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1
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"The article provides a comprehensive review of the interplay between endocrine disorders and liver dysfunction, offering insightful perspectives on how various hormonal imbalances contribute to liver diseases such as metabolic liver disease and cirrhosis. From a clinical standpoint, the paper emphasizes the bidirectional nature of this relationship, with endocrine dysfunction not only exacerbating liver conditions but also liver damage impacting hormone metabolism. The article goes beyond theoretical mechanisms, proposing multidisciplinary management strategies that could improve patient outcomes, especially in conditions like non-alcoholic fatty liver disease (NAFLD) and cirrhosis. The therapeutic approaches outlined, including the integration of endocrine evaluation in liver disease care, underline the importance of a holistic treatment model for more personalized and effective interventions. Overall, this review is an essential resource for researchers and clinicians aiming to refine treatment protocols for patients with complex liver-endocrine disorders, providing a deeper understanding of the underlying pathophysiology and offering practical recommendations for integrated care."
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Vargas-Beltran AM, Armendariz-Pineda SM, Martínez-Sánchez FD, Martinez-Perez C, Torre A, Cordova-Gallardo J. Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches. World J Gastroenterol 2025; 31(32): 108827 [PMID: 40900772 DOI: 10.3748/wjg.v31.i32.108827]
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2
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"This retrospective study provided a useful method using MRI and deep learning to analyze the diagnosis for liver cancer in patients with better efficacy after image reconstruction. Although the statistical and flowchart data was applied to present the general map of this combined method, the critical presentation of direct image in HCC and normal group under artificial technology treatment was not enough to be displayed in the full manuscript and supplementary document. Suggest that author can provide these supportive images with feature indication for other ways such as data-bank online or subsequent demonstration submission using letter to the editor. "
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Wang ZZ, Song SM, Zhang G, Chen RQ, Zhang ZC, Liu R. Multiparametric magnetic resonance imaging of deep learning-based super-resolution reconstruction for predicting histopathologic grade in hepatocellular carcinoma. World J Gastroenterol 2025; 31(34): 111541 [DOI: 10.3748/wjg.v31.i34.111541]
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3
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"PTBD and ERCP are the commonly used methods for biliary drainage. In low-income settings, advanced techniques such as EUS-guided therapies are often unavailable, limiting clinicians' options. This study compares the efficacy of PTBD and ERCP in a low-income country. Both groups showed good therapeutic success, but the PTBD group had low clinical success. This difference may be due to the type of patients enrolled in PTBD, most likely those with Bismuth type 3/4, for which PTBD is typically used. The authors did not specify the aetiology (benign vs malignant) or the level of obstruction in their patients. Complications were more frequent in PTBD patients and were mainly non-biliary related, possibly indicating that sicker patients underwent interventions. These confounding factors should be considered before concluding that PTBD is less effective than ERCP for severe cholangitis. The outcome was based solely on the resolution of cholangitis; including the normalisation of bilirubin levels would have been more informative."
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Karim MM, Moatter S, Amin M, Parkash O. Comparison of endoscopic retrograde cholangiopancreatography drainage vs percutaneous transhepatic biliary drainage in severe cholangitis: A study from low-middle income country. World J Gastrointest Pharmacol Ther 2025; 16(3): 107167 [DOI: 10.4292/wjgpt.v16.i3.107167]
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4
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"The manuscript addresses a highly relevant topic and is enriched with numerous references. The distinction between management strategies for cT1–2 versus cT3–4 disease is particularly valuable. However, the actual role of interventions in the setting of pT3–4 tumors remains to be fully clarified. A broader discussion could be warranted regarding the clinical implications of omental metastases identified post-resection (on the surgical specimen) in patients with cT3–4 disease. Should this finding prompt a more complete disease staging? Could it provide a rationale for referring patients to intraperitoneal therapies (HIPEC, NIPEC, PIPAC)? We eagerly await the results of ongoing trials to better define these aspects."
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Ilhan E, Yildirim M. Current debate in gastric cancer surgery: Omentectomy? World J Gastrointest Surg 2025; 17(8): 108110 [DOI: 10.4240/wjgs.v17.i8.108110]
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5
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"This timely basic study by Groover et al. (WJG 2025; 31: 104277) investigates sex‑based differences in liver expression of estrogen receptors (ERα/ERβ) and tumor necrosis factor-alpha (TNF‑α), elucidating their roles in hepatitis C virus (HCV) pathogenesis. Leveraging human explant tissues from HCV-related cirrhosis and hepatocellular carcinoma (HCC) alongside normal controls, the authors perform RT‑qPCR and Western blot analyses to reveal differential expression patterns by sex and disease state. These findings advance our understanding of why HCV disease progression may diverge between males and females.
The study is commendable for its focus on human tissue specimens and its dual molecular and protein-level methodology, enhancing translational relevance. Additionally, exploring both ER subtypes and TNF-α offers a multifaceted view of hormonal and inflammatory interplay in HCV-mediated liver pathology. The observations pave the way for sex-informed therapeutic strategies and risk stratification.
Nonetheless, the commentary could be strengthened by more detailed insights into downstream signaling pathways, such as NF-κB or apoptosis pathways, which are alluded to but not fully dissected. Moreover, whether the observed ER and TNF-α alterations are causative or reactive remains open. Future investigations integrating functional assays, prospective cohorts, and multi-omics profiling would significantly bolster mechanistic clarity and clinical translation.
In summary, Groover et al. deliver a valuable contribution linking sex-specific molecular expression to HCV pathogenesis, highlighting promising directions for future research."
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Groover S, Addison S, Nicks S, Mwangi M, Brooks A, Kaul A, Kaul R. Sex based relative expression of estrogen receptors and tumor necrosis factor-alpha in liver affects hepatitis C virus viral pathogenesis. World J Gastroenterol 2025; 31(32): 104277 [PMID: 40900774 DOI: 10.3748/wjg.v31.i32.104277]
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6
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"This review takes the bidirectional relationship between the endocrine system and liver function as its starting point and systematically outlines the roles of the thyroid, parathyroid, pancreas, adrenal glands, and sex hormones in liver diseases. It not only summarizes the interactions between common endocrine disorders (such as hypothyroidism, insulin resistance, and Cushing’s syndrome) and hepatic injury, but also provides mechanistic insights into key processes, including lipid metabolism disorders, oxidative stress, and hormone conversion. In addition, the article discusses emerging therapeutic approaches, highlighting the potential of TRβ agonists, GLP-1 receptor agonists, and SGLT2 inhibitors. By emphasizing the mutual reinforcement between endocrine disorders and liver diseases, this review offers valuable references for clinicians in the management of MASLD/NASH, cirrhosis, and hormone-related conditions. Importantly, it reminds us that future strategies for liver disease treatment should not be confined to the liver itself, but must also integrate the broader endocrine context.
Nevertheless, the review also has certain limitations. Some sections remain primarily descriptive and observational, with relatively limited exploration of molecular pathways and immune-metabolic interactions. Furthermore, the discussion of sex hormones and the parathyroid axis is relatively brief and lacks incorporation of the latest clinical evidence. Looking ahead, integration of multi-omics technologies with large-scale clinical datasets will be essential to further advance knowledge in this field and to promote the development of interdisciplinary diagnostic and therapeutic strategies."
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Vargas-Beltran AM, Armendariz-Pineda SM, Martínez-Sánchez FD, Martinez-Perez C, Torre A, Cordova-Gallardo J. Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches. World J Gastroenterol 2025; 31(32): 108827 [PMID: 40900772 DOI: 10.3748/wjg.v31.i32.108827]
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7
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"Dear Author,
We read with great interest the case report by Zhang et al. describing a rare invasive inflammatory fibrotic polyp (IFP) of the duodenum with subserosal involvement. This first documented case of duodenal IFP extending beyond the muscularis propria (Figure 5A) provides valuable insights into the potential invasiveness of this entity. However, two key limitations warrant attention to enhance the clinical applicability of this finding:
The preoperative evaluation revealed limitations: Biopsy limitations: Initial endoscopic biopsies yielded only necrotic tissue, failing to sample viable tumor areas (Figure 1). EUS-FNA not attempted: Despite EUS identifying muscularis propria involvement (Figure 2), fine-needle aspiration (FNA) was not performed to obtain diagnostic material. This led to misdiagnosis as a stromal tumor and unnecessary radical surgery (distal gastrectomy + lymphadenectomy). Current guidelines recommend EUS-FNA for submucosal duodenal masses to avoid overtreatment[1]. As shown in Figure 2B, the lesion size (37.1 mm × 24.5 mm) was amenable to FNA, which could have provided adequate tissue for CD34/SMA immunohistochemistry and potentially prevented surgery.
In conclusion, this case report fills the gap in the understanding of invasive duodenal IFP, but the above aspect need further improvement to better reveal the biological nature of the lesion and guide clinical practice. We look forward to seeing more in-depth studies on this rare disease in the future.
"
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Zhang FM, Ning LG, Wang JJ, Zhu HT, Feng MB, Chen HT. Invasive inflammatory fibrotic polyp of the duodenum: A case report. World J Gastrointest Surg 2025; 17(8): 107558 [DOI: 10.4240/wjgs.v17.i8.107558]
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8
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"Dear Editor,
We read with great interest the article “Changes in liver and spleen stiffness after transjugular intrahepatic portosystemic shunt and their relationship with prognosis” by Liu et al. This study provides valuable insights into the dynamic changes of liver and spleen stiffness post-transjugular intrahepatic portosystemic shunt (TIPS) and their prognostic value, filling an important gap in non-invasive monitoring of TIPS outcomes. However, three aspects could be further refined to enhance the study’s clinical relevance and evidence robustness.
