Friday 16 September
08:30

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EUS22-09
08:30 - 10:30

Session 1:
Pancreatic Cancer: What's new?

Moderators: Jacques DEVIÈRE (Chair of department) (Brussels, Belgium), Marc GIOVANNINI (Chef) (Marseille, France)
08:30 - 09:00 Pancreatic Cancer: EUS-FNA or EUS-FNB? Julio IGLESIAS (Head of Endoscopy) (Keynote Speaker, Santiago de Compostela, Spain)
09:00 - 09:30 Pancreatic Cancer: ERCP or EUS-guided biliary drainage? Fauze MALUF-FILHO (Keynote Speaker, sao Paulo, Brazil)
09:30 - 10:00 Pancreatic Cancer & duodenal stenosis: Endoscopic management of concomitant biliary and duodenal malignant obstruction? Jean Philippe RATONE (Keynote Speaker, Marseille, France)
10:00 - 10:30 Is Surgery always needed after endoscopic ampullectomy for papillary adenocarcinoma ? Olivier TURRINI (surgeon) (Keynote Speaker, Marseille, France)
Amphitheater
10:30

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EUS22-10
10:30 - 11:00

Coffee Break

Exhibition Area
11:00

"Friday 16 September"

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EUS22-11
11:00 - 12:30

Session 2
EUS advanced imaging and new therapeutic procedures

Moderators: Marc GIOVANNINI (Chef) (Marseille, France), Fauze MALUF-FILHO (sao Paulo, Brazil), Mahmoud OMAR (Clinical Director) (Kuwait, Kuwait)
11:00 - 11:30 Contrast Enhanced EUS & Elastography in 2022. Julio IGLESIAS (Head of Endoscopy) (Keynote Speaker, Santiago de Compostela, Spain)
11:50 - 12:10 EUS guided gastric varice therapy: Is endoscopic route obsolete? Mostafa IBRAHIM (Keynote Speaker, Egypt)
12:10 - 12:30 EUS guided RF ablation of small PNET: is surgery obsolete? Marc GIOVANNINI (Chef) (Keynote Speaker, Marseille, France)
Amphitheater
12:30

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EUS22-12
12:30 - 13:15

Industry Symposium - Pentax Europe

12:30 - 13:15 EUS-guided therapeutics for patients with altered anatomy. Schalk VAN DER MERWE (Keynote Speaker, Leuven, Belgium), Helga BERTANI (Doctor) (Keynote Speaker, Modena, Italy)
Amphitheater
13:15

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EUS22-13
13:15 - 14:15

Lunch Break

Exhibition Area
14:15

"Friday 16 September"

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EUS22-14
14:15 - 15:00

Industry Symposium - Cook Medical

14:15 - 15:00 EUS-guided portal pressure measurement: A step closer to personalised care in portal hypertension. Wim LALEMAN (Keynote Speaker, Leuven, Belgium)
Amphitheater
15:00

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EUS22-15
15:00 - 15:45

Session 3
Cholangiocarcinoma: How to manage ?

Moderator: Julio IGLESIAS (Head of Endoscopy) (Santiago de Compostela, Spain)
15:00 - 15:15 Is pre-operative drainage needed and how? Guido COSTAMAGNA (Full Professor of Surgery) (Keynote Speaker, Rome, Italy)
15:15 - 15:30 Role of ERCP in the management of non surgical Cholangiocarcinoma. Jacques DEVIÈRE (Chair of department) (Keynote Speaker, Brussels, Belgium)
15:30 - 15:45 Role of EUS in the management of non surgical Cholangiocarcinoma. Fabrice CAILLOL (Keynote Speaker, Marseille, France)
Amphitheater
15:45

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EUS11-15B
15:45 - 16:30

Industry Symposium - BOSTON SCIENTIFIC
EUS-guided anastomoses by LAMS: where are we in 2022?

