Thursday 15 September
08:00

Thursday 15 September

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EUS22-01
08:00 - 08:45

Registration & Welcome

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Thursday 15 September

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EUS22-02
08:45 - 10:30

LIVE DEMO 1

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
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Thursday 15 September

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EUS22-03
10:30 - 11:00

Coffee Break

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11:00

Thursday 15 September

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Eus22-04
11:00 - 13:00

LIVE DEMO 2

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
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Thursday 15 September

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EUS22-05
13:00 - 14:00

LUNCH BREAK

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14:00

Thursday 15 September

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EUS22-06
14:00 - 16:00

LIVE DEMO 3

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
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16:00

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EUS22-07
16:00 - 16:30

Coffee Break

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16:30

Thursday 15 September

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EUS22-08A
16:30 - 17:30

LIVE DEMO 4

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
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17:30

Thursday 15 September

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EUS22-08B
17:30 - 18:30

Oral Communications

Moderator: Erwan BORIES (Marseille, France)
17:30 - 17:40 #32734 - OC01 Endoscopic Treatment of Pancreatic Duct Disruption and Fistulas after Surgery, Pancreatitis, Abdominal Trauma: a tertiary center retrospective study.
Endoscopic Treatment of Pancreatic Duct Disruption and Fistulas after Surgery, Pancreatitis, Abdominal Trauma: a tertiary center retrospective study.

Background and study aims: Main pancreatic duct (MPD) disruption and fistulas can occur

after pancreatic surgery, abdominal trauma, acute or chronic pancreatitis. Unlike endoscopic

transpapillary drainage, experience in the management of these conditions with EUS-guided

procedures is not well reported. We aimed to determine technical and clinical success of

endoscopic techniques used in MPD disruption management. Methods: 33 patients

endoscopically treated for MPD disruption between 2015 and 2021 were retrospectively

analyzed. The primary endpoint was to evaluate clinical and technical efficacy. Secondary

endpoints were occurrence of minor and major procedure-related adverse events. Results:

Clinical success was observed in 87.9% (n=29) of patients and technical success in all

cases. Endoscopic techniques for MPD disruption included ERCP (n=17, 51.5%),

EUS-guided cystogastrostomy (n=8, 24.2%), combination of the two techniques (n=2, 6.1%),

EUS-guided pancreaticogastrostomy (n=5, 15.2%) and EUS-guided rendezvous technique

(n=1, 3%). Peripancreatic fluid collection was observed in 20 patients (60.6%) and

were mainly treated by EUS-guided cystogastrostomy and ERCP. Minor complication

occurred in two patients (6%) and major complication in one patient (3%). Conclusions:

Endoscopic treatment for management of MPD disruption shows an excellent clinical and

technical efficacy with a good safety profile. Emergent techniques using EUS broaden the

therapeutic possibilities in this indication and should be the first treatment option in defined

clinical presentations.


Louison TAMBWE* (Lausanne, Switzerland), Sarra OUMRANI*, Domenico GALASSO, Elodie ROMAILLER, Mariola MARX, Robert MAXIME, Greuter THOMAS, Godat SÉBASTIEN
17:40 - 17:50 #32649 - OC02 EUS-guided versus PTC-guided rendezvous in case of failed biliary cannulation by ERCP: a case-control study.
OC02 EUS-guided versus PTC-guided rendezvous in case of failed biliary cannulation by ERCP: a case-control study.

Background

Endoscopic ultrasound-guided rendezvous (EUS-RV) is an alternative salvage technique to percutaneous transhepatic cholangiography rendezvous (PTC-RV) for biliary cannulation in failed ERCP.  Comparative data on these two techniques are lacking.

Methods

A case-control study was conducted in a tertiary referral center. All consecutive patients that underwent a rendezvous procedure between 2014 and 2022 for failed biliary cannulation were included. Patients that underwent PTC-RV (between February 2014 and February 2018) were compared to those who underwent EUS-RV (between March 2018 and March 2022). The primary endpoints of interest were technical success rate and complication rate. 

Results

A total of 59 consecutive procedures in 57 patients were included for analysis; 20/59 (33.9%) were PTC-RV; the remaining 39/59 (66.1%) procedures were EUS-RV. Two patients in the PTC-RV group underwent two procedures. Of the PTC-RV procedures, 18/20 (90.0%) were technically successful, as compared to 28/39 EUS-RV procedures (71.8%) (p = 0.184; fig. 1).  Adverse events were reported in 7/20 PTC-RV procedures (35.0%) and in 13/39 EUS-RV procedures (33.3%) (p= 1.000). In 5/20 PTC-RV procedures (25.0%) and 4/39 EUS-RV procedures (10.3%), the adverse event was considered major (defined as Clavien-Dindo classification of 3 or more) (p= 0.249).

Conclusions

EUS-RV has an acceptable success rate and is not associated with an increased risk of adverse events as compared to PTC-RV. 


Michiel HANSSENS, Elisabeth DHONDT, Helena DEGROOTE, Pieter HINDRYCKX (Ghent, Belgium, Belgium)
17:50 - 18:00 #32743 - OC03 EUS-guided portal pressure gradient measurement: our preliminary experience.
OC03 EUS-guided portal pressure gradient measurement: our preliminary experience.

AIMS. We report our experience on EUS-guided portal pressure gradient (EUS-PPG). METHODS. Patients were referred to a tertiary academic center for EUS-PPG. We used a 25G dedicated needle (EchoTip Insight™). The procedure was performed as previously reported. Deep sedation was administered by anesthesiogists. RESULTS. Fifteen patients (8 males/7 females), median age 52±13 yo) were referred for EUS-guided PPG measurement. Indications: assessment of NAFLD 11; idiophatic portal hypertension 2; evaluation for curative therapy in hepatocellular carcinoma 2. In 4 patients anticoagulants were withdrawn. Four patients were sedated without orothracheal intubation and 11 were intubated. Bilobar liver biopsies were also performed in 11 patients. PPG was successfully obtained in 13/15 patients (87%). The average time to obtain the PPG was 25±13 minutes (graphic). In 6 cases the PPG was ≥5 mmHg (one case shown esophageal varices with PPG of 16 mmHg), and 5 without varices with PPG ranging 5-10 mmHg. In 2 cases PPG was not obtained (for exacerbated breathing movements and non-reliable pressure measurements (probably for excesive bending of the echoendoscope and use of the elevator, see figure). In one case, chronic pancreatitis was diagnosed. Mean time for PPG plus bilobar hepatic biopsy was 49±11 minutes. No adverse events were registered inmediately and one month later. CONCLUSIONS. In our preliminary experience, EUS-guided PPG measurement seems safe providing useful clinical information.


Rafael ROMERO-CASTRO (SEVILLE, Spain), Isabel CARMONA-SORIA, Victoria Alejandra JIMENEZ-GARCIA, Patricia CORDERO-RUIZ, Francisco BELLIDO-MUÑOZ, Angel CAUNEDO-ALVAREZ
18:00 - 18:10 #32634 - OC04 Endoscopic Ultrasound-guided Rendezvous Technique for Treatment of Malignant Biliary Obstruction.
OC04 Endoscopic Ultrasound-guided Rendezvous Technique for Treatment of Malignant Biliary Obstruction.

