Visceral Medicine最新文献

{"title":"Current Treatment Options in Neuroendocrine Tumors of the Appendix.","authors":"Frederike Butz, Johann Pratschke, Martina T Mogl","doi":"10.1159/000543185","DOIUrl":"10.1159/000543185","url":null,"abstract":"<p><strong>Background: </strong>While appendiceal neuroendocrine tumors (aNETs) are rare, they are the most common type of appendiceal neoplasms, often discovered incidentally during surgeries for acute appendicitis. Appendiceal NETs are typically well-differentiated and associated with an excellent prognosis after adequate surgical therapy.</p><p><strong>Summary: </strong>Management of aNETs depends on tumor size, grade, and risk factors for lymph node and metastasis. Current guidelines from the European Neuroendocrine Tumor Society (ENETS) recommend appendectomy only for low-risk tumors (<1 cm) and more extensive resection (right hemicolectomy [RHC]) for high-risk tumors (>2 cm or incomplete resection). However, the management of intermediate-sized tumors (1-2 cm) remains debated as RHC may not improve survival. Risk factors such as lymphovascular invasion or mesoappendiceal infiltration over 3 mm may prompt RHC consideration. However, current evidence suggests that long-term outcome is not affected by the extent of surgery in aNETs 1-2 cm in size questioning the necessity of RHC in these cases. Advanced metastatic aNETs, extremely rare in occurrence, follow treatment guidelines similar to other gastroenteropancreatic NETs and may involve multimodal therapy, including surgery, radiological interventions, and systemic treatment tailored to the patient's condition and disease burden.</p><p><strong>Key messages: </strong>Appendectomy is adequate for most aNETs, particularly those smaller than 1 cm, G1, and without high-risk features. RHC is recommended for tumors larger than 2 cm, but for tumors 1-2 cm, evidence increasingly suggests that RHC may not confer a survival benefit. Metastatic aNETs are rare, and individualized, multidisciplinary therapy approaches are recommended.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"42 3","pages":"108-112"},"PeriodicalIF":1.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563907","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":"Precursor Lesions in Hepatocellular Carcinogenesis.","authors":"Elke Roeb, Maryam Schneider","doi":"10.1159/000553489","DOIUrl":"https://doi.org/10.1159/000553489","url":null,"abstract":"<p><strong>Background: </strong>The development of hepatocellular carcinoma (HCC) in a chronically diseased liver, often referred to as hepatocarcinogenesis, is a complex process characterized by the progressive accumulation and interaction of genetic alterations, leading to abnormal growth, malignant transformation of liver parenchymal cells, followed by vascular invasion and metastasis.</p><p><strong>Summary: </strong>Precancerous conditions of the liver comprise a spectrum of histopathological and clinical entities that confer a significantly elevated risk of progression to primary hepatic malignancy, most notably HCC and, less commonly, intrahepatic cholangiocarcinoma. These states are characterised not by overt malignant transformation but by molecular, architectural, and cytological alterations that create a permissive environment for oncogenesis. Parasitic infection must likewise be recognised within this framework. Chronic hepatosplenic schistosomiasis due to <i>Schistosoma mansoni</i> induces longstanding granulomatous inflammation and periportal fibrosis. The basic hepatic architecture, including the hepatic lobules and their zonation, is illustrated in Figure 1. Although the parasite does not directly transform hepatocytes, the resultant portal hypertension, chronic immune activation, and fibrotic remodelling create a milieu that may facilitate hepatocarcinogenesis, particularly in conjunction with viral hepatitis or other hepatic insults. Thus, <i>S. mansoni</i> infection constitutes an indirect but clinically relevant precancerous condition in endemic regions.</p><p><strong>Key messages: </strong>In sum, precancerous situations in the liver are less discrete lesions than dynamic pathological states marked by chronic injury, regeneration, and molecular derangement. Their clinical significance resides in the imperative for vigilant surveillance, timely intervention, and, where feasible, modification of underlying aetiological factors. This review discusses HCC precursor lesions associated with a selection of regulatory networks important for liver regeneration, cell cycle control, and their potential significance in the pathogenesis of HCC with special emphasis on Schistosomiasis.