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Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with biliary stenting is a minimally invasive medical procedure employed to address both malignant and benign obstructions within the biliary tract. Benign biliary strictures (BBSs), typically arising from surgical interventions such as liver transplants and cholecystectomy, as well as chronic inflammatory conditions, present a common clinical challenge. The current gold standard for treating BBSs involves the periodic insertion of plastic stents at intervals of 3–4 months, spanning a course of approximately one year. Unfortunately, stent occlusion emerges as a prevalent issue within this treatment paradigm, leading to the recurrence of symptoms and necessitating repeated ERCPs. In response to this clinical concern, we initiated a pilot study, delving into the microbial composition present in bile and on the inner surfaces of plastic stents. This investigation encompassed 22 patients afflicted by BBSs who had previously undergone ERCP with plastic stent placement. Our preliminary findings offered promising insights into the microbial culprits behind stent occlusion, with Enterobacter and Lactobacillus spp. standing out as prominent bacterial species known for their biofilm-forming tendencies on stent surfaces. These revelations hold promise for potential interventions, including targeted antimicrobial therapies aimed at curtailing bacterial growth on stents and the development of advanced stent materials boasting anti-biofilm properties.

Pregnancy is characterized by maternal adaptations that are necessary to create a welcoming and hospitable environment for the fetus. Studies have highlighted how the microbiota modulates several networks in humans through complex molecular interactions and how dysbiosis (defined as quantitative and qualitative alterations of the microbiota communities) is related to human pathologies including gynecological diseases. This review analyzed how maternal uterine, vaginal, and gut microbiomes could impact on fetus health during the gestational period. We evaluated the role of a dysbiotic microbiota in preterm birth, chorioamnionitis, gestational diabetes mellitus and pre-eclampsia. For many years it has been hypothesized that newborns were sterile organisms but in the past few years this paradigm has been questioned through the demonstration of the presence of microbes in the placenta and meconium. In the future, we should go deeper into the concept of in utero colonization to better understand the role of microbiota through the phases of pregnancy. Numerous studies in the literature have already showed interesting results regarding the role of microbiota in pregnancy. This evidence gives us the hope that microbiota modulation could be a novel strategy to reduce the morbidity and mortality related to pregnancy complications in the future.

Correspondence to Dr Ivo Boškoski, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy; ivo.boskoski@policlinicogemelli.it We thank Chaussade et al that raised important questions regarding the potential ways of airborne transmission of microorganisms through endoscopes light source processors1 2 and their discussion on our previously published work on endoscopes used in positive and critically ill patients with SARS-CoV-2.2 Today we know that high viral loads on nasal and throat specimens characterise the early stage of COVID-19 disease, with viral load peaks during the first 7–10 days after symptoms onset and subsequent progressive decline over time.3–5 The dynamic of SARS-CoV2 infection is not yet completely understood but can be strongly influenced by clinical factors such as age, comorbidities, serological response and many other factors.5 For instance, elderly patients might have higher viral loads.5 Our analysis included 12 patients with moderate-to-severe COVID-19 disease and a mean age of 73 (53–93) years, who underwent a digestive or pulmonary endoscopic procedure after a mean time of 22.7 (IQR 9.75–32.5) days from symptoms onset or first positive PCR for SARS-CoV-2 on a nasopharyngeal swab. Surprisingly, the virus could not be detected on any part of endoscopes immediately after the procedure, regardless of the kind of procedure and scope used. [...]we could not validate the endoscope reprocessing with PAA, though we could postulate that the role of the endoscope as an infection vehicle is lower than we could expect. The potential risk of SARS-CoV2 transmission described by Chaussade et al due to the environmental contamination derived from the circulation of air inside, from and to the light source processor is certainly not negligible.