Lesions of ampulla of Vater are uncommon and often discovered incidentally. Most adenomatous lesions can be treated by endoscopic papillectomy which can obviate the need for surgery. Data regarding effectiveness for endoscopic papillectomy especially for larger lesions is lacking. We aimed to assess the impact of polyp size on recurrence on subsequent ERCP procedures following initial papillectomy. After approval of the study from local IRB, patients with diagnosis of ampullary lesion who were treated with endoscopic papillectomy at our quaternary care referral center were included in the study from January 2017 to December 2024. Charts were obtained using the relevant billing and ICD10 codes from electronic medical records and were then individually reviewed by a group of researchers to extract relevant information. Patients were divided into two groups based on polyp size; ≤ 20 mm and > 20 mm for comparison. A total of 71 patients underwent endoscopic papillectomy at our institute during this time period. 37 had polyps less than 20 mm (smaller polyp group), and 34 had polyps ≥ 20 mm (larger polyp group). Patients with larger polyps were older with a mean age of 67.5 ± 10.2 compared to 57.8 ± 16.0 in the smaller polyp group (p = 0.019). There was no significant difference between race and sex of the two groups. Hot snare was the most employed tool in both groups, with occasional use of cold snare in conjunction (44.1

The incidence of cholecystitis and cholelithiasis is higher in patients with cirrhosis. Decompensated liver disease places them at higher risk for morbidity and mortality from cholecystectomy, and many providers prefer non-surgical approaches. We compared cystic duct stenting (CDS) to other modalities mainly percutaneous cholecystostomy (PC), cholecystectomy, and medical management. We performed a retrospective cohort study. After obtaining IRB approval, we gathered records of all patients at our health care system who had acute cholecystitis on presentation and an underlying diagnosis of cirrhosis with MELD-Na ≥ 15 from 2015 to 2022. Outcomes included 30-day mortality, 60-day mortality, 1-year mortality, 30-day readmission, and worsening liver disease as characterized by increasing MELD-Na by ≥ 3 or new onset ascites or encephalopathy following management. 67 patients met our inclusion criteria. 19 patients had CDS and were compared to 48 patients managed by other modalities, i.e., cholecystectomy (n = 12), PC (n = 17) and medical management (n = 19). There was no difference in demographics, etiology of cirrhosis, or mean MELD-Na between the two groups. We noticed a significant difference in the protective effect of CDS on one-month readmission rate and liver function with RR of 0.56 (0.4–0.9, P = 0.038) and RR 0.49 (CI 0.3–0.8, P = 0.01), respectively. The only complication in the cystic duct stent group was one case of pancreatitis (5.2

Background:The safety and technical success of endoscopic ultrasound-guided antegrade treatment (EUS-AG) compared to balloon enteroscopy-assisted endoscopic cholangiopancreatography (BE-ERCP) for choledocholithiasis in Roux-en-Y gastrectomy has not been well documented. We performed a systematic review and meta-analysis to assess the safety and efficacy of the 2 procedures. Methods:A systematic search of multiple databases was undertaken through January 25, 2024, to identify relevant studies comparing the 2 procedures. Standard meta-analysis methods were employed using a random-effects model. For each outcome, risk-ratio (RR), 95% confidence interval (CI), and P-values were generated. P<0.05 was considered significant. Heterogeneity was assessed using the I 2 statistic. Results:Three studies with 795 patients (95 in the EUS-AG group and 700 in the BE-ERCP group) were included. The technical success rate was similar between EUS-AG and BE-ERCP (RR 1.08, 95%CI 0.84-1.38; P=0.57; I 2=56%). The overall rate of adverse effects was higher in the BE-ERCP group than in the EUS-AG group (RR 1.95, 95%CI 1.21-3.15; P=0.006; I 2=0 %). Rates of clinical success, pancreatitis, perforation, and bile peritonitis were similar between the 2 procedure techniques. Conclusions:Our analysis showed no distinct advantage in using one technique over the other for patients with Roux-en-Y anatomy in achieving technical and clinical success. However, the incidence of adverse effects was greater in the BE-ERCP group than in the EUS-AG group.

