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This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.
Pediatric airway endoscopy, including nasopharyngolaryngoscopy (NPL), microlaryngobronchoscopy (MLB), and flexible bronchoscopy, plays an essential role diagnosing and managing airway disorders in children. Each technique offers unique distinct advantages, and when paired with imaging modalities such as X-rays, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI), clinicians gain a more comprehensive and accurate assessment of the airway. This review explores the complementary role of endoscopy and imaging in pediatric airway evaluation, emphasizing how their combined use improves diagnostic accuracy, guides treatment planning, and facilitates multidisciplinary care. While endoscopy remains the gold standard for visualizing airway pathology, integrating imaging enhances understanding of both structural and functional abnormalities, ultimately improving clinical outcomes in this vulnerable patient population.
Colon capsule endoscopy (CCE) is an increasingly used noninvasive alternative to colonoscopy for colonic investigation. However, its widespread adoption is constrained by suboptimal completion rates (CR), inadequate bowel preparation, and a high follow-up endoscopy rate (FER), collectively undermining cost-effectiveness and service efficiency. Evidence on patient-level predictors of these outcomes remains fragmented. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, CENTRAL, and PubMed Central were searched. Patient-level factors associated with completion rate, bowel preparation adequacy, successful CCE, and FER were extracted. Random-effects meta-analyses were performed to pool unadjusted and adjusted odds ratios. Ten studies comprising 4374 participants met inclusion criteria. The pooled completion rate was 73% (95% CI 68%-78%), and pooled bowel preparation adequacy was 72% (95% CI 60%-81%). Chronic opioid use was consistently associated with reduced performance, demonstrating lower completion rates (unadjusted OR 0.54, 95% CI 0.40-0.73; adjusted OR 0.55, 95% CI 0.28-1.09) and poorer bowel preparation adequacy (adjusted OR 0.49, 95% CI 0.26-0.96). Diabetes was independently associated with inadequate bowel preparation (adjusted OR 0.40, 95% CI 0.36-0.45). Increasing age showed borderline statistical significance but minimal clinical impact. The pooled follow-up endoscopy rate was 61% (95% CI 56%-67%). CCE performance is strongly influenced by patient-level factors, particularly chronic opioid use and diabetes. Targeted patient selection is the most immediately actionable strategy to improve efficiency, whereas individual participant data meta-analyses are needed to enable robust risk stratification of CCE.
Obesity has emerged as one of the leading global drivers of gastrointestinal and metabolic disease, contributing substantially to the burden of metabolic dysfunction-associated steatotic liver disease (MASLD), gastroesophageal reflux disease (GERD), Barrett's esophagus, pancreatitis, colorectal neoplasia, and obesity-associated malignancies. Simultaneously, the rapid expansion of glucagon-like peptide-1 (GLP-1) receptor agonists and minimally invasive bariatric endoscopic interventions has transformed the therapeutic landscape of obesity management and increasingly positioned gastroenterologists at the intersection of obesity medicine, hepatology, therapeutic endoscopy, nutrition, and metabolic care. This narrative review evaluates the evolving role of gastroenterologists in obesity medicine and discusses the integration of pharmacologic, endoscopic, metabolic, and hepatologic approaches into modern gastrointestinal practice. A focused literature review was conducted by searching PubMed and Google Scholar, prioritizing peer-reviewed publications from 2015 to 2026, with inclusion of landmark earlier studies where relevant. Articles were selected based on clinical relevance, methodological quality, and applicability to the evolving role of gastroenterologists in metabolic care. The role of gastroenterologists is expanding beyond traditional luminal and procedural practice into longitudinal metabolic disease management. The emergence of GLP-1 receptor agonists, dual incretin therapies, and endobariatric procedures has accelerated GI involvement in obesity treatment and preventive metabolic care. In parallel, the increasing prevalence of MASLD and obesity-related gastrointestinal disorders has reinforced the importance of comprehensive obesity management strategies involving gastroenterologists within multidisciplinary care teams. Integration of obesity medicine into gastroenterology training programs and metabolic clinics may further redefine the future scope of GI practice. Modern gastroenterology is undergoing a transition toward obesity-focused and metabolic care. As pharmacologic and endoscopic obesity therapies continue to evolve, gastroenterologists are uniquely positioned to play a central role in the multidisciplinary management of obesity-associated gastrointestinal disease.
