Background:The development of hepatocellular carcinoma (HCC) in a chronically diseased liver, often referred to as hepatocarcinogenesis, is a complex process characterized by the progressive accumulation and interaction of genetic alterations, leading to abnormal growth, malignant transformation of liver parenchymal cells, followed by vascular invasion and metastasis. Summary:Precancerous conditions of the liver comprise a spectrum of histopathological and clinical entities that confer a significantly elevated risk of progression to primary hepatic malignancy, most notably HCC and, less commonly, intrahepatic cholangiocarcinoma. These states are characterised not by overt malignant transformation but by molecular, architectural, and cytological alterations that create a permissive environment for oncogenesis. Parasitic infection must likewise be recognised within this framework. Chronic hepatosplenic schistosomiasis due to Schistosoma mansoni induces longstanding granulomatous inflammation and periportal fibrosis. The basic hepatic architecture, including the hepatic lobules and their zonation, is illustrated in Figure 1. Although the parasite does not directly transform hepatocytes, the resultant portal hypertension, chronic immune activation, and fibrotic remodelling create a milieu that may facilitate hepatocarcinogenesis, particularly in conjunction with viral hepatitis or other hepatic insults. Thus, S. mansoni infection constitutes an indirect but clinically relevant precancerous condition in endemic regions. Key Messages:In sum, precancerous situations in the liver are less discrete lesions than dynamic pathological states marked by chronic injury, regeneration, and molecular derangement. Their clinical significance resides in the imperative for vigilant surveillance, timely intervention, and, where feasible, modification of underlying aetiological factors. This review discusses HCC precursor lesions associated with a selection of regulatory networks important for liver regeneration, cell cycle control, and their potential significance in the pathogenesis of HCC with special emphasis on Schistosomiasis.
Introduction:Dumping syndrome (DS) is a frequent complication after Roux-en-Y gastric bypass (RYGB), causing gastrointestinal and neurohumoral symptoms that can significantly affect quality of life. Transoral outlet reduction (TORe) has been used in clinical practice as a therapy of DS alongside other conservative and surgical approaches. Effectiveness of different therapy options remains unclear. This meta-analysis aimed to provide an overview of the available data concerning TORe. Methods:A meta-analysis was conducted, including ten retrospective studies identified through a literature search in five databases. All studies analyzed the resolution of DS symptoms after TORe through evaluation of the Sigstad score. Results:The literature search yielded 1,014 publications, of which ten retrospective studies involving a total of 320 patients met the inclusion criteria for this meta-analysis. The analysis showed that TORe led to a pooled success rate, defined as overall improvement of symptoms based on subjective patient responses or reduction of Sigstad score to <7 points of 95.59%, significant weight loss (p < 0.001), and an average reduction of Sigstad score by 8.71 points, indicating a consistent improvement in the severity of DS (p < 0.001). Conclusion:This meta-analysis demonstrates that TORe can be an effective, endoluminal treatment option for DS following RYGB. However, limitations include the retrospective nature of the studies, lack of long-term follow-up, and inconsistent outcome measures. No distinction between early and late DS was observed in any of the included trials. Future research should focus on prospective trials, standardized outcomes, and comparisons with surgical options in order to fully assess the efficacy and durability of TORe. The use of additional objective primary outcome measures, such as oral glucose tolerance testing and continuous glucose monitoring, is suggested.
