BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure; however, its short-term outcomes and comorbidity resolution remain underexplored. AIM To evaluate short-term weight loss outcomes and comorbidity improvements in patients with obesity within 12 months after LSG. METHODS A single-center retrospective analysis was conducted on 122 patients with obesity who underwent LSG between June 2019 and June 2024. Weight, body mass index, excess weight loss percentage, total weight loss percentage, and metabolic parameters were assessed preoperatively and 1 month, 3 months, 6 months, and 12 months postoperatively. RESULTS Significant reductions in weight (115.36 ± 18.72 kg to 90.65 ± 18.59 kg) and body mass index (38.73 ± 5.17 kg/m2 to 30.32 ± 5.01 kg/m2) were observed at 12 months (P < 0.05). Excess weight loss percentage reached 71.84% and total weight loss percentage showed a consistent upward trend. Marked improvements were also observed in type 2 diabetes, hypertension, dyslipidemia, hyperuricemia, and fatty liver disease (all P < 0.05). CONCLUSION LSG is effective for achieving significant short-term weight loss and ameliorating obesity-related metabolic comorbidities, highlighting its value as a therapeutic intervention for severe obesity.

BACKGROUND In addition to gastric cancer, emerging evidence indicate that individuals treated for Helicobacter pylori (H. pylori ) infection experience a significant reduction in both colorectal cancer (CRC) proportion and mortality, suggesting a potential causative role of this infection in CRC. However, in the Chinese population, it remains unclear whether H. pylori infection is involved in the early stages of colorectal carcinogenesis or is associated with the risk of colorectal polyps (CPs). Therefore, we conducted a retrospective study based on 5986 gastroscopy and colonoscopy patients without a treatment history of H. pylori in Zhejiang Province (China). AIM To investigate H. pylori ’s association with CRC and the different types of CPs, and its potential to alter their risks. METHODS A retrospective cross-sectional study was performed with 5986 patients who had undergone gastroscopy and colonoscopy. Pearson χ 2 test was used for analyzing how H. pylori are correlated to various CPs and CRC. H. pylori as a risk factor for various CPs and CRC was determined by multivariable logistic regression. RESULTS H. pylori -positive patients demonstrated a significantly higher proportion of advanced adenomas (AAs) than negative patients (7.51% vs 5.61%; P = 0.006), with a non-significant increase in CRC proportion (1.45% vs 1.15%). No significant differences were observed for non-adenomatous polyps or low-risk adenomas, and infection levels showed no association with CRC or CPs proportion. H. pylori infection was linked to a more distal CRC location (P < 0.05) but not to AAs characteristics. Furthermore, the analysis showed an association between H. pylori infection and increased odds of AAs (odds ratio = 1.53, 95% confidence interval: 1.20-1.93) and RC (odds ratio = 1.70, 95% confidence interval: 1.01-2.80). CONCLUSION In a similar clinical population of Chinese, H. pylori infection may be a risk factor for both AAs and CRC but not non-adenomatous polyps or low-risk adenomas. This suggests that H. pylori -positive patients should prioritize colonoscopy.

