We present the clinical case of a 39-year-old woman with a medical history of juvenile idiopathic arthritis and uveitis, evaluated for abdominal pain and distension, difficulty gaining weight, and diarrhea. Blood tests were requested, including antibodies which were negative and common genetic markers, showing positivity for HLA DQ 7.5. A gastroscopy with duodenal biopsies revealed findings consistent with stage 3b of the modified Marsh classification. Due to diagnostic uncertainty, an IEL study was performed, showing a characteristic CD pattern, leading to the initiation of a strict gluten-free diet (GFD). During follow-up, the patient showed partial improvement, with persistent digestive symptoms. A repeat endoscopic study revealed persistent atrophy, but refractory disease type 2 was ruled out. During a flare of rheumatologic disease, Tocilizumab was initiated by Rheumatology, resulting in improvement of duodenal atrophy.

We present the case of a 22-year-old patient with a relevant previous history of trichophagia (Rapunzel Syndrome) in adolescence who presented Giant Gastric Trichobezoar that required subtotal gastrectomy for its resolution.

We present the case of a 27-year-old man, with no previous diseases, who was referred to the Department of Otorhinolaryngology in May 2023 for a 2-cm right submandibular lymphadenopathy of two month's evolution. He did not report fever or night sweats, and no oral or genital ulcers were observed. He presented eosinophilia in the analysis performed and a maculopapular exanthema on the left leg and malleolus areas, which was initially treated with topical antibiotic and corticosteroids. A soft tissue ultrasound revealed two right laterocervical lymphadenopathies at levels I and II. Given the suspicion of a primary hematological tumor, a PET-CT scan was conducted to complete the study, which revealed hypermetabolic laterocervical bilateral lymphadenopaties. In June 2023, a programmed cervicotomy was conducted, with complete excision of the right main lymphadenopathy in the Ib region, which showed a histological result of reactive lymphadenitis with intense eosinophilia, vascular proliferation, and fibrosis. These findings suggest Kimura disease as the first possibility. Due to sporadic episodes of choking that were not associated with specific food, persistent elevated IgE levels and eosinophilia in peripheral blood tests, and skin alterations, the study was completed with a gastroscopy to rule out the presence of eosinophilic esophagitis, which showed erosive duodenitis, with villous shortening and increased lymphoplasmacytic cellularity of the lamina propria, findings consistent with celiac disease, which was afterwards confirmed with the presence of positive anti-endomysial and transglutaminase antibodies, and the presence of HLA-DQ8 positive in homozygosis in the genetic study. The patient started systemic treatment with corticosteroids and gluten-free diet, which he continues to take at present.

We present a rare case of ruptured pancreatic carcinosarcoma in a 56-year-old male who underwent radical surgery and adjuvant chemotherapy. Despite the typical poor prognosis associated with this aggressive tumor, the patient achieved an overall survival of 20 months postoperatively. This case emphasizes the challenges in diagnosing and managing pancreatic carcinosarcoma and highlights the potential benefits of aggressive surgical and chemotherapeutic interventions in achieving extended survival.

We present the case of a 64-year-old male diagnosed with corticosteroid-dependent ulcerative colitis in 1999, who underwent total proctocolectomy with a J-pouch in 2005. Three years later, he developed recurrent histologically confirmed pouchitis, with clinical worsening. Several therapies were tried, including Infliximab, which provided stability for six years, until the development of antibodies led to moderate pouchitis in the rectal stump. Attempts with Adalimumab, Vedolizumab, and Ustekinumab failed, leading to worsening cuffitis, pouchitis, and anastomotic stenosis. Tofacitinib was started at 10 mg/12h, leading to a >50% reduction in fecal calprotectin and a PDAI drop from 4 to 0 within four weeks. After reducing the dose to 5 mg/12h, disease control was maintained, and the patient remains asymptomatic after two years and seven months, with normal colonoscopy findings showing complete mucosal healing. Despite advances in treatment, around 15% of ulcerative colitis patients require surgery, and 30-50% of those develop acute or chronic cuffitis or pouchitis. Tofacitinib, a JAK inhibitor, is approved for ulcerative colitis but has shown inconsistent results in treating pouchitis and cuffitis. While some studies report a lack of efficacy, others show potential responses in refractory cases. More research with larger patient cohorts is needed to better understand the role of JAK inhibitors in this context.

Amoebiasis is an infection caused by the intestinal protozoan Entamoeba histolytica. It is transmitted via the faecal-oral route and primarily affects the intestinal tract and the liver. It is prevalent in tropical countries but is uncommon in Europe, where it is typically diagnosed in immigrants and tourists from endemic regions. However, an increase in autochthonous cases is being observed in Spain. A case is presented of a 56-year-old Spanish male with no relevant epidemiological history who attended the Emergency Department due to right hypochondrial pain and fever. An abdominal CT scan revealed circumferential mural thickening in the caecum and a large cystic mass in the right hepatic lobe. The study was completed with a colonoscopy, which showed ulcers with an infectious appearance in the caecum and right colon (biopsies were non-diagnostic), and an abdominal ultrasound, which characterised the hepatic lesion as an abscess. An ultrasound-guided drainage was performed and a sample was sent to Microbiology, which tested positive for Entamoeba histolytica. He received empirical antibiotic therapy with ceftriaxone and metronidazole, resulting in a favourable clinical outcome.

Recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. Our study aimed to analyze the recurrence risk factors for advanced adenomas and investigating the difference from any polyp recurrence.

Esophagitis dissecans superficialis (EDS) is an uncommon condition that is infrequently associated with autoimmune dermatoses. We present the case of a 75-year-old patient who developed EDS secondary to bullous pemphigoid after vaccination against SARS-CoV-2, with typical endoscopic and histological findings.

A 71-year-old male patient with a history of bladder neoplasia underwent Bricker-type surgery, during which an iatrogenic rectal injury occurred. During surgery, an unsuccessful suture attempt was made, leading to the appearance of fecaluria after 48 hours. A computed tomography scan revealed a small continuity defect in the rectal wall, accompanied by a 25-mm adjacent collection. Percutaneous drainage was placed in an attempt to achieve spontaneous closure, but this was unsuccessful. A rectoscopy was performed, identifying a wall defect in the mid-rectum. A review with a paediatric gastroscope confirmed communication to a cavity drained by urethra (recto-urethral fistula). Endoscopic vacuum therapy (EVT) (Endo-SPONGE®, B.Braun; Melsungen, Hesse, Germany) was initiated, achieving negative pressures (KCI Acelity V.A.C.® ATS® Negative Pressure Wound Therapy Unit; -100 mmHg). An endoscopic review after 72 hours confirmed the appearance of granulation tissue and the initiation of cavity closure. After three replacements (a total of four sponges), cavity collapse was achieved, but complete closure of the orifice was not attained. An over-the-scope clip (OTSC® 11.5-14 mm type-t, Ovesco; Tübingen, Baden-Wurttemberg, Germany) was placed, but fecaluria persisted, albeit with lesser intensity. Ultimately, successful closure was achieved by placing a second over-the-scope clip, two conventional hemoclips (Novaclip-R3 16 mm, Vytil; Hangzhou, Zhejiang, China), and instilling endoscopic biodegradable cyanoacrylate adhesive (Glubran® 2, GEM; Viareggio, Lucca, Italy).

A 64-year-old man was admitted to the hospital due to "recurrent abdominal pain for 8 months" and had a history of multiple episodes of pancreatitis. CT scan showed an enlarged pancreas with no normal pancreatic tissue . Contrast enhancement scan in the arterial phase displayed moderate enhancement in the solid portion, while the cystic necrosis area showed no enhancement. It was suspected to be pancreatic cancer, and laparoscopic exploration of the pancreas followed by partial pancreatectomy was performed. Finally, it was confirmed as pancreatic squamous cell carcinoma by immunohistochemistry (P63 (+), CK5/6 (+)). Seven days after the operation, F18-FDG PET/CT showed multiple soft tissue density masses in the upper abdominal wall along the laparoscopic trajectory with increased uptake.

The incidence of hilar cholangiocarcinoma is (1-2) / 100,0001. Due to the high location of obstruction, the treatment of hilar cholangiocarcinoma is complicated, especially for patients with gastrointestinal surgery. The traditional ERCP technique is to find a way to place more stents to treat obstructive jaundice. When ERCP fails, (Percuteneous transhepatic cholangial drainage, PTCD) is often chosen, but the effect is not ideal. The reason is that patients do not want to carry a drainage tube, which affects the quality of life of patients. Secondly, PTCD technology is bile external drainage technology, which will affect the balance of water and electrolytes in the patient's body, and the patient's appetite will also decrease. Here, we provide a bridge technique of EUS-BD to solve the problem of simultaneous drainage of left liver and right liver with a stent, in order to provide a new treatment idea for endoscopists.

Preoperative rehabilitation, or prehabilitation, plays a crucial role in improving outcomes for patients undergoing complex surgeries like pancreaticoduodenectomy. In the article "Prehabilitation in Patients Undergoing Pancreaticoduodenectomy: A Randomized Controlled Trial" by Ausania et al., valuable insights are provided into this emerging field. However, key methodological details, such as the randomization process and allocation concealment, were not fully described. Randomization and allocation concealment are essential in randomized controlled trials to prevent selection bias and ensure valid, unbiased results. Without proper allocation concealment, the trial's outcomes may be skewed, overestimating treatment effects. This paper underscores the importance of transparent reporting of these processes to maintain scientific rigor and enhance the reliability of study findings.

