Search Results (3,560)

Background/Objectives: Entero-enteric fistula (EEF) formation following multiple magnet ingestion is a rare but severe complication among pediatric patients. The widespread availability of neodymium magnets in toys has increased incidence of ingestion and subsequent gastrointestinal injuries. This systematic review aims to summarize the clinical features, diagnostics, management and outcomes of pediatric EEF cases related to magnet ingestion and report our institution’s experience with four such cases. Methods: A systematic review was conducted using PubMed/Medline (January 1995–February 2025), focusing on EEF after ingestion of ≥2 magnets in patients ≤18 years old. Studies reporting original EEF cases were included. Data extraction included demographics, clinical presentation, diagnostic imaging, intervention type, fistula number/location, hospital stay, complications and outcomes. Four institutional cases were also analyzed. Results: Sixty-nine studies encompassing 130 pediatric patients were included. Median age was 3.3 years; 58% were male. The most common symptoms were abdominal pain (43%) and vomiting (29%). Abdominal X-ray identified magnets in all cases. Surgical intervention was required in 95.5%, while 5.5% were treated endoscopically. Ileal and jejunal fistulas were most common. Postoperative complications occurred in 19%, including bowel obstruction, infection and one death. Our four cases, aged 2 months to 5 years, each required surgery, with one patient readmitted for obstruction managed conservatively. Conclusions: Despite the case heterogeneity of this review, EEF is a potentially life-threatening complication of multiple magnet ingestion in children. Prompt diagnosis with abdominal X-ray and timely surgical management are essential. Increased clinical suspicion and public awareness are crucial for prevention and early intervention. Full article

Background: Erosive gastritis has various causes, and severe damage to the mucosa can cause symptoms such as indigestion, abdominal pain, nausea, and vomiting. The condition is defined by visible erosions that emerge as discrete defects in the gastric mucosa. Stillen^® is a natural mucosal-protective agent derived from Artemisia asiatica, but its comparative efficacy versus rebamipide remains unclear. This systematic review and network meta-analysis evaluated whether Stillen^® leads to non-inferior endoscopic improvement outcomes compared to rebamipide in patients with acute or chronic gastritis. Methods: Databases including PubMed, EMBASE, Cochrane Library, RISS, KoreaMed, ClinicalTrials.gov, and ICTRP were searched through 15 August 2025. Eligible studies were randomized controlled trials (RCTs) comparing Stillen^® with rebamipide or other mucosal-protective agents in gastritis. Two reviewers independently screened studies, extracted data, and evaluated the risk of bias. The primary outcome was the improvement rate (≥50% erosion reduction); the secondary outcome was the cure rate (complete erosion resolution) and safety outcomes. Results: A total of 11 RCTs met the inclusion criteria, with 9 contributing to the primary network analysis. Stillen^® was non-inferior to rebamipide in terms of the improvement rate at 2 weeks (OR: 1.11, 95% CI: (0.88, 1.39) in FAS) and in pooled analysis across 2, 3, and 4 weeks. Cure rates showed no significant differences between the two agents. The safety outcomes were comparable, with no significant differences. Most studies were assessed as having a low risk of bias, and the certainty of evidence was rated as high for most efficacy outcomes. Conclusions: The network meta-analysis suggests that Stillen^® is non-inferior to rebamipide in improving erosions in patients with acute or chronic gastritis. Full article

Background: Biliary strictures are diagnosed using endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology and biopsy. However, brush cytology shows a sensitivity of 9–56.1% and a diagnostic accuracy of 43–65.4%, while biopsy demonstrates a sensitivity of 48%. Both methods exhibit high specificity but limited sensitivity. While rapid on-site evaluation (ROSE) is effective in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), its application in ERCP-obtained samples remains underexplored. Methods: This prospective pilot study was conducted at Okayama University Hospital from April 2019 to July 2024. Patients requiring ERCP-guided sampling for bile duct strictures were included. ROSE was applied to brush cytology with up to three additional attempts and to imprint cytology from biopsy samples with up to two attempts. Diagnostic accuracy was assessed based on pathology and clinical course. Results: Among 37 patients (median age: 73 years, add range, and male–female ratio: 27:10), 18 had hilar and 19 had distal bile duct strictures. Brush cytology required one, two, or three attempts in twenty-six, six, and five cases, respectively, whereas biopsy required one or two attempts in thirty-five and two cases, respectively. Among the thirty-seven cases, thirty-five were malignant and two were benign. The B-ROSE group showed a sensitivity, specificity, and accuracy of 71.4%, 100.0%, and 73.0%, respectively, compared to lower accuracy in the conventional group, where single brush cytology attempts yielded a sensitivity of 48.6% and an accuracy of 48.6%, and single biopsy attempts showed a sensitivity of 68.6% and an accuracy of 70.3%. Conclusions: B-ROSE improves diagnostic accuracy, reduces repeat sampling, and minimizes patient burden in ERCP-based diagnosis of bile duct strictures, making it a valuable addition to current diagnostic protocols. Full article

