Introduction Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes. Methods Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed. Results Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy. Conclusions Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available.

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Objectives: In patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a shamcontrolled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis. Methods:The SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a multicenter, international, sham-controlled, randomized trial comparing endoscopic ultrasound + ERCP with miES vs. endoscopic ultrasound + sham for the management of ARP. A total of 234 consented patients having two or more discrete episodes of acute pancreatitis, pancreas divisum confirmed by magnetic resonance cholangiopancreatography, and no other clear etiology for acute pancreatitis will be randomized. Both cohorts will be followed for a minimum of 6 months and maximum of 48 months. Results:The trial is powered to detect a 33% risk reduction of acute pancreatitis frequency. Conclusions:The SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up.

Since it was first reported in December 2019, the novel COVID-19 pandemic has infected 3,656,644 individuals worldwide and resulted in 256,736 deaths as of May 5, 2020. 1 In the United States, which is the current disease hotspot, 67,456 patients have died as of May 5, 2020, and it is projected that nearly 134,242 (range, 95,091-241,917) will die by August 1, 2020. 2 As the pandemic evolves globally, state and local governments, professional medical societies, and healthcare systems have developed strategies to prepare and respond to the surge of the pandemic. Despite these measures, healthcare personnel (HCP) carry a 3-fold greater risk of COVID-19 infection compared with the general population and represent 3% to 20% of all infections in hotspots. [3][4][5] To reduce transmissibility across patients and HCP, as well as to preserve critical healthcare resources, the Surgeon General, the Center for Medicare & Medicaid Services, and many professional medical societies, including those in gastroenterology, have recommended postponing all elective surgeries and procedures (at the time of writing this manuscript). 6 In the absence of a proven vaccine, effective therapy, or widely available testing for early identification and isolation of new cases, social distancing has prevailed as the main public health intervention and may become a prolonged "new normal." Therefore, HCP needs to adapt to these rapidly evolving policies in all medical subspecialties and be prepared for a surge of COVID-19 cases in their healthcare facilities. In this article, we will focus on the impact of COVID-19 in the endoscopic management of pancreatobiliary disorders.