Thursday 19 September
08:30

Thursday 19 September

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EUS19-1
08:30 - 10:15

Live Demo
Session 1

Moderators: David BERNARDINI (Toulon, France), Ch. BOUSTIÈRE (Aubagne, France), Laurent HEYRIES (Marseille, France), Mahmoud OMAR (Kuwait)
Experts: Marianna ARVANITAKI (Belgium), Marc BARTHET (Marseille, France), Erwan BORIES (Marseille, France), Guido COSTAMAGNA (Italy), Marc GIOVANNINI (Marseille, France), Mostafa IBRAHIM (Egypt), Horst NEUHAUS (Germany), D. SEO (Korea, Republic of)
Amphithéatre
10:45

Thursday 19 September

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EUS19-2
10:45 - 12:45

Live Demo
Session 2

Moderators: David BERNARDINI (Toulon, France), Ch. BOUSTIÈRE (Aubagne, France), Laurent HEYRIES (Marseille, France), Mahmoud OMAR (Kuwait)
Experts: Marianna ARVANITAKI (Belgium), Marc BARTHET (Marseille, France), Erwan BORIES (Marseille, France), Guido COSTAMAGNA (Italy), Marc GIOVANNINI (Marseille, France), Mostafa IBRAHIM (Egypt), Horst NEUHAUS (Germany), D. SEO (Korea, Republic of)
Amphithéatre
13:45

Thursday 19 September

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EUS19-3
13:45 - 15:45

Live Demo
Session 3

Moderators: David BERNARDINI (Toulon, France), Ch. BOUSTIÈRE (Aubagne, France), Laurent HEYRIES (Marseille, France), Mahmoud OMAR (Kuwait)
Experts: Marianna ARVANITAKI (Belgium), Marc BARTHET (Marseille, France), Erwan BORIES (Marseille, France), Guido COSTAMAGNA (Italy), Marc GIOVANNINI (Marseille, France), Mostafa IBRAHIM (Egypt), Horst NEUHAUS (Germany), D. SEO (Korea, Republic of)
Amphithéatre
16:15

Thursday 19 September

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EUS19-4
16:15 - 17:15

Live Demo
Session 4

Moderators: David BERNARDINI (Toulon, France), Ch. BOUSTIÈRE (Aubagne, France), Laurent HEYRIES (Marseille, France), Mahmoud OMAR (Kuwait)
Experts: Marianna ARVANITAKI (Belgium), Marc BARTHET (Marseille, France), Erwan BORIES (Marseille, France), Guido COSTAMAGNA (Italy), Marc GIOVANNINI (Marseille, France), Mostafa IBRAHIM (Egypt), Horst NEUHAUS (Germany), D. SEO (Korea, Republic of)
Amphithéatre
17:15

Thursday 19 September

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EUS19-5
17:15 - 18:30

Free paper Session

Moderators: Ch. BOUSTIÈRE (Aubagne, France), Mahmoud OMAR (Kuwait)
17:15 - 17:30 #19639 - CO01 Trend towards less aggressive endoscopic ultrasound (EUS) surveillance for pancreatic cystic neoplasms (PCN): Results of 8-year single-center experience.
CO01 Trend towards less aggressive endoscopic ultrasound (EUS) surveillance for pancreatic cystic neoplasms (PCN): Results of 8-year single-center experience.

Background: While there are a few published guidelines on the management of PCNs, the optimal surveillance algorithm for PCNs is still a point of contention. EUS is a more sensitive modality for pancreatic imaging and fine needle aspiration (FNA) with molecular analysis provides additional information to better characterize PCNs. No prior study reports longitudinal results from serial surveillance by EUS with FNA results. We now report long-term data of pancreatic cysts followed by endoscopic ultrasound with FNA.

Methods: We performed a single-center, retrospective analysis of 727 patients (252M/475F, mean age 67, age range 21-94) who had pancreatic cysts on EUS from Jan-2010 to Dec-2017. Follow-up EUS was performed on 342 of these patients. Follow-up FNA with molecular analysis was available for analysis in 159 of these patients. Significant growth rate was defined as >2mm size increase.

Results: Of the 342 patients who had follow-up EUS, 121 (35%) patients had an increase in cyst size, while remaining 221 (65%) patients showed no change or a decrease in cyst size. Twenty-eight (8%) patients showed a growth rate >30%/year. The mean growth rate for all 342 patients was -0.26mm/year.  Prior to 2015, the mean EUS follow-up interval was 11.6 months. After 2015, the mean EUS follow-up interval increased to 19.3 months. Of the 159 patients with FNA follow-up, 73 had repeat molecular analysis performed. 

Figure 1: Change in molecular analysis results in 73/159 patients with follow-up FNA

Benign to Benign - 36

Benign to Statistically Indolent - 9

Benign to Statistically Higher Risk - 3

Statistically Indolent to Benign - 15

Statistically Indolent to Statistically Indolent - 8

Statistically Indolent to Statistically Higher Risk - 1

Statistically Higher Risk to Statistically Higher Risk -1

Discussion: There was a trend toward less frequent EUS surveillance of pancreatic cysts in this study. With close follow-up on serial EUS with FNA and molecular analyses, PCNs infrequently demonstrated progression. Coupled with the data obtained from our series of patients who had surveillance by EUS, where the mean growth rate of pancreatic cysts was low, we suggest that the recent decrease in surveillance is warranted.

Timothy NGUYEN (Newport Coast, USA), Spencer KIEU, Paul KORC, Robert SELBY, Phuong NGUYEN
17:30 - 17:45 #19625 - CO02 The macrodilatation of the sphincter of Oddi or Sphincteroplasty in the treatment of large stones of the main bile duct about 48 cases in a Moroccan Department.
CO02 The macrodilatation of the sphincter of Oddi or Sphincteroplasty in the treatment of large stones of the main bile duct about 48 cases in a Moroccan Department.

