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Following publication of the original article [1], the co-author “Nikolaos Pararas” has misspelled wrongly as “Nikolaos Parasas”. The original article has been corrected.

Background: Management of biliary disorders in patients with altered anatomy may be challenging. EUS-guided gastrointestinal anastomosis using lumen apposing metal stent (LAMS) have been introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However the appropriate stent indwelling time is still uncertain. We report long-term LAMS deployment after duodeno-jejunal or jejuno-jejunal anastomosis (EUS-DJA) to allow endoscopic re-interventions in case of recurrences. Methods: 11 consecutive patients underwent to EUS-DJA with long standing LAMS between January 2017 and December 2018. ERC treatment was carried out over a 12 months period with multiple endoscopic sessions across DJA. Results: Technical success was 91% (10/11 pts) for EUS-DJA and 100% for ERC. Four patients presented stricture recurrence after an average of 489±31.7 days from the end of ERC treatment. A novel ERC across LAMS anastomosis was feasible in all cases. At average of 781 days±253 all LAMS are still in place with no evidence of any adverse event. Conclusion: Long-term LAMS placement after EUSDJA may be feasible and safe in order to maintain a direct access to the excluded limb.

Introduction: Surgery is the gold standard treatment of morbid obesity and its related co-morbidities. However early or late surgical related adverse events(AE) occurs in 4 to 25% of patients requiring, in most cases, re- interventions. Endoscopy is an effective treatment especially if it is per- formed soon after occurrence of AE. However a comprehensive evalua- tion of long-term results and need for revisional surgery after endoscopic management is lacking. aims & Methods: The aim of this study is to report overall results and long- term outcomes of patients underwent to endoscopic management for AE following bariatric surgery in a tertiary interventional endoscopic center. From January2013 to April2019, 830 consecutive patients(640F), average age 44(17 - 72), underwent upper GI endoscopy for suspected AE following obesity surgery. 651 patients underwent Sleeve Gastrectomy, 167 gastric-by-pass(98 Roux- en-Y and 69 Omega)(GBP)and 12 had lap-band. 168 patients presented an AE after revisional bariatric surgery. 358 patients were addressed for sepsis due to supposed leak(extravasation of medium contrast). 226 patients presented dysphagia due to GI stenosis. 201 subjects presented fistula(abnormal communication between two re- epithelized structures or skin due to previous placement of surgical drain- age). 28 patients had a perigastric intra-abdominal collection. 12 patients had partial intragastric migration of gastric band. 5 presented weight regain following GBP for enlargement of G-J anas- tomosis. Endoscopic management according to the different type of AE were one or an association of the following: endoscopic internal drain- age, septotomy, stenting with Lumen apposed metal stent, Argon plasma coagulation(APC) anastomotic remodeling and trans-oral lap band abla- tion. Clinical success was defined as follows: leak and fistula: no medium con- trast extravasation, no chemistry tests alterations no need for prolonged antibiotics therapy. Stricture: adequate passage of medium contrast at swallow study or easy crossing of the stricture with a standard gastro- scope. Lap band migration:uneventful removal. Loss of excess weight after G-J anastomotic remodeling with APC. Long term clinical success was con- sidered after a minimum follow up of more than 18 months. results: 89 patients underwent endoscopy after one week from index surgery(5,13 ± 1,92days), 451 between 8 and 42days(19,63 ± 9,17), 93 patients between 43 and 91days(60,34 ± 13,07) and 197 after more than 91days(854,93 ± 1170,37). Overall mean period was of 223days(0-2100) from index surgery. 70 patients(8.4%) presented normal findings at upper endoscopy. An average of 6 endoscopic sessions(1-31) were needed to achieve AE reso- lution in 72%(598) of patients. At long follow up (more than 18 months) 16%(96 out 598) of patients healed were lost whereas. 8%(66) are still under treatment. Overall mortality was of 0,6%(5 out 830) whereas overall AE related to en- doscopic treatment was of 2%(15)namely bleeding, stent migration with/ or perforation. 3 patients with perforation required emergency surgery. 11.%(91 patients) underwent revisional surgery either for endoscopic treat- ment failure or poor quality of life after an average of 331days(15 - 1400). conclusion: According to this large case series endoscopy plays a pivotal role in the management of AE following bariatric surgery guaranteeing good results with low morbidity and mortality rates avoiding emergency surgery in 65% of cases. However several endoscopic sessions are needed. Long-term follow up showed that 11% of patients require, revisional sur- gery, either in case of endoscopic clinical success.

