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1
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"Dear Editor,
I read with great interest the editorial by Papadakos et al. on the evolving immunotherapeutic landscape in gastrointestinal stromal tumors (GISTs). The authors provide a comprehensive overview of the tumor microenvironment (TME), challenges in immunotherapy response, and emerging strategies. I would like to offer several complementary insights and suggest future directions for translational and clinical research.
1. Stratifying GISTs Through Immune Profiling:
The authors rightly emphasize the immunosuppressive TME in GISTs. Building on this, emerging evidence from proteomic and transcriptomic studies supports the existence of distinct immune clusters ranging from inflamed “hot” tumors (TLS⁺/B-cell-rich) to immune-desert “cold” phenotypes. These immune subtypes have shown clear prognostic and predictive value for checkpoint inhibitor response, with objective response rates reaching 50% in TLS-rich subgroups. Integration of spatial profiling and CXCL13 expression as biomarkers may refine patient selection for PD-1/PD-L1 blockade.
2. 2. Rationale for Combination Strategies:
While the editorial correctly notes the modest activity of ICIs in unselected patients, combinatorial approaches offer promise. For example, pegylated interferon-alpha-2b (PegIFNα2b) in conjunction with imatinib significantly enhances immune infiltration and suppresses PI3K/mTOR signaling, achieving remarkable response rates in early trials. Similarly, imatinib’s ability to reverse immunosuppression via IDO downregulation and Treg reduction provides a mechanistic rationale for synergy with ICIs, particularly in PDGFRA D842V-mutant GISTs.
3. Targeting Tumor Antigens and TME Components:
Antibody-based therapies like SR1 (anti-KIT) have demonstrated macrophage-dependent cytotoxicity even in imatinib-resistant models. This offers a novel route to bypass TKI resistance. Additionally, novel modalities such as bispecific antibodies targeting KIT or PDGFRA in conjunction with CD3⁺ T cell engagement may overcome immune exclusion in “cold” tumors.
4. Addressing IDO Inhibitor Failures:
The editorial notes the challenges with IDO1-targeted therapies. We propose that resistance may stem from spatial heterogeneity and compensatory activation of AhR and TDO2 pathways. Poly-pathway blockade, rather than IDO inhibition alone, may be essential to overcome this resistance.
5. Moving Forward: Future success in GIST immunotherapy will depend on Immune subtyping based on TLS, B cell density, and proteomic clusters (Im-I to Im-IV), Rational combination trials of TKIs + ICIs ± TME-modifying agents, Validation of biomarkers such as CXCL13, CD276, and KIT-derived neoantigens in prospective cohorts.
In conclusion, the editorial provides an excellent foundation for discourse. We advocate for multi-center, biomarker-driven clinical trials to translate these emerging insights into tailored immunotherapy regimens for GIST patients.
Sincerely,
Fen Wang
Oncology Department, Peking University Shenzhen Hospital."
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Papadakos SP, Argyrou A, Karniadakis I, Vogli S, Theocharis S. Immunotherapy in gastrointestinal stromal tumors: Current landscape and future horizons. World J Clin Oncol 2025; 16(6): 104314 [DOI: 10.5306/wjco.v16.i6.104314]
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2
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"Pulmonary fibrosis (PF), a chronic and fatal lung disease affecting millions of people worldwide, urgently needs more effective means. In this paper, the effect of cells vesicles in improving PF was verified through cell lines and rat models, and the possible pathways through which this effect was exerted were investigated. Anyway, there are still some aspects of the article that deserve further discussion. Most importantly, whether the therapeutic effect is exerted through the said signaling pathway needs to be further confirmed. In addition, the text has problems such as writing errors, suspected incompleteness of ethics, and relatively weak research significance."
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Wang LL, Ouyang MY, Yang ZE, Xing SN, Zhao S, Yu HY. Mesenchymal stem cells-derived exosomes alleviate radiation induced pulmonary fibrosis by inhibiting the protein kinase B/nuclear factor kappa B pathway. World J Stem Cells 2025; 17(6): 106488 [DOI: 10.4252/wjsc.v17.i6.106488]
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"We read with great interest the work of Abdelsamie and colleagues, who describe the characteristics of acute myocardial infarction (AMI) in young patients, including presentation, risk factors, coronary angiography findings, and management strategies.1
While AMI is predominantly observed in individuals over 45, its occurrence in younger adults has garnered increasing attention due to its distinct risk factors and long-term consequences. When it occurs, early-onset AMI is often associated with substantial morbidity, psychosocial impact, and economic burden for patients and their families.2 We commend the authors for addressing this important topic, we would like to offer several suggestions that may help to further strengthen the clarity and clinical applicability of the study.
First, the Methods section of the manuscript appears concise and would benefit from additional details to enhance reproducibility. Specifically, the Subjects subsection could provide a more comprehensive account of the exclusion criteria. While inclusion criteria are described, it remains unclear whether important conditions, such as severe cardiomyopathy, rheumatic heart disease, or malignancy, were excluded. Clarifying these aspects would strengthen the credibility and interpretability of the study findings. Additionally, more structured descriptions of Clinical data collection are warranted. It would be helpful to specify how many categories of clinical data were collected (e.g., demographic, biochemical, echocardiographic, electrocardiographic), which variables were included in each, and at what time points they were assessed (e.g., at admission, post-intervention, at discharge).
Second, while the authors correctly note that single-vessel disease predominates among young AMI patients and present the distribution of culprit vessels, the severity and characteristics of the lesions remain insufficiently detailed. Specifically, the lack of ACC/AHA lesion classification and TIMI flow grading limits the angiographic assessment. These indices are clinically relevant for guiding intervention strategy and risk stratification and would add valuable context to the findings.
Third, although the study aims to explore the presentation, risk factors, angiographic findings, and management of young AMI patients, it is noteworthy that clinical symptoms at presentation are not detailed. Given the clinical importance of symptom characterization for early recognition and diagnosis, including this information would help clinicians recognize such cases more effectively. Regarding the management domain, further elaboration on pharmacological therapy, particularly the use of beta-blockers, statins, and antiplatelet agents, would enhance the clinical relevance of the study. It also raises the question of whether young AMI patients tend to present with higher heart rates, and if so, whether adequate heart rate control was achieved during hospitalization or at discharge. As heart rate plays a crucial role in the progression and prognosis of coronary artery disease, such information would provide valuable insight into the effectiveness of secondary prevention strategies in this specific population.
Finally, we appreciate the authors’ observation that obesity, hyperlipidemia, and smoking are prominent in young AMI patients. However, to strengthen this conclusion, we encourage the authors to consider a prospective cohort study design with multivariable adjustment, which could formally assess whether these are independent risk factors for early-onset AMI. Such analysis would increase the translational value of their findings and potentially guide targeted prevention strategies in this unique population.
In conclusion, this study brings attention to a clinically important and under-explored population. We hope that the authors will consider these suggestions to further refine their methodological and clinical insights in future work.
