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Three percent of patients with pancreatic ductal adenocarcinoma (PDAC) present a germline pathogenic variant (GPV) associated with an increased risk of this tumor, CDKN2A being one of the genes associated with the highest risk. There is no clear consensus on the recommendations for surveillance in CDKN2A GPV carriers, although the latest guidelines from the International Cancer of the Pancreas Screening Consortium recommend annual endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI) regardless of family history. Our aim is to describe the findings of the PDAC surveillance program in a cohort of healthy CDKN2A GPV heterozygotes. This is an observational analysis of prospectively collected data from all CDKN2A carriers who underwent screening for PDAC at the high-risk digestive cancer clinic of the “Hospital Clínic de Barcelona” between 2013 and 2021. A total of 78 subjects were included. EUS or MRI was performed annually with a median follow-up of 66 months. Up to 17 pancreatic findings were described in 16 (20.5%) individuals under surveillance, although most of them were benign. No significant precursor lesions were identified, but an early PDAC was detected and treated. While better preventive strategies are developed, we believe that annual surveillance with EUS and/or MRI in CDKN2A GPV heterozygotes may be beneficial.

Colorectal cancer (CRC) is a leading cause of mortality worldwide. We conducted a genome-wide association study meta-analysis of 100,204 CRC cases and 154,587 controls of European and East Asian ancestry, identifying 205 independent risk associations, of which 50 were unreported. We performed integrative genomic, transcriptomic and methylomic analyses across large bowel mucosa and other tissues. Transcriptome- and methylome-wide association studies revealed an additional 53 risk associations. We identified 155 high confidence effector genes functionally linked to CRC risk, many of which had no previously established role in CRC. These have multiple different functions, and specifically indicate that variation in normal colorectal homeostasis, proliferation, cell adhesion, migration, immunity and microbial interactions determines CRC risk. Cross-tissue analyses indicated that over a third of effector genes most likely act outside the colonic mucosa. Our findings provide insights into colorectal oncogenesis, and highlight potential targets across tissues for new CRC treatment and chemoprevention strategies.

Background: Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Treatment effectiveness remains a subject of debate considering bacterial antimicrobial resistance. Our aim was to analyse the diagnostic methods and eradication treatments for H. pylori infection in Serbia. Methods: An observational multicentre prospective study was conducted in Serbia, as part of the European Registry on H. pylori Management (Hp-EuReg). Demographics, treatment indication, diagnostic methods, previous eradication attempts and treatment were collected at AEG-REDCap e-CRF. Modified intention-to-treat (mITT) and per protocol (PP) effectiveness analyses were performed. Safety, compliance and bacterial antimicrobial resistance rates were reported. Data was quality checked. Results: Overall 283 patients were included, with a mean age of 55±15 years. Dyspepsia (n=214, 77%) was the most frequent treatment indication, and histology (n=144, 51%) was the most used diagnostic method. Overall eradication rate was 95% (PP) and 94% (mITT). Most prevalent first-line therapy was quadruple PPI+clarithromycin+amoxicillin+metronidazole, with a 96% effectiveness (p

In the version of this article initially published, the author affiliations incorrectly listed “Candiolo Cancer Institute FPO-IRCCS, Candiolo (TO), Italy” as “Candiolo Cancer Institute, Candiolo, Italy.” The change has been made to the HTML and PDF versions of the article.

Background Current guidelines recommend genetic counseling and intensive colonoscopy surveillance for patients with ≥ 10 colorectal adenomas based on scarce data. We investigated the prevalence of this condition in a fecal immunochemical test (FIT)-based colorectal (CRC) screening program, and the incidence of metachronous lesions during follow-up. Methods We retrospectively included all FIT-positive participants with ≥ 10 adenomas at index colonoscopy between 2010 and 2018. Surveillance colonoscopies were collected until 2019. Patients with inherited syndromes, serrated polyposis syndrome, total colectomy, or lacking surveillance data were excluded. The cumulative incidence of CRC and advanced neoplasia were analyzed by Kaplan–Meier analysis. Risk factors for metachronous advanced neoplasia were investigated by multivariable logistic regression analysis. Results 215 of 9582 participants (2.2 %) had ≥ 10 adenomas. Germline genetic testing was performed in 92 % of patients with ≥ 20 adenomas, identifying two inherited syndromes (3.3 %). The 3-year cumulative incidence of CRC and advanced neoplasia were 1 % and 16 %, respectively. In 39 patients (24.2 %), no polyps were found on first surveillance colonoscopy. The presence of an advanced adenoma was independently associated with a higher risk of advanced neoplasia at first surveillance colonoscopy (odds ratio 3.91, 95 %CI 1.12–13.62; P = 0.03). Beyond the first surveillance colonoscopy, the risk of metachronous advanced neoplasia was lower. Conclusions The prevalence of ≥ 10 adenomas in a FIT-based CRC screening program was 2.2 %; a small proportion of inherited syndromes were detected, even amongst those with ≥ 20 adenomas. A low rate of post-colonoscopy CRC was observed and the risk of advanced neoplasia beyond the first surveillance colonoscopy tended to progressively decrease throughout successive follow-ups.

