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1
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"Proton pump inhibitors (PPIs) are acid-suppressive agents that irreversibly bind to the gastric mucosa’s H+/K+ ATPase proton pump. They are the first-line treatment for various gastrointestinal conditions, including peptic ulcers and gastroesophageal reflux disease, demonstrating superior efficacy compared to traditional acid-suppressive therapies. PPIs have become one of the most widely prescribed long-term medications globally, however, an increasing number of adverse effects have been reported. Numerous studies have confirmed PPIs’ extensive and significant impact on the gut microbiota from the oral cavity to the rectum. Gut dysbiosis is a significant adverse effect of PPIs, potentially exceeding the microbiota-altering impact of antibiotics. While gastric acid suppression plays an important role, PPIs also affect the gut microbiota through multiple mechanisms. Several studies have identified a potential association between PPIs and IBD, suggesting that PPIs may influence the onset, progression, and treatment efficacy of IBD. Although the underlying mechanisms remain unclear, many researchers speculate that dysbiosis induced by PPIs plays a critical role, given the similarities in gut microbiota changes observed in PPIs users and IBD patients. Authors concluded that this association may be influenced by study design, age differences, and protopathic bias, thereby limiting causal inference. Clinicians should interpret this association cautiously, and future prospective studies with rigorous bias control are needed to determine whether PPI use contributes to inflammatory bowel disease pathogenesis. I agree to authors’ opinion.
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Gao M, Yin RR, Mao X, Shao ZX, Shi YY. Association between proton pump inhibitor use and the risk of inflammatory bowel disease: A systematic review and meta-analysis. World J Gastroenterol 2026; 32(22): 116469 [DOI: 10.3748/wjg.v32.i22.116469]
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"1. Overall assessment
Ethics approval, study registration, and funding disclosure are complete, and the study generally complies with international ethical standards for medical research. The work is based on a 499-patient multi-centre retrospective cohort and uses OS together with 3- and 5-year cumulative survival rates as primary endpoints; Kaplan-Meier survival analysis and Cox proportional-hazards modelling are used to evaluate prognostic factors, and the overall analytical framework is consistent with common analytical approaches in oncology prognostic research. Statistical procedures, including survival time definition, censoring handling, and baseline comparison, are reported relatively completely, and the figures and baseline characteristics are presented clearly. In the context of relatively limited real-world long-term survival evidence on ICWM in CRLM, this study provides a useful foundation for future research.
Although the research question is clinically valuable and the cohort size is reasonable, several methodological limitations may affect causal interpretation; the findings are therefore more appropriately regarded as hypothesis-generating evidence.
2. Major methodological concerns
(a) Immortal time bias
The study defines cohort A by "continuous TCM >=3 months" and uses the date of initial diagnosis as the OS time origin. This combination of exposure definition and survival time origin may introduce immortal time bias, because patients have to survive long enough to qualify for cohort A. The reclassification of some patients from cohort B to cohort A during follow-up also points to a potential time-dependent exposure issue. A landmark analysis (e.g., a 3- or 6-month landmark) or modelling TCM as a time-dependent covariate would help reduce this risk of bias.
(b) Residual confounding
The grouping is not randomized, and the choice of TCM may be related to factors such as adherence, socioeconomic status, family support, and treatment tolerability. These unmeasured variables may also influence survival, and Cox regression alone may not fully address residual confounding. Propensity-score-based approaches (e.g., PSM or IPTW) could be considered to improve covariate balance. If these unmeasured data cannot be retrospectively extracted, this should be explicitly listed as a study limitation in the Discussion.
(c) Exposure heterogeneity and treatment-intensity imbalance
The TCM exposure in cohort A includes individualized decoctions together with several patent medicines (Anteke, Pingxiao, Compound Cantharidin, Xihuang, Weimaining). These patent medicines may differ in mechanism and potential efficacy, and combining them under a single “TCM exposure” may weaken interpretability. Additional variation across treatment stages may further increase within-exposure heterogeneity. In addition, the manuscript states only that patients received "best available treatment according to guidelines," without reporting treatment-intensity indicators such as chemotherapy lines, biologic agent use rate, or relative dose intensity (RDI). Stratified sensitivity analyses by patent-medicine category or by decoction-only exposure, together with reporting of systemic treatment intensity, would be useful additions.
3. Statistical and reporting considerations
Covariate adjustment in the Cox model
The multivariable Cox model includes only four covariates: primary tumour site, RAS/BRAF status, local treatment of liver metastases, and cohort assignment. For CRLM survival analysis, prognostic models generally need to cover key dimensions such as patient status, tumour biology, disease burden, and treatment intensity in a relatively comprehensive way. The variables currently included are concentrated on selected treatment factors and molecular features, while several well-recognized prognostic factors have not yet been entered into the model. For example, age differs significantly between the two groups (62.47 vs 58.51 years, P<0.01) but is not adjusted for; ECOG/KPS is used only as an inclusion criterion (0-2) rather than as a covariate; and liver metastatic burden indicators (such as number of metastases, maximum lesion diameter, synchronous vs metachronous status, and extrahepatic disease) are also not included. Treatment-intensity indicators such as chemotherapy lines and RDI are not reported.
Multiplicity and subgroup analyses
Figure 2 presents multiple subgroup analyses (age, sex, primary site, gene status, local treatment, treatment lines, and metastasis location, among others), but the manuscript does not address the multiple-comparisons issue. A large number of subgroup tests may increase the risk of false-positive findings; we suggest that the authors interpret subgroup results cautiously and consider reporting adjusted P values for key subgroups in order to reduce the likelihood of false-positive findings.
Proportional-hazards assumption
Follow-up in this study is relatively long (up to 132 months), and time-varying treatment effects are plausible. Formal assessment of the Cox proportional-hazards assumption (e.g., Schoenfeld residuals) would strengthen confidence in the reported hazard ratios.
Safety reporting
The methods section notes that major adverse reactions would be tracked during follow-up, but the manuscript does not report a safety comparison between the two cohorts, nor does it present indicators such as HILI, myelosuppression, or hepatic/renal function. Given that ICWM is evaluated as a long-term treatment exposure, additional safety data would help support a more comprehensive assessment of its clinical value. If these data cannot be systematically obtained, this limitation should be further clarified in the Discussion.
References
The reference base broadly covers CRLM epidemiology, local liver-directed therapies, and TCM-related mechanisms, and is reasonably current and on-topic. Incorporating the most recent systematic reviews or meta-analyses on integrative medicine in advanced colorectal cancer, where available, would further strengthen the literature base.
4. Language and interpretation
The manuscript is clearly structured and well organized, and on the whole follows standard reporting conventions for observational cohort studies. However, causal and associative language are mixed in places. For example, the title uses verbs with a more causal connotation such as "prolong," and the Discussion contains expressions such as "reduced the risk of death by 35%" and "protective factors," whereas the Abstract Conclusion is phrased associatively as "is associated with longer OS." Maintaining greater consistency in the use of associative rather than causal language throughout the manuscript would better match the evidence level of a retrospective observational design.
5. Conclusion
Overall, this study addresses a clinically relevant question and contributes useful real-world evidence regarding ICWM in CRLM. The findings are best interpreted as hypothesis-generating. Addressing the methodological limitations identified above, particularly immortal time bias, residual confounding, and limited covariate adjustment, in future studies would strengthen causal inference and improve the interpretability of the results.
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Bian JY, Sun YX, Wang LF, He WT, Liu CB, Wang XQ, Zhang T. Integrated Chinese and Western medicine prolong survival in colorectal cancer with liver metastasis: A retrospective cohort study. World J Clin Oncol 2026; 17(5): 118265 [DOI: 10.5306/wjco.v17.i5.118265]
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3
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"Post-stroke depression (PSD) is a frequent complication that worsens recovery and quality of life. Clinicians should prioritize early screening of PSD, especially in patients with cognitive impairment, severe disability, or social isolation. Biological markers such as inflammation and neurotransmitter imbalance may guide risk stratification, while predictive models can support monitoring. Management requires a multimodal approach: antidepressants, psychotherapy, and rehabilitation programs, complemented by family and social support. If integrated into routine stroke care, these strategies enable timely intervention, reduces complications, and promote fast functional recovery."
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Gu JX, Liu CQ, Chen GX, Yao T, Sun ZX, Wang Y. Post-stroke depression update 2025: Mechanisms, prediction, and management. World J Psychiatry 2026; 16(6): 115996 [DOI: 10.5498/wjp.v16.i6.115996]
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"This study is methodologically rigorous, employing a large sample size, LASSO regression, and dual validation to ensure robust results. The dynamic online nomogram enhances clinical usability and identifies clear risk factors, including cognition, albumin, and surgical parameters. Limitations include its single‑institution scope, short validation period, and the need for prospective testing of clinical impact. Overall, it provides a solid foundation and meaningful step toward proactive management of emergence delirium in older adults."
