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Sbrozzzi-Vanni A, Galloro G, Piciucchi M, Castellani D, Germani U, Dell'Amico I, Zito F, Pallio S, Mangiafico S, Zullo A, Manta R. Over-the-scope Technique for Partially Covered Self-expandable Metal Stent Placement to Treat Duodenal Perforation during EUS. J Gastrointestin Liver Dis 2023; 32:65-69. [PMID: 37004238 DOI: 10.15403/jgld-4625] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/02/2022] [Indexed: 04/03/2023]
Abstract
BACKGROUND AND AIMS Although endoscopic ultrasound (EUS) is generally safe, duodenal perforation may occur during the procedure. When the iatrogenic break is wide, endoscopic positioning of a covered self- expandable metal stent is indicated to avoid a more invasive surgical approach. We evaluated the efficacy of the 'over-the-scope stenting' (OTSS) technique to treat iatrogenic duodenal perforations occurred during EUS. METHODS Data of patients with large iatrogenic duodenal perforations treated with OTSS procedure were collected in 5 centers. Technical success was defined as a correct stent placement on the perforation site, and clinical success as complete healing of the duodenal leak at stent removal 3 weeks later. RESULTS A total of 15 (7 males; median age: 78 years, range 47-91) patients were included in this series. A correct stent positioning was achieved in all cases (technical success: 100%), and the perforation was healed in all, apart from one patient at stent removal (clinical success: 93%). This patient was successfully treated with a novel stent placement. No immediate post-procedural adverse events occurred, and no need for emergency surgery was recorded. In one (6.7%) patient, stent migration occurred 10 days after positioning, and it was spontaneously expulsed with stool movement without complications two days later. CONCLUSIONS Our data showed that the OTTS technique for partially covered self-expandable metal stent placement is feasible, safe and effective to tread large iatrogenic duodenal perforation occuring during EUS.
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Affiliation(s)
- Andrea Sbrozzzi-Vanni
- Gastroenterology and Digestive Endoscopy, 'San Camillo Forlanini' Hospital, Rome, Italy. .
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, Endoscopic Surgery Unit, University Federico II - School of Medicine, Naples, Italy.
| | - Matteo Piciucchi
- Gastroenterology and Digestive Endoscopy Unit, 'Santa Maria della Stella' Hospital, Orvieto, Italy.
| | - Danilo Castellani
- Digestive Endoscopy Unit, 'Spedali Riuniti' Hospital, Livorno, Italy.
| | - Ugo Germani
- Digestive Endoscopy Unit, 'Spedali Riuniti' Hospital, Livorno, Italy.
| | | | - Francesco Zito
- Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Unit of Surgical Digestive Endoscopy, University of Naples 'Federico II', Naples.
| | - Socrate Pallio
- Digestive Endoscopy Unit, 'G. Martino' Hospital, Messina, Italy.
| | - Santi Mangiafico
- Gastroenterology and Digestive Endoscopy Unit, 'S. Agostino Estense' Hospital, Baggiovara, Italy.
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy.
| | - Raffaele Manta
- Digestive Endoscopy Unit, 'Spedali Riuniti' Hospital, Livorno, Italy.
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Buonocore MR, Germani U, Castellani D, Petrogiannopoulos L, Pallio S, Piciucchi M, Sbrozzi-Vanni A, Zullo A, Manta R. Timing of endoscopic therapy for acute bilio-pancreatic diseases: a practical overview. Ann Gastroenterol 2021; 34:125-129. [PMID: 33654349 PMCID: PMC7903577 DOI: 10.20524/aog.2021.0580] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
Diseases of the pancreas and hepatobiliary tree often require a therapeutic approach with endoscopic retrograde cholangiopancreatography (ERCP), generally following noninvasive imaging techniques. Appropriate indications and the correct timing for urgent ERCP would benefit both patients and clinicians and allow optimal utilization of health resources. Indications for urgent (<24 h) ERCP include severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, in the absence of percutaneous drainage, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management. In patients who have severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis, early (<48-72 h) ERCP is indicated. This overview aims to provide decisional flowcharts that can be easily used for managing patients with acute bilio-pancreatic disorders when they are referred to the Emergency Department.
