Xavier Andújar

Background: Previous studies suggested that Interleukin‐10 (IL‐10) depletion in Crohn's disease (CD) could predict outcome. Aim: To determine IL‐10 in blood and at different intestinal locations in patients with active CD and to assess its potential prognostic capacity to identify aggressive CD.Methods: Twenty‐three patients with CD were included. Ulcerative colitis (UC), infectious colitis and healthy individuals acted as controls. Serum and mucosal samples were taken at baseline and 1 month after steroid initiation in CD patients. Patients were classified according to steroid response. Control samples were obtained from different intestinal locations. IL‐10 expression was measured with real‐time polymerase chain reaction, immunofluorescence (intestine) and ELISA (serum, biopsy cultures' supernatants and tissue homogenates).Results: CD and UC showed an increase in IL‐10 messenger RNA (mRNA) versus controls (p < .0001) in mucosa, whereas IL‐10 protein secretion was increased in all types of intestinal inflammation (p < .001). No differences in IL‐10 mRNA were found in CD at baseline regarding steroid response, but levels decreased in non‐responders versus responders (p = .027) and were restored with rescue therapy. Serum IL‐10 was increased in steroid‐refractory CD at baseline and after treatment.Conclusions: Abnormal IL‐10 levels in refractory patients in both mucosa and blood have physiopathological relevance and may have potential clinical applications.

Background: SARS-CoV-2 may produce intestinal symptoms that are generally mild, with a small percentage of patients developing more severe symptoms. The involvement of SARS-CoV-2 in the physiopathology of bowel damage is poorly known. Transmission electron microscopy (TEM) is a useful tool that provides an understanding of SARS-CoV-2 invasiveness, replication and dissemination in body cells but information outside the respiratory tract is very limited. We report two cases of severe intestinal complications (intestinal lymphoma and ischaemic colitis) in which the presence of SARS-CoV-2 in intestinal tissue was confirmed by TEM. These are the first two cases reported in the literature of persistence of SARS-CoV-2 demonstrated by TEM in intestinal tissue after COVID 19 recovery and SARS-CoV-2 nasopharyngeal clearance. Case presentation: During the first pandemic peak (1st March–30th April 2020) 932 patients were admitted in Hospital Universitari Mútua Terrassa due to COVID-19, 41 (4.4%) required cross-sectional imaging techniques to assess severe abdominal pain and six of them (0.64%) required surgical resection. SARS-CoV-2 in bowel tissue was demonstrated by TEM in two of these patients. The first case presented as an ileocaecal inflammatory mass which turned to be a B-cell lymphoma. Viral particles were found in the cytoplasm of endothelial cells of damaged mucosa. In situ hybridization was negative in tumour cells, thus ruling out an oncogenic role for the virus. SARS-CoV-2 remained in intestinal tissue 6 months after nasopharyngeal clearance, suggesting latent infection. The second patient had a severe ischaemic colitis with perforation and SARS-CoV-2 was also identified in endothelial cells. Conclusions: Severe intestinal complications associated with COVID-19 are uncommon. SARS-CoV-2 was identified by TEM in two cases, suggesting a causal role in bowel damage.

An 80-year-old woman with pluripathology was admitted with cholangitis. A computed tomography scan showed a dilated common bile duct (CBD) and a possible distal choledocholithiasis. An endoscopic retrograde cholangiopancreatography was performed and the duct was swept with a balloon, revealing a polypoid lesion of adenomatous appearance through the papilla. The pathology confirmed a tubulo-villous adenoma with high grade focal dysplasia. An endoscopic ultrasound revealed the presence of a 10 × 8 mm polyp in the CBD ([Fig. 1]). As the patient was a high risk surgical candidate, endoscopic treatment was indicated in accordance with a multidisciplinary committee. The papilla was reached using the duodenoscope and a papilloplasty was performed with a 12-mm pneumatic balloon ([Video 1]). With the help of the Fogarty balloon and a biopsy forceps, the polyp was tractioned toward the duodenum and polypectomy was performed using a pediatric hot snare ([Fig. 2]). Then, a fulguration soft coagulation was done and a fully covered self-expanding metallic biliary stent was placed. Video 1 Endoscopic removal of a tubulovillous adenoma with high grade focal dysplasia in the distal common bile duct. After a 2-month follow-up period, a baby scope cholangioscopy showed no macroscopic lesion after removing the stent. In addition, fulguration with argon beam was applied to the polypectomy site. In the next follow-up at 6 months, a baby scope cholangioscopy showed no remaining polyp ([Fig. 3]). Pathology confirmed the absence of adenoma at 2 and 6 months. No complications were detected during follow-up. Adenomas of the extrahepatic bile duct are uncommon benign neoplasms with an unknown malignant potential [1] [2] [3]. Surgery is the current treatment [1] [2] [3], with only five published cases of successful endoscopic treatment in nonsurgical patients [2]. In the current case, the key to achieving technical success was good visualization through the papilla (papilloplasty + stent) and the use of a pediatric polypectomy snare with the help of the balloon. Endoscopy_UCTN_Code_TTT_1AR_2AF

Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

There is very limited information regarding region-specific immunological response in human intestine. We aimed to determine differences in immune compartmentalisation between ileum and colon in healthy and inflamed mucosa. T cell profile and its apoptosis were measured by flow cytometry, Th1, Th17, Treg [CD4 ⁺ CD25 ⁺ FOXP3 ⁺ ], double positive [DP, CD3 ⁺ CD4 ⁺ CD8 ⁺ ] and double negative T cells [DN, CD3 ⁺ CD4 ^- CD8 ^- ], immunohistochemistry [FOXP3, caspase-3], and real-time polymerase chain reaction [PCR] [IFN-γ, IL-17-A, and FOXP3] on biopsies from different regions of healthy intestine and of intestine in inflammatory bowel diseases. Healthy colon showed higher percentages of Treg, Th17, and DN, and lower numbers of DP T cells compared with ileum [ p < 0.05]. Some but not all region-specific differences were lost in inflammatory conditions. Disease-specific patterns were found: a Th1/Th17 pattern and a Th17 pattern in Crohn’s disease and ulcerative colitis respectively, whereas a reduction in Th1/Th17 was found in microscopic colitis. In colonic Crohn’s disease and microscopic colitis, DN T cells had a pattern inverse to that of Th1/Th17 (increase in microscopic colitis [ p < 0.05] and decrease in Crohn’s disease [ p < 0.005]). Higher levels of lymphocyte apoptosis were found in healthy colon compared with the ileal counterparts [ p = 0.001]. All forms of colonic inflammation presented a dramatic decrease in apoptosis compared with healthy colon. By contrast ileal Crohn’s disease showed higher levels of cleaved-Caspase ⁺ CD3 ⁺ cells. Immunological differences exist in healthy gastrointestinal tract. Inflammatory processes overwhelm some location-specific differences, whereas others are maintained. Care has to be taken when analysing immune response in intestinal inflammation, as location-specific differences may be relevant.

Background and aims: Stenosis is one of the most frequent local complications in Crohn’s disease (CD). Surgery is not the ideal treatment because of the high rate of postoperative recurrence. Endoscopic balloon dilation (EBD) currently is the current treatment of choice for short strictures amenable to the procedure. However, it is not applicable or effective in all the cases, and it is not without related complications. Our goal was to summarize the published information regarding the use and the role of the stents in the treatment of CD stricture. A Medline search was performed on the terms “stricture,” “stenosis,” “stent” and “Crohn’s disease.” Results: a total of 19 publications met our search criteria for an overall number of 65 patients. Placing a self-expanding metal stent (SEMS) may be a safe and effective alternative to EBD and/or surgical intervention in the treatment of short stenosis in patients with CD. Indications are the same as those for EBD. In addition, SEMS may be useful in stenosis refractory to EBD and may be suitable in the treatment of longer or more complex strictures that cannot be treated by EBD. With the current information, it seems that the best treatment option is the placement of a fully covered stent for a mean time of 4 weeks. Regarding the use of biodegradable stents, the information is limited and showing poor results. Conclusions: the use of stents in the treatment of strictures in CD should be taken into account either as a first endoscopic therapy or in case of EBD failure.