Aims Defining the etiology of biliary stenosis is challenging, and endoscopic tissue sampling often shows a low diagnostic yield. We evaluated the diagnostic yield of endoscopic ultrasound (EUS) fine-needle aspiration/biopsy (FNA/FNB) and endoscopic retrograde cholangiopancreatography (ERCP) brushing/biopsy in biliary stenosis

Aims Endoscopic ultrasonography (EUS) with fine needle aspiration (EUS-FNA) has been proposed in addition to cholangiopancreatography (ERCP) for tissue sampling in the diagnosis of a malignant from non-malignant biliary stenosis. Aim of the study was to evaluate the diagnostic power of EUS-FNA alone and in combination with ERCP in biliary stenosis.

Abstract Background The role of histological activity in clinical management of ulcerative colitis (UC) is under investigation. Primary aim was, in a prospective study, to assess the role of histological activity as predictor of clinical relapse in a cohort of UC patients (patients) undergoing colonoscopy and followed-up for 1 year. Secondary aim was to assess the correlation between clinical, endoscopic and histological activity scores. Methods From February 2016 to February 2017 consecutive UC patients with clinical indication for colonoscopy were enrolled and clinically followed-up for 1 year. Inclusion criteria: (1) UC diagnosis; (2) Age > 18, ≤ 80 years; (3) regular follow-up; (4) indication for colonoscopy. During colonoscopy ≥2 biopsies was taken from ≥1 macroscopically involved and, possibly, from ≥1 uninvolved area. The day of colonoscopy clinical activity was assessed by the Mayo partial score, endoscopic activity by the Mayo endoscopic score, histological activity by the Geboes Simplified Score (GSS). Scores blindly assessed by three investigators. Statistical analysis: data expressed as mean [range], Spearman’s correlation coefficients, Cox hazards regression model used for univariate and multivariate analyses to identify predictors of clinical relapse at 1 year (HR[95% CI]). Results UC cohort included 77 UC patients. Characteristics of these 77 UC patients: 43 (55.8%) males, age 51 [24–80]; UC duration 14.7 [1–48] years. UC extent included n (%): 33 (42.8%) pancolitis, 24 (31.2%) left-sided, 20 (26%) proctitis. The day of colonoscopy, UC was clinically active in 15 (19.4%), inactive in 62 (80.6%) patients. Endoscopic activity was observed in 39 (50.6%) patients, histological activity (GSS≥ 3.1) in 37(48%) patients. Moderate correlations were observed between clinical and endoscopic scores (r = 0.439;p < 0.0001) clinical and histological scores (r = 0.32;p = 0.0045), endoscopic and histological scores (r = 0.653;p < 0.0001). During the clinical follow-up at 1 year, UC clinical relapse occurred in 24 (31%) patients, while 53 (69%) patients maintained clinical remission. At baseline colonoscopy, 11/24 (46%) UC patients were clinically active, 15/24 (63%) showed endoscopic activity and 16/24 (67%) patients histological activity. Univariate analysis identified clinical activity (HR 4.82 [2.15–10.82]; p < 0.001) and histological activity (HR 2.599 [1.11–6.08]; p < 0.027) as significant predictive factors for clinical relapse at 1 year. Multivariate model confirmed histological activity as predictive marker of clinical relapse (HR 2.44 [1.04–5.75]; p < 0.041). Conclusion Histological activity provided independent information for clinical relapse in a cohort of UC patients prospectively followed up for 1 year. Histological activity had a significant correlation with the endoscopic and clinical activity scores.

Histological Activity as A Predictor of Clinical Outcome in Ulcerative Colitis: A 1-Year Real-World Prospective Study Neri B1, Romeo S1, Ruffa A1, Calabrese E1, Sena G1, Grasso E1, Lolli E1, Michelangela M1, Zorzi F1, Palmeri G2 Soldati S3 and Biancone L1* 1Department of Systems Medicine, GI Unit, University “Tor Vergata” of Rome, Italy 2Pathology Unit, University “Tor Vergata” of Rome, Italy 3Department of Epidemiology, Lazio Regional Health Service, Rome, Italy

The relationship between clinical, endoscopic and histological scores used in ulcerative colitis (UC) is debated. Primary aim was to assess, in a prospective study, the correlation between clinical, endoscopic, and histological scores of activity in a cohort of UC patients undergoing colonoscopy. Secondary aim was to assess the role of histological scores in clinical practice. From February 2016 to February 2017 UC patients undergoing colonoscopy according to clinical indication were enrolled. Inclusion criteria: (1) diagnosis of IBD; (2) age> 18, <80 years; (3) regular follow-up; (4) indication for colonoscopy. During colonoscopy ≥2 biopsies were taken from ≥1 macroscopically involved area and, possibly, from ≥1 uninvolved area. All colonoscopies were performed by the same IBD-dedicated gastroenterologist. Clinical activity was assessed with Mayo partial score (activity ≥3),1 endoscopic activity with the Mayo endoscopic score (activity ≥2).1 Histological activity was assessed by the same IBD-dedicated pathologist using the Geboes Simplified Score for UC (activity ≥3.1).2 Scores were blindly assessed. Follow-up was planned at 1 year. Data expressed as median [range]; coefficient of correlation; T-test. UC cohort included 91 patients (M 52 [57%], age 51 [24–80] years, UC duration 15 years [1–48] years). UC extent was n (%): pancolitis 43(47%), left sided 25(28%), proctitis 22(25%) patients. The day of colonoscopy UC was clinically active in 16 (18%), inactive in 75 (82%) patients. Endoscopic activity was observed in 46(51%) patients (Mayo score: [n]: 0[17];1[28]; 2[21], 3[25]). In UC, microscopic activity (GSS ≥ 3.1) was observed in 39/91 (43%) patients: 5 of these 39 patients were in endoscopic remission. Significant correlation was observed between clinical vs. endoscopic scores (r = 0.486; p < 0.0001); clinical vs. histological scores (r = 0.35; p < 0.0001). At 1-year clinical follow-up data were available in 77 UC patients (75%). In 1 year, UC has been clinically active in 24 (31%) patients, inactive in 53 (69%) patients. 11/24 (46%) patients were clinically active at baseline, 15/24 (63%) patients endoscopically and 16/24 (67%) patients histologically. Of the 5 patients in endoscopic remission and histological activity at baseline, 1 had a clinical relapse. In a prospective study, significant correlation was observed between clinical, endoscopic and histological activity in UC. Histological activity observed in UC patients in endoscopic remission may represent a predictive marker of clinical relapse. Correlation between clinical and endoscopic, endoscopic and histological, clinical and histological activity scores References 1. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. N Engl J Med 1987;317:1625–9. 2. Jauregui-Amezaga A, Geerits A, Das Y et al. A simplified Geboes score for ulcerative colitis. J Crohns Colitis 2017;11:305–313.

First‐degree relatives (FDRs) of patients with colorectal cancer (CRC) have an increased CRC risk. Few studies have addressed if adenoma and advanced adenoma risk is increased among individuals, 40–49 years of age, with a family history of CRC. Therefore, the aim of the study was to define the prevalence and location of adenoma, advanced adenoma and CRC, according to age, in asymptomatic individuals with a family history of CRC.