Objectives: Few attempts have been made to determine the risk factors for the recurrence of esophageal varices (EV) and the optimal surveillance interval. This study analyzed whether endoscopic ultrasonography can be used to predict EV recurrence and determine the optimal timing for surveillance endoscopy post‐treatment. Methods: We retrospectively evaluated patients with EVs who underwent endoscopic variceal ligation (EVL) combined with argon plasma coagulation (APC), followed by endoscopic ultrasonography (EUS) using a miniature ultrasonic probe 1 month after APC. Factors associated with EV recurrence were assessed using the Fine‐Gray competing risk regression model, with death considered as the competing risk. The cumulative incidence of EV recurrence was estimated using the cumulative incidence function, and groups were compared using Gray's test. Results: Of 163 eligible patients, 37 (23%) experienced EV recurrence during a median follow‐up period of 36 months (interquartile range: 15–76 months). Multivariable analysis revealed that the presence of perforating veins (PVs) was a significant factor for EV recurrence (sub‐distribution hazard ratio, 4.30; 95% confidence interval, 2.13–8.71; p < 0.001). The cumulative incidence of EV recurrence was significantly higher in patients with PV than in those without (6‐month and 1‐year recurrence rates: 27.3% and 41.6% vs. 3.9% and 5.5%, respectively; p < 0.001). Conclusions: PVs detected using EUS independently predict EV recurrence risk after EVL combined with APC. Given that patients with PVs experience a high recurrence rate within 6 months, comprehensive surveillance endoscopy at 6‐month intervals is recommended in the first year post‐treatment.

Background/Objectives: The optimal timing for biliary drainage in elderly patients remains controversial. This study compared the clinical outcomes of early versus late biliary drainage in elderly patients diagnosed with acute cholangitis associated with common bile duct stones (CBDS). Methods: This single-center, retrospective cohort study compared early (within 24 h of admission) versus late (>24 h after admission) biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP) in 143 elderly patients diagnosed with acute cholangitis, who were divided into early and late groups, respectively. Results: There were no statistical differences in patient characteristics between the early and late drainage groups. Although the time to clinical success was significantly shorter in the early drainage group, there were no significant differences in persistent organ failure, length of hospital stay, in-hospital and 30-day mortality, and ERCP-related adverse events (AEs) between the early and late groups. In the late group, the clinically worsened group tended to exhibit higher white blood cell counts and lower platelet counts on admission. Conclusions: Time to clinical success was significantly shorter in the early drainage group than in the late group. No statistically significant differences in persistent organ failure, length of hospital stay, in-hospital and 30-day mortality, and ERCP-related adverse AEs were detected between early and late biliary drainage in elderly patients with acute cholangitis associated with CBDS.

Background/Objectives: Oral prednisolone (PSL) and budesonide multi-matrix (BUD-MMX) are used to induce remission in ulcerative colitis (UC); however, their therapeutic positioning remains unclear. Comparative data from real-world practices are limited. This study assessed the efficacy and safety of PSL and BUD-MMX in patients with active UC. Methods: Consecutive outpatients with UC initiated on oral PSL or BUD-MMX at two tertiary referral centers were included. The primary outcome was clinical remission at week 8, defined as a partial Mayo score (PMS) ≤ 1 with a rectal bleeding subscore of 0. Secondary outcomes included clinical response and safety. Pre-specified subgroup analyses were performed according to baseline disease activity. Results: Sixty PSL-treated and 40 BUD-MMX-treated patients were evaluated at week 8. Clinical remission was achieved in 65.0% and 55.0% of the PSL and BUD-MMX groups, respectively, whereas a clinical response was observed in 75.0% and 62.5%, respectively. No patient with a baseline PMS of 2–3 was initiated on PSL. Among patients with a baseline PMS of 4–5, the remission and response rates at week 8 were similar between the groups. In contrast, remission in patients with a baseline PMS ≥ 6 was numerically lower in the BUD-MMX group. Treatment escalation rates were comparable in the overall cohort, whereas adverse events were more frequent in the PSL group (23.3% vs. 2.4%). Conclusions: Treatment selection between PSL and BUD-MMX appeared to reflect baseline disease activity, with a partial overlap in the moderate clinical range. BUD-MMX may be a reasonable initial option for selected patients.