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Gastroenterol. Insights, Volume 16, Issue 4 (December 2025) – 6 articles

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14 pages, 494 KB

Open AccessReview

Management of Antithrombotic Therapy in Acute Gastrointestinal Bleeding

by Konstantinos Papantoniou, Christos Michailides, Dimitrios Velissaris and Konstantinos Thomopoulos

Gastroenterol. Insights 2025, 16(4), 41; https://doi.org/10.3390/gastroent16040041 - 23 Oct 2025

Viewed by 218

Abstract

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising prevalence of cardiovascular and thromboembolic diseases. Balancing the risk of ongoing hemorrhage against the potentially life-threatening consequences of thrombosis remains a delicate and critical clinical decision. This review provides a practical, evidence-based approach to the periprocedural management of antithrombotic therapy in urgent endoscopy, particularly in the context of acute GI bleeding. We summarize the indications, pharmacokinetics, and reversal strategies for commonly used agents, including warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin, aspirin, and P2Y12 inhibitors. Risk stratification is discussed in detail, considering both the urgency and bleeding risk of endoscopic procedures, as well as the thromboembolic risk associated with temporary drug interruption. Special considerations are given to high-risk patients, such as those with recent coronary stents, mechanical heart valves, or atrial fibrillation with elevated stroke risk scores. Close consultation and collaboration with other specialties, including cardiology and hematology, is often essential to optimize patient outcomes. Recommendations based on real-world clinical experience alongside formal guideline directives aim to support safe and timely endoscopic intervention without compromising systemic thrombotic protection, especially in emergent situations. Full article

(This article belongs to the Special Issue Advances in the Management of Gastrointestinal and Liver Diseases)

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10 pages, 249 KB

Open AccessArticle

African and Hispanic Americans Have Higher Healthcare-Related Burden Without Higher Mortality When Admitted with Acute Diverticulitis

by Luis M. Nieto, Sharon I. Narvaez, Kenneth J. Vega, Do Han Kim, Donghyun Ko, Frank J. Lukens and Pedro Palacios-Argueta

Gastroenterol. Insights 2025, 16(4), 40; https://doi.org/10.3390/gastroent16040040 - 21 Oct 2025

Viewed by 154

Abstract

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample of adult patients discharged for AD. Patients were classified into six racial and ethnic groups: Caucasian, African American (AA), Hispanic, Asian, Native American (NA), and other. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for primary and secondary outcomes. Results: A total of 647,119 admissions with acute diverticulitis (AD) were identified. Most patients were Caucasian (about three-quarters), followed by Hispanics (11%), AA (9%), Asians (1%), Native Americans (<1%), and other (2%). Minority groups were generally younger than Caucasians and less likely to undergo colonoscopy or surgical procedures such as partial or total colectomy. In the multivariable analysis, both Hispanics and AA were less likely to present with complicated diverticulitis. Despite this, their hospitalizations were associated with higher overall charges and costs. No significant differences were found across groups in terms of inpatient mortality or the need for percutaneous abscess drainage. Conclusions: Hispanic and AA have higher healthcare- related charges and costs compared to Caucasians when admitted with AD. Further studies are needed to understand the healthcare-related spending variations seen in these groups despite them often having less complicated AD. Full article

(This article belongs to the Section Gastrointestinal Disease)

19 pages, 888 KB

Open AccessReview

Liquid Biopsy in Pancreatic Ductal Adenocarcinoma: Clinical Utility, Trials, and Future Directions

by Ahmed Bendari, Oana Vele, Brett Baskovich, Alaa Bendari, Mona Sebika, Juan Luis Gomez Marti, Kritika Krishnamurthy and Saeed Asiry

Gastroenterol. Insights 2025, 16(4), 39; https://doi.org/10.3390/gastroent16040039 - 19 Oct 2025

Viewed by 369

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, tumor-educated platelets (TEPs), and cell-free RNAs (cfRNAs)—offers dynamic insights into PDAC biology. This review advances beyond the prior literature by offering a unified synthesis that bridges molecular mechanisms, biomarker dynamics, and clinical translation within the context of PDAC. It also summarizes key clinical trials evaluating liquid biopsy in PDAC, underscoring its growing impact on precision oncology. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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11 pages, 230 KB

Open AccessArticle

Outcomes of EUS-Guided Gallbladder Drainage: A Case Series from a Tertiary Referral Center in Ireland

by Mohamed Wael Mohamed, Olufemi Aoko and Danny Cheriyan

Gastroenterol. Insights 2025, 16(4), 38; https://doi.org/10.3390/gastroent16040038 - 16 Oct 2025

