搜索结果：Annals of gastroenterology

Immune-mediated diarrhea and colitis (IMDC) due to checkpoint inhibition infrequently presents with normal stool biomarkers and no endoscopic or histologic evidence of inflammation. Little is known about the treatment needs and outcomes of this subset of patients. We aimed to describe this entity and clarify the role of immunosuppressive treatments in its management. This was a single-center, retrospective study of patients treated with immune checkpoint inhibitors who developed clinical symptoms of IMDC, with no evidence of inflammation based on fecal calprotectin or endoscopic/histologic evaluation, between January 2010 and February 2024. Of 1151 patients with IMDC, 131 (11.4%) had no evidence of inflammation. These patients more frequently had PD-1/L1 agent exposure (P=0.019) and presented with less severe diarrhea than patients with evidence of inflammation (P<0.001). This group had a lower rate of hospitalization (P=0.003). Around 40% of patients with no evidence of inflammation required immunosuppressive treatment. There was no difference in clinical symptoms or severity between patients requiring immunosuppression and those who did not. Our study is the first to explore IMDC with no elevations in calprotectin and normal endoscopic/histologic findings. We found that PD-1/PD-L1 inhibition may predispose patients to developing this form of IMDC, which is associated with a lower severity of diarrhea, fewer hospitalizations and lower recurrence rates. Many patients still require immunosuppressive treatment, and a small subset later develop colonic inflammation. Future studies are needed to further elucidate the treatment needs and outcomes of this patient population.

Glucagonoma remains a very rare neuroendocrine tumor of the pancreas, accounting for 2% of all islet-cell carcinomas. The aim of this review is to highlight important aspects of pancreatic glucagonoma, including epidemiology, clinical presentation and diagnostic evaluation, and to elucidate the current therapeutic management of this nosologic entity. A combined automated and manual systematic search of the literature was performed using electronic search engines (Medline/PubMed, Scopus, Ovid and Cochrane Library), until April 2025. Glucagonoma originates from the a-cells of the pancreatic Langerhans islets. Its reported incidence is 1 in 20,000,000 per year. Typical clinical manifestations include necrolytic migratory erythema, diabetes mellitus (DM), weight loss and anemia, along with elevated serum glucagon levels. Other symptoms, such as venous thrombosis, neuropsychiatric findings known as 4D (dermatitis, DM, deep-vein thrombosis, depression), or diarrhea can also be present. Unfortunately, metastases are encountered in the majority of patients. Prompt diagnosis is usually accomplished by computed tomography and magnetic resonance imaging. The only treatment option is the surgical resection of the tumor. Conservative management, based on the administration of chemotherapy, somatostatin analogs, molecular targeted therapy and peptide receptor radionuclide therapy is also an alternative.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about potential aspiration risk during upper gastrointestinal (GI) endoscopy. We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1 RA therapy on procedural outcomes in patients undergoing upper GI endoscopy. We searched Medline and Cochrane library up to July 2025 without restrictions. Eligible studies evaluated patients undergoing upper GI endoscopy, comparing those taking GLP-1 RAs with those who were not. Outcomes of interest were the incidence of retained gastric contents (RGC), bronchopulmonary aspiration, and procedure discontinuation. Pooled estimates are expressed as odds ratios (ORs) with 95% confidence intervals (CIs), using a random-effects meta-analysis with inverse variance weighting. Twenty-four observational studies, predominantly retrospective, met the inclusion criteria: these comprised 184,707 participants, of whom 59,095 were taking GLP-1 RAs. Mean age was 58.7 years, 48.8% were women, and 51.2% had type 2 diabetes. Use of GLP-1 RAs was associated with higher rates of RGC (OR 4.82, 95%CI 3.66-6.35) and procedure discontinuation (OR 3.93, 95%CI 2.42-6.39) compared with control treatment. In contrast, the incidence of aspiration events was similar between groups (OR 1.1, 95%CI 0.84-1.48). Results remained consistent in a sensitivity analysis based on propensity score matching to control for confounders. GLP-1 RA therapy is associated with a greater incidence of RGC and higher rates of endoscopy termination, but not with a higher risk of aspiration. Adjusting the fasting duration, rather than routinely discontinuing GLP-1 RAs, may represent a reasonable management approach.

