Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them

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Mistakes in endoscopic retrograde cholangiopancreatography and how to avoid them

Thierry Ponchon, Jerome Rivory, Mathieu Pioche

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

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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

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UEG Podcast Episode

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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

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Abstract

Published

2024

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ALVERINE CITRATE AND THE LIVER: A HIDDEN RISK IN A COMMON ANTISPASMODIC

Soraya Gioftsiou 1, Malak Faiz 1, Christos Christidis 2

Affiliations

1 Universite Internationale Abulcasis des Sciences de la Sante, Rabat, Morocco

2 Institut Mutualiste Montsouris, Paris, France

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Abstract

Clinical Case Summary

Drug-induced liver injury is an adverse effect of many pharmaceutical agents. Alverine citrate, an antispasmodic agent found in the fixed-dose combination Meteospasmyl (alverine citrate and simethicone), is widely used in functional gastrointestinal disorders. To date, only three cases are published in the literature. We report a case, with strong evidence, including a rechallenge confirming the causality.
Patient Observation: A 43-year-old woman presented with biliary-type abdominal pain. Her medical history was limited to hypertension treated with bisoprolol with no alcohol use or recent medication. Abdominal ultrasound revealed uncomplicated cholelithiasis; liver tests were normal. Alverine citrate was prescribed for symptomatic relief. Within two weeks, she developed jaundice and fatigue with a normal clinical examination. Blood tests showed severe hepatocellular injury: ALT and AST were 22× and 39× ULN, bilirubin was 274 µmol/L, and GGT/ALP were mildly elevated. Viral and autoimmune panels were negative. Imaging excluded biliary obstruction. Liver biopsy revealed portal inflammation with eosinophilic infiltrates, suggestive of immunoallergic hepatitis. The discontinuation of the drug led to normalization of liver enzymes. 3 years later, the patient was inadvertently re-exposed to alverine citrate, triggering a reproducible episode of acute hepatitis, thereby confirming causality. Diagnostic probability was assessed with the RUCAM score (12, "highly probable") and Naranjo scale (8, "probable"). Only three prior cases of alverine citrate-induced hepatitis, none of which reported a confirmed rechallenge. Although liver biopsy is not routinely required in DILI, it was essential here for diagnostic clarification.
Alverine citrate should be recognized as a rare cause of acute hepatitis. This case confirms its hepatotoxic potential and underscores the importance of early recognition and drug withdrawal to prevent recurrence.

References

RUCAM Scale: https://clincasequest.hospital/rucam-scale/
Naranjo Scale: https://proeurodilinet.eu/wp-content/uploads/2019/03/Causality-assessment-training-course-15-MARCH-.pdf
Couzigou P et al. Hepatitis and Alverine Citrate. J Hepatol. 1997. https://www.sciencedirect.com/science/article/abs/pii/S0168827897801870
Turkish case report. Turk J Gastroenterol. 2004. https://pubmed.ncbi.nlm.nih.gov/15259090/
Korean case report. Korean J Hepatol. 2010. https://pubmed.ncbi.nlm.nih.gov/20375645/
Simethicone safety review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033443/
Zhang X et al. Histopathologic Manifestations of Drug-induced Hepatotoxicity. Clin Liver Dis. 2013.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

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Marianna Arvanitakis

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Juozas Kupcinskas

ALVERINE CITRATE AND THE LIVER: A HIDDEN RISK IN A COMMON ANTISPASMODIC

Christos Christidis

OUTCOMES OF EUS-GUIDED GALLBLADDER DRAINAGE IN ACUTE CHOLECYSTITIS WITH CONTAINED PERFORATION: A PROSPECTIVE COHORT

Michele Reni

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

CYSTIC TUMOURS OF THE PANCREAS: THE VALUE OF ENDOSCOPIC ULTRASOUND

Nawal Kabbaj

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OUTCOMES OF EUS-GUIDED GALLBLADDER DRAINAGE IN ACUTE CHOLECYSTITIS WITH CONTAINED PERFORATION: A PROSPECTIVE COHORT

