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This article discusses the use of peroral endoscopic septotomy (POES) as a technique for treating Zenker's diverticulum, a condition affecting the esophagus. The study, conducted in two Italian referral centers, aimed to assess the efficacy of POES after at least one year of follow-up. The results showed that POES was effective in treating Zenker's diverticulum, with a high technical success rate. However, there were a few cases of poor clinical response and adverse events, including one severe case of bleeding. Overall, POES is considered a promising technique, but the possibility of adverse events should be taken into account. [Extracted from the article]

This article discusses the use of endoscopic papillary large balloon dilation (EPLBD) in the treatment of difficult choledocholithiasis, a condition characterized by the presence of stones in the common bile duct. The Italian Society of Digestive Endoscopy (SIED) conducted a nationwide survey to assess the current use and knowledge of the EPLBD technique among Italian endoscopists. The survey found that 68% of endoscopists adopted EPLBD as the first choice for difficult choledocholithiasis, and 43% performed maximal papillosphincterotomy before EPLBD. The survey also highlighted the effectiveness and safety of the EPLBD technique, with complications reported in less than 5% of patients. Overall, the survey suggests that the use of EPLBD has increased among Italian endoscopists and is considered the preferred approach for difficult choledocholithiasis. [Extracted from the article]

A letter to the editor is presented in response to the article regarding the review on balloon-assisted enteroscopy.

This article discusses a study conducted in Italy to evaluate the adherence of Italian endoscopic centers to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines on biliary stenting in malignant distal strictures. The study included 827 patients with distal malignant biliary strictures who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2020 and January 2022. The results showed that while there was full adherence to the guidelines for certain aspects, such as post-ERCP acute pancreatitis prophylaxis and retreatments, there were areas where adherence was poor, such as the excessive use of plastic stents and the routine performance of sphincterotomy. The study concludes that there is a need to improve adherence to the ESGE guidelines in these specific areas. [Extracted from the article]

This article discusses the need for a triage system to prioritize colonoscopies and effectively stratify the risk of colorectal cancer (CRC) among patients undergoing colonoscopy. The study derived and validated a predictive model for CRC based on the Italian RAO criteria, which categorize patients into high, intermediate, and low priority groups. The predictive model included factors such as age, previous colonoscopy history, clinical indications, and alarm features. The model based on RAO criteria outperformed models based on other criteria, and it was geographically and prospectively validated. The study concludes that this clinical prediction tool can help clinicians prescribe colonoscopies appropriately and optimize resource allocation. [Extracted from the article]

This article discusses the impact of inappropriate indications for colonoscopy on waste production and the potential benefits of intervention. The study, conducted in Italy, involved 2,546 patients undergoing colonoscopy for clinical indications outside of colorectal cancer (CRC) screening programs. The researchers developed a predictive model based on patient-related variables and indication criteria to identify low-risk patients who could potentially avoid colonoscopy. The results showed that by sparing low-risk and inappropriate colonoscopies, a significant reduction in carbon dioxide emissions could be achieved. However, using appropriateness criteria may result in missing some patients with CRC. The study suggests that a clinical predictive model based on patient-related variables and Italian criteria could effectively reduce carbon dioxide emissions while maintaining a low miss rate for CRC. [Extracted from the article]

This article discusses a multicenter prospective study conducted in Italy to validate the RAO criteria for colonoscopy indication. The study involved 9 institutions and included 2,546 adult patients undergoing colonoscopy. The RAO criteria, which prioritize colonoscopy based on different clinical indications, were found to be more discriminative than the EPAGE-II and ASGE criteria. The study suggests that the RAO criteria can be used to triage patients and determine the priority of colonoscopy examinations. [Extracted from the article]

The article discusses the challenges of performing endoscopic biliary drainage (BD) in patients with altered anatomy, which reduces the chances of success compared to patients with standard anatomy. The study, conducted in multiple Italian centers, aimed to explore the different approaches to BD in patients with altered anatomy and the number of attempts required. The results showed that interventional endoscopic ultrasound (EUS) had a higher clinical success rate compared to device-assisted enteroscopy (DAE). However, a significant proportion of patients required multiple attempts to achieve success. The study concludes that despite the sub-optimal success rate, interventional EUS is an effective option for patients with altered anatomy. [Extracted from the article]

