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The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 71-76页

作者： Alessandro Fugazza Matteo Colombo Michel Kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar Dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini andrea iannone Kareem Khalaf Nageshwar Reddy andrea Anderloni Alessandro Repici Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSVia Manzoni 5620089RozzanoMilanoItaly Gastroenterology Rutgers Robert Wood JohnsonNew BrunswickNew JerseyUSA Vatche and Tamar Manoukian Division of Digestive Diseases University of CaliforniaLos Angeles School of Medicine at UCLALos AngelesCaliforniaUSA Division of Digestive and Liver Disorders Indiana University School of MedicineIndianapolisINUSA Department of Gastroenterology and Hepatology University Hospitals LeuvenKU Leuven3000 LeuvenBelgium U.O.C.di Gastroenterologia ed Endoscopia Digestiva Ospedale Giuseppe MazziniASL TeramoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly Borland Groover Clinic JacksonvilleFloridaUSA Department of Gastroenterology and Hepatology King Fahad Medical CityRiyadhSaudi Arabia Asian Institute of Gastroenterology HyderabadIndia Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy Department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly

Background: Duodenoscope-related multidrug-resistant organism(MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 bleeding.Conclusions: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

关键词： Single-operator cholangioscopy Single-use duodenoscope Endoscopic retrograde cholangiopancreatography Indeterminate biliary stricture Difficult biliary stones

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Endoscopic ultrasound-guided ablation of solid pancreatic lesions:A systematic review of early outcomes with pooled analysis

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World Journal of Gastrointestinal Oncology 2022年第2期14卷 533-542页

作者： Marco Spadaccini Milena Di Leo andrea iannone Daan von den Hoff Alessandro Fugazza Piera Alessia Galtieri Gaia Pellegatta Roberta Maselli andrea Anderloni Matteo Colombo Peter D Siersema Silvia Carrara Alessandro Repici Endoscopic Unit Department of GastroenterologyIRCCS Humanitas Research HospitalRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20090MilanItaly Endoscopy Unit Azienda Ospedale PoliclinicoBari 70124Italy Endoscopy Unit Radboud University Medical CenterNijmegen 6525 GANetherlands

BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation(EUS-RFA)is emerging as a complementary therapeutic approach for pancreatic solid masses.However,results of published data are difficult to interpret because of a retrospective design and small sample size.AIM To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and efficacy.METHODS A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent EUS-RFA.The primary outcomes were procedure-related adverse events(AEs)and mortality.Secondary outcomes were the technical success rate and the effects on primary tumor growth.Statistical analyses were performed using Stata version 14.0.RESULTS In total,14 studies were included,with 120 patients undergoing 153 ablations of 129 solid pancreatic lesions.The STARmed technology was used in seven studies,the Habib system in six studies,and the HybridTherm probe in one study.The pooled technical success rate was 99.0%(I2:25.82%).The pooled overall AE rate was 8.0%(I2:11.46%).Excluding mild AEs,the pooled rates of serious AEs was 1.0%(I2:0%).No mortality related to the procedure was reported.CONCLUSION The present pooled analysis confirms the safety and feasibility of EUS-RFA.

关键词： Pancreatic cancer Neuroendocrine tumors Habib Cryotechnology Pancreas Endoscopic ultrasound

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Rifabutin as salvage therapy for Helicobacter pylori eradication:Cornerstones and novelties

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World Journal of Gastroenterology 2022年第45期28卷 6356-6362页

作者： Antonia Valeria Borraccino Francesca Celiberto Maria Pricci Bruna Girardi andrea iannone Maria Rendina Enzo Ierardi Alfredo Di Leo Giuseppe Losurdo Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy THD SpA Correggio 42015Italy

