World Journal of Gastrointestinal Surgery最新文献

{"title":"Endoscopic anti-reflux mucosal resection for patients with gastroesophageal reflux disease: Clinical efficacy and impact on gut microbiota.","authors":"Zhe Han, Hai-Bo Jiang, Fan-Ke Wang, Zhong-Yu Wang, Hong-Fei Pang, Yuan-Yuan Wang, Ming Wei","doi":"10.4240/wjgs.v17.i6.103336","DOIUrl":"10.4240/wjgs.v17.i6.103336","url":null,"abstract":"<p><strong>Background: </strong>In recent years, endoscopic anti-reflux mucosal resection (ARMS) has demonstrated benefits, including good efficacy, ease of operation, low cost, and fewer complications; however, it is still in the exploratory stage.</p><p><strong>Aim: </strong>To evaluate the clinical efficacy of ARMS in patients with gastroesophageal reflux disease (GERD) and its effects on the gut microbiota.</p><p><strong>Methods: </strong>This single-center, retrospective, self-controlled study included 80 patients with GERD. All patients underwent endoscopic ARMS and were followed for at least 3 months after surgery. The primary outcome measures were changes in the gut microbiota before and after treatment and clinical efficacy.</p><p><strong>Results: </strong>After surgery, the counts of <i>Escherichia coli</i> and <i>Staphylococcus aureus</i> were significantly lower than those before surgery (<i>P</i> < 0.05), whereas the counts of <i>Bifidobacterium</i> and <i>Lactobacillus</i> were significantly higher than those before surgery (<i>P</i> < 0.05). Symptoms, such as reflux and heartburn, were markedly relieved postoperatively. The average Gerd Q score prior to surgery was 11.32 ± 1.26 points, which decreased to 5.89 ± 0.52 points 3 months after surgery. All patients used proton pump inhibitors before surgery, and the proportion of patients using proton pump inhibitors declined significantly postoperatively. Sixteen patients (20.0%) experienced surgery-related adverse reactions within 2 weeks to 1 month post-surgery. The incidence rates of postoperative esophageal stricture and delayed bleeding were 15.0% and 5.0%, respectively.</p><p><strong>Conclusion: </strong>Endoscopic ARMS can effectively alleviate reflux symptoms, maintain gut microbiota balance, and improve gastrointestinal function in patients with GERD.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"103336"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529756","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 sintilimab combined with nab-paclitaxel plus S-1 for neoadjuvant treatment of locally advanced gastric cancer.","authors":"Qiu-Xian Chen, Yong-Bin Zhang, Wei-Ming Zeng, Yi-Chen Cai, Chen-Bin Lv, Ming-Qiao Lian, Rong-Jie Huang, Ming-Jie Lian, Wei-Long Lian, Qian-Hui Xu, Yu-Qin Sun, Li-Sheng Cai","doi":"10.4240/wjgs.v17.i6.106361","DOIUrl":"10.4240/wjgs.v17.i6.106361","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is a leading global cause of cancer mortality, with poor survival in locally advanced stages. While immune checkpoint inhibitors (ICIs) like sintilimab have improved outcomes in advanced disease, their role as neoadjuvant therapy remains understudied. This study investigates sintilimab combined with nab-paclitaxel/S-1 as preoperative treatment for locally advanced gastric cancer (LAGC), addressing an unmet need for effective neoadjuvant strategies.</p><p><strong>Aim: </strong>To explore the efficacy and safety of combination treatment with sintilimab and nab-paclitaxel plus S-1 as neoadjuvant therapy for LAGC.</p><p><strong>Methods: </strong>Clinical data from 82 patients diagnosed with LAGC, who underwent preoperative treatment and surgery between April 2020 and December 2022, were included. Patients were divided into 2 groups according to treatment regimen: ICI (sintilimab + nab-paclitaxel + S-1; and non-ICI (nab-paclitaxel + S-1). Imaging and pathological efficacy, intra- and postoperative conditions, molecular subtypes, short-term survival outcomes, and safety were compared between the 2 groups.</p><p><strong>Results: </strong>Imaging evaluation of therapeutic efficacy revealed that the inclusion of ICI yielded a significantly higher complete response rate (13.2% <i>vs</i> 0.0%; <i>P</i> = 0.048), and objective response rate (69.8% <i>vs</i> 31.0%, <i>P</i> = 0.001) compared with non-ICI treatment. Pathological evaluation revealed that the ICI group exhibited a significantly higher pathological complete response rate (13.2% <i>vs</i> 0.0%; <i>P</i> = 0.048) and major pathological response rate (35.8% <i>vs</i> 13.8%; <i>P</i> = 0.041) than those in the non-ICI group. The two-year disease-free survival rate in the ICI group was greater than that in the non-ICI group (83.0% <i>vs</i> 55.2%; <i>P</i> = 0.043). The use of ICI did not increase the incidence of adverse reactions (47.2% <i>vs</i> 41.4%; <i>P</i> = 0.614) or perioperative adverse events (18.9% <i>vs</i> 13.8%; <i>P</i> = 0.761).