Splenic injury is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP). There are only 34 cases reported in the literature up to now. Based on a case of a 72-year-old man, who after ERCP due to choledocholithiasis developed a large perisplenic and subcapsular hematoma, we carried out an extensive review of all cases of ERCP-induced splenic injury found in the literature. We searched PubMed/Medline and Google Scholar till 15 April 2023, for published case reports and series using the following terms: splenic injury after ERCP, ERCP-induced splenic injury, and post-ERCP splenic trauma. The case reports included were in English, Spanish, and German literature. We attempt to discuss the possible clinical image, the available diagnostic methods, the potential treatment alternatives, and predisposing factors related to this entity. Furthermore, a theory of a possible mechanism of this injury is discussed and supported schematically. The ERCP-induced splenic injury is rare and a high index of suspicion is needed for diagnosis. Therefore, we present two diagnostic algorithms, which according to our opinion may assist the evaluation of this complication and lead to early accurate diagnosis and appropriate management. Collectively, our findings support that although ERCP-induced splenic injury is an unexpected/unusual complication of ERCP, following the proper steps can be timely diagnosed and treated.

Background/Objectives: To evaluate the diagnostic performance of ultrasound-guided attenuation parameter (UGAP) for the assessment of hepatic steatosis in a population at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (PDFF) as the reference standard, and to also derive optimal population-specific diagnostic thresholds. Methods: In this single-center prospective study, 64 adults at risk for MASLD underwent UGAP measurement and MRI-PDFF. UGAP was performed according to standardized manufacturer-recommended protocols and standardized on the right hepatic lobe. Hepatic steatosis was staged using established MRI-PDFF thresholds. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Cohort-UGAP cut-offs were derived using the Youden index. Associations between UGAP and clinical parameters were assessed using correlation and regression analyses. Results: UGAP correlated strongly with MRI-PDFF (ρ = 0.82, p < 0.001). The areas under the ROC curve (AUCs) for detecting mild, moderate, and severe steatosis were 0.86, 0.96, and 0.96, respectively. Right-lobe acquisitions outperformed left-lobe measurements, while four-region averaging yielded the highest diagnostic performance. UGAP values were associated with BMI, waist circumference, and liver enzymes. Conclusions: UGAP provides an accurate noninvasive assessment of hepatic steatosis, demonstrating high overall diagnostic agreement with MRI-PDFF. Right-lobe acquisition and multi-regional averaging further improve its performance. While cohort-specific threshold optimization may enhance clinical applicability, larger studies are needed to fully confirm its accuracy in advanced stages.

Background/Objectives: Prostatic artery embolization (PAE) with n-butyl cyanoacrylate (NBCA) glue-lipiodol mixture has several advantages over PAE with microspheres for the treatment of symptomatic benign prostatic hyperplasia (BPH). However, distal penetration of glue-lipiodol in intraprostatic vasculature is often not possible and proximal-only prostatic artery (PA) occlusion with glue may fail to induce significant prostatic infarction. To mitigate this limitation, the authors applied and evaluated SEquential utilization of MIcrospheres and GLUE for PAE (SEMIGLUE-PAE). Meth-ods: For SEMIGLUE-PAE, embolization began with microspheres (100-300μm) with the microcatheter tip at the distal extraprostatic part of the PA; intraprostatic advancement of the microcatheter and injection of additional microspheres was then at-tempted. When flow stasis in intraprostatic branches was observed, embolization continued with small aliquots (0.1ml) of glue-lipiodol mixture (1:8) with the same initial position of microcatheter tip, until the distal one half (to two thirds) of the extraprostatic PA was filled with the mixture. SEMIGLUE-PAE was applied in 20 consecutive patients with symptomatic BPH. Short-term improvement in imaging and clinical parameters and safety were evaluated. Results: Clinical success rate was 95%, 90% and 83.6% at 3, 6 and 12 months post SEMIGLUE-PAE, respectively. Three months post SEMIGLUE-PAE, mean reduction of prostate volume was 32.4% (p< 0.01) and mean improvement of international prostate symptom score was 61.2% (p< 0.01). Mean percentage of prostatic infarction (measured within 24 hours post PAE and compared to baseline PV) was 45.7%. Minor (only) complications were encountered in 4/20 patients. Conclusions: SEMIGLUE-PAE seems to be safe, effective and feasible, especially for operators with limited experience in embolization with glue.