Abstract Gastroparesis is a disorder characterized by delayed gastric emptying and is associated with significant impairment in patient quality of life. Although its pathogenesis is not fully understood, it is thought to arise from a combination of cellular, structural, and neuromuscular abnormalities involving the gastric body and pylorus. While established medical therapies target these underlying mechanisms, a subset of patients remain refractory to pharmacologic management and require procedural intervention. Per-oral pyloromyotomy (POP) has emerged as a minimally invasive therapeutic option that directly targets pyloric dysfunction. In this review, we examine the pathophysiology of gastroparesis, describe the technical aspects of the POP procedure, and summarize current clinical outcomes and safety data supporting its role in the management of medically refractory gastroparesis.
Abstract As incidentally discovered pancreatic cysts become increasingly common on cross-sectional imaging, understanding their diagnosis and management has grown in clinical importance. Pancreatic mucinous cystic neoplasms (MCNs) are mucin-producing cystic lesions characterized by pathognomonic ovarian-like stroma, almost exclusively identified in middle-aged women. While historically considered benign tumors with inherent malignant potential, the management of MCNs is currently evolving as recent data clarify the risks of high-grade dysplasia and invasive carcinoma. This review integrates current literature on MCN diagnosis and treatment, emphasizing the utility of cross-sectional imaging and endoscopic ultrasound. The surgical decision-making process is increasingly influenced by the risk of postoperative morbidity and long-term complications, such as diabetes. Furthermore, this review explores the potential of next-generation sequencing, cyst fluid proteomics, and confocal laser endomicroscopy to improve preoperative diagnostic accuracy. Ultimately, a shift toward personalized management is anticipated, utilizing multi-center trial data and molecular diagnostics to better distinguish between patients requiring definitive resection and those suitable for conservative surveillance.
Abstract Transarterial radioembolization (TARE) with Yttrium-90 (Y-90) is increasingly utilized as a first-line modality in the management of hepatocellular carcinoma, offering effective local tumor control with favorable toxicity profiles. While traditionally viewed as palliative, accumulating evidence supports its use as curative intent therapy and in bridging or downstaging patients to transplant. This review explores the expanding role of Y-90 in downstaging patients beyond transplant criteria and in bridging those already eligible. We highlight the outcomes from pivotal studies, including LEGACY and DOSISPHERE-01, which demonstrate high rates of sustained tumor response, low transplant list dropout, and excellent posttransplant survival—especially when TARE is delivered segmentally and with personalized dosimetry. Y-90's ability to preserve hepatic function and achieve superior local control in larger tumors makes it particularly well-suited to the transplant population. We compare Y-90 with transarterial chemoembolization, addressing key distinctions in efficacy, durability, and tolerability. Practical considerations—including patient selection, treatment planning, transplant timing, and multidisciplinary coordination—are reviewed. Finally, we discuss future directions, including the role of Y-90 in combination with immunotherapy and ongoing prospective transplant-centered trials.
Abstract Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide, and recent epidemiologic trends have demonstrated an alarming rise in early-onset CRC. This has prompted increased efforts in searching for solutions to improve screening strategies and understanding how to best risk-stratify this increasingly younger at-risk population. Current screening modalities carry inherent limitations that are often multifactorial, including issues with sensitivity, specificity, patient adherence/compliance, cost, and access. We review the current evidence, limitations, and future efforts on the use of artificial intelligence and Computer-Aided Adenoma Detection and Diagnosis systems to augment and enhance existing screening approaches to improve both detection and efficacy.
Abstract In well-selected patients with unresectable, liver-limited colorectal liver metastases (CRLM), liver transplantation (LT) is a promising and feasible option. However, hepatic disease containment during the waitlist period remains vital for success, emphasizing the need for a “bridging therapy.” We utilize expert clinical guidance to define the role of Yttrium-90 (Y-90) as a bridge to liver transplant. This comprehensive review assesses the role of Y-90 radioembolization across various levels of evidence, including both prospective and retrospective studies. As a first- and second-line adjunct, Y-90 improves hepatic progression-free survival (hPFS). As a second-line therapy, Y-90 improves PFS and hPFS. The results of recent case series confirm the feasibility on an individual level and explore its unique use in radiation lobectomy. Personalized dosimetry is crucial, as a higher absorbed tumor dose is linked to a better response. As a bridge, Y-90 can effectively control intrahepatic tumor burden in the optimal period between systemic therapy and LT. Given the scarcity of living and deceased donor liver transplantation, a disciplined Y-90 bridging strategy helps preserve LT eligibility. Future studies focusing on standardized selection, dosimetry, and timing to LT are warranted in patients with CRLM in the transplant pathway.
