Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is indicated for multiple pancreatic and biliary pathologies and carries a heightened risk profile compared with other endoscopic procedures. Considerable research has been directed towards discerning risk factors associated with complications such as post-ERCP pancreatitis and post-ERCP bleeding. Despite this, data on chronic liver disease (CLD) as a risk factor for complications is limited. We aimed to assess the outcomes of patients with CLD who underwent therapeutic or diagnostic ERCP to determine whether these patients had different outcomes relative to patients without CLD. Methods: We used the National Inpatient Sample (NIS) database to inquire for all adult patients who underwent ERCP between 2016 and 2019 using the International Classification of Disease, Tenth Revision (ICD-10) coding. The group was stratified into 2 groups: patients with CLD and those without. The main outcome we looked at was the rate of post-ERCP pancreatitis, post-ERCP hemorrhage, and perforation between the 2 groups. The secondary outcomes were in-hospital mortality and length of stay. A multivariate regression model was used to estimate the association of CLD with ERCP outcomes. Results: We identified a total of 883,825 patients who underwent ERCP between 2016 and 2019. Among these, 21,212 (2.4%) had CLD and 862,613 (97.6%) did not have CLD. The mean age for patients in liver disease group was 61.66 years and in group without liver disease was 60.46 years. The predominant ethnicity in both groups was whites. Additional admission-related factors are outlined in Table 1. The rate of post-ERCP pancreatitis (8.8% vs. 6.7%, P < 0.001) with adjusted odds ratio (aOR) 1.3; and post-ERCP hemorrhage (8.8% vs. 6.69%, P < 0.001) with aOR 1.35, was higher in the patient group with CLD. The rate of post-procedure perforation was not significantly different in both groups. For secondary outcomes; the in-hospital mortality (3.03% vs. 1.58%, P < 0.001) and length of stay (7 days vs. 3 days, P < 0.001) were higher in the patients with chronic liver disease. The outcomes are mentioned in Table 2. Conclusion: Although ERCP is considered a safe procedure, it is one of the endoscopic procedures associated with the highest risk of complications. As a result, risk stratification is crucial. Certain demographics, conditions like end-stage renal disease, liver cirrhosis, and procedural factors have been identified as risk factors for post-ERCP complications. Our study represents newer data, with use of revised ICD codes, to demonstrate increased risk in patients with liver disease. On the basis of these results, ERCP should be used judiciously in this population and further studies are required for identifying reversible risk factors to improve outcomes.

Background and Aims:Radiofrequency ablation (RFA) is a proven therapy for solid organ tumors. Endoscopic ultrasound-guided RFA (EUS-RFA) is a less invasive, emerging technique that may serve as an alternative to surgical resection for unresectable pancreatic tumors (UPT). However, its efficacy, safety, and clinical outcomes in tumor subgroups remain unclear. This systematic review and meta-analysis evaluate the efficacy, clinical, and technical success (TS) of EUS-RFA for UPT. Methods:A comprehensive search of PubMed, Web of Science, Embase, Cochrane, and Clinicaltrials.gov (as of April 2025) identified studies on EUS-RFA and pancreatic tumors. Primary outcomes were TS, defined as probe placement and ablation regardless of outcome, and clinical success (CS), defined as symptomatic improvement or tumor size reduction with necrosis. Secondary outcomes included adverse events and efficacy for tumor subtypes. A pooled analysis using random-effect modeling was performed using the metafor R package. Results:Seventeen studies involving 168 patients (52.38% female) and 182 tumors were included. Tumors included pancreatic neuroendocrine tumors (106, 58.24%), pancreatic ductal adenocarcinomas (49, 26.92%), and others. Tumors were located primarily in the body, neck, or tail (54.02%). Average ablation sessions per patient were 1.1. Pooled TS and CS rates were 89% and 84%, respectively. Nonfunctional neuroendocrine tumors and mixed type showed the highest CS rate (91%). The most common adverse event included abdominal pain (6.5%) and hyperamylasemia (3.6%). Conclusion:EUS-RFA is a promising, safe modality for managing UPT, with high TS (89%) and CS (84%) rates. Larger clinical trials are needed to confirm safety, outcomes, and survival benefits for pancreatic cancer subtypes.

