BACKGROUND AND AIMS:Pancreas divisum (PD) is a congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic minor papilla sphincterotomy (MiES) is the most common procedure performed in the management of PD-related ARP. The aim of this study is to perform a meta-analysis estimating the efficacy and the safety of MiES in the management of patients with PD-related ARP. METHODS:A research was performed in Pubmed, EMBASE and Web of science, the studies were reviewed and selected according to inclusion and exclusion criteria. Evaluation of Heterogeneity and publication bias was performed, and a random effect model was used to estimate the effect size of each study. RESULTS:One hundred and thirteen articles were selected and reviewed, 13 met the inclusion criteria. All the studies were retrospective with a mean follow-up duration of 45.9 months. A total of 323 patients with PD-related ARP treated with MiES were included in the meta-analysis. The overall clinical success rate of MiES (defined as no further episodes of ARP, reduction of episodes of ARP, or improvement in quality of life) was of 77% (95%CI: 72%-81%; p = 0.30). Evaluating only the studies with clinical success rate defined as "no further AP in the follow-up" the clinical success rate was of 69.8% (95%CI: 61.3%-77.2%; p = 0.57), while evaluating the studies with other definitions (reduction of episodes of ARP or improvement in quality of life) the clinical success rate was of 81.2% (95%CI: 75.2%-86.1%; p = 0.45). The common fixed effects model disclosed a 25.5% overall adverse events rate (95%CI: 19.3%-32.8%; p = 0.42): acute pancreatitis in 14.3% (95%CI: 9.7%-20.6%; p = 0.36), bleeding in 5.6% (95%CI: 2.9%-10.4%; p = 0.98), and other adverse events in 5.6% (95%CI: 2.9%-10.4%; p = 0.67). CONCLUSION:MiES is an effective and relatively safe treatment in the management of PD-related ARP. The retrospective nature of the studies selected is the main limitations of this metanalysis. Prospective trials are needed to confirm these data.

Aims Per-Oral Endoscopic Myotomy (POEM) was introduced in clinical practice few years ago, and quickly become one of the first line treatments of esophageal motility disorders. We report on the outcomes of the first 1000 patients treated with POEM in a single tertiary referral center during 11 years.

Aims Data of the long-term outcomes of ERCP to detect cholangiocarcinoma and treat dominant strictures in Primary sclerosing cholangitis (PSC) are scarce.

Aims Anastomotic dehiscence and leaks, though infrequent, represent serious complications in surgical procedures, often leading to increased morbidity and mortality. Advance in endoscopy have sought to resolve these complications with different techniques. One of them is EndoVacuum Therapy (EVT), indicated to drain collections and close perforations, having promising results with a low adverse event rate [1], despite prolonging the hospitalization and increasing costs.

Aims Biliary adverse events manifest in approximately 25% of liver transplant recipients. Among these, anastomotic biliary strictures (ABS) are the most prevalent, occurring in approximately 6%-12% of cases and can be successfully managed endoscopically. Our study aims to present the evolution of method and long-term results of placing multiple plastic stents to treat ABS after orthotopic liver transplantation (OLT).

Aims The aim of this study is to perform a case-control study to evaluate the risk for post-ERCP pancreatitis (PEP) in post-liver transplantation (LT) patients

Text A 72-years-old male presented with a complete hypopharyngeal stenosis following laryngeal cancer surgery and radiotherapy. Balloon dilatations and endoscopic ultrasound-guided recanalization failed, so a magnetic compression anastomosis was attempted. A magnetic ring was placed at the distal side of the stenosis through the gastrostomy site while another magnetic ring was inserted through the mouth. The procedure was successfully completed, the patient was discharged after 24 hours, magnets were expelled after 11 days, and, following regular balloon dilations, was able to eat after 3 months. This is the first report of endoscopic magnetic compression anastomosis to treat a complete hypopharyngeal stenosis in adults.

Text A 74 year-old lady underwent endoscopic papillectomy. At the end of en-bloc resection severe bleeding occurred. A 25-gauge needle was advanced to perform a submucosal injection of diluted epinephrine (1:10000). The presence of abundant amount of blood in the duodenum reduced the visibility and an excessive pression on the needle tip led to duodenal wall perforation. Two 16 mm endoclips were placed and promptly closed the duodenal wall defect. The patient was referred for urgent CT scan, confirming the presence of free air in the retroperitoneum. After 7 days a control CT scan showed reduction of the retropeumoperitoneum without collections. Clinical course was uneventful. The patient is free of recurrence after 2 year.

