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No data on mortality in celiac disease are currently available in southern Europe. Our aim was to evaluate mortality and the cause of death in adult celiac disease in a Mediterranean area. In all, 228 adults with celiac disease were histologically diagnosed in our department from 1980 to 1997. Full information on their state of health was obtained in 216 of 228 patients. A tabulation of patient-years at risk was constructed in terms of age at diagnosis and the interval from diagnosis. Standardized mortality ratio was calculated by dividing the number of observed deaths by the number of expected deaths. Twelve deaths were observed, whereas 3.12 deaths were expected (SMR = 3.8; 95% CI 2-7). The increased mortality was mainly observed within four years from diagnosis (8 observed; 1.4 expected) (SMR = 5.8; 95% CI 2.5-11.5). Twelve tumors were observed (six lymphomas). In conclusion, mortality from adult celiac disease in our geographical area is increased compared with the general population, and this increased risk seems due to non-Hodgkin's lymphoma. [ABSTRACT FROM AUTHOR]

Concordance in the extent of disease among the family members of patients with Crohn's disease has not been widely investigated. Furthermore, the relationship between the site of the disease and familial occurrence has never been studied. Our aim was to evaluate the familial occurrence of Crohn's disease in the various sites. Nine hundred thirty-four patients with Crohn's disease, observed consecutively in two gastrointestinal departments, were investigated to determine first-degree familial incidence (in both Crohn's disease and ulcerative colitis). Whenever two or more members were attending the same clinic, only one was regarded as a propositus. The analysis, therefore, was carried out on 882 patients. The exact site of the disease was determined in all patients either at diagnosis or during the follow-up by colonoscopy and by small bowel enema. The rate of concordance in the extent of disease and familial occurrence in the various sites was evaluated and the difference was calculated by chi-square test. Sixty-one propositi were identified among all the patients. Forty-nine had familial occurrence for the same disease (concordant patients), whereas 12 had at least one relative with ulcerative colitis (discordant patients). In 44 propositi with only one relative affected, the rates of concordance in the extent of the disease were 84, 68, 18, and 0% respectively, for the ileum, the ileum-right colon, the ileum-total colon, and the colon. The number of propositi in the various sites was as follows: 4 of 162 (2.4%) patients with the disease located in the colon, 1 of 9 (11%) with the jejunum site, 24 of 380 (6.3%) with the ileum site, 16 of 165 (9.7%) with the ileum and right colon site, and 16 of 164 (9.7%) with the ileum and total colon site. The chi-square values of propositi distribution among other sites and the colon was, respectively, as follows: jejunum, 2.2 (N.S.); ileum, 3.4 (P = 0.06); ileum and right colon, 7.4 (P = 0.006); and ileum and total colon, 7.4 (P = 0.006). This study shows a pronounced concordance in the site of the disease for family members with Crohn's disease and suggests that familial occurrence in Crohn's disease is less frequent when the disease is located in the colon rather than elsewhere. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, presents a systematic review with network meta-analysis comparing the efficacy of different bowel preparations for colonoscopy. The study evaluated randomized controlled trials that assessed bowel cleansing using the Boston Bowel Preparation Scale (BBPS). The primary outcome was cleansing success, defined as a total BBPS score of ≥6, and the secondary outcome was adenoma detection rate (ADR). The results showed that 2L PEG+simethicone, 2L PEG+lactulose, and 1L PEG+ASC were associated with high rates of cleansing success, with 2L PEG+simethicone also showing a significantly higher ADR. The authors recommend further randomized studies with larger sample sizes for a more accurate comparison of these products on ADR. [Extracted from the article]

This article discusses a randomized controlled trial that aimed to evaluate the effectiveness of combining a Computer Aided Detection (CADe) system and a G-EYE balloon in detecting adenomas during colonoscopy in a fecal immunochemical test (FIT)-based colorectal cancer screening program. The study included 188 subjects who underwent either CADe colonoscopy or CADe+GEYE colonoscopy. The results showed that there were no significant differences in the rate of "high-risk" subjects or the adenoma detection rate between the two groups. The authors suggest that the high detection rate of lesions with CADe may have limited the impact of the mucosal-exposure device. However, caution is advised as these are preliminary findings and full data is still awaited. [Extracted from the article]

