1
|
Zulli C, Gagliardi M, Fusco M, Abbatiello C, Sica M, Maurano A. Off-label use of novel hemostatic gel to treat wound dehiscence after stapled hemorrhoidectomy. Endoscopy 2023; 55:E557-E558. [PMID: 36931308 PMCID: PMC10023250 DOI: 10.1055/a-2045-7426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Claudio Zulli
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| | - Mario Gagliardi
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| | - Michele Fusco
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| | - Carmela Abbatiello
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| | - Mariano Sica
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d’Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, Salerno, Italy
| |
Collapse
|
2
|
Gagliardi M, Iovino P, Gargano D, Zulli C, Fortino L, Santonicola A. Can esophageal symptoms be associated with sleep disorders in esophageal rare diseases? A prospective case-control study across achalasia, eosinophilic esophagitis and gastroesophageal reflux disease. Minerva Gastroenterol (Torino) 2023; 69:365-373. [PMID: 37642600 DOI: 10.23736/s2724-5985.21.03002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND The association between sleep disorders and gastroesophageal reflux disease (GERD) has been the subject of several studies; however, quality of sleep has been under investigated in adult patients with eosinophilic esophagitis (EoE) and achalasia (Ach). This study aims to evaluate the prevalence of sleep disturbances in patients with EoE and Ach compared to GERD patients and their associations with esophageal symptoms. METHODS Thirty Ach patients and 20 EoE patients were consecutively enrolled and compared to a control group of 46 GERD patients. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (from 0 to 6) of esophageal symptoms, Pittsburgh Sleep Quality Index (PSQI) questionnaire to assess sleep quality, a SF-36 survey to investigate health-related quality of life (both physical (PCS) and mental (MCS) component scales), Beck Depression Inventory-II (BDI-II) and State Trait Anxiety Inventory (STAI) to assess the presence of depression and anxiety. RESULTS The prevalence of sleep disturbances was 66.7% in Ach, 50% in EoE, and 60% in GERD patients (P=0.5). PCS and MCS significantly correlated with depression and anxiety levels. Ach patients showed significantly higher intensity-frequency scores of dysphagia for solids (Scheffè P<0.001) and liquids (Scheffè P<0.001) than EoE and GERD patients. No differences were found in the intensity-frequency scores of the esophageal symptoms among the three groups. There was a significant association between worst quality of sleep and higher intensity-frequency scores of regurgitation. CONCLUSIONS Sleep disturbances are common with Ach and EoE, similar to GERD patients. Moreover, there is a significant association between regurgitation, a typical GERD symptom, and poor quality of sleep, independent from diagnosis.
Collapse
Affiliation(s)
- Mario Gagliardi
- Unit of Gastroenterology, Scuola Medica Salernitana Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy -
| | - Paola Iovino
- Unit of Gastroenterology, Scuola Medica Salernitana Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | | | - Claudio Zulli
- Division of Gastroenterology, G. Fucito Hospital, AOU Ruggi d'Aragona, Salerno, Italy
| | - Luigi Fortino
- Unit of Gastroenterology, Scuola Medica Salernitana Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Antonella Santonicola
- Unit of Gastroenterology, Scuola Medica Salernitana Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| |
Collapse
|
3
|
Zulli C, Sica M, Fusco M, Abbatiello C, D'Antonio A, Maurano A, Gagliardi M. Use of a cholangioscopy-guided retrieval snare for the macrobiopsy of a choledochal polyp. Endoscopy 2022; 54:E672-E673. [PMID: 35168282 DOI: 10.1055/a-1747-3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Claudio Zulli
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Salerno, Italy
| | - Mariano Sica
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Salerno, Italy
| | - Michele Fusco
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Salerno, Italy
| | - Carmela Abbatiello
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Antonio D'Antonio
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Salerno, Italy
| | - Mario Gagliardi
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| |
Collapse
|
4
|
Mony S, Ghandour B, Raijman I, Manvar A, Ho S, Trindade AJ, Benias PC, Zulli C, Jacques J, Ichkhanian Y, Zuchelli T, Ghanimeh MA, Irani S, Canakis A, Sanaei O, Szvarca D, Zhang L, Bejjani M, Akshintala V, Khashab MA. An international experience with single-operator cholangiopancreatoscopy in patients with altered anatomy. Endosc Int Open 2022; 10:E898-E904. [PMID: 35692911 PMCID: PMC9187392 DOI: 10.1055/a-1794-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and study aims The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. Technical success was defined as completing the intended procedure with the use of D-SOCP. Results Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail.
Collapse
Affiliation(s)
- Shruti Mony
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Isaac Raijman
- Greater Houston Gastroenterology, Houston, Texas, United States
| | - Amar Manvar
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Sammy Ho
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Arvind J. Trindade
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Petros C. Benias
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Claudio Zulli
- Division of Gastroenterology and Hepatology, Hospital of Salerno, G. Fucito Center, Mercato San Severino, Italy
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Limoges Dupuytren Hospital, Lyon, France
| | - Yervant Ichkhanian
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | - Tobias Zuchelli
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | | | - Shayan Irani
- Digestive Disease Institute at Virginia Mason Medical Center, Seattle, Washington, United States
| | - Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Daniel Szvarca
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| |
Collapse
|
5
|
Gagliardi M, Sica M, Oliviero G, Maurano A, Zulli C. Endoscopic Application of Purastat® in the Treatment of Solitary Rectal Ulcer Syndrome. J Gastrointestin Liver Dis 2021; 30:324. [PMID: 34551030 DOI: 10.15403/jgld-3688] [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] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Mario Gagliardi
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| | - Mariano Sica
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| | - Giovanni Oliviero
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| | - Attilio Maurano
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| | - Claudio Zulli
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| |
Collapse
|
6
|
Andreozzi P, de Nucci G, Devani M, Redaelli D, Schettino M, Iuliano D, Zulli C, Maurano A, Bottiglieri ME, Paspatis G, Dinelli M, Manes G. The high rate of spontaneous migration of small size common bile duct stones may allow a significant reduction in unnecessary ERCP and related complications: results of a retrospective, multicenter study. Surg Endosc 2021; 36:3542-3548. [PMID: 34494152 DOI: 10.1007/s00464-021-08676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Common bile duct stones (CBDS) can spontaneously migrate through the duodenal papilla. In this case, ERCP could be unnecessary and a significant rate of complications could be avoided. In this study, we aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS and at analysing the factors associated to spontaneous stone migration. METHODS We conducted a retrospective multi-centre analysis of patients undergoing ERCP for CBDS in a 12-month period. 1016 patients with CBDS were analysed. In all patients CBDS was diagnosed with adequate imaging methods performed prior to ERCP. ERCPs with failed biliary cannulation were excluded. Data regarding patients' characteristics, imaging findings and ERCP procedure were analysed. RESULTS 1016 patients with CBDS undergoing ERCP were analysed (male sex 43.3%; mean age 69.9 ± 16.5 years). Diagnosis of CBDS was obtained by EUS in 415 patients (40.8%), MR in 343 (33.8%), CT in 220 (21.7%), and US in 38 (3.7%). No stones were found at ERCP in 179 patients (17.6%), in 14 (6.2%) when ERCP was performed within 6 h from imaging study, in 114 (18.5%) between 7 h and 7 days, in 32 (24.6%) between 8 and 29 days, and in 19 (43.2%) after 30 days. The rate of unnecessary ERCP occurred significantly more frequently in patients in whom imaging methods demonstrated either sludge or ≤ 5 mm CBDS (29.9 vs. 8.3%; p < 0.001). DISCUSSION Spontaneous migration of small CBDS is a frequent event, and ≤ 5 mm size and a delay in ERCP > 7 days represent predictive factors for it. We suggest that CBDS ≤ 5 mm should not undergo immediate removal and this fact would allow reducing the rate of unnecessary ERCP with their related complications. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.
