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Background and Aim: Contrast harmonic endoscopic ultrasound (CH-EUS) was recently introduced to clinical practice; its reproducibility among endosonographers is unknown. Our aim was to assess the interobserver agreement (IA) in CH-EUS. Methods: Fifteen endosonographers (eight experienced and seven non-experienced) from 11 Italian EUS centers evaluated 80 video-cases (40 solid pancreatic lesions, 20 pancreatic cystic lesions and 20 submucosal lesions) of CH-EUS, according to the degree of enhance- ment, the pattern of distribution and the washout of the contrast agent. IAwithin each group and between the two groups of observers was assessed with the Fleiss kappa statistic. Results: Overall IAwas moderate for the uptake and fair for the pattern of distribution and the washout. In solid pancreatic lesions, IA was moderate for the uptake and fair for the pattern and the washout. In cystic pancreatic lesions, IA was uniformly moderate for the assessment of uptake, slight for the pattern and fair for the washout. In submucosal tumors, IA was substantial for the uptake, slight for the pattern and fair for the washout. Non- experienced endosonographers demonstrated, in most cases, comparable IAwith the expe- rienced ones. Conclusions: Interobserver agreement among endosonographers for CH EUS was satis- factory. In particular, overall IA varied from slight to substantial, being fair in the majority of cases. Inherent structural features of the lesions, as well as technical differences between the variables assessed, could have accounted for the fluctuation of the results. Outcomes of IA were reproducible between experienced and non-experienced endosonographers.

SUMMARY Background: Anti-Helicobacter pylori therapy has been reported to cause regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma in a high percentage of patients. However, in some patients, these lesions persist despite antibiotic treatment. Aim: To determine the various endosonographic findings that may predict the regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma postantibiotics. Methods: Seventy-six patients with Helicobacter pyloripositive gastric mucosa-associated lymphoid tissue lymphoma were studied. Follow-up data were available on 51 patients. All patients were treated with antibiotics. Participants underwent pre- and post-anti-Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach. Results: Helicobacter pylori was eradicated in 45 of 51 (88%) patients. At the 2-year follow-up, complete regression of mucosa-associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0. None of the stage T2 N1 patients achieved clinical regression. Conclusions: Endoscopic ultrasonography evaluation of gastric mucosa-associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and posttreatment follow-up evaluation of these lesions. Accurate staging is essential in the determination of the optimal treatment modality.

Endoscopic ultrasonography (EUS) is a relatively new diagnostic technique; although it has greatly shown its utility in many diseases, its diffusion is still limited. In very few European academic centers EUS is included in basic endoscopic gastrointestinal (GI) fellowship; for this reason endoscopists interested in EUS generally attend intensive EUS workshops, where available. Recently, in some university centers, for example in Italy, long-term training courses in advanced endoscopy, including EUS, have been organized. These educational periods comprehend an extensive calendar of didactic lectures, live procedures, and hands-on training. Topics taught generally are: basics of ultrasound, indications, risks and expected outcome of EUS, normal/pathologic EUS anatomy, management of procedure-related complications, and management of sedation during endoscopy. After a mean of 250–500 supervised EUS exams, the trainee is expected to achieve a good competence in this technique.

Clinical, histological, histochemical and ultrastructural characteristics of eight cases of carcinoid tumors of the non-antral portion of the stomach are presented. Four cases with multiple polypoid lesions are accompanied by an increased level of gastrin. A normal level of gastrin was present in the other four cases with isolated tumor and a normal component of endocrine cells in the uninvolved mucosa. In the first group with multiple lesions, the histological and histochemical analysis of the endocrine cells revealed a wide range of appearances: a) “simple hyperplasia”, b) “nodular hyperplasia”, and c) carcinoid tumor. These aspects suggested a different pathogenesis for the carcinoid tumors of the non-antral portion of the stomach with possible therapeutical implications. ACTA PATHOL. JPN. 35: 361–375, 1985.