Background/AimsPercutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, no study has evaluated the safety of PEG tube placement in patients over the age of 100 years. MethodsWe conducted a retrospective review of patient records for patients who underwent PEG tube placement. Thirty patients aged 100 years and older were identified and a random sample of 275 patients was selected for comparison. ResultsThe mean age of the patients was 80.6±16.2 years. No procedure-related deaths or major complications were identified; the overall inpatient mortality rate was 7.6%. Minor complications were noted in 4% (n=12) of the patients. Centenarian patients were predominantly female (80% [n=24] vs. 54% [n=147], p=0.006), with a mean age of 100.5±0.9 years. There was no significant difference in procedural success rates (93.3% vs. 97.4%, p=0.222) or inpatient mortality (6.7% [n=2] vs. 7.7% [n=21], p=1.000) between the two groups. However, a higher minor complication rate was noted in the older patients (13.3% [n=4] vs. 2.9% [n=8], p=0.022). ConclusionsSuccess rates, major complications and inpatient mortality associated with PEG tubes in patients aged over 100 years are comparable to those observed in relatively younger patients at our center; however minor complication rates are relatively higher. These findings lead us to believe that PEG tubes may be safely attempted in carefully selected patients in this subset of the population.

Plasmacytoma is a neoplastic production of a single line of plasma cells, usually forming monoclonal immunoglobulin. It most often occurs in the bone marrow; however, in 3% of the cases, solitary extramedullary plasmacytoma arises, which is a proliferation in the soft tissue, outside the bone marrow. In only 10% of the cases is the gastrointestinal tract involved. A 77-year-old female presented with lethargy, abdominal fullness, bilious vomiting, and clay-colored stools. The patient was anemic with initial laboratory results showing increased total and direct bilirubin with elevated transaminases. Despite conservative management, liver function tests (LFTs) continued to increase. On endoscopic ultrasound (EUS), there was mild diffuse mucosal thickening consistent with possible infiltrative disease of the gastric body without any obvious focal lesions. There was a 1.7 cm × 1.8 cm hypoechoic heterogeneous lesion noted in the porta hepatis and fine needle aspiration (FNA) was performed. Cytology showed infiltrative plasma cells. The patient was then taken for computed tomography (CT)-guided biopsy of the liver. Pathology showed liver involvement by atypical plasma cells in a nodular and sinusoidal pattern. Immunohistochemical staining appropriately identified the solitary extramedullary plasmacytoma. Plasma cell neoplasm is essentially a clonal disease of differentiated B-cells that can encompass a broad spectrum and present as asymptomatic monoclonal gammopathy of undetermined significance to plasma cell neoplasms or multiple myeloma. Five percent of patients with multiple myelomas are diagnosed with extramedullary plasmacytomas, and even less than that are diagnosed as a primary lesion. When the liver is affected, either as a direct diffuse neoplastic plasma cell infiltration, or as a single or multiple space occupying lesion as plasmacytomas, symptomatic features include extrahepatic biliary obstruction, jaundice, or ascites. In our case, the patient was diagnosed via EUS-guided FNA (EUS-FNA) bringing to light an alternative method to its diagnosis.

Antiarrhythmic drugs are commonly prescribed cardiac drugs. Due to their receptor mimicry with several of the gastrointestinal tract receptors, they can frequently lead to gastrointestinal side effects. These side effects are the most common reasons for discontinuation of these drugs by the patients. Knowledge of these side effects is important for clinicians that manage antiarrhythmic drugs. This review focuses on the gastrointestinal side effects of these drugs and provides a detailed up-to-date literature review of the side effects of these drugs. The review provides case reports reported in the literature as well as possible mechanisms that lead to gastrointestinal side effects.

Bouveret syndrome, a rare cause of intestinal obstruction, occurs by passage of a gallstone through a cholecystoduodenal fistula into the intestinal lumen. Presenting symptoms are nausea, vomiting, and abdominal pain. In some cases, chronic symptoms result in weight loss. Typically, the syndrome is diagnosed via x-ray, ultrasound, or computed tomography. Treatment options are endoscopic or surgical. Endoscopic approaches include mechanical lithotripsy, electrohydraulic lithotripsy, stone extraction, laser lithotripsy, extracorporeal shockwave lithotripsy, and/or duodenal stenting. When stone fragments migrate distally, surgical removal becomes necessary. We describe a distinct endoscopic treatment via stone breakage, followed by pushing the fragments of the stone into the jejunum, resolving the intestinal obstruction.

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