BackgroundThe ideal treatment approach for H. pylori infection has not yet been defined; therefore, the most effective management strategies for adult patients need to be identified to ensure clinical practice is aligned with the best standard of care. Our aim was to perform a review of research studies from the European Registry on H. pylori management (Hp-EuReg) by synthesizing the most clinically relevant information from each published manuscript.MethodsAll research studies published between 2013 and 2022, evaluating any information related to H. pylori infection management within the Hp-EuReg, a long-term registry of routine clinical practice by gastroenterologists in Europe, were included in the review.ResultsOverall, 26 studies have been published to date, where 12 evaluated the overall European data and the remaining were performed locally among the 28 participating countries. Eighteen studies evaluated the effectiveness of first- and/or second-line treatment, where one focused on penicillin allergic patients, six focused on specific treatment schemes, one evaluated the role of statins as a concomitant drug when combined with the eradication therapy, one assessed the adverse event profile of treatments, one evaluated the bacterial antibiotic resistance trends, and a last one reported on the common mistakes in routine clinical practice of European gastroenterologists.ConclusionThe Hp-EuReg had a major influence on the routine clinical practice of European gastroenterologists, improving H. pylori eradication treatment success, allowing to make recommendations in line with the current consensus guidelines and potentially serving as a model for other diseases.

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Resumen Este documento de posicionamiento, auspiciado por la Asociacion Espanola de Gastroenterologia, la Sociedad Espanola de Endoscopia Digestiva y la Sociedad Espanola de Anatomia Patologica, tiene como objetivo establecer recomendaciones para realizar una endoscopia digestiva (EDA) de calidad en la deteccion y vigilancia de lesiones precursoras de cancer gastrico (LPCG) en poblaciones con incidencia baja, como la espanola. Para establecer la calidad de la evidencia y los niveles de recomendacion se ha utilizado la metodologia basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un metodo Delphi. El documento evalua diferentes medidas para mejorar la calidad de la EDA en este contexto y hace recomendaciones de como evaluar y tratar las lesiones identificadas. Se recomienda que la EDA de vigilancia de LPCG sea realizada por endoscopistas con capacitacion adecuada, administrando premedicacion oral y uso de sedacion. Para mejorar la identificacion de LPCG se recomienda el uso de endoscopios de alta definicion y cromoendoscopia convencional o digital, y para las biopsias debe utilizarse el NBI para dirigirlas a las areas mas sospechosas de metaplasia intestinal. En cuanto a la evaluacion de las lesiones visibles, el riesgo de invasion de la submucosa debe evaluarse con endoscopios de magnificacion y reservar la ecoendoscopia para aquellas con sospecha de invasion profunda. En las lesiones susceptibles de reseccion endoscopica, la diseccion endoscopica submucosa se considera la tecnica de eleccion.

Patients with serrated polyposis syndrome (SPS) have multiple and/or large serrated colonic polyps and higher risk for colorectal cancer. SPS inherited genetic basis is mostly unknown. We aimed to identify new germline predisposition factors for SPS by functionally evaluating a candidate gene and replicating it in additional SPS cohorts.After a previous whole-exome sequencing in 39 SPS patients from 16 families (discovery cohort), we sequenced specific genes in an independent validation cohort of 211 unrelated SPS cases. Additional external replication was also available in 297 SPS cases. TheWe identified 2 rare germline variants in theAfter whole-exome sequencing in SPS cases with familial aggregation and replication of results in additional cohorts, we identified rare germline variants in the

O objetivo deste estudo de abordagem interpretativa foi analisar postagens, emredes sociais, de grupos religiosos femininos em busca de negociações simbólicas que, a partirda moda, profanam o sagrado e sacralizam o profano. O percurso metodológico ancorou-se nacaptação e na análise das imagens de looks construídos, das legendas que as acompanham edos textos e comentários compartilhados juntamente com as fotos. Dez contas de Instagram –de mulheres caracterizadas como influenciadoras digitais e identificáveis como pertencentesà igreja Assembleia de Deus – foram acompanhadas e analisadas. Os resultados encontradosdiscutem sobre o uso, por essas mulheres, do capital da moda para borrar os limites das regrasreligiosas, fazendo negociações simbólicas entre o campo mundano e o religioso, o que nospermitiu relacionar esses achados com a sociedade da transparência de Han.

