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Clavenna MG, La Vecchia M, Sculco M, Joseph S, Barberis E, Amede E, Mellai M, Brossa S, Borgonovi G, Occhipinti P, Boldorini R, Robotti E, Azzimonti B, Bona E, Pasolli E, Ferrante D, Manfredi M, Aspesi A, Dianzani I. Distinct Signatures of Tumor-Associated Microbiota and Metabolome in Low-Grade vs. High-Grade Dysplastic Colon Polyps: Inference of Their Role in Tumor Initiation and Progression. Cancers (Basel) 2023; 15:3065. [PMID: 37370676 DOI: 10.3390/cancers15123065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
According to the driver-passenger model for colorectal cancer (CRC), the tumor-associated microbiota is a dynamic ecosystem of bacterial species where bacteria with carcinogenic features linked to CRC initiation are defined as "drivers", while opportunistic bacteria colonizing more advanced tumor stages are known as "passengers". We reasoned that also gut microbiota-associated metabolites may be differentially enriched according to tumor stage, and be potential determinants of CRC development. Thus, we characterized the mucosa- and lumen-associated microbiota (MAM and LAM, respectively) and mucosa-associated metabolites in low- vs. high-grade dysplastic colon polyps from 78 patients. We show that MAM, obtained with a new biopsy-preserving approach, and LAM differ in composition and α/β-diversity. By stratifying patients for polyp histology, we found that bacteria proposed as passengers by previous studies colonized high-grade dysplastic adenomas, whereas driver taxa were enriched in low-grade polyps. Furthermore, we report altered "mucosa-associated metabolite" levels in low- vs. high-grade groups. Integrated microbiota-metabolome analysis suggests the involvement of the gut microbiota in the production and consumption of these metabolites. Altogether, our findings support the involvement of bacterial species and associated metabolites in CRC mucosal homeostasis in a tumor-stage-specific manner. These distinct signatures may be used to distinguish low-grade from high-grade dysplastic polyps.
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Affiliation(s)
| | - Marta La Vecchia
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Marika Sculco
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Soni Joseph
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Elettra Barberis
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, 28100 Novara, Italy
| | - Elia Amede
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, 28100 Novara, Italy
| | - Marta Mellai
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, 28100 Novara, Italy
| | - Silvia Brossa
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Giulia Borgonovi
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, "Maggiore della Carità" Hospital, 28100 Novara, Italy
| | - Renzo Boldorini
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Elisa Robotti
- Department of Sciences and Technological Innovation, Università del Piemonte Orientale, 15121 Alessandria, Italy
| | - Barbara Azzimonti
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, 28100 Novara, Italy
| | - Elisa Bona
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100 Vercelli, Italy
| | - Edoardo Pasolli
- Department of Agricultural Sciences, University of Naples Federico II, 80055 Portici, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, 80055 Portici, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Marcello Manfredi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, 28100 Novara, Italy
| | - Anna Aspesi
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Irma Dianzani
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
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Cassinotti A, Mezzina N, De Silvestri A, Di Paolo D, Lenti MV, Bezzio C, Stradella D, Mauri M, Zadro V, Ricci C, Casini V, Radice E, Massari A, Maconi G, Saibeni S, Caprioli F, Tari R, Fichera M, Cortelezzi CC, Parravicini M, Tinelli C, Testoni PA, Pace F, Segato S, Invernizzi P, Occhipinti P, Manes G, Di Sabatino A, Pastorelli L, Vecchi M, Ardizzone S. Continuous clinical remission with biologics in ulcerative colitis: the 'AURORA' comparison study. Eur J Gastroenterol Hepatol 2022; 34:1238-1246. [PMID: 36165081 DOI: 10.1097/meg.0000000000002443] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Comparative trials among biological drugs for the treatment of ulcerative colitis (UC) provided conflicting results. After patent expire of infliximab originator, adalimumab, infliximab biosimilar, golimumab and vedolizumab have been approved in Italy.We compared the efficacy of these four biologics in UC according to the concept of continuous clinical remission (CCR). METHODS In a retrospective, multicentre study, all UC patients treated with adalimumab, infliximab biosimilar, golimumab or vedolizumab between 2014 and 2019 were included. All drugs were compared to each other according to the 1-year CCR rate, defined as Mayo partial score ≤2, with bleeding subscore = 0, without any relapse or optimization with dose escalation, topical treatments or steroid use after first clinical remission. RESULTS Four-hundred sixteen patients (adalimumab = 90, infliximab biosimilar = 105, golimumab = 79, vedolizumab = 142) were included. CCR was achieved in similar percentages among the groups (33%, 37%, 28%, 37%, respectively). All drugs were equivalent in biologic-naive patients, while vedolizumab was better than a second anti-TNFα in prior anti-TNFα agent failures. No differences were found according to type of adverse events or severe adverse events. CONCLUSIONS Based on a strict definition of clinical remission, all biologics appear equally effective at 1 year. Changing to vedolizumab is more effective than switching to another anti-TNFα in TNFα failures.
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Affiliation(s)
- Andrea Cassinotti
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Nicolò Mezzina
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Postgraduate School in Gastroenterology, University of Milan, Milan
| | | | - Dhanai Di Paolo
- Postgraduate School in Gastroenterology, University of Milan, Milan
- Gastroenterology Unit, Policlinico San Donato, San Donato Milanese
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | | | | | - Martina Mauri
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | - Valentina Zadro
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Postgraduate School in Gastroenterology, University of Milan, Milan
| | - Chiara Ricci
- Gastroenterology Unit, ASST Spedali Civili Brescia, Brescia
| | | | | | - Alessandro Massari
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
| | | | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano
| | - Roberto Tari
- Gastroenterology Unit, Ospedale Maggiore della Carità, Novara
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | | | - Marco Parravicini
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Fabio Pace
- Gastroenterology Unit, ASST Bergamo Est, Seriate
| | - Sergio Segato
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | | | | | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - Luca Pastorelli
- Gastroenterology Unit, Policlinico San Donato, San Donato Milanese
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Postgraduate School in Gastroenterology, University of Milan, Milan
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
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3
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Fugazza A, Troncone E, Amato A, Tarantino I, Iannone A, Donato G, D'Amico F, Mogavero G, Amata M, Fabbri C, Radaelli F, Occhipinti P, Repici A, Anderloni A. Difficult biliary cannulation in patients with distal malignant biliary obstruction: An underestimated problem? Dig Liver Dis 2022; 54:529-536. [PMID: 34362708 DOI: 10.1016/j.dld.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Failed biliary cannulation still poses a major challenge in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). To date, there is a lack of data on rates of Difficult Biliary Cannulation (DBC) in patients with distal malignant biliary obstruction (DMBO). MATERIALS This was a retrospective study (09/2015 to 02/2019) of consecutive patients with DMBO that underwent ERCP in four Italian centers. The primary outcome was to evaluate the rate of DBC. Secondary outcomes were: cannulation failure, rate of adverse events (AEs), the predictive factors for DBC as well as for AEs. RESULTS A total of 622 patients with DMBO, were included in the study, with 351(56,4%) matching the definition of DBC. One-hundred and two ERCP-related AEs occurred in 97 of 622 patients (15,6%). Subjects with DBC showed a higher risk for AEs (p = 0.02). The lack of pancreatitis prophylaxis (p = 0.03), diagnosis of cholangiocarcinoma (p = 0.02), the use of papillotomy (OR=1.98; 95%CI = 1.14-3.45) and the combination of two or more techniques for cannulation (OR = 2.88; 95%CI = 1.04-7.97) were associated with the occurrence of AEs. CONCLUSIONS According to the results of this study, patients with DMBO carries a higher rate of DBC thus requiring alternative techniques for biliary drainage. Furthermore, DBC carries a high risk for AEs. Further prospective multicentric studies are needed to confirm these data in this specific subgroup of patients.