Background:Gallbladder carcinoma is an uncommon but highly lethal malignancy that is frequently diagnosed at an advanced stage. Among proposed precursor lesions, true neoplastic gallbladder polyps (particularly adenomas and intracholecystic papillary neoplasms) have received increasing attention as potential steps in an adenoma-carcinoma sequence, analogous to colorectal tumorigenesis [CA Cancer J Clin. 2021;71(3):209-49, Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, and Radiology. 2022;305(2):277-89]. However, most gallbladder polyps detected on imaging are benign, and the absolute cancer risk in incidentally detected polyps remains low [CA Cancer J Clin. 2021;71(3):209-49, Br J Radiol. 2022;95(1137):20220152, Radiology. 2022;305(2):277-89, JAMA Netw Open. 2020;3(5):e205143, and Abdom Radiol. 2024;49(9):3158-65]. Summary:Gallbladder polyps are identified in roughly 3-7% of adults undergoing abdominal ultrasonography, with the majority representing non-neoplastic cholesterol or inflammatory lesions [Br J Radiol. 2022;95(1137):20220152, Radiology. 2022;305(2):277-89, JAMA Netw Open. 2020;3(5):e205143, and Chin Med J. 2024;137(14):1674-83]. Only a minority are adenomatous or preinvasive neoplasms with malignant potential [Br J Radiol. 2022;95(1137):20220152, Chin Med J. 2024;137(14):1674-83, and Am J Surg Pathol. 2012;36(9):1279-301]. Across surgical and imaging series, size is the most consistently validated risk factor for neoplasia, with thresholds around 10 mm widely adopted in guidelines as an indication for cholecystectomy in otherwise low-risk patients [Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, and Am J Roentgenol. 2024;222(5):e2330720]. Additional factors associated with neoplastic histology and gallbladder carcinoma include sessile morphology, older age, primary sclerosing cholangitis, Asian ethnicity, and interval growth during surveillance [Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, Am J Roentgenol. 2024;222(5):e2330720, Korean J Gastroenterol. 2023;81(5):197-202, and Diagnostics. 2024;14(4):374]. Contemporary European joint guidelines and other international society statements advocate a risk-stratified algorithm that combines polyp size, morphology, and clinical risk factors to guide decisions between cholecystectomy, ultrasonographic follow-up, or discharge [Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, and Am J Roentgenol. 2024;222(5):e2330720]. Key Messages:Most incidentally detected gallbladder polyps are benign and will never progress to cancer; only a small fraction are true neoplastic precursor lesions [Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, JAMA Netw Open. 2020;3(5):e205143, Korean J Gastroenterol. 2023;81(5):197-202, and Diagnostics. 2024;14(4):374]. Polyps measuring at least 10 mm, sessile morphology, older age, primary sclerosing cholangitis, and certain high-risk clinical backgrounds are associated with increased malignant potential, whereas the absolute cancer risk in polyps smaller than 10 mm is very low in large cohort and meta-analytic data [Br J Radiol. 2022;95(1137):20220152, Eur Radiol. 2022;32(5):3358-68, JAMA Netw Open. 2020;3(5):e205143, Korean J Gastroenterol. 2023;81(5):197-202, and Diagnostics. 2024;14(4):374]. Updated international guidance, therefore, supports a selective, size- and risk factor-based approach to surgery and follow-up rather than universal surveillance or prophylactic cholecystectomy [Eur Radiol. 2022;32(5):3358-68, Radiology. 2022;305(2):277-89, Abdom Radiol. 2024;49(9):3158-65, and Am J Roentgenol. 2024;222(5):e2330720].
Background:Third-space endoscopy uses the submucosal layer as an intentional working corridor to enable dissection, myotomy, or enucleation while preserving organ integrity. The aim of this article was to provide a concise, procedure-based overview of established third-space endoscopic tunneling techniques - peroral endoscopic myotomy (POEM) including major variants, endoscopic submucosal tunnel dissection (ESTD) and submucosal tunneling endoscopic resection (STER) - while discussing endoscopic submucosal dissection (ESD) as the foundational submucosal dissection technique and endoscopic intermuscular dissection as an advanced intermuscular extension. Summary:ESD established the principles of controlled submucosal entry, dissection and hemostasis that enabled subsequent tunneling techniques. ESTD adapts these principles to a mucosal flap-valve/tunnel approach for selected large esophageal neoplastic lesions. POEM has become a standard platform for achalasia and has been adapted to diverticular and gastric pyloric myotomy, whereas STER allows enucleation of selected muscularis propria subepithelial tumors with preserved mucosal integrity. Adoption remains limited by technical complexity, learning curves and infrastructure requirements, structured training and standardized outcome reporting are key enablers. Key Messages:Third-space endoscopy represents a shift toward endoscopic organ preservation. Continued innovation, transparent outcome reporting, and competency-based training pathways are essential for safe dissemination.