Background:Risk stratification in liver disease includes liver elastography (LE) and portal pressure gradient (PPG) measurement. Objectives:We examined the efficacy and safety of endoscopic ultrasound (EUS)-liver biopsy (EUS-LB) and the correlation between EUS-PPG and EUS-LE in patients with liver disease. Study design:This is a prospective and retrospective, single-center study. Methods:Data from patients who underwent concomitant EUS-LE, EUS-PPG, and EUS-LB were analyzed. Histologically, significant fibrosis (SF) was considered F2-F4, non-significant fibrosis (NSF) as F0-F1, advanced fibrosis (AF) as F3-F4, and non-advanced fibrosis (NAF) as F0-F2. Results:In total, 25 patients underwent EUS-PPG measurement; 60% were male (mean age, 60 years). EUS-LE and EUS-LB were performed in 88% and 96% of patients, respectively (the technical success rate was 100%). The mean number of portal tracts was 14.3. Histological diagnosis was achieved in all patients; 67% had SF. The mean EUS-LE was 24.1 kPa, and the mean PPG was 4.6 mmHg. Portal hypertension (PH; PPG >5 mmHg) and clinically significant PH (PPG >10 mmHg) were found in 44% and 12%, respectively. Patients with SF had a higher mean PPG (5.9 vs 2.8 mmHg; p = 0.003) and mean shear wave measurement (SWM; 30.0 vs 15.6 kPa; p = 0.02) compared to the NSF group. Patients with AF had a higher mean PPG (6.0 vs 3.4 mmHg; p = 0.01) and mean SWM (32.0 vs 18.8 kPa; p = 0.04) compared to the NAF group. There were no significant adverse events. Conclusion:Concomitant EUS-LB and PPG is safe. EUS-PPG and EUS-LE correlate with the degree of fibrosis on histology. Larger studies are needed to optimize their values in clinical practice.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is indicated for multiple pancreatic and biliary pathologies and carries a heightened risk profile compared with other endoscopic procedures. Considerable research has been directed towards discerning risk factors associated with complications such as post-ERCP pancreatitis and post-ERCP bleeding. Despite this, data on chronic liver disease (CLD) as a risk factor for complications is limited. We aimed to assess the outcomes of patients with CLD who underwent therapeutic or diagnostic ERCP to determine whether these patients had different outcomes relative to patients without CLD. Methods: We used the National Inpatient Sample (NIS) database to inquire for all adult patients who underwent ERCP between 2016 and 2019 using the International Classification of Disease, Tenth Revision (ICD-10) coding. The group was stratified into 2 groups: patients with CLD and those without. The main outcome we looked at was the rate of post-ERCP pancreatitis, post-ERCP hemorrhage, and perforation between the 2 groups. The secondary outcomes were in-hospital mortality and length of stay. A multivariate regression model was used to estimate the association of CLD with ERCP outcomes. Results: We identified a total of 883,825 patients who underwent ERCP between 2016 and 2019. Among these, 21,212 (2.4%) had CLD and 862,613 (97.6%) did not have CLD. The mean age for patients in liver disease group was 61.66 years and in group without liver disease was 60.46 years. The predominant ethnicity in both groups was whites. Additional admission-related factors are outlined in Table 1. The rate of post-ERCP pancreatitis (8.8% vs. 6.7%, P < 0.001) with adjusted odds ratio (aOR) 1.3; and post-ERCP hemorrhage (8.8% vs. 6.69%, P < 0.001) with aOR 1.35, was higher in the patient group with CLD. The rate of post-procedure perforation was not significantly different in both groups. For secondary outcomes; the in-hospital mortality (3.03% vs. 1.58%, P < 0.001) and length of stay (7 days vs. 3 days, P < 0.001) were higher in the patients with chronic liver disease. The outcomes are mentioned in Table 2. Conclusion: Although ERCP is considered a safe procedure, it is one of the endoscopic procedures associated with the highest risk of complications. As a result, risk stratification is crucial. Certain demographics, conditions like end-stage renal disease, liver cirrhosis, and procedural factors have been identified as risk factors for post-ERCP complications. Our study represents newer data, with use of revised ICD codes, to demonstrate increased risk in patients with liver disease. On the basis of these results, ERCP should be used judiciously in this population and further studies are required for identifying reversible risk factors to improve outcomes.