Fecal calprotectin (FC) has become an indispensable tool in everyday clinical practice for the diagnosis and management of inflammatory bowel disease (IBD). Nonetheless, specific and clear recommendations for its use are scarce. On behalf of the Hellenic Group for the Study of IBD (EOMIFNE), a group of experts have formulated 18 statements with the aim to provide evidence for the best use of FC and offer practical guidance in common clinical scenarios. Statements address issues for the proper application of FC measurement in the diagnostic workup of patients with gastrointestinal symptoms, and as a screening tool for the management of established IBD, including pediatric patients. Thus, the present manuscript aims to propose a standardized approach for the optimal use of FC in patient care, also taking into account non-medical concerns.

Small bowel adenocarcinoma (SBA) is a rare and serious complication of Crohn's disease (CD), with symptoms often mimicking CD-related symptoms. Therefore, preoperative diagnosis of SBA is difficult, since conventional imaging is rarely diagnostic. This study aims to evaluate the utility of imaging and endoscopic modalities in detecting SBA among patients with CD. A retrospective review of medical records from a multi-institutional tertiary care center was conducted. ICD-10 codes were used to identify patients with CD who were diagnosed with SBA between January 1, 2019, and November 24, 2024. Of 92 patients identified, 36 met the inclusion criteria. Twenty-one (58.3%) were male, and 35 (97.2%) were Caucasian. The median age at SBA diagnosis was 61 years, with a median 19-year interval from initial CD diagnosis to SBA diagnosis. Thirty-one patients (86.1%) had preoperative imaging, but only 7/31 (22.6%) had findings that raised concern for malignancy. Eight (22.2%) of the patients who underwent endoscopy were diagnosed with SBA or dysplasia on endoscopic biopsy; 18 cases were discovered incidentally during surgery. Sixteen patients (44.4%) had stage III or IV cancer at diagnosis, and 18 patients (50.0%) achieved oncologic remission. Among patients with CD diagnosed with SBA, a large proportion of imaging and endoscopic studies failed to suggest malignancy. Given the substantial proportion of patients diagnosed at advanced stages, and the associated poor outcomes, a high index of suspicion and multimodal evaluation could improve the diagnostic yield in long-standing CD patients with new or changing symptoms.

Cholecystectomy (CCY) may alter bile acid flow and gut microbiota, increasing the risk of gastrointestinal disease. Prior studies have suggested that CCY may be associated with bile acid diarrhea and microscopic colitis; however, the association with the new diagnosis of inflammatory bowel disease (IBD) remains unstudied. In this study, we evaluated whether CCY was associated with a greater risk of de novo IBD. We conducted a retrospective cohort study, analyzing data from the TriNetX network (2010-2024), using 1:1 propensity score matching between adult patients undergoing CCY and controls, based on variables that included demographics, comorbidities and medication use. The primary outcome was risk of de novo IBD. Secondary outcomes included the risk of developing ulcerative colitis (UC) or Crohn's disease (CD). Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to compare time-to-event rates. Among 570,317 matched pairs, CCY was associated with a greater risk of IBD (adjusted HR [aHR] 1.29, 95%CI 1.22-1.35; P<0.001), and specifically CD (aHR 1.83, 95%CI 1.69-1.99; P<0.001), but not the risk of UC. This elevated risk persisted across both sexes and all age groups. Among patient characteristics, tobacco use was associated with the greatest additional risk of IBD post-CCY (aHR 1.43, 95%CI 1.19-1.76; P<0.001). Prior CCY is associated with a greater risk of CD but not UC. These findings support the need for a low threshold to think about CD in patients with gastrointestinal symptoms after CCY.

