BACKGROUND & AIMS:The recent approval of pharmacological therapies for fibrotic metabolic dysfunction-associated steatohepatitis (MASH) has increased the need for accurate identification of treatment-eligible patients. Current recommendations increasingly rely on non-invasive tests (NITs), including vibration-controlled transient elastography (VCTE), while multiparametric ultrasound (MPUS) may provide additional opportunities for non-invasive assessment. However, agreement between histology and imaging-based approaches remains uncertain. We compared treatment eligibility based on histology, VCTE, and MPUS in two international biopsy-proven cohorts of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:We analysed two biopsy-proven MASLD cohorts: CAP-IPDMA (n=1029), including VCTE and controlled attenuation parameter (CAP), and iLEAD (n=124), including MPUS. Treatment eligibility was assessed using histologically confirmed F2/F3 MASH and NIT-based recommendations from international expert panels. RESULTS:In CAP-IPDMA, 277/1029 patients (26.9%) met the histological definition of "at-risk MASH". Depending on the VCTE cut-off, 13.2-32.0% qualified for treatment. Overlap between histological "at-risk MASH" and VCTE thresholds was limited, reaching 27.8% when using VCTE 8-15 kPa, and decreasing when narrower or higher thresholds were applied. Among patients identified only by VCTE 8-15 kPa, males had lower median AST and ALT than those fulfilling only the histological indication (35 vs 48 IU/L p=0.034 and 45 vs 62 IU/L p=0.0072, respectively). In iLEAD, 21/124 patients (16.9%) met the histological definition, while 13.7-16.1% were eligible based on SWE thresholds, again with a similarly limited overlap. CONCLUSIONS:Histology and non-invasive tests capture partly distinct patient populations, meaning that both the number and type of patients selected for therapy depend on the chosen modality and cutoffs. As vibration-controlled transient elastography and multiparametric ultrasound become increasingly accessible in clinical practice, prospective validation is essential for establishing reliable non-invasive treatment pathways. IMPACT AND IMPLICATIONS:The current literature reflects a paradigm shift away from biopsy-based approaches toward NIT-based assessment of treatment eligibility in metabolic dysfunction-associated steatotic liver disease (MASLD), which may substantially affect which patients receive newly approved therapies. Our results are important for clinicians, researchers, and guideline developers because histology and current NIT cut-offs identify only partially overlapping patient populations, implying that different diagnostic strategies select different risk profiles. In practice, these findings support thoughtful implementation of NIT-based treatment pathways, the use of repeated measurements, and prospective validation of NIT thresholds to guide clinical care, trial design, and health policy decisions.

Anale intraepitheliale Neoplasien (AIN), insbesondere „high-grade squamous intraepithelial lesions“ (HSIL) sind zentrale Vorläuferläsionen des analen Plattenepithelkarzinoms. Obwohl das Analkarzinom in der Allgemeinbevölkerung selten bleibt, zeigen bestimmte Risikogruppen, insbesondere Menschen mit HIV, Männer mit gleichgeschlechtlichen Sexualkontakten, Organtransplantierte sowie Frauen nach vulvären oder schweren zervikalen Dysplasien /Karzinomen, deutlich erhöhte Inzidenzen. Mit der ANCHOR-Studie (NEJM 2022) wurde erstmals belegt, dass die Behandlung analer HSIL das Risiko für ein invasives Analkarzinom signifikant reduziert. Damit verschiebt sich die klinische Fragestellung von der grundsätzlichen Sinnhaftigkeit einer Intervention hin zur gezielten Identifikation geeigneter Screeningpopulationen. Der Artikel fasst die aktuelle Evidenz zu Epidemiologie, Risikostratifikation, Diagnostik, Therapie und Nachsorge zusammen. Ein generelles Screening ist nicht sinnvoll; entscheidend ist ein risikoadaptiertes Vorgehen. Die High-Resolution Anoscopy (HRA) bleibt diagnostischer Referenzstandard, ist jedoch ressourcenintensiv und nicht flächendeckend verfügbar. Therapeutisch stehen ablative, topische und chirurgische Verfahren zur Verfügung, wobei Rezidive häufig sind. Die HPV-Impfung ist ein wichtiges Instrument der Primärprävention, zeigt jedoch keinen gesicherten therapeutischen Nutzen bei bereits manifester HSIL.

