Thursday 19 September |
08:45 |
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EUS01
08:45 - 10:30
LIVE DEMO 1
Moderators:
David BERNARDINI (Gastro-enterologist) (Aubagne, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts:
Marianna ARVANITAKI (Expert, Belgium), Marc BARTHET (Professor) (Expert, Marseille, France), Erwan BORIES (Expert, Marseille, France), Fabrice CAILLOL (Expert, Marseille, France), Marc GIOVANNINI (Chef) (Expert, Marseille, France), Mostafa IBRAHIM (Expert, Egypt), Arnaud LEMMERS (Expert, Bruxelles, Belgium), Fauze MALUF-FILHO (Expert, sao Paulo, Brazil), Jean Philippe RATONE (Expert, Marseille, France)
scientific co worker s:
Fabio CIPOLLETTA (Endoscopist) (scientific co worker , Naples, Italy), Yanis DAHEL (Doctor) (scientific co worker , Marseille, France), Domenico GALASSO (Chief of Gastroenterology Unit) (scientific co worker , Montreux, Switzerland), Solene HOIBIAN (PH) (scientific co worker , Marseille, France), Mariana MILASHKA (Doctor) (scientific co worker , Avignon, France)
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10:30 |
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EUS02
10:30 - 11:00
COFFEE BREAK
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11:00 |
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EUS03
11:00 - 13:00
LIVE DEMO 2
Moderators:
David BERNARDINI (Gastro-enterologist) (Aubagne, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts:
Marianna ARVANITAKI (Expert, Belgium), Marc BARTHET (Professor) (Expert, Marseille, France), Erwan BORIES (Expert, Marseille, France), Fabrice CAILLOL (Expert, Marseille, France), Marc GIOVANNINI (Chef) (Expert, Marseille, France), Mostafa IBRAHIM (Expert, Egypt), Arnaud LEMMERS (Expert, Bruxelles, Belgium), Fauze MALUF-FILHO (Expert, sao Paulo, Brazil), Jean Philippe RATONE (Expert, Marseille, France)
scientific co worker s:
Fabio CIPOLLETTA (Endoscopist) (scientific co worker , Naples, Italy), Yanis DAHEL (Doctor) (scientific co worker , Marseille, France), Domenico GALASSO (Chief of Gastroenterology Unit) (scientific co worker , Montreux, Switzerland), Solene HOIBIAN (PH) (scientific co worker , Marseille, France), Mariana MILASHKA (Doctor) (scientific co worker , Avignon, France)
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13:00 |
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EUS04
13:00 - 14:00
Lunch Break
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14:00 |
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EUS05
14:00 - 16:00
LIVE DEMO 3
Moderators:
David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France)
Experts:
Marianna ARVANITAKI (Expert, Belgium), Marc BARTHET (Professor) (Expert, Marseille, France), Fabrice CAILLOL (Expert, Marseille, France), Marc GIOVANNINI (Chef) (Expert, Marseille, France), Mostafa IBRAHIM (Expert, Egypt), Arnaud LEMMERS (Expert, Bruxelles, Belgium), Fauze MALUF-FILHO (Expert, sao Paulo, Brazil), Jean Philippe RATONE (Expert, Marseille, France)
scientific co worker s:
Fabio CIPOLLETTA (Endoscopist) (scientific co worker , Naples, Italy), Yanis DAHEL (Doctor) (scientific co worker , Marseille, France), Domenico GALASSO (Chief of Gastroenterology Unit) (scientific co worker , Montreux, Switzerland), Solene HOIBIAN (PH) (scientific co worker , Marseille, France), Mariana MILASHKA (Doctor) (scientific co worker , Avignon, France)
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16:00 |
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EUS06
16:00 - 16:30
COFFEE BREAK
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16:30 |
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EUS07
16:30 - 17:30
LIVE DEMO 4
Moderators:
David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France)
Experts:
Marianna ARVANITAKI (Expert, Belgium), Marc BARTHET (Professor) (Expert, Marseille, France), Fabrice CAILLOL (Expert, Marseille, France), Marc GIOVANNINI (Chef) (Expert, Marseille, France), Mostafa IBRAHIM (Expert, Egypt), Arnaud LEMMERS (Expert, Bruxelles, Belgium), Fauze MALUF-FILHO (Expert, sao Paulo, Brazil), Jean Philippe RATONE (Expert, Marseille, France)
scientific co worker s:
Fabio CIPOLLETTA (Endoscopist) (scientific co worker , Naples, Italy), Yanis DAHEL (Doctor) (scientific co worker , Marseille, France), Solene HOIBIAN (PH) (scientific co worker , Marseille, France), Mariana MILASHKA (Doctor) (scientific co worker , Avignon, France)
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17:30 |
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EUS08
17:30 - 18:00
ORAL COMMUNICATIONS
17:30 - 17:37
#40926 - OC01 EUS Guided Liver Biopsy Versus Percutaneous Liver Biopsy for the Evaluation of Liver Diseases, a Retrospective Study from a Tertiary Hospital In India.
OC01 EUS Guided Liver Biopsy Versus Percutaneous Liver Biopsy for the Evaluation of Liver Diseases, a Retrospective Study from a Tertiary Hospital In India.
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.
Rahul SODANI, Hameed RAINA (sringar, India)
17:37 - 17:44
#43689 - OC02 EUS-guided Portal Pressure Gradient Measurement with EUS-guided bi-lobar liver biopsy: Clinical Usefulness.
OC02 EUS-guided Portal Pressure Gradient Measurement with EUS-guided bi-lobar liver biopsy: Clinical Usefulness.
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.