The human gut microbiome represents a complex and dynamic ecosystem that is central to maintaining health and preventing disease. Defining a "normal" gut microbiome remains challenging, given the significant variability arising from host physiology, lifestyle, genetics, geography and environmental exposures. This review synthesizes current evidence regarding the composition and functions of the gut microbiota in healthy individuals from diverse populations. At the taxonomic level, healthy gut microbial communities are typically dominated by the phyla Firmicutes and Bacteroidetes, with additional contributions from Actinobacteria and Proteobacteria. However, substantial inter-individual and regional differences are observed, such as a higher prevalence of Prevotella in populations consuming fiber-rich Eastern diets, and greater Bacteroides abundance in Western cohorts. Anatomical location and health status also influence alpha-diversity, underscoring the need to interpret diversity metrics within context. Furthermore, the gut microbiome performs essential functional roles across multiple organ systems, including fermentation of dietary fibers into short-chain fatty acids, regulation of immune responses, modulation of the gut-brain axis, maintenance of intestinal barrier integrity, and support of cardiovascular and hepatic functions. These findings support the conceptualization of the microbiome as a multifunctional organ system that integrates host and environmental signals. In summary, a healthy gut microbiome is best understood as a dynamic equilibrium, characterized by functional resilience and adaptability, rather than a fixed microbial profile. Interpreting this variability is crucial for developing targeted interventions to prevent disease.

Primary biliary cholangitis (PBC) is an autoimmune epithelitis of small intrahepatic bile ducts that affects predominately females, and is characterized by chronic cholestasis, circulating PBC-related autoantibodies, and progressive disease at the histological level. Key manifestations include pruritus, fatigue, hyperpigmentation, dry-gland syndrome, xanthelasmas and frequent concurrent extrahepatic autoimmune diseases, although approximately half the patients are nowadays completely asymptomatic at diagnosis. The current Consensus Statements of the Hellenic Autoimmune Liver Diseases Study Group aim to provide updated and practical statements to clinicians for PBC diagnosis and management. The presence of antimitochondrial antibodies is a key diagnostic marker for PBC. PBC-specific antinuclear antibodies (anti-gp210 and anti-sp100) also bear diagnostic and prognostic significance. Following diagnosis, this document provides guidance on the comprehensive assessment and risk stratification of patients, using demographic factors, clinical and biochemical laboratory findings, liver autoimmune serology and fibrosis stage. After 6-12 months of therapy with first-line treatment (13-15 mg/kg/day ursodeoxycholic acid [UDCA]), a new risk-stratification procedure should be performed, based on the assessment of biochemical response using a continuous scoring system (either GLOBE or UK-PBC score). In non-responders, add-on treatment to UDCA with a second-line agent, a proliferator-activated receptor agonist (PPAR), either elafibranor (PPAR&#x3b1;/&#x3b4; agonist) or seladelpar (PPAR&#x3b4; agonist), is recommended. The treatment target-also known as deep response-should aim to achieve bilirubin within the normal range, specifically at values <0.6&#xd7; upper limit of normal, along with normalization of alkaline phosphatase. The disease-associated major symptoms (pruritus, fatigue and cognitive dysfunction) should also be promptly recognized and managed in a holistic manner, as they negatively affect the patient's health-related quality of life.