BACKGROUND Laparoscopic anterior resection for colorectal cancer often necessitates a temporary protective stoma to mitigate anastomotic-leak risk, yet stoma reversal is frequently delayed by postoperative ileus. Western medicine offers limited pro-motility options, while traditional Chinese medicine (TCM) has shown promise within enhanced-recovery protocols. Modified Da-Cheng-Qi decoction (mDCQD), a purgative- and qi-moving formula, has demonstrated intestinal motility benefits, but its specific impact on stoma-reversal timing remains unexamined. We undertook a retrospective study to determine whether mDCQD accelerates stoma closure and reduces postoperative ileus after laparoscopic colorectal resection with protective stoma. AIM To investigate the effect of mDCQD on stoma reversal time and incidence of postoperative ileus after laparoscopic anterior resection for colorectal cancer. METHODS A retrospective analysis was conducted on 283 patients who underwent laparoscopic anterior resection for colorectal cancer with prophylactic stoma at our hospital from January 2022 to August 2024. According to whether mDCQD was used postoperatively, patients were divided into observation group (132 cases) and control group (151 cases). The control group received conventional treatment postoperatively, while the observation group received oral mDCQD (raw rhubarb 12 g, mirabilite 10 g, immature bitter orange 15 g, magnolia bark 15 g, radish seed 15 g, aucklandia root 10 g, areca seed 10 g, cannabis seed 15 g) starting from postoperative day 2-3 (the day of gastric tube removal) in addition to conventional treatment, twice daily, 150 mL each time, continued until anal gas passage and defecation. Observation indicators included stoma reversal time, incidence of postoperative ileus, time to first anal gas passage, time to first defecation, time to bowel sound recovery, TCM symptom scores, quality of life scores European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), gastrointestinal hormone levels [motilin (MTL), gastrin (GAS), vasoactive intestinal peptide (VIP)], and inflammatory and nutritional indicators [C-reactive protein (CRP), procalcitonin (PCT), albumin (ALB), prealbumin (PA)]. Kaplan-Meier method and Cox proportional hazards regression model were used to analyze factors affecting stoma reversal time. RESULTS The stoma reversal time in the observation group was 118.5 ± 23.7 days, shorter than 142.8 ± 28.4 days in the control group (t = 7.623, P < 0.001). The incidence of postoperative ileus in the observation group was 6.1% (8/132), lower than 18.5% (28/151) in the control group (χ 2 = 10.245, P = 0.001). The time to first anal gas passage (52.3 ± 10.8 hours vs 68.7 ± 14.2 hours), time to first defecation (78.6 ± 15.3 hours vs 96.4 ± 18.7 hours), and time to bowel sound recovery (38.2 ± 8.5 hours vs 51.6 ± 11.3 hours) in the observation group were all shorter than those in the control group (P < 0.001). On postoperative days 5 and 7, TCM symptom scores in the observation group were lower than those in the control group (P < 0.001). At 3 months after stoma surgery, the EORTC QLQ-C30 overall health status score in the observation group was 68.5 ± 11.7 points, higher than 62.3 ± 13.2 points in the control group (t = 4.19, P < 0.001). On postoperative days 5 and 7, MTL and GAS levels in the observation group were higher than those in the control group, while VIP levels were lower (P < 0.001); CRP and PCT levels in the observation group were lower than those in the control group, while ALB and PA levels were higher (P < 0.05). Multivariate Cox regression analysis showed that the use of mDCQD was an independent factor for shortening stoma reversal time (hazard ratio = 2.147, 95% confidence interval: 1.658-2.781, P < 0.001). CONCLUSION mDCQD can shorten stoma reversal time after laparoscopic anterior resection for colorectal cancer, reduce the incidence of postoperative ileus, promote intestinal function recovery, and improve patients’ quality of life. It is a safe and effective integrated traditional Chinese and Western medicine treatment method.

BACKGROUND Lower gastrointestinal bleeding is a common clinical presentation. However, appendiceal bleeding is exceedingly rare and often results in diagnostic delay or misdiagnosis. CASE SUMMARY We report the case of a 28-year-old man presenting with a two-day history of intermittent hematochezia. A colonoscopy revealed continuous fresh blood exuding from the appendiceal orifice. Computed tomography angiography demonstrated active bleeding from the appendix. An immediate laparoscopic appendectomy was performed. Pathological examination indicated that the bleeding originated from vascular dysplasia of the appendix. Postoperatively, no recurrence of bleeding or complications occurred, and the patient was discharged home on postoperative day 3. CONCLUSION Appendiceal bleeding is rare. Its cause remains obscure, challenging diagnosis. Colonoscopy is the primary diagnostic tool; appendectomy provides definitive treatment.

