Mohamed AbdAlla Salman

Background: Endoscopic dilation is first‐line therapy for symptomatic benign esophageal strictures but remains operator‐dependent. Artificial intelligence (AI) could support assessment, risk stratification, and documentation; however, evidence from adjacent tasks is often mistaken for procedure‐specific validation. Aim: To map the evidence for AI in benign esophageal stricture dilation, assess transferability and methodological quality, and propose a translational pathway. Methods: We searched PubMed/MEDLINE, Scopus, and Europe PMC from inception through June 28, 2026, using prespecified searches in adults and children. Studies were classified by evidence provenance and appraised using design‐adapted domain considerations. Results: Within the search date and eligibility criteria, no AI system was identified that guided, monitored, or assessed dilation itself; two retrospective single‐center studies applied machine learning in the target population for other tasks. Adjacent neoplasia and engineering studies support component feasibility, while clinical cohorts identify candidate predictors. Functional lumen imaging probe technology provides non‐AI measurement and potential reference labels. Recurrent concerns included selected or retrospective samples, limited external validation, and high concern about applicability to dilation. Performance cannot be transferred across mismatched target tasks, acquisition physics, reference standards, populations or operating contexts, or consequences of error. Conclusion: Adjacent evidence can justify candidate components. Procedure‐specific calibration and validation remain necessary. Priorities are calibrated morphometric variables with prespecified reference standards and reproducible documentation using synchronized multimodal and outcome data. External validation should be followed by human‐controlled advisory testing before intraprocedural automation.

Background: Obesity increases the risk of chronic kidney disease and has been linked to proteinuria and albuminuria. Roux-en-Y gastric bypass (RYGB) plays a significant role in the treatment of obesity and type-2 diabetes mellitus (T2DM). This study aimed to examine the effect of RYGB on albuminuria in patients with morbid obesity and T2DM. Methods: This prospective, non-randomized, controlled study included two groups of patients with morbid obesity and T2DM; allocation was by patient preference rather than randomization. The RYGB Group (n = 64) underwent RYGB, and the Control Group (n = 58) received conservative (lifestyle) measures only. Micro- and macroalbuminuria were determined from spot urine albumin-to-creatinine ratio (uACR) on a first-morning urine sample. Patients were monitored for 15 months for remission and improvement of albuminuria. Groups were compared using the independent-sample t-test, Mann–Whitney test, or chi-square test as appropriate, and multivariable logistic regression was used to adjust for baseline differences. Results: The groups differed significantly at baseline in age, body mass index (BMI), HOMA-IR index, LDL-cholesterol, and ALT. RYGB achieved a significantly (p < 0.001) greater rate of albuminuria remission (57.8%) than diet control (24.1%). None of the baseline characteristics were associated with albuminuria remission except lower baseline triglyceride (p = 0.012) and LDL-cholesterol (p = 0.040) levels. Albuminuria remission was associated with significantly greater weight loss (p = 0.003) and lower BMI (p = 0.019), fasting plasma insulin (p = 0.014), HOMA-IR (p = 0.011), total cholesterol (p = 0.026), LDL-cholesterol (p = 0.001), ALT (p = 0.033), and AST (p = 0.009). After adjustment for baseline differences, RYGB remained the only independent predictor of albuminuria remission (adjusted odds ratio 3.27, 95% CI 1.23– 8.67; p = 0.017). Conclusion: In this non-randomized cohort, RYGB was associated with a significantly higher rate of albuminuria remission than lifestyle intervention over 15 months. Remission was associated with greater weight loss, lower plasma insulin, and improved insulin sensitivity rather than with diabetes remission itself. Randomized or better-adjusted prospective studies are warranted to confirm these findings.

