[Role of ERCP in the era of videolaparoscopic cholecystectomy. Personal experience]. / Il ruolo della CPRE nell'era della colecistectomia videolaparoscopica. Nostra esperienza.

INTRODUCTION: In subjects operated by videolaparoscopic cholecystectomy (VLC) incidence of synchronous cholecysto-choledochal stones is 7-20%. Aim of the study is to report our experience in endoscopic treatment of common bile duct (CBD) stones before VLC (sequential treatment). PATIENTS AND METHODS: From January 2001 to May 2007, 189 ERCP for synchronous cholecysto-choledochal stones were performed with analgo-sedation. In selected cases antibiotics and protease inhibitors were used. RESULTS: CBD clearance was 100%. The incidence of complications (mild, moderate and severe) was 8.2%, mortality 0.53% (1 patient). We observed 31 cases of transient asymptomatic hyperamilasemia (16.4%). A total of 186 subjects were operated by VLC, with only 3 conversion, without procedure-related mortality. CONCLUSIONS: In our opinion, the best treatment of syncronous cholecisto-choledochal stones is related to available tools and human experience, but for an experienced surgical and endoscopic team the sequential approach is feasible, safe and effective.

[Endoscopic surveillance of colon-rectum in the narrow band imaging era]. / Sorveglianza endoscopica del colon-retto. Ruolo del Narrow Band Imaging (NBI).

BACKGROUND AND AIMS: Colonoscopic surveillance is an established method of colorectal cancer (CRC) screening that reduces death rates, but has an adenoma miss rate of 10-20%. Narrow band imaging (NBI), a novel endoscopic technology, highlights superficial mucosal capillaries and improves contrast for small adenomas. This study evaluated the role of NBI in the improving colon adenoma detection. PATIENTS AND METHODS: White light colonoscope was compared with NBI for adenoma detection during colonoscopy. 120 patients presenting for diagnostic colonoscopy were randomly assigned to undergo colonoscopy using either conventional white light or NBI colonscope during instrument withdrawal. The outcome parameter was the difference in the adenoma detection rate between the two techniques. All polyps detected were removed for histopathological analysis. RESULTS: Adenomas were detected more frequently in the NBI group (51) than in the control group (49); however, the difference was not statistically significant (p = 0.128). The extubation time was significatively longer in the NBI group (p = 0.003). CONCLUSIONS: In our experience, the NBI did not increased the adenomas detection rate compared to white light by an endoscopist with a known high detection rate using white light.