Thursday 15 September
08:00

"Thursday 15 September"

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EUS22-01
08:00 - 08:45

Registration & Welcome

Welcome Area
08:45

"Thursday 15 September"

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EUS22-02
08:45 - 10:30

LIVE DEMO 1

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
Amphitheater
10:30

"Thursday 15 September"

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EUS22-03
10:30 - 11:00

Coffee Break

Exhibition Area
11:00

"Thursday 15 September"

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Eus22-04
11:00 - 13:00

LIVE DEMO 2

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
Amphitheater
13:00

"Thursday 15 September"

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EUS22-05
13:00 - 14:00

LUNCH BREAK

Exhibition Area
14:00

"Thursday 15 September"

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EUS22-06
14:00 - 16:00

LIVE DEMO 3

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
Amphitheater
16:00

"Thursday 15 September"

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EUS22-07
16:00 - 16:30

Coffee Break

Exhibition Area
16:30

"Thursday 15 September"

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EUS22-08A
16:30 - 17:30

LIVE DEMO 4

Moderators: David BERNARDINI (Gastro-enterologist) (Aubagne, France), Erwan BORIES (Marseille, France), Laurent HEYRIES (PHD) (Marseille, France), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
Experts: Fabrice CAILLOL (Marseille, France), Guido COSTAMAGNA (Full Professor of Surgery) (Rome, Italy), Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France), Mostafa IBRAHIM (Egypt), Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain), Wim LALEMAN (Leuven, Belgium), Fauze MALUF-FILHO (sao Paulo, Brazil), Jean Philippe RATONE (Marseille, France)
scientific co worker s: Fabio CIPOLLETTA (Endoscopist) (Naples, Italy), Domenico GALASSO (Chief of Gastroenterology Unit) (Montreux, Switzerland), Mariana MILASHKA (Doctor) (Avignon, France)
Amphitheater
17:30

"Thursday 15 September"

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EUS22-08B
17:30 - 18:30

Oral Communications

Moderator: Erwan BORIES (Marseille, France)
17:30 - 17:40 #32734 - OC01 Endoscopic Treatment of Pancreatic Duct Disruption and Fistulas after Surgery, Pancreatitis, Abdominal Trauma: a tertiary center retrospective study.
Endoscopic Treatment of Pancreatic Duct Disruption and Fistulas after Surgery, Pancreatitis, Abdominal Trauma: a tertiary center retrospective study.

Background and study aims: Main pancreatic duct (MPD) disruption and fistulas can occur

after pancreatic surgery, abdominal trauma, acute or chronic pancreatitis. Unlike endoscopic

transpapillary drainage, experience in the management of these conditions with EUS-guided

procedures is not well reported. We aimed to determine technical and clinical success of

endoscopic techniques used in MPD disruption management. Methods: 33 patients

endoscopically treated for MPD disruption between 2015 and 2021 were retrospectively

analyzed. The primary endpoint was to evaluate clinical and technical efficacy. Secondary

endpoints were occurrence of minor and major procedure-related adverse events. Results:

Clinical success was observed in 87.9% (n=29) of patients and technical success in all

cases. Endoscopic techniques for MPD disruption included ERCP (n=17, 51.5%),

EUS-guided cystogastrostomy (n=8, 24.2%), combination of the two techniques (n=2, 6.1%),

EUS-guided pancreaticogastrostomy (n=5, 15.2%) and EUS-guided rendezvous technique

(n=1, 3%). Peripancreatic fluid collection was observed in 20 patients (60.6%) and

were mainly treated by EUS-guided cystogastrostomy and ERCP. Minor complication

occurred in two patients (6%) and major complication in one patient (3%). Conclusions:

Endoscopic treatment for management of MPD disruption shows an excellent clinical and

technical efficacy with a good safety profile. Emergent techniques using EUS broaden the

therapeutic possibilities in this indication and should be the first treatment option in defined

clinical presentations.


Louison TAMBWE* (Lausanne, Switzerland), Sarra OUMRANI*, Domenico GALASSO, Elodie ROMAILLER, Mariola MARX, Robert MAXIME, Greuter THOMAS, Godat SÉBASTIEN
17:40 - 17:50 #32649 - OC02 EUS-guided versus PTC-guided rendezvous in case of failed biliary cannulation by ERCP: a case-control study.
OC02 EUS-guided versus PTC-guided rendezvous in case of failed biliary cannulation by ERCP: a case-control study.

