Bhanu Siva Mohan Pinnam

Background Limited literature exists on labor and delivery outcomes after bariatric surgery. This study assesses the impact of prior bariatric surgery on peripartum outcomes. Methods We queried the National Inpatient Sample (2016–2020) for labor and delivery admissions, categorizing them into three cohorts: prior bariatric surgery (BaS), obesity without prior bariatric surgery, and controls without obesity. We used a multivariate regression model, adjusting for confounders, to compare peripartum outcomes. Results We identified 22,685 BaS cases, 2.1 million pregnant controls with obesity, and 16.37 million pregnant controls without obesity. Compared to controls with obesity, the BaS cohort had lower rates of cesarean delivery [43% vs 46.8%, adjusted odds ratio (aOR) 0.72, p < 0.001], fetal distress [aOR 0.79, p < 0.001), post-partum hemorrhage (aOR 0.67, p < 0.001), fetal disproportion (aOR 0.36, p < 0.001), and premature rupture of membranes (aOR 0.88, p = 0.04). Compared to controls without obesity, the BaS group had higher rates of cesarean delivery (43% vs 29.57%, aOR 1.43, p < 0.001), breech presentation (aOR 1.4, p < 0.001), thromboembolic events (aOR 2.47, p = 0.01), and pregnancy termination (aOR 1.59, p = 0.048), but lower rates of assisted delivery (aOR 0.54, p < 0.001), fetal disproportion (aOR 0.56, p = 0.025), PROM (aOR 0.87, p = 0.024), and placenta previa (aOR 0.63, p = 0.019). The BaS group had longer hospitalizations (3.11 vs 2.56 days, p < 0.001) and higher hospitalization charges ($25,941 vs $20,760, p < 0.001) compared to controls without obesity. Conclusion Pregnancy after bariatric surgery is associated with lower odds of cesarean delivery and postpartum complications, relative to the general population with obesity. This underscores the positive impact of bariatric surgery on peripartum outcomes.

Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Pancreatic lesions consist of both neoplastic and non-neoplastic lesions and often pose a diagnostic and therapeutic challenge due to similar clinical and radiological features. In recent years, pancreatic lesions have been discovered more frequently as incidental findings due to the increased utilization and widespread availability of abdominal cross-sectional imaging. Therefore, it becomes imperative to establish an early and appropriate diagnosis with meticulous differentiation in an attempt to balance unnecessary treatment of benign pancreatic lesions and missing the opportunity for early intervention in malignant lesions. Endoscopic ultrasound (EUS) has become an important diagnostic modality for the identification and risk stratification of pancreatic lesions due to its ability to provide detailed imaging and acquisition of tissue samples for analysis with the help of fine-needle aspiration/biopsy. The recent development of EUS-based technology, including contrast-enhanced endoscopic ultrasound, real-time elastography–endoscopic ultrasound, miniature probe ultrasound, confocal laser endomicroscopy, and the application of artificial intelligence has significantly augmented the diagnostic accuracy of EUS as it enables better evaluation of the number, location, dimension, wall thickness, and contents of these lesions. This article provides a comprehensive overview of the role of the different types of EUS available for the diagnosis and differentiation of pancreatic cancer from other pancreatic lesions while discussing their key strengths and important limitations.

Background/Aims: Radiation proctitis (RP), a well-known complication of pelvic radiation therapy, may lead to recurrent hospitalizations. We aimed to assess readmissions of RP in the United States. Methods: We analyzed the Nationwide Readmission Database from 2016 to 2020 to identify all 30-, 60-, and 90-day readmissions of RP in the United States. Hospitalization characteristics, predictors, clinical outcomes, and healthcare burdens were assessed. Results: From 2016 to 2020, we noted a declining trend of 30-, 60-, and 90-day readmissions of RP in the US. However, the all-cause 30-, 60-, and 90-day readmission rates of RP were still high at 13.7%, 19.4%, and 23.16%, respectively. On readmission, RP was identified as the admitting diagnosis in only 20.61%, 17.87%, and 15.76% of 30-, 60-, and 90-day readmissions, respectively. The mean age for all readmissions was 70 years with a significant male dominance. Lower endoscopy at index admission reduced the risk of readmissions within 90 days, but this was not statistically significant. However, the Charlson Comorbidity Index (CCI) score was an independent predictor of all readmissions. Furthermore, the mean length of stay was 5.57 (95% CI 5.15–6), 5.50 (95% CI 5.12–5.89), and 5.47 (95% CI 5.07–5.87) days and the mean hospitalization charge was USD 60,451 (95% CI USD 54,728–66,174), USD 62,671 (95% CI USD 57,326–68,015), and USD 62,144 (95% CI USD 57,144–67,144) for 30-, 60-, and 90-day readmissions. The all-cause inpatient mortality for 30-, 60-, and 90-day readmissions was 3.58%, 3.89%, and 3.46%, respectively. Conclusions: RP readmissions are a significant healthcare burden. Further efforts must be directed toward improving management strategies to reduce readmission rates.

Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a delay in diagnosis and treatment, resulting in poor clinical outcomes and low survival rates. Endoscopic Ultrasound (EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era, with exponential advancements in technology and device innovation, EUS is also being increasingly used in a variety of therapeutic interventions. In the context of pancreatic cancer where therapies are limited due to the advanced stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover, due to their minimally invasive nature and ability to provide real-time images for tumor localization and therapy, they are associated with fewer complication rates compared to conventional open and laparoscopic approaches. In this article, we detail the most current and important therapeutic applications of EUS for pancreatic cancer, namely EUS-guided Fine Needle Injections, EUS-guided Radiotherapy, and EUS-guided Ablations. Furthermore, we also discuss the feasibility and safety profile of each intervention in patients with pancreatic cancer to provide gastrointestinal medical oncologists, radiation and surgical oncologists, and therapeutic endoscopists with valuable information to facilitate patient discussions and aid in the complex decision-making process.