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POST-ERCP ACUTE PANCREATITIS IN LIVER TRANSPLANTED PATIENTS: A CASE-CONTROL STUDY

Tommaso Schepis 1, Andrea Tringali 1, Giulia Polidori 1, Ivo Boskoski 1, Federica Borrelli de Andreis 1, Pietro Familiari 1, Vincenzo Perri 1, Guido Costamagna 1, Cristiano Spada 1

Affiliations

1 Fondazione Policlinico Universitrio Agostino Gemelli, Rome, Italy

Summary

AI Generated

A single-center retrospective case-control study found that post-liver transplantation patients had a significantly higher prevalence of post-ERCP pancreatitis compared to controls undergoing ERCP for other indications.

Among 106 liver transplant patients undergoing ERCP for biliary complications, post-ERCP pancreatitis occurred in 7.5% compared to 3.5% in 452 control patients (OR: 2.37, 95% CI: 0.98-5.75, P=0.048).
Double guide-wire cannulation, considered a criterion of difficult cannulation, was significantly more common in liver transplant patients (19.8% versus 12.2%, OR: 1.78, P=0.041).
All patients received rectal indomethacin as prophylaxis and underwent procedures under general anesthesia or deep sedation.
The authors note that the retrospective design and use of a historic control group are main study limitations and that prospective studies are needed to confirm the findings.

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Abstract

Introduction

Post-ERCP pancreatitis (PEP) is the most frequent adverse event (AE) following ERCP with a 3.5-9.7% overall incidence across studies. ERCP is performed also to treat post-liver transplantation (LT) biliary complications. The occurrence of PEP in LT patients is not well studied, however in some series a slight increase in PEP incidence has been described.
The aim of this study is to perform a case-control study to evaluate the risk for PEP in post-LT patients.

Aims & Methods

This is a case-control retrospective study performed at a single high-volume endoscopy center. All consecutive patients undergoing ERCP for the first time (native papilla) for post-LT biliary complications from January 2015 to September 2022, were reviewed from a prospectively maintained ERCP database. The control group consisted of patients with native papilla undergoing ERCP for indications different than post-LT biliary complications at the same unit from January 2019 to December 2019. Demographic data, technical data, and post-ERCP AEs were recorded. Rectal indomethacin was administrated in all cases as PEP prophylaxis. General anesthesia or deep sedation was used in all cases. Statistical analysis was performed with SPSS 20 software. Descriptive data are reported as mean/median ± standard deviation/range, or percentage. Categorical data were compared using the χ₂ test. P values <0.05 were considered statistically significant.

Results

One hundred and six post-LT patients were included in the “case” group and 452 in the “control” group. Patients’ characteristics are summarized in Table 1. PEP prevalence was significantly higher in the case group (8/106, 7.5%) compared with the control group (15/452, 3.5%) (OR: 2.37, 95% CI: 0.98-5.75, P= 0.048). Double guide-wire cannulation prevalence (considered a criterion of difficult cannulation) was significantly higher in the case group (21/106, 19.8%) compared with the control group (54/442, 12.2%) (OR: 1.78, 95% CI: 1.02-3.10, P= 0.041). PEP prevalence resulted still higher in LT patients (OR: 4.19, 95% CI: 1.01-6.06, P= 0.04) after exclusion from the control group of pancreatic cancer patients (n=104), considered at lower risk for PEP assuming pancreatic duct obstruction as a protective factor.

Table 1: Patients characteristics (n: number, LT: liver transplantation, AEs: adverse events, PEP: post-ERCP pancreatitis).

	LT-group	Control group
Demographics: No. of patients, n Age (years), mean ± SD Sex (men), n (%)	106 65.5 ± 12.7 81 (76.4)	452 69.9 ± 13.8 213 (47.1)
Technical data: Biliary sphincterotomy, n (%) Pancreatic sphincterotomy, n (%) Plastic stent placement, n (%) Metal stent placement, n (%) Double guide-wire cannulation, n (%) Prophylactic pancreatic stent, n (%) Naso-biliary drainage, n (%)	106 (100%) 0 77 (72.6) 2 (1.8) 21 (19.8) 21 (19.8) 18 (16.9)	436 (96.4) 16 (3.5) 44 (9.7) 114 (25.2) 54 (12.2) 54 (12.2) 105 (23.2)
AEs: Bleeding, n (%) Perforation, n (%) PEP, n (%)	3 (2.8) 0 8 (7.5)	10 (2.2) 0 15 (3.5)

Conclusion

LT patients are at higher risk of PEP when compared with patients undergoing ERCP for other indication. Biliary cannulation seems to be more difficult in LT patients and this could explain the higher risk of PEP. The main limitations of this study are the retrospective design and the presence of a historic cohort group as controls. Prospective studies are needed to confirm these data.