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Affiliation(s)
- Matteo Rossano Buonocore
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia (Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Raffaele Manta)
| | - Ugo Germani
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia (Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Raffaele Manta)
| | - Danilo Castellani
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia (Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Raffaele Manta)
| | - Leonidas Petrogiannopoulos
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia (Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Raffaele Manta)
| | - Socrate Pallio
- Digestive Endoscopy Unit "G. Martino", General Hospital Messina (Socrate Pallio)
| | - Matteo Piciucchi
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Orvieto (Matteo Piciucchi)
| | - Andrea Sbrozzi-Vanni
- Digestive Endoscopy Unit, Apuane General Hospital of Massa (Andrea Sbrozzi-Vanni)
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, Rome (Angelo Zullo), Italy
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Unit, General Hospital of Perugia (Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Raffaele Manta)
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3
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Piciucchi M, Sbrozzi-Vanni A, Rossi A, Satriano A, Dell’Amico I, Francesco VD, Zullo A, Manta R. Preliminary considerations regarding the risk of COVID-19 and disease severity in chronic gastrointestinal conditions. Ann Gastroenterol 2020; 33:327-329. [PMID: 32624651 PMCID: PMC7315710 DOI: 10.20524/aog.2020.0498] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
The novel RNA betacoronavirus SARS-CoV-2 is driving great efforts in clinical and basic research and several studies of the epidemiology, risk factors, clinical and virological features of this infection are already available. However COVID-19 is a totally new pathological entity, and many gray areas regarding associated diseases still need to be elucidated, especially in the group of patients who suffer from preexistent gastrointestinal disease. The aim of this review is to summarize the published data on the correlation between chronic gastrointestinal disorders and COVID-19.
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Affiliation(s)
- Matteo Piciucchi
- Digestive Endoscopy Unit, Santa Maria Hospital of Orvieto (Matteo Piciucchi, Alice Rossi)
| | - Andrea Sbrozzi-Vanni
- Digestive Endoscopy Unit, Apuane Hospital of Massa (Andrea Sbrozzi-Vanni, Iginio Dell’Amico)
| | - Alice Rossi
- Digestive Endoscopy Unit, Santa Maria Hospital of Orvieto (Matteo Piciucchi, Alice Rossi)
| | - Alissa Satriano
- Nutriton Department, General Hospital of Perugia (Alissa Satriano)
| | - Iginio Dell’Amico
- Digestive Endoscopy Unit, Apuane Hospital of Massa (Andrea Sbrozzi-Vanni, Iginio Dell’Amico)
| | - Vincenzo De Francesco
- Gastroenterology and Digestive Endoscopy, Riuniti Hospital, Foggia (Vincenzo De Francesco)
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome (Angelo Zullo)
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy, General Hospital of Perugia (Raffaele Manta), Italy
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Abstract
Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.
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Affiliation(s)
- Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
| | - Mariaemilia Traini
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
| | - Matteo Piciucchi
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marianna Signoretti
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
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Stigliano S, Belisario F, Piciucchi M, Signoretti M, Delle Fave G, Capurso G. Recurrent biliary acute pancreatitis is frequent in a real-world setting. Dig Liver Dis 2018; 50:277-282. [PMID: 29311029 DOI: 10.1016/j.dld.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/29/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data about recurrent acute pancreatitis (RAP) are limited. AIMS To evaluate the rate of RAP and associated factors. METHODS Single-centre prospective study of consecutive patients at first episode of acute pancreatitis (AP) being followed-up. RESULTS Of 266 consecutive AP patients, (47% biliary, 15.4% alcoholic, 14.3% idiopathic) 66 (24.8%) had RAP in a mean follow-up of 42 months; 17.9% of recurrences occurred within 30 days from discharge. Age, gender, smoking and severity of first AP were not associated with RAP risk. The rate of biliary RAP was 31.3% in patients who did not receive any treatment, 18% in those treated with ERCP only, 16% in those who received cholecystectomy only, and 0% in those treated both with surgery and ERCP. Patients with biliary AP who received cholecystectomy had a significantly longer time of recurrence-free survival and reduced recurrence risk (HR = 0.45). In patients with alcoholic AP, the rate of recurrence was lower in those who quit drinking (5.8% vs 33%; p = 0.05). The alcoholic aetiology was associated with a higher risk of having >2 RAP episodes. CONCLUSION RAP occurs in about 25% of cases, and failure to treat biliary aetiology or quitting drinking is associated with increased recurrence risk.
