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An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice

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Hepatobiliary & Pancreatic Diseases International 2016年第2期15卷 220-222页

作者： Georgios Tziatzios Paraskevas Gkolfakis ioannis s papanikolaou George Dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit 2nd Department of Internal Medicine and Research Institute "Attikon" University General Hospital Medical School University of Athens

Despite the effectiveness of endoscopic retrograde cholangiopancreatography（ERCP） for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged postERCP jaundice due to toxicity of the contrast agent Iobitridol（~174;XENETIX, Guerbet, Roissy Cd G Cedex, France） in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/d L. Other potential causes of direct hyperbilirubinemia were ruled out and patient＇s liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

关键词： endoscopic retrograde cholangiopancreatography jaundice adverse effect Iobitridol

Colonoscopy attachments for the detection of precancerous lesions during colonoscopy:A review of the literature

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World Journal of Gastroenterology 2018年第37期24卷 4243-4253页

作者： Paraskevas Gkolfakis Georgios Tziatzios Eleftherios spartalis ioannis s papanikolaou Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticResearch Institute and Diabetes CenterMedical SchoolNational and Kapodistrian University of Athens''Attikon”University General HospitalAthens 12462Greece Laboratory of Experimental surgery and surgical Research National and Kapodistrian University of AthensAthens 12462Greece

Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them-transparent cap, Endocuff, Endocuff Vision and Endorings-are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.

关键词： Adenoma detection rate Adenoma miss rate Colonoscopy Cup Endocuff Endocuff Vision Endorings

Artificial intelligence-aided colonoscopy:Recent developments and future perspectives

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世界胃肠病学杂志：英文版 2020年第47期26卷 7436-7443页

作者： Giulio Antonelli Paraskevas Gkolfakis Georgios Tziatzios ioannis s papanikolaou Konstantinos Triantafyllou Cesare Hassan Gastroenterology Unit Nuovo Regina Margherita HospitalRome 00153Italy Department of Translational and Precision Medicine “Sapienza”University of RomeRome 00185Italy Department of Gastroenterology Hepatopancreatology and Digestive Oncology Erasme University HospitalUniversite Libre de BruxellesBrussels 1070Belgium Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticMedical SchoolNational and Kapodistrian University of Athens“Attikon”University General HospitalAthens 12462Greece

Artificial intelligence(AI)systems,especially after the successful application of Convolutional Neural Networks,are revolutionizing modern *** Endoscopy has shown to be a fertile terrain for the development of AI systems aiming to aid endoscopists in various aspects of their daily *** detection can be one of the two main aspects in which AI can increase diagnostic yield and abilities of *** colonoscopy,it is well known that a substantial rate of missed neoplasia is still present,representing the major cause of interval *** addition,an extremely high variability in adenoma detection rate,the main key quality indicator in colonoscopy,has been extensively *** other domain in which AI is believed to have a considerable impact on everyday clinical practice is lesion characterization and aid in“optical diagnosis”.By predicting in vivo histology,such pathology costs may be averted by the implementation of two separate but synergistic strategies,namely the“leave-in-situ”strategy forstic lesions in the rectosigmoid tract,and“resect and discard”for the other diminutive *** this opinion review we present current available evidence regarding the role of AI in improving lesions’detection and characterization during colonoscopy.

关键词： Artificial intelligence Colonoscopy Polyp Adenoma Detection Characterization

Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

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World Journal of Gastroenterology 2019年第9期25卷 1158-1170页

作者： Konstantinos Triantafyllou Paraskevas Gkolfakis Georgios Tziatzios ioannis s papanikolaou Lorenzo Fuccio Cesare Hassan Hepatogastroenterology Unit Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center Medical School National and Kapodistrian University of Athens ‘‘Attikon" University General Hospital Department of Medical and surgical sciences S. Orsola-Malpighi University Hospital Endoscopy Unit Nuovo Regina Margherita Hospital

