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Chronic pancreatitis (CP) is a progressive inflammatory disease with several complications. Endoscopic methods make essential contributions to diagnosis and treatment. Endoscopic ultrasound is considered the most sensitive method for diagnosing early CP. Symptoms related to CP, failure of medical therapy, pancreatic changes in imaging (obstructive stones, strictures, and main pancreatic duct [MPD] dilatation), and complications (strictures, pseudocyst, and disruption of MPD) require interventional endoscopic methods. Pancreatic duct stenting could be beneficial when the patient has a dominant stricture in the pancreatic head or a refractory MPD stricture. Before stenting, underlying malignancy should be ruled out by brush cytology. In refractory cases, multiple plastic stents or fully covered self-expanding stents are necessary. Extracorporeal shock wave lithotripsy can also be performed with or without endoscopic retrograde cholangiography for stones in the pancreatic duct. In this case, the stone characteristics, stricture, and exocrine function determine the procedure. Endoscopic ultrasound-guided transmural or transpapillary drainage may be performed for pseudocyst-related CP, which has a success rate similar to surgery. Endosonography-guided celiac plexus block can also be used to treat CP.

Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is a rare, aggressive tumor. In the absence of metastasis in diagnosis, close observation and long-term follow-up is needed to monitor and slow its progress. We report a young patient who presented with nonbiliary pancreatitis. Upon finding Virchow’s nodule, we conducted tests and observed multiple lymph nodes and liver and pancreatic metastasis. We subsequently made a diagnosis of AFPGC. This study describes the different presentations of this rare but aggressive subtype of gastric cancer with a review of the literature.

Parvovirus B19 infection is usually self-limiting in immunocompetent individuals. Twenty-five percent of infected individuals are completely asymptomatic during infection, with 50% of them presenting flu-like symptoms and the remaining patients presenting erythema infectiosum, arthralgia, or arthritis. More rarely, transient aplastic crisis is seen in individuals with chronic haemolytic disorders. Chronic pure red cell aplasia and aplastic anaemia may also be observed in immunocompromised patients. There is sufficient evidence in the literature suggesting that B19 infections can also cause a spectrum of liver diseases, ranging from elevated transaminase levels to acute hepatitis, fulminant liver failure, and even chronic hepatitis. This case report discusses a patient with acute parvovirus infection and newly diagnosed autoimmune hepatitis (AIH) and the role of this viral infection in the disease.

Intestinal tuberculosis is an uncommon form of tuberculosis, and its diagnosis remains a challenge in patients with Crohn's disease. The clinical, endoscopic, radiologic, and histologic features of Crohn's disease and tuberculosis are remarkably similar, posing a diagnostic challenge. Accurate diagnosis of these two conditions remains vital to the decision on the treatment of the patients. Computerized tomography, endoscopic ultrasound (EUS), capsule endoscopy, balloon enteroscopy, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and laparoscopy can be beneficial in the diagnosis of intestinal tuberculosis. Herein, we report a case where tuberculosis could not be documented, although the patient displayed lymphocytosis in ascites and weight loss. Laparoscopy was diagnostic and the patient benefited from the correct treatment.

