Poorly Differentiated Neuroendocrine Carcinoma of the Sigmoid Tract in Long-Standing Ulcerative Colitis: Report of a Case and Review of the Literature.

A 37-year-old male with long-standing and extensive ulcerative pancolitis developed a rapidly lethal poorly differentiated neuroendocrine carcinoma (NEC) in the sigmoid colon. Prior biopsies obtained from multiple sites of the colon during endoscopic surveillance showed minimal inflammatory changes and no sign of dysplasia. Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies, and adenocarcinoma is the most common type of colorectal neoplasm associated with ulcerative colitis and Crohn's disease, but other types of epithelial and nonepithelial tumors have also been described in IBD. NECs arising in the setting of ulcerative colitis are very rare and are reported as anecdotic findings. We describe the clinicopathological features of an IBD-related NEC and review the previously reported cases

Can we improve the detection rate and interobserver agreement in capsule endoscopy?

Background: Data about strategies for improving the diagnostic ability of capsule endoscopy readers are lacking. Aim: (1) To evaluate the detection rate and the interobserver agreement among readers with different experience; (2) to verify the impact of a specific training (hands-on training plus expert tutorial) on these parameters. Methods: 17 readers reviewed 12 videos twice; between the two readings they underwent the training. The identified small bowel findings were described by a simplified version of Structured Terminology and classifies as clinically significant/non-significant. Findings identified by the readers were compared with those identified by three experts (Reference Standard). Results: The Reference Standard identified 26 clinically significant findings. The mean detection rate of overall readers for significant findings was low (about 50%) and did not change after the training (46.2% and 46.4%, respectively). There was no difference in the detection rate among readers with different experience. The interobserver agreement with the Reference Standard in describing significant findings was moderate (k= 0.44; CI95%: 0.39-0.50) and did not change after the training (k= 0.44; CI95%: 0.38-0.49) or stratifying readers according to their experience. Conclusions: Both the interobserver agreement and the detection rate of significant findings are low, regardless of the readers' experience. Our training did not significantly increase the performance of readers with different experience

Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care

Background and aims:Restructuring activities have been necessary during the lockdown phase of the coronavirusdisease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-careprocedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. Weaimed to investigate how IBD management was restructured during the lockdown phase, the impact of therestructuring on standards of care and how Italian IBD units have managed post-lockdown activities.Methods:A web-based online survey was conducted in two phases (April and June 2020) among the Italian Groupfor IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuingscheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdownphase.Results:Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visitsand 7% of follow-up visits were regularly done, while>70% of follow-up scheduled visits and 5% of first visits weredone virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% ofbiological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modifiedmanagement of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biologicaltherapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtualclinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future.Conclusion:Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to bemaintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, suchas virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 er

Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results From the SoCOVID-19 Survey

none46noneFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, GionataFantini, Massimo Caludio; Biancone, Livia; Dragoni, Gabriele; Bezzio, Cristina; Miranda, Agnese; Ribaldone, Davide Giuseppe; Bertani, Angela; Bossa, Fabrizio; Allocca, Mariangela; Buda, Andrea; Mocci, Giammarco; Soriano, Alessandra; Guglielmi, Francesco William; Bertani, Lorenzo; Baccini, Flavia; Loddo, Erica; Privitera, Antonino Carlo; Sartini, Alessandro; Viscido, Angelo; Grossi, Laurino; Casini, Valentina; Gerardi, Viviana; Ascolani, Marta; Di Ruscio, Mirko; Casella, Giovanni; Savarino, Edoardo; Stradella, Davide; Pumpo, Rossella; Cortelezzi, Claudio Camillo; Daperno, Marco; Ciardo, Valeria; Nardone, Olga Maria; Caprioli, Flavio; Vitale, Giovanna; Cappello, Maria; Comberlato, Michele; Alvisi, Patrizia; Festa, Stefano; Campigotto, Michele; Bodini, Giorgia; Balestrieri, Paola; Viola, Anna; Pugliese, Daniela; Armuzzi, Alessandro; Saibeni, Simone; Fiorino, Gionat

The PROSit cohort of infliximab biosimilar in IBD : a prolonged follow-up on the effectiveness and safety across Italy

Background: We report a prospective, nationwide cohort evaluating the safety and effectiveness of CT-P13. Methods: A structured database was used to record serious adverse events (SAEs), clinical remission/response, inflammatory biomarkers (CRP and calprotectin), and endoscopic findings. Results: Eight hundred ten patients with inflammatory bowel disease (IBD) (452 Crohn's disease [CD]) were enrolled. Four hundred fifty-nine patients were na\uefve to anti-TNF\u3b1 (group A), 196 had a previous exposure (group B), and the remaining 155 were switched to CT-P13 (group C). All patients were included in the safety evaluation with a mean follow-up of 345 \ub1 215 days and a total number of 6501 infusions. One hundred fifty-four SAEs were reported (19%), leading to cessation of the biosimilar in 103 subjects (12.7%). Infusion reactions were 71, leading to cessation of the biosimilar in 53 subjects (6.5%), being significantly more frequent in patients pre-exposed to anti-TNF\u3b1 (P = 0.017). The efficacy of therapy was calculated in 754 IBD patients, with a mean follow-up of 329 \ub1 202 days. Forty-eight patients had a primary failure (6.4%), and 188 (25.6%) lost response during follow-up. Six hundred twenty-eight (364 CD) and 360 IBD patients (222 CD) completed the follow-up at 6 and 12 months, respectively. At 12 months, patients without loss of response were 71%, 64%. and 82% in groups A, B, and C, respectively (log rank P = 0.01). Clinical/endoscopic scores and inflammatory biomarkers dropped significantly in CD and UC patients (P = 0.01 and P < 0.0001) compared with baseline. Conclusions: In this large prospective cohort, no further signals of difference in safety and effectiveness of CT-P13 in IBD has been observed