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Mangiavillano B, Facciorusso A, Di Matteo FM, Barbera C, Larghi A, Rizzatti G, Carrara S, Lisotti A, Fusaroli P, De Luca L, Di Leo M, Conti Bellocchi MC, Spadaccini M, Dabizzi E, Auriemma F, Stigliano S, Ramai D, Calabrese F, Manfrin E, Paduano D, Hassan C, Repici A, Crinó SF. Establishing the optimal number of passes during EUS-FNB for diagnosis of pancreatic solid lesions: Prospective multicenter study. Endosc Int Open 2024; 12:E467-E473. [PMID: 38585018 PMCID: PMC10997423 DOI: 10.1055/a-2236-7654] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 04/09/2024] Open
Abstract
Background and study aims The optimal number of needle passes during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is not yet established. We aimed to perform a per-pass analysis of the diagnostic accuracy of EUS-FNB of solid pancreatic lesions using a 22G Franseen needle. Patients and methods Consecutive patients with solid pancreatic lesions referred to 11 Italian centers were prospectively enrolled. Three needle passes were performed; specimens were collected after each pass and processed individually as standard histology following macroscopic on-site evaluation (MOSE) by the endoscopist. The primary endpoint was diagnostic accuracy of each sequential pass. Final diagnosis was established based on surgical pathology or a clinical course of at least 6 months. Secondary endpoints were specimen adequacy, MOSE reliability, factors impacting diagnostic accuracy, and procedure-related adverse events. Results A total of 504 samples from 168 patients were evaluated. Diagnostic accuracy was 90.5% (85.0%-94.1%) after one pass and 97.6% (94.1%-99.3%) after two passes ( P =0.01). Similarly, diagnostic sensitivity and sample adequacy were significantly higher adding the second needle pass (90.2%, 84.6%-94.3% vs 97.5%, 93.8%-99.3%, P =0.009 and 91.1%, 85.7%-94.9% vs 98.2%, 95.8%-99.3%, P =0.009, one pass vs two passes, respectively). Accuracy, sensitivity, and adequacy remained the same after the third pass. The concordance between MOSE and histological evaluation was 89.9%. The number of passes was the only factor associated with accuracy. One case of mild acute pancreatitis (0.6%) was managed conservatively. Conclusions At least two passes should be performed for the diagnosis of solid pancreatic lesions. MOSE is a reliable tool to predict the histological adequacy of specimens.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Italy
| | | | | | - Carmelo Barbera
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara di Modena (Mo), Italy
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unita Sanitaria Locale di Modena, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Carrara
- Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | - Luca De Luca
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Milena Di Leo
- Division of Gastroenterology, Digestive Endoscopy Unit, Rozzano (Milan), Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | | | - Marco Spadaccini
- Digestive Endoscopy Unit, Division of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Italy
| | - Emanuele Dabizzi
- Digestive Endoscopy, Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Modena, Modena, Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Italy
- Gastroenterologia, Università Federico II, Napoli, Italy
| | - Serena Stigliano
- Operative Endoscopy Department, Campus Bio-Medico University, Roma, Italy
| | - Daryl Ramai
- Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, United States
| | - Federica Calabrese
- Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Varese, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, University of Verona Hospital Trust P.Le L.A. Scuro 10, Verona, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefano Francesco Crinó
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
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Norsa L, Morotti F, Mantegazza C, Meroni M, Deganello Saccomani M, Banzato C, Parma B, Franchino G, Di Nardo G, Sansotta N, Orizio P, Dabizzi E, Fava GR, Chiaro A, Pellegrino M, Fornaroli F, Pizzol A, Strisciuglio C, Pacenza C, Ruggiero C, Russo G, Oliva S. Mobile Health technology in pediatric esophagogastroduodenoscopy quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition. Gastrointest Endosc 2024:S0016-5107(24)00180-9. [PMID: 38513921 DOI: 10.1016/j.gie.2024.03.