Background: Diet has a relevant role in triggering symptoms in inflammatory bowel disease (IBD) from the patients’ perspective, but there is gap the between patients’ and doctors’ perceptions. Few studies have addressed this topic. The aim of this study was to evaluate food habits and nutrition knowledge in a homogeneous cohort of patients with IBD from southern Italy. Methods: 167 consecutive patients with IBD were recruited. The survey was based on the administration of a semi-structured questionnaire assessing demographics, disease features, dietary behavior, and food intolerance. Results: The majority of patients did not consider food a cause of their disease. However more than 80% changed their diet after the diagnosis and most report an improvement in symptoms. Spiced and seasoned foods, dairy products, vegetables, and fruit were often avoided. A dairy-free diet was adopted by 33.7%. Food choices were based on self-experience and not on medical counselling. Dietary modifications deeply impact on lifestyle. Conclusions: Most of the patients with IBD set diet and lifestyle on self-experience and give up many foods. This has an impact on psychosocial functioning and can lead to nutritional deficiencies. High quality studies are warranted to assess evidence-based dietary strategies and develop patient-targeted dietary recommendations.

Background: The COVID-19 outbreak has led IBD clinics to adopt a remote monitoring approach in order to guarantee an adequate follow-up of patients with inflammatory bowel disease (IBD) and ensure the rules of social distancing. Aim: The aim of the study was to perform a survey on IBD patients who underwent remote monitoring in our tertiary referral center, to assess adherence, patients’ perceptions and satisfaction, and finally their opinions for future monitoring. Furthermore, we evaluated changes in disease activity and Quality of Life (QoL) using validated questionnaires. Methods: Consecutive patients with IBD scheduled for follow-up visits were switched to remote monitoring through e-mail from March 2020 to February 2021. Patients were asked to complete a questionnaire focusing on the following elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. Results: Four hundred and twenty four Caucasian patients completed the survey. 233 (55.1%) were male, 220 (52.0%) had Crohn’s Disease (CD). Median baseline Mayo Score and Harvey Bradshaw Index were 3 and 4, respectively. 9 (2.1%) patients were referred to the emergency department because of disease flares. 410 (96.9%) patients were satisfied with telemedicine, and 320 (76.5%) patients reported that they would maintain this approach also after COVID-19 pandemic. Overall, on univariate logistic regression analysis, none of the variables were related to patients’ satisfaction or to an improved QoL. The presence of ulcerative colitis was associated with the need for treatment change. Conclusions: Our results suggest that a telemedicine approach is well accepted by patients with IBD and could represent an effective tool in monitoring disease activity. Further controlled studies are warranted to properly assess if telemedicine can replace face-to-face consultations in IBD.

Background Lumen-apposing metal stents (LAMSs) are widely used for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Safety is a major concern and the timing of LAMS removal is debated owing to the risk of adverse events (AEs). Previous studies showed early stent removal was associated with a reduced risk of AEs, but data are still conflicting. The aim of this systematic review with meta-analysis was to identify the optimal timing for LAMS removal. Methods Major databases were systematically searched until May 2024. The outcome assessed was the cumulative incidence of AEs related to the early (within 3–4 weeks) versus late (after 3–4 weeks) removal of the LAMS. A random-effects (DerSimonian–Laird) model was used to pool the results. Results Eight studies (1820 patients; mean age 54–61.6 years; 63 % men) were included in the analysis. PFCs included walled-off necrosis (WON; 58.2 %) and pseudocysts (41.8 %). Pooled LAMS-related AEs rate were similar in the late versus early removal groups (risk ratio [RR] 1.03, 95 %CI 0.47–2.28; P = 0.94). Sensitivity analysis, including only studies applying a 4-week cut-off, confirmed a comparable AEs rate (RR 0.80, 95 %CI 0.38–1.65; P = 0.59). The mean (SD) follow-up of the studies was 208 (88) days. Conclusions The results of this meta-analysis showed no difference in the incidence of AEs between early and late removal of LAMSs in the presence of moderate heterogeneity across studies. Removal within 4 weeks is not warranted, and it may instead be planned on a clinical case-by-case basis according on the patient's condition. ^‡ Joint first authors Received: 14 October 2024 Accepted after revision: 05 March 2025 Article published online: 29 April 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMSs) has become the standard for managing pancreatic fluid collections (PFCs), especially walled-off necrosis (WON). However, LAMS-specific adverse events (AEs), including bleeding, stent occlusion, and infection, remain a concern. To mitigate these complications, some experts advocate placing coaxial double-pigtail plastic stents (DPPSs) within LAMSs. This narrative review critically examines the evidence from retrospective and prospective studies, one RCT, and recent meta-analyses on this combined approach. While the routine use of coaxial double-pigtail plastic stents (DPPSs) within LAMSs is not universally supported, emerging data suggest benefits in select high-risk scenarios, such as large WON, debris-rich cavities, or disconnected pancreatic duct syndrome (DPDS), in which coaxial DPPS within LAMSs can reduce occlusion, infection, and recurrence. In addition, the type of LAMS appears to influence safety outcomes: the SPAXUS stent shows lower bleeding and migration rates than the Hot AXIOS. We propose a pragmatic algorithm for the patient-tailored use of coaxial DPPS and discuss technical innovations to improve outcomes. While evidence is still evolving, personalized strategies and future high-quality studies are needed to define the optimal role of coaxial DPPS within LAMSs in the EUS-guided drainage of PFCs.

In the above-mentioned article the Graphical Abstract has been corrected. This was corrected in the online version on August 28, 2025. Article published online: 28 August 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

A 33-year-old man was referred to our institution for the management of a percutaneous pancreatic fistula after acute pancreatitis due to SARS-CoV-2 infection. He developed a peripancreatic collection (PPC), which was percutaneously drained because of infection. After resolution of the collection, percutaneous leakage from the main pancreatic duct (MPD) was observed. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary and pancreatic sphincterotomy, and placement of both pancreatic and biliary stents; however, the leak persisted. He was then referred to our institution, where initial management included ERCP with placement of two transpapillary pancreatic stents and the removal of the percutaneous catheter; however, fluid continued to leak from the percutaneous fistula ([Fig. 1]). A multidisciplinary board decided to perform a rendezvous procedure with interventional radiology to facilitate endoscopic ultrasound (EUS) transgastric drainage of the pancreatic area that was currently draining into the percutaneous fistula ([Video 1]) [1] [2] [3]. Video 1 Management of pancreato-cutaneous fistula after percutaneous drainage of peripancreatic collection. The procedure included an initial ERCP with replacement of the two pancreatic stents ([Fig. 2]) while the radiologist percutaneously placed a guidewire through the fistula to the point of leakage in the MPD. Then, using EUS, the point at which the percutaneous guidewire entered the MPD was identified and, under EUS guidance, a second guidewire was inserted transgastrically into the MPD through a 19-gauge needle and then advanced out through the percutaneous fistula ([Fig. 3]). Dilation up to 10 mm was performed to create a transgastric pancreatic fistula. The next step was to percutaneously insert a double-pigtail (10 Fr) stent, releasing the distal side into the stomach and the proximal side into the MPD, in order to stabilize the newly created fistula. Another transgastric plastic stent was endoscopically placed through the gastropancreatic fistula ([Fig. 4]). Injection of contrast dye through the percutaneous fistula confirmed complete drainage into the stomach. In conclusion, the procedure achieved complete exclusion and resolution of the pancreatic-cutaneous fistula. Endoscopy_UCTN_Code_TTT_1AR_2AI Article published online: 12 June 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany