INTRODUCTION: Upper gastrointestinal (UGI) cancers, comprising malignancies of the esophagus, stomach, duodenum, pancreas, liver, biliary tract, and gallbladder, are the second leading cause of cancer-related mortality in the United States and are associated with significant comorbidities. Recent studies show a disproportionate rise in pancreatic and stomach cancer among young adults. This study aims to use a nationwide, population-based cohort to (i) evaluate the trend of all UGI cancer as an aggregate and (ii) examine the role of demographics, histology, and tumor stage in UGI cancer incidence among young adults. METHODS: Individuals diagnosed with UGI cancer in the United States from 2001 to 2019 were identified and obtained from the Surveillance, Epidemiology, and End Results—National Program of Cancer Registries database. The primary outcomes were incidence rates of UGI cancer (calculated per 100,000, age-adjusted to the year 2000 US population), stratified by sex and age (< 55 years for young adults and ≥ 55 years for older adults). Trends, annual percentage change, and average annual percentage change were calculated using the parametric method. Sensitivity analysis was performed according to primary site and histology; further analysis examining race and cancer stage was performed in the young adult subgroup. RESULTS: A total of 2,333,161 patients with UGI cancer were identified. Most cases were male, and 14.3% were < 55 years of age. Incidence of UGI cancer increased most in women younger than 55 years, driven primarily by pancreatic and stomach cancers, as well as neuroendocrine tumor and gastrointestinal stromal tumor histology. African American race and localized tumors and malignancy with distant spread are also contributing to the disparate increase among young women. UGI mortality rates have not changed significantly in young adults. DISCUSSION: The overall incidence rate of upper gastrointestinal cancer is increasing significantly in young women compared with men. Increased endoscopic procedures and disparate exposure to risk factors are likely contributing to these trends.

EUS–guided liver biopsy (EUS-LB) is an alternative to traditional percutaneous and transjugular approaches. Determining the optimal needle gauge requires balancing diagnostic yield with procedural safety. This meta-analysis compares the efficacy and safety of 19-gauge (19G) versus 22-gauge (22G) fine needle biopsy (FNB) needles in EUS-LB. We searched PubMed, Google Scholar, and Cochrane databases for studies comparing 19G and 22G FNB needles with Franseen or Fork tip designs. Outcomes assessed included tissue adequacy, diagnostic adequacy, number of complete portal tracts (CPTs), length of the longest tissue segment, and total specimen length (TSL). Data were analyzed using a random-effects model, presenting results as standardized mean differences (SMDs) and relative risks (RRs) with 95% confidence intervals (CIs). Five studies with 205 patients were included. The 19G needle demonstrated higher tissue adequacy (RR, 1.596; 95% CI, 0.969–2.631; P = 0.066) and diagnostic adequacy (RR, 1.421; 95% CI, 0.942–2.145; P = 0.094) compared to the 22G needle. It yielded greater CPTs (SMD, 1.705; 95% CI, −0.652 to 4.062; I ² = 97.34%), longer tissue segments (SMD, 5.039; 95% CI, −0.276 to 10.354; I ² = 97.24%), and increased TSL (SMD, 4.156; 95% CI, −0.268 to 8.579; I ² = 98.75%). The 19G needle may provide superior tissue and diagnostic outcomes in EUS-LB without increasing adverse effects compared to the 22G needle, although these differences were not statistically significant. This suggests a need for further high-quality research to confirm these preliminary findings.

Background: Palm and sole skin eruptions have a broad differential diagnosis. It is particularly important to recognize common causes as well as their association with certain chemotherapy regimens such as Capecitabine. Case report: A 79-year-old woman presented with a painful rash on her hands and feet for 1 week. She had metastatic colon cancer and was in her third week of treatment with capecitabine. Her diagnosis was a medication side-effect from chemotherapy. Capecitabine was stopped and she had some clinical improvement over the next two days. She was discharged with oncology follow up for resumption of Capecitabine at a lower dose with improvement in her rash 3 weeks later. Discussion: Skin rashes are a commonly encountered complaint in patients in the inpatient and outpatient setting. It is important to maintain a broad differential diagnosis in those with rashes of the palmoplantar surfaces of the hands and feet. Recognizing skin changes as a possible manifestation of underlying malignancy or a medication side-effect is key in appropriate diagnosis and treatment.