ERCP is the first-line procedure for managing biliary obstructions, but it is not always feasible. Percutaneous transhepatic biliary drainage is a widely accepted alternative but it is associated with high mortality. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising and evolving alternative, being frequently used in benign and malignant biliary diseases with a high success rate and fewer complications. A 56-year-old male presents to the ER with abdominal pain, jaundice, pruritus, nausea and weight loss.Analytically: AST 89,ALT 292,ALP 425,GGT 1192,Bilirubin 8.65,Ca 19.9 16822.5. A TAP CT showed dilation of the intrahepatic bile ducts;hypodense pseudonodular filling of infiltrative suggestion in the hilar region and along the hepatic pedicle; multiple liver and lung metastases. An MRCP revealed a perihilar extrahepatic cholangiocarcinoma(Klatskin IIIa), with liver metastases and gallbladder invasion, inter-aorto-caval and hepatic hilum adenopathies and pulmonary metastasis. An Ultrasound-guided biopsy confirmed the diagnosis. Due to worsening of jaundice and nausea and given the extension of the billiary stenosis, it was decided to perform an EUS-BD using the Rendezvous technique (EUS-RV). The guidewire was introduced into the duodenum by transhepatic route after gastrohepatic puncture of the left lobe by echoendoscopy. Balloon dilation of the stenosis was performed and 2 self-expanding metallic protheses were placed.The procedure was uneventful and resulted in significant clinical improvement. EUS-BD is an effective, safe, and innovative technique for biliary drainage. It is primarily used as a rescue procedure but published data demonstrates some clinical advantages over ERCP. Because of difficultly in advancing the guidewire through malignant strictures, EUS-RV is preferred for managing benign conditions. EUS-BD is a complex and challenging procedure and requires careful patient selection, highly skilled endoscopists and specialized centers.


Inês PESTANA (Castelo Branco, Portugal), Marisa LINHARES, Diana RAMOS, Marco PEREIRA, Ana CALDEIRA, Rui SOUSA, Eduardo PEREIRA, António BANHUDO
18:10 - 18:20 #32552 - OC05 AN EXTENSIVE SYSTEMATIC REVIEW OF AN ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VERSUS PERCUTANEOUS TRANSHEPATIC CHOLANGIGRAPHY.
OC05 AN EXTENSIVE SYSTEMATIC REVIEW OF AN ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VERSUS PERCUTANEOUS TRANSHEPATIC CHOLANGIGRAPHY.

Aim:

Endoscopic ultrasound-guided biliary drainage (EUS–BD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract whereas Percutaneous transhepatic cholangiography (PTC) is a diagnostic and therapeutic procedure [1]. The present study examined the technical aspects and outcomes of these different approaches to biliary drainage.

Methods:

A search of different databases, including PubMed, Embase, clinicaltrials.gov, Cochrane Library, Scopus, and Google Scholar, was performed according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing percutaneous transhepatic biliary drainage (PTBD) and EUS–BD.

Results:

Six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions than EUS–BD patients (4.9 vs. 1.3), experienced more post-procedure pain (4.1 vs. 1.9), and had more late adverse events (53.8% vs. 6.6%). There was a significant reduction in total bilirubin in both groups (16.4 to 3.3 and 17.2–3.8 for EUS–BD and PTBD, respectively, P = 0.002) at the 7-day follow-up. There were no significant differences observed for complication rates between PTBD and EUS–BD (3.3 vs. 3.8). PTBD was associated with a higher adverse event rate than EUS–BD in all procedures, including reinterventions (80.4% vs. 15.7%, respectively) and a higher index procedure (39.2% vs. 18.2%, respectively).

Conclusions:

The findings of the present systemic review revealed that EUS–BD is linked with a higher rate of effective biliary drainage and manageable procedure-related adverse event profile compared with PTBD. These findings highlight the evidence for successful EUS–BD implementation.

References:

1- Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900 [PMID: 11571690 DOI: 10.1055/s-2001-17324]


Eyad Mohamed Osman GADOUR (Manchester, United Kingdom), Zeinab HASSAN
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20:00

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EUS22-08C
20:00 - 23:00

Gala Dinner

Friday 16 September
08:30

Friday 16 September

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EUS22-09
08:30 - 10:30

Session 1:
Pancreatic Cancer: What's new?

Moderators: Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France)
08:30 - 09:00 Pancreatic Cancer: EUS-FNA or EUS-FNB? Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain)
09:00 - 09:30 Pancreatic Cancer: ERCP or EUS-guided biliary drainage? Fauze MALUF-FILHO (sao Paulo, Brazil)
09:30 - 10:00 Pancreatic Cancer & duodenal stenosis: Endoscopic management of concomitant biliary and duodenal malignant obstruction? Jean Philippe RATONE (Marseille, France)
10:00 - 10:30 Is Surgery always needed after endoscopic ampullectomy for papillary adenocarcinoma ? Olivier TURRINI (surgeon) (marseille, France)
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Friday 16 September

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EUS22-10
10:30 - 11:00

Coffee Break

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11:00

Friday 16 September

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EUS22-11
11:00 - 12:30

Session 2
EUS advanced imaging and new therapeutic procedures

Moderators: Marc GIOVANNINI (Chef) (Marseille, France), Fauze MALUF-FILHO (sao Paulo, Brazil), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
11:00 - 11:30 Contrast Enhanced EUS & Elastography in 2022. Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain)
11:50 - 12:10 EUS guided gastric varice therapy: Is endoscopic route obsolete? Mostafa IBRAHIM (Egypt)
12:10 - 12:30 EUS guided RF ablation of small PNET: is surgery obsolete? Marc GIOVANNINI (Chef) (Marseille, France)
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EUS22-12
12:30 - 13:15

Industry Symposium - Pentax Europe

12:30 - 13:15 EUS-guided therapeutics for patients with altered anatomy. Schalk VAN DER MERWE (Leuven, Belgium), Helga BERTANI (Doctor) (Modena, Italy)
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13:15

Friday 16 September

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EUS22-13
13:15 - 14:15

Lunch Break

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14:15

Friday 16 September

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EUS22-14
14:15 - 15:00

Industry Symposium - Cook Medical

14:15 - 15:00 EUS-guided portal pressure measurement: A step closer to personalised care in portal hypertension. Wim LALEMAN (Leuven, Belgium)
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15:00

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EUS22-15
15:00 - 15:45

Session 3
Cholangiocarcinoma: How to manage ?

Moderator: Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain)
15:00 - 15:15 Is pre-operative drainage needed and how? Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy)
15:15 - 15:30 Role of ERCP in the management of non surgical Cholangiocarcinoma. Jacques DEVIÈRE (Chair of department) (Brussels, Belgium)
15:30 - 15:45 Role of EUS in the management of non surgical Cholangiocarcinoma. Fabrice CAILLOL (Marseille, France)
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EUS11-15B
15:45 - 16:30

Industry Symposium - BOSTON SCIENTIFIC
EUS-guided anastomoses by LAMS: where are we in 2022?

Keynote Speaker: Enrique PEREZ CUADRADO ROBLES (Paris, France)
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16:30

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EUS22-16
16:30 - 17:00

Coffee Break

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17:00

Friday 16 September

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EUS22-17
17:00 - 18:00

Oral Communications

Moderators: Fabrice CAILLOL (Marseille, France), Marc GIOVANNINI (Chef) (Marseille, France)
17:00 - 17:10 #32736 - OC07 Endoscopic ultrasound-guided pancreatic duct drainage: a single center observational study.
OC07 Endoscopic ultrasound-guided pancreatic duct drainage: a single center observational study.

