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Manta R, Del Nero L, Todd B, Parodi A, De Ceglie A, Zito F, Pasquale L, Zullo A, Conio M. Newly designed OTS Clip for preventing fully-covered self-expandable metal stent migration in the gastrointestinal tract. Endosc Int Open 2023; 11:E284-E287. [PMID: 36968979 PMCID: PMC10038747 DOI: 10.1055/a-2032-4147] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/11/2022] [Indexed: 03/26/2023] Open
Abstract
Background and study aims
Fully-covered self-expandable metal stents (FCSEMS) are frequently used for endoscopic management of gastrointestinal lesions. However, stent migration occurs in up to one-third of patients. Different tools are used to anchor stents to prevent migration. A specifically designed over-the-scope device (Stentfix OTS Clip system) was recently introduced to prevent fully covered SEMS migration in the gastrointestinal tract. The study aimed to evaluate technical success and stent migration rates with the Stentfix device.
Patients and methods
Data were collected from consecutive patients at four participating centers who were at high risk of FCSEMS migration and in whom the anchoring system was used to prevent migration.
Results
A total of 31 patients were enrolled. Technically successful clip placement was achieved in all cases. At follow-up, the distal part of the device dislocated from the duodenum into the antrum at 3 days in one patient, accounting for a 3.2 % (95 % CI = 0–9.4) rate of stent migration. The underlying lesion being treated healed in all patients, but 10 patients died before stent removal due to neoplastic progression.
Conclusions
A dedicated over-the-scope stent fixation device appears to be safe and effective in preventing fully-covered SEMS migration through the gastrointestinal tract.
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Affiliation(s)
- Raffaele Manta
- Gastroenterology and Digestive Endoscopy Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenzo Del Nero
- Gastroenterology Department, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Baron Todd
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Andrea Parodi
- Gastroenterology and Digestive Endoscopy Unit, Lavagna Hospital, Lavagna (GE), Italy
| | - Antonella De Ceglie
- Gastroenterology Department, General Hospital of Sanremo, Sanremo (IM), Italy
| | - Francesco Zito
- Gastroenterology and Digestive Endoscopy Unit, AORN “Antonio Cardarelli”, Napoli Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, A. Irpino (AV), Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome, Italy
| | - Massimo Conio
- Gastroenterology Department, General Hospital of Sanremo, Sanremo (IM), Italy
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Del Nero L, Sheijani AD, De Ceglie A, Bruzzone M, Ceppi M, Filiberti RA, Siersema P, Conio M. A Meta-Analysis of Endoscopic Stenting Versus Surgical Treatment for Malignant Gastric Outlet Obstruction. World J Surg 2023; 47:1519-1529. [PMID: 36869171 DOI: 10.1007/s00268-023-06944-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND AIM Surgical gastrojejunostomy (GJJ) and endoscopic stenting (ES) are the two most available treatments for palliation of malignant gastric obstruction (MGOO). The aim of this study is to compare these two techniques regarding efficacy, safety, time of hospitalization and survival. METHODS We performed a literature search from January 2010 to September 2020 to identify available randomized controlled studies and observational studies that compared ES and GJJ for the treatment of MGOO. RESULTS A total of 17 studies were found. ES and GJJ showed similar technical and clinical success rate. ES was superior to obtain early oral re-feeding, shorter length of hospitalization and a lower incidence of complications than GJJ. Surgical palliation had a lower recurrence rate of obstructive symptoms and longer overall survival than ES. CONCLUSIONS Both procedures have advantages and disadvantages. Probably we should not find the best palliation but the best approach based on the patient characteristics and tumor type.
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Affiliation(s)
- Lorenzo Del Nero
- Gastroenterology Department, Santa Corona Hospital, ASL 2 Savonese, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy.
| | - Afscin Djahandideh Sheijani
- Gastroenterology Department, Santa Corona Hospital, ASL 2 Savonese, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Antonella De Ceglie
- Gastroenterology Department, Sanremo General Hospital, ASL1 Imperiese, Sanremo, IM, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Peter Siersema
- Gastroenterology Department, Santa Corona Hospital, ASL 2 Savonese, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy.,Gastroenterology Department, Sanremo General Hospital, ASL1 Imperiese, Sanremo, IM, Italy.,Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Massimo Conio
- Gastroenterology Department, Santa Corona Hospital, ASL 2 Savonese, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
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Del Nero L, Dabizzi E, Ceglie AD, Ziola S, Zerbi A, Baron TH, Conio M. Familial pancreatic cancer. Clin Res Hepatol Gastroenterol 2023; 47:102079. [PMID: 36681116 DOI: 10.1016/j.clinre.2023.102079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
Pancreatic cancer (PC) carries a poor prognosis with an overall 5-year survival of less than 10%. Early diagnosis, though cumbersome, is essential to allow complete surgical resection. Therefore, primary and secondary prevention are critical to reduce the incidence and to potentially prevent mortality. Given a relatively low lifetime risk of developing PC, identification of high-risk individuals is crucial to allow identification of pre-malignant lesions and small, localized tumors. Although 85-90% of PC cases are sporadic, we could consider risk stratification for the 5-10% of patients with a family history and the 3-5% of cases due to inherited genetic syndromes. These high-risk populations should be considered for screening and surveillance of PC. MRI/MRCP and EUS are the preferred modalities, due to their high sensitivity in lesion detection. Surveillance should be personalized, considering genetics and family history, and assessment of risk factors that may increase cancer risk. Screening programs should be limited to tertiary referral center, with high-volumes and adequate facilities to manage these patients.
