Abby Kunitsky, Steve R Siegal, Mark Bloomston, Bassan Allan, Augustine Salami
{"title":"Endoscopic Ultrasound-guided Esophagojejunal Anastomosis for Delayed Reconstruction: A Case Series on the Novel Technique and our Experience.","authors":"Abby Kunitsky, Steve R Siegal, Mark Bloomston, Bassan Allan, Augustine Salami","doi":"10.15403/jgld-6029","DOIUrl":"10.15403/jgld-6029","url":null,"abstract":"<p><p>Esophagojejunal (EJ) anastomoses are integral to gastrointestinal reconstructive surgeries following procedures such as gastrectomy, particularly in cases of cancer or Roux-en-Y reconstruction. However, the traditional surgical EJ anastomosis approach can pose challenges with notable risks such as anastomotic leakage, stricture, or fistula formation. Endoscopic interventions have been employed for managing these adverse outcomes through stent placement, but a primarily endoscopic EJ anastomosis technique has not yet been described. This retrospective case series details five patients who underwent delayed endoscopic EJ anastomosis, with each patient under differing circumstances of instability necessitating this emergent alternative to standard surgical reconstruction. This approach involved the placement of a lumen-apposing metal stent between the esophagus and jejunum. Successful endoscopic EJ anastomosis was achieved in all cases, with hospital stays ranging from 6-13 days. Adverse events included stent migration, dysphagia, and stricture. Subsequent management strategies for these adverse events included stent removal and exchange, balloon dilation, triamcinolone injection, and appropriate follow-up. Follow-up evaluations revealed successful outcomes with no mortalities or anastomotic leaks. Primarily endoscopic EJ anastomosis for delayed reconstruction emerges as an advanced, minimally invasive alternative in complex patients deemed unsuitable for conventional surgical reconstruction secondary to instability or critical conditions. Within the literature, this is the first human case series description of an endoscopic EJ anastomosis with stent placement between the esophagus and jejunum. This novel technique offers the potential in improving patient outcomes which warrants further investigation to optimize these endoscopic techniques and assess its long-term efficacy across a larger patient cohort.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"400-406"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kosuke Suzuki, Maiko Kishino, Mai Watanabe, Kouichi Nonaka
{"title":"Gastric Amyloid Light-Chain Amyloidosis with Fascinating Endoscopic Findings. A Case of Magnified Narrow-Band Imaging Resembling Lymphoproliferative Disease.","authors":"Kosuke Suzuki, Maiko Kishino, Mai Watanabe, Kouichi Nonaka","doi":"10.15403/jgld-6166","DOIUrl":"https://doi.org/10.15403/jgld-6166","url":null,"abstract":"","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"284"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rucsandra-Ilinca Diculescu, Doina Istratescu, Tudor Stroie, Ana-Gabriela Prada, Adina Emilia Croitoru, Vlad M Croitoru, Vladislav Brașoveanu, Traian Dumitrașcu, Gabriel Becheanu, Vlad Herlea, Ioana Gabriela Lupescu, Mugur Cristian Grasu, Gabriel Constantinescu, Mircea Mănuc, Cristian Gheorghe, Liana Gheorghe, Cătălina Poiană
{"title":"Small Bowel Neuroendocrine Neoplasms: A Single Tertiary Center Real World Experience.","authors":"Rucsandra-Ilinca Diculescu, Doina Istratescu, Tudor Stroie, Ana-Gabriela Prada, Adina Emilia Croitoru, Vlad M Croitoru, Vladislav Brașoveanu, Traian Dumitrașcu, Gabriel Becheanu, Vlad Herlea, Ioana Gabriela Lupescu, Mugur Cristian Grasu, Gabriel Constantinescu, Mircea Mănuc, Cristian Gheorghe, Liana Gheorghe, Cătălina Poiană","doi":"10.15403/jgld-6433","DOIUrl":"10.15403/jgld-6433","url":null,"abstract":"<p><strong>Background and aims: </strong>Small bowel neuroendocrine neoplasms (SB-NENs) are a rare type of tumor that is clinically challenging and is often diagnosed in advanced stages. This retrospective study aimed to characterize the clinical presentation, diagnostic workup, and therapeutic strategies, as well as to evaluate the prognosis of patients managed in a tertiary care center in Bucharest, Romania, over five years.</p><p><strong>Methods: </strong>We conducted an observational, retrospective cohort study on 42 cases of SB-NEN evaluated at our center between January 1, 2020, and March 31, 2025. Data regarding clinicopathological characteristics, treatments, and disease evolution were summarized. Overall survival was estimated at 1, 3, and 5 years.