30-Second Takeaway
- Liquid biopsy assays show high sensitivity for EOCRC and gastric cancer in symptomatic or high-risk groups.
- Faecal calprotectin and plasma proteomics begin to operationalize preclinical Crohn’s disease.
- Simple LSM and FIB-4 thresholds refine post-SVR HCC surveillance in cACLD.
Week ending December 13, 2025
Noninvasive GI risk stratification: liquid biopsy, ML scores, and pre-disease IBD states
Exosome-based liquid biopsy accurately detects early-onset colorectal cancer
The ENCODER multicenter study developed a 6-marker exosome/cell-free RNA panel for early-onset colorectal cancer detection in 542 individuals across four countries. In the independent testing cohort, sensitivity was 91.6% and specificity 87.5%, with an AUC of 95.6%. Sensitivity for screening-relevant stages I–III was 97.3%, and 61.5% for high-grade dysplasia lesions. Performance remained high in patients aged 20–35 years, supporting potential use in very young at-risk adults. Biomarker levels fell rapidly after surgery, becoming negative by day 4, suggesting utility for perioperative monitoring.
Faecal calprotectin screening identifies presymptomatic Crohn’s in first-degree relatives
In the PIONIR pre-screening phase, 331 asymptomatic first-degree relatives of Crohn’s patients underwent faecal calprotectin testing. Persistent elevation >70 µg/g on at least two tests occurred in roughly one-fifth of screened relatives and prompted panenteric endoscopy or ileocolonoscopy. Among 42 evaluated, 9 had endoscopic appearances compatible with presymptomatic Crohn’s, while 33 were categorized as potential pre-Crohn’s disease. A threshold >225 µg/g predicted presymptomatic Crohn’s with AUC 0.97, sensitivity 89%, and specificity 94%. About 22% with a single elevated value normalized on repeat, emphasizing the need for confirmatory testing before invasive workup.
Post-SVR HCV patients with LSM ≥20 kPa or FIB-4 ≥3.25 remain high-risk for HCC
This cohort included 425 patients with HCV-related compensated advanced chronic liver disease achieving sustained virological response. Over approximately 4 years, 26 patients (6%) developed hepatocellular carcinoma, an incidence of 15.3 per 1000 person-years. Baseline and 1-year liver stiffness ≥20 kPa were independently associated with incident HCC, with hazard ratios around 4.5. Baseline and 1-year FIB-4 ≥3.25 also strongly predicted HCC, with hazard ratios up to 7.79. Changes in LSM or FIB-4 were not predictive, indicating that absolute thresholds should guide surveillance intensity.
References
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Additional Reads
Optional additional studies from this edition.