Journal of Gastrointestinal Surgery最新文献

{"title":"Giant Brunner gland hamartoma of the duodenum","authors":"Bijit Saha , Bijan Basak , Gourab Bhaduri","doi":"10.1016/j.gassur.2026.102348","DOIUrl":"10.1016/j.gassur.2026.102348","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102348"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097117","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":"Real-world outcomes in patients with cirrhosis undergoing cholecystectomy: a population-based study","authors":"Sulaiman Nanji ,&nbsp;Sean Bennett ,&nbsp;Zuhaib M. Mir ,&nbsp;Vanessa Wiseman ,&nbsp;Maya Djerboua ,&nbsp;Jennifer A. Flemming","doi":"10.1016/j.gassur.2026.102355","DOIUrl":"10.1016/j.gassur.2026.102355","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cirrhosis face increased surgical risk. This study aimed to characterize real-world perioperative outcomes after cholecystectomy in patients with cirrhosis and identify independent predictors of postoperative liver decompensation events (POLDEs) and mortality.</div></div><div><h3>Methods</h3><div>This was a population-based, retrospective cohort study that used administrative health data from Ontario, Canada. Patients with cirrhosis who underwent cholecystectomy between January 2009 and December 2018 were included. Perioperative outcomes were described, including POLDEs and mortality. Modified Poisson regression analysis was used to identify independent predictors of POLDEs and 90-day mortality while accounting for clustering at the institutional level.</div></div><div><h3>Results</h3><div>A total of 4769 patients were analyzed. The leading etiology of cirrhosis was metabolic dysfunction–associated steatotic liver disease (66%). Most patients (69%) underwent elective surgery. The mean hospital stay was 3.6 days, with a 13% complication rate. Within 90 days, 27% of patients returned to the emergency department, and 10% of patients required readmission. Moreover, 83 patients (1.7%) experienced POLDEs, and 91 patients (1.9%) died. Higher Model for End-Stage Liver Disease-Sodium scores were associated with both postoperative decompensation and mortality. Independent predictors of POLDEs included older age, alcohol-related cirrhosis, and previous decompensation. The predictors of 90-day mortality included advanced age, comorbidities, emergent surgery, and postoperative decompensation.</div></div><div><h3>Conclusion</h3><div>Although early liver-related complications and mortality remain low overall, patients with advanced age, comorbidity, history of decompensation, and emergent surgery have significantly worse outcomes. Moreover, the high rates of emergency visits and readmissions highlight the substantial healthcare utilization in this population.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102355"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100261","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":"Hospital volume stratification using stratum-specific likelihood ratios for pancreatectomy","authors":"Kristen N. Kaiser ,&nbsp;Alexa J. Hughes ,&nbsp;Brian M. Ruedinger ,&nbsp;Jeanette W. Chung ,&nbsp;Katie Ross-Driscoll ,&nbsp;Adam S. Wilk ,&nbsp;Alexandra Roch ,&nbsp;Michael G. House ,&nbsp;Karl Y. Bilimoria ,&nbsp;Ryan J. Ellis","doi":"10.1016/j.gassur.2026.102349","DOIUrl":"10.1016/j.gassur.2026.102349","url":null,"abstract":"<div><h3>Background</h3><div>Recent literature suggests that volume-outcome associations for pancreatectomy have attenuated over time, leading some researchers to question the continued relevance of volume thresholds. However, this perceived attenuation may reflect the methodological limitations of single, binary cutoffs rather than a true weakening of the underlying relationship. Stratum-specific likelihood ratios (SSLRs) generate multiple empirically derived volume strata that may detect persistent gradients that are obscured by binary stratification. The objectives of this study were to (i) define volume strata for pancreatectomy using SSLR, (ii) assess the robustness of these strata across multiple outcomes, and (iii) examine whether the association persists in modern cohorts.</div></div><div><h3>Methods</h3><div>Patients who underwent pancreatectomy between 2004 and 2021 were identified using the National Cancer Database. The volume strata were defined by SSLR based on the 90-day postoperative mortality. The temporal threshold stability was assessed by stratified outcome analysis (chi-squared test).</div></div><div><h3>Results</h3><div>Overall, 61,920 patients underwent pancreatectomy at 982 facilities with a 90-day mortality rate of 5.4%. SSLR analysis yielded 6 volume strata: ≤3, 4 to 9, 10 to 20, 21 to 47, 48 to 120, and ≥121 procedures/year with decreasing 90-day mortality (≤3: 11%; 4–9: 7.3%; 10–20: 6.1%; 21–47: 4.2%; 48–120: 3.3%; ≥121: 2.3%; <em>P</em> &lt;.001). The optimized threshold of 21 procedures/year was identified based on SSLR. Temporal stratification into 5-year periods (2006–2010, 2011–2015, and 2016–2020) demonstrated persistent volume-outcome associations across volume strata (<em>P</em> &lt;.001).</div></div><div><h3>Conclusion</h3><div>SSLR reveals persistent volume-outcome associations for pancreatectomy across multiple empirically derived strata, even in contemporary data. These findings suggest that reports of an attenuated volume-outcome relationship may reflect limitations of single, static cutoffs rather than true weakening of this association.