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Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

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World Journal of Gastrointestinal Endoscopy 2015年第8期7卷 799-805页

作者： claudio de angelis Milena Marietti Mauro Bruno Rinaldo Pellicano Mario Rizzetto department of Gastroenterology and Digestive Endoscopy "Città della Salute e della Scienza"University of Turin

In recent years,the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms,probably due to the widespread use of high-resolution imaging ***,there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound(EUS)in the diagnostic work *** noninvasive imaging tests(transabdominal ultrasound,computed tomography or magnetic resonance cholangiopancreatography)fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent,the probability of having biliary disease is considered *** this setting,using EUS,the presence of pathologic findings(choledocholithiasis,strictures,chronic pancreatitis,ampullary or pancreatic tumors,cholangiocarcinoma),not always with a benign course,has been *** aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS *** point out to a promising role of EUS in the identification of a potential biliary *** is a low invasive technique,with high accuracy,that could play a double cost-effective role:identifying pathologic conditions with dismal prognosis,in asymptomatic patients with negative prior imaging tests,and excluding pathologic conditions and further follow-up in healthy subjects.

关键词： Unexplained common bile duct dilatation Endoscopic ultrasound Normal liver enzymes

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超声内镜在胰腺癌中的应用现状与展望

中国普通外科杂志 2014年第3期23卷 269-277页

作者： claudio de angelis Rosario Francesco Brizzi Rinaldo Pellicano 冯铁成李新营意大利都灵大学圣.乔瓦尼巴蒂斯塔医院内镜与超声内镜中心胃肠与肝病科

胰腺疾病的诊治在临床上一直是一个难点。在过去的几年中我们见证了放射学和核医学成像的技术进步。考虑到这一点,我们尝试描述超声内镜(EUS)在胰腺癌(PC)诊断及分期的过程中新的角色。到目前为止对于PC最准确的成像技术是对比增强计算... 详细信息

胰腺疾病的诊治在临床上一直是一个难点。在过去的几年中我们见证了放射学和核医学成像的技术进步。考虑到这一点,我们尝试描述超声内镜(EUS)在胰腺癌(PC)诊断及分期的过程中新的角色。到目前为止对于PC最准确的成像技术是对比增强计算机断层扫描(CT)和EUS。后者在检测微小病灶及评估肿瘤大小和淋巴结情况时具有最高的精度,但对于一个可疑的胰腺病变的患者而言,螺旋CT或最新的磁共振成像(MRI)仍是首要的选择。如在CT、MRI扫描为阴性结果而临床上高度怀疑PC,或是CT/MRI扫描后可疑病变需细胞组织学确认时,可应用EUS。相信在不久的将来用于诊断和治疗胰腺疾病的EUS将有更大的发展空间,并且病理结果将为其提供最好的应用证据。

关键词：胰腺肿瘤超声检查腔内超声检查

Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

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World Journal of Gastrointestinal Endoscopy 2021年第11期13卷 555-564页

作者： Helga Bertani Raffaele Pezzilli Flavia Pigo Mauro Bruno claudio de angelis Guido Manfredi Gabriele delconte Rita Conigliaro Elisabetta Buscarini Gastroenterology and Digestive Endoscopy Unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41124Italy department of Internal Medicine Policlinico S.Orsola MalpighiBologna 40121Italy Gastroenterology and Digestive Endoscopy Unit AOU Cittàdella Salute e della ScienzaUniversity of TurinTurin 10100Italy Gastroenterology and Digestive Endoscopy department Ospedale MaggioreCrema 26013Italy department of Diagnostic Endoscopy and Endoscopic Surgery Istituto Nazionale TumoriMilano 20019Italy

