V.02.9 AN INDETERMINATE BILIARY STRICTURES ASSESSED USING THE NEXT GENERATION SPYGLASS DS SYSTEM: A VIDEO CASE

Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

presence of a large obstructive stone in the duodenal bulb, unable to be removed endoscopically even after pyloric dilation. To improve the obstructive symptoms, the patient underwent gastro-jejunal anastomosis with partial relief of the obstruction. In order to fragment the stone, we performed another endoscopic procedure. A laser Holmium YAG 30 W (HLS30W, Olympus GmbH) treatment was applied for a total of about 200 minutes which resulted in stone’s fragmentation into small parts removed by extraction basket and retrieval device. Results: The patient was discharged 15 days after with a complete resolution of the occlusive symptoms. The cholecystectomy was cancelled.

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irregular and ulcerated lesion was located in the distal common bile duct. Multiple targeted biopsies were then taken through the spyglass biopsies channel using a dedicated biopsies forceps. A 6 cm uncovered metallic stent was then placed. The histopathological analysis confirmed a pancreatic neoplasia involving the biliary duct. Conclusions: The next generation SpyGlass system appeared to be an useful and safe technique that allows the characterization of an indeterminate biliary stricture and it can be easily performed by one operator. In addition, the improvement of the images quality, compare to the previous generation of SpyGlass system, allows an accurate inspection of the biliary tract.

V.02.10 AN INNOVATIVE EVALUATION OF PANCREATIC CYSTS BY CONFOCAL LASER ENDOMICROSCOPY AND FIBER OPTIC LIGHTING DIRECT VISUALIZATION SYSTEM Gaia S.*, Bruno M., Ribaldone D.G., Fasulo R., Marietti M., De Angelis C. AUO Città della Salute e della Scienza, Gastroenterology and Endoscopy Unit, University of Turin, Turin, Italy

Conclusions: Holmium laser lithotripsy is safe and effective in the treatment of a large impacted gallstone in the duodenum.

V.02.9 AN INDETERMINATE BILIARY STRICTURES ASSESSED USING THE NEXT GENERATION SPYGLASS DS SYSTEM: A VIDEO CASE Murino A.*, Pedroni N., Pisanu R., Pinna R., Sanna P., Zaru S., Cugia L. Ospedale Civile SS Annunziata, Sassari, Italy Background and aim: Cholangiocarcinoma typically presents as biliary strictures; an accurate diagnosis is fundamental to address the best management. Although intraductal brushing during ERCP is the designated method for tissue sampling of biliary strictures, its sensitivity is low varying between of 27% to 56%. Spyglass system also known as Peroral cholangioscopy (POC) permits direct visualization and biopsies of the biliary tree for diagnostic procedures. The aim of this video case was to show the usefulness of the next generation of Spyglass system for the characterization of a indeterminate biliary stricture. Material and methods: A 70 years old male with a suspected lesion located in the head of the pancreas, identified at CT scan and associated with a biliary stricture underwent EUS and ERCP. At that time brush cytology and fine needle aspiration (FNA) were performed and a plastic biliary stent was successfully placed. Despite the improvement of the patient symptoms, a certain diagnosis was not made due to inconclusive results of brush cytology and FNA. After a few months, following the worsening of the patient conditions, a next generation of Spyglass system was performed during the ERCP in order to charachterise the indeterminate biliary stricture. Results: During the ERCP a clogged plastic biliary stent (Olympus double layer, 6cm 10 Fr) was identified in placed and removed using a polypectomy snare. Once the cholangiography was performed, a stricture located in the distal common bile duct was identified and dilated using a 12mm balloon dilatation. A SpyGlass assessment of the biliary tract was then successfully performed and an endophyting

Background and aim: Pancreatic cysts are a frequent diagnostic challenge. Endoscopic ultrasound (EUS) with Fine Needle Aspiration is often used for differential diagnosis, but both cytology and cystic fluid analysis are often inconclusive. Material and methods: We report a video showing the exploration of two different pancreatic cysts with both confocal laser endomicroscopy (CLE) probe by Cellvizio (AQ flex probe; Mauna Kea Technologies) and direct visualization by SpyGlass System (Boston Scientific). Case A: a 75-year-old woman presented with an incidentally discovered, 4 cm cyst of the pancreatic body identified on CT scan. Case B: a 45-year-old woman presented with a slightly growing 6 cm cyst of the pancreatic tail and two previous episodes of acute pancreatitis. On EUS exploration contrast enhanced thin peripheral septa were detected. The cysts were punctured with a 19 gauge Expect Flexible Needle (Boston Scientific) in which the CLE probe and SpyGlass optic fiber were introduced. Results: Macroscopic and microscopic images of the pancreatic wall are provided in the VIDEO and the utility of CLE and Spyglass is discussed comparing the diagnostic yield of these innovative procedures with cyst cytology and CEA/amylase levels in the cystic fluid. Conclusions: New promising devices are available to obtain a definite diagnosis of pancreatic cysts by direct endoscopic and microscopic exploration.

V.02.11 EUS GUIDED CISTO-GASTRIC DRAINAGE AFTER EUS-GUIDED GASTRO-GASTRIC ANASTOMOSIS TO TREAT A SIMPTOMATIC PANCREATIC PSEUDOCYST IN PATIENT WITH ROUX–EN-Y GASTRIC BY-PASS: THE DREAM BECAMES REALITY! Sica M.*, Manta R., Tringali A., Mutignani M. Surgical Digestive Diagnostic and Interventional Endoscopy, “Niguarda Ca’ Granda Hospital”, Milano, Italy Background and aim: From 10% to 15% of acute pancreatitis is complicated by pancreatic pseudocysts, which show spontaneous resolution in 50% of the cases. Treatment is indicated in symptomatic or complicated persistent pseudocysts. Drainage of pancreatic pseudocysts using endoscopic techniques is the current preferred method.