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. 

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.

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.

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.

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.

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.