Yaseen Perbtani

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Pseudoaneurysm formation is a rare but potentially fatal complication of necrotizing pancreatitis due to the risk of rupture. We report a 28-year-old man with walled-off pancreatic necrosis who developed catastrophic hemorrhage from a ruptured pseudoaneurysm during endoscopic ultrasound-guided necrosectomy, resulting in intraprocedural cardiac arrest. The patient required immediate cardiopulmonary resuscitation and emergent angiography, which identified the bleeding source and achieved hemostasis via coil embolization. He survived following prompt multidisciplinary intervention. This case highlights the unpredictable nature of vascular complications in necrotizing pancreatitis and the critical role of rapid multidisciplinary response in managing life-threatening hemorrhage.

Splenic complications occur in approximately 2% of patients with chronic pancreatitis. Standard endoscopic ultrasound (EUS)-guided transmural drainage requires a Doppler-free window and may be unsafe when collaterals traverse the intended tract. We report a 42-year-old woman with alcoholic chronic pancreatitis and splenic vein thrombosis presented with a perisplenic pseudocyst that enlarged from 10.8 to 18.9 cm over 1 month. EUS confirmed intervening vasculature precluding stent placement; a narrow Doppler-free path permitted 19-gauge needle access. Continuous aspiration through a 3-way stopcock system evacuated approximately 1,000 mL with marked decompression. This case highlights EUS-guided needle decompression when vasculature constrains conventional drainage.

Epiphrenic diverticula are rare and often debilitating, particularly when associated with esophagogastric junction outflow obstruction, and their management is challenging in high-risk surgical candidates. We describe a 77-year-old woman with severe dysphagia, regurgitation, and significant weight loss caused by a large distal epiphrenic diverticulum and esophagogastric junction outflow obstruction. Given her multiple comorbidities, she was not a surgical candidate and underwent peroral endoscopic myotomy with diverticulotomy. The procedure was completed safely, resulting in complete symptom resolution and normalization of her Eckardt score. This case highlights peroral endoscopic myotomy with diverticulotomy as a minimally invasive, anatomy-directed solution for complex esophageal diverticula.

Gastroparesis is a chronic gastric motility disorder marked by delayed gastric emptying in the absence of mechanical obstruction. For patients with symptoms refractory to medical and dietary therapy, Gastric Peroral Endoscopic Myotomy (G‐POEM) has emerged as a minimally invasive, pylorus‐targeted intervention that directly addresses pyloric dysfunction. Technical success rates consistently exceed 95%, reflecting procedural standardization and a favorable learning curve. Short‐term symptom improvement is reported in up to 80% of patients and is often accompanied by enhanced gastric emptying and quality of life (QOL). Long‐term outcomes show sustained clinical success of 50%–77.5% at 3–4 years, influenced by disease etiology and neuromuscular progression. Endoluminal functional lumen imaging probe, a functional imaging tool that measures pyloric distensibility, has shown promise in identifying optimal candidates and assessing procedural efficacy, though standardized predictive thresholds are still lacking. Overall, G‐POEM has become a leading pylorus‐directed therapy for refractory gastroparesis. Comparative data suggest that G‐POEM offers superior clinical efficacy and durability relative to botulinum toxin injection and gastric electrical stimulation, with fewer complications than surgical pyloroplasty. This review integrates the current clinical evidence supporting G‐POEM, with a focus on patient selection, procedural outcomes, QOL, and durability of response. It also examines comparative data with alternative therapies and addresses ongoing areas of controversy, including procedural technique, repeat intervention, and the predictive value of prior pyloric‐directed therapies. G‐POEM represents a safe and effective treatment modality for appropriately selected patients and continues to shape the landscape of gastroparesis management.

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice.

Semaglutide, a glucagon-like peptide-1 receptor agonist widely used for managing type 2 diabetes mellitus and obesity. Reports of semaglutide-associated hepatotoxicity are exceedingly rare. We detail a case of a 44-year-old woman who developed liver injury with elevated liver enzymes after semaglutide initiation for weight management. Liver enzyme levels normalized after discontinuing the drug and worsened upon rechallenge, confirming semaglutide's potential to cause liver injury. In addition, our case study encompasses a literature review of all reported semaglutide-related drug-induced liver injury cases, highlighting the need for diligent liver function monitoring in patients on semaglutide and offering valuable insights into its hepatotoxic potential.