Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is a key procedure in managing biliary and pancreatic disorders. In cases of difficult cannulation (DC), when standard cannulation techniques (SCT) fail, precut sphincterotomy (PS) may be used as an alternative technique, often by experienced endoscopists. PS has been shown to improve cannulation success rates, but its use has been associated with an increased risk of adverse events, including post-ERCP pancreatitis (PEP), perforation, and bleeding. Despite this it is argued that it might be safer to proceed with PS early rather than to traumatise the papilla with continuous attempts with SCT. DC is defined as cannulation taking more than 5 minutes, more than 5 attempts or accidently entering the pancreatic duct with a guidewire more than once and is known to be associated with more complications than non-DC. The aim of this study was to compare outcomes of PS versus SCT in cases of DC, regarding complication rates and successful cannulation.

Aims & Methods

Data were retrieved from the Swedish National Register for Gallstone surgery and ERCP, GallRiks from September 2016 to December 2023. A total of 30,561 ERCPs, performed as index ERCPs without rendezvous technique, were identified and cross-checked. Logistic regression analyses were conducted, adjusting for endoscopist and clinic volume using generalized estimating equations.

Results

Altogether 9,909 procedures were classified as DC among which 3,005 (30%) were performed with PS, compared to 434 (2%) of 20,218 in the non-DC group. In DC the rate of pancreatitis was 9.4%, cholangitis 2.3%, bleeding 1.4%, bile leakage 1.9% and perforation 0.7%. PS was not associated with increased risk of procedure related complications in DC. The rate of successful cannulation in DC was 87.9% when SCT were used and 70.4% when PS was performed.

Conclusion

PS is a safe technique in ERCP when cannulation is difficult and is not associated with an increased risk of complications compared to SCT.

Introduction

Aims & Methods

Results

Conclusion

References

Introduction

Computer-aided diagnosis (CAD) systems are widely implemented in the medical field for the analysis of medical images. PolyDeep is a CAD system that has demonstrated its efficacy in lesion detection.

Aims & Methods

The aim of this study is to determine whether PolyDeep increases the adenoma detection rate (ADR) in the context of expert endoscopists participating in a regional, population-based colorectal cancer screening program in Spain. PolyDeep Advance 3 (NCT05513261) is a multicentric, randomized controlled clinical trial. For the primary endpoint, we aimed to assess whether the ADR is superior in PolyDeep-assisted colonoscopy compared to conventional colonoscopy. As secondary endpoints, we aimed to determine whether PolyDeep-assisted colonoscopy improves the polyp detection rate (PDR), serrated lesion detection rate (SLDR), advanced serrated lesion detection rate (ASLDR), and advanced adenoma detection rate (AADR). We included participants who underwent colonoscopy for screening (i.e. those with a positive faecal immunochemical occult blood test – FIT+) or for surveillance after resection of advanced adenomas. We compared both groups using the chi-square and t-Student test.

Results

Between November 2023 and May 2024, we recruited 857 patients, of whom 30 were excluded. The baseline characteristics of the 827 patients included in the analysis were similar (male: 59.3%, screening colonoscopy: 66.7%, mean age: 61.7 ± 6.5 years, withdrawal time: 10:49 ± 04:32 minutes, colorectal cancer incidence: 2.8%). However, there were significant differences between both groups in the Boston Bowel Preparation Scale (conventional colonoscopy: 7.7 ± 1.3 vs. PolyDeep-assisted colonoscopy: 7.4 ± 1.3, p = 0.01). Regarding ADR, we did not find statistically significant differences between conventional and PolyDeep-assisted colonoscopy (57.7% vs. 60.8%, p = 0.4). Similarly, for the secondary endpoints, there were no significant differences in PDR (68.7% vs. 69.6%, p = 0.8), SLDR (32.0% vs. 29.4%, p = 0.5), ASLDR (5.3% vs. 5.1%, p = 1.0), or AADR (24.5% vs. 23.6%, p = 0.8). In Table 1, we described lesion detection rates between both groups by indication (i.e., FIT+ or surveillance).

Conclusion

In the context of expert endoscopists PolyDeep did not increase the ADR.