1
|
Milluzzo SM, Landi R, Perri V, Familiari P, Boškoski I, Pafundi PC, Farina A, Ricci R, Spada C, Costamagna G, Tringali A. Diagnostic accuracy and interobserver agreement of cholangioscopy for indeterminate biliary strictures: A single-center experience. Dig Liver Dis 2024; 56:847-852. [PMID: 38016895 DOI: 10.1016/j.dld.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND STUDY AIMS Characterization of indeterminate biliary strictures (IDBS) still represents a major challenge. Digital single-operator cholangioscopy (DSOC) could potentially overcome limits of conventional biopsy and brush sampling. The aim of this study was to compare diagnostic accuracy of visual evaluation and DSOC-guided biopsies to conventional trans-papillary sampling techniques and to evaluate the inter-observer agreement (IOA) on visual diagnosis. PATIENTS AND METHODS All consecutive patients undergoing DSOC-guided biopsy after conventional sampling techniques for IDBS during a six-year period were retrospectively evaluated. Final diagnosis was based on histological evaluation of the surgical specimen if available or a clinical follow-up of at least 6 months. For IOA, 20-second DSOC clips were retrospectively reviewed by 6 experts and 6 trainees and classified according to the Monaco Classification. RESULTS Thirty-five patients underwent DSOC for IDBS in the study period; 14 patients (F = 9) with a median age of 64 years (range 53-76) met the study aim. After DSOC, strictures location was changed in three patients (additional yield of 21.4 %). Intraductal DSOC-guided biopsy were technically successful in all cases, with an adequacy of 92.8 %. No adverse events were recorded. Final diagnosis was benign disease in five cases and cholangiocarcinoma in the others. For IOA, 29 videos were evaluated with almost perfect agreement for final diagnosis (kappa 0.871; agreement 93.1, p <0.001), although overall accuracy of DSOC visual finding was 73.6 % and 64.4 % for experts and trainees, respectively. CONCLUSIONS DSOC could improve diagnostic accuracy for IDBS, since it showed high sensitivity for visual finding and high specificity for DSOC guided-biopsy. Visual diagnosis seems reliable for diagnosis using the Monaco Classification.
Collapse
Affiliation(s)
| | - Rosario Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy.
| | - Vincenzo Perri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Pietro Familiari
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Ivo Boškoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Pia Clara Pafundi
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annarita Farina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy
| | - Riccardo Ricci
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Anatomia Patologica, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Department of Pathology, Roma, Lazio, Italy
| | - Cristiano Spada
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| |
Collapse
|
2
|
Schepis T, Pafundi PC, Tringali A, Carcagnì A, Familiari P, Landi R, Boskoski I, Perri V, Spada C, Costamagna G. Endoscopic minor papilla sphincterotomy in patients with complete pancreas divisum and acute recurrent pancreatitis: a metanalysis. Scand J Gastroenterol 2024; 59:225-231. [PMID: 37795553 DOI: 10.1080/00365521.2023.2266079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS Pancreas divisum (PD) is a congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic minor papilla sphincterotomy (MiES) is the most common procedure performed in the management of PD-related ARP. The aim of this study is to perform a meta-analysis estimating the efficacy and the safety of MiES in the management of patients with PD-related ARP. METHODS A research was performed in Pubmed, EMBASE and Web of science, the studies were reviewed and selected according to inclusion and exclusion criteria. Evaluation of Heterogeneity and publication bias was performed, and a random effect model was used to estimate the effect size of each study. RESULTS One hundred and thirteen articles were selected and reviewed, 13 met the inclusion criteria. All the studies were retrospective with a mean follow-up duration of 45.9 months. A total of 323 patients with PD-related ARP treated with MiES were included in the meta-analysis. The overall clinical success rate of MiES (defined as no further episodes of ARP, reduction of episodes of ARP, or improvement in quality of life) was of 77% (95%CI: 72%-81%; p = 0.30). Evaluating only the studies with clinical success rate defined as "no further AP in the follow-up" the clinical success rate was of 69.8% (95%CI: 61.3%-77.2%; p = 0.57), while evaluating the studies with other definitions (reduction of episodes of ARP or improvement in quality of life) the clinical success rate was of 81.2% (95%CI: 75.2%-86.1%; p = 0.45). The common fixed effects model disclosed a 25.5% overall adverse events rate (95%CI: 19.3%-32.8%; p = 0.42): acute pancreatitis in 14.3% (95%CI: 9.7%-20.6%; p = 0.36), bleeding in 5.6% (95%CI: 2.9%-10.4%; p = 0.98), and other adverse events in 5.6% (95%CI: 2.9%-10.4%; p = 0.67). CONCLUSION MiES is an effective and relatively safe treatment in the management of PD-related ARP. The retrospective nature of the studies selected is the main limitations of this metanalysis. Prospective trials are needed to confirm these data.
Collapse
Affiliation(s)
- T Schepis
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - P C Pafundi
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Carcagnì
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
3
|
Familiari P, Borrelli de Andreis F, Landi R, Mangiola F, Boskoski I, Tringali A, Perri V, Costamagna G. Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority randomised controlled trial. Gut 2023:gutjnl-2021-325579. [PMID: 37072180 DOI: 10.1136/gutjnl-2021-325579] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Peroral endoscopic myotomy (POEM) has become standard treatment for achalasia with comparable efficacy to surgery. In most of published series, the length of myotomy is 12-13 cm. Shorter cuts could have the advantage of shorter procedure time and possibly reduced gastro-oesophageal reflux disease (GORD) rate. DESIGN This single-centre, patient-blinded, randomised, non-inferiority clinical trial included 200 patients, who were randomly allocated, to receive either a long-POEM (13 cm; 101 patients) or a short-POEM (8 cm; 99 patients). Primary outcome was defined as an Eckardt symptom score of ≤3 at 24 months after the procedure; a non-inferiority design was chosen with an accepted success range of 6% between the two treatments. Secondary outcomes included operating time, complication rate, postoperative manometry, GORD rate and quality of life. RESULTS In the intention-to-treat analysis, clinical success rates were 89.1% in the long-POEM and 98.0% in the short-POEM group, resulting in an absolute between-group difference of -8.9% (90% CI -14.5 to -3.3).Procedure time was significantly reduced in the short-POEM as compared with the long-POEM group (40 vs 50 min, p<0.0001). Severe adverse events occurred in one patient in both groups.No differences were observed in postoperative GORD: acid exposure >6% on pH monitoring study at 6 months was seen in 34.3% (long-POEM) vs 31.1% (short-POEM), while endoscopic oesophagitis was diagnosed in 37.6% vs 51.5% at 6 months and in 21% vs 24.5% at 24 months. Regular proton pump inhibitor use was not different either (36.8% vs 37.5%). CONCLUSIONS Our study demonstrates non-inferiority of a shorter cut length of POEM as compared with the standard treatment, which saved some procedural time. GORD rate was not reduced by reducing cutting length. TRIAL REGISTRATION NUMBER NCT03450928.
Collapse
Affiliation(s)
- Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Federica Borrelli de Andreis
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
| | - Francesca Mangiola
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| |
Collapse
|
4
|
Buscemi P, Velpini B, Cosma C, Milani C, Landi R, Innocenti M, Baggiani L, Nerattini M, Lorini C, Bonaccorsi G. USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic. Eur J Public Health 2022. [PMCID: PMC9594657 DOI: 10.1093/eurpub/ckac131.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves. Methods This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed. Results Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period. Conclusions The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs. Key messages • The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic. • The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.