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Affiliation(s)
- Serena Stigliano
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Flaminia Belisario
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Matteo Piciucchi
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Marianna Signoretti
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Gianfranco Delle Fave
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Gabriele Capurso
- Digestive & Liver Disease Unit, S. Andrea Hospital, University "La Sapienza", Rome, Italy.
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Archibugi L, Piciucchi M, Stigliano S, Valente R, Zerboni G, Barucca V, Milella M, Maisonneuve P, Delle Fave G, Capurso G. Exclusive and Combined Use of Statins and Aspirin and the Risk of Pancreatic Cancer: a Case-Control Study. Sci Rep 2017; 7:13024. [PMID: 29026148 PMCID: PMC5638859 DOI: 10.1038/s41598-017-13430-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/25/2017] [Indexed: 12/12/2022] Open
Abstract
Data on the association between aspirin and statin use and Pancreatic Ductal AdenoCarcinoma (PDAC) risk are conflicting. These drugs are often co-prescribed, but no studies evaluated the potential combined or confounding effect of the two at the same time. We aimed to investigate the association between aspirin and statin exclusive and combined use and PDAC occurrence. Data on environmental factors, family and medical history were screened in a case-control study. PDAC cases were matched to controls for age and gender. Power calculation performed ahead. Odds ratios (OR) and 95% confidence intervals(CI) were obtained from multivariable logistic regression analysis. In 408 PDAC patients and 816 matched controls, overall statin (OR 0.61; 95%CI,0.43-0.88), but not aspirin use was associated to reduced PDAC risk. Compared to non-users, exclusive statin (OR 0.51; 95%CI,0.32-0.80) and exclusive aspirin users (OR 0.64; 95%CI,0.40-1.01) had reduced PDAC risk. Concomitant statin and aspirin use did not further reduce the risk compared with statin use alone and no interaction was evident. Statin protective association was dose-dependent, and consistent in most subgroups, being stronger in smokers, elderly, obese and non-diabetic patients. The present study suggests that statin use is associated to reduced PDAC risk, supporting a chemopreventive action of statins on PDAC.
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Affiliation(s)
- Livia Archibugi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Matteo Piciucchi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Serena Stigliano
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberto Valente
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Zerboni
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Viola Barucca
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Michele Milella
- Medical Oncology Unit, Istituto Nazionale Tumori Regina Elena (IFO), Rome, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Gianfranco Delle Fave
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
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Piciucchi M, Capurso G, Valente R, Larghi A, Archibugi L, Signoretti M, Stigliano S, Zerboni G, Barucca V, La Torre M, Cavallini M, Costamagna G, Marchetti P, Ziparo V, Delle Fave G. Early onset pancreatic cancer: risk factors, presentation and outcome. Pancreatology 2015; 15:151-5. [PMID: 25708929 DOI: 10.1016/j.pan.2015.01.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 10/06/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND About 10% of pancreatic cancer patients are aged ≤50 at diagnosis and defined as Early Onset Pancreatic Cancer (EOPC). There is limited information regarding risk factors for EOPC occurrence and their outcome. AIM To investigate risk factors, presentation features and outcome of EOPC patients. METHODS Consecutive, histologically confirmed, pancreatic cancer patients enrolled. Data regarding environmental and genetic risk factors, clinical and pathological information, treatment and survival were recorded. EOPC patients (aged ≤50 at diagnosis) were compared to older subjects. RESULTS Twenty-five of 293 patients (8.5%) had EOPC. There was no difference regarding sex distribution, medical conditions and alcohol intake between EOPC and older subjects. EOPC patients were more frequently current smokers (56% vs 28% p = 0.001) and started smoking at a significantly lower mean age (19.8 years, 95%CI 16.7-22.9) as compared to older patients (26.1, 95%CI 24.2-28) (p = 0.001). Current smoking (OR 7.5; 95%CI 1.8-30; p = 0.004) and age at smoking initiation (OR 0.8 for every increasing year; 95%CI 0.7-0.9; p = 0.01) were significant and independent risk factors for diagnosis of EOPC. There were no differences regarding genetic syndromes and pancreatic cancer family history. EOCP presented less frequently with jaundice (16% vs 44%, p = 0.006) and had a higher rate of unresectable disease, albeit not significantly (84% vs 68%, p = 0.1). EOPC patients were more frequently fit for surgery or chemotherapy than their counterpart, resulting in similar stage-specific survival probability. CONCLUSION EOPC seems related to active and early smoking but not to familial syndromes. Young patients display aggressive disease but not worse outcome.
