Background and aims Liver transplantation (LT) in alcohol‐associated hepatitis (AH) remains controversial, in part because spontaneous recovery (SR) can occur. There is a paucity of data on SR in patients with severe AH who undergo LT evaluation. The purpose of this study was to determine factors associated with SR and survival in patients with severe AH who undergo LT evaluation. Approach and results This is a retrospective study of ALD patients with Model for End‐Stage Liver Disease (MELD) >25 and <90 days abstinence who underwent LT evaluation at a single center between 2012 and 2018. One hundred forty‐four patients (median age, 45.5 years; 68.1% male) were included. Forty‐nine (34%) underwent LT and 95 (66%) patients did not undergo LT, and of those, 34 (23.6%) experienced SR. Factors associated with recovery were younger age (OR, 0.92; p = 0.004), lower index international normalized ratio (INR; 0.31; p = 0.03), and lower peak MELD (OR, 0.83; p = 0.02). Only 7 patients (20.6%) achieved a compensated state with a MELD <15 and absence of therapy for ascites or HE. Survival was improved in patients who underwent early LT when compared to SR. Survival was impaired in SR following relapse to alcohol use when compared to SR patients who abstained and LT recipients. Among all 6‐month survivors of AH, alcohol use trended toward an association with mortality (HR, 2.05; p = 0.17), but only LT was associated with decreased mortality risk (HR, 0.20; p = 0.005). Conclusions SR from AH after LT evaluation is associated with age, index INR, and lower peak MELD. Most recovered patients continue to experience end‐stage complications. LT is the only factor associated with lower mortality.

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Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this. Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification. Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method. Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE (p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25). Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.

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INTRODUCTION: The prevalence of obesity continues to rise worldwide. It has been demonstrated that conditions such as T2DM and gallbladder disease, among other comorbidities, are related to Class II and III obesity (BMI ≥ 35). To combat this issue, bariatric surgery has been shown to be the most effective and durable weight loss method in individuals with a BMI ≥ 40 or BMI ≥ 35 with an obesity-related comorbidity. The rate of obesity among IBD patients parallels that of the general population and is approaching 30% nationwide. In recent years, there has been an increase in clinical research supporting the use of bariatric surgery within the IBD population as a safe and efficacious treatment option. CASE DESCRIPTION/METHODS: We present a case series of patients with a pre-operative diagnosis of IBD who underwent bariatric surgery at our hospital. Selection process was based on an ICD 9 or 10 diagnosis of IBD prior to Bariatric Surgery referral. Patients with a diagnosis of IBD but not followed by a gastroenterologist were excluded from this review. Patient data was extracted by the Clinical Research Data Service team from the electronic medical record. They identified 144 patients with IBD diagnoses who were seen at bariatric surgery clinic from 2003-2018. 5 IBD patients (3 CD, 2 UC) who underwent bariatric surgery were included in this data set and analyzed for IBD disease activity, operative complications, mortality, post-operative complications and overall excess weight loss (%EWL) at 6-month follow-up. All IBD patients who had bariatric surgery at this facility were included in data analyses. Bariatric surgical procedures included sleeve gastrectomy and Roux-en-Y. Mean age at time of referral was 43 years ± 12. One major perioperative complication was identified in a UC patient, pulmonary embolism complicated by splenic infarct. %EWL at 6-month follow-up was 35.4% ± 12.8. No patients required rehospitalization and mean length of hospital stay for the operation was 2.5 days ± 1.7. DISCUSSION: There were no IBD-related complications (glucocorticoid use or rehospitalization) seen within 30 days of surgery and no major complications (including SBO) were noted within a median follow-up of 54 months. As clinical data continues to emerge regarding bariatric surgery in the obese IBD population, it has become increasingly apparent that the pre-operative diagnosis of IBD should not exclude considerations for utilizing a surgical treatment modality for weight reduction in select patients.