Keynote Speaker: Enrique PEREZ CUADRADO ROBLES (Keynote Speaker, Paris, France)
Amphitheater
16:30

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EUS22-16
16:30 - 17:00

Coffee Break

Exhibition Area
17:00

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EUS22-17
17:00 - 18:00

Oral Communications

Moderators: Fabrice CAILLOL (Marseille, France), Marc GIOVANNINI (Chef) (Marseille, France)
17:00 - 17:10 #32736 - OC07 Endoscopic ultrasound-guided pancreatic duct drainage: a single center observational study.
OC07 Endoscopic ultrasound-guided pancreatic duct drainage: a single center observational study.

Background and aims: Pancreatic duct (PD) obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by endoscopic retrograde pancreatography with dilatation of the PD and placement of pancreatic stents. However, in some patients, the classic transpapillary approach cannot be performed because of anatomical inability to access the papilla, rupture of the PD, intracanal lithiasis that cannot be crossed or tight stenosis due to extrinsic compression by parenchymal pancreatic calcifications. Endoscopic ultrasound-guided PD drainage (EUS-PDD) is an efficient and minimally invasive therapeutic possibility in these patients and constitutes an alternative to surgical management. We aimed to evaluate technical and clinical success of EUS-PDD.

Methods: Data of patients who underwent EUS-PDD in our center between 2016 and 2021 were retrospectively reviewed. Technical success was defined as successful stent placement in PD. Clinical success was defined as pain ≤2 on the Numerical Rating Scale (NRS, 0-10) and no recurrence of obstructive pancreatitis post procedure.

Results 38 patients (mean age 55.7 years, 71% male) were included. Indications of EUS-PDD were chronic calcifying pancreatitis in 71% of patients (74% due to alcohol abuse). Other indications included anastomotic stenosis or rupture of PD. The average intervention time was 50.4 minutes. Technical success was achieved in 89.5% of patients. Clinical success was 91.2%. Remaining pain NRS > 2 occurred in 8.8% of patients and obstructive pancreatitis recurrence in 8.8%. Three patients had pancreatitis recurrence, which was of alcoholic origin. Adverse event occurred in 11 patients (28.9%): stent migration without digestive perforation in 7 patients, stent migration with digestive perforation in 2 patients, hemorrhagic shock in 1 patient and increased post procedure pain in 1 patient. Among them, 7 patients were successfully treated by a new endoscopic procedure, 1 patient by surgical procedure, 1 patient by radiological procedure and 1 patient by hybrid radiological and surgical treatment. The average hospital stay was 2.5 days.

Conclusion EUS-PDD had a high technical and clinical success rate in our center. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with failed endoscopic retrograde pancreatography.


Elodie ROMAILLER (Lausanne, Switzerland), Thomas GREUTER, Maxime ROBERT, Sarra OUMRANI, Alain SCHOEPFER, Sebastien GODAT
17:10 - 17:20 #32742 - OC08 Duplicated common bile ducts; A rare type Vb.
OC08 Duplicated common bile ducts; A rare type Vb.

A potentially devastating complication of routine laparoscopic cholecystectomy include iatrogenic bile duct injuries which represent a stable incidence rate of 0.3% over the past 3 decades. Whilst related to several relative risks such as surgeon experience, and patient factors (older age, male sex), misinterpretation of biliary tree anatomy remains the most common cause, accounting for 80% of iatrogenic Common Bile Duct injuries. Whilst extremely rare, a duplicate common bile duct anomaly remains a potential variation to encounter during biliary surgery, with 30 recognised cases in the worldwide literature, of which type Vb accounting for 4. We report the case of a rare type Vb variation encountered during intra-operative laparoscopic cholecystectomy and confirmed on cholangiogram. To our knowledge, this is the first documented Type Vb case encountered in an Australian population. Given these anomalies are asymptomatic and can perpetuate iatrogenic common bile duct injuries, awareness of all subtypes is crucial. Irrevocably, preoperative Magnetic Resonance Cholangiopancreatography can help recognise these anomalies before the operating theatre, however their widespread adoption is limited by expensive and availability.


