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Introduction Endoscopic retrograde cholangiopancreatography (ERCP) plays an indispensable role in treating pancreato-biliary diseases but carries a risk of post-ERCP pancreatitis (PEP). Despite advances in the prevention strategies, prevention of PEP remains imperfect, necessitating more refined hydration methods. This study investigates the effectiveness of lactated Ringer’s solution versus plasma solution in preventing PEP.Method and analysis This multicentre, double-blind, randomised controlled trial, will be initiated by the investigator-sponsor, and conducted in three tertiary centres in South Korea. The aim of this study is to assess the effectiveness of hydration in preventing PEP in patients with naïve papillae. It will target patients with naïve papillae, focusing on those at medium to high risk of PEP. Patients aged ≤18 years and those with serious comorbidities, acute/chronic pancreatitis and various other medical conditions will be excluded. Eligible participants will be randomly assigned into two arms in equal numbers: (1) PEP prevention using lactated Ringer’s solution and (2) PEP prevention using plasma solution. The primary outcome of this study will be the occurrence of PEP, and secondary outcomes will be additional risk factors and potential adverse events related to ERCP. With a total enrolment of 844 patients, the study will be able to detect significant differences between the intervention arms.Ethics and dissemination Ethical approval is obtained from each institution (Asan Medical Centre, 2023-0382; Seoul National University Hospital, H-2302-05-1404; Samsung Medical Centre, SMC 2023-02-001-009). All participants provided informed consent following clear explanation of the study procedures. The results of the study will be disseminated in peer-reviewed journals and research conferences.Trial registration number NCT05832047.Protocol version Ver 4.1 (2023).

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

Abstract Background Nafamostat mesilate decreases the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, no studies have administered nafamostat mesilate after ERCP. So we investigated if the infusion of nafamostat mesilate after ERCP can affect the post-ERCP pancreatitis (PEP) in high-risk patients. Methods In a tertiary hospital, 350 high-risk patients of PEP were reviewed retrospectively. Among them, 201 patients received nafamostat mesilate after ERCP. Patient-related and procedure-related risk factors for PEP were collected. We performed a propensity score matching to adjust for the significant different baseline characteristics. The incidence and severity of PEP were evaluated according to the infusion of nafamostat mesilate. The risk factors of PEP were also analyzed by multivariate logistic regression. Results The baseline characteristics were not different after the matching. The PEP rate (17.4% vs. 10.3%, P = 0.141) was insignificant. Among the PEP patients, mild PEP was significantly higher in the nafamostat mesilate group (85.7% vs. 45.5%, P = 0.021). Only one patient in the nafamostat mesilate group developed severe PEP. Although young age (odds ratio [OR] 3.60, 95% CI 1.09–11.85, P = 0.035) was a risk factor, nafamostat mesilate (odds ratio [OR] 0.30, 95% CI 0.09–0.98, P = 0.047) was a protective factor for moderate to severe PEP. Conclusions The administration of nafamostat mesilate after ERCP in high-risk patients was not effective in preventing PEP, but may attenuate the severity of PEP.

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

Abstract Background FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the first-line chemotherapy for metastatic pancreatic cancer (mPC). However, the evidence is lacking comparing not only two regimens, but also sequential treatment (FFX–GnP vs. GnP–FFX). Methods Data of 528 patients (FFX, n = 371; GnP, n = 157) with mPC were collected retrospectively. Propensity score matching was conducted to alleviate imbalance of the two groups. Overall survival (OS), progression free survival (PFS), and toxicity of patients were analyzed. Results In the whole population, OS (12.5 months vs. 10.3 months, P = 0.05) and PFS (7.1 months vs. 5.8 months, P = 0.02) were longer in the FFX group before matching and after matching (OS: 11.8 months vs. 10.3 months, P = 0.02; PFS: 7.2 months vs. 5.8 months, P

Abstract Background There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. Methods A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. Results The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P

