Sultan Mahmood

Background and Aims: Completely obstructed benign biliary strictures (BBS) are difficult to treat. Magnetic compression anastomosis (MCA) has recently been used in such cases with reportedly low complication rates. This study aimed to evaluate the safety and efficacy of MCA in the management of complete benign biliary obstruction. Methods: Multiple databases were searched to identify studies evaluating the safety and efficacy of MCA in complete BBS from inception to December 26, 2025. Outcomes of interest included technical success (recanalization), stricture recurrence, procedure-related adverse events, and cholangitis. Pooled estimates with 95% CIs were calculated using a Mantel-Haenszel random-effects model. Heterogeneity was assessed using the I ² statistic. Results: Six studies comprising 182 patients met the inclusion criteria. The pooled technical success rate of MCA was 92.6% (95% CI: 87.5%-95.7%). The pooled stricture recurrence rate was 18.5% (95% CI: 10.7%-30.2%). The pooled rate of procedure-related adverse events was 7.6% (95% CI: 1.9%-25.9%), and the pooled rate of postprocedure cholangitis was 3.8% (95% CI: 1.5%-9.2%). Conclusion: This meta-analysis demonstrates that MCA is a safe and effective treatment for complete benign biliary strictures. MCA appears to be a highly effective and minimally invasive therapeutic option for refractory biliary strictures, achieving high technical success rates even in patients who have failed conventional interventions. However, the current evidence base is limited by small, nonrandomized studies. Larger, preferably randomized, studies are needed to define optimal clinical indications, standardize treatment protocols, and clarify MCA’s role as a potential standard-of-care therapy.

Esophageal leak is a well-described complication of endoscopic peroral endoscopic myotomy (POEM). Although various endoscopic techniques exist for managing mucosal defects, their efficacy is not universal, and successful closure is not guaranteed. The endoscopic vacuum therapy (EVT, EndoVAC) has been implemented in the management of mucosal defects. We hereby present a 46-year-old man who developed a persistent esophageal leak after POEM, which was successfully managed with the EndoVAC following multiple unsuccessful closure attempts using conventional methods.

Duodenal diverticula are common but rarely complicated by abscess formation. Standard management includes antibiotics, percutaneous drainage, or surgery when minimally invasive approaches fail. We report a 75-year-old woman with a 4.4 × 4.0 cm duodenal diverticular abscess refractory to antibiotics. Endoscopic ultrasound-guided drainage with an 8 × 8 mm lumen-apposing metal stent led to immediate pus evacuation and clinical resolution. This case illustrates the expanding role of lumen-apposing metal stents as a safe, minimally invasive option for complex duodenal abscesses when conventional approaches are not feasible.

Pancreatoblastoma (PB), an extremely rare malignancy of the pancreatic tissue, comprises less than 1% of all pancreatic tumors. Owing to the rarity of the malignancy and the potential for multiple differential diagnoses, adult-onset PB can be challenging to diagnose. The hallmark characteristic in diagnosing adult PB is found histologically. In approximately 90% of cases, squamous corpuscles are observed. We present the case of a patient diagnosed with adult-onset PB, who presented with key clinical and pathological features, as well as rarer characteristics, associated with the malignancy.