Resumen Este documento de posicionamiento, auspiciado por la Asociacion Espanola de Gastroenterologia, la Sociedad Espanola de Endoscopia Digestiva y la Sociedad Espanola de Anatomia Patologica, tiene como objetivo establecer recomendaciones para el cribado del cancer gastrico (CG) en poblaciones con incidencia baja, como la espanola. Para establecer la calidad de la evidencia y los niveles de recomendacion se ha utilizado la metodologia basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un metodo Delphi. El documento evalua el cribado en poblacion general, individuos con familiares con CG y lesiones precursoras de CG (LPCG). El objetivo de las intervenciones debe ser la reduccion de la mortalidad por CG. Se recomienda el uso de la clasificacion OLGIM y determinar el subtipo de metaplasia intestinal (MI) para evaluar las LPCG. No se recomienda establecer cribado poblacional endoscopico de CG ni de Helicobacter pylori. Sin embargo, el documento establece una recomendacion fuerte para el tratamiento de H. pylori si se detecta la infeccion, y su investigacion y tratamiento en individuos con antecedentes familiares de CG o con LPCG. En cambio, no se recomienda el uso de test serologicos para detectar LPCG. Se sugiere cribado endoscopico unicamente en los individuos con criterios de CG familiar. En cuanto a los individuos con LPCG, solo se sugiere vigilancia endoscopica ante MI extensa asociada a algun factor de riesgo adicional (MI incompleta y/o antecedentes familiares de CG) tras la reseccion de lesiones displasicas o en pacientes con displasia sin lesion visible tras una endoscopia digestiva alta de calidad con cromoendoscopia.

Resumen Introduccion En un estudio previo demostramos que un pequeno programa de formacion mejoraba los indicadores de calidad de la esofagogastroduodenoscopia (EGD) que llegaban a los estandares recomendados. Sin embargo, desconocemos el efecto de esta formacion a largo plazo. El objetivo de este estudio fue valorar la calidad de las EGD despues de 3 anos de haber realizado un programa de mejora. Material y metodos Estudio comparativo de 2 cohortes: EGD posteriores a un programa de formacion realizado en 2016 (grupo A) y EGD en enero-marzo de 2019 (grupo B). El grupo B se dividio en 2 subgrupos: endoscopistas que habian participado en el programa de formacion previo (B1) y los que no (B2). Se utilizaron los indicadores de calidad intraprocedimiento recomendados por la ASGE-ACG. Resultados Se analizaron un total de 1.236 EGD, 600 en el grupo A y 636 en el B (439 subgrupo B1 y 197 subgrupo B2). El numero de exploraciones completas fue inferior en el grupo B (566 [94,3%] vs. 551 [86,6%]; p Conclusiones La mejora observada en 2016 tras un programa de formacion no perdura a los 3 anos. Es necesario hacer programas de formacion continuados para mantener la calidad de la EGD por encima de los estandares recomendados.

Objectives: The role of colorectal neoplasms (CRN) as a common potential source of recurrent Streptococcus gallolyticus subsp. gallolyticus (SGG) and Enterococcus faecalis (EF) endocarditis remains unstudied. We aimed to investigate what proportion of episodes of recurrent endocarditis are caused by a succession of SGG and EF, or vice versa, and to assess the role of a colonic source in such recurrent episodes. Methods: we conducted a retrospective analysis of two prospective endocarditis cohorts (1979–2019) from two Spanish hospitals, providing descriptive analyses of the major features of the endocarditis episodes, colonoscopy findings, and histologic results. Results: among 1552 IE episodes, 204 (13.1%) were caused by EF and 197 (12.7%) by SGG, respectively. There were 155 episodes (10%) of recurrent IE, 20 of which (12.9%) were due to a succession of SGG/EF IE in 10 patients (the first episode caused by SGG in eight cases, and by EF in two cases). The median follow-up was 86 (interquartile range 34–156) months. In 8/10 initial episodes, the causative microorganism was SGG, and all patients were diagnosed with CRN either during the initial episode or during follow-up. During the second episode of IE or follow-up, colonoscopies revealed CRN in six patients. Conclusions: There seems to be an association between SGG and EF in recurrent endocarditis that warrants further investigation. Our findings reinforce the need for systematically performing colonoscopy in the event of endocarditis caused by both microorganisms.

