Annals of Gastroenterology

Concluding a 15-year tenure as Editor-in-Chief of Annals of Gastroenterology: growth, challenges and achievements

Ioannis E. Koutroubakis — Thu, 20 Nov 2025 13:16:42 +0200

Endoscopic strategies for the management of locally recurrent colorectal adenomas

Tommaso Antenucci, Rosario Arena — Thu, 20 Nov 2025 13:20:43 +0200

Endoscopic resection is the standard approach for removing colorectal adenomas. Despite technical advances, recurrence remains a concern. This unique review explores current endoscopic strategies for the management of local adenoma recurrence, evaluating efficacy, safety and limitations, based on available evidence.

Keywords Cancer, endoscopy, recurrence, resection, polypectomy
Ann Gastroenterol 2025; 38 (6): 581-587

Radiological biliary intervention for stone disease

Panagiotis Sardelis, Akshay Sethi, Miltiadis Krokidis — Thu, 20 Nov 2025 13:24:09 +0200

Gallstones are primarily crystalline cholesterol formations that may present significant medical concerns, often leading to bile duct obstruction. Their genesis is multifaceted, influenced by genetics, diet and age. Over the decades, the biliary stone management domain has undergone a transformation, propelled by clinical demands and technological advances. This review focuses on percutaneous treatments, highlighting the shift from foundational percutaneous transhepatic cholangiography to advanced percutaneous transhepatic cholangioscopy, emphasizing patient safety, efficacy, and outcomes. The significance of patient-reported outcomes, capturing aspects that include pain and post-intervention quality of life, is accentuated. A critical analysis reveals a gap in our understanding of the long-term resilience of percutaneous interventions, particularly with respect to averting stone recurrence or treating chronic strictures. The potential of technological enhancements, including advanced endoscopes and real-time imaging, is acknowledged, though the need for rigorous clinical validation must be stressed. Decision-making challenges, due to the myriads of available interventions, are highlighted, emphasizing the need for evidence-based algorithms. Economically, the cost dynamics, both direct and ancillary, of these interventions come to the forefront. Concluding, the paper advocates for continuous innovation, ensuring that biliary stone management remains efficient, patient-centered, safe, and economically justified.

Keywords Percutaneous biliary intervention, biliary stones, biliary strictures, cholangioscopy, interventional radiology

Ann Gastroenterol 2025; 38 (6): 588-594

Performance of endoscopic submucosal dissection and submucosal tunneling endoscopic resection for esophageal submucosal tumors: A multicenter retrospective cohort study

Thu, 20 Nov 2025 13:29:59 +0200

Background Esophageal submucosal tumors (ESTs) were typically managed through surveillance, but there is now a shift towards endoscopic resection. Endoscopic submucosal dissection (ESD) and submucosal tumor endoscopic resection (STER) appear to be safe and effective treatment options; however, evidence from non-East Asian centers is limited.

Methods This retrospective multicenter study included 97 patients from 15 centers across 9 countries who underwent endoscopic resection of ESTs via ESD or STER. Demographics, tumor characteristics, procedural details, adverse events and follow-up outcomes were recorded and analyzed.

Results Of the 97 patients, 48 underwent ESD and 49 STER. Most lesions were located in the lower esophagus and originated from the muscularis propria. En bloc resection was achieved in 95% of cases, with no significant difference between techniques (STER: 92% vs. ESD: 98%, P=0.18). The most common histologic diagnosis was leiomyoma (52%), followed by granular cell tumors (22%) and gastrointestinal stromal tumors (6%). Adverse events were infrequent: 9 cases of perforation were recorded, with only 4 being unintentional and all managed endoscopically. Follow-up data revealed only 1 case of local recurrence in a patient with a 50 mm lesion treated by STER. Hospital stay was longer after STER than ESD (3 vs. 2 days, P<0.001).