Introduction: Cleft lip and/or palate (CLP) is frequently associated with persistent nasal obstruction, often due to structural deformities unaddressed by primary surgical repair. While subjective assessment tools are commonly used to evaluate nasal patency, they underestimate functional impairment, particularly nasal valve collapse. This study aims to objectively evaluate nasal obstruction and identify its anatomical causes in CLP patients after primary rhinoplasty. Methods: We conducted an observational study involving 21 children aged 8–16 with CLP who had undergone primary cheilorhinoplasty but not secondary nasal surgery. Each participant underwent clinical evaluation, nasal endoscopy, acoustic rhinometry, and active anterior rhinomanometry (AAR), both before and after nasal decongestion. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess subjective symptoms. Obstructive sites were diagnosed based on established criteria combining endoscopic and functional findings. Results: Objective nasal obstruction was identified in 80.9% of patients, with nasal valve collapse observed in 66.7%, most commonly among unilateral and bilateral CLP subtypes. External nasal valve collapse was the predominant form (57.1%), followed by internal valve involvement (38.1%). Notably, the NOSE score did not reliably correlate with the AAR results, underlining the limitations of subjective assessment tools. Structural anomalies such as septal deviation (52.5%) and turbinate hypertrophy (23.8%) were also prevalent. Conclusions: This study highlights nasal valve collapse as a major, underrecognized contributor to persistent nasal obstruction in CLP patients after primary repair. Objective assessment methods like AAR and targeted endoscopy should be routinely integrated into secondary rhinoplasty planning. These findings advocate for a personalized approach to secondary nasal reconstruction in CLP patients, integrating objective functional data into surgical planning. Such strategies align with personalized medicine principles by tailoring interventions to individual anatomical and physiological characteristics. Full article

Pancreatic pseudocysts (PPCs) are frequent complications of acute and chronic pancreatitis, characterized by encapsulated collections of pancreatic fluid. Historically managed by open surgical approaches, treatment paradigms have significantly evolved with advancements in imaging and minimally invasive techniques. This review outlines the historical progression and current standards in PPC management, covering conservative, surgical, laparoscopic, and endoscopic interventions. Conservative management remains a valid first-line option for asymptomatic, stable pseudocysts, particularly in the absence of complications. Surgical techniques, once the mainstay, such as marsupialization and internal drainage procedures (cystogastrostomy, cystojejunostomy, and cystoduodenostomy), now serve as alternatives when less invasive methods fail. Laparoscopic approaches offer reduced morbidity and faster recovery, especially for complex or inaccessible PPCs. However, endoscopic drainage, particularly endoscopic ultrasound-guided transmural drainage using plastic or metal stents—especially lumen-apposing metal stents (LAMSs)—has become the preferred modality due to its efficacy, safety profile, and cost effectiveness. Emerging technologies, including robotic-assisted surgery and hybrid techniques, promise further refinement in PPC management. This review synthesizes current evidence and expert guidelines, providing a comprehensive overview of evolving strategies and future directions in the treatment of PPCs. Full article

Background and Objectives: Preoperative biliary drainage (PBD) in patients with periampullary neoplasms remains a debated topic, with various techniques available and conflicting evidence regarding their impact on postoperative outcomes. This study aimed to assess, in a high-volume pancreatic surgery center, whether the choice among endoscopic, surgical, or no preoperative biliary drainage influences postprocedural and postoperative complication rates. Materials and Methods: A retrospective cohort study was conducted at the Surgical Department of the “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca, Romania, between January 2017 and May 2023. A total of 655 patients undergoing pancreaticoduodenectomy or total pancreatectomy for resectable periampullary tumors were divided into three groups: no PBD, endoscopic PBD, and surgical PBD. Clinical, procedural, and postoperative variables were collected and statistically analyzed. Results: Endoscopic drainage was associated with a significantly higher rate of postoperative intra-abdominal abscesses, postoperative pancreatic fistula (POPF), and pancreaticojejunostomy fistula compared to surgical drainage and no PBD. Patients in the endoscopic group also exhibited significantly higher rates of positive bile cultures, particularly with pluribacterial populations. Procedure-related complications, such as pancreatitis and cholangitis, were significantly lower in the surgical drainage group. No significant differences were found among groups regarding postoperative hospital stay, relaparotomy rates, or 90-day mortality. Conclusions: Surgical biliary drainage was associated with lower perioperative morbidity compared to endoscopic drainage. While endoscopic drainage remains the most commonly used approach, surgical drainage may offer a safer alternative in selected patients. Prospective randomized controlled trials are warranted to validate these findings. Full article

