Journal of Gastrointestinal Surgery最新文献

{"title":"Preoperative endoscopy in revisional bariatric surgery: who should hold the scope?","authors":"Sergio Carandina ,&nbsp;Salvatore Avallone ,&nbsp;Viola Zulian ,&nbsp;Francesco Angrisani ,&nbsp;Luigi Angrisani ,&nbsp;Antonio Iannelli","doi":"10.1016/j.gassur.2025.102303","DOIUrl":"10.1016/j.gassur.2025.102303","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative esophagogastroduodenoscopy (EGD) is a key component of revisional bariatric surgery workup. However, the completeness and surgical relevance of reports may vary depending on whether the examination is performed by a gastroenterologist or a bariatric surgeon. This study aimed to compare the diagnostic completeness and surgical relevance of preoperative EGD reports performed by gastroenterologists with that performed by bariatric surgeons in candidates for revisional bariatric surgery.</div></div><div><h3>Methods</h3><div>This was a retrospective study that reviewed 88 patients who underwent revisional bariatric surgery after sleeve gastrectomy (SG) or gastric bypass (GB) between January 2024 and April 2025 in 2 bariatric centers in France. Patients were divided into 2 groups: group G (endoscopy by gastroenterologists [n = 44]) and group S (endoscopy by bariatric surgeons [n = 44]). Each report was evaluated using a standardized checklist of surgery-relevant items. The primary endpoint was the Completeness Index (CoI; percentage of mandatory items documented). The secondary endpoints included use of objective measurements, classification of sleeve dilation, documentation of bile reflux, and structured reporting.</div></div><div><h3>Results</h3><div>In the SG subgroup (n = 48), reports by surgeons achieved higher CI scores than those of gastroenterologists (93.5% ± 10.3% vs 69.6% ± 10.6%, respectively; <em>P</em> &lt;.0001). Sleeve dilation classification and bile reflux were consistently documented by surgeons but rarely by gastroenterologists. In the GB subgroup (n = 40), surgeon-performed reports also showed greater completeness than gastroenterologist-performed reports (88.7% ± 11.4% vs 41.2% ± 9.1%, respectively; <em>P</em> &lt;.0001), with more frequent documentation of pouch size, anastomosis diameter, and configuration. Both groups described anatomical landmarks, such as the esophagogastric junction, comparably.</div></div><div><h3>Conclusion</h3><div>Surgeon-performed EGD provides more complete, surgery-oriented information than gastroenterologist-performed examinations, particularly regarding sleeve morphology, pouch size, and anastomotic configuration. Structured reporting and collaboration are essential for optimizing preoperative evaluation in revisional bariatric surgery.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102303"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia megalatriensis as differential diagnosis of recurrence in a long-term survivor of gastric cancer: an uncommon cause of dysphagia beyond the alimentary tract","authors":"Enrique Biel ,&nbsp;Juan Sánchez-Parrilla ,&nbsp;Manuel Pera","doi":"10.1016/j.gassur.2025.102305","DOIUrl":"10.1016/j.gassur.2025.102305","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102305"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy dose intensity and outcomes in resected pancreatic cancer","authors":"Nicholas Galouzis,&nbsp;Evelyn V. Alexander,&nbsp;Maria Fotinos,&nbsp;Lusine Mesropyan,&nbsp;Carrie Luu,&nbsp;Mohammad R. Khreiss,&nbsp;Taylor S. Riall","doi":"10.1016/j.gassur.2025.102287","DOIUrl":"10.1016/j.gassur.2025.102287","url":null,"abstract":"<div><h3>Background</h3><div>Optimal treatment of locoregional pancreatic cancer includes chemotherapy and surgical resection. Chemotherapy can be difficult to tolerate, requiring dose reductions or missed cycles. This study aimed to evaluate the rates of dose reduction and outcomes based on the relative dose intensity (RDI) of chemotherapy received.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective study (2020–2024) of patients who underwent curative-intent treatment of pancreatic malignancy with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) or gemcitabine/nab-paclitaxel (Gem-Nab) and surgical resection. The total chemotherapy dose administered was recorded, and the outcomes were compared between patients who received &lt;70% RDI and those who received ≥70% RDI of the standard dosing regimens.