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Upper endoscopy procedures (UEP, esophagogastroduodenoscopy [EGDS] and retrograde endoscopic retrograde cholangiography [ERCP]) are an established standard of care in pediatric gastroenterology. The Pediatric endoscopy quality improvement network (PEnQuIN) recently published its pediatric-specific endoscopy quality guidelines. This study, initiated by the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), aims to evaluate the adherence of Italian Pediatric Endoscopy Centers to these established quality standards. METHODS Conducted between April 2019 and March 2021, this nationwide study utilized a smartphone app-based approach. Data encompassing pediatric endoscopy facilities, patient profiles, endoscopy indications, 17 procedure-related PEnQuIN indicators, and a GHAA-9m patient satisfaction questionnaire were systematically collected. RESULTS A comprehensive analysis of 3582 procedures from 24 PECs revealed that 2654 (76%) were UEP. The majority of centers (75%) involved more than one operator, with 9 PEC incorporating adult endoscopists, responsible for 5% of UEPs. Overall, adherence to quality standards was good; however, areas of improvement include sub-optimal reporting of sedation details, adherence to disease-specific guidelines, and patient satisfaction questionnaire completeness (56%). The complication rate aligned with literature standards (1%), and patient satisfaction was generally high. A noteworthy observation was a 30% decrease monthly reporting rate and a shift in disease-specific patterns following the COVID-19 outbreak. CONCLUSIONS Pediatric UEP practices in Italy adhere well to established quality standards. Emphasizing the adoption of disease-specific guidelines is crucial for optimizing resources, enhancing diagnostic accuracy, and minimizing unnecessary procedures. Prioritizing patient satisfaction is important for immediate enhancements in practice as well as for future research endeavors.
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Affiliation(s)
- Lorenzo Norsa
- Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
| | - Francesco Morotti
- Division of Pediatrics, Department of Health Sciences, Università degli Studi del Piemonte Orientale, Novara, Italy; Neonatology and Neonatal Intensive Care Unit, Spedali Civili Children's Hospital, Brescia, Italy
| | - Cecilia Mantegazza
- Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Milena Meroni
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | | | - Claudia Banzato
- Department of Pediatrics, Woman's & Child's University Hospital of Verona, Italy
| | - Barbara Parma
- Department of Pediatric, Mariani Foundation Center for Fragile Child. ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Giulia Franchino
- Department of Pediatric, Mariani Foundation Center for Fragile Child. ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Naire Sansotta
- Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Giorgio Raffaele Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Chiaro
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Pizzol
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Caterina Pacenza
- Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
| | - Cosimo Ruggiero
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Giusy Russo
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
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Cennamo V, Botter A, Landi S, Graziosi F, Bassi M, Dabizzi E, Ghersi S, Cerone G, Bonfiglioli R. Can single-use versus standard duodenoscope improve ergonomics in ERCP? A comparative, simulation-based pilot study. Endosc Int Open 2024; 12:E419-E427. [PMID: 38504744 PMCID: PMC10948267 DOI: 10.1055/a-2231-7393] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 03/21/2024] Open
Abstract
Background and study aims Musculoskeletal disorders (MSDs) and injuries (MSIs) are frequent in gastrointestinal endoscopy. The aim of this study was to assess potential ergonomic advantages of a lighter single-use duodenoscope compared with a standard reusable one for endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP). Methods Three experienced endoscopists performed an ergonomic, preclinical, comparative protocol-guided simulation study of a single-use and a standard reusable duodenoscope using an anatomic bench model. Surface EMG signals from left forearm and arm muscles were recorded. A commercial inertial sensor-based motion capture system was applied to record body posture as well. Results A significant lowering of root mean square amplitude and amplitude distribution of biceps brachii signal (ranging from 13% to 42%) was recorded in all the participants when using a single-use duodenoscope compared with a reusable one. An overall reduction of muscle activation amplitude and duration was also associated with the single-use duodenoscope for forearm muscles, with different behaviors among subjects. Participants spent most of the time in wrist extension (> 80%) and ulnar deviation (> 65%). A consistent pattern of functional range of motion employed for completing all procedures was observed. Conclusions Our study showed that a lighter scope has a promising effect in reducing upper arm muscle activity during ERCP with potential benefit on musculoskeletal health in the ERCP setting.