The role of colorectal neoplasms (CRN) as a common potential source of recurrentwe conducted a retrospective analysis of two prospective endocarditis cohorts (1979-2019) from two Spanish hospitals, providing descriptive analyses of the major features of the endocarditis episodes, colonoscopy findings, and histologic results.among 1552 IE episodes, 204 (13.1%) were caused by EF and 197 (12.7%) by SGG, respectively. There were 155 episodes (10%) of recurrent IE, 20 of which (12.9%) were due to a succession of SGG/EF IE in 10 patients (the first episode caused by SGG in eight cases, and by EF in two cases). The median follow-up was 86 (interquartile range 34-156) months. In 8/10 initial episodes, the causative microorganism was SGG, and all patients were diagnosed with CRN either during the initial episode or during follow-up. During the second episode of IE or follow-up, colonoscopies revealed CRN in six patients.There seems to be an association between SGG and EF in recurrent endocarditis that warrants further investigation. Our findings reinforce the need for systematically performing colonoscopy in the event of endocarditis caused by both microorganisms.

Traditionally, the literature indicates that consumers have acted as prosumers voluntarily and for hedonic or leisure motivations. Only a few studies contend that consumers engage in prosumption ac...

Este estudo qualitativo busca contribuir para o entendimento do fenomeno do sonho de consumo como um processo reconhecido pelo consumidor, criativo e ciclico. Consumidores podem realizar parte do consumo ao imaginar como e possuir um objeto ou viver uma experiencia de consumo desejada. Compreender sonhos de consumo realizados por familias que visitaram a Disney World avanca com a perspectiva dos sonhos analisados como antecipacao do consumo. Os achados do estudo permitiram discutir significados e praticas em diferentes etapas do sonho “possivel”: antes, quando estavam planejando a viagem; durante a experiencia de concretizacao do sonho; e depois, quando retornaram do sonho realizado.

Pancreatic cancer (PC) is a highly lethal disease, mostly incurable when detected. Thus, despite advances in PC treatments, only around 7% of patients survive 5-years after diagnosis. This morbid outcome is secondary to multifactorial reasons, such as late-stage diagnosis, rapid progression and minimal response to chemotherapy. Based on these factors, it is of special relevance to identify PC high-risk individuals in order to establish preventive and early detection measures. Although most PC are sporadic, approximately 10% cases have a familial basis. No main causative gene of PC has been identified but several known germline pathogenic mutations are related with an increased risk of this tumor. These inherited cancer syndromes represent 3% of all PC. On the other hand, in 7% of cases of PC, there is a strong family history without a causative germline mutation, a situation known as familial pancreatic cancer (FPC). In recent years, there is increasing evidence supporting the benefit of genetic germline analysis in PC patients, and periodic pancreatic screening in PC high-risk patients (mainly those with a lifetime risk greater than 5%), although there is no general agreement in the group of patients and individuals to study and screen. In the present review, we expose an update in the field of hereditary and FPC, with the aim of describing the current strategies and implications in genetic counseling, surveillance and therapeutic interventions.

BACKGROUND & AIMS: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and panchromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.

the COVID-19 pandemic has seriously affected the world population, and has put health personnel in the spotlight as they are tasked with its management. Given their important role in the current health crisis, physicians have been heavily affected in terms of their professional practice, financial conditions and physical and mental health. The objective of this study was to determine the consequences of the COVID-19 pandemic for Colombian endoscopists and compare the effects on endoscopists from South America and from Spain.in June 2021, an electronic survey was sent to 292 endoscopists from Colombia, South America and Spain to determine the impact of the pandemic on their professional practice, economic situation, physical and mental health, and training of the residents under their charge. Participants were recruited via convenience sampling.a reduction in the number of endoscopic procedures was reported by 69.9 % of the respondents, and 72.3 % of endoscopists in Colombia stated that their income had decreased. Regarding the doctor-patient relationship, 43.8 % of the respondents believed it had worsened. In addition, 70.9 % reported having experienced changes in their emotional state, especially those related to feeling sad or depressed, and 56.5 % reported that the pandemic had negatively affected the training of residents. Finally, 24.7 % of endoscopists tested positive for COVID-19, and 19.2 % reported the death of a family member due to COVID-19.the COVID-19 pandemic has had a negative impact on the professional practice, financial situation and physical and mental health of Ibero-American endoscopists. These problems must be identified in a timely manner to develop and implement strategies aimed to prevent their occurrence.