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Variceal bleeding from ileum identified and treated by single balloon enteroscopy

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World Journal of Gastroenterology 2009年第15期15卷 1904-1905页

作者： Mario Traina ilaria tarantino Luca Barresi Filippo Mocciaro Gastroenterology Department ISMETT/UPMC Department of Internal MedicineO.V.Cervello

We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver *** upper and lower endoscopy were negative for bleeding lesions. We decided to perform the examination of the small bowel using single-balloon *** lower enteroscopy revealed signs of bleeding from varices of the *** this report,we showed that the injection of a sclerosant solution can be accomplished using a freehand technique via the single balloon enteroscopy.

关键词： Ectopic varices Ileal bleeding Enteroscopy Portal hypertension Glue injection

Simultaneous endoscopic ultrasound fine needle aspiration and endoscopic retrograde cholangio-pancreatography:Evaluation of safety

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World Journal of Gastroenterology 2007年第28期13卷 3861-3863页

作者： ilaria tarantino Luca Barresi Marta Di Pisa Mario Traina Istituto Mediterraneo Trapianti e Terapie ad alta specializzazione University of Pittsburgh Medical CenterItaly

AIM: To investigate the rate of complications of endoscopic retrograde cholangio-pancreatography (ERCP) performed immediately after endoscopic ultrasound fine needle aspiration (EUS-FNA) in a large series of patients. METHODS: Patients with the following conditions were considered candidates for EUS-FNA and ERCP: diagnosis of locally advanced or metastatic pancreatic lesion not eligible for surgery, and patients with pancreatic lesion of unknown nature causing jaundice. Data were prospectively collected on the following parameters: indication for FNA, EUS findings, pathological diagnosis, procedure duration of EUS-FNA and combined EUS-FNA and ERCP, and immediate and late complications. RESULTS: From January 2004 to October 2006, 72 patients were deemed eligible for combined EUS and ERCP. In 25/72 EUS-FNA was performed to obtain a pathology diagnosis of lesions causing biliary obstruction, and ERCP sequentially performed to drain the biliary system. No immediate complications occurred except for two mild bleeding episodes post sphincterotomy. No late complications were recorded except for one patient who experienced fever, promptly recovered with antibiotic therapy. CONCLUSION: Simultaneous approach appears to be feasible and safe. When possible, this can be considered the reference standard to avoid double sedation and reduce duration of the procedure and hospital stay.

关键词： Pancreatic mass Endoscopic ultrasound fine needle aspiration Biliary stent Jaundice Endoscopictherapy

Endoscopic ultrasound guided biliary drainage

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World Journal of Gastrointestinal Endoscopy 2012年第7期4卷 306-311页

作者： ilaria tarantino Luca Barresi Carlo Fabbri Mario Traina Unit of Gastroenterology and Digestive Endoscopy ISMETT Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center54000 Palermo Italy Unit of Gastroenterology and Digestive Endoscopy AUSL Bologna Bellaria-Maggiore Hospital40121 Bologna Italy

Endoscopic retrograde cholangio-pancreatography is the most appropriate technique for treating common bile duct and pancreatic duct stenosis secondary to benign and malignant diseases. Even if the procedure is performed by skillful endoscopist, there are patients in whom endoscopic stent placement is not possible. Common causes of failure include complex peripapillary diverticula, prior surgery procedures, tumor involvement of the papilla, biliary sphincter stenosis, and impacted stones. Percutaneous trans-hepatic biliary drainage (PTBD) and surgical intervention carry morbidity and mortality. Recently endoscopic ultrasonography-guided biliary drainage has been reported as an alternative technique. Endoscopic ultrasonography- guided biliary drainage using either direct access or a rendezvous technique has attracted attention as an alternative procedure to PTBD, with a technical success between 75%-100% and with low complication rate. We have reviewed published data on EUS guided biliary drainage procedures with the aim of summarizing the efficacy and safety of this promising method.

关键词： Interventional endoscopic ultrasonography Endoscopic ultrasonography drainage Biliary drainage Endoscopic retrograde cholangio-pancreatography

Percutaneous transarterial embolization of extrahepatic arteroportal fistula

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World Journal of Gastroenterology 2006年第34期12卷 5562-5564页

作者： Gianluca Marrone Settimo Caruso Roberto Miraglia ilaria tarantino Riccardo Volpes Angelo Luca Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT) Palermo Italy

Arteroportal fistula is a rare cause of prehepatic portal hypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding. Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the color- Doppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed. Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

关键词： Portal hypertension Arteroportal fistula Portal shunt Esophageal varices bleeding Embolization Interventional radiology Psudoaneurysm

