Aims We describe a patient that was successfully treated for refractory esophageal stenosis and chronic gastrocutaneous fistula with combined endoscopic-radiology intervention.

Aims A paradigm shift in ERCP training has been recently advocated, with a focus on competence-based training to ensure adequate milestones are met by all trainees. We aimed to characterize real-life practices and degree of trainee exposure to hands-on training in ERCP.

Aims Chronic radiation proctopathy is common manifestation of the epithelial damage to the rectum caused by radiation therapy. Despite its uncertain long-term efficacy and side effects occurring in up to 20% of patients, because of the lack of effective topical agents argon plasma coagulation of teleangiectasias is currently treatment of choice [1].

Aims Radiofrequency ablation (RFA) is a well established method for treating Barrett esophagus, gastric antral vascular ectasia and postirradiation proctitis. We describe succesfull use of RFA in treating large high-grade squamocellular dysplastic lesion in the esophagus.

Aims The impact of trainee involvement on the outcome of complex endoscopic procedures such as ERCP remains unclear. We aimed to evaluate the degree of trainee involvement in the real-life practice of ERCP procedures in a teaching setting.

Aims ERCP training remains a sensitive issue, with current data showing that traditional training methods, based on a hands-on, master-disciple paradigm, fall short of producing competent trainees. We aimed to evaluate whether a novel approach to training might improve the learning curve for novice endoscopists training in ERCP.

Quality standards for the practice of ERCP have been recently updated; however there is limited data regarding the impact of trainee involvement on procedure-related outcomes and patient safety. We aimed to evaluate whether trainee involvement increases the risk of procedure failure or adverse events.

AIMTo evaluate epidemiology and demographic data of patients diagnosed with Barrett’s esophagus in University Hospital Centre Zagreb between January 2012 and December 2017.MATERIALS AND METHODSIn a 6 year period, upper GI endoscopy was performed in 19950 patients. We have analysed endoscopy and hospital database regarding pathohistological confirmation and demographic data of patients diagnosed with Barrett’s esophagus .RESULTSEndoscopy suspicion of esophageal metaplasia (ESEM) was made in 592 patients. Pathohistological confirmation of Barrett’s esophagus was established in 163 patients (0.8%). Intestinal metaplasia without dysplasia was diagnosed in 137 patients, low grade dysplasia in 20 patients, high grade dysplasia in three and early cancer in three patients.In the group of 163 patients with confirmed Barrett’s esophagus 116 (71%) were male and 47 (29%) were female with median age of 58 years. Hiatal hernia was observed during endoscopy in 92 patients (56%).Patients with high grade dysplasia and early cancer have been treated with bandEMR and then radio frequency ablation (RFA), and all the patients with confirmed low grade dysplasia have been treated with RFA.CONCLUSIONBarrett’s esophagus still has a low incidence in Croatia, even in a high volume tertiary referral Centre.

Hemangioma of the small intestine is a rare vascular malformation which mostly presents as occult gastrointestinal bleeding and iron-deficiency anemia. Patients are often asymptomatic except of fatigue due to anemia. Hemangiomas can arise anywhere in the luminal gastrointestinal tract, with jejunum as the most commonly involved site. They are very hard to recognize mostly due to their localization. Video capsule endoscopy and balloon-assisted enteroscopy have very much improved preoperative diagnostics and made major contribution to establishing the diagnosis - which was very difficult in the past and almost all cases were diagnosed during or after the operation. Surgical resection is still the conventional treatment modality, although with the improvement of endoscopic therapeutic interventions (endoscopic mucosal resection, argon-plasma coagulation) there are more therapeutic possibilities.

Although the incidence of the most frequent malignant gastric tumour, adenocarcinoma, has been decreasing, during the last decades the incidence of proximal localizations of gastric cancer as well as esophagogastric cancer has been increasing. Due to the late detection of initially advanced disease the outcomes of treatment for the patients are unsatisfactory. Diagnosis is set by tumour biopsy during endoscopy. The basis of treatment of locoregional disease is surgery in combination with perioperative chemotherapy. Alternatively, if no preoperative chemotherapy is administered, adjuvant chemoradiotherapy or chemotherapy should be performed. Metastatic disease is treated with palliative chemotherapy and best supportive care. Treatment decisions should be individualized according to patients’ characteristics and made after multidisciplinary team discussion. The following text presents the clinical guidelines in order to standardize the diagnostic procedures, treatment and monitoring of patients with gastric cancers in the Republic of Croatia.

SMSA classification system consists of four factors (size, morphology, site, access) from which it identifies four different levels of polyp complexity (L1-L4).

Aim of the study was to evaluate the role of self-expandable metal stents (SEMS) for palliation of malignant dysphagia in lung cancer patients.

Despite advances in recent years we currently lack a formal algorithm for training endoscopists in ERCP and data regarding technical success and outcomes of procedures involving trainees is very limited. We aimed to analyze the impact of trainee involvement on the cannulation technique of the common bile duct.

To evaluate the clinical utility and diagnostic impact of single balloon enteroscopy (SBE) in a cohort of patients at a single tertiary center.

