Kurdi, Ahmed T.

ABSTRACT The combination of cirrhosis and chronic pancreatitis is rare and poses increased risk of hemorrhage requiring close clinical monitoring. We present a patient with history of alcohol-associated cirrhosis and chronic pancreatitis who was admitted to the intensive care unit with clinical hemorrhage believed secondary to epistaxis. After initial delay, esophagogastroduodenoscopy ultimately found blood and clots evacuating through the ampulla consistent with hemosuccus pancreaticus confirmed with computed tomography angiography. The patient ultimately improved with coil and gel foam vascular embolization. This case highlights the dangers of early diagnostic closure and presents a rare finding of hemosuccus without pseudoaneurysm formation.

Lay Summary Inflammatory Bowel Diseases offers an editorial fellowship for GI and IBD fellows with a background in clinical, translational, and basic research and who are interested to experience the editorial process. Herein, the inaugural fellows compile their experience as a guide for future applicants on the fellowship’s responsibilities and highlights.

ABSTRACT The purpose of this case series is to review the endoscopic detection of anal intraepithelial neoplasia and anal squamous cell carcinoma including the role of rectal retroflexion and narrow-band imaging. Four cases of anal intraepithelial neoplasia were incidentally discovered in women aged 55–71 years. Anal lesions identified included sessile polyps, nodular mucosa, and circumferential polyps. A fifth patient, who presented with abdominal pain, was found to have a 3 cm anal squamous cell carcinoma on diagnostic colonoscopy, despite a negative colonoscopy 21 months earlier. In the absence of contraindications, retroflexion should be performed on all patients. Suspicious anal mucosa warrants biopsy.

AbstractBackgroundPatients with end‐stage heart failure frequently have significant congestive hepatopathy requiring hepatology assessment prior to heart transplantation listing. An elevated Model for End‐stage Liver Disease score with modification to exclude INR (MELD‐XI) has been associated with increased mortality following heart transplantation (HT). This study's primary aim was to examine whether Child‐Turcotte‐Pugh (CTP) classification is associated with post‐transplant mortality in patients bridged to transplant with left ventricular assist devices.Methods and ResultsWe conducted a retrospective analysis of 134 patients from our center. Age, CTP class, and MELD‐XI at HT were included in the multivariate model for the primary outcome, which demonstrated a significant association between 1‐year mortality and CTP class (CTP‐A HR: .08, CI .01–.46, P < .01; CTP‐B HR: .25, CI .05–1.2, P = .08; reference group CTP‐C), and MELD‐XI (HR: 1.15; CI: 1.03–1.28; P = .01), but no significant difference for age (HR: .97; CI: .93–1.01; P = .15). Only 13/33 patients with CTP improvement after assist device also had improvement in MELD‐XI.ConclusionsPatients with relatively low MELD‐XI scores with discordantly high CTP classification may be a distinct subset for whom MELD‐XI underestimates the risk of mortality after heart transplantation compared to CTP.