BACKGROUND Gastric tumors originating from the muscularis propria layer, particularly those with extraluminal growth, pose therapeutic challenges because treatment must balance complete resection with preservation of gastric integrity. Although both digestive endoscopic super-minimally invasive surgery (DESMIS) and laparoscopic wedge resection (lap MWR) are increasingly used, objective preoperative criteria to guide selection between these approaches remain unclear. AIM To target observable preoperative indicators and compare the efficacy of DESMIS and Lap MWR for treating EGT-MP, aiming to guide optimal treatment plan selection for such tumors at different locations. METHODS Patients who underwent DESMIS or Lap MWR for EGT-MP at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2019 and December 2023 were retrospectively selected. Basic patient information, surgical, health economics, and efficacy evaluation indicators; pathological types; postoperative medical management; and laboratory tests were recorded. They were categorized into the endoscopic full-thickness resection, submucosal tunneling endoscopic resection (STER), and laparoscopic minimally invasive surgery (LMIS) groups for intergroup comparisons. RESULTS Overall, 542 patients were included in the study, with 98, 99, and 345 in the endoscopic full-thickness resection, submucosal tunneling endoscopic resection, and LMIS groups, respectively. The LMIS group had larger tumor sizes within the EGT-MP, longer operative times, greater blood loss, longer hospital stays, higher surgical costs, lower incidence of postoperative adverse reaction, shorter duration of proton pump inhibitor (PPI), less frequent use of PPI infusion therapy, a shorter antimicrobial treatment duration, fewer patients requiring escalation to higher-level antibiotics, and a shorter time to resume oral intake than the other groups. Lap MWR resulted in a greater preoperative decrease in hemoglobin levels, a lower postoperative level of white blood cell and C-reactive protein, and a greater increase in alanine and aspartate aminotransferase levels from preoperative values than DESMIS. When analyzing by tumor location, Lap MWR for EGT-MP in the stomach did not result in longer operative times, surgical costs, or hospital stays compared with DESMIS. However, the duration of PPI use was shorter, the method of PPI administration was simpler, the duration of antimicrobial treatment was shorter, the antibiotic level was lower, and the time to resume oral intake was shorter. DESMIS for EGT-MP in the fundus of the stomach had shorter operative times, less blood loss, and lower surgical costs compared with Lap MWR. However, the duration of nasogastric tube placement and antimicrobial treatment was not longer. CONCLUSION DESMIS provides several advantages for EGT-MP, achieving surgical outcomes comparable to those of Lap MWR while yielding better health economics benefits. Our findings suggest that Lap MWR and DESMIS are more advantageous for EGT-MP in the antrum and fundus of the stomach, respectively.

This narrative review presents a synthesis of studies that examine the associations between perioperative nutritional status and its effects on gastrointestinal anastomosis, particularly the complications that can increase patient morbidity and mortality. A comprehensive literature search was conducted via five bibliographic databases: PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane, which included English language articles published recently. The results from the search yielded 151 articles, 46 of which were included for review on the basis of eligibility criteria. The results were identified within the following objectives: Anastomotic leakage, complications, recovery, length of hospital stay, and survival rates. Across more than 100000 gastrointestinal surgery cases reviewed, malnutrition was consistently associated with increased rates of postoperative complications (anastomotic leakage, surgical site infection, and increased length of hospital stay). Multimodal nutritional assessment tools (NRS-2002, PG-Subjective Global Assessment, and serum albumin) demonstrated strong predictive value for identifying postoperative complications. Although the data lacked sufficient evidence, early enteral nutrition was associated with a trend toward reduced infection and leakage rates. Preferential evidence revealed improved gut microbial balance and tissue tensile strength with probiotic supplementation, which may enhance anastomotic healing. Increasing perioperative nutritional status through a multidisciplinary approach is essential for reducing anastomotic leakage and improving surgical outcomes and recovery.