References
1. Ahmed Hegazi Abdelsamie HOA, Ahmed Taha Abdelwahed. Acute myocardial infarction in the young: A 3-year retrospective study. World Journal of Cardiology 2025;17(6) doi: 10.4330/wjc.v17.i6.106445
2. Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016;8(12):728-34. doi: 10.4330/wjc.v8.i12.728
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Hegazi Abdelsamie A, Abdelhadi HO, Abdelwahed AT. Acute myocardial infarction in the young: A 3-year retrospective study. World J Cardiol 2025; 17(6): 106445 [PMID: 40575428 DOI: 10.4330/wjc.v17.i6.106445]
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4
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"The manuscript by Camille Kass and co-authors focuses on the issue of eating disorders following bariatric surgery that may be associated with physical and physiological changes, as well as various psychological phenomena related to the effects of the surgery and dietary modifications. Diagnosis and treatment of these disorders require appropriate categorization within disease classification systems, particularly the DSM-5. However, creating such a classification with the inclusion of new categories in the existing list or expanding the diagnostic criteria requires a requires the accumulation of a sufficiently large database. The presented article describes a case of eating disorder after bariatric surgery with a detailed description of symptoms and their dynamics in the course of complex therapy. Based on the data obtained and the results of literature analysis, the authors conclude that the observed disorder is the closest to avoidant/restrictive food intake disorder according to DSM-5. At the same time, the results of the patient's follow-up confirm the opinions expressed by other authors about the need to include body dysmorphia, and the loss of personal identity associated with severe weight loss, in the diagnostic criteria for ARFID. The presented article has some relevance for the development of a diagnostic system for eating disorders. However, it should be noted that the authors did not practically consider the possible influence of the patient's premorbid background (generalized anxiety disorder) and its interaction with the effects of bariatric surgery on the observed eating disorders. In general, it seems reasonable and interesting to conduct such an analysis using author’s own results and data from the literature. "
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Cass K, Leggett A, Gibson DG. Diagnostic dilemma of avoidant/restrictive food intake disorder after bariatric surgery: A case report and review of literature. World J Clin Cases 2025; 13(24): 106941 [DOI: 10.12998/wjcc.v13.i24.106941]
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5
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"This article is a study on the development and validation of a visceral adipose tissue (VAT)-based delta radiomics model to predict secondary loss of response to infliximab therapy in patients with Crohn’s disease. Both VAT and mesenteric adipose tissue are types of fat tissue that influence the pathogenesis and treatment outcomes in Crohn’s disease, but each has distinct characteristics. VAT refers to a broad range of adipose tissue and affects systemic inflammation and treatment outcomes. In contrast, mesenteric adipose tissue is specifically located around the intestines and is deeply involved in local inflammation and the progression of intestinal pathology. Although mesenteric adipose tissue is considered a part of VAT, its specific role in Crohn’s disease has attracted particular attention. Abnormal proliferation of mesenteric adipose tissue has been suggested to contribute to complex conditions, including intestinal fibrosis, strictures, and perforation. In the future, further investigation into the relationship between VAT and mesenteric adipose tissue is warranted."
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Li X, Song FL, He HF, Zeng SM, Feng ZC, Rong PF. Longitudinal computed tomography-based delta-radiomics of visceral adipose tissue predicts infliximab secondary loss of response in Crohn’s disease patients. World J Gastroenterol 2025; 31(21): 105895 [PMID: 40538512 DOI: 10.3748/wjg.v31.i21.105895]
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6
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"Commentary on articles published in World Journal of Gastroenterology
Reader Perspective
Prof. Zeinab Nabil Ahmed Said
Reader’s code: 02441096)
Prevalence and risk factors of Helicobacter pylori infection in Xinjiang Uygur Autonomous Region: A cross-sectional study of all age groups
Jiang Q, Liu WD, Hui WJ, Kong WJ, Feng Y, Kuerbanjiang A, Huang XL, Gao F. Prevalence and risk factors of Helicobacter pylori infection in Xinjiang Uygur Autonomous Region: A cross-sectional study of all age groups. World J Gastroenterol 2025; 31(21): 106033 [PMID: 40538506 DOI: 10.3748/wjg.v31.i21.106033]
The study is a cross sectional prevalence study to evaluate the H. pylori infection and risk factors in one of the large province in China that located in the northwest of the country with multiethnic aggregation. Such studies pave the way for policy makers for effective implementation of prevention and control strategies. The study involves 15 regions with 18951708 population. A total of 4665 people were surveyed, with questionnaire surveys and H. pylori antibody blood tests were conducted. 4361 were tested for H. pylori antibody. Social, economic factors, public health conditions, as well as dietary and living habits among different areas were evaluated to identify risk factors associated with H. pylori prevalence in different regions.
Methodology:
The reason for having blood samples in the morning on an empty stomach is not clarified. Also, the type of tested Ig must be mentioned. IgG is denoting previous exposure not current infection. Active infection is detected by urea breath tests and stool antigen tests.
Results:
It is better to say overall H pylori prevalence rather than infection.
Tables: Significant p value is better to be marked, by *for example.
Discussion:
This section is well organized and theoretical analysis of data is well presented, however, to avoid the limitation of some missing data, sensitivity analysis is better to be done.
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Zhang Y, Tang YW, Zhou J, Wei YR, Peng YT, Yan Z, Yue ZH. Electroacupuncture at ST36 ameliorates gastric dysmotility in rats with diabetic gastroparesis via the nucleus tractus solitarius-vagal axis. World J Gastroenterol 2025; 31(21): 107395 [PMID: 40538511 DOI: 10.3748/wjg.v31.i21.107395]
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7
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"Dear Editor,
Thank you for inviting me to review the manuscript entitled "Efficacy Comparison of Intravenous Proton Pump Inhibitors versus Oral Potassium-Competitive Acid Blockers Before Endoscopic Therapy for Bleeding Peptic Ulcers." Upon review, I am particularly impressed by the study's advancements and strengths in the following areas:
Focused and Clinically Relevant Topic: This study directly addresses a critical question in gastroenterological practice: optimizing the management strategy for acute upper gastrointestinal bleeding before endoscopic intervention. Comparing the widely used intravenous PPIs with the emerging oral PCABs renders the topic highly timely and of significant clinical value, providing valuable evidence to inform optimal treatment decisions.
Clinically Aligned Study Design: The authors employed a retrospective single-center design, effectively capturing the real-world scenario where physicians select medication (PPI or PCAB) based on individual patient circumstances. Such research based on real-world data yields results with greater direct relevance for guiding routine clinical practice.
Sophisticated Statistical Methodology: Recognizing the potential for confounding inherent in retrospective observational studies, the authors proactively applied Propensity Score Matching (PSM), an advanced statistical technique, to mitigate potential confounders and balance inter-group differences. This demonstrates the authors' commitment to methodological rigor and enhancing the reliability of the findings.
Focus on Core Clinical Outcomes: Selecting rebleeding rate as a primary endpoint is a key strength. This is a robust indicator directly reflecting treatment efficacy and patient safety. Focusing on this core outcome ensures the results possess clear clinical relevance and directly serve the fundamental goal of improving patient prognosis.
Introduction of an Innovative Concept: The proposed "Green Endoscopy" hypothesis – suggesting oral PCABs might reduce waste associated with intravenous drug administration – represents a highly forward-thinking and innovative perspective. This reflects the authors' attention not only to efficacy but also to the sustainability and environmental impact of medical practice, thereby broadening the dimensions of treatment strategy evaluation and opening a valuable new direction for future research.
Clear Data Presentation and Defined Core Findings: The core methodology and results sections are presented clearly, enabling readers to grasp the study's framework and principal findings. Particularly noteworthy is the preliminary indication of comparable efficacy between intravenous PPIs and oral PCABs on key observational metrics, which in itself provides valuable information for clinical practice.
Overall Readability: The manuscript is generally well-written and fluent, effectively communicating the main content and intent of the research, ensuring the efficient transmission of scientific information.
Summary:
Scientific Quality: Grade B
Language Quality: Grade B
Recommendation: Meets publication standards
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Lim NR, Chung WC. Intravenous proton pump inhibitors vs oral potassium competitive acid blockers before endoscopic treatment of bleeding peptic ulcers. World J Gastrointest Endosc 2025; 17(6): 104234 [PMID: 40547546 DOI: 10.4253/wjge.v17.i6.104234]
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8
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"The retrospective study on Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia by Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH is well conducted and written.
It very nicely describes the three techniques ESD, STER and LSW for lesions of the esophagus with excellent illustrations of all the three techniques with figures.
It paves the path for feasibility of further studies will large number of sample size. "
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Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261 [PMID: 40575341 DOI: 10.3748/wjg.v31.i23.106261]
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9
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"This paper provides a systematic review of artificial intelligence (AI) models in the diagnosis of irritable bowel syndrome (IBS), highlighting the potential of AI to improve diagnostic accuracy using complex biomarkers such as the fecal microbiome, gas chromatography, neuroimaging, and protease activity. The review comprehensively summarizes the performance of AI models across various studies, showing promising diagnostic accuracy, particularly in models using fecal microbiome analysis. The findings are clinically relevant, as AI has the potential to overcome the limitations of current symptom-based diagnostic frameworks like the Rome IV criteria, offering a more objective and precise approach to IBS diagnosis."