Background/Objectives: Acute infected necrotizing pancreatitis remains associated with substantial morbidity and mortality. The step-up approach combines minimal-invasive drainage with endoscopic transgastric or percutaneous necrosectomy and has been shown to improve outcomes compared with open surgery. Laparoscopic-assisted necrosectomy (LAPN) may be performed in cases of infected walled-off necrosis (WON) following percutaneous drainage and is typically carried out using laparoscopic instrumentation. A newly implemented interdisciplinary approach includes sinus tract endoscopy, guided necrosectomy (STEN), which employs flexible endoscopy through a surgically created sinus tract and offers a less invasive and more targeted alternative to LAPN, providing improved visualization of complex necrotic cavities and facilitating repeatable step-up debridement. This study aimed to assess the introduction of STEN compared with LAPN in the management of infected WON within a step-up approach. Methods: A retrospective analysis of patients with infected walled-off necrosis (WON) treated using a step-up approach between 2019 and 2025 was conducted. Patients who underwent CT-guided percutaneous drainage followed by either STEN or LAPN were included. Demographic characteristics and clinical outcomes were collected. The primary endpoint was a composite outcome comprising major complications and 6-month mortality. Secondary outcomes included overall complication rates, need for reinterventions, and length of hospital stay. Results: During the study period, 17 patients were included. All patients were managed using a step-up approach: nine underwent STEN and eight underwent LAPN. In the STEN group, six patients (66.7%) met the primary endpoint, all due to major complications, with no mortality observed. In the LAPN group, the primary endpoint occurred in four patients (50.0%), including one death and three major complications. Conclusions: Our study showed that both STEN and LAPN were effective in treating infected WON within a step-up approach. STEN and LAPN showed comparable outcomes. However, these findings should be interpreted as exploratory and with caution given the retrospective design and the small sample size of this study. Further studies with larger patient cohorts are warranted to confirm these findings and to better define the role of this technique in the management of infected necrotizing pancreatitis.

BACKGROUND:Acute infected necrotizing pancreatitis is characterized by high rates of systemic infection with organ failure and mortality. The step-up approach combining percutaneous drainage with laparoscopic-assisted pancreatic necrosectomy (LAPN) or transgastric necrosectomy shows a lower incidence of complications and mortality than open necrosectomy. This study aimed at comparing minimal-invasive percutaneous and endoscopic step-up approach. METHODS:A retrospective analysis of patients undergoing the step-up approach for infected necrotizing pancreatitis between 2019 and 2023 was conducted. Percutaneous treatment involved CT-guided percutaneous drainage followed by LAPN if needed, while the endoscopic approach used transgastric drainage and endoscopic necrosectomy. Primary outcome was a composite of major complications or 6-month mortality. Secondary outcomes included complication rates, number of reinterventions, duration of hospital stay and mortality. RESULTS:The study included 31 patients. Eighteen patients underwent the percutaneous step-up approach, consisting of CT-guided drainage, followed by LAPN in 11 cases (61.1%). Thirteen patients were treated endoscopically which involved transgastric drainage, followed by necrosectomy in 7 cases (53.8%). The composite of major complications or death occurred in 55.6% of the percutaneous group and in 53.8% of the endoscopic group. Postoperative major complications were reported in eight patients in the percutaneous group and five in the endoscopic group. Four patients required LAPN after endoscopic necrosectomy due to insufficient improvement. CONCLUSION:LAPN and endoscopic necrosectomy are effective in controlling local and systemic infection in severe necrotizing pancreatitis. LAPN remains important in managing extensive infected necrosis, particularly when transgastric methods cannot fully address the necrosis cavity.