Background and aims: Pancreatic duct (PD) obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by endoscopic retrograde pancreatography with dilatation of the PD and placement of pancreatic stents. However, in some patients, the classic transpapillary approach cannot be performed because of anatomical inability to access the papilla, rupture of the PD, intracanal lithiasis that cannot be crossed or tight stenosis due to extrinsic compression by parenchymal pancreatic calcifications. Endoscopic ultrasound-guided PD drainage (EUS-PDD) is an efficient and minimally invasive therapeutic possibility in these patients and constitutes an alternative to surgical management. We aimed to evaluate technical and clinical success of EUS-PDD.

Methods: Data of patients who underwent EUS-PDD in our center between 2016 and 2021 were retrospectively reviewed. Technical success was defined as successful stent placement in PD. Clinical success was defined as pain ≤2 on the Numerical Rating Scale (NRS, 0-10) and no recurrence of obstructive pancreatitis post procedure.

Results 38 patients (mean age 55.7 years, 71% male) were included. Indications of EUS-PDD were chronic calcifying pancreatitis in 71% of patients (74% due to alcohol abuse). Other indications included anastomotic stenosis or rupture of PD. The average intervention time was 50.4 minutes. Technical success was achieved in 89.5% of patients. Clinical success was 91.2%. Remaining pain NRS > 2 occurred in 8.8% of patients and obstructive pancreatitis recurrence in 8.8%. Three patients had pancreatitis recurrence, which was of alcoholic origin. Adverse event occurred in 11 patients (28.9%): stent migration without digestive perforation in 7 patients, stent migration with digestive perforation in 2 patients, hemorrhagic shock in 1 patient and increased post procedure pain in 1 patient. Among them, 7 patients were successfully treated by a new endoscopic procedure, 1 patient by surgical procedure, 1 patient by radiological procedure and 1 patient by hybrid radiological and surgical treatment. The average hospital stay was 2.5 days.

Conclusion EUS-PDD had a high technical and clinical success rate in our center. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with failed endoscopic retrograde pancreatography.


Elodie ROMAILLER (Lausanne, Switzerland), Thomas GREUTER, Maxime ROBERT, Sarra OUMRANI, Alain SCHOEPFER, Sebastien GODAT
17:10 - 17:20 #32742 - OC08 Duplicated common bile ducts; A rare type Vb.
OC08 Duplicated common bile ducts; A rare type Vb.

A potentially devastating complication of routine laparoscopic cholecystectomy include iatrogenic bile duct injuries which represent a stable incidence rate of 0.3% over the past 3 decades. Whilst related to several relative risks such as surgeon experience, and patient factors (older age, male sex), misinterpretation of biliary tree anatomy remains the most common cause, accounting for 80% of iatrogenic Common Bile Duct injuries. Whilst extremely rare, a duplicate common bile duct anomaly remains a potential variation to encounter during biliary surgery, with 30 recognised cases in the worldwide literature, of which type Vb accounting for 4. We report the case of a rare type Vb variation encountered during intra-operative laparoscopic cholecystectomy and confirmed on cholangiogram. To our knowledge, this is the first documented Type Vb case encountered in an Australian population. Given these anomalies are asymptomatic and can perpetuate iatrogenic common bile duct injuries, awareness of all subtypes is crucial. Irrevocably, preoperative Magnetic Resonance Cholangiopancreatography can help recognise these anomalies before the operating theatre, however their widespread adoption is limited by expensive and availability.


David ARMANY (Sydney, Australia)
17:20 - 17:30 #32739 - OC09 RECOMMENDATIONS FOR SAFE USE OF LAMS BASED ON A LARGE SINGLE CENTER EXPERIENCE.
OC09 RECOMMENDATIONS FOR SAFE USE OF LAMS BASED ON A LARGE SINGLE CENTER EXPERIENCE.

Background and Aims

Lumen-apposing metal stents (LAMS) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize safe deployment of LAMS for the different indications.  The aim of this study was to evaluate the impact of this approach over time. 

Methods

We conducted a single center study on consecutive patients that underwent LAMS placement for on- and off-label indications between June 2020 and June 2022.  Endpoints included technical success, clinical success and adverse event rates. We compared the results with our previously published early experience with LAMS (N=61, between March 2018 and May 2020).

Results

This cohort consisted of 168 LAMS in 153 patients.  Almost half of them (48.2%) were placed for off-label indications.  While the technical and clinical success rate were similar to our previously published cohort (96.4% and 92.9% versus 93.4% and 88.5%, respectively), the adverse event rate dropped from 21.3% to 8.9% (Table 1). 

Conclusion

Our results demonstrate a clinically relevant drop of LAMS-related adverse events over time related to optimized step-by-step protocols for the different on- and off-label indications.  


Sebastian STEFANOVIC, Helena DEGROOTE, Pieter HINDRYCKX (Ghent, Belgium, Belgium)
17:30 - 17:40 #32735 - OC10 Endoscopic treatment of post-surgical esophageal fistulas, retrospective analysis of a single tertiary center cohort.
OC10 Endoscopic treatment of post-surgical esophageal fistulas, retrospective analysis of a single tertiary center cohort.

Background: Anastomotic fistulas are a frequent and dreaded complication of esophagectomy. Endoscopic therapy using different techniques is now a well-established first line treatment option. The aim of our study was to evaluate the efficacy of such endoscopic treatments.
Methods: 73 patients with post-operative esophageal fistulas were retrospectively analyzed after being treated with different endoscopic techniques at CHUV. The primary endpoint was to evaluate technical and clinical efficacy of endoscopic treatments. The secondary endpoint was to evaluate the endoscopic treatments-related complications.
Results: In 94.5% (n=69) of patients, the intervention was effectively carried out from a technical point of view. In 82.2% (n = 60) of patients, treatment led to successful complete closure of the fistula. Minor complications related to the procedure occurred in 21.9% (n = 16) of patients and major complications in 6.8% (n = 5). The mortality rate related to the procedure was 2.7% (n = 2).
Conclusions: Endoscopic treatment is a technically achievable, highly effective way of treating post-operative esophageal fistulas. It allows patients with high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal complications without having to resort to invasive surgical solutions.


Sebastian PETRUZZELLA (Lausanne, Switzerland), Elodie ROMAILLER, Thomas GREUTER, Domenico GALASSO, Maxime ROBERT, Styliani MANTZIARI, Sébastien GODAT
17:40 - 17:50 #29342 - OC11 Multi-target Endoscopic Ultrasound EUS-M guided biopsy is superior to PET Scan for Staging malignancies.
OC11 Multi-target Endoscopic Ultrasound EUS-M guided biopsy is superior to PET Scan for Staging malignancies.

Introduction

PET scan is widely used not only to diagnose malignancy and its staging, but small proportion of patient do have false positive results. EUS now is well established modality to get tissue diagnosis and with multi-target approach can help stage disease more accurately with histopathological results. We share our experience with EUS-M cases with different variety of malignancies.

