Background: Liver biopsy (LB) has historically been performed percutaneously. A newer method of obtaining an LB is by endoscopic ultrasound (EUS)guidance.

Aims: To compare the safety and efficacy of this new method with the standard technique.

 

Methods: It was a retrospective comparative study. All adult patients with undiagnosed abnormal liver enzymes were included. The EUS-guided liver biopsy (EUS-LB) procedure was done using 19 G Shark Core FNB needle (Medtronic) .  Two to three passes were taken. Percutaneous liver biopsy (PC-LB) was done by a single experienced radiologist under USG guidance with 18 Guage CorVocet needle (Meritmedica ).

Results:

 Mean total core length (TCL) in EUS-LB =18.9 mm (IQR 15.3–22.5); PC-LB =22.6 mm (IQR 19.0-27.2)P=0.04.Number of complete portal tracts(CPT) in PC-LB= 26 (15–36); PC-LB = 24 (17–31)  (p = 0.20).). Histologic diagnosis= 97.4% in the EUS-LB group, 98.7% in the PC-LB group (P = 0.541). Mean Hospital stay in EUS-LB=2hrs (1-3 hrs) vs. 3.9 hrs (3-6hrs) in PS-LB (P = 0.02). Pain requiring analgesics = 3 in EUS-LB and 75 in PC-LB group (p=0.0005).

 

Conclusion: EUS-LB was safer, with less hospital stay, no pain and more patient satisfaction than PC-LB, with comparable efficacy.

 

AIMS We report our experience on EUS-guided portal pressure gradient measurement (EUS-PPGm). METHODS Prospective unicenter study of patients referred for EUS-PPGm. A 25G needle, EchoTip Insight, was used for EUS-PPGm and a 19G needle (FNB/ FNA) in case of an additional EUS-guided bi-lobar liver biopsy (EUS-BLB). Prophylactic antibiotherapy was administered. RESULTS The EUS-PPGm procedure was performed in 50 patients, 23 males/27 females, median age 32±2 yo). Indications: assessment of MASLD in morbid obese patients before bariatric surgery, 39; idiophatic portal hypertension (IPH), 8; evaluation for curative therapy in hepatocellular carcinoma (HCC), 3. EUS-BLB was also performed in 40/50 patients (80%). EUS-PPGm was obtained in 44/50 patients (88%). In 17/44 cases (39%) the PPG was >5 mmHg: 3 in IPH, 1 in HCC and 14/39 (36%) in morbid obese patients. In this last group was observed mild portal hypertension with neither ultrasonographic/endoscopic signs of portal hypertension nor significant liver fibrosis on EUS-BLB (90% F1, 5% F1 and 5% F2). Patients with IPH and HCC were treated accordingly with the results of EUS-PPGm. In 6 cases (12%) EUS-PPGm was not obtained: rapid breathing movements (1 case) and non-reliable pressure measurements (5 cases). In one case the 25G needle passed in close proximity to the hepatic artery. We experienced difficulty in puncture the hepatic and the portal vein in one and two cases, respectively. In one case the 25G dedicated needle failed to transverse the liver capsule. Mean time to obtain EUS-PPGm 22±2 minutes, EUS-BLB 17±1 minutes and combined EUS-PPGm plus EUS-BLB 45±2 minutes. Three adverse events were observed. One mild epigastric pain 2 day after a combined procedure, one self-limited bleeding from the cardias and one atrial fibrillation. No other adverse events were registered one month after the procedures. CONCLUSIONS EUS-PPGm, even combined with EUS-BLB, seems safe, providing relevant clinical information. There are technical aspects that should be known to improve the safety, accuracy and availibility of this procedure (1). A notewhorty proportion of morbid obese patients were precociously diagnosed by EUS-PPGm of portal hypertension in early reversible stages. 1. Romero-Castro R, Carmona-Soria I, Jiménez-García VA, et al. Endoscopic ultrasound-guided portal pressure gradient measurement: improving safety and overcoming technical difficulties. Endoscopy. 2023;55(S 01):E878-E80.

Introduction: The aetiology of acute pancreatitis remains unclear in approximately 10–30% of patients, even after a comprehensive diagnostic evaluation. These cases are defined as Idiopathic acute pancreatits (IAP). It is a challenging entity where Endoscopic ultrasonography (EUS) has become a reliable diagnostic tool. The aim of our study is to investigate the role of endoscopic ultrasonography (EUS) in Idiopathic Acute Pancreatitis (IAP). Materials and Methods: This is a retrospective descriptive study, including 93 patients who underwent an EUS examination for idiopathic acute pancreatitis between January 2018 and July 2024. Results: The mean age of our patients was 55 ± 16.3 years, with extremes ranging from 17 to 89 years. The sex ratio (M/F) was 0.84, with a slight female predominance of 55.7%. A history of previous acute pancreatitis was found in 32.7% of cases, and 16.3% of patients had undergone cholecystectomy. The diagnostic yield in our study was 71%. Biliary origin was retained in 40.4% (n=36) of patients; 19 of whom benefited́ from complementary ERCP during the same operatory time. A tumor pathology was found in 32.5% of cases (n=30) and chronic pancreatitis in 22.4% of patients (n=20). We also found three cases of pancreas divisum, four cases of sphincter of Oddi dysfunction and one case of choledochocele. EUS examination was normal in the remaining 29% of cases, and no causative aetiology was directly identified Conclusion: EUS has transformed the assessment of IAP by identifying underlying causes that were previously undetectable. Its detailed imaging of the pancreas and surrounding structures, combined with EUS-guided sampling techniques, has enhanced diagnostic accuracy and informed therapeutic decisions. Integrating EUS into the diagnostic process for IAP improves patient management and targeted interventions can be implemented.

Introduction : Colorectal cancer is one of the most common cancers worldwide. However, early detection of colorectal polyps can reduce its occurrence. This study aims to investigate the quality criteria for ensuring effective polypectomy, thereby minimizing the risk of subsequent development of this fatal cancer. Materials and methods: This is a retrospective and analytical study spread over 7 years (2017-2023) collating all patients who underwent polypectomy at the Hepato-Gastro-Enterolgy Department of Ibn Rochd University Hospital. The criteria used to assess a polypectomy as being of good quality were: good colonic preparation, complete colonoscopy, monobloc excision, complete resection of the polyp with recovery , and removal of all lesions during the same session. Data analysis was performed using Jamovi software. Results: A total of 259 polyps were resected in 151 patients. The median age was 58 years [48-67], with a M/F sex ratio of 1.15. Colonic preparation was good in 43.7% of cases, and colonoscopy was complete in 67% of cases. Polyps were located in the right colon (16.6%), transverse colon (15.1%), left colon (11.6%), sigmoid (25.1%) and rectum (31.7%). The mean polyp size was 10.4 mm, ranging from 1 to 8 mm. Of the polyps, 68% were sessile and 28% were pedunculated. Regarding polypectomy, almost half of the polyps were removed by mucosectomy. The use of a diathermic loop and cold forceps accounted for 19.7% and 21.2% of cases respectively. Resection was performed monoblocally in 95.8% of cases, with successful completion in 93.8%. In 58.3% of cases, it was possible to remove all lesions in the same session. Polyps were recovered in 80.3% of cases. Poor colonic preparation was identified as the primary statistically significant factor (p < 0.001) associated with non-compliance with quality criteria, particularly regarding the complete removal of all polyps during the same session. Conclusion: Optimization of polypectomy represents an essential pillar in the effective prevention of colorectal cancer. This study focuses on the quality criteria associated with this procedure, while highlighting the determining factors for ensuring an effective polypectomy.