Obesity represents a significant challenge for anesthesia management due to different drug pharmacodynamics and an increased risk of perioperative complications. Multimodal opioid-sparing total intravenous anesthesia is one of the options for positively influencing these complications. Since opioid-sparing methods are still considered by most anesthesiologists to be the only alternative techniques, we present our initial experiences and a comparison with inhalation anesthesia in laparoscopy as inspiration for others. Keywords obesity, opioid-sparing anesthesia, multimodal techniques, TIVA, anesthesia depth monitoring

Introduction: Acute pancreatitis (AP) is a medical-surgical emergency whose prevalence is rising worldwide. Similarly, the incidence of chronic pancreatitis (CP) is increasing. The aim of our work was to determine the incidence, prevalence, and comorbidities of acute and chronic pancreatitis in hospitalized patients in the largest hospital in Cotonou, Benin. Methods: This was a retrospective descriptive cross-sectional study conducted from September 09 to October 31, 2022 using medical records of patients hospitalized from January 1, 2011 to October 31, 2022 for acute or chronic pancreatitis in three wards of the Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, Benin. Results: During the study period, 15682 patients were hospitalized, including 14 cases of AP, representing a hospital prevalence of 0.09% and a frequency of 1.2 cases per year, and 08 cases of CP, representing a hospital prevalence of 0.05% and a frequency of 0.7 cases per year. The poor clinical picture, however, was dominated by abdominal pain (found in 100% of AP cases and 75% of CP cases). As a result, there were many undetermined causes (35.7% of AP and 62.5% of CP), but no specifically tropical causes could be identified. Treatment was mainly medical, with the exception of surgical management in cases where the disease was discovered intraoperatively. Mortality was 14.3% for AP and 37.5% for CP. Conclusion: In Cotonou, hospital prevalence was low for both acute and chronic pancreatitis. An in-depth etiological investigation would be welcome to identify the causes of these pathologies in Benin. Keywords prevalence, chronic pancreatitis, acute pancreatitis, cause, treatment, Benin

Background: Colorectal carcinoma (CRC) develops through a multi-stage process called the adenoma-carcinoma sequence. The objectives of this study were to evaluate the expression levels of beta-catenin, cyclin D1, and Stress-Induced Phosphoprotein 1 (STIP1) in the progression from adenoma to carcinoma and to investigate their relationships with clinicopathological features in CRC. Patients and methods: The study included 88 CRC, 20 tubular adenoma (TA), 20 villous adenoma (VA), and 10 normal colon mucosa (NCM) tissue samples, randomly selected from the routine archival materials of the pathology department. Results: Immunohistochemical ß-catenin expression was higher in the TA group than the CRC group (P = 0.007). Cyclin D1 and STIP1 expressions were higher in the TA (P = 0.008; P < 0.001, respectively) and VA (P = 0.002) groups than in the CRC group. STIP1 expression was found to be higher in TA and VA groups compared to the CRC group (P < 0.001; P = 0.002, respectively). Cyclin D1 was expressed at a higher level in the TA and VA groups compared to the CRC group (P = 0.008; P = 0.002, respectively). In addition, positive relations were found between ß-catenin and cyclin D1 (P = 0.025), ß-catenin and STIP1 (P = 0.014), cyclin D1 and STIP1 (P = 0.001) expressions. Conclusion: Our results suggest that ß-catenin, cyclin D1, and STIP1 expressions were interrelated in CRC cases. We found that all three markers were highly expressed, particularly during adenomatous transformation, but their effects diminished in the invasive phase of the tumor. Keywords colorectal cancer, stress-inducible protein-1, cyclin D1, imunohistochemie

Background: Pediatric gallstone disease presents unique management challenges. This systematic review analyzes current treatment strategies in children under 18 years of age. Methods: We conducted a literature search (2015–2025) in PubMed, EMBASE, and the Cochrane Library for studies involving pediatric gallstone patients treated with ursodeoxycholic acid (UDCA), laparoscopic cholecystectomy (LC), endoscopic retrograde cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE). Results: Across 758 pediatric cases from 10 studies, LC combined with ERCP showed high efficacy and low complication rates. LCBDE was effective but carried a potentially higher risk of complications. UDCA treatment demonstrated limited success and frequent recurrence. The overall surgical complication rate was 4.7%. Treatment outcomes were influenced by patient-specific factors (e. g., underlying disease, hydration status, and obesity) and proceduralist expertise. Conclusions: LC combined with ERCP appears to be a highly effective intervention for gallstones in children. LCBDE is a viable alternative, although it may be associated with greater complication risk. UDCA is not recommended as a primary treatment based on suboptimal long-term outcomes. Further large-scale, multicenter studies are essential to refine pediatric gallstone management. Keywords treatment, cholelithiasis, gallstones, management, child, infants

Malignant and paramalignant ascites significantly reduce the quality of life of oncology patients and are primarily managed with palliative care. A rare but clinically challenging variant includes encapsulated paramalignant fluid collections that are not amenable to standard percutaneous drainage. We present the case of a 65-year-old woman with advanced pancreatic cancer and peritoneal carcinomatosis who developed a large encapsulated collection causing gastric outlet obstruction. To relieve her symptoms, we performed transgastric drainage of the collection using endoscopic ultrasound guidance with the placement of a lumen-apposing metal stent. The procedure was carried out without complications and led to rapid clinical improvement. The patient was subsequently discharged for home palliative care. The aim of this case report is to highlight the usability of LAMS in uncommon indications in oncologic patients. Keywords EUS drenáž, malignant ascites, pancreatic cancer, encapsulated collection