Introduction: Endoscopic treatment of benign biliary stricture (BBS) re- mains challenging with 15% of recurrence ater metallic or multiple plastic stenting. We experimented endobiliary radiofrequency ablation (ERFA) with the aim to eradicate biliary fibroplasia endoscopically. We report our first experience of ERFA in the management of refractory BBS. aims & Methods: 8 patients with BBS (5 postoperative strictures, 2 chronic inflammatory strictures and 1 post stenting stricture) were treated from august 2014 to march 2018. All had previously unsuccessful endoscopic treatment with dilatations (1,75 [0-3]) and plastic or metallic stenting dur- ing a median of 18 months (9-48). Bipolar ERFA was delivered at power of 10 W for 90 seconds per stricture segment, followed by a 10 mm balloon dilatation without stent placement. Data were collected on technical suc- cess (ERFA delivery), clinical success (stricture resolution), adverse events and follow-up. results: ERFA was performed in 8 patients (7 men) with a median age of 56 years (range 20-81). All patients had stricture resolution after ERFA. No severe adverse event occurred with only a case of short abdominal mild pain. The median follow-up is 31 months. BBS resolution without the need for further stenting was achieved in 6 patients. The 2 patients with inflammatory stricture had BBS relapse after initial resolution at 10 and 12 months, one underwent surgery, the other metallic stenting for 9 months with no further relapse at 2 years. Wednesday, October 23, 2019 Tuesday, October 22, 2019 Monday, October 21, 2019 274 UEG Journal | Abstract Book conclusion: ERFA appears to be a safe and effective treatment for refractory BBS, especially for postoperative strictures. Further studies are warranted.

Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide, commonly performed using laparoscopic multiport. Feasibility and safety of single-port sleeve gastrectomy (SPSG) have been proved. We reported a standardized procedure describing the different steps as a reference for bariatric surgeons. MATERIALS: Two news concepts are necessary: "surgical corridor," surgeon working in a small intraperitoneal area is less disturbed by excess abdominal fat and liver hypertrophy; "parietal space" is the area in the abdominal wall through the instruments are introduced, it's important to preserve this. The patient was placed in a seated position and we utilized 2.5-3 cm skin incision in the umbilicus. Single trocar was placed; a flexible camera and double curve grasper are needed to decrease grasper conflict. Dissection of the stomach was obtained by 47 cm Thunderbeat (Olympus-Japan), the sleeve of the stomach was created over a 36F calibrator. A 60-mm roticulating XL staplers were used and beginning 4 cm proximal to the pylorus next to the gastro-pancreatic ligament and heading toward the left side of the gastro-esophageal junction. We utilized a linear staple line using 4 to 7 staples; hemostasis is controlled by bipolar coagulation. RESULTS: Specimen was removed easily through the single-site trocar. Parietal defect is easily repaired. Operating time is 41 min. The patient was discharged at day 1 without naso-gastric tube or drainage. No complication. CONCLUSION: Umbilical SPSG is nowadays a standardized procedure based on the surgical corridor and the parietal space. This is a safe and reproductive procedure applicable in most patients with massive obesity but necessitate learning curve.

