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Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Rondonotti E, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Elli L, Girelli CM, Hassan C, Marmo R, Riccioni ME, Oliva S, Scarpulla G, Soncini M, Vecchi M, Pennazio M. Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met? Endosc Int Open 2021; 9:E122-E129. [PMID: 33532548 PMCID: PMC7834698 DOI: 10.1055/a-1319-0742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark. Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures. Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014-2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5 %, 10.9 %, 31.1 %, 67.7 %, 53.4 %, and 32.2 % of centers, respectively. Conclusions The present survey shows significant variability across SBCE centers; only four (4/10: 40 %) SBCE procedural minimum standards were met by a relevant proportion of the centers ( ≥ 80 %). Our data should help in identifying target areas for quality improvement programs in SBCE.
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Affiliation(s)
- Emanuele Rondonotti
- Unità Operativa Complessa di Gastroenterologia, Ospedale Valduce, Como, Italy
| | - Cristiano Spada
- Unità Operativa di Endoscopia Digestiva, Università Cattolica, Rome, Italy,Unità Operativa di Endoscopia Digestiva, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Unità Operativa di Endoscopia Digestiva, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Struttura Operativa Complessa di Gastroenterologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- Unità Operativa Malattia Infiammatorie Croniche Intestinali, Dipartimento di Medicina e Chirurgia (DIMEC), Ospedale S. Orsola-Malpighi Università di Bologna, Bologna, Italy
| | | | - Luca Elli
- Unità Operativa Complessa di Gastroenterologia ed Endoscopia-Centro per la Prevenzione e Diagnosi della Malattia Celiaca, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Maria Girelli
- Unità Di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Cesare Hassan
- Unità Operativa di Endoscopia Digestiva, Ospedale Nuovo Regina, Rome, Italy
| | - Riccardo Marmo
- Unità Operativa di Gastroenterologia, Ospedale Curto, Polla, Italy
| | - Maria Elena Riccioni
- Unità Operativa di Endoscopia Digestiva, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Unità Operativa di Gastroenterologia e Epatologia Pediatrica, Università La Sapienza, Rome, Italy
| | - Giuseppe Scarpulla
- Unità Operativa di Gastroenterologia, Ospedale M. Raimondi, San Cataldo, Italy
| | - Marco Soncini
- Dipartimento di Medicina Interna, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Maurizio Vecchi
- Dipartimento di Scienze Biomediche, Università degli Studi di Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Pennazio
- Divisione di Gastroenterologia U, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, Torino, Italy
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Girelli CM, Soncini M, Rondonotti E. Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding. World J Gastroenterol 2017; 23:697-702. [PMID: 28216977 PMCID: PMC5292344 DOI: 10.3748/wjg.v23.i4.697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.
METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.
RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).
CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
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Girelli CM, Pometta R, Facciotto C, Mella R, Bernasconi G. First report of splenic rupture following deep enteroscopy. World J Gastrointest Endosc 2016; 8:391-394. [PMID: 27170840 PMCID: PMC4861856 DOI: 10.4253/wjge.v8.i9.391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/13/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
Splenic rupture is a rare complication of diagnostic and therapeutic gastrointestinal endoscopy procedures. Herein, we report for the first time a case of splenic rupture following therapeutic retrograde double-balloon enteroscopy, which occurred in an 85-year-old man who was treated for recurrent mid-intestinal bleeding that resulted from ileal angioectasia. This patient promptly underwent an operation and eventually recovered.