Collapse
Affiliation(s)
- Paolo Andreozzi
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Germana de Nucci
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Massimo Devani
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Davide Redaelli
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Mario Schettino
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Donato Iuliano
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Claudio Zulli
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Attilio Maurano
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | | | - Gregorios Paspatis
- Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Marco Dinelli
- Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy.
| |
Collapse
|
7
|
Gagliardi M, Sica M, Oliviero G, Maurano A, Zulli C. Endoscopic Application of Purastat® in the Treatment of Solitary Rectal Ulcer Syndrome. J Gastrointestin Liver Dis 2021. [PMID: 34375377 DOI: 10.15403/jgld-3680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/01/2022]
Abstract
A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or a family history of gastrointestinal diseases. Laboratory tests showed haemoglobin 10.9 g/dl, MCV 72fl, ferritin 18 U/l. Physical examination was normal. The patient underwent a colonoscopy which identified a single ulcer of 2.5 cm of diameter without bleeding signs in the distal rectum, 4 cm from the anal margin. Histopathological examination revealed shallow ulceration with fibrosis in lamina propria. We decided to treat the ulcer with one application of Purastat. Four weeks later, a follow-up colonoscopy revealed a complete mucosal healing with only mild residual mucosal erythema. Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon benign proctologic disease usually affecting young adults with a prevalence of 1:100.000 per year, equally affecting women and men with a slight predominance in young women. SRUS is characterized by chronic rectal pain and bleeding, constipation, incomplete evacuation, tenesmus and mucous discharge impairing the patients' quality of life. In past years several topical agents have been used reporting clinical improvements, also if none of them has been evaluated in prospective controlled trials. Purastat (3D-Matrix Europe SAS, France) is a novel self-assembling peptide developed as a haemostatic agent for endoscopic and surgical procedures. In addition to the known haemostatic effect, it has been hypothesized that the activated Purastat nanostructure favors the cell and tissue proliferative process since the similarity of the activated Purastat 3-D nanostructure with the natural extracellular matrix (ECM-SM) scaffold material would result in an adequate adherence of cells and regenerative tissues, achieving more effective healing of the mucosa. Based on this hypothetical re-epithelizing property of Purastat, we decided to use it in this patient, achieving mucosal healing and symptoms improvement.
Collapse
Affiliation(s)
- Mario Gagliardi
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| | - Mariano Sica
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| | - Giovanni Oliviero
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| | - Attilio Maurano
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| | - Claudio Zulli
- Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
| |
Collapse
|
8
|
Brewer Gutierrez OI, Godoy Brewer G, Zulli C, Tejaswi S, Pawa R, Jamidar P, Robles-Medranda C, Pawa S, Camilion JV, Oleas R, Parsa N, Runge T, Miaw D, Ichkhanian Y, Khashab MA. Multicenter experience with digital single-operator cholangioscopy in pregnant patients. Endosc Int Open 2021; 9:E116-E121. [PMID: 33532547 PMCID: PMC7834694 DOI: 10.1055/a-1320-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background and study aims The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed 1 Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; 2 safety of D-SOC in pregnancy; and 3 maternal and neonatal outcomes after D-SOC during/after pregnancy. Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included. Results A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100 %). Moreover, 50 % of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4 ± 7.2 mGy and 0.5 ± 0.8 min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2 ± 2.6 weeks. Median birth weight was 2.5 kg [IQR: 2.2-2.8]. No birth defects were noted. Conclusion ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.
