Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them

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Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them

Mathieu Pioche, Thierry Ponchon, Jerome Rivory

Summary

AI Generated

This material discusses 10 common or high-impact mistakes made during endoscopic retrograde cholangiopancreatography and strategies to avoid them.

Endoscopic retrograde cholangiopancreatography is a widespread technique used for treating diseases of the bile and pancreatic ducts.
ERCP is associated with rare but potentially severe morbidity.
Some adverse events associated with ERCP are directly linked to commonly made mistakes and can therefore be prevented.
The material covers 10 common or high-impact procedural mistakes and their prevention strategies, relevant to clinicians performing or overseeing ERCP.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Polkowski M, et al. Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a randomized trial comparing two management strategies. Endoscopy 2007; 39: 296–303. [Link]

Manes G, et al.. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019 May;51(5):472-491. doi: 10.1055/a-0862-0346. Epub 2019 Apr 3. PMID: 30943551. [Link]

Dumonceau JM, et al.. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020 Feb;52(2):127-149. [Link]

Dickinson RJ and Davies S. Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol 1998; 10: 423–428. [Link]

Vandervoort J, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652–656. [Link]

Christensen M, et al. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60: 721–731. [Link]

Testoni PA, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 Jul;48(7):657-83. [Link]

Veitch AM, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 2016; 65: 374–389. [Link]

Buxbaum JL, et al. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021 Aug;94(2):207-221.e14. doi: 10.1016/j.gie.2020.12.032. Epub 2021 May 20. PMID: 34023065. [Link]

10.

Kylänpää L, et al. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial. Endoscopy. 2021 Oct;53(10):1011-1019. ) [Link]

11.

Levenick JM, et al. Rectal indomethacin does not prevent post-ERCP pancreatitis in consecutive patients. Gastroenterology 2016; 150: 911–917. [Link]

12.

Sethi S, et al. A meta-analysis on the role of rectal diclofenac and indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas 2014; 43: 190–197. [Link]

13.

Elmunzer BJ, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414–1422. [Link]

14.

Hintze RE, et al. Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1997; 29: 182–187. [Link]

15.

Soares KC, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 2014; 3: 18–34. [Link]

16.

Dumonceau JM, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017. Endoscopy. 2018 Sep;50(9):910-930. doi: 10.1055/a-0659-9864. Epub 2018 Aug 7. PMID: 30086596. [Link]

17.

Draganov PV, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347–353. [Link]

18.

Clinicopathologic session; biliary cirrhosis secondary to extrahepatic obstruction. Prensa Médica Mex 1950; 15: 119–122. Spanish.

19.

Warter J and Sacrez A. The problem of complicated jaundice (hepatitis-extrahepatic biliary obstruction syndrome). Strasbg Méd 1962; 13: 666–676. French.

20.

Pioche M and Ponchon T. Management of bile duct leaks. J Visc Surg 2013; 150: S33–S38. [Link]

21.

Dechêne A, et al. Endoscopic management is the treatment of choice for bile leaks after liver resection. Gastrointest Endosc 2014; 80: 626–633.e1. [Link]

22.

Kumar A, et al. Mirizzi’s syndrome: lessons learnt from 169 patients at a single center. Korean J Hepato-Biliary-Pancreat Surg 2016; 20: 17–22. [Link]

23.

Elhanafy E, et al. Mirizzi Syndrome: how it could be a challenge. Hepatogastroenterology 2014; 61: 1182–1186. [Link]

24.

Hazzan D, et al. Combined endoscopic and surgical management of Mirizzi syndrome. Surg Endosc 1999; 13: 618–620. [Link]

Abstract

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.

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

More Like This:

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis

VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

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FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

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UEG Mistakes In Articles

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Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis, Malina Wiesand, Paraskevas Gkolfakis

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Dumonceau JM, et al.. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020 Feb;52(2):127-149. [Link]

Dickinson RJ and Davies S. Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol 1998; 10: 423–428. [Link]

Vandervoort J, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652–656. [Link]

Christensen M, et al. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60: 721–731. [Link]

Testoni PA, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 Jul;48(7):657-83. [Link]

Buxbaum JL, et al. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021 Aug;94(2):207-221.e14. doi: 10.1016/j.gie.2020.12.032. Epub 2021 May 20. PMID: 34023065. [Link]

10.