Aims The aim of this study is to report the experience of a high-volume endoscopy center in the use of single-use EXALT Model D duodenoscope (Boston Scientific Corporation, USA).

Background: Acute recurrent pancreatitis (ARP) is a rare manifestation of Intraductal Papillary Mucinous Neoplasms (IPMN) of the pancreas; ARP is a relative indication for pancreatic surgery in the setting of IPMN. Endoscopic pancreatic sphincterotomy (EPS) has been described as a minimal invasive treatment to reduce the episodes of ARP secondary to mucus migration in IPMN.Methods: patients with IPMN-related ARP treated with ESP from January 2004 to December 2020 were retrospectively selected. Clinical and technical data were recorded. A clinical follow-up (minimum 12 months) was performed to assess the number of episodes of AP occurring after EPS.Results: 25 patients were included. The mean follow-up after ESP was 93.4 months (SD +/- 56.6). The mean number of AP before and after EPS were respectively 3.29 (SD +/- 1.04) and 0.51 (SD +/- 0.71). A complete response (no further episodes of AP) and a partial response ( > 50% reduction of AP episodes) were ob-tained in 64% and 24% of the cases, respectively, with an overall response rate of 88%. One post-EPS bleeding and one minor-papilla stenosis were reported and were endoscopically managed. Two patients underwent pancreatic resection for the occurrence of high-risk stigmata for cancer progression.Conclusions: EPS is a safe and effective treatment to reduce the number of episodes of AP in selected patients with IPMNs-related ARP. Prospective trials are needed to confirm these data.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Text A 35 years-old woman was admitted to our endoscopy unit for rectal bleeding. The patient had a diagnosis of cervix adenocarcinoma treated with radiotherapy, complicated by colic perforation. An emergency Hartmann’s procedure with colic resection, rectal stump closure, and terminal colostomy was performed. The rupture of the right internal iliac artery occurred and was treated with the placement of a vascular stent. The rectoscopy revealed a foreign body in the blind end of the rectal stump. A CT scan confirmed the complete migration of the vascular stent between the rectum and a contiguous chronic pelvic collection.

Benign biliary stenosis (BBS) can be caused by a variety of etiologies, including post-operative injuries (i.e., post-cholecystectomy, liver transplantation), chronic pancreatitis, chronic cholangiopathies and traumas.

Aims Peroral endoscopic myotomy (POEM) is a fascinating procedure for the treatment of patients with esophageal motility disorders, but it is known to be associated with an high risk of post-operative gastroesophageal reflux (GERD). Aims of this study are to evaluate the incidence of iatrogenic GERD and to identify possible associations with preoperative, perioperative and postoperative factors.

Endoscopic transpapillary biopsy under fluoroscopic control is a well-established method for tissue sampling in the case of biliary stenosis during endoscopic retrograde cholangiopancreatography (ERCP). Nevertheless, some adverse events and technical challenges, especially in proximal strictures, have been reported [1]. Cholangioscopy-guided biopsy remains an expensive, niche technique with small-sized forceps, making histological analysis difficult [2]. Finding a safe, cost-effective technique for histology remains a challenge. Herein we report a new technique for transpapillary biopsy using a biliary dilation catheter.

Aims Endoscopic Sleeve Gastroplasty (ESG) is a restrictive endoscopic bariatric procedure providing excellent results in the recent years (16% TBWL at 6 months, 1.1% complications). As every endoscopic procedure, ESG is repeatable. In this short case series, we analyze the technical aspects and short-term outcomes of the re-do ESG.

A 52-year-old patient was referred for esophageal perforation after vomiting initially treated with surgery without success and thoracic drainage. Esophagogastroscopy showed a 5-cm long rupture in the lower esophageal wall, resulting in a 5 × 5 cm purulent cavity. Under endoscopic and fluoroscopic guidance, 9 sessions of Esosponge placement (11 sponges) were performed, firstly applied inside the collection and finally inside the esophageal lumen due to reduction of the perforation’s caliber. During 2 sessions double sponges were inserted simultaneously into the cavity. Final esophagogastroscopy and barium contrast radiography showed a small residual pseudodiverticulum. The patient returned to oral nutrition and fully recovered.