</div></div><div><h3>Results</h3><div>A total of 46 patients had complete dosing information (33 in the mFOLFIRINOX group and 13 in the Gem-Nab group). In addition, 56.5% of patients met the 70% threshold (60.6% in the mFOLFIRINOX group and 46.2% in the Gem-Nab group). Compared with patients who received ≥70% RDI, those who received &lt;70% RDI were significantly older (65.7 ± 11.4 vs 73.0 ± 7.1, respectively; <em>P</em> =.01) and had a higher Charlson Comorbidity Index (4.5 ± 2.1 vs 5.9 ± 1.4, respectively; <em>P</em> =.02). Dose reduction was required in 59.0% of patients during treatment. Of note, 20% of patients who completed &gt;5 months of treatment still received &lt;70% RDI and had significantly worse survival (15.5 months in patients who received &lt;70% RDI vs 40.5 months in patients who received ≥70% RDI; <em>P</em> =.05).</div></div><div><h3>Conclusion</h3><div>Dose reduction is common when treating resectable pancreatic cancer with mFOLFIRINOX or Gem-Nab. Just over half the cohort achieved the ≥70% RDI threshold. Time in months or cycles may not adequately define chemotherapy completion, as one-fifth of patients completed treatment by duration but failed to achieve the ≥70% RDI threshold, which affected survival.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102287"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single-center retrospective study of conversion surgery in stage IV gastric cancer: association with immune checkpoint inhibitor-based chemotherapy","authors":"Yuki Ushimaru,&nbsp;Takeshi Omori,&nbsp;Kazuyoshi Yamamoto,&nbsp;Kei Yamamoto,&nbsp;Yasunori Masuike,&nbsp;Yoshitomo Yanagimoto,&nbsp;Norihiro Matsuura,&nbsp;Takahito Sugase,&nbsp;Takashi Kanemura,&nbsp;Ryota Mori,&nbsp;Masatoshi Kitakaze,&nbsp;Masahiko Kubo,&nbsp;Yasunari Fukuda,&nbsp;Hisateru Komatsu,&nbsp;Masaaki Miyo,&nbsp;Toshinori Sueda,&nbsp;Yoshinori Kagawa,&nbsp;Kunihito Gotoh,&nbsp;Shogo Kobayashi,&nbsp;Hiroshi Miyata","doi":"10.1016/j.gassur.2025.102301","DOIUrl":"10.1016/j.gassur.2025.102301","url":null,"abstract":"<div><h3>Background</h3><div>Stage IV gastric cancer remains challenging to treat despite recent advances in systemic therapy. Among patients with favorable responses to chemotherapy, conversion surgery aiming for R0 resection has shown promise in improving survival. Immune checkpoint inhibitors (ICIs) have become a key component of systemic treatment, but their prognostic impact in the setting of conversion surgery remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 98 patients with gastric cancer who received platinum-based doublet chemotherapy followed by minimally invasive surgery. Patients were stratified into ICI (n = 41) and non-ICI groups (n = 57). Perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were evaluated using Kaplan–Meier analysis and Cox regression models.</div></div><div><h3>Results</h3><div>The median operative time was 345 min, and the median blood loss was 5 mL. R0 resection was achieved in 79.6% of cases, and the median hospital stay was 7 days. Clavien–Dindo grade ≥ II complications occurred in 12.2% of patients. ICI-treated patients had significantly longer PFS (hazard ratio [HR], 0.418; <em>P</em> =.0008) and OS (HR, 0.437; <em>P</em> =.024). R0 resection was independently associated with improved PFS (HR, 0.179; <em>P</em> &lt;.0001) and OS (HR, 0.231; <em>P</em> &lt;.0001). Multivariate analysis identified pathological N status, R0 resection, and ICI use as independent predictors of PFS.</div></div><div><h3>Conclusion</h3><div>Among patients who underwent conversion surgery in this real-world cohort, those treated with ICI-based chemotherapy demonstrated more favorable long-term outcomes than those treated with chemotherapy alone. Although our findings do not demonstrate a causal relationship of ICI therapy on resectability, they suggest that ICI-based chemotherapy may be associated with improved survival in appropriately selected patients with human epidermal growth factor receptor 2–negative stage IV gastric cancer. Prospective studies are warranted to clarify optimal indications and perioperative strategies for integrating ICI-based regimens into conversion treatment.