Objective Cost-effectiveness of surveillance for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. We combined different categories of risks of IPMN progression and of IPMN-unrelated mortality to improve surveillance strategies. Design Retrospective analysis of 926 presumed BD-IPMNs lacking worrisome features (WFs)/high-risk stigmata (HRS) under surveillance. Charlson Comorbidity Index (CACI) defined the severity of comorbidities. IPMN relevant changes included development of WF/HRS, pancreatectomy or death for IPMN or pancreatic cancer. Pancreatic malignancy-unrelate ..read more

With the approval of drug treatment for metabolic dysfunction-associated steatohepatitis (MASH) approaching, it is of paramount importance to have non-invasive means to monitor response to treatment.1 Currently, conditional approval is based on liver histology, with MASH resolution without worsening of fibrosis and fibrosis improvement without worsening of MASH being the two key histological endpoints. Liver histology is required to diagnose MASH as well as its resolution. This strict, rigid approach is already cumbersome and hampered by significant observer variability within clinical trials2 ..read more

In the realm of cholangiocarcinoma (CCA), a malignancy often presenting with biliary stenosis, the clinical need to re-establish duct patency offers a unique opportunity to profile bile content, facilitating the identification of potential diagnostic and prognostic biomarkers. Various studies have explored the significance of biochemically distinct molecules in the bile of patients with CCA by comparing with healthy or unrelated biliary disorder controls. These investigations revealed promising candidates for diagnostic purposes, encompassing proteins (eg, clusterin, soluble B7-H4, alpha-1 ant ..read more

Chong IY, Aronson L, Bryant H, et al. Mapping genetic vulnerabilities reveals BTK as a novel therapeutic target in oesophageal cancer. Gut 2018;67:1780-1792. This article has been corrected after publication. The authors inadvertently used incorrect loading controls in Figure 6C and 6D. Figures 6C and 6D have now been corrected with the correct loading control. The caption of Figure 6D has been amended to clarify that this figure is an extended analysis of the experiment carried out in Figure 5C ..read more

Recently, Jarosova et al1 carried out a multicentre randomised trial to assess the impact of endoluminal radiofrequency ablation (RFA) plus stenting with stenting alone in patients with malignant biliary obstruction. The authors demonstrated that there was no benefit of endoluminal biliary RFA in patients with cholangiocarcinoma (CCA) and pancreatic cancer on survival or stent patency. Their results were in agreement with the only Western randomised controlled study conducted by Albers et al.2 We notice that hilar CCA accounted for a large proportion (85.9%, 73/85) in CCA arm of the current st ..read more

We have read with interest the excellent review by Trauner and Fuchs on the novel therapeutic approaches that are currently developed for treating non-alcoholic steatohepatitis (NASH).1 Although there are no licensed pharmacotherapies for NASH, long-acting fibroblast growth factor-21 (FGF-21) analogues are being evaluated to treat NASH because FGF-21 is a pleotropic liver-derived hormone regulating lipid metabolism, insulin sensitivity and energy homeostasis, all mechanisms closely implicated in NASH development.2 To quantify the magnitude of the possible hepatoprotective effects of FGF-21 ana ..read more

Basic scienceETS2: a major new target in inflammatory bowel disease Stankey C, Bourges C, Haag L, et al. A disease-associated gene desert directs macrophage inflammation through ETS2. Nature 2024; doi: 10.1038/s41586-024-07501-1. Using genome-wide association studies (GWAS) results, functional genomics was used to identify a new target in inflammatory bowel disease (IBD). A co-localisation analysis showed that the intergenic region on chromosome 21q22 (chr21q22) contained the haplotype predisposing to five autoimmune diseases. This is a non-coding region or ‘gene desert’. Using chromatin immun ..read more

Background Metabolic disorders and inflammatory bowel diseases (IBD) have captured the globe during Westernisation of lifestyle and related dietary habits over the last decades. Both disease entities are characterised by complex and heterogeneous clinical spectra linked to distinct symptoms and organ systems which, on a first glimpse, do not have many commonalities in clinical practice. However, experimental studies indicate a common backbone of inflammatory mechanisms in metabolic diseases and gut inflammation, and emerging clinical evidence suggests an intricate interplay between metabolic d ..read more

Inflammation is a critical component of most acute and chronic liver diseases. The liver is a unique immunological organ with a dense vascular network, leading to intense crosstalk between tissue-resident immune cells, passenger leucocytes and parenchymal cells. During acute and chronic liver diseases, the multifaceted immune response is involved in disease promoting and repair mechanisms, while upholding core liver immune functions. In recent years, single-cell technologies have unravelled a previously unknown heterogeneity of immune cells, reshaping the complexity of the hepatic immune respo ..read more

Message In a survey among 260 outpatients and staff in a tertiary care endoscopy unit, we calculated transportation-related greenhouse gas emissions for each endoscopic procedure to be 11.5 kg CO2e. According to our calculation model, this represents 32.7% of scope 3 carbon emissions, highlighting the central role of patient and staff transportation. Combining two procedures into one appointment, where indicated, reduces transportation-related CO2 emissions by 13%. Notably, 37% of outpatients reported a preference for videoconferencing over in-person pre-endoscopic consultations, representing ..read more