Macrodilatation of the sphincter of Oddi (MDSO) consists of a large dilatation of the papilla which completes an endoscopic sphincterotomy in cases of gross choledochal calculus. The aim of this work is to evaluate the results and complications of sphincteroplasty and associated factors. Patients and Methods: Retrospective study conducted at the Department of Hepatology and Gastroenterology II of Military Hospital between, in a period of 9 years, between January 2010 and March 2019, including 48 patients diagnosed with big stones of the main bile duct. Defined by a diameter ≥ 15 mm and whose treatment required the use of sphincteroplasty. The success of the gesture was defined by the absence of residual calculation at the end of the procedure. Results: Mean age of the patients was 63.5 ± 12 years (40 years to 83 years). The sex ratio was 0.7 (28 women, 20 men). 11.3% of the patients included in the studies had a history of cholecystectomy, 6.8% of the patients had gallbladder stones, 57.9% of the patients had multiple stones (≥2), 29.6% had 13.6% of patients had an associated endoscopic sphincterotomy, and in 11.3% there was a difference in caliber between the calculation and the diameter of the bile duct downstream. The clinical presentation of the patients was as follows: cholangitis was found in 7 patients; dissociated biliary symptoms suggestive of lithiasis migration in 28 patients while 13 patients showed no symptoms. The average number of stones found was 1.86 ± 0.8 per patient with extremes ranging from 1 to 10. The average diameter of the bile duct was 18 ± 4 mm that of the stones was 18 ± mm, and that of Macrodilating balloon was 16.9 ± 1.5 mm with extremes ranging from 14 to 20 mm. The success rate of sphincteroplasty was 91.6% (44 patients). Extraction was not possible in 4 patients with macrocalculations with an average diameter of 19 ± 2 mm. Two of these patients had undergone a plastic biliary prosthesis; the other two were surgically treated. The complication rate was 6.8% in the form of minimal bleeding from the margins curbed by pneumatic compression. Conclusion: Macrodilatation of the sphincter of Oddi is an effective method at the cost of a low morbidity for the endoscopic extraction of big stones of the main bile duct. The success rate is 91.6% and immediate complications are rare. No factors studied seem to be associated with the failure or success of this technique.

Sara JAMAL (Rabat, Morocco), Hassan SEDDIK, Sanaa BERRAG, Khaoula LOUBARIS, Reda BERRAIDA, Ilham EL KOTI, Ahmed BENKIRANE
17:45 - 18:00 #19619 - CO03 Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in cytopathological diagnosis of subepithelial lesions of esophagus.
CO03 Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in cytopathological diagnosis of subepithelial lesions of esophagus.

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in cytopathological diagnosis of subepithelial lesions of esophagus

Introduction: Subepithelial lesions of the gastrointestinal tract occur at a rate of 1/300 during endoscopy. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a reliable minimally invasive method in the differential diagnosis of subepithelial lesions.

Aim: The goal of this study was to investigate the EUS-FNA results according to the size and origin of the esophageal-derived subepithelial lesions (SEL) detected during upper GIS endoscopy.

Materials and Methods: The data of the patients who had esophageal SML detected between January 2010 and February 2018 in EUS Laboratory of Gastroenterology Department of Ankara University Faculty of Medicine were evaluated retrospectively.

Results: EUS procedure was performed in 200 patients due to the esophageal subepithelial lesion. 50 of them (24 males, 26 females, mean age: 49.96 (min: 20 max: 70)) received EUS-FNA. The mean lesion size was 29.02 mm (11-115 mm),  The originating layer was 72% (36) muscularis propria (4th layer origin) and 28% (14) muscularis mucosa (2nd layer origin). 4% of the SELs were located in the proximal esophagus, 42% were in the middle esophagus and 54% were in the distal esophagus.

72% (36/50) of the biopsy specimens obtained with EUS-FNA showed sufficiency for diagnostic accuracy. Cytopathology revealed mesenchymal cell tumors in 34 patients, bronchogenic cyst in 1 patient and abscess in 1 patient. The diagnosis rate was 76.9% (10/13) in lesions <2cm, 78.2% (18/23) in lesions between 2-3 cm and 64.2% (27/36) in 3-4 cm lesions. EUS FNA positivity was 75% (27/36) in muscularis propria origin and 71.4% (10/14) in muscularis mucosal origin.

Conclusion: Approximately 75 percent of the subepithelial lesions of the esophagus can be diagnosed by EUS-guided aspiration biopsy. The size of the lesion and the layer from which it originated had no effect on the EUS-FNA result.

Mesut GÜMÜŞSOY, Koray CEYHAN, Serkan DUMAN (Ankara, Turkey), Kamani LUBNA, Aysun ÇALIŞKAN, Mübin ÖZERCAN, Ramazan ER, Ellik ZEYNEP
18:00 - 18:15 #19620 - CO04 Assessment of Solid Pancreatic Lesions with EUS Elastography.
CO04 Assessment of Solid Pancreatic Lesions with EUS Elastography.

Assessment of Solid Pancreatic Lesions with EUS Elastography

 

Aim: Evaluation of EUS-FNA cytology results with EUS-elastography color pattern and strain ratio scores in malignant solid lesions of the pancreas.

 

Methods: 132 patients who had pancreatic lesions detected with EUS in our department between January 2014 and June 2019 were included in this retrospective study. EUS elastography color pattern, strain ratio measurements and real-time EUS FNA were performed on all patients. The tissue stiffness score and coloration modes of the lesions were evaluated. We divided the lesions into five groups by their coloration modes: dark blue, blue, yellow-green,yellow-green-blue and blue-green and also into two groups by their tissue stiffness: strain ratio scores ≥4 or <4

 

Results: 132 patients with solid pancreatic lesions were included in this study. 78(59.1%) were male with an average age of 60.6, and 54(40.9%)  were female with an average age of 54.5. The mean diameter of the long and short axis were 27.1 mm and 21.5 mm, respectively. Cytopathology results revealed that 78 (59.1%) lesions were malign. The median strain ratio of all malignant lesions was 34.5 (1.5-444). Of the lesions with a value of 4 or higher, 75 (96,2%) were malignant. According to the elastography coloration mode of malignant lesions, 64 (82.1%) lesions were dark blue, 8(10.3%) were blue, 3(3.8%) were green-blue, 1 was (1.3%) blue-green-yellow, and 2 (.,6%)cwere green-yellow.

 

Conclusions: EUS is an effective and safe method for assessing solid pancreatic lesions with fine needle aspiration. 96.2% of patients with diagnosed malignancy  showed tissue stiffness (strain ratio) ≥4 with EUS elastography. Endoscopic elastography is a non-invasive method, which can discriminate between malign and benign pancreatic solid lesions.

Mehmet BEKTAŞ (Ankara, Turkey), Mesut GÜMÜŞSOY, Serkan DUMAN, Mübin ÖZERCAN, Ramazan ER, Koray CEYHAN
18:15 - 18:30 #19617 - CO05 New software, for the virtual 3D reality, in the use of endo-ultrasonography for rectal adenocarcinoma.
CO05 New software, for the virtual 3D reality, in the use of endo-ultrasonography for rectal adenocarcinoma.

MRI and rectal EUS are determinant for staging of rectal adenocarcinoma. EUS has been criticized for lack of precision and systematization. Images can be unclear for other specialists. We present the results of the rectal EUS in 3D and in coronal, sagittal and front sections, using an electronic spreadsheet and  a new computer program (3d.eus) . This system is independent of the ultrasonography computer. A multicenter study is scheduled, and a future development with other diseases.