Abstract Background Several systemic inflammatory response (SIR) markers, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and albumin-to-globulin ratio (AGR), have emerged as prognostic markers in various cancers. The aim of this study was to explore the impact of SIR markers on the survival outcomes of unresectable intrahepatic cholangiocarcinoma (IHC) patients. Methods Patients with histologically confirmed, unresectable IHC treated with gemcitabine plus cisplatin (GP) chemotherapy in a single tertiary hospital from 2012 to 2016 were retrospectively reviewed. Progression-free survival (PFS) and overall survival (OS) were determined using unadjusted Kaplan-Meier and adjusted Cox-proportional-hazards analysis. Time-dependent receiver operating characteristic (ROC) analysis was performed to compare the performance of the SIR markers in predicting OS. Results A total of 137 patients received a median of six cycles (interquartile range [IQR], 3–11) of GP chemotherapy with a median observation time of 9.9 months (range, 1.8–54.7 months). The median PFS and OS of all patients were 7.8 months and 9.9 months, respectively. Among the SIR markers, high PLR (> 148) and high NLR (> 5) were associated with a short PFS (Hazard ratio [HR] 1.828, P = 0.006; HR 1.738, P = 0.030, respectively) and short OS (HR 2.332, P

Background: The aim of this study was to evaluate the efficacy and safety of gemcitabine plus nab-paclitaxel (GnP) as second-line chemotherapy following first-line FOLFIRINOX treatment failure in advanced pancreatic cancer. Methods: This was a multicenter, single-arm, open-label, phase 2 trial done at three tertiary centers in South Korea from May 2018 to December 2019. Eligible patients were aged 20 years or older, had histologically confirmed advanced pancreatic ductal adenocarcinoma, and disease progression after receiving first-line FOLFIRINOX. Patients received a second-line GnP regimen as intravenous nab-paclitaxel at a dose of 125 mg/m 2 and gemcitabine at a dose of 1000 mg/m 2 , on days 1, 8, and 15 every 4 weeks until disease progression or unacceptable toxicity. The primary outcome was survival rate at 6 months and the secondary outcomes were median progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events. This study is registered with Clinicaltrials.gov. (NCT03401827) Results: Forty patients were enrolled in the study. The survival rate at 6 months was 72.5% [95% confidence interval (CI), 59.9–87.7], achieving superiority over prespecified assumed 6-month OS rate of 20% for best supportive care only ( p

Abstract Background Although several studies have suggested that aspirin and statins may help prevent pancreatic ductal adenocarcinoma (PDAC), this concept has been controversial. This study aimed to evaluate the association between use of statin or aspirin and PDAC in a nationwide large cohort. Methods In this nested case‐control study, we used data from a 12‐year nationwide longitudinal cohort in Korea. Cases with PDAC and controls who were matched to cases by age, sex, income, and index year at a 1:5 ratio were established. We used multivariate logistic regression analyses to identify the independent risk factors of PDAC. Results We identified a total of 827 patients with PDAC between 2007 and 2013, and included 4135 matched controls. Diabetes mellitus, chronic and acute pancreatitis, pancreatic cystic lesions, and cholelithiasis were independent risk factors for PDAC. Statin use (odds ratio [OR], 0.92; 95% confidence interval [CI] 0.76‐1.11; P = .344; adjusted OR [aOR], 0.70; 95% CI 0.56‐0.87; P = .001) was associated with a reduced risk of PDAC after correction of the confounding factors, but aspirin use (OR, 0.98; 95% CI 0.84‐1.15; P = .838; aOR 0.84; 95% CI 0.70‐1.01, P = .068) was not associated with PDAC. Among the patients with risk factors, both statin use (OR, 0.50; 95% CI 0.38‐0.66; P

