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However, few studies evaluated the outcomes and prognoses of patients with upper GI vascular ectasia hemorrhage treated with APC in comparison with new laser coagulation. In the current study, we aimed to investigate and compare the efficacies of endoscopic APC treatment and dual emission endoscopic laser treatment (DEELT) in patients with GI angiodysplasia and their treatment outcomes. Twenty-two patients reported lower gastrointestinal bleeding; 10 patients reported melena; 30 patients had anemia at the time of the diagnosis. Gastrointestinal (GI) angiodysplasias are typically discrete, flat or slightly raised, bright-red lesions 2 to 10 mm in size. [Extracted from the article]

Background: Management of biliary adverse events (BAEs) after biliodigestive anastomosis is challenging. We propose a new endoscopic approach to improve BAEs in this clinical setting.Methods: Patients who had BAEs after a hepaticojejunostomy with Roux-en-Y loop or a Whipple procedure underwent creation of an entero-enteral endoscopic bypass (EEEB) between the duodenal/gastric wall and the biliary jejunal loop under endoscopic ultrasound (EUS) and fluoroscopic guidance using specifically designed fully covered self-expandable metal stents.Results: 32 consecutive patients underwent EEEB, which was successful in all but one patient. One procedural and five long-term mild adverse events occurred. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Disease recurred in two patients who were successfully re-treated through the EEEB.Conclusions: Our retrospective study showed that in patients with BAEs after biliodigestive anastomosis, EEEB is safe, feasible, and allows a successful long-term treatment of different BAEs in a tertiary referral center with high-level experience in both endoscopic retrograde cholangiopancreatography and EUS. [ABSTRACT FROM AUTHOR]

Background: Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes. Methods: We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up. Results: In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (<15 days) and 3 as delayed (>15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed. Conclusions: EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients. [ABSTRACT FROM AUTHOR]

None The possibilities of performing endoscopic gastroenteral bypass and entero-enteral bypass have been explored recently in patients with Roux-en-Y reconstruction after subtotal gastrectomy or biliary anastomosis; however, data are still scant and based on limited follow-up. The operative gastroscope was pushed through the endoscopic gastroenteral bypass and the biliary stents were removed, although the procedure proved difficult because one of the stents was entrapped in an anastomotic recess of the hepaticojejunostomy. [Extracted from the article]

The article discusses a case study of a two year old boy presenting with choledocholithiasis and severe gastroesophageal reflux disease, wherein topics include the boy having bile fistula from the surgical drain, treatment using linear echoendoscopy, and placement of a metal stent.

The article describes the case of the use of endoscopic technique for bilious vomiting in a patient following gastrojejunal surgical bypass, and discusses the adverse effect of gastrojejunal Billroth II or single Rouxen-Y reconstructions and symptoms experienced by the patient.

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC‐LAMS) is currently a well‐established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) could represent an easy and valid option. We performed a prospective study with a new EC‐LAMS with the primary aim to assess the clinical success rate of EUS‐GBD as a first‐line approach to the palliation of DMBO. Methods: In all, 37 consecutive patients undergoing EUS‐GBD with a new EC‐LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC‐LAMS placement. Results: The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC‐LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent‐related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1–8). Conclusion: Endoscopic ultrasound‐guided gallbladder drainage with the new EC‐LAMS is a valid option in palliative endoscopic biliary drainage as a first‐step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC‐LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: To generate a prognostic model based on a nomogram for adverse event (AE) prediction after lumen‐apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC). Methods: Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Results were expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Discrimination was assessed by c‐statistics and calibrated by comparing deciles of predicted and observed ORs. Results: Overall, 516 patients were included (males 68%, mean age 61.6 ± 15.2 years). PFCs were predominantly walled‐off necrosis (52.1%). Independent predictors of AE occurrence were injury of main pancreatic duct (OR in the case of leak 2.51, 95% CI 1.06–5.97, P = 0.03; OR in the case of complete disruption 2.61, 1.53–4.45, P = 0.01), abnormal vessels (OR in the case of perigastric varices 2.90, 1.31–6.42, P = 0.008; OR in the case of pseudoaneurysm 2.99, 1.75–11.93, P = 0.002), using a multigate technique (OR 3.00, 1.28–5.24; P = 0.05), and need of percutaneous drainage (OR 2.81, 1.03–7.65, P = 0.04). By nomogram, a score beyond 200 points corresponded to a 50% probability of AE occurrence. The model was confirmed even when excluding mild AEs and it showed optimal discrimination (c‐index 76.8%, 95% CI 74–79), confirmed after internal validation. Conclusion: Patients with preprocedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage or a multigate technique are at higher risk for AE. [ABSTRACT FROM AUTHOR]

Background and Study Aim: The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side‐by‐side. Fully covered self‐expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non‐responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success. Patients and Methods: Ninety‐one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post‐OLT‐AS between 2007 and 2017. Forty‐nine (54%) patients were treated with cSEMS as a second‐line treatment. Results: All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0–6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7–16.0; p value 0.004). Conclusions: cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti‐migration stents. [ABSTRACT FROM AUTHOR]

