Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Background/Aims: Various lumen-apposing metal stents (LAMS) have been used for the endoscopic ultrasound-guided transmural drainage (EUS-TD) of postoperative pancreatic fluid collections (POPFC) and peripancreatic fluid collections (PFC). In this study, we aimed to assess the efficacy and safety of novel electrocautery-enhanced LAMSs (Hot-Plumber with Z-EUS IT) with different inter-flange lengths (13 to 33 mm) for managing POPFC and PFC. Methods: We reviewed the interventional EUS database of Asan Medical Center to identify consecutive patients with POPFC or PFC who underwent EUS-TD with the novel LAMSs between April 2023 and December 2023. Technical success, clinical success, and adverse events were evaluated. Results: Ten patients (5 with POPFCs and 5 with PFCs) were included in the analysis. The technical and clinical success rates were 100% and 90%, respectively. The LAMS was placed using either the freehand technique (n=5) or the over-the-guide wire technique (n=5). One patient successfully underwent endoscopic necrosectomy for walled-off necrosis through a novel LAMS.Two patients experienced adverse events (one stent migration and one infection). The LAMS was removed in 7 out of 10 patients after resolution of the fluid collection at a median of 61 days (interquartile range, 31 to 69 days) post-LAMS placement. Conclusions EUS-TD using the novel LAMS for POPFC and PFC demonstrated high efficacy and an acceptable safety profile. This novel LAMS represents a viable option when selecting stents for EUS-guided drainage of the POPFC and PFC.

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Background/Aims: Various lumen-apposing metal stents (LAMS) have been used for the endoscopic ultrasound-guided transmural drainage (EUS-TD) of postoperative pancreatic fluid collections (POPFC) and peripancreatic fluid collections (PFC). In this study, we aimed to assess the efficacy and safety of novel electrocautery-enhanced LAMSs (Hot-Plumber with Z-EUS IT) with different inter-flange lengths (13 to 33 mm) for managing POPFC and PFC. Methods: We reviewed the interventional EUS database of Asan Medical Center to identify consecutive patients with POPFC or PFC who underwent EUS-TD with the novel LAMSs between April 2023 and December 2023. Technical success, clinical success, and adverse events were evaluated. Results: Ten patients (5 with POPFCs and 5 with PFCs) were included in the analysis. The technical and clinical success rates were 100% and 90%, respectively. The LAMS was placed using either the freehand technique (n=5) or the over-the-guide wire technique (n=5). One patient successfully underwent endoscopic necrosectomy for walled-off necrosis through a novel LAMS.Two patients experienced adverse events (one stent migration and one infection). The LAMS was removed in 7 out of 10 patients after resolution of the fluid collection at a median of 61 days (interquartile range, 31 to 69 days) post-LAMS placement. Conclusions EUS-TD using the novel LAMS for POPFC and PFC demonstrated high efficacy and an acceptable safety profile. This novel LAMS represents a viable option when selecting stents for EUS-guided drainage of the POPFC and PFC.

Background/Aims: Various lumen-apposing metal stents (LAMS) have been used for the endoscopic ultrasound-guided transmural drainage (EUS-TD) of postoperative pancreatic fluid collections (POPFC) and peripancreatic fluid collections (PFC). In this study, we aimed to assess the efficacy and safety of novel electrocautery-enhanced LAMSs (Hot-Plumber with Z-EUS IT) with different inter-flange lengths (13 to 33 mm) for managing POPFC and PFC. Methods: We reviewed the interventional EUS database of Asan Medical Center to identify consecutive patients with POPFC or PFC who underwent EUS-TD with the novel LAMSs between April 2023 and December 2023. Technical success, clinical success, and adverse events were evaluated. Results: Ten patients (5 with POPFCs and 5 with PFCs) were included in the analysis. The technical and clinical success rates were 100% and 90%, respectively. The LAMS was placed using either the freehand technique (n=5) or the over-the-guide wire technique (n=5). One patient successfully underwent endoscopic necrosectomy for walled-off necrosis through a novel LAMS.Two patients experienced adverse events (one stent migration and one infection). The LAMS was removed in 7 out of 10 patients after resolution of the fluid collection at a median of 61 days (interquartile range, 31 to 69 days) post-LAMS placement. Conclusions EUS-TD using the novel LAMS for POPFC and PFC demonstrated high efficacy and an acceptable safety profile. This novel LAMS represents a viable option when selecting stents for EUS-guided drainage of the POPFC and PFC.

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Background/Aims: Various lumen-apposing metal stents (LAMS) have been used for the endoscopic ultrasound-guided transmural drainage (EUS-TD) of postoperative pancreatic fluid collections (POPFC) and peripancreatic fluid collections (PFC). In this study, we aimed to assess the efficacy and safety of novel electrocautery-enhanced LAMSs (Hot-Plumber with Z-EUS IT) with different inter-flange lengths (13 to 33 mm) for managing POPFC and PFC. Methods: We reviewed the interventional EUS database of Asan Medical Center to identify consecutive patients with POPFC or PFC who underwent EUS-TD with the novel LAMSs between April 2023 and December 2023. Technical success, clinical success, and adverse events were evaluated. Results: Ten patients (5 with POPFCs and 5 with PFCs) were included in the analysis. The technical and clinical success rates were 100% and 90%, respectively. The LAMS was placed using either the freehand technique (n=5) or the over-the-guide wire technique (n=5). One patient successfully underwent endoscopic necrosectomy for walled-off necrosis through a novel LAMS.Two patients experienced adverse events (one stent migration and one infection). The LAMS was removed in 7 out of 10 patients after resolution of the fluid collection at a median of 61 days (interquartile range, 31 to 69 days) post-LAMS placement. Conclusions EUS-TD using the novel LAMS for POPFC and PFC demonstrated high efficacy and an acceptable safety profile. This novel LAMS represents a viable option when selecting stents for EUS-guided drainage of the POPFC and PFC.

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.