Rafael ROMERO-CASTRO (SEVILLE, Spain), Victoria Alejandra JIMENEZ-GARCIA, Isabel CARMONA-SORIA, Paula FERNANDEZ-ALVAREZ, Patricia CORDERO-RUIZ, Maria TOUS-ROMERO, Francisco BELLIDO-MUÑOZ, Carlos ORTIZ-MOYANO, Javier GARCIA-PEREZ, Rodriguez-Tellez MANUEL, Angel CAUNEDO-ALVAREZ
17:44 - 17:51
#43684 - OC03 What is the contribution of endosonography in Idiopathic Acute Pancreatitis?
OC03 What is the contribution of endosonography in Idiopathic Acute Pancreatitis?
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.
Jihane BENASS (Rabat, Morocco), Chaimaa JIOUA, Amine ACHEMLAL, Salma AZAMMAM, Fedoua ROUIBAA, Hassan SEDDIK
17:51 - 17:58
#43512 - OC04 Optimization of colorectal polypectomy: Study of quality criteria for effective colorectal cancer prevention.
OC04 Optimization of colorectal polypectomy: Study of quality criteria for effective colorectal cancer prevention.
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.
Hind LAHSSINI (Casablanca), Fatima Ezzahra EL RHAOUSSI, Mohamed TAHIRI, Fouad HADDAD, Wafaa HLIWA, Ahmed BELLABEH, Wafaa BADRE
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20:00 |
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EUS09
20:00 - 23:30
GALA DINNER
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Friday 20 September |
08:30 |
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EUS10
08:30 - 10:30
SESSION 1
What's new in Pancreatic Cancer?
Moderators:
Marianna ARVANITAKI (Belgium), Marc GIOVANNINI (Chef) (Marseille, France)
08:30 - 09:00
Diagnostic of pancreatic cancer: EUS-FNA or EUS-FNB?
Mostafa IBRAHIM (Keynote Speaker, Egypt)
09:00 - 09:30
Biliary drainage for pancreatic cancer: EUS guided or ERCP?
Fauze MALUF-FILHO (Keynote Speaker, sao Paulo, Brazil)
09:30 - 10:10
Is neo adjuvant chemotherapy needed for left sided pancreatic adenocarcinoma?
Olivier TURRINI (surgeon) (Keynote Speaker, Marseille, France)
10:00 - 10:30
Is "a la carte treatment" possible for pancreatic adenocarcinoma?
Nelson DUSETTI (Keynote Speaker, Marseille, France)
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10:30 |
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EUS11
10:30 - 11:00
COFFEE BREAK
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11:00 |
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EUS12
11:00 - 12:30
SESSION 2
Moderators:
Marc BARTHET (Professor) (Marseille, France), Fauze MALUF-FILHO (sao Paulo, Brazil)
11:00 - 11:30
Pancreatic Fluid collections : When to use LAMS or plastic stents?
Fabrice CAILLOL (Keynote Speaker, Marseille, France)
11:30 - 12:00
EDGE and EEDE Techniques: results and indications.
Domenico GALASSO (Chief of Gastroenterology Unit) (Keynote Speaker, Montreux, Switzerland)
12:00 - 12:30
EUS guided pancreatic duct drainage. What technique and which indications in 2024.
Marc GIOVANNINI (Chef) (Keynote Speaker, Marseille, France)
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12:30 |
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EUS13
12:30 - 13:15
INDUSTRY SYMPOSIUM COOK
From engineer to endoscopist: Developing cutting-edge medical devices
Moderator:
Fabrice CAILLOL (Marseille, France)
Keynote Speakers:
Michael CLANCY, Marc GIOVANNINI (Chef) (Keynote Speaker, Marseille, France)
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13:15 |
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EUS14
13:15 - 14:15
LUNCH
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Exhibition Aera |
14:15 |
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EUS15
14:15 - 15:00
SESSION 3
Ampullary and biliary cancer
Moderators:
Fabrice CAILLOL (Marseille, France), Arnaud LEMMERS (Bruxelles, Belgium)
14:15 - 14:30
Technique, indication and results of biliary drainage for proximal malignant biliary stenosis.
Arnaud LEMMERS (Keynote Speaker, Bruxelles, Belgium)
14:30 - 14:45
Technique, indication and results of biliary radiofrequency fo proximal malignant biliary stenosis.
Jean Philippe RATONE (Keynote Speaker, Marseille, France)
14:45 - 15:00
Malignant ampullary tumors : Surgery or Endoscopic treatment?
Anais PAIEN (Keynote Speaker, Marseille, France)
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15:00 |
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EUS16
15:00 - 15:45
INDUSTRY SYMPOSIUM
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15:45 |
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EUS17
15:45 - 16:15
COFFEE BREAK
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16:15 |
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EUS18
16:15 - 17:00
SESSION 4
New EUS procedures
Moderators:
Erwan BORIES (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
16:15 - 16:30
Eus guided variceal therapy.
Mostafa IBRAHIM (Keynote Speaker, Egypt)
16:30 - 16:45
EUS-guided gastro-jejunal anastomosis and new approaches.
Marc BARTHET (Professor) (Keynote Speaker, Marseille, France)
16:45 - 17:00
Shear Wave Elastography, DFI : Which place today?
Marc GIOVANNINI (Chef) (Keynote Speaker, Marseille, France)
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EUS19
17:00 - 17:45
ORAL COMMUNICATIONS
17:00 - 17:07
#43691 - OC05 EUS-guided pancreatic duct drainage: endoscopic and clinical practice experience.
OC05 EUS-guided pancreatic duct drainage: endoscopic and clinical practice experience.
