BACKGROUND:Ampullary neuroendocrine tumors (NETs) are extremely rare, representing 0.3%-1% of gastrointestinal NETs and less than 2% of periampullary cancers. Due to their rarity, there is limited data on their natural history, management, and outcomes. Current European Neuroendocrine Tumor Society guidelines (2023) recommend pancreaticoduodenectomy (PD) as the standard treatment. However, this approach is invasive and associated with high morbidity and mortality. Emerging evidence suggests that endoscopic papillectomy (EP) could be a viable alternative in selected cases. This retrospective multicenter study aimed to evaluate the feasibility and outcomes of endoscopic resection for ampullary NETs. METHODS:This retrospective case series included 14 patients who underwent EP for ampullary NETs between 2011 and 2022 across three Italian tertiary centers. Pre-procedural evaluation was performed following European Society of Gastrointestinal Endoscopy guidelines. Endoscopic papillectomy was performed under monitored sedation, using standard snares for en bloc resection. Follow-up endoscopy was conducted at a median of 3 months. Primary outcomes included complete resection (R0) and recurrence rates; secondary outcomes focused on adverse events. RESULTS:Fourteen patients (median age: 62.5 years; 50% male) were included. Median tumor size was 18 mm. In 12 out of 14 cases, ampullary NETs were diagnosed only after endoscopic resection. Post-resection histology identified 8 G1 NETs (Ki-67 1%) and 6 G2 NETs (Ki-67 5%). Complete resection was achieved in 11 cases (78.6%). Among 3 incomplete resections, 2 were managed surgically, while 1 was followed up without recurrence. Residual disease was detected in 3 patients: 2 were managed endoscopically, and 1 required surgery. No recurrences occurred during a median follow-up of 14.5 months. Adverse events occurred in 42.9% of patients, including 5 cases of bleeding and 1 case of mild pancreatitis, all resolved without major sequelae. Median hospital stay was 2.5 days. CONCLUSIONS:Our findings suggest that EP offers a promising alternative to surgery in selected patients with ampullary NETs. Endoscopic resection was associated with high rates of R0 and favorable short-term outcomes, with effective endoscopic management of residual disease and procedure-related adverse events. Consistent post-procedural surveillance remains essential to detect residual or recurrent disease. Larger prospective studies are warranted to refine patient selection criteria, optimize protocols, and establish the long-term efficacy.

BACKGROUND AND AIM:We present the first experience with the submucosal injection-guided septotomy (SING) technique, which integrates the principles of flexible endoscopic septotomy with submucosal endoscopy, applied in different phases of the procedure for the treatment of Zenker's diverticulum (ZD). METHODS:Prospectively collected data from consecutive ZD patients treated with SING at three Italian centers (October 2019-August 2024) were analyzed. The primary outcome was clinical success (CS; Kothari-Haber Score < 2 at 3 months), whereas secondary outcomes included technical success (TS), procedural time, adverse events (AEs), hospital stay, and time to recurrence (Kaplan-Meier method). We also performed subgroup analysis according to ZD dimension (large vs. small) and to soft diverticuloscope use. RESULTS:A total of 102 patients underwent SING (median age 74 years [IQR 68-81]; 69.7% male). Median diverticulum depth was 30 mm (IQR 25-40) and baseline KHS score 4 (IQR 3-6). CS was achieved in 98% (95% CI 93.6%-99.8%), with 7% (95% CI 2.9%-13.9%) experiencing symptom recurrence over a median follow-up of 370 days (IQR 297-747). Recurrence-free probabilities were 93.5% at 6 months, 92.0% at 12 months, and 92.0% at 24 months. TS was 100%, median procedural time 30 min (IQR 25-45), and AEs occurred in 3 patients (2.9%), all managed endoscopically. CONCLUSIONS:SING is a safe and effective endoscopic treatment for ZD. Prospective comparative studies with standard techniques are warranted.

INTRODUCTION:Risk of transmission of carbapenemase-producing organisms (CPO) from duodenoscopes has been widely described and is now considered a well-known threat. Data on infection rates are limited to case series and confined to the setting of infection outbreaks. To date, data on universal screening for multidrug-resistant microorganisms of patients referring to the Endoscopy service are extremely scant. AIM:to evaluate the overall incidence of CPO colonization after endoscopic retrograde cholangiopancreatography (ERCP). METHODS:All consecutive patients undergoing ERCP at our Service were evaluated. All enrolled patients underwent rapid rectal swab for KPC genes 2-24 h before the endoscopic procedure, with Xpert Carba-R rapid detection swabs. 72 h after ERCP, patients underwent a second rapid rectal swab for CPO. RESULTS:from July 2022 to 15th November 2023 539 patients referring to the Endoscopy Unit for ERCP were evaluated. Of these, 16 had already a known colonization for MDR. The other 523 patients were screened: 10 resulted positive for CPO. Of the remaining 513 patients, 355 underwent post-procedural swab, and 9 (2,5 %) had a rectal colonization from CPO. CONCLUSIONS:duodenoscope-related infections are an open issue. Routine screening with anal swabs could provide early recognition of infection outbreaks and identification of high-risk cases to drive proper resource allocation.

BACKGROUND:Difficult benign biliary and pancreatic strictures are generally managed by using a Soehendra screw or cystotome. Many previous studies described the techniques without information even of mid-term follow-up. AIM:To confirm the long-term patency of dilated strictures following the application of a cystotome. METHODS:Data were collected from analysis of the literature using appropriate key words. Technical success was defined as the ability to traverse the stricture. Clinical success was defined as drainage of biliary or pancreatic strictures and symptoms' resolution. PRISMA criteria were followed to write the present review. RESULTS:Three papers were selected following the inclusion criteria. Our case series was added to the review of the literature. Reported technical and clinical success rates were 100% in all the studies and the rate of adverse events was reported from 9.1% to 60%. However, data on follow-up and long-term patency are scant. CONCLUSION:The use of a cystotome can be considered an alternative method for dilation of difficult pancreatic and biliary strictures, after the failure of conventional modalities. According to available literature, long-term results are rarely described, and this is still a crucial issue to evaluate the effectiveness of the technique.