The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis.

INTRODUCTION: conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. OBJECTIVE: to evaluate the influence of case volume on ERCP outcomes. PATIENTS AND METHODS: an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. RESULTS: a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4 % vs 93.3 % vs 93 % (p = 0.037). The AE rate was 13.8 %, 12.6 % and 10.3 % (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5 %, 7.3 % and 5 % (p = 0.01). The rate of complex procedures was 12 %, 14.8 % and 27 % (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. CONCLUSION: a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.

Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures.

OBJECTIVE: Despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). DESIGN: A prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. RESULTS: An initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. CONCLUSION: Implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.

Accuracy of fecal calprotectin for the prediction of endoscopic activity in patients with inflammatory bowel disease.

BACKGROUND: Fecal calprotectin is a noninvasive marker of inflammatory bowel disease. AIM: To evaluate the accuracy of calprotectin for prediction of endoscopic activity in inflammatory bowel disease. METHODS: One-hundred patients were prospectively included. Quantum Blue® (Bühlmann) kits were used to determine calprotectin. Endoscopic activity was calculated. Various serum markers (platelets, leukocytes, C-reactive protein, and albumin) were recorded. RESULTS: Calprotectin was higher in patients with endoscopic activity than in those without activity: in ulcerative colitis, with the low- (29 ±â€¯14 vs. 301 ±â€¯174, p < 0.001) and high- (99 ±â€¯727 vs. 617 ±â€¯801, p < 0.001); and in Crohn's disease, with the low- (29 ±â€¯59 vs. 124 ±â€¯268, p < 0.01) and high-range kit (99 ±â€¯37 vs. 287 ±â€¯607, p < 0.01). Serological marker concentrations did not vary with endoscopic activity. The area under the ROC curve of calprotectin for the prediction of endoscopic activity was 0.9 in ulcerative colitis and 0.8 in Crohn's disease. The best cut-off points for the detection of activity in ulcerative colitis were 50 for the low- (sensitivity 85%, specificity 79%) and 102 for the high- (sensitivity 85%, specificity 79%); in Crohn's disease, 54 for the low- (sensitivity 71%, specificity 75%) and 122 for the high-range kit (sensitivity 71%, specificity 75%). CONCLUSIONS: Fecal calprotectin concentration has good diagnostic accuracy for the detection of endoscopic activity in inflammatory bowel disease and performs better in ulcerative colitis than in Crohn's disease.

El volumen de CPRE por endoscopista se asocia a mayor tasa de éxito y menor tasa de pancreatitis post-CPRE. Análisis de un registro prospectivo / The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis

Introducción: la influencia del volumen anual de colangiopancreatografía retrógrada endoscópica (CPRE) en sus resultados ha sido analizada con resultados contradictorios.Objetivo: evaluar la influencia del volumen de CPRE en sus resultados. Material y métodos: análisis sobre base de datos prospectiva comparando los resultados de la CPRE en tres periodos definidos por el número de endoscopistas que la realizan: periodo I, con cinco endoscopistas; periodo II, con cuatro; y periodo III, con tres. Incluimos CPRE biliar en papila acce sible y virgen. Las variables principales fueron las tasas de canulación y los efectos adversos. Los grados de complejidad III y IV, según la clasificación de la Sociedad Americana de Endoscopia Digestiva (ASGE, por sus siglas en inglés), se consideraron procedimientos de alta complejidad. Resultados: fueron incluidos 2.561 pacientes: 727 (periodo I), 972 (periodo II) y 862 (periodo III). No hubo diferencias en edad y sexo entre grupos (p > 0,05). La tasa de canulación fue significativamente mayor en los periodos II y III: 92,4 % vs. 93,3 % vs. 93 % (p = 0,037). La tasa de efectos adver sos (EA) fue de 13,8 %, 12,6 % y 10,3 % (p > 0,05). La tasa de pancreatitis post-CPRE fue significativamente menor en el periodo III: 8,5 %, 7,3 % y 5 % (p = 0,01). El porcentaje de procedimientos de alta complejidad fue de 12 %, 14,8 % y 27 % (p < 0,0001), respectivamente. La regresión logística mostró tasas de canulación y pancreatitis post-CPRE significativamente mejores en el periodo III tras ajustar por sexo, complejidad y endoscopista. Conclusión: un mayor volumen anual de CPRE por endoscopista se asoció con mayor tasa de canulación y menor tasa de pancreatitis post-CPRE, a pesar de la mayor complejidad de los procedimientos. Estos efectos beneficiosos parecen diferir entre endoscopistas(AU)

Pancreatitis aguda como complicación fatal de la quimioembolización de un carcinoma hepatocelular / Acute pancreatitis as fatal complication after chemoembolization of hepatocellular carcinoma

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