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COVID-19 pandemic enforced the interruption of routine endoscopic examinations raising the issue of potential delays in the diagnosis of high-risk lesions. We conducted a multicentre study to assess the decrease of GI and pancreato-biliary high-risk lesions detection consequent to the reduction of the endoscopic activity. The lockdown period was compared to the equivalent timeframe of the previous 3 years. Endoscopic procedures decreased by 72.9% (elective 72.4% and urgent 51.3%); the overall cases of high-grade dysplasia/cancers decreased by 59.1% (23.4% pancreato-biliary cancers; 70.6% and 68.8% upper and lower GI lesions). The postemergency period should aim at limiting high-risk lesions delayed diagnoses. A multicentre, retrospective, cross-sectional study was performed in eight tertiary centres, representative of Northern and Southern Italy, to assess the decrease of GI and pancreato-biliary lesions detected, as a consequence of the reduction of endoscopic procedures caused by the COVID-19 pandemic restrictions. Five were academic centres (62.5%), and all working groups were involved in research activities and training programmes. We collected data from the pandemic lockdown period from 9 March to 4 May (11°−18° week) of 2020, referred as P2; and the equivalent prepandemic period (11°−18° week) of 2019, referred as P1. Data from the corresponding periods of the previous 2 years (2017 and 2018) were also collected in order to assess trends of the last 3 years. Main parameters analysed were: ### Endoscopic procedures The total number of endoscopic procedures performed at the eight centres in P1 was 13 293 (median 1912/centre; IQ 25th–75th: 1135–2691) procedures against 3799 (median 408/centre; IQ 25th–75th: 331–842) performed in P2, thus representing an overall reduction of 71.4% (details shown in figure 1). Figure 1 Percentage reduction of the global activities of the endoscopy units in P2 compared with P1. …

Prospective studies have identified a number of patient- and procedure-related independent risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, with different conclusions, so various questions are still open. The endoscopist's expertise, case volume, and case mix can all significantly influence the outcome of ERCP procedures, but have been investigated little to date.We identified patient- and procedure-related risk factors for post-ERCP pancreatitis and the impact of the endoscopist's experience and the center's case volume, using univariate and multivariate analysis, in a multicenter, prospective study involving low- and high-volume centers, over a 6-month period.A total of 3,635 ERCP procedures were included; 2,838 (78%) ERCPs were performed in the 11 high-volume centers (median 257 each) and 797 in the 10 low-volume centers (median 45 each). Overall, 3,331 ERCPs were carried out by expert operators and 304 by less-skilled operators. There were significantly more grade 3 difficulty procedures in high-volume centers than in low-volume ones (P0.0001). Post-ERCP pancreatitis occurred in 137 patients (3.8%); the rates did not differ between high- and low-volume centers (3.9% vs. 3.1%) and expert and non-expert operators (3.8% vs. 5.5%). However, in high-volume centers, there were 25% more patients with patient- and procedure-related risk factors, and the pancreatitis rate was one-third higher among non-expert operators. Univariate analysis found a significant association with pancreatitis for history of acute pancreatitis, either non-ERCP- or ERCP-related and recurrent, young age, absence of bile duct stones, and biliary pain among patient-related risk factors, and10 attempts to cannulate the Vater's papilla, pancreatic duct cannulation, contrast injection of the pancreatic ductal system, pre-cut technique, and pancreatic sphincterotomy, among procedure-related risk factors. Multivariate analysis also showed that a history of post-ERCP pancreatitis, biliary pain,10 attempts to cannulate the Vater's papilla, main pancreatic duct cannulation, and pre-cut technique were significantly associated with the complication.A history of pancreatitis among patient-related factors, and multiple attempts at cannulation among procedure-related factors, were associated with the highest rates of post-ERCP pancreatitis. Pre-cut sphincterotomy, although identified as another significant risk factor, appeared safer when done early (fewer than 10 attempts at cannulating), compared with repeated multiple cannulation. The risk of post-ERCP pancreatitis was not associated with the case volume of either the single endoscopist or the center; however, high-volume centers treated a larger proportion of patients at high risk of pancreatitis and did a significantly greater number of difficult procedures.

Worldwide literature review from PubMed indicate that progress has been made in first aid assistance, diagnosis and treatment of ruptured abdominal aortic aneurysms, which led to a reduced operative mortality. Nevertheless, ruptured aneurysms may present atipically in about half of the cases, thus leading to an initially uncorrect diagnosis up to 25% of cases. Mean survival interval from onset of symptoms and death is 10-14 hours, thus indicating that time exists to consider the new imaging techniques in 80% of patients, particularly the TC multislice. This, when is strategically located close to the emergency or the operative room, can rapidly allow a correct diagnosis and provide an accurate morphological evaluation, thus enabling the surgeon to plan the most adequate treatment with open or endovascular repair.

PURPOSE: The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL). METHODS: All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease. RESULTS: Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p