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Introduction

Dilated CBD on non-invasive imaging with normal or borderline derangement of LFT and unremarkable physical signs has been always a diagnostic dilemma. In the clinical setting, however, to determine the presence of ductal calculi or importantly a tumor remains a significant dilemma; a balance must be struck between invasive ERCP, associated complications and potential inaccurate diagnosis. We made a protocol to do EUS prior to ERCP in all such cases, where the previous investigations did not give a conclusive evidence of the pathology. We studied the efficacy of EUS in such cases for reaching a conclusive diagnosis and avoid unnecessary ERCP and its incipient complications.

Aims & Methods

To evaluate the efficacy of EUS prior to ERCP for patients with dilated CBD and other inconclusive imaging with normal or borderline derangement of LFT.
A total of 900 patients were referred for ERCP in last 6 years with inconclusive imaging study for dilated CBD and normal to borderline deranged LFT’s.

Results

482 - CBD stones
08 - Pancreatic Malignancy
12 - Distal Cholangiocarcinoma
04 - CBD Sludge
34 - Ampullary Tumor
30 - Impacted Stone at ampulla
12 - Distal CBD polyps
06 - WON Compression
12 - Chronic Pancreatitis Related Stricture
86 - Presumed Spontaneous passage of stones,
44 - Type 1 Choledochal cyst,
60 - Periampullary diverticulum,
40 - Stones in Hartman’s pouch,
34 - Small ampullary adenoma,
16 - Duodenal ulcers with scarring
20 - Post cholecystectomy dilatation

ERCP was performed in 557 cases ( 61.9%) and avoided in 38.1%).
In the cases of pancreatic malignancy, distal cholangiocarcinoma, ampullary tumors, FNA was done and patients without cholangitis were not offered ERCP but subjected to surgery. Two patients with CBD sludge had cholangitis so ERC was done. Distal CBD polyps were removed at ERCP and two had intraductal ductal extensions so surgery was offered. Only two patients each with choledochal cyst and post duodenal ulcer scarring underwent ERC as they had cholangitis.

Conclusion

EUS has remarkable diagnostic yield in detecting etiology of dilated CBD and avoids unnecessary ERCP’s in patients with unidentified cause on other imaging modality.

Disclosure

The authors have nothing to disclose.

EUS PRIOR TO ERCP IN CASES WITH DILATED CBD ON OTHER IMAGING WITH NORMAL OR BORDERLINE DERANGED LFT- IS IT REALLY WORTH?

Pankaj Desai 1, Mayank V Kabrawala 1, Chintan Patel 1, Ritesh Prajapati 1, Rinkalben Kakadiya 1

1 SIDS Hospital & Research Centre, Surat, India

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Online Course

accredited

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This interactive course explores why optimising polyp detection is central to high-quality colonoscopy and its direct impact on morbidity and mortality. Designed for general gastroenterologists and young endoscopists, the course addresses key quality indicators, bowel preparation, scoping techniques, and the integration of AI for improved detection. Participants will learn to interpret and apply optical diagnosis systems (NICE, WASP, LST-classification, BLINC) and to choose appropriate therapeutic strategies tailored to polyp type and patient context. Surveillance intervals and outcome factors, including family history and syndromes, will be discussed in line with ESGE guidelines. Case-based discussions will focus on communication with patients regarding diagnosis and management. By combining expert testimony, videos, and practical strategies, the course aims to improve participants’ endoscopic practice, ensuring earlier detection, appropriate treatment, and better long-term outcomes.

Target Audience:

Gastroenterologists (in training)
Other physicians and surgeons
Nurses
Medical students

Impact of Polyp Detection in Colonoscopy

Raf Bisschops, Manuele Furnari, Veronique Van der Voort, Pieter Sinonquel

Event

Impact of Polyp Detection in Colonoscopy

Topics

Endoscopy Colorectal

Accreditation status

accredited

Duration

1 hour

Published

2025

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.