Minimally invasive surgery provides clear benefits to patient outcomes and is now standard practice in high-income countries. However, it remains underutilized in low- and middle-income countries (LMICs) due to limited training opportunities, infrastructure, mentorship, and long-term program sustainability. Recognizing these challenges, the Global Affairs Committee of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) launched the Global Laparoscopic Advancement Program (GLAP) to build sustainable laparoscopic training capacity. Over the past decade, GLAP has trained over 400 surgeons across Latin America and Africa, including programs in Costa Rica, Mexico, El Salvador, Ethiopia, Namibia, Uganda, Zimbabwe, and Kenya. The objective of this White Paper is to define strategic principles, operational considerations, and best practices necessary to build sustainable simulation-based laparoscopic training programs in low-resource regions, drawing on ten years of GLAP implementation experience and distilled into a structured 10-step guideline. This White Paper was developed through expert consensus among members of the Global Affairs Committee and collaborators involved in the design and delivery of the global laparoscopic advancement program (GLAP). Contributors with direct programmatic experience identified key operational considerations across program planning, implementation, and sustainability. Draft recommendations were iteratively reviewed and refined among authors until consensus was achieved. Consensus was reached on a 10-step implementation framework organized across three phases. Pre-program preparation includes: (1) establish strategic alignment, (2) assemble the team, (3) go to site, (4) establish operational structure, and (5) shape the curriculum. Program execution includes: (6) gather the right faculty, (7) lead delivery of a high-quality program, and (8) appreciate the moment. Post-program sustainability includes: (9) perform a structured debrief and (10) transition to local ownership. This can be summarised in the cognitive aid "SAGES GLAP!". GLAP demonstrates that structured, simulation-based laparoscopic training can be successfully implemented in LMICs when programs are carefully planned, contextually adapted, and supported by committed local leadership. These insights provide a practical framework for expanding minimally invasive surgery globally, highlighting the importance of combining international expertise with local ownership to build lasting surgical capacity.
The benefits of minimally invasive hysterectomy are widely recognized. However, laparoscopic hysterectomy is more technically difficult in patients with enlarged uteri. In this study, we sought to compare surgical outcomes for patients with large uteri (greater than 1 kg) undergoing laparoscopic versus open hysterectomy. This was a retrospective cohort study performed at a tertiary-care academic center, including all patients who underwent laparoscopic or open hysterectomy for a benign indication between January 1, 2009 and December 31, 2024. The primary outcome was a composite measure of intraoperative and postoperative complications, readmissions, and reoperations. A total of 509 patients underwent hysterectomy for uteri larger than 1 kg: 268 via laparotomy and 241 via laparoscopy. After controlling for confounding variables, the risk of any complication, readmission or reoperation was similar in the laparoscopy and laparotomy groups (OR 1.09 [0.68-1.77], P = .7119). Median estimated blood loss was lower in the laparoscopy group as compared to the laparotomy group (100 vs 300 mL, P < .001). Mean operative time was longer in the laparoscopy group by 24 minutes (188 vs 164 minutes, P < .001). The median length of stay was 0 days for the laparoscopy group, versus 2 days for the laparotomy group (P < .001). Our results suggest that laparoscopic hysterectomy is feasible even for patients with uterine weight exceeding 1 kg. While operative time was longer in the laparoscopy group, this increase in operative time was not associated with an increase in perioperative complications.