References

[1] Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015; 81: 143-149.e9.
[2] Moy BT, Birk JW. A review on the management of biliary complications after orthotopic liver transplantation. Journal of clinical and translational hepatology. 2019 Mar 28;7(1):61.
[3] Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol. Published online 2013. doi:10.3748/wjg.v19.i19.284.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Biliary and cholostatic disease (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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INNOVATIVE PROCEDURE FOR GENOTYPIC ANTIBIOTIC SUSCEPTIBILITY TESTING IN GASTRIC ASPIRATES FOLLOWING THE INTRAPROCEDURAL DETECTION OF H. PYLORI BY THE COMBINED ENDOSCOPY/ENDOFASTER METHOD

Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

UEG Online Course

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Acute pancreatitis

Ali Alexander Aghdassi, Markus M. Lerch

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Overview

Acute pancreatitis is the most frequent pancreatic disease and the most common reason for emergency room admission for all nonmalignant gastrointestinal diseases. This rapid-onset and painful inflammation of the pancreas is troublesome to manage because it has a diverse and often unpredictable clinical course. Although the inflammation usually subsides, complications can develop, and some patients will progress to chronic pancreatitis.
Learning objectives

The aetiology of acute pancreatitis
The different classification systems for acute pancreatitis
The diagnosis of acute pancreatitis
The therapeutic regimes for acute pancreatitis
Target audience

This course is suitable for gastroenterologists in training, but it is also appropriate for physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology.

Reviewed & updated February 2023

Event

Acute pancreatitis

Topics

Pancreas

Accreditation status

accredited

Duration

1 hour

Published

2020

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Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

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Familial Mediterranean fever

Manik Gemilyan 1

Affiliations

1 Yerevan State Medical University, Yerevan, Armenia

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Abstract

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Surgery Neurogastroenterology & Motility

Session

Mistakes in… Upper GI

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

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HEPATIC CAUDATE LOBE HYPERTROPHY MIMICKING HEPATOCELLULAR CARCINOMA

Ramzi Tababi 1, Ghada Gharbi 1, Asma Ben Mohamed 1, Manel Yakoubi 1, Moufida Mahmoudi 1, Amal Khsiba 1, Mouna Medhioub 1, Mohamed Lamine Hamzaoui 1

Affiliations

1 Taher Maamouri University Hospital, Nabeul, Tunisia

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Abstract

Clinical Case Summary

Caudate lobe hypertrophy is a common finding in cirrhotic liver, although giant variants are rare. Nevertheless, any lesion on a cirrhotic liver warrants consideration for hepatocellular carcinoma (HCC).
This case involves a 28-year-old male patient irregularly followed up at our center for secondary biliary cirrhosis. With a history of intrahepatic bile duct paucity due to Alagille syndrome since neonatal age, he is a current smoker (10 pack-years) with no alcohol abuse. After three years lost to follow-up, the patient presented with a gradual 4-month onset of jaundice, dark urine, and upper right quadrant discomfort. Laboratory findings revealed worsening liver function tests: total bilirubin 11.5 mg/dl (vs 2.5 mg/dl), predominantly conjugated 7.6 mg/dl (vs 1.7 mg/dl), alkaline phosphatases 3.3x ULN (vs 2.6x ULN), gamma-glutamyl transferase 6.4x ULN (vs 4.5x ULN), aspartate aminotransferase 3.8x ULN (vs 1.7x ULN), alanine aminotransferase 1.5x ULN (vs 1.3x ULN).
The 4-phase CT scan revealed a dysmorphic liver with a large mass spanning segments 4, 5, 6, 7, and 8, measuring 130x100mm. The mass exhibited arterial enhancement without late phase washout and no evidence of a capsule. This mass displaced the hepatic veins and abutted the inferior vena cava and portal branches, without signs of invasion. MRI showed a similar appearance with no diffusion restriction. Initially suspected as HCC, the mass was classified as LIRADS-4. Alpha-foetoprotein level was normal. CT-guided biopsy retrieved multiple 41mm samples. Histopathological findings indicated annular fibrosis with histological cholestasis and no malignant cells. Therefore, the established diagnosis was caudate lobe hypertrophy, following a multidisciplinary team discussion and review of radiological features.
Despite this entity's rarity, biopsy seems crucial to rule out HCC, especially with abnormal vascular behavior like arterial enhancement, to avoid overtreatment.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