The nursing staff are fully trained in digestive, thoracic, and ENT procedures to allow endoscopy nurses to work only in our regular endoscopy unit. The "second wave" of the outbreak of COVID-19 confirmed the need for long-term projects to manage diagnostic and therapeutic endoscopies in patients testing positive for SARS-COV-2 [1]. Referrals and experience are constantly increasing worldwide, and many patients with COVID-19 undergo endoscopies in many centers [2][3]. [Extracted from the article]

Background and Study Aim: Advance biliopancreatic endoscopies are nowadays performed in non-operating room anesthesia (NORA) under general anesthesia (GA). We evaluate the outcomes of non-intubated patients in prone position who received GA for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral center for digestive endoscopy. Patients and Methods: Anesthesiological records, anamnestic, and intraoperative data of patients who underwent advanced therapeutic biliopancreatic endoscopies at our tertiary referral center from January 2019 until January 2020 were collected in the present observational study. Results: One hundred fifty-three patients (93 M; median age: 68-year-old; mean ASA status: 2) were considered eligible for a procedure in the prone position with GA in spontaneous breathing. Prone position was always the initial setting. Propofol administration through a target-controlled infusion (TCI) pump was the choice to achieve GA. In our experience, desaturation appears to be the most frequent adverse event, accounting for 35% of cases (55/153). Treatment foresaw additional oxygen through a nasopharyngeal catheter, which proved to be a sufficient measure in almost all patients (52/55). Other adverse events (i.e., inadequate sedative plan, pain, and bradycardia) accounted for 2.6% of cases (4/153). Conclusions: Non-intubated GA in the prone position may be regarded as a safe procedure, as long as the anesthesiological criteria of exclusion are respected and the anesthesiological team has become acquainted with the peculiar NORA setting and familiar with the management of possible adverse events. [ABSTRACT FROM AUTHOR]

2) showed bile duct dilatation and a distal stricture of the common bile duct. At her 1-month follow-up visit, the patient had developed two liver abscesses (S4 - S8), which were probably related to bile duct contamination during the cholangioscopy. [Extracted from the article]

We also perform urgent endoscopies in high-risk patients (fever > 37.5 °C not related to other causes, respiratory symptoms); ambulatory visits for high-risk patients are generally postponed. 2 Double-room setting to minimize Covid-19 spread during digestive endoscopy for positive patients. a The double room setting. b Dressing room with clean and unclean areas. c Endoscopy room. Following the precautions described above, between 22 February and 3 April, we performed 924 endoscopies (six Covid-19-positive patients) and no members of our digestive endoscopy team have reported symptoms. [Extracted from the article]

None Hepatic lesions are common in abdominal traumas [1] and generally involve liver parenchyma. At the six-month follow-up, both stents were removed, and two "hand-tailored", fully covered, 6-mm × 3-cm self-expandable metal stents (WallFlex; Boston Scientific) were placed through the new choledocoduodenostomy to consolidate the anastomosis ([1]). [Extracted from the article]

Background and aim: Clinically relevant pancreatic leaks of jejunal-pancreatic anastomosis after pancreato-duodenectomy (PD) occur in 9–15% of cases. Endoscopic strategies for management of pancreatic fistula, may allow to avoid reoperation and shorten times for fistula closure, but are still understudied and not widely performed. Aim of the present paper is to describe different endoscopic techniques used to treat such conditions. Methods: It was a retrospective, single centre, study. All patients who underwent endoscopic treatment for pancreatic leaks following PD between 1st January 2013 and 31th May 2019 at our Centre were reviewed. Depending on the morphology and severity of the leak, four main endoscopic techniques were performed: (1) trans-anastomotic intraductal pancreatic stent insertion; (2) lumen-apposing metal stent between the jejunal loop and the retroperitoneum toward the pancreatic stump insertion ("yoyo-stent"); (3) large calibre nose-to-retroperitoneum drain insertion; (4) when a wide damage of the jejunal wall or a coexistent biliary-jejunal leak were observed, triple metal stent insertion was performed as follow in order to close the defect: enteral fully-covered SEMS in the jejunal stump, a pancreatic metal stent into the Wirsung duct and a fully-covered SEMS across the bilio-digestive anastomosis, through the meshes of the enteral stent. In all cases, surgical drain was simultaneously retracted. Results: We identified 13 patients who underwent endoscopic treatment for POPF after PD. In total, 5 patients underwent "Yoyo stent insertion", 3 with nose-to-collection drain placement and four patients were treated with triple-stent insertion; in only one patient intrapancreatic SEMS insertion was performed. Technical success was 100% and clinical success was 83.3%. Mean time for leak closure was 4.8 days (range 2–10). During the follow-up interval, no leak recurrences were observed. Conclusions: Our experience confirms efficacy and safety of endoscopic management of POPF following pancreatoduodenectomy management. Endoscopy should play a central role in this clinical scenario. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the go-to method for obtaining samples from gastrointestinal tract and pancreatic lesions. When the transduodenal approach is utilized, the use of a more flexible needle, such as a nitinol 19-gauge (G) needle, has been recommended. The aim of this study was to evaluate the feasibility and accuracy of 19-G flexible aspiration needles in obtaining samples from solid lesions through a transduodenal approach. Methods: This was a retrospective analysis of prospectively collected data from eight Italian endoscopy centers. Consecutive patients with solid lesions who underwent transduodenal EUS-FNA with a 19-G flexible needle were included. Results: A total of 201 patients were enrolled. According to histology, EUS, radiology and 12 months of follow-up, 151 patients had malignant lesions and 50 patients had benign lesions. EUS-FNA was feasible in all cases. An adequate histologic sample was obtained in all except eight cases (96.1%). The sensitivity of EUS-FNA was 92.1% (95% confidence interval [CI], 86.8%–95.7%), and the specificity was 100% (95% CI, 90.5%–100%). The positive predictive value was 100% (95% CI, 93.4%–100%), and the negative predictive value was 74% (95% CI, 62.8%–82.7%). The diagnostic accuracy was 93.5% (95% CI, 89.2%–96.5%). Conclusions: The transduodenal approach for obtaining samples from solid lesions using a 19-G flexible needle seems feasible and accurate. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 39-year-old woman with acute biliary pancreatitis (ABP) in which an impacted biliary stone in papilla was observed during endoscopic retrograde cholangiopancreatography (ERCP).