David ARMANY (Sydney, Australia)
17:20 - 17:30 #32739 - OC09 RECOMMENDATIONS FOR SAFE USE OF LAMS BASED ON A LARGE SINGLE CENTER EXPERIENCE.
OC09 RECOMMENDATIONS FOR SAFE USE OF LAMS BASED ON A LARGE SINGLE CENTER EXPERIENCE.

Background and Aims

Lumen-apposing metal stents (LAMS) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize safe deployment of LAMS for the different indications.  The aim of this study was to evaluate the impact of this approach over time. 

Methods

We conducted a single center study on consecutive patients that underwent LAMS placement for on- and off-label indications between June 2020 and June 2022.  Endpoints included technical success, clinical success and adverse event rates. We compared the results with our previously published early experience with LAMS (N=61, between March 2018 and May 2020).

Results

This cohort consisted of 168 LAMS in 153 patients.  Almost half of them (48.2%) were placed for off-label indications.  While the technical and clinical success rate were similar to our previously published cohort (96.4% and 92.9% versus 93.4% and 88.5%, respectively), the adverse event rate dropped from 21.3% to 8.9% (Table 1). 

Conclusion

Our results demonstrate a clinically relevant drop of LAMS-related adverse events over time related to optimized step-by-step protocols for the different on- and off-label indications.  


Sebastian STEFANOVIC, Helena DEGROOTE, Pieter HINDRYCKX (Ghent, Belgium, Belgium)
17:30 - 17:40 #32735 - OC10 Endoscopic treatment of post-surgical esophageal fistulas, retrospective analysis of a single tertiary center cohort.
OC10 Endoscopic treatment of post-surgical esophageal fistulas, retrospective analysis of a single tertiary center cohort.

Background: Anastomotic fistulas are a frequent and dreaded complication of esophagectomy. Endoscopic therapy using different techniques is now a well-established first line treatment option. The aim of our study was to evaluate the efficacy of such endoscopic treatments.
Methods: 73 patients with post-operative esophageal fistulas were retrospectively analyzed after being treated with different endoscopic techniques at CHUV. The primary endpoint was to evaluate technical and clinical efficacy of endoscopic treatments. The secondary endpoint was to evaluate the endoscopic treatments-related complications.
Results: In 94.5% (n=69) of patients, the intervention was effectively carried out from a technical point of view. In 82.2% (n = 60) of patients, treatment led to successful complete closure of the fistula. Minor complications related to the procedure occurred in 21.9% (n = 16) of patients and major complications in 6.8% (n = 5). The mortality rate related to the procedure was 2.7% (n = 2).
Conclusions: Endoscopic treatment is a technically achievable, highly effective way of treating post-operative esophageal fistulas. It allows patients with high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal complications without having to resort to invasive surgical solutions.


Sebastian PETRUZZELLA (Lausanne, Switzerland), Elodie ROMAILLER, Thomas GREUTER, Domenico GALASSO, Maxime ROBERT, Styliani MANTZIARI, Sébastien GODAT
17:40 - 17:50 #29342 - OC11 Multi-target Endoscopic Ultrasound EUS-M guided biopsy is superior to PET Scan for Staging malignancies.
OC11 Multi-target Endoscopic Ultrasound EUS-M guided biopsy is superior to PET Scan for Staging malignancies.

Introduction

PET scan is widely used not only to diagnose malignancy and its staging, but small proportion of patient do have false positive results. EUS now is well established modality to get tissue diagnosis and with multi-target approach can help stage disease more accurately with histopathological results. We share our experience with EUS-M cases with different variety of malignancies.

