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The diagnostic role of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) and fine needle biopsy (FNB) of pelvic masses has not been well established. We aimed to evaluate the diagnostic accuracy of EUS plus FNA/FNB in suspected local recurrence of pelvic masses.All consecutive patients with a history of lower gastrointestinal and pelvic mass undergone EUS-FNA/FNB were included in the study.In total 34 patients who underwent EUS-guided FNA or FNB of a perirectal mass were enrolled. The sampled lesion was a mass in 22 patients (64.7%) and a lymph node in 10 patients (29.4%). The univariate logistic regression analysis for diagnostic accuracy showed lesion size as a significant predictor of diagnostic accuracy [odds ratio (OR), 1.61; 1.08-2.27; P = 0.02]. Diagnostic sensitivity was 100% (71.5-100%) with EUS-FNB and 75% (34.9-96.8%) with EUS-FNA (P = 0.12); specificity was 100% in both groups (P = 1.0). Sample adequacy was 94.1% in the whole cohort, with 20/20 adequacy rate (100%) in the EUS-FNB group and 12/14 (85.7%) in the EUS-FNA group (P = 0.28).This is the first study demonstrating the diagnostic yield of EUS plus FNA/FNB in patients with pelvic masses comparing the two needles. Our results highlight the relevance of this technique, especially in undefined masses during oncological follow-up.

The pandemic diffusion of the SARS-CoV-2 infection throughout the world required measures to prevent and strategies to control the infection, as well as the reallocation of the hospital structures in order to take care of an increased number of infected patients. Endoscopy Units should be able to perform endoscopic procedures on COVID-19 infected as well as on noninfected patients. The aim of this manuscript is to propose a model for a fast reorganization of the endoscopy department environment in order to safely perform endoscopic procedures in this Pandemic COVID-19 scenario, according to the current advices given by the Scientific Societies.

Background: The mental resources required by laparoscopy (LS) and open (OS) surgery may be different; if this hypothesis is correct, the analysis of subjective total workload (STW) could allow to identify the causes of such differences and reduce the risk of error.

Background Target Controlled Infusion is a sophisticated tool for providing optimal sedation regimen avoiding under or oversedation in gastrointestinal endoscopy. Aims To compare standard moderate sedation vs. non-anaesthesiologist-administered propofol sedation during gastrointestinal endoscopy. Methods Randomized controlled trial of 70 consecutive colonoscopies and 70 consecutive esophagogastroduodenoscopies (EGD). Standard group ( n = 70), received fentanyl (1 μg/kg) + midazolam (0.03–0.04 mg/kg) or midazolam only; propofol group ( n = 70), received fentanyl (1 μg/kg) + propofol Target Controlled Infusion (1.2–1.6 μg/ml) or propofol Target Controlled Infusion only. Discharge time, endoscopist satisfaction and patient satisfaction were recorded in all endoscopies. Results Colonoscopy: discharge time was significantly shorter in the propofol than the standard group (1.1 ± 0.3 vs. 5 ± 10.2 min, respectively; P = 0.03). Endoscopist satisfaction was significantly higher (98.3 ± 11.4/100 vs. 87.2 ± 12/100; P = 0.001); patient satisfaction was significantly higher (95 ± 9.3/100 vs. 85.5 ± 14.4/100; P = 0.002) in the propofol compared to the standard group. EGD: discharge time was not significantly different in the propofol and standard groups (1.1 ± 0.7 vs. 3.9 ± 9.2 min, respectively; P = 0.146). Endoscopist satisfaction was significantly higher (92.7 ± 14.3/100 vs. 82.8 ± 21.2/100; P = 0.03); patient satisfaction was significantly higher (93.8 ± 18.2/100 vs. 76.5 ± 25.2/100; P = 0.003). In the propofol group 94.3% of patients vs. 71.4% of patients in standard group asked to receive the same sedation in the future ( P = 0.021). Conclusion Target Controlled Infusion is a promising method for non-anaesthesiologist-administered propofol sedation.

