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Background and Aims: Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. Methods: This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. Results: Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB (small bowel) transit time for the first indicative image of MD was 57% of the total SB transit time. Conclusions: Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

Introduction: The execution of upper endoscopy at the proper time is key to correctly managing patients with upper gastrointestinal bleeding (UGIB). Nonetheless, the definition of “time” for endoscopic examinations in UGIB patients is imprecise. The primary aim of this study was to verify whether the different definitions of “time” (i.e., the symptoms-to-endoscopy and presentation-to-endoscopy timeframes) impact mortality. The secondary purpose of this study was to evaluate the similarity between the two timeframes. Methods: A post-hoc analysis was performed on a prospective multicenter cohort study, which included UGIB patients admitted to 50 Italian hospitals. We collected the timings from symptoms and presentation to endoscopy, together with other demographic, organizational and clinical data and outcomes. Results: Out of the 3324 patients in the cohort, complete time data were available for 3166 patients. A significant difference of 9.2 h (p < 0.001) was found between the symptoms-to-endoscopy vs. presentation-to-endoscopy timeframes. The symptoms-to-endoscopy timeframe demonstrated (1) a different death risk profile and (2) a statistically significant improvement in the prediction of mortality risk compared to the presentation-to-endoscopy timeframe (p < 0.0002). The similarity between the two different timeframes was moderate (K = 0.42 ± 0.01; p < 0.001). Conclusions: The symptoms-to-endoscopy and presentation-to-endoscopy timeframes referred to different timings during the management of upper endoscopy in bleeding patients, with the former being more accurate in correctly identifying the mortality risk of these patients. We suggest that further studies be conducted to validate our observations, and, if confirmed, a different definition of time should be adopted in endoscopy.

Background and aim of the study: Polyposis syndromes such as Peutz–Jeghers (PJ) and familial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the risk is approximately 60–90% for PJ and 40–70% for FAP. The primary aim of this study was to evaluate the efficacy of device-assisted enteroscopy (DAE) in the detection and treatment of small bowel polyps to reduce the risk of surgery. The secondary objective was to study complications and mortality. Methods: We conducted a retrospective cohort study by analyzing a structured database. Between September 2006 and October 2019, we observed and followed 42 consecutive patients with polyposis syndromes; they underwent device-assisted enteroscopy and three were excluded from elective surgery after the exam. The endoscopic exams were performed for diagnostic and therapeutic purposes. Results: Thirty-nine patients were evaluated with a mean follow up of 6.7 years (±SD 2.7), 79.5% were female with a mean age of 43.8 years (±SD 15.02), and 68 enteroscopies were performed with the removal of 64 polypoid lesions. One bleeding episode occurred after operative enteroscopy, and the need for subsequent surgery occurred in six patients with PJ and in five patients with FAP. The surgical indications in PJ patients were the presence of large polyps (three patients) and three cases of intussusception, one of which was a patient with a polyp in the proximal ileum, not reachable with the scope. One patient with PJ died from pancreatic cancer during follow up. The surgical indications in patients with FAP were the presence of four large polyps with high-grade dysplasia and one ampullary neoplasia recurrence. Conclusions: In PJ patients, the endoscopic treatment of small bowel polyps was safe. During the follow-up period, the patients with successful endoscopic treatment did not need surgery. In FAP patients treated with DAE, none developed cancer.

BACKGROUND: There are limited data on the effect of the medical care setting on survival in patients admitted with acute upper gastrointestinal bleeding.AIMS: To identify the organisational and care setting which provides the optimal survival in patients with acute upper gastrointestinal bleeding.METHODS: A retrospective observational study of administrative data from a cohort of patients admitted to a Regional or Local hospital, and cared for in a gastroenterology or general ward.PRIMARY OUTCOME: 30 day survival for non-variceal bleeding and 42 day survival for variceal bleeding.RESULTS: Out of 3368 patients, the source of bleeding was non-variceal in 2980 (88.5%). Survival, adjusted for clinical and organisational factors, was higher in patients admitted to a gastroenterology ward vs other wards (OR = 2.02 p CONCLUSION: Survival was optimal for patients treated in a gastroenterology ward independently of Regional or Local hospital setting.

Background. Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies. Aim. To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen. Results. A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens. Conclusion. Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients’ needs.