Conclusions ESD and STER are effective and safe for ESTs, with high en bloc resection rates, minimal adverse events and very low recurrence during short-term follow up. These findings support the broader adoption of advanced endoscopic resection, which is transforming the management of ESTs from surgical to endoscopic treatment.

Keywords Esophageal submucosal tumors, submucosal tunneling endoscopic resection, endoscopic submucosal dissection

Ann Gastroenterol 2025; 38 (6): 595-603

Prevalence of Helicobacter pylori infection and gastric intestinal metaplasia in Greek patients

Thu, 20 Nov 2025 13:43:04 +0200

Background Knowledge of the local prevalence of Helicobacter pylori (H. pylori) infection and gastric intestinal metaplasia (GIM) is imperative in screening the population for gastric cancer. The aim of our study was to estimate the histopathological prevalence of H. pylori infection and GIM in Greek patients.

Methods This was a single-center retrospective study. The age, sex, endoscopic diagnosis, the presence of H. pylori gastritis and the presence of either complete or incomplete GIM, were extracted from the medical reports of our study group and stored in Microsoft Excel. The analysis was focused on the epidemiologic behavior of 2 histologic diagnoses: the presence of H. pylori gastritis and GIM.

Results H. pylori gastritis was recorded in 910 of the 2343 patients studied (38.8%, 95% confidence interval [CI] 36.8-40.8%). GIM was found in 601 of 2317 patients (25.9%, 95%CI 24.2-27.8%). The prevalence of incomplete GIM was 15.2%. These results are consistent with those observed in other European countries.

Conclusions This study is the first large Greek study to estimate the histopathological prevalence of H. pylori infection and GIM in a population from a primary care gastrointestinal unit. There was a strong association between H. pylori infection and the development of GIM. H. pylori were more prevalent in non-operated stomachs compared with operated. There was no difference in the prevalence of GIM between operated and non-operated stomachs.

Keywords Helicobacter pylori, gastric intestinal metaplasia, prevalence, Greek population

Ann Gastroenterol 2025; 38 (6): 604-609

Epidemiology, risk factors and natural history of eosinophilic esophagitis in patients with inflammatory bowel disease: a population-based cohort study from the United States

Thu, 20 Nov 2025 13:48:03 +0200

Background Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immunemediated disorders whose coexistence is incompletely defined.

Methods We conducted a cohort study using the TriNetX database, examining a cohort of patients with IBD and EoE over the period 2013-2022. We stratified the cohort by type of IBD, age, sex and race, to assess the incidence and risk factors for the development of EoE in patients with IBD. Additionally, we evaluated the 5-year risk of EoE-specific outcomes in patients with and without IBD.

Results Among 234,582 IBD patients (mean age 45.4 years; 52.5% female; 74.8% White; 52.8% Crohn’s disease [CD]), EoE incidence was 0.60% in ulcerative colitis (UC) and 0.83% in CD, highest in 30-34yearold White males. IBD increased EoE risk vs. matched nonIBD controls (adjusted odds ratio [aOR] 2.88, 95% confidence interval [CI] 2.59-3.19). Risk factors in UC were age <40 years (aOR 1.82, 95%CI 1.53-2.16) and male sex (aOR 1.83, 95%CI 1.56-2.15). In CD, age <40 years (aOR 2.71, 95%CI 2.35-3.13), male sex (aOR 1.81, 95%CI 1.58-2.06), obesity (aOR 1.41, 95%CI 1.13-1.75), and prior intestinal surgery (aOR 1.22, 95%CI 1.10-1.50) were significant. After PSM, concurrent IBD reduced the 5year composite risk of esophageal dilation and/or dupilumab use (aOR 0.39, 95%CI 0.29-0.52) compared with EoE alone.

Conclusions IBD confers roughly 3fold higher odds of EoE. Younger age and male sex are universal risk factors; obesity and surgery are risk factors in CD. EoE complicating IBD is associated with fewer fibrostenotic sequelae than isolated EoE.

