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Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation

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World Journal of Gastroenterology 2010年第37期16卷 4751-4754页

作者： gabriele curcio Marco Spada Fabrizio di Francesco Ilaria Tarantino Luca Barresi Gaetano Burgio Mario Traina Department of Gastroenterology IsMeTT UPMC

Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife. We report a case of a colorectal anastomosis web occlusion, treated without electrocision. Gastrografin enema and sigmoidoscopy showed complete obstruction at the anastomotic site due to the presence of an anastomotic occlusive web. In order to avoid thermal injuries, we decided to use a suprapapillary biliary puncture catheter. The Artifon catheter was inserted into the center of the circular staple line at the level of the anastomosis, and fluoroscopic identification of the proximal bowel was obtained with dye injection. A 0.025-inch guidewire was then passed through the catheter into the colon and progressive pneumatic dilatation was performed. The successful destruction of the occlusive web facilitated passage of the colonoscope, allowing evaluation of the entire colon and stoma closure after three months of follow-up. The patient tolerated the procedure well, with no complications. This report highlights an alternative non-electrosurgical approach that uses a new device that proved to be safe and useful.

关键词： Anastomosis Dilation Balloon Obstructed Artifon

Tulip bundle technique and fibrin glue injection:Unusual treatment of colonic perforation

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World Journal of Gastroenterology 2011年第8期17卷 1088-1090页

作者： Filippo Mocciaro gabriele curcio Ilaria Tarantino Luca Barresi Marco Spada Sergio Li Petri Mario Traina Department of Gastroenterology IsMeTT UPMC Surgery Unit IsMeTT UPMC

We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic *** lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two *** we chose to use a fibrin glue injection to obtain a complete *** days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in *** of the sigma showed complete repair of the *** report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.

关键词：纤维蛋白胶结肠镜穿孔技术郁金香治疗 Sigma 检查表

Case of obscure-overt gastrointestinal bleeding after pediatric liver transplantation explained by endoscopic ultrasound

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World Journal of Gastrointestinal Endoscopy 2012年第12期4卷 571-574页

作者： gabriele curcio Marta Di Pisa Roberto Miraglia Pieralba Catalano Luca Barresi Ilaria Tarantino Antonino Granata Marco Spada Mario Traina Department of Gastroenterology Liver Transplantation Unit Department of Radiology Liver Transplantation Unit Department of Pediatric Liver Transplantation Unit

Portal hypertension,which is a common finding in children awaiting liver transplantation,is also found after ***'s reported the case of a 6-year-old girl,transplanted for biliary atresia,who had a severe obscure-overt bleeding presenting with *** esophagogastroduodenoscopy showed several duodenal small,bulging lesions,with some red *** the lesions,a depressed area of 2cm,covered with mixed hyperemic and white mucosa,was *** better evaluate these lesions,we performed an endoscopic ultrasonography(EUS) that showed multiple,round hypoechoic areas 0.5-5mm in diameter,compatible with duodenal varices,and several periduodenal anechoic lesions compatible with collaterals.A consecutive computed tomography scan showed a stenosis of the portal vein anastomosis confirmed with a transhepatic portography,which was successfully treated with balloon *** further episodes of bleeding were observed during the *** case report suggests that EUS is safe and feasible in young children when using echoendoscopes designed for use in *** further studies are needed to validate the employment of this technique in the management and follow-up of pediatric portal hypertension.

关键词： Obscure bleeding Pediatric Endoscopic ultrasound Liver transplantation Gastrointestinal

胰腺的膀胱的损害: 内视镜的超声形态学和内视镜的超声罚款针渴望帮助怎么开诊断难题

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World Journal of Gastrointestinal Endoscopy 2012年第6期4卷 247-259页

作者： Luca Barresi Ilaria Tarantino Antonino Granata gabriele curcio Mario Traina Unit of Gastroenterology and Digestive Endoscopy Mediterranean Institute for Transplantation and Advanced Specialized Therapies90146 PalermoItaly

Cystic lesions of the pancreas are being diagnosed with increasing frequency,covering a vast spectrum from benign to malignant and invasive *** investigations can be done to discriminate between benign and non-evolutive lesions from those that require *** the moment,there is no single test that will allow a correct diagnosis in all *** ultrasound(EUS) morphology,cyst fluid analysis and cytohistology with EUS-guided fine needle aspiration can aid in this difficult diagnosis.

关键词： Pancreatic cystic lesions Endoscopic ultrasound Endoscopic ultrasound fine needle aspiration

盖住的自我有为避免 stent 赶出的胰腺的 pseudocyst 的在内的闪耀的塑料的可扩充的金属性的 stent

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World Journal of Gastrointestinal Endoscopy 2012年第4期4卷 148-150页

作者： Ilaria Tarantino Marta Di Pisa Luca Barresi gabriele curcio Antonino Granata Mario Traina Department of Gastroenterology and Digestive Endoscopy Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT/University of Pittsburgh Medical Center 90100 Palermo Italy

Endoscopic ultrasound-guided drainage has recently been recommended for increasing the drainage rate of endoscopically managed pancreatic fluid collections and decreasing the morbidity associated with conventional endoscopic trans-mural drainage. The type of stent used for endoscopic drainage is currently a major area of interest. A covered self expandable metallic stent (CSEMS) is an alternative to conventional drainage with plastic stents because it offers the option of providing a larger-diameter access fi stula for drainage, and may increase the fi nal success rate. One problem with CSEMS is dislodgement, so a metallic stent with flared or looped ends at both extremities may be the best option. An 85-year-old woman with severe comorbidity was treated with percutaneous approach for a large (20 cm) pancreatic pseudocyst with corpuscolated material inside. This approach failed. The patient was transferred to our institute for EUS-guided transmural drainage. EUS confi rmed a large, anechoic cyst with hyperechoic material inside. Because the cyst was large and contained mixed and corpusculated fluid, we used a metallic stent for drainage. To avoid migration of the stent and potential mucosal growth above the stent, a plastic prosthesis (7 cm, 10 Fr) with flaps at the tips was inserted inside the CSEMS. Two months later an esophagogastroduodenoscopy was done, and showed patency of the SEMS and plastic stents, which were then removed with a polypectomy snare. The patient experienced no further problems.

关键词： Pancreatic pseudocyst Self expandable metallic stent