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Rossi RE, Girelli CM, Bernasconi G, Conte D. Currently neglected, physical examination maintains its clinical relevance. Intern Emerg Med 2014; 9:871-4. [PMID: 25253634 DOI: 10.1007/s11739-014-1132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit-Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Universita` degli Studi di Milano, Milan, Italy,
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Rondonotti E, Soncini M, Girelli CM, Russo A, Ballardini G, Bianchi G, Cantù P, Centenara L, Cesari P, Cortelezzi CC, Gozzini C, Lupinacci G, Maino M, Mandelli G, Mantovani N, Moneghini D, Morandi E, Putignano R, Schalling R, Tatarella M, Vitagliano P, Villa F, Zatelli S, Conte D, Masci E, de Franchis R. Can we improve the detection rate and interobserver agreement in capsule endoscopy? Dig Liver Dis 2012; 44:1006-11. [PMID: 22858420 DOI: 10.1016/j.dld.2012.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/15/2012] [Accepted: 06/20/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data about strategies for improving the diagnostic ability of capsule endoscopy readers are lacking. AIM (1) To evaluate the detection rate and the interobserver agreement among readers with different experience; (2) to verify the impact of a specific training (hands-on training plus expert tutorial) on these parameters. METHODS 17 readers reviewed 12 videos twice; between the two readings they underwent the training. The identified small bowel findings were described by a simplified version of Structured Terminology and classifies as clinically significant/non-significant. Findings identified by the readers were compared with those identified by three experts (Reference Standard). RESULTS The Reference Standard identified 26 clinically significant findings. The mean detection rate of overall readers for significant findings was low (about 50%) and did not change after the training (46.2% and 46.4%, respectively). There was no difference in the detection rate among readers with different experience. The interobserver agreement with the Reference Standard in describing significant findings was moderate (k = 0.44; CI95%: 0.39-0.50) and did not change after the training (k = 0.44; CI95%: 0.38-0.49) or stratifying readers according to their experience. CONCLUSIONS Both the interobserver agreement and the detection rate of significant findings are low, regardless of the readers' experience. Our training did not significantly increase the performance of readers with different experience.
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Girelli CM. [Capsule endoscopy in Crohn's disease]. Recenti Prog Med 2011; 102:238-45. [PMID: 21779105 DOI: 10.1701/893.9841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Capsule endoscopy appropriateness in Crohn's disease.The incidence of Crohn's disease is steadily growing in western countries and the diagnosis is still delayed from symptoms onset by several years. Up to one third of patients have exclusive disease location in the small bowel, the tract less accessible to conventional diagnostic visualization. In the last decade, astonishing improvements in radiologic and endoscopic imaging allowed to better diagnose small bowel Crohn's disease. In particular, capsule endoscopy is a high sensitive tool in diagnosing subtle inflammatory lesions of the mucosa, but retention risk and low specificity limit its use in this setting. The present review provides a critical evaluation of the published studies addressed to the diagnostic role of small bowel capsule endoscopy in established, suspect, operated Crohn's disease and unclassified inflammatory bowel disease: in an attempt to help the clinician to utilize capsule endoscopy properly in the different clinical scenarios associated to inflammatory bowel disease.
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Girelli CM, Serio G, Rocca E, Rocca F. Refractory ulcerative colitis and iatrogenic colorectal Kaposi's sarcoma. Dig Liver Dis 2009; 41:170-4. [PMID: 18054849 DOI: 10.1016/j.dld.2007.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/30/2007] [Accepted: 10/16/2007] [Indexed: 12/11/2022]
Abstract
Colorectal Kaposi's sarcoma, a human herpes virus-8 associated mesenchymal tumour, is exceedingly rare in human immunodeficiency virus-negative subjects and almost always reported in association with severe, refractory, inflammatory bowel disease. In this paper we report a case--the second from Italy--of a colorectal Kaposi's sarcoma in a human immunodeficiency virus-negative, heterosexual man with severe refractory ulcerative colitis. Kaposi's sarcoma developed after starting glucocorticosteroid therapy, supporting the theory that colorectal Kaposi's sarcoma associated with ulcerative colitis is iatrogenic.
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Affiliation(s)
- C M Girelli
- First Division of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Italy.
