Top journals this week: BMJ / J Hepatology / Lancet GH / Gastroenterology
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surfaced 17held 26filtered out 152
91.3% of what published this week did not make the issue. That filter is the product.
Every paper vs. its guideline standard
No paper this week forces an outright change to the standard. That is the usual, honest result.
Each paper is matched to the guideline that governs its question, then placed by how it moves it. Every card quotes the standard it was measured against, with its source and review date. Click a segment to filter the issue.
The signal map
Study rigor (x) by shift in the standard (y, 1 to 5); dot area = journal impact factor, color = subspecialty. Click a dot to open its card.
New evidenceBarrett's esophagusesophageal cancerbiomarkercapsule endoscopy
Clinical takeawayConsider using the capsule-sponge-TFF3 test as a non-invasive screening tool to rule out esophageal adenocarcinoma in patients at risk for Barrett's esophagus, pending further validation in broader populations.
What it foundThe capsule-sponge-TFF3 test had a high negative predictive value (99.7%) for esophageal adenocarcinoma over long-term follow-up compared to standard endoscopic screening.
ContextThis supports the potential utility of the capsule-sponge-TFF3 test as a reliable screening method for select populations, though it does not replace standard diagnostic procedures.
Today’s standard
Diagnose esophageal cancer by EGD with biopsies, then stage with EUS for locoregional (T + N) extent and CT chest/abdomen/pelvis plus PET for distant disease, and refer all patients urgently to a multidisciplinary team (thoracic surgery, medical oncology, radiation oncology).
the full guideline text
Treat early T1a intramucosal adenocarcinoma with endoscopic eradication (EMR/ESD plus RFA); manage T1b and beyond with neoadjuvant chemoradiation followed by surgery (CROSS regimen) or definitive chemoradiation for proximal SCC, with palliative stenting, feeding tube, and nutrition support as needed.
Clinical takeawayConsider adopting CAQ systems for colonoscopy to improve adenoma detection, particularly in settings where ADR is suboptimal. The trade-off is a modest increase in withdrawal time (0.63 minutes). Interpret AADR and ACDR improvements cautiously due to low event rates.
What it foundComputer-aided quality assurance (CAQ) increased adenoma detection rate by 43% (RR 1.43, 95% CI 1.17-1.73) compared to standard colonoscopy.
ContextConfirms prior evidence that enhanced visualization tools improve ADR, with new data suggesting this extends to advanced adenomas (54% increase in AADR) and adenocarcinomas (30% increase in ACDR), though these findings are limited by low event rates.
Today’s standard
Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA, CT colonography, or flexible sigmoidoscopy as Tier 2 alternatives.
the full guideline text
A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.
Clinical takeawayConsider duvakitug 900 mg every 2 weeks for adults aged 18-75 with moderately to severely active ulcerative colitis, including those with inadequate response, loss of response, or intolerance to prior therapies, while monitoring for adverse events.
What it foundDuvakitug 900 mg achieved clinical remission in 48% of patients vs 20% with placebo at week 14, with a 26% higher posterior mean response rate (95% CrI 8 to 44). Adverse event incidence was similar to placebo (43% vs 52%).
ContextThis provides new evidence for duvakitug, an anti-TL1A monoclonal antibody, as a potential treatment option in a population with limited response to conventional or advanced therapies.
Today’s standard
Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing and pathogen studies.
the full guideline text
Treat by disease extent and severity: mild-moderate proctitis/left-sided/extensive disease with topical and oral 5-ASA (escalating to budesonide-MMX), and moderate-severe disease with advanced therapy (anti-TNF, vedolizumab, ustekinumab, JAK inhibitors, S1P modulators, or anti-IL-23p19). Apply treat-to-target (STRIDE-II) reassessment, screen for acute severe UC by Truelove-Witts criteria for inpatient IV-steroid management, and perform CRC surveillance colonoscopy starting 8 years from symptom onset.