Background: EUS-guided pancreatic duct drainage (EUSPDD) is an endoscopic procedure which is indicated in symptomatic patients with evidence of pancreatic duct obstruction after failure of transpapillary drainage or impossibility to perform EWSL in the contest of chronic pancreatitis or altered anatomy causes (Whipple or Roux-en-Y surgery for example). Nowadays, it is a challenging procedure performed by few endoscopist. Clinical and technical success rate is still lacking and heterogenous, therefore acquisition of new data and experience is necessary.
Material & Methods: This is a retrospective observational single-center study including patients (pts) undergone EUSPDD from March 2018 to July 2023 using plastic stent (7Fr 10cm), delivered with an electrocautery-enhanced catheter, after transpapillary drainage failure. Also, it was evaluated exocrine pancreatic function by fecal elastase (FE-1) and nutritional markers (prealbumin and magnesium).
Results: Total of 15 pts (M:F=11:4) with median age of 72 years old. 13 pts (86.6%) had a chronic pancreatitis diagnosis with radiological evidence duct pancreatic alterations (5 stenosis, 3 lithiasis, 4 both, 1 duct rupture); 2 pts had a post-surgical stenosis. All pts were symptomatic: 6 pts (40%) shows multiple episodes of acute pancreatitis and 9 (60%) had abdominal pain non responder to medical therapy. Pancreatic duct had median dilatation of 7 mm (4-15.6 mm). Every transmural access was performed through gastric wall with single plastic stent (7Fr 10cm) placement. Technical success was obtained in 11 pts (73%) of which 2 pts had early stent migration and in 4 pts (26.6%) EUSPDD was failed. No other adverse events. 13 (86.6%) had a condition of pancreatic exocrine insufficiency with FE-1 < 200 µg/g in 8 pts and < 100 µg/g in 5 pts under pancreatic enzyme replacement therapy. Magnesium median value was 0.74 mmol/L (0.5-0.8 mmol/L) and prealbumin median value was 0.22 g/L (0.11-0.26 g/L), both at the low normal serum level. During clinical follow up, pts undergone to EUSPDD had no pain, improvement of general quality of life and nutritional markers.
Conclusion: EUSPDD still remain a challenging endoscopic procedure indicated only for selected cases and performed by expert endoscopist. However, EUSPDD seems to have a reasonable clinical success rate but we need further data to improve endoscopic experience and clinical awareness.
Matteo MARASCO, Sebastien GODAT, Bruno ANNIBALE, Francesco PANZUTO, Domenico GALASSO (Montreux, Switzerland)
17:07 - 17:14
#43687 - OC06 Management of arterial bleeding complicating endoscopic ultrasound-guided cystogastrostomy.
OC06 Management of arterial bleeding complicating endoscopic ultrasound-guided cystogastrostomy.
INTRODUCTION
Endoscopic ultrasound (EUS)-guided pseudocyst drainage is nowadays a a standard first-line therapy procedure with minimal morbidity and mortality. Although the use of EUS Doppler techniques has enhanced the safety of transmural puncture by helping avoid major vessels, immediate complications such as bleeding still occur in 1-2% of cases, due to the fact that vessels on the internal wall of the pseudocyst might be compressed by the fluid and thus not visible on color Doppler.
CASE REPORT
A 63-year-old man was referred to our hospital with abdominal pain and distension resulting from a history of pancreatic pseudocyst (PPC). Abdominal contrast-enhanced computed tomography, MRCP and endoscopic ultrasound examinations showed a pseudocyst in the tail of pancreas. Good adhesion was noted between the cyst wall and the posterior gastric wall. EUS imaging was used to determine the cyst puncture site and confirm the lack of intervening vessels. A 19-gauge needle was employed to perform the primary PPC puncture and access the cavity, which helped to create a fistula between the PPC and gastric lumen. A 0.035 in hydrophilic guidewire was inserted through the needle and then coiled into the cyst cavity. The needle was withdrawn, while the guidewire remained in the cyst. Next, a 6F cystotome was utilized to dilate the fistula. Unfortunately, after we removed the cystotome, an acute hemorrhage surrounding the fistula occurred. Under EUS, we noted a significant spurting (pulsatile) arterial bleeding started from the puncture level inside the pseudocyst, being easily visible on the gray-scale mode, with minimal intragastric bleeding and the blood flow was similar to a stream. The electrocautery-assisted cystotome was replaced and used to cauterize the bleeding vessel, successfully stopping the hemorrhage.
In our case, the sudden spurting arterial bleeding was most probably caused by the blade which extends in the tip of the 19G trocar, probably by damaging concealed vessels at the internal wall of the pseudocyst, which were not visible initially, but were probably decompressed during EUS-guided drainage
Conclusion
Hemorrhagic complications during EUS-guided pseudocyst drainage can occur, because the vessels on the internal wall of the pseudocyst might be compressed by the fluid and thus not visible on color Doppler. Electrocautery-assisted cystotomes may represent a useful tool for the successful treatment of bleeding during EUS-guided drainage.Video case available
Jihane BENASS (Rabat, Morocco), Amine ACHEMLAL, Tarik ADDAJOU, Salma AZAMMAM, Chaimaa JIOUA, Imane MOUSLIM, Fedoua ROUIBAA, Hassan SEDDIK
17:14 - 17:21
#43653 - OC07 Endoscopic ultrasound-guided drainage of pancreatic collections using lumen-apposing metal stents.
OC07 Endoscopic ultrasound-guided drainage of pancreatic collections using lumen-apposing metal stents.