Introduction: Gastric varices (GV) represent 20% of patients with portal hypertension. Endoscopic cyanoacrylate injection is recommended in bleeding gastric varices. Nevertheless, it is associated with more than 25% of re-bleeding and se- rious adverse events, mainly glue embolization. Endoscopic ultrasound (EUS)-guided and combined coil and glue injection provide a new alter- native treatment for bleeding varices. aims & Methods: This is a retrospective analysis of EUS-guided coil and glue injection for gastric varices bleeding from 10/2013 to 03/2019. We used linear therapeutic ultrasound endoscopes without fluoroscopic con- trol. The procedures were performed on general anesthesia and antibio- prophylaxia. We injected cyanoacrylate combined with Lipiodol after the application of one or many coils (5 x 50 mm). A control EUS was done at 4 weeks. The primary outcomes were varices obliteration and the need of reinter- vention. results: 33 patients were treated by EUS-guided coil and glue injection, 26 (78%) for recent bleeding varices and 7 (22%) for primary prophylaxis. There was 60% of males and the mean age is 61 years (28-84). Technical success was achieved in all patients (100%). The mean number of coil was 1.2 (1-3 coils) and the mean volume of glue injected was 1.5 mL (0.5- 3 mL). Complete obliteration was confirmed for the 33 patients (100%), 30 after one session (91%), 2 after 2 sessions and one after 4 sessions. Post-procedure pain occured in 3 patients (9%) during 1 to 7 days. No symptomatic embolization was observed with a mean follow-up of 436 days (21-1818). conclusion: EUS-guided combined coil and glue injection for gastric and ectopic varices appears to be a feasible and highly effective technique with less re-bleeding and complication than the classic endoscopic glue-only injection.

Purpose: Although association between colorectal cancer (CRC) and metabolic syndrome (MetS) is established, specific features of CRC arising in patients presenting with MetS have not been clearly identified. Method: All patients who underwent colectomy for CRC from January 2005 to December 2014 at Institut Mutualiste Montsouris were identified from a prospectively collected database and characteristics were compared in the entire population and in a 1:2 matched case-control analysis [variables on which matching was performed were CRC localization (right- or left-sided) and AJCC stage (0 to IV)]. Results: Out of the 772 identified patients, 98 (12.7%) presented with MetS. Entire population analysis revealed that CRC associated with MetS was more frequent in men (71.4 vs. 47.8%, p < 0.001), more often right-sided (71.4 vs. 50.4%, p < 0.001) and presented with less synchronous liver metastasis (4.1 vs. 8.7%, p = 0.002). Case-control analysis confirmed the gender association (p < 0.001) and showed HNPCC (p < 0.001) and history family of CRC (p = 0.010) to be significantly more frequent in Non-MetS patients. Conclusions: CRC associated with MetS is more frequent in men, more often right-sided, and presents with fewer synchronous metastasis. Further investigations should be designed in order to confirm these results and to enhance our knowledge of carcinogenesis related to MetS.

Introduction: Complete transection of the common bile duct is a dramatic complication after biliary surgery especially after laparoscopic cholecystectomy. Since 1995 we have proposed an endoscopic – radiologic rendez-vous that successfully obtains the reconstruction of the biliary tree in a minimal invasive way. After treatment with 4 or 5 biliary plastic stents left in place for at least one year1 patients were followed up for at least five years. Aims and Methods: Since 1995, 91 patients were treated for complete transection of the common bile duct: 3 patients had traumatic biliary section, 88 iatrogenic, (73 after lap.chole. 15 after open surgery). All patients were successfully treated with endoscopic-radiologic rendez-vous and after right and left transhepatic approach 4 or 5 plastic 10 F stents were radiologically put in place. After 12 months, the stents were endoscopically removed and a control cholangiography with an ERCP was performed. If stones and sludge were found they were removed. In case of duct stenosis a new transhepatic approach was made and several plastic stents put in place again for 12 months. The patients were followed up for 5 years with blood analysis, ultrasounds and MR cholangiography. Results: 60 patients were evaluated as 21 were lost at follow-up and 10 are under treatment, 44 patients (73%) are well after 5 years without any symptoms of cholestasis and biliary dilatation at MR cholangiography. 2 patients died for sepsis after 6 and 12 months of treatment. 4 patients had cholangitis after 6 and 8 months: the stents were removed and replaced after recovery, 16 patients had stenosis of the main bile duct after stent removal: they were treated again with 4 plastic stents for 1 year, 8 patients had stenosis recurrence during follow up after 2 or 3 years: they were treated endoscopically and a fully covered selfexpanding metallic stent left in place for one year. All patients, also those retreated, are well after 5 years of follow up. Conclusion: The radiologic-endoscopic rendez-vous is a safe and efficient technic for minimal invasive treatment of the common bile duct complete section. It is challenging for the radiologist as the intrahepatic biliary ducts are thin and for the endoscopist that has to puncture the duct often clipped. It requires many sessions for complete treatment and in a few cases treatment for stenosis recurrence but in this way we can avoid surgical treatment on the biliary tree that requires difficult intervention which has a high morbidity and mortality. Disclosure: Nothing to disclose

