Intestinal Research Articles

Multiple Ileal and Colonic Stenoses: Is It Always Crohn's Disease?

A 62-year-old woman presented with multiple ileal and colonic stenoses, initially suspected to be Crohn's disease. Despite unremarkable endoscopic biopsies, surgery was performed due to clinical deterioration, and histological analysis confirmed the presence of metastatic breast cancer. This case highlights the importance of considering metastatic disease in the differential diagnosis of gastrointestinal (GI) strictures, particularly when inflammatory bowel disease markers are inconclusive or marginal. Clinicians should be aware of the potential for breast cancer to metastasize to the GI tract, which may present with symptoms mimicking primary GI diseases.

Pseudocyst-Portal Vein Fistula with Hepatic Pseudocysts as Life-Threatening Complication of Pancreatitis: A Case Series with Review of Literature

AbstractPseudocyst-portal vein fistula (PPVF) manifesting as hepatic pseudocyst is a very rare vascular complication of pancreatitis. We present three cases of pancreatitis manifesting as PPVF with hepatic pseudocyst. One of them had a symptomatic pseudocyst with nonpatent portal vein with sepsis, which was managed with endoscopic drainage. The second case had a symptomatic pseudocyst with nonpatent portal vein without any manifestation of sepsis or gastrointestinal (GI) bleed, which was managed conservatively with gradual improvement. The third case manifested with sepsis with organ failure and GI bleed; portal vein reconstruction was planned, but the patient succumbed to sepsis. During a follow-up of 12 months, the first two patients had an uncomplicated course. Patency of the portal vein played a key role in determining the further course of treatment. In case of a nonpatent portal vein, endoscopic drainage may be preferred in case of symptomatic patients, whereas asymptomatic patients may be managed conservatively.

Gastrointestinal Safety Assessment of GLP-1 Receptor Agonists in the US: A Real-World Adverse Events Analysis from the FAERS Database

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used to treat obesity and diabetes but are linked to a variety of gastrointestinal (GI) adverse events (AEs). Real-world data on GLP-1 RA-related GI AEs and outcomes are limited. This study assessed GI AEs and adverse outcomes using the US FDA Adverse Event Reporting System (FAERS). Methods: This retrospective pharmacovigilance study used the US FDA FAERS database (2007–2023). We searched GLP-1 RA medications, AEs, and adverse outcomes. Demographic, treatment indication, and AE data were collected. Descriptive analysis involved frequencies and percentages, while reporting odds ratio (ROR), proportional reporting ratio, Bayesian confidence propagation neural network, and multivariate logistic regression were used to analyze GLP-1 RA-related GI AEs and outcomes. Results: From 2007 to 2023, a total of 187,757 AEs were reported with GLP-1 RAs, and 16,568 were GLP-1 RA-associated GI AEs in the US. Semaglutide was linked to higher odds of nausea (IC025: 0.151, βCoeff: 0.314), vomiting (IC025: 0.334, βCoeff: 0.495), and delayed gastric emptying (IC025: 0.342, βCoeff: 0.453). Exenatide was associated with pancreatitis (IC025: 0.601, βCoeff: 0.851) and death (ROR: 4.50, IC025: 1.101). Overall, semaglutide had a broader range of notable adverse effects; by comparison, dulaglutide and liraglutide use was associated with fewer significant GI AEs. Conclusions: Analysis of the FAERS data reveals that GLP-1 RAs, particularly semaglutide and exenatide, are significantly associated with specific GI AEs, such as nausea, vomiting, delayed gastric emptying, and pancreatitis. Clinicians should be aware of these potential risks to ensure optimal monitoring and patient safety. This study demonstrated the utility of pharmacovigilance data in identifying safety signals, which can inform future pharmacoepidemiological investigations to confirm causal relationships. Clinicians should be aware of these potential risks to ensure optimal monitoring and patient safety.