Introduction and Objectives: Pancreatic collections (PC) are a common local complication of acute pancreatitis (AP), often requiring drainage if symptomatic or infected. Management of symptomatic PC involves surgical, percutaneous, and endoscopic drainage. The study aimed to evaluate the effectiveness and safety of Endoscopic ultrasound (EUS) - guided drainage using metallic stents for managing PC.
Material: This retrospective study included adult patients with symptomatic PC who underwent EUS–guided drainage with a LAMS at our hospital between 2017 and first 6 months of 2024. Evaluation variables included demographic data, imaging findings, technical success (correctly placement of LAMS), clinical success (symptomatic resolution and reduction in PC size), number of additional interventions, stent removal time, and complication rates.
Results: The study included 13 patients (8 male; mean age 66 ± 12,61 years), with a total of 14 metallic stents placed (3 pseudocysts and 10 encapsulated necrotic collections). The most common indications for intervention were infection, followed by abdominal pain and gastric outlet obstruction. The mean size of the collections was 15 ± 6,43 cm. The largest walled-off necrosis (WON) (30 cm) required sequential placement of 2 metallic stents. Stent types included 5 Hot AXIOS®, 2 NAGI®, and 7 Hot SPAXUS®. The technical success rate was 100%, and the clinical success rate was 71.43%. Necrosectomy sessions were performed in 8 patients, averaging 1,86 sessions per patient. The mean time to stent removal was 34 days. Within 3 months post-stent removal, 1 patient required endoscopic placement of plastic stents. Complications occurred in 2 patients: one case of intra-gastric stent migration and one mild acute pancreatitis episode. There were no procedure-related mortalities. Additionally, two patients required surgical intervention: one underwent necrosectomy, and unfortunately, one patient died before surgery.
Conclusions: Our study showed that LAMS are effective and safe for endoscopic drainage of PC. The high technical success rate and favorable clinical outcomes, coupled with a relatively low incidence of adverse events, highlight LAMS as a reliable option in managing symptomatic PC. The importance of timely stent removal to minimiza potential complications is emphasized. Moving forward, we plan to conduct a multicenter study to validate these findings across diverse patient populations.
Margarida PORTUGAL (Faro, Portugal), Marta EUSÉBIO, Isabel CARVALHO, Luís RELVAS, Sónia BARROS, Bruno PEIXE
17:21 - 17:28
#43683 - OC08 Comparative diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for tissue sampling of solid pancreatic lesions without ROSE.
OC08 Comparative diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for tissue sampling of solid pancreatic lesions without ROSE.
Introduction: Endoscopic ultrasound-guided tissue sampling plays a central role in the accurate diagnosis of solid pancreatic lesions and is considered currently the safest and most efficient diagnostic technique. The aim of our study was to compare the diagnostic yield of FNA needles with FNB needles in solid pancreatic lesions.
Aims & Methods: We conducted a retrospective and analytical study between January 2022 and June 2024. We included all patients with solid pancreatic lesions who underwent an endoscopic ultrasound-guided sampling. Three types of needles were used: 1- 22G fine needle aspiration (FNA) needles, 2- 19G FNA needles and 3- newer generation 20G fine needle biopsy (FNB) needles. For each patient, we performed an average of two needle passes, with fanning systematically performed. Additionally, suction was used during sampling with FNA needles and we evaluated the quality of all the samples by Macroscopic On-Site Evaluation (MOSE) (presence of white core tissue).
Results: 54 patients were included in our study. The mean age was 59.6 +/- 15 years. The sex ratio was 1.5. 23 patients underwent UES-FNA, while 31 patients underwent EUS-FNB. In our series, the overall diagnostic yield of EUS-guided sampling was 63.6%. 88.2% of biopsies performed using FNB needles were conclusive compared to 31.7% when FNA needles were used. The diagnostic accuracy of 19G FNA needles was 81%. In pairwise comparison, the presence of adequate tissue core was significantly higher in the FNB group (p-value=0.006).
In multivariate analysis, after adjusting for covariates (age, sex, size of the pancreatic mass on endoscopic ultrasound examination, and type of needle used), only the size of the lesion (p=0.04) and the use of newer generation FNB needles (p=0.03) were associated with obtaining a positive histopathological diagnosis. The anatomical location of the lesion (head/body/tail) did not influence the diagnostic accuracy (p value = 0,5).
No complications were reported in both techniques.
Conclusion: Newer generation FNB needles appear to offer a greater diagnostic performance in the sampling of solid pancreatic masses when Rapid On-Site Evaluation is not available. These results have immediate clinical practice implications and could help endoscopists meet the quality indicator threshold of having a sensitivity that equals or exceeds 85%, as advocated by European and American societies of gastroenterology.
Jihane BENASS (Rabat, Morocco), Amine ACHEMLAL, Imane MOUSLIM, Salma AZAMMAM, Fedoua ROUIBAA, Hassan SEDDIK
17:28 - 17:35
#43686 - OC09 ENDOSCOPIC MANAGEMENT OF HEPATIC HYDATID CYSTS RUPTURED IN THE BILIARY DUCTS.
OC09 ENDOSCOPIC MANAGEMENT OF HEPATIC HYDATID CYSTS RUPTURED IN THE BILIARY DUCTS.
Introduction
Hepatic hydatid cyst usually runs asymptomatically, while clinical symptoms, are usually due to complications that supervene. The most commonly encountered complication is rupture into the biliary tree with secondary biliary obstruction by intracystic material and cholangitis. The aim of our study is to evaluate the contribution of endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnostic and particularly therapeutic management of ruptured liver hydatid cysts in the bile ducts.