Background: Anal squamous cell carcinoma is a rare disease strongly associated with the human papillomavirus (HPV) and preceded by the premalignant anal squamous intraepithelial lesion (ASIL). High-resolution anoscopy (HRA) using a colposcope is considered the gold standard for detecting and managing ASIL. Despite being recommended in current guidelines for anal cancer screening, HRA availability remains limited. Although generally well tolerated, concerns about follow-up adherence persist. We have developed an endoscopic technique using high-resolution flexible endoscopes for detection, resection, and screening of ASIL. Our previous research suggests that this method is effective and gentle, but patients’ experiences of this approach remain underexplored. The aim of this study was to explore patients’ experiences of endoscopic detection, treatment, and screening of anal squamous intraepithelial lesions. Method: A qualitative approach was used involving semi-structured interviews and abductive qualitative content analysis. The 32-item COREQ checklist guided the reporting of the study. All participants followed a standardized protocol for treatment and follow-up. Results: Analysis of 16 interviews (female n = 7, male n = 9, age 19–72 years) yielded four categories: a comforting encounter in an exposed situation (with four subcategories); impact on intimate relationships (with one subcategory); living with uncertainty (with four subcategories); and physical discomfort (with two subcategories). Conclusions: High-resolution endoscopy is a well-tolerated and effective diagnostic and therapeutic modality for ASIL. However, the psychological impact of HPV-related conditions highlights the need for appropriate psychosocial support. These findings underscore the importance of integrating patient-centered care principles into the implementation of novel diagnostic and therapeutic technologies. Full article

Zenker’s diverticulum (ZD) is an esophageal condition that results in an outpouching of the mucosal layer through a weakened area in the hypopharyngeal wall. This condition can cause symptoms like dysphagia, regurgitation, and aspiration, impacting patients’ quality of life. Historically, open surgery was the primary treatment. Although effective, this method is associated with longer recovery times and risks such as infections, nerve damage, and prolonged hospitalization. Rigid endoscopic stapling emerged as a less invasive alternative, offering high success rates for patients with favorable anatomy. Zenker’s peroral endoscopic myotomy (Z-POEM), adapted from treatments for achalasia, represents the latest advancement in ZD management. It involves creating a submucosal tunnel and precisely dividing the cricopharyngeus muscle. Z-POEM is minimally invasive and often provides quick relief with a high success rate of around 92%, while enabling outpatient treatment or brief hospital stays. However, it requires specialized expertise, and long-term data on recurrence rates are still emerging. This review discusses the evolution of these treatment modalities through comprehensive searches of PubMed, MEDLINE, and ScienceDirect databases. Studies reporting on treatment outcomes, complication rates, operative times, and clinical success associated with open surgery, rigid endoscopic stapling, and Z-POEM were included, with emphasis on meta-analyses, multicenter studies, and large case series highlighting Z-POEM’s comparable success to open surgery and increased patient tolerance. Open surgery achieves long-term symptom resolution rates of 90–95% but is associated with higher complication rates (up to 30%) and prolonged recovery times. Rigid endoscopic stapling offers symptom relief in approximately 90% of cases, with lower morbidity and shorter hospital stays (1–2 days), though anatomical limitations restrict its use. Z-POEM has demonstrated clinical success rates of 85.5–93%, with major complications reported in 4.8–5% of cases and recurrence rates as low as 1.4% at one-year follow-up in larger diverticula. Z-POEM’s minimally invasive nature and suitability for high-risk patients make it increasingly preferred in specialized centers. Management of Zenker’s diverticulum has evolved significantly, with endoscopic techniques, particularly Z-POEM, offering comparable success to open surgery but with fewer complications and faster recovery. Ongoing advances in endoscopic equipment and technique, along with emerging data on long-term outcomes, are likely to further refine treatment algorithms for ZD, especially for elderly and high-risk populations. Future directions in ZD management include ongoing research to enhance the safety and efficacy of endoscopic techniques, with new technologies on the horizon that could further improve outcomes and accessibility. Full article