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761914","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":"Transoral Outlet Reduction in Treating Dumping Syndrome after Roux-En-Y Gastric Bypass: A Systematic Review and Meta-Analysis.","authors":"Larissa Sundrum, Alida Finze, Mirko Otto, Johanna Betzler, Sebastian Schölch, Svetlana Hetjens, Christoph Reissfelder, Susanne Blank, Christine Stier","doi":"10.1159/000552820","DOIUrl":"https://doi.org/10.1159/000552820","url":null,"abstract":"<p><strong>Introduction: </strong>Dumping syndrome (DS) is a frequent complication after Roux-en-Y gastric bypass (RYGB), causing gastrointestinal and neurohumoral symptoms that can significantly affect quality of life. Transoral outlet reduction (TORe) has been used in clinical practice as a therapy of DS alongside other conservative and surgical approaches. Effectiveness of different therapy options remains unclear. This meta-analysis aimed to provide an overview of the available data concerning TORe.</p><p><strong>Methods: </strong>A meta-analysis was conducted, including ten retrospective studies identified through a literature search in five databases. All studies analyzed the resolution of DS symptoms after TORe through evaluation of the Sigstad score.</p><p><strong>Results: </strong>The literature search yielded 1,014 publications, of which ten retrospective studies involving a total of 320 patients met the inclusion criteria for this meta-analysis. The analysis showed that TORe led to a pooled success rate, defined as overall improvement of symptoms based on subjective patient responses or reduction of Sigstad score to <7 points of 95.59%, significant weight loss (<i>p</i> < 0.001), and an average reduction of Sigstad score by 8.71 points, indicating a consistent improvement in the severity of DS (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates that TORe can be an effective, endoluminal treatment option for DS following RYGB. However, limitations include the retrospective nature of the studies, lack of long-term follow-up, and inconsistent outcome measures. No distinction between early and late DS was observed in any of the included trials. Future research should focus on prospective trials, standardized outcomes, and comparisons with surgical options in order to fully assess the efficacy and durability of TORe. The use of additional objective primary outcome measures, such as oral glucose tolerance testing and continuous glucose monitoring, is suggested.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762558","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":"Gallbladder Polyps as Precursors of Gallbladder Carcinoma: A Narrative Review for Clinical Practice.","authors":"Saeed Aldarwish, Sebastian Hinz, Clemens Schafmayer","doi":"10.1159/000553138","DOIUrl":"10.1159/000553138","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gallbladder carcinoma is an uncommon but highly lethal malignancy that is frequently diagnosed at an advanced stage. Among proposed precursor lesions, true neoplastic gallbladder polyps (particularly adenomas and intracholecystic papillary neoplasms) have received increasing attention as potential steps in an adenoma-carcinoma sequence, analogous to colorectal tumorigenesis [CA Cancer J Clin. 2021;71(3):209-49, Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, and Radiology. 2022;305(2):277-89]. However, most gallbladder polyps detected on imaging are benign, and the absolute cancer risk in incidentally detected polyps remains low [CA Cancer J Clin. 2021;71(3):209-49, Br J Radiol. 2022;95(1137):20220152, Radiology. 2022;305(2):277-89, JAMA Netw Open. 2020;3(5):e205143, and Abdom Radiol. 2024;49(9):3158-65].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;Gallbladder polyps are identified in roughly 3-7% of adults undergoing abdominal ultrasonography, with the majority representing non-neoplastic cholesterol or inflammatory lesions [Br J Radiol. 2022;95(1137):20220152, Radiology. 2022;305(2):277-89, JAMA Netw Open. 2020;3(5):e205143, and Chin Med J. 2024;137(14):1674-83]. Only a minority are adenomatous or preinvasive neoplasms with malignant potential [Br J Radiol. 2022;95(1137):20220152, Chin Med J. 2024;137(14):1674-83, and Am J Surg Pathol. 2012;36(9):1279-301]. Across surgical and imaging series, size is the most consistently validated risk factor for neoplasia, with thresholds around 10 mm widely adopted in guidelines as an indication for cholecystectomy in otherwise low-risk patients [Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, and Am J Roentgenol. 