Foreign body (FB) ingestion is a relatively frequent occurrence in the pediatric population with multiple potential sequelae. Appropriate intervention may range from urgent endoscopic retrieval to watchful waiting, with multiple variables influencing the decision. The four key variables include the type of object ingested, the anatomical location of the FB, the presence and severity of symptoms, and the time since ingestion. In this position paper, we provide an evidence-based approach to the management of ingested foreign bodies, incorporating expert opinion where existent evidence alone is insufficient to guide clinical judgement. We offer a clear, clinically relevant guide, with user-friendly algorithms, to assist in real-time decision making. We also include practical tips from experts on how to safely and effectively perform endoscopic removal of an ingested FB.
Long-term real-world data on vedolizumab outcomes remain limited: the LONG-LIVE study evaluates 5-year effectiveness and safety in a large Italian cohort. This is a long-term extension of the multicenter LIVE study involving patients with Crohn's disease (CD) and ulcerative colitis (UC). The primary outcome was the cumulative probability of major adverse clinical outcomes (the composite of IBD-related surgeries, non-surgical hospitalizations, and serious adverse events). Secondary outcomes included cumulative incidences of IBD-related surgery and non-surgical hospitalization, vedolizumab persistence, rates of death, cancer and adverse events of special interest (AESIs), and longitudinal response group transitions; outcomes in elderly patients (≥ 65 years) were compared to non-elderly using inverse probability weighting (IPW). Overall, 782 patients were included (50.4% CD; 49.6% UC; 76.3% anti-tumor necrosis factor (TNF)-experienced; 4324.1 patient-years of follow-up). The 5-year probability of major adverse clinical outcomes was 29.4% (no difference between CD and UC). In CD, penetrating behavior (aHR 1.77) predicted higher risk of the primary endpoint, while colonic location was protective (aHR 0.51). In UC, the primary endpoint was predicted by elderly age (aHR 1.99) and comorbidity burden (aHR 1.27). Five-year cumulative incidences were 23.4% for surgery and 14.3% for non-surgical hospitalization. Patients with CD had higher hospitalization risk than patients with UC (sHR 1.80). Mortality, neoplasm diagnosis, and AESIs occurred at rates of 3.93, 3.93, and 6.27 per 1000 patient-years. Five-year drug persistence was 38.7%. Achieving deep remission within 24 months mediated the relationship between initial clinical response and sustained deep remission at last follow-up. After IPW, elderly patients had a higher risk of major adverse clinical outcomes and non-surgical hospitalization; AESI and cancer rates did not differ. Approximately one in three patients experienced a major adverse clinical outcome over 5 years, driven primarily by disease-related complications rather than adverse events, with a consistent safety profile across age groups. Vedolizumab is a gut-selective biologic therapy approved for Crohn's disease (CD) and ulcerative colitis (UC). While its short-term effectiveness is well established, data on what happens to patients beyond 2 years of treatment remain limited. In this study, we followed 782 patients for up to 7 years across 47 Italian centers to track hard clinical outcomes: surgery, hospitalization, serious adverse events, and death. About one in three patients experienced a major adverse clinical outcome over 5 years—a composite endpoint that includes IBD-related surgeries, non-surgical hospitalizations, and serious adverse events—with no meaningful difference between CD and UC. Surgery occurred in approximately one in five patients, and non-surgical hospitalizations were more frequent in CD. Serious adverse events, including deaths, cancers, and infections, remained uncommon throughout follow-up. Patients who responded early to treatment were more likely to achieve deep remission within 2 years, which was in turn associated with deep remission at last follow-up. Elderly patients faced higher risks of hospitalization and major adverse clinical outcomes, but not of cancer or serious adverse events, suggesting that vedolizumab can be used across different age groups without a disproportionate increase in safety risk.