When several Helicobacter pylori eradication treatments fail,guidelines recommend a cultured guided approach;however,culture is not widely available.Therefore,a rifabutin based regimen could be the best solution.Rifabutin indeed shows a low rate of antibiotic resistance.Rifabutin is generally used in combination with amoxicillin in a triple therapy,with eradication rates about 80%in third-line regimens.The ideal duration of this therapy should range between 10 and 12 d.Combinations with antibiotics other than amoxicillin have demonstrated even better results,such as vonoprazan,which is a type of novel acid suppressor drug.Finally,a new formulation of triple therapy in a single capsule is under investigation,which is a field that deserves further investigation.Some notes of caution about rifabutin should be mentioned.This drug is used to treat tuberculosis or atypical mycobacteria;therefore,before starting a rifabutin-based eradication regimen,Mycobacterium tuberculosis infection should be thoroughly tested,since its use could promote the development of antibiotic resistance,thus affecting its effectiveness against Koch’s bacillus.Additionally,some serious side effects must be evaluated before starting any rifabutin-based therapy.Adverse effects include fever,nausea,vomiting and bone marrow suppression.For this reason,full blood count surveillance is required.

关键词： Helicobacter pylori Eradication Rifabutin Antibiotic resistance Rescue therapy Treatment

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Extra-intestinal manifestations of non-celiac gluten sensitivity: an expanding paradigm

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World Journal of Gastroenterology 2018年第14期24卷 1521-1530页

作者： Giuseppe Losurdo Mariabeatrice Principi andrea iannone Annacinzia Amoruso Enzo Ierardi Alfredo Di Leo Michele Barone Section of Gastroenterology Department of Emergency and Organ Transplantation University "Aldo Moro" of Bari

Non celiac gluten sensitivity(NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease(CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports. In most cases they are characterized by vague symptoms such as ‘foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described. NCGS has an immune-related background. Indeed there is a strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most commonly autoimmune disorders associated to NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases. The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported; it could be a characteristic feature that could help the diagnosis and be simultaneously managed. A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy. NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis. Finally, a link with functional disorders(irritable bowel syndrome and fibromyalgia) is a topic under discussion. In conclusion, the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by eviden

关键词： Non celiac gluten sensitivity celiac disease gluten gluten ataxia autoimmunity gluten-related disorders thyroiditis extra-intestinal

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Role of concomitant therapy for Helicobacter pylori eradication: A technical note

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World Journal of Gastroenterology 2016年第38期22卷 8638-8640页

作者： Giuseppe Losurdo Floriana Giorgio andrea iannone Mariabeatrice Principi Michele Barone Alfredo Di Leo Enzo Ierardi Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of Bari

We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen for Helicobacter pylori(H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy(91.2% vs 77.9%, P < 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this metaanalysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluated a priori antibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration.

关键词： Helicobacter pylori Eradication Sequential Concomitant Triple therapy Antibiotic resistances

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Noninvasive molecular analysis of Helicobacter pylori : Is it time for tailored first-line therapy?

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World Journal of Gastroenterology 2017年第14期23卷 2453-2458页

作者： Enzo Ierardi Floriana Giorgio andrea iannone Giuseppe Losurdo Mariabeatrice Principi Michele Barone Antonio Pisani Alfredo Di Leo Gastroenterology Section Department of Emergency and Organ Transplantation University of Bari

The main problem of Helicobacter pylori(H. pylori) infection management is linked to antibiotic resistances. This phenomenon has grown in the last decade, inducing a dramatic decline in conventional regimen effectiveness. The causes of resistance are point mutations in bacterial DNA, which interfere with antibiotic mechanism of action, especially clarithromycin and levofloxacin. Therefore, international guidelines have recently discouraged their use in areas with a relevant resistance percentage, suggesting first-line schedules with expected high eradication rates, i.e., bismuth containing or non-bismuth quadruple therapies. These regimens require the daily assumption of a large number of tablets. Consequently, a complete adherence is expected only in subjects who may be motivated by the presence of major disorders. However, an incomplete adherence to antibiotic therapies may lead to resistance onset, since sub-inhibitory concentrations could stimulate the selection of resistant mutants. Of note, a recent meta-analysis suggests that susceptibility tests may be more useful for the choice of first than second-line or rescue treatment. Additionally, susceptibility guided therapy has been demonstrated to be highly effective and superior to empiric treatments by both meta-analyses and recent clinical studies. Conventional susceptibility test is represented by culture and antibiogram. However, the method is not available everywhere mainly for methodology-related factors and fails to detect hetero-resistances. Polymerase chain reaction(PCR)-based, culture-free techniques on gastric biopsy samples are accurate in finding even minimal traces of genotypic resistant strains and hetero-resistant status by the identification of specific point mutations. The need for an invasive endoscopic procedure has been the most important limit to their spread. A further step has, moreover, been the detection of point mutations in bacterial DNA fecal samples. Few studies on clarithromycin susceptibility have shown an overall high sensitiv