Background: Esophageal varices (EVs) are a serious consequence of portal hypertension in chronic liver disease, particularly in hepatitis C virus (HCV) infection. While endoscopy remains the gold standard for diagnosis, there is growing interest in human platelet antigen (HPA) polymorphisms as potential non-invasive markers associated with EV development. Aim: To assess the association between HPA-1, HPA-2, and HPA-3 gene polymorphisms and the presence and severity of EVs in cirrhotic patients. Methods: In this case-control study, 150 patients with HCV-related cirrhosis were enrolled and divided into two groups based on endoscopic findings: 75 with EVs and 75 without. HPA genotyping was performed using polymerase chain reaction with sequence-specific primers (PCR-SSP). Statistical analysis included univariate and multivariate logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Results: The HPA-3 (ab + aa) genotypes were significantly associated with the presence of EVs in univariate analysis (OR: 2.244, 95% CI: 1.039– 4.847, p = 0.040), but this association was not maintained in multivariate analysis (OR: 0.679, 95% CI: 0.209– 2.211, p = 0.521). Higher grades of varices were significantly associated with HPA-1 (a), HPA-2 (b), and HPA-3 (a) alleles (p < 0.05). Platelet count and platelet count-to-spleen diameter (PC/SD) ratio were also significantly associated with EVs in univariate analysis (p < 0.001). In multivariate analysis, serum creatinine (OR: 0.234, 95% CI: 0.116– 0.473, p < 0.001) and portal vein diameter (OR: 1.542, 95% CI: 1.231– 1.930, p < 0.001) were identified as independent predictors of EVs. Conclusion: HPA polymorphisms were associated with the presence and severity of esophageal varices but were not independent predictors. Further multicenter prospective studies are needed to clarify their clinical utility.

Background Laparoscopic sleeve gastrectomy (LSG), which is increasing in popularity, is associated with certain complications. One of the most dreaded complications following LSG is a leakage from the staple line. Therefore, it is mandatory for surgeons to be alert to the risk factors of leakage and to be familiar with the leakage treatment choices. The aim of this study is to assess the post-LSG leakage rate, predictors of leakage, and present the treatment algorithm and its outcomes. Methods This retrospective cohort study included patients who underwent LSG at our institution during the period from 2018 to 2023. The diagnosis and management algorithm of leakage, as well as the outcomes of treatment, were assessed. Results Out of the included 1289 patients, leakage occurred in 14 patients (1.09%). All patients with leakage primarily received supporting treatment. Finally, the leak resolution rate was 92.86% (13/14). Leakage-management complications occurred in four patients (28.57%), all of whom required ICU admission. Regression analysis showed that higher BMI was the only significant predictor of non-resolution after initial treatment (p<0.001), while smoking (p = 0.002) and diabetes mellitus (p = 0.009) were the predictors of leakage occurrence. Conclusion The treatment algorithm used in the current study proved effective in managing post-LSG leakage, despite the occurrence of some complications. Computed tomography (CT) and endoscopy demonstrated a complementary diagnostic role in accurately identifying leaks. Smoking and diabetes mellitus were identified as predictors of leakage occurrence, while higher BMI was significantly associated with non-resolution of leakage after initial treatment.

Background: Acute uncomplicated appendicitis has traditionally been managed surgically, but recent trials suggest nonoperative treatment with antibiotics may be effective in selected adults. This meta-analysis compares long-term outcomes of antibiotics versus surgery and evaluates predictors of treatment failure, including the presence of an appendicolith. Methods: We systematically searched MEDLINE, Embase, CENTRAL, and clinical trial registries up to July 2024. We included randomized controlled trials (RCTs) comparing antibiotics versus appendectomy in adults with imaging-confirmed uncomplicated appendicitis. The primary outcome was 1-year treatment success. Secondary outcomes included complication rates, recurrence, and subgroup analysis by appendicolith. A meta-regression explored the relationship between appendicolith prevalence and treatment failure. Results: Seven RCTs (n=3164) were included. The 1-year treatment success rate was significantly lower in the antibiotics group (73.8%) versus surgery (98.1%) (RR 0.78, 95% CI: 0.73-0.84). Complication rates were comparable (RR 0.57, 95% CI: 0.29-1.12). Patients with appendicolith had a significantly higher failure rate (up to 46%). Meta-regression confirmed a positive correlation between appendicolith prevalence and antibiotic failure. Conclusions: Antibiotics can be effective in selected patients, but recurrence and treatment failure remain concerns, particularly in the presence of appendicolith. Appendectomy remains the definitive treatment. This meta-analysis, including the most recent trials and a novel meta-regression, provides timely insights for shared decision-making.