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Although upper gastrointestinal (GI) endoscopy is a crucial diagnostic tool for evaluating lesions of the upper GI tract, its findings are not always definitive, necessitating histopathological confirmation. This retrospective study aimed to assess the spectrum of histopathological lesions and their correlation with endoscopic impressions at Methodist Hospital, Wenchi, Ghana. A retrospective observational study was conducted on patients who underwent upper GI endoscopy with biopsy between August 2024 and September 2025. Out of 513 patients who underwent upper GI endoscopy, 176 were biopsied, but 46 were excluded due to missing histopathology reports, leaving 130 patients for analysis. Endoscopic impressions were compared with histopathological diagnoses across different GI tract sites (esophagus, stomach, and duodenum). Diagnostic accuracy was calculated with sensitivity, specificity, and 95% confidence intervals (CIs). Agreement was assessed using Cohen's Kappa and prevalence-adjusted bias-adjusted Kappa (PABAK). Of the 130 patients, 97.7% of lesions were benign (predominantly chronic gastritis), and 2.3% were malignant. Endoscopy demonstrated a sensitivity of 100% (95% CI: 29.2-100) and specificity of 99.2% (95% CI: 95.8-100) for malignant lesions. Cohen's Kappa was 0.796, indicating substantial agreement, while PABAK was 0.966, reflecting near-perfect concordance after adjusting for prevalence. Upper GI endoscopy showed high diagnostic accuracy and substantial concordance with histopathology for benign lesions such as gastritis. These findings suggest that clinicians in resource-deprived areas where histopathology is not readily available or may be associated with long turnaround times can safely commence targeted treatments for benign upper GI conditions based primarily on endoscopic findings.
Guidelines recommend esophagogastroduodenoscopy (EGD) and colonoscopy to investigate iron deficiency anemia (IDA), but not small bowel examination. Determine diagnostic yield and location of lesions causing IDA. Prospective, multicenter clinical trial. Two public hospitals (UK and Hong Kong) and a private health center (Hungary). Patients with IDA referred for EGD and colonoscopy. Participants had small bowel capsule endoscopy, EGD and colonoscopy. Lesions were described by a blinded consensus panel using a diagnostic register and the Saurin classification (P1 and P2: possible and likely cause of bleeding respectively). The primary outcome was diagnostic yield and location of potential bleeding lesions and secondary outcome, impact on management. In 170 patients (median 60.0 years, 47.6% female), small bowel capsule endoscopy identified P1 or P2 lesions in 85 (50.0%; 95% CI, 42.2 to 57.7), EGD in 48 (28.2%; 95% CI, 21.6 to 35.6) and colonoscopy in 34 (20.0%; 95% CI, 14.2 to 26.8). Capsule endoscopy P1 or P2 lesion yield was higher than EGD (p<0.001) and colonoscopy (p<0.0001). P2 lesions alone were identified in 17 (10.0%; 95% CI, 6.0 to 15.5), 11 (6.5%; 95% CI, 3.3 to 11.3) and 16 (9.4%; 95% CI, 5.4 to 14.8) patients respectively. Pan-GI endoscopy identified potential bleeding lesions in 121 patients (71.1%; 95% CI, 64.4 to 77.9) which changed management in 89 (52·3%; 95% CI, 44.5 to 60.0). Lesions with bleeding potential were more common in the small bowel than upper GI tract and colon in patients with IDA.
Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis and significantly affects health-related quality of life (HRQoL). In borderline resectable (BR) and locally advanced (LA) PDAC, neoadjuvant FOLFIRINOX may enable surgical resection, but its toxicity can further compromise HRQoL. Evidence on longitudinal HRQoL changes during FOLFIRINOX in this context remains limited. This study evaluated HRQoL trajectories in patients with BR and LA PDAC receiving neoadjuvant chemotherapy (NACT) within a surgical selection strategy. This longitudinal analysis included patients from the multicenter prospective PeRFormanCe trial (NCT05298722), investigating outcomes in BR and LA PDAC treated with FOLFIRINOX as NACT. HRQoL was assessed at baseline and after 4, 8, and 12 NACT cycles using EORTC QLQ-C30 and PAN26 questionnaires. Changes over time were analyzed using linear mixed-effect models. Clinically meaningful differences were defined as ≥10-point mean changes with 95% confidence intervals. Twenty patients were included (35% female), 12 (60%) had LA PDAC. The median number of NACT cycles was 8 (IQR 7-12). Sixteen patients (80%) underwent surgical exploration, and 11 (55%) achieved resection. During NACT, patients reported improvements in insomnia, pain, hepatic symptoms, bloating and appetite loss. Muscle weakness, cognitive deterioration, and side effects increased. Among patients completing 12 cycles, weight loss and flatulence decreased, global health status (baseline 64, SE 4.05) and fatigue scores improved. In patients with BR and LA PDAC treated with FOLFIRINOX as NACT, HRQoL can be preserved over time despite variations in symptoms. These findings contribute to informed, patient-centered decision-making in the neoadjuvant setting. ClinicalTrials.gov Identifier NCT05298722. Date of registration March 28, 2022.
