Endoscopic resection has become an accepted approach for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), but there are technical challenges, especially during ESD for SNADETs. The aim of this study is to evaluate the efficacy and safety of an innovative traction technique for ESD in the treatment of SNADETs. We sought to evaluate the clinical value of detachable clip combined with rubber band-assisted ESD (DCRB-ESD) in the treatment of SNADETs in a large tertiary center. The patients who underwent DCRB-ESD or conventional endoscopic submucosal dissection (C-ESD) between July 2010 and December 2025 were enrolled in this study. Propensity score matching was applied to match patients with similar baseline characteristics. The clinical characteristics of patients and lesions, submucosal fibrosis, procedural time, therapeutic outcomes, adverse events, and follow-up data were analyzed. One hundred and forty-nine patients were included in this study. Of these patients, 54 patients were matched in each group via propensity score matching. The en bloc resection rate and R0 resection rate of SNADETs in the DCRB-ESD group were superior to those in the C-ESD group [100 vs. 94.4%, P = 0.24; 96.3 vs. 85.2%, P < 0.05]. The procedure time was significantly shorter in the DCRB-ESD group than in the C-ESD group [48.5(28.9-81.2) vs. 57.1(40.1-119.8)min, P < 0.05]. Although there were no statistical differences in postoperative complications (1.9 vs. 5.6%, P = 0.62), the rate of intraoperative complications in the DCRB-ESD group was significantly lower than that in the C-ESD group (7.4 vs. 22.2%, P < 0.05). DCRB-ESD is a safe and effective method for treating superficial duodenal epithelial tumors. It can shorten procedural time, reduce technical difficulty, and may facilitate the management of larger lesions or those with submucosal fibrosis.

A 43-year-old man with a history of heavy alcohol consumption presented with seven episodes of hematochezia within 8h (50-100g each), accompanied by vague upper abdominal discomfort. Initial treatment for suspected acute gastrointestinal bleeding with esomeprazole and somatostatin was ineffective. Two hours after admission, recurrent hematochezia occurred with hemodynamic deterioration, including hypotension, decreased hemoglobin, pallor, tachycardia, and cold extremities. Contrast-enhanced abdominal CT demonstrated contrast extravasation and blood accumulation in the ileocecal region, suggesting bleeding from the appendiceal and ileocecal arteries. Colonoscopy revealed segmental intraluminal blood and persistent bleeding from the appendiceal orifice despite repeated irrigation. Emergency laparoscopic appendectomy was performed. Histopathology showed thick-walled vascular proliferation consistent with an appendiceal Dieulafoy's lesion. The patient recovered uneventfully without recurrent bleeding during a 6-month follow-up. This case highlights the atypical, rapidly progressive nature of appendiceal Dieulafoy's lesion and the diagnostic value of contrast-enhanced CT and timely endoscopy.

Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled patients with solid pancreatic lesions who underwent EUS-guided FNB, directly compared the Franseen-tip with other FNB needles. Six databases were systematically searched through July 2025, and study selection, data extraction, and risk of bias assessment (QUADAS-2 tool) were performed independently by two reviewers. Pooled estimates were generated using random-effects and bivariate hierarchical models. Sixteen studies (2,010 Franseen vs. 2,811 comparator) were included. Bivariate analysis showed that sensitivity and specificity of the Franseen needle were comparable to newer-generation comparator needles (sensitivity 91.3% vs. 94.0%; specificity 99.99% vs. 99.15%), whereas older-generation needles demonstrated lower sensitivity (80.8%) and inferior discriminatory performance (Negative Likelihood Ratio [LR⁻] 0.19 vs. 0.09). Diagnostic accuracy was higher with the Franseen needle (RR 1.07, 95% CI 1.01-1.14; I2 = 69%). Sample adequacy was similar overall (RR 1.04, 95% CI 0.95-1.14) but superior to older-generation needles (RR 1.19, 95% CI 1.02-1.41) and in lesions > 30mm (RR 1.14, 95% CI 1.02-1.28, I2 = 81.2%). The Franseen needle achieved nominally strong diagnostic performance (DOR 116.6), although small-study effects were observed. Primary procedural outcomes were comparable between Franseen and comparator needles, including technical success (RR 1.00, 95% CI 0.98-1.02) and histological core procurement (RR 1.04, 95% CI 0.92-1.17). The Franseen needle had fewer low-cellularity samples (RR 0.56, 95% CI 0.45-0.69) and lower specimen bloodiness (RR 0.48, 95% CI 0.25-0.90) but a slightly higher overall adverse event rate (RR 1.29, 95% CI 1.06-1.57). The Franseen needle provides superior diagnostic accuracy and sample adequacy compared to older-generation FNB needles with comparable performance to newer-generation designs. It reduces low-cellularity samples and specimen bloodiness, although adverse events are slightly increased, with other primary procedural outcomes remaining comparable. PROSPERO (Registration No. CRD420251123856).

