Łukasz Nawacki

Background/Objectives: Hospital length of stay (LOS) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) may reflect baseline condition and underlying disease as well as procedure-related morbidity. We evaluated factors associated with prolonged hospital stay (PLOS) and the association of post-ERCP pancreatitis (PEP) with hospitalization duration. Methods: This retrospective single-center secondary analysis included 806 consecutive patients undergoing ERCP within 48 h of admission in 2019–2021. PLOS was defined as total LOS ≥ 12 days, corresponding to hospitalization above the 75th percentile. Modified Poisson regression estimated adjusted risk ratios (aRRs); LOS was also analyzed using negative binomial and median quantile regression. Sensitivity analyses used LOS > 7 and >14 days, a PLOS/death composite, and a PEP-excluded cohort. Results: Among 788 live discharges with complete LOS data, 176 (22.3%) met the PLOS criterion. In the primary Model A, emergency admission (aRR 3.01, 95% CI 2.01–4.51), cholangitis/postoperative indication (aRR 2.71, 95% CI 1.57–4.66), liver disease (aRR 1.85, 95% CI 1.10–3.12), and age (aRR 1.12 per 10 years, 95% CI 1.02–1.22) were associated with PLOS. PEP was associated with PLOS when added as a post-procedural exposure (aRR 2.34, 95% CI 1.67–3.29). Baseline associations were broadly preserved across sensitivity analyses. Conclusions: Prolonged hospitalization was associated mainly with acute clinical context, underlying disease, and patient characteristics. PEP was also associated with longer hospitalization, but this result should be interpreted cautiously because the historical PEP adjudication rule was not retained.

A Patient With a Left Ventricular Assist Device Requiring Emergency Surgery for a Strangulated Umbilical Hernia: A Case Report - Article abstract #951673

Background Severe obesity causes hemodynamic changes in the circulatory system and may lead to heart failure. Weight loss achieved with bariatric surgery can reverse many of the hemodynamic and structural abnormalities caused by obesity. Methods In 39 consecutive patients undergoing bariatric surgery, echocardiographic examinations were performed before surgery and 3 and 6 months after surgery. Detailed echocardiographic parameters assessing the function of the left atrium (LA) and the left (LV) and right ventricle (RV) were analyzed. Results The study population consisted of 76% women with mean body mass index (BMI) of 40.3 kg/m2 and mean age of 42.4 years. At 3- and 6-month follow-up after bariatric surgery there was a reduction in LV mass (109.7 vs. 99.1 vs. 87.4 kg/m2; p < 0.001), LV end diastolic volume (47.1 vs. 30.0 vs. 43.7; p < 0.001) and stroke volume (29.7 vs. 24.3 vs. 26.3; p = 0.05). Simultaneously an improvement in global longituginal strain (-14.38 vs. -16.79 vs. -18.01) and an increase in LA strain parameters (reservoir : 22.5 vs. 28.0 vs. 31.1; p < 0.001 and conduit: -12.8 vs. -16.5 vs. -19.6) were observed. Comparison of RV parameters before and after bariatric surgery showed improvement in global strain of RV (-15.9 vs. -18.8 vs. -18.38%; p = 0.005), free wall strain (-18.38 vs. -19.70 vs. -19.50; p = 0.042) and reduction in tricuspid regurgitation velocity (1.84 vs. 1.67 vs. 1.46±0.52; p = 0.01). Conclusions Weight loss contributes to rapid improvement in LA, LV and RV function. New echocardiographic parameters earlier detect subclinical hemodynamic changes associated with obesity and weight loss after bariatric surgery.

Background: Colorectal cancer (CRC) remains a major global health problem, with rising incidence among younger individuals. The implementation of next-generation sequencing (NGS) has enabled comprehensive multigene analysis to identify cancer-predisposing variants and molecular alterations in tumors. However, data on age-related genetic differences in CRC from Central and Eastern European populations, including Poland, remain limited. Methods: This study aimed to explore molecular differences in CRC between patients aged ≤50 and >50 years in a Polish cohort. Tumor DNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue samples obtained from 54 treatment-naive patients. Targeted sequencing of hot spot regions of 50 genes with known association to cancer was performed using an AmpliSeq for Illumina Cancer Hotspot Panel v2. Results: Variant frequencies in younger vs. older patients were: TP53 (71.4% vs. 57.6%), APC (57.1% vs. 45.5%), KRAS (28.1% vs. 72.7%), NRAS (28.6% vs. 0%), SMAD4 (9.5% vs. 12.1%), PIK3CA (14.3% vs. 24.2%), and FBXW7 (4.8% vs. 14.7%). Co-occurrence of APC/KRAS/TP53 variants was observed in 20% of cases. KRAS mutations were significantly more frequent in older patients (p-value = 0.001), while NRAS mutations occurred exclusively in younger patients (29% vs. 0%, p = 0.021). Overall, 46% of patients exhibited multiple gene alterations (≥3 mutations). Notably, IDH1 and CTNNB1 variants were found only in patients with better prognosis, whereas TP53 variants were nearly five times more frequent in patients with worse outcomes. Conclusions: Multigene panel sequencing revealed distinct age-related molecular patterns in CRC. Younger patients were more likely to harbor NRAS variants, whereas KRAS alterations predominated in older individuals. These findings underscore the relevance of NGS-based multigene profiling for risk stratification and personalized therapy in colorectal cancer.