BACKGROUND Endocuff-a plastic device with flexible projections-mounted on the distal tip of the colonoscope, promises improved colonic mucosa *** To elucidate the effect of Endocuff on adenoma detection rate(ADR), advanced ADR(AADR) and mean number of adenomas per colonoscopy(MAC).METHODs Literature searches identified randomized-controlled trials evaluating Endocuffassisted colonoscopy(EAC) vs conventional colonoscopy(CC) in terms of ADR,AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk(RR) [95%confidence interval(CI)] and mean difference(MD)(95%CI). The rate of device removal in EAC arms was also *** We identified nine studies enrolling 6038 patients. All studies included mixed population(screening, surveillance and diagnostic examinations). seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR(95%CI): 1.18(1.05-1.32); Ι~2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR(95%CI): 1.37(1.08-1.74); Ι~2 = 49% vs 1.10(0.99-1.24); Ι~2= 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR(95%CI): 1.03(0.85-1.25); Ι~2 = 15% and MD(95%CI): 0.30(-0.17-0.78);Ι~2 = 99%]. subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3%(95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along *** EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.

关键词： Adenoma detection rate Colonoscopy Adenoma Detection Endocuff Endocuff-Vision

Abnormal DNA methylation as a cell-free circulating DNA biomarker for colorectal cancer detection:A review of literature

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World Journal of Gastrointestinal Oncology 2017年第4期9卷 142-152页

作者： Michail Galanopoulos Nikolaos Tsoukalas ioannis s papanikolaou Maria Tolia Maria Gazouli Gerassimos J Mantzaris Department of Gastroenterology 'Evaggelismos-Ophthalmiatreion Athinon-Polycliniki' Department of Medical Oncology Veterans Hospital (417 NIMTS) Hepatogastroenterology Unit Second Department of Internal Medicine and Research InstituteAttikon University General HospitalMedical SchoolNational and Kapodistrian University of Athens Department of Radiotherapy/Radiation Oncology Faculty of MedicineSchool of Health SciencesUniversity of Thessaly Department of Basic Medical sciences Laboratory of Biology Medical SchoolNational and Kapodistrian University of Athens

Colorectal cancer(CRC) is one of the most prevalent malignancies in the world. CRC-associated morbidity and mortality is continuously increasing, in part due to a lack of early detection. The existing screening tools such as colonoscopy, are invasive and yet high cost, affecting the willingness of patients to participate in screening programs. In recent years, evidence is accumulating that the interaction of aberrant genetic and epigenetic modifications is the cornerstone for the CRC development and progression by alternating the function of tumor suppressor genes, DNA repair genes and oncogenes of colonic cells. Apart from the understanding of the underlying mechanism(s) of carcinogenesis, the aforementioned interaction has also allowed identification of clinical biomarkers, especially epigenetic, for the early detection and prognosis of cancer patients. One of the ways to detect these epigenetic biomarkers is the cell-free circulating DNA(circ DNA), a blood-based cancer diagnostic test, mainly focusing in the molecular alterations found in tumor cells, such as DNA mutations and DNA *** this brief review, we epitomize the current knowledge on the research in circ DNA biomarkers-mainly focusing on DNA methylation-as potential blood-based tests for early detection of colorectal cancer and the challenges for validation and globally implementation of this emergent technology.

关键词： Colorectal cancer early detection Colorectal cancer screening Circulating free DNA Colorectal cancer blood-based biomarkers DNA methylation blood biomarkers

Management of primary retroperitoneal synovial sarcoma: A case report and review of literature

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World Journal of Gastrointestinal surgery 2019年第1期11卷 27-33页

作者： Aikaterini Mastoraki Dimitrios schizas ioannis s papanikolaou George Bagias Nikolaos Machairas George Agrogiannis Theodore Liakakos Nikolaos Arkadopoulos 4th Department of surgery National and Kapodistrian University of Athens Attikon University Hospital 1st Department of surgery National and Kapodistrian University of Athens Laikon Hospital Hannover Medical school Clinic for General Visceral and Transplant Surgery 3rd Department of surgery National and Kapodistrian University of Athens Attikon University Hospital 1st Department of Pathology National and Kapodistrian University of Athens

BACKGROUND synovial sarcoma(ss) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the ***, several cases of retroperitoneal ss(Rss) have been described. We herein report a case of Rss presented in our *** sUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space ss. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic *** Rss is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.