Kylänpää L, et al. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial. Endoscopy. 2021 Oct;53(10):1011-1019. ) [Link]

11.

Levenick JM, et al. Rectal indomethacin does not prevent post-ERCP pancreatitis in consecutive patients. Gastroenterology 2016; 150: 911–917. [Link]

12.

13.

Elmunzer BJ, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366: 1414–1422. [Link]

14.

Hintze RE, et al. Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1997; 29: 182–187. [Link]

15.

Soares KC, et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 2014; 3: 18–34. [Link]

16.

17.

18.

Clinicopathologic session; biliary cirrhosis secondary to extrahepatic obstruction. Prensa Médica Mex 1950; 15: 119–122. Spanish.

19.

Warter J and Sacrez A. The problem of complicated jaundice (hepatitis-extrahepatic biliary obstruction syndrome). Strasbg Méd 1962; 13: 666–676. French.

20.

Pioche M and Ponchon T. Management of bile duct leaks. J Visc Surg 2013; 150: S33–S38. [Link]

21.

Dechêne A, et al. Endoscopic management is the treatment of choice for bile leaks after liver resection. Gastrointest Endosc 2014; 80: 626–633.e1. [Link]

22.

Kumar A, et al. Mirizzi’s syndrome: lessons learnt from 169 patients at a single center. Korean J Hepato-Biliary-Pancreat Surg 2016; 20: 17–22. [Link]

23.

Elhanafy E, et al. Mirizzi Syndrome: how it could be a challenge. Hepatogastroenterology 2014; 61: 1182–1186. [Link]

24.

Hazzan D, et al. Combined endoscopic and surgical management of Mirizzi syndrome. Surg Endosc 1999; 13: 618–620. [Link]

Abstract

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.

Published

2025

More Like This:

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Marianna Arvanitakis

VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

Marcello Dallio

FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

Anna Mrzljak

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

Mitsuhiro Fujishiro

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VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

Mario Romeo 1, Carmine Napolitano 1, Paolo Vaia 1, Fiammetta Di Nardo 1, MICHELE IZZO 1, Giuseppina Martinelli 1, Alessandro Federico 1, Marcello Dallio 1

Affiliations

1 University of Campania Luigi Vanvitelli, Naples, Italy

Summary

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Abstract

Clinical Case Summary

In advanced chronic liver disease (ACLD) patients, the endoscopic evidence of esophageal and/or gastric varices denotes the presence of clinically significant portal hypertension (CPSH), representing the main clinical consequence of portal hypertension (PH).
In this setting, although infrequently, besides typical sites (i.e., esophagus and stomach), PH-related varices can manifest even in other atypical portosystemic-shunt districts, including the vagina. CSPH-related vaginal varices bleeding can occur as a rare complication documented by limited case reports.
A 62-year-old female patient with viral (eradicated Hepatitis C Virus infection)-related- decompensated (grade 2 ascites)-ACLD, complicated by CSPH (grade F2 esophageal varices), was admitted to our Department in February 2025 for microcitic anemia. Anamnesis revealed a previous gastric cancer managed with total gastrectomy resection in 2021.
On admission, abdominal imaging showed radiological signs of ACLD/PH (coarse pattern, splenomegaly, dilated splenic-portal axis). Esophagogastroduodenoscopy ruled out active sources of bleeding, whereas colonoscopy revealed anal congestive not-bleeding varices. During the hospitalization, an episode of metrorrhagia imposed gynecologic evaluation with vaginal speculum examination. This assessment documented vaginal varices with the relative rupture as the current cause of the bleeding, suggesting this site is the further district for (CS)PH manifestation consequently to potentially occurred total gastrectomy-determined changes in abdominal vascular anatomy.
In ACLD patients receiving surgery altering abdominal vascularization, variceal bleeding represents a possible CSPH-related complication occurring even in atypical sites, such as the vagina. This scenario imposes an adequate tailored management, monitoring unusual bleeding signs, and adopting appropriate preventive strategies by including gynecologic evaluation in follow-up.