Methods

Total of 25 cases underwent EUS-M from June 2020 till June 2022. Informed consent was obtained, with Covid screen test with PCR was performed before procedure.  Procedures were done with all SOPs as per institutional guidelines. 22G FNB needle was used in 24 cases, 25G needle in 01 case; Franseen design with capillary suction method used to obtain visible core samples for histopathology without ROSE. All cases have confirmed histopathological diagnosis with same pathology from other site of Biopsy. Order of Biopsy was NodesLiver metastatic lesion→ Primary Tumour. In cases of nodes mediastinal→ porta-hepatis/ pancreatic→ Para-aortic. All sample were adequate for making confirmatory diagnosis on tissue sample.

Results.

Among total 25 cases, Age 54 Mean (22-77) with 16 Males. Duration of procedure 38 Minutes Mean (20-85). Cases with multiple lymphadenopathy from different anatomical regions were 09 while  other sites include Liver for metastasis and Primary tumour from pancreas/CBD/GB in 16 cases. Multiple site single pass was performed in 24 cases. 19 cases had malignant pathologies. Final diagnosis of Disease was pancreatic adenocarcinoma 07, NETs 02, Lymphoma 04, GB Adenocarcinoma/Cholangiocarcinoma 06 and metastatic RCC 01, TB 01. 04 cases had benign disease. All procedures were done under Conscious sedation as day care procedure. There were no immediate or early complication in all cases.

Conclusion

EUS-M is safe and accurate modality to stage malignancy with superiority over PET Scan to obtain histological diagnosis.


Adeel URREHMAN (Karachi, Pakistan)
17:50 - 18:00 #32727 - OC12 Aortic Wall Abrasion Caused By Needle Injury After EUS-Guided FNA of a Mediastinal Hemangioma.
OC12 Aortic Wall Abrasion Caused By Needle Injury After EUS-Guided FNA of a Mediastinal Hemangioma.

Introduction

Benign mediastinal cysts, accounting for approximately 20% of mediastinal masses, are challenging to diagnose. While endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) can provide a reasonably accurate diagnosis of mediastinal foregut cysts by distinguishing solid from cystic lesions, little is known about procedural complications asides from an increased risk of infection. We report a rare case in which EUS-guided FNA, performed on mediastinal hemangioma preliminarily misdiagnosed as bronchogenic cyst, resulted in an aortic hematoma caused by aortic wall abrasion from FNA needle injury.

Case presentation

A 29-year-old female patient was commissioned for endoscopic ultrasound of an asymptomatic accidental mediastinal lesion. Chest CT revealed a 4.9 x 2.9 x 10.1 cm thin-walled cystic mass in posterior mediastinum, abutting and seemingly arising from the esophagus. Endoscopic ultrasound (EUS) revealed a large, anechoic cystic lesion with regular thin wall with negative Doppler in posterior mediastinum. Preliminary EUS diagnosis was esophageal duplication cyst or bronchogenic cyst. Upon administration of prophylactic antibiotics, EUS-guided fine needle aspiration (FNA) was performed using single-use 19-gauge aspiration needle (EZ Shot 3; Olympus, Tokyo, Japan), and about 70cc of serous pinkish fluid was aspirated. The patient was in a stable condition with no signs of complication. One day after EUS- FNA, thoracoscopic resection for mediastinal mass was conducted. Purple and multi-loculated large cyst, well capsulated without any connection to esophagus, was observed in posterior mediastinum and subsequently removed. Upon the removal, however, an aortic hematoma caused by a focal descending aortic wall injury was observed. After a few days of close observation, the patient was discharged upon stable findings from 3D aorta angio CT.

Conclusion

We report a rare and severe complication of EUS- FNA, in which aspiration needle caused a direct injury to aorta. In mediastinal lesions, EUS-FNA should only be performed when necessary and—when it’s done—injection needs to be performed with great care to avoid the possibility of damaging adjacent organs or digestive tract walls.


Sol KIM (Seoul, Korea), Yu Kyung CHO
Amphitheater
Saturday 17 September
08:30

Saturday 17 September

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HOS1EF-G1
08:30 - 10:30

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EUS-FNA Group 1

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08:30 - 10:30

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EUS-FNA Group 2

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EUS Pseudocyst Drainage - Biliary Drainage Group 1

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EUS Pseudocyst Drainage - Biliary Drainage Group 2

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EUS Pseudocyst Drainage - Biliary Drainage Group 3

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Room 3
11:00

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EPOSTER
00:00 - 00:00

E-posters Displayed

00:00 - 00:00 #29340 - EP01 Hybrid endoscopic ultrasound in the Covid-19 era for the tissue diagnosis of Solid lesions: An Initial experience from a tertiary care centre in Pakistan.
EP01 Hybrid endoscopic ultrasound in the Covid-19 era for the tissue diagnosis of Solid lesions: An Initial experience from a tertiary care centre in Pakistan.

Introduction:

Endoscopic Ultrasound (EUS) is well-established mode of intervention for tissue acquisition in solid organs with rapid on-site evaluation (ROSE). In the Covid-19 era implementation of infection control mechanisms has led modified hybrid technique to get high diagnostic yield for tissue sampling. Combination of Covid-19 SOPs and tissue acquisition method outline this hybrid technique to get high diagnostic Yield. We share our initial experience of EUS cases performed with this approach without ROSE.

Methods:        

All 125 cases who underwent EUS guided biopsy from June 2020 till June 2022 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during procedure.

Results: Among these cases, 85 were male, mean age 56 years (range 22-90), Mean duration of procedure 28 minutes mean (10-90 min). 91 cases  for organ targeted for malignant pathology include pancreas 53, liver 03, lymph nodes 22, subepithelial lesions 10, mediastinal lesions 15, common-bile duct/gall bladder 07, gastric and retroperitoneal 01 case, 13 cases had a multi-targeted biopsy for the additional staging of disease. The number of ‘passes’ with the needle was average 02 with single pass 20, two pass 60, three passes 20, multitarget single pass in 25. Needle size (Franseen design) used for procedures was 22G in 115 cases and 25G in 10. Common tissue diagnoses include pancreatic adenocarcinoma 38, neuroendocrine tumours 06, tuberculosis 07, gastrointestinal stromal tumours 03, leiomyoma 05, lymphoma 06, metastatic renal cell carcinoma 05, squamous cell carcinoma 05, cholangiocarcinoma/gall bladder adenocarcinoma 13, Sarcoma 03 , solid pseudopapillary epithelial neoplasm of pancreas (SPEN) 03 and one case for Schwannoma, breast metastasis, accessory spleen, ectopic pancreas, sarcoidosis There were no immediate or early complications in all cases.

Conclusion:

Hybrid EUS in Covid 19 Era has emerged as a useful/cost-effective and safe approach to get tissue yield without the need for ROSE.

 


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #29346 - EP02 Pancreatic Solid Lesions Accompanied by Large Pseudocysts – How to Obtain a Histological Diagnosis.
EP02 Pancreatic Solid Lesions Accompanied by Large Pseudocysts – How to Obtain a Histological Diagnosis.

 Pseudocysts accompanying pancreatic solid lesions are rare findings and represent a big hurdle in obtaining a pre-operative histological diagnosis. Although they are usually complications of pancreatitis, pseudocysts can develop as a consequence of compression on the main pancreatic duct of solid masses whose characterization is essential. If the cyst is of moderate-large size, the acoustic effect of the fluid content and also the compression of the cyst itself on the pancreatic parenchima make often impossible to visualize the lesion which is squeezed too far from the probe to be seen. As a result, perfoming endoscopic-ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) of the solid mass underneath it is usually very challenging.

