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Mangiafico S, Bertani H, Pigò F, Russo S, Lupo M, Cocca S, Grande G, Germani U, Manta R, Conigliaro R. A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy. Surg Laparosc Endosc Percutan Tech 2024; 34:156-162. [PMID: 38421183 DOI: 10.1097/sle.0000000000001271] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Acute pancreatitis in 10% to 20% of cases can be associated with necrosis of the pancreatic gland, peripancreatic tissue, or both. We report a case series of a new endoscopic approach to treat infected pancreatic necrosis (IPN). PATIENTS AND METHODS Consecutive patients with IPN, extending from the perigastric area up to the paracolic gutters or into the pelvis, were prospectively studied from January 2017 to June 2022. The treatment protocol was radiologic percutaneous drainage as the first step, followed by fully covered metal stent placement (FC-SEMS) in the track of the catheter. Percutaneous endoscopic necrosectomy (PEN) was performed 2 to 4 days later using a flexible endoscope through the percutaneous tract. About 2 to 4 weeks later, when a matured sac was visible, EUS-guided endoscopic transluminal drainage (ETD) with lumen-apposing metal stents (LAMS) was performed. Control of sepsis with resolution of collection(s) was the primary outcome measure. RESULTS We included 18 patients, males in 50% of cases with age 60±12 years old. Most frequent cause of pancreatitis was biliary (7 cases) followed by alcoholic in 6 cases; in 3 cases pancreatitis was caused by hyperlipemia and in 2 cases was idiopathic. Mean size of WON was 18±2 cm. For PEN, SEMSs used were esophageal FC-SEMS. LAMS used for ETD were Hot Axios, Hot Spaxus and Nagistent. Mean time of endoscopic intervention for PEN and ETD was 18±3 and 37±4 days, respectively. In 5 cases adverse events occurred: 3 cases of overinflations resolved with introduction of Verres needles in abdomen. In 2 cases postprocedural GI bleeding required endoscopic intervention. In all cases control of sepsis was reached together with resolution of collections. No cases of deaths were observed. CONCLUSIONS Step-up percutaneous and transluminal endoscopic necrosectomy therapy is an effective strategy for large-size IPN with combined central and peripheral necrosis.
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Affiliation(s)
- Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Salvatore Russo
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Marinella Lupo
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Silvia Cocca
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
| | - Ugo Germani
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria Della Misericordia Hospital of Perugia, Perugia, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Modena (Baggiovara-Policlinico), Modena
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Parodi MC, Antonelli G, Galloro G, Radaelli F, Manes G, Manno M, Camellini L, Sereni G, Caserta L, Arrigoni A, Fasoli R, Sassatelli R, Pigò F, Iovino P, Scimeca D, De Luca L, Rizkala T, Tringali A, Campari C, Capogreco A, Testoni SGG, Bertani H, Fantin A, Mitri RD, Familiari P, Labardi M, De Angelis C, Anghinoni E, Rubeca T, Cassoni P, Zorzi M, Mussetto A, Hassan C, Senore C. SIED-GISCOR recommendations for colonoscopy in screening programs: Part I - Diagnostic. Dig Liver Dis 2023:S1590-8658(23)01070-8. [PMID: 38105148 DOI: 10.1016/j.dld.2023.11.028] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The implementation of FIT programs reduces incidence and mortality from CRC in the screened subjects. The ultimate efficacy for CRC morbidity and mortality prevention in a FIT program depends on the colonoscopy in FIT+ subjects that has the task of detecting and removing these advanced lesions. Recently, there has been growing evidence on factors that influence the quality of colonoscopy specifically withing organized FIT programs, prompting to dedicated interventions in order to maximize the benefit/harm ratio of post-FIT colonoscopy. This document focuses on the diagnostic phase of colonoscopy, providing indications on how to standardise colonoscopy in FIT+ subjects, regarding timing of examination, management of antithrombotic therapy, bowel preparation, competence and sedation.
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Affiliation(s)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Giuseppe Galloro
- Surgical Endoscopy Unit, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
| | | | - Giampiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | | | - Giuliana Sereni
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Caserta
- Department of Medicine - Unit of Gastroenterology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Arrigo Arrigoni
- Diagnostic and Interventional Digestive Endoscopy, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Renato Fasoli
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, SA, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Tommy Rizkala
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | | | - Cinzia Campari
- Screening Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Capogreco
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | - Alberto Fantin
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Maurizio Labardi
- Gastroenterology and Endoscopy Department, Firenze Hospital, Firenze, Italy
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emanuela Anghinoni
- Servizio Medicina Preventiva nelle Comunità - AUSL Mantova, via Dei Toscani 1, 46100 Mantova, Italy
| | - Tiziana Rubeca
- S.C. Laboratorio regionale prevenzione oncologica, ISPO, Firenze, Italy
| | - Paola Cassoni
- Department of Medical Science, Pathology unit, University of Turin, Turin, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Alessandro Mussetto
- Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Viale Vincenzo Randi, 5, Ravenna 48121, Italy
| | - Cesare Hassan
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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Grande G, Cocca S, Pigò F, Conigliaro R, Bertani H. Exposed endoscopic full-thickness resection and overstitch suture after incomplete nonexposed endoscopic full-thickness resection. VideoGIE 2023; 8:247-248. [PMID: 37303705 PMCID: PMC10251680 DOI: 10.1016/j.vgie.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Endoscopic resection and suture of neoplastic recurrence after the use of endoscopic full-thickness resection devices for invasive rectal adenocarcinoma.
