AIMTo evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels.METHODSOur institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who re-evaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 μg/g.RESULTSForty-four patients with IBD (38 with Crohn’s disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (κ = 0.540), type of disease (κ = 0.410) and the presence of active signs in CTE (κ = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The κ values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (κ = 0.495, P = 0.001).CONCLUSIONWe found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.

Metastatic pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis. Until recently, cytotoxic chemotherapy was the only treatment option. Currently, there are subgroups of patients with PDAC either with somatic or germline mutations who are candidates for targeted agents. Germline mutations in the BRCA1 and BRCA2 genes promote the incapacity of tumor cells to recover from DNA-accumulated damage caused by cytotoxic drugs, like platinum agents, and, most recently, through a diverse process by poly(adenosine diphosphate-ribose) polymerase inhibitor (PARPi). A 59-year-old female who was treated for a triple negative breast cancer 8 years ago with surgery, adjuvant chemotherapy and radiotherapy, presented with increasing back pain. Investigation revealed multiple liver nodules and a large mass in the head of the pancreas. Biopsy confirmed PDAC. She received 13 cycles of FOLFIRINOX, achieving partial response both in the liver and pancreatic lesion, with resolution of symptoms. Due to increasing neuropathy, chemotherapy was stopped, and the patient was followed. Sixteen months later, her CA19-9 levels increased. Given limiting neuropathy, the patient was restarted on FOLFIRI only. After 8 cycles, there was disease progression plus uncontrolled back pain. A mutational test was requested and confirmed a BRCA1 germline mutation. The patient was started on olaparib. After 3 cycles, images showed a significant response and after 6 cycles, it remained stable, with persistent fall in CA19-9 levels. She is currently on treatment, with ongoing response. In conclusion, patients with metastatic PDAC and

Background and objective Optical colonoscopy is the gold standard method for the diagnosis of colorectal cancer (CRC) and it allows for biopsy and resection, as well as documentation of synchronous lesions. CT colonography (CTC) and colon endoscopic capsule (CEC) are also recommended as alternative minimally invasive or non-invasive procedures. Prospective studies comparing these three approaches are scarce in the current literature. In light of this, the aim of this pilot study was to compare the efficacy of polyp detection between these three methods in patients with a history of curative surgical resection of CRC. Methods Patients were consecutively recruited and all procedures were sequentially conducted on the same day. The primary endpoint was the detection rate of polyps, whereas secondary endpoints were the detection of polyps according to size and location, and the adverse events caused by these procedures. Results A total of 21 patients were consecutively included and all of them underwent all three interventions. No adverse events, local recurrences, or metachronous lesions were detected. In two cases with elevated carcinoembryonic antigen (CEA), CTC unveiled distant metastasis. Optical colonoscopy registered a mean of 0.4 polyp >6 mm and 1.3 polyps <6 mm per patient. CTC unveiled only 0.5 polyp >6 mm/patient and no smaller lesions were documented, whereas findings for the colon capsule comprised an average of 0.4 polyps >6 mm and 0.7 polyps <6 mm per patient. Statistical difference was not demonstrated, except for virtual colonoscopy in terms of the total number of polyps detected in comparison to optical colonoscopy. Conclusions Optical colonoscopy showed superior results in comparison to virtual colonoscopy while there was no statistical difference in comparison to colon capsule. Notwithstanding occasional difficulties, all three techniques were well tolerated. Hence, decisions concerning the use of each diagnostic method should be based on their availability, professional expertise, contraindications, and patient preferences.

Highlights Metastatic gastric cancer has a poor prognosis. Multimodal era in gastric cancer has changed the outcomes of those patients. Good responders of metastatic gastric cancer should be discussed in multidisciplinary.

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