Scandinavian Journal of Gastroenterology最新文献

{"title":"Expert panel perspectives on improving the diagnosis and management of metabolic dysfunction-associated steatohepatitis in Denmark.","authors":"Aleksander Krag, Jens Søndergaard, Mette Theil, Mette Lehmann Andersen, Frede Lyck, Lone McColaugh, Katrine Prier Lindvig, Lise Lotte Gluud","doi":"10.1080/00365521.2026.2663324","DOIUrl":"https://doi.org/10.1080/00365521.2026.2663324","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide. Progression to metabolic dysfunction-associated steatohepatitis (MASH) can result in fibrosis, cirrhosis, and increased mortality. MASLD and MASH are often under-diagnosed due to their asymptomatic nature, limited awareness, and stigma associated with both liver disease and increased body weight, often resulting in delayed diagnosis. Unclear referral pathways from general practice to specialists and dietitians are often delayed, limiting timely and coordinated care. Given the growing concern regarding MASH and its urgent challenges, the first national, structured, multidisciplinary expert group in Denmark was convened to identify recommendations by capturing a broad, practice-oriented perspective.</p><p><strong>Methods: </strong>Eleven experts with overlapping roles participated, including nine with scientific and clinical expertise in obesity, diabetes, and gastroenterology/hepatology, two from general practice, a dietitian, and three representing patient associations, ensuring both clinical and patient perspectives.</p><p><strong>Results: </strong>The expert panel identified seven focus areas for improving MASH diagnosis and management in Denmark. Key challenges included late diagnosis, low awareness, and suboptimal referral pathways. Moreover, the panel highlighted the need for standardised referral processes, interdisciplinary collaboration, and increased awareness in primary care to enable timely detection and coordinated care. The framework provides a practice-oriented foundation for national strategies, supporting structured patient pathways, coherent management, and future implementation initiatives.</p><p><strong>Conclusions: </strong>Taken together, this publication can serve as a reference for general practitioners, medical specialists, dietitians, professional societies, and healthcare authorities, to support the development of structured, sustainable pathways for MASH care in Denmark.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-11"},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842225","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":"Pancreatic exocrine insufficiency after esophageal and gastric surgery: the PEGAS study.","authors":"Maria Lampi, Patrick Maisonneuve, Ioannis Rouvelas, Mats Lindblad, Fredrik Klevebro, J Enrique Dominguez Munoz, Jutta Keller, J-Matthias Löhr, Magnus Nilsson, Miroslav Vujasinovic","doi":"10.1080/00365521.2026.2664646","DOIUrl":"https://doi.org/10.1080/00365521.2026.2664646","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic exocrine insufficiency (PEI) is a potential but under-recognized complication after upper gastrointestinal (GI) surgery, contributing to malabsorption and nonspecific GI symptoms.</p><p><strong>Aims and methods: </strong>This prospective cohort study included adult patients undergoing esophagectomy or gastrectomy at a single tertiary referral center between March 2022 and January 2024. A total of 51 patients were included, with 34 completing full follow-up. The primary outcome was the prevalence of PEI. A secondary outcome was the effect of pancreatic enzyme replacement therapy (PERT) in patients with PEI.</p><p><strong>Results: </strong>Among 31 patients undergoing esophagectomy, one (3.2%) was diagnosed with PEI. In contrast, PEI was identified in five (25.0%) of 20 patients after total or subtotal gastrectomy. PERT was administered in all patients with PEI. At 12-months' follow-up, clinical improvement in PEI symptoms was observed in four of six patients, while in two patients, disease progression due to cancer prevented assessment of the PERT effect.</p><p><strong>Conclusions: </strong>PEI is a clinically significant postoperative complication after upper GI surgery. These findings support the inclusion of pancreatic exocrine function assessment in the postoperative follow-up of gastric surgery patients, particularly those presenting with nonspecific GI symptoms and malabsorption, to enable timely diagnosis and management.