关键词： Retroperitoneal tumours synovial sarcoma Case report Clinical presentation Diagnostic modalities Therapeutic management

Facing the challenge of venous thromboembolism prevention in patients undergoing major abdominal surgical procedures for gastrointestinal cancer

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World Journal of Gastrointestinal Oncology 2018年第10期10卷 328-335页

作者： Aikaterini Mastoraki sotiria Mastoraki Dimitrios schizas Raphael Patras Nikolaos Krinos ioannis s papanikolaou Andreas Lazaris Theodore Liakakos Nikolaos Arkadopoulos 4th Department of surgery National and Kapodistrian University of AthensAttikon University HospitalAthens 12462Greece Department of Vascular surgery National and Kapodistrian University of AthensAttikon University HospitalAthens 12462Greece 1st Department of surgery National and Kapodistrian University of AthensLaikon HospitalAthens 11527Greece

Venous thromboembolism(VTE)refers to a hypercoa-gulable state that remains an important and preven-table factor in the surgical treatment of *** includes two identical entities with regards to deep vein thrombosis and pulmonary *** incidence of VTE after major abdominal interventions for gastro-intestinal,hepato-biliary and pancreatic neoplastic disor-ders is as high as 25%without *** use of classic or low-molecular-weight heparin,anti-Xa factors,antithrombotic stocking,intermittent pneumatic compression devices and early mobilization have been ***,thromboprophylaxis is often dis-continued after discharge,although a serious risk may persist long after the initial triggering event,as the coagu-lation system remains active for at least 14 d *** aim of this review is to evaluate the results of the current practice of VTE prevention in cancer patients undergoing major abdominal surgical operations,with special attention to adequately elucidated guidelinesand widely accepted *** addition,the recent literature is presented in order to provide an update on the current concepts concerning the surgical manage-ment of the disease.

关键词： Deep vein thrombosis Pulmonary embolism Gastro-intestinal cancer Thromboprophylaxis Venous thromboembolism

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;Ps 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

Endoscopic ultrasonography for gastric submucosal lesions

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World Journal of Gastrointestinal Endoscopy 2011年第5期3卷 86-94页

作者： ioannis s papanikolaou Konstantinos Triantafyllou Anastasia Kourikou Thomas Rsch Hepatogastroenterology Unit 2nd Department of Internal Medicine-PropaedeuticAttikon University General HospitalMedical SchoolUniversity of Athens Department of Interdisciplinary Endoscopy University Hospital Hamburg-Eppendorf

Gastric submucosal tumors(sMTs) are a rather frequent finding,occurring in about 0.36%of routine upper *** ultrasonography(EUs) has emerged as a reliable investigative procedure for evaluation of these *** EUs has the ability to differentiate intramural tumors from extraluminal compressions and can also show the layer of origin of gastric *** can be further characterized by their layer of origin,echo pattern and ***-risk criteria of their malignant potential are presented,although the emergence of EUs-FNA has opened new indications for transmural tissue diagnosis and expanded the possibilities of EUs in sMTs of the *** diagnosis should address whether the sMT is a Gastrointestinal stromal tumour(GIsT) or another tumor type and evaluate the malignant potential of a given ***,there seems to be a lack of data on the optimal strategy in sMTs suspected to be GIsTs with a negative EUs-FNA tissue *** current management strategies,as well as open questions regarding their treatment are also presented.

关键词： Endoscopic ultrasound Gastric submucosal tumors EUs-guided fne needle aspiration Gastrointestinal stromal tumours