Background and aim: Optical diagnosis (OD) of colonic polyps is poorly reproducible outside high-volume referral centres. Present study aimed to assess whether real-time AI-assisted OD is accurate enough to implement the leave-in-situ strategy for diminutive (5mm) rectosigmoid (DRSPs) polyps. Methods: Consecutive colonoscopy outpatients with 5mm) rectosigmoid (DRSPs) polyps. Methods: Consecutive colonoscopy outpatients with >1 DRSP were included. DRSPs were categorized as adenomas or non-adenomas by the endoscopist, with different expertise in OD, with the assistance of real-time AI system (CADEYE, Fujifilm Co., Tokyo-Japan). Primary study endpoint was >90% negative predictive value (NPV) for adenomatous histology in high-confidence AI-assisted OD of DRSPs (Preservation and Incorporation of Valuable endoscopic Innovations (PIVI-1) threshold), with histopathology as reference standard. The agreement between optical- and histology-based post-polypectomy surveillance intervals (>90%, PIVI-2 threshold) was also calculated according to European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force (USMSTF) guidelines. Results: Overall 596 DRSPs were retrieved for histology in 389 patients; AI-assisted high-confidence OD was made in 92.3%. The NPV of AI-assisted OD for DRSPs (PIVI-1) was 91.0% (95%CI [87.1-93.9]%). PIVI-2 threshold was met in 97.4% (95%CI [95.7-98.9]%) and 92.6% (95%CI [90.0-95.2]%) of patients according to ESGE and USMSTF, respectively. The AI-assisted OD accuracy was significantly lower for non-experts (82.3%; 95% CI [76.4-87.3]%) than for experts (91.9%; 95%CI [88.5-94.5]%), however non-experts in OD quickly approached experts’ performances over time. Conclusion: AI-assisted OD matches the required PIVI thresholds. However, this does not offset the need for a high-level confidence and expertise by the endoscopist. The AI system seems to be useful especially for non-experts.

Paraduodenal hernia is a rare pathology but its involvement in bowel obstruction syndrome should be always taken into account during diagnostic process.

Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vomiting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely reported in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction).

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Purpose. Bowel preparation for surveillance endoscopy following surgery can be impaired by suboptimal bowel function. Our study compares two groups of patients in order to evaluate the influence of colorectal resection on bowel preparation. Methods. From April 2010 to December 2011, 351 patients were enrolled in our retrospective study and divided into two homogeneous arms: resection group (RG) and control group. Surgical methods were classified as left hemicolectomy, right hemicolectomy, anterior rectal resection, and double colonic resection. Bowel cleansing was evaluated by nine skilled endoscopists using the Aronchick scale. Results. Among the 161 patients of the RG, surgery was as follows: 60 left hemicolectomies (37%), 62 right hemicolectomies (38%), and 33 anterior rectal resections (20%). Unsatisfactory bowel preparation was significantly higher in resected population (44% versus 12%; P value = 0.000). No significant difference (38% versus 31%, P value = ns) was detected in the intermediate score, which represents a fair quality of bowel preparation. Conclusions. Our study highlights how patients with previous colonic resection are at high risk for a worse bowel preparation. Currently, the intestinal cleansing carried out by 4 L PEG based preparation does not seem to be sufficient to achieve the quality parameters required for the post-resection endoscopic monitoring.

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