 

Michel CASSAGNOU (Tourcoing)
Amphithéatre
Friday 20 September
08:30

Friday 20 September

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EUS20-1
08:30 - 10:30

Session Pancreas/Bile Ducts

Moderators: Marianna ARVANITAKI (Belgium), Marc GIOVANNINI (Marseille, France), D. SEO (Korea, Republic of)
08:30 - 08:50 What's new in the surgical management of side branch IPMN ? Olivier TURRINI (France)
08:50 - 09:10 Cholangiocarcinoma : Biliary drainage: For whom and how? Guido COSTAMAGNA (Italy)
09:10 - 09:30 EUS FNB for solid pancreatic mass : Is EUS-FNA still needed? Erwan BORIES (Marseille, France)
09:30 - 09:50 What's the place of cholangioscopy in 2019 ? Horst NEUHAUS (Germany)
09:50 - 10:30 CONFERENCE: Place of EUS guided local therapy for pancreatic tumors. D. SEO (Korea, Republic of)
Amphithéatre
11:00

Friday 20 September

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EUS20-2
11:00 - 11:30

Free paper Session

Moderators: David BERNARDINI (Toulon, France), Ch. BOUSTIÈRE (Aubagne, France), Christian PESENTI (Marseille, France)
11:00 - 11:15 #19596 - CO06 Innovation of EUS-guided Transmural Drainage using a Novel Self-Expanding Metal Stent.
CO06 Innovation of EUS-guided Transmural Drainage using a Novel Self-Expanding Metal Stent.

Backgrounds: Endoscopic ultrasonography (EUS)-guided transmural drainage has been accepted as a modality of choice in pancreatic pseudocyst and acute cholecystitis. Each type of stent, including double-pigtail plastic stents, tubular self-expandable metal stents (SEMS), and lumen-apposing metal stents, for these procedure has its own disadvantages. To overcome their disadvantages, this animal study evaluated the feasibility of a newly designed twisted fully covered metal stent with dual coiled ends.

Methods: We performed the EUS-guided GB drainage with a newly developed metal stent in eight mini pigs with surgically induced GB distension. This novel stent is a twisted fully covered SEMS with dual 360-degree coiled ends. The stent has been maintained for four to seven weeks after EUS-guided GB drainage. The primary outcome was the technical success rate, and the secondary outcomes were adverse events, stent dysfunction, stent removability, and fistula formation.

Results: The stent was placed successfully between the gallbladder and the stomach in all cases without any adverse event. We observed neither stent migration nor dysfunction during the study period, and all the stents were removed easily as scheduled. We confirmed successful cholecysto-gastric fistula formation in all cases.

Conclusion: EUS-guided transmural drainage and fistula formation using a new twisted fully covered SEMS with dual coiled ends was technically feasible without any adverse event in this animal study. 

Sang Hyub LEE (Seoul, Korea, Republic of), Gunn HUH, Jin Ho CHOI, Woo Hyun PAIK, Ji Kon RYU, Yong-Tae KIM, Seok JEONG, Don Haeng LEE
11:15 - 11:30 CO07 - Risk factors associated with adverse evets during EUS guided tissue sampling. Lee KWANG HYUCK (Korea)
Amphithéatre
11:30

Friday 20 September

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EUS20-3
11:30 - 12:15

PENTAX SYMPOSIUM

Moderators: Marc BARTHET (Marseille, France), Marc GIOVANNINI (Marseille, France)
11:30 - 12:15 Expanding EUS-guided therapy to the new level- Our experience with a true therapeutic echendocope. Geoffroy VANBIERVLIET (Nice Cedex 3, France)
11:30 - 12:15 Expanding EUS-guided therapy to the new level - Can we have better outcomes performing EUS-guided therapy? Alberto LARGHI (Rome, Italy)
Amphithéatre
13:30

Friday 20 September

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EUS20-4
13:30 - 14:15

COOK SYMPOSIUM
Endo-hepatology: the future of EUS?

13:30 - 14:15 Endo-hepatology: the future of EUS? Schalk VAN DER MERWE (Leuven, Belgium)
Amphithéatre
14:15

Friday 20 September

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EUS20-5
14:15 - 16:00

Round table on therapeutic EUS

Moderators: Marianna ARVANITAKI (Belgium), Marc GIOVANNINI (Marseille, France), D. SEO (Korea, Republic of)
14:15 - 14:35 Pancreatic collection drainage: Is lams the panacea ? Marianna ARVANITAKI (Belgium)
14:35 - 14:55 EUS guided pancreatic duct drainage : Is it ready for prime time ? Nan GE (China)
14:55 - 15:15 EUS guided biliary drainage in altered anatomy: Is it the first choice ? Marc BARTHET (Marseille, France)
15:15 - 15:35 EUS guided biliary drainage : What's stents to use ? Fabrice CAILLOL (Marseille, France)
14:15 - 16:00 EUS guided fiducial placement for SBRT. D. SEO (Korea, Republic of)
15:55 - 16:00 Questions/answers.
Amphithéatre
16:30

Friday 20 September

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EUS20-6
16:30 - 17:30

Free Paper Session

Moderators: Erwan BORIES (Marseille, France), Marc GIOVANNINI (Marseille, France)
16:30 - 16:42 #19624 - CO08 Is the diverticular papilla a factor in the failure of catheterization of the main bile duct in lithiasis pathology? Experience of a Moroccan Department : About 846 cases.
CO08 Is the diverticular papilla a factor in the failure of catheterization of the main bile duct in lithiasis pathology? Experience of a Moroccan Department : About 846 cases.

Introduction: The duodenal diverticula are frequent (6 to 20%), and they preferentially sit in the papillary region and are called juxta-, peri-para-papillary or valerian. The latter may be a difficulty in the catheterization of the main bile duct and are more common in cases of associated cholelithiasis. The objective of our study is to calculate the prevalence of juxta-papillary diverticula (JPD) in patients with VBP lithiasis and evaluate their influence on the success rate of main bile duct catheterization in lithiasis pathology.

Patients and Methods:This is a retrospective study conducted from April 2004 until April 2018. There were included 846 patients having benefited from an ERCP for lithiasis of the main bile duct. The presence or absence of a juxta-papillary diverticulum has been noted. We compared the success rate of catheterization of the main bile duct in patients with juxta-papillary diverticulum (group I) versus patients without diverticular disc (group II).

Results:The mean age of the patients was 58 ± 13 years, 515 women and 331 men (sex ratio H / F: 0.64). Patients with a diverticular disc (group I) accounted for 9.6% of the patients included (81 patients). Group II consisted of 765 patients (90.4%). The success rate of the main bile duct catheterization was 96.4% in group II versus 86.5% in group I (p: 0.007). The overall rate of early complications was 6% in group II versus 7.4% in group I (p = 0.12).

