Faculty Bibliography

BACKGROUND AND AIMS/OBJECTIVE:) imaging to quantify mucosal perfusion and its association with ulcer healing. METHODS:values were compared across regions and between healed and non-healed ulcers. RESULTS:. CONCLUSION/CONCLUSIONS:thresholds and define its role in clinical decision-making after RYGB.

The liver plays an important role in cardiovascular disease by amplifying systemic inflammation, while the underlying mechanisms remain to be defined. Soluble epoxide hydrolase (sEH) is a pro-inflammatory enzyme, and pharmacological inhibition of sEH was shown to protect against various inflammatory diseases. In this study, we have identified a novel role of the liver, through expression of sEH, in the pathogenesis of abdominal aortic aneurysm (AAA). sEH expression and activity were markedly higher in mouse liver compared with aorta and further increased in the context of AAA. Pharmacological inhibition or hepatocyte-specific disruption of sEH prevented AAA formation in two animal models of AAA (angiotensin II infusion and aortic calcium chloride application in male mice), concomitant with reduced expression of complement C3 and serum amyloid A, liver-derived inflammatory factors causally linked to AAA formation. Interestingly, data from co-incubation of liver ex vivo with aorta identified galectin-3 secreted from the aneurysm-prone aorta that activates sEH in the liver. We also determined 12,13-dihydroxyoctadecenoic acid (DiHOME) and various circulating pro-inflammatory cytokines as a downstream mechanism potentially associated with hepatic sEH in the context of AAA. These novel findings provide direct evidence that bidirectional crosstalk between aorta and liver contributes to AAA via hepatic sEH.

INTRODUCTION/BACKGROUND:We sought to perform the first validation of the American Society for Gastrointestinal Endoscopy complexity grades for esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). METHODS:We used Pearson correlation coefficients to measure the correlation between complexity grades and both work relative value units and malpractice relative value units (RVUs) obtained from the Centers for Medicare and Medicaid Services. RESULTS:There was moderate to strong positive correlation between complexity grades and both work relative value unit and malpractice RVU for a range of EGD, colonoscopy, and EUS procedures. This was not observed for ERCP procedures, with many RVU values remaining low for even the most complex ERCP cases. DISCUSSION/CONCLUSIONS:The American Society for Gastrointestinal Endoscopy's endoscopic complexity grading system for EGD, colonoscopy, and EUS seems to correlate reasonably well with other recognized metrics of complexity and risk. The complexity levels for ERCP may be valid, but there is poor correlation with how these procedures are valued by Medicare.

BACKGROUND/UNASSIGNED:Endoscopic submucosal dissection (ESD) is an established therapy for superficial esophageal lesions. Endoscopic ultrasound (EUS) is commonly used to assess submucosal invasion (SMI) and lymphadenopathy. METHOD/UNASSIGNED:Retrospective cohort of patients with esophageal and gastroesophageal junction lesions undergoing EUS before ESD (2014-2025). EUS T stage was compared with final pathology to evaluate detection of SMI. RESULTS/UNASSIGNED: = 7). CONCLUSION/UNASSIGNED:EUS showed limited reliability for pre-ESD staging of esophageal/GEJ lesions, with suboptimal performance in detecting SMI. As depth of invasion determines therapeutic strategy, EUS should not be used in isolation but rather alongside expert endoscopic assessment and biopsy. ESD remains central by offering definitive treatment and precise histologic staging.

BACKGROUND AND AIMS:Stenosis after laparoscopic sleeve gastrectomy (LSG) is common. Endoscopic balloon dilation is first-line therapy but often requires multiple sessions and may fail. Surgical conversion to Roux-en-Y gastric bypass is effective but invasive. Endoscopic tunneled stricturotomy offers a less-invasive alternative. We compared clinical success, adverse events, and length of stay between endoscopic and surgical treatments for post-LSG stenosis. METHODS:This retrospective, matched cohort study included patients treated with endoscopic stricturotomy (ENDO) group or Roux-en-Y gastric bypass conversion (SURG) group, matched 1:1 by age, sex, body mass index, time from LSG, and previous treatments. The Fisher exact and t tests were used. RESULTS:In 24 patients (12/group), the rate of adverse events was lower in ENDO (0% vs 41.7%, P = .04). Length of stay was shorter in ENDO (1.21 vs 2.57 days, P = .03). Clinical success was 83.3% (ENDO) versus 100% (SURG) (P = .48). CONCLUSIONS:Endoscopic stricturotomy is a safe, effective alternative for refractory post-LSG stenosis.

