Background: The treatments for cancer palliation in patients with concomitant malignant biliary obstruction (MBO) and gastric outlet obstruction (MGOO) are still under investigation due to the lack of evidence available in the medical literature. We performed a systematic search and critical review to investigate efficacy and safety among patients with MBO and MGOO undergoing both endoscopic ultrasound-guided biliary drainage (EUS-BD) and MGOO endoscopic treatment. Methods: A systematic literature search was performed in PubMed, MEDLINE, EMBASE, and the Cochrane Library. EUS-BD included both transduodenal and transgastric techniques. Treatment of MGOO included duodenal stenting or EUS-GEA (gastroenteroanastomosis). Outcomes of interest were technical success, clinical success, and rate of adverse events (AEs) in patients undergoing double treatment in the same session or within one week. Results: 11 studies were included in the systematic review for a total number of 337 patients, 150 of whom had concurrent MBO and MGOO treatment, fulfilling the time criteria. MGOO was treated by duodenal stenting (self-expandable metal stents) in 10 studies, and in one study by EUS-GEA. EUS-BD had a mean technical success of 96.4% (CI 95%, 92.18–98.99) and a mean clinical success of 84.96% (CI 95%, 67.99–96.26). The average frequency of AEs for EUS-BD was 28.73% (CI 95%, 9.12–48.33). Clinical success for duodenal stenting was 90% vs. 100% for EUS-GEA. Conclusions: EUS-BD could become the preferred drainage in the case of double endoscopic treatment of concomitant MBO and MGOO in the near future, with the promising EUS-GEA becoming a valid option for MGOO treatment in these patients.

J Indian Prosthodont Soc, Official publication of Indian Prosthodontic Society

Large language models (LLMs) are transforming the medical landscape by enhancing access to information, diagnostics, treatment customization, and medical education, especially in areas like Gastroenterology. LLMs utilize extensive medical data to improve decision-making, leading to better patient outcomes and personalized medicine. These models are instrumental in interpreting medical literature and synthesizing patient data, facilitating real-time knowledge for physicians and supporting educational pursuits in medicine. Despite their potential, the complete integration of LLMs in real-life remains ongoing, particularly requiring further study and regulation. This review highlights the existing evidence supporting LLMs’ use in Gastroenterology, addressing both their potential and limitations. Recent studies demonstrate LLMs’ ability to answer questions from physicians and patients accurately. Specific applications in this field, such as colonoscopy, screening for colorectal cancer, and hepatobiliary and inflammatory bowel diseases, underscore LLMs’ promise in improving the communication and understanding of complex medical scenarios. Moreover, the review discusses LLMs’ efficacy in clinical contexts, providing guideline-based recommendations and supporting decision-making processes. Despite these advancements, challenges such as data completeness, reference suitability, variability in response accuracy, dependency on input phrasing, and a lack of patient-generated questions underscore limitations in reproducibility and generalizability. The effective integration of LLMs into medical practice demands refinement tailored to specific medical contexts and guidelines. Overall, while LLMs hold significant potential in transforming medical practice, ongoing development and contextual training are essential to fully realize their benefits.

A 61-year-old man was referred to our institute for endoscopic ultrasound (EUS) evaluation of a subcentimeter subepithelial lesion of the duodenal bulb. Ultrasound imaging showed a homogeneous, hypoechoic lesion of 15 mm in diameter in the fourth layer of the inferior wall of the duodenal bulb ([Fig. 1 a, b]). EUS-guided fine needle aspiration showed a gastrointestinal stromal tumor (GIST) and a computed tomography scan confirmed only a localized lesion ([Fig. 1 c]). The growth in size of the GIST with respect to the previous examination was an indication for resection, which remains the only modality that can offer permanent cure of GISTs, and avoid tumor rupture and injuries to the pseudocapsule [1]. Given the wishes of the patient and in order to avoid major surgery, a multidisciplinary team (endoscopist, oncologist, and surgeon) proposed an endoscopic mini-invasive approach. The procedure was performed with the patient under general anesthesia and with the administration of prophylactic antibiotics. Dissection was performed using an O-type HybridKnife (Erbe Elektromedizin, Germany) and we infused only saline solution into the lumen in order to prevent retroperitoneal CO₂ leakage and the consequent subcutaneous emphysema. We performed a full-thickness resection with the aim of achieving a radical oncological resection ([Video 1]). The excision resulted in a complete duodenal wall defect, about 25 × 25 mm ([Fig. 2]), which was closed with three endosutures placed using the OverStitch endoscopic suturing system (Apollo Endosurgery, USA). Video 1 A gastrointestinal stromal tumor of the duodenal bulb is resected with a full-thickness mini-invasive endoscopic approach, with the defect being closed using the OverStitch device. In the post-procedural phase, the patient developed pain in the hypochondrium that was easily controlled with a single dose of ibuprofen; oral intake was restarted in the fourth postoperative day. In the following 2 months of follow-up, the patient remained asymptomatic. In conclusion, endoscopic full-thickness resection of a duodenal GIST appears to be safe, even if skill-demanding, and can be a valid mini-invasive alternative to surgery. Endoscopy_UCTN_Code_TTT_1AO_2AG