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Bhagavathula AS, Al Qady AM, Aldhaleei WA. Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review. World J Gastroenterol 2025; 31(23): 106836 [PMID: 40575334 DOI: 10.3748/wjg.v31.i23.106836]
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10
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"This paper provides a timely and insightful review on the application of machine learning (ML) in diagnosing and treating esophageal disorders, including conditions like GERD, esophageal cancer, and achalasia. The study highlights the potential of AI in enhancing diagnostic accuracy and personalizing treatment strategies, which could greatly improve patient outcomes in gastroenterology. The comprehensive synthesis of current literature and the focus on ML’s role in automating diagnosis and optimizing treatment are highly relevant for clinical practice. The manuscript offers significant value by showing how ML can transform the management of esophageal diseases and improve patient care."
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Liu SW, Li P, Li XQ, Wang Q, Duan JY, Chen J, Li RH, Guo YF. Recent advances in machine learning for precision diagnosis and treatment of esophageal disorders. World J Gastroenterol 2025; 31(23): 105076 [PMID: 40575335 DOI: 10.3748/wjg.v31.i23.105076]
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11
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"The article focuses on the feasibility of using Wuling powder, which modulates the precursor of brain-derived neurotrophic factor/p75 neurotrophin receptor/sortilin and brain-derived neurotrophic factor/tropomyosin receptor kinase B signaling pathways, in the treatment of ulcerative colitis complicated by depression. This problem is highlighted in the article by Wang et al, where they demonstrate that application of the traditional Chinese medicine Wuling normalizes the signaling pathways in the nervous tissue, reduces manifestations of depression and intestinal inflammation in patients with ulcerative colitis. This study is notable for an extremely promising and strategically new objective and a very impressive methodological level of research"
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Smirnova OV, Sinyakov A, Kasparov EV. Application of Wuling powder in the treatment of ulcerative colitis complicated by depression as a new therapy principle. World J Gastroenterol 2025; 31(23): 106538 [PMID: 40575332 DOI: 10.3748/wjg.v31.i23.106538]
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12
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" Gastroparesis, a diabetic complication with a worsening delay in gastric emptying (GE), responsible of further serious complications, is due to the progressive multifactorial damage of the enteric neurons. It could be discovered early by performing the antral real-time ultrasonography annually, which measures the GE of a semi-solid meal. Furthermore if “the body surface gastric mapping”, evaluating the gastric bioelectric activity, is normal, the cause of GE may be pylorospasm, to be confirmed manometrically. Subsequently, a strict control of glycemia, even with “artificial pancreas” devices, together with prokinetics intake, which counteracts the symptoms and gastric dilatation, must be done, after the correction of a possible pylorospasm."
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Bortolotti M. Gastroparesis, a diabetic complication causing further, even serious, complications: How to prevent its worsening? World J Gastroenterol 2025; 31(23): 104932 [PMID: 40575340 DOI: 10.3748/wjg.v31.i23.104932]
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13
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"This study highlights the transformative potential of artificial intelligence (AI) in irritable bowel syndrome diagnosis by leveraging complex biomarkers such as fecal microbiome composition and neuroimaging features. By systematically evaluating the performance of various AI models, it reveals both their strengths and limitations, with some achieving near-perfect accuracy. However, significant variability in study methodologies and dataset heterogeneity pose challenges to clinical implementation. The findings emphasize the need for standardized validation protocols to enhance reproducibility and real-world applicability. As AI continues to evolve, its integration into irritable bowel syndrome diagnostics could refine precision medicine approaches, offering a data-driven alternative to current symptom-based diagnostic criteria."
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Bhagavathula AS, Al Qady AM, Aldhaleei WA. Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review. World J Gastroenterol 2025; 31(23): 106836 [PMID: 40575334 DOI: 10.3748/wjg.v31.i23.106836]
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14
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"This study compares endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and laparoscopic wedge resection for submucosal tumors originating from the muscularis propria at the esophagogastric junction and cardia. Despite technical challenges, all methods demonstrated safety, practicality, and high en bloc resection rates, with laparoscopic wedge resection showing superior microscopic complete resection. Recurrence rates were comparable across methods, even for high-risk gastrointestinal stromal tumors. These findings underscore the feasibility of minimally invasive approaches for treating submucosal tumors in challenging anatomical locations, advancing diagnostic precision and treatment efficacy while minimizing patient burden."
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Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261 [PMID: 40575341 DOI: 10.3748/wjg.v31.i23.106261]
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15
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"This review synthesizes machine learning (ML) applications in esophageal disorders, emphasizing three critical advances: (1) Automated analysis of multimodal diagnostic data achieving accuracy rates of 80%-95% across different conditions; (2) Integration of deep learning with endoscopic imaging enabling real-time assistance in diagnosis and risk stratification; and (3) Development of novel non-invasive screening approaches through ML-based biomarker identification. The convergence of artificial intelligence with clinical medicine demonstrates transformative potential in addressing current diagnostic challenges and enabling precision medicine in esophageal disease management."
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Liu SW, Li P, Li XQ, Wang Q, Duan JY, Chen J, Li RH, Guo YF. Recent advances in machine learning for precision diagnosis and treatment of esophageal disorders. World J Gastroenterol 2025; 31(23): 105076 [PMID: 40575335 DOI: 10.3748/wjg.v31.i23.105076]
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16
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"This paper provides a comprehensive and timely comparison between intravenous proton pump inhibitors (PPIs) and oral potassium competitive acid blockers (PCABs) in the management of non-variceal upper gastrointestinal bleeding (NVUGIB) prior to endoscopic treatment. The study demonstrates that pre-endoscopic PCAB administration is more effective than PPI injection in reducing the need for therapeutic endoscopic interventions and minimizing re-bleeding events. Given the growing interest in optimizing acid suppression therapies, the findings are significant, suggesting that oral PCABs could offer a practical, effective alternative to intravenous PPIs, especially in emergency settings. Overall, the study contributes valuable insights into the management of bleeding peptic ulcers and has important clinical implications, especially for enhancing treatment protocols in emergency gastroenterology settings."
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Lim NR, Chung WC. Intravenous proton pump inhibitors vs oral potassium competitive acid blockers before endoscopic treatment of bleeding peptic ulcers. World J Gastrointest Endosc 2025; 17(6): 104234 [PMID: 40547546 DOI: 10.4253/wjge.v17.i6.104234]
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17
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"This paper provides valuable insights into the clinicopathologic characteristics and treatment outcomes of colorectal laterally spreading tumors (LSTs) treated with endoscopic resection techniques. The study identifies key predictive factors such as tumor size, morphology, and histological grade, which are associated with high-grade dysplasia, carcinoma, and submucosal invasion. The development of a nomogram model that incorporates these factors is a significant contribution, offering a practical tool for predicting treatment outcomes. However, the study is retrospective, and its applicability to broader clinical settings could be improved with prospective, multi-center trials. Despite this, the paper’s detailed analysis of risk factors and its proposed nomogram for predicting clinical outcomes provide valuable guidance for clinical practice and future research in the field of colorectal cancer prevention and treatment."
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Guo LH, Hu KF, Miao M, Ding Y, Zhang XJ, Ye GL. Endoscopic resection of colorectal laterally spreading tumors: Clinicopathologic characteristics and risk factors for treatment outcomes. World J Gastrointest Endosc 2025; 17(6): 106412 [PMID: 40547554 DOI: 10.4253/wjge.v17.i6.106412]
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18
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"This paper explores the potential of artificial intelligence (AI) in reducing missed adenomas and polyps during colonoscopy, particularly in improving diagnostic accuracy for small bowel lesions. The study demonstrates that AI-assisted systems significantly increase adenoma detection rates (ADR) and reduce missed adenomas and polyps, offering a more efficient and accurate diagnostic tool for clinical practice. The manuscript clearly presents the promising applications of AI in colonoscopy and emphasizes its important role in enhancing early colorectal cancer screening. However, while the results are encouraging, there is insufficient discussion on the long-term implementation challenges and practical applications of AI in clinical settings. Overall, the paper highlights the great potential of AI in improving colonoscopy diagnostic efficiency, offering significant clinical value."