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Affiliation(s)
- Lorenzo Del Nero
- Gastroenterology Department, Santa Corona Hospital, Pietra Ligure, ASL 2 Savonese, Italy.
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Antonella De Ceglie
- Gastroenterology Department, Sanremo General Hospital, Sanremo (IM), ASL1 Imperiese, Italy
| | - Sebastiano Ziola
- Gastroenterology Department, Santa Corona Hospital, Pietra Ligure, ASL 2 Savonese, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Massimo Conio
- Gastroenterology Department, Santa Corona Hospital, Pietra Ligure, ASL 2 Savonese, Italy; Endoscopie, Clinique Saint George, Nice, France
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Conio M, Manta R, Filiberti RA, Baron TH, Pasquale L, Marini M, De Ceglie A. Cap-assisted EMR versus standard inject and cut EMR for treatment of large colonic laterally spreading tumors: a randomized multicenter study (with videos). Gastrointest Endosc 2022; 96:829-839.e1. [PMID: 35697127 DOI: 10.1016/j.gie.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Piecemeal EMR of colorectal laterally spreading tumors (LSTs) >20 mm is effective. Experience is limited in the use of cap-assisted EMR (EMR-C) for resection of colonic lesions. We compared the efficacy and the safety of EMR-C for the removal of colonic LSTs ≥30 mm with "inject-and-cut" standard EMR (EMR-S). METHODS In this randomized trial from 4 Italian centers, 138 patients were treated with EMR-C and 102 with EMR-S. The rates of residual lesions, percentage of recurrence after 12 months, and adverse events were evaluated. RESULTS One hundred forty-three lesions were resected with EMR-C and 102 with EMR-S. Argon plasma coagulation (APC) was used as adjunctive treatment in 2.9% of EMR-Cs and in 22.5% of EMR-Ss (P < .001). The median time required was 20 minutes for EMR-C and 30 minutes for EMR-S (P < .001). Adverse events (AEs) occurred in 14 EMR-Cs (10.1%; 2 perforations, 11 bleeding events, and 1 stenosis) and in 22 EMR-Ss (21.6%; 1 perforation and 21 bleeding events) (P = .017). Intraprocedural AEs occurred in 3.6% of EMR-Cs and 16.7% of EMR-Ss (P = .001). Overall, residual lesions within 12 months were found to be significantly higher with EMR-S (32 patients, 31.4%) than with EMR-C (8 patients, 5.8%) (P < .001). Recurrence at follow-up colonoscopy in 12 months occurred in 7 EMR-Cs (5.1%) and 17 EMR-Ss (16.7%; P < .001). CONCLUSIONS The study demonstrated the feasibility and safety of EMR-C for removing large colorectal LSTs, with higher eradication rates, shorter resection time, and less use of APC when compared with EMR-S. (Clinical trial registration number: NCT03498664.).
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Affiliation(s)
- Massimo Conio
- Gastroenterology Department, Santa Corona General Hospital, Savonese, Italy; Polyclinique St George, Nice, France
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Department, General Hospital, Perugia, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luigi Pasquale
- Gastroenterology and Digestive Endoscopy Department, O. Frangipane Hospital, Avellino, Italy
| | - Mario Marini
- Gastroenterology and Operative Endoscopy Unit, Santa Maria Alle Scotte Hospital, Siena, Italy
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Maimone A, De Ceglie A, Siersema PD, Baron TH, Conio M. Colon ischemia: A comprehensive review. Clin Res Hepatol Gastroenterol 2021; 45:101592. [PMID: 33662779 DOI: 10.1016/j.clinre.2020.101592] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
The clinical and endoscopic features of colon ischemia (CI) are non-specific. CI is correctly identified at the time of presentation in only 9% of patients is. The true incidence is likely underestimated because many mild cases resolve spontaneously without medical treatment. Furthermore, since most cases of CI are transient, and no specific cause is detected they are often considered to be "idiopathic". In the setting of severe CI correct diagnosis and prompt recognition and therapy as well as identification of underlying causes are crucial for a favourable outcome. Although less severe, mild cases may present with similar symptoms, the prognosis and management are completely different and managed conservatively rather than with surgery. Unfortunately, data from most studies and current guidelines do not provide recommendations on the long-term management of CI or about the need for endoscopic follow-up to detect the development chronic, recurrent and/or ischemic colonic strictures. In this review, we focus on the definition of CI, its aetiology, and patterns of presentation. We highlight the pharmacological and/or endoscopic management as determined severity of disease that allow for improved outcomes. Prompt recognition and treatment using a multidisciplinary approach are essential for successful management of severe CI because mortality rates are significantly higher when the diagnosis is delayed.
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Affiliation(s)
- Antonella Maimone
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology (Route 763), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Massimo Conio
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy; Department of Gastroenterology, Santa Corona General Hospital, Pietra Ligure, SV, Italy.
