United European Gastroenterology Journal最新文献

{"title":"The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN).","authors":"Mohammad Abu Hilal, Bas A Uijterwijk, Daniël H L Lemmers, Boris V Janssen, Marc G Besselink, Denise Bianchi, Arantza Fariña, Noriyoshi Fukushima, Anthony J Gill, Seung-Mo Hong, Alyssa Krasinskas, Claudio Luchini, Laura Melocchi, Giulio Rossi, Aldo Scarpa, Olca Basturk, Deyali Chatterjee, Angela Chou, Irene Esposito, Roger Feakins, Bas Groot Koerkamp, Ralph H Hruban, Stefano La Rosa, Chanjuan Shi, Aatur Singhi, Joanne Verheij, Huamin Wang, Sergio Alfieri, Fabio Ausania, Adnan Alseidi, Marco J Bruno, Ugo Boggi, Claudio Bnà, Christos Dervenis, Massimo Falconi, Michele Ghidini, Jakob W Kist, Giovanni Marchegiani, Michele Milella, Roberto Salvia, Ajith Siriwardena, Hanneke Wilmink, Alberto Zaniboni, Shaimaa Al-Janabi, Maia Blomhoff Holm, Eva Roos, Naoki Sano, In Hye Song, Zeynep Tarcan, Gianpaolo Balzano, Isabella Frigerio, Alfredo Guglielmi, Giuseppe Malleo, Horacio Asbun, Volkan Adsay, Caroline Verbeke","doi":"10.1002/ueg2.70074","DOIUrl":"10.1002/ueg2.70074","url":null,"abstract":"<p><strong>Importance: </strong>The lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.</p><p><strong>Objective: </strong>The PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.</p><p><strong>Design: </strong>An international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.</p><p><strong>Results: </strong>The 38 consensus questions and 51 recommendations provide guidance on the following key aspects: I. More specific anatomic criteria for the definition of what qualifies as \"ampullary\" neoplasms, their distinction from duodenal and common bile duct tumors, and clinicopathologic characteristics of anatomic subsets; II. Avoidance of the confusing term \"periampullary\" for final classification; III. Refined definitions of intestinal, pancreatobiliary and mixed subtypes, and introduction of rare histologic subtypes; IV. The use and limitations of immunohistochemical and molecular profiling; V. Biopsy acquisition; VI. Clinical information required for accurate pathology assessment of biopsies and ampullectomy specimens; VII. Key items to be included in pathology reports of endoscopic specimens.</p><p><strong>Conclusions and relevance: </strong>Recognition of the Brescia PERIPAN guidelines will allow a more accurate classification of true ampullary cancers and their differentiation from other \"periampullary\" tumors. This will have significant implications for endoscopic interpretation and management, staging, pathologic diagnosis and therapeutic evaluation as well as oncologic treatment of various anatomic and histologic subsets of ampullary tumors. This will enhance the quality of both clinical care and future research in this complex medical field.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1048-1068"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Adherence to Standard Therapy in Autoimmune Hepatitis: Impact of Steroid Use and Over-the-Counter Medications.","authors":"Ewa Wunsch, Linda Krause, Ansgar Wilhelm Lohse, Christoph Schramm, Bernd Löwe, Natalie Uhlenbusch, Romée Snijders, José Willemse, Maciej Janik, Tom J G Gevers, Piotr Milkiewicz","doi":"10.1002/ueg2.70083","DOIUrl":"10.1002/ueg2.70083","url":null,"abstract":"<p><strong>Background and aims: </strong>Non-adherence to treatment may be one of the most important causes for the failure of therapy goals in autoimmune liver diseases (AILD). We aimed to assess factors related to non-adherence in adult non-transplanted patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC).</p><p><strong>Approach and results: </strong>A cross-sectional online survey was conducted in patients with AILD who were prescribed pharmacotherapy for liver disease. Adherence was defined as skipping their medication less than once a week and never reducing or stopping their medication themselves. Sociodemographic data were analyzed relating to medication and disease-related factors in the context of adherence. Multivariable logistic regression analyses were used to identify factors associated with adherence while adjusting for known confounders. A total of 1097 patients with AILD were included: 444 patients with AIH, 377 with PBC and 276 with PSC. Patients with AIH were the most non-adherent group (47%), in comparison to those suffering from PBC (29%), and PSC (38%). In multivariable logistic regression models, over-the-counter medication use was identified as one important common factor that was negatively associated with treatment adherence in all patients and most relevant in the case of the AIH group. Among standard treatments, steroids, though not azathioprine, were negatively associated with adherence in the AIH group.