World Journal of Gastrointestinal Surgery最新文献

{"title":"Gastric adenomyoma in children: A case report.","authors":"Jie Zhang, Song Sun, Shan Zheng, Yang-Yang Ma, Gong Chen","doi":"10.4240/wjgs.v17.i9.107297","DOIUrl":"10.4240/wjgs.v17.i9.107297","url":null,"abstract":"<p><strong>Background: </strong>Gastric adenomyoma (GA) in children is a relatively rare condition, and currently, there is limited knowledge regarding its optimal diagnostic methods and treatment strategies. To improve our understanding GA particularly in children, one case of a 4-month-old boy was reported and existing literature was comprehensively reviewed.</p><p><strong>Case summary: </strong>A 4-month-old boy was admitted to the hospital with a 2-month history of recurrent vomiting of gastric contents. Ultrasound examination demonstrated that the pyloric canal muscle was 3.2 mm in thickness, 14.6 mm in diameter, and 17.6 mm in length. Pathological finding showed that a mass approximately 2.8 cm × 2 cm × 1.5 cm in size and grayish-white in color was detected. The cystic wall was composed of smooth muscles lined with the gastric mucosal epithelium and a small amount of intestinal epithelium. Scattered glandular epithelium and a small amount of pancreatic tissue were observed in smooth muscle. Immunohistochemistry revealed positivity for gastrin, insulin, and smooth muscle actin, confirming the diagnosis of GA. In addition, the Ki-67 proliferation index was low.</p><p><strong>Conclusion: </strong>We report a case of GA in children, successfully treated with laparoscopic surgery. Ultrasound and computed tomography may be helpful in differential diagnosis when detecting low-density septal lesions biased toward one side. We also review the existing literature data regarding GA in children.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"107297"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of endoscopic retrograde cholangiopancreatography in the treatment of bile duct stones.","authors":"Dan-Feng Gong, Long Cheng","doi":"10.4240/wjgs.v17.i9.109270","DOIUrl":"10.4240/wjgs.v17.i9.109270","url":null,"abstract":"<p><strong>Background: </strong>The current surgical treatments for bile duct stones (BDSs) demonstrate suboptimal efficacy, warranting further exploration of superior therapies or improvement of existing surgical protocols.</p><p><strong>Aim: </strong>To assess the therapeutic efficacy and safety profiles of endoscopic retrograde cholangiopancreatography (ERCP) <i>vs</i> common bile duct exploration (CBDE) in BDS treatment.</p><p><strong>Methods: </strong>This study enrolled 103 consecutive patients with BDSs treated at the First People's Hospital of Changde from January 2024 to January 2025, with 53 patients undergoing ERCP (ERCP group) and 50 receiving conventional CBDE (CBDE group). Comprehensive comparative analyses were conducted across multiple parameters, including clinical efficacy, surgical success rate, safety (bile leakage incidence, surgical site infection, acute pancreatitis, and acute cholangitis), postoperative biochemical markers (total bilirubin and serum amylase), surgery-related metrics (stone removal time, procedure duration, intraoperative blood loss, and hospitalization time), and postoperative recovery indicators (time to intestinal recovery, jaundice resolution, biliary drainage removal, and postoperative activity recovery).</p><p><strong>Results: </strong>The ERCP group demonstrated markedly superior overall efficacy than the CBDE group, with similar surgical success rates and comparable stone removal durations. Importantly, patients undergoing ERCP experienced fewer complications overall, required less operative time, had minimal intraoperative blood loss, and needed shorter hospitalization periods. Recovery parameters such as bowel function recovery, jaundice resolution, biliary stent removal, and normal activity resumption, were significantly improved in the ERCP group. Both groups demonstrated substantial postoperative reductions in total bilirubin and amylase, with no significant intergroup differences.</p><p><strong>Conclusion: </strong>ERCP demonstrates effectiveness and safety in managing BDSs, thereby providing notable clinical benefits that support its broader implementation in medical practice.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"109270"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer.","authors":"Liu-Liu Wei, Yue-Liang Lai, Kang-Hua Qiu, Xin He, Tao Yang","doi":"10.4240/wjgs.v17.i9.106995","DOIUrl":"10.4240/wjgs.v17.i9.106995","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer. Despite the increased risk of pulmonary complications, such as pleural effusion and pulmonary infection, postoperative recovery time and survival outcomes are similar to younger patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To investigate the safety and efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer by comparing treatment-related complications, surgical outcomes, and long-term survival between elderly patients (≥ 65 years) and younger patients (&lt; 65 years).