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Background: The management of large distal penile calculi has evolved with the advent of endoscopic techniques. However, open surgical management remains a viable option, particularly in resource-limited settings. This study aimed to evaluate the efficacy and safety of open surgical management for large distal penile calculi and compare the results with the existing literature on endoscopic management. Methods: A retrospective review of 25 patients who underwent open surgical management for large distal penile calculi (>1.5 cm) was conducted. Patient demographics, stone characteristics, intraoperative data, postoperative outcomes, and complications were analyzed. The results were compared with the existing literature on endoscopic management. Results: The mean age of the patients was 45.6 ± 8.2 years, and the mean stone size was 1.8 ± 0.3 cm. The success rate of open surgical management was 96%, with intraoperative and postoperative complication rates of 12% each. Stricture formation and recurrence rates were 4% and 0%, respectively. The mean operative time was 35.6 ± 8.4 minutes, and the patient satisfaction rate was 92%. Compared to endoscopic management, open surgery demonstrated lower stricture formation rates (4% vs. 5- 10%, p = 0.04) and recurrence rates (0% vs. 2-5%, p = 0.02). Conclusion: Open surgical management is a safe and effective approach for treating large distal penile calculi, with high success rates, low complication rates, and minimal risk of long-term complications. It may be a preferred option, particularly in resource-limited settings. Further prospective comparative studies are needed to establish the role of open surgical management in the contemporary era of endoscopic surgery. [ABSTRACT FROM AUTHOR]

(1) Background: Lower gastrointestinal bleeding (LGIB) accounts for 20% of all gastrointestinal bleeds. LGBI originates in the colon, rectum, and anus, mainly in patients who are receiving antiaggregant or anticoagulant treatment. The major causes are diverticular disease, colitis, hemorrhoids, and angiodysplasia. The literature studies underline that Direct Oral Anticoagulants (DOACs) are effective in reducing the risk of thromboembolic events but are associated with a higher risk of lower gastrointestinal bleeding (LGIB), particularly lower hemorrhoid bleeding. (2) Methods: The aim of our review is to revise the risk of hemorrhoid bleeding, pathophysiology, and management in patients taking DOACs in light of the most modern evidence. (3) Conclusions: central to the management of hemorrhoid bleeding in patients receiving DOAC therapy is the consideration of a tailored approach that respects the delicate equilibrium between the need for thromboembolic prophylaxis and the potential for bleeding complications. Cessation of anticoagulation, if clinically feasible, constitutes a fundamental cornerstone in the control of hemorrhage. This pause in therapy aims to mitigate the exacerbation of bleeding risk while offering a window for the implementation of local measures to manage hemorrhoid bleeding. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure associated with a non-negligible risk of postoperative adverse events, especially fistulas, the majority of which occur at the angle of His. This adverse event requires a multidisciplinary approach involving intensive care, surgery, interventional endoscopy, and radiology. Despite the absence of an algorithmic endoscopic approach, a primarily endoscopic management of fistulas after LSG is now standard of care in most institutions. Case Report: A 66-year-old female with grade III obesity, obstructive sleep apnea, type 2 diabetes, and hypertension underwent LSG. She developed abdominal pain, hypovolemic shock, and severe anemia (Hb 6.5 g/dL). A computed tomography (CT) scan revealed hemoperitoneum without active bleeding, managed with transfusion of packed blood cells. A week later, a new CT scan performed for leukocytosis and abdominal pain revealed pneumoperitoneum. An esophagogastroduodenoscopy revealed a 20-mm fistula orifice at the angle of His. A novel esophageal covered metallic stent was placed for a period of 5 weeks. The fistula orifice decreased to 4 mm and communicated through a fistulous tract with a residual subphrenic abscess measuring 62 × 20 mm. Pus was collected from the abscess and drained internally with a 10-Fr double pigtail plastic stent through the fistula orifice. Following an initial period of improvement, clinical deterioration required percutaneous subphrenic abscess drainage. Two weeks later, the double pigtail plastic stent was removed, the fistula orifice was ablated with argon plasma 40W/1L and closed with an over-the-scope clip of 10 mm. Patient improved and was discharged 4 months after the LSG. Conclusion: The Luso-Cor esophageal stent is a specifically designed covered metallic stent with a 5-mm uncovered ring near the proximal edge, which reduces the risk of migration. Two articulating zones in the middle portion allow better adaptation to altered anatomy after LSG and a distal flare reduces retrograde reflux of fluid. This stent overcomes strictures in the gastric tube, concomitantly present in nearly 50% of patients with fistulas after LSG. The novel Luso-Cor esophageal stent provided a bridge to clinical stability with a significant reduction in the size of the fistula orifice which was closed with complementary therapeutic endoscopic procedures.

