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Endoscopy units are considered to be at an increased risk of infection by SARS-CoV-2. Our aim is to assess the correlation between pre-endoscopic screening with reverse-transcription-polymerase-chain-reaction (RT-PCR) in asymptomatic individuals scheduled for elective endoscopy and the epidemiological data published by the local Health Administration.Observational retrospective study collecting the results of our screening strategy spanning June/2020-June/2021, the effective potential growth (EPG), an index measuring the outbreak risk, and the 7 and 14-day cumulative incidence (CI). Indication, delay and the findings of the endoscopic examinations were registered for RT-PCR positive patients.A total of 5808 tests were performed, yielding 125 positive results (2.15%). All positive tests occurred in weeks of high/very high risk (EPG100) with the highest monthly rate being 9.36%, recorded in January/2021. A significant correlation (rho=0.796; p0.001) between weekly positive rates and EPG was observed, and a significantly lower weekly number of positive tests was recorded when EPG100. Planning the screening strategy one week ahead according to EPG100 would have avoided up to 826 tests with only one positive result to account for. One hundred and thirteen individuals tested positive and 89 endoscopies were delayed. The most common findings were colon polyps, colorectal cancer and gastric metaplasia. Oncological diagnosis was delayed 50±3 days.No positive RT-PCR test were registered out of high-risk periods. Epidemiological administrative data in the preceding two weeks showed a significant correlation with screening results and could be useful to plan pre-endoscopic screening and avoid unnecessary tests.

Psoas abscess is a rare condition and is usually related to diseases of the gastrointestinal tract. The clinical presentation is often nonspecific, frequently delaying diagnosis. In our environment, Crohn's disease is the most common underlying condition in psoas abscess, although its occurrence in the course of Crohn's disease is also considered to be rare. We present a series of three patients with Crohn's disease who developed psoas abscess at different time points (at diagnosis of Crohn's disease, within the first year of disease, and years after diagnosis). We review the literature and focus on the clinical factors associated with the occurrence of these abscesses and the therapeutic approach to both this septic complication and the underlying disease.

Getting ready for a colonoscopy is difficult and involves many steps. Information given to patients is very important for adherence to treatment. We created a novel smart phone application (SPA) aimed to increase bowel preparation quality and patient satisfaction.We carried out a prospective, endoscopist-blinded, randomized, controlled trial. We enrolled 260 outpatient (58% female, age range 21-75 years) owners of a smartphone. Patients were allocated to two different protocols: instructions provided by SPA (SPA group; n = 108) or written instructions with visual aids (control group; n = 152). All procedures were carried out in the afternoon and patients received the same purgative regimen (2 L polyethylene glycol (PEG) solution plus ascorbic acid), in a full-dose same-day regimen. The study was designed to detect an improvement in quality of bowel preparation using the Harefield Cleansing Scale (HCS) scale. Effect of protocol on patient satisfaction was assessed with a specific questionnaire at the time of colonoscopy.Proportion of patients who obtained successful bowel preparation for colonoscopy (HCS A or B) was significantly higher in the SPA group than in the control group (100% vs 96.1%, respectively; P = 0.037). Mean global HCS scores were similar in both groups. Patient-reported tolerability and overall experience with the prescribed bowel preparation were significantly higher for the SPA group than for the control group.Successful cleansing and patient acceptability with the use of SPA were superior to written instructions in outpatients submitted for colonoscopy using 2 L PEG solution plus ascorbic acid.

The appropriateness criteria for colonoscopy developed by a European expert panel (EPAGE), published in 1999, were revised this year (EPAGE II), but have not yet been evaluated.(1) To analyze colonoscopies performed at our hospital, and (2) to evaluate the appropriateness of the new EPAGE II criteria.We retrospectively analyzed 700 colonoscopies (48% males, mean age 58 years). Forty-five colonoscopies (6.4%) were excluded for insufficient bowel preparation or elective indication. EPAGE II criteria classified colonoscopies as "appropriate", "inappropriate" and "uncertain".Ninety-four percent (n=655) of colonoscopies were evaluated. The most frequent indication for colonoscopy (19%) was screening of colorectal cancer (CRC). Seventy percent of colonoscopies were "appropriate", and 18% were "inappropriate", with significant differences according to where the request was made. The most inappropriate indication was postpolypectomy follow-up, due to shorter follow-up intervals. An endoscopic diagnosis was made in 315 patients (48%), with a finding of significant lesions in 25% (n=167; CCR, adenomas, inflammatory bowel disease, angiodysplasia and benign stricture). The indications most frequently associated with relevant findings were screening of CRC (17.3%) and postpolypectomy follow-up (16.7%) but this association was non-significant. Only iron-deficiency anemia was significantly associated with CRC (p0.0001).Eighteen percent of requests for colonoscopy were inappropriate and 12% provided incomplete information. The indication most strongly associated with a diagnosis of CRC was iron-deficiency anemia. The EPAGE II criteria showed a significant correlation with an endoscopic diagnosis of CRC.

Psoas abscess is a rare condition and is usually related to diseases of the gastrointestinal tract. The clinical presentation is often nonspecific, frequently delaying diagnosis. In our environment, Crohn's disease is the most common underlying condition in psoas abscess, although its occurrence in the course of Crohn's disease is also considered to be rare. We present a series of three patients with Crohn's disease who developed psoas abscess at different time points (at diagnosis of Crohn's disease, within the first year of disease, and years after diagnosis). We review the literature and focus on the clinical factors associated with the occurrence of these abscesses and the therapeutic approach to both this septic complication and the underlying disease.

Dear Sir, Infliximab is the only biological agent approved for the treatment of ulcerative colitis (UC).1 Its efficacy is only counterbalanced by the increased risk of severe infections and its own immunogenicity that may limit its applicability because of acute infusion reactions and loss of efficacy. Since most clinical data come from RCTs, there is limited experience with the use of infliximab among patients with UC and concomitant conditions that may increase the risk of infections. We report the case of a patient with alcoholic cirrhosis with portal hypertension, chronic pancreatitis, and ulcerative colitis treated with infliximab. A 45-year-old Caucasian male was admitted in our hospital because of a moderate acute flare of UC. He was a smoker and had been a heavy drinker until two years before, when he was diagnosed of alcoholic cirrhosis and portal hypertension because of his first ascites …