Collapse
Affiliation(s)
- P Buscemi
- School of Hygiene and Preventive Medicine, University of Florence , Florence, Italy
| | - B Velpini
- School of Hygiene and Preventive Medicine, University of Florence , Florence, Italy
| | - C Cosma
- School of Hygiene and Preventive Medicine, University of Florence , Florence, Italy
| | - C Milani
- Department of Health Sciences, University of Florence , Florence, Italy
| | - R Landi
- Azienda USL Toscana Centro , Florence, Italy
| | - M Innocenti
- Department of District Healthcare Network, Azienda USL Toscana Centro , Florence, Italy
| | - L Baggiani
- Department of District Healthcare Network, Azienda USL Toscana Centro , Florence, Italy
| | - M Nerattini
- Florence Local Health District, Società della Salute di Firenze , Florence, Italy
| | - C Lorini
- Department of Health Sciences, University of Florence , Florence, Italy
| | - G Bonaccorsi
- Department of Health Sciences, University of Florence , Florence, Italy
| |
Collapse
|
5
|
AbiMansour JP, Ichkhanian Y, Minami H, Familiari P, Landi R, Costamagna G, Seewald S, Callahan ZM, Ujiki MB, Pioche M, Ponchon T, Roman S, Cho JY, Yoo IK, Sippey M, Marks JM, Eleftheriadis N, Khumbari V, Gutierrez OIB, Khashab MA. Durability of per-oral endoscopic myotomy beyond 6 years. Endosc Int Open 2021; 9:E1595-E1601. [PMID: 34790520 PMCID: PMC8589554 DOI: 10.1055/a-1553-9846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia. Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated. Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years ( P < 0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5 %). Type I achalasia (OR 10.8, P = 0.04) was found to be associated with clinical failure on logistic regression analysis. Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastroesophageal reflux post-procedure which persist at long-term follow-up.
Collapse
Affiliation(s)
- Jad P. AbiMansour
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology Nagasaki University Hospital Nagasaki, Japan
| | - Pietro Familiari
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Stefan Seewald
- Center of Gastroenterology Hirslanden Private Clinic Group Zürich, Switzerland
| | | | - Michael B. Ujiki
- Department of Surgery NorthShore University HealthSystem Evanston, USA
| | - Mathieu Pioche
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Thierry Ponchon
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Sabine Roman
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Megan Sippey
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Jeffrey M. Marks
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | - Vivek Khumbari
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | | | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| |
Collapse
|
6
|
Soddu D, Sola D, Bellan M, Boin E, Cittone MG, Zecca E, Matino E, Pedrazzoli R, Rizzi E, Pedrinelli AR, Tonello S, Vassia V, Landi R, Pirisi M, Sainaghi PP. Red cell distribution width is a potential predictor of early relapse in polymyalgia rheumatica. Reumatismo 2021; 73:117-121. [PMID: 34342213 DOI: 10.4081/reumatismo.2021.1395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Red blood cell distribution width (RDW) has been studied as a prognostic biomarker for different chronic inflammatory diseases. In this paper we aim to evaluate its potential role in the prediction of early relapse in patients affected by polymyalgia rheumatica (PMR). We revised retrospectively clinical records of patients who received a diagnosis of PMR, according to 2012 ACR/EULAR classification criteria, for whom baseline clinical and laboratory data were available. The baseline RDW variation coefficient was correlated to the risk of relapse, in the first 6 months of the disease. We identified 44 patients [females 15 (34.0%)/males 29 (66.0%); median age 80 (72-83)], 9 of whom had an early relapse. These patients showed a larger median RDW than patients who did not relapse [13.7 (13.5-14.9)% vs 13.5 (12.7-14.2)%; p=0.04). The two groups were comparable for all the other clinical and laboratory parameters considered. Interestingly, patients in the higher half of the RDW distribution showed a shorter relapse-free survival (p<0.03). In a stepwise logistic regression, RDW (p=0.01) predicted the risk of relapse at 6 months, while age, gender, CRP, ESR, Hb, MCV and prednisone dose did not fit the model. Our results show that RDW is an independent biomarker of early relapse, making this parameter a potentially promising predictive marker in PMR.
Collapse
Affiliation(s)
- D Soddu
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - D Sola
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - M Bellan
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - E Boin
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - M G Cittone
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Zecca
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - E Matino
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Pedrazzoli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Rizzi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - A R Pedrinelli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - S Tonello
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - V Vassia
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Landi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - M Pirisi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - P P Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| |
Collapse
|
7
|
Boškoski I, Schepis T, Tringali A, Familiari P, Bove V, Attili F, Landi R, Perri V, Costamagna G. Personalized Endoscopy in Complex Malignant Hilar Biliary Strictures. J Pers Med 2021; 11:jpm11020078. [PMID: 33572913 PMCID: PMC7911877 DOI: 10.3390/jpm11020078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant hilar biliary obstruction (HBO) represents a complex clinical condition in terms of diagnosis, surgical and medical treatment, endoscopic approach, and palliation. The main etiology of malignant HBO is hilar cholangiocarcinoma that is considered an aggressive biliary tract's cancer and has still today a poor prognosis. Endoscopy plays a crucial role in malignant HBO from the diagnosis to the palliation. This technique allows the collection of cytological or histological samples, direct visualization of the suspect malignant tissue, and an echoendoscopic evaluation of the primary tumor and its locoregional staging. Because obstructive jaundice is the most common clinical presentation of malignant HBO, endoscopic biliary drainage, when indicated, is the preferred treatment over the percutaneous approach. Several endoscopic techniques are today available for both the diagnosis and the treatment of biliary obstruction. The choice among them can differ for each clinical scenario. In fact, a personalized endoscopic approach is mandatory in order to perform the proper procedure in the singular patient.
Collapse
Affiliation(s)
- Ivo Boškoski
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Tommaso Schepis
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Tringali
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Pietro Familiari
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
| | - Vincenzo Bove
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
| | - Fabia Attili
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
| | - Rosario Landi
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
| | - Vincenzo Perri
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
| | - Guido Costamagna
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, 20123 Rome, Italy; (T.S.); (A.T.); (P.F.); (V.B.); (F.A.); (R.L.); (V.P.); (G.C.)
