Mohamed Othman Othman

Treatment for exocrine pancreatic insufficiency (EPI) includes pancreatic enzyme replacement therapy (PERT). Although PERT may improve symptoms, there are currently no EPI symptom measures to monitor PERT treatment. This analysis evaluated the utility of the Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q) in patients with chronic pancreatitis and EPI treated with pancrelipase. This prospective, observational study (NCT04949828) included adult patients with chronic pancreatitis and EPI who were recommended pancrelipase 72,000 lipase units per meal and 36,000 lipase units per snack by an independent physician. Outcomes included the change from baseline to 1 month and 3 months after treatment initiation in PEI-Q symptom score, PEI-Q symptom severity categories, and health-related quality of life (HRQoL) as measured by the PEI-Q impact domain score. The per-protocol population included 32 and 29 patients with data at 1 and 3 months after pancrelipase initiation, respectively. A significant reduction in mean PEI-Q symptom scores was observed from baseline to 1 month (- 1.0; p < 0.001) and 3 months (- 1.1; p < 0.001). Despite all patients having moderate/severe EPI symptoms at baseline, 62.5% and 62.1% of patients reported mild/no EPI symptoms after 1 and 3 months, respectively. There was also a significant reduction in mean PEI-Q impact scores from baseline to 1 month (- 1.0; p < 0.001) and 3 months (- 1.2; p < 0.001), indicating improved HRQoL. Pancrelipase improved patient-reported EPI symptoms and HRQoL based on the PEI-Q, which may be a useful tool for monitoring PERT treatment in patients with chronic pancreatitis and EPI.

Tara Keihanian, Robert Luke Pecha, Margarita Riojas, Kristin Andrews Staggers, Mohamed Othman Othman, and Kalpesh Kanu Patel. Int J Gastrointest Interv -0001;0:. https://doi.org/10.18528/ijgii260001

Background Despite advancements in endoscopic resection (ER), surgery for nonmalignant colorectal polyps remains common. A prior analysis reported increasing surgical rates from 2000 to 2014. Using the TriNetX US Research Network, we aimed to compare the proportion of patients referred for ER versus surgical colectomy for nonmalignant polyps each year from 2015 to 2023. Methods We identified adults (≥18 years) diagnosed with nonmalignant colorectal polyps following colonoscopy using validated ICD-10 and CPT codes. Patients with colorectal cancer or inflammatory bowel disease were excluded. The primary outcome was incidence of ER (EMR or ESD) vs. colectomy between 2 weeks and 6 months post-colonoscopy. Secondary outcomes included 30-day adverse events (AEs) and mortality. Propensity score matching was used to compare groups. Odds ratios (ORs) were calculated for secondary outcomes. Results Of 1,060,302 patients undergoing colonoscopy from 2015 to 2023, 6,295 (0.594%, 95% CI: 0.579–0.609%) were referred for ER and 4,208 (0.397%, 95% CI: 0.385–0.409%) were referred surgery for large nonmalignant colorectal polyps detected and not resected on index colonoscopy. ER incidence rose from 0.26% (2015) to 0.67% (2023), while surgery rates declined from 0.45% to 0.35%. Post-matching, ER was associated with significantly lower 30-day mortality (0.161% vs. 1.304%; OR: 0.122) and fewer AEs, including cardiac events, thromboembolic events, pulmonary complications, sepsis, and surgical site infections. Discussion Over the past decade, ER for nonmalignant colorectal polyps increased while surgical resections declined. ER was associated with significantly lower mortality and morbidity. These findings support continued efforts to promote ER as a safer, effective alternative to surgery.

