Background/Aims Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled‐off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen‐apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta‐analyses head‐to‐head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Methods We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta‐analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Results Thirteen studies were included in the meta‐analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty‐three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P = .986, RR = 1.00 [95% CI 0.93‐1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P = .139, RR = 1.063 [95% CI 0.98‐1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P = .009, RR = 0.746 [95% CI 0.60‐0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P = .05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P = .640). Conclusion The PFCs drainage is an indication when persistent symptoms or PFCs‐related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.

Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

No abstract

Objective Pancreatic stones result from chronic pancreatitis and can occur in the main pancreatic duct, pancreatic branches or parenchyma. Although extracorporeal shock wave lithotripsy (ESWL) is considered the first‐line treatment, per‐oral pancreatoscopy (POP) has emerged as a useful method for treating pancreatic stones. The aim of this systematic review and meta‐analysis was to determine the efficacy and safety of POP‐guided lithotripsy, electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL), in patients with pancreatolithiasis. Methods Literature review was conducted in PubMed, OVID, MEDLINE and Cochrane Library databases for studies published up to August 2020. Results Altogether 15 studies were analyzed, of which 11 were retrospective and four were prospective. The studies comprised 370 patients, of whom 66.4% were male. The patients underwent 218 EHL and 155 LL. The pooled technical and clinical success rate of the overall POP was 88.1% and 87.1%. For EHL‐POP, the pooled technical success rate was 90.9% (95% CI 87.2%‐95.2%) and the pooled clinical success rate was 89.8% (95% CI 87.2%‐95.2%). While for LL‐POP, the pooled technical and clinical success rate was 88.4% (95% CI 85.9%‐95.1%) and 85.8% (95% CI 80.6%‐91.6%). In total 43 adverse events occurred (12.1%; 95% CI 8.7%‐15.5%). Conclusion POP‐guided lithotripsy has a high rate of technical and clinical success for managing pancreatolithiasis with a low complication rate. Both EHL‐POP and LL‐POP achieve similar efficacy in the endoscopic therapy of pancreatolithiasis. Further large randomized controlled trials are needed to compare EHL‐POP and LL‐POP with ESWL and evaluate whether POP may replace ESWL as the first‐line management of pancreatolithiasis.

An 82-year-old woman was referred for endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. After cannulation of the pancreatic duct, transpancreatic sphincterotomy and placement of a 5-fr stent in the pancreas were performed. A fully covered self-expandable metal stent was placed because of persistent post-biliary sphincterotomy bleeding. The next day, the patient showed melena, hematemesis, and decreased hemoglobin levels. A gastroscopy was performed and active oozing bleeding from the papilla was evident. Injection therapy with epinephrine and hemoclips was performed. A few hours later, a new episode of hematochezia occurred. Repeat endoscopy showed persistent active bleeding from the papilla (▶ Fig. 1). Hemostatic powder (Hemospray; Cook Medical,

Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy An 89-year-old woman presented to our department having experienced acute cholecystitis a few weeks previously. Her comorbidities, chronic kidney disease, and congestive heart failure meant she was not a suitable candidate for surgery. She underwent EUS-guided gallbladder drainage, which was performed without complications. During this procedure, a 10-mm × 10-mm lumen-apposing metal stent (LAMS) (Hot Axios; Boston Scientific) was implanted for gallbladder drainage. A few days later, the patient complained of right-upper quadrant abdominal pain and fever, and a new acute cholecystitis episode was diagnosed.

Objective: To evaluate the relation between gastric H. pylori infection and dyslipidemia. Methods: Eligible subjects were all adult; we enrolled those patients with dyspepsia who had undergone esophagogastroduodenoscopy. They were divided in 2 groups: Case group: patients who have a histologic diagnosis of infection for H. pylori. Control group: Patients who had previous negative biopsy for H. pylori. All patients had basic serology and lipid profiles, both groups were compared. Results: 120 patients were evaluate, 63 were female (52.5%). Of 77 patients with dyslipidemia, 40 were positive H. pylori (51.9%), and 20 of 43 non -dyslipidemic patients were positive H. pylori (46.5%). Cholesterol values were 196.6 ± 42.

Background and study aims Approximately 11 % of biliary cannulations are considered difficult. The double guidewire (DGW-T) and transpancreatic sphincterotomy (TPS) are two useful techniques when difficult cannulation exists and the main pancreatic duct is unintentionally accessed. We carried out a systematic review and meta-analysis to evaluate the effectiveness and security of both DGW-T and TPS techniques in difficult biliary cannulation. Methods We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. Were included all RCT which showed a comparison between TPS and DGW in difficult biliary cannulation. Endpoints computed were successful cannulation rate, median cannulation time, and adverse events rate. Results Four studies were selected (4 RCTs). These studies included 260 patients. The mean age was 64.79 ± 12.99 years. Of the patients, 53.6 % were men and 46.4 % were women. The rate of successful cannulation was 93.3 % in the TPS group and 79.4 % in the DGW-T group (P = 0.420). The rate of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) was lower in patients who had undergone TPS than DGW-T (TPS: 8.9 % vs DGW-T: 22.2 %, P = 0.02). The mean cannulation time was 14.7 ± 9.4 min in the TPS group and 15.1 ± 7.4 min with DGW-T (P = 0.349). Conclusions TPS and DGW are two useful techniques in patients with difficult cannulation. They both have a high rate of successful cannulation; however, the PEP was higher with DGW-T than with TPS.