Viewed by 337

Abstract

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). EUS-GBD has emerged as a promising minimally invasive option, offering high technical and clinical success with fewer complications and need for reinterventions. The objective of this study was to evaluate the clinical outcomes of EUS-GBD in high-risk surgical patients with acute cholecystitis. Methods: We conducted a single-center retrospective study evaluating outcomes of EUS-GBD in a tertiary referral center in Ireland. Data from ten high-risk patients with acute cholecystitis who underwent EUS-GBD using a 15 mm × 10 mm HOT AXIOS lumen-apposing metal stent (LAMS) between October 2017 and September 2018 were analyzed. Parameters assessed included technical and clinical success, adverse events, and 1-year mortality. Results: The mean age of patients was 79.5 years (range 65–95). Technical success of stent placement was achieved in all patients with no immediate complications. A trans-gastric approach was used in 7 patients while a trans-duodenal route was employed in the remaining 3. 1–year mortality following EUS-GBD was 20%. Stents were not removed in any patient in this series. No patient experienced stent-related adverse events, re-occurrence of cholecystitis, or the need for re-intervention. Conclusions: EUS-GBD has very high technical and clinical success rates, with low risk of complications and need for re-intervention in comparison to other options of GB decompression. It is, however, not widely available, and it requires a skilled endoscopist with experience in interventional EUS. Full article

(This article belongs to the Section Gastrointestinal Disease)

15 pages, 1013 KB

Open AccessArticle

Divergent Trends in Esophageal Adenocarcinoma and Squamous Cell Carcinoma Incidence, 2000–2022

by Vinit H. Majmudar, Kyle Nguyen-Ngo and Michael Tadros

Gastroenterol. Insights 2025, 16(4), 37; https://doi.org/10.3390/gastroent16040037 - 9 Oct 2025

Viewed by 566

Abstract

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 1274 KB

Open AccessArticle

Impact of Hypoglycemia on Morbidity, Mortality, and Resource Utilization in Gastrointestinal Stromal Tumor: A Nationwide Analysis

by Manasa Ginjupalli, Jayalekshmi Jayakumar, Arnold Forlemu, Anuj Raj Sharma, Praneeth Bandaru, Vikash Kumar, Kameswara Santosh Dheeraj Nalluri and Madhavi Reddy

Gastroenterol. Insights 2025, 16(4), 36; https://doi.org/10.3390/gastroent16040036 - 25 Sep 2025

Viewed by 389

Abstract

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National Inpatient Sample (NIS) 2018–2020. Adult GIST discharges were identified by ICD-10-CM codes and stratified by hypoglycemia. Primary outcomes were in-hospital mortality and resource utilization—length of stay (LOS) and total hospital charge. Secondary outcomes included malnutrition, sepsis, ascites, peritonitis, bowel perforation, intestinal obstruction, gastrointestinal bleeding, and iron deficiency anemia. Analyses used survey-weighted logistic regression for binary outcomes and generalized linear models for continuous outcomes. A propensity score-matched sensitivity analysis balanced sepsis and malnutrition. Results: Among 61,725 GIST hospitalizations, 0.72% had hypoglycemia. Mortality was 12.6% with hypoglycemia vs. 3.1% without; adjusted odds of death were higher (aOR 4.16, 95% CI 2.06–8.37; p < 0.001). Hypoglycemia was also associated with malnutrition (aOR 5.63, 3.37–9.40), sepsis (aOR 4.00, 2.24–7.14), ascites (aOR 3.43, 1.63–7.19), and peritonitis (aOR 2.91, 1.17–7.22). LOS was 4.61 days longer on average (not significant; p = 0.185), and total hospital charge was $5218 higher (β = 19,116.8; p = 0.95). In the matched cohort, the mortality association attenuated but persisted (aOR 1.38, 1.27–1.49; p < 0.001); peritonitis remained significant (aOR 1.10, 1.04–1.17), intestinal obstruction (aOR 4.91, 3.44–7.05) and iron deficiency anemia (aOR 3.54, 1.62–7.74) became significant, while ascites and gastrointestinal bleeding were not significant. Conclusions: Hypoglycemia in GIST, although uncommon, marks a higher-risk inpatient trajectory with increased mortality and several complications; these signals largely persist after balancing severity proxies. Resource-use differences were directionally higher but not statistically significant. Recognition of hypoglycemia may aid risk stratification and inpatient management in GIST. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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