AGA 2020 / ACG 2019 / AGA 2024 CPU on positioning · reviewed 2026-04-22
Emergingrelative to this standard
Reinisch W … Jairath V · Lancet Gastroenterology & Hepatology · IF 30.9 · PubMed ↗
Clinical takeawayConsider measuring serum IgA levels in MASLD patients for additional risk stratification, particularly in those without advanced fibrosis but with unexplained disease progression. No clinical action yet: the therapeutic implications of IgA-targeted interventions remain investigational.
What it foundElevated IgA (≥ 318 mg/dL) independently predicted liver-related events in MASLD patients (HR=3.17, 95% CI 1.27-7.91), with a 5-year cumulative incidence of 24.0% vs lower rates in other subgroups.
ContextChallenges the current fibrosis-centric risk assessment in MASLD by identifying an immune-driven high-risk phenotype independent of fibrosis stage, supported by multi-omics validation across cohorts.
Today’s standard
Statins are safe and recommended in MASLD/MASH and compensated cirrhosis when indicated for cardiovascular risk reduction, and they have hepatic benefit (reduce ALT, may slow MASH progression, reduce HCC risk).
the full guideline text
Start per standard CV risk-based criteria with baseline LFTs; routine ALT monitoring on statin is not required and pre-existing transaminitis is not a contraindication. Hold or reduce only for clinically significant ALT elevation, severe muscle symptoms, or decompensated cirrhosis on an individualized basis.
New evidenceartificial intelligencecolorectal cancer screeningLynch syndromecomputer-aided detection
Clinical takeawayConsider using AI-assisted colonoscopy (e.g., CAD EYE) during Lynch syndrome surveillance to improve adenoma detection, acknowledging potential bias from unblinded endoscopists.
What it foundAI-assisted colonoscopy (CAD EYE) increased adenoma detection rate to 24% vs 16% with HD-WL alone in Lynch syndrome surveillance.
ContextThis study provides new evidence supporting AI-assisted colonoscopy in Lynch syndrome, where prior evidence was sparse and inconsistent.
Today’s standard
After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., low-risk adenomas 7-10 years, intermediate/high-risk adenomas and advanced serrated lesions 3 years, >10 adenomas 1 year with polyposis evaluation), and apply the shortest interval indicated when findings are mixed.
the full guideline text
Confirm complete resection and adequate prep before applying an interval, and use site-check/tumor-board pathways for piecemeal resection and malignant (T1) polyps. Refer for genetic evaluation when Lynch, FAP/AFAP/MAP, or serrated polyposis syndrome criteria are met.
Clinical takeawayNo need to modify contraceptive counseling or screening for colorectal cancer based on hormonal contraceptive use in premenopausal women, as modern formulations show no clear protective or harmful effect.
What it foundCurrent or recent hormonal contraceptive use (all types) showed no significant change in colorectal cancer risk (IRR 0.94, 95% CI 0.83-1.06) vs. never users, with similar null effects for progestogen-only pills (IRR 1.09) and levonorgestrel IUDs (IRR 0.96).
ContextRefutes prior hypotheses that hormonal contraception might influence colorectal cancer risk in young women, aligning with recent null findings for modern formulations.
Clinical takeawayConsider using the CIRI model as a non-invasive alternative to HVPG for stratifying decompensation risk in cACLD patients, particularly where HVPG or LSM are unavailable. No clinical action yet: requires further validation before widespread adoption.
What it foundCIRI model predicted hepatic decompensation with 1- and 2-year AUROCs of 0.816 and 0.815 in the development cohort (vs. MELD and FIB-4, both p<0.001) and 0.836 and 0.769 in external validation (vs. HVPG, both p>0.900; vs. LSM, both p<0.05), using a cutoff of ≥-8.25 to identify high-risk patients (equivalent to HVPG ≥10mmHg). The model was trained on 11 demographic and routine laboratory parameters (specifics not provided in abstract).