Background: Ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) frequently co-occur. Ulcerative colitis in PSC patients represents a distinctive phenotype characterized by a milder clinical course and inflammation but increased risk for colorectal cancer (CRC) and other solid tumors. We aimed to investigate these correlations in our IBD cohort. Methods: We evaluated medical charts from patients diagnosed with UC alone and PSC/UC in our referral center for inflammatory bowel diseases from 2011–2015. Descriptive statistical analysis was conducted for comparison of clinical characteristics between two groups. Multivariate logistic regression was preformed to identify the association of PSC with overall cancer, CRC and other tumors outside the digestive tract. Analysis was adjusted for age, gender, immunomodulator and biologics use. A two-sided p-value <0.05 indicated independent statistical significance. Results: A total of 349 patients with UC and 25 with distinctive PSC/UC phenotype were identified. Patients with PSC/UC were younger (38.4±10.85 vs 45.53±16.02; p=0.029), diagnosed for UC at younger age (28.04±9.64 vs 36.35±15.29; p=0.005), more likely to be male compared to the patients with only UC (p=0.013) and have pancolitis at initial presentation (94% vs 43%; p<0.001). PCS/UC patients were less likely to require UC-related hospitalization, steroids, immunomodulators and biologics but these differences were not statistically significant. PSC/UC patients had significantly increased overall risk of cancer compared to UC patients (OR 3.66; 95% CI: 1.17–11.41; p=0.025). Regarding CRC incidence PSC/UC patients revealed also a significantly increased risk compared to UC patients (OR 7.80; 95% CI: 1.75–35.20; p=0.008). Conclusions: PSC/UC patients represent a distinctive phenotype with male predominance, younger age and pancolitis in most patients. PSC/UC phenotype is associated with increased risk for CRC and increased overall risk for cancer. It is possible that we failed to find the connection between other specific solid tumors and PSC/UC except cholangiocarcinoma due to a relatively small sample size. However, it is important to maintain rigorous surveillance programme in patients with PSC/UC phenotype regarding cancer.

INTRODUCTION:Endoscopic ultrasonography (EUS) quantitative elastography methods are developed for non-invasive differentiation of pancreatic masses.AIMS:First: To evaluate the diagnostic value of strain ratio (SR) and hue histogram (HH) in patients with pancreatic masses and to determine the cut-off value between pancreatic cancer and focal pancreatitis using a pancreatic tissue close to the mass as a reference area. Second: To calculate new variable HH ratio (HHR) in an attempt to improve sensitivity, specificity and accuracy of the method.METHODS:In a prospective single center study, 149 patients were examined: 105 with the pancreatic masses and 44 controls using Pentax EUS linear probes in combination with Hitachi platforms. SR and HH were automatically calculated by machine software. Finally, two groups were formed: Pancreatic cancer group (58 patients) and focal pancreatitis group (47 patients). All statistical analysis has been made in SPSS 14.0 (SPSS Inc., Chicago, USA).CONCLUSION:Statistical analysis in our study showed that SR with a cut-off value of 7.59 reaches 100% sensitivity and 95% specificity with overall accuracy of 97% (confidence intervals [CI]: 92-97%) in detection of pancreatic cancer. Statistical analysis also showed that HH with a cut-off value of ≥86 reaches 100% sensitivity and just 45% specificity with overall accuracy of 66% (CI: 61-66%) in detection of pancreatic cancer. New variable HHR with cut-off ≥1.153 was slightly better with 98% sensitivity and 50% specificity, with overall accuracy of 69% (CI: 63-70%). SR showed significantly higher specificity compared with HH and HHR. More HH studies on Hitachi platforms are needed.

Background: CDI is the main cause of antibiotic associated infectious diarrhea.Incidence, severity and burden on the healthcare system related to CDI have increased in last decade in many industrialized countries.Epidemiological data of CDI are scarce in Southern Europe.Aims: To evaluate incidence and secular trend of nosocomial CDI between 2000 and 2009 in two Spanish referral hospitals.To analyze the highest incidence rates across specialties.Methods: Setting: Two referral hospitals in the Barcelona metropolitan area.Design: Retrospective surveillance study.Laboratory CDI diagnosis: Positive toxigenic culture and/or toxin detection in fecal samples using cell citoxicity neutralization assay.Patients: All in-patients from whom an appropriate fecal sample was submitted for CDI study between January 2000 and December 2009 were included.Nosocomial CDI case definition: A nosocomial CDI case was defined by the presence of either a positive stool test for C. difficile toxin or toxigenic C. difficile more than 48 hours after admission and that not have been diagnosed of CDI within the previous 28 days.Results: We identified 278 cases.Between 2000 and 2005 CDI incidence remained stable (0.52 and 0.54 cases/10.000inpatient days in 2000 and 2005 respectively).During second half of this decade a four fold increase in incidence occurred (0.79, 1.48, 1.95 y 2.33 cases/10.000in-patient days in 2006, 2007, 2008 y 2009 respectively).During de same period there was an increased hospitalary antibiotics consumption (from 56 to 67 defined daily doses/100 in-patient days between 2000 and 2009) that correlated with nosocomial CDI incidence (r = 0.98, p < 0.001).Hematology, ICU, Infectious Diseases and Gastroenterology Departments had the highest CDI incidence rates.Conclusions: CDI incidence has quadruplicate during second half of last decade coinciding with an increased use of antibiotics.Our results highlight the importance of CDI surveillance in hospitals, specially among high risk departments.