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-10"},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842212","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":"Colonoscopy in elderly patients: diagnostic yield, pre-referral assessment and quality indicators in two Swedish cohorts.","authors":"Michiel van Nieuwenhoven, Shwan Ghaderi, Ann-Sofie Backman, Michiel van Nieuwenhoven, Ann-Sofie Backman, Charlotte Höög, Anna Forsberg, Jóhann P Hreinsson, Olga Bednarska, Thomas de Lange, Nils Nyhlin, Jonas Varkey, Kaisa Fritzell, Daniel Sjöberg, Nikolaos Papachrysos, Johannes Blom","doi":"10.1080/00365521.2026.2664650","DOIUrl":"https://doi.org/10.1080/00365521.2026.2664650","url":null,"abstract":"<p><strong>Objectives: </strong>Colonoscopy in elderly, frail patients requires weighing diagnostic yield against procedure-related risk, but real-world data are limited. We describe outcomes from two Swedish cohorts undergoing non-screening colonoscopy in two regions.</p><p><strong>Methods: </strong>We combined aggregated results from two retrospective cohort studies. The Ersta cohort included all patients aged ≥75 years undergoing colonoscopy in 2022 and compared inpatient versus outpatient examinations. The Örebro cohort included all colonoscopies in patients aged ≥80 years during 2016-2018. We extracted data on indications, pre-referral investigations, findings, quality indicators, and short-term mortality. For Örebro, we used previously calculated odds ratios and positive predictive values for significant findings.</p><p><strong>Results: </strong>At Ersta, 1,066 patients aged ≥75 years underwent 1,144 colonoscopies; 40% were performed in inpatients admitted for bowel preparation. Colorectal cancer was diagnosed in 5%, inflammatory bowel disease in 6%, microscopic colitis in 3%, and other colitis in 4%, with similar proportions in inpatients and outpatients. One-year mortality was 6% after inpatient and 1% after outpatient colonoscopy. In Örebro, 565 colonoscopies in patients aged ≥80 years were analyzed. Significant findings occurred in 26.2% (colorectal cancer 18.8%, high-grade dysplasia 4.6%, any colitis 5.0%, with some overlap). Abnormal rectal examination, abnormal abdominal imaging, low ferritin, and positive f-Hb predicted significant disease. Altered bowel habits was the most common indication but had an odds ratio below 1 for significant disease.</p><p><strong>Conclusions: </strong>In elderly Swedish patients, colonoscopy detects colorectal cancer or colitis, but many examinations show benign or no findings. Selection using simple pre-referral tests and life expectancy may reduce low-yield examinations.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-8"},"PeriodicalIF":1.7,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820071","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":"Pancreatic acinar cell cystadenoma: single-center experiences and a systematic review.","authors":"Camille Evrard, Maria Baldursdottir, Louiza Loizou, Carlos Valls, Raffaella Pozzi Mucelli, Nina Bloch, Sam Ghazi, Poya Ghorbani, J-Matthias Löhr, Miroslav Vujasinovic","doi":"10.1080/00365521.2026.2663322","DOIUrl":"https://doi.org/10.1080/00365521.2026.2663322","url":null,"abstract":"<p><strong>Aims: </strong>Pancreatic cystic lesions (PCLs) range from benign to malignant, creating diagnostic and therapeutic challenges. While most PCLs are serous or mucinous neoplasms, rare entities such as acinar cell cystadenoma (ACC) remain poorly characterized. This study reports a tertiary center cohort and a systematic literature review.</p><p><strong>Methods: </strong>We retrospectively analyzed 23 ACC patients at Karolinska University Hospital. A systematic review was performed following PRISMA guidelines.</p><p><strong>Results: </strong>In our cohort (median age 67.0 years; 73.9% male), ACCs were most often incidentally detected, with abdominal pain being the most frequent indication for imaging. No patients underwent surgery, and no malignant transformation was observed during a median follow-up of 10.4 months. Most patients (87%) underwent both CT and MR imaging, and 65.2% fulfilled proposed imaging diagnostic criteria.The systematic review included 41 studies with 165 patients. Abdominal pain was the most common indication for imaging, and most patients underwent pancreatic surgery. Median follow-up was 1.3 years, with no malignant transformation observed. Imaging typically showed well-circumscribed cystic lesions, usually non-communicating with the main pancreatic duct and mimicking other cystic neoplasms. Histopathology consistently demonstrated an acinar phenotype with low proliferative activity.</p><p><strong>Conclusions: </strong>ACC appears to be an asymptomatic, incidentally discovered lesion, with imaging playing a central diagnostic role. Neither endocrine nor exocrine pancreatic insufficiency nor malignant transformation was observed. However, the relatively short overall follow-up limits conclusions regarding long-term outcomes.