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of 148 patients with advanced gastric cancer in elderly patients who received neoadjuvant chemotherapy in our hospital from January 2015 to October 2023 were retrospectively analyzed, and these patients were divided into young and middle-aged groups (111 patients) and elderly groups (37 patients), and their clinicopathology and prognosis were compared.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Neoadjuvant chemotherapy induced anemia (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.235, &lt;i&gt;P&lt;/i&gt; = 0.628), leukopenia (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.613, &lt;i&gt;P&lt;/i&gt; = 0.434), neutropenia (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.011, &lt;i&gt;P&lt;/i&gt; = 0.918) and thrombocytopenia (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.253, &lt;i&gt;P&lt;/i&gt; = 0.628) in both groups. Hematological complications, nausea (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.092, &lt;i&gt;P&lt;/i&gt; = 0.762), vomiting (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.166, &lt;i&gt;P&lt;/i&gt; = 0.683), diarrhea (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.015, &lt;i&gt;P&lt;/i&gt; = 0.902) and mucositis (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.199), and there was no significant difference in the incidence of nonhematological complications (&lt;i&gt;P&lt;/i&gt; = 0.766). Between the old group and the young and middle-aged groups, no significant differences were observed in operative time (&lt;i&gt;t&lt;/i&gt; = 0.270, &lt;i&gt;P&lt;/i&gt; = 0.604), intraoperative blood loss (&lt;i&gt;t&lt;/i&gt; = 1.140, &lt;i&gt;P&lt;/i&gt; = 0.250), or R0 removal rate (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0.105, &lt;i&gt;P&lt;/i&gt; = 0.750). Although the incidence of postoperative complications was higher in the old group (37.8%) compared to the young and middle-aged groups (25.2%), this difference did not reach statistical significance (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 2.172, &lt;i&gt;P&lt;/i&gt; = 0.141). However, the elderly group demonstrated significantly higher incidences of pleural effusion (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 7.007, &lt;i&gt;P&lt;/i&gt; = 0.008) and pulmonary infection (&lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 10.204, &lt;i&gt;P&lt;/i&gt; = 0.001) than the young and middle-aged groups. When examining survival outcomes, neither the 3-year progression-free survival (&lt;i&gt;t&lt;/i&gt; = 0.494, &lt;i&gt;P&lt;/i&gt; = 0.482) nor the 3-year overall survival (&lt;i&gt;t&lt;/i&gt; = 0.013, &lt;i&gt;P&lt;/i&gt; = 0.908) showed significant differences between the elderly group and the young and middle-aged groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Neoadjuvant chemotherapy combined with radical gastrectomy is safe and effective i","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"106995"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exocrine pancreatic insufficiency and quality of life after oncologic gastric surgery: Evaluation from a single tertiary center.","authors":"Claudio Fiorillo, Sergio Alfieri, Beatrice Biffoni, Lodovica Langellotti, Chiara Lucinato, Giuseppe Massimiani, Roberta Menghi, Davide De Sio, Maria C Puzzangara, Fausto Rosa, Vanessa Gentili, Elisabetta Gambaro, Vincenzo Tondolo, Giuseppe Quero","doi":"10.4240/wjgs.v17.i9.107789","DOIUrl":"10.4240/wjgs.v17.i9.107789","url":null,"abstract":"<p><strong>Background: </strong>Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency (EPI). However, limited data are available regarding the incidence and impact of EPI on quality of life (QoL) following gastric surgery.</p><p><strong>Aim: </strong>To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.</p><p><strong>Methods: </strong>EPI was assessed using fecal elastase measurement and classified into: (1) No-EPI (fecal elastase > 200 μg/g); (2) Moderate EPI (fecal elastase 100-200 μg/g); and (3) severe EPI (fecal elastase < 100 μg/g). QoL was measured using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire.</p><p><strong>Results: </strong>Sixteen out of 44 (36.4%) patients developed EPI post-operatively: 9 (56.2%) patients had moderate EPI while 7 (43.8%) patients had severe EPI. Severe EPI was more frequently observed in younger patients (5/7: 71.4%; <i>P</i> = 0.05), in more advanced disease stages (7/7: 100%; <i>P</i> = 0.05), lymph nodes metastases (7/7: 100%; <i>P</i> = 0.04) and in the mixed histotypes (4/7: 66.7%; <i>P</i> = 0.02) compared to the no-EPI and moderate EPI groups. QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score [65 (59-92)] compared to the no-EPI/moderate EPI groups [89 (84-100)] (<i>P</i> = 0.002). Lower scores were particularly evident in the core (<i>P</i> < 0.0001) and disease-specific symptoms domains (<i>P</i> = 0.002) in the severe EPI group compared to the no-EPI/moderate EPI groups.