Autoimmune liver diseases, including primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH), are rare chronic conditions with significant morbidity. However, population-based epidemiological data from Latin America remain limited. This study aimed to describe the geographic distribution and demographic patterns of PBC and AIH in Colombia between 2018 and 2024. A descriptive, cross-sectional population-based study was conducted using data from the Comprehensive Social Protection Information System (SISPRO) of the Colombian Ministry of Health. Individuals with at least 1 recorded diagnosis coded as K74.3 (PBC) or K75.4 (AIH) according to the International Classification of Diseases, 10th Revision (ICD-10), were identified. Administrative prevalence estimates were calculated per 100,000 population, using official population projections from the National Administrative Department of Statistics (DANE). Age- and sex-specific distributions were analyzed, and geographic variation was visualized using choropleth maps at the regional level. A total of 6504 PBC cases and 11,225 AIH cases were identified. The estimated national administrative prevalence was 14.7 per 100,000 population for PBC and 17.0 per 100,000 for AIH. Both conditions showed marked female predominance. PBC was more frequent in women aged 50-69 years. However, AIH demonstrated a broader age distribution, affecting individuals from young adulthood to older age. Higher prevalence estimates were observed in multiple northern regions, particularly in the Caribbean region. This first nationwide administrative assessment of PBC and AIH in Colombia demonstrates marked sex differences and regional variation, highlighting the need to improve diagnostic awareness and strengthen epidemiological surveillance of autoimmune liver diseases in Latin America.

Hemorrhoids arise from dilated vessels in the submucosal layer of the anorectal canal. Hemorrhoids are responsible for 4 million office and emergency visits annually in the US. Hemorrhoidal energy therapy (HET) is a novel nonsurgical, bipolar energy-based instrument for treating hemorrhoids. It has multiple benefits, such as requiring only a single session for resolution of symptoms, and minimizing heat-related collateral damage. However, there are limited data regarding the effectiveness and adverse events of HET. We performed the first systematic review to evaluate the efficacy and safety of HET in the treatment of internal hemorrhoids. A comprehensive search was performed from major databases to identify studies that investigated HET to treat hemorrhoids. The primary outcomes were technical success and clinical success. The secondary outcomes were total adverse events and individual adverse events, such as postprocedural bleeding and incontinence. Eight studies with 512 patients were included in the meta-analysis. The average age was 55.6 years, and the majority of patients were female. Most patients presented with grade I and grade II hemorrhoids. The HET demonstrated technical and clinical success rates of 100% and 86.1%, respectively. All adverse events were determined to be mild, according to the ASGE lexicon, except for 1 case of perianal hematoma that required hospitalization. Our study demonstrates that HET is an effective and safe treatment for grade I and II internal hemorrhoids.

Metformin has been reported to be effective as an adjunctive therapy in cancer treatment. In this study, the synergistic effects of metformin and radiotherapy were investigated in colorectal cancer cell lines and colorectal cancer organoids, as were the underlying mechanisms. This was an experimental study conducted in vitro. Cell proliferation was investigated in vitro after treatment of colorectal cancer cell lines with metformin and radiation. Western blotting was used to analyse treatment-induced changes in p53 expression. The combination index for metformin and irradiation was calculated. Organoids were generated via genomic analysis of colorectal cancer cells from surgical specimens from patients with colorectal cancer. Responses of colorectal cancer organoids with and without p53 mutations to metformin and radiation were compared. Organoids cultured from human colorectal cancer and cell lines were used. In experiments using the colorectal cancer cell lines HCT116 and Lovo, which are p53 wild type cells, the combination treatment of metformin and irradiation appeared to have a synergistic effect. In HCT116 and Lovo cells, metformin treatment increased TP53 expression. No synergistic effect of metformin treatment and irradiation was demonstrated in WiDr and SW620 cells, which contain p53 mutations. Measurements of cell proliferation rates in colorectal cancer organoids also confirmed a similar trend in p53 wild-type organoids and those with p53 mutations. Mutations in the p53 gene in colorectal cancer cells may influence the synergistic effect of metformin and radiotherapy.