Conclusion:The presence of a PDI appears to significantly decrease the success rate of the main bile duct catheterization in lithiasis pathology without increasing the risk of early complications. Prospective studies with large series, however, remain necessary to confirm these results.

Sara JAMAL (Rabat, Morocco), Hassan SEDDIK, Fouad NEJJARI, Khaoula LOUBARIS, Reda BERRAIDA, Ilham EL KOTI, Ahmed BENKIRANE
16:42 - 16:54 #19621 - CO09 Endoscopic Ultrasound (EUS) Fine Needle Biopsy (FNB) and Endoscopic Submucosal Dissection (ESD) for Radical Resection of a large Gastric Gastrointestinal Stromal Tumor (GIST).
CO09 Endoscopic Ultrasound (EUS) Fine Needle Biopsy (FNB) and Endoscopic Submucosal Dissection (ESD) for Radical Resection of a large Gastric Gastrointestinal Stromal Tumor (GIST).

Introduction

We report a case of a GIST of the gastric antrum that was successfully treated after a carefull EUS in association of FNB with an Endoscopic Submucosal Dissection (ESD).

FS,a 45 yers-old female, was refferred to our third level Gastroenterological Unit in Siena because of submucosal lesion located in gastric antrum wich determined bleeding and anemia (Hb 7,5 g/dl). She had not known allergies and family history was not significant. Se did not take drugs. The patient was a smoker (20 cigarettes/day), consumed alcohol occasionally, and denied taking illicit drugs.

A CT scan showed a gastric wall thickening of about 40x38x30 mm dimension placed at the limit between gastric body and antrum with contrast enhancement.

EUS demonstrated ipoechoic lesion with a rich vascolarization, originated by submucosal layer, with ulcerated surface. It was performed fine needle biopsy (FNB) that diagnosed Gastrointestinal Stromal Tumor (GIST). Oncologic serological test were negative.

Despite the considerable size of the GIST, because of its submucosal origin and the absence of metastasis, we decided for an endoscopic approach. Patient underwent to an endoscopic submucosal dissection (ESD) with dualknife obtained an en bloc resection. No bleeding complicated the resection.

At the end of the procedure FS underwent to an abdomen and chest X-ray and then to a CT scan that showed pneumoperitoneum and pneumomediastinum without gastric perforation. Either the pneumoperitoneum and pneumomediastinum were treated conservatively through a transcutaneous small dreinage placemente then removed in a few hours.

FS was then observed, treated with antibiotics, feeded after two days and then discharged after four days.

Definitive histology confirmed GIST with low mitotic count.

In tis case a meticulous EUS study allowed to decide for a low invasive resective procedure.

Despite considerable size ESD obtained a complete resection of the gastric GIST lesion decreasing hospitalization days.

Raffaele MACCHIARELLI, Alessia SANTINI (Siena, Italy), Silvia RENTINI, Elena GIANNI, Ivano BIVIANO
16:54 - 17:06 #19627 - CO09 Severe acute colitis: Predicting response factors to intravenous corticosteroid therapy about 81 cases in a Moroccan Department.
CO09 Severe acute colitis: Predicting response factors to intravenous corticosteroid therapy about 81 cases in a Moroccan Department.

Introduction : Severe acute colitis may be a revelation or occur in the course of a known chronic intestinal inflammatory disease, particularly hemorrhagic colitis. Intravenous corticosteroid therapy is the first-line medical treatment for the severe acute colitis.

The purpose of our work is to assess the predictors of response to intravenous corticosteroid therapy during severe acute colitis.

Materials and methods: This is a 5 year retrospective study, from June 2013 to December 2018, including 81 cases of severe acute colitis collected in the Department of Hepatology and Gastroenterology I of the Military Training Hospital of Rabat in Morocco. The severe acute colitis was defined by a Lichtiger score above 10. Clinical, biological, endoscopic and radiological data were collected and analyzed by SPSS20.

Results: The average age of our patients is 37.9-17.1 years with a clear female predominance (63 F/ 18 H), 16 patients (22.2%) had a known inflammatory bowel disease (IBD).  The average Lichtiger Scale was 13-1.45, 34 patients (33.3%) were naive to steroids, 31 patients (33.3%) had endoscopic gravity criteria.  In univariate analysis, the factors significantly associated with intravenous corticosteroid therapy failure were: J3-elevated CRP (45mg/l), blood presence at J3, pancolic impairment, non-naïve corticosteroid status. In multi-variance analysis and adjusting for the above factors, only CRP (c-reactive protein) was 45mg/l at J3 is significantly associated with intravenous corticosteroid therapyfailure (OR 1.3, p-0.02).

Conclusion: Our study supports the literature on the value of pCR-to-J3 dosage to assess response or failure to intravenous corticosteroid therapy in the initial management of severe acute colitis.

 

Sara JAMAL (Rabat, Morocco), Sanaa BERRAG, Fouad NEJJARI, Mouna TAMZAOURTE, Aziz AOURARH
17:06 - 17:18 #19618 - CO10 The role of endoscopic ultrasonography in esophageal cancer staging.
CO10 The role of endoscopic ultrasonography in esophageal cancer staging.

The role of endoscopic ultrasonography in esophageal cancer staging

Introduction:  Endoscopic ultrasonography (EUS) is an effective and reliable method for local staging of esophageal cancers and provides information about the prognosis of the disease. EUS staging is performed only after distant metastasis is excluded from CT or PET-CT.

Aim: The goal of this study is to compare EUS staging with postoperative histopathological staging, which is the gold standard in patients diagnosed with esophageal cancer without distant metastasis by CT or PET-CT after preoperative or neoadjuvant CRT and to investigate the diagnostic accuracy of EUS in tumor and lymph node staging.

Materials and Methods: Between January 2010 and November 2018, 139 patients diagnosed with esophageal cancer in the Chest Surgery Clinic of Ankara University Faculty of Medicine underwent preoperative radial type EUS device staging in the EUS laboratory of Gastroenterology Department. Histopathological and EUS stages of 74 operated out of 139 patients were compared. TNM classification was used for EUS staging.

Results: Of the 74 patients included in the study, 43 (58.1%) were male and 31 (41.9%) were female, and the mean age was 59 (28-86). The tumor was located in the distal esophagus in 54 patients, in the distal esophagus and esophagogastric junction in 8 patients, and in the middle esophagus in 9 patients. Biopsy revealed 40 patients with squamous cell carcinoma and 23 patients with adenocarcinoma. The mean tumor length was 5 cm. The mean tumor thickness in EUS was 13.6 mm. 25 (33.7%) of 74 patients who underwent preoperative staging with EUS received neoadjuvant CRT.

In 49 patients who did not receive preoperative CRT, the diagnostic accuracy rate of EUS was according to stages; T1: 66.6%, T2: 80%, T3: 65%, T4: 0%, overall: 65%; N staging rate was 92%. In 29 patients who received neoadjuvant CRT, the diagnostic accuracy rate of EUS was T1: 33%, T2: 50%, T3: 55.5%, T4: 100% and overall: 40%. All of the 7 patients who did not detect any tumor on histopathological examination after surgery the EUS stage was minimal T1 and above.

Conclusion: EUS is an effective and reliable method in the preoperative staging of esophageal cancers. The diagnostic accuracy rate of US in restaging after CRT is low, and in all patients with no tumor detected after surgery, the EUS stage was minimal T1 and above.

Mehmet BEKTAŞ (Ankara, Turkey), Mübin ÖZERCAN, Serkan DUMAN, Kamani LUBNA, Aysun ÇALIŞKAN, Mesut GÜMÜŞSOY, Ellik ZEYNEP, Hakan KUTLAY
17:18 - 17:30 #19622 - CO11 The effectiveness of endoscopic dilations in benign digestive stenosis in a Moroccan population: Retrospective study about 93 cases.
CO11 The effectiveness of endoscopic dilations in benign digestive stenosis in a Moroccan population: Retrospective study about 93 cases.

Introduction: Endoscopic dilations are an interventional endoscopy technique indicated in the organic and motor stenosis of the digestive tract. The purpose of our work is to evaluate the effectiveness of this technique in the treatment of benign digestive stenosis.

Materials and methods: This is a descriptive retrospective study, in a period of 9 years, from March 2010 to March 2019. We included 93 patients having a benign digestive stenosis treated endoscopically by dilation with candles or balloon, collected at  the department of Hepato-Gastroenterology I of the Military Training Hospital Mohammed V of  Rabat in Morocco.

Results : The average age was 45.2 years with a slight female predominance. The main symptomatology was dysphagia for esophageal stenosis. The causes of these stenosis were: achalasia in 30 cases, peptic stenosis in 21 cases, anastomots in 18 cases, a Vincent Plummer Syndrom in 12 cases and caustic stenosis in 3 cases, 3 stenosis after sleeverectomy and 6 cases of colic stenosis. 54 patients received candle-dilation and 39 patients were treated with pneumatic balloon dilation. The number of dilation was on average 2 sessions (extreme: 1-4 sessions). No immediate complications were reported. The evolution of the patients was satisfactory, a case of anastomotic stenosis (oeso-jejunal anastomosis for carcinoid tumor operated 6 years ago) that was resistant to dilation several times.

Conclusion: Endoscopic dilation is an effective technique in the management of benign digestive stenoses and is an alternative to surgery, its complications are exceptional when the rules of action are respected.

Sara JAMAL (Rabat, Morocco), Fedoua ROUIBAA, Mouna TAMZAOURTE, Aziz AOURARH
Amphithéatre
17:30

Friday 20 September

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EUS20-7
17:30 - 17:45

Closing remarks and adjourn

Keynote Speaker: Marc GIOVANNINI (Marseille, France)
Amphithéatre
Saturday 21 September
08:30

Saturday 21 September

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HOS1
08:30 - 10:30

Hands on Session
EUS RFA Group 1

Saturday 21 September

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HOS2
08:30 - 10:30

Hands on Session
EUS-FNA - Group 1

Saturday 21 September

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HOS3
08:30 - 10:30

Hands on Session
EUS FNA - Group 2

Saturday 21 September

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HOS4
08:30 - 10:30

Hands on Session
EUS guided collection drainage - Group 1

Saturday 21 September

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HOS5
08:30 - 10:30

Hands on Session
EUS guided collection drainage - Group 2

Saturday 21 September

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HOS6
08:30 - 10:30

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EUS guided collection drainage - Group 3

11:00

Saturday 21 September

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HOS7
11:00 - 13:00

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EUS RFA - Group 1

Saturday 21 September

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HOS8
11:00 - 13:00

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EUS-FNA - Group 1

Saturday 21 September

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HOS9
11:00 - 13:00

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EUS-FNA - Group 2

Saturday 21 September

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HOS10
11:00 - 13:00

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EUS guided collection drainage - Group 1

Saturday 21 September

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HOS11
11:00 - 13:00

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EUS guided collection drainage - Group 2

Saturday 21 September

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HOS12
11:00 - 13:00

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EUS guided collection drainage - Group 3

08:30
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POSTER
08:30 - 18:00

Poster Session
Poster are displayed from 8:30am on September 19th, to 05:30pm on September 20th

08:30 - 18:00 #19610 - PO01 ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE USING THE HOT-AXIOS SYSTEM: NEW PERSPECTIVES AND INDICATIONS.
PO01 ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE USING THE HOT-AXIOS SYSTEM: NEW PERSPECTIVES AND INDICATIONS.

Background: Lumen apposing metal stents (LAMS) were originally developed for pancreatic fluid collections drainage (EUS-PFCD). Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and endoscopic ultrasound-guided biliary drainage (EUS-BD) have been increasingly used as an alternative to percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography (ERCP) or in patients unfit for surgery. Recently, a novel dedicated fully-covered and electrocautery-enhanced LAMS (Hot AxiosTM; Boston Scientific) has been developed.

Aim & Methods: This study aimed to evaluate the safety and feasibility of EUS-GBD, EUS-BD and EUS-PFCD with Hot AxiosTM system. Twenty five patients (56% women, median age 77.6 ± 12.3 years) presenting pancreatic fluid collections, inoperable acute gallstone cholecystitis (with or without bile duct lithiasis) or malignant bile duct obstruction (after failed ERCP), were consecutively enrolled. All the patients underwent EUS-guided drainage using Hot AxiosTM system over a one-year period. Primary outcomes were technical and clinical success. We also recorded the occurrence of adverse events, procedure time, and stent patency.

Results: Fifteen patients unfit for surgery presented acute gallstone cholecystitis (four with associated common bile duct lithiasis). Four patients showed pancreatic fluid collections (three with walled-off necrosis). Six patients failed ERCP because of malignant bile duct obstruction (five presenting advanced pancreatic head cancer and one advanced hilar cholangiocarcinoma). The procedure was technically successful in 24/25 patients (96%). The clinical success was obtained in all patients. Adverse events occurred in 1 patient (4%) (gastric bleeding). Stent patency was good in all the cases. The median procedure time was 20 min (range 14-26). LAMS was removed four weeks after placement, in patients with good life expectancy, otherwise it was left indefinitely. No complications as “buried stent” were observed at the moment of removal. Starting from LAMS’ placement, median follow-up time was 181.2 days (range 30–365) assessed by abdomen computer tomography (CT-scan).

Conclusion: EUS-guided drainage by Hot AxiosTM system has high technical and long-term success rates, shows very low complications and reintervention rates, being able to be left indefinitely or easily removed. Patients unfit for surgery because of comorbidity and/or end-stage disease are best candidates.

Antonio CICCONE (Pesaro, Italy), Giorgio VALERII, Candeloro BALDASSARRE, Maria MARSICO, Carmelo BARBERA
08:30 - 18:00 #19614 - PO02 Adrenal pseudocyst- a rare disease mimicking giant pancreatic cystic neoplasm- a case report.
PO02 Adrenal pseudocyst- a rare disease mimicking giant pancreatic cystic neoplasm- a case report.

Introduction: EUS guided sampling for biochemical and cytological analysis is recommended for managing cystic lesions of the pancreas when they are bigger than 10 mm. We report a case of a patient with cystic lesion of adrenal origin, which was mimicking pancreatic cystic tumor.

Case: We present a 31 years old woman with pain in the left part of the abdomen, severe anemia, which has led to two hemotransfusions, no data for acute pancreatitis in the past. All these symptoms started a few months after giving birth. During the hospital stay we diagnosed severe iron deficiency anemia and a palpable tumor mass in the left upper abdomen. CT-scan showed a 160 mm cystic tumor most probably originating from the pancreatic tail. The performed EUS revealed large cystic tumor, engaging the body and tail of the pancreas with thick wall (20mm). Cystic fluid was aspirated, the "strip sign" was negative and there were very low levels of amylase, lipase and CEA in the aspirate. Cytology from the capsule was inconclusive. We referred the patient for surgery with the suspicion of solid pseudopapillary neoplasm of the pancreas.Laparotomy was performed. Large cystic mass was found, most probably originating from the pancreas, engaging surrounding structures. Multivisceral resection was performed. The pathology report changed the diagnosis to adrenal pseudocyst.

Pseudocysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal pseudocysts can however present with severe abdominal pain and can be comlicated by hemorrhage, rupture or infection. There are few reports which show a connection between high levels of hormones during pregnancy and growth of the pseudocyst. Epidemiologically, adrenal pseudocysts are more common in women and typically are found between ages of 30 and 60.

Conclusion: Adrenal pseudocysts are quite rare.Most of the times the diagnosis can be challenging and a comlex approach is always needed. Radiological and clinical features of the tumor are nonspecific, thus, histopathological examination is essential in order to establish a definitive diagnosis.

Petko KARAGYOZOV (Sofia, Bulgaria), Violeta MITOVA, Kiril DRAGANOV, Ivan TISHKOV, Yordan KYUCHUKOV
08:30 - 18:00 #19615 - PO03 Rupture of a pancreatic pseudocyst with mediastinal involvement- a rare life threatening complication of chronic pancreatitis, requiring multidisciplinary approach- a case report.
PO03 Rupture of a pancreatic pseudocyst with mediastinal involvement- a rare life threatening complication of chronic pancreatitis, requiring multidisciplinary approach- a case report.

Introduction: Pancratic pseudocysts are a common complication of acite and chronic pancreatitis. In rare cases, an ascending involvement of the mediastinum is observed. The condition has diverse insidious manifestations. Patients could be asymptomaticor they cen present with dysphagia, chest pain, dyspnea, cardiac rhythm disorders or congestive heart failure. The clinical course is unpredictable and could rapidly turn into a life-threatening condition due to airway or cardiac compression. The literature reports different treatment approaches: conservative therapy with observation, endoscopic treatment or surgical drainage. We present a case of a pancreatic pseudocyst with mediastinal and cervical involvement, manifested with respiratory insufficiency.

Case: A 47-year-old woman was admitted for abdominal pain and ascites. The diagnostic workout established chronic calcifying pancreatitis, peripancreatic fluid collection, ascites, partial thrombosis of the portal vein and v. cava inferior. Despite the optimal medication treatment the patient developed severe dyspnea. Progressive pleural effusions were established, which led to the performance for bilateral thoracic drainage. However, the general condition of the patient and the respiratory function deteriorated and a symmetric cervical oedema occured. We performed EUS, which revealed an increase of fluid collections with involvement of the posterior mediastinum and the parapharyngeal space.

We opted for a combination of therapeutic interventions, including surgical mediastinal drainage, followed by EUS-guided transgastric drainage of the pancreatic pseudocyst and ERCP with stenting of the main pancreatic duct and common bile duct. After the procedures we registered fast improvement in the respiratory function and the general condition of the patient. The mediastinal drainages were removed on the fourth post-procedural day due to lack of secretion and the patient was discharged on the seventf day in good general condition.

Discussion: The thoracic and cervical extension of the pancreatic pseudocyst is quite uncommon. It is a diagnostic and therapeutic challenge due to its diverse clinical manifestations and lack of experience with such cases. EUS could be extremely in detection and dynamic follow-up of not only intraabdominal but also mediastinal complication of pancreatitis. It offers safe and precise options for drainage, which makes it first-line treatment.

Petko KARAGYOZOV (Sofia, Bulgaria), Irina BOEVA, Ivan TISHKOV, Tsvetan MINCHEV
08:30 - 18:00 #19616 - PO04 Endoscopic Cystogastrostomy could be performed safely in young children.
PO04 Endoscopic Cystogastrostomy could be performed safely in young children.

Endoscopic ultrasound guided interventions could be feasible with adult endoscopes and accessories in pediatrics. We report a large pancreatic pseudocyst in a 3-year old child, which developed following chemotherapy for acute lymphoblastic leukemia. After multiple trials of percutaneous drainage and infection, the patient was referred for EUS guided drainage. Successfully, 10 Fr 5 cm silicon double pigtail stent was inserted into the cyst using a Fujifilm linear echoendoscope with good drainage. 

Khaled RAGAB, Elsayed GHONEEM, Mariam ZAGHLOUL (kafrelsheikh, Egypt)
08:30 - 18:00 #19623 - PO05 What are the factors and features associated with vascular complications in the pseudocyst drainage process?
PO05 What are the factors and features associated with vascular complications in the pseudocyst drainage process?

AIM: Endoscopic drainage forms the basis of symptomatic pancreatic pseudocyst treatment and we investigated the vascular pathologies of our cases with pseudocyst drainage.

METHOD: We evaluated the drainage process of 12 patients (F/M= 5/7) who were indicated for cystgastrostomy. Pigtail stents were placed and cystogastrostomy was performed on the patients. The endoscopic, EUS, CT, portal doppler findings of the patients were evaluated with drainage process data. Follow-up of the patients was performed by USG and CT. The diagnosis time of the pseudocyst, the drainage time, the localization of the cyst, the diameter, the number of stents applied or NBD were assessed by evaluating the coexistence of concomitant vascular pathologies. FINDINGS: The mean age of the patients was (F/M=56.6/46.28). Duration of diagnosis of acute pancreatitis with pseudocyst was done at the end of the first month in 6 patients, at the third month in 4 patients, and after the 5th month in 2 patients. All cases had symptoms such as abdominal pain, loss of appetite, weight loss and nausea.  The localization of the cysts in the pancreas was 4 in body, 8 in head + body. The mean diameter of the cysts was 13.3 cm. Time between diagnosis of pseudocyst and drainage time; in 5 cases, drainage was performed in the normally recommended period (6-8 wk) and in 7 cases with an average delay of 4.35 months. In the cystogastrostomy procedure in one case hemorrhage into a cyst that was stopped with medical treatment took place and mild acute pancreatitis developed in one case. Full drainage time of the cyst was 8.4 weeks in patients who underwent drainage at normal recommended time, and over 9 weeks in patients with delayed drainage. Five patients underwent double stents and the others underwent a single stent. One patient underwent intense cyst fluid and the other underwent NBD due to abscess development. In cases which had a cyst diameter of over 10cm, in the head + body location there were splenic vein thrombosis, superior mesenteric vein thrombosis and collaterals. Six of these cases were accompanied by fundus varices. RESULTS: In our cases, in the development of vascular complications, the pseudocyst; the size of its diameter, its being located in head + body, late application of drainage process seems to be related. In such cases, it may be advised to follow more closely and to keep this possibility in mind in order to diagnose thrombosis and varicose development which may accompany thrombosis.

 

Aliye SOYLU (Istanbul, Turkey), Aysun ERBAHCECI, Isa SEVINDIR, Emre AKAR, Serdal CAKMAK, Serkan IPEK, Erhan ALTINOZ
08:30 - 18:00 #19626 - PO06 Recto-colic polyps: Prevalence and support (Experience of a Moroccan department).
PO06 Recto-colic polyps: Prevalence and support (Experience of a Moroccan department).

Introduction: Colorectal polyps are common in the general population. Endoscopy is used to detect and characterize the type of polyp. This is fundamental to determining the technique to be used to perform the resection. The objective of our study is to determine the prevalence of colcolic polyps within our department and their management

Materials and Methods: This is a descriptive and analytical retrospective study, spanning a period of 19 years, from January 2000 to April 2019, collected in the service of Hepao-Gastroenterology II of the Mohammed V Military Training Hospital in Rabat, Morocco. The Inclusion Criteria was patients aged 18 with less than 4 colorectal polyps over 3 mm and having undergone endoscopic resection. Resection techniques have been studied as well as complication management. The statistical analysis was done using SPSS 24.0 software.

Result : 3.23% (n -214) of patients who received total colonoscopy during the study period ( n-6607) had one or more polypectomies. The average number of polyps in each patient was 1.32 -0.66. The history of cto-colic cancer operated on was 13.2% (n-27). The indication of total colonoscopy was dominated by rectorrhies in 22.9% (n-47). During colonoscopy, the majority of polyps were located in the left colon in 45.1% (n-93) with a predominance of sessile polyps (Is) which accounted for 73.83% (n-158). The most commonly used resection technique was exeresis clamp biopsy and polypectomy. The rate of early complication was 2% (no.2), and the rate of late complication after endoscopic hemostasis was zero.

Conclusion : Endoscopic resection of rectocolic polyps is currently an alternative to radical surgery, decreasing incidence and mortality from colcolic cancer. In our department the prevalence was 3.23%, the most commonly used resection technique was exeresis clamp biopsy and polypectomy.

Sara JAMAL (Rabat, Morocco), Hassan SEDDIK, Samir MRABTI, Khaoula LOUBARIS, Hanae BOUTALLAKA, Reda BERRAIDA, Ilham EL KOTI, Ahmed BENKIRANE
08:30 - 18:00 #19628 - PO07 The interest of endoscopic sphincterotomy in the management of acute bile pancreatitis : A retrospective study about 96 cases in a Morocan population.
PO07 The interest of endoscopic sphincterotomy in the management of acute bile pancreatitis : A retrospective study about 96 cases in a Morocan population.

Introduction: Bile lithiasis is the main cause of acute pancreatitis (AP). The objective of our work is to evaluate the therapeutic interest of  endoscopic sphincterotomy (SE) in the management of acute bile pancreatitis through the analysis of results obtained in a Moroccan department and a review of literature.

Materials and Methods: This is a retrospective study, in a period of 8 years, from September 2010 to December 2018, collected in the Department of Hepatology and Gastroenterology II of the Military Training Mohammed V of Rabat in Morocco, including patients carriers of acute pancreatitis of bile origin and having benefited from an endoscopic retrograde Cholangio-pancreatography (ERCP) for diagnostic and therapeutic purposes.

Results: 96 patients with acute pancreatitis received an ERCP with the intention of endoscopic sphincterotomy. The diagnosis of the bile origin of the AP was made on clinical, biological and morphological arguments. The success rate of the SE was 89%. ERCP has allowed the extraction of one or more gallstones in 73 patients. The progression of acute pancreatitis after ERCP was favourable in the majority of cases, cure was raised in 91 patients with a success rate of 89%.

Discussion: Emergency decompression of the bile ducts is a priority therapeutic objective in the management of bile-based AP. SE has shown efficacy on the evolution of PA in series of four randomized prospective studies subject to compliance with its summary indications as follows; AP with angiocholitis and or obstructive jaundice, severe acute pancreatitis, SE can be achieved at 72 degrees hour.

Conclusion: Through this study we can conclude that endoscopic sphincterotomy is an effective method in the management of acute bile pancreatitis.

Sara JAMAL (Rabat, Morocco), Hassan SEDDIK, Khaoula LOUBARIS, Reda BERRAIDA, Ilham EL KOTI, Ahmed BENKIRANE
08:30 - 18:00 #19629 - PO08 Efficacy of Thalidomide in the management of recurrent digestive hemorrhage: About a case and a review of literature.
PO08 Efficacy of Thalidomide in the management of recurrent digestive hemorrhage: About a case and a review of literature.

Introduction: Angiodysplasia is currently considered one of the most common causes of occult digestive bleeding in the elderly and hemodialysis. The treatment of endoscopic hemostasis is usually offered first-line most often by clotting with argon plasma or bipolar electrocoagulation. In the event of frequent recurrences despite appropriate endoscopic treatment, systemic thalidomide medical therapy may be offered as a complementary treatment. The objective of our case is to report the efficacy of Thalidomide in refractory digestive bleeding due to gastrointestinal angiodysplasia in the cas of a chronic hemodialysis patient.

