Background and Aim: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. Methods:Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. Results: One hundred and nine consecutive patients under-went EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. Conclusions:Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.

The clinical presentation and evolution, neuropathological findings, and genotyping of three members of a Spanish family aVected with fatal familial insomnia are reported. The mother and two of her oVspring developed a rapidly evolving disease with insomnia and behavioural disorders as the initial symptoms and died between 5 and 10 months after the onset of the illness. Frontal brain biopsy in the mother disclosed only non-significant spongiosis, and full neuropathological examination of her oVspring showed thalamic and olivary degeneration with isolated focal cortical spongiosis. Genetic examination could only be performed in the contemporary patients and both harboured the prion protein (PrP) 178Asn mutation and homozygous 129 Met/Met genotype. (J Neurol Neurosurg Psychiatry 2000;68:774-777)

Apolipoprotein E-ɛ4 (ApoEɛ4 allele is a major risk factor of late-onset Alzheimer's disease (AD). We now report that: (1) this allelic variant is more frequent among patients with age-associated memory impairment (AAMI) than among healthy control subjects; (2) after a 3 year follow-up, those AAMI patients who developed dementia had ApoEɛ4 more frequently than those who did not; (3) ApoE allele distribution did not differ significantly between demented AAMI and late-onset AD patients. These results suggest that ApoEɛ4 predicts the development of dementia in AAMI patients, and that AAMI, an idiopathic amnesic syndrome of high prevalence among the elderly, and late-onset AD are different stages of the same disorder.

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