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Filiberti RA, Fontana V, De Ceglie A, Blanchi S, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Rosa A, D'Onofrio V, Iaquinto G, Conio M. Dietary Habits and Risk of Esophagitis and Barrett's Esophagus: A Multicenter Italian Case-Control Study. Dig Dis Sci 2021; 66:3448-3460. [PMID: 33073332 DOI: 10.1007/s10620-020-06658-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Barrett's esophagus (BE) and esophagitis share potentially modifiable risk factors such as obesity, smoking, and alcohol. The role of diet on BE and esophagitis is still debated. AIMS The objective of this study was to examine the association between some dietary habits and the risk of BE and esophagitis in Italy. METHODS A multicenter case-control study involving 1285 individuals was carried out in 12 areas. Patients with a new diagnosis of BE (320) or esophagitis (359) and a group of endoscopic controls (606) were included. Information on personal history and dietary habits was collected using a structured questionnaire. RESULTS No clear monotonic significant dose-response relationship was found for most of the considered food items. Nevertheless, the most extreme consumption category of red meat, cold cuts, dairy products, and fried foods showed esophagitis risk excesses varying from 19 to 49%. A higher fat rich diet seemed to increase risk by 49% for BE and 94% for esophagitis. A downward tendency in esophagitis (- 27%) and BE risk (- 20%) was found associated with higher frequency of fresh fruit intake. In addition, a statistically significant twofold increased risk for both BE and esophagitis was found for subjects eating late evening snacks more than once every three days in comparison with the lowest intake category (no consumption). CONCLUSIONS BE and esophagitis patients appeared to be more likely than controls to follow a diet rich in fats and poor in fruit and vegetables. Late evening snacks were found to be associated with both disorders.
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Affiliation(s)
- Rosa Angela Filiberti
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 16132, Genoa, Italy.
| | - Vincenzo Fontana
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 16132, Genoa, Italy
| | - Antonella De Ceglie
- Gastroenterology, General Hospital, Via Giovanni Borea 56, 18038, Sanremo, IM, Italy
| | - Sabrina Blanchi
- Gastroenterology, General Hospital, Via Giovanni Borea 56, 18038, Sanremo, IM, Italy
| | - Teresa Lacchin
- Policlinico San Giorgio, Gastroenterology, Pordenone, Italy
| | - Marina De Matthaeis
- Gastroenterology, General Hospital, Via Giovanni Borea 56, 18038, Sanremo, IM, Italy
| | - Orazio Ignomirelli
- IRCCS CROB, Digestive Endoscopy, Strada Provinciale di Piano del Conte, 85028, Rionero in Vulture, PZ, Italy
| | - Roberta Cappiello
- Gastroenterology, S. Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy
| | - Alessandra Rosa
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 16132, Genoa, Italy
| | - Vittorio D'Onofrio
- Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Contrada Amoretta, 83100, Avellino, Italy
| | - Gaetano Iaquinto
- Divisione di Gastroenterologia, Clinica Santa Rita, Via Appia, 83042, Atripalda, AV, Italy
| | - Massimo Conio
- Gastroenterology, General Hospital, Via Giovanni Borea 56, 18038, Sanremo, IM, Italy
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Conio M, Filiberti RA, Siersema PD, Manta R, Blanchi S, De Ceglie A. A new designed self-expandable metal stent for the management of benign radiotherapy-induced hypopharyngeal or cervical esophageal strictures. Surg Endosc 2021; 36:2290-2299. [PMID: 33903933 DOI: 10.1007/s00464-021-08504-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS The management of patients with hypopharyngeal or cervical esophageal refractory benign strictures (RBS) after surgery and radiotherapy ± chemotherapy for laryngeal cancer is challenging. We aimed to assess the long-term efficacy and safety of a new designed fully covered SEMS in these patients. METHODS We reviewed the results of a prospectively collected database of 40 consecutive patients with dysphagia due to RBS of the cervical esophagus or hypopharynx after surgery and radiotherapy with or without chemotherapy for laryngeal cancer, unfit for surgery, referred in two tertiary-care endoscopic centers from June 2005 to December 2018. All of them were treated with placement of a Niti-S Conio cervical stent. RESULTS After placement of the first stent, dysphagia improved in all patients. The total number of adverse events was 35 out of a total of 299 procedures (11.7%): 25 (8.4%) stent migrations, 6 (2%) tumor overgrowth, 3 severe pain and 1 pharyngo-cutaneous fistula. Stents were periodically changed. In only one patient with a cervical esophageal stricture the stent was definitively removed after 7 sessions of stent placement because of stricture resolution. Patients were followed-up for a median of 11.6 months and a significant improvement in dysphagia was reported in all patients (p < 0.001). CONCLUSIONS The use of this conformable, small caliber new designed Niti-S stent, exchanged periodically, appeared safe and permitted durable oral intake in patients with difficult-to-treat hypopharyngeal or cervical esophagus strictures, avoiding the need for periodic dilations.
