搜索结果：Hepatology (Baltimore, Md.)

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Colorectal carcinoma (CRC) remains a leading cause of cancer mortality, largely due to metastasis. Solid tumors, including CRC, must adapt to intratumoral hypoxia and oxidative stress, but the tumor-cell programs that couple these pressures to metastatic competence remain unclear. Across human CRC cohorts and cell lines, HIF-1α was coordinately upregulated and co-expressed with the metabolic effectors GLUT3 and fatty-acid synthase (FASN), most prominently in metastatic lesions. Using HIF-1α (HRE), SREBP1 (SRE), and NRF2 (ARE) transcriptional reporters, we identified HRE-high and SRE-high CRC subpopulations with enhanced clonogenicity and invasion that drove accelerated tumor growth and increased lung metastatic burden across multiple CRC models. Mechanistically, IGF1 and insulin signaling through IGF1R and AKT-mTOR increased HIF-1α and induced FASN and GLUT3, enabling lipogenic, glycolytic, and antioxidant programs to withstand hypoxic and oxidative stress. HIF-1α engaged an HRE-containing proximal region of the human FASN promoter independently of SREBP1. Stress assays revealed functional specialization: FASN promoted NRF2-associated antioxidant capacity and resistance to oxidative injury, whereas GLUT3 preferentially supported hypoxia tolerance. In vivo, lipid nanoparticle-encapsulated echinomycin rapidly suppressed HRE, SRE, and ARE activity, reduced peri-hypoxic induction of FASN and GLUT3, inhibited tumor growth, and eliminated lung metastasis. These findings define a growth factor-responsive, HIF-1α-centered stress-adaptive state and highlight HIF-1α transcriptional activity as a therapeutic target in metastatic CRC.

Liver transplantation (LT) remains the only definitive treatment for end-stage liver disease and selected hepatic malignancies. However, persistent organ shortages continue to drive high waitlist mortality worldwide. Hepatitis B virus (HBV)-positive donors, including hepatitis B surface antigen (HBsAg)-positive and anti-hepatitis B core antibody-positive (HBsAg-negative) donors, represent an increasingly important but historically underused resource. The introduction of high-barrier nucleos(t)ide analogs, the selective use of hepatitis B immunoglobulin, and pre- and posttransplant vaccination have markedly reduced viral transmission, enabling safe transplantation in both HBV-immune and selected HBV-naive recipients. Regional guidelines and consensus statements, including those from the American Society of Transplantation, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, and Asian Pacific Association for the Study of the Liver, support individualized, risk-directed prophylaxis and posttransplant surveillance. Ethical considerations, particularly informed consent and risk-benefit discussions in the setting of organ scarcity, remain central to clinical decision-making. Large cohort studies demonstrate comparable graft and patient survival with HBV-negative grafts, along with economic advantages and expansion of the donor pool. However, evidence in HBV-naive recipients remains limited, with most data derived from immune or previously infected recipients, highlighting the need for careful patient selection and robust prophylaxis. Available evidence on the use of HBsAg-positive donors in HBV-naive recipients is obtained predominantly from cadaveric donor transplantation, as experience with HBsAg-positive living donors remains limited. This narrative review summarizes current evidence on the use of HBsAg-positive grafts in LT, with a focus on HBV-naive recipients, based predominantly on cadaveric donor experience.

Zinc (Zn) is an essential micronutrient whose concentration and location are tightly regulated by Zn transporters. Mycobacterium tuberculosis (M.tb) resides in macrophage phagosomes, where it requires access to micronutrients, including Zn. Our data show that ZIP8 is the only Zn transporter in human macrophages highly induced by M.tb and is enriched at the M.tb phagosome. Using human and murine macrophages and mice deficient in ZIP8, we found that M.tb exploits ZIP8 to enhance its growth. ZIP8 imports Zn into the cytosol and out of the phagosome to subvert Zn poisoning. Cytosolic Zn dampens NF-κB activation and pro-inflammatory cytokine production while enhancing matrix metalloproteinase (MMP) production. Understanding the Zn- and ZIP8-dependent host response to M.tb infection is critical since dietary Zn deficiency and polymorphic ZIP8 variants are associated with increased susceptibility to tuberculosis and other infectious diseases.