Background Acid exposure time ( AET) is considered the most useful parameter to predict response of reflux-related heartburn to medical or surgical treatment. However, recent studies showed high rates of heartburn response to proton pump inhibitor ( PPI) therapy in patients with normal AET. We aimed to compare the efficacy of postreflux swallow-induced peristaltic wave ( PSPW) index and mean nocturnal baseline impedance ( MNBI) with AET in linking PPI-responsive heartburn to reflux. Methods Off-therapy impedance- pH tracings from 425 patients, 317 with PPI-responsive and 108 with PPI-refractory heartburn were blindly re-analyzed. Demographic and endoscopic characteristics, conventional impedance- pH variables, PSPW index, and MNBI were assessed with multivariate logistic regression to identify factors independently associated with PPI responsiveness. Prediction models were developed to assess the strength of reflux linkage with factors independently associated with PPI responsiveness by calculating the area under the curve ( AUC) at receiver-operating-characteristic ( ROC) analysis. Key Results At multivariate logistic regression analysis, AET, MNBI, and PSPW index were the only factors independently associated with PPI responsiveness, abnormal values found in 60%, 76%, and 92% of PPI-responsive cases ( P<.017). At ROC analysis, PSPW index ( AUC:.794, P=.002) and MNBI ( AUC: 0.742, P=.003), both separately and combined ( AUC: 0.811, P<.001) linked reflux with PPI-responsiveness better than AET ( AUC: 0.687). Conclusions & Inferences AET, PSPW index, and MNBI are independently associated with PPI-responsive heartburn. PSPW index and MNBI can link PPI-responsive heartburn to reflux better than AET and should become part of the standard analysis of impedance- pH tracings. [ABSTRACT FROM AUTHOR]

Introduction One of the critical factors that influence graft function after live donor liver transplantation is the presence or absence of global or sectorial liver congestion. Many authors advocate for routine middle hepatic vein (MHV) reconstruction because it is often difficult to determine when the MHV or one of its major branches have functional significance. Predictive tests to assess hemodynamic and functional significance of the MHV and its tributaries are still under study. Case Report We have described a novel intraoperative manipulation and Doppler ultrasonographic evaluation that led to the decision to include the MHV with the right lobe graft. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that they have no conflict of interest.

Background: Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular., Methods: The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process., Results and Conclusions: The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO., (© 2024. The Author(s).)

Pancreatic fluid collections (PFCs), including pancreatic pseudocysts (PPs) and walled-off pancreatic necrosis (WON), are common complications of pancreatitis and pancreatic surgery. Historically, the treatment of these conditions has relied on surgical and radiological approaches. The treatment of patients with PFCs has already focused toward an endoscopy-based approach, and with the development of dedicated lumen-apposing metal stents (LAMS), it has almost totally shifted towards interventional Endoscopic Ultrasound (EUS)-guided procedures. However, there is still limited consensus on several aspects of PFCs treatment within the multidisciplinary management. The interventional endoscopy and ultrasound (i-EUS) group is an Italian network of clinicians and scientists with special interest in biliopancreatic interventional endoscopy, especially interventional EUS. This manuscript focuses on the second part of the results of a consensus conference organized by i-EUS, with the aim of providing evidence-based guidance on several intra- and post-procedural aspects of PFCs drainage, such as clinical management and follow-up., Competing Interests: Conflict of Interest There is no financial support to this study. Chiara Coluccio: Lecturer per steris. Cecilia Binda: Lecturer fees for Fujifilm, Steris, Q3 Medical, Boston Scientific. Andrea Lisotti received consultancy from Boston Scientific. Giuseppe Vanella: lecture fees from Boston Scientific and travel grants from Euromedical. Carlo Fabbri: consultant per Boston scientific, Lecturer per steris e Q3 medical All the other authors have no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Background and Study Aims: Balanced propofol sedation (BPS) administered by adequately trained non-anaesthesiologist personnel has gained popularity in GI endoscopy because of its shorter procedure and recovery time, high patient satisfaction, and low rate of adverse events (AEs), despite being considered controversial. We report data from an audit of endoscopist-directed (ED) nurse-administered sedation in an Italian referral hospital., Patients and Methods: Consecutive endoscopic procedures performed between 2020 and 2022 were considered. Under the guidance of the endoscopist, the nurse administered midazolam/fentanyl, followed by a progressive top-up dosage of a 10-20 mg bolus of propofol to achieve moderate to deep sedation. The endoscopists and nurses were all certified in our hospital with a continuous and scheduled training from 2006., Results: During the study period, a total of 19,407 examinations (7,803 EGDS, 10,439 colonoscopies, 77 PEG, 697 EUS, and 365 ERCP) and 14,415 patients were included. Of these, 29.4 % of patients were classified as ASA I, 66.5 % as ASA II, and 5.1 % as ASA III. Hypotension was recorded in 1,293 (6 %) examinations and bradycardia in 176 (0.9 %) patients. Eleven patients (0.06 %) had minor respiratory adverse events. Two patients (0.01 %) had major AEs requiring orotracheal intubation., Conclusions: ED-BPS is safe in low-risk patients. Major AEs occurred in 0.01 % of procedures., Competing Interests: Conflicts of interest No conflict of interest, (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)