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| |
Collapse
|
8
|
Familiari P, Landi R, Mangiola F, Vita C, Boskoski I, Tringali A, Costamagna G. Endoscopic treatment of intramural fistula and mucosal tear after peroral endoscopic myotomy. Endoscopy 2021; 53:E25-E26. [PMID: 32483783 DOI: 10.1055/a-1173-7623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Pietro Familiari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, CERTT, Centre for Endoscopic Research, Therapeutics and Training, Rome, Italy
| | - Rosario Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
| | - Francesca Mangiola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
| | - Camilla Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
| | - Ivo Boskoski
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, CERTT, Centre for Endoscopic Research, Therapeutics and Training, Rome, Italy.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg Cedex, France
| | - Andrea Tringali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, CERTT, Centre for Endoscopic Research, Therapeutics and Training, Rome, Italy.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg Cedex, France
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, CERTT, Centre for Endoscopic Research, Therapeutics and Training, Rome, Italy.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg Cedex, France
| |
Collapse
|
9
|
Bellan M, Parisi S, Stobbione P, Pedrinelli AR, Rizzi E, Casciaro GF, Vassia V, Landi R, Cittone MG, Rigamonti C, Patrucco F, Ditto MC, Finucci A, Realmuto C, Todoerti M, Parodi M, Rossi P, Pirisi M, Fusaro E, Sainaghi PP. Impact of the COVID-19 outbreak on an Italian cohort of systemic sclerosis patients. Scand J Rheumatol 2020; 49:505-506. [PMID: 32856492 DOI: 10.1080/03009742.2020.1800083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Bellan
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,CAAD, Centre for Autoimmune and Allergic Diseases , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - S Parisi
- Rheumatology Unit, AOU City of Health and Science University Hospital of Turin , Turn, Italy
| | - P Stobbione
- Rheumatology Unit, SS Antonio e Biagio and Cesare Arrigo Hospital , Alessandria, Italy
| | - A R Pedrinelli
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - E Rizzi
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - G F Casciaro
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - V Vassia
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - R Landi
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - M G Cittone
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - C Rigamonti
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - F Patrucco
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy
| | - M C Ditto
- Rheumatology Unit, AOU City of Health and Science University Hospital of Turin , Turn, Italy
| | - A Finucci
- Rheumatology Unit, AOU City of Health and Science University Hospital of Turin , Turn, Italy
| | - C Realmuto
- Rheumatology Unit, AOU City of Health and Science University Hospital of Turin , Turn, Italy
| | - M Todoerti
- Rheumatology Unit, SS Antonio e Biagio and Cesare Arrigo Hospital , Alessandria, Italy
| | - M Parodi
- Rheumatology Unit, SS Antonio e Biagio and Cesare Arrigo Hospital , Alessandria, Italy
| | - P Rossi
- Rheumatology Unit, SS Antonio e Biagio and Cesare Arrigo Hospital , Alessandria, Italy
| | - M Pirisi
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,CAAD, Centre for Autoimmune and Allergic Diseases , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| | - E Fusaro
- Rheumatology Unit, AOU City of Health and Science University Hospital of Turin , Turn, Italy
| | - P P Sainaghi
- Department of Translational Medicine, University of Eastern Piedmont UPO , Novara, Italy.,CAAD, Centre for Autoimmune and Allergic Diseases , Novara, Italy.,Internal Medicine Division and Rheumatology Unit, AOU University Hospital Maggiore della Carita , Novara, Italy
| |
Collapse
|
10
|
Bove V, Schepis T, Boškoski I, Landi R, Orlandini B, Pontecorvi V, Familiari P, Tringali A, Perri V, Costamagna G. Bilio-pancreatic endoscopy during COVID-19 pandemic. Therap Adv Gastroenterol 2020; 13:1756284820935187. [PMID: 32636930 PMCID: PMC7315654 DOI: 10.1177/1756284820935187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023] Open
Abstract
On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan (Hubei Province of China). In January 2020, a new coronavirus named SARS-CoV2 was isolated and, since that time, SARS-CoV2 related disease (COVID-19) rapidly spread all over the world becoming pandemic in March 2020. The COVID-19 outbreak dramatically affected the public-health and the health-care facilities organization. Bilio-pancreatic endoscopy is considered a high-risk procedure for cross-contamination and, even though it is not directly involved in COVID-19 diagnosis and management, its reorganization is crucial to guarantee high standards of care minimizing the risk of SARS-CoV2 transmission among patients and health-care providers. Bilio-pancreatic endoscopic procedures often require a short physical distance between the endoscopist and the patient for a long period of time, a frequent exchange of devices, the involvement of a large number of personnel, the use of complex endoscopes difficult to reprocess. On this basis, endoscopic units should take precautions with adjusted management of bilio-pancreatic endoscopy. The aim of this article is to discuss the approach to bilio-pancreatic endoscopy in the COVID-19 era with focus on diagnostic algorithms, indications, management of the endoscopic room, proper use of Personal Protective Equipment and correct reprocessing of instrumentation.
Collapse
Affiliation(s)
- Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Largo A. Gemelli, 8, Rome, 00168, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Tommaso Schepis
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Beatrice Orlandini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| |
Collapse
|
11
|
Brewer Gutierrez OI, Moran RA, Familiari P, Dbouk MH, Costamagna G, Ichkhanian Y, Seewald S, Bapaye A, Cho JY, Barret M, Eleftheriadis N, Pioche M, Hayee BH, Tantau M, Ujiki M, Landi R, Invernizzi M, Yoo IK, Roman S, Haji A, Hedberg HM, Parsa N, Mion F, Fayad L, Kumbhari V, Agarwalla A, Ngamruengphong S, Sanaei O, Ponchon T, Khashab MA. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study. Endosc Int Open 2020; 8:E650-E655. [PMID: 32355884 PMCID: PMC7165007 DOI: 10.1055/a-1120-8125] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9-60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.
Collapse
Affiliation(s)
| | - Robert A. Moran
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Pietro Familiari
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Mohamad H. Dbouk
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Guido Costamagna
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Yervant Ichkhanian
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Stefan Seewald
- Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
| | - Amol Bapaye
- Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Joo Young Cho
- Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
| | | | | | - Mathieu Pioche
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Bu' Hussain Hayee
- Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
| | - Marcel Tantau
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Ujiki
- NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
| | - Rosario Landi
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Martina Invernizzi
- Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
| | - In Kyung Yoo
- Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
| | - Sabine Roman
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Amyn Haji
- Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
| | - H. Mason Hedberg
- NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
| | - Nasim Parsa
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Francois Mion
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Lea Fayad
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Vivek Kumbhari
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Anant Agarwalla
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Saowanee Ngamruengphong
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Omid Sanaei
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Thierry Ponchon
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Mouen A. Khashab
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| |
Collapse
|
12
|
Costantini A, Familiari P, Costantini M, Salvador R, Valmasoni M, Capovilla G, Landi R, Mangiola F, Provenzano L, Briscolini D, Merigliano S, Costamagna G. Poem Versus Laparoscopic Heller Myotomy in the Treatment of Esophageal Achalasia: A Case-Control Study from Two High Volume Centers Using the Propensity Score. J Gastrointest Surg 2020; 24:505-515. [PMID: 31848870 DOI: 10.1007/s11605-019-04465-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 05/24/2019] [Accepted: 11/04/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND POEM has recently had a widespread diffusion, aiming at being the treatment of choice for esophageal achalasia. The results of ongoing RCTs against laparoscopic myotomy are not available, yet. We, therefore, designed this propensity score (PS) case-control study with the aim of evaluating how POEM compares to the long-standing laparoscopic Heller myotomy + Dor fundoplication (LHD) and verifying if it may really replace the latter as the first-line treatment for achalasia. METHODS Two groups of consecutive patients undergoing treatment for primary achalasia from January 2014 to November 2017 were recruited in two high-volume centers, one with extensive experience with POEM and one with LHD. Patients with previous endoscopic treatment were included, whereas patients with previous LHD or POEM were excluded. A total of 140 patients in both centers were thus matched. LHD and POEM were performed following established techniques. The patients were followed with clinical (Eckardt score), endoscopic, and pH-manometry evaluations. RESULTS The procedure was successfully completed in all the patients. POEM required a shorter operation time and postoperative stay compared to LHD (p < 0.001). No mortality was recorded in either group. Seven complications were recorded in the POEM group (five mucosal perforations) and 3 in the LHD group (3 mucosal perforations)(p = 0.33). Two patients in the POEM group and one in the LHD were lost to follow-up. One patient in both groups died during the follow-up for unrelated causes. At a median follow-up of 24 months [15-30] for POEM and 31 months [15-41] for LHD (p < 0.05), 99.3% of the POEM patients and 97.7% of the LHD patients showed an Eckardt score ≤ 3 (p < 0.12). Four years after the treatment, the probability to have symptoms adequately controlled was > 90% for both groups (p = 0.2, Log-rank test). HR-Manometry showed a similar reduction in the LES pressure and 4sIRP; 24-h pH-monitoring showed however an abnormal exposure to acid in 38.4% of POEM patients, as compared to 17.1% of LHD patients (p < 0.01) and esophagitis was found in 37.4% of the POEM and 15.2% of LHD patients (p < 0.05). CONCLUSION POEM provides the same midterm results as LHD. This study confirms, however, a higher incidence of postoperative GERD with the former, even if its real significance needs to be further evaluated.