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Affiliation(s)
- Giuseppe Grande
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Silvia Cocca
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
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Russo S, Conigliaro R, Coppini F, Dell'Aquila E, Grande G, Pigò F, Mangiafico S, Lupo M, Marocchi M, Bertani H, Cocca S. Acute left-sided malignant colonic obstruction: Is there a role for endoscopic stenting? World J Clin Oncol 2023; 14:190-197. [PMID: 37275939 PMCID: PMC10236983 DOI: 10.5306/wjco.v14.i5.190] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/23/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
The therapy of left-sided malignant colonic obstruction continues to be one of the largest problems in clinical practice. Numerous studies on colonic stenting for neoplastic colonic obstruction have been reported in the last decades. Thereby the role of self-expandable metal stents (SEMS) in the treatment of malignant colonic obstruction has become better defined. However, numerous prospective and retrospective investigations have highlighted serious concerns about a possible worse outcome after endoscopic colorectal stenting as a bridge to surgery, particularly in case of perforation. This review analyzes the most recent evidence in order to highlight pros and cons of SEMS placement in left-sided malignant colonic obstruction.
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Affiliation(s)
- Salvatore Russo
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Francesca Coppini
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, IRCCs di Reggio Emilia, Reggio Emilia 42122, Italy
| | - Emanuela Dell'Aquila
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome 0144, Italy
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Marinella Lupo
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Margherita Marocchi
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
| | - Silvia Cocca
- Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
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Conigliaro R, Pigò F, Bertani H, Greco S, Burti C, Indriolo A, Di Sario A, Ortolani A, Maroni L, Tringali A, Barbaro F, Costamagna G, Magarotto A, Masci E, Mutignani M, Forti E, Tringali A, Parodi MC, Assandri L, Marrone C, Fantin A, Penagini R, Cantù P, Di Benedetto F, Ravelli P, Vivarelli M, Agnes S, Mazzaferro V, De Carlis L, Andorno E, Cillo U, Rossi G. Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group. Liver Int 2022; 42:1861-1871. [PMID: 35302273 DOI: 10.1111/liv.15246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND STUDY AIM The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success. PATIENTS AND METHODS Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment. RESULTS All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0-6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7-16.0; p value 0.004). CONCLUSIONS cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti-migration stents.
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Affiliation(s)
- Rita Conigliaro
- Azienda Ospedaliero Universitaria - Ospedale Civile di Baggiovara, Modena, Italy
| | - Flavia Pigò
- Azienda Ospedaliero Universitaria - Ospedale Civile di Baggiovara, Modena, Italy
| | - Helga Bertani
- Azienda Ospedaliero Universitaria - Ospedale Civile di Baggiovara, Modena, Italy
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Grande G, Pigò F, Caruso A, Russo S, Lupo M, Piccoli M, Conigliaro R. Too big to go out: gastric endoscopic submucosal dissection of giant lipoma complicated by intestinal obstruction. Endoscopy 2021; 53:E474-E475. [PMID: 33540434 DOI: 10.1055/a-1346-8122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Angelo Caruso
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Salvatore Russo
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Marinella Lupo
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Micaela Piccoli
- Division of General, Emergency Surgery and New technologies Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Modena, Italy
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Bertani H, Pezzilli R, Pigò F, Bruno M, De Angelis C, Manfredi G, Delconte G, Conigliaro R, Buscarini E. Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions. World J Gastrointest Endosc 2021; 13:555-564. [PMID: 34888007 PMCID: PMC8613675 DOI: 10.4253/wjge.v13.i11.555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/25/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer. Needle-based confocal endomicroscopy (nCLE) is an imaging technique that enables visualization of the mucosal layer to a micron resolution. Its application has demonstrated promising results in the distinction of PCLs. This study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration (EUS-FNA) to distinguish mucinous from non-mucinous lesions.
AIM To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous lesions.
METHODS Patients who required EUS-FNA between 2015 and 2017 were enrolled prospectively. During EUS-FNA, confocal imaging, analyses of the tumor markers carcinoembryonic antigen and amylase, and cytologic examination were conducted. All patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance imaging. nCLE videos were independently reviewed by 6 observers to reach a final diagnosis (mucinous vs non-mucinous) based on criteria derived from previous studies; if there was disagreement > 20%, a final diagnosis was discussed after consensus re-evaluation. The sensitivity, specificity, and accuracy of nCLE were calculated. Adverse events were recorded.
RESULTS Fifty-nine patients were included in this study. Final diagnoses were derived from surgery in 10 patients, cytology in 13, and imaging and multidisciplinary team review in 36. Three patients were excluded from final diagnosis due to problems with nCLE acquisition. Fifty-six patients were included in the final analysis. The sensitivity, specificity, and accuracy of nCLE were 80% [95% confidence interval (CI): 65-90], 100% (95%CI: 72-100), and 84% (95%CI: 72-93), respectively. Post-procedure acute pancreatitis occurred in 5%.
CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.
