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Binda C, Perini B, Coluccio C, Giuffrida P, Fabbri S, Gibiino G, Vizzuso A, Giampalma E, Fabbri C. Metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off pancreatic necrosis. Minerva Surg 2024; 79:183-196. [PMID: 38127434 DOI: 10.23736/s2724-5691.23.10132-8] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Pancreatic fluid collections (PFCs) are one of the local complications of acute pancreatitis and include walled-off pancreatic necrosis (WOPN), which are complex entities with challenging management. The infection of pancreatic necrosis leads to a poorer prognosis, with a growth of the mortality rate up to 30%. The primary strategy for managing PFCs is a minimally invasive step-up approach, with endosonography-guided transmural drainage and debridement as the preferred and less invasive method. Percutaneous drainage (PCD) can be the technique of choice when endoscopic drainage is not feasible, for example for early PFCs without a mature wall or for the anatomic location and extension to the paracolic gutter of the collection. As PCD alone may be ineffective, especially when a great amount of necrosis is present, a percutaneous endoscopic necrosectomy (PEN) has been proposed, showing interesting results. The technique consists of the placement of an esophageal fully or partially covered self-expandable metal stent (SEMS) percutaneously into the collection and a direct debridement can be performed using a flexible endoscope through the SEMS. In this review, we will discuss about the role of metal stent and PEN for the management of complex walled-off pancreatic necrosis.
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Affiliation(s)
- Cecilia Binda
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Barbara Perini
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy -
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, Padua, Italy
| | - Chiara Coluccio
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Paolo Giuffrida
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
- Section of Gastroenterology and Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Stefano Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Giulia Gibiino
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Antonio Vizzuso
- Unit of Radiology, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Emanuela Giampalma
- Unit of Radiology, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
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Binda C, Dajti E, Giuffrida P, Trebbi M, Coluccio C, Cucchetti A, Fugazza A, Perini B, Gibiino G, Anderloni A, Repici A, Fabbri C. Efficacy and safety of endoscopic ultrasound-guided hepatico-gastrostomy: a meta-regression analysis. Endoscopy 2024. [PMID: 38447958 DOI: 10.1055/a-2282-3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND STUDY AIM EUS-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of the study were to provide a systematic review with meta-analysis and meta-regression of features and outcomes of this procedure. METHODS MEDLINE, Scopus, Web-of-Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of proportions and meta-regression of potential modifiers of the main outcome measures were applied. The main outcome was technical success. Secondary outcomes were clinical success and procedure-related adverse events (AEs). RESULTS Thirty-three studies including 1644 patients were included in the meta-analysis. Malignant biliary obstruction was the underlying cause in almost all (99.6%) cases; the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgical altered anatomy (18.4%) and hilar stenosis (16%). Pooled technical success of EUS-HGS was 97.7% (95%-CI: 96.1-99%, I2=0%), the intention to treat (ITT) clinical success was 88.1% (95%-CI: 84.7-91.2%, I2=33.9%) and procedure-related AEs occurred in 12% (95%-CI: 9.8-14.5%, I2=20.4%), being cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure related AEs was reduced with the use of dedicated stents at the univariable meta regression analysis. Meta-regression showed that technical success and clinical success rates were modified by centers' experience (>4/year). CONCLUSIONS EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with malignant biliary obstruction. Future studies should address the impact of center experience, patient selection, and use of dedicated stents to improve this technique's performance.
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Affiliation(s)
- Cecilia Binda
- Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy
- Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy., University of Bologna, Bologna, Italy
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Margherita Trebbi
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy, AUSL della Romagna, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy., AUSL della Romagna, Forlì-Cesena, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Italy, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, Humanitas Research Hospital, Rozzano, Italy
| | - Barbara Perini
- Gastroenterology Unit, Azienda Ospedale-Università di Padova (AOUP), Padua, Italy., University of Padua, Padova, Italy
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forlì-Cesena, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, Morgagni-Pierantoni Hospital, Forli, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo Viale Camillo Golgi 19, 27100 Pavia (PV)., Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy. Forlì-Cesena, Emilia-Romagna, IT, AUSL della Romagna, Forlì-Cesena, Italy
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Binda C, Fabbri S, Perini B, Boschetti M, Coluccio C, Giuffrida P, Gibiino G, Petraroli C, Fabbri C. Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved. Medicina (Kaunas) 2024; 60:333. [PMID: 38399620 PMCID: PMC10890047 DOI: 10.3390/medicina60020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5, 45100 Rovigo, Italy
| | - Martina Boschetti
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Chiara Petraroli
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
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Barbaro F, Papparella LG, Chiappetta MF, Ciuffini C, Fukuchi T, Hamanaka J, Quero G, Pecere S, Gibiino G, Petruzziello L, Maeda S, Hirasawa K, Costamagna G. Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study. Eur J Gastroenterol Hepatol 2024; 36:162-167. [PMID: 38131424 DOI: 10.1097/meg.0000000000002684] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS Endoscopic treatment of recurrent/residual colonic lesions on scars is a challenging procedure. In this setting, endoscopic submucosal dissection (ESD) is considered the first choice, despite a significant rate of complications. Endoscopic full-thickness resection (eFTR) has been shown to be well-tolerated and effective for these lesions. The aim of this study is to conduct a comparison of outcomes for resection of such lesions between ESD and eFTR in an Italian and a Japanese referral center. METHODS From January 2018 to July 2020, we retrospectively enrolled patients with residual/recurrent colonic lesions, 20 treated by eFTR in Italy and 43 treated by ESD in Japan. The primary outcome was to compare the two techniques in terms of en-bloc and R0-resection rates, whereas complications, time of procedure, and outcomes at 3-month follow-up were evaluated as secondary outcomes. RESULTS R0 resection rate was not significantly different between the two groups [18/20 (90%) and 41/43 (95%); P= 0.66]. En-bloc resection was 100% in both groups. No significant difference was found in the procedure time (54 min vs. 61 min; P= 0.9). There was a higher perforation rate in the ESD group [11/43 (26%) vs. 0/20 (0%); P= 0.01]. At the 3-month follow-up, two lesions relapsed in the eFTR cohort and none in the ESD cohort (P= 0.1). CONCLUSION eFTR is a safer, as effective and equally time-consuming technique compared with ESD for the treatment of residual/recurrent colonic lesions on scars and could become an alternative therapeutic option for such lesions.