Endoscope tip protectors (ETP) are commercially available, but their effect on reducing the number and type of damages to the instruments and the economic impact of reducing repair costs are largely unknown. We conducted a prospective, blinded cohort, operational quality improvement study at a large, quaternary endoscopic referral center to assess the frequency and types of endoscope damage as well as analyze the effect on repair costs. A cohort of 21 upper endoscopes, 16 colonoscopes and 11 echoendoscopes was utilized. Phase 1 involved 1,800 procedures without ETP, followed by Phase 2 utilizing the ETP for 1,800 procedures. The endoscope cohort was assessed after each procedure, at the 900-procedure point, and at the end of each phase of the study to ensure the capture of any unidentified damage. A cost per case analysis (CPC) and cost-effectiveness analysis (CEA) were performed using the overall cost of damage repair per volume of procedures, from the perspective of the overall fleet as well as the specific types of endoscopes studied. ETP use was associated with a 36.4% decrease in overall fleet repair costs, from $167.64 to $106.72 per case, with a 48.7%, 64.7% and 28.4% CPC reduction respectively for upper endoscopes, colonoscopes and echoendoscopes. CEA found that the use of ETP dominated non-use for the entire endoscope fleet, upper endoscopes and colonoscopes but not echoendoscopes. ETP was associated with a decrease in CPC repair costs and was the dominant practice strategy from a CEA standpoint for all endoscope classes except echoendoscopes. ETP use should be considered to reduce endoscope repair costs. Further studies are warranted to validate these findings.

Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic functional impairment remain incompletely defined. We prospectively evaluated the pancreatic exocrine and endocrine function in patients with ANP and attempted to identify associated risk factors. Patients aged 18-80years with ANP defined by theRevised Atlanta Classificationwere enrolled and prospectively followed for 6months. Exocrine function was assessed using fecal elastase-1 (FE-1), and endocrine function was evaluated using fasting glucose, postprandial glucose, HbA1c, and homeostatic model assessment of insulin resistance (HOMA-IR). Clinical severity, etiology, anatomic distribution of necrosis, infected necrosis, and interventions were analyzed as predictors of dysfunction. Thirty patients completed 6-month follow-up. At 6months, exocrine insufficiency occurred in 40% of patients (mild 16.7%, severe 23.3%). Endocrine dysfunction was observed in 30% of patients, including diabetes mellitus (6.7%) and prediabetes (23.3%). Necrosis involving the pancreatic head was significantly associated with exocrine insufficiency (p = 0.003). Moderately severe acute pancreatitis independently predicted exocrine dysfunction (p = 0.01). No clinical or radiologic factor predicted endocrine insufficiency. Exocrine insufficiency appears to be relatively common following ANP, with a possible association observed in patients with moderately severe disease and head-dominant necrosis; however, these findings require further validation. Endocrine dysfunction was observed in approximately one-third of patients, but no consistent predictors were identified in this cohort.

Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle. We aimed to evaluate the efficacy and safety of PAEM. This retrospective study included patients who underwent PAEM for lower rectal lesions between January 2017 and December 2024 at the Osaka International Cancer Institute. PAEM was performed intentionally after October 2023, whereas unintentional PAEM occurred during endoscopic submucosal dissection (ESD) prior to October 2023. Short-term outcomes were assessed, and negative vertical margin rates were compared between groups. Among 242 consecutive patients who underwent ESD for lower rectal lesions, PAEM was performed in 25 patients (unintentional PAEM, 13; intentional PAEM, 12). The median age was 66years (range, 38-89years), and 14 patients (56%) were female. En bloc resection was performed for all 25 lesions. Histological examinations showed 19 adenocarcinomas (pTis, 3; pT1, 11; pT2, 5), 3 other tumors, and 3 non-residual tumors (salvage treatment after endoscopic resection). After PAEM, hematochezia occurred in 14 patients (56%), but most cases were self-limited and one patient had hematochezia requiring prolonged hospitalization. The negative vertical margin rate was higher in the intentional PAEM group than in the unintentional PAEM group, with similar findings observed in an additional analysis excluding salvage cases (88% vs. 33%, P = 0.007). PAEM was feasible and generally safe. Intentional PAEM may facilitate vertical margin control in selected cases with severe fibrosis.