BACKGROUND Pancreaticoduodenectomy has achieved significant clinical advancements, offering patients optimal long-term survival outcomes. However, even in medical centers with high surgical volumes, the incidence of postoperative complications remains relatively high following pancreaticojejunostomy (PJ). In clinical practice, our team has proposed the PJ with mucosal-priority healing (PM-PJ). AIM To observe the characteristics of intestinal mucosal cell migration and the changes of inflammatory factors during the pancreaticojejunal anastomosis. METHODS Thirty-six beagle dogs were randomly divided into two groups, namely, the PM-PJ group (n = 18) and the control group (n = 18), which underwent classic end-to-side invagination PJ. Six beagles were sacrificed on postoperative days 7, days 14, and days 21 to obtain PJ tissue. The primary outcomes were postoperative mortality, morbidity, and pathological changes in the anastomosis. RESULTS All surgeries were successful. In the study group, the incidence rates of anastomotic leakage and pancreatitis were 0% and 11.1% (2/18), respectively, whereas in the control group, these rates were 5.6% (1/18) and 16.7% (3/18), respectively. Serum levels of transforming growth factor β1, interleukin (IL)-10, tumor necrosis factor-α, and IL-6 were elevated at all postoperative time points in both groups, with more significant increases observed in the study group at certain time points. Pathological examination revealed superior anastomotic healing in the study group at all time points. The expression levels of collagen I/III and alpha smooth muscle actin proteins in the anastomoses of both groups showed temporal changes, with more pronounced variations in the study group at specific time points. CONCLUSION PM-PJ surgery proved safe and reliable, with lower anastomotic leakage vs controls; complications were comparable. Transforming growth factor β1/IL-6 rose markedly on postoperative days 7 and days 14.

BACKGROUND The global shortage of organs from deceased donors has led transplant centers to maximize the utilization of each donation after brain death. Concomitant liver procurement and simultaneous pancreas-kidney (SPK) transplantation are increasingly performed; however, the celiac trunk and its branches are shared by both grafts. Effectively dividing these vessels without compromising arterial inflow presents a significant technical challenge, and no consensus exists regarding the optimal strategy for vessel allocation and reconstruction. AIM To analyze graft outcomes following arterial allocation between the liver and pancreas, with particular focus on the technique of gastroduodenal artery reconstruction. METHODS In this single-center, retrospective study, 395 adult liver transplantations were performed at our hospital from January 2018 to June 2019. Propensity score matching was used to balance covariates, resulting in a cohort of 102 patients. This group included 34 patients who underwent liver transplantation with concurrent pancreas procurement [pancreas-using group (PUG)] and 68 patients without pancreas procurement [non-PUG (NPUG)]. Clinical data and outcomes of both groups, as well as 34 patients who underwent SPK transplantation during the same period, were analyzed. RESULTS No significant differences were observed in preoperative, intraoperative characteristics or postoperative surgical complications between the two groups (P > 0.05). On days 2, 3, and 4 post-surgery, PUG patients exhibited lower alanine aminotransferase (183.62 ± 103.91 U/L, 130.69 ± 65.19 U/L, 90.42 ± 34.01 U/L) and aspartate aminotransferase (97.33 ± 46.38 U/L, 47.55 ± 21.71 U/L, 34.03 ± 16.2 U/L) levels compared to NPUG patients (P < 0.05). The proportion of patients achieving normal total bilirubin levels within 7 days was significantly higher in the PUG group (73.5%) compared to the NPUG group (48.5%) (P < 0.05). Graft survival rates at 6 months, 12 months, and 18 months were 97.1%/95.5%, 97.1%/95.5%, and 97.1%/95.5% in the PUG/NPUG groups, respectively. Patient survival rates were identical in both groups (97.1% at all time points). For SPK transplantation patients, kidney/pancreas/patient survival rates were 96.2%/100%/100%, 96.2%/100%/100%, and 96.2%/90%/100% at 6 months, 12 months, and 18 months, respectively. CONCLUSION The allocation of donor blood vessels between the liver and pancreas does not adversely affect the prognosis of either graft when the pancreas is used. The described technique offers a novel approach to arterial reconstruction in SPK transplantation.