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Affiliation(s)
- Massimo Conio
- Department of Gastroenterology, Sanremo General Hospital, Sanremo, IM, Italy. .,Department of Gastroenterology, Santa Corona General Hospital, Pietra Ligure, SV, Italy.
| | | | - Peter D Siersema
- Department. of Gastroenterology and Hepatology (Route 763), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy, General Hospital, 06129, Perugia, Italy
| | - Sabrina Blanchi
- Department of Gastroenterology, Sanremo General Hospital, Sanremo, IM, Italy
| | - Antonella De Ceglie
- Department of Gastroenterology, Sanremo General Hospital, Sanremo, IM, Italy
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Conio M, Savarese MF, Baron TH, De Ceglie A. A newly designed over-the-scope-clip device to prevent fully covered metal stents migration: A pilot study. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.tige.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Conio M, Mangiavillano B, Caruso A, Filiberti RA, Baron TH, De Luca L, Signorelli S, Crespi M, Marini M, Ravelli P, Conigliaro R, De Ceglie A. Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: a randomized multicenter study. Gastrointest Endosc 2018; 88:283-291.e3. [PMID: 29653120 DOI: 10.1016/j.gie.2018.03.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/30/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstructions. We aimed to compare stent patency, the adverse events rate, and overall survival of covered versus uncovered self-conformable metal stents in patients with primary malignant extrahepatic biliary strictures, not eligible for surgery. METHODS This is a multicenter randomized trial analyzing 158 patients with inoperable distal malignant biliary obstruction conducted in 5 Italian referral centers between December 2014 and October 2016. Seventy-eight patients were randomized to receive a fully covered SEMS (FCSEMS), and 80 patients received uncovered SEMSs (USEMSs). Data from 148 (72 FCSEMSs and 76 USEMSs) of 158 patients were analyzed. RESULTS Median time of stent patency was lower for FCSEMSs (240 days vs 541 days for USEMSs; P = .031). Adverse events occurred with 19 FCSEMSs (26.4%) and 10 USEMSs (13.2%); P = .061. The main causes of FCSEMS dysfunction were migration (7% vs 0% in the USEMS group) and early occlusion mainly because of sludge or overgrowth; late stent occlusion because of tumor ingrowth occurred in 13.2% of patients in the USEMS group. There were no significant differences either in levels of conjugated bilirubin improvement or in overall survival between the FCSEMS and USEMS groups. Median survival was 134 days in the FCSEMS group and 112 days in the USEMS group (P = .23). CONCLUSION The number of stent-related adverse events was higher, although not significantly, among patients in the FCSEMS group. FCSEMSs had a significantly higher rate of migration than USEMSs, and stent occlusion occurred earlier. A significant difference in the patency rate was observed in favor of the USEMS group. (Clinical trial registration number: NCT02102984.).
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Affiliation(s)
- Massimo Conio
- Gastroenterology Department, General Hospital, Sanremo (IM)
| | | | - Angelo Caruso
- Gastroenterology and Digestive Endoscopy Department, Azienda Ospedaliera Universitaria di Modena, Sant'Agostino Estense Hospital, Baggiovara (MO)
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Luca De Luca
- Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Pesaro
| | - Sergio Signorelli
- Gastroenterology and Gastrointestinal Endoscopy Unit, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Mattia Crespi
- Gastroenterology Department, General Hospital, Sanremo (IM)
| | - Mario Marini
- Gastroenterology and Operative Endoscopy Unit, Santa Maria Alle Scotte Hospital, Siena, Italy
| | - Paolo Ravelli
- Gastroenterology and Gastrointestinal Endoscopy Unit, ASST, Papa Giovanni XXIII, Bergamo, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Department, Azienda Ospedaliera Universitaria di Modena, Sant'Agostino Estense Hospital, Baggiovara (MO)
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Parodi A, Vanbiervliet G, Hassan C, Hebuterne X, De Ceglie A, Filiberti RA, Spada C, Conio M. Colon capsule endoscopy to screen for colorectal neoplasia in those with family histories of colorectal cancer. Gastrointest Endosc 2018; 87:695-704. [PMID: 28554656 DOI: 10.1016/j.gie.2017.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colon capsule endoscopy (CCE) has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk people. Our aim was to prospectively assess the accuracy of CCE as a screening tool in first-degree relatives (FDRs) of people with CRC by using optical colonoscopy (OC) with segmental unblinding as the reference standard. METHODS Consecutive patients admitted with a CRC diagnosis (index cases) were prospectively evaluated and invited to contact their FDRs. Available FDRs were invited to undergo CCE and OC on the following day, with segmental unblinding of CCE results. Sensitivity, specificity, and predictive values/negative predictive values (PPV/NPV) of CCE were assessed for detecting patients with any polyp ≥6 mm and ≥10 mm. RESULTS A total of 177 FDRs (median age 57.0 years, 54.8% female) identified from 211 index cases were included. Both CCE and OC were completed in all the included FDRs. Overall, CCE identified 51 of 56 FDRs with polyps ≥6 mm (sensitivity 91%; 95% CI, 81-96) and correctly classified as negative 107 of 121 participants without lesions ≥6 mm (specificity 88%; 95% CI, 81-93). Per-patient positive and negative predictive values for ≥6 mm lesions were 78% (95% CI, 67-87) and 95% (95% CI, 90-98), respectively. CCE detected 24 of 27 patients with polyps ≥10 mm and correctly classified as negative 142 of 150 patients, corresponding to 89% sensitivity and 95% specificity. Post-CCE referral rates to colonoscopy were 37% and 18%, respectively. CONCLUSIONS CCE is an accurate method to screen FDRs of patients with CRC and could be offered as an alternative to those who decline or are unfit for colonoscopy screening. (Clinical trial registration number: NCT01184781.).