</p><p><strong>Results: </strong>Computed tomography was the most frequently used imaging method for diagnosis (52.4%). Surgery was the most adopted method for obtaining the pathological specimen, used in 70.7% of cases. The majority of tumors were well-differentiated (85.6%). The overall survival distribution showed a median survival time of 94 months. The cumulative proportion of patients surviving at 1 year was 97.6%, at 3 years was 89.3% and at 5 years was 75.7%. There was a significant difference in overall survival stratified by tumor grading (p=0.006), indicating that this was a significant prognostic factor; the metastatic status and large tumors showed a trend toward statistical significance, but they did not meet the conventional threshold (p=0.068 and 0.103, respectively).</p><p><strong>Conclusions: </strong>SB-NEN showed favorable outcomes, with surgery improving survival even in some metastatic cases. Lower tumor grade was associated with a better prognosis, while somatostatin analogues (SSA) therapy showed no survival benefit. Patients with large tumors and metastatic disease also showed a trend towards reduced survival.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"309-316"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chiara Rocchi, Marco Massidda, Jessica Piroddu, Salvatore Francesco Vadalà di Prampero, Milutin Bulajic
{"title":"Endoscopic Stricturotomy for the Treatment of Inflammatory Bowel Diseases' Ileocolonic Strictures: A Systematic Review.","authors":"Chiara Rocchi, Marco Massidda, Jessica Piroddu, Salvatore Francesco Vadalà di Prampero, Milutin Bulajic","doi":"10.15403/jgld-6149","DOIUrl":"https://doi.org/10.15403/jgld-6149","url":null,"abstract":"<p><strong>Background and aims: </strong>Inflammatory and fibrotic strictures are common in inflammatory bowel diseases (IBD) and are challenging conditions to manage. Endoscopic stricturotomy (ESt) is considered as an emerging treatment option. We aimed to summarise evidence on the efficacy of ESt for the treatment of IBD-associated strictures.</p><p><strong>Methods: </strong>The databases Pubmed and Cochrane Controlled Trial Register were searched to identify all reports related to ESt in IBD, published till January 2025. A systematic review was conducted identifying clinical and endoscopic improvement.</p><p><strong>Results: </strong>18 studies involving 317 patients were included in the analysis. ESt improved symptoms in 64.2% of patients after a median follow-up of 7.8 months. Endoscopic improvement was detected in 22% of patients after 9 months. Mean length of treated strictures was 1.6 cm. Major adverse events resulted in 5.6% of patients treated by ESt.</p><p><strong>Conclusions: </strong>Endoscopic stricturotomy seems to be an effective option for treatment of IBD' strictures. However further data is required to confirm the role of ESt in this setting.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"343-349"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vonoprazan-containing Dual and Triple Therapies are Non-inferior to Bismuth-quadruple Therapy for Helicobacter pylori Eradication: A Single-center, Prospective, Open-label, Real-World Study.","authors":"Ya-Bin Qi, Xiao-Ting Li, Qiao-Qiao Shao, Lu Xu, Wen-Jing Zhang, Shuai-Bo Song, Qin-Nan Yan, Shi-Yu Shi, Ruo-Bing Hu, Amr Mekky, Chen Zhang, Jing Ma, Wei Xiao, Kuan Li, Ting-Ting Liu, Xin-Hui Fang, Li-Da Zhang, Guo-Hong Yang, Song-Ze Ding","doi":"10.15403/jgld-6183","DOIUrl":"10.15403/jgld-6183","url":null,"abstract":"<p><strong>Background and aims: </strong>Vonoprazan (Vo) and amoxicillin (Amx) dual therapy has shown promising results for Helicobacter pylori (H. pylori) eradication. However, its efficacy needs to be verified in an area with a high prevalence of both H. pylori and gastric cancer. It is also unknown if the modified Vo-Amx plus bismuth (Bis) regimen might increase the eradication rate. We aimed to investigate the efficacy and safety of Vo-Amx and Vo-Amx-Bis regimens, compared to bismuth-containing quadruple therapy (BQT) for H. pylori eradication, as well as factors that affect the curing rate.</p><p><strong>Methods: </strong>A total of 342 treatment-naïve H. pylori-infected patients were screened and 255 were enrolled and randomized into Vo-Amx, Vo-Amx-Bis, and BQT groups for treatment. H. pylori infection status was determined by 13C-urea breath test. The eradication rate and incidence of adverse events were assessed, and factors that might affect the curing rate were also analyzed.