Purpose: This study aimed to report the real-world outcomes of intravesical gemcitabine for bacillus Calmette–Guérin (BCG)–unresponsive, high-risk, non–muscle-invasive bladder cancer (HR-NMIBC) in Korean patients who were unable or unwilling to undergo radical cystectomy (RC). Materials and Methods: This retrospective study included 131 patients (median age, 69 years; 88.5% men) treated with intravesical gemcitabine for BCG-unresponsive HR-NMIBC at nine centers between May 2019 and April 2022. The primary endpoint was 1-year recurrence-free survival (RFS). The secondary endpoints included factors influencing RFS, progression-free survival (PFS), cystectomy- free survival, cancer-specific survival (CSS), overall survival (OS), and safety. Survival analysis was performed using the Kaplan-Meier method, and risk factors for recurrence were assessed using Cox regression models. Results: Patients were followed up for a median duration of 25 months, with carcinoma in situ (CIS) in 41.9% of the patients. The 1-year and 2-year RFS rates were 68% and 42%, while the 1-year and 2-year PFS rates were 87% and 77%, respectively. No significant factors influencing RFS were identified. Seventeen patients underwent RC during a median follow-up of 16 months, with the condition in three patients progressing to muscle-invasive disease on final pathological analysis. The 2-year CSS and OS rates were 98% and 97%, respectively. Intravesical gemcitabine was well-tolerated, with only seven patients (5.3%) unable to complete the full induction course. Conclusion Our research highlights the potential of intravesical gemcitabine as a viable bladder-sparing treatment option for BCG-unresponsive HR-NMIBC, providing real-world evidence on its safety, efficacy, and tolerability.

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.

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.

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.