Background Gastric variceal bleeding is a life-threatening complication of portal hypertension. Cyanoacrylate injection is the standard endoscopic treatment that carries a significant risk of ectopic embolization, particularly in patients with gastrorenal shunts. Adding endoscopic clips before injection may enhance safety and efficacy, yet evidence remains limited. This study evaluates the safety and effectiveness of clip-assisted cyanoacrylate injection (clip-ECI). Methodology A systematic search was conducted on PubMed, Web of Science, CINAHL, Embase, Google Scholar, and the Cochrane Library on October 9, 2025, following the PRISMA 2020 guidelines. The protocol was registered on PROSPERO (CRD420251166002). The primary outcome was rebleeding. Secondary outcomes included technical success, adverse events, ectopic embolism, and procedure-related mortality. Meta-analysis was performed using R version 3.4.3 (R Core Team) with a random-effects model expressed as proportions and 95% confidence intervals (CIs). Results Six studies involving 465 participants treated with clip-ECI were included, four in the meta-analysis due to overlapping populations. Most participants were middle-aged males with cirrhosis from hepatitis B, presenting with GOV2 or IGV1 gastric varices; 41.7–100% had gastrorenal shunts. The pooled technical success rate was 99% (95% CI 0.97–1.0; p = 0.97; I² = 0%), rebleeding 11% (95% CI 0.08–0.16; p = 0.1; I² = 50.4%), adverse events 20% (95% CI 0.15–0.26; p = 0.37; I² = 0%), ectopic embolism 3% (95% CI 0.00–0.37; p = 0.01; I² = 85.1%), deaths attributable to ectopic embolism 1% (95% CI 0.00–0.04; p = 0.67; I² = 0%) and overall mortality 4% (95% CI 0.01–0.14; p = 0.01; I² = 80.6%). Compared with conventional injection, clip-ECI showed fewer embolic complications and a non-significant trend toward lower rebleeding. Conclusion Clip-ECI appears highly effective with low rebleeding and embolic complication rates, supporting its safety for gastric varices, particularly in patients with gastrorenal shunts. Large multicenter randomized trials are needed to strengthen these findings and establish clinical protocols.

Background and Aims: Endoscopic clipping is the standard method for mucosotomy closure in per-oral endoscopic myotomy (POEM) and gastric per-oral endoscopic myotomy (G-POEM). Concerns remain regarding potential leaks and long-term complications. This meta-analysis compares the technical success rates and outcomes of endoscopic clipping and suturing for mucosotomy closure in E-POEM/G-POEM. Methods: A systematic search of databases for studies comparing endoscopic clipping and suturing in E-POEM/G-POEM was conducted. The primary outcomes were technical success rates, and the secondary outcomes were cost, procedure time, and complications. Meta-analyses and sensitivity analysis were performed. Results: Three studies with a total of 91 patients were included. The technical success rates were similar between suturing and clipping, with a success rate of 100% (48/48) for suturing and 94.4% (41/43) for clipping (odds ratio 1.03, 95% confidence interval 0.89–1.19, p = 0.50). There was no significant difference in procedure time between the two methods (SMD −0.73; CI: −1.70 to 0.23; p = 0.13). The cost of suturing was higher on average (mean: $1751, range: $873–$2353) compared to clipping (mean: $898, range: $703–$1083), but the difference was not statistically significant (SMD 1.85, CI −5.05 to 1.35, p = 0.25) with high heterogeneity. Complications for clipping and suturing were also comparable. Conclusions: Both endoscopic clipping and suturing achieve successful mucosotomy closure in E-POEM/G-POEM without any significant difference in the cost and the time between the two closure methods. Further investigation with larger, randomized, controlled trials are necessary to determine their roles in routine practice.