Introduction: Early clinical adverse events (AEs) after endoscopic biliary drainage (EBD) for malignant biliary obstruction (MBO) remain clinically important, and no simple bedside score is available to support early risk stratification in this setting. Aims & Methods: We aimed to quantify 7-day clinical AEs after initial EBD for MBO and to derive an internally validated bedside score for early postprocedural management. In this retrospective single-centre cohort study at a tertiary academic centre, we included consecutive adults undergoing initial EBD for MBO between 2016 and 2023 by ERCP or EUS-guided biliary drainage. The primary endpoint was any clinical AE within 7 days, graded according to the AGREE classification; major AEs were predefined as AGREE grade ≥IIIA. Prespecified routine preprocedural and periprocedural variables were entered into a multivariable logistic model, internally validated, and translated into a pragmatic 5-item bedside score (EDIGO). Diagnostic performance was assessed at prespecified rule-out thresholds, with descriptive comparison against clinician-selected outpatient management. Results: Among 461 patients, any 7-day clinical AE occurred in 15.4% of patients, including 9.8% major AEs. The score incorporated 5 predictors: ASA III, preprocedural cholangitis, altered anatomy, higher baseline total bilirubin, and Bismuth-Corlette type IV obstruction. The full model showed good discrimination (AUC 0.800), and the derived score retained good discrimination (AUC 0.779). At the prespecified low-risk threshold (EDIGO 0–1), 34.7% of patients were classified as low risk, with 94.4% sensitivity, 97.5% negative predictive value, and an observed 2.5% 7-day AE rate. Observed 7-day AE rates increased across prespecified risk groups: 2.5% for EDIGO 0–1, 16.8% for EDIGO 2–4, and 53.3% for EDIGO ≥5. Clinician-selected outpatient management involved a similar proportion of patients (34.1%) but had a higher observed 7-day AE rate (10.8%). Conclusion: EDIGO is a 5-item bedside score that stratifies 7-day clinical AE risk after initial EBD for MBO and provides strong rule-out performance to support early triage alongside clinician judgment. It may support early postprocedural management by identifying patients suitable for outpatient care and those requiring closer monitoring. Prospective multicentre external validation is required before routine implementation.

Background: Despite technical refinements in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), stent migration remains a dreaded complication associated with significant morbidity. Methods: We performed a retrospective analysis of patients undergoing conventional EUS-HGS (Group 1) compared with patients undergoing EUS-HGS using the clip-assisted anchor technique (Group 2). In Group 2, following technical success, a hemostatic clip was applied to the intragastric portion of the stent to prevent intraperitoneal migration. Outcomes, including stent migration, adverse events, and need for re-intervention, were compared between groups. Results: A total of 52 patients underwent EUS-HGS during the study period (18 in Group 2). The “Candy Sign” was observed in 18 patients (35.3% vs. 33.3%; p = 1.0). Stent migration occurred exclusively in Group 1 (17.6% vs. 0%; p = 0.15). Peri-procedural adverse events were more frequent in Group 1 (23.5% vs. 5.5%; p = 0.13). Importantly, the requirement for re-intervention was significantly higher in Group 1 (26.5% vs. 0%; p = 0.01). Conclusion: Clip-assisted anchoring during EUS-HGS is an effective technique that reduces stent migration and significantly reduces the need for re-intervention. Despite comparable rates of initial “candy sign," the absence of migration-related complications in the clip-assisted group highlights its potential role as a practical strategy to enhance procedural safety in routine clinical practice.

ABSTRACT Background: Peroral cholecystoscopy (POC) after EUS-guided gallbladder drainage (EUS-GBD) enables direct gallbladder visualization and stone clearance, but evidence remains limited to small case series. We aimed to evaluate the efficacy and safety of POC after EUS-GBD in a large cohort of high-risk surgical patients with acute calculous cholecystitis. Methods: Between December 2024 and January 2026, consecutive high-risk patients with acute calculous cholecystitis who underwent EUS-GBD at a tertiary referral center were prospectively enrolled and retrospectively analyzed. POC was scheduled 4–6 weeks after EUS-GBD. Outcomes included complete gallstone clearance, adverse events, and recurrence of cholecystitis. Results: Sixty-one patients underwent POC after EUS-GBD. Complete stone clearance was achieved in 55 patients (90.2%). Spontaneous stone passage occurred in 38 patients (62.3%), while 17 (27.9%) required POC-assisted stone removal, including basket extraction in 15, net retrieval in 1, and electrohydraulic lithotripsy in 1. POC-related adverse events occurred in 3 patients (4.9%) and included hypoxia, fever, and aspiration pneumonitis. All resolved with conservative management. After a median follow-up of 242 days, 2 patients (3.2%) developed recurrent cholecystitis and were successfully managed endoscopically. Conclusions: POC after EUS-GBD was effective and safe for gallstone clearance, with a low rate of recurrent cholecystitis, and represents a practical minimally invasive treatment option for selected high-risk patients. Further multicenter studies are warranted to validate these findings.