Keywords Eosinophilic esophagitis, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, risk factors

Ann Gastroenterol 2025; 38 (6): 610-617

Epidemiology of metabolic syndrome in patients with inflammatory bowel disease: a population-level cohort study from the United States

Thu, 20 Nov 2025 13:56:57 +0200

Background Epidemiological data on metabolic syndrome (MetS) in patients with inflammatory bowel disease (IBD) are limited.

Methods A retrospective cohort study was conducted using the United States (US) Collaborative Network (TriNetX) to obtain data for patients with IBD between 2010 and 2023. The primary aim of the study was to estimate the prevalence of MetS in ulcerative colitis (UC) and Crohn’s disease (CD). Prevalence was further characterized by age, sex, race, disease location, IBD medications, history of surgery, and IBD phenotype.

Results Among 100,890 patients with IBD, metabolic syndrome (MetS) affected 34.4% overall (UC 32.4%, CD 34.3%). Prevalence rose sharply with age (12-14% at 18-39 to 47-50% at ≥65) and was higher in men than women. Rates were greatest among American Indian (CD 45.2%), Black (40%) and Hispanic (38-39%) populations, and lowest in Asian patients (26%). MetS clustered with more severe phenotypes (stricturing CD, prior CD surgery) and was not elevated among patients receiving advanced therapy. MetS was associated with greater systemic corticosteroid use and higher surgery/colectomy risk, while stricture and fistula risks in CD were similar; advanced
therapy was not initiated more frequently in CD.

Conclusion Our study provides updated epidemiological estimates of MetS in patients with IBD in the US.

Keywords Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, metabolic syndrome, epidemiology

Ann Gastroenterol 2025; 38 (6): 618-628

Disease burden and unmet medical need in patients with Crohn’s disease in Greece: a cross-sectional patient survey

Thu, 20 Nov 2025 14:01:55 +0200

Background Improving Crohn’s disease (CD) management requires a comprehensive understanding of the disease’s full impact. Τhis real-world, patient-reported survey investigated the disease burden and unmet medical needs among Greek patients with CD.

Methods Between October 2023 and January 2024, members of the Hellenic Society of Crohn’s Disease and Ulcerative Colitis Patients (HELLESCC) completed a structured questionnaire. The questionnaire captured demographics, disease and treatment characteristics, as well as patient-reported outcomes: Short Inflammatory Bowel Disease Questionnaire (SIBDQ), Work Productivity and Activity Impairment (WPAI), Patient Health Questionnaire-9 (PHQ-9), treatment satisfaction, and treatment adherence. To determine associated factors, both univariate and multivariate logistic regression analyses were carried out.

Results Among 240 CD patients, 52.9% had active disease and 83.7% were treated with advanced therapies (biological/small molecule agents). Approximately 73.1% reported impaired quality of life (QoL) (SIBDQ <60), 30.9% reduced work productivity, and 36.0% limitations in daily activities. Nearly half (46.1%) reported moderate-to-severe depressive symptoms (PHQ-9 ≥10). Four of 10 patients expressed dissatisfaction with their treatment and 9.9% reported reduced adherence. Higher disease activity was associated with poorer QoL, reduced work productivity, worse mental health, and lower treatment satisfaction. Notably, 76.3% of patients on advanced
therapies reported impaired QoL. Of these, 30.9% were in clinical remission.

Conclusions In Greece, CD patients continue to bear a substantial disease burden, evidenced by reduced QoL, impaired work productivity and daily activity, high rates of depression, and persistent disease activity. A significant proportion also reported dissatisfaction with their treatment, underscoring ongoing unmet needs in disease management.

Keywords Crohn’s disease, disease burden, unmet medical need, patient-reported outcomes

Ann Gastroenterol 2025; 38 (6): 629-640

Accuracy of intestinal ultrasonography in the evaluation of patients with moderate-to-severe ulcerative colitis starting infliximab therapy

Thu, 20 Nov 2025 14:06:17 +0200

Background Intestinal ultrasound (IUS) is accurate in detecting active ulcerative colitis (UC), but its role in repeated monitoring during biologic therapy remains to be established. This study aimed to assess correlations between IUS findings and the Mayo endoscopic score (MES), clinical and biochemical indices, and to evaluate the utility of IUS for monitoring infliximab (IFX) therapy and predicting outcomes.

