Gastroenterology

Early high-energy enteral feeding provides no benefit in acute pancreatitis and may increase complications

This multicenter double-blind RCT compared immediate high-energy enteral feeding (30 kcal/kg/day) with gradual escalation over 4 days in acute pancreatitis. Mortality or severe pancreatitis did not differ between high- and low-energy strategies in the modified intention-to-treat population. Unadjusted analyses suggested more organ failure and pain relapse with early high-energy feeding, though differences lost significance after multiplicity correction. The trial was stopped early for futility, indicating superiority of high-energy feeding was unlikely. These results support gradual escalation of enteral nutrition instead of aggressive early caloric targets in acute pancreatitis. 1

EUS-guided gastrojejunostomy outperforms alternatives for malignant gastric outlet obstruction palliation

This network meta-analysis pooled 8 RCTs (430 patients) comparing surgical GJ, stomach-partitioning GJ, EUS-GJ, and enteral stents for malignant gastric outlet obstruction. All other modalities were significantly inferior to EUS-GJ in clinical success, including both surgical techniques and enteral stents. Surgery was also inferior to enteral stenting for clinical success and was associated with longer hospital stay. Technical success and severe adverse events were similar, but enteral stents required substantially more reinterventions than EUS-GJ and surgery. EUS-GJ emerged as the preferred option where expertise exists, with enteral stents as a more accessible but less durable alternative. 2

Major GI bleeding worsens prognosis in cardiovascular disease, but early antithrombotic resumption improves outcomes

INTERBLEED prospectively enrolled 3,814 adults with cardiovascular disease, including 1,612 with major GI bleeding and 2,202 without. GI bleeding was independently associated with higher 12-month all-cause mortality and increased risk of recurrent GI bleeding, but not higher MACE overall. Resuming antithrombotics between 4–7 days or 8–30 days after bleeding reduced MACE compared with discontinuation or very delayed resumption. Any antithrombotic use after enrollment was associated with lower all-cause mortality without higher recurrent GI bleeding risk. These findings support structured antithrombotic reintroduction within 4–30 days once hemostasis and stability are achieved. 3

cfDNA fragmentome profiling enables noninvasive detection of liver disease and prognosis estimation

This study used whole-genome cfDNA fragmentome analysis in 1,576 individuals with liver disease and diverse other morbidities. A machine-learning classifier detected early liver disease, advanced fibrosis, and cirrhosis with high sensitivity in separate discovery and validation cohorts. The liver-disease classifier showed limited cross-reactivity with other conditions, indicating disease- and organ-specific fragmentomic signatures. Fragmentome and methylome alterations reflected liver and immune contributions and predicted overall survival in independent morbidity cohorts. These results suggest cfDNA liquid biopsy could support cirrhosis screening and risk stratification pending clinical translation and validation. 4