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Xin Y, He B, Wei XH, Yan YL, Huang C, Gao CY, Wang S, Zhang GM, Li R, Wu Y. Construction and validation of a predictive model for the risk of emergence delirium in older adult patients. World J Psychiatry 2026; 16(6): 115839 [DOI: 10.5498/wjp.v16.i6.115839]
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5
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"This is a well-written and presented a rare case report on "Clinical management of porcelain gallbladder: A case report". This manuscript gives additional new knowledge to the existing literature.Porcelain gallbladder is a rare clinical entity that should always be considered due to its well-established association with gallbladder carcinoma. I think that this manuscript is worth to be published in the World Journal of Gastrointestinal Surgery."
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Chen SJ, Chen S, Hu AY, Li QS, Fan Y, Chen YG, Tian S, Li HL, Peng CJ, Han M. Clinical management of porcelain gallbladder: A case report. World J Gastrointest Surg 2026; 18(5): 116359 [DOI: 10.4240/wjgs.v18.i5.116359]
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"This article is well structured and fully compliant with the STROBE checklist. This retrospective study systematically compared the efficacy and safety of traction-preclosure-assisted endoscopic full-thickness resection (TPC-EFTR) with conventional EFTR for the treatment of gastric subepithelial tumors (SETs). The authors clearly formulated the inclusion and exclusion criteria, with a particular emphasis on endoscopic contraindications for lesions characterized by large size, extraluminal growth, dissemination, or potential recurrence. Both primary and secondary outcome measures were well defined in detail.
Regarding primary efficacy outcomes, the en bloc resection rates were comparable between the two groups, whereas the TPC-EFTR group achieved a significantly higher complete resection rate. For secondary outcomes, the TPC-EFTR group demonstrated superior safety profiles, including shortened operation time and wound closure time, as well as a reduced incidence of pneumoperitoneum. In terms of postoperative prognosis, no significant between-group difference was observed in tumor recurrence rate, while the TPC-EFTR group presented higher EQ-VAS scores. Overall, the methodological design of this study meets the standard requirements of retrospective clinical research.
Nevertheless, several limitations of this study remain to be addressed. First, although no statistically significant differences were detected, potential selection bias may exist with respect to the size and anatomical location of enrolled lesions. Second, postoperative CT examinations were performed only based on clinical symptoms, which might lead to an underestimation of the actual pneumoperitoneum rate, a limitation that has also been acknowledged by the authors. Furthermore, EFTR is a technically demanding procedure that is currently restricted to high-level tertiary hospitals. Accordingly, the clinical popularization of conventional EFTR remains challenging, and further validation and prospective investigations are still required to confirm the clinical value of TPC-EFTR.
In conclusion, this study is pioneering and clinically promising, and the TPC-EFTR technique exhibits favorable application prospects. Multi-center, large-sample, and long-term follow-up studies are warranted prior to the widespread clinical application of TPC-EFTR."
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Li X, Zhang RY, Wen XD, Li XQ, Liu WH. Traction-preclosure-assisted vs conventional endoscopic full-thickness resection for gastric subepithelial tumors: Safety, efficacy in a retrospective cohort (with video). World J Gastroenterol 2026; 32(19): 112955 [DOI: 10.3748/wjg.v32.i19.112955]
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7
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"This article discusses an interesting topic. This is problem solving oriented study, with benefit to clinical practice. The comparative study showed that the MV-Flow™ has ability to visualize smaller vessels with slower blood flow, which is particularly relevant, as they challenge the prevailing concept that smaller vessels in deep endometriotic nodules are poorly vascularized.
The ethics meet the requirement of the Journal.
Caveats or drawbacks:“There is no previous data to allow a meaningful estimation. For this reason, we do consider this study as a preliminary exploratory study” in the “Statistical analysis”section is not adequate.
The study design is not sound and the results are not sound and robust. An important limitation is that there is no golden standard(contrast-enhanced ultrasound or other methods) for reference, even the pulsed wave Doppler has not been used for attempting measurement to verify the presence of microvascularity. Using conventional power Doppler as reference is not sufficient.
The dimensions displayed by the two different imaging protocols are not exactly the same dimension, as in the Figure 2 A,B,C,D, and the sampling volume is larger than good.
Some punctuate color regions are artifacts, leading to an unauthentic conclusion that MV-Flow™ has very high sensitivity for microcirculation. "
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Alcazar JL, Pich Barroso DM, Sanchez O, Brunel I, Vilches JC, Orozco R. Enhanced detection of vascularization in rectal endometriosis: A comparative study of microvascular flow and power Doppler. World J Radiol 2026; 18(5): 119223 [DOI: 10.4329/wjr.v18.i5.119223]
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"This important review explored the relationship between hypochlorhydria, microbial dysbiosis, and gastric mucosal immune responses, and how these factors promote the transition from chronic gastritis to metaplasia and malignancy. In addition, the authors describe recent developments in multi-omics technologies that are uncovering new dimensions of host-microbe interactions in the gastric niche, thereby extending the classic Correa cascade into a more comprehensive, ecosystem-based model of gastric carcinogenesis.
It seems that future perspectives on the gastric microenvironment will shift from simple descriptions of microbes to active therapeutic and diagnostic interventions, aiming to enable personalized management of patients with gastric cancer. It is also believed that advances in metabolomic analyses, microbiome modulation, utilization of specialized pro- and prebiotics, gastric microbiome transplantation, use of targeted antimicrobial drugs, modifications of the tumor microenvironment, as well as the use of ex vivo models and artificial intelligence will contribute decisively not only to the prevention and early detection of gastric cancer but also to a more effective complementary therapeutic intervention.
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Zheng HC, Zhou T, Sun L, Ding X. Gastric microenvironment and gastric cancer: Interplay of acid, microbiota, and inflammation. World J Gastroenterol 2026; 32(20): 117044 [DOI: 10.3748/wjg.v32.i20.117044]
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9
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"This is very interesting paper about the predictor of acute hepatic failure. Author indicates that a decrease in peripheral blood natural killer (NK) cells and changes in their functional markers can help predict the progression and severity of liver failure, particularly in conditions like acute-on-chronic liver failure (ACLF). A sharp reduction or dysfunction in circulating NK cells in the bloodstream—often alongside an accumulation of these cells in the liver itself—indicates an overwhelming immune response and correlates with a poorer prognosis. In severe liver diseases like hepatitis-induced ACLF, peripheral NK cells become depleted and show a higher expression of apoptosis and exhaustion markers. Studies suggest that at the time of hospital admission, evaluating circulating NK cell levels alongside standard clinical markers can effectively help identify patients who may survive spontaneously versus those who will require an urgent liver transplant. Finally, our results suggest that more recruitment of NK cells to the liver is somehow responsible for the failure of the native. Explain why peripheral natural killer cells reflect the prognosis more sensitively than other parameters of acute liver failure. a significant drop in peripheral Natural Killer (NK) cell counts and a shift in their functional profile are reliable biomarkers for predicting poor clinical outcomes. Patients with severe liver failure exhibit significantly reduced proportions of NK cells in their peripheral blood compared to healthy individuals. These peripheral NK cells often show signs of exhaustion and dysfunction. Many of them undergo apoptosis (cell death) or migrate directly into the inflamed liver tissue. Researchers have found that the degree of this peripheral NK cell reduction directly correlates with disease severity (e.g., HBV-DNA levels) and can serve as a strong predictive indicator for patient survival or the need for a liver transplant. Please tell me the mechanism between the predictor of acute hepatic failure and the degree of peripheral NK cell."
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Xu JX, Li HG, Xu X, Lu D. Letter to the Editor: Characteristics of peripheral blood lymphocyte subpopulations in acute-on-chronic liver failure: A call for further exploration. World J Gastroenterol 2026; 32(20): 116109 [DOI: 10.3748/wjg.v32.i20.116109]
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10
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"This is a good paper. Human liver ischemia/reperfusion injury (IRI) is a common and major clinical problem complicating liver surgery. The pathogenesis underlying IRI is complex, involving a series of signaling mediators and mechanisms. This study aimed to investigate the effects of Magnesium Isoglycyrrhizinate (MgIG) on the liver function after IRI in liver resection treated with or without MgIG. MgIG is a magnesium salt of glycyrrhizic acid stereoisomer, commonly derived from licorice root. The full name of MgiG is tetrahydrate magnesium 18α, 20β-hydroxy-11-oxon orolean-12-en-3β-yl-2-O-β-D-glucopyranurosyl-α-D-glucopy ranosiduronate. Glycyrrhizin is commonly used clinically as a liver protective medicine. MgIG is the fourth generation of glycyrrhizin preparations. It has better affinity with target cell receptors, and stronger anti-inflammatory and anti-oxidation effects. It has been shown to stabilize hepatocyte membrane and improve liver function. MgIG has shown the effects of lowering the liver toxicity of free fatty acid by preventing mitochondrial damage and protecting hepatocytes from ischemia and reperfusion induced injury. Function: It provides anti-inflammatory, antioxidant, and hepatocyte membrane-stabilizing effects. Used post-surgery, it is associated with a more rapid decrease in liver enzymes (such as ALT and AST) and better regulation of inflammatory cytokines.Ischemia-reperfusion injury: Studies have shown it can mitigate liver damage caused by blocking the hepatic blood supply during the surgical procedure. Previous studies showed that MgIG administration significantly ameliorated CCl4-induced biochemical alterations and lipid peroxidation in the liver of mice or rats The protective effects of MgIG might be resulted from the elimination of oxygen free radicals before the damage to macromolecular and metabolism of the cells. I ask some questions for authors.1. Please describe the extent of liver resection and the presence or absence of cirrhosis in the patient's background. 2.Please also describe parameters other than GOT used to assess the drug's effectiveness. 3.Please provide more detailed information about the effects of MGIG on reperfusion injuries. 4.During liver surgery, how many minutes of ischemia were administered using the Pringel procedure? 5.Author’s data suggests that MG has a hepatoprotective effect on the liver, but please consider comparing it with other medications.