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-13"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820122","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 factors for major gastrointestinal bleeding in septic patients: a multicenter retrospective study.","authors":"Yi Zhang, Haibo Zhang, Yuanyuan Feng, Lijuan Zhang, Bing Zhao, Shu Wang, Lianyang Zhang, Yang Li","doi":"10.1080/00365521.2026.2636063","DOIUrl":"10.1080/00365521.2026.2636063","url":null,"abstract":"<p><strong>Introduction: </strong>Major gastrointestinal bleeding (MGB) is a critical complication of sepsis that is associated with a poor prognosis. We aimed to identify independent predictors of MGB in a large multicenter cohort of septic patients to facilitate clinical risk stratification.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed data collected from four tertiary hospitals in China between 2016 and 2023. Data on patient demographics, comorbidities, infection sources, admission laboratory parameters and treatments were collected. The primary outcome was MGB within 28 d, defined as overt bleeding with a hemoglobin drop >20 g/L or transfusion requirement.</p><p><strong>Results: </strong>Of 10,249 eligible patients, 205 (2.0%) developed MGB. In-hospital mortality was significantly higher in the MGB group compared to the non-MGB group (44.0% <i>vs.</i> 17.0%, <i>p</i> < 0.001). Multivariable analysis identified independent risk factors for MGB: renal dysfunction (aOR 1.61), malignancy or immunosuppression (aOR 1.55), gastrointestinal infection (aOR 1.50), elevated blood urea nitrogen (BUN; aOR 1.03) and older age (aOR 1.01). Conversely, urinary tract infection (aOR 0.29) and higher baseline hemoglobin (HGB) levels (aOR 0.99) were associated with a lower risk. The predictive model achieved an area under the curve (AUC) of 0.702.</p><p><strong>Conclusions: </strong>Although MGB occurred in only 2.0% of septic patients, it was associated with substantially higher mortality. Older age, renal dysfunction, elevated BUN and gastrointestinal sources were key drivers of risk, while urinary tract infection was associated with a lower risk. These findings underscore the importance of early risk stratification and targeted preventive strategies in high-risk patients to mitigate bleeding events and improve survival.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"516-524"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326803","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":"Sex discordance between patients and endoscopists and colonoscopy outcome: a database analysis.","authors":"F Theunissen, D M de Jong, H Tejeda Mora, P C J Ter Borg, R J T Ouwendijk, L M J W van Driel, M J Bruno, P D Siersema, M C W Spaander","doi":"10.1080/00365521.2026.2636743","DOIUrl":"10.1080/00365521.2026.2636743","url":null,"abstract":"<p><strong>Background and study aim: </strong>Sex disparities in medicine have been shown to have clinical implications for patient outcomes. Previous studies have highlighted worse outcomes for female patients treated by male physicians in cardiology and surgery. This study aims to assess the effect of sex discordance between patients and endoscopists on colonoscopy outcomes.</p><p><strong>Methods: </strong>Data from a gastrointestinal (GI) endoscopy database was used. All colorectal cancer (CRC) screening colonoscopies performed between January 2016 and December 2020 in 17 Dutch hospitals were analyzed. Primary outcomes included cecal intubation rate (CIR), adenoma detection rate (ADR), polyp detection rate (PDR) and patient discomfort measured by the Gloucester Comfort Scale (GCS). Associations between sex discordance (male-male, male-female, female-female and female-male) and outcomes were estimated using logistic mixed-effects models, accounting for various covariates and random effects.</p><p><strong>Results: </strong>We included 44,944 CRC-screening colonoscopies performed by 115 endoscopists, 53.4% were sex-concordant procedures. Predicted probabilities for CIR, ADR, PDR and discomfort were in male patients with male endoscopists 0.98, 0.65, 0.75, 0.01 <i>vs</i>. 0.98, 0.67, 0.77, 0.02, respectively, in male patients with female endoscopists. In female patients with female endoscopists these outcomes were 0.98, 0.54, 0.67, 0.04 <i>vs</i>. 0.98, 0.55, 0.66, 0.03, respectively, in female patients with male endoscopists.</p><p><strong>Conclusions: </strong>Although subjective discomfort scores were slightly higher for female endoscopists, both for male and female patients, our results show that endoscopist sex has a negligible impact on CRC-screening colonoscopy outcomes.