Critical considerations for the management of gastrointestinal mixed neuroendocrine non-neuroendocrine neoplasms and pure neuroendocrine carcinomas

Mixed neuroendocrine non-neuroendocrine neoplasms constitute rare tumors that are located mainly in the gastrointestinal (GI) tract and have high degrees of malignancy, and the frequency of these tumors has been increasing. They consist of a neuroendocrine neoplastic component with another component of adenocarcinoma usually and have a dismal prognosis. The rare GI pure neuroendocrine carcinoma is highly aggressive and requires complex and extensive management since a genetic distinction exists between it and GI non-neuroendocrine neoplasms, which are generally slow-growing lesions. The most common GI-mixed neuroendocrine non-neuroendocrine neoplasms are colorectal, followed by gastric, mainly in the gastroesophageal junction. Current imaging modalities of nuclear medicine and radiology play important roles in the accuracy of diagnosis. Liquid biopsy may contribute to early detection and timely diagnosis. Ultrasonography, either endoscopic or abdominal, is a technique that contributes to a diagnosis; additionally, contrast-enhanced ultrasonography is very helpful in follow-up appointments. Histopathology establishes a definite diagnosis and stage by evaluating the cell differentiation grade and the cell proliferation index Ki67. The genetic profile can be valuable in diagnosis and gene therapy. Surgical resection with wide lymphadenectomy, whenever possible, and adjuvant chemotherapy constitute the main therapeutic management strategies. Targeted therapy and immunotherapy achieve encouraging results.

HIF-2α level in adolescents with chronic inflammatory pathology of the upper gastrointestinal tract

Сhronic inflammatory diseases of the gastrointestinal tract are among the most common pathological conditions in adolescents. A significant role in the pathogenesis of gastrointestinal tract diseases is given to the functioning of the oxygen sensor system, the main mediator of which is hypoxia-inducible factor 2 (HIF-2α). Therefore, the purpose of the study was to determine the level of HIF-2α in the plasma of patients with chronic inflammatory pathology of the gastrointestinal tract, taking into account the endoscopic picture of the lesion, localization of the pathological process, age and gender of the patient. The study involved 70 adolescents aged 8-18 years with chronic gastroduodenitis (CGD), gastroesophageal reflux disease (GERD), gastric or duodenal ulcer and 25 peers who had been classified as healthy. The plasma concentration of HIF-2α was measured by a sandwich-linked ELISA. Helicobacter pylori infection was determined by urease test or by ELISA. According to the data obtained, the HIF-2α plasma level was higher in patients with chronic inflammatory gastrointestinal disease compared to the control group. In boys with chronic gastroduodenal disease, the level of HIF-2α was higher than in girls. CGD and GERD were characterized by a higher HIF-2α level in plasma than gastric and duodenal ulcers. The HIF-2α level did not depend on the age of the patients or the presence of Helicobacter pylori infection. Keywords: adolescents, chronic gastroduodenitis, gastroesophageal reflux disease, gastrointestinal tract, HIF-2α

In Vitro Protective Effects of a Standardized Extract of Opuntia ficus-indica (L.) Mill. Cladodes and Olea europaea L. Leaves Against Indomethacin-Induced Intestinal Epithelial Cell Injury

Nonsteroidal anti-inflammatory drugs (NSAIDs) can induce serious adverse effects in gastrointestinal (GI) mucosa, increasing intestinal permeability and leading to mitochondrial dysfunction, oxidative stress, apoptosis and inflammation. As proton pump inhibitors are effective in protecting against NSAID-induced gastropathy but not NSAID-induced enteropathy, current research is focused on natural products as protective substances for therapy and prevention of intestinal injury. Herein, through the use of an in vitro model based on intestinal epithelial cell (Caco-2) damage caused by indomethacin (INDO), we examined the protective activity of a commercially available standardized extract (OFI+OE) from Opuntia ficus-indica (L.) Mill. cladodes and Olea europaea L. leaves. Pre-treatment with OFI+OE prevented INDO-induced intestinal epithelial barrier damage, as demonstrated by TEER measurement, fluorescein permeability, and tight junction protein expression. The extract showed positive effects against INDO-induced oxidative stress and correlated activation of apoptosis, decreasing pro-apoptotic markers BAX and Caspase-3 and increasing anti-apoptotic factor Bcl-2. Moreover, the extract inhibited the NF-κB pathway and pro-inflammatory cascade. In conclusion, these data support the use of OFI+OE extract as a natural strategy for therapy and prevention of intestinal mucosal damage, demonstrating its beneficial effects against INDO-induced intestinal damage, through modulation of oxidative, apoptotic, and inflammatory pathways.

Consequential Catastrophe: A Rare Interaction of Upper Gastrointestinal Haemorrhage and Acute Coronary Syndrome

Gastrointestinal (GI) bleeding is a common medical condition that results in up to 10% mortality rate. The severity of bleeding ranges from occult blood loss to massive hemorrhage, with the latter often resulting in rapid onset of anemia. Anemia is an independent risk factor for developing acute coronary syndrome (ACS). Here, we present a case of acute upper GI bleeding developing anemia, which led to ACS.