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Wang SY, Gao JC, Wu SD. Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy: A systematic review and meta-analysis. World J Gastroenterol 2025; 31(21): 105753 [PMID: 40538513 DOI: 10.3748/wjg.v31.i21.105753]
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19
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"This paper explores the application of deep learning models, including DenseNet121, ResNet50, VGG16, and Vision Transformer, for classifying pediatric video capsule endoscopy (VCE) images, aiming to improve diagnostic efficiency for pediatric gastrointestinal diseases. The study is highly relevant to clinical needs, particularly in enhancing diagnostic accuracy and reducing manual review time. The results show that the deep learning models used performed excellently in classifying various lesions, such as normal mucosa, ulcers, and polyps. However, the novelty of the study is somewhat limited, as it mainly applies existing deep learning architectures without providing new methods. The discussion on clinical applications is also brief, lacking in-depth analysis of the model's applicability, limitations, and challenges in real-world clinical settings. Overall, the paper offers valuable insights into the automated diagnosis of pediatric gastrointestinal diseases, but it would benefit from more original data and a deeper exploration of clinical applications."
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Huang YH, Lin Q, Jin XY, Chou CY, Wei JJ, Xing J, Guo HM, Liu ZF, Lu Y. Classification of pediatric video capsule endoscopy images for small bowel abnormalities using deep learning models. World J Gastroenterol 2025; 31(21): 107601 [PMID: 40538507 DOI: 10.3748/wjg.v31.i21.107601]
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20
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"This article makes a valuable contribution to the field in several ways.
It addresses an important knowledge gap, as you noted, regarding risk features associated with high-grade PHB-NETs.
Figures are clear and informative, risk factors are well defined, and the methodology is rigorous, going beyond descriptive statistics to include appropriate statistical analyses.
The inclusion of Ki-67 and mitotic rate is also of particular interest, as it allows for a clear classification of NETs into different grade categories.
Of course, as a retrospective single-center study, the work has inherent limitations. For future research, a larger, multi-center study including follow-up and survival data would greatly enhance the strength and clinical applicability of your findings.
Overall, I consider this a meaningful contribution to the field of endoscopy.
Congratulations on this work."
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Tasneem AA, Luck NH, Mubarak M. Pancreato-hepatobiliary neuroendocrine tumors diagnosed through endoscopic ultrasound: Clinical characteristics and factors associated with high-grade lesions. World J Gastrointest Endosc 2025; 17(6): 105904 [PMID: 40547556 DOI: 10.4253/wjge.v17.i6.105904]
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21
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"I commend the authors for presenting a comprehensive and clinically insightful narrative review on the pathophysiology and management of crush syndrome. The review effectively integrates classical understanding with emerging concepts, such as ferroptosis and novel biomarkers (e.g., NGAL, KIM-1, and microRNAs), which reflect the evolving landscape of diagnostic and therapeutic strategies. These inclusions are particularly valuable for clinicians managing patients in high-stakes settings like disaster medicine, trauma centers, and military deployments.
From a vascular surgery perspective, the discussion on compartment syndrome and the role of fasciotomy is well-aligned with surgical principles. However, I would encourage the authors to elaborate further on vascular injury differentials in crush trauma and how ischemia-reperfusion damage might mimic or mask compartment syndrome in the early phase. Additionally, the indication thresholds for surgical decompression could benefit from refinement based on emerging hemodynamic monitoring techniques or tissue oximetry.
Psychiatrically, the review’s brief but important reference to post-traumatic stress disorder (PTSD) and psychosocial rehabilitation highlights the interdisciplinary nature of crush syndrome recovery. Further elaboration on structured mental health interventions—especially in survivors of mass casualty events—would be of great interest to readers from neuropsychiatric fields.
Overall, this review is a timely and important contribution, and I hope it stimulates further translational research and the development of unified clinical guidelines. I look forward to follow-up articles that explore targeted pharmacological interventions and early diagnostic tools."
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Khan S, Neradi D, Unnava N, Jain M, Tripathy SK. Pathophysiology and management of crush syndrome: A narrative review. World J Orthop 2025; 16(4): 104489 [PMID: 40290606 DOI: 10.5312/wjo.v16.i4.104489]
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22
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"This study evaluated the technical and clinical success of minor papilla cannulation, sphincterotomy, and subsequent procedures, which are highly difficult among ERCP techniques. Although relatively rare, these procedures are essential for certain patients, and the significance of this study lies in its analysis of clinical outcomes based on long-term data. If treatments using EUS or single-operator cholangioscopy are investigated in further studies, researchers will need to demonstrate superiority over the results of this study."
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Ren X, Qu YP, Xia T, Tang XF. Technical success, clinical efficacy, and safety of endoscopic minor papilla interventions for symptomatic pancreatic diseases. World J Gastroenterol 2025; 31(20): 100192 [PMID: 40495942 DOI: 10.3748/wjg.v31.i20.100192]
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23
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"Cass K et al.'s report of the first documented case of avoidant/restrictive food intake disorder (ARFID) following Roux-en-Y gastric bypass (RYGB) surgery highlights critical diagnostic gaps in post-bariatric eating pathology assessment. This instance illustrates how ARFID, marked by the avoidance of food due to fear of adverse outcomes such as nausea, can arise independently after surgery, differing from body-image-centered disorders like anorexia nervosa. The likely reason for previous underreporting is diagnostic overshadowing, where symptoms are mistakenly attributed to expected surgical side effects, and limitations in the DSM-5-TR, which excludes patients experiencing weight-loss-related body dysmorphia but not driven by fat phobia.
The patient's significant weight loss of 52.3 kg in just six months highlights the role of extreme weight suppression in inducing physiological stress, such as metabolic adaptation and hepatitis, which may exacerbate aversion to food. Additionally, voluntary vomiting, often reported by post-bariatric patients as a means of relieving discomfort rather than controlling weight, remains a challenging diagnostic issue. The current DSM-5-TR inaccurately categorizes this behavior as anorexia nervosa (AN) or bulimia, indicating a need for revised criteria for ARFID. Furthermore, body image disturbance in this population frequently stems from loose skin or identity disruption, rather than a fear of weight gain, emphasizing the importance of distinguishing this condition from AN to prevent ineffective treatments.
Prospective studies are necessary for future endeavors to ascertain the prevalence of ARFID, refine the DSM criteria to differentiate behavioral motivations (such as vomiting intent), and establish integrated multidisciplinary care models. Given the widespread increase in bariatric surgeries, it is urgent to develop surgery-specific diagnostic frameworks. Clinicians must screen for ARFID in post-bariatric patients who avoid food due to fear of aversive outcomes, regardless of any concurrent body image issues or intentional vomiting."
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Cass K, Leggett A, Gibson DG. Diagnostic dilemma of avoidant/restrictive food intake disorder after bariatric surgery: A case report and review of literature. World J Clin Cases 2025; 13(24): 106941 [DOI: 10.12998/wjcc.v13.i24.106941]
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24
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"The authors present a timely and comprehensive overview of endoscopic strategies for INP. Particularly commendable is the emphasis on procedural standardization, multidisciplinary decision-making, and the evolving role of lumen-apposing metal stents.
However, I would like to highlight one important clinical aspect that merits more attention: the influence of patient-specific immunonutritional status and comorbidities. Numerous studies, including work by Zerem et al., have shown that sarcopenia, hypoalbuminemia, and diabetes mellitus are significant predictors of poor clinical outcomes and secondary infections, even after technically successful drainage procedures. Acknowledging and integrating these patient-level risk factors into procedural decision-making could enhance the individualization of care and improve long-term outcomes.
Additionally, while the authors discuss timing and technique in detail, post-procedural follow-up protocols are only briefly addressed. Standardized imaging and biomarker-based follow-up strategies could reduce inter-center variability and help detect complications early."
