PhD defence P.M.A. (Pauline) Stassen

Summary:

This thesis aimed to better define the clinical role of advanced endoscopy in pancreaticobiliary diseases and to offer guidance for improving its outcome in patients suffering from biliary or pancreatic diseases. 
In the first part, the clinical value of a relatively novel endoscopic technique, i.e. cholangiopancreatoscopy (SOC), for use in the diagnostic and therapeutic algorithm of pancreaticobiliary diseases, was evaluated. Also, using a survey, we evaluated the current clinical practice patterns of SOC regarding the applied techniques and main indications throughout Europe. In addition, we evaluated the diagnostic accuracy of SOC in diagnosing biliary strictures and intraductal papillary mucinous neoplasms. Finally,  we investigated technical success of electrohydraulic lithotripsy using pancreatoscopy for the treatment of obstructive pancreatic duct stones. 
In the last part, we focused on contributing to the body of evidence on existing diagnostic and therapeutic endoscopic interventions in biliary and pancreatic diseases. First, we investigated the role of EUS-guided removal of common bile duct stones by means of ERCP in the treatment of patients with acute biliary pancreatitis. Then, we evaluated the outcome after endoscopic therapy in patients with symptomatic pancreas divisum. Also, the safety and effectiveness of a novel tissue resection tool was evaluated in the treatment of acute necrotizing pancreatitis. Finally, the prevalence, clinical course and possible risk factors for stent migration-induced duodenal perforation (SMDP) after biliary stent placement was evaluated. In the present part of the thesis, the main findings and conclusions are summarized and discussed with recommendations for future research.