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Background and Aim: Data on post‐endoscopic retrograde cholangiopancreatography (ERCP) adverse events and readmission rates in liver transplantation (LT) patients remain scarce. This study determined the 30‐day procedure‐related readmission rate following ERCP in an LT cohort at an Australian tertiary academic center. Methods: All unplanned readmissions within 30 days following ERCP in orthotopic LT patients between December 2012 and August 2021 were retrospectively identified. Demographic data, procedure variables, and readmission characteristics were also collected. Results: Forty‐five procedure‐related readmissions were identified (3.3%) from a total of 1369 ERCP procedures. This included 33 cases of cholangitis (2.4%), 7 cases of nonspecific abdominal pain (0.5%), 5 cases of mild post‐ERCP pancreatitis (0.5%), and 3 cases of bleeding (0.2%). No procedure‐related mortality was observed. Conclusion: The procedure‐related readmission rate following ERCP in this LT cohort was 3.3%, which is likely lower than comparable studies carried out on the overall population. [ABSTRACT FROM AUTHOR]

Background and Aims: Strictures are the most common biliary complication after liver transplantation, and endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard in its management. Failure to cross the biliary anastomosis requires a repeated attempt with ERCP, referral for percutaneous transhepatic cholangiography (PTC) or surgery. We present our experience with the digital single operator cholangioscope (D‐SOC) in achieving guidewire access in a liver transplant cohort with difficult biliary strictures who have failed conventional ERCP methods. Methods: This was a retrospective study involving two adult liver transplant centers servicing the two most populated states in Australia. Deceased‐donor liver transplant recipients undergoing D‐SOC for biliary strictures who have failed conventional methods to achieve biliary access were included. Results: Between July 2017 to April 2022, eighteen patients underwent D‐SOC after failing to achieve guidewire placement through standard ERCP techniques. Thirteen out of eighteen (72%) had successful guidewire placement with index D‐SOC. Five of eighteen patients (28%) had unsuccessful guidewire placement with D‐SOC. In two of these patients, use of D‐SOC informed further endoscopic management, with one avoiding PTC and the other avoiding surgery. Two of the five patients required PTC and one patient was left unstented. Three patients developed post D‐SOC cholangitis. Conclusions: D‐SOC is effective at achieving guidewire access in post‐liver transplant patients who fail conventional ERCP techniques and should be considered in the treatment algorithm as a step before PTC and surgery. [ABSTRACT FROM AUTHOR]

Background and Aims Currently used endoscopic items for the assessment of pouchitis and cuffitis have deficiencies in reliability and validation. We assessed the reliability and accuracy of new endoscopic items for pouchitis and of the Ulcerative Colitis Endoscopic Index of Severity [UCEIS] for cuffitis. Methods Three new endoscopic items were assessed and included in the Monash pouchitis endoscopic subscore: bleeding [absent/contact/spontaneous]; erosions [absent/<10/≥10]; and ulceration [absent/<10%/≥10%]. Three raters evaluated 44 pouchoscopy videos in duplicates, in random order. Intra- and inter-rater reliability of all endoscopic items and UCEIS were assessed. Clinical and histological pouchitis disease activity index [PDAI] subscores were also assessed and faecal calprotectin was measured. Results All three Monash endoscopic items had substantial intra-rater reliability with intraclass correlation coefficients [ICCs] >0.61 [95% CI >0.61], compared with only ulcers from the currently used PDAI endoscopic subscore, but inter-rater reliability was only substantial for ulceration and no better than those of the currently used endoscopic items. The Monash endoscopic subscore had a strong positive correlation with the reference standard global endoscopic lesion severity r = 0.80 [95% CI 0.80‐0.80] and the reference standard PDAI endoscopic subscore r = 0.70 [95% CI 0.67–0.73], which was higher than the correlation observed for the currently used PDAI endoscopic subscore. The UCEIS had substantial intra-rater reliability, but only fair inter-rater reliability and poor diagnostic performance for cuffitis. Conclusions The Monash endoscopic items, and endoscopic subscore they generate, have enhanced overall performance compared with the currently used PDAI items and subscore. Further validation and responsiveness to change in disease state are indicated. [ABSTRACT FROM AUTHOR]