</p><p><strong>Conclusions: </strong>This anonymous survey revealed high non-adherence in patients with AILD, particularly those with AIH treated with steroids. Over-the-counter medication intake may reflect low treatment confidence in standard treatments and should be carefully assessed in patients with AILD in a clinical setting.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1184-1193"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.","authors":"Lisa Sandmann, Julius F M Egge, Anja Tiede, Alena F Ehrenbauer, Martin A Kabelitz, Hannah Rieland, Jim B Mauz, Bernhard C Meyer, Heiner Wedemeyer, Karin Weissenborn, Benjamin Maasoumy","doi":"10.1002/ueg2.70095","DOIUrl":"10.1002/ueg2.70095","url":null,"abstract":"<p><strong>Background: </strong>Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS. The role of AMM in risk stratification of post-TIPS oHE is unclear.</p><p><strong>Objective: </strong>To investigate the role of AMM in the prediction of oHE in patients receiving TIPS placement.</p><p><strong>Methods: </strong>Patients with TIPS placement were recruited within a prospective observational study protocol with follow-up (FU) visits at 1, 3, 6, and 12 months after TIPS. Post hoc analyses of AMM levels for the association with the primary (oHE) and secondary endpoints (hepatic decompensation, infections, death/liver transplantation) during the first year after TIPS placement were performed.</p><p><strong>Results: </strong>Of 188 patients with TIPS placement, 148 patients with available baseline AMM levels were included. During follow-up, 37% (55/148) of patients developed oHE. In multivariable competing risk analysis, baseline AMM/ULN (HR 2.03 [CI 1.42-2.89], p = 0.001) and Freiburg index of post-TIPS survival (FIPS) score (HR 1.52 [CI 1.03-2.24], p = 0.037) were independently associated with oHE. The published cut-off AMM/ULN > 1.4 showed comparable results (HR 2.40 [CI 1.24-4.65], p = 0.01). AMM at FU1 was available in 100 patients, of whom 28% (28/100) developed oHE after FU1. In multivariable competing risk analysis, AMM/ULN (HR 5.48 [CI 2.37-12.67], p < 0.001), psychometric hepatic encephalopathy score (HR 0.86 [0.78-0.96], p = 0.005) and FIPS (HR 3.57 [CI 1.79-7.14], p < 0.001) at FU1 were independently associated with oHE after FU1. No significant association between AMM/ULN and the secondary endpoints was detected.</p><p><strong>Conclusion: </strong>AMM levels before TIPS are independently associated with oHE after TIPS placement. AMM levels may serve as an additional marker for risk stratification of patients.</p><p><strong>Trial registration: </strong>Clinical trial number NCT04801290.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1171-1183"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homologous Repair-Deficient Pancreatic Cancer: Refined Targeting of DNA Damage Response is an Effective Therapeutic Strategy.","authors":"Alica K Beutel, Christopher J Halbrook, Menar Ekizce, Jessica Lindenmayer, Elodie Roger, Sabrina E Calderon, Thomas Seufferlein, Alexander Kleger, Johann Gout, Lukas Perkhofer","doi":"10.1002/ueg2.12773","DOIUrl":"10.1002/ueg2.12773","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignancy with a high mortality rate. While up to 20% of PDAC patients harbor mutations in genes involved in homologous recombination (HR) repair, only 5% of germline BRCA1/2 mutation carriers have an approved treatment option with the PARP inhibitor (PARPi) olaparib. Characterizing HR-deficient (HRD) genotypes beyond gBRCA1/2 that are susceptible to PARPi has potential to substantially broaden the eligible patient population, and defining the optimal inhibitor may further optimize treatment strategies to advance personalized medicine in PDAC.</p><p><strong>Objective: </strong>Our previous preclinical work showed synthetic lethality of a multi-pronged DNA damage repair interference strategy using the PARPi olaparib, ATR inhibitor VE-822, and DNA-PK inhibitor CC-115 (termed PAD) in ATM deficiency. In the present study, we challenged the role of olaparib in our PAD combination and assessed the regimen's efficacy across various HRD genotypes.</p><p><strong>Methods: </strong>We assessed a spectrum of DNA damage repair-interfering drugs to identify the most potent inhibitor in HRD. Using ATM, BRCA1, BRCA2 and PALB2-defective versus HR-proficient murine PDAC cells, we systematically investigated the feasibility of expanding an optimized PAD regimen within defined HRD genotypes in vitro and in vivo. The regimen's efficacy was validated in PDAC patient-derived organoids with and without deleterious class IV/V alterations in HRD genes.