Gastroesophageal junction (GEJ) cancers have shown a rising global incidence, with unique anatomical and biological features distinguishing them from esophageal and gastric carcinomas. This study evaluates the clinicopathological characteristics, treatment modalities, survival outcomes, and recurrence patterns of GEJ cancers in an Indian population. This study was conducted on 107 patients with histologically confirmed GEJ carcinoma treated at a tertiary cancer center in India between 2012 and 2024. Demographic, clinical, radiological, surgical, and survival data were reviewed. Staging was based on endoscopy and contrast-enhanced CT. Multimodality treatment strategies were implemented, including neoadjuvant chemoradiotherapy (CROSS), chemotherapy (FLOT), and definitive chemoradiotherapy for unresectable cases. Survival was analyzed using Kaplan-Meier methods, and predictors of recurrence were assessed using Cox regression. The cohort had a male-to-female ratio of 3.45:1 with a mean age of 53 years. Adenocarcinoma was the predominant histology (63.6%). Curative resection was achieved in 79.4%, with an R1 rate of 2.4%. The most common surgical approach was Ivor Lewis esophagectomy (63.6%). The 2-, 3-, and 5-year disease-free survival (DFS) rates were 82%, 75%, and 56%, respectively; overall survival (OS) rates were 88%, 77%, and 59%. Recurrence occurred in 35.3% of patients, predominantly systemic. On multivariate analysis, lympho-vascular invasion, extent of lymphadenectomy, and pathological stage significantly predicted recurrence. Gastroesophageal junction cancers in India predominantly affect middle-aged males and are mostly adenocarcinomas. Multimodality treatment, including neoadjuvant therapy and extended lymphadenectomy, shows promising survival. However, systemic recurrence remains a major challenge. Early detection, personalized treatment, and standardized follow-up are essential to improve outcomes. These findings highlight the urgent need for resource-sensitive national strategies to tackle the rising burden of GEJ cancers.
To synthesize clinical presentation, anatomic patterns, diagnostic evaluation, and treatment outcomes of laryngeal IgG4-related disease (IgG4-RD) and highlight features that may support earlier diagnosis in unexplained laryngeal stenosis or mass-like lesions. Systematic searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were performed through January 1, 2026, limited to English-language human studies combining IgG4-RD with laryngeal and upper-airway terms. Eligible studies reported histopathologic or clinicopathologic confirmation of IgG4-RD involving the supraglottic, glottic, or subglottic larynx with data on presentation, diagnosis, treatment, or outcomes. Two reviewers independently screened records and extracted data. Twenty-seven publications met inclusion criteria, yielding 32 patients. Most were middle-aged with slight female predominance and presented with hoarseness, dyspnea, or stridor. Supraglottic and subglottic involvement predominated; multilevel airway disease occurred in about one third of cases. Endoscopy and imaging showed two main patterns: fibrostenotic circumferential narrowing resembling idiopathic subglottic stenosis and mass-like or polypoid lesions mimicking neoplasia. Histologic confirmation often required deep submucosal or repeat biopsy after nondiagnostic superficial sampling, and serum IgG4 levels were frequently normal despite biopsy-proven disease. Most patients received systemic glucocorticoids, often with additional immunosuppressive therapy and endoscopic dilation or airway surgery; relapse and progression to fixed fibrostenosis were common. Laryngeal IgG4-RD is an uncommon but underrecognized cause of airway obstruction and voice disturbance. Clinicians should include it in the differential diagnosis of unexplained laryngeal stenosis or submucosal masses and obtain adequately deep biopsies alongside long-term immunomodulatory and airway-preserving surgical strategies.