DESCRIPTION/UNASSIGNED:A work group representing the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) prepared a new VA/DoD clinical practice guideline (CPG) for tobacco use treatment. This article provides a synopsis of the 2026 CPG, which addresses use of commercially available tobacco and nicotine products. METHODS/UNASSIGNED:A multidisciplinary work group developed 19 key questions on clinical topics of highest priority for the VA and DoD populations. Published literature from 1 January 2014 to 10 December 2024 was systematically reviewed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. Recommendations were made by consensus and informed by evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, which assesses quality of evidence and balances benefits and harms, patient preferences, and feasibility. The final document incorporated input from peer review by an external group of experts. RECOMMENDATIONS/UNASSIGNED:The 2026 guideline includes 32 recommendations across 10 topic areas. Key recommendations for increasing abstinence from combustible tobacco include recommending motivational interviewing to increase engagement in treatment of tobacco and nicotine use (strong) and use of U.S. Food and Drug Administration-approved pharmacotherapies (strong), with varenicline recommended over monotherapy with other agents (strong), combination nicotine replacement therapy ([NRT] for example, patch plus lozenge) recommended over NRT monotherapy (single agent) (strong), and extending use of bupropion sustained release beyond 12 weeks (weak). Other key recommendations include varenicline for increasing abstinence from smokeless tobacco (strong) and electronic nicotine delivery systems (weak) and use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days (weak).

BACKGROUND:Fewer than 20% of donated lungs are transplanted. We examined the impacts of donor management and recovery at an in-hospital donor care unit (DCU) established in 2021 versus the donor hospital (DH). METHODS:(P/F ratio) were examined as a hypothesized effect modifier. We projected the national impact of improved utilization on lung transplant volume. RESULTS:After adjusting for donor differences, lung utilization was 88% higher (aRR: 1.88; 95% CI: 1.40, 2.53) in the DCU versus DH setting. Median P/F ratio increased from 275 to 348 mmHg (p<0.0001) in the DCU and explained approximately 38% of the improvement in lung utilization. Non-lung organ utilization was either improved or non-inferior in the DCU. Lung graft survival and pulmonary function were similar for recipients of DCU versus DH-managed donors. Nationally, an 88% improvement in lung utilization among donors not currently transferred to a DCU could theoretically result in ≥300 more lung transplants per year. CONCLUSIONS:Lung transplantation can be nearly doubled through lung-centric donor management in a DCU, without sacrificing recipient outcomes nor the utilization of other organs. Donor management practices to optimize lung utilization should be proliferated by establishing more DCUs and, where feasible, applying lung-centric protocols in donor hospitals.

The liver is the primary site of metastasis in pancreatic ductal adenocarcinoma (PDAC), and liver metastases are a major cause of mortality^1,2. Nutrient availability in the metastatic niche influences colonization efficiency; however, the metabolic heterogeneity of disseminated tumour cells can also reshape the local microenvironment^3-5. Loss of phosphoglycerate dehydrogenase (PHGDH), the rate-limiting enzyme in de novo serine biosynthesis, is observed in nearly 40% of PDACs, and renders these cells dependent on exogenous serine (exSer)⁶. Although a neuron-tumour metabolic cross-talk supports exSer-dependent PDAC cells at the primary site⁶, it remains unclear how these cells adapt to the metastatic liver niche. Here we show that exSer-dependent PDAC cells reprogram neighbouring hepatocytes through a CXCL5-CXCR2 axis. Activation of CXCR2 in hepatocytes promotes PI3K-AKT signalling, leading to the sequestration of FOXO3A in the cytoplasm and derepression of PHGDH transcription, thereby enhancing serine production in hepatocytes. This hepatocyte-derived serine supports the outgrowth of exSer-dependent PDAC liver metastases. Accordingly, genetic or pharmacological inhibition of individual nodes within the CXCL5-CXCR2-PI3K-AKT-FOXO3A axis, or hepatocyte-specific deletion of Phgdh or Cxcr2, markedly reduces the liver-metastasis burden in mice and prolongs survival, particularly when dietary serine is restricted. Our findings reveal a cancer cell-hepatocyte metabolic cross-talk and identify therapeutic targets for exSer-dependent PDAC liver metastases.