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V.01.2: Endoscopic Anterograde Rendez-Vous for Completely Obstructed Colo-Rectal Anastomosis (with Video)
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Video V.01 Video
V.01.1 ENDOSCOPIC MANAGEMENT OF A DUODENAL DUPLICATION CYST CAUSING ACUTE RECURRENT PANCREATITIS. A CASE REPORT C. Becchetti ∗ , A. Fantin, F.P. Russo, G.C. Sturniolo Ospedale Civile di Padova, Padova, Italy Background and aim: Duodenal duplication (DD) is a rare congenital abnormality reported mainly in infancy, seldom in adolescent and adults. Patients with duodenal duplication cysts can present with symptoms related to compression, such as abdominal pain, nausea, vomiting or dyspepsia. Depending on the location and type of the lesion DD can also result in other complications, including pancreatitis, bowel obstruction, gastrointestinal bleeding, perforation and jaundice. Duodenal duplication cysts are usually treated with surgical resection, although endoscopic treatment has been reported especially in cases where the duplication is in close proximity to the major duodenal papillae. Material and methods: We report a case of a DD cyst, on the second portion of the duodenum, in a 24-year-old young lady referring to us for her third episode of acute pancreatitis. She complaining typical back pain and vomiting after meal, with elevations of pancreatic enzymes. The diagnosis of DD was suspcted by MRI abdominal imaging and upper GI endoscopic ultrasonography (video). Using a duodenoscope we performed an incision of the cyst. The initial puncture through the cyst roof was performed by using a needle-knife sphincterotome (video). The endoscopist used a regular sphincterotome to enlarge the incision through the cyst roof without immediate complications. Biopsies of the opposite wall of the cyst were made and results of histopathologic analysis showed benign duodenal mucosa, which confirmed the diagnosis. After three months from the procedure the patient is asymptomatic. Results: This current case illustrates that DD cyst can be adequately drained endoscopically, without recurrence at least during 3 month of follow-up. Conclusions: Endoscopic treatment is a viable and potentially preferable alternative to surgery for DD cyst.
V.01.2 ENDOSCOPIC ANTEROGRADE RENDEZ-VOUS FOR COMPLETELY OBSTRUCTED COLO-RECTAL ANASTOMOSIS (WITH VIDEO) F. Auriemma ∗ , R. Maselli, L. Poliani, P.A. Galtieri, A. Fugazza, G. Lollo, R. Semeraro, G. Amvrosiadis, M. Di Leo, S. Carrara, E.C. Ferrara, A. Anderloni, A. Spinelli, M. Montorsi, A. Repici Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic dilation is the treatment of choice for anastomotic colonic stenosis. There are only few reports in the literature of endoscopic management of completely obstructed colo-rectal anastomosis (no visible residual lumen). In most cases it requires combined surgical approaches, or more recently, an endoscopic lumen-apposing self-expandable metal stent placement. We describe a case of successful endoscopic management of a completely obstructed colonic anastomosis by using a combined en-
doscopic anterograde rendez-vous and retrograde transanal transillumination technique. Material and methods: This is the case of an 85-year-old male who had undergone a ultra-low anterior rectal resection with a loop ileostomy for a rectal carcinoma (pT3a N0) in June 2016. After three months, he developed a completely obstructed stricture with no histologic evidence of malignancy (Fig. 1). A combined anterograde-retrograde bowel and rectal barium enema showed a complete stricture, with a distance between the two lumens of about 10 mm (Fig. 2). Results: In September 2016 the rendez-vous technique was performed. The procedure consisted in an endoscopic access through the ileostomy up to colon side of the anastomosis. An endoscopic breach was obtained by cutting the wall with a needle knife, guided by transanal digital pressure and trans-illumination from the rectal side (Fig. 3). Then, a 0.035 guidewire was inserted through the breach (Fig. 4). Over the wire a mechanical dilation with Savary dilators up to 14 mm was performed, under endoscopic anterograde view.
No complications related to the procedure were registered. The patient underwent subsequent mechanical dilation and finally the intestinal reconnection was scheduled and performed. Conclusions: In literature there are only few reports of endoscopic treatment of completely obstructed colonic anastomosis and in the most of them balloon or mechanical dilation are performed. This rendez-vous technique has been described previously, requiring fluoroscopy or double endoscopic approach. In difficult cases, where a completely obstructed anastomotic strictures are encountered and a proximal access given by ileo or colostomy is present, a rendez-vous approach can be safely and effectively applied to obtain recanalization.
