Introduction

The risk of developing gastric carcinoma is closely associated with the severity and extent of premalignant conditions, namely gastric atrophy and intestinal metaplasia. The most recent guidelines for screening and surveillance recommend collecting biopsies from at least two topographic sites (two from the antrum/incisura and two from the corpus, placed in separate and clearly labelled vials), considering incisura angularis biopsy as optional.

Aims & Methods

This study aims to assess the relevance of performing a random biopsy of the incisura angularis for the diagnosing and staging premalignant gastric conditions. We conducted a retrospective cohort study between November/2023 and January/2025, including patients undergoing screening upper endoscopy, endoscopy for dyspeptic symptoms or chronic gastritis monitoring. Biopsies were collected according to the RE.GA.IN protocol, with an additional biopsy from the incisura angularis placed in a third vial. Endoscopic and histological findings were collected and analyzed.

Results

A total of 192 patients underwent high-quality endoscopy, including virtual chromoendoscopy with Blue Light Imaging (57.3% female; mean age 59.6±15.2 years). Most procedures (56.3%) were performed without sedation, followed by anesthesia (23.4%) and conscious sedation (20.3%), with overall good (76.6%) and reasonable (16.7%) tolerance. High risk OLGA/OLGIM stages (III and IV) were identified in 2.1% and 7.8% of patients, respectively (OLGA: stage I-29.7%, II-5.7%, III - 2.1%; OLGIM: stage I - 18.8%, II - 18.8%, III - 7.3%, IV - 0.5%). The addition of a random incisura angularis biopsy altered the overall OLGA score in 16.1% of patients and the OLGIM score in 15.6%, but it contributed to an upgrade to high-risk stages in only three patients (1.6%). Specifically, in two patients, the OLGIM stage increased from 0 to III, and in one patient, the OLGA stage increased from 0 to III.

Conclusion

Our findings suggest that while the incisura angularis biopsy provides some additional diagnostic value, its impact on identifying high-risk patients and influencing the recommended endoscopic surveillance intervals is limited.

References

1. Rugge M, Genta RM, Malfertheiner P, et al. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut. 2024;73(3):407-441. Published 2024 Feb 23. doi:10.1136/gutjnl-2023-331164
2. Dinis-Ribeiro M, Libânio D, Uchima H, et al. Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025. Endoscopy. 2025;57(5):504-554. doi:10.1055/a-2529-5025
3. Ferrari F, Ogata DC, Mello CAL. Role of incisura angularis biopsy in gastritis staging and risk assessment of gastric cancer. Arq Gastroenterol. 2023;60(4):478-489. doi:10.1590/S0004-2803.23042023-120

Introduction

Common bile duct (CBD) dilation can be associated with a wide range of underlying conditions, from benign to significant pathology, including malignancy¹. A recently proposed score by Raza et al. aims to predict the likelihood of significant findings on endoscopic ultrasound (EUS) in patients with incidental CBD dilation², potentially optimizing its use. This study aims to validate this score in a cohort of patients who previously underwent EUS for incidental CBD dilation.

Aims & Methods

Patients with incidental CBD dilation (≥6mm or ≥8mm post-cholecystectomy) who underwent EUS and met the inclusion criteria were retrospectively analyzed. Patient demographics, clinical, laboratory and imaging data were collected to calculate the score: age ≥70 years (1 point), acute non-billiary type abdominal pain (2 points), previous endoscopic retrograde cholangiopancreatography (2 points), CBD diameter ≥15mm or ≥17mm if prior cholecystectomy (2 points). EUS findings were reviewed to identify outcomes.

Results

Sixty-five patients met the inclusion criteria for analysis, 39 females (60%) and 26 males (40%), mean age of 71.5 ± 8.5 years. Overall yield of EUS for significant findings was 21.5%, including 8 patients with choledocolithiasis (12.3%), 4 patients with ampullary adenoma (6.2%), 1 patient with a biliary mass (1.5%) and 1 patient with a pancreatic mass (1.5%). Among the cohort, 23 patients (35.4%) had a score of 0 and none had a significant finding. Thus, a score ≥1 had a sensitivity of 100% and specificity of 45.1%, reliably excluding significant findings. A score ≥3 had a sensitivity of 71.4% and a specificity of 94.1% for identifying meaningful pathology, enabling the identification of high-risk patients with greater precision.

Conclusion

The predictive score effectively stratifies patients with incidental CBD dilation, potentially reducing unnecessary EUS in low-risk individuals while prioritizing high-risk cases. This model enhances resource utilization and targeted care. Further research in larger cohorts may confirm its generalizability.

References

1. Kelly NM, Tharian B, Tham TCK. Natural history of unexplained biliary dilation. Gut 2011;60(Suppl 1):A32-42.
2. Raza, Z., Altayar, O., Mahmoud, T., Abusaleh, R., Ghazi, R., Early, D., Kushnir, V. M., Lang, G., Sloan, I., Hollander, T., Rajan, E., Storm, A. C., Abu Dayyeh, B. K., Chandrasekhara, V., & Das, K. K. (2024). Clinical predictors of significant findings on EUS for the evaluation of incidental common bile duct dilation.Gastrointestinal Endoscopy,100(4), 670–678.e1. https://doi.org/10.1016/j.gie.2024.04.2902

Introduction

Acute biliary pancreatitis (ABP) has been shown to be associated with increasing incidence and health-care costs, and possibly higher mortality than other etiologies. Despite the existence of various scoring systems, early and accurate risk stratification remains difficult. Due to heterogeneity of populations, focusing on one etiology might reveal important insights concerning predictors of outcome.