BACKGROUND Pancreatic cystic lesions(PCLs)are considered a precursor of pancreatic ***-based confocal endomicroscopy(nCLE)is an imaging technique that enables visualization of the mucosal layer to a micron *** application has demonstrated promising results in the distinction of *** study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration(EUS-FNA)to distinguish mucinous from non-mucinous *** To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous *** Patients who required EUS-FNA between 2015 and 2017 were enrolled *** EUS-FNA,confocal imaging,analyses of the tumor markers carcinoembryonic antigen and amylase,and cytologic examination were *** patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance *** videos were independently reviewed by 6 observers to reach a final diagnosis(mucinous vs non-mucinous)based on criteria derived from previous studies;if there was disagreement>20%,a final diagnosis was discussed after consensus *** sensitivity,specificity,and accuracy of nCLE were *** events were *** Fifty-nine patients were included in this *** diagnoses were derived from surgery in 10 patients,cytology in 13,and imaging and multidisciplinary team review in *** patients were excluded from final diagnosis due to problems with nCLE ***-six patients were included in the final *** sensitivity,specificity,and accuracy of nCLE were 80%[95%confidence interval(CI):65-90],100%(95%CI:72-100),and 84%(95%CI:72-93),*** acute pancreatitis occurred in 5%.CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.

关键词： Needle-based confocal endomicroscopy Pancreatic cystic lesion Pancreatic adenocarcinoma Endoscopic ultrasound Endoscopic ultrasound fine-needle aspiration Intraductal papillary mucinous neoplasm Serous cyst adenoma

Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

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World Journal of Gastroenterology 2017年第8期23卷 1328-1337页

作者： claudio Romano Salvatore Oliva Stefano Martellossi Erasmo Miele Serena Arrigo Maria Giovanna Graziani Sabrina Cardile Federica Gaiani Gian Luigi de'angelis Filippo Torroni Unit of Pediatrics Department of Human Pathology in Adulthood and Childhood“G.Barresi”University of Messina department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome Institute for Maternal and Child Health IRCCS‘Burlo Garofalo’ department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II” Gastroenterology and Endoscopy Unit G.Gaslini Children’s Hospital-IRCCS Gastroenterology and Endoscopy Unit “San Giovanni Addolorata”Hospital Hepatology Gastroenterology and Nutrition UnitBambino GesùChildren’s Hospital Gastroenterology and Endoscopy Unit University of Parma department of Surgery and Transplantation Digestive Surgery and Endoscopy UnitBambino GesùChildren’s Hospital

There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://***/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

关键词： Gastrointestinal bleeding Endoscopy Lower gastrointestinal bleeding Upper gastrointestinal bleeding Pediatric

Italian survey on non-steroidal anti-inflammatory drugsand gastrointestinal bleeding in children

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World Journal of Gastroenterology 2016年第5期22卷 1877-1883页

作者： Sabrina Cardile Massimo Martinelli Arrigo Barabino Paolo Gandullia Salvatore Oliva Giovanni Di Nardo Luigi Dall'Oglio Francesca Rea Gian Luigi de'angelis Barbara Bizzarri Graziella Guariso Enzo Masci Annamaria Staiano Erasmo Miele claudio Romano Gastroenterology and Endoscopic Unit Department of PediatricsUniversity of Messina98100 MessinaItaly department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II”80131 NaplesItaly department of Pediatric Gastroenterology Gaslini Institute16148 GenoaItaly department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome00185 RomeItaly Digestive Surgery and Endoscopy Unit Bambino GesùChildren’s Hospital00165 RomeItaly Gastroenterology and Endoscopy Service University of Parma43126 ParmaItaly Unit of Paediatric Gastroenterology Digestive EndoscopyHepatologyand Care of Children with Liver TransplantationDepartment of Women’s and Children’s HealthUniversity Hospital of Padova35128 PadovaItaly Gastrointestinal Endoscopy Azienda Ospedaliera San Paolo University HospitalUniversity of Milan20142 MilanItaly

AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug(NSAIDs) use in ***: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber(physician or selfmedication) were examined. RESULTS: Fifty-one patients, including 34 males, were enrolled(median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients(68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients(56.9%)]. Seven patients had positive family history of Helicobacter pylori(H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four(47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom(33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51(62%) patients, duodenal lesions in 17(33%) and esophageal lesions in 8(15%). In 10/51(19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight(94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51(6%) patients, an endoscopic hemostasis was ***: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in

关键词： Hematemesis Gastrointestinal bleeding non-steroidal anti-inflammatory drug Melena Pediatrics