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Affiliation(s)
- Vincenzo Cennamo
- Department of Gastroenterology and Interventional Endoscopy, Bellaria-Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Alberto Botter
- Department of Electronics and Telecommunication, Politecnico di Torino, Turin, Italy PoliToBIOMed Lab, Politecnico di Torino, Laboratory for Engineering of the Neuromuscular System (LISiN), Torino, Italy
| | - Stefano Landi
- Department of Gastroenterology and Interventional Endoscopy, Bellaria-Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Francesca Graziosi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Occupational Medicine Unit, bologna, Italy
| | - Marco Bassi
- Department of Gastroenterology and Interventional Endoscopy, Bellaria-Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Emanuele Dabizzi
- Department of Gastroenterology and Interventional Endoscopy, Bellaria-Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Stefania Ghersi
- Department of Gastroenterology and Interventional Endoscopy, Bellaria-Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Giacinto Cerone
- Department of Electronics and Telecommunication, Politecnico di Torino, Turin, Italy PoliToBIOMed Lab, Politecnico di Torino, Laboratory for Engineering of the Neuromuscular System (LISiN),, Torino, Italy
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Occupational Medicine Unit, bologna, 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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Bassi M, Righi E, Dabizzi E, Ghersi S, Apolito P, Landi S, Cennamo V. Gastric pyogenic granuloma: rare entity, usual therapy. Endoscopy 2022; 54:E635-E636. [PMID: 35120385 DOI: 10.1055/a-1730-4529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Marco Bassi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Elisa Righi
- Anatomic Pathology Unit, AUSL Bologna, Bologna Metropolitan Department of Pathology, Bologna, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Stefania Ghersi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Pasquale Apolito
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Stefano Landi
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy
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Binda C, Dabizzi E, Sinagra E, Fornelli A, Saragoni L, Cennamo V, Anderloni A, Fabbri C. Micro-Biopsy Forceps in the Assessment of Peritoneal Carcinomatosis: A Possible New Indication? Clin Endosc 2021; 54:613-617. [PMID: 33765374 PMCID: PMC8357587 DOI: 10.5946/ce.2020.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is defined as a metastatic involvement of the peritoneum by several other primary sites and it is characterized by a marked worsening of prognosis, with limited treatment opportunities. Subsequently, PC should be ruled out before any invasive treatment is administered. A new through-the-needle micro-biopsy forceps (MF) was recently introduced that permits micro-histology cores. In this case series, we evaluated the feasibility of MF in the assessment of PC to complete patient diagnostic work-ups. Five consecutive patients referred for endoscopic ultrasound staging were sampled using MF. Sampling was feasible in all patients with a technical success of 100%. No adverse events were reported in any cases. This technique was feasible and safe with a technical success rate of 100%. It permitted sampling of peritoneal irregularity, obtained high-quality tissue fragments in all cases, and enabled an additional assessment, i.e., immunohistochemical staining.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Emanuele Sinagra
- Servizio di Endoscopia Digestiva, Fondazione Istituto G. Giglio di Cefalù, Cefalù (PA), Italy.,Section of Nutrition, Istituto Euromediterraneo di Scienze e Tecnologia (IEMEST), Palermo, Italy
| | - Adele Fornelli
- Pathology Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, AUSL Romagna, Forlì, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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8
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Bassi M, Ferrari M, Ghersi S, Livi V, Dabizzi E, Trisolini R, Cennamo V. Dual aspect endoscopic evidence of tuberculous bronchoesophageal fistula: successful closure from the esophagus. Endoscopy 2020; 52:E378-E380. [PMID: 32219786 DOI: 10.1055/a-1138-0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Affiliation(s)
- Marco Bassi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Marco Ferrari
- Interventional Pulmonology Unit, Cardiothoracic Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefania Ghersi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Vanina Livi
- Interventional Pulmonology Unit, Cardiothoracic Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.,Interventional Pulmonology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Cardiothoracic Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.,Interventional Pulmonology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Vincenzo Cennamo