Background

Endoscopic ultrasound-guided rendezvous (EUS-RV) is an alternative salvage technique to percutaneous transhepatic cholangiography rendezvous (PTC-RV) for biliary cannulation in failed ERCP.  Comparative data on these two techniques are lacking.

Methods

A case-control study was conducted in a tertiary referral center. All consecutive patients that underwent a rendezvous procedure between 2014 and 2022 for failed biliary cannulation were included. Patients that underwent PTC-RV (between February 2014 and February 2018) were compared to those who underwent EUS-RV (between March 2018 and March 2022). The primary endpoints of interest were technical success rate and complication rate. 

Results

A total of 59 consecutive procedures in 57 patients were included for analysis; 20/59 (33.9%) were PTC-RV; the remaining 39/59 (66.1%) procedures were EUS-RV. Two patients in the PTC-RV group underwent two procedures. Of the PTC-RV procedures, 18/20 (90.0%) were technically successful, as compared to 28/39 EUS-RV procedures (71.8%) (p = 0.184; fig. 1).  Adverse events were reported in 7/20 PTC-RV procedures (35.0%) and in 13/39 EUS-RV procedures (33.3%) (p= 1.000). In 5/20 PTC-RV procedures (25.0%) and 4/39 EUS-RV procedures (10.3%), the adverse event was considered major (defined as Clavien-Dindo classification of 3 or more) (p= 0.249).

Conclusions

EUS-RV has an acceptable success rate and is not associated with an increased risk of adverse events as compared to PTC-RV. 


Michiel HANSSENS, Elisabeth DHONDT, Helena DEGROOTE, Pieter HINDRYCKX (Ghent, Belgium, Belgium)
17:50 - 18:00 #32743 - OC03 EUS-guided portal pressure gradient measurement: our preliminary experience.
OC03 EUS-guided portal pressure gradient measurement: our preliminary experience.

AIMS. We report our experience on EUS-guided portal pressure gradient (EUS-PPG). METHODS. Patients were referred to a tertiary academic center for EUS-PPG. We used a 25G dedicated needle (EchoTip Insight™). The procedure was performed as previously reported. Deep sedation was administered by anesthesiogists. RESULTS. Fifteen patients (8 males/7 females), median age 52±13 yo) were referred for EUS-guided PPG measurement. Indications: assessment of NAFLD 11; idiophatic portal hypertension 2; evaluation for curative therapy in hepatocellular carcinoma 2. In 4 patients anticoagulants were withdrawn. Four patients were sedated without orothracheal intubation and 11 were intubated. Bilobar liver biopsies were also performed in 11 patients. PPG was successfully obtained in 13/15 patients (87%). The average time to obtain the PPG was 25±13 minutes (graphic). In 6 cases the PPG was ≥5 mmHg (one case shown esophageal varices with PPG of 16 mmHg), and 5 without varices with PPG ranging 5-10 mmHg. In 2 cases PPG was not obtained (for exacerbated breathing movements and non-reliable pressure measurements (probably for excesive bending of the echoendoscope and use of the elevator, see figure). In one case, chronic pancreatitis was diagnosed. Mean time for PPG plus bilobar hepatic biopsy was 49±11 minutes. No adverse events were registered inmediately and one month later. CONCLUSIONS. In our preliminary experience, EUS-guided PPG measurement seems safe providing useful clinical information.


Rafael ROMERO-CASTRO (SEVILLE, Spain), Isabel CARMONA-SORIA, Victoria Alejandra JIMENEZ-GARCIA, Patricia CORDERO-RUIZ, Francisco BELLIDO-MUÑOZ, Angel CAUNEDO-ALVAREZ
18:00 - 18:10 #32634 - OC04 Endoscopic Ultrasound-guided Rendezvous Technique for Treatment of Malignant Biliary Obstruction.
OC04 Endoscopic Ultrasound-guided Rendezvous Technique for Treatment of Malignant Biliary Obstruction.

