InFocus - Issue 2, October 2015 

Focus On...


Interview with Dr. Marc Giovannini

Dr. Marc Giovannini from the Institut Paoli-Calmettes in Marseille, France, talks to InFocus about UEGW, synergies between EUS and ERCP and the future for the segment.

Head of the Digestive Oncology Medico-surgical Department

  •   Over 20 years of EUS and ERCP experience
  •   1,500 EUS and 800 ERCP cases p.a.
  •   ~1.000 scientific publications
  •   Focus on EUS & ERCP for pancreatic cancer, neuroendocrine tumors and hepatocellular carcinoma
  •   International advisor of PENTAX Medical, COOK Medical, Taewoong Medical and Mauna Kea Technologies

Important activities:

  • President of Euro EUS (2008-2013)
  • Individual member ESGE board (since 2010)
  • Editor in chief of “Endoscopic Ultrasound” journal (since 2012)


PENTAX Medical: Dear Marc, thank you for your time. First off, what are your greatest expectations from the UEGW in this year? What do you mostly expect in the biliopancreatic segment?

Marc Giovannini: Well, since I am deeply involved in the treatment of pancreatic cancer, all new knowledge on this devastating disease is my main focus. Secondly, new therapies including surgery and radio-chemotherapy as well as alternative treatments such as radiofrequency ablation of pancreatic tumors are my areas of interest.

Especially in the EUS, I would like to get a better definition of the place of EUS-FNA and also a better definition of what to do if a biopsy is not conclusive: how to manage the patient then? This is a very important question today. Further for EUS-FNA; what is the best needle? When is cytology enough? When do we need histology?

For the ERCP – which is difficult to separate from therapeutic EUS – the question is alike: what is the best technique, if ERCP initially fails? Is it PET/CT? Is it EUS-guided biliary drainage? I think on this we need more randomized studies.

PM: From your point of view as an expert and dedicated teacher, what are the main synergies in the complementary fields of EUS and ERCP?

MG: As mentioned, these techniques should not be separated. I think it is a big mistake to say, being able to perform just ERCP would be enough. The future will be parallel training in both techniques, ERCP and therapeutic EUS.

It is a great advantage that, for example in case of failed ERCP one can move on with therapeutic EUS: just change the scope to perform a EUS-guided biliary drainage or rendezvous or choledochoduodenostomy or hepatico-gastrostomy – what you want. It all then happens in the same room, with one anesthesia, with therefore reduced risk of cholangitis and infection, and less antibiotics but more convenience and quality to patient.

The same team being capable of performing both techniques on the same day will become most important in the future. The reason is that this is in the very interest of the patient.

PM: Of which developments do you think that will most likely happen in the techniques of ERCP and EUS in the next future?

MG: Future of EUS will be more and more therapeutic, this is for sure. Speaking of techniques such as combined drainage of bile duct and gastro-entero anastomosis, e.g. for patients with advanced pancreatic cancer with double stenosis of the duodenum. Also therapeutic interventions like radio-frequency ablation, injection of targeted therapies…  

In the next years there will be for sure more local ablative treatment options including radiotherapy and -frequency etc. Further the future might be the combination of EUS-guided nano-treatment for bilio-pancreatic tumors.

However, I do not see great development of ERCP by itself – it is rather about the accessories in detail, like expanded portfolio of stents with chemotherapies. One thing however, will be the cholangioscopy because access to the ducts will open windows and options for new local treatments.

PM: What do you value most in PENTAX Medical support in the biliopancreatic segment?

MG: PENTAX Medical has the advantage of having probably the best EUS equipment: you can see very well and therefore you target very well.

But as said before; it becomes more and more about local therapies. Now it might be the time for the companies to generally cooperate more with each other, and with doctors as well.

Collaboration will become very important. Now PENTAX should work in association with other companies, including pharmaceutical companies, in order to be able to support (or even provide) more targeted solutions. And therefore, maybe it will be more and more important to create consortiums including doctors such as oncologists, pathologists, and endoscopists, next to companies from the pharmaceutical, accessories and endoscope industries. The aim might be trying to elaborate protocols on local treatments of pancreatic cancers, or advancements in combining general and local treatment of tumors.

I think this is the way to work in the future. Not just to work alone, having a nice product – but also broadly using this technology, not only for diagnostic purposes. Here PENTAX have already done a lot, with the development of the slim EUS scope for example. Now you should work more in the field of treatment which will be the next big thing.

PM: Thank you very much for your time and feedback. As always, greatly appreciated and a pleasure speaking to you. 


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