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Clinical Case Summary

A 79-year-old patient was admitted with cholangitis. His past medical history includes pancreas-preserving duodenectomy for Vater’s ampullary lateral spreading tumor (LST) 5 years ago. At that time, frozen histology of the surgical specimen had shown low-grade dysplasia (LGD) and focal high-grade dysplasia ampullary adenoma; a very short segment of 5mm distal common biliary duct (CBD) was resected as well at that time and this was adenoma-free, finally leading to Roux en Y anatomy. During the current admission the patient underwent a CT scan that shows healthy hepaticojejunal anastomosis with a 2cm biliary stone above the anastomosis and with upstream biliary dilatation(Figure 1). In view of altered anatomy and of a long hepaticojejunal loop seen on CT scan, anterograde endoscopic retrograde cholangiopancreatography (ERCP) was deemed impossible. Percutaneous Transhepatic Cholangiography was performed instead, confirming a large filling defect above the anastomosis. Balloon dilatation of the anastomosis took place, followed by unsuccessful radiological attempts to push the stone distally. Percutaneous Transhepatic Cholangioscopy with a dedicated short single-use cholangioscope (SpyGlass™ Discover) was then performed showing a large biliary stone (Figure 2). Electrohydraulic lithotripsy was applied, fragmenting the stone in small pieces that were easily flashed down into the small bowel loop. Interestingly, following that a large (approx. 12mm in diam) choledochal adenomatous polyp was seen just above the anastomosis (Figure 3). Biopsies (SpyBite™ Max Biopsy Forceps) were taken from this polyp (these have finally shown enteric type choledochal tubulovillous adenoma with LGD). An external-internal Percutaneous Transhepatic Drain was left in place, in good position and working well. The patient had an uneventful stay, with almost normalization of his cholestatic biochemistry 14 days following the procedure.

References

Figure 1: CT scan without contrast revealed healthy hepaticojejunal anastomosis with a 2cm biliary stone (red arrow) above the anastomosis and with upstream biliary dilatation (star)-(mid CBD diam ~ 3.4cm, significant intrahepatic biliary tree dilatation)
Figure 2: Multiple stones visualized during cholangioscopy.
Figure 3: A large (approx. 12mm in diam) choledochal adenomatous polyp was revealed just above the anastomosis

PERCUTANEOUS TRANSHEPATIC CHOLANGIOSCOPY FOR ELECTROHYDRAULIC LITHOTRIPSY AFTER PANCREAS-PRESERVING DUODENECTOMY: AN UNEXPECTED FINDING

Vasileios Lekakis 1, Dimitra Lakiotaki 1, Maria Tampaki 1, Stavros Papadakos 1, Chrysovalantis Vergadis 2, Andreas Koutsoumpas 1

1 Kapodistrian University of Athens, Athens, Greece

2 Department of Radiology, Division of Interventional Radiology, "Laiko" General Hospital, 11527 Athens, Greece, Athens, Greece

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

UEG Online Course

accredited

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This course builds on foundational concepts to examine contemporary mechanisms driving GORD phenotypes. We revisit key epidemiological and clinical distinctions before exploring gastric physiology, including postprandial acid–bile dynamics, H. pylori-related acid output, motility patterns, obesity-related changes, and post-surgical anatomy. Oesophagogastric junction competence (LES pressure, TLESRs, hiatal hernia) and refluxate characteristics (acidic to gaseous; PPI-modified) are discussed with emphasis on symptom generation. We detail epithelial biology, micro- and macroinflammatory responses across NERD and erosive disease, and advances in nociceptive signalling, receptor expression, central modulation, and hypervigilance. Key clinical studies, cytokine-driven pathways, and emerging therapeutic approaches are highlighted. The course concludes with implications for diagnosis, phenotype-guided management, and outstanding research questions.

GORD Pathophysiology - Part 2

Edoardo Savarino, Ahsen Ustaoglu

Event

GORD Pathophysiology Part 2

Topics

Neurogastroenterology & Motility

Accreditation status

accredited

Duration

1 hour

Published

2026

UEG Online Course

New

accredited

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Bowel function is significantly affected after rectal surgery. While sphincter-preserving techniques aim to maintain anal continence, many patients experience a spectrum of bowel dysfunction, collectively known as Low Anterior Resection Syndrome (LARS). LARS includes symptoms such as incontinence, constipation, urgency, and stool clustering, which can severely impact a patient’s quality of life. The prevalence of LARS is alarmingly high, affecting a majority of patients, and symptoms can persist for years after surgical treatment.

Target audience

Gastroenterologists
Colorectal surgeons
Oncologists
Nurses/Stoma therapists
Primary care physicians

Consequences of proctology surgery (LARS)

Harald Rosen, Andreas Rink, Peter Christensen, Franco Marinello

Event

Consequences of proctology surgery (LARS)

Topics

Surgery

Accreditation status

accredited

Duration

1 hour

Published

2026

UEG Online Course

accredited

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Acute severe ulcerative colitis (ASUC) remains the most severe form of UC and is sometimes associated with mortality. Adequate evaluation, early and correct intervention, and follow-up with a multidisciplinary approach are crucial in management. A comprehensive approach to ASUC, epidemiology, definition, diagnosis, evaluation, and medical and surgical management are all discussed in this online course by Haluk Tarik Kani, Irene Marafini, Joana Roseira, Wilhelmus A. Bemelman and Fernando Magro.

Target audience
We believe both gastroenterology trainees and early career gastroenterologists and surgeons will find in this online course a thorough and updated review on ASUC management.

Acute Severe Ulcerative Colitis

Fernando Magro, Haluk Tarik Kani, Joana Roseira, Irene Marafini, Wilhelmus A. Bemelman

Event

Acute Severe Ulcerative Colitis

Topics

IBD

Accreditation status

accredited

Duration

1 hour

Published

2025

UEG Online Course

accredited

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This comprehensive course introduces participants to the transformative role of artificial intelligence in gastroenterology. Designed for healthcare professionals, the course covers fundamental AI concepts, clinical applications, and research perspectives. Key topics include machine learning techniques, AI-assisted diagnostics, and the integration of AI systems in clinical practice. Participants will explore the benefits and challenges of AI adoption, ethical considerations, and the regulatory landscape, with an emphasis on evidence-based decision-making.

The course includes extensive PowerPoint presentations and tailored video lectures. Examples are used to demonstrate real-world applications of the material. The total duration of the course is approximately 50 minutes, with an estimated completion time of 60 minutes, including the final assessment.