Digestive and Liver Disease - Volume 48 - Supplement 2

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

e125

Conclusions:

In the reported case EUS-guided RFA appeared feasible

and effective, remarkably with no complication and a short time

hostpital stay.

V.02.3

WALLED-OFF PANCREATIC NECROSIS: THE NEW ERA OF

ENDOSCOPIC TREATMENT

Anderloni A.*, Di Leo M., Carrara S., Maselli R., Repici A.

Humanitas, Rozzano, Italy

Background and aim:

Nowadays, the interventional strategy for

walled-off pancreatic necrosis (WOPN) is the minimally invasive

step-up approach, including endoscopic drainage. Recently

new specifically electrocautery-enhanced delivery system for

interventional EUS such as Hot-AXIOS™ has significantly changed

the technical approach in this setting allowing a simple, safe and

time saving procedure.

Material and methods:

We described a case of WOPN treated

by endoscopic technique. A 68-year-old woman with a history

of previous (two months) acute necrotic biliary pancreatitis was

admitted to our hospital for management of symptomatic WOPN.

The patient underwent a CT scan that showed a capsulated necrotic

collection, with diameter of 18 cm, compressing the gastric wall.

EUS examination confirmed CT scan finding. In the same session

a 15 mm diameter, double-flange, lumen apposing, metal sent

was deployed under EUS guidance across the gastric antrum in a

fluoroless manner.

Results:

EUS-guided transmural drainage with the Hot AXIOS system

had none complication and was successful. Few days later the patient

was treated by three endoscopic necrosectomy sessions combined

with nasocystic drainage. During necrosectomy endoscopic

debridement and irrigation with betadine and oxygenated water

was performed. A significant reduction in collection diameter was

seen on the CT scan repeated after the procedures, so nasocystic

drainage was removed and the patient started enteral feeding

regimen. The patient was discharged after 7 days asymptomatic

and in good clinical conditions. The stent was endoscopically easily

removed after three months.

Conclusions:

Hot AXIOS system allows a safe, fast and easy EUS-

guided fluoroless transmural drainage of pancreatic collection

and in the same time provides easy entry to the cavity in order to

perform possible necrosectomy. So far, only ERCP dedicated devices

have been adapted for this purposes. In the last years, however, new

specifically designed devices for interventional EUS such as Hot-

AXIOS™ have significantly changed the technical approach to WOPN

allowing a simple, safe and time saving procedure.

V.02.4

NOVEL SINGLE OPERATOR DIGITAL COLANGIOSCOPE FOR A

DIAGNOSIS OF CYSTIC DUCT CARCINOMA: A CASE REPORT

Anderloni A.*

, Fugazza A.

, Di Leo M.

, Repici A.

Istituto Clinico Humanitas, Rozzano(MI), Italy,

Azienda Ospedaliera

Universitaria Parma, Parma, Italy

Background and aim:

Cystic duct carcinoma (CDC) is a rare tumor

with only few cases have been reported in the literature. Usually, this

cancer is detected only when it is in an advanced stage and became

clinically relevant with obstructive jaundice by compressing the

hepatic hilum or the common hepatic duct. Several classifications

of CDC were reported and the definitions were essentially the same:

a part of gallbladder cancer in which the center is located in the

cystic duct.

Material and methods:

We present a case of an 83-year-old man,

admitted to our Institution, for jaundice and abdominal pain. His

past medical history revealed coronary artery bypass, type II

diabetes and chronic kidney disease.

MRI demostrated dilatation of proximal common bile duct (CBD) and

of the intrahepatic biliary ducts, with an obstacle at the insertion of

the cystic duct. The subsequent EUS revealed an hypoechoic lesion

(7 mm diameter) with irregular margins in the cystic duct (Fig 2).

The lesion was punctured with a 25-gauge needle but the cytological

examination was inconclusive.

Results:

A colangioscopy was performed, using a novel single

operator cholangioscope (SpyGlass Direct Visualization System,

Boston Scientific, Natick, Mass, USA) that revealed an adenomatous

ulcerating mass in the cystic duct proximal to the confluence with

the common bile duct.

Endoscopic biopsies (SpyBite biopsy forcep, Boston Scientific)

performed under direct visualization revealed an adenocarcinoma

of the cystic duct (Video).

Eventually the patient died two weeks after the endoscopic

procedure due to a heart attack.

Conclusions:

The single-operator peroral cholangioscopy technique

is an advanced technique for intraluminal visual inspection, and for

therapeutic intervention of the biliary and pancreatic ducts. The

novel digital colangioscope (Spy Glass DS) seems easy to use and

offer an accurate visualization of the biliary duct. It allows to reach

specific area of the biliary three and to perform biopsies under direct

visualization. This new endoscopic instrument seems very useful to

define the cause of indeterminate biliary obstruction.

V.02.5

EUS GUIDED RE-ESTABLISHMENT OF BOWEL CONTINUITY AFTER

COMPLETE CLOSURE OF COLORECTAL ANASTOMOSIS (WITH

VIDEO)

Orsello M.*, Crinò S.F., Armellini E., Ballarè M., Montino F.,

Saettone S., Tari R., Occhipinti P.

Azienda Ospedaliero Universitaria “Maggiore della Carità”, Novara,

Italy

Background and aim:

Stenosis of a surgical anastomosis is a

common complication of rectal surgery. While endoscopic treatment

is relatively simple when a residual lumen is identifiable, it may be

challenging when the obstruction is complete. We report a case

of eus guided endoscopic re-establishment of bowel continuity. A

complete video documentation is offered.

Material and methods:

A 73 year-old man underwent a low anterior

resection with a loop colostomy for treatment of a colorectal

neoplasm. The procedure was complicated by deiscense of the

anastomosis, requiring a second surgical look. During preoperative

study for colonostomy reversal, a complete obstruction of the

anastomosis was found.

Results:

Using a double endoscopic access (standard endoscopy

trough the colostomy and endoscopic ultrasound trough the

rectum). The pre-anastomostic loop was filled with water and

ultrasonographically identified. Under EUS guidance a 19G Access

needle was inserted into the preanastomotic loop then a 0.035 inch

guidewire was passed trough and catched up by a forcep. A 10 mm

pneumatic dilation was performed.

Later on a 30x12 mm biflanged fully covered self expandable metal

stent (Nagi, Taewong, Corea) was deployed across the anastomosis

under endoscopic view.

Postoperative course was uneventful.

Conclusions:

This is a further demonstration of the great capability

of endoscopic ultrasound to lead complex interventional endoscopic

procedure.

EUS guided re-establishment of bowel continuity is feasible and

may be an alternative to challenging surgical procedures.