Adenoma and Sessile Serrated Polyp Detection Rates in Adults Using GLP-1 Receptor Agonists.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly used for managing diabetes and obesity. While they improve glycemic control, they also delay gastrointestinal motility, potentially leading to inadequate bowel preparation for colonoscopy, which can increase the risk of missed lesions. This study aims to evaluate the impact of GLP-1RA use on the quality of bowel preparation and on adenoma and sessile serrated adenoma (SSP) polyp detection.

Spray Cryotherapy Esophageal Consortium (SPEC) Consensus Recommendations for Liquid Nitrogen Spray Cryotherapy in Barrett's Esophagus and Esophageal Cancer using a Modified Delphi Process.

Introduction: The study aimed to develop consensus recommendations for the safe and appropriate use of liquid nitrogen spray cryotherapy (LNSC) in Barrett's esophagus (BE) and esophageal cancer (EC).

Methods: Statements were initially formulated and grouped into categories of indications, training, pre-, intra-, and post-procedure recommendations, frequency/timing of repeat procedures, and contraindications. Two investigators assessed the strength of the evidence for each statement using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Stereotactic ablative radiation therapy for extracranial metastases from malignant melanoma: An international multi-institutional analysis.

Objective: To report on local control (LC), toxicity, and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for extracranial metastases from malignant melanoma.

Methods: The RSSearch Patient Registry was searched for patients with extracranial melanoma metastases treated with SABR. LC was defined as the time from completion of SABR to the date of last radiographic follow-up with either stability or decrease in size of the treated metastasis or the date at which lesion growth was radiographically confirmed per RECIST criteria.

Beyond GOG258 and PORTEC3: A National Cancer Database analysis of adjuvant therapy for improved survival in high-risk endometrial cancer.

Purpose: High-risk Endometrial Cancer (EC) treatment decisions have been informed by two large, randomized trials: GOG-258 and PORTEC-3. Directly comparing these studies to determine the optimal treatment strategy remains challenging as neither included all three arms of interest: chemotherapy alone, chemotherapy combined with radiation, and radiation therapy alone. This study addresses this gap by analyzing National Cancer Database (NCDB) data to evaluate the comparative effectiveness of chemotherapy alone, chemoradiotherapy, and radiation therapy alone.

Long-term outcomes of EUS-guided antegrade intervention with transmural and transanastomotic plastic stenting for benign bilioenteric anastomotic strictures (with video).

Background And Objectives: Recurrence of benign bilioenteric anastomotic strictures (BAS) is common after enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP), percutaneous intervention, or EUS-guided antegrade intervention (EUS-AI). This study evaluated the long-term outcomes of EUS-AI with transmural and transanastomotic stenting (TAS) following EUS-guided hepaticogastrostomy (HGS) in BAS.

Methods: Consecutive patients with BAS undergoing EUS-AI with or without TAS after failed deep enteroscopy between January 2016 and June 2023 were retrospectively analyzed.

Biologically Informed Decision-Making for PMRT in pT3N0M0 Luminal Breast Cancers (Protocol MF22-02): International Multicenter Real-World Data.

Background: Current guidelines do not list definitive recommendations for postmastectomy radiation therapy (PMRT) in patients with luminal pT3N0M0 breast cancer (BC). Increased data suggests de-escalation of radiation therapy (RT) in genomically defined biologically favorable luminal BCs. The goal of this study is to determine whether PMRT can be safely omitted for this specific subgroup of patients.

Journey to complete remission of dysplasia and intestinal metaplasia after ESD and EMR of Barrett's esophagus-related neoplasia.

Background And Study Aims: Although endoscopic submucosal dissection (ESD) is associated with higher en-bloc and R0 resection rates than cap-assisted endoscopic mucosal resection (cEMR), its comparative impact on achieving complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) in BE endoscopic eradication therapy (EET) is not well defined. We aimed to compare the journey of patients from initial endoscopic resection (ER) with ESD and cEMR to achieving CRD and CRIM.

Patients And Methods: Patients undergoing ESD or cEMR followed by ablation for BE neoplasia at two academic institutions in the United States were included.

Twice daily template-based interstitial brachytherapy for gynecologic cancers: What is the optimal dose?

Introduction: Several factors of template-based interstitial brachytherapy in gynecologic cancers, including large tumor size, invasion into adjacent organs or fistula, dose heterogeneity, and twice daily fractionation cause inherent dose-escalation effects, potentially increasing toxicity. This study reports a single-institutional dose escalation experience in twice daily template-based interstitial brachytherapy treatments to demonstrate tumor control and toxicity outcomes, with the hypothesis that with image-based planning dose-escalation with interstitial brachytherapy is safe and efficacious.