Methods In this prospective open-label study, patients with moderate-to-severe UC starting IFX were assessed at baseline and at week 14. Flexible sigmoidoscopy, IUS and measurement of fecal calprotectin levels were performed at both time points. Correlations between bowel wall thickness (BWT) and MES, C-reactive protein (CRP), calprotectin, and the Simple Clinical Colitis Activity Index (SCCAI) were analyzed across both visits.

Results Thirty-two patients completed baseline evaluations and 21 completed follow up. Median age was 38 years; 53% were male. Disease extent was left-sided in 41% and extensive in 59%. BWT showed moderate correlations with MES (r=0.43, P=0.0015), and CRP (r=0.40, P=0.007), and a weak correlation with calprotectin (r=0.19, P=0.25). No significant differences in BWT, MES, CRP or calprotectin were observed at either time point. The only significant improvement was in SCCAI, from 7 (4.8-8) to 3 (1-5) (P=0.009). Baseline BWT and MES did not differ significantly
between responders and non-responders.

Conclusions BWT measured by IUS correlates with endoscopic and biochemical markers of disease activity. IUS may serve as a reliable, noninvasive alternative to endoscopy for monitoring treatment response in UC.

Keywords Intestinal ultrasound, ulcerative colitis, infliximab, Mayo endoscopic score, bowel wall thickness

Ann Gastroenterol 2025; 38 (6): 641-647

Interleukin 12/23 and interleukin 23 inhibitors for moderate-to-severe ulcerative colitis: a systematic review and network meta-analysis

Thu, 20 Nov 2025 14:12:56 +0200

Background Ulcerative colitis (UC) is a chronic inflammatory disease affecting ~1.5 million individuals, causing significant impairment in quality of life, psychological well-being, and healthcare burden. Using indirect meta-analysis, this study compared the efficacy and safety of anti-interleukin (IL)-12/23 and IL-23 agents vs. placebo and each other, during induction and maintenance in moderate-to-severe UC.

Methods A systematic search of PubMed, Cochrane, Scopus, Web of Science, and ClinicalTrials. gov was conducted on October 1, 2024. The randomized controlled trials (RCTs) included evaluated ustekinumab, mirikizumab, risankizumab, and guselkumab. The primary outcomes were clinical remission and endoscopic improvement at both induction and maintenance endpoints. Odds ratios (ORs) with 95% confidence intervals (CIs) and surface under the cumulative ranking (SUCRA) values were used to rank treatment efficacy.

Results Six RCTs (n=3808) were analyzed for induction and 5 RCTs (n=1697) for maintenance. During induction, risankizumab demonstrated the highest clinical remission rates (OR 3.89, 95%CI 2.24- 6.75; SUCRA 80.7%) and endoscopic improvement rates (OR 4.21, 95%CI 2.12-8.35; SUCRA 87.6%) compared to placebo. In maintenance, guselkumab showed the highest clinical remission (OR 4.28, 95%CI 1.58-11.59; SUCRA 81.6%) and endoscopic improvement (OR 4.21, 95%CI 2.12-8.35; SUCRA 93.1%), and was superior to risankizumab (OR 2.05, 95%CI 1.09-3.84) for endoscopic outcomes.

Conclusions Risankizumab was most effective in induction, while guselkumab was more effective in maintenance. Head-to-head trials are warranted.

Keywords Ulcerative colitis, interleukin-12/23 inhibitors, interleukin-23 inhibitors, systematic review, network meta-analysis

Ann Gastroenterol 2025; 38 (6): 648-660

Darvadstrocel: real-world clinical outcomes and economic impact in the Spanish national health system

Thu, 20 Nov 2025 14:21:15 +0200

Background Complex perianal fistulas in Crohn’s disease (CD) represent a therapeutic challenge. Darvadstrocel has demonstrated efficacy in clinical trials, but evidence from real-life clinical practice is limited. This study evaluated the effectiveness and safety of darvadstrocel in real-life clinical practice, and assessed the economic impact associated with the outcome-based payment model (OBPM) linked to its funding within the Spanish National Health System.

