This expert review provides crucial best practice guidance for managing ampullary adenomas, emphasizing improved endoscopic assessment and resection strategies to optimize patient outcomes. Ampullary adenomas can harbor malignancy in 20%-40% of cases; obtaining at least six biopsies is essential for accurate histopathological assessment. Use side-viewing duodenoscopes for better visualization and reduced pancreatitis risk during biopsy; […]
Category: Surgical Endoscopy
Advanced Techniques for Difficult Biliary Cannulation Show Similar Outcomes
A study assessing advanced techniques for difficult biliary cannulation shows they are similarly effective, challenging the notion of a superior method in ERCP. Initial cannulation success rates were 72% for double-guidewire, 68% for transpancreatic sphincterotomy, and 68% for precut fistulotomy (p = .882); all techniques achieved 100% final success. Median cannulation times were comparable, with […]
Impact of EUS on Cholangiocarcinoma Surgical Decisions
Endoscopic ultrasound (EUS) significantly influences surgical decisions in cholangiocarcinoma by identifying new findings, leading to 10% of patients being excluded from curative-intent surgery. Overall, EUS findings excluded patients from surgery 10% of the time, with 7% for perihilar cholangiocarcinoma. The incremental benefit of EUS over traditional imaging revealed a further 3% of patients with malignant […]
Endoscopic Submucosal Dissection for Ampullary Tumors Yields High Recurrence
Endoscopic submucosal dissection (ESD) effectively achieves en bloc resection of laterally spreading ampullary tumors, but significant recurrence remains a concern. Among 55 patients analyzed, the 3-year cumulative incidence of residual/recurrent tumors was 33%, with all recurrences confined to the papilla. Positive or indeterminate papillary ductal margins emerged as a leading risk factor, increasing the likelihood […]
Endoscopic Grading of Gastric Intestinal Metaplasia Shows High Accuracy
Endoscopic grading of gastric intestinal metaplasia (EGGIM) effectively identifies extensive disease with high sensitivity and specificity, enhancing patient risk stratification for surveillance. Pooled sensitivity of EGGIM is 90% and specificity is 92%, based on 1,143 patients across seven studies using narrow-band or blue light imaging. The diagnostic odds ratio is 105.93, with an AUC of […]
Endoscopic Therapy for Cystic Duct Remnant Stones Shows High Success
ERCP is a highly effective and safe option for managing symptomatic cystic duct remnant stones in post-cholecystectomy patients, reducing the need for surgical excision. Technical success was achieved in 95% of cases (20/21), with clinical success at 91% (19/21). Balloon sweep alone cleared stones in 43% of patients, with cholangioscopy and electrohydraulic lithotripsy frequently required […]
Achalasia Treatment: Heller’s Myotomy and POEM Lead Success
This systematic review shows that Heller’s myotomy and peroral endoscopic myotomy (POEM) outperform botulinum toxin for long-term symptom relief in primary achalasia. At 5 years, Heller’s myotomy and POEM have a treatment success rate that is significantly greater than botulinum toxin (odds ratios of 6.39 and 6.33, respectively). Botulinum toxin showed less treatment success at […]
Sphincter-Sparing Preclosure Technique Cuts Complications in Endoscopic Papillectomy
Sphincter-sparing preclosure technique-assisted endoscopic papillectomy significantly reduces delayed bleeding and shortens hospital stays compared to conventional methods. Delayed bleeding rate dropped to 0% in the preclosure group versus 17.95% in the conventional group (p = .017). Immediate bleeding rates were also lower in the preclosure group (37.93% vs 66.67%; p = .027). Cannulation time and […]
Conversion drainage matches primary in acute cholecystitis
For high-risk patients with acute cholecystitis, conversion to endoscopic ultrasound-guided gallbladder drainage after percutaneous drainage achieved outcomes comparable to primary drainage. Multicenter study of 141 patients: technical success was 95.8% after conversion versus 98.3% with primary drainage. Results remained comparable after adjustment, despite more cancer and greater comorbidity in the conversion group. Clinical success, adverse […]
EUS-Guided Gallbladder Drainage Effective for Symptomatic Cholelithiasis
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a safe and effective option for nonoperative candidates with symptomatic cholelithiasis without cholecystitis. Complete gallstone clearance achieved in 100% of patients; 87% cleared in one treatment. All 23 patients had technical success with LAMS placement, and no procedure-related adverse events occurred. No symptom recurrence noted over a mean follow-up […]