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Zeng Y, Zhang JW, Yang J. Endoscopic management of infected necrotizing pancreatitis: Advancing through standardization. World J Gastroenterol 2025; 31(20): 107451 [PMID: 40495946 DOI: 10.3748/wjg.v31.i20.107451]
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25
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"I read a very interesting article "Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy: A systematic review and meta-analysis" (Meta-Analysis). The authors of the article presented a perfect analysis of the list of references in accordance with the PRISMA system. The article is devoted to the effectiveness of using artificial intelligence for recognizing colonoscopic images. The authors confirmed a higher efficiency in recognizing colon neoplasms using artificial intelligence than endoscopists."
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Wang SY, Gao JC, Wu SD. Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy: A systematic review and meta-analysis. World J Gastroenterol 2025; 31(21): 105753 [PMID: 40538513 DOI: 10.3748/wjg.v31.i21.105753]
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26
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"The authors describe the role of molecular genetic, subtypes, application of organoid and treatment options in colorectal cancer very effectively and with nicely labelled illustrations. The role of artificial intelligence in managing colorectal cancer in evolving and holds a considerable role in identifying markers and defining management in coming years. "
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Qi GX, Zhao RX, Gao C, Ma ZY, Wang S, Xu J. Recent advances and challenges in colorectal cancer: From molecular research to treatment. World J Gastroenterol 2025; 31(21): 106964 [PMID: 40538516 DOI: 10.3748/wjg.v31.i21.106964]
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27
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"The title of this article is not only novel but also accurately reflects the scope and focus of the content presented. It captures the reader’s attention while maintaining consistency with the study’s objectives and findings. Additionally, the references are cited appropriately, demonstrating thorough literature review and academic rigor throughout the manuscript.
"
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Wang WX, Dang FL, Li TT, Yu Y. Nalbuphine vs sufentanil as effective analgesics for postoperative pain management in gastric cancer resection. World J Gastrointest Pharmacol Ther 2025; 16(2): 103232 [PMID: 40575361 DOI: 10.4292/wjgpt.v16.i2.103232]
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"This article discusses the importance of perioperative nutritional support and prehabilitation in patients undergoing gastrointestinal surgery. Perioperative nutritional support includes care before, during, and after surgery. Comprehensive nutritional support programs improve immune function and wound healing, and shorten the length of hospital stay. Prehabilitation enhances the patient's condition before surgery and reduces the risk of complications. Future research needs to identify the optimal combination and amount of nutritional components. However, the paper does not specifically mention GLIM (Global Leadership Initiative on Malnutrition). Nevertheless, the importance of nutritional support throughout the document, as well as the evaluation and improvement of nutritional status before and after surgery, may align with the improvement goals of GLIM. Further investigation is warranted."
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Triantafillidis JK. Perioperative nutritional support in patients undergoing gastrointestinal surgery: Current views with an emphasis on prehabilitation efforts. World J Gastrointest Surg 2025; 17(6): 101244 [DOI: 10.4240/wjgs.v17.i6.101244]
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"This study presents significant findings regarding the metabolic effects of esophagectomy with gastric conduit reconstruction, particularly in T2D patients. Although the observed remission rate is modest compared to bariatric surgery outcomes, it opens up a new avenue for exploring the potential benefits of esophagectomy on metabolic health, especially in patients with comorbid diabetes. The study provides evidence that the use of a narrow gastric tube during esophagectomy might contribute to better diabetes outcomes, offering a potential modification to surgical practice that could improve patient care and prognosis."
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Xing HJ, Hu MY, Jiang YQ, Li XH, Zhu B, Wang ZQ. Remission of type 2 diabetes one year after esophagectomy with gastric conduit reconstruction: A prospective cohort study. World J Gastrointest Surg 2025; 17(6): 105514 [DOI: 10.4240/wjgs.v17.i6.105514]
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30
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"The topic of perioperative nutritional support is highly relevant, particularly in the context of enhancing patient recovery and reducing postoperative complications. Given the increasing focus on improving surgical outcomes through preoperative interventions, this manuscript addresses a critical aspect of patient care. This paper underscores the importance of perioperative nutritional interventions and their potential to significantly improve postoperative outcomes, including reduced complications, shorter hospital stays, and faster recovery. Given the high rates of malnutrition and postoperative complications in gastrointestinal surgery patients, this review is highly significant for improving clinical practice. While the article touches on prehabilitation, the section could delve deeper into the specific methods of implementation and the practical challenges faced in clinical settings. A more detailed discussion of how to integrate prehabilitation into routine clinical practice, especially in less resource-rich environments, would add value for practitioners looking to apply these strategies."
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Triantafillidis JK. Perioperative nutritional support in patients undergoing gastrointestinal surgery: Current views with an emphasis on prehabilitation efforts. World J Gastrointest Surg 2025; 17(6): 101244 [DOI: 10.4240/wjgs.v17.i6.101244]
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31
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"This review article is a really helpful and up-to-date look at how PET/CT scans using FDG are used for bile duct cancer (BTC). The authors do a great job pulling together the latest research, especially focusing on the past three years. They carefully examine how well PET/CT works for the different types of BTC – like cancers inside the liver (ICC), near the liver's exit (PCC), further down the bile duct (DCC), and gallbladder cancer (GBC). This breakdown is important because each type behaves differently.
A key point the review makes is comparing PET/CT to standard scans like CT or MRI. PET/CT is generally better at finding cancer spread to lymph nodes, even if they aren't enlarged, and at spotting distant cancer spread elsewhere in the body. This can be crucial for planning treatment and avoiding unnecessary surgeries. However, the review honestly points out that PET/CT isn't perfect. It can sometimes miss smaller bile duct cancers (especially PCC) or cancers that produce a lot of mucus. It can also give "false alarms" due to inflammation, infection, or the presence of stents.
The article highlights a significant shift happening: moving beyond just looking at the pictures to actually measuring things from the scan. Measurements like how "hot" the cancer appears (SUVmax) or the total amount of active cancer (MTV, TLG) can help doctors predict how aggressive the cancer might be and how long patients might live. Even more exciting is brand new research showing these PET/CT measurements might give clues about the cancer's genetics (like KRAS mutations in ICC) without needing a new biopsy. The review also covers advanced computer analysis of the scans (radiomics and AI), which shows promise in predicting things like how likely the cancer is to invade blood vessels or come back after surgery, especially for ICC.
The authors also touch on the potential of combining PET with MRI (PET/MRI). This newer technology might offer better pictures of the soft tissues around the bile ducts and gallbladder, which could be useful for seeing exactly where the cancer is locally or if it has come back. However, more studies are needed, particularly for gallbladder cancer.
Overall, this is a very valuable summary. It clearly explains where PET/CT is most useful right now for BTC patients – mainly in accurate staging to find hidden spread and guide treatment choices. It also effectively shows where the field is heading: using the scan data more precisely to understand the cancer's biology and predict outcomes, paving the way for more personalized care. The balanced view of both the strengths and weaknesses of PET/CT makes this review practical for doctors and informative for researchers looking at the future of imaging for these difficult cancers.
"
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Yin JX, Fan X, Chen QL, Chen J, He J. Progress in the application of fludeoxyglucose positron emission tomography computed tomography in biliary tract cancer. World J Hepatol 2025; 17(5): 105446 [PMID: 40501462 DOI: 10.4254/wjh.v17.i5.105446]
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32
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"This bibliometric study systematically examines artificial intelligence applications in hepatobiliary surgery from 2014-2024, offering a quantitative perspective on this evolving field. The research effectively maps global publication patterns, collaborative networks, and research priorities. The title accurately defines the scope, while the abstract concisely summarizes objectives, methodology, and key findings. Keywords demonstrate appropriate thematic alignment, and the background section adequately contextualizes AI's integration into hepatobiliary practice, noting its clinical relevance for diagnostic and therapeutic applications.
Methodologically, the study employs Web of Science data with visualization tools (CiteSpace/VOSviewer) to analyze authorship, institutional contributions, national productivity, and keyword evolution. However, the search strategy shows limitations through its predominant focus on "CNN" (Convolutional Neural Networks), overlooking emerging architectures like Transformer models that are gaining prominence in medical AI research. Results clearly demonstrate China's leadership in publication volume alongside the United States' influence in citation impact, with network visualizations effectively illustrating these geographical patterns. The discussion reasonably outlines AI's role in imaging diagnostics and tumor segmentation, though greater analytical depth regarding clinical implementation challenges - such as model validation requirements and integration with surgical workflows - would strengthen its practical relevance.