Collapse
Affiliation(s)
- Andrea Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Center for Endoscopic Research, Therapeutics and Training (CERTT), Rome, 00168, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Center for Endoscopic Research, Therapeutics and Training (CERTT), Rome, 00168, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy.
| | - Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Center for Endoscopic Research, Therapeutics and Training (CERTT), Rome, 00168, Italy
| | - Francesca Mangiola
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Center for Endoscopic Research, Therapeutics and Training (CERTT), Rome, 00168, Italy
| | - Luca Provenzano
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Dario Briscolini
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica 3, Università di Padova, 35128, Padova, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Center for Endoscopic Research, Therapeutics and Training (CERTT), Rome, 00168, Italy
| |
Collapse
|
13
|
Tringali A, Massinha P, Schepis T, Landi R, Boškoski I, Perri V, Bove V, Costamagna G. Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. Gastrointest Endosc 2020; 91:584-592. [PMID: 31629720 DOI: 10.1016/j.gie.2019.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. METHODS Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. RESULTS Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. CONCLUSIONS An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.
Collapse
Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paulo Massinha
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy; Gastroenterology Department, Garcia de Orta Hospital, E.P.E, Almada, Portugal
| | - Tommaso Schepis
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
14
|
Costamagna G, Tringali A, Perri V, Familiari P, Boškoski I, Barbaro F, Landi R. Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents: long-term results in a large cohort of patients. Gastrointest Endosc 2020; 91:81-89. [PMID: 31175873 DOI: 10.1016/j.gie.2019.05.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic therapy of benign biliary strictures with multiple plastic stent (MPS) placement has shown satisfactory results. However, the literature describes various benign biliary stricture etiologies. The aim of this study was to evaluate long-term MPS results in patients with postcholecystectomy biliary strictures (PCBSs). METHODS PCBS patients without complete bile duct transection were included. ERCP consisted of placing an increasing plastic stent number over time, exchanged at regular intervals (3-4 months), until complete morphologic stricture disappearance. After stent removal, patient follow-up comprised liver function tests and clinical assessment. RESULTS One hundred fifty-four patients (43.5% men; mean age, 53 years) were enrolled; in 43% of the cases, PCBSs were involved or were close to the main hepatic confluence. PCBS resolution rate was 96.7% (n = 149). A mean maximum number of 4.3 ± 1.6 stents were placed side-by-side; a mean of 4.2 ± 1.5 ERCPs per patient was needed to obtain PCBS resolution during a mean treatment period of 11.8 ± 6.4 months. Unscheduled stent exchange because of cholangitis, jaundice, or pain occurred in 7.4% of cases. Procedure-related mortality was absent. Follow-up data were available in 85.2% of cases. After a mean follow-up of 11.1 ± 4.9 years, stricture recurrence rate was 9.4% (n = 12). Subsequent to retreatment, 83.3% of patients (n = 10) were asymptomatic after a mean time of 9 years, whereas 2 patients underwent hepaticojejunostomy because of failed retreatment. Statistical analysis revealed no risk factors for PCBS recurrence after MPS. CONCLUSIONS Endoscopic therapy of PCBSs with MPSs is safe and effective at long-term follow-up. PCBSs involving or close to the main hepatic confluence were successfully treated with MPSs. PCBS recurrence rate is low and can be successful endoscopically retreated without precluding possible surgical treatment.
Collapse
Affiliation(s)
- Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Andrea Tringali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Vincenzo Perri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Pietro Familiari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Ivo Boškoski
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Federico Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| | - Rosario Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia. Digestive Endoscopy Unit; Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training-CERTT
| |
Collapse
|
15
|
Familiari P, Mangiola F, Landi R, Costamagna G. Endoscopic treatment of GERD: is there still a chance? Endosc Int Open 2019; 7:E1701-E1703. [PMID: 31803821 PMCID: PMC6887643 DOI: 10.1055/a-1012-1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy,Corresponding author Dr. Pietro Familiari Digestive Endoscopy UnitFondazione Policlinico Universitario A. Gemelli IRCCSLargo Gemelli 800168 RomeItaly+390630156581
| | - Francesca Mangiola
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
16
|
Boškoski I, Tringali A, Familiari P, Bove V, Landi R, Attili F, Perri V, Onder G, Mutignani M, Costamagna G. A 17 years retrospective study on multiple metal stents for complex malignant hilar biliary strictures: Survival, stents patency and outcomes of re-interventions for occluded metal stents. Dig Liver Dis 2019; 51:1287-1293. [PMID: 31036471 DOI: 10.1016/j.dld.2019.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/16/2019] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic placement of SEMSs for malignant hilar biliary strictures (MHBS) is well-established palliative treatment for inoperable patients. Objectives of this study were evaluation of survival and stents patency after placement of multiple SEMS for palliation of complex MHBS. METHODS Retrospective review of patients with MHBS that underwent ERCP with insertion of multiple SEMSs for palliation. Survival-associated factors and stents patency were analyzed by Cox multivariate analysis. RESULTS Between January 1998 and January 2015, 740 patients with nonoperable MHBS that underwent ERCP were identified and only 18.2% of these received multiple SEMSs. Complications were observed in 7.5% of the patients with no procedure-related mortality. Palliative therapies (chemotherapy, external beam radiotherapy and high dose rate brachytherapy) were done in some patients, and outcomes were evaluated. Overall mean survival of the 134 patients was 323 days. Of these, 59% did not had stents malfunction while 41% patients had episodes of SEMSs malfunction and mean survival after re-interventions was 502.9 days. Survival was not influenced by type of tumor, sex or age. CONCLUSIONS Endoscopic multiple SEMSs placement is safe and effective in patients with complex MHBS. Survival is independent from the type and complexity of MHBS while is prolonged in patients undergoing HDR brachytherapy. Prompt recognition of SEMSs malfunction is fundamental for survival.
Collapse
Affiliation(s)
- Ivo Boškoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy.
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Pietro Familiari
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Vincenzo Bove
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Rosario Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Fabia Attili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Vincenzo Perri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
| | | | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy; Catholic University, Centre for Endoscopic Research therapeutics and Training (CERTT), Rome, Italy
| |
Collapse
|
17
|
Tringali A, Voiosu T, Schepis T, Landi R, Perri V, Bove V, Voiosu AM, Costamagna G. Pancreas divisum and recurrent pancreatitis: long-term results of minor papilla sphincterotomy. Scand J Gastroenterol 2019; 54:359-364. [PMID: 30880501 DOI: 10.1080/00365521.2019.1584640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Pancreas divisum (PD) is the most common congenital variant of the pancreatic ductal system and a potential cause of acute recurrent pancreatitis (ARP). Endoscopic therapy is a therapeutic option for symptomatic PD, but there is limited data on long-term results. We aimed to assess the effect of minor papilla endoscopic sphincterotomy (MiES) in the setting of ARP in patients with PD. Methods: Consecutive patients treated by MiES were included. Clinical data, including gender, age, smoking and drinking habits, number of episodes of acute pancreatitis (AP) as well as technical data pertaining to the endoscopic therapy were reviewed. Patients available for follow-up were contacted to assess the long-term impact of MiES using the Patient's Global Impression of Change (PGIC) questionnaire. Results: A total of 138 patients with PD including 77 patients with ARP underwent MiES; 48 patients were available for long-term follow-up using the PGIC score, with a mean follow-up period of 9.7 years. Procedure-related adverse events developed in 10 cases (12.9%): 5 post-MiES delayed bleeding and 5 mild pancreatitis. MiES was clinically successful in 35 patients (72.9%) who did not experience any more episodes of AP. Improvement in quality of life (PGIC ≥6) occurred in 41/48 patients (85.4%). On multivariate analysis, stenosis of the MiES was the only predictive factor for increased risk of recurrent pancreatitis after initial therapy. Conclusion: MiES resulted an efficient treatment for ARP in patients with PD with clinical benefit, patient satisfaction and improved quality of life even at long-term follow-up.
