Amr Elserafy

Background: Endoscopic sleeve gastroplasty (ESG), a natural orifice transluminal endoscopic procedure, is increasingly integrated into multidisciplinary obesity care. We performed a systematic review and meta‐analysis to quantify the durability of ESG‐associated weight loss and metabolic outcomes across short‐ and long‐term follow‐up. Methods: Databases were searched from inception to September 2, 2025 (PROSPERO: CRD420251139333). Peer‐reviewed studies reporting ESG outcomes were included; primary outcomes were % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and BMI reduction, stratified by follow‐up (≤ 6 months vs. ≥ 1 year). Random‐effects models were used; heterogeneity ( I ² ), publication bias (Egger's test), GRADE assessment, sensitivity analyses, and meta‐regression for baseline BMI were performed. Results: Thirty‐three studies (8880 patients; 31 cohorts, 2 RCTs) were included. %TBWL increased from 8.66% (1 month) to 16.13% (6 months) and was 17.88% at 1 year. Long‐term pooled %TBWL declined modestly over time (17.88% at 1 year to 15.67% at 3 years). Remission rates were 62% for type 2 diabetes, 43% for hypertension, and 43% for dyslipidaemia. Weight regain occurred in 6%. Baseline BMI predicted higher %TBWL but lower %EBWL. Conclusion: ESG is associated with clinically meaningful weight loss maintained beyond 6 months with modest attenuation over longer follow‐up, alongside favourable metabolic remission rates and low reported weight regain.

Background: The optimal interventional approach for necrotizing pancreatitis remains debated. We performed a systematic review with network meta‐analysis and proportional meta‐analysis to compare endoscopic trans‐gastric necrosectomy (EN), minimally invasive surgical necrosectomy (MIN), and open necrosectomy (ON). Methods: Databases were searched from inception through March 2026. Eligible studies included randomized and observational comparative studies enrolling adults with necrotizing pancreatitis requiring necrosectomy and comparing ON, MIN, and/or EN. Nine binary outcomes were assessed in a frequentist random‐effects network meta‐analysis. Separate proportional meta‐analysis of single‐arm studies pooled mortality, clinical success, complications, and need for additional surgery. Risk of bias was assessed using RoB 2 and ROBINS‐I, and confidence in network estimates was assessed using CINeMA. Results: Thirty‐three studies were included. Nine comparative studies were included in the network meta‐analysis, and 24 single‐arm studies were analyzed separately. EN was associated with lower mortality, fewer complications, less new‐onset multiple organ failure, less exocrine insufficiency, fewer new ICU admissions, and better overall treatment ranking than ON. EN also outperformed MIN for complications and new‐onset multiple organ failure, whereas MIN was superior to ON for multiple organ failure, exocrine insufficiency, incisional hernia, and ICU admission. Bleeding, re‐intervention, and new‐onset diabetes did not differ significantly across techniques. In single‐arm pooling, EN and MIN showed comparable mortality, clinical success, complications, and need for additional surgery. Conclusions: Endoscopic necrosectomy appears to offer the most favorable overall profile for necrotizing pancreatitis, whereas minimally invasive surgical approaches also improve several outcomes compared with open necrosectomy. Open surgery should likely remain reserved for selected rescue situations.

Background: Acute uncomplicated appendicitis has traditionally been managed surgically, but recent trials suggest nonoperative treatment with antibiotics may be effective in selected adults. This meta-analysis compares long-term outcomes of antibiotics versus surgery and evaluates predictors of treatment failure, including the presence of an appendicolith. Methods: We systematically searched MEDLINE, Embase, CENTRAL, and clinical trial registries up to July 2024. We included randomized controlled trials (RCTs) comparing antibiotics versus appendectomy in adults with imaging-confirmed uncomplicated appendicitis. The primary outcome was 1-year treatment success. Secondary outcomes included complication rates, recurrence, and subgroup analysis by appendicolith. A meta-regression explored the relationship between appendicolith prevalence and treatment failure. Results: Seven RCTs (n=3164) were included. The 1-year treatment success rate was significantly lower in the antibiotics group (73.8%) versus surgery (98.1%) (RR 0.78, 95% CI: 0.73-0.84). Complication rates were comparable (RR 0.57, 95% CI: 0.29-1.12). Patients with appendicolith had a significantly higher failure rate (up to 46%). Meta-regression confirmed a positive correlation between appendicolith prevalence and antibiotic failure. Conclusions: Antibiotics can be effective in selected patients, but recurrence and treatment failure remain concerns, particularly in the presence of appendicolith. Appendectomy remains the definitive treatment. This meta-analysis, including the most recent trials and a novel meta-regression, provides timely insights for shared decision-making.

Introduction: Colonic diverticular disease (diverticulosis) is a currently worldwide increasing gastrointestinal disorder with a particularly high prevalence in Western countries. The operative treatment of acute diverticulitis could be executed through open or laparoscopic techniques. A non-resectional procedure, namely laparoscopic peritoneal lavage (LPL) and drainage, has also been adopted as a less invasive treatment strategy to treat patients with diverticular perforation and purulent peritonitis.Aim: The present work was conducted to pool the currently available evidence regarding the safety and efficacy of LPL for the treatment of complicated perforated diverticulitis.Methods: The analysis included studies that compared patients who underwent LPL to those who underwent surgical resection. Fifteen articles were eligible for this review after searching the Scopus, PubMed Central, Cochrane Library, and Google Scholar databases.Results: The meta-analysis demonstrated that operative time and blood loss were significantly lower in the LPL group (p<0.001). The rates of overall morbidity and reoperation were comparable in the two groups (p = 0.57 and 0.74, respectively). There were significantly lower rates of cardiovascular (p < 0.001) and respiratory complications (p = 0.01), incisional/parastomal hernia formation (p = 0.02), ICU admission (p < 0.001), length of hospital stay (p < 0.001), permanent stoma formation (p < 0.001), and mortality (p < 0.001), and higher rates of sepsis (p = 0.03), intra-abdominal abscess formation (p < 0.001), and postoperative recurrence (p < 0.001) in the LPL group.Conclusions: Compared to the colon resection procedures for the treatment of complicated diverticulitis, laparoscopic peritoneal lavage had comparable overall morbidity and reoperation rates and lower rates of permanent stoma formation and mortality. Still, there is concern regarding the recurrence and intra-abdominal abscess formation.