</p><p><strong>Conclusion: </strong>The combination of sintilimab with nab-paclitaxel + S-1 for neoadjuvant treatment of LAGC improved efficacy in patients without increasing adverse drug reactions and perioperative adverse events, suggesting that this treatment regimen is safe and feasible.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106361"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529808","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":"Perioperative nutritional support in patients undergoing gastrointestinal surgery: Current views with an emphasis on prehabilitation efforts.","authors":"John K Triantafillidis","doi":"10.4240/wjgs.v17.i6.101244","DOIUrl":"10.4240/wjgs.v17.i6.101244","url":null,"abstract":"<p><p>Continuously increasing reports in the international medical literature, along with current guidelines from international societies, support the view that perioperative enteral nutrition (EN) and immunonutrition offer significant benefits to patients with benign and/or malignant digestive disorders, including reduction of postoperative infections and hospital stay. A vital component of the rehabilitation of patients after major gastrointestinal surgery is a comprehensive nutritional rehabilitation program. It has been shown that implementing an integrated nutritional support program significantly improves patients' immune responses, accelerates wound healing processes, reduces pain and accompanying anxiety, and decreases hospital length of stay. It appears that, in addition to the efforts of rehabilitation, prehabilitation, <i>i.e.</i> the return to the presurgery level of physical fitness, is or should be a vital objective of the team responsible for rehabilitating patients undergoing gastrointestinal surgery. The present review summarized the most up-to-date data on the role of perioperative nutritional support (EN and immune EN) in the rehabilitation and prehabilitation of patients undergoing major digestive surgery. Systematic and comprehensive perioperative nutritional support for these patients should become a daily clinical practice element of paramount importance.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"101244"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529851","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":"Application of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for patients with gastric cancer.","authors":"Jing Yu, Min Li, Xiang-Zhi Qin, Lei Gong, Long Qin, Zhen-Bing Lv, Wei Guo, Bin Huang, Yun-Hong Tian","doi":"10.4240/wjgs.v17.i6.106009","DOIUrl":"10.4240/wjgs.v17.i6.106009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;At present, the concept of surgical treatment of gastric cancer (GC) has changed from \"radical treatment\" to \"care for patients\" to a certain extent. The reconstruction method is the most likely to affect the postoperative life of the patient. Currently, the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC. However, more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure, with more reconstruction steps and longer reconstruction time, and the incidence of postoperative complications such as adhesive intestinal obstruction, internal abdominal hernia and volvulus is high. Moreover, the incidence of Roux stasis syndrome is 10%-30% after traditional Roux-en-Y reconstruction. Thus, we modified the traditional Roux-en-Y alimentary tract reconstruction, and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To evaluate the clinical advantages, feasibility, and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy (total gastrectomy) for GC were divided into two groups: fifty-four in the conventional Roux-en-Y reconstruction group (Orr group) and forty-three in the modified Roux-en-Y reconstruction group (the modified group). Perioperative and short-term outcomes were analyzed, including complications, postoperative weight loss, hemoglobin levels, and nutritional status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Orr group and the modified group showed no statistically significant differences in baseline characteristics. Compared with the Orr group, the modified group had shorter digestive tract reconstruction and operation times, less intraoperative bleeding, and shorter postoperative hospital stays compared to the Orr group. Although both groups had similar amounts of intraoperative blood loss, postoperative recovery times, and hospital expenses, the Orr group experienced longer operation times and digestive tract reconstruction times. Furthermore, the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications, with