Acute pancreatitis during pregnancy is a rare but potentially severe condition that may adversely affect both maternal and fetal outcomes. Although advances in intensive care have improved prognosis, the impact of the disease on pregnancy outcomes remains an important clinical concern. This study aimed to investigate maternal and fetal outcomes in pregnancies complicated by acute pancreatitis and to evaluate the effect of disease severity on these outcomes. This retrospective study was conducted at a tertiary care center and included 25 pregnant women diagnosed with acute pancreatitis and 100 healthy controls between February 2020 and February 2025. Maternal and fetal outcomes were first compared between the acute pancreatitis and control groups. Subsequently, patients with acute pancreatitis were classified into mild and severe subgroups according to disease severity, and subgroup analyses were performed. Clinical, laboratory, and obstetric outcomes were analyzed using appropriate statistical methods. Patients with acute pancreatitis had significantly longer hospital stays and higher rates of maternal intensive care unit admission compared with controls (p < 0.001 for both). Gestational age at delivery was lower and neonatal birth weights were reduced in the acute pancreatitis group (p < 0.001 and p = 0.004, respectively). Neonatal mortality was also higher in this group (p < 0.001). In subgroup analyses, patients with severe acute pancreatitis had higher maternal ICU admission rates (p = 0.001), longer ICU stays (p = 0.005), and increased neonatal ICU admissions (p = 0.022). Acute pancreatitis during pregnancy is associated with adverse maternal, fetal, and neonatal outcomes, particularly in severe cases. Early recognition and close multidisciplinary management in tertiary centers may help reduce complications and improve pregnancy outcomes.

Non-invasive laboratory-based models have been proposed to estimate portal hypertension severity in patients with compensated advanced chronic liver disease (cACLD), but external validation in diverse populations remains limited. We aimed to externally validate two such models, originally developed in European cohorts, for predicting clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10mmHg) and severe portal hypertension (HVPG ≥ 16mmHg) in a U.S.-based cACLD cohort. We conducted a retrospective single-center study of adults with cACLD who underwent HVPG measurement between 2014 and 2024. Patients with active hepatic decompensation, hepatocellular carcinoma, or prior transjugular intrahepatic portosystemic shunt were excluded. Model performance of the Vienna laboratory-based model and the FIB-4 plus albumin (FIB4 +) model was evaluated using discrimination (area under the receiver operating characteristic curve [AUROC]) and calibration metrics, including calibration intercepts, slopes, and Brier scores. The cohort included 143 patients (median age 56years; 54% female), predominantly with metabolic dysfunction-associated steatotic liver disease or alcohol-related liver disease. Median HVPG was 7mmHg, with CSPH present in 33% and HVPG ≥ 16mmHg in 11%. Discrimination was modest for both models. The Vienna model achieved AUROCs of 0.71 for HVPG ≥ 10mmHg and 0.77 for HVPG ≥ 16mmHg, while the FIB4 + model achieved AUROCs of 0.69 and 0.71, respectively. Both models systematically overestimated risk, demonstrating poor calibration across thresholds. Negative predictive values for HVPG ≥ 16mmHg exceeded 95% for both models. Predictive performance was weaker in non-viral etiologies. In this U.S.-based external validation, laboratory-based models for portal hypertension showed modest discrimination and poor calibration, with systematic risk overestimation. While high negative predictive values suggest potential utility as rule-out tools for severe portal hypertension, recalibration and prospective validation are required before clinical implementation.

We report a rare 18-cm splenic tail anomaly presenting with a unique "tadpole" sign on CT hyper-realistic rendering (HRR), which was managed conservatively and identified as a congenital variation to prevent misdiagnosis and unnecessary invasive procedures.