Methods An observational, descriptive, retrospective study was conducted on patients treated with darvadstrocel in the Servizo Galego de Saúde (SERGAS) between December 2019 and December 2024. Data were collected from the Therapeutic Value of Medicines Information System (VALTERMED), including demographic, clinical, safety and effectiveness variables at 6 and 12 months post-treatment. Descriptive statistics and Fisher’s exact test were used for subgroup analyses.

Results A total of 26 patients were included (50.0% female; median age: 38.4 years). Combined remission was achieved in 69.2% (n=18) at 6 months and 57.7% (n=15) at 12 months. No significant differences were observed among subgroups. No treatment-related adverse events were reported. Regarding sustainability, the OBPM resulted in SERGAS covering 81.5% of the total treatment costs, as the second payment installment was not made for non-responders.

Conclusions Darvadstrocel demonstrated high effectiveness and safety in real-world clinical practice for patients with CD and complex perianal fistulas, with remission rates consistent with previous studies. The implementation of the OBPM linked to health outcomes proved to be a valuable tool for funding innovative therapies.

Keywords Darvadstrocel, mesenchymal stem cells, Crohn’s disease, remission induction, safety

Ann Gastroenterol 2025; 38 (6): 661-666

Risk of colorectal cancer after weight loss in the obese: a pooled cohort study

Thu, 20 Nov 2025 14:25:51 +0200

Background Though the link between obesity and colorectal cancer (CRC) is convincing, the impact of weight loss after obesity on CRC risk is unknown.

Methods This pooled study from the Multiethnic Cohort, Nurses’ Health Study and Health Professionals Follow-Up Study included adults aged 45-75, with 3+ available body mass index (BMI) measures. The primary analysis included persons of all weights, with exposure (BMI) subjected to group-based trajectory modeling. Time-to-incident CRC was evaluated using accelerated failure time models. A subanalysis evaluated the risk of CRC in persons with obesity who had weight loss, compared to persons with stable obesity.

Results A total of 193,046 persons were analyzed (median age 49 years, 66% female). Among persons with severe degrees of obesity who lost weight, there was a longer CRC-free duration in whites (acceleration factor [AF] 2.30, 95% confidence interval [CI] 1.23-4.29; P=0.01), persons of “Other” race (AF 2.54, 95%CI 2.45-2.63; P<0.001), Asian/Native Hawaiian/Other Pacific Islanders (AF 1.11, 95%CI 1.06-1.18; P<0.001), and Black/African Americans (AF 1.09, 95%CI 1.07-1.10; P<0.001). BMI was not associated with altered CRC risk in Hispanic/Latinos. Among 40,606
persons with obesity who had weight loss, higher degrees of weight loss were associated with a longer CRC-free duration. While weight loss of 5-10% had an AF of 1.14 (95%CI 1.04-1.24; P=0.01), the optimal degree of weight loss was 15-20%, AF 1.53 (95%CI 1.28-1.83; P<0.001).

Conclusions Weight loss after obesity is associated with a lower CRC risk in diverse populations. In persons with obesity, 15-20% weight loss appears to be optimal.

Keywords Colorectal cancer, group-based trajectory modeling, obesity, weight loss

Ann Gastroenterol 2025; 38 (6): 667-675

Universal screening for viral hepatitis in all inpatients of a university internal medicine department

Thu, 20 Nov 2025 17:04:03 +0200

The global medical community has set a goal of reducing the prevalence of viral hepatitis by 2030, focusing on screening large segments of the population who are unaware of being infected. This study aimed to investigate the efficacy of screening hospitalized patients for viral hepatitis.