With the Superb Micro-Vascular Imaging (SMI), the established Doppler technology has been extended by another mode. With this technique, microvascular structures with slow blood flow can now also be displayed in real time. As with the introduction of Doppler ultrasound, this new technique opens further diagnostic fields for the examiner, which were previously reserved for magnetic resonance imaging (MRI), computed tomography (CT) or contrast ultrasound (CEUS). Focal nodular hyperplasia (FNH) of the liver is characterized by a typical spoke-wheel vascular malformation (spoke-wheel sign, SWS) anda good example using SMI for the diagnostic profit of our patients. The aim of this report is to describe the use of SMI as a new non-invasive, quick, and probably cost-effective diagnostic imaging tool

Anal cancer is a relatively rare tumor but has shown a continuous increase of new diseases with a doubling of the incidence in the last 20 years. Nearly all anal cancers are induced by a persisting infection with human papillomavirus (HPV). In the guidelines program for oncology for the first time German language S3 guidelines for optimization of the diagnostics, treatment and aftercare of anal cancer have been compiled under the patronage of the German Society of Coloproctology. Suggestions for recommendations were compiled in interdisciplinary working groups based on the formulated key questions, which were modified and graded within a nominal consensus procedure. After the systematic literature search the endpoint-related assessment and classification of the evidence was carried out within the framework of the GRADE procedure. A total of 93 recommendations and statements were formulated with respect to the topics prevention and screening, diagnostics and staging, supportive measures before and after targeted tumor treatment, treatment of anal cancer in stages I-III, response evaluation following primary chemoradiotherapy, aftercare, treatment of residual and recurrent anal cancer, treatment of metastatic anal cancer (stage IV), palliative care and rehabilitation. The new guidelines provide a foundation for the optimization of interdisciplinary and cross-sectoral care of anal cancer patients. Based on quality indicators future health services research should investigate whether the guideline recommendations are taken into consideration and whether these contribute to an improvement in care.

BACKGROUND:Diagnostic tools for liver disease can now include estimation of the grade of hepatic steatosis (S0 to S3). Controlled attenuation parameter (CAP) is a non-invasive method for assessing hepatic steatosis that has become available for patients who are obese (FibroScan XL probe), but a consensus has not yet been reached regarding cutoffs and its diagnostic performance. We aimed to assess diagnostic properties and identify relevant covariates with use of an individual patient data meta-analysis. METHODS:We did an individual patient data meta-analysis, in which we searched PubMed and Web of Science for studies published from database inception until April 30, 2019. Studies reporting original biopsy-controlled data of CAP for non-invasive grading of steatosis were eligible. Probe recommendation was based on automated selection, manual assessment of skin-to-liver-capsule distance, and a body-mass index (BMI) criterion. Receiver operating characteristic methods and mixed models were used to assess diagnostic properties and covariates. Patients with non-alcoholic fatty liver disease (NAFLD) were analysed separately because they are the predominant patient group when using the XL probe. This study is registered with PROSPERO, CRD42018099284. FINDINGS:16 studies reported histology-controlled CAP including the XL probe, and individual data from 13 papers and 2346 patients were included. Patients with a mean age of 46·5 years (SD 14·5) were recruited from 20 centres in nine countries. 2283 patients had data for BMI; 673 (29%) were normal weight (BMI <25 kg/m2), 530 (23%) were overweight (BMI ≥25 to <30 kg/m2), and 1080 (47%) were obese (BMI ≥30 kg/m2). 1277 (54%) patients had NAFLD, 474 (20%) had viral hepatitis, 285 (12%) had alcohol-associated liver disease, and 310 (13%) had other liver disease aetiologies. The XL probe was recommended in 1050 patients, 930 (89%) of whom had NAFLD; among the patients with NAFLD, the areas under the curve were 0·819 (95% CI 0·769-0·869) for S0 versus S1 to S3 and 0·754 (0·720-0·787) for S0 to S1 versus S2 to S3. CAP values were independently affected by aetiology, diabetes, BMI, aspartate aminotransferase, and sex. Optimal cutoffs differed substantially across aetiologies. Risk of bias according to QUADAS-2 was low. INTERPRETATION:CAP cutoffs varied according to cause, and can effectively recognise significant steatosis in patients with viral hepatitis. CAP cannot grade steatosis in patients with NAFLD adequately, but its value in a NAFLD screening setting needs to be studied, ideally with methods beyond the traditional histological reference standard. FUNDING:The German Federal Ministry of Education and Research and Echosens.