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Affiliation(s)
- Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41124, Italy
| | - Raffaele Pezzilli
- Department of Internal Medicine, Policlinico S.Orsola Malpighi, Bologna 40121, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41124, Italy
| | - Mauro Bruno
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, Turin 10100, Italy
| | - Claudio De Angelis
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, Turin 10100, Italy
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Department, Ospedale Maggiore, Crema 26013, Italy
| | - Gabriele Delconte
- Department of Diagnostic Endoscopy and Endoscopic Surgery, Istituto Nazionale Tumori, Milano 20019, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41124, Italy
| | - Elisabetta Buscarini
- Gastroenterology and Digestive Endoscopy Department, Ospedale Maggiore, Crema 26013, Italy
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Russo S, Grande G, Manta R, Mangiafico S, Bertani H, Pigò F, Conigliaro R. Large iatrogenic sigmoid colon perforation treated with endoloop-assisted clip closure and over-the-scope clip: a case report. Endoscopy 2021; 53:E433-E434. [PMID: 33506466 DOI: 10.1055/a-1333-0620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Salvatore Russo
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Giuseppe Grande
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Raffaele Manta
- Azienda Ospedaliera di Perugia, Gastroenterology and Digestive Endoscopy Unit
| | - Santi Mangiafico
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Helga Bertani
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Flavia Pigò
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
| | - Rita Conigliaro
- Azienda Ospedaliero-Universitaria di Modena, Gastroenterology and Digestive Endoscopy Unit
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Verhaegh BPM, Münch A, Guagnozzi D, Wildt S, Cebula W, Diac AR, Fernández-Bañares F, Al-Khalaf MAR, Pedersen N, Kupcinskas J, Bohr J, Macaigne G, Lucendo AJ, Lyutakov I, Tontini GE, Pigò F, Russo E, Hjortswang H, Miehlke S, Munck LK. Course of Disease in Patients with Microscopic Colitis: A European Prospective Incident Cohort Study. J Crohns Colitis 2021; 15:1174-1183. [PMID: 33433605 DOI: 10.1093/ecco-jcc/jjab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The disease course of microscopic colitis [MC] is considered chronic but benign. However, this assumption is based on mainly retrospective studies, reporting on incomplete follow-up of selective cohorts. Systematic, prospective and unbiased data to inform patients and healthcare professionals on the expected course of the disease and real-life response to therapy are warranted. METHODS A prospective, pan-European, multi-centre, web-based registry was established. Incident cases of MC were included. Data on patient characteristics, symptoms, treatment and quality of life were systematically registered at baseline and during real-time follow-up. Four disease course phenotypes were discriminated and described. RESULTS Among 381 cases with complete 1-year follow-up, 49% had a chronic active or relapsing disease course, 40% achieved sustained remission after treatment and 11% had a quiescent course. In general, symptoms and quality of life improved after 3 months of follow-up. A relapsing or chronic active disease course was associated with significantly more symptoms and impaired quality of life after 1 year. CONCLUSIONS A minority of MC patients follow a quiescent disease course with spontaneous clinical improvement, whereas the majority suffer a chronic active or relapsing disease course during the first year after diagnosis, with persisting symptoms accompanied by a significantly impaired quality of life.
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Affiliation(s)
- Bas P M Verhaegh
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andreas Münch
- Department of Gastroenterology and Hepatology in Linköping and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Danila Guagnozzi
- Neuro-Immuno-Gastroenterology Group, Digestive Physiology and Pathophysiology Unit, Vall d'Hebron Research Institute; Digestive System Department, Vall d'Hebron University Hostpital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Signe Wildt
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Wojciech Cebula
- Division of Gastroenterology, Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Andreea R Diac
- Division of Gastroenterology, Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Fernando Fernández-Bañares
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Magid A R Al-Khalaf
- Division of Gastroenterology, Department of Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Natalia Pedersen
- Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Johan Bohr
- Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gilles Macaigne
- Hepatogastroenterology Unit, Centre Hospitalier de Marne-la-Vallee, France
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ivan Lyutakov
- Department of Gastroenterology, Medical University of Sofia, University Hospital Tsaritsa Yoanna- ISUL, Sofia, Bulgaria
| | - Gian-Eugenio Tontini
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Flavia Pigò
- Gastroenterologia ed Endoscopia Digestiva, Ospedale Civile di Baggiovara, Modena, Italy
| | - Evangelos Russo
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology in Linköping and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany.,Center for Esophageal Disorders, University Hospital Eppendorf, Hamburg, Germany
| | - Lars K Munck
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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10
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Donato G, Forti E, Mutignani M, Laterra MA, Arese D, Coppola F, Zaccari P, Mariani A, Arcidiacono PG, Pigò F, Conigliaro R, Costa D, Tringali A, Lavagna A, Rocca R, Gabbiadini R, Fugazza A, Repici A, Fava G, Marini F, Mosca P, Urban F, Monica F, Crinò SF, Gabbrielli A, Blois M, Binda C, Sbrancia M, Fabbri C, Frego R, Dinelli M, Imbesi V, Gambitta P, Balzarini M, Segato S, Grazioli LM, Spada C, Amato A, Venezia G, Aragona G, Rosa C, Alvisi C, Devani M, Manes G, Dell’Amico I, Gemme C, Reati R, Auriemma F, Mangiavillano B, Rodi M, Bertani H, Mazzucco D, Armellini E, Cantù P, Penagini R, Occhipinti P. A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy. Endosc Int Open 2021; 9:E629-E634. [PMID: 33880397 PMCID: PMC8050562 DOI: 10.1055/a-1380-3419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background and study aims COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.
