Gabriel Allo

Background: Reliable prognostic biomarkers for treatment response in patients with biliary tract cancer (BTC) who receive chemoimmunotherapy are still lacking. The objective of this study was to evaluate the potential of early C‐reactive protein (CRP) kinetics as a tool for predicting survival in these patients. Methods: The authors retrospectively analyzed patients with BTC who received chemoimmunotherapy at eight tertiary centers and evaluated CRP kinetic models with regard of their prognostic ability within the first 3 months of treatment. Results: Progression‐free survival (PFS) and overall survival (OS) differed according to CRP dynamics. The median PFS was not reached (95% confidence interval [CI], not reached to not reached) for patients with consistently normal CRP, 11.0 months (95% CI, 6.7–15.3 months) for those with initially normal CRP, 6.0 months (95% CI, 3.6–8.4 months) for those with subsequent CRP normalization, and 2.0 months (95% CI, 0.9–3.1 months) for those with persistently elevated CRP. The corresponding median OS was not reached (95% CI, not reached to not reached) for patients with consistently normal CRP, 26 months (95% CI,15.5–36.5 months) for those with initially normal CRP, 23 months (95% CI, 12.0–34.0 months) for those with subsequent normalization, and 9.0 months (95% CI, 6.3–11.7 months) for those with persistently elevated CRP (PFS, log‐rank p < .001; OS, p = .005). The overall response rates were 50%, 33.3%, 36.0%, and 21.2%, respectively. The prognostic performance of this model remained stable when subgroup definitions were based on 6‐week cutoffs. Conclusions: CRP kinetics may be a valuable prognostic tool for early response assessment in patients with BTC who receive chemoimmunotherapy. However, these findings require prospective external validation in larger cohorts.

In this real-world cohort of 231 patients receiving chimeric antigen receptor (CAR) T-cell therapy, hepatotoxicity occurred in 58% of patients, predominantly as transient transaminase elevations, and...

Aim: Upper gastrointestinal bleeding (UGIB) is associated with an unfavorable outcome in cancer patients. In patients with biliary tract cancer (BTC), data on the incidence, management, and prognostic implications of UGIB are limited. This study investigated the prevalence, treatment efficacy, and prognostic factors associated with UGIB in BTC. Methods: This retrospective observational study included all patients with BTC and UGIB, treated at a tertiary care center between 2010 and 2023. Clinical, laboratory, endoscopic, and survival data were obtained from hospital records. Outcomes included short‐term rebleeding within 14 days and overall survival. Results: Among 1033 BTC patients, 37 (3.6%) experienced UGIB. The predominant etiologies were tumor‐associated bleeding due to tumor infiltration (27.0%), variceal bleeding (21.6%), and ulcer bleeding (16.2%). Endoscopic therapy was performed in 43.2% of cases, achieving hemostasis in 78.6% of actively bleeding patients. Short‐term rebleeding occurred in 28.6%. The 30‐day mortality following UGIB was 35.7%. Tumor‐associated UGIB correlated with significantly increased mortality (HR = 2.83, 95% CI 1.1–7.27, p = 0.030) and markedly reduced overall survival (28 vs. 90 days, p = 0.022). Conclusions: UGIB is a rare but severe complication in BTC. Tumor‐associated UGIB was associated with poor prognosis and markedly shortened survival, underscoring the necessity for careful clinical assessment and close follow‐up in this high‐risk cohort.

10.1055/a-2679-6906 We congratulate Brand et al. on their recent study investigating the use of a photometric capsule to stratify patients with suspected nonvariceal upper gastrointestinal bleeding [1]. The concept of a device that reliably detects blood in the gastrointestinal tract and supports timing of inpatient endoscopy is certainly appealing. However, its optimal use in everyday clinical practice to save healthcare resources still needs a more precise definition. The authors demonstrate convincingly that a negative photometric capsule examination (PCE) allows identification of low-risk patients who can undergo non-emergency endoscopy within 48–96 hours, without worsening outcome. The negative prognostic value of 100%, as well as avoidance of 95% of early endoscopies are striking results. Consequently, the use of PCE might have the potential to significantly decrease weekend on-call service demands by reducing the requirement for emergency endoscopies within 24 hours. However, this benefit primarily applies to weekend patients presenting between Friday night and early Sunday morning, while on weekdays, early endoscopy during regular working hours, followed by timely discharge, has already been proven to be safe and cost-effective for stable patients with upper gastrointestinal bleeding [2]. Consequently, any savings from reduced weekend on-call services must be weighed against the additional costs of the capsule device, hospitalization, monitoring, medication, and the potential risk of nosocomial infections while awaiting endoscopy. Looking forward, the potential of PCE may lie not in deferring inpatient endoscopy but rather in enabling safe outpatient management. As PCE appears to be a valuable tool for risk stratification, future studies should explore whether a negative PCE can reliably identify patients who could be safely discharged with outpatient endoscopy, even if their Glasgow–Blatchford Score is >1. This strategy may offer more substantial cost savings by reducing unnecessary hospitalization and emergency endoscopy. Article published online: 22 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about its negative impact on patients with chronic liver diseases by contributing to hepatic decompensations such as acute variceal bleeding (AVB). This study aimed to evaluate the impact of the COVID-19 pandemic on clinical outcomes in cirrhotic patients with AVB in Germany. Methods: This retrospective national multicenter study compared patients with cirrhosis and AVB treated at four tertiary care centers in Germany before (2016–2020) and during the pandemic (2020–2022). The primary endpoint was 6-week mortality, and secondary outcomes included infections, transfusion requirement and rebleeding. Results: The baseline characteristics of the 247 patients were largely comparable between the two groups, however metabolic dysfunction-associated steatotic liver disease was more prevalent during the pandemic compared to the pre-pandemic period (12.5% vs. 4.8%, p = 0.048). Only one patient tested positive for SARS-CoV-2. Six-week mortality (32.2% vs. 30.1%; p = 0.767) and rebleeding rates (22.8% vs. 22.3%; p = 1.000) did not differ significantly between groups. Interestingly, intubation rates, length of stay on the intensive care unit, post AVB infection rates and types of infection were also comparable (all p > 0.05), while transjugular intrahepatic portosystemic shunt placement (TIPS) after bleeding was performed more frequently during the pandemic (23.2% vs. 11.3%, p = 0.019). Conclusions: Relevant patient-related AVB outcomes were unaffected during the COVID-19 pandemic. These findings suggest the resilience of critical AVB management practices in German tertiary centers. The increased use of TIPS and MASLD prevalence during the pandemic may reflect evolving clinical practice and patient profiles warranting further investigation.