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
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9
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Cennamo V, Bassi M, Landi S, Apolito P, Ghersi S, Dabizzi E, Polifemo AM, Gizzi G, Guicciardi S, Indelicato G, Cascone C, Tovoli D, Tumietto F, Viale P, Jovine E, Repici A. Redesign of a GI endoscopy unit during the COVID-19 emergency: A practical model. Dig Liver Dis 2020; 52:1178-1187. [PMID: 32425734 PMCID: PMC7229969 DOI: 10.1016/j.dld.2020.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
The pandemic diffusion of the SARS-CoV-2 infection throughout the world required measures to prevent and strategies to control the infection, as well as the reallocation of the hospital structures in order to take care of an increased number of infected patients. Endoscopy Units should be able to perform endoscopic procedures on COVID-19 infected as well as on noninfected patients. The aim of this manuscript is to propose a model for a fast reorganization of the endoscopy department environment in order to safely perform endoscopic procedures in this Pandemic COVID-19 scenario, according to the current advices given by the Scientific Societies.
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Affiliation(s)
- Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy.
| | - Marco Bassi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Stefano Landi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Pasquale Apolito
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Stefania Ghersi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Anna Maria Polifemo
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | | | - Stefano Guicciardi
- Health Directorate, Local Health Authority Unit of Bologna, Bologna, Italy
| | - Giuseppe Indelicato
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Carmelo Cascone
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Daniele Tovoli
- Director of Prevention and Protection Service, Local Health Authority of Bologna, Bologna, Italy
| | - Fabio Tumietto
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elio Jovine
- Department of Surgery, Local Health Authority of Bologna, Bologna, Italy
| | - Alessandro Repici
- Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano (Milan)
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10
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Cennamo V, Landi S, Dabizzi E. What is Best Testing Ground for Clinical Evaluation of Single-use Duodenoscopes? Clin Gastroenterol Hepatol 2020; 18:1899-1900. [PMID: 32068152 DOI: 10.1016/j.cgh.2020.02.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Stefano Landi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
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11
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Testoni PA, Fanti L, Antonucci E, Dabizzi E. Inverted "upside-down" esophageal fully-covered self-expanding metal stent is effective for temporary treatment of colorectal strictures: a pilot case series. Endosc Int Open 2019; 7:E818-E823. [PMID: 31198846 PMCID: PMC6561771 DOI: 10.1055/a-0869-7270] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/06/2018] [Indexed: 12/02/2022] Open
Abstract
Background and study aims Placement of a fully-covered self-expanding metal stent (FC-SEMS) is a valid alternative for benign and malignant colorectal strictures treatment. Despite the reportedly high technical success rate, stenting is still challenging, due to high rates of adverse events. Migration still represents the main issue, although several anti-migration systems have been proposed. Patients and methods Before insertion, esophageal Beta Niti-S FC-SEMSs were inverted and reloaded on the deployment device to invert the proximal and distal parts of the stent, with the largest end placed above the stricture to contrast peristaltic activity. The inverted "upside-down" Beta Niti-S FC-SEMS was placed in five consecutive patients: four pts with benign anastomotic stricture unresponsive to repeated balloon dilation and persisting for at least 10 weeks, and one with malignant rectal neoplasia. In five patients, six inverted FC-SEMSs were placed. Results The modified FC-SEMS did not migrate in 5/6 cases (83 %). Stent migration occurred in the neoplastic case, induced by neoadjuvant chemotherapy. The "upside-down" esophageal Beta Niti-S FC-SEMS stayed in place for an average of 6 weeks, achieving resolution of stricture in all patients but one, who required an additional stent placement, due to incomplete stricture resolution after 6 weeks. Conclusion The inverted esophageal Beta Niti-S FC-SEMSs proved to be effective in treating colorectal stricture in all cases, with no spontaneous migration or significant side effects, and achieved resolution of strictures where a traditional approach, recommended by guidelines, failed.