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Affiliation(s)
- Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Daniele Arese
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Franco Coppola
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Piera Zaccari
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy,Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | - Deborah Costa
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | - Alberto Tringali
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | | | - Rodolfo Rocca
- Gastroenterology Unit, AO Ordine Mauriziano, Torino, Italy
| | - Roberto Gabbiadini
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Giammarco Fava
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Francesco Marini
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Piergiorgio Mosca
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Flavia Urban
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | - Fabio Monica
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | | | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona, Italy
| | - Matteo Blois
- Operative Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Livorno, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | | | | | - Venerina Imbesi
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Pietro Gambitta
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | | | - Sergio Segato
- Gastroenterology Unit, ASST Sette-Laghi, Varese, Italy
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Ospedale Valduce, Como, Italy
| | - Giovanna Venezia
- Gastroenterology Unit, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Ospedale Civile, AUSL Piacenza, Italy
| | - Cesare Rosa
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | - Costanza Alvisi
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | | | | | - Iginio Dell’Amico
- Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Massa Carrara, Italy
| | - Carlo Gemme
- Gastroenterology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Raffaella Reati
- ASST Rhodense, Presidio di Garbagnate Milanese, Milan, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas – Mater Domini, Castellanza, Varese, Italy
| | | | - Marcello Rodi
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Andrea, ASL VC, Vercelli, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | | | - Elia Armellini
- Gastroenterology and Digestive Endoscopy Unit, ASST Bergamo Est, Bergamo, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pietro Occhipinti
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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11
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Caruso A, Russo S, Grande G, Pigò F, Mangiafico S, Bertani H, Conigliaro R. Endoscopic full-thickness resection in a recurrent perianastomotic esophagojejunal cancer followed by fully covered metal stent placement for lumen occlusion. Endoscopy 2020; 52:E337-E338. [PMID: 32187625 DOI: 10.1055/a-1113-7001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Angelo Caruso
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Salvatore Russo
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Giuseppe Grande
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Flavia Pigò
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Santi Mangiafico
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Helga Bertani
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
| | - Rita Conigliaro
- Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Endoscopia Digestiva, Baggiovara, Italy
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12
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Grande G, Cocca S, Russo S, Mangiafico S, Caruso A, Pigò F, Conigliaro R, Bertani H. COVID-19 and the Gastrointestinal System: Lesions Beyond the Symptoms? ACG Case Rep J 2020; 7:e00464. [PMID: 33062797 PMCID: PMC7523829 DOI: 10.14309/crj.0000000000000464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/02/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022] Open
Abstract
The outbreak of the COVID-19 pandemic has radically changed the daily hospital care activity for all medical specialists. Although the predominant symptoms of this new coronavirus infection are respiratory, the gastrointestinal tract is also significantly involved. In this short report, we will discuss a new and unexpected clinical presentation related to COVID-19 colonization of upper gastrointestinal tract.
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Affiliation(s)
- Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Silvia Cocca
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Salvatore Russo
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Angelo Caruso
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy
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13
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Caruso A, Sgamato C, Bertani H, Pigò F, Mangiafico S, Grande G, Conigliaro RL. Underwater endoscopic submucosal dissection of an obstructing giant colonic lipoma. Endoscopy 2020; 52:E90-E91. [PMID: 31561257 DOI: 10.1055/a-1011-3617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Angelo Caruso
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - Costantino Sgamato
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - Flavia Pigò
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - Santi Mangiafico
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - Giuseppe Grande
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - Rita Luisa Conigliaro
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
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14
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Mangiafico S, Pigò F, Bertani H, Caruso A, Grande G, Sgamato C, Manta R, Conigliaro R. Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis. Endosc Int Open 2020; 8:E50-E58. [PMID: 31921984 PMCID: PMC6949178 DOI: 10.1055/a-1005-6401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/05/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with "conventional" techniques are lacking. In this study, we aimed to compare first-line endoscopic hemostasis achieved using conventional techniques with that achieved using OTSC placement for NVUGIB. Patients and methods From January 2007 to March 2018, 793 consecutive patients underwent upper endoscopy with the hemostasis procedure. Among them, 327 patients were eligible for inclusion (112 patients had OTSC placement and 215 underwent conventional hemostasis). After propensity score matching and adjustment for confounding factors, 84 patients were stratified into the "conventional" group and 84 into the OTSC group. Patient characteristics and outcomes (rebleeding rate, mortality rate within 30 days, and adverse events) were compared between the two groups. Results In the unmatched cohort, hemostasis with OTSC was more frequent in cases of duodenal ulcers with Forrest Ia to IIa and in patients with a higher Rockall score compared with the "conventional group". In the matched cohort, 93 % of the patients in the "conventional group" underwent hemostasis with epinephrine + through-the-scope clip. Rebleeding events were significantly less frequent in the OTSC group (8 % vs 20 %, 95 %CI 3 - 16 vs 12 - 30; P = 0.02); however, the mortality rate in the two groups was not significantly different (6 % vs 2 %, 95 %CI 1 - 8 vs 2 - 13; P = 0.4). Conclusions OTSC is a safe and effective tool for achieving hemostasis, and we recommend its use as the first-line therapy for lesions with a high risk of rebleeding and in patients with a high risk Rockall score.
