Therapeutic Advances in Gastroenterology最新文献

{"title":"Comment on: Continuous versus intermittent anticoagulation during endoscopic treatment of esophageal varices in cirrhosis: a randomized controlled trial.","authors":"Janis Fernandes, Sanchit Sharma, Rohit Gupta","doi":"10.1177/17562848261463425","DOIUrl":"10.1177/17562848261463425","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261463425"},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International collaborative experiences in managing pyoderma gangrenosum in patients with inflammatory bowel disease.","authors":"Jan Guse, Andreas Blesl, Philip Esters, Katja Matthes, Renate Schmelz, Carsten Schmidt, Julia Wanzl, Elisabeth Schnoy, Niels Teich, Viktoria Hentschel, Andreas Stallmach, Jessica Rueddel, Kathleen Lange","doi":"10.1177/17562848261461012","DOIUrl":"10.1177/17562848261461012","url":null,"abstract":"<p><p>Pyoderma gangrenosum (PG) is a rare but challenging extraintestinal manifestation (EIM) of inflammatory bowel diseases (IBD), affecting 6%-48% of IBD patients. This retrospective study analyzed affected patients and evaluated therapeutic strategies for both IBD remission and PG resolution. A multicenter retrospective analysis was conducted on patients with IBD and PG in eight tertiary IBD centers. Demographic data, prior therapies, surgeries, and treatment of PG were collected retrospectively, and treatment responses were assessed. The cohort included 50 patients (median age: 43 years; 68% female). Crohn's disease was present in 58% and ulcerative colitis in 42%. Fifty percent of patients had prior surgery, 68% had an intestinal stoma in their medical history. 48% were experienced with biologic therapy, predominantly anti-tumor necrosis factor (TNF) therapy (83%). PG mainly affected the lower extremities (52%) and peristomal areas (24%). Systemic steroids were used in 52% (26/50) and led to PG resolution in only 11.5% (3/26). Anti-TNF therapy was the main approach, used in 68% (34/50) of patients, with resolution achieved in 80% (27/34). Calcineurin inhibitors were given to 26% (13/50) of patients and induced resolution in 38% (5/13). Three of six non-responders were successfully switched to infliximab. Overall, PG resolution was achieved in 80% (40/50), correlating with IBD remission in 78% (31/40) of these patients. The median time to PG resolution was 4 months. Anti-TNF therapy was an effective treatment for PG in IBD patients, even in those with prior nonresponse to calcineurin inhibitors. Systemic steroids showed low response rates. PG healing mostly aligned with IBD remission, underlining the need for tailored long-term therapy.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261461012"},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib for anti-TNFα refractory immune checkpoint inhibitor-induced colitis: a case report.","authors":"Grigorios Petrousis, Charlotte R H Hedin, Stephan L Haas, Hans Strid, Francesca Bresso, Katarina Bilén","doi":"10.1177/17562848261458694","DOIUrl":"10.1177/17562848261458694","url":null,"abstract":"<p><p>Although immune checkpoint inhibitors have revolutionized oncologic therapy, they are frequently associated with a wide spectrum of immune-related adverse events, most notably immune-mediated colitis (ImC). For cases of moderate-to-severe colitis, treatment typically involves corticosteroids with escalation to biologic agents such as infliximab or vedolizumab when necessary. However, treatment-refractory cases remain a major clinical challenge. We report the case of a 52-year-old woman with triple-negative breast cancer who developed severe ImC after pembrolizumab therapy. Despite high-dose corticosteroids and infliximab, her condition remained refractory. Initiation of upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, led to rapid clinical improvement and complete endoscopic remission of the colitis. This report highlights the therapeutic potential of upadacitinib against ImC, while also analysing the possible twofold role of JAK1-inhibitors in enhancing antitumour therapy efficacy and limiting the potential immune-related adverse events.