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"500-506"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435184","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":"All-cause and liver-related mortality among people who inject drugs with chronic hepatitis C virus infection in Oslo, Norway.","authors":"C M Pihl, K B Malme, K Ulstein, J Hauge, Ø Backe, T Foshaug, O Dalgard, H Midgard","doi":"10.1080/00365521.2026.2636072","DOIUrl":"10.1080/00365521.2026.2636072","url":null,"abstract":"<p><strong>Background: </strong>Data on mortality among people who inject drugs with hepatitis C virus (HCV) infection remain limited, particularly in settings with a high OAT coverage. We aimed to assess all-cause and liver-related mortality and to evaluate associations between key exposures and mortality among people who inject drugs with HCV infection.</p><p><strong>Methods: </strong>We included individuals evaluated for HCV treatment in a low-threshold clinic for people who inject drugs in Oslo, Norway, between 2013-2020 and linked data to the Norwegian Cause of Death Registry. Mortality was analysed using person-time, Poisson regression models to assess crude and adjusted IRRs, and Kaplan-Meier survival curves for subgroup comparison.</p><p><strong>Results: </strong>Among 506 individuals (27.8% female, median age 49.1 years, 77.0% recent injecting drug use, 15.9% liver cirrhosis, 77.8% HCV treatment uptake), 39 (7.7%) deaths were recorded. All-cause mortality was 2.11/100 PY (95% CI 1.50-2.88). Liver-related mortality was 1.07/100 PY (95% CI 0.22-3.12) among those with liver cirrhosis and 0.16/100 PY (95% CI 0.03-0.47) overall. Drug-induced deaths accounted for the largest proportion of deaths (28.2%). HCV treatment was associated with lower all-cause mortality (adjusted IRR 0.22 [95% CI 0.06-0.76]; <i>p</i> = 002), while liver cirrhosis was associated with increased mortality (adjusted IRR = 2.78 [95% CI 1.00-7.65]; <i>p</i> = 0.049).</p><p><strong>Conclusion: </strong>Liver-related mortality among people who inject drugs with HCV cirrhosis was low. Mainly driven by drug-related deaths, all-cause mortality was higher among individuals with untreated HCV infection and among those with liver cirrhosis, underscoring the need for strategies that integrate HCV treatment with overdose prevention and access to broader healthcare.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"535-543"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435206","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":"Peptic ulcer bleeding and use of transarterial embolization at a center without on-site interventional radiologists: a retrospective cohort study.","authors":"Maria Vestergaard Jensen, Johanne Gormsen, Sarah Gierahn, Mette Astrup Tolver","doi":"10.1080/00365521.2026.2632748","DOIUrl":"10.1080/00365521.2026.2632748","url":null,"abstract":"<p><strong>Objective: </strong>To determine the incidence of rebleeding after initial endoscopic hemostasis for peptic ulcer bleeding. Furthermore, to investigate the risk factors for rebleeding, outcomes of this patient group and to assess the effect of prophylactic transarterial embolization (pTAE) in a setting without on-site interventional radiology.</p><p><strong>Material and methods: </strong>This single-center retrospective cohort study included patients treated for peptic ulcer bleeding from 2020-2023 at Zealand University Hospital, Denmark. Follow-up was one year. A high-risk subgroup was defined as patients with duodenal ulcer, hemodynamic instability, and Forrest score Ia-IIb. Mortality risk was analyzed using Kaplan-Meier estimation. Patients undergoing pTAE were transferred to a tertiary center.</p><p><strong>Results: </strong>A total of 174 patients were included. Rebleeding occurred in 28% and was associated with low BMI, smoking, duodenal ulcer, high-risk Forrest classification, and hypotension at admission. Rebleeding was linked to longer hospital stay and higher rates of adverse events, but no significant difference in mortality. The high-risk subgroup had significantly higher rebleeding rates and 90- and 365-day mortality. Ten patients (6%) underwent pTAE after initial endoscopic hemostasis with rebleeding and mortality rates equal to the non-pTAE group. Among 49 patients with rebleeding, 25% underwent pTAE after a second successful endoscopic intervention and had lower one-year mortality compared to those without pTAE (17% vs. 43%).</p><p><strong>Conclusion: </strong>Rebleeding after initial successful endoscopic hemostasis for peptic ulcer bleeding was frequent and associated with adverse clinical outcomes, but not increased mortality. Patients undergoing pTAE after rebleeding had lower mortality, but the limited number of pTAE patients precluded firm conclusions on the effect.