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Affiliation(s)
- Santi Mangiafico
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
| | - Flavia Pigò
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
| | - Helga Bertani
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
| | - Angelo Caruso
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
| | - Giuseppe Grande
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
| | - Costantino Sgamato
- University of Naples Federico II, Department of Clinical Medicine and Surgery, Gastroenterology Unit, Naples, Italy
| | - Raffaele Manta
- Azienda Ospedaliera di Perugia, Gastroenterology and Digestive Endoscopy Unit, Perugia, Italy
| | - Rita Conigliaro
- Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Gastroenterology and Digestive Endoscopy Unit, Modena, Italy
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15
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Radaelli F, Fuccio L, Paggi S, Hassan C, Repici A, Rondonotti E, Semeraro R, Di Leo M, Anderloni A, Amato A, Trovato C, Bravi I, Buda A, de Bellis M, D'Angelo V, Segato S, Tarantino O, Musso A, Fasoli R, Frazzoni L, Liverani E, Fabbri C, Di Giulio E, Esposito G, Pigò F, Iannone A, Dentali F. Periendoscopic management of direct oral anticoagulants: a prospective cohort study. Gut 2019; 68:969-976. [PMID: 30064986 DOI: 10.1136/gutjnl-2018-316385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To assess the frequency of adverse events associated with periendoscopic management of direct oral anticoagulants (DOACs) in patients undergoing elective GI endoscopy and the efficacy and safety of the British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) recommendations (NCT02734316). DESIGN Consecutive patients on DOACs scheduled for elective GI endoscopy were prospectively included. The timing of DOAC interruption and resumption before and after the procedures were recorded, along with clinical and procedural data. Procedures were stratified into low-risk and high-risk for GI-related bleeding, and patients into low-risk and high-risk for thromboembolic events. Patients were followed-up for 30 days for major and clinically relevant non-major bleeding events (CRNMB), arterial and venous thromboembolism and death. RESULTS Of 529 patients, 38% and 62% underwent high-risk and low-risk procedures, respectively. There were 45 (8.5%; 95% CI 6.3% to 11.2%) major or CRNMB events and 2 (0.4%; 95% CI 0% to 1.4%) thromboembolic events (transient ischaemic attacks). Overall, the incidence of bleeding events was 1.8% (95% CI 0.7% to 4%) and 19.3% (95% CI 14.1% to 25.4%) in low-risk and high-risk procedures, respectively. For high-risk procedures, the incidence of intraprocedural bleeding was similar in patients who interrupted anticoagulation according to BSG/ESGE guidelines or earlier (10.3%vs10.8%, p=0.99), with a trend for a lower risk as compared with those who stopped anticoagulation later (10.3%vs25%, p=0.07). The incidence of delayed bleeding appeared similar in patients who resumed anticoagulation according to BSG/ESGE guidelines or later (6.6%vs7.7%, p=0.76), but it tended to increase when DOAC was resumed earlier (14.4%vs6.6%, p=0.27). The risk of delayed major bleeding was significantly higher in patients receiving heparin bridging than in non-bridged ones (26.6%vs5.9%, p=0.017). CONCLUSION High-risk procedures in patients on DOACs are associated with a substantial risk of bleeding, further increased by heparin bridging. Adoption of the BSG/ESGE guidelines in periendoscopic management of DOACs seems to result in a favourable benefit/risk ratio. TRIAL REGISTRATION NUMBER NCT02734316; Pre-results.
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Affiliation(s)
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Paggi
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | | | - Rossella Semeraro
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Milan, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Cristina Trovato
- Digestive Endoscopy Unit, European Institute of Oncology, Milan, Italy
| | - Ivana Bravi
- Digestive Endoscopy Unit, European Institute of Oncology, Milan, Italy
| | - Andrea Buda
- Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
| | - Mario de Bellis
- Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Valentina D'Angelo
- Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sergio Segato
- Gastroenterology and GI Endoscopy Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Alessandro Musso
- Gastroenterology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Renato Fasoli
- Digestive Endoscopy Unit, ASL 1 Liguria, Imperia Hospital, Imperia, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisa Liverani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Emilio Di Giulio
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, S. Agostino-Estense Hospital, Modena, Italy
| | | | - Francesco Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy
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Pigò F, Bertani H, Grande G, Abate F, Vavassori S, Conigliaro RL. Post-polypectomy bleeding after colonoscopy on uninterrupted aspirin/non steroideal antiflammatory drugs: Systematic review and meta-analysis. Dig Liver Dis 2018; 50:20-26. [PMID: 29089272 DOI: 10.1016/j.dld.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/15/2017] [Revised: 09/12/2017] [Accepted: 10/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM The aim of this systematic review and meta-analysis was to assess the risk of post-polypectomy bleeding (PPB) in patients that underwent colorectal polypectomy and exposed to ASA/NSAIDs. METHODS Relevant publications were identified in MEDLINE/EMBASE for the period 1950-2016. Studies with specified ASA/NSAIDs exposure and bleeding rate were included. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was based on fixed or random effect models in relation to the heterogeneity. RESULTS 11 studies (4 prospective and 7 retrospective) including 9307 patients were included in the analyses. Overall, 344 patients (OR 1.8; 95% CI 1.2-2.7; p-value 0.001, I2 52%) experienced rectal bleeding after procedure. While the rate of immediate PPB on aspirin and/or NSAIDs was not increased (OR 1.1; CI 95% 0.6-2.1; d.f.=1, p=0.64, I2 0%), the risk of delayed PPB was augmented (OR 1.7; 95% CI 1.2-2.2; d.f.=8, p=0.127, I2 36%). CONCLUSIONS ASA/NSAIDs are not a risk factor for immediate PPB but the chance of delayed is increased.
