Purpose: To evaluate how CRC screening practices differ between e-cigarette users and non-users. Design: Cross-sectional study design. Setting: National Cancer Institute’s Health Information National Trends Survey (HINTS 5). Subjects: Respondents aged 45 to 75 years. Measures: Demographics, CRC screening, e-cigarette use, cancer history, presence of comorbidities, and access to a primary care provider. Analysis: The demographic characteristics of the study participants were evaluated by their e-cigarette smoking status using chi-squared tests. The differences in CRC screening between e-cigarette users and non-users were evaluated using a multivariate logistic regression model. Results: We identified a total of 6963 participants, of which 181 (2.6%) were e-cigarette users. The prevalence of e-cigarette use was inversely related to age. A significant portion were uninsured (10.7% vs 5.9% of non-users), and almost half (49.9%) were current tobacco smokers. E-cigarette users were as likely to undergo CRC screening compared to non-users [OR 1.40; 95% CI (0.74, 2.66)]. Increasing age, educational level, health insurance, comorbidity, access to a primary care provider, personal history of cancer, and presence of a comorbidity were associated with increased participation in CRC screening. However, e-cigarette use was not associated with increased screening. Conclusion: Our study found no significant difference in CRC screening rates between e-cigarette users and non-users. While screening behaviors appear unaffected for now, ongoing surveillance is important as more users reach screening age given the uncertainties surrounding the long-term effects of e-cigarette use.

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.Methods: In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).Results: Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36–0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, –7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47–2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52–2.42; p=0.31) between the two groups.Conclusions: The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.

Background/Aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.Methods: Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. “Primary precut” was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I² statistic.Results: The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90–97.60) with no heterogeneity (Q, 7.10; df, 8; I²=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20–3.10; I²=0; p =0.942); bleeding, 2.60% (95% CI, 1.70–4.00, I²=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60–3.60; I²=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40–1.90; I²=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70–16.10; I²=83.39; p<0.001).Conclusions: Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.

Nephrogenic diabetes insipidus is a rare, often underrecognized complication of long-term lithium therapy. Lithium-induced nephrogenic diabetes insipidus results from chronic renal exposure, leading to significant polyuria, dehydration, and hypernatremia. We describe a case of a 55-year-old White caucasian male with a schizoaffective disorder managed with lithium who presented with altered mental status and electrolyte abnormalities following a recent stroke. Evaluation revealed nephrogenic diabetes insipidus as the primary etiology, likely exacerbated by recent changes in medication adherence. The patient responded well to fluid resuscitation, reduced lithium dosage, and targeted electrolyte management. This case underscores the need for vigilance in monitoring patients with nephrogenic diabetes insipidus on chronic lithium therapy, as early recognition and treatment are essential in preventing renal impairment and improving clinical outcomes.