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Affiliation(s)
- Andrea Parodi
- Gastroenterology Department, General Hospital of Sanremo, Sanremo, Italy; Gastroenterology Unit, Ospedale Galliera, Genova, Italy
| | | | - Cesare Hassan
- Gastroenterology Unit, Ospedale Nuovo Regina Margherita, Rome, Italy
| | - Xavier Hebuterne
- Gastroenterology, Hôpital Archet 2, University Hospital of Nice, Nice, France
| | | | - Rosa Angela Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino-IST- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Cristano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Massimo Conio
- Gastroenterology Department, General Hospital of Sanremo, Sanremo, Italy
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Affiliation(s)
| | - Antonella De Ceglie
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | - Mattia Crespi
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | - Massimo Conio
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
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Filiberti RA, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Rosa A, Foti M, Laterza F, D'Onofrio V, Iaquinto G, Conio M. Alcohol consumption pattern and risk of Barrett's oesophagus and erosive oesophagitis: an Italian case-control study. Br J Nutr 2017; 117:1151-1161. [PMID: 28478792 DOI: 10.1017/s0007114517000940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Knowledge about the association between alcohol and Barrett's oesophagus and reflux oesophagitis is conflicting. In this case-control study we evaluated the role of specific alcoholic beverages (red and white wine, beer and liquors) in 339 Barrett's oesophagus and 462 oesophagitis patients compared with 619 endoscopic controls with other disorders, recruited in twelve Italian endoscopic units. Data on alcohol and other individual characteristics were obtained from structured questionnaires. No clear, monotonic significant dose-response relationship was pointed out for red wine. However, a generalised U-shaped trend of Barrett's oesophagus/oesophagitis risk due to red wine consumption particularly among current drinkers was found. Similar results were also found for white wine. Liquor/spirit consumption seemed to bring about a 1·14-2·30 risk excess, although statistically non-significant, for current Barrett's oesophagus/oesophagitis drinkers. Statistically significant decreasing dose-response relationships were found in Barrett's oesophagus for frequency and duration of beer consumption. Similar, but less clear downward tendencies were also found for oesophagitis patients. In conclusion, although often not statistically significant, our data suggested a reduced risk of Barrett's oesophagus and oesophagitis with a low/moderate intake of wine and beer consumption. A non-significant increased risk of Barrett's oesophagus/oesophagitis was observed with a higher intake of any type of heavy alcohol consumption, but no conclusion can be drawn owing to the high number of non-spirit drinkers and to the small number of drinkers at higher alcohol intake levels.
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Affiliation(s)
- Rosa A Filiberti
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Vincenzo Fontana
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Antonella De Ceglie
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
| | - Sabrina Blanchi
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
| | - Enzo Grossi
- 3Medical Department,Bracco Spa,Via E Folli 50,20134 Milan,Italy
| | - Domenico Della Casa
- 4Digestive Endoscopic Surgery,Spedali Civili di Brescia,Piazzale Spedali Civili 1,25123 Brescia,Italy
| | - Teresa Lacchin
- 5Endoscopy,Policlinico San Giorgio,Via Gemelli 10,33170 Pordenone,Italy
| | - Marina De Matthaeis
- 6Gastroenterology and Digestive Endoscopy,Ospedale di Lavagna,ASL 4 Chiavarese,Via Don Bobbio 25,16033 Lavagna,Italy
| | - Orazio Ignomirelli
- 7Endoscopy,IIRCCS,Centro di Riferimento Oncologico di Basilicata,Via Padre Pio 1,85028 Rionero in Vulture,Potenza,Italy
| | - Roberta Cappiello
- 8Gastroenterology,S. Maria degli Angeli Hospital,Via Piave 54,33170 Pordenone,Italy
| | - Alessandra Rosa
- 1Clinical Epidemiology,IRCCS AOU San Martino-IST,Largo R Benzi 10,16132 Genova,Italy
| | - Monica Foti
- 9Gastroenterology,LARC Private Clinic,Cso Venezia 10,10155 Torino,Italy
| | - Francesco Laterza
- 10Department of Internal Medicine,Unit of Endoscopy and Gastroenterology,University Hospital SS.Annunziata, G.D'Annunzio University,Via dei Vestini,66100 Chieti,Italy
| | - Vittorio D'Onofrio
- 11Gastroenterology and Digestive Endoscopy,S. G. Moscati Hospital,Via San Giuseppe Moscati,83100 Avellino,Italy
| | - Gaetano Iaquinto
- 11Gastroenterology and Digestive Endoscopy,S. G. Moscati Hospital,Via San Giuseppe Moscati,83100 Avellino,Italy
| | - Massimo Conio
- 2Gastroenterology,General Hospital,Via G Borea 56,18038 Sanremo,Imperia,Italy
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Affiliation(s)
- Benedetto Mangiavillano
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | - Antonella De Ceglie
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | - Paolo Quilici
- Department of Pathological Anatomy, General Hospital, Sanremo, Italy
| | - Corrado Ruggeri
- Department of Pathological Anatomy, General Hospital, Sanremo, Italy
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14
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De Ceglie A, Hassan C, Mangiavillano B, Matsuda T, Saito Y, Ridola L, Bhandari P, Boeri F, Conio M. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol 2016; 104:138-55. [PMID: 27370173 DOI: 10.1016/j.critrevonc.2016.06.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/23/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022] Open
Abstract
AIM To assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the treatment of colorectal lesions. METHODS A literature search was conducted from January 2000 to May 2015. The main outcomes were: recurrence after "en bloc" and "piecemeal" resection; procedure related adverse events; the EMR endoscopic success rate and the completely eradicated resection rate (R0) after ESD. RESULTS A total of 66 studies were included in the analysis. The total number of lesions was 17950 (EMR: 11.873; ESD: 6077). Recurrence rate was higher in the EMR than ESD group (765/7303l vs. 50/3910 OR 8.19, 95% CI 6.2-10.9 p<0.0001). EMR-en bloc resection was achieved in 6793/10803 lesions (62.8%) while ESD-en bloc resection was obtained in 5500/6077 lesions (90.5%) (OR 0.18, p<0.0001, 95% CI 0.16-0.2). Perforation occurred more frequently in ESD than in EMR group (p<0.0001, OR 0.19, 95% CI 0.15-0.24). CONCLUSIONS Endoscopic resection of large colorectal lesions is safe and effective. Compared with EMR, ESD results in higher "en bloc" resection rate and lower local recurrence rate, however ESD has high procedure-related complication rates.