First, the study lacks analysis of the impact of TIPS shunt patency on changes in liver and spleen stiffness. The authors report that spleen stiffness decreases significantly post-TIPS and correlates with portal pressure gradient (PPG), but they do not clarify whether these stiffness changes are influenced by shunt function (e.g., stenosis or occlusion). Clinically, TIPS shunt dysfunction (a common complication) can lead to re-elevated portal pressure, which may reverse the initial reduction in spleen stiffness. Without documenting shunt patency status (e.g., via Doppler ultrasound or venography) at each follow-up time point and stratifying stiffness trends by patency, it is difficult to determine whether the observed stiffness changes are purely due to TIPS-induced hemodynamic improvement or confounded by shunt dysfunction. This gap limits the ability to interpret stiffness trends as reliable indicators of long-term TIPS efficacy.
Second, the study does not explore the relationship between changes in liver/spleen stiffness and the severity of overt hepatic encephalopathy (OHE). Although logistic regression shows no correlation between baseline stiffness and post-TIPS OHE, the dynamic changes in stiffness (e.g., the magnitude of spleen stiffness reduction) may still be associated with OHE risk. For example, a more pronounced decrease in spleen stiffness might reflect better portal decompression, potentially reducing the risk of OHE by altering gut-liver axis function or ammonia metabolism. Additionally, the study only includes OHE of grade ≥2, excluding milder grades (grade 1), which are clinically relevant for early intervention. Analyzing stiffness changes in relation to OHE severity and including all OHE grades would provide a more comprehensive understanding of how stiffness correlates with this key TIPS complication.
Third, the study’s subgroup analysis of liver cirrhosis etiology is insufficient to inform the etiology-specific prognostic value of stiffness. The cohort includes patients with viral, alcoholic, and immunological cirrhosis, but the authors do not stratify survival outcomes or stiffness trends by etiology. Previous studies have shown that cirrhosis etiology affects liver stiffness progression and TIPS prognosis—for instance, alcoholic cirrhosis may be associated with more rapid stiffness changes due to ongoing inflammation, compared to viral cirrhosis. Without etiology-specific subgroup analyses, it is unclear whether the identified liver stiffness cutoff (35.15 kPa) or the prognostic role of stiffness applies uniformly across different etiologies. This limits the study’s ability to guide personalized TIPS assessment for patients with distinct cirrhosis causes.
In conclusion, Liu et al.’s work makes a meaningful contribution to non-invasive monitoring of TIPS outcomes. Addressing the above issues—by integrating shunt patency data, analyzing stiffness changes with OHE severity, and exploring etiology-specific effects—would further strengthen the study’s scientific rigor and clinical utility. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Liu XF, Huang XC, Ye QJ, Yuan LJ, Gao GF, Li JY, Feng DP. Changes in liver and spleen stiffness after transjugular intrahepatic portosystemic shunt and their relationship with prognosis. World J Gastrointest Surg 2025; 17(8): 109884 [DOI: 10.4240/wjgs.v17.i8.109884]
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9
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"Dear Editor,
We read with great interest the article “Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness” by Tseng et al. This study innovatively explores the correlation between computed tomography (CT)-based morphomics and functional assessments (bioelectrical impedance analysis [BIA], hand grip strength [HGS], cardiopulmonary exercise testing [CPET]) in esophageal cancer patients, providing valuable evidence for preoperative physical fitness evaluation. However, three aspects could be further refined to enhance the study’s clinical applicability and evidence robustness.
First, the study lacks analysis of the impact of tumor stage and neoadjuvant therapy on the relationship between morphomics and functional indicators. The cohort includes newly diagnosed esophageal cancer patients, but the article does not specify the distribution of tumor stages (e.g., T stage, N stage) or whether patients received neoadjuvant chemotherapy/radiotherapy before CT and functional assessments. Clinically, advanced tumor stages may directly affect muscle mass (via malnutrition or tumor-related inflammation), while neoadjuvant therapy can cause treatment-related muscle loss (cachexia) or changes in cardiorespiratory fitness. Without stratifying outcomes by tumor stage or adjusting for neoadjuvant therapy status, it is difficult to determine whether the observed correlations between morphomics (e.g., dorsal muscle group [DMG] volume) and CPET/BIA results are confounded by these factors. This gap limits the ability to generalize the findings to patients at different disease stages or treatment phases.
Second, the study does not clarify the clinical significance of morphomic parameter thresholds for predicting low cardiorespiratory fitness (CRF). The authors report that morphomics (combining bone mineral density [BMD], visceral fat [VF] area, and DMG volume) predicts low ventilatory anaerobic threshold normalized by body weight (VAT/BW < 11 mL/kg/min) with an optimism-corrected AUC of 0.778. However, they do not provide specific cutoff values for the key morphomic variables (e.g., how much VF area or DMG volume increases/decreases the risk of low CRF) or validate these thresholds in clinical practice. For example, if a VF area > X cm² or DMG volume < Y cm³ is associated with a significantly higher risk of low CRF, such thresholds would help clinicians quickly identify high-risk patients via routine CT scans. Without defining these actionable cutoffs, the predictive model’s practical value for preoperative screening remains limited.
Third, the homogeneity of the cohort (98% male, Taiwanese population) raises concerns about generalizability, yet the study does not discuss or address potential sex- or ethnicity-related differences in morphomics-functional correlations. Previous studies have shown that body composition (e.g., muscle-fat distribution) and its association with physical fitness vary by sex—for instance, women may have different muscle density thresholds or fat-mass impacts on CRF compared to men. Additionally, ethnic differences in body composition (e.g., Asian vs. Western populations) could affect morphomic parameter norms and their correlation with BIA/CPET results. By excluding female patients and focusing solely on a Taiwanese cohort, the study’s findings may not apply to more diverse populations. Exploring sex-stratified analyses (if feasible with additional data) or acknowledging these limitations with suggestions for multicenter, multiethnic validation would strengthen the study’s external validity.
In conclusion, Tseng et al.’s work makes a meaningful contribution to integrating morphomics into esophageal cancer preoperative assessment. Addressing the above issues—through stratification by tumor stage/neoadjuvant therapy, defining clinical thresholds for predictive morphomic parameters, and expanding cohort diversity—would further enhance the study’s scientific rigor and clinical translational value. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Tseng WHS, Huang SC, Wang SC, Lin J, Zhang P, Liu YC, Chao YK, Chiu CH. Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness. World J Gastrointest Surg 2025; 17(8): 108600 [DOI: 10.4240/wjgs.v17.i8.108600]
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10
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"Dear Editor,
We read with great interest the article “Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction” by Zhou et al. This study pioneers the evaluation of a novel combination therapy for advanced hilar malignant biliary obstruction (MBO), a clinical challenge with limited treatment options, and reports promising technical success and safety profiles. However, three aspects could be further clarified or expanded to enhance the study’s validity and clinical translational value.
First, the study lacks subgroup analysis of outcomes based on stent configuration types and primary disease etiology. The authors employed four stent configurations (Type X, T, Y, and Tandem) tailored to different biliary obstruction patterns, yet they did not compare key endpoints—such as median overall survival (OS), stent patency, or complication rates—across these configurations. For example, Type Y stents (used in 41.2% of patients) may have distinct drainage efficiency or patency durability compared to Tandem stents, which could guide clinicians in selecting the optimal configuration for specific Bismuth subtypes. Additionally, the cohort includes patients with diverse primary diseases (13 with hilar cholangiocarcinoma, 2 with gallbladder cancer liver metastasis, etc.), but no analysis was conducted to determine if the therapy’s efficacy varies by tumor type. Given that different malignancies have distinct biological behaviors (e.g., gallbladder cancer tends to be more aggressive than hilar cholangiocarcinoma), stratifying outcomes by etiology would help identify patient subgroups most likely to benefit from this treatment.
Second, the impact of concurrent systemic anticancer therapy on survival outcomes was not adequately addressed. The study mentions that 6 of 17 patients received sequential systemic treatments (e.g., lenvatinib, hepatic artery infusion chemotherapy). These therapies are known to improve survival in advanced biliary tract cancers, yet the current analysis does not adjust for their potential confounding effect—for instance, whether patients receiving systemic therapy had longer OS independent of the combination stent-seed treatment. Without subgroup comparisons (e.g., OS between patients with vs. without concurrent systemic therapy) or multivariate analysis incorporating these treatments as covariates, it is difficult to isolate the true efficacy of the 125I seed strip-double stent regimen. This gap limits the ability to conclude whether the observed survival benefit (median OS 189 days) is primarily driven by the local intervention or concurrent systemic therapy.
Third, the study provides insufficient details on long-term radiation-related safety and late complications. While the authors report no severe early complications and only one case of seed strip migration, they do not mention long-term monitoring for radiation-induced adverse events—such as bile duct stricture progression, liver parenchyma damage, or secondary malignancies—despite 125I’s half-life of 60.1 days and cumulative absorbed dose of 82.3–83.6 Gy. Additionally, the definition of “late complications” is unclear, and the follow-up period (final follow-up July 31, 2023) is not specified in terms of median duration for surviving patients. For a therapy involving radioactive seeds, documenting long-term radiation safety (e.g., imaging evidence of liver injury, changes in liver function over time) is critical to assessing its overall risk-benefit profile, especially for patients with prolonged survival (e.g., the 3 surviving patients with patent stents).
In summary, Zhou et al.’s study makes a valuable contribution to the management of advanced hilar MBO by introducing a novel combination therapy. Addressing the above issues—through subgroup analyses of stent configurations and etiology, adjustment for concurrent systemic therapy, and detailed long-term safety monitoring—would further strengthen the study’s evidence base and provide more actionable guidance for clinical practice. We look forward to seeing supplementary data or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Zhou CG, Zhang Y, Li H, Liu KY, Yang XY, Gao K. Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction. World J Gastrointest Surg 2025; 17(8): 108579 [DOI: 10.4240/wjgs.v17.i8.108579]
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11
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"Dear Editor,
We read with great interest the article “Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes” by Zhang et al. This study provides valuable insights into the association between obstructive jaundice and sarcopenia, as well as the subsequent effects on postoperative outcomes, which fills an important gap in clinical research on hepatobiliary-pancreatic diseases. However, three aspects could be further refined to enhance the depth of evidence and clinical applicability of the findings.