Collapse
Affiliation(s)
- Andrea Tringali
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Theodor Voiosu
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,c Gastroenterology Department , Colentina Clinical Hospital , Bucharest , Romania.,d Carol Davila School of Medicine, Internal medicine , Bucharest , Romania
| | - Tommaso Schepis
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy
| | - Rosario Landi
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Vincenzo Perri
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Vincenzo Bove
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy
| | - Andrei Mihai Voiosu
- c Gastroenterology Department , Colentina Clinical Hospital , Bucharest , Romania
| | - Guido Costamagna
- a Digestive Endoscopy Unit, Policlinico Agostino Gemelli Foundation IRCCS , Rome , Italy.,b Centre for Endoscopic Research Therapeutics and Training - CERTT, Catholic University of the Sacred Heart , Rome , Italy.,e Chair of Digestive Endoscopy, IHU-USIAS , University of Strasbourg , Strasbourg , France
| |
Collapse
|
18
|
Tringali A, Vadalà di Prampero SF, Landi R, Bove V, Familiari P, Hamanaka J, Attili F, Costamagna G. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc 2018; 88:939-946. [PMID: 30142349 DOI: 10.1016/j.gie.2018.08.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/01/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Symptomatic main pancreatic duct (MPD) strictures secondary to chronic pancreatitis (CP) may benefit from endoscopic insertion of single or multiple plastic stents. MPD stricture resolution after single plastic stent removal is uncommon. The use of removable fully covered, self-expandable metal stents (FC-SEMSs) to dilate MPD strictures secondary to CP was evaluated. METHODS Patients with CP and symptomatic MPD stricture located in the head of the pancreas persisting for 3 months or more after placement of a single plastic stent were enrolled in a prospective single-arm trial. A nitinol FC-SEMS was inserted and removed after 6 months. The FC-SEMS diameter and length were chosen according to the stricture anatomy and MPD diameter above the stricture. Our primary objective was FC-SEMS removability. Secondary outcomes were MPD stricture resolution rate and adverse events. RESULTS Between December 2012 and October 2014, 15 patients (10 male, mean age 60 years) were enrolled. Pancreatic calcifications were present in 6 (40%) patients. Four patients (27%) had a history of alcohol abuse. In 10 patients, the FC-SEMS was inserted through the major papilla, whereas 5 patients (3 pancreas divisum, 2 dominant dorsal duct) received the stent through the minor papilla. One patient developed cholangitis after 24 hours due to occlusion of the biliary sphincterotomy from the FC-SEMS; cholangitis resolved after insertion of a plastic biliary stent. Complete distal migration of the FC-SEMS was reported in 7 patients (47%) (5 asymptomatic, 2 symptomatic with recurrence of pancreatitis). All migrations occurred with the 3-cm-long FC-SEMS. Four patients (27%) developed de novo stricture induced by the FC-SEMS at the level of the flared end and were excluded from the follow-up; 1 patient with FC-SEMS migration had failed stricture resolution. One patient was lost to follow-up. Finally, 9 patients with MPD stricture resolution had a mean follow-up of 38.9 months (range, 5.3-55.3 months), and 89% were asymptomatic. CONCLUSIONS FC-SEMS removability from the MPD in CP was feasible in all cases, and 90% of the patients were asymptomatic after 3 years. Migration seems more frequent with the 3-cm-long FC-SEMS. Occurrence of FC-SEMS-induced pancreatic strictures is a major issue and deserves further assessment. According to our experience, pancreatic FC-SEMSs have promising results, but a careful evaluation in the setting of clinical trials is needed.
Collapse
Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy; CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy
| | - Salvatore Francesco Vadalà di Prampero
- Department of Gastroenterology and GI Endoscopy, University Hospital of Udine, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Rosario Landi
- CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Vincenzo Bove
- CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Pietro Familiari
- CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Jun Hamanaka
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy; Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Fabia Attili
- CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy; CERTT, Centre for Endoscopic Research, Therapeutics and Training - Catholic University, Rome, Italy; Digestive Endoscopy, IHU-USIAS, University of Strasbourg, Strasbourg, France
| |
Collapse
|
19
|
Allocca M, Landi R, Bonovas S, Fiorino G, Papa A, Spinelli A, Furfaro F, Peyrin-Biroulet L, Armuzzi A, Danese S. Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting. Digestion 2018; 96:166-172. [PMID: 28903094 DOI: 10.1159/000480231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/06/2017] [Accepted: 08/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Most Crohn's disease (CD) patients develop endoscopic recurrence within one year of intestinal resection. The best treatment method to prevent post-operative CD recurrence remains uncertain. METHODS A total of 155 CD patients from 2 referral centres, who were undergoing intestinal resection with ileo-colonic anastomosis (January 2004-January 2015), were included. All subjects received preventive therapy with tumour necrosis factor antagonists (anti-TNFs), thiopurinesor mesalazine. The primary outcome was the rate of endoscopic recurrence (Rutgeerts score ≥i2) in the 3 treatment groups. RESULTS Patients treated with anti-TNFs were at significantly lower risk of endoscopic recurrence during the follow-up than those receiving thiopurines or mesalazine (incidence rates of 2.2, 3.0 and 4.8 per 100 person-months, respectively, log-rank, p = 0.011). The median time to recurrence was significantly longer in patients treated with anti-TNFs than in those who received thiopurines or mesalazine (37.0, 13.7, and 16.8 months, respectively, log-rank, p = 0.011). Anti-TNFs were more effective than mesalazine (univariable analysis, hazard ratio [HR] 0.45, 95% CI 0.26-0.77, p = 0.004; multivariable analysis, HR 0.45, 95% CI 0.26-0.77, p = 0.004), and non-significantly superior over thiopurines. CONCLUSION Anti-TNF therapy was the most effective strategy for the prevention of endoscopic CD recurrence.
Collapse
|
20
|
Valerii G, Tringali A, Landi R, Boškoski I, Familiari P, Bizzotto A, Perri V, Petruzziello L, Costamagna G. Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up. Scand J Gastroenterol 2018; 53:490-494. [PMID: 29458293 DOI: 10.1080/00365521.2018.1438508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigate the efficiency of endoscopic mucosal resection (EMR) of non-ampullary sporadic duodenal adenomas (NASDA) in a retrospective analysis with long-term follow-up. METHODS Consecutive patients undergoing EMR of NASDA between May 2002 and December 2016 were retrospectively identified from an electronic database. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly for up to five years. RESULTS EMR of 75 NASDA was performed in 68 patients (56% en-bloc, 44% piecemeal). Retroperitoneal perforations occurred in 3/68 (4.4%) patients, were treated by surgical (n = 2) or percutaneous (n = 1) drainage; delayed bleeding was reported in 13/75 (17.3%) resections and was successfully managed by endoscopy (n = 12) or radiologic embolization (n = 1). There was no procedure-related mortality. Follow-up was available in 61/68 patients (89.7%) after a median time of 59 months from resection. Residual and recurrent adenoma were diagnosed in 9 (14.5%) and 6 (10.9%) cases, respectively; all but one were successfully retreated endoscopically. CONCLUSIONS EMR for NASDA is effective with a favorable long-term outcome. Local recurrences can be retreated endoscopically. A recall system, patient's compliance to endoscopic follow-up are mandatory to detect recurrences and their prompt treatment.
