Latest Advances in Pancreatobiliary Endoscopy

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 12519

Special Issue Editors


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Guest Editor
Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
Interests: pancreatobiliary; advanced endoscopy; endoscopic ultrasound; endoscopic retrograde cholangiopancreatography; artificial intelligence; interventional EUS

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Guest Editor
Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
Interests: pancreatobiliary; advanced endoscopy; endoscopic ultrasound; endoscopic retrograde cholangiopancreatography; artificial intelligence; interventional EUS

Special Issue Information

Dear Colleagues,

Background and history of this topic: In recent years, the clinical applications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) have become increasing involved in everyday practice, and the endoscopists’ armamentarium is rapidly expanding due to endoscopic procedures becoming more complex and interventional, with a higher chance of dealing with different benign and malignant biliopancreatic conditions with a minimally invasive approach. In particular, EUS technology has progressed substantially, moving from a supplementary diagnostic add-on to a key modality in both the diagnosis and treatment of a wide range of disorders.

Aim and scope of the Special Issue: Given the complexity of this topic and its impact on clinical practice and public health, Medicina is launching a Special Issue entitled “Latest Advances in Pancreatobiliary Endoscopy” with the aim of gathering accurate and up-to-date scientific information on all aspects of the endoscopic management of benign and malignant conditions.

What kind of papers we are soliciting: narrative and systematic reviews, original manuscripts.

Dr. Marco Spadaccini
Dr. Alessandro Fugazza
Guest Editors

Manuscript Submission Information

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Keywords

  • pancreas
  • biliary
  • advanced endoscopy
  • endoscopic ultrasound
  • endoscopic retrograde cholangiopancreatography
  • interventional EUS

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Published Papers (7 papers)

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Research

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11 pages, 649 KiB  
Article
Italian Survey on Endoscopic Biliary Drainage Approach in Patients with Surgically Altered Anatomy
by Aurelio Mauro, Cecilia Binda, Alessandro Fugazza, Giuseppe Vanella, Vincenzo Giorgio Mirante, Stefano Mazza, Davide Scalvini, Ilaria Tarantino, Carlo Fabbri, Andrea Anderloni and on behalf of the i-EUS Group
Medicina 2024, 60(3), 472; https://doi.org/10.3390/medicina60030472 - 13 Mar 2024
Viewed by 1165
Abstract
Background and Objectives: Biliary drainage (BD) in patients with surgically altered anatomy (SAA) could be obtained endoscopically with different techniques or with a percutaneous approach. Every endoscopic technique could be challenging and not clearly superior over another. The aim of this survey [...] Read more.
Background and Objectives: Biliary drainage (BD) in patients with surgically altered anatomy (SAA) could be obtained endoscopically with different techniques or with a percutaneous approach. Every endoscopic technique could be challenging and not clearly superior over another. The aim of this survey is to explore which is the standard BD approach in patients with SAA. Materials and Methods: A 34-question online survey was sent to different Italian tertiary and non-tertiary endoscopic centers performing interventional biliopancreatic endoscopy. The core of the survey was focused on the first-line and alternative BD approaches to SAA patients with benign or malignant obstruction. Results: Out of 70 centers, 39 answered the survey (response rate: 56%). Only 48.7% of them declared themselves to be reference centers for endoscopic BD in SAA. The total number of procedures performed per year is usually low, especially in non-tertiary centers; however, they have a low tendency to refer to more experienced centers. In the case of Billroth-II reconstruction, the majority of centers declared that they use a duodenoscope or forward-viewing scope in both benign and malignant diseases as a first approach. However, in the case of failure, the BD approach becomes extremely heterogeneous among centers without any technique prevailing over the others. Interestingly, in the case of Roux-en-Y, a significant proportion of centers declared that they choose the percutaneous approach in both benign (35.1%) and malignant obstruction (32.4%) as a first option. In the case of a previous failed attempt at BD in Roux-en-Y, the subsequent most used approach is the EUS-guided intervention in both benign and malignant indications. Conclusions: This survey shows that the endoscopic BD approach is extremely heterogeneous, especially in patients with Roux-en-Y reconstruction or after ERCP failure in Billroth-II reconstruction. Percutaneous BD is still taken into account by a significant proportion of centers in the case of Roux-en-Y anatomy. The total number of endoscopic BD procedures performed in non-tertiary centers is usually low, but this result does not correspond to an adequate rate of referral to more experienced centers. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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Review

