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This article, published in the journal Endoscopy, examines the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients aged 80 and above. The study found that while ERCP is a safe and effective procedure for elderly patients, they are at a higher risk of adverse events (AEs) and mortality compared to younger patients. The incidence of AEs such as bleeding, perforation, pancreatitis, and cholangitis was not significantly different between the two age groups, but the 30-day mortality rate was significantly higher in the elderly group. The study concludes that ERCP can be performed in elderly patients, but the increased risks should be taken into consideration. [Extracted from the article]

This article discusses the use of peroral endoscopic septotomy (POES) as a technique for treating Zenker's diverticulum, a condition affecting the esophagus. The study, conducted in two Italian referral centers, aimed to assess the efficacy of POES after at least one year of follow-up. The results showed that POES was effective in treating Zenker's diverticulum, with a high technical success rate. However, there were a few cases of poor clinical response and adverse events, including one severe case of bleeding. Overall, POES is considered a promising technique, but the possibility of adverse events should be taken into account. [Extracted from the article]

This article discusses the need for a triage system to prioritize colonoscopies and effectively stratify the risk of colorectal cancer (CRC) among patients undergoing colonoscopy. The study derived and validated a predictive model for CRC based on the Italian RAO criteria, which categorize patients into high, intermediate, and low priority groups. The predictive model included factors such as age, previous colonoscopy history, clinical indications, and alarm features. The model based on RAO criteria outperformed models based on other criteria, and it was geographically and prospectively validated. The study concludes that this clinical prediction tool can help clinicians prescribe colonoscopies appropriately and optimize resource allocation. [Extracted from the article]

This article discusses the use of endoscopic papillary large balloon dilation (EPLBD) in the treatment of difficult choledocholithiasis, a condition characterized by the presence of stones in the common bile duct. The Italian Society of Digestive Endoscopy (SIED) conducted a nationwide survey to assess the current use and knowledge of the EPLBD technique among Italian endoscopists. The survey found that 68% of endoscopists adopted EPLBD as the first choice for difficult choledocholithiasis, and 43% performed maximal papillosphincterotomy before EPLBD. The survey also highlighted the effectiveness and safety of the EPLBD technique, with complications reported in less than 5% of patients. Overall, the survey suggests that the use of EPLBD has increased among Italian endoscopists and is considered the preferred approach for difficult choledocholithiasis. [Extracted from the article]

This article discusses the impact of inappropriate indications for colonoscopy on waste production and the potential benefits of intervention. The study, conducted in Italy, involved 2,546 patients undergoing colonoscopy for clinical indications outside of colorectal cancer (CRC) screening programs. The researchers developed a predictive model based on patient-related variables and indication criteria to identify low-risk patients who could potentially avoid colonoscopy. The results showed that by sparing low-risk and inappropriate colonoscopies, a significant reduction in carbon dioxide emissions could be achieved. However, using appropriateness criteria may result in missing some patients with CRC. The study suggests that a clinical predictive model based on patient-related variables and Italian criteria could effectively reduce carbon dioxide emissions while maintaining a low miss rate for CRC. [Extracted from the article]

This article discusses a multicenter prospective study conducted in Italy to validate the RAO criteria for colonoscopy indication. The study involved 9 institutions and included 2,546 adult patients undergoing colonoscopy. The RAO criteria, which prioritize colonoscopy based on different clinical indications, were found to be more discriminative than the EPAGE-II and ASGE criteria. The study suggests that the RAO criteria can be used to triage patients and determine the priority of colonoscopy examinations. [Extracted from the article]

Gastrointestinal perforations and post-surgical fistulas are dreaded complications that dramatically increase morbidity and mortality. A new endoscopic over-the-scope clip (OTSC) system may be potentially useful for sealing visceral perforations in several clinical settings. We evaluated the advantages and clinical impact of the placement of OTSCs on the management of non-malignant gut leaks in 12 consecutive patients. OTSCs of 9.5 or 10.5mm were used, according to the diameter of the defect within the wall. The indications for treatment were mainly related to postsurgical fistulas. Healing of the fistula was assessed by endoscopic or radiological means, and failed only once. No OTSC-related complications occurred. Endoscopic closure of perforations and post-surgical fistulas with the OTSC system is a simple and minimally invasive technique. This approach, when feasible, may be less expensive and more advantageous than a surgical approach. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding the review on balloon-assisted enteroscopy.