Fish-Bone Migration to the Liver Causing Hepatic Abscess: A Scoping Review of Published Cases (2015–2025)

Background: Foreign body ingestion is common; however, migration of an ingested fish bone into the liver with subsequent abscess formation is rare, frequently presents with nonspecific abdominal symptoms, and poses a diagnostic challenge in routine clinical practice, often leading to delayed diagnosis. Methods: A scoping review of PubMed, Google Scholar, SciELO, and ScienceDirect identified human case reports and case series (2015–2025) describing confirmed intrahepatic fish-bone migration or penetration causing hepatic abscess. Reports without radiologic or intraoperative confirmation and those involving non–fish-bone foreign bodies were excluded. Extracted data included demographics, migration routes, imaging findings, management, and outcomes. Results: Twenty-seven publications reporting 29 patients met the inclusion criteria, including 25 individual case reports and 2 case series. Presumed transgastric migration was reported in 22 patients (75.9%), and the left hepatic lobe was involved in 20 cases (69.0%). Computed tomography identified a linear radiodense foreign body in 24 patients (82.8%). Surgical or minimally invasive foreign-body removal was performed in 21 patients (72.4%), with generally favorable outcomes, although follow-up reporting was variable. Conclusion: Intrahepatic fish-bone migration is a rare but clinically important cause of hepatic abscess and should be considered in patients with unexplained, particularly left-lobe, hepatic abscesses when CT demonstrates a linear foreign body or when response to standard therapy is atypical; timely source control is usually effective

Biopsy-Detected Microscopic Colitis and Nonspecific Chronic Inflammatory Change in Patients with Chronic Diarrhea and Normal Colonoscopy: A Two-Case Series

Chronic diarrhea may occasionally persist despite macroscopically normal colonoscopy, and in selected patients, random colonic biopsy may reveal histologic abnormalities not apparent endoscopically. We report two illustrative cases of biopsy-detected microscopic or nonspecific inflammatory abnormalities in patients initially managed as having a functional bowel disorder.This retrospective descriptive case series included two adults identified during routine clinical practice over a recent two-year period (approximately 2024–2025) at a tertiary care hospital who underwent colonoscopy with random colonic biopsies despite macroscopically normal colonic mucosa, due to persistent diarrhea-predominant symptoms. Clinical follow-up was available for approximately six weeks in Case 1 and eight weeks in Case 2.In both patients, colonoscopy revealed macroscopically normal colonic mucosa, except for hemorrhoids. In Case 1, histopathology showed preserved crypt architecture, increased intraepithelial lymphocytes, and mild lamina propria inflammation, consistent with lymphocytic microscopic colitis. In Case 2, biopsy showed increased intraepithelial lymphocytes with chronic inflammatory infiltrates in the lamina propria, interpreted as nonspecific chronic inflammatory change. Both patients received colonic-release budesonide with short-term subjective symptomatic improvement on available follow-up.These cases illustrate that biopsy-detected microscopic or nonspecific inflammatory abnormalities may occasionally be identified in selected patients with persistent diarrhea and normal colonoscopy. They should not be interpreted as evidence of routine biopsy yield, but they support individualized biopsy decisions in carefully selected patients after exclusion of more common causes

The Liver-Heart Axis: A Narrative Review of Clinical Implications of the MASLD Redefinition for Internists

Introduction: Metabolically-dysfunction-associated steatotic liver disease (MASLD) represents a paradigm shift emphasizing the metabolic underpinnings of hepatic steatosis and its systemic consequences. MASLD carries a substantial cardiovascular burden. This review examines the clinical implications of the MASLD redefinition for internists, with particular focus on the liver-heart axis. Methods: We conducted a narrative review synthesizing evidence through December 2024. Literature searches were performed in PubMed, EMBASE, and Cochrane Library using terms including "MASLD," "nonalcoholic fatty liver disease," "metabolic dysfunction-associated steatohepatitis, "cardiovascular disease," and "cardiometabolic risk." Priority was given to systematic reviews, meta-analyses, and large prospective cohort studies. Results: MASLD is associated with increased risks of coronary artery disease, myocardial infarction, heart failure with preserved ejection fraction, atrial fibrillation, and cardiovascular mortality. These associations are mediated through insulin resistance, chronic inflammation, oxidative stress, atherogenic dyslipidemia, hepatokine dysregulation, gut-derived metabolites, and genetic determinants — though substantial residual confounding by shared cardiometabolic risk factors remains. Hepatic fibrosis stage emerges as a critical amplifier of cardiovascular risk. Integrated management requires systematic case-finding, fibrosis risk stratification using validated noninvasive tools, comprehensive cardiovascular assessment, intensive lifestyle intervention, and pharmacotherapy including incretin-based therapies, sodium-glucose cotransporter-2 inhibitors, and statins. Conclusions: Internists must adopt integrated approaches addressing both hepatic and cardiovascular manifestations of MASLD. The liver-heart axis requires recognition as an interconnected system, with cardiovascular risk management prioritized alongside hepatic care. While the MASLD nomenclature is intended to improve disease recognition and patient engagement, prospective validation of these anticipated benefits remains needed