</p><p><strong>Conclusion: </strong>Gastrectomy is a cause of EPI. Younger patients, aggressive disease and advanced stages are significant risk factors for more severe EPI. Severe EPI worsens QoL, being associated with a higher rate of gastrointestinal symptoms.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"107789"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of predictive factors for delayed hemorrhage after endoscopic submucosal dissection in early-stage gastric carcinoma.","authors":"Shou-Yuan Xu, Qi-Feng Lou, Ai-Yu Yu, Yu-Feng Tong, Qi Ding","doi":"10.4240/wjgs.v17.i9.109159","DOIUrl":"10.4240/wjgs.v17.i9.109159","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) remains a substantial global health burden, and its early detection and treatment is critical for optimizing patient outcomes. Endoscopic submucosal dissection (ESD) is a minimally invasive technique for early GC but is linked to an increased risk of complications, such as delayed hemorrhage, which underscore the need for a comprehensive investigation into the disease's risk factors.</p><p><strong>Aim: </strong>To perform a comprehensive review and meta-analysis of the literature to identify and quantify risk factors associated with late-onset bleeding subsequent to ESD for early GC.</p><p><strong>Methods: </strong>Studies reporting risk factors for delayed bleeding after ESD for early GC were identified through a comprehensive search of electronic databases (PubMed, Embase, and Cochrane Library). The selection of studies, data retrieval, and quality evaluation were carried out separately by two reviewers. The combined odds ratios (OR) along with their 95% confidence intervals (CI) were calculated utilizing a random-effects approach. The meta-analysis has been registered on the International Registry of Systematic Review and Meta-analysis Protocols (INPLASY202540116).</p><p><strong>Results: </strong>A total of 11 publications comprising 1945 patients were incorporated into the present analysis. The following risk factors were found to be significantly associated with an increased risk of delayed bleeding after ESD: Long operation time (OR = 2.55, 95%CI: 2.40-2.72, <i>I</i>² = 11%, <i>n</i> = 5 studies), lesions detected in the upper part of the stomach (OR = 3.44, 95%CI: 3.19-3.70, <i>I</i>² = 0%, <i>n</i> = 4 studies), advanced age (OR = 3.61, 95%CI: 3.47-3.76, <i>I</i>² = 38%, <i>n</i> = 5 studies), history of taking antithrombotic drugs (OR = 2.58, 95%CI: 2.48-2.68, <i>I</i>² = 45%, <i>n</i> = 3 studies), resection size > 40 mm (OR = 3.01, 95%CI: 2.78-3.26, <i>I</i>² = 31%, <i>n</i> = 5 studies), hemodialysis (OR = 2.42, 95%CI: 2.33-2.51, <i>I</i>² = 0%, <i>n</i> = 4 studies), presence of ulcers (OR = 2.54, 95%CI: 2.33-2.77, <i>I</i>² = 0%, <i>n</i> = 3 studies).</p><p><strong>Conclusion: </strong>This meta-analysis identified several risk factors associated with an increased probability of delayed bleeding after ESD for early GC, including long operation time, lesions in the upper stomach, advanced age, antithrombotic drug use, large resection size, hemodialysis, and the presence of ulcers.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"109159"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of comorbid gastroesophageal reflux disease on laryngopharyngeal reflux disease: Clinical characteristics and risk factors.","authors":"Dan-Dan Xu","doi":"10.4240/wjgs.v17.i9.108715","DOIUrl":"10.4240/wjgs.v17.i9.108715","url":null,"abstract":"<p><strong>Background: </strong>Research thoroughly examining how gastroesophageal reflux disease (GERD) affects clinical presentations in patients with laryngopharyngeal reflux disease (LPRD) and exploring the associated triggers is limited.</p><p><strong>Aim: </strong>To investigate the effect of comorbid GERD on the clinical characteristics of patients with LPRD and determine risk contributors.</p><p><strong>Methods: </strong>In total, 150 patients with LPRD admitted between October 2022 and October 2024 were divided into the GERD (<i>n</i> = 74) or non-GERD (<i>n</i> = 76) group based on their comorbid GERD status. The clinical data collected included age, sex, body mass index (BMI), marital status, smoking, alcohol consumption, and eating habits in the 3-hour window before sleep. The following reflux-related symptoms were recorded: (1) Hoarseness/voice disorders; (2) Persistent throat clearing; (3) Excessive phlegm/postnasal drip; (4) Difficulty swallowing food or water; (5) Postprandial or supine coughing; (6) Breathing difficulties; (7) Bothersome cough; (8) Throat foreign body sensation; (9) Heartburn, chest pain; and (10) Stomach pain. The Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) tools were used. Binary logistic regression identified contributors to GERD in LPRD.