Method All patients hospitalized in an internal medicine department between January 2021 and September 2023 underwent screening for hepatitis B and C (HBV/C).

Results A total of 3914 patients were screened (mean age 69.8±16.9 years). A total of 112 (2.9%) patients had positive surface antigen, and 1281 (32.8%) patients had evidence of prior HBV infection (anti-HBc+), of whom the majority (952, 74.4%) also had concurrent positive anti- HBs antibodies. HBV DNA testing was performed in 65 patients (58%), with 60 patients (92.3%) showing detectable HBV DNA levels. Of these, 13 had chronic HBV infection, and 47 had chronic HBV hepatitis. Finally, 28 patients (71.8% of eligible patients) received treatment. During screening for HCV, 102 patients (2.7%) were anti-HCV(+), and 53 patients (52%) underwent HCV RNA testing. Twenty-nine patients showed detectable HCV RNA levels (54.7%), with 13 patients eventually receiving treatment (52% of eligible patients).

Conclusions Screening for viral hepatitis can be easily and effectively performed in hospitalized patients. However, significant care should be taken to ensure that all patients undergo the entire screening process and receive treatment when eligible. Additionally, a substantial proportion of patients with previous HBV infection was recorded, which is of considerable importance in the era of immunosuppressive therapies.

Keywords Hepatitis, screening, hospitalized, viral, prevalence

Ann Gastroenterol 2025; 38 (6): 676-680

Magnetic resonance elastography combined with fibrosis-4 index for diagnosing at-risk metabolic dysfunction-associated steatohepatitis: a systematic review and meta-analysis of diagnostic test accuracy studies

Thu, 20 Nov 2025 17:08:31 +0200

Background Patients with metabolic dysfunction-associated steatohepatitis (MASH; nonalcoholic fatty liver disease activity score ≥4) and significant fibrosis (≥F2; at-risk MASH) are at increased risk for disease progression. Magnetic resonance elastography (MRE) combined with the fibrosis-4 (MEFIB) index enables the noninvasive diagnosis of at-risk MASH and significant fibrosis. We assessed the performance of the MEFIB index for ruling in/out both target conditions.

Methods We analyzed studies up to February 2025 assessing the performance of MEFIB index for ruling in (MRE≥3.3 kPa plus FIB-4≥1.6) and out (MRE<3.3 kPa plus FIB-4<1.6) at-risk MASH or significant fibrosis, using liver biopsy as the reference standard. We calculated pooled diagnostic accuracy estimates using bivariate random-effects models.

Results We included 7 studies with 3356 participants. For ruling in at-risk MASH, the MEFIB index yielded a pooled specificity of 0.94 (95% confidence interval [CI] 0.74-0.99), and a positive likelihood ratio (LRp) of 5.3 (95%CI 1.8-15.7). For ruling out at-risk MASH, the MEFIB index had a pooled sensitivity of 0.77 (95%CI 0.62-0.88) and a negative likelihood ratio (LRn) of 0.34 (95%CI 0.23-0.52). For ruling in significant fibrosis, the MEFIB index achieved a summary specificity of 0.93 (95%CI 0.85-0.97) with LRp 8.2 (95%CI 4.5-14.9). For excluding significant fibrosis, the pooled sensitivity and LRn of the MEFIB index were 0.88 (95%CI 0.79-0.94) and 0.16 (95%CI 0.08-0.31), respectively.

Conclusions MEFIB index has acceptable accuracy for diagnosing at-risk MASH and significant fibrosis. Proposed thresholds can be used to identify both target conditions in high prevalence settings and facilitate patient recruitment in clinical trials.

