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Management strategies of Barrett's esophagus

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World Journal of Gastroenterology 2012年第43期18卷 6216-6225页

作者： Giovanni D de palma department of General Geriatric Oncologic Surgery and Advanced Technologies Center of Excellence for Technical Innovation in Surgery University of Naples Federico II 80131 Naples Italy

Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.

关键词： Barrett’s esophagus Diagnosis Management strategies Esophagectomy Esophageal adenocarcinoma

Confocal laser endomicroscopy in the “in vivo” histological diagnosis of the gastrointestinal tract

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World Journal of Gastroenterology 2009年第46期15卷 5770-5775页

作者： Giovanni D de palma department of Surgery and Advanced Technologies Center of Excellence for Technical Innovation in SurgeryUniversity of Naples Federico ⅡSchool of Medicine

Recent technological advances in miniaturization have allowed for a confocal scanning microscope to be integrated into a conventional flexible endoscope,or into trans-endoscopic probes,a technique now known as confocal endomicroscopy or confocal laser *** newly-developed technology has enabled endoscopists to collect real-time in vivo histological images or "virtual biopsies" of the gastrointestinal mucosa during endoscopy,and has stimulated significant interest in the application of this technique in clinical *** review aims to evaluate the current data on the technical aspects and the utility of this new technology in clinical gastroenterology and its potential impact in the future,particularly in the screening or surveillance of gastrointestinal neoplasia.

关键词： Confocal microscopy Diagnostic imaging Gastrointestinal neoplasms Precancerous conditions Endoscopy Virtual histology

Endoscopic papillectomy: Indications, techniques, and results

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World Journal of Gastroenterology 2014年第6期20卷 1537-1543页

作者： Giovanni D de palma Center of Excellence for Technical Innovation in Surgery Department of Clinical Medicine and Surgery University of Naples Federico Ⅱ School of Medicine

Endoscopic papillectomy (EP) is currently accepted as a viable alternative therapy to surgery in sporadic ampullary adenoma and has been reported to have high success and low recurrence rates. At present, the indications for EP are not yet fully established. The accepted criteria for EP include size (up to 5 cm), no evidence of intraductal growth, and no evidence of malignancy on endoscopic findings (ulceration, friability, and spontaneous bleeding). Endoscopic ultrasound (EUS) is the imaging modality of choice for local T staging in ampullary neoplasms. Data reported in the literature have revealed that linear EUS is superior to helical computed tomography in the preoperative assessment of tumor size, detection of regional nodal metastases and detection of major vascular invasion. Endoscopic ampullectomy is performed using a standard duodenoscope in a similar manner to snare polypectomy of a mucosal lesion. There is no standardization of the equipment or technique and broad EP methods are described. Endoscopic ampullectomy is considered a ‘‘high-risk’’ procedure due to complications. Complications of endoscopic papillectomy can be classified as early (pancreatitis, bleeding, perforation, and cholangitis) and late (papillary stenosis) complications. The appropriate use of stenting after ampullectomy may prevent post-procedural pancreatitis and papillary stenosis. Tumor