Methods: Patients treated with template-based interstitial brachytherapy at our institution from 2006 to 2022 were identified.

The Role of Adjuvant Chemotherapy in Endometrial Cancer Following Preoperative Neoadjuvant Chemoradiation Therapy.

Objectives: In patients with surgically unresectable disease who undergo neoadjuvant chemoradiation (CRT) or neoadjuvant radiation therapy (RT) before surgical staging, little is known about whether adjuvant chemotherapy confers a survival benefit. We aim to explore the survival impact of adjuvant chemotherapy in patients with locally advanced endometrial cancer who undergo neoadjuvant CRT or RT.

Methods: A retrospective, single-institution review of all patients from April 2008 to October 2021 who underwent neoadjuvant RT or CRT before surgical resection of endometrial cancer was performed.

Tumor-to-Breast Volume Ratio and Outcomes After Oncoplastic Breast Conserving Surgery.

Introduction: Oncoplastic breast conserving surgery (OBCS) can offer oncologically safe and cosmetically satisfying results for patients with breast cancer. However, the relative oncologic safety of high tumor-volume oncoplastic resections is largely unknown. This study investigated the association between tumor-to-breast volume ratio, recurrence, and surgical complications in OBCS.

Fuzzy Analytical Hierarchy Process-based Risk Priority Number Approach in Failure Modes and Effects Analysis for Magnetic Resonance Imaging-guided High-dose-rate Brachytherapy for Gynecologic Cancer.

Purpose: Failure modes and effects analysis (FMEA) is commonly used to identify, prioritize, and mitigate potential failure modes (FMs) by assigning a risk priority number (RPN). However, traditional RPN-based FMEA has limitations, particularly when handling the degree of interdependency within processes. To address this, we propose a fuzzy analytical hierarchy process (AHP)-based RPN method, designed to prioritize FMs by accurately weighing risk factors in magnetic resonance imaging (MRI)-guided high-dose-rate brachytherapy (BT) for gynecologic (GYN) cancer.

Optimal Sequencing in Same-Day Bidirectional Endoscopy: A Tertiary US Healthcare Center Experience.

Background: Same-day performance of esophagogastroduodenoscopy (EGD) and colonoscopy is called bidirectional endoscopy (BDE). BDE is commonly performed, but the optimal sequence for which procedure to do first is not well established. This is the first study in the US to investigate the optimal sequence for BDE.

Dose finding, bioavailability, and PK-PD of oral triapine with concurrent chemoradiation for locally advanced cervical cancer and vaginal cancer (ETCTN 9892).

Background: The addition of IV triapine to chemoradiation appeared active in phase I and II studies but drug delivery is cumbersome. We examined PO triapine with cisplatin chemoradiation.

Methods: We implemented a 3 + 3 design for PO triapine dose escalation with expansion, starting at 100 mg, five days a week for five weeks while receiving radiation with weekly IV cisplatin for locally advanced cervical or vaginal cancer.

Efficacy and Safety of Cryoablation in Barrett's Esophagus and Comparison with Radiofrequency Ablation: A Meta-Analysis.

Background: The mainstay approach in endoscopic eradication therapy (EET) for dysplastic Barrett's esophagus (BE) includes the endoscopic resection of visible lesions, accompanied by ablation of the residual metaplastic epithelium. Cryoablation therapy is one such emerging ablation technique in this field. This systematic review with a meta-analysis aims to accumulate pooled data on cryoablation performance in the treatment of patients with BE and to compare this technique to the standard of care radiofrequency ablation (RFA).

Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma: What is an Adequate Margin?

Objective: We aim to explore whether the surgical tumor free margin is important for overall survival (OS) and local control in patients who undergo neoadjuvant radiation (RT) for vulvar cancer.

Methods: A retrospective review from 2004 to 2021 of patients who underwent RT followed by surgical resection was performed. Patients were categorized into groups based on margin status (no residual disease, >8 mm, close margins defined as 1 to 7 mm, or positive).

Lymph node dissection after neoadjuvant chemotherapy improves overall survival in clinical stage III endometrial cancer.

Objective: To investigate whether performing a lymph node dissection during hysterectomy improves overall survival in patients with clinical stage III endometrial cancer who received neoadjuvant chemotherapy.

