The ASIDE Gastroenterology Journal, a specialized publication of the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE), is a peer-reviewed, open-access journal dedicated to advancing gastroenterology through scholarship that promotes diversity, equity, inclusion, and accessibility. The journal provides an international platform for clinicians, researchers, educators, and public health professionals to publish work that improves gastrointestinal and hepatobiliary health outcomes across diverse and historically underrepresented populations. Aims & Scope ASIDE Gastroenterology publishes high-quality research and evidence-based scholarship across the full spectrum of gastroenterology and hepatology, with a specific focus on health equity, disparities, and inclusive care. Publication Frequency: Quarterly (4 issues per year) ASIDE Gastroenterology ISSN (Print) 3066-4004 ISSN (Online) 3066-4012
American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE)
Copyright and Licensing All articles published in ASIDE Gastroenterology are open access and are made freely available online immediately upon publication, without embargo. Creative Commons License This journal applies the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license, anyone may copy, redistribute, remix, transform, and build upon the material for any purpose (including commercial use), provided that appropriate credit is given to the original author(s), a link to the license is provided, and any changes are indicated. Machine-readable license metadata is embedded in each article and its DOI record. Copyright Holder Copyright in all articles remains with the author(s). By submitting a manuscript, authors grant the publisher (American Society for Inclusion, Diversity, and Equity in Healthcare – ASIDE) a non-exclusive license to publish, distribute, and archive the work under CC BY 4.0. Third-party Material Any material (e.g., images, figures, or tables) that is not covered by CC BY 4.0 will be clearly indicated within the article. Users must obtain permission directly from the relevant copyright holder for reuse of such third-party material. Author Rights and Self-Archiving Authors may deposit all versions of their work (preprint, author’s accepted manuscript, and the version of record) in institutional or subject repositories of their choice immediately upon publication, without embargo, provided that the DOI and license information (CC BY 4.0) are included.
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surpassed viral hepatitis as the primary driver of chronic liver disease globally. While traditionally viewed through the lens of hepatic progression, its clinical trajectory is increasingly defined by extrahepatic complications. Objective: This narrative review evaluates MASLD as a manifestation of systemic metabolic failure, specifically analyzing its role in accelerating cardiovascular dysfunction and extrahepatic carcinogenesis—the two principal causes of mortality in this population. Methods: A comprehensive literature synthesis was conducted from 2020 to December 2025, using databases including PubMed, Scopus, and the Egyptian Knowledge Bank (EKB) to identify high-impact studies and international guidelines. Results: The pathophysiology involves a metabolic cascade whereby hepatic lipid accumulation and insulin resistance trigger systemic inflammatory signaling. Disrupted lipid handling and genetic determinants promote pro-atherogenic and pro-oncogenic environments. The review advocates a transition to risk-stratified approaches using noninvasive biomarkers, such as the FIB-4 index. Conclusion: Addressing the bidirectional relationship between hepatic steatosis and systemic comorbidities requires a multidisciplinary therapeutic strategy. This framework provides a basis for early intervention to reduce the burden of cardiovascular events and malignancy among patients with MASLD.
Copyright (c) 2026 Menatalla M. A. Mohamed, Maha M. M. I. Taha, Mohnd M. M. R. Ibrahim https://creativecommons.org/licenses/by/4.0
Fish-Bone Migration to the Liver Causing Hepatic Abscess: A Scoping Review of Published Cases (2015–2025)
Background: Foreign body ingestion is common; however, migration of an ingested fish bone into the liver with subsequent abscess formation is rare, frequently presents with nonspecific abdominal symptoms, and poses a diagnostic challenge in routine clinical practice, often leading to delayed diagnosis. Methods: A scoping review of PubMed, Google Scholar, SciELO, and ScienceDirect identified human case reports and case series (2015–2025) describing confirmed intrahepatic fish-bone migration or penetration causing hepatic abscess. Reports without radiologic or intraoperative confirmation and those involving non–fish-bone foreign bodies were excluded. Extracted data included demographics, migration routes, imaging findings, management, and outcomes. Results: Twenty-seven publications reporting 29 patients met the inclusion criteria, including 25 individual case reports and 2 case series. Presumed transgastric migration was reported in 22 patients (75.9%), and the left hepatic lobe was involved in 20 cases (69.0%). Computed tomography identified a linear radiodense foreign body in 24 patients (82.8%). Surgical or minimally invasive foreign-body removal was performed in 21 patients (72.4%), with generally favorable outcomes, although follow-up reporting was variable. Conclusion: Intrahepatic fish-bone migration is a rare but clinically important cause of hepatic abscess and should be considered in patients with unexplained, particularly left-lobe, hepatic abscesses when CT demonstrates a linear foreign body or when response to standard therapy is atypical; timely source control is usually effective.
Copyright (c) 2026 Zaid Alezzi, Tarek Aboubakr, Ashraf Yahia Hegab, ‪Abdulkarim Hasan‬‏ https://creativecommons.org/licenses/by/4.0
ERCP Timing in Gallstone Disease: A Meta-Analysis of One-Stage versus Two-Stage Strategies
Background: Cholecystocholedocholithiasis involves gallbladder and bile duct stones. Standard two-stage care involves ERCP followed by cholecystectomy, whereas single-stage intraoperative ERCP may streamline treatment. We performed a meta-analysis comparing stone clearance, complications, and hospital stay between single-stage and two-stage strategies. Method: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2025 for clinical studies comparing one-stage laparo-endoscopic rendezvous with two-stage ERCP + LC. RCTs and observational studies reporting stone clearance, complications, conversion, bile leaks, hospital stay, repeat ERCP, or cannulation failure were included. Data extraction and ROB2/NOS assessments were done independently. Result: Twenty-four studies met the inclusion criteria. The one-stage approach demonstrated significantly higher CBD clearance (96.5% vs. 91.8%; RR = 1.03) and a notably lower overall complication rate (11.55% vs. 19.56%; RR = 0.51). Postoperative pancreatitis (RR = 0.50), cholangitis (RR = 0.33), and bleeding (RR = 0.47) were also significantly reduced. Although conversion to open surgery and bile leak rates were lower in the one-stage group, these differences were not statistically significant. Importantly, single-stage management resulted in shorter hospital stays (mean difference = −3.23 days), fewer postoperative repeat ERCPs (RR = 0.21), and markedly reduced cannulation failure (RR = 0.26). Conclusion: The one-stage approach for managing bile duct stones offers higher clearance rates, fewer complications, and shorter hospital stays compared to the two-stage approach. These results support adopting one-stage treatment as a more effective and efficient clinical strategy.
