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.

In patients considered high risk of laparoscopic cholecystectomy, percutaneous gallbladder drainage is traditionally considered first-line treatment option. Recent evidence supports endoscopic gallbladder drainage as a safe and feasible alternate option. We describe a case of Roux-en-Y gastric bypass surgery patient with acute cholecystitis and choledocholithiasis with unsuccessful laparoscopic cholecystectomy because of difficult operative field, underwent successful single-session endoscopic ultrasound–directed transgastric endoscopic retrograde cholangiopancreatography and endoscopic ultrasound–guided transmural gallbladder drainage at our institution.

Background: The optimal first-line biologic therapy for refractory ulcerative proctitis (UP) remains uncertain, largely because patients with UP are frequently excluded from biologic clinical trials, limiting evidence to guide treatment selection. This study evaluated outcomes among patients with UP treated with first-line TNF inhibitors or vedolizumab. Methods: We performed a retrospective cohort study using the TriNetX database between 1995 and 2023. Propensity score matching was applied to balance demographics, laboratory parameters, and baseline medications. Primary outcomes included corticosteroid use, all-cause emergency room (ER) visits and hospitalizations, and colectomy, assessed at 6, 12, and 24 months after initiation of TNF inhibitors or vedolizumab. Secondary outcomes described real-world biologic usage patterns in UP. Results: Among 641 patients with UP receiving advanced therapy, the most commonly used biologics were adalimumab (39%), infliximab (27%), and vedolizumab (26%). Ustekinumab was used in 12% of patients. In matched analyses, TNF inhibitor therapy was associated with reduced ER visits and hospitalizations at 6 and 12 months compared with vedolizumab (6 months: 14.3% vs. 25%, aOR 0.50, p-value 0.03; 12 months: 16.1% vs. 35.2%, aOR 0.35, p-value 0.01). By 24 months, no significant differences were observed. Corticosteroid use and colectomy rates were similar across therapies at all time points. In a subgroup comparison between adalimumab and vedolizumab, results were consistent with the primary analysis, with lower short-term ER visits and/or hospitalizations among patients receiving adalimumab. Conclusions: In this propensity-matched analysis, TNFi therapy was associated with lower short-term healthcare utilization, with no significant differences observed in corticosteroid use. These findings should be interpreted cautiously given nonspecific outcomes and potential residual confounding from unmeasured disease variables such as endoscopic activity.

Surgical clip migration is a rare but important cause of delayed postcholecystectomy complications. An 83-year-old man presented 8 years after laparoscopic cholecystectomy with abdominal pain and jaundice. Imaging showed biliary dilation with a 20-mm common bile duct stone. Endoscopic retrograde cholangiopancreatography with cholangioscopy identified a migrated surgical clip serving as the nidus. Electrohydraulic lithotripsy achieved fragmentation, followed by balloon extraction and placement of a fully covered metal stent. The patient recovered uneventfully. This case highlights the need to consider clip migration in patients with late-onset biliary obstruction after cholecystectomy and supports cholangioscopy-guided lithotripsy as a definitive therapy.

Gastrointestinal stromal tumors (GISTs) of the rectum are rare and present unique management challenges due to their proximity to vital pelvic organs. This report describes the case of a 73-year-old man with multiple comorbidities who was diagnosed with a 3.1 cm distal rectal gastrointestinal stromal tumor. Successful exposed endoscopic full-thickness resection was performed resulting in complete excision of the gastrointestinal stromal tumor and complete endoscopic rectal reconstruction was performed using endoscopic overstitch device. This case demonstrates the effectiveness of free hand endoscopic full-thickness resection as a minimally invasive treatment of rectal GISTs and other subepithelial lesions, particularly in patients for whom traditional surgery poses elevated risks.