BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) still has a relatively high complication rate, underscoring the importance of high-quality training. Despite existing guidelines, real-world data on training conditions remain limited. This pan-European survey aims to systematically explore the perceptions surrounding ERCP training. METHODS: A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs. RESULTS: Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%). CONCLUSIONS: The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.
- MeSH
- Cholangiopancreatography, Endoscopic Retrograde * standards adverse effects MeSH
- Adult MeSH
- Gastroenterology * education MeSH
- Clinical Competence standards MeSH
- Middle Aged MeSH
- Humans MeSH
- Surveys and Questionnaires statistics & numerical data MeSH
- Education, Medical, Graduate * standards methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Keywords
- perkutánní transhepatická drenáž, perkutánní transhepatická cholangiografie,
- MeSH
- Biliary Tract Surgical Procedures * methods MeSH
- Cholangiography methods MeSH
- Cholestasis surgery MeSH
- Drainage * methods MeSH
- Informed Consent MeSH
- Radiography, Interventional methods MeSH
- Humans MeSH
- Postoperative Care MeSH
- Bile Ducts, Intrahepatic surgery diagnostic imaging MeSH
- Check Tag
- Humans MeSH
Stenózy biliární anastomózy patří mezi nejčastější biliární komplikace u pacientů po transplantaci jater. Biliární komplikace jsou spojeny s vyšší letalitou, morbiditou, rizikem selhání funkce štěpu a k léčbě vyžadují zpravidla opakované endoskopické intervence s pravidelnou výměnou stentů. Biodegradabilní stenty jsou novými typy stentů z bio degradabilních polymerů, jejichž hlavní výhodou může být snížení počtu endoskopických intervencí a s nimi spojených komplikací. Cílem našeho článku byl popis případů dvou pacientů po transplantaci jater s časně zjištěnou stenózou biliární anastomózy, která byla řešena endoskopickým zavedením bio degradabilních stentů. V obou případech bylo endoskopické zavedení stentu technicky dobře proveditelné a nevyskytly se žádné periprocedurální ani postprocedurální komplikace. Klinický průběh a kontrolní zobrazení po 8 měsících svědčily pro regresi stenózy u obou pacientů.
Biliary anastomotic strictures are one of the most common biliary complications in patients after liver transplantation. Biliary complications are associated with higher mortality, morbidity, risk of graft failure and usually require repeated endoscopic interventions with regular stent replacement for treatment. Biodegradable stents are new types of stents made of bio degradable polymers, which may have the main advantage of reducing the number of endoscopic interventions and associated complications. The aim of our article was to describe the cases of two patients after liver transplantation with early biliary anastomotic strictures, which were resolved by endoscopic placement of bio degradable stents. In both cases, endoscopic stent placement was technically feasible and there were no periprocedural or postprocedural complications. The clinical course and fol low-up imaging at 8 months showed regression of the strictures in both patients.
- Keywords
- benigní biliární stenózy,
- MeSH
- Anastomosis, Surgical * methods MeSH
- Cholangiopancreatography, Endoscopic Retrograde methods MeSH
- Cholestasis * etiology MeSH
- Diagnostic Imaging methods MeSH
- Humans MeSH
- Postoperative Complications MeSH
- Aged MeSH
- Stents * standards MeSH
- Liver Transplantation adverse effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Nedávné zavedení WHO klasifikace cytologie pankreatobiliárních nádorů si kladlo za cíl zlepšit diagnostiku a management těchto tumorů. V předkládané práci jsou stručně popsány metody diagnostiky těchto tumorů. Důraz je pak kladen na detailní srovnání předešlé klasifikace dle Papanicolaou a nové WHO klasifikace a změny, které zavedení WHO klasifikace přivádí. V poslední části článku pak přinášíme konkrétní zajímavé případy z naší praxe ilustrující možná diagnostická úskalí cytologického hodnocení.
The recent introduction of the WHO cytology classification of pancreatobiliary tumours aimed to improve the diagnosis and management of these tumours. The present paper briefly describes the methods of diagnosis. Emphasis is then put on a detailed comparison of the previous Papanicolaou classification and the new WHO classification and description of the changes brought about by the introduction of the WHO classification. In the last part of the paper, we present interesting cases from our practice illustrating possible diagnostic pitfalls of cytological evaluation.