This article discusses a study conducted in Sicily to evaluate the long-term effectiveness and safety of using a duodenal uncovered self-expandable metallic stent (SEMS) in treating malignant gastric outlet obstruction (GOO). The study included 106 patients, with 23 having advanced neoplasia. The technical success rate of the stent placement was 100%, and the average procedural time was 14 minutes. The study found that enteral stenting improved the quality of life for patients, with a high clinical success rate and low adverse events. However, patients with advanced neoplastic status had lower clinical success rates. Overall, the study suggests that SEMS is a feasible and safe option for patients with GOO, particularly those who are candidates for chemotherapy or surgery. [Extracted from the article]

This article discusses the use of endoscopic retrograde cholangiography (ERC) with multiple plastic biliary stents placed sequentially and side-by-side (multistenting) as a minimally invasive alternative to surgery for post-cholecystectomy biliary strictures (PCBS). The study, conducted at a single referral center in Sicily, evaluated the efficacy of this approach in 12 patients with PCBS. The results showed that the use of multiple plastic stents was safe and effective, with a high success rate and low recurrence rate. However, it did require multiple ERC sessions, which increased the risks associated with anesthesia. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the challenges and outcomes of performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA). The study retrospectively enrolled 30 patients with SAA who underwent ERCP, with the main indications being common bile duct stones, neoplastic obstructive jaundice, bilio-pancreatic leak, and bilio-digestive anastomotic stricture. The results showed that while reaching the biliary target remains a technical issue in SAA, the endoscopic technique had similar efficacy compared to patients with normal anatomy, although it required more procedural time and higher technical skills. The article emphasizes the importance of understanding different types of postoperative reconstruction and choosing the most appropriate endoscopic instruments and techniques to increase technical success and prevent complications. [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 a case study of an 83-year-old woman who had previously undergone a partial gastrectomy with Roux-en-Y gastro-jejunostomy and was experiencing abdominal pain and jaundice. The patient had common bile duct dilatation with gallstones, and due to her surgically altered anatomy, the authors performed endoscopic retrograde cholangiopancreatography (ERCP) using a double-balloon enteroscope (BE-ERCP). The procedure involved sphincterotomy, endoscopic papillary balloon dilation, and direct access of the enteroscope into the common bile duct to extract the stone. The authors conclude that BE-ERCP is a feasible and safe therapeutic procedure for patients with surgically altered anatomy, although it may require more time and technical skills. [Extracted from the article]

A 70-year-old man underwent colonoscopy in 2020 and was found to have a rectal polyp. After multiple unsuccessful attempts at endoscopic resection, the polyp was treated with trans-anal endoscopic microsurgery (TEM) at another institution. In 2023, a recurrence of the polyp was detected, and the patient was referred to a different institution to explore endoscopic treatment options. An endoscopic submucosal dissection (ESD) with mesorectal exposure was performed, resulting in a successful en bloc resection. The patient experienced symptoms of stenosis afterward, which were treated with mechanical dilation. [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]

This article presents the results of a multicenter study conducted in Italy on the development of a risk scoring system for predicting acute pancreatitis after ERCP (endoscopic retrograde cholangiopancreatography). The study collected detailed information on sociodemographic, clinical, and endoscope-related factors from adult patients undergoing ERCP. The researchers identified several factors associated with the risk of post-ERCP pancreatitis (PEP), including sex, age, position during the exam, history of acute pancreatitis, papilla status, and cannulation method. Based on these factors, a risk scoring system was developed to help clinicians stratify the risk of the procedure and inform patients. [Extracted from the article]

Background and Aims: The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing. Various cleansing solutions are currently available, but their comparative efficacy remains uncertain. This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy., Methods: MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations. The primary outcome was cleansing success (CS), and the secondary outcome was adenoma detection rate (ADR)., Results: On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations), 2 L PEG + simethicone (RR = 1.25 [95 %CI = 1.13-1.37]), 2 L PEG + lactulose (RR = 1.22 [95 %CI = 1.10-1.38]) and 1 L PEG + ascorbate (ASC) (RR = 1.03 [95 %CI = 1.01-1.06]) were significantly superior to 2 L PEG + ASC. Overall, 2 L PEG + lactulose resulted as the best product (SUCRA 0.94), followed by 2 L PEG + simethicone (SUCRA 0.93). On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations), only 2 L PEG + simethicone (RR = 1.60 [95 %CI = 1.05-2.43]) resulted significantly superior to 2 L PEG + ASC., Conclusions: 2 L PEG + simethicone, 2 L PEG + lactulose, and 1 L PEG + ASC seemed to provide high rates of CS, albeit only 2 L PEG + simethicone was associated with significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR., Competing Interests: Declaration of competing interest RV and LF received consultation fees from AlfaSigma and Norgine. MM, RDM and AR received consultation fees from Norgine. Other authors have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of this manuscript., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

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