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OUTCOME OF PRECUT SPHINCTEROTOMY COMPARED TO STANDARD CANNULATION TECHNIQUES IN ERCP WITH DIFFICULT CANNULATION

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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.

OUTCOME OF PRECUT SPHINCTEROTOMY COMPARED TO STANDARD CANNULATION TECHNIQUES IN ERCP WITH DIFFICULT CANNULATION

Maria Söderström 1, Gabriel Sandblom 2, Eva-Lena Syrén 1, Lars Enochsson 2, Bengt Isaksson 1

1 Uppsala University, Uppsala, Sweden

2 Karolinska Institutet, Stockholm, Sweden

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary

Submission format

Abstract

Session

Textbook knowledge and limits of HPB endoscopy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Do I need cholangloscopy?

Torsten Beyna 1, Katarzyna Pawlak 2

1 Evangel. Krankenhaus Düsseldorf, Düsseldorf, Germany

2 Hospital of the Ministry of Interior and Administration, Szczecin, Poland

Event

UEG Week Berlin 2025

Session

Crash course: Tough endoscopists for tough stones

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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10 YEARS OF EUS-GUIDED ENTERO-ENTERAL ENDOSCOPIC BYPASS (EEEB) AND SUBSEQUENT ERC TO TREAT HEPATICO-JEJUNOSTOMY'S ANASTOMOTIC STRICTURES

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Introduction

Since re-do surgery and interventional radiology are considered the first-line treatment for bilio-digestive anastomotic stricture, endoscopic treatment has been used as a minimally invasive alternative for the management of these adverse event considering both EUS-guided and retrograde approaches. We proposed a totally endoscopic approach to improve the endotherapy of bilio-digestive anastomotic stricture. [1-2]

Aims & Methods

From January 2014 to December 2023, 87 consecutive patients affected by bilio- digestive anastomotic stricture treated by endoscopic enteral-enteral bypass (EEEB) and subsequent endoscopic retrograde cholangiography (ERC) were included in the present study. 77 patients underwent hepaticojejunostomy on Roux-en-Y loop; 10 patients underwent Whipple-Child procedure.

Results

87 consecutive patients (mean age= 66 y.o.; 53 M, 34 F) underwent EEEB which was successful in all but two patients because of a perforation secondary to bypass stent misplacement during the stent’s release and an intraprocedural bleeding (technical success rate in 85/87, 97.5%). When EEEB was successfully performed in all the cases with the effective treatment of the anastomotic biliary stricture using large bore fully-covered self-expandable metal stents (SEMS). During a mean follow-up of 66 months (range: 12-120 months), we reported a 100% clinical success (defined as clinical complete resolution of the stricture). In seven cases, recurrent biliary stricture occurred, successfully re-treated through the EEEB (biliary strictures’ recurrence rate: 8.2%). Five cases of buried flair of the lumen-apposing metal stent used for the EEEB into the gastric wall were reported; four treated by pneumatic dilation and stent-in-stent treatment and one by redo EEEB. No other long-term adverse events were experienced.

Conclusion

EEEB-guided ERC is safe, feasible, and effective in tertiary referral centers with high-level experience in both ERCP and EUS. It lets the use of endoscopes with large operative channel to treat the stenosis with large-bore SEMS to manage complex and multiple-ducts biliary anastomosis’ strictures, to guarantee a long-lasting gradual dilation and to re-treat the patients in case of recurrence. [3]

References

[1] Mutignani M, et al. Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. Endoscopy 2019; 51: 1146-1150.

[2] Mutignani M, et al. Endoscopic entero-enteral bypass to treat postsurgical benign complications of hepatico-jejunostomy: Update of a 7-year single-center experience. Endosc Int Open. 2023 Apr 24;11(4):E394-E400. doi: 10.1055/a-2032-3077. PMID:37102184; PMCID: PMC10125775.

[3] Mutignani M, et al. Letter to Editor on “Comparison between endoscopic biliary stenting combined with balloon dilation and balloon dilation alone for treatment of benign hepaticojejunostomy anastomotic stricture.”. J Gastrointest Surg 2019;doi.org/10.1007/s11605-019-04450-3.

10 YEARS OF EUS-GUIDED ENTERO-ENTERAL ENDOSCOPIC BYPASS (EEEB) AND SUBSEQUENT ERC TO TREAT HEPATICO-JEJUNOSTOMY'S ANASTOMOTIC STRICTURES

Marta Pagliaro 1, Lorenzo Dioscoridi 1, Camilla Gallo 1, Giulia Bonato 1, Francesco Pugliese 1, Andrea Palermo 1, Marianna Bravo 1, Marcello Cintolo 1, Edoardo Forti 1, Massimiliano Mutignani 1

1 ASST Great Metropolitan Hospital Niguarda, Milano, Italy, Milano, Italy

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary

Submission format

Abstract

Session

Textbook knowledge and limits of HPB endoscopy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Effective hands-on training for therapeutic devices from an endoscopy nurse perspective

SABRINA COX 1

1 Aneurin Bevan University Health Board, Newport, Wales, United Kingdom

Event

UEG Week Berlin 2025

Topics

Nurses

Session

New trends and developments in endoscopic techniques

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg 1

1 Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

Therapy update: MASH and metabolic disorders

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Endoscopic management of pancreatic fistulas

Robert C. Verdonk 1

1 St. Antonius Ziekenhuis, Nieuwegein, Netherlands

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Pancreas Surgery

Session

Post-OP complications: When do we need to step in?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

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Introduction

The use of lumen-apposing metal stents (LAMS) in therapeutic endoscopy has significantly increased in recent years due to their expanding role in a variety of procedures, such as drainage of pancreatic fluid collections, endoscopic ultrasound (EUS)-guided choledochoduodenostomy, EUS-guided gallbladder drainage, gastro-enteric anastomoses, or abscess drainage.

Aims & Methods

This study aims to analyze the spectrum of indications and complication rates between 2016 and 2024. It includes a retrospective analysis of all patients who received LAMS at our center during this period.

Results

A total of 201 LAMS placements were performed: 82 for biliary drainage, 69 for peripancreatic collections, 41 for gastric outlet obstruction, 8 for abscesses, and 1 for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE). Initially, LAMS were primarily used for the drainage of collections; however, in recent years, anastomoses have become the predominant indication. Overall, we performed 124 anastomoses (61.7%) over the observation period. Among the patients, 86 (42.8%) had malignancies necessitating LAMS placement.
The overall complication rate was 7.5% (15 cases): 6 cases of primary stent maldeployment, 5 bleeds, 2 infections related to walled-off necrosis (WON)/LAMS obstruction, and 2 buried stents. Three patients required surgery, and one underwent radiological embolization for a leak from a splenic artery pseudoaneurysm. No 30-day mortality was observed, although one patient died 65 days post-drainage, 36 days after LAMS extraction, due to splenic artery bleeding.

Conclusion

LAMS use has evolved substantially at our institution, shifting from drainage to anastomotic applications, with EUS-guided gallbladder drainage now being the most common procedure.
Despite the broad spectrum of indications, the complication rate remained low (7.5%) and was managed non-surgically in 80% of cases.
These findings support continued expansion of LAMS in therapeutic endoscopy.