Single-incision laparoscopic surgery (SILS) has emerged as a refinement of minimally invasive techniques, offering potential cosmetic and postoperative recovery benefits. This review aimed to evaluate the current evidence regarding the safety, feasibility, and outcomes of SILS for ileal J-pouch-anal anastomosis (IPAA). A structured literature search was performed in PubMed for studies published between January 2010 and January 2025, focusing on adult and pediatric patients undergoing restorative proctocolectomy with IPAA performed through a single incision. Twenty-two studies were identified, encompassing 182 procedures. The mean operative time ranged from 144-284 min. Reported conversion to multiport laparoscopy or open surgery occurred in 3.9% of cases, while the mean estimated blood loss varied from 27-136 mL. The median length of hospital stay was 4 days in most studies. Major postoperative complications (Clavien-Dindo grade &#x2265;III) occurred in approximately 9% of patients, most commonly small-bowel obstruction or anastomotic leak. Cosmetic satisfaction and postoperative pain scores were generally favorable, although long-term functional outcomes were rarely reported. SILS-IPAA appears feasible and safe in selected patients, particularly when performed by experienced surgeons familiar with conventional laparoscopic restorative proctocolectomy. The current literature is heterogeneous and limited by small sample sizes and overlapping institutional data. Further comparative studies, especially in the context of robotic platforms, are needed to define the role of SILS in modern pouch surgery.

Abdominal bloating, distension, excessive gas, abdominal pain, diarrhea and constipation are common symptoms that may arise from carbohydrate malabsorption, carbohydrate intolerance, small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO), or disorders of gut-brain interaction. Hydrogen- and methane-based breath tests are safe, noninvasive, inexpensive and widely used, but differences in indications, patient preparation, test performance and interpretation can lead to inconsistent diagnoses and management. At the recommendation of the Israeli Gastroenterology Association, a multidisciplinary panel of adult and pediatric gastroenterologists, neurogastroenterologists, dietitians, clinical nutrition specialists and heads of gastrointestinal laboratories reviewed the literature and reached consensus during 8 meetings. This guideline provides practical standards for breath testing in adults and children. The panel recommends simultaneous measurement of hydrogen and methane, structured symptom recording during testing, standardized pretest preparation, and cautious interpretation in settings that alter anatomy or orocecal transit time. Lactulose is recommended as the preferred substrate for SIBO/IMO testing, with glucose as an acceptable alternative. Carbohydrate malabsorption should be distinguished from intolerance by the presence or absence of typical symptoms during the test. The guideline also defines suspected hypersensitivity and highlights methane production as a cause of false-negative hydrogen-based carbohydrate tests. These recommendations are intended to harmonize breath test practice and reporting, and to support rational, test-directed treatment in adult and pediatric patients.

Subclinical hepatic encephalopathy (SHE) is considered an early stage of clinical encephalopathy and has been associated with shortened lifespan and increased healthcare-associated burden. We aimed to assess the prevalence of SHE in patients with cirrhosis and to elucidate the potential factors related to its occurrence. Thirty consecutive patients with cirrhosis were evaluated between March and July 2017. The exclusion criteria included overt hepatic encephalopathy, recent gastrointestinal hemorrhage, neurological disease, and the use of lactulose or non-absorbable antibiotics. After exclusion, 23 patients were included in this study. Twenty healthy age- and sex-matched controls were also included. SHE was assessed using the number connection test (NCT) and the inhibitory control test (ICT). The NCT completion time was significantly longer in cirrhotic patients than in controls (77&#xb1;45 vs. 27&#xb1;6 sec, P<0.001), with 78.3% of cirrhotic patients showing abnormal results. ICT correct target recognition was also significantly lower in cirrhotic patients (18.5&#xb1;21.8% vs. 56.2&#xb1;15.8%, P<0.001), with 60.9% showing abnormal results. By combining NCT and ICT, 39.1% of patients with cirrhosis were diagnosed with SHE. No significant associations were detected between the Child-Turcotte-Pugh class or baseline parameters and the presence of SHE. At the 3-month follow up, the SHE diagnosis remained consistent, with 66.7% of those diagnosed at baseline still exhibiting SHE. SHE is prevalent in patients with cirrhosis and significantly affects cognitive and psychomotor abilities. Although the study sample was small, these findings highlight the necessity of regular psychometric testing in cirrhotic patients to identify and manage SHE.

