Mahnoor Inamullah

Background/Objectives: Laparoscopic cholecystectomy (LC) is the current gold standard in patients with acute cholecystitis. Percutaneous cholecystostomy (PC) remains an option for those who are not surgical candidates but is associated with adverse effects. We studied technical success and patient satisfaction for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) after initially receiving a PC drain. Methods: A multi-center study was conducted at 4 institutions involving patients who initially received a PC. These patients were given the option to transition to receive EUS-GBD. A 5-point Likert scale was used to assess patient satisfaction comparing PC vs. EUS-GBD. Demographic data, including age, sex, reason for PC, complications, and patient satisfaction scores, were collected. Result: All seven patients who underwent percutaneous cholecystostomy rated their experience as 1 (very dissatisfied), whereas the same patients rated EUS-guided gallbladder drainage with a mean satisfaction score of 4.7 (very satisfied). Conclusions: EUS-GBD is effective and offers higher satisfaction scores in patients who are not surgical candidates.

Background: Pancreatic stents (PSs) play a crucial role in the management of pancreatic duct obstructions, particularly in the context of endoscopic retrograde cholangiopancreatography (ERCP). However, stent migration remains a significant complication, leading to risks such as pancreatitis, pancreatic duct stenosis, and abscess formation. This study aims to evaluate the efficacy of various endoscopic techniques for retrieving proximally migrated or broken pancreatic stents, highlighting optimal strategies for improving patient outcomes. Methods: A retrospective multicenter review was conducted across six hospitals from 2016 to 2024. Patients with proximally migrated or broken pancreatic stents referred for endoscopic retrieval after failed attempts at other facilities were included. Demographic data, stent characteristics, and retrieval techniques were analyzed. Endoscopic methods included SpyGlass forceps, SpyGlass baskets, Soehendra retriever stents, balloon sweeps, flower baskets, and extension pancreatic sphincterotomy. Procedural success, retrieval times, and post-procedural outcomes were assessed. Results: Twelve patients underwent endoscopic retrieval, including two with broken stents. All procedures were successful, with retrieval times averaging 30 to 45 min. Two patients developed pancreatic duct narrowing, requiring balloon dilation. All patients had new stents placed to maintain duct patency, and no major complications were observed. Follow-up evaluations confirmed complete resolution of migration-related issues, with all stents removed. Conclusions: Endoscopic retrieval of migrated pancreatic stents is highly effective, with specialized techniques ensuring a 100% success rate in this study. Early intervention and the selection of appropriate retrieval methods are critical in minimizing complications. Further research is needed to refine retrieval strategies and standardize protocols to enhance clinical outcomes.

Background/Objectives: Pancreatic neoplasms, including adenocarcinoma, pancreatic neuroendocrine tumors (pNETs), intraductal papillary mucinous neoplasms (IPMNs), and high-grade cystic lesions, often require surgical resection as a form of curative treatment. However, comorbidities and high-risk features may preclude surgery. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a minimally invasive alternative with proven cytoreductive efficacy in solid tumors. This case series evaluates the safety and efficacy of EUS-RFA in patients with various unresectable, non-metastatic pancreatic neoplasms. Methods: A retrospective review was conducted on eight patients who underwent EUS-RFA at our institutions between July 2021 and February 2025. All patients were deemed unsuitable surgical candidates due to comorbidities such as advanced age, cardiovascular disease, renal insufficiency, and COPD or due to patient resistance to surgical intervention. EUS-RFA was performed using a 19-gauge RFA needle (Taewoong Corporation). Follow-up imaging was conducted 3 to 6 months after the completion of RFA treatment. Results: All eight patients demonstrated a good to excellent response in terms of tumor size reduction. The most notable response was observed in a patient with pNET, resulting in complete resolution from 15.6 × 12.0 mm to 0.0 × 0.0 mm after two RFA treatments. Other neoplasms, including pancreatic adenocarcinoma and intraductal papillary mucinous neoplasms (IPMNs), also demonstrated significant reductions. Mild post-procedure complications, including pancreatitis and abdominal pain, were noted in three cases. Conclusions: EUS-RFA is a promising alternative for managing unresectable pancreatic neoplasms in high-risk patients. Our findings support its use across various tumor types with favorable outcomes and minimal complications, reinforcing its role in expanding therapeutic options beyond surgery.

Background: Nissen Fundoplication (NF) and Transoral Incisionless Fundoplication (TIF) are established procedures for the treatment of gastroesophageal reflux disease (GERD). However, the surgically induced plication can loosen over time. This multicenter study aims to evaluate the safety and efficacy of Antireflux Mucosectomy (ARMS) and Resection and Plication (RAP) in symptomatic patients with prior NF or TIF that has become loose. Patients and methods: Eighteen patients were enrolled in the study. Ten had prior TIF, while eight had prior NF. Half of these patients had a Hill Grade 3 Valve while the other half had a Hill Grade 2 valve. Endoscopic submucosal dissection (ESD) was performed in six patients, while endoscopic mucosal resection (EMR) was performed in twelve patients. A follow-up endoscopy was performed at 4–12 weeks. Results: At follow-up, 11 patients had a Hill Grade 1 valve, and seven patients had a Hill Grade 2 valve. All patients had improvement in symptoms for up to 32 months. Conclusions: In this pilot study, ARMS/RAP appears to be an effective option in patients who had prior NF or TIF with recurrent GERD symptoms.

Stents utilized for pyloric, duodenal, or anastomotic malignant strictures are generally uncovered and are not retrievable. Taewoong Medical created a through-the-scope stent that is fully covered, retrievable, and can be placed beyond the esophagus for benign gastroduodenal strictures as an alternative to surgical approaches. The aim of this paper is to examine the safety and efficacy of short-term, fully covered, self-expanding metal stents (FC-SEMS) in refractory benign strictures of the pylorus, duodenum, and gastrojejunal anastomosis. This multicenter case series was conducted at four hospitals from January 2018 through December 2020. Patients presenting with benign strictures of the pylorus, duodenum, or gastrojejunal anastomosis were entered into the study. A therapeutic channel scope was utilized to place FC-SEMS to open strictures. The stents were removed a few weeks later. A four-point gastric outlet obstruction scoring system (GOOSS) was used to record improvement. Statistically significant improvement in GOOSS was found between the pre-procedure and the four-week follow-up. Fully covered, retrievable metal stents appear safe and effective in the management of refractory benign pyloric, duodenal, and anastomotic strictures. This may provide a less invasive option in the management of these strictures compared to surgery.

Background: Anal fissures cause severe pain and can be difficult to treat. Medical therapy is initially used, followed by sigmoidoscopy-guided botox injections if the medical therapy is not successful. With this technique, however, it is not clear whether botox is injected into the muscle layer or submucosa. Aim: To evaluate the efficacy of EUS-guided botox injection directly into the internal sphincter. Methods: Consecutive patients with chronic anal fissure refractory to conventional endoscopic botulinum toxin type A injection were enrolled in the study. EUS was performed using a linear array echoendoscope, and a 25 G needle was used to inject botox. All patients were followed up at one- and two-month intervals. Results: Eight patients with chronic anal fissures were included in the study. Six patients had an excellent response to botox at the two-month interval using a visual analog pain scale, while one patient had a moderate response with a pain score reduction of 40%. One patient had no response. No complications were noted. An improvement in visual analog scale (pre-score > post-score) was statistically significant at the p < 0.01 level. Conclusion: EUS-guided botox injection into the internal sphincter appears to be a promising technique for patients with refractory anal fissure with pain.