Lateral Spreading Tumors (LSTs) are a type of non-polypoid lesion known for their flat morphology, which often leads to them going undetected. However, especially nongranular (NG) LSTs have the potential for malignant transformation. Recent advances in endoscopic technologies have improved the detection of these lesions. Despite growing research interest in their role in colorectal cancer (CRC) development, a comprehensive molecular characterization of LSTs is still lacking. The aim of this review is to highlight the current knowledge of the molecular characteristics of LSTs, that may help in determining whether LSTs can be prognostic indicators and identifying cases where they may rapidly progress to CRC through characteristic molecular pathways. From a mutational point of view, LSTs seem to be more closely associated with inflammatory bowel diseases (IBDs) than with polypoid lesions. Nonetheless, they have peculiar epigenetic and genetic traits, which set them apart from other adenomas or bowel diseases. Elucidating their role in CRC development would provide benefits for their classification and management, by enhancing clinical surveillance strategies for patients diagnosed with these lesions in order to improve the efficient prevention of colorectal cancer. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease with a dismal prognosis; this is in part due to its late diagnosis at advanced stages. For many patients, medical treatment is the only practicable therapy. In recent years, the development of new technologies that investigate genomic biomarkers has improved the concept of precision medicine to treat patients with PDAC. Through endoscopic ultrasound–tissue acquisition (EUS-TA), tissue from pancreatic cancers can be collected; thus, it has the potential to advance personalized treatment by allowing the assessment of genomic alterations. In this review, we explore the role of EUS in genomic profiling and its strengths and pitfalls in obtaining samples for next-generation sequencing (NGS). Full article

This study investigated the oral microbiome of horses maintained on a high soluble carbohydrate diet based on sugarcane, in comparison to those fed a pasture-based diet composed of Cynodon spp., aiming to identify associations between dietary intake, the composition of oral microbial communities, and the occurrence of dental caries and diastemata. A total of 20 healthy horses, both male and female, with an average age of 9 ± 3 years and weight of 400 ± 100 kg, without a defined breed, were selected. They were divided into two groups: the High Soluble Carbohydrate Group (HSCCG), consisting of 10 horses fed sugarcane for at least 3 years, and the Low Soluble Carbohydrate Group (LSCCG), consisting of 10 horses fed pasture with Cynodon spp. Dental examinations were performed using an adapted oral endoscope to assess caries and diastemata, and saliva samples were collected for microbiota analysis. Statistical analyses included a Student’s t-test and Mann–Whitney test, with significance set at p < 0.05. Horses in the HSCCG had a higher presence of peripheral caries (p = 0.001), as well as differences in the degree (p = 0.010), class (p = 0.05), and presence of diastemata. Microbial diversity indices (Chao, inverse Simpson, and Shannon) showed no significant differences, but the relative abundance differed (p = 0.003). Linear Discriminant Analysis revealed distinct microbial profiles: Candidatus Saccharibacteria and Bacteroidetes were more abundant in the HSCCG, while Cyanobacteria_Chloroplast and Proteobacteria dominated in the LSCCG. Over 35 genera differed significantly between groups. The study concludes that diet plays a significant role in shaping oral microbiota and influencing the development of dental caries in horses. Full article

Cholangiocarcinoma is a rare, highly aggressive malignancy of the hepatobiliary tract with poor prognosis, often diagnosed at advanced stages when curative surgical resection is not feasible. Management increasingly relies on advanced endoscopic interventions to address malignant biliary obstruction and improve clinical outcomes. Beyond conventional biliary stenting, adjunctive endoscopic ablation therapies have emerged as promising strategies to improve both stent patency and survival. This review comprehensively examines the evolving role of radiofrequency ablation and photodynamic therapy in the treatment of unresectable cholangiocarcinoma. Radiofrequency ablation utilizes localized thermal energy to induce coagulative tumor necrosis and offers advantages including procedural simplicity, favorable safety profile, and cost-effectiveness; however, its efficacy may be limited by tumor size, location, and proximity to critical structures. In contrast, photodynamic therapy employs light-activated photosensitizers to selectively induce cytotoxicity in malignant tissue, demonstrating superior outcomes in prolonging both stent patency and overall survival across multiple studies and meta-analyses. Photodynamic therapy’s ability to treat more diffuse and peripheral lesions represents an important advantage, though its use is limited by photosensitivity reactions and shallow tissue penetration. Ultimately, endoscopic ablation therapies represent valuable adjunctive options in the multidisciplinary care of patients with unresectable cholangiocarcinoma. As technological advances continue and more comparative data emerge, optimized patient selection and individualized integration of these therapies hold potential to significantly improve outcomes in this challenging malignancy. Full article

