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The majority of patients with Crohn's disease and a proportion of patients with ulcerative colitis will ultimately require surgical treatment despite advances in diagnosis, therapy, and endoscopic interventions. The surgical procedures that are most commonly done include bowel resection with anastomosis, strictureplasty, faecal diversion, and ileal pouch. These surgical treatment modalities result in substantial alterations in bowel anatomy. In patients with inflammatory bowel disease, endoscopy plays a key role in the assessment of disease activity, disease recurrence, treatment response, dysplasia surveillance, and delivery of endoscopic therapy. Endoscopic evaluation and management of surgically altered bowel can be challenging. This consensus guideline delineates anatomical landmarks and endoscopic assessment of these landmarks in diseased and surgically altered bowel., Competing Interests: Declaration of interests CNB reports grants and personal fees from AbbVie, Janssen Canada, Pfizer Canada, and Takeda Canada, and personal fees from Roche Canada, Bristol Myers Squibb Canada, Sandoz Canada, Mylan Pharmaceuticals, Takeda, and Medtronics Canada. DHB reports grants from Medtronic. JS reports personal fees from Takeda and Pfizer. PGK reports grants and personal fees from Pfizer and Takeda, and personal fees from AbbVie and Jansen. UN reports grants and personal fees from Takeda, Janssen, and AbbVie, and personal fees from Pfizer. RKC reports personal fees from AbbVie, Janssen, Pfizer, Samsung Bioepis, and Takeda. WJS reports grants, personal fees, and stock or stock options from Prometheus Biosciences; grants and personal fees from AbbVie, Abivax, Alimentiv, Arena Pharmaceuticals, Boehringer-Ingelheim, Celgene, Genentech (Roche), Gilead Sciences, Glaxo Smith Kline, Janssen, Lilly, Pfizer, Seres Therapeutics, Shire, Surrozen, Takeda, and Theravance Biopharma; personal fees and stock or stock options from Beigene, Gossamer Bio, Oppilan Pharma, Progenity, Shoreline Bioscience, and Vivreon Biosciences; grants and stock options from Allakos; personal fees from Alivio Therapeutics, Admirx, Alfasigma, Allergan, Amgen, Applied Molecular Transport, Avexegen Therapeutics, Bausch Health (Salix), Bellatrix Pharmaceuticals, Boston Pharmaceuticals, Bristol Meyer Squibb, Celltrion, Cellularity, Conatus, Cosmo Pharmaceuticals, Escalier Biosciences, Ferring, Forbion, Equillium, Glanmark Pharmaceuticals, Immunic (Vital Therapies), Incyte, Index Pharmaceuticals, Intact Therapeutics, Kyowa Kirin Pharmaceutical Research, Kyverna Therapeutics, Landos Biopharma, Miraca Life Sciences, Nivalis Therapeutics, Novartis, Nutrition Science Partners, Otsuka, Pandion Therapeutics, Paul Hastings, Protagonist Therapeutics, Provention Bio, Reistone Biopharma, Ritter Pharmaceuticals, Shanghai Pharma Biotherapeutics, Sienna Biopharmaceuticals, Sigmoid Biotechnologies, Sterna Biologicals, Sublimity Therapeutics, Thetis Pharmaceuticals, Tigenix, Tillots Pharma, UCB Pharma, Vendata Biosciences, Vivelix Pharmaceuticals, and Zealand Pharma; and stock or stock options from Ventyx Biosciences and Vimalan Biosciences. MSS reports grants and personal fees from Janssen, AbbVie, Takeda, and Pfizer, and grants from Prometheus. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP)., Objectives: To carry out a calculation of the standard direct costs of AEP, and to make a financial comparison with their surgical alternatives., Methods: Calculation of the standard direct cost in carrying out each procedure. An endoscopist detailed the time, personnel, materials, consumables, recovery room time, stents, pathology and medication used. The cost of surgical procedures was the average cost recorded in the hospital., Results: Thirty-eight AEP were analyzed. The technique showing lowest cost was gastroscopy + APC (€116.57), while that with greatest cost was ERCP with cholangioscopy + stent placement (€5083.65). Some 34.2% of the procedures registered average costs of €1000-2000. In 57% of cases, the endoscopic alternative was 2-5 times more cost-efficient than surgery, in 31% of cases indistinguishable or up to 1.4 times more costly., Conclusion: Standard direct cost of the majority of AEP is reported using a methodology that enables easy application in other centers. For the most part, endoscopic procedures are more cost-efficient than the corresponding surgical procedure., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. Methods: This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. Results: A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16–4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1–3.9), variegated AG shape (OR2.46; 95%CI, 1–6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2–58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. Conclusions: EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model. [ABSTRACT FROM AUTHOR]