The recent advances in enteral stents design and composition introduced novel usage and indications, heading to a continuous addition of prostheses application in clinical practice. Since the first use to palliate malignant diseases, improving patient’s quality of life, in the last decades we assisted to a large spread, often becoming a first choice treatment in GI disorders. Indeed, the clinical indication of gastrointestinal stents includes endoscopic treatment of fistula and leaks besides the well-established role of restoring lumen patency in benign and malignant conditions. Several different kind of stents have been developed, each one with its own characteristics and benefits, including self-expandable plastic and metal stents, available as uncovered, partially covered, and fully covered as well as biodegradable stents. Recently, new drug-eluting stents, working both as palliative treatment and as local chemotherapy, are under evaluation. This review aims to critically evaluate the most recently published literature about enteral stents and to address endoscopists’ choice for a better patient management.

Mo1479 Staging of Esophageal and Junctional Cancer: Low Accuracy for EUS Tool in T2 N0 Patients Germana De Nucci*, Emanuele Dabizzi, Maria C. Petrone, Sabrina G. Testoni, Davide Bona, Luigi Bonavina, Pier Alberto Testoni, Paolo G. Arcidiacono Gastroenterology and Gatrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy; Gastroenterology and Digestive Endoscopy, G. Salvini Hospital, Milan, Italy; Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy Background & Aim: Despite the poor prognosis of esophageal carcinoma (EC), the stage of the disease correlates with the length of survival and recommended treatment. Accurate staging of EC is important since it directs further management. After distant metastases have been ruled out by CT scanning or PET-CT, Endoscopic Ultrasound (EUS) is the best available tool in the preoperative locoregional staging, being able to define the depth of tumor invasion and to visualize and even sample locoregional lymph nodes. Accurate staging is important to define T2N0 cancers, which can proceed directly to surgery. When compared to surgical pathology, EUS showed to have about 85 % of accuracy in staging tumor depth and about 75 % in detecting regional lymph node metastases. Aim of the present study was to report a single high volume center’s experience with EUS staging in a rare subset of patients with T2N0 esophageal cancers, evaluating the accuracy of EUS staging for T2N0 tumors. Materials & Methods: We conducted a retrospective study from our database of patients, enrolled prospectively, that underwent EUS for staging EC between January 2010 and August 2014. We identified patients with T2N0 tumors who underwent surgical resection. The preoperative EUS staging (cTNM) was then compared to surgical pathology (pTNM) results to evaluate accuracy. Results: 509 patients underwent EUS for staging of EC. Of these, 43 patients (33 men, mean age 67 years) received a diagnosis of cT2N0 disease by EUS. Surgical resection of EC was performed after a mean of 11 days post-EUS. When compared to final pathologic outcomes, 40 % of patients (17/43) were evaluated correctly and referred for appropriate therapy, 49 % of patients (21/ 43) were understaged by EUS and 12 % of patients (5/43) were overstaged. Among the 21 understaged patients, understaging occurred due to tumor depth in 6 patients (29 %), nodal involvement in 7 patients (33 %) and both in 8 patients (38 %). The 5 overstaged patients had a histological T1b stage, without nodal involment. EUS showed an accuracy of 65 % in staging for tumor depth and of 82 % in staging for nodal involvement. Positive predictive value of EUS diagnosis of cT2N0 EC was 40 % (17 pT2N0/43 cT2N0). Conclusions: In this challenging group of patients with T2N0 tumors, EUS understaged EC in 49 % of cases resulting in surgical resection when neoadjuvant chemoradiation may have been beneficial. This underline that T2N0 EC is a branching point in the clinical decision making for the management of EC and that accurate clinical staging in patients with T2N0 EC is of paramount importance. Further improvement in EUS imaging quality at various depth is needed.

