Introduction

Pancreatic duct (PD) stones frequently occur in chronic calcifying pancreatitis (CCP) and are a main factor contributing to pain onset and exacerbation as well as impaired quality of life (QOL). In these patients endoscopic intervention with removal of obstructing pancreatic duct (PD) calculi and regaining pancreatic duct drainage should be performed. In this regard, digital single operator video pancreatoscopy (d-SOVP) is still under investigation for the treatment of PD stones but seems to be an emerging alternative to standard endoscopic procedures with reported success rates between 43%-100%, based on small retrospective studies. However, while reported short term success rates seem very promising, there is still poor evidence for long-term clinical success and benefit for patients` quality of life.

Aims & Methods

Aims: To investigate the role of d-SOVP guided PD-stone lithotripsy in patients with CCP on clinical success and QOL in a long-term follow-up (FU).
Methods: Patients with CCP undergoing d-SOVP (SpyGlass DS) guided lithotripsy of PD stones with initial technical and clinical success were recruited in this retrospective analysis. Persistence of technical success (ductal clearance) and clinical success (defined as pain reduction >50 % in numerical rating scale (NRS)) as well as postinterventional QOL were evaluated by database analysis and a systematic questionnaire (based on SF-12) regarding pain intensity and incidence, painkiller intake and impact on QOL every 6 months obtained in the respective outpatient clinic. Data are presented as mean±SD.

Results

A total of 32 patients was evaluated during long-term FU of 40.8±8.3 months (range 32 – 57 months). 81% of patients (26/32) reported a significant and lasting decrease in pain and symptom burden with mean decrease of NRS from 6.1±0.55 (preinterventionally) to 1.6±0.35 at last reported visit of FU, p<0.01. In 4 patients (12.5%) subsequent pancreatic duct stenting was required due to persistent PD strictures, no recurrent intraductal stones were observed. 3 patients (9.4%) reported persistent pain, with 2 of these being eligible for partial pancreatectomy. QOL criteria significantly improved in 81% of patients defined by major improvements of their general health status and everyday life performance. Two patients were lost to follow-up, 3 patients (9.4%) died during follow up.

Conclusion

D-SOVP guided lithotripsy is safe and effective, achieving high rates of initial technical and clinical success rates as defined by complete ductal clearance and QOL. Beneficial effects on symptom control and QOL persist in the majority of CCP patients after approximately 41 months of FU. Therefore, we suggest d-SOVP to become the intervention of choice in these complex patients. Nevertheless, further prospective trials are warranted to prove these results.

Disclosure

Mark Ellrichmann, Horst Neuhaus, Torsten Beyna and Christian Gerges received lecture from Boston Scientific.

Introduction

Non-variceal gastrointestinal bleeding is a common condition associated with significant morbidity and mortality. Several approaches are available for primary endoscopic treatment. The standard endoscopic approach uses contact thermal methods or hemoclips with or without pre-injection of diluted epinephrine. A newer alternative is the use of an over-the-scope clip (OTSC).

Aims & Methods

The aim of our study was to evaluate the efficacy of these two modalities in the treatment of non-variceal gastrointestinal bleeding.
Methods: PubMed, EMBASSE and the Cochrane Library databases were searched for multicentre randomised controlled trials comparing the efficacy of OTSC with standard endoscopic procedures for the primary treatment of non-variceal gastrointestinal bleeding published up to January 2024. The primary outcome measure was the 7-day re-bleeding rate. We also assessed the presence of persistent bleeding, 30-day rebleeding rate, length of hospital stay and mortality. A systematic review and network meta-analysis was performed for both treatments.

Results

Four trials met the inclusion criteria and were included. Regarding the 7-day rebleeding rate, OTSC showed superior efficacy compared to standard endoscopic therapy in the treatment of non-variceal gastrointestinal bleeding (RR 0.29, 95%CI 0.14-0.62). OTSC was also superior to standard endoscopic therapy in terms of re-bleeding within 30 days (RR 0.43, 95%CI 0.24-0.78). In terms of failure to achieve primary haemostasis, results were similar between the two methods, with a trend in favour of OTSC (RR 0.37, 95%CI 0.37-1.02). Finally, no differences were found in mortality (RR 0.61, 95%CI 0.25-1.51) and length of hospital stay (SMD -0.01, 95%CI -0.20-0.17).

Conclusion

OTSC significantly reduced the 7-day and 30-day re-bleeding rate compared to standard endoscopic therapy. There were no differences in mortality and length of hospital stay.

Disclosure

Julio Iglesias-Garcia: Advisor Fuji

Introduction

Evaluate the predictive factors of failure rate of clearing the biliary system from stones at the initial ERCP.

Aims & Methods

This is a retrospective descriptive and analytical study from September 2004 to September 2023.
All patients with bile duct stones, who underwent ERCP with endoscopic sphincterotomy and stone extraction by standard techniques (extraction balloon or Dormia basket) were included in this study.

Results

A total of 1080 ERCPs were performed to extract biliary duct stones .

