BACKGROUND:Recurrent acute pancreatitis (RAP) or acute-on-chronic flares in chronic pancreatitis (CP) have limited preventive options beyond addressing the underlying aetiology. Statins, due to their anti-inflammatory properties, have been proposed as a potential prophylactic treatment. OBJECTIVE:We aimed to evaluate whether simvastatin could reduce the recurrence of pancreatitis. DESIGN:At 23 centres, we conducted a triple-blind, randomised, controlled, superiority trial enrolling patients with at least two episodes of RAP or CP flares in the previous 12 months. Participants were randomly assigned to receive simvastatin or placebo for 1 year. The primary endpoint was the recurrence of pancreatitis. The target sample size was 144 patients; however, an interim analysis was planned in the event of slow recruitment. RESULTS:A total of 85 patients (42.1% women) were included in the interim analysis. In the intention-to-treat analysis, no significant differences were observed regarding recurrence: 46.2% simvastatin versus 44.4% placebo; OR 1.07, 95% CI 0.43 to 2.66; p=0.88, or time to recurrence. No statistically significant differences were observed in recurrence in per-protocol analysis (35.5% simvastatin vs 41.9% placebo; OR 0.76, 95% CI 0.27 to 2.12; p=0.60). Development of diabetes mellitus was more frequent in the simvastatin group (4 vs 0 patients; OR not calculable, p=0.04). CONCLUSION:This trial, evaluating simvastatin versus placebo for the prevention of pancreatitis, did not demonstrate a reduction in recurrence rate, although results might be underpowered due to early termination. The relationship between statins in these patients and new-onset diabetes requires further investigation. TRIAL REGISTRATION NUMBER:NCT04021498.

Background: Lynch syndrome (LS) is associated with an increased risk of upper gastrointestinal cancers, but the incidence of gastric cancer (GC) and duodenal cancer (DC), and the clinical impact of esophagogastroduodenoscopy (EGD) surveillance, remain uncertain. We aimed to estimate GC and DC incidence in LS and to assess the association of EGD surveillance with cancer risk. Methods: We searched PubMed, EMBASE, and Scopus from inception to Jan 15, 2026 for cohort studies and clinical trials reporting GC or DC incidence in genetically confirmed LS. We pooled incidence rates (IR) per 1,000 person-years (p-y), overall and by mismatch repair (MMR) gene, and pooled relative risks (RR) for EGD surveillance versus no surveillance. Registered in PROSPERO (CRD420251056416). Findings: We included 35 studies comprising 33,530 patients (47·2% male). Pooled IRs per 1,000 p-y were 0·95 (95% CI 0·54–1·36) for GC and 1·92 (0·75–3·10) for DC. By genotype, GC incidence was highest in MSH2 carriers (1·27 [0·74–1·80]) and very low in MSH6 carriers (0·03 [0–0·19]). EGD surveillance was associated with lower GC risk (RR 0·31, 0·14–0·69), but not with a statistically significant reduction in DC risk (RR 0·78, 0·35–1·74). Interpretation: LS confers an increased incidence of upper gastrointestinal cancers, with marked variation by MMR gene. Observational evidence suggests EGD surveillance may be associated with lower GC risk, supporting risk-adapted management and the need for higher-quality comparative studies.

Background:Hidradenitis suppurativa (HS) is a chronic, recurrent skin disease that may be associated with inflammatory bowel disease (IBD). Objectives:This study aimed to describe the features and therapeutic requirements of IBD and HS in patients who present both entities and the risk factors for HS development in patients with IBD. Methods:Case-controlled, retrospective study of all patients diagnosed with IBD-HS in the ENEIDA registry. Cases were paired 1:2 with controls (IBD without HS). Design:This was a retrospective, case-control study. Results:A total of 819 patients were included: 273 patients with IBD-HS and 546 controls. Female sex (62% vs 44%, p = 0.0001), active smoking (45% vs 18%, p = 0.0001), Crohn's disease (CD; 83% vs 55%, p = 0.0001), perianal disease (59% vs 33%, p = 0.0001), extraintestinal manifestations (38% vs 17%, p = 0.0001), and psychiatric disorders (18% vs 2%, p < 0.05) were more frequent among patients with IBD-HS than in controls. The average body mass index was greater in the IBD-HS group. The most frequently HS-affected locations were axillary (57%) and genital (43%) areas. Use of biologicals and CD-related perianal surgery was more common among patients with CD-HS (77% vs 66%, p = 0.003; 37% vs 13%, p < 0.001), compared to controls with only CD. Conclusion:Patients with IBD-HS exhibit a distinctive phenotype with higher therapeutic requirements for the subset of patients with CD-HS compared to those without HS. Assessment of this comorbidity should be considered in patients with suggestive skin lesions and IBD to improve the outcomes of both conditions.