Endoscopic retrograde cholangiopancreatography (ERCP)
Copyright (c) 2025 Mohamed Gamal, Mohamed Wagdy, Mahmoud Abd El-Nasser, Abdalla Ahmed Mohamed, Abdelrhman Waleed Kotb, Abdulrahman Ziada, Abdelrahman Abdalla Mohamed https://creativecommons.org/licenses/by/4.0
Endoscopic Sphincterotomy Increases the Risk of Pyogenic Liver Abscess: A Retrospective Study Using Real-World Data
Introduction: Pyogenic liver abscess (PLA) after Endoscopic Retrograde Cholangiopancreatography (ERCP) is a rare infectious adverse event. The association between post-ERCP PLA and endoscopic sphincterotomy has not been extensively studied. Methods: We conducted a retrospective study using the TriNetX platform by including patients without history of PLA who received ERCP between October 2015 and December 2020. Two groups were made: the endoscopic sphincterotomy (ES) group (patients who received ES during ERCP) and the control group (patients who did not receive ES). The primary outcome was the risk of developing PLA within 1 year of the index ERCP. The secondary outcomes included sepsis, broad-spectrum antibiotics use, need for PLA drainage, and post-ERCP mortality within one year of the index ERCP. Results: There were 169 patients (1.43%) in the ES group who developed PLA compared to 123 patients (1.04%) in the control group, Relative Risk (RR): 1.37, P-value = 0.007. A total of 241 patients (2.05%) in the ES group developed sepsis compared to 176 patients (1.49%) in the control group, RR: 1.37, P-value = 0.001. A total of 2,954 patients (25.1%) in the ES group received treatment with broad-spectrum antibiotics compared to 2,132 patients (18.1%) in the control group, RR: 1.5, P-value < 0.0001. There was no statistically significant difference in the need for PLA drainage (RR: 1.19, P-value = 0.34) or mortality (RR: 0.969, P-value = 0.49). Conclusion: ES during ERCP was associated with an increased risk for PLA, sepsis, and broad-spectrum antibiotics use. No mortality difference was found.
Copyright (c) 2025 Abdellatif Ismail, Bisher Sawaf, Pinghsin Hsieh, Khalid Aloum, Shahem Abbarh, Mhd Kutaiba Albuni, Mohammed Al-Aquily, Mostafa Suhail Najim, Amir Humza Sohail, Saurabh Chandan https://creativecommons.org/licenses/by/4.0
Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis
Background: Sodium hyaluronate, commonly used in ESD, has drawbacks such as high cost and potential tumorigenesis. Sodium alginate (Na alginate) and Mesna offer promising alternative solutions with their viscoelastic and mucolytic properties. In this review we aimed to evaluate the safety and efficacy of Na alginate and Mesna solutions in ESD. Methods: A systematic search was conducted across multiple databases. Inclusion criteria were randomized controlled trials and observational studies assessing Na alginate and Mesna in ESD. Primary outcome included en-bloc resection rates. Secondary outcomes included adverse events such as perforation and delayed bleeding, and procedural time. Results: Eight studies involving 255 patients were included in this analysis. Overall en-bloc resection rate for sodium alginate was 97% [95% CI (93%-99%); I2:0%]. En-bloc resection subgroup analysis revealed 97% [95% CI (93%-99%); I2:0%] for 0.6% sodium alginate and 95% [95% CI (70%-99%); I2: 0%] for 0.4% sodium alginate. Moreover, En-bloc resection rate for Mesna was 98% [95%CI: 92%-100%); I2: 0%]. Delayed bleeding rates for sodium alginate were 5% [95% CI (1%-20%); I2: 65.2%]; however, after subgroup analysis delayed bleeding was 2% [95% CI (1%-6%); I2: 0%] for 0.6% sodium alginate and 22% [95% CI (8%-49%); I2:0%] for 0.4% sodium alginate. Perforation rate for 0.6% sodium alginate was 1% [95% CI (0%-5%); I2: 0%]. Conclusion: Na alginate (0.6%) and Mesna are effective and safe alternatives to sodium hyaluronate for submucosal injection in ESD. These solutions offer potential cost-effective and safer options for clinical practice, with Na alginate (0.6%) showing particularly low adverse event rates.