First, the study lacks analysis of the impact of preoperative biliary drainage (PBD) on sarcopenia and postoperative outcomes. The article mentions that PBD is recommended for patients with total bilirubin (TBIL) levels exceeding 34-51 μmol/L, yet it does not specify how many patients in the obstructive jaundice group underwent PBD, nor does it explore whether PBD affects sarcopenia-related indicators (such as grip strength, walking speed, and appendicular skeletal muscle index) or modifies the association between jaundice severity and sarcopenia. Clinically, PBD can alleviate cholestasis, improve nutritional absorption, and reduce systemic inflammation—factors that may mitigate muscle loss. Without stratifying outcomes by PBD status, it is difficult to determine whether PBD could serve as an intervention to reduce sarcopenia risk in patients with severe jaundice, which limits the study’s guidance for preoperative management.
Second, the correlation between sarcopenia and long-term outcomes (e.g., in-hospital mortality, long-term survival) was not investigated. The current analysis focuses on short-term outcomes such as postoperative hospital stay and complication rates, but it does not mention in-hospital mortality data or follow-up results beyond discharge. Previous studies have shown that sarcopenia is associated with reduced long-term survival in patients undergoing abdominal surgery, such as hepatectomy or pancreaticoduodenectomy. For patients with obstructive jaundice (especially those with malignant etiologies), clarifying whether sarcopenia predicts long-term prognosis would provide more comprehensive evidence for clinical decision-making—for example, guiding the intensity of follow-up or the need for long-term nutritional interventions. The absence of such data weakens the study’s ability to address the full clinical impact of sarcopenia.
Third, the study does not explore the potential mediating role of inflammatory or nutritional biomarkers in the relationship between obstructive jaundice and sarcopenia. The discussion hypothesizes that jaundice-induced inflammation (e.g., elevated TNF-α, IL-6) and malnutrition contribute to muscle loss, but the study did not measure these biomarkers (e.g., cytokine levels, vitamin D, or amino acid profiles) or analyze their mediating effects. For instance, if patients with severe jaundice have higher IL-6 levels that are independently associated with sarcopenia, this would support inflammation as a key mechanism linking jaundice to muscle wasting. Without such analyses, the proposed pathophysiological pathway remains speculative, and it is difficult to identify potential targets for interventions (e.g., anti-inflammatory therapies or vitamin D supplementation) to prevent sarcopenia in this population.
In conclusion, Zhang et al.’s study makes a meaningful contribution to understanding the prevalence and short-term impact of sarcopenia in patients with obstructive jaundice. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more actionable guidance for preoperative assessment and intervention in this patient group. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Zhang RN, Cui JY, Zhao ZH, Li YT, Liu ZW, Zhang JY, Wei Q, Lu YM, Chen QP. Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes. World J Gastrointest Surg 2025; 17(8): 107209 [DOI: 10.4240/wjgs.v17.i8.107209]
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12
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"Letter to the Editor
Dear Editor,
We read with great interest the article “Clinical observation of combined transarterial chemoembolization and targeted therapy in postoperative recurrent colorectal cancer with liver metastasis” by Liu et al., which provides valuable insights into the efficacy and safety of multimodal therapy for this challenging clinical condition. The study’s focus on survival outcomes and quality of life offers meaningful references for clinical practice, yet there are three aspects that we believe could be further refined to enhance the robustness and interpretability of the findings.
First, the article lacks detailed analysis of the impact of prior treatment history on study outcomes. As shown in Table 1, 26.7% of patients received prior systemic chemotherapy, and 13.3% had prior targeted therapy. These prior treatments may influence the response to the combined TACE-targeted therapy regimen—for example, patients with prior exposure to anti-VEGF or anti-EGFR agents might develop drug resistance, thereby affecting OS, PFS, and adverse event profiles. However, the current study does not stratify outcomes by prior treatment status or adjust for this factor in multivariate analysis. Clarifying whether prior treatment history is an independent confounding variable would help readers better understand the applicability of the study’s conclusions to different patient subgroups (e.g., treatment-naive vs. pretreated patients).
Second, the description of TACE procedure standardization and dose adjustments is insufficient. The study mentions that TACE was repeated every six weeks based on tumor response and patient tolerance, but it does not specify key details such as the criteria for modifying the number of TACE sessions (e.g., how “tumor response” or “tolerance” was objectively defined) or adjustments to chemotherapeutic agent doses (e.g., whether doxorubicin/cisplatin doses were reduced in patients with liver dysfunction). Additionally, 93.3% of patients received doxorubicin and 86.7% received cisplatin, suggesting potential overlapping use of these two agents, yet the study does not explain the rationale for combined vs. single-agent selection. Variability in TACE protocols could introduce bias in outcome comparisons between treatment groups; standardizing and detailing these procedures would improve the reproducibility of the study results.
Third, the quality of life (QoL) assessment lacks long-term follow-up and subgroup analysis of symptom dynamics. The study evaluates QoL only at baseline and six months post-treatment, but cancer therapy-related QoL changes may be dynamic—for instance, some patients might experience delayed improvements or worsening of symptoms (e.g., fatigue, pain) after six months. Extending QoL follow-up to 12 or 24 months would provide a more comprehensive understanding of the sustained impact of treatment on patient well-being. Furthermore, while the study notes greater QoL improvements in the bevacizumab group, it does not analyze QoL differences based on clinical characteristics such as the number of liver metastases or ECOG performance status. For example, patients with multiple metastases might derive less benefit in QoL despite similar survival outcomes, which would be clinically relevant for treatment decision-making.
Overall, Liu et al.’s study makes a valuable contribution to the field of postoperative recurrent colorectal cancer with liver metastasis. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more comprehensive guidance for clinical practice. We look forward to seeing additional data or supplementary analyses to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital "
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Erkek A, Yıldırak MK, Yıldız A, Sevinç B. Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease. World J Gastrointest Surg 2025; 17(8): 107476 [DOI: 10.4240/wjgs.v17.i8.107476]
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13
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"The figures are attactive and interesting.
I would like to suggest the authors to look into the binding sites (such as 5'UTR and 3'UTR) of the RNA bining proteins, and compare the contribution of these binding sites.
It will be interesting to identify effects of exercise based on types, intensity, duration and frequency."
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Lu Y, Kong JD, Zhao LN. Role of RNA-binding proteins in exercise-induced mRNA regulation: Unveiling biomarkers and therapeutic targets for schizophrenia. World J Psychiatry 2025; 15(9): 107498 [DOI: 10.5498/wjp.v15.i9.107498]
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14
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"The paper, "Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson's disease," offers a comprehensive overview of how transcranial magnetic stimulation (TMS) can effectively address the non-motor symptoms of Parkinson's disease (PD). Beyond the motor deficits, PD patients frequently experience a triad of debilitating non-motor symptoms: psychological issues (depression, anxiety), chronic pain, and cognitive impairment. The efficacy of TMS in treating this diverse range of symptoms suggests a unifying mechanism rooted in the modulation of shared, dysfunctional neural circuits. This paper provides important insights into the treatment and management of Parkinson's disease using rTMS, so I hope many readers will read it. Furthermore, I would like to add that rTMS has recently been applied to the frequent emergence of chronic pain disorders as non-motor disorders in Parkinson's disease, and write a letter discussing the common target brain circuits for these disorders."
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Zhou XL, Li Y, Xia W, Zheng YY, Wu AP. Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson’s disease. World J Psychiatry 2025; 15(9): 108497 [DOI: 10.5498/wjp.v15.i9.108497]
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15
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"This study addresses an important and timely issue in the management of Helicobacter pylori infection, particularly given the rising problem of drug resistance. The authors have clearly explained the challenges with conventional susceptibility testing, which is slow and laborious due to the bacterium’s fastidious growth. The new chromogenic medium-based method they propose is interesting and practical, as it uses urease activity to visually identify resistant strains while suppressing susceptible ones with antibiotics. The methodology is described in a clear and detailed manner, and the inclusion of standard reference strains as controls adds credibility. The results are impressive, showing that resistance can be detected in just 28-36 hours—far quicker than the usual 11-day protocol—without compromising accuracy. The high detection rate (90.5%) and strong agreement with standard microdilution testing make a strong case for the method’s reliability. The study rightly points out the simplicity and potential clinical usefulness of this approach, which could help doctors make faster treatment decisions and improve patient outcomes. Some minor points that could be addressed include how well the method performs in samples with mixed infections or varying urease activity, and a discussion on its cost-effectiveness and feasibility for routine use in clinical labs. Overall, this is a well-conducted and valuable study with strong translational potential."
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Guan AX, Yang SY, Wu T, Zhou WT, Chen H, Huang ZS, Luo PP, Huang YQ. Novel chromogenic medium-based method for the rapid detection of Helicobacter pylori drug resistance. World J Gastroenterol 2025; 31(32): 106424 [PMID: 40900768 DOI: 10.3748/wjg.v31.i32.106424]
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16
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"Dear Author(s),
I read with interest your clinical study on clinical results of stapled hemorrhoidopexy in the surgical treatment of grade 4 hemorrhoids. It is quite interesting that the recurrence rates of stapled hemorrhoidopexy were found to be high in your study. I think it is a very good study that contributes to the literature. Congratulations and I wish you continued successful studies.
Best Regards,
Dr.Adnan Özpek"
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Erkek A, Yıldırak MK, Yıldız A, Sevinç B. Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease. World J Gastrointest Surg 2025; 17(8): 107476 [DOI: 10.4240/wjgs.v17.i8.107476]
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17
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"Dear Author(s),
I read with interest your clinical study on temporary protective loop ileostomy closure time. It is quite interesting that there is no statistical difference between early and late closure. I think it is a very good study that contributes to the literature. Congratulations and I wish you continued successful studies.