Survival disparities in prostate cancer are driven in part by social and economic factors, including housing insecurity. Rent subsidies in the form of federal housing assistance are a well-established strategy for alleviating housing insecurity, but their association with prostate cancer care and survival is unknown. Using linked federal housing assistance data, SEER cancer registry data, and Medicare claims, we assessed workup and treatment receipt and two-year survival among individuals aged 66 to 95 who were diagnosed with prostate cancer in 2007 to 2019. We used logistic and Cox regression models to compare outcomes between individuals receiving housing assistance upon prostate cancer diagnosis and a comparison group without housing assistance, using propensity score matching to balance sociodemographic and clinical characteristics. There were 1,839 individuals with housing assistance (and 5,517 without assistance) included in the workup and treatment analyses and 4,451 individuals with housing assistance (and 13,353 without assistance) in the survival models. Receipt of housing assistance was not associated with guideline-concordant workup (62.7% vs 61.2%, OR 1.02 [95% CI 0.97, 1.07], p = 0.48) or active treatment (63.7% vs 62.2%, OR 1.02 [95% CI: 0.99, 1.06], p = 0.22) but was associated with improved overall survival in the 2 years following diagnosis (hazard ratio for mortality: 0.88 [95% CI: 0.81, 0.96]). Older adults receiving housing assistance at the time of a prostate cancer diagnosis experienced better overall survival than a matched comparison group without housing assistance. Results suggest that expanding access to housing assistance might support greater and more equitable survival in prostate cancer.

Background/Objective: Blood-based assays for colorectal cancer (CRC) screening have emerged as promising non-invasive screening modalities, yet their real-world diagnostic performance across platforms remains unclear. Existing studies evaluating circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) based assays as non-invasive alternatives to stool-based tests vary substantially in methodology, population, and study design. In our systematic review and meta-analysis, we quantify the diagnostic yield of contemporary cfDNA/ctDNA for CRC detection through pooled sensitivity and specificity. Methods: A systematic search of diagnostic accuracy studies published through December 2025 was conducted by two researchers in PubMed and the Cochrane Library. Studies reporting sensitivity and specificity were included. Pooled proportions with the 95% confidence interval (CI) were calculated using a hierarchical bivariate random-effects model. Subgroup analyses were conducted stratified by cancer stage and advanced adenoma. (PROSPERO CRD420261290686). Results: Fifty-eight studies involving 63,309 subjects were included. The pooled sensitivity and specificity for colorectal cancer detection were 82.9% (95% CI: 79.9-85.5%) and 90.7% (95% CI: 89.2-92.0%), respectively. HSROC analysis demonstrated excellent overall diagnostic accuracy with an AUC of 0.937. Pooled sensitivity for advanced adenoma was suboptimal at 46% (CI: 32-59%). Detection sensitivity increased progressively by stage, from 70% (CI: 62-78%) in stage I CRC to 90% (CI: 87-92%) in stage IV CRC. Conclusions: These findings position next-generation cfDNA/ctDNA assays as promising, scalable, patient-friendly CRC screening tools with performance characteristics comparable to established non-invasive tests. Integration of cfDNA/ctDNA assays into population-level screening programs may substantially expand screening uptake by overcoming key barriers associated with stool-based modalities.

Proposed treatment algorithms favor the use of upadacitinib in medically refractory Crohn's disease (CD) and ulcerative colitis (UC). There has not yet been data published regarding efficacy of prolonged induction in CD or the efficacy of re-escalation to induction dosing in patients with either CD or UC. The aim of this study was to evaluate the real-world efficacy and safety of prolonged and/or re-escalation upadacitinib therapy in patients with inflammatory bowel disease (IBD) and prior inadequate response to standard upadacitinib treatment. This was a retrospective, dual-center study of the efficacy of prolonged induction or re-escalation of upadacitinib in patients with IBD with prior inadequate response to standard upadacitinib treatment. Fifty-five patients met eligibility criteria. Thirty-nine (70.9%) persisted on upadacitinib therapy while 16 (29.1%) met the primary endpoint for upadacitinib failure. Of those that had comparative objective data, 62.5% had improvement in endoscopic activity, 100% had normalization of an elevated CRP, and 83.3% experienced a decrease in FCP by >50%. There were no new safety signals. Over two-thirds of patients met the primary endpoint of persistence on therapy without requiring surgery, steroids, or additional biologic/small molecule inhibitor during follow-up. In a subset of patients who had adequate baseline and follow up objective data, the majority of patients had improvement in mucosal healing, decrease by 50% in FCP, and normalization of CRP. This study shows promising results that prolonged upadacitinib induction or dose re-escalation may improve clinical outcomes in a medically refractory patient population.

