Background/Objectives: H. pylori is the main preventable risk factor for gastric cancer through the development of extensive precancerous lesions, namely mucosal atrophy and intestinal metaplasia. Methods: This multicenter, nationwide study enrolled consecutive patients who underwent their first upper gastrointestinal endoscopy with standard biopsies. Clinical, endoscopic and histological data were gathered for statistical analysis using both univariate and multivariate analyses. Results: Data from 775 patients were collected, and H. pylori infection was detected in 172 (22.2%) cases. The infection prevalence significantly increased with age, and it was significantly higher in patients aged ≥50 years compared to younger patients (26.2% vs. 13.7%; p < 0.001; OR: 2.23; 95% CI = 1.48–3.36). The prevalence of extensive gastric precancerous lesions was 2.6%. The multivariate analysis showed that H. pylori infection (OR: 4.77; 95% CI = 1.51–15; p = 0.007), family history of gastric cancer (OR: 4.86; 95% CI = 1.36–15; p = 0.007), and age (OR: 1.07; 95% CI = 1.02–1.13; p = 0.007) independently increased the risk of these lesions. Conclusions: Data provided by this large study on the endoscopic prevalence of both H. pylori infection and extensive precancerous lesions in the stomach may be useful for designing preventive strategies aimed at reducing gastric cancer mortality.

BACKGROUND:Studies on surveillance of Intraductal Papillary Mucinous Neoplasms (IPMNs) are mainly retrospective with inherited bias. AIM:To identify factors associated with the development of relevant changes in low risk IPMN under surveillance. METHODS:This study analysed IPMN patients enrolled between 2015-2017 in the prospective observational multicentric registry PANcreatic CYsts (PANCY), focusing on brunch duct (BD). Extension of surveillance until December 31st, 2021 was proposed to the recruited patients. Relevant changes were defined as: worrisome features/high risk stigmata/pancreatic cancer, pancreatectomy, death due to IPMN/pancreatic cancer. RESULTS:At diagnosis, from 647 IPMNs, 547 (60%) were BD, 87 (9%) mixed type, and 13 (1%) main duct. 57 (8.8%) underwent immediate surgery and 590 (91.2%) active surveillance. Of them 34 (5.7%) underwent surgery with 2/3 malignancy. Malignancy rates for BD- and mixed-IPMNs under surveillance were 2.7% and 12.5%. Smoking (OR 2.2) and cyst size >15 mm at diagnosis (OR 7.1) were independent risk factors for relevant changes at multivariate analysis. The combination of cyst size ≤15 mm & age >65 was a protective factor at univariate analysis (OR 0.1), mainly in no smokers (OR 0.2, p < 0.01). CONCLUSIONS:BD-IPMN progression risk is low for lesions <15 mm in non-smokers, >65 years patients. Surgery and follow-up criteria are still imperfect, leading to inappropriate utilization of resources.

Upper gastrointestinal symptoms, including dyspepsia, gastro-oesophageal reflux disease (GERD), and alarm symptoms, frequently prompt referral for upper gastrointestinal endoscopy (UGIE). However, inappropriate endoscopic prescriptions contribute to increased healthcare costs, prolonged waiting lists, and environmental burden. We aimed to evaluate the diagnostic yield of UGIE according to the age threshold and presenting symptoms in routine clinical practice. In this nationwide, multicentre, cross-sectional study, consecutive adult patients undergoing their first UGIE for upper gastrointestinal symptoms were enrolled across 18 Italian centres. During pre-endoscopy patients’ interview, the main symptom was captured and accordingly used to categorize symptomatology as dyspepsia, reflux symptoms, or alarm symptoms. Endoscopic and histological findings, including Helicobacter pylori infection status, were prospectively collected. The association between clinical variables and endoscopic lesions was assessed using univariate and multivariate analyses. Overall, 762 patients were included (mean age 55.5 ± 15.4 years; 42.1

Background and study aims:Despite lower patient adherence, the overnight split-dose (SD) intestinal preparation regimen is currently recommended for early morning colonoscopies. Using low-volume preparation, we compared performance of a "day before late" (DBL) regimen, with the whole preparation taken between 8.30 pm and midnight on the day before the endoscopic procedure vs the overnight SD regimen for colonoscopies scheduled between 8 am and 10 am. Patients and methods:Patients were randomized to the DBL group (n = 162) or SD group (n = 158). The SD group took the second dose 5 hours before colonoscopy. Successful bowel cleansing, defined as an overall Boston Bowel Preparation Score ≥ 3, safety, compliance and tolerability were assessed in the two groups. Results:The DBL regimen failed to demonstrate non-inferiority compared with the SD regimen in terms of successful bowel cleansing (DBL, 88.2 % vs SD, 98.1%, P < 0.001). Subgroup analysis on colonoscopies before 9 am showed BBPS ≥ 3 rates of 94.6% and 100% in the DBL and SD groups, respectively P = 0.126). The two regimens showed similar compliance and tolerability. Compared with SD patients (25.5%), a lower proportion of DBL patients (13.9%) reported fear of incontinence during the journey to the hospital ( P = 0.01). Conclusions:Albeit more tolerable, the DBL regimen was less effective than the SD regimen with regard to successful bowel cleansing for colonoscopies between 8 am and 10 am. Subgroup analysis on colonoscopies scheduled before 9 am showed that the two regimens have similar efficacy, suggesting that the DBL regimen may be a valuable alternative to the SD regimen for very early morning colonoscopies.

