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Background Biliary plastic stent (PS) mandates timely removal or replacement. The coronavirus disease 2019 (COVID-19) pandemic had affected the accessibility to medical therapy resulting in delay. We evaluated the burden of retained biliary PS, clinical profile, and impact of COVID-19 pandemic on stent retention. Material and Method Endoscopy database records between November 2019 and April 2022 were reviewed retrospectively to identify patients who had undergone stent exchange or removal > 3 months, that is, retained stents. Demography, comorbidity, indication and outcomes of index endoscopic retrograde cholangiopancreatography, size and duration of indwelling biliary PS, clinical presentation, imaging findings, cholangiography findings, stent-related complications, and stone formation and endotherapy details were noted. Results A total of 252 patients (100 [39.68%] males; median age 47 years [interquartile range [IQR] 32–56 years]) had common bile duct (CBD) stent retention. Median duration of retained CBD stent was 5 months (IQR = 4–6 months). Seventy (27.8%) were symptomatic with cholangitis (22, 8.7%), only jaundice (16, 6.3%), and only biliary abdominal pain (32, 12.7%). Sixty-one of 70 (87.1%) had abnormal imaging; 59/70 (84.3%) had new onset biliary stone or sludge (p ≤ 0.005). Stent retention > 6 months was significantly associated with stent fragmentation (0 vs. 20, p < 0.005) and choledocholithiasis (9 vs. 58, p < 0.005). Small caliber stent retention was more symptomatic (7 vs. 10 French [12/28 [42.85%] vs. 58/224 [25%], p = 0.049]). Univariate logistic regression analysis showed serum aspartate aminotransferase (AST), alkaline phosphatase levels, and CBD stent retention > 6 months were significantly associated with complications. On multivariate logistic regression analysis, serum AST > 2× upper limit normal (odds ratio [OR] = 5.487, 95% confidence interval [CI] = 3.1–9.9, p ≤ 0.005) and CBD stent retention > 6 months (OR = 8.6, CI = 3.1–23.92, p ≤ 0.005) were associated with complications. Out of 101 COVID-19 pandemic-attributed delay, 56/101 (55.44%) had symptomatic stent dysfunction. Endoscopic technical success rate was 97%, unsuccessful ones were due to large stones and impacted stents; with no mortality. Conclusion CBD PS stent retention, although mostly asymptomatic, can result in significant morbidity like jaundice, cholangitis, stent migration, fragmentation, or impaction in one-fourth of patients. Use of 7 Fr stent, retention duration > 6 months, abnormal imaging findings, and AST > twice the upper limit were significantly associated with complications. Endoscopic management was successful in 97% of patients. [ABSTRACT FROM AUTHOR]

Objective: There is paucity of data on lower gastrointestinal bleed (LGIB) in the pediatric population. We aimed to retrospectively review the endoscopy findings in patients younger than 18 years, presenting with lower gastrointestinal (GI) bleed and undergoing colonoscopy. Materials and Methods: Retrospective review of the endoscopy database at the department of gastroenterology at a tertiary care center from Western India was conducted between June 2017 until December 2021. Patients ≤18 years with LGIB, who underwent colonoscopy within 7 days of onset of bleed, were included in the study. Demographic details, endoscopic findings, and complications were noted. Results: In all, 55 patients were included in study (65% males; median age: 13 years [range: 1–18 years]). The most common endoscopic findings were polyps in 26 (47.2%) patients, colitis in 15 (27.2%) patients, solitary rectal ulcer syndrome (SRUS) in 6 (11.3%) patients, and hemorrhoids in 3 (5.4%) patients. Five (9%) patients had normal colonoscopy in whom the cause remained unidentified on further evaluation. However, no repeat episode was documented on a follow-up of 30 days. The most common location of a polyp was the rectum (64%). Two patients had multiple polyps (2 each). All the patients underwent a successful polypectomy. Pathology reported juvenile polyps in 25 biopsies. Four were diagnosed as inflammatory bowel disease (IBD), while 11 had acute infective colitis. Patients with infectious colitis as compared to IBD had higher incidence of fever (55 vs. 0%) and lesser incidence of previous similar events (22 vs. 66%). Those with polyps were younger than those without polyps (9.1 vs. 14.3 years; p = 0.000). Polyps were significantly more common in boys (84%; 22/26; p = 0.014) than in girls. No complications occurred in this cohort of patients. Conclusions: Polyps are the most common cause of LGIB in patients ≤18 years, followed by colitis. Polyps were more common in younger males. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal varices develop as a consequence of portal hypertension (PHT) in patients with chronic liver disease. Hence, screening of all cirrhotic patients with upper gastrointestinal endoscopy to detect the presence of significant esophageal varices implies a number of unnecessary endoscopies and has its limitation where such facilities are not available, especially in the rural part of country., Method: Patients with either sex, aged between 18 and 60 years with diagnosis of cirrhosis were studied. Detailed history, physical examination along with relevant investigations were recorded and upper gastrointestinal endoscopy was done within 2-3 days of investigation. Esophageal varices were graded as I-IV, using the Paquet grading system and patients were classified dichotomously either as having large esophageal varices (LEV) group A (Grade III-IV) and no varices group B (grade I-II)., Result: A total of 50 patients with cirrhosis of liver were recruited in the study. Among hematological markers, only low platelet count was significantly associated with the presence of LEV ( P value <0.05). None of the biochemical markers were found to be significantly associated with LEV. All the ultrasonographic parameters, i.e. spleen size, splenic vein size, portal vein size, and the presence of portosystemic collaterals were found to be significantly associated with the presence of LEV ( P value <0.05)., Conclusion: Though upper gastrointestinal endoscopy remains the gold standard for the diagnosis of esophageal varices in cirrhotic patients,those patients at high risk of having LEV can be screened by using clinical, hematological, biochemical, and radiological markers., Competing Interests: There are no conflicts of interest., (Copyright: © Journal of Family Medicine and Primary Care.)