Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Malignancy-related gastrointestinal bleeding (GIB) remains a significant clinical challenge, contributing substantially to morbidity, mortality, and healthcare utilization in patients with cancer. Up to 10% of individuals with advanced malignancies develop GIB during their disease, and these episodes are frequently characterized by a high risk of rebleeding and poor long-term hemostatic control. Tumor-associated bleeding typically arises from friable, infiltrative, and highly vascular lesions that respond suboptimally to conventional endoscopic techniques such as thermal coagulation or mechanical clipping. These limitations underscore the need for improved diagnostic accuracy and more reliable therapeutic options. Recent advances in imaging modalities, including contrast-enhanced CT studies, have enhanced the ability to localize and characterize bleeding sources in complex oncologic cases. Parallel developments in endoscopic hemostasis—such as over-the-scope clips and contact-free coagulation devices—have expanded the therapeutic armamentarium for managing malignant bleeding. Clinically, topical hemostatic powders—particularly TC-325—represent a highly effective option for achieving rapid endoscopic hemostasis, supported by the strongest comparative evidence and the highest rates of immediate bleeding control among currently available technologies. In this review, we synthesize contemporary diagnostic approaches to GIB and place particular emphasis on the evolving and emerging therapeutic strategies for malignancy-related bleeding. We also highlight innovative technologies that are reshaping clinical practice and improving management options in this challenging clinical domain....
Nutritional deficiencies and metabolic alterations are common complications following bariatric surgery, requiring often lifelong monitoring and supplementation. The aim of this retrospective study is to investigate whether a structured follow-up can mitigate micronutrient deficiencies and metabolic changes. This study was conducted at Cannizaro Hospital (Catania, Italy), a national referral center accredited by SICOB (Italian Society for Bariatric and Metabolic Surgery). The cohort included patients who underwent bariatric surgery who completed one year follow-up between October 2022 and May 2024. Medical records such as anthropometric, clinical and laboratory data were collected for each patient at five different timepoints: baseline, 1-, 3-, 6- and 12-months post-surgery. Serum levels of iron, hemoglobin, vitamin D, folate, vitamin B12 and uric acid were analyzed to assess nutritional and metabolic status over time. One-year follow-up adherence of the patient cohort was equal to 97.5%. A significant increase in serum iron, vitamin D and folate levels was observed one year after surgery. Hemoglobin and vitamin B12 levels remained stable over time. Uric acid showed a significant rise at 1 month after surgery, followed by a progressive reduction by 12 months. This study highlights the importance of a structured follow-up program after bariatric surgery, contributing to the prevention of common postoperative complications....
Background/Objectives: Recurrence after curative gastrectomy for gastric cancer remains common, and treatment options are limited. In selected patients with isolated locoregional relapse, salvage re-gastrectomy may provide durable disease control. This study compared outcomes of salvage re-gastrectomy and chemotherapy for isolated locoregional recurrence. Methods: We reviewed 500 consecutive gastrectomies performed between 2010 and 2024. In total, 66 patients (12.8%) developed isolated locoregional recurrence after previous R0 resection: 25 underwent salvage re-gastrectomy, and 41 received chemotherapy. Propensityscore matching (intended 1:2) was used to balance clinical and pathologic variables, yielding 42 patients (17 surgery, 25 chemotherapy). The primary endpoint was overall survival (OS) from recurrence diagnosis; secondary endpoints included perioperative outcomes and patterns of treatment failure. Results: There were no 30-, 60-, or 90-day deaths after salvage re-gastrectomy. Overall mortality was lower in the surgical group (41.2%) compared with chemotherapy (80.0%; p = 0.010). Salvage re-gastrectomy was independently associated with better OS (HR 0.15, 95% CI 0.02–0.87, and p = 0.035). A longer disease-free interval correlated strongly with survival (ρ = 0.80 and p < 0.001). Surgical patients experienced fewer local (0% vs. 52%) and peritoneal (0% vs. 20%) recurrences. Conclusions: For carefully selected patients with late, isolated locoregional recurrence, salvage re-gastrectomy is feasible and associated with longer survival and improved local control compared with chemotherapy alone. Larger prospective studies are warranted....
Background: A protein called ‘apoptosis inhibitor of macrophage (AIM)’ is involved in the pathogenesis of obesity-associated disease. Although it is widely recognized that concurrent obesity affects the disease progression of chronic liver disease, as does concurrent type 2 diabetes mellitus (T2DM), the involvement of AIM in the pathogenesis of obesity or insulin resistance is not yet understood in patients with primary biliary cholangitis (PBC). Methods: Obesity was defined as a body mass index (BMI) exceeding 25, and insulin resistance was defined as a homeostasis model assessment for insulin resistance (HOMA-IR) value exceeding 2.0, respectively. Hepatic steatosis was estimated based on the classification proposed by Brunt and colleagues. The histological stage was determined by Scheuer’s classification. Results: Twelve (25.0%) of the forty-eight PBC patients had concurrent obesity, and seven (14.6%) had concurrent T2DM. The PBC patients with obesity had significantly higher frequency of hepatic steatosis. Compared to the patients without T2DM, those with concurrent T2DM had significantly higher serum ALT levels and more advanced histological stages. The patients’ serum AIM levels were not associated with concurrent obesity or concurrent T2DM. Our analyses identified the following as the factors that significantly affected the patients’ AIM levels: serum immunoglobulin G, albumin, tumor necrosis factor-α levels, and the histological stages. Conclusions: These results indicate that AIM may not be involved in obesity or insulin resistance, but it may be associated with the disease severity of PBC....
Background/Objectives: Intraductal papillary mucinous neoplasms (IPMN) are the most common pancreatic cystic lesions and are established precancerous entities. Side-branch IPMN (SB-IPMN) is the most prevalent subtype and generally carries a low risk of malignant transformation. The revised 2024 Kyoto guidelines define management and surveillance strategies based on high-risk stigmata and worrisome features; however, real-life adherence to these recommendations remains variable. To compare real-world management of SB-IPMN at a tertiary medical center with Kyoto guideline-based recommendations using an AIgo-based decision-support tool. Methods: SB-IPMN cases were retrospectively analyzed. An algorithm implementing the Kyoto guidelines was used to generate recommended management strategies based on imaging, clinical, and laboratory data, and these recommendations were compared with actual clinical decisions. Long-term clinical and radiological follow-up data were collected, including development of pancreatic ductal adenocarcinoma (PDAC). Results: A total of 368 patients (69% male; median age 69.5 years) were followed for a median of 48.5 months radiologically and 64 months clinically. Median cyst size at presentation was 10 (6–14) mm. Only 58 patients (15.8%) were managed in accordance with the Kyoto guidelines; most underwent more intensive surveillance (60.3%), while 23.9% received less intensive monitoring (p = 0.04). Larger cyst size (>2 cm) was associated with higher concordance with current guidelines. Younger patients, including all patients under 50 years of age, were more frequently over-surveilled. Over-surveillance resulted in an excess of 0.42 MRI/MRCP examinations per patient-year. Only one PDAC case occurred, arising after more than five years of cyst stability. Conclusions: Fewer than 20% of patients with SB-IPMN were managed according to Kyoto guidelines. Over-surveillance was common, particularly in younger patients, without apparent oncologic benefit. AIgobased decision-support tools may help standardize care and optimize resource utilization....
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