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Affiliation(s)
- Pier Alberto Testoni
- Gastroenterology and Gastrointestinal Endoscopy Division, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Division, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Antonucci
- Division of Surgical and Gastrointestinal Products, Euromedical s.r.l., San Zeno Naviglio, Italy
| | - Emanuele Dabizzi
- Pancreato-Biliary Endoscopy and Ultrasonography Division, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy,Corresponding author Emanuele Dabizzi, MD Pancreato-Biliary Endoscopy and Ultrasonography DivisionSan Raffaele Scientific InstituteVita-Salute San Raffaele UniversityVia Olgettina 6020132 MilanItaly+39-02-2643-5609
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12
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Kovacevic B, Karstensen JG, Havre RF, Pham KDC, Giovannini M, Dabizzi E, Arcidiacono P, Santo E, Sequeiros EV, Klausen P, Rift CV, Hasselby JP, Toxværd A, Kalaitzakis E, Hansen CP, Vilmann P. Initial experience with EUS-guided microbiopsy forceps in diagnosing pancreatic cystic lesions: A multicenter feasibility study (with video). Endosc Ultrasound 2018; 7:383-388. [PMID: 30168479 PMCID: PMC6289018 DOI: 10.4103/eus.eus_16_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Cystic lesions of the pancreas represent a diagnostic dilemma. Recently, a through-the-needle microbiopsy forceps has become available, enabling procurement of EUS-guided histological specimens from the pancreatic cyst wall. The aim of this study was to evaluate the use of this novel instrument in a multicenter clinical setting. Patients and Methods Patients referred for EUS evaluation of pancreatic cysts and attempted EUS-guided microbiopsy was included retrospectively from six international tertiary centers. Patient's demographics, EUS findings, technical and clinical success, and histopathological results were recorded. Results : A total of 28 patients were identified. We report a technical success rate of 85.7% (n = 24). Biopsies were generally of good quality and contributed to the diagnosis in 20 patients (clinical success of 71.4%). Three adverse events were recorded (10.7%). Conclusions The use of the microbiopsy forceps is feasible with acceptable rates of technical and clinical success. Prospective studies are warranted to determine the diagnostic potential compared to the other modalities. However, the results from this preliminary study are promising.
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Affiliation(s)
- Bojan Kovacevic
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - John Gásdal Karstensen
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev; Department of Gastrointestinal Surgery, Slagelse Hospital, Slagelse, Denmark
| | | | | | - Marc Giovannini
- Department of Hepato-Gastroenterology, Institut Paoli Calmettes, Marseille, France
| | - Emanuele Dabizzi
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Milan, Italy
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Pia Klausen
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Charlotte Vestrup Rift
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Toxværd
- Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Gastrointestinal Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Capone P, Petrone MC, Dabizzi E, Mariani A, Arcidiacono PG. Endoscopic ultrasound-guided drainage of a pancreatic fluid collection using a novel lumen-apposing metal stent complicated by stent occlusion. Endoscopy 2017; 48 Suppl 1:E203. [PMID: 27285655 DOI: 10.1055/s-0042-108572] [Citation(s) in RCA: 2] [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: 12/13/2022]
Affiliation(s)
- Pietro Capone
- Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Emanuele Dabizzi
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
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14
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Lami G, Galli A, Macrì G, Dabizzi E, Biagini MR, Tarocchi M, Messerini L, Valanzano R, Milani S, Polvani S. Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy (fujinon intelligent color enhancement) in dysplasia evaluation. World J Clin Oncol 2017; 8:168-177. [PMID: 28439498 PMCID: PMC5385438 DOI: 10.5306/wjco.v8.i2.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/26/2016] [Revised: 12/11/2016] [Accepted: 03/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients.
