One to two in five ampullary adenomas are already cancer, and six biopsies is the minimum

The edition in brief

Five findings for the gastroenterology and hepatology desk. An AGA Clinical Practice Update on ampullary neoplasms, built from expert review rather than systematic evidence, advises side-viewing duodenoscopy for assessment, at least six biopsies because 20–40% of ampullary adenomas already harbour malignancy, endoscopic ultrasound for staging in lesions being considered for resection, and en bloc snare papillectomy with prophylactic pancreatic stenting, rectal NSAIDs and aggressive hydration; intraductal extension beyond 1 cm should go to surgery, and surveillance runs at 3, 6 and 12 months then annually for five years. In the MYR301 phase 3 trial, 150 patients with chronic hepatitis D treated with bulevirtide for up to 144 weeks reached virologic response in 73–92% at end of treatment, but by 96 weeks after stopping this fell to about 30% across arms, with sustained undetectable HDV RNA in 23 of 64 patients who were undetectable at the end of treatment; post-treatment hepatic serious adverse events occurred in 14% and resolved in 85% of those. A Cochrane review of 10 trials and 1,349 participants found thymosin-α1 associated with lower all-cause mortality (risk ratio 0.53, 95% CI 0.29–0.96) and serious adverse events (0.72, 0.53–0.99), but graded the evidence very low for every outcome except serious adverse events. The Rome Foundation's paediatric global study of 8,000 children across four countries found disorders of gut-brain interaction in 28.0%, falling from about 41% at ages 0–3 to 22% in adolescents. And a Gut review proposes exposure-driven accelerated carcinogenesis to explain early-onset and post-colonoscopy colorectal cancer.