Background/Objectives: Neuroendocrine neoplasms (NENs) of the rectum (rNEN) are a rare and heterogeneous group of tumors that can vary greatly in their biological behavior, from benign to highly aggressive. While small and well-differentiated tumors can often be handled endoscopically and still face a very good prognosis, tumor size, and grade, as well as lymph node and distant metastasis, are known risk factors for impaired prognosis. This study aimed at the identification of further prognostic factors in rNEN. Methods: A retrospective analysis of patients treated for rNEN at the ENTES Center of Excellence at Charité—Universitätsmedizin, including n = 121 patients, was performed to identify risk factors for recurrence, progression, and impaired outcome. Results: Progression-free survival (PFS) and overall survival (OS) differed significantly according to tumor grade (p < 0.001). In rNET patients undergoing surgery, the Ki-67 index and distant metastases were independent risk factors for shorter PFS. Among stage I rNETs, 10 patients developed disease recurrence, associated with lymphatic invasion (1.9% vs. 30.0%, p = 0.008) and higher Ki-67 values (2 (1–6) vs. 2 (1–16), p = 0.054). Conclusions: Tumor grade and presence of metastases represent important predictive factors in rNEN. Notably, even small, early-stage rNETs can harbor a risk of recurrence when unfavorable pathological features are present, highlighting the importance of tailored, risk-adapted surveillance strategies to optimize patient outcomes. Full article

Background: Rectal neuroendocrine tumors (NETs) ≤ 10 mm are commonly managed by endoscopic resection. However, the optimal technique remains controversial. We aimed to compare the efficacy and safety of a simplified endoscopic mucosal resection (sEMR) technique, performed without submucosal injection, with conventional endoscopic submucosal dissection (ESD) for small rectal NETs. Methods: This retrospective, single-center study included 74 patients with histologically confirmed rectal NETs ≤ 10 mm treated with sEMR (n = 37) or ESD (n = 37) between January 2022 and January 2025. Patients in the ESD group were matched 1:1 by age and gender. Baseline characteristics, procedural outcomes, histopathologic findings, and cost were analyzed. The primary outcome was histological complete resection (R0) rate; secondary outcomes included en bloc resection, intraoperative bleeding, tumor-to-margin distance, operation time, and material costs. Results: The R0 resection rate was significantly higher in the sEMR group compared to the ESD group (91.9% vs. 67.6%; p = 0.019). Tumor-to-margin distance was also significantly greater in the sEMR group [median (IQR): 0.2 (0.1–0.3) mm vs. 0.1 (0–0.2) mm; p = 0.024]. Intraoperative bleeding was less frequent in the sEMR group (2.7% vs. 21.6%; p = 0.028). Median operation time (409 vs. 1469 s; p < 0.001) and material cost (1486 vs. 6390 CNY; p < 0.001) were both significantly lower in the sEMR group. Conclusions: Compared with ESD, the simplified EMR technique without submucosal injection demonstrated higher R0 resection rates, lower bleeding risk, shorter operation time, and lower costs for small rectal NETs. sEMR may offer a safe, efficient, and cost-effective alternative in selected patients. Full article

Rectal cancer remains a significant clinical challenge due to its complex anatomy and the critical need to balance oncological radicality with functional preservation. Multimodal treatment strategies, including neoadjuvant therapy, advanced endoscopic techniques, and precise surgical approaches, have evolved to optimize patient outcomes. Neoadjuvant chemoradiotherapy improves resectability and local control in locally advanced tumors, while endoscopic treatment offers organ-preserving options for carefully selected early-stage cancers. Surgical resection, primarily through total mesorectal excision (TME), remains the cornerstone of curative therapy, with minimally invasive and transanal approaches enhancing precision and recovery. In advanced and recurrent cases, extended procedures such as pelvic exenteration provide potential for cure despite substantial morbidity. This review summarizes current evidence on the indications, techniques, and outcomes of neoadjuvant, endoscopic, and surgical treatments for rectal cancer, emphasizing individualized treatment planning to achieve optimal oncological and functional results. Full article