ContextChallenges current reliance on HVPG (invasive) and LSM (infrastructure-dependent) by offering a scalable, non-invasive tool with comparable performance. Study populations included cACLD patients with steatotic liver disease as the leading etiology (54% in development, 44% in validation), with median follow-up of 18.5 and 27.5 months, respectively.
Today’s standard
In confirmed cirrhosis (with congestive/cardiac and alternative-etiology red flags excluded), maintain HCC surveillance with liver ultrasound plus AFP every 6 months and screen for varices by EGD, using carvedilol (preferred NSBB) for clinically significant portal hypertension or varices.
the full guideline text
Refer to transplant at MELD 12-14 with a first decompensation, immunize (including non-live RZV zoster and pneumococcal series), monitor bone density and nutrition, and manage decompensations (ascites/SBP, hepatic encephalopathy, HRS-AKI, hyponatremia, ACLF) per stage. Statins are positively recommended in compensated disease and protein should not be restricted.
New evidenceMASLDepidemiologybiomarkerbasic science
Clinical takeawayConsider cryptogenic SLD as a distinct high-risk phenotype in lean patients (BMI <25 kg/m²) without CMRFs. Monitor these patients for liver injury using non-invasive fibrosis assessment tools (e.g., FIB-4, VCTE, MRE) and consider closer follow-up despite the absence of traditional metabolic risk factors.
What it foundCryptogenic steatotic liver disease (SLD), defined as lean SLD (BMI <25 kg/m²) without cardiometabolic risk factors (CMRFs), was associated with a 2.5-fold increased risk of liver-related death (HR 2.5, 95% CI 1.4 to 4.3) compared to non-SLD/no CMRF in the KNHIS cohort.
ContextThis challenges the assumption that lean SLD without CMRFs is benign, showing it carries a significant liver-related mortality risk, though direct comparison to metabolic-associated SLD was not performed.
Today’s standard
Confirm MASLD by hepatic steatosis on imaging (or biopsy) plus at least one cardiometabolic criterion and exclusion of competing etiologies, then risk-stratify fibrosis using a sequential non-invasive approach (FIB-4 first, then VCTE/MRE, with biopsy only if discordant).
the full guideline text
Lifestyle modification with ≥7-10% weight loss, Mediterranean diet, and exercise is the foundation for all patients; add pharmacotherapy (resmetirom, semaglutide, pioglitazone, or vitamin E) for F2-F3 MASH, and manage cardiometabolic risk with statins for ASCVD reduction plus glycemic and blood-pressure control. Perform HCC surveillance with ultrasound and AFP every 6 months only if cirrhosis is present.
AASLD 2023 Practice Guidance · reviewed 2026-04-22
Clinical takeawayConsider zalfermin 30 mg co-administered with semaglutide 2.4 mg weekly as a potential treatment for patients with metabolic dysfunction-associated steatohepatitis and clinically significant fibrosis (F2-F4c), pending phase 3 confirmation of efficacy and safety. Monitor for adverse effects as part of clinical trials or post-marketing surveillance.
What it foundZalfermin 30 mg plus semaglutide 2.4 mg achieved a higher proportion of participants with ≥1-stage liver fibrosis improvement (NASH CRN fibrosis scale) and no worsening of metabolic dysfunction-associated steatohepatitis at week 52 compared to placebo (specific percentage not provided in abstract). Adverse effects included [specific adverse effects if mentioned in abstract].
ContextThis study provides new evidence for a combination therapy in a population with limited treatment options, challenging the current standard of care which lacks approved pharmacotherapies for fibrosis in metabolic dysfunction-associated steatohepatitis.
Today’s standard
Confirm MASLD by hepatic steatosis on imaging (or biopsy) plus at least one cardiometabolic criterion and exclusion of competing etiologies, then risk-stratify fibrosis using a sequential non-invasive approach (FIB-4 first, then VCTE/MRE, with biopsy only if discordant).
the full guideline text
Lifestyle modification with ≥7-10% weight loss, Mediterranean diet, and exercise is the foundation for all patients; add pharmacotherapy (resmetirom, semaglutide, pioglitazone, or vitamin E) for F2-F3 MASH, and manage cardiometabolic risk with statins for ASCVD reduction plus glycemic and blood-pressure control. Perform HCC surveillance with ultrasound and AFP every 6 months only if cirrhosis is present.
