Mitsuhashi, Shuji

Malignant hilar biliary obstruction (MHBO) is most commonly caused by cholangiocarcinoma or gallbladder cancer and frequently presents with obstructive jaundice, pruritus, and/or cholangitis. These symptoms impair performance status and delay the initiation of chemotherapy, making biliary drainage essential for both palliation and oncologic treatment. Endoscopic transpapillary biliary stenting via endoscopic retrograde cholangiopancreatography is the standard approach for biliary decompression. In patients with unresectable disease, either plastic or self-expandable metal stents may be used. Optimal outcomes are achieved when drainage encompasses more than 50% of functional liver volume, while atrophic segments should be avoided. When transpapillary access is not feasible or unsuccessful, alternative approaches such as percutaneous transhepatic biliary drainage or endoscopic ultrasound-guided biliary drainage may be considered. Adjunctive therapies, including photodynamic therapy and radiofrequency ablation, are being investigated to enhance local tumor control and prolong stent patency. With continued advances in stent technology, imaging modalities, and endoscopic techniques, the management of MHBO is expected to become increasingly individualized and effective.

ABSTRACT Glucagon-like peptide-1 receptor agonists (GLP-1RA) are generally avoided in patients with a history of pancreatitis due to concerns about potential associated risk of acute pancreatitis (AP). However, their role in managing severe hypertriglyceridemia (HTG) remains underexplored. We present a case of a 42-year-old woman with recurrent HTG-induced AP who was initiated on GLP-1RA and achieved 15% weight loss, sustained triglyceride reduction, and remained AP-free while on that therapy. This case highlights a potential new role for the use of GLP-1RAs for HTG-AP.

AbstractInternational Statistical Classification of Disease and Related Health Problems, 10th Revision codes (ICD‐10) are used to characterize cohort comorbidities. Recent literature does not demonstrate standardized extraction methods. Objective: Compare COVID‐19 cohort manual‐chart‐review and ICD‐10‐based comorbidity data; characterize the accuracy of different methods of extracting ICD‐10‐code‐based comorbidity, including the temporal accuracy with respect to critical time points such as day of admission. Design: Retrospective cross‐sectional study. Measurements: ICD‐10‐based‐data performance characteristics relative to manual‐chart‐review. Results: Discharge billing diagnoses had a sensitivity of 0.82 (95% confidence interval [CI]: 0.79–0.85; comorbidity range: 0.35–0.96). The past medical history table had a sensitivity of 0.72 (95% CI: 0.69–0.76; range: 0.44–0.87). The active problem list had a sensitivity of 0.67 (95% CI: 0.63–0.71; range: 0.47–0.71). On day of admission, the active problem list had a sensitivity of 0.58 (95% CI: 0.54–0.63; range: 0.30–0.68)and past medical history table had a sensitivity of 0.48 (95% CI: 0.43–0.53; range: 0.30–0.56). Conclusions and Relevance: ICD‐10‐based comorbidity data performance varies depending on comorbidity, data source, and time of retrieval; there are notable opportunities for improvement. Future researchers should clearly outline comorbidity data source and validate against manual‐chart‐review.

AbstractCOVID‐19 has disproportionately affected low‐income communities and people of color. Previous studies demonstrated that race/ethnicity and socioeconomic status (SES) are not independently correlated with COVID‐19 mortality. The purpose of our study is to determine the effect of race/ethnicity and SES on COVID‐19 30‐day mortality in a diverse, Philadelphian population. This is a retrospective cohort study in a single‐center tertiary care hospital in Philadelphia, PA. The study includes adult patients hospitalized with polymerase‐chain‐reaction‐confirmed COVID‐19 between March 1, 2020 and June 6, 2020. The primary outcome was a composite of COVID‐19 death or hospice discharge within 30 days of discharge. The secondary outcome was intensive care unit (ICU) admission. The study included 426 patients: 16.7% died, 3.3% were discharged to hospice, and 20.0% were admitted to the ICU. Using multivariable analysis, race/ethnicity was not associated with the primary nor secondary outcome. In Model 4, age greater than 75 (odds ratio [OR]: 11.01; 95% confidence interval [CI]: 1.96–61.97) and renal disease (OR: 2.78; 95% CI: 1.31–5.90) were associated with higher odds of the composite primary outcome. Living in a “very‐low‐income area” (OR: 0.29; 95% CI: 0.12–0.71) and body mass index (BMI) 30–35 (OR: 0.24; 95% CI: 0.08–0.69) were associated with lower odds of the primary outcome. When controlling for demographics, SES, and comorbidities, race/ethnicity was not independently associated with the composite primary outcome. Very‐low SES, as extrapolated from census‐tract‐level income data, was associated with lower odds of the composite primary outcome.