Background:Patients with inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn's disease with colonic involvement, are at increased risk of colorectal cancer as a result of chronic intestinal inflammation. Colitis-associated dysplasia represents the principal premalignant lesion in this setting and constitutes the critical link between sustained inflammation and colorectal carcinogenesis. IBD-associated dysplasia develops due to the inflamed mucosal field and follows a distinct, inflammation-driven pathway characterized by field cancerization, multifocality, and early genetic and epigenetic alterations. Summary:This review explores the potential cellular and molecular mechanisms that contribute to colitis-associated dysplasia. These mechanisms include chromosomal instability, oncogenic mutations, epigenetic remodeling, metabolic reprogramming, and immune dysregulation. Particular emphasis is placed on the histological assessment and diagnostic classification of dysplasia in IBD, encompassing both conventional and nonconventional dysplastic subtypes and the associated diagnostic challenges. In addition, contemporary strategies for dysplasia detection are discussed, highlighting advances in endoscopic techniques and emerging imaging modalities that aim to improve lesion recognition. Current evidence guiding the management of dysplastic lesions is also reviewed, with focus on endoscopic resection techniques, surgical indications, and individualized post-resection surveillance strategies. Key Messages:Colitis-associated dysplasia is a biologically distinct and clinically heterogeneous precursor to colorectal cancer in IBD. Optimal management requires an integrated, multidisciplinary approach combining expert histopathological evaluation, advanced endoscopic detection, and individualized therapeutic decision-making. Continued advances in diagnostic strategies may further improve risk stratification and outcomes for patients with IBD.
Introduction:Esophageal stricture (ES) is a frequent and clinically significant adverse event after wide-field endoscopic submucosal dissection (ESD) for superficial esophageal neoplasia. Despite multiple prophylactic strategies, prevention remains challenging, and current steroid-based regimens offer limited efficacy. This study evaluated the efficacy and safety of budesonide orodispersible tablets (BOT) for ES prevention after wide-field ESD. Methods:This retrospective, dual-center study evaluated prospectively collected data from patients with superficial esophageal neoplasia undergoing wide-field ESD (≥50% circumferential extent) between August 2020 and August 2024. All patients received BOT (Jorveza® 1 mg twice daily; Dr. Falk Pharma GmbH, Germany) for 4-8 weeks post-ESD. Patients receiving additional stricture-prevention measures were excluded. The primary endpoint was post-ESD stricture. Secondary endpoints included BOT-related adverse events. Results:Twenty patients (mean age 62.8 ± 10.8 years) underwent ESD with BOT prophylaxis. ES occurred in 35.0% overall - 13.3% after resections involving 50-90% of the esophageal circumference and 100% after circumferential (100%) resections. Patients with strictures had greater circumferential resection extent (85.7% vs. 59.2%; p = 0.036). Four strictures were mild (≤7 dilations) and 3 refractory (≥8). BOT was well tolerated; 2 patients (10.0%) developed asymptomatic esophageal candidiasis, and no systemic steroid-related adverse events occurred. Conclusion:BOT prophylaxis was well tolerated and may reduce strictures after non-circumferential resections; however, its protective effect appears limited in circumferential resections. Combination strategies may be warranted in high-risk patients.