Background/Aims Recurrent pyogenic cholangitis (RPC) is a chronic progressive disease frequently accompanied by cholangiocarcinoma (CCA). This study aimed to investigate the natural course of RPC and identify factors associated with CCA. Methods : From January 2005 to December 2016, 310 patients diagnosed with RPC at Seoul National University Hospital were included. Complications and management during follow-up were recorded. CCA-free probability was estimated by Kaplan-Meier method, and risk factors associated with CCA were analyzed using log-rank test and Cox’s proportional hazard regression model. Results : Mean age at diagnosis was 59.1±10.9 years and mean follow-up duration was 84.0±64.1 months. An intrahepatic duct stone was found in 253 patients (81.6%). Liver atrophy was identified in 185 patients (59.7%) and most commonly located at the left lobe (65.4%). Acute cholangitis, liver abscesses, cirrhotic complications, and CCA developed in 41.3%, 19.4%, 9.7%, and 7.4%, respectively. During follow-up, complete resolution rate after hepatectomy, biliary bypass surgery, and choledocholithotomy with T-tube insertion reached 82.3%, 55.2%, and 42.1%, respectively. None of the patients who maintained complete resolution by the last follow-up day developed CCA. In univariate analysis, female, both-sided intrahepatic duct stones, and liver atrophy at any location were associated with increased risk of CCA. Multivariate analysis revealed that both-sided atrophy significantly increased risk of CCA (hazard ratio, 4.56; 95% confidence interval, 1.48 to 14.09; p=0.008). In 21 patients who developed intrahepatic CCA, tumor was located mostly in the atrophied lobe (p=0.023). Conclusion : s In RPC patients, acute cholangitis, liver abscess, cirrhotic complications, and CCA frequently developed. Both-sided liver atrophy was a significant risk factor for developing CCA.

Abstract Background Gallbladder cancer (GBC) is likely to be diagnosed at progressive stages and shows a very poor prognosis. Combination therapy with gemcitabine and cisplatin (GEMCIS) has been widely used as first-line palliative chemotherapy for advanced GBC. This study was designed to investigate the efficacy of GEMCIS and identify prognostic factors in patients with unresectable GBC. Methods Patients with GBC who were treated with GEMCIS from January 2008 to June 2017 in a single tertiary hospital were included. All cases of GBC were diagnosed by pathologic findings and extent of the tumour was assessed by imaging tests. Combination chemotherapy consisted of cisplatin 25 mg/m2 and gemcitabine 1000 mg/m2 intravenously on days 1 and 8 every 3 weeks. To determine factors affecting prognosis, Kaplan–Meier survival analysis, log-rank test and the Cox proportional hazard regression linear model were used. All variables with P

(1) Background: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an alternative treatment for pancreatic tumors. Currently, EUS-RFA has been trialled to treat hepatic tumors. However, little has been reported about optimal settings for EUS-RFA in patients with hepatic tumors. We evaluated the ablation effect after in vivo RFA using a new EUS-RFA electrode in a pig model. (2) Methods Four pigs were used for the in vivo test. The in vivo testing was divided into two tests based on the length of the RFA electrode (0.5, 0.7, 1 or 1.5 cm), the ablation power (30 W or 50 W), and the ablation time (10 or 15 s). In test one, ablation effect was evaluated based on the electrode length and power. In test two, ablation effect was assessed based on power and time. (3) Results: In test one, the ablation width and depth correlated with the length of the electrode and power (0.5 cm, 10 W, 10 s: width 0.46 cm, depth 0.65 cm vs. 1.5 cm, 75 W, 10 s: width 0.77 cm, depth 1.80 cm). In test two, ablation width and depth were similar when RFA was set at 1.5cm, 50 W, and 10 s or 1 cm, 30 W, and 15 s (0.65 cm, 1.14 cm vs. 0.65cm, 1.26 cm). (4) Conclusions: The relationship between electrode length, ablation power, and ablation time, and the resulting ablation effect in pig livers suggest that EUS-RFA produces effective ablation while minimizing thermal injury.