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Affiliation(s)
- Alessandro Fugazza
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy.
| | - Edoardo Troncone
- Department of Systems Medicine, University of Rome ``Tor Vergata'', Rome 00133, Italy
| | - Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Ilaria Tarantino
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giulio Donato
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Ferdinando D'Amico
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
| | - Giuseppe Mogavero
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Michele Amata
- Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Medical Department, Forlì-Cesena Hospitals, AUSL Romagna
| | - Franco Radaelli
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Pietro Occhipinti
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Departement of Gastroenterology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
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4
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Repici A, Spada C, Cannizzaro R, Traina M, Maselli R, Maiero S, Galtieri A, Guarnieri G, Di Leo M, Lorenzetti R, Capogreco A, Spadaccini M, Antonelli G, Zullo A, Amata M, Ferrara E, Correale L, Granata A, Cesaro P, Radaelli F, Minelli Grazioli L, Anderloni A, Fugazza A, Finati E, Pellegatta G, Carrara S, Occhipinti P, Buda A, Fuccio L, Manno M, Hassan C. Novel 1-L polyethylene glycol + ascorbate versus high-volume polyethylene glycol regimen for colonoscopy cleansing: a multicenter, randomized, phase IV study. Gastrointest Endosc 2021; 94:823-831.e9. [PMID: 33940043 DOI: 10.1016/j.gie.2021.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Adequate bowel cleansing is critical to ensure quality and safety of a colonoscopy. A novel 1-L polyethylene glycol plus ascorbate (1L-PEG+ASC) regimen was previously validated against low-volume regimens but was never compared with high-volume regimens. METHODS In a phase IV study, patients undergoing colonoscopy were randomized 1:1 to receive split-dose 1L PEG+ASC or a split-dose 4-L PEG-based regimen (4L-PEG) in 5 Italian centers. Preparation was assessed with the Boston Bowel Preparation Scale (BBPS) by local endoscopists and centralized reading, both blinded to the randomization arm. The primary endpoint was noninferiority of 1L-PEG+ASC in colon cleansing. Secondary endpoints were superiority of 1L-PEG+ASC, patient compliance, segmental colon cleansing, adenoma detection rate, tolerability, and safety. RESULTS Three hundred eighty-eight patients (median age, 59.8 years) were randomized between January 2019 and October 2019: 195 to 1L-PEG+ASC and 193 to 4L-PEG. Noninferiority of 1L-PEG+ASC was demonstrated for cleansing in both the entire colon (BBPS ≥ 6: 97.9% vs 93%; relative risk [RR], 1.03; 95% confidence interval [CI], 1.001-1.04; P superiority = .027) and in the right-sided colon segment (98.4% vs 96.0%; RR, 1.02; 95% CI, .99-1.02; P noninferiority = .013). Compliance was higher with 1L-PEG+ASC than with 4L-PEG (178/192 [92.7%] vs 154/190 patients [81.1%]; RR, 1.10; 95% CI, 1.05-1.12), whereas no difference was found regarding safety (moderate/severe side effects: 20.8% vs 25.8%; P = .253). No difference in adenoma detection rate (38.8% vs 43.0%) was found. CONCLUSIONS One-liter PEG+ASC showed noninferiority compared with 4L-PEG in achieving adequate colon cleansing and provided a higher patient compliance. No differences in tolerability and safety were detected. (Clinical trial registration number: NCT03742232.).
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Affiliation(s)
- Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Renato Cannizzaro
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Stefania Maiero
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessia Galtieri
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanni Guarnieri
- UO Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Milena Di Leo
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Antonio Capogreco
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giulio Antonelli
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Angelo Zullo
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michele Amata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Elisa Ferrara
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Antonino Granata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto ISMETT, Palermo, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Andrea Anderloni
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro Fugazza
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Elena Finati
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Gaia Pellegatta
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Silvia Carrara
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Andrea Buda
- Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Manno
- Digestive Endoscopy Unit, Carpi-Mirandola Hospitals, Azienda USL Modena
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
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5
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Barberis E, Joseph S, Amede E, Clavenna MG, La Vecchia M, Sculco M, Aspesi A, Occhipinti P, Robotti E, Boldorini R, Marengo E, Dianzani I, Manfredi M. A new method for investigating microbiota-produced small molecules in adenomatous polyps. Anal Chim Acta 2021; 1179:338841. [PMID: 34535255 DOI: 10.1016/j.aca.2021.338841] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 12/24/2022]
Abstract
The intestinal microbiota is composed of a large number of different bacteria that produce a variety of metabolites. Colorectal cancer, which typically develops from adenomatous polyps, is highly influenced by microbiota. Since a variety of molecular changes may occur as these polyps transform from benign tumor to malignant carcinoma, the ability to study the microbiota-produced metabolites can lead to new discoveries about the development and progression of this cancer. However, to address the complexity of the microbiota-produced molecules, novel methods are needed. To this aim, in the present work, we developed a high-throughput metabolomics method to capture the metabolic complexity of the microbiota metabolome adherent to adenomatous polyps and adenocarcinoma. For the first time, the method enables the simultaneous quantification of almost 300 metabolites, while preserving the integrity of the original sample. The metabolomics approach was analytically validated and had excellent performances in terms of recovery, linearity, specificity, intra- and inter-day precision, limits of detection, and quantification. Furthermore, the clinical potential of the method was demonstrated in adenoma collected for a colorectal adenoma study.
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Affiliation(s)
- Elettra Barberis
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy
| | - Soni Joseph
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Elia Amede
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy
| | | | - Marta La Vecchia
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Marika Sculco
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Anna Aspesi
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, 'Maggiore Della Carità' Hospital, Novara, Italy
| | - Elisa Robotti
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Novara, Italy
| | - Renzo Boldorini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Emilio Marengo
- Department of Sciences and Technological Innovation, University of Piemonte Orientale, Novara, Italy
| | - Irma Dianzani
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Marcello Manfredi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Center for Translational Research on Autoimmune and Allergic Diseases, University of Piemonte Orientale, Novara, Italy.
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6
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Donato G, Occhipinti P, Correale L, Spadaccini M, Repici A, Anderloni A, Fugazza A, Mosca P, Tringali A, Costamagna G, Bulajic M, de Pretis G, Gabbrielli A, Di Matteo FM, Faggiani R, Ayoubi M, De Luca L, Cantù P, Blois M, Dell’Amico I, Maurano A, Savarese MF, Manes G, Ferraro R, Barberis M, Hassan C. A prospective study on quality in endoscopic retrograde cholangiopancreatography (ERCP): trend in Italy from the REQUEST study. Endosc Int Open 2021; 9:E1563-E1571. [PMID: 34540552 PMCID: PMC8445684 DOI: 10.1055/a-1531-4691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure with a relatively high rate of adverse events. Data on training of operators and fulfillment of quality indicators in Italy are scarce. The goal of this study was to assess the overall quality of ERCP in Italy compared to international standards. Patients and methods This was a prospective, observational study from different Italian centers performing ERCP. Operators answered a questionnaire, then recorded data on ERCPs over a 1-to 3-month period. Results Nineteen Italian centers participated in the study. The most common concern of operators about training was the lack of structured programs. Seven/19 centers routinely used conscious sedation for ERCP. Forty-one experienced operators and 21 trainees performed 766 ERCPs: a successful deep biliary cannulation in native-papilla patients was achieved in 95.1 % of cases; the post-ERCP pancreatitis (PEP) rate was 5.4 % in native-papilla patients; cholangitis rate was 1.0 %; bleeding and perforation occurred in 2.7 % and 0.4 % of the patients, respectively. Conclusions This study revealed that, overall, ERCP is performed in the participating Italian centers meeting good quality standards, but structured training and sedation practice are still subpar. The bleeding and perforation rate slightly exceeded the American Society of Gastrointestinal Endoscopy indicator targets but they are comparable to the reported rates from other international surveys.