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Affiliation(s)
- Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Luigi Giovanni Papparella
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Michele Francesco Chiappetta
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Section of Gastroenterology and Hepatology, Promise, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Cristina Ciuffini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Hamanaka
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Università Cattolica del Sacro Cuore, Roma
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, Forlì, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
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Gibiino G, Binda C, Secco M, Giuffrida P, Coluccio C, Perini B, Fabbri S, Liverani E, Jung CFM, Fabbri C. Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery. Medicina (Kaunas) 2023; 59:1941. [PMID: 38003990 PMCID: PMC10672978 DOI: 10.3390/medicina59111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Postoperative non variceal upper gastrointestinal haemorrhage may occur early or late and affect a variable percentage of patients-up to about 2%. Most cases of intraluminal bleeding are an indication for urgent Esophagogastroduodenoscopy (EGD) and require endoscopic haemostatic treatment. In addition to the approach usually adopted in non-variceal upper haemorrhages, these cases may be burdened with difficulties in terms of anastomotic tissue, angled positions, and the risk of further complications. There is also extreme variability related to the type of surgery performed, in the context of oncological disease or bariatric surgery. At the same time, the world of haemostatic devices available in digestive endoscopy is increasing, meeting high efficacy rates and attempting to treat even the most complex cases. Our narrative review summarises the current evidence in terms of different approaches to endoscopic haemostasis in upper bleeding in altered anatomy after surgery, proposing an up-to-date guidance for endoscopic clinicians and at the same time, highlighting areas of future scientific research.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Matteo Secco
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, 35128 Padua, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Elisa Liverani
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
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Gibiino G, Cucchetti A, Mocchegiani F, Bocchino A, Gaudenzi F, Binda C, Raumer L, Fabbri C, Cristini F, Vivarelli M, Ercolani G. Alarming correlation between multidrug-resistant bacteriobilia and morbidity after pancreatic surgery. Dig Liver Dis 2023; 55:1502-1508. [PMID: 37263811 DOI: 10.1016/j.dld.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pancreatic surgery is characterized by high morbidity and mortality. Biliary colonization may affect clinical outcomes in these patients. AIMS This study aimed to verify whether bacteriobilia and multidrug resistance (MDR) detected during and after pancreatic surgery may have an impact on post-operative outcomes. METHODS Data from patients undergoing pancreatic surgery involving bile duct transection (2016-2022) in two high-volume centers were analyzed in relationship to overall morbidity, major morbidity and mortality after pancreato-duodenectomy (PD) or total pancreatectomy (TP). Simple and multivariable regressions were used. RESULTS 227 patients submitted to PD (n=129) or TP (n=98) were included. Of them, 133 had preoperative biliary drainage (BD; 56.6%), mostly with the employment of endoscopic stents (91.7%). Bacteriobilia was detected in 111 patients (48.9%), and remarkably, observed in patients with BD (p=0.001). In addition, 25 MDR pathogens were identified (22.5%), with a significant prevalence in patients with BD. Multivariable regression analysis showed BD was strongly related to MDR isolation (odds ratio [OR]: 5.61; p=0.010). MDR isolation was the main factor linked to a higher number of major complications (OR: 2.75; p=0.041), including major infection complications (OR: 2.94; p=0.031). CONCLUSIONS Isolation of MDR from biliary swab during PD or TP significantly increases the risk of a worse post-operative outcome. Pre-operative precautions could improve patient safety.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì, Italy.