Toxicity profile and clinical outcomes of stereotactic body radiotherapy with afocal boost without fiducials or perirectal hydrogel spacer for localized prostate cancer.

Whole-prostate dose escalation in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) can improve oncological outcomes, albeit at the cost of increased toxicity. Afocal boost to the dominant intraprostatic lesion (DIL) is gaining interest as an alternative approach. Herein, we investigate the safety and efficacy of this approach. This retrospective study enrolled patients with localized PCa who underwent five-fraction SBRT with afocal boost to the DIL at our institution between May 2016 and August 2021. The prescription doses to the whole prostate were 35 and 36.25 Gy for low- to favorable intermediate-risk PCa and unfavorable intermediate- to high-risk PCa, respectively. The focal boost to the DIL was up to 115-140% of the prescribed dose. None of the patients underwent pretreatment fiducial or perirectal hydrogel spacer placement. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities and oncological outcomes were assessed. Among the 520 patients, 44% were categorized as patients with high-risk PCa. The median follow-up period was 42.9months. No acute or late grade ≥3 toxicities were observed. Acute and late grade2 GU toxicities were observed in 22.3 and 6.1%, respectively, while GI toxicities were observed in 2.1 and 0.8% of the patients. The 4‑year relapse-free survival rate was 94.8% among all patients. Our results indicate that SBRT with afocal boost without fiducials or perirectal hydrogel spacer for localized PCa has apromising toxicity profile and oncological outcomes. Longer follow-up studies are necessary to adequately evaluate late toxicities and efficacy.

How I Do It: Management of Upper Gastrointestinal Perforations and Leaks (With Video)

Transmural gastrointestinal (GI) tract defects are defined as a complete interruption of the gastrointestinal lumen, and can be characterized as perforations, leaks, and fistulae. Each arise from distinct mechanisms and must be managed with an approach tailored accordingly. While traditionally managed surgically, the emergence of a variety of tools and techniques have enabled endoscopists to offer a less invasive alternative to effectively manage gastrointestinal leaks and perforations. Herein, in this “How I Do It” overview, we focus on the assessment and endoscopic management of GI perforations and leaks, including device selection, adjunctive techniques, and post-procedural considerations.

Navigating gastrointestinal endoscopy challenges in the intensive care unit: A mini review.

Patients in the intensive care unit (ICU) may need bedside endoscopy for gastrointestinal (GI) emergencies. Conducting endoscopy in the ICU for critically ill patients needs special consideration. This mini review focuses on indications for bedside endoscopes, including GI bleeding, volvulus, and bowel obstruction. It explains the risks associated with urgent endoscopies in critical patients and outcomes. Hemodynamic instability, coagulopathy, and impaired mucosal visualization are important considerations before bedside endoscopy. It also discusses the anesthesia considerations for non-operating room anesthesia. Multidisciplinary collaboration, meticulous patient selection, and procedural optimization help mitigate risks and maximize procedural success.

Anlotinib plus chemotherapy as a first-line treatment for gastrointestinal cancer patients with unresectable liver metastases: a multicohort, multicenter, exploratory trial

This multicohort phase II trial (ALTER-G-001; NCT05262335) aimed to assess the efficacy of first-line anlotinib plus chemotherapy for gastrointestinal (GI) cancer patients with unresectable liver metastases. Eligible patients with colorectal cancer (Cohort A) or noncolorectal and nonesophageal GI cancer (Cohort C) received six cycles of anlotinib plus standard chemotherapeutic regimens followed by anlotinib plus metronomic capecitabine as a maintenance therapy. Liver metastasectomy can be performed when liver metastases are converted to resectable lesions. The primary outcome was the investigator-confirmed objective response rate (ORR) in the intention-to-treat population. Among the 47 patients in Cohort A, the ORR was 40.4% (95% CI 26.4–55.7), including 1 with a complete response (CR) and 18 who achieved a partial response (PR). The median progression-free survival (PFS) was 8.7 months (95% CI 7.3-NE), and the median overall survival (OS) was not reached. In Cohort C, 14 of 44 patients achieved a PR, with an ORR of 31.8% (95% CI 18.6–47.6). The PFS and OS were 5.8 months (95% CI 4.8–6.5) and 11.4 months (95% CI 5.8–19.3), respectively. The liver metastasectomy rate in patients with liver-limited disease was 22.7% (5/22) in Cohort A and 6.7% (2/30) in Cohort C. For pancreatic cancer patients, the ORR of the efficacy-evaluable population was 36.0% (9/25), and those with liver-limited metastasis had better survival. Moreover, no new safety concerns emerged. In conclusion, an anlotinib-based first-line regimen demonstrated promising antitumor activity among GI cancer patients with unresectable liver metastases and led to liver metastasectomy in selected patients.