Giuseppe Vanella 1, Lucía Guilabert 2, Francesco Frigo 3, Rosa Claudia Stasio 3, Roberto Leone 4, Matteo Tacelli 1, Nicole Liscia 5, Luigi Leta 5, Nicolò Pecorelli 4, Giulio Belfiori 5, Michele Reni 4, Massimo Falconi 1, Gabriele Capurso 1, Paolo Giorgio Arcidiacono 1

Affiliations

1 IRCCS San Raffaele Institute, Milan, Italy|||Vita-Salute San Raffaele University, Milan, Italy

2 Dr. Balmis General University Hospital from Alicante, Alicante, Spain

3 IRCCS San Raffaele Institute, Milan, Italy|||University of Turin, Turin, Italy

4 Vita-Salute San Raffaele University, Milan, Italy|||IRCCS San Raffaele Institute, Milan, Italy

5 IRCCS San Raffaele Institute, Milan, Italy

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Abstract

Introduction

EUS-guided Gallbladder Drainage (EUS-GBD) with Lumen Apposing Metal Stent (LAMS) is a standard treatment for management of acute cholecystitis (AC) in unfit-for-surgery patients. Gallbladder Perforation is standardly considered as a contraindication to EUS-GBD.

Aims & Methods

This series aims at exploring outcomes of EUS-GBD in patients with AC and contained perforation (cp-AC).
All consecutive patients undergoing EUS-GBD in a single tertiary institution between 2020 and 2024 were enrolled in a prospective registry (PROTECT, ClinicalTrials.gov NCT04813055). Patients with cp-AC were included in this series, when presenting gallbladder wall rupture with adjacent encapsulated fluid collections. Baseline demographics and technical details were registered together with Technical success, Clinical success, Adverse Events (AEs), Recurrence and Survival evaluated every 60 days.

Results

From a prospective cohort of 48 EUS-GBD, 19 patients presented with cp-AC (median age 71 [62-78], male 42.1%, Charlson Comorbidity Index of 8 [7-9.8]). Acute cholecystitis was iatrogenic in 79% of these cases (ERCP with metal stenting in 14 and TACE in 1). Reason to avoid surgery was underlying malignancy in 89.5% and comorbidities in 15.8%. Amongst underlying malignancies, the most frequent one was Pancreatic Adenocarcinoma.
Ascites was present in 26.3% of cases. All procedures were performed transduodenally, with an operative luminal space of 31 [25 – 36] mm and a median tract thickness of 6 [5-8] mm.
A 10 mm Hot Axios LAMS was used in 95% of cases, and the release was free-hand in 89% and over-the-wire after former distention in 11% of cases. Antibiotic prophylaxis and coaxial double-pigtail plastic stents were adopted in 95% of cases.
Technical success was 100%. Clinical success was 94.7%, with a statistically significant 7-days reduction of white blood cells (p=0.0017 ) and C Reactive Protein (p=0.0067) .
AEs were registered in 21% of cases, severe/fatal in 11%.
Of note, 2 AEs (1 fatal) were related to additional attempts of draining liver abscesses adjacent to the GBD.
Five patients (27%) underwent additional endoscopic procedures for peroral cholecystoscopy, GBD clearance and LAMS removal, while 2 (11%) patients experienced uneventful LAMS migration.
Median hospital stay was 8 [6-13] days and median time to chemotherapy was 26 [19-56] days for those who were candidate to oncological treatment (N=10).
After a median follow-up of 254 [56-454] days, no AC recurrence was registered.