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Xie ZQ, Wei JX, Zhong JY, Luo X, Zhuang HK, Ma XW, Wang QB, Tan WL, Wang BK, Chen YJ, Li CJ, Shang CZ. Effectiveness of magnesium isoglycyrrhizinate on perioperative hepatic function protection in patients undergoing hepatectomy. World J Gastroenterol 2026; 32(19): 116513 [DOI: 10.3748/wjg.v32.i19.116513]
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11
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"Simpler technique but critical evaluations noted. Important for patient care. Type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR) are growing global health concerns, with DR remaining a major cause of vision loss. The study identifies indirect bilirubin (IBIL) as a potential biomarker that is inversely linked to DR risk in patients with T2DM. Although the findings are clinically important, limitations such as the cross-sectional design, single-center setting, and possible confounding factors reduce generalizability."
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Zhang Z, Shan XQ, Liang FM, Zhang LX. Letter to the Editor: Indirect bilirubin: A potential predictive biomarker for diabetic retinopathy and its clinical translational potential. World J Diabetes 2026; 17(5): 115813 [DOI: 10.4239/wjd.v17.i5.115813]
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12
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"This case-control study recruited 303 participants from Kunming, exploring associations between serum vitamin D, VDR FokI polymorphism and diabetic retinopathy (DR) in T2DM patients. It found vitamin D deficiency and VDR FokI ff genotype were independent risk factors for DR.
The study adopted rigorous grouping and standard laboratory detection, applied Sanger sequencing for accurate genotyping, and controlled common clinical confounding factors, offering valuable population evidence for DR early risk prediction.
However, single-center cross-sectional design cannot confirm causality. It lacked DR severity stratification and ignored lifestyle and sunlight exposure confounders. Future work should adopt multicenter prospective cohorts and further explore the molecular mechanism of VDR variants affecting DR pathogenesis. "
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Liu ZH, Ran ZQ, Yang R, Chen LX, Wang ZZ, Li YY, Han R. Vitamin D, vitamin D receptor FokI polymorphism, and diabetic retinopathy: A case-control study in Kunming, China. World J Diabetes 2026; 17(5): 118141 [DOI: 10.4239/wjd.v17.i5.118141]
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13
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"In this manuscript, the authors aimed to establish a prognostic indicator for patients with advanced-stage hepatocellular carcinoma who received nivolumab as the initial treatment. Several biochemical parameters, including alpha-fetoprotein and the neutrophil-to-lymphocyte ratio (NLR), were retrospectively analyzed. The cut-off value for NLR was determined using a receiver operating characteristic (ROC) curve to distinguish patients with survival times longer than the median survival time. However, the efficacy of this cut-off value was subsequently validated using the same cohort in which the cut-off value had originally been established. Under these conditions, it is expected that the validation would yield favorable predictive results. Therefore, because both the establishment and validation of the cut-off value were conducted within the same cohort, the significance and predictive performance of the cut-off value cannot be considered methodologically validated."
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Guo R, Gao M. Predictive value of neutrophil-lymphocyte ratio for prognosis in patients with advanced hepatocellular carcinoma treated with programmed cell death 1 inhibitors. World J Gastroenterol 2026; 32(18): 118416 [DOI: 10.3748/wjg.v32.i18.118416]
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14
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"This is a well-written and presented rare case report on "Giant serosal cavernous hemangioma of the ileum". This manuscript gives additional new knowledge to the existing literature.The authors emphasize the importance of a better understanding of "cavernous hemangioma" by clinicians, and the necessity of timely diagnosis and treatment. I think that this manuscript is suitable ,and worth to be published in World Journal o Gastrointestinal Surgery."
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Si HB, Qin HJ, Wang YP, Nie FF. Giant serosal cavernous hemangioma of the ileum: A case report and review of literature. World J Gastrointest Surg 2026; 18(4): 115954 [DOI: 10.4240/wjgs.v18.i4.115954]
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15
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"Formerly ,the neutrophil/lymphocyte ( N/R) ratio also reflected the severity of COVID-19. In this study, the authors state that the N/L ratio is an indicator that correlates with the prognosis of HCC receiving program inhibitor administration.
NLR values have also been shown to predict survival in various cancers including urologic cancer , nasopharyngeal cancer , colon cancer , as well as lung cancer . In addition, other authors say that the NLR has been found to be a prognostic risk factor for HCC after treatments other than TACE, such as hepatectomy , liver transplantation and sorafenib therapy . Please explain the mechanism by which the N/L ratio serves as an indicator of prognosis. Explain the mechanism by which the NLR cutoff was set to 3.165. Systemic inflammatory responses have been shown to reflect the promotion of angiogenesis, and DNA damage and tumor invasion through upregulation of cytokines. A simple index of systemic inflammation is the neutrophil–lymphocyte ratio (NLR). Elevated NLR has recently been shown associated with poorer prognosis in patients with various types of malignant tumors, including colorectal cancer, HCC, intrahepatic cholangiocellular carcinoma, and pancreatic cancer. Furthermore, elevated NLR have shown a significant correlation with poor outcome in patients undergoing LT for HCC. I think that One mechanism by which elevated NLR can lead to a higher tumor recurrence rate involves an increased number of circulating neutrophils secreting the vascular endothelial growth factor (VEGF), resulting in higher levels of VEGF in the tumors. Moreover,an elevated Platelet-to-Lymphocyte Ratio (PLR), often with a cut-off , is a significant, low-cost prognostic biomarker for poor overall survival (OS) and disease-free survival (DFS) in hepatocellular carcinoma (HCC) patients. It reflects heightened systemic inflammation and correlates with tumor aggressiveness, such as large tumor size, vascular invasion, and recurrence. Please comment about platelet /lymphocyte ratio about the prognosis HCC receiving receiving program inhibitor administration.
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Guo R, Gao M. Predictive value of neutrophil-lymphocyte ratio for prognosis in patients with advanced hepatocellular carcinoma treated with programmed cell death 1 inhibitors. World J Gastroenterol 2026; 32(18): 118416 [DOI: 10.3748/wjg.v32.i18.118416]
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16
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"This article addresses a clinically important issue in complex hepatocellular carcinoma surgery: the potential navigation value of combining intraoperative ultrasound with indocyanine green fluorescence imaging. The study is valuable because it evaluates not only tumor visualization but also clinically relevant endpoints, including tumor localization, occult lesion detection, margin control, perioperative outcomes, and survival-related outcomes. The topic is timely and relevant to hepatobiliary surgeons, particularly in the context of precision hepatectomy and minimally invasive liver surgery.
However, the interpretation should remain cautious because the study is retrospective and single-center in design. Potential selection bias, learning-curve effects, and heterogeneity in fluorescence protocols may influence the results. The comparison also appears to reflect a systematic combined-navigation strategy versus conventional surgery rather than a pure navigation versus non-navigation comparison. Therefore, the findings are clinically encouraging and suitable for hypothesis generation, but prospective multicenter validation with standardized navigation endpoints is needed.
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Zhang S, Li SY, Zhou B. Navigation value of intraoperative ultrasound combined with indocyanine green fluorescence in complex hepatocellular carcinoma resection. World J Gastrointest Surg 2026; 18(4): 116412 [DOI: 10.4240/wjgs.v18.i4.116412]
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17
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" The manuscript is written well. Its structure is appropriate for this type of article. Ethical approval form meets the requirements. Methods are appropriate and effective. Results are appropriate of methods and are authentic. Tables and biostatistics data are perfect. The references are adequate of topic. Language of article is satisfied."