The optimal extent of gastrectomy for elderly patients with upper gastric cancer (GC) remains controversial. This study compared short-term surgical outcomes and mid-term nutritional changes between proximal gastrectomy (PG) and total gastrectomy (TG) in patients aged ≥75 years. This retrospective cohort study included 27 elderly patients with upper GC who underwent laparoscopic TG (n=13) or PG (n=14) between 2014 and 2023. Short-term outcomes included operative variables, postoperative complications, and length of hospital stay. Mid-term outcomes included reflux esophagitis, anastomotic stricture, and longitudinal changes in body weight, hemoglobin levels, and albumin levels up to 2 years postoperatively. A subgroup analysis was performed for patients aged ≥80 years. The PG group consisted exclusively of patients with clinical T1 disease, whereas the TG group included patients with more advanced tumors. Postoperative complications occurred in 31% of patients in the TG group and 14% of patients in the PG group. The median length of postoperative hospital stay was significantly shorter in the PG group (12 vs. 15 days, p=0.048). Postoperative weight loss was consistently greater in the TG group, with a significant difference at one month. The decline in serum hemoglobin levels was significantly greater in the TG group at one and two years. No significant differences were observed in albumin levels. In patients aged ≥80 years, PG showed numerically favorable trends in complication rates, length of hospital stay, and nutritional parameters. PG may provide short- and mid-term functional advantages over TG in elderly patients with upper GC, while maintaining acceptable surgical safety. Function-preserving surgery should be considered for appropriately selected elderly patients.
Many techniques can reapproximate fascia during herniorrhaphy. Reports suggest utility of interrupted figure-of-eights for large defects less amenable to running suture closures. However, anecdotal concerns regarding 'ischemic' qualities of figure-of-eights may dissuade utilization, despite no substantiating evidence. This study compares wound morbidity for figure-of-eights vs running sutures for fascial closure during open ventral hernia repair (VHR). A prospectively maintained hernia-specific registry was queried for open VHRs from 1/1/2014 to 12/31/2023 with fascial closure, ≥ 10 cm defect width, CDC Class 1 wound, fascial closure via figure-of-eights or running suture, and clinical follow-up at 30 days. Cases featuring anterior myofascial or cutaneous flaps were excluded. Surgical site occurrence (SSO), surgical site infection (SSI), SSO/SSI requiring procedural intervention (SSO/I-PI), recurrence, and patient-reported quality-of-life (QoL) at 30-day and 1-year intervals were considered. SSO at 30 days was selected as the primary outcome to serve as a surrogate for suture line ischemia, and 1-year recurrence was a key secondary outcome of interest. Baseline factors including age, BMI, gender, race, ASA class, immunosuppressant use, smoking, diabetes, hernia width, and hernia length were controlled via multivariable regression. A total 4195 cases met criteria and 31% utilized figure-of-eights (n = 1317). Multivariable logistic regression found no increased risk of 30-day SSO or 1-year recurrence for figure-of-eight vs running suture closure. Adjusted odds of SSI (OR 1.47; 95% CI 1.11, 1.95) and SSO/I-PI (OR 1.31; 1.02, 1.70) were greater for figure-of-eight closures. No associations were identified regarding patient-reported QoL or 1-year outcomes. This retrospective analysis of wound morbidity in clean cases identified an increased risk of SSI and SSO/I-PI for figure-of-eight closures at 30 days vs running closures. Though the association may relate to residual confounding from selective utilization in high complexity repairs rather than an ischemic nature, the results suggest figure-of-eights should perhaps be reserved for challenging or high-tension fascial reapproximation.
