Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and com...Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of ...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of GIST cases.These tumors often present with nonspecific symptoms,making early detection challenging.This case discusses a duodenal GIST misdiagnosed as pancreatic cancer due to obstructive jaundice.CASE SUMMARY A 40-year-old male with jaundice and abdominal symptoms underwent imaging,which suggested a malignant periampullary tumor.Preoperative misdiagnosis of pancreatic cancer was made,and surgery was performed.Postoperative histopathology confirmed a duodenal GIST.The role of artificial intelligence in the diagnostic pathway is explored,emphasizing its potential to differentiate between duodenal GISTs and other similar conditions using advanced imaging analysis.CONCLUSION Artificial intelligence in radiomic imaging holds significant promise in enhancing the diagnostic process for rare cancers like duodenal GISTs,ensuring timely and accurate treatment.展开更多
BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as exp...BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.展开更多
Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including ...Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including computed tomography(CT),magnetic resonance imaging(MRI),endoscopic imaging,and genomic profiles-to enable intelligent decision-making for individualized therapy.This approach leverages AI algorithms to fuse imaging,endoscopic,and omics data,facilitating comprehensive characterization of tumor biology,prediction of treatment response,and optimization of therapeutic strategies.By combining CT and MRI for structural assessment,endoscopic data for real-time visual inspection,and genomic information for molecular profiling,multimodal AI enhances the accuracy of patient stratification and treatment personalization.The clinical implementation of this technology demonstrates potential for improving patient outcomes,advancing precision oncology,and supporting individualized care in gastrointestinal cancers.Ultimately,multimodal AI serves as a transformative tool in oncology,bridging data integration with clinical application to effectively tailor therapies.展开更多
BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and...BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.展开更多
Gastrointestinal(GI)cancers remain a leading cause of cancer-related morbidity and mortality worldwide.Artificial intelligence(AI),particularly machine learning and deep learning(DL),has shown promise in enhancing can...Gastrointestinal(GI)cancers remain a leading cause of cancer-related morbidity and mortality worldwide.Artificial intelligence(AI),particularly machine learning and deep learning(DL),has shown promise in enhancing cancer detection,diagnosis,and prognostication.A narrative review of literature published from January 2015 to march 2025 was conducted using PubMed,Web of Science,and Scopus.Search terms included"gastrointestinal cancer","artificial intelligence","machine learning","deep learning","radiomics","multimodal detection"and"predictive modeling".Studies were included if they focused on clinically relevant AI applications in GI oncology.AI algorithms for GI cancer detection have achieved high performance across imaging modalities,with endoscopic DL systems reporting accuracies of 85%-97%for polyp detection and segmentation.Radiomics-based models have predicted molecular biomarkers such as programmed cell death ligand 2 expression with area under the curves up to 0.92.Large language models applied to radiology reports demonstrated diagnostic accuracy comparable to junior radiologists(78.9%vs 80.0%),though without incremental value when combined with human interpretation.Multimodal AI approaches integrating imaging,pathology,and clinical data show emerging potential for precision oncology.AI in GI oncology has reached clinically relevant accuracy levels in multiple diagnostic tasks,with multimodal approaches and predictive biomarker modeling offering new opportunities for personalized care.However,broader validation,integration into clinical workflows,and attention to ethical,legal,and social implications remain critical for widespread adoption.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to s...Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to symptom heterogeneity and the absence of reliable biomarkers.Artificial intelligence(AI)enables the integration of multimodal data to enhance FGID management through precision diagnostics and preventive healthcare.This minireview summarizes recent advancements in AI applications for FGIDs,highlighting progress in diagnostic accuracy,subtype classification,personalized interventions,and preventive strategies inspired by the traditional Chinese medicine concept of“treating the undiseased”.Machine learning and deep learning algorithms have demonstrated value in improving IBS diagnosis,refining FD neuro-gastrointestinal subtyping,and screening for GERD-related complications.Moreover,AI supports dietary,psychological,and integrative medicine-based interventions to improve patient adherence and quality of life.Nonetheless,key challenges remain,including data heterogeneity,limited model interpretability,and the need for robust clinical validation.Future directions emphasize interdisciplinary collaboration,the development of multimodal and explainable AI models,and the creation of patientcentered platforms to facilitate a shift from reactive treatment to proactive prevention.This review provides a systematic framework to guide the clinical application and theoretical innovation of AI in FGIDs.展开更多