AASLD 2023 Practice Guidance · reviewed 2026-04-22
Reinforcesrelative to this standard
Loomba R … Gluud LL · Lancet Gastroenterology & Hepatology · IF 30.9 · PubMed ↗
Endoscopyrct · n=150 · Jul 15, 2026
Rigor86
Shift25
Practice80
Standing41
Signal score, how each part rates
Study rigorStrongrct
ShiftModerateAdds to an open question
Practice relevanceStrongBears on a bedside decision
New evidenceERCPendoscopy qualitybiliary stricturecomputer-aided detection
Clinical takeawayFor difficult biliary cannulation in patients with both malignant and benign biliary obstruction, consider double-guidewire (DGT), trans-pancreatic sphincterotomy (TPS), or precut fistulotomy as equally effective salvage options, but weigh DGT's lower pancreatitis risk (10%) against precut's reduced contrast use and higher pancreatitis risk (24%). Base choice on anatomy, operator skill, and resource availability.
What it foundInitial biliary cannulation success rates were similar across techniques (72% DGT, 68% TPS, 68% precut), with 100% final success in all groups; precut used less contrast dye (p<0.005), while post-ERCP pancreatitis rates were numerically higher with TPS (22%) and precut (24%) vs DGT (10%).
ContextConfirms that advanced techniques for difficult cannulation achieve similar success rates in patients with both malignant and benign biliary obstruction despite prior uncertainty about comparative efficacy, though hints at tradeoffs in contrast use and pancreatitis risk.
Today’s standard
Confirm acute pancreatitis by the Atlanta criteria (any 2 of 3: characteristic pain, lipase/amylase >3x ULN, or imaging), stratify severity with BISAP/SIRS within 24 h and APACHE II for ICU triage, and manage with moderate goal-directed lactated Ringer's, early oral feeding within 24-72 h, and opioid analgesia.
the full guideline text
Give etiology-specific care: same-admission cholecystectomy for mild gallstone AP (emergent ERCP only for concurrent cholangitis or persistent biliary obstruction), insulin/plasmapheresis for hypertriglyceridemia, and abstinence support for alcohol. Reserve antibiotics for infected necrosis and manage necrosis with a step-up approach once walled-off at 4+ weeks.
ACG 2024 · reviewed 2026-04-22
Emergingrelative to this standard
Elhoseeny MM … Othman AAA · Gastrointestinal Endoscopy · IF 8.0 · PubMed ↗
Clinical takeawayScreen hEDS/HSD patients for chronic GI symptoms (especially heartburn, dysphagia, GERD) following SOC for GERD (alarm feature assessment first, empiric PPI trial if no alarms). Assess for comorbid DGBIs (functional dysphagia 34.2%) and extraintestinal conditions (chronic fatigue 49%, migraine 38.2%, OI 35.9%, POTS 21.9%).
What it found65.3% of hEDS/HSD patients report at least one chronic GI symptom (OR 4.29 vs controls), with heartburn (34.7%), functional dysphagia (34.2%), and GERD (41.3%) most common. Evidence quality is low due to clinical heterogeneity; associations should not be interpreted as causal.
ContextConfirms high prevalence of GI symptoms and DGBIs in hEDS/HSD, previously reported anecdotally; quantifies associations (OR 4.29) and specific symptom rates. Evidence is limited by clinical heterogeneity.
Today’s standard
Screen for alarm features (dysphagia, odynophagia, GI bleeding, iron-deficiency anemia, weight loss, persistent vomiting, palpable mass) before any empiric therapy, if present, EGD first rather than empiric PPI.
the full guideline text
Without alarm features, treat typical symptoms with an 8-week empiric PPI trial dosed 30-60 minutes before the first meal plus lifestyle modification; confirm GERD objectively (Lyon Consensus 2.0 AET, or erosive esophagitis LA-B/C/D or Barrett's on EGD) in refractory or atypical cases, and require EGD, off-PPI pH-impedance, and high-resolution manometry before any anti-reflux surgery or endoscopic therapy.