Endoscopic treatment of biliary complications after liver transplantation

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World Journal of Gastroenterology 2008年第26期14卷 4185-4189页

作者： ilaria tarantino Luca Barresi Ioannis Petridis Riccardo Volpes Mario Traina Bruno Gridelli Department of Gastroenterology Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical Center (UPMC)Palermo 90100Italy Department of Surgery Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)University of Pittsburgh Medical CenterPalermo 90100Italy

AIM： To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS： This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography （ERCP） was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after i year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach （PTC） or surgery was adopted. RESULTS： From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, i patient was retransplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3±13.13 mo and 21.02± 14.10 mo, ***： Albhough ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whebher obher endoscopic protocols or new devices, could improve bhe current results.

关键词： Endoscopic retrograde cholangiopancreatography Biliary complication Liver transplant Benignstenosis Biliary leak

Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition:a systematic review and meta-analysis

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Gastroenterology Report 2022年第1期10卷 544-551页

作者： Antonio Facciorusso Stefano Francesco Crino Paraskevas Gkolfakis Daryl Ramai Andrea Lisotti Ioannis S Papanikolaou Benedetto Mangiavillano ilaria tarantino Andrea Anderloni Carlo Fabbri Konstantinos Triantafyllou Pietro Fusaroli Gastroenterology Unit Department of Surgical and Medical SciencesUniversity of FoggiaFoggiaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly Department of Gastroenterology Hepatopancreatologyand Digestive OncologyCUB Erasme HospitalUniversite Libre de Bruxelles(ULB)BrusselsBelgium Gastroenterology and Hepatology University of Utah HealthSalt Lake CityUTUSA Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticMedical SchoolNational and Kapodistrian University of Athens‘Attikon’University General HospitalAthensGreece Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanzaVareseItaly Endoscopy Service Department of Diagnostic and Therapeutic ServicesIRCCS-ISMETTPalermoItaly Digestive Endoscopy Unit Humanitas Clinical and Research Center—IRCCSRozzanoMilanoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly

Background:Endoscopic ultrasound(EUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes(LNs)located next to the gastrointestinal *** study aimed to compare the pooled diagnostic performance of EUS-guided fine-needle biopsy(EUS-FNB)and fine-needle aspiration(EUS-FNA)for LNs ***:We searched PubMed/MedLine and Embase databases through August *** outcome was diagnostic accuracy;secondary outcomes were sensitivity,specificity,sample adequacy,optimal histological core procurement,number of passes,and adverse *** performed a pairwise meta-analysis using a random-effects *** results are presented as odds ratio(OR)or mean difference along with 95%confidence interval(CI).Results:We identified nine studies(1,276 patients)in this *** these patients,66.4%were male;the median age was 67 *** accuracy was not significantly different between the two approaches(OR,1.31;95%CI,0.81–2.10;P=0.270).The accuracy of EUS-FNB was significantly higher when being performed with newer end-cutting needles(OR,1.87;95%CI,1.17–3.00;P=0.009)and in abdominal LNs(OR,2.48;95%CI,1.52–4.05;P<0.001)than that of *** difference in terms of sample adequacy was observed between the two approaches(OR,1.40;95%CI,0.46–4.26;P=0.550);however,histological core procurement and diagnostic sensitivity with EUS-FNB were significantly higher than those with EUS-FNA(OR,6.15;95%CI,1.51–25.07;P=0.010 and OR,1.87;95%CI,1.27–2.74,P=0.001).The number of needle passes needed was significantly lower in the EUS-FNB group than in the EUS-FNA group(mean difference,-0.54;95%CI,-0.97 to -0.12;P=0.010).Conclusions EUS-FNA and EUS-FNB perform similarly in LN sampling;however,FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.

关键词： EUS FNA FNB cancer metastases lymphoma

Pancreatic cystic lesions:How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

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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

Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 53-61页

作者： Benedetto Mangiavillano Mouen A Khashab ilaria tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici Gastrointestinal Endoscopy Unit Humanitas-Mater Domini Humanitas Huniversity Division of Gastroenterology and Hepatology Johns Hopkins Hospital Gastroenterology and Endoscopy Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center IRCCS Digestive Endoscopy Unit Istituto Clinico Humanitas Research Hospital Unit of Gastroenterology Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography(EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP). The advent of lumen-apposing metal stents(LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

关键词： Malignant biliary strictures Malignant duodenal stenosis Bilio-duodenal stenosis Biliary self-expandable metal stent Duodenal self-expandable metal stent Lumen-apposing metal stents Gastro-jejunostomy

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