[This corrects the article DOI: 10.1159/000549436.].

Primary neuroendocrine tumors (NETs) of the rectum are rare and often present with nonspecific gastrointestinal symptoms, making early diagnosis challenging. We report the case of a 42-year-old male with persistent pruritus ani and mild rectal bleeding refractory to conventional treatment, ultimately diagnosed with a well-differentiated Grade 1 rectal NET. This case underscores the importance of maintaining clinical suspicion for rare malignancies when evaluating persistent anorectal symptoms and highlights the critical role of thorough endoscopic evaluation in achieving early diagnosis and favorable outcomes.

A 77-year-old woman presented with cholestatic hepatitis, initially diagnosed with choledocholithiasis and treated via ERCP; however, her persistent transaminase levels did not improve. A subsequent liver biopsy revealed ductopenia, consistent with vanishing bile duct syndrome (VBDS). She had been on long-term amoxicillin for maintenance therapy related to recurrent infections from sacral decubitus ulcers. Amoxicillin was determined to be the most likely offending agent behind VBDS and was discontinued. After the withdrawal of the culprit medication, the case was monitored for nearly three years, and the patient’s transaminase levels consistently trended downward with ursodeoxycholic acid before she ultimately passed away from complications arising from other comorbidities.

Introduction: Despite the use of narrow-band imaging, comprehensive endoscopic evaluation of the laryngopharynx in the endoscopy suite remains challenging because of its complex anatomical structure, limited working space, and reactions such as gagging and coughing. Consequently, minute synchronous neoplasms may occasionally be overlooked during the initial endoscopic assessment. We hypothesized that argon–plasma coagulation (APC) could serve as a minimally invasive treatment for minute synchronous neoplasms of the head and neck detected during endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection (ELPS/ESD) for primary lesions. Case presentation: We report three cases of pharyngeal cancer treated with ELPS/ESD under general anesthesia: an 82-year-old man, a 73-year-old man, and a 40-year-old woman. During intraoperative endoscopic observation, nine minute lesions measuring 3–7 mm that had not been detected in the endoscopy suite were identified in three patients. These lesions were immediately treated with APC, a non-contact technique that uses ionized argon gas to coagulate abnormal tissue. In Cases 1, 2, and 3, the lengths of hospital stay were 10, 11, and 6 days, respectively, and the follow-up periods were 9 months, 6 months, and 6 months, respectively. Within this limited follow-up period, no post-procedural bleeding, post-procedural hoarseness, or post-procedural swallowing dysfunction was observed. Conclusions: Based on this small case series with limited follow-up, intraoperative APC may be a feasible adjunctive approach for the ablation of minute synchronous lesions detected during ELPS/ESD for pharyngeal cancer.

Introduction: This report presents three cases of unintentional ingestion of beer line cleaner (BLC), a strongly caustic alkaline solution (pH 13–14). In each incident, unflushed BLC entered the draft system and was served as drinkable beer (pH 4.0–4.5) in different taverns due to deficiencies in regulatory oversight and enforcement. Case Presentations: A 37-year-old female, a 37-year-old male, and a 40-year-old male presented with esophageal injuries after consuming contaminated beer in unrelated events. Endoscopy revealed findings ranging from erythema and esophageal nodules to benign strictures and very severe Grade D esophagitis. Patients required extended proton pump inhibitor therapy and dietary changes, and they experienced ongoing symptoms, including dysphagia, reflux, taste alterations, and weight loss. Conclusion: This case series highlights the serious and lasting consequences of BLC ingestion and underscores the need for standardized beer line flushing protocols, tracer dyes, and point-of-use testing to prevent future exposures in commercial establishments where uniform regulations are insufficient. It also demonstrates the underreported health risks associated with accidental BLC ingestion. Greater physician awareness can facilitate earlier diagnosis and treatment and improve outcomes. Enhanced reporting of BLC ingestion can increase identification of caustic hazards and strengthen public health awareness of this largely unrecognized risk.

Introduction: Gallstone ileus of the colon is a rare cause of large bowel obstruction, usually caused by a gallbladder-to-colon fistula allowing stone entry. The classical presentation is with episodic subacute obstruction. Contrast-enhanced CT is valuable for diagnosis, with surgery being the preferred treatment; however, endoscopic therapy has been described and may also be attempted. Case Presentation: We describe the case of an 81-year-old female with a medical history significant for atrial fibrillation and congestive heart failure. She presented with a 2-week history of constipation, abdominal pain, distention, nausea, and vomiting. Clinically, her abdomen was distended but without signs of peritonitis. A CT scan showed a cholecystoduodenal fistula, along with a 3.3-cm gallstone causing a large bowel obstruction at the sigmoid colon. An attempt at flexible sigmoidoscopy to remove the stone failed due to its size and distal hypertrophy. The patient underwent exploratory laparotomy and Hartmann’s procedure to relieve the obstruction and remove the gallstone. Conclusion: Gallstone ileus remains an uncommon but clinically important cause of mechanical bowel obstruction, typically occurring in elderly patients with significant comorbidities. This case underscores an especially rare manifestation – large bowel obstruction secondary to gallstone ileus – which can pose diagnostic and therapeutic challenges and is easily overlooked. By illustrating this atypical presentation, our report highlights the need for heightened clinical suspicion in older patients presenting with bowel obstruction and pneumobilia. Furthermore, it emphasizes the spectrum of available management strategies and the importance of individualized decision-making based on patient frailty, anatomical considerations, and surgical risk.