The mean age was 58.9 +/- 14.4 years and 59.5% were females.
The mean diameter ofthe Bile duct was 13.4+/- 4.31 mm. The presence of a biliary stricture in 6.3%.
The primary vacuity rate was 75.1%. Supplementary techniques were used in 22.7% of cases.
On univariate analysis, the predictive factors for failure after use of standard techniques were: age(OR: 0.9;CI95%:-0.03- -0.01;p<0.001); gender(OR:0.7;CI95%:-0.5--0.02;p=0.036); previous cholecystectomy (OR:1.3,CI95%:0.02-0.6;p=0.035);presence of angiocholitis(OR: 0.4; CI95%:-1.1- -0.4;p<0.001); dilatation of the CBD >15mm (OR:0,8,CI95%:-0.2-0.1;p<0.001), biliary stricture (OR:0.3;CI95%:-1.7--0.7;p<0.001) and the presence of impacted and/or large stone (OR:0.1;CI95%:-2--1;p<0.001).
On multivariateanalysis, only the presence of angiocholitis (OR:1.9;CI95%: 0.2-1;p=0.001),impacted and/or large stone (OR:2.5;CI95%:0.5-1.3;p<0.001), dilatation ofthe CBD >15mm (OR:0.88;CI95%:-0.17- -0.07;p<0.001), and biliary stricture(OR:2.9;CI95%:0.4-1.7;p=0.002) were significantly associated with failure ofthe primary CBD vacuity rate.
The overall vacuity rate after using the supplementary techniques was 92.4%.

Conclusion

In our study, predictivefactors for failure of the primary CBD vacuity rate were the presence ofangiocholitis, impacted and/or large stone, dilatation of the CBD (>15mm)and biliary stricture.

Introduction

There are few studies evaluating the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients aged 90 years and above (nonagenarian). This study's main goal was to compare the technical success and complications of ERCP in patients over 90 years or younger patient group.

Aims & Methods

929 naive patients who underwent ERCP at the tertiary referral center between January 2021 and December 2023 were retrospectively analyzed. The patient's medical records were reviewed for comorbidities, periampullary diverticulum, cannulation time, cannulation method, technical success, procedure duration, and ERCP-related complications.

Results

A total of 929 naive patients underwent ERCP; 895 (96.3%) patients were < 90 years old and 34 (3.7%) patients were≥ 90 years old. The median ERCP procedure time (18.5 min vs. 18 min, P=0.660), and cannulation time (8 min vs. 7 min, P=0.824) did not differ in patients with two groups respectively. The successful cannulation rate in the nonagenarian group was 34 (100%), and in the younger group was 891 (99.6%), there was no significant difference between the two groups (P=1). The main indication of the ERCP procedure was choledocholithiasis in both groups. There was no significant difference in the ERCP-related complications between the two groups. The main cannulation technique was selective sphincterotomy in both groups.

There was no significant difference in cannulation techniques between the two groups. Patients belonging to the nonagenarian group had a higher frequency of periampullary diverticulum (20.6%) compared to the younger group (14.3%). Type 2B diverticula was the most seen in both groups (11.8% vs. 4.9%). However, there was no significant difference in the presence of periampullary diverticulum between the two groups. The number of chronic concomitant diseases (cardiovascular diseases, chronic lung diseases, chronic renal diseases) was significantly higher in the nonagenarian group [13 (38.2%) vs. 114 (12.7%), P<0.001].

Conclusion

In this study, we showed that ERCP was a safe and successful procedure in patients with nonagenarians. Although comorbidities were substantially higher, ERCP was a successful procedure for nonagenarian patients because the rates of complications are similar to those of younger adult patients.

Introduction

Long-term outcomes of gastric subepithelial lesions have not been elucidated. To reveal the natural history, we initiated a prospective, 10-year follow-up of patients with small (≤20 mm) gastric subepithelial lesions in September 2014. Here, we report the results of an interim analysis of a prospective observational study.

Aims & Methods

In total, 567 patients with 609 lesions were prospectively registered between September 2014 and August 2016. The location, size, morphology, and number of subepithelial lesions were recorded on a web-based case report form.

Results

The endoscopic follow-up period was 4.60 ± 1.73 years (mean ± SD), and survival data were investigated for 5.28 ± 1.68 years. This interim analysis revealed that the estimated cumulative incidence of a size increase ≥5 mm, after accounting for patients’ death and resection of the tumor as competing risk events, was 4.5%. In addition, the estimated cumulative incidence of lesion size increase ≥5 mm or resection of lesions was 7.7% at 5 years, and that of size increase ≥10 mm or resection of lesions was 4.3% at 5 years.

Conclusion

These results indicate that approximately one in 13 patients with small (≤20 mm) gastric subepithelial lesions may require resection or further investigation for increased tumor size (≥5 mm) within five years under active surveillance.

References

Nishida T, Hirota S, Yanagisawa A et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008; 13: 416-30.

Disclosure

This study has been conducted as an Academic Committee Working Group of the Japan Gastroenterological Endoscopy Society.

Introduction

To evaluate the utility of the unroofing technique in the diagnosis of gastrointestinal subepithelial tumors (SETs), we performed a multicenter retrospective study.

Aims & Methods

This study was conducted in 10 hospitals and involved all eligible patients who underwent unroofing techniques to gain biopsy for gastrointestinal SETs between April 2015 and March 2021. The primary endpoint was the rate of correct diagnosis with the unroofing technique, and the secondary endpoints were the incidence of adverse events and the factors contributing to the correct diagnosis.

Results

The study included 61 patients with 61 gastrointestinal SETs, a median tumor size of 20 mm, and a median procedure time of 38 minutes with 82% successful tumor exposure. The rate of tissue acquisition was 98.4%, and the rate of pathological diagnosis was 72.1%. In 44 cases with a pathological diagnosis, two showed discrepancies with the postresection pathological diagnosis. No factors, including facility experience, organ, tumor size, or tumor exposure, significantly affected the correct diagnosis. No significant differences in the correct diagnosis rate were observed between less than ten experiences and more than ten experiences (74.1 vs. 70.6%). The correct diagnosis rates for tumors <20 mm and ≥20 mm were 76.9% and 65.7%, respectively. There was one case of delayed bleeding and two cases of perforations.

Conclusion

The diagnostic yield of the unroofing technique was acceptable. The unroofing technique was beneficial regardless of institutional experience, organ, tumor size, or actual tumor exposure.