References

McHugh PP, Jeon H, Gedaly R, Johnston TD, Depriest PD, Ranjan D. Vaginal varices with massive hemorrhage in a patient with nonalcoholic steatohepatitis and portal hypertension: Successful treatment with liver transplantation. Liver Transpl. 2008 Oct;14(10):1538-40. doi: 10.1002/lt.21506. PMID: 18825698.
Kreek MJ, Raziano JV, Hardy RE, Jeffries GH. Portal hypertension with bleeding vaginal varices. Ann Intern Med. 1967 Apr;66(4):756-9. doi: 10.7326/0003-4819-66-4-756. PMID: 6067181.
Chan G, Taqi A, Drage M, Quan D. A case report of massive vaginal variceal hemorrhage in a patient with cirrhosis secondary to nonalcoholic steatohepatitis unresolved even after successful liver transplantation. Transplant Proc. 2013 Mar;45(2):835-7. doi: 10.1016/j.transproceed.2012.04.033. Epub 2012 Sep 19. PMID: 23267803.
Lebrec D, Benhamou JP. Ectopic varices in portal hypertension. Clin Gastroenterol. 1985 Jan;14(1):105-21. PMID: 3872747.
Nagata J, et al. Vaginal bleeding in a patient with type C liver cirrhosis without a past history of laparotomy: successful treatment with partial splenic artery embolization. Clin J Gastroenterol. 2012 Aug;5(4):275-81. doi: 10.1007/s12328-012-0316-3. Epub 2012 Jun 30. PMID: 26182393.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

More Like This:

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis

VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

Marcello Dallio

FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

Anna Mrzljak

TIME DEPENDENCY AND RISK FACTORS OF SPLANCHNIC VEIN THROMBOSIS DEVELOPMENT IN THE EARLY PHASE OF ACUTE PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Balint Eross

SEVERE HERPETIC ESOPHAGITIS IN IMMUNOCOMPETENT YOUNG ADULT

João Pinto

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

Mitsuhiro Fujishiro

UEG Poster

Standard Poster

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FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

Viktor Domislovic 1, Maja Sremac 1, Iva Košuta 1, Vibor Sesa 1, Andrijana Jovic 2, Kresimir Grsic 3, Neven Papic 4, Anna Mrzljak 1,5

Affiliations

1 University Hospital Centre Zagreb, Zagreb, Croatia

2 University Hospital Center Zagreb, Zagreb, Croatia

3 University Clinical Hospital Centre Zagreb, Zagreb, Croatia

4 University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia

5 University of Zagreb School of Medicine, Zagreb, Croatia

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Abstract

Clinical Case Summary

Objective: Streptococcal toxic shock syndrome (STSS), caused by group A Streptococcus pyogenes (GAS), is characterized by shock and multiorgan failure and is associated with a high mortality rate. Organ transplant recipients are especially vulnerable due to immunosuppressive therapy. Although critical for graft survival, immunosuppression increases susceptibility to infections infections, the leading cause of morbidity and mortality early after liver transplantation (LT).
Summary of the case: A 69-year-old female on dual immunosuppressive regimen with mycophenolate mofetil (MMF) and tacrolimus due to LT in 2010 and chronic kidney disease, presented to the emergency department after tripping at home and injuring her neck with a wooden splinter from a chair. She developed progressive neck swelling and erythema, along with a maculopapular rash across her trunk and extremities (Figure 1). Contrast-enhanced CT scan showed a multiloculated abscess (59x32x85 mm) (Figure 2). Her leucocyte count was 22.4×10⁹/L, CRP 327.4 mg/L, and creatinine 233 μmol/L. Microbiological analysis tested positive for GAS, which was highly suggestive of STSS. She developed hypotension, dyspnea and fever prompting an urgent surgical drainage. MMF was discontinued and tacrolimus reduced. She was treated with cephazolin (2g every 8 hours for five days) and clindamycin (900mg IV every 8 hours for two weeks). Her skin rash slowly resolved, CRP decreased to 53.0 mg/L and kidney function improved. A CT scan confirmed resolution and showed no new abscess formation (Figure 2). After two years of follow-up, she is unremarkable.
Conclusion: STSS in organ transplant recipients is a complex clinical challenge that demands managing infections while minimizing the risk of graft rejection. This case highlights the importance of rapid interventions for infection complications in vulnerable population of transplanted patients even in the late course after transplant.