2024;222(5):e2330720]. Additional factors associated with neoplastic histology and gallbladder carcinoma include sessile morphology, older age, primary sclerosing cholangitis, Asian ethnicity, and interval growth during surveillance [Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, Am J Roentgenol. 2024;222(5):e2330720, Korean J Gastroenterol. 2023;81(5):197-202, and Diagnostics. 2024;14(4):374]. Contemporary European joint guidelines and other international society statements advocate a risk-stratified algorithm that combines polyp size, morphology, and clinical risk factors to guide decisions between cholecystectomy, ultrasonographic follow-up, or discharge [Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, and Am J Roentgenol. 2024;222(5):e2330720].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;Most incidentally detected gallbladder polyps are benign and will never progress to cancer; only a small fraction are true neoplastic precursor lesions [Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, JAMA Netw Open. 2020;3(5):e205143, Korean J Gastroenterol. 2023;81(5):197-2","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714877","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":"Topical Budesonide for Stricture Prevention following Wide-Field Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasia.","authors":"Tobias Blasberg, Andreas Wannhoff, Moritz Meiborg, Johannes Richl, Lukas Hiebel, Ardian Mekolli, Ahmad Amanzada, Volker Ellenrieder, Jürgen Hochberger, Karel Caca, Edris Wedi","doi":"10.1159/000553342","DOIUrl":"https://doi.org/10.1159/000553342","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal stricture (ES) is a frequent and clinically significant adverse event after wide-field endoscopic submucosal dissection (ESD) for superficial esophageal neoplasia. Despite multiple prophylactic strategies, prevention remains challenging, and current steroid-based regimens offer limited efficacy. This study evaluated the efficacy and safety of budesonide orodispersible tablets (BOT) for ES prevention after wide-field ESD.</p><p><strong>Methods: </strong>This retrospective, dual-center study evaluated prospectively collected data from patients with superficial esophageal neoplasia undergoing wide-field ESD (≥50% circumferential extent) between August 2020 and August 2024. All patients received BOT (Jorveza® 1 mg twice daily; Dr. Falk Pharma GmbH, Germany) for 4-8 weeks post-ESD. Patients receiving additional stricture-prevention measures were excluded. The primary endpoint was post-ESD stricture. Secondary endpoints included BOT-related adverse events.</p><p><strong>Results: </strong>Twenty patients (mean age 62.8 ± 10.8 years) underwent ESD with BOT prophylaxis. ES occurred in 35.0% overall - 13.3% after resections involving 50-90% of the esophageal circumference and 100% after circumferential (100%) resections. Patients with strictures had greater circumferential resection extent (85.7% vs. 59.2%; <i>p</i> = 0.036). Four strictures were mild (≤7 dilations) and 3 refractory (≥8). BOT was well tolerated; 2 patients (10.0%) developed asymptomatic esophageal candidiasis, and no systemic steroid-related adverse events occurred.</p><p><strong>Conclusion: </strong>BOT prophylaxis was well tolerated and may reduce strictures after non-circumferential resections; however, its protective effect appears limited in circumferential resections. Combination strategies may be warranted in high-risk patients.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766205","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":"Colitis-Associated Dysplasia in Inflammatory Bowel Diseases: From Pathogenesis to Treatment.","authors":"Fotios Fousekis, Michael Vieth, Timo Rath, Markus F Neurath, Raja Atreya","doi":"10.1159/000553304","DOIUrl":"10.1159/000553304","url":null,"abstract":"<p><strong>Background: </strong>Patients with inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn's disease with colonic involvement, are at increased risk of colorectal cancer as a result of chronic intestinal inflammation. Colitis-associated dysplasia represents the principal premalignant lesion in this setting and constitutes the critical link between sustained inflammation and colorectal carcinogenesis. IBD-associated dysplasia develops due to the inflamed mucosal field and follows a distinct, inflammation-driven pathway characterized by field cancerization, multifocality, and early genetic and epigenetic alterations.