Introduction: COVID-19 significantly affected endoscopic practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU). This multicenter study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020). Aims & Methods: Patients undergoing endoscopy during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Those deemed as low risk or negative for COVID-19 via polymerase chain reaction (PCR) testing were contacted 7-14 days later to assess infection status. Information for possible COVID-19 infection of PEU and number of weekly endoscopies in each center during the lockdown period were also recorded. Results: One thousand two hundred sixty-seven endoscopies were performed in 1222 individuals, across 9 European centers (6 countries). Among the 1135 pre-endoscopically low risk or PCR negative for COP0911 VID-19, 254 (22.4%) were tested post-endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% (95%CI: 0.2-0.12). The majority (6 patients, i.e., 75%) turned positive after esophagogastroduodenoscopy (EGD). Of these, 4 (50%) were considered obviously irrelevant to endoscopy, but for the other 50% the route of transmission remained obscure. Data regarding 163 PEU was recorded;5 [3%;95%CI: 0.4-5.7) tested positive during the study period. In 4 of them (2% of the total), the infection was considered to be associated to their work environment. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown. Conclusion: COVID-19 transmission in endoscopic units is highly unlikely in a lockdown setting, provided endoscopies are reduced to emergency cases and PPM are implemented.
Introduction. Foreign body ingestion is a common problem in large-volume endoscopic departments. Several techniques and devices have been described for the safe endoscopic removal of these objects. However, these devices may not be suitable in every clinical setting or—as in our case—they may not even be available. Case Presentation. We report the case of a 34-year-old patient, presenting with sharp foreign body ingestion. The foreign bodies were safely removed using a handmade protective hood due to lack of a commercial device. In our case, improvisation proved to be of great benefit for the patient as well as for the endoscopist. Discussion. Improvised interventions can be of special interest in the setting of insufficiently funded or equipped endoscopic departments.
Current guidelines advocate 3-4 passes with a fine-needle aspiration (FNA) to achieve high rates of diagnostic samples for malignancy when performing endoscopic ultrasound (EUS)-guided sampling of solid pancreatic lesions, in the absence of on-site cytologic evaluation. The aim of this study is to compare 2 vs. 3 needle passes in EUS-FNA for solid pancreatic lesions in terms of incremental diagnostic yield and to identify factors associated with the procedure's outcome. In this retrospective study, 2 passes of EUS-FNA were found to have similar diagnostic yield compared to 3 passes for the diagnosis of solid pancreatic masses, suggesting that there might be no significant incremental tissue yield when 3 passes are performed.
Abstract Background Ustekinumab (UST), a monoclonal antibody against the shared p40 subunit of IL-12/IL-23, has been approved for the treatment of moderate to severe ulcerative colitis (UC). The aim of this ambi-directional study is to collect and analyze data from a large cohort of Greek patients with UC treated with UST. Methods Data from UC patients treated with UST in 15 Greek hospitals were analyzed to evaluate rates of clinical response (CR, 50% reduction in UC-PRO2 compared to baseline) at week 16 of treatment, steroid-free clinical remission (SFCRem, pMAYO score <3 with UC PRO2=0) at weeks 16 and 54, and endoscopic healing (EH, endoscopic MAYO=0 and/or UCEIS=0-1, with 1 allowed only for vascular score) at week 54. Results Characteristics of the 132 enrolled patients are shown in Table 1. Most patients, 98/ 74% commenced UST treatment for active disease despite treatment and 92/ 72% had been exposed to biologic agents prior to UST (anti-TNFs, 66/50%, vedolizumab (VDZ) 57/43%). Fifty-three (40%) and 29 (22%) had received a single or two biologics (IFX and VDZ, 18/14%), respectively. By week 54, 19 had discontinued treatment due to no response. A sum of 116 patients have reached week 16, out of whom 104 have enough data to be analyzed. SFCRem was achieved in 49/47% patients. Analysis of patients with active disease at induction (87 in total with adequate data) showed that CR was achieved in 64/74%. Of 49 patients who completed 54 weeks of treatment, 25/51% were in SFCRem. Of 38 patients with adequate endoscopic data 14 /37% achieved EH. Patients who achieved SFCRem at week 16 were more likely to maintain SFCRem at week 54 (OR=3.89 [1.10-13.76], P=0.035). CR at week 16 was not associated with SFCRem at week 54. In univariate analysis SFCRem at week 54 was negatively associated with baseline disease activity (pMAYO score OR=0.78 [0.61-0.99], P=0.047; UCEIS OR=0.55 [0.36-0.85], P=0.007; WBC/1000: OR=0.65 [0.49-0.87], P=0.003), refractoriness to IFX (OR=0.27 [0.08-0.85], P=0.026), and positively associated with concomitant use of 5-ASA at UST initiation (OR=3.69 [1.05-12.96], P=0.041) but not at week 54 (P=0.757). EH at week 54 was negatively associated with refractoriness to IFX (OR=0.13 [0.02-0.71], P=0.019) and VDZ (OR=0.19 [0.05-0.79], P=0.022). Conclusion UST is mostly used as 2nd or 3rd line treatment for moderate to severe UC. By the end of induction, patients' majority showed CR, while at year 1 SFCRem was achieved in 51% and EH in almost 40% of patients. Negative predictive factors of SFCRem at week 54 included baseline disease activity, WBC count and resistance to prior treatment with IFX, while concomitant use of 5-ASA at baseline had positive effect. Negative predictive factors for EH at week 54 were refractoriness to IFX or VDZ.
Vedolizumab, an anti-integrin antibody, is effective for moderate to severe ulcerative colitis and Crohn’s disease treatment with a good safety profile due to its gut selective mechanism of action. Upper respiratory tract vedolizumab adverse events are common; however, they are mild and do not require treatment withdrawal. Herein, we present a 39-year-old patient under vedolizumab treatment for ulcerative colitis who presented acute severe interstitial lung injury that necessitated vedolizumab withdrawal and systemic steroids administration.
A 72-year-old woman with obesity presented with recurrent episodes of emesis, mild abdominal pain, and intolerance to oral intake. Overall, she was in good clinical condition. Her vital signs were normal but physical examination revealed mild epigastric tenderness without peritoneal signs or ileus. Laboratory studies were unremarkable but chest X-rays showed distended mediastinum. Computed tomography of the chest and abdomen revealed herniation of nearly the entire stomach into the mediastinum, compatible with mesenteroaxial gastric volvulus ([Fig. 1]).
Einleitung Die “European Society of Gastrointestinal Endoscopy” Leitlinien empfehlen 3 oder 4 Nadelpassagen um eine ausreichende Probe >90 % der soliden pankreatischen Läsionen (SPL) zu gewinnen bei nicht vorhandener vor-Ort-zytologischen Evaluation; diese Empfehlung basiert auf einer Evidenz niedriger Qualität.
Aims Endoscopic-ultrasound fine-needle-aspiration (EUS-FNA) has become the standard of care for the diagnosis of pancreatic and peripancreatic tumors, and several factors are associated with its diagnostic accuracy. The aim of this study is to evaluate factors that are associated with the diagnostic accuracy of EUS-FNA in our center.
Aims COVID-19 has significantly affected endoscopic practice, as GI-endoscopy is considered a risky procedure for transmission of infection towards personnel of endoscopy units (PEU) and patients. ESGE recommended reduction of non-emergency endoscopies, personal protection measures (PPM) and post-endoscopy calls to patients, to check their COVID-19 status. This study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
BACKGROUNDCoronavirus disease 2019 (COVID-19) significantly affected endoscopy practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU). AIMTo assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020).