Informal caregivers of individuals with inflammatory bowel disease (IBD) face unpredictable responsibilities that may compromise their health. While caregiver burden and psychological distress are well-documented, little is known about caregivers' self-care practices and their determinants. A multicenter cross-sectional study was conducted across 9 Italian IBD Units between April and June 2024. Caregivers completed validated measures of self-care (Self-Care of Informal Caregivers Inventory), caregiver burden (Zarit Burden Interview), and psychological distress (Depression Anxiety Stress Scales-21). Logistic regression models were used to identify predictors of inadequate self-care behaviors. A total of 229 caregivers were included (mean age 52.2&#xb1;13.6 years; 59% women). Adequate self-care was high for routine behaviors such as daily hygiene (98.7%) and regular meals (87.8%), but low for emotionally and socially demanding behaviors, including professional counseling (18.3%), asking for assistance (12.2%), and accepting help (20.6%). Being unpartnered was associated with a higher likelihood of inadequate physical activity (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.32-4.17). Higher anxiety was related to inadequate attention to bodily discomfort (OR 1.32, 95%CI 1.11-1.56), whereas higher caregiver burden and depression were associated with a lower likelihood of inadequate emotional wellbeing strategies (OR 0.97, 95%CI 0.95-0.99), and inadequate help-seeking (OR 0.80, 95%CI 0.68-0.93), respectively. Caregivers maintain basic health habits but show marked vulnerabilities in emotional and social self-care domains. Psychological distress and relational factors play a key role, underscoring the need for caregiver-centered interventions that promote emotional wellbeing, resilience, and help-seeking.

Pembrolizumab is a monoclonal antibody that targets the programmed cell death-1 (PD-1) protein. Blocking this pathway alters T-cell activity, and has been approved for the treatment of several malignancies, including microsatellite instability-high (MSI-H) and mismatch repair-deficient (dMMR) colorectal cancers. The aim of this study was to evaluate the effect of pembrolizumab on colonic anastomotic healing in a rat model. Sixty male Wistar rats were randomly divided into 2 groups of 30: a control group, and an experimental group receiving pembrolizumab. Each group was further divided into 3 subgroups of 10 rats, sacrificed on postoperative day (POD) 3, 7 or 14. All animals underwent laparotomy, a 1-centimeter segmental colectomy, and an end-to-end colonic anastomosis. Postmortem evaluation included measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological assessment. Statistically significant differences in bursting pressure (P=0.019) and rupture site (P=0.033) were observed between the groups on POD 7. Tissue hydroxyproline levels were significantly lower in the pembrolizumab-treated subgroups on POD 7 (P=0.003), and POD 14 (P=0.001). Histopathological analysis demonstrated significant differences on POD 3, in neovascularization (P=0.026), fibroblast ingrowth (P=0.005), and collagen deposition (P=0.030), suggesting impaired inflammatory-phase healing. This experimental study suggests that a high single dose of pembrolizumab may negatively affect colonic anastomotic healing in rats. Further studies are necessary to determine the safety of intestinal anastomosis in both emergency and elective clinical settings.