This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patient...This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patients with familial GISTs.The actual incidence of GISTs may be underestimated due to diagnostic limitations and the long-term low-risk behavior of some GISTs.The molecular landscape of GISTs is primarily driven by mutations in the KIT and platelet-derived growth factor receptor alpha(PDGFRA)genes.A subset of GISTs without these mutations known as wild-type GISTs,may harbor other rare mutations,impacting their response to targeted therapies.Clinically,patients with GISTs present with nonspecific symptoms,often leading to delayed diagnosis.Genetic predispositions in familial GISTs provide insights into the genetic architecture and extragastrointestinal manifestations of GISTs.Management has evolved from surgical interventions to molecular-based therapies using tyrosine kinase inhibitors.The management of GISTs,especially in familial cases,requires a multidisciplinary approach.Cases of different gene mutations were reported in the same family,suggesting that incorporating genetic testing into routine clinical practice is crucial for the early identification of high-risk individuals and the implementation of tailored surveillance programs.展开更多
Recent research has increasingly highlighted the potential oncogenic effects of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection within the gastrointestinal tract.Growing evidence suggests that SAR...Recent research has increasingly highlighted the potential oncogenic effects of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection within the gastrointestinal tract.Growing evidence suggests that SARS-CoV-2 may contribute to the development of gastrointestinal malignancies through several mechanisms,including sustained chronic inflammation,disruption of normal cellular homeostasis,and potential viral integration into host cells.These pathological processes have the potential to dysregulate critical cellular pathways,thereby promoting cancer development in vulnerable populations.A thorough understanding of how SARS-CoV-2 interacts with the development of gastro-intestinal cancer is essential for optimizing patient care and establishing compre-hensive,long-term monitoring protocols.This review highlighted the pressing need for ongoing research into the complex relationship between SARS-CoV-2 infection and the risk of gastrointestinal cancer.展开更多
Objective To evaluate the clinical efficacy of Traditional Chinese Medicine(TCM)hot-pack therapy in treating postoperative gastrointestinal dysfunction in patients undergoing surgery for gastrointestinal malignancies....Objective To evaluate the clinical efficacy of Traditional Chinese Medicine(TCM)hot-pack therapy in treating postoperative gastrointestinal dysfunction in patients undergoing surgery for gastrointestinal malignancies.Method 60 postoperative patients with gastrointestinal malignancies were randomized into a treatment group(n=30)and a control group(n=30).Both groups received standard postoperative supportive care,including oral mosapride citrate(5 mg,three times daily,starting 6 h post-op,for 3 days).The treatment group additionally received external abdominal application of a TCM hot-pack twice daily(20-30 min each)for 3 days.Primary endpoints were time to first flatus,first defecation,and first oral intake.Secondary endpoints included numeric scores for abdominal pain and distension at 24 h and 72 h post-op,and overall clinical efficacy.Result Compared with controls,the treatment group showed significantly faster recovery:time to first flatus(50.3±7.8 h vs.62.5±9.4 h),first defecation(72.1±11.3 h vs.85.2±13.6 h),and first oral intake(48.0±9.5 h vs.62.5±12.4 h)(all P<0.01).At 24 h and 72 h,the treatment group reported lower abdominal pain and distension scores(24 h pain 5.1±1.3 vs.6.0±1.4,distension 2.3±0.5 vs.2.8±0.6;72 h pain 3.9±0.8 vs.4.7±0.9,distension 1.9±0.5 vs.2.3±0.6;P<0.05 to P<0.01).Total effective rate was higher in the treatment group(96.7%vs.90.0%,χ^(2)=6.96,P=0.031).Conclusion TCM hot-pack therapy combined with routine care significantly accelerates recovery of gastrointestinal function,shortens duration of postoperative dysfunction,and alleviates abdominal pain and distension in patients after gastrointestinal malignancy surgery,demonstrating notable clinical benefit.展开更多