Best Regards,
Dr.Adnan Özpek"
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Özcan P, Düzgün Ö. Comparison of complication rates after early and late closure of loop ileostomies: A retrospective cohort study. World J Gastrointest Surg 2025; 17(8): 109432 [DOI: 10.4240/wjgs.v17.i8.109432]
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18
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"This paper presents an insightful exploration into the potential of miR-126-3p as a predictive biomarker for treatment response in patients with primary biliary cholangitis (PBC) who are refractory to ursodeoxycholic acid (UDCA). The study highlights the variability in therapeutic responses among PBC patients and proposes miR-126-3p as a reliable marker for distinguishing between UDCA-sensitive and resistant individuals. This could be a game-changer in personalized medicine, allowing for more tailored and effective treatment strategies. The use of a cohort-based approach with rigorous statistical analysis, including ROC curve evaluation, enhances the credibility of the findings. From a clinical perspective, the identification of miR-126-3p as a biomarker with high sensitivity and specificity (82.4% sensitivity and 84.6% specificity) for predicting UDCA responsiveness is highly promising. It could facilitate earlier interventions for non-responders, preventing the progression of the disease and reducing the need for liver transplantation. The findings of this study are particularly important in clinical settings where timely adjustments in treatment are critical for improving patient outcomes."
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Pan SD, Xiong CY, Shen YJ, Tian JH, Wang YL, Wang JN, Wang SY, Li FY, Wang LF, Qiu Q, Yang L, Liu XM, Luan JQ, Zou ZS, Wang FS, Meng FP. MicroRNA-126-3p as a predictive biomarker for patients with primary biliary cholangitis refractory to ursodeoxycholic acid. World J Gastroenterol 2025; 31(31): 109828 [PMID: 40901689 DOI: 10.3748/wjg.v31.i31.109828]
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"This article presents a detailed study on the role of TSC22D1 in LSEC dysfunction and its impact on macrophage polarization in non-alcoholic fatty liver disease (NAFLD). The authors successfully highlight TSC22D1 as a key regulator of LSEC dysfunction and its involvement in macrophage M1 polarization, exacerbating liver fibrosis through the TWEAK/FN14 signaling pathway. The findings provide novel insights into the mechanisms underlying NAFLD progression and suggest that TSC22D1 could serve as a promising therapeutic target for managing NAFLD-related fibrosis. From a clinical perspective, the study is highly relevant as it addresses the complex interplay between endothelial dysfunction, inflammation, and fibrosis in NAFLD, a condition that is increasing in prevalence globally. The paper’s strength lies in its integration of single-cell transcriptomic data and in vivo experimental validation, making it an important contribution to the understanding of NAFLD pathogenesis. The potential for targeting TSC22D1 to modulate these pathways offers exciting therapeutic possibilities."
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Ding W, Xu XQ, Wu LL, Wang Q, Wang YQ, Chen WW, Tan YL, Wang YB, Jiang HJ, Dong J, Yan YM, Xu XZ. TSC22D1 promotes liver sinusoidal endothelial cell dysfunction and induces macrophage M1 polarization in non-alcoholic fatty liver disease. World J Gastroenterol 2025; 31(31): 109605 [PMID: 40901684 DOI: 10.3748/wjg.v31.i31.109605]
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"The article is well written, explaining the uses of hybrid technique using laparoscopy and endoscopy for gastric and also duodenal, colon and rectal lesions.
It describes laparoscopic endoscopic cooperative surgery in a comprehensive manner. The technique is very well explained with the help of illustrations.
The future for robotic laparoscopic endoscopic cooperative surgery and combining it with artificial intelligence will surely expands its role in coming years. "
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Parikh KS, Kaw P, Kumar A. Laparoendoscopic surgery in gastrointestinal diseases: Status and future perspectives. World J Gastrointest Endosc 2025; 17(8): 107617 [PMID: 40838165 DOI: 10.4253/wjge.v17.i8.107617]
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"Mesenchymal stem cells (MSCs) have demonstrated unique advantages in the treatment of neurodegenerative diseases, including: (1) possessing multipotent differentiation potential, which can induce differentiation into neural lineage cells such as neurons and glial cells to replenish lost cells. (2) By releasing neurotrophic factors (such as BDNF, NGF), cytokines, and extracellular vesicles through the paracrine effect, endogenous nerve regeneration and synaptic remodeling are promoted. (3) To exert immunomodulatory function, regulate microglial polarization and T cell response to alleviate neuroinflammation. (4) Low immunogenicity (low expression of MHC-II) reduces the risk of immune rejection. (5) Having homing ability, it can selectively migrate to the lesion area in response to chemotactic signals. (6) And exert neuroprotective effects by inhibiting oxidative stress, regulating calcium homeostasis, and reducing abnormal protein aggregation, providing important support for cell replacement and microenvironment repair in neurodegenerative diseases.
The authors' article highlights the significant potential of stem cell therapy in treating neurodegeneration, emphasizing how mesenchymal stem cells mitigate the progression of neurodegenerative diseases by regulating molecular pathways associated with abnormal protein accumulation, neuroinflammation, oxidative stress, and neurodegeneration. It is worthwhile reading. Future studies should further explore the interplay between the two.
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Cui CX, Shao XN, Li YY, Qiao L, Lin JT, Guan LH. Therapeutic potential of mesenchymal stem cells in neurodegenerative diseases. World J Stem Cells 2025; 17(8): 107717 [DOI: 10.4252/wjsc.v17.i8.107717]
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"This is a well-structured, clinically relevant retrospective study that provides a comprehensive analysis of risk factors for subclinical atherosclerosis in a high-risk population of patients with Type 2 Diabetes Mellitus (T2DM). The findings are valid and align with established pathophysiological knowledge. This study successfully identifies and confirms a cluster of traditional and diabetes-related risk factors (age, glycemic control, renal function, SUA, HDL-C) that are independently associated with carotid plaque formation in T2DM patients. It provides a evidence-based rationale for clinicians to closely monitor UACR and SUA as part of a comprehensive cardiovascular risk assessment.
As acknowledged, important confounding variables like diabetes duration, detailed lifestyle factors (diet, smoking, physical activity), medication use (e.g., SGLT2 inhibitors, GLP-1 RAs, statins, allopurinol), and socioeconomic status were not accounted for, which could influence the results. The single-center study with a homogenous Chinese population limits the generalizability of the findings to other ethnic and geographic groups.
In summary, this is a solid, methodologically sound study that offers valuable clinical insights despite its inherent limitations, effectively serving as a foundation for further research rather than a practice-changing breakthrough. As the authors suggest, these findings should be validated in prospective, longitudinal, and multi-center studies with larger, more diverse cohorts. Integrating these biomarkers with imaging advances and other novel inflammatory or metabolic markers could lead to more powerful predictive models.
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Shi L, Li NJ. Comprehensive analysis of risk factors associated with carotid plaque in patients with type 2 diabetes mellitus. World J Diabetes 2025; 16(8): 104180 [PMID: 40837341 DOI: 10.4239/wjd.v16.i8.104180]
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"This study addresses a critical clinical challenge—early identification of sepsis in high-risk ALF patients—using a well-constructed dynamic nomogram (SIALF). The model’s strong performance (AUROC 0.835–0.849) outperforms SOFA and SIRS across both internal/external validation cohorts, highlighting its robustness. Key strengths include:
1. Practical Predictors: Integration of readily available clinical variables (age, total bilirubin, LDH, albumin, mechanical ventilation) enhances feasibility for ICU use.
2. Clinical Utility: The online dynamic nomogram facilitates real-time risk assessment, enabling timely interventions like antibiotic stewardship or organ support.
3. Rigorous Validation: External validation in a Chinese cohort (FMCPH) supports generalizability, despite the derivation cohort’s Western origin."
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Qi R, Wang X, Kuang ZD, Shang XY, Lin F, Chang D, Mu JS. Dynamic nomogram predicts sepsis risk in patients with acute liver failure: Analysis of intensive care database with external validation. World J Gastroenterol 2025; 31(31): 105229 [PMID: 40901690 DOI: 10.3748/wjg.v31.i31.105229]
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"The knowledge and therapeutic applications of Endoscopic ultrasound are ever-expanding. The authors have neatly provided various EUS training models across the world. As a new trainee, I know the importance of having a structured EUS program and a good mentor. In India, most centres don't include EUS training as part of their fellowship, as it is considered an advanced endoscopic procedure. However, the increasing utility of EUS in gastroenterology is changing this trend. The learning curve of diagnostic EUS is relatively steep compared to therapeutic EUS, which was my personal experience. This minireview provides an overview of EUS training worldwide and emphasises the need for further structured training modules."
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Delsa H, Khannoussi W, Ghoneem E, Okasha HH. Endoscopic ultrasound training: Current state, challenges, and the path to proficiency. World J Gastrointest Endosc 2025; 17(8): 107458 [PMID: 40838151 DOI: 10.4253/wjge.v17.i8.107458]
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"Issa and colleagues provide a timely, practice-oriented overview of sedation in GI endoscopy and rightly emphasize balancing efficacy, safety, and cost. Their focus on opioid-sparing strategies is particularly relevant for ambulatory units.
The trial they highlight (midazolam alone vs midazolam–fentanyl) suggests that, in selected low-risk cases, opioids may be unnecessary without sacrificing patient comfort or procedural success. Important limitations—single-operator design, higher midazolam dosing, and hints of longer cecal intubation—temper generalizability and justify replication.
2) On delivery models, non-anesthesiologist propofol can be safe when programs use formal training, selection (ASA I–II), and robust monitoring; remimazolam is promising for hemodynamic stability but still needs head-to-head pragmatic trials that include recovery time and cost.
A pragmatic pathway could be: (1) short, low-nociception diagnostics in ASA I–II → midazolam-based moderate sedation (consider midazolam alone); (2) prolonged/therapeutic cases → propofol with trained teams; (3) high-risk or deep sedation anticipated → anesthesiology support and full physiologic monitoring. Governance should track adverse events, patient-reported outcomes, recovery, and cost per completed case.
