OUTCOMES OF BILIO-PANCREATIC EUS IN PATIENTS WITH SURGICALLY ALTERED UPPER GI ANATOMY: A RETROSPECTIVE MULTICENTER STUDY

SF Crinò; L Brozzi; MC Petrone; JW Poley; S Carrara; L Barresi; C Fabbri; M Rimbas; CD Angelis; PG Arcidiacono; M Signoretti; L Lamonaca; I Barbuscio; C Binda; A Gheorghe; S Rizza; A Gabbrielli

doi:10.1055/s-0040-1704327

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(S 01): S106
DOI: 10.1055/s-0040-1704327

ESGE Days 2020 oral presentations

Friday, April 24, 2020 17:00 – 18:30 Biliary diseases Liffey Hall 2

OUTCOMES OF BILIO-PANCREATIC EUS IN PATIENTS WITH SURGICALLY ALTERED UPPER GI ANATOMY: A RETROSPECTIVE MULTICENTER STUDY

Authors

SF Crinò

¹University of Verona, Digestive Endoscopy Unit, Verona, Italy
L Brozzi

¹University of Verona, Digestive Endoscopy Unit, Verona, Italy
MC Petrone

²San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, Milano, Italy
JW Poley

³Erasmus MC, University Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands
S Carrara

⁴Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milano, Italy
L Barresi

⁵IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy,
C Fabbri

⁶Forli-Cesena Hospital, AUSL Romagna, Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena, Italy
M Rimbas

⁷Colentina Clinical Hospital, Carol Davila University of Medicine, Gastroenterology Department, Bucharest, Romania
CD Angelis

⁸Città della Salute e della Scienza di Torino, Gastroenterology and Digestive Endoscopy Unit, Torino, Italy
PG Arcidiacono

²San Raffaele Scientific Institute IRCCS, Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, Milano, Italy
M Signoretti

³Erasmus MC, University Medical Centre, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands
L Lamonaca

⁴Humanitas Clinical and Research Center IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milano, Italy
I Barbuscio

⁵IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy,
C Binda

⁶Forli-Cesena Hospital, AUSL Romagna, Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena, Italy
A Gheorghe

⁷Colentina Clinical Hospital, Carol Davila University of Medicine, Gastroenterology Department, Bucharest, Romania
S Rizza

⁸Città della Salute e della Scienza di Torino, Gastroenterology and Digestive Endoscopy Unit, Torino, Italy
A Gabbrielli

¹University of Verona, Digestive Endoscopy Unit, Verona, Italy

Abstract

Volltext

Aims Little is known about outcomes of bilio-pancreatic endosonography (EUS) in patients with surgically altered upper gastrointestinal (GI) anatomy. We aimed to assess the performance of EUS, the rate of procedural success and of EUS-related adverse events (AEs), according to post-surgical anatomies.

Methods Patients with post-surgical altered upper GI anatomy who underwent EUS for the evaluation of the bilio-pancreatic region between January 2008 and June 2018 in 8 European centers were included.

Results Of 242 patients (162 males, mean age 66.4 ± 12.5), 86 had (35.5%) Billroth II (BII), 77 (31.8%) duodenopancreatectomy, 23 (9.5%) Billroth I, 19 (7.9%) distal esophagectomy, 15 (6.2%) total gastrectomy, 14 (5.8%) sleeve gastrectomy, and 8 (3.3%) Roux-en-Y. Sleeve gastrectomy, BI, and duodenopancreatectomy were associated with the highest rate of success (100%, 95.7%, and 92.2%, respectively). Head of pancreas visualization was significantly impacted by total gastrectomy, BII, and Roux-en-Y (success rate 6.7%, 53.7%, and 57.1%, respectively). The pancreatic body and tail were correctly examined in more than 90% of the cases in all groups except for esophagectomy and total gastrectomy patients (82.4% and 71.4%, respectively). The overall technical success of EUS-guided tissue acquisition (TA) was 78.2% (68/87 cases): 16 lesions failed to be visualized whereas in 5 it was impossible to puncture the lesion, resulting in a diagnostic accuracy of 71.3% (95% CI, 60.6-80.5).

Four (1.6%) AEs were observed: 1 mucosal tearing in a BII patient, 1 cardiac arrest in a distal esophagectomy patient, 1 bleeding after EUS-TA in a BI patient, and 1 acute pancreatitis after EUS-TA in a sleeve gastrectomy patient.

Conclusions The yield of bilio-pancreatic EUS in surgically altered upper GI anatomy is dependent on lesion location and surgery type. Before considering EUS in these patients, one must carefully consider the location of the target lesion and if it could be approachable by EUS.