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102301"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Medicaid expansion on treatment and outcomes in patients undergoing surgery for common colorectal conditions","authors":"Mayin Lin ,&nbsp;John C. Hsieh ,&nbsp;Miya C. Yoshida ,&nbsp;Julie S. Hong ,&nbsp;Christopher M. Foglia ,&nbsp;Steven Y. Chao","doi":"10.1016/j.gassur.2025.102300","DOIUrl":"10.1016/j.gassur.2025.102300","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102300"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for operative intervention in adult patients with foreign body ingestion","authors":"Shea Gallagher ,&nbsp;Cameron Ghafil ,&nbsp;Li Ding ,&nbsp;Yu-Tung Wu ,&nbsp;Edward Compton ,&nbsp;Shivani Sundaram ,&nbsp;Philip Paulson ,&nbsp;Morgan Schellenberg ,&nbsp;James Buxbaum ,&nbsp;Matthew Martin ,&nbsp;Kenji Inaba ,&nbsp;Kazuhide Matsushima","doi":"10.1016/j.gassur.2025.102297","DOIUrl":"10.1016/j.gassur.2025.102297","url":null,"abstract":"<div><h3>Background</h3><div>The management of foreign body ingestion (FBI) in the adult population varies widely given the lack of evidence-based guidelines. This study aimed to identify risk factors associated with the need for operative intervention in these cases.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study between July 2015 and January 2021. All adult patients (age ≥18 years) presenting after FBI were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was used to identify foreign body (FB) characteristics associated with operative interventions.</div></div><div><h3>Results</h3><div>A total of 303 patient encounters were included. Ingested FBs were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Notably, 40% underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%) and colonoscopy (4.6%). Twelve patients (4.0%) underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median FB lengths than patients without these complications (11.5 vs 3.0 cm; <em>P</em> &lt;.001). On multivariate regression analysis, FB length was significantly associated with the need for operative intervention (odds ratio [OR], 1.67 for each centimeter increment; <em>P</em> &lt;.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR, 0.20; <em>P</em> =.04).</div></div><div><h3>Conclusion</h3><div>Adult patients who present after FBI can often be managed conservatively. The length of ingested objects seems to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk FBs should be considered when feasible.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102297"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphadenectomy through a triple-instrument cervical approach: a technical advance in single-port mediastinoscopic radical esophagectomy for esophageal cancer","authors":"Shuhei Komatsu ,&nbsp;Tomoki Konishi ,&nbsp;Soichiro Ogawa ,&nbsp;Yoshihisa Matsumoto ,&nbsp;Yuji Fujita ,&nbsp;Hisataka Matsuo ,&nbsp;Yoshiaki Kuriu ,&nbsp;Hisashi Ikoma ,&nbsp;Kazuma Okamoto ,&nbsp;Hirotaka Konishi ,&nbsp;Hitoshi Fujiwara ,&nbsp;Eigo Otsuji ,&nbsp;Atsushi Shiozaki","doi":"10.1016/j.gassur.2025.102296","DOIUrl":"10.1016/j.gassur.2025.102296","url":null,"abstract":"<div><h3>Background</h3><div>Single-port mediastinoscopic radical esophagectomy represents the least invasive form of esophagectomy that avoids thoracotomy or thoracoscopy. However, conventional double-instrument approaches are constrained by a narrow operative field, often leading to limited mediastinal lymph node dissection and a risk of recurrent laryngeal nerve (RLN) injury. Although the introduction of continuous intraoperative nerve integrity monitoring (NIM) has markedly reduced the incidence of RLN palsy, the adequacy of lymphadenectomy remains a major concern. To address this limitation, we introduced a triple-instrument cervical approach to enhance operative visibility and precision.</div></div><div><h3>Methods</h3><div>Between May 2020 and April 2025, 48 consecutive patients with thoracic esophageal cancer underwent single-port mediastinoscopic radical esophagectomy with continuous NIM at our institution. Among these patient, 26 underwent a triple-instrument cervical approach, whereas 22 underwent a conventional double-instrument approach. Clinicopathological characteristics and perioperative outcomes were compared between the 2 groups.