Introduction: Esophageal neuroendocrine carcinoma is an extremely rare type of esophageal cancer. Due to the limited number of cases, there are no established diagnostic and treatment guidelines. Case Presentation: A 60-year-old male presented with dysphagia and was subsequently diagnosed with large cell neuroendocrine carcinoma of the esophagus. He received four cycles of treatment with adebrelimab combined with etoposide and carboplatin, which resulted in significant tumor shrinkage. Conclusion: Esophageal neuroendocrine carcinoma is a highly malignant tumor with a high mortality rate. A better understanding of its diagnosis and treatment strategies may contribute to favorable trends in patient outcomes, while its actual effect on long-term prognosis remains to be validated with extended follow-up.

Introduction: Inflammatory bowel disease (IBD) is associated with Takayasu arteritis (TAK). Chronic recurrent multifocal osteomyelitis (CRMO) is a nonbacterial osteomyelitis that occurs at multiple sites, some of which are associated with IBD. We herein report a pediatric patient diagnosed with CRMO and TAK 13 years after the onset of very early-onset ulcerative colitis (VEO-UC). Concurrent presentations of UC, TAK, and CRMO are extremely rare. Case Presentation: A 15-year-old female diagnosed with VEO-UC at 22 months developed CRMO and TAK 13 years later despite maintained remission on infliximab. The patient was presented with knee pain and fever. 18-fluorodeoxyglucose positron emission tomography revealed not only multiple bone uptake but also arterial wall thickening. Contrast-enhanced magnetic resonance imaging showed circumferential wall thickening from distal aortic arch to descending aorta. Bone biopsy confirmed chronic osteomyelitis without infection. TAK (type IIb) and CRMO were diagnosed. Methylprednisolone pulse therapy was administered for induction. Treatment was switched to adalimumab (ADA), which has reported efficacies for all three conditions. However, only TAK did not achieve remission. ADA was switched to tocilizumab (TCZ) without changing other medications to treat TAK, successfully achieving remission of all three diseases and allowing steroid reduction. Conclusion: Clinicians should consider concurrent vasculitis and CRMO when IBD patients present with unexplained inflammatory responses. TCZ may effectively treat TAK developing in anti-tumor necrosis factor-treated UC patients.

Introduction: Complete anastomotic occlusion following rectal surgery is a rare and challenging complication. While surgical revision remains the standard treatment, it is associated with significant morbidity. Recently, novel endoscopic techniques have emerged as minimally invasive alternatives. Case Presentation: We report the case of a 64-year-old patient who developed complete rectal anastomotic occlusion after low anterior resection and declined further surgery. Five months later, spontaneous recanalization was observed, allowing for successful endoscopic treatment using a lumen-apposing metal stent (LAMS). The stent was later removed, and ileostomy reversal was completed successfully. Conclusion: Watchful surveillance for spontaneous recanalization may offer a safe opportunity for endoscopic intervention in selected high-risk, diverted patients with complete rectal anastomotic occlusion. LAMS may serve as an effective alternative to fully covered self-expandable metal stents in cases of severe strictures.

Plain Language SummaryBiliary-enteric anastomotic strictures (BEAS) following pancreaticoduodenectomy present a significant therapeutic challenge. The combination of surgically altered gastrointestinal anatomy and severe fibrotic stenosis often renders conventional endoscopic interventions ineffective. This study reports a novel dual-modality strategy for the treatment of refractory BEAS, which combines a percutaneous transhepatic cholangiodrainage (PTCD)-endoscopic retrograde cholangiopancreatography (ERCP) rendezvous technique with an innovative mechanical dilation method. We present the case of a 50-year-old male who was diagnosed with BEAS by magnetic resonance cholangiopancreatography (MRCP) 4 years after undergoing pancreaticoduodenectomy. He presented with recurrent episodes of abdominal pain, fever, and jaundice. Previous attempts to dilate the stricture using either conventional ERCP techniques or standard PTCD approaches alone had been unsuccessful. Consequently, a novel hybrid approach that utilized both PTCD for access and endoscopic therapy for treatment was employed. The procedure involved advancing a guidewire through the PTCD tract into the jejunal lumen under fluoroscopic guidance, which was then endoscopically retrieved using foreign body forceps. Bidirectional traction stabilized the access route, enabling gastroscopic navigation to the anastomosis. For the refractory stenosis, controlled mechanical dilation was performed using a stent retriever for rotational drilling, followed by balloon dilation and placement of a nasobiliary catheter. After a 2-week interval, secondary therapeutic dilation was performed via the established PTCD tract, and the drainage catheter was subsequently removed. At the 3-month follow-up, the patient remained asymptomatic, with no evidence of recurrent cholangitis or other complications.