Background. Colorectal cancer (CRC) remains a major global public health problem, particularly in Western countries. The imple-mentation of next-generation sequencing (NGS) has enabled multigene panel analysis to identify cancer-predisposing variants and characterize molecular alterations in tumors. To investigate molecular differences in CRC between patients younger than 50 years and those older than 50 years. Methods. Inclusion criteria were the absence of prior radio- or chemotherapy and availability of DNA suitable for NGS. Patients were divided into two age groups: ≤50 years and >50 years. DNA was extracted from FFPE tissue samples. Targeted sequencing was performed using an Illumina hotspot cancer panel comprising 50 genes (700 amplicons). Results. Mutation frequencies in younger vs. older patients were: TP53 (76% vs. 64%), APC (57% vs. 45%), KRAS (43% vs. 73%), NRAS (29% vs. 0%), SMAD4 (9% vs. 15%), PIK3CA (14% vs. 33%), FBXW7 (5% vs. 15%). Co-occurrence of APC/KRAS/TP53 mutations was observed in 20% of cases. KRAS mutations were significantly more frequent in older patients (p=0.001), while NRAS mutations occurred exclusively in younger patients (29% vs. 0%, p=0.021). Overall, 46% of patients exhibited multiple gene alter-ations (≥3 mutations). Notably, IDH1 and CTBX1 mutations were found only in patients with better prognosis, whereas TP53 mu-tations were nearly twice as common in patients with worse outcomes. Conclusions. Multigene panel sequencing revealed distinct age-related molecular patterns in CRC. Younger patients were more likely to harbor NRAS mutations, whereas KRAS alterations predominated in older individuals. These findings underscore the relevance of NGS-based multigene profiling for risk stratification and personalized therapy in colorectal cancer.

Background: Biliary acute pancreatitis (AP) during pregnancy is a challenging situation, and current guidelines for AP, pregnancy care, and surgery do not specifically address its management. This study investigated the safety and effectiveness of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy in AP. Methods: This international retrospective multicenter cohort study encompassed questions related to demographic information, clinical presentation, management strategies, timing of cholecystectomy, approaches to the procedure, complications, and outcomes. Continuous variables were summarized as medians with interquartile ranges, and categorical variables as frequencies and percentages. Group comparisons used Welch's t ‐test, Pearson's chi‐squared, or Fisher's exact tests. Results: A total of 101 cases from 14 countries and 19 centers were enrolled. Cholecystectomy after mild AP during pregnancy had a lower rate of readmission due to recurrent AP or other gallstone‐related complications compared with those who did not undergo surgery after a mild AP during pregnancy (0% vs. 24%; n = 0/17 vs. n = 12/49, p = 0.027). Cholecystectomy performed during pregnancy was associated with a low surgical complication rate, identical to that seen in postpartum procedures (12% vs. 10%; n = 2/17 vs. n = 3/30; p > 0.999). Preterm birth occurred in 7.1% ( n = 1/14) of patients with cholecystectomy versus 11% ( n = 5/45) without. Fetal loss after surgery occurred only in the first trimester ( n = 3/17 vs. n = 1/49). No difference was seen in readmission (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138), fetal loss (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138) and preterm birth (6%, n = 1/17 vs. 8%, n = 1/12; p > 0.999) between the surgical and ERCP groups. The fetal loss (9.1%, n = 2/22 vs. 5.4%, n = 4/74; p = 0.618) and preterm birth rates (5.9%, n = 1/17 vs. 12%, n = 8/65; p = 0.677) did not significantly differ between patients with and without ERCP during pregnancy. Conclusion: Cholecystectomy is effective and safe in pregnant patients during the second or third trimester in cases of mild biliary pancreatitis. ERCP is safe in any trimester.