</p><p><strong>Results and conclusion: </strong>Here, we demonstrate a remarkable potency of the PARPi talazoparib in HRD PDAC. Substituting olaparib, currently the only approved inhibitor in PDAC, with talazoparib in our PAD regimen enhanced its efficacy while maintaining comparable tolerability in vivo. Importantly, we show that PAD is an effective therapeutic regimen that can be extended to the most prevalent HR-defective genotypes in PDAC including ATM, BRCA1, BRCA2 and PALB2 in a preclinical setting. Collectively, these data provide a strong rationale to implement the refined regimen, talazoparib-based PAD, as a therapeutic concept tailored for HRD PDAC patients.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1328-1342"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Allied Healthcare Professionals Maybe the Answer to Upscaling Gut-Directed Hypnotherapy.","authors":"Dipesh H Vasant, Jane Boissiere, Peter J Whorwell","doi":"10.1002/ueg2.70051","DOIUrl":"10.1002/ueg2.70051","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1044-1045"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma POSTN Derived From Bile Proteome Is a Promising Biomarker for Cholangiocarcinoma With Efficacy Comparable and Complementary to CA19.9.","authors":"Lichieh Julie Chu, Chia-Jung Tsai, Chun-Chun Chien, Yung-Chin Hsiao, Jau-Song Yu, Jun-Yi Tsai, Ta-Sen Yeh","doi":"10.1002/ueg2.70054","DOIUrl":"10.1002/ueg2.70054","url":null,"abstract":"<p><strong>Background: </strong>Cholangiocarcinoma presents a global health challenge due to its increasing incidence and poor prognosis, primarily resulting from delayed diagnosis. There is an urgent need for a reliable biomarker to enhance early detection.</p><p><strong>Materials and methods: </strong>Patients with cholangiocarcinoma were enrolled into three cohorts: a discovery set (n = 6), a verification set (n = 34), and a validation set (n = 146), for seeking potential biomarkers, while patients with gallstones served as controls. Three cholangiocarcinoma transcriptome datasets from the gene expression omnibus (GEO) were analyzed. Techniques employed included liquid chromatography-tandem mass spectrometry (LC-MS/MS), multiple reaction monitoring, and enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Using a discovery set, bile proteome profiling identified 57 upregulated proteins that were either unique to cholangiocarcinoma or exhibited ≥ 2-fold changes compared to controls. The GEO transcriptome datasets yielded 48 upregulated genes consistently expressed in cholangiocarcinoma. POSTN (periostin) emerged as a viable biomarker by intersecting these two omics analyses. In the verification set, bile and plasma POSTN levels in cholangiocarcinoma were 4.7-fold and 2.1-fold higher, respectively, compared to controls. In the validation set, the sensitivity, specificity, and AUC of plasma POSTN for diagnosing cholangiocarcinoma were 78%, 85%, and 0.86, respectively, compared to 67%, 90%, and 0.86 for CA19.9. The combination of plasma POSTN and CA19.9 improved these metrics to 87%, 91%, and 0.94, respectively. Protein interactome analysis demonstrated that POSTN was predominantly connected to structural proteins of extracellular matrix (ECM). Patients with higher plasma POSTN levels exhibited higher expression of transcriptional regulators of epithelia-mesenchymal transition (EMT) and worse overall survival compared with those with lower levels.</p><p><strong>Conclusions: </strong>Plasma POSTN, derived from the bile proteome, demonstrates both comparable and complementary efficacy to CA19.9, emerging as a promising biomarker for diagnosing cholangiocarcinoma. Beyond its diagnostic capability, POSTN's role in extracellular matrix interactions and EMT regulation highlights its prognostic potential.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1155-1170"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic Shock Caused by Small Bowel Ischemia in Eosinophilic Granulomatosis With Polyangiitis.","authors":"Vlad Pavel, Patricia Mester, Florian Weber, Martina Müller, Stephan Schmid","doi":"10.1002/ueg2.70093","DOIUrl":"10.1002/ueg2.70093","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1350-1351"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of Hepatocellular Carcinoma After Liver Transplantation: The Blind Spot of HCC Management.","authors":"M Ningarhari, G Lassailly, S Dharancy, C Moreno, E Trépo","doi":"10.1002/ueg2.70078","DOIUrl":"10.1002/ueg2.70078","url":null,"abstract":"<p><p>Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) significantly impacts transplant outcomes, responsible for half of all deaths in the first 5 years after LT for HCC, with a 12-15-month median overall survival after recurrence. Recent advances in post-LT risk stratification and efficacy data of radical local treatments with curative intent support risk-adapted tailored surveillance. To date, only