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Saibeni S, Virgilio T, D'Incà R, Spina L, Bortoli A, Paccagnella M, Peli M, Sablich R, Meucci G, Colombo E, Benedetti G, Girelli CM, Casella G, Grasso G, de Franchis R, Vecchi M. The use of thiopurines for the treatment of inflammatory bowel diseases in clinical practice. Dig Liver Dis 2008; 40:814-20. [PMID: 18479986 DOI: 10.1016/j.dld.2008.03.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 02/19/2008] [Accepted: 03/27/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thiopurines are the most commonly used immunomodulatory drugs in inflammatory bowel diseases. AIM To evaluate the use, the therapeutic and safety profiles of thiopurines in a large sample of IBD patients. METHODS We reviewed 3641 case histories of IBD patients. Thiopurines were prescribed in 582 patients (16.0%); the analysis was performed on the 553 (267 ulcerative colitis, 286 Crohn's disease) with exhaustive clinical data. RESULTS The main indications for treatment were steroid-dependence (328/553, 59.3%) and steroid-resistance (113/553, 20.7%). Thiopurines were started when CD were younger than UC patients (p<0.001) but earlier from diagnosis in UC than in CD patients (p=0.003). Efficacy was defined as optimal (258/553, 46.6%), partial (108/553, 19.5%), absent (85/553, 15.4%) and not assessable (102/553, 18.4%). Efficacy was independent of disease type, location/extension or duration and age at starting. Side effects were observed in 151/553 (27.3%) patients, leading to drug discontinuation in 101 (18.3%). 15 out of the 130 (11.5%) patients who took thiopurines for more than 4 years relapsed, more frequently in CD than in UC (OR=3.67 95% C.I. 0.98-13.69; p=0.053). CONCLUSIONS Thiopurines confirm their clinical usefulness and acceptable safety profile in managing complicated IBD patients. The majority of patients treated for longer than 4 years maintain response. No clinical and demographic predictive factors for efficacy and side effects were identified.
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Affiliation(s)
- S Saibeni
- IRCCS Policlinico Hospital, Mangiagalli and Regina Elena Foundation Milan, Italy.
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Girelli CM, Porta P, Malacrida V, Barzaghi F, Rocca F. Clinical outcome of patients examined by capsule endoscopy for suspected small bowel Crohn's disease. Dig Liver Dis 2007; 39:148-54. [PMID: 17196893 DOI: 10.1016/j.dld.2006.10.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Revised: 10/27/2006] [Accepted: 10/30/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Capsule endoscopy has a greater diagnostic yield than radiology for detecting subtle inflammatory changes of the small bowel mucosa, but the clinical significance of these abnormalities is still uncertain because of the lack of long-term follow-ups. AIM AND METHODS To verify the accuracy of capsule endoscopy in a cohort of patients with suspected Crohn's disease of the small bowel, taking as 'gold standard' the final diagnosis made after a long follow-up. From April 2002 to March 2005, we enrolled and examined by capsule endoscopy 27 consecutive patients with abdominal pain and diarrhea lasting more than 3 months and at least one of the following: anaemia, weight loss, fever, extra-intestinal manifestation(s) of inflammatory bowel disease. All patients already had an unremarkable pan-endoscopy, serology for celiac disease and intestinal radiology inconclusive for small bowel abnormality. On the basis of capsule endoscopy findings, patients were distributed in three groups; Group A had severe stricturing lesions requiring surgery; Group B, moderate inflammatory lesions further investigated invasively; Group C, minimal inflammatory changes or normal findings, clinically observed every 3 months (median 21 months, range 15-29). RESULTS Small bowel inflammatory lesions were found in 16 of the 27 patients (diagnostic yield 59%). Three had surgery (Group A) and Crohn's disease was confirmed in two; the remainder had ileal adenocarcinoma in a pathological context of chronic inflammation. Crohn's disease was histologically confirmed in four of the five patients in Group B. Group C comprised 19 patients; Crohn's disease was confirmed in seven out of eight with positive capsule endoscopy, while only one of the patients with normal findings later developed overt ileal Crohn's disease. Sensitivity, specificity, positive and negative likelihood ratio were, respectively, 93%, 84%, 5.8 and 0.08. Assuming a 50% pre-test probability of disease, capsule endoscopy gave a post-test probability of 85%. CONCLUSIONS In our selected cohort, capsule endoscopy was highly sensitive in detecting small bowel inflammatory changes, enhancing by nearly 35% the pre-test probability of structural small bowel disease. Focal erythema and luminal debris may limit the specificity of capsule endoscopy.