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261458694"},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified colonoscopy outcomes and referral-factor associations in the Swedish colorectal cancer fast-track pathway: a retrospective cohort study.","authors":"Abdullah Jajan, Michiel van Nieuwenhoven","doi":"10.1177/17562848261460138","DOIUrl":"10.1177/17562848261460138","url":null,"abstract":"<p><strong>Background: </strong>The standardised course of care colorectal cancer pathway (SCC-CRC) is a symptom-based fast-track diagnostic pathway. Age-related differences in outcomes and referral-factor associations within different age groups are incompletely described.</p><p><strong>Objective: </strong>To describe colonoscopy outcomes across age groups in SCC-CRC and evaluate unadjusted and adjusted associations between referral factors and CRC and advanced colorectal lesions.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Methods: </strong>A cohort of 3258 patients referred through SCC-CRC and investigated with colonoscopy during 2016-2023 was grouped by age (18-40, 41-50, 51-60, 61-70, 71-80, >80 years). Referral factors were analysed using positive predictive value (PPVs), sensitivity, specificity, likelihood ratios and logistic regression adjusted for age, sex and coexisting referral factors; a second model included faecal immunochemical test (FIT) among patients with available FIT data.™.</p><p><strong>Results: </strong>CRC was detected in 0% of patients aged 18-40, 6.5% aged 41-50, 11.2% aged 51-60, 18.3% aged 61-70, 18.1% aged 71-80 and 21.2% aged >80. The frequency of referral factors varied across age groups, while the PPV for CRC increased with age. Rectal and radiological findings were associated with CRC across age groups. In adjusted analysis without FIT, radiological findings, rectal findings, anaemia and visible blood were independently associated with CRC. Among patients with FIT data, positive FIT was strongly associated with CRC and negative FIT had a high negative predictive value.</p><p><strong>Conclusion: </strong>CRC detection increased with age in this symptomatic cohort. Several referral factors were independently associated with CRC, but PPV increased with age, partly because CRC prevalence increased with age. Routine FIT testing in SCC-CRC referrals and complete FIT data capture should be assessed in future studies.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261460138"},"PeriodicalIF":3.8,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of enteroscopy in the diagnosis and interventional management of small intestine diseases.","authors":"Beata Huszcza, Karolina Grabowska, Tomasz Romańczyk, Ewa Małecka-Wojciesko","doi":"10.1177/17562848261454545","DOIUrl":"10.1177/17562848261454545","url":null,"abstract":"<p><p>Evaluation of the small intestine is technically difficult because of its length and anatomy. Capsule endoscopy and device-assisted enteroscopy (DAE) have expanded diagnostic and therapeutic options in recent years. This narrative review summarizes the current indications, therapeutic procedures, safety, and role of enteroscopy compared with other small bowel imaging methods. A literature search was performed in the MEDLINE database covering publications from February 2001 to February 2025, using predefined inclusion and exclusion criteria. The main indications include small intestinal bleeding, inflammatory bowel diseases such as ulcerative colitis and Crohn's disease, celiac disease, and tumors of the small intestine. Enteroscopy allows identification of bleeding sources, assessment of disease extent and complications, and detection of neoplastic lesions. Capsule endoscopy is usually the first test performed because it is less invasive. However, DAE allows tissue sampling and therapeutic intervention if abnormalities are detected. It can also be useful in cases where non-invasive imaging is inconclusive. The main therapeutic procedures include hemostasis, balloon dilation of short symptomatic strictures, polypectomy, and foreign body removal. Balloon dilation is recommended for selected benign strictures and may reduce the need for surgery. Enteroscopy is considered a safe procedure. The overall risk of complications ranges from 0.4% to 5.5% for both double-balloon and single-balloon enteroscopy, with no significant difference between them. Major adverse events, including perforation, pancreatitis, and bleeding, are uncommon and generally do not exceed 3%. The risk is higher in therapeutic interventions. Elderly patients are more likely to experience sedation-related side effects, including aspiration and hypoxia. Despite its advantages, enteroscopy remains technically demanding and mostly available in specialized centers. Further standardization and wider availability are needed.