Copyright (c) 2025 Hazem Abosheaishaa, Abdallfatah Abdallfatah , Imad Samman Tahhan, Abdelmalek Abdelghany , Iyiad Alabdul Razzak, Mohamed A. M. Amer , Ahmed Y. Azzam, Muhammed Amir Essibayi, Mahmoud Nassar, Omar Abdelhalim , Sherif Andrawes https://creativecommons.org/licenses/by/4.0
Emphysematous Gastritis in a Patient with Concomitant COVID-19 Infection and Celiac Trunk Stenosis: A Case Report
This case report reviews a 75-year-old male with several comorbidities who presented with acute encephalopathy and sepsis in the setting of COVID-19 pneumonia, who was noted to have significant gaseous distention of the stomach, emphysematous gastritis (EG), and severe stenosis of the celiac trunk on initial CT imaging. He was treated with empiric IV antibiotics, including ceftriaxone and metronidazole, which were changed to intravenous piperacillin-tazobactam after 24 hours. After being evaluated by surgery and gastroenterology, it was determined that risks outweighed the benefits of EGD and surgical intervention as the patient had a labile hemodynamic status. After extensive goals of care discussions with the patient’s family, he was transitioned to comfort measures only on day 4 of admission and ultimately passed the same day due to cardiopulmonary arrest. EG is often diagnosed late in its course and is associated with extremely high mortality, even with surgical intervention. Evidence from recent case series suggests increasing success with conservative management in selected patients; there are no formal guidelines.
Copyright (c) 2025 Hira Khan, Anjali Rajagopal, Murali Dharan https://creativecommons.org/licenses/by/4.0
The Impact of Vonoprazan on Tacrolimus Blood Levels in Transplant Recipients: A Systematic Review and Meta-Analysis
Background: Tacrolimus is essential for immunosuppression in transplant recipients but presents risks of toxicity and rejection due to its narrow therapeutic window. Vonoprazan, increasingly replacing proton pump inhibitors (PPIs) in these patients, may alter tacrolimus blood levels, but its impact remains unclear. Objective: To assess how switching from PPIs to vonoprazan affects tacrolimus through concentration and concentration-to-dose ratio, and to summarize related liver and kidney safety markers in transplant recipients. Methods: A systematic review was conducted of four Japanese studies (140 kidney or liver transplant recipients) evaluating tacrolimus-based immunosuppression before and after conversion to vonoprazan. The synthesis used exploratory meta-analyses and narrative interpretation, with clinically meaningful changes prespecified, while emphasizing study limitations. Results: Across studies, a trend toward higher tacrolimus levels was seen after switching to vonoprazan. However, the magnitude and consistency of these changes varied substantially between studies, and most results did not surpass thresholds for clinical concern. Liver and kidney safety signals were generally small and inconsistent. High risk of bias, considerable heterogeneity, and absence of pooled clinical endpoints prevent drawing firm conclusions from quantitative data. Pooled estimates are reported as exploratory only. Conclusions: There is low-certainty evidence that vonoprazan may increase tacrolimus exposure in transplant recipients, but the clinical significance is unclear due to small, regionally focused studies with major methodological limitations. Therapeutic drug monitoring during and after conversion is prudent, and well-controlled trials in diverse populations are needed before definitive recommendations can be made.
Copyright (c) 2025 Islam Rajab, Mohamed R. Ezz, Mohamed S. Elgendy, Omar K. Elsawy, Mohamed Wagdy, Mohamed A. Elshewikh, Abdallah Hussein, Patrick Tempera, Walid Baddoura https://creativecommons.org/licenses/by/4.0
Mycophenolate Mofetil Use for Inflammatory Bowel Disease
Mycophenolate Mofetil (MMF) is a prodrug that gets converted to mycophenolic acid (MPA). MPA inhibits the Akt/mTOR and STAT5 pathways and has a reversible cytostatic effect on T and B lymphocytes [1]. MMF is FDA-approved for immunosuppressive therapy after solid organ transplantation. MMF has been used for multiple inflammatory/autoimmune conditions including psoriasis, dermatomyositis, autoimmune hepatitis, lupus erythematosus, myasthenia gravis, and Takayasu arteritis [2]. In this Editorial, we discuss the recently published systematic review and meta-analysis by Balassiano et al [3]. This systematic review and meta-analysis studied the use of MMF for the treatment of IBD patients. This review included both retrospective studies, case series, and clinical trials that evaluated the use of MMF in patients with IBD. Included patients were intolerant or unresponsive to Azathioprine. MMF was used in the included studies for induction and maintenance of remission, or as a steroid sparing agent/immunomodulator. This study demonstrated MMF’s efficacy in both induction and maintenance of remission in IBD patients. MMF was associated with added benefits for patients on steroids as well as those on anti-TNF therapy [3]. MMF has several boxed warnings in the United States, limiting its use outside FDA-approved indications. MMF should be prescribed only by healthcare providers experienced in immunosuppressive therapy and organ transplant management, with access to comprehensive laboratory and medical resources [4]. There is also a significant risk of infections associated with immunosuppression including but not limited to opportunistic infections, which may result in significant morbidity and mortality. MMF use is associated with an increased risk of malignancy including but not limited to lymphoma and skin cancers. There is also a boxed warning suggesting avoiding MMF use in pregnancy if alternative therapies are available as its use is associated with congenital malformation and first-trimester pregnancy loss [5]. MMF has been associated with endoscopic findings that could be similar to acute colitis, IBD, ischemia, and graft-versus-host disease. Development of such side effects or endoscopic findings can lead to discontinuation of treatment, treatment interruption, or medication non-compliance [6, 7]. In this study, the pooled event rate for adverse events was 26.1% (20.3%-32.8%). The side effect profile is crucial in determining the role of MMF in IBD treatment. The IBD field is evolving around a patient-centered approach when it comes to therapeutic selection. IBDologists extensively discuss potential side effects and explore the patient’s risk appetite. In general, more than one in four is considered a relatively high risk. While side effects could constitute a major challenge for MMF use in IBD patients, their impact on treatment adherence, disease progression, and quality of life must be carefully weighed against MMF’s potential benefits. The development of side effects has been associated with specific risk factors that increase the risk of developing side effects which could open the door for drug adjustment and close monitoring that might allow its use. These risk factors include using a non-enteric coated formulation, increased MMF blood levels, concomitant use of other immunosuppressant agents like calcineurin inhibitors, and female sex [8-11]. MMF is relatively inexpensive compared to other IBD therapies. A dose price can be as low as $0.32 for an oral dose and as high as $129.57 for an IV dose. This is cheaper compared to Azathioprine prices [12]. With the evolving widespread use of biosimilars, we are heading to an era with better accessibility to advanced IBD therapies and this will allow gastroenterologists to adopt the recommended top-down approach in therapeutic selection [13]. The ACG guidelines for Crohn’s disease recommend combining an immunomodulator with anti-TNF rather than using anti-TNF alone [14]. Hernandez-Camba et al. showed added benefits of anti-TNF when combined with MMF [15]. This suggests potential benefits of MMF as an immunomodulator that could decrease anti-TNF immunogenicity and decrease the risk of secondary non-response. The study has some significant limitations. The included studies had heterogeneous designs. The study lacked a control group and did not compare MMF to alternatives such as Azathioprine or Mercaptopurine. The IBD therapies are expanding and it’s an evolving field with multiple advancements annually. Selection of therapy in patients with IBD is a multi-step and complex process that involves close consideration of the disease stage, patient population, disease complications, medication history, prognostic factors, presence of extra-intestinal manifestations of IBD, potential side effects of medications, patients’ preferences and cost implications [14]. In conclusion, this study highlights the potential benefits of MMF as a steroid-sparing agent or as an immunomodulator in conjunction with ant-TNF. It provides evidence for the use of MMF as an alternative for those intolerant or unresponsive to Azathioprine and Methotrexate.
