Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) placement may facilitate pancreatic fluid collections (PFC) drainages but data on related-adverse events, particularly bleeding, are limited. Few data suggest that a co-axial plastic double pig tail stent (DPS) might reduce bleeding risk. Primary aim was the feasibility, efficacy and safety of Hot Axios(Boston Scientific) in a series of patients undergoing PFC EUS-guided drainage. Second aim was to assess the efficacy of DPS placement into the LAMS in order to decrease bleeding.

A preliminary report involving 16 pts with LA PDAC showed that EUS-HTP was feasible and safe, with a 6-month post treatment survival. Aim of the study was to assess the outcomes of LA PDAC pts treated with chemotherapy±radiotherapy (CT±RT) plus EUS-HTP vs those receiving only CT±RT.

Background and study aims With common bile duct (CBD) stones, access to the CBD can be achieved through the papilla orifice followed by standard biliary sphincterotomy (SBS), or through precut fistulotomy (PF) in case of difficult cannulation. The two methods alter papilla anatomy differently, potentially leading to a different rate of stone recurrence. No data have been published on stone recurrence after PF in patients with CBD stones. The aim of this study was to evaluate CBD stone recurrence, reintervention rate after PF versus SBS, and complications. Patients and methods This was a retrospective single-center cohort study including patients undergoing for the first time endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones with PF in case of failed repeated cannulation attempts, matched for sex/age to patients with SBS randomly extracted from our database. T -test and Fisher's tests were used for continuous and categorical variable comparison. Recurrence probability was calculated with Kaplan-Meier curve. Factors associated with ERCP repetition were evaluated with logistic regression through a Cox's proportional hazards model. Results Eighty-five patients with PF were included, with 85 matched controls (mean age 68.7 years, 45.9 % males). Overall, patients with PF had the same reintervention rate as those with SBS (14.1 % vs. 12.9 %) with a hazard ratio (HR) of 1.11 (95 % CI 0.49 - 2.50; P = 0.81), but mean time to reintervention was significantly lower (74.9 +/- 74.6 vs. 765.6 +/- 961.3 days; P < 0.0001), with 100 % of stones recurring within the first year in the PF group vs. 54.5 % in the SBS group ( P = 0.01). The only factor associated with ERCP repetition risk was incomplete CBD clearing. Complications, including pancreatitis, did not differ significantly. Conclusions The reintervention rate was significantly higher in the short term after PF. Therefore, closer follow-up in the first 6 to 12 months after ERCP might be appropriate for patients underoing PF.

Literature data show a low sensitivity (30 – 50%) for endoscopic ultrasound (EUS) fine needle aspiration (FNA) in differential diagnosis of pancreatic cystic lesions (PCL).

Endoscopic Ultrasound (EUS) has recently shown the feasibility and efficacy of different local treatments for pancreatic tumors. Cryotherm ablation is a hybrid bipolar ablative technique, combining radiofrequency thermal injury with the cooling effect of a cryogenic gas. Although this approach has been evaluated in preliminary trials, data on radiological perspectives, to improve necrosis depiction and reduce patients discomfort and costs are still lacking. To evaluate differences in MDCT and DW-MRI imaging on tumor size and necrosis induced by the cryotherm treatment with HybridTherm (HTP) probe (ERBE Elektromedizin GmbH, Germany). We evaluated all the consecutive patients with stage III pancreatic adenocarcinoma presented at our tertiary referral center from February 2015 to October 2017. These pts were enrolled in an ongoing randomized controlled trial and belong to the chemotherapy+HTP treatment group. HTP ablation was conducted under deep sedation, up to 3 times at 1-month interval. Patients underwent MDCT and DW-MRI scan 72h after treatment and at T0 and 2, 4 and 6 months after treatment began. We assessed the difference in tumor and ablation size and volume between MDCT and DW-MRI. Data were considered for analysis only if both imaging techniques were available for the same date. The paired T-Test and the Wilcokson matched-pairs signed rank test were used for statistical analysis. 15 consecutive patients (8 M, mean age 63±11 years) underwent HTP treatment (mean 2.2 per pt) for locally advanced (11 pts) and borderline resectable (4 pts) disease in the study period. In 3 pts MRI was not feasible and they were excluded. A total of 41 MDCT and DW-MRI scans were identified. See tab.1 for details. We observed no difference in tumor size between MDCT and DW-MRI (p=0.816 for long axis and p=0.313 for short axis) as well as between DW-MRI and ADC-Map (p=0.120 and p=0.431, respectively). Linear regression analysis for the comparison of both MDCT/DW-MRI and MRI/ADC-Map showed a p=<0.001. We reported a significant difference between the CT and MRI size of the ablation zone, for both long and short axis (p=0.0029). EUS-guided tumor ablation is an effective treatment complementary to chemotherapy. This preliminary evaluation highlighted the agreement and correspondence of both MDCT and DW-MRI in the tumor evaluation, whereas a significant difference in the evaluation of ablation necrosis, suggesting that DW-MRI could be essential to increase necrosis detection in responder patients

Intraductal papillary mucinous neoplasms (IPMN) are mucin-producing, pancreatic cystic tumors, with a long-term potential for progression to adenocarcinoma. The Sendai criteria, based on imaging features, can differentiate the lesions into high and low risk of progression, influencing the patient management. However, few data are still available about clinical management and a better understanding in the natural history is critical.

INTRODUCTION:Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to diagnose pancreatic malignancies. Different EUS-FNA techniques have been described to improve sample quality. Recently, a new technique, using capillarity, has been proposed.AIM:To assess the quality of cytological samples, comparing two different FNA techniques, in order to optimize tissue acquisition.METHODS:All consecutive patients with solid pancreatic lesions, requiring an EUS-FNA, were included in the study between July and September 2013. All procedures were done under deep sedation. FNA was performed using a 25 gauge needle, using both capillary and aspiration technique. Patients were randomized to undergo firstly one or the other technique. Samples were evaluated "on site" by expert cytotechnologist. An expert cytopathologist, blinded for the technique used, reviewed the slides, for final diagnosis and assessed sampling quality. Quality of samples was evaluated through the assessment of the amount of blood, cellularity, tumoral versus normal cells ratio and adequacy for final diagnosis. Data were analyzed with Student's t-test and Chi-square test, assuming a significant P value of 0.05.RESULTS:A total of 30 consecutive patients (19 M, mean age 67.8 years) with an EUS finding of pancreatic solid lesion were included in the study. Cytological final diagnosis was adenocarcinoma in 25/30 (83.3%) cases, neuroendocrine tumor 1/30 (3.3%), intraductal papillary mucosal neoplasms with high-grade dysplasia 2/30 (6.7%), gastrointestinal stromal tumor in 1/30 (3.3%) and negative for malignant cells 1/30 (3.3%). The difference between the overall blood amount score per technique was not statistically significant (P = 0.61) as well as the cellularity score (P = 0.08). In 13/30 patients (43%) the two techniques reported concordant T/N ratio. In 6/30 patients (20%) final diagnosis was achieved only by capillary obtained smears. In 1/30 patients (3.3%) the diagnosis was done with aspiration. In the remnant, the ratio between the two techniques was similar. Adequacy was reached in 24/30 (80%) with aspiration and 29/30 (97%) with capillary technique (P = 0.04).CONCLUSIONS:Aspiration and capillary sampling techniques provided similar results in cellularity and blood amount. However, adequacy rate was significantly superior in capillary technique. Furthermore, in 20% of cases, final diagnosis was achieved only with capillary samples.