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Affiliation(s)
- Flavia Pigò
- Endoscopy Unit, New Civil Hospital S. Agostino Estense, Modena, Italy.
| | - Helga Bertani
- Endoscopy Unit, New Civil Hospital S. Agostino Estense, Modena, Italy
| | - Giuseppe Grande
- Endoscopy Unit, New Civil Hospital S. Agostino Estense, Modena, Italy
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Mangiafico S, Caruso A, Manta R, Grande G, Bertani H, Mirante V, Pigò F, Magnano L, Manno M, Conigliaro R. Over-the-scope clip closure for treatment of post-pancreaticogastrostomy pancreatic fistula: A case series. Dig Endosc 2017; 29:602-607. [PMID: 28095614 DOI: 10.1111/den.12806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The over-the-scope clip (OTSC) system is a recently developed endoscopic device. In the last few years, it has been successfully used for severe bleeding or deep wall lesions, or perforations of the gastrointestinal (GI) tract. We hereby report a series of patients with post-pancreaticogastrostomy pancreatic fistula in whom OTSC were used as endoscopic treatment. METHODS From January 2012 to July 2015, we prospectively collected data on cases of postoperative pancreatic fistula. These patients underwent pancreaticoduodenectomy in a high-volume center of hepatobiliopancreatic surgery. After conservative management, OTSC closure was done by single skilled operators in anesthesiologist-assisted deep sedation. RESULTS A total of seven patients were enrolled. According to the International Study Group of Pancreatic Surgery criteria, we observed grade B postoperative pancreatic fistula in all cases. All patients were treated with 12/6 t-type OTSC. In two cases, a second clip was successfully applied to a second site adjacent to the original closure site. In all cases, subsequent fluoroscopy showed no contrastographic spreading through the wall. There were no complications related to the procedure itself, not from the endoscopy point of view, nor from the anesthesiological perspective. There were no device malfunctions. Further clinical and endoscopic evaluation was made 8 weeks later and showed no fistula or anastomotic defect recurrence. No patients required additional endoscopic or interventional procedures. CONCLUSION In consideration of clinical and technical success, OTSC placement in POPF seems to be effective, safe and technically relatively easy to carry out.
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Affiliation(s)
- Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Angelo Caruso
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Vincenzo Mirante
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
| | - Luigi Magnano
- Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK
| | - Mauro Manno
- Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Carpi, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, New Civil S. Agostino Estense Hospital, Modena, Italy
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Pigò F, Bertani H, Manno M, Mirante VG, Caruso A, Mangiafico S, Manta R, Rebecchi AM, Conigliaro RL. Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use. Clin Endosc 2017; 50:287-292. [PMID: 28183158 PMCID: PMC5475522 DOI: 10.5946/ce.2016.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022] Open
Abstract
Background/Aims We studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy. Methods We conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed. Results The case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3–15.5), administration of heparin (OR, 16.5; 95% CI, 6.2–44), comorbidity (OR, 2.3; 95% CI, 1.4–3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7–6.0) were associated with PPB. Conclusions The incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.
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Affiliation(s)
- Flavia Pigò
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Helga Bertani
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Mauro Manno
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Vincenzo Giorgio Mirante
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Angelo Caruso
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Santi Mangiafico
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | - Raffaele Manta
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
| | | | - Rita Luisa Conigliaro
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy
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Manno M, Soriani P, Mirante VG, Grande G, Pigò F, Conigliaro RL. Endoscopic dissection of a symptomatic giant gastric leiomyoma arising from the muscularis propria. Endoscopy 2017; 49:E141-E142. [PMID: 28355652 DOI: 10.1055/s-0043-103402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mauro Manno
- Digestive Endoscopy Unit, Azienda USL Modena, Ramazzini Hospital, Carpi, Italy
| | - Paola Soriani
- Digestive Endoscopy Unit, Azienda USL Modena, Ramazzini Hospital, Carpi, Italy
| | - Vincenzo G Mirante
- Digestive Endoscopy Unit, Azienda USL Modena, Ramazzini Hospital, Carpi, Italy
| | - Giuseppe Grande
- Rete Integrata Provinciale di Endoscopia Digestiva, Baggiovara Hospital, Modena, Italy
| | - Flavia Pigò
- Rete Integrata Provinciale di Endoscopia Digestiva, Baggiovara Hospital, Modena, Italy
| | - Rita L Conigliaro
- Rete Integrata Provinciale di Endoscopia Digestiva, Baggiovara Hospital, Modena, Italy
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Grande G, Manno M, Alberghina N, Barbera C, Zulli C, Tontini GE, Pigò F, Conigliaro R. Quick, safe and effective repair of EUS-related duodenal perforation using over-the-scope clip system (with video). Dig Liver Dis 2016; 48:1099-100. [PMID: 27211883 DOI: 10.1016/j.dld.2016.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 02/06/2023]
Abstract
Duodenal perforation is a rare but potentially life-threating complication of bilio-pancreatic endoscopic-ultrasound (EUS) examination. Here we report a case of 90 yeas-old patient underwent to EUS with curvilinear ecoendoscope and complicated by duodenal wall perforation. As reported in our case, Over-the-scope clipping system represents a quick, safe and effective approach in order close the leak and prevent further complication.
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Affiliation(s)
- Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy.