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Issa IA, Lakis R, Issa T. Sedation in endoscopy: Finding the balance between safety and efficacy. World J Gastrointest Endosc 2025; 17(8): 109695 [PMID: 40838158 DOI: 10.4253/wjge.v17.i8.109695]
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"The authors are to be congratulated for providing both a systematic review and real-world evidence, which together highlight the clinical value of this multimodal approach.
The findings clearly demonstrate that TCC-NSAID therapy achieves superior pain relief, functional improvement, and higher patient satisfaction compared with NSAID monotherapy, without a significant rise in adverse events. The observed reduction in postoperative opioid requirements is especially relevant, given the current emphasis on opioid-sparing strategies.
Nonetheless, some caveats merit consideration. The striking imbalance between sample sizes in the real-world dataset (156,713 on NSAIDs alone vs. 492 on TCC-NSAIDs) raises the possibility of sampling bias. Moreover, the substantial heterogeneity reported in functional outcomes and postoperative pain reduction suggests the need for cautious interpretation. Importantly, long-term safety data for TCC remain limited, particularly in patients with hepatic or renal comorbidities, and should be explored further before routine adoption.
Overall, this work adds valuable evidence supporting the synergistic use of TCC with NSAIDs in acute musculoskeletal and postoperative pain
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Karmakar A, Jaiswal A, Mandal S, Khan AA, Mitra M. Therapeutic efficacy of thiocolchicoside-nonsteroidal anti-inflammatory drug combination in pain management: A systematic review and cross-sectional real-world study. World J Orthop 2025; 16(8): 106769 [PMID: 40838227 DOI: 10.5312/wjo.v16.i8.106769]
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"This paper provides a detailed review of the clinical efficacy and mechanisms of Bletilla striata in treating peptic ulcers (PUs). The study explores both monotherapy and compound formulations, highlighting its potential in promoting ulcer healing, reducing inflammation, and improving gastric mucosal repair. The inclusion of experimental data and clinical studies demonstrates Bletilla striata's therapeutic efficacy, particularly in combination with conventional treatments like PPIs and antibiotics for Helicobacter pylori eradication. The clinical relevance of this paper is high, especially for those working in gastroenterology and traditional Chinese medicine. It brings attention to an herbal remedy with promising effects on PUs, a common and often recurring condition. However, the review also suggests that more rigorous clinical trials and studies focusing on the long-term safety and efficacy of Bletilla striata in PU treatment are needed."
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Sun YT, Zhou F, Zheng HX, Xiao JD. Clinical efficacy and mechanism of Bletilla striata and Chinese herbal compounds in treatment of peptic ulcer. World J Gastroenterol 2025; 31(30): 110145 [PMID: 40904885 DOI: 10.3748/wjg.v31.i30.110145]
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"This article provides a comprehensive review of the gut microbiota and its critical role in dyslipidemia. The authors effectively highlight the bidirectional relationship between the gut microbiome and lipid metabolism, elucidating the molecular mechanisms that underlie the modulation of lipid homeostasis by microbial metabolites such as SCFAs. The clinical implications of this research are vast, as it points to the gut microbiota as a promising therapeutic target for managing lipid disorders, such as hyperlipidemia, by potentially modulating microbial composition through probiotics, prebiotics, and fecal microbiota transplantation. However, while the review offers significant insight into potential therapeutic strategies, it also highlights the need for more robust evidence from longitudinal clinical trials and further exploration of the mechanistic pathways involved. "
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Lv J, Zhao HP, Yu Y, Wang JH, Zhang XJ, Guo ZQ, Jiang WY, Wang K, Guo L. From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention. World J Gastroenterol 2025; 31(30): 108680 [PMID: 40904889 DOI: 10.3748/wjg.v31.i30.108680]
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"Wang et al should be acknowledged for their real-world study, assessing the efficacy and safety of perioperative immunotherapy (sintilimab) plus chemotherapy (SOX) for patients with non-metastatic gastric cancer (GC). They suggested that pathological response rate and overall survival were significantly improved with perioperative sintilimab plus SOX chemotherapy compared to perioperative chemotherapy alone. In addition, safety data showed lower frequency of high-grade adverse events in immuno-chemotherapy combination. However, the study presents several limitations, such as:
- the retrospective nature, leading to selection bias;
- the limited power of the study, in fact, a larger phase-III trials, assessing perioperative immunotherapy plus chemotherapy (Keynote-585 and MATTERHON) were recently published;
- the sub-optimal chemotherapy regimen (SOX) used in combination with immunotherapy.
Finally, according to Wang and MATTERHON data, we can conclude, that immunotherapy added to chemotherapy cures more patients with stage-II/III gastric cancer compared to chemotherapy, constituting a possible new standard of care. "
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Wang YC, Zhang CG, Wang YW, Guo C, Pan T, Yu PJ, Cai BJ, Ding RH, Qiang JL, Deng CQ, Hu CH, Xu YH. SOX plus sintilimab vs P-SOX vs SOX as neoadjuvant therapy in advanced gastric cancer: Efficacy and safety. World J Gastrointest Oncol 2025; 17(8): 109646 [PMID: 40837776 DOI: 10.4251/wjgo.v17.i8.109646]
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"The strength of the article published by Tarallo et al [1] lies in its thorough analysis of the post–endoscopic retrograde cholangiopancreatography (ERCP) complications, which will serve as a valuable source of information for clinicians across the globe. The complications mentioned in the review, although less frequent, if mismanaged, can prolong the hospitalisation, exacerbate the healthcare costs, and significantly increase the morbidity and mortality.
With the development and availability of advanced endoscopic techniques and interventional radiology, the role of surgery in managing ERCP-related complications has decreased. For instance, post-sphincterotomy bleeding (PSB) can be initially managed with various endoscopic methods, and angiographic embolisation is the second-line option [1,2]. Similarly, perforations (particularly, Types II and III), stent migration–induced perforations and Dormia basket impaction also benefit from endoscopic approaches [1,3,4].
Surgery plays a crucial role in severe or refractory cases. When embolisation fails, approximately 10% of the patients with PSB need surgical ligation of the bleeding artery [1,5]. With delayed surgery (>24 h), the mortality rate for Type I perforations is as high as 75% [1,6]. Similarly, stent migration–induced perforations and Dormia basket impaction not responding to endoscopic techniques require surgical intervention [1,7,8]. Early recognition is of paramount importance for improving the outcome. Furthermore, this review advocates a multidisciplinary approach that integrates endoscopists, surgeons and interventional radiologists. This collaboration is crucial, particularly when non-operative methods fail.
Although this review has been very extensive, we would like to highlight the significance of risk factors and preventive measures, which the authors should have mentioned. The ERCP technique has been refined over the past five decades; however, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure- and operator-related factors. Although non-modifiable, patient-related risk factors allow close monitoring and initiation of preventive measures. For example, the risk of post-ERCP bleeding can be attenuated via pre-procedural optimisation and the adoption of intra-procedural techniques. Patients with thrombocytopenia and coagulopathy should receive blood product transfusions to alleviate the risk of procedure-related bleeding. Using endoscopic papillary large balloon dilatation and performing sphincterotomy in the 11 o’clock to 1 o’clock axis may also reduce the risk of PSB. The reason is that this area has the lowest concentration of arteries based on micro-dissections of cadaveric pancreatico–duodenal specimens.
Future challenges and directions: While the review provides a comprehensive framework, it also indicates gaps in current practice, such as the lack of standardised guidelines for ERCP-related complications. This finding underscores the need for further research to establish evidence-based protocols. Moreover, the importance of early recognition indicates the need for the incorporation of simulation-based learning tools and multidisciplinary integration to enhance readiness for these rare yet critical complications.
Conclusion: Despite extensive research and refinement of this technique, ERCP-related complications remain a major issue. Identifying risk factors for ERCP-related complications, implementing measures that alleviate the risk of complications, and promptly treating the complications are crucial to ensure favourable clinical outcomes. Predictive models can be developed in future research to identify patients at risk of severe complications, thus enabling clinicians to implement preventive strategies.
References:
1. Tarallo M, Crocetti D, Coppola A, Iannone I, Lamazza A, Sapienza P, Fiori E. Endoscopic retrograde cholangiopancreatography-related adverse events: What is the role of surgery today? World J Gastrointest Surg 2025; 17(7): 107385 [PMID: 40740903 DOI: 10.4240/wjgs.v17.i7.107385]
2. Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, Beyna T, Dinis-Ribeiro M, Hritz I, Mariani A, Paspatis G, Radaelli F, Lakhtakia S, Veitch AM, van Hooft JE. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52:127-149.
3. Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, Dhillon A, Fragaki M, Gonzalez JM, Repici A, van Wanrooij RLJ, van Hooft JE. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy. 2020;52:792-810.
4. Syed IA, Hanif MF, Malik AK, Aujla UI. Cholangioscope-Guided Electrohydraulic Lithotripsy as a Rescue Technique for an Impacted Dormia Basket With Large Common Bile Duct Stone. ACG Case Rep J. 2023;10:e00981.
5. Dunne R, McCarthy E, Joyce E, McEniff N, Guiney M, Ryan JM, Beddy P. Post-endoscopic biliary sphincterotomy bleeding: an interventional radiology approach. Acta Radiol. 2013;54:1159-1164.
6. Cirocchi R, Kelly MD, Griffiths EA, Tabola R, Sartelli M, Carlini L, Ghersi S, Di Saverio S. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon. 2017;15:379-387.
7. Zorbas KA, Ashmeade S, Lois W, Farkas DT. Small bowel perforation from a migrated biliary stent: A case report and review of literature. World J Gastrointest Endosc. 2021;13:543-554.
8. O'Brien JW, Tyler R, Shaukat S, Harris AM. Laparoscopic Common Bile Duct Exploration for Retrieval of Impacted Dormia Basket following Endoscopic Retrograde Cholangiopancreatography with Mechanical Failure: Case Report with Literature Review. Case Rep Surg. 2017;2017:5878614.
