Background and Aims: Sleeve gastrectomy (SG) has become significantly more common in recent years. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is the major risk factor for Barrett's esophagus (BE). We aimed to assess the prevalence of BE in patients who had undergone SG. Methods: We searched the major search engines ending in July 2020. We included studies on patients who had undergone esophagogastroduodenoscopy (EGD) after SG. The primary outcome was the prevalence of BE in patients who had undergone SG. We assessed heterogeneity using I 2 and Q statistics. We used funnel plots and the classic fail-safe test to assess for publication bias. We used random-effects modeling to report effect estimates. Results: Our final analysis included 10 studies that included 680 patients who had undergone EGD 6 months to 10 years after SG. The pooled prevalence of BE was 11.6% (95% confidence interval [CI], 8.1%-16.4%; P < .001; I 2 Z 28.7%). On logistic meta-regression analysis, there was no significant association between BE and the prevalence of postoperative GERD (b Z 3.5; 95% CI, À18 to 25; P Z .75). There was a linear relationship between the time of postoperative EGD and the rate of esophagitis (b Z 0.13; 95% CI, 0.06-0.20; P Z .0005); the risk of esophagitis increased by 13% each year after SG. Conclusions: The prevalence of BE in patients who had EGD after SG appears to be high. There was no correlation with GERD symptoms. Most cases were observed after 3 years of follow-up. Screening for BE should be considered in patients after SG even in the absence of GERD symptoms postoperatively. (Gastrointest Endosc 2021;93:343-52.)

IntroductionPancreas cysts (PCs) are being diagnosed with increasing frequency given the widespread use of cross-sectional imaging in our health care system [1]. PCs can be broadly categorized as either non-neoplastic or neoplastic, with the latter being estimated as high as 13.5 % in the general population [2]. Accurate diagnosis and risk stratification of neoplastic cysts are crucial as to provide guidance for the most appropriate management strategy.The optimal diagnostic approach to PCs remains unclear as there is currently no single test that can reliably differentiate non-neoplastic PCs from those lesions with malignant potential or harboring malignancy. Given the well-recognized limitations of imaging alone [2-4], EUS-guided fine-needle aspiration (EUS-FNA) for cytology and cyst fluid analysis is the commonly performed guideline endorsed test for aid with diagnosis and risk stratification [4][5][6][7][8][9][10]. FNA cytology is often limited by the scant cellularity within the cyst fluid [11,12]. While cyst fluid carcinoembryonic antigen (CEA) has been traditionally used to differentiate mucinous versus non-mucinous PCs [13], it has ABSTR AC T Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-theneedle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs. MethodsComprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB. Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7-15.4]; I 2 = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0-7.4], I 2 = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5-52.3]; I 2 = 48), for a MC (OR: 8.9; 95 % [CI: 1.9-40.8]; I 2 = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9-36.9]; I 2 = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4-97.6]; I 2 = 36.5 %) and 94 % (95 % CI: [81.5-99.7]; I 2 = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3-14.1]; I 2 = 82.9).Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in riskstratifying MCs and providing a specific cyst diagnosis. Supplementary materialOnline content viewable at: https://doi.

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Hepatocellular carcinoma is the most common primary liver malignancy and is a common indication for liver transplantation. To qualify for liver transplantation, the size and number of tumors must be within established criteria. The Milan criteria is the most well-established of these criteria, however there is evidence these criteria can be safely expanded without affecting outcomes. While awaiting liver transplantation, locoregional therapy can be used as bridging therapy to maintain the tumor burden within criteria. Locoregional therapy can also be used to decrease tumor burden within transplant criteria, a process called downstaging. For tumors <3 cm, thermal ablation-most commonly using a radio-frequency probe-is preferred when feasible and offers tumor control approaching that of resection. Larger or multifocal lesions are usually treated with either trans-arterial chemoembolization or yttrium-90 trans-arterial radioembolization. The choice between these two interventions is generally based on institutional preference as neither has demonstrated survival advantage in the transplant population. However, single center trials show longer time to progression, improved downstaging success, and less microvascular invasion in patients treated