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With the improvement in flexible endoscopic technology and the availability of new endoscopic devices, current endoscopic therapies spare many patients who would otherwise undergo surgical repair of gastrointestinal fistulas. These endoscopic techniques include gastrointestinal stents, endoscopic suturing, cardiac septal occluders, endo-sponge, vacuum therapy and others. This review elaborates on the indications, evidence, procedural details, efficacy, and complications of various endoscopic techniques for the management of gastrointestinal fistulas. [ABSTRACT FROM AUTHOR]

Background & Aims: Gastric antral vascular ectasia (GAVE) is an uncommon cause of non-variceal upper gastrointestinal bleeding that is characterized by dilation of blood vessels in the antrum of the stomach. Various co-morbidities are associated with the development of GAVE, but the impact of co-morbidities on unplanned GAVE readmissions is unclear. The aim of this study was to assess the national incidence, 30-day mortality rate, and 30-day readmissions related to GAVE. Secondary outcomes were evaluation of predictors of early readmission, hospital length of stay (LOS) and total hospitalization charges. Methods: Using the 2016 National Readmission Database, we analyzed discharges for GAVE. ICD-10 CM codes were utilized to identify associated comorbidities and inpatient procedures during the index admission. 30-day readmissions were identified for GAVE. Secondary measures of outcomes including LOS and hospitalization charges were also calculated. Risk factors for early readmission were also evaluated using multivariate analysis to adjust for confounders. Results: A total of 18,375 index admissions for GAVE were identified. 20.49% (n=3,720) of the discharged patients were readmitted within 30 days. 30-day mortality of GAVE-related admissions was 1.82% (n=335). Early readmissions accounted for 20,157 hospital days along with $189 million in hospitalization costs. Multivariate analysis revealed that the presence of portal hypertension (OR 1.63; 95% CI 1.37-1.93; p=0.0001) and chronic kidney disease (CKD) (OR 1.62, 95% CI 1.44-1.82; p<0.0001) significantly increased the odds of early readmission. Conclusions: Our analysis demonstrates that the overall 30-day mortality rate of GAVE-related admissions is relatively low, but the 30-day readmission rate is significantly high. Patients with comorbid CKD and portal hypertension have a significantly higher risk of readmission. Further studies are required to determine if therapeutic interventions such as argon plasma coagulation or radiofrequency ablation during the index admission may prevent readmissions in these specific subgroups. [ABSTRACT FROM AUTHOR]

Isolated pancreatic tuberculosis is an exceedingly rare condition, even in areas of the world where the disease is highly prevalent. Abdominal tuberculosis is a common form of extrapulmonary tuberculosis but involvement of the pancreas is very rare. We report a case of isolated pancreatic tuberculosis presenting as a pancreatic mass in a patient with persistent abdominal pain and jaundice. Clinically and radiologically, the mass mimicked a malignant pancreatic tumor with a vastly different prognostic implication and therapeutic approach. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) can provide valuable diagnostic information in this scenario. After the tissue showed evidence of acid-fast bacilli and the cultures showed growth of Mycobacterium tuberculosis, antituberculosis therapy was initiated. Conservative management is usually successful in alleviating symptoms and leading to a cure. The excellent response to ATT makes it imperative that these patients are diagnosed early and managed appropriately to avoid unnecessary surgery and associated morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Angiodysplasia is the most common vascular lesion of the gastrointestinal (GI) tract. However, limited epidemiological data exists on hospitalizations related to angiodysplasia of the intestine (ADOI) in the United States (U.S.). The aim of this study is to analyze inpatient trends and outcomes in hospitalizations with ADOI. Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of angiodysplasia of the intestine with or without hemorrhage (ICD-9 code 569.85 and 569.84 respectively) as principal and/or secondary diagnosis during the period from 2001 to 2011. Results: In 2001, there were 39,244 admissions with discharge diagnosis of ADOI as compared to 41,214 in 2011 (p <0.0001). Women (58.0%) were more commonly affected than men (42.0%) (p < 0.0001). Overall in-hospital mortality rate was 2.2% for patients with ADOI with hemorrhage and 1.6% for patients with ADOI without hemorrhage (p <0.0001). Mean cost of hospitalization increased from $10,701 in 2001 to $12,478 in 2011 (16.6% increase, p < 0.0001). Conclusion: The total number of hospitalizations with ADOI increased significantly with women having significantly higher hospitalization rates. Mortality rate was higher in hospitalizations with ADOI with hemorrhage than those without hemorrhage. There was a notable increase in the average cost of hospitalization. [ABSTRACT FROM AUTHOR]