Methods
We conducted an ambispective descriptive study, from January 2014 to June 2024, which included 55 patients with a hydatid cyst fistulized in the bile ducts. ERCP and endoscopic sphincterotomy were performed in all patients. Overall success was defined by definitive vacuity of the main bile duct.
Results
Among the ERCPs performed in our department during the study period, 4.2% (n = 55) were for a hepatic hydatid cyst communicating with the bile ducts.
The mean age was 46.1 ±14.8 years with a male predominance of 66%.
For our 55 patients included in the study, ERCP was performed in 56% of cases before surgical management of hydatid cyst, and in 44% postoperatively.
ERCP was indicated for acute cholangitis in 44.9% of the cases and for persistent external biliary fistula in 34% of the cases.
The median bile duct diameter was 10mm[7-14] and the median cyst diameter was 35mm[26-47].
Sphincterotomy was performed in 96% of patients allowing extraction of hydatid material by balloon or Dormia in 87.8% of the cases. Nevertheless 20% required naso-biliary drainage and 8% benefited from biliary stent placement.
The overall success rate was 97% (n=53). The immediate complication rate was 7%(n=4), 1 patient had hemobilia and 3 patients had edge bleeding.
The evolution was marked by the disappearance of jaundice after 5 to 10 days and by the drying up of the external biliary fistula after 10 days.
Conclusion
Our study confirms that endoscopic treatment of ruptured hydatid cyst in the bile ducts is an effective therapeutic procedure, with a low rate of immediate complications and a good long-term evolution.
Jihane BENASS (Rabat, Morocco), Amine ACHEMLAL, Tarik ADDAJOU, Salma AZAMMAM, Chaimaa JIOUA, Imane MOUSLIM, Fedoua ROUIBAA, Hassan SEDDIK
17:35 - 17:42
#43685 - OC10 Diagnostic value of endoscopic ultrasonography in dilated bile ducts without visible imaging obstruction.
OC10 Diagnostic value of endoscopic ultrasonography in dilated bile ducts without visible imaging obstruction.
Introduction
Dilated commun bile duct is frequently found on abdominal ultrasound of CT scans. Endoscopic ultrasonography (EUS) is an effective diagnostic tool that enables direct vizualisation of the CBD and adjacent biliopancreatic structures.
The aim of this study was to review the role of endoscopic ultrasonography (EUS) in assessing the etiology of unexplained common bile duct dilatation when conventional imaging was non conclusive.
Methods
This is a retrospective descriptive study conducted from January 2015 to June 2024, including 59 patients with intra-and/or extra-hepatic bile duct dilatation in the absence of any obstructive lesion. TODANI classification was considered for common bile duct (CBD) cystic dilatations.
Results
We enrolled 59 patients responding to inclusion criteria, which represented 10% of all indications of EUS. The mean age of our patients was 60±12,30 years, with a female predominance.
EUS showed a dilated CBD in 56,9% of cases with a double duct sign in 5,9% of cases. The main diagnoses revealed were a cystic dilatation of CBD in 43,1%, predominated by type Ia and Ib in 38,1% and 4% respectively, a choledocholithiasis in 5.9% of the cases, an ampulloma in 3,9% of cases, and papillomatosis of the bile ducts in 2% of cases. The pancreatic head cancer was suspected during echo-endoscopy and then confirmed histologically in 3% of patients. However, EUS examination allowed us to exclude the diagnosis of biliary ducts dilatation in 41% of our patients. No complications were recorded secondary to the procedure.
Conclusion
EUS is a minimally-invasive safe tool with a good diagnostic accuracy in CBD dilations without obvious etiology on conventional imaging.
Jihane BENASS (Rabat, Morocco), Tarik ADDAJOU, Amine ACHEMLAL, Salma AZAMMAM, Fedoua ROUIBAA, Hassan SEDDIK
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17:45 |
"Friday 20 September"
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EUS20
17:45 - 17:50
CLOSINGS REMARKS AND ADJOURN
Keynote Speaker:
Marc GIOVANNINI (Chef) (Keynote Speaker, Marseille, France)
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Saturday 21 September |
08:30 |
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HDS1EFG1
08:30 - 10:30
Hands-On Session
EUS-FNA Group 1
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HDS1EFG2
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HDS1EPDG1
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EUS Pseudocyst Drainage/Biliary Drainage Group 1
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HDS1EPDG2
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EUS Pseudocyst Drainage/Biliary Drainage Group 2
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HDS1EPDG3
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EUS Pseudocyst Drainage/Biliary Drainage Group 3
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HDS1EGRG1
08:30 - 10:30
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EUS GUIDED RFA Group1
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10:30 |
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PACAF
10:30 - 11:00
Coffee Break
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11:00 |
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HDS2EFG1
11:00 - 13:00
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HDS2EPDG1
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EUS Pseudocyst Drainage/Biliary Drainage Group 1
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HDS2EPDG2
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EUS Pseudocyst Drainage/Biliary Drainage Group 2
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HDS2EPDG3
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EUS Pseudocyst Drainage/Biliary Drainage Group 3
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EPOSTER
00:00 - 00:00
EPOSTERS
00:00 - 00:00
#40927 - EP01 EUS Guided Cysto-gastrostomy and Direct Endoscopic Necrosectomy (DEN) in Pseudocysts and walled-off necrosis, Our Experience over two years. An Observational Retrospective Study from a Tertiary Center in United Arab Emirates.
EP01 EUS Guided Cysto-gastrostomy and Direct Endoscopic Necrosectomy (DEN) in Pseudocysts and walled-off necrosis, Our Experience over two years. An Observational Retrospective Study from a Tertiary Center in United Arab Emirates.
