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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.

Globus sensation is a common presenting symptom encountered by primary care physicians, otolaryngologists, and gastroenterologists. Although common, it can have a significant impact on quality of life and is often difficult to treat, given lack of a standardized approach to diagnosis and management. In this concise review, we outline the various causes that may contribute to globus sensation, encompassing sinonasal processes such as post-nasal drip, esophageal conditions including laryngopharyngeal and gastroesophageal reflux, and psychological factors as well as structural abnormalities, among others. We also provide a framework on how to approach diagnosis and management of this symptom, which frequently requires multidisciplinary care between otolaryngologists and gastroenterologists. Patients with globus sensation and typical sinonasal symptoms may be empirically trialed on topical nasal sprays. Similarly, in patients with globus sensation and heartburn or regurgitation, a trial of acid suppression medications may be considered. In patients with globus sensation and alarm symptoms, urgent nasolaryngoscopy and endoscopy should be pursued. In patients with isolated globus sensation, work-up often entails nasolaryngoscopy followed by endoscopy. In these patients with a negative initial work-up, we highlight important considerations for when to consider empirical therapy vs when to pursue additional diagnostic testing, which is guided by the clinical context, severity of the patient's symptoms and impact on quality of life, and shared decision-making.

Clostridioides difficile infection is a common cause of clinically significant diarrhea, often becomes recurrent, and can be fatal when severe or fulminant. The purpose of this America Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice for C difficile infection management. This expert review was commissioned by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership. The review was developed from expert opinion and a review of the published literature. Because systematic reviews were not performed, these best practice advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. The review underwent internal peer review by the Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. BEST PRACTICE ADVICE STATEMENTS BEST PRACTICE ADVICE 1: Prevention of C difficile infection should include proper barrier protection and disinfection with United States Environmental Protection Agency-approved sporicidal agents in health care settings. Patients should be counseled on the importance of handwashing and to consider disinfecting areas of the home potentially contaminated with C difficile spores, to prevent reinfection. Reassurance should be provided that C difficile infection transmission to unaffected family members is uncommon. BEST PRACTICE ADVICE 2: C difficile infection is a clinical diagnosis that requires compatible symptoms (typically acute diarrhea, following antibiotics) in combination with supportive laboratory testing. Multistep testing is preferred for best diagnostic accuracy; however, patients with discordant testing who have a high clinical suspicion for C difficile infection should be treated. BEST PRACTICE ADVICE 3: Clinicians should classify hospitalized patients with C difficile infection as having nonsevere, severe, or fulminant disease at diagnosis. White blood cell count >15,000 cells/uL and/or creatinine >1.5 × baseline are indicative of severe C difficile infection and increased risk for recurrence and poor outcomes. Patients with additional findings of shock, ileus, or megacolon have fulminant C difficile infection, which can be fatal. BEST PRACTICE ADVICE 4: Fidaxomicin (200 mg twice daily oral for 10 days) is a narrower spectrum agent, and given lower recurrence rates, is favored as first-line therapy for nonfulminant C difficile infection. However, given practical considerations, vancomycin (125 mg 4 times daily oral for 10 days) is also acceptable therapy. Metronidazole should not be used outside of fulminant disease. BEST PRACTICE ADVICE 5: Cholestyramine and other bile acid-binding agents should not be used as monotherapy or concurrently with oral vancomycin or fidaxomicin. Psyllium fiber can be used to bulk stools in patients who have recovered from the infection. BEST PRACTICE ADVICE 6: Following treatment of C difficile infection, clinicians should not perform routine test of cure. Stool testing should only be performed for persistent worsening of diarrheal symptoms. BEST PRACTICE ADVICE 7: First C difficile infection recurrence (second episode) within 8 weeks of completing anti-C difficile infection therapy should be treated with either a tapering course of vancomycin or fidaxomicin. Treatment of C difficile infection should include a risk assessment for C difficile infection recurrence and consideration of microbiota restoration therapy to prevent recurrence. BEST PRACTICE ADVICE 8: Fecal microbiota-based therapies (fecal microbiota spores, live-brpk, fecal microbiota, live-jslm, or conventional fecal microbiota transplant) should be offered after treatment of a second recurrence (third C difficile infection episode). Microbiota restoration therapy may be considered after treatment of an initial infection or first recurrence in patients who are at high risk for further recurrence or in patients whose initial C difficile infection episode was particularly morbid or difficult to treat. BEST PRACTICE ADVICE 9: Prolonged, low dose, suppressive vancomycin regimen (125 mg daily) for secondary prophylaxis may be considered in patients with multiple recurrent episodes who are not candidates for fecal microbiota-based therapies due to ongoing comorbidities, limited life expectancy, or ongoing/frequent systemic antibiotics or who have failed multiple courses of fecal microbiota-based therapy. BEST PRACTICE ADVICE 10: Fulminant C difficile infection should be managed by a multidisciplinary team (gastroenterology/infectious disease, surgery, medicine/critical care) and treated with high-dose vancomycin 500 mg every 6 hours (oral or enteral), with metronidazole 500 mg intravenously every 8 hours, and if ileus is present, rectal vancomycin 500 mg every 6 hours should be added. BEST PRACTICE ADVICE 11: Multi-dose fecal microbiota transplantation (fresh-directed donors, or institutional stool banks) delivered via lower endoscopy, should be considered in individuals with fulminant C difficile infection. Fecal microbiota, live-jslm (Rebyota), and fecal microbiota spores, live-brpk (Vowst) have not been studied and are not approved for treatment of severe and/or fulminant C difficile infection. Due to high risk of C difficile infection recurrence, patients who recover from severe or fulminant C difficile infection should be maintained on a suppressive vancomycin regimen until a final fecal microbiota transplantation can be administered as an outpatient. BEST PRACTICE ADVICE 12: Use of vancomycin is not advised during systemic antibiotic administration to prevent C difficile infection. Probiotics are not advised to prevent an initial or recurrent C difficile infection. To promote restoration of healthy gut microbiota, patients should be instructed to consume a healthy diet including a variety of fruits and vegetables, rich in both soluble and insoluble fiber. BEST PRACTICE ADVICE 13: During the treatment of C difficile infection or the prevention of its recurrence, the use of proton pump inhibitors should be evaluated. If a legitimate indication exists for their use, proton pump inhibitor discontinuation is not necessary. BEST PRACTICE ADVICE 14: Individuals with a history of C difficile infection should be specifically counseled to avoid unnecessary antibiotic therapy.

