Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

New Paradigms for Colonoscopic Management of Diminutive Colorectal Polyps: Predict, Resect, and Discard or Do Not Resect?

The possibility to predict in vivo the histology of colorectal polyps by advanced endoscopic imaging has resulted in the implementation of a more conservative management for diminutive lesions detected at colonoscopy. In detail, a predict-and-do-not-resect strategy has been proposed for diminutive lesions located in the rectosigmoid tract, whilst a predict-resect-and-discard policy has been advocated for nonrectosigmoid diminutive polyps. Recently, the American Society for Gastrointestinal Endoscopy set required thresholds to be met, before allowing the adoption of these policies in the clinical field. The ability of current endoscopic imaging in reaching these thresholds would depend on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended. Aim of this review is to summarize the data supporting the application of both a predict-and-do-not-resect and a predict-resect-and-discard policies, also addressing the potential pitfalls associated with these strategies.

Furazolidone-based therapies for Helicobacter pylori infection: a pooled-data analysis

Furazolidone-based therapies are used in developing countries to cure Helicobacter pylori infection due to its low cost. The low bacterial resistance toward furazolidone may render appealing the use of this drug even in developed countries. However, some relevant safety concerns do exist in using furazolidone. This was a systematic review with pooled-data analysis of data regarding both eradication rate and safety of furazolidone-based therapies for H. pylori infection. Intention-to-treat [ITT] and per-protocol [PP] eradication rates were calculated. Following furazolidone-based first-line therapy, H. pylori eradication rates were 75.7% and 79.6% at ITT and PP analysis, respectively [P<0.001]. The overall incidence of side effects and severe side effects were 33.2% and 3.8%, respectively. At multivariate analysis, only high-dose furazolidone was associated with increased therapeutic success [OR: 1.5, 95% CI: 1.3-2.7; P<0.001], while occurrence of side effects was relevant following treatment for a long duration [OR: 2.9, 95% CI: 2.2-4.1; P<0.001], high-dose furazolidone [OR: 2.3, 95% CI: 1.7-3.2; P<0.001] and bismuth-containing regimens [OR: 2.1, 95% CI: 1.5-2.8; P<0.001]. Furazolidone-based regimens usually achieve low eradication rates. Only a high-dose regimen improves the cure rate, but simultaneously increases the incidence of severe side effects. Therefore, we suggest that patients have to be clearly informed about the possible genotoxic and carcinogenetic effects for which furazolidone use is not approved in developed countries