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Affiliation(s)
- Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Pietro Occhipinti
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Loredana Correale
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Marco Spadaccini
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Pieve Emanuele, Milano, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Pieve Emanuele, Milano, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Piergiorgio Mosca
- Division of Gastroenterology, Department of Gastroenterology & Transplantation, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Milutin Bulajic
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy,Mater Olbia Hospital-Qatar Foundation Endowment & Gemelli Foundation, Gastroenterology and GI Endoscopy Unit, Olbia (OT), Italy
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Chiara, Trento, Italy
| | | | | | - Roberto Faggiani
- Gastroenterology and Endoscopy Unit, Department of Oncological and Specialty Medicine, S. Camillo Forlanini Hospital, Rome, Italy
| | - Mohammad Ayoubi
- Gastroenterology and Endoscopy Unit, Gradenigo-Humanitas, Torino, Italy
| | - Luca De Luca
- Gastroenterology and Digestive Endoscopy Unit, A.O. Ospedale Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Matteo Blois
- Interventional Endoscopy Unit, Azienda USL Toscana Nord-Ovest, Livorno, Italy
| | | | - Attilio Maurano
- Operative Endoscopy Unit, Azienda Ospedaliera Universitaria di Salerno, Italy
| | - Maria Flavia Savarese
- Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo (IM), Italy
| | - Giampiero Manes
- Department of Gastroenterology and Digestive Endoscopy, ASST Rhodense Garbagnate Milanese, Milano, Italy
| | - Raffaella Ferraro
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Andrea, ASL VC, Vercelli, Italy
| | - Mauro Barberis
- Gastroenterology Unit, Policlinico di Monza, Monza (MB), Italy
| | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy
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7
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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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8
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Frazzoni L, Spada C, Radaelli F, Mussetto A, Laterza L, La Marca M, Piccirelli S, Cortellini F, Rondonotti E, Paci V, Bazzoli F, Fabbri C, Manno M, Aragona G, Manes G, Occhipinti P, Cadoni S, Zagari RM, Hassan C, Fuccio L. 1L- vs. 4L-Polyethylene glycol for bowel preparation before colonoscopy among inpatients: A propensity score-matching analysis. Dig Liver Dis 2020; 52:1486-1493. [PMID: 33250131 DOI: 10.1016/j.dld.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/05/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inpatients are at risk for inadequate colon cleansing. Experts recommend 4L-polyethylene-glycol (PEG) solution. A higher colon cleansing adequacy rate for a hyperosmolar 1L-PEG plus ascorbate prep has been recently reported. AIMS We aimed to determine whether 1L-PEG outperforms 4L-PEG among inpatients. METHODS post-hoc analysis of a large Italian multicenter prospective observational study among inpatients (QIPS study). We performed a propensity score matching between 1L-PEG and 4L-PEG group. The primary outcome was the rate of adequate colon cleansing as assessed by unblinded endoscopists through Boston scale. Secondary outcome was the safety profile. RESULTS Among 1,004 patients undergoing colonoscopy, 724 (72%) were prescribed 4L-PEG and 280 (28%) 1L-PEG. The overall adequate colon cleansing rate was 69.2% (n = 695). We matched 274 pairs of patients with similar distribution of confounders. The rate of patients with adequate colon cleansing was higher in 1L-PEG than in 4L-PEG group (84.3% vs. 77.4%, p = 0.039). No different shift in serum concentration of electrolytes (namely Na+, K+, Ca2+), creatinine and hematocrit were observed for both preparations. CONCLUSION We found a higher rate of adequate colon cleansing for colonoscopy with the 1L-PEG bowel prep vs. 4L-PEG, with apparent similar safety profile, among inpatients. A confirmatory randomized trial is needed. (ClinicalTrials.gov no: NCT04310332).
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Affiliation(s)
- Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Liboria Laterza
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marina La Marca
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Fabio Cortellini
- Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | | | - Valentina Paci
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospital, AUSL Romagna, Forli-Cesena, Italy
| | - Mauro Manno
- UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Italy
| | - Giovanni Aragona
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, Piacenza, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy
| | - Pietro Occhipinti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy
| | - Rocco Maurizio Zagari
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy.
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9
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Attardo S, Chandrasekar VT, Spadaccini M, Maselli R, Patel HK, Desai M, Capogreco A, Badalamenti M, Galtieri PA, Pellegatta G, Fugazza A, Carrara S, Anderloni A, Occhipinti P, Hassan C, Sharma P, Repici A. Artificial intelligence technologies for the detection of colorectal lesions: The future is now. World J Gastroenterol 2020; 26:5606-5616. [PMID: 33088155 PMCID: PMC7545398 DOI: 10.3748/wjg.v26.i37.5606] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Several studies have shown a significant adenoma miss rate up to 35% during screening colonoscopy, especially in patients with diminutive adenomas. The use of artificial intelligence (AI) in colonoscopy has been gaining popularity by helping endoscopists in polyp detection, with the aim to increase their adenoma detection rate (ADR) and polyp detection rate (PDR) in order to reduce the incidence of interval cancers. The efficacy of deep convolutional neural network (DCNN)-based AI system for polyp detection has been trained and tested in ex vivo settings such as colonoscopy still images or videos. Recent trials have evaluated the real-time efficacy of DCNN-based systems showing promising results in term of improved ADR and PDR. In this review we reported data from the preliminary ex vivo experiences and summarized the results of the initial randomized controlled trials.
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Affiliation(s)
- Simona Attardo
- Department of Endoscopy and Digestive Disease, AOU Maggiore della Carità, Novara 28100, Italy
| | | | - Marco Spadaccini
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Roberta Maselli
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Harsh K Patel
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA 70124, United States
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Antonio Capogreco
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Matteo Badalamenti
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | | | - Gaia Pellegatta
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Alessandro Fugazza
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Silvia Carrara
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Andrea Anderloni
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Pietro Occhipinti
- Department of Endoscopy and Digestive Disease, AOU Maggiore della Carità, Novara 28100, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Roma 00153, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Alessandro Repici
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
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10
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Maselli R, Iacopini F, Azzolini F, Petruzziello L, Manno M, De Luca L, Cecinato P, Fiori G, Staiano T, Rosa Rizzotto E, Angeletti S, Caruso A, Coppola F, Andrisani G, Viale E, Missale G, Panarese A, Mazzocchi A, Cesaro P, Campanale M, Occhipinti P, Tarantino O, Crosta C, Brosolo P, Sferrazza S, Rondonotti E, Amato A, Fuccio L, Costamagna G, Repici A. Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes. Dig Liver Dis 2020; 52:64-71. [PMID: 31629705 DOI: 10.1016/j.dld.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/29/2018] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. METHODS All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. RESULTS Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were <50 years old; 7 (24%) were female; 16 (70%) were located in Northern Italy. Overall ESD volume was <40 cases in 9 (31%) operators, 40-80 in 8 (27.5%), 80-150 in 4 (13.8%) and >150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3-93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80-150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). CONCLUSION ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.
