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This article, published in the journal Endoscopy, discusses the standardization of a technique called EUS-guided hepaticogastrostomy (EUS-HG). The study evaluates different methods of fistula dilation used during EUS-HG and their impact on procedure time, technical success, clinical success, and adverse events. The results show that the use of a filiform catheter for fistula creation reduces procedure time and adverse events compared to other methods. The authors recommend the use of a filiform catheter for fistula dilation in EUS-HG to increase safety and allow for its use in other medical centers. [Extracted from the article]

Acute pancreatitis is associated with significant morbidity and mortality. It can develop complications such as fluid collections and necrosis. Infection of necrosis occurs in about 20-40 % of patients with severe acute pancreatitis, and is associated with organ failure and worse prognosis. In the past few years the treatment of pancreatic collections has shifted from open surgery to minimally invasive techniques such as endoscopic ultrasound-guided drainage. These guidelines from a selection of experts among the Endoscopic Ultrasound Group, Spanish Society of Gastrointestinal Endoscopy (GSEED-USE) are intended to provide advice on the management of pancreatic collections based on a thorough review of the available scientific evidence. It also reflects the experience and clinical practice of the authors, who are advanced endoscopists or clinical pancreatologists with extensive experience in managing patients with acute pancreatitis.

Background and Aims: Traditionally, palliative treatment of malignant gastric outlet obstruction (GOO) has been surgical, but surgical treatment carries significant morbidity and mortality rates. Endoscopic placement of a duodenal self-expandable metal stent (D-SEMS) has been proven to be successful for this indication in the short term. However, D-SEMSs are likely to malfunction over time. EUS-guided gastroenterostomy (EUS-GE) may help overcome these limitations. We aimed to evaluate stent failure-free survival at 3 months., Methods: A nationwide multicenter, observational study of D-SEMS and EUS-GE procedures for patients with malignant GOO was conducted at 7 academic centers from January 2015 to June 2020. Stent failure-free survival at 1, 3, and 6 months; technical and clinical success; adverse events (AEs); and patient survival were evaluated in both groups and compared., Results: Ninety-seven patients were included in the D-SEMS group and 79 in the EUS-GE group. Pancreatic cancer was the main underlying malignancy in 53.4%. No statistically significant differences regarding technical (92.8% vs 93.7%) or clinical success (83.5% vs 92.4%) were found. AE rates did not differ between groups (10.3% vs 10.1%), although 2 events in the EUS-GE group required surgical management. Patients in the EUS-GE group had improved stent patency when compared with those patients in the D-SEMS group at 3 months (92.23% vs 80.6%; adjusted hazard ratio, .37; P = .033)., Conclusions: EUS-GE seems to have improved patency outcomes when compared with D-SEMS placement for palliative treatment of malignant GOO. Prospective trials are needed to fully compare their efficacy and AE profile., (Published by Elsevier Inc.)

