CLINICAL CASES

INSTITUT PAOLI-CALMETTES

EUS-ENDO 2019

CASE N°1

Mrs MAE…., FEMALE, 72 YEARS OLD

JULY 2019: ABDOMINAL PAIN AFTER MEAL

GASTROSCOPY & COLONOSCOPY : NORMAL

AUGUST 2019: Ct SCAN SHOWED A DILATION OF THE MAIN PANCREATIC DUCT IN THE TAIL

SCHEDULED FOR EUS EVALUATION PANCREATIC MASS MISSED BY THE Ct SCAN ?

IPMN OF THE MAIN DUCT ?

CASE N°2

Mr BIZ…, MALE , 67 YEARS OLD

SINCE JANUARY 2019, EPIGASTRIC PAIN , WEIGHT LOSS

Ct SCAN & MRI SHOWED A CHRONIC PANCREATITIS WITH CALCIFICATIONS

AUGUST 2019: PAIN INCREASE AND AN EUS IS PERFORMED

EUS SHOWED AN IMPACTED STONE IN THE MPD (ISTHMUS)

1 SESSION OF ESWL WAS PERFORMED WITH A FRAGMENTATION OF THE STONE

SCHEDULED FOR ERCP+PANCREATIC SPHINCTEROTOMY AND STONE EXTRACTION

CASE N°3

Mrs BAR…., FEMALE, 48 YERAS OLD

JULY 2019 : SEVERE ACUTE PANCREATITIS OF UNKNOWN ORIGIN

AUGUST 2019: PANCREATIC PSEUDOCYST OF 60 MM OF DIAMETER

SEPTEMBER 2019: PERSISTANCE OF THE PSEUDOCYST WHICH INCREASE IN SIZE 100 X 70 MM

EUS SHOWED A PARTIALLY NECROTIC PSEUDOCYST AND MICRO STONES IN THE GALLBLADDER

SCHEDULED FOR EUS GUIDED DRAINAGE DISCUSSION PLASTIC STENT VS LAMS

CASE N°4

Mrs PER…,FEMALE, 65 YEARS OLD

APRIL 2019 : Ct SCAN FOR THE FOLLOW-UP OF AN ANEUVRYSM OF THE ABDOMINAL AORTA SHOWED A PULMONARY LESION (LEFT LOBE)

Ct GUIDED BIOSPSY FOUND AN ADENOCARCINOMA AND A SURGERY WAS PERFORMED (LESION pT1N0M0)

AUGUST 2019: PET-SCAN SHOWED A PANCREATIC FIXATION

Ct AND MRI SHOWED A 12 MM LESION IN THE HEAD OF THE PANCREAS

SCHEDULED FOR AN EUS WITH FNA or FNB, ELASTOGRAPHY & SONOVUE

CASE N°5

Mrs DOUV, FEMALE, 85 YEARS OLD

APRIL 2019 : JAUNDICE WITH DILATION OF THE CBD AND IHBD

EUS & MRI: CHOLANGIOCARCINOMA OF THE LOWER PART OF THE CBD OF 15X12 MM

PATIENT REFUSE THE SURGERY AND A BILIARY STENT WAS INSERTED

SEPTEMBER 2019: DUODENAL STENOSIS DUE TO AN INVOLVEMENT OF THE DUODENUM LUMEN

6/9/2019 : A DUODENAL STENT IS INSERTED

12/9/2019 : JAUNDICE RELAPSE

SCHEDULED FOR AN HEPATICO-GASTROSTOMY

CASE N°6

Mrs DAD…,FEMALE, 90 YEARS OLD

AUGUST 2019: CHOLANGITIS DUE TO CDB STONES

26/8/2019 : ERCP SHOWED PERI-DIVERTICULAR PAPILLA

SPHINCTEROTOMY WAS PERFORMED BUT THE STONE WASN’T EXTRACTED

A PLASTIC STENT OF 9 CM/10F WAS INSERTED

SCHEDULED FOR STONE EXTRACTION OR SPY-GLASS LITHOTRIPSY

CASE N°7

Mr KRAU…, MALE, 76 YEARS OLD

2016: 2 EPISODES OF MILD ACUTE PANCREATITIS

EUS & MRI : IPMN MIXTE TYPE

JUNE 2019: SIZE OF THE CYST IN THE UNCINATE INCREASE AND THE DIAMETER OF THE MPD REACH 7 MM. IN THE TAIL, A CYST INCREASE FROM 20 TO 28 MM

SCHEDULED FOR AN EUS EVALUATION +/- FNA AND CONTRAST ENHANCED IMAGING

CASE N°8

Mr FENO….,MALE, 67 YEARS OLD

JUNE 2019 : FINDING A DIABETES

JULY 2019: Ct SCAN & MRI SHOWED A DILATION OF THE MPD

PATIENT IS ASYMPTOMATIC

SCHEDULED FOR A DIAGNOSTIC EUS CCP ?