Endoscopic ultrasound (EUS)-guided transenteric drainage of pancreatic fluid collections (PFCs) is a well-established procedure. Recently a novel lumen-apposing, fully covered self-expanding metal stent (SEMS) has been developed to overcome the limitations of conventional SEMS for EUS-guided transenteric interventions [1–3]. A 71-year-old woman with jaundice due to a pancreatic head adenocarcinoma was treated by endoscopic retrograde cholangiopancreatography (ERCP) and placement of a fully covered self-expanding metal stent (FCSEMS). The patient developed moderately severe acute pancreatitis, complicated by a 12-cm necrotic infected fluid collection in the pancreatic body, which was not controlled by antibiotic therapy and intravenous hydration. EUS-guideddrainagewasperformedusing a 10-Fr cystotome, followed by placement of a 0.035-inch guidewire, with a lumenapposing FCSEMS (Niti-S-SPAXUS, TaewoongCorp., Seoul, SouthKorea; diameter 16mm, length 20mm) then passed over the guidewire and deployed under fluoroscopic and endoscopic control (●" Video 1). The patient’s symptoms resolved within 24 hours and she was discharged 3 days later. After 2 weeks, the patient underwent a computed tomography (CT) scan because of recurrence of her fever, which showed incomplete resolution of the PFC with air inside it. A gastroscopy was performed, which showed necrotic tissue occluding the stent. Endoscopic necrosectomy was performed using different devices and forced irrigation with saline (●" Video 2). Complete cleaning of the cavity was achieved. A further CT scan performed after 2 months showed complete resolution of the collection. EUS-guided drainage of PFCs using this new lumen-apposing FCSEMS is technically feasible. In this case the clinical success of drainage was limited by early stent occlusion due to impacted necrotic tissue, which led to the patient requiring a second hospital admission and further treatment. Fortunately the large stent diameter allowed necrosectomy to be performed and the anchoring flanges prevented stent dislodgement during the procedure. Further data are needed to evaluate the possible role of a nasocystic tube in preventing stent occlusion, as has been reported for other models of lumen-apposing FCSEMS [4,5], in patients with a complicated PFC.

SpyGlass single-operator peroral cholangioscopy appears to be a promising technique to overcome some limitations of conventional peroral cholangioscopy. We aimed to prospectively evaluate the SpyGlass system in a cohort of patients with indeterminate biliary lesions.Patients with indeterminate strictures or filling defects at endoscopic retrograde cholangiopancreatography (ERCP) were consecutively enrolled. After SpyGlass visual evaluation, targeted biopsies were taken with the SpyBite and histopathological assessment was made by two experienced gastrointestinal pathologists. SpyBite-targeted biopsy results were evaluated by assessing agreement with surgical specimens and by evaluation of final, clinical follow-up-based diagnosis.Fifty-two patients participated in the study. In 7 cases, definite diagnosis (stones, varices) was made by SpyGlass endoscopic evaluation. In 42 of the remaining 45 cases, material suitable for histopathology assessment was provided by the SpyBite. Overall, a definite diagnosis was made in 49 (7 + 42; 94 %) cases. Agreement of SpyBite biopsy results with surgical specimen diagnosis was found in 38/42 (90 %) cases; sensitivity, specificity, and positive and negative predictive values were 88, 94, 96, and 85 %, respectively. Procedure-related complications consisted of one case of mild cholangitis and one case of mild pancreatitis.In our series, the SpyGlass system allowed adequate biopsy sampling and definite diagnosis with high accuracy in the vast majority of patients with indeterminate biliary lesions. Its use was associated with a low complication rate. Further refinements of the technique are warranted, but the SpyGlass system has the potential to become a diagnostic standard for the assessment of indeterminate biliary lesions.

Background and aims The utility of Carcino Embryonic Antigen (CEA) in differentiating malignant from benign pancreatic cysts is controversial. We sought to examine the role of CEA in differentiating benign from malignant cysts and its utility in progression of cyst size in follow-up. Methods Retrospective chart review of patients who underwent Endoscopic Ultrasound with Fine Needle Aspiration for mucinous cysts between 1998 and 2010. CEA was measured in benign and malignant mucinous cysts. Coefficient of determination ( R 2 ) was used to measure the association between change in cyst size and CEA. Mann–Whitney test was used to compare the median values of CEA. Results 143 patients (38.4% males) were included (mean age 68.9 ± 0.8 years). 105 patients had intra-cystic CEA measured. 63 patients underwent surgery while 80 patients were in the follow-up group. In the surgical group, median CEA value for benign and malignant mucinous neoplasms was 796 and 438 ng/ml, respectively ( p = 0.79). The median follow-up was 21 months. There was no correlation between CEA level and progression in cyst size in patients who had >6 months of follow-up, R 2 = 0.0002. Malignant transformation was observed in 5 (5.9%) patients. Conclusion CEA level was not predictive of malignant cyst nor cyst size progression over follow-up.

