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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Polese L. Removal of a large rectal polyp with endoscopic submucosal dissection-trans-anal rectoscopic assisted minimally invasive surgery hybrid technique: A case report. World J Gastrointest Surg 2023; 15:2932-2937. [PMID: 38221999 PMCID: PMC10784841 DOI: 10.4240/wjgs.v15.i12.2932] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) can be used for the en-bloc removal of superficial rectal lesions; however, the lack of a traction system makes the procedure long and difficult in the presence of extensive lesions. CASE SUMMARY A large polyp occupying 2/3 of the rectal circumference and extending 5 cm in length was removed by ESD with the help of laparoscopic forceps introduced via trans-anal rectoscopic assisted minimally invasive surgery, a disposable platform designed to aid in transanal minimally invasive surgery. Traction of the polyp by forceps during the operation was dynamic, and applied at various points and in various directions. The polyp was removed en-bloc without complications in 1 h and 55 min. A sigmoidoscopy performed 50 d later showed normal healing without polyp recurrence. CONCLUSION The technique presented here could overcome the issues caused by lack of traction during ESD for rectal lesions.
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Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova 35128, Italy
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Passuello N, Polese L, Ometto G, Grossi U, Mammano E, Vittadello F, Frasson A, Tessari E, Bartolotta P, Gregori D, Sarzo G. Outcomes of Laparoscopic Surgery in Very Elderly Patients with Colorectal Cancer: A Survival Analysis and Comparative Study. J Clin Med 2023; 12:7122. [PMID: 38002734 PMCID: PMC10672623 DOI: 10.3390/jcm12227122] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is a global health concern, particularly among the elderly population. This study aimed to assess the impact of laparoscopic surgery on CRC patients aged ≥80 years. (2) Methods: We conducted a retrospective analysis of prospectively collected data from consecutive CRC patients who underwent surgery at our institution between July 2018 and July 2023. The patients were categorized into three groups: those aged over 80 who underwent laparoscopic surgery (Group A), those aged over 80 who underwent open surgery (Group B), and those under 80 who underwent laparoscopic surgery (Group C). We examined various clinical and surgical parameters, including demographic data, medical history, surgical outcomes, and survival. (3) Results: Group A (N = 113) had shorter hospital stays than Group B (N = 23; p = 0.042), with no significant differences in complications or 30-day outcomes. Compared to Group C (N = 269), Group A had higher comorbidity indices (p < 0.001), more emergency admissions, anemia, low hemoglobin levels, colonic obstruction (p < 0.001), longer hospital stays (p < 0.001), and more medical complications (p = 0.003). Laparotomic conversion was associated with obstructive neoplasms (p < 0.001), and medical complications with ASA scores (p < 0.001). Both the medical and surgical complications predicted adverse 30-day outcomes (p = 0.007 and p < 0.001). Survival analysis revealed superior overall survival (OS) in Group A vs. Group B (p < 0.0001) and inferior OS vs. Group C (p < 0.0001). After a landmark analysis, the OS for patients aged 80 or older and those under 80 appeared to be similar (HR 2.55 [0.75-8.72], p = 0.136). (4) Conclusions: Laparoscopic surgery in very elderly CRC patients shows comparable oncological outcomes and surgical complications to younger populations. Survival benefits are influenced by age, comorbidities, and medical complications. Further prospective multicenter studies are needed in order to validate these findings.
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Affiliation(s)
- Nicola Passuello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
| | - Giulia Ometto
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
- Surgery Unit 2, Regional Hospital Treviso, 31100 Treviso, Italy
| | - Enzo Mammano
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Fabrizio Vittadello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Alvise Frasson
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Emanuela Tessari
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Giacomo Sarzo
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
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Polese L, Giugliano E, Valmasoni M. Patient Position in Operative Endoscopy. J Clin Med 2023; 12:6822. [PMID: 37959286 PMCID: PMC10649681 DOI: 10.3390/jcm12216822] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
It is well known by surgeons that patient positioning is fundamental to exposing the organs when performing an operation via laparoscopy, as gravity can help move the organs and facilitate the exposure of the surgical site. But is it also important for endoscopic procedures? This paper examines various types of endoscopic operations and addresses the issue of the patient's position. The patient's position can be changed not only by rotating the patient along the head-toe axis but also by tilting the surgical bed, as is undertaken during laparoscopic surgical procedures. In particular, it is useful to take into account the effect of gravity on lesion exposure, tumour traction during dissection, crushing by body weight, risk of sample drop, risk of damage to adjacent organs, and anatomical exposure for procedures with radiological support. The endoscopist should always keep in mind the patient's anatomy and the position of the endoscope during operative procedures, not limited to considering only intraluminal vision.
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Affiliation(s)
- Lino Polese
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (E.G.); (M.V.)
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Polese L, Giugliano E, Cadrobbi R, Boemo DG. Diode Laser Therapy for Radiation-Induced Vascular Ectasia: Long-Term Results and Cost Analysis. Life (Basel) 2023; 13:life13041025. [PMID: 37109554 PMCID: PMC10144337 DOI: 10.3390/life13041025] [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] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Collateral damage to surrounding healthy tissues has been reported in patients who undergo radiation therapy for pelvic malignancies. This study aimed to evaluate the safety, efficacy and cost efficiency of endoscopic diode laser therapy in patients diagnosed with chronic radiation proctitis (CRP). METHODS The data of 24 patients (median age 78, range 67-90 years) who presented rectal bleeding and were diagnosed with CRP after undergoing high-dose radiotherapy for prostatic cancer and underwent diode laser therapy were evaluated retrospectively. Non-contact fibers were used in the patients who underwent the procedure without sedation in an outpatient setting. RESULTS The patients underwent a median of two sessions; overall, a mean of 1591 J of laser energy per session was used. No complications were noted during or after the procedures. Bleeding was completely resolved in 21/24 (88%) patients, and two patients showed improvement (96%). It was not necessary to suspend antiplatelet (six patients) or anticoagulant (four patients) therapy during the treatment course. The mean cost per session was EUR 473.4. CONCLUSIONS The study findings demonstrated that endoscopic non-contact diode laser treatment in CRP patients is safe, effective and cost efficient. For this procedure, antiplatelet and anticoagulant therapy suspension, intraprocedural sedation and hospital admission are not required.
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Affiliation(s)
- Lino Polese
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Emilia Giugliano
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Roberto Cadrobbi
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
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Polese L, Prevedello L, Belluzzi A, Giugliano E, Albanese A, Foletto M. Endoscopic sleeve gastroplasty: results from a single surgical bariatric centre. Updates Surg 2022; 74:1971-1975. [PMID: 36168089 PMCID: PMC9514673 DOI: 10.1007/s13304-022-01385-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of the endoscopic sleeve gastroplasty (ESG) procedure. Patients ineligible for bariatric surgery due to comorbidities or low Body Mass Index (BMI) were offered ESG. Gastric tubularization was carried out via multiple multi-bite sutures across the greater curvature of the stomach. The patients underwent a water-soluble swallow test on post-operative day 1 (POD-1) to assess gastric emptying and were placed on a soft diet if upper GI tract function was confirmed. From January 2019 to March 2022, 27 patients underwent ESG: 14 for severe obesity with comorbidities, including liver transplant, end-stage kidney disease, severe cardiovascular and respiratory diseases. The mean BMI before treatment was 36 ± 9 kg/m2. Two patients (7%) who developed gastric bleeding were successfully treated with packed red blood cells (PRBC) transfusions. After a mean follow-up of 18 months, the percentage of total body weight loss (%TBWL) and the percentage of excess weight (%EWL) were 11 ± 7 and 39 ± 27, respectively. The latter was significantly higher in the patients with an initial BMI < 40 kg/m2 (50 vs 22, p < 0.05). The patients whose gastric sleeve extended for more than a third of the length of the stomach (p < 0.05) had better results. ESG was found to be effective and safe in high-risk surgical patients whose initial BMI was (< 40). Studies characterized by larger number of patients and longer follow-up periods will be able to confirm these results.
