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Overlap syndrome indicates the coexistence of 2 or more autoimmune liver diseases in the same individual, occurring simultaneously or sequentially. Cases of overlap of autoimmune hepatitis (AIH) with primary biliary cholangitis (PBC) and of AIH with primary sclerosing cholangitis (PSC) are known and have defined criteria for diagnosis. Overlap between PBC and PSC has been reported in only a few case reports. The cause for the rarity of this entity compared to other overlap syndromes is unclear. We present a case of an overlap syndrome of PBC with PSC in a 35-year-old woman.

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The International Study Group of Liver Surgery has defined bile duct leak (BDL) as "fluid with an increased bilirubin concentration in the abdominal drain or in the intra-abdominal fluid or as the need for radiologic intervention because of bil-iary fluid collection or re-laparotomy resulting from bile peritonitis". 1 Bile leak is commonly associated with surgeries (such as cholecystectomy, liver transplantation, partial hepatectomy, and hydatid cyst excision). However, it may also occur secondary to various necro-inflammatory conditions involving the liver. The most frequent cause of bile leak is iatrogenic, and cholecystectomy is the most common procedure associated with this condition. Bile leak occurs in 0.1%-0.5% of patients who underwent open cholecystectomy. 2,3 Approximately 0.5%-2% of patients who underwent laparoscopic cholecystectomy can develop bile leak, with the majority arising from the cystic duct stump. 4-6 The clinical presentation of bile leak varies from asymptomatic drainage of bile to life-threatening conditions including biliary peritonitis. Thus, bile leak can be associated with significant morbidity and can lead to death if left untreated. The communication between the biliary tree and amoebic liver abscess is observed in up to 27% of cases, and it commonly presents with jaundice and has a longer duration. 7 In

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin-and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and October 2021 was performed of various databases for comparative studies evaluating the outcomes of thin-versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

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