METHODS Seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope (for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps < 6 mm. Formalin-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAP-associated fundic gland polyps.
RESULTS Sixty-nine (90.8%) patients had gastric polyps (34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52 (68.4%) in duodenum (7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the II/III portion.
CONCLUSION FICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient’s prognosis and treatment strategies.
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Affiliation(s)
- Emanuele Dabizzi
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
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Abstract
OPINION STATEMENT The recent advances in enteral stents design and composition introduced novel usage and indications, heading to a continuous addition of prostheses application in clinical practice. Since the first use to palliate malignant diseases, improving patient's quality of life, in the last decades we assisted to a large spread, often becoming a first choice treatment in GI disorders. Indeed, the clinical indication of gastrointestinal stents includes endoscopic treatment of fistula and leaks besides the well-established role of restoring lumen patency in benign and malignant conditions. Several different kind of stents have been developed, each one with its own characteristics and benefits, including self-expandable plastic and metal stents, available as uncovered, partially covered, and fully covered as well as biodegradable stents. Recently, new drug-eluting stents, working both as palliative treatment and as local chemotherapy, are under evaluation. This review aims to critically evaluate the most recently published literature about enteral stents and to address endoscopists' choice for a better patient management.
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Affiliation(s)
- Emanuele Dabizzi
- Pancreato-Biliary Endoscopy Division and Endosonography Division, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy Division and Endosonography Division, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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17
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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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18
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Fanti L, Gemma M, Agostoni M, Rossi G, Ruggeri L, Azzolini ML, Dabizzi E, Beretta L, Testoni PA. Target Controlled Infusion for non-anaesthesiologist propofol sedation during gastrointestinal endoscopy: The first double blind randomized controlled trial. Dig Liver Dis 2015; 47:566-71. [PMID: 25840875 DOI: 10.1016/j.dld.2015.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Target Controlled Infusion is a sophisticated tool for providing optimal sedation regimen avoiding under or oversedation in gastrointestinal endoscopy. AIMS To compare standard moderate sedation vs. non-anaesthesiologist-administered propofol sedation during gastrointestinal endoscopy. METHODS Randomized controlled trial of 70 consecutive colonoscopies and 70 consecutive esophagogastroduodenoscopies (EGD). Standard group (n=70), received fentanyl (1 μg/kg)+midazolam (0.03-0.04 mg/kg) or midazolam only; propofol group (n=70), received fentanyl (1 μg/kg)+propofol Target Controlled Infusion (1.2-1.6 μg/ml) or propofol Target Controlled Infusion only. Discharge time, endoscopist satisfaction and patient satisfaction were recorded in all endoscopies. RESULTS Colonoscopy: discharge time was significantly shorter in the propofol than the standard group (1.1 ± 0.3 vs. 5 ± 10.2 min, respectively; P=0.03). Endoscopist satisfaction was significantly higher (98.3 ± 11.4/100 vs. 87.2±12/100; P=0.001); patient satisfaction was significantly higher (95 ± 9.3/100 vs. 85.5 ± 14.4/100; P=0.002) in the propofol compared to the standard group. EGD: discharge time was not significantly different in the propofol and standard groups (1.1 ± 0.7 vs. 3.9 ± 9.2 min, respectively; P=0.146). Endoscopist satisfaction was significantly higher (92.7 ± 14.3/100 vs. 82.8 ± 21.2/100; P=0.03); patient satisfaction was significantly higher (93.8 ± 18.2/100 vs. 76.5 ± 25.2/100; P=0.003). In the propofol group 94.3% of patients vs. 71.4% of patients in standard group asked to receive the same sedation in the future (P=0.021). CONCLUSION Target Controlled Infusion is a promising method for non-anaesthesiologist-administered propofol sedation.