A portal cavernoma is a network formed by localized dilation of the hepatic portal system. This study aims to describe a case of portal cavernoma in a 69-year-old adult presenting with gastrointestinal hemorrhage. This is a 69-year-old patient with no particular medical history admitted for hematemesis associated with diffuse abdominal pain. Clinical examination revealed blood pressure of 100/60 mmHg and tenderness in the epigastric region. Upper gastrointestinal endoscopy revealed a large bulbar ulcer in flare-up. Helicobacter pylori testing in stool samples was positive. The initial diagnosis was a bulbar ulcer, and the patient was placed on treatment to eradicate H. pylori. However, an abdominal ultrasound performed later suggested heterogeneous portal vein thrombosis, which was confirmed by abdominal CT scan. Given these findings, we made a diagnosis of portal cavernoma revealed by gastrointestinal hemorrhage. Treatment consisted of 40 mg of injectable omeprazole every 12 h, 40 mg of propranolol per day, and one sachet of Gaviscon every 8 h. Anticoagulation was initiated with enoxaparin and then continued with 4 mg of acenocoumarol per day. The patient responded well to treatment, with regression of abdominal pain and gastrointestinal hemorrhage, and was discharged home after 10 days following two stable INR readings. Although most commonly described in pediatrics, this clinical case sheds light on adult forms of the disease.

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.

Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy. We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1. A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio&#xa0;=&#xa0;0.76, 95% confidence interval 0.68-0.84; p&#xa0;<&#xa0;0.00001) and injection pain (risk ratio&#xa0;=&#xa0;0.16, 95% confidence interval 0.09-0.26; p&#xa0;<&#xa0;0.00001) compared with propofol. No significant differences were observed between the two agents in the incidence of bradycardia, hypoxemia, and postoperative nausea and vomiting. Regarding efficacy outcomes, ciprofol was associated with a longer time to loss of consciousness compared with propofol (mean difference&#xa0;=&#xa0;4.67 seconds, 95% confidence interval 0.65-8.70; p&#xa0;=&#xa0;0.02), while no significant differences were observed in anesthesia success rate, procedure completion rate, and awakening time. Based on the currently available evidence from randomized trials conducted in China, ciprofol showed comparable efficacy to propofol and was associated with lower incidences of hypotension and injection pain in older patients. These findings may still be informative for anesthetic management in broader settings, although further validation is needed. PROSPERO registration number: CRD420251179366.

Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasia but remains technically demanding because of limited traction, lack of triangulation, and high operator workload, contributing to a steep learning curve. We evaluated a novel endoluminal robotic platform designed to provide surgical-like bimanual triangulation, stable traction/counter-traction, and improved ergonomics while preserving compatibility with standard gastroscopes. The robotic system (Intilume System, Agilis Robotics, Hong Kong, SAR) uses an external positioning cart to drive two 3.5-mm flexible robotic instruments mounted onto a native gastroscope via a cap-and-sheath interface and controlled by compact pen-style motion-tracking controllers enabling seated operation. Available instruments included a bipolar T-knife and a tissue grasper. In a randomized crossover ex vivo porcine stomach study, two gastroenterology fellows without prior ESD experience and two interventional endoscopy fellows with early experience each performed four ESDs (two robotic, two conventional), for a total of 16 procedures. Outcomes included en bloc resection, procedure time, specimen surface area, dissection speed, tissue injury, and operator workload assessed using NASA-TLX, with exploratory OSATS and GEARS evaluations. All procedures were completed (8 robotic, 8 conventional). Robotic ESD achieved 100% en bloc resection versus 75% with conventional ESD (p&#x2009;=&#x2009;0.47), was significantly faster (14.1&#x2009;&#xb1;&#x2009;4.3 vs 21.6&#x2009;&#xb1;&#x2009;7.6&#xa0;min; p&#x2009;=&#x2009;0.028), and demonstrated higher dissection speed (36.5&#x2009;&#xb1;&#x2009;23.4 vs 16.3&#x2009;&#xb1;&#x2009;10.1 mm2/min; p&#x2009;=&#x2009;0.05). No muscular injuries occurred with robotic ESD compared with 5/8 conventional cases; no full-thickness injuries occurred. Operator workload was markedly lower with robotic ESD (NASA-TLX 34.7&#x2009;&#xb1;&#x2009;24.1 vs 75.0&#x2009;&#xb1;&#x2009;15.4; p&#x2009;=&#x2009;0.002). In a randomized ex vivo model, a bimanual endoluminal robotic platform compatible with standard endoscopes demonstrated promising improvements in ESD efficiency, tissue control, and operator ergonomics compared with conventional ESD. These preliminary findings support further development and progression to first-in-human feasibility evaluation, with potential to facilitate ESD skill acquisition pending clinical validation.

Dieulafoy's ulcer is a rare but potentially fatal vascular malformation characterized by the presence of an abnormally large submucosal arteriole that erodes the overlying mucosa without an identifiable primary ulceration. Its duodenal location is exceptional. We report the case of a 76-year-old patient with multiple comorbidities, admitted to the emergency department of the Avicenne Military Hospital in Marrakech for melena that had been progressing for four days, accompanied by severe anemia (Hb 5.4 g/dL). An upper gastrointestinal endoscopy (EGD) revealed a Dieulafoy's lesion in the second part of the duodenum (D2), with spontaneous, diffuse bleeding and no visible ulceration. Endoscopic hemostasis was achieved by injection of adrenaline (6 cc) followed by the placement of two hemostatic metal clips, with a good clinical outcome.

Standard forceps biopsies often provide insufficient cellular yield for single-cell and spatial transcriptomic analyses. We assessed the feasibility of cold-snare resection in inflammatory bowel disease (IBD) and compared immune cell composition with standard forceps biopsies. Patients with active IBD at endoscopy were included. One cold-snare resection and two standard biopsies were obtained from inflamed mucosa in the ileum, colon or rectum. Sample quality and cell yield were evaluated using histology staining and flow cytometry. Adverse events (AEs) were recorded peri-procedurally, at a 7-day follow-up, and up to 30 days. Thirty-four patients with IBD were included. Cold-snare resection was successful in all cases and yielded significantly higher number of T-cells (median 71&#xd7;103 vs. 17&#xd7;103, p=0.016) and rare innate lymphoid cells (median 576 vs. 127, p=0.016) compared with standard forceps biopsies. Four mild AEs were reported. Cold-snare resection improves mucosal tissue integrity and cellular quality compared with standard biopsies, supporting its use for translational studies in IBD.