Background: Third-space endoscopy uses the submucosal layer as an intentional working corridor to enable dissection, myotomy, or enucleation while preserving organ integrity. Aim: To provide a concise, procedure-based overview of established third-space endoscopic tunneling techniques – peroral endoscopic myotomy (POEM) including major variants, endoscopic submucosal tunnel dissection (ESTD) and submucosal tunneling endoscopic resection (STER) – while discussing ESD as the foundational submucosal dissection technique and EID as an advanced intermuscular extension. Content summary: ESD established the principles of controlled submucosal entry, dissection and hemostasis that enabled subsequent tunneling techniques. ESTD adapts these principles to a mucosal flap-valve/tunnel approach for selected large esophageal neoplastic lesions. POEM has become standard platform for achalasia and has been adapted to diverticular and gastric pyloric myotomy, whereas STER allows enucleation of selected muscularis propria subepithelial tumors with preserved mucosal integrity. Adoption remains limited by technical complexity, learning curves and infrastructure requirements, structured training and standardized outcome reporting are key enablers. Conclusion: Third-space endoscopy represents a shift toward endoscopic organ preservation. Continued innovation, transparent outcome reporting, and competency-based training pathways are essential for safe dissemination.
INTRODUCTION: Preoperative characterization of pancreatic cystic lesions (PCLs) remains inaccurate when based on morphology alone. We aimed to determine whether integrating complementary imaging (cross-sectional imaging plus endoscopic ultrasound) and clinical history, particularly history of pancreatitis, improves diagnostic accuracy compared with single-modality imaging. METHODS: This retrospective study included consecutive patients with PCLs treated at a tertiary referral center (test cohort) and a confirmatory cohort from a second hospital. Preoperative diagnostic accuracy was assessed in patients with histological confirmation. Multivariable logistic regression identified independent predictors of correct preoperative diagnosis. Additionally, a secondary multivariable logistic regression analysis included all patients using final diagnosis at follow-up (mean 2.4 ± 0.3 years) was performed. RESULTS: In the test cohort, 258 patients were analyzed; 59 (23%) had histological confirmation. Overall preoperative accuracy was 63% (validation cohort: 68%). No significant difference was observed between MRI, CT or endoscopic ultrasound alone. Complementary imaging was independently associated with higher diagnostic accuracy in multivariable analysis, as was main pancreatic duct dilation. In the full cohort, a history of acute or chronic pancreatitis was the only independent predictor of correct diagnosis and strongly predicted pseudocysts (80% vs. 10% without pancreatitis; p<0.00001). Combining complementary imaging with pancreatitis history further improved overall diagnostic accuracy and significantly increased detection of malignant PCLs compared with MRI alone (p=0.03). CONCLUSION: Diagnostic accuracy of PCLs is limited with single-modality imaging. A stepwise strategy integrating complementary imaging and clinical history, particularly a history of pancreatitis, significantly improves identification of malignant lesions and may refine guideline-based management.
Introduction:IgG4-related retroperitoneal fibrosis (IgG4-related RPF) is a rare systemic fibro-inflammatory disorder that may present as a mass-forming lesion, mimicking malignancy. Gastrointestinal involvement is uncommon, and acute large bowel obstruction as the initial presentation is exceedingly rare. Case Presentation:A 59-year-old male presented with acute abdominal pain, distension, and obstructive symptoms. Colonoscopy identified a stenosing lesion at the left colic flexure, histologically confirmed as a polypoid adenoma. Contrast-enhanced computed tomography (CT) revealed a mass infiltrating the left colic flexure, peripancreatic fat, and pancreatic tail, with significant colonic dilatation. Emergency surgery was performed due to bowel obstruction. En bloc extended left hemicolectomy, distal pancreatectomy, and wedge gastrectomy with loop ileostomy were carried out. Histopathology confirmed IgG4-related RPF involving pericolic and peripancreatic fat, sparing the pancreatic parenchyma. Serum IgG4 was within normal limits. The patient had an uneventful recovery. Conclusion:This case illustrates a rare presentation of IgG4-related RPF manifesting as acute bowel obstruction. Despite imaging and clinical features suggestive of malignancy, histopathological confirmation revealed benign pathology with an inflammatory fibrosing process. Awareness of such atypical manifestations is crucial to prevent unnecessary radical oncological resections.
