The Effect of Statin Therapy on the Incidence of Infections: A Retrospective Cohort Analysis

Statins have been postulated to prevent infection through immunomodulatory effects

Access fistulotomy: technical tips for success

Background and Aims: Biliary cannulation, although critical to procedural success in ERCP, can be difficult and, if unsuccessful, can lead to longer hospital stays, repeat procedures, and increased costs. Expertise in adjunct techniques, including access fistulotomy, can increase success rates and potentially avoid these issues. The aim of this case series is to describe the technique of access fistulotomy and illustrate key points that are important for successful biliary access. Methods: Three cases are reviewed in which access fistulotomy was used to achieve biliary access. The steps for the procedure are reviewed, and key technical tips and anatomic landmarks are illustrated in the video. Results: Successful biliary access is obtained using fistulotomy in 3 cases. In each case, the anatomic landmarks of the papilla and intraduodenal biliary segment are reviewed. The first case illustrates a large papilla in which initial incision followed by careful exposure reveals a clear “onion ring” structure corresponding to the bile duct. The second case requires stepwise incision, each guided by anatomic landmarks before the biliary adventitia is identified, leading to biliary cannulation. In the third case, the utility of fistulotomy in a duodenal diverticulum is illustrated. Recognition of the distorted anatomy allowed precise, careful incision leading to biliary access. Conclusions: Access fistulotomy is an invaluable technique to aid in biliary access. Knowledge of key landmarks and careful evaluation of the incision are critical to successful biliary access when performing fistulotomy

Endoscopic ultrasound‐guided portal pressure gradient identifies patients with previously undiagnosed clinically significant portal hypertension

Abstract Aims Portal hypertension (PH) is a complication of cirrhosis that leads to hepatic decompensation. Assessing the portal pressure gradient (PPG) provides valuable information for disease assessment, staging, and prognosis. In this study, we aimed to report the utilization of endoscopic ultrasound (EUS)‐guided PPG (EUS‐PPG) measurements in a real‐world setting. Methods This retrospective analysis included patients at a tertiary care center who underwent EUS‐PPG between February 2021 and May 2022. The most common indication was to establish or exclude the diagnosis of cirrhosis, followed by an assessment of surgical risk in the setting of suspected cirrhosis. Extensive demographic and clinical data were collected, and statistical analysis was performed using the Student's t test. Results Eighteen patients underwent EUS‐PPG. Technical success was achieved in 17 of the 18 patients. No complications were observed. The mean scores of Child‐Pugh, Model for End‐Stage Liver Disease‐Sodium, and Fibrosis‐4 scores were 5.1 ± 0.5, 9.0 ± 3.0, and 3.7 ± 4.5, respectively. Of the 18 patients, two presented with esophageal varices and six with portal hypertensive gastropathy. The mean PPG was 5.8 ± 4.5 mmHg, and five patients exhibited clinically significant PH (CSPH). Of the 18 patients, 15 underwent concurrent EUS‐liver biopsy, which was 100% successful and provided diagnostic histology for all patients. The PPG data led to changes in the clinical management of 17 patients. Conclusions EUS‐PPG is safe and technically feasible. The Child‐Pugh score did not correlate well with the presence of CSPH; however, PPG measurements resulted in changes in the management of almost all patients. Larger studies correlating EUS‐PPG with other assessments of liver diseases are required

The Effect of Statin Therapy on the Incidence of Infections: A Retrospective Cohort Analysis

INTRODUCTION: Statins have been postulated to prevent infection through immunomodulatory effects. OBJECTIVES: To compare the incidence of infections in statin-users to that in non-users within the same healthcare system. METHODS: This was a retrospective cohort study of patients enrolled as Tricare Prime or Plus in the San Antonio military multi-market. Statin-users were patients who received a statin for at least 3 months between 10/1/2004 and 9/30/2005. Non-users were patients who did not receive a statin within the study period (10/1/2003 to 9/30/2009). Inpatient and outpatient International Classification of Diseases, 9(th) Revision, Clinical Modification (ICD-9-CM) codes were used to determine the incidence of infections during the follow-up period (10/1/2005 to 9/30/2009) via multivariable regression analysis and time to infection via Cox regression analysis. RESULTS: Of 45,247 patients who met the study criteria, 12,981 (29%) were statin-users and 32,266 were non-users. After adjustments for age, gender, Charlson Comorbidity Score, tobacco use, alcohol abuse/dependence, health care utilization, and use of specific medication classes, statin use was associated with an increased incidence of common infections [odds ratio (OR): 1.13; 95% CI: 1.06–1.19], but not influenza or fungal infections (OR: 1.06, 95% CI: 0.80–1.39; OR: 0.97; 95% CI: 0.91–1.04, respectively). Time to first infection was similar in statin-users and non-users in all infection categories examined. CONCLUSION: Statin use was associated with an increased incidence of common infections, but not influenza or fungal infections. This study does not support a protective role of statins in infection prevention; however, the influence of potential confounders cannot be excluded