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Pavlidis L, Geropoulos G, Kechagias KS, Psarras K, Patel V, Reza L, Prakash N, Athanasiou C, Geropoulos V, Anestiadou E, Triantafyllou T, Sapalidis K, Laskou S, Dimitroulis D. Near-infrared fluorescence with indocyanine green for minimally invasive hernia surgery: A systematic review and evidence synthesis. World J Clin Cases 2026; 14(14): 118964 [DOI: 10.12998/wjcc.v14.i14.118964]
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18
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" The manuscript is written well. Its structure is appropriate for this type of article. Ethical approval form meets the requirements. Methods are appropriate and effective. Results are appropriate of methods and are authentic. Tables and biostatistics data are perfect. The references are adequate of topic. Language of article is satisfied."
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Walędziak M, Różańska-Walędziak A. Three-port robotic sleeve gastrectomy-another step forward: A case report. World J Clin Cases 2026; 14(14): 117795 [DOI: 10.12998/wjcc.v14.i14.117795]
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19
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" The manuscript is written well. Its structure is appropriate for this type of article. Ethical approval form meets the requirements. Methods are appropriate and effective. Results are appropriate of methods and are authentic. Tables and biostatistics data are perfect. The references are adequate of topic. Language of article is satisfied."
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Raveglia F, Degiovanni S, Bertolaccini L, Cara A, Cassina EM, Danuzzo F, Libretti L, Pirondini E, Sibilia MC, Spinelli F, Tuoro A, De Simone M, Chiarelli M, Cioffi U, Petrella F. Beyond survival: Pain as the main determinant of long-term quality of life after thoracic trauma surgery. World J Clin Cases 2026; 14(13): 119644 [DOI: 10.12998/wjcc.v14.i13.119644]
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20
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"This study addresses an important and timely clinical question, providing relevant data on the use of ustekinumab in postoperative recurrence of Crohn’s disease. The multicenter design enhances the external validity and applicability of the findings in real-world practice. The integrated assessment combining endoscopic, clinical, and biological outcomes represents a major strength of the study. Overall, the results support the efficacy and safety of ustekinumab, particularly in a first-line setting. However, the retrospective design introduces inherent limitations, including potential selection bias and residual confounding. The relatively short follow-up period limits the ability to draw conclusions regarding long-term efficacy and durability of response. The observed differences in response among stricturing and penetrating phenotypes are intriguing but remain hypothesis-generating and require further validation in larger prospective cohorts.
Despite these limitations, the study provides valuable real-world evidence supporting early use of ustekinumab in postoperative Crohn’s disease. The manuscript is well structured, clearly written, and easy to follow, with a coherent presentation of results and clinically meaningful interpretation."
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Ma XZ, Han XZ, Zhang WY, Tian F, Zhou XC, Zhou LY, Teng YS, Lei L, Sheng JQ, Jin P, Zhao XM, Jia Y. Effectiveness of ustekinumab in postoperative Crohn's disease management: Evidence from a Chinese multicenter cohort. World J Gastroenterol 2026; 32(16): 116781 [DOI: 10.3748/wjg.v32.i16.116781]
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21
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"1 Ethics: Does the ethical approval form provided by the author meet the requirements?
The Ethics Committee of the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, waived the need for ethics approval.
2 Methods: Is the experimental method effective? Can it be repeated by fellow researchers (according to adequate textual/citation content presented)?
The study is moderately effective as it is retrospective clinical design how ever detailed methodology is missing. furthermore, it is judged on statistical variation not on experimental results variations
3 Results: Are the results true and authentic? Is the theory or hypothesis of universal significance validated or partially validated?
The results are appropriately authentic and consistent. Sample size is lower, hence hypothesis is moderately validated. Present study demonstrate the prognosis relevance which is insufficient for application in clinical settings.
4 Figures and tables: Does the author provide perfect tables, line charts and/or graphs? Or, does the author provide figures and tables that are confusing, poorly constructed and/or not well-annotated?
Figure and tables are adequately presented
5 Biostatistics: Does the author provide perfect biostatistics data? Or, does the author provide tables and line charts that have mistakes in the data?
Standard statistical approach is used in the current study with respect to study design
6 References: Does the author scientifically and reasonably cite the latest references which are important in this field and related to the scientific problems and research hypotheses addressed in the study? Or, does the author self-cite, omit, mis-cite and/or over-cite references?
Appropriate
7 Language: Does the language in article correctly, clearly and concisely express the information? Or, does the article have multiple grammatical and spelling mistakes?
Acceptable format, formal and scientifically clear
8 Caveats or drawbacks: What are the caveats or drawbacks for the results?
Single center results
Lower sample size which might effect on statistical significance
Transparency in methodology
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Stawarz K, Gorzelnik A, Klos W, Korzon J, Kissin F, Bienkowska-Pluta K, Stawarz G, Rusetska N, Zwoliński J. Prognostic value of clinicopathological parameters in adenoid cystic carcinoma: A retrospective cohort study. World J Clin Oncol 2026; 17(4): 116329 [DOI: 10.5306/wjco.v17.i4.116329]
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22
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"This review article explores the complex relationship between nutrition, ultra‑processed food consumption, and colorectal cancer development. It highlights how diets rich in additives, refined sugars, and industrial fats contribute to dysbiosis, inflammation, and oxidative stress, thereby increasing cancer risk. Conversely, dietary interventions such as fasting, caloric restriction, and ketogenic regimens show promise in reprogramming tumor metabolism and enhancing therapeutic responses. The authors emphasize that while mechanistic evidence is strong, clinical studies remain limited, heterogeneous, and often small in scale. Overall, the paper underscores the potential of personalized nutrition as a complementary strategy in colorectal cancer prevention and treatment, but stresses the need for well‑designed trials to validate safety, adherence, and long‑term outcomes."
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Lima RSP, Sousa JDS, Neres MSO, de Sousa DJM, Martins JA, Pereira IC, da Silva ACA, Severo JS, Torres-Leal FL, da Silva MTB. Colorectal cancer therapy and nutrition: From ultra-processed consumption to metabolic reprogramming. World J Gastrointest Oncol 2026; 18(4): 115511 [DOI: 10.4251/wjgo.v18.i4.115511]
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23
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"This article provides valuable insight into the role of CD161⁺CD8⁺ T cells in HBV‑associated hepatocellular carcinoma, emphasizing their contribution to T‑cell exhaustion. The study highlights that PD‑1 inhibitors reduce PD‑1⁺ subsets but fail to affect CD161 expression, suggesting independent regulatory mechanisms. These findings underscore CD161 as a distinct and promising immunotherapeutic target, complementing but not overlapping with PD‑1 blockade strategies. While the evidence is compelling, broader patient cohorts and longitudinal studies will be essential to confirm clinical relevance and therapeutic potential."
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Liu CR, Zhang M, Wang MQ, Zhang W, Li J, Shi GZ, Liang FF, Li YP, Huang N. CD161+CD8+ T cells in patients with hepatitis B virus-associated hepatocellular carcinoma. World J Gastrointest Oncol 2026; 18(4): 114547 [DOI: 10.4251/wjgo.v18.i4.114547]
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24
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"The study presents a novel synthetic lethality strategy combining atorvastatin and gefitinib for colorectal cancer. It demonstrates strong experimental evidence with both in vitro and in vivo validation, highlighting mechanistic clarity via the AMPK‑SREBP1 pathway. While promising and translational, limitations in sample size and treatment duration suggest further clinical validation is needed."
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Huang JH, Ma JQ. HMGCR loss is synthetic lethal with PIK3CD inhibition in colorectal cancer cells. World J Gastrointest Oncol 2026; 18(4): 114220 [DOI: 10.4251/wjgo.v18.i4.114220]
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25
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"The work is very interesting. In particular, the discussion is rich and leads to many insights into the relationship between diabetes and coronary heart disease (CAD) and how to address both simultaneously in a prevention strategy. This paper could be a trailblazer for further research investigating the use of other drugs currently used to treat both diabetes and CAD."
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Tsironikos GΙ, Zakynthinos GΕ, Kyprianidou D, Rammou V, Antonogiannis T, Bargiota A, Zakynthinos E, Tsolaki V. Metformin fails to prevent diabetes in non-diabetic cardiovascular patients: Systematic review and meta-analysis. World J Cardiol 2026; 18(4): 115712 [DOI: 10.4330/wjc.v18.i4.115712]
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26
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"The authors deserve praise for coming up with a new and well-thought-out way to solve a difficult clinical problem. This case report beautifully shows how customised three-dimensional printed titanium ribs can be used successfully with bilateral flap coverage to fix a complicated chest wall defect. Combining cutting-edge 3D printing technology with sound reconstructive surgical principles is a forward-thinking approach that works well and looks good.
The manuscript is well-organised, clearly written, and backed up by relevant clinical information and images. It gives thoracic and reconstructive surgeons a lot of useful information about planning before surgery, customising implants, and surgical techniques. This report adds important information to the growing field of personalised surgical reconstruction and sets a good example for how it can be used in the future."