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Affiliation(s)
- Lino Polese
- 1St Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Chirurgia Generale 1, sesto piano Policlinico, Azienda Ospedale-Università Padova University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Luca Prevedello
- Bariatric Unit, Week Surgery, Padova University Hospital, University of Padova, Padua, Italy
| | - Amanda Belluzzi
- Bariatric Unit, Week Surgery, Padova University Hospital, University of Padova, Padua, Italy
| | - Emilia Giugliano
- 1St Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Chirurgia Generale 1, sesto piano Policlinico, Azienda Ospedale-Università Padova University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Alice Albanese
- Bariatric Unit, Week Surgery, Padova University Hospital, University of Padova, Padua, Italy
| | - Mirto Foletto
- Bariatric Unit, Week Surgery, Padova University Hospital, University of Padova, Padua, Italy
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Salmaso C, Toniolo I, Fontanella CG, Da Roit P, Albanese A, Polese L, Stefanini C, Foletto M, Carniel EL. Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery. Ann Biomed Eng 2020; 48:2466-2483. [PMID: 32472365 DOI: 10.1007/s10439-020-02542-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain intensities. Further computational investigations revealed the potentialities of hybrid endoscopic procedures to induce both reduction of stomach capacity and enhancement of gastric receptors mechanical stimulation. In conclusion, biomechanics proved to be useful for the investigation of BS effects. Future exploitations of the biomechanical methods may largely improve BS reliability, efficacy and penetration rate.
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Affiliation(s)
- C Salmaso
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - I Toniolo
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy.
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy.
| | - C G Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - P Da Roit
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - A Albanese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - L Polese
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - C Stefanini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - E L Carniel
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
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Polese L, La Raja C, Fasolato S, Frigo AC, Angeli P, Merigliano S. Endoscopic diode laser therapy for gastric hyperplastic polyps in cirrhotic patients. Lasers Med Sci 2020; 36:975-979. [PMID: 32815064 DOI: 10.1007/s10103-020-03127-7] [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] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
Purpose Endoscopic polypectomy to remove gastric hyperplastic polyps in cirrhotic patients is associated to a high risk of postprocedural bleeding. The current study set out to examine the effect of diode laser therapy used to treat this type of polyps in cirrhotic patients. Methods This single-center study retrospectively examined the data of cirrhotic patients with macroscopic bleeding or anemia who underwent diode laser therapy (940 nm wave length, 30-W power setting in continuous mode) to remove histology-confirmed hyperplastic gastric polyps. Results A total of 222 polyps (mean diameter 10 ± 8 mm) were treated in 55 patients who were included in the study. No complications such as bleeding or perforations were reported. After a mean of 5 ± 4 sessions, 31 patients (56%) were completely healed. In 16 patients (29%), there was only a partial response (mean polyp reduction diameter of 64 ± 15%), while 8 (15%) patients did not respond to treatment. Statistically significant better results were noted in the patients who underwent ≥ 2 laser sessions. Hemoglobin levels and number of blood transfusions required were not statistically different after treatment. After a mean study period of 21 ± 17 months, polyp recurrences were noted in 11 patients (20%), but none of the polyps had degenerated. Conclusion Diode laser therapy was found to be a safe treatment for hyperplastic polyps in cirrhotic patients. Due to the presence of others bleeding lesions in cirrhotic patients, this treatment did not have an impact on anemia and transfusion requirements.
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Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy. .,Clinica Chirurgica 3, Policlinico Universitario 6 Piano, Via Giustiniani 2, 35128, Padova, Italy.
| | - Carlotta La Raja
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy
| | - Silvano Fasolato
- Department of Medicine, 5th Medical Unit, University of Padova, Padua, Italy
| | - Anna Chiara Frigo
- Department of Cardiology, Chest and Vascular Surgery, University of Padova, Padua, Italy
| | - Paolo Angeli
- Department of Medicine, 5th Medical Unit, University of Padova, Padua, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy
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Rodella L, Capezzuto E, De Palma G, Maurano A, Geraci G, Golia M, Marciano E, Polese L, Ricco G, Trentino P, Nikonov E, Kashin S. COVID-19 pandemic: Practical advice for Endoscopy Units. Mistakes to be avoided. Experience of the Italian North-Eastern Venetian Region. Dok gastroenterol 2020; 9:5. [DOI: 10.17116/dokgastro202090215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
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Polese L, Muraro A, Besutti V, Palù G. P03 Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome caused by Enterobius vermicularis: clinical and microbiological evidence and effective treatment with mebendazole. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, ITALY
| | - Antonella Muraro
- Department of Women and Child Health, University of Padova, Padova, ITALY
| | - Valeria Besutti
- Microbiology and Virology Unit, Azienda Ospedaliera di Padova, Padova, ITALY
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Padova, ITALY
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Bressan A, Marini L, Michelotto M, Frigo AC, Da Dalt G, Merigliano S, Polese L. Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease. Colorectal Dis 2018; 20:923-930. [PMID: 29706003 DOI: 10.1111/codi.14240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered. METHOD Patients' characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow-up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period. RESULTS Histological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4-575.5). CONCLUSION Anastomotic stenosis is a frequent, long-term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.
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Affiliation(s)
- A Bressan
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Clinic, University of Padua, Padua, Italy
| | - L Marini
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Clinic, University of Padua, Padua, Italy
| | - M Michelotto
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - A C Frigo
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, Padua, Italy
| | - G Da Dalt
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Clinic, University of Padua, Padua, Italy
| | - S Merigliano
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Clinic, University of Padua, Padua, Italy
| | - L Polese
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Clinic, University of Padua, Padua, Italy
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Polese L. Role of quality of life in elective surgery for diverticular disease. Ann Laparosc Endosc Surg 2018. [DOI: 10.21037/ales.2018.08.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Polese L, Besutti V, Muraro A, Palù G. Evidence that Enterobius vermicularis plays a causative role for PFAPA and recurrent aphthous stomatitis. Minerva Med 2018; 109:498-500. [PMID: 29856193 DOI: 10.23736/s0026-4806.18.05709-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy -
| | - Valeria Besutti
- Unit of Microbiology and Virology, Hospital of Padua, Padua, Italy
| | - Antonella Muraro
- Department of Women and Child Health, University of Padua, Padua, Italy
| | - Giorgio Palù
- Unit of Microbiology and Virology, Hospital of Padua, Padua, Italy.,Department of Molecular Medicine, University of Padova, Padua, Italy
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Polese L, Bressan A, Savarino E, Vecchiato M, Turoldo A, Frigo A, Sturniolo GC, De Manzini N, Petri R, Merigliano S. Quality of life after laparoscopic sigmoid resection for uncomplicated diverticular disease. Int J Colorectal Dis 2018. [PMID: 29525902 DOI: 10.1007/s00384-018-3005-y] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL). METHODS All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease. RESULTS Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p < 0.0001). The surgically treated patients reported a worse quality of life before treatment with respect to the patients treated conservatively (mean 21.12 surgical vs 15.41 conservative, p = 0.0048). The surgically treated patients presented better post-treatment global scores with respect to the conservatively treated patients (mean: 6.90 surgical vs 10.61 conservative, p = 0.0186). Covariance analysis confirmed that the differences between the pre- and post-treatment DV-QoL scores were significantly higher in the surgical (p = 0.0002) with respect to the non-surgical patients. As far as single items were concerned, differences between the two groups were found in the pre- and post-treatment "concerns" and "behavioral changes" DV-QoL items. CONCLUSIONS Sigmoidectomy reduces concerns about diverticulitis and behavioral changes due to the disease. Quality of life should be considered when referring patients with uncomplicated diverticulitis to surgery. Prospective studies are required to confirm this result.
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Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy. .,Clinica Chirurgica 3^, Policlinico Universitario, sesto piano. Via Giustiniani 2, 35128, Padova, Italy.
