Semaglutide, a glucagon-like peptide-1 receptor agonist widely used for managing type 2 diabetes mellitus and obesity. Reports of semaglutide-associated hepatotoxicity are exceedingly rare. We detail a case of a 44-year-old woman who developed liver injury with elevated liver enzymes after semaglutide initiation for weight management. Liver enzyme levels normalized after discontinuing the drug and worsened upon rechallenge, confirming semaglutide's potential to cause liver injury. In addition, our case study encompasses a literature review of all reported semaglutide-related drug-induced liver injury cases, highlighting the need for diligent liver function monitoring in patients on semaglutide and offering valuable insights into its hepatotoxic potential.

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice.

Epiphrenic diverticula are rare and often debilitating, particularly when associated with esophagogastric junction outflow obstruction, and their management is challenging in high-risk surgical candidates. We describe a 77-year-old woman with severe dysphagia, regurgitation, and significant weight loss caused by a large distal epiphrenic diverticulum and esophagogastric junction outflow obstruction. Given her multiple comorbidities, she was not a surgical candidate and underwent peroral endoscopic myotomy with diverticulotomy. The procedure was completed safely, resulting in complete symptom resolution and normalization of her Eckardt score. This case highlights peroral endoscopic myotomy with diverticulotomy as a minimally invasive, anatomy-directed solution for complex esophageal diverticula.

Pseudoaneurysm formation is a rare but potentially fatal complication of necrotizing pancreatitis due to the risk of rupture. We report a 28-year-old man with walled-off pancreatic necrosis who developed catastrophic hemorrhage from a ruptured pseudoaneurysm during endoscopic ultrasound-guided necrosectomy, resulting in intraprocedural cardiac arrest. The patient required immediate cardiopulmonary resuscitation and emergent angiography, which identified the bleeding source and achieved hemostasis via coil embolization. He survived following prompt multidisciplinary intervention. This case highlights the unpredictable nature of vascular complications in necrotizing pancreatitis and the critical role of rapid multidisciplinary response in managing life-threatening hemorrhage.