Introduction

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a promising minimally invasive technique for the management of unresectable pancreatic adenocarcinoma. Despite its potential, the practical outcomes and overall survival implications of this technique require thorough assessment in real-world settings.

Aims & Methods

This prospective study aimed to evaluate the feasibility, safety, and efficacy of EUS-RFA in patients with locally advanced or metastatic pancreatic adenocarcinoma. For the procedure, an RFA 19-g needle with an electrode active tip length of 10 mm was introduced into the tumor through the working channel of the echoendoscope. The generator settings were set at 35 W, and energy was applied from the distal to the proximal margin of the tumor until the entire lesion was treated. (video 1 EUS RFA PADC.mp4) The primary endpoints were technical success, complication rate, and overall survival.

Results

Twenty consecutive patients (58% female; average age 60 +/- 11.5 years; average tumor diameter, 37 +/- 16.7 mm) underwent EUS-RFA combined with subsequent chemotherapy. Sixteen patients (80%) were diagnosed with locally advanced adenocarcinoma, while four (20%) had metastatic disease. Technical success was achieved in 100% of the cases. The median overall survival was 15 +/- 2.2 months. No adverse events were reported. It should be noted that a patient with locally advanced adenocarcinoma downstaged after multimodal therapy and underwent surgical resection.

Conclusion

EUS-RFA is a feasible and safe treatment modality for patients with unresectable pancreatic adenocarcinoma, with high technical success and low complication rates. Future studies with larger cohorts are needed to confirm these findings and optimize treatment protocols.

Introduction

Atrophic gastritis (AG) is a well-established precursor of gastric cancer, and its most frequent aetiological agent is Helicobacter pylori (H. pylori). Accurate risk stratification is essential to optimise endoscopic surveillance and resource allocation. The Operative Link on Gastritis Assessment (OLGA) system offers a histological staging tool to quantify the severity of gastric atrophy and associated cancer risk. Despite high H. pylori endemicity in Colombia, local data on the prevalence of advanced OLGA stages remains scarce. This study aimed to elucidate the distribution of OLGA stages and their correlation with age and H. pylori status in a large dyspeptic cohort.

Aims & Methods

We conducted a cross-sectional, observational study of adult patients undergoing upper gastrointestinal endoscopy for dyspepsia between January 2019 and December 2023 at a high-volume reference centre in Bogotá, Colombia. All cases followed the updated Sydney biopsy protocol, with five mapped gastric samples analysed by experienced gastrointestinal pathologists. The OLGA system was applied to stage gastric atrophy (0–IV). H. pylori detection was based on histology using Giemsa and H&E stains. Demographic variables, H. pylori status, OLGA stage, and histological features were recorded. Data were processed using SPSS v26, and statistical significance was set at p<0.05.

Results

Out of 6,746 patients (mean age: 59 years; 73.4% female), 99% exhibited low-risk OLGA stages (0–II). Only 3 patients (0.04%) presented with advanced OLGA stages (III–IV). A positive correlation was noted between increasing age and the frequency of gastric atrophy, although this did not correspond to an increase in advanced stages. H. pylori infection was confirmed in 82% of the cohort, showing an upward trend over the study period. Interestingly, no cases of H. pylori infection were observed among patients with OLGA III–IV. The majority of infections were restricted to the antrum. Gastric dysplasia and cancer were rare events, both observed in <1% of patients. The association between H. pylori and gastric cancer did not reach statistical significance (OR 0.49; 95% CI 0.23–1.04; p=0.07).

Conclusion

Despite the high prevalence of H. pylori, the frequency of advanced OLGA stages remains remarkably low in Colombian dyspeptic patients. These findings reinforce the utility of the OLGA system, coupled with Sydney protocol biopsies, as a valuable approach to risk stratification. Only 1% of patients would benefit from endoscopic surveillance under international guidelines, suggesting that widespread follow-up may be unnecessary and potentially wasteful.

References

1. Rugge M, Genta RM, Dixon MF. OLGA staging for gastritis: a tutorial. Dig Liver Dis. 2008 Oct;40(10):650–8. doi:10.1016/j.dld.2008.02.029.
2. El-Zimaity HM, Graham DY. Evaluation of gastric mucosal atrophy in clinical practice: OLGA is OK, but incomplete and in need of standardization. Am J Gastroenterol. 2011 Feb;106(2):469–70. doi:10.1038/ajg.2010.417.
3. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992 Dec 1;52(24):6735–40.
4. Herrera-Goossens A, Bravo LE, Correa P. Helicobacter pylori infection and histopathological findings in a population at high risk for gastric cancer in Colombia. Am J Gastroenterol. 2005 Nov;100(11):2314–20. doi:10.1111/j.1572-0241.2005.00226.x.

