Background Novel 8.9-Fr and 11-Fr digital cholangiopancreatoscopes (Scivita Medical) have recently become available in Europe, but data on technical performance and safety remain limited. We report initial real-world experience with the Scivita platform. Methods This international, multicenter, retrospective cohort study included consecutive patients undergoing digital single-operator cholangioscopy (dSOC) or pancreatoscopy (dSOP) between March and October 2025 at 10 European centers. The primary outcome was technical success, defined as achievement of the intended procedural goal. Secondary outcomes included intra- and post-procedural complications, classified using the AGREE classification. Results In total, 77 patients (54.5% female; median age 70 years [IQR: 60-76]) were included. In 68 patients, 78 dSOC procedures achieved an overall technical success rate of 91% (71/78): choledocholithiasis 87% (33/38), biliary strictures 96% (24/25), selective cannulation 100% (2/2), evaluation of intraductal margins 50% (1/2), and migrated stent removal 100% (1/1). In all, 9 patients underwent 11 dSOP procedures, with an overall technical success rate of 63.6% (7/11): stone clearance 66.7% (4/6), intraductal papillary mucinous neoplasm assessment 50% (1/2), bridging pancreatic duct disruption 0% (0/1). No intraprocedural complications occurred. Postprocedural complications followed six dSOC procedures: cholangitis in two, mild post-ERCP pancreatitis in two, and abdominal pain without a clear substrate in two. One patient developed mild pancreatitis after dSOP. Conclusion Scivita dSOC demonstrated high technical success and an excellent safety profile. Larger prospective studies are warranted to validate these findings and define the role of dSOC and dSOP of Scivita cholangiopancreatoscopy in clinical practice, while also taking into account cost-effectiveness and environmental impact.

Lemmels's syndrome is obstructive jaundice due to periampullary duodenal diverticula in the absence of a neoplasm or choledocholithiasis. The aim of this study is to present our 15-year experience on this rare pathology. Endoscopy, imaging, and histopathology records of all the patients with obstructive jaundice who were managed in surgical unit 3 in our institute between January 2010 and December 2024 were reviewed retrospectively. Patients who were found to have periampullary duodenal diverticula were included in this study. Descriptive statistics were used to summarize the data. Of 10 cases of Lemmel's syndrome, there were 4 male and 6 female patients. Contrast enhanced computed tomography was done in all the cases and confirmed the diagnosis. Upper gastrointestinal endoscopy was done in all the cases to rule out any other associated mucosal pathology of stomach or duodenum. Surgical intervention was done in 4 cases. Duodenal diverticula were detected in up to 27% of patients requiring upper gastrointestinal endoscopy and imaging studies; while they became symptomatic in only 1-2% of the cases and were causing complications in up to 5% of the cases. Before attributing periampullary diverticula as a cause of obstructive jaundice, it is important to rule out other benign as well as malignant pathologies causing obstructive jaundice.

Percutaneous transhepatic biliary drainage (PTBD) is a common interventional radiology (IR) procedure typically used in the treatment of biliary obstruction when an endoscopic approach has failed or is not technically feasible. PTBD has a low overall complication rate with the Society of Interventional Radiology suggesting adverse event thresholds of 10% for major complications, 5.7% for hemorrhage, 2% for hemobilia, and 3.3% for death, with the average reported rates of each of these being significantly lower. However, in rare instances serious complications such as vascular injury occur. The present report describes a case of a 62-year-old woman with Non-Alcoholic Steatohepatitis (NASH) cirrhosis and remote Whipple procedure who developed symptomatic choledocholithiasis with failed Endoscopic Retrograde Cholangiopancreatography (ERCP). Interventional radiology was consulted for PTBD, which was complicated by an iatrogenic portobiliary fistula (PBF). Diagnosis required sequential imaging and procedural evaluation, as initial non-invasive computed tomography (CT) and initial portal venography failed to clearly demonstrate the connection due to catheter occlusion of the fistula. This case report focuses on the management of this complication, which was successfully treated with balloon-expandable covered stent placement in the biliary system and dual-tract coil embolization.

Choledocholithiasis after pancreaticoduodenectomy is difficult to manage because surgically altered anatomy limits conventional endoscopic access. This difficulty is compounded when afferent loop stenosis is present. We report a 53-year-old man with a previous pancreaticoduodenectomy who presented with abdominal pain and fever. Imaging revealed common bile duct stones. During endoscopic retrograde cholangiopancreatography, severe afferent loop stenosis prevented duodenoscope advancement and guidewire cannulation. The peroral eyeMAX cholangioscope was then used; its slim profile allowed traversal of the stenosis, enabling direct visualization and balloon-assisted stone extraction. This case highlights peroral cholangioscopy as an effective rescue option in this difficult setting.