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Affiliation(s)
- Roberta Maselli
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy.
| | | | - Francesco Azzolini
- Division of Gastroenterology & G.I. Endoscopy, Vita Salute San Raffaele University, Milan, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Division of Gastroenterology Fondazione A. Gemelli-Università Cattolica del Sacro Cuore Hospital, IRCCS, Rome, Italy
| | - Mauro Manno
- Digestive Endoscopy Unit, USL Modena, Carpi Hospital, Italy
| | - Luca De Luca
- Division of Gastroenterology & G.I. Endoscopy, Ospedali Riuniti Marche Nord Hospital, Pesaro, Italy
| | - Paolo Cecinato
- Unit of Gastroenterology and Digestive Endoscopy, USL-IRCCS Reggio Emilia Hospital, Reggio Emilia,Italy
| | - Giancarla Fiori
- IEO, Digestive Endoscopy Unit, Istituto Europeo di Oncologia IRCCS Hospital, Milano, Italy
| | - Teresa Staiano
- Digestive Endoscopy Unit, FPO-IRCCS Candiolo Cancer Institute, Candiolo, TO, Italy
| | - Erik Rosa Rizzotto
- Division of Gastroenterology & G.I. Endoscopy, S. Antonio Hospital, Padova, Italy
| | - Stefano Angeletti
- Digestive Endoscopy Unit, Sant'Andrea Hospital, a Sapienza university, Roma, Italy
| | - Angelo Caruso
- Division of Gastroenterology & G.I. Endoscopy, Baggiovara Hospital, AOU di Modena, Italy
| | - Franco Coppola
- Digestive Endoscopy Unit, Division of Gastroenterology, ASLTO4, Turin, Italy
| | | | - Edi Viale
- Division of Gastroenterology & G.I. Endoscopy, Vita Salute San Raffaele University, Milan, Italy
| | - Guido Missale
- Digestive Endoscopy Unit, ASST Spedali Civili, Brescia University, Italy
| | - Alba Panarese
- Department of Gastroenterology and Digestive Endoscopy, National Research Institute specialized in Gastroenterology ¨S. De Bellis¨ , Castellana Grotte, BA, Italy
| | - Alessandro Mazzocchi
- Gastroenterology Endoscopy Unit, San Giovanni Battista Hospital, San Giovanni battista, Italy
| | - Paola Cesaro
- Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Mariachiara Campanale
- Digestive Endoscopy Unit, Division of Gastroenterology Fondazione A. Gemelli-Università Cattolica del Sacro Cuore Hospital, IRCCS, Rome, Italy
| | - Pietro Occhipinti
- Division of Gastroenterology, ¨ Maggiore della CaritਠHospital and University, Novara, Italy
| | - Ottaviano Tarantino
- Division of Gastroenterology & G.I. Endoscopy, San Giuseppe Hospital, ASL Toscana centro, Empoli, Italy
| | - Cristiano Crosta
- IEO, Digestive Endoscopy Unit, Istituto Europeo di Oncologia IRCCS Hospital, Milano, Italy
| | - Piero Brosolo
- Division of Gastroenterology, Hospital of Pordenone, Pordenone, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, APSS, Trento, Italy
| | - Emanuele Rondonotti
- Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy
| | - Arnaldo Amato
- Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Cattolica del Sacro CuoreUniversity, Centre for Endoscopic Research Therapeutics and Training CERTT, Roma, Italy; Université de Strasbourg Institut d'Etudes Avancées USIAS, Strasbourg, France
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy; Humanitas University, Department of Biomedical Science, Milan, Italy
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11
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Di Leo M, Crinò SF, Bernardoni L, Rahal D, Auriemma F, Correale L, Donato G, Massidda M, Anderloni A, Manfrin E, Armellini E, Poliani L, Fugazza A, Semeraro R, Occhipinti P, Repici A, Carrara S. EUS-guided core biopsies of pancreatic solid masses using a new fork-tip needle: A multicenter prospective study. Dig Liver Dis 2019; 51:1275-1280. [PMID: 31010744 DOI: 10.1016/j.dld.2019.03.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 11/19/2018] [Revised: 02/26/2019] [Accepted: 03/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound-guided sampling (EUS sampling) is a safe and effective technique. The study aim was to evaluate the presence of a histological core from pancreatic lesions using a new 25G fork-tip needle. METHODS Observational multicenter prospective and analytical study, including consecutive patients with solid pancreatic masses referred for EUS-guided sampling. At each needle pass, the endoscopist performed macroscopic on-site evaluation (MOSE). The primary outcome was the histological core procurement rates. Secondary outcomes were the evaluation of interobserver agreement between endoscopists and pathologists, adequacy of EUS samples for the diagnosis and post-procedure adverse events. RESULTS 100 patients were enrolled in 3 centers. The mean size of the lesions was 28.5 mm (SD 11.7). Final diagnoses were adenocarcinoma (68%), neuroendocrine tumor (21%), inflammatory mass/benign lesions (8.0%), and pancreatic metastasis (3.0%). The pathologists described the presence of a core in 67 samples (67.0% of patients), with poor agreement with MOSE (kappa, 0. 12; 95% CI: 0.03-0.28). The diagnostic accuracy was 93%. We observed 6% of mild adverse events. CONCLUSION The new 25-gauge core needle showed good overall adequacy and a good rate of histological specimens during EUS sampling of solid pancreatic masses, with a minimum number of passes and no major complications. Clinicaltrial.gov number, NCT02946840.
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Affiliation(s)
- Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, G. B. Rossi University Hospital, Verona, Italy
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, G. B. Rossi University Hospital, Verona, Italy
| | - Daoud Rahal
- Pathological Department, Humanitas Research Hospital, Milan, Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Giulio Donato
- Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Marco Massidda
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, G. B. Rossi University Hospital, Verona, Italy
| | - Elia Armellini
- Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Laura Poliani
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Rossella Semeraro
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Pietro Occhipinti
- Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
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12
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Antonini F, Delconte G, Fuccio L, De Nucci G, Fabbri C, Armellini E, Frazzoni L, Fornelli A, Magarotto A, Mandelli E, Occhipinti P, Masci E, Manes G, Macarri G. EUS-guided tissue sampling with a 20-gauge core biopsy needle for the characterization of gastrointestinal subepithelial lesions: A multicenter study. Endosc Ultrasound 2019; 8:105-110. [PMID: 29770781 PMCID: PMC6482599 DOI: 10.4103/eus.eus_1_18] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Indexed: 12/12/2022] Open
Abstract
Background and Objective: A new 20-gauge (G) biopsy needle with a core-trap technology has been developed with a large core size and enhanced flexibility. The aim of this multicenter study was to determine the feasibility, efficacy, and safety of EUS-guided fine-needle biopsy (EUS-FNB) with the new 20G needle in diagnosing subepithelial lesions (SELs). Materials and Methods: Retrospectively collected data from consecutive patients with SELs undergoing EUS-FNB with the 20G needle at five centers were analyzed. Results: A total of 50 SELs were included. The mean lesion size was 43.1 ± 17.5 mm. The lesion locations were esophagus (n = 1), stomach (n = 37), distal duodenum (n = 5), rectum (n = 6), and colon (n = 1). The procedure was technically feasible in all patients. Definitive diagnosis with full histological assessment including immunohistochemistry was obtained in 88% (44/50) of the patients. Considering malignant versus benign lesions, the sensitivity, specificity, positive predictive value, and negative predictive value were 85% (95% confidence interval [CI] 70.2–94.3), 100% (95% CI 58.7%–100%), 100% (95% CI 85.1%–100%), and 62.5 (95% CI 27.7–84.8), respectively. No major complications requiring additional care have been observed. Conclusions: In this multicenter study, we found that EUS-FNB with the new 20G core needle is an effective and safe method for the diagnosis of SELs with a high rate of producing adequate histological material and high diagnostic accuracy even from difficult-to-approach anatomical locations.