ERCP is the first-line procedure for managing biliary obstructions, but it is not always feasible. Percutaneous transhepatic biliary drainage is a widely accepted alternative but it is associated with high mortality. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a promising and evolving alternative, being frequently used in benign and malignant biliary diseases with a high success rate and fewer complications. A 56-year-old male presents to the ER with abdominal pain, jaundice, pruritus, nausea and weight loss.Analytically: AST 89,ALT 292,ALP 425,GGT 1192,Bilirubin 8.65,Ca 19.9 16822.5. A TAP CT showed dilation of the intrahepatic bile ducts;hypodense pseudonodular filling of infiltrative suggestion in the hilar region and along the hepatic pedicle; multiple liver and lung metastases. An MRCP revealed a perihilar extrahepatic cholangiocarcinoma(Klatskin IIIa), with liver metastases and gallbladder invasion, inter-aorto-caval and hepatic hilum adenopathies and pulmonary metastasis. An Ultrasound-guided biopsy confirmed the diagnosis. Due to worsening of jaundice and nausea and given the extension of the billiary stenosis, it was decided to perform an EUS-BD using the Rendezvous technique (EUS-RV). The guidewire was introduced into the duodenum by transhepatic route after gastrohepatic puncture of the left lobe by echoendoscopy. Balloon dilation of the stenosis was performed and 2 self-expanding metallic protheses were placed.The procedure was uneventful and resulted in significant clinical improvement. EUS-BD is an effective, safe, and innovative technique for biliary drainage. It is primarily used as a rescue procedure but published data demonstrates some clinical advantages over ERCP. Because of difficultly in advancing the guidewire through malignant strictures, EUS-RV is preferred for managing benign conditions. EUS-BD is a complex and challenging procedure and requires careful patient selection, highly skilled endoscopists and specialized centers.


Inês PESTANA (Castelo Branco, Portugal), Marisa LINHARES, Diana RAMOS, Marco PEREIRA, Ana CALDEIRA, Rui SOUSA, Eduardo PEREIRA, António BANHUDO
18:10 - 18:20 #32552 - OC05 AN EXTENSIVE SYSTEMATIC REVIEW OF AN ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VERSUS PERCUTANEOUS TRANSHEPATIC CHOLANGIGRAPHY.
OC05 AN EXTENSIVE SYSTEMATIC REVIEW OF AN ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VERSUS PERCUTANEOUS TRANSHEPATIC CHOLANGIGRAPHY.

Aim:

Endoscopic ultrasound-guided biliary drainage (EUS–BD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract whereas Percutaneous transhepatic cholangiography (PTC) is a diagnostic and therapeutic procedure [1]. The present study examined the technical aspects and outcomes of these different approaches to biliary drainage.

Methods:

A search of different databases, including PubMed, Embase, clinicaltrials.gov, Cochrane Library, Scopus, and Google Scholar, was performed according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing percutaneous transhepatic biliary drainage (PTBD) and EUS–BD.

Results:

Six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions than EUS–BD patients (4.9 vs. 1.3), experienced more post-procedure pain (4.1 vs. 1.9), and had more late adverse events (53.8% vs. 6.6%). There was a significant reduction in total bilirubin in both groups (16.4 to 3.3 and 17.2–3.8 for EUS–BD and PTBD, respectively, P = 0.002) at the 7-day follow-up. There were no significant differences observed for complication rates between PTBD and EUS–BD (3.3 vs. 3.8). PTBD was associated with a higher adverse event rate than EUS–BD in all procedures, including reinterventions (80.4% vs. 15.7%, respectively) and a higher index procedure (39.2% vs. 18.2%, respectively).

Conclusions:

The findings of the present systemic review revealed that EUS–BD is linked with a higher rate of effective biliary drainage and manageable procedure-related adverse event profile compared with PTBD. These findings highlight the evidence for successful EUS–BD implementation.

References:

1- Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900 [PMID: 11571690 DOI: 10.1055/s-2001-17324]


Eyad GADOUR (Manchester, United Kingdom), Zeinab HASSAN
Amphitheater
20:00

"Thursday 15 September"

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EUS22-08C
20:00 - 23:00

Gala Dinner