</div></div><div><h3>Results</h3><div>Triple-instrument access significantly increased the number of mediastinal lymph nodes retrieved (median: 22 [IQR, 7–46] vs 16 [IQR, 2–42]; <em>P</em> =.048), without significant differences in blood loss (median: 123 vs 63 mL; <em>P</em> =.266), RLN palsy (7.7% vs 4.5%; <em>P</em> =.881), or hospital stay (median: 14 days in both groups; <em>P</em> =.883). Multivariate analysis identified the triple-instrument technique as an independent predictor of high lymph node yield (odds ratio, 5.55 [95% CI, 1.19–25.8]; <em>P</em> =.029).</div></div><div><h3>Conclusion</h3><div>The triple-instrument cervical approach represents a technically feasible and oncologically sound refinement of single-port mediastinoscopic esophagectomy. By combining continuous NIM and improved ergonomics, this technique enhances mediastinal lymphadenectomy without increasing morbidity.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102296"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic antireflux surgery with the RefluxStop implant for severe sufferers with complex disease: a retrospective study of the first 100 patients with 12-month follow-up at an early adopter institution","authors":"Joerg Zehetner ,&nbsp;Norbert Niebuhr ,&nbsp;Ioannis Linas ,&nbsp;Ulf Kessler ,&nbsp;Yannick Fringeli","doi":"10.1016/j.gassur.2025.102293","DOIUrl":"10.1016/j.gassur.2025.102293","url":null,"abstract":"<div><h3>Background</h3><div>The RefluxStop procedure, shown to effectively eliminate gastroesophageal reflux disease (GERD) symptoms in clinical trial, has been offered at our clinic since 2020. Promising short-term outcomes in the initial cohorts have been published. The outcomes for 100 patients with a follow-up of at least 1 year have been presented.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted with the first 100 patients to reach the 12-month postoperative follow-up. The primary endpoint was symptom resolution, which was quantified using the GERD Health-Related Quality of Life (GERD-HRQL) score. The secondary effectiveness endpoints included patient satisfaction and proton pump inhibitor (PPI) use. Safety data were reported as surgical complications up to 90 days and device- or surgery-related complications during the 12-month follow-up.</div></div><div><h3>Results</h3><div>At baseline, 53% of the patients had a hiatal hernia of ≥4 cm, 66% of the patients had ineffective esophageal motility, and 46% of the patients reported preoperative dysphagia. The median GERD-HRQL score (0–75 points) decreased by 97.6% from 42.5 (IQR, 29.0–50.0) preoperatively to 1.0 (IQR, 0.0–5.0) at 12 months (<em>P</em> &lt;.001). PPI use decreased from 94.8% at baseline to 5.2% at 12 months. Two cases of early device penetration to the stomach occurred, attributable to surgical technique with unduly tight pouch closure; no intervention was required. In addition, two patients (2%) required revision surgery for hiatal repair, with both having a hernia of &gt;7 cm at baseline.</div></div><div><h3>Conclusion</h3><div>In this cohort of 100 patients with severe symptoms, the RefluxStop procedure resulted in excellent 12-month outcomes, with a median of 97.6% improvement in the total GERD-HRQL score, resolving GERD symptoms to a high level of satisfaction, even in patients with clinically complex conditions.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102293"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary on “Minimally invasive surgery in hepatocellular carcinoma: evolving trade-offs of patient selection and recurrence risk”","authors":"Abu Bakar Hafeez Bhatti","doi":"10.1016/j.gassur.2025.102299","DOIUrl":"10.1016/j.gassur.2025.102299","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102299"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Shouldice renaissance: revisiting tissue repair in the era of mesh-based technique","authors":"Vipul D. Yagnik ,&nbsp;Prema Ram Choudhary ,&nbsp;Pankaj Garg","doi":"10.1016/j.gassur.2025.102304","DOIUrl":"10.1016/j.gassur.2025.102304","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 2","pages":"Article 102304"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}