Hepatitis C virus (HCV) has emerged as a major global health concern and, if left untreated, can lead to significant liver damage, including cirrhosis, decompensated liver disease, and hepatocellular carcinoma (HCC). Approximately 40% of patients with HCV infection experience extrahepatic manifestations, including renal involvement. HCV-related renal disease is of significant importance among patients with chronic kidney disease (CKD), leading to higher morbidity and mortality. The renal damage due to HCV infection primarily results from cryoglobulinemia and glomerulonephritis, with conditions such as membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN) being most prevalent. Despite advancements in treatment, including the use of directly acting antiviral agents (DAAs), renal complications remain a significant burden in untreated patients. HCV-positive patients on hemodialysis (HD) or those who have undergone kidney transplantation face increased mortality rates compared to their HCV-negative counterparts. Managing HCV infection before kidney transplantation is crucial to mitigate the risk of HCV-related renal complications. Conversely, kidney transplantation from HCV-infected donors is well established, as post-transplant treatment for HCV is safe and effective, potentially reducing mortality and morbidity for patients on transplant waiting lists. This review aims to provide a comprehensive analysis of the renal manifestations of HCV, emphasizing the importance of early diagnosis and treatment to improve patient outcomes.

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.

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 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.

Pancreatic cysts with high-risk characteristics are at increased risk of harboring high-grade dysplasia or pancreatic cancer. Endoscopic ultrasound may clarify the nature of the cystic lesion and its malignant potential. A mural nodule found through endoscopic ultrasound within a cyst may represent malignancy and require fine-needle aspiration. Pancreatic pseudocysts are benign walled-off fluid collections that form in the setting of pancreatitis and may be difficult to differentiate from neoplastic cysts. Pseudoaneurysms form when pancreatitis inflammation damages vessel walls and can cause fatal hemorrhage. We present a pancreatic pseudocyst with pseudoaneurysm mimicking a neoplastic cyst with a mural nodule.