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Acute pancreatitis (AP) is a significant cause of morbidity worldwide, with a steadily rising incidence, particularly in Western nations. This article provides a comprehensive overview of the epidemiology, aetiology, pathophysiology, and management of AP. The various aspects of the Revised Atlanta classification system are emphasized for its utility in defining AP severity, stratifying risk and guiding treatment. Both the role of imaging and the 'step-up' approach to guide procedural and endoscopic management are discussed, demonstrating the shift towards minimally invasive techniques. Early recognition of organ dysfunction and supportive care, including judicious fluid management, nutritional support, and appropriate use of antibiotics, are critical to improving outcomes. Specific considerations and recommendations for the management of local and systemic complications are outlined, with recommendations for early referral to specialized centres for optimal care. [ABSTRACT FROM AUTHOR]

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 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. 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. 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. 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. A, Propensity-matched Kaplan-Meier curve comparing 5-year survival in patients who received esophagectomy versus endoscopic treatment for cT1bN0 esophageal cancer. B, Kaplan-Meier curve comparing 5-year survival in patients with well-differentiated tumors that received esophagectomy versus endoscopic treatment for cT1bN0 esophageal cancer. Blue line shows endoscopic intervention and red line shows esophagectomy. OR , Odds ratio; CI , confidence interval; HR , hazard ratio. [Display omitted] [ABSTRACT FROM AUTHOR]

In this multicenter observational study, we evaluated different tumor diameters for identifying ≥ pT2 upper tract urothelial carcinoma at radical nephroureterectomy. In preoperative predictive models including 932 patients, the > 2-cm cutoff (odds ratio, 2.38; 95% confidence interval, 1.70-3.32; P < .001) was independently associated. This tumor size threshold could help to best select patients for kidney-sparing surgery. Introduction: The objective of this study was to evaluate the performance of different tumor diameters for identifying ≥ pT2 upper tract urothelial carcinoma (UTUC) at radical nephroureterectomy. Patients and Methods: This was a multi-institutional retrospective study that included 932 patients who underwent radical nephroureterectomy for nonmetastatic UTUC between 2000 and 2016. Tumor sizes were pathologically assessed and categorized into 4 groups: ≤ 1 cm, 1.1 to 2 cm, 2.1 to 3 cm, and > 3 cm. We performed logistic regression and decision-curve analyses. Results: Overall, 45 (4.8%) patients had a tumor size ≤ 1 cm, 141 (15.1%) between 1.1 and 2 cm, 247 (26.5%) between 2.1 and 3 cm, and 499 (53.5%) > 3 cm. In preoperative predictive models that were adjusted for the effects of standard clinicopathologic features, tumor diameters > 2 cm (odds ratio, 2.38; 95% confidence interval, 1.70-3.32; P < .001) and > 3 cm (odds ratio, 1.81; 95% confidence interval, 1.38-2.38; P < .001) were independently associated with ≥ pT2 pathologic staging. The addition of the > 2-cm diameter cutoff improved the area under the curve of the model from 58.8% to 63.0%. Decision-curve analyses demonstrated a clinical net benefit of 0.09 and a net reduction of 8 per 100 patients. Conclusion: The 2-cm cutoff appears to be most useful in identifying patients at risk of harboring ≥ pT2 UTUC. This confirms the current European Association of Urology guideline's risk stratification. Tumor size alone is not sufficient for optimal risk stratification, rather a constellation of features is needed to select the best candidate for kidney-sparing surgery. [ABSTRACT FROM AUTHOR]

Background Prosthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes. Objectives We will describe our methods and experience with endoscopic management of intraluminal gastric band erosions after bariatric procedures. Setting University hospital in the United States. Methods A retrospective review of our bariatric surgery database identified patients undergoing removal of gastric bands. A chart review was then undertaken to confirm erosion of prosthetic material into the gastrointestinal tract. Baseline characteristics, operative reports, and follow-up data were analyzed. Results Sixteen patients were identified with an eroded gastric band: 11 after banded gastric bypass, 3 after laparoscopic adjustable gastric band (LAGB), and 2 after vertical banded gastroplasty. All patients were successfully treated with endoscopic removal of the prosthetic materials using either endoscopic scissors or ligation of the banding material with off-label use of a mechanical lithotripter device. Complications included a postoperative gastrointestinal bleed requiring repeat endoscopy, 1 patient with asymptomatic pneumoperitoneum requiring observation, and 1 with seroma at the site of LAGB port removal. Conclusions Endoscopic management of intraluminal prosthetic erosion after gastric banded bariatric procedures can be safe and effective and should be considered when treating this complication. Erosion of the prosthetic materials inside the gastric lumen allows for potential endoscopic removal without free intraabdominal perforation. Endoscopic devices designed for dividing eroded LAGBs may help standardize and increase utilization of this approach. [ABSTRACT FROM AUTHOR]

Summary Traumatic pancreatic injuries are rare: their severity correlates with main pancreatic duct involvement. We report the case of a 5-year-old child who presented with complete disruption of the main pancreatic duct, treated successfully with an endoscopically inserted double pigtail stent. [ABSTRACT FROM AUTHOR]