Copyright (c) 2025 Ahmed Abomhya, Ahmed Elmoursi https://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Tofacitinib in Pediatric Ulcerative Colitis Patients: A Systematic Review
Introduction: Ulcerative colitis (UC), an inflammatory Bowel Disease (IBD), is a chronic illness of unknown mechanism affecting the colonic mucosa, mainly causing diarrhea and bleeding. It can potentially disrupt the quality of life. Tofacitinib, a Janus Kinase inhibitor, showed a promising effect in inducing remission in IBD patients. In this study, we aim to assess the efficacy and safety of Tofacitinib in treating children with ulcerative colitis. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), we searched four electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies reported up to July 2024. We reported outcomes as frequencies and proportions in our study. Results: We identified five studies encompassing 83 children diagnosed with IBD, of which 57 children had ulcerative colitis. The proportion of patients achieving a clinical response across one included study was 66.67%. The proportion of patients achieving clinical remission was 38.46%. Also, the proportion of patients achieving steroid-free remission across the three studies was 48.57%. The rate for serious adverse events was 25.53% across the three included studies. Conclusion: Tofacitinib could be useful in achieving clinical remission in children with UC and reducing colectomy rates. Also, a low infection rate and the incidence of serious adverse events were observed. Future randomized controlled trials with larger samples and longer follow-up periods are needed to support these findings.
Copyright (c) 2025 Abdelaziz A. Awad, Mohamed A. Aldemerdash, Ahmed Aldemerdash, Esraa Awad, Salma Allam, Ahmed L. Youseif, Alshimaa M. Abu alabbas, Nermin Elhossiny, Hazem Abosheaishaa https://creativecommons.org/licenses/by/4.0
Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis
Introduction: Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract, but it carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assess its efficacy and safety. Methodology: We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model. Results: The initial search retrieved 216 studies, and eight studies were included in the final analysis after screening. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol and Dexmedetomidine plus Midazolam revealed the same findings regarding restlessness and bradycardia compared to controls, which confirmed the adjunctive effects of Dexmedetomidine. Conclusion: Dexmedetomidine appears safe and effective as an adjunctive sedative in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may reflect reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations.
Dexmedetomidine use in endoscopic procedures
Copyright (c) 2025 Hazem Abosheaishaa , Abdallfatah Abdallfatah, Abdelmalek Abdelghany, Arshia Sethi, Abdellatif Ismail, Doha Mohamed, Moataz Aboeldahb, Omar Abdelhalim, Islam Mohamed, Ahmed Y. Azzam, Muhammed Amir Essibayi, David J. Altschul, Mahmoud Nassar, Mohammad Bilal https://creativecommons.org/licenses/by/4.0
Potential Use of Icosapent Ethyl in the Management of Acute Pancreatitis
Dear Editor, We are writing to highlight the potential use of Icosapent Ethyl (Vascepa) as a management option for acute pancreatitis. To the best of my knowledge, a limited number of studies have investigated this use, but it is not yet Food and Drug Administration (FDA) approved for this indication. Previous studies have suggested that omega-3 fatty acids, such as Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA), may have anti-inflammatory properties and could potentially be beneficial in reducing the inflammation and triglyceride levels associated with acute pancreatitis [1]. These mechanisms consist of systemic inflammation reduction by the inhibition of inflammatory mediators since omega-3 fatty acids inhibit the synthesis of pro-inflammatory cytokines such as IL-1β and IL-6 [2]. Moreover, they alter intracellular signaling pathways linked to transcription factors such as nuclear factor-κB, which impacts the expression of genes linked to inflammation [3]. Surprisingly, it helped with inflammation resolution by enhancing the removal of inflammatory cells and promoting the production of certain pro-resolving mediators in mice with pancreatitis [4]. EPA may serve as a valuable dietary supplement for individuals with risk factors for heart disease. It has potential benefits for conditions such as cardiovascular disease, diabetes, obesity, cancer, and stroke. EPA has been shown to lower inflammation, cholesterol, blood pressure, and blood clotting, and improve coronary artery function. Additionally, it can reduce inflammation and enhance body composition, supporting weight loss efforts [5]. A case study reported the use of Icosapent Ethyl as a treatment for severe acute pancreatitis in a 31-year-old male patient with abrupt acute alcoholic pancreatitis, requiring ICU admission, intubation, and mechanical ventilation, renal replacement therapy, and pressors; the patient showed remarkable improvement after initiation of icosapent Ethyl treatment via gastrostomy tube (G-tube) and had a complete recovery [1]. A randomized clinical trial (RCT) by Wang (2008) investigated the impact of omega-3 fatty acid supplementation on inflammation and systemic disease progression in severe acute pancreatitis. 40 patients with severe acute pancreatitis were randomly assigned to receive parenteral nutrition with either soybean oil or fish oil. Results revealed that patients who received fish oil had higher levels of EPA, reduced C-reactive protein (CRP) levels, and improved oxygenation index after five days of treatment. Additionally, the fish oil group had a shorter duration of continuous renal replacement therapy compared to the control group. The study concludes that supplementing parenteral nutrition with omega-3 fatty acids can effectively decrease inflammation, enhance respiratory function, and reduce the need for Continuous Renal Replacement Therapy (CRRT) in severe acute pancreatitis [6]. Currently, treatment options for acute pancreatitis caused by hypertriglyceridemia are limited as there are no FDA-approved options for intractable hyperchylomicronemia. Lifestyle modifications, such as weight loss and dietary intake limitations, are essential in treating patients with hypertriglyceridemia [7]. However, these findings suggest that Vascepa may be a breakthrough therapy for severe acute pancreatitis due to its anti-inflammatory activity and the absence of direct therapy for the disease. More research including RCTs is needed to confirm the safety and efficacy of Vascepa as a management option for acute pancreatitis.