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Affiliation(s)
| | - Cesare Hassan
- Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Lorenzo Ridola
- Gastroenterology Unit, "Sapienza" University, Rome, Italy
| | - Pradeep Bhandari
- Gastroenterology Department, Portsmouth Hospital NHS Trust, Portsmouth, Hampshire, UK
| | - Federica Boeri
- Gastroenterology Department, General Hospital, Sanremo, Italy
| | - Massimo Conio
- Gastroenterology Department, General Hospital, Sanremo, Italy.
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15
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Mangiavillano B, De Ceglie A, Boeri F, Conio M. Cap-assisted endoscopic mucosal resection of large nonampullary duodenal polyps in MYH-associated polyposis syndrome. Gastrointest Endosc 2016; 83:1038. [PMID: 26551731 DOI: 10.1016/j.gie.2015.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/28/2015] [Indexed: 02/08/2023]
Affiliation(s)
| | - Antonella De Ceglie
- Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, Sanremo, Italy
| | - Federica Boeri
- Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, Sanremo, Italy
| | - Massimo Conio
- Gastroenterology and Gastrointestinal Endoscopy, Borea Hospital, Sanremo, Italy
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16
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Dabizzi E, De Ceglie A, Kyanam Kabir Baig KR, Baron TH, Conio M, Wallace MB. Endoscopic "rescue" treatment for gastrointestinal perforations, anastomotic dehiscence and fistula. Clin Res Hepatol Gastroenterol 2016. [PMID: 26209869 DOI: 10.1016/j.clinre.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Luminal perforations and anastomotic leaks of the gastrointestinal tract are life-threatening events with high morbidity and mortality. Early recognition and prompt therapy is essential for a favourable outcome. Surgery has long been considered the "gold standard" approach for these conditions; however it is associated with high re-intervention morbidity and mortality. The recent development of endoscopic techniques and devices to manage perforations, leaks and fistulae has made non-surgical treatment an attractive and reasonable alternative approach. Although endoscopic therapy is widely accepted, comparative data of the different techniques are still lacking. In this review we describe, benefits and limitations of the current options in the management of patients with perforations and leaks, in order to improve outcomes.
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Affiliation(s)
- Emanuele Dabizzi
- Gastroenterology and Digestive Endoscopy Division, Vita-Salute San Raffaele Univeristy, San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella De Ceglie
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Massimo Conio
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
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17
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Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47:829-54. [PMID: 26317585 DOI: 10.1055/s-0034-1392882] [Citation(s) in RCA: 852] [Impact Index Per Article: 94.7] [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: 02/07/2023]
Abstract
UNLABELLED This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. MAIN RECOMMENDATIONS 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 - 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence).
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Affiliation(s)
- Pedro Pimentel-Nunes
- Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Instituto Portugues de Oncologia, Porto, Portugal
| | - Thierry Ponchon
- Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
| | - Alessandro Repici
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Michael Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Arnaldo Amato
- Gastroenterology Unit, Ospedale Valduce, Como, Italy
| | - Frieder Berr
- University Clinic of Internal Medicine I, Salzburg, Austria
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Massimo Conio
- Department Gastroenterology and Endoscopy, Ospedale di Sanremo, Sanremo, Italy
| | | | - Cord Langner
- Institute of Pathology, Medizinische Universität Graz, Graz, Austria
| | | | - Helmut Messmann
- Department of Internal Medicine III, Klinikum Augsburg, Augsburg, Germany
| | - Mario Morino
- Department of Surgery, University Hospital of Turin, Turin, Italy
| | - Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Hubert Piessevaux
- Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Massimo Rugge
- Department of Pathology, Università di Padova, Padova, Italy
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St. Mark's Hospital & Imperial College, London, UK
| | | | | | - Sergey Kashin
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | | | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Pierre H Deprez
- Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
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18
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Filiberti R, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Foti M, Laterza F, Annese V, Iaquinto G, Conio M. Smoking as an independent determinant of Barrett's esophagus and, to a lesser degree, of reflux esophagitis. Cancer Causes Control 2015; 26:419-29. [PMID: 25555994 DOI: 10.1007/s10552-014-0518-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the role of smoking in Barrett's esophagus (BE) and erosive esophagitis (E) compared to endoscopic controls with no BE or E. Smoking is considered a cause of both BE and E, but results on this topic are quite controversial. METHODS Patients with BE (339), E (462) and controls (619: 280 with GERD (gastroesophageal reflux disease)-negative and 339 with GERD-positive anamnesis) were recruited in 12 Italian endoscopy units. Data were obtained from structured questionnaires. RESULTS Among former smokers, a remarkable upward linear trend was found in BE for all smoking-related predictors. In particular, having smoked for more than 32 years increased the risk more than two times (OR 2.44, 95 % CL 1.33-4.45). When the analysis was performed in the subgroup of subjects with GERD-negative anamnesis, the risk of late quitters (<9 years) passed from OR 2.11 (95 % CL 1.19-3.72) to OR 4.42 (95 % CL 1.52-12.8). A noticeably positive dose-response relationship with duration was seen also among current smokers. As regards E, no straightforward evidence of association was detected, but for an increased risk of late quitters (OR 1.84, 95 % CL 1.14-2.98) in former smokers and for early age at starting (OR 3.63, 95 % CL 1.19-11.1) in GERD-negative current smokers. CONCLUSIONS Smoking seems to be an independent determinant of BE and, to a lesser degree, of E. The elevation in risk is independent from GERD and is already present in light cigarette smokers. Smoking cessation may reduce, but not remove this risk.