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Federico Mocchegiani
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Bocchino
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Federico Gaudenzi
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì, Italy
| | - Luigi Raumer
- Infectious Diseases Unit, Forlì-Cesena Hospitals, Ausl Romagna
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì, Italy
| | | | - Marco Vivarelli
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
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7
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Gibiino G, Sbrancia M, Binda C, Coluccio C, Fabbri S, Giuffrida P, Gallo G, Saragoni L, Maselli R, Repici A, Fabbri C. Usefulness of Contrast-Enhanced Endoscopic Ultrasound (CH-EUS) to Guide the Treatment Choice in Superficial Rectal Lesions: A Case Series. Diagnostics (Basel) 2023; 13:2267. [PMID: 37443660 DOI: 10.3390/diagnostics13132267] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Large rectal lesions can conceal submucosal invasion and cancer nodules. Despite the increasing diffusion of high-definition endoscopes and the importance of an accurate morphological evaluation, a complete assessment in this setting can be challenging. Endoscopic ultrasound (EUS) plays an established role in the locoregional staging of rectal cancer, although this technique has a tendency toward the over-estimation of the loco-regional (T) staging. However, there are still few data on contrast-enhanced endoscopic ultrasound (CH-EUS), especially if this ancillary technique may increase the accuracy for predicting invasive nodules among large rectal lesions. MATERIAL AND METHODS Consecutive large (≥20 mm) superficial rectal lesions with high-definition endoscopy, characterized by focal areas suggestive for invasive cancer/2B type according to JNET classification, were considered for additional standardized evaluation via CH-EUS with Sonovue ©. RESULTS From 2020 to 2023, we evaluated 12 consecutive superficial rectal lesions with sizes ranging from 20 to 180 mm. This evaluation provided additional elements to support the therapeutic decision made. Lesions were treated with surgical (3/12) or endoscopic treatment (9/12) according to their morphology and CH-EUS evaluation. CONCLUSION Contrast-enhanced endoscopic ultrasound can provide an additional evaluation for large and difficult-to-classify rectal lesions. In our experience, CH-EUS staging corresponded to the final pathological stages in 9/12 (75%) lesions, improving the distinction between T1 and T2 lesions. Larger prospective studies and randomized trials should be conducted to support and standardize this approach.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Graziana Gallo
- Pathology Department, M. Bufalini Hospital, Emilia Romagna, 47521 Cesena, Italy
| | - Luca Saragoni
- Pathology Department, G.B. Morgagni-L. Pierantoni Hospital, Emilia-Romagna, 47121 Forlì, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
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Binda C, Jung CFM, Fabbri S, Giuffrida P, Sbrancia M, Coluccio C, Gibiino G, Fabbri C. Endoscopic Management of Postoperative Esophageal and Upper GI Defects-A Narrative Review. Medicina (Kaunas) 2023; 59:medicina59010136. [PMID: 36676760 PMCID: PMC9864982 DOI: 10.3390/medicina59010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
- Correspondence:
| | - Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Paolo Giuffrida
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
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9
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Binda C, Gibiino G, Sbrancia M, Coluccio C, Cazzato M, Carloni L, Cucchetti A, Ercolani G, Sambri V, Fabbri C. Microbiota in the Natural History of Pancreatic Cancer: From Predisposition to Therapy. Cancers (Basel) 2022; 15:cancers15010001. [PMID: 36611999 PMCID: PMC9817971 DOI: 10.3390/cancers15010001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
Early microbiome insights came from gut microbes and their role among intestinal and extraintestinal disease. The latest evidence suggests that the microbiota is a true organ, capable of several interactions throughout the digestive system, attracting specific interest in the biliopancreatic district. Despite advances in diagnostics over the last few decades and improvements in the management of this disease, pancreatic cancer is still a common cause of cancer death. Microbiota can influence the development of precancerous disease predisposing to pancreatic cancer (PC). At the same time, neoplastic tissue shows specific characteristics in terms of diversity and phenotype, determining the short- and long-term prognosis. Considering the above information, a role for microbiota has also been hypothesized in the different phases of the PC approach, providing future revolutionary therapeutic insights. Microbiota-modulating therapies could open new issues in the therapeutic landscape. The aim of this narrative review is to assess the most updated evidence on microbiome in all the steps regarding pancreatic adenocarcinoma, from early development to response to antineoplastic therapy and long-term prognosis.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
- Correspondence: ; Tel.: +39-3488609557
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
| | - Maria Cazzato
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
| | - Lorenzo Carloni
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- General and Oncologic Surgery, Morgagni—Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- General and Oncologic Surgery, Morgagni—Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Vittorio Sambri
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- Microbiology Unit, Hub Laboratory, AUSL della Romagna, 47121 Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, 47121 Forlì-Cesena, Italy
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Borrelli DE Andreis F, Schiepatti A, Gibiino G, Fabbri C, Baiardi P, Biagi F. Is it time to rethink the burden of non-coeliac gluten sensitivity? A systematic review. Minerva Gastroenterol (Torino) 2022; 68:442-449. [PMID: 34929997 DOI: 10.23736/s2724-5985.21.03077-1] [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] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Non-coeliac gluten sensitivity (NCGS) is still a poorly defined clinical condition. This review aims to describe the clinical features of subjects with a symptomatic response to gluten intake, and to estimate the prevalence of NCGS. EVIDENCE ACQUISITION Literature search was conducted in accordance with PRISMA recommendations. The PubMed database was searched for original articles until 1st June 2020. EVIDENCE SYNTHESIS We identified 30 relevant articles, including 14 studies that investigated NCGS through a double-blind, placebo-controlled crossover trial (DBPCC), and 16 that examined the role of gluten in causing symptoms without a DBPCC. We found that regardless of the diagnostic work up, gluten-sensitive patients were predominately middle-aged females complaining of abdominal pain, bloating and diarrhea. The pooled prevalence of NCGS after DBPCC was 24% (5-34%). Subjects with irritable bowel syndrome or self-reporting gluten intolerance accounted for the vast majority of the patients who did not start a DBPCC. A symptomatic response to a gluten-free diet (GFD) occurred in between 7% and 93% of patients. No data on long-term outcomes of NCGS individuals were reported. CONCLUSIONS Clinical features of NCGS patients did not differ among all the included studies, whereas prevalence figures are rather heterogeneous. Long-term benefit of a GFD on these patients still needs to be ascertained.