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Affiliation(s)
- Matteo Piciucchi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Roberto Valente
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Alberto Larghi
- Endoscopy Division, Gemelli Hospital, Faculty of Medicine and Surgery, Catholic University of Rome, Italy
| | - Livia Archibugi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Marianna Signoretti
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Serena Stigliano
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giulia Zerboni
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Viola Barucca
- Oncology Department, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Marco La Torre
- General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Marco Cavallini
- General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Guido Costamagna
- Endoscopy Division, Gemelli Hospital, Faculty of Medicine and Surgery, Catholic University of Rome, Italy
| | - Paolo Marchetti
- Oncology Department, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Vincenzo Ziparo
- General Surgery Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Gianfranco Delle Fave
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
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Piciucchi M, Capurso G, Archibugi L, Delle Fave MM, Capasso M, Delle Fave G. Exocrine pancreatic insufficiency in diabetic patients: prevalence, mechanisms, and treatment. Int J Endocrinol 2015; 2015:595649. [PMID: 25892991 PMCID: PMC4393909 DOI: 10.1155/2015/595649] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 12/09/2014] [Revised: 02/28/2015] [Accepted: 03/09/2015] [Indexed: 02/07/2023] Open
Abstract
Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III), caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI) has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25-74%) and type II (28-54%) diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.
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Affiliation(s)
- Matteo Piciucchi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
- *Gabriele Capurso:
| | - Livia Archibugi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Martina Maria Delle Fave
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Marina Capasso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Gianfranco Delle Fave
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
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Anania G, Gigante E, Piciucchi M, Pilozzi E, Pucci E, Pellicelli AM, Capotondi C, Rossi M, Baccini F, Antonelli G, Begini P, Fave GD, Marignani M. Liver biopsy: Analysis of results of two specialist teams. World J Gastrointest Pathophysiol 2014; 5:114-119. [PMID: 24891983 PMCID: PMC4025071 DOI: 10.4291/wjgp.v5.i2.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/10/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams.
METHODS: Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy was assessed by a revision performed by a single pathologist unaware of the previous pathology report. Clinical, laboratory and demographic patient characteristics, the adverse events rate and the diagnostic adequacy of LB were analyzed.
RESULTS: During the study period, 226 patients, 126 males (56%) and 100 females (44%), underwent LB: 167 (74%) were carried out by the G team, whereas 59 (26%) by the IR team. LB was mostly performed in a day hospital setting by the G team, while IR completed more procedures on inpatients (P < 0.0001). The groups did not differ in median age, body mass index (BMI), presence of comorbidities and coagulation parameters. Complications occurred in 26 patients (16 G team vs 10 IR team, P = 0.15). Most gross samples obtained were considered suitable for basal histological evaluation, with no difference among the two teams (96.4% G team vs 91.5% IR, P = 0.16). However, the samples obtained by the G team had a higher mean number of portal tracts (G team 9.5 ± 4.8; range 1-29 vs IR team 7.8 ± 4.1; range 1-20) (P = 0.0192) and a longer mean length (G team 22 mm ± 8.8 vs IR team 15 ± 6.5 mm) (P = 0.0001).