Background/Aims The combination of nab-paclitaxel and gemcitabine (nab-P/Gem) is widely used for treating meta-static pancreatic cancer (MPC). We aimed to evaluate the therapeutic outcomes and prognostic role of treatment-related peripheral neuropathy in patients with MPC treated with nab-P/Gem in clinical practice. Methods : MPC patients treated with nab-P/Gem as the first-line chemotherapy were included. All 88 Korean patients underwent at least two cycles of nab-P/Gem combination chemotherapy (125 and 1,000 mg/m2, respectively). Treatment-related adverse events were monitored through periodic follow-ups. Overall survival and progression-free survival were estimated by the Kaplan Meier method, and the Cox proportional hazards regression linear model was applied to assess prognostic factors. To evaluate the prognostic value of treatment-related peripheral neuropathy, the landmark point analysis was used. Results : Patients underwent a mean of 6.7±4.2 cycles during 6.3±4.4 months. The median overall survival and progression-free survival rates were 14.2 months (95% confidence interval [CI], 11.8 to 20.3 months) and 8.4 months (95% CI, 7.1 to 13.2 months), respectively. The disease control rate was 84.1%; a partial response and stable disease were achieved in 30 (34.1%) and 44 (50.0%) patients, respectively. Treatment-related peripheral neuropathy developed in 52 patients (59.1%), and 13 (14.8%) and 16 (18.2%) patients experienced grades 2 and 3 neuropathy, respectively. In the landmark model, at 6 months, treatment-related peripheral neuropathy did not have a significant correlation with survival (p=0.089). Conclusion : s Nab-P/Gem is a reasonable choice for treating MPC, as it shows a considerable disease control rate while the treatment-related peripheral neuropathy was tolerable. The prognostic role of treatment-related neuropathy was limited.

BackgroundThe use of biologics in inflammatory bowel disease (IBD) has increased recently. However, studies on whether the proportion of IBD patient visits to the emergency department (ED) has decreased are scarce. We investigated the trends in IBD-related ED visits and hospitalization rates.MethodsMedical records of IBD-related visits to the ambulatory department (AD) and the ED of the Seoul National University Bundang Hospital in 2007, 2009, 2012, and 2014 were reviewed. Multiple-variable logistic regression analysis was used to identify significant risk factors for hospitalization.ResultsThe proportion of IBD patients who visited ED was 12.3% in 2007, 9.7% in 2009, 8.3% in 2012, and 6.4% in 2014 (P = 0.002). The most common chief complaints were abdominal pain (66.9%) in Crohn's disease (CD) patients and hematochezia (36.5%) in ulcerative colitis (UC) patients. The hospitalization rate following ED visits was 47.2% in CD patients and 55.6% in UC patients (P = 0.100). Multiple-variable analysis showed that significant risk factors associated with hospitalization in CD were aggressive disease behavior (odds ratio[OR] 3.54, P = 0.017) and presence of steroid exposure (OR 2.35, P = 0.047). Elevated C-reactive protein (CRP) (>0.5 mg/dL) (OR 5.40, P = 0.016) was the only risk factor associated with hospitalization in UC.ConclusionsThe proportion of ED visits decreased from 2007 to 2014; there was no significant change in hospitalization rates. Disease behavior/presence of steroid exposure and elevated CRP were associated with hospitalization among CD and UC patients who visited the ED, respectively.

[This corrects the article DOI: 10.1371/journal.pone.0210703.].

Background/Aims Various techniques have been introduced to the maximize the performance of endoscopic ultrasound-guided biopsy (EUS-FNB). Blood contamination is a one of the factors that may decrease the specimen quality. The aim of this study was to compare the diagnostic accuracy between slow-pull (SP) and heparin filling (HF) methods in EUS-FNB for pancreatic masses. Methods This retrospective study was conducted at a tertiary referral center in Korea. A total of three needle passes were performed in all patients. The SP method was used for the first pass, and the HF method was used for the second and third passes. The primary outcome was the diagnostic accuracy in differentiating malignancy from benign lesions. Secondary outcome measures included sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Results A total of 250 consecutive patients with pancreatic masses were analyzed. The most common diagnosis was pancreatic adenocarcinoma (n=203, 81.2 %). The diagnostic accuracy of the SP method, first and second HF method was 91.6 %, 94.4 % and 96.0 %, respectively. The sensitivity of the SP method, first and second HF method was 90.7 %, 93.8 % and 95.6 %, respectively. The second and third pass using the HF method had superior diagnostic accuracy and sensitivity compared with the SP method (p=.049 and .004, respectively). There were no significant differences in the specificity, NPV, and PPV between the methods. Conclusion The HF method demonstrated higher diagnostic accuracy and sensitivity compared to the SP method in EUS-FNB for pancreatic masses. It is advisable to consider adopting HF method to maximize the diagnostic yield in EUS-FNB. [ABSTRACT FROM AUTHOR]

