Current Opinion in Gastroenterology最新文献

{"title":"Neuroendocrine tumors of the stomach and duodenum: evolving classification, endoscopic management, and surveillance.","authors":"Arjun Chatterjee, Michelle K Kim","doi":"10.1097/MOG.0000000000001186","DOIUrl":"10.1097/MOG.0000000000001186","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gastric and duodenal neuroendocrine tumors are increasingly encountered in gastroenterology practice, often as incidental findings during upper endoscopy or cross-sectional imaging. This review summarizes recent advances in epidemiology, classification, diagnostic evaluation, endoscopic management, surgical decision-making, and surveillance for these tumors.</p><p><strong>Recent findings: </strong>Contemporary epidemiologic data show a rising incidence of gastroenteropancreatic neuroendocrine neoplasms, likely reflecting increased endoscopic detection, improved imaging, and greater diagnostic recognition. Modern classification emphasizes anatomic site, differentiation, grade, functional status, and subtype-specific biology. For gastric neuroendocrine tumors, management differs substantially among type 1, type 2, type 3, and emerging proton pump inhibitor-associated tumors. Type 1 tumors are usually indolent and may be managed with surveillance or endoscopic resection, whereas type 3 tumors require careful staging because of higher metastatic potential. For duodenal neuroendocrine tumors, tumor location, particularly ampullary or periampullary involvement, strongly influences staging, resection strategy, and surveillance. Endoscopic resection is increasingly used for selected low-risk lesions, including small type 3 gastric neuroendocrine tumors and nonampullary duodenal neuroendocrine tumors, although prospective evidence remains limited.</p><p><strong>Summary: </strong>Gastric and duodenal neuroendocrine tumors require individualized, risk-adapted management based on site, subtype, size, grade, invasion depth, lymphovascular invasion, nodal status, metastatic disease, and functional context. Endoscopy remains central to diagnosis and treatment, while EUS, cross-sectional imaging, and somatostatin receptor imaging should be used selectively when results will alter management. Multidisciplinary decision-making is essential for higher risk lesions, borderline cases, and patients being considered for organ-preserving therapy.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"335-343"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition support in gastroenterology: opinion on current literature.","authors":"Rianna Deringer, Camila Schmeil Silva, Daniel Klein","doi":"10.1097/MOG.0000000000001194","DOIUrl":"10.1097/MOG.0000000000001194","url":null,"abstract":"<p><strong>Purpose of review: </strong>Historically, enteral nutrition has been the preferred therapy due to its physiologic benefits, with parenteral nutrition selected if enteral nutrition was contraindicated or insufficient; however, recent advances in nutrition support have prompted reevaluation of this process. This review summarizes the current evidence regarding enteral nutrition and parenteral nutrition in gastrointestinal oncology, inflammatory bowel disease (IBD), critical care, and gastrointestinal surgery.</p><p><strong>Recent findings: </strong>In gastric cancer, parenteral nutrition may improve the nutritional status and clinical outcomes of treatment-related gastrointestinal dysfunction. In IBD, exclusive enteral nutrition may be effective for inducing remission and promoting mucosal healing, whereas parenteral nutrition is preferred in intestinal failure and severe complications. Studies have shown the value of early parenteral nutrition when enteral nutrition is contraindicated or insufficient, specifically for improving nutrient delivery and reducing complications in critically ill and surgical patients. Additional areas of interest include caloric and protein dosing, indirect calorimetry, and the effect of nutrition support on the gut microbiome.</p><p><strong>Summary: </strong>Current evidence supports a patient-centered approach to nutrition support with enteral nutrition remaining as the preference when the gastrointestinal tract can be utilized and parenteral nutrition as an important alternative or adjunct in select populations. Future research should focus on the refinement of supplemental parenteral nutrition practices and the development of evidence-based approaches for specific disease states.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"358-364"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postgastric endoscopic submucosal dissection defect management: should we close, shield, or leave open?","authors":"Kanwal Bains, Arjun Dhir, Neil R Sharma","doi":"10.1097/MOG.0000000000001199","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001199","url":null,"abstract":"<p><strong>Purpose of review: </strong>Postprocedural defect management following gastric endoscopic submucosal dissection (ESD) remains controversial. Asian practice has traditionally favored meticulous prophylactic hemostasis without routine closure, supported by routine post-ESD hospitalization, whereas Western centers increasingly use endoscopic suturing, closure, and shielding to prevent delayed bleeding, perforation, and hospitalization. This review evaluates contemporary evidence on defect closure and shielding, emphasizing risk stratification and evolving practice patterns.