Acute pancreatitis (AP) is a common disease resulting in local and systemic inflammation. It is now recognized that long-term complications can develop following an AP episode, including persistent GI symptoms, exocrine pancreatic dysfunction (EPD), and recurrence of AP. While nutrition plays a key role in recovery, the impact of diet patterns on gastrointestinal (GI) symptoms and recurrent AP remains unclear. A secondary analysis of participants from the multicenter, post-acute pancreatic exocrine insufficiency (PAPPEI) study who completed a standardized dietary questionnaire was performed to assess dietary patterns after AP. A dietary pattern score was developed to compare dietary changes over time, where a higher score reflects a more favorable dietary pattern. Significant changes in dietary pattern scores were observed over time with average scores peaking at three months (10.3 ± 3.0) then declining at one year (9.2 ± 3.0) ( P =0.024). Lower baseline dietary pattern scores were linked to recurrent AP ( P = 0.035), >10% weight loss ( P =0.016) and persistent GI symptoms ( P =0.030) at 12 months. Dietary patterns may contribute to the development of GI symptoms, weight loss and recurrent AP. Further research validating our observations and investigations into dietary interventions to reduce GI symptoms and disease recurrence is warranted.

Prevention, screening and diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) can prevent morbidity and mortality in people receiving HIV care. However, there is limited information about the availability of HBV and HCV services at HIV clinics globally. The International epidemiology Databases to Evaluate AIDS (IeDEA) conducted surveys of service delivery and practices at participating HIV treatment centers from seven regions. We used 2023 survey data to measure availability of HBV vaccination, HBV and HCV screening, HBV surface antigen (HBsAg), HBV DNA, HCV antibody, HCV RNA testing. Multivariable logistic regression models were used to test associations of site characteristics with HBV and HCV services. HBV vaccination was available on-site at 67.7% of 204 HIV treatment sites. Screening for HBV and HCV at HIV care enrollment was reported by 72.1% and 50% of sites, respectively. HBsAg, HBV DNA, HCV antibody and HCV RNA testing were available on-site at 77%, 47.6%, 61.8% and 44.6% of sites, respectively. Sites serving predominately rural (vs. urban) populations were less likely to report on-site availability of HBV DNA (odds ratio (OR):0.07; 95% confidence interval (CI):0.01-0.68;P=0.02), HCV antibody (OR=0.18; 95% CI:0.04-0.92;P=0.04) and HCV RNA (OR=0.10; 95% CI:0.01-0.90;P=0.04) testing. Life-saving services such as HBV vaccination, HBsAg and HCV antibody testing were available on-site at most HIV treatment sites participating in the IeDEA network. Lower availability at rural sites suggests that expansion of services is important to eliminate HBV and HCV as public health problems in people receiving HIV care.