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Affiliation(s)
- Filippo Antonini
- Unit of Gastroenterology and Digestive Endoscopy, Augusto Murri Hospital, Fermo, Italy
| | - Gabriele Delconte
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Germana De Nucci
- Unit of Gastroenterology and Digestive Endoscopy, ASST Rhodense, Garbagnate Milanese (MI), Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy
| | - Elia Armellini
- Division of Gastroenterology, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Adele Fornelli
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Enzo Mandelli
- Unit of Gastroenterology and Digestive Endoscopy, ASST Rhodense, Garbagnate Milanese (MI), Italy
| | - Pietro Occhipinti
- Division of Gastroenterology, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Enzo Masci
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianpiero Manes
- Unit of Gastroenterology and Digestive Endoscopy, ASST Rhodense, Garbagnate Milanese (MI), Italy
| | - Giampiero Macarri
- Unit of Gastroenterology and Digestive Endoscopy, Augusto Murri Hospital, Fermo, Italy
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13
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Spada C, Cannizzaro R, Bianco MA, Conigliaro R, Di Giulio E, Hassan C, Marmo R, Occhipinti P, Radaelli F, Repici A, Ricci E, Costamagna G. Preparation for colonoscopy: Recommendations by an expert panel in Italy. Dig Liver Dis 2018; 50:1124-1132. [PMID: 30172650 DOI: 10.1016/j.dld.2018.07.036] [Citation(s) in RCA: 3] [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: 12/29/2017] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite several guidelines on bowel preparation being available, their applicability in Italy is poorly investigated. AIMS (1) To create expert-based recommendations for the Italian setting based on available international guidelines on bowel preparation for colonoscopy; (2) to assess consensus across the Italian endoscopy community. METHODS The study was conducted in 2 phases: (a) statements formulation, (b) assessment of consensus. For the first phase, 6 topics related to bowel preparation were identified: (1) efficacy/tolerability; (2) timing; (3) assessment of quality of bowel preparation; (4) factors associated with inadequate preparation; (5) patient education and (6) impact of organisational factors. For each topic, statements were produced and voted by a panel of experts. For consensus assessment, the invited participants were asked to rate the statements. The statement achieved a good level of agreement when at least 70% of voters agreed with it. RESULTS 25 statements were agreed in the first phase. Agreement was not achieved by the endoscopy community for 7 statements, mainly concerning practical aspects (i.e. strategies for management of patients with inadequate preparation, organisational factors). CONCLUSION A clinically relevant consensus was achieved on the main topics of bowel preparation, such as the choice of laxative and the time of administration, and it may help to homogenize the colonoscopy practice in Italy. Nevertheless, there are a few country-specific preparation-related issues that need to be addressed.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit, A. Gemlli IRCCS University Hospital, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy.
| | - Renato Cannizzaro
- Department of Gastroenterology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | - Emilio Di Giulio
- Digestive Endoscopy Unit, "La Sapienza" University, Ospedale S. Andrea, Roma, Italy
| | - Cesare Hassan
- Department of Gastroenteology, Ospedale Nuova Regina Margherita, Roma, Italy
| | - Riccardo Marmo
- Gastroenterology and Digestive Endoscopy Unit, Polla Hospital, Salerno, Italy
| | - Pietro Occhipinti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale SS Trinità, Borgomanero, Italy
| | - Franco Radaelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Valduce, Como, Italy
| | - Alessandro Repici
- Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Milano, Italy
| | - Enrico Ricci
- Gastroenterology and Digestive Endoscopy Unit, Ospedale G.B. Morgagni, Forlì, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, A. Gemlli IRCCS University Hospital, Rome, Italy; IHU, USIAS Strasbourg University, Strasbourg, France
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Armellini E, Manfrin E, Trisolini E, Andorno S, Ballarè M, Bernardoni L, Boldorini RL, Gabbrielli A, Frulloni L, Larghi A, Occhipinti P, Scarpa A, Crinò SF. Histologic retrieval rate of a newly designed side-bevelled 20G needle for EUS-guided tissue acquisition of solid pancreatic lesions. United European Gastroenterol J 2018; 7:96-104. [PMID: 30788121 DOI: 10.1177/2050640618804443] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 05/15/2018] [Accepted: 08/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background Innovative approaches to improve diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) have focused on needle design with development of fine-needle biopsy (FNB) needles with microcore-acquisition technology. Recently, a 20-gauge (20G) antegrade-cutting-side-bevelled biopsy needle (ProCore®) was developed for EUS-TA, but data about its diagnostic performance and histological capability are scant. Objectives We assessed the diagnostic performance and histologic retrieval rate of a new 20G antegrade-cutting-side-bevelled biopsy needle compared with a 22G reverse-side-bevelled needle for EUS sampling of solid pancreatic lesions. Patients and methods A retrospective analysis of 238 consecutively collected patients who underwent EUS-TA using a 20G or a 22G ProCore® needle, without rapid on-site evaluation (ROSE), was conducted at two centres.Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Histologic tissue retrieval was evaluated applying a scoring system for each case. Results Sensitivity and specificity were estimated as 98.4-100% in the 20G-, and 94.9-100% in the 22G-needle groups, respectively (p > 0.99). The 20G procured more histologic-grade tissues (92.6% vs 49.5%, p < 0.0001) achieved by a lower number of passes (2.64 vs 3.44, p < 0.0001) compared to the 22G. Conclusions Both side-bevelled FNB needles achieved a high diagnostic sensitivity. The 20G-side-bevelled needle obtained a significantly higher microcore retrieval rate.
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Affiliation(s)
- Elia Armellini
- Department of Gastroenterology, 'Maggiore della Carità' Hospital, Novara, Italy
| | - Erminia Manfrin
- Department of Pathology and Diagnostics, G.B. Rossi University Hospital, Verona, Italy
| | - Elena Trisolini
- Department of Health Sciences, School of Medicine, University of Eastern Piedmont 'Amedeo Avogadro', Novara, Italy
| | - Silvano Andorno
- Department of Health Sciences, School of Medicine, University of Eastern Piedmont 'Amedeo Avogadro', Novara, Italy
| | - Marco Ballarè
- Department of Gastroenterology, 'Maggiore della Carità' Hospital, Novara, Italy
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Renzo Luciano Boldorini
- Department of Health Sciences, School of Medicine, University of Eastern Piedmont 'Amedeo Avogadro', Novara, Italy.,Department of Pathology, 'Maggiore della Carità' Hospital, Novara, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, 'Maggiore della Carità' Hospital, Novara, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, G.B. Rossi University Hospital, Verona, Italy.,ARC-Net Research Centre, G.B. Rossi University Hospital, Verona, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
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15
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Affiliation(s)
- Elia Armellini
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Monica Leutner
- Department of Pathology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Davide Stradella
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Marco Ballarè
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
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16
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Radaelli F, Paggi S, Repici A, Gullotti G, Cesaro P, Rotondano G, Cugia L, Trovato C, Spada C, Fuccio L, Occhipinti P, Pace F, Fabbri C, Buda A, Manes G, Feliciangeli G, Manno M, Barresi L, Anderloni A, Dulbecco P, Rogai F, Amato A, Senore C, Hassan C. Barriers against split-dose bowel preparation for colonoscopy. Gut 2017; 66:1428-1433. [PMID: 27196589 DOI: 10.1136/gutjnl-2015-311049] [Citation(s) in RCA: 33] [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] [Received: 11/07/2015] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake. DESIGN In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire. RESULTS Of the 1447 patients (mean age 59.2±13.5 years, men 54.3%), 61.7% and 38.3% chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3% in 8:00 patients to 96% in 14:00 patients (p<0.001, χ2 for linear trend). At multivariate analysis, colonoscopy appointment before 10:00 (OR 0.14, 95% CI 0.11 to 0.18), travel time to endoscopy service >1 h (OR 0.55, 95% CI 0.38 to 0.79), low education level (OR 0.72, 95% CI 0.54 to 0.96) and female gender (OR 0.74, 95% CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0% vs 1.4% and 1.5% vs 0.9%, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95% CI 2.40 to 4.63) and polyp detection (OR 1.46, 95% CI 1.11 to 1.92). CONCLUSION Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered. TRIAL REGISTRATION NUMBER NCT02287051; pre-result.
