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Transgastric and transduodenal endoscopic drainages and necrosectomy are minimally invasive and effective way for the treatment of infected necrosis in the setting of acute pancreatitis (AP), but are limited in case of large and distant collections or in case of altered anatomy. We present an exclusively endoscopic approach consisting of multimodal endoscopic necrosectomy. We included consecutive patients with severe AP and presenting with large and infected necrosis requiring one transgastric and at least one extra-gastric access, among which are percutaneous, transcolonic, and/or transgrelic access. All accesses and necrosectomy sessions were performed endoscopically with CO2 insufflation. Six consecutive patients were treated. The location of infected collections were perigastric (100%), right and left paracolonic (67% and 67%), and paraduodenal (33%). All patients had transgastric or transduodenal access, all had at least one percutaneous access (total: 7 accesses), one had one transcolonic access, and one had one transjejunal access. A median of 4 necrosectomy sessions (2-5) were performed. All patients recovered without additional surgical necrosectomy. Full endoscopic multimodal management of infected necrosis with step-up approach seems feasible, safe, and effective in very large collections. [ABSTRACT FROM AUTHOR]

This article discusses a novel therapeutic option for the treatment of refractory gastroparesis, a condition characterized by delayed stomach emptying. The study focuses on the use of drain-assisted endoscopic ultrasound-guided gastroenterostomy (EUS-GEA) in patients who did not respond to gastric peroral endoscopic myotomy (GPOEM), another treatment option for gastroparesis. The study found that EUS-GEA was effective in 75% of patients at 6 months, with no observed complications or adverse events. The authors conclude that EUS-GEA with the drain-assisted technique shows promise as a safe and effective treatment for gastroparesis refractory to other treatments, but further research is needed to confirm these findings. [Extracted from the article]

Sphincter of Oddi dysfunction (SOD) is a benign non-tumoral disorder of the major papilla. It occurs mainly after cholecystectomy but can also occur before surgery. Biliary pain and biliary colic are the most frequent symptoms although recurrent pancreatic pain or pancreatitis can also be presenting symptoms. In about half of the cases, there is a fibrotic stricture of the sphincter of Oddi, probably secondary to the passage of biliary stones, while in the remaining half, the syndrome is due to ampullary motility disorders. The diagnosis of SOD first requires exclusion of choledocholithiasis or ampullary tumor, by means of ERCP, endoscopic ultrasound or magnetic resonance imaging. Findings on biliary manometry will establish the diagnosis, but this technique is performed less and less often because its high risk of inducing pancreatitis discourages its use as a diagnostic procedure. Biliary scintigraphy offers a risk-free alternative albeit with lower sensitivity. Medical treatment relies on the administration of trimebutine and nitroglycerine when pain occurs. Their efficacy is moderate. Sometimes patients are referred for endoscopic sphincterotomy. Endoscopic treatment should be performed only for patients with biliary pain associated with hepatic function disorders and/or bile duct dilatation. Practicians and patients should be aware that endoscopic sphincterotomy in this clinical setting is associated with a high risk of pancreatitis and its efficacy is limited in patients with pain but without laboratory anomalies or dilatation of the biliary duct (type III Milwaukee classification). Patients with Milwaukee classification type III disorders have mostly functional complaints or psychosocial disabilities and require only medical management. [ABSTRACT FROM AUTHOR]

This article compares two techniques, endoscopic ultrasound guided choledocoduodenostomy (EUS-CD) and hepaticogastrostomies (EUS-HG), for the treatment of distal malignant biliary obstructions (DMBO). The study found that both techniques had similar technical and clinical outcomes, but in cases of duodenal stenosis, EUS-HG had a lower rate of biliary reinterventions. The study emphasizes the importance of expertise in EUS-HG for these situations. Overall, the findings suggest that both techniques are viable options for managing DMBO, but the choice of technique may depend on the specific circumstances and the level of expertise available. [Extracted from the article]

This article discusses the use of different strategies for ultrasound-guided biliary drainage in cases of gastric outlet obstruction (GOO) in patients with pancreatobiliary and gastroduodenal neoplasia. The study compared the efficiency of two methods, EUS-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS), in treating biliary obstruction. The results showed no significant difference in technical success, clinical success, or adverse events between the two methods. However, there was a significant difference in survival without biliary obstruction during follow-up in favor of EUS-HGS. The study concludes that patients with double stenosis have a poor prognosis, and the choice of biliary drainage route or treatment method for duodenal stenosis does not significantly affect the occurrence of biliary obstruction. [Extracted from the article]