There has been an increasing incidence of pancreatic cystic lesions on imaging. Management of pancreatic cysts has been dictated by advanced neoplasia (high-grade dysplasia or pancreas adenocarcinoma) risk; however, the appropriate surveillance strategy is not well characterized for all cyst subtypes. A retrospective analysis was performed at MD Anderson Cancer Center evaluating pancreatic cysts identified on EUS and cross-sectional imaging between January 2000 and April 2023. Patient demographics, clinical factors, and cyst characteristics were collected. Univariate and multivariate logistic regression analyses were performed to ascertain factors predicting advanced neoplasia. 3817 EUS reports were identified with 763 lesions meeting inclusion and exclusion criteria. There were 137 (18.0
BACKGROUND AND AIMS: Gastroparesis is a chronic motility disorder often accompanied by constipation. Defecation disorders are a common, treatable cause of refractory constipation; however, recognition and management in gastroparesis remain unclear. We assessed real-world rates of defecation disorder diagnosis and use of anorectal manometry (ARM) and pelvic floor therapies in gastroparesis with constipation and related healthcare utilization outcomes. METHODS We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network (2000-2022). Adults with gastroparesis were identified, and rates of constipation, defecatory disorder diagnosis, ARM, biofeedback therapy (BFT), and pelvic floor physical therapy (PFT) were assessed. Among patients with gastroparesis and constipation, outcomes were compared between those with and without ARM after 1:1 propensity score matching. Outcomes included emergency department visits, hospitalizations, abdominal imaging, nasogastric tube (NGT) placement, gastrostomy tube placement, and total parenteral nutrition (TPN). RESULTS Among 295,016 patients with gastroparesis, 88,062 (29.9%) had constipation, but only 4828 (1.4%) had a defecatory disorder diagnosis. Among those diagnosed, 1291 (33.3%) underwent ARM and 147 (3.8%) received BFT. After matching, Patients who underwent ARM had lower odds of NGT placement (aOR 0.69, 95% CI 0.47-0.80), abdominal imaging (aOR 0.68, 95% CI 0.61-0.78), emergency department visits (aOR 0.80, 95% CI 0.78-0.85), and hospitalizations (aOR 0.58, 95% CI 0.44-0.76). No significant differences were observed in TPN or gastrostomy tube placement. CONCLUSIONS In this large, real-world cohort, defecatory disorders appear markedly underrecognized and pelvic floor-directed therapies were underutilized in gastroparesis-associated constipation. Patient who underwent Anorectal manometry had lower healthcare utilization, supporting earlier physiologic evaluation in refractory cases.
Common bile duct stone (CBDS) recurrence remains a clinical concern after endoscopic stone clearance. Although both endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) are widely used, whether differences in papillary sphincter disruption influence long-term recurrence and pneumobilia remains uncertain. To compare long-term CBDS recurrence after EPBD versus EST and to explore the associations among sphincterotomy extent, pneumobilia, and recurrence. Adults with native papillae who underwent ERCP for CBDSs ≤10 mm at two centers from 2004 to 2024 were retrospectively analyzed. Patients treated with EST or EPBD alone who achieved complete stone clearance were included. The primary outcome was CBDS recurrence. Inverse probability of treatment weighting (IPTW), Cox regression, and propensity-score matching were used to adjust for confounding. Among 4,848 screened, 1,119 were included (971 EST and 148 EPBD). Recurrence occurred in 151 EST patients (15.6
Slow-transit constipation (STC) is a subtype of chronic constipation characterized by delayed colonic transit without obstructive defecation. Because in vivo human experimentation is constrained, animal models remain the primary tool for probing STC pathogenesis and testing therapies, yet no unified framework exists for judging howwell current models reproduce human disease. This review systematically appraises the reported STC animal models against a single validity framework and identifies design criteria for the next generation of models. We reviewed pharmacological agent-induced models (loperamide, diphenoxylate, alosetron, morphine, atropine), a physical stimulus model (ice-water gavage), surgical models (rectal distension, partial outlet obstruction, chemical ablation of the enteric plexus), and a naturally occurring inbred strain (the CFP/Yit mouse), and appraised each using the Face–Construct–Predictive validity framework. Existing models show substantial gaps in face validity (drug-withdrawal-dependent, self-limiting constipation rather than chronic progressive dysmotility), construct validity (few reproduce enteric glial cell loss, enteric neuronde generation, interstitial cell of Cajal depletion, and inflammatory infiltration), and predictive validity (induction agents confound therapeutic readouts). Advances in enteric glial biology, microbiota–short-chain fatty acid–motility signalling, single-cell transcriptomics of enteric glia, and genetic susceptibility point toward transgenic, pelvic-nerve-intervention, selective enteric glial ablation, and organoid–enteric nervous system co-culture designs, with sex-stratified evaluation and systematic clinical translation studies. The Face–Construct–Predictive framework exposes the translational shortfall of current STC animal models and defines concrete design criteria for clinically relevant successors, guiding model selection and prioritizing future research.