Severe biliary strictures present a substantial challenge in endoscopic interventions, often resistant to conventional dilation techniques. This case series explores the successful utilization of coronary angioplasty balloons, typically reserved for cardiovascular applications, in six patients with tight biliary strictures where standard through-the-scope (TTS) balloons failed. The patients, ranging from pediatric to adult cases, exhibited diverse etiologies, including post-transplant and chronic inflammatory strictures. Results demonstrated the versatility and efficacy of coronary balloons, achieving complete biliary flow restoration without complications. This study highlights the potential of coronary balloon angioplasty as an indispensable tool for complex endoscopic retrograde cholangiopancreatography (ERCP) procedures. These findings support the broader adoption of this technique and warrant further investigations through larger clinical studies. Keywords ERCP, coronary balloon, biliary stenting, severe biliary strictures, endoscopic dilation, case series

Liver transplantation is a complex treatment primarily for patients with acute and chronic liver failure and liver tumors. However, transplantation carries health risks, including the rare potential transmission of an undiagnosed cancerous tumor from the donor. Organ donors are routinely tested for infectious diseases and attention is also paid to tumor screening, because organ recipients are at risk of rapid growth and aggressive spread of malignancy due to the immunosuppressive regimen they receive to prevent rejection of the transplanted organ. This study examines a potential case of malignant melanoma being transmitted from the donor to the recipient after a liver transplant. The donor was a 58-year-old man with multiple health issues and an unknown family history of cancer or smoking habits. It wasn‘t until 20 days after his organs were collected that he was diagnosed with metastatic malignant melanoma in the paratracheal node. The recipient was a 56-year-old patient with cirrhosis from a combination of alcohol abuse and hepatitis B. The recipient was diagnosed with malignant melanoma 395 days after transplantation. Despite the lack of genetic testing, the cancer was likely transferred from the donor rather than being a de novo occurrence. To prevent transmission of malignancies, thorough personal history, physical examination, and rational use of imaging and laboratory methods should be part of the screening process for organ donors without unnecessarily prolonging the waiting time for transplantation. Keywords liver transplantation, melanoma, immunosuppression, transmission of malignancy

Filgotinib is a preferential JAK-1 inhibitor, which was introduced in clinical practice in ulcerative colitis patients in 2022. In that year, many real-world clinical data have been published, documenting that filgotinib therapy is associated with high efficacy and safety. The most important project in real clinical practice is the GALOCEAN study, from which the first preliminary data have been presented. Clinical practice confirmed that the anti-inflammatory efficacy of filgotinib is similar to tofacitinib, but slightly lower than upadacitinib. Compared to upadacitinib and tofacitinib, long-term therapy with filgotinib is associated with a lower frequency of side effects. Keywords filgotinib, ulcerative colitis, JAK inhibitors, upadacitinib, tofacitinib

osinophilic esophagitis (EoE) is a chronic, progressive, and immune-mediated disease of the esophagus characterized by a marked infiltration of eosinophils in the mucosa (≥ 15 eosinophils per high-power field in at least one biopsy sample) in the absence of other causes of esophageal eosinophilia. Specific risk factors for the development of the disease are not known; however, male sex, atopy, and a positive family history significantly increase the risk of its occurrence. A personal history often reveals concomitant asthma, allergic rhinitis, atopic dermatitis, or food allergy. The condition may also be drug-induced (e. g., due to oral immunotherapy). Clinical presentation is age-dependent. In infants and young children, symptoms are usually nonspecific – feeding difficulties, vomiting, and failure to thrive. In older children and adolescents, dysphagia, odynophagia, regurgitation, or food impaction in the esophagus are more common. Diagnosis of EoE is based on a combination of clinical presentation, endoscopic findings, and histological examination of biopsy samples. The key diagnostic criterion is demonstration of eosinophilic infiltration of the esophageal mucosa in at least one biopsy specimen. Treatment includes the use of proton pump inhibitors, topical corticosteroids, or implementation of an elimination diet. The aim of this article is to present the issue of this disease in childhood and to publish the experience from our department. Keywords eosinophilic esophagitis, pediatric, dysphagia

Introduction: Hereditary pancreatitis consists of severe genetically determined disorders of trypsinogen release and activation, which can either causally or as a concomitant etiological factor lead to recurrent episodes of pancreatitis, potentially resulting in the development of chronic inflammation of the pancreas. Case description: We present a case report of a 2.5-year-old patient treated for acute lymphoblastic leukemia, who developed acute recurrent pancreatitis during the intensive phase of therapy. This led to permanent structural changes in the pancreas without impairment of its exocrine or endocrine function. Acute pancreatitis can be a rare side effect of some chemotherapeutic agents. Given the atypical recurrence of attacks and their onset after the administration of chemotherapeutics, which do not typically list the development of pancreatitis among their side effects, molecular-genetic testing targeted at hereditary pancreatitis was performed, yielding a positive finding of a mutation in the SPINK1 gene. Conclusion: This case report illustrates the benefit of a targeted search for possible causes of recurrent pancreatitis, including genetic testing. Keywords acute pancreatitis, hereditary pancreatitis, acute recurrent pancreatitis, SPINK1, acute lymphoblastic leukemia, chemotherapy