Introduction: EUS-guided Cysto-gastrostomy with either lumen opposing metal stent or plastic stent placement is now the standard of care in the management of symptomatic pseudocysts and walled-off necrosis. However, this modality is not widely utilized in our region due to lack of expertise and knowledge.
The aim of this study was to evaluate the efficacy and safety and to generate the evidence of this modality in this part of the Middle East Region.
Patients and Methods: All adult patients who were referred and admitted with acute severe pancreatitis complicated with peripancreatic fluid collections were enrolled in this study from January 2022 to January 2024. A total of 68 such cases were admitted during this time in our hospitals.39 patients required drainage.15 patients had walled-off necrosis and 24 had symptomatic pseudocysts. All procedures were performed by single expert Endosonographer in an endoscopic suit without fluoroscopy.
Results:
27 were males and 12 were females. The etiology of pancreatitis was alcohol in 4, gallstone in 18, drugs like Methotrixate and semaglutide in 2, pancreatic divisum in 2, Hypertriglyceridemia in 2, trauma in 2, and idiopathic in 9 cases.
Average age was 38 ± 3 years. Average size of the collections was 9.2 x 5.7 cm ± 3.1 x 2.9 cm. Twelve patients underwent Direct Endoscopic Necrosectomy. An average of 2 sessions (range 1-4) were performed. Technical success of EUS-guided Cysto-gastrostomy was 100 %. Clinical success was 94.87% (37/39). One patient each required percutaneous and surgical drainage. Two serious adverse events (5.12%) in the form of severe bleeding and stent mal-deployment were seen which were managed endoscopically. There was one (2.56%) mortality due to severe pancreatitis. Average stay in the hospital post-procedure was 2 days (IQR 1-3) in the pseudocyst and 8 days (IQR 6-13) in the walled-off-necrosis group. Average time per session of DEN = 2.5 ± 1.2 hours.
Conclusion: EUS EUS-guided cysto-gastrostomy with stenting and Direct Endoscopic Necrosectomy (DEN) are effective and safe minimally invasive modalities of management in symptomatic pseudocysts and walled-off Necrosis post pancreatitis in this region where expertise in EUS is evolving.
Hameed RAINA (sringar, India)
00:00 - 00:00
#43514 - EP02 Perceptions and Obstacles in Colorectal Cancer Screening: State of Knowledge and Limitations.
EP02 Perceptions and Obstacles in Colorectal Cancer Screening: State of Knowledge and Limitations.
Introduction :
Screening for colorectal cancer (CRC) represents a major challenge, given its incidence and impact on morbidity and mortality. Unfortunately, despite the significant prevalence of this entity, there is currently no systematic national screening program.
This study aims to examine the state of knowledge of Moroccan patients about colorectal cancer while shedding light on factors that could influence participation in future screening programs.
Materials and Methods:
This study was conducted using an anonymous questionnaire distributed to patients with no personal history of colorectal cancer, who consulted the emergency department of the hepato-gastroenterology service. Data analysis was performed using Jamovi software.
Results:
We collected 157 patients, predominantly male (58.6%) with a sex ratio of 1.41. The median age was 48 years [34-57].
Among the patients questioned, 35% were illiterate, 40.8% had a primary school education. 30% had no health coverage, and 86% said they had already heard of colorectal cancer from friends and family in 52.6% of cases.
According to the subjects surveyed, diet (24.2%), family history of CRC (22.3%) and the presence of colorectal polyps (17.8%) were the main risk factors for CRC. The main warning signs were rectal discharge (33%) and transit disorders (19%). These signs were reported by 63.7% of patients, of whom 26% sought medical advice.
82.2% of patients surveyed were willing to participate in the CRC screening program.
89.2% of participants said they had never consulted a doctor for screening. Such a finding was linked respectively to the absence of symptoms, lack of means, absence of recommendation and non-involvement of the attending physician in 22.3%; 20.4% and 14% of cases respectively.
Conclusion:
The need to develop awareness strategies and prior knowledge of the determinants and limitations of colorectal cancer screening should enable the implementation of a policy aimed at improving awareness, education and prevention of this type of cancer.
Hind LAHSSINI (Casablanca), Fatima Ezzahra EL RHAOUSSI, Mohamed TAHIRI, Fouad HADDAD, Wafaa HLIWA, Ahmed BELLABEH, Wafaa BADRE
00:00 - 00:00
#43559 - EP03 Pancreatic Extragastrointestinal Stromal Tumor - A Rare Case Report.
EP03 Pancreatic Extragastrointestinal Stromal Tumor - A Rare Case Report.
Gastrointestinal stromal tumors (GISTs) are the most prevalent mesenchymal neoplasms of the digestive tract, comprising 1-3% of all gastrointestinal malignancies.
We report a case of a 74-year-old female diagnosed with recent-onset diabetes mellitus, hypertension, and dyslipidemia. She presented with a 4-month history of weight loss, anorexia, and constipation. CT scan revealed a solid, heterogeneous, nodular formation (7.7x4.9cm) in the pancreatic head, in apparent contact with the duodenum and without dilation of the bile or pancreatic ducts.
Endoscopic ultrasound (EUS) documented an extrapancreatic mass with echogenic and anechoic areas, no doppler signal, and peripheral vascularization. EUS-guided fine-needle biopsy was performed using a 22G needle (2 transgastric and 1 transbulbar passages), revealing glandular cells suggestive of pancreatic origin, with no neoplastic cells.
