Background The advantage of using the macroscopic on-site evaluation (MOSE) technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) performed with 22G Franseen needles has not been investigated. We aimed to compare EUS-FNB with MOSE vs. EUS-FNB performed with three needle passes. Methods This randomized trial involved 10 Italian referral centers. Consecutive patients referred for EUS-FNB of pancreatic or nonpancreatic solid lesions were included in the study and randomized to the two groups. MOSE was performed by gross visualization of the collected material by the endoscopists and considered adequate when a white/yellowish aggregate core longer than 10 mm was retrieved. The primary outcome was diagnostic accuracy. Secondary outcomes were specimen adequacy, number of needle passes, and safety. Results 370 patients with 234 pancreatic lesions (63.2 %) and 136 nonpancreatic lesions (36.8 %) were randomized (190 EUS-FNB with MOSE and 180 with standard EUS-FNB). No statistically significant differences were found between EUS-FNB with MOSE and conventional EUS-FNB in terms of diagnostic accuracy (90.0 % [95 %CI 84.8 %–93.9 %] vs. 87.8 % [95 %CI 82.1 %–92.2 %]; P = 0.49), sample adequacy (93.1 % [95 %CI 88.6 %–96.3 %] vs. 95.5 % [95 %CI 91.4 %–98 %]; P = 0.31), and rate of adverse events (2.6 % vs. 1.1 %; P = 0.28). The median number of passes was significantly lower in the EUS-FNB with MOSE group (1 vs. 3; P < 0.001). Conclusions The accuracy of EUS-FNB with MOSE is noninferior to that of EUS-FNB with three needle passes. MOSE reliably assesses sample adequacy and reduces the number of needle passes required to obtain the diagnosis with a 22G Franseen needle.

Background and study aims Surgery is the considered the therapeutic cornerstone for pancreatic neuroendocrine tumors (P-NETs), although burdened by high risk of significant adverse events. Recently, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been described for P-NETs. We aimed to evaluate the effectiveness and safety of EUS-RFA for treatment of P-NETs. Patients and methods We prospectively included all consecutive patients with P-NET ≤ 20 mm who were treated with EUS-RFA and were followed-up for at least 12 months. Results Ten patients (5 males, mean age 78.6 years, mean body mass index 28.2) with 11 P-NETs (mean size 14.5 mm; range 9 – 20 mm) localized in the pancreatic head (3 lesions), pancreatic body (5 lesions), and tail (3 lesions) underwent complete EUS ablation with one session of RFA. Complete ablation of P-NET was reached using a single-session RFA with a mean of 2.3 treatment applications per session. At both 6 – and 12-months computed tomography scans, all the patients had complete disappearance of lesions with radiological normalization. Regarding safety, only two cases of mild abdominal pain were recorded in two subjects with pancreatic head lesion, which were effectively treated with analgesics. The mean duration of hospital stay was 4 days (range 3 – 7 days). Conclusions EUS-RFA is effective and safe in treating P-NETs. It may be considered an effective therapeutic option in the treatment of small P-NETs independently from their functional status.

Low-volume preparations are gaining attention for higher acceptability but have been never evaluated in IBD. We compare the efficacy, safety, and tolerability of a 2-L PEG with a 4-L PEG solution in patients with ulcerative colitis. This is a multicenter, randomized, single-blind study. Adult outpatients with ulcerative colitis undergoing colonoscopy received either 2-L PEG plus bisacodyl or 4-L PEG. Bowel cleansing was assessed using the Ottawa Scale and rated as adequate if the score was ≤2 in each colon segment. Patient acceptance, satisfaction, and related symptoms were recorded. Preparation was adequate in 80% of the 211 patients without any differences between groups. Mean Ottawa scores for whole and right colon were similar in the 2 groups. As concern tolerability, 83% patients in 2-L PEG arm and 44.8% in 4-L PEG arm reported no or mild discomfort (P < 0.0001) and 94.3% and 61.9% expressed their willingness to repeat the preparation (P < 0.001). Palatability was better with 2-L PEG, whereas related symptoms occurred more frequently with 4-L PEG. Regardless of preparation, split dosage was associated with better cleansing. Further predictors of poor cleansing were moderate/severe discomfort during preparation and more than 6 hours between end of preparation and colonoscopy. Extension and severity of colitis did not influence quality of preparation. Low-volume PEG is not inferior to 4-L PEG for bowel cleansing in ulcerative colitis, but it is better tolerated and accepted. The time interval from solution intake and colonoscopy is the most important factor affecting quality of cleansing in ulcerative colitis.

Lymphocytic and collagenous colitis are emerging as common findings in subjects undergoing colonoscopy for chronic non-bloody diarrhea (CNBD). Data concerning microscopic colitis (MC) are still limited and affected by controversial epidemiological evidences. Recent converging lines of evidence suggest that MC correlates a lower risk of colorectal neoplasia. Accordingly, we prospectively assessed MC prevalence in a multicenter cohort of subjects submitted to colonoscopy for CNBD, thereby defining whether MC influences the risk of colorectal neoplasia. Consecutive patients with CNBD of unknown origin underwent pan-colonoscopy with multiple biopsies. The prevalence of neoplastic patients in MC was compared with that observed in negative CNBD subjects. Among 8006 colonoscopy, 305 subjects were enrolled for CNBD. Patients with CNBD were more likely to be women than men (odds ratio = 1.5; P = 0.001). Histopathology detected high prevalence of MC (16%) with a clear predominance of collagenous colitis (70%). A striking age-dependent rise in MC-associated risk was observed, depicting outstanding differences among varying age groups, as in the number needed to screen 1 new case. Gender distribution was balanced within MC patients (Female/Male = 1.5/1), especially among lymphocytic colitis (Female/Male = 1.2/1). MC patients were negatively associated with the risk of neoplastic polyps compared with negative CNBD subjects (odds ratio = 0.22; P = 0.035). MC is the first cause of CNBD in subjects submitted to colonoscopy. Multiple biopsies are strongly recommended, even in the case of uneventful endoscopic inspection, especially for age ≥40 years. MC has a reduced risk of colorectal neoplasia, suggesting that this model of chronic inflammation plays a protective effect against colorectal carcinogenesis.

Gastric carcinogenesis is a multistep process triggered by Helicobacter pylori and characterized by accumulation of molecular alterations. Two mechanisms are implicated in cancer-related molecular alterations: genetic and epigenetic. The former includes changes in the DNA sequence, the latter occurs without changes of DNA sequence. However, the most important difference between genetic and epigenetic alterations is that epigenetic changes are potentially reversible by eliminating toxic agents. DNA methylation is the major epigenetic phenomenon of eukaryotic genomes and involves the addition of a methyl group to the carbon 5 position of the cytosine ring within the CpG dinucleotide. DNA methylation is needed for the normal development of cells, whereas aberrant methylation of CpG islands confers a selective growth advantage that results in cancerous growth. The stomach is one of the organs frequently showing aberrant methylation of DNA epithelial cells because of its accessibility to exogenous toxic agents such as H. pylori infection. Aberrant methylation of CpG islands occurs early in gastric carcinogenesis, tends to increase as the process advances and is prevalently related to the infection. In conclusion, gastric cancer is mainly an epigenetic disease and H. pylori, acting through inflammatory mediators, may play a key role in the development of such molecular alterations.