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Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

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UEG Journal Best Paper Award

Mathias Cook 1

Affiliations

1 Aalborg University Hospital, Aalborg, Denmark

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy IBD

Session

Hot topics in European Gastroenterology

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

INNOVATIVE PROCEDURE FOR GENOTYPIC ANTIBIOTIC SUSCEPTIBILITY TESTING IN GASTRIC ASPIRATES FOLLOWING THE INTRAPROCEDURAL DETECTION OF H. PYLORI BY THE COMBINED ENDOSCOPY/ENDOFASTER METHOD

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INNOVATIVE PROCEDURE FOR GENOTYPIC ANTIBIOTIC SUSCEPTIBILITY TESTING IN GASTRIC ASPIRATES FOLLOWING THE INTRAPROCEDURAL DETECTION OF H. PYLORI BY THE COMBINED ENDOSCOPY/ENDOFASTER METHOD

Riccardo Vasapolli 1,2, Florent Ailloud 3,4, Beate Spiessberger 3,4, Peter Malfertheiner 1, Sebastian Suerbaum 3,4,2, Christian Schulz 1,2

Affiliations

1 University Hospital LMU Munich, Munich, Germany

2 DZIF Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich, Germany

3 Max von Pettenkofer Institute, Ludwig Maximilians University of Munich, Munich, Germany

4 National Reference Center for Helicobacter pylori, Munich, Germany

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Abstract

Introduction

Antibiotic resistance in Helicobacter pylori (H. pylori) poses an increasing challenge for infection management. Genotypic antibiotic susceptibility testing (GAST) is proposed as cost-effective approach for successful treatment.

Aims & Methods

Aim of our study was to evaluate GAST for detecting clarithromycin and levofloxacin resistance in gastric aspirates from H. pylori-positive patients compared to conventional phenotypic AST (PAST).
Patients undergoing upper GI endoscopy (UGE) between February 2022 and April 2023 were prospectively recruited. Real-time diagnosis of H. pylori was pursued during UGE through gastric juice analysis by Endofaster¹. In case of intraprocedural H. pylori detection, two types of gastric aspirates were collected: a) undiluted gastric juice (GJ) and b) water rinse aspirate (WR). The WR was obtained after complete removal of the GJ and instillation of 30 mL sterile saline solution against the wall of the stomach corpus. Furthermore, gastric biopsies were collected for histology and culture-based PAST by E-test. Sanger sequencing of the 23S rRNA and gyrA genes from H. pylori was performed using gastric aspirates to detect polymorphisms associated with resistance to macrolides and fluoroquinolones, respectively. The test accuracy of GJ-GAST and WR-GAST was determined using PAST as the gold standard. The McNemar test was used to compare sensitivities and specificities between GJ- and WR-GAST. The level of agreement among different AST was assessed by Cohen’s κ-value.

Results

Seventy-two consecutive patients (29/43 male/female; mean age, 47.0 ± 13.5 years) tested H. pylori-positive during the UGE were included in the study. According to PAST the resistance rates were 15.3% (11/72) for clarithromycin and 18.1% (13/72) for levofloxacin. The diagnostic measures of GJ-GAST and WR-GAST for resistance detection, as well as their agreement with PAST are shown in Table 1. Overall, GAST and PAST results showed substantial agreement (κ-value ranging from 0.67 to 0.77) and a very high level of concordance (>93%) for detecting clarithromycin and levofloxacin resistance using both GJ and WR.
There were no significant differences in diagnostic performances between GJ- and WR-GAST (p > 0.05), as confirmed by an almost perfect agreement with a κ-value of 0.93 for both clarithromycin and levofloxacin. Additionally, molecular analysis, involving the inspection of Sanger chromatograms, enabled an increase in the detection of heteroresistance cases by 33% for clarithromycin and up to 50% for levofloxacin, compared to PAST.

