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Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. The aim of our study is to evaluate the complication rate of ERCP in the treatment of choledocholithiasis and to assess the factors related to their occurrence. Methods: This is a retrospective descriptive and analytical study including 1048 patients who underwent ERCP for choledocholithiasis between January 2007 and August 2021. The factors associated with the occurrence of post-ERCP complications were studied by logistic regression analysis. Results: Among the patients studied, 60.5% had a simple lithiasis, 27.6% had multiple choledochal stones and 11.9% had large stones (> 15mm). Clinically, 18.7% of the patients presented with cholangitis and 9.4% with acute pancreatitis. A periampullary diverticulum was found in 9.4% of cases. A common bile duct stenosis was present in 6.5% of cases. The primary vacuity rate was 77.3%. However, additional manoeuvres were used in 20.5% of cases. Complications were reported in 5.8% of cases, including hemorrhage in 4.5%, pancreatitis in 0.8%, cholangitis in 0.2%, perforation in 0.1% and dormia impaction in 0.2%. No death was reported due to our procedures. In a multivariate analysis following adjustment of confounding factors, only the presence of a large stone (OR= 5.9, CI (1.460- 23.875), p=0.013) and female gender (OR= 1.867, CI (1.012-3.444), p=0.046) increased the risk of complications during ERCP. Conclusion: Our study suggests that female gender and the presence of à large gallstone are associated with a high risk of post-ERCP complications.

Background and study aims: During the COVID-19 pandemic, endoscopic procedures were associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to early endoscopy. The aim of this study was to assess the impact of the pandemic and the lockdown on the performance of digestive endoscopy for UGIB. Patients and methods: This is a retrospective observational cohort of 350 patients, conducted between January 2019 and December 2020, in the emergency endoscopy department of our institution. We have divided our patients into two groups, according to the period in which they were admitted (respectively pre-pandemic and pandemic periods corresponding to the year 2019 and 2020), and we have split the pandemic period into 3 subgroups according to the lockdown, each of these 3 phases was compared to its counterpart of the pre-pandemic period by adapting the same dates. Results: There was no difference in the number of admissions for UGIB before and after the COVID-19 pandemic. However, patients admitted during the pandemic period were significantly older. Peptic ulcer remained the main cause of UGIB in both study periods, with a significant decrease in the pandemic period. The subgroups analysis of the pandemic and pre-pandemic period showed that patients admitted during the lockdown phase were significantly older, with a significant decrease in the ulcerative origin of UGIB and an increase in the need for endoscopic haemostasis procedures, whereas during the post-lockdown period, there was furthermore an increase in the number of patients with UGIB of neoplastic origin. Conclusion: Despite the current epidemiological context, digestive endoscopy must be performed within the usual timeframe while adopting adequate precaution measures. Our study suggest that the reorganisation of our endoscopy department during the pandemic was effective in coping with routine endoscopic emergencies during this ........

Background and study aims: Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. Indeed, they can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. The current study reports that major gastrointestinal manifestations as initial symptoms of COVID-19 may suggest the diagnosis in patients who have been exposed, even in the absence of respiratory symptomatology. Patients and methods This prospective, descriptive, cross-sectional, and monocentric study of 713 cases was conducted in a field hospital in Morocco over a 5-week period from June 21 to July 25, 2020. Results The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastrointestinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286–1.698; p < 0.001) and treatment side effects (OR = 1.069, CI: 1.020–1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. Conclusion Gastrointestinal manifestations are common during COVID-19 and appear to be linked to a longer duration of the disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal–oral transmission. Therefore, hygiene is extremely important, especially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.

Background: Klatskin's tumour is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications. The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure. Methods: This is a retrospective and analytical study of 75 patients, conducted between July 2009 and August 2021, including all patients admitted with Klatskin's tumour and for whom endoscopic drainage was indicated. Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis. Results: The average age of our patients was 62.67 years with a male predominance of 68%. Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases. Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases, by a metal prosthesis in 45.2% and by nasobiliary drain in 4.1% . Forty-seven percent of patients had dilatation of the stenosis prior to prosthesis placement. Causes of stenting failure were primarily related to failure of papilla catheterisation, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumour. In multivariate analysis and by adjusting the studied parameters, namely the age, gender, bismuth tumour type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and the bismuth tumour classification affect the success rate. Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p

Introduction: Le drainage biliaire endoscopique connait des progres incessants et prend une large place dans le traitement palliatif des stenoses malignes des voies biliaires. Notre objectif est dexposer les resultats de cette technique dans notre formation, ainsi que les differents facteurs associes a son echec ou son succes. Methodes:Il sagit dune etude retrospective entre Janvier 2008 et novembre 2020, a propos de 204 patientsayant beneficie dun drainage endoscopique pour stenose biliaire dorigine neoplasique, et qui sont repartis en 3 groupes: les patients atteints dun cholongiocarcinome dans le groupe A , dun cancer du pancreas dans groupe B , et dun calculocancer dans le groupe C . Lanalyse statistique a ete realisee par le logiciel SPSS20.0. Resultats:Lage moyen etait de 63,5±11,4 ans avec un sex ratio a 1,4. Le succes global etait de 82,4% et letude comparative des resultats dans les 3 groupes a montre un taux de succes a 86,6% du groupe B, suivi du groupe C a 80,8% et du groupe A a 76,4%. En analyse multivariee et en ajustant les parametres etudies, a savoir le sexe, lage, limagerie, la presence de metastases et la dilatation endoscopique de la stenose, seule la presence de metastases et la dilatation endoscopique de la stenose modifient le taux de succes. La dilatation endoscopique de la stenose avant la mise en place de prothese multiplie par 8 le taux de succes [OR=9,177p