关键词： Helicobacter pylori 抗菌素抵抗 Noninvasive 分子的测试定制的治疗凳子

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Prevalence and associated factors of obesity in inflammatory bowel disease:A case-control study

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World Journal of Gastroenterology 2020年第47期26卷 7528-7537页

作者： Giuseppe Losurdo Rosa Federica La Fortezza andrea iannone Antonella Contaldo Michele Barone Enzo Ierardi Alfredo Di Leo Mariabeatrice Principi Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy

BACKGROUND In recent years,an increasing prevalence of obesity in inflammatory bowel disease(IBD)has been observed.Obesity,moreover,has been directly correlated with a more severe clinical course and loss of response to treatment.AIM To assess the prevalence and associated factors of obesity in IBD.METHODS We collected data about IBD disease pattern and activity,drugs and laboratory investigations in our center.Anthropometric measures were retrieved and obesity defined as a body mass index(BMI)>30.Then,we compared characteristics of obese vs non obese patients,and Chi-squared test and Student’s t test were used for discrete and continuous variables,respectively,at univariate analysis.For multivariate analysis,we used binomial logistic regression and estimated odd ratios(OR)and 95%confidence intervals(CI)to ascertain factors associated with obesity.RESULTS We enrolled 807 patients with IBD,either ulcerative colitis(UC)or Crohn’s disease(CD).Four hundred seventy-four patients were male(58.7%);the average age was 46.2±13.2 years;438(54.2%)patients had CD and 369(45.8%)UC.We enrolled 378 controls,who were comparable to IBD group for age,sex,BMI,obesity,diabetes and abdominal circumference,while more smokers and more subjects with hypertension were observed among controls.The prevalence of obesity was 6.9%in IBD and 7.9%in controls(not statistically different;P=0.38).In the comparison of obese IBD patients and obese controls,we did not find any difference regarding diabetes and hypertension prevalence,nor in sex or smoking habits.Obese IBD patients were younger than obese controls(51.2±14.9 years vs 60.7±12.1 years,P=0.03).At univariate analysis,obese IBD were older than normal weight ones(51.2±14.9 vs 44.5±15.8,P=0.002).IBD onset age was earlier in obese population(44.8±13.6 vs 35.6±15.6,P=0.004).We did not detect any difference in disease extension.Obese subjects had consumed more frequently long course of systemic steroids(66.6%vs 12.5%,P=0.02)as well as antibiotics such as metronidazole or ciprofloxacin(71.4%vs 54

关键词： Inflammatory bowel disease Obesity Body mass index Antibiotics Risk factor Corticosteroids

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Silymarin,boswellic acid and curcumin enriched dietetic formulation reduces the growth of inherited intestinal polyps in an animal model

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World Journal of Gastroenterology 2020年第14期26卷 1601-1612页

作者： Bruna Girardi Maria Pricci Floriana Giorgio Mariano Piazzolla andrea iannone Giuseppe Losurdo Mariabeatrice Principi Michele Barone Enzo Ierardi Alfredo Di Leo THD SpA Correggio 42015Italy Gastroenterology Section Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy

BACKGROUND Some substances of plant origin have been reported to exert an effect in reducing intestinal neoplasm development,especially in animal models.Adenomatous polyposis coli multiple intestinal neoplasia-ApcMin/+is the most studied murine model of genetic intestinal carcinogenesis.AIM To assess whether an enriched nutritional formulation(silymarin,boswellic acid and curcumin)with proven“in vitro”and“in vivo”anti-carcinogenetic properties may prevent inherited intestinal cancer in animal model.METHODS Forty adenomatous polyposis coli multiple intestinal neoplasia-ApcMin/+mice were used for the study of cancer prevention.They were divided into two groups:20 assumed standard and 20 enriched diet.At the 110th d animals were sacrificed.In each group,four subgroups received intraperitoneal bromodeoxyuridine injection at different times(24,48,72 and 96 h before the sacrifice)in order to assess epithelial turnover.Moreover,we evaluated the following parameters:Intestinal polypoid lesion number and size on autoptic tissue,dysplasia and neoplasia areas by histological examination of the whole small intestine,inflammation by histology and cytokine mRNA expression by real-time polymerase chain reaction,bromodeoxyuridine and TUNEL immunofluorescence for epithelial turnover and apoptosis,respectively.Additionally,we performed western blotting analysis for the expression of estrogen alpha and beta receptors,cyclin D1 and cleaved caspase 3 in normal and polypoid tissues.RESULTS Compared to standard,enriched diet reduced the total number(203 vs 416)and the mean±SD/animal(12.6±5.0 vs 26.0±8.8;P<0.001)of polypoid lesions.In enriched diet group a reduction in polyp size was observed(P<0.001).Histological inflammation and pro-inflammatory cytokine expression were similar in both groups.Areas of low-grade dysplasia(P<0.001)and intestinal carcinoma(IC;P<0.001)were significantly decreased in enriched diet group.IC was observed in 100%in standard and 85%in enriched formulation assuming animals.Enriched diet showed a faster epitheli

关键词： Intestinal cancer Familial adenomatous polyposis Chemopreventive diet Apc^Min/+mice Boswellia Curcumin

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HBsAg clearance by Peg-interferon addition to a long-term nucleos(t)ide analogues therapy

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World Journal of Gastroenterology 2014年第26期20卷 8722-8725页

作者： Michele Barone andrea iannone Alfredo Di Leo Gastroenterology Unit Department of Medical and Surgical ScienceUniversity of Foggia Gastroenterology Unit Department of Emergency and Organ Transplantation (D.E.T.O.)University of Bari

The ideal endpoint of hepatitis B virus(HBV)antiviral therapy is HBsAg loss,a difficult goal to obtain,especially in HBeAg negative patients.Herein,we report the results obtained by the addition of peg-interferonα-2a to a long-lasting nucleos(t)ide analogues therapy in a HBeAg negative,genotype D patient with steadily HBV-DNA negative/HBsAg positive values.In 2002,our Caucasian 44-year-old male patient received lamivudine and,4 years later,added adefovir because of a virological breakthrough.In 2011,considering his young age,liver stiffness(4.3 kPa)and HBsAg levels(3533IU/mL),we added Peg-interferonα-2a for six months(3in combination with nucleos(t)ide analogues followed by 3 mo of Peg-interferonα-2a monotherapy).A decrease of HBsAg levels was observed after 1 mo(1.21log)of Peg-interferon and 3 mo(1.88 log)after the discontinuation of all drugs.Later,a complete clearance of HBsAg was obtained with steadily undetectable HBVDNA serum levels(<9 IU/mL).HBsAg clearance by the addition of a short course of Peg-interferonα-2a represents an important result with clinical and pharmacoeconomic implications,considering that nucleos(t)ide analogues therapy in HBeAg negative chronic hepatitis B patients is considered a long-lasting/life-long treatment.

关键词： Addition HBeAg negative HBsAg clearance Nucleos(t)

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Novel frontiers of agents for bowel cleansing for colonoscopy

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World Journal of Gastroenterology 2021年第45期27卷 7748-7770页

作者： Milena Di Leo andrea iannone Monica Arena Giuseppe Losurdo Maria Angela Palamara Giuseppe Iabichino Pierluigi Consolo Maria Rendina Carmelo Luigiano Alfredo Di Leo Unit of Digestive Endoscopy San Paolo HospitalMilan 20090Italy Section of Gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy Unit of Digestive Endoscopy University of MessinaHospital"G.Martino"Messina 98121Italy

The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel preparation(BP).In this review,we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy.Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’acceptability.The role of the diet before colonoscopy was also changed,as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’tolerance and/or quality of BP.The review also described BP in special situations,as lower gastrointestinal bleeding,elderly people,patients with chronic kidney disease,patients with inflammatory bowel disease,patients with congestive heart failure,inpatient,patient with previous bowel resection,pregnant/lactating patients.The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales.Finally,the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota.Moreover,the study underlined several points needed to further investigations.

关键词： Colonoscopy Bowel preparation Cleansing agents Polyethylene glycol Adequate cleansing Constipation

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