Collapse
Affiliation(s)
- Olaya I. Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Gala Godoy Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Claudio Zulli
- Division of Gastroenterology, University Hospital G. Fucito, Ruggi d’Aragona, Salermo, Italy
| | - Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento California, United States
| | - Rishi Pawa
- Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Priya Jamidar
- Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Carlos Robles-Medranda
- Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Swati Pawa
- Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Jose V. Camilion
- Nova Southeastern College of Ostheopathic Medicine, Davie, Florida, United States
| | - Roberto Oleas
- Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO
| | - Thomas Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Diana Miaw
- Division of Gynecology & Obstetrics, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| |
Collapse
|
9
|
Oliviero G, Gagliardi M, Napoli M, Labianca O, D'Antonio A, Sica M, Maurano A, Zulli C. Fatal Outcome Consequent to an Endoscopic Full Thickness Resection of a Colonic Lateral Spreading Tumor: A Case Report. Am J Case Rep 2020; 21:e922855. [PMID: 32729555 PMCID: PMC7414825 DOI: 10.12659/ajcr.922855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patient: Male, 77-year-old Final Diagnosis: Enterocolic fistula Symptoms: Diarrhea • pain and guarding of the abdomen • weight loss Medication:— Clinical Procedure: Colonoscopy with colon biopsy Specialty: Gastroenterology and Hepatology
Collapse
Affiliation(s)
- Giovanni Oliviero
- Gastroenterology Unit, San Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Mario Gagliardi
- Gastroenterology Unit, San Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Marco Napoli
- Digestive Surgical Endoscopy Unit, Polyclinic Agostino Gemelli Foundation, Rome, Italy
| | - Orazio Labianca
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Italy
| | - Antonio D'Antonio
- Pathological Anatomy Unit, San Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Mariano Sica
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Italy
| | - Claudio Zulli
- Digestive Endoscopy Unit, Gaetano Fucito Hospital, Mercato San Severino, Italy
| |
Collapse
|
10
|
Pilone V, Tramontano S, Renzulli M, Zulli C, Schiavo L. Gastroesophageal Reflux After Sleeve Gastrectomy: New Onset and Effect on Symptoms on a Prospective Evaluation. Obes Surg 2020; 29:3638-3645. [PMID: 31267475 DOI: 10.1007/s11695-019-04046-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/19/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss. OBJECTIVES We prospectively evaluated the effect of a standardized SG technique on GERD symptoms in 104 patients. METHODS All patients were surveyed on the presence of heartburn and/or regurgitation with a specific questionnaire (GERD-HRQL). Esophagogastroduodenoscopy (EGDS) was performed in the preoperative phase and after 12 months. RESULTS All patients completed a 12-month follow-up. In the preoperative phase, 27.9% presented GERD symptoms (29 cases), while endoscopic findings were observed in 19.2% (20 cases). Preoperative GERD was ameliorated/solved in 65.5% of cases. The mean value of the GERD-HRQL score was significantly lower in postoperative evaluation (33.8 vs 19.4; p < 0.05). At 12-month EGDS, esophagitis was present in 13.5%, and GERD-HRQL symptoms were recorded in 10.6%. Considering patients treated until December 2015 (group 1, 44 patients) and those treated after December 2015 (group 2, 60 patients), all new clinical and endoscopic GERD diagnoses were observed in group 1; the majority of unsolved GERD cases was present in Ggoup 1 (8 vs 2; p < 0.05). CONCLUSION Significant amelioration on preoperative GERD was confirmed after SG. New characteristics of reflux are emerging in SG patients, often asymptomatic. Standardization is necessary to define the real effect of SG on GERD.
Collapse
Affiliation(s)
- Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy.,General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Claudio Zulli
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy.,IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| |
Collapse
|
11
|
Zulli C, Dumont JL, Cereatti F, Ceci V, Tuszynski T, Fazi M, Donatelli G. Rescue ERCP after delayed migration of a lumen-apposing metal stent following endoscopic ultrasound-guided choledochoduodenostomy. Endoscopy 2020; 52:E215-E216. [PMID: 31863439 DOI: 10.1055/a-1073-7317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Claudio Zulli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, ASST Ospedale Cremona, Cremona, Italy
| | - Vincenzo Ceci
- Emergency Department, Ospedale Santo Spirito, Roma, Italy
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Maurizio Fazi
- Digestive Endoscopy Unit, Ospedale M.G. Vannini Figlie di San Camillo, Roma, Italy
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| |
Collapse
|
12
|
Brewer Gutierrez OI, Raijman I, Shah RJ, Elmunzer BJ, Webster GJ, Pleskow D, Sherman S, Sturgess RP, Sejpal DV, Ko C, Maurano A, Adler DG, Mullady DK, Strand DS, DiMaio CJ, Piraka C, Sharahia R, Dbouk MH, Han S, Spiceland CM, Bekkali NL, Gabr M, Bick B, Dwyer LK, Han D, Buxbaum J, Zulli C, Cosgrove N, Wang AY, Carr-Locke D, Kerdsirichairat T, Aridi HD, Moran R, Shah S, Yang J, Sanaei O, Parsa N, Kumbhari V, Singh VK, Khashab MA. Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones. Endosc Int Open 2019; 7:E896-E903. [PMID: 31281875 PMCID: PMC6609233 DOI: 10.1055/a-0889-7743] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background and study aims The role of the digital single-operator pancreatoscopy (D-SOP) with electrohydraulic (EHL) or laser lithotripsy (LL) in treating pancreatic ductal stones is unclear. We investigated the safety and efficacy of D-SOP with EHL or LL in patients with obstructing pancreatic duct stones.
Patients and methods Retrospective analysis of 109 patients who underwent D-SOP for pancreatic stones at 17 tertiary centers in the United States and Europe from February 2015 to September 2017. Logistic regression was performed to identify factors associated with the need for more than one D-SOP with EHL/LL.
Results Most patients were males (70.6 %),mean age 54.7 years. Fifty-nine (54.1 %) underwent EHL and 50 (45.9 %) underwent LL. Mean procedure time was longer in the EHL group (74.4 min vs 53.8 min; P < 0.001). Ducts were completely cleared (technical success) in 89.9 % of patients (94.1 % in EHL vs 100 % in LL; P = 0.243), achieved in a single session in 73.5 % of patients (77.1 % by EHL and 70 % by LL; P= 0.5).D-SOP failed in 11 patients (10.1 %); 6 patients were treated with extracorporeal shockwave lithotripsy (ESWL), 1 with surgery,1 with combined treatment (ESWL + D-SOP EHL) and 3 with other. Fourteen adverse events occurred in 11 patients (10.1 %). Patients with more than three ductal stones were more likely to have technical failure compared to those with less than three stones (17 % vs. 4.8 %; P = 0.04). Having more than three stones was independently associated with the need for more than one D-SOC EHL/LL session (OR 2.94, 95 % CI 1.13 – 7.65).
Conclusion D-SOP with EHL or LL is effective and safe in patients with pancreatic ductal stones.