Retrospective evaluations of multidisciplinary team (MDT) review of pancreatic cystic lesions (PCL) demonstrate improved PCL management. Endoscopic ultrasound (EUS) evaluates PCL for worrisome features; however, its influence on MDT is unclear and may be attenuated by anchoring/confirmation bias. We aimed to evaluate the impact of EUS and the overall performance of MDT evaluation of PCL. Four mock MDT sessions at two institutions were presented imaging from 40 consecutive PCL cases (20 "high-risk" with advanced neoplasia, 20 "low-risk" with pathologic low-grade dysplasia or ≥ 3 years of non-progression on surveillance), with and without upfront EUS/FNA (cytology, CEA, Amylase), in a randomized, crossover design. Group 1 adjudicated without EUS, Group 2 adjudicated with EUS, and Group 3 adjudicated with EUS after initially adjudicating without it. The cohort included branch-duct (n = 20), mixed type (n = 6), and main duct (n = 4) IPMN, MCN (n = 5), and non-mucinous PCL (n = 5). Group 2 (EUS) correctly identified mucinous PCL with 97% sensitivity and 70% specificity, significantly higher than Group 1 (No EUS) (Sensitivity 91%, Specificity 20%; p = 0.04). Group 3 (Unblinded to EUS) performed significantly worse in mucinous PCL identification compared with Group 2, indicating cognitive bias (Sensitivity 97%, Specificity 10% (p = 0.0003)). Group 2 correctly identified high-risk PCL that required surgical intervention with 85% sensitivity and 85% specificity, significantly higher than Group 1 (Sensitivity 60%, Specificity 75%; p = 0.0016) and Group 3 (Sensitivity 73%, Specificity 80%, p = 0.0485). While susceptible to cognitive bias, EUS significantly improves MDT assessment of PCL. MDT establishes a high bar for iterative additions of biomarkers to PCL analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) is essential for pancreaticobiliary disease management; however, there are risks associated with the procedure, particularly post-ERCP pancreatitis (PEP). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in metabolic disease, possess anti-inflammatory and cytoprotective properties that may influence periprocedural outcomes. Their impact on ERCP adverse events remains unclear; therefore, we aimed to investigate whether GLP-1 influences short-term postprocedural outcomes using a large real-world database. We conducted a retrospective cohort study using the TriNetX US Collaborative Network, identifying adults (18 y or older) who underwent ERCP between January 2015 and December 2024. Patients were categorized based on documented preprocedure GLP-1 receptor agonist exposure. Propensity score matching (1:1) was performed using demographic, clinical, procedural, and pharmacologic covariates to minimize confounding, yielding 2 well-balanced cohorts. Thirty-day post-ERCP outcomes-including acute pancreatitis, cholangitis, sepsis, gastrointestinal bleeding, biliary stricture, choledocholithiasis, and repeat ERCP-were assessed using ICD-10 and CPT codes. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were calculated. Of 250,502 patients with ERCP screened, 21,818 propensity-matched individuals were included in the final analysis. Compared with matched nonusers, patients receiving GLP-1 receptor agonists had significantly lower 30-day rates of all major ERCP-related adverse events. GLP-1 RA exposure was associated with reduced risks of acute pancreatitis (RR: 0.47, 95% CI: 0.43-0.51), cholangitis (RR: 0.56, 95% CI: 0.50-0.62), sepsis (RR: 0.51, 95% CI: 0.46-0.57), gastrointestinal bleeding (RR: 0.49, 95% CI: 0.40-0.61), biliary stricture (RR: 0.52, 95% CI: 0.48-0.55), repeat ERCP (RR: 0.53, 95% CI: 0.48-0.58), and choledocholithiasis (RR: 0.66, 95% CI: 0.62-0.71). Results were consistent across time-to-event analyses over the 30-day follow-up period. In this large real-world analysis, preprocedure GLP-1 RA therapy was associated with markedly reduced 30-day ERCP-related adverse events, most notably PEP. These findings highlight a potential protective role of GLP-1 signaling in the periprocedural inflammatory response and support prospective studies evaluating GLP-1 RAs as adjunctive prophylactic agents in ERCP. Further prospective studies are needed.

Gastro-esophageal reflux disease (GERD) occurs in most (~75%) patients with systemic sclerosis (SSc) and significantly impacts quality of life. Current recommendations lack depth and therefore, our aim was to produce practical, consensus-based recommendations for refractory SSc-related GERD. An international, multidisciplinary Steering Board (SB) was assembled (n=19) consisting of clinicians (rheumatologists, gastroenterologists, GI surgeons), an expert methodologist, and patient representation. After reviewing the latest definitions of GERD and refractory GERD in the published literature, the SB collectively devised a practical definition of SSc refractory-GERD. Initial recommendations were drafted/agreed upon by the SB based on review of the existing guidelines, published literature, and expert opinion. Two online voting rounds were conducted to determine whether items should be accepted, with >75% and >60% SB agreement required for first and second rounds, respectively. There was a good response/completion rate for the initial (74%) and final (84%) voting rounds. The SB agreed on all 36 draft recommendations. The majority (n=34) were approved in the first round. Recommendations were organized according to the following categories: general approach to management (n=5), assessment (n=6), non-pharmacological (n=2) and pharmacological (n=10) management, endoscopic and surgical treatment (n=3), and special circumstances, including refractory GERD and SSc-ILD (n=3), myositis and SSc CTD-overlap (n=3) and peri-lung transplant (n=4). The group of experts has drafted extended and practical recommendations for the management of SSc refractory-GERD. The necessity of a structured approach and a patient assessment is highlighted in order to provide a multi-disciplinary approach to the tailored choice of the treatment. Our work also has also identified significant unmet needs and has provided a research agenda to advance the field.