Keywords MEFIB index, metabolic dysfunction-associated steatohepatitis, fibrosis, systematic review, meta-analysis

Ann Gastroenterol 2025; 38 (6): 681-690

Ferric carboxymaltose is safe and more effective than oral iron for patients with decompensated cirrhosis and iron deficiency anemia, and demonstrates circulatory, renal and prognostic benefits

Thu, 20 Nov 2025 17:21:33 +0200

Background Iron deficiency anemia (IDA) commonly complicates patients with decompensated cirrhosis (DC). We investigated the efficacy of intravenous ferric carboxymaltose (FCM) over oral iron in treating IDA in these patients, the circulatory and renal effects of each treatment, and the prognostic impact of FCM.

Methods We prospectively evaluated non-acutely anemic patients with DC and hemoglobin levels 8-10 g/dL: 58 with IDA (serum ferritin <30 ng/mL) and 90 without IDA. Patients with IDA received oral iron polymaltose (IP) for 3 months and those not achieving hemoglobin increases ≥2 g/dL switched to FCM. Systemic vascular resistance (SVR) as mean arterial pressure/cardiac output ratio, plasma renin activity (PRA), plasma aldosterone, glomerular filtration rate (GFR) and renal blood flow (RBF) were evaluated 3 months after each treatment. All patients with recurrent IDA during follow up received FCM. New/recurrent decompensation and survival rates were assessed
in patients with and without IDA.

Results Hemoglobin increased by ≥2 g/dL in 6/51 (11.7%) patients who tolerated IP, compared to 34/45 (75.5%; P<0.001) FCM-treated patients. FCM use was safe and, unlike IP, it significantly increased SVR, GFR and RBF, while significantly reducing PRA and plasma aldosterone (P<0.001). Percentage hemoglobin changes correlated with changes in SVR (r=0.533; P<0.001), GFR (r=0.775; P<0.001) and RBF (r=0.803; P<0.001). FCM-treated patients showed lower 5-year risk of decompensation (P=0.002) and mortality (P=0.006), and lower incidence of hepatorenal syndrome (n=0.03), than patients without IDA.

Conclusions FCM outperforms oral iron in ameliorating IDA in DC patients with DC. Addressing IDA yields positive circulatory, renal and prognostic outcomes.

Keywords Iron deficiency anemia, decompensated cirrhosis, ferric carboxymaltose, circulatory function, prognosis

Ann Gastroenterol 2025; 38 (6): 691-698

Prospective analysis of outcomes in umbilical hernia repair for patients with decompensated cirrhosis

Thu, 20 Nov 2025 17:26:45 +0200

Background Elective umbilical hernia repair (UHR) is recommended for symptomatic patients who have decompensated cirrhosis with ascites. However, the exact timing, the type of surgery, and the factors affecting the outcomes are not clearly defined.

Methods We prospectively collected data of patients with decompensated cirrhosis and ascites, who underwent UHR between January 2016 and July 2024. Complications and mortality were recorded during the early post-surgery period, at 30 days, at 3 months, and at 12 months after surgery. Our aim was to assess the short-term and long-term outcomes of decompensated cirrhotic patients who underwent either elective or emergency UHR.

Results We included 19 patients (15 male), median model for end-stage liver disease score 15 (interquartile range [IQR] 11-39), who underwent UHR (16 emergent, 3 elective). Median survival time at 12 months after UHR was 5.5 months (IQR 0.3-86), whereas the mortality rates at 12 months were up to 68.42% (13/19 patients). No association was found between survival and type of surgery, type of anesthesia, preoperative use of diuretics, ascites grade or laboratory findings. Survival rates at 30 days (P=0.086), 3 months (P=0.022), and 12 months (P=0.031) postoperatively were better in patients who underwent emergent UHR.

Conclusions UHR in decompensated cirrhotics is associated with high mortality. Several risk factors are implicated in the outcomes, with the severity of liver disease having a central role.

Keywords Umbilical hernia repair, cirrhosis, mortality, survival, risk factors

Ann Gastroenterol 2025; 38 (6): 699-708

Non-pharmacological techniques complementary to sedation administration decrease pain and anxiety during gastrointestinal endoscopic procedures: a meta-analysis

Thu, 20 Nov 2025 17:31:13 +0200

Background We performed a meta-analysis to assess the effect of non-pharmacological techniques, such as virtual reality (VR) and music, as adjuncts to sedation administration during gastrointestinal (GI) endoscopic procedures.