Both macroscopic and histological lesions are frequently detected at upper endoscopy in elderly patients. We assessed the prevalence of main endoscopic and histological alterations in elderly (> 65 years old) patients. In this study, clinical, endoscopic and histological features of patients referred for upper endoscopy in clinical practice were retrieved. Both univariate and multivariate analyses were executed. Comparisons with previous data were performed. A total of 1336 underwent upper endoscopy in the 28 participating centres. At endoscopy, at least one macroscopic lesion was present in overall 420 (31.4

Background: Both macroscopic and histological lesions are frequently detected at upper endoscopy in elderly patients. We assessed the prevalence of the main endoscopic and histological alteration in aged patients who underwent upper endoscopy. Methods: In this cross-sectional study, clinical, endoscopic, and histological features of consecutive elderly patients referred for upper endoscopy in clinical practice were retrieved. Data were analysed at both univariate and multivariate analyses. Results: A total of 1,336 (M/F: 595/741; Mean age: 74.1; range: 65-102) underwent upper endoscopy during one month in the 28 participating centres. At endoscopy, at least one macroscopic lesion was present in overall 420 (31.4%) patients. Erosive gastritis (13.3%) and erosive oesophagitis (9.8%) were the most prevalent lesions, whilst Barrett’s oesophagus, gastric ulcer, duodenal ulcer and erosive duodenitis were observed in 1.8%, 2%, 1.4%, and 3.1% patients, respectively. Nine (0.6%) cases of oesophageal, 25 (1.8%) gastric, and 2 (0.1%) duodenal neoplasia were detected. At histology, H. pylori infection was diagnosed in 99 (15.9%) patients, and extensive (antral plus corporal) precancerous lesions on gastric mucosa were detected in 80 patients (14.5%). Endoscopic lesions were more frequent in males, in patients who underwent first endoscopy, and in those with alarm symptoms, whilst were reduced in patients receiving PPI therapy. At multivariate analysis, no independent predictor was found. Conclusions: Our data found that frequency of erosive and neoplastic lesions remained high in elderly patients, whilst the prevalence of both H. pylori infection and peptic ulcer was decreased.

BackgroundPost–fecal immunochemical test (FIT) colonoscopy represents a setting with an enriched prevalence of advanced adenomas. Due to an expected higher risk of colorectal cancer (CRC), postpolypectomy surveillance is recommended, generating a substantially increased load on endoscopy services. The aim of our study was to investigate postpolypectomy CRC risk in a screening population of FIT+ subjects after resection of low-risk adenomas (LRAs) or high-risk adenomas (HRAs).MethodsWe retrieved data from a cohort of patients undergoing postpolypectomy surveillance within a FIT-based CRC screening program in Italy between 2002 and 2017 and followed-up to December 2021. Main outcomes were postpolypectomy CRC incidence and mortality risks according to type of adenoma (LRA/HRA) removed at colonoscopy as well as morphology, size, dysplasia, and location of the index lesion. We adopted as comparators FIT+/colonoscopy-negative and FIT– patients. The absolute risk was calculated as the number of incident CRCs per 100,000 person-years of follow-up. We used Cox multivariable regression models to identify associations between CRC risks and patient- and polyp-related variables.ResultsOverall, we included 87,248 post-FIT+ colonoscopies (133 endoscopists). Of these, 42,899 (49.2%) were negative, 21,650 (24.8%) had an LRA, and 22,709 (26.0%) an HRA. After a median follow-up of 7.25 years, a total of 635 CRCs were observed. For patients with LRAs, CRC incidence (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.92–1.53) was not increased compared with the FIT+/colonoscopy-negative group, while for HRAs a significant increase in CRC incidence (HR, 1.53; 95% CI, 1.14–2.04) was found. The presence of 1 or more risk factors among proximal location, nonpedunculated morphology, and high-grade dysplasia explained most of this excess CRC risk in the HRA group (HR, 1.85; 95% CI, 1.36–2.52). Patients with only distal pedunculated polyps without high-grade dysplasia, representing 39.2% of HRA, did not have increased risk compared with the FIT– group (HR, 0.87; 95% CI, 0.59–1.28).ConclusionsCRC incidence is significantly higher in patients with HRAs diagnosed at colonoscopy. However, such excess risk does not appear to apply to patients with only distal pedunculated polyps without high-grade dysplasia, an observation that could potentially reduce the burden of surveillance in FIT programs.