INTRODUCTION Metastatic pancreatic tumors account for 2-5% of all pancreatic tumors. The most common metastatic tumors of the pancreas are adenoca. kidney, melanoma, colorectal cancer, breast cancer and sarcoma. Metastatic adenocarcinoma kidneys relatively rarely affect the pancreas, which after resection are associated with a long survival rate. CASE REPORT A 76-year-old man with a history of right-sided nephrectomy due to adenocarcinoma kidney was hospitalized due to obstructive icterus. The previously performed MSCT of the abdomen verified the expansive process of the head of the pancreas with a diameter of about 4 cm. Choledocholithiasis and hypoechoic expansive formation of the uncinate process with a diameter of 3.5 cm were verified by endoscopic ultrasound. A fine needle biopsy performed with a 22 G needle pathohistologically confirmed metastatic adenocarcinoma kidneys. The planned ERCP was abandoned due to spontaneous propulsion of the concretion. The patient was presented to the oncology multidisciplinary team. Due to the workload of patients with numerous comorbidities, sterotactic body radiation therapy (SBRT) was done. CONCLUSION The presented case highlights the possibility of metastatic adenocarcinoma kidneys for a long time after nephrectomy due to adenocarcinoma of the kidney with a description of the possibility of treatment with stereotactic radiotherapy.

INTRODUCTION Adenocarcinoma of the pancreas represent a significant diagnostic and therapeutic challenge, and are often associated with a poor treatment outcome. CASE REPORT A 64-year-old patient with a history of arterial hypertension and hyperlipoproteinemia in anamnesis was hospitalized because of dull pain in the epigastrium and under the right costal arch, accompanied by nausea and obstructive jaundice. Abdominal ultrasound and abdominal CT with contrast verified one expansive mass of the head of the pancreas with a diameter of 2 cm and one expansive mass of the body of the pancreas with a diameter of 1.2 cm with enlargement of the regional lymph nodes with consequent dilatation of the commom bile duct, intrahepatic bile ducts and gall bladder. An endoscopic ultrasound performed with a Fine Needle Biopsy with a 22 G needle revealed adnocarcinoma of the pancreas (Figure 1). The patient was transferred to the department of abdominal surgery, where she underwent total pancreatectomy and splenectomy with the formation of gastroenteric anastomosis and hepaticojejunal anastomosis. The procedure and the post-procedural course were without complications, and after the postoperative recovery, neoadjuvant therapy was started. Twenty months after the operation, the patient has no signs of recurrence of malignant pancreatic disease. CONCLUSION The presented case shows a synchronous tumor of the pancreas in the diagnosis and treatment of which a multidisciplinary approach is required. According to our knowledge, this is the first description of a synchronous solid adenocarcinoma pancreas.

Introduction: Distinguishing mucinous from non-mucinous pancreatic cysts guides surveillance and surgical decisions. Intracystic glucose ≤2.8 mmol/L is recognised as a useful marker for mucinous cysts, but laboratory turnaround often delays interpretation until after the procedure. If point-of-care testing (POCT) is reliable, clinicians could make earlier decisions and potentially avoid repeat sampling. Methods: A retrospective review was performed of patients undergoing EUS-FNA of pancreatic cysts in whom paired intracystic glucose measurements were available from both laboratory assay and bedside glucometer testing. Cyst fluid CEA, cyst morphology and cyst size were recorded where available. Concordance between laboratory and point-of-care glucose measurements was assessed using the clinically relevant ≤2.8 mmol/L cut-off for mucinous cysts. Results: Eleven patients were included (median age 63 years; range 42–87). Three cysts were classified as mucinous or suspected mucinous, one was malignant, and the remaining were non-mucinous (pseudocysts, simple cyst, serous cystadenoma and one indeterminate non-mucinous lesion). Intracystic glucose measurements demonstrated a high degree of similarity between point-of-care and laboratory testing, with very strong correlation (r=0.95). Using the clinically relevant ≤2.8 mmol/L threshold, diagnostic agreement between methods was observed in 10 of 11 cases (91%), indicating close concordance for mucinous classification. In this cohort, all mucinous or suspected mucinous cysts demonstrated low intracystic glucose on point-of-care testing, consistent with expected pathophysiology and supported by elevated CEA levels where available. No procedure-related complications were observed. Conclusions: Point-of-care intracystic glucose showed close agreement with laboratory glucose and correctly identified all mucinous or suspected mucinous cysts in this pilot group. The ability to obtain cyst glucose immediately during EUS-FNA may help clinicians make earlier decisions around surveillance or surgical referral, without waiting for laboratory results or serum testing. Although numbers are small, these findings support continued prospective data collection to determine whether POCT can reduce diagnostic delay and repeat procedures in routine practice.

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