No abstract

It is presently a universal practice to administer vitamin K at birth. Hence, the serious bleeding manifestations from vitamin K deficiency are nowadays very rare. We describe a case of late vitamin K deficiency bleeding presenting as intracranial hemorrhage with impending coning and the related review of literature. Such severe bleeding episodes due to vitamin K deficiency are associated with multiple cranial involvement and impending brain herniation is probably rare.

Background and study aims Advanced endoscopic resection techniques carry a risk of delayed bleeding (DB). A novel fully synthetic self-assembling peptide (SAP) has shown promising results in mitigating this risk. In this meta-analysis, we evaluated all available data and analyzed the effectiveness of SAP in reducing delayed bleeding (DB) after advanced endoscopic resection of gastrointestinal luminal lesions. Methods Electronic databases (PubMed, Embase, and Cochrane Library) from January 2010 through October 2022 were searched for publications addressing the use of SAP solution in patients undergoing advanced endoscopic resection of gastrointestinal lesions. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models. Results The initial search identified 277 studies, of which 63 relevant articles were reviewed. The final analysis included data from 6 studies comprising 307 patients that met inclusion criteria. The pooled rate of delayed bleeding was 5.73% (95% CI = 3.42 – 8.59). Mean patient age was 69.40 years (SD = 1.82). The weighted mean size of resected lesions was 36.20 mm (95% CI = 33.37 – 39.02). ESD was used in 72.69% (95% CI = 67.62 – 77.48), while EMR was used in 26.42% (95% CI = 21.69 – 31.44) of the procedures. Among the 307 patients, 36% were on antithrombotic medications. No adverse events were attributable to using SAP, with a pooled rate of 0.00% (95% CI = 0.00 – 1.49). Conclusions Self-assembling peptide solution appears promising in reducing post-procedural delayed bleeding after advanced endoscopic resection of high-risk gastrointestinal lesions with no reported adverse events.

Background and Aim POEM is a minimally invasive endoscopic procedure for the treatment of achalasia and certain spastic esophageal motility disorders, delivering excellent results in experienced hands. However, this complex and technically challenging procedure requires advanced endoscopic skills. The aim of this study was to conduct a systematic review and meta-analysis of current data to evaluate the learning curve for esophageal POEM in new adopters of this technique. Methods Electronic databases (PubMed, Embase, and Cochrane Library) from inception through November 2021 were searched for publications addressing the learning curve in POEM. Pooling was conducted by both fixed and random-effects models. Secondary outcomes reviewed were clinical success defined by Eckardt score 3 or less when available and adverse events. Results We included 8 studies involving 1904 patients that met inclusion criteria. In the pooled analysis, new adopters of POEM attained proficiency at a mean of 24.6 procedures (95% CI = 23.93 - 25.41). Once proficiency was achieved, the pooled total procedure time plateaued at a mean of 85.38 minutes (95% CI = 81.48 - 89.28). The pooled mean procedure time per centimeter of myotomy was 6.25 minutes (95% CI = 5.69 - 6.82). The pooled mean length of myotomy in this study was 11.49 centimeters (95% CI = 10.90 - 12.08). Conclusions Our analysis shows that new adopters of POEM with previous advanced endoscopy experience will require about 25 procedures to attain proficiency. The average time for each procedure once proficiency is attained is about 85 minutes

The prevalence of pancreatic cysts has been rising due to the widespread use of cross-sectional imaging (CT scan and MRI) of the abdomen. While most pancreatic cysts are benign and do not require treatment or surveillance, a significant minority are premalignant and rarely malignant. The risk stratification of these lesions is not straightforward, and individual risk assessment, cyst size, distribution, and alarming morphologic features (when present) can guide the next steps in management. Neoplastic pancreatic cysts are mucinous or non-mucinous. Endoscopic ultrasound with fine-needle aspiration is often required to classify pancreatic cysts into mucinous and non-mucinous cysts and to assess the malignant potential. Advances in endoscopic techniques (confocal laser endomicroscopy, microforceps biopsy) can provide a definitive diagnosis of pancreatic cysts in some cases; however, the use of these techniques involves a higher risk of adverse events.