Gastrointestinal (GI) interventional endoscopy has evolved into a cornerstone of modern gastroenterology, offering minimally invasive solutions for complex conditions. However, these procedures are not without risk, particularly with respect to post-procedural infections. While rare, such infections can have significant clinical consequences and are increasingly recognized as a public health concern. This narrative review provides a comprehensive overview of infections associated with GI endoscopy, focusing on transmission mechanisms, microbial agents involved, host susceptibility, preventive strategies, and diagnostic and therapeutic approaches. Infections following GI endoscopy remain infrequent but clinically significant, particularly in high-risk procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. Duodenoscopes represent a major vector for exogenous infection, often involving multidrug-resistant bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus spp. Host-related factors increase the risk of infection. Risk factors associated with post-endoscopic infections include advanced age, male sex, non-white ethnicity, immunosuppression, presence of cholangiocarcinoma, autoimmune diseases, liver cirrhosis of viral and/or alcoholic etiology, chronic kidney disease, high-risk cardiac conditions, or chemotherapy. New reprocessing methods, such as ethylene oxide gas sterilization, automated endoscope reprocessors, and selective use of single-use endoscopes and duodenoscopes, may contribute to lowering infection rates. Greater awareness of infection risks, improved infection control practices, and adherence to updated guidelines are crucial for enhancing patient safety in digestive endoscopy. Multidisciplinary strategies, including surveillance, device innovation, and personalized risk assessment, are needed to address this evolving challenge.

Cholangiocarcinoma (CCA) is an adenocarcinoma originating from the epithelial cells of the bile ducts/hepatocytes or peribiliary glands. There are three types of cholangiocarcinoma: intrahepatic, perihilar and distal. CCA represents approximately 3% of the gastrointestinal malignancies. The incidence of CCA is higher in regions of the Eastern world compared to the Western countries. There are multiple risk factors associated with cholangiocarcinoma such as liver fluke, primary sclerosing cholangitis, chronic hepatitis B, liver cirrhosis and non-alcoholic fatty liver disease. Endoscopy plays an important role in the diagnosis and management of cholangiocarcinoma. The main endoscopic methods used for diagnosis, biliary drainage and delivering intrabiliary local therapies are endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. The purpose of this review is to analyze the current data found in literature about cholangiocarcinoma, with a focus on the actual diagnostic tools and endoscopic management options.

Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 years). In twelve patients (85.7%), the diagnosis was confirmed by using the Curacao Criteria. The most common reason for admission was epistaxis, with 9 patients (57%) presenting with nosebleed refractory to prolonged self-tamponade. The biochemical abnormalities identified were elevations in AP and gamma-GT; liver synthetic function was generally normal, even though 21% of patients had clinical or imaging findings for cirrhosis. Nosebleeds were the main reason for admission and significantly impacted quality of life through anemia and frequent hospital admissions. However, the visceral manifestations seemed to be more serious. The hepatic arteriovenous malformations (AVMs) appeared to remain asymptomatic or led to minimal changes for the majority of patients; some cases were associated with liver and biliary tract ischemia, necrosis leading to acute liver failure and even death. Hepatic AVMs can also lead to high-output heart failure due to arterio-venous shunting. The most frequent AVM was hepatic artery to hepatic vein, with secondary hepatic vein dilation and hemodynamic consequences.

Introduction: The management of symptomatic peripancreatic fluid collections (PFCs), including pancreatic pseudocysts (PPs) and walled-off necrosis (WON), remains a clinical challenge. Methods: We conducted a single-center retrospective cohort study to compare the efficacy, safety, and cost of endoscopic drainage (lumen-apposing metal stent vs. double pigtail stent) and percutaneous drainage for PFCs. From an initial cohort of 75 patients with symptomatic PFCs between 2020 and 2025, 63 underwent drainage procedures. Primary endpoints were the clinical success, defined as >50% collection size reduction, and the need for direct endoscopic necrosectomy (DEN). Secondary endpoints included adverse events, recurrence rates, length of hospital stay (LOS), and procedural costs. Results: In our study, endoscopic drainage proved high clinical efficacy for PFCs, especially PPs. Once a technique was chosen, complication rates were comparable, indicating no clear safety advantage for either approach. While percutaneous drainage relieved symptoms and reduced collection size in half of the cases, the other half had only transient or partial improvement. When comparing endoscopic drainage techniques, median costs and length of hospital stay trended higher for lumen-apposing metal stent (LAMS) than double pigtail stent (DPS), but the differences were not statistically significant. However, the “other” group proved markedly higher costs and the longest mean hospital stay. Conclusions: The choice of drainage technique impacts short-term outcomes and safety profile in managing PFCs. Our findings support a tailored, step-up approach, prioritizing endoscopic ultrasound-guided drainage based on PFC characteristics to optimize clinical outcomes.

Liver transplantation represents the definitive intervention for various etiologies of liver failure and encompasses a spectrum of rare indications crucial to understanding the diverse landscape of end-stage liver disease, with significantly improved survival rates over the past three decades. Apart from commonly encountered liver transplant indications such as decompensated cirrhosis and liver cancer, several rare diseases can lead to transplantation. Recognition of these rare indications is essential, providing a lifeline to individuals facing complex liver disorders where conventional treatments fail. Collaborative efforts among healthcare experts lead not only to timely interventions but also to the continuous refinement of transplant protocols. This continued evolution in transplant medicine promises hope for those facing diverse and rare liver diseases, marking a paradigm shift in the landscape of liver disease management.