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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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Relief of jaundice in malignant biliary obstruction:When should we consider endoscopic ultrasonography-guided hepaticogastrostomy as an option?

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 234-240页

作者： Alessandro Fugazza matteo colombo Marco Spadaccini Edoardo Vespa Roberto Gabbiadini Antonio Capogreco Alessandro Repici Andrea Anderloni Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSMilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly

Background:Since it was first described in 2001,endoscopic ultrasonography-guided biliary drainage(EUS-BD)has emerged as an alternative procedure for achieving an endoscopic internal drainage in case of endoscopic retrograde cholangiopancreatography(ERCP)*** drainage can be achieved by either a transduodenal extrahepatic approach through EUS-guided choledochoduodenostomy(EUS-CDS),or a transgastric intrahepatic approach,namely EUS-guided hepaticogastrostomy(EUS-HGS)which already holds a remarkable place in the treatment of patients with malignant biliary *** sources:For this review we did a comprehensive search of PubMed/MEDLINE from inception to May 31,2021 for papers with a significant sample size(at least 20 patients enrolled)dealing with *** on technical success,clinical success and rate of adverse events were ***:A total of 22 studies with different design,com prising 874 patients,were *** success was achieved in about 96% of cases(ranging from 65% to 100%).Clinical success was obtained in almost 91% of cases(ranging from 76% to 100%).Overall rate of adverse events was 19%(ranging from 0% to 35%).Abdominal pain,self-limiting pneumoperitoneum,bile leak,cholangitis,bleeding,perforation and intraperitoneal migration of the stent were the most ***:Despite both safety and efficacy profile,at the moment HGS still remains a challenging procedure at every single step and must therefore be conducted by a very experienced endoscopist in interventional EUS and ERCP procedures,who is able to deal with the possible severe adverse events of this procedure.A rapid introduction in clinical practice of dedicated devices is desiderable.

关键词： EUS-guided hepaticogastrostomy EUS-guided biliary drainage Hepaticogastrostomy Interventional EUS

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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 ultrasound-guided ablation of solid pancreatic lesions:A systematic review of early outcomes with pooled analysis

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World Journal of Gastrointestinal Oncology 2022年第2期14卷 533-542页

作者： Marco Spadaccini Milena Di Leo Andrea Iannone Daan von den Hoff Alessandro Fugazza Piera Alessia Galtieri Gaia Pellegatta Roberta Maselli Andrea Anderloni matteo colombo Peter D Siersema Silvia Carrara Alessandro Repici Endoscopic Unit Department of GastroenterologyIRCCS Humanitas Research HospitalRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20090MilanItaly Endoscopy Unit Azienda Ospedale PoliclinicoBari 70124Italy Endoscopy Unit Radboud University Medical CenterNijmegen 6525 GANetherlands

BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation(EUS-RFA)is emerging as a complementary therapeutic approach for pancreatic solid ***,results of published data are difficult to interpret because of a retrospective design and small sample *** To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and *** A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent *** primary outcomes were procedure-related adverse events(AEs)and *** outcomes were the technical success rate and the effects on primary tumor *** analyses were performed using Stata version *** In total,14 studies were included,with 120 patients undergoing 153 ablations of 129 solid pancreatic *** STARmed technology was used in seven studies,the Habib system in six studies,and the HybridTherm probe in one *** pooled technical success rate was 99.0%(I2:25.82%).The pooled overall AE rate was 8.0%(I2:11.46%).Excluding mild AEs,the pooled rates of serious AEs was 1.0%(I2:0%).No mortality related to the procedure was *** The present pooled analysis confirms the safety and feasibility of EUS-RFA.

关键词： Pancreatic cancer Neuroendocrine tumors Habib Cryotechnology Pancreas Endoscopic ultrasound

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Artificial intelligence and inflammatory bowel disease: Where are we going?