Robotic median arcuate ligament release prior to pancreatoduodenectomy.

Celiac artery stenosis presents significant risks in pancreatoduodenectomy (PD), including elevated incidences of postoperative hepatic ischemia and clinically relevant pancreatic fistulae. Addressing this stenosis preoperatively is crucial to avoid complication. While stenosis predominantly arises from vasculopathy, managed with stenting, median arcuate ligament syndrome (MALS) is an atypical cause characterized by the median arcuate ligament's extrinsic compression of the celiac artery. Pre-PD surgical release of this ligament has demonstrated nearly 90% success rate in resolving ischemic complications. The celiac axis can be decompressed through open or minimally invasive techniques. Robotic-assisted celiac artery decompression is an attractive approach due to superior visualization and enhanced dexterity, which facilitate the complex dissection required at the diaphragmatic hiatus. The patient is a 49-year-old male diagnosed with pancreatic adenocarcinoma, who also exhibited severe celiac axis stenosis on preoperative imaging. Median arcuate ligament release prior to PD was pivotal in preventing hepatic ischemia consequent to the ligation of the gastroduodenal artery during PD and in re-establishing normal arterial flow to the upper gastrointestinal tract, thereby circumventing otherwise preventable complications. The patient underwent an uneventful robotic PD following the median arcuate ligament release. Robotic-assisted median arcuate ligament release prior to pancreatoduodenectomy is a safe and effective technique for decompression of celiac axis stenosis. This procedure facilitates meticulous dissection while minimizing postoperative complications and helps to circumvent otherwise preventable outcomes.

Water beads: Expanding toy and 'new' problem for paediatric surgeons and community.

Water beads made from superabsorbent polymers can lead to bowel obstruction, which can sometimes be fatal. This article aims to highlight the dangers of such toys and to propose an innovative, safe and effective approach to diagnostic and therapeutic management. We report two cases of children with intestinal obstruction following the ingestion of products based on superabsorbent polymers. They were diagnosed and treated in two different centres using varying techniques. We compare our experiences with the few cases reported in the literature. Since water beads are radiolucent, ultrasound or CT scans are crucial for diagnosis. As in one of our cases, radiography of the upper gastrointestinal tract with contrast can be very helpful. Laparotomy with enterotomy is the main surgical approach reported in literature to extract the water spheres. We report two cases managed using a minimally invasive approach, and one of them is the second one described in the literature, treated endoscopically. Water beads pose a potential danger to children, making it necessary to limit the sale of this type of toy. We offer a management flowchart based on our experience and evidence from the literature.

Morphological digital assessment and transcripts of gastric and duodenal visfatin in growing piglets fed with increasing amounts of polyphenols from olive mill waste extract.

Visfatin is an adipokine with mediatory effects on inflammation. It is expressed at low levels in the pig stomach, but its role in the gastrointestinal (GI) tract is not well understood. This study explored visfatin expression and localization in the stomach and duodenum of piglets fed varying levels of polyphenols derived from olive mill waste extract, known for their antioxidant and immunomodulatory properties. Twenty-seven piglets were assigned to three dietary groups: control (commercial feed), low polyphenol (120 ppm), and high polyphenol (240 ppm) groups. After 14 days of feeding, samples from the glandular stomach and duodenum were collected from 13 piglets. Immunohistochemistry (IHC), digital image analysis (DIA) using QuPath software, and double-label immunofluorescence were performed to detect visfatin-positive cells and co-localize them with serotonin. Additionally, relative gene expression of visfatin was assessed via RT-qPCR. Visfatin-positive cells were identified in 5 out of 13 piglets, localized mainly in the basal portion of gastric and intestinal glands. The morphology of those cells was consistent with neuroendocrine cells and confirmed by co-localization of visfatin and serotonin. No significant differences were found in cell positivity or morphology between dietary groups or between tissues. However, visfatin transcript levels increased with the dose of polyphenolic extract. These findings suggest that dietary polyphenols may modulate visfatin gene expression in the GI tract. The study also highlights the value of digital anatomy for enhancing the accuracy and reproducibility of anatomical research. Further studies are needed to elucidate the functional role of visfatin transcript and protein in the porcine GI tract.