Copyright (c) 2025 Hazem Abosheaishaa, Mahmoud Nassar https://creativecommons.org/licenses/by/4.0
Usage of Trapezoid RX Wire Guided Retrieval Basket with the Alliance™ II Inflation Handle for Treatment of Bouveret Syndrome: A Rare Clinical Entity
Bouveret Syndrome is an infrequent manifestation of gallstone disease, causing gastric outlet obstruction. This syndrome has diagnostic and therapeutic challenges due to its rarity and non-specific clinical presentation. Here, we present a case report involving a 78-year-old female patient who experienced gastric outlet blockage due to the presence of a sizable gallstone. A novel technique was applied wherein a trapezoid RX wire-guided retrieval basket (Boston Scientific) was utilized with Esophagogastroduodenoscopy to remove the stone without the need for surgical intervention. Post-procedure monitoring demonstrated a smooth recovery with immediate relief of symptoms. Imaging confirmed the absence of residual gallstones or obstruction.
Copyright (c) 2025 Mahmod Ghoname, Hazem Abosheaishaa, Arshia Sethi, Sharif Abbas, Sherif Hegab, Moataz Yousry Soliman https://creativecommons.org/licenses/by/4.0
Comparative Outcomes of Esophageal Stent Placement in Esophageal Cancer Patients: A Prospective Study of 183 Cases
Introduction: Esophageal stent placement is a vital, minimally invasive procedure for alleviating dysphagia and enabling smoother food passage. It offers immediate relief, reduces hospital stays, and enhances quality of life for high-risk patients. Effective for both malignant and benign conditions, stenting is cost-efficient and requires skilled professionals for optimal outcomes. This study examines outcomes of various stent types in esophageal cancer patients, evaluating efficacy, safety, and quality-of-life impacts. Methods: Between January and December 2022, 183 patients with esophageal cancer were enrolled from three tertiary healthcare facilities. Patients were divided into three groups based on the esophageal stent used: self-expanding metallic stents (SEMS, n = 84), self-expanding plastic stents (SEPS, n = 61), and fully covered self-expanding metallic stents (FCSEMS, n = 38). All stent placements were performed under endoscopic guidance, with follow-up assessments at 1 week, 1 month, 3 months, and 6 months to evaluate stent patency, dysphagia relief, and complications. Results: Technical success rates were high: SEMS 96.4%, SEPS 95.1%, and FCSEMS 97.4%. Immediate dysphagia relief occurred in 87.4% of patients. FCSEMS had a significantly longer median patency duration (8.0 months) compared to SEMS (6.3 months) and SEPS (5.6 months). Additionally, SEPS exhibited a higher migration rate (13.1%), while overall complications were noted in 18.0% of patients. Conclusions: Esophageal stent placement effectively palliates dysphagia in cancer patients. FCSEMS shows advantages with prolonged patency, yet careful stent selection is essential to optimize patient outcomes. These findings underscore the importance of individualized treatment planning and regular monitoring to achieve optimal outcomes.
Fully covered self-expanding metallic stents (FCSEMS)
Copyright (c) 2025 Ahmed E. Salem, Hazem Abosheaishaa, Sarah Meribout, Morad Zaaya, Carla Barberan Parraga, Kantash Kumar, Aye Cherry, Mohammed Abusuliman, Mohamed Eldesouki, Omar Abdelhalim, Yuriy Tsirlin, Aaron Z. Tokayer https://creativecommons.org/licenses/by/4.0
Evaluating Biliary Complications in Jaundiced Patients with Alcohol-Related Hepatitis: A Retrospective Study
Introduction: This study aims to differentiate whether jaundice in patients with alcoholic hepatitis (AH) is due to alcohol-related liver disease or underlying biliary pathology, including choledocholithiasis, primary sclerosing cholangitis, primary biliary cholangitis, benign strictures, cholangiocarcinoma, or pancreatic cancer. Accurate differentiation is crucial for appropriate treatment decisions. Methods: A non-interventional retrospective study examined patients admitted to our institute for presumed alcohol-related hepatitis management from 2016 to 2023. The primary outcome was the occurrence of biliary processes, whether benign or malignant, in patients managed for alcohol-related hepatitis within 90 days. Secondary outcomes assessed bilirubin level trends over seven days to evaluate steroid effects on alcohol-related hepatitis and predict underlying biliary processes. Variables were analyzed using bivariate and multivariate logistic regression with biliary process as the dependent variable. Results: Our study revealed that patients with alcohol-related hepatitis and jaundice who had dilated common bile duct (CBD) or pancreatic duct (PD) on cross-sectional imaging were more likely to have biliary processes regardless of cholecystectomy history p-value 0.007 (CI 0.03-0.242) OR 7.5 and p-value 0.001 (CI 0.58-1.34), OR 1.2 respectively. However, there was no correlation between biliary process incidence and various demographic or clinical factors. Conclusion: Cross-sectional imaging should be routinely used to evaluate biliary tree conditions in alcohol-related hepatitis patients with jaundice who have dilated CBD, particularly those with previous cholecystectomy or gallstones on imaging studies. This systematic approach enables early identification of underlying biliary issues and facilitates prompt, appropriate management decisions.
