Introduction: Colonic endoluminal stent placement is a commonly utilized and effective endoscopic approach for the management of malignant large bowel obstruction and is an emerging approach for the management of some benign etiologies of large bowel obstruction. However, recent studies evaluating the evolution of clinical scenarios and patient populations for which stenting is performed in real-world practice are lacking. Methods: We assessed colonic stent utilization patterns in a tertiary care academic medical center over the past 10 years. We analyzed the demographics and patient and procedure characteristics of the initial (first half of study period) and latter (second half of the study period) procedures to assess trends over time using standard descriptive statistics. Results: Our analysis was notable due to its provision of some novel insights. The frequency of colonic stent placement procedures increased significantly over time by comparison of the procedure volume for the initial 5-year interval (22 colonic stent procedures) relative to the latter 5-year interval (49 colonic stent procedures) (p = 0.03). The median age of patients who underwent colonic stent placement was significantly lower in the latter 5 years, compared with the initial 5 years of the study period (mean of 81.41 vs. 58.73 years, respectively, p < 0.001). The increased diversity of indications for colonic stent placement was also noted over time. Conclusions: Our data highlight the evolution of colonic stent placement in tertiary care practice over time and are notable for some interesting trends, including the increased utilization of colonic stent placement over time, the broadening of indications for colonic stent placement to include benign indications, and lower patient age at the time of colonic stent placement over time. These findings will help inform the clinical practice of colonic stent placement and provide a foundation to guide future research on the topic.

Background: The role of nonselective beta blockers (NSBB) in patients with cirrhosis and spontaneous bacterial peritonitis (SBP) has been a subject of debate. Conflicting studies exist regarding their impact on mortality in this population. This study aims to evaluate the effect of NSBB on mortality in patients with cirrhotic ascites and a history of SBP. Methods: Data were obtained from the TRNETX database, identifying patients aged 18 to 80 years with cirrhosis, ascites, and SBP using ICD-9 and ICD-10 codes. The study period spanned from September 2001 to January 2024. Patients were divided into two groups: those with SBP receiving NSBB (SBP + NSBB), such as carvedilol, nadolol, and propranolol, and those with SBP not receiving NSBB (SBP − NSBB). The primary outcome was all-cause mortality, and the secondary outcome was the development of acute kidney injury (AKI). Outcomes were assessed over a two-year follow-up period. Additionally, we evaluated the association of NSBB use and mortality in cirrhotic ascites by creating two separate cohorts: patients with cirrhotic ascites on NSBB (Ascites + NSBB) and those not on NSBB (Ascites − NSBB). A 1:1 propensity score matching was conducted based on baseline demographics, comorbidities, and laboratory parameters, including creatinine, INR, sodium, albumin, and bilirubin. Results: Before propensity matching, 18,160 patients were identified in the SBP-NSBB cohort, and 14,198 patients were in the SBP + NSBB cohort. After matching, each group comprised 11,801 patients. Patients with SBP who did not receive NSBB therapy exhibited higher mortality than those on NSBB therapy [OR 1.12, 95% CI 1.05–1.21]. Conversely, the incidence of AKI was higher in the SBP + NSBB group [OR 0.91, 95% CI 0.87–0.95]. In the cirrhotic ascites cohort, patients not receiving NSBB (Ascites − NSBB) demonstrated higher mortality compared to those on NSBB (Ascites + NSBB) [OR 1.17, 95% CI 1.13–1.20]. Conclusions: In a propensity-matched analysis of large patient cohorts, NSBB therapy was associated with reduced mortality in both patients with cirrhotic ascites and those with SBP. Despite a higher incidence of AKI in the SBP + NSBB group, NSBB treatment appears beneficial in reducing overall mortality in these populations.

Cholangiocarcinoma is a rare gastrointestinal malignancy with an annual incidence of 0.3 to 6 cases per 100,000, and, usually, it is reported as adenocarcinoma in about 95% of the cases. It can develop as a result of combination of genetic predispositions and various risk factors like but not limited to choledochal cysts, cholelithiasis/choledocholithiasis, yet its diagnosis is challenging due to difficulties in obtaining tissue for diagnosis. In this study, we present a challenging case in diagnosis that reveals undifferentiated carcinoma with osteoclast-like giant cells in the perihilar region of the bile duct.

Clostridioides difficile enteritis (CDE) is a rare condition usually seen in patients with recent abdominal surgery and/or antibiotics. A 49-year-old male patient presented following a Nissen fundoplication surgery with watery diarrhea, abdominal pain, tenderness, tachycardia, and hypotension. Stool polymerase chain reaction for C. difficile was positive, enzyme immunoassay negative. Abdominal CT was suggestive of enteritis. He was treated with a course of oral vancomycin. This study highlights that CDE can occur following other surgeries apart from ileostomy/colectomy and should be on the differential for high-risk patients (hospitalization, proton pump inhibitor (PPI) use, and antibiotic exposure).