Pancreatic cancer is one of the most deadly solid tumors, with an overall 5-year survival rate of less than 5%. Due to a non-specific clinical presentation, it is often diagnosed at an advanced stage and is rarely amenable for curative treatment. Therefore early diagnosis and appropriate staging are still essential to define the best care and to improve patient survival. Several imaging modalities are currently available for the evaluation of pancreatic cancer. This review focuses on different techniques and discusses the diagnostic management of patients with pancreatic cancer. This review was conducted utilizing Pubmed and was limited to papers published within the last 5 years. The search key words pancreatic cancer, pancreatic adenocarcinoma, pancreatic tumors, diagnosis, radiology, imaging, nuclear imaging, endoscopy, endoscopic ultrasound and biochemical markers were used.

Mo1347 Clinicopathologic Factors That Influence the Accuracy of HighFrequency Catheter EUS for Superficial Esophageal Carcinomas Bong Eun Lee, Gwang HA. Kim, Hyun Jeong Lee*, Dong Hoon Baek, Geun Am Song Pusan National University Hospital, Busan, Republic of Korea Aim: To assess the accuracy of endoscopic ultrasonography (EUS) conducted with a high-frequency (20 MHz) catheter probe for determining the depth of superficial esophageal carcinoma (SEC), and to identify clinicopathologic factors that influence the accuracy of EUS for differentiating mucosal and submucosal lesions. Methods: A total of 126 patients with endoscopically suspected SEC, who underwent EUS and curative treatment at Pusan National University Hospital during 2005-2013, were enrolled. We reviewed the medical records of 126 patients and compared EUS findings with histopathologic results according to the clinicopathologic factors. Results: A total of 114 lesions in 113 patients were included in the final analysis. EUS assessment of tumor invasion depth was accurate in 78.9% (90/114) patients. Accuracy did not differ according to histologic type, tumor differentiation, tumor location, or macroscopic shape. However, accuracy significantly decreased for tumors R3 cm in size (p Z 0.002). Overestimation and underestimation for the invasion depth was found in 11 lesions (9.6%) and in 13 lesions (11.4%), respectively. In multivariate analyses, tumor size R3 cm was the only factor significantly associated with EUS accuracy (P Z 0.031), and was specifically associated with underestimation of true invasion depth. Conclusion: EUS using a high-frequency catheter probe generally provides highly accurate assessment of the SEC invasion depth. However, accuracy decreases for tumors R3 cm, suggesting that caution is warranted when selecting treatments for such tumors according to pretreatment EUS staging.

Luminal perforations and anastomotic leaks of the gastrointestinal tract are life-threatening events with high morbidity and mortality. Early recognition and prompt therapy is essential for a favourable outcome. Surgery has long been considered the "gold standard" approach for these conditions; however it is associated with high re-intervention morbidity and mortality. The recent development of endoscopic techniques and devices to manage perforations, leaks and fistulae has made non-surgical treatment an attractive and reasonable alternative approach. Although endoscopic therapy is widely accepted, comparative data of the different techniques are still lacking. In this review we describe, benefits and limitations of the current options in the management of patients with perforations and leaks, in order to improve outcomes.