V.01.3 SINGLE STEP EUS-GUIDED FLUOROLESS GALLBLADDER DRAINAGE USING THE AXIOS SYSTEM LUMEN APPOSING METAL STENT C. Barbera ∗,2 , G. Grande 1 , N. Alberghina 2 , M. Manno 2 , C. Zulli 1 , R. Conigliaro 1 1 Gastroenterology
and Digestive Endoscopy Unit, NOCSAE Hospital, AUSL of Modena, Italy; 2 Gastroenterology and Digestive Endoscopy Unit, Carpi Hospital, AUSL of Modena, Italy Background and aim: Severe acute cholecystitis is a condition that
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Video V.01 Video
V.01.1 ENDOSCOPIC MANAGEMENT OF A DUODENAL DUPLICATION CYST CAUSING ACUTE RECURRENT PANCREATITIS. A CASE REPORT C. Becchetti ∗ , A. Fantin, F.P. Russo, G.C. Sturniolo Ospedale Civile di Padova, Padova, Italy Background and aim: Duodenal duplication (DD) is a rare congenital abnormality reported mainly in infancy, seldom in adolescent and adults. Patients with duodenal duplication cysts can present with symptoms related to compression, such as abdominal pain, nausea, vomiting or dyspepsia. Depending on the location and type of the lesion DD can also result in other complications, including pancreatitis, bowel obstruction, gastrointestinal bleeding, perforation and jaundice. Duodenal duplication cysts are usually treated with surgical resection, although endoscopic treatment has been reported especially in cases where the duplication is in close proximity to the major duodenal papillae. Material and methods: We report a case of a DD cyst, on the second portion of the duodenum, in a 24-year-old young lady referring to us for her third episode of acute pancreatitis. She complaining typical back pain and vomiting after meal, with elevations of pancreatic enzymes. The diagnosis of DD was suspcted by MRI abdominal imaging and upper GI endoscopic ultrasonography (video). Using a duodenoscope we performed an incision of the cyst. The initial puncture through the cyst roof was performed by using a needle-knife sphincterotome (video). The endoscopist used a regular sphincterotome to enlarge the incision through the cyst roof without immediate complications. Biopsies of the opposite wall of the cyst were made and results of histopathologic analysis showed benign duodenal mucosa, which confirmed the diagnosis. After three months from the procedure the patient is asymptomatic. Results: This current case illustrates that DD cyst can be adequately drained endoscopically, without recurrence at least during 3 month of follow-up. Conclusions: Endoscopic treatment is a viable and potentially preferable alternative to surgery for DD cyst.
V.01.2 ENDOSCOPIC ANTEROGRADE RENDEZ-VOUS FOR COMPLETELY OBSTRUCTED COLO-RECTAL ANASTOMOSIS (WITH VIDEO) F. Auriemma ∗ , R. Maselli, L. Poliani, P.A. Galtieri, A. Fugazza, G. Lollo, R. Semeraro, G. Amvrosiadis, M. Di Leo, S. Carrara, E.C. Ferrara, A. Anderloni, A. Spinelli, M. Montorsi, A. Repici Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic dilation is the treatment of choice for anastomotic colonic stenosis. There are only few reports in the literature of endoscopic management of completely obstructed colo-rectal anastomosis (no visible residual lumen). In most cases it requires combined surgical approaches, or more recently, an endoscopic lumen-apposing self-expandable metal stent placement. We describe a case of successful endoscopic management of a completely obstructed colonic anastomosis by using a combined en-
doscopic anterograde rendez-vous and retrograde transanal transillumination technique. Material and methods: This is the case of an 85-year-old male who had undergone a ultra-low anterior rectal resection with a loop ileostomy for a rectal carcinoma (pT3a N0) in June 2016. After three months, he developed a completely obstructed stricture with no histologic evidence of malignancy (Fig. 1). A combined anterograde-retrograde bowel and rectal barium enema showed a complete stricture, with a distance between the two lumens of about 10 mm (Fig. 2). Results: In September 2016 the rendez-vous technique was performed. The procedure consisted in an endoscopic access through the ileostomy up to colon side of the anastomosis. An endoscopic breach was obtained by cutting the wall with a needle knife, guided by transanal digital pressure and trans-illumination from the rectal side (Fig. 3). Then, a 0.035 guidewire was inserted through the breach (Fig. 4). Over the wire a mechanical dilation with Savary dilators up to 14 mm was performed, under endoscopic anterograde view.
No complications related to the procedure were registered. The patient underwent subsequent mechanical dilation and finally the intestinal reconnection was scheduled and performed. Conclusions: In literature there are only few reports of endoscopic treatment of completely obstructed colonic anastomosis and in the most of them balloon or mechanical dilation are performed. This rendez-vous technique has been described previously, requiring fluoroscopy or double endoscopic approach. In difficult cases, where a completely obstructed anastomotic strictures are encountered and a proximal access given by ileo or colostomy is present, a rendez-vous approach can be safely and effectively applied to obtain recanalization.
V.01.3 SINGLE STEP EUS-GUIDED FLUOROLESS GALLBLADDER DRAINAGE USING THE AXIOS SYSTEM LUMEN APPOSING METAL STENT C. Barbera ∗,2 , G. Grande 1 , N. Alberghina 2 , M. Manno 2 , C. Zulli 1 , R. Conigliaro 1 1 Gastroenterology
and Digestive Endoscopy Unit, NOCSAE Hospital, AUSL of Modena, Italy; 2 Gastroenterology and Digestive Endoscopy Unit, Carpi Hospital, AUSL of Modena, Italy Background and aim: Severe acute cholecystitis is a condition that