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Li XA, Chen JY, Bu J, Wu HW. Customized three-dimensional printed titanium ribs combined with bilateral flaps for reconstruction of chest wall defect: A case report. World J Orthop 2026; 17(4): 117533 [DOI: 10.5312/wjo.v17.i4.117533]
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27
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"The manuscript "Management and Prevention of Iatrogenic Ipsilateral Femoral Neck Fracture During Intramedullary Nailing of Femoral Shaft" talks about a clinically important but often overlooked problem in orthopaedic trauma surgery. The authors did a great job of stressing how important it is to be careful during intramedullary nailing. They also talked about both ways to avoid problems and how to handle them when they do happen.
The article is well-organised, with a clear progression from identifying the problem to finding solutions that work. The focus on early diagnosis, safety measures during surgery, and imaging protocols adds a lot of clinical value. The section on technical details and surgical tips is especially interesting, making the paper very useful for both new and experienced surgeons.
The manuscript adds to the existing body of literature by putting together current evidence and making recommendations that can help lower complication rates and improve patient outcomes. In general, this article is well-written, informative, and useful in a clinical setting, so it should be published."
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Nallakumarasamy A, Vetrivel VN, Balaji VP, Yadav R, Jeyaraman N, Muthu S, Jeyaraman M. Management and prevention of iatrogenic ipsilateral femoral neck fracture during intramedullary nailing of femoral shaft. World J Orthop 2026; 17(4): 116107 [DOI: 10.5312/wjo.v17.i4.116107]
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28
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" The manuscript is written well. Its structure is appropriate for this type of article. Ethical approval form meets the requirements. Methods are appropriate and effective. Results are appropriate of methods and are authentic. Tables and biostatistics data are perfect. The references are adequate of topic. Language of article is satisfied."
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Usuda D, Furukawa D, Imaizumi R, Ono R, Kaneoka Y, Nakajima E, Kato M, Sugawara Y, Shimizu R, Inami T, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Perforative peritonitis caused by long-term retention of a rectal foreign body: A case report. World J Clin Cases 2026; 14(11): 119572 [DOI: 10.12998/wjcc.v14.i11.119572]
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"Congratulations on the publication of your paper. This is a significant achievement, and I am delighted to see that your dedicated efforts in daily clinical practice and academic work have borne fruit.
I read your paper with great interest, particularly because my own specialty is emergency medicine. I also occasionally encounter cases of anorectal foreign bodies in clinical practice, and I believe your paper will serve as a highly valuable reference for the management of such cases in the future.
The manuscript is very well organized, clear, and easy to follow. In addition, it incorporates up-to-date information and presents the topic in a balanced and informative manner. Overall, I consider this to be a high-quality paper of substantial clinical value.
In recognition of these strengths, I would give this work the highest evaluation. Writing and publishing a paper while maintaining a busy clinical workload is no small accomplishment, and I sincerely hope that you will continue to build on this success and further expand your academic achievements.
Congratulations once again on this excellent work."
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Usuda D, Furukawa D, Imaizumi R, Ono R, Kaneoka Y, Nakajima E, Kato M, Sugawara Y, Shimizu R, Inami T, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Perforative peritonitis caused by long-term retention of a rectal foreign body: A case report. World J Clin Cases 2026; 14(11): 119572 [DOI: 10.12998/wjcc.v14.i11.119572]
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"5-FU is the basis of the therapeutic regimens for the pharmacological treatment of gastric cancer (GC). However, the main downside of this treatment is the development of resistance, which, understandably, negatively affects patients’ clinical outcomes. Therefore, innovative therapeutic strategies are needed to overcome 5-FU resistance and improve the prognosis of GC. The authors of the study under review investigated the effects of Xiangshaliujunzi decoction (XSLJZD) on GC cell lines. They found that XSLJZD inhibited cell viability and proliferation, while promoting PANoptosis in 5-FU-resistant cells. Suppression of ZEB1 increased pyroptosis, apoptosis, and the expression of other proteins associated with programmed cell death.
The selection of this work for comment was based on two reasons: i) the use of complementary therapy, whether or not based on traditional Chinese Medicine in the treatment of various benign and malignant digestive disorders, should be adopted internationally. The results are no longer empirical but are based on valid clinical and laboratory data, ii) The authors, in designing their study, among other things, investigated the effect of PANoptosis processes (apoptosis, pyroptosis, and necroptosis) which are a very hot topic of research internationally not only in malignant digestive diseases, but also in a host of other benign conditions such as inflammatory bowel disease. Their results, although experimental, reinforce the view that XSLJZD overcomes 5-fluorouracil (5-FU) resistance in GC by inducing PANoptosis."
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Gao H, Yin DF, Xing XR, Zhou LJ, Yu R. MiR-200a-3p/ZEB1/IRF1-mediated PANoptosis prompts Xiangshaliujunzi decoction to overcome 5-fluorouracil resistance in gastric cancer. World J Gastroenterol 2026; 32(14): 114331 [DOI: 10.3748/wjg.v32.i14.114331]
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"This draft provides a clear and engaging overview of diabetic retinopathy (DR), presenting it as more than just a vascular complication and highlighting its neurovascular nature. Diabetic retinopathy (DR), and its effective explanation as a complex, multifactorial, and increasingly recognized neurovascular disorder rather than solely a microvascular complication. The paper effectively emphasizes the global burden of the disease and the limitations of current treatments, especially anti-VEGF therapies, while drawing attention to the importance of early retinal changes. One of the main strengths of the review is its broader perspective beyond glucose control. The discussion of inflammation, lipid metabolism, and immune processes is well integrated and reflects current thinking in the field. The discussion of broader perspective as “beyond-glycemia” framework, reinforcing the need for multidimensional therapeutic strategies. The writing flows logically, making complex mechanisms easier to follow. The section on the gut-retina axis is particularly interesting and adds a fresh dimension to the topic. It clearly explains how gut microbiota may influence retinal health through metabolic and immune pathways. The inclusion of microbial metabolites, extracellular vesicles, and immune modulation as mediators of gut-retina communication demonstrates a developed understanding of the current evidence. Overall, the draft is well-organized, informative, and forward-looking, with a strong focus on potential new therapies and future research directions.
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Zeppieri M, Drigo A, Capobianco M, Visalli F, Cappellani F, Musa M, Giglio R, Tognetto D, Khouyyi M, Gagliano C, D’Esposito F, Inferrera L. Beyond glycemia: The influence of systemic inflammation, lipids, and the gut-retina axis in diabetic retinopathy. World J Diabetes 2026; 17(3): 114603 [DOI: 10.4239/wjd.v17.i3.114603]
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"It has been stated that PPI s alone are good effective for aspirin induced gastrointestinal bleeding, but not sufficiently effective for clopidogrel induced gastrointestinal bleeding. However,co-administration with rebamipide provides sufficient hemostatic effect. Please comment the reason why pPI with rebamipide is good effect for the gastrointestinal bleeding with clopidogrel.
Please comment the side effect of long term with pPI use."
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Kim M, Chi SA, Kim JE, Kim ER, Hong SN, Kim YH, Kim K, Chang DK. Optimal strategies for mitigating gastrointestinal bleeding in patients receiving antiplatelet therapy: Real-world study. World J Gastroenterol 2026; 32(14): 115790 [DOI: 10.3748/wjg.v32.i14.115790]
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"The article explains very well the relevance of the Boruta variables in the clinical-endoscopic model for AIG-associated G-NETs and clearly highlights its strengths and limitations. The text structure is good, and the logical presentation of information facilitates the understanding of the process and the mechanisms involved.
In addition, the text is grammatically correct, managing to present new perspectives on how feature selection and the integration of clinical and endoscopic biomarkers can contribute to risk stratification and personalized management of patients with AIG. This approach makes a clear contribution to the specialized literature, opening avenues for future research and practical application of predictive models.
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Yu QQ. Risk stratification of gastric neuroendocrine tumors in autoimmune gastritis: Evaluating the clinical value of an integrated clinical-endoscopic model. World J Gastroenterol 2026; 32(13): 115440 [DOI: 10.3748/wjg.v32.i13.115440]
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"This is a well-written and presented a rare case report on Splenic tuberculous mass following anti-tuberculosis therapy was misdiagnosed as a splenic tumor.
Careful questioning of a patient's medical history is crucial for avoiding misdiagnosis and inappropriate treatment.
In this case, the failure to carefully question the patient's medical history at the outset is a deficiency.
I think that this manuscript is suitable and worth to be published in World Journal of Gastrointestinal Surgery.