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Affiliation(s)
- F Radaelli
- Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - S Paggi
- Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - A Repici
- Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | | | - P Cesaro
- Poliambulanza Foundation Hospital, Brescia, Italy
| | - G Rotondano
- Maresca Hospital, ASLNA3sud, Torre del Greco, Naples, Italy
| | - L Cugia
- SS Annunziata Hospital, Sassari, Italy
| | - C Trovato
- European Institute of Oncology, Milan, Italy
| | - C Spada
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - L Fuccio
- S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - F Pace
- Bolognini Hospital, Seriate, Italy
| | - C Fabbri
- Bellaria-Maggiore Hospital, Bologna, Italy
| | - A Buda
- S. Maria del Prato Hospital, Feltre, Italy
| | - G Manes
- G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | | | - M Manno
- Ospedali di Carpi e Mirandola, Modena, Italy
| | - L Barresi
- IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - A Anderloni
- Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | | | - F Rogai
- University Hospital Careggi, Florence, Italy
| | - A Amato
- Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - C Senore
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - C Hassan
- Nuovo Regina Margherita Hospital, Rome, Italy
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17
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Regge D, Iussich G, Segnan N, Correale L, Hassan C, Arrigoni A, Asnaghi R, Bestagini P, Bulighin G, Cassinis MC, Ederle A, Ferraris A, Galatola G, Gallo T, Gandini G, Garretti L, Martina MC, Molinar D, Montemezzi S, Morra L, Motton M, Occhipinti P, Pinali L, Soardi GA, Senore C. Comparing CT colonography and flexible sigmoidoscopy: a randomised trial within a population-based screening programme. Gut 2017; 66:1434-1440. [PMID: 27196588 DOI: 10.1136/gutjnl-2015-311278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/11/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/16/2022]
Abstract
IMPORTANCE AND AIMS The role of CT colonography (CTC) as a colorectal cancer (CRC) screening test is uncertain. The aim of our trial was to compare participation and detection rate (DR) with sigmoidoscopy (flexible sigmoidoscopy (FS)) and CTC in a screening setting. DESIGN SETTING AND PARTICIPANTS We conducted two randomised clinical trials (RCTs). (1) Participation RCT: individuals, aged 58 years, living in Turin (Italy), were randomly assigned to be invited to FS or CTC screening; (2) detection RCT: residents in northern Italy, aged 58-60, giving their consent to recruitment, were randomly allocated to CTC or FS. Polyps ≥6 mm at CTC, or 'high-risk' distal lesions at FS, were referred for colonoscopy (TC). MAIN OUTCOME MEASURES Participation rate (proportion of invitees examined); DR of advanced adenomas or CRC (advanced neoplasia (AN)). RESULTS Participation was 30.4% (298/980) for CTC and 27.4% (267/976) for FS (relative risk (RR) 1.1; 95% CI 0.98 to 1.29). Among men, participation was higher with CTC than with FS (34.1% vs 26.5%, p=0.011). In the detection RCT, 2673 subjects had FS and 2595 had CTC: the AN DR was 4.8% (127/2673, including 9 CRCs) with FS and 5.1% (133/2595, including 10 CRCs) with CTC (RR 1.08; 95% CI 0.85 to 1.37). Distal AN DR was 3.9% (109/2673) with FS and 2.9% (76/2595) with CTC (RR 0.72; 95% CI 0.54 to 0.96); proximal AN DR was 1.2% (34/2595) for FS vs 2.7% (69/2595) for CTC (RR 2.06; 95% CI 1.37 to 3.10). CONCLUSIONS AND RELEVANCE Participation and DR for FS and CTC were comparable. AN DR was twice as high in the proximal colon and lower in the distal colon with CTC than with FS. Men were more likely to participate in CTC screening. TRIAL REGISTRATION NUMBER NCT01739608; Pre-results.
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Affiliation(s)
- Daniele Regge
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Nereo Segnan
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
| | - Loredana Correale
- im3D S.p.A., Turin, Italy
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Cesare Hassan
- AOU Città della Salute e della Scienza, CPO Piemonte, SCDO Epidemiologia screening e registro tumori, Turin, Italy
| | - Arrigo Arrigoni
- Endoscopy Unit, Ospedale San Giovanni Antica Sede, Turin, Italy
| | - Roberto Asnaghi
- Radiology Unit, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy
| | | | - Gianmarco Bulighin
- Endoscopy and Gastroenterology Unit, U.l.s.s. 20 Verona, Ospedale G. Fracastoro-San Bonifacio, Verona, Italy
| | - Maria Carla Cassinis
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Ederle
- Endoscopy and Gastroenterology Unit, U.l.s.s. 20 Verona, Ospedale G. Fracastoro-San Bonifacio, Verona, Italy
| | - Andrea Ferraris
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Teresa Gallo
- Radiology Unit, Ospitale Mauriziano, Turin, Italy
| | - Giovanni Gandini
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Licia Garretti
- Radiology Unit, Ospedale San Giovanni Antica Sede, Turin, Italy
| | - Maria Cristina Martina
- Radiology Unit, Department of Surgical Science, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Stefania Montemezzi
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Lia Morra
- im3D S.p.A., Turin, Italy
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Massimiliano Motton
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Lucia Pinali
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Gian Alberto Soardi
- Radiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Senore
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
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18
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Armellini E, Crinò SF, Ballarè M, Occhipinti P. Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor. Endoscopy 2016; 47 Suppl 1 UCTN:E600-1. [PMID: 26671543 DOI: 10.1055/s-0034-1393677] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 12/29/2022]
Affiliation(s)
- Elia Armellini
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Stefano F Crinò
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Marco Ballarè
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Pietro Occhipinti
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
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Gentilli S, Oldani A, Zanni M, Ferreri E, Terrone A, Valente G, Occhipinti P. Gastro-splenic fistula as a complication of chemotherapy for large B cell lymphoma. Ann Ital Chir 2016; 87:S2239253X16025731. [PMID: 27456604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Gastro-splenic fistula is a rare entity in which malignant tumors are the primary cause, followed by perforated peptic ulcers and Crohn's disease. CASE REPORT A 66 years old patient undergoing chemotherapy for gastric large cells B lymphoma presented fever, fatigue and worsening of general conditions. A CT scan showed the presence of an abdominal abscess resulting from a pathological communication between stomach and spleen. RESULTS En - bloc splenectomy and gastric wedge resection was performed; gastric wall was sutured with a linear stapler. Postoperative stay was uneventful; alimentation was restarted 5 days after the surgical procedure, and the patient was discharged 2 days later CONCLUSION We have described an unusual case of gastric fistula complicating chemotherapy early diagnosed and successfully treated. KEY WORDS Chemothera Gastrosplenic fistula, Lymphoma, Surgery.