Description of the technique

When there is a suspicion of a solid mass along with a moderate-large size pseudocyst, having a histological confirmation of cancer before surgery is essential and nowadays considered as standard of care. Using a 19G FNA needle to aspirate the cyst to dryness improves dramatically the lesion accessibility which becomes in the end visible and approachable with a standard EUS guided FNA or FNB. The procedure is safe and easy to perform under conscious sedation.

Conclusions

EUS guided aspiration of large pseudocysts developed as complication of pancreatic lesions can be a crucial step in facilitating the histological confirmation of potential malignant lesions prior to surgery, allowing their visualization and biopsy.


Francesca D'ERRICO (Bari (Italy), Italy), Francesco DECEMBRINO
00:00 - 00:00 #32633 - EP03 Instantaeous stimulated Raman histology.
EP03 Instantaeous stimulated Raman histology.

Conventional histopathology, currently the ‘gold-standard’ for pathological diagnosis of cancer, requires extensive sample preparations that are achieved within time scales that are not compatible with intra-operative situations where quick decisions must be taken. Providing to pathologists a close to real-time technology revealing tissue structures at the cellular level with histologic quality would provide an invaluable tool for surgery guidance with evident clinical benefit.

Here, we specifically develop a stimulated Raman histology (SRH) imaging based framework that demonstrates gastro-intestinal (GI) and brain (CNS) cancer detection of unprocessed human surgical specimens. The technique can observe in real time a fresh biopsy sample and generate a virtual histology image, in 3D, that show excellent agreement with the standard hematoxylin, eosin (HE) staining. The attached figure shows an overlay of an SRH image (acquired in 1s) on an ex-tempo HE image obtained in 40 minutes in an intra-operative context. We report excellent agreements between SRH and HE images acquire on the same patients for healthy, pre-cancerous and cancerous colon, pancreas and liver biopsies. Finally, we show that the SRH imaged samples remain fully compatible for further histological work such as histo-chemistry and molecular biology. This proves to be a valuable asset when the biopsy is small and valuable as in brain stereotaxic samples. These developments pave the way for instantaneous label free GI and CNS histology in an intra-operative context.


Hervé RIGNEAULT (Marseille), Barbara SARRI, Flora POIZAT, Romain APPAY, Cécile CADOR, Fabrice CAILLOL, Marc GIOVANNINI
00:00 - 00:00 #32745 - EP04 Experience with the use of FNB 20g ProCore needle in the study of pancreatic and non-pancreatic solid tumors in Colombia.
EP04 Experience with the use of FNB 20g ProCore needle in the study of pancreatic and non-pancreatic solid tumors in Colombia.

BACKGROUND: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a maim technique for diagnosis of pancreatic and non-pancreatic tumors. The 20G ProCore FNB needle, plays an important role in obtaining better samples for accurate diagnosis, as it enables histopathological study of the specimens. 

AIMS:  demonstrate the experience in endoscopic ultrasound guided biopsy for the study of pancreatic and non-pancreatic solid tumors using the 20G ProCore needle,

METHODS: We conducted a retrospective study of 18 years older patients with pancreatic and non pancreatic solid tumors who underwent EUS guided FNB using a 20G ProCore needle from January 2019 to November 2021 in a Colombian referral universitary hospital of biliopancreatic diseases from Bogota Colombia. We investigated the patients’ clinical characteristics and the diagnostic accuracy and safety. The primary outcome was the accuracy and secondary outcomes were technical factors and related complications. 

RESULTS: A total of 29 patients were included, average age of 65 years. Gender distribution: 51,7% were female gender and 48,27% were male. Pancreatic tumors (79,3%) and non-pancreatic tumor (20,68%), tumor size between 10 to 61 mm (median 34 mm). Pancreatic tumors were located mainly at the head (52,1%), body (34,78%) and tail (8,69%), Regarded to non-pancreatic tumors, distribution was peripancreatic in 4,34% and mediastinum, perigastric and hepatic hilum. Diagnostic accuracy was 93,10%. 66% was malignant tumors being adenocarcinoma de most common finding in 44,4% of the cases, followed by poorly differentiated carcinoma and neuroendocrine tumors (33%). Related complications, present in 1% of the cases.

CONCLUSIONS: Endoscopic ultrasound guided FNB using  20G ProCore needle has a high diagnosis accuracy for pancreatic and non-pancreatic tumor, independent of the location and size of the tumor,  with low adverse events. Our study demonstrated similar technical successes, and diagnosis accuracy in the diagnosis of malignant solid tumors compared with other literature reports.


Renzo PINTO-CARTA (BOGOTA, Colombia), Fernando SIERRA
00:00 - 00:00 #32744 - EP05 The Ampulla of Vater; a target for metastatic melanoma?
EP05 The Ampulla of Vater; a target for metastatic melanoma?

Malignant melanomas are insidious aggressive cancers that can prove to be fatal, with Australia harbouring the highest incidence of skin cancers worldwide. Surprisingly, as little as 13.4% of patients undergoing surgical resection of high-risk melanomas remain disease free after two years with 31.6% showing evidence of distant spread. Although rare, secondary tumours of the Ampulla of Vater have been documented with the most common primaries involving breast, renal and melanoma cancers. We report the case of a malignant melanoma of the Ampulla of Vater occurring in a patient 4 years post-surgical resection of a Stage II melanoma manifesting as acute pancreatitis with obstructive jaundice. Given the rarity of secondary ampullary tumours, metastatic melanoma should always be considered in patients with obstructive jaundice and a history of melanoma resection. In the absence of distant disease, surgery may be considered along with other forms of palliative therapy after consensus at MDT and consideration of patient preference. 


David ARMANY (Sydney, Australia), Preet GOSAL
00:00 - 00:00 #32741 - EP06 The yield of EUS guided sampling in biliopancreatic masses.
EP06 The yield of EUS guided sampling in biliopancreatic masses.

Introduction

 EUS-guided sampling is an effective diagnostic method in the etiological workup of biliopancreatic masses. We aimed to evaluate the performance of EUS-guided sampling in biliopancreatic masses. Purpose We aimed to evaluate the performance of EUS-guided sampling in biliopancreatic masses.

Materials and methods

 This was a retrospective study, over 26 months, that was included all patients with a biliopancreatic mass who had undergone a EUS guided sampling, either by fine-needle aspiration (FNA) or by fine-needle biopsy (FNB). The EUS was performed under sedation, using FNA needles (22G and 19G) or FNB needles (22G and 20G). During the sampling process, the slow pull capillary technique with macroscopic on-site evaluation (MOSE) was applied.

 Results

 Forty-five EUS guided sampling were carried out. The median age of patients was 63 years [36–85] with a sex ratio M/F of 1.36. The sampling site was pancreatic in 39 cases (86.66%), ampullary in 6 cases (13.33%). The needle’s trajectory was transduodenal in 44 cases (97.8%) and transgastric in one case (2.2%) for a pancreatic tail mass. The average number of needle passes was 2. The result was conclusive in 73.3% of cases and inconclusive in 26.7% of cases. FNB was used in 30 cases (66.7%) with 21 samples (70%) being conclusive, and FNA was utilized in 15 cases (33.3%) with 11 FNA (73.33%) being conclusive. Pancreatic adenocarcinoma was found in 64.4% of cases (n = 29), biliary adenocarcinoma in 6.7% of cases, three cases had borderline normal pancreatic tissue. The diagnostic accuracy, sensitivity, and specificity of all EUS guided sampling were respectively 73%, 72%, and 100%. Six patients (13.3%) were found to be free of neoplastic cells, and four (8.9%) had hemorrhagic and inflammatory specimens. No complications related to the procedure were observed.