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Affiliation(s)
- Federica Borrelli DE Andreis
- Gastroenterology Unit, IRCCS Pavia Institute, Istituti Clinici Scientifici Maugeri, University of Pavia, Pavia, Italy
| | - Annalisa Schiepatti
- Gastroenterology Unit, IRCCS Pavia Institute, Istituti Clinici Scientifici Maugeri, University of Pavia, Pavia, Italy -
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Paola Baiardi
- Scientific Direction, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Federico Biagi
- Gastroenterology Unit, IRCCS Pavia Institute, Istituti Clinici Scientifici Maugeri, University of Pavia, Pavia, Italy
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11
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Fabbri C, Baron TH, Gibiino G, Arcidiacono PG, Binda C, Anderloni A, Rizzatti G, Pérez-Miranda M, Lisotti A, Correale L, Gornals JB, Tarantino I, Petrone MC, Cecinato P, Fusaroli P, Larghi A. The endoscopic ultrasound features of pancreatic fluid collections and their impact on therapeutic decisions: an interobserver agreement study. Endoscopy 2022; 54:555-562. [PMID: 34496421 DOI: 10.1055/a-1640-4365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS-related PFC features and the therapeutic approaches used. METHODS 50 EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage solid component, presence of infection, recognition of and communication with the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet's AC1 coefficient was used to assess interobserver agreement. RESULTS A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75). CONCLUSIONS Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted.
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Affiliation(s)
- Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital of Forlì and Bufalini Hospital of Cesena, AUSL Romagna, Italy
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Giulia Gibiino
- Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital of Forlì and Bufalini Hospital of Cesena, AUSL Romagna, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Cecilia Binda
- Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital of Forlì and Bufalini Hospital of Cesena, AUSL Romagna, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | - Manuel Pérez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Loredana Correale
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Joan B Gornals
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Maria Chiara Petrone
- Pancreato-biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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12
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Gibiino G, Sartini A, Gitto S, Binda C, Sbrancia M, Coluccio C, Sambri V, Fabbri C. The Other Side of Malnutrition in Inflammatory Bowel Disease (IBD): Non-Alcoholic Fatty Liver Disease. Nutrients 2021; 13:nu13082772. [PMID: 34444932 PMCID: PMC8398715 DOI: 10.3390/nu13082772] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/26/2022] Open
Abstract
Steatohepatitis and hepatobiliary manifestations constitute some of the most common extra-intestinal manifestations of Inflammatory Bowel Disease (IBD). On the other hand, non-alcoholic fatty liver disease (NAFLD) affects around 25% of the world’s population and is attracting ever more attention in liver transplant programs. To outline the specific pathways linking these two conditions is a pressing task for 21st-century researchers. We are accustomed to expecting the occurrence of fatty liver disease in obese people, but current evidence suggests that there are several different pathways also occurring in underweight patients. Genetic factors, inflammatory signals and microbiota are key players that could help in understanding the entire pathogenesis of NAFLD, with the aim of defining the multiple expressions of malnutrition. In the current review, we summarize the most recent literature regarding the epidemiology, pathogenesis and future directions for the management of NAFLD in patients affected by IBD.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
- Correspondence: ; Tel.: +39-3488609557
| | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, 50100 Florence, Italy;
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
| | - Vittorio Sambri
- Unit of Microbiology, The Great Romagna Hub Laboratory, 47522 Pievesestina, Italy;
- Unit of Microbiology, DIMES, University of Bologna, 40125 Bologna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, 47121 Forlì, Italy; (A.S.); (C.B.); (M.S.); (C.C.); (C.F.)
- Gastroenterology and Digestive Endoscopy Unit, Ospedale M.Bufalini, AUSL Romagna, 47521 Cesena, Italy
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13
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Macchione IG, Lopetuso LR, Ianiro G, Napoli M, Gibiino G, Rizzatti G, Petito V, Gasbarrini A, Scaldaferri F. Akkermansia muciniphila: key player in metabolic and gastrointestinal disorders. Eur Rev Med Pharmacol Sci 2020; 23:8075-8083. [PMID: 31599433 DOI: 10.26355/eurrev_201909_19024] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Gut microbiota has a key role in host metabolic regulation and immune response, and its dysbiosis represents one of the main causes of gastrointestinal diseases. In this scenario, Akkermansia muciniphila is a crucial player in keeping the integrity of the gastrointestinal tract. MATERIALS AND METHODS This review focuses on the correlation between gut microbiota and intestinal homeostasis, primarily exploring A. muciniphila and its involvement in the development of metabolic disorders and gastrointestinal diseases. RESULTS Akkermansia muciniphila belongs to the Verrucomicrobia phylum, and it colonizes the mucus layer in the gastrointestinal tract, representing 1 to 4% of the fecal microbiota. It stimulates mucosal microbial networks, and it improves intestinal barrier function, providing crucial host immunological responses. Several studies have demonstrated the possible involvement of A. muciniphila in the development of intestinal and metabolic disorders. Indeed, adipose and glucose metabolisms are influenced by A. muciniphila, and its levels inversely correlate to inflammatory conditions, such as inflammatory bowel disease, obesity, and diabetes. Conversely, its therapeutic administration decreases their development. CONCLUSIONS A. muciniphila exerts a key role in the maintenance of intestinal health and in host metabolic modulation. Future studies could open new horizons towards its potential therapeutic applications in gastrointestinal and extra-intestinal diseases.
