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APC can be useful in reducing the regained weight after RYGB, and patients showed 6-10% total weight loss at 12 months. Randomized trials would be needed to validate the findings.

Background and study aims  Obesity is a serious disease, resulting in significant morbidity and mortality. Intragastric balloons (IGBs) have been in use since the 1980s. After the insertion of an IGB, complications such as migration of the device and even severe gastric perforation can occur, requiring laparoscopic surgery. Here, we report three cases of gastric perforation after IGB insertion. In all three cases, the perforation was successfully repaired through an exclusively endoscopic approach.

Background Sleeve gastrectomy is a well-standardized surgical treatment for obesity. However, rates of weight regain after sleeve gastrectomy in long-term follow-up are relatively high. This multicenter study is the first to evaluate the use of an endoscopic sleeve gastroplasty (ESG) technique for the management of this population. Methods This was a multicenter retrospective study, including patients with weight regain following sleeve gastrectomy who underwent ESG for weight loss. Primary outcomes included absolute weight loss, percent total weight loss (%TWL), change in body mass index (BMI), percent excess weight loss (%EWL) at 6 and 12 months, and safety profile. Clinical success was defined as achieving ≥ 25 % EWL at 1 year, ≤ 5 % serious adverse event (SAE) rate following society-recommended thresholds, and %TWL ≥ 10 %. Results 34 patients underwent ESG after sleeve gastrectomy. Technical success was 100 %. At 1 year, 82.4 % and 100 % of patients achieved ≥ 10 %TWL and ≥ 25 % EWL, respectively. Mean (SD) %TWL was 13.2 % (3.9) and 18.3 % (5.5), and %EWL was 51.9 % (19.1) and 69.9 % (29.9) at 6 months and 1 year, respectively. Mean (SD) %TWL was 14.2 % (12.5), 19.3 % (5.3), 17.5 % (5.2), and 20.4 % (3.3), and %EWL was 88.5 % (52.8), 84.4 % (22.4), 55.4 % (14.8), and 47.8 % (11.2) for BMI categories of overweight and obesity class I, II, and III, respectively, at 1 year. No predictors of success were identified in the multivariable regression analysis. No SAEs were reported. Conclusion ESG appears to be safe and effective in the management of weight regain following sleeve gastrectomy.

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MBHs are rare benign liver lesions, also known as von Meyenburg complexes, and were first described in the early 20th century. They consist of multiple small interlobular biliary cystic lesions or hamartomas that are not connected to the main biliary tree. MBHs are the result of biliary ductal plate malformations during embryonic development. MBHs are usually asymptomatic and are found incidentally. It is key to differentiate MBHs from metastases, simple liver cysts, and Caroli's disease.MBHs are easily detectable on cross-sectional imaging, and a liver biopsy is usually not necessary. MRCP with contrast material reveals multiple small (<15-mm) irregular cystic liver lesions without attenuation or enhancement, and the extrahepatic and intrahepatic biliary trees are normal. By contrast, liver metastatic lesions and Caroli's disease show contrast enhancement. As seen in the case described here, MBHs can become infected, which can lead to cholangitis and lifethreatening septic shock, as seen in this case.Fewer than 15 MBH cases of cholangitis have been reported in the literature. The most common reported microorganisms are Escherichia coli, Enterococcus faecium, Enterobacter cloacae, and Klebsiella pneumoniae. Over 90% of reported cases of MBHs with cholangitis had a single cholangitis episode and responded to intravenous antibiotics. Notably, Panda et al reported a case of MBH that required liver transplantation for the treatment of recurrent cholangitis. Finally, MBHs are rare biliary duct congenital abnormalities that can be complicated by cholangitis, but they usually respond to antibiotics, and endoscopic or surgical interventions are generally not necessary in most instances.

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