Conclusion

In the context of AC, contained perforation with adjacent collections does not seem to represent a contraindication to EUS-GBD with LAMS, despite the additional complexity related to a thicker interluminal distance. Management of large adjacent abscesses should involve multidisciplinary management and might require percutaneous drainage.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Therapeutic EUS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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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

Marcello Dallio

CYSTIC TUMOURS OF THE PANCREAS: THE VALUE OF ENDOSCOPIC ULTRASOUND

Nawal Kabbaj

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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

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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

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Marianna Arvanitakis

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Juozas Kupcinskas

ALVERINE CITRATE AND THE LIVER: A HIDDEN RISK IN A COMMON ANTISPASMODIC

Christos Christidis

OUTCOMES OF EUS-GUIDED GALLBLADDER DRAINAGE IN ACUTE CHOLECYSTITIS WITH CONTAINED PERFORATION: A PROSPECTIVE COHORT

Michele Reni

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

CYSTIC TUMOURS OF THE PANCREAS: THE VALUE OF ENDOSCOPIC ULTRASOUND

Nawal Kabbaj

UEG Poster

Standard Poster

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

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CYSTIC TUMOURS OF THE PANCREAS: THE VALUE OF ENDOSCOPIC ULTRASOUND

ZOULIKHA TAMMOUCH 1, Mouna Salihoun 1, FATIHA BOUHAMOU 1, Acharki Mohamed 1, Serraj Ilham 1, Nawal Kabbaj 2

Affiliations

1 Ibn Sina Hospital, Rabat, Morocco

2 Ibn Sina Hospital, mohamed 5 s EFD-Hepatogastroenterology unit, Rabat, Morocco

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Abstract

Introduction

Cystic pancreatic tumors are rare tumours that are increasingly being discovered incidentally due in part to the improved performance of pancreatic imaging modalities (ultrasound, multidetector CT scan, MRI) and advancements in knowledge regarding the characteristics of these lesions. They are represented by serous cystadenomas (SC), mucinous cystadenomas (MC), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary tumors of the pancreas (SPTP). The aim is to study the epidemiological, clinical, biological, and etiological aspects of these pancreatic tumors.

Aims & Methods

This single-centre study was carried out from September 2015 to August 2023 and included all patients with cystic tumours of the pancreas. False pancreatic cysts were excluded from the study. Epidemiological, clinical, biological and echo-endoscopic data were collected from endoscopic-ultrasounds registers. All endoscopic-ultrasounds were performed under Propofol sedation using a Pentax-type radial and/or linear video echo-endoscope, and cytoponctions were performed using 19 G echotip needles for biochemical analysis of the cystic fluid and/or anatomopathological study.

Results

Out of a total of 649 biliopancreatic endoscopic ultrasounds performed, 53 patients were included, representing a prevalence of 8.16%. The mean age was 62.3 years (29-82 years) with a clear female predominance (Sex Ratio = 0.65). Discovery circumstances were incidental findings in 21 cases (39%), epigastric pain in 17 cases (32%), acute pancreatitis in 6 cases (11.3%), jaundice in 6 cases (11.3%), and abdominal pain in 3 cases (5.6%). Biochemically, cholestasis was found in 12 cases (22.6%), cytolysis in 5 cases (9.4%), and elevated Ca19-9 in 6 cases (11.3%). Endoscopic ultrasound revealed the location, number, and size of the tumor: 21 cases (39.6%) were located in the pancreatic head, 13 cases (24.5%) in the body, 9 cases (17%) in the tail, and 10 cases (18.9%) were multifocal, with an average tumor size of 28.5 mm (1.9-76 mm). Communication with pancreatic ducts was observed in 35 cases (66%), and Wirsung duct dilation in 16 cases (30.1%). Cytology was performed in 27 cases (51%). The endoscopic ultrasound appearance combined with cystic fluid analysis favored IPMN in 42 cases (79.2%), mucinous cystadenoma in 5 cases (9.4%), serous cystadenoma in 3 cases (5.7%), and SPTP in 3 cases (5.7%).

Conclusion

Cystic pancreatic tumors are rare neoplasms predominantly affecting women in their sixties, often discovered incidentally. They predominantly occur in the pancreatic head and are mainly comprised of IPMN followed by mucinous cystadenomas, with serous cystadenomas and SPTPs being less common.

Disclosure

no links of interest

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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