Purpose: Gallstones are the most common cause of acute pancreatitis (AP), which usually necessitate hospitalization. Although cholecystectomy is required to prevent recurrent episodes, no clear guidelines have been established yet regarding the proper timing of cholecystectomy after an AP incidence. The objective was to evaluate the impact of AP on the course of cholecystectomy procedures, both by comparing patients with and without a history of AP and by analyzing the AP subgroup according to timing and severity. Methods: This retrospective evaluation was performed on patients who had undergone cholecystectomy for various causes in six hospitals in Poland. Patients were divided into the following three groups: patients without AP, patients with a history of AP, and patients with active AP. The analyzed variables included the surgical type and duration, postoperative complications, AP severity, and time elapsed between cholecystectomy and AP treatment completion. Results: In total, 4183 patients were included in the study, including 3948 without AP, 209 with a history of AP, and 26 with active AP. The most common surgical indications in patients with active AP and history of AP were concomitant cholecystitis (53.85%) and cholelithiasis (82.3%), respectively. The mean complication rates were not significantly different between groups. The surgical type was significantly affected by AP severity. Surgery in the period between 15 and 31 days post-AP attack was associated the highest frequency of minimally invasive surgery and shortest surgical duration, although the differences were not significant. Conclusion: Inflammation is the most common associated cause of surgery during the course of active AP. Surgery at 15–31 days post-AP attack was associated with a higher frequency of minimally invasive surgery and shorter operative duration, although these differences did not reach statistical significance. Our findings therefore suggest, but do not confirm, that this may represent a favorable time window, which warrants further evaluation in prospective studies.

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically significant complication of ERCP, with a multifactorial etiology involving patient- and procedure-related risk factors. Despite preventive measures such as NSAIDs and peri-procedural stenting, the incidence of PEP has not substantially declined. We aimed to assess clinical determinants of PEP in a large real-world cohort treated with standardized procedural protocols. Materials and Methods: This retrospective single-center study analyzed 806 patients who underwent ERCP between January 2019 and December 2021. All procedures were performed by a single operator under general anesthesia with standardized prophylaxis (diclofenac 100 mg per rectum and cefazolin 2 g intravenously). Patients with delayed ERCP (>48 h from admission) or active acute pancreatitis were excluded. Logistic regression was used to identify independent predictors of PEP, hospital stay, and in-hospital mortality. Results: PEP occurred in 60 patients (7.4%). Independent risk factors included stenosis of the papilla of Vater (OR = 2.45; p = 0.025), gallbladder stones (OR = 2.66; p = 0.001), prior acute pancreatitis (OR = 2.72; p = 0.005), and sphincterotomy (OR = 2.53; p = 0.016). PEP was associated with longer hospitalization (MD = 4.5 days; p < 0.001) and increased in-hospital mortality (6.7% vs. 1.7%; p = 0.032). Conclusion: Stenosis of the papilla, gallbladder stones, prior acute pancreatitis, and sphincterotomy independently increased the risk of PEP, whereas older age, previous ERCP, and pancreaticoduodenal tumors were associated with a reduced risk. Despite standardized prophylaxis, PEP remains a relevant clinical concern. Identification of high-risk patients and individualized procedural planning are essential to minimizing complications.

Obesity is a recognized risk factor for gastrointestinal diseases and is also suspected of aggravating intestinal reflux, causing intestinal atrophy and metaplasia, and an increased risk of carcinogenesis. This study aimed to evaluate the prevalence of upper gastrointestinal pathologies in patients undergoing esophagogastroduodenoscopy procedures, including their relationship to patient body mass index (BMI) values. This retrospective analysis included 368 consecutive outpatients examined by a single physician from March 1, 2023 to February 29, 2024. The analysis was based on the results of endoscopic and histopathological examinations in the patient group. We collected their baseline characteristics. The assessment of endoscopy results included the Campylobacter-like organism screening, status of erosive esophagitis, degree of endoscopic signs of gastroesophageal reflux disease as assessed during endoscope withdrawal, status of Z-line displacement as per the Prague classification, degree of Z-line displacement relative to the diaphragmatic branches, and nature of the gastric lake contents. Histopathological assessment focused on the presence of chronic inflammation and the features of active inflammatory processes, foveolar hyperplasia, gastric mucosal atrophy, intestinal metaplasia, and Barrett esophagus. A correlation was observed between the BMI and the prevalence of esophageal hiatal hernia, particularly in relation to large hernias. Interestingly, an inverse relationship was shown regarding the incidence of intestinal reflux. Although biliary reflux and Helicobacter pylori infection increased the incidence of intestinal metaplasia in gastric mucosa and Barrett esophagus, these findings were not statistically significant. Furthermore, concomitant thyroid diseases were associated with a higher incidence of biliary reflux and Barrett esophagus. Although BMI correlated with a higher prevalence of large esophageal hiatal hernias, an inverse association was observed with intestinal reflux. Additionally, thyroid diseases were linked to higher incidences of biliary reflux and Barrett esophagus.