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Li ZK, Zhang K, Zhang HL, Lv XL, Guo JQ, Tan W. Splenic tuberculous mass following anti-tuberculosis therapy was misdiagnosed as a splenic tumor: A case report. World J Gastrointest Surg 2026; 18(3): 115137 [DOI: 10.4240/wjgs.v18.i3.115137]
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"
The article meets basic ethical standards with reported approval, though fuller disclosure of consent procedures would enhance transparency. The methodology is appropriate and largely reproducible, but lacks some detail on controls and implementation, limiting full replication. Results are logically presented and consistent with the study design, providing partial support for the hypothesis, though broader generalizability is constrained. Figures and tables are relevant but occasionally insufficiently annotated, reducing clarity. Biostatistical analysis is acceptable, yet could be strengthened through more comprehensive reporting of effect sizes and confidence intervals. References are generally current and relevant, although inclusion of additional recent key studies would improve scholarly depth. The language is clear and mostly concise, with minor grammatical issues. Key limitations include a relatively small and possibly non-representative sample, potential bias, and inadequate discussion of confounding factors, all of which may affect the strength and applicability of the conclusions.
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Chen X, Zhang LL, Zhou Y, Dong DX, Qian XY. Mitochondrial autophagy in diabetes-related cognitive decline and skin ulcers: Mechanistic insights and therapeutic implications. World J Diabetes 2026; 17(3): 112177 [DOI: 10.4239/wjd.v17.i3.112177]
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"This is a single-center, double-blind, randomized, placebo-controlled trial that enrolled a sufficient number of patients who met the Rome IV diagnostic criteria for FD. Patients were randomized to receive LPZ (30 mg once daily) in combination with FM (flupenthixol 0.5 mg + melitracen 10 mg) or a matching placebo for 2 weeks, followed by a 4-week follow-up. At week 2, the clinical response rate was higher in the LPZ + FM group than in the placebo group. The LPZ + FM group showed greater reductions in PDS, SF-NDI, PHQ-9, Generalized Anxiety Disorders-7, and Pittsburgh Sleep Quality Index scores, with improvements maintained throughout the follow-up.
The first comment concerns the usefulness of such studies. These studies are very useful in daily clinical practice precisely because of the magnitude of the problem worldwide.
The second comment concerns the study design. In my opinion, another pure group could be included that would receive only the FM combination. The results could separate the percentage contribution of each regimen to the final clinical outcome.
In any case, as the authors note, multicenter studies are required to demonstrate the effectiveness of a combination of pharmaceutical agents for the treatment of this frequent and condition with significant functional consequences."
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Wang XY, Yin KH, Cheng L, Wang XY, Qiao Y, Tang XR, Wang B, Yan XJ, Chen SL. Efficacy and safety of lansoprazole combined with flupentixol-melitracen for functional dyspepsia: A randomized, double-blinded, placebo-controlled clinical trial. World J Gastroenterol 2026; 32(13): 117115 [DOI: 10.3748/wjg.v32.i13.117115]
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"This is a compelling topic with significant clinical relevance.
The development of this system stems from a key gap: while guidelines for several incidental findings already exist, consistent and integrated recommendations within radiology reports are lacking.
The objectives of this proposal were clearly presented and well defined. The aims were to standardize terminology and decision-making for incidental findings while ensuring a transparent and reproducible link between the findings and their corresponding recommendations. Furthermore, the Incidental-Reporting and Data System (I-RADS) seeks to facilitate data collection and establish an infrastructure for artificial intelligence algorithms to learn from clearly labeled, standardized datasets—enabling machine learning, registries, and big-data research in ways that current fragmented guidelines cannot. Additionally, I-RADS can be integrated into structured reporting platforms, thereby streamlining the diagnostic workflow.
I-RADS is not intended to replace existing guidance on incidental findings, such as the ACR recommendations, but rather to complement and consolidate them into a single, simplified cross-sectional system.
The proposed I-RADS system features a conceptual framework designed to provide a unified and simplified approach to the classification and communication of incidental findings across imaging modalities and anatomical regions.
The reviewer acknowledged that the proposal for the Incidental-Reporting and Data System represents an innovative effort with positive implications. However, unlike other systems, I-RADS must account for a wide range of miscellaneous conditions—such as aortic dissection, occult or chronic splenic rupture, thrombus in the left atrium or main pulmonary artery, retained foreign bodies, and displacement of iatrogenic grafts—which, while not malignant, are life-threatening or hazardous. These should be carefully considered. The methodology for the development of I-RADS requires revision, and the efficacy of the system needs to be validated."
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Arkoudis NA, Moschovaki-Zeiger O, Koutserimpas C, Lama N, Velonakis G, Filippiadis D, Spiliopoulos S, Kelekis N. Proposing Incidental-Reporting and Data System: A classification system for incidental findings in radiology. World J Radiol 2026; 18(3): 119025 [PMID: 41937992 DOI: 10.4329/wjr.v18.i3.119025]
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"TIPS is good procedure for esophageal varix. This procedure is portal vein -hepatic vein shunt.
TIPS decrease portal pressure and causes highout for heart. Some patient after TIPS suffer from Eck and heart failure. Please comment about the diameter of TIPS and preoperative heart. What kinds of parameter for heart is suitable parameter for heart failure after TIPs?
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Zhang TQ, Zhang L, Yong X, Tian C, Chen BJ, Qin JP, Mu D, Tang SH. Transjugular intrahepatic portosystemic shunt for variceal bleeding due to hereditary hemorrhagic telangiectasia with cirrhosis: A case report. World J Gastroenterol 2026; 32(12): 119002 [DOI: 10.3748/wjg.v32.i12.119002]
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" The manuscript is written well. Its structure is appropriate for this type of article. Ethical approval form meets the requirements. Methods are appropriate and effective. Results are appropriate of methods and are authentic. Tables and biostatistics data are perfect. The references are adequate of topic. Language of article is satisfied"
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Siyal M, Tahseen MU, Asim M, Niaz TS, Zakaria N, Leghari A, Niaz SK. Slipped and caught in the cecum: Endoscopic retrieval of a migrated foley feeding jejunostomy tube: A case report. World J Clin Cases 2026; 14(8): 118316 [DOI: 10.12998/wjcc.v14.i8.118316]
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40
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"Researchers have concluded that elastography can provide an objective assessment of esophageal varices and may serve as a non-invasive screening tool for diagnosis and treatment indication. While abdominal ultrasound follow-up is recommended for patients with chronic liver disease, ultrasound elastography may allow for more appropriate screening of patients requiring esophageal varices via endoscopy. This is expected to reduce the need for upper gastrointestinal endoscopy, which is an uncomfortable procedure for patients, and enable more efficient medical care. Further large-scale prospective studies are needed to further validate the usefulness of this non-invasive assessment "
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Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, Ramírez-Mejía MM, Qi XS, Poo JL, Méndez-Sánchez N. Toward noninvasive prediction of treatment outcomes in patients with variceal bleeding. World J Gastroenterol 2026; 32(11): 115723 [DOI: 10.3748/wjg.v32.i11.115723]
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"It has long been established that respiratory and digestive diseases coexist in a proportion of patients. This coexistence shares significant pathogenetic mechanisms, including microbial, immunological, and metabolic pathways. The combined clinical manifestations of two different systems often require complex therapeutic interventions.
Thus, in recent years, the lung-gut axis has emerged as equally important, underscoring the complex bidirectional regulatory network between gastrointestinal and respiratory diseases. The clinical coexistence of digestive and respiratory system diseases in the same patient poses both diagnostic and therapeutic challenges, and their management should be rational and effective, aiming to reduce the risk of worsening the underlying diseases.
The treatment of these coexisting pathological conditions requires a deep knowledge of their pathophysiology and significant experience in treating them. The need for cooperation between the gastroenterologist and the pulmonologist for the most rational treatment of patients is self-evident. This cooperation for the treatment of combined digestive diseases with diseases of other systems, in my opinion, will be increasingly required in the coming years, as the common pathogenetic mechanisms are clarified and the therapeutic quiver is enriched with new pharmaceutical agents."
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Huang HJ, Liu PP, Dong DF. Research progress on comorbidity between gastrointestinal and pulmonary diseases from the perspective of the gut-lung axis. World J Gastroenterol 2026; 32(11): 115846 [DOI: 10.3748/wjg.v32.i11.115846]
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"Review summary and Recommendations
1. Clinical Context:
Walled-off pancreatic necrosis (WON) is heterogeneous in clinical course. While some patients resolve with transmural drainage alone, others deteriorate and require direct endoscopic necrosectomy (DEN). Chronological criteria, such as the 4-week cutoff in the revised Atlanta classification, do not reliably predict clinical trajectory.
2. Key Findings:
o Persistent sepsis, systemic inflammatory response syndrome (SIRS), hypoalbuminemia, anemia, extensive necrosis (>30–40%), and unfavorable anatomical patterns predict drainage failure and DEN requirement.
o Lone et al’s predictive model (AUC 0.892) demonstrates strong discriminative ability, supporting early identification of patients unlikely to respond to drainage alone.
o The concept of “passive drainage failure” captures patients at high risk, characterized by large solid debris, compartmentalized collections, and persistent systemic inflammation.
