Salvatore Francesco Vadalà di Prampero

Background Obesity is a chronic and highly prevalent disease. Although bariatric surgery is the most effective treatment, access remains limited. Endoscopic bariatric therapies have emerged as minimally invasive alternatives. MEGA (Endoscopic Gastric Megaplication) is a modified version of POSE 2.0 that uses two G-LIX devices, a 33-mm G-PROX, and fewer sutures (mean: six) to create double gastric plications, with the goal of streamlining the procedure. Objective To evaluate the technical reproducibility, clinical efficacy, and safety of the MEGA technique at 6 months in a multicenter cohort of patients with obesity, and to explore inter-center variability and correlations between technical and clinical outcomes. Methods This retrospective multicenter cohort study included 54 patients with BMI (kg/m²) ≥ 27and comorbidities or BMI ≥ 30, treated with MEGA across six European centers experienced in bariatric endoscopy. Procedures were performed by local endoscopists after standardized training by a single instructor. Technical variables (number of sutures, procedure time) and clinical outcomes (%TBWL, %EBWL) were analyzed. Results At 6 months, mean %TBWL was 14.75 ± 6.24% (95% CI:13.05–16.45), and mean %EBWL was 56.17 ± 33.75% (95% CI: 46.96–65.39), with no significant differences among centers (p = 0.406). Overall, 81.5% of patients (95% CI: 69.2–89.6) achieved ≥ 10% TBWL. No serious adverse events were reported. No correlation was found between number of sutures and %TBWL. Conclusion In this preliminary multicenter study with 6-month follow-up, the MEGA technique was associated with clinically meaningful weight loss and no serious adverse events. Larger prospective studies with long-term follow-up are needed.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is an extremely rare malignancy with nonspecific radiological features, often requiring histological confirmation. We report the case of a 57-year-old woman presenting with abdominal pain and cholestasis, in whom imaging revealed a pancreatic head mass. After an initial nondiagnostic endoscopic ultrasound sampling, endoscopic ultrasound–guided fine-needle biopsy performed at our tertiary referral center allowed definitive diagnosis by identifying characteristic osteoclast-like giant cells and undifferentiated neoplastic cells with a specific immunohistochemical profile. This case highlights the key role of endoscopic ultrasound–guided fine-needle biopsy in the preoperative diagnosis of undifferentiated carcinoma with osteoclast-like giant cells.

Introduction Fluid-filled intragastric balloon (FF-IGB) placement is an endoscopic bariatric procedure that effectively achieves short-term weight loss in patients affected by obesity. Comparative data among different balloon volumes are lacking. This study aimed to assess efficacy and safety of FF-IGB at different volumes. Methods A randomized single-center analysis over 156 patients undergoing FF-IGB at a volume of 500 ml, 600 ml, or 700 ml with 6-month follow-up was conducted. Outcomes included postprocedural adverse events (AEs), early device removal for intolerance, evaluation of percentage of total weight loss (TWL%), excess weight loss (EWL%), and quality of life (QoL) at 6-month follow-up. Results The mean age of our cohort was 46.2 years, and 69.2% were female. The mean BMI was 41.9 kg/m². Pain was the main adverse event being detected in 78.3% patients, followed by nausea (76.8%), and vomiting (50.7%). No serious AEs were reported. Ten patients required early balloon removal for epigastric pain, nausea, and vomiting. The FF-IGB volume was not associated with nausea (p = 0.657), vomiting (p = 0.487), pain (p = 0.182), or early removal (p = 0.988). Decrease in body mass index (BMI) after 6 months was significant (mean BMI 35.24 kg/m², SD 7.17, p < 0.001). Mean TWL% after 6 months was 14.16. No significant difference between the FF-IGB volume and TWL% (p = 0.412) was detected. At 6 months follow-up, the mean EWL% was 30.8 ± 23.3 with no differences among the three groups of different FF-IGB volumes (p = 0.733). A significant improvement of QoL was detected at 6 months unrelated to the FF-IGB volume (p = 0.849). Conclusion FF-IGB placement resulted in significant weight loss over a 6-month period. No differences in TWL%, EWL%, rate of AEs, percentage of early device removal, and QoL were detected among the three groups with a different IGB volume. A 500 ml filling volume could be “the magic number” as no significant benefits are achieved with a greater volume. Key Points • Fluid-filled intragastric balloon (FF-IGB) placement effectively achieves short-term weight loss in patients affected by obesity, but comparative data among different balloon volumes are lacking. • Weight-loss outcomes, adverse-event rates, and quality-of-life gains were identical across 500 ml, 600 ml, and 700 ml balloon volumes. • A 500 ml filling volume for fluid-filled intragastric balloons could be “the magic number,” as larger volumes confer no additional benefit.