immunosuppressive regimen minimisation has been recognised as a potential preventive measure, although the respective roles of calcineurin inhibitor minimisation and mTOR inhibitor introduction remain inconclusive. Retrospective studies highlight the considerable heterogeneity between patients with recurrent HCC after LT in terms of timing, anatomical distribution, and applicability of treatments. Selected patients may benefit in a durable manner from local approaches with a curative intent, while tyrosine kinase inhibitors remain the first line systemic treatments. The use of immune checkpoint inhibitors is a major challenge associated with major risks of graft rejection and related mortality, that should be evaluated in prospective clinical trials. The impact on recurrent HCC of recent changes of pre-LT management, such as expanded selection criteria or the increasing use of downstaging strategies including post-ICI LT, has not been evaluated yet. Recurrent HCC after LT is a major unmet need, calling for a prospective and multicentre effort to improve outcomes for this special population.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1069-1076"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbial Signatures Associated With Clinical Remission in Inflammatory Bowel Disease Treated With Biologics: A Comprehensive Multi-Cohort Analysis.","authors":"Qingyang Zheng, Yun Zhong, Haifeng Lian, Jieru Zhuang, Lichun Wang, Jianyong Chen, Huaiming Wang, Hui Wang, Xijie Ye, Zicheng Huang, Keli Yang","doi":"10.1002/ueg2.70064","DOIUrl":"10.1002/ueg2.70064","url":null,"abstract":"<p><strong>Background and aims: </strong>The relationship between gut microbiota and biological treatment response in inflammatory bowel disease (IBD) remains incompletely understood. We sought to characterize microbial signatures associated with clinical remission and develop a prediction model for clinical remission.</p><p><strong>Methods: </strong>We analyzed 16 S rRNA gene sequencing data from two independent public cohorts (n = 231) treated with biologics (infliximab: n = 23; adalimumab: n = 22; ustekinumab: n = 186). Microbial diversity and taxonomic compositions were compared between the remission and non-remission groups. Random Forest algorithm was employed to construct a prediction model using differential genera and clinical features, with performance evaluated through cross-validation. The model was further validated in a local cohort (n = 29).</p><p><strong>Results: </strong>Significant differences in alpha and beta diversity were observed between the remission and non-remission groups (p < 0.05). MaAsLin2 analysis identified 25 differentially abundant genera (p < 0.05). Among these, we selected the top 10 genera with highest importance scores (Parabacteroides_B_862066, Agathobaculum, Ruminococcus_E, Sutterella, Clostridium_R_135822, Hominilimicola, Onthenecus, Butyricimonas, Bariatricus, Hominenteromicrobium) to build the Random Forest model, notably all enriched in remission patients. The model demonstrated robust predictive performance for clinical remission (AUC: 0.895), which was further validated in the local cohort (AUC: 0.750).</p><p><strong>Conclusion: </strong>There is a relationship between gut microbial signatures and biological treatment outcomes in IBD patients. A predictive model based on gut microbiota composition may help stratify patients for treatment response. Further investigation of microbiome modulation strategies may enhance therapeutic efficacy.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1263-1277"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study.","authors":"Mike van Dooren, Elise A J de Savornin Lohman, Jarmila van der Bilt, Marieke T de Boer, Djamila Boerma, Philip Bos, Andries E Braat, Steve M M de Castro, Bartholomeus J G A Corten, Freek Daams, Joris I Erdmann, Floris Ferenschild, Ansje S Fortuin, Nanette van Geloven, Erik van der Hoeven, Rutger Klicks, Flip M Kruyt, Barbara S Langenhoff, Mike S L Liem, Philip V M Linsen, Misha Luyer, Vincent B Nieuwenhuijs, Pim Olthof, Peter W Plaisier, Charles van Rossem, Ruud Schrauwen, Jennifer Schreinemakers, Gian Piero Serafino, Ernst Jan Spillenaar Bilgen, Koen Talsma, Merel M Tielemans, Charlotte J Tutein Nolthenius, Philip de Reuver","doi":"10.1002/ueg2.70057","DOIUrl":"10.1002/ueg2.70057","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.</p><p><strong>Methods: </strong>Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.</p><p><strong>Results: </strong>A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9-47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.</p><p><strong>Discussion: </strong>Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1133-1140"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}