Objective. It is well known that low-grade intraepithelial neoplasia (LGIN) in Barrett's oesophagus (BE) might progress to high-grade intraepithelial neoplasia (HGIN) or carcinoma. Since accurate diagnosis of LGIN is difficult, general pathologists are frequently uncertain about the diagnosis of LGIN and its follow-up risks. The purpose of this study was to analyse the divergence between the diagnoses of general and specialized gastrointestinal pathologists. Material and methods. Fifty consecutive patients with a previous diagnosis of LGIN in BE, made by a general pathologist, were included in our study. The histopathological slides of every patient were reassessed in a blinded fashion by two specialized gastrointestinal (GI) pathologists. Inter-observer variability was calculated using kappa statistics. Results. LGIN was confirmed by specialized pathologists in only 25/50 patients (50%). Twenty-one patients (42%) had Barrett's metaplasia without intraepithelial neoplasia and in 4 patients (8%) HGIN or Barrett's carcinoma (BC) was revealed. Inter-observer agreement between the general and specialized pathologists for the diagnosis of LGIN was poor (κ = − 0.17) and good between both of the specialized pathologists (κ = 0.69). Patients with HGIN/BC were treated by endoscopic resection or surgery. In patients with LGIN, ablative therapy was performed. Complete response was achieved in 25 patients, but 3 patients developed HGIN and 1 patient developed BC after 10±3.6 months. Conclusions. BE with LGIN is difficult to diagnose. Inter-observer variability is unacceptable between general and specialized pathologists and therefore when diagnosing LGIN a second opinion should always be sought by a specialized GI pathologist. Ablation therapy seems to be effective in patients with LGIN, but follow-up endoscopies are necessary to detect metachronous neoplasia.

Aims In recently published comparative studies, it is reported that percutaneous transhepatic biliary drainage (PTBD) is less successful, causes more adverse events, and needs more re-interventions than endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with malignant extrahepatic bile duct obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. Could an improved technique of PTBD produce better results to use this technique for further comparative studies with EUSBD? Methods In our tertiary referral hospital, 116 prospectively documented, and retrospectively analyzed PTBDs with ultrasound guided ductal puncture were performed. In 16 of 30 PTBDs with metal stent implantation in malignant diseases, metal stent was inserted as a one-step procedure by endoscopic luminal guidance in the first session. Results Fifteen of 16 (94%) or 14/16 (88%) of PTBDs with primary metal stent implantation were technically or clinically successful. Mainly the left liver was used as access route for PTBD. Procedure time was 68.1 minutes (25–118), fluoroscopic time: 18.6 minutes (3–46), and patient radiation exposure: 5957 μGy/m² (471–17,569). In 2/16 (12.5%) patients, adverse events (1 × mild and 1 × moderate grade of severity) were documented. One re-intervention was necessary (0.1/patient) in the observation time of 6 months. The mean overall survival time was 163.2 (7–864) days after PTBD. Conclusions PTBD with ultrasound-guided ductal puncture and primary metal implantation by endoscopic luminal guidance in patients with malignant extrahepatic bile duct obstruction showed good technical and clinical success and low adverse event and reintervention rates in our retrospective cohort study. Clinical Trial Registration: ClinicalTrials.gov ID: NCT03541590.