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.

(1) Background: Alcohol consumption is one of the main causes of acute pancreatitis. (2) Material and Methods: In this unicentric retrospective cohort study, we selected 1855 patients from the Bucharest Acute Pancreatitis Index (BUC-API) who presented with acute pancreatitis. We investigated correlations between Alcoholic Acute Pancreatitis (AAP) and the rate of complications, cost, length of hospitalization and rate of recurrence. (3) Results: We found a moderately strong association between AAP and recurrence (p < 0.01) and observed that the disease is likelier to evolve with pseudocysts and walled-off necrosis than other forms of AP. Patients with AAP are less likely to have a morphologically normal pancreas than patients suffering from AP of other causes (p < 0.01), but a low probability of requiring intensive care unit admission (p < 0.01) significantly lowers daily cost (Md = 154.7 EUR compared to Md = 204.4 EUR) (p < 0.01). (4) Conclusions: This study’s data show that patients with AAP have a greater rate of pseudocyst occurrence, lower intensive care unit admittance rate and lower cost of hospitalization than patients with AP of other causes. Typical Sketch: A middle-aged male tobacco smoker with recurrent AP, lower risk of in-hospital mortality and complications such as pseudocysts; treated in a gastroenterological ward and discharged at-will.

Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Naso-biliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted.

Background/Objectives: Post-surgical gastrointestinal fistulas represent severe complications associated with significant morbidity and therapeutic challenges. Over-the-scope clipping systems have expanded endoscopic management options; however, data regarding the Padlock Clip™ in mixed populations of acute and chronic fistulas remain limited. This study aimed to evaluate the feasibility, safety, and clinical outcomes of the Padlock Clip™ in the endoscopic management of post-surgical gastrointestinal fistulas in a tertiary referral center. Methods: We conducted a retrospective single-center study including 28 adult patients treated with the Padlock Clip™ between January 2021 and December 2025. Technical success, clinical success, reintervention rates, and adverse events were assessed. Exploratory subgroup analyses were performed according to surgical etiology and fistula complexity. Results: Technical success was achieved in 25/28 patients (89.3%), and clinical success occurred in 23/28 cases (82.1%). Reintervention was required in seven patients (25.0%). Adverse events occurred in three patients (10.7%) and were limited to clip migration. The median follow-up duration was 6.5 months (range 3–32 months). Sleeve gastrectomy-related fistulas demonstrated lower technical success compared with non-sleeve cases (72.7% vs. 100%). Immediate technical success was associated with a trend toward improved clinical outcomes. Complex fistulas showed lower healing rates and higher reintervention frequency. Conclusions: The Padlock Clip™ is a feasible and safe option for endoscopic management of post-surgical gastrointestinal fistulas. Immediate technical success appeared to be associated with improved clinical outcomes and may represent a potential factor in achieving durable fistula closure. Complex fistulas and sleeve gastrectomy-related defects may require multimodal therapeutic approaches.

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.