Arturan Ibrahimli

Objective: To evaluate the use and impact of current surgical guidelines for chronic pancreatitis (CP) across Europe. Summary Background Data: Current guidelines recommend morphology-based surgery for CP, but international studies evaluating their use and impact are lacking. Methods: Post hoc analysis of the prospective multicenter ESCOPA study, including patients undergoing surgery for symptomatic CP at 22 centers in 13 countries (June 2021–November 2022), with 6-month follow-up. Patients were stratified by morphologic subtype: “isolated dilated main pancreatic duct (MPD),” “isolated enlarged pancreatic head (PH),” “combined dilated MPD and enlarged PH,” and “small duct disease.” Treatment was based on the European HaPanEU and International IAP-APA-JPS-EPC guidelines. Primary outcomes were 90-day major morbidity, mortality, and pain relief at 6 months. Practice variation was assessed, including a case-based survey. Results: Overall, 207 patients were included following surgery for CP, with 1.4% 90-day mortality and 72.6% pain relief. The surgical approach varied widely by morphologic subtype: duodenum-preserving pancreatic head resections (DPPHR) were most common for “combined dilated MPD and enlarged PH” (46.8%, P =0.016); whereas formal pancreatectomy predominated for “isolated dilated MPD” (63.3%, P =0.040) and “small duct disease” (66.0%, P =0.004). Guideline-concordant surgery (66%) was not associated with improved rates of major morbidity (12.9% vs. 18.8%, P =0.387), mortality (1.6% vs. 1.6%, P >0.999), or pain relief (75.3% vs. 66.7%, P =0.468). Outcomes were also comparable between drainage/parenchyma-preserving surgery and formal pancreatectomy. Survey findings confirmed practice variation, including the use of formal and V-shaped pancreatectomy for small duct disease. Conclusion: The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.

Gastric cancer (GC) is a leading cause of cancer-related mortality globally, with a 5-year survival rate remaining below 50% despite advancements in treatment. The standard care for locally advanced GC includes curative gastrectomy combined with perioperative chemotherapy. Different factors may influence chemotherapy responses, underscoring the need for biomarkers to tailor treatment. GP73, a Golgi-associated protein, has been implicated in cancer progression and prognosis, though its role in GC remains poorly understood. This study aimed to evaluate the association between pretreatment GP73 expression and overall survival (OS) and chemotherapy response in locally advanced GC patients. This was a retrospective study of 92 locally advanced GC patients who received neoadjuvant chemotherapy and underwent surgery between 2017 and 2024. GP73 expression was assessed in pretreatment biopsy samples via immunohistochemistry. Clinicopathological data were analyzed, and the correlation between GP73 expression and survival, as well as chemotherapy response, was evaluated. Tumor regression was graded using the Mandard Tumor Regression Grade scale. Continuous variables were demonstrated as median and interquartile range. High GP73 expression was observed in 64% of patients and correlated with poor tumor differentiation and reduced likelihood of radical surgery. Univariate analysis revealed that high GP73 expression was significantly associated with poorer overall survival (p < 0.001). Multivariate Cox model identified high GP73 status as an independent prognostic factor for poor OS (HR 4.53, p < 0.001). However, no significant correlation was found between GP73 expression and chemotherapy response (p = 0.32). This study suggests that high pretreatment GP73 expression is a marker of poor prognosis in locally advanced GC, linked to poorer survival and less favorable tumor characteristics. These results highlight the need for personalized treatment strategies incorporating GP73 and other clinicopathological factors to optimize outcomes for GC patients. The online version contains supplementary material available at 10.1186/s12876-026-04713-9.

Background: Desmoid tumor is a locally aggressive fibroblastic/myofibroblastic neoplasm frequently arising in deep soft tissues. Although it can be well circumscribed, a desmoid tumor generally infiltrates surrounding tissues and tends to recur locally without metastasizing. While commonly arising in the extremities and abdominal wall, primary hepatic involvement is exceedingly uncommon. Case Report: We report the case of a 20‐year‐old woman presenting with progressive jaundice, pruritus, weight loss, and abdominal pain. Imaging revealed a 3 × 3 cm hepatic hilar mass with bile duct dilation, initially suggestive of cholangiocarcinoma. Histopathological examination following a tru‐cut biopsy demonstrated features consistent with desmoid‐type fibromatosis, confirmed by nuclear β‐catenin positivity. Due to clinical deterioration, the patient underwent a left hemihepatectomy. The postoperative course was uneventful. Adjuvant tamoxifen therapy was administered, and follow‐up imaging showed no recurrence. Despite the hormonal changes of a subsequent pregnancy, no disease progression was observed. Conclusion: This report highlights an extremely rare presentation of desmoid tumor in the hepatic hilum, mimicking malignancy. It underscores the importance of histopathological confirmation, multidisciplinary management, and individualized follow‐up strategies, especially in women of reproductive age.