Collapse
Affiliation(s)
| | - Isaac Raijman
- Greater Houston Gastroenterology, Texas, United States
| | - Raj J. Shah
- Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Douglas Pleskow
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
| | - Richard P. Sturgess
- Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
| | - Divyesh V. Sejpal
- Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
| | - Christopher Ko
- Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
| | - Attilio Maurano
- University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology University of Utah School of Medicine, Utah, United States
| | - Daniel K. Mullady
- Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Daniel S. Strand
- Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
| | - Christopher J. DiMaio
- Division of Gastroenterology Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, United States
| | - Cyrus Piraka
- Henry Ford Hospital, Detroit, Michigan, United States
| | - Reem Sharahia
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | - Mohamad H. Dbouk
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Samuel Han
- Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
| | - Clayton M. Spiceland
- Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Moamen Gabr
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Benjamin Bick
- Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
| | - Laura K. Dwyer
- Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
| | - Dennis Han
- Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
| | - James Buxbaum
- Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
| | - Claudio Zulli
- University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Natalie Cosgrove
- Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
| | - David Carr-Locke
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | | | - Hanaa Dakour Aridi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Robert Moran
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Shawn Shah
- Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Vikesh K. Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States,Corresponding author Mouen A. Khashab, MD Johns Hopkins Hospital1800 Orleans StreetSheikh Zayed TowerBaltimore, MD 21287+1-410-502-7010
| |
Collapse
|
13
|
Zulli C, Grande G, Tontini GE, Labianca O, Geraci G, Sciumè C, Antypas P, Fiocca F, Manes G, Devani M, Manta R, Maurano A. Endoscopic papillary large balloon dilation in patients with large biliary stones and periampullary diverticula: Results of a multicentric series. Dig Liver Dis 2018; 50:828-832. [PMID: 29709460 DOI: 10.1016/j.dld.2018.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/06/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Stone extraction represents the most frequent indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic papillary large balloon dilation (EPLBD) is a recent introduced approach consisting of an endoscopic papillary large balloon dilation following limited endoscopic sphyncterotomy (ES), which has been proven to be safe and effective for extraction of large common bile duct (CBD) stones. Peri-ampullary diverticula (PAD) are described in 10-20% of patients undergoing ERCP. Aim of our study is to evaluate efficacy and safety of EPLBD for the extraction of large biliary stones in patients with PAD. METHODS The prospectively collected endoscopy databases of 4 Italian ERCP high-volume centers were reviewed retrospectively, and all consecutive patients with an instrumental diagnosis of large biliary stones and PAD, between September 2014 and October 2016, were included in this study. RESULTS Eighty-one patients (36 males, median age 75 years) were treated between September 2014 and October 2016. Deep biliary cannulation was reached in 78/80 patients. Successful extraction was achieved in 74/78 patients at the first attempt. AEs occurred in 8 patients (1 severe). Younger age, stone size and incomplete stone extraction were significantly associated with AEs. CONCLUSIONS EPLBD is an effective and safe technique in patients with PAD and large biliary stones, which avoids the need of other techniques, thereby reducing the risks of adverse events.
Collapse
Affiliation(s)
- Claudio Zulli
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Giuseppe Grande
- Department of Gastroenterology and Digestive Endoscopy Unit, OCSAE Hospital, Modena, Italy.
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orazio Labianca
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Girolamo Geraci
- Section of General and Thoracic Surgery, School of Medicine, University Hospital "Paolo Giaccone" of Palermo, Palermo, Italy
| | - Carmelo Sciumè
- Section of General and Thoracic Surgery, School of Medicine, University Hospital "Paolo Giaccone" of Palermo, Palermo, Italy
| | - Pavlos Antypas
- Emergency Endoscopy Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Fausto Fiocca
- Emergency Endoscopy Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Gianpiero Manes
- Department of Gastroenterology "Salvini" Hospital, Garbagnate, Milan, Italy
| | - Massimo Devani
- Department of Gastroenterology "Salvini" Hospital, Garbagnate, Milan, Italy
| | - Raffaele Manta
- Department of Gastroenterology and Digestive Endoscopy Unit, OCSAE Hospital, Modena, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| |
Collapse
|
14
|
Manta R, Zulli C, Zullo A, Forti E, Tringali A, Dioscoridi L, Zito F, Bertani H, Conigliaro R, Mutignani M. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series. Endosc Int Open 2017; 5:E1111-E1115. [PMID: 29124119 PMCID: PMC5677460 DOI: 10.1055/s-0043-118659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIM Gallbladder drainage in patients with cholecystitis who are unsuitable for surgery may be performed by endoscopic ultrasound (EUS)-guided placement of specifically designed fully covered metal stents. We describe the first case series of patients treated with a silicone-covered nitinol stent with bilateral anchor flanges. PATIENTS AND METHODS Data from consecutive patients with acute cholecystitis who were deemed unsuitable candidates for surgery were collected. The stent placement procedure was performed in two tertiary endoscopy centers by four experienced endoscopists. Technical and clinical success rates, as well as adverse events and clinical outcome at follow-up, were assessed. RESULTS EUS-guided drainage for cholecystitis was performed in 16 patients (mean age 84 years; nine males). Technical and clinical success rates were 100 % (16/16) and 94 % (15/16), respectively; an early failure due to stone impaction occurred in the remaining case and required placement of a new stent. Symptom relief occurred in 11/15 cases (73 %) within 1 day, and within 2 days in the remaining 4 patients. Bleeding occurred in two patients (13 %): in one patient intraprocedural bleeding was successfully stopped during endoscopy; and delayed bleeding occurred in one patient requiring arterial embolization for catastrophic bleeding (patient died 10 days later). No cases of cholecystitis recurrence or biliary obstruction were observed during a median follow-up of 112 days (range 49 - 180 days). CONCLUSIONS Our data showed that EUS-guided gallbladder drainage with a specially designed stent is feasible and successful in patients with acute cholecystitis who are unfit for surgery.
Collapse
Affiliation(s)
- Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterology UnitNuovo Ospedale Civile Sant’ Agostino-EstenseViale Giardini AuslBaggiovaraModenaItaly+39-059-659235
| | - Claudio Zulli
- Endoscopy Unit, AOUI San Giovanni di Dio e Ruggi d’Aragona, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Edoardo Forti
- Surgical Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Francesco Zito
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Helga Bertani
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Rita Conigliaro
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | | |
Collapse
|
15
|
Manta R, Zulli C, Zullo A, Forti E, Tringali A, Dioscoridi L, Zito F, Bertani H, Conigliaro R, Mutignani M. Erratum: Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with a silicone-covered nitinol short bilaterally flared stent: a case series. Endosc Int Open 2017; 5:C3. [PMID: 29200440 PMCID: PMC5709092 DOI: 10.1055/s-0043-123267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 10/28/2022] Open
Abstract
[This corrects the article DOI: 10.1055/s-0043-118659.].