Objective A modification of other reported endoscopic techniques for intracerebral clot evacuation is described and illustrated. Methods From January 2014 to December 2014, we operated on 6 patients harboring a spontaneous supratentorial intracerebral hemorrhage using a fully endoscopic freehand technique. Clinical chart and surgical videos were analyzed. Volumetric evaluation of the clot preoperatively and the residual hematoma postoperatively was performed. Clinical outcome was measured using the modified Rankin Scale and Glasgow Outcome Scale. Results The mean operative time was 96 minutes (range, 72–125 minutes). Clot evacuation was >90% in all patients. No patient experienced rebleeding after surgery. Two patients died. The Glasgow Outcome Scale score at 6 months was 4 in 2 patients, 3 in 2 patients, and 1 (death) in 2 patients. The modified Rankin Scale score at 6 months was 6 (death) in 2 patients, 4 in 2 patients, 3 in 1 patient and 2 in 1 patient. Conclusions The proposed minimally invasive technique allows a good rate of hematoma evacuation and intraoperative bleeding control. Further studies in large series are needed to confirm the role of this freehand endoscopic technique. [ABSTRACT FROM AUTHOR]

Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches. [ABSTRACT FROM AUTHOR]

Objective Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF. Methods Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-Tisseel R ) under general anesthesia. Results Nine children (7 male, 2 female) with age range 3 months to 3 years (mean 1.5 year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7 months to 10 years (mean 4.2 years). Conclusions Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF. Level of evidence Level IV study. [ABSTRACT FROM AUTHOR]

Summary Reports of duodenal loss of substance after laparoscopic cholecystectomy are rare. We report successful management of a large duodenal defect that occurred after cholecystectomy by endoscopic insertion of a duodenal stent and double pigtail catheters. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The actual benefit of endoscopic techniques in the non-operative management (NOM) of pancreatic injury is still unclear, with its role and effectiveness in the NOM of pancreatic injury remains defined and doubted. The purpose of this study was to evaluate the feasibility and long-term results of endoscopic techniques in the NOM of blunt pancreatic injury, and to determine whether NOM can be performed safely for selective patients with pancreatic injury. Patients and methods: The records and follow-up data of all patients with blunt pancreatic injuries over 16-year period from October 1, 1996, to September 30, 2012 at our department were retrospectively reviewed. Failure of NOM (FNOM) occurred if laparotomy was required after attempted NOM. Results: 132 patients (32% of all patients with blunt pancreatic injury) underwent NOM, including 58 who underwent endoscopic management (EM) and 74 who were observed without EM (NO-EM). FNOM of overall NOM was 20%, including 30% of NO-EM and 9% of EM. There was no significant difference in FNOM for NO-EM versus EM for grade I, however, a significant decrease in FNOM was noted with the addition of EM for grade II and III. EM was a statistically significant independent risk factor. Regular follow-up of 1 year showed that, for patients from grade I to III, 53 patients (42%) from operative management (OM) and 34 patients (46%) of the NO-EM developed various pancreatic-related complications, while only 15 patients (26%) of the EM developed such complications, and the difference was significant. Conclusion: Application of strictly defined selection criteria for NOM and EM in patients with blunt pancreatic injury resulted in one of the lowest FNOM rates (9%) and pancreatic-related complications incidence (25%). Selective application of EM for hemodynamically stable patients with blunt pancreatic injury will extend the indications for, and improve success of NOM. [Copyright &y& Elsevier]

The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up evaluation is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to raised intraepithelial neoplasia and are decreasing in parallel with Helicobacter pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia. Gastrointestinal stromal tumors have low incidence and no known associations, but their malignant potential is high; early diagnosis and proper management are crucial. Although rare and benign, inflammatory fibroid polyps need to recognized, particularly by pathologists, to avoid misdiagnosis. Gastric neuroendocrine tumors (carcinoids) are important because of their association with either atrophic gastritis or the multiple endocrine neoplasia syndromes; those that do not arise in these backgrounds have high malignant potential and require aggressive management. The review concludes with some practical suggestions on how to approach gastric polyps detected at endoscopy. [Copyright &y& Elsevier]

Abstract: Objective: Skull base encephaloceles are difficult to diagnose and to treat. Traditionally, they are approached externally via craniotomic routes. Endoscopic management of skull base defects is the standard treatment in adults. Our aim is to evaluate the efficacy and safety of endoscopic endonasal repair of basal encephaloceles in the paediatric population. Methods: Retrospective evaluation of paediatric encephaloceles managed endoscopically at a tertiary referral centre. Results: Eleven subjects fitted the criteria of the study. Mean age at surgery was 6.1±4.6 SD years, while mean follow-up was 46.5±28 SD months. Most of the defects were located in the anterior cranial fossa. All patients were managed successfully with no complications. Conclusions: Endonasal endoscopic management of congenital encephaloceles is feasible in paediatric patients. Meticulous pre-op neuroimaging is of paramount importance when dealing with such cases. [Copyright &y& Elsevier]

