Early diagnosis of extraluminal locoregional recurrence (LRR) near the anastomosis after surgery for gastrointestinal malignancies is challenging. This study evaluated the diagnostic performance of endoscopic ultrasound (EUS), EUS-guided fine-needle aspiration (EUS-FNA), and an integrated diagnostic pathway in this context. We retrospectively analyzed patients who underwent EUS at our hospital between April 2014 and April 2025 for suspected extraluminal LRR. We collected clinical, procedural, and pathological data. Each patient had at least 6 months of clinical-imaging follow-up. The final diagnosis was based on pathology (surgical or EUS-FNA) or confirmed disease progression and served as the reference standard for calculating diagnostic performance. Seventy-seven patients were included. EUS identified suspicious extraluminal lesions in 37 patients; 35 of these underwent EUS-FNA. EUS alone demonstrated a sensitivity of 94.6

Acute gastrointestinal bleeding caused by duodenal tumors remains a clinical challenge. Conventional endoscopic hemostasis has limited efficacy in preventing rebleeding, and surgical resection presents significant risks and is often not feasible. Endoscopic ultrasound-guided embolization (EUS-VE) with cyanoacrylate is widely performed for variceal bleeding, but its application to tumor-related bleeding is uncommon. In this study, we used EUS-VE for acute duodenal tumor-related bleeding. A total of 13 EUS-VE procedures were performed in 12 patients from August 2024 to December 2025. The technical success rate was 100%, and the clinical success rate within 30 days was 84.6% (11/13). Among the 12 patients, the 90-day rebleeding and mortality events occurred in 1 (8.33%) and 3 (25%) patients, respectively. Three patients (25%) developed fever after EUS-VE, including one case suspected to be procedure-related. This pilot study suggests that EUS-VE may be a feasible alternative for duodenal tumor-related bleeding. Its efficacy and safety require further validation with larger sample sizes.

Refractory non-variceal upper gastrointestinal bleeding (NVUGIB) remains a clinical challenge. Endoscopic ultrasound–guided angioembolization (EUS-A) may offer a salvage hemostatic approach, but evidence is limited. This study aimed to evaluate the efficacy and safety of EUS-A for management of refractory NVUGIB. Twenty-eight patients with NVUGIB who underwent EUS-A at The Second Affiliated Hospital of Soochow University from January 2023 to December 2025 were enrolled in this study. Endoscopic ultrasound-guided intravascular cyanoacrylate injection was carried out when patients had failed and/or were deemed unsuitable candidates for standard therapies. The data were retrospectively collected. A total of 28 patients underwent 30 EUS-A procedures. Among these, 8 cases were due to bleeding from benign lesions. The technical success rate was 100

Background:Inflammatory bowel disease (IBD) in older adults has become a new concern in high- and middle-income countries (HMICs). However, the latest disease burden and temporal trends remain to be systemically clarified.Methods:Disease burden data of 172 HMICs were extracted from GBD 2023, including incidence, prevalence, and DALYs on IBD, ulcerative colitis (UC), and Crohn's disease (CD) among older adults. Stratified analysis was performed based on disease subtype, sex, and gross national income (GNI). A correlation analysis was utilized to evaluate the association of the indicators and income levels. Temporal trends (2000-2023) and future burden up to 2040 were further analyzed.Results:In 2023, the incidence, prevalence and DALY rate of IBD in older adults were highest in high-income countries (HCs), and all indicators showed a positive correlation with GNI per capita. From 2000 to 2023, the most significant increase in incidence was observed in Libya, China, and Lebanon. The burden of UC was greater than that of CD, and the incidence ratio of UC/CD was negatively correlated with GNI per capita. The incidence of UC was higher among older males, whereas CD had a higher incidence among older females. Until 2040, the prevalence of IBD and its subtypes would increase across all GNI levels. Notably, the prevalence of UC in lower-middle-income countries (LMCs) may double.Conclusions:The disease burden of IBD among older adults in HMICs continues to increase. Future strategies should be customized based on each country's specific needs and development stage.

Radiation-induced rectal injury (RRI) limits radiotherapy and results in a poor clinical prognosis. In this study, we report a radioprotective strategy for preventing RRI using a thermoresponsive amifostine-loaded chitosan biogel. Specifically, the biogel is synthesized via the reaction of crocetin with cysteine-modified chitosan and sodium alginate, followed by incorporating amifostine-sodium glycerophosphate solution. The storage modulus increases markedly at the gel point of ∼30 °C. The biogel possesses favorable biocompatibility in vitro and maintains the ability of cells to migrate and proliferate after 8 Gy irradiation. Meanwhile, it possesses good stability in artificial intestinal fluid and can slowly release amifostine for more than 12 h. With the aid of endoscopy, the biogel can be precisely delivered to the colorectal region and alleviates RRI by promoting mucosal recovery, enhancing crypt activity, and modulating inflammation. In addition, the biogel shows a trend toward increasing the abundance of gut flora and the counts of probiotics, thereby maintaining gut microbial homeostasis. This work provides a simple yet transformative tactic by the thermoresponsive biogel, and presents a promising avenue for clinical prevention of RRI.