Collapse
Affiliation(s)
- Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterology UnitNuovo Ospedale Civile Sant’ Agostino-EstenseViale Giardini AuslBaggiovaraModenaItaly+39-059-659235
| | - Claudio Zulli
- Endoscopy Unit, AOUI San Giovanni di Dio e Ruggi d’Aragona, G. Fucito Center, Mercato San Severino (SA), Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Edoardo Forti
- Surgical Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Francesco Zito
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Helga Bertani
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | - Rita Conigliaro
- Gastroenterology Unit, Nuovo Ospedale Civile Sant’ Agostino-Estense, Baggiovara-Modena, Italy
| | | |
Collapse
|
16
|
Grande G, Manno M, Zulli C, Barbera C, Mangiafico S, Alberghina N, Conigliaro RL. An alternative endoscopic treatment for massive gastric bezoars: Ho:YAG laser fragmentation. Endoscopy 2017; 48 Suppl 1:E217. [PMID: 27310895 DOI: 10.1055/s-0042-109057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Giuseppe Grande
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Mauro Manno
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Claudio Zulli
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Carmelo Barbera
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Santi Mangiafico
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Nadia Alberghina
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | | |
Collapse
|
17
|
Contaldo M, Lucchese A, Gentile E, Zulli C, Petruzzi M, Lauritano D, Amato MR, Esposito P, Riegler G, Serpico R. Evaluation of the intraepithelial papillary capillary loops in benign and malignant oral lesions by in vivo Virtual Chromoendoscopic Magnification: a preliminary study. J BIOL REG HOMEOS AG 2017; 31:11-22. [PMID: 28691449] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This preliminary study aims to establish the Virtual Chromoendoscopic Magnification (VCM) feasibility to visualize and distinguish the Intraepithelial Papillary Capillary Loops (IPCL) patterns of benign oral pathologies from malignant ones. Thirty-one consecutive subjects affected by oral lesions/pathologies underwent white light examination and VCM imaging by the Narrow Band Imaging System (Olympus Medical Systems Corp., Tokyo, Japan). A class system of four IPCL types corresponding to progressive vessel disarray was adopted. IPCL type IV were considered criterion of malignancy. A histopathological exam completed the diagnosis: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. IPCL patterns of benign oral entities ranged from types I to III. IPCL type IV was associated with malignancy in 4 out of 6 cases. Sensitivity, specificity, PPV, and NPV were 100%, 93%, 67% and 100%, respectively. This study preliminarily describes IPCL patterns of different oral mucosal diseases and confirms the association between IPCL IV and oral cancer.
Collapse
Affiliation(s)
- M Contaldo
- University of Campania-Luigi Vanvitelli, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Italy
| | - A Lucchese
- University of Campania-Luigi Vanvitelli, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Italy
| | - E Gentile
- University of Campania-Luigi Vanvitelli, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Italy
| | - C Zulli
- University of Campania-Luigi Vanvitelli, Department of Clinical and Experimental Medicine - Gastroenterology, Naples, Italy
| | - M Petruzzi
- University of Bari Aldo Moro, Dipartimento Interdisciplinare di Medicina, Sezione Malattie OdontostomatologichePoliclinico di Bari, Bari, Italy
| | - D Lauritano
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - M R Amato
- University of Campania-Luigi Vanvitelli, Department of Clinical and Experimental Medicine - Gastroenterology, Naples, Italy
| | - P Esposito
- University of Campania-Luigi Vanvitelli, Department of Clinical and Experimental Medicine - Gastroenterology, Naples, Italy
| | - G Riegler
- University of Campania-Luigi Vanvitelli, Department of Clinical and Experimental Medicine - Gastroenterology, Naples, Italy
| | - R Serpico
- University of Campania-Luigi Vanvitelli, Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Naples, Italy
| |
Collapse
|
18
|
Sica M, Zulli C, Manta R, Villanacci V, Conigliaro R, Bassotti G. One-shot balloon dilation of esophageal stricture due to unusual lichen planus localization. J Gastrointestin Liver Dis 2016; 25:427. [PMID: 27981295 DOI: 10.15403/jgld.2014.1121.254.sic] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mariano Sica
- Gastroenterology and Endoscopy Unit, Nuovo Ospedale Civile Sant' Agostino-Estense, Modena, Italy.
| | - Claudio Zulli
- Gastroenterology and Endoscopy Unit, Nuovo Ospedale Civile Sant' Agostino-Estense, Modena, Italy
| | - Raffaele Manta
- Gastroenterology and Endoscopy Unit, Nuovo Ospedale Civile Sant' Agostino-Estense, Modena, Italy
| | | | - Rita Conigliaro
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| |
Collapse
|
19
|
Zulli C, Sica M, Caruso A, Conigliaro RL, Manta R. A rare case of biliary tract stenosis caused by intraductal varices diagnosed by single-operator per-oral cholangioscopy. Gastrointest Endosc 2016; 84:1052-1053. [PMID: 27404949 DOI: 10.1016/j.gie.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Claudio Zulli
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Mariano Sica
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | - Angelo Caruso
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| | | | - Raffaele Manta
- Gastrointestinal Endoscopy Unit, NOCSAE Baggiovara Hospital, Modena, Italy
| |
Collapse
|
20
|
Di Mitri R, Mocciaro F, Pallio S, Pecoraro GM, Tortora A, Zulli C, Attardo S, Maurano A. Efficacy and safety of endoscopic papillary balloon dilation for the removal of bile duct stones: Data from a “real-life” multicenter study on Dilation-Assisted Stone Extraction. World J Gastrointest Endosc 2016; 8:646-652. [PMID: 27803771 PMCID: PMC5067471 DOI: 10.4253/wjge.v8.i18.646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/17/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment.
METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram).
RESULTS Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01).
CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.
Collapse
|
21
|
Grande G, Manno M, Alberghina N, Barbera C, Zulli C, Tontini GE, Pigò F, Conigliaro R. Quick, safe and effective repair of EUS-related duodenal perforation using over-the-scope clip system (with video). Dig Liver Dis 2016; 48:1099-100. [PMID: 27211883 DOI: 10.1016/j.dld.2016.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 02/06/2023]
Abstract
Duodenal perforation is a rare but potentially life-threating complication of bilio-pancreatic endoscopic-ultrasound (EUS) examination. Here we report a case of 90 yeas-old patient underwent to EUS with curvilinear ecoendoscope and complicated by duodenal wall perforation. As reported in our case, Over-the-scope clipping system represents a quick, safe and effective approach in order close the leak and prevent further complication.