</p><p><strong>Results: </strong>In per-protocol (PP) analysis, H. pylori eradication rates in Vo-Amx, Vo-Amx-Bis, and BQT groups were 95.1%, 92.7%, and 90.4%, respectively (p>0.05). In intention-to-treat (ITT) analysis, eradication rates in Vo-Amx, Vo-Amx-Bis, and BQT groups were 91.8%, 89.4%, and 88.2%, respectively (p>0.05). The eradication efficacy of Vo-Amx and Vo-Amx-Bis groups was non-inferior to that of BQT group, and the incidence of side effects (including nausea, vomiting, anorexia, abdominal pain, diarrhea, palpitation, dizziness, and debilitation) was lower than that of BQT group (6.1% and 4.9%, vs 45.8%, respectively, p<0.001). Successful eradication was associated with lower body surface area (BSA) in BQT group (p<0.05), but not in Vo-Amx and Vo-Amx-Bis groups. Gender, cigarette smoking, alcohol drinking, side effects, education level, body mass index, infection status of family members, and the frequency of dining out did not affect the curing rate in all three groups (p> 0.05).</p><p><strong>Conclusions: </strong>Efficacy of the two Vo-containing regimens was comparable and non-inferior to the BQT in this region, and could serve as the first-line regimen for H. pylori eradication, and reduced use of one antibiotic per each patient treatment in real-world clinical application.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"295-303"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giuseppe Chiarioni, Stefan-Lucian Popa, Christian Lambiase, Massimo Bellini
{"title":"The Combination of Fluocinolone Acetonide and Ketocaine Hydrochloride in the Conservative Management of Symptomatic Hemorrhoidal Disease: An Overview of Preclinical and Clinical Data.","authors":"Giuseppe Chiarioni, Stefan-Lucian Popa, Christian Lambiase, Massimo Bellini","doi":"10.15403/jgld-6306","DOIUrl":"https://doi.org/10.15403/jgld-6306","url":null,"abstract":"<p><p>Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population. It is characterized by symptomatic enlargement and displacement of anal cushions, frequently associated with pain, bleeding, and reduced quality of life. The pathophysiology of HD includes vascular congestion, venous stasis, and vascular dilatation, promoted by increased nitric oxide activity. Inflammatory responses are considered crucial in HD, with NF-κB playing a major role. Treatment strategies for HD vary from conservative approaches to office-based and surgical interventions. Conservative therapies, such as topical agents and flavonoid-based systemic treatments, serve as the mainstay of low-grade HD management, while invasive procedures are reserved for refractory cases. Topical formulations containing fluocinolone acetonide (FLA) and ketocaine hydrochloride (KH) combine anti-inflammatory and anesthetic effects, providing rapid and sustained relief from pain, itching, and inflammation. FLA exerts potent anti-inflammatory effects by inhibiting NF-κB and induces vasoconstrictive activity by reducing nitric oxide levels, while KH provides localized analgesia by blocking sodium channels. Collectively, these agents mitigate vascular congestion, inflammation, and HD symptoms. Clinical evidence supports the efficacy of this combination in alleviating acute symptoms, reducing recurrence, and improving patient outcomes. The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events. Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD. Furthermore, its combination with flavonoid-based supplements, which improve venous tone and reduce capillary permeability, may aid in preventing recurrence. This combined approach leverages the rapid symptom relief provided by topical agents and the long-term benefits of systemic therapies, promoting comprehensive HD management and reducing the risk of recurrence.</p>","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"370-380"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Quality Indicators for Esophagogastroduodenoscopy: Need, Current Status and Challenges.","authors":"Rahul Karna, Himsikhar Khataniar, Mohammad Bilal","doi":"10.15403/jgld-6286","DOIUrl":"https://doi.org/10.15403/jgld-6286","url":null,"abstract":"","PeriodicalId":94081,"journal":{"name":"Journal of gastrointestinal and liver diseases : JGLD","volume":"34 3","pages":"279-282"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}