Screening and surveillance methods for dysplasia in inflammatory bowel disease patients:Where do we stand?

Patients with long-standing ulcerative colitis(UC) and extensive Crohn's colitis(CC) are at increased risk for dysplasia and colorectal cancer(CRC). Several studies have shown that UC extending proximal to the rectum, CC involving at least 1/3 of the colon, co-existence of primary sclerosing cholangitis, undetermined or unclassified colitis, family history of CRC and young age at diagnosis appear to be independent risk factors for inflammatory bowel disease(IBD)-related CRC. Therefore, screening and surveillance for CRC in IBD patients is highly recommended by international and national guidelines, whilst colonoscopy remains the unequivocal tool in order to detect potentially resectable dysplastic lesions or CRC at an early stage. Although the importance of screening and surveillance is widely proven, there is a controversy regarding the time of the first colonoscopy and the criteria of who should undergo surveillance. In addition, there are different recommendations among scientific societies concerning which endoscopic method is more efficient to detect dysplasia early, as well as the terminology for reporting visible lesions and the management of those lesions. This article concisely presents the main endoscopic methods and techniques performed for detecting dysplasia and CRC surveillance in patients with IBD focusing on their evidence-based accuracy and efficiency, as well as their cost-effectiveness. Finally, newer methods are mentioned, highlighting their applicability in daily endoscopic practice.

Pattern and Risk Factors of Liver Injury among Hospitalized Covid-19 Patients:The Experience of a Greek Referral Hospital

Background:Although the new coronavirus(SARS-COV-2)affects predominantly the respiratory system,concomitant liver manifestations are common among COVID-19 patients.Aim:To investigate the prevalence and pattern of liver impairment(hepatocellular,cholestatic,mixed)and identify risk factors potentially associated with the liver injury in hospitalized patients with Covid-19.Materials and Methods:This retrospective study enrolled consecutive patients with Covid-19 who had evidence of liver injury on admission and/or during hospitalization in a tertiary hospital.Patient demographic,clinical and laboratory data were captured from the hospital’s electronic data monitoring system.Univariate and multivariate logistic regression analysis were applied to identify risk factors for liver injury.Results:Overall,of the 113 hospitalized Covid-19 patients,73(64.6%)patients had evidence of liver injury.Admission to Intensive Care Unit and length of in-hospital stay were identified as independent risk factors for liver injury by multivariate analysis(p=0.014 and p=0.001,respectively).35 patients(47.9%)had hepatocellular and 18 patients(24.7%)had cholestatic liver injury.Admission to Intensive Care Unit was statistically significantly associated with hepatocellular injury(p=0.006).Conclusions:Liver injury is common in hospitalized Covid-19 patients.Hepatocellular-type injury is more common and is associated with a more severe course of disease.