Current guidelines recommend a rigorous follow-up for patients with endoscopically treated upper tract urothelial carcinoma, including cystoureteronephscopy, CT urography, and urine cytology. Our retrospective study evaluated the effectiveness of cytology and FISH analysis (flourescence in-situ hybridization) in this followup protocol. Sensitivity and specificity rates were 76% and 50% for cytology, and 58.6% and 63.1% for FISH. Negative predictive values were relatively low as well (69% and 60% for cytology and FISH, respectively). In only one case (0.17%), the tests result changed management. Cytology and FISH may be omitted from the low-grade UTUC follow-up regimen. Background: Current guidelines recommend a stringent follow-up regimen that includes interval cystoureteronephscopy, CT urography, and selective urine cytology sampling for upper tract urothelial carcinoma (UTUC) patients undergoing endoscopic treatment and management. There are no recommendations regarding FISH analysis. Our purpose was to assess the efficacy of cytology and FISH as part of the follow-up protocol and its significance to clinical decision-making in this scenario. Methods: The medical records of all patients who managed endoscopically for UTUC at our institute between 2014 and 2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant according to Par is cr iter ia. Results: Dur ing the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up regimen of low-grade UTUC. Urine from the affected upper tract was sampled for cytology in 377 procedures, and FISH analyses were performed in 273. In 75.4% of FISH analyses, the result was different from the cytology results: FISH found malignant aberrations in 15.5% of cases where cytology was benign. Furthermore, FISH classified all the cells defined as atypical via cytology as either benign or malignant. In only one case (0.17%), the urinary cytology report changed the follow-up regimen. Conclusion: Cytology may be omitted from the follow-up protocol of low-grade UTUC. In the handful of cases cytology does assist the diagnosis of UTUC, there is an additional benefit to performing FISH analysis, particularly when cellular atypia is reported in the cytology results. [ABSTRACT FROM AUTHOR]

Historically, ureteral reimplantation (UR) has been the gold standard for treatment of primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent urinary tract infections. In infants, open surgery with reimplantation of a grossly dilated ureter into a small bladder, can be technically challenging with significant morbidity. Therefore, less invasive endoscopic management such as dilatation or incision of the ureter–vesical junction, has emerged as an alternative to reimplantation during the last decades. To systematically evaluate the effectivity, safety, and potential benefits of endoscopic treatment (dilatation with or without balloon or incision) of POM in comparison to UR. A systematic review was conducted. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 20 participants and a mean follow-up more than 12 months were eligible for inclusion. Of 504 articles identified, 8 articles including 338 patients were eligible for inclusion (0 RCTs, 1 NRSs, and 7 case series). Age at time of surgery was minimum 15 days to a maximum of 192 months. Indications for endoscopic treatment (ET) included patients with loss of split renal function (>10%) and worsening of hydroureteronephrosis. The studies analysed reported a success rate ranging from 35% to 97%. Success was defined as stabilization of differential renal function without further procedures. A post-operative complication rate of 23–60% was reported (mostly transient haematuria, urinary tract infections and stent migration or intolerance). In 14% of the cases salvage UR following initial ET, was performed due to relapse of symptomatic POM. Endoscopic treatment for persistent or progressive POM in children is a minimally invasive alternative to UR with a long-term modest success rate. Additionally, it can be performed within a wide age span, with equal success rate and complication rates. [ABSTRACT FROM AUTHOR]

Esophageal cancer, comprising two histological types, adenocarcinoma and squamous cell carcinoma, has a poor prognosis because it is frequently diagnosed at advanced stage. In contrast, survival of patients with superficial cancer is excellent. Improvement of endoscopic devices (high-definition, chromoendoscopy, zoom) and the development of new endoscopic classification has significantly improved the ability to detect and characterize esophageal lesions. Endoscopic treatments are now recognized as the gold standard treatment for superficial esophageal cancers, with an excellent curative resection rate, and a lower morbidity compared to surgery. For superficial tumors, in the absence of ulceration, or stricturing lesion, en-bloc "staging" resection can be proposed. Pathology will define the curative nature of the resection. In case of a non-curative resection, rescue treatment (surgery, radiotherapy or radiochemotherapy) may be proposed. Digestive endoscopy has a major role in the management of Barrett's esophagus to prevent adenocarcinoma and limit the risk of metachronous cancer after curative resection. Artificial intelligence should play an important role in the detection and characterization of esophageal lesions in the future, but has not been validated in clinical practice, yet. [ABSTRACT FROM AUTHOR]

Background: Fibro-osseous lesions include a variety of bone lesions with different clinical and histopathological features. Case Description: We report a case of cemento-ossifying lesion involving the left ethmoid and sphenoid sinus in a 17-year-old male patient. Computed tomography showed an expansile hyperdense lesion with sclerosed peripheral mantle epicentered on the left ethmoid and sphenoid sinus and extending into the left nasal cavity. Magnetic resonance imaging was done for preoperative planning. Transnasal endoscopic resection was performed and histopathological examination confirmed the diagnosis of ossifying fibroma (OF). Conclusion: Involvement of the ethmoid sinus with OF is a rare condition; therefore, we examined the literature for similar cases to highlight the possible clinical presentation and management. Endoscopic management is a safe, effective approach with a low rate of complications. [ABSTRACT FROM AUTHOR]