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Tarallo M, Crocetti D, Coppola A, Iannone I, Lamazza A, Sapienza P, Fiori E. Endoscopic retrograde cholangiopancreatography-related adverse events: What is the role of surgery today? World J Gastrointest Surg 2025; 17(7): 107385 [PMID: 40740903 DOI: 10.4240/wjgs.v17.i7.107385]
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"This is a well-designed and clearly articulated case-control study that investigates the psychological predictors of Diabetic Ketoacidosis (DKA) in children with Type 1 Diabetes Mellitus (T1DM) in Saudi Arabia. The authors use the Health Belief Model (HBM) as a theoretical framework but uniquely introduce and test "perceived understanding" as a key predictive construct. The central finding—that a caregiver's cognitive understanding of diabetes management is a more powerful predictor of adherence and DKA prevention than their emotional perceptions of severity or susceptibility—is both compelling and clinically significant. The study is methodologically sound for its design, and its findings offer a valuable, practical contribution to pediatric diabetes care and health behavior theory.
However, there are few weaknesses that can taken into account to further increase the value of the study.
1. Use of modified scales: The authors correctly acknowledge that they adapted items from existing validated tools. While they demonstrated good internal consistency for most scales, the Cronbach's alpha for "perceived susceptibility" was only 0.68. This is generally considered the lower limit of acceptability and may have weakened its potential predictive power in the model. To build on this excellent work, the authors should consider formally validating their modified "perceived understanding" scale in a larger, more diverse Saudi population to create a robust instrument for future studies.
2. Extremely high correlations: The correlation coefficients between perceived understanding and the three adherence behaviors (r = 0.93 to 0.95) are unusually high for psychosocial research. This could suggest a degree of tautology or item overlap between the "understanding" and "adherence" scales—that is, the questions used to measure the two constructs may be assessing very similar underlying concepts. While this does not invalidate the primary finding, it is a point of methodological consideration. The authors could briefly address the very high correlation in the discussion as a point of interest, perhaps speculating on the conceptual overlap and how future instruments could be refined to better distinguish between cognitive understanding and the enactment of that understanding (adherence).
3. Single-center study: The research was conducted at a single tertiary military hospital in Riyadh. This limits the generalizability of the findings to other regions in Saudi Arabia or to different types of healthcare settings (e.g., non-military, rural clinics) where educational resources and patient populations may differ.
4. Caregiver-reported data: The reliance on caregiver reports for adherence behaviors is a potential source of social desirability and recall bias. This is a common and often necessary limitation in pediatric research but remains a weakness compared to objective adherence data (e.g., glucometer downloads, pharmacy records). Future studies should aim to incorporate objective measures of adherence to complement the caregiver-reported data and strengthen the validity of the findings.
5. Longitudinal design: A prospective, longitudinal study could establish the temporal relationship between improving understanding and subsequent improvements in adherence and clinical outcomes (e.g., reduced DKA incidence), thereby moving from correlation to demonstrating causality."
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Alissa N, Al Zahrani S. Psychological predictors of diabetic ketoacidosis in children: Health belief model-based case-control study. World J Diabetes 2025; 16(8): 110088 [PMID: 40837335 DOI: 10.4239/wjd.v16.i8.110088]
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"Sun present a valuable 10-year retrospective analysis of 3,256 pancreatic cancer patients across 14 Chinese hospitals. Key findings include a median overall survival of 183 days, late-stage diagnosis (56.9% Stage IV), and superior efficacy of combination therapies (e.g., gemcitabine + fluorouracil in adjuvant settings; HR = 0.35). The study underscores the urgent need for early detection and optimized chemotherapy in China’s clinical landscape."
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Sun WY, Zhang SS, Zhang SK, Qin RY, Zhou B, Liu J, Li SP, Chen RF, Wang CF, Fan JH. Treatment options in patients with pancreatic cancer: A 10-year multicenter epidemiological investigation in China. World J Gastrointest Oncol 2025; 17(8): 106447 [PMID: 40837749 DOI: 10.4251/wjgo.v17.i8.106447]
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"The article provides a review of the literature and the authors' own data on the problem of diagnosing acute hemorrhagic leukoencephalitis (AHLE), which is a rare but very dangerous disease with high mortality. The authors present data on the magnetic resonance imaging spectrum obtained from 4 patients and suggest that MRI data may be potential biomarkers for early diagnosis and choice of therapy for suspected AHLE. Noting the theoretical and practical significance of the research, I would like to note the following. According to modern concepts, AHLE can be an autoimmune disease, in particular, associated with the effects of viral infections and/or immunizations, including COVID. In this regard, it is of interest to provide a more detailed view of the range of tests performed in patients to detect viral markers, as well as information about vaccinations."
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Shukla A, Nayyar N, Kumari P, Kumar A, Takkar P. Magnetic resonance imaging spectrum of acute hemorrhagic leukoencephalitis: Four case reports. World J Clin Cases 2025; 13(28): 107759 [PMID: 40881012 DOI: 10.12998/wjcc.v13.i28.107759]
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"The manuscript is very interesting, as the authors attempt to describe a rather important topic in arthroplasty practice that is the the outcomes from bilateral Total Hip Arthroplasty.
There is a clear lack of concesus on the topic, with advantages and disadvantages associated for both of the options ( single staged vs double) ; nevertheless the patients' general medical status and the expactations are of paramount importance for the final decision. "
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Sharma H, Verma R, Kumar L, Ali A, Khurana G, Gurnani V, Mittal S, Jajodia N. Single staged bilateral total hip replacement and its outcomes: A cross-sectional study. World J Orthop 2025; 16(8): 102298 [PMID: 40838229 DOI: 10.5312/wjo.v16.i8.102298]
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"This review article provides a comprehensive overview of the role of the gut microbiota (GM) in the pathogenesis and therapeutic intervention of dyslipidemia.
The gut microbiota produces metabolic byproducts such as short-chain fatty acids (SCFAs) and secondary bile acids, which act on the liver and adipose tissue to regulate lipid metabolism. SCFAs promote fatty acid oxidation, suppress lipid accumulation, and stimulate the secretion of appetite-suppressing hormones such as GLP-1 and PYY.
When the gut environment becomes imbalanced, the intestinal barrier function deteriorates, allowing lipopolysaccharides (LPS) to enter the bloodstream and cause metabolic endotoxemia. This, in turn, triggers chronic inflammation and exacerbates dyslipidemia. In addition, the gut microbiota modifies the composition of bile acids and regulates lipid metabolic pathways via the nuclear receptor FXR and the membrane receptor TGR5. Moreover, bacterial-derived exosomes and non-coding RNAs may induce epigenetic changes in host genes related to lipid metabolism.
Diet has a significant influence on the gut microbiota. High-fat, low-fiber diets disrupt its composition, whereas Mediterranean and plant-based diets have beneficial effects. Therapeutic strategies targeting the gut microbiota—such as probiotics, prebiotics, and fecal microbiota transplantation (FMT)—are promising, but personalization is required to achieve maximal benefit.
However, several challenges remain in this field:
• Many studies are observational, lacking experimental evidence to support causal relationships.
• Human studies are easily influenced by confounding factors such as genetic background, diet, and medications.
• Large interindividual differences in gut microbiota make standardized treatments difficult.
• Specific methods to achieve personalized medicine have not yet been established.
• The effects of probiotics and FMT tend to be short-term, with insufficient knowledge regarding their long-term efficacy or optimal timing of intervention.
• FMT carries the risk of introducing pathogens or antibiotic resistance genes, necessitating established donor criteria to ensure safety.
• Most studies investigate single strains over short periods, leaving the effects of multi-strain interventions and long-term administration unclear; interspecies differences must also be taken into account.
To overcome these limitations, it is considered essential to elucidate causal relationships through long-term and multifaceted research, establish personalized therapeutic approaches, and develop standardized protocols with an emphasis on safety.
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Lv J, Zhao HP, Yu Y, Wang JH, Zhang XJ, Guo ZQ, Jiang WY, Wang K, Guo L. From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention. World J Gastroenterol 2025; 31(30): 108680 [PMID: 40904889 DOI: 10.3748/wjg.v31.i30.108680]
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"This study shows that endoscopic interventions involving the minor papilla, such as minor papilla cannulation, sphincterotomy, balloon dilation, stone extraction, and other procedures, is a feasible treatment modality for obstructive chronic pancreatitis. Adverse events from endoscopic minor papilla intervention are high, and these complex interventions should only be performed by experienced endoscopists. The study was a single center retrospective study, and the majority of the patients were male, which limits the generalizability of the results."
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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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"This study by Guilmoteau et al shows that the relatively newer endoscopic technique of simultaneous stent-beside-stent strategy for malignant hilar biliary obstruction has higher technical success rate when compared to sequential stent-beside-stent technique, and a similar technical success rate to sequential stent-inside-stent technique. Interestingly, there was no significant difference in clinical success or adverse events between these three groups, and the risk of recurrent biliary obstruction was not significant between the simultaneous and sequential groups. The study states that technical failure is associated with a higher rate of fatal cholangitis; however, the P value provided is 0.085 with the CI crossing 1 (CI 0.78-44.4) so this finding is not statistically significant. A valuable addition to this study would be to evaluate the rates of improvement in radiographic biliary dilatation between these three strategies, and if improvement in biliary dilatation was achieved bilaterally or unilaterally. Nevertheless, this is an interesting study which shows that simultaneous stent-beside-stent management of malignant hilar biliary obstruction may be favored over the sequential stent-beside-stent strategy as the former strategy has higher technical success rates."