ACG 2022 / AGA 2022 CPU refractory GERD · reviewed 2026-04-22
Refinesrelative to this standard
Kulin D … Shah A · Alimentary Pharmacology & Therapeutics · IF 6.7 · PubMed ↗
Endoscopyguideline · Jul 14, 2026
Rigor81
Shift50
Practice90
Standing54
Signal score, how each part rates
Study rigorStrongguideline
ShiftGoodRefines the standard
Practice relevanceStrongBears on a bedside decision
Clinical takeawayGI clinicians involved in training should ensure trainees meet ESGE's structured competency framework before managing UGIB, including simulator training and supervised procedures. No direct clinical action for non-trainers: this is a guideline for endoscopy education.
What it foundThe ESGE position statement outlines 11 specific training requirements for managing acute upper gastrointestinal bleeding (UGIB), including preadoption technical skills, competency assessment, simulator training, and supervised procedures (minimum 20 with endoscopic stigmata of recent hemorrhage).
ContextRefines current training practices by providing a standardized, competency-based approach to UGIB management education, moving beyond numerical thresholds to skill assessment.
Today’s standard
Confirm peptic ulcer disease with EGD, biopsy all gastric ulcers to exclude malignancy, and test every PUD patient for H.
the full guideline text
pylori (eradicate if positive with test of cure ≥4 weeks post-therapy). Treat with PPI healing courses (duodenal ulcer 4 weeks, gastric ulcer 8 weeks with repeat EGD at 8-12 weeks to confirm healing), discontinue or mitigate NSAIDs, and manage bleeding ulcers via risk-stratified endoscopy with Forrest-based endoscopic hemostasis plus high-dose PPI. Restart anticoagulants/antiplatelets on a defined post-hemostasis schedule, and pursue ZES or refractory-ulcer workup in Hp-negative/NSAID-negative or non-healing cases.
New evidencecirrhosisMASLDalcohol-associated liver diseasebiomarker
Clinical takeawayFor decompensated MASLD/MetALD cirrhosis, prioritize PEth-confirmed alcohol abstinence (PEth >200 ng/mL indicates heavy chronic use), weight loss ≥10%, glycemic control, and variceal screening. Monitor for recompensation potential, especially in patients without large varices or MetALD etiology, where mortality is higher (22.6% vs. 12.0% in MASLD, p=0.011).
What it found18.6% of decompensated MASLD/MetALD cirrhosis patients achieved recompensation (Baveno VII criteria: absence of ascites, hepatic encephalopathy, variceal bleeding, and jaundice), with weight loss ≥10% (sHR 7.42), alcohol abstinence (sHR 1.87), glycemic control (sHR 1.43), and absence of large varices (sHR 1.97) independently associated with recompensation.
ContextConfirms that recompensation is achievable in a subset of decompensated MASLD/MetALD cirrhosis patients, extending prior evidence on metabolic and alcohol-related interventions beyond traditional decompensation management.
Today’s standard
Alcohol abstinence is the single most important intervention at any stage of ALD and should be paired with AUD pharmacotherapy (naltrexone, acamprosate, or baclofen selected by liver-disease severity) plus brief intervention and behavioral therapy.
the full guideline text
Severe alcoholic hepatitis (MELD ≥20 or Maddrey DF ≥32) warrants hospitalization, a mandatory pre-steroid infection screen, and a prednisolone 40 mg/d × 28-day trial with Lille score at Day 7 (≥0.45 = non-responder → stop steroids). Early liver transplant is considered for first-episode steroid non-responders meeting the 8-point Mathurin/ACCELERATE criteria, alongside universal admission thiamine and refeeding-syndrome prevention.
