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Retreatment with PegIFN-alpha-2b and ribavirin for a minimum of 48 weeks should be considered in all patients unresponsive to previous IFN-based therapies. Baseline GGT values and RVR are highly predictive for retreatment outcome.

Background Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) is considered as standard of care to reduce the risk of post-ERCP pancreatitis. It has been suggested that aggressive hydration might further reduce this risk. Guidelines already recommend aggressive hydration in patients who are unable to receive rectal NSAIDs, although it is laborious and time consuming. We aimed to evaluate the added value of aggressive hydration in patients receiving prophylactic rectal NSAIDs.Methods FLUYT, a multicentre, open-label, randomised, controlled trial done across 22 Dutch hospitals, included patients aged between 18 and 85 years with moderate to high risk of post-ERCP pancreatitis. Patients were randomly assigned (1:1) by a web-based module with varying block sizes to a combination of aggressive hydration and rectal NSAIDs (100 mg diclofenac or indomethacin; aggressive hydration group) or rectal NSAIDs (100 mg diclofenac or indomethacin) alone (control group). Randomisation was stratified according to treatment centre. Aggressive hydration comprised 20 mL/kg intravenous Ringer's lactate solution within 60 min from the start of ERCP, followed by 3 mL/kg per h for 8 h. The control group received normal intravenous saline with a maximum of 1•5 mL/kg per h and 3 L per 24 h. The primary endpoint was post-ERCP pancreatitis and was analysed on a modified intention-to-treat basis (including all patients who underwent randomisation and an ERCP and for whom data regarding the primary outcome were available). The trial is registered with the ISRCTN registry, ISRCTN13659155.

Original article 703Introduction ! Screening strategies that employ colonoscopy for the detection and removal of precursors of colorectal cancer (CRC) effectively reduce CRC-related mortality [1,2]. Apart from participation grades, the efficacy of population-based CRC screening depends on the quality of colonoscopy. Colonoscopy quality is ultimately reflected by a reduction in the incidence of CRC following colonoscopy. However, measurement of post-colonoscopy CRC is cumbersome and does not allow direct feedback. Several procedural indicators have been suggested for the monitoring of quality [3]. Two recent studies showed that the adenoma detection rate (ADR) of endoscopists was inversely associated with the risk of post-colonoscopy CRC [4,5] and related death [5]. In another study, patients dying from CRC were less likely to have undergone a previous complete colonoscopy than matched controls [6]. In addition, a substantial proportion of colorectal tumors originate from the right-sided colon [7], which underlines the importance of performing a complete colonoscopy, as measured by the cecal intubation rate (CIR). ADR and CIR have been reported to vary between hospitals depending on case mix and institutional or procedural factors [8 -10]. Case mix is determined by nonmodifiable patient characteristics, such as age, sex, co-morbidity, and indication for colonoscopy. In order to provide a useful incentive for hospitals to improve the quality of colonoscopy, a comparison of CIR and ADR between institutions should enable detection of differences that are independently affected by modifiable * The first two authors contributed equally to the work. ** Both senior authors contributed equally to the work. Background and study aims: Cecal intubation rate (CIR) and adenoma detection rate (ADR) have been found to be inversely associated with the occurrence of post-colonoscopy colorectal cancer. Depicting differences in CIR and ADR between hospitals could provide incentives for quality improvement. The aim of this study was to compare quality parameters of routine colonoscopies between seven hospitals in The Netherlands in order to determine the extent to which possible differences were attributable to procedural and institutional factors. Patients and methods: Consecutive patients undergoing colonoscopy were prospectively included between November 2012 and January 2013 at two academic and five nonacademic hospitals. Patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded. Main outcome measures were CIR and ADR. Results: A total of 3129 patients were included (mean age 59 ± 15 years; 45.5 % male). The major- Belderbos

Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.