Collapse
Affiliation(s)
- Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy.
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Nadia Alberghina
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Carmelo Barbera
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Claudio Zulli
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, Baggiovara di Modena, MO, Italy
| |
Collapse
|
22
|
Zulli C, Sica M, De Micco R, Del Prete A, Amato MR, Tessitore A, Ferraro F, Esposito P. Continuous intra jejunal infusion of levodopa-carbidopa intestinal gel by jejunal extension tube placement through percutaneous endoscopic gastrostomy for patients with advanced Parkinson's disease: a preliminary study. Eur Rev Med Pharmacol Sci 2016; 20:2413-2417. [PMID: 27338069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Levodopa is the gold standard in the pharmacological treatment of Parkinson's disease (PD) and its oral administration is associated with the development of disabling motor and non-motor complications in advanced disease. Levodopa is rapidly metabolized and has a short plasma half-life thus requiring frequent, repeated dosing. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa. A new therapeutic protocol for patients with advanced PD include a carbidopa/levodopa combination using continuous, modulated enteral administration achieved inserting a Jejunal Extension Tube Placement through Percutaneous Endoscopic Gastrostomy (PEG-J). The aim of this work is to assess efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) delivered continuously through an intrajejunal percutaneous tube (PEG-J). PATIENTS AND METHODS We enrolled 11 adults with advanced PD and preserved sensitivity to L-dopa. For pre-procedural endoscopic evaluation each patient underwent a diagnostic esophagogastroduodenoscopy (EGD) 7 days before PEG-J placement to evaluate the presence of gastric anatomical or wall anomalies and the presence of oesophageal or gastric varices. Treatment with LCIG, consisting of a water-based suspension containing micronized levodopa (20 mg/mL) and carbidopa (5 mg/mL) in methylcellulose (Duodopa®), was administered by continuous jejunal infusion for 12h/day using a portable pump (CADD-Legacy) by PEG-J. Clinical evaluations were performed at baseline (T0) before LCIG initiation, and after 3 (T3) and 6 (T6) months of therapy. The efficacy and safety outcomes were assessed by using the Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III and IV. RESULTS Mean age of patients was 71.18 ± 5.4 SD at LCIG initiation. Out of the 11 patients, 2 (18%) dropped-out LCIG at T3. Patients showed statistically significant (p < 0.05) higher performances in activities of daily living and a statistically significant (p < 0.001) lower incidence and severity of motor fluctuations, as rating by UPDRS part IV, compared to their best oral therapy. During observational period, 5 patients experienced adverse events. Success rate for PEG-J placement was 100%. CONCLUSIONS Our work shows that continuous intrajejunal infusion of LCIG ensures a reduction in motor Fluctuations compared to oral administration of levodopa-carbidopa in advanced PD. Based on our results and on the evidence emerging in the literature, this therapeutic approach should be the gold standard for therapy in these patients.
Collapse
Affiliation(s)
- C Zulli
- Endoscopy Unit, Department of Clinical and Experimental Medicine "Magrassi e Lanzara", Second University of Naples, Naples, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Zulli C, Del Prete A, Romano M, Esposito F, Amato MR, Esposito P. Refractory gastric antral vascular ectasia: a new endoscopic approach. Eur Rev Med Pharmacol Sci 2015; 19:4119-4122. [PMID: 26592837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.
Collapse
Affiliation(s)
- C Zulli
- Endoscopy Unit, Department of Clinical and Experimental Medicine "Magrassi e Lanzara", Second University of Naples, Naples, Italy.
| | | | | | | | | | | |
Collapse
|
24
|
Zulli C, Maurano A, Tammaro S. Endoscopic closure of a rectal diverticulum perforation during a diagnostic colonoscopy. Acta Gastroenterol Belg 2015; 78:344-345. [PMID: 26448419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
25
|
Federico A, Zulli C, de Sio I, Del Prete A, Dallio M, Masarone M, Loguercio C. Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:16841-16857. [PMID: 25492998 PMCID: PMC4258554 DOI: 10.3748/wjg.v20.i45.16841] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/16/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder in Western countries and is increasingly being recognized in developing nations. Fatty liver disease encompasses a spectrum of hepatic pathology, ranging from simple steatosis to non-alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and end-stage liver disease. Moreover, NAFLD is often associated with other metabolic conditions, such as diabetes mellitus type 2, dyslipidemia and visceral obesity. The most recent guidelines suggest the management and treatment of patients with NAFLD considering both the liver disease and the associated metabolic co-morbidities. Diet and physical exercise are considered the first line of treatment for patients with NAFLD, but their results on therapeutic efficacy are often contrasting. Behavior therapy is necessary most of the time to achieve a sufficient result. Pharmacological therapy includes a wide variety of classes of molecules with different therapeutic targets and, often, little evidence supporting the real efficacy. Despite the abundance of clinical trials, NAFLD therapy remains a challenge for the scientific community, and there are no licensed therapies for NAFLD. Urgently, new pharmacological approaches are needed. Here, we will focus on the challenges facing actual therapeutic strategies and the most recent investigated molecules.
Collapse
|
26
|
Zulli C, Federico A, Gaeta L, Del Prete A, Iadevaia M, Gravina AG, Romano M, Loguercio C. A facebook survey to obtain alcohol-related information by young people and adolescents. An Italian study. Acta Gastroenterol Belg 2014; 77:18-24. [PMID: 24761687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Alcohol consumption by adolescents and young adults is an issue of significant public concern. Internet-based Social Networking sites, such as Facebook, are potential avenues to reach young people easily. OBJECTIVE to underline the innovation in proposing surveys to collect health-related information regarding young people alcohol consumption and other substances abuse by using Social Networking Websites, particularly Facebook. METHODS A questionnaire investigating modalities of alcohol consumption, drinking patterns' risk behaviors and other substances abuse was proposed through a "Facebook event" to young Italian Facebook users aged between 16 and 32. Each Facebook user invited to the event was free to participate, to answer to the questionnaire and to invite his "Facebook friends". RESULTS During the 89 days of permanence on the Social Network, 1846 Facebook users participated the event and 732 of them decided spontaneously to answer the questionnaire. The frequency of answering was 8.2 people per day. About 200 users wrote a positive comment to the initiative on the wall of the event. Sixty% of subjects participating the survey were females. Ninety-one% of people answering the questionnaire were alcohol consumers. More than 50% of alcohol consumers were also smokers. Approximately 50% of subjects were binge drinkers. Illegal drugs were used by the 22.2% of the interviewed people. CONCLUSIONS Facebook resulted an efficient and rapid tool to reach young people from all over Italy and to propose surveys in order to investigate alcohol consumption and alcohol-related health problems in the youth.
