Endoscope tip protectors (ETP) are commercially available, but their effect on reducing the number and type of damages to the instruments and the economic impact of reducing repair costs are largely unknown. We conducted a prospective, blinded cohort, operational quality improvement study at a large, quaternary endoscopic referral center to assess the frequency and types of endoscope damage as well as analyze the effect on repair costs. A cohort of 21 upper endoscopes, 16 colonoscopes and 11 echoendoscopes was utilized. Phase 1 involved 1,800 procedures without ETP, followed by Phase 2 utilizing the ETP for 1,800 procedures. The endoscope cohort was assessed after each procedure, at the 900-procedure point, and at the end of each phase of the study to ensure the capture of any unidentified damage. A cost per case analysis (CPC) and cost-effectiveness analysis (CEA) were performed using the overall cost of damage repair per volume of procedures, from the perspective of the overall fleet as well as the specific types of endoscopes studied. ETP use was associated with a 36.4% decrease in overall fleet repair costs, from $167.64 to $106.72 per case, with a 48.7%, 64.7% and 28.4% CPC reduction respectively for upper endoscopes, colonoscopes and echoendoscopes. CEA found that the use of ETP dominated non-use for the entire endoscope fleet, upper endoscopes and colonoscopes but not echoendoscopes. ETP was associated with a decrease in CPC repair costs and was the dominant practice strategy from a CEA standpoint for all endoscope classes except echoendoscopes. ETP use should be considered to reduce endoscope repair costs. Further studies are warranted to validate these findings.

Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic functional impairment remain incompletely defined. We prospectively evaluated the pancreatic exocrine and endocrine function in patients with ANP and attempted to identify associated risk factors. Patients aged 18-80years with ANP defined by theRevised Atlanta Classificationwere enrolled and prospectively followed for 6months. Exocrine function was assessed using fecal elastase-1 (FE-1), and endocrine function was evaluated using fasting glucose, postprandial glucose, HbA1c, and homeostatic model assessment of insulin resistance (HOMA-IR). Clinical severity, etiology, anatomic distribution of necrosis, infected necrosis, and interventions were analyzed as predictors of dysfunction. Thirty patients completed 6-month follow-up. At 6months, exocrine insufficiency occurred in 40% of patients (mild 16.7%, severe 23.3%). Endocrine dysfunction was observed in 30% of patients, including diabetes mellitus (6.7%) and prediabetes (23.3%). Necrosis involving the pancreatic head was significantly associated with exocrine insufficiency (p = 0.003). Moderately severe acute pancreatitis independently predicted exocrine dysfunction (p = 0.01). No clinical or radiologic factor predicted endocrine insufficiency. Exocrine insufficiency appears to be relatively common following ANP, with a possible association observed in patients with moderately severe disease and head-dominant necrosis; however, these findings require further validation. Endocrine dysfunction was observed in approximately one-third of patients, but no consistent predictors were identified in this cohort.

Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled patients with solid pancreatic lesions who underwent EUS-guided FNB, directly compared the Franseen-tip with other FNB needles. Six databases were systematically searched through July 2025, and study selection, data extraction, and risk of bias assessment (QUADAS-2 tool) were performed independently by two reviewers. Pooled estimates were generated using random-effects and bivariate hierarchical models. Sixteen studies (2,010 Franseen vs. 2,811 comparator) were included. Bivariate analysis showed that sensitivity and specificity of the Franseen needle were comparable to newer-generation comparator needles (sensitivity 91.3% vs. 94.0%; specificity 99.99% vs. 99.15%), whereas older-generation needles demonstrated lower sensitivity (80.8%) and inferior discriminatory performance (Negative Likelihood Ratio [LR⁻] 0.19 vs. 0.09). Diagnostic accuracy was higher with the Franseen needle (RR 1.07, 95% CI 1.01-1.14; I2 = 69%). Sample adequacy was similar overall (RR 1.04, 95% CI 0.95-1.14) but superior to older-generation needles (RR 1.19, 95% CI 1.02-1.41) and in lesions > 30mm (RR 1.14, 95% CI 1.02-1.28, I2 = 81.2%). The Franseen needle achieved nominally strong diagnostic performance (DOR 116.6), although small-study effects were observed. Primary procedural outcomes were comparable between Franseen and comparator needles, including technical success (RR 1.00, 95% CI 0.98-1.02) and histological core procurement (RR 1.04, 95% CI 0.92-1.17). The Franseen needle had fewer low-cellularity samples (RR 0.56, 95% CI 0.45-0.69) and lower specimen bloodiness (RR 0.48, 95% CI 0.25-0.90) but a slightly higher overall adverse event rate (RR 1.29, 95% CI 1.06-1.57). The Franseen needle provides superior diagnostic accuracy and sample adequacy compared to older-generation FNB needles with comparable performance to newer-generation designs. It reduces low-cellularity samples and specimen bloodiness, although adverse events are slightly increased, with other primary procedural outcomes remaining comparable. PROSPERO (Registration No. CRD420251123856).