| | - Alice Bressan
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
| | - Massimo Vecchiato
- Department of General Surgery, University Hospital of Udine, Udine, Italy
| | - Angelo Turoldo
- Department of Medical and Surgical Sciences, University of Trieste, Trieste, Italy
| | - Annachiara Frigo
- Department of Cardiology, Chest and Vascular Surgery, University of Padova, Padova, Italy
| | | | - Nicolò De Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Trieste, Italy
| | - Roberto Petri
- Department of General Surgery, University Hospital of Udine, Udine, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
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Polese L, Bressan A, Sperti C. Endoscopic ultrasound guided drainage of a pancreatic pseudocyst: a case report of a fistula to the common bile duct. MINERVA CHIR 2018; 73:349-351. [PMID: 29471615 DOI: 10.23736/s0026-4733.18.07620-4] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy -
| | - Alice Bressan
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Polese L, Marini L, Rizzato R, Picardi E, Merigliano S. Endoscopic diode laser therapy for chronic radiation proctitis. Lasers Med Sci 2017; 33:35-39. [DOI: 10.1007/s10103-017-2323-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022]
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Salvador R, Costantini M, Capovilla G, Polese L, Merigliano S. Esophageal Penetration of the Magnetic Sphincter Augmentation Device: History Repeats Itself. J Laparoendosc Adv Surg Tech A 2017; 27:834-838. [PMID: 28586287 DOI: 10.1089/lap.2017.0182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An alternative approach to the treatment of gastroesophageal reflux disease (GERD) has recently been introduced in clinical practice, involving the implantation of a magnetic sphincter augmentation device (MSAD). This "magnetic ring" is implanted laparoscopically around the lower esophageal sphincter to improve its barrier function. The literature is still limited on the midterm results achieved in controlling reflux because the MSAD is a very new procedure. So far, only a few cases of the MSAD causing erosion of the esophagus have been reported. METHODS We report on two cases of progressive and severe dysphagia after the implantation of an MSAD elsewhere. In both cases, the symptoms were caused by the migration of the device into the esophagus. RESULTS The devices were removed endoscopically in a single step in both cases, using the Olympus cutter. After 3 months, the first patient had a laparoscopic Nissen fundoplication without any complications and with a good final reflux control. The second only underwent removal of the device, using the same endoscopic approach and again without any complications. CONCLUSIONS Judging from the literature, MSAD implantation may be an effective way to control GERD, but the method can carry major complications, such as migration of the device into the esophagus (as in the two cases reported here). Endoscopic removal of a device possibly penetrating inside the esophagus is feasible and safe, and may later be followed up with a laparoscopic antireflux procedure without any particular difficulty.
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Affiliation(s)
- Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica III, School of Medicine, University of Padova , Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica III, School of Medicine, University of Padova , Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica III, School of Medicine, University of Padova , Padova, Italy
| | - Lino Polese
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica III, School of Medicine, University of Padova , Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological and Gastroenterological Sciences, Clinica Chirurgica III, School of Medicine, University of Padova , Padova, Italy
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Carniel EL, Frigo A, Fontanella CG, De Benedictis GM, Rubini A, Barp L, Pluchino G, Sabbadini B, Polese L. A biomechanical approach to the analysis of methods and procedures of bariatric surgery. J Biomech 2017; 56:32-41. [DOI: 10.1016/j.jbiomech.2017.02.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
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Polese L, Porzionato A, Luisetto R, Mastrogiacomo D, Macchi V, De Caro R, Norberto L, Merigliano S. Roux-en-Y gastrojejunal bypass using a hybrid NOTES-12 mm trocar technique in a porcine model. MINIM INVASIV THER 2016; 25:86-90. [PMID: 26751102 DOI: 10.3109/13645706.2015.1125929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To evaluate the feasibility and safety of Roux-en-Y gastrojejunal bypass procedure using a hybrid NOTES-12 mm trocar technique in a survival porcine model. MATERIAL AND METHODS The procedure was carried out on ten pigs. Two gastroscopes were introduced through the mouth and through a 12 mm trocar, respectively. A mechanical circular gastro-jejunal anastomosis was created by introducing a stapler after the trocar incision was enlarged. A 21 mm EEA OrVil circular stapler was utilized in the first six pigs and a 25 mm one was used in the other four. All pigs were fed beginning 24 hours after the procedure and were euthanized three weeks later. RESULTS The procedure was successfully completed in all ten animals. The mean length of the skin incision was 2.5 cm. All pigs survived without complications. Endoscopic inspection detected anastomotic strictures in 5/6 of the 21 mm-stapler and in 0/4 of the 25 mm-stapler anastomoses (p < 0.05). CONCLUSION Roux-en-Y gastrojejunal bypass using a hybrid NOTES-single 12 mm trocar access technique is a simple and safe procedure in a survival porcine model. Functional results need to be evaluated by further studies.
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Affiliation(s)
- Lino Polese
- a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy
| | - Andrea Porzionato
- b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy
| | - Roberto Luisetto
- c Department of Experimental Surgery , University of Padova , Padova , Italy
| | - Doralba Mastrogiacomo
- a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy
| | - Veronica Macchi
- b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy
| | - Raffaele De Caro
- b Section of Anatomy, Department of Molecular Medicine , University of Padova , Padova , Italy
| | - Lorenzo Norberto
- a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy
| | - Stefano Merigliano
- a Department of Surgery, Oncology and Gastroenterology , University of Padova , Padova , Italy
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Pozza A, Erroi FR, Scarpa M, Polese L, Rampazzo L, Norberto L. Palliative therapy for esophageal cancer: laser therapy alone is associated with a better functional outcome. Updates Surg 2015; 67:61-7. [PMID: 25627110 DOI: 10.1007/s13304-015-0277-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/29/2014] [Indexed: 01/02/2023]
Abstract
The aim of our study was to compare functional outcome and survival in patients who underwent laser therapy (LT) or laser therapy and esophageal stenting (LTES) to palliate inoperable esophageal cancer. Two hundred and twenty-seven consecutive patients who had endoscopic palliation for esophageal cancer were enrolled in this retrospective study. One hundred and sixty-four underwent LT alone and 63 had LTES. A dysphagia score was adopted (0: absolute dysphagia; 1: liquid diet; 2: semisolid diet; 3: free diet). Survival analysis and non parametric statistics were performed. Patients in the LTES group reported a significantly worse dysphagia score than LT patients (p < 0.01). LTES patients more frequently reported difficulty swallowing than LT patients (p < 0.01). No difference between LTES and LT groups was observed in terms of overall survival. Only radiotherapy resulted in a significant predictor of better survival (p = 0.007). Despite a similar survival, LTES is a predictor of a worse functional palliation than LT alone. Radiotherapy was associated with better survival in patients treated with LT. Therefore, these data seem to suggest that a combination of endoscopic LT and external radiotherapy may yield the best results in palliative care of advanced esophageal cancer.
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Affiliation(s)
- Anna Pozza
- Surgical Endoscopy Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, via Giustinani 2, 35128, Padua, Italy,
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Polese L, Lezoche E, Porzionato A, Lezoche G, Da Dalt G, Macchi V, Stecco C, De Caro R, Norberto L, Merigliano S. Transanal ileoproctostomy is feasible in human cadavers. Colorectal Dis 2014; 16:O367-9. [PMID: 24916474 DOI: 10.1111/codi.12684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/28/2014] [Indexed: 02/08/2023]
Abstract
AIM An ileorectal bypass performed entirely through a transanal route has recently been described in an animal model. The present study aimed to demonstrate its technical feasibility in four human cadavers. METHOD A transanal endoscopic microsurgery (TEM) device and endoscopic instruments were used. The principal steps of the procedure included insertion of the TEM device, rectostomy above the peritoneal reflection, peritoneoscopy using a standard gastroscope and delivery of the small bowel through the proctostomy to perform an anastomosis. RESULTS The procedure was successfully completed using transanal access in all cases. The mean procedure time was 90 min. The bypass was patent, and the anastomosis between the intraperitoneal rectum and the terminal ileum was leakproof. CONCLUSION Transanal ileoproctostomy is technically feasible in human cadavers. The procedure may become an alternative to stoma formation in selected patients with colonic obstruction.
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Affiliation(s)
- L Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Porzionato A, Polese L, Lezoche E, Macchi V, Lezoche G, Da Dalt G, Stecco C, Norberto L, Merigliano S, De Caro R. On the suitability of Thiel cadavers for natural orifice transluminal endoscopic surgery (NOTES): surgical training, feasibility studies, and anatomical education. Surg Endosc 2014; 29:737-46. [PMID: 25060684 DOI: 10.1007/s00464-014-3734-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical training in virtual, animal and cadaver models is essential for minimally invasive surgery. Thiel cadavers are suitable for laparoscopy, but there are few data about the use of embalmed (Tutsch method) and slightly embalmed (Thiel method) cadavers in procedures of Natural Orifice Transluminal Endoscopic Surgery (NOTES), which are usually developed and learned on swine models and fresh frozen cadavers. The aim of this study was thus to assess the use of these cadavers for NOTES approaches. METHODS The following surgical procedures were evaluated: transanal total mesorectal excision (four cadavers: one Tutsch, two Thiel, one fresh frozen), transanal ileorectal bypass (five cadavers: one Tutsch, three Thiel, one fresh frozen), and transvaginal appendectomy (two Tutsch cadaver). RESULTS The Thiel method ensured tissue flexibility and consistency suitable for performing the above surgical procedures with good results and without complications, with only a small increase in rigidity with respect to fresh specimens. Cadavers embalmed with higher formalin concentrations (Tutsch method) were more difficult to use, due to high tissue rigidity and resistance of the abdominal wall to pneumoperitoneum, although NOTES accesses were possible. CONCLUSIONS Thiel cadavers are suitable for transanal/transrectal and transvaginal NOTES approaches, for training surgical residents/specialists and also for surgical research. In minimally invasive surgery (and particularly in NOTES), integration between cadaver (fresh frozen and/or Thiel) and animal models would represent the gold standard, allowing guaranteed knowledge of and respect for human surgical anatomy and correct management of surgery on living subjects. NOTES approaches to human cadavers may also be proposed for the anatomical education of medical students.