Methods We performed a systematic review across MEDLINE and Cochrane Central Register libraries of randomized controlled trials (RCTs), published between 2014 and 2024, evaluating how non-pharmacological techniques affected patients’ reported pain (primary outcome), an anxiety and satisfaction (secondary outcomes), during endoscopy. We performed pairwise metaanalyses and expressed the effect size on study outcomes. We assessed the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation approach.

Results Twelve RCTs analyzing outcomes from 1511 patients (non-pharmacological techniques n=762; standard sedation n=749) were included. Compared to the sedation-only group, application of non-pharmacological techniques resulted overall in significantly lower pain as mean difference [MD] -1.02, 95% confidence interval [CI] -1.64 to -0.41; Ι2=64%) and anxiety (MD -1.07, 95%CI -1.75 to -0.39; Ι2=20%), with higher satisfaction (MD 1.67, 95%CI 0.50-2.84; Ι2=94%). There was low confidence in the estimates, due to the possibility of performance and detection bias in the majority of the studies, and the high level of heterogeneity. This effect regarding reported
pain was consistent for virtual reality (3 RCTs, n=241) and music (10 RCTs, n=1270): MD -1.05, 95%CI -1.74 to -0.37; I2=0%, and MD -1.00, 95%CI -1.80 to -0.20; I2=73%, respectively.

Conclusion Concomitant application of virtual reality and/or music as adjuncts to sedation administration during GI endoscopic procedures decreases pain and anxiety, at the same improving time patient satisfaction.

Keywords Music, virtual reality, non-pharmacological, endoscopy, pain

Ann Gastroenterol 2025; 38 (6): 709-719

Routine esophagogastroduodenoscopy before upper endoscopic ultrasound for non-luminal indications: clinical value and findings from a large single-center experience

Thu, 20 Nov 2025 17:36:08 +0200

Background Most echoendoscopes are oblique viewing instruments, potentially limiting their value in mucosal evaluation during upper endoscopic ultrasound (EUS) examinations. This raises at least the potential for missed mucosal lesions. While esophagogastroduodenoscopy (EGD) prior to EUS ma mitigate this, performing EGD adds
both cost and time to upper EUS. This study evaluated the utility of routine EGD before EUS in asymptomatic patients.

Methods We performed a retrospective, single-center, cohort study including 626 patients undergoing EUS for pancreaticobiliary/mediastinal indications over a 5-year period (2017-2022). Exclusion criteria included luminal symptoms or prior upper gastrointestinal surgery. Clinically significant EGD findings and their impact on management were analyzed.

Results Among 568 patients who underwent EGD before EUS, 16.8% (n=95) had clinically significant lesions, including reflux esophagitis (32.7%), Barrett’s esophagus (12.7%) and gastritis (17.3%). Additionally, 16.6% (n=94) exhibited findings affecting the feasibility of EUS (e.g., strictures, large hiatal hernias). Management changes occurred in 54.3% of cases, primarily biopsies (54.3%) and medication initiation (36.6%). Only 4.6% had a prior EGD within 6 months of their EUS.

Conclusions Routine EGD before EUS can detect clinically significant mucosal lesions in asymptomatic patients, as well as anatomical factors influencing EUS performance. These findings support considering the incorporation of routine EGD into pre-EUS evaluations to optimize diagnostic accuracy and patient management.

Keywords Esophagogastroduodenoscopy, endoscopic ultrasound, upper gastrointestinal tract, diagnostic accuracy, luminal lesions

Ann Gastroenterol 2025; 38 (6): 720-724

RE: Increased capture of post-endoscopic retrograde cholangiopancreatography adverse events by delayed (day 7) follow-up calls: a prospective comparison of physician- and nurse-initiated calls

Andrew A. Thomson — Thu, 20 Nov 2025 17:38:23 +0200