Interobserver Agreement in Dysplasia Grading of Intraductal Papillary Mucinous Neoplasms: Performance of Kyoto Guidelines and Optimization of Endomicroscopy Biomarkers through Pathology Reclassification.

Background And Aims: Interobserver agreement (IOA) among pancreaticobiliary (PB) pathologists in evaluating high-grade dysplasia and/or invasive carcinoma (HGD-IC) of IPMNs remains understudied. EUS-guided needle-based confocal endomicroscopy (nCLE) can evaluate papillary architecture in branch-duct (BD)-IPMNs. We assessed IOA among PB pathologists in classifying dysplasia in resected IPMNs and compared the performance of the Kyoto guidelines' high-risk stigmata (HRS) and pre-surgical EUS-nCLE against reclassified pathology.

Endoscopic ultrasound (EUS)-guided gastrojejunostomy for management of superior mesenteric artery (SMA) syndrome.

The mainstay of treatment for superior mesenteric artery (SMA) syndrome involves aggressive enteral feeding distal to the area of obstruction. We present a case of palliative endoscopic ultrasound (EUS)-guided gastrojejunostomy as management of SMA syndrome in a patient with concomitant metastatic pancreatic adenocarcinoma. Following the procedure, our patient demonstrated significantly improved tolerance of oral intake.

Diagnosis and treatment of a biliary fistula to walled-off pancreatic necrosis.

Video 1Visualization and treatment of a biliary fistula into a walled-off pancreatic necrosis collection.

A Review on Endoscopic Management of Acute Cholecystitis: Endoscopic Ultrasound-Guided Gallbladder Drainage and Endoscopic Transpapillary Gallbladder Drainage.

A percutaneous cholecystostomy tube (PCT) is the conventionally favored nonoperative intervention for treating acute cholecystitis. However, PCT is beset by high adverse event rates, need for scheduled reintervention, and inadvertent dislodgement, as well as patient dissatisfaction with a percutaneous drain. Recent advances in endoscopic therapy involve the implementation of endoscopic transpapillary drainage (ETP-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), which are increasingly preferred over PCT due to their favorable technical and clinical success combined with lower complication rates.