Introduction: The aims of this retrospective multicentre study were to assess the technical success and adverse events of ERCP procedures in children in French and Belgian centres. Methods: All children aged one day to seventeen years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results: 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72% of our patients (340/470). The median age at intervention was 10.9 years. ERCP was therapeutic in 90% (423/470) and diagnostic in cases of neonatal cholestasis in 10% of the patients. The most common biliary indication was choledocholithiasis, and the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92% of cases (270/294); pancreatic cannulation, in 96% (169/176) of cases; and planned therapeutic procedures, in 91% (388/423) of cases. The overall complication rate was 19% (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12% (40/340) and sepsis in 5% (18/340) of cases. In the univariate analyses, pancreatic stent removal was protective against PEP (OR 0.1; 95% CI: 0.01-0.75, p=0.03), and sepsis was associated with liver transplantation history (OR 7.27, 95% CI: 1.7-31.05, p=0.01). Five patients had post-ERCP haemorrhage, and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion: Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

No abstract

Endoscopic diverticuloscope-assisted diverticulotomy with submucosal dissection knives is a safe and effective alternative treatment for patients with a symptomatic Zenker's diverticulum measuring between 2 and 10 cm.

Endoscopic evaluation after chemoradiotherapy (CR) is impossible with an esophageal stent in place. The main study objective was to evaluate self-expanding plastic stent (SEPS) removal post-CR. Secondary end-points were the improvement of dysphagia and patients' quality of life. From October 2008 to March 2011, 20 dysphagic patients who suffered from advanced esophageal cancer were enrolled in a multicenter, prospective study. SEPS was inserted prior to CR and then removed endoscopically. SEPS efficiency (dysphagia score) and tolerance, as well as the patients' quality of life (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire validated for the esophagus), were monitored. Continuous variables were compared using a paired t-test analysis for matched data. A P-value of less than 0.05 was considered statistically significant. Twenty patients (15 men and 5 women), aged 61.5 years (Ϯ9.88) (range 43-82 years), with adenocarcinoma (n = 12) and squamous cell carcinoma (n = 8), were enrolled. SEPS were successfully inserted in all patients (100%). There was one perforation and three episodes of migration. All of these complications were medically treated. The mean dysphagia score at the time of stent placement was 2.79 (0.6). Mean dysphagia scores obtained on day 1 and day 30 post-SEPS placement were 0.7 (0.9) (P < 0.0001) and 0.45 (0.8) (P < 0.0001), respectively. Quality of Life Questionnaire validated for the esophagus score showed an improvement in dysphagia (P = 0.01) and quality of oral feeding (P = 0.003). All SEPS were removed endoscopically without complications. In two patients, the stent was left in place due to metastatic disease. SEPS are extractable after CR of esophageal cancer. Early stenting by SEPS prior to and during CR may reduce dysphagia and improve quality of oral alimentation.KEY WORDS: dysphagia, esophageal cancer, quality of life, self-expanding plastic stent.

Background: Liver cirrhosis and esophageal cancer share several risk factors, such as alcohol intake and overweight. Endoscopic resection is the gold standard treatment for superficial tumors. Portal hypertension and coagulopathy may increase the bleeding risk in these patients. This study aims to assess the safety and efficacy of endoscopic resection for early esophageal neoplasia in patients with cirrhosis or portal hypertension. Methods: This retrospective multicentric international study included consecutive patients with cirrhosis or portal hypertension who underwent endoscopic resection in the esophagus from January 2005 to March 2021. Results: 134 lesions in 112 patients were treated, in 101 (77%) cases by endoscopic submucosal dissection. Most patients (128/134 cases, 96%) had liver cirrhosis, with esophageal varices in 71 procedures. To prevent bleeding, 7 patients underwent a transjugular intrahepatic portosystemic shunt, 8 had endoscopic band ligation (EBL) before resection, 15 received vasoactive drugs, 8 a platelet transfusion and 9 underwent EBL during the resection procedure. The complete macroscopic resection rate, en-bloc resection rate and curative resection rate were 92%, 86%, and 63%, respectively. Three perforations, 8 delayed bleedings, 8 sepsis, 6 cirrhosis decompensations within 30 days and 22 esophageal strictures occurred. No adverse event required surgery. In univariate analyses, cap-assisted endoscopic mucosal resection was associated with more delayed bleeding (p=0.01). Conclusions: In case of liver cirrhosis or portal hypertension, endoscopic resection of early esophageal neoplasia in patients appears to be effective and should be considered in expert centres with choice of resection technique following ESGE guidelines without undertreatment.