Presentation issues require attention as Figure 3 suffers from resolution limitations affecting text legibility, while Figures 10-11 contain non-essential graphical elements that reduce interpretive clarity. Strategic labeling could enhance data communication in these visualizations. Statistical approaches are appropriately applied for bibliometric analysis, and referenced literature shows generally authoritative coverage. Minor language issues exist, including inconsistent quotation usage in the abstract (e.g., "classification", "CT and "diagnosis") and occasional terminology variations, though these do not substantially hinder comprehension.
Collectively, this work provides a structured, data-informed overview of AI research in hepatobiliary surgery during the specified decade. It documents the field's development trajectory, identifies primary research themes and key contributors, and establishes baseline patterns of international collaboration. The analysis offers researchers a useful reference point for understanding current research landscapes and potential partnership opportunities. With refinements addressing methodological scope, analytical depth, and visual presentation, the study could serve as a more comprehensive benchmark for future investigations in this domain.
"
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Zheng RJ, Li DL, Lin HM, Wang JF, Luo YM, Tang Y, Li F, Hu Y, Su S. Bibliometrics of artificial intelligence applications in hepatobiliary surgery from 2014 to 2024. World J Gastrointest Surg 2025; 17(5): 104728 [PMID: 40502490 DOI: 10.4240/wjgs.v17.i5.104728]
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33
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"The he article is well-written, and the research methodology is scientifically rigorous. The article holds significant scientific value and clinical relevance in the research of stem cell therapies for retinal pigment epithelium (RPE) cells. I hope the authors will address the current challenges in future studies, advancing the application of stem cell therapies in the treatment of RPE-related diseases. Thank you once again for your outstanding contributions to this field."
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Sorrentino FS, Parmeggiani F, Gardini L, Fontana L, Musa M, Gagliano C, Zeppieri M. Stem cell therapy for retinal pigment epithelium disorders. World J Stem Cells 2025; 17(5): 103100 [PMID: 40503367 DOI: 10.4252/wjsc.v17.i5.103100]
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"Title: A Critical Appraisal of Dissociative Psychosis and Dissociative Schizophrenia as Distinct Entities
Body:
Having reviewed the article titled "Are dissociative psychosis and dissociative schizophrenia reality?" by H. Belli, I am compelled to offer a commentary that reflects on the conceptualization and clinical significance of these conditions. The article presents a comprehensive analysis of dissociative phenomena within the context of psychotic disorders, challenging readers to reconsider the boundaries between dissociative and schizophrenic experiences.
Belli's work prompts a reevaluation of the diagnostic criteria and the potential overlap between dissociative symptoms and schizophrenia. The discussion on the role of childhood trauma as a precipitating factor for dissociative experiences that may manifest as psychotic symptoms is particularly noteworthy. It suggests a bio-psycho-social model that could enhance our understanding of the etiology and comorbidity of these disorders.
The article also underscores the importance of psychometric testing in identifying dissociative features in individuals with psychotic disorders. This approach could potentially lead to more personalized and effective treatment strategies, emphasizing the need for a trauma-informed care framework.
In conclusion, Belli's article contributes to a growing body of research that questions the traditional dichotomy between dissociative and psychotic disorders. It advocates for a more integrated view that recognizes the complexity of mental health conditions and the impact of early life experiences on later psychiatric outcomes. I look forward to future studies that build on these insights and further explore the implications for clinical practice and mental health policy.
Reviewer: Lu Hou"
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Belli H. Are dissociative psychosis and dissociative schizophrenia reality? World J Psychiatry 2025; 15(4): 102008 [PMID: 40309595 DOI: 10.5498/wjp.v15.i4.102008]
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35
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"This study by Wang et al. presents a compelling advancement in the noninvasive prediction of variceal bleeding risk in Budd-Chiari syndrome (BCS) patients using a combined radiomics and clinical model (R+C model). The integration of high-dimensional radiomics features with clinical parameters to stratify bleeding risk is both innovative and clinically relevant. The authors should be commended for conducting a multicenter study with an external validation cohort, which strengthens the generalizability of their findings.
Strengths of the Study:
Innovative Use of Radiomics: The application of radiomics in BCS—a relatively rare and under-studied condition—represents a novel contribution. The extraction of hepatic and splenic texture features from CT images enhances the predictive capability beyond conventional clinical models.
Robust Methodology: The use of LASSO Cox regression for feature selection and validation of the model using an external cohort adds credibility. The model’s performance metrics, such as the C-index (0.906 for training and 0.859 for validation), demonstrate excellent discriminative ability.
Clinical Utility: The development of an accessible online tool for individualized risk prediction (https://bcsvh.shinyapps.io/BCS_Variceal_Bleeding_Risk_Tool/) is a practical step towards clinical translation, potentially aiding in decision-making for prophylactic interventions.
Risk Stratification: The ability to categorize patients into low-, medium-, and high-risk groups offers a framework for personalized management strategies, which could reduce unnecessary interventions in low-risk patients and prioritize high-risk individuals for aggressive preventive therapies.
Limitations and Areas for Improvement:
Retrospective Design: As with all retrospective studies, the potential for selection bias and unmeasured confounding exists. Prospective validation in diverse populations, including Western cohorts where thrombophilic etiologies of BCS predominate, is necessary.
Limited Radiomics Scope: The use of single-slice regions of interest (ROIs) for liver and spleen may not capture the full heterogeneity of these organs. A volumetric or multi-slice approach could improve robustness.
Generalizability: The study population is entirely Chinese, with BCS cases predominantly due to membranous obstruction—an etiology not common in other geographic regions. Thus, external validation in populations with differing BCS etiologies is crucial.
Anticoagulation Risk Interpretation: While anticoagulation was found to be an independent risk factor for bleeding, the model does not differentiate between anticoagulant types or dosing strategies. Given the importance of anticoagulation in BCS, further work is needed to clarify safe therapeutic windows.
Manual Segmentation: The reliance on manual ROI delineation is resource-intensive and may limit scalability. Incorporating semi-automated or AI-driven segmentation could enhance reproducibility and feasibility in routine clinical settings"
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Wang ZD, Nan HJ, Li SX, Li LH, Liu ZC, Guo HH, Li L, Liu SY, Li H, Bai YL, Dang XW. Development and validation of a radiomics-based prediction model for variceal bleeding in patients with Budd-Chiari syndrome-related gastroesophageal varices. World J Gastroenterol 2025; 31(19): 104563 [PMID: 40497088 DOI: 10.3748/wjg.v31.i19.104563]
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36
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"I read a very interesting manuscript. The authors propose to use Hericium erinaceus to regress gastric mucosal atrophy. The authors present convincing evidence of the effectiveness of this medicine. Prevention of gastric cancer has several successive stages of implementation (detection of precancerous diseases and precancerous changes in the gastric mucosa, implementation of screening, diagnostics, verification of diagnosis by morphological methods and treatment). Preventive treatment of precancerous lesions has a very limited number of means and methods. I believe that it is necessary to continue studying and using Hericium erinaceus. Perhaps Hericium erinaceus will be an effective drug for the prevention of gastric cancer."
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Pellegrino R, Gravina AG. Potential of traditional Chinese medicine in gastrointestinal disorders: Hericium erinaceus in chronic atrophic gastritis. World J Gastroenterol 2025; 31(20): 106615 [PMID: 40495939 DOI: 10.3748/wjg.v31.i20.106615]
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37
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"This paper systematically analyzes the etiology of the two major subtypes of inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis. It is highly comprehensive and commendable. It examines the etiology broadly, focusing on immune responses and considering genetic changes, gut microbiota, and social and environmental factors. On the other hand, further discussion is needed regarding how concretely these theoretical insights into etiology are linked to the development of therapeutic approaches. Additionally, genetic factors and changes in gut microbiota can vary by region, making universal evaluation difficult.
