UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

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

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

Introduction

Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) is primarily used for biliary drainage in patients with malignant distal biliary obstruction. A recent meta-analysis reported a reintervention rate of 15.8% with EUS-CDS. However, studies analyzing the factors associated with reintervention on follow-up after EUS-CDS are limited.

Aims & Methods

The study aimed to analyze the incidence and predictors of reintervention in patients with malignant biliary obstruction undergoing EUS-CDS. The present study is a retrospective analysis of data from eight tertiary care centers in India from January 2022 to January 2024. Patients aged 18-70 years with malignant distal biliary obstruction undergoing EUS-CDS, with a follow-up duration of more than eight weeks, were included. The study's primary outcome was reintervention, which was required in patients with failure of jaundice to improve due to stent migration or stent blockage during the follow‑up, presenting as the worsening of jaundice, with or without cholangitis. The secondary outcomes included clinical success and adverse events. Multivariate analysis using the logistic regression model was used to identify the independent predictors of reintervention.

Results

A total of 140 patients underwent EUS-CDS, out of which 134 patients completed the 8-week follow-up. The median age of the patients was 54.5 (range: 22-90) years, with 53% (71/134) being male. The most common indication for EUS-CDS was inaccessible papilla (59/134, 44.0%), followed by failed cannulation (57/134, 42.5%). The technical success rate was 97.8% (131/134), with placement of self-expanding metal stent (SEMS) in 86.6% (116/134) and lumen-apposing metal stent in 11.2% (15/134). Coaxial double pigtail plastic stent was placed in 19.4% (26/134) cases. Periprocedural adverse events (AE) were seen in 6% (8/134) cases, with severe AE in 0.7% (1/134) cases. Clinical success was achieved in 93.9% (123/131) of the cases with successful stent placement. Over a median follow-up of 20 weeks, reintervention was required in 8.4% of the cases after a median interval of 11 weeks. All patients requiring reintervention could be managed successfully with endoscopic or percutaneous techniques. On multivariate analysis (Table 1), cholangitis at presentation [Odd ratio (OR) 6.26, 95% confidence interval (CI) 1.03-38.09; p =.046] and the absence of coaxial stent with concomitant duodenal stent (OR 7.41, 95% CI: 1.44-38.05; p=.016) were independent predictors of reintervention in the overall cohort. On subgroup analysis of patients undergoing EUS-CDS with SEMS, the absence of coaxial stent with concomitant duodenal stent (OR 10.15, 95% CI: 1.80-57.29; p=.009) was an independent predictor of reintervention.

Parameters	All patients (N = 131)		Only SEMS (N = 116)
Parameters	Odds ratio (95% CI)	p-value	Odds ratio (95% CI)	p-value
Inaccessible papilla	0.85 (0.21 – 3.50)	0.817	0.818 (0.19 – 3.41)	0.782
Cholangitis at presentation	6.26 (1.03 – 38.09)	0.046	5.71 (0.88 – 37.19)	0.068
Baseline bilirubin	1.05 (0.94 – 1.17)	0.386	1.07 (0.94 – 1.21)	0.287
CBD size > 15 mm	3.63 (0.36 – 36.26)	0.273	4.31 (0.37 – 49.82)	0.243
Absence of coaxial stent with concomitant duodenal stent	7.41 (1.44 – 38.05)	0.016	10.15 (1.80 – 57.29)	0.009

Conclusion

Reintervention on follow-up after EUS-CDS is required in around 8.4% of cases, with all cases being managed successfully. The absence of coaxial stent with concomitant duodenal stent was an independent predictor of reintervention in the overall cohort as well as in those undergoing EUS-CDS with SEMS.

PREDICTORS OF REINTERVENTION AFTER ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY FOR DISTAL MALIGNANT BILIARY OBSTRUCTION

Suprabhat Giri 1, Bhavik Shah 2, Jimmy Narayan 3, Sridhar Sundaram 4, Radhika Chavan 5, Viswanath Reddy 6, SHIVAM KHARE 7, Jijo Varghese 8, Bipadabhanjan Mallick 1, Aditya Kale 4

1 Kalinga Institute of Medical Sciences, Bhubaneswar, India

2 Shree Narayana Hospital, Raipur, India

3 IMS and SUM Hospital, Bhubaneswar, India

4 Tata Memorial Hospital, Mumbai, India

5 Ansh Clinic, Ahmedabad, India

6 Yashoda Hospital, Hyderabad, India

7 Sir Ganga Ram Hospital, New Delhi, India

8 NS Hospital, Kollam, India

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

Managing bile duct disease (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Standards and Guidelines

New

Clinical Practice Guideline

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

Not sure what you can access? Learn more about account types.

ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Podcast Episode

UEG Podcast

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

Not sure what you can access? Learn more about account types.

Best practises for caring for LGBTQ+ people in GI with Alexander Goldowsky (rewind)

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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

Not sure what you can access? Learn more about account types.

ABSTRACT

Background

Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.

Methods

Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.

Results

A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9–47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

Discussion

Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.