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Nadia Alberghina
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Carmelo Barbera
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Claudio Zulli
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
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Tursi A, Brandimarte G, Di Mario F, Annunziata ML, Bafutto M, Bianco MA, Colucci R, Conigliaro R, Danese S, De Bastiani R, Elisei W, Escalante R, Faggiani R, Ferrini L, Forti G, Latella G, Graziani MG, Oliveira EC, Papa A, Penna A, Portincasa P, Søreide K, Spadaccini A, Usai P, Bonovas S, Scarpignato C, Picchio M, Lecca PG, Zampaletta C, Cassieri C, Damiani A, Desserud KF, Fiorella S, Landi R, Goni E, Lai MA, Pigò F, Rotondano G, Schiaccianoce G. Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study. United European Gastroenterol J 2015; 4:604-13. [PMID: 27536372 DOI: 10.1177/2050640615617636] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/22/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. AIMS We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available. METHODS For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery. RESULTS We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. CONCLUSIONS DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
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Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria L Annunziata
- Division of Gastroenterology, Istituto di Rocovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Italy
| | - Mauro Bafutto
- Instituto Goiano de Gastroenterologia e Endoscopia digestiva, Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brasil
| | - Maria A Bianco
- Division of Gastroenterology, T. Maresca Hospital, Torre del Greco, Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Italy
| | - Rita Conigliaro
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Silvio Danese
- Humanitas University, IBD Center, Humanitas Clinical and Research Hospital, Via Manzoni, Rozzano, Milan, Italy
| | | | - Walter Elisei
- Division of Gastroenterology, Azienda Sanitaria Locale Azienda Sanitaria Locale Roma H., Rome, Italy
| | - Ricardo Escalante
- Loira Medical Center, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Luciano Ferrini
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, S. Maria Goretti Hospital, Latina, Italy
| | - Giovanni Latella
- Division of Gastroenterology, S. Salvatore Hospital, L'Aquila, Italy
| | - Maria G Graziani
- Service of Digestive Endoscopy, S. Camillo Hospital, Rome, Italy
| | - Enio C Oliveira
- Department of Surgery, Federal University of Goiás, Goiânia, Brasil
| | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Antonio Penna
- Division of Gastroenterology, S. Paolo Hospital, Bari, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Antonio Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Paolo Usai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Piera G Lecca
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | | | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Alberto Damiani
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Kari F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Serafina Fiorella
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Rosario Landi
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Elisabetta Goni
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria A Lai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Flavia Pigò
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Gianluca Rotondano
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Giuseppe Schiaccianoce
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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Manno M, Mangiafico S, Caruso A, Barbera C, Bertani H, Mirante VG, Pigò F, Amardeep K, Conigliaro R. First-line endoscopic treatment with OTSC in patients with high-risk non-variceal upper gastrointestinal bleeding: preliminary experience in 40 cases. Surg Endosc 2015. [PMID: 26201415 DOI: 10.1007/s00464-015-4436-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS The over-the-scope clip (OTSC; Ovesco, Tübingen, Germany) is a novel endoscopic clipping device designed for tissue approximation. The device has been used in the closure of fistulas and perforations. We hereby report a series of patients with high-risk non-variceal upper gastrointestinal bleeding (NVUGIB) lesions in whom OTSCs were used as first-line endoscopic treatment. PATIENTS AND METHODS We prospectively collected and retrospectively analysed data over a period of 12 months from October 2013 to November 2014 from all consecutive patients who underwent emergency endoscopy for acute severe high-risk NVUGIB and were treated with OTSC as primary first-line therapy. RESULTS We included forty consecutive patients with mean age 69 years (range 25-94 years). All patients were treated with the non-traumatic version of the OTSC system (23 with the 11 mm version and 17 with the 12 mm version). Indications for OTSC treatment included gastric ulcer with large vessel (Forrest IIa) (n = 8, 20 %), duodenal ulcer (Forrest Ib) (n = 7, 18 %), duodenal ulcer with large vessel (Forrest IIa) (n = 6, 15 %), Dieulafoy's lesion (n = 6, 15 %) and other secondary indications (n = 13, 32 %). Technical success and primary haemostasis were achieved in all patients (100 %). No re-bleeding, need for surgical or radiological embolization treatment or other complications were observed during the follow-up period of 30 days. CONCLUSIONS We conclude OTSC placement as a first-line endoscopic treatment seems to be effective, safe and easy to perform and should be considered in patients with high-risk NVUGIB lesions.
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Affiliation(s)
- Mauro Manno
- Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy.
| | - Santi Mangiafico
- Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy
| | - Angelo Caruso
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy
| | - Carmelo Barbera
- Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy
| | - Vincenzo G Mirante
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy
| | - Flavia Pigò
- Digestive Endoscopy Unit-Northern Area, Ospedale di Carpi, Azienda USL di Modena, Via G. Molinari, 2, 41012, Carpi, Italy
| | - Khanna Amardeep
- Gastroenterology and Digestive Endoscopy Unit, Queens Medical Centre, Derby Road, Nottingham, UK
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena, MO, Italy
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Pigò F, Bertani H, Manno M, Mirante VG, Caruso A, Conigliaro RL. Radiofrequency ablation for chronic radiation proctitis: our initial experience with four cases. Tech Coloproctol 2014; 18:1089-92. [PMID: 24915942 DOI: 10.1007/s10151-014-1178-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 09/15/2013] [Accepted: 05/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic radiation proctitis (CRP) occurs up to 20 % of patients after pelvic radiotherapy, with rectal bleeding as the main presenting complaint. Radiofrequency ablation (RFA) has recently been used in the management of Barrett's esophagus, but its efficacy in CRP has to be studied. The aim of this case series was to describe four cases of patients with CRP treated with RFA that demonstrate the efficacy and safety of the technique. METHODS All the procedures were performed with HALO 90 or HALO 90 Ultra ablation catheter fitted on the distal end of a standard flexible endoscope. For each patient, the severity of symptoms was assessed at baseline and after the last treatment session. RESULTS At least two sessions of RFA (maximum 4) were necessary, at three-month intervals, to completely control the symptoms. No major complications were observed. CONCLUSIONS RFA was effective and safe for control bleeding in this case series. Adequately powered randomized controlled trials are needed to establish the safety and efficacy of RFA for CRP.
