UEGJournal Abstracts 2021 - 723

Liver & biliary
ertheless, it would be interesting to figure out which one of the two techniques
should be considered as Gold Standard for bile duct dilatation. For
this aim, some aspects should be taken into consideration, such as the
fact that ERCP insufflates pressure into the biliary tract and it could distort
some measures.
References:
1. Buxbaum JL, Abbas Fehmi SM, Sultan S, et al. ASGE guideline on the role
of endoscopy in the evaluation and management of choledocholithiasis.
Gastrointest Endosc. 2019 Jun; 89(6): 1075-1105.
2. Kamath SU, Dharap SB, Kumar V. Scoring system to preoperatively predict
choledocholithiasis. Indian J Gastroenterol. 2016 May; 35(3): 173-8.
Disclosure: Nothing to disclose.
P0782
ERCP IN BILROTH-II CASES. EXPERIENCE, TIPS AND TRICKS
A. Filin1
, D. Chernikh1
, V. Duvanskiy2
1Leningrad Clinical Regional Hospital, Endoscopy, Saint
Petersburg, Russia, 2Scobelkin State Scientific Center of Laser
Medicine, Department of Endoscopy, Endoscopic and Laser
Surgery, Moscow, Russia
Contact E-Mail Address: doctor_eagleowl@mail.ru
Introduction: There are different indications for Billroth-II gastric resection,
such as complications of stomach ulcer disease, tumors, bariatric
surgery. It changes the anatomy and approach to papilla of Vater. In most
of such cases ERCP becomes a significant challenge for endoscopists.
Aims & Methods: We intended to show the advantage of application of forward-viewing
scopes with proper accessories to solve the problems with
ERCP in patients after short-loop Billroth-II operations (when it is possible
to reach papilla).
We performed ERCP with forward-viewing scopes by Olympus and Pentax.
The diameter of instrumental channel was 2.8 and 3.2 mm respectively.
The idea was to match the axis oh the bile duct and instrumental channel
in optimal way. In some cases we applied transparent distal cap for better
view and positioning. The diameter of instruments was feasible to instrumental
channel of the scopes. Special instrument for sphincterotomy was
applied, called " Billrothotome " . Electrosurgical unit was ESG-100, Pulsecut
slow mode, 120 W expected for sphincterotomy.
Results: We got an experience of 11 cases of ERCP after short-loop Billroth-II
operations. Distal malignant strictures - 3, biliary stones - 8. The
cannulation rate of success was 100%, operation success - 91%, we failed
to insert plastic stent in one case with rigid bile duct stricture formed by
pancreatic head tumor. Transparent distal cap was applied in 5 cases and
effectively supported bile duct cannulation in 100% of cases providing
proper position and better visualization. " Billrothotome " was very effective
in 100% of cases for sphincterotomy, as it is specially designed for " inversed
cut " . There was no significant bleeding. Stone extraction with traditional
baskets were 100% cases effective, stone retraction was even more
easy, than in normal ERCP cases, due to antegrade papillary approach
and axial match. Successful placing of plastic stents was performed in 4
cases (strictures -2, complicated bile duct stones -2). In some cases stent
placement was rather challenging, because the absence of elevator on the
scope and lower pushing ability comparing to duodenoscope. In one case
we successfully performed cholangioscopy with normal scope and direct
electrohydraulic lithotripsy (bile duct diameter 20mm, multiple barrelshaped
stones).
Conclusion: ERCP after short-loop Billroth-II operations can be successfully
performed with forward-viewing scopes. Some special devises increase
the efficiency of the procedure. Forward-viewing scopes have some advantages
for positioning, cannulation, sphincterotomy and stone extracVol.