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surpassed viral hepatitis as the primary driver of chronic liver disease globally. While traditionally viewed through the lens of hepatic progression, its clinical trajectory is increasingly defined by extrahepatic complications. Objective: This narrative review evaluates MASLD as a manifestation of systemic metabolic failure, specifically analyzing its role in accelerating cardiovascular dysfunction and extrahepatic carcinogenesis—the two principal causes of mortality in this population. Methods: A comprehensive literature synthesis was conducted from 2020 to December 2025, using databases including PubMed, Scopus, and the Egyptian Knowledge Bank (EKB) to identify high-impact studies and international guidelines. Results: The pathophysiology involves a metabolic cascade whereby hepatic lipid accumulation and insulin resistance trigger systemic inflammatory signaling. Disrupted lipid handling and genetic determinants promote pro-atherogenic and pro-oncogenic environments. The review advocates a transition to risk-stratified approaches using noninvasive biomarkers, such as the FIB-4 index. Conclusion: Addressing the bidirectional relationship between hepatic steatosis and systemic comorbidities requires a multidisciplinary therapeutic strategy. This framework provides a basis for early intervention to reduce the burden of cardiovascular events and malignancy among patients with MASLD

ERCP Timing in Gallstone Disease: A Meta-Analysis of One-Stage versus Two-Stage Strategies

Background: Cholecystocholedocholithiasis involves gallbladder and bile duct stones. Standard two-stage care involves ERCP followed by cholecystectomy, whereas single-stage intraoperative ERCP may streamline treatment. We performed a meta-analysis comparing stone clearance, complications, and hospital stay between single-stage and two-stage strategies. Method: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2025 for clinical studies comparing one-stage laparo-endoscopic rendezvous with two-stage ERCP + LC. RCTs and observational studies reporting stone clearance, complications, conversion, bile leaks, hospital stay, repeat ERCP, or cannulation failure were included. Data extraction and ROB2/NOS assessments were done independently. Result: Twenty-four studies met the inclusion criteria. The one-stage approach demonstrated significantly higher CBD clearance (96.5% vs. 91.8%; RR = 1.03) and a notably lower overall complication rate (11.55% vs. 19.56%; RR = 0.51). Postoperative pancreatitis (RR = 0.50), cholangitis (RR = 0.33), and bleeding (RR = 0.47) were also significantly reduced. Although conversion to open surgery and bile leak rates were lower in the one-stage group, these differences were not statistically significant. Importantly, single-stage management resulted in shorter hospital stays (mean difference = −3.23 days), fewer postoperative repeat ERCPs (RR = 0.21), and markedly reduced cannulation failure (RR = 0.26). Conclusion: The one-stage approach for managing bile duct stones offers higher clearance rates, fewer complications, and shorter hospital stays compared to the two-stage approach. These results support adopting one-stage treatment as a more effective and efficient clinical strategy

Annular Pancreas in Adults Presenting as Chronic Pancreatitis and Duodenal Obstruction: Literature Review and a Case Report

Background: Annular pancreas is a rare congenital anomaly with an estimated incidence of 3.4 per 1,00,000 live births. It is more commonly diagnosed in infants. Its occurrence in adults is exceptionally rare but clinically significant, as seen in our case, where it presented as a duodenal obstruction. Case presentation: We present a case of an adult male who presented with a 3-week history of projectile bilious vomiting associated with postprandial abdominal pain and early satiety. Imaging studies revealed a segment of the pancreas encircling the second part of the duodenum, along with pancreatolithiasis. Based on the diagnosis of annular pancreas with chronic calcific pancreatitis, the patient underwent pylorus-preserving pancreatoduodenectomy. Materials and Methods: A structured literature review was performed using PubMed and Scopus databases, covering the period from 2018 to 2024. A total of 24 case reports were analyzed. Results: The review confirms that annular pancreas remains a rare condition, often undiagnosed in asymptomatic individuals with abdominal pain (83.3%) and vomiting (41.6%) as the most common symptoms. The most common diagnostic modality is the CT scan (computed tomography), at 64.1%, and surgical procedures, such as gastrojejunostomy, are the most common treatment modality, at 46.5%.  Conclusions: It is a rare congenital condition that usually remains undiagnosed in asymptomatic individuals but typically presents with abdominal pain and vomiting when symptomatic. Diagnosis relies primarily on CT imaging. Conservative management is preferred for asymptomatic cases, and surgery is for symptomatic patients. Further research is needed to develop standardized management protocols

Efficacy and Safety of Tislelizumab in Combination with Chemotherapy versus Placebo Plus Chemotherapy in Patients with Advanced Gastric Cancer or Gastroesophageal Junction Cancer: A Systematic Review of Randomized Controlled Trials