"July effect" also known as "July phenomenon" are adverse patient outcomes related to the changeover of medical residents in teaching hospitals in the United States at a particular time of the year. This study aims to explore this phenomenon on hospital outcomes among patients with nonvariceal upper gastrointestinal bleeding (UGIB). The National Inpatient Sample data from Jan 1, 2016, to Dec. 31, 2020, was used. Patients admitted in teaching hospitals between May and August were stratified patients into two groups; May & June; as (Non-July Effect), July & August as (July Effect). The study involved a comprehensive assessment and comparison of various clinical outcomes, including the likelihood of mortality, length of hospital stay, and the utilization and timing of esophagogastroduodenoscopy (EGD). These analyses were conducted while controlling factors such as socio-demographic variables, hospital characteristics, and associated comorbidities to ensure accurate and meaningful results. A total of 53,710 patients had non-variceal UGIB. There is no significant difference in Mortality risk (aOR&#x2009;=&#x2009;1.10, 95% CI: 0.86-1.40, p&#x2009;=&#x2009;0.4406), Length of hospitalization (0.98, 0.91-1.05, p&#x2009;=&#x2009;0.5410), EGD (1.04, 0.94-1.32, p&#x2009;=&#x2009;0.4412), and Early EGD (0.97, 0.80-1.19, p&#x2009;=&#x2009;0.7759) between the July effect and non-July effect groups. The analysis reveals no significant differences in mortality rates, length of hospitalization, or endoscopy and its timing among patients with UGIB during the July effect compared to those not affected by this phenomenon. Our study corroborates previous research on the July phenomenon while also exploring this phenomenon in upper gastrointestinal bleeding.

Saudi Arabia has a high obesity rate (> 35%), increasing the risk of gastroesophageal reflux disease (GERD) and presents major health risks. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery that reduces mortality. Controversies exist regarding the recommended meal frequency following bariatric surgery, as some patients experience increased GERD symptoms postoperatively. In this study, we describe the association between meal frequency and GERD at least one year after LSG. We conducted a retrospective cohort study based on data collected from electronic medical records over a six-year period (2016-2022) at a private gastroenterology clinic in the Kingdom of Saudi Arabia. Clinical, endoscopic, and radiological examinations of the upper gastrointestinal tract were reviewed as indicated. Paired-sample t-tests and two-way analyses of variance (ANOVA) were performed. The study included 109 participants (62 women, 47 men) aged 17-66 years, mostly Saudi Arabian. All patients lost weight, with Body mass index (BMI) decreasing from 46.37 to 31.24&#x2005;kg/m2. Primary complaints were heartburn (77.1%), epigastric pain (70.6%), retrosternal burning (50.5%), nausea (35.8%), and vomiting (30.3%). Only 15.6% had a history of preoperative endoscopy. Typical long-term daily postoperative meal patterns were 1-2 meals (43%), 3-4 meals (28.4%), 5-6 meals (8.2%), and more than six meals (4.6%). Most patients with RO consumed 1-2 meals (19.2%) or 3-4 meals (15.6%), compared to 5-6 meals (4.6%) and over six meals (0.9%). No significant association was observed between meal frequency and RO (p&#x2009;=&#x2009;0.09, 0.24, 1.00). Large daily meals, with few frequent meals that meet daily caloric requirements, did not show statistically significant association with reflux oesophagitis (RO).

Extraforaminal lumbar disc herniations and foraminal stenosis are challenging due to nerve root proximity. Conventional lateral transforaminal endoscopy requires a long oblique trajectory and is obstructed by the iliac crest at L5-S1. We describe a full-endoscopic monoportal Wiltse paraspinal technique with inferior foraminal docking and its preliminary outcomes. Ten consecutive patients (4 women, 6 men; mean age 61.1 years, range 50-76) were prospectively analyzed between September and December 2025. Pathologies comprised 7 extraforaminal disc herniations and 3 foraminal stenoses at L3-L4, L4-L5, and L5-S1 (2, 3, and 5 cases, respectively). Through a paraspinal incision 4-6&#x2009;cm from midline, dilatation of the multifidus-longissimus interval allows inferior bony docking on the caudal transverse process before foraminal recalibration. VAS leg/back pain, ODI, and satisfaction were assessed preoperatively and at 3 months. No intraoperative complication, conversion, or postoperative instability occurred. Mean VAS leg pain decreased from 7.9 to 2.8 (-65%); VAS back pain from 7.4 to 4.1; ODI from 55.2% to 28.7% (-48%). All 4 patients with preoperative neurological deficits improved. Satisfaction was very satisfied (4, 40%), satisfied (5, 50%), and undecided (1, 10%), yielding 90% satisfactory outcomes. At L5-S1, the iliac crest never obstructed the trajectory. The full-endoscopic monoportal Wiltse approach with inferior foraminal docking is a feasible, safe, and coherent technique for lateral lumbar disc pathology and foraminal stenosis. Its principal advantage is that it avoids the risk of exiting nerve root injury inherent to the percutaneous targeting of the transforaminal approach. These preliminary results support further prospective comparative studies.

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.

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.