Angiosarcomas originating from the gastrointestinal tract are rare but highly aggressive tumors with poor prognosis. These tumors can be misdiagnosed as benign and malignant gastrointestinal tract lesions. The definitive histological diagnosis of angiosarcomasis made by pathologists based on immunohistochemical analysis demonstrating cluster of differentiation 31 (CD31), factor VIII-related antigen (FVIIIRAg), erythroblast transformation specific related gene (ERG), and cluster of differentiation 34 (CD34). Angiosarcomas are treated with a single or multimodality approach that may include resection, radiotherapy, chemotherapy, and palliative care, depending on the stage of disease and the condition of the patient. No matter the treatment option, metastasis and death rates are substantially highin patients with angiosarcoma. In this context, a 59-year-old male with synchronous double primary angiosarcoma arising from the gastric and rectum who presented with the complaint of abdominal pain and distention to the outpatient clinic is presented in this case report, along with a brief literature review.

Background/Objectives: The HALP score is a simple immunonutritional index calculated from routine preoperative hemoglobin, albumin, lymphocyte, and platelet values. We evaluated its association with mortality after liver transplantation for non-malignant indications and its prognostic contribution when considered with the Model for End-stage Liver Disease (MELD) score. Methods: We retrospectively analyzed 194 adults who underwent liver transplantation for non-malignant disease at a single center between January 2015 and January 2025. The primary outcome was all-cause post-transplant death. The cohort-derived HALP threshold was used for exploratory Kaplan–Meier and Cox analyses, while continuous HALP was examined in sensitivity analyses. Censoring-adjusted cumulative/dynamic ROC analyses evaluated discrimination at 30 days, 90 days, 1 year, and 3 years. Results: Over a median observed follow-up of 1108 days, 43 recipients (22.2%) died. Non-survivors had lower HALP values than survivors [0.52 (0.39–0.67) vs. 0.77 (0.54–1.04); p < 0.001]. HALP had the highest observed conventional AUC among the evaluated markers for overall mortality (AUC 0.735; 95% CI 0.657–0.814); pairwise AUC differences were not formally tested. The exploratory threshold was 0.6786. Mortality occurred in 36.3% of the low-HALP group and 9.7% of the high-HALP group. After adjustment for MELD and albumin, high versus low HALP remained associated with lower mortality (HR 0.239; 95% CI 0.116–0.493; p < 0.001). HALP also showed consistent time-dependent discrimination across the four evaluated horizons (AUC 0.713–0.738). Conclusions: Lower preoperative HALP was associated with higher post-transplant mortality in this non-malignant liver transplant cohort. HALP may provide complementary risk information, but the cohort-derived threshold requires independent external validation before clinical use.

Background and aims: Serum vitamin B12 may increase during liver injury, but its association with clinical outcomes in acute hepatitis remains incompletely characterized. We evaluated admission vitamin B12 in relation to in-hospital outcomes and explored a combined vitamin B12–ferritin index. Methods: This retrospective single-center study included 186 adults hospitalized with acute hepatitis or acute liver injury during 2018–2025. Clinical outcomes were gastroenterology ward length of stay, liver transplantation, and in-hospital mortality. Additional exploratory analyses evaluated ICU admission, recorded encephalopathy, and a composite of ICU admission, transplantation, or death. Discrimination was assessed using receiver operating characteristic analysis. Eight vitamin B12 results exceeded the assay reporting limit of 4000 pg/mL; available numerical analyses used a top-coded representation, with these observations tied at the upper limit. Results: Nine patients (4.8%) died and one (0.5%) underwent transplantation; 20 (10.8%) met the exploratory composite outcome, all of whom required ICU care. Eleven patients had recorded hepatic encephalopathy. Vitamin B12 AUCs were 0.935 (95% CI 0.891–0.979) for mortality, 0.944 (0.904–0.984) for death or transplantation, and 0.938 (0.897–0.980) for the ICU-inclusive composite. Vitamin B12 was not associated with gastroenterology ward length of stay (Spearman ρ=0.017; P=0.818). The exploratory B12–Ferritin Index had a composite-outcome AUC of 0.892, providing no demonstrated improvement over vitamin B12. Conclusions: Higher admission vitamin B12 was associated with adverse in-hospital outcomes, but not with gastroenterology ward length of stay. The limited event count, assay upper-limit censoring, and uncertain timing of sampling relative to deterioration restrict prognostic interpretation. Prospective validation is required before clinical application.

