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UEG Mistakes In Articles

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Endoscopic retrograde cholangiopancreatography (ERCP) is a widespread technique used for the treatment of different diseases of the bile and pancreatic ducts. The technique is, however, associated with rare but potentially severe morbidity. Some of the adverse events associated with ERCP are directly linked to commonly made mistakes and can, therefore, be prevented. Here, we discuss 10 common and/or high-impact mistakes that are made during ERCP and how they can be avoided.

Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them

Thierry Ponchon, Jerome Rivory, Mathieu Pioche

Topics

Endoscopy Hepatobiliary Pancreas

Citation

Pioche M, Rivory J and Ponchon T. Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them. UEG Education 2016: 16: 24–26.

Published

2024

UEG Mistakes In Articles

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Cholangioscopy is a minimally invasive, endoscopic technique that allows direct visualisation of the bile ducts, facilitating both diagnostic and therapeutic interventions. It is a useful tool in managing biliary diseases, allowing characterisation and tissue acquisition for strictures of undetermined aetiology, facilitating extension assessment for biliary cancer and providing intraductal lithotripsy for complex biliary stones.

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis, Malina Wiesand, Paraskevas Gkolfakis

Published

2025

UEG Podcast Episode

Journal Podcast

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Episode 9: Harmonising Gastroenterology Training Across Europe

Mohsan Subhani, Sophie Schlosser-Hupf, Henriette Heinrich

Topics

Education & Training

Published

2026

UEG Podcast Episode

UEG Podcast

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Best of UEG Week 2024 with Pilar Acedo Nunez and Juozas Kupcinskas on "Bench to Bedside"

Pilar Acedo, Juozas Kupcinskas, Julia Mayerle

Published

2024

UEG Podcast Episode

UEG Podcast

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Complications in endoscopy with Srisha Hebbar Part 2

Srisha Hebbar, Pradeep Mundre

Topics

Endoscopy

Published

2025

UEG Poster

Standard Poster

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Introduction

Primary sclerosing cholangitis (PSC) is an idiopathic cholestatic disease. Recent genome-wide studies (GWAS) have identified about 30 disease susceptible genes to PSC. We investigated the expression profiles of these genes in the liver biopsy samples of the patients with PSC, and revealed that the expression of TNFRSF14, which is a one of the risk genes for PSC, was upregulated in the biliary epithelial cell (BEC) of PSC compared to that in normal liver tissue and primary biliary cholangitis (PBC) liver tissue. TNFRSF14 is a member of the tumor necrosis factor receptor superfamily associated with inflammation and fibrosis. We also clarified that the expression of LIGHT, an active ligand for TNFRSF14, was elevated in the BEC of PSC^１). These molecules are mainly expressed on lymphocytes, and in other inflammatory diseases, many reports have mentioned to the associations between these molecules in the sera and the disease progression.

Aims & Methods

Aims: In this study, we aimed to evaluate the concentrations of these molecules in the sera and bile of PSC.
Methods: The concentrations of soluble TNFRSF14 and LIGHT in the sera and bile were measured by enzyme-linked immunosorbent assay. The samples were collected from the following cases:
• Serum: 73 patients with PSC, 35 patients with PBC and 53 healthy controls.
• Bile: 15 patients with PSC, 12 patients with malignant biliary obstruction (MBO), 19 patients with biliary lithiasis (BL).
The bile samples were obtained during endoscopic retrograde cholangiopancreatography. The median values of the serum (s) and bile (b) concentrations of each group were evaluated by Mann-Whittney U test.

Results

sTNFRSF14 in the PSC group was significantly higher than those in the healthy controls (6.301 v.s. 4,247 pg/mL, P < 0.001) and the PBC group (4,987 pg/mL, P < 0.001).
sLIGHT in the PSC group was 87 pg/mL, which was higher than those in the healthy controls (61 pg/mL, P = 0.012), and was comparable to those in the PBC group (106 pg/mL, P = 0.142).
bTNFRSF14 in the PSC group was 2,005 pg/mL, showing no significant difference compared to those in the MBO (1,794 pg/mL, P = 0.516) and the BL group (1,987 pg/mL, P = 0.504).
bLIGHT in the PSC group was 523 pg/mL, remarkably higher than those in the MBO (82 pg/mL, P < 0.001) and the BL group (268 pg/mL, P = 0.024).

