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Background: Klatskin's tumour is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications. The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure. Methods: This is a retrospective and analytical study of 75 patients, conducted between July 2009 and August 2021, including all patients admitted with Klatskin's tumour and for whom endoscopic drainage was indicated. Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis. Results: The average age of our patients was 62.67 years with a male predominance of 68%. Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases. Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases, by a metal prosthesis in 45.2% and by nasobiliary drain in 4.1% . Forty-seven percent of patients had dilatation of the stenosis prior to prosthesis placement. Causes of stenting failure were primarily related to failure of papilla catheterisation, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumour. In multivariate analysis and by adjusting the studied parameters, namely the age, gender, bismuth tumour type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and the bismuth tumour classification affect the success rate. Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p<0.001]. However, tumours classified as bismuth IV [OR=8; p<0.001] or bismuth IIIa [OR=5; p=0.004] were associated with a risk of endoscopic treatment failure. Conclusion: Our study suggests that the presence of metastatic hilar cholangiocarcinoma classified as bismuth IV or bismuth IIIa appear to be associated with failure of endoscopic biliary drainage, whereas endoscopic dilatation prior to prosthesis placement appears to be associated with success.

Autoimmune pancreatitis is one of the less recognised associations and remains poorly understood. The overall reported prevalence of autoimmune pancreatitis in inflammatory bowel disease patients is 0.4% [5, 6] considering the only two studies in the literature specifically examining this issue, and that concern Asian populations. Autoimmune pancreatitis in the setting of inflammatory bowel disease is challenging to diagnose but a clinically important entity to recognize and treat. Here we report a case of a 43-year-old women followed for ulcerative colitis, presented with epigastric pain and dyspepsia symptoms associeted to steatorrhea and 12 kg weight loss in 2 months. Laboratory tests found fasting plasma glucose at 1.27 g/l. HbA1c was 8%, IgG4 Levels were normal and the fecal elastase level was low. Magnetic resonance imaging of abdomen revealed a swollen pancreas especially in the uncus. The Bilio-pancreatic endoscopic ultrasound showed heterogeneous hypoechoic lesion of the pancreas head. And the biopsy of the pancreas revealed signs compatible with autoimmune pancreatitis type 2. A final diagnosis of ulceratice colitis associated autoimmune pancreatitis type 2 was made and the patient was treated with corticosteroids, with impressive improvement during his follow-up. In the context of inflammatory bowel disease, autoimmune pancreatitis is a rare and challenging to identify condition. The creation of clear guidelines and diagnostic standards for autoimmune pancreatitis is anticipated to improve awareness of the condition and result in a rise in the number of confirmed cases during the ensuing years.

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Introduction: Le drainage biliaire endoscopique connait des progres incessants et prend une large place dans le traitement palliatif des stenoses malignes des voies biliaires. Notre objectif est dexposer les resultats de cette technique dans notre formation, ainsi que les differents facteurs associes a son echec ou son succes. Methodes:Il sagit dune etude retrospective entre Janvier 2008 et novembre 2020, a propos de 204 patientsayant beneficie dun drainage endoscopique pour stenose biliaire dorigine neoplasique, et qui sont repartis en 3 groupes: les patients atteints dun cholongiocarcinome dans le groupe A , dun cancer du pancreas dans groupe B , et dun calculocancer dans le groupe C . Lanalyse statistique a ete realisee par le logiciel SPSS20.0. Resultats:Lage moyen etait de 63,5±11,4 ans avec un sex ratio a 1,4. Le succes global etait de 82,4% et letude comparative des resultats dans les 3 groupes a montre un taux de succes a 86,6% du groupe B, suivi du groupe C a 80,8% et du groupe A a 76,4%. En analyse multivariee et en ajustant les parametres etudies, a savoir le sexe, lage, limagerie, la presence de metastases et la dilatation endoscopique de la stenose, seule la presence de metastases et la dilatation endoscopique de la stenose modifient le taux de succes. La dilatation endoscopique de la stenose avant la mise en place de prothese multiplie par 8 le taux de succes [OR=9,177p<0,001], alors que la presence de metastases diminue ce taux de 88% et augmente le risque dechec [OR=0,117 p<0,001]. Conclusion:Notre etude a demontre que la presence de metastases semble etre significativement associee a lechec du drainage biliaire endoscopique et la dilatation endoscopique avant la mise en place de la prothese semble etre associee a son succes.