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13 pages, 2062 KiB  
Review
Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches
by Alessandro Fugazza, Marta Andreozzi, Hamid Asadzadeh Aghdaei, Agustin Insausti, Marco Spadaccini, Matteo Colombo, Silvia Carrara, Maria Terrin, Alessandro De Marco, Gianluca Franchellucci, Kareem Khalaf, Pardis Ketabi Moghadam, Chiara Ferrari, Andrea Anderloni, Giovanni Capretti, Gennaro Nappo, Alessandro Zerbi and Alessandro Repici
Medicina 2024, 60(4), 638; https://doi.org/10.3390/medicina60040638 - 16 Apr 2024
Cited by 2 | Viewed by 1595
Abstract
Gastrojejunostomy is the principal method of palliation for unresectable malignant gastric outlet obstructions (GOO). Gastrojejunostomy was traditionally performed as a surgical procedure with an open approach butrecently, notable progress in the development of minimally invasive procedures such as laparoscopic gastrojejunostomies have emerged. Additionally, [...] Read more.
Gastrojejunostomy is the principal method of palliation for unresectable malignant gastric outlet obstructions (GOO). Gastrojejunostomy was traditionally performed as a surgical procedure with an open approach butrecently, notable progress in the development of minimally invasive procedures such as laparoscopic gastrojejunostomies have emerged. Additionally, advancements in endoscopic techniques, including endoscopic stenting (ES) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE), are becoming more prominent. ES involves the placement of self-expandable metal stents (SEMS) to restore luminal patency. ES is commonly the first choice for patients deemed unfit for surgery or at high surgical risk. However, although ES leads to rapid improvement of symptoms, it carries limitations like higher stent dysfunction rates and the need for frequent re-interventions. Recently, EUS-GE has emerged as a potential alternative, combining the minimally invasive nature of the endoscopic approach with the long-lasting effects of a gastrojejunostomy. Having reviewed the advantages and disadvantages of these different techniques, this article aims to provide a comprehensive review regarding the management of unresectable malignant GOO. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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17 pages, 1988 KiB  
Review
Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives
by Edoardo Troncone, Rosa Amendola, Alessandro Moscardelli, Elena De Cristofaro, Pasquale De Vico, Omero Alessandro Paoluzi, Giovanni Monteleone, Manuel Perez-Miranda and Giovanna Del Vecchio Blanco
Medicina 2024, 60(4), 633; https://doi.org/10.3390/medicina60040633 - 14 Apr 2024
Viewed by 1849
Abstract
In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide [...] Read more.
In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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18 pages, 1623 KiB  
Review
Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue
by Magdalini Manti, Jimil Shah, Apostolis Papaefthymiou, Antonio Facciorusso, Daryl Ramai, Georgios Tziatzios, Vasilios Papadopoulos, Konstantina Paraskeva, Ioannis S. Papanikolaou, Konstantinos Triantafyllou, Marianna Arvanitakis, Livia Archibugi, Giuseppe Vanella, Marcus Hollenbach and Paraskevas Gkolfakis
Medicina 2024, 60(2), 340; https://doi.org/10.3390/medicina60020340 - 19 Feb 2024
Cited by 1 | Viewed by 2052
Abstract
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10–15% of patients have complex biliary stones, requiring additional [...] Read more.
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10–15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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17 pages, 6983 KiB  
Review
Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved
by Cecilia Binda, Stefano Fabbri, Barbara Perini, Martina Boschetti, Chiara Coluccio, Paolo Giuffrida, Giulia Gibiino, Chiara Petraroli and Carlo Fabbri
Medicina 2024, 60(2), 333; https://doi.org/10.3390/medicina60020333 - 16 Feb 2024
Cited by 2 | Viewed by 2300
Abstract
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs [...] Read more.
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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11 pages, 578 KiB  
Review
Will Endoscopic-Ultrasound-Guided Choledocoduodenostomy with Electrocautery-Enhanced Lumen-Apposing Metal Stent Placement Replace Endoscopic Retrograde Cholangiopancreatography When Treating Distal Malignant Biliary Obstructions?
by Thomas Guilmoteau, Jérémie Albouys, Abdelkader Taibi, Romain Legros, Marion Schaefer and Jérémie Jacques
Medicina 2024, 60(2), 220; https://doi.org/10.3390/medicina60020220 - 27 Jan 2024
Cited by 2 | Viewed by 1655
Abstract
Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both [...] Read more.
Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a “game changer”; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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Other

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4 pages, 889 KiB  
Case Report
The Usefulness and Reliability of Coagrasper for Artery Bleeding during Endoscopic Necrosectomy
by Yuki Ito, Mitsuru Okuno, Keisuke Iwata, Masahiro Kawade, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki and Eiichi Tomita
Medicina 2023, 59(10), 1861; https://doi.org/10.3390/medicina59101861 - 19 Oct 2023
Viewed by 1328
Abstract
Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was [...] Read more.
Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was directly visible, we grasped it using a Coagrasper and coagulated the bleeding point. However, the bleeding was aggravated after coagulation owing to an extension of the vessel damage. The entire vessel was grasped, and complete hemostasis was achieved. The Coagrasper is useful for managing arterial bleeding; however, it should be employed only on the basis of its characteristics and in suitable scenarios. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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