</p><p><strong>Results: </strong>Compared with the non-GERD group, the GERD group, with a notably higher BMI, included greater proportions of older patients, female patients, smokers, and alcohol users and a higher prevalence of bothersome cough, heartburn, chest pain, and stomach pain; however, excessive phlegm or postnasal drip was less common. Additionally, patients with LPRD and comorbid GERD had notably higher RSI and RFS scores. Age (<i>P</i> = 0.017), sex (<i>P</i> = 0.029), smoking (<i>P</i> = 0.012), and alcohol consumption (<i>P</i> = 0.036) were significant triggers for GERD comorbidity in LPRD.</p><p><strong>Conclusion: </strong>Comorbid GERD exacerbates clinical manifestations of patients with LPRD. Advanced age, female sex, smoking, and alcohol consumption predispose patients with LPRD to GERD development.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"108715"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of stellate ganglion block anesthesia on cognition and biomarkers in patients undergoing gastrointestinal surgery.","authors":"Ming-Min Yang, Wei Tu, Xue Yan","doi":"10.4240/wjgs.v17.i9.106913","DOIUrl":"10.4240/wjgs.v17.i9.106913","url":null,"abstract":"<p><strong>Background: </strong>Surgery is a common treatment for gastrointestinal tumors. General anesthesia (GA), while effective, can cause oxidative stress reactions and neuroinflammation, potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction. The stellate ganglion block (SGB) can reduce sympathetic excitability and stress responses. This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.</p><p><strong>Aim: </strong>To analyze the effects of SGB plus GA on hemodynamic stability, oxidative stress, neuroinflammation, cognitive function, and gastrointestinal function in patients undergoing gastrointestinal surgery.</p><p><strong>Methods: </strong>Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups: A single GA group and an SGB combined with GA group (40 patients each). Hemodynamics, oxidative stress response, laboratory indices, cognitive function, and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups. Pain levels and complications were also recorded.</p><p><strong>Results: </strong>Before anesthesia induction, no significant differences were found in various indexes (including hemodynamics, oxidative stress indicators, laboratory indices, cognitive function scores, and gastrointestinal function indicators) between the two groups (<i>P</i> > 0.05). At tracheal intubation, 3 minutes after, and extubation, the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group (<i>P</i> < 0.05). Twenty-four hours postoperatively, oxidative stress indicators (malondialdehyde and nitric oxide) were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group (<i>P</i> < 0.05). Cognitive function scores [Mini-Mental State Examination and Montreal Cognitive Assessment (MoCA)] and gastrointestinal function indicators (motilin) were also significantly better in the SGB-GA combined group (<i>P</i> < 0.05). The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group. No significant differences were found in the time of first postoperative ambulation, catheter removal time, and 24-hour postoperative pain between groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Combining SGB with GA can maintain perioperative hemodynamic stability, reduce oxidative stress and neuroinflammatory injury, and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"106913"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of preoperative immunonutrition <i>vs</i> standard oral nutrition in patients undergoing colorectal surgery: A randomized controlled trial.","authors":"Manivaasan Pannirselvam, Zaidi Zakaria, Michael Pak-Kai Wong, Mohd Hady Shukri Abdul Satar, Nor Syarahani Jusoh, Andee Dzulkarnaen Zakaria, Muhammad Faeid Othman","doi":"10.4240/wjgs.v17.i9.108127","DOIUrl":"10.4240/wjgs.v17.i9.108127","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery. Nonetheless, the advantages of preoperative immunonutrition remain controversial.</p><p><strong>Aim: </strong>To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.</p><p><strong>Methods: </strong>This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024. In this study, the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients. Meanwhile, a conventional oral nutrition supplement was provided to the control group. The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded. Incidence of nosocomial infections, surgical site infections, and the total length of hospital stay were considered secondary data.