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Affiliation(s)
- Rosa Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi, 10, 16132, Genoa, Italy,
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De Ceglie A, Filiberti R, Baron TH, Ceppi M, Conio M. A meta-analysis of endoscopic stenting as bridge to surgery versus emergency surgery for left-sided colorectal cancer obstruction. Crit Rev Oncol Hematol 2013; 88:387-403. [PMID: 23845505 DOI: 10.1016/j.critrevonc.2013.06.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/25/2013] [Accepted: 06/13/2013] [Indexed: 02/06/2023] Open
Abstract
The best approach to resolve colonic obstruction in patients with left-sided colon cancer is not established. In this meta-analysis the efficacy of stenting as bridge-to-surgery was compared to emergency surgery for the management of left-sided colonic obstruction. Fourteen studies (randomized and non controlled studies) were identified, including 405 patients in the stent group and 471 in the emergency group. The difference between proportions was evaluated as effect size (ESi). There was large heterogeneity among the studies. Stenting offered advantages over emergency surgery in terms of increase in primary anastomosis (ES=25.1%, p<0.001), successful primary anastomosis (ES=23.7%, p<0.001), reduction of stoma creation (ES=-27.1%, p=0.03), infections (ES=-7.9%, p=0.006) and other morbidities (ES=-13.4%, p<0.001). The interventions were similar in regards to length of hospitalization, preoperative mortality and long-term survival.
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Affiliation(s)
- Antonella De Ceglie
- Unit of Digestive Endoscopy, IRCCS National Cancer Center Giovanni Paolo II, Bari, Italy
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20
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De Ceglie A, Filiberti R, Blanchi S, Fontana V, Fisher DA, Grossi E, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Casa DD, Foti M, Laterza F, Rosati R, Annese V, Iaquinto G, Conio M. History of cancer in first degree relatives of Barrett's esophagus patients: a case-control study. Clin Res Hepatol Gastroenterol 2011; 35:831-8. [PMID: 21924696 DOI: 10.1016/j.clinre.2011.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/26/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Familial clusters of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) have been reported. This study evaluates the history of cancer in BE patients families. METHODS In two years, patients with BE (272), esophagitis (456) and controls (517) were recruited in 12 Italian Endoscopy Units. Cancer family history in first-degree (FD) relatives was determined by a questionnaire. RESULTS Approximately 53% of BE, 51% of esophagitis, and 48% of controls had at least one relative affected by any type of malignancy. Probands with at least one esophageal or gastric (E/G) cancer-affected relative showed a BE risk which was at least eighty-five percent higher than that of probands without affected relatives. The relative risk of BE was 4.18, 95% CL=0.76-23.04 if a FD relative had early (mean age ≤ 50 years) onset E/G cancer compared to late onset E/G cancer. CONCLUSION In this sample there was no evidence that a family history of cancer was associated with the diagnosis of BE. An intriguing result was the association between the occurrence of E/G cancers at earlier ages (< 50 years) among BE relatives with respect the control group. This could suggest a genetic contribution in onset of these tumors, but the sample was too small to demonstrate a significant association. Further exploration of family history of E/G cancer and a diagnosis of BE in larger samples is warranted.
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Affiliation(s)
- Antonella De Ceglie
- Unit of Digestive Endoscopy, Cancer Institute Giovanni Paolo II, Bari, Italy
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Scotto F, De Ceglie A, Guerra V, Misciagna G, Pellecchia A. Determinants of patient satisfaction survey in a gastrointestinal endoscopy service. ACTA ACUST UNITED AC 2009. [DOI: 10.1108/14777270910952243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ceglie AD, Bilardi C, Blanchi S, Picasso M, Muzio MD, Trimarchi A, Conio M. Acute small bowel obstruction caused by endometriosis: A case report and review of the literature. World J Gastroenterol 2008; 14:3430-4. [PMID: 18528943 PMCID: PMC2716600 DOI: 10.3748/wjg.14.3430] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare (1%-7%). Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction, ranging from 7% to 23% of all cases with intestinal involvement. We report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery, in a woman whose symptoms were not related to menses. Histology of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular alteration. Endometrial lymph node involvement, with a cystic glandular pattern was also detected.