Bouveret's syndrome is a rare complication resulting from gallstone disease. Both surgical and endoscopical procedures are performed, with the disease to be seen as strictly interdisciplinary. There are no well-established recommendations for this condition. In this paper, we want to describe our experience from 6 cases in 3 Swiss hospitals from 2015 to 2017 with emphasis on the endoscopic technique of electrohydraulic lithotripsy followed by balloon dilatation and propose a treatment algorithm.

BACKGROUND AND AIMS Accurate diagnosis and staging of non-alcoholic fatty liver disease are essential for the management of this disorder. Controlled attenuation parameter (CAP) has been suggested as a new noninvasive measurement made during transient elastography to assess liver steatosis. The aim of this study was to evaluate CAP as a diagnostic tool for identifying the presence and degree of hepatic steatosis in consecutive patients in an outpatient liver unit of a tertiary centre. METHODS Between March 2015 and August 2016, all patients who underwent liver biopsy underwent liver stiffness measurement with simultaneous CAP determination using the FibroScan® M or XL probe. Steatosis, inflammatory activity and fibrosis were assessed using the histological SAF scoring system. In addition, fibrosis was scored according to the METAVIR system, and body mass index (BMI) and the underlying liver disease were also recorded. RESULTS 224 patients were included in the analysis; 146 (65.2%) were male. Steatosis grades were distributed as follows: S0 n = 85 (37.9%), S1 n = 82 (36.6%), S2 n = 33 (14.7%), S3 n = 24 (10.7%). Mean BMI was 26.8 kg/m2, for the S0 group 24.9 kg/m2, S1 26.5 kg/m2, S2 27.3 kg/m2 and S3 32.5 kg/m2. The CAP differed significantly between steatosis groups S0 to S3. The area under receiver operating characteristics curve for S0 vs S1–S3 was 0.78, for S0/1 vs S2/3 0.83 and for S0–2 vs S3 0.82. Calculated cut-off values were 258.5 dB/m for S0 vs S1–3, 282.5 dB/m for S0/1 vs S2/3 and 307.5 dB/m for S0–2 vs S3. CONCLUSIONS CAP values are strongly associated with the degree of steatosis irrespective of the underlying liver disease. Integrating CAP measurements in the standard work-up may identify patients with NAFLD.

Background: Endoscopic full thickness resection (EFTR) by the Full Thickness Resection Device (FTRD) has recently been introduced as a method to allow resection of certain lesions such as adenomatous polyps that would not be resectable by standard polypectomy techniques. We report our clinical experience with FTRD procedures, assessing technical success, completeness of resection (R0 status), rate of histologically proven FTR and safety. Patients and methods: We conducted a retrospective analysis of 33 consecutive patients with colonic polyps treated with FTRD from May 2015 to November 2016. Results: Indications mainly were adenoma recurrence or residual adenoma with nonlifting sign after previous polypectomy. In the 31 cases amenable to EFTR, resection was en bloc and histologically complete (R0) in 87.9% (29/33) of patients. Histologically confirmed complete full thickness resection (FTR) was achieved in 80.6% (25/31). Three post-procedure bleedings and one perforation were seen. Conclusion: FTRD offers an additional endoscopic approach to treat nonlifting colorectal lesions. EFTR by FTRD appears to be feasible and efficacious in the resection of benign neoplasms of up to 30mm in diameter and may be an alternative to surgery in selected patients. Given a significant rate of complications, safety is a concern and needs to be assessed in larger prospective studies.