Hepatitis C virus (HCV) infection is a major public health concern, with more than 58 million people chronically infected worldwide. The management of HCV, once the domain of specialists only, has been revolutionized by the advent of direct-acting antiviral therapies. To reduce the burden of HCV in the United States (US), emphasis is now being placed on the involvement of primary care physicians in the management of HCV patients. Inclusion of more primary care providers in the HCV diagnosis and treatment initiatives can assist in achieving the goal of HCV elimination, especially in the medically underserved areas. To actively engage in the management of HCV, primary care providers must understand its epidemiology, risk factors, natural history, current treatment regimen, and potential complications. This manuscript reviews these key areas, along with presenting the cost-effectiveness of treatment and evidence-based guidelines for follow-up care in adults with chronic HCV infection who have undergone HCV treatment. Equipped with this foundational knowledge about HCV management, primary care physicians can play a vital role in eliminating HCV.

Surgical reversal of Roux-en-Y gastric bypass is associated with significant morbidity. Endoscopic ultrasound (EUS)-guided creation of gastro-gastric (GG) fistulas, using lumen apposing metal stents (LAMS) offers a minimally invasive alternative, but the inability to leave stents in long-term and fistula closure soon after stent removal limits durability. Consecutive patients underwent parallel-LAMS septotomy for partial reversal of the RYGB between 2023 and 2025 at two tertiary centers. Technical and clinical outcomes were assessed. Six patients (mean age 64.5 years), mean BMI of 21.9 ± 3.9 kg/m2 underwent parallel-LAMS septotomy. Technical and clinical success was achieved in all 6 patients (100%). All anastomoses were durable on median follow-up of 24 weeks (range 16-50). There were no major adverse events. Parallel-LAMS septotomy provides a safe and effective endoscopic approach to achieve a durable GG anastomosis, thereby partially reversing RYGB without reliance on in-dwelling stents.

Gastro-jejunal (GJ) anastomotic strictures occur in up to 30 % of patients after Roux-en-Y gastric bypass (RYGB). Endoscopic therapies such as balloon dilatation and stent placement are generally considered first-line, but a subset of patients remain refractory and require highly morbid revisional surgery. We report on consecutive RYGB patients with GJ stenosis with ≥2 failed prior endoscopic therapies, who underwent Endoscopic ultrasound-assisted gastric outlet remodeling (EUS-GOR). Twelve patients [mean age 59.08 years (range=45-85), 83.3% female] underwent attempted EUS-GOR between 2024 and 2025. Technical success was achieved in 10 of 12 patients (83.3%). Two attempts were aborted due to inability to identify a safe window for LAMS deployment. Amongst the technically successful cases (n=10), clinical success was achieved in 9 patients (90%). Mean GOOSS improved from 1.3 ± 0.8 pre-procedure to 2.8 ± 1.5 at follow-up (p=0.002). BMI increased from 24.8 ± 13.3 kg/m² to 25.8 ± 15.8 kg/m² (p=0.067), and serum albumin improved from 3.1 ± 1.2 g/dl to 4.1 ± 1.4 g/dl (p=0.02) at follow up. There were no major adverse events. At mean follow up of 23.4 weeks (range= 4- 63 weeks), one patient experienced significant re-stenosis of the anastomosis. No patients required surgical revision. EUS-GOR is technically feasible, safe and clinically effective in patients with refractory GJ strictures post-RYGB. This technique may offer a minimally invasive alternative to surgical revision in high-risk patients.

Hydrogen peroxide (H ₂ O ₂ ) is a caustic agent capable of causing serious gastrointestinal injury, yet its use as an enema is promoted in some alternative medicine communities for constipation. We report a case of a 56-year-old man who developed portal and mesenteric venous air embolism and chemical colitis following self-administration of an H ₂ O ₂ enema. Imaging revealed extensive portal venous gas and colitis. Colonoscopy confirmed diffuse mucosal injury, and biopsies showed acute colitis with ulceration. The patient was treated with intravenous fluids, broad-spectrum antibiotics, and hyperbaric oxygen therapy, resulting in resolution of gas embolism. This case highlights the dangers of H ₂ O ₂ enemas and the potential role of hyperbaric therapy in management.

Primary Squamous Cell Biliary Carcinoma With Liver Metastasis Is Rare but Malicious