Methods: The National Cancer Database was queried to identify all patients with clinical stage III endometrial cancer who had undergone pre-operative chemotherapy as first course of treatment followed by hysterectomy with or without lymph node dissection between the years 2004 and 2020. Univariable and multivariable models were performed to investigate prognostic factors on overall survival.

The Clinical Utility of a 7-Gene Biosignature on Radiation Therapy Decision Making in Patients with Ductal Carcinoma In Situ Following Breast-Conserving Surgery: An Updated Analysis of the DCISionRT PREDICT Study.

Background: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy (RT) is a standard treatment for ductal carcinoma in situ (DCIS). A low-risk patient subset that does not benefit from RT has not yet been clearly identified. The DCISionRT test provides a clinically validated decision score (DS), which is prognostic of 10-year in-breast recurrence rates (invasive and non-invasive) and is also predictive of RT benefit.

Clinical Outcomes and Safety of Upper Endoscopy While on Glucagon-Like Peptide-1 Receptor Agonists.

Glucose-like peptide-1-receptor agonists (GLP-1RAs) have become integral to the management of type 2 diabetes and obesity. GLP-1RAs work in part through delaying gastric emptying, raising concerns about retained gastric contents (RGC) during esophagogastroduodenoscopy (EGD). The American Society of Anesthesiologists currently recommends holding GLP-1RAs for 1 dosing cycle before elective procedures, however, the American Gastroenterological Association (AGA) advocates proceeding with endoscopy in asymptomatic patients adhering to standard perioperative protocols without medication withholding and suggests implementing a liquid diet the day before endoscopy in lieu of stopping the medication.

Can an in-person hands-on applicator-based teaching session improve trainee knowledge and comfort with complex gynecologic brachytherapy?

Introduction: With the emergence of imaged-based planning and hybrid applicators the complexity of gynecologic brachytherapy has dramatically increased. Despite the known advantages of brachytherapy, notable national declines in utilization of brachytherapy have been documented. Clearly improved education in the sphere of gynecologic brachytherapy is needed.

Comparative Effectiveness of Virtual Versus In-person Visits for Abdominal Pain During the COVID-19 Pandemic.

Background And Aims: The COVID-19 pandemic has highlighted the importance of telemedicine in improving healthcare access and reducing costs. This study aimed to assess order compliance in the virtual versus in-person setting for the initial evaluation of abdominal pain (AP) prior to and during the pandemic.

Methods: A retrospective evaluation of virtual and in-person outpatient gastroenterology visits for AP were identified through natural language processing from January 2019 through September 2021 at the Cleveland Clinic main campus and regional hospitals in Ohio.

The role of obesity in treatment planning for early-stage cervical cancer.

Objectives: Optimal management of obese patients with early-stage cervical cancer is debated despite evidence of non-inferior survival in obese patients undergoing radical hysterectomy with pelvic lymphadenectomy (RH) compared to primary radiation with or without radiosensitizing chemotherapy (RT). Objectives included describing patient factors affecting disposition to RH versus RT; comparing RH outcomes for obese (BMI >30 mg/m) and non-obese patients; and comparing differences in recurrence free survival (RFS) and overall survival (OS).

Methods: This was a single institution cohort study of all cervical cancer patients who underwent RH or were candidates for RH based on clinical stage.

Treatment of Internal Mammary Nodes is Associated With Improved Overall Survival in Breast Cancer: A Meta-Analysis.

Introduction: The role of internal mammary nodal irradiation (IMNI) as a component of regional nodal radiotherapy is a controversial issue in breast radiation oncology with conflicting results presented in recent landmark trials. We thus created a meta-analysis of available data to better ascertain the potential benefit of IMNI. We hypothesize that with the increased power available within a meta-analysis, IMNI will prove to improve overall survival (OS) in breast cancer.

Intracranial intraoperative radiotherapy (IORT): evaluation of electrocorticography and peri-operative seizure risk.

Background: Intra-operative radiotherapy (IORT) for brain metastases (BMs) and primary brain tumors has emerged as an adjuvant radiation modality that allows for consolidation of care into a single anesthetic episode with surgical resection. Yet, there is a paucity of data regarding the impact that IORT may have on peri-operative and long-term seizure risk.

Methods: A retrospective analysis of patients receiving IORT during tumor resection was performed via registry including data regarding peri-operative anti-seizure medications and anesthetic agents.

Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study.

Background And Objectives: An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma.

Methods: Patient data (N = 309) were collected from 14 international radiosurgery centers. The median patient age was 50 years (range 11-87 years).