Background: There is very limited evidence on the causal effects of blood metabolites on pancreatitis risks. To reveal the causal associations between plasma metabolites and pancreatitis risks, we performed two-sample Mendelian randomization (MR) and Bayesian model averaging (MR-BMA) analyses in European ancestry.Methods: The summary-level statistics from two genome-wide association studies with 249 and 123 metabolic traits derived from two separate cohorts involving ~115,000 (UK Biobank) and ~25,000 individuals from European ancestry were used for the analyses. The summary statistics of four pancreatitis datasets from FinnGen R5 and two pancreatitis datasets from UK Biobank were exploited as the outcome. We first performed univariable MR analysis with different metabolic GWAS data on multiple pancreatitis datasets to demonstrate the association pattern among different metabolites categories. Next, we exploited the MR-BMA method to pinpoint the dominating factors on the increased risk of pancreatitis.Results: In the primary analysis with 249 traits, we found that plasma triglycerides were positively associated with pancreatitis risk. Intriguingly, a large number of traits associated with saturation or unsaturation of fatty acids also demonstrated causal associations. The replication study analyzing 123 metabolic traits suggested that bisallylic groups levels and omega-3 fatty acids were inversely correlated with pancreatitis risk. MR-BMA analyses indicated that the ratio of triglycerides to total lipid in various HDL particles played leading roles in pancreatitis susceptibility. In addition, the degree of unsaturation, the ratio of polyunsaturated fatty acids to monounsaturated fatty acids and the level of monounsaturated fatty acids showed causal associations with either decreased or increased pancreatitis susceptibility.Conclusions: Our MR study provided an atlas of causal associations of genetically predicted blood metabolites on pancreatitis, and offered genetic insights showing intervention in triglycerides and the supplementation of unsaturated fatty acids are potential strategies in the primary prevention of pancreatitis.

Gastroblastoma is an extremely rare stomach tumor that primarily presents in adolescent and early adulthood, with a biphasic cell morphology of epithelioid and spindle cells. In light of its similarity to other childhood blastomas, it has been named gastroblastoma. Few patients showed a potential of metastasis and recurrence, however, most of the reported cases were alive, with no evidence of the disease after surgical treatment. Commonly, MALAT1-GLI1 fusion has been considered to be the most relevant mutation. Herein, we present a case of an asymptomatic 58-year-old man who happened to find a submucosal gastric mass during a gastroscope and received endoscopic submucosal excavation (ESE). He turned out to have a gastroblastoma with a novel PTCH1::GLI2 fusion confirmed by Sanger sequencing. The patient was discharged two days after ESE without any complication and was recurrence-free during his one-year follow-up. According to the previous literature and our own experience, in cases with characteristic histopathology and immunohistochemistry patterns, a diagnosis of gastroblastoma should be considered even without a MALAT1-GLI1 fusion. Gastroblastoma pursues a favorable clinical outcome and endoscopic therapy could be an effective alternative treatment choice.

The malignant potential of pancreatic cystic lesions (PCLs) varies dramatically, leading to difficulties when making clinical decisions. This study aimed to develop noninvasive clinical‐radiomic models using preoperative CT images to predict the malignant potential of PCLs. It also investigates the biological mechanisms underlying these models. Patients from two retrospective and one prospective cohort, all undergoing surgical resection for PCLs, are divided into four datasets: training, internal test, external test, and prospective application sets. Eleven machine learning classifiers are employed to construct radiomic models based on selected features. Cyst fluid from the prospective cohort is collected for proteomic and lipidomic analysis. The radiomic models demonstrated high accuracy, with area under the receiver operating characteristic curves (AUCs) > 0.93 across the training (n = 262), internal test (n = 50), and external test (n = 50) sets. AUCs ranged from 0.92 to 0.96 for the prospective cohort (n = 34). Meanwhile, differentially‐expressed proteins and lipid molecules, along with their associated signaling pathways, are identified between high and low groups of clinical‐radiomic scores. This models can effectively and accurately predict the malignant potential of PCLs, with multi‐omics evidence suggesting the biological mechanisms involving secretion function and lipid metabolism underlying clinical‐radiomic models.

Afferent loop obstruction is a complication following upper gastrointestinal bypass surgeries [1] that can precipitate pancreatitis, cholangitis, or perforation, etc. Timely interventions are therefore required to avoid severe complications. A 61-year-old man who underwent a total gastrectomy and esophagojejunostomy (Roux-en-Y) for gastric signet ring cell carcinoma three years previously was admitted to our hospital with abdominal pain and vomiting. Computed tomography ([Fig. 1]) revealed dilation and gas-liquid levels of the afferent loop without signs of cancer recurrence. The gastroscope and guidewire were unable to proceed deeply to the afferent loop through the end-to-side jejuno-jejunal anastomosis because of significant angulation. Therefore, we attempted endoscopic ultrasound (EUS)-guided enteroenterostomy using a lumen-apposing metal stent (LAMS) to relieve afferent loop obstruction [Video 1], [Fig. 2]). A guidewire was placed into the efferent loop under gastroscopy. A linear echoendoscope (GF-UCT180; Olympus Medical Systems, Tokyo, Japan) was delivered to the efferent loop assisted with an endoloop along the guidewire, and the dilated afferent loop was displayed on the EUS image. A 15-mm LAMS (Hot AXIOS; Boston Scientific Corp., Marlborough, Massachusetts, USA) was deployed across the afferent and efferent loops. A large amount of intestinal fluid was extruded into the efferent lumen via the LAMS. The clinical complaints were resolved, and after three days, oral intake was recovered without vomiting or pain. After one week, CT ([Fig. 3]) showed improvement in the dilation of the afferent loop. No complications were seen during the follow-up. Therefore, EUS-guided enteroenterostomy with a LAMS is a technically feasible, effective, and minimally invasive procedure for afferent loop obstruction. Notably, EUS-guided gastroenterostomy is appropriate for surgical patients with a remnant stomach [1] [2] [3], whereas enteroenterostomy or external drainage are optional measures for patients undergoing total gastrectomy. Due to the advantages of no enteral fluid loss and better quality of life, EUS-guided enteroenterostomy should be the prioritized therapeutic approach for afferent loop obstruction in patients undergoing total gastrectomy. Endoscopy_UCTN_Code_TTT_1AS_2AG Article published online: 15 July 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

The endoscopic findings of gastric mucosa-associated lymphoid tissue (MALT) lymphoma are highly nonspecific and the sampling error or false-negative probabilities during conventional biopsy make its diagnosis more challenging. Confocal laser endomicroscopy is a novel technology which allows in vivo microscopic analysis of gastrointestinal mucosa. Here we present a case of gastric MALT lymphoma by targeted biopsy guided by magnifying endoscopy and probe-based confocal laser endomicroscopy.

Endoscopic interventions for postoperative esophageal strictures and fistulas are inherently challenging. The use of conventional self-expandable metallic stents has been restricted due to high migration rates. There has been no report about malignant esophageal stricture and postoperative fistula managed with a lumen-apposing metal stent (LAMS). We present a case of refractory postoperative anastomotic stricture and esophagobronchial fistula following esophagectomy. Endoscopic deployment of a LAMS effectively relieved the obstruction and sealed the fistula, with the patient tolerating the procedure well and experiencing sustained symptom resolution for 4 weeks. This case suggests the potential role of LAMS in maintaining luminal patency and sealing fistulas. Endoscopic ultrasound-guided LAMS placement should be a technically feasible, effective and minimally invasive approach for postoperative esophageal stenosis and fistula.