Gastrointestinal(GI)cancers,which predominantly manifest in the stomach,colorectum,liver,esophagus,and pancreas,accounting for approximately 35%of global cancer-related mortality.The advent of liquid biopsy has introd...Gastrointestinal(GI)cancers,which predominantly manifest in the stomach,colorectum,liver,esophagus,and pancreas,accounting for approximately 35%of global cancer-related mortality.The advent of liquid biopsy has introduced a pivotal diagnostic modality for the early identification of premalignant GI lesions and incipient cancers.This non-invasive technique not only facilitates prompt therapeutic intervention,but also serves as a critical adjunct in prognosticating the likelihood of tumor recurrence.The wealth of circulating exosomes present in body fluids is often enriched with proteins,lipids,microRNAs,and other RNAs derived from tumor cells.These specific cargo components are reflective of processes involved in GI tumorigenesis,tumor progression,and response to treatment.As such,they represent a group of promising biomarkers for aiding in the diagnosis of GI cancer.In this review,we delivered an exhaustive overview of the composition of exosomes and the pathways for cargo sorting within these vesicles.We laid out some of the clinical evidence that supported the utilization of exosomes as diagnostic biomarkers for GI cancers and discussed their potential for clinical application.Furthermore,we addressed the challenges encountered when harnessing exosomes as diagnostic and predictive instruments in the realm of GI cancers.展开更多
Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the smal...Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine.Although the exact prevalence of GIST is not known,the incidence of GIST has been increasing.GISTs arise from interstitial cells of Cajal.Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene.15%of GISTs do not have these mutations and they are called wildtype GISTs.Almost all GISTs express KIT receptor tyrosine kinase.Histologically,GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type.The median size of GISTs varies from 2.7 cm to 8.9 cm.Clinically,patients with small GISTs remain asymptomatic but as the GIST size increases,patients present with various symptoms depending on the location of the GIST.Most of GISTs are located in the stomach or small bowel.Diagnosis is suspected on imaging and endoscopic studies,and confirmed by tissue acquisition with immunohistochemical staining.The aggressiveness of GISTs depends on the size,mitotic index and location.Surgical resection is the treatment of choice.But various endoscopic modalities of resection are increasingly being tried.Tyrosine kinase inhibitors are extremely useful in the management of large GISTs,unresectable GISTs and metastatic GISTs.Treatment options for metastatic GISTs also include radiotherapy,chemotherapy,hepatic artery embolization,chemoembolization and radiofrequency ablation.展开更多
BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting...BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.展开更多
Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs ...Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs can directly replicate the current diagnostic and treatment standards for GISTs.This study aims to further elucidate the clinical and pathological characteristics,diagnosis,treatment,and prognosis of EGISTs by analyzing the research results of domestic scholars in the field of EGISTs in the past decade.Methods:A review was conducted on original Chinese and English research articles published from 2013 to 2022 focusing on EGISTs.A descriptive approach was used to extract key information from the literature,including patient demographics,tumor location,tumor diameter,mitotic figures,risk stratification,immunohistochemical markers,cell type,and prognostic factors.The data were subjected to statistical analysis.Results:A total of 12 articles containing 780 EGIST patients were included.The male-to female incidence of EGISTs was 0.92꞉1.The most common sites of EGISTs were mesentery(30.96%),peritoneum or retroperitoneum(28.53%),omentum(20.32%),and pelvic cavity(12.52%).52.77%of EGISTs had tumor diameters greater than 10 cm,and the proportions of EGISTs with nuclear fission patterns greater than 5/50 high power field(HPF)and greater than 10/50 HPF were 51.24%and 26.11%,respectively.The proportion of high-risk EGISTs was 79.05%.The positive rates of immune markers CD117,CD34,and DOG-1 in EGISTs were 82.3%,69.0%,and 79.5%,respectively.The proportion of Ki-67>5%was 49.2%,and the proportion of Ki-67>10%was 24.8%.The proportions of EGISTs in spindle cells,epithelial cells,and mixed cells were 74.4%,14.8%,and 13.1%,respectively.The diameter of the tumor,resection method,risk level,Ki-67 index,mitotic counts,presence of rupture/bleeding/necrosis/peripheral tissue invasion/recurrence and metastasis,as well as the use of imatinib treatment after surgery were important factors affecting the prognosis of EGISTs.Conclusion:Current medical research is relatively well cognizant of GISTs with primary sites in the gastrointestinal tract.Compared with GISTs,EGISTs have large tumor diameters,high mitotic counts,a high percentage of high-risk grades,relatively unique molecular expression,and high aggressiveness.EGISTs differ from GISTs in clinicopathological characteristics.Whether EGISTs and GISTs share a common origin remains unclear.If they are distinct tumor entities,separate diagnostic and treatment guidelines for EGISTs should be established.If EGISTs are ultimately confirmed to be a special subtype of GISTs,then directly applying existing GIST-based standards to EGISTs may be inappropriate.A more scientific approach would involve subclassifying EGISTs based on anatomical location and then tailoring treatment strategies accordingly with reference to GIST guidelines.展开更多
Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submuco...Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.展开更多
Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeuti...Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.展开更多
In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of tre...In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.展开更多
BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dys...BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction.The stellate ganglion block(SGB)can reduce sympathetic excitability and stress responses.This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.AIM To analyze the effects of SGB plus GA on hemodynamic stability,oxidative stress,neuroinflammation,cognitive function,and gastrointestinal function in patients undergoing gastrointestinal surgery.METHODS Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups:A single GA group and an SGB combined with GA group(40 patients each).Hemodynamics,oxidative stress response,laboratory indices,cognitive function,and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups.Pain levels and complications were also recorded.RESULTS Before anesthesia induction,no significant differences were found in various indexes(including hemodynamics,oxidative stress indicators,laboratory indices,cognitive function scores,and gastrointestinal function indicators)between the two groups(P>0.05).At tracheal intubation,3 minutes after,and extubation,the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group(P<0.05).Twentyfour hours postoperatively,oxidative stress indicators(malondialdehyde and nitric oxide)were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group(P<0.05).Cognitive function scores[Mini-Mental State Examination and Montreal Cognitive Assessment(MoCA)]and gastrointestinal function indicators(motilin)were also significantly better in the SGB-GA combined group(P<0.05).The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group.No significant differences were found in the time of first postoperative ambulation,catheter removal time,and 24-hour postoperative pain between groups(P>0.05).CONCLUSION Combining SGB with GA can maintain perioperative hemodynamic stability,reduce oxidative stress and neuroinflammatory injury,and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.展开更多
文摘Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of GIST cases.These tumors often present with nonspecific symptoms,making early detection challenging.This case discusses a duodenal GIST misdiagnosed as pancreatic cancer due to obstructive jaundice.CASE SUMMARY A 40-year-old male with jaundice and abdominal symptoms underwent imaging,which suggested a malignant periampullary tumor.Preoperative misdiagnosis of pancreatic cancer was made,and surgery was performed.Postoperative histopathology confirmed a duodenal GIST.The role of artificial intelligence in the diagnostic pathway is explored,emphasizing its potential to differentiate between duodenal GISTs and other similar conditions using advanced imaging analysis.CONCLUSION Artificial intelligence in radiomic imaging holds significant promise in enhancing the diagnostic process for rare cancers like duodenal GISTs,ensuring timely and accurate treatment.
文摘BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.
基金Supported by Xuhui District Health Commission,No.SHXH202214.
文摘Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including computed tomography(CT),magnetic resonance imaging(MRI),endoscopic imaging,and genomic profiles-to enable intelligent decision-making for individualized therapy.This approach leverages AI algorithms to fuse imaging,endoscopic,and omics data,facilitating comprehensive characterization of tumor biology,prediction of treatment response,and optimization of therapeutic strategies.By combining CT and MRI for structural assessment,endoscopic data for real-time visual inspection,and genomic information for molecular profiling,multimodal AI enhances the accuracy of patient stratification and treatment personalization.The clinical implementation of this technology demonstrates potential for improving patient outcomes,advancing precision oncology,and supporting individualized care in gastrointestinal cancers.Ultimately,multimodal AI serves as a transformative tool in oncology,bridging data integration with clinical application to effectively tailor therapies.
基金Supported by 2025 Henan Medical Education Research Project,No.WJLX2025038.
文摘BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.
