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Background and aims The present study was aimed to assess the risk of SARS-CoV-2 infection and associated factors among HCWs in endoscopy centers in Italy. Methods All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey during the first months of the COVID-19 outbreak in Italy. Results 314/1306 (24%) SIED members accounting for 201/502 (40%) endoscopic centers completed the survey. Personal Protection Equipment (PPE) were available in most centers, but filtering face-piece masks (FFP2 or FFP3) and negative pressure room were not in 10.9 and 75.1%. Training courses on PPE use were provided in 57.2% of centers only; there was at least one positive HCW in 17.4% of centers globally, 107/3308 (3.2%) HCWs were diagnosed with COVID-19 with similar rates of physicians (2.9%), nurses (3.5%) and other health operators (3.5%). Involvement in a COVID-19 care team (OR: 4.96) and the lack of training courses for PPE, (OR: 2.65) were associated with increased risk. Conclusions The risk of COVID-19 among endoscopy HCWs was not negligible and was associated with work in a COVID-19 care team and lack of education on proper PPE use. These data deserve attention during the subsequent waves.

Objective: Immunoglobulin G4-related disease (IgG4-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG4-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG4-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG4-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG4-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG4-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.

Objectives Endoscopic ultrasound through-the-needle biopsy (EUS-TTNB) is a useful tool for differential diagnosis among pancreatic cystic lesions (PCLs). Cystic fluid cytology (CFC) is recommended by guidelines, but its diagnostic accuracy is about 50%. The aim of this meta-analysis is to assess the clinical impact of EUS-TTNB in terms of technical success (TS), histological accuracy (HA) and diagnostic yield (DY). Methods Original studies in English language on EUS-TTNB were searched in MEDLINE and EMBASE until October 2019. Diagnostic accuracy of EUS-TTNB for identification of mucinous PCLs was calculated using individual diagnostic data of patients who underwent CFC and surgery. Results Nine studies, including 454 patients who underwent EUS-TTNB, met the inclusion criteria for the meta-analysis. TS and HA of EUS-TTNB were, respectively, 98.5% (95% Confidence Interval [CI] 97.3%-99.6%) and 86.7% (95%CI 80.1-93.4). DY was 69.5% (95%CI 59.2-79.7) for EUS-TTNB and 28.7% (95%CI 15.7-41.6) for CFC. Heterogeneity persisted significantly high in most of subgroup analyses. In the multivariate meta-regression, cyst size was independently associated with higher DY. Sensitivity and specificity for mucinous PCLs were 88.6 and 94.7% for EUS-TTNB, and 40 and 100% for CFC. Adverse events rate was 8.6% (95%CI 4.0-13.1). Conclusions This meta-analysis shows that EUS-TTNB is a feasible technique that allows a high rate of adequate specimens to be obtained for histology; in about two-thirds of patients a specific histotype diagnosis could be assessed. The number of adverse events is slightly higher respect to standard EUS-FNA, but complications are very rarely severe.

Background Increasing number of expert recommendations and guidelines of cancer surveillance have become available in the last decade. This complex scenario have increased the uncertainty on the most valuable approach to adopt. This study aim to evaluate the case of premalignant pancreatic primarily cystic tumors surveillance, assessing the differences of programmes proposed and applied. Methods A review of American, European and International guidelines for surveillance of asymptomatic neoplastic pancreatic cysts was performed to assess the difference of programmes proposed. An amibispective observational study, form 1995 to 2019, was conducted on patients with premalignant pancreatic primarily cystic tumors monitored in 10 centers from 4 European countries. We estimated incidence of pancreatic cancer and surgery intervention for high grade dysplasia (HGD)/Pancreatic cancer. We also assessed the follow-up visits and exams frequency during the surveillance period and the relative mean cost per patient-year. Results The guidelines reported significant differences in patient’s stratification, surveillance intensity (frequency of visits-exams), and surveillance duration. In the study conducted, 961 patients were enrolled with a median (IQR) follow-up of 4.47(2.8-7.0) years. HGD or Pancreatic carcinoma was reported by 43(4.4%) patients and 67(7.0%) undergone pancreatic surgery. Within the pancreatic surgery performed, 60.6% was rated as over-treated (None/low-moderate grade dysplsya). A big variability was reported in the surveillance with a median (IQR) visit per patient-year of 0.77(0.49-1.03) and with a mean cost per-patient year of €163.3. Conclusions Significant heterogeneity between surveillance approaches was reported in guidelines and clinical practice. Reliable and specific data on efficacy and costs associated to surveillances programmes proposed are needed in order to perform robust assessment and help decision makers in implementing the most valuable one. Key messages Significant variability of surveillance programmes proposed and applied for pancreatic cystic are reported in the guidelines and clinical practice. We need more robust efficacy and costs data in order to identify the most valuable surveillances approach to implement in clinical practice and recommend in the national and international guidelines.