Dupilumab is increasingly used for the treatment of eosinophilic esophagitis (EoE), yet its infectious safety profile in real-world clinical practice remains incompletely defined. Given the immunomodulatory effects of IL-4/IL-13 pathway inhibition, understanding infection risk relative to conventional therapies, such as proton pump inhibitors (PPIs) and swallowed TCS, is clinically important. Using the TriNetX Research USA network, we conducted three retrospective propensity-matched cohort analyses among adults with EoE initiating (1) dupilumab vs. PPIs, (2) dupilumab vs. topical steroids, (3) dupilumab vs. combined PPI/topical steroid therapy, and (4) dupilumab vs. no treatment. Patients receiving other systemic immunosuppressive biologics were excluded. One-to-one matching was adjusted for demographics and comorbidities associated with infection risk. Infectious outcomes ≥ 30days post-index were noted. Relative risks and Kaplan-Meier analyses were performed. After propensity matching, cohorts included 3053 pairs (dupilumab v. PPI), 2143 pairs (dupilumab v. topical steroids), 3973 pairs (dupilumab v. combined therapy), and 2329 pairs (dupilumab vs. no treatment). Infection rates were similar between dupilumab and PPIs or topical steroids alone across all outcomes. Compared with combined PPI/topical steroid therapy, dupilumab was associated with lower rates of COVID-19 (10.3 vs. 12.6%; RR 0.82, p = 0.001), pneumonia (1.9 vs 2.7%; RR 0.69, p = 0.011), and influenza (1.6 vs 2.3%; RR 0.71, p = 0.034). Herpes zoster, cellulitis, or urinary tract infection had similar rates. In large real-world matched cohorts, dupilumab was not associated with increased infectious risk compared with standard EoE therapies. These findings provide reassurance regarding the infectious safety of dupilumab in routine clinical practice.

Although guidelines recommend early cholecystectomy (CCY) after ERCP for choledocholithiasis-associated cholangitis, surgery is frequently deferred, particularly in severe disease. We evaluated real-world outcomes and decision-making between same-admission versus deferred CCY to assess the impact of surgical delay. We conducted a retrospective cohort study on patients with choledocholithiasis-associated cholangitis from 2011 to 2022. Primary outcomes were the occurrence of ≥ 1 recurrent biliary event (RBE) within one year, and 30-day mortality andreadmissions. Secondary outcomes included operative complications, length of stay, and reasons for delay. Multivariable logistic regression adjusted for age, comorbidities, sex, and severity, with subgroup analyses for Grade III cholangitis. Kaplan-Meier survival analysis evaluated time to first RBE. Among 171 patients (mean [SD] age, 66.2 [19.1] years; 85 [49.7%] female), 94 (55%) had CCY deferred. Same-admission CCY was associated with lower odds of RBEs (aOR 0.01; 95% CI 0-0.08; p < 0.001) and 30-day readmission (1.3% vs. 13.8%; aOR 0.11; 95% CI 0.01-0.48; p = 0.0023), with similar complication rates and length of stay. Kaplan-Meier analysis confirmed superior RBE-free survival for same-admission CCY (log-rank p < 0.001). Among patients with Grade III cholangitis (n = 34), same-admission CCY reduced RBE rate (0% vs. 56.5%; p < 0.001) without increasing intraoperative or postoperative complications. Deferral was most often due to high surgical risk (21.3%), concurrent pathology (20.2%), or patient preference (14.9%). Same-admission CCY for choledocholithiasis-associated acute cholangitis reduced recurrence and 30-day readmission without increasing postoperative complications, mortality, or length of stay, including in Grade III cholangitis. These findings support same-admission CCY after clinical stabilization.