The authors declare that they have no conflict of interest. letter We read with great interest the article by de Lima et al. on the application of endoscopic vacuum therapy (EVT) to upper gastrointestinal perforations [1]. Comments on "Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations" Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations. [Extracted from the article]

Background: Pancreatic leaks occur as a complication of upper gastrointestinal surgery, acute pancreatitis, or abdominal trauma. Pancreatic fistulas and leaks are primarily managed conservatively. Overall, conservative measures are successful in more than half of cases. Whenever conservative treatment is not efficient, surgery is usually considered the treatment of choice. Nowadays however, endoscopic treatment is being increasingly considered and employed in many cases, as a surgery sparing intervention.Aim: To introduce a classification of pancreatic fistulas according to the location of the leak and ductal anatomy and finally propose the best suited endoscopic method to treat the leak according to current literature.Methods: We performed an extensive review of the literature on pancreatic fistulae and leaks.Results: In this paper, we review the various types of leaks and propose a novel endoscopic classification of pancreatic fistulas in order to standardize and improve endoscopic treatment.Conclusions: A proper and precise diagnosis should be made before embarking on endoscopic treatment for pancreatic leaks in order to obtain prime therapeutic results. A multidisciplinary team of interventional endoscopists, pancreatic surgeons, and interventional radiologists is best suited to care for these patients. [ABSTRACT FROM AUTHOR]

Background: A number of patients with inoperable pancreatic cancer may concurrently complain of pain, biliary obstruction, and duodenal stenosis. Endoscopic palliative treatments and opioid therapy are generally performed in these patients. The study aimed to assess the efficacy and safety of a multimodal 'one-Session Three Endoscopic Procedures' (one-STEP) to simultaneously treat cholestasis, restore duodenal transit, and achieve pain relief in selected patients with advanced pancreatic cancer.Methods: Selected patients diagnosed with an advanced pancreatic cancer presenting with biliary obstruction, duodenal stenosis, and severe pain treated with the one-STEP were considered. The one-STEP endoscopic approach included biliary and duodenal stenting, and EUS-guided celiac plexus neurolysis. The technical success rate, complications, pain relief, and opioid use at follow-up were assessed.Results: A total of 15 patients were treated. The one-STEP was successful in 13 (87 %) cases, while it failed in two patients due to the impossibility of dilating the neoplastic mass for creating a fistula. No endoscopy-related complications occurred. The median of pain intensity was 8 (range 7-10) at entry and significantly decreased to 2 (range 2-4) 72 h following celiac plexus neurolysis. At follow-up (median survival 4 months; range 3-8), only 3 (20 %) needed of narcotic treatment in the last period.Conclusions: The multimodal one-STEP is an effective and safe endoscopic approach for palliative treatment of biliary and duodenal stenosis, and for relieving chronic pain in patients with advanced pancreatic cancer. [ABSTRACT FROM AUTHOR]

B Video 1 b Intrabiliary thulium laser lithotripsy conducted through a cholangioscopic guide to complete a difficult biliary lithiasis. Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. [Extracted from the article]

Benign bilio-digestive anastomotic strictures are different from biliary post-OLT (orthotopic liver transplantation) anastomotic strictures, post-cholecystectomy strictures and biliary strictures related to chronic pancreatitis; the latter three types, in fact, are pure biliary strictures. 3 Zhang X, Wang X, Wang L. Effect of covered self-expandable metal stents compared with multiple plastic stents on benign biliary stricture: a meta-analysis. [Extracted from the article]

The article presents a case study of 67-year-old man with recurrent cholangitis caused by benign stricture of a bilioenteric anastomosis. He had a history of sclerosing cholangitis and left hepatectomy with Roux-en-Y bilioenteric reconstruction. The patient was treated using endoscopic ultrasound (EUS)-guided transenteric anastomosis. It discusses the use of EUS-guided duodenojejunal anastomosis and the importance of expert and skilled endoscopists to successfully perform the procedure.