Background Endoscopic intervention for pancreatic fluid collections (PFCs) with disconnected pancreatic duct syndrome (DPDS) has been associated with failures and increased need for additional endoscopic and non-endoscopic interventions. The primary aim of this study was to determine the outcomes of endoscopic ultrasound (EUS)-guided transmural drainage of PFCs in patients with DPDS. Methods In patients undergoing EUS-guided drainage of PFCs from January 2013 to January 2018, demographic profiles, procedural indications and details, adverse events, outcomes, and subsequent interventions were retrospectively collected. Overall treatment success was determined by PFC resolution on follow-up imaging or stent removal without recurrence. Results EUS-guided drainage of PFCs was performed in 141 patients. DPDS was present in 57 of them (40 %) and walled-off necrosis was the most frequent type of PFC (55 %). DPDS was not associated with lower clinical success, increased number of repeat interventions, or increased time to PFC resolution. Patients with DPDS were more likely to be treated with permanent transmural plastic double-pigtail stents (odds ratio [OR] 6.4; 95 % confidence interval [CI] 2.5 – 16.5; P < 0.001). However, when stents were removed, DPDS was associated with increased PFC recurrence after stent removal (OR 8.0; 95 %CI 1.2 – 381.8; P = 0.04). Conclusions DPDS frequently occurs in patients with PFCs but does not negatively impact successful resolution. DPDS is associated with increased PFC recurrence after stent removal.

INTRODUCTION: Esophageal dilation procedures are frequently performed on patients who are taking antithrombotic medications. The aim of this study was to evaluate whether patients on antithrombotic therapies have an increased risk of bleeding from esophageal dilation. METHODS: A retrospective propensity-matched cohort study was conducted to evaluate patients in the TriNetX US Collaborative Network database who underwent esophageal dilation procedures. The primary outcome was to assess the effect of anticoagulants and dual-antiplatelet therapies (DAPTs) on the rate of postprocedural gastrointestinal bleeding within 30 days. RESULTS: Patients on anticoagulants were found to be at higher risk of postprocedural gastrointestinal bleeding compared with patients not on anticoagulants (relative risk [RR], 1.43; 95% confidence interval [CI], 1.06–1.92; P = 0.017). The anticoagulant group had higher rates of blood transfusion and intensive care unit admission. The DAPT group had a higher rate of gastrointestinal bleeding compared with no antiplatelet therapy, though this did not reach statistical significance (RR, 1.64; 95% CI, 0.97–2.75; P = 0.06). When compared with aspirin monotherapy, the difference in bleeding rates was also not statistically significant (RR, 1.36; 95% CI, 0.84–2.19; P = 0.2). There was no difference in the rates of blood transfusion or intensive care unit admission when DAPT was compared separately with aspirin and with no antiplatelet groups. In addition, early resumption of anticoagulation or antiplatelet therapy was not associated with increased postprocedural bleeding. DISCUSSION: Patients on anticoagulants at the time of esophageal dilation were at higher risk of postprocedural bleeding. DAPT was numerically associated with a higher risk of bleeding, but this did not reach statistical significance. These findings aim to inform the clinical decision making in preprocedure and postprocedure management of esophageal dilation procedures.

In this review, we explore the evolving role of endoscopic ultrasound (EUS) in diagnosing and managing pancretobiliary malignancies. For solid pancreatic lesions, techniques like fine-needle biopsy (FNB), contrast-enhanced EUS (CE-EUS), and macroscopic on-site evaluation (MOSE) improve sample quality and diagnostic accuracy. In cystic pancreatic lesions, fine-needle aspiration (FNA), molecular testing, and confocal laser endomicroscopy (nCLE) aid in distinguishing benign from malignant cysts. For cholangiocarcinoma, EUS guided sampling is more accurate than CT in assessing distal lesions and lymph node metastases, while combining EUS with magnetic resonance cholangiography (MRC) enhances diagnostic sensitivity. In gallbladder cancer, EUS surpasses CT and MRI in detecting lymphadenopathy and staging tumors. EUS-FNB (Fine needle biopsy) improves biopsy accuracy, especially for unresectable cases. These advancements highlight EUS as a critical tool for early cancer detection, staging, and tissue acquisition. Beyond diagnosis, EUS plays a pivotal therapeutic role in managing complications such as malignant biliary obstruction and gastric outlet obstruction, offering minimally invasive alternatives like EUS-guided biliary drainage and gastroenterostomy with high clinical success and improved patient outcomes.

An abstract is unavailable. This article is available as a PDF only.