INTRODUCTION:Clinicians have several imaging options to evaluate suspected or confirmed small bowel Crohn's disease (SB-CD), including computed tomography enterography (CTE), magnetic resonance enterography (MRE), intestinal ultrasound (IUS), and video capsule endoscopy (VCE). METHODS:Direct head-to-head comparative analysis and network meta-analysis were conducted on all available modalities using a random effects model. Furthermore, each modality was ranked using the surface under the cumulative ranking curve approach (P-score). RESULTS:The present review included 29 studies with a total population of 2609 individuals. The pooled sensitivity, specificity, and diagnostic accuracy for the detection of SB-CD were 89.6%, 86.2%, and 71.5% for VCE; 82%, 71.6%, and 67.9% for MRE; 79.6%, 82.7%, and 52.3% for CTE; and 89.3%, 72%, and 71% for IUS, respectively. The network meta-analysis found that VCE exhibited superior diagnostic accuracy compared to CTE and MRE, while demonstrating comparable performance between VCE and IUS, as well as among MRE, CTE, and IUS. Further, the ranking analysis positioned VCE (P-score .97) as the most effective diagnostic modality for SB-CD, followed by IUS, MRE, and CTE. Subgroup analysis showed that VCE had significantly better diagnostic accuracy than the other modalities for detecting proximal SB-CD. Regarding adverse events, VCE was associated with capsule retention in 3.3% of the cases in these studies. CONCLUSIONS:VCE exhibited superior diagnostic performance for detecting established proximal SB-CD compared to other imaging modalities. Clinicians should weigh the benefits and risks, and incorporate other modalities, such as MRE and IUS to optimize diagnosis and management.

Background: Colorectal carcinoma (CRC) is one of the leading causes of cancer related death globally. Prevalence of Nutritional Anemia is high among CRC patients. We aim to evaluate the role of Nutritional anemia on outcomes of CRC hospitalization. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database, including all adult CRC patients hospitalized in the United States from 2016 to 2019. Patients were stratified into those with and without nutritional anemia (16.19% vs 83.81%) which included iron, B12, folate deficiency and other nutritional anemia per ICD-10 coding. Mortality was the primary outcome whereas length of stay (LOS), total charges, acute kidney injury (AKI), pulmonary embolism (PE), deep vein thrombosis (DVT), colonoscopy, abdominal surgery and lower gastrointestinal (GI) bleeding were secondary outcomes. Multivariate regression model was used to estimate the outcomes of CRC hospitalization after adjusting for potential confounders. Results: A total of 504,515 patients were hospitalized for CRC. Among two groups, patients with anemia were older in age. Mortality was significantly lower among patients with nutritional anemia. Lower GI bleeding and colonoscopy during inpatient stay were significantly higher among CRC cohort with nutritional anemia. Similarly, LOS, total hospitalization charges, AKI, PE and DVT were also significantly higher among anemia cohort. However, need for abdominal surgery was significantly lower among CRC patients with nutritional anemia. Conclusions: Nutritional anemia in CRC patients is associated with longer length of stay, increased cost, higher risk of in-patient complications. Therefore, it should be corrected to optimize outcomes among CRC patients.

BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic tool for biliary and pancreatic diseases. Frail and elderly patients, especially those aged ≥ 90 years are generally considered a higher-risk population for ERCP-related complications. AIM To investigate outcomes of ERCP in the Non-agenarian population (≥ 90 years) concerning Frailty. METHODS This is a cohort study using the 2018-2020 National Readmission Database. Patients aged ≥ 90 were identified who underwent ERCP, using the international classification of diseases-10 code with clinical modification. Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail. The primary outcome was mortality, and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP. We used univariate and multivariate regression models for analysis. RESULTS A total of 9448 patients were admitted for any indications of ERCP. Frail and non-frail patients were 3445 (36.46%) and 6003 (63.53%) respectively. Indications for ERCP were Choledocholithiasis (74.84%), Biliary pancreatitis (9.19%), Pancreatico-biliary cancer (7.6%), Biliary stricture (4.84%), and Cholangitis (1.51%). Mortality rates were higher in frail group [adjusted odds ratio (aOR) = 1.68, P = 0.02]. The Intra-procedural complications were insignificant between the two groups which included bleeding (aOR = 0.72, P = 0.67), accidental punctures/lacerations (aOR = 0.77, P = 0.5), and mechanical ventilation rates (aOR = 1.19, P = 0.6). Post-ERCP complication rate was similar for bleeding (aOR = 0.72, P = 0.41) and post-ERCP pancreatitis (aOR = 1.4, P = 0.44). Frail patients had a longer length of stay (6.7 d vs 5.5 d) and higher mean total charges of hospitalization ($78807 vs $71392) compared to controls (P < 0.001). The 30 d all-cause readmission rates between frail and non-frail patients were similar (P = 0.96). CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail. Larger studies are warranted to investigate and mitigate modifiable risk factors.

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.