Recent studies suggest an increased risk of serious infections associated with proton pump inhibitor (PPI) use in young children, but no study simultaneously examined the impact of acid-suppressive medication (ASM) use during pregnancy and childhood on infection risk in children. This study aimed to investigate the associations between prenatal and/or childhood exposure to ASMs and serious infections in children. A national cohort study was conducted based on the entire medical claims data in Taiwan, comparing prenatal and/or childhood exposure to PPIs or histamine-2 receptor antagonists (H2RAs) with antacid exposure in an active-comparator design. We quantified the risks of hospitalization for overall serious infection and specific infections, including sepsis, acute bronchiolitis or bronchitis, pneumonia, acute gastroenteritis, pyelonephritis, cellulitis or soft-tissue infection, meningitis or encephalitis, and septic arthritis or osteoarthritis, among children with prenatal and/or childhood exposure to PPIs or H2RAs. Adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Among 195,377 mother-child pairs prenatally exposed to PPIs or H2RAs (13.39% of the prenatal cohort) and 1,263,741 pairs exposed to antacids, prenatal exposure to PPIs or H2RAs was associated with an increased risk of overall serious infection compared with antacid exposure (AHR: 1.09; 95% CI: 1.06-1.12), as well as specific infections, including sepsis (AHR: 1.21; 95% CI: 1.03-1.12), acute bronchiolitis or bronchitis (AHR: 1.07; 95% CI: 1.03-1.11), pneumonia (AHR: 1.10; 95% CI: 1.04-1.15), acute gastroenteritis (AHR: 1.12; 95% CI: 1.06-1.18), and pyelonephritis (AHR: 1.10; 95% CI: 1.02-1.19). Subgroup analyses demonstrated consistent results for PPI and H2RA exposure when analyzed separately. Childhood exposure to PPIs or H2RAs was also associated with increased risks of serious infections, with the highest risks generally observed among children exposed during both prenatal and childhood periods (AHR 1.12 for overall serious infection; AHR 1.62 for sepsis; AHR 1.29 for acute bronchiolitis or bronchitis; AHR 1.06 for pneumonia; AHR 1.30 for acute gastroenteritis; and AHR 1.24 for pyelonephritis). This nationwide cohort study provides real-world evidence of an association between prenatal and childhood exposure to PPIs or H2RAs and an increased risk of serious infections in children.

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Obesity is a major cardiovascular risk factor, particularly in excessive visceral adipose tissue accumulation. This study assessed the efficiency of three image processing algorithms (Otsu, K-means, and Fuzzy C-means) in quantifying abdominal adipose tissue from single-slice MRI image analysis obtained using a standard acquisition protocol. We developed a novel, open-source algorithm to delineate visceral and somatic adipose tissue by comparing the distance from the centroid of the largest segmented regions to the center of the image. Segmentation methods were evaluated against a manual reference. The study included 68 patients (30 males and 38 females) aged between 8 and 84. All algorithms showed satisfactory accuracy, with Otsu thresholding consistently performing slightly better. Segmentation efficiency was analyzed within subgroups defined by gender, age, weight status, and diagnosis. Accuracy remained acceptable across subgroups, although male sex and higher weight status in adults were associated with superior results. Linear regression models were implemented to address errors concerning visceral and somatic adipose tissue quantification. Correlations between adipose tissue surface and BMI emerged, with significant differences in adipose tissue distribution across genders and age groups. Our findings highlight the potential of MRI-based adipose tissue segmentation in cardiovascular risk stratification using a novel, open-source algorithm.