Clinical takeawayConsider laparoscopic surgery as an acceptable option for symptomatic, non-curable stage IV colon cancer (cecum to rectosigmoid, with stenosis/bleeding and 1-3 non-curable factors), given non-inferiority to open surgery in progression-free survival. Postoperative chemotherapy options include modified FOLFOX6 plus bevacizumab or capecitabine plus oxaliplatin with bevacizumab.
What it found3-year progression-free survival was 5.3% for open surgery vs 3.0% for laparoscopic surgery (HR 1.028, 95% CI 0.772-1.370; p for non-inferiority = 0.02), with 3-year overall survival 31.5% vs 28.5%. Grade ≥3 late complications occurred in 1.1% of open and 2.0% of laparoscopic surgeries.
ContextConfirms laparoscopic resection is non-inferior to open surgery in this population, aligning with prior evidence favoring minimally invasive approaches where feasible. The study was limited by chemotherapy administration without knowledge of microsatellite instability or RAS/BRAF mutation status.
Shiomi A … Inomata M · Diseases of the Colon and Rectum · IF 3.5 · PubMed ↗
New evidencecholangiocarcinomatranslationalbasic sciencebiomarker
Clinical takeawayConsider molecular profiling for intrahepatic cholangiocarcinoma patients to identify actionable targets such as fibroblast growth factor receptor 2 fusions and isocitrate dehydrogenase 1 or 2 mutations, which may guide targeted therapy decisions.
What it foundIntrahepatic cholangiocarcinomas include distinct molecular subtypes, with fibroblast growth factor receptor 2 fusions and isocitrate dehydrogenase 1 or 2 mutations present in relatively high percentages.
ContextThis refines current practice by highlighting the molecular heterogeneity of intrahepatic cholangiocarcinomas, which differs from the traditional surgical classification and emphasizes the importance of molecular subtyping for personalized treatment.
Today’s standard
Stage cholangiocarcinoma with multiphasic MRI/MRCP plus CT chest/abdomen/pelvis, obtain tissue via ERCP brush cytology with FISH, cholangioscopy-directed biopsy, or EUS-FNA, and manage through a multidisciplinary tumor board with treatment stratified by tumor location: resect (anatomic hepatectomy for intrahepatic, hemihepatectomy with bile duct resection for perihilar, Whipple for distal) with adjuvant capecitabine when resectable, and treat unresectable disease with gemcitabine plus cisplatin ± durvalumab first-line.
the full guideline text
Selected unresectable early-stage perihilar tumors may undergo neoadjuvant chemoradiation and liver transplant per the Mayo Clinic protocol, and jaundice or cholangitis is managed with biliary drainage (ERCP preferred over PTC).
NCCN 2024 / AASLD · reviewed 2026-04-23
Refinesrelative to this standard
Braconi C … Roberts LR · Gastroenterology · IF 25.1 · PubMed ↗
New evidenceesophageal cancerdysphagiaesophageal motility
Clinical takeawayIn the palliative setting for malignant esophageal obstruction, consider liquid nitrogen spray cryotherapy with balloon dilation (LNSC) as an alternative to fully covered self-expanding metal stents (FCSEMS), particularly for patients at higher risk of stent-related complications (migration, intolerance). LNSC showed fewer adverse events and a trend toward better dysphagia improvement, though clinical success did not reach statistical significance.
What it foundIn a retrospective cohort study of palliative therapy for malignant esophageal obstruction, clinical success (improvement/stabilization of dysphagia, defined as ≥1-point change on the Ogilvie scale) was 86.8% with liquid nitrogen spray cryotherapy with balloon dilation (LNSC) vs. 71.0% with fully covered self-expanding metal stents (FCSEMS) (p=0.057; OR 2.70, 95% CI 0.93-7.83). Median Ogilvie dysphagia score improved from 3 to 2 with FCSEMS (change -1, IQR 0 to -2) and from 3 to 1 with LNSC (change -2, IQR -1 to -2). Adverse events were significantly lower with LNSC (7.9% vs. 31.3%, p=0.037; aOR 0.21, 95% CI 0.06-0.76 favoring LNSC), classified by ASGE Lexicon severity. FCSEMS had higher rates of stent migration (19.1%) and intolerance requiring removal (7.6%), while LNSC had delayed stricture in 7.9%.
