Cold snare's trade-off, enzymes fail for pancreatitis pain, and when to stop surveillance

The edition in brief

Five findings for gastroenterologists and hepatologists. An individual-patient meta-analysis of four trials (1,509 large non-pedunculated colorectal polyps) found cold snare resection far safer than hot endoscopic mucosal resection (major adverse events 1.7% vs 5.9%) but with more than double the residual or recurrent adenoma (26.5% vs 12.8%), worst in high-grade-dysplasia lesions. A double-blind trial from India found non-enteric-coated pancreatic enzyme replacement did not improve pain in chronic pancreatitis. An international Delphi consensus concluded MASLD raises colorectal cancer risk and called for earlier, risk-adapted screening and metabolic management. A pearl covers non-invasive liver fibrosis staging with FIB-4. The practice-changer is an AGA Clinical Practice Update on when to stop surveillance of pancreatic cystic lesions and hepatocellular carcinoma in older adults: it advises discontinuing surveillance of stable low-risk cysts after five years or where comorbidity precludes intervention, and stopping HCC surveillance when life expectancy is under one to two years, basing decisions on fibrosis and risk rather than age alone.