Nowadays, obesity represents an immense burden for global healthcare. The number of overweight or obese cases has exceeded that of underweight individuals.1 Bariatric surgery is accepted as a safe and effective treatment for patients with morbid obesity and has gained widespread popularity in the past two decades. Advancements in surgical techniques, perioperative care, and fellowship-based bariatric surgery training have substantially reduced morbidity and mortality rates. Nevertheless, several controversial aspects of surgical treatments of morbidly obese patients are still to be considered. Here we discuss the mistakes made when managing patients who are candidates for or have been submitted to bariatric surgery in the preoperative, perioperative, and postoperative periods. As high-level evidence is lacking for many aspects of surgical bariatric care, the discussion is based on our long-standing clinical experience.

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Coeliac disease is an autoimmune disorder triggered by gluten, which activates an immune reaction against the autoantigen tissue transglutaminase (TG2) in genetically predisposed subjects. Genetic susceptibility to coeliac disease has been proven by its close linkage with major histocompatibility complex (MHC) class II human leukocyte antigen (HLA) DQ2 and DQ8 haplotypes. The identification of biomarkers for coeliac disease (e.g. endomysial antibodies [EmA] and antibodies to TG2 [anti-TG2]) has changed the epidemiology of coeliac disease from being a rare to a frequent condition, with an expected prevalence of 1% in the worldwide population. Coeliac disease can be difficult to diagnose because symptoms vary from patient to patient, and the majority of patients who have coeliac disease remain undiagnosed. Small intestinal biopsy remains the gold standard for coeliac disease diagnosis, and a delayed diagnosis in the elderly can be considered a risk factor for complications. Complicated coeliac disease is not so frequent, but for those who have it, the prognosis is very poor, with a low rate of survival after 5 years.

Barrett’s oesophagus is a premalignant condition of the distal oesophagus predisposing to oesophageal adenocarcinoma. Given the potential for malignant progression and the poor prognosis of eosophageal adenocarcinoma when diagnosed at a symptomatic stage, patients with known Barrett oesophagus undergo regular endoscopic surveillance to detect neoplastic progression at an early and preferably endoscopically, treatable stage. Endoscopic management of early Barrett oesophagus neoplasia consists of a combination of endoscopic imaging, endoscopic resection and endoscopic ablation. Below we discuss a number of mistakes that are frequently made when managing Barrett oesophagus neoplasia and how to avoid them. Much of this discussion draws on existing guidelines (for background reading, check the ESGE Barrett oesophagus guideline), but in many instances the underlying evidence (even in the guideline) is missing and therefore many of our practically driven recommendations are based on common sense and our experience in this field.

Ultrasound is a routine diagnostic procedure widely used in gastroenterology departments worldwide, and gastrointestinal ultrasound (GIUS) has become increasingly important in diagnosing and following gastrointestinal disorders. Being a real-time imaging modality, it has some advantages over static imaging modalities such as CT and MRI, and it allows the examiner to perform various techniques and methods to enhance visualisation. GIUS requires more than essential ultrasound experience, and acquiring good images for correct interpretation can be challenging even for the experienced examiner. As such, there are several pitfalls that clinicians should be aware of. Based on our clinical experience with an evidence-based approach, we present the ten most common mistakes made in gastrointestinal ultrasound and how to avoid them.