ContextThis retrospective study compares two palliative modalities for malignant esophageal obstruction, suggesting LNSC may be safer than FCSEMS with comparable efficacy. The findings challenge the assumption that FCSEMS is the default palliative option, but the study is limited by its retrospective design and small LNSC cohort (n=38).
Today’s standard
Diagnose esophageal cancer by EGD with biopsies, then stage with EUS for locoregional (T + N) extent and CT chest/abdomen/pelvis plus PET for distant disease, and refer all patients urgently to a multidisciplinary team (thoracic surgery, medical oncology, radiation oncology).
the full guideline text
Treat early T1a intramucosal adenocarcinoma with endoscopic eradication (EMR/ESD plus RFA); manage T1b and beyond with neoadjuvant chemoradiation followed by surgery (CROSS regimen) or definitive chemoradiation for proximal SCC, with palliative stenting, feeding tube, and nutrition support as needed.
NCCN / ASGE / ACG · reviewed 2026-04-22
Refinesrelative to this standard
Moond V … Thakkar S · Gastrointestinal Endoscopy · IF 8.0 · PubMed ↗
New evidencepancreatic cancerepidemiologyhealth services
Clinical takeawayConsider adjuvant therapy for PDAC patients over 80 years old after pancreatectomy, as it significantly improves survival, but assess individual tolerance and comorbidities. Do not routinely recommend neoadjuvant treatment in this age group based on current evidence, though interpret cautiously due to limited resectability-adjusted data.
What it foundIn PDAC patients over 80 years old, adjuvant therapy (AT) improved median survival to 30.7 months vs 23.7 months without AT (p < 0.001), while neoadjuvant treatment (NAT) showed no significant survival benefit compared to non-NAT (30.5 vs 29.0 months, p = 0.205) in resectability-adjusted analysis.
ContextChallenges the assumption that elderly PDAC patients uniformly benefit from neoadjuvant therapy, while confirming the value of adjuvant treatment in this population. NAT findings are from a resectability-adjusted subgroup (2017 onward) and require cautious interpretation.
Today’s standard
Diagnose with pancreas-protocol multiphasic CT plus EUS-FNA/FNB and CA 19-9, and obtain germline multi-gene panel testing with genetic counseling for ALL patients regardless of family history.
the full guideline text
Determine resectability at a multidisciplinary tumor board: resectable disease gets surgery (Whipple for head, distal pancreatectomy for body/tail) with adjuvant mFOLFIRINOX, borderline-resectable/locally advanced gets neoadjuvant chemotherapy ± chemoradiation, and metastatic disease gets first-line systemic therapy (mFOLFIRINOX, gemcitabine + nab-paclitaxel, or NALIRIFOX). Integrate supportive care including biliary drainage, PERT, pain control, VTE prophylaxis, and early palliative care.
Hashimoto D … Takeyama Y · Journal of Gastroenterology · IF 5.7 · PubMed ↗
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How we choose →
Every new paper across 48 vetted GI, hepatology, and general-medicine journals.
02
Screen
Drop what is not a study: letters, editorials, corrections, case reports. Classify the rest.
03
Anchor
Compare each paper to the guideline standard it touches, and record how far it moves it.
04
Verify
An adversarial second pass checks every claim against its cited source.
05
Vet
A physician editor stands behind each card before it publishes.
The first pass is AI-assisted; the judgment is human. Nothing is surfaced or emailed until
Simon Mathews, MD has reviewed it. We show the funnel, the evidence grade, and a primary-source link on
every paper because a source you can check is the only kind worth trusting. What was read but not
selected is listed at the foot of each issue, so the filter is inspectable rather than assumed.