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102349"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100224","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":"Perceived discrimination, communication, and healthcare utilization after gastrointestinal surgery: a moderated mediation analysis","authors":"Odysseas P. Chatzipanagiotou ,&nbsp;Areesh Mevawalla ,&nbsp;Azza Sarfraz ,&nbsp;Andrea Baldo ,&nbsp;Abdulaziz Elemosho ,&nbsp;Ishika Agarwal ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.gassur.2026.102350","DOIUrl":"10.1016/j.gassur.2026.102350","url":null,"abstract":"<div><h3>Background</h3><div>In the United States, perceived discrimination in healthcare settings (PDHS) has been linked with delayed care. Surgery represents a high-stakes, vulnerable period that can leave a lasting impression on future healthcare utilization. We sought to assess the association between PDHS and delayed care, as well as evaluate the mediating and moderating roles of patient-clinician communication (PCC) and sociodemographic factors on timing of healthcare delivery.</div></div><div><h3>Methods</h3><div>Adults who underwent gastrointestinal procedures before completing the Healthcare Access and Utilization Survey in the All of Us Research Program. Associations were examined using structural equation modeling (SEM). Variance decomposition was used to quantify the contributions of sociodemographic moderators.</div></div><div><h3>Results</h3><div>Among 1866 participants (46.4% hepatopancreatobiliary, 41.6% colorectal, and 12.0% esophagogastric) included in the study, median age was 62.0 years (IQR, 52.0–70.0). Most participants were female (1306 [70.3%]) and non-Hispanic White (1571 [84.2%]). Participants who delayed care were more often aged 18 to 44 years (39.0% vs 11.6%) and less frequently married (55.5% vs 63.5%) (both <em>P</em> &lt;.05). In adjusted SEM, higher PDHS was associated with worse PCC (β, −0.46 [95% CI, −0.56 to −0.36]) and greater odds of delayed care (adjusted odds ratio [aOR], 1.55 [95% CI, 1.20–2.01]). PCC mediated 14.8% of the PDHS-delayed care association. PDHS (57.9%), age (9.6%), and income (4.3%) contributed most to PCC variance. Delayed care was associated with higher odds of poor quality of life (aOR, 2.65), poor mental health (aOR, 2.65), and poor physical health (aOR, 2.24) (all <em>P</em> &lt;.001).</div></div><div><h3>Conclusion</h3><div>PCC mediated the relationship between discrimination and healthcare delays with sociodemographic factors influencing this effect. Higher PDHS and worse PCC increased the odds of delayed care, leading to worse health and quality of life.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102350"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100226","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":"Implementation of an enhanced recovery after surgery protocol for esophagectomy: an evaluation in a high-volume tertiary center","authors":"Cezanne D. Kooij ,&nbsp;Iris van Haarlem ,&nbsp;Maxime E. Sanders ,&nbsp;Femke E. Lammes ,&nbsp;Sylvia van der Horst ,&nbsp;B. Feike Kingma ,&nbsp;Marije Marsman ,&nbsp;Olaf L. Cremer ,&nbsp;Elles Steenhagen ,&nbsp;Ad Kerst ,&nbsp;Carlo Schippers ,&nbsp;Jan W. van den Berg ,&nbsp;Shaun R. Preston ,&nbsp;Edward Cheong ,&nbsp;Jelle P. Ruurda ,&nbsp;Richard van Hillegersberg","doi":"10.1016/j.gassur.2026.102353","DOIUrl":"10.1016/j.gassur.2026.102353","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, accelerate recovery, and reduce length of hospital stay (LOS). This study aimed to evaluate the implementation and evolution of an ERAS protocol for esophageal resection in a western high-volume tertiary center.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed all consecutive patients who underwent esophagectomy for esophageal cancer at the University Medical Center Utrecht between May 2015 and December 2023, divided into 4 cohorts based on protocol changes. Robot-assisted minimally invasive esophagectomy with cervical esophagogastrostomy and epidural pain management was the standard of care. An ERAS protocol, focused on preoperative optimization of nutritional and physical fitness, intrathoracic anastomosis, and multidisciplinary postoperative support, was implemented in October 2016. The first cohort served as the pre-ERAS baseline, with subsequent cohorts indicating a change in protocol. Data were extracted from a prospectively maintained database. The primary outcome was median LOS. Secondary outcomes included perioperative dietary, surgical, clinical, and physiotherapeutic measures.</div></div><div><h3>Results</h3><div>A total of 526 patients were included. Median LOS decreased from 16 days (IQR, 11–25) in the pre-ERAS cohort to 13 (IQR, 9–21), 11 (IQR, 8–15), and 11 days (IQR, 8–18) in successive cohorts (<em>P</em> &lt;.001; hazard ratio [HR], 0.68; 95% CI, 0.52–0.90; <em>P</em> =.007). This reduction remained significant after adjusting for covariates (HR, 0.58; 95% CI, 0.44–0.77; <em>P</em> &lt;.001). Median LOS of patients with a textbook outcome decreased from 11 days (IQR, 11–14) in the pre-ERAS cohort to 10 (IQR, 8–13), 10 (IQR, 8–12), and 8 days (IQR, 7–11) in subsequent cohorts (<em>P</em> &lt;.001). Several secondary ERAS outcomes improved over the years (dietitian involvement, surgical approach, extubation in the operating room, drain/line management). A reduction in postoperative complications was observed (from 81% to 74%; <em>P</em> =.033), whereas mortality and readmission rates remained stable.