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Affiliation(s)
- F Pigò
- Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Modena, Italy,
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24
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Pigò F, Bertani H, Manno M, Mirante V, Caruso A, Barbera C, Manta R, Bassotti G, Olivetti G, Conigliaro RL. i-Scan high-definition white light endoscopy and colorectal polyps: prediction of histology, interobserver and intraobserver agreement. Int J Colorectal Dis 2013; 28:399-406. [PMID: 23014976 DOI: 10.1007/s00384-012-1583-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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] [Accepted: 09/16/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Aim of the study was the evaluation of high-definition white light (HDWL) i-Scan endoscopy for diagnostic prediction of histology, inter- and intraobserver agreement for colorectal polyps. METHODS In this prospective single-center cohort study, a skilled endoscopist, with HDWL i-Scan, predicted on real-time the histology of 150 polyps from 78 patients undergoing colonoscopy. Subsequently, four endoscopists, not involved in the collection of cases, predicted the polyps' histology (neoplastic vs nonneoplastic) and repeated the assessment after 6 months. RESULTS Real-time assessment of the lesions predicted a correct histology in 138/150 cases with a sensitivity, specificity, and accuracy of 95, 82, and 92 %, respectively. Sensitivity, specificity, and accuracy of post-acquisition evaluation were 87.7, 61.7, and 82.2 %, respectively. The κ values of inter- and intraobserver agreement of prediction of histology were 0.462 (0.373-0.537) and 0.657 (0.523-0.917). Among the subset of polyps (n = 82) with good/excellent quality image, sensitivity and accuracy of HDWL i-Scan improved (97 %, p = 0.003 and 94 %, p = 0.002, respectively) as well as κ value of interobserver agreement (0.699). CONCLUSIONS HDWL i-Scan technology helps for characterization of polyps of the colon with good accuracy even if it cannot replace, at the moment, the histopathological examination. Reproducibility among operators is supported by a moderate substantial interobserver and intraobserver agreement.
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Affiliation(s)
- Flavia Pigò
- Digestive Endoscopy Unit, New Civil Hospital S. Agostino Estense of Modena, Modena, Italy.
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Bertani H, Frazzoni M, Dabizzi E, Pigò F, Losi L, Manno M, Manta R, Bassotti G, Conigliaro R. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci 2013; 58:188-93. [PMID: 22875309 DOI: 10.1007/s10620-012-2332-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 05/03/2012] [Accepted: 07/18/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope. AIMS Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett's esophagus (BE) participating in a surveillance program. METHODS Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist. RESULTS Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10%) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42%) patients; dysplasia was confirmed in 14 cases (28%) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100%, respectively. CONCLUSIONS Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.
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Affiliation(s)
- Helga Bertani
- Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy.
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Manno M, Pigò F, Manta R, Barbera C, Bertani H, Mirante VG, Dabizzi E, Caruso A, Olivetti G, Hassan C, Zullo A, Conigliaro R. Bowel preparation with polyethylene glycol electrolyte solution: optimizing the splitting regimen. Dig Liver Dis 2012; 44:576-9. [PMID: 22456624 DOI: 10.1016/j.dld.2012.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 12/12/2011] [Revised: 02/06/2012] [Accepted: 02/19/2012] [Indexed: 12/11/2022]
Abstract
AIM Quality of bowel cleansing significantly increases the shorter the time between bowel solution intake and endoscopic examination. We tested the efficacy and patient tolerability following a modified polyethylene glycol electrolyte (PEG) splitting regimen. METHODS This was a prospective, single-blind, randomized, study. Patients were assigned to receive either PEG 4 L the afternoon before colonoscopy or PEG 3 L the day before and 1 L 3h before the procedure the day of colonoscopy. RESULTS The study population consisted of 336 patients, including 168 participants in each study arm. Although the bowel preparation quality was similarly quoted as excellent/good following the split and full regimen (95.2% vs 92.8%; p=0.3), a significant (p<0.0001) shift from good towards an excellent preparation (26.8% vs 68.4%) was observed following the split regimen as compared to the full regimen (55.4% vs 37.5%). The incidence of side-effects did not differ. When patients were asked about a future preparation if needed, 69% and 31% following the split and full regimen, respectively, declared to accept again the same preparation, the difference being statistically significant (p<0.001). CONCLUSIONS Our data found that an excellent bowel cleansing could be frequently achieved by simply modifying the split regimen from the standard PEG 2 plus 2 L to 3 plus 1 L.
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Affiliation(s)
- Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S.Agostino-Estense - Baggiovara di Modena, Modena, Italy.
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Manta R, Manno M, Bertani H, Barbera C, Pigò F, Mirante V, Longinotti E, Bassotti G, Conigliaro R. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy 2011; 43:545-8. [PMID: 21409741 DOI: 10.1055/s-0030-1256196] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [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] [Indexed: 02/06/2023]
Abstract
Gastrointestinal perforations and post-surgical fistulas are dreaded complications that dramatically increase morbidity and mortality. A new endoscopic over-the-scope clip (OTSC) system may be potentially useful for sealing visceral perforations in several clinical settings. We evaluated the advantages and clinical impact of the placement of OTSCs on the management of non-malignant gut leaks in 12 consecutive patients. OTSCs of 9.5 or 10.5 mm were used, according to the diameter of the defect within the wall. The indications for treatment were mainly related to post-surgical fistulas. Healing of the fistula was assessed by endoscopic or radiological means, and failed only once. No OTSC-related complications occurred. Endoscopic closure of perforations and post-surgical fistulas with the OTSC system is a simple and minimally invasive technique. This approach, when feasible, may be less expensive and more advantageous than a surgical approach.
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Affiliation(s)
- R Manta
- Gastroenterology and Endoscopy Unit, S. Agostino Estense Civil Hospital, Modena, Italy.
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