Esophageal food impaction (EFI) is a common complaint of patients presenting to the emergency department. EFI requires urgent evaluation by the gastroenterology service and often necessitates esophagogastroduodenoscopy (EGD) for management. Timing of EGD in patients with EFI that does not improve with medical management remains a point of contention. We aim to evaluate outcomes of EFI in the context of time to intervention. A retrospective cohort study was performed among patients who presented to a multicenter health system with EFI between 2018 and 2022. Patients with EFI that did not resolve after medical management and required EGD were included. Outcome analysis evaluated rates of complications and hospitalizations. Two hundred eighty sis unique patient presentations were included. 175 (61.2

BACKGROUND:Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease with a significant risk of developing hepatocellular carcinoma (HCC). Recent clinical evidence indicates the potential benefits of statins in cancer chemoprevention and therapeutics. However, it is still unclear if these drugs can lower the specific risk of HCC among patients with MASLD. AIM:To investigate the impact of statin use on the risk of HCC development in patients with MASLD. METHODS:A systematic review and meta-analysis of all the studies was performed that measured the effect of statin use on HCC occurrence in patients with MASLD. The difference in HCC risk between statin users and non-users was calculated among MASLD patients. We also evaluated the risk difference between lipophilic versus hydrophilic statins and the effect of cumulative dose on HCC risk reduction. RESULTS:A total of four studies consisting of 291684 patients were included. MASLD patients on statin therapy had a 60% lower pooled risk of developing HCC compared to the non-statin group [relative risk (RR) = 0.40, 95%CI: 0.31-0.53, I 2 = 16.5%]. Patients taking lipophilic statins had a reduced risk of HCC (RR = 0.42, 95%CI: 0.28-0.64), whereas those on hydrophilic statins had not shown the risk reduction (RR = 0.57, 95%CI: 0.27-1.20). The higher (> 600) cumulative defined daily doses (cDDD) had a 70% reduced risk of HCC (RR = 0.30, 95%CI: 0.21-0.43). There was a 29% (RR = 0.71, 95%CI: 0.55-0.91) and 43% (RR = 0.57, 95%CI: 0.40-0.82) decreased risk in patients receiving 300-599 cDDD and 30-299 cDDD, respectively. CONCLUSION:Statin use lowers the risk of HCC in patients with MASLD. The higher cDDD and lipophilicity of statins correlate with the HCC risk reduction.

Key Clinical MessageEndoscopic ultrasonography (EUS) is crucial in diagnosing gastrointestinal sarcoidosis, especially when patients exhibit refractory abdominal symptoms. Our case highlights the significance of considering sarcoidosis in such cases and emphasizes the utility of EUS for accurate diagnosis and guiding appropriate treatment.AbstractGastrointestinal sarcoidosis is a rare and challenging manifestation of sarcoidosis that often presents with nonspecific abdominal symptoms, making diagnosis a complex process. We report the case of a 46‐year‐old African American female who experienced chronic epigastric abdominal pain, recurrent nausea, vomiting, and diarrhea for 15 years. Despite extensive investigations, including multiple biopsies, she was misdiagnosed with cyclic vomiting syndrome. Subsequently, an endoscopic ultrasound (EUS) revealed prominent lymph nodes and gastric granulomas, leading to a diagnosis of GS. This case underscores the importance of considering sarcoidosis in patients with refractory abdominal symptoms and highlights the utility of EUS in diagnosing this rare condition.

BACKGROUND Elective cholecystectomy (CCY) is recommended for patients with gallstone-related acute cholangitis (AC) following endoscopic decompression to prevent recurrent biliary events. However, the optimal timing and implications of CCY remain unclear. AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database (NRD). METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020. Our primary outcome was all-cause 30-d readmission rates, and secondary outcomes included in-hospital mortality, length of stay (LOS), and hospitalization cost. RESULTS Among the 124964 gallstone-related AC hospitalizations, only 14.67% underwent the same admission CCY. The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group (5.56% vs 11.50%). Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attributable to surgery. Although the most common reason for readmission was sepsis in both groups, the second most common reason was AC in the interval CCY group. CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission. These readmissions can potentially be prevented by performing same-admission CCY in appropriate patients, which may reduce subsequent hospitalization costs secondary to readmissions.

Metastasis to the stomach is a rare occurrence, especially from renal cell carcinoma (RCC). We report a case of a 76-year-old man with a history of RCC, in remission for 11 years postnephrectomy, who presented with gastrointestinal symptoms, was found to have a 2 cm gastric mass confirmed as metastatic RCC. Endoscopic submucosal dissection was attempted, but due to the hypervascular nature of the mass, a hybrid endoscopic submucosal dissection was performed, achieving complete resection. Follow-up at 7 months showed no recurrence, highlighting the potential for endoscopic treatment options for isolated gastric metastasis, despite the lack of specific guidelines.