Study on the role of postoperative rehabilitation based on the ERAS concept for patients undergoing pancreaticoduodenectomy: Protocol for a randomized controlled clinical trial.

Pancreaticoduodenectomy (PD), an abdominal surgery, is known for its complexity, cost and inherent risks. Recently, there has been increasing interest in enhanced recovery after surgery (ERAS) as a therapeutic approach. However, the mechanisms underlying postoperative functional recovery remain uncertain, and there are limited data on the efficacy of ERAS in postoperative physiotherapy following complex PD. This study aims to examine the feasibility and effectiveness of conducting a large powered randomized controlled trial (RCT) to evaluate a 2-week postoperative rehabilitation program based on the ERAS concept for patients undergoing pancreaticoduodenectomy. This study is a RCT with a single treatment group. From June 2022 to June 2024, 28 PD patients will participate in the trial. Patients will be randomly assigned to either a control group receiving standard clinical care or an intervention group undergoing a 2-week postoperative rehabilitation program. Cardiopulmonary function will be assessed using the 6-minute walk test (6MWT), and gastrointestinal (GI) recovery will be evaluated using the Intake, Feeling nausea, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system. Secondary outcomes, including changes in recovery quality post-surgery, will be evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Quality of Recovery Questionnaire (QOR-40). Additional recorded items will include time to first flatus and feces, daily volume of stomach fluid, time to gastric tube removal, length of hospital stay (LOS), and postoperative complications. The study will utilize the I-FEED score, a novel tool for assessing GI function, to monitor the impact of a 2-week postoperative rehabilitation exercise program on patients. The primary outcome will focus on improvements in cardiopulmonary capacity following postoperative rehabilitation activities.

Tracking the journey: Gastrointestinal transit and intraluminal pH dynamics in aging populations using wireless motility capsule.

Gastrointestinal (GI) changes may alter drug absorption, potentially impacting both efficacy and safety of oral pharmacotherapy. However, the GI physiology is rarely studied in the aging population. This study aimed to explore GI transit time and pH in geriatric inpatients and older adults, and compare these findings with those from young volunteers METHODS: A prospective study was performed in geriatric inpatients and community-dwelling adults aged ≥ 75 years. GI transit and intraluminal pH were assessed by using a wireless motility capsule system. Participants' data were pooled with those from a previous study in healthy young volunteers (n = 11). Multivariable linear regression models were developed to identify explanatory variables for GI transit time and pH value. We recruited 30 subjects (median age 80 [interquartile range (IQR) = 77-83] years). When compared to young volunteers (median age 21 [20-33]) years), geriatric inpatients (N = 8) exhibited prolonged gastric emptying times (median = 0.63 h [IQR = 0.32-0.86 h] vs median = 2.98 h [IQR = 1.50-20.35 h], p < 0.01). Community-dwelling older adults (N = 22) did not demonstrate delayed gastric emptying (median = 0.42 h [IQR = 0.36-0.53 h]; p = 0.85. Proton pump inhibitors (PPI) use was associated with increased gastric pH (median pH = 3.75 [IQR = 1.69-4.96] vs. non-PPI median pH = 1.28[IQR = 1.01-1.70]; p < 0.01) in the pooled analysis. The total older cohort had significantly lower small intestine pH compared to young group (median pH = 6.8 vs. 7.2; p < 0.01). Older age did not necessarily alter GI physiology with respect to gastric emptying time and luminal pH values. Only geriatric inpatients exhibited delayed gastric emptying of the motility capsule as compared to young volunteers, while community-dwelling older adults did not. Prevalent PPI use in the aging population led to higher gastric pH levels, with substantial intersubject variability.

Novel Use of Manganese Gluconate as a Marker for Visualization of Tablet Dissolution in the Fed Human Stomach Using Magnetic Resonance Imaging.

Magnetic resonance imaging (MRI) of dry or solid materials in the gastrointestinal (GI) tract requires the use of contrast agents to enhance visualization of the dosage forms. In this study, we explore the novel use of manganese gluconate added to tablets. Manganese was released during tablet dissolution, generating a bright "halo" effect around the tablets, consistent with shortening of the longitudinal relaxation time of the bulk water surrounding the tablet. This is the first study to use MRI to directly image tablet dissolution in the fed stomach using a manganese gluconate contrast agent as dissolution marker.