"
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Yang QH, Zhang CN. Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis. World J Gastroenterol 2025; 31(19): 106406 [PMID: 40497094 DOI: 10.3748/wjg.v31.i19.106406]
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38
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"This minireview article provides a systematic comparison of the pathogenic mechanisms of Crohn’s disease and ulcerative colitis. It outlines six shared mechanisms—including immune dysregulation, genetics, microbiota imbalance, and infections—and identifies 14 key differences between the two diseases. The article is well-structured, comprehensive in scope, and supported by clear diagrams, offering strong academic value and clinical relevance. While its originality and depth of mechanistic insight could be further improved and the discussion on clinical translation is somewhat limited, it remains a well-organized and information-rich review suitable for researchers and clinicians alike."
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Yang QH, Zhang CN. Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis. World J Gastroenterol 2025; 31(19): 106406 [PMID: 40497094 DOI: 10.3748/wjg.v31.i19.106406]
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39
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"This article explores the role of the "obesity paradox" in immunotherapy for hepatocellular carcinoma (HCC), suggesting that obese patients may experience better survival outcomes when treated with immune checkpoint inhibitors such as lenvatinib and camrelizumab. Based on recent clinical findings, the authors discuss leptin-mediated immune modulation as a possible mechanism, noting that obesity may enhance the efficacy of anti-PD-1 therapies but potentially reduce the effectiveness of anti-VEGF treatments. While the topic is novel and clinically relevant, the current evidence remains limited and the mechanistic explanation could be more detailed. Overall, the article provides a valuable perspective on the dual role of obesity in HCC immunotherapy and highlights the need for further research in this area."
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Sierra L, Abu-Hammour MN, Chatterjee A, Simons-Linares CR. Obesity paradox role in the immunosuppressive treatment of hepatocellular carcinoma. World J Gastroenterol 2025; 31(19): 105617 [PMID: 40497086 DOI: 10.3748/wjg.v31.i19.105617]
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40
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"Reader′s comments:
We are delighted to read the interesting article by Hu et al entitled: "Pescadillo ribosomal biogenesis factor 1 and programmed death-ligand 1 in gastric and head and neck squamous cell carcinoma"it is an interesting study, but we have some comments:
In section of patients selection: exclusion criteria: it is not clear what was meant by pathological condition?????
I think it is better to represent demographic , clinical data of enrolled patients.
Result section: it is better to clear if difference between positive and negative patients is significant or not.
What about expression of the studied markers in adjacent non tumor tissues????????
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Hu XN, Li CF, Huang SM, Nie CL, Pang R. Pescadillo ribosomal biogenesis factor 1 and programmed death-ligand 1 in gastric and head and neck squamous cell carcinoma. World J Gastroenterol 2025; 31(19): 106644 [PMID: 40497089 DOI: 10.3748/wjg.v31.i19.106644]
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41
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"Shukla et al.'s comprehensive review on remnant pancreatic carcinoma (RPC) brings much-needed attention to a rare but clinically formidable entity increasingly recognized in the era of improved surgical outcomes and long-term survival following partial pancreatectomy. Their work, titled "Remnant Pancreatic Carcinoma: The Current Status", outlines the epidemiology, risk factors, surveillance strategies, and therapeutic challenges of RPC, providing a valuable clinical framework for a condition historically relegated to case reports and small series.
The authors astutely emphasize the evolving landscape of RPC, shaped by the growing volume of patients undergoing distal or proximal pancreatectomy for benign or malignant lesions. The incidence of RPC is likely underestimated, given limited long-term follow-up in most cohorts. As such, the article's call for structured postoperative surveillance protocols is particularly timely. Importantly, Shukla et al. underscore that remnant pancreatic malignancies may arise de novo or as recurrences, and often present with more aggressive histological and molecular profiles, reinforcing the need for tailored risk stratification.
A notable strength of this review is its discussion on the putative mechanisms underlying RPC, including genetic predisposition, field cancerization, and chronic inflammation of the residual gland. These insights are crucial for identifying high-risk patients who may benefit from enhanced surveillance or prophylactic strategies. However, while the authors reference KRAS and TP53 mutations, a more extensive exploration of genomic drivers and their potential as surveillance biomarkers would have added translational depth.
Surgically, re-resection remains the mainstay of curative intent in selected patients with adequate functional reserve. The article appropriately highlights the technical and oncological complexities of completion pancreatectomy. Nonetheless, future perspectives might benefit from the integration of evolving minimally invasive approaches and neoadjuvant strategies tailored to RPC biology.
One of the article’s understated yet significant contributions is its implication that RPC represents a failure of current surveillance paradigms. Given the shift towards parenchyma-sparing resections and increased survivorship, integrating longitudinal imaging and biomarker monitoring—such as circulating tumor DNA (ctDNA) or CA 19-9 kinetics—may optimize early detection. Moreover, data on long-term outcomes post-remnant resection remain sparse, and prospective registries are needed to define survival benchmarks and refine selection criteria.
In conclusion, Shukla et al. succeed in framing RPC not merely as a post-surgical curiosity, but as a distinct oncological entity warranting multidisciplinary attention. Their review lays the foundation for future clinical and translational studies in a domain poised to grow in relevance. Establishing consensus on definitions, risk stratification algorithms, and surveillance protocols will be essential to improving outcomes in this uniquely challenging subset of pancreatic cancer."
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Shukla A, Kalayarasan R, Sai Krishna P, Pottakkat B. Remnant pancreatic carcinoma: The current status. World J Clin Oncol 2025; 16(5): 107039 [PMID: 40503403 DOI: 10.5306/wjco.v16.i5.107039]
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42
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"The “obesity paradox” in hepatocellular carcinoma suggests better outcomes in patients with obesity undergoing immunotherapy, potentially due to leptin-driven immune modulation and enhanced nutritional reserves. While promising, these findings have only been demonstrated with lenvatinib and camrelizumab, and have not yet been observed with more commonly used immunotherapy treatments for hepatocellular carcinoma, such as nivolumab, pembrolizumab, or bevacizumab. Although intriguing, this phenomenon remains limited by the scope of current studies"
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Sierra L, Abu-Hammour MN, Chatterjee A, Simons-Linares CR. Obesity paradox role in the immunosuppressive treatment of hepatocellular carcinoma. World J Gastroenterol 2025; 31(19): 105617 [PMID: 40497086 DOI: 10.3748/wjg.v31.i19.105617]
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"Six common and fourteen unique aspects of the pathogenesis of inflammatory bowel disease, primarily Crohn’s disease and ulcerative colitis, illustrate the causes and beneficial factors of resistance to inflammatory bowel disease, providing critical insights for the targeted treatment of Crohn’s disease and ulcerative colitis. Utilizing the main contents of this paper allows for the development of comprehensive interventions that reduce harmful influences, enhance protective factors and use an integrative approach to address the diseases for the benefit of the human being"
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Yang QH, Zhang CN. Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis. World J Gastroenterol 2025; 31(19): 106406 [PMID: 40497094 DOI: 10.3748/wjg.v31.i19.106406]
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"The article is devoted to the problem of introducing narrative medicine into primary health care systems. This process is part of the enriching the humanistic dimensions of medical care and, in general, of a systemic approach to maintaining public health. The relevance of this problem has significantly increased recently due to the increasing role of instrumental component of the medical industry and some dehumanization associated primarily with the crisis of individualizing clinical approach and increasing standardization in the provision of medical services. It is expected that the development of narrative medicine can improve the comfort of doctor-patient interaction, provide a personalized approach with improved diagnostic efficiency and quality of treatment.
The authors analyze the main problems of the widespread introduction of narrative medicine in primary health care, namely, the strengthening of the humanitarian component in the educational programs of medical professionals, increasing the burden on the staff, the need to allocate additional funds, the peculiarities of the national health care system of China.
The article discusses possible solutions to some of these problems, such as the involvement of volunteers, application of artificial intelligence, optimization of equipment operation mode in order to save money. Feedback mechanisms, telemedicine methods, etc. are built into the implementation system proposed by the authors.
However, it seems that the proposed schemes need experimental validation, which requires the creation of interdisciplinary research groups in which doctors and humanities can interact.
Given the peculiarities of the humanitarian environment of Chinese society, it would be appropriate to include representatives of different schools of psychology and even philosophy in such groups.
In general, given the novelty of the problem and its relevance, the quality of the article is quite high.