Copyright (c) 2025 Junaid Khan, Qamar Iqbal , Gajendra Acharya , Mubasshar Shahid , Safana Ismail , Umme Ferdaush , Christina Gomez , Osama Kaddourah https://creativecommons.org/licenses/by/4.0
An Unusual Case of Disseminated Hydatid Disease: A Laparoscopic Wonder
Human echinococcosis, caused by Echinococcus tapeworms, is a zoonotic disease in which ingested eggs of the tapeworm form cysts in the organs known as Hydatid cysts. These cysts are commonly found in the Liver and lungs, but in rare cases, they can also be found in the spleen, ovaries, round ligament, and peritoneal cavity. Treatment typically involves surgery. This is a case of a 32-year-old female who presented with chief complaints of pain in the abdomen for 2 months, which was associated with nausea, vomiting, reduced appetite, and increased size of mass per abdomen. Further investigations revealed the presence of multiple disseminated hydatid cysts in the upper abdomen and the peritoneal cavity. This was a rare & unusual entity that was meticulously managed by minimally invasive laparoscopic surgery. Echinococcosis can occur anywhere in the body, with concurrent localizations in the liver, spleen, round ligament, ovaries, and peritoneal cavity, which are rare and pose a diagnostic as well as a surgical management challenge. The inconvenience of multiple localization and the risk of contamination usually lead to open surgery in these cases. The presented case is unique due to the laparoscopic approach to the multiple localizations of hydatid disease, advocating for a minimally invasive first-line approach even in these particular localizations.
Copyright (c) 2025 Gajendra Bhati, Raghav Bansal, Vanessa Pamela Salolin Vargas , Ripanbir Singh Kahlon https://creativecommons.org/licenses/by/4.0
Efficacy and Safety of Tislelizumab in Combination with Chemotherapy versus Placebo Plus Chemotherapy in Patients with Advanced Gastric Cancer or Gastroesophageal Junction Cancer: A Systematic Review of Randomized Controlled Trials
Introduction: Advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC) is an aggressive malignancy often having a poor prognosis. Despite current systemic therapies, GC/GEJC remains the third most common cause of cancer-related deaths worldwide. Tislelizumab, an anti-PD1 antibody, has shown promising results in treating various cancers. Therefore, this systematic review investigated the efficacy and safety of tislelizumab plus chemotherapy for patients with GC/GEJC. Methods: Five databases were systematically searched until July 10, 2024. Articles identified in the screening process included two RCTs based on predefined inclusion criteria. We performed data extraction sheets and quality assessments using the Cochrane ROB2 tool. Results: Out of the two randomized controlled trials (RCTs), 1646 patients were included in our systematic review. In Rational-306, efficacy outcomes improved, overall survival (OS) significantly improved from 10.6 months (95\% CI 9.3–12.1) to 17.2 months (95\% CI 15.8–20.1), and progression-free survival (PFS) from 5.6 months (4.9–6.0) to 7.3 months (6.9–8.3). Rational-305 also notably significantly improved. Outcomes: Improved OS from 12.9 months (12.1-14.1) to 15 months (13.6-16.5), and PFS from 6.2 months (5.6 to 6.9) to 6.9 months (5.7 to 7.2). The proportion of patients with any grade 3 or worse treatment-related adverse events was similar between treatment groups. Conclusion: Compared with chemotherapy and placebo, Tislelizumab plus chemotherapy demonstrates superior efficacy with a similar safety profile in the two groups, encouraging the use of the tislelizumab group in patients with GC/GEJC.
Copyright (c) 2025 Ahmed Reda Bahr, Ahmed Magdy Hassan, Mohamed Wagdy, Mahmoud Abdelkader, Ahmed Samy Elgammal https://creativecommons.org/licenses/by/4.0
Alternative Gastrointestinal Conditions Identified in Patients Meeting Rome IV Criteria for Irritable Bowel Syndrome or Functional Diarrhea Referred to Secondary Care: A Prospective Study
Introduction: Organic gastrointestinal (GI) disorders can be missed in individuals with irritable bowel syndrome (IBS). This study investigated the frequency of organic disorders in patients with diarrhea-predominant IBS or functional diarrhea and the impact of treatment for any identified alternative diagnoses. Methods: Between April 2019 and March 2020, the results of comprehensive investigations, including blood and fecal tests, a 75selenium homophobic acid taurine scan, a breath test, and endoscopies performed on consecutive eligible patients, were recorded. Symptom burden was reassessed after treatment for any GI conditions identified. Results: 66 (15 males) consecutive patients were included. Two patients (3%) were diagnosed with colonic malignancy; 21 (38%) had bile acid diarrhea; one (1%) had pancreatic exocrine insufficiency; and 31 (54%) had small intestinal bacterial overgrowth. 21 patients (32%) had at least two GI diagnoses. Significant improvement in symptoms occurred following treatment (p<0.0001). Conclusions: Multiple co-existing conditions were detected in many of these patients, with one-third of the cohort having more than one abnormal test. When these alternative diagnoses were treated, patients reported significant symptomatic improvement. Larger studies are required to validate our findings, and these patients' investigative and management pathways should be amended accordingly.