A pan-European survey of robotic training for gastrointestinal surgery: European Robotic Surgery Consensus (ERSC) initiative.

There has been a recent rapid growth in the adoption of robotic systems across Europe. This study aimed to capture the current state of robotic training in gastrointestinal (GI) surgery and to identify potential challenges and barriers to training within Europe. A pan-European survey was designed to account for the opinion of the following GI surgery groups: (i) experts/independent practitioners; (ii) trainees with robotic access; (iii) trainees without robotic access; (iv) robotic industry representatives. The survey explored various aspects, including stakeholder opinions on bedside assisting, console operations, challenges faced and performance assessment. It was distributed through multiple European surgical societies and industry, in addition to social media and snowball sampling, between December 2023 and March 2024. A total of 1360 participants responded, with valid/complete responses from 1045 participants across 38 European countries. Six hundred and ninety-five (68.0%) experts and trainees were not aware of a dedicated robotic training curriculum for trainees, with 13/23 (56.5%) industry representatives not incorporating training for trainees in their programme. Among trainees with access to robotic systems, 94/195 (48.2%) had not performed any robotic cases, citing challenges including a lack of certified robotic trainers and training lists. Both experts and trainees agreed that trainees should start bedside assisting and operating on the console earlier than they currently do. Assessment tools of trainee performance were not being used by 139/479 (29.0%) participants. This pan-European survey highlights the need for a standardised robotic curriculum to address the gap in visceral training, assessment and certification. A greater emphasis may be required on implementing robotic training earlier through simulation training, dual console learning, bedside assisting, key clinical performance indicators, and assessment tools. The findings will guide the development of a pan-European consensus on the essential components of a comprehensive training programme for GI robotic surgery.

Features of gastrointestinal acute graft-versus-host disease in children undergoing hematopoietic stem cell transplantation.

Graft-versus-host disease (GVHD) commonly affects the gastrointestinal (GI) tract among children who undergo hematopoietic stem cell transplantation (HSCT). Studies concerning GI-acute GVHD (aGVHD) in developing countries are limited. Therefore, our aims were (1) to demonstrate clinical characteristics, endoscopic and histopathological findings in children with GI-aGVHD post-HSCT and (2) to compare features, risk factors, and clinical outcomes of children with GI-aGVHD versus non GI-aGVHD. A retrospective single-center study was conducted on patients receiving the first successful HSCT aged <20 years old between January 2011 and December 2020. The patients were divided into groups with GI-aGVHD (clinically or endoscopy-histopathologically diagnosed) and without GI-aGVHD. Various aforementioned data were recorded to compare the risk factors and clinical outcomes of children with and without GI-aGVHD. Among 246 children post-HSCT, we identified 42 cases (17%) with GI-aGVHD (32 cases with the clinical diagnosis and 10 cases with endoscopy-histopathology confirmed diagnosis) and 204 patients without GI-aGVHD. When compared with children without GI-aGVHD, the GI-aGVHD group had higher rates of hypovolemic shock, renal failure, more extended hospital stays, and deaths (all p < 0.05). The GI-aGVHD group also had a higher proportion of cases with nonhematologic malignancy (odds ratio [OR] = 2.34, 95% confidence interval [CI] = 1.01-5.41, p = 0.047) and cytomegalovirus (CMV) reactivation before the GI-aGVHD episode (OR = 2.22, 95% CI = 1.09-4.51, p = 0.027). GI-aGVHD after HSCT leads to increased morbidity and death. Underlying nonhematologic malignancy and history of CMV reactivation are associated with GI-aGVHD. Direct links between the aforementioned factors and the development of GI-aGVHD merit future studies.

Role of Local Therapy for Metastatic Gastrointestinal Malignancies

AbstractOligometastatic disease is an increasingly recognized intermediate tumor state between locally confined and widely metastatic cancer. Oligometastatic gastrointestinal (GI) malignancies represent a heterogeneous spectrum of disease, and treatment strategies are tailored to each patient and are impacted by multiple factors. Recent advances in systemic therapies, imaging techniques, and local treatment modalities have revolutionized cancer treatment and present new opportunities to improve outcomes in patients with a limited burden of metastatic disease. However, there is currently a lack of consensus and robust literature to guide patient selection and treatment strategies, including the optimal role and timing of local therapies as adjuncts to standard-of-care systemic therapy. The intent of this review is to comprehensively discuss the role of local therapies in the modern management of oligometastatic GI malignancies.