Collapse
Affiliation(s)
- Giorgio Valerii
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Andrea Tringali
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Rosario Landi
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Ivo Boškoski
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Pietro Familiari
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | | | - Vincenzo Perri
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Lucio Petruzziello
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy
| | - Guido Costamagna
- a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy.,c Digestive Endoscopy, IHU-USIAS , University of Strasbourg , Strasbourg , France
| |
Collapse
|
21
|
Affiliation(s)
- Ivo Boškoski
- Fondazione Policlinico Gemelli, Rome, Italy.,IHU, Istitut de Chirurgie Guidée par l'Image, Strasbourg, France.,Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,IHU, USIAS Strasbourg University, Strasbourg, France
| | - Rosario Landi
- Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,IHU, USIAS Strasbourg University, Strasbourg, France
| | - Vincenzo Bove
- Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,IHU, USIAS Strasbourg University, Strasbourg, France
| | - Andrea Tringali
- Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,IHU, USIAS Strasbourg University, Strasbourg, France
| | - Guido Costamagna
- Fondazione Policlinico Gemelli, Rome, Italy.,Catholic University of Rome, Rome, Italy.,IHU, USIAS Strasbourg University, Strasbourg, France
| |
Collapse
|
22
|
Tringali A, Bove V, Perri V, Landi R, Familiari P, Boškoski I, Costamagna G. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy 2017; 49:64-68. [PMID: 27706525 DOI: 10.1055/s-0042-117235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background and study aim Leakage of the surgical suture is the main complication of laparoscopic sleeve gastrectomy (LSG) and is amenable to endoscopic therapy. The aim of this study was to evaluate the efficacy of a specifically designed self-expandable metal stent (SEMS) to seal the leakage. Patients and methods Over a 2-year period, patients referred for the treatment of post-LSG fistulas underwent placement of a fully covered esophagogastric SEMS with a specific design. Results A total of 10 patients were treated after a mean time of 50.9 days from the diagnosis of post-LSG leakage. A total of 11 SEMSs were placed. After stent removal, the leakage was seen to have healed in eight patients. Two patients who were treated with an SEMS with different mesh design, experienced stent migration, which required alternative endoscopic treatment such as the insertion of double-pigtail stents. After a mean follow-up period of 13.4 months, all patients were asymptomatic. Conclusions: Placement of a specifically designed SEMS for the treatment of post-LSG fistulas seems a promising first-line therapy according to this small series.
Collapse
Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
| |
Collapse
|
23
|
Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall'Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber WD, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017; 49:83-91. [PMID: 27617420 DOI: 10.1055/s-0042-111002] [Citation(s) in RCA: 50] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This Executive summary of the Guideline on pediatric gastrointestinal endoscopy from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) refers to infants, children, and adolescents aged 0 - 18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; endoscopic management of corrosive ingestion and stricture/stenosis; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) have been dealt with in other Guidelines and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance will be addressed in an imminent sister publication.
Collapse
Affiliation(s)
| | - Mike Thomson
- International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, Weston Bank, Sheffield, UK
| | | | - Marta Tavares
- Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Raoul Furlano
- Department of Pediatric Gastroenterology and Nutrition, University Children's Hospital Basel, Switzerland
| | - Manon Spaander
- Department of Gastroenterology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Christos Tzvinikos
- Department of Pediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK
| | - Hanneke Ijsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jérôme Viala
- Department of Pediatric Gastroenterology, Robert-Debré Hospital, Paris, France
| | - Luigi Dall'Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Marc Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Slovenia
| | - Yvan Vandenplas
- Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal
| | - Radan Keil
- Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic
| | | | - Eva Brownstone
- IV Medical Department, Rudofstiftung Hospital, Vienna, Austria
| | - Štěpán Hlava
- Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic
| | - Patrick Gerner
- Department of General Pediatrics, Children's Hospital Freiburg University, Freiburg, Germany
| | - Werner Dolak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Wolf Dietrich Huber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Simon Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andreas Vecsei
- Department for Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Austria
| | - Lars Aabakken
- GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway
| | - Jorge Amil-Dias
- Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal
| | - Alessandro Zambelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Robbiani di Soresina, Italy
| |
Collapse
|
24
|
Piscaglia AC, Laterza L, Cesario V, Gerardi V, Landi R, Lopetuso LR, Calò G, Fabbretti G, Brisigotti M, Stefanelli ML, Gasbarrini A. Nodular lymphoid hyperplasia: A marker of low-grade inflammation in irritable bowel syndrome? World J Gastroenterol 2016; 22:10198-10209. [PMID: 28028368 PMCID: PMC5155179 DOI: 10.3748/wjg.v22.i46.10198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 07/24/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the prevalence of nodular lymphoid hyperplasia (NLH) in adult patients undergoing colonoscopy and its association with known diseases.
METHODS We selected all cases showing NLH at colonoscopy in a three-year timeframe, and stratified them into symptomatic patients with irritable bowel syndrome (IBS)-type symptoms or suspected inflammatory bowel disease (IBD), and asymptomatic individuals undergoing endoscopy for colorectal cancer screening. Data collection included medical history and final diagnosis. As controls, we considered all colonoscopies performed for the aforementioned indications during the same period.
RESULTS One thousand and one hundred fifty colonoscopies were selected. NLH was rare in asymptomatic individuals (only 3%), while it was significantly more prevalent in symptomatic cases (32%). Among organic conditions associated with NLH, the most frequent was IBD, followed by infections and diverticular disease. Interestingly, 31% of IBS patients presented diffuse colonic NLH. NLH cases shared some distinctive clinical features among IBS patients: they were younger, more often female, and had a higher frequency of abdominal pain, bloating, diarrhoea, unspecific inflammation, self-reported lactose intolerance and metal contact dermatitis.
CONCLUSION About 1/3 of patients with IBS-type symptoms or suspected IBD presented diffuse colonic NLH, which could be a marker of low-grade inflammation in a conspicuous subset of IBS patients.
Collapse
|
25
|
Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:825-839. [PMID: 27931639 DOI: 10.1016/j.bpg.2016.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
The experience of the "endoscopic community" in pediatric patients is limited, but during recent years increased skills of the endoscopists and technological improvements lead to a standardization of pediatric endoscopy and the development of specialized pediatric endoscopy unit. Adverse events related to diagnostic and therapeutic endoscopy in children are usually rare. Diagnosis, prevention and treatment of complications in pediatric endoscopy is crucial when dealing with benign diseases in children. The complication rate of diagnostic EGD and colonoscopy in children are extremely low. Therapeutic procedures have obviously an increased rate of adverse events. Esophageal dilations are the most common indication for endoscopic therapy in children and can lead to perforations which requires prompt diagnosis and management. Complications of ERCP in pediatric age are similar to those reported in adults. The experience in pediatric emergency endoscopy (mainly foreign body removal) is consolidated and related adverse events extremely rare. Sedation of children during endoscopy maybe needs further evaluation and standardization, to reduce the rate of specific complications.
Collapse
Affiliation(s)
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.
| |
Collapse
|
26
|
Pugliese D, Felice C, Landi R, Papa A, Guidi L, Armuzzi A. Benefit-risk assessment of golimumab in the treatment of refractory ulcerative colitis. Drug Healthc Patient Saf 2016; 8:1-7. [PMID: 26893582 PMCID: PMC4745853 DOI: 10.2147/dhps.s62649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Significant advances in the management of patients with ulcerative colitis (UC) have been made since the introduction of anti-tumor necrosis factor (TNF)-alpha agents, especially for those who fail or do not tolerate conventional therapies. Two drugs, infliximab first, then adalimumab afterward, showed effectiveness in inducing and maintaining long-term remission both in pivotal trials as well as in clinical practice. However, approximately 25% of patients with UC, who fail or do not tolerate all available therapies, require a colectomy for refractory disease. The therapeutic scenario of UC has been recently upgraded by the introduction of golimumab, the latest anti TNF-alpha agent to be approved. Golimumab is a totally humanized monoclonal antibody, administered by a subcutaneous injection every 4 weeks. Treatment with golimumab has shown to be effective to induce sustained clinical benefit in tough-to-treat patients with UC, including steroid and/or immunosuppressive refractory and steroid-dependent patients. In this review, we summarize all available efficacy and safety data of golimumab in UC, analyzing the potential therapeutic position for the treatment of refractory patients with UC.
