Patients with coronavirus disease 2019 (COVID-19) have been presenting with varying signs and symptoms. The medical community is being updated with new knowledge about this disease daily. We present a case of intrahepatic hemorrhage in a patient diagnosed with C0VID-19 which we believe was caused by endothelialitis, which is a characteristic feature of COVID-19. Nevertheless, further continued studies are required to validate this point. We aim to educate the medical community about the possible complications by COVID-19 in the liver and highlight that N-acetylcysteine (NAC) may be a useful option in these cases.

Background and study aims Following colorectal surgery, anastomotic dehiscence and leak formation has an incidence of 2 % to 7 %. Endo-SPONGE has been applied in the management of anastomatic leaks (ALs) after colorectal surgery. This is the first systematic review and meta analysis to evaluate the efficacy and safety of Endo-SPONGE in the management of colorectal ALs. Patients and methods The primary outcomes assessed were the technical and clinical success of Endo-SPONGE placement in colorectal ALs. The secondary outcomes assessed were the overall adverse events (AEs) and the AE subtypes. Pooled estimates were calculated using random-effects models with 95 % confidence interval (C. I.). The statistical analysis was done using STATA v16.1 software (StataCorp, LLC College Station, Texas, United States). Results The analysis included 17 independent cohort studies with a total of 384 patients. The rate of technical success was 99.86 % (95 % CI: 99.2 %, 100 %; P = 0.00; I2  = 70.69 %) and the calculated pooled rate of clinical success was 84.99 % (95 % CI: 77.4 %, 91.41 %; P = 0.00; I2  = 68.02 %). The calculated pooled rate of adverse events was 7.6 % (95 % CI: 3.99 %, 12.21 %; P = 0.03; I2  = 42.5 %) with recurrent abscess formation and bleeding being the most common AEs. Moderate to substantial heterogeneity was noted in our meta-analysis. Conclusions Endoscopic vacuum therapy appears to be a minimally invasive, safe, and effective treatment modality for patients with a significant colorectal leak without any generalized peritonitis with high clinical and technical success rates and a low rate of adverse events. Further prospective or randomized controlled trials are needed to validate our findings.

Coronavirus disease 2019 (COVID-19), which is currently causing a global pandemic, is found to be associated with abnormal coagulation parameters and hyper-coagulable state with increased risk of venous thromboembolism (VTE). Here, we present two non-ICU cases of COVID-19, complicated with acute pulmonary embolism (PE). As of now, there are no proper guidelines established on anticoagulation in these patients. We discuss the pathophysiology and management strategy based on recently published studies on anticoagulation in COVID-19 patients.

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Background and Objectives: EUS-guided ethanol ablation has emerged as an alternative method for pancreatic lesions. Recently, paclitaxel was added to ethanol to assess ablative effects in pancreatic lesions. We performed a systematic review and meta-analysis on EUS-guided ethanol ablation (EUS E) versus EUS-guided ethanol with paclitaxel (EUS EP) ablation for the management of pancreatic lesions. Methods: Comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Google Scholar, and Web of Science databases (from inception to May 2020). The primary outcome evaluated complete ablation of the lesions radiologically and the secondary outcome evaluated adverse events (AEs). Results: Fifteen studies on 524 patients were included in our analysis. The pooled complete ablation rate was 58.89% (95% confidence interval (CI) = 38.72–77.80, I 2 = 91.76%) and 55.99% (95% CI = 44.66–67.05, I 2 = 0) in the EUS E and EUS EP groups ( P = 0.796), respectively. The pooled AE rates were 13.92% (95% CI = 4.71–26.01, I 2 = 83.43%) and 31.62% (95% CI = 3.36–68.95, I 2 = 87.9%) in the EUS E and EUS EP groups ( P = 0.299), respectively. The most common AE was abdominal pain at 7.27% (95% CI = 1.97–14.6, I 2 = 68.2%) and 12.44% (95% CI = 0.00–39.24, I 2 = 81.1%) in the EUS E and EUS EP groups ( P = 0.583), respectively. Correlation coefficient (r) was ‒0.719 ( P = 0.008) between complete ablation and lesion size. Conclusion: Complete ablation rates were comparable among both groups. AE rates were higher in the EUS EP group. Further randomized controlled trials are needed to validate our findings.

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