Search

We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.

Background and Objective: A new 20-gauge (G) biopsy needle with a core-trap technology has been developed with a large core size and enhanced flexibility. The aim of this multicenter study was to determine the feasibility, efficacy, and safety of EUS-guided fine-needle biopsy (EUS-FNB) with the new 20G needle in diagnosing subepithelial lesions (SELs). Materials and Methods: Retrospectively collected data from consecutive patients with SELs undergoing EUS-FNB with the 20G needle at five centers were analyzed. Results: A total of 50 SELs were included. The mean lesion size was 43.1 ± 17.5 mm. The lesion locations were esophagus (n = 1), stomach (n = 37), distal duodenum (n = 5), rectum (n = 6), and colon (n = 1). The procedure was technically feasible in all patients. Definitive diagnosis with full histological assessment including immunohistochemistry was obtained in 88% (44/50) of the patients. Considering malignant versus benign lesions, the sensitivity, specificity, positive predictive value, and negative predictive value were 85% (95% confidence interval [CI] 70.2–94.3), 100% (95% CI 58.7%–100%), 100% (95% CI 85.1%–100%), and 62.5 (95% CI 27.7–84.8), respectively. No major complications requiring additional care have been observed. Conclusions: In this multicenter study, we found that EUS-FNB with the new 20G core needle is an effective and safe method for the diagnosis of SELs with a high rate of producing adequate histological material and high diagnostic accuracy even from difficult-to-approach anatomical locations.

Background and aim Endoscopic ultrasound-guided sampling (EUS sampling) is a safe and effective technique. The study aim was to evaluate the presence of a histological core from pancreatic lesions using a new 25G fork-tip needle. Methods Observational multicenter prospective and analytical study, including consecutive patients with solid pancreatic masses referred for EUS-guided sampling. At each needle pass, the endoscopist performed macroscopic on-site evaluation (MOSE). The primary outcome was the histological core procurement rates. Secondary outcomes were the evaluation of interobserver agreement between endoscopists and pathologists, adequacy of EUS samples for the diagnosis and post-procedure adverse events. Results 100 patients were enrolled in 3 centers. The mean size of the lesions was 28.5 mm (SD 11.7). Final diagnoses were adenocarcinoma (68%), neuroendocrine tumor (21%), inflammatory mass/benign lesions (8.0%), and pancreatic metastasis (3.0%). The pathologists described the presence of a core in 67 samples (67.0% of patients), with poor agreement with MOSE (kappa, 0. 12; 95% CI: 0.03–0.28). The diagnostic accuracy was 93%. We observed 6% of mild adverse events. Conclusion The new 25-gauge core needle showed good overall adequacy and a good rate of histological specimens during EUS sampling of solid pancreatic masses, with a minimum number of passes and no major complications. Clinicaltrial.gov number, NCT02946840.

Background and Objectives: In the perspective of improving accuracy of endoscopic ultrasound (EUS)-guided sampling, the efforts of innovation have focused on needle design, with the development of micro-core acquisition technology, and puncture technique variations. Available studies have shown that fine needle biopsy (FNB) needles can achieve a satisfactory diagnostic yield after fewer passes when compared to fine needle aspiration (FNA) needles, without an overall diagnostic advantage. Limited data are available to explain these results. We compared FNA and side-beveled FNB needles for micro-core/cellular material retrieval and diagnostic performance in pancreatic solid lesions. Methods: This was a single-center retrospective study of 110 consecutive patients who underwent EUS-sampling for a solid pancreatic lesion. All cellular material was collected for cell-block construction. The cytological examination was performed according to Papanicolaou. KRAS analysis was used as an ancillary technique to resolve indeterminate cases. Sensitivity and specificity were calculated in FNA (EchoTip® Ultra) and in FNB (EchoTip ProCore®) categories. All cases were evaluated for cellularity and micro-core (fragment retaining tissue architecture) retrieval. We compared FNA and FNB needles of different diameter (FNA: 19, 22, and 25G and FNB: 20, 22, and 25G), as well as large (19–20G) and small bore needles (22–25G). Results: Considering only positive cytology as diagnostic for malignancy, FNB needles showed higher sensitivity than FNA needles (86.4% vs. 54.9%, P = 0.002). If KRAS-mutated indeterminate cases were considered as malignant, overall sensitivity was 94.7%. In subcategories (FNB vs. FNA), sensitivity was 97.7% versus 92.2%, P = 0.37. Micro-cores were present in 65.2% of FNB versus 15.1% of FNA samples (P < 0.0001), rising to 95.2% in 20G-FNB category, and in 88.5% of large bore versus 20.5% of small bore needles (P < 0.0001). Considering the overall amount of cellular material (micro-cores plus cellular aggregates), FNB needles were better than FNA (91.3% vs. 62.3%, P = 0.001). The needle diameter did not influence the overall amount of cellular material retrieval since a satisfactory amount could be retrieved in both categories (large vs. small bore needles: 88.5% vs. 71.2%, P = 0.063). Conclusions: FNB needles allowed a relevant improvement in positive cytology with reduced need of KRAS mutational assessment or ancillary techniques. Dedicating all cellular material to the construction of cell-blocks and high retrieval rate of micro-cores may explain these results.

Background and aim. Earlier diagnosis and more effective treatments are improving the survival of patients with HCC. Moreover, the natural history of HCC patients is different from that patients with non-neoplastic indications for liver transplantation. This issue becomes critical to provide an equitable allocation policy to patients listed for transplantation. UNOS adopted a MELD-based policy that assigns the native MELD for patients with stage I HCC and 22 points for patients stage II HCC listed for Liver Transplant (LT), with an additional three points added every 3 months of waiting time in list for the latter. Organs are then assigned on the basis of the MELD score, irrespective of the indication. In countries outside the UNOS area, allocation for HCC patients still misses uniformity. Aim. The aim of the study was to generate an updated prognostic model for HCC applicable to organ allocation. Material and methods. We analysed disease progression (death or progression of HCC beyond T2 stage) in a cohort of 177 consecutive patients that presented with HCC inside the Milan criteria. Patients were treated according to the BCLC algorithm and prospectively followed by imaging every 3 months; 76 patients (43%) were listed for transplantation according to AISF/CNT guidelines. Transplanted patients were censored at the time of transplantation. Results. Median follow-up was 16 months. HCC progressed beyond T2 stage in 75 cases; 8 patients died while in T2 stage and 68 were transplanted. To verify the ability of the UNOS policy to predict HCC progression rate (PR), we compared the expected PR according to the UNOS policy with the observed PR for the respective population at risk. The current policy resulted in a large overestimation of PR in T2 patients. Two sensitivity analyses were conducted to identify risk factor (RF) for progression using the log-rank method: in the first one, transplanted patients were considered as disease progression; in the second one, only non-transplanted patients were analysed. RF significant in any analysis was considered for multivariable analysis. RF with the strongest relationship to progression included tumor persistence after local therapy or recurrence inside Milan criteria (HR 2.52–3.16; p < 0.0001). Using strongest RF for progression and the patient's natural MELD, an adjusted model applicable to organ allocation was generated, which decreased the discrepancy between expected and observed PR. Conclusions. Tumor persistence/recurrence inside Milan criteria after treatment strongly predicted the risk of tumor progression beyond Milan criteria. The current MELD exception largely overestimates progression in T2 patients treated according to BCLC. An adjusted model that begins with the patient's natural MELD, and stratifies progressive risk according to the response to local treatment, better captures the PR of T2 HCC