Endoscopic approach to benign biliary obstruction

AbstractDuring the past 30 years, the endoscopic approach to benign biliary strictures (BBS) became the preferred “mini-invasive” treatment modality for benign diseases. Endoscopic plastic or metallic stenting, and balloon dilation represent the gold standard treatment for BBS. Side-by-side insertion of multiple plastic stents is a very effective treatment option for BBS following cholecystectomy or liver transplantation. This strategy has a low recurrence rate on long-term follow-up, with better results than fully covered self-expandable metal stents (FC-SEMS). FC-SEMS seems to have an advantage and higher stricture resolution rate in patients with BBS secondary to chronic pancreatitis. Dilation of dominant biliary strictures in patients with primary sclerosing cholangitis has a lower rate of infective complications than the stenting treatment. Endoscopic retrograde cholangiopancreatography represents a safe and effective approach to BBS, with a very high success rate, especially when such cases are managed in a multidisciplinary setting

Covered self-expandable metal stents for pancreatic duct stricture: a systematic review and meta-analysis

Background and study aims Placement of a covered (C)-self-expandable metal stent (SEMS) has been recently investigated as an alternative endoscopic treatment for main pancreatic duct stricture (MPDS) in chronic pancreatitis. Our aim was to carry out a systematic review and meta-analysis of studies quantifying efficacy and safety of C-SEMSs in the management of MPDS.Methods A multiple database search was performed, including MEDLINE, Embase and Cochrane Library, from January 2000 to September 2020, to identify studies reporting the efficacy and safety of C-SEMSs in patients with MPDS. Stricture and pain resolution were investigated. Other outcomes included technical success, stent migration, stricture recurrence and need for repeated stent placement. Pancreatitis, severe abdominal pain requiring stent removal and de-novo stricture were recorded as complications.Results Nineteen studies were identified, which included a total of 300 patients. C-SEMSs showed a pooled stricture resolution rate of 91 % [95 % confidence interval (CI), 85 %-96 %] and a pooled pain resolution rate of 92 % (95 % CI, 85 %-98 %). The pooled proportion for stricture recurrence was equal to 6 % (95 % CI, 1 %-14 %), while stent migration occurred in 33 of 300 patients, the pooled proportion being 7 % (95 % CI 1 %-15 %). The pooled mean stent duration was 133 days (95 % CI, 100-166 days). The most common complication was pancreatitis (3 %, 95 % CI 0 %-8 %), while de-novo stricture pooled proportion was 2 % (95 % CI, 0 %-5 %).Conclusions C-SEMSs are effective and safe in the treatment of MPDS. However, there is a significant need for further high-quality, well-designed studies to produce evidence-based data on short and long-term efficacy, safety, costs of C-SEMSs, and also optimal stent duration

Endoscopic ultrasound-guided drainage of a fungal liver abscess using a lumen-apposing metal stent: case report and literature review

Abstract Liver abscesses are rare entities for which percutaneous drainage is traditionally employed. The technique is simple, but associated with a significant rate of side effects and patient discomfort. We herein report a case of fungal left liver lobe abscess that was successfully treated by using EUS-guided drainage, with insertion of a large caliber lumen-apposing metal stent. The literature review we performed on the topic seems to favor, at least for abscess in the left and/or caudate liver lobes, EUS as compared to percutaneous drainage

Robotics and Artificial Intelligence in Gastrointestinal Endoscopy: Updated Review of the Literature and State of the Art

Abstract Purpose of Review Gastrointestinal endoscopy includes a wide range of procedures that has dramatically evolved over the past decades. Robotic endoscopy and artificial intelligence are expanding the horizons of traditional techniques and will play a key role in clinical practice in the near future. Understanding the main available devices and procedures is a key unmet need. This review aims to assess the current and future applications of the most recently developed endoscopy robots. Recent Findings Even though a few devices have gained approval for clinical application, the majority of robotic and artificial intelligence systems are yet to become an integral part of the current endoscopic instrumentarium. Some of the innovative endoscopic devices and artificial intelligence systems are dedicated to complex procedures such as endoscopic submucosal dissection, whereas others aim to improve diagnostic techniques such as colonoscopy. Summary A review on flexible endoscopic robotics and artificial intelligence systems is presented here, showing the m3ost recently approved and experimental devices and artificial intelligence systems for diagnosis and robotic endoscopy

Surgical data science for safe cholecystectomy: a protocol for segmentation of hepatocystic anatomy and assessment of the critical view of safety

Minimally invasive image-guided surgery heavily relies on vision. Deep learning models for surgical video analysis could therefore support visual tasks such as assessing the critical view of safety (CVS) in laparoscopic cholecystectomy (LC), potentially contributing to surgical safety and efficiency. However, the performance, reliability and reproducibility of such models are deeply dependent on the quality of data and annotations used in their development. Here, we present a protocol, checklists, and visual examples to promote consistent annotation of hepatocystic anatomy and CVS criteria. We believe that sharing annotation guidelines can help build trustworthy multicentric datasets for assessing generalizability of performance, thus accelerating the clinical translation of deep learning models for surgical video analysis.Comment: 24 pages, 34 figure

Linearly chirped fiber Bragg grating response to thermal gradient: from bench tests to the real-time assessment during in vivo laser ablations of biological tissue

The response of a fiber optic sensor [linearly chirped fiber Bragg grating (LCFBG)] to a linear thermal gradient applied on its sensing length (i.e., 1.5 cm) has been investigated. After these bench tests, we assessed their feasibility for temperature monitoring during thermal tumor treatment. In particular, we performed experi- ments during ex vivo laser ablation (LA) in pig liver and in vivo thermal ablation in animal models (pigs). We investigated the following: (i) the relationship between the full width at half maximum of the LCFBG spectrum and the temperature difference among the extremities of the LCFBG and (ii) the relationship between the mean spectrum wavelength and the mean temperature acting on the LCFBG sensing area. These relationships showed a linear trend during both bench tests and LA in animal models. Thermal sensitivity was significant although different values were found with regards to bench tests and animal experiments. The linear trend and significant sensitivity allow hypothesizing a future use of this kind of sensor to monitor both temperature gradient and mean temperature within a tissue undergoing thermal treatment

Endorotor-Based Endoscopic Necrosectomy as a Rescue or Primary Treatment of Complicated Walled-off Pancreatic Necrosis. A Case Series.

Direct endoscopic necrosectomy (DEN) is a cumbersome, time-consuming procedure that can be necessary in cases of infected pancreatic walled-off necrosis (WON) not responding to endoscopic ultrasound (EUS)- guided drainage only. Until now, DEN has been performed with non-dedicated devices, thus requiring multiple, long-lasting sessions to achieve adequate clearance of necrotic content. These results in prolonged hospital stay, increased costs and have potential consequences for patients who must undergo multiple endoscopic interventions under sedation. We report four cases of DEN performed in patients with WON after EUS-guided drainage with the Endorotor system, a new morcellator device specifically designed to perform the procedure