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Guilmoteau T, Rouquette O, Buisson A, Cambier S, Abergel A, Poincloux L. Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction. World J Gastroenterol 2025; 31(19): 101913 [PMID: 40497097 DOI: 10.3748/wjg.v31.i19.101913]
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"On behalf of the reviewers, I am pleased to inform you that your manuscript has been evaluated and is recommended for acceptance in its current form. The study presents a well-designed methodology, robust results, and a significant contribution to the field of Specific Field. The clarity of presentation and adherence to journal guidelines are commendable. The manuscript has been reviewed and is deemed suitable for publication. The article describes the content clearly, possesses professionalism, and meets the acceptance criteria. Agree to accept.Agreed to receive the article, which is professional, clearly expressed, forward-looking, logically coherent and well-written.No further changes are required."
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Imbrizi M, Azevedo MFC, Baima JP, Queiroz NSF, Parra RS, Ferreira SDC, Sassaki LY, Chebli JMF. Positioning and sequencing of advanced therapies in inflammatory bowel disease: A guide for clinical practice. World J Gastroenterol 2025; 31(29): 107745 [PMID: 40809925 DOI: 10.3748/wjg.v31.i29.107745]
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"Inflammatory bowel disease is a chronic, debilitating, lifelong disease with waxing and waning. Since the disease is chronic, long-term medical therapy is required. Often, a few patients may not be adherent to medications due to various reasons, and this study explored this aspect with the expansion of Withdrawal of drugs in IBD. Most of the patients who were not adherent may present with acute severe ulcerative colitis, and most of them will have recapture of the remission with steroids or original drugs. This Study also showed a similar picture, with only 1/4 requiring corticosteroids. This study is well-written, but in the era of treat-to-target, it notably overlooks the histological findings in patients with ASA withdrawal. Addition of Endoscopic and histopathological findings after withdrawal, even without relapse, would have given a better picture"
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Atay A, Ergul M, Ozturk O, Acun KC, Cagir Y, Durak MB, Yuksel I. Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy. World J Gastroenterol 2025; 31(30): 110112 [PMID: 40904881 DOI: 10.3748/wjg.v31.i30.110112]
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"I was very impressed by the article "From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention". The authors of the review scientific publication carefully analyzed modern information on the problem of dyslipidemia pathogenesis, linked lipid metabolism with many factors of genetics, environment, and lifestyle. The authors also identified the cause-and-effect relationships between dyslipidemia and colonic microbiota."
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Lv J, Zhao HP, Yu Y, Wang JH, Zhang XJ, Guo ZQ, Jiang WY, Wang K, Guo L. From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention. World J Gastroenterol 2025; 31(30): 108680 [PMID: 40904889 DOI: 10.3748/wjg.v31.i30.108680]
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"This retrospective study aims to compare the feasibility, resection rates, and complications of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) to laparoscopic wedge resection (LWR) in the treatment of subepithelial lesions (SELs) arising from the muscularis propria at the esophagogastric junction (EGJ) or gastric cardia. Lee et al. show that ESD, STER, and LWR are all feasible methods for resecting these lesions. Interestingly, the R0 resection rate is lower for ESD and especially STER when compared to LWR, however this may be related to the greater proportion of leiomyomas found in the ESD and STER groups, and leiomyomas are typically benign with very low chance for progression to malignancy. It is unclear if these lesions were sampled with EUS-guided fine needle biopsy prior to deciding on ESD, STER, or LWR, as achieving en bloc resection is more important for lesions with malignant potential such as GIST. Nevertheless this study shows that endoscopic resection methods such as ESD and STER are viable alternatives to surgical resection of SELs at the EGJ and gastric cardia. It is important for patients to have a complete pre-procedural workup including EUS, fine needle biopsy when possible, and CT chest and abdomen prior to embarking on resection."
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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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"This study investigates the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and diabetic gastric motility disorders (DGMD) in patients with type 2 diabetes mellitus (T2DM), using electrogastrogram (EGG) to assess gastric electrical rhythm. The findings suggest that MASLD is an independent risk factor for DGMD, with patients diagnosed with MASLD showing significant gastric motility abnormalities. This research is important for understanding the interplay between metabolic disorders and gastrointestinal complications, offering potential early indicators for clinicians to monitor and manage DGMD in T2DM patients. The study’s results are clinically significant, as they highlight the need for healthcare providers to be aware of gastric motility issues in T2DM patients with MASLD. Early intervention, including EGG testing, could help prevent the development of diabetic gastroparesis and improve patient care."
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Wang XX, Yan C, Wang SJ, Zhu H, Cao CC, Wu L, Wang S, Hu J, Zhang HH. Analysis of gastric electrical rhythm in patients with metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus. World J Hepatol 2025; 17(7): 109067 [PMID: 40747237 DOI: 10.4254/wjh.v17.i7.109067]
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"This article discusses the Triglyceride-Glucose-Waist Circumference (TyG-WC) index as a promising non-invasive biomarker for diagnosing and assessing metabolic dysfunction-associated steatotic liver disease (MASLD). It highlights the growing recognition of the TyG-WC index in identifying individuals at risk for MASLD and associated complications, such as cardiovascular disease and diabetes. The research outlines its strong diagnostic performance across diverse populations and underscores the importance of further studies to validate its predictive capacity. With its simplicity and affordability, the TyG-WC index holds significant potential in improving MASLD diagnosis and risk stratification, offering a practical tool for both clinicians and researchers. "
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Priego-Parra BA, Román-Calleja BM, Gallego-Duran R, Gracia-Sancho J, Velarde Ruiz-Velasco JA, Remes-Troche JM. Triglyceride-glucose-waist circumference index: A powerful tool for metabolic dysfunction-associated steatotic liver disease. World J Hepatol 2025; 17(7): 107668 [PMID: 40747214 DOI: 10.4254/wjh.v17.i7.107668]
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"The title "Deciphering the oncogenic role of Rac family small GTPase 3 (RAC3) in hepatocellular carcinoma (HCC) through multiomics integration" by Liu R et al., (2025) represents a good basic study that discuss RAC3 as a key HCC oncogenic driver; its overexpression links to poor prognosis/resistance. Targeting the RAC3/E2F1 axis offers a new therapy, which highlights RAC3 as a biomarker/target. the prognostic value of RAC3 protein expression in HCC but this study requires validation by clinical follow-up studies and the mechanistic interplay between E2F1 and RAC3 in HCC requires experimental confirmation. The Future work need in vitro and in vivo models to validate the E2F1/RAC3 axis, dissect its impact on cell-cycle dynamics, and explore its translational potential in overcoming therapy resistance."
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Liu R, Li JC, Li SD, Li JD, He RQ, Chen G, Feng ZB, Wei JL. Deciphering the oncogenic role of Rac family small GTPase 3 in hepatocellular carcinoma through multiomics integration. World J Hepatol 2025; 17(7): 106151 [PMID: 40747231 DOI: 10.4254/wjh.v17.i7.106151]
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The challenge of optimizing postoperative recovery and long-term outcomes in patients undergoing gastric cancer (GC) surgery continues to pose significant clinical and logistical hurdles, despite advancements in surgical techniques and perioperative care (1). In this study, Tang and Zhang present valuable findings on the integration of enhanced recovery after surgery (ERAS) protocols with a multidisciplinary collaboration model, highlighting its potential to improve gastrointestinal recovery, psychological status, and patient satisfaction in the postoperative setting.
In their retrospective analysis of GC patients undergoing radical gastrectomy, the authors demonstrated that those managed under a multidisciplinary ERAS model experienced significantly faster recovery of gastrointestinal function—as evidenced by earlier first flatus and defecation—alongside shorter postoperative hospital stays and reduced complication rates. Recent studies have further supported the beneficial effects of ERAS protocols on gastrointestinal function in patients with GC (2,3). In addition to these objective clinical metrics, the study also reported improvements in subjective outcomes, including lower anxiety and depression scores, better sleep quality, and higher overall patient satisfaction, suggesting that integrated perioperative care may positively impact both physiological and psychological recovery trajectories. Their work contributes to the extensive and growing body of literature demonstrating the benefits of ERAS in gastrointestinal surgery (4,5).
Despite the encouraging findings, several important methodological concerns warrant further discussion. First, the study is retrospective in design, yet the number of patients in the ERAS group and the control group was matched at a strict 1:1 ratio (n=60 each), a distribution that appears non-random and unexplained. Such parity raises the possibility of selective inclusion or post hoc group assignment, which can introduce bias and compromise the internal validity of the findings. Second, the authors did not specify whether any patients initially considered for ERAS management were excluded due to protocol deviation, medical contraindications, or perioperative complications. Without a transparent description of patient selection and exclusion criteria for the ERAS cohort, it is difficult to assess the generalizability and applicability of the results to broader clinical populations.
A significant limitation lies in its retrospective, single-center design. Without randomization or stratified analysis of critical confounders—such as comorbidity profiles, tumor stage, surgical approach, and baseline nutritional status—the validity of causal inferences is limited (8). Additionally, the absence of detailed compliance metrics for ERAS components (e.g., early feeding, ambulation targets, analgesia protocols) restricts reproducibility and hinders the evaluation of individual contributors to the observed outcomes.
In conclusion, this study reinforces the value of multidisciplinary ERAS pathways in GC surgery.
References
1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2024 doi 10.3322/caac.21834.
2. Lee HJ, Kim J, Koo BW, Suh YS, Lee JM, Han DS, et al. Survey of Perioperative Practices in Gastric Cancer Surgery for Establishing an Enhanced Recovery After Surgery Program Across 10 Tertiary Hospitals in South Korea. J Gastric Cancer 2025;25(3):424-36 doi 10.5230/jgc.2025.25.e27.
3. Tian Q, Wang H, Guo T, Yao B, Liu Y, Zhu B. The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2024;56(1):2306194 doi 10.1080/07853890.2024.2306194.
4. Wang J, Yuan T, Shi J. Application of Medical-Nursing Integration Multidisciplinary-Assisted Surgical Wound Nursing Mode in Improving the Quality of Wound Treatment. Emerg Med Int 2022;2022:9299529 doi 10.1155/2022/9299529.
