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Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

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World Journal of Gastroenterology 2024年第1期30卷 70-78页

作者： Alessandro Fugazza kareem khalaf Katarzyna M Pawlak Marco Spadaccini Matteo Colombo Marta Andreozzi Marco Giacchetto Silvia Carrara Chiara Ferrari Cecilia Binda Benedetto Mangiavillano Andrea Anderloni Alessandro Repici Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly Division of Gastroenterology St.Michael’s HospitalUniversity of TorontoToronto M5B 1W8ONCanada Department of Anesthesia Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsRomagna 47121Italy Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanza 21100Italy Gastroenterology and Digestive Endoscopy Unit Fondazione IRCCS Policlinico San MatteoPavia 27100Italy

This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage(EUS-GBD)as a salvage approach in cases of unsuccessful conventional ***-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of *** procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events,making it a safe and effective option for appropriate ***,EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary ***,patient selection is critical for the success of EUS-GBD,and proper patient selection and risk assessment are important to ensure the safety and efficacy of the *** the field continues to evolve and mature,ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD,ultimately leading to improved outcomes for patients.

关键词： Endoscopic ultrasound-guided gallbladder drainage Gallbladder drainage Acute cholecystitis Malignant obstruction Interventional endoscopic ultrasound Lumen-apposing metal stents

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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 ***: 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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Tauroursodeoxycholic acid: a potential therapeutic tool in neurodegenerative diseases

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Translational Neurodegeneration 2022年第1期11卷 444-460页

作者： kareem khalaf Paolo Tornese Antoniangela Cocco Alberto Albanese Department of Neurology IRCCS Humanitas Research HospitalRozzanoMIItaly

Most neurodegenerative disorders are diseases of protein homeostasis, with misfolded aggregates accumulating. The neurodegenerative process is mediated by numerous metabolic pathways, most of which lead to apoptosis. In recent years, hydrophilic bile acids, particularly tauroursodeoxycholic acid (TUDCA), have shown important anti-apoptotic and neuroprotective activities, with numerous experimental and clinical evidence suggesting their possible therapeutic use as disease-modifiers in neurodegenerative diseases. Experimental evidence on the mechanisms underlying TUDCA’s neuroprotective action derives from animal models of Alzheimer’s disease, Parkinson’s disease, Huntington’s diseases, amyotrophic lateral sclerosis (ALS) and cerebral ischemia. Preclinical studies indicate that TUDCA exerts its effects not only by regulating and inhibiting the apoptotic cascade, but also by reducing oxidative stress, protecting the mitochondria, producing an anti-neuroinflammatory action, and acting as a chemical chaperone to maintain the stability and correct folding of proteins. Furthermore, data from phase II clinical trials have shown TUDCA to be safe and a potential disease-modifier in ALS. ALS is the first neurodegenerative disease being treated with hydrophilic bile acids. While further clinical evidence is being accumulated for the other diseases, TUDCA stands as a promising treatment for neurodegenerative diseases.

关键词： Amyotrophic lateral sclerosis Alzheimer’s disease Bile acids Disease-modifying Huntington’s disease Neurodegeneration Neuroprotection Parkinson’s disease Ursodeoxycholic acid Tauroursodeoxycholic acid

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Endoscopic management of difficult common bile duct stones:Where are we now?A comprehensive review

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World Journal of Gastroenterology 2021年第44期27卷 7597-7611页

作者： Alberto Tringali Deborah Costa Alessandro Fugazza Matteo Colombo kareem khalaf Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Department of MedicineConegliano HospitalULSS 2 Marca TrevigianaConegliano 31015Italy Digestive Endoscopy Unit Department of GastroenterologyHumanitas Research Hospital IRCCSRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone *** recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse *** this review,we outline a stepwise approach in CBD stone *** first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical *** the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale *** discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical ***,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management *** addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have *** conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.