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Affiliation(s)
- I G Macchione
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Gibiino G, Garcovich M, Ainora ME, Zocco MA. Spleen ultrasound elastography: state of the art and future directions - a systematic review. Eur Rev Med Pharmacol Sci 2020; 23:4368-4381. [PMID: 31173311 DOI: 10.26355/eurrev_201905_17944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE An early and accurate diagnosis of clinically significant portal hypertension is mandatory for a correct prediction and management of the complications usually observed in patients affected by chronic liver disease (CLD). Spleen stiffness measurement is arising as a promising non-invasive technique, giving a reliable measure of haemodynamic changes occurring during cirrhosis progression, but contrasting data are available to date. MATERIALS AND METHODS A systematic review was performed including the several studies dealing with the spleen stiffness measurement in the evaluation of portal hypertension in adult patients affected by hepatic or extra-hepatic portal hypertension (PH). Results were organized in technical classification from the first one-dimensional device (TE) to the latest ultrasound elastographic techniques (pSWE and 2D-SWE). RESULTS We evaluated a total of nearly twenty studies dealing with all available elastographic techniques that were usually compared with HVPG, which is the gold standard for diagnosing the presence of PH. Spleen stiffness showed overall a good diagnostic accuracy to diagnose clinically significant PH in CLD, in some cases even with reliable cut-off values for severe PH. CONCLUSIONS Spleen ultrasound elastography could be an accurate non-invasive tool for assessing the presence of portal hypertension. However, the different techniques available to date and the various cut-off values suggested might still limit the impact on clinical practice.
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Affiliation(s)
- G Gibiino
- Department of Internal Medicine, Gastroenterology and Hepatology, A. Gemelli Hospital - IRCCS, Catholic University of Rome, Rome, Italy.
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15
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Garcovich M, Di Stasio E, Zocco MA, Riccardi L, Ainora ME, Annicchiarico BE, Gibiino G, Santopaolo F, Gasbarrini A, Pompili M. Assessing Baveno VI criteria with liver stiffness measured using a new point-shear wave elastography technique (BAVElastPQ study). Liver Int 2020; 40:1952-1960. [PMID: 32510772 DOI: 10.1111/liv.14558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS To date, no study has explored the potential role of ElastPQ, a novel point-SWE technique, in the assessment of clinically significant portal hypertension. The aim of our study was to determine a liver stiffness (LS) cut-off value measured by ElastPQ and laboratory parameters that could help to identify those patients who can safely avoid screening endoscopy. METHODS Data were collected on 1422 patients who underwent ElastPQ measurement from January 2013 to January 2016 in our Department. Inclusion criteria were a LS value of ≥7 kPa, an upper gastrointestinal endoscopy within 12 months and a diagnosis of compensated chronic liver disease. Exclusion criteria were history of decompensated liver disease, evidence of porto-spleno-mesenteric vein thrombosis and non-cirrhotic portal hypertension. Varices were graded as low-risk varices (grade <2) or varices needing treatment (VNT, grade ≥2). RESULTS The study included 195 patients (120 [61%] HCV, 171 [88%] Child-Pugh A). Varices were present in 35% cases, with 10% prevalence of VNT. According to ROC curve analysis, LS measurement and platelet count were evaluated as predictors of VNT. Overall, 75/195 (38%) met the 'BAVElastPQ' criteria (that is, LS < 12 kPa and platelet count >150 000/μL). Within this group, 11/75 (15%) had any grade of varices and only 1/75 (1%) had VNT. The BAVElastPQ criteria gave sensitivity of 0.95, specificity of 0.42, positive predictive value of 0.15 and negative predictive value of 0.99. CONCLUSIONS The BAVElastPQ criteria correctly identified 99% of patients without VNT. By applying such criteria, we could have potentially avoided 38% of surveillance endoscopies in our cohort.
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Affiliation(s)
- Matteo Garcovich
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Di Stasio
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria A Zocco
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Riccardi
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria E Ainora
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Brigida E Annicchiarico
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Gibiino
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Santopaolo
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Pompili
- Department of Internal Medicine, Gastroenterology and Liver Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Pecere S, Gibiino G, La Milia DI, Bertè G, Burrelli Scotti G, Petruzziello C, Minordi LM, Manfredi R, Franceschi F, Ojetti V, Gasbarrini A. Acute uncomplicated diverticulitis: key points for early management. A single-centre retrospective study. Eur Rev Med Pharmacol Sci 2020; 24:2710-2718. [PMID: 32196622 DOI: 10.26355/eurrev_202003_20543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Acute uncomplicated diverticulitis is an important clinical condition usually managed in clinical practice with antibiotic therapies and hospitalization in ward. In this setting, recent papers and guidelines suggest to limit the use of antibiotics in selected cases and encourage an early discharge in low-risk patients. The purpose of this retrospective study is to identify serological inflammatory markers and CT findings of acute uncomplicated diverticulitis (AUD) at the onset of the disease and the correlation with the need for in-patient or out-patient management. PATIENTS AND METHODS It was used a database drawn from the collection of the patients admitted to our Emergency Room from January 2016 to 2019 and undergoing urgent abdominal CT-scan for suspicious of acute diverticulitis. For each patient we considered biochemical and radiological parameters at the onset of the disease and if patients were managed as in-patients (hospitalization in ward) or as out-patient (early discharged or after observation in Short Stay Unit). RESULTS Among patients with early diagnosis of AUD, 108 (65%) were hospitalized in ward with mean time of in-stay of 6.94 days, while only 58 (35%) patients with same diagnosis were managed as out-patient and early discharged from emergency room or after observation in short stay unit with a mean time of in-stay significantly shorter (3.39 days, p-value 0.0007). Higher levels of C reactive protein and the length of colon involved considered as percentage (%) in comparison with the entire colon were significantly related to the need for hospitalization (p-value 0.03). CONCLUSIONS Biochemical parameters and a more advanced radiological evaluation, as the length (%) of colon involved, could allow a stratification of patients with diagnosis of AUD at the admission and help physicians in the early management.
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Affiliation(s)
- S Pecere
- Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Varone F, Gibiino G, Gasbarrini A, Richeldi L. Evaluation of the lung microbiome as a therapeutic target in the management of idiopathic pulmonary fibrosis: role of antioxidant/antibiotic combination therapy. Eur Rev Med Pharmacol Sci 2019; 23:6379-6386. [PMID: 31364146 DOI: 10.26355/eurrev_201907_18463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Changes in the composition of the lung microbiome influence many lung diseases, including idiopathic pulmonary fibrosis (IPF), with a demonstrated association between the progression of IPF and the assessed pulmonary microbial community. A hypothesis to explain the pathogenesis of IPF is that an oxidant-antioxidant imbalance causes repeated epithelial cell injury and endogenous and exogenous antioxidants/redox modulators influence fibrogenesis, protect the lung against fibrosis, and prevent its progression. MATERIALS AND METHODS The present article is focused on Lung Microbiome in Idiopathic Pulmonary Fibrosis and the role of Antioxidant/Antibiotic Combination Therapy. RESULTS N-Acetylcysteine (NAC) at concentrations possibly achievable by nebulization showed an in vitro synergy with colistin against S. maltophilia isolates (a common coloniser of the respiratory tract of patients with chronic lung disease). Combined NAC plus colistin seems to have a beneficial role in restoring oxidant injury which may be related to its antioxidant effect. Progress has been made in the identification of the lung microbiome and the possible causal role of bacteria in the IPF pathogenesis. Recent studies suggest that antibacterial therapy in combination with antioxidant therapy may be a promising avenue for the treatment of this untreatable disease. Novel routes of administration are also an important area of research and studies assessing the use of inhaled NAC in patients with IPF could be considered.
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Affiliation(s)
- F Varone
- U.O. Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCSS - Università Cattolica del Sacro Cuore, Rome, Italy.
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18
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Gibiino G, Lopetuso L, Ricci R, Gasbarrini A, Cammarota G. Coeliac disease under a microscope: Histological diagnostic features and confounding factors. Comput Biol Med 2018; 104:335-338. [PMID: 30409469 DOI: 10.1016/j.compbiomed.2018.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/15/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
Coeliac disease (CD) and gluten-related disorders represent an important cornerstone of the daily practice of gastroenterologists, endoscopists and dedicated histopathologists. Despite the knowledge of clinical, serological and histological typical lesions, there are some conditions to consider for differential diagnosis. From the first description of histology of CD, several studies were conducted to define similar findings suggestive for microscopic enteritis. Considering the establishment of early precursor lesions, the imbalance of gut microbiota is another point still requiring a detailed definition. This review assesses the importance of a right overview in case of suspected gluten-related disorders and the several conditions mimicking a similar histology.
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Affiliation(s)
- Giulia Gibiino
- Internal Medicine and, Gastroenterology and Hepatic Diseases Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Loris Lopetuso
- Internal Medicine and, Gastroenterology and Hepatic Diseases Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Ricci
- Institute of Pathology, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and, Gastroenterology and Hepatic Diseases Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Cammarota
- Internal Medicine and, Gastroenterology and Hepatic Diseases Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Binda C, Lopetuso LR, Rizzatti G, Gibiino G, Cennamo V, Gasbarrini A. Actinobacteria: A relevant minority for the maintenance of gut homeostasis. Dig Liver Dis 2018; 50:421-428. [PMID: 29567414 DOI: 10.1016/j.dld.2018.02.012] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/26/2018] [Accepted: 02/19/2018] [Indexed: 02/06/2023]
Abstract
Actinobacteria are one the four major phyla of the gut microbiota and, although they represent only a small percentage, are pivotal in the maintenance of gut homeostasis. During the last decade many studies focused the attention on Actinobacteria, especially on their role both in gastrointestinal and systemic diseases and on their possible therapeutic use. In fact, classes of this phylum, especially Bifidobacteria, are widely used as probiotic demonstrating beneficial effects in many pathological conditions, even if larger in vivo studies are needed to confirm such encouraging results. This review aims to explore the current knowledge on their physiological functions and to speculate on their possible therapeutic role(s) in gastrointestinal and systemic diseases.