Background:Colorectal cancer (CRC) remains a leading cause of cancer mortality, and metastatic disease still carries a poor prognosis, highlighting the need for preclinical models that better reflect human tumor biology. Orthotopic murine CRC models more closely recapitulate the native tumor microenvironment and metastatic routes than subcutaneous or in vitro systems. Summary:In this review, we summarize transplantable orthotopic CRC mouse models and discuss their establishment techniques, applications, and limitations. A systematic literature search was performed in PubMed using the terms "murine colorectal cancer model," "orthotopic colorectal cancer," "cecal implantation," "rectal cancer mouse model," and "tumor organoid transplantation." We describe commonly used approaches, including open surgical implantation and minimally invasive transanal methods, and compare key design choices such as tumor source (syngeneic vs. xenograft), implantation site, and readouts for local growth and metastasis. We also highlight practical considerations, including immune competence and technical complexity that influence reproducibility and model selection for specific research questions. Key Messages:Transplantable orthotopic models are indispensable for studying site-specific tumor-host interactions and metastasis in CRC. Model choice should be guided by the intended biological question, immune context, and procedural feasibility. Continued refinement and standardization, including integration of immune and microenvironmental components, will further improve translational relevance.
Background:Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and clinically relevant complication of ERCP. While mechanical, hydrostatic, and chemical injury have been classically implicated in its pathogenesis, recent studies highlight additional mechanisms, including microvascular dysfunction, pancreatic steatosis, and calcium-calcineurin-driven acinar injury. Recent advances have reshaped our understanding of risk factors, optimal cannulation techniques, pharmacologic prophylaxis, and early diagnostic approaches. Summary:This review combines established knowledge with current evidence for the prevention and early recognition of PEP. The number of pancreatic duct wire passages has been identified as a strong, objective predictor of PEP, beyond the traditional definitions of difficult cannulation. The DIPPP randomized trial confirms that rectal indomethacin and diclofenac offer equivalent prophylactic efficacy. Somatostatin analogs reduce overall and moderate PEP but show limited impact on mild or severe disease. Pancreatic steatosis has emerged as a significant risk phenotype. Perfusion CT provides a promising physiologic biomarker for early detection of PEP. These data support the development of a prevention algorithm integrating NSAIDs, evidence-based cannulation strategy, selective pancreatic duct stenting, lactated Ringer's hydration, and early post-procedure risk assessment. Key Messages:Established interventions supported by high-quality RCTs: (1) Rectal NSAIDs remain the cornerstone of PEP prophylaxis and should be given to all the eligible patients. (2) Prophylactic pancreatic duct stenting provides additional benefit in high-risk cases. (3) Minimizing papillary trauma through guidewire-first cannulation and early adoption of advanced rescue techniques is a critical modifiable determinant of PEP risk. Adjunctive or investigational strategies: (1) Aggressive hydration should be individualized as trials do not show consistent incremental benefit over NSAIDs alone. (2) Combination regimens (NSAIDs + hydration or stenting) appear promising in indirect analyses, but definitive superiority over optimized NSAID-based prophylaxis remains unproven. (3) Emerging approaches including calcineurin inhibition, cryoprevention, and AI-based risk prediction are mechanistically compelling but remain investigational pending prospective validation.
NEXT GEN Day is a joint initiative of the CAJC (Working Group of Young Surgeons of the DGAV) and JUGA, the young professionals' section of the DGVS, embedded within the annual Congress for Visceral Medicine. Targeting residents and early career specialists, the program integrates interdisciplinary education, hands-on workshops, and structured networking at the interface of surgery and internal medicine. Following record participation in 2025, NEXT GEN 2026 will return with an updated program, including the renewed "President Meets NEXT GEN" format, further strengthening education and collaboration in visceral medicine.