Tu1649 Comparison of EUS-Guided Tissue Acquisition Using 25-Gauge and 22-Gauge Core Biopsy Needles Through Needle Cross-Over: a Prospective, Randomized Study Se Woo Park*, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, SI Young Song, Seungmin Bang Department of Internal Medicine, Institute of Gastroenterology, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea (the Republic of); Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of) Backgrounds: Even though theoretically thicker needle is able to get more tissue, hardness of the needle can lead to mechanical damage to endoscope, technical failure or potential blood contamination of sample. It is uncertain if needle gauge impacts the diagnostic outcomes of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) of pancreatic mass lesions. Aim The aim of this study was to evaluate 25G core biopsy needles in procurement rate of histologic core compared with 22G needles through EUS-FNB of pancreatic mass. Methods: From March 2014 to July 2014, 56 patients with solid pancreatic mass underwent EUS-FNB with both 25G and 22G core biopsy needle. Needle sequence was selected randomly, and two passes were made with each needle, consisting of 20 uniform to-and-fro movements on each pass with 10-ml syringe suction. A pathologist blinded to sequence of needle evaluated specimens for presence of the histologic core. Results: The mean age of the patients was 65.8 9.5 (range, 44-89) and 35 patients (62.5%) were male. The mean size of pancreatic masses was 35.3 17.1 mm (range 14-122.3 mm). Twenty eight patients (50%) had tumor at head/uncinate process of pancreas. There was no significant difference in procurement rate (for 25G 49/56 [87.5%] and for 22G 46/56 [82.1%], PZ0.599) and diagnostic accuracy (for 25G 98%, for 22G 95%). There were no technical failures or procedure related adverse events. Conclusion: Our study results confirm a trend towards a better procurement of histologic core and diagnostic accuracy for the 25-gauge needle though the difference was not significant. Furthermore, in a particular anatomic site, the 25-gauge needle could be recommended because it has a diagnostic accuracy similar to that of the 22-gauge needle but has fewer technical difficulties. Tu1650 Feasibility and Diagnostic Yield of a New EUS Guided Histology 20-Gauge Needle in the Evaluation of Intraintestinal and Extraintestinal Lesions Julio Iglesias-Garcia*, Priscilla A. Van Riet, Alberto Larghi, Marc Giovannini, Maria C. Petrone, Jose Larino-Noia, Jan-Werner Poley, Erwan Bories, Emanuele Dabizzi, Ihab Abdulkader, Genevieve M. Monges, Katharina Biermann, Guido Rindi, Claudio Doglioni, Guido Costamagna, Paolo G. Arcidiacono, Marco J. Bruno, Enrique Dominguez-Munoz Gastroenterology, University Hospital. Foundation for research in digestive diseases, Santiago de Compostela, Spain; Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Digestive Endoscopy Unit, Catholic University, Rome, Italy; Endoscopic Unit, Paoli-Calmettes institut, Marseilles, France; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita Salute San Raffaele University, Milan, Italy; Pathology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Foundation for research in digestive diseases, Santiago de Compostela, Spain; Pathology, Paoli-Calmettes institut, Marseilles, France; Pathology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Pathology, Vita Salute San Raffaele University, Milan, Italy; Pathology, Catholic University, Rome, Italy Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an accurate technique for sampling intraintestinal and extraintestinal lesions. However, cytology possesses certain limitations, which may be overcome if histological specimens are provided to the pathologist. The aim of the study was to evaluate the feasibility and accuracy of a newly developed 20-gauge histology needle. Methods: Retrospective analysis of a prospectively collected data base including patients who underwent EUS-guided biopsy with the 20-gauge ProCore histology needle with reverse bevel (3-HD-20) for the evaluation of intraintestinal or extraintestinal lesions. EUS procedures were performed under sedation with linear echoendoscopes (Olympus and Pentax). Samples recovered into cytological solution or formalin and processed for histological evaluation. Results were compared to the gold standard of surgical histopathology, or global pathological, clinical and radiological assessment, and follow-up in non-operated cases. Feasibility of the procedure and different technical aspects were recorded. Percentage of samples suitable for histological evaluation and the overall diagnostic accuracy were evaluated. Results are shown as mean and standard deviation or 95% confidence interval. Results: 51 patients (mean age 62.2 years, range 36-83 years, 26 male) were included. A total of 52 lesions were attempted to be sampled (mean size 31.88 12.4mm). Indications were pancreatic www.giejournal.org Vol mass (nZ30), intraabdominal lymph nodes (LN) (nZ6), subepithelial lesions (nZ6), liver mass (nZ3) and 1 cases of mediastinal LN, lung cancer, rectal mass, esophageal lesion, hiliar mass, intraabdominal mass and a left suprarenal gland mass. Lesions were accessed from esophagus in 3 cases, stomach in 27 cases, bulbous in 15 cases, second part of the duodenum in 6 cases and from the rectum in 1 case. EUS-guided biopsy was feasible in 50 cases (96.1%), with a mean of 1.7 passes (range 1-4). From 50 cases completed, sample quality was adequate for histological assessment in 46 lesions (92.0%). In the intention to treat analysis, diagnostic yield was 84.6% (95%CI: 72.5-91.9) and in per protocol analysis, diagnostic yield was 88.0% (95%CI 76.2-94.4). There were 2 (3.9%) mild complications (intraparietal hematomas at the place of FNB). Conclusion: The EUS-guided biopsy with the 20gauge Procore histology needle provides with a very good core sample for histological evaluation allowing a high histopathologic diagnostic accuracy. Tu1651 Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasound Guided Pancreatic Core Biopsy With Procore Needle Dongwook Oh*, Sang Soo Lee, Jin-Seok Park, Tae Young Park, Tae Jun Song, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (the Republic of) Objective: Histologic diagnosis is important for the diagnosis of autoimmune pancreatitis (AIP). Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been performed to establish histologic diagnosis. To evaluate the usefulness of EUS-FNB using 19-gauge ProCore needles for the diagnosis of AIP. Methods: EUSFNB with 19-gauge ProCore needle was performed in 15 patients who were suspected with AIP between July 2012 and July 2014. These patients were classified based on the international consensus diagnostic criteria (ICDC). Results: The amount of obtained tissue samples was enough for histologic diagnosis. 15 patients were classified into type 1 AIP (nZ14; definite nZ10, probable nZ4), type 2 AIP (nZ1, definite). Based on the ICDC, 5 and 6 of 15 patients have level 1 (positive for 3 or 4 items) and level 2 (positive for 2 items) histological findings. 7 of 15 patients showed typical diffuse swelling on parenchymal imaging. Among them, 4 and 3 of 8 patients were positive for level 1 and level 2 histologic findings. 8 of 15 patients showed atypical imaging (low-density mass, segmental enlargement with delayed enhacement) on parenchymal imaging. Among these patients, 2 and 3 of 8 patients were positive for level 1 and level 2 histologic findings. There was no adverse events after procedure. Conclusions: EUS-FNB by using 19-gauge ProCore needle is a safe and useful for histologic diagnosis of AIP. Clinical findings of 15 patients ume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSC Total (n[15)

