General HPB 
PG01 General HPB: Endoscopy (ePoster) 
Selection of ePoster Presentations from Abstract Submissions
PG01-01 Double-Endoscope Necrosectomy via Enlarged Transgastric Access Site, a Novel Modified NOTES-Associated Technique for Walled-Off Necrosis in Acutenecrotizing Pancreatitis
Qida Hu, China

Q. Hu1, F. Meyer2, U. Will3
1Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, China, 2Department of General, Abdominal, Vascular, and Transplant Surgery, University Hospital of Magdeburg, Germany, 3Department of Gastroenterology, Municipal Hospital (SRH Wald-Klinikum), Germany

Introduction: Endoscopic modalities, in particularly the natural orifice transluminal endoscopic surgery (NOTES), have minimized the invasiveness for pancreatic necrosis, therefore becoming increasingly important. However, the transmural access to the pancreatic necrosis was limited by the size of the available transendosccopic balloon catheters, with the maximum diameter of 20 mm. We herein reported a novel modified NOTES-associated technique using double-endoscopes to create an enlarged transgastric access site and a more efficient necrosectomy for WON in acute necrotizing pancreatitis.
Methods: After confirmation of successful puncture by aspiring the fluid collection content under EUS guidance, a 0.035-inch Jagwire guidewire was then advanced through the puncture needle, and a 6-F-outer plastic sheath was then advanced into the gastric wall to create cystogastrostomy. We then exchanged the EUS needle was exchanged for a balloon catheter, followed by dilatation with an over-the-wire balloon to extent the access diameter to at least 10 mm. The second therapeutic endoscope was then placed to the access site with another balloon catheter to achieve double-balloon dilation to increase the access diameter up to 40 mm. Necrosectomy was therefore performed using the two forward-viewing endoscopes.
Results: All 4 cases undergoing the modified endoscopic necrosectomies were performed successfully, making the technical success rate 100%. No severe postoperative complication was observed. Within a 9-month follow-up period, all the pancreatic necrosis was resolved, which indicated a clinical success rate of 100%.
Conclusions: A complete necrosectomy has become possible because of maximal enlargement of the transgastric access site with double endoscopes.
PG01-02 Resection of the Spleen Using Radiofrequency Ablation
Dmitry Ionkin, Russian Federation

D. Ionkin1, R. Ikramov1,1, Y. Stepanova2, M. Alimurzaeva2
1Oncology, A.V. Vishnevsky National Medical Research Center of Surgery, Russian Federation, 2Radiology, A.V. Vishnevsky National Medical Research Center of Surgery, Russian Federation

Objective: to expand the possibilities of performing organ-saving interventions in patients with focal spleen formations.
Materials and methods: Since 1976, we have gained experience in treating> 450 patients with local formations of the spleen. In recent years, with benign lesions, we give preference to organ-preserving interventions. We performed 86 laparoscopic and robot-assisted surgeries with spleen preservation.
We have experience in performing > 60 liver resections using RFA. In recent years, we began to perform similar operations on the spleen. Using the Cool-Tipe Radionics® device, 12 patients were operated on. The following morphological forms of focal formations were noted: echinococcal cyst - 3, abscesses - 2, hamartoma - 1, hemangioma - 2, lymphangioma -3, hemlimphangioma -1.Twice such operations were performed by laparoscopic access using 3 trocars.
Results: The RFA intervention time has not increased compared to standard operations. In one observation, a small hematoma was noted along the edge of the spleen resection, which did not require repeated intervention. In the remaining patients, the postoperative period was uneventful. According to instrumental research methods, in the long term there was a zone of moderate decrease in blood flow along the edge of the resection with a thickness of up to 5-7 mm. There were no signs of relapse.
Conclusion: With benign local formation of the spleen, if technical difficulties arise during organ-saving operations, it is possible to use radiofrequency ablation. The use of this technique allows resection of the spleen with good near and long-term results to be performed almost bloodlessly.
PG01-03 Endoscopic Management of Surgical Jaundice in Nigeria
Olusegun Alatise, Nigeria

O. Alatise1, M. Owojuyigbe2, A. Omisore3, D. Ndububa4, A. Asombang5
1Surgery, Obafemi Awolowo University, Nigeria, 2Anaesthesia, Obafemi Awolowo University, Nigeria, 3Radiology, Obafemi Awolowo University, Nigeria, 4Medicine, Obafemi Awolowo University, Nigeria, 5Medicine, Warren Alpert Medical School of Brown University, United States

Introduction: Endoscopy management of obstructive jaundice has been limited in Nigeria because of unavailability of ERCP, despite growing demand. This study presents our experience establishing an ERCP program at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.
Methods: ERCP was introduced into a well-established advanced endoscopy unit at OAUTHC. We employed an apprenticeship-style model of training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collate the sociodemographic and clinicopathologic information on consecutive patients who underwent ERCP from March 2018- December 2019.
Result: From 155 referrals, 130 patients underwent ERCP, with a median age of 55 (range 8-83). 50.8% (66/130) were male. In total, 143 procedures were performed on this cohort. Sixteen percent of referrals were inappropriate, secondary to misdiagnosis or poor functional status. Ten patients required a repeat procedure due to technical failure, while three patients had a planned second-stage procedure. The most common indications were cancer of the head of pancreas (52/130), choledocholithiasis (33/130), cholangiocarcinoma (18/130) and gallbladder cancer (9/130). Almost all patients (99%) had sphincterotomies and (57/130) had a stent inserted. Twenty-four of these individuals (42%) had self-expanding metallic stents inserted. In total, seven patients had post ERCP pancreatitis and five periprocedural mortalities were recorded.
Conclusion: Using an apprenticeship-style educational model - an experienced endoscopist with a well-established endoscopy unit, it is possible to develop an ERCP program in Nigeria without travelling abroad. The multidisciplinary nature of ERCP service delivery places an incentive on training within the home institution environment.