Heterotopic pancreas (HP) is a congenital anomaly characterized by pancreatic tissue located outside its normal anatomical site, without anatomical or vascular continuity with the pancreas proper. HP typically occurs in the stomach or duodenum, whereas esophageal HP is extremely rare. Malignant transformation is even rarer, with only a limited number of reported cases. We report a case of adenocarcinoma arising from esophageal HP successfully managed by multidisciplinary treatment. A 32-year-old woman presented with persistent epigastric pain accompanied by severe right-sided posterior thoracic pain that was markedly positional, preventing her from resting in the supine position. Upper gastrointestinal endoscopy revealed ectopic gastric mucosa with a papillary elevation in the lower thoracic esophagus (Lt), and endoscopic US (EUS) demonstrated a homogeneous hypoechoic submucosal mass. Contrast-enhanced CT and esophagography identified a well-defined 30-mm lesion arising from the right wall of the Lt, without distant metastasis or lymphadenopathy. Although EUS-guided fine-needle aspiration (EUS-FNA) and referral for a second opinion were recommended, the patient declined both because of intractable pain and requested immediate surgical management. Thoracoscopic tumor resection was therefore performed for diagnostic and therapeutic purposes. Histopathology confirmed pancreatic-type adenocarcinoma arising from Heinrich type I HP, with lymphatic invasion and a positive resection margin. Accordingly, 3 cycles of adjuvant chemotherapy with gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) were administered over 3 months. Follow-up CT and PET-CT showed no recurrence or metastasis, and robot-assisted subtotal esophagectomy was performed 7 months after the initial surgery. Postoperative pathology demonstrated fibrotic scar tissue without residual malignancy. The patient declined further adjuvant therapy and remains free of recurrence 12 months after the second surgery. Esophageal HP carcinoma is exceedingly rare. Multidisciplinary treatment following pancreatic cancer protocols enabled curative resection and favorable outcomes. Given the malignant potential, meticulous preoperative evaluation and individualized therapeutic planning are essential.
While tissue adhesives are widely used in the closure of surgical incisions, contact dermatitis remains a poorly characterized complication. Dermabond™ (Ethicon; DB) and LiquiBand® (Advanced Medical Solutions; LB) are two commonly used tissue adhesives; however, there are no direct data comparing their risk of contact dermatitis. In this randomized controlled trial, we compare the rate of contact dermatitis associated with DB versus LB in patients undergoing laparoscopic abdominal surgery. This was a single-center, intra-patient randomized controlled trial which included patients undergoing elective laparoscopic or robotic abdominal surgery. For each patient, DB was applied to incisions on one side of the abdomen and LB was applied to the contralateral side. The side for each glue was randomized by date of the month. The primary outcome was the proportion of patients experiencing contact dermatitis within 6 weeks postoperative period. One hundred eighty patients were enrolled, and 1 was lost to follow up. Contact dermatitis occurred in 21 of 180 patients (11.7%). DB alone caused reactions in 3 patients (1.7%), LB alone in 1 patient (0.6%), and both adhesives in 17 patients (9.5%). The matched-pairs odds ratio for LB versus DB was 0.33 (95% CI 0.01-4.15, p = 0.63). A sensitivity analysis for patients lost to follow up did not change the results. 7 (33%) patients required treatment for contact dermatitis, all of whom had bilateral reactions. Contact dermatitis due to tissue adhesive was seen in 11.7% of patients; however, there was no statistically significant difference between the rates seen with DB and LB. The risks and benefits of tissue adhesive should be carefully considered when choosing to use these products in the closure of surgical incisions, and surgeons need to have a clear management algorithm for dermatitis should it occur. This risk does not seem to be mitigated by manufacturer, so adhesive choice may reasonably be guided by factors such as cost, availability, or institutional preference.
