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The effectiveness of screening esophagogastroduodenoscopy (EGD) for refractory gastroesophageal reflux disease (GERD) symptoms alone has not been validated.We performed an observational study of patients with refractory GERD who underwent EGD from 2013 to 2016 at a tertiary hospital. Among 928 patients with GERD, we excluded patients with other alarm features, other indications for EGD, history of gastroesophageal surgery, or EGD done for other diagnostic procedures, and identified 301 patients who underwent EGD solely for persistent reflux symptoms such as heartburn or regurgitation.Among 301 patients with refractory GERD, 81.4% of patients were taking PPIs. 49.8% of patients had completely normal EGD findings and 33.6% of patients had benign or incidental findings. Two patients (0.6%) had LA grade C or D esophagitis, and 16.3% of patients had irregular Z line or salmon-colored mucosa. 91.0% (122/134) who had a biopsy had normal or benign findings. 4.0% (12/301) of patients had biopsy-proven intestinal metaplasia which is similar to the previously known prevalence of intestinal metaplasia in patients without heartburn (5.6%) and none had dysplasia or malignancy. Male sex was associated with endoscopic intestinal metaplasia suspected lesions in multivariate analysis (OR: 1.96, 95% CI: 1.04-3.70,Most patients who underwent EGD for refractory GERD symptoms alone did not have pathological findings requiring a change in management. Screening EGD for patients only with persistent reflux symptoms should not be routinely recommended.

Background: Only about 50% of acute gallstone pancreatitis admissions undergo index cholecystectomy.Aims: We aimed to analyze the national trends in acute gallstone pancreatitis management: the proportion and optimal timing of cholecystectomy. Methods: Adult admissions with acute gallstone pancreatitis and associated procedures were extracted from National Inpatient Sample (2005-2014yy). Patients with index cholecystectomy were identified and divided into early and delayed intervention groups. Trends, complications, mortality, and hospital resource utilization were analyzed. Results: In 991,476 acute gallstone pancreatitis hospitalizations, the rate of index cholecystectomy remained low at 53-55%. Analysis of cholecystectomy complications and resource utilization demonstrated the safest and most cost-effective strategy is to perform cholecystectomy during 24-72 hours of admission. A risk difference of 12.6% in the complication rate was observed between early (72hrs) cholecystectomy groups. Delay in cholecystectomy to day five or beyond was associated with significantly higher morbidity, mortality, and resource utilization. Conclusion: The rate of index cholecystectomies to prevent recurrent acute gallstone pancreatitis remains significantly low nationally (53-55%). Our analysis demonstrates that cholecystectomy should be avoided in the first 24 hours, and optimal timing for intervention is from 24 to 72 hours of acute gallstone pancreatitis hospitalization. Careful patient selection and timing of definitive operative management are important to ensure the best clinical outcomes and avoid unnecessary healthcare expenses.

Weight regain after Roux-en-Y gastric bypass (RYGB) occurs in 25–50% of patients in 5–10 years after RYGB, and is attributed to multiple factors including metabolic, behavioral, psychological and anatomical changes. Studies have demonstrated that a dilated gastrojejunal stoma ≥15 mm is an independent risk factor associated with weight regain and that the diameter of stoma demonstrates a positive linear correlation with the amount of weight regain. Intraluminal endoscopic interventions for the treatment of a dilated gastrojejunal stoma can be broadly divided into endoscopic plication and ablation/resection techniques. Several of these techniques that have been studied to mitigate weight regain and/or to achieve additional weight loss after RYGB are no longer available or routinely performed. However, in the past 5 years, endoscopic transoral outlet reduction (eTOR) with the Overstitch endoscopic suturing device has emerged as the primary and most widely used endoscopic RYGB revision procedure. The eTOR procedure has level one evidence demonstrating safety and efficacy with 8.5%, 6.9% and 8.8% total weight loss at 1, 3, and 5 years respectively. Argon plasma coagulation has emerged as an additional option with a recent randomized controlled trial demonstrating significant weight loss compared to diet and exercise alone. Additional ablation techniques such as modified EMR/ESD, RFA, over-the-scope clipping and cryotherapy remain experimental or investigational approach at this point. Endoscopic revision procedures are a safe and effective treatment of weight regain after RYGB and should be offered as a part of a multidisciplinary management strategy as an early intervention to halt post-RYGB weight regain.

Cancer patients receiving chemotherapy face an increased risk of reactivation of chronic hepatitis B virus infection. To determine the HBV screening rate in patients receiving cancer chemotherapy in various clinical settings. We identified 11,959 adult cancer patients (age ≥ 18 years) receiving parenteral chemotherapy between 2012 and 2015 within a major US hospital network, including a large university hospital, community teaching hospitals, and community oncology clinics. Two thousand and forty-five patients (17.1%) were screened for either HBV surface antigen (HBsAg) or HBV core antibody (HBcAb) before chemotherapy, and 1850 patients (15.5%) had both HBsAg and HBcAb tested before chemotherapy. 8.4% were exposed to HBV, and 0.9% had chronic HBV infection (both HBsAg/HBcAb positive). Patients with hematologic tumor were more often screened than with solid tumor (55.6 vs. 8.3%, p