关键词： Common bile duct stones Balloon dilation Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Anastomoses,Roux en y Double balloon enteroscopy Mechanical lithotripsy Cholangioscopy

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Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence

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World Journal of Gastroenterology 2022年第29期28卷 3814-3824页

作者： Marco Spadaccini Glenn Koleth James Emmanuel kareem khalaf Antonio Facciorusso Fabio Grizzi Cesare Hassan Matteo Colombo Benedetto Mangiavillano Alessandro Fugazza Andrea Anderloni Silvia Carrara Alessandro Repici Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research Hospital and UniversityMilan 20800Italy Department of Gastroenterology and Hepatology Queen ElizabethKota Kinabalu 88200SabahMalaysia Section of Gastroenterology Department of Medical SciencesUniversity of FoggiaFoggia 71122Italy Department of Immunology and Inflammation Humanitas Clinical and Research HospitalRozzano 20089Italy Digestive Endoscopy Unit Division of GasteroenterologyHumanitas Mater DominiCastellanza 21053Italy

Early detection of pancreatic cancer has long eluded clinicians because of its insidious nature and *** metastatic or locally invasive when symptomatic,most patients are deemed *** those who are symptomatic,multi-modal imaging modalities evaluate and confirm pancreatic ductal *** asymptomatic patients,detected pancreatic lesions can be either solid or *** clinical implications of identifying small asymptomatic solid pancreatic lesions(SPLs)of<2 cm are tantamount to a better *** accurate detection of SPLs undoubtedly promotes higher life expectancy when resected early,driving the development of existing imaging tools while promoting more comprehensive screening *** imaging tool that has matured in its reiterations and received many image-enhancing adjuncts is endoscopic ultrasound(EUS).It carries significant importance when risk stratifying cystic lesions and has substantial diagnostic value when combined with fine needle aspiration/biopsy(FNA/FNB).Adjuncts to EUS imaging include contrast-enhanced harmonic EUS and EUS-elastography,both having improved the specificity of FNA and *** review intends to compile all existing enhancement modalities and explore ongoing research around the most promising of all adjuncts in the field of EUS imaging,artificial intelligence.

关键词： Pancreatic ductal adenocarcinoma Pancreatic cancer Endoscopic ultrasound Contrast-enhanced endoscopic ultrasound Endoscopic ultrasound contrast agents Endoscopic ultrasound elastography Artificial intelligence Fractal analysis Endoscopy Imaging

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Endoscopic management of benign biliary strictures:Looking for the best stent to place

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World Journal of Clinical Cases 2023年第31期11卷 7521-7529页

作者： Matteo Colombo Edoardo Forcignanò Leonardo Da Rio Marco Spadaccini Marta Andreozzi Carmelo Marco Giacchetto Silvia Carrara Roberta Maselli Piera Alessia Galtieri Gaia Pellegatta Antonio Capogreco Davide Massimi kareem khalaf Cesare Hassan Andrea Anderloni Alessandro Repici Alessandro Fugazza Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research HospitalRozzano 20089MilanItaly Department of Surgical Sciences University of TurinTorino 10124PiemonteItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20089MilanItaly Division of Gastroenterology St.Michael’s HospitalUniversity of TorontoToronto M5B1T8OntarioCanada Endoscopy Unit First Department of Internal MedicineFondazione IRCCS Policlinico San MatteoUniversity of PaviaPavia 27100Italy

Benign biliary strictures(BBS)might occur due to different pancreaticobiliary *** etiology and location of biliary strictures are responsible of a wide array of clinical *** endoscopic approach endoscopic retrograde cholangiopancreatography represents the first-line treatment for BBS,considering interventional radiology and surgery when endoscopic treatment fails or it is not *** purpose of this review is to provide an overview of possible endoscopic treatments for the optimal management of this subset of patients.

关键词： Benign biliary strictures Endoscopic retrograde cholangiopancreatography Endoscopic management Biliary stent

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Role of endoscopic ultrasound in vascular interventions:Where are we now?

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World Journal of Gastrointestinal Endoscopy 2022年第6期14卷 354-366页

作者： Alessandro Fugazza kareem khalaf Matteo Colombo Silvia Carrara Marco Spadaccini Glenn Koleth Edoardo Troncone Roberta Maselli Alessandro Repici Andrea Anderloni Division of Gastroenterology and Digestive Endoscopy Department of GastroenterologyHumanitas Research HospitalRozzano 20089Italy Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20090Italy Department of Systems Medicine University of Rome"Tor Vergata"Roma 00133Italy

From a mere diagnostic tool to an imperative treatment modality,endoscopic ultrasound(EUS)has evolved and revolutionized safer efficient options for vascular *** it is an alternative treatment option in the management of gastrointestinal bleeding,primarily variceal type *** treatment option prior to EUS incorporation had limited efficiency and high adverse *** characterization and detail provided by EUS gives a cutting edge towards a holistically successful management *** indicates that EUS-guided combination therapy of coil embolization and glue injection has the higher efficacy for the treatment of ***,similar treatment options that exist for esophageal and other ectopic variceal bleeding was also *** conclusion,many studies refer that a combination therapy of coil and glue injection under EUS guidance provides higher technical success with fewer recurrence and adverse events,making its adaptation in the guideline extremely ***-hepatology is a novel disciple with a promising future outlook,we reviewed topics regarding portal vein access,pressure gradient measurement,and thrombus biopsy that are crucial interventions as alternative of radiological *** purpose of this review is to provide an update on the latest available evidence in the literature regarding the role of EUS in vascular *** reviewed the role of EUS in variceal bleeding in recent studies,especially gastric varices and novel approaches aimed at the portal vein.