concurrent treatable organic gastrointestinal conditions
Copyright (c) 2025 Dennis Poon, Giles Major, Jervoise Andreyev https://creativecommons.org/licenses/by/4.0
A Systematic Review and Meta-Analysis of Liver Transplant Outcomes in Lean Versus Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease Patients
Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent hepatic disease with metabolic dysfunction-associated steatohepatitis (MASH) as its severe necro-inflammatory subtype. At present, it is the second leading cause of liver transplant. A systematic literature review (SLR) was conducted to assess the effect of lean vs non-lean BMI on clinical outcomes after transplant in MASLD patients. Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar databases was executed. Review Manager 5.4.1 was used for statistical analyses. A random-effect model was used with the results reported as Odds Ratio (OR) and 95% confidence interval (CI). A narrative approach was used where it was not feasible to conduct a meta-analysis. Results: Eleven observational studies were included in the SLR. Pooled results from three studies showed no significant difference in mortality between lean and non-lean patients at 1 year (OR= 0.78, p= 0.76), 2 years (OR= 0.83, p= 0.24), and 5 years (OR= 1.07, p= 0.51) post-transplant. There was also no significant relation of lean and non-lean BMI in graft survival, observed over 30 days (OR= 1.34, p= 0.27), 1 year (OR= 0.75, p= 0.25), 2 years (OR= 1.20, p= 0.45), and 5 years (OR= 1.07, p= 0.60) post-transplant. Qualitative analysis suggested morbid obesity is linked with higher waitlist dropout in MASH patients. Conclusion: The qualitative analysis of eight studies indicates a trend towards poorer outcomes in the non-lean group. There is a need for further investigations to comprehensively examine the factors influencing the relationship between BMI and post-transplant outcomes.
Metabolic dysfunction-associated steatotic liver disease (MASLD)
Non-alcoholic fatty liver disease (NAFLD)
Metabolic Dysfunction-Associated Steatotic Liver Disease
Copyright (c) 2025 Manesh Kumar Gangwani, Omar Irfan, Muhammad Aziz, Fnu Priyanka, Dushyant Singh Dahiya , Umar Hayat , Fouad Jaber, Hassam Ali, Sumant Inamdar , Mauricio Garcia Saenz de Sicilia https://creativecommons.org/licenses/by/4.0
Gastrointestinal Non-Hodgkin Lymphoma: A Multifaceted Malady
Lymphomas account for approximately 5% of human malignancies and are classified as Hodgkin or non-Hodgkin variants. Non-Hodgkin lymphomas (NHL) constitute nearly 90% of all lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histological subtype. Although primarily nodal, extranodal involvement is common in NHL, with the gastrointestinal (GI) tract being the most frequently involved extranodal site. Lymphomas constitute only 1–4% of gastrointestinal malignancies, with appendix being an exceedingly rare site of involvement. Lymphomas are conventionally staged utilizing the Ann-Arbor system and risk categorized per the International Prognostic Index (IPI). The Dawson’s criteria differentiate primary versus secondary gastrointestinal lymphoma. Diagnosis of lymphoma relies heavily on conventional and immune stained histopathology. Surgery offers the best therapeutic option in localized disease, while chemotherapy is preferred in diffuse or non-resectable diseases. We present a unique and an exceedingly uncommon combination of recurrent DLBCL with appendicular involvement, gastrointestinal hemorrhage, hepatic metastases, and obstructive jaundice. This case highlights the diagnostic challenges posed by extranodal lymphoma, particularly in rare sites such as the appendix. It underscores the critical role of multimodal imaging, endoscopic intervention, and immunohistochemical profiling in diagnosing, staging, and managing intraabdominal lymphomas.
Copyright (c) 2025 Mathew Vadukoot Lazar, George Sarin Zacharia, Mudhasir Ahmad, Syed Mohamed Shimar, Ipsita Panda, Mohammad Ali, Hardik Patel https://creativecommons.org/licenses/by/4.0
Annular Pancreas in Adults Presenting as Chronic Pancreatitis and Duodenal Obstruction: Literature Review and a Case Report
Background: Annular pancreas is a rare congenital anomaly with an estimated incidence of 3.4 per 1,00,000 live births. It is more commonly diagnosed in infants. Its occurrence in adults is exceptionally rare but clinically significant, as seen in our case, where it presented as a duodenal obstruction. Case presentation: We present a case of an adult male who presented with a 3-week history of projectile bilious vomiting associated with postprandial abdominal pain and early satiety. Imaging studies revealed a segment of the pancreas encircling the second part of the duodenum, along with pancreatolithiasis. Based on the diagnosis of annular pancreas with chronic calcific pancreatitis, the patient underwent pylorus-preserving pancreatoduodenectomy. Materials and Methods: A structured literature review was performed using PubMed and Scopus databases, covering the period from 2018 to 2024. A total of 24 case reports were analyzed. Results: The review confirms that annular pancreas remains a rare condition, often undiagnosed in asymptomatic individuals with abdominal pain (83.3%) and vomiting (41.6%) as the most common symptoms. The most common diagnostic modality is the CT scan (computed tomography), at 64.1%, and surgical procedures, such as gastrojejunostomy, are the most common treatment modality, at 46.5%. Conclusions: It is a rare congenital condition that usually remains undiagnosed in asymptomatic individuals but typically presents with abdominal pain and vomiting when symptomatic. Diagnosis relies primarily on CT imaging. Conservative management is preferred for asymptomatic cases, and surgery is for symptomatic patients. Further research is needed to develop standardized management protocols.