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Affiliation(s)
- C M Girelli
- Gastroenterology and Digestive Endoscopy Service. 1st Division of Internal Medicine, Hospital of Busto Arsizio, Italy.
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Girelli CM, Rocca F. [Early diagnosis of pancreatic carcinoma]. Recenti Prog Med 2001; 92:400-1. [PMID: 11433720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The poor prognosis of pancreatic carcinoma seems mainly due to the late symptoms onset. Age, cigarette smoking, family history of pancreatic carcinoma, chronic pancreatitis, a history of previous malignancy, new onset of diabetes mellitus without family history or overweight, and secondary failure to oral antidiabetic agents in a long standing type 2 diabetes mellitus are the hitherto identified risk factors. In consideration of the increasing availability of endoscopic ultrasonography--the most accurate examination in the diagnosis of small pancreatic masses--a perspective multicentric screening study on subjects with some of these risk factors may be justified at this time.
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Affiliation(s)
- C M Girelli
- Unità Operativa Medicina I, Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Circolo di Busto Arsizio.
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Girelli CM, Scarpellini M. Gastric Crohn's disease and SAPHO syndrome. Clin Exp Rheumatol 2001; 19:356. [PMID: 11407099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Imperiali G, Meucci G, Alvisi C, Fasoli R, Ferrara A, Girelli CM, Rocca F, Saibeni S, Minoli G. Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII). Am J Gastroenterol 2000; 95:1014-6. [PMID: 10763952 DOI: 10.1111/j.1572-0241.2000.01943.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Little is known about the clinical features and natural history of segmental colitis associated with diverticula. Our aim was to evaluate the incidence of segmental colitis associated with diverticula in patients undergoing colonoscopy, its clinical picture, and its outcome. METHODS This was a multicenter, prospective study. Patients with inflammatory bowel disease (IBD)-like lesions limited to colonic segments with diverticula were enrolled. Patients were treated with oral and topical 5-aminosalicylic (5-ASA) until remission was achieved; clinical and endoscopic follow-up was planned at 6 wk and 12 months. RESULTS A total of 5457 consecutive colonoscopies were recorded at five participating institutions; 20 patients (0.36%) met the endoscopic criteria for segmental colitis associated with diverticula. All had lesions in the left colon, and one also had lesions in the right colon. In six cases, a specific diagnosis was made thereafter. The remaining 14 patients (0.25% of colonoscopies; eight men; age range, 49-80 yr) were in clinical and endoscopic remission at the first follow-up visit. At onset, 13/14 had hematochezia, seven had diarrhea, and five had abdominal pain; only one had weight loss. No subject had fever. In all but one case, blood chemistries were normal. Five patients had had similar symptoms previously. Thirteen of 14 patients were in clinical and endoscopic remission at 12 months. CONCLUSIONS This endoscopic picture is not an exceptional finding. Hematochezia was the main clinical feature, and no relation with gender, age, or smoking habit was found. Blood chemistries were generally normal and the rectum was spared. The histological features were not diagnostic and most patients did not complain of any abdominal symptoms 12 months after enrollment.