文摘Gastrointestinal(GI)cancers remain a leading cause of cancer-related morbidity and mortality worldwide.Artificial intelligence(AI),particularly machine learning and deep learning(DL),has shown promise in enhancing cancer detection,diagnosis,and prognostication.A narrative review of literature published from January 2015 to march 2025 was conducted using PubMed,Web of Science,and Scopus.Search terms included"gastrointestinal cancer","artificial intelligence","machine learning","deep learning","radiomics","multimodal detection"and"predictive modeling".Studies were included if they focused on clinically relevant AI applications in GI oncology.AI algorithms for GI cancer detection have achieved high performance across imaging modalities,with endoscopic DL systems reporting accuracies of 85%-97%for polyp detection and segmentation.Radiomics-based models have predicted molecular biomarkers such as programmed cell death ligand 2 expression with area under the curves up to 0.92.Large language models applied to radiology reports demonstrated diagnostic accuracy comparable to junior radiologists(78.9%vs 80.0%),though without incremental value when combined with human interpretation.Multimodal AI approaches integrating imaging,pathology,and clinical data show emerging potential for precision oncology.AI in GI oncology has reached clinically relevant accuracy levels in multiple diagnostic tasks,with multimodal approaches and predictive biomarker modeling offering new opportunities for personalized care.However,broader validation,integration into clinical workflows,and attention to ethical,legal,and social implications remain critical for widespread adoption.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
基金Supported by The Natural Science Foundation of China,No.82374292the Plans for Major Provincial Science and Technology Projects of Anhui Province,No.202303a07020003the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine,No.ZYYCXTD-C-202401.
文摘Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to symptom heterogeneity and the absence of reliable biomarkers.Artificial intelligence(AI)enables the integration of multimodal data to enhance FGID management through precision diagnostics and preventive healthcare.This minireview summarizes recent advancements in AI applications for FGIDs,highlighting progress in diagnostic accuracy,subtype classification,personalized interventions,and preventive strategies inspired by the traditional Chinese medicine concept of“treating the undiseased”.Machine learning and deep learning algorithms have demonstrated value in improving IBS diagnosis,refining FD neuro-gastrointestinal subtyping,and screening for GERD-related complications.Moreover,AI supports dietary,psychological,and integrative medicine-based interventions to improve patient adherence and quality of life.Nonetheless,key challenges remain,including data heterogeneity,limited model interpretability,and the need for robust clinical validation.Future directions emphasize interdisciplinary collaboration,the development of multimodal and explainable AI models,and the creation of patientcentered platforms to facilitate a shift from reactive treatment to proactive prevention.This review provides a systematic framework to guide the clinical application and theoretical innovation of AI in FGIDs.
基金National Natural Science Foundation of China,No.82370569Basic and Applied Basic Research Foundation of Guangdong Province,No.2022A1515012647the Key Program for Science and Technology Projects of Social Development in Zhuhai,No.2220004000249(to Li XF).
文摘This editorial discusses Wang et al's article on familial gastrointestinal stromal tumors(GISTs).We read with great interest this article concerning the diagnosis,treatment,and post-treatment management of patients with familial GISTs.The actual incidence of GISTs may be underestimated due to diagnostic limitations and the long-term low-risk behavior of some GISTs.The molecular landscape of GISTs is primarily driven by mutations in the KIT and platelet-derived growth factor receptor alpha(PDGFRA)genes.A subset of GISTs without these mutations known as wild-type GISTs,may harbor other rare mutations,impacting their response to targeted therapies.Clinically,patients with GISTs present with nonspecific symptoms,often leading to delayed diagnosis.Genetic predispositions in familial GISTs provide insights into the genetic architecture and extragastrointestinal manifestations of GISTs.Management has evolved from surgical interventions to molecular-based therapies using tyrosine kinase inhibitors.The management of GISTs,especially in familial cases,requires a multidisciplinary approach.Cases of different gene mutations were reported in the same family,suggesting that incorporating genetic testing into routine clinical practice is crucial for the early identification of high-risk individuals and the implementation of tailored surveillance programs.
文摘Recent research has increasingly highlighted the potential oncogenic effects of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection within the gastrointestinal tract.Growing evidence suggests that SARS-CoV-2 may contribute to the development of gastrointestinal malignancies through several mechanisms,including sustained chronic inflammation,disruption of normal cellular homeostasis,and potential viral integration into host cells.These pathological processes have the potential to dysregulate critical cellular pathways,thereby promoting cancer development in vulnerable populations.A thorough understanding of how SARS-CoV-2 interacts with the development of gastro-intestinal cancer is essential for optimizing patient care and establishing compre-hensive,long-term monitoring protocols.This review highlighted the pressing need for ongoing research into the complex relationship between SARS-CoV-2 infection and the risk of gastrointestinal cancer.
