Aims The management of Mirizzi syndrome has been primarily surgical, ranging from cholecystectomy to en bloc resection with hepatico-jejunostomy for advanced Csendes III and IV types. The introduction of digital single-operator cholangioscopy (dSOC) allows for ductal clearance in patients with Mirizzi syndrome. Although small series have highlighted the feasibility of an endoscopic approach, there is a lack of comprehensive comparisons between surgical and endoscopic treatments. The objective of the current study is to compare the outcomes and safety of dSOC-guided lithotripsy with the surgical approach.

Rare malignant mesenchymal pancreatic tumors are systematized and reported in this review. The focus is on the appearance on imaging. The present overview summarizes the data and shows that not every pancreatic tumor corresponds to the most common entities of ductal adenocarcinoma or neuroendocrine tumor.

© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Primary sclerosing cholangitis (PSC) is a rare cholestatic disorder with a prevalence of 16.2 per 100 000 population. It is characterised by progressive inflammation and destruction of the intrahepatic and extraheptic bile ducts culminating in progressive fibrosis and cirrhosis. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC. bile ducts culminating in progressive fibrosis and cirrhosis. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC.

Rare malignant pancreatic lesions are systematically reported in this review. The focus is on the imaging appearance of the rare epithelial pancreatic tumors such as the solid pseudopapillary neoplasm, acinar cell carcinoma, rare subtypes of adenocarcinoma, and pancreatoblastoma as seen on ultrasound, EUS, and contrast-enhanced ultrasound or EUS. The present overview summarizes the data and shows that not every pancreatic tumor is likely to be the most common entities of ductal adenocarcinoma or neuroendocrine tumor.

Aims Single session EUS/ERCP for biliary stone disease has the advantages of obtaining immediate, real-time information from EUS, administering only one sedation for both diagnosing and treating biliary stones, and potentially avoiding an unnecessary ERCP in the event of a spontaneous passage of CBD stones. The objective of this study was to review the combined EUS-ERCP procedures for biliary stone disease and how it alters the proportion of patients undergoing subsequent ERCP. A secondary objective was to assess the imaging modalities that led to the ERCP request and any correlation between the EUS findings, liver function tests (LFTs), abdominal ultrasound (USS)/CT/MRCP findings and scan-to-ERCP time.

The focus of the review is on primary benign mesenchymal pancreatic tumors and their imaging appearance. These tumors are extremely rare. Usually, they are not diagnosed until postoperative histology is available, and so even benign tumors have undergone extensive pancreatic resection. The very limited data on abdominal and EUS findings including contrast-enhanced techniques of these pancreatic lesions are summarized here. Case reports will be presented for some of these rare tumors with application of modern ultrasound and endosonographic techniques.

In 2014, the British Society of Gastroenterology (BSG) published a standards framework outlining key performance indicators for ERCP practitioners and services. In the last 10 years there have been numerous changes to clinical practice yet there remains considerable variation in service delivery in the UK. In 2021 the BSG commissioned an ERCP endoscopy quality improvement project (EQIP) comprising members from all relevant stakeholding groups. This document draws from the results of a national survey of ERCP practitioners and units performed in 2022/23 supported by detailed stakeholder interviews. These results informed a draft document and series of statements that were revised at 2 group meetings and through several iterations. Each statement was included only after achieving 100% consensus from all participants. This service specification has set out 70 consensus statements covering the patient journey from booking to discharge and follow up, the members of the ERCP team, requirements for continued professional development and clinical governance, equipment and facilities and network provision and MDT working. This document describes the key components of a high quality and safe ERCP Service, seen from the patient’s perspective. It provides a detailed template for service delivery that should now be implemented by ERCP practitioners and units through the UK and should be used by ERCP providers and commissioners to benchmark services and guide continuous quality improvement.

Objectives: Standard endoscopic retrograde cholangiopancreatography (ERCP) sampling techniques for pancreaticobiliary malignancy have modest yields that could lead to delays in treatment. We evaluated whether combining EUS-guided tissue acquisition (EUS-TA) with ERCP improved time to first outpatient evaluation and treatment. Materials and Methods: All patients without a prior pathological diagnosis who underwent index ERCP at Leeds Teaching Hospitals NHS Trust, United Kingdom, for malignant distal biliary obstruction from 2015 to 2020 were considered. Results: A total of 292 patients were included, of whom 74.7% (n = 202) underwent EUS-TA/ERCP. A combined approach was more likely to establish a positive diagnosis (96.5% [n = 195] vs 57.8% [n = 52], P < 0.01) and less likely to require further sampling procedures (2.0% [n = 4] vs 17.8% [n = 16], P < 0.01). Mean times to first outpatient evaluation (16.9 vs 24.5 days [P = 0.01]) and oncological treatment (55.1 vs 79.3 days [P = 0.03]) were significantly shorter. A third (n = 86) of patients with a positive diagnosis did not receive oncological/surgical treatment. Conclusions: A combined approach was associated with improved yield and reduced time to evaluation/treatment, with similar success and adverse event rates. Careful multidisciplinary discussion is recommended to avoid performing unnecessary EUS procedures.