Background: Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis.Aim: To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up. Methods:We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre-and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre-and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I 2 statistic. Results:We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than preprocedure; mean difference (MD) (95% CI) −1.4 (−1.9, −0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre-and post-procedure EndoFLIP measurements.Conclusions: G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.

Infective endocarditis is a significant healthcare burden due to the associated high mortality and complications. Endocarditis caused by both Candida albicans (C. albicans) and non-Candida albicans Candida (NCAC) species has been associated with a substantial rise in in-hospital morbidity and mortality. We used the Pubmed database to identify 47 out of 101 articles that had met our inclusion and exclusion criteria. We had put in place a broad inclusion criterion with no age or gender restrictions. These 47 articles included abstracts, 11 review articles, 13 case reports, 10 research articles, 1 clinical trial report, 1 meta-analysis, and other research articles. And they comprehensively cover the pathogenesis, risk factors, and management of infections caused by C. albicans and NCAC species in the past 26 years. The articles we scanned provided us with information on different associations in correlation to multiple types of Candida species. Here, we discuss the association between Candida and endocarditis, a major cause of morbidity and mortality in both C. albicans and NCAC. We also present our understanding regarding this interesting association and attempt to address some of the recurring questions.

ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): −1.12 (−1.62–−0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.

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Background Sex is thought to play a significant role in predicting outcomes in numerous diseases. The role sex plays in acute pancreatitis (AP) remains limited. We sought to determine if sex is associated with hospitalization outcomes in this population, using a large national database. Methods This was a retrospective study of adult patients with AP utilizing the 2016 and 2017 National Inpatient Sample via ICD‐10 codes. The clinical courses of females were compared to that of males. The primary outcome was all‐cause inpatient mortality. Secondary outcomes, including healthcare utilization, were assessed. Statistical analyses were performed using STATA, version 16.1. Results Of the 553 480 adult patients hospitalized with AP; 25.3% had AP secondary to alcohol (61.4% male, 38.6% female) and 17.44% secondary to gallstones (48.6% male, 51.4% female). Females were significantly older than males (52.81 years vs 50.97 years, P < .01). Females had a significantly lower likelihood of mortality (aOR: 0.69), shock (aOR: 0.64), sepsis (aOR: 0.70), acute kidney injury (aOR 0.66), intensive care unit admission (aOR 0.53), and pancreatic drainage (aOR 0.61) as compared to males (all with P < .01). There was no significant difference between females and males with regards to mean length of stay and hospitalization charges and costs. Conclusions In this large cohort of patients admitted for AP, despite being significantly older, we found that females had significantly improved clinical outcomes, including lower mortality, compared to males. Further prospective studies are needed to accurately understand these differences to guide clinical practice.