Pneumatosis intestinalis is a rare disorder that can be secondary to a variety of causes among which includes oncological treatment. Most cases due to oncological treatment are reported with targeted therapy but there is growing number of cases secondary to tyrosin kinase inhibitors that includes Lenvatinib which it can be used in the treatment of hepatocarcinoma.

Extrahepatic metastases in hepatocellular carcinoma (HCC) often signify a poor prognosis. This case details the five-year survival of a patient with HCC and adrenal metastasis managed with an aggressive multimodal approach, including ablation, systemic therapy, and surgical resection. Despite therapeutic advances, metastatic HCC management remains a clinical challenge, underscoring the need for individualized treatment strategies beyond traditional staging systems. Further research is essential to determine the role of surgical resection and other treatment modalities in the metastatic setting.

This case involves a 69-year-old female with a history of Roux-en-Y gastric bypass who presented with gastric outlet obstruction of the excluded stomach, secondary to pancreatic cancer with malignant duodenal stenosis and confirmed liver metastasis. The excluded stomach was significantly dilated, posing a high risk of perforation.

Early liver transplantation for severe alcohol-associated hepatitis represents a transformative therapeutic approach that can significantly improve survival and achieves standard survival after LT compared to other indications. Early evaluation and an adequate selection of candidates, including organic and psychosocial criteria, are essential. Multidisciplinary management, including the addiction team for the treatment of alcohol use disorder, decreases the risk of alcohol relapse after liver transplantation and is associated with improved outcomes.

We present the case of a patient who presents a duodenal perforation after placement of a plastic biliary stent due to pancreatic head neoplasia, who underwent endoscopic removal of the biliary stent and closure of the perforation with OTSC.

Plummer-Vinson syndrome (PVS) is a rare disorder characterized by a triad of iron-deficiency anemia, cervical dysphagia, and post-cricoid esophageal webs. The exact relationship between anemia and web formation remains unclear, with current hypotheses lacking strong evidence. Although treating anemia generally resolves dysphagia, some cases require endoscopic intervention. PVS is considered a precancerous condition due to its association with squamous cell carcinoma of the hypopharynx or upper esophagus. We present the case of a 53-year-old woman with psoriatic arthritis who exhibited iron-deficiency anemia unresponsive to oral iron and persistent dysphagia. Gastroscopy revealed esophageal narrowing, and she underwent successful balloon dilation following iron therapy. The patient is now asymptomatic. While the etiopathogenesis of PVS remains unknown, autoimmune conditions may play a role. Due to its potential link to neoplastic lesions, recognizing and managing PVS is critical. Further research is required to improve understanding and identify those at risk.

Diagnosing perihilar cholangiocarcinoma can be challenging. Previous studies suggest that the sensitivity of taking three cholangioscopy-guided biopsies is approximately 70%. We hypothesized that obtaining four or more biopsies might improve the sensitivity for diagnosing perihilar cholangiocarcinoma.

A 64-year-old man was admitted for hematemesis. Esophagogastroduodenoscopy revealed a gastric ulcer with a visible vessel on the posterior wall of the gastric body. After admission, the patient developed multiple episodes of massive hematemesis. During emergent esophagogastroduodenoscopy, he developed hemodynamic instability due to spurting bleeding. On day 18 of hospitalization, hemostasis was achieved using hemostatic forceps; however, contrast-enhanced computed tomography performed on the same day revealed a small splenic artery pseudoaneurysm (SAP) that had not been previously detected. To prevent fatal re-bleeding, interventional radiology was performed, and coil embolization was applied proximal to the pseudoaneurysm. The patient recovered without further hematemesis. One month later, exposed coils were observed from the healing ulcer, and celiac trunk angiography confirmed splenic artery thrombosis. Despite multiple attempts at endoscopic intervention, the patient developed recurrent hematemesis, suggesting that the gastric ulcer had eroded into the splenic artery, forming the SAP and causing significant hemorrhage. Although SAPs secondary to gastric ulcers are extremely rare, early recognition is critical because they carry a high risk of rupture and mortality. Endoscopic procedure alone may be insufficient, and an endovascular approach is a standard treatment to prevent life-threatening re-bleeding.

A 67-year-old male was admitted to our hospital with a diagnose of a <1-cm clear dehiscence orifice at the gastroesophageal anastomosis. Considering of the cachexia state and the size of fistula, a new endoscopic clipping therapy, called mucosal incision-assisted closure with clips, was performed. The procedure as follows: First, used electrotome to puncture and destroy the epithelium of the fistula mouth. Then, mucosal incision was performed at the the proximal end of the fistula. Finally, one leg of the clip inserted into the dissected mucosa, and another leg was clamped to the fistula's opposite side to directly close the anastomotic defect. The whole process was finished in just a few minutes. After the operation, adequate nutrition and antibiotic support were given. The patient recovered rapidly and was discharged after 14 days without any complication. This successful case confirmed that mucosal incision-assisted closure with clips is a potentially viable and tight option for sealing esophageal leak, with excellent clamping and closing force.