BackgroundHepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations for more patients outside these guidelines. Our case shows a patient with intermediate stage hepatocellular carcinoma presenting a good outcome after curative treatment.Case presentationWe report the case of an 80-year-old Moroccan man, who was positive for hepatitis c virus, presenting an intermediate stage hepatocellular carcinoma (three lesions between 20 and 60 mm). He presented a complete tumor necrosis after portal vein embolization and achieved 24-month disease-free survival after surgery.ConclusionsPerioperative care in liver surgery and multidisciplinary discussion can help to extend indications for liver resection for hepatocellular carcinoma outside European Association for the Study of the Liver/American Association for the Study of Liver Diseases recommendations and offer a curative approach to selected patients with intermediate and advanced stage hepatocellular carcinoma.

Afferent limb syndrome (ALS) is a rare complication of duodenopancreatectomy, resulting from the mechanical obstruction of the afferent limb usually after local malignancy recurrence. Management of ALS (ie, surgery and palliative therapy) is often unsatisfactory. We present 5 cases of endoscopic ultrasound-guided internal drainage of the afferent limb using lumen-apposing metal stents. All procedures were successful, with no related complications; 2 patients had a complete regression of their symptoms, one experienced cholangitis recurrence, and 2 patients died after some weeks because of their malignancies. Endoscopic ultrasound-guided enteroenterostomy offers a convenient and safe palliative solution for patients presenting ALS.

Background and study aims Iatrogenic endoscopic ultrasound (EUS) perforations are life-threatening adverse event and to date, surgery has been the main treatment for them. The aim of this study was to assess feasibility and safety of conservative treatment with over-the-scope clips (OTSC). Patients and methods We performed a retrospective study, including iatrogenic EUS duodenal perforation with conservative endoscopic management from 2011 to August 2018. Patients who initial had surgical management were excluded. Results In 8504 EUS procedure occurred, 13 perforations occurred (0.15 %). Eleven patients were included in the study, all women. Mean patient age was 75 years (range 68 – 88). Eighth of 11 perforations (72.7 %) were due to a radial probe and three of 11 (27.3 %) were due to a curvilinear probe. Eleven procedures (100 %) were performed as diagnostic. Defect size ranged from 10 to 15 mm. All procedures were successful. Three of eleven patients (27 %) had a stay in intensive care unit for less than 72 hours and length of total hospital stay ranged from 3 to 22 days. Conclusion Conservative endoscopic treatment of Iatrogenic EUS perforation, with OTSC is feasible, efficient and safe.

Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store.A "characterize, resect, and discard" strategy has been proposed as a new approach, allowing more expeditious and efficient management of the patient with colonic polyps as well as histologic procedure cost savings. However, despite recent advances, the technologies embedded in currently available endoscopes have not proven to be sufficiently reliable to implement that strategy in the routine endoscopic practice. 1 Full-field optical coherence tomography (FFOCT) is an emerging optical technique for the rapid evaluation of tissue architecture. 2 FFOCT has been used to image fresh and fixed human tissues such as skin, 3 cornea, 4 brain, 5 and even pancreatic biopsy specimens. 6 FFOCT might prove useful during colonoscopy, when a rapid on-site assessment of tissue architecture can determine whether to discard polyps and immediately advise patients on subsequent surveillance or to warrant further histologic analysis. Here, we present the technical feasibility of ex vivo FFOCT imaging on colonic polyps and its ability to visualize cellular and architectural features of normal and neoplastic colonic tissue.