PhD defence S.E. (Sophia) van der Wiel

Dissertation in short:

This thesis explored how to improve medical therapy for patients with a disease of hepatopancreatobiliary and duodenal tract. First, it provided insight in simulation-based training in gastrointestinal endoscopy, specifically in training endoscopic retrograde cholangiopancreatoscopy (ERCP). Then, we evaluated procedural success of ERCP performance in the Netherlands after implementation of a mandatory nationwide registry in 2016. In the last part of this thesis, we focused on the outcome of more advanced endoscopic procedures. Firstly, we evaluated if a novel mechanical endoscopic tissue resection tool was sufficient and safe in removing necrotic tissue in patients with walled-off pancreatic necrosis. Secondly, we performed a study to evaluate endoscopic pancreatoscopy-guided intraductal lithotripsy as first line treatment in patients with chronic pancreatitis and obstructive main pancreatic duct stones. Finally, in the last study of this thesis, we explored the success of endoscopic resection of advanced adenomas of the ampulla of Vater. In this final chapter we summarize and discuss our findings and provide recommendations and possible directions for future research.