Summary: The objective of this paper is to present a case of a 2-year-old girl diagnosed with a meningo-encephalocele after episodes of meningitis, and treated with a transnasal endoscopic approach using nasal septal flaps pediculated at the sphenopalatine artery. Endoscopic repair is a viable and minimally invasive alternative to traditional craniotomy, however technical difficulties encountered as well as questions that remain unanswered are discussed. [Copyright &y& Elsevier]

Abstract: We describe a rare case of fistula between the Wirsung duct and the right psoas muscle. The initial clinical presentation was localised in the thigh and successful treatment was achieved by exclusive mini-invasive techniques. [Copyright &y& Elsevier]

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To date, the optimal surgical technique for ureterocele complex remains unclear and a diverse range of management options have been suggested. Some endoscopic approaches share major drawbacks such as de novo vesicoureteral reflux (VUR) into ureterocele moiety that can mandate revision surgery. In this study, long-term outcomes of double-puncture technique are evaluated. Records of patients treated by double-puncture technique between 1999 and 2014 were reviewed. Patients with a history of previous ureterocele surgery, follow-up period of less than two years, or an orthotopic ureterocele were excluded. In this technique, a double-J stent is inserted into two punctured sites at the poles of an ectopic ureterocele. Subsequently, anterior and posterior collapsed walls of a ureterocele were fulgurated at multiple points to create surface welding of the urine channel. Follow-up data regarding success of ureterocele decompression, de novo VUR, febrile urinary tract infection (UTI), and the need for further intervention were recorded. Forty-eight patients (51 ureteroceles) were assessed in this study. Bilateral ureterocele double puncture was performed for three patients (6.3%). Mean (range) age at the time of surgery was 2.9 (2 months–13 years) years. Mean follow-up was 6.1 (2–15.2) years. Successful decompression was achieved in all except two ureteroceles (success rate = 96.1%) (Summary Figure). New-onset VUR to punctured moiety was diagnosed in another two patients. No postoperative febrile UTI was encountered. Double-puncture technique is a successful endoscopic intervention for immediate and durable decompression of ectopic ureteroceles without incurring major complications. Summary Figure Complete collapse of a 17.6 mm × 9 mm ureterocele at right ureterovesical junction following double puncture technique (A, B, C). The double-J stent is evident inside the collapsed ureterocele four weeks postoperatively. A significant decrease in right upper pole hydronephrosis is achieved during the course of follow up (D, E, F). Summary Figure [ABSTRACT FROM AUTHOR]

Background We describe a rare case of a sphenoid sinus myxoma that was resected via an endoscopic endonasal skull base approach. We review the literature regarding these rare tumors of the paranasal sinuses. Case Description A 72-year-old woman was diagnosed with an incidental sphenoid sinus tumor and left sphenoid wing meningioma during a workup for left-sided proptosis and diplopia. Biopsies of the sphenoid wing and sphenoid sinus tumors were obtained. After undergoing surgical resection of the meningioma, the patient then underwent definitive resection of the sphenoid sinus myxoma via endoscopic endonasal skull base approach. Postoperative imaging demonstrated a gross total resection. The patient suffered postoperative thromboembolic complications due to underlying hypercoagulable state but made a complete recovery and returned to her neurologic baseline. There has been no evidence of recurrent myxoma in the sphenoid sinus 24 months after surgery. Discussion Myxomas are benign tumors derived from primitive mesenchyme. Myxomas very rarely present in the paranasal or skull base location. Complete surgical resection is the primary treatment for these tumors. The endoscopic endonasal approach is an effective technique for resecting various benign and more aggressive extradural skull base tumors. Conclusions Myxomas of the sphenoid sinus are rare. The endoscopic endonasal skull base approach is an effective and minimal access technique for resection of this rare tumor of the sphenoid sinus. [ABSTRACT FROM AUTHOR]

Summary: The cause of bile duct leaks can be either iatrogenic or more rarely, traumatic. The most common cause is related to laparoscopic cholecystectomy. While surgical repair has been the standard for many years, management in these often morbid and complex situations must currently be multidisciplinary incorporating the talents of interventional radiologists and endoscopists. Based on the literature and in particular the recent recommendations of the European Society of Gastrointestinal Endoscopy (ESGE), this review aims to update the management strategy. The incidence of these complications decreases with surgeon experience attesting to the value of training to prevent these injuries. Bile duct injuries must be categorized and their mapping detailed by magnetic resonance cholangiography MRCP or endoscopic cholangiography (ERCP) when endoscopic therapy is considered. Endoscopic management should be preferred in the absence of complete circumferential interruption of the common bile duct. The ESGE recommends insertion of a plastic stent for 4 to 8 weeks without routine sphincterotomy. For complete circumferential injuries, hepaticojejunostomy is usually necessary. In conclusion, adequate training of surgeons is essential for prevention since the incidence of bile duct injury decreases with experience. Faced with a bile duct injury, a multidisciplinary team approach, involving radiologists, endoscopists and surgeons improves patient outcome. [Copyright &y& Elsevier]