BACKGROUND Randomized trials have compared primary transmural endoscopic ultrasound-guided biliary drainage with endoscopic retrograde cholangiopancreatography. However, differences in devices, expertise, patient selection, and outcome definitions limit broad conclusions. AIM To compare the efficacy and safety of primary ultrasound-guided vs retrograde biliary drainage. METHODS PubMed, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization registry records indexed using CENTRAL were searched on August 6, 2026, without language restrictions. We included randomized trials comparing primary transmural ultrasound-guided vs retrograde drainage for malignant distal biliary obstruction. Risk ratios were calculated using Paule-Mandel random effects and modified Hartung-Knapp confidence intervals. Pancreatitis was examined using continuity-corrected risk ratio, Peto odds ratio, exact odds ratio, and absolute risk difference. RESULTS The six trials included 739 participants. Technical success did not differ significantly (risk ratio 1.08, 95% confidence interval 0.96-1.22; I 2 = 64%), and clinical success was comparable (risk ratio 1.01, 95% confidence interval 0.95-1.07; I 2 = 0%). Procedure-related adverse events were similar (risk ratio 0.83, 95% confidence interval 0.53-1.31). Pancreatitis occurred in 2/374 (0.5%) vs 24/365 (6.6%) participants (risk ratio 0.20, 95% confidence interval 0.05-0.77; Peto odds ratio 0.17, 95% confidence interval 0.08-0.36). The absolute risk difference was -6.0%, corresponding to a number needed to treat of 17. Stent dysfunction or re-intervention was numerically less frequent, with its confidence interval including no effect. CONCLUSION Ultrasound-guided drainage reduces pancreatitis and is a reasonable alternative for selected patients in expert centers; however, it is not a universal replacement for retrograde drainage.
BACKGROUND Rouvière’s sulcus is an important anatomic structure that may protect against bile duct injuries and guide parenchymal transection during hepatectomies. However, there are still multifarious classifications in use that prevent proper analysis of existing data. AIM To identify all existing data using a uniform classification of Rouvière’s sulcus. METHODS This study had two parts. First, a 5-year observational study of all consecutive cholecystectomies in an Eastern Caribbean nation was performed. Data were categorized using a standardized classification identifying open, closed, slit and scar-type variants. The second part of the study was a systematic literature review of medical archiving platforms, searching Rouvière’s sulcus variants. In instances where other classifications were used, we studied the descriptions and published images in order to categorize data using the standardized classification. The raw data were used to calculate global prevalence for each variant, which was then compared to that in our population using χ 2 tests to compare contingency tables in SPSS version 20 (IBM Corp, Armonk, NY, United States). Fisher exact tests were used for values < 5. A P value < 0.05 was considered significant. RESULTS Data were collected from 356 persons in the observational study, revealing that Rouvière’s sulcus was present in 296 (83.2%) individuals. We encountered 140 open-type, 69 closed-types, 65 slit-types and 22 scar-type variants. There were 57 relevant articles from the systematic review that reported 76.88% global prevalence of Rouvière’s sulcus in 25196 persons. This was significantly lower than the prevalence of Rouvière’s sulcus in our population (83.2%; P = 0.005306). The Eastern Caribbean population was unique for having significantly lower proportions of open-type variants (39.33% vs 56.69%; P < 0001), and greater proportions of slit-type variants (18.26% vs 14.15%; P = 0.033397). The global prevalence of the closed-type Rouvière’s sulcus (23.64% vs 19.38%; P = 0.061988) and the scar-type Rouvière’s sulcus (8.11% vs 6.18%; P = 0.188331) were similar to that in Eastern Caribbean. CONCLUSION Although persons of Eastern Caribbean descent have a greater prevalence of Rouvière’s sulcus than global statistics, there are important differences in the proportion of variants. Surgeons practicing in these regions must be aware of these differences, particularly the lower prevalence of the “classic” open-type sulcus, as the other variants are more difficult to recognize intra-operatively.
BACKGROUND Periodontitis is a chronic inflammatory disease driven by dysbiotic oral biofilms and host immune response. Emerging evidence suggests that gut microbiota imbalance may influence periodontal inflammation through systemic immune and metabolic pathways. The overall strength of this association remains unclear. AIM To evaluate the association between gut microbiota dysbiosis and periodontal disease severity. METHODS This systematic review and meta-analysis followed PRISMA guidelines. PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library were searched to January 31, 2026. Eligible studies included clinical and observational studies assessing gut microbiota and periodontal parameters. Two reviewers performed selection, extraction, and bias assessment. Random effects models calculated pooled standardized mean differences and odds ratios with 95 percent confidence intervals. Heterogeneity was assessed using I 2. RESULTS Twenty-nine studies with 3876 participants were included. Periodontitis patients showed reduced gut microbial diversity compared with controls, the pooled standardized mean difference for alpha diversity was -0.76 (95%CI: -1.01 to -0.50), P < 0.001. Altered Firmicutes to Bacteroidetes ratio increased odds of severe periodontitis, odds ratio 2.18 (95%CI: 1.55 to 3.06), P < 0.001. Pro-inflammatory taxa increased, while butyrate producing genera decreased. C-reactive protein, interleukin 6, tumor necrosis factor alpha, and interleukin 17 were elevated. CONCLUSION Gut microbiota dysbiosis shows a significant association with periodontal disease severity and systemic inflammation.
