Gastrointestinal Tuberculosis (GITB) and Crohn’s disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course.

Proton pump inhibitors (PPI) may impact the absorption of vitamin B12. We performed a systematic review to ascertain if PPI use increases risk of vitamin B12 deficiency.Electronic databases (Pubmed...

One of the most essential procedures for individuals with biliopancreatic disorders is endoscopic retrograde cholangiopancreatography (ERCP). It is based on the combination of endoscopy and radiology to study the biliopancreatic ducts and apply therapeutic solutions. ERCP is currently used to treat choledocholithiasis with or without cholangitis, as well as pancreatic duct stones, benign bile, and pancreatic leaks. On the other hand, ERCP is an unpleasant procedure that must be conducted under anesthetic (moderate sedation, deep sedation, or general anesthesia). With procedures becoming more challenging, the role of anesthesia in ERCP has become even more relevant, and the use of general anesthesia has become better defined. In the last decades, many drugs have been used and some new drugs, like dexmedetomidine, have been recently introduced for sedation or anesthesia during ERCP. Moreover, the scientific community is still divided on the level of sedation to be applied, as well as on appropriate airway management. We therefore performed a narrative review of the literature to assess currently available anesthetic medications for elective ERCP and evidence supporting their effectiveness.

Background and Aims: Mediastinal pseudocysts (MP) are rare, and surgery is the conventional treatment modality. However, in the last decade, excellent outcomes have been reported with endoscopic transpapillary drainage. Endoscopic ultrasound (EUS) guided trans-esophageal transmural drainage of MP is a minimally invasive and effective non-surgical treatment modality, but the experience is limited. We aimed to report our experience of EUS-guided transmural drainage in 10 patients with MP‘s. Methods: A retrospective analysis of patients with pancreatic fluid collections treated with EUS-guided transmural drainage over the last ten years was completed to to identify patients with MP‘s. Results: Ten patients (8 males, with a mean age of 34.9±9.17 years) with MP treated with EUS-guided transesophageal transmural drainage were identified. Nine patients with MP had concurrent chronic pancreatitis, and only one had MP following acute necrotizing pancreatitis. The mean size of MP was 5.70±1.64 cm, and nine patients (90%) had concurrent abdominal pseudocyst. EUS-guided transesophageal transmural drainage was technically successful in all ten patients. Transmural plastic stents were placed in 9 patients, whereas one patient underwent single-time complete aspiration of the MP. There were no immediate or delayed procedure-related complications. All ten patients had a successful outcome, with the mean resolution time being 2.80±0.79 weeks. There has been no recurrence of PFC or symptoms in nine (90%) successfully treated patients over a mean follow-up period of 43.3 months. Conclusions: EUS-guided trans-esophageal drainage of MP is safe with a high technical and clinical success rate.

Aims Liver biopsy can be performed by the traditional percutaneous radiology guided route (PC-LB) or under endoscopic ultrasound guidance (EUS-LB) and limited data exist on the comparison between the two and hence this study was planned. Methods This is a parallel-group, single-blinded, randomized controlled trial conducted at two tertiary care centers in India from July 2020-August 2021. Consecutive patients requiring liver biopsy were randomized into either the EUS-LB or the PC-LB arm. Aggregate specimen length, longest specimen length, number of complete portal tracts (CPTs), and diagnostic adequacy were assessed. Post-procedure pain was measured using the visual analog scale (VAS) at 1, 4, and 24 hrs post-procedure. Results A total of 48 patients (30 males; 62.5% with a mean age of 37.25±12.7 years) were randomized into EUS-LB (n=24) and PC-LB (n=24). EUS-LB yielded significantly greater aggregate specimen length (33.5 vs 15.0 mm; p<0.0001) and a higher number of CPTs (17.5 vs. 7.5; p<0.001). The longest length of the specimen was noted in PC-LB arm (10.5 vs. 8.0;p=0.04). Diagnostic adequacy was similar between the two arms. The most common post-procedure side effect was pain. Pain was noted in higher proportion in PC-LB arm (87.5% vs. 16.7%; p<0.001) and had higher analgesic requirement (41.7% vs 4.2%;p=0.004). VAS score was significantly higher in the PC-LB at all the measured time points of 1, 4, and 24 hrs (p<0.001). Conclusions EUS-LB showed significantly better aggregate specimen length and more CPTs compared to PC-LB. Post-procedure pain in the first 24 hrs was significantly greater in the PC-LB arm.(Trial No:CTRI/2020/09/027989) Publication Date: 14 April 2022 (online) © 2022. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany