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: Marc BARTHET (Marseille, FRANCE), Erwan BORIES (Marseille, FRANCE), Guido COSTAMAGNA (ITALY), Jacques DEVIERE (BELGIUM), Marc GIOVANNINI (Marseille, FRANCE), Mostafa IBRAHIM (EGYPT), Horst NEUHAUS (GERMANY), D. SEO (KOREA)
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: Marc BARTHET (Marseille, FRANCE), Erwan BORIES (Marseille, FRANCE), Guido COSTAMAGNA (ITALY), Jacques DEVIERE (BELGIUM), Marc GIOVANNINI (Marseille, FRANCE), Mostafa IBRAHIM (EGYPT), Horst NEUHAUS (GERMANY), D. SEO (KOREA)
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: Marc BARTHET (Marseille, FRANCE), Erwan BORIES (Marseille, FRANCE), Guido COSTAMAGNA (ITALY), Jacques DEVIERE (BELGIUM), Marc GIOVANNINI (Marseille, FRANCE), Mostafa IBRAHIM (EGYPT), Horst NEUHAUS (GERMANY), D. SEO (KOREA)
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: Marc BARTHET (Marseille, FRANCE), Erwan BORIES (Marseille, FRANCE), Guido COSTAMAGNA (ITALY), Jacques DEVIERE (BELGIUM), Marc GIOVANNINI (Marseille, FRANCE), Mostafa IBRAHIM (EGYPT), Horst NEUHAUS (GERMANY), D. SEO (KOREA)
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