Background: The major issue after liver resection for colorectal liver metastases (CRLM) is the high incidence of recurrence. Unlike open liver resection (OLR), recurrence following laparoscopic liver resection (LLR) is not well documented. The aim of this study was to analyze recurrence patterns and treatment following LLR for CRLM. Study design: All patients who underwent LLR for CRLM from 2000 to 2016 were reviewed. Patients who presented with recurrence were compared to those who did not. Recurrence-free survival (RFS), overall survival (OS), and risk of recurrence and survival prognostic factors were analyzed. Results: Overall, 273 patients were included, of which 157 (57.5%) were treated for one liver metastasis (LM). Median follow-up was 41 (12-187) months and associated extrahepatic disease was present in 27% of patients (mainly pulmonary, 65%). After a median of 16 (3-151) months, 197 (72%) patients presented with recurrence. Recurrences were early (< 6 months) in 22.8% of cases, occured in a single site in 66% and were intrahepatic, extrahepatic, or both in 44, 30, and 26%, respectively. Recurrences were treated with surgery or chemotherapy only in 45 and 47%, respectively. 3-, 5-, and 10-year OS was 82, 71, and 43%, respectively. Independent risk factors for recurrence were node-positive primary tumor, extrahepatic disease before hepatectomy, and R1 resection. Conclusion: LLR for CRLM does not seem to be associated with distinctive recurrence patterns. LLR for CRLM yielded satisfying RFS and OS and should therefore be considered whenever possible.

Rapid weight loss after bariatric surgery is associated with a high prevalence of gallstone formation. In laparoscopic Roux-en-Y gastric bypass (RYGBP), the bypassed segment is not readily available for endoscopic or radiographic examination. We propose a laparoscopic Janeway gastrostomy for secondary access to excluded structures in bariatric centers with no mandatory technical equipment in endoscopic retrograde cholangiopancreatography (ERCP), double-balloon ERCP or spiral enteroscopy. METHOD: This was a single-institution retrospective review of a prospectively collected database of patients with a history of laparoscopic RYGBP who underwent laparoscopic Janeway gastrostomy for duodenal and biliary access. The operative indications, technical aspects, endoscopic findings, outcomes, and complications were investigated. RESULTS: Five patients with a history of RYGBP underwent laparoscopic Janeway gastrostomy for exploration of the bypassed segment. All of them had biliary pathology, and all underwent successful ERCP and papillotomy. The gastrostomies were closed secondarily. The mean duration of hospitalization was 12 days. No complications developed. All procedures were performed laparoscopically. CONCLUSION: If access to excluded structures and simultaneous ERCP was not possible, temporary laparoscopic Janeway gastrostomy could be the last option alternative for a staged ERCP to gain access to the bypassed structures. It is a feasible and safe solution for the exploration and treatment of patients with a history of RYGBP in bariatric centers that have no endoscopists with expertise in ERCP.