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Affiliation(s)
- Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy.
| | - Marco Gemma
- Department of Anesthesiology, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Massimo Agostoni
- Department of Anesthesiology, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Gemma Rossi
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Laura Ruggeri
- Department of Anesthesiology, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Maria Luisa Azzolini
- Department of Anesthesiology, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Emanuele Dabizzi
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Luigi Beretta
- Department of Anesthesiology, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
| | - Pier Alberto Testoni
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientific Institute San Raffaele, Milan, Italy
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Bertani H, Frazzoni M, Dabizzi E, Pigò F, Losi L, Manno M, Manta R, Bassotti G, Conigliaro R. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci 2013; 58:188-93. [PMID: 22875309 DOI: 10.1007/s10620-012-2332-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 05/03/2012] [Accepted: 07/18/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope. AIMS Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett's esophagus (BE) participating in a surveillance program. METHODS Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist. RESULTS Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10%) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42%) patients; dysplasia was confirmed in 14 cases (28%) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100%, respectively. CONCLUSIONS Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.
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Affiliation(s)
- Helga Bertani
- Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy.
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20
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Othman MO, Patel M, Dabizzi E, Asbun HJ, Stauffer J, Wallace MB, Woodward TA, Raimondo M. Carcino Embryonic Antigen and long-term follow-up of mucinous pancreatic cysts including intraductal papillary mucinous neoplasm. Dig Liver Dis 2012; 44:844-8. [PMID: 22789399 DOI: 10.1016/j.dld.2012.06.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/05/2012] [Accepted: 06/11/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The utility of Carcino Embryonic Antigen (CEA) in differentiating malignant from benign pancreatic cysts is controversial. We sought to examine the role of CEA in differentiating benign from malignant cysts and its utility in progression of cyst size in follow-up. METHODS Retrospective chart review of patients who underwent Endoscopic Ultrasound with Fine Needle Aspiration for mucinous cysts between 1998 and 2010. CEA was measured in benign and malignant mucinous cysts. Coefficient of determination (R(2)) was used to measure the association between change in cyst size and CEA. Mann-Whitney test was used to compare the median values of CEA. RESULTS 143 patients (38.4% males) were included (mean age 68.9 ± 0.8 years). 105 patients had intra-cystic CEA measured. 63 patients underwent surgery while 80 patients were in the follow-up group. In the surgical group, median CEA value for benign and malignant mucinous neoplasms was 796 and 438 ng/ml, respectively (p=0.79). The median follow-up was 21 months. There was no correlation between CEA level and progression in cyst size in patients who had >6 months of follow-up, R(2)=0.0002. Malignant transformation was observed in 5 (5.9%) patients. CONCLUSION CEA level was not predictive of malignant cyst nor cyst size progression over follow-up.
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Affiliation(s)
- Mohamed O Othman
- Department of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, United States
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Manno M, Pigò F, Manta R, Barbera C, Bertani H, Mirante VG, Dabizzi E, Caruso A, Olivetti G, Hassan C, Zullo A, Conigliaro R. Bowel preparation with polyethylene glycol electrolyte solution: optimizing the splitting regimen. Dig Liver Dis 2012; 44:576-9. [PMID: 22456624 DOI: 10.1016/j.dld.2012.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/06/2012] [Accepted: 02/19/2012] [Indexed: 12/11/2022]
Abstract
AIM Quality of bowel cleansing significantly increases the shorter the time between bowel solution intake and endoscopic examination. We tested the efficacy and patient tolerability following a modified polyethylene glycol electrolyte (PEG) splitting regimen. METHODS This was a prospective, single-blind, randomized, study. Patients were assigned to receive either PEG 4 L the afternoon before colonoscopy or PEG 3 L the day before and 1 L 3h before the procedure the day of colonoscopy. RESULTS The study population consisted of 336 patients, including 168 participants in each study arm. Although the bowel preparation quality was similarly quoted as excellent/good following the split and full regimen (95.2% vs 92.8%; p=0.3), a significant (p<0.0001) shift from good towards an excellent preparation (26.8% vs 68.4%) was observed following the split regimen as compared to the full regimen (55.4% vs 37.5%). The incidence of side-effects did not differ. When patients were asked about a future preparation if needed, 69% and 31% following the split and full regimen, respectively, declared to accept again the same preparation, the difference being statistically significant (p<0.001). CONCLUSIONS Our data found that an excellent bowel cleansing could be frequently achieved by simply modifying the split regimen from the standard PEG 2 plus 2 L to 3 plus 1 L.