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Affiliation(s)
- Andrea Porzionato
- Section of Anatomy, Department of Molecular Medicine, University of Padova, Via A. Gabelli 65, 35127, Padua, Italy
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Carniel EL, Fontanella CG, Polese L, Merigliano S, Natali AN. Computational tools for the analysis of mechanical functionality of gastrointestinal structures. Technol Health Care 2013; 21:271-83. [DOI: 10.3233/thc-130722] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Lino Polese
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Merigliano
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Arturo Nicola Natali
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
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Polese L, Merigliano S, Mungo B, Rizzato R, Luisetto R, Ancona E, Norberto L. Totally stapled gastrojejunal anastomosis using hybrid NOTES: single 12-mm trocar approach in a porcine model. Surg Endosc 2012; 26:2527-31. [PMID: 22476830 DOI: 10.1007/s00464-012-2226-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 02/14/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of a totally stapled gastrojejunal anastomosis performed using one transabdominal 12-mm trocar and a gastroscope in a porcine model. METHODS The procedure was carried out on six domestic pigs weighing 45 kg using a hybrid technique with a gastroscope and a 12-mm Hasson trocar, positioned in the left hypochondrium. At the end of the procedure a mechanical circular 21-mm gastrojejunal anastomosis was performed by inserting the stapler through a small gastrotomy after enlarging the trocar incision. RESULTS In all six cases the procedure was completed through a single 3 cm abdominal incision and without complications. The mean operating time was 2 h, and endoscopic investigation showed that the anastomoses were intact, patent, and airtight. CONCLUSIONS Totally stapled gastrojejunal anastomosis using a hybrid NOTES-single 12-mm trocar approach is a feasible procedure in the porcine model. Further survival studies are warranted, particularly to evaluate the functional results of this procedure.
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Affiliation(s)
- Lino Polese
- Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy.
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26
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Polese L, Vecchiato M, Frigo AC, Sarzo G, Cadrobbi R, Rizzato R, Bressan A, Merigliano S. Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Colorectal Dis 2012; 14:e124-8. [PMID: 21910814 DOI: 10.1111/j.1463-1318.2011.02819.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [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: 12/13/2022]
Abstract
AIM The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated. METHOD Patient characteristics, indications for surgery, surgical technique and postoperative complications were prospectively recorded. Stenosis was evaluated by rectoscopy at regular intervals, and patients were treated only if symptomatic. After at least 6 months following surgery, patients were asked to respond to the Short Form 36-item quality-of-life questionnaire during a telephone interview. RESULTS Of the original 211 patients considered, 195 underwent a follow-up rectoscopy and were included in the study. Benign stenosis were found in 26 (13%), and 19 (73%) symptomatic patients were treated successfully (15 with endoscopic dilatation and four with radial diathermic surgical incisions). Risk factors for anastomotic stenosis according to univariate analysis were female sex, diverticulitis, mechanical anastomosis, and anastomosis located between 8 and 12 cm from the anal verge. The significant risk factors identified by multivariate analysis were diverticulitis (OR 5, P=0.002) and mechanical anastomosis (OR 9, P=0.04). The self-perceived quality of life of patients with stenosis was significantly worse compared with controls. CONCLUSION Since diverticulitis and mechanical anastomosis are risk factors for anastomotic stenosis, surgeons should take this into account when they are considering what type of anastomotic technique to utilize.
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Affiliation(s)
- L Polese
- Department of Surgical and Gastroenterological Sciences, 1st Surgical Clinic, Coloproctology Unit, Ospedale S. Antonio, Padova, Italy.
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Polese L, Boetto R, De Franchis G, Angriman I, Porzionato A, Norberto L, Sturniolo GC, Macchi V, De Caro R, Merigliano S. B1a lymphocytes in the rectal mucosa of ulcerative colitis patients. World J Gastroenterol 2012; 18:144-9. [PMID: 22253520 PMCID: PMC3257441 DOI: 10.3748/wjg.v18.i2.144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 03/07/2011] [Revised: 06/12/2011] [Accepted: 06/19/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls.
METHODS: Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls. CD5+ B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine®. Immunohistochemical analysis of B and T lymphocytes was also performed. Correlations between, on the one hand, rectal B1a cell concentrations and, on the other, erythrocyte sedimentation rate and C-reactive protein levels and clinical, endoscopic and histological disease activity indices were evaluated.
RESULTS: Rectal B-lymphocyte (CD19+/CD45+) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%, P = 0.001 and 501 ± 91 cells/mm2vs 117 ± 18 cells/mm2, P < 0.001); Rectal B1a cell density (CD5+CD19+) was higher in UC patients than in healthy controls (85 ± 15 cells/mm2vs 31 ± 6.7 cells/mm2, P = 0.009). Rectal B1a cell (CD5/CD19+) rate correlated inversely with endoscopic classification (Rs = -0.637, P < 0.05).
CONCLUSION: B1a lymphocytes seem to be involved in the pathogenesis of UC, however, the role they play in its early phases and in disease activity, have yet to be defined.
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Abstract
Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive genodermatosis. While its incidence is unknown, approximately 300 cases have been reported in the literature. The syndrome typically presents with a characteristic facial rash (poikiloderma), its diagnostic hallmark, and heterogeneous clinical features including congenital skeletal abnormalities, sparse hair distribution, juvenile cataracts, and a predisposition to osteosarcoma. Gastrointestinal symptoms, such as pyloric stenosis, anal atresia, annular pancreas, and rectovaginal fistula, have also been reported sporadically. This is a report describing a patient diagnosed with RTS referred to us because of dysphagia caused by esophageal stenosis. Long-term results of endoscopic dilation are also presented.
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Affiliation(s)
- L Polese
- Department of Surgical and Gastroenterological Sciences Department of Medical Diagnostic Sciences and Special Therapies, Pathology Unit, Via Giustiniani 2, University of Padova, Padua, Italy.
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Polese L, Angriman I, Mungo B, Luisetto R, Frego M, Merigliano S, Norberto L. Ileorectal bypass performed entirely through a transanal route in a porcine model. Surg Endosc 2011; 25:3022-7. [PMID: 21484531 DOI: 10.1007/s00464-011-1664-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Pozza A, Scarpa M, Ruffolo C, Polese L, Erroi F, Bridda A, Norberto L, Frego M. Colonic carcinogenesis in IBD: molecular events. Ann Ital Chir 2011; 82:19-28. [PMID: 21657151] [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
Patients with ulcerative colitis (UC) and Crohn's disease (CD) are at increased risk of developing intestinal cancers via mechanisms that remain incompletely understood. Several evidences suggest a causal link between chronic inflammation and the development of cancer in the gastrointestinal tract. In fact, patients with UC are exposed to repeated episodes of inflammation that predispose to various tumorigenic events and the sequence of these events are different from those that contribute to develop a sporadic colorectal cancer. In UC carcinogenesis the early events are represented by DNA methylation that produce an inhibition of onco-suppressor genes, mutation of p53, aneuploidy and microsatellite instability. Hypermethylation of tumor suppressors and DNA mismatch repair gene promoter regions, is an epigenetic mechanism of gene silencing that contributes to tumorigenesis and might represent the first step in inflammatory carcinogenesis. P53 is frequently mutated in the early stages of UC-associated cancer, in 33-67% of patients with dysplasia and in 83-95% of UC related cancer patients. Moreover, aneuploidy is an independent risk factor for forthcoming carcinogenesis in UC Finally, the inconsistency between the high cumulative rate of dysplasia in UC and the relatively lower incidence of invasive cancer raises the question about the mechanisms of immunosurveillance that may prevent malignant progression of neoplasm in the colon in most cases. Co-stimulatory molecule CD80 up-regulation in colonic mucosa in UC dysplasia may be one of these mechanism.