Background:Endoscopic eradication therapy (EET) is the standard of care for dysplastic Barrett's esophagus (BE) and early esophageal adenocarcinoma (EAC). Successful outcomes require a structured, evidence-based approach. Summary:Recognising and removing visible neoplasia is a crucial step in EET. Endoscopic mucosal resection (EMR) is efficient and safe for most dysplastic lesions, while endoscopic submucosal dissection (ESD) enables en bloc resection and more precise staging when submucosal invasion is suspected. Radiofrequency ablation remains the most established method for eradicating residual BE, with hybrid APC and cryoballoon ablation emerging as potential alternatives. Optimal therapy also depends on appropriate patient selection, multidisciplinary team involvement (MDT), effective acid control, and structured surveillance. Key Messages:(1) EET is effective, safe, and now central to managing dysplastic BE and early EAC. (2) High-quality optical diagnosis, careful technique selection, meticulous resection, and accurate histopathology assessment underpin good outcomes. (3) In most cases, ablation is recommended for durable remission, with RFA the first-line option. (4) Care is best delivered by specialist, multidisciplinary centres that adapt therapy to the individual patient within their wider clinical context.
Introduction:Despite advances in multimodal therapy, local and distant recurrence remain major challenges in rectal cancer management. Preoperative MRI and pathological findings offer prognostic information on local burden of disease. However, the value of these factors in predicting recurrence is not fully defined. This study aimed to identify and reassess MRI and pathological predictors for recurrence in rectal cancer. Methods:In this single-center retrospective study, patients with stage I-III rectal cancer who received surgery with curative intent between 2014 and 2021 at a German referral cancer center were analyzed using univariate analysis. Results:A total of 279 consecutive patients were included. After a median follow-up of 54 months, local recurrence (LR) occurred in 20 patients (7.2%) and distant metastasis (DM) in 44 patients (15.8%). Advanced pathological UICC stage was found to be significantly associated with both LR (p = 0.003) and DM (p = 0.002). After neoadjuvant therapy, tumor downstaging correlated with a markedly lower incidence of DM (p = 0.010). A positive circumferential resection margin was found to be linked to a higher risk of DM (p = 0.035). Conclusion:Our study identifies tumor downstaging after neoadjuvant therapy as a prognostically relevant factor. This finding emphasizes the necessity of incorporating treatment response into postoperative risk stratification to tailor an individualized surveillance strategy.
Background:Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that can occur in the postoperative period, often mimicking surgical site infections (SSIs). The clinical overlap between PG and SSIs - including erythema, wound dehiscence, and purulent discharge - makes timely diagnosis challenging. Case Presentation:A 61-year-old female with a history of ovarian cancer and metachronous liver metastasis underwent an open left hemihepatectomy. On the fifth postoperative day, she developed erythema, wound dehiscence, and necrosis unresponsive to broad-spectrum antibiotics. Wound cultures remained sterile. Dermatologic consultation and histopathology confirmed the diagnosis of PG, characterized by dense neutrophilic infiltration and pyogenic folliculitis. High-dose corticosteroid therapy led to marked clinical improvement within 5 days, with full wound healing achieved by discharge. Conclusion:Postoperative PG should be considered in non-resolving postoperative wound complications with negative cultures and antibiotic failure. In this context, prior exposure to PARP inhibitors may be a biologically plausible cofactor through immune modulation; however, a causal link remains unproven. Early dermatology consultation and biopsy are essential to avoid harmful debridement and expedite immunosuppression.
Introduction: Hirschsprung’s disease is a congenital anomaly affecting intestinal motility. Its main characteristic is the absence of ganglion cells in the distal colon, which results in chronic constipation. To date, confirmatory biopsies in the pediatric population have been obtained through suction biopsies or open surgical procedures. Therapeutic endoscopic full-thickness resection (EFTR) has been successfully used in adult endoscopy to treat various diseases of the lower gastrointestinal tract. This procedure has been shown to be safe and effective. Methods: A single-center retrospective case series study from May 2024 to September 2025, including 13 pediatric patients aged 3.5–14.4 years (median 9.5 years) with therapy-refractory constipation, who underwent an EFTR biopsy using Ovesco diagnostic FTRD® as part of the diagnostic workup for Hirschsprung’s disease. EFTR was performed in the distal rectum, 2 cm above the linea dentata, to exclude an ultrashort variant of Hirschsprung’s disease. Results: All EFTR procedures were successful, and only 1 patient had non-hemodynamically relevant rectal bleeding during the 1-year follow-up. All biopsies fulfilled the requirements to validate or exclude Hirschsprung’s disease, showing an excellent success rate of full-thickness resection (100%). Conclusions: This is the first case series of EFTR using the Ovesco diagnostic FTRD® technique in pediatric patients for the diagnosis of Hirschsprung’s disease. EFTR is a safe, time-saving, and successful method that can be used to diagnose Hirschsprung’s disease in pediatric patients starting from 3 years of age.