Summary: The most common functional challenge after Ivor-Lewis esophagectomy is delayed emptying of the gastric conduit. One of the primary endoscopic treatment strategies is performing a pyloric dilatation. However, the effects of dilation have never been scientifically proven. A novel method to detect pyloric distensibility (DI) is the endoluminal functional lumen imaging probe (EndoFlip™). The purpose of this study is to analyze the effects of pyloric dilatation using an EndoFlip™ measurement. Forty-nine patients after Ivor-Lewis esophagectomy were included retrospectively from June 2021 to August 2023 at University Hospital Cologne, Germany. All patients suffered from early delayed emptying of the gastric conduit (DGCE). DI was measured before and after endoscopic dilatation using EndoFlip™ at 40, 45, and 50 mL balloon filling. The Student’s t-test and Chi-Squared test were used. All tests were two-sided, with statistical significance set at P ≤ 0.05. EndoFlip™ measurement and pyloric dilatation were feasible in all patients and no adverse events were recorded. DI proved to be smaller in patients before dilatation compared to patients after dilatation. For 40, 45, and 50 mL balloon filling, the mean DI was 5.0 versus 10.0, 4.5 versus 9.1, and 4.0 and 7.5 mm2/mmHg before versus after dilatation. The differences were significant in all balloon fillings. Endoscopic dilatation of the pylorus is the primary endoscopic treatment strategy in patients suffering from DGCE. Currently, the success of dilatation can only be measured with clinical data. This study could demonstrate that EndoFlip™ can be used as an additional diagnostic tool to rate the success of pyloric dilatation.

Background: Combined Immuno‐chemotherapy consisting of gemcitabine, cisplatin and the programmed death‐ligand one inhibitor durvalumab (GCD) is the new standard of care for patients with biliary tract cancers (BTC) based on positive results of the TOPAZ‐1 study.Objective: We here evaluated the efficacy and safety of GCD for BTC in a German multicenter real‐world patient cohort.Methods: Patients with BTC treated with GCD from 9 German centers were included. Clinicopathological baseline parameters, overall survival (OS), response rate and adverse events (AEs) were retrospectively analyzed. The prognostic impact was determined by Kaplan–Meier analyses and Cox regression models.Results: A total of 165 patients treated with GCD between 2021 and 2024 were included in the study. Median OS and median progression‐free survival were 14 months (95% CI 10.3–17.7) and 8 months (95% CI 6.8–9.2), respectively. The best overall response rate was 28.5% and disease control rate was 65.5%. While extrahepatic and intrahepatic BTC showed similar outcomes, mOS was significantly shorter in patients with gall bladder cancer (GB‐CA) with 9 months (95% CI 5.5–12.4; p = 0.02). In univariate analyses age ≥70 years, Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥1, status post cholecystectomy, GB‐CA and high baseline CRP values were significantly associated with OS. ECOG PS ≥ 1 and GB‐CA remained independent prognostic factors for OS in multivariable cox regression analysis. AEs have been reported in 130 patients (78.8%), including 149 grade 3–4 AEs (25.5%). One patient died of severe infectious pneumonia. Immune‐related (ir)AEs occurred in 17 patients (10.3%), including 9 grade 3–4 irAEs (2.2%), which led to treatment interruption in 4 patients.Conclusions: Immuno‐chemotherapy in patients with BTC was feasible, effective and safe in a real‐life scenario. Our results were comparable to the phase 3 clinical trial results (TOPAZ‐1). Reduced efficacy was noted in patients with GB‐CA and/or a reduced performance status that warrants further investigation.

LINKED CONTENT: This article is linked to He et al papers. To view these articles, visit https://doi.org/10.1111/apt.18093 and https://doi.org/10.1111/apt.18132