thirty-four patients were analyzed. Median time to closure was 16 days (IQR, 10-25). Mean time to closure was longer for early than for late leaks (21.1 vs. 13.0 days, respectively; p = 0.01). In multivariable models, high-grade leak and an ERCP interval ≥ 1 month were factors associated with delayed closure, whereas an initial 10 Fr plastic stent was associated with lower odds of delayed closure (time to closure > 16 days) in univariable analyses. Within 12 months, 18/33 (54.5%) developed strictures; this occurred in 18/19 (94.7%) high-grade leaks and 0/14 (0%) low-grade leaks; in multivariable models, timing and stent caliber were not significant.</p><p><strong>Conclusion: </strong>In this single-center cohort, leak grade was associated with both healing time and stricture risk. These findings suggest that leak grade may be useful for risk stratification and could help inform the intensity of endoscopic surveillance. However, grade-based treatment strategies require prospective validation before clinical implementation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5841-5846"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697254","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":"Type 3 Autoimmune Pancreatitis: What Do We Know So Far?","authors":"Miłosz Caban, Barbara Włodarczyk, Łukasz Durko, Renata Talar-Wojnarowska","doi":"10.1007/s10620-026-10120-7","DOIUrl":"10.1007/s10620-026-10120-7","url":null,"abstract":"<p><p>The increasing use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to a rise in immune-related adverse events (irAEs). Type 3 autoimmune pancreatitis (AIP-3) has been proposed as a rare form of pancreatic injury induced by ICIs with autoimmune pancreatitis-like features and variable presentations. Its diagnosis is not straightforward. Moreover, the role of available therapeutic options, particularly mainly glucocorticosteroids (GCS), remains uncertain. Currently, there are no clear guidelines for AIP-3 management. Data on AIP-3 are derived mainly from small retrospective studies and provide limited-quality evidence. In addition, the diagnostic criteria and management of AIP-3 vary substantially between studies. Some researchers have classified asymptomatic pancreatic enzyme elevations during ICI therapy as AIP-3; however, isolated hyperlipasemia should not be considered sufficient for this diagnosis. This comprehensive, narrative review summarizes current knowledge about AIP-3 and discusses epidemiology, etiopathogenesis, clinical presentations, diagnosis, and treatment based on the most recent evidence.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"6039-6052"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat ERCP in the Era of Interventional EUS: Toward an Individualized Rescue Strategy.","authors":"Filippo Antonini, Antonio Facciorusso, Lorenzo Fuccio","doi":"10.1007/s10620-026-10107-4","DOIUrl":"10.1007/s10620-026-10107-4","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"6131-6132"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404028","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":"Development and Validation of a Crotonylation-Related Prognostic Risk Model for Cholangiocarcinoma Based on Integrative Transcriptome Analysis.","authors":"Xinlei He, Mingyue Lv, Jiamin Chen, Qiancheng Zhu, Jianfu Zhao, Wenhui Chen","doi":"10.1007/s10620-026-10055-z","DOIUrl":"10.1007/s10620-026-10055-z","url":null,"abstract":"<p><strong>Background: </strong>Cholangiocarcinoma (CCA) is a common and highly refractory malignancy; however, biomarkers and therapeutic targets associated with its progression remain incompletely understood. Crotonylation is an emerging lysine acylation modification that has been implicated in multiple diseases.</p><p><strong>Aims: </strong>In this study, we aimed to identify crotonylation-related prognostic genes in CCA.</p><p><strong>Methods: </strong>First, differentially expressed genes (DEGs) with consistent expression patterns were identified using the TCGA-CHOL and GSE26566 datasets. Key module genes associated with the expression patterns of known lysine crotonylation-related gene (LCRG) scores were subsequently identified through weighted gene co-expression network analysis (WGCNA), and candidate genes were obtained by intersection analysis.</p><p><strong>Results: </strong>Three prognostic genes, complement factor H (CFH), phosphatidylcholine N-methyltransferase (PEMT), and tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein epsilon (YWHAE), were ultimately selected to construct and validate a prognostic risk model. In addition, immune infiltration analysis revealed significant differences in mast cell abundance between the high- and low-risk groups. Moreover, the expression levels of the immune checkpoints FMS-like tyrosine kinase 3 (FLT3) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) also differed between the two risk groups.</p><p><strong>Conclusions: </strong>These findings may have important implications for CCA immunotherapy and provide a theoretical basis for improving diagnostic and prognostic assessment in CCA.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5363-5377"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387525","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}