Purpose Percutaneous drainage is the standard nonsurgical treatment for liver abscess. Recent retrospective studies suggest that endoscopic ultrasound (EUS)-guided drainage may be an effective and safe alternative. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-guided drainage as a stand-alone approach and in comparison, with percutaneous drainage. Methods PubMed, EMBASE, and Cochrane databases were searched from inception through November 2025. The primary outcome was clinical success; secondary outcomes included technical success, total adverse events, and abscess relapse. Sensitivity analyses using a treatment-arm continuity correction were performed to address zero-event cells. Results Eleven studies were included (EUS, n = 186; percutaneous drainage, n = 325). In single-arm studies, pooled technical and clinical success rates with EUS were both 1.00 (95% CI, 0.95–1.00 and 0.99–1.00, respectively). Pooled total adverse event and relapse rates were 0.02 (95% CI, 0.00–0.12) and 0.00 (95% CI, 0.00–0.01), respectively. Comparative studies showed no significant differences between EUS and percutaneous drainage in technical success (RR 1.00, 95% CI, 0.83–1.19) or clinical success (RR 1.02, 95% CI, 0.86–1.22). EUS was associated with a significantly lower risk of total adverse events (RR 0.34, 95% CI, 0.15–0.76), while relapse rates were similar (RR 0.83, 95% CI, 0.30–2.33). Sensitivity analyses yielded consistent findings across all outcomes. Conclusion EUS-guided drainage is an effective and safe treatment for liver abscesses primarily involving the left hepatic and caudate lobes. Although EUS was associated with a lower risk for adverse events, larger comparative studies are needed to define its role in right lobe abscesses.

Achalasia is associated with increased risk of esophageal cancer, particularly squamous cell carcinoma. Although esophageal myotomy improves dysphagia, its impact on cancer risk and mortality remains unclear. We conducted a retrospective cohort study using the TriNetX research network, including adults (≥ 18 years) with achalasia confirmed by esophageal manometry. Patients were categorized based on treatment of those undergoing esophageal myotomy (peroral endoscopic myotomy [POEM] or laparoscopic Heller myotomy [LHM]) and those managed without myotomy. Patients with prior esophagectomy or malignancies associated with increased esophageal cancer risk were excluded. The primary outcome was incident esophageal cancer; secondary outcomes included all-cause mortality. Propensity score matching balanced baseline characteristics. Associations were assessed using adjusted odds ratios (aORs) and Cox proportional hazards models. Overall survival was assessed using Kaplan–Meier analysis and compared with the log-rank test. Among 18,186 patients with achalasia, 3,758 underwent esophageal myotomy and 14,428 were managed without myotomy. After matching, esophageal cancer incidence was low and did not differ significantly between the myotomy and non-myotomy cohorts (0.29% vs 0.27%; aOR 1.1, 95% confidence interval [CI] 0.47–2.6). In contrast, myotomy was associated with significantly lower all-cause mortality (3.25% vs 7.22%; aOR 0.43, 95% CI 0.35–0.54). Independent predictors of esophageal cancer included male sex, older age, and personal history of gastrointestinal malignancy. In short-term follow-up, esophageal myotomy in achalasia was associated with lower all-cause mortality and similar esophageal cancer incidence. These findings suggest benefits beyond symptom control, including a potential survival advantage.

Background and Aims Endoscopic submucosal dissection (ESD) of duodenal tumors is challenging due to its unique anatomy and high risk of adverse events. Its use is limited in the United States due to procedural complexity. Our study highlights the feasibility of ESD for managing duodenal tumors in the US. Methods This retrospective cohort included duodenal ESD lesions at two tertiary US medical centers from 2017 to 2024. The primary outcomes included technical success, en bloc, R0, and curative resection rates. Secondary outcomes were adverse events and recurrence rates. Results Seventy-four duodenal lesions in 70 patients were resected by three endoscopists with variable levels of experience in ESD. Most lesions (56%) were located in the duodenal bulb. Technical success was 100%, with en bloc and R0 resection rates of 78.3% and 51.4%, respectively. Mean procedure time was 85.9 ± 50.4 min. Neuroendocrine tumors had higher en bloc (90% vs. 62.5%) but lower R0 resection rates (43.8% vs. 53.1%) than adenomas. Adenomas had more positive lateral margins (50% vs. 18.3%). Larger lesions (> 30 mm) had lower en bloc resection rates than smaller ones (≤ 30 mm). The overall adverse event rate was 25.7%. Intraprocedural deep muscle injury and bleeding were more common in lesions > 3 cm (18.2% and 6%) than in smaller lesions (7.3% and 2.4%). Conclusions Duodenal ESD has lower en-bloc and R0 resection rates, but higher risk of adverse events compared to other sites. An individualized approach and careful discussion of endoscopic versus non-endoscopic options with every patient is warranted.