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Affiliation(s)
- G Imperiali
- Dipartimento di Gastroenterologia, Ospedale Valduce, Como, Italy
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Meucci G, Bortoli A, Riccioli FA, Girelli CM, Radaelli F, Rivolta R, Tatarella M. Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. GSMII (Gruppo di Studio per le Malattie Infiammatorie Intestinali). Eur J Gastroenterol Hepatol 1999; 11:909-13. [PMID: 10514127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To evaluate the prevalence and the clinical evolution of patients with an initial diagnosis of indeterminate colitis. DESIGN Retrospective, observational study. SETTING Fifteen gastrointestinal units in northern Italy. PARTICIPANTS Patients with an initial diagnosis of indeterminate colitis seen between 1988 and 1993. INTERVENTIONS Patients were traced through a common database and centres were requested to update their clinical follow-up. MAIN OUTCOME MEASURES Frequency of patients with an initial diagnosis of indeterminate colitis among those with IBD; rate of patients who subsequently had a definite diagnosis of either Crohn's disease or ulcerative colitis. RESULTS Fifty out of 1113 IBD patients (4.6%) had been diagnosed as having indeterminate colitis. During follow-up, 37 patients (72.5%) had a definite diagnosis of either Crohn's disease or ulcerative colitis. The cumulative probability of having a definite diagnosis of either ulcerative colitis or Crohn's disease was 80% 8 years after the first one (i.e. the first diagnosis). The probability of having a diagnosis of Crohn's disease was increased in patients with fever at onset, segmental endoscopic lesions or extra-intestinal complications and in current smokers. The probability of having a diagnosis of ulcerative colitis was increased in patients who had not undergone appendectomy before diagnosis. CONCLUSIONS In our area, indeterminate colitis accounts for about 5% of initial diagnoses of IBD. In about 80% of patients, a diagnosis of either ulcerative colitis or Crohn's disease is made within 8 years. Several clinical and demographic features can help in identifying those patients more likely to have a subsequent diagnosis of Crohn's disease and those more likely to have a subsequent diagnosis of ulcerative colitis.
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Affiliation(s)
- G Meucci
- Dipartimento di Gastroenterologia, Ospedale Valduce, Como, Italy.
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Girelli CM, Mirata C, Casiraghi A. Effect of blood letting on serum aminotransferase levels of patients with chronic hepatitis C and iron overload. Recenti Prog Med 1998; 89:241-4. [PMID: 9676130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To confirm the existing evidence that blood letting reduces serum aminotransferase levels and to seek factors associated with a greater reduction in subjects with chronic hepatitis C and iron overload. DESIGN Prospective, open label, non controlled study in two northern Italian hospitals. PATIENTS Sixteen patients with histologically proven chronic hepatitis, positive hepatitis C virus serology, HCV-RNA detectable in their sera, and histological and biochemical signs of iron overload, nonresponders to interferon alpha therapy, underwent weekly phlebotomies until serum ferritin values < or = 50 ng/mL were obtained. Serum aminotransferases, serum ferritin and transferrin saturation were then measured and compared with values at baseline. RESULTS Alanine aminotransferase and aspartate aminotransferase levels fell after phlebotomies from 193 +/- 107 IU/L to 115 +/- 53 IU/L (t = 4.94, p = 0.0001) and from 124 +/- 60 IU/L to 85 +/- 35 IU/L (t = 3.76, p = 0.002), respectively. The magnitude of the reduction correlated with baseline aminotransferase levels (r = 0.68, p = 0.004 for alanine aminotransferase and r = 0.63, p = 0.009 for aspartate aminotransferase), but not with those of serum ferritin and transferrin saturation percentage, nor with the quantity of iron removed. There was a trend towards a greater alanine aminotransferase reduction in patients with the highest baseline serum ferritin (r = 0.26, p = 0.14). CONCLUSIONS Blood letting was effective in reducing serum aminotransferase levels of patients with chronic hepatitis C and iron overload, especially those with the highest baseline aminotransferase levels.
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Affiliation(s)
- C M Girelli
- Unità Operativa di Medicina I, Ospedale, Busto Arsizio, Varese
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Abstract
We report the case of a middle-aged woman presenting epigastric discomfort, hepatomegaly, biochemical signs of cholestasis, bone marrow plasmocytosis and Bence Jones proteinuria. Percutaneous liver biopsy disclosed kappa light chain deposition disease of the liver and fine needle aspiration of abdominal fat showed amyloid substance. Renal blood chemistries and urinalysis were repeatedly normal. To our knowledge, this is the first reported case of kappa light chain deposition disease of the liver and concomitant amyloidosis without renal involvement as the first manifestation of plasma cell dyscrasia. This condition should be considered in the differential diagnosis of intrahepatic cholestatic liver disease.