关键词： Endoscopic ultrasound Cyanoacrylate Coil injection Gastric varices Gastrointestinal bleeding Vascular endoscopic treatments

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Percutaneous endoscopic gastrostomy and jejunostomy:Indications and techniques

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World Journal of Gastrointestinal Endoscopy 2022年第5期14卷 250-266页

作者： Alessandro Fugazza Antonio Capogreco Annalisa Cappello Rosangela Nicoletti Leonardo Da Rio Piera Alessia Galtieri Roberta Maselli Silvia Carrara Gaia Pellegatta Marco Spadaccini Edoardo Vespa Matteo Colombo kareem khalaf Alessandro Repici Andrea Anderloni Division of Gastroenterology and Digestive Endoscopy Department of GastroenterologyHumanitas Research Hospital-IRCCSRozzano 20089MilanItaly Unit of Gastroenterology and Digestive Endoscopy AUSL Bologna Bellaria-Maggiore HospitalBologna 40121Italy Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

Nutritional support is essential in patients who have a limited capability to maintain their body ***,oral feeding is the main approach for such *** physiological nutrition is not possible,positioning of a nasogastric,nasojejunal tube,or other percutaneous devices may be feasible *** a percutaneous endoscopic gastrostomy(PEG)is a suitable option to be evaluated for patients that need nutritional support for more than 4 *** diseases require nutritional support by PEG,with neurological,oncological,and catabolic diseases being the most *** can be performed endoscopically by various techniques,radiologically or surgically,with different outcomes and related adverse events(AEs).Moreover,some patients that need a PEG placement are fragile and are unable to express their will or sign a written informed *** conditions highlight many ethical problems that become difficult to manage as treatment *** aim of this manuscript is to review all current endoscopic techniques for percutaneous access,their indications,postprocedural follow-up,and AEs.

关键词： Percutaneous endoscopic gastrostomy Enteral nutrition Gastrostomy Percutaneous endoscopic jejunostomy Indications and techniques

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Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

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World Journal of Gastrointestinal Endoscopy 2023年第4期15卷 248-258页

作者： Ludovico Alfarone Marco Spadaccini Gianluca Franchellucci kareem khalaf Davide Massimi Alessandro De Marco Silvia Ferretti Valeria Poletti Antonio Facciorusso Roberta Maselli Alessandro Fugazza Matteo Colombo Antonio Capogreco Silvia Carrara Cesare Hassan Alessandro Repici Department of Biomedical Sciences Humanitas UniversityRozzano 20089Italy Department of Gastroenterology Division of Gastroenterology and Digestive EndoscopyHumanitas Research HospitalIRCCSRozzano 20089MilanItaly Division of Gastroenterology St.Michael's HospitalUniversity of TorontoToronto M5B 1W8Canada Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaFoggia 71100Italy

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal ***,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly *** to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard *** having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be *** events are primarily caused by electrocautery-induced ***,ER techniques with a better safety profile are needed to overcome these *** snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal *** aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

关键词： Non-ampullary duodenal adenomas Endoscopic resection Cold snare polypectomy Hot snare polypectomy Safety Efficacy

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On chaotic properties of new semidynamical systems of Lasota type in two spaces

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International Journal of Biomathematics 2018年第5期11卷 201-215页

作者： Habeeb kareem Abdullah Amal khalaf Haydar Yaqoob All Hussein Department of Mathematics Faculty of Education for Girls University of Kufa Najaf Iraq

The present study is concerned with construct two new semidynamical systems which are generated by two partial differential equations of Lasota type. In addition, this study discusses the asymptotic properties： Strong stability, exponential stability, periodic points, the density of periodic points, transitivity and chaos in two spaces： Lp space and Lp space.

关键词： Initial value problems for linear first-order equations stability periodic solutions chaotic dynamics.

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