For early anastomotic strictures, conservative approaches involve parenteral nutrition and bowel rest, with most obstructions relieving spontaneously. Conservative approaches involve parenteral nutrition and bowel rest, with most obstructions relieving spontaneously. However, reoperation may be required for refractory cases. Corticosteroids may be effective in reducing inflammatory edema and restoring luminal patency. We report a case of a 50-year-old woman who developed small bowel obstruction following laparoscopic small bowel resection and anastomosis due to a strangulated femoral hernia. CT with oral and intravenous contrast suggested peri-anastomotic edema without evidence of leak or peritonitis. Conservative interventions in the form of nil per mouth, intravenous fluids, and nasogastric (NG) tube failed, and intravenous hydrocortisone, tapered over five days, was administered. This resulted in rapid improvement of bowel function without recurrence and avoidance of reoperation. This case highlights the potential role of short-term corticosteroid therapy as an adjunct to other conservative measures in carefully selected patients, particularly in the setting of partial obstruction without evidence of leak, to avoid the need for resurgery.

Corrigendum for the article Changes in Plasma Growth Differentiation Factor-15 After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients: A Prospective Study

Introduction: Colonic diverticular disease (diverticulosis) is a currently worldwide increasing gastrointestinal disorder with a particularly high prevalence in Western countries. The operative treatment of acute diverticulitis could be executed through open or laparoscopic techniques. A non-resectional procedure, namely laparoscopic peritoneal lavage (LPL) and drainage, has also been adopted as a less invasive treatment strategy to treat patients with diverticular perforation and purulent peritonitis.Aim: The present work was conducted to pool the currently available evidence regarding the safety and efficacy of LPL for the treatment of complicated perforated diverticulitis.Methods: The analysis included studies that compared patients who underwent LPL to those who underwent surgical resection. Fifteen articles were eligible for this review after searching the Scopus, PubMed Central, Cochrane Library, and Google Scholar databases.Results: The meta-analysis demonstrated that operative time and blood loss were significantly lower in the LPL group (p<0.001). The rates of overall morbidity and reoperation were comparable in the two groups (p = 0.57 and 0.74, respectively). There were significantly lower rates of cardiovascular (p < 0.001) and respiratory complications (p = 0.01), incisional/parastomal hernia formation (p = 0.02), ICU admission (p < 0.001), length of hospital stay (p < 0.001), permanent stoma formation (p < 0.001), and mortality (p < 0.001), and higher rates of sepsis (p = 0.03), intra-abdominal abscess formation (p < 0.001), and postoperative recurrence (p < 0.001) in the LPL group.Conclusions: Compared to the colon resection procedures for the treatment of complicated diverticulitis, laparoscopic peritoneal lavage had comparable overall morbidity and reoperation rates and lower rates of permanent stoma formation and mortality. Still, there is concern regarding the recurrence and intra-abdominal abscess formation.

Background: Roux-en-Y gastric bypass (RYGB) has long been one of the main metabolic and bariatric choices. It has been the most frequently used conversional procedure for a sleeve gastrectomy (SG) with suboptimal initial clinical response (SoCR) or recurrent weight gain (RWG). RYGB provides its effect through both dietary restriction and malabsorption, with efficient weight and metabolic control relating to the excluded gut. This study was designed to investigate the effect of long biliopancreatic limb (BPL) RYGB versus short BPL RYGB post-SoCR or RWG of SG on weight loss and metabolic profile. Patients and Methods: This is a randomized controlled trial that included patients who had undergone SG with SoCR or RWG and were equally enrolled in the long BPL (LRYGB-LBPL) group and the short BPL group (LRYGB-SBPL). The patients were followed for 1 year, and weight loss, metabolic profile, and postoperative complications were analyzed. The LRYGB-LBPL group showed statistically significant improvements in EBMIL%, HbA1c reduction, and HDL levels, while other outcomes showed no significant differences. This study’s findings suggest that extending the BPL length in conversional RYGB may enhance the procedure’s effectiveness in certain aspects of weight reduction and metabolic profile, although many outcomes were similar between groups.