Colonic diverticulosis and diverticular disease are among the most common gastrointestinal disorders encountered in clinical practice. These Italian guidelines focus on the diagnosis and management of diverticulosis and diverticular disease in the adult population, providing practical and evidence-based recommendations for clinicians. Experts from five Italian scientific societies, constituting a multidisciplinary panel, conducted a comprehensive review of meta-analyses, systematic reviews, randomised controlled trials, and observational studies to formulate 14 PICO questions. The assessment of the quality of the evidence and the formulation of the recommendations were carried out using an adaptation of the GRADE methodology. The guidelines covered the following topics: i) Management of diverticulosis; ii) Symptomatic uncomplicated diverticular disease: diagnosis and treatment; iii) Acute diverticulitis: diagnosis and treatment; iv) Management of diverticular disease complications; v) Prevention of recurrent acute diverticulitis; vi) Interventional management of diverticular disease.

Background/Aim: Prevalence of gastroduodenal endoscopic and histological lesions may modify over time due to different factors. We assessed both macroscopic and histological lesions currently detected at upper endoscopy performed in routine practice. Patients and Methods: Clinical, endoscopic, and histological data of consecutive adult patients referred for upper endoscopy in the 28 participating centres were analysed. Only patients who underwent the first endoscopic examination were considered. Prevalence of erosive/ulcerative lesions, cancers and extensive precancerous lesions in the stomach, and Helicobacter pylori infection was computed. Results: A total of 1,431 patients underwent endoscopy for gastro-oesophageal reflux symptoms (31.5%), dyspepsia (29.4%), or alarm symptoms (18.5%). Erosive oesophagitis or Barrett’s oesophagus was detected in 210 (14.7%) cases, peptic ulcer in 49 (3.4%), and a neoplastic lesion in 17 (1.2%). H. pylori was present in 201 (22.6%) cases, and extensive precancerous lesions on gastric mucosa in 46 (5.6%) patients. Gastric lesions were more prevalent in patients aged ≥50 years (26% vs. 18%; p = 0.001), and peptic ulcers were more frequently detected in patients with H. pylori (9.4% vs. 2.3%; p = 0.001) and in males (5.8% vs. 1.6%; p = 0.001), while neoplastic lesions in patients with alarm symptoms (3.8% vs. 0.6%; p = 0.001). Conclusions: The overall endoscopic lesions were more prevalent in patients aged ≥50 years, peptic ulcer and erosions were more frequent in H. pylori-infected patients, and extensive gastric precancerous lesions were present in less than 6% of cases.

Background and Aims: International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. Methods: Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. Results: A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. Conclusions: Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.

BACKGROUND:Colorectal cancer (CRC) screening programs based on fecal immunochemical tests (FITs) represent the standard of care for population-based interventions. Their benefit depends on the identification of neoplasia at colonoscopy after FIT positivity. Colonoscopy quality measured by adenoma detection rate (ADR) may affect screening program effectiveness.OBJECTIVE:To examine the association between ADR and postcolonoscopy CRC (PCCRC) risk in a FIT-based screening program.DESIGN:Retrospective population-based cohort study.SETTING:Fecal immunochemical test-based CRC screening program between 2003 and 2021 in northeastern Italy.PATIENTS:All patients with a positive FIT result who had a colonoscopy were included.MEASUREMENTS:The regional cancer registry supplied information on any PCCRC diagnosed between 6 months and 10 years after colonoscopy. Endoscopists' ADR was categorized into 5 groups (20% to 39.9%, 40% to 44.9%, 45% to 49.9%, 50% to 54.9%, and 55% to 70%). To examine the association of ADR with PCCRC incidence risk, Cox regression models were fitted to estimate hazard ratios (HRs) and 95% CIs.RESULTS:Of the 110 109 initial colonoscopies, 49 626 colonoscopies done by 113 endoscopists between 2012 and 2017 were included. After 328 778 person-years follow-up, 277 cases of PCCRC were diagnosed. Mean ADR was 48.3% (range, 23% and 70%). Incidence rates of PCCRC from lowest to highest ADR group were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10 000 person-years. There was a significant inverse association between ADR and PCCRC incidence risk, with a 2.35-fold risk increase (95% CI, 1.63 to 3.38) in the lowest group compared with the highest. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (CI, 0.95 to 0.98).LIMITATION:Adenoma detection rate is partly determined by FIT positivity cutoff; exact values may vary in different settings.CONCLUSION:In a FIT-based screening program, ADR is inversely associated with PCCRC incidence risk, mandating appropriate colonoscopy quality monitoring in this setting. Increasing endoscopists' ADR may significantly reduce PCCRC risk.PRIMARY FUNDING SOURCE:None.

Aims Although the split dose regimen is recommended as bowel preparation in patients underwent to morning colonoscopy, its use in daily practice remains limited. Conversely, the classic day before regimen account for up to 35% of inadeguate bowel cleansing.