Introduction
Endoscopic Retrograde Cholangiopancreatography (ERCP) has become an increasingly common procedure that can result in the development of Post ERCP Pancreatitis (PEP). PEP can lead to prolonged length of stay in hospital and in some cases, develop into severe pancreatitis. Several invasive prophylactic treatments are currently used by clinicians. Further investigation is needed into minimally invasive, low risk and low-cost prophylactic treatments. The purpose of this systematic review was to assess the effectiveness of aggressive fluid therapy on patients undergoing ERCP vs standard fluid therapy, in prevention of PEP.
Method
Electronic databases, including The Cochrane Library, Medline, PubMed and CINAHL Complete were searched using appropriate MeSH and Keyword terms ("Ringer's Lactate" and “fluid resuscitation” and "Cholangiopancreatography, Endoscopic Retrograde"). Results were restricted by publication date between January 2011 and September 2021. The search was limited to full text randomised controlled trials (RCTs) published in English. Trials the Cochran ‘Risk if Bias’ tables were used to assess appropriateness and data was extracted using a standard data extraction tool. Meta-analysis was undertaken when deemed appropriate and feasible.
Results
Four RCTs (n=962) reporting one comparison (aggressive fluid therapy versus standard hydration using only Lactated Ringer’s Solution) were included in this review. Incidence of PEP was lower in the aggressive fluid therapy group (OR 0.30, 95% CI 0.18 to 0.50; participants = 962; studies = 4; I2 = 0%).
Conclusion
This review found evidence of effectiveness for aggressive fluid hydration in reducing incidence of PEP, hyperamylasemia. Included trials were inconsistent in the definition of aggressive fluid therapy. Further, high-quality trials are required to determine the best fluid therapy protocol and confirm findings from this review.

*Mrs.Dorina Curri ,International Development Manager *Eng.Massimo Alghisi ,GM
*Bongiovanni Davide ,Project Product Manager * Cagnetta Matteo ,Technical Office

Key Words:
Machine Learing (ML)
Artificial Intelligence (AI)
The Internet of Things (IoT)

Introduction
One industry hit hard by the pandemic was healthcare. A positive was it forced the broader sector to reexamine patient care and technology solutions.
Medical device manufacturers are currently focusing on technologies that automate manual processes, leverage patient health data, and improve patient care in 2023.
Nuova Sb System srl were forced to scramble to keep up with these changes of ‘Fourth Industrial Revolution’ .
Nuova Sb System is focused to implement two of the main trends of Medical Devices for 2023 such as Machine Learning (ML and Internet of Things (IoT).
Case 1 – Why to stay close to the role that Artificial Intelligence has in AFERs?
The medical devices are turning to AI to help in various ways. AI is perhaps the most accurate, fast and reliable technology to treat the growing patient population in gastroenterology and endoscopy. Machine learning (ML) enables the medical devices to find cost-effective solutions, save time and increase the quality of patient treatment ,like:
• Automated tasks
• Adverse outcomes based on patient-specific data
• Processing and analyzing large amounts of data gathered by medical devices
• Managing medical records
Case 2 – Why to stay close to the role that ‘The Internet of Things’ has in AFERs?
IoT is a relatively new concept to most ,the interconnective technology has been around for two decades .The Internet of Things promises to transform a wide range of fields. IoT Medical Devices for remote monitoring connect equipment to gain live insights into equipment use and performance.
How Nuova Sb System srl implemented Case 1 in "GANDY AFER":
1. Automated Device
2. Fast Reprocessing ( time saving )
3. Consumables Management
4. Manage waiting list
5. Cycle based on history of the first cycle
6. Safety of patient& operator
7. Data Reports

How Nuova Sb System srl implemented Case 1 in "GANDY AFER":
1. Remote Control (Diagnosis, Assistance, Support )
2. Locate
3. SOFTWARE traceability(Statistic, Operational, Support strategic choices)


CONCLUSION
The "Fourth Industrial Revolution" has had a significant impact all over the world, including the health sector where the most innovative companies, such as Nuova Sb System, have embraced it by developing the newest product GANDYs AFER according to IPC.