</p><p><strong>Results: </strong>This study involved 58 patients who were allocated into two groups. No dropouts were documented. The mean age of the participants was 61.20 ± 12.96, and most were males (63.38%). All participants' baseline and surgical characteristics in both arms were also generally comparable. The participants in this study underwent colorectal surgery, where most had laparoscopic surgery (58%). Based on the results, no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation, the onset of a normal diet, and hospital stay between the experimental and control groups. Both groups also recorded 10 (17.24%) infectious complications.</p><p><strong>Conclusion: </strong>The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients. Conclusively, routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"108127"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remimazolam reduces State-Trait Anxiety Inventory-State Scale scores in hemorrhoid surgery with spinal-epidural anesthesia: A randomized trial.","authors":"Tao Hu, Qian Huang, Lai Wei, Shi Zhong, Jing Wang","doi":"10.4240/wjgs.v17.i9.110034","DOIUrl":"10.4240/wjgs.v17.i9.110034","url":null,"abstract":"<p><strong>Background: </strong>In the field of anesthesia for procedure for prolapse and hemorrhoids (PPH) surgery, combined spinal-epidural (CSE) anesthesia has been a common approach. However, exploring new combinations to optimize patient outcomes remains crucial. Remimazolam, a short-acting benzodiazepine, shows potential for improving sedation and reducing patient anxiety. The effects of combining remimazolam with CSE anesthesia, compared to traditional CSE anesthesia alone, on patient anxiety, sedation depth, and hemodynamics during PPH surgery have not been fully elucidated.</p><p><strong>Aim: </strong>To compare remimazolam-CSE <i>vs</i> CSE alone on State-Trait Anxiety Inventory-State scale (STAI-S) scores, sedation, and hemodynamics in PPH surgery.</p><p><strong>Methods: </strong>This study is a single-center, prospective, randomized controlled trial. Between November 23, 2022, and August 6, 2024, 60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group (30 patients each). STAI-S scores, Ramsay sedation scores, and hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate) were measured at multiple time points. Two-way mixed-effects ANOVA and <i>post-hoc</i> analyses were performed.</p><p><strong>Results: </strong>The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room [mean: 28.80 <i>vs</i> 54.03, mean difference (95%CI): 25.23 (21.24-29.23), <i>P</i> < 0.001] and 24 hours post-operation [mean: 45.07 <i>vs</i> 54.53, mean difference (95%CI): 9.47 (6.29-12.64), <i>P</i> < 0.001] than the CSE group. Moreover, the Combined group achieved a deeper sedation level during intraoperative maintenance [median: 5.00 (IQR: 5.00-5.00) <i>vs</i> 2.00 (IQR: 2.00-2.00); median difference (95%CI): 3.00 (3.00-3.00), <i>P</i> < 0.001]. Regarding hemodynamics, a significant inter-group difference in systolic blood pressure was observed at the start of the surgery [mean: 128.8 <i>vs</i> 114.7 for the Combined and CSE groups, mean difference (95%CI): 14.17 (0.77-27.57), adjusted <i>P</i> = 0.033].</p><p><strong>Conclusion: </strong>Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores, enhancing intraoperative sedation, and stabilizing systolic blood pressure at a critical stage, indicating its superiority in perioperative management.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"110034"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsatellite instability and its impact on nutritional and inflammatory profiles in colorectal cancer.","authors":"Hong-Da Qu, Xue Gao, Ping Xiao, Yan Jiao","doi":"10.4240/wjgs.v17.i9.108215","DOIUrl":"10.4240/wjgs.v17.i9.108215","url":null,"abstract":"<p><p>Microsatellite instability (MSI) is a critical molecular feature in colorectal cancer (CRC) that not only determines response to immunotherapy but also influences systemic nutritional and inflammatory status. MSI-high (MSI-H) CRC is characterized by heightened systemic inflammation, altered cytokine profiles, and unique gut microbiota compositions. Concurrently, MSI-H patients often exhibit poorer nutritional status, as reflected by lower body mass index, decreased serum albumin, and metabolic dysregulation. These immunonutritional alterations influence patient outcomes by affecting prognosis, response to therapy, and overall survival. This editorial summarizes current evidence linking MSI status with inflammatory and nutritional markers, highlighting the clinical implications of integrating nutritional assessment and inflammatory modulation into the maagement of CRC patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 9","pages":"108215"},"PeriodicalIF":1.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}