BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

Introduction: There are concerns regarding the effectiveness and safety of SARS-CoV-2 vaccine in inflammatory Bowel Disease (IBD) patients. This systematic review and meta-analysis comprehensively summarises the available literature regarding the safety and effectiveness of SARS-CoV-2 vaccine in IBD. Methods: Three independent reviewers performed a comprehensive review of all original articles describing the response of SARS-CoV-2 vaccines in patients with IBD. Primary outcomes were (1) pooled seroconversion rate SARS-CoV-2 vaccination in IBD patients (2) comparison of breakthrough COVID-19 infection rate SARS-CoV-2 vaccination in IBD patients with control cohort and (3) pooled adverse event rate of SARS-CoV-2 vaccine. All outcomes were evaluated for one and two doses of SARS-CoV-2 vaccine. Meta-regression was performed. Probability of publication bias was assessed using funnel plots and with Egger's test.Results: Twenty-one studies yielded a pooled seroconversion rate of 73.7% and 96.8% in IBD patients after one and two doses of SARS-CoV-2 vaccine respectively. Sub-group analysis revealed non-statistically significant differences between different immunosuppressive regimens for seroconversion. Meta-regression revealed that the vaccine type and study location independently influenced seroconversion rates.There was no statistically significant difference in breakthrough infection in IBD patients as compared to control after vaccination. Conclusion:In summary, the systematic review and meta-analysis suggest that SARS-CoV-2 vaccine is safe and effective in IBD patients.

Background and Aims: Hemospray is a non-contact modality of endoscopic hemostasis that has been used in the management of upper gastrointestinal bleeding (UGIB) with varying success. Our aim was to evaluate the efficacy of Hemospray in the management of UGIB. Methods: An electronic bibliographic search of digital dissertation databases was performed from inception till October 2019. All prospective studies, including randomized controlled trials evaluating the efficacy of Hemospray in the management of UGIB were analysed. The primary outcome was immediate haemostasis and the secondary outcome was rebleeding rate. Subgroup analyses based on etiology of UGIB (tumour-related, variceal, etc) were also performed. Results: A total of 11 prospective studies, including 4 randomized trials were included for the analysis. The pooled immediate haemostasis rate with Hemospray was 93% (95% CI 90.3-95%, p<0.001). Rebleeding occurred in 14.4% (95% CI 8.8-22.8%, p<0.001) of patients. For the subgroup of tumour-related bleeding, the immediate haemostasis rate was 95.3% (95% CI 89.6-97.3%; p <0.001) and rebleeding rate was 21.9% (95% CI 13.9-32.7%, p <0.001). In patients with variceal bleeding, immediate haemostasis was achieved in 92.7% (95% CI 83.6-96.9%; p<0.001) of patients, with a rebleeding rate of 3.1% (95% CI 0.9-10.2%, p <0.001). Conclusion: Hemospray shows high immediate haemostasis and low bleeding percentages. The odds were in its favour compared to conventional endoscopic modalities, but not statistically significant. The results are undermined by the risk of bias in the studies. Nevertheless, it is an easy technique that should be further investigated with better studies.

Importance/BackgroundDespite the global healthcare’s exhaustive efforts to treat COVID-19, we still do not have an effective cure for it. Repurposing Ivermectin, a known antiparasitic agent, for treating COVID-19 has demonstrated positive results in several studies. We aim to evaluate the benefit and risk of Ivermectin in COVID-19.MethodsWe conducted a systematic search for full-text manuscripts published from February 1, 2020 to March 27, 2021 that focused on efficacy and safety of Ivermectin therapy against COVID-19. The primary outcomes were overall mortality, need for intensive care unit (ICU) admission; secondary outcomes were - adverse effects, need for mechanical ventilation. Random-effects models were used for all analysis.ResultsWe included a total of 38 studies (n=15,002) in the qualitative analysis (Mortality N=28, ICU admission= 8, Mechanical Ventilation= 10, Adverse events=28) and out of these, 30 studies (n=11,291) were included in the quantitative analysis (Mortality N=22, ICU admission= 5, Mechanical Ventilation= 9, Adverse events=17). In the mortality meta-analysis, odds of death were lower in the Ivermectin-arm compared to the non-Ivermectin arm. (OR 0.39, 95% CI 0.22-0.70; I2=81%). Subgroup analysis of 12 randomized controlled trials with severity-based data showed mortality benefit overall (OR 0.33, 95% CI 0.15-0.72; I2=53%) and in the mild/moderate sub-group (OR 0.10, 95% CI 0.03-0.33; I2=0%). Benefit of Ivermectin in decreasing; the need for ICU admission (OR 0.48, 95% CI 0.17-1.37; I2=59%) and mechanical ventilation (OR 0.64, 95% CI 0.40-1.04; I2=17%) was not significant. The quantitative analysis of adverse effects with Ivermectin use was inconclusive (OR 0.92, 95% CI 0.64-1.33; I2=14%).ConclusionOur meta-analysis suggests that Ivermectin could be an effective adjuvant therapy in reducing mortality, particularly in patients with mild-moderate clinical presentation of COVID-19. Trends of decreased need for ICU admissions and mechanical ventilation were observed but were not significant. The analysis for adverse effects was inconclusive.HighlightsWhat We Already Know about This TopicCOVID-19 is an ongoing global pandemic, for which Ivermectin has been tried on a therapeutic and prophylactic basis.Results from several clinical trials and observational studies suggest that Ivermectin may improve survival and clinical outcomes with a good safety profile when compared with other treatments; however, the current evidence is limited.What This Article Tells Us That Is NewThis systematic review and meta-analysis provide a summary of the latest literature on the efficacy and safety of Ivermectin use for COVID-19.Based on our quantitative and qualitative analysis, we found that Ivermectin may be a potentially useful adjuvant therapy in reducing mortality, the need for ICU admissions and mechanical ventilation in COVID-19 patients.

Background and Aim A delay in performing colonoscopies after positive fecal tests in a screening program may risk neoplastic progression. Our objective is to conduct a systematic review and meta‐analysis to evaluate the effects of timing of a colonoscopy after a positive fecal test on the detection of colorectal cancer. Methods Cochrane guidelines and PRISMA statement were followed for this review. Digital dissertation databases were searched from inception to June 1, 2020, and all studies reporting the detection rates of colorectal cancer on the basis of different time intervals between a positive fecal test and the post‐test colonoscopy were included. We compared the detection rates of colorectal cancer (overall and advanced‐stage) and advanced adenoma based on different time intervals. Results A total of 361 637 patients from six observational studies were included for the analysis. The odds of detecting any colorectal cancer (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.23–2.03, P < 0.001), advanced‐stage colorectal cancer (OR 2.16, 95% CI 1.47–3.16, P < 0.001), or advanced adenomas (OR 1.17, 95% CI 1.06–1.28, P = 0.001) are significantly higher if the colonoscopies are performed after 6 months from a positive fecal test, compared with within 6 months. There was no significant difference in the detection rates based on a 1‐month, a 2‐month, or a 3‐month cut‐off. Conclusions A delay of colonoscopies beyond 6 months after positive fecal tests is associated with a higher odds of detecting colorectal cancer. A timely follow up of patients with positive fecal tests is warranted.