Background/Aims EUS-guided antegrade intervention (EUS-AI) has emerged as a therapeutic option for benign bilioenteric anastomotic stricture (BAS). However, it has not been standardized yet and data on long-term outcomes are limited. This study aimed to assess the long-term outcomes of a two-staged EUS-AI with transmural/transanastomotic stenting (TAS) in patients with BAS. Methods Consecutive patients with BAS undergoing a two-stage EUS-AI after failed deep enteroscopy between January 2016 and June 2023 were retrospectively analyzed. In the first session, EUS-guided hepaticogastrostomy (HGS) with a transmural covered metal stent was performed to create the fistula. Four weeks later, the second session involved stent removal and antegrade intervention (balloon dilation, stone removal, and TAS) through HGS tract based on the protocol (Figure1). TAS was performed using one or two double 7Fr pigtail plastic stents, with the intent of long-term indwelling for refractory or recurrent BAS or on-demand reintervention. The primary outcome was the time to reintervention (TR) after TAS. Secondary outcomes were technical success of antegrade intervention, endoscopic reintervention rate (IR), and stricture recurrence rate after TAS removal. Results Thirty-eight patients underwent two-stage EUS-AI, with a median follow-up of 36.5 months (range 6.2 – 101). Antegrade intervention was successful in 34 patients (89.5%), of whom 28 (73.7%) proceeded to TAS. The median TR after TAS was 691 days (95% CI, 564 – NA). The IR was 49.9% (12/28, 8 in scheduled intervention and 4 in unscheduled intervention). Endoscopic reintervention was successful in 83.3% of cases, while percutaneous intervention was required in 16.7%. TAS removal was performed in 12 patients (42.9%) after a median stent maintenance time of 647 days, with no stricture recurrence requiring endoscopic reinterventions during a median follow-up period of 422 days. Conclusion Two-stage EUS-AI with TAS for patients with BAS showed promising long-term clinical outcomes in terms of stricture recurrence [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic radiofrequency ablation (RFA) combined with stent placement has emerged as a potential treatment strategy for patients with unresectable biliary cancer. However, the comparative efficacy of metal versus plastic stents, with or without RFA, is not well established. This study aimed to evaluate overall survival (OS) among four treatment groups: metal stent alone, metal stent with RFA, plastic stent alone, and plastic stent with RFA. Methods A retrospective cohort study was conducted on patients with unresectable biliary cancer who underwent stent placement. Kaplan-Meier survival curves were generated to compare survival across the four treatment groups, and median survival times were reported. Statistical significance between groups was assessed using the log-rank test. Results A total of 211 patients were included in the analysis, with 34 patients excluded due to prior stent insertion, short follow-up periods, or surgical interventions. The remaining patients were divided into four groups: metal stent (N=77), metal stent + RFA (N=32), plastic stent (N=35), and plastic stent + RFA (N=33). Median survival times were as follows: metal stent alone, 208 days; metal stent with RFA, 317 days; plastic stent alone, 245.5 days; and plastic stent with RFA, 294 days. Patients receiving metal stents with RFA exhibited the longest median survival among the groups. The log-rank test demonstrated statistically significant differences in survival across the groups (p<0.0001). Conclusion RFA combined with metal stent placement is associated with significantly prolonged survival in patients with unresectable biliary cancer. These findings suggest the potential benefit of RFA with metal stents and warrant further prospective randomized studies to confirm these results and refine treatment strategies. [ABSTRACT FROM AUTHOR]