CONCLUSION: LB can be performed with similar outcomes both by G and IR. Use of larger dimension needles allows obtaining better samples, with a similar rate of adverse events.
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Piciucchi M, Crippa S, Del Chiaro M, Valente R, Pezzilli R, Falconi M, Delle Fave G, Capurso G. Outcomes of intraductal papillary mucinous neoplasm with "Sendai-positive" criteria for resection undergoing non-operative management. Dig Liver Dis 2013; 45:584-8. [PMID: 23453065 DOI: 10.1016/j.dld.2013.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are few data on the outcome of patients with intraductal papillary mucinous neoplasms of the pancreas meeting criteria for resection (Sendai-positive), and not operated. AIM To evaluate outcome of patients with a resectable, Sendai-positive intraductal papillary mucinous neoplasm, and not operated. METHODS Multicentre, retrospective analysis of prospectively enrolled patients, with resectable Sendai-positive, not-operated intraductal papillary mucinous neoplasm. Overall-survival and disease-specific survival were the primary end-point, and progression-free survival secondary. RESULTS Thirty-five patients (60% male, median age 77) enrolled: 40% main-duct, 60% branch-duct intraductal papillary mucinous neoplasms. In 19 patients surgery was ruled out due to comorbidities, in 7 because aged > 80, 9 refused surgery. Twelve (34.3%) patients died after a mean of 32.5 months, 8 due to disease progression, 4 due to comorbidities. The median overall, disease-specific and progression-free survival were 52, 55, and 44 months respectively. Main duct involvement and age at diagnosis were associated with worse overall and progression-free survival, only main duct involvement with worse disease-specific survival (52 months main duct vs. 64 branch duct; P = 0.04). CONCLUSION These results suggest that in elderly and comorbid patients with Sendai-positive intraductal papillary mucinous neoplasms, especially of the branch duct, a conservative approach could be reasonable, as associated with a relatively good outcome, and should be carefully discussed with the patients.
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Affiliation(s)
- Matteo Piciucchi
- Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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Larghi A, Panic N, Capurso G, Leoncini E, Arzani D, Salvia R, Del Chiaro M, Frulloni L, Arcidiacono PG, Zerbi A, Manta R, Fabbri C, Ventrucci M, Tarantino I, Piciucchi M, Carnuccio A, Boggi U, Costamagna G, Delle Fave G, Pezzilli R, Bassi C, Bulajic M, Ricciardi W, Boccia S. Prevalence and risk factors of extrapancreatic malignancies in a large cohort of patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Oncol 2013; 24:1907-1911. [PMID: 23676419 DOI: 10.1093/annonc/mdt184] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The objectives of this study are to estimate prevalence and incidence of extrapancreatic malignancies (EPMs) among intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, and to identify risk factors for their occurrence. PATIENTS AND METHODS We conducted multicentric cohort study in Italy from January 2010 to January 2011 including 390 IPMN cases. EPMs were grouped as previous, synchronous (both prevalent) and metachronous (incident). We calculated the observed/expected (O/E) ratio of prevalent EPMs, and compared the distribution of demographic, medical history and lifestyle habits. RESULTS Ninety-seven EPMs were diagnosed in 92 patients (23.6%), among them 78 (80.4%) were previous, 14 (14.4%) were synchronous and 5 (5.2%) were metachronous. O/E ratios for prevalent EPMs were significantly increased for colorectal carcinoma (2.26; CI 95% 1.17-3.96), renal cell carcinoma (6.00; CI 95% 2.74-11.39) and thyroid carcinoma (5.56; CI 95% 1.80-12.96). Increased age, heavy cigarette smoking, alcohol consumption and first-degree family history of gastric cancer are significant risk factors for EPMs, while first-degree family history of colorectal carcinoma was borderline. CONCLUSION We report an increased prevalence of EPMs in Italian patients with IPMN, especially for colorectal carcinoma, renal cell and thyroid cancers. A systematic surveillance of IPMN cases for such cancer types would be advised.