The serological support for early diagnosis and differential diagnosis of inflammatory bowel diseases (IBDs) is actually very limited. In this study, we evaluated the performance of a promising multiparametric method including either well-established and newly developed biomarkers. We conducted a multicenter cross-sectional study at the Gastroenterology Units of Udine (Italy), Rijeka (Croatia) and Belgrade (Serbia). Sera was collected from IBD patients, and autoantibody profiles were determined using a mosaic cell and tissue-based indirect immunofluorescence (IIF) method simultaneously investigating anti-saccharomyces cerevisiae antibodies (ASCAs), anti-atypical perinuclear neutrophilic antibodies (P-ANCAs), anti-pancreatic antigens antibodies (PABs) and anti-goblet cells antibodies (GAB). The study finally enrolled 156 patients with IBD: 100 affected by Crohn’s disease (CD) and 56 by ulcerative colitis (UC). Twenty age-sex matched blood donors (BDs) were included as controls. PAB (anti-CUZD1 and/or anti-GP2 antibodies) were present in 24 CD patients versus none of the UC patients or BDs (24% sensitivity, 100% specificity). As regards CD patients, combined positivity of PAB and ASCA (sensitivity 84%, specificity 71.4%) performed better than ASCA alone. Colon involvement (87.5% vs. 60.5%; p = 0.014), deep mucosal lesions (58.3% vs. 25.0%; p = 0.002) and need for biologic therapies (79.2% vs. 46.1%; p = 0.005) were significantly more prevalent in PAB-positive than in PAB-negative CD patients. Multivariate analysis identified PAB positivity (OR = 3.67; 95%CI = 1.29–10.46) and anti-CUZD1 in particular (OR = 3.54; 95%CI = 1.08–11.63) as significant risk factors for deep mucosal lesion development in CD. A multiparametric diagnostic approach appears very useful to better characterize IBD patients. PABs, whether isolated or combined with other autoantibodies, may support differential diagnosis but above all facilitate the selection of CD patients at risk for more severe disease.

Cytomegalovirus (CMV) infection is usually asymptomatic or causes a mild mononucleosis-like syndrome, whereas severe symptoms are rarely reported. We report a case of a 70-year-old woman who was admitted to our center because of severe clinical presentation with anorexia, epigastric pain, nausea, postprandial vomiting, and significant weight loss. Esophagogastroduodenoscopy with biopsies showed ulcerative chronic gastritis with scattered large cells with inclusion bodies. Immunohistochemistry and polymerase chain reaction for CMV-DNA resulted positive. A gastric emptying of solid scintigraphy showed severe gastroparesis. The patient was discharged after 2 months of antiviral therapy completely asymptomatic. To the best of our knowledge, this is the first case of CMV-related gastroparesis in an immunocompetent patient, successfully treated with antiviral therapy.

Introduction: The serological support to early diagnosis and differential diagnosis of inflammatory bowel diseases (IBD) is actually very limited. In this study we evaluated the performance of a promising multiparametric method including either well established and newly developed biomarkers. Methods: This multicenter retrospective observational study finally enrolled 156 patients with IBD, 100 affected by Crohn’s disease (CD) and 56 by ulcerative colitis (UC) recruited at the Gastroenterology Units of Udine (Italy), Rijeka (Croatia) and Belgrade (Serbia). Twently age-sex matched blood donors (BD) were included as controls. Autoantibody profiles were determined using a mosaic cell and tissue-based indirect immunofluorescence (IIF) method simultaneously investigating: anti-saccharomyces cerevisiae antibodies (ASCA), anti-atypical perinuclear neutrophilic antibodies (P-ANCA), anti-pancreatic antigens antibodies (PAB) and anti-goblet cells antibodies (GAB). Results: PAB (anti-CUZD1 and/or anti-GP2 antibodies) were present in 24 CD patients versus none of UC patients or BD (24% sensitivity, 100% specificity). As regards CD patients, combined positivity of PAB and ASCA (sensitivity 84%, specificity 71.4%) performed better than ASCA alone. Colon involvement (87.5% vs. 60.5%; p=0.014), deep mucosal lesions (58.3% vs. 25.0%; p=0.002) and need for biologic therapies (79.2% vs. 46.1%; p=0.005) were significantly more prevalent in PAB-positive than in PAB-negative CD patients. Multivariate analysis identified PAB positivity (OR=3.67; 95%CI=1.29-10.46) and anti-CUZD1 in particular (OR=3.54; 95%CI=1.08-11.63) as significant risk factors for deep mucosal lesions development in CD. Conclusion: A multiparametric diagnostic approach appears very useful to better characterize IBD patients. PAB, isolated or combined with other autoantibodies, may support both differential diagnosis and selection of CD patients at risk for more severe disease.