Background The role diminutive polyps and small polyps play in the development of advanced neoplasia (AN) or cancer during follow-up (FU) continues to be debated. Recent studies have shown that the risk of AN development during FU is higher in patients with > 5 small polyps but similar in patients with – or – small polyps2,3. Given these findings, the current study aimed to evaluate if current European FU guidelines1 at first screening colonoscopy according to the number of low-grade dysplasia tubular adenoma < 1 cm (“micropolyps”, MP) are too strict. Methods A longitudinal cohort study was carried out on a representative sample (50%) of patients who underwent a screening colonoscopy (clean colon) in 2010 showing at least 1 polyp. Patients with AN or cancers were excluded. Polyps > 1 cm or villous or high grade dysplasia/carcinoma in situ were considered AN. These patients made a FU colonscopy according to UE screening CCR guidelines. Patients were split up according to European guidelines in Low risk (– MP), Intermediate risk (– MP) and High risk (>5 MP). Data were analyzed by SPSS program. Results Of 640 patients included in the sample 172 (27%) were included in the surveillance program (mean age 62,2± 5,7 yr, 5–0), 120 male (69,8%). During first colonoscopy (2010) 370 MP were detected (M±SD 2,1±1,5, range –3 polyps for each patient). During FU (median 5.5 years), 315 colonoscopies were performed (mean 1.8; range –) and an AN was detected in 23 patients (13.4%): 20/23 tubulovillous microadenoma, 1/23 high grade dysplasia, 2/23 tubular adenoma > 1 cm. The detection of AN among patients in treatment with ASA was non significantly lower than the others. AN detection was lower among Low risk patients (13/108; 10.7%) as compared to Intermediate risk (7/33; 17.5%) and High risk (3/8; 27.3%) (P=ns). According to Kaplan-Meier analysis, the cumulative risk of AN among High risk was significantly increased (p=0.035) (figure 1). No interval cancers were found during the follow-up. Conclusions These findings suggest that EU guidelines for surveillance colonoscopies for > 3 small LGD polyps are excessively strict. We propose extending the time for a repeat colonscopy FU for these patients to 5 yrs References Segnan N. et al. European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis First Edition 2011 Chang MM, et al. Digest Liv Dis 2018; 50: 847–852 Jung YK, et al. Am J Gastroenterol 2018: 113(12):185–1.

Background: The improvement of liver fibrosis assessed using transient elastography (TE) by FibroScan® is leading to new insights in the concepts of fibrosis regression. The possibility of using new direct antiviral agents (DAA) in cirrhotic patients, previous excluded from PegInterferon treatment for risk of hepatic failure, has permitted to verify the hypothesis of fibrosis regression in these patients. TE should be interpreted taking into account the inflammatory profile associated with hepatitis.

Introduction: The epidemiology of hepatitis B in Europe is changing, with migration causing significant increases in prevalence rates. It is of paramount importance to identify the most effective ways to contain the disease. Systematic screening and treatment of migrants for CHB virus infection is likely to be cost-effective, but it is crucial to take into account the significant associated costs and the considerable net investment by governments.

Introduction: Hepatitis viruses screening is a secondary prevention strategy to detect earlier liver diseases and begin precociously antiviral treatment to prevent liver disease progression. Worldwide HCV prevalence is generally low and only in few countries is higher than 3.5%. Immigrants in Italy come predominantly from Eastern Europe, Asia and Africa. In all these areas HCV prevalence is lower than HBV.

s of the A.I.S.F. Annual Meeting 2010 /Digestive and Liver Disease 43S (2011), S65–S108 S81 diographic epicardial fat measurement could represent an easy diagnostic tool to define visceral and cardiac adiposity and could be proposed to better predict the cardiovascular risk.

independent groups of patients.Mir-224_1 has been described upregulated in hepato-cellular carcinomas.Moreover, deregulation of miR-217 has been reported in pancreatic cancers.Mir-23a inhibits both the development of B cells and the production of IL-6.Interestingly, in our study mir-122 is slightly up-regulated in NRs compared to SVRs.The levels of expression of miRNAs involved in tumoral processes were higher in the liver of NRs than in SVRs and RRs.Conclusion: NRs and SVRs present different miRNAs hepatic expression, before treatment.In particular, mir-99a, mir-181a-2*, mir-23a and mir-217 were significantly deregulated in NRs compared to SVRs.Thus, treatment response could be predicted with a molecular miRNAs signature.

Pegylated interferon (PEG-IFN) and ribavirin is the most effective treatment for chronic hepatitis C virus (HCV) hepatitis, but the rate of sustained virological response (SVR) remains approximately 50%, and 15–20% of all treated patients have a virological relapse after completing the treatment. Studies on the SVR have failed to discriminate between non-responders and relapsers.

Insulin resistance (IR) reduces response to pegylated-interferon (PEG-IFN)/ribavirin in chronic hepatitis C (CHC), but the mechanisms are still undefined. We examined the relationship between baseline insulin levels, the main component affecting homeostasis model of assessment - insulin resistance (HOMA-IR) for assessment of IR in non-diabetic patients, and the 'acute' virological response to PEG-IFN measured 24 h after the first injection and taken as correlate of intracellular interferon signalling. In 62 patients treated with PEG-IFN/Ribavirin, serum insulin and HOMA-IR were assessed at baseline, while hepatitis C virus (HCV)-RNA was measured at baseline and 24 h, 1, 2, 4 and 12 weeks after treatment initiation. Sustained virological response was examined 24 weeks after therapy discontinuation. Mean baseline insulin was 11.52 +/- 8.51 U/L and mean HOMA-IR was 2.65 +/- 2.01 both being significantly higher with advanced liver fibrosis. Hepatitis C virus-RNA decay observed 24 h after the first injection of PEG-IFN was significantly lower (0.7 +/- 0.8 log) in patients with HOMA > or =3 compared with those with HOMA <3 (1.7 +/- 0.8, P = 0.001). A highly significant (r = -0.42) inverse correlation was observed between baseline insulin levels and the 24-h HCV-RNA decay. The difference in early viral kinetics between patients with HOMA > or =3 or <3 resulted in a significant difference in the percentage of patients achieving rapid (week 4) and sustained virological response. Multivariate analysis, inclusive of patient age, HCV genotype and fibrosis stage, identified baseline insulin levels as the main independent variable affecting the 24-h response to PEG-IFN. Hyperinsulinaemia reduces the cellular response to Pegylated-interferon in CHC with IR. Strategies to reduce insulin levels before initiation of treatment should be pursued to improve efficacy of anti-viral treatment.