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261454545"},"PeriodicalIF":3.8,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of celiac disease on the clinical course of inflammatory bowel disease: CEL_EII study by GETECCU.","authors":"Inmaculada Alonso-Abreu, Laura Ramos, Alejandro Hernandez-Camba, Carmen Yagüe-Caballero, Raquel Vicente Lidón, Carlos Taxonera, Miguel A García-Brenes, Javier P Gisbert, Maria Chaparro, Lucia Madero Velázquez, Marta Carrillo-Palau, Laura Arranz, Beatriz Castro Senosiain, Irene García de la Filia Molina, María Rojas-Feria, Francisco López Romero-Salazar, Iria Bastón-Rey, María Sánchez-Azofra, Sabino Riestra, Pablo Pérez-Galindo, Silvia Patricia Ortega Moya, Eduard Brunet-Mas, Patricia Sanz Segura, Antonio M Caballero Mateos, Margalida Calafat, Belén Botella Mateu, Noemí Manceñido Marcos, Iago Rodríguez-Lago, Cristina Suarez Ferrer, Ana Gutiérrez","doi":"10.1177/17562848261452511","DOIUrl":"10.1177/17562848261452511","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) and celiac disease (CeD) are immune-mediated digestive disorders with shared genetic, immunological, and environmental risk factors.</p><p><strong>Objectives: </strong>This study aimed to assess whether the coexistence of CeD and IBD is associated with a differential IBD disease course.</p><p><strong>Design: </strong>Multicenter case-control study.</p><p><strong>Methods: </strong>This study included patients with both CeD and IBD, and controls with IBD alone in a 1:2 ratio, matched by sex, IBD type, and year of diagnosis. CeD was diagnosed based on a Marsh score >1. Data on IBD phenotype and treatment, mortality and neoplasm development were collected from medical records.</p><p><strong>Results: </strong>The study included 66 celiac-IBD patients (30 ulcerative colitis, 6 indeterminate colitis, 30 Crohn's disease; mean age 30 ± 14 years) and 132 non-celiac-IBD patients (68 ulcerative colitis, 4 indeterminate colitis, 60 Crohn's disease; mean age 32 ± 14 years). Among patients with CeD, Marsh type 3 was the most frequently observed lesion. No significant differences were observed between celiac and non-celiac-IBD patients in terms of IBD extension, extraintestinal manifestations, or coexisting autoimmune diseases. Similarly, no differences were found in outcomes including perianal disease, use of mesalamine, immunomodulators, biologics, need for surgery, or development of neoplasms. No deaths occurred in either group.</p><p><strong>Conclusion: </strong>In this large multicenter cohort, the concurrent diagnosis of CeD and patients with IBD was not associated with a different IBD phenotype or worse outcomes compared to non-celiac-IBD patients. The coexistence of CeD does not appear to alter the natural history of IBD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261452511"},"PeriodicalIF":3.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of wet suction on specimen quality and diagnostic accuracy in EUS-guided tissue acquisition: a systematic review and meta-analysis of randomized controlled trials.","authors":"Po-Feng Huang, Jung-Chun Lin, Tien-Yu Huang, Peng-Jen Chen, Chi-Wei Yang, Yu-Ting Kuo, Hsuan-Wei Chen","doi":"10.1177/17562848261458692","DOIUrl":"10.1177/17562848261458692","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is critical for diagnosing solid lesions. The wet-suction technique, which pre-fills the needle lumen with saline, has been proposed to improve specimen quality compared with conventional dry suction. This study aimed to evaluate the efficacy of wet suction versus dry suction in EUS-TA.</p><p><strong>Objectives: </strong>This study aimed to evaluate the efficacy of wet suction versus dry suction in EUS-TA.</p><p><strong>Design: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA 2020 guidelines.