Serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promises to assist in assessing exposure to and confirming the diagnosis of coronavirus disease 2019 (COVID-19), and to provide a roadmap for reopening countries worldwide. Considering this, a proper understanding of serologic-based diagnostic testing characteristics is critical. The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic characteristics of serological-based COVID-19 testing. Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. Full-text observational studies that reported IgG or IgM diagnostic yield and used nucleic acid amplification tests (NAATs) of respiratory tract specimens, as a the reference standard in English language were included. A bivariate model was used to compute pooled sensitivity, specificity, positive/negative likelihood ratio (LR), diagnostic odds ratio (OR), and summary receiver operating characteristic curve (SROC) with corresponding 95% confidence intervals (CIs). Five studies (n=1,166 individual tests) met inclusion criteria. The pooled sensitivity, specificity, and diagnostic accuracy for IgG was 81% [(95% CI, 61-92);I 2 =95.28], 97% [(95% CI, 78-100);I 2 =97.80], and 93% (95% CI, 91-95), respectively. The sensitivity, specificity, and accuracy for IgM antibodies was 80% [(95% CI, 57-92);I 2 =94.63], 96% [(95% CI, 81-99);I 2 =92.96] and 95% (95% CI, 92-96). This meta-analysis demonstrates suboptimal sensitivity and specificity of serologic-based diagnostic testing for SARS-CoV-2 and suggests that antibody testing alone, in its current form, is unlikely to be an adequate solution to the difficulties posed by COVID-19 and in guiding future policy decisions regarding social distancing and reopening of the economy worldwide.

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Chronic pancreatitis (CP) is a heterogeneous disease, with different causes and often a long delay between onset and full classic presentation. Clinical presentation depends on the stage of the disease. In earlier stages, recurrent episodes of acute pancreatitis are the major signs dominating clinical presentation. As the inflammatory process goes on, less acute episodes occur, and pain adopts different aspects or may even disappear. After 10–15 years from onset, functional insufficiency occurs. Then, a classic presentation with pain and pancreatic exocrine and endocrine insufficiency appears. Diagnosis remains challenging in the early stages of the disease, as its initial presentation is usually ill-defined and overlaps with other digestive disorders. Computed tomography and magnetic resonance cholangiopancreatography should be the first choice in patients with suspected CP. If the results are normal or equivocal but still there is a high suspicion of CP, the next option should be endoscopic ultrasound. Endoscopic retrograde cholangiopancreatography is mainly a therapeutic technique, and for the diagnostic purpose should only be used when all other imaging modalities and pancreatic function tests have been exhausted. Indirect tests are used to quantify the degree of insufficiency in already-established late CP. Recommendations on CP were developed by Clube Português do Pâncreas (CPP), based on literature review to answer predefined topics, subsequently discussed and approved by all members of CPP<i>.</i> Recommendations are separated in two parts: “chronic pancreatitis etiology, natural history, and diagnosis,” and “chronic pancreatitis medical, endoscopic, and surgical treatment.” This abstract pertains to part I.

Chronic pancreatitis (CP) is a complex disease that should be treated by experienced teams of gastroenterologists, radiologists, surgeons, and nutritionists in a multidisciplinary environment. Medical treatment includes lifestyle modification, nutrition, exocrine and endocrine pancreatic insufficiency correction, and pain management. Up to 60% of patients will ultimately require some type of endoscopic or surgical intervention for treatment. However, regardless of the modality, they are often ineffective unless smoking and alcohol cessation is achieved. Surgery retains a major role in the treatment of CP patients with intractable chronic pain or suspected pancreatic mass. For other complications like biliary or gastroduodenal obstruction, pseudocyst drainage can be performed endoscopically. The recommendations for CP were developed by Clube Português do Pâncreas (CPP), based on literature review to answer predefined topics, subsequently discussed and approved by all members of CPP<i>.</i> Recommendations are separated in two parts: “chronic pancreatitis etiology, natural history, and diagnosis,” and “chronic pancreatitis medical, endoscopic, and surgical treatment.” This abstract pertains to part II.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease of the hepatobiliary system, characterized by pro-gressive inflammation, fibrosis, and stricturing of the intraand extra-hepatic bile ducts. [1][2][3] Histopathologically, PSC is characterized by inflammation and fibrosis of the intra-and extra-hepatic ductal epithelium, which can ultimately progress to end-stage liver disease and cirrhosis, and increase the risk for cholangiocarcinoma. 4,5 The presentation of PSC is highly variable, ranging from asymptomatic in the early stages, to recurrent episodes of cholangitis with fever, jaundice, pruritus, abdominal pain and fatigue. However, median survival tends to be significantly decreased in patients who are symptomatic at the time of diagnosis. 6,7 Epidemiological studies of PSC have reported a prevalence rate of approximately 1 per 10,000, and incidence rates between 0.4 and 2.0 per 100,000 per year in Northern Europe and the US. 8 PSC conforms to the definition of rare diseases, affecting less than 200,000 individuals in the

Background: The American Society for Gastrointestinal Endoscopy (ASGE) 2010 guidelines for suspected choledocholithiasis were recently updated by proposing more specific criteria for selection of high-risk patients while advocating for using noninvasive studies for intermediate and low risk individuals. Both guidelines recommend direct endoscopic retrograde cholangiopancreatography (ERCP) for ascending cholangitis and choledocholithiasis on imaging. As per 2010 guidelines, total bilirubin > 4 mg/dl and total bilirubin between 1.8 to 4 mg/dl along with dilated bile duct on imaging met criteria for direct ERCP. In 2019 guideline, this was changed to total bilirubin > 4 mg/dl in combination with CBD dilation > 6 mm as an indication for direct ERCP. We aim to compare the performance and diagnostic accuracy of 2019 vs 2010 criteria for predicting choledocholithiasis. Methods: From a prospectively maintained database (2013 to 2019) of over 10,000 ERCPs performed by 70 Gastroenterologist's in our hospital system comprising of 14 hospitals, a random sample of 1400 ERCPs with indication of choledocholithiasis was selected. Data regarding demographics, total bilirubin level, imaging studies such as abdominal ultrasound, computed tomography of abdomen or magnetic resonance cholangiopancreatography (MRCP), Intraoperative cholangiogram (IOC), Endoscopic ultrasound (EUS) and ERCP results were retrospectively collected by chart review. Patients with prior sphincterotomy were excluded. Results: From a random sample of 1400 ERCPs, 843 patients had native papilla and were included in the study. Both 2010 and 2019 guidelines were applied to the same patient population. Overall, 61.2% (518) were deemed high risk and met criteria for direct ERCP as per 2010 guidelines compared to only 37.7% (318) as per revised 2019 guidelines. This difference of 200 patients (24%) was statistically significant as per z statistics comparing two population proportions (p value < 0.001). Choledocholithiasis were found at ERCP in 76.5% (395/518) as per 2010 guidelines, compared to 82.1% (261/318) of those who met the 2019 high risk criteria. Once again, this difference (76.5% vs 82.07%, respectively) was statistically significant (p value < 0.001). In our patient cohort, overall specificity of 2010 guidelines was 46.9% and this improved to 75.0% as per 2019 criteria (Table 1). Conclusion: Our study shows that the strategy proposed by updated 2019 ASGE guidelines is more specific for detection of choledocholithiasis when compared to the 2010 criteria. These findings suggest adherence to the new guidelines would potentially minimizes the procedure adverse events for those individuals who do not meet the high-risk criteria.