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"507-515"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220782","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":"Cohort study of neurological and psychiatric morbidity in dermatitis herpetiformis and celiac disease.","authors":"Noora Nilsson, Teea Salmi, Merja Viikki, Johanna Palmio, Pekka Collin, Heini Huhtala, Inka Koskinen, Katri Kaukinen, Timo Reunala, Kaisa Hervonen, Camilla Pasternack","doi":"10.1080/00365521.2026.2636062","DOIUrl":"10.1080/00365521.2026.2636062","url":null,"abstract":"<p><strong>Background: </strong>Neurological and psychiatric morbidity has been associated with celiac disease but has been scarcely studied in dermatitis herpetiformis (DH), a cutaneous manifestation of celiac disease. Hence, this cohort study aimed to investigate neurological and psychiatric morbidity in patients with DH and celiac disease.</p><p><strong>Methods: </strong>The study comprised 368 DH patients and 1,072 celiac disease patients without DH and their 1,099 and 3,197 refences, matched 1:3 on age, sex, calendar period and place of residence. Their neurological and psychiatric morbidity was studied using the Care Register for Health Care and international classification of diseases codes. Hazard ratios (HR) were calculated using Cox proportional hazard model.</p><p><strong>Results: </strong>In DH the risk for any neurological disease was not statistically significantly increased (HR 1.27; 95% CI 0.94-1.71), but Alzheimer's disease and extrapyramidal diseases were found to be more common in DH when compared with their references. In contrast, in celiac disease excess risks for any neurological disease (HR 1.31; 95% CI 1.09-1.56) and particularly for migraine and headaches were detected. The risk for any psychiatric disease was found to be decreased in DH (HR 0.65; 95% CI 0.47-0.90), as were the risks for anxiety and substance abuse. In celiac disease, increased risks for any psychiatric disease (HR 1.20; 95% CI 1.01-1.42), depression, and anxiety disorders were noted.</p><p><strong>Conclusions: </strong>The neurological and psychiatric morbidity of patients with DH and celiac disease patients without DH seems to differ, but the reasons for this varying disease burden remain yet unidentified.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"479-488"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318229","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":"Anti-reflux mechanism of an enteral extended biliary stent: a computational fluid dynamics study.","authors":"Xue Fan, Xin Zhang, Dongxin Qu, Yingchun Wang, Xiue Yan, Xiangchun Lin, Xuedong Chen, Yonghui Huang","doi":"10.1080/00365521.2026.2648050","DOIUrl":"https://doi.org/10.1080/00365521.2026.2648050","url":null,"abstract":"<p><strong>Background: </strong>Enterobiliary reflux is a significant risk factor for stent occlusion following endoscopic retrograde biliary drainage. This study used computational fluid dynamics (CFD) to compare traditional plastic biliary stents (PBSs) with enteral extended biliary stents (EEBSs), aiming to explain the prolonged patency observed with EEBS from a fluid dynamics perspective.</p><p><strong>Methods: </strong>A three-dimensional digital model of the biliary tract, duodenum and the fluid domain was constructed. Using CFD, we numerically simulated fluid flow to analyze the pressure and velocity fields at the terminus of both PBS and EEBS. Flow field visualization techniques were employed to reveal the causes of reverse flow and assess the mechanisms of reflux.</p><p><strong>Findings: </strong>Simulations revealed that PBS created a counter-directional pressure gradient at its terminus. The angled flow relative to intestinal contents caused flow stagnation and vortex formation, increasing reflux risk. In contrast, EEBS extends to the distal duodenum, aligning bile flow with intestinal contents. According to Bernoulli's principle, low-velocity bile at the EEBS tip forms a high-pressure zone, which synergizes with the high-velocity, low-pressure flow in the intestinal lumen to effectively suppress reflux.</p><p><strong>Interpretation: </strong>The EEBS optimizes the flow field by extending the flow path and avoiding flow separation, which likely contributes to its prolonged patency. These findings provide a theoretical basis for designing anti-reflux stents. Future models should incorporate duodenal peristalsis to enhance physiological fidelity.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-11"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820081","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}