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Affiliation(s)
- Cecilia Binda
- Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Sacred Heart of Rome, A. Gemelli Hospital, Italy
| | - Loris Riccardo Lopetuso
- Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Sacred Heart of Rome, A. Gemelli Hospital, Italy
| | - Gianenrico Rizzatti
- Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Sacred Heart of Rome, A. Gemelli Hospital, Italy
| | - Giulia Gibiino
- Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Sacred Heart of Rome, A. Gemelli Hospital, Italy
| | - Vincenzo Cennamo
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Sacred Heart of Rome, A. Gemelli Hospital, Italy.
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20
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Bassi M, Luigiano C, Ghersi S, Fabbri C, Gibiino G, Balzani L, Iabichino G, Tringali A, Manta R, Mutignani M, Cennamo V. A multicenter randomized trial comparing the use of touch versus no-touch guidewire technique for deep biliary cannulation: the TNT study. Gastrointest Endosc 2018; 87:196-201. [PMID: 28527615 DOI: 10.1016/j.gie.2017.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/24/2016] [Accepted: 05/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS There are 2 techniques described for selective bile duct guidewire cannulation, the touch (T) technique (engaging the papilla with a sphincterotome and then advancing the guidewire) and the no-touch (NT) technique (engaging the papilla only with the guidewire). The aim of this prospective, multicenter randomized study was to compare the outcomes of the 2 guidewire cannulation techniques. METHODS Three hundred consecutive patients with naïve papillae were enrolled in 2 groups (150 to T group and 150 to NT group). A maximum of 15 biliary cannulation attempts, for no longer than 5 minutes, or a maximum of 5 unintentional cannulations of the pancreatic duct for each group were performed. If biliary cannulation failed, the patient was crossed over to the other technique with the same parameters. The primary outcome was the guidewire cannulation success rate using either the T or NT technique. Secondary outcomes were the number of attempts and cannulation duration, number of pancreatic duct cannulations, and adverse events. RESULTS The primary cannulation rate was significantly higher in the T group compared with the NT group (88% vs 54%, P < .001), and the cannulation rate was significantly higher using the T technique compared with the NT technique also after crossover (77% vs 17%, P < .001). The mean number of cannulation attempts was 4.6 in the T group versus 5.5 in the NT group (P = .006), and the duration of cannulation before crossover (P < .001) and overall cannulation duration after crossover (P < .001) were significantly lower in the T group. The number of unintended pancreatic duct cannulations was statistically higher using the T technique compared with the NT technique (P = .037). The rates of adverse events did not significantly differ between the 2 groups. CONCLUSIONS Our results clearly indicated that the T technique is superior to the NT technique for biliary cannulation. (Clinical trial registration number: NCT01954602.).
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Affiliation(s)
- Marco Bassi
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | | | - Stefania Ghersi
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | - Giulia Gibiino
- Gastroenterology Department Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Lucio Balzani
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna, Bologna, Italy
| | | | - Alberto Tringali
- Digestive Endoscopy Unit, Niguarda Cà Granda Hospital, Milan, Italy
| | - Raffaele Manta
- Digestive Endoscopy Unit, Niguarda Cà Granda Hospital, Milan, Italy
| | | | - Vincenzo Cennamo
- Gastroenterology and Digestive Endoscopy Unit, AUSL Bologna, Bologna, Italy
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Affiliation(s)
- Giulia Gibiino
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
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Fabbri C, Gibiino G, Fornelli A, Cennamo V, Grifoni D, Visani M, Acquaviva G, Fassan M, Fiorino S, Giovanelli S, Bassi M, Ghersi S, Tallini G, Jovine E, Gasbarrini A, de Biase D. Team work and cytopathology molecular diagnosis of solid pancreatic lesions. Dig Endosc 2017; 29:657-666. [PMID: 28190274 DOI: 10.1111/den.12845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/30/2016] [Accepted: 02/08/2017] [Indexed: 02/05/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer-associated death in the next decade or so. It is widely accepted that tumorigenesis is linked to specific alterations in key genes and pancreatic neoplasms are some of the best characterized at the genomic level. Recent whole-exome and whole-genome sequencing analyses confirmed that PDAC is frequently characterized by mutations in a set of four genes among others: KRAS, TP53, CDKN2A/p16, and SMAD4. Sequencing, for example, is the preferable technique available for detecting KRAS mutations, whereas in situ immunochemistry is the main approach for detecting TP53 gene alteration. Nevertheless, the diagnosis of PDAC is still a clinical challenge, involving adequate acquisition of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and specific pathological assessment from tissue architecture to specific biomolecular tests. The aim of the present review is to provide a complete overview of the current knowledge of the biology of pancreatic cancer as detected by the latest biomolecular techniques and, moreover, to propose a paradigm for strict teamwork collaboration in order to improve the correct use of diagnostic sources.