References

Figure 1. a) swollen and erythematous left side of the neck with a visible purulent secretion and enlarged lymph nodes in the submental, submandibular regions. b) maculopapular rash on the skin of the trunk and upper abdomen with desquamation in the flexural areas, primarily under the breasts
Figure 2. CT images of the neck with contrast in axial a), b), c) and coronal d), e), f) CT showing initially cellulitis and the multiple abscess collections of the left tonsile, submandibular space, levels II and III and abscess collection of the sternocleidomastoid muscle and later resolution of abscess.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

More Like This:

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis

VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

Marcello Dallio

FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

Anna Mrzljak

TIME DEPENDENCY AND RISK FACTORS OF SPLANCHNIC VEIN THROMBOSIS DEVELOPMENT IN THE EARLY PHASE OF ACUTE PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Balint Eross

SEVERE HERPETIC ESOPHAGITIS IN IMMUNOCOMPETENT YOUNG ADULT

João Pinto

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

Mitsuhiro Fujishiro

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TIME DEPENDENCY AND RISK FACTORS OF SPLANCHNIC VEIN THROMBOSIS DEVELOPMENT IN THE EARLY PHASE OF ACUTE PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Ruben Zsolt Borbély 1,2, Bálint Gellért 1, Bryan Mangalath Philip 1, Dalma Dobszai 3, Brigitta Teutsch 3,1, Ádám Zolcsák 1, Dániel Sándor Veres 1, Balint Eross 1,3, Peter Jeno Hegyi 1, Eszter Ágnes Szalai 1, Peter Hegyi 1,3,4, Nándor Faluhelyi 1,3

Affiliations

1 Semmelweis University, Budapest, Hungary

2 Bajcsy-Zsilinszky Hospital and Clinic, Budapest, Hungary

3 University of Pécs, Pécs, Hungary

4 Interdisciplinary Centre of Excellence for Research Development and Innovation University of Szeged, Szeged, Hungary

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Abstract

Introduction

Splanchnic vein thrombosis (SVT) is a local complication of acute pancreatitis (AP) that may lead to subsequent complications such as portal hypertension, gastrointestinal bleeding, and mesenteric ischemia.^1,2 Despite its clinical significance, there is limited data in the literature concerning the temporal development and associated risk factors of SVT.

Aims & Methods

Our aim was to understand the time course and risk factors of SVT in the early phase of AP. To identify relevant studies we conducted a systematic search across four major medical databases (Embase, MEDLINE via PubMed, Scopus, and Cochrane Central Register of Controlled Trials) on 27th of October 2022. We included studies that employed appropriate imaging techniques in adult patients with AP, reported SVT data from the early phase of AP, and provided reliable information about the timing of imaging relative to AP symptom onset or hospital admission. We excluded studies that reported data on patients with a recent history of malignant disease or recent surgical procedures. We calculated the proportion of patients affected by SVT with 95% confidence intervals (CI). We conducted subgroup analyses based on diagnostic timing and disease characteristics. To assess the risk of bias we used the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies and the GRADEpro tool to determine the level of evidence. The protocol for this method was registered prospectively in the PROSPERO database, with registration number CRD42022367578.

Results

Data from 14 eligible studies and 1,951 patients was pooled; the proportion of patients with SVT in the early phase of AP (within 11 days after symptom onset or 5 days after hospital admission) was 0.13 (CI 0.07-0.23). The occurrence was lowest 0-3 days after symptom onset at 0.06 (CI 0.03-0.1), it increased to 0.23 (CI 0.16-0.31) between 3-11 days. Disease factors influencing SVT occurrence were severity (mild: 0.14 (CI 0.04-0.39), moderate: 0.23 (CI 0.09-0.47), severe: 0.31 (CI 0.15-0.54), p=0.21), etiology (alcoholic 0.31 (CI 0.13-0.58), biliary 0.12 (CI 0.04-0.3), p=0.03), and pancreatic necrosis (absent 0.10 (CI 0.04-0.25), under 30% 0.25 (CI 0.1-0.5), over 30% 0.55 (CI 0.29-0.78), p= 0.01).