 Conclusions

 EUS guided sampling combined with the slow pull capillary technique and MOSE allows a diagnostic accuracy of more than 73%. Patients with indecisive results would require a second diagnostic method (second EUS guided sampling, percutaneous ultrasound/scanno-guided biopsy, or surgical biopsy) after discussion in a multidisciplinary team.


Emna BENNOUR (Rabat, Morocco), Mohamed BORAHMA, Fatima Zahra CHABIB, Imane BENELBARHDADI, Fatima Zahra AJANA
00:00 - 00:00 #32740 - EP07 The yield of EUS guided sampling in Cystic pancreatic neoplasms.
EP07 The yield of EUS guided sampling in Cystic pancreatic neoplasms.

Introduction

Cystic pancreatic neoplasms are characterized by the replacement of the pancreatic epithelium to neoplastic mucussecreting cells. The diagnostic approach aims to confirm the diagnosis of a cystic tumor and evaluates its benignity or malignancy. Purpose We aimed to evaluate the performance of EUS guided sampling of cystic pancreatic neoplasms.

Materials and methods

This was a retrospective study, over 24 months, that was included all patients with cystic pancreatic neoplasms who had undergone a EUS guided fine-needle aspiration. The EUS was performed using fine-needle aspiration (FNA) needles (22G and 19G)or fine-needle biopsy (FNB)needles (22G). During the sampling process, the macroscopic aspect of the liquid was noted and in the presence of associated solid mass, the slow pull capillary technique with macroscopic on-site evaluation (MOSE)was applied.

Results

patients benefited from a EUS-guided aspiration of suspicious cystic pancreatic neoplasms. The median age was 58.5years[38-84] with a sex ratio M/F of1.25. FNA or FNB was done for all patients. The median size of cysts was 26.72mm[16-70mm]. The number of passages required was 2passages for 9patients (90%) and 1passage for 1patient (10%). The needle used was a 22G needle for 7patients (70%), a 22G-Procore for 2patients (20%), a 19G needle for 1patient (10%). A EUS guided sampling of solid mass associated was performed in 8patients (80%). The communication between the cyst and branch duct was found in 5patients (50%), a cystic mass appearance was found in 5patients (50%). The appearance of the liquid was clear in 6patients (60 %), sero-haematic in 3patients (30%) brownish and viscous in 1patient (10%) Mural nodules were absent in 8patients (80%), present in 2patients (20%) The biochemical analysis of the cystic liquid was done for CEA and amylase in 4patients (40%) and were 291.38[2.55-1040] and 20538.6[5-83330] respectively. The seric CA19-9 and CEA were 159.41[2-1164] and 6.6[1.09-5.6] respectively. The histopathological analysis found adenocarcinoma in 3patients (30%), hemorrhagic and inflammatory in 2patients (20%), a ductal mutinous tumor in 1patient (10%), a serous cyst in 1patient (10%), and lymphocytic infiltrations in 1patient (10%).

Conclusions

EUS guided sampling of cystic pancreatic neoplasms was conclusive in (50%)of patients and allowed histological proof of malignancy. A negative result can be handled by a second attempt.


Emna BENNOUR (Rabat, Morocco), Mohamed BORAHMA, Fatima Zahra CHABIB, Imane BENELBARHDADI, Fatima Zahra AJANA
00:00 - 00:00 #32738 - EP08 Echo-endoscopie des lésions sous muqueuses gastriques : Expérience d’un centre tunisien.
EP08 Echo-endoscopie des lésions sous muqueuses gastriques : Expérience d’un centre tunisien.

Introduction : L’écho-endoscopie (EE) a fait ses preuves dans la caractérisation des lésions  gastriques sous muqueuses (LGSM). D’introduction relativement récente dans notre centre, nous nous proposons à travers ce travail, de rapporter notre expérience et d’évaluer la concordance de l’EE avec le diagnostic radiologique et histologique des LGSM.  

Méthodes :

Type d’étude : Il s’agit d’une étude rétrospective, monocentrique, descriptive

Période : 3 ans (Janvier 2019- Juin 2022)

Inclusion : Nous avons inclus tous les patients présentant une LGSM chez qui une écho-endoscopie a été pratiquée afin de caractériser la lésion.

Modalités de l’EE: L’examen était réalisé sous anesthésie générale, moyennant un échoendoscope de type Fujifilm® radial ou linéaire.

Paramètres étudiés : Nous avons recueilli les données cliniques, endoscopiques, morphologiques histologiques, si disponibles et thérapeutiques et calculé la concordance de l’EE avec l’imagerie et l’histologie.

Résultats :

Trente-trois LGSM ont été colligées (chez des patients d’âge moyen de 52 ans [21 – 69 ans] et de genre-ratio H/F de 0,3). En endoscopie, les lésions avaient une taille moyenne de 18 mm ­[3-49], d’aspect ulcéré dans 14 des cas, de muqueuse d’aspect normale (n=10), polyploïde (n=4), ombiliqué (n=3). 

En EE, les LGSM se développaient à partir de la 4ème couche dans 52% des cas, de la 3ème  couche dans 26% des cas, et de la 2ème  couche dans 13 % des cas.

Les lésions étaient homogènes chez 8 patients et hétérogènes chez 15 autres ; associées à des adénopathies chez 8 patients.

Au terme de l’EE, parmi les LGSM,  les diagnostics évoqués étaient : Tumeur stromale (n=9), tumeur neuroendocrine (n=1), lipome (n=2), pancréas aberrant (n=2), ADK gastrique (n=1),lésion d’allure kystique (n=1), léiomyome (n=1). Vingt (66%) patients ont eu une confirmation histologique. Sur le plan anatomopathologique, les diagnostics retenus étaient une tumeur stromale gastrique (n=6), tumeur neuroendocrine (n=2), adénocarcinome gastrique (n=3), lipome (n=1) et léiomyome (n=1).

Finalement, les résultats écho-endoscopiques étaient concordants avec l’imagerie chez 17 patients (51%) et chez 13 patients parmi les 20 (65%) ayant eu une confirmation histologique.

Conclusion : Les résultats de notre étude confirment l’intérêt de l’écho-endoscopie dans la caractérisation des lésions sous muqueuses gastriques permettant un diagnostic présomptif dans plus de la moitié des cas et en orientant ainsi la prise en charge de ces lésions.

 


Meriam SABBAH (Tunis, Tunisia), Fatma KAHLAOUI, Dorra TRAD, Norsaf BIBANI, Nawel BELLIL, Houssaina JELASSI, Dalila GARGOURI
00:00 - 00:00 #32731 - EP09 Endoscopic ultrasound EUS-S guided splenic lesion biopsy; noninvasive modality as an alternative to splenectomy.
EP09 Endoscopic ultrasound EUS-S guided splenic lesion biopsy; noninvasive modality as an alternative to splenectomy.