</p><p><strong>Methods: </strong>Electronic searches of PubMed, Embase, Cochrane CENTRAL, and additional databases were performed through January 2025. Primary outcomes were blood contamination, cellularity, and integrity scores; secondary outcomes were diagnostic accuracy and specimen adequacy. Effect sizes were calculated using Hedges' <i>g</i> or risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Seven RCTs (784 patients; 1566 specimens) were included. Wet suction significantly reduced blood contamination (Hedges' <i>g</i> = 0.289, 95% CI: 0.178-0.401, <i>p</i> < 0.0001) and improved cellularity (Hedges' <i>g</i> = 0.420, 95% CI: 0.241-0.599, <i>p</i> < 0.0001) with low heterogeneity. Integrity score showed no significant difference (<i>p</i> = 0.054). Overall diagnostic accuracy was similar between techniques (RR = 1.025, <i>p</i> = 0.548), but subgroup analysis revealed higher accuracy for wet suction in EUS-fine needle aspiration (FNA; RR = 1.162, <i>p</i> = 0.001). Specimen adequacy did not differ significantly (<i>p</i> = 0.074).</p><p><strong>Conclusion: </strong>Wet suction improves sample quality by reducing blood contamination and increasing cellularity, with potential diagnostic benefit in FNA procedures. Effects on integrity and adequacy remain inconclusive. Larger, standardized trials are warranted to confirm these findings.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261458692"},"PeriodicalIF":3.8,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary research on the effectiveness and safety of metal clip-assisted endoscopic variceal ligation in the treatment of gastric varices.","authors":"Wang Yi, Li Xiuling, Ding Hui, Li Zhenjuan, Li Jiaxin, Quan Runzhao","doi":"10.1177/17562848261453281","DOIUrl":"10.1177/17562848261453281","url":null,"abstract":"<p><strong>Background: </strong>Gastric variceal bleeding is a common and serious complication of liver cirrhosis and carries a high mortality. Endoscopic variceal ligation (EVL) is widely used, but its efficacy for gastric varices is limited by incomplete variceal capture and a high rate of post-ligation rebleeding.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of metal clip-assisted endoscopic variceal ligation (MEVL) versus traditional ligation (TL) in adults with cirrhotic gastric varices.</p><p><strong>Design: </strong>Single-center retrospective observational cohort study, reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement.</p><p><strong>Methods: </strong>Adults with cirrhosis and gastroesophageal (gastroesophageal varices)-type varices undergoing elective ligation for primary or secondary prophylaxis at Henan Provincial People's Hospital between May 2019 and December 2023 were included; emergency endoscopies were excluded. Non-selective beta-blocker co-therapy was standardized. Baseline imbalance was addressed by propensity score matching and inverse probability of treatment weighting (IPTW), pre-specified as the primary balancing method. Multivariable logistic regression, Cox proportional hazards modeling, and post hoc power were computed in SPSS 26 and Python 3.11.</p><p><strong>Results: </strong>Ninety-nine patients were analyzed (MEVL <i>n</i> = 46; TL <i>n</i> = 53) with comparable baseline characteristics. One-session eradication was achieved in 33 of 46 MEVL patients (71.7%) compared with 26 of 53 TL patients (49.1%), favoring MEVL after IPTW adjustment (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.03-6.27; <i>p</i> = 0.042) and on Cox regression (adjusted hazard ratio 1.53, 95% CI 1.00-2.35; <i>p</i> = 0.049). Early rebleeding between 120 h and 6 weeks occurred in 0 of 46 MEVL patients versus 5 of 53 TL patients (9.4%; <i>p</i> = 0.059; post hoc power 87%); the adjusted OR for any rebleeding favored MEVL (0.24, 95% CI 0.07-0.82; <i>p</i> = 0.023). All-cause mortality (3/46 vs 6/53) and adverse reactions (11/46 vs 14/53) did not differ.</p><p><strong>Conclusion: </strong>MEVL was associated with higher one-session eradication than TL, with no increase in adverse reactions. A reduction in cumulative rebleeding was suggested by adjusted logistic regression but was not confirmed by time-to-event Cox analysis; this finding should be interpreted as exploratory rather than definitive. Multicenter prospective validation is required.</p><p><strong>Clinical trial registration: </strong>Since this is a retrospective, non-randomized study, it was not registered as a clinical trial.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261453281"},"PeriodicalIF":3.8,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted versus conventional endoscopic submucosal dissection: a systematic review and meta-analysis.","authors":"Menghan Wang, Yan Zhao, Yijun Chen, Wenhai Wang","doi":"10.1177/17562848261458700","DOIUrl":"10.1177/17562848261458700","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted endoscopic submucosal dissection (RA-ESD) has been developed to address the ergonomic and technical limitations of conventional ESD (C-ESD). However, the current evidence base remains limited and is predominantly derived from preclinical studies.