Background: Thoracic epidural analgesia (TEA) is a key component of Enhanced Recovery After Surgery protocols for major abdominal and thoracic procedures. Despite its benefits for pain management, TEA has been associated with an increased risk of postoperative urinary retention (POUR). Consequently, it is common practice to maintain a urinary catheter (UC) for the duration of TEA. This study aimed to evaluate the impact of early UC removal in patients receiving TEA through a randomized controlled trial. Methods: In this randomized controlled trial approved by the Rostock University Medical Center Ethics Board (AZ A2018-0220), patients scheduled for elective major abdominal or thoracic surgery with anticipated TEA within 1 year were enrolled. Participants were randomized into two groups: the early removal group (ERG), where the UC was removed within 48 h post-surgery, and the standard group (SG), where the UC was retained until TEA discontinuation. POUR was defined as a residual urine volume of ≥400 mL measured by ultrasound, and catheter-associated urinary tract infections (CAUTIs) were assessed. Results: Of the 99 patients initially enrolled, 81 patients were available for analysis. In the ERG (n = 43), the UC was removed within 48 h, whereas in the SG (n = 38), the UC was maintained until TEA cessation. The incidence of POUR was similar between the groups, with 1 patient in each group (2.3% in ERG vs. 2.6% in SG, p = 1) requiring recatheterization. CAUTI developed in 4 patients (4.9%), all of whom were in the SG (10.5%), indicating a statistically significant association between the timing of UC removal and CAUTI incidence (p = 0.044). Conclusion: Our results suggest that early UC removal under TEA is safe and does not significantly increase the risk of POUR while reducing the incidence of CAUTIs. These findings support the feasibility of early UC removal in this patient population and may inform future guidelines on perioperative UC management in the context of TEA.
Background: Echinococcosis is a parasitic disease, caused by the larval stage of the genus Echinococcus. Echinococcusmultilocularis and Echinococcus granulosus cause alveolar echinococcosis (AE) and cystic echinococcosis (CE) in humans. Pathologists may be confronted with the larval stage of both species. Diagnosis may be difficult due to the low incidence in daily routine. However, right diagnosis of the pathologist is still the gold standard and crucial for further treatment of the patient. Summary: Macroscopically, specimens of AE show multiple small cysts and a bread-like appearance. Instead, CE manifests as solitary or multiple grape-like cysts. In this review, we give a short algorithm for the differential diagnosis on histological grounds. Hematoxylin and eosin staining is supported by an additional periodic acid-Schiff (PAS) staining, highlighting the laminated layer (LL) as key microscopic structure. Lymphocytes and fibrosis are present at the interface with the adjoining liver tissue. The main difference lies in the morphology of the LL. In the PAS staining, this deeply violet structure is fragmented and thin in AE, while in CE, it is broad and striated. Further important characteristics are the size of the cysts and the pericystic fibrosis. The different types of CT lesions correspond to different histological features. Treatment with benzimidazoles may influence morphology. Immunohistochemistry (IHC) with the monoclonal antibodies (mAbs) EmG3 and Em2G11 shows differences in staining patterns regarding AE and CE. IHC is decisive to settle the diagnosis in unclear situations and when only small particles of E. multilocularis (SPEMS) or E. granulosus (SPEGS) are present, e.g., in lymph nodes. Key Messages: The PAS-positive LL is the microscopic hallmark for the differential diagnosis of AE/CE. For further support in unclear situations, IHC with mAb EmG3 and mAb Em2G11 is advised.