Sleeve gastrectomy has consistently been linked to gastroesophageal reflux disease and Barrett's esophagus. At the same time, the long-term effects of glucagon-like peptide-1 receptor agonists, particularly short-acting agents such as liraglutide, are less well understood. We compared the incidence of Barrett's esophagus and esophageal cancer among patients treated with liraglutide vs. those who underwent sleeve gastrectomy. We conducted a retrospective cohort study using a large electronic health record database. Adults with obesity treated with liraglutide were compared to those who underwent sleeve gastrectomy. Propensity score matching was used to balance demographics, comorbidities, medication use and body mass index. The primary outcome was the incidence of Barrett's esophagus without dysplasia diagnosed 3 years or more after treatment. Secondary outcomes involved esophageal cancer and Barrett's esophagus with dysplasia. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. We analyzed 10,048 sleeve gastrectomy and 10,048 liraglutide patients. Barrett's esophagus without dysplasia was more frequent in the sleeve (0.3%) than in the liraglutide (0.1%) group, with a risk difference of 0.2% (95%CI 0.1-0.3%) and RR 2.70 (95%CI 1.31-5.56). Barrett's esophagus with dysplasia was also more common in the sleeve group (0.1% vs. 0%). No significant difference in esophageal cancer was observed. Sleeve gastrectomy is associated with a higher risk of Barrett's esophagus compared to liraglutide, though esophageal cancer rates did not differ. Liraglutide may offer a safe option for patients at risk of esophageal complications.

Appendiceal neuroendocrine neoplasms (aNENs) represent an increasingly recognized and heterogeneous subset of gastroenteropancreatic neuroendocrine tumors (NETs), most often identified incidentally on appendectomy specimens. Postoperative management relies on accurate risk stratification grounded in histopathological assessment and aligned with major international guidelines (WHO, ENETS), which distinguish between well-differentiated NETs (NET grades 1 to 3) and poorly differentiated neuroendocrine carcinomas. Critical prognostic determinants shaping therapeutic decision-making include tumor size, proliferative index (Ki-67), depth of invasion-particularly mesoappendiceal involvement-and lymphovascular invasion (LVI). Consensus recommendations suggest simple appendectomy as definitive treatment for low-risk tumors (<1 cm) and right hemicolectomy for high-risk lesions (>2 cm) or those exhibiting LVI. However, the management of intermediate-sized aNENs (1.0-2.0 cm) remains the principal area of clinical uncertainty, with emerging data suggesting that appendectomy alone may be sufficient for carefully selected patients without adverse pathological factors. This review synthesizes and critically appraises the most recent evidence and international guidelines with the goal of refining current clinical practice. In particular, it provides an updated framework for individualized risk stratification, evaluates the balance between oncological benefit and procedural morbidity in determining the optimal surgical approach, and outlines evidence-based surveillance strategies to support a more consistent, risk-adapted multidisciplinary management of aNENs.

Ulcerative colitis (UC) carries an increased risk of colorectal carcinoma (CRC) through the inflammation-dysplasia-carcinoma sequence. Recently, several nonconventional dysplastic subtypes have been recognized, often lacking classical features and posing diagnostic challenges. This retrospective study evaluated dysplasia frequency and patterns in UC patients using archival colonoscopic biopsy specimens from the Pathology Laboratory at Ain Shams University Hospitals between 2020 and 2024. A total of 694 patients with histologically confirmed UC were included. For each patient, 1 representative colonoscopic biopsy was evaluated: the most recent biopsy from the most distal colonic site when multiple biopsies were available. This specimen was reviewed histologically, regardless of whether dysplasia had previously or concurrently been diagnosed at another site. Based on this standardized approach, 203 of the 694 patients (29.3%) were found to have dysplasia, including 88 patients (43.3%) with conventional dysplasia and 115 patients (56.7%) with nonconventional dysplasia. The most common nonconventional subtype was dysplasia with increased Paneth cell differentiation (48.7%), followed by hypermucinous dysplasia (19.1%), crypt cell dysplasia (18.3%), goblet cell-deficient dysplasia (11.3%), and serrated dysplasia variants (2.6%). Over 87% of nonconventional dysplastic lesions presented endoscopically with flat/invisible appearance; however, serrated dysplasia subtypes represented an exception, as all serrated lesions in our cohort were polypoid. Patients with nonconventional dysplasia were significantly younger (median 29.5 vs. 35 years for conventional dysplasia, P=0.015). Nonconventional dysplasia is frequent in UC, and often presents endoscopically with flat/invisible appearance. Pathologists should recognize and report these subtypes to improve surveillance accuracy.