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Affiliation(s)
- Anna Pozza
- Department of Surgical and Gastroenterological Sciences P.G. Cevese, University of Padua, Italy
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Scarpa M, Angriman I, Prando D, Polese L, Ruffolo C, Pilon F, Erroi F, Mescoli C, Ninfo V, D'Amico DF, Norberto L. Helicobacter pylori and gastroesophageal reflux disease: a cross sectional study. Hepatogastroenterology 2011; 58:69-75. [PMID: 21510289] [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: 05/30/2023]
Abstract
UNLABELLED BACKGROUND\ AIMS Helicobacter Pylori (H. Pylori) is a key pathogenetic factor in gastritis, peptic ulcer disease, gastric carcinoma and lymphoma but its relationship with gastroesophageal reflux disease (GERD) is controversial. The aim of the study is to estimate the possible association between the presence of H. pylori and GERD. METHODOLOGY In this retrospective study we examined the endoscopy and pathology reports of all the 638 consecutive patients who had upper gastrointestinal endoscopy and adequate mucosal sampling in 2005 in our department at the University of Padova. Yates corrected chi2 test was used to compare the H. Pylori frequency in the different histological groups. Multinomial logistic regression was used to identify possible predictors of H. Pylori infection. RESULTS In this selected population 133 patients were affected by H. Pylori infection (20.8%) and 107 were affected by GERD according to Montreal definition. No significant relation between H. Pylori infection and GERD or NERD (non erosive reflux disease) was evidenced. As expected histological gastritis at the examination confirmed to be the strongest predictor of infection with a odds ratio of 39.4 (95% CI 5.4-287.4, p < 0.01). Upper abdominal pain showed to be the only clinical independent predictors for the presence of H. Pylori infection with a odds ratio of 1.5 (95% CI 1.0-2.3, p = 0.04). CONCLUSIONS Our study showed that in north eastern Italy there is no association between H. Pylori infection and GERD. On the contrary presence of histological gastritis and upper abdominal pain were confirmed to be significant predictors of H. Pylori infection. No endoscopic characteristic is significantly related to the presence of H. Pylori.
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Affiliation(s)
- Marco Scarpa
- Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
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Ruffolo C, Scarpa M, Polese L, D'Amico FE, Boetto R, Pozza A, D'Incà R, Checchin D, Sturniolo GC, Bassi N, Angriman I. Clinical presentation and diagnosis of intestinal adenocarcinoma in Crohn's disease: analysis of clinical predictors and of the life-time risk. J Gastrointest Surg 2010; 14:1746-51. [PMID: 20628906 DOI: 10.1007/s11605-010-1265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 04/28/2010] [Accepted: 06/07/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Late diagnosis of cancer in CD often occurs, and the prognosis is poor. The primary aim of this study was to assess the relationship between clinical presentation and diagnosis of intestinal adenocarcinoma in CD; the secondary aim was to evaluate the timing of cancer occurrence in CD patients. PATIENTS AND METHODS Medical records of 12 consecutive patients with intestinal adenocarcinoma in CD and of 79 consecutive CD patients undergoing bowel surgery were reviewed. Presentation symptoms were analyzed as possible predictors. Timing of intestinal adenocarcinoma occurrence in patients with CD was analyzed including all the 347 consecutive patients that had undergone surgery for CD in our institute from January 1984 to June 2008. Life table analysis and uni/multivariate analyses were performed. RESULTS Ten men and two women underwent surgery for intestinal cancer in CD with a median age of 50 years (31-68). Carcinomas were localized in the terminal ileum in four cases, right colon in three, transverse colon in one, sigmoid colon in one, rectum in two, and an anorectal fistula in one. Only three patients were pre-operatively diagnosed with cancer. At multivariate analysis only age (OR 1.057 (95% CI 0.999-1.107), p = 0.05) and obstruction (OR 6.530 (95% CI 1.533-27.806), p = 0.01) significantly predicted cancer diagnosis. The risk rate (RR) for cancer occurrence started to rise at the end of the third decade of life (RR = 0.005). The analysis of risk rate for cancer occurrence during overt CD showed that it is initially high at onset (RR = 0.001) and after two other peaks at 150 months from onset, it began to rise again. The presence of Crohn's colitis was associated to a significant risk of cancer (HR = 4.790, p = 0.009) while the use of 5-ASA resulted to be a protective factor against cancer occurrence (HR = 0.122, p = 0.013). DISCUSSION In CD, rectal bleeding, the most common alarm symptom for intestinal cancer, is not useful for an early diagnosis. CD patients presenting with an older age and obstruction should be thoroughly investigated to rule out neoplastic lesions. There is probably no safe interval of CD where surveillance for intestinal cancer can be omitted. In the meantime, even in absence of active disease, all CD patients should undergo therapy with 5-ASA.
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Affiliation(s)
- Cesare Ruffolo
- II Department of Surgery, IV Unit, Regional Hospital Cà Foncello, Treviso, Italy.
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Polese L, Angriman I, Scarpa M, Pagano D, Parente P, Erroi F, Frego M, D'Amico DF, Norberto L. Diode laser treatment of Barrett's esophagus: long-term results. Lasers Med Sci 2010; 26:223-8. [PMID: 20821340 DOI: 10.1007/s10103-010-0836-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 08/24/2010] [Indexed: 11/25/2022]
Abstract
Different ablation techniques have been utilized in the treatment of Barrett's esophagus (BE) to reduce the risk of degeneration. Treatment complications, risk of recurrence, and buried intestinal metaplasia (IM) are all major concerns. The effect of diode laser treatment on BE, studied in a group of patients over a long-term period, is presented here. All patients with histology of IM or low-grade dysplasia (LGD) treated with diode laser therapy for BE and followed for at least 24 months were included in the study. Treatment sessions were carried out every 3 months and bioptic follow-up examinations were done yearly. Patients without antireflux surgery received proton pump inhibitors. A total of 20 patients with IM, four of them with LGD, were treated with 161 laser sessions (in mean eight per patient) without complications. Complete, sustained endoscopic and histologic remission was obtained in 13 patients (11/12 with BE ≤ 3 cm and 2/8 with BE >3 cm, p < 0.01) and a mean of 83 ± 27% of the metaplasic tissue was removed in all the patients. All four cases of LGD healed to squamous tissue. No buried metaplasia, recurrences, or disease progressions were reported after a mean follow-up of 6 years and 2 months. Diode laser ablation is a safe and effective method in most cases of short BE, while it is less effective in the long form, requiring a large number of sessions. Long-term results show that the risk of recurrence and of buried intestinal metaplasia underneath neosquamous epithelium is negligible.
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Affiliation(s)
- Lino Polese
- Surgical Endoscopy Unit, 1st Surgical Clinic, Surgical and Gastroenterological Sciences, Padova University, Padova, Italy.
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Scarpa M, Mescoli C, Rugge M, D'Incà R, Ruffolo C, Polese L, D'Amico DF, Sturniolo GC, Angriman I. Restorative proctocolectomy for inflammatory bowel disease: the Padova prognostic score for colitis in predicting long-term outcome and quality of life. Int J Colorectal Dis 2009; 24:1049-57. [PMID: 19415309 DOI: 10.1007/s00384-009-0700-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Accepted: 04/01/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 10-20% of cases, it is impossible to distinguish between ulcerative colitis and Crohn's colitis, affecting the possibility to predict the long-term outcome after restorative proctocolectomy (RPC). The study aimed to assess the accuracy of a new prognostic score for inflammatory bowel diseases (IBD) colitis [the Padova Prognostic Score for Colitis (PPSC)] in predicting long-term clinical/functional outcome and quality of life after RPC. MATERIALS AND METHODS The PPSC was created by the integration of histological and clinical information. The accuracy of the PPSC was tested in predicting long-term clinical outcome (i.e. pouch complications/survival) and quality of life of 58 consecutive patients who had undergone RPC in our institute from 1984 to 2004. Clinical outcome was assessed with an ad hoc functional questionnaire and the revision of the hospital and outpatients clinic notes. Quality of life surveys were carried out with the Padova IBD Quality of Life (PIBDQL) and with Cleveland Global Quality of Life (CGQL) scores. RESULTS The PPSC predicted pouch fistulae (accuracy = 84.5%; sensitivity = 50%; specificity = 90%) and changes in sexual life (accuracy = 71%; sensitivity = 23%; specificity = 87%). The PPSC also predicted the PIBDQL score with an accuracy of 62%, a sensitivity of 28% and a specificity of 97%, whilst it predicted the CGQL score with an accuracy of 29%, a sensitivity of 12% and a specificity of 80%. The PPSC failed to predict pouchitis or pouch failure. CONCLUSIONS The Padova Prognostic Score for Colitis proved effective in predicting pouch fistulae or abscesses, but not pouchitis and pouch failure. The PPSC was accurate in predicting disease-specific quality of life.