基金2024 Technological Innovation Project of Shapingba District,Chongqing(2024174)。
文摘Objective To evaluate the clinical efficacy of Traditional Chinese Medicine(TCM)hot-pack therapy in treating postoperative gastrointestinal dysfunction in patients undergoing surgery for gastrointestinal malignancies.Method 60 postoperative patients with gastrointestinal malignancies were randomized into a treatment group(n=30)and a control group(n=30).Both groups received standard postoperative supportive care,including oral mosapride citrate(5 mg,three times daily,starting 6 h post-op,for 3 days).The treatment group additionally received external abdominal application of a TCM hot-pack twice daily(20-30 min each)for 3 days.Primary endpoints were time to first flatus,first defecation,and first oral intake.Secondary endpoints included numeric scores for abdominal pain and distension at 24 h and 72 h post-op,and overall clinical efficacy.Result Compared with controls,the treatment group showed significantly faster recovery:time to first flatus(50.3±7.8 h vs.62.5±9.4 h),first defecation(72.1±11.3 h vs.85.2±13.6 h),and first oral intake(48.0±9.5 h vs.62.5±12.4 h)(all P<0.01).At 24 h and 72 h,the treatment group reported lower abdominal pain and distension scores(24 h pain 5.1±1.3 vs.6.0±1.4,distension 2.3±0.5 vs.2.8±0.6;72 h pain 3.9±0.8 vs.4.7±0.9,distension 1.9±0.5 vs.2.3±0.6;P<0.05 to P<0.01).Total effective rate was higher in the treatment group(96.7%vs.90.0%,χ^(2)=6.96,P=0.031).Conclusion TCM hot-pack therapy combined with routine care significantly accelerates recovery of gastrointestinal function,shortens duration of postoperative dysfunction,and alleviates abdominal pain and distension in patients after gastrointestinal malignancy surgery,demonstrating notable clinical benefit.
文摘Gastrointestinal(GI)cancers,which predominantly manifest in the stomach,colorectum,liver,esophagus,and pancreas,accounting for approximately 35%of global cancer-related mortality.The advent of liquid biopsy has introduced a pivotal diagnostic modality for the early identification of premalignant GI lesions and incipient cancers.This non-invasive technique not only facilitates prompt therapeutic intervention,but also serves as a critical adjunct in prognosticating the likelihood of tumor recurrence.The wealth of circulating exosomes present in body fluids is often enriched with proteins,lipids,microRNAs,and other RNAs derived from tumor cells.These specific cargo components are reflective of processes involved in GI tumorigenesis,tumor progression,and response to treatment.As such,they represent a group of promising biomarkers for aiding in the diagnosis of GI cancer.In this review,we delivered an exhaustive overview of the composition of exosomes and the pathways for cargo sorting within these vesicles.We laid out some of the clinical evidence that supported the utilization of exosomes as diagnostic biomarkers for GI cancers and discussed their potential for clinical application.Furthermore,we addressed the challenges encountered when harnessing exosomes as diagnostic and predictive instruments in the realm of GI cancers.
文摘Gastrointestinal stromal tumor(GIST)is a rare but an important clinical entity seen in our clinical practice.It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine.Although the exact prevalence of GIST is not known,the incidence of GIST has been increasing.GISTs arise from interstitial cells of Cajal.Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene.15%of GISTs do not have these mutations and they are called wildtype GISTs.Almost all GISTs express KIT receptor tyrosine kinase.Histologically,GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type.The median size of GISTs varies from 2.7 cm to 8.9 cm.Clinically,patients with small GISTs remain asymptomatic but as the GIST size increases,patients present with various symptoms depending on the location of the GIST.Most of GISTs are located in the stomach or small bowel.Diagnosis is suspected on imaging and endoscopic studies,and confirmed by tissue acquisition with immunohistochemical staining.The aggressiveness of GISTs depends on the size,mitotic index and location.Surgical resection is the treatment of choice.But various endoscopic modalities of resection are increasingly being tried.Tyrosine kinase inhibitors are extremely useful in the management of large GISTs,unresectable GISTs and metastatic GISTs.Treatment options for metastatic GISTs also include radiotherapy,chemotherapy,hepatic artery embolization,chemoembolization and radiofrequency ablation.
文摘BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.
