The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS‐guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre‐operative EUS‐guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS‐guided loco‐regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS‐guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.

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Objective: The 2016 ESC Dyslipidemia guidelines established LDL-cholesterol and HbA1c targets at 70 mg/dl and 7% for patients at very-high cardiovascular risk. The 2019 Dyslipidemia guidelines set LDL-cholesterol targets as low as 55 mg/dl for patients with diabetes, hypertension and atherosclerotic cardiovascular disease (ASCVD) or severe chronic kidney disease (CKD), while maintaining 70 mg/dl targets for patients at high cardiovascular risk. The purpose of our study was to establish a baseline of LDL-cholesterol target achievement based on past years’ experience. Design and method: We performed a retrospective study on patients admitted to our Internal Medicine and Cardiology Department, from January 2014 to December 2018. All patients had arterial hypertension (HTN) and type 2 diabetes mellitus (T2DM). Data regarding patient demographics, comorbidities and laboratory assay results (including glycemia, glycated hemoglobin and a complete lipid profile) were recorded. Data analysis was performed using SPSS version 20. Results: A total of 1239 patients were enrolled with a mean age of 71.3 ± 10.1 years and a slight female predominance (59.4% female). All patients were at very-high risk according to 2016 guidelines, but only 56.3% based on 2019 guidelines: 54.3% had ASCVD and 4.2% had severe CKD. LDL-cholesterol target achievement was 28.6% and 12.4% according to 2016 and 2019 ESC recommendations. The overall mean LDL-cholesterol value was 97.1 ± 39.4 mg/dl, but LDL-cholesterol values were lower after 2016 (93.4 vs. 100.7, p = 0.030) supposedly owing to the publication of the guideline. In terms of HbA1c targets achievement, overall HbA1c was 7.2 ± 1.5% and there was no difference in target achievement before and after 2016: 60.1% vs. 53.8%, p = 0.105. Conclusions: Our study shows that very few patients reach the desired treatment goals but lower targets equal better control of risk factors. We also believe that the timing of guideline publication may have an effect on risk factor correction: yearly publications from the American Diabetes Association may help as a reminder about target HbA1c levels, leading to tighter control.

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