Collapse
Affiliation(s)
- Daniela Pugliese
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Carla Felice
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Rosario Landi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Alfredo Papa
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Luisa Guidi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Alessandro Armuzzi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| |
Collapse
|
27
|
Tursi A, Brandimarte G, Di Mario F, Annunziata ML, Bafutto M, Bianco MA, Colucci R, Conigliaro R, Danese S, De Bastiani R, Elisei W, Escalante R, Faggiani R, Ferrini L, Forti G, Latella G, Graziani MG, Oliveira EC, Papa A, Penna A, Portincasa P, Søreide K, Spadaccini A, Usai P, Bonovas S, Scarpignato C, Picchio M, Lecca PG, Zampaletta C, Cassieri C, Damiani A, Desserud KF, Fiorella S, Landi R, Goni E, Lai MA, Pigò F, Rotondano G, Schiaccianoce G. Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study. United European Gastroenterol J 2015; 4:604-13. [PMID: 27536372 DOI: 10.1177/2050640615617636] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/22/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. AIMS We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available. METHODS For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery. RESULTS We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. CONCLUSIONS DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
Collapse
Affiliation(s)
- Antonio Tursi
- Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria L Annunziata
- Division of Gastroenterology, Istituto di Rocovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Italy
| | - Mauro Bafutto
- Instituto Goiano de Gastroenterologia e Endoscopia digestiva, Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brasil
| | - Maria A Bianco
- Division of Gastroenterology, T. Maresca Hospital, Torre del Greco, Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Italy
| | - Rita Conigliaro
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Silvio Danese
- Humanitas University, IBD Center, Humanitas Clinical and Research Hospital, Via Manzoni, Rozzano, Milan, Italy
| | | | - Walter Elisei
- Division of Gastroenterology, Azienda Sanitaria Locale Azienda Sanitaria Locale Roma H., Rome, Italy
| | - Ricardo Escalante
- Loira Medical Center, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Luciano Ferrini
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, S. Maria Goretti Hospital, Latina, Italy
| | - Giovanni Latella
- Division of Gastroenterology, S. Salvatore Hospital, L'Aquila, Italy
| | - Maria G Graziani
- Service of Digestive Endoscopy, S. Camillo Hospital, Rome, Italy
| | - Enio C Oliveira
- Department of Surgery, Federal University of Goiás, Goiânia, Brasil
| | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Antonio Penna
- Division of Gastroenterology, S. Paolo Hospital, Bari, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Antonio Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Paolo Usai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Piera G Lecca
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | | | - Claudio Cassieri
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Alberto Damiani
- Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy
| | - Kari F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Serafina Fiorella
- Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy
| | - Rosario Landi
- Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy
| | - Elisabetta Goni
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Maria A Lai
- Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy
| | - Flavia Pigò
- Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy
| | - Gianluca Rotondano
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - Giuseppe Schiaccianoce
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| |
Collapse
|
28
|
Pugliese D, Guidi L, Ferraro PM, Marzo M, Felice C, Celleno L, Landi R, Andrisani G, Pizzolante F, De Vitis I, Papa A, Rapaccini GL, Armuzzi A. Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study. Aliment Pharmacol Ther 2015; 42:880-8. [PMID: 26235565 DOI: 10.1111/apt.13352] [Citation(s) in RCA: 64] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/01/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psoriasis is an emerging paradoxical side effect in patients with inflammatory bowel disease (IBD) when treated with anti-TNF alpha. Patients with severe skin lesions unresponsive to topical therapy need to withdraw from treatment. AIM To estimate the incidence of paradoxical psoriasis in a large cohort of IBD patients treated with anti-TNF alpha and to analyse its clinical correlates. METHODS A retrospective cohort study on all IBD patients who started anti-TNF alpha at our IBD Centre from January 2008 to December 2013 was performed. Proportional hazards regression models were used to estimate the association between each predictor and time to the development of psoriasis. Time-dependent predictors were updated at each available time point. RESULTS Four hundred and two patients were included. Participants contributed a total of 839 person-years of follow-up, during which 42 incident cases of psoriasis were recorded, with an incidence rate of five per 100 person-years. Cox-regression survival analysis revealed smoking as independent predictor of psoriasis (HR: 2.37, 95% CI: 1.36-4.48; P = 0.008). Conversely, concomitant immunosuppressive therapy was inversely related to psoriasis (HR: 0.33, 95% CI: 0.12-0.92; P = 0.03). CONCLUSIONS Paradoxical psoriasis is a relevant side effect of anti-TNF alpha therapy, with an incidence rate of five per 100 person-years. Smoking is confirmed as the main risk factor for developing lesions. The combination therapy with anti-TNF alpha plus immunosuppressants is associated with a reduced risk of paradoxical psoriasis.
Collapse
Affiliation(s)
- D Pugliese
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - L Guidi
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - P M Ferraro
- Nephrology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - M Marzo
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - C Felice
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - L Celleno
- Dermatology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - R Landi
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - G Andrisani
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - F Pizzolante
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - I De Vitis
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - A Papa
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - G L Rapaccini
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - A Armuzzi
- IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy
| |
Collapse
|
29
|
Laterza L, Ianiro G, Scoleri I, Landi R, Bruno G, Scaldaferri F, Gaetani E, Campanale M, Gasbarrini A. Rifaximin for the treatment of diarrhoea-predominant irritable bowel syndrome. Expert Opin Pharmacother 2015; 16:607-15. [PMID: 25641072 DOI: 10.1517/14656566.2015.1007951] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Rifaximin is a non-absorbable, semisynthetic antibiotic that acts as an inhibitor of bacterial RNA synthesis, with a broad spectrum of antibacterial activity. Due to its poor absorption, rifaximin has an increased exposure to the intestine, thus it is suitable for the treatment of many gastrointestinal (GI) diseases. In irritable bowel syndrome (IBS) pathogenesis, gut microbiota impairment may play a major role. The possibility of modulating intestinal bacteria using antibiotics, in particular, rifaximin, has been demonstrated to improve IBS symptoms in non-constipation subtypes of IBS. AREAS COVERED We reviewed the use of rifaximin in diarrhoea-predominant IBS, focusing on its pharmacokinetic characteristics, its absorption in GI disease, its lack of interaction with other drugs and its new extended release formulation. EXPERT OPINION Rifaximin, with its low systemic absorption and no clinically significant interactions with other drugs, may represent a treatment of choice for IBS, mainly due to its ability to act on IBS pathogenesis, through the modulation of gut microbiota. Further studies to analyse the effect of rifaximin treatment on the composition of faecal microbiota are warranted. In particular, they need to evaluate whether resistant bacterial strains are selected and whether they are still present in the faecal sample even a long time after therapy.
Collapse
Affiliation(s)
- Lucrezia Laterza
- Catholic University of Rome, Internal Medicine and Gastroenterology Department , Largo Gemelli 8, 000168 Rome , Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Piscaglia AC, Ventura MT, Landolfo G, Giordano M, Russo S, Landi R, Zulian V, Forte F, Stefanelli ML. Chronic anisakidosis presenting with intestinal intussusception. Eur Rev Med Pharmacol Sci 2014; 18:3916-3920. [PMID: 25555884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Anisakidosis is a parasitic infection caused by the ingestion of row or uncooked fish, containing larval nematodes from the Anisakidae family. Intestinal anisakidosis represents about 4% of all cases, the majority being localized in the small bowel, with rare colonic involvement. Here we present an infrequent case of chronic anisakidosis, presenting with intestinal intussusception. CASE REPORT A 52 years old woman, chronically treated with immunosuppressants, presented to our Institution with acute abdominal pain and vomiting, due to colocolic intussusception. Colonoscopy successfully reduced the intussusception and revealed the presence of a voluminous colonic submucosal mass, near the hepatic flexure. Therefore, the patient underwent laparoscopic right hemicolectomy. The diagnosis of anisakidosis was made when the histological examination of the surgical specimen revealed the infestation of the intestinal wall by a nematode of the Anisakidae family, with an intense erosive-inflammatory adjacent reaction.