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Affiliation(s)
- Marco Scarpa
- Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Padua, Italy
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Frego M, Bridda A, Ruffolo C, Scarpa M, Polese L, Bianchera G. The hostile neck does not increase the risk of carotid endarterectomy. J Vasc Surg 2009; 50:40-7. [PMID: 19563953 DOI: 10.1016/j.jvs.2008.12.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 12/19/2008] [Accepted: 12/19/2008] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hostile neck anatomy is assumed to be associated with increased surgical risk for patients undergoing carotid endarterectomy (CEA) and is often considered a reason to choose carotid stenting or medical management. This retrospective case-control study evaluated whether, and how much, anatomically hostile necks represent a condition of higher surgical risk of early and late mortality and major or minor morbidity. METHODS The data for 966 homogeneous CEA patients was prospectively entered in a computer database. Seventy-seven had a hostile neck anatomy due to previous oncologic surgery or neck irradiation, restenoses after CEA, high carotid bifurcation, or bull-like and inextensible neck. A case-control matched-pair cohort study considered sex, age (5-year intervals), and year of operation. Regional anesthesia was used for all operations for atherosclerotic stenosis >or=70%, conforming to the European Carotid Surgery Trial (ECST) in symptomatic and asymptomatic patients, at a single center and by one surgeon or under his direct supervision. RESULTS The hostile neck patients and the control group were matched for age, sex, carotid-related symptoms, degree of stenoses, and main risk factors for cardiovascular diseases. Intraoperative variables were substantially equivalent in the two groups; however, procedure length and clamping time were, respectively, about 22 minutes (P = .0001) and 7 minutes longer (P = .01) in the hostile neck group. Rates of postoperative mortality and neurologic events were equivalent. Peripheral nerve lesions were multiple and significantly more frequent in the hostile neck patients (21% with >or=1 cranial nerve lesion vs 7% of controls, P = .03), yet all were transient and limited to a few months. The subgroups of patients with hostile neck, restenoses, and bull-like inextensible necks required the longest operative and clamping time, and those with bull-like and high bifurcation had the most frequent cranial nerve dysfunctions. At the respective follow-up of 47 and 45 months, survival curves (P = .48) and the incidence of restenoses and fatal and nonfatal strokes were similar (5 and 4, respectively). CONCLUSIONS Hostile necks led to more complex CEA procedures but without substantial consequences in early and late morbidity and mortality. Most patients with hostile neck can undergo CEA at low risk, with the benefit of effective long-lasting stroke prevention similar to standard patients. In our opinion, the more frequent but temporary cranial nerve dysfunctions that occur are not sufficient to consider hostile neck patients noneligible for CEA.
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Affiliation(s)
- Mauro Frego
- Department of Surgical and Gastro-Enterological Sciences, 1st Surgical Clinic, University of Padova, Padova, Italy.
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Seewald S, Ang TL, Teng KY, Groth S, Zhong Y, Richter H, Imazu H, Omar S, Polese L, Seitz U, Bertschinger P, Altorfer J, Soehendra N. Endoscopic ultrasound-guided drainage of abdominal abscesses and infected necrosis. Endoscopy 2009; 41:166-74. [PMID: 19214899 DOI: 10.1055/s-0028-1119501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Traditionally abdominal abscesses have been treated with either surgical or radiologically guided percutaneous drainage. Surgical drainage procedures may be associated with considerable morbidity and mortality, and serious complications may also arise from percutaneous drainage. Endoscopic ultrasound (EUS)-guided drainage of well-demarcated abdominal abscesses, with adjunctive endoscopic debridement in the presence of solid necrotic debris, has been shown to be feasible and safe. This multicenter review summarizes the current status of the EUS-guided approach, describes the available and emerging techniques, and highlights the indications, limitations, and safety issues.
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Affiliation(s)
- S Seewald
- Center of Gastroenterology, Klinik Hirslanden Zurich, Switzerland.
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Scarpa M, Pagano D, Ruffolo C, Pozza A, Polese L, Frego M, D'Amico DF, Angriman I. Health-related quality of life after colonic resection for diverticular disease: long-term results. J Gastrointest Surg 2009; 13:105-12. [PMID: 18751760 DOI: 10.1007/s11605-008-0667-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 08/08/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only. PATIENTS AND METHODS Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3-102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used. RESULTS The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only. CONCLUSIONS Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD.
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Affiliation(s)
- Marco Scarpa
- Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Clinica Chirurgica I, Policlinico Universitario, via Giustiniani 2, 35128, Padova, Italy.
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Scarpa M, Pagano D, Ruffolo C, Pozza A, Polese L, Frego M, D'Amico DF, Angriman I. Health-related quality of life after colonic resection for diverticular disease: long-term results. Gastroenterology 2009. [PMID: 18751760 DOI: 10.1016/s0016-5085(08)64044-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/27/2022]
Abstract
BACKGROUND AND AIMS While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only. PATIENTS AND METHODS Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3-102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used. RESULTS The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only. CONCLUSIONS Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD.
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Affiliation(s)
- Marco Scarpa
- Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Clinica Chirurgica I, Policlinico Universitario, via Giustiniani 2, 35128, Padova, Italy.
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Scarpa M, Bertin M, Ruffolo C, Polese L, D'Amico DF, Angriman I. A systematic review on the clinical diagnosis of gastrointestinal stromal tumors. J Surg Oncol 2008; 98:384-92. [PMID: 18668671 DOI: 10.1002/jso.21120] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this work was to assess the prevalence of symptoms of gastrointestinal stromal tumors (GISTs) and the diagnostic yield of clinical procedures for its diagnosis. METHODS Medical databases were consulted between 1998 and 2006 for potentially relevant publications. All studies dealing with the clinical presentation of GIST and related diagnostic procedures were included. Two researchers worked independently on the study selection, quality assessment, data extraction, and analysis phases of the study. RESULTS Forty-six observational studies were included with a total of 4,534 patients. Gastrointestinal bleeding was the most common clinical presentation. Twenty studies provided adequate information on the diagnostic yield of various procedures. The pooled diagnostic yield of endoscopy + mucosal biopsy and of intestinal contrast radiography was 33.8% (0-100%) and 35.1% (11-100%), respectively, while that of EUS and that of EUS-FNA was 68.7% (40-100%) and 84.0% (73.8-100%), respectively. Abdominal CT scan and MRI had similar pooled diagnostic yields: 73.6% (34.8-100%), and 91.7% (75-100%), respectively. CONCLUSION Endoscopy + mucosal biopsy should be reserved to patients with gastrointestinal bleeding. EUS-FNA provides direct visualization of the neoplasm and adequate samples for molecular diagnosis. EUS, abdominal CT and MRI may be considered valid alternatives whenever EUS-FNA is unavailable or a cytological diagnosis is unnecessary.
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Affiliation(s)
- Marco Scarpa
- Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Padova, Italy.
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Scarpa M, Bertin M, Ruffolo C, Polese L, D'Amico DF, Angriman I. A systematic review on the clinical diagnosis of gastrointestinal stromal tumors. J Surg Oncol 2008. [PMID: 18668671 DOI: 10.1002/jso.2112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this work was to assess the prevalence of symptoms of gastrointestinal stromal tumors (GISTs) and the diagnostic yield of clinical procedures for its diagnosis. METHODS Medical databases were consulted between 1998 and 2006 for potentially relevant publications. All studies dealing with the clinical presentation of GIST and related diagnostic procedures were included. Two researchers worked independently on the study selection, quality assessment, data extraction, and analysis phases of the study. RESULTS Forty-six observational studies were included with a total of 4,534 patients. Gastrointestinal bleeding was the most common clinical presentation. Twenty studies provided adequate information on the diagnostic yield of various procedures. The pooled diagnostic yield of endoscopy + mucosal biopsy and of intestinal contrast radiography was 33.8% (0-100%) and 35.1% (11-100%), respectively, while that of EUS and that of EUS-FNA was 68.7% (40-100%) and 84.0% (73.8-100%), respectively. Abdominal CT scan and MRI had similar pooled diagnostic yields: 73.6% (34.8-100%), and 91.7% (75-100%), respectively. CONCLUSION Endoscopy + mucosal biopsy should be reserved to patients with gastrointestinal bleeding. EUS-FNA provides direct visualization of the neoplasm and adequate samples for molecular diagnosis. EUS, abdominal CT and MRI may be considered valid alternatives whenever EUS-FNA is unavailable or a cytological diagnosis is unnecessary.
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Affiliation(s)
- Marco Scarpa
- Department of Surgery, Veneto Oncological Institute (IOV-IRCCS), Padova, Italy.