Aims & Methods

We conducted a retrospective, multicenter cohort study including all patients admitted with ABP between 2018 and 2021 at two hospitals. Epidemiological, clinical, and outcome data were analyzed. The main clinical outcome of interest was a hierarchical composite endpoint of five mutually exclusive clinical states: (i) death (90-day all-cause mortality), (ii) severe AP and/or admission to the intensive care unit (ICU), (iii) endoscopic, interventional radiological, or surgical interventions, (iv) moderately-severe AP, (v) mild AP. Univariable logistic regression identified parameters associated with worse outcomes, which were then tested in multivariable models. Emphasis was placed on early availability and clinical practicality of predictors. We aimed to stratify patients into outcome trajectories reflecting both health impact and healthcare resource utilization.

Results

Out of 569 total acute pancreatitis cases, 217 (38.1%) patients had ABP (mean age 65.9 ±17.4 years; median length of stay (LOS) 7 days, IQR 4;11) Mild, moderately-severe, and severe disease occurred in 62.2%, 30.0%, and 7.8% of patients. All-cause 90-day mortality was 2.3%. Several parameters were significantly (p<0.05) associated with worse outcomes, including BISAP and the Charlson comorbidity index (CCI) (p<0.001). Individually, BISAP and CCI classified patients reasonably, however, wide prognostic uncertainty persisted. When combining BISAP and CCI (BISAP-C), 5 discrete risk groups were identified, ranging from low (group 1, BISAP 0-2 & CCI 0-2) to very-high risk (group 5, BISAP 3-5 & CCI ≥6) (see Table 1). The prevalence of severe outcomes (i–iii) increased across these strata: 2.4% (Group 1), 9.5% (Group 2), 27.3% (Group 3), 60% (Group 4), and 62.5% (Group 5), with LOS also significantly longer in higher-risk groups (p<0.001). Mortality was 50% in group 5, while, importantly, 97.6% of patients in group 1 experienced mild-to-moderate AP without ICU admission, persistent organ dysfunction, surgical or endoscopic interventions, and no fatality, supporting potential early discharge. This also occurred in 90.5% of group 2. Notably, Groups 1 and 2 together comprised nearly 80% of the cohort.

Conclusion

Comorbidity seems to play a major role concerning worse outcomes in ABP. The combination of CCI and BISAP (BISAP-C), both comprised of early-on and easily available parameters, offers improved early prognostic discrimination and may provide tailored, individualized management and healthcare resource utilization.

Introduction

Tissue acoustic properties, such as sound speed, attenuation, and impedance, are closely associated with its mechanical characteristics. Acoustic microscopy, which employs high-frequency ultrasound ranging from several tens of MHz to several GHz, enables the quantitative evaluation of these acoustic properties. Understanding the acoustic properties of biological tissues may offer new insights into disease pathology. Furthermore, because clinical ultrasound images depend on tissue acoustic properties, understanding them could improve the interpretation of echogenic patterns and contribute to developing new diagnostic approaches. Although acoustic microscopy has been applied to cardiovascular and cutaneous tissues in medical research, studies focusing on the liver, particularly hepatic tumours, remain limited.

Aims & Methods

This study aimed to quantify sound speed in hepatocellular carcinoma (HCC)—the most common primary liver tumour—and to examine its relationship with histopathological features. Histopathological classification followed World Health Organization criteria, including histological grade (well, moderately, and poorly differentiated) and histological growth pattern (trabecular, pseudoglandular, and solid). Tissue sound speed was measured using a scanning acoustic microscope (AMS-50SI; Honda Electronics Co., Ltd.) with an 80 MHz transducer. Regions of interest were identified on haematoxylin and eosin-stained slides. Serial 10 μm-thick sections were prepared from formalin-fixed, paraffin-embedded tissue blocks and rehydrated for measurement. Differences in sound speed among histological categories were compared, and statistical analysis was conducted to assess significance. A p-value of < 0.05 was considered significant. This study was approved by the institutional review board, and written informed consent was obtained.

Results

Tissue sound speed was measured at 66 sites from 51 patients. Histological grading identified 22 well, 41 moderately, and 3 poorly differentiated cases. Median sound speeds were 1584.0 m/s, 1595.9 m/s, and 1550.1 m/s, respectively. Poorly differentiated HCC showed significantly lower sound speed than the other grades (p = 0.021). Growth patterns included 50 trabecular, 10 pseudoglandular, and 6 solid cases, with median sound speeds of 1595.9 m/s, 1586.0 m/s, and 1563.6 m/s, respectively. The trabecular pattern tended to exhibit higher sound speed than the solid pattern (p = 0.063). Tissues with abundant fat or glycogen (n = 16) had significantly lower sound speeds than those without (p = 0.002). After excluding these cases, which could act as potential confounding factors, sound speed in poorly differentiated HCC remained significantly lower (p = 0.016), and higher values in the trabecular pattern persisted. Additionally, the pseudoglandular pattern showed greater variability in sound speed than the trabecular pattern.

Conclusion

Variations in acoustic properties among histological subtypes of HCC may contribute to developing novel quantitative assessments in ultrasound imaging and pathological diagnosis.

Disclosure

Kazuto Kobayashi, a co-author, has reported a relationship with Honda Electronics Co., Ltd. that includes: employment.