BACKGROUND AND STUDY AIMS : Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA). PATIENTS AND METHODS : Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. RESULTS : Mean cysts size was 36.7 mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5 %) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28 % AEs rate), low-risk (1.4 % AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1 % AEs rate, including the remaining patients). CONCLUSION : TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB., Competing Interests: S.F. Crinò has received speaker's fees from Steris Endoscopy. A. Larghi has provided consultancy to Pentax and Boston Scientific, and has received teaching fees from Medtronic and Boston Scientific. D. Yang has provided consultancy to Olympus, Boston Scientific, Lumendi, and Steris Endoscopy. P.V. Draganov has provided consultancy to Olympus, Boston Scientific, Cook Medical, Merit, Fujifilm, Microtech, Lumendi, and Steris. J.R. Aparicio has provided consultancy to Boston Scientific. C. Robles-Medranda has provided consultancy to Pentax Medical, Boston Scientific, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, and Mediconsgroup. A. Repici has provided consultancy to Boston Scientific and Medtronic, and has received grant support from Fujifilm. The remaining authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Most studies on endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) for palliation of malignant gastric outlet obstruction (GOO) utilized a 15-mm lumen-apposing metal stent (LAMS). More recently, a 20-mm LAMS has become available. This study aimed to compare rates of technical and clinical success and adverse events (AEs) in patients undergoing EUS-GE using a 20-mm vs. 15-mm LAMS., Methods: Patients who underwent EUS-GE with 15-mm or 20-mm LAMS for malignant GOO during the period from January 2018 to October 2020 were included. The primary outcome was clinical success, defined as an increase in the gastric outlet obstruction score (GOOS) by at least 1 point during follow-up. Secondary outcomes were technical success, maximum tolerated diet, re-intervention rate, and rate/severity of AEs., Results: 267 patients (mean age 67 years, 43 % women) with malignant GOO from 19 centers underwent EUS-GE. Clinical success rates were similar for the 15-mm and 20-mm stents (89.2 % [95 %CI 84.2 %-94.2 %] vs. 84.1 % [77.4%-90.6 %], respectively). However, a significantly higher proportion of patients in the 20-mm group tolerated a soft solid/complete diet at the end of follow-up (91.2 % [84.4 %-95.7 %] vs. 81.2 % [73.9 %-87.2 %], P  = 0.04). Overall, AEs occurred in 33 patients (12.4 % [8.4 %-16.3 %]), with similar rates for 15-mm and 20-mm stents (12.8 % [7.5 %-18.2 %] vs. 11.8 % [6 %-17.6 %]), including incidence of severe/fatal AEs (2 % [0.4 %-5.8 %] vs. 3.4 % [0.9 %-8.4 %])., Conclusions: The 20-mm and 15-mm LAMS show similar safety and efficacy for patients undergoing EUS-GE for malignant GOO. The 20-mm LAMS allows a more advanced diet and is, thus preferred for EUS-GE., Competing Interests: A. Anderloni is a consultant for Boston Scientific, Medtronic and Olympus. J.R. Aparicio is a consultant for Boston Scientific. J.M. Buscaglia is a consultant for Abbvie. B. Confer is a consultant for Boston Scientific. D.L. Diehl is a consultant for Boston Scientific. C.J. DiMaio is a consultant for Boston Scientific, Covidien, and SafeHeal; and a speaker for AbbVie, Mauna Kea, and STERIS. A. Fugazza is a consultant for Boston Scientific and Olympus. M.T. Huggett is a consultant for Boston Scientific, Olympus America, and Cook Medical. M.A. Khashab is a consultant for Boston Scientific, Olympus, Medtronic, GI Supply, MicroTech, and Apollo. H.S. Khara is a consultant for Boston Scientific. T.E. Kowalski is a consultant for Boston Scientific and Medtronic. N.A. Kumta is a consultant for Boston Scientific, Apollo Endosurgery, Intuitive Surgery, Medtronic, and Olympus. D. Loren is a consultant for Boston Scientific, Olympus, and Pinnacle Biologics; and receives research support from Medtronic. J.M. Nieto is a consultant for Boston Scientific. B. Paranandi is a consultant for Boston Scientific and Olympus America. K. D-C. Pham is a consultant for Boston Scientific; he is a speaker for Boston Scientific, Cook Medical, Olympus America and Taewoong Medical; and he is on on the advisory board of Ambu. D.K. Pleskow is a consultant for Boston Scientific, Olympus America, and FujiFilm. D.V. Sejpal is a consultant for Boston Scientific and Olympus America. R.Z. Sharaiha is a consultant for Boston Scientific, Cook Medical, Olympus, and Lumendi. A.J. Trindade is a consultant for Pentax Medical and Olympus America. R.R. Watson is a consultant for Boston Scientific. The remaining authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: Dr. Aparicio is a consultant for Boston Scientific.

Competing Interests: Dr. Aparicio is a consultant for Boston Scientific. The remaining authors declare that they have no conflict of interest.

Competing Interests: Drs. Aparicio and Berzin are consultants for Boston Scientific. The remaining authors declare that they have no conflict of interest.

Insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is an increasingly used treatment in the management of the complications of portal hypertension. However, one of the complications of this technique is refractory or recurrent hepatic encephalopathy, which poses a difficult clinical problem. We report the case of a patient who underwent TIPS insertion to control bleeding due to esophageal varices. The patient subsequently developed refractory hepatic encephalopathy, requiring reduction of the caliber of the shunt., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Infections in patients with cirrhosis are a common complication causing substantial morbidity and mortality. Bacterial translocation plays an important role in the pathogenesis of many infections in cirrhosis. In turn, infections are involved in the pathogenesis of many episodes of decompensated cirrhosis, such as esophageal variceal bleeding, renal insufficiency, the hemodynamic alterations of cirrhosis, and hepatic encephalopathy. Spontaneous bacterial peritonitis is currently the most frequent infection in cirrhosis. Mortality from this entity has recently decreased due to early diagnosis, the use of appropriate antibiotic therapy, and albumin administration. However, infections due to multiresistant microorganisms have recently increased, leading to greater mortality. Primary prophylaxis with quinolones is effective in preventing infections and is associated with lower mortality in a selected population of patients with liver cirrhosis., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)