Endoscopic techniques for diagnosis and treatment of gastroentero-pancreatic neuroendocrine neoplasms:Where we are

BACKGROUND The correct localization of the primary tumor site and a complete histological diagnosis represent the milestones for the proper management of gastro-enteropancreatic neuroendocrine neoplasms(GEP-NENs).AIM To analyze current evidence on the role of endoscopy in the diagnosis/treatment of GEP-NENs.METHODS An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 15 years,using both medical subject heading(MeSH)terms and free-language keywords:gastro-enteropancreatic neuroendocrine neoplasms;endoscopy;ultrasound endoscopy;capsule endoscopy;double-balloon enteroscopy;diagnosis;therapy;staging.RESULTS In the diagnostic setting,endoscopic ultrasonography(EUS)represents the diagnostic gold standard for pancreatic NENs and the technique of choice for the locoregional staging of gastric,duodenal and rectal NENs.The diagnosis of small bowel NENs(sbNENs)has been improved with the advent of video capsule endoscopy and double-balloon enteroscopy,which allow for direct visualization of the entire small bowel;however,data regarding the efficacy/safety of these techniques in the detection of sbNENs are scanty and often inconclusive.From a therapeutic point of view,endoscopic removal is the treatment of choice for the majority of gastric NENs(type 1/2),for well-differentiated localized nonmetastatic duodenal NENs<1 cm,confined to the submucosa layer and for<10 mm,stage T1–T2,rectal NENs.EUS-guided pancreatic locoregional ablative treatments have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients.CONCLUSION Standard axial endoscopy and EUS still play a pivotal role in several GEP-NENs.Advanced techniques for increasing the rate of R0 resection should be reserved for high-volume referral centers.

Impact of COVID-19 on inflammatory bowel disease practice and perspectives for the future

Coronavirus disease 2019(COVID-19)is an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2(SARS-CoV-2);since its first description in December 2019,it has rapidly spread to a global pandemic.Specific concerns have been raised concerning patients with inflammatory bowel diseases(IBD),which are chronic autoimmune inflammatory disorders of the gut that frequently require immunosuppressive and biological therapies to control their activity.Accumulating evidence has so far demonstrated that patients with IBD are not at increased risk of contracting severe acute respiratory syndrome coronavirus 2 infection.As for the general population,the identified risk factors for severe COVID-19 course among IBD patients have been established to be advanced age and the presence of comorbidities.Treatment with high-dose corticosteroids has also been associated with an increased risk of death in IBD patients with COVID-19.Information on COVID-19 is constantly evolving,with data growing at a rapid pace.This will guarantee better knowledge and stronger evidence to help physicians in the choice of the best therapeutic approach for each patient,concurrently controlling for the risk of IBD disease under treatment and the risk of COVID-19 adverse outcomes and balancing the two.Moreover,the impact of the enormous number of severe respiratory patients on healthcare systems and facilities has led to an unprecedented redeployment of healthcare resources,significantly impacting the care of patients with chronic diseases.In this newly changed environment,the primary aim is to avoid harm whilst still providing adequate management.Telemedicine has been applied and is strongly encouraged for patients without the necessity of infusion therapy and whose conditions are stable.The severe acute respiratory syndrome coronavirus 2 pandemic has already revolutionized the management of patients with chronic immune-mediated diseases such as IBD.Direct and indirect effects of the COVID-19 pandemic will be present for some time.This is the reason why continuous research,rapid solutions and constantly updated guidelines are of utmost importance.The aim of the present review is,therefore,to point out what has been learned so far as well as to pinpoint the unanswered questions and perspectives for the future.

Acute mesenteric ischemia and small bowel imaging findings in COVID-19:A comprehensive review of the literature

BACKGROUND Coronavirus disease 2019(COVID-19),an infectious condition caused by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2),has rapidly spread worldwide since its first description in Wuhan in December 2019.Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality,extrapulmonary involvement has progressively gained relevance.In particular,gastrointestinal(GI)signs and symptoms,reported in up to two-thirds of patients with COVID-19,might represent the first and,in some cases,the only disease presentation.Their presence has been associated in some studies with an increased risk of a severe disease course.Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection.Although not typical of SARS-Co V-2 infection,several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging.The radiological findings were mainly reported in patients with abdominal symptoms,among which abdominal pain was the most common.AIM To discuss small bowel radiological manifestations of SARS-Co V-2 infection in abdominal imaging studies.METHODS Bibliographical searches were performed in Pub Med,using the following keywords:"COVID-19"AND"imaging"AND"gastrointestinal"OR"abdominal"OR"small bowel".RESULTS Of 62 patients with described radiologic small bowel alterations,mesenteric ischemia was diagnosed in 31 cases(50%),small bowel wall thickening in 10 cases(16%),pneumatosis in nine cases(15%),intussusception in eight cases(13%),pneumoperitoneum in two cases(3%)and paralytic ileus in two cases(3%).We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman.CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-Co V-2 infection or collateral findings in infected patients,but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.