Clinical case: This is a 74-year-old woman, chronically hemodialysis, admitted for management of a melena. A high gastrointestinal endoscopy and colonoscopy showed diffuse angiodysplasia involving the entire digestive tract. The small intestine was explored by high and low double balloon enteroscopy. Despite several sessions of argon clotting, the digestive hemorrhage is persistent and requires several transfusions. Treatment with thalidomide at 100 mg/day was initiated after the patient's informed consent and elimination of contraindications of this medication. After 4 months of treatment, gastrointestinal bleeding was controlled and the patient remained stable over the past 12 months during follow-up.

Conclusion: Bleeding due to angiodysplastic lesions of the digestive tract is commonly observed in hemodialysis patients and is responsible of a significant morbidity and mortality. This clinical case illustrates the possible use of Thalidomide as an effective therapeutic option in hemodialysis patients to control recurrent gastrointestinal bleeding by angiodysplies.

Sara JAMAL (Rabat, Morocco), Mouna TAMZAOURTE, Aziz AOURARH
08:30 - 18:00 #19630 - PO09 Papillary and mucinous intrachannel tumourspancreatic (IPMNs) : Accidental discovery about a case and a review of literature.
PO09 Papillary and mucinous intrachannel tumourspancreatic (IPMNs) : Accidental discovery about a case and a review of literature.

Introduction:

Papillary and mucinous intrachannel tumors of the pancreas (IPMNs)) are cystic lesions of the pancreas developing at the expense of the main and secondary ducts. Recent studies have indicated that patients with IPMNs often develop extra-pancreatic malignancies synchronously. We report a clinical case of IPMNs discovered incidentally during the extension of a rectal adenocarcinoma.

Clinical case: 

A 49-year-old patient admitted for management of rectorragies that has been evolving for 1 year associated with abdominal pain, non-fat glairo-bloody diarrhea, tenesms and weight loss. The colonoscopy objective the presence of a rectal adenocarcinoma locally associated with a cystic pancreatic lesion. The radiological aspect was typical of intrapapillary and mucinous tumors of the body of the pancreas. Bilio-pancreatic echoendoscopy has shown the appearance of a IPMNs with malignancy criteria. The patient was referred for pre-operative radio-chemotherapy for rectal adenocarcinoma. The patient was operated on from an exeresis of the rectum with postoperative chemotherapy. A pancreatic scan at 16 months of follow-up showed the same results with more or less stable lesions. A cephalic duodeno-pancreatectomy was considered remotely from chemotherapy.

Conclusion:

The presence of IPMNs is associated with a significantly higher risk of developing extra-pancreatic cancer, including colorectal cancer. In most cases, IPMNs are discovered by chance, especially in the balance of another tumour. This discovery may change the therapeutic strategy depending on whether it is disturbing or not.

 

Sara JAMAL (Rabat, Morocco), Fedoua ROUIBAA, Aziz AOURARH
08:30 - 18:00 #19631 - PO10 Primary rectal linitis plastica complicated with Krukenburg tumor.
PO10 Primary rectal linitis plastica complicated with Krukenburg tumor.

Background and aims:

Primary linitis plastica (PLP) of the rectum is an uncommon entity (0.1% of colorectal cancer) that is difficult to diagnose due to the lack of mucosal lesions on endoscopy, the low diagnostic yield of biopsy and non-specific findings of barium radiology and computerized tomography. We present an unusual case of PLP associated with krukenburg tumor in a young patient, diagnosed at the department of Hepatology and Gastroenterology I of the Military Training Hospital of Rabat in Morocco

Clinical case:

31 years old woman, presented with 1 year history of dysenteric syndrome and severe loss of weight. The rectal examination showed a circumferential tumor at 3 cm from the anal margin. The biopsy revealed an adenocarcinoma with independent cell out of signet ring. Gastric endoscopic ultrasonographically was normal. Pelvic CT scan and MRI showed stenotic rectal tumor extending to the rectosigmoid junction with perirectal fat infiltration, a right ovarian mass of 5 cm in diameter with multiple cysts and peritoneal carcinomatosis. The patient underwent an exploratory laparotomy. The histopathological finding of ovarian mass was consistent with metastatic adenocarcinoma of the rectum. The patient received palliative treatment.

Conclusion:

The delay of diagnosis darkens the prognosis and complicates the therapeutic attitude.

Sara JAMAL (Rabat, Morocco), Fedoua ROUIBAA, Aziz AOURARH
08:30 - 18:00 #19642 - PO11 Effectiveness of the endoscopic dilations in the management of Achalasia : A retrospective study about 84 cases in a Moroccan Department.
PO11 Effectiveness of the endoscopic dilations in the management of Achalasia : A retrospective study about 84 cases in a Moroccan Department.

Introduction: Achalasia is defined by a deficit, complete or not, of the relaxation of the lower esophageal sphincter in response to swallowing and the disappearance of esophageal peristalsis. The various treatments proposed so far are only symptomatic attempts to minimize the motor abnormalities observed on the esophageal body and, more particularly for endoscopic treatments, to remove the sphincteric obstacle.

The purpose of our study is to evaluate the effectiveness of the endoscopic dilation in patients with achalasia supported in our department.

Materials and methods: This is a retrospective study, spread over a period of 9 years, from January 2010 until January 2019, gathered in the Department of Hepatology and Gastroenterology I of the Military Training Hospital Mohammed V of Rabat in Morocco, including 84 patients with achalasia, whose diagnosis was retained on a set of clinical arguments, endoscopic, manometric; The effectiveness of the treatment was judged by the Eckart Score. Failure was defined by the lack of improvement after a number of dilations> 3.

Results: The average age of our patients is 44 years [18-70 years] with a sex ratio of 0.75. Dysphagia was the main symptom present in all our patients, followed by weight loss present in 46.42% of patients. The average Eckart score before dilation was 5.5. Oesogastroduodenal fibroscopy was performed in all patients and showed a positive jump in 82.14%. Manometry was performed in all our patients and confirmed the diagnosis of achalasia in all cases. We performed a total of 174 balloon dilation sessions. With average 2, 07 sessions per patient (1-5). 72 patients (85.71%) presented a remission after less than 4 sessions. Only 12 patients (14.28%) presented refractory stenosis, 6 of which were operated while the other six continued dilation. The average time to recidivism was 2.3 months. The average Eckart score after dilation was 1.5 (range 0 to 6).

Conclusion: The results of our study are in line with those in the literature which emphasize the effectiveness of esophageal dilation in case of achalasia, which can limit as much as possible the role of surgery and metal endoscopic prostheses for such a benign pathology.

Sara JAMAL (Rabat, Morocco), Tarik ADDAJOU, Sanaa BERRAG, Fouad NEJJARI, Mouna TAMZAOURTE, Aziz AOURARH