3. Step-Up vs Upfront DEN:
o Timing should not be guided solely by predefined intervals but by individualized risk assessment.
o Step-up strategies minimize unnecessary interventions but may delay care in high-risk patients.
o Upfront DEN can prevent deterioration in selected patients but carries higher procedural risk if overused.
o Guidelines support necrosectomy in cases of persistent sepsis, cavity compartmentalization, or failure of cavity collapse despite adequate drainage.
4. Safety Considerations:
o DEN is effective but carries 15–30% complication rates, including bleeding, perforation, stent occlusion, and infection exacerbation.
o Deferring DEN in patients with ongoing infection or high necrotic burden may worsen outcomes and complicate later intervention.
o Risk stratification is essential to balance procedural risk against the risk of inaction.
5. Future Directions:
o Integration of multivariate risk models, incorporating clinical, biochemical, and imaging variables, may individualize timing decisions.
o AI and machine learning could enhance predictive accuracy, using longitudinal data and quantitative necrosis assessment.
o The paradigm shift is toward intervention guided by patient-specific risk rather than temporal thresholds.
Recommendations
1. Clinical Practice:
o Implement early risk stratification in all WON cases to identify patients at high risk of drainage failure.
o Reserve step-up strategies for low-to-moderate risk patients and consider early DEN for high-risk phenotypes.
o Monitor clinical, laboratory, and imaging markers closely to guide escalation decisions.
2. Research:
o Validate predictive models like Lone et al’s across larger, multi-center cohorts.
o Investigate AI-driven, real-time risk scoring systems integrating necrosis quantification and host response metrics.
o Explore the interplay of nutritional status, necrosis morphology, and systemic inflammation as modifiers of intervention timing.
3. Guideline Implications:
o Guidelines should emphasize risk-based rather than time-based criteria for DEN.
o Step-up and upfront strategies should be framed as complementary, with risk stratification as the central decision-making tool.
Bottom Line:
Timing of DEN should transition from protocol-driven intervals to personalized, risk-guided decisions. Intervention becomes appropriate when waiting poses greater risk than acting.
"
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Singeap AM, Chiriac S, Minea H, Trifan A. Between step-up and upfront intervention: Risk stratification as the missing link in timing endoscopic necrosectomy. World J Gastrointest Endosc 2026; 18(3): 116865 [DOI: 10.4253/wjge.v18.i3.116865]
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"This is a high-level evaluation of a study or meta-analysis that summarizes its overall quality, reliability, strengths, limitations, and clinical relevance without going into excessive technical detail. It’s the type of assessment a clinician, journal reviewer, or guideline committee might write to quickly judge how much weight to give the study’s findings.
Overall Quality:
The meta-analysis includes 17 randomized controlled trials with 1,689 patients, representing a moderate-to-high-quality evidence base. The search strategy was comprehensive, covering multiple international and Chinese databases, which minimizes publication bias.
Strengths:
• Large, pooled sample size with randomized controlled trial design.
• Direct comparison between minimally invasive ES and standard TS.
• Evaluates both efficacy and safety, including recovery time and costs.
• Clinically relevant outcomes such as bleeding, prolapse, complications, and hospital stay.
Limitations:
• Variation in ES and TS techniques across studies may introduce heterogeneity.
• Follow-up durations were not consistently reported, limiting assessment of long-term outcomes and recurrence.
• Most studies had relatively small individual sample sizes, which may affect statistical power for less common complications.
Clinical Relevance:
• Provides strong evidence that ES is a safe, effective, and cost-efficient alternative to TS.
• Supports adoption of ES as a first line minimally invasive option for internal hemorrhoid treatment, especially for patients seeking faster recovery.
Conclusion:
The meta-analysis is methodologically sound and clinically meaningful. While some heterogeneity exists, the findings are consistent and indicate that ES offers meaningful advantages over TS in terms of safety, recovery, and cost. Further large-scale, multicenter studies with standardized protocols would strengthen the evidence base.
"
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Wu SY, Chen YS, Li XH, Yu TJ, Xie F, Jiang QF, Lan Y, He P, Li SC, Li WS, Chen WD. Efficacy and safety of endoscopic sclerotherapy vs traditional surgery in the treatment of internal hemorrhoids: A meta-analysis. World J Gastrointest Endosc 2026; 18(3): 116697 [DOI: 10.4253/wjge.v18.i3.116697]
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"Summary: This study presents an exploratory analysis of bilateral upper limb sEMG activity in an experienced endoscopist during simulated colonoscopy, focusing on different bowel loop configurations. Key findings include:
• Muscle activation and fatigue: Complex loops significantly increase muscle load and fatigue, particularly in the left extensor digitorum and stabilizing muscles like the left flexor carpi radialis and right middle deltoid.
• Bilateral asymmetry: The left arm consistently sustains high activation, while the right arm shows task-specific activation, suggesting differential biomechanical demands for gross stabilization versus fine manipulation.
• Correlation with procedure duration: Longer insertion times are associated with more rapid fatigue in stabilizer muscles.
• Implications: These results objectively demonstrate increased biomechanical demand during challenging colonoscopy maneuvers, supporting the need for ergonomic interventions, workload management, and device design optimization.
Strengths:
• Comprehensive sEMG analysis across 14 bilateral muscles with high temporal resolution (1500 Hz).
• Clear differentiation of muscle load and fatigue patterns across loop types.
• Quantitative correlation between loop complexity, insertion time, and fatigue metrics.
• Direct applicability to ergonomic and occupational health improvements in endoscopy.
Limitations:
• Single-operator study limits generalizability.
• Simulation model may not fully capture anatomical variability and real-world procedural stress.
• Small sample size; statistical power and inter-operator variability not addressed.
Recommendations:
1. Manuscript refinement: Emphasize novelty and clinical relevance, particularly the practical applications for ergonomic device design and occupational safety protocols.
2. Future research: Recommend multi-operator studies to validate muscle activation patterns across experience levels and real-world procedures.
3. Ergonomic integration: Suggest incorporating findings into colonoscopy training programs and device evaluation to reduce repetitive strain injuries.
4. Data visualization: Consider additional heatmaps or muscle activation timelines to highlight asymmetry and fatigue progression, enhancing interpretability for clinicians.
Overall Assessment:
The study provides valuable, objective biomechanical data supporting ergonomic improvements in colonoscopy. With minor clarifications and broader context regarding clinical translation, this manuscript is suitable for publication in this journal focusing on endoscopy, and also journals directing occupational health, or medical ergonomics.
"
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Wang RG, Wang YQ, Cao H. Bilateral upper limb surface electromyography analysis during single-operator colonoscopy: Implications for ergonomics and occupational health. World J Gastrointest Endosc 2026; 18(3): 116646 [DOI: 10.4253/wjge.v18.i3.116646]
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"Summary:
This retrospective cross-sectional study evaluated 801 patients with inoperable esophageal malignancies undergoing self-expandable metallic stent (SEMS) placement using the vertebral column and diaphragm as fluoroscopic landmarks. Patients ranged from 18–95 years (mean 50 ± 15), with 50.9% female. Dysphagia was the presenting symptom (mean duration 3.84 months), and squamous cell carcinoma was the predominant histology (74.16%). Tumors most commonly involved the middle third of the esophagus, and inoperability was primarily due to distant metastases (52.81%). Tracheoesophageal fistula was present in 6%, and the mean stricture length was 8.4 cm. Pre-stent dilatation was required in 17.4% of patients. SEMS lengths ranged from 8–18 cm. The landmark-based technique achieved 100% technical success without major immediate adverse events. Repeat interventions were minimal (1.87% re-stenting for tumor overgrowth; 1.37% dilatation for tumor ingrowth).
Reviewer Comments:
Strengths:
*Large patient cohort with comprehensive demographic and tumor characteristics.
*Clear demonstration of technical feasibility and safety of landmark-based SEMS placement.
*Low rates of immediate complications and repeat interventions indicate procedural reliability.
Limitations:
*Retrospective design limits causal inference and generalizability.
*Lack of comparative data with conventional SEMS placement techniques.
*No formal assessment of patient-reported outcomes (e.g., dysphagia relief scores, quality of life).
*Long-term stent patency and survival data are not reported.
Recommendations:
*Consider prospective, comparative studies to validate the landmark-based approach against standard techniques.
*Include standardized patient-centered outcomes (dysphagia scoring, nutritional status, and quality of life).
*Explore the applicability of this technique in anatomically complex or upper esophageal tumors.
*Discussion could be strengthened by addressing limitations related to stent type, tumor morphology, and fluoroscopic variability.
Overall Assessment:
The study presents a practical, reproducible technique for SEMS placement using vertebral and diaphragmatic landmarks with excellent technical success. The findings are clinically relevant, particularly for high-volume centers performing palliative esophageal stenting. Future prospective studies are warranted to assess long-term outcomes and patient-centered benefits."
