Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Dysphagia and respiratory complications are the major problems in patients suffering from malignant strictures of the cervical esophagus. In inoperable cases, interventional palliation is the cornerstone of treatment. The aim of this study was to evaluate the use of self-expanding plastic stents (SEPS) in this group of patients. In a retrospective study, 23 patients suffering from various malignant obstructive diseases of the cervical esophagus, including squamous cell carcinoma (n = 10), laryngeal cancer (n = 7), lung cancer with esophageal invasion (n = 5), and metastatic breast cancer (n = 1), underwent SEPS placement, under endoscopic and fluoroscopic guidance. Tracheoesophageal fistula was documented in five patients. Technical success rate, improvement of dysphagia grade, and stent-related complications were evaluated after stent placement. Stent insertion was successfully achieved in all cases, namely in 20 patients at the first stent placement attempt and in three patients after a second attempt. Dysphagia grade was notably improved after 24 h. In two cases, major complications occurred. These were successfully treated without the need of stent extraction. Barium swallowing studies demonstrated complete sealing of all fistulas. Foreign-body sensation that gradually disappeared within the first week after stent placement was observed in eight patients. Recurrence of dysphagia occurred in three patients, due to hyperplastic tissue proliferation (n = 2) and tumor overgrowth (n = 1). Late migration of the stent was detected in one case after 67 days. SEPS placement is an effective and safe palliative treatment for malignant strictures of the cervical esophagus. Main advantages include easy retrievability and reduced rates of reinterventions.

Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder-Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.

BackgroundEndoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events.MethodsIn the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts.ResultsA total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications.ConclusionESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.

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Background & Aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aim to compare the three endoscopic techniques. Methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion from several tertiary care centers were included in a dedicated registry over three years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events, duration of hospital stay and follow up data were collected. Results 96 patients were included (47.7% M, mean age 62): STER n=34, EFTR n=34, LECS n=280. The lesions included leiomyoma, GIST and other. The mean lesion size was 28mm (STD 16, range 20-72mm). The majority of lesions in the EFTR and laparoscopic assisted resection group were GISTs. There was no significant difference in clear resection margins, post procedure complication rates, recurrence rate and total follow up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR (p<0.01). Total hospital stay for the laparoscopic assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) (p value<0.01). Conclusion STER, EFTR, and laparoscopic assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and adverse event rates. Laparoscopic assisted resection appears more time consuming and is associated with a longer hospital stay.

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