Collapse
|
27
|
Abstract
Hepatic encephalopathy is a challenging complication in patients with advanced liver disease. It can be defined as a neuropsychiatric syndrome caused by portosystemic venous shunting, ranging from minimal to overt hepatic encephalopathy or coma. Its pathophysiology is still unclear, although increased levels of ammonia play a key role. Diagnosis of hepatic encephalopathy is currently based on specific tests evaluating the neuropsychiatric state of patients and their quality of life; the severity of hepatic encephalopathy is measured by the West Haven criteria. Treatment of hepatic encephalopathy consists of pharmacological and corrective measures, as well as nutritional interventions. Rifaximin received approval for the treatment of hepatic encephalopathy in 2010 because of its few side effects and pharmacological benefits. The aim of this work is to review the use and efficacy of rifaximin both in acute and long-term management of hepatic encephalopathy. Treatment of overt hepatic encephalopathy involves management of the acute episode as well as maintenance of remission in those patients who have previously experienced an episode, in order to improve their quality of life. The positive effect of rifaximin in reducing health care costs is also discussed.
Collapse
Affiliation(s)
- Maddalena Diana Iadevaia
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| | - Anna Del Prete
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| | - Claudia Cesaro
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| | - Laura Gaeta
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| | - Claudio Zulli
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| | - Carmelina Loguercio
- Department of Internistica Clinica e Sperimentale, F Magrassi e A Lanzara, Hepatogastroenterology Unit, Second University of Naples, Naples, Italy
| |
Collapse
|
28
|
Luzzi R, Belcaro G, Zulli C, Cesarone MR, Cornelli U, Dugall M, Hosoi M, Feragalli B. Pycnogenol® supplementation improves cognitive function, attention and mental performance in students. Panminerva Med 2011; 53:75-82. [PMID: 22108481] [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: 05/31/2023]
Abstract
AIM This study compared the effects of supplementation with Pycnogenol® on cognitive function, attention and mental performance in students with an 8 week, evaluation study. Pycnogenol® was used in healthy students; the supplement was used with the aim of enhancing "normal" mental performances. METHODS Attention, memory, evaluation of executive functions were included and students were also evaluated - in the 8-week study - according to results of the university tests. Fifty-three students (range 18-27 years) were included and Pycnogenol® was administered for 8 weeks. A group of equivalent students were followed up as a control group. RESULTS In the 8-week study Pycnogenol® supplementation improved sustained attention, memory, executive functions and mood ratings in the students. The improvement was statistically significant. The actual performance on real tests was measured in students undergoing university examinations. The controls failed 9 tests out a total of 84 (10.71%). In the Pycnogenol® group the students failed 7 tests out of 112 (6.25%) with a difference of 4.46% of failures in the Pycnogenol® group that performed, statistically, generally better. The average test score measured by the marks obtained was 23.81 (1.1) in controls vs. 26.1(1.3) (P<0.024) in the Pycnogenol® group (+2.29 equivalent to 7.6%). CONCLUSION This study indicates a role for Pycnogenol® to improve cognitive function in normal students.
Collapse
Affiliation(s)
- R Luzzi
- Irvine3 Labs, Department of Biomedical Sciences Chieti - Pescara University, Pescara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Errichi BM, Belcaro G, Hosoi M, Cesarone MR, Dugall M, Feragalli B, Bavera P, Hosoi M, Zulli C, Corsi M, Ledda A, Luzzi R, Ricci A. Prevention of post thrombotic syndrome with Pycnogenol® in a twelve month study. Panminerva Med 2011; 53:21-27. [PMID: 22108473] [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: 05/31/2023]
Abstract
AIM Post-thrombotic syndrome is a common complication following deep vein thrombosis. The aim of this twelve month registry study was to compare the efficacy of compression stockings and per oral administration of Pycnogenol® standardized pine bark extract on the severity and incidence of post thrombotic syndrome signs and symptoms. METHODS One hundred fifty-six patients with a single, major episode of proximal deep vein thrombosis (DVT) were assigned to one of three groups receiving treatment with either compression stockings (group 1), Pycnogenol® (group 2) or the combination of both (group 3) over an investigational period of one year. The study evaluated treatment on edema using a scoring system, the ankle circumference, and the limb volume as ratio to the healthy contralateral limb. RESULTS Two new incidents of DVT occurred in the group of 55 patients wearing compression stockings between the third and sixth months, whereas no DVT cases occurred in the two other groups which took Pycnogenol®. The edema symptom score was gradually decreased in all three groups during the one year treatment period. Pycnogenol® was significantly more effective from six months onwards than compression stockings for relieving edema symptoms (P<0.05). Symptoms were more effectively reduced with the combination of Pycnogenol® and compression stockings than with the individual regimen alone (P<0.05). Limb volume and ankle circumference were likewise more effectively reduced with Pycnogenol® plus stockings than with compression stockings alone after six months. Ambulatory venous pressure progressively decreased in all three groups after twelve months treatment as compared to baseline. Compression stockings and Pycnogenol® were of comparable efficacy, there were no significant differences of ambulatory venous pressure between groups following twelve months treatment. Laser Doppler flowmetry at the dorsum of feet showed improved micro-circulation which was further demonstrated by increased pO2 and decreased pCO2. Importantly, none of the patients developed ulcerations during the observational period. CONCLUSION This study suggests that Pycnogenol® may have significant long-term protective efficacy for individuals following a thrombotic event. Moreover, Pycnogenol® appears to be at least as effective for post-thrombosis management as compression stockings, while the combination of both is superior. An important aspect is the patient compliance which was found to be much better in the Pycnogenol® group with two drop-outs due to non-medical reasons, whereas in the compression stockings group eighteen patients were lost to follow-up because wearing stockings at higher temperatures is bothersome.