</p><p><strong>Summary: </strong>This review explores the potential cellular and molecular mechanisms that contribute to colitis-associated dysplasia. These mechanisms include chromosomal instability, oncogenic mutations, epigenetic remodeling, metabolic reprogramming, and immune dysregulation. Particular emphasis is placed on the histological assessment and diagnostic classification of dysplasia in IBD, encompassing both conventional and nonconventional dysplastic subtypes and the associated diagnostic challenges. In addition, contemporary strategies for dysplasia detection are discussed, highlighting advances in endoscopic techniques and emerging imaging modalities that aim to improve lesion recognition. Current evidence guiding the management of dysplastic lesions is also reviewed, with focus on endoscopic resection techniques, surgical indications, and individualized post-resection surveillance strategies.</p><p><strong>Key messages: </strong>Colitis-associated dysplasia is a biologically distinct and clinically heterogeneous precursor to colorectal cancer in IBD. Optimal management requires an integrated, multidisciplinary approach combining expert histopathological evaluation, advanced endoscopic detection, and individualized therapeutic decision-making. Continued advances in diagnostic strategies may further improve risk stratification and outcomes for patients with IBD.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698351","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":"Third-Space Endoscopy in Gastrointestinal Disease: Techniques, Outcomes, and Future Directions: A Narrative Review.","authors":"Esma Z Kizilaslan, Mousa Ayoub, Oscar Cahyadi, Peter Ewald, Alanna Ebigbo","doi":"10.1159/000553034","DOIUrl":"10.1159/000553034","url":null,"abstract":"<p><strong>Background: </strong>Third-space endoscopy uses the submucosal layer as an intentional working corridor to enable dissection, myotomy, or enucleation while preserving organ integrity. The aim of this article was to provide a concise, procedure-based overview of established third-space endoscopic tunneling techniques - peroral endoscopic myotomy (POEM) including major variants, endoscopic submucosal tunnel dissection (ESTD) and submucosal tunneling endoscopic resection (STER) - while discussing endoscopic submucosal dissection (ESD) as the foundational submucosal dissection technique and endoscopic intermuscular dissection as an advanced intermuscular extension.</p><p><strong>Summary: </strong>ESD established the principles of controlled submucosal entry, dissection and hemostasis that enabled subsequent tunneling techniques. ESTD adapts these principles to a mucosal flap-valve/tunnel approach for selected large esophageal neoplastic lesions. POEM has become a standard platform for achalasia and has been adapted to diverticular and gastric pyloric myotomy, whereas STER allows enucleation of selected muscularis propria subepithelial tumors with preserved mucosal integrity. Adoption remains limited by technical complexity, learning curves and infrastructure requirements, structured training and standardized outcome reporting are key enablers.</p><p><strong>Key messages: </strong>Third-space endoscopy represents a shift toward endoscopic organ preservation. Continued innovation, transparent outcome reporting, and competency-based training pathways are essential for safe dissemination.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698380","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":"How to Improve the Management of Pancreatic Cystic Lesions? Role of Medical History and Complementary Imaging.","authors":"Tobias Kleemann, Philip Podlesny, Quang Trung Tran, Denise Müller, Philipp Göltl, Matthias Ebert, Sebastian Belle, Michael Hirth","doi":"10.1159/000552938","DOIUrl":"10.1159/000552938","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative characterization of pancreatic cystic lesions (PCLs) remains inaccurate when based on morphology alone. We aimed to determine whether integrating complementary imaging (cross-sectional imaging plus endoscopic ultrasound) and clinical history, particularly history of pancreatitis, improves diagnostic accuracy compared with single-modality imaging.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with PCLs treated at a tertiary referral center (test cohort) and a confirmatory cohort from a second hospital. Preoperative diagnostic accuracy was assessed in patients with histological confirmation. Multivariable logistic regression identified independent predictors of correct preoperative diagnosis. Additionally, a secondary multivariable logistic regression analysis included all patients using final diagnosis at follow-up (mean 2.4 ± 0.3 years) was performed.