Collapse
Affiliation(s)
- A C Piscaglia
- Gastroenterology and Endoscopy Unit, State Hospital, Republic of San Marino.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Akerman PA, Riccioni ME, Bizzotto A, Galasso D, Landi R, Costamagna G. Enteroscopic Balloon Dilation of Multiple Ileal Strictures in Suspected Crohn's Disease. Video Journal and Encyclopedia of GI Endoscopy 2013; 1:228-229. [DOI: 10.1016/s2212-0971(13)70097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
32
|
De Feo G, Galasso M, Landi R, Donnarumma A, De Gisi S. A comparison of the efficacy of organic and mixed-organic polymers with polyaluminium chloride in chemically assisted primary sedimentation (CAPS). Environ Technol 2013; 34:1297-1305. [PMID: 24191462 DOI: 10.1080/09593330.2012.745622] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
CAPS is the acronym for chemically assisted primary sedimentation, which consists of adding chemicals to raw urban wastewater to increase the efficacy of coagulation, flocculation and sedimentation. The principal benefits of CAPS are: upgrading of urban wastewater treatment plants; increasing efficacy of primary sedimentation; and the major production of energy from the anaerobic digestion of primary sludge. Metal coagulants are usually used because they are both effective and cheap, but they can cause damage to the biological processes of anaerobic digestion. Generally, biodegradable compounds do not have these drawbacks, but they are comparatively more expensive. Both metal coagulants and biodegradable compounds have preferential and penalizing properties in terms of CAPS application. The problem can be solved by means of a multi-criteria analysis. For this purpose, a series of tests was performed in order to compare the efficacy of several organic and mixed-organic polymers with that of polyaluminium chloride (PACl) under specific conditions. The multi-criteria analysis was carried out coupling the simple additive weighting method with the paired comparison technique as a tool to evaluate the criteria priorities. Five criteria with the following priorities were used: chemical oxygen demand (COD) removal > turbidity, SV60 > coagulant dose, and coagulant cost. The PACl was the best alternative in 70% of the cases. The CAPS process using PACl made it possible to obtain an average COD removal of 68% compared with 38% obtained, on average, with natural sedimentation and 61% obtained, on average, with the best PACl alternatives (cationic polyacrylamide, natural cationic polymer, dicyandiamide resin).
Collapse
Affiliation(s)
- G De Feo
- Department of Industrial Engineering, University of Salerno, Fisciano (SA), Italy.
| | | | | | | | | |
Collapse
|
33
|
Boškoski I, Tringali A, Landi R, Familiari P, Contini ACI, Pintus C, Costamagna G. Endoscopic retrieval of a duodenal perforating teaspoon. World J Gastrointest Endosc 2013; 5:186-188. [PMID: 23596543 PMCID: PMC3627843 DOI: 10.4253/wjge.v5.i4.186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/05/2013] [Indexed: 02/05/2023] Open
Abstract
Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.
Collapse
|
34
|
Napoletano C, Rughetti A, Landi R, Pinto D, Bellati F, Rahimi H, Spinelli GP, Pauselli S, Sale P, Dolo V, De Lorenzo F, Tomao F, Benedetti-Panici P, Frati L, Nuti M. Immunogenicity of allo-vesicle carrying ERBB2 tumor antigen for dendritic cell-based anti-tumor immunotherapy. Int J Immunopathol Pharmacol 2009; 22:647-58. [PMID: 19822081 DOI: 10.1177/039463200902200310] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dendritic cells (DCs) are able to orchestrate innate and acquired immunity and can activate and sustain a long-lasting anti-tumor immune response in vivo when used as anti-tumor cell therapy. The selection of the antigen and the choice of its formulation are key points in designing anti-cancer DC-based vaccines. Cell released vesicles/exosomes have been shown to transfer antigens, HLAI/peptide complexes and co-stimulatory molecules to recipient cells. In this study we describe the generation of an allogenic microvesicle cell factory in which the expression of a specific tumor antigen was combined to the expression of co-stimulatory and allogeneic molecules. The DG75 lymphoblastoid cell line was selected as microvesicle producer and transfected with ErbB2, as tumor antigen prototype. The shed microvesicles transferred antigenic components to recipient DCs, increasing their immunogenicity. DC pulsing resulted in cross-presentation of ErbB2 both in HLAI and HLAII compartments, and ErbB2-specific CD8+ T cells from cancer patients were activated by DCs pulsed with vesicle-bound ErbB2. The microvesicle cell factory proposed may represent a source of cell free immunogen to be used for DC-based cancer therapy.
Collapse
Affiliation(s)
- C Napoletano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Della Pietra B, Landi R, Luongo C, Vicario C. [Normative and medico-legal aspects of hyperbaric reanimation medicine]. Minerva Anestesiol 1991; 57:309-18. [PMID: 1944960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- B Della Pietra
- Cattedra R di Medicina Legale e delle Assicurazioni, I Facoltà di Medicina e Chirurgia, Università degli Studi, Napoli
| | | | | | | |
Collapse
|
37
|
Renda A, Landi R, Coppola L, Carbone I, Cristiano S, Pipolo L. [Inflammatory pseudotumor of the ileus: clinical contribution]. Ann Ital Chir 1989; 60:543-5; discussion 545-6. [PMID: 2639612] [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: 01/01/2023]
Abstract
Inflammatory pseudotumor is a rare benign lesion; the lung and conducting airways can be the seat where is often localized. The ileal localization, reported at present, can be defined unique. In our case was very difficult to perform a right diagnosis cause the absence of pathognomonic symptoms. Surgical procedure too was not able to resolve the diagnostic problem: in fact macroscopically the lesion seemed an ileal carcinoma or Crohn's disease. Only the microscopical examination with the individuation of Russell's bodies, macrophages and other inflammatory cells can perform the right diagnosis.
Collapse
|
38
|
Renda A, Salvatore M, Sava M, Landi R, Lastoria S, Coppola L, Schlom J, Colcher D, Zannini G. Immunoscintigraphy in the follow-up of patients operated on for carcinoma of the sigmoid and rectum. Preliminary report with a new monoclonal antibody: B72.3. Dis Colon Rectum 1987; 30:683-6. [PMID: 3304885 DOI: 10.1007/bf02561688] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Thirty patients who had curative surgery for sigmoid and rectal carcinoma were studied by immunoscintigraphy using a new monoclonal antibody: B72.3 radiolabeled with Iodine-131 (I-131) or Indium-111 (In-111). Results were compared with other conventional diagnostic procedures such as computed tomography, ultrasound, endoscopy, and tumor markers. Seven patients had local recurrences and/or distant metastases. Immunoscintigraphy identified all local recurrences (five cases) that were confirmed by CT and was able to localize three of five liver metastases (two false-negatives). Furthermore, immunoscintigraphy also recorded a false-positive. Preliminary use of B72.3 shows good potential for the evaluation and detection of neoplastic sites.
Collapse
|
39
|
Zannini G, Renda A, Lepore R, Coppola L, Landi R, D'Antonio M. Mechanical anterior resection for carcinoma of the midrectum: long-term results. Int Surg 1987; 72:18-9. [PMID: 3596971] [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: 01/06/2023] Open
Abstract
Long term results are reported on 108 patients treated by curative mechanical anterior resection for midrectum carcinoma. The functional results were good but there was a large number of local recurrences for carcinoma at Dukes C stage (28% of the total cases). Oncological results suggest that greater importance should be given to early diagnosis and to pathogenesis and risk factors for recurrence.
Collapse
|
40
|
Renda A, Sava M, Angelillo M, Lepore R, Coppola L, Landi R. [Instrumental follow-up of anterior mechanical resection]. MINERVA CHIR 1986; 41:2037-9. [PMID: 3547175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
41
|
Renda A, Coppola L, Landi R. [Ulcerative colitis and Crohn's disease: indications for surgery and the technical choice]. MINERVA CHIR 1985; 40:259-62. [PMID: 3991022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|