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Laparoscopic fundoplication for gastroesophageal reflux disease

World Journal of Gastroenterology 2014年第39期20卷 14272-14279页

作者： marzio frazzoni Micaela Piccoli Rita Conigliaro Leonardo frazzoni Gianluigi Melotti Digestive Pathophysiology Unit Baggiovara Hospital 41100 Modena Italy Digestive Endoscopy Unit Baggiovara Hospital 41100 Modena Italy Department of General Surgery Baggiovara Hospital 41100 Modena Italy

Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.

关键词： Gastroesophageal reflux disease Refractory gastroesophageal reflux disease Laparoscopic fundoplication Impedance-pH monitoring Proton pump inhibitors

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Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

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World Journal of Gastrointestinal Surgery 2016年第11期8卷 719-728页

作者： Salvatore Tolone Giorgia Gualtieri Edoardo Savarino marzio frazzoni Nicola de Bortoli Manuele Furnari Giuseppina Casalino Simona Parisi Vincenzo Savarino Ludovico Docimo Division of General and Bariatric Surgery Second University of Naples Division of Gastroenterology Department of Surgery Oncology and Gastroenterology University of Padua Division of Gastroenterology Baggiovara Hospital Division of Gastroenterology Department of Internal Medicine University of Pisa Division of Gastro-enterology Department of Internal Medicine University of Genoa

Gastroesophageal reflux disease(GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors(PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental(such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH /impedance-pH monitoring) and clinical features(such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

关键词： Gastroesophageal reflux disease Antireflux surgery Outcome predictors Fundoplication Nissen Laparoscopy High resolution manometry ImpedancepH monitoring

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Cholangiocarcinoma and malignant bile duct obstruction: A review of last decades advances in therapeutic endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 582-592页

作者： Helga Bertani marzio frazzoni Santi Mangiafico Angelo Caruso Mauro Manno Vincenzo Giorgio Mirante Flavia Pigò Carmelo Barbera Raffaele Manta Rita Conigliaro Digestive Endoscopy Unit Baggiovara Hospital Digestive Pathophysiology Unit Baggiovara Hospital

In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of patients with malignant bile duct obstruction, and allows rapid reduction of jaundice decreasing the risk of biliary sepsis. When biliary drainage and stenting cannot be achieved with endoscopy alone, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording successful biliary drainage in more than 80% of cases. The purpose of this review is to focus on the currently available endoscopic management options in patients with cholangiocarcinoma.

关键词： Cholangiocarcinoma Malignant bile ductobstruction Interventional endoscopy Endoscopictherapy Self-expandable metal stent

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Management of gastro-esophageal reflux disease:Practice-oriented answers to clinical questions

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World Journal of Gastroenterology 2023年第5期29卷 773-779页

作者： Leonardo frazzoni Lorenzo Fuccio Rocco Maurizio Zagari Department of Digestive Diseases IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S OrsolaBologna 40138Italy Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy

Gastro-esophageal reflux disease(GERD)is a condition which is frequently faced by primary care physicians and *** management of GERD is crucial to maximise both patient care and resource *** fact,the management of patients with GERD is complex and poses several questions to the clinician who faces them in clinical *** instance,many aspects should be considered,including the appropriateness of indication to endoscopy,the quality of the endoscopic examination,the use and interpretation of ambulatory reflux testing,and the choice and management of anti-reflux treatments,i.e.,protonpump inhibitors and *** of the present review was to provide a comprehensive update on the clinical management of patients with GERD,through a literature review on the diagnosis and management of patients with GER *** details,we provide practice-oriented concise answers to clinical questions,with the aim of optimising patient management and healthcare resource use.

关键词： Gastro-esophageal reflux disease Diagnosis Management Proton-pump inhibitor

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Pelvic radiation disease:Updates on treatment options

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World Journal of Clinical Oncology 2015年第6期6卷 272-280页

作者： Leonardo frazzoni Marina La Marca Alessandra Guido Alessio Giuseppe Morganti Franco Bazzoli Lorenzo Fuccio Department of Medical and Surgical Sciences S.Orsola-Malpighi HospitalUniversity of Bologna Division of Radiation Oncologym S.Orsola-Malpighi Hospital University of Bologna

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue,especially of distal large bowel,thus inducing gastrointestinal(GI) radiation-induced toxicity. Indeed,up to half of radiationtreated patients say that their quality of life is affected by GI symptoms(e.g.,rectal bleeding,diarrhoea). The constellation of GI symptoms- from transient to longterm,from mild to very severe- experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease(PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories,i.e.,medical and endoscopic. Of note,most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding(i.e.,causing chronic anemia) should firstly be considered for medical management(i.e.,sucralfate enemas,metronidazole and hyperbaric oxygen); in case of failure,endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute,transfusion requiring,bleeding. More well-performed,high quality studies should be performed,especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.

关键词： Pelvic radiation disease Radiation-induced proctopathy Radiotherapy Gastrointestinal toxicity Sucralfate Metronidazole Probiotics Argon plasma coagulation Hyperbaric oxygen Formalin

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Prevention of pelvic radiation disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第1期6卷 1-9页

作者： Lorenzo Fuccio Leonardo frazzoni Alessandra Guido Department of Medical and Surgical Sciences S.Orsola-Malpighi Hospital University of Bologna Division of Radiation Oncology S.OrsolaMalpighi Hospital University of Bologna

Pelvic cancers are among the most frequently diagnosed cancers worldwide. Treatment of patients requires a multidisciplinary approach that frequently includes radiotherapy. Gastrointestinal(GI) radiation-induced toxicity is a major complication and the transient or long-term problems, ranging from mild to very severe, arising in non-cancerous tissues resulting from radiation treatment to a tumor of pelvic origin, are actually called as pelvic radiation disease. The incidence of pelvic radiation disease changes according to the radiation technique, the length of follow up, the assessmentmethod, the type and stage of cancer and several other variables. Notably, even with the most recent radiation techniques, i.e., intensity-modulated radiotherapy, the incidence of radiation-induced GI side effects is overall reduced but still not negligible. In addition, radiation-induced GI side effects can develop even after several decades; therefore, the improvement of patient life expectancy will unavoidably increase the risk of developing radiation-induced complications. Once developed, the management of pelvic radiation disease may be challenging. Therefore, the prevention of radiation-induced toxicity represents a reasonable way to avoid a dramatic drop of the quality of life of these patients. In the current manuscript we provide an updated and practical review on the best available evidences in the field of the prevention of pelvic radiation disease.

关键词： Pelvic radiation disease Radiotherapy Gastrointestinal toxicity Amifostine Aminosalicylates Sucralfate Beclomethasone dipropionate Probiotics supplementation Misoprostol Mesalazine

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