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Armellini E, Crinò SF, Orsello M, Ballarè M, Saettone S, Tari R, Occhipinti P. New endoscopic over-the-scope clip system for treatment of a chronic post-surgical tracheoesophageal fistula. Endoscopy 2016; 47 Suppl 1 UCTN:E437-8. [PMID: 26397859 DOI: 10.1055/s-0034-1392673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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)
- Elia Armellini
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Stefano F Crinò
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Marco Orsello
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Marco Ballarè
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Silvia Saettone
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Roberto Tari
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Pietro Occhipinti
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
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Armellini E, Crinò SF, Ballarè M, Pallio S, Occhipinti P. Endoscopic ultrasound-guided ethanol ablation of pancreatic neuroendocrine tumours: A case study and literature review. World J Gastrointest Endosc 2016; 8:192-197. [PMID: 26862370 PMCID: PMC4734979 DOI: 10.4253/wjge.v8.i3.192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/08/2015] [Revised: 08/20/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
Here we offer a review of the literature regarding endoscopic ultrasound-guided ethanol ablation for pancreatic neuroendocrine tumours and describe the case of a cystic tumour completely ablated after a multisession procedure. A total of 35 PubMed indexed cases of treated functioning and non-functioning pancreatic neuroendocrine tumours resulted from our search, 29 of which are well-documented and summarised. Endoscopic ultrasound-guided ethanol ablation appears as a local, minimally invasive treatment of pancreatic neuroendocrine tumours, suitable for selected patients. This technique appears feasible, relatively safe and efficient, especially when applied to symptom relief in functioning tumours, aiming at loss of endocrine secretion. For non-functioning tumours, where the goal is complete tissue ablation, eus guided ethanol ablation can provide good results for patients who are unfit for surgery or for those who refuse surgical resection. Its role in “fit for surgery” patients requires assessment through further studies.
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Abstract
This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.
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Affiliation(s)
- Elia Armellini
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Stefano Francesco Crinò
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Marco Orsello
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Marco Ballarè
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Roberto Tari
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Silvia Saettone
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Franco Montino
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
| | - Pietro Occhipinti
- Elia Armellini, Stefano Francesco Crinò, Marco Orsello, Marco Ballarè, Roberto Tari, Silvia Saettone, Franco Montino, Pietro Occhipinti, Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", 28100 Novara, Italy
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Armellini E, Crinò SF, Orsello M, Ballarè M, Tari R, Saettone S, Montino F, Occhipinti P. Novel endoscopic over-the-scope clip system. World J Gastroenterol 2015; 21:13587-13592. [PMID: 26730172 PMCID: PMC4690190 DOI: 10.3748/wjg.v21.i48.13587] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/25/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy’s lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in “difficult” scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.
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24
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Occhipinti P, Saettone S, Cristina S, Ridola L, Hassan C. Correlation between adenoma and serrated lesion detection rates in an unselected outpatient population. Dig Liver Dis 2015; 47:508-11. [PMID: 25659823 DOI: 10.1016/j.dld.2015.01.003] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Serrated lesions have been recently implicated in colorectal carcinogenesis. Adenoma detection rate has been related with the risk of interval cancer. The correlation between adenoma detection rate and the serrated lesion detection rate is unclear. AIM To assess the correlation between adenoma- and serrated lesion-detection rate in an unselected setting of outpatient colonoscopies. METHODS Consecutive outpatients were retrospectively evaluated in one centre. Detection rates were expressed as number of patients with at least one serrated lesion or adenoma. For each endoscopist, correlation between adenoma detection rate and serrated lesions detection rate was calculated. RESULTS Six endoscopists performed 2974 colonoscopies. 3240 lesions (59.5% adenomas, 37.8% serrated lesions, 0.5% cancer, and 2.3% other histology) were detected in 1228 procedures. Median adenoma detection rate and serrated lesions detection rate per endoscopist were 29.3% and 22.4%, respectively. A positive correlation between adenoma and serrated lesion detection rate (r(2)=0.78, p<0.001) was detected. CONCLUSIONS Our study showed a statistically significant correlation between adenoma detection rate and serrated detection rate.
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Affiliation(s)
- Pietro Occhipinti
- Gastroenterology and Endoscopic Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Silvia Saettone
- Gastroenterology and Endoscopic Unit, Maggiore della Carità University Hospital, Novara, Italy.
| | - Silvia Cristina
- Pathology Unit, S.S. Trinità Hospital ASL NO, Borgomanero, Italy
| | - Lorenzo Ridola
- Endoscopic Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Cesare Hassan
- Endoscopic Unit, Nuovo Regina Margherita Hospital, Rome, Italy
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25
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Repici A, Hassan C, Radaelli F, Occhipinti P, De Angelis C, Romeo F, Paggi S, Saettone S, Cisarò F, Spaander M, Sharma P, Kuipers EJ. Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: results from a multicenter, prospective trial. Gastrointest Endosc 2013; 78:106-14. [PMID: 23582472 DOI: 10.1016/j.gie.2013.01.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 10/15/2012] [Accepted: 01/24/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND In vivo prediction of colorectal polyp histology by narrow-band imaging (NBI) could potentially avoid post-polypectomy histologic examination or resection of diminutive lesions, thereby reducing costs and risk. OBJECTIVE To assess whether NBI is able to predict colonoscopy surveillance intervals and histology of distal diminutive polyps according to American Society for Gastrointestinal Endoscopy (ASGE) criteria. DESIGN Prospective, multicenter study. SETTING Five endoscopic centers. PATIENTS Consecutive patients undergoing colonoscopy in 5 centers were included. INTERVENTION Participating endoscopists were required to pass a before-study qualifying examination. Histology of polyps that were <10 mm was predicted at NBI and assigned a designation of high or low confidence. MAIN OUTCOME MEASUREMENTS Accuracy of high-confidence NBI prediction for polyps ≤5 mm in predicting surveillance intervals and negative predictive value (NPV) for adenomatous histology in the rectosigmoid colon were compared with the ASGE thresholds (90% agreement, 90% NPV). RESULTS A total of 278 patients (mean age, 63 years; 58% male) were enrolled. At colonoscopy, 574 (97.3%) polyps <10 mm (429 ≤5 mm, 60% adenomatous) were retrieved for histologic analysis. Sensitivity, specificity, positive and negative predictive values, and accuracy of high confidence-NBI predictions for adenomatous histology in lesions ≤5 mm were 90%, 88%, 89%, 89%, and 89%, respectively. High-confidence characterization of polyps ≤5 mm predicted the correct surveillance interval in 92% to 99% of cases, according to the American and European guidelines. NPV of high-confidence NBI for adenomatous histology for the rectosigmoid colon lesions ≤5 mm was 92%. LIMITATIONS Only experienced endoscopists were included. CONCLUSION High-confidence prediction of histology for polyps ≤5 mm appears to be sufficiently accurate to avoid post-polypectomy histologic examination of the resected lesions as well as to allow rectosigmoid hyperplastic polyps to be left in place without resection. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01675752.).
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26
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Villanacci V, Cristina S, Muscarà M, Saettone S, Broglia L, Antonelli E, Salemme M, Occhipinti P, Bassotti G. Pseudomembranous collagenous colitis with superimposed drug damage. Pathol Res Pract 2013; 209:735-9. [PMID: 24080283 DOI: 10.1016/j.prp.2013.04.016] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/16/2013] [Accepted: 04/26/2013] [Indexed: 02/07/2023]
Abstract
Pseudomembranous collagenous colitis is a rare pathological condition, not related to infectious agents, and characterized by thickening of the subepithelial collagen and formation of pseudomembranes. We report one such case, which responded to budesonide treatment after failures of previous approaches given, being unaware of the correct diagnosis.