Conclusion

One in eight patients develops SVT in the early phase of AP. Alcoholic etiology and pancreatic necrosis increase the risk of SVT. In addition, this risk seems to increase with the duration of AP; therefore, looking for and diagnosing SVT with imaging is important in the management of AP.

References

1. Nawacki L, Matykiewicz J, Stochmal E, Gluszek S. Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences. Clin Appl Thromb Hemost. 2021;27.
2. Valeriani E, Riva N, Di Nisio M, Ageno W. Splanchnic Vein Thrombosis: Current Perspectives. Vascular Health and Risk Management. 2019;15.

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

More Like This:

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis

VAGINAL BLEEDING IN ADVANCED CHRONIC LIVER DISEASE-DETERMINED CLINICALLY SIGNIFICANT PORTAL HYPERTENSION: A RARE CASE OF RUPTURE OF VAGINAL VARICES IN A PATIENT WITH A HISTORY OF TOTAL GASTRECTOMY

Marcello Dallio

FROM TRAUMA TO TRIUMPH: MANAGING TOXIC SHOCK SYNDROME AND SEVERE NECK ABSCESS IN IMMUNOSUPPRESSED PATIENT AFTER LIVER TRANSPLANTATION

Anna Mrzljak

TIME DEPENDENCY AND RISK FACTORS OF SPLANCHNIC VEIN THROMBOSIS DEVELOPMENT IN THE EARLY PHASE OF ACUTE PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Balint Eross

SEVERE HERPETIC ESOPHAGITIS IN IMMUNOCOMPETENT YOUNG ADULT

João Pinto

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

Mitsuhiro Fujishiro

UEG Poster

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SEVERE HERPETIC ESOPHAGITIS IN IMMUNOCOMPETENT YOUNG ADULT

Marco Pereira 1, João Pinto 1, Inês Pestana 1, Joana Barreiro 1, Ana Caldeira 1, Antonio Jose Duarte Banhudo 1

Affiliations

1 Hospital Castelo Branco, Castelo Branco, Portugal

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Abstract

Clinical Case Summary

Infectious esophagitis occurs most commonly in immunocompromised patients. Candida is the most common cause, followed by Herpes simplex virus. While HSV is known to cause esophagitis in immunocompromised patients, its occurrence in immunocompetent patients is rare.
We present the case of a 23 year-old male patient who was admitted to the emergency room with retrosternal chest pain, odynophagia, dysphagia, fever and hematemesis. Blood results showed leukocytosis and C-reactive protein of 93.5 mg/L.
An esophagogastroduodenostomy revealed multiple round and coalescing white plaques in the entire esophagus. The distal esophagus was severely affected and highly friable. Biopsies were taken.
A diagnosis of severe infectious esophagitis was assumed with an endoscopic appearance suggestive of esophageal candidiasis. He started treatment with fluconazole 400mg daily. Considering the medical history and clinical findings, intravenous acyclovir 5mg/Kg every 8 hours was added.
The patient denied drug and alcohol abuse but confirmed unprotected sexual intercourse with two women. HIV-1/2, HBV and HCV were negative. Serological results revealed positive HSV 1/2 IgM and negative IgG.
Clinical improvement allowed discharge on day 3 with oral fluconazole and acyclovir treatment.
Biopsies later confirmed herpetic esophagitis.
On follow-up, the patient was asymptomatic and with complete endoscopic resolution. Serological tests revealed HSV-1 seroconversion, confirming a diagnosis of HSV-1 primo-infection esophagitis.
Herpetic esophagitis in immunocompetent hosts is usually related to a primo-infection and the patient is often a young healthy male. It is an endoscopic and histopathological diagnosis with multiple, discrete, volcano-shaped or coalescent small ulcers. In some cases, the endoscopic appearance may mimic Candida esophagitis. While most cases in immunocompetent patients require no specific treatment, evidence indicates that acyclovir may shorten the duration of the disease.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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

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

Affiliations

1 The University of Tokyo, Tokyo, Japan

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

3 Saitama Medical University, Saitama, Japan

4 Tokyo Women's Medical University, Tokyo, Japan

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Abstract

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.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

BILIARY (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Marcello Dallio

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