Introduction: Advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC) is an aggressive malignancy often having a poor prognosis. Despite current systemic therapies, GC/GEJC remains the third most common cause of cancer-related deaths worldwide. Tislelizumab, an anti-PD1 antibody, has shown promising results in treating various cancers. Therefore, this systematic review investigated the efficacy and safety of tislelizumab plus chemotherapy for patients with GC/GEJC. Methods: Five databases were systematically searched until July 10, 2024. Articles identified in the screening process included two RCTs based on predefined inclusion criteria. We performed data extraction sheets and quality assessments using the Cochrane ROB2 tool. Results: Out of the two randomized controlled trials (RCTs), 1646 patients were included in our systematic review. In Rational-306, efficacy outcomes improved, overall survival (OS) significantly improved from 10.6 months (95\% CI 9.3–12.1) to 17.2 months (95\% CI 15.8–20.1), and progression-free survival (PFS) from 5.6 months (4.9–6.0) to 7.3 months (6.9–8.3). Rational-305 also notably significantly improved. Outcomes: Improved OS from 12.9 months (12.1-14.1) to 15 months (13.6-16.5), and PFS from 6.2 months (5.6 to 6.9) to 6.9 months (5.7 to 7.2). The proportion of patients with any grade 3 or worse treatment-related adverse events was similar between treatment groups. Conclusion: Compared with chemotherapy and placebo, Tislelizumab plus chemotherapy demonstrates superior efficacy with a similar safety profile in the two groups, encouraging the use of the tislelizumab group in patients with GC/GEJC

Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

Introduction: Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract, but it carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assess its efficacy and safety. Methodology: We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model. Results: The initial search retrieved 216 studies, and eight studies were included in the final analysis after screening. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol and Dexmedetomidine plus Midazolam revealed the same findings regarding restlessness and bradycardia compared to controls, which confirmed the adjunctive effects of Dexmedetomidine. Conclusion: Dexmedetomidine appears safe and effective as an adjunctive sedative in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may reflect reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations

Emphysematous Gastritis in a Patient with Concomitant COVID-19 Infection and Celiac Trunk Stenosis: A Case Report

This case report reviews a 75-year-old male with several comorbidities who presented with acute encephalopathy and sepsis in the setting of COVID-19 pneumonia, who was noted to have significant gaseous distention of the stomach, emphysematous gastritis (EG), and severe stenosis of the celiac trunk on initial CT imaging. He was treated with empiric IV antibiotics, including ceftriaxone and metronidazole, which were changed to intravenous piperacillin-tazobactam after 24 hours. After being evaluated by surgery and gastroenterology, it was determined that risks outweighed the benefits of EGD and surgical intervention as the patient had a labile hemodynamic status. After extensive goals of care discussions with the patient’s family, he was transitioned to comfort measures only on day 4 of admission and ultimately passed the same day due to cardiopulmonary arrest. EG is often diagnosed late in its course and is associated with extremely high mortality, even with surgical intervention. Evidence from recent case series suggests increasing success with conservative management in selected patients; there are no formal guidelines

Comparative Outcomes of Esophageal Stent Placement in Esophageal Cancer Patients: A Prospective Study of 183 Cases

Introduction: Esophageal stent placement is a vital, minimally invasive procedure for alleviating dysphagia and enabling smoother food passage. It offers immediate relief, reduces hospital stays, and enhances quality of life for high-risk patients. Effective for both malignant and benign conditions, stenting is cost-efficient and requires skilled professionals for optimal outcomes. This study examines outcomes of various stent types in esophageal cancer patients, evaluating efficacy, safety, and quality-of-life impacts. Methods: Between January and December 2022, 183 patients with esophageal cancer were enrolled from three tertiary healthcare facilities. Patients were divided into three groups based on the esophageal stent used: self-expanding metallic stents (SEMS, n = 84), self-expanding plastic stents (SEPS, n = 61), and fully covered self-expanding metallic stents (FCSEMS, n = 38). All stent placements were performed under endoscopic guidance, with follow-up assessments at 1 week, 1 month, 3 months, and 6 months to evaluate stent patency, dysphagia relief, and complications. Results: Technical success rates were high: SEMS 96.4%, SEPS 95.1%, and FCSEMS 97.4%. Immediate dysphagia relief occurred in 87.4% of patients. FCSEMS had a significantly longer median patency duration (8.0 months) compared to SEMS (6.3 months) and SEPS (5.6 months). Additionally, SEPS exhibited a higher migration rate (13.1%), while overall complications were noted in 18.0% of patients. Conclusions: Esophageal stent placement effectively palliates dysphagia in cancer patients. FCSEMS shows advantages with prolonged patency, yet careful stent selection is essential to optimize patient outcomes. These findings underscore the importance of individualized treatment planning and regular monitoring to achieve optimal outcomes