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27
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Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, Mangiavillano B, Carlino A, Rossi GB, Occhipinti P, Cennamo V. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. ACTA ACUST UNITED AC 2011; 146:1157-62. [PMID: 22006874 DOI: 10.1001/archsurg.2011.233] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the short- and long-term efficacy of self-expanding metal stents (SEMSs) in patients with colorectal obstruction and incurable cancer and the related factors that affect outcomes. DESIGN Retrospective analysis of SEMS placement for incurable colorectal obstruction in a 3-year period. SETTING Five tertiary care endoscopic centers. PATIENTS AND INTERVENTION Consecutive patients (N = 201) undergoing stenting for incurable malignant obstruction. MAIN OUTCOME MEASUREMENTS Clinical and technical success of stenting, complications rate, and factors affecting outcomes. RESULTS Technical success was achieved in 184 of 201 patients (91.5%) and clinical success occurred in 165 of 184 patients (89.7%; 82.1% of 201 patients). Technical and clinical failures were more frequent in extrinsic and long colorectal stenoses. Overall, 165 patients had normal bowel movements during follow-up (mean [SD], 115.5 [100.3] days; range, 1-500 days), 15 developed complications, 127 had a functioning SEMS at the time of death, and 23 were alive at completion of the study. Twenty-four (11.9%) major complications occurred: 11 migrations, 12 perforations, and 1 reobstruction. Migration of SEMSs was associated with stent diameter less than 25 mm. Bevacizumab therapy increased the risk of perforation by 19.6-fold. Karnofsky performance status of 50 or less was associated with shorter survival and a 3.7-fold higher risk of death within 6 months after the stent was placed. CONCLUSIONS The use of SEMSs is safe and effective for palliation of incurable malignant colonic obstruction; approximately 75% of patients with SEMSs are able to avoid colostomy.
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Affiliation(s)
- Gianpiero Manes
- Department of Gastroenterology, University Hospital L. Sacco, Milano, Italy.
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Marmo R, Rotondano G, Rondonotti E, de Franchis R, D'Incà R, Vettorato MG, Costamagna G, Riccioni ME, Spada C, D'Angella R, Milazzo G, Faraone A, Rizzetto M, Barbon V, Occhipinti P, Saettone S, Iaquinto G, Rossini FP. Capsule enteroscopy vs. other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study. Eur J Gastroenterol Hepatol 2007; 19:535-42. [PMID: 17556898 DOI: 10.1097/meg.0b013e32812144dd] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Capsule enteroscopy is considered the gold standard for evaluating patients with obscure gastrointestinal bleeding. The costs of capsule enteroscopy examination, however, make it uncertain whether the clinically relevant diagnostic gain is also associated with cost savings. AIM To evaluate the incremental cost-effectiveness ratio of capsule enteroscopy in patients with obscure gastrointestinal bleeding. METHODS Retrospective study was carried out in nine Italian gastroenterology units from 2003 to 2005. Data on 369 consecutive patients with obscure gastrointestinal bleeding were collected. The diagnostic yield of capsule enteroscopy vs. other imaging procedures was evaluated as a measure of efficacy. The values of Diagnosis Related Group 175 (euro 1884.00 for obscure-occult bleeding and euro 2141.00 for obscure-overt bleeding) were calculated as measures of economic outcomes in the cost analysis. RESULTS Obscure and occult gastrointestinal bleeding was recorded in 177 patients (48%) with a mean duration of anemia history of 17.6+/-20.7 months. Among patients, 60.9% had had at least one hospital admission, 21.2% at least two, and 1.2% of obscure bleeders up to nine admissions. Overall, 58.4% of patients had positive findings with capsule enteroscopy compared with 28.0% with other imaging procedures (P<0.001). The mean cost of a positive diagnosis with capsule enteroscopy was euro 2090.76 and that of other procedures was euro 3828.83 with a mean cost saving of euro 1738.07 (P<0.001) for one positive diagnosis. CONCLUSIONS Capsule enteroscopy is a cost-saving approach in the evaluation of patients with obscure gastrointestinal bleeding.
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Affiliation(s)
- Riccardo Marmo
- Division of Gastroenterology, L.Curto Hospital, Polla, Sant'Arsenio, Italy.
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Ruzza M, Andorno S, Ballarè M, Brondolo R, Cusumano S, D'Andrea F, La Terra G, Occhipinti P, Picchini G, Sartori M. [A sustained response in chronic hepatitis C treated with interferon]. Recenti Prog Med 1994; 85:433-7. [PMID: 7938875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We analyzed 27 subjects with long-term response, from a group of 110 interferon treated patients with biopsy-proven chronic hepatitis and serum anti-HCV antibodies. The following variables were assessed as potential predictors: sex, age, ALT level before the therapy was started, liver structure, type of interferon, total amount of interferon. Total amount of administered interferon statistically correlated with long-term response by univariate analysis. Nevertheless upon stepwise logistic multivariate analysis none of them was independently predictive of long-term response. Additional studies would be needed in order to develop a model capable of predicting from pre-treatment features which patients are likely to have long-term response.
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Affiliation(s)
- M Ruzza
- Clinica Medica Generale, Dipartimento di Scienze Biomediche ed Oncologia Umana, Università, Novara
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30
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Affiliation(s)
- M Del Piano
- Gastrointestinal Endoscopy Unit, Ospedale Maggiore di Novara, Italy
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31
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Del Piano M, Manfredda I, Montino F, Occhipinti P. [Comparison of 3 methods of preparation for colonoscopy]. MINERVA GASTROENTERO 1993; 39:89-92. [PMID: 8364106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We compared three cleansing methods of preparation for colonoscopy in 150 patients: the first containing a mixture of cathartics, especially sennosides: the second containing polyethyleneglycol: the third containing a mixture of monosodic monohydrated and bisodic heptahydrated phosphate. We evaluated the tolerability, the compliance and the side effects of the preparations. Regarding the evaluated parameters, it was found that the mixture of monosodic and bisodic heptahydrated phosphate was more valid than the other preparations.
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Affiliation(s)
- M Del Piano
- II Divisione di Medicina Generale, Ospedale Maggiore della Carità di Novara
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32
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33
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Boccardi A, Spalluto F, Del Piano M, Occhipinti P, Montino F, Bergamaschi V. [A gastric leiomyoma of conspicuous size. A case report]. Minerva Dietol Gastroenterol 1990; 36:119-21. [PMID: 2247259] [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: 12/31/2022]
Abstract
The authors describe a large gastric leiomyoma with prevailing subserous growth. Conventional X-ray examination and endoscopy failed to diagnose the lesion properly. On the contrary, with CT it was possible to hypothesize the existence of leiomyoma with the correct definition of the outline of the lesion.
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Affiliation(s)
- A Boccardi
- Servizio di Radiodiagnostica, Ospedale Maggiore della Carità, Novara
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34
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Brunero M, Graziano L, Di Mattia O, Arceci F, Occhipinti P. [Neoplasms of the duodenum. A description of 2 clinical cases]. MINERVA CHIR 1989; 44:1385-8. [PMID: 2761741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Duodenal tumours are a rare pathology, hard to diagnose early because of the unsubstantial symptomatology even though, in recent years, with the advent of improved techniques, a larger number have found their way into the literature. Two cases of duodenal cancer, one an adenocarcinoma localised in the first portion of the duodenum and one a subpapillary leiomyosarcoma are reported. 2 and 5 years respectively after the operation, both patients are in good health and do not present signs of disease.
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35
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Cardano S, D'Andrea F, Occhipinti P. [A case of fibro-lamellar carcinoma of the liver]. G Clin Med 1988; 69:439-41. [PMID: 2854085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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36
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Del Piano M, Montino F, Occhipinti P, Rossi F, Maffei S, Rudoni M. [Scintigraphy using labelled sucralfate in the diagnosis of chronic idiopathic inflammatory diseases of the intestine]. Ann Ital Med Int 1988; 3:126-31. [PMID: 3152843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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37
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Campanini M, Saglietti G, Zaccala G, Occhipinti P, Cardano S, Monteverde A. [Behavior of thyroid hormones in chronic hepatopathies]. Recenti Prog Med 1986; 77:405-10. [PMID: 3797791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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