MAIN DUCT IPMN ?

AMPULLARY TUMOR ?

CASE N°9

Mr JOVA…., MALE, 60 YEARS OLD

2000 : ACUTE ALCOHOLIC PANCREATITIS

CALCIFYING CHRONIC PANCREATITIS WITH EPIGASTRIC PAIN

MRCP: PANCREAS DIVISUM WITH A DORSAL DUCT DILATED

4/9/2019 : FAILURE TO CANNULATE THE MINOR PAPILLA

SCHEDULED FOR A SECOND ERCP WITH MINOR PAPILLA CANNULATION

IF FAILURE : PANCREATICO- BULBOSTOMY GUIDED BY EUS

CASE N°10

Mr MOR…, MALE, 72 YEARS OLD

JUNE 2019 : ASTHENIA, WEIGHT LOSS, CHOLESTASIS , CHRONIC RENAL INSUFFISANCY, HYPOTHYROIDISM

SEPTEMBER 2019: Ct SCAN : CHOLANGIOCARCINOMA SEGMENT 4 AND 5 WITH ARTERIAL INVOLVEMENT AND PARTIAL PORTAL VEIN THROMBOSIS

SCHEDULED FOR ERCP WITH BIOPSIES , BRUSHING AND BILIARY DRAINAGE

CASE N°11

Mr MAR….,MALE, 46 YEARS OLD

GERD SINCE 10 YEARS

DECEMBER 2018: EGD BARRETT’S ESOPHAGUS C1M3

BIOPSIES: LOW GRADE DYSPLASIA

PPI : 40 MG X 2 (ESOMEPRAZOLE)

APRIL 2019 : EGD : SAME RESULTS, LGD CONFIRMED BY 2 PATHOLOGISTS

SCHEDULED FOR CONFOCAL EXAMINATION FOLLOW BY HYBRID-APC

CASE 12

Mr PEDR…, FEMALE, 71 YEARS OLD

AUGUST 2019: ISOLATED JAUNDICE WITH CHOLESTASIS

Ct-SCAN & MRI : CHOLANGIOCARCINOMA TYPE IIIA BISTMUTH CLASSIFICATION WITH CELIAC AND LOMBO-AORTIC LN

EUS SHOWED CELIAC LN, EUS-FNA : NO MALIGNANT CELLS

SCHEDULED FOR BRUSHING, BIOPSIES AND BILIARY DRAINAGE METALLIC OR PLASTIC STENT ?

UNI OR BI-LATERAL DRAINAGE ?

CASE N°13

Mr PA…, MALE, 69 YEARS OLD MALE

2007: ESOPHAGECTOMY FOR AN ADENOCARCINOMA pT1bN0M0

2010 : REGURGITATION WITH RECURRENT PNEUMOPATHIES

2018-2019: 6 HOSPITALISATIONS FOR SEVERE PULMONARY INFECTIONS

EGD: PYLORIC SPASM, CONFIRMED BY THE GASTROGRAFFIN TRANSIT

SCHEDULED FOR G-POEM

CASE N°14

Mr GER…, MALE, 80 YEARS OLD

AUGUST 2019: ASTHENIA, WEIGHT LOSS AND JAUNDICE

CT-SCAN & MRI: SUSPICION OF CHOLANGIOCARCINOMA TYPE IV BSIMUTH CLASSIFICATION

9/9/2019: ERCP / LEFT LOBE WAS DRAINED BY A 12 CM/10F PLASTIC STENT AND THE RIGHT LOBE BY AN INTERNAL-EXTERNAL PERCUTANEOUS DRAIN

PATIENT WAS INCLUDED IN BILIARY RFA PROTOCOLE

SCHEDULED FOR BILIARY RFA AND STENTING

CASE N°15

Mr SER…, MALE, 69 YEARS OLD 18/12/2017: LEFT NEPHRECTOMY FOR CARCINOMA APRIL 2019: Ct-SCAN SHOWED A PANCREATIC LESION IN THE BODY OF 14 MM

OF DIAMETER EUS-FNA: PANCREATIC METASTASIS FROM A RENAL CANCER, BUT THE EUS

SHOWED 3 LESIONS, 1 IN HEAD OF 4 MM, 1 IN THE ISTHMUS OF 6 MM AND THE THIRD IN THE BODY OF 14 MM

2/5/2019: INCLUSION IN PANCREATIC RFA PROTOCOLE FIRST SESSION OF PANCREATIC RFA

2/7/2019: EVALUATION : PARTIAL NECROSIS 50% SCHEDULED FOR A SECOND SESSION OF RFA GUIDED BY SONOVUE

CASE N°16

Mr BAJ…, MALE, 70 YEARS OLD JULY 2019 : EPIGASTRIC PAIN, WEIGHT LOSS AND JAUNDICE Ct-SACN SHOWED A PANCREATIC MASS IN THE HEAD OF THE PANCREAS EUS-FNA: PANCREATIC ADENOCARCINOMA 25/7/2019: METALLIC STENT OF 6 CM/10MM WAS INSERTED SEPTEMBER 2019 : VOMITING, STILL JAUNDICE AND WEIGHT LOSS 9/9/2019 : DUODENAL STENT WAS INSERTED Ct6sCAN SHOWED A DYSFUNCTION OF THE BILIARY STENT SCHEDULED FOR HEPATICO-GASTROSTOMY

