Narrow band imaging with magnification endoscopy for celiac disease: results from a prospective, single-center study.

In celiac disease (CD), the intestinal lesions can be patchy and partial villous atrophy may elude detection at standard endoscopy (SE). Narrow Band Imaging (NBI) system in combination with a magnifying endoscope (ME) is a simple tool able to obtain targeted biopsy specimens. The aim of the study was to assess the correlation between NBI-ME and histology in CD diagnosis and to compare diagnostic accuracy between NBI-ME and SE in detecting villous abnormalities in CD. Forty-four consecutive patients with suspected CD undergoing upper gastrointestinal endoscopy have been prospectively evaluated. Utilizing both SE and NBI-ME, observed surface patterns were compared with histological results obtained from biopsy specimens using the k-Cohen agreement coefficient. NBI-ME identified partial villous atrophy in 12 patients in whom SE was normal, with sensitivity, specificity, and accuracy of 100%, 92.6%, and 95%, respectively. The overall agreement between NBI-ME and histology was significantly higher when compared with SE and histology (kappa score: 0.90 versus 0.46; P = 0.001) in diagnosing CD. NBI-ME could help identify partial mucosal atrophy in the routine endoscopic practice, potentially reducing the need for blind biopsies. NBI-ME was superior to SE and can reliably predict in vivo the villous changes of CD.

[Metal endoprosthesis in the treatment of acute neoplastic occlusion of the colon. Our experience]. / Endoprotesi metalliche nel trattamento delle occlusioni acute neoplastiche del colon. Nostra esperienza.

BACKGROUND: Acute large-bowel obstruction represents a surgical challenge whose management is controversial, usually requiring emergent surgery in adverse circumstances with increased morbidity and mortality compared with elective situations. METHODS: We report our experience with self-expanding metal stents in the initial management of acute neoplastic colorectal obstruction. From December 2000 to February 2003, insertion of self-expanding metal stents under endoscopic and fluoroscopic guidance was attempted in 22 patients, in 9 as primary palliative measure (group A) whereas in 13 as a bridge to surgery (group B). RESULTS: Stenting was technically successful in 20 patients. There were 2 perforations, and one patient died as a consequence. Nine of the 11 patients in the group B underwent elective colonic resection while in two patients with advanced malignancy the stent was considered as a definitive palliative treatment. In all 10 patients with ultimate prosthesis (8 group A, 2 group B) two dislocations and one recurrent obstruction were noted in the mean follow-up of 12 months. CONCLUSION: Self expanding metal stents represent a good option in the treatment of large bowel obstruction, providing time for a complete preoperative evaluation and mechanical bowel preparation as well as for restoring patient's general conditions thus avoiding emergency surgery with considerably lower morbidity and mortality rates. In patients with advanced cancer, they provide an alternative to surgery with satisfactory results.

Comparison of colloidal bismuth subcitrate and metronidazole, both in combination with an H2-antagonist as therapy for Helicobacter pylori.

In this random study, the efficacy of either colloidal bismuth subcitrate (CBS) or metronidazole in combination with an H2-antagonist in the treatment of various gastric pathologies was evaluated, along with the trends in antibody levels. Among the 40 Helicobacter pylori-positive patients with various gastroduodenal pathologies who underwent chemotherapy, 27 were treated with CBS and 13 with metronidazole. H. pylori was eradicated in 48.14% of the patients treated with CBS and 53.8% of those treated with metronidazole. After therapy, no statistically significant or slight decrease in the serum levels of antibodies was found.

[Endoscopic treatment of postoperative external pancreatic fistula by means of papillotomy and naso-pancreatic drainage]. / Trattamento endoscopico di una fistola pancreatica esterna postoperatoria mediante papillotomia e drenaggio naso-pancreatico.

External pancreatic fistula is a common complication after pancreatic resection. We report a case successfully treated by endoscopic papillotomy and a naso-pancreatic tube.