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Affiliation(s)
- Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S.Agostino-Estense - Baggiovara di Modena, Modena, Italy.
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Manno M, Barbera C, Bertani H, Manta R, Mirante VG, Dabizzi E, Caruso A, Pigo F, Olivetti G, Conigliaro R. Single balloon enteroscopy: Technical aspects and clinical applications. World J Gastrointest Endosc 2012; 4:28-32. [PMID: 22347529 PMCID: PMC3280352 DOI: 10.4253/wjge.v4.i2.28] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/16/2012] [Accepted: 02/06/2012] [Indexed: 02/05/2023] Open
Abstract
The small bowel has long been considered a black box for endoscopists because of its long length and the presence of multiple complex loop. Most of the small bowel is inaccessible by traditional endoscopic means. In addition, radiographic studies have significant limitations with regard to diagnostic yield, and surgery is an invasive alternative. This limitation was overcome through the development of balloon enteroscopy that becomes established throughout the world for diagnostic and therapeutic examinations of the small bowel. The single-balloon enteroscope (SBE) system (Olympus, Tokyo, Japan) was introduced into the commercial market in 2007. Several study demonstrated its efficacy and safety. Early reports on the use of single-balloon enteroscopy have suggested a high diagnostic yield and similar therapeutic potential to that of the double-balloon endoscope. SBE is viable technique for in the management of small bowel disease. Technically, it is easy to perform, may be efficient, and in the literature data available, seems to provide high diagnostic and therapeutic yield.
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Affiliation(s)
- Mauro Manno
- Mauro Manno, Carmelo Barbera, Helga Bertani, Raffaele Manta, Vincenzo Giorgio Mirante, Emanuele Dabizzi, Angelo Caruso, Flavia Pigo, Giampiero Olivetti, Rita Conigliaro, Gastroenterology and Digestive Endoscopy Unit, New S. Agostino Estense Civil Hospital, 41126 Baggiovara di Modena, Italy
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Dabizzi E, Panossian A, Raimondo M. Management of pancreatic neuroendocrine tumors. MINERVA GASTROENTERO 2010; 56:467-479. [PMID: 21139544] [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: 05/30/2023]
Abstract
Neuroendocrine tumors are a heterogeneous group of rare tumors originating from neuroendocrine cells with secretory characteristics, and are primarily located in gastric, duodenal, pancreatic, and small and large bowel mucosa. Due to their extremely variable biologic and clinical behaviour, diagnosis is often delayed after a prolonged workup. Many advances have been made in recent years in the diagnosis, characterization, and treatment of neuroendocrine tumors. This review focuses on pancreatic neuroendocrine tumors, discussing the relatively new, multidisciplinary approach to their management. A Pubmed search was performed, limited to papers published within the last five years, using the key words NETs, pancreatic NETs, pancreatic tumors, diagnosis, imaging, nuclear imaging, endoscopy, endoscopic ultrasound, and biochemical markers.
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Affiliation(s)
- E Dabizzi
- Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
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Manno M, Barbera C, Dabizzi E, Mussetto A, Conigliaro R. Safety of single-balloon enteroscopy: our experience of 72 procedures. Endoscopy 2010; 42:773; author reply 774. [PMID: 20806161 DOI: 10.1055/s-0030-1255599] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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