Amidst the obesity and type II diabetes mellitus (T2DM) epidemics, glucagon-like peptide-1 receptor agonists (GLP-1RAs) stand out as a promising therapeutic ally, achieving notable success in glycemic control and weight management. While GLP-1RAs’ positive clinical outcomes are commendable, they introduce significant gastrointestinal (GI) challenges, emphasizing the pivotal role of gastroenterologists in understanding and managing these implications. Physicians should be vigilant of potential complications if endoscopy is indicated and considered. A protocol coined “The Three E’s: Education, Escalation, and Effective Management” is essential as the first defense against GLP-1RA-induced dyspepsia, necessitating routine GI consultations. Awareness and intervention of potential aspiration due to GLP-1RA-induced gastroparesis are vital in clinical management. Furthermore, the evolving recognition of GLP-1RAs’ beneficial effects on non-alcoholic steatohepatitis (NASH) suggests gastroenterologists will increasingly prescribe them. Thus, a comprehensive understanding of pharmacological properties and potential GI complications, including the undetermined cancer risk landscape, becomes paramount. This review accentuates the nuances of GLP-1RA therapy from a gastroenterological lens, juxtaposing the therapeutic potential, manageable side effects, and circumstantial challenges, ensuring that GI specialists remain at the forefront of holistic care in obesity and T2DM management.

The quality of upper gastrointestinal endoscopy (EGD) is crucial and carries significant consequences for patient outcomes, the employment of healthcare resources, and the future course of gastroenterology as a medical specialty. In this review, we navigate through the terrain of the Quality Indicators (QIs) for EGD, shedding light on their indispensable function in ensuring and augmenting the quality of patient care throughout the pre-procedural, intra-procedural, post-procedural, and outcome-oriented facets of the practice. We delve into the comprehensive scope of the QIs and the challenges impeding the delivery of high-quality EGD, from variability in practitioner training and patient compliance to the systemic limitations of current QIs and the barriers hindering the adoption of advanced techniques. Future directions for bolstering the quality of EGD are highlighted, encapsulating the integration of emergent endoscopic technologies, the evolution of patient-centered metrics, the refinement of endoscopist training and credentialing processes, and the promise held by Artificial Intelligence (AI). Particular emphasis is placed on the role of advanced endoscopic techniques and equipment in enhancing EGD quality. This article presents a cogent narrative, promoting the pursuit of excellence in EGD as an ever-evolving endeavor that necessitates the collective dedication of clinicians, researchers, educators, and policymakers.

Therapeutic development for metabolic-dysfunction-associated steatohepatitis (MASH) trails behind the success seen in hepatitis C virus (HCV) management. HCV, characterized by a viral etiology, benefits from direct-acting antivirals (DAAs) targeting viral proteins, achieving cure rates exceeding 90%. In contrast, MASH involves complex metabolic, genetic, and environmental factors, presenting challenges for drug development. Non-invasive diagnostics like ultrasound, FibroScan, and serum biomarkers, while increasingly used, lack the diagnostic accuracy of liver biopsy, the current gold standard. This review evaluates therapies for MASH, including resmetirom (Rezdiffra) and combinations like pioglitazone and vitamin E, which show potential but offer modest improvements due to MASH’s heterogeneity. The limited efficacy of these treatments highlights the need for multi-targeted strategies addressing metabolic and fibrotic components. Drawing parallels to HCV’s success, this review emphasizes advancing diagnostics and therapies for MASH. Developing effective, patient-specific therapies is crucial to closing the gap between MASH and better-managed liver diseases, optimizing care for this growing health challenge.

Background/Aims: Procedural duration has been proposed as a marker of esophagogastroduodenoscopy (EGD) quality; however, formal benchmarks remain undefined. This study examined the association between EGD duration and clinically significant findings (CSFs), as well as procedural behaviors contributing to diagnostic yield.Methods: We conducted a retrospective analysis of 120 first-time diagnostic EGDs performed at a single academic center and categorized procedures as lasting 6 minutes. Logistic regression models were used to assess associations among procedure time, quality metrics (photographs, landmarks, biopsies), clinical indications, and CSF detection.Results: Longer procedures were independently associated with a high rate of CSF detection. Compared with procedures lasting 6 minutes had 17.5-fold greater odds of detecting a CSF (p=0.02). Procedures performed for bleeding or “other” indications were independently associated with a high diagnostic yield (p=0.02 and 0.03, respectively). Although increased photo count and landmark documentation correlated with time, neither was independently predictive of CSFs after adjustment. Procedural duration also showed a stepwise increase in the number of biopsies obtained, photographs taken, and landmarks identified.Conclusions: Longer EGD duration was independently associated with increased CSF detection in a stepwise manner. Procedural time may serve as a practical, unifying measure correlated with multiple performance behaviors reflective of comprehensiveness in diagnostic EGD.

Purpose: To compare early postoperative outcomes after Descemet membrane endothelial keratoplasty (DMEK) led by ophthalmology residents versus attendings at an academic institution. Methods: This retrospective cohort study included 99 eyes undergoing DMEK between January 2022 and December 2024 at Albany Medical Center and its affiliate cornea practice. Cases were categorized by primary surgeon as resident (postgraduate year 4) or attending. Demographic, preoperative, intraoperative, and postoperative variables were collected. The primary outcome was change in best-corrected visual acuity (logMAR). Secondary outcomes included intraocular pressure, central corneal thickness, endothelial cell density, operative time, surgical complications, and graft survival by Kaplan–Meier analysis. Results: Forty-eight surgeries were resident-led and 51 attending-led. Baseline characteristics were balanced. Best-corrected visual acuity improved significantly across the cohort (F = 38.45, P < 0.001), with a mean gain of −0.25 logMAR at 8 to 16 weeks and no group difference ( P = 0.192). Intraocular pressure fluctuated postoperatively and central corneal thickness decreased by −97.5 µm at 8 to 16 weeks (both P < 0.001), with neither measure differing between groups ( P = 0.092 and P = 0.412). In a paired subset (n = 13), postoperative recipient endothelial cell density exceeded preoperative values by 547 cells/mm ² ( P = 0.002). Operative time (34.8 vs. 35.8 minutes, P = 0.834), complication rates (25.0% vs. 27.5%, P = 0.82), and graft survival (log-rank P = 0.22) were also similar. Conclusions: Resident-led DMEK achieved comparable early postoperative outcomes to attending-led cases, supporting the inclusion of DMEK in residency curricula as a safe and effective way to expand ophthalmic surgical training.