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Scarpa M, Bortolami M, Morgan SL, Kotsafti A, Ruffolo C, D'Incà R, Bertin E, Polese L, D'Amico DF, Sturniolo GC, Angriman I. TGF-beta1 and IGF-1 and anastomotic recurrence of Crohn's disease after ileo-colonic resection. J Gastrointest Surg 2008; 12:1981-90. [PMID: 18704594 DOI: 10.1007/s11605-008-0641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 07/22/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND After bowel resection, Crohn's disease (CD) recurs frequently in the site of the anastomosis. Alteration of normal healing processes may play a role in this phenomenon. Transforming growth factor beta (TGF-beta) and insulin-like growth factor (IGF-1) are involved in wound healing mechanisms with pro-fibrogenic properties. The aim of this study was to assess the expression of TGF-beta1 and insulin-like growth factor 1 (IGF-1) in the different zones of the bowel wall to understand why side-to-side anastomosis are associated to a lower recurrence rate compared to end-to-end ones. PATIENTS AND METHODS Seventeen patients affected by CD who underwent ileo-colonic resection from 2004 to 2005 were enrolled in this study. Full-thickness tissue samples were obtained from the mesenteric, the lateral, and the anti-mesenteric sides of the macroscopically diseased and healthy ileum for each patient. TGF-beta1 and IGF-1 messenger RNAs (mRNAs) were quantified by real-time polymerase chain reaction. Myeloperoxidase activity and histological disease activity were assessed to quantify the ileal inflammation. Vimentin, desmin, and alpha-smooth muscle actin were stained with immunohistochemistry to assess the fibroblast, smooth muscle cell, and myofibroblasts populations. Comparisons and correlations were carried out with nonparametric tests. RESULTS In diseased ileum, TGF-beta1 mRNA transcripts in the antimesenteric side were significantly lower than those of the mesenteric side (p = 0.05), and a significant correlation between TGFbeta-1 levels in diseased bowel and the sampling site was observed (tau = 0.36, p = 0.03). On the contrary, neither the IGF-1 mRNA transcripts nor the distribution of fibroblast, smooth muscle cell, and myofibroblasts populations showed any relation with the sampling site. CONCLUSION TGF-beta1 mRNA expression was lower in the anti-mesenteric side of the diseased ileum, and this was consistent with the success of side-to-side anastomosis in preventing CD recurrence. Since high expression of TGF-beta1 was associated to early recurrence, it seems rationale to construct the anastomosis on the anti-mesenteric side of the bowel.
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Affiliation(s)
- Marco Scarpa
- Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, Università di Padova, via Giustiniani 2, 35128, Padova, Italy.
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Ruffolo C, Scarpa M, Faggian D, Pozza A, Navaglia F, D'Incà R, Hoxha P, Romanato G, Polese L, Sturniolo GC, Plebani M, D'Amico DF, Angriman I. Cytokine network in rectal mucosa in perianal Crohn's disease: relations with inflammatory parameters and need for surgery. Inflamm Bowel Dis 2008; 14:1406-12. [PMID: 18452203 DOI: 10.1002/ibd.20486] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nowadays anti-TNF-alpha antibodies are used for the treatment of perianal Crohn's disease (CD). Nevertheless, this treatment is effective in only a part of these patients and recent studies suggested a role for other cytokines in chronic bowel inflammation. The aim of this study was to assess the cytokine profile in the rectal mucosa of patients affected by perianal CD and to understand its relations with the systemic cytokine profile and inflammatory parameters and the need for surgery. METHODS Seventeen patients affected by perianal CD, 7 affected by CD without perianal involvement, and 17 healthy controls were enrolled and underwent blood sampling and endoscopy. During endoscopy rectal mucosal samples were taken and the expression of TNF-alpha, IL-6, IL-1 beta, IL-12, and TGF-beta1 was quantified with enzyme-linked immunosorbent assay (ELISA). Local cytokine levels were compared and correlated with diagnosis, therapy, phenotype (fistulizing and stenosing), and disease activity parameters. RESULTS In the group with perianal CD, rectal mucosal IL-1 beta, IL-6, and serum IL-6 and TNF-alpha were higher than in patients with small bowel CD and healthy controls. IL-12 and TGF-beta1 mucosal levels did not show any differences among the 3 groups. Mucosal IL-6 significantly correlated with the Perianal Crohn's Disease Activity Index and mucosal TNF-alpha and IL-1 beta. Mucosal TNF-alpha and IL-1 beta showed a direct correlation with the histological grade of disease activity. CONCLUSIONS The cytokines network analysis in perianal CD shows the important involvement of IL-1 beta, IL-6, and TNF-alpha. Furthermore, mucosal levels of IL-6 and IL-12 are predictors of recurrence and of need for surgery in perianal CD patients.
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Affiliation(s)
- Cesare Ruffolo
- Clinica Chirurgica 1, Department of Surgical and Gastroenterological Sciences, University of Padua, Padova, Italy.
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Angriman I, Scarpa M, Ruffolo C, Pomerri F, Filosa T, Polese L, Pagano D, Norberto L, D’Amico DF. Double contrast small-bowel radiography in the preoperative assessment of Crohn’s disease: Is it still useful? Surg Today 2008; 38:700-4. [DOI: 10.1007/s00595-007-3700-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 08/23/2007] [Indexed: 12/22/2022]
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44
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Scarpa M, Erroi F, Ruffolo C, Mollica E, Polese L, Pozza G, Norberto L, D'Amico DF, Angriman I. Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results. Surg Endosc 2008; 23:577-82. [PMID: 18389312 DOI: 10.1007/s00464-008-9884-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 01/23/2008] [Accepted: 02/11/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of this cross-sectional study were to assess the long-term quality of life, the body image, and the cosmetic and functional results in patients who had laparoscopic-assisted for colorectal cancer. METHODS Forty-two patients were enrolled in this study: 21 consecutive patients who had undergone laparoscopic-assisted colonic resection and 21 patients who had open colonic resection, selected according to stage, gender, age, cancer site, and type of resection. The patients answered four questionnaires about their quality of life, body image, functional, and cosmetic results. Nonparametric tests were used for statistical analysis. RESULTS Postoperative hospital stay was shorter in patients who had laparoscopic-assisted resection. The cosmetic score was significantly better in the laparoscopic-assisted group than in the open group (p < 0.01). In spite of similar overall body image score, patients who had a laparoscopic-assisted resection reported a significantly better satisfaction with their own body (p = 0.05). Quality-of-life and functional results were similar in both groups. CONCLUSIONS The cosmetic results and the consequent satisfaction with the body were significantly better after laparoscopic assisted resection compared to equivalent open procedure. These effects seemed to be temporary but they could help patients to accept the burden of surgery.
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Affiliation(s)
- Marco Scarpa
- Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy.
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45
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Scarpa M, Romanato G, Manzato E, Ruffolo C, Marin R, Basato S, Zambon S, Filosa T, Zanoni S, Pilon F, Polese L, Sturniolo GC, D'Amico DF, Angriman I. Restorative proctocolectomy for ulcerative colitis: impact on lipid metabolism and adipose tissue and serum fatty acids. J Gastrointest Surg 2008; 12:279-87. [PMID: 17955308 DOI: 10.1007/s11605-007-0380-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 09/26/2007] [Indexed: 01/31/2023]
Abstract
The aim of this prospective study was to evaluate the changes of the metabolism of circulating and storage lipids in patients with ulcerative colitis after restorative proctocolectomy. Fifteen consecutive patients and 15 sex- and age-matched healthy controls were enrolled. Disease activity, diet, inflammatory parameters, plasma lipoprotein concentrations, and fatty acids (FA) of serum phospholipids and of the subcutaneous adipose tissue were assessed at colectomy and at ileostomy closure. In ulcerative colitis patients, total cholesterol and docosahexaenoic acid were lower than in healthy subjects (p < 0.01 and p < 0.05). The median interval between colectomy and ileostomy closure was 6 (range 2-9) months. During that interval, the inflammatory parameters improved, high-density lipoproteins (HDL) cholesterol increased (p < 0.01), and low-density (LDL) cholesterol decreased (p = 0.01). At ileostomy closure, serum arachidonic acid levels were increased (p = 0.04), whereas serum oleic acid level was decreased (p = 0.02). In this interval, no significant alteration, either in serum n-3 FA precursors or in the FA of subcutaneous adipose tissue, was observed. The increase of serum arachidonic acid after colectomy might suggest a lower utilization for inflammatory process. The reduction of LDL cholesterol is an index of malabsorption probably due to the accelerated transit and to the exclusion of the terminal ileum caused by the covering ileostomy.