5. Lee HJ, Kim J, Yoon SH, Kong SH, Kim WH, Park DJ, et al. Effectiveness of ERAS program on postoperative recovery after gastric cancer surgery: a randomized clinical trial. Int J Surg 2025;111(5):3306-13 doi 10.1097/js9.0000000000002328.
6. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78(5):606-17 doi 10.1093/bja/78.5.606.
7. Choi CI, Park JK, Chung JH, Lee SH, Hwang SH, Jeon TY, et al. The application of enhanced recovery after surgery protocol after distal gastrectomy for patients with gastric cancer: a prospective randomized clinical trial. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2024;28(6):791-8 doi 10.1016/j.gassur.2024.02.032.
8. Tian Y, Cao S, Li L, Yu W, Ding Y, Zhang G, et al. Three-year Survival Outcomes of Patients With Enhanced Recovery After Surgery Versus Conventional Care in Laparoscopic Distal Gastrectomy: The GISSG1901 Randomized Clinical Trial. Annals of surgery 2025;282(1):46-55 doi 10.1097/sla.0000000000006603."
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Tang YH, Zhang J. Clinical effect of enhanced recovery after surgery based on multidisciplinary collaboration model in postoperative gastric cancer surgery. World J Gastrointest Surg 2025; 17(7): 105387 [PMID: 40740921 DOI: 10.4240/wjgs.v17.i7.105387]
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"In the era of the investigation based management, Clinical examination is fast becoming absolute. The Authors in this paper have clearly explained the methods and utility of one of the important clincal examination in the gastroebterology practice. I conragulate the authors for writing this review and this will be important clinical guide for upcoming/ new trainees in the field of surgery/ gastroenterology"
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Zhu LJ, Zeng XL, Yang XD. Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders. World J Gastrointest Surg 2025; 17(7): 106471 [PMID: 40740891 DOI: 10.4240/wjgs.v17.i7.106471]
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"This research highlights the potential of NET-related markers as biomarkers for liver damage, offering a promising avenue for early diagnosis and therapeutic targeting. The study is particularly relevant given the global rise in metabolic diseases and liver conditions like MASLD. The inclusion of multiple models allows for a more comprehensive understanding of how different types of liver damage—fibrosis, steatohepatitis, and simple steatosis—affect systemic inflammation and NET formation. These findings could pave the way for novel treatment strategies focusing on regulating NETosis, which may be beneficial for clinical management of MASLD and related liver diseases."
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Feješ A, Belvončíková P, Bečka E, Strečanský T, Pastorek M, Janko J, Filová B, Babál P, Šebeková K, Borbélyová V, Gardlík R. Myeloperoxidase, extracellular DNA and neutrophil extracellular trap formation in the animal models of metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(27): 106166 [PMID: 40741100 DOI: 10.3748/wjg.v31.i27.106166]
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"This paper provides an insightful contribution to the field of MAFLD by developing a machine learning-based model for early detection in high-metabolic-risk populations. The integration of clinical data and TCM features adds a unique, holistic perspective, which could enhance the model's diagnostic power. The use of advanced statistical methods, such as LASSO and RFE, strengthens the reliability of the predictive model. The XGBoost algorithm demonstrated superior performance, making it a promising tool for non-invasive MAFLD screening in clinical settings. Overall, the study presents a significant step towards improving MAFLD detection and has promising clinical implications, especially in cost-effective screening and early intervention for at-risk populations."
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Tian Y, Zhou HY, Liu ML, Ruan Y, Yan ZX, Hu XH, Du J. Machine learning-based identification of biochemical markers to predict hepatic steatosis in patients at high metabolic risk. World J Gastroenterol 2025; 31(27): 108200 [PMID: 40741101 DOI: 10.3748/wjg.v31.i27.108200]
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"Tian et al. (2025) present a compelling prospective observational study employing machine learning (ML) to identify biochemical and clinical markers predictive of hepatic steatosis in individuals at high metabolic risk. Metabolic-associated fatty liver disease (MAFLD) is prevalent yet frequently underdiagnosed, especially in early stages when traditional screening modalities like ultrasonography lack sensitivity. Thus, the authors’ development of a noninvasive, cost-effective ML-based predictive model is timely and clinically relevant, aiming for early identification and improved resource utilization.
A methodological strength of the study is its comprehensive use of multiple ML algorithms—XGBoost, Random Forest (RF), Support Vector Machine (SVM), and Logistic Regression (LR)—representing diverse modeling approaches. This allowed for robust comparative analysis, with each algorithm selected for specific strengths: XGBoost for nonlinear interactions, RF for overfitting resistance, SVM for high-dimensional data, and LR for baseline interpretability. This methodological breadth effectively balances predictive performance and clinical practicality.
To manage high-dimensional data (156 initial candidate features), the study employed dual feature selection techniques: recursive feature elimination (RFE) and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Combining these strategies yielded a robust set of ten core features, significantly reducing complexity while ensuring predictive accuracy. These final predictors, including the AST/ALT ratio, triglycerides, and waist circumference, are clinically meaningful and closely correlate with hepatic steatosis, reinforcing the validity of their selection.
Among the ML models evaluated, XGBoost demonstrated superior performance with an area under the ROC curve (AUC) of approximately 0.82, surpassing RF, SVM, and LR. XGBoost’s predictive strength was further validated through cross-validation (mean AUC ~0.918), suggesting robust internal consistency. Importantly, the model achieved high accuracy (84%) and an F1-score of 0.84, reflecting a balanced sensitivity and specificity crucial for clinical implementation.
Another innovative aspect was incorporating Traditional Chinese Medicine (TCM) indicators alongside conventional clinical metrics. Two TCM-derived features, greasy tongue coating and tongue edge redness, emerged prominently among the top predictors, bridging traditional holistic diagnostics and contemporary data analytics. These TCM indicators likely represent underlying metabolic dysregulation consistent with “damp-heat” conditions in TCM theory, aligning with inflammation and metabolic dysfunction commonly observed in MAFLD.
Incorporating TCM features provides valuable additional diagnostic perspectives, potentially capturing subtle clinical signs not represented in standard biomedical metrics. The quantitative integration of these features through digital analysis and expert validation represents a significant methodological innovation. However, several practical challenges must be considered. TCM diagnostic standardization and reproducibility outside controlled research settings may pose limitations. Differences in tongue appearance influenced by diet, hydration, and oral hygiene could introduce variability. Thus, ensuring consistent reproducibility and gaining broad clinical acceptance remain critical tasks for future research.
Clinically, the authors’ ML tool holds significant promise for noninvasive screening, particularly valuable in routine healthcare settings where expensive or invasive procedures like MRI-PDFF or liver biopsies are impractical. This model’s reliance on common biochemical and clinical data enhances its applicability, particularly in resource-limited settings. Stratification by predicted risk allows targeted use of advanced imaging or specialist follow-up, optimizing clinical workflows and resource allocation.
Nevertheless, the model’s limitations must be acknowledged. First, external validation in multicenter cohorts is essential, given the study’s single-center design and potential population-specific biases. Moreover, the lack of MAFLD subtyping overlooks disease heterogeneity, possibly limiting predictive accuracy for specific patient subsets (e.g., diabetic vs. non-diabetic patients, mild vs. severe steatosis). Addressing these nuances through subgroup-specific analyses or longitudinal follow-up studies will enhance interpretability and clinical utility.
Future research could expand the feature set to include advanced biomarkers or imaging modalities to enhance predictive precision. Further, refining TCM integration through sophisticated image analysis or correlating TCM features with biochemical markers would provide stronger mechanistic insights. Prospective studies evaluating clinical outcomes of model-driven interventions, such as lifestyle modification or TCM-based therapies, could demonstrate tangible patient benefits and validate real-world clinical impact.
In conclusion, Tian et al. present a robustly designed study introducing an innovative ML-based approach for early hepatic steatosis detection in high-risk populations. The inclusion of TCM diagnostic features exemplifies a novel integration of traditional medicine within contemporary predictive frameworks. Although initial results are promising, external validation, refinement for disease heterogeneity, and practical clinical integration remain critical next steps. This pioneering work significantly contributes to metabolic medicine and predictive hepatology, paving the way for improved, patient-centered management of fatty liver disease.
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Tian Y, Zhou HY, Liu ML, Ruan Y, Yan ZX, Hu XH, Du J. Machine learning-based identification of biochemical markers to predict hepatic steatosis in patients at high metabolic risk. World J Gastroenterol 2025; 31(27): 108200 [PMID: 40741101 DOI: 10.3748/wjg.v31.i27.108200]
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"This article provides forward-looking insights into liver disease treatment. It begins by accurately identifying the key factors contributing to chronic liver diseases such as alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease, and metabolic dysfunction-associated steatohepatitis, as well as the limitations of current treatments. This lays a solid foundation for subsequent innovative treatment ideas, helping readers clearly understand the existing challenges.When exploring solutions, it skillfully combines nanoparticles, gut microbiome modulation, and artificial intelligence, showcasing the immense potential of interdisciplinary integration. It lists various key types of nanocarriers, offering researchers abundant references, and elaborates on their diverse applications in modulating the gut microbiome for the treatment of chronic liver diseases, thereby broadening research perspectives.However, there is room for improvement in the details. For instance, the listed future challenges are somewhat vague. If each challenge were supported by more specific examples or data, the article would be more convincing. Additionally, a more in-depth explanation of how artificial intelligence precisely predicts treatment responses and enables personalized interventions could be beneficial, making it easier for readers without expertise in AI to understand.Overall, this article injects new vitality and hope into the field of liver disease treatment. It offers valuable insights for researchers and medical professionals. It is believed that these innovative therapeutic approaches will soon be applied in clinical practice, thereby enhancing patients' prognoses and quality of life. The article holds significant scientific and practical importance and is worthy of further research and attention."
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Khurana A, Hartmann P. Gut microbiome-specific nanoparticle-based therapeutics for liver diseases. World J Gastroenterol 2025; 31(27): 109105 [PMID: 40741099 DOI: 10.3748/wjg.v31.i27.109105]
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