Introduction

There has been a shift from percutaneous drainage towards endoscopic ultrasound (EUS)-guided drainage for management of post-operative pancreatic fluid collections (POPFC). However, available series have been limited by sample size and little is known about the factors that may influence clinical success.

Aims & Methods

Our aim was to evaluate the outcomes of EUS-guided drainage of POPFC following pancreatic surgery and identify predictors of clinical success.
We performed a retrospective review of patients who underwent EUS-guided drainage of POPFC between 2014 and August 2024 at three academic centers. Primary outcome was clinical success, defined as the complete radiological regression of the collection and resolution of symptoms without the need for additional drainage procedures.

Results

In total, 265 cases were included (mean age 64 [SD±13.9] years, 37% pylorus-resecting pancreatoduodenectomy). Early drainage (≤14 days) was performed in 52% of cases (n=138) and DPPS were used in 209 cases (79%).
Clinical success with a single EUS drainage procedure was achieved in 160 cases (60.4%). Step-up interventions were required in 67 patients (25.3%), 37 of which required endoscopic revision only. Technical success was achieved in 90% (n=238) and adverse events occurred in 43 cases (16%).
Stent type, drainage timing, splenectomy and drainage route did not seem to significantly influence clinical success. Multivariate analysis including stent type and surgical history, showed that distal pancreatectomy was an independent risk factor for clinical failure.

Conclusion

EUS-guided drainage of POPFC was effective in the majority of cases with a single procedure, although distal pancreatectomy was suggested as an independent risk factor for clinical failure. These results further support the use of EUS-guided drainage for the management of postoperative collections.

Disclosure

HH declares no competing interests. MB received trial support from Boston Scientific and holds consultancy agreements with Dekra, Ovesco and Prion Medical. GV received lecture fees from Boston Scientific and travel grants from Pentax Medical and Euromedical. RVW holds a consultancy agreement with Boston Scientific. Schalk van der Merwe holds the Cook chair in Interventional endoscopy, has consultancy agreements with Cook, Pentax and Olympus and co-chairs the Boston-Scientific Chair in Therapeutic Biliopancreatic Endoscopy.

Clinical Case Summary

Drug-induced liver injury is an adverse effect of many pharmaceutical agents. Alverine citrate, an antispasmodic agent found in the fixed-dose combination Meteospasmyl (alverine citrate and simethicone), is widely used in functional gastrointestinal disorders. To date, only three cases are published in the literature. We report a case, with strong evidence, including a rechallenge confirming the causality.
Patient Observation: A 43-year-old woman presented with biliary-type abdominal pain. Her medical history was limited to hypertension treated with bisoprolol with no alcohol use or recent medication. Abdominal ultrasound revealed uncomplicated cholelithiasis; liver tests were normal. Alverine citrate was prescribed for symptomatic relief. Within two weeks, she developed jaundice and fatigue with a normal clinical examination. Blood tests showed severe hepatocellular injury: ALT and AST were 22× and 39× ULN, bilirubin was 274 µmol/L, and GGT/ALP were mildly elevated. Viral and autoimmune panels were negative. Imaging excluded biliary obstruction. Liver biopsy revealed portal inflammation with eosinophilic infiltrates, suggestive of immunoallergic hepatitis. The discontinuation of the drug led to normalization of liver enzymes. 3 years later, the patient was inadvertently re-exposed to alverine citrate, triggering a reproducible episode of acute hepatitis, thereby confirming causality. Diagnostic probability was assessed with the RUCAM score (12, "highly probable") and Naranjo scale (8, "probable"). Only three prior cases of alverine citrate-induced hepatitis, none of which reported a confirmed rechallenge. Although liver biopsy is not routinely required in DILI, it was essential here for diagnostic clarification.
Alverine citrate should be recognized as a rare cause of acute hepatitis. This case confirms its hepatotoxic potential and underscores the importance of early recognition and drug withdrawal to prevent recurrence.

References

1. RUCAM Scale: https://clincasequest.hospital/rucam-scale/
2. Naranjo Scale: https://proeurodilinet.eu/wp-content/uploads/2019/03/Causality-assessment-training-course-15-MARCH-.pdf
3. Couzigou P et al. Hepatitis and Alverine Citrate. J Hepatol. 1997. https://www.sciencedirect.com/science/article/abs/pii/S0168827897801870
4. Turkish case report. Turk J Gastroenterol. 2004. https://pubmed.ncbi.nlm.nih.gov/15259090/
5. Korean case report. Korean J Hepatol. 2010. https://pubmed.ncbi.nlm.nih.gov/20375645/
6. Simethicone safety review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033443/
7. Zhang X et al. Histopathologic Manifestations of Drug-induced Hepatotoxicity. Clin Liver Dis. 2013.