Introduction

The diagnosis of solid pancreatic tumours (SPT) is a clinical challenge and endoscopic ultrasound (EUS) is an essential tool in this setting. A new EUS-guided advanced imaging technique, detective flow imaging (DFI), has been developed to provide information on microvascularisation and low-velocity blood flow without the need for contrast agents.

Aims & Methods

The aim of our study was to evaluate DFI-EUS findings in SPT and compare them with those of contrast-enhanced harmonic EUS with Sonovue® (CEHEUS).
Methods: Prospective and descriptive study including patients with SPT who underwent EUS evaluation. The procedures were performed with a linear echoendoscope (Fujifilm 740UT) attached to the Arietta-850 ultrasound system. Lesions were graded according to the degree of vascularisation using DFI and CEHEUS. The final diagnosis was based on EUS sampling and long-term clinical and radiological follow-up when histology was not available.

Results

106 patients (mean age 67.9 years [range 24-88 years], 48 males) were finally included. The mean lesion size was 28.4±16.2 mm. 46 (43.4%) tumours were located in the pancreatic head, 35 (33.0%) in the body, 1 (0.9%) in the neck, 19 (17.9%) in the tail and 5 (4.7%) in the uncinate process. 63 (59.4%) patients were diagnosed with adenocarcinoma, 30 (28.4%) with neuroendocrine tumour, 6 (5.6%) with inflammatory mass, 2 (1.9%) with pancreatic squamous cell carcinoma and lipoma, and 1 (1.2%) each with pancreatic necrosis, acinar carcinoma and accessory spleen. The vascular pattern of SPT evaluated by CEHEUS and EUS-DFI was concordant in 98.1% of cases. All adenocarcinomas, pancreatic necrosis and pancreatic squamous cell carcinoma were hypovascular. Inflammatory masses were isovascular. Lipomas, accessory spleen and acinar carcinoma were hypervascular on both CEHEUS and EUS-FI. All 30 neuroendocrine tumours were hypervascular on CEHEUS and 28 (93.3%) on EUS-DFI.

Conclusion

DFI-EUS allows evaluation of the vascularisation pattern of pancreatic tumours with comparable accuracy to CEHEUS but without the need for contrast.

Disclosure

Julio Iglesias-Garcia: Advisor Fujifilm

Introduction

EUS-guided Gastroenterostomy (EUS-GE) represents a recent breakthrough in therapeutic endosonography, with most existing data derived from retrospective studies focused on short-term technical outcomes. Limited information is available on long-term outcomes, the need for reinterventions and modifications of Lumen Apposing Metal Stents (LAMS) over time.

Aims & Methods

All consecutive EUS-GE performed in a single institution with the Wireless Simplified Technique (WEST) between 2020 and 2024 were enrolled in a prospective registry (PROTECT, ClinicalTrials.gov NCT04813055), with efficacy and safety outcomes assessed every 60 days. The primary outcomes were symptom recurrence after initial clinical success (rate, proportion) and dysfunction-free survival (DyFS) estimated using Kaplan Meier curves. Endoscopic LAMS reassessments were used to calculate the time to first modification of the stent and surrounding tissues, whilst Radiologic imaging was used to estimate the change in stent calibre (linear regression).

Results

164 EUS-GEs (median age 66 [60-74], male 52.4%, malignant indication 99.4% [pancreatic cancer 73.2%, metastatic 58.3%]) were included. A 20 mm LAMS was used in 98.8%, dilated up to 18 mm in 98.8% of cases. Technical and Clinical success rates were 98.8% and 96.3%, respectively. Adverse events (AEs) were registered in 15.2% (procedure-related 6.1%, severe/fatal 3.7%).
Over a median follow-up of 112 [40-190] days, symptom recurrence occurred in 9.1%, but was related to stent dysfunctions in 10/154 (6.5%) cases. Stent dysfunctions happened after a median of 231 [67-321] days from the procedure, all of which (100%) were successfully managed endoscopically. Estimated DyFS at 6 and 12 months was 97.5% and 82.6%, respectively.
Among 38 patients undergoing endoscopic LAMS re-evaluation for different reasons, tissue reactions on the gastric or jejunal side were observed in 34.2% after a median of 190 [33-351] days, and LAMS ingrowth was seen in 13.2% after a median of 421 [250-560] days. A total of 132 CT scans from 75 patients were analysed, with regression analysis revealing a reduction in LAMS diameter of ≈ 0.25 mm + 0.03 every 2 months (F-test p<.0001).

Conclusion

In the natural history of EUS-GE, subclinical LAMS changes and tissue reactions can be frequently detected during follow-up along with a progressive narrowing of LAMS diameter. However, most of these modifications are asymptomatic, with a 6.5% rate of endoscopic reinterventions, all performed successfully. Analysis of these curves may be helpful to plan scheduled reinterventions, especially in cases with benign indication or in long-term survivors.

Introduction

The pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) within 72 hours is recommended. Nevertheless, recent research emphasizes the challenges associated with timely provision of TIPS within this limited timeframe.

Aims & Methods

The objective of this study was to assess the impact of time for performing TIPS on patient outcomes and identify a more appropriate timeframe. This study enrolled patients referred to our hospital for TIPS procedure between January 2012 and December 2021. The duration between the recent variceal bleeding episode and TIPS procedure was documented. Predetermined outcomes were assessed in relation to various groups at four distinct time intervals: 72 hours, 5 days, 14 days, and 28 days. The primary outcome was the long-term survival rate.

Results

A total of 1180 patients were included in the study. There were no significant differences in patient outcomes between the early and late TIPS groups when patients grouped by 72 hours, 14 days, and 28 days. However, when comparing the late TIPS (>5 days) group to the early TIPS (≤5 days) group, a significantly lower 5-year survival rate was observed in the late TIPS group (71.0% vs 80.4%; HR, 1.88; 95% CIs, 1.14-3.12; P = 0.014). The variceal rebleeding rate did not show a significant difference between the two groups (P = 0.91).

Conclusion

Early TIPS within a 5-day window may confer a survival benefit in contrast to TIPS procedures performed beyond this timeframe. It may be advisable to expand the timeframe for pre-emptive TIPS to align with current clinical practices.