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Background: Inflammatory bowel disease (IBD) occurs in up to 70%–80% of patients with primary sclerosing cholangitis (PSC). Oral vancomycin therapy (OVT) has been reported to be effective in the treatment of IBD associated with PSC (IBD-PSC). Objectives: To examine the effectiveness and safety of OVT in the treatment of IBD-PSC by performing a systematic review and pooled analysis of the literature. Design: We performed a systematic review and pooled analysis of studies reporting IBD clinical response to OVT in IBD-PSC. Data sources and methods: A systematic search was conducted in Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science from database inception to June 3, 2024. We included adult and pediatric studies that reported on clinical response (defined as any improvement in IBD-related clinical symptoms) of IBD-PSC patients treated with OVT (including pre- and post-liver transplantation cohorts). Pooled analyses of OVT response and safety were performed. Results: A total of 21 (open-label, non-controlled) studies including 290 patients with IBD-PSC treated with OVT were included. The median duration of OVT to treat IBD-PSC was 32.5 weeks (interquartile range (IQR): 19–83 weeks). The total daily dose of OVT ranged from 250 to 1500 mg. Concomitant treatment included the following: mesalamine in 14.5% (n = 42), advanced therapies in 10.7% (n = 31), and immunosuppressive agents in 14.1% (n = 41). Clinical response was noted in 47.6% (138/290) and clinical remission in 43.5% (100/230). The biochemical remission rate post-OVT was 68.8% (55/80) and endoscopic remission was 39.4% (80/203). Three studies (n = 11) reported no episodes of acute cholangitis while on OVT. Five studies (n = 69) reported an incidence rate of 8.7% of vancomycin-resistant enterococci post-OVT to treat IBD-PSC. Conclusion: OVT was associated with clinical response/remission in almost half of patients with IBD-PSC with a favorable side effect profile. Further prospective randomized trials are needed to confirm the dosing, efficacy, treatment duration, and long-term safety of OVT for the treatment of IBD-PSC. Trial registration: The study protocol was registered with PROSPERO a priori (no. CRD42023438341). [ABSTRACT FROM AUTHOR]

Developmental cyst is occasionally seen in children but are less common in adults. Complete removal of developmental cyst is necessary because there are risk of infection, squamous cell carcinoma, and recurrence due to incomplete resection. The best approach for resection of developmental cyst is still controversial. Although transsacral approach, open abdominal approach, or a combination of both have been often employed to date, reports of laparoscopic surgery have been appearing in recent years. We performed laparoscopic surgery for four patients with this disease: (i) 29-year-old woman with epidermoid cyst; (ii) 21-year-old woman with dermoid cyst; (iii) 55-year-old woman with epidermoid cyst; and (iv) 77-year-old woman with epidermoid cyst. No perioperative complications occurred and no recurrence has developed so far in any patients. Laparoscopic surgery can be considered as one of the optimal treatment options for developmental cyst., (© 2024 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, and chronic cholestatic diseases that can progress to liver failure. The goals of treatment are to halt the progression of liver disease to cirrhosis and/or liver failure, and alleviate symptoms associated with these diseases. Ursodeoxycholic acid has historically been the first-line treatment of PBC, with obeticholic acid and fibrates used as second-line or adjunctive therapies. However, the treatment landscape is rapidly expanding. Recently, 2 new second-line agents gained US Food and Drug Administration approval for the treatment of PBC, and several other therapies remain under investigation with promising results. Although significant progress has been made in the development of therapies for PBC, there are no current approved treatments of PSC other than liver transplantation although several emerging therapies have shown encouraging results. This review outlines the current and upcoming treatments of PBC and PSC., (Copyright © 2024 by The American College of Gastroenterology.)