Background and Aims In symptomatic patients with ileoanal pouches, pouchoscopy is needed for accurate diagnosis but is invasive. We aimed to assess the utility of non-invasive gastrointestinal ultrasound and faecal calprotectin in ileoanal pouch patients. Methods Patients with an ileoanal pouch were consecutively enrolled in this cross-sectional study from clinics in Victoria, Australia. The pouchitis disease activity index was used as a reference standard. Video-recorded pouchoscopies were reviewed by three gastroenterologists. Pouch, pre-pouch, and cuff biopsies were reviewed by a single pathologist. Ultrasound was performed by a single gastroenterologist transabdominally and transperineally. Faecal calprotectin was measured from morning stool samples. All examiners were blinded to patients' clinical history. Results A total of 44 participants had a pouchoscopy, of whom 43 had a faecal calprotectin test and 42 had an ultrasound; 17 had pouchitis, 15 had pre-pouch ileitis, and 16 had cuffitis. Pouch wall thickness of <3 mm was 88% sensitive in excluding pouchitis, and pouch wall thickness of ≥4 mm was 87% specific in diagnosing pouchitis. Transabdominal ultrasound had good utility [area under the curve: 0.78] in diagnosing moderate-severe pre-pouch ileitis. Transperineal ultrasound had good utility for the diagnosis of pouchitis [area under the curve: 0.79]. Faecal calprotectin differentiated inflammatory from non-inflammatory pouch disorders, such as irritable pouch syndrome, with an area under the curve of 0.90. Faecal calprotectin <100 µg/g ruled out inflammatory pouch disorders with a sensitivity of 94%. Conclusions Faecal calprotectin and ultrasound are accurate and complementary tests to diagnose and localise inflammation of the ileoanal pouch. Prospective studies are needed to validate proposed sonographic indices and calprotectin levels. [ABSTRACT FROM AUTHOR]

Background and Aim: Cholecystectomy and endoscopic retrograde cholangiopancreatography are the gold standard for managing acute cholecystitis and malignant biliary obstruction, respectively. Recent advances in therapeutic endoscopic ultrasound (EUS) have provided alternatives for managing patients in whom these approaches fail, namely, EUS‐guided gallbladder drainage (EUS‐GB) and EUS‐guided bile duct drainage (EUS‐BD). We aimed to assess the technical and clinical success of these techniques in the largest multicenter cohort published to date. Methods: A retrospective, multicenter, observational study involving 17 centers across Australia and New Zealand was conducted. All patients who had EUS‐GB or EUS‐BD performed in a participating center using a lumen apposing metal stent between 2016 and 2020 were included. Primary outcome was technical success, defined as intra‐procedural successful drainage. Secondary outcomes included clinical success and 30‐day mortality. Results: One hundred and fifteen patients underwent EUS‐GB (n = 49) or EUS‐BD (n = 66). EUS‐GB was technically successful in 47 (95.9%) while EUS‐BD was successful in 60 (90.9%). All failed cases were due to maldeployment of the distal flange outside of the targeted lumen. Clinical success of EUS‐GB was achieved in 39 (79.6%). No patients required subsequent cholecystectomy. Clinical success of EUS‐BD was achieved in 52 (78.8 %). Thirty‐day mortality was 14.3% for EUS‐GB and 12.1% for EUS‐BD. Conclusions: EUS‐guided gallbladder drainage and EUS‐BD are promising alternatives for managing nonsurgical candidates with cholecystitis and malignant biliary obstruction following failed endoscopic retrograde pancreatography. Both techniques delivered high technical success with acceptable clinical success. Further research is needed to investigate the gap between technical and clinical success. [ABSTRACT FROM AUTHOR]

Background and Aim: During COVID‐19 outbreak, restrictions to in‐person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess "failure‐to‐attend" (FTA) rate and satisfaction for two endoscopy‐related compulsory telehealth clinics during the COVID‐19 outbreak. Methods: Consecutive patients booked for endoscopy‐related telehealth clinics at a tertiary hospital were prospectively assessed. In‐person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review. Results: There were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in‐person follow‐up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%. Conclusions: The use of phone consultations in endoscopy‐related clinics during the COVID‐19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in‐person follow‐up consultations and physical examination were low. [ABSTRACT FROM AUTHOR]