AIM To test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients. METHODS Seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope (for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps < 6 mm. Formalin-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAP-associated fundic gland polyps. RESULTS Sixty-nine (90.8%) patients had gastric polyps (34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52 (68.4%) in duodenum (7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the II/III portion. CONCLUSION FICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient’s prognosis and treatment strategies.

Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope. Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett’s esophagus (BE) participating in a surveillance program. Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist. Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10 %) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42 %) patients; dysplasia was confirmed in 14 cases (28 %) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100 %, respectively. Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.

Many endoscopic imaging modalities have been developed and introduced into clinical practice to enhance the diagnostic capabilities of upper endoscopy. In the past, detection of dysplasia and carcinoma of esophagus had been dependent on biopsies taken during standard white-light endoscopy (WLE). Recently high-resolution (HR) endoscopy enables us to visualize esophageal mucosa but resolution for glandular structures and cells is still low. Probe-based confocal laser endomicroscopy (pCLE) is a new promising diagnostic technique by which details of glandular and vascular structures of mucosal layer can be observed. However, the clinical utility of this new diagnostic tool has not yet been fully explored in a clinical setting. In this paper we will highlight this new technique for detection of esophageal dysplasia and carcinoma from a clinical practice perspective.

Aim Quality of bowel cleansing significantly increases the shorter the time between bowel solution intake and endoscopic examination. We tested the efficacy and patient tolerability following a modified polyethylene glycol electrolyte (PEG) splitting regimen. Methods This was a prospective, single-blind, randomized, study. Patients were assigned to receive either PEG 4 L the afternoon before colonoscopy or PEG 3 L the day before and 1 L 3 h before the procedure the day of colonoscopy. Results The study population consisted of 336 patients, including 168 participants in each study arm. Although the bowel preparation quality was similarly quoted as excellent/good following the split and full regimen (95.2% vs 92.8%; p = 0.3), a significant ( p vs 68.4%) was observed following the split regimen as compared to the full regimen (55.4% vs 37.5%). The incidence of side-effects did not differ. When patients were asked about a future preparation if needed, 69% and 31% following the split and full regimen, respectively, declared to accept again the same preparation, the difference being statistically significant ( p Conclusions Our data found that an excellent bowel cleansing could be frequently achieved by simply modifying the split regimen from the standard PEG 2 plus 2 L to 3 plus 1 L.