a reduced incidence of reflux esophagitis and improved nutritional status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety, simplicity, and a reduction in bile reflux. This method shortens operation times and minimizes postoperative complications, aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival. This method warran","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106009"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529735","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":"Challenges in colorectal cancer post-surgical surveillance: A critical evaluation and path forward.","authors":"Arunkumar Krishnan, Diptasree Mukherjee","doi":"10.4240/wjgs.v17.i6.106965","DOIUrl":"10.4240/wjgs.v17.i6.106965","url":null,"abstract":"<p><p>A recent study by Sala-Miquel <i>et al</i> investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer (CRC) after surgical resection. This research highlighted the significance of using computed tomography (CT), colonoscopy, and tumor markers for the early detection of recurrence or metastasis. The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients. However, the study has several limitations that must be considered. It was retrospective and conducted at a single center, which may affect the generalizability of the results. Further, the absence of a control group and the exclusion of stage IV patients limit the study's applicability. Methodological issues, including insufficient adjustment for confounding variables, a lack of sensitivity analyses, and limitations in time-dependent covariate analysis, further constrain the conclusions' robustness. Moreover, while the study emphasizes the role of CT scans, it does not adequately address their potential risks and underrepresents the importance of colonoscopy. Future research should focus on multicenter, prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management. By addressing these limitations, researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106965"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529736","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":"Computed tomography 3D reconstruction and texture analysis for evaluating the efficacy of neoadjuvant chemotherapy in advanced gastric cancer.","authors":"Chun-Ye Wang, Lei Zhang, Jing-Wei Ma","doi":"10.4240/wjgs.v17.i6.104545","DOIUrl":"10.4240/wjgs.v17.i6.104545","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) remains a significant global health challenge, with high incidence and mortality rates. Neoadjuvant chemotherapy is increasingly used to improve surgical outcomes and long-term survival in advanced cases. However, individual responses to treatment vary widely, and current imaging methods often fall short in accurately predicting efficacy. Advanced imaging techniques, such as computed tomography (CT) 3D reconstruction and texture analysis, offer potential for more precise assessment of therapeutic response.</p><p><strong>Aim: </strong>To explore the application value of CT 3D reconstruction volume change rate, texture feature analysis, and visual features in assessing the efficacy of neoadjuvant chemotherapy for advanced GC.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical and imaging data of 97 patients with advanced GC who received S-1 plus Oxaliplatin combined chemotherapy regimen neoadjuvant chemotherapy from January 2022 to March 2024. CT texture feature analysis was performed using MaZda software, and ITK-snap software was used to measure the tumor volume change rate before and after chemotherapy. CT visual features were also evaluated. Using postoperative pathological tumor regression grade (TRG) as the gold standard, the correlation between various indicators and chemotherapy efficacy was analyzed, and a predictive model was constructed and internally validated.</p><p><strong>Results: </strong>The minimum misclassification rate of texture features in venous phase CT images (7.85%) was lower than in the arterial phase (13.92%). The volume change rate in the effective chemotherapy group (75.20%) was significantly higher than in the ineffective group (41.75%). There was a strong correlation between volume change rate and TRG grade (<i>r</i> = -0.886, <i>P</i> < 0.001). Multivariate analysis showed that gastric wall peristalsis (OR = 0.286) and thickness change rate ≥ 40% (OR = 0.265) were independent predictive factors. Receiver operating characteristic curve analysis indicated that the volume change rate [area under the curve (AUC) = 0.885] was superior to the CT visual feature model (AUC = 0.795). When the cutoff value was 82.56%, the sensitivity and specificity were 85.62% and 96.45%, respectively.