BACKGROUND:This research project is motivated by the increasing prevalence of gallstones and biliary tract diseases in patients of advanced age, while also recognizing that the comorbidity burden of this population may necessitate a tailored treatment approach. Acute cholecystitis can rapidly progress to systemic inflammatory response syndrome, sepsis and even death. Age per se has no bearing on the severity of acute cholecystitis, but the burden of comorbidity in older patients may lead to rapid disease progression. METHODS:The GOLDENEYE study is an international, multicenter, prospective, observational research project designed to compare the outcomes of different management strategies for acute cholecystitis in seniors. The primary aims are to evaluate the efficacy of different treatments-supportive care, percutaneous gallbladder drainage, early or delayed cholecystectomy, and EUS-guided gallbladder drainage-on one-year additional treatment modalities, hospital readmissions, and outpatient care. Secondary outcomes are quality of life and survival rates. The study implements propensity score matching analysis to account for the non-randomized allocation of treatment modalities. Patients ≥ 70 years diagnosed with acute cholecystitis, as per the Tokyo guidelines, are included. Exclusion criteria include prior episodes of cholecystitis or pancreatitis, terminal illness, and concurrent diagnosis of acute pancreatitis, cholangitis, bile duct disease, or digestive malignancy. Data collection is performed with the REDCap platform for data entry and monitoring. DISCUSSION:The GOLDENEYE study aims to generate evidence-based insights that will significantly influence the management of acute cholecystitis in elderly patients, ultimately improving patient outcomes and healthcare practices in this growing demographic population. CLINICALTRIALS:gov, NCT07006298.

Background: The growing number of premalignant colonic lesions undergoing surgical treatment can lead to increased overtreatment. Objectives: We assessed the magnitude of overtreatment by comparing rates of adverse events related to surgical and endoscopic treatment of complex benign polyps. Design: This was a single-center retrospective study conducted at a tertiary care hospital. Methods: This study included patients with benign colonic lesions treated surgically during 2005–2021 and compared with a cohort with complex lesions (Size, Morphology, Site, and Access (SMSA) ⩾3) treated endoscopically during 2018–2022. Adverse events, need for reintervention, mortality, and length of hospital stay were compared using propensity score (PS)-matching analysis. The cohorts were matched 1:1 with adjustment for sex, age, SMSA, and size as covariates. Surgical and endoscopic adverse events were described using the Clavien–Dindo (surgical group) and AGREE (endoscopic group) classifications. Results: Of 240 included patients, PS matching yielded 71 pairs. Adverse events were more frequent with surgical treatment (odds ratio (OR) 3.27; 95% confidence interval (CI) 1.59–6.71), as were severe adverse events (OR 7.5; 95% CI 2.1–27.0), need for reintervention (OR 25.6; 95% CI 3.3–200.0), and mean length of hospital stay (10 vs 0 days, p < 0.001). One (1.4%) patient in the surgical group and none in the endoscopic group died ( p = 0.39). Conclusion: An excess of severe adverse events with surgical treatment of complex benign polyps reflects overtreatment. Adequate pathways must be established for referral of these lesions for endoscopic treatment.

INTRODUCTION:To compare metachronous colorectal cancer (CRC) and advanced adenoma (AA) risk in patients with proximal vs. distal adenomas. METHODS:We searched Pubmed, Embase, and Cochrane for cohort studies and clinical trials. Proximal adenomas were those located proximal to the descending colon. Pooled incidence rate ratios and 95% confidence intervals (CI) for CRC and AA were calculated using a random-effects model. RESULTS:Compared with patients with only distal adenomas, patients with any proximal adenoma had a higher risk of metachronous CRC (1.70, 95% CI 1.17-2.45), proximal CRC (3.65, 95% CI 1.57-8.46), and AA (1.82, 95% CI 1.41-2.34). DISCUSSION:Baseline adenoma proximal location is associated with future detection of CRC and AA.