- MeSH
- Cholangiopancreatography, Endoscopic Retrograde methods MeSH
- Cytological Techniques methods MeSH
- Diagnostic Imaging methods MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Pancreatic Neoplasms * diagnosis pathology MeSH
- Biliary Tract Neoplasms * diagnosis pathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Keywords
- pankreatoskopie,
- MeSH
- Cholangiopancreatography, Endoscopic Retrograde MeSH
- Endosonography MeSH
- Middle Aged MeSH
- Humans MeSH
- Lecithin Cholesterol Acyltransferase Deficiency diagnostic imaging MeSH
- Pancreas * diagnostic imaging pathology MeSH
- Pancreatectomy MeSH
- Pancreatitis complications MeSH
- Pancreatic Ducts diagnostic imaging pathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Anastomosis, Surgical methods instrumentation MeSH
- Digestive System Surgical Procedures methods instrumentation MeSH
- Cholangiopancreatography, Endoscopic Retrograde methods instrumentation MeSH
- Diagnostic Techniques, Digestive System instrumentation MeSH
- Gastroenterology * methods instrumentation MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
Migrace pankreatobiliarního stentu není častá komplikace, většinou bez závažných následků, ale někdy způsobující perforace střeva. Autoři popisují migraci DB stentu do sigmoidea s následnou zcela asymptomatickou perforací stěny střeva. Vzhledem ke klinickému stavu a věku pacientky byla perforace úspěšně řešena endoskopicky.
Pancreatobiliary stent migration is not a common complication, mostly without serious consequences, but sometimes causing intestinal perforation. The authors describe migration of the DB stent into the sigmoid with subsequent completely asymptomatic perforation of the bowel wall. Due to the patient’s clinical condition and age, the perforation was successfully treated endoscopically.
- Keywords
- biliarní stent,
- MeSH
- Cholangiopancreatography, Endoscopic Retrograde * adverse effects MeSH
- Cholangitis therapy MeSH
- Endoscopes, Gastrointestinal MeSH
- Humans MeSH
- Intestinal Perforation surgery etiology MeSH
- Aged, 80 and over MeSH
- Stents adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
1: ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2: ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3: ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4: ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5: ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6: ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7: ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8: ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.
[A rare cause of biliary obstruction - a case study]
Prezentujeme kazuistiku 47leté ženy s cholecystolitiázou, u které bylo v rámci diagnostiky obstrukčního ikteru zjištěno solidně-cystické subhepatální ložisko s útlakem žlučových cest. Po doplnění zobrazovacích metod (UZ, CT, MR) a endoskopické retrográdní cholangiopankreatikografii (ERCP) s drenáží žlučových cest duodenobiliárním stentem byla pacientka přímo indikována k resekčnímu výkonu, předoperačně byla zvažována především mucinózní neoplazie žlučových cest či jejich cystická anomálie. Při operaci byla provedena resekce ložiska společně s přilehlým žlučníkem a žlučovými cestami. Histologie z resekátu překvapivě prokázala nenádorovou afekci – adenomyomatózu extrahepatálních žlučových cest.
We present a case study of a 47-year-old woman with cholecystolithiasis, in whom a diagnostic examination showed a solid-cystic lesion in the subhepatic region, oppressing the biliary tract. After completing examinations with imaging techniques (ultrasound, CT, MR) and endoscopic retrograde cholangiopancreatography (ERCP) with biliary drainage through a duodeno-biliary stent, the patient was directly indicated for a resection. Mucinous neoplasia of the biliary tract or cystic anomalies were considered as possible diagnoses prior to the surgery. The lesion was resected together with the adjacent gallbladder and biliary ducts. Surprisingly, the histological examination of the resected tissue showed a non-tumorous affection – adenomyomatosis of extrahepatic biliary ducts.
- MeSH
- Adenomyoma surgery diagnosis MeSH
- Cholangiopancreatography, Endoscopic Retrograde MeSH
- Cholestasis * diagnostic imaging MeSH
- Diagnosis, Differential MeSH
- Middle Aged MeSH
- Humans MeSH
- Treatment Outcome MeSH
- Gallbladder surgery pathology MeSH
- Bile Ducts, Extrahepatic surgery pathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
1: ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2: ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3: ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4: ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5: ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6: ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7: ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8: ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence.