Introduction

Spleen can be the site of infectious as well as malignant lesions. With Cross-Sectional imaging these lesions can be localized but histology is essential for definitive diagnosis. Strategies to obtain splenic mass tissue include surgical, and percutaneous image guided approaches. Endoscopic Ultrasound (EUS)-guided biopsy is a safe and effective method for obtaining samples from spleen as an alternative to splenectomy.

Methods

We present two cases of splenic lesion underwent EUS guided biopsy. Procedure was done after informed consent with standard coagulation profile/ platelet counts and performed under conscious sedation. No immediate or late complications or adverse events noted.

Results

Case 1;

72 years old male known case of vasculitis on multiple immunosuppressant medications came with complaints of abdominal pain and weight loss. CT scan abdomen revealed splenic mass and EUS-guided splenic mass biopsy was performed which revealed B cell related lymphoproliferative disorder.

Case 2:

62 years old female presented with weight loss and decrease appetite, CT scan showed large splenic mass with another peripancreatic nodal mass. EUS guided biopsy performed revealed diffuse large B cell Lymphoma.

Conclusion

EUS-S in patients with splenic masses is a safe and effective diagnostic modality as an alternative to splenectomy.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #32650 - EP10 Pancreatic Lymphangioma: A rare diagnosis.
EP10 Pancreatic Lymphangioma: A rare diagnosis.

Lymphangiomas are rare, benign lesions of vascular origin with lymphatic differentiation. Pancreatic lymphangiomas are extremely rare (less than 0.2% of all pancreatic lesions).

We present the case of a 44-year-old male who underwent a CT scan that showed an hypodense nodular image located between the inferior vena cava (IVC) and the 2nd part of the duodenum. An endoscopic ultrasound showed a cystic lesion with a well-defined and regular wall and a long axis of 23 mm located between the IVC and the cephalic portion of the pancreas and in proximity with the hepatic hilum, raising the hypothesis of a pancreatic cystic lesion. However, fine needle aspiration (FNA) revealed a milky fluid, raising the likely possibility of a lymphangioma. The fluid triglyceride was elevated and citology showed a predominance of lymphocytes, supporting the diagnosis of lymphangioma. Pancreatic lymphangioma is often asymptomatic and discovered as an incidental finding but the clinical presentation depends on the size, location, mass effect and complications. Most of the imaging studies are non-specific and cannot reliably distinguish between a lymphangioma and a pancreatic neoplasm. However, EUS can allow a preoperative diagnosis, particularly because of EUS-FNA of the cystic fluid and its  consequent citological and biochemical studies. In asymptomatic patients, a conservative approach with imaging surveillance can be undertaken. However, curative treatment involves complete surgical excision.


Inês PESTANA (Castelo Branco, Portugal), Ana CALDEIRA, Mara COSTA, Marisa LINHARES, Diana RAMOS, Marco PEREIRA, Rui SOUSA, Eduardo PEREIRA
00:00 - 00:00 #29344 - EP11 Primary Pancreatic Lymphoma PPL presenting as a pancreatic head mass with obstructive jaundice: Atypical presentation of Lympho-proliferative disease.
EP11 Primary Pancreatic Lymphoma PPL presenting as a pancreatic head mass with obstructive jaundice: Atypical presentation of Lympho-proliferative disease.

 

Background

Primary pancreatic lymphoma (PPL) is a rare disease with clinical and radiological features often resembling pancreatic adenocarcinoma which is the most common primary pancreatic malignancy. Since both malignancies have different clinical outcomes with the former having a good prognosis, it is therefore important to have histopathological and cytopathological diagnosis of suspected pancreatic lesions. We present a case encountered as obstructive jaundice as our experience.

Case Presentation

We report a case of a 60-years-old woman known case of ischemic heart disease presenting with abdominal pain and jaundice of one month duration.  Patient for referred with abdominal imaging  CT scan Abdomen; findings  suggestive of pancreatic head mass. Subsequent Endoscopic ultrasound EUS guided biopsy was done using 22G FNB needle with tissue cores were obtained. Final histology confirmed it to be a primary pancreatic lymphoma with immunohistochemical stains suggestive of B cell origin lympho-proliferative disease. Patient also develop gastric outlet symptoms and underwent percutaneous biliary drainage as ampulla not accessible endoscopically to jaundice. PET scan was done for staging of disease before starting chemotherapy. She was started on R-CHOP (Rituximab, cyclophosphamide, Doxorubicin Hydrocholoride,Vincristine Sulphate,Prednisone) chemotherapy and completed 6 cycles. Her end of treatment follow up  PET-CT scan showed interval  normalization of FDG avid mass.

Conclusion

Keeping In view the excellent response to treatment in case of PPL, this rare entity which is often mistaken as a pancreatic adenocarcinoma should be kept in the differentials of any pancreatic lesions and EUS guided biopsy should be consider in suspected cases for early diagnosis and prompt treatment.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #29341 - EP12 Application of Endoscopic Ultrasound EUS in evaluation of mediastinal lesions.
EP12 Application of Endoscopic Ultrasound EUS in evaluation of mediastinal lesions.

Introduction:

Endoscopic Ultrasound (EUS) has emerged as a useful tool to obtain tissue acquisition for diagnosis. In mediastinology, EUS plays its supportive role in certain areas in mediastinum to obtain via trans-oesophageal route safely and accurately tissue diagnosis from lesions suspected likely malignancy either lung pathologies or metastasis from other primaries. In third world countries tuberculosis is also commonly encountered along with it. We share our initial experience of different pathologies encountered in EUS guided biopsy of mediastinal lesions.

Methods:

Total of 21 cases underwent EUS guided Biopsy from June 2020 till June 2022. Informed consent was obtained, with Covid screen test with PCR was performed before procedure.  Procedures were done with all SOPs as per institutional guidelines. 22G FNB needle in 20 cases and 25G in one case; Franseen design with capillary suction method used to obtain visible core samples for histopathology without Rapid-Onsite-Evaluation (ROSE). All cases have adequate sample for histological diagnosis. Post procedure oral antibiotic was given to all patients.

Results:

Among these cases, 13 were male, mean age 55 years (range 22-87), mean duration of procedure 21 minutes (10-35 min). Majority of them; 12 cases were malignant pathologies while remaining 09 were benign. The number of ‘passes’ with the needle was average 2.5 with single pass 02, two pass 10, three passes 05 and multitarget lesions were 04. There were Mediastinal lesions in 16 cases and mediastinal nodes biopsy in 05 cases. Common tissue diagnoses include Tuberculosis 06, Squamous cell Carcinoma 04, Lymphoma 03, Benign in 02, Sarcomatoid carcinoma 02 and Metastatic renal Cell Carcinoma 01, Metastatic breast 01, Sarcoidosis 01, Solitary fibrous tumour 01. There were no immediate or early complications in all cases.

Conclusion:

EUS guided biopsy of lesions in different mediastinal areas is safe and provide tissue diagnosis with high diagnostic accuracy with use of FNB needles.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #32659 - EP13 Spectrum of different variety of Subepithelial lesions and its evaluation by Endoscopic ultrasound EUS.
EP13 Spectrum of different variety of Subepithelial lesions and its evaluation by Endoscopic ultrasound EUS.

Introduction: With the advancement in endoscopic technology, Endoscopic Ultrasound EUS guided approach in diagnosing and surveillance of subepithelial lesions is crucial in management of these rare lesions identified incidentally on routine endoscopy. EUS plays crucial role in providing tissue diagnosis also to identify its origin which layer it arise and in addition its behaviour whether benign or malignant. We share our experience of different spectrum of cases of SELs we encountered during routine endoscopy.