</p><p><strong>Objectives: </strong>To systematically evaluate the comparative efficacy and safety of RA-ESD versus C-ESD.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>A comprehensive literature search was conducted in major electronic databases in accordance with the PRISMA 2020 Statement. Comparative studies assessing RA-ESD versus C-ESD were included. Continuous outcomes were pooled using mean differences (MDs), and dichotomous outcomes were analyzed using odds ratios (ORs), both with 95% confidence intervals (CIs). Random-effects models were applied for all primary analyses.</p><p><strong>Results: </strong>Twelve studies (<i>n</i> = 581) were included, of which the majority were preclinical. In exploratory pooled analyses, RA-ESD was associated with shorter submucosal dissection time (min) (MD -6.62, 95% CI -9.38 to -3.86) and overall procedure time (min) (MD -6.00, 95% CI -9.13 to -2.86). Dissection speed (mm²/min) was higher with RA-ESD (MD 35.80, 95% CI 8.98 to 62.62), although heterogeneity was substantial. The blind dissection rate (%) was lower in the RA-ESD group (MD -22.64, 95% CI -31.49 to -13.78). RA-ESD was associated with a higher en bloc resection rate (OR 6.44, 95% CI 1.05 to 39.39) and a lower risk of muscular injury (OR 0.18, 95% CI 0.06 to 0.53). No significant difference in perforation was observed.</p><p><strong>Conclusion: </strong>RA-ESD demonstrates promising technical advantages over C-ESD, including improved procedural efficiency and reduced technical difficulty, without an apparent increase in major adverse events. However, given that the current evidence is predominantly preclinical and characterized by substantial heterogeneity, these findings should be interpreted as preliminary and hypothesis-generating. Further well-designed clinical studies are required to confirm the real-world effectiveness, safety, and long-term outcomes of RA-ESD.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD420261336534.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261458700"},"PeriodicalIF":3.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compartment-based biomarker integration for clinical monitoring in eosinophilic esophagitis.","authors":"Adam Wawrzeńczyk, Katarzyna Napiórkowska-Baran, Marta Tykwińska, Maciej Szota, Zbigniew Bartuzi, Józef Sławatycki, Alina Kanikowska, Krzysztof Pałgan","doi":"10.1177/17562848261452494","DOIUrl":"10.1177/17562848261452494","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease in which symptoms correlate imperfectly with histologic and structural activity, necessitating repeated endoscopy for diagnosis and monitoring. As therapeutic options expand, including biologic agents, there is an increasing need for biomarkers that can inform clinical decision-making and support treat-to-target strategies. This narrative review synthesizes current evidence on tissue-based, circulating, and minimally invasive biomarkers in EoE and proposes a compartment-based clinical hierarchy to contextualize their performance in routine practice. While type 2 cytokine pathways define disease biology, their systemic measurement demonstrates limited diagnostic and monitoring value. By contrast, tissue transcriptomic signatures and esophageal-proximal assessments-particularly eotaxin-3 and eosinophil-derived granule proteins-show stronger correlation with mucosal inflammation and therapeutic response. Structural and epithelial markers further highlight that histologic remission does not necessarily equate to restoration of mucosal integrity. Across domains, biomarker utility follows a consistent gradient, with tissue and luminal assessments most closely reflecting active disease, whereas circulating markers serve adjunctive roles. Histologic scoring systems remain the reference standard; however, multimodal integration of molecular and minimally invasive tools may enable remodeling-aware monitoring and reduce endoscopy burden in selected clinical contexts. Prospective validation within clearly defined management algorithms is required before routine implementation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261452494"},"PeriodicalIF":3.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}