Pain is one of the most frequent and debilitating symptoms associated with pancreatic ductal adenocarcinoma (PDAC). More than 60% of patients suffer from significant pain at diagnosis. The prevalence increases during the progression of the disease and is associated with anorexia, weight loss, and impaired social interactions. The pathophysiology of pain includes the combined effects of tumor growth and spread, perineural invasion, neuroimmune interactions, peripheral nerve remodeling, and central nervous system sensitization. Pain is additionally modulated by comorbid conditions, such as anxiety or depression, as well as treatment-related toxicity. Previous reports have used simple unidimensional scales to assess pain intensity, but as pain in PDAC is multidimensional, there is a need to develop new and robust instruments to assess pain. The treatment follows the World Health Organization three-step analgesic ladder. Non-opioid analgesics can be used to improve pain, but strong opioids are often used to relieve pain and suffering. When opioids are used, there should be a focus on the management of the side effects. Patients with anxiety and depression may benefit from treatment with selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, and tricyclic antidepressants that also have effects on pain. In some cases, more experimental drugs such as ketamine may be used. Celiac plexus neurolysis and local irradiation therapies are supplementary methods used to treat PDAC pain, but the response is unpredictable, and the durability is relatively short. The reduced survival associated with celiac ganglia injection, especially in patients with advanced disease, has also tempered enthusiasm.

Although guidelines recommend early cholecystectomy (CCY) after ERCP for choledocholithiasis-associated cholangitis, surgery is frequently deferred, particularly in severe disease. We evaluated real-world outcomes and decision-making between same-admission versus deferred CCY to assess the impact of surgical delay. We conducted a retrospective cohort study on patients with choledocholithiasis-associated cholangitis from 2011 to 2022. Primary outcomes were the occurrence of&#x2009;&#x2265;&#x2009;1 recurrent biliary event (RBE) within one year, and 30-day mortality and&#xa0;readmissions. Secondary outcomes included operative complications, length of stay, and reasons for delay. Multivariable logistic regression adjusted for age, comorbidities, sex, and severity, with subgroup analyses for Grade III cholangitis. Kaplan-Meier survival analysis evaluated time to first RBE. Among 171 patients (mean [SD] age, 66.2 [19.1] years; 85 [49.7%] female), 94 (55%) had CCY deferred. Same-admission CCY was associated with lower odds of RBEs (aOR 0.01; 95% CI 0-0.08; p&#x2009;<&#x2009;0.001) and 30-day readmission (1.3% vs. 13.8%; aOR 0.11; 95% CI 0.01-0.48; p&#x2009;=&#x2009;0.0023), with similar complication rates and length of stay. Kaplan-Meier analysis confirmed superior RBE-free survival for same-admission CCY (log-rank p&#x2009;<&#x2009;0.001). Among patients with Grade III cholangitis (n&#x2009;=&#x2009;34), same-admission CCY reduced RBE rate (0% vs. 56.5%; p&#x2009;<&#x2009;0.001) without increasing intraoperative or postoperative complications. Deferral was most often due to high surgical risk (21.3%), concurrent pathology (20.2%), or patient preference (14.9%). Same-admission CCY for choledocholithiasis-associated acute cholangitis reduced recurrence and 30-day readmission without increasing postoperative complications, mortality, or length of stay, including in Grade III cholangitis. These findings support same-admission CCY after clinical stabilization.

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Spatial computer vision techniques have the potential to improve the diagnostic performance of colonoscopy. However, the lack of 3D colonoscopy datasets for training and validation hinders their development. This paper introduces C3VDv2, the second version (v2) of the high-definition Colonoscopy 3D Video Dataset, featuring enhanced realism designed to facilitate the quantitative evaluation of 3D colon reconstruction algorithms. 192 video sequences totaling 169,371 frames were captured by imaging 60 unique, high-fidelity silicone colon phantom segments. Ground truth depth, surface normals, optical flow, occlusion, diffuse maps, six-degree-of-freedom pose, coverage map, and 3D models are provided for 169 colonoscopy videos. Eight simulated screening colonoscopy videos acquired by a gastroenterologist are provided with ground truth poses. Lastly, the dataset includes 15 videos with colon deformations for qualitative assessment. C3VDv2 emulates diverse and challenging scenarios for 3D reconstruction algorithms, including fecal debris, mucous pools, blood, debris obscuring the colonoscope lens, en-face views, and fast camera motion. The enhanced realism of C3VDv2 will allow for more robust and representative development and evaluation of 3D reconstruction algorithms.