</div></div><div><h3>Conclusion</h3><div>After ERAS implementation for esophagectomy, median LOS decreased from 16 to 11 days over 7 years, with stable readmission rates. These results support ERAS as a valuable tool to optimize perioperative care, leading to a significant reduction in length of postoperative hospital stay.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102353"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100251","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":"Letter to the editor regarding “Predictors for operative intervention in adult patients with foreign body ingestion”","authors":"Jiancheng Ye ,&nbsp;Wen Lyu","doi":"10.1016/j.gassur.2026.102372","DOIUrl":"10.1016/j.gassur.2026.102372","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102372"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197703","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":"Epstein-Barr virus-associated smooth muscle tumor of the liver in a kidney transplant recipient treated with hepatectomy","authors":"Goro Ueda,&nbsp;Erik R. Henning Ander,&nbsp;Chirag S. Desai","doi":"10.1016/j.gassur.2026.102346","DOIUrl":"10.1016/j.gassur.2026.102346","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102346"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093100","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":"Gastrointestinal mantle cell lymphoma","authors":"Tian-Qi Zhao ,&nbsp;Liu-Yun Zhang ,&nbsp;Wei Liu","doi":"10.1016/j.gassur.2026.102364","DOIUrl":"10.1016/j.gassur.2026.102364","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102364"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180534","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":"Colorectal cancer T stage, size at diagnosis, and presentation 2017 to 2023: an analysis using Veterans Affairs data","authors":"Kirthi S. Bellamkonda ,&nbsp;Laura Newton ,&nbsp;Caroline Korves ,&nbsp;Daniel Weinberger ,&nbsp;Gabrielle Zwain ,&nbsp;Mark Eid ,&nbsp;Xavier Fowler ,&nbsp;Aravind Ponukumati ,&nbsp;Douglas Robertson ,&nbsp;Matthew Z. Wilson ,&nbsp;Amy C. Justice ,&nbsp;Anita Vashi ,&nbsp;Philip P. Goodney ,&nbsp;Louise Davies","doi":"10.1016/j.gassur.2026.102344","DOIUrl":"10.1016/j.gassur.2026.102344","url":null,"abstract":"<div><h3>Purpose</h3><div>Colorectal cancer is the fourth most common cancer in the United States, and early detection decreases mortality. We evaluated recent trends in colon cancer incidence and changes in rates of presentation with bowel obstruction before and during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>This was a longitudinal study of the United States veterans from 2017 to 2023. The primary exposure was the time period prepandemic (January 1, 2017, to February 29, 2020) compared with pandemic (March 1, 2020, to October 31, 2023). The primary outcome was new colon cancer diagnoses. We compared observed with expected diagnoses during the pandemic period. Malignant bowel obstruction at the index diagnosis date, American Joint Committee on Cancer tumor stage, and tumor size at the time of diagnosis were compared by period using standardized differences and bootstrapped CIs.</div></div><div><h3>Results</h3><div>There were 22,256 new colon cancer diagnoses made in United States Department of Veterans Affairs Medical Centers (VA): mean age of 71 ± 11 years, 96% male, and 72% White. Comparing the pandemic with prepandemic periods, the proportion of cancers &gt;4 cm increased from 48.9% to 57.3% and the proportion with malignant bowel obstruction at presentation doubled from 2.7% to 5.3%. An estimated 619 cases were “missed” during the pandemic: they were expected but not observed diagnoses. There were greater observed than expected large cancers and fewer observed than expected small cancers during the pandemic according to forecast analyses.</div></div><div><h3>Conclusion</h3><div>Interruptions in care after the onset of the COVID-19 pandemic had measurable consequences among United States veterans through the end of 2023. Among those diagnosed, the median size was larger and more presented with bowel obstruction. This may be because decreased screening activity combined with lower healthcare utilization changed the distribution of cancer size at diagnosis to be larger, underlining the importance of encouraging engagement or re-engagement of veterans in colorectal cancer screening.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102344"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046845","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 “Overuse of subtotal cholecystectomy: surgeon practice patterns and outcomes in a large healthcare system”","authors":"Chad G. Ball","doi":"10.1016/j.gassur.2026.102365","DOIUrl":"10.1016/j.gassur.2026.102365","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"30 4","pages":"Article 102365"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165712","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}