TH is associated with improved long-term outcomes in Crohn's disease and may be a more suitable target than MH.

Background and study aims Previous studies have suggested a high prevalence of musculoskeletal injuries (MI) in endoscopists. Little evidence has come from European countries. Our main aim was to evaluate the prevalence, type, and impact of MI among Portuguese endoscopists. We also sought to identify risk factors for the development, severity and number of endoscopy-related MI. Material and methods A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG – CEREGA. Results The survey was completed by 171 endoscopists (response rate of 24.3 %), 55.0 % female with a median age of 36 years (range 26–78). The prevalence of at least one MI related to endoscopy was 69.6 % (n = 119), the most frequent being neck pain (30.4 %) and thumb pain (29.2 %). The median time for MI development was 6 years (range 2 months-30 years). Severe pain was reported by 19.3 %. Change in endoscopic technique was undertaken by 61.3 % and reduction in endoscopic caseload was undertaken by 22.7 %. Missing work was reported by 10.1 %, with the median time off from work being 30 days (range 1–90). Female gender and ≥ 15 years in practice were independently associated with MI and severe pain. Years in practice, weekly-time performing endoscopy, and gender were significant predictors of the number of MI. Conclusions Prevalence of MI was significant among Portuguese endoscopists and had a relevant impact on regular and professional activities.

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INTRODUCTION: The performance of endoscopy is characterized by frequent and repetitive activities. Endoscopists often report musculoskeletal injuries (MI). The widespread use of endoscopy and the execution of more technically challenging procedures may lead to higher rates of repetitive stress injuries. Despite previous American and Asian reports, little evidence has come from Europe. We aimed to determine the prevalence, risk factors and impact of MI among Portuguese endoscopists. METHODS: A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (SPG, n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG–CEREGA. RESULTS: The survey was completed by 171 endoscopists (response rate of 24.3%), 55.0% female, with a median age of 36 years (31-50). The majority of the respondents were consultants (77.8%; trainees 22.2%), with 97.7% currently performing endoscopy. The median time of endoscopic practice was 9 years (5-22). Regarding practice setting, 52.0% worked in academic centers, 41.5% in community centers and 63.9% in private practice. The median weekly-working time was 50 hours (45-60), 50% (37.5-62.5%) performing endoscopy. The prevalence of reported MI was 69.6% (n = 119). The median time for MI development was 6 years (3-16). The most common sites of injury were neck (42.9%) and thumb (42.0%). In 45.4%, the pain was evident both in work and daily activities and 22.7% referred pain even at rest. In the respondents with MI, 34.5% changed practice and/or reduced working activity and 33.6% reduced work-unrelated physical activity. Missing work was reported by 10.1% [median 30 days (4-45)]. The most common treatments were NSAIDs (57.1%) and physiotherapy (30.3%) but surgery was required in 1.7%. In the multivariate logistic regression, endoscopic practice >15 years (OR 3.514, P = 0.004), female gender (OR 2.443, P = 0.018) and higher percentage of time performing upper endoscopy (OR 0.974, P = 0.026) were independently associated with MI. CONCLUSION: Musculoskeletal injuries were reported by over two thirds of the portuguese endoscopists that completed our survey. These injuries had a significant impact on regular and professional activities. Female endoscopists and those with a minimum of 15 years of practice are at higher risk. The identification of these risk factors may result in practice changes to reduce the burden of the injuries.

Introduction: Colorectal cancer (CRC) is extremely rare in pediatric age. A poor outcome has been reported. Aims: We aimed to characterize a group of pediatric CRC patients. Materials and Methods: All patients with CRC below 18 years old registered in our Familial Cancer Risk Clinic (2002-2016) were included. Clinical and histologic features were evaluated. Germline mutations, microsatellite instability, and DNA mismatch repair proteins expression were analyzed. Results: Five patients were included (3 males; mean age at diagnosis: 14.2 years (range, 9 to 17 y) and 4/5 had family history of cancer in second-degree relatives. With a maximum follow-up of 5.6 years, 2/5 patients died after 10 and 24 months, and 1 recurred after 15 months. All tumors were ≥pT3N2 and 3/5 presented signet ring cells/mucinous histology, corresponding to cases with stronger family history of cancer. Nevertheless, all CRCs analyzed (n=4) were microsatellite stable and/or expressed all mismatch repair proteins. Loss of heterozygosity for the 3 Bethesda dinucleotide markers was detected in 1/3 informative CRCs. A likely pathogenic germline MSH2 mutation was identified in only 1 patient. Conclusions: Pediatric CRC presented advanced disease and poor prognosis. These tumors had distinct histologic and molecular presentations, resembling features from different carcinogenic pathways, thus suggesting a heterogenous nature.

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Ressecção endoscópica de tumor neuroendócrino duodenal com um novo dispositivo de ressecção transmural Palavras ChaveEndoscopia · Duodeno · Tumor neuroendócrino · Ressecção transmural Most well-differentiated, non-functional duodenal neuroendocrine tumours (NETs) limited to the mucosa/ submucosa can be treated effectively with endoscopic resection [1]. A full-thickness resection device (FTRD; Ovesco Endoscopy ® ) enables endoscopic transmural resection of suitable lesions with a fast minimally invasive technique [2]. A colonic FTRD was used for duodenal lesions as an "off-label" indication with good clinical outcomes and a complication rate comparable to duodenal endoscopic mucosal resection [3]. A duodenal FTRD (d-FTRD) with smaller diameter (19.5 vs. 21 mm), balloonassisted insertion and less clip interdental space was developed allowing easier upper oesophageal sphincter passage and minimising bleeding risk.We describe a 74-year-old male with a 10-mm postpyloric bulbar submucosal lesion (Fig. 1, 2) with biopsies showing a well-differentiated NET. Endoscopic ultrasonography showed a submucosal lesion. Endoscopic ultrasonography and 68-Ga DOTA-NOC PET/CT displayed no lymph node involvement or distant metastases. An attempt to resect with band ligation endoscopic mucosal resection failed because of an absence of aspiration into the cap. Transmural resection with the d-FTRD was scheduled in the operating room under general anaesthesia. Lesion borders were marked with argon plasma coagulation. Upper oesophageal sphincter dilation was performed with Savary-Gilliard bougie dilator (15-18 mm) allowing d-FTRD insertion. A paediatric colonoscope (outer diameter: 11.8 mm; working channel calibre: 3.2 mm) was then advanced to the duodenum with the d-FTRD attached. Traction of the lesion to the cap with the grasper and slight aspiration were done, followed by overthe-scope clip release (d-FTRD clip). Aspiration was nec-This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

Video 1 BougieCap (Ovesco Endoscopy AG, Tübingen, Germany) dilation in a refractory peptic stricture. ▶ Fig. 1 The 8 mm BougieCap (Ovesco Endoscopy AG, Tübingen, Germany) was attached to the 5.4 mm gastroscope tip.