Methods: All 10 cases who underwent EUS guided biopsy from June 2020 till June 2022 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during procedure. Procedures were done in conscious sedation and informed consent was obtained. All sample were collected using MOSE macroscopic onsite evaluation.

Results: Among these cases, 05 were male, mean age 52 years (range 35-73), Mean duration of procedure 22 minutes mean (13-35 min). 08 cases have malignant/premalignant pathologies while remaining 02 cases were benign. Majority of lesions had gastric origin 08 while remaining 02 were oesophageal. The number of ‘passes’ with the needle was average 2.4 with two pass 05, three passes 04 while one patient had obvious diagnosis no biopsy was done. Needle (Franseen design) used for procedures was 22G size in all 09 cases. Common tissue diagnoses include gastrointestinal stromal tumours 03, Benign (Ectopic pancreas) 02, leiomyoma 04, and Schwannoma 01. There were no immediate or early complications in all cases.

Conclusion: EUS plays a crucial role in evaluation of subepithelial lesions SELs; to confirm its diagnosis as well its origin which layer it arise, make a management plan and its surveillance when required in smaller lesions.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #29343 - EP14 Endoscopic Spectrum of Neuro-endocrine tumors from different primary Origins.
EP14 Endoscopic Spectrum of Neuro-endocrine tumors from different primary Origins.

 

Introduction

Neuroendocrine tumors (NET) are rare, with gastrointestinal tract and lungs being the most frequent sites of origin. These tumors are most often diagnosed by endoscopists and frequently as incidentally found lesions. Endoscopic ultrasound (EUS) is a good modality to evaluate these lesions.

Method

We present six cases diagnosed as NETs on histopathology with different spectrum of presentation, endoscopic features and site of origin. Endoscopic and EUS guided biopsy was performed to help evaluate and stage these lesions in all cases.

Results

Case-1: 47 years old female, underwent EUS guided biopsy for a large well defined homogenous-hyperechoic mass in the head of pancreas. Case-2: 35 years-old male patient, underwent EUS guided biopsy performed for a large > 5 cm solid-cum-cystic lesion noted in the head/uncinate process of pancreas. Case-3: 51 years old female, presented with bleeding PR and weight loss. Colonoscopy demonstrated a semi-circumferential ulcerated friable fungating mass starting from anal verge upto 10 cm. Case-4: 61 years old female, with left breast Invasive ductal carcinoma. Staging CT scan showed porta-hepatis mass. EUS shows well-defined nodal vascular mass at the porta hepatis and peri-gastric region.Case-5: 60 years old female, underwent upper GI endoscopy (OGD) for dyspepsia, which showed incidental finding of sub-epithelial nodule in D1. EUS demonstrated a well-defined tumor within layer 4 of anterior wall of duodenal bulb with intact serosa. Case-6: 41 years old female underwent OGD for abdominal symptoms and anemia, which revealed a polypoidal mass in gastric body. EMR was used to resect the lesion.

 

Conclusion:

NET`s can be found at various sites in the GI tract, and EUS with biopsy are extremely helpful in the diagnosis and staging of disease.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #32658 - EP15 Safety and efficacy of Endoscopic Ultrasound EUS-G in geriatric population.
EP15 Safety and efficacy of Endoscopic Ultrasound EUS-G in geriatric population.

Introduction: Endoscopic Ultrasound EUS is now considered as standard of care in diagnosis of oncology patient to help plan management. Endoscopy in elderly population is also important when they need tissue diagnosis to further treatment plan in suspected malignant pathology. We share our experience of EUS-G in elderly population which plays pivotal role in their management. All sample were considered adequate by expert pathologist to conclude histological diagnosis.

 

Methods: All 40 cases who underwent EUS guided biopsy from June 2020 till June 2022 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during procedure. Procedures were done in conscious sedation and consent was obtained and those patients who were on antiplatelet or anticoagulation agents were hold as appropriate. All sample were collected using MOSE macroscopic onsite evaluation.

Results: Among these cases, 32were male, mean age 73 years (range 65-90), Mean duration of procedure 27 minutes mean (10-71 min). 32 cases for organ targeted for malignant pathology include pancreas 17, lymph nodes 03, subepithelial lesions 01, mediastinal lesions 08, common-bile duct/gall bladder 05, and retroperitoneal 01 case, 05 cases had a multi-targeted biopsy for the additional staging of disease. The number of ‘passes’ with the needle was average 2.4 with single pass 07, two pass 18, three passes 07, multitarget single pass in 08. Needle size (Franseen design) used for procedures was 22G in 35 cases and 25G in 05. Common tissue diagnoses include pancreatic adenocarcinoma 15, tuberculosis 01, gastrointestinal stromal tumours 01, Benign 07, lymphoma 01, metastatic renal cell carcinoma 04, squamous cell carcinoma 03, cholangiocarcinoma/gall bladder adenocarcinoma 05, and Sarcoma 03. There were no immediate or early complications in all cases.

Conclusion:

EUS-G is safe and effective modality in evaluating and diagnosing different variety of pathologies in elderly populations with high diagnostic yield.


Adeel URREHMAN (Karachi, Pakistan)
00:00 - 00:00 #31981 - EP16 Differentiating factors for significant gastric post-ESD bleeding requiring emergent hemostasis.
EP16 Differentiating factors for significant gastric post-ESD bleeding requiring emergent hemostasis.

Introduction: In case of bleeding after gastric endoscopic submucosal dissection (ESD), it is difficult to decide whether to perform emergent hemostasis or not. This study was designed to clarify differentiating factors for significant gastric post-ESD bleeding which requires emergent hemostasis.

Methods: A total of 2,039 cases who developed bleeding after ESD for gastric neoplasm in a single center were enrolled. Their medical records were retrospectively reviewed. Their comorbidities, biochemical results, pathologic characteristics, history of previous ESD, current medication, and clinical findings at the time of bleeding events were reviewed. Significant bleeding was defined as bleeding which required emergent embolization or endoscopic hemostasis for visible exposed vessels or ongoing bleeding.

Results: Out of the total 2,039 ESD patients, 309 developed post-ESD bleeding. Among them 113 (36.6%) underwent an endoscopy and 73 (23.6%) needed embolization or endoscopic hemostasis. In those who did not undergo an endoscopy, the bleeding was minor and spontaneously improved. Overall, factors independently related with significant bleeding were demonstrated as hypoalbuminemia (OR 19.743, 95% CI: 2.084-187.011, p = 0.003), size of the specimen (OR 1.252, 95% CI: 1.025-1.528, p = 0.027), and previous history of adjacent ESD (OR 6517, 95% CI: 1.593-26.669, p = 0.009). Whereas, location of the lesion, malignant pathology of the lesion, and shock at the time of bleeding event were not associated with significant bleeding.

Conclusion: For post-ESD bleeding in patients with hypoalbuminemia, large size of specimen, or previous history of adjacent ESD, emergent hemostasis should be considered.


Joo Hyun LIM (Seoul, Korea), Sang Gyun KIM
00:00 - 00:00 EP17 Gastric Glomus Tumor, A Case Report and Literalture review. Stylianos STYLIANIDIS (Gastroenterologist) (UNITED KINGDOM, United Kingdom)