Background and study aims Periampullary diverticula (PAD), often detected incidentally during imaging or endoscopy, has been linked to pancreaticobiliary diseases. Previous studies focusing on ERCP patients may overestimate PAD prevalence and its association with these diseases. This study aimed to explore the relationship between PAD characteristics, including size and type, and the occurrence of pancreaticobiliary diseases. Patients and methods Patients who underwent gastroscopy at the Second Affiliated Hospital of Soochow University from January 2018 to December 2022 and were found to have PAD (PAD group) were selected. A control group of patients without PAD was matched by gender and age in a 1:3 ratio. The characteristics of PAD and its correlation with pancreaticobiliary diseases were analyzed. Results The detection rate of PAD was 0.73 %. A total of 389 patients in the PAD group and 1,167 in the control group were included. The incidence of pancreaticobiliary diseases was significantly higher in the PAD group compared to the control group (51.2 % vs. 32.6 %, P < 0.001). Elderly PAD patients (>60 years) had larger diverticula and a higher incidence of pancreaticobiliary diseases than non-elderly PAD patients (≤60 years). Among different types of PAD, Type I PAD patients had the highest incidence of gallbladder stones and acute pancreatitis. No statistically significant correlation was found between PAD size and pancreaticobiliary diseases, and the incidence of bile duct stones was lower in the giant diverticulum group. Conclusion The presence of PAD is significantly associated with pancreaticobiliary diseases, particularly in elderly PAD patients and those with Type I PAD, where there is a strong correlation with biliary diseases and acute pancreatitis.

Background:Peritoneal lesions present diagnostic challenges, necessitating precise imaging techniques. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) offers a promising approach for accurate diagnosis, aiding in optimal patient management and treatment planning. Objective:This study aims to assess the diagnostic efficacy of EUS-FNA in peritoneal lesions to offer insight in guiding optimal patient management. Methods:A prospective observational study was conducted, and a total of 58 patients who underwent EUS-FNA of the peritoneum at our hospital between October 2021 and November 2021 were included. The ultrasound diagnostic instrument facilitated puncture guidance, with 2-5 punctures performed in various parts of the selected peritoneal lesion areas. The analysis encompassed evaluating the sensitivity, specificity, positive predictive value, and negative predictive value of biopsy for diagnosing peritoneal-associated lesions, alongside assessing the number of punctures, puncture satisfaction, and incidence of postoperative complications. Results:The included patients undergoing EUS-FNA revealed that 41 (70.69%) had malignant lesions, while 17 (29.31%) presented with benign lesions. The diagnostic accuracy of EUS-FNA for peritoneal lesions was determined to be 94.83%, with a diagnostic sensitivity of 97.30% for malignant tumors, specificity of 90.48%, positive predictive value of 94.74%, and negative predictive value of 95%. Lesions exhibited a size range of 2.5cm × 2.9cm to 15.2cm × 9.8cm. Each patient underwent 2-5 punctures (3.3 ± 1.4), with a puncture satisfaction rate of 96.55%. The incidence of postoperative complications following EUS-FNA was found to be 3.45%. Conclusion:EUS-FNA exhibits substantial diagnostic utility for peritoneal-related lesions, marked by exceptional accuracy, sensitivity, specificity, and favorable safety. Its clinical adoption is warranted, promising improved patient care and management.

Hepatocellular carcinoma (HCC) is a major health threat worldwide. This study found that WDR54 is overexpressed in liver cancer tissues and is inversely correlated with patient prognosis. Through comprehensive cell biology experiments, we demonstrated that WDR54 plays a pivotal role in promoting the malignant proliferation and metastasis of HCC. Further molecular biology investigations, including transcriptome sequencing, revealed that WDR54 exerts its biological effects by modulating the NF-κB signaling pathway. Specifically, WDR54 interacts with RBBP5 to enhance the transcription of p65, thereby promoting HCC proliferation and metastasis. Additionally, the potential impact of WDR54 on tumor cell metabolism and tumor heterogeneity is explored. The findings of this study deepen our understanding of the molecular pathology of liver cancer and lay a foundation for future clinical applications.

Colonic TNF-alpha silencing via orally administered siRNA provides a promising modality for the anti-inflammatory treatment of ulcerative colitis (UC), which however, is greatly challenged by the low gastrointestinal stability, insufficient colonic accumulation, and difficulties in transfecting colonic macrophages. Herein, a nanocomplex-in-polymersome nanoformulation (PAP@NCs) with high gastrointestinal stability, low systemic absorption, excellent colon accumulation, and robust colonic macrophage transfection efficiency was developed. To fabricate the nanoformulation, an alpha-helical polypeptide with potent membrane-penetrating capability first complexed with tumor necrosis factor-alpha (TNF-alpha) siRNA to form cell-ingestible nanocomplexes (NCs, similar to 150 nm), which were further encapsulated into polymersomes (similar to 600 nm) self-assembled from an azoreductase-responsive polymer (PAP). PAP@NCs maintained desired stability during gastrointestinal transit, and exhibited low intestinal absorption yet high colonic accumulation due to their large diameter. Inside the colon, the polymersomes were dissociated by azoreductases and the encapsulated NCs were released to transfect colonic macrophages and silence TNF-alpha by similar to 75%. Consequently, PAP@NCs efficiently suppressed the colonic inflammation, restored the epithelial barrier, and alleviated the disease severity in acute and chronic UC mouse models. This study provides an efficient strategy to overcome the multiple barriers against oral formulation-mediated colonic gene silencing, and it may provide a promising addition to the management of colitis and other colonic diseases.