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Lei NJ, Vaishnani DK, Shaheen M, Pisheh H, Zeng J, Ying FR, Yang QQ, Wang CY, Ma J, Pan JY, Hou NJ. Embedding narrative medicine in primary healthcare: Exploration and practice from a medical humanities perspective. World J Clin Cases 2025; 13(22): 105684 [DOI: 10.12998/wjcc.v13.i22.105684]
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45
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"The studied groups were not homogeneous by age and gender proportion. Research does not achieve the objectives of the experiment.
The results are unreliable and cannot be considered to be a meaningful contribution to research progress in this field.
Furthermore, the comorbidity was not reported: this represents a further limit that could affect the results.
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Buterin A, Vuckovic M, Spanja Prpic S, Zaharija V, Nonkovic M, Prpic T. Comparison of functional recovery of the knee following total knee arthroplasty in patients with and without ankle symptoms. World J Orthop 2025; 16(5): 106004 [PMID: 40496260 DOI: 10.5312/wjo.v16.i5.106004]
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46
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"This prospective study rightly identifies a significant problem i.e.,preoperative ankle pain might effect the early functional outcome in patients undergoing total knee arthroplasty for primary Osteoarthritis knee.It is often overlooked but the deformity at the level of knee definitely impacts the biomechanics alignment of the entire lower limb and also at the ankle. The key finding was patients exhibited significantly lower KOOS scores and extension recovery at 3 months postoperatively, even after adjusting for demographic confounders. This reiterates the necessity for a complete lower limb assessment and managing preoperatively any hip/ankle symptoms preoperatively to optimize TKA outcomes. The methodology, protocol, grouping of patients was all good.
The authors could have given a detailed radiographic alignment of the patient's lowerliimbs that were operated to substantiate the preoperative status and the results postoperatively. Even though AOFAS score, is an appropriate tool for assessing the ankle symptoms and pathologies, a detailed radiographic assessment of the ankle including ankle hind foot assessment, weight bearing alignment could have been added/ mentioned. Incorporating pre- and postoperative radiographs would have allowed the authors to better delineate whether the observed differences in KOOS and knee extension were attributable to underlying mechanical misalignment or simply symptomatic variation.
A gait analysis of the patients can also be included to add objective assessment to the data. That would tell us whether the results are an outcome of any malalignment or just symptomatic variation.
A longer followup would also suggest us whether the symptoms are resolving over time or still persisting."
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Buterin A, Vuckovic M, Spanja Prpic S, Zaharija V, Nonkovic M, Prpic T. Comparison of functional recovery of the knee following total knee arthroplasty in patients with and without ankle symptoms. World J Orthop 2025; 16(5): 106004 [PMID: 40496260 DOI: 10.5312/wjo.v16.i5.106004]
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"This study addresses the deficit of medical humanities in China’s resource-limited primary healthcare (PHC) system by systematically exploring pathways to integrate narrative medicine (NM) into grassroots care. Situated within the Healthy China 2030 policy framework, the research proposes actionable strategies for humanizing PHC through theoretical analysis and practical innovations, such as the One-Minute Patient Narrative and 11253 Family Doctor Service Model. Key contributions include: (1) revealing tensions between policy mandates and on-the-ground realities, emphasizing NM’s localization to regional disparities; (2) enhancing care efficiency via AI-mediated narrative analysis (e.g., a 25% increase in treatment adherence); and (3) offering scalable models to ensure PHC sustainability.
However, three critical gaps require further exploration. First, cultural dynamics—such as patients’ traditional deference to medical authority and healthcare commercialization—demand culturally adaptive interventions (e.g., competency training for clinicians, redefining relational medicine values). Current analyses lack actionable steps to operationalize these strategies across diverse contexts. Second, sustainability challenges—including the feasibility of urban NM models in high-demand rural settings and volunteer system stability in under-resourced areas—are underexamined. Systemic inequities (e.g., funding gaps, workforce shortages) further constrain implementation. Third, while short-term metrics like patient satisfaction are prioritized, long-term systemic issues—health equity, clinician burnout, and bureaucratic barriers to PDCA (Plan-Do-Check-Act) cycles—remain unaddressed. Future studies must adopt mixed-method evaluations to bridge these gaps and enable NM’s transition from pilot projects to systemic reform.
To further this agenda, this study presents a three-pillar framework. Firstly, by fostering interdisciplinary collaboration, we aim to integrate public health experts, community advocates, and policymakers. Together, they will devise NM interventions, such as narrative-driven public health campaigns. This approach will transform patient stories into effective social governance tools, thereby enhancing the inclusivity of medical decision-making. Secondly, we propose establishing an ethical AI governance system. This system will ensure that AI-driven narrative data processing aligns with China's data security regulations. We plan to adopt encryption technology and an informed consent mechanism to bolster privacy protections. Additionally, we will systematically mitigate technical biases through algorithm fairness audits and transparent training protocols, including the use of open dataset sources. Finally, we advocate for a global localization adaptation strategy, drawing inspiration from international practices like the Indian Asha worker model. While respecting the universal principle of patient autonomy, we intend to devise localized solutions, such as a health narrative literacy improvement project tailored for rural areas. This will facilitate the effective integration of medical humanistic values within diverse social and cultural contexts.
Ultimately, this framework aims to shift healthcare paradigms from fragmented, biomarker-centric models to holistic, humanistic systems. By empowering patients and frontline workers as NM co-designers through participatory research, localized innovations can catalyze structural reforms, ensuring medical services prioritize humanistic care over purely biomedical metrics. "
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Lei NJ, Vaishnani DK, Shaheen M, Pisheh H, Zeng J, Ying FR, Yang QQ, Wang CY, Ma J, Pan JY, Hou NJ. Embedding narrative medicine in primary healthcare: Exploration and practice from a medical humanities perspective. World J Clin Cases 2025; 13(22): 105684 [DOI: 10.12998/wjcc.v13.i22.105684]
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" Endoscopic gastroplasty treatments were significantly better in reducing total body weight, excessive weight, and average weight among obese population. No significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation. Lack of comparative, long-term follow-up and randomized studies, reporting and selection bias, high level of heterogeneity were the major limitations in the currently available meta-analyses."
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Abdulla M, Mohammed N, AlQamish J, Arau RT. Efficacy and safety of endoscopic gastroplasty for treatment of obesity: An overview of comparative meta-analyses. World J Gastrointest Endosc 2025; 17(5): 105158 [PMID: 40438714 DOI: 10.4253/wjge.v17.i5.105158]
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"This review comprehensively explores the latest advancements in gastrointestinal (GI) endoscopy, highlighting innovations in diagnostic and therapeutic techniques for GI cancers. Cutting-edge technologies such as magnification endoscopy, narrow-band imaging, endoscopic ultrasound with fine-needle biopsy, and artificial intelligence-enhanced methods are transforming cancer detection, staging, and management. Endoscopic approaches like submucosal dissection and mucosal resection are improving outcomes for premalignant and malignant lesions. These developments underscore the pivotal role of endoscopy in reducing morbidity, mortality, and healthcare costs associated with GI cancers."
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Abusuliman M, Jamali T, Zuchelli TE. Advances in gastrointestinal endoscopy: A comprehensive review of innovations in cancer diagnosis and management. World J Gastrointest Endosc 2025; 17(5): 105468 [PMID: 40438719 DOI: 10.4253/wjge.v17.i5.105468]
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"Gastric polyps (GPs) are a common clinical disease. In recent years, with the change in dietary habits, the incidence of GPs is increasing in China. GPs are usually found by gastroscopy. Some GPs may have malignant potential and are associated with hereditary diseases. Therefore, early detection and biopsy examination are important in clinical practice to better reduce the rate of cancer。It is an interesting manuscript. Authors can succeed to present their idea in a clear way adding information to the existing literature."
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Zheng L, Shi YQ, Xue T, Duan SL. Evaluating the detection rate and pathological features of polyps in patients with upper gastrointestinal endoscopy. World J Gastrointest Endosc 2025; 17(5): 105471 [PMID: 40438721 DOI: 10.4253/wjge.v17.i5.105471]
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