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This article compares the effectiveness and safety of two treatment options, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) and enteral stenting (ES), for malignant gastric outlet obstruction (mGOO). The study found that EUS-GE had a lower rate of stent dysfunction and shorter hospitalization time compared to ES. Early clinical success was associated with the patient's performance status, and a tailored approach based on patient condition and prognosis is recommended for the endoscopic treatment of mGOO. The study was conducted at two Italian centers and included 198 patients. [Extracted from the article]

This article compares the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (FNA) and biopsy (FNB) in solid pancreatic lesions (SPLs) with a diameter of 15 mm or less. The study included 368 patients who underwent either FNA or FNB, with FNB outperforming FNA in terms of diagnostic accuracy and sample adequacy. The study also found that the use of FNA and a final diagnosis of benign conditions negatively impacted accuracy. The overall adverse event rate was low, and the feasibility of evaluating the Ki-67 index in pancreatic neuroendocrine tumors (Pan-NETs) was demonstrated. The study suggests that FNB may be superior to FNA in terms of performance, even with fewer passes performed. [Extracted from the article]

We describe the establishment of a seronegative occult hepatitis B virus (HBV) infection (OBI) in a successfully vaccinated infant who underwent liver transplantation from an donor positive for antibody to hepatitis B core antigen (anti-HBc). The use of highly sensitive droplet digital polymerase chain reaction assays revealed a not negligible and transcriptionally active intrahepatic HBV reservoir (circular covalently closed DNA, relaxed circular DNA, and pregenomic RNA: 5.6, 2.4, and 1.1 copies/1000 cells, respectively), capable to sustain ongoing viral production and initial liver damage. Next-generation sequencing revealed a peculiar enrichment of hepatitis B surface antigen vaccine-escape mutations that could have played a crucial role in OBI transmission. This clinical case highlights the pathobiological complexity and the diagnostic challenges underlying OBI. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the reliability and clinical utility of NS3 sequencing in hepatitis C virus (HCV) 1-infected patients who were candidates to start a PI-containing regimen.Methods: NS3 protease sequencing was performed by in-house-developed HCV-1 subtype-specific protocols. Phylogenetic analysis was used to test sequencing reliability and concordance with previous genotype/subtype assignment by commercial genotyping assays.Results: Five hundred and sixty-seven HCV plasma samples with quantifiable HCV-RNA from 326 HCV-infected patients were collected between 2011 and 2014. Overall, the success rate of NS3 sequencing was 88.9%. The success rate between the two subtype protocols (HCV-1a/HCV-1b) was similarly high for samples with HCV-RNA >3 log IU/mL (>92% success rate), while it was slightly lower for HCV-1a samples with HCV-RNA ≤3 log IU/mL compared with HCV-1b samples. Phylogenetic analysis confirmed the genotype/subtype given by commercial genotyping assays in 92.9% (303/326) of cases analysed. In the remaining 23 cases (7.1%), 1 was HCV-1g (previously defined as subtype 1a), 1 was HCV-4d (previously defined as genotype 1b) and 1 was HCV-1b (previously defined as genotype 2a/2c). In the other cases, NS3 sequencing precisely resolved the either previous undetermined/discordant subtype 1 or double genotype/subtype assignment by commercial genotyping assays. Resistance-associated variants (RAVs) to PI were detected in 31.0% of samples. This prevalence changed according to PI experience (17.1% in PI-naive patients versus 79.2% in boceprevir/telaprevir/simeprevir-failing patients). Among 96 patients with available virological outcome following boceprevir/telaprevir treatment, a trend of association between baseline NS3 RAVs and virological failure was observed (particularly for HCV-1a-infected patients: 3/21 failing patients versus 0/22 achieving sustained virological response; P = 0.11).Conclusions: HCV-NS3 sequencing provides reliable results and at the same time gives two clinically relevant pieces of information: a correct subtype/genotype assignment and the detection of variants that may interfere with the efficacy of PI. [ABSTRACT FROM AUTHOR]