1
|
Schepis T, Tringali A, D'aversa F, Perri V, Familiari P, Boškoski I, Nista EC, Costamagna G. Endoscopic pancreatic sphincterotomy in patients with IPMN-related recurrent pancreatitis: A single center experience. Dig Liver Dis 2023; 55:107-112. [PMID: 36369197 DOI: 10.1016/j.dld.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acute recurrent pancreatitis (ARP) is a rare manifestation of Intraductal Papillary Mucinous Neoplasms (IPMN) of the pancreas; ARP is a relative indication for pancreatic surgery in the setting of IPMN. Endoscopic pancreatic sphincterotomy (EPS) has been described as a minimal invasive treatment to reduce the episodes of ARP secondary to mucus migration in IPMN. METHODS patients with IPMN-related ARP treated with ESP from January 2004 to December 2020 were retrospectively selected. Clinical and technical data were recorded. A clinical follow-up (minimum 12 months) was performed to assess the number of episodes of AP occurring after EPS. RESULTS 25 patients were included. The mean follow-up after ESP was 93.4 months (SD± 56.6). The mean number of AP before and after EPS were respectively 3.29 (SD ± 1.04) and 0.51 (SD ± 0.71). A complete response (no further episodes of AP) and a partial response (>50% reduction of AP episodes) were obtained in 64% and 24% of the cases, respectively, with an overall response rate of 88%. One post-EPS bleeding and one minor-papilla stenosis were reported and were endoscopically managed. Two patients underwent pancreatic resection for the occurrence of high-risk stigmata for cancer progression. CONCLUSIONS EPS is a safe and effective treatment to reduce the number of episodes of AP in selected patients with IPMNs-related ARP. Prospective trials are needed to confirm these data.
Collapse
Affiliation(s)
- T Schepis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - A Tringali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy.
| | - F D'aversa
- Pia Fondazione Cardinale Panico, Medicine Department, Tricase, Italy
| | - V Perri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - P Familiari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - I Boškoski
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - E C Nista
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Medical and Surgical Science Department, Rome, Italy
| | - G Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| |
Collapse
|
2
|
Piantanida E, Boškoski I, Quero G, Gallo C, Zhang Y, Fiorillo C, Arena V, Costamagna G, Perretta S, De Cola L. Nanocomposite hyaluronic acid-based hydrogel for the treatment of esophageal fistulas. Mater Today Bio 2021; 10:100109. [PMID: 33997760 PMCID: PMC8095189 DOI: 10.1016/j.mtbio.2021.100109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Fistulas are abnormal connections between two body parts that can impair the quality of life. The use of biological glues represents the least invasive procedure to fill the fistula; however, it is limited by the need of multiple injections, the persistence of infection and the failure in the treatment of high-output fistulas. We describe herein the use of an injectable nanocomposite hydrogel that is able to form in situ a tissue-mimicking matrix as an innovative material for the treatment of esophageal fistulas. Injectable hydrogels that have the dual advantage of being implantable with a minimally invasive approach and of adapting their shape to the target cavity, while the introduction of mesoporous silica nanoparticles opens the possibility of drug/biomolecules delivery. The hydrogel is based on hyaluronic acid (HA), the crosslinking process occurs at physiological conditions leading to a hydrogel made of >96% by water and with a large-pore micro-architecture. The kinetic profile of the hydrogel formation is studied as a function of HA molecular weight and concentration with the aim of designing a material that is easily injectable with an endoscopic needle, is formed in a time compatible with the surgical procedure and has final mechanical properties suitable for cell proliferation. The in vivo experiments (porcine model) on esophageal-cutaneous fistulas, showed improved healing in the animals treated with the hydrogel compared with the control group.
Collapse
Affiliation(s)
- E Piantanida
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
| | - I Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - G Quero
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
| | - C Gallo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - Y Zhang
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
| | - C Fiorillo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - V Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8 00168, Rome, Italy
| | - G Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - S Perretta
- IRCAD, Strasbourg 1 place del'Hȏpital, 67000 Strasbourg, France
| | - L De Cola
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
| |
Collapse
|
3
|
Kohoutova D, Tringali A, Papparella G, Perri V, Boškoski I, Hamanaka J, Costamagna G. Endoscopic treatment of chronic pancreatitis in pediatric population: Long-term efficacy and safety. United European Gastroenterol J 2018; 7:270-277. [PMID: 31080612 DOI: 10.1177/2050640618817699] [Citation(s) in RCA: 18] [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: 07/26/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022] Open
Abstract
Background Chronic pancreatitis (CP) in children is an inreasingly recognized disease. Objective The purpose of study was to analyse the safety and long-term efficacy of endoscopic treatment in children with CP. Methods Records of 38 patients aged <18 years, referred to the Digestive Endoscopy Unit at Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS between 1991 and 2017, were reviewed. Abdominal pain, analgesia and number of episodes of acute pancreatitis in the pre- and post- endoscopic retrograde cholangiopancreatography (ERCP) period were evaluated. Need for surgery was assessed. Therapeutic intervention data and complications were interrogated. Results In total 158 ERCPs were performed. Median post-ERCP follow-up was 7 years. The majority of patients had CP type IV (47%) and type Ib (37%) (Cremer's classification). Major papilla pancreatic sphincterotomy was performed in 47%, major and minor in 24% and minor in 29% of patients. Stones/plugs were removed in at least one ERCPs in 66% individuals. Eleven out of 38 patients had stricture of the pancreatic duct; these were dilated and stented in 5/11 and stented in 6/11. Five complications were recorded (3%). Severity and frequency of abdominal pain improved significantly; p < 0.001. Use of analgesia and number of episodes of acute pancreatitis decreased significantly; p < 0.001. One child required subsequent surgery. Conclusion Endoscopic management of symptomatic CP in children is safe and effective.
Collapse
Affiliation(s)
- D Kohoutova
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,The Royal Marsden NHS Foundation Trust, London, UK.,Charles University, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, 2nd Department of Internal Medicine - Gastroenterology, Hradec Kralove, Czech Republic
| | - A Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Papparella
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - V Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - I Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia
| | - J Hamanaka
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - G Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Centre for Endoscopic Research Therapeutics and Training - CERTT, Università Cattolica del Sacro Cuore, Roma, Italia.,Chair of Digestive Endoscopy, IHU-USIAS, University of Strasbourg, Strasbourg, France
| |
Collapse
|
4
|
Bove V, Tringali A, Boškoski I, Gigante G, Costamagna G. ESWL-assisted removal of a calcified pancreatic stent. Endoscopy 2014; 45 Suppl 2 UCTN:E163. [PMID: 23716113 DOI: 10.1055/s-0032-1326642] [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)
- V Bove
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy.
| | | | | | | | | |
Collapse
|
5
|
Laterza L, Scaldaferri F, Bruno G, Agnes A, Boškoski I, Ianiro G, Gerardi V, Ojetti V, Alfieri S, Gasbarrini A. Pancreatic function assessment. Eur Rev Med Pharmacol Sci 2013; 17 Suppl 2:65-71. [PMID: 24443071] [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: 06/03/2023]
Abstract
Several non invasive tests are available to assess pancreatic function, but no one is routinely used in clinical practice to diagnose chronic pancreatitis, due to their poor sensitivity in diagnosing mild pancreatic insufficiency. (13)C breath tests share the same limits of the other non invasive functional tests, but the mixed triglyceride breath test seems to be useful in finding the correct dosage of enzyme substitutive therapy to prevent malnutrition in patients with known pancreatic insufficiency.
Collapse
Affiliation(s)
- L Laterza
- Internal Medicine and Gastroenterology Department, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|