[Instruments and accessories for interventional endoscopic ultrasonography]. / Strumenti e accessoriper ecoendoscopia interventistica.

Endoscopic ultrasound-guided (EUS) biopsy is now an established method for acquisition of cytohistological specimens. Some other procedures can be performed successfully in most instances (e.g., celiac plexus block, pseudocystic drainage), and some are being performed but need further refinement or validation (e.g., pancreatic and biliary drainage, ablation of pancreatic cyst neoplasm). The present review describes the interventional endoscopes, the needle systems and the specific devices for other interventional procedures available on the market.

Quality assurance and colonoscopy.

BACKGROUND AND STUDY AIMS: Little is known concerning the usefulness and feasibility of quality assurance programs in gastrointestinal departments. The aim of this study was to identify the indicators of quality in colonoscopy, to check their use in clinical practice, and to identify their threshold values. MATERIALS AND METHODS: A prospective study was performed in four endoscopic units. In the first phase, a questionnaire was used to identify the indicators that were considered important and easy to record; in the second phase, the selected items were prospectively recorded. RESULTS: Data from 603 colonoscopies were evaluated. The selected indicators were: rate of cecal intubation, rate of examinations with normal findings, rates of complications, appropriateness of indications, use of a washing machine for disinfection, duration of the disinfection procedure, rate of procedures repeated due to poor colon cleansing, rate of operative procedures, length of waiting time, rate of procedures performed for follow-up of known disease, experience of the operator, and rate of procedures performed with the patient under conscious sedation. A striking difference emerged between the technical standards at three centers, which were fairly good, and the standard at the fourth center, which was less satisfactory. The length of the waiting time was high in all centers, as well as the rate of examinations conducted with an inappropriate indication. The rate of procedures performed under conscious sedation varied widely between the centers. CONCLUSIONS: The study of the indicators of quality of colonoscopy is feasible and easy to perform in clinical practice, and can be useful for quality assurance programs.

[Digestive hemorrhage secondary to biliary ileus. Endoscopic diagnosis]. / Emorragia digestiva secondaria a ileo biliare. Diagnosi endoscopica.

A rare case of gastrointestinal hemorrhage is presented. The cause of bleeding was ulcer of the descending duodenum due to erosion of an impacted gallstone. Oral endoscopy made possible a preoperative diagnosis and, pushing the gallstone, made surgery easier. The patient underwent enterolithotomy and had a completely uneventful course.

[The diagnostic use of laparoscopy in liver pathology in light of the evolution of imaging diagnosis]. / L'impiego diagnostico della laparoscopia nella patologia epatica alla luce dell'evoluzione della diagnostica per immagini.

We considered 87 patients suffering from chronic hepatic pathology. 62 patients have resulted suffering from cirrhosis or chronic active hepatitis, 25 from neoplasias. In the patient's group with chronic liver disease the humoral tests were not able to differentiate between cirrhosis or chronic active hepatitis. In the present retrospective experience echography showed sensibility 0.53 and specificity 0.91. In cirrhosis group, sensibility 0.5 and specificity 0.60 in chronic active hepatitis, sensibility 0.8 and specificity 0.95 in the neoplasia group. Peritoneoscopy showed sensibility 0.97 and specificity 0.93 in the cirrhosis group and sensibility 0.90 and specificity 1.00 in the neoplasia group. We had one case of major complication: hemoperitoneum from tear of adhesion secondary to previous laparotomy. We can conclude that peritoneoscopy is an useful procedure in the study of liver chronic disease and it still finds indication in selected cases of focal illness.