Aims: Endoscopic submucosal dissection (ESD) is an established technique for the curative resection of large colorectal lesions; however, intraoperative bleeding remains a major technical challenge. Electrosurgical coagulation modes are modifiable procedural factors that may influence bleeding control and procedural efficiency. This study aimed to compare the clinical outcomes of Swift and Spray coagulation modes during colorectal ESD. Methods: This retrospective, single-center study included 594 consecutive patients who underwent colorectal ESD between January 2021 and December 2025. Patients were divided into the Spray and Swift coagulation groups according to the coagulation mode used during submucosal dissection. Procedural characteristics, intraoperative and delayed bleeding, perforation rates, and other adverse events were analyzed and compared between groups. Results: Baseline patient and lesion characteristics were comparable between the two groups. The mean procedure time was significantly shorter in the Spray coagulation group compared with the Swift coagulation group (42.2±23.7 vs 51.7±31.9 minutes, p

Non-anastomotic biliary strictures (NAS) represent one of the most challenging complications after living donor liver transplantation (LDLT) and are associated with heterogeneous outcomes following endoscopic retrograde cholangiopancreatography (ERCP). While ERCP is widely accepted as first-line therapy, the impact of stricture localization on endoscopic treatment success remains insufficiently defined. This study aimed to determine whether stricture location, as defined by the Buis classification, predicts ERCP outcomes in patients with NAS after LDLT. In this retrospective single-center study, LDLT recipients who underwent ERCP for post-transplant biliary strictures between January 2020 and January 2025 were evaluated. Among 124 patients with post-transplant biliary strictures, 44 patients (35.5%) with NAS constituted the study cohort and were analyzed separately from patients with anastomotic strictures (n=80). Pre-procedural magnetic resonance cholangiopancreatography was used to classify NAS according to the Buis classification. ERCP technical success, clinical success, recurrence, complications, and the need for percutaneous or surgical interventions were assessed and compared according to Buis-defined stricture locations. Overall ERCP success rates were significantly lower in patients with NAS compared with anastomotic strictures (63.6% vs. 88.7%, p<0.001). Within the NAS cohort, ERCP success varied markedly according to stricture location. Technical success rates were highest in Buis type 1 strictures (94.4%) and progressively declined in type 2 (74.0%), type 3 (40.0%), and type 4 lesions (33.3%) (p<0.001). Strictures involving intrahepatic regions, particularly C and D zones, were associated with significantly lower sustained clinical success and a higher need for adjunctive percutaneous interventions. Percutaneous guidewire-assisted access or biliary drainage was required in 61.3% of patients with intrahepatic involvement compared with 18.2% in extrahepatic-limited disease (p=0.002). Repeat ERCP sessions were more frequent in complex NAS patterns (median 5 vs. 2 sessions, p=0.004). Post-ERCP cholangitis occurred more commonly in NAS patients with multifocal intrahepatic disease (31.8%), whereas rates of pancreatitis (6.8%), bleeding (4.5%), and perforation (0%) remained low and comparable across locations. Sustained clinical success without recurrence was highest in extrahepatic-limited strictures (81.8%) and lowest in diffuse intrahepatic disease (22.2%). Stricture location is a major determinant of ERCP success in non-anastomotic biliary strictures after LDLT. Buis classification–based pre-procedural assessment provides valuable prognostic information and may guide individualized treatment strategy selection. Early consideration of percutaneous approaches in intrahepatic NAS may improve clinical outcomes, reduce repeated ERCP sessions, and minimize procedure-related complications.