9 | October 2021
Contact E-Mail Address: sebastian.m.milluzzo@gmail.com
Introduction: A precise characterization of indeterminate biliary strictures
still represents a major challenge. This has relevant clinical implications
since a delay in the diagnosis can negatively influence patient
management and prognosis. Due to inadequate diagnostic performances
of conventional biopsy and brushing sampling during endoscopic retrograde
cholangiopancreatography (ERCP), novel technologies have been
proposed. Digital single-operator cholangioscopy (DSOC) could potentially
overcome these issues. Performing a direct visualization of the
biliary tree, DSOC can be a valuable and accurate tool for differentiating
malignant from benign stenosis. Furthermore, DSOC-guided intraductal
biopsies can be performed, although prior studies have reported a suboptimal
diagnostic accuracy.
Aims & Methods: The primary endpoint of this study was to analyze the diagnostic
accuracy of visual DSOC and DSOC-guided intraductal biopsy for
indeterminate biliary strictures. As secondary endpoints, additional yield
of DSOC, technical success, adequacy of intraductal DSOC-guided biopsy
and adverse event rate were evaluated.
Consecutive DSOC performed for indeterminate biliary strictures during a
6-year period were retrospectively evaluated. Demographic characteristics,
stricture location, pre-procedural laboratory tests, DSOC findings and
adverse events were collected. Final diagnosis was based on histological
evaluation of the surgical specimen if available or a consistent follow-up
of at least 6 months.
Results: Thirty-five patients (M:F = 16:19) were collected, with a mean age
of 65 years (range 21 - 83). Three patients repeated DSOC with biopsy due
to inadequate sampling and uncertain diagnosis. Twelve patients (34.3%)
had a native papilla while 16 (45.7%) had plastic biliary stent in place.
Twenty patients (57.1%) presented with jaundice, 25 (71.4%) had anicteric
cholestasis, 11 (31.4%) had increase of CA 19.9 and 2 (5.7%) high level of
serum IgG4. Previous inadequate sampling was obtained in 21/35 patients
(60%)(1 EUS-FNA, 1 EUS-FNB, 19 brushing and/or biopsy during conventional
ERCP). Stricture was located at common bile duct in 31.4% (11/35),
common hepatic duct in 20% (7/35), right hepatic duct 11.4% (4/35), and
hilum in 37.2% (13/35). After DSOC, strictures were excluded and/or location
changed in 15 patients (additional yield of 42.85%). Intraductal DSOCguided
biopsy were technically successful in 96.1% of the cases (25/26),
with an adequacy of 76% (19/25).
Final diagnosis was benign biliary stricture in 60% of the cases (9 benign
biliary scar, 6 normal duct, 3 primary sclerosing cholangitis, 1 Mirizzi's
Syndrome, 1 lymph nodes compression and 1 autoimmune IgG4-related
disease) and malignancy in the remaining 40% (6 cholangiocarcinoma
and 8 biliary adenocarcinoma).
Diagnostic accuracy for malignancy of intraductal DSOC-guided biopsy
was 86.7%, sensitivity 75% (95% IC; 46.4% - 92%), specificity 100% (95%
IC; 74.7% - 100%), PPV 100% (95% IC; 74.7% - 100%) and NPV 77.8% (95%
IC; 49,1% - 93.5%). Diagnostic accuracy for malignancy of visual DSOC was
723
tion, but there are some limits in stenting abilities comparing to traditional
duodenoscopes, such as maximal stent diameter and pushing power.
Disclosure: Nothing to disclose.
P0783
DIAGNOSTIC ACCURACY OF DIGITAL SINGLE-OPERATOR
CHOLANGIOSCOPY FOR INDETERMINATE BILIARY STRICTURE:
AN ITALIAN SINGLE-CENTER EXPERIENCE
S.M. Milluzzo1
R. Ricci1
1
, A. Tringali1
, G. Costamagna1
Fondazione Policlinico Universitario A. Gemelli IRCCS - Università
Cattolica del Sacro Cuore, Rome, Italy
, V. Perri1, P. Familiari1
, I. Boskoski1
,
UEGJournal Abstracts 2021

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