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Affiliation(s)
- C M Girelli
- Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Circolo di Busto Arsizio, VA, Italy
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Girelli CM, Reguzzoni G, Rocca F. [Alendronate-induced esophagitis. A report of 2 cases]. Recenti Prog Med 1997; 88:223-5. [PMID: 9244956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cases of esophagitis associated with the use of alendronate are described. Both patients were women with no past history of heartburn or dyspepsia, who started alendronate for postmenopausal osteoporosis at least one week before the symptoms onset, by taking the drug with half a glass of tap water at bedtime. The first patient suffered from a severe chest pain; endoscopy showed confluent erosions of the lower third of the esophagus. The second patient had odynophagia and developed exudates and greyish plaques on the mucosa of the upper third of the esophagus. Histological examination of the esophageal specimens of both patients disclosed no Monilia, hyphae, or nuclear viral inclusions. Both patients stopped alendronate with complete recovery at follow-up. A brief review of the etiopathogenesis of pill esophagitis is also presented. Finally, emphasis is placed on the selection of patients for therapy with alendronate with warnings on how to take the drug correctly.
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Affiliation(s)
- C M Girelli
- U.O. Medicina I e Servizio di Gastroenterologia ed Endoscopia Digestiva, Azienda USSL 3, Busto Arsizio, Varese
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Girelli CM, Cuvello P, Limido E, Rocca F. Duodenogastric reflux: an update. Am J Gastroenterol 1996; 91:648-53. [PMID: 8677924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the role of duodenogastric reflux in the pathogenesis of reflux gastritis is firmly established, for other foregut diseases, such as chronic gastritis, esophagitis, functional dyspepsia, peptic ulcer, and malignancy, it remains controversial and only speculative. The aim of this paper is to review merits and flaws of the methods currently used for the detection of duodenogastric reflux, with emphasis on the newly developed method for 24-h bilirubin detection in the gastric and esophageal content, by a fiberoptic small-size probe (Bilitec 2000), and to summarize recent advances in understanding the role of duodenogastric reflux in foregut disorders, in an attempt to identify topics for future research.
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Affiliation(s)
- C M Girelli
- Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Circolo di Busto Arsizio, Italy
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Abstract
Two cases of streptococcal toxic shock-like syndrome that occurred at our hospital are described. They represent the second and third cases reported from Italy. Both patients were women, had a portal of entry from cutaneous infection of a limb and suddenly developed high degree fever, severe hypotension, necrotizing fasciitis, acute renal failure, hepatic damage, thrombocytopenia and bleeding from a stress-related duodenal ulcer. One patient was leukopenic. The first patient needed resuscitation in the intensive care unit and emergency surgical debridement of the affected limb, whereas the second improved with medical therapy, but needed duodenal surgery for uncontrolled bleeding. Both patients slowly recovered and survived. Finally, a short update on the pathogenesis of the syndrome is also presented.
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Affiliation(s)
- C M Girelli
- Medicina Ia, Hospital of Busto Arsizio (VA), Italy
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Girelli CM, Reguzzoni G, Limido E, Savastano A, Rocca F. Pancreatic carcinoma: differences between patients with or without diabetes mellitus. Recenti Prog Med 1995; 86:143-6. [PMID: 7617956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to assess the prevalence and type of diabetes mellitus in patients with pancreatic carcinoma and if the risk factors for the cancer have a different distribution among diabetics and non-diabetics, we reviewed the charts of 127 histologically and/or cytologically proven pancreatic carcinomas consecutively diagnosed from 1977 to 1989 and referred to our Primary Care Hospital from the attending physician. 48 out of 127 (37.7%) subjects were found to be diabetic; 3 had long standing insulin dependent diabetes mellitus, 10 long standing non insulin dependent diabetes mellitus and 35 (73% of all diabetics) new onset diabetes mellitus. 5 out of 10 long standing non insulin dependent diabetics showed secondary failure to oral antidiabetic agents and weight loss in the last six months before the diagnosis of pancreatic carcinoma. When compared to non-diabetics, all diabetics were older (p = 0.05), drank less alcohol (p = 0.047) and had a higher rate of previous neoplasms (p = 0.005). New onset diabetics had a less advanced cancer than those of long standing (p = 0.009). Our study calls for a careful search for pancreatic carcinoma in new onset diabetes of elderly and in long standing, weight losing, non insulin dependent diabetics on secondary failure to oral antidiabetic agents and support the hypothesis that diabetes associated pancreatic carcinoma may bear an its own etiopathogenesis.
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Affiliation(s)
- C M Girelli
- Unità Operativa Medicina I, Ospedale di Circolo, Busto Arsizio, Varese
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Girelli CM, Mirata C, Lesinigo E, Casiraghi A. Iron overload and response to alpha-interferon in chronic hepatitis C. Am J Gastroenterol 1995; 90:170-1. [PMID: 7695721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Girelli CM, Reguzzoni G, Barzaghi F, Berrino F. Changes in Diagnostic Approach and Factors Affecting Treatment and Survival of Pancreatic Carcinoma in a Retrospective Series over Twelve Years. Tumori 1994; 80:198-203. [PMID: 8053076 DOI: 10.1177/030089169408000306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AimsIdentify the following aspects of pancreatic carcinoma: 1) the prevalence of some risk factors, 2) the accuracy of the diagnostic tecniques and the pattern of their utilization over the years, 3) the factors affecting the therapeutic choice and mortality.MethodsRetrospective study on all patients with a final diagnosis of pancreatic carcinoma seen at the Ospedale di Busto Arsizio, from January 1978 to August 1989.ResultsThere were 155 patients, 68 ±11.6 years old, with a 1.2 male to female ratio. Antemortem pathologic confirmation was obtained in 127 cases (82%); 45% were smokers and 45% drinkers. Diabetes mellitus, a history of peptic disease, a past neoplasm and gallstone disease were respectively present in 36.1%, 12.3%, 11% and 8.2% of the cases; 61.9% 23.8% and 9% of the tumors were located respectively in the head, body and tail; 1.3%, 40% and 51.5% were respectively in stage II, III and IV. Ultrasound abdominal scanning and computerized tomography sensitivity were respectively 67.5% and 72.5% (p = NS). In addition, carcinoembryonic antigen, fine needle aspiration biopsy and percutaneous transhepatic cholangiography showed respectively a 66.6%, 88.9% and 93% sensitivity. Together the non-invasive imaging procedures dramatically decreased the number of unnecessary exploratory laparotomies over the years (p = 0.005) without changing the stage at diagnosis or survival. Among the tested variables (age, sex, year of diagnosis, past diseases, co-morbidity, location and stage of the tumor), only the head location and a less advanced stage were significantly related to a surgical choiche (p< 0.001). Overall one-year survival rate was 13.4%, and among the tested variables, only a less advanced stage and the aggressive treatment were associated to a longer survival (p< 0.001).ConclusionsThe prevalence of diabetes mellitus in patients with pancreatic carcinoma may be higher than previously expected; the wide use of diagnostic imaging, dramatically reduced the number of unnecessary exploratory laparotomies over the years; aggressively treated patients with a less advanced stage have a slight, but significant improvement in survival.
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Affiliation(s)
- C M Girelli
- Unità Operativa Medicina I, Ospedale di Busto Arsizio (Varese), Italy
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Girelli CM, Savastano A. [Isoniazid-induced vasculitis. Description of a case of pericarditis with cardiac tamponade and multisystemic involvement]. Recenti Prog Med 1991; 82:475-7. [PMID: 1745832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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