After the multidisciplinary discussion, pancreatoduodenectomy was decided. Pathological evaluation revealed a 4.6x4x3 cm spindle cell neoplasm with cystic and hemorrhagic areas, <5 mitoses/5mm². Immunohistochemistry showed DOG-1 positivity and negativity for CKAE1/AE3, EMA, SMA, desmin, CD34, S100, cytokeratin, and CD31, confirming a pancreatic GIST (pT2;pN0;LV0;Pn0;R0).
This case consolidates the possibility of this type of tumor involving the pancreas as a primary site. Successful surgery and subsequent surveillance demonstrate the efficacy of a multidisciplinary approach.
Margarida PORTUGAL (Faro, Portugal), Marta EUSÉBIO, Isabel CARVALHO, Luís RELVAS, Sónia BARROS
00:00 - 00:00
#43655 - EP04 Clinical Efficacy of EUS-guided-fine-needle aspiration in solid pancreatic lesions. A single center experience.
EP04 Clinical Efficacy of EUS-guided-fine-needle aspiration in solid pancreatic lesions. A single center experience.
Introduction and Aim: EUS-guided-fine-needle aspiration (EUS FNA) has an important impact on the clinical evaluation of pancreatic lesions. We aim to evaluate the diagnostic utility of EUS FNA in solid pancreatic lesions in our center.
Methods: Data were collected prospectively on all consecutive patients with solid pancreatic masses undergoing EUS-FNA from July 2021 to June 2024. The sample was considered adequate, if a sufficient number of representative cells of the targeted lesion was obtained. They were reported as malignant, atypical, benign, or as inadequate. All specimens were collected; aspirates were placed onto glasses for cytological examination and biopsies fixed in formalin for histology. Data on target lesion, diagnostic adequacy, accuracy, and complications were obtained for each patient. Diagnostic accuracy was assessed based on clinical and surgical follow-up.
Results: 70 patients, 38 (54.3%) males and 32 (45.7%) females, mean age of 64.94±8.970 years underwent EUS FNA for solid pancreatic lesions. 26 (37.2%) of lesions were located in the head, 2 (2.9%) in the neck, 34 (48.5%) in the body and 8 (11.4%) in the tail of pancreas. Mean lesion size was 3.54 cm (1.8-7cm), and mean number of passes 2.9 (1-5cm). Histological diagnosis was reported as malignant in 52 (74%), of cases, atypical in 2 (3%), benign in 14 (20%) and inadequate in 2 (3%) of cases. No association was found between lesion location, size, and number of passes with EUS-FNA malignancy (p=0.145; p=0.133; p=0.588 respectively). Overall accuracy was 76.5%, and was significantly higher for the last 35 EUS 88.6% 95%CI 75.7-97.2 vs 69.7% 95%CI 61.3%-88.2%, p= 0.005). EUS-FNA determined the proper treatment option in 45 of 70 patients. No complications were observed.
Conclusion: In our experience EUS FNA provided an accurate diagnosis in approximately 76.5% of patients and had an impact in management of 64.3 % of patients.
Marsela SINA (Tirana, Albania, Albania), Sara HOXHA, Aferdita DJEGSI, Xhensila PEMAJ, Klevis VRAPI, Irda RRUGEJA, Skerdi PRIFTI
00:00 - 00:00
#43680 - EP05 Single-operator cholangioscopy in the management of proximally migrated biliary stents – single center experience.
EP05 Single-operator cholangioscopy in the management of proximally migrated biliary stents – single center experience.
Endoscopic biliary stenting is a well established modality to treat pancreatobuiliary diseases. However, migration is reported in 5%-10% of cases. Management of proximally migrated stents using standard techniques(guidewire cannulation, snare, forceps, Soehendra stent retriever) can be technically challenging. Cholangioscopy and retrieval under direct visualization could be a useful tool in such cases.
Our aim was to evaluate the application of single-operator cholangioscopy in the management of proximally migrated biliary stents in terms of efficacy and safety.
We performed a retrospective analysis of a prospective database and identified 100 cases of proximally migrated stents from January 2018 throughout March 2024. We evaluated the retrieval technique, success rate, and adverse events. Patients were divided into two groups. In the first cholangioscopy was not performed n=62/62%/. We found a technical success rate in 69,35% /n=43/. In 19 removal was not achieved and was followed by placement of second plastic stent n=19/30.65%/.In the second group, n=38/38%/ cholangioscopy with SpyGlass (Boston Scientific, Marlborough, Massachusetts, USA) was the retrieval technique with a technical success rate of 100%. There was a statistically significant difference between the two groups in terms of technical success in favor of the group with cholangioscopy(p< 0.001). Cholangioscopy was performed either after the failure of standard techniques or as the first-choice tool. In five cases we performed pancreatoscopy for extraction of migrated stents with only one case of postprocedural pancreatitis. We experienced adverse events/AE/ in 17 cases as pancreatitis was the most common one- n=11/64,71% of all AE/, followed by cholangitis n=5/29,41% and one bleeding n=1/5,88%/. In the first group, the rate of adverse events was 17,74%/n=11/ against 13,95%/n=6/ for the second group. There was no statistically significant difference between the two groups. The mean procedure time was 34,35 minutes for the first group and 42,24 minutes for the second one- in favor of the first group. It is important to note that in some cases cholangioscopy was performed after failure of standard techniques which prolonged the procedure time.
Conclusion: Cholangioscopy is a safe and effective technique to extract migrated stents with a high rate of efficacy and an acceptable rate of adverse events. It could be proposed as a first choice in cases where failure of standard techniques is suspected.
Petko KARAGYOZOV (Sofia, Bulgaria), Nadica SHUMKA, Yoana PETKOVA
00:00 - 00:00
#43681 - EP06 Gastric Peroral Endoscopic Myotomy improves chronic alterations of stool frequency in patients with refractory gastroparesis.
