Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.

Stiffness declines significantly after achieving response, and the magnitude of decline is greater in the first year after treatment, while it tends to plateau from 1 year onwards.

We report the case of a patient with refractory ulcerative colitis who developed cholestatic acute liver damage after a single infusion of infliximab. Unusual aspects of this case were the early onset (after the first administration) of liver damage and the absence of antinuclear antibodies, alcohol intake, hepatotoxic drugs and all known viral and metabolic causes of hepatic injury. Moreover, no serological or morphological findings of primary sclerosing cholangitis were observed. The patient's liver damage resolved spontaneously within 6 weeks. Although a direct relationship between administration of infliximab and onset of acute liver damage could not be definitely established, our case suggests that infliximab may induce direct liver damage, the course of which is similar to acute cholestatic hepatitis and resolves following withdrawal of the drug.

Background:Real-time elastography (RTE) may increase the diagnostic accuracy of fine-needle aspiration guided by endoscopic ultrasound. The aim of this study was to establish the diagnostic accuracy, sensitivity, and specificity of this combined methodological approach in a cohort of patients with solid pancreatic masses.Methods:We reviewed data from 54 patients with solid pancreatic lesions referred to our institution between January 2014 and June 2015. RTE, assessed in terms of strain ratio, was performed both qualitatively and semi-quantitatively, and a 25G needle was inserted into the most suspicious part of the lesion. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values were calculated.Results:The median lesion size was 35 mm (interquartile range: 25-43 mm). A diagnosis of adenocarcinoma was confirmed in 85.1% of cases. RTE, with a strain ratio cutoff of 4.21, showed a sensitivity of 86.9%, a specificity of 75%, and diagnostic accuracy of 85.1%. The diagnostic accuracy, sensitivity, and specificity of the combined methodology were 94.4%, 93.4%, and 100%, respectively. The positive predictive value was 100%, the negative predictive value 72.7% and the negative likelihood ratio 6.5. No severe adverse events were registered.Conclusion:The combination of RTE with endoscopic ultrasound-guided fine-needle aspiration appears to be an efficient and safe technique for the characterization of solid pancreatic masses.