Objective: Near‐infrared autofluorescence (NIRAF) characteristics of parathyroid glands in primary hyperparathyroidism (pHPT) vary, with unclarity regarding the underlying mechanism. Similarly, ^99m Tc‐sestamibi uptake in diseased parathyroid glands is variable. There is a suggestion that oxyphilic cell content may influence both imaging modalities. This study aims to analyze the relationship between NIRAF imaging characteristics, ^99m Tc‐sestamibi uptake, and cellular composition in pHPT. Study Design: Retrospective analysis of an Institutional Review Board‐monitored prospective database. Setting: Single tertiary referral center. Methods: NIRAF characteristics of parathyroid glands of patients with pHPT between 2019 and 2024 were compared with ^99m Tc‐sestamibi scan findings from a prospective database. Using third‐party software, brightness intensity and heterogeneity index (HI) of the glands were calculated. A subgroup of parathyroid glands obtained from consecutive patients with pHPT in 2020 to 2021 underwent histological analysis. Results: A total of 428 patients with 638 diseased parathyroid glands were analyzed. Forty‐seven percent of the glands showed an uptake on ^99m Tc‐sestamibi scans. The brightness intensity of the NIRAF signals from parathyroid glands that were seen versus not seen on sestamibi was 2.1 versus 2.3 ( P = .002) and HI 0.18 versus 0.17 ( P = .35), respectively. On multivariate analysis, low autofluorescence intensity, high gland volume, and single adenoma were associated with detectability on ^99m Tc‐sestamibi scan ( P < .0001). Intraglandular adipose tissue content was lower in diseased glands that were detected on ^99m Tc‐sestamibi scans (0% vs 5%, P < .0001). Conclusion: Our findings indicate an inverse relationship between autofluorescence intensity and detectability on ^99m Tc‐sestamibi scans and a lack of correlation between different cell types and autofluorescence properties.

Background: Berardinelli–Seip syndrome is an infrequently seen and potentially fatal genetic disorder characterized by the absence of adipose tissue. Herein, we report a first‐in‐literature liver transplant done on a 7‐year‐old girl because of liver cirrhosis caused by the Berardinelli–Seip syndrome.Case Report: Physical examination showed prominent subdermal fat tissue loss and mild muscle hypertrophy, giving her a slim appearance, hirsutism, thick hair, a large head in contrast to the body, low anterior hairline, icterus, prominent facial contours, prominent mandibula, loss of buccal fat, low set ears, and large limbs. After the diagnosis, she admitted to our clinic because of variceal esophageal bleeding and increasing liver enzymes. Transplantation decision was made and orthothopic liver transplantation done by the surgery team.Discussion: Common causes of death in Berardinelli–Seip syndrome patients are infections and liver cirrhosis. The mean age of the patients was 27.1 at the time of death. There is no any established cure for congenital lipodystrophies so far. However, some symptomatic treatment methods are found to be helpful. The main point of the case report to be discussed is the liver transplantation done by our surgical team. There are no examples of any transplantation in Berardinelli–Seip syndrome patients, but several reports can be found of patients with kidney or liver failure.Conclusion: Berardinelli–Seip syndrome is a rare disorder with no cure but a chance of improving lifestyle and life expectancy. The transplantation option should be considered in young patients after a multidisciplinary review.

Digestive disease-caused death rates are significantly high in the South Caucasus region. The latest Global Burden of Disease (GBD) data are a subject of discussion and should lead to serious steps to be taken. Azerbaijan, Armenia, and Georgia are three countries in the region with similar cultures but different roots. The problem seems to affect every country in the region with slightly different rates. It is crucial to start investigations into the detailed cause and to take serious steps in order to prevent digestive disease-caused deaths in the region. This letter aims to arouse awareness of the problem in the region.