BACKGROUND Transcatheter arterial chemoembolization (TACE) failure or refractoriness in hepatocellular carcinoma (HCC) refers to patients who continue to experience tumor progression or recurrence after TACE. Drug-eluting bead (DEB) TACE guided by digital subtraction angiography (DSA) is a novel interventional technique. However, the efficacy of DEB-TACE varies among patients, making the analysis of the factors influencing treatment outcomes clinically important for optimizing therapeutic strategies and improving prognosis. AIM To explore the factors influencing the clinical efficacy of DSA-guided DEB-TACE in the treatment of TACE failure/refractoriness in patients with HCC. METHODS A retrospective analysis was conducted in 96 patients with HCC who were admitted to our hospital between January 2021 and December 2023, met the criteria for TACE failure or refractoriness, and underwent real-time DSA-guided DEB-TACE. Based on the modified response evaluation criteria in solid tumors criteria assessed at the 1-year follow-up, patients were classified into a favorable-outcome group (complete or partial response) and a poor-outcome group (stable or progressive disease). The clinical data of the two groups were compared, and multivariate logistic regression analysis was conducted to identify independent factors affecting treatment outcomes. RESULTS Among 96 patients with HCC and TACE failure/refractoriness, 64 had favorable outcomes, whereas 32 had poor outcomes. Univariate analysis revealed that the two groups exhibited statistically significant differences (P < 0.05) in lesion diameter ≥ 5 cm, multiple lesions, Child-Pugh class B, and preoperative alpha-fetoprotein (AFP) level ≥ 400 ng/mL. Multivariate logistic regression analysis identified lesion diameter, multiple lesions, Child-Pugh classification, and preoperative AFP levels as independent risk factors for poor outcomes in patients with HCC and TACE failure or refractoriness (P < 0.05). CONCLUSION The efficacy of DSA-guided DEB-TACE in patients with TACE-refractory HCC is closely linked to lesion diameter, multiplicity, Child-Pugh class, and preoperative AFP levels.

BACKGROUND In pancreatic neuroendocrine neoplasms (pNENs) with liver metastasis, marked upregulation of T-LAK cell-originated protein kinase (TOPK) is associated with poor prognosis. AIM To elucidate the role of TOPK in pNEN progression and metastasis and to explore the underlying mechanisms. The therapeutic potential of the TOPK inhibitor HI-TOPK-032 was further investigated to inform targeted treatment strategies. METHODS TOPK expression was assessed in tissue samples from 23 patients with pNENs, with and without liver metastasis. TOPK was knocked down in the BON-1 cell line to examine its effects on cell proliferation, epithelial-mesenchymal transition, and activation of the mitogen-activated protein kinase (MAPK) axis. RNA-seq analyzed gene expression changes following TOPK knockdown. The effects of HI-TOPK-032 on pNENs cell proliferation, migration, and invasiveness were also evaluated. RESULTS TOPK was significantly upregulated in pNENs with liver metastasis and correlated with poorer overall survival. TOPK knockdown in BON-1 cells reduced proliferative capacity and epithelial-mesenchymal transition-related protein expression and led to marked downregulation of MAPK pathway-associated genes. Treatment with HI-TOPK-032 demonstrated therapeutic potential by suppressing aggressive cellular phenotypes and inducing apoptosis. CONCLUSION TOPK plays a critical role in pNEN progression and liver metastasis through the MAPK axis. HI-TOPK-032 exhibits promising antitumor activity by targeting TOPK, suggesting its potential as a therapeutic option for pNENs with liver metastasis. Further in vivo and clinical validation is warranted.