</p><p><strong>Recent findings: </strong>Durable mechanical closure may reduce delayed bleeding in selected high-risk patients, particularly those receiving antithrombotic therapy or with elevated BEST-J scores. Emerging techniques, including the reopenable clip-over-the-line method (ROLM), endoscopic hand suturing (EHS), endoscopic suturing platforms, and dedicated closure devices, demonstrate high technical success and favorable safety. Evidence quality remains limited, comprising retrospective studies, propensity-matched cohorts, and a single underpowered randomized controlled trial, with substantial heterogeneity in closure technique, patient populations, lesion characteristics, and baseline bleeding risk. Meticulous vessel identification, coagulation, and selective clipping still achieve favorable outcomes in expert centers without routine closure. Shielding with polyglycolic acid (PGA) sheets, fibrin glue, and polymer-based barriers offers an intermediate option when durable closure is impractical.</p><p><strong>Summary: </strong>Current evidence does not support universal closure of all gastric ESD defects. Management should instead be selective, risk-stratified, and technique-conscious integrating bleeding risk, lesion characteristics, procedural setting, and local closure expertise. Low-risk defects may be safely managed with meticulous hemostasis alone, whereas durable closure appears most beneficial in carefully selected high-risk patients. Prospective comparative studies are needed to define which methods provide clinically meaningful, scalable benefit.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 6","pages":"344-350"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging insights in gastric cancer pathogenesis.","authors":"Luderve Rosier, Katherine S Garman","doi":"10.1097/MOG.0000000000001185","DOIUrl":"10.1097/MOG.0000000000001185","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Gastric cancer (GC) is a leading cause of cancer-related mortality worldwide. Although Helicobacter pylori (Hp) is a well known, leading risk factor for GC, not all patients with Hp develop malignancy, highlighting the multifactorial mechanisms involved in gastric carcinogenesis. This review summarizes recent insights into GC pathogenesis and the implications for risk stratification, screening surveillance, and prevention.</p><p><strong>Recent findings: </strong>Emerging evidence suggests complex interactions between microbial, genetic, environmental, and immune factors in GC pathogenesis. Chronic Hp induces irreversible changes in the gastric mucosa, underscoring the benefits of early detection and treatment. New data suggest treating Hp in younger adults may be most effective for reducing GC risk. Several microbial pathogens have been associated with GC, an evolving area of research. Recent studies also expand our understanding of hereditary and early-onset GC, including the roles of CDH1 , CTNNA1 , and homologous recombination genes. New data also highlights the contribution of environmental factors such as alcohol and acid-blocking medications on GC risk.</p><p><strong>Summary: </strong>Gastric carcinogenesis involves dynamic interactions between the gastric microbiome, host genetics, immune interactions, and environmental exposures beyond Hp infection. Improved understanding of these processes may inform prevention and early detection strategies in clinical practice.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"351-357"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 agonists before endoscopy: separating fact from fiction.","authors":"Tilak Shah","doi":"10.1097/MOG.0000000000001195","DOIUrl":"10.1097/MOG.0000000000001195","url":null,"abstract":"<p><strong>Purpose of review: </strong>Glucagon-1 receptor agonists (GLP-1A) delay gastric emptying, which has raised concerns about heightened risk of increased residual gastric volume (RGV) despite appropriate fasting measures. RGV could increase risk of pulmonary aspiration during sedated procedures like upper endoscopy. The purpose of this review is to summarize literature on pathophysiology of delayed gastric emptying, and to highlight recent publications on risk of RGV and preventive strategies.</p><p><strong>Recent findings: </strong>GLP-1A delay gastric emptying via vagally mediated pathways; with long-term use this delay in gastric emptying is attenuated. GLP-1A significantly increases risk of RGV. Holding a dose of GLP-1A or continuing the medication with 24 h of clear liquids beforehand are both effective strategies. There is a trend towards greater effectiveness with the latter approach. In experienced hands, point of care ultrasound (POCUS) is highly accurate at identifying RGV before sedation.