Congenital muscular torticollis (CMT) is a common pediatric musculoskeletal condition resulting from unilateral contracture of the sternocleidomastoid muscle. When conservative treatment fails, surgical intervention is required. Traditional open approaches leave visible cervical scars, prompting the need for minimally invasive alternatives. This study evaluates the clinical outcomes of an innovative endoscopic sub-platysmal release technique for CMT in children. We retrospectively analyzed pediatric patients (<10 years) with CMT who underwent endoscopic release via a sub-platysmal approach under general anesthesia after failed at least 6 months of conservative therapy. The procedure utilized a 2.7-mm endoscope and radiofrequency ablation with gravity-fed hemostatic irrigation. Outcomes were assessed using the Cheng and Tang scoring system, including neck rotation deficiency, lateral bending deficiency, craniofacial asymmetry, and head tilt. Operative time, blood loss, and complications were recorded. Minimum follow-up was 30 months. A total of 44 patients (28 males, 16 females; mean age 3.88 ± 2.15 years) operated between January 2019 and December 2023 were analyzed. The cohort had a mean follow-up of 49.3 ± 8.2 months. Mean operative time was 35.2 ± 6.4 min, and mean blood loss was 4.5 ± 1.2 mL. At final follow-up, the median neck rotation deficiency significantly improved from 26.5° (IQR, 23.1°-29.4°) preoperatively to 3.0° (IQR, 2.5°-4.1°) (P < 0.001), and lateral bending deficiency improved from 18.2° (IQR, 15.8°-20.5°) to 2.5° (IQR, 2.0°-3.3°) (P < 0.001). According to Cheng and Tang scoring, 42 patients (95.4%) achieved excellent or good outcomes, with earlier intervention demonstrating significantly higher clinical scores. No intraoperative or postoperative complications were observed. This endoscopic sub-platysmal approach is a safe and effective minimally invasive technique for pediatric CMT, offering excellent functional recovery, minimal blood loss, superior cosmetic outcomes, and a remarkable safety profile. It represents a valuable addition to the surgical armamentarium for pediatric musculoskeletal disorders.
Intraluminal postpancreatoduodenectomy hemorrhage is an uncommon but potentially devastating complication, with clinically complex and multifactorial sources. Current evidence on optimal management, particularly the role of angiography, remains controversial. This study aimed to optimize the management strategies for intraluminal postpancreatoduodenectomy hemorrhage by analyzing data from a high-volume center. This single-center, retrospective study studied consecutive patients who underwent pancreatoduodenectomy from July 2018 to June 2025. The clinical manifestations, management, and outcomes of intraluminal postpancreatoduodenectomy hemorrhage were analyzed. Among the 3,011 patients who underwent pancreatoduodenectomy, intraluminal postpancreatoduodenectomy hemorrhage was observed in 115 patients (3.8%). The overall mortality of intraluminal postpancreatoduodenectomy hemorrhage patients was 6.1%. The bleeding sources were identified in 63 patients (54.8%), among whom 33 (28.7%) were diagnosed as "false" intraluminal postpancreatoduodenectomy hemorrhage because of primary extraluminal hemorrhage. Multivariate analyses suggested that high body mass index (odds ratio, 1.30; 95% confidence interval, 1.06-1.58; P = .010) was an independent risk factor for "false" intraluminal postpancreatoduodenectomy hemorrhage. Angiography demonstrated superior localization of bleeding sources (65.3%) compared with endoscopy (32.7%) and computed tomography (26.1%) (P < .001), with a lower false-positive rate than relaparotomy (2.0% vs 17.5%, P = .030). Definitive hemostasis rate was comparable between angiography (44.9%) and relaparotomy (50.0%), both significantly outperforming endoscopy (21.2%, P = .008). "False" intraluminal postpancreatoduodenectomy hemorrhage represents a significant subset of intraluminal postpancreatoduodenectomy hemorrhage cases. Angiography may serve as a reliable tool for both the diagnosis and treatment of intraluminal postpancreatoduodenectomy hemorrhage, particularly when "false" intraluminal postpancreatoduodenectomy hemorrhage is highly suspected.