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Affiliation(s)
- Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Giulia Gibiino
- Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Adele Fornelli
- Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Italy
| | - Vincenzo Cennamo
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Daniela Grifoni
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Italy
| | - Michela Visani
- Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy
| | - Giorgia Acquaviva
- Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy
| | - Matteo Fassan
- Department of Medicine, Anatomic Pathology, University of Padua, Padova, Italy
| | - Sirio Fiorino
- Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Silvia Giovanelli
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Marco Bassi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Stefania Ghersi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Giovanni Tallini
- Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy
| | - Elio Jovine
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy
| | - Antonio Gasbarrini
- Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Italy
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Abstract
The huge variety of extragastric diseases linked to Helicobacter pylori infection is widely known, and new studies are conducted every year on this topic. Neurological disorders and metabolic syndrome are some of the main issues debated in the most recent literature. Articles on the association of H. pylori with skin diseases, inflammatory bowel diseases, immunologic impairment, kidney dysfunction, allergic asthma, and respiratory diseases have been published as well. In this perspective, eradication therapy for this infection could become a mandatory measure in prevention strategy.
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Affiliation(s)
- Jean-Dominique de Korwin
- Department of Internal Medicine, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Gianluca Ianiro
- Department of Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Catholic University of Rome, Milano, Italy
| | - Giulia Gibiino
- Department of Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Catholic University of Rome, Milano, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Gastroenterology and Hepatology, Agostino Gemelli Hospital, Catholic University of Rome, Milano, Italy
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Gibiino G, Fabbri C, Fagiuoli S, Ianiro G, Fornelli A, Cennamo V. Defining the biology of intrahepatic cholangiocarcinoma: molecular pathways and early detection of precursor lesions. Eur Rev Med Pharmacol Sci 2017; 21:730-741. [PMID: 28272710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor of the biliary tract with growing incidence and dismal prognosis. It is responsible for 10-20% of primary liver cancer worldwide, but early diagnosis is still a challenge and few treatment options are available. Aim of this review is to summarize the current knowledge about biological features and arising molecular patterns of this disease. The identification of emerging biomarkers and early detection of precursor lesions shall play a key role in the perspective of future tailored targeted therapies.
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Affiliation(s)
- G Gibiino
- Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy.
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Muratori R, Lisotti A, Fusaroli P, Caponi A, Gibiino G, Eusebi LH, Azzaroli F, Brighi N, Altimari G, Bazzoli F. Severe hypernatremia as a predictor of mortality after percutaneous endoscopic gastrostomy (PEG) placement. Dig Liver Dis 2017; 49:181-187. [PMID: 27856199 DOI: 10.1016/j.dld.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/10/2016] [Accepted: 10/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy is the preferred option for providing enteral nutrition, allowing for an improvement in survival and quality of life. AIM To evaluate risk factors for early and delayed mortality after gastrostomy placement. METHODS A single-center retrospective analysis of a prospectively-collected database including all patients undergoing gastrostomy placement for enteral nutrition was performed. Two operators performed all the procedures according to the most recent guidelines. RESULTS Analysis included data on 438 patients [178 male; 80.5 (72-86) year-old]. Indications for PEG were stroke (34.0%), dementia (31.3%), neurodegenerative disorders (18.5%), coma (9.1%) and cancer (7.1%). No periprocedural adverse events was observed. Mean survival was 14.6±3.4months; 1-month and 3-month mortality rates were 4.0% and 8.1%, respectively. Severe hypernatremia (≥150mmol/L) was independently related to 1-month mortality (odds ratio 25.4; P<0.0001), while C-reactive protein level>4.3mg/dL was independently related to 3-month mortality (odds ratio 5.3; P=0.003). Kaplan-Meier and Cox-regression analysis identified male gender (hazard ratio 2.32; P=0.0002), severe hypernatremia (hazard ratio 4.3; P<0.0001), C-reactive protein>4.3mg/dL (hazard ratio 3.5; P=0.0014), leukocytosis (hazard ratio 1.97; P=0.0036) and presence of underlying malignancy (hazard ratio 2.4; P=0.0013) as independent risk factors for long-term mortality. DISCUSSION Presence of severe hypernatremia and increased C-reactive protein levels were strongly correlated with early and delayed mortality in our population. Studies are necessary to understand whether correcting underlying dehydration and inflammation further improves patients' outcomes.
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Affiliation(s)
- Rosangela Muratori
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy.
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Alessandra Caponi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Giulia Gibiino
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Leonardo Henry Eusebi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Francesco Azzaroli
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | - Nicole Brighi
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
| | | | - Franco Bazzoli
- S. Orsola-Malpighi Hospital, Bologna, Department of Medical and Surgical Sciences-DIMEC, University of Bologna, Italy
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Lisotti A, Caponi A, Gibiino G, Muratori R. Safety and efficacy of extracorporeal shock-wave lithotripsy in the management of biliary stones after orthotopic liver transplantation. Dig Liver Dis 2015; 47:817-8. [PMID: 26143107 DOI: 10.1016/j.dld.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/23/2015] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy.
| | - Alessandra Caponi
- Gastroenterology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy.
| | - Giulia Gibiino
- Gastroenterology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy.
| | - Rosangela Muratori
- Gastroenterology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy.
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