</p><p><strong>Conclusion: </strong>The CT 3D reconstruction volume change rate can serve as a preferred quantitative indicator for evaluating the efficacy of neoadjuvant chemotherapy in GC. Combining it with a CT visual feature predictive model can further improve the accuracy of efficacy evaluation.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"104545"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529803","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":"Role of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios in rectal cancer prognosis.","authors":"Li-Li Shao, Xiang Li, Li-Fen Wang","doi":"10.4240/wjgs.v17.i6.106813","DOIUrl":"10.4240/wjgs.v17.i6.106813","url":null,"abstract":"<p><strong>Background: </strong>An efficient index holds the potential to predict rectal cancer prognosis.</p><p><strong>Aim: </strong>To investigate the impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) on rectal cancer prognosis.</p><p><strong>Methods: </strong>This retrospective study involved 180 patients with rectal cancer from the Changzhi People's Hospital of Shanxi Province. A 2-mL blood sample was collected at 24 h preoperatively and 72 h postoperatively to measure neutrophils, lymphocytes, platelets, and monocytes using an automatic blood analyzer. Preoperative and postoperative NLR, PLR, and MLR were compared. Patients were followed up for 12 months and categorized into good and poor prognosis groups. A receiver operating characteristic curve was constructed to analyze their predictive values.</p><p><strong>Results: </strong>The NLR, PLR, and MLR values were significantly lower post-surgery (<i>P</i> < 0.05). A total of 152 and 28 patients were categorized in the good and poor prognosis groups, respectively. Patients with poor prognoses exhibited slightly higher postoperative NLR, PLR, and MLR values than those with good prognoses (<i>P</i> < 0.05). Receiver operating characteristic analysis showed that the area under the curve for NLR, PLR, and MLR was 0.828 with a sensitivity and specificity of 89.29% and 90.79%, respectively. These values were higher than individual NLR (area under the curve: 0.660, sensitivity: 67.86%, specificity: 54.61%), PLR (0.668, 75.00%, 55.30%), and MLR (0.635, 60.71%, 48.03%), all showing statistically significant differences (<i>P</i> < 0.05), effectively predicting patient outcomes.</p><p><strong>Conclusion: </strong>The findings of this study indicated that NLR, PLR, and MLR values of patients with rectal cancer can be used to effectively predict the outcome of patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106813"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529870","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":"Analysis of risk factors for post-operative infection following drug-eluting trans arterial chemo embolization in hepatocellular carcinoma: A retrospective study.","authors":"Gang Wang, Rui Qi","doi":"10.4240/wjgs.v17.i6.106276","DOIUrl":"10.4240/wjgs.v17.i6.106276","url":null,"abstract":"<p><strong>Background: </strong>Post-operative infection is a common and serious complication following drug-eluting trans arterial chemo embolization (D-TACE) in patients with hepatocellular carcinoma (HCC), potentially compromising treatment efficacy and increasing morbidity.</p><p><strong>Aim: </strong>To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE, and to provide evidence for clinical prevention and targeted intervention strategies.</p><p><strong>Methods: </strong>Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed. Patient demographics, laboratory test results, tumor characteristics, and surgery-related parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.</p><p><strong>Results: </strong>Post-operative infection occurred in 20 cases (25.97%) among the 77 patients. Univariate analysis showed that age ≥ 65 years, Child-Pugh grade B, tumor diameter ≥ 5 cm, operation time ≥ 120 minutes, preoperative albumin < 35 g/L, and comorbid diabetes were significantly associated with post-operative infection (<i>P</i> < 0.05). Multivariate logistic regression analysis identified Child-Pugh grade B (OR = 2.851, 95%CI: 1.426-5.698), operation time ≥ 120 minutes (OR = 2.367, 95%CI: 1.238-4.523), and preoperative albumin < 35 g/L (OR = 2.156, 95%CI: 1.147-4.052) as independent risk factors for post-operative infection.