Clinical Endoscopy

Systematic Review and Meta-Analysis

Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis: Vishali Moond, Pradeep Yarra, Mannat Bhatia, Sheza Malik, Vineel Malavarappu, Hassam Ali, Saurabh Chandan, Douglas G. Adler, Babu P. Mohan; Clin Endosc 2025;58(3):377-385. Published online March 31, 2025; DOI: https://doi.org/10.5946/ce.2024.211

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Background
/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line.
Methods
We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics.
Results
Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia.
Conclusions
Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

Citations

Citations to this article as recorded by

Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
Natalie J. Wilson, Nicholas Mordan, Cole Potrock, Nicholas J. Shaheen
American Journal of Gastroenterology.2026; 121(2): 302. CrossRef
Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef

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Systematic Review and Meta-analysis

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis: Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari; Clin Endosc 2025;58(2):240-252. Published online February 3, 2025; DOI: https://doi.org/10.5946/ce.2024.120

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

Citations

Citations to this article as recorded by

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Takato Maeda, Norihiro Hanabata, Shohei Igarashi, Masayoshi Ko, Koji Shimaya, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba
DEN Open.2026;[Epub] CrossRef
Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef
Minimally invasive, maximum impact: advances in the application of colonic stents
Filippos Koutroumpakis, Emmanuel Coronel
Current Opinion in Gastroenterology.2026; 42(1): 19. CrossRef
Causes of stenting complications for malignant colorectal stenosis in patients with acute obstructive colonic obstruction
Khosiyat T. Solijonova, I. A. Semenenko, A. E. Voynovskiy, P. A. Barbado Mamedova, O. V. Kanadashvili, G. V. Sinyavin, A. R. Iskandarova
Surgery and Oncology.2026; 16(1): 86. CrossRef
A Multicenter Prospective Study on the Safety and Efficacy of the New Low Axial Force Self‐Expandable Metallic Stent With Slim Delivery System for Malignant Colorectal Obstruction
Takeshi Mizumoto, Yuzuru Tamaru, Toshio Kuwai, Akihisa Matsuda, Shuji Saito, Satoshi Ikeda, Kazuhiro Hiyama, Hirofumi Chiba, Yorinobu Sumida, Takaaki Yoshikawa, Chikako Tokoro, Tetsuro Maruyama, Hiroyuki Isayama, Yoshihisa Saida
Digestive Endoscopy.2026;[Epub] CrossRef
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Adrian Marius Silaghi, Catalin Cicerone Grigorescu, Dragos Serban, Laura Carina Tribus, Vlad Denis Constantin, Ion Motofei, Dan Dumitrescu, Corneliu Tudor, Victor Dumitrescu, Bogdan Mihai Cristea, Tudor Mihai Badescu
Journal of Clinical Medicine.2026; 15(12): 4416. CrossRef
Bridging to surgery versus palliation in malignant colorectal obstruction: complication risks and mediation by clinical success
Huanhua Wu, Yuan Wan, Dan Li, Ketong Wu, Bo Zhang
Updates in Surgery.2026;[Epub] CrossRef
Colonic Stenting in Obstructed Colorectal Cancer as a Bridge to Surgery
Sarah Tham, Edwin Yang
Diseases of the Colon & Rectum.2026; 69(7): 1852. CrossRef
Colon stenting for colorectal cancer complicated by intestinal obstruction
S.A. Aliyev, E.S. Aliyev, N.M. Khidirova
P.A. Herzen Journal of Oncology.2026; 15(4): 109. CrossRef
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Nan Zun Teo, James Weiquan Li, James Chi Yung Ngu, Tiing Leong Ang
Singapore Medical Journal.2025; 66(Suppl 1): S38. CrossRef

6,120 View
223 Download
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