An Italian prospective multicenter study on colonoscopy practice and quality: What has changed in the last 10 years

Background: A relevant number of adenomas can be missed during colonoscopy. Aims: Assess the current status of colonoscopy procedures in Italian centers. Methods: A prospective observational study involving 17 hospitals (34 endoscopists) included consecutive patients undergoing standard colonoscopy. In the first phase, endoscopists performed consecutive colonoscopies. In the second phase, retraining via an online learning platform was planned, while in the third phase data were collected analogously to phase 1. Results: A total of 3,504 patients were enrolled. Overall, a BBPS score ≥6 was obtained in 95.6% of cases (94.8% and 96.9% in the pre- and post-training phases, respectively). 88.4% of colonoscopies had a withdrawal time ≥6 min (88.2% and 88.7% in the pre- and post-training phases). Median adenoma detection rate (ADR) was 39.1%, with no significant differences between the pre- and post-training phases (40.1% vs 36.9%; P = 0.83). In total, 81% of endoscopists had a ADR performance above the 25% threshold. Conclusion: High colonoscopy quality standards are achieved by the Italian hospitals involved. Quality improvement initiatives and repeated module-based colonoscopy-training have been promoted in Italy during the last decade, which appear to have had a significant impact on quality colonoscopy metrics together with the activation of colorectal cancer screening programs

Contrast enhanced computed tomography and 18-fluorine-labelled 2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography correlation in the management of a patient with primary mediastinal seminoma and candidate to liver transplant”, Gazzetta Medica Italiana Archivio per le Scienze Mediche

We report a case of a 34 years old man with primary mediastinal seminoma, discovered after investigations for worsening dyspnea. A peculiarity of this patient is the coexistence of other diseases that mutually influence each other as congenital liver shunts, thrombosis of the vena cava, right chronic heart failure and thyroid goiter. Immediately after the diagnosis of the seminoma he underwent 4 cycles of chemotherapy (CHT) with Cisplatin, Etoposide and Bleomycin (BEP), according to the standard scheme. In this case (18FDG-PET/CT), assessing the biological behaviour of the disease, has proved an essential adjunct in the clinical management of this patient. 18FDG-PET/CT has avoided that the patient performed others contrast enhancement computed tomography (CE-CT) that could further damage the kidneys and interfere with the thyroid function and the thrombogenesis. Furthermore 18FDG-PET/CT, excluding the seminoma recurrence or spread disease, allowed to choose the right therapeutic treatment and to place the patient on the transplant waiting list because of the presence of liver shunts. An assessment as accurate as possible, of remission after treatment has an important role for decision making to stop treatment or to initiate further one. 18FDG-PET/CT is actually the best predictor of active seminoma in postchemotherapy residual lesions