Cholecystocolonic fistula (CCF) is a rare type of cholecystoenteric fistula, which are sometimes diagnosed incidentally in patients undergoing cholecystectomy. They are usually a complication of chronic cholecystitis, often secondary to gallstones, and they are difficult to diagnose due to their rarity and vague clinical presentation. If untreated, they can lead to complications such as acute cholangitis, biliary peritonitis, and biliary cirrhosis. This highlights the importance of early recognition of CCF and timely treatment. While the generally accepted management is surgical, there are no consensus guidelines available. We present a case of a 79-year-old with a CCF, diagnosed preoperatively in the setting of workup for acute cholangitis and choledocholithiasis. She presented with four days of right-sided abdominal pain and one day of vomiting and new jaundice. She was initially hypotensive with elevated inflammatory markers, hyperbilirubinaemia, and deranged liver function tests. Contrast-enhanced CT revealed an 11 mm distal common bile duct calculus with hepatic biliary dilatation, gas in the gallbladder lumen, and a large gallstone in the hepatic flexure, which were suggestive of an underlying CCF. She underwent a laparoscopic converted to open cholecystectomy with transcystic bile duct exploration and choledochotomy, as well as right hemicolectomy due to extensive oedema and inflammation surrounding the CCF. This was later followed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary sphincterotomy. Her CCF and acute cholangitis were thus successfully treated with surgical intervention, and she recovered well. The rare occurrence of CCF highlights the importance of having a high index of clinical suspicion preoperatively as well as maintaining surgical flexibility if it is encountered during an operation. Early recognition and surgical intervention of CCF are important to prevent life-threatening complications.

Prompt diagnosis using CT is critical in gallstone ileus, as symptoms are often nonspecific. A combined surgical approach-comprising enterolithotomy, cholecystectomy, and fistula repair-effectively addresses both the obstruction and its underlying source, achieving favorable outcomes even in complex presentations.

Necrotizing pancreatitis is a severe complication of acute pancreatitis that may not become radiographically evident until several days after symptom onset. Although progression from gallstone pancreatitis is well recognized, concurrent postoperative complications and Clostridioides difficile infection can obscure the clinical picture and delay diagnosis. This case adds to the literature by demonstrating how overlapping postoperative findings and concurrent infection masked the evolution of necrotizing pancreatitis despite initial clinical improvement and illustrating treatment approaches in such situations. A 61-year-old man presented with worsening right upper quadrant abdominal pain radiating to the back and was diagnosed with gallstone pancreatitis secondary to choledocholithiasis. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone extraction followed by delayed laparoscopic cholecystectomy. After initial improvement and discharge, he returned with severe abdominal pain, nausea, vomiting, and systemic inflammatory findings. Exploratory laparotomy revealed chemical peritonitis of pancreatic origin without biliary leak or enteric perforation. During hospitalization, he developed Clostridioides difficile colitis, further complicating interpretation of persistent abdominal pain, leukocytosis, and inflammatory markers. Interval MRI ultimately demonstrated sterile peripancreatic necrosis and fluid collections consistent with necrotizing pancreatitis. The patient was managed with bowel rest, total parenteral nutrition, drainage of peripancreatic fluid, treatment of Clostridioides difficile infection, serial imaging, and multidisciplinary care involving surgery, gastroenterology, infectious disease, critical care, and internal medicine. His symptoms gradually improved, and he was discharged with outpatient surgical follow-up. This case highlights the unpredictable progression of gallstone pancreatitis to necrotizing pancreatitis despite early intervention and apparent clinical recovery. Persistent or worsening postoperative abdominal pain should prompt continued reassessment, as concurrent infections such as Clostridioides difficile may obscure an evolving pancreatic process. Serial laboratory evaluation, interval imaging, and multidisciplinary collaboration are essential for timely diagnosis and improved patient outcomes in complex cases.

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for the management of suspected biliary disease; however, a proportion of procedures yield no therapeutic findings, exposing patients to avoidable risks. This systematic review and meta-analysis evaluated the incidence, predictors, and clinical consequences of negative ERCP. A structured review was conducted in accordance with PRISMA 2020 principles, including studies of adult patients undergoing ERCP for suspected choledocholithiasis or biliary obstruction. Negative ERCP was defined as the absence of stones, sludge, or any therapeutic intervention. Across included studies, the incidence of negative ERCP ranged from 10 to 40%, with higher rates observed in intermediate-risk populations. Predictors included normalization of liver enzymes, lack of bile duct dilation, smaller or transient stones, and delays between presentation and intervention. Several studies have suggested that spontaneous stone passage is a key contributor. Importantly, negative ERCP was associated with clinically relevant complication rates, including post-ERCP pancreatitis, comparable to those observed in therapeutic procedures. These findings highlight limitations in current risk stratification and emphasize the need for confirmatory diagnostic strategies before ERCP. Reducing unnecessary ERCP has important implications for patient safety, healthcare utilization, and clinical outcomes.