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Affiliation(s)
| | - N Panic
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; Faculty of Medicine, University of Belgrade, Belgrade; University Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - G Capurso
- Digestive and Liver Disease Unit, University 'Sapienza', Rome
| | - E Leoncini
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Arzani
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Salvia
- Department of Surgery, University of Verona, Verona
| | | | - L Frulloni
- Department of Gastroenterology, University of Verona, Verona
| | - P G Arcidiacono
- Department of Gastroenterology & Gastrointestinal Endoscopy, San Raffaele Hospital, Milano
| | - A Zerbi
- Pancreatic Surgery Section, Istituto Humanitas, Milano
| | - R Manta
- Department of Gastroenterology, S. Agostino Hospital, Modena
| | - C Fabbri
- Department of Gastroenterology, Bellaria Maggiore Hospita, Bologna
| | - M Ventrucci
- Department of Internal Medicine, University of Bologna, Bologna
| | | | - M Piciucchi
- Digestive and Liver Disease Unit, University 'Sapienza', Rome
| | | | - U Boggi
- Department of Surgery, University of Pisa, Pisa
| | | | - G Delle Fave
- Digestive and Liver Disease Unit, University 'Sapienza', Rome
| | - R Pezzilli
- Department of Internal Medicine, University of Bologna, Bologna
| | - C Bassi
- Department of Surgery, University of Verona, Verona
| | - M Bulajic
- Faculty of Medicine, University of Belgrade, Belgrade; University Clinical-Hospital Center 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia; Department of Gastroenterology, University Clinical Hospital 'Santa Maria della Misericordia', Udine
| | - W Ricciardi
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Boccia
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; IRCCS San Raffaele Pisana, Rome, Italy.
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12
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Valente R, Antonelli M, Piciucchi M, Federici GF, Signoretti M, Iannicelli E, Capurso G, Delle Fave G. Celiac disease and CFTR mutations in patients with chronic asymptomatic pancreatic hyperenzymemia. Am J Gastroenterol 2013; 108:618. [PMID: 23552311 DOI: 10.1038/ajg.2013.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Pancreatic neuroendocrine tumours (PETs) are the second most frequent pancreatic neoplasms. Their poor chemosensitivity, high rate of metastatic disease and relatively long survival make PETs an ideal field to be explored for novel therapies based on specific molecular changes. PETs are generally sporadic but can also arise within hereditary syndromes, such as multiple endocrine neoplasia type 1, von Hippel-Lindau, neurofibromatosis type 1 and tuberous sclerosis complex, which represent a model for sporadic cases too. Among allelic imbalances, main genomic changes involve gain of 17q, 7q and 20q and loss of 11q, 6q and 11p, which identify regions of putative candidate oncogenes or tumour suppressor genes (TSGs), respectively, sometime with potential prognostic significance. Overexpression of Src-like kinases and cyclin D1 (CCND1) oncogene has been described. As for TSGs, P53 (TP53), DPC4/SMAD4 and RB (RB1) are not implicated in PET tumorigenesis, while for p16INK4a (CDKN2A), TIMP3, RASSF1A and hMLH1, more data are available, suggesting a role for methylation as a silencing mechanism. In the last decade, gene expression profile studies, analysis of microRNAs and, more recently, large-scale mutational analysis have highlighted commonly altered molecular pathways in the pathology of PETs. The roles of the mammalian target of rapamycin pathway, and its connection with Src kinases, and the activity of a number of tyrosine kinase receptors seem to be pivotal, as confirmed by the results of recent clinical trials with targeted agents. Mutations of DAXX and ATRX are common and related to altered telomeres but not to prognosis.
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Affiliation(s)
- Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, S. Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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14
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Valente R, Capurso G, Pierantognetti P, Iannicelli E, Piciucchi M, Romiti A, Mercantini P, Larghi A, Federici GF, Barucca V, Osti MF, Di Giulio E, Ziparo V, Delle Fave G. Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy. World J Gastrointest Oncol 2012; 4:22-5. [PMID: 22403738 PMCID: PMC3296805 DOI: 10.4251/wjgo.v4.i2.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 08/30/2011] [Revised: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 02/05/2023] Open
Abstract
Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient’s age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery.