BackgroundStrategies for managing the elderly with acute cholecystitis need to be refined.AimsTo examine additional procedures, hospital readmissions, and outpatient visits in the year following the index admission.Patients and methodsSingle-institution retrospective study of fifty consecutive patients aged ≥70 years admitted with acute cholecystitis. A propensity score matching analysis adjusted for demographic and clinical variables was carried out.ResultsThe one-year rates of additional procedures were 0%, 47.4%, and 72.7% for surgery, supportive care (SC), and percutaneous gallbladder drainage (PCGD), respectively. The one-year readmission rate was 0%, 15.8%, and 50% after these index procedures, respectively. After propensity score analysis, patients who received SC (55.6% vs. 0%, P = .03) or PCGD (77.8% vs. 0%, P = .002) had a higher rate of additional procedures compared to those who underwent surgery. Additionally, patients receiving PCGD had a higher readmission rate than those undergoing surgery (55.6% vs. 0%, P = .03). Nine patients who received SC and nine patients who received PCGD could have potentially undergone surgery during the index admission. This would have resulted in improved one-year outcomes.ConclusionCholecystectomy during the index hospitalization may provide better one-year outcomes than SC or PCGD in at least 50% of patients ≥70 years with acute cholecystitis.

Objective Exocrine pancreatic insufficiency (EPI) is common after pancreatic surgery. In patients with chronic pancreatitis, our previous results supported the use of fecal elastase-1 (FE-1) over the 13C-mixed triglyceride breath test (13C-MTBT) for the diagnosis of EPI. However, it is poorly established how the performance of these two tests compares to the diagnosis of EPI after pancreatic surgery. Patients and methods FE-1 and 13C-MTBT were compared with the gold standard coefficient of fat absorption (CFA). Area under ROC curve (AUC) and best cutoffs were used to assess presence of EPI. Patient characteristics were evaluated by extent of pancreatic resection. Results The AUC (95% confidence interval) was 0.724 (0.578–0.871) for FE-1 and 0.640 (0.482–0.799) for 13C-MTBT in the diagnosis of EPI. A pairwise comparison of the FE-1 and 13C-MTBT AUCs showed no statistically significant difference (P=.20). The best cut-off point was 65.5μg/g for FE-1 and 22.5% for 13C-MTBT. According to contingency analysis, both the FE-1 threshold of 65.5μg/g (P=.005) and the 13C-MTBT threshold of 22.5% (P=.015) showed statistical significance for diagnosing EPI. Conclusion FE-1 was more accurate for diagnosing EPI after pancreatic surgery, but the differences were not statistically different.

Background: The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life. Methods: The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis. Results: The study included 212 patients (84 years [81-86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6-13]; laparoscopic, 5 days [4-8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed. Conclusions: Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenar- ians with acute cholecystitis undergoing cholecystectomy. (c) 2024 AEC. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Evidence on adherence, diagnostic performance and impact on survival to intensive follow-up after surgery for colorectal cancer (CRC) is limited. AIM:To analyze the diagnostic performance of surveillance colonoscopy, computed tomography (CT), and tumor markers (TMs) in detecting CRC recurrence or metastasis during follow-up after CRC resection. Secondary objectives included degree of adherence to clinical practice guidelines surveillance recommendations and factors associated with adherence and all-cause and CRC mortality. METHODS:The single-center retrospective cohort study including patients undergoing curative resection of stage I-III CRC during 2010-2015. Follow-up was performed using TMs every 6 months, yearly CT for 5 years, and colonoscopy at years 1 and 4. Demographic, primary tumor data, and results at follow-up were collected. RESULTS:Of 574 included patients included, 153 had recurrences or metastases. Of this group, 136 (88.9%) were diagnosed by CT, 10 (6.5%) by CT and colonoscopy, and 7 (4.6%) by colonoscopy; only 67.8% showed TMs elevation. Adherence to follow-up recommendations was 68.8% for the first colonoscopy, 74% for the first CT scan, and 96.6% for the first blood test; these values declined over time. Younger age at diagnosis [odds ratio (OR) 0.93; 95%CI: 0.91-0.95], CRC stages I-II (OR 0.38; 95%CI: 0.24-0.61), and adherence to follow-up recommendations (OR 0.30; 95%CI: 0.20-0.46) were independently associated with lower risk for all-cause death at 5 years. CONCLUSION:CT scan had the highest diagnostic yield. Adherence to follow-up recommendations was low and decreased during follow-up. Younger age at diagnosis, stage, and follow-up adherence were associated with lower 5-year mortality.