</p><p><strong>Results: </strong>In the test cohort, 258 patients were analyzed; 59 (23%) had histological confirmation. Overall preoperative accuracy was 63% (validation cohort: 68%). No significant difference was observed between MRI, CT, or endoscopic ultrasound alone. Complementary imaging was independently associated with higher diagnostic accuracy in multivariable analysis, as was main pancreatic duct dilation. In the full cohort, a history of acute or chronic pancreatitis was the only independent predictor of correct diagnosis and strongly predicted pseudocysts (80% vs. 10% without pancreatitis; <i>p</i> < 0.00001). Combining complementary imaging with pancreatitis history further improved overall diagnostic accuracy and significantly increased detection of malignant PCLs compared with MRI alone (<i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>Diagnostic accuracy of PCLs is limited with single-modality imaging. A stepwise strategy integrating complementary imaging and clinical history, particularly a history of pancreatitis, significantly improves identification of malignant lesions and may refine guideline-based management.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655025","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":"Cold and Hot Snaring for Colorectal Polyps.","authors":"Ingo Steinbrück","doi":"10.1159/000552407","DOIUrl":"10.1159/000552407","url":null,"abstract":"<p><strong>Background: </strong>The resection of colorectal polyps has diversified in recent years. Nowadays, a variety of techniques exist, including forceps and snare resection without or with prior submucosal injection (endoscopic mucosal resection [EMR]), as well as without or with diathermy current (\"cold\" or \"hot\"). Other options include underwater EMR (U-EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection. When discussing resection techniques, the endpoints of safety (e.g., perforation or delayed bleeding) and effectiveness (e.g., residual/recurrent adenoma) should be considered.</p><p><strong>Summary: </strong>The current evidence-based roles of various resection techniques are provided. Additional measures, such as margin coagulation and clip closure of the resection site, are also discussed.</p><p><strong>Key messages: </strong>Cold snare resection should be performed for small polyps (≤9 mm) and sessile-serrated lesions without dysplasia of any size due to its beneficial safety profile and satisfactory effectiveness. Polyps ≥20 mm should be treated with the hot snare, as it is more effective, particularly in case of piecemeal resection with additional margin coagulation. U-EMR is an option to optimize effectiveness for the removal of polyps measuring 20-40 mm. Potentially malignant polyps are best removed en bloc by ESD. The future role of cold snare resection with margin coagulation for large low-grade adenomas is subject of ongoing studies.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426619","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":"Retroperitoneal Fibrosis with Pancreatic, Colonic Involvement Mimicking Malignancy: A Case Report.","authors":"Saeed Aldarwish, Anne-Sophie Becker, Imad Kamaleddine, Clemens Schafmayer","doi":"10.1159/000552406","DOIUrl":"10.1159/000552406","url":null,"abstract":"<p><strong>Introduction: </strong>IgG4-related retroperitoneal fibrosis (IgG4-related RPF) is a rare systemic fibro-inflammatory disorder that may present as a mass-forming lesion, mimicking malignancy. Gastrointestinal involvement is uncommon, and acute large bowel obstruction as the initial presentation is exceedingly rare.</p><p><strong>Case presentation: </strong>A 59-year-old male presented with acute abdominal pain, distension, and obstructive symptoms. Colonoscopy identified a stenosing lesion at the left colic flexure, histologically confirmed as a polypoid adenoma. Contrast-enhanced computed tomography (CT) revealed a mass infiltrating the left colic flexure, peripancreatic fat, and pancreatic tail, with significant colonic dilatation. Emergency surgery was performed due to bowel obstruction. En bloc extended left hemicolectomy, distal pancreatectomy, and wedge gastrectomy with loop ileostomy were carried out. Histopathology confirmed IgG4-related RPF involving pericolic and peripancreatic fat, sparing the pancreatic parenchyma. Serum IgG4 was within normal limits. The patient had an uneventful recovery.</p><p><strong>Conclusion: </strong>This case illustrates a rare presentation of IgG4-related RPF manifesting as acute bowel obstruction. Despite imaging and clinical features suggestive of malignancy, histopathological confirmation revealed benign pathology with an inflammatory fibrosing process. Awareness of such atypical manifestations is crucial to prevent unnecessary radical oncological resections.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450609","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}