基金supported by the National Natural Science Foundation(81960508)。
文摘Objective:There is currently no consensus on whether extra-gastrointestinal stromal tumors(EGISTs)and gastrointestinal stromal tumors(GISTs)are the same type of tumor,and whether the diagnosis and treatment of EGISTs can directly replicate the current diagnostic and treatment standards for GISTs.This study aims to further elucidate the clinical and pathological characteristics,diagnosis,treatment,and prognosis of EGISTs by analyzing the research results of domestic scholars in the field of EGISTs in the past decade.Methods:A review was conducted on original Chinese and English research articles published from 2013 to 2022 focusing on EGISTs.A descriptive approach was used to extract key information from the literature,including patient demographics,tumor location,tumor diameter,mitotic figures,risk stratification,immunohistochemical markers,cell type,and prognostic factors.The data were subjected to statistical analysis.Results:A total of 12 articles containing 780 EGIST patients were included.The male-to female incidence of EGISTs was 0.92꞉1.The most common sites of EGISTs were mesentery(30.96%),peritoneum or retroperitoneum(28.53%),omentum(20.32%),and pelvic cavity(12.52%).52.77%of EGISTs had tumor diameters greater than 10 cm,and the proportions of EGISTs with nuclear fission patterns greater than 5/50 high power field(HPF)and greater than 10/50 HPF were 51.24%and 26.11%,respectively.The proportion of high-risk EGISTs was 79.05%.The positive rates of immune markers CD117,CD34,and DOG-1 in EGISTs were 82.3%,69.0%,and 79.5%,respectively.The proportion of Ki-67>5%was 49.2%,and the proportion of Ki-67>10%was 24.8%.The proportions of EGISTs in spindle cells,epithelial cells,and mixed cells were 74.4%,14.8%,and 13.1%,respectively.The diameter of the tumor,resection method,risk level,Ki-67 index,mitotic counts,presence of rupture/bleeding/necrosis/peripheral tissue invasion/recurrence and metastasis,as well as the use of imatinib treatment after surgery were important factors affecting the prognosis of EGISTs.Conclusion:Current medical research is relatively well cognizant of GISTs with primary sites in the gastrointestinal tract.Compared with GISTs,EGISTs have large tumor diameters,high mitotic counts,a high percentage of high-risk grades,relatively unique molecular expression,and high aggressiveness.EGISTs differ from GISTs in clinicopathological characteristics.Whether EGISTs and GISTs share a common origin remains unclear.If they are distinct tumor entities,separate diagnostic and treatment guidelines for EGISTs should be established.If EGISTs are ultimately confirmed to be a special subtype of GISTs,then directly applying existing GIST-based standards to EGISTs may be inappropriate.A more scientific approach would involve subclassifying EGISTs based on anatomical location and then tailoring treatment strategies accordingly with reference to GIST guidelines.
文摘Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.
文摘Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.
文摘In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.
文摘BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction.The stellate ganglion block(SGB)can reduce sympathetic excitability and stress responses.This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.AIM To analyze the effects of SGB plus GA on hemodynamic stability,oxidative stress,neuroinflammation,cognitive function,and gastrointestinal function in patients undergoing gastrointestinal surgery.METHODS Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups:A single GA group and an SGB combined with GA group(40 patients each).Hemodynamics,oxidative stress response,laboratory indices,cognitive function,and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups.Pain levels and complications were also recorded.RESULTS Before anesthesia induction,no significant differences were found in various indexes(including hemodynamics,oxidative stress indicators,laboratory indices,cognitive function scores,and gastrointestinal function indicators)between the two groups(P>0.05).At tracheal intubation,3 minutes after,and extubation,the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group(P<0.05).Twentyfour hours postoperatively,oxidative stress indicators(malondialdehyde and nitric oxide)were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group(P<0.05).Cognitive function scores[Mini-Mental State Examination and Montreal Cognitive Assessment(MoCA)]and gastrointestinal function indicators(motilin)were also significantly better in the SGB-GA combined group(P<0.05).The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group.No significant differences were found in the time of first postoperative ambulation,catheter removal time,and 24-hour postoperative pain between groups(P>0.05).CONCLUSION Combining SGB with GA can maintain perioperative hemodynamic stability,reduce oxidative stress and neuroinflammatory injury,and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.