Background/Aims The prevalence and natural history of SPINK1, PRSS1, and CFTR mutations in idiopathic pancreatitis (ICP) are not well-documented. This study evaluates the prevalence, genetic and clinical characteristics, and long-term outcomes of gene-associated chronic pancreatitis (GCP) compared to alcoholic chronic pancreatitis (ACP). Methods From January 1997 to July 2023, a cohort of 711 ICP patients underwent DNA testing for SPINK1, PRSS1, and CFTR mutations. A propensity score-matched analysis was conducted to compare GCP to ACP patients at a 1:3 ratio. Results Gene mutations were identified in 23.2% of idiopathic pancreatitis patients, with SPINK1 being the most common mutation (70%). GCP patients experienced significantly more pancreatic pain (89.3% vs. 70.7%) and had a shorter median time to symptom onset (26.2 years vs. 42.6 years) compared to ACP patients. Pancreatic cancer was observed in 3.6% of GCP patients, with a cumulative risk reaching 16.7% by age 70, while the incidence was lower in ACP patients. Although GCP patients exhibited higher cumulative risks, the hazard ratio for gene mutation status was not statistically significant (HR: 1.53). However, a Cambridge classification grade ＞3 was a significant predictor of pancreatic cancer outcomes (HR: 4.58, p=0.034). Conclusion GCP patients exhibit distinct clinical characteristics and outcomes compared to ACP patients, necessitating individualized evaluation and management strategies. Given the significant cumulative risk of pancreatic cancer in GCP, early and regular surveillance is recommended, particularly for those with higher Cambridge classification grades. [ABSTRACT FROM AUTHOR]

Background/Aims Type 3 autoimmune pancreatitis (AIP), or immune checkpoint inhibitor- induced pancreatic injury (ICI-PI), varies from asymptomatic hyperlipidemia to acute pancreatitis (AP). The role of ICIs in causing type 3 AIP remains unclear. This study aimed to assess the incidence and clinical features of type 3 AIP in cancer patients receiving ICIs. Methods A retrospective analysis was conducted on 8,836 cancer patients treated with ICIs between 2011 and 2023 at a tertiary referral center in Korea. After excluding cases with clear alternative causes of pancreatitis and follow-up periods shorter than 2 weeks, 8,132 patients were analyzed. The primary outcome was the incidence of type 3 AIP. Results Type 3 AIP was observed in 309 patients (3.8%), with 158 cases of ICI-AP (1.9%). Liver cell carcinoma showed the highest type 3 AIP incidence (7.55%). Atezolizumab (5.15%) and nivolumab (4.73%) had the highest rates. Among type 3 AIP patients, 116 (37.5%) continued ICI therapy with spontaneous lipase improvement, while 18 (5.8%) discontinued due to persistent lipase elevation. Steroid was administered to 55 patients, with 25 (45.5%) resuming ICI therapy after lipase improvement. Conclusion Though uncommon, type 3 AIP carries a significant risk for cancer patients on ICIs, particularly those with liver cell carcinoma or treated with atezolizumab and nivolumab. Steroid therapy may help manage elevated lipase levels, allowing continuation of ICI therapy in select cases. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic ultrasonography (EUS)-guided transmural drainage has been accepted as a modality of choice in peripancreatic fluid collection and acute cholecystitis. Each type of stent, including double-pigtail plastic stents, tubular self-expandable metal stents (SEMS), and lumen-apposing metal stents, for these procedure has its own advantages and disadvantages. To overcome their disadvantages, this animal study evaluated the feasibility of a newly designed twisted fully covered SEMS with spiral coiled ends. Methods We performed the EUS-guided cholecystogastrostomy with a newly developed metal stent in eight mini pigs with surgically induced gallbladder distension. This novel stent is a twisted fully covered SEMS with spiral coiled ends, a diameter of 8 mm, and a length of 6 cm. The stent has been maintained for 4 to 7 weeks after EUS-guided cholecystogastrostomy. The primary outcome was the technical success rate, and the secondary outcomes were adverse events, stent dysfunction, stent removability, and fistula formation. Results The stent was placed successfully between the gallbladder and the stomach in all cases without any adverse event. We observed neither stent migration nor dysfunction during the study period, and all the stents were removed easily as scheduled. We confirmed successful cholecystogastric fistula formation at endoscopic and histologic level in all cases. Conclusions EUS-guided transmural drainage and fistula formation using a new twisted fully covered metal stent with spiral coiled ends was technically feasible without any adverse event in this animal study. Further clinical studies are needed to evaluate its efficacy and safety in real practice. [ABSTRACT FROM AUTHOR]