</p><p><strong>Conclusion: </strong>Liver function status, operation time, and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE. For high-risk patients, enhanced perioperative management, appropriate timing of surgery, and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106276"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529733","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":"Comparison between interrupted closure technique and traditional closure technique in endoscopic full-thickness resection for treating gastric subepithelial lesions.","authors":"Meng Zhang, Jiao Liu, Yun-Peng Dong, Qian Zhao, Mei-Ling Lin, Teng-Jiao Gao, Jia-Li Feng, Yi-Fei Wang, Yu-Fan Guo, Zhen Wang, Wen Jia, Zhuo Yang","doi":"10.4240/wjgs.v17.i6.106069","DOIUrl":"10.4240/wjgs.v17.i6.106069","url":null,"abstract":"<p><strong>Background: </strong>Gastric subepithelial lesions (SELs) are elevated lesions originating from the muscularis mucosa, submucosa, or muscularis propria, and may also include extraluminal lesions. For small SELs (less than 5 cm), complete endoscopic excision is the preferred treatment. Endoscopic full-thickness resection (EFTR) has proven to be an effective approach.</p><p><strong>Aim: </strong>To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.</p><p><strong>Methods: </strong>This single-center, prospective, randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024. A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group (<i>n</i> = 44) or the traditional closure group (<i>n</i> = 46).</p><p><strong>Results: </strong>All patients had complete resection and wound closure without any severe postoperative complications. The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group (2.27% <i>vs</i> 26.09%, <i>P</i> = 0.001), demonstrating interrupted closure technique can reduce the incidence of gas-related issues. Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group (15.91% <i>vs</i> 41.30%, <i>P</i> = 0.008). Additionally, the median duration of antibiotic use was lower in the experimental group (3.5 days <i>vs</i> 5 days, <i>P</i> = 0.013). Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The interrupted closure technique in EFTR for treating gastric SELs is safe and effective, reducing the incidence of intraoperative gas complications and postoperative infections.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"106069"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529801","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 dexmedetomidine-ropivacaine transversus abdominis plane block on analgesia and cognitive impairment risk in colorectal cancer surgery.","authors":"Xing Zhang, Guang-Rong Xiang, Zhi-Xin Wang, Ming-Qing Peng, Min Li","doi":"10.4240/wjgs.v17.i6.102907","DOIUrl":"10.4240/wjgs.v17.i6.102907","url":null,"abstract":"<p><strong>Background: </strong>The dexmedetomidine (DEX) plus ropivacaine treatment enables a transversus abdominis plane block (TAPB) of the peripheral nerves in patients undergoing radical resection for colorectal cancer (CRC) that can provide clinical data for improving the postoperative analgesic effect, reducing the risk of cognitive impairment, and decreasing the circulating levels of serum inflammatory factors and stress hormones.</p><p><strong>Aim: </strong>To assess the impact of DEX plus ropivacaine-enabled TAPB on pain, postoperative cognitive dysfunction (POCD), and inflammatory/stress factors.</p><p><strong>Methods: </strong>Our patient cohort was randomly divided into control and observation groups (60/group). The observation group used a DEX plus ropivacaine-enabled TAPB, while the control group employed a ropivacaine-enabled TAPB. The pain score [Visual Analogy Scale (VAS), Montreal Cognitive Assessment (MoCA)], serum inflammatory factor level (C-reactive protein, interleukin-6 and tumor necrosis factor-α), serum stress hormone levels (cortisol and adrenaline) and postoperative adverse reactions were compared between the two groups.</p><p><strong>Results: </strong>The observation group VAS scores were lower than those of the control group (better analgesic effect, <i>P</i> < 0.05). The MoCA and POCD scores decreased post-surgery in the observation group (<i>P</i> < 0.05). In the elderly, the overall VAS and MoCA scores were significantly reduced compared with the young group. The C-reactive protein, interleukin-6, tumor necrosis factor-α, cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery (<i>P</i> < 0.05). There was no significant difference in adverse reactions between the two groups post-surgery, but the incidence of adverse reactions in the observation group was still lower. DEX continuously inhibited p65-phosphorylation levels in the nuclear factor κB pathway at multiple time points, and its inhibitory effect became more significant over time.</p><p><strong>Conclusion: </strong>DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels, and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 6","pages":"102907"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529805","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}