Copyright (c) 2025 Gajendra Bhati, Shruti Pandey, Ripanbir Singh Kahlon , Raghav Bansal https://creativecommons.org/licenses/by/4.0
Mycophenolate Mofetil for the Treatment of Resistant Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Background: This systematic review evaluates the efficacy and safety of Mycophenolate Mofetil (MMF) for managing treatment‐resistant Inflammatory Bowel Disease (IBD), emphasizing remission rates and adverse effects. Methods: Observational and controlled trials assessing MMF’s impact on IBD were included, excluding non-English and pediatric studies. Comprehensive searches were conducted in Embase, Medline/PubMed, Scopus, and Web of Science through October 2023. The risk of bias was evaluated using the NIH quality assessment tool, and results were synthesized using a random-effects meta-analysis model. Results: Twelve studies comprising 446 participants (333 with Crohn’s disease and 113 with ulcerative colitis) were analyzed. The meta-analysis revealed remission rates of 62.2% at 8 weeks and 52.8% at 6 months. Adverse effects occurred in 26.1% of patients, with nausea and vomiting being the most common. Treatment discontinuation due to failure and intolerance was observed in 29.7% and 20% of cases, respectively. Discussion: The findings suggest that MMF effectively induces remission in IBD patients unresponsive to conventional therapies, although a notable proportion experienced adverse events or treatment failure. Careful patient selection and monitoring are essential. Conclusion: MMF presents a promising alternative for managing resistant IBD, but its adverse effect profile warrants cautious application. Further research is needed to optimize dosing strategies and assess long-term outcomes in this challenging patient population. These results underscore the potential of MMF as an effective therapeutic option while emphasizing the importance of individualized treatment plans and rigorous clinical monitoring. Future studies should focus on long-term safety and dosing. Additional robust research is required.
Copyright (c) 2025 Natalie Balassiano, Jasmine Tidwell , Omar Abdelhalim, Mohammed Abusuliman, Mahmoud Nassar, Azizullah Beran, Ivan Cancarevic, Hazem Abosheaishaa https://creativecommons.org/licenses/by/4.0
Pancreatic Rest Complicated by Actinomyces Gastric Abscess in a Young Male: A Case Report
Pancreatic rest, or ectopic pancreatic tissue, is a rare condition. It is characterized by pancreatic tissue outside its usual location, most commonly in the gastric antrum or proximal small intestine. We present a rare case of a 21-year-old male with recurrent epigastric pain, vomiting, and fever. Imaging and endoscopic ultrasound (EUS) identified a subepithelial lesion with features consistent with pancreatic rest. Subsequent fine-needle aspiration (FNA) grew Actinomyces and Streptococcus. Given persistent symptoms and incomplete resolution despite prolonged antibiotics, he underwent partial gastrectomy. This case highlights an unusual infectious complication of pancreatic rest with Actinomyces and underscores the need to consider surgical intervention in cases refractory to medical therapy.
Copyright (c) 2025 Ayah Obeid, Frank Lin, Anuraag Bandi, Loveleen Sidhu, Sinan Kutty, Gurshawn Singh, Lisa Stoll https://creativecommons.org/licenses/by/4.0
Insights into the Epidemiology and Determinants of Helicobacter Pylori Negative Gastritis: A Retrospective Study
Introduction: The prevalence of Helicobacter pylori (HP)-negative gastritis is rising in the United States, yet its origins and risk factors remain largely unexplored. This study aims to assess the prevalence of HP-negative gastritis and explore the demographic, clinical, and risk factor profiles that differentiate HP-negative from HP-positive subjects with histological evidence of gastritis. Methods: We conducted a retrospective analysis of 241 patients who underwent Esophagogastroduodenoscopy (EGD) for upper gastrointestinal symptoms at a tertiary care center between July 2020 and July 2021. Symptoms prompting referral included dysphagia, abdominal pain, nausea, and others. Gastric biopsies were collected from the antrum and body, and clinical, demographic, and laboratory data were analyzed to compare HP-negative and HP-positive gastritis cases. Results: Of the patients biopsied, 38.2% (n=92) showed histological evidence of gastritis, with 78% of these being HP-negative and 22% HP-positive. HP-negative cases were predominantly chronic chemical gastritis (61.5%), while all HP-positive cases were active chronic gastritis. Significant ethnic disparities were noted; 61.5% of HP-negative patients were Caucasian, and 72.7% of HP-positive patients were African American. Medical comorbidities, particularly gastroesophageal reflux disease (GERD), were more associated with HP-negative gastritis. The antrum was more frequently affected in HP-negative cases compared to HP-positive cases. Conclusion: HP-negative gastritis is significantly linked with Caucasian ethnicity and existing medical comorbidities but shows no strong associations with the analyzed lifestyle or medication factors. These findings highlight the need for further large-scale prospective studies to better understand the etiology, risk factors, and clinical implications of HP-negative gastritis.
Copyright (c) 2025 Ahmed E. Salem, Syed Matthew Kodilinye, Morad Zaaya, Carla Barberan Parraga, Sarah Meribout, Samar Pal S. Sandhu, Cherry Aye, Kantash Kumar, Joseph A. Menand, Neha Sharma, MariaLisa Itzoe, Tanuj R. Chokshi, Mohammed Abusuliman, Islam Mohamed, Abdallfatah Abdallfatah, Hazem Abosheaishaa, Yuriy Tsirlin https://creativecommons.org/licenses/by/4.0