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De Ceglie A, Lapertosa G, Blanchi S, Di Muzio M, Picasso M, Filiberti R, Scotto F, Conio M. Endoscopic mucosal resection of large hyperplastic polyps in 3 patients with Barrett’s esophagus. World J Gastroenterol 2006; 12:5699-704. [PMID: 17007025 PMCID: PMC4088173 DOI: 10.3748/wjg.v12.i35.5699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophago-gastric junction (EGJ) associated with Barrett’s esophagus (BE) with low-grade dysplasia (LGD), by endoscopic mucosal resection (EMR).
METHODS: Cap fitted EMR (EMR-C) was performed in 3 patients with hyperplastic-inflammatory polyps (HIPs) and BE.
RESULTS: The polyps were successfully removed in the 3 patients. In two patients, with short segment BE (SSBE) (≤ 3 cm), the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm x 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous re-epithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR.
CONCLUSION: EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.
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De Ceglie A, Gatteschi B, Blanchi S, Scotto F, Pellecchia A, Conio M. Esophageal granular cell tumor treated by endoscopic mucosal resection. A case report and review of the literature. Dig Dis Sci 2005; 50:1875-9. [PMID: 16187190 DOI: 10.1007/s10620-005-2954-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 01/28/2005] [Indexed: 12/17/2022]
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25
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Ranieri G, Coviello M, Patruno R, Valerio P, Martino D, Milella P, Catalano V, Scotto F, De Ceglie A, Quaranta M, Ribatti D, Pellecchia A. Vascular endothelial growth factor concentrations in the plasma-activated platelets rich (P-APR) of healthy controls and colorectal cancer patients. Oncol Rep 2004; 12:817-20. [PMID: 15375505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Vascular endothelial growth factor (VEGF) is known to play a key role in tumour angiogenesis. Our preliminary published data suggest that plasma-activated platelets rich (P-APR) rather than other plasma compartments (i.e. plasma, plasma-platelets poor) or serum is the more suitable blood fraction for measuring VEGF in a miscellaneous series of gastrointestinal cancer patients. The aim of this confirmatory study was to assess VEGF in P-APR blood compartments of 30 healthy control subjects (HCS) and a homogeneous series of 62 colorectal cancer patients (CRCP), prospectively collected, to evaluate its possible clinical-biological significance. Samples of plasma (P) in both sodium citrate (SC) and sodium citrate-theophylline-adenosine-dipyridamole (CTAD) were collected from venous blood. After the centrifugation and separation methods VEGF levels were detected by ELISA in P-APR. The best differentiation between HCS and CRCP in VEGF level was seen for P-APRCTAD (median value: 255 pg/ml versus 142 pg/ml; p=0.000 by Mann-Whitney U test). No significant correlation among the P-APR VEGF concentrations and the main clinical pathological features was found. We suggest that P-APRCTAD fraction, obtained according to well standardised conditions, could represent the suitable blood compartment for the assessment of VEGF as marker of malignant intestinal transformation.
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Affiliation(s)
- Girolamo Ranieri
- Department of Experimental Oncology, National Cancer Institute, I-Bari 70126, Italy.
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Ranieri G, Coviello M, Patruno R, Valerio P, Martino D, Milella P, Catalano V, Scotto F, De Ceglie A, Quaranta M, Ribatti D, Pellecchia A. Vascular endothelial growth factor concentrations in the plasma-activated platelets rich (P-APR) of healthy controls and colorectal cancer patients. Oncol Rep 2004. [DOI: 10.3892/or.12.4.817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ugenti I, De Ceglie A, Ferrarese F, Rizzo C, Manta R, Fabiano G. [Gastric anisakidosis: personal experience]. Chir Ital 2004; 56:301-5. [PMID: 15152528] [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: 04/29/2023]
Abstract
Anisakidosis is a parasitic disease of the human gastrointestinal tract caused by ingestion of marine nematode larvae such as anisakis simplex or, rarely, Pseudoterranova, present in raw or undercooked fish. Frequent sites of involvement by anisakis are the stomach, small intestine, rarely the colon, or the peritoneum, liver, pancreas, lung and tonsils, anisakidosis is a self-limiting disease; the symptoms arise 12-24 hours after ingesting raw fish and include nausea, diarrhoea, and severe abdominal pain, but also anaphylactic reactions. At the site of penetration, anisakis causes marked oedema, eosinophilic infiltration and granuloma formation. There are haematological abnormalities such as marked leukocytosis of the peripheral blood, eosinophilia, and positive PCR and serum antibodies to the larva's surface antigens. The diagnosis of anisakidosis can be made by endoscopy, radiology and US, but the disease is often diagnosed at surgical intervention. In the gastric form of anisakidosis, EGIDS has both a diagnostic role and a therapeutic one because it is possible to remove the worm using biopsy forceps. We report on one case of gastric anisakidosis, in a women, hospitalised for intense epigastric pain and vomiting after ingesting raw fish. She underwent gastroscopy. A worm was extracted from the gastric mucosa using biopsy forceps. This was followed by clinical improvement. The worm was identified by its macroscopic and microscopic characteristics as an anisakis larva. At laboratory examination, marked leukocytosis and eosinophilia of the patient's peripheral blood were observed 3-4 days after ingestion of anisakis.
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Affiliation(s)
- Ippazio Ugenti
- Sezione di Chirurgia Generale, Dipartimento di Scienze Chirurgiche Generali e Specialistiche-Università degli Studi di Bari
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