	GJ-GAST		WR-GAST
	Clarithromycin	Levofloxacin	Clarithromycin	Levofloxacin
Sensitivity	63.6% (30.8% - 89.1%)	69.2% (38.6% - 90.9%)	54.6% (23.4% - 83.3%)	66.7% (34.9% - 90.1%)
Specificity	100 % (94.0% - 100%)	98.3% (90.8% - 100%)	100% (94.1% - 100%)	100% (93.7% - 100%)
Accuracy	94.4% (86.2%-98.4%)	93.0% (84.3% - 97.7%)	93.1% (84.5% - 97.7%)	94.2% (85.8% -98.4%)
Positive predictive value	100% (59.0% - 100%)	90.0% (56.0% - 98.5%)	100% (54.1 % - 100%)	100% (63.1% - 100%)
Negative predictive value	93.8% (87.3% - 97.0%)	93.4% (86.3% - 97.0%)	92.4% (86.5% - 95.9%)	93.4% (86.5% - 96.9%)
Pairwise concordance	67/71 (93.1%)	66/71 (93.0%)	67/72 (93.0%)	66/70 (94.3%)
κ-value	0.75 (0.51 - 0.98)	0.74 (0.53 - 0.95)	0.67 (0.41 - 0.93)	0.77 (0.55 - 0.98)

Table 1. Diagnostic performances of GJ-GAST and WR-GAST for detection of clarithromycin and levofloxacin resistances, as compared to PAST. 95% confidence intervals are indicated in brackets.

Conclusion

Genotypic AST from gastric aspirates, following intraprocedural diagnosis of H. pylori, provides highly accurate results for detecting clarithromycin and levofloxacin resistances, comparable to conventional phenotypic AST. This novel method of GAST, performed using water rinse aspirates collected during UGE, is a valid and practical tool for tailoring eradication regimens.

References

1. Vasapolli R, Ailloud F, Suerbaum S, et al. Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori. World J Gastroenterol 2023;29:1638-1647.

Event

UEG Week Vienna 2024

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H.pylori basics

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Markus M. Lerch

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Manik Gemilyan

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Mohamed Lamine Hamzaoui

UEG Journal Best Paper Award

Mathias Cook

INNOVATIVE PROCEDURE FOR GENOTYPIC ANTIBIOTIC SUSCEPTIBILITY TESTING IN GASTRIC ASPIRATES FOLLOWING THE INTRAPROCEDURAL DETECTION OF H. PYLORI BY THE COMBINED ENDOSCOPY/ENDOFASTER METHOD

Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry

UEG Presentation

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A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

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A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Benjamin Norton 1, Apostolis Papaefthymiou 1, Andrea Telese 1, Alejandro Nieponice 2, Leonardo Rodriguez Grunert 3, Pablo Becerra Hoebel 3, Charlie Murray 1, Kenneth Chang 4, C. Roberto Simons-Linares 5, Rehan Haidry 1

Affiliations

1 Cleveland Clinic London, London, United Kingdom

2 Hospital Universitario, Fundacion Favaloro, Buenos Aires, Argentina

3 Clinica Colonial, Santiago, Chile

4 University of California Irvine, Orange, United States

5 Cleveland Clinic Ohio, Ohio, United States

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Abstract

Introduction

DA is a promising disease-modifying endoscopic treatment for type 2 diabetes (T2D), which targets hypertrophied duodenal mucosa. The FDA-cleared RFVA system (Aqua Medical Inc., Pleasanton, CA) is an emerging technique for DA. This is a single-use, through-the-scope (10.5 FR), circumferential ablation catheter, and an electrosurgical generator that uses RF energy to convert saline into heated vapor at the catheter tip which is released into the duodenum creating a 2 cm treatment zone. The ablation is performed under direct visualization without fluoroscopy. We investigated the RFVA system in a first-in-human pilot dose-escalation study,