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Affiliation(s)
- Roberto Valente
- Roberto Valente, Gabriele Capurso, Matteo Piciucchi, Emilio Di Giulio, Gianfranco Delle Fave, Digestive and Liver Disease Unit, Second Medical School, "La Sapienza" University, S. Andrea Hospital, 00189 Rome, Italy
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Corleto VD, Gambardella S, Gullotta F, D'Apice MR, Piciucchi M, Galli E, Lucidi V, Novelli G, Delle Fave G. New PRSS1 and common CFTR mutations in a child with acute recurrent pancreatitis, could be considered an "Hereditary" form of pancreatitis ? BMC Gastroenterol 2010; 10:119. [PMID: 20950468 PMCID: PMC2970583 DOI: 10.1186/1471-230x-10-119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 02/25/2010] [Accepted: 10/15/2010] [Indexed: 01/17/2023] Open
Abstract
Background acute recurrent pancreatitis is a complex multigenic disease, the diagnosis is even more difficult when this disease develops in a child. Case Presentation a 6-years old boy, hospitalized with epigastric pain radiating to the back showed high serum levels of serum amylase, lipase, CRP and erythrosedimentation rate. Several similar milder episodes of pain, followed by quick recovery and complete disappearance of symptoms were reported during the previous 13 months. The child was medically treated and after 7 days with normal clinic and laboratory tests was discharged with a hypolipidic diet. All the known aetiologic hypotheses were excluded by anamnestic investigation, clinical observation and biochemical evaluation, whereas, anatomic abnormality were excluded by a secretin stimulated magnetic resonance (MRI). At the last follow-up visit, (11 months later), the child showed a normal body weight and anthropometric profile, without further abdominal pain. Mutation screening for coding regions of PRSS1, SPINK1, CFTR and the new hereditary pancreatitis-associated chymotrypsin C (CTRC) genes showed a novel variation, c.541A > G (p.S181G), in the exon 4 of PRSS1 gene and the classical CF p.F508del mutation in the CFTR. Both mutations were present in his clinically normal mother and absent in the patient's father. Conclusions this report extend the spectrum of PRSS1 mutations, however, the absence of family history of pancreatitis leaves the present case without the hallmark of the hereditary origin of pancreatitis. At the present knowledge it can be only stated that the combined genotype CFTR (F508del)/PRSS1 (S181G) is associated to a mild phenotype of acute recurrent pancreatitis in this child without any further conclusion on its pathogenetic role or prediction on the course of the disease.
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Affiliation(s)
- Vito D Corleto
- Dept. of Digestive and Liver Disease, II School of Medicine, University La Sapienza, Rome, Italy.
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Piciucchi M, Merola E, Marignani M, Signoretti M, Valente R, Cocomello L, Baccini F, Panzuto F, Capurso G, Fave GD. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World J Gastroenterol 2010; 16:3692-6. [PMID: 20677342 PMCID: PMC2915430 DOI: 10.3748/wjg.v16.i29.3692] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the rate of spontaneous tube migration and to compare the effects of naso-gastric and naso-intestinal (NI) (beyond the ligament of Treitz) feeding in severe acute pancreatitis (SAP).
METHODS: After bedside intragastric insertion, tube position was assessed, and enteral nutrition (EN) started at day 4, irrespective of tube localization. Patients were monitored daily and clinical and laboratory parameters evaluated to compare the outcome of patients with nasogastric (NG) or NI tube.
RESULTS: Spontaneous tube migration to a NI site occurred in 10/25 (40%) prospectively enrolled SAP patients, while in 15 (60%) nutrition was started with a NG tube. Groups were similar for demographics and pancreatitis aetiology but computed tomography (CT) severity index was higher in NG tube patients than in NI (mean 6.2 vs 4.7, P = 0.04). The CT index seemed a risk factor for failed obtainment of spontaneous distal migration. EN trough NG or NI tube were similar in terms of tolerability, safety, clinical goals, complications and hospital stay.
CONCLUSION: Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.
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