</p><p><strong>Summary: </strong>Recent studies have considerably enhanced our understanding of the pathophysiology and risk of RGV with GLP1A.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"365-368"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introduction.","authors":"","doi":"10.1097/MOG.0000000000001198","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001198","url":null,"abstract":"","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 6","pages":"v-vi"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stomach and duodenum: advances, controversies, and best practices.","authors":"Tilak Shah","doi":"10.1097/MOG.0000000000001196","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001196","url":null,"abstract":"","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 6","pages":"333-334"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The emerging role of endoscopy in neurogastroenterology.","authors":"Thomas Frieling","doi":"10.1097/MOG.0000000000001188","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001188","url":null,"abstract":"<p><strong>Purpose of review: </strong>Purpose of the review is provision of an up-to-date literature review on the growing importance of endoscopy in neurogastroenterology and its limitations.</p><p><strong>Recent findings: </strong>Traditionally, the diagnostic role of endoscopy in neurogastroenterology lies in the initial suspicion of motility disorders and exclusion of important differential diagnoses. Endoscopy may serve also as a carrier for positioning examination devices such as the Bravo reflux-capsule to proof gastroesophageal reflux or the endoluminal functional lumen imaging probe (EndoFLIP). New interesting aspects are the resection-based and biopsy-based extraction of tissue for examination of the enteric nervous system by the full thickness resection device (FTRD) to detect structural gastrointestinal neuromuscular lesion and confocal laser endomicroscopy (CLE) to investigate potential correlations for food intolerance. Effectiveness of endoscopic therapy is dependent on whether the measured circumscribed dysfunction correlates with the symptoms and explains them. This is the case in esophageal achalasia and hypercontractile motility disorders. However, in gastropareses, the significance of endoscopic therapy is limited because of its complex pathophysiology.</p><p><strong>Summary: </strong>There is an emerging role of endoscopy in neurogastroenetrology. However, effectiveness of endoscopic therapy is dependent on careful patient selection and evidence of a circumscribed dysfunction that correlates with the symptoms and explains them.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 5","pages":"306-311"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introduction.","authors":"","doi":"10.1097/MOG.0000000000001192","DOIUrl":"10.1097/MOG.0000000000001192","url":null,"abstract":"","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 5","pages":"v"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic esophagitis - more than eosinophils?","authors":"Fabian Luca Meichtry, Thomas Greuter","doi":"10.1097/MOG.0000000000001190","DOIUrl":"10.1097/MOG.0000000000001190","url":null,"abstract":"<p><strong>Purpose of review: </strong>Eosinophilic esophagitis (EoE) is a chronic, type 2 inflammatory disease with a rapidly rising incidence and is a leading cause of solid-food dysphagia in young adults. While diagnosis has traditionally relied on esophageal eosinophilia, the central role of eosinophils in driving symptoms and disease activity has been increasingly questioned, as several non or low-eosinophilic EoE variants have recently been characterized. This review summarizes the current understanding of these emerging entities and their position within the EoE spectrum.</p><p><strong>Recent findings: </strong>Current concepts support EoE as a Th2-mediated, multicellular disorder driven by genetic susceptibility, epithelial barrier dysfunction, and allergen-induced immune responses. Three EoE variants (EoE-like esophagitis, lymphocytic esophagitis, and nonspecific esophagitis) present with EoE-typical symptoms but fall below the diagnostic eosinophil threshold. Molecular and longitudinal data reveal distinct yet overlapping inflammatory signatures and demonstrate dynamic transitions between phenotypes, including progression to classical EoE in a subset of patients.</p><p><strong>Summary: </strong>EoE variants demonstrate that clinically meaningful esophageal inflammation and structural remodeling can occur in the absence of significant tissue eosinophilia. Recognition of these entities has direct implications for biopsy strategy, histologic assessment beyond peak eosinophil counts, structured longitudinal monitoring and therapy to prevent fibrostenotic complications.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"325-332"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}