CASE N°17

Mr SAL…, MALE, 41 YEARS OLD

2018: DIABETES, ALCOHOL ABUSER

SEPTEMBER 2019: WEIGHT LOSS (< 10 Kg), EPIGASTRIC PAIN

LIPASE > 2000 UI/L, GGT=1200 UI, ASAT=600, ALAT= 1000, BILIRUBIN= 48 MMOL/L

Ct-SCAN: DILATION OF THE MPD WITH PANCREATIC STONES, A PSEUDO-CYST OF 40 MM IN THE HEAD OF THE PANCREAS AND A BILIARY STENOSIS OF THE CBD WITH IHBD DILATED

SCHEDULED FOR ERCP AND BILIARY DRAINAGE AND PSEUDO-CYST DRAINAGE TRANS MURAL OR TRANS PAPILLAIRE ?

CASE 18

Mr JOUA…, MALE, 64 YEARS OLD

ALCOHOL ABUSER

LONG BARRETT’S ESOPHAGUS C2M8

JULY 2019: RANDOM BIOPSIES SHOWED IN SITU CARCINOMA AT 32 CM OF THE DENTAL ARCHES

SCHEDULED FOR NEW EGD WITH MAPPING AND RESECTION OF THE IN SITU CARCINOMA ESD OR EMR WITH BAND LIGATION ???

CASE N°19

Mrs TOUC…, MALE, 70 YEARS OLD

AUGUST 2019: BILIARY ACUTE PANCREATITIS WITH LIPASEMIA > 5000 UI/L

Ct-SCAN SHOWED A CIRRHOTIC LIVER (ALCOHOL ABUSER) AND A DILATED CBD WITH AN IMAGE OF STONE

EUS HAS CONFIRMED THE CBD STONE

9/9/2019 ERCP FAILED TO CANNULATE AN INTRA DIVERTICULAR PAPILLA AND THE PATIENT WAS REFERRED FOR A SECOND ATTEMPT

SCHEDULED FOR ERCP AND BILE DUCT STONE EXTRACTION

CASE N°20

Mr KOH….,MALE, 82 YEARS OLD

AUGUST 2019 : PET-SCAN FOR THE STAGING OF BLADDER CANCER

PET-SCAN SHOWED AN HYPERFIXATION IN THE RECTUM

SIGMOIDOSCOPY FOUND A RECTAL POLYP TYPE MIXT LST+ NODULAR AREA

SCHEDULED FOR EMR

CASE N°21

Mr PERG…., MALE, 77 YEARS OLD

2 AND 4 SEPTEMBER 2019: CHOLANGITIS DUE TO BILIARY STONES

2 ATTEMPTS OF ERCP WITH PRE-CUTTING AND FAILURE TO DEEP CANNULATION OF THE CBD

PATIENT IS REFERRED THE 6/9/2019 IN OUR HOSPITAL WITH A CLINICAL OF BILIARY PERITONITIS PROBABLY DUE TO AN INJURY OF THE CBD

Ct-SCAN SHOWED PERITONEAL FLUID, SURGERY WAS PERFORMED IN EMERGENCY AND CONFIRMED THE DIAGNOSIS OF BILE PERITONITIS

PERITONEAL LAVAGE WAS PERFORMED AND THE BILE DUCT WAS DRAINED BY A KHER DRAIN

12/9/2019: MRCP SHOWED MULTIPLE LARGE CBD STONES

SCHEDULED FOR STONE EXTRACTION OR SPY GLASS LITHOTRYPSY

CASE N°22

MrS D’ORA…,FEMALE, 73 YEARS OLD

JUNE 2019 : DIARHHEA SINCE 2 MONTHS

COLONOSCOPY: VILLOUS POLYP OF 4 CM IN THE RECTM

ERUS : LESION usT1N0

SCHEDULED FOR ENDOSCOPIC RESECTION EMR ?

ESD ?

BEFORE RESECTION NEW ENDOSCOPIC STAGING +/- ERUS

CASE N°23

Mr MAT…., MALE, 82 YEAR OLD

END OF AUGUST 2019: JAUNDICE, WEIGT LOSS

Ct-SCAN SHOWED A PANCREATIC MASS IN THE HEAD OF THE PANCREAS WITH INVOLVEMENT OF THE SMV

BILIRUBIN LEVEL > 250 MMOL/L

SCHEDULED FOR EUS-FNA AND BILIARY DRAINAGE DURING THE SAME SESSION

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