Collapse
Affiliation(s)
- B M Errichi
- Irvine3 Labs, Department of Biomedical Sciences Chieti - Pescara University, Pescara, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Belcaro G, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Gizzi G, Ippolito E, Ricci A, Cacchio M, Cipollone G, Ruffini I, Fano F, Hosoi M, Rohdewald P. Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol. Redox Rep 2009; 13:271-6. [PMID: 19017467 DOI: 10.1179/135100008x309019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In a previous, double-blind, placebo-controlled study we evaluated the efficacy of a 3-month treatment with Pycnogenol for 156 patients with osteoarthritis of the knee. Pycnogenol significantly decreased joint pain and improved joint function as evaluated using the WOMAC score and walking performance of patients on a treadmill. In this study, we further investigated the anti-inflammatory and antioxidant activity of Pycnogenol in a subset of the osteoarthritis patients presenting with elevated C-reactive protein (CRP) and plasma-free radicals. Elevated CRP levels have been suggested to be associated with disease progression in osteoarthritis. In our study, 29 subjects of the Pycnogenol group and 26 patients in the placebo group showed CRP levels higher than 3 mg/l at baseline. Comparison of blood specimens drawn at baseline and after 3-month treatment showed that Pycnogenol significantly decreased plasma free radicals to 70.1% of baseline values. Plasma CRP levels decreased from baseline 3.9 mg/l to 1.1 mg/l in the Pycnogenol group whereas the control group had initial values of 3.9 mg/l which decreased to 3.6 mg/l. The CRP decrease in the Pycnogenol was statistical significant as compared to the control group (P < 0.05). Fibrinogen levels were found to be lowered to 62.8% of initial values (P < 0.05) in response to Pycnogenol. No significant changes for plasma free radicals, CRP and fibrinogen were found in the placebo-treated group. The decrease of systemic inflammatory markers suggests that Pycnogenol may exert anti-inflammatory activity in osteoarthritic joints and patients did not present with other ailments or infections. The nature of the anti-inflammatory effects of Pycnogenol with regard to CRP warrants further investigation.
Collapse
Affiliation(s)
- G Belcaro
- Westfälische Wilhelms-Universität Münster, Münster, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Stuard S, Cesarone MR, Belcaro G, Ledda A, Cornelli U, Di Renzo A, Grossi MG, Pellegrini L, Gizzi G, Vinciguerra G, Dugall M, Corsi M, Ippolito E, Di Palma T, Zulli C, Del Boccio G. [NPT (near patient test) in the pharmacy: document and practice guidelines 2008]. Minerva Cardioangiol 2008; 56:11-20. [PMID: 19597405] [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: 05/28/2023]
Abstract
NPT tests in the pharmacy. Blood testing can be made with NPT (near patient testing) directly in the pharmacy. Most tests can be made with a single drop of blood (i.e. from a finger) and results are comparable with results from blood test obtained with standard vein blood samples. NPT is basically used for: 1 - evaluating the risk of a disease. 2 evaluating or confirming the presence of a disease. 3 to manage and monitor treatments. The social role of the pharmacy in NPT (particularly in cardiovascular screening) is very important as the pharmacy is an institution with capillary diffusion in the territory. The pharmacy often constitutes an important, first-level consultancy point for the population, particularly where health institutions are far away (small villages) or not easily accessible. Rules for NPT. Guidelines for NPT testing in the pharmacy have been proposed and discussed in a consensus meeting (Spoleto, 2007). NPT guidelines suggest operating management and technical procedures and indicate prospective lines of action defining new roles for the pharmacy. Coagulation tests can be now made in the pharmacy at a very low cost and with an efficacy comparable to blood tests obtained with a vein sample. Results can be read in seconds. This test is also available for personal use and home testing. NPT: The Clinical Study. The evaluation of the results of a clinical study (patients with venous thrombosis/pulmonary embolisation, patients with fibrillation and patients with artificial cardiac valves) indicates that costing is very favourable for NPT which may reduce costs and improve management of many clinical conditions and their monitoring. Training and control systems help NPT testing to be reliable and useful to screen and manage most clinical and risk conditions. The clinical study also shows the positive correlation between NPT tests and standard' tests. In conclusion NPT tests are now very reliable and cost-effective and can be used for screening, diagnosis and to monitor treatments.
Collapse
Affiliation(s)
- S Stuard
- U.O. Nefrologia, L'Aquila, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Belcaro G, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G, Ledda A, Di Renzo A, Stuard S, Dugall M, Pellegrini L, Errichi S, Gizzi G, Ippolito E, Ricci A, Cacchio M, Cipollone G, Ruffini I, Fano F, Hosoi M, Rohdewald P. Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects. Phytother Res 2008; 22:518-23. [PMID: 18386255 DOI: 10.1002/ptr.2376] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of 100 mg Pycnogenol daily (oral capsules) in a 3 month study in patients with osteoarthritis (OA). OA symptoms were evaluated by WOMAC scores, mobility by recording their walking performance (treadmill). Treatment (77 patients) and placebo group (79) were comparable for age, sex distribution, WOMAC scores, walking distances and use of antiinflammatory drugs. The global WOMAC score decreased by 56% (p < 0.05) in the treatment group versus 9.6% in the placebo group. Walking distance in the treadmill test was prolonged from 68 m at the start to 198 m after 3 months treatment (p < 0.05), under placebo, from 65 m to 88 m (NS). The use of drugs decreased by 58% in the treatment group (p < 0.05) versus 1% under placebo. Gastrointestinal complications decreased by 63% in the treatment group, but only 3% under placebo. Overall, treatment costs were reduced significantly compared with placebo. Foot edema was present in 76% of the patients of the treatment group at inclusion and in 79% of the controls. After 3 months edema decreased in 79% of Pycnogenol patients (p < 0.05) vs 1% in controls. In conclusion, Pycnogenol offers an option for reduction of treatment costs and side effects by sparing antiinflammatory drugs.
Collapse
Affiliation(s)
- G Belcaro
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti-pescara University and San Valentino Vascular Screening Project, San Valentino, PE, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|