Gastroenterology

Abstinence-induced ‘recompensation’ in alcohol-related decompensated cirrhosis delivers striking survival benefits

Among 633 patients with decompensated alcohol-related cirrhosis who became abstinent, 31.1% achieved Baveno VII–defined hepatic recompensation over median 36 months. Recompensation required sustained abstinence, resolution of ascites and encephalopathy off therapy, no variceal bleeding, and restoration to Child-Pugh A or MELD <10. Early abstinence within 1 month of decompensation and absence of further decompensation independently increased recompensation probability. No recompensated, still-abstinent patient died of liver-related causes, and recompensation was strongly associated with markedly lower all-cause mortality. Hepatocellular carcinoma occurred only in non-recompensated patients, implying negligible residual HCC risk once recompensation is achieved and maintained. 1

Repeated biennial FIT maintains clinically relevant CRC yield; normal series does not justify early stopping

This study followed 2.81 million invitees through seven rounds of biennial FIT colorectal cancer screening from 2010 to 2023. Nearly 30% were consistently adherent, and colonoscopy completion after a positive FIT reached 87.3%. The first round provided the highest FIT positivity, positive predictive values, and cancer detection rates, with subsequent rounds showing lower but stable yields. By the seventh round, CRC positive predictive values remained 1.6–2.2% at median age 62–65, well below first-time screeners but still clinically relevant. The authors argue that, despite declining positive predictive values, ongoing detection supports against early cessation after consecutive negative FITs in adherent individuals. 2

EUS-guided coils plus cyanoacrylate vs TIPS for gastric varices: similar bleeding control, different complications

This multicenter retrospective study propensity-matched 124 cirrhotic patients with gastric variceal bleeding treated by EUS-guided coils plus cyanoacrylate or TIPS plus embolization. Technical success was 100% in both groups, with similar recurrent bleeding (11.29% vs 9.68%) and mortality (4.84% vs 1.61%). TIPS plus embolization caused more postprocedural abdominal pain and hepatic encephalopathy than EUS-guided therapy, and treatment type independently predicted encephalopathy risk. Conversely, ectopic embolism, all pulmonary, occurred more often after EUS-guided coils plus cyanoacrylate (9.68% vs 0%). 3

Reflex AST:ALT pathway substantially increases population-level cirrhosis detection

This Welsh quasi-experimental study evaluated a reflex AST testing and automated AST:ALT reporting pathway between 2010 and 2023. Among 78,917 individuals with liver disease, intervention regions showed significantly higher cirrhosis diagnosis rates than control regions. Incidence rate ratios for cirrhosis were 1.24 and 1.16 in the two intervention regions, indicating materially increased detection. Composite chronic liver disease diagnoses rose transiently in one region, suggesting an early front-loading of new case identification. 4