Gastric outlet obstruction (GOO) is a potential complication of pancreatic or distal gastric malignancy and may present in as many as 15%-20% of patients with pancreatic adenocarcinoma. [1,2] Ampullary cancer, lymphoma, and biliary malignancy may also cause GOO. There are also several benign etiologies of GOO including chronic pancreatitis, peptic ulcer ABSTRACT Gastric outlet obstruction (GOO) is characterized by epigastric pain and postprandial vomiting secondary to mechanical obstruction. Management of GOO is usually focused on alleviating the symptoms of obstruction and can be achieved by surgical gastrojejunostomy or enteral stenting. Recent studies have shown success with EUS-guided gastroenterostomy (EUS-GE) in the management of GOO but data is limited. We, therefore, conducted a meta-analysis to evaluate the safety and efficacy of EUS-GE in the management of GOO. A comprehensive literature review was conducted by searching the Embase and PubMed databases from inception to January 2019 to identify all studies that evaluate the efficacy and safety of EUS-GE in GOO. Our primary outcome was to evaluate technical success and clinical success. Secondary outcomes were to evaluate the need for reintervention and adverse events of the procedure. Twelve studies including 285 patients were included in the meta-analysis. Technical success was achieved in 266 patients with a pooled technical success of 92% (95% confidence interval [CI]: 88%-95%). Clinical success was achieved in 90% of the patients (95% CI: 85%-94%). Recurrence of symptoms or unplanned reintervention was needed in 9% of the patients (95% CI: 6%-13%) and adverse events were reported in 12% of the patients (95% CI: 8%-16%). The heterogeneity tests among studies were nonsignificant with I 2 = 0. EUS-GE is a safe and efficacious treatment modality for the management of benign and malignant GOO. Larger prospective studies are needed to further evaluate its utility in GOO.

TIPS after LT can be clinically effective in patients with RA with a MELD score less than 15. This suggests that TIPS could be used as a means to extend posttransplant survival but should be carefully individualized in patients with a MELD score more than or equal to 15.

Transarterial chemoembolization (TACE) is an effective modality for the treatment of Hepatocellular Carcinoma. It is used to treat small tumors and to downstage large tumors to meet liver transplant criteria. TACE can be associated with multiple side effects, including fever, right upper quadrant pain, nausea, vomiting, hepatic failure, hepatic encephalopathy, cholecystitis and pancreatitis. Neurological complications after TACE are rare, usually caused by cerebral embolism, and confirmed by means of imaging studies. Spinal cord ischemia secondary to TACE is extremely rare and can lead to significant morbidity. We report a case of paraparesis caused by TACE with normal imaging and nerve conduction studies, suggestive of localized vasculitis.

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The recommended therapy for chronic hepatitis C (CHC) infection is the combination of a Pegylated interferon and Ribavirin. Almost all such patients on combination therapy experience one or more adverse events during the course of treatment. Significant neurological side effects are rare. A few cases of Bell's Palsy, chronic in flammatory demyelinating polyneuropathy and even one case of acute demyelinating polyneuropathy with atypical features for GuillainBarre syndrome (GBS) associated with Interferon therapy have been reported but no report of GBS with typical features has been published. We present a case report of typical GBS associated with Peginterferon alfa2a and Ribavirin used for treatment of CHC infection.