BACKGROUNDLiver cirrhosis is characterized by chronic inflammation and fibrosis, with Th17 cells playing a crucial role in its progression. Recent evidence suggests that dietary salt influences immune diseases by modulating Th17 differentiation. This study assessed the impact of dietary salt on Th17-driven inflammation in patients with compensated cirrhosis and explored its effects on liver injury in mouse models.METHODSA nondrug, open-label, nonrandomized study involved 37 patients with compensated cirrhosis, who were given personalized guidelines to reduce salt intake over 3 months. Changes in Th17-driven inflammation and liver function markers were assessed at baseline and after salt restriction. In parallel, the impact of a high-salt diet on hepatic CD4+ T cells was analyzed in mouse models of acute liver injury and fibrosis.RESULTSHigh salt intake was associated with Th17-mediated inflammation and correlated with markers of impaired liver function in these patients. Importantly, moderating salt intake through a personalized nutritional intervention was sufficient to reduce CD4+ T cell-mediated inflammation. Furthermore, analysis of RNA-seq data revealed enrichment of salt-induced Th17 gene signatures in both liver tissue and peripheral cells from patients with liver disease. Similarly, mice fed a high salt diet showed hepatic enrichment of Th17 cells and exacerbated liver fibrosis upon injury. Mechanistic studies revealed that high sodium conditions activated NF-κB and induced IL-6 production in hepatocytes, which may promote Th17 responses.CONCLUSIONDietary salt exacerbates Th17-driven inflammation and contributes to cirrhosis progression. Salt reduction may represent a viable therapeutic approach to manage inflammation in compensated cirrhosis.FUNDINGGrants PI19/01554 and PI22/01907 from Instituto de Salud Carlos III (Madrid, Spain), CDEI-03/20-A and CIPROM/2023/4 from Generalitat Valenciana (Valencia, Spain), CNS2023-145676 from the National Research Agency (AEI) (Madrid, Spain), and LCF/BQ/D121/11860047 from La Caixa Foundation (Barcelona, Spain).

BACKGROUND AND AIMS:Serrated polyps (SPs) are precursors to 15% to 20% of colorectal cancers (CRCs). However, there are uncertainties regarding which SPs require surveillance and at what intervals, with recommendations adapted from those for adenomas in the absence of solid evidence. Our aim was to assess which SP risk characteristics relate to a higher risk of metachronous CRC or advanced polyps. METHODS:We systematically searched PubMed, Embase, and Cochrane for cohort studies, case-control studies, and clinical trials from inception to December 31, 2023, of CRC or advanced polyps (advanced adenoma [AA] or advanced SP) incidence at surveillance stratified by baseline SP size, dysplasia, location, and multiplicity. We defined advanced SPs as those ≥10 mm or with dysplasia. CRC and advanced polyp incidence per 1000 person-years were estimated. We performed a meta-analysis by calculating pooled relative risks (RRs) using a random-effects model. RESULTS:A total of 5903 studies were reviewed, and 14 were included with 493,949 patients (mean age, 59.5 years; 55% men). The mean follow-up was 4.9 years. CRC incidence per 1000 person-years was 2.09 (95% confidence interval [CI], 1.29-2.90) for advanced SPs, 1.52 (95% CI, 0.78-2.25) for SPs of ≥10 mm, 5.86 (95% CI, 2.16-9.56) for SPs with dysplasia, 1.18 (95% CI, 0.77-1.60) for proximal SPs, 0.52 (95% CI, 0.08-1.12) for ≥3 SPs, 0.50 (95% CI, 0.35-0.66) for nonadvanced SPs, and 0.44 (95% CI, 0.41-0.46) for normal colonoscopy findings. Metachronous CRC risk was higher in advanced SPs versus nonadvanced SPs (RR, 1.84; 95% CI, 1.11-3.04) and versus normal colonoscopy findings (RR, 2.92; 95% CI, 2.26-3.77), in SPs of ≥10 mm versus <10 mm (RR, 2.61; 95% CI, 1.43-4.77) and versus normal colonoscopy findings (RR: 3.52; 95% CI, 2.17-5.69); and in SPs with dysplasia versus normal colonoscopy findings (RR: 2.71; 95% CI, 2.00-3.67). No increase in CRC or advanced polyp risk was found in patients with proximal versus distal SPs, nor in ≥3 SPs versus 1 or 2 SPs. CONCLUSIONS:CRC risk is significantly higher in patients with baseline advanced SPs after 4.9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SPs.