Conclusion

sTNFRSF14 in the PSC group was higher than those in the healthy control and the PBC group, and this result was equivalent to the previous report about the upregulated expression in the liver biopsy samples. While soluble LIGHT was secreted non-specifically in the sera of cholestatic liver disease, the elevated bile concentration of LIGHT can be involved in in the unique biology of PSC. Further research is needed to elucidate the involvement of these two molecules in the pathogenesis of PSC.

References

1) Digestive Liver Disease 2024 Feb;56(2):305-311.

THE CONCENTRATIONS OF TNFRSF14 AND LIGHT IN THE SERA AND BILE OF THE PATIENTS WITH PRIMARY SCLRELOSING CHOLANGITIS

Sachiko Kanai 1, Hiroaki Fujiwara 2, Suguru Mizuno 3, Takahiro Kishikawa 4, Takuma Nakatsuka 4, Naminatsu Takahara 4, Yousuke Nakai 5, Ryosuke Tateishi 4, Mitsuhiro Fujishiro 4

1 The University of Tokyo, Tokyo, Japan|||The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan

2 The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan|||The University of Tokyo, Tokyo, Japan

3 Saitama Medical University, Saitama, Japan

4 The University of Tokyo, Tokyo, Japan

5 The University of Tokyo, Tokyo, Japan|||Tokyo Women's Medical University, Tokyo, Japan

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

BILIARY (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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ENDOSCOPIC INTERMUSCULAR DISSECTION FOR EARLY GASTRIC CANCER WITH SEVERE SUBMUCOSAL FIBROSIS

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Introduction

Severe submucosal fibrosis (SSF) in early gastric cancer (EGC) is known to cause technical difficulty for endoscopic resection.^{1, 2} Various methods have been reported to tackle this problem. However, there is no established consensus on the management of this situation. Endoscopic intermuscular dissection (EID) has been successfully used in the rectum to overcome SSF.³ The procedure involves the dissection between the circular and longitudinal layers of the muscularis propriae. Recently, the procedure has been used in the stomach for en bloc resection of a neuroendocrine tumor.⁴ We report a case endoscopic resection of early gastric cancer with severe submucosal fibrosis where EID was used to attain a negative vertical margin.

Aims & Methods

We aim to demonstrate the use of EID in the stomach to overcome the challenge of SSF in endoscopic resection of early cancer. An 81 year male underwent an upper endoscopy for heaviness and discomfort in the epigastrium for few months. It revealed an approximately 25mm lesion around a healed ulcer scar at the gastric angle on the lesser curvature side with irregular surface and vascular pattern and a clear demarcation line. Biopsy showed high grade dysplasia and endoscopic resection was planned. Since the lesion was over a healed ulcer scar, and endoscopy showed convergence of gastric folds towards the lesion, SSF was expected. The resection was started by conventional endoscopic submucosal dissection in retroflexion and a tunnel was created under the distal side of the tumor. However, after the incision and initial submucosal dissection, we encountered SSF. We decided to carefully dissect in the intermuscular plane underneath the fibrotic area by identifying and separating the circular and longitudinal muscle layer. Similar method was used on the oral side where EID was performed after initial ESD and tunnel was completed. Resection was accomplished and the circular muscle defect in the middle of the ulcer was closed with multiple endoclips.

Results

Total procedure time was 60 minutes. En bloc specimen measured 56mm x 40mm. There were no immediate or early complications. Patient was started on soft diet on post procedure day 1 and discharged on day 5. Pathology was tubular adenoma with high grade dysplasia. Horizontal and vertical margins were negative and specimen contained the muscle layer.

Conclusion

This case demonstrates the feasibility of EID in the stomach without any special accessories or equipment. EID can be used to overcome severe submucosal fibrosis in early gastric cancer. Further studies on wider applicability of gastric EID in clinical practice would be worthwhile.

References

Jeong JY, Oh YH, Yu YH et al. Does submucosal fibrosis affect the results of endoscopic submucosal dissection of early gastric tumors?. Gastrointestinal endoscopy. 2012 jul 1;76(1):59-66.
Higashimaya M, Oka S, Tanaka S et al. Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer. 2013 Jul;16:404-10.
Toyonaga T, Ohara Y, Baba S et al. Peranal endoscopic myectomy (PAEM) for rectal lesions with severe fibrosis and exhibiting the muscle-retracting sign. Endoscopy. 2018 aug;50(08):813-7.
Despott EJ, Lucaciu LA, Murino A et al. First report of gastric endoscopic intermuscular dissection. Endoscopy. 2024 Dec;56(S 01):E132-3.