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Affiliation(s)
- Marco Scarpa
- Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, University of Padova, Padova, Italy.
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46
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Polese L, D'Incà R, Angriman I, Scarpa M, Pagano D, Ruffolo C, Lamboglia F, Sturniolo GC, D'Amico DF, Norberto L. Gastrointestinal telangiectasia: a study by EGD, colonoscopy, and capsule endoscopy in 75 patients. Endoscopy 2008; 40:23-9. [PMID: 18058652 DOI: 10.1055/s-2007-967039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 12/10/2022]
Abstract
BACKGROUND The distribution of lesions in the gastrointestinal tract in patients with sporadic telangiectasia is at present unknown. PATIENTS AND METHODS 75 patients with sporadic telangiectasia underwent esophagogastroduodenoscopy (EGD), capsule endoscopy, and colonoscopy. Endoscopic diagnosis of telangiectasia and gastrointestinal bleeding were required for enrollment in the study. Hemorrhagic diathesis, co-morbidity, number of blood transfusions, and subsequent management were also noted. RESULTS 35 of the patients presented with gastroduodenal vascular lesions, 51 with small-bowel lesions, and 28 with colonic lesions. 67 % of patients in whom EGD found telangiectasia also presented small-bowel vascular lesions at capsule endoscopy and 43 % colonic lesions at colonoscopy. 54 % percent of patients with positive colonoscopy also presented gastroduodenal lesions and 48 % small-bowel lesions. Patients with known duodenal lesions were more likely to have small-bowel lesions at capsule endoscopy (odds ratio [OR] 10.19, 95 % CI 2.1 - 49.33, P = 0.003). Patients with associated diseases, such as liver cirrhosis, chronic renal failure, or heart valvulopathy, presented more severe disease requiring blood transfusions (OR 6.37, 95 % CI 1.39 - 29.2, P = 0.015). The number of blood transfusions correlated with the number of sites affected ( R = 0.35, P = 0.002). The detection of new lesions at capsule endoscopy allowed new treatment in 46 % of patients. Mean follow-up was 18 months. CONCLUSIONS Sporadic telangiectasia is a multifocal disease potentially involving the whole digestive tract. Patients with duodenal telangiectasia show a higher risk of jejunal or ileal lesions. Capsule endoscopy is a useful diagnostic tool for the detection of such small-bowel vascular lesions, indicating a more specific prognosis and treatment strategy.
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Affiliation(s)
- L Polese
- Department of Surgical and Gastroenterological Sciences, University of Padova, Italy.
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Ruffolo C, Scarpa M, Polese L, Angriman I. Adenocarcinoma after restorative proctocolectomy for cancer in ulcerative colitis. Int J Colorectal Dis 2007; 22:1557-1558. [PMID: 17279349 DOI: 10.1007/s00384-006-0269-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Accepted: 12/22/2006] [Indexed: 02/04/2023]
Affiliation(s)
- Cesare Ruffolo
- Clinica Chirurgica 1^, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, Padua, 35100, Italy.
| | - Marco Scarpa
- Clinica Chirurgica 1^, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, Padua, 35100, Italy
| | - Lino Polese
- Clinica Chirurgica 1^, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, Padua, 35100, Italy
| | - Imerio Angriman
- Clinica Chirurgica 1^, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, Padua, 35100, Italy
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Frego M, Lumachi F, Bianchera G, Pilon F, Scarpa M, Ruffolo C, Polese L, Angriman I, Norberto L, Miotto D, Motta R, Zanon A, Picchi G. Risk factors of endoleak following endovascular repair of abdominal aortic aneurysm. A multicentric retrospective study. In Vivo 2007; 21:1099-1102. [PMID: 18210763] [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: 05/25/2023]
Abstract
Endoleak (EL) represents the most common complication following endovascular abdominal aortic aneurysm repair (EVAR). Unfortunately, the long-term results of EVAR and its durability have been questioned, and EL are variably associated with a risk of late failure. The aim of this retrospective study was to identify risk factors for this complication of aneurysm-endograft complex in patients who underwent EVAR. A group of 104 consecutive patients (99 men, 5 women; median age, 74 years; range, 50-89 years) were enrolled in the study. Both preoperative and follow-up imaging studies were obtained using helical computed tomography scanning at 1, 6, 12, 24, 36 months after EVAR and blindly reviewed by a surgeon and a radiologist. Twenty-seven (25.9%) patients developed EL during follow-up, of which 10 (37%) were primary (<30 days from EVAR), and 17 (63%) were secondary EL. Age and smoking did not affect the EL onset, while a body mass index >25 and a history or presence of arterial hypertension represented significant (p<0.05) risk factors. Moreover, both greatest diameter and maximum length of the aneurysm were significantly higher (p<0.01) in patients who developed EL. No relationship was found with the anatomical features of the aortic neck (i.e. length and diameter), and between the initial size of the aneurysm and the dimension at the time of EL. In conclusion, in our study, being overweight, arterial hypertension and the initial size of the aneurysm represent risk factors for EL development.
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Affiliation(s)
- Mauro Frego
- Department of Surgical & Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
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Polese L, Cillo U, Brolese A, Boccagni P, Neri D, Bassi D, Erroi F, Zanus G, D'Amico DF, Norberto L. Endoscopic treatment of bile duct complications after orthotopic liver transplantation. Transplant Proc 2007; 39:1942-4. [PMID: 17692660 DOI: 10.1016/j.transproceed.2007.05.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/24/2022]
Abstract
AIM To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who have undergone ortotopic liver transplantation (OLT). METHODS We reviewed data from 42 consecutive patients who underwent ERCP for biliary complications after OLT over an 8-year period, in particular recording indications and success of the treatment after a mean of 17 months follow-up. RESULTS Cholangiograms performed in 33/42 patients (79%) displayed anastomotic strictures in 17 patients (52%), bile duct stones in 8 (24%), both bile duct stones and an anastomotic stricture in 2 (6%), papillary stenosis in 1 (3%), and anastomotic biliary leakage in 1 (3%). In contrast, the contrastogram was normal in four patients (12%). Stone extraction was completed in 9/10 patients (90%) with a mean of 1.2 sessions, while stricture dilation was achieved in 12/19 patients (63%) after a mean of 1.7 sessions, by stent positioning (n = 7), balloon dilation (n = 4), or Soehendra dilator (n = 1). Both biliary leakage and papillary stenosis were cured by ERCP. Only one procedure-related complication -- severe pancreatitis (2.4%) -- was observed and no mortality. CONCLUSION ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures.
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Affiliation(s)
- L Polese
- Department of Surgical and Gastroenterological Sciences, 1st Surgical Clinic, Surgical Endoscopy Unit, Padova University, Padova, Italy
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Scarpa M, Ruffolo C, Bertin E, Polese L, Filosa T, Prando D, Pagano D, Norberto L, Frego M, D'Amico DF, Angriman I. Surgical predictors of recurrence of Crohn's disease after ileocolonic resection. Int J Colorectal Dis 2007; 22:1061-9. [PMID: 17534633 DOI: 10.1007/s00384-007-0329-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 05/10/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Anastomotic recurrence after bowel resection is a major problem in Crohn's disease (CD) surgery. The aims of this retrospective study are to assess the role of anastomotic configuration, the type of suture and the type of surgical approach (laparoscopy-assisted vs laparotomy) in CD recurrence. Secondary end points were to identify any possible predictor that would help the selection of patients for medical prophylaxis. MATERIALS AND METHODS In this retrospective study, we enrolled 141 consecutive patients who had undergone ileocolonic resection for CD. Univariate actuarial analysis was performed according to demographic, clinical and surgical predictors. Variables that resulted to be significant at the univariate analysis were included in two multivariate Cox proportional hazards models that analyzed symptomatic and surgical recurrence, respectively. RESULTS In the long-term, handsewn side-to-side anastomosis reported a significantly lower surgical recurrence rate than stapled end-to-side (p < 0.05). At multivariate analysis, anastomosis type, surgical and intestinal complications (p < 0.01) and age at CD onset (p < 0.05) resulted to be significant predictors for re-operation for CD recurrence. Multivariate analysis showed that surgical complication was also a significant predictor of symptomatic recurrence. CONCLUSIONS Side-to-side anastomosis configuration seems to delay re-operation and can be assumed as the standard configuration in ileocolonic anastomosis in CD. Post-operative complications and young age at disease onset might be a signal of aggressive CD that may warrant prophylactic pharmacological therapy.
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Affiliation(s)
- Marco Scarpa
- Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, Università di Padova, via Giustiniani 2, 35128 Padova, Italy.
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