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Grape seed extract (GSE) supplement use is becoming more popular today for its potential chemopreventive and chemotherapeutic role. We report a 49-year-old male who presented with recurrent nausea, vomiting, diarrhea, and acute weakness following GSE use. A thorough medical workup ensued and no causes were identified clinically, procedurally, or with imaging. Symptoms resolved after GSE discontinuation and the patient remained symptom-free 5 years later. This case illustrates the paucity of documented detailed clinical cases and lack of controlled trials detailing a thorough and reproducible adverse effect profile of GSE supplement.

DCD, and 56 (11.0%) LDLT. Baseline characteristics are described in Table 1. The most common biliary complication was anastomotic stricture in all 3 donor types (51.7% in DBD, 50.8% in DCD, 64.1% in LDLT). ERCP was performed most often in LDLT recipients compared to DCD and DBD recipients (51.8% vs 37.6% and 28.7%, p<0.01) (Table 2). LDLT recipients required significantly greater number of median [IQR] ERCPs compared to DCD and DBD (8 [4,12] vs 4 [2,6] and 3 [2,5], p<0.01). Unplanned ERCPs were required in 33.9% of LDLT recipients compared to 19.0% in DCD, and 17.0% in DBD, p<0.01). However, the interval between ERCPs was not significantly different between the three donor types. The LDLT group had a higher rate of ERCP AEs, 7.7% compared to the DBD 5.9% and DCD 4.7% groups, pZ0.02, primarily related to post-procedure cholangitis (6.3%). Conclusions: Frequency of ERCP varies significantly among different donor organ types and is significantly higher among LDLT transplant recipients. LDLT recipients required significantly more ERCP sessions and had a significantly higher rate of unplanned ERCPs highlighting the complexity of this donor pool. While biliary complications in LDLT are well recognized, these results highlight the increased procedural burden and related risks associated with LDLT compared to DCD and DBD transplant recipients.

Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations, and a significant economic burden. Extracorporeal shock wave lithotripsy (ESWL) can be used to treat pancreatic stones and is less invasive when compared to other modalities. In this review article, we have discussed the role of ESWL in the treatment of pancreatic stones and how it differs from other modalities. Databases were searched electronically for articles discussing the treatment of pancreatic ductal stones by ESWL or other modalities. Articles discussing or comparing treatment success rates were preferentially included. An inductive approach was used to identify articles related to the treatment of pancreatic stones with ESWL throughout the review process. Although laser lithotripsy and electrohydraulic lithotripsy appear to have higher success rates, the potential for ESWL to affect clinical outcomes is substantial, especially in individuals with a higher risk for invasive procedures. The decision to perform ESWL should be considered if the outcome will substantially alter the clinical management when performed by an experienced endoscopist. Further randomized controlled trials are needed to compare ESWL and peroral pancreatic lithotripsy methods.

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