EP06 Gastric Peroral Endoscopic Myotomy improves chronic alterations of stool frequency in patients with refractory gastroparesis.
Aims: Gastroparesis is a chronic motility disorder of the stomach characterized by delayed emptying without outflow obstruction. Main symptoms are early satiety, nausea, vomiting, and bloating. In our daily practice, we observed some patients presenting with concomitant chronic alteration of stool frequency. The present study describes the impact of gastric peroral endoscopic myotomy (GPOEM) on chronic diarrhea or constipation.
Methods: This retrospective study analyzed the clinical course of patients with refractory gastroparesis and concomitant chronic alteration of stool frequency who were consecutively treated by GPOEM between January 2019 and October 2023 in a tertiary referral center.
Results: Of 107 patients with refractory gastroparesis treated by GPOEM, 11 (10.3%) patients (mean age 60.4± 16.2 years, 64 % female) had altered bowel frequency for > 6 months before GPOEM without any other underlying disease. Ten patients suffered from chronic diarrhea and one patient had chronic constipation. Gastroparesis was considered of diabetic etiology in three patients, idiopathic in two patients and because of thoraco-abdominal surgery in six patients. Scintigraphy confirmed delayed gastric emptying in 10/11 (91%) of cases. GPOEM was technically feasible in all patients without adverse events during or after endoscopic treatment. Median follow-up period was of 170 days (IQR 33-1002). In 9/11 (81%) patients, GPOEM achieved clinical success with a mean Gastroparesis Cardinal Symptom Index (GCSI) of 3.1 (IQR 2.7-3.4) before, and 0.9 (IQR 0.7-1.7) after the endoscopic treatment. Normalization of bowel movements after GPOEM was observed in 9/11 (81%) of patients. Two patients had partial symptom improvement (loose bowels, but normal frequency), one of them without improvement of GCSI and persistent delayed emptying on scintigraphy.
Conclusion: Gastroparesis may present with concomitant chronic diarrhea improving after endoscopic treatment by GPOEM. These observations need to be confirmed in larger studies.
Maxime JACCARD (Lausanne, Switzerland), Mariola MARX, Sébastien GODAT
00:00 - 00:00
#43688 - EP07 Incidental cardiovascular findings during oncological EUS.
EP07 Incidental cardiovascular findings during oncological EUS.
The authors present three cases in which endoscopic ultrasonography (EUS), performed for oncological indications, led to cardiovascular diseases’ diagnosis, unexpected in two cases.
Case 1: A 46-years-old female is addressed for histological sampling of a suspected lymphoma. EUS examination shows a thrombus of the proximal abdominal aorta, further confirmed by contrast-enhanced CT scan. Antiplatelet treatment is initiated.
Case 2: A 68-years-old male treated for lung cancer, having a previous diagnosis of an atrial mass, in doubt between a metastasis and a thrombus, is sent to EUS for a CT suspicion of esophageal tumor. The EUS examination proves that the atrial mass is a metastasis, as vessels are visualized through color Doppler.
Case 3: A 77-years-old male with a recently discovered Klatskin tumor is sent to EUS examination to assess the proximity of the portal vein and hepatic artery with the tumor, for a possible resection. During the EUS an abnormal pattern of atrial movement is noticed: shallow contractions, quick heart rate. The ECG shows high ventricular response atrial fibrillation, leading to anticoagulant treatment.
Conclusion: The good visualization of cardiovascular structures, such as the heart chambers and certain vessels, leads to the discovery of pathological modifications that need to be investigated and treated. Gross pathological modifications of the cardiovascular structures should be recognized by all EUS practitioners.
Valentin MILITARU (Cluj-Napoca, Romania), Alexandra DORCA, Florentina Claudia MILITARU, Anghel Adrian UDREA
00:00 - 00:00
#43690 - EP08 Rare oesophageal GIST diagnosed by EUS.
EP08 Rare oesophageal GIST diagnosed by EUS.
Introduction
Gastrointestinal stromal tumors (GISTs) account for less than 1% of digestive tract tumors. The most common location of these tumors is the stomach, while the esophageal location is estimated to be between 0.7–5% of all GISTs. The diagnosis of esophageal GISTs is mainly based upon endoscopic evaluation with histologic confirmation.
Methods
We report a rare case of esophageal GIST confirmed by echoendoscopy with biopsy.
Case report
We report the case of a 62 years old man with medical history of hypertension who presented dysphagia (2 months, solid and liquid) with no weightloss. Upper gaqtrointestinale endoscopy showed a Submucosal lesion located in the lower esophagus, extending over 10 cm, and reachig the cardia. Per endoscopic biopsy were negative. CT scan showed an heterogeneous with predominently soft tissue attenuation. esophageal mass measuring 54x61x54 mm in direct contact of the aorta without signs of invasion. There were also multiple hypoattenuating lesions, with minimal enhancing. The largest being located between segments V and VI of the liver, suggesting liver metastases. Liver Biopsy was negative. Echoendoscopy with biopsy (FNB 22 G needle) of the oesophageal mass showed mesencymatous tumor mae of fusiform cells with Dog 1 and CD117 positivity. Neoadjuvant imatinib administration was proposed to downsizing the tumor.
Conclusion
Esophageal GISTs are rare and their diagnosis and management are poorly studied. Echoendoscopy with biopsy can help to held the diagnosis and to propose adequate treatment.
Meriam SABBAH (Tunis, Tunisia), Asma SABBEK, Houssaina JELASSI, Sabrine SOUA, Norsaf BIBANI, Dalila GARGOURI
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