Aims & Methods

We aimed to assess the safety, tolerability, and efficacy of RFVA for DA in patients with T2D (NCT05887635). This was a prospective single-centre study enrolling 27 patients with uncontrolled T2D (glycated hemoglobin (HbA1c) 7.5-10%) despite ≥1 oral antidiabetic drug (OAD). DA was performed under general anaesthesia after a 4-week run-in period to ensure stable glycaemic control. Patients were admitted overnight and given a modified post-procedure diet for 14 days. The ablation targeted ≥9 cm of the post-ampullary duodenal mucosa. The initial RFVA dose was 180 J single application (n=2). Once acute safety was established the next patients received 180 J double application (n=11). After establishing chronic safety over four weeks, the final patients received 200 J double application (n=14). The primary outcomes were change in HbA1c at 12- and 24-weeks, and the number of serious adverse events (SAE).

Results

Twenty-seven patients with a mean (SD) T2D duration of 6 years (2.6) underwent DA. The mean age was 54 years (6.6), 48.2% were male, and the mean baseline BMI was 30.3 kg/m2 (4.2). The baseline HbA1c was 8.5% (0.7) and fasting glucose was 8.9 mmol/L (2.6). The technical success of DA was 100%. The mean number of ablations delivered per patient was 5 (180 J single), 14 (180 J double), and 18 (200 J double). In the second half of the cohort, the mean endoscopy time was 43.6 minutes (9.2), catheter time was 30.6 minutes (7), and ablation length was 14.3 cm (1.8). The change in HbA1c at 4 weeks and 12 weeks was -0.9% (0.9; p<0.001) and -1.2% (1.1; p<0.0001), respectively without change in OADs (Table 1). At 12 weeks, 80% (n=20) undergoing double application had a >0.5% reduction in HbA1c. All patients were discharged the next day with no SAE or unanticipated device-related events. There were no episodes of severe hypoglycaemia. Abdominal pain was the most common, self-limiting adverse event with five deemed mild and two moderate (requiring temporary oral antispasmodics). A 4-week follow-up endoscopy and duodenal biopsy (n=27) showed no stricture and normal mucosal histology.

Compared to baseline values †Data analysed using t-test*
Table 1 – Clinical outcomes for patients undergoing duodenal ablation.
Change at 12 weeks (double application)	Mean change (SD)*	P value†
HbA1c - %	-1.2 (1.1)	<0.001
Fasting fingerstick glucose - mmol/L	-1.8 (1.9)	<0.001
Post-prandial fingerstick glucose - mmol/L	-3.5 (2.4)	<0.001
Fasting blood glucose - mmol/L	-1.5 (2.3)	=0.003
HOMA-IR	-1.1 (2.0)	=0.016
Weight - kg	-2.4 (5.0)	=0.024
Body mass index - kg/m²	-0.9 (1.9)	=0.024

Conclusion

DA using RFVA is a safe, well-tolerated, and relatively quick endoscopic procedure for the management of poorly controlled T2D. Early efficacy data shows a clinically significant reduction in HbA1c at 4- and 12-weeks.

Disclosure

RH declares educational grants to support research infrastructure from Cook Medical, Odin Vision, Pentax Medical, Endogastric Solutions, Apollo Endosurgery, Medtronic, and Aqua Medical. LRG, PBH, AN, KC, and RSL all declare educational grants for research support and/or travel costs from Aqua Medical.

Event

UEG Week Vienna 2024

Topics

Endoscopy Mechanisms & Personalised Medicine Small Intestine & Nutrition

Submission format

Abstract

Session

Obesity: Endoscopy and drugs

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Markus M. Lerch

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Mohamed Lamine Hamzaoui

UEG Journal Best Paper Award

Mathias Cook

INNOVATIVE PROCEDURE FOR GENOTYPIC ANTIBIOTIC SUSCEPTIBILITY TESTING IN GASTRIC ASPIRATES FOLLOWING THE INTRAPROCEDURAL DETECTION OF H. PYLORI BY THE COMBINED ENDOSCOPY/ENDOFASTER METHOD

Florent Ailloud

A PILOT INVESTIGATION OF THE SAFETY, TOLERABILITY AND EFFECTIVENESS OF RADIOFREQUENCY VAPOR (RFV) ABLATION FOR DUODENAL MUCOSAL ABLATION (DA) FOR THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS (STEAN T-2DM PILOT)

Rehan Haidry