Gastroenterology

EUS-CDS outperforms ERCP for malignant distal biliary obstruction, mainly by slashing postprocedural pancreatitis

In 220 patients with malignant distal biliary obstruction, primary EUS-guided choledochoduodenostomy (EUS-CDS) cut postprocedural pancreatitis from 7.3% to 1.8% versus ERCP (RR 0.25). EUS-CDS achieved higher technical success than ERCP (94.6% vs 78.9%) and required roughly half the procedure time. Overall adverse event rates, clinical success, stent patency, and mortality were similar between groups over 6 months. These data support EUS-CDS with lumen-apposing metal stents as a preferred primary drainage option in selected patients with a dilated bile duct. 1

Low-dose aspirin in IBD halves colorectal cancer risk and lowers mortality in nationwide cohort

In a Taiwanese propensity score–matched cohort of 5486 IBD patients, long-term aspirin use halved colorectal cancer risk (adjusted HR 0.42). Aspirin users also had lower all-cause mortality (adjusted HR 0.66) compared with nonusers over follow-up. Dose-response analyses suggested optimal chemopreventive intensity near 80 mg/day, with increasing benefit at higher cumulative exposure. These observational data support low-dose aspirin as a potential chemopreventive strategy in IBD, pending randomized validation and bleeding-risk assessment. 2

Diet quality modulates IBD inflammation via subtype-specific microbiome pathways

In 198 adults (CD, UC, and controls), IBD patients reported lower dietary diversity, fiber intake, and nutritional adequacy than controls. Microbiome diversity was lowest in Crohn’s disease, intermediate in UC, and correlated positively with fiber, fruits, vegetables, and nuts intake. Mediation analysis showed coffee, whole wheat bread, and healthier diets reduced Harvey–Bradshaw index in CD through specific bacteria and metabolites. In UC, Mediterranean-like diets, fruits, and coffee lowered CRP via greater microbial richness, reduced dysbiosis, and short-chain–fatty-acid–related functions. 3

When confounding is addressed, PPIs are not linked to upper GI cancer and may even be protective long term

This Israeli matched case-control study included 875 incident upper GI cancers and 8750 matched controls with detailed PPI exposure data. Unadjusted models showed strong positive associations between PPI use and cancer, driven largely by recent use and underlying symptoms. After excluding the year before diagnosis and adjusting for upper GI symptom diagnoses, no harmful association remained for PPI use. Remote PPI exposure (>3 years) was associated with lower cancer odds, for example omeprazole adjusted OR 0.62, with similar findings in gastric-cancer-only analyses. 4