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Siyal M, Asim M, Qureshi S, Ghazanfar S, Siddiqui AR, Ahmed N, Altaf A, Zakaria N, Yaseen A, Kakar F, Kadir S, Hasan MK, Niaz SK. Navigating self-expandable metallic stent placement in inoperable esophageal malignancies: A landmark-based technique using the vertebral column and diaphragm. World J Gastrointest Endosc 2026; 18(3): 116060 [DOI: 10.4253/wjge.v18.i3.116060]
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46
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"This study underscores the importance of considering systemic immune modulation in H. pylori infection, particularly in DU patients, and may inform future research on cytokine-mediated disease mechanisms and potential therapeutic strategies. Further, the study bridges gap between gastroenterology and systemic immunology, showing that H. pylori eradication can have meaningful systemic effects, which is clinically relevant for patient care, risk assessment, and possibly long-term outcomes. Furthermore, the findings suggest that H. pylori eradication confers systemic immunological benefits beyond the resolution of gastric pathology, including a distinct anti-inflammatory shift in duodenal ulcer patients. Incorporating disease-specific immune responses into clinical practice could support more personalized post-eradication monitoring and management. Future guidelines might consider systemic inflammation outcomes as an additional rationale for timely eradication, particularly in patients at risk for inflammation-related comorbidities."
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de Melo FF, Lemos FFB, Leal RAOS, Rocha GA, de Magalhães Queiroz DM. Helicobacter pylori eradication is associated with systemic anti-inflammatory shift in duodenal ulcer patients compared to those with gastritis. World J Gastrointest Endosc 2026; 18(3): 116958 [DOI: 10.4253/wjge.v18.i3.116958]
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47
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"Review Summary Report
Review Notes:
• The study addresses an important clinical question and provides practical guidance for treatment selection.
• Retrospective design and relatively small sample size, especially in the stent group, limit the strength of conclusions.
• Cost-effectiveness data are valuable but could be strengthened with more detailed breakdowns (e.g., procedural vs. post-procedural costs).
• Future prospective studies or randomized trials could validate these findings and refine patient selection criteria for SEMS use.
"
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Yuan HF, Liu P, Guo CQ, Bi YH. Comparative study of self-expandable stent placement, bougie dilation, and balloon dilation for post-inflammatory oesophageal strictures. World J Gastrointest Endosc 2026; 18(3): 117303 [DOI: 10.4253/wjge.v18.i3.117303]
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48
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"The manuscript addresses a highly relevant and timely topic in medical education. The focus on VR-based endoscopy training is well-motivated given patient safety concerns and the growing adoption of simulation-based methods. The systematic review methodology is appropriate, and the results are clearly summarized. Overall, the manuscript is of interest to readers in gastroenterology, medical education, and simulation-based training.
• Significance: Addresses a highly relevant topic in endoscopy training and patient safety; VR-based training is of growing interest.
• Strengths:
o Clear focus on multiple endoscopic procedures (EGD, colonoscopy, ERCP, EUS).
o Adherence to PRISMA 2020 guidelines is noted.
o Quantitative outcomes (odds ratios, P-values, competency scores) enhance rigor.
o Balanced conclusion emphasizes VR as an adjunct to conventional training.
• Major Points for Revision:
o Provide detailed search strategy (databases, terms, date range) and inclusion/exclusion criteria; consider adding a PRISMA flow diagram.
o Clarify study selection and screening process; report if independent reviewers were used.
o Include risk-of-bias assessment for included studies using standard tools (e.g., Cochrane RoB 2, ROBINS-I).
o Discuss heterogeneity across studies (simulator type, trainee experience, training duration) and its impact on results.
o Address clinical relevance beyond skill metrics (e.g., patient outcomes, procedural complications, skill retention).
o Standardize outcome reporting for clarity (odds ratios, mean ± SD, pass rates).
• Minor Points:
o Ensure consistent abbreviation usage (GIE vs GI endoscopy).
o Simplify complex sentences for readability.
o Include review registration information if available (e.g., PROSPERO).
• Recommendation: Minor to moderate revision; manuscript is strong but would benefit from enhanced methodological transparency and discussion of heterogeneity and clinical impact.
"
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Gadour E, Miutescu B, Nica C, Taheri E, Al Saeed Z, Raheem B, Facciorusso A, AlQahtani MS. Virtual reality training for gastrointestinal endoscopy: A systematic review of efficacy and outcomes. World J Gastrointest Endosc 2026; 18(3): 117820 [DOI: 10.4253/wjge.v18.i3.117820]
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49
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"Overall Assessment: This manuscript addresses a highly relevant and timely topic, evaluating the diagnostic performance of AI-assisted colonoscopy for real-time colorectal polyp histology. The study is well-structured, with rigorous methodology and clear presentation of results. The findings, demonstrating that AI outperforms human endoscopists—particularly in less experienced operators—are clinically important. However, several aspects require clarification and elaboration to strengthen the manuscript’s impact and reproducibility.
Major Comments: Search Strategy & Study Selection: Please provide full details of the literature search, including databases, search terms, date range, and inclusion/exclusion criteria. A PRISMA flow diagram would enhance transparency.
Quality Assessment: Include a table summarizing QUADAS-2 risk of bias assessments for all studies. Clarify how studies with high risk of bias were considered in analyses.
Heterogeneity: Substantial heterogeneity (I² = 74.3%) is reported. Consider subgroup or meta-regression analyses based on AI type, polyp characteristics, or endoscopist experience to explore sources of variability.
Statistical Analysis: Clarify whether hierarchical or bivariate models were considered, as these are often preferred in diagnostic accuracy meta-analyses.
Clinical Interpretation: Discuss the practical significance of AI’s improved accuracy, including potential impact on management decisions, optical biopsy strategies, and clinical workflows.
Limitations: Explicitly address publication bias, spectrum bias, and generalizability of AI algorithms across centers. Also, note that AI technology is rapidly evolving, which may limit applicability of current findings.
Minor Comments: Clarify the definition of “human experts” (experience, certification).
*Specify polyp types included in the analysis.
*Consider tables summarizing AI algorithms, training/validation datasets, and imaging modalities.
*Streamline some sentences for readability and consistency in terminology.
*Briefly mention future considerations such as cost-effectiveness, regulatory, and ethical implications of AI deployment.
Recommendation: The manuscript is important and of high interest, but minor to moderate revisions are required to clarify methodology, address heterogeneity, and strengthen discussion of clinical applicability and limitations."
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Curlej P, Soldera J. Artificial intelligence in predicting colorectal polyp histology: Systematic review and meta-analysis of diagnostic accuracy in real-time procedures. World J Gastrointest Endosc 2026; 18(3): 116381 [DOI: 10.4253/wjge.v18.i3.116381]
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50
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"Post-ERCP pancreatitis (PEP) is comprehensive and clearly outlined both epidemiology and pathophysiology. The discussion appropriately highlights the multifactorial nature of PEP and effectively integrates patient- and procedure-related risk factors. The emphasis on individualized risk assessment and evidence-based preventive strategies is well-placed. To further strengthen the manuscript for a critical audience, consider the following suggestions:
1. Clarify incidence ranges: You report an incidence of 3–15% in general populations and up to 40% in high-risk patients. Providing references for these ranges and defining “high-risk” explicitly (e.g., presence of multiple risk factors, prior pancreatitis, or sphincter of Oddi dysfunction) would enhance clarity.
2. Risk factor hierarchy: While multiple risk factors are listed, it may be helpful to indicate which factors carry the strongest evidence or highest odds ratios, perhaps in a table or figure. This helps readers quickly gauge clinical impact.
3. Preventive strategies: The paragraph mentions rectal NSAIDs, pancreatic stenting, hydration, and precut sphincterotomy. It could be strengthened by briefly noting the level of evidence or guideline recommendation for each (e.g., ESGE or ASGE guidelines), distinguishing strategies supported by strong randomized trials versus observational data.
4. Pharmacologic agents: The statement that agents like somatostatin, gabexate, and nafamostat have inconsistent efficacy is accurate, but citing meta-analyses or systematic reviews would make this more authoritative.
5. Emerging tools: Mentioning AI and risk prediction models is forward-looking. Consider briefly highlighting specific models that have shown promise or limitations, to give readers a sense of current clinical applicability.
6. Future directions: The call for standardization and validation is important. You might also suggest exploring combination preventive strategies and personalized approaches based on risk stratification, which would align with precision medicine trends.
Overall, the paragraph is well-structured and readable, with a clear progression from epidemiology to pathogenesis, risk factors, prevention, and future directions. Addressing the points above would enhance rigor and utility for a specialist audience.
"
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Xu PW, Xu QQ, Yu Y, Jiao Y, Liu YH, Yang L. Risk factors and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2026; 18(3): 115736 [DOI: 10.4253/wjge.v18.i3.115736]
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