Methods

Total of 25 cases underwent EUS-M from June 2020 till June 2022. Informed consent was obtained, with Covid screen test with PCR was performed before procedure.  Procedures were done with all SOPs as per institutional guidelines. 22G FNB needle was used in 24 cases, 25G needle in 01 case; Franseen design with capillary suction method used to obtain visible core samples for histopathology without ROSE. All cases have confirmed histopathological diagnosis with same pathology from other site of Biopsy. Order of Biopsy was NodesLiver metastatic lesion→ Primary Tumour. In cases of nodes mediastinal→ porta-hepatis/ pancreatic→ Para-aortic. All sample were adequate for making confirmatory diagnosis on tissue sample.

Results.

Among total 25 cases, Age 54 Mean (22-77) with 16 Males. Duration of procedure 38 Minutes Mean (20-85). Cases with multiple lymphadenopathy from different anatomical regions were 09 while  other sites include Liver for metastasis and Primary tumour from pancreas/CBD/GB in 16 cases. Multiple site single pass was performed in 24 cases. 19 cases had malignant pathologies. Final diagnosis of Disease was pancreatic adenocarcinoma 07, NETs 02, Lymphoma 04, GB Adenocarcinoma/Cholangiocarcinoma 06 and metastatic RCC 01, TB 01. 04 cases had benign disease. All procedures were done under Conscious sedation as day care procedure. There were no immediate or early complication in all cases.

Conclusion

EUS-M is safe and accurate modality to stage malignancy with superiority over PET Scan to obtain histological diagnosis.


Adeel URREHMAN (Karachi, Pakistan)
17:50 - 18:00 #32727 - OC12 Aortic Wall Abrasion Caused By Needle Injury After EUS-Guided FNA of a Mediastinal Hemangioma.
OC12 Aortic Wall Abrasion Caused By Needle Injury After EUS-Guided FNA of a Mediastinal Hemangioma.

Introduction

Benign mediastinal cysts, accounting for approximately 20% of mediastinal masses, are challenging to diagnose. While endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) can provide a reasonably accurate diagnosis of mediastinal foregut cysts by distinguishing solid from cystic lesions, little is known about procedural complications asides from an increased risk of infection. We report a rare case in which EUS-guided FNA, performed on mediastinal hemangioma preliminarily misdiagnosed as bronchogenic cyst, resulted in an aortic hematoma caused by aortic wall abrasion from FNA needle injury.

Case presentation

A 29-year-old female patient was commissioned for endoscopic ultrasound of an asymptomatic accidental mediastinal lesion. Chest CT revealed a 4.9 x 2.9 x 10.1 cm thin-walled cystic mass in posterior mediastinum, abutting and seemingly arising from the esophagus. Endoscopic ultrasound (EUS) revealed a large, anechoic cystic lesion with regular thin wall with negative Doppler in posterior mediastinum. Preliminary EUS diagnosis was esophageal duplication cyst or bronchogenic cyst. Upon administration of prophylactic antibiotics, EUS-guided fine needle aspiration (FNA) was performed using single-use 19-gauge aspiration needle (EZ Shot 3; Olympus, Tokyo, Japan), and about 70cc of serous pinkish fluid was aspirated. The patient was in a stable condition with no signs of complication. One day after EUS- FNA, thoracoscopic resection for mediastinal mass was conducted. Purple and multi-loculated large cyst, well capsulated without any connection to esophagus, was observed in posterior mediastinum and subsequently removed. Upon the removal, however, an aortic hematoma caused by a focal descending aortic wall injury was observed. After a few days of close observation, the patient was discharged upon stable findings from 3D aorta angio CT.

Conclusion

We report a rare and severe complication of EUS- FNA, in which aspiration needle caused a direct injury to aorta. In mediastinal lesions, EUS-FNA should only be performed when necessary and—when it’s done—injection needs to be performed with great care to avoid the possibility of damaging adjacent organs or digestive tract walls.


Sol KIM (Seoul, Korea), Yu Kyung CHO
Amphitheater