Background:Type I autoimmune pancreatitis (AIP) is a rare form of pancreatitis that belongs to the IgG4-related disease (IgG4-RD) spectrum (1). Autoimmune pancreatitis responds brilliantly to glucocorticoids, but iatrogenic toxicity associated with prolonged steroid therapy represents a relevant clinical concern in the long-term (2). B cell depletion therapy proved to be effective in inducing IgG4-RD remission, yet most evidence are derived from small and heterogenous cohorts.Objectives:We performed a systematic review and meta-analysis to estimate the remission rate following rituximab-based induction treatment.Methods:Two reviewers searched MEDLINE, SCOPUS, and EMBASE until December 2020 to identify studies on remission rate and relapse rate of Type I AIP after induction of remission with rituximab. Studies involving three or more patients were included, including the most recent or most numerous cohorts in case of duplicates This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effects were calculated using a random-effects model and expressed in terms of pooled remission, relapse and adverse effects (AEs) rates.Results:Seven cohort studies met inclusion criteria for the meta-analysis for a total of 101 patients. Reasons for rituximab administration were relapsing disease (63.5%), new diagnosis (18.5%) or glucorticoids intolerance (17.9%). The median follow-up time was 18.5 months. The pooled rate of complete response at 6 months from induction of remission was 88.9% (95% CI 80.5%-93.9%) without heterogeneity (I2=0%) (Figure 1). The median time to relapse was 9.75 months. The pooled estimate of relapse rate was 21% (95% CI 10.5%-40.3%) with moderate heterogeneity (I2=51%), being 35.9% (95% CI 17.3%-60.1%) in the 4 studies with rate of other organs involvement (OOI)>80% and as low as 10.1% (4.8%-20.3%) in the others. The pooled estimate of rituximab-related AEs was 25% (95% CI 8.8%53%) with substantial heterogeneity (I2=73.6%). There was no publication bias.Conclusion:Treatment of type I AIP with rituximab is associated with high remission rate, a higher relapse rate in presence of OOI and limited AEs. Randomized controlled trials with adequate power are needed to confirm these findings.References:[1]Lanzillotta M, Mancuso G, Della-Torre E. Advances in the diagnosis and management of IgG4 related disease. BMJ. 2020;369:m1067[2]Lanzillotta M, Vinge-Holmquist O, Overbeek KA, et al. PrescrAIP: A Pan-European Study on Current Treatment Regimens of Auto-Immune Pancreatitis. Front Med (Lausanne). 2020;7:408Disclosure of Interests:None declared

Introduction: Acute Pancreatitis (AP) is the most frequent complication after Endoscopic Retrograde Cholangiopancreatography (ERCP). Some prophylactic strategies are the use of pancreatic stents or peri-procedural nonsteroidal anti-inflammatory drugs (NSAIDs). Statins are widely used lipid-lowering drugs. Recent studies suggest that chronic statin intake may be associated to a lower incidence of AP. Methods: Our aim is to investigate whether chronic statin and/or acetylsalicylic acid (ASA) intake is associated to a lower incidence of PEP. Stark project is an international, multicenter, prospective, cohort study, developed under the auspices of “Pancreas 2000”. Consecutive patients undergoing ERCP in seven european centers, older than 18, were included prospectively. Demographic and medical data were retrieved by anamnesis. Patients were followed-up to detect those with PEP. The sample size was estimated to be 1, 016 participants. A univariate analysis and multivariate analysis (binary logistic regression) were performed. Results: 1150 patients were included. Mean age was 68.4 years (SD 14.5). 561 (48.8%) patients were female. 70 patients developed post-ERCP-AP (PEP) (6.1%) ; 25 patients (8.1%) under chronic statin treatment versus 45 patients (5.4%) who do not (p= 0.086). Multivariate analysis showed an aOR of 1.679 (0.941-2.994), p 0.079 for PEP incidence in statin users. Regarding ASA consumption, 11 patients (6.6%) under ASA treatment versus 59 patients (6%) who were not consuming ASA, developed PEP (p= 0.753). Multivariate analysis showed an aOR of 1.017 (0.487-2.127), p=0.963 for PEP incidence among ASA users. Conclusion: Our data suggest that chronic statin and/or ASA intake isnt statistically associated to an increase incidence of PEP.

and moderate-severe steatosis (OR 2.1; 95%CI, 1.1-4.1; p=0.03). SVR rates were not related to HOMA in the overall population [63% (220/351) vs 60% (29/48), p=0.75], nor in subgroup analysis by virus genotype [genotype 1: 43% (61/143) for ≤ 2 HOMA vs 53% (9/17) for > 2 HOMA (p=0.45); genotype 2 and 3: 83% (143/173) vs 80% (20/25), p=0.78, respectively]. In SVR patients, baseline and follow up HOMA values were similar (1.12±0.82 vs 1.17±1.1, p=0.25). Conversely, nonresponders had increased HOMA values trough 18 months follow up (from 1.17±0.7 to 1.49±1.3, p=0.007); IR de-novo occurred more frequently in non-SVR than in SVR patients [24% (25/106) vs 8% (16/198), p=0.0003]. Conclusions: While the outcome of Peg-IFN/Rbv therapy is not influenced by IR, the latter is prevented once SVR is achieved.