Introduction and Aim: Chronic pancreatitis is a pathologic fibroinflammatory syndrome of the pancreas. Treatment includes medical management and endoscopic and/or surgical interventions. Our aim was to describe progression in patients with chronic pancreatitis whose initial management was either endoscopic or surgical., Material and Methods: A retrospective, analytic, observational, and longitudinal study was conducted that included patients diagnosed with chronic pancreatitis treated at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI from 2015 to 2021., Results: Twenty-two patients were included in the study; 12 underwent endoscopy and 10 underwent surgery. The mean number of interventions performed was 3 in the endoscopic management group and 1.1 in the surgical management group (p = 0.001). Regarding pain remission (partial or total), results were statistically significant in favor of surgical management (p = 0.035). Of the 12 patients that initially underwent endoscopy, 7 (58.3%) eventually required surgery during follow-up. There were no statistically significant differences with respect to opioid and pancreatin use, readmissions, weight loss, steatorrhea, newly diagnosed diabetes, or deaths during follow-up., Conclusion: Pain is the main indication for invasive treatment, whether endoscopic or surgical, in patients with chronic pancreatitis. Slightly more than half of the patients that were initially managed endoscopically required surgery during follow-up. Management decisions should be multidisciplinary and individualized for each patient., (Copyright © 2024 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Background: Currently, perioperative complications of classic Whipple surgery occur at a rate of approximately 40%. Common complications include delayed gastric emptying, pancreatic fistula, and bile leakage, whereas gastrojejunostomy (GJ) leakage is rare., Case Summary: This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple procedure. After surgery, the patient was transferred to the clinic after four days of intensive care, where vacuum therapy was used to handle a developing subcutaneous collection. The patient, who had bile in the drains and incision during follow-up, underwent endoscopic examination on the 21 st day after the operation. An opening of approximately 4 mm was observed in the GJ anastomosis during endoscopy. Five titanium clips were used to close the openings. The drainage of bile decreased to less than 50 mL on the first day after the procedure, and the patient's oral intake was opened., Conclusion: Current literature reports a GJ leakage rate of 0. 54% following Whipple surgery, with clinical findings lasting on average between 4-34 days. Surgery was the main form of therapy for this case, with a success rate of 84%, and percutaneous drainage was also utilized as a treatment option. This case report is the first to document endoscopic treatment of GJ leaks following the classic Whipple procedure., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: Esophageal cancers that invade the submucosa (T1b) have increased risk for occult lymph node metastases. To avoid the morbidity and recovery from esophagectomy, patients with cT1bN0 tumors have been increasingly managed endoscopically. We hypothesized that tumor attributes could predict upstaging and outcome associated with surgical and endoscopic treatment. Our objective was to evaluate the comparative effectiveness of esophagectomy across different cT1bN0 tumor attributes., Methods: Treatment-naïve patients who underwent endoscopic management or esophagectomy for a clinical stage cT1bN0 esophageal cancer diagnosed between 2010 and 2018 in the National Cancer Database were identified. Factors associated with upstaging were assessed by logistic regression. Adjusted survival was assessed by Kaplan-Meier analysis of 528 propensity-matched pairs and accelerated time failure models, stratified across tumor attributes., Results: Overall, 1469 patients classified as cT1bN0 were identified; 926 underwent esophagectomy and 543 were managed endoscopically. In general, patients who were managed endoscopically were older (median, 71; interquartile range, 63-78; vs 66; interquartile range, 60-72; P < .0001) with smaller tumors compared with the patients who were managed with esophagectomy. Nodal upstaging was associated with lymphovascular invasion (odds ratio [OR], 6.88; confidence interval [CI], 4.39-10.77; P < .0001), poor tumor differentiation (OR, 2.77; CI, 1.30-5.88; P = .0081), and tumor size >1 cm (OR, 3.19; CI, 1.49-6.83, P = .0028). Overall survival was better among propensity-matched patients who underwent esophagectomy (5-year 68.4% vs 59.7% endoscopic, P < .001). However, accelerated time failure models suggested similar outcomes among patients with well-differentiated tumors managed surgically or endoscopically., Conclusions: Esophagectomy was associated with improved survival for cT1bN0 esophageal cancer; however, endoscopic treatment may achieve similar survival in patients with favorable tumor attributes. Further study is warranted., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are 2 distinct gastric vascular abnormalities that may present with acute or chronic blood loss. PHG requires the presence of portal hypertension and is typically associated with chronic liver disease, whereas there is controversy about the association of GAVE with chronic liver disease and/or portal hypertension. Distinguishing between GAVE and PHG is crucial because their treatment strategies differ. This review highlights characteristic endoscopic appearances and the clinical features of PHG and GAVE, which, in turn, aid in their appropriate management., (Copyright © 2023 Elsevier Inc. All rights reserved.)