Celal Ulasoglu,1 Zeynep Nilufer Tekin,2 Kubra Akan,1 Arda Yavuz1 1Department of Gastroenterology, Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey; 2Department of Radiology, Medeniyet University, Goztepe Education and Research Hospital, Istanbul, TurkeyCorrespondence: Celal UlasogluDepartment of Gastroenterology, Medeniyet University, Goztepe Education and Research Hospital, Istanbul, TurkeyTel +90 216 5666600Fax +90 216 6065210Email ulasoglu@gmail.comPurpose: To identify the correlation of nonalcoholic pancreatic steatosis (NAPS) with nonalcoholic fatty liver disease (NAFLD) in an outpatient group. Based on its metabolic and imaging properties, NAPS has been increasingly recognized in recent years; however, its interaction with NAFLD is still not clear.Patients and Methods: In this cross-sectional observational study, 345 consecutive patients without any chronic illness who were referred to the senior radiologist for abdominal ultrasound (US) were included. The US report showed hepatic and pancreatic echogenicity. The patients’ demographic, anthropometric, and laboratory data were collected from medical records.Results: Overall, NAPS and NAFLD were seen in 227 (65.8%) and 219 (63.5%) patients, respectively. Normal echogenicity was noted in 74 (21.4%) patients. Forty-four patients (12.8%) had steatotic liver without NAPS, 52 (15.1%) had steatotic pancreas without NAFLD, and 175 (50.7%) had steatosis in both organs. The discordance in steatosis grading between NAPS and NAFLD was 55.1%. Insulin resistance was present in 8.7, 26.7, 19, and 61.3% of patients with no steatosis, only NAFLD, only NAPS, and steatosis in both organs, respectively. Evident NAFLD and NAPS having grade 2 and 3 steatosis were present in 15.3% and 29.0% of the study group, respectively. Cholecystolithiasis was present in 6.8, 13.6, and 28.8% of patients with normal echogenic pancreas, only NAFLD, and only NAPS, respectively (p=0.01).Conclusion: Based on the ultrasonographic, clinical, demographic, and anthropometric features of the included patients, we found that NAPS did not fully accompany nonalcoholic fatty liver. Despite severe pancreatic steatosis, more than a quarter of cases had normal liver echogenicity. Insulin resistance frequency was insignificantly higher in NAFLD than NAPS (p=0.694). The significantly higher frequency of cholecystolithiasis in NAPS needs further large-scale studies. The inconsistency of steatosis degree in NAPS and NAFLD in > 50% cases may reflect differences in the pathophysiology of these two clinical entities.Keywords: nonalcoholic pancreatic steatosis, nonalcoholic fatty liver disease, insulin resistance, ultrasound

Surgeries for obesity can lead to complications. Dumping syndrome is one such complication caused by the quick passage of hyperosmolar chyme from the stomach to the duodenum. Mild cases can be cured with dietary modification and medical treatment. However, refractory cases may need invasive treatment options, such as transoral outlet reduction or surgery. We successfully treated a 48-year-old female with dumping syndrome, using a combination of argon plasma coagulation and hemoclips to narrow the pyloric lumen. We suggest that this new technique could be a cheap and easily accessible alternative to surgery, especially in countries where the specialised devices needed to treat such cases are unavailable.

Hepatosteatosis, a common condition, is increasing in prevalence. It is typically associated with diet, alcohol consumption and obesity. In some cases, a rare genetic disease may be the underlying defect. Lipid storage myopathy (LSM) is a genetic disease caused by lipid metabolism defects. LSM often affects the muscles, heart and liver. Coenzyme Q, riboflavin or carnitine replacement can be beneficial in some cases. We describe a patient who presented with liver failure and was unresponsive to treatment. LEARNING POINTS Hepatosteatosis can be associated with genetic disease and not just diet. Lipid storage disease should be considered in patients presenting with liver disease with hypoglycaemia, muscle weakness and a family history. Lipid storage disease is a rare heterogeneous genetic condition that has no specific treatment and requires further research.

Human immunodeficiency virus (HIV) is a worldwide disease with an increasing number of cases globally. Initially, HIV cholangiopathy was often observed among such patients but has become rare after three decades because of the availability of new treatment options and potent antiretroviral drugs. Consequently, its occurrence now suggests drug resistance or disease progression. The relationship between cholangiocarcinoma and HIV remains unclear. We report the case of a patient with high-grade dysplasia of the ductus choledochus and uncontrolled disease which was treated with potent antiviral agents and bile duct dilatation. LEARNING POINTS HIV cholangiopathy should be kept in mind in an HIV-positive patient even if they are receiving combination antiretroviral therapy (cART); endoscopic retrograde cholangiopancreatography can provide symptomatic relief. Once HIV cholangiopathy is detected, close follow-up for cholangiocarcinoma is required. Opportunistic infections can cause cholangiocarcinoma in HIV-positive patients.