A 13-year-old boy presented with an 8-year history of repeated episodes of anemia. Laboratory investigations confirmed iron deficiency anemia due to occult blood loss from the gastrointestinal tract. Despite undergoing esophagogastroduodenoscopy, colonoscopy, and push enteroscopy, no abnormalities were detected. Subsequent computed tomography enterography also yielded normal results. However, a capsule endoscopy revealed multiple superficial ulcers in the jejunum and proximal ileum. Initially, the patient was treated for Crohn’s disease using various therapeutic approaches, all of which were unsuccessful. Further investigation led to a positive diagnosis for a rare condition known as chronic enteropathy associated with SLCO2A1 mutation (CEAS), marking the first reported case in India.

We report a case of appendicitis after endoscopic polypectomy at the appendix orifice that was treated by laparoscopic surgery. In this article, we present a brief introduction to this disease entity and discuss the experiences learned from this case.

Bronchobiliary fistula is a very rare entity that presents with bilioptysis. We present a noteworthy case involving a patient with portal cavernoma cholangiopathy complicated by cholangitis and bronchobiliary fistula. The diagnosis was established through high-resolution computed tomography of the thorax and bronchoscopic evaluation. Subsequently, the patient underwent endoscopic retrograde cholangiopancreatography with stenting of the common bile duct. Remarkably, the bronchobiliary fistula resolved 1 month after the procedure.

Polytetrafluoroethylene (PTFE) grafts are artificial vascular grafts commonly utilized for reconstructing the middle hepatic vein during living donor liver transplantation. In this report, we present three cases of expanded PTFE (ePTFE) graft migration into the gastrointestinal tract. These migrations were incidentally discovered and later migrated grafts were successfully removed endoscopically. The first case involved a patient presenting with epigastric discomfort, with a migrated ePTFE graft observed in the duodenal lumen during esophagogastroduodenoscopy (EGD). In the second case, a patient who visited the emergency room with hematochezia was found to have a migrated ePTFE graft in the colonic lumen on colonoscopy. The third case involved a patient undergoing regular EGD after endoscopic submucosal dissection for early gastric cancer; graft migration into the duodenal lumen was documented over time through sequential surveillance EGDs. The graft was endoscopically removed after complete migration. Contrary to previous reports, the three cases presented here did not exhibit serious clinical symptoms, and they were successfully treated through endoscopic foreign body removal without complications. We believe these occasions were possible due to the slow migration of the graft and the concurrent spontaneous closure of the fistula tract.

The spleen is one of the organs most commonly affected by blunt abdominal trauma. Splenectomy is often indicated for high-grade post-traumatic injuries and in patients who are hemodynamically unstable, while non-operative management (NOM) is considered for the remaining cases. Patients who have undergone splenectomy are at an increased risk of overwhelming post-splenectomy infection, leading to a shift in the consensus toward managing splenic trauma with spleen-preserving NOM approaches, such as splenic artery embolization, when possible. Patients with grade IV and V splenic injuries who are hemodynamically stable and do not have an active bleed are often candidates for prophylactic angioembolization. This intervention reduces the risk of re-bleeding, preserves splenic function, and decreases the likelihood of requiring a splenectomy. However, not all facilities have access to interventional radiology (IR). Through this case report, we emphasize the importance of using the period of conservative management to either consult with an IR specialist or transfer the patient to a center equipped with IR, given the high risk of re-bleeding or delayed rupture of the spleen. An additional unusual finding in our case was a re-bleed occurring beyond the typical interval for NOM as reported in most literature.

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique frequently employed in the management of bleeding gastric varices among patients with portal hypertension. Bleeding from gastric varices is associated with higher mortality and morbidity compared to bleeding from esophageal varices, which are typically managed endoscopically. Compared to other interventions for gastric varices, BRTO is less invasive and can be performed in patients with poor hepatic reserve. The procedure involves occlusion of the outflow of the portosystemic shunt— often a gastrorenal shunt—using an occlusion balloon, followed by injection of a sclerosant into the varix. In this report, we describe a technique for accessing gastric varices that lack a gastrorenal shunt; this is accomplished using alternative shunt routes, such as the inferior phrenic vein. The reported approach is technically challenging due to the relatively small size of these shunts and the scarcity of cases documented in the literature regarding their use.

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups.Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Gastrointestinal (GI) bleeding is a serious complication with a high mortality rate (45%–55%) that can result from a variety of conditions, including portal hypertension, diverticulosis, or splenic vein thrombosis. There are a variety of established treatment strategies for GI bleeds, and there are different indications and contraindications for each. In this case, colonoscopy did not identify any active source of bleeding. Furthermore, because this GI hemorrhage did not involve any shunts, balloon-occluded retrograde transvenous obliteration was not performed. Additionally, a transjugular intrahepatic portosystemic shunt was ruled out due to the poor primary shunt patency rate. Here, we report the treatment of a GI bleed with N-butyl-2-cyanoacrylate (n-BCA) liquid embolization with no complications. This case demonstrates the potential of using n-BCA to treat small bowel varices.