INTRODUCTION Endoscopic ultrasound (EUS) was initially developed as a diagnostic modality but has in the past years gained a role in various therapeutic applications involving the gastrointestinal tract and surrounding structures. The advent of lumen apposing metal stents (LAMS) revolutionized the field of therapeutic EUS. LAMS enable the creation of an anastomotic conduit between the gastrointestinal tract wall and adjacent fluid-filled cavities or other parts of the gastrointestinal tract. AREAS COVERED In this review, we discuss the history of the development of the LAMS, the concept behind the LAMS, commercially available LAMS, indications of LAMS, and LAMS related adverse events. We conducted a literature search of the PubMed database for studies published between January 2011 and august 2025 using combinations of relevant keywords. EXPERT OPINION The availability of LAMS has revolutionized the scope of interventional EUS in various gastrointestinal conditions. As new indications continue to evolve, obtaining informed consent, maintaining proficiency in interventional EUS, and anticipating potential complications are the key to clinical success.
INTRODUCTION:Standard enteral formulas are widely used in pediatric practice but may be associated with gastrointestinal (GI) intolerance, limited food diversity, and caregiver dissatisfaction. Growing interest in whole-food feeding has led to increased use of blenderized tube feeds and commercially prepared food-based enteral formulas (FBEFs), although definitions, indications, and implementation strategies remain heterogeneous. AREAS COVERED:This expert opinion review summarizes available evidence and practice-based insights from an international, multidisciplinary panel of physicians and registered dieticians on the use of real-food enteral nutrition in pediatric clinical practice. The article was informed by a narrative literature review and a structured expert discussion. Key domains addressed include the definition of FBEF, physiological and psychosocial benefits, clinical indications, administration route and feeding modality, caregiver and cultural considerations, monitoring, transition to adult care, comparison with homemade blenderized tube feeding, and the emerging role of fully plant-based enteral formulas. EXPERT OPINION:The current evidence, although largely derived from small observational studies, together with real-life experience in clinical practice, suggests that FBEFs are well tolerated and may improve reflux, retching, vomiting, bowel habits, and, additionally, caregiver-reported satisfaction. FBEFs offer standardized nutritional composition, food safety, shelf stability, and a lower preparation burden, while still aligning with families' preferences for food-derived ingredients. In our opinion, FBEFs represent a valuable option or children requiring long-term enteral feeding, particularly those with intolerance to standard formulas, provided that product selection, monitoring, and caregiver education are individualized.
INTRODUCTION:Cholestasis prevents optimal treatment of perihilar cholangiocarcinoma (pCCA). To counteract this, biliary drainage (BD) has long been regarded as mandatory prior to any treatment. However, increasing evidence has highlighted the risks associated with BD, notably cholangitis, indicating that while often necessary, drainage requires careful clinical judgment. AREAS COVERED:This narrative literature review outlines the historical development of BD and its rationales, including the restoration of liver function, a prerequisite for liver hypertrophy-inducing procedures, and improvement of performance status. The review also addresses its drawbacks, particularly the risk of cholangitis due to bacterial colonization of the biliary tree and summarizes the evidence shaping contemporary clinical practice. EXPERT OPINION:Once regarded as mandatory, BD can no longer be justified as a routine intervention for every pCCA patient, given the associated risks. Undrained partial hepatectomy should be considered in patients with moderate bilirubin levels, adequate future liver remnant volume, absence of cholangitis, normal performance status, and preserved liver and renal function. Still, this applies to only a minority of patients. Similarly, systemic therapy may be feasible without BD in highly selected patients. Future research should focus on defining selection criteria, investigating new biomarkers of cholestasis, and refining drainage techniques to minimize complications of BD.