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World Journal of Gastroenterology 2023年第3期29卷 508-520页

作者： Leonardo Da Rio Marco Spadaccini Tommaso Lorenzo Parigi Roberto Gabbiadini Arianna Dal Buono Anita Busacca Roberta Maselli Alessandro Fugazza matteo colombo Silvia Carrara Gianluca Franchellucci Ludovico Alfarone Antonio Facciorusso Cesare Hassan Alessandro Repici Alessandro Armuzzi Department of Endoscopy Humanitas Research HospitalIRCCSRozzano 20089MilanoItaly Department of Biomedical Sciences Humanitas UniversityRozzano 20089MilanoItaly IBD Center Humanitas Research HospitalIRCCSRozzano 20089MilanoItaly Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaFoggia 71122FoggiaItaly

Inflammatory bowel diseases,namely ulcerative colitis and Crohn’s disease,are chronic and relapsing conditions that pose a growing burden on healthcare systems *** of their complex and partly unknown etiology and pathogenesis,the management of ulcerative colitis and Crohn’s disease can prove challenging not only from a clinical point of view but also for resource *** intelligence,an umbrella term that encompasses any cognitive function developed by machines for learning or problem solving,and its subsets machine learning and deep learning are becoming ever more essential tools with a plethora of applications in most medical *** this regard gastroenterology is no exception,and due to the importance of endoscopy and imaging numerous clinical studies have been gradually highlighting the relevant role that artificial intelligence has in inflammatory bowel diseases as *** aim of this review was to summarize the most recent evidence on the use of artificial intelligence in inflammatory bowel diseases in various contexts such as diagnosis,follow-up,treatment,prognosis,cancer surveillance,data collection,and ***,insights into the potential further developments in this field and their effects on future clinical practice were discussed.

关键词： Inflammatory bowel disease Artificial intelligence Machine learning Crohn’s disease Ulcerative colitis Computer-aided diagnosis

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The interplay of drug therapeutics and immune responses to SARS-CoV-2

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Cellular & Molecular Immunology 2024年第2期21卷 197-200页

作者： Valeria Fumagalli matteo Iannacone Division of Immunology Transplantationand Infectious DiseasesIRCCS San Raffaele Scientific InstituteMilanItaly Vita-Salute San Raffaele University MilanItaly Experimental Imaging Centre IRCCS San Raffaele Scientific InstituteMilanItaly

The SARS-CoV-2 pandemic has necessitated rapid therapeutic and preventative *** vaccines form the frontline of defense,antiviral treatments such as nirmatrelvir have emerged as vital adjunctive measures,particularly for those unable or unwilling to be *** review delves into the potential influence of nirmatrelvir on enduring *** parallel,the potential of drug repurposing is explored,with bisphosphonates being examined for their possible effects against COVID-19 due to their immunomodulatory *** importance of rigorous clinical trials and careful interpretation of preliminary data is emphasized.

关键词： SARS-CoV-2 Nirmatrelvir Bisphosphonates Adaptive immunity Drug repurposing

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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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Recent Advances in the Synthesis and Polymerization of New CO_(2)-Based Cyclic

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Chinese Journal of Chemistry 2024年第4期42卷 430-443页

作者： matteo Lanzi Arjan W.Kleij Institute of Chemical Research of Catalonia(ICIQ) The Barcelona Institute of Science and Technology(BIST)Av.Països Catalans 1643007 TarragonaSpain Catalan Institute of Research and Advanced Studies(ICREA) Pg.Lluís Companys 2308010 BarcelonaSpain

Carbon dioxide can be converted into functional heterocycles known as cyclic carbonates,whose recent reactivity has been expanded towards the formation of tailor-made engineering *** minireview gives an overview of the most topical developments in this area with a special focus on the synthetic methods employed to prepare these CO_(2)based *** addition,their application potential in the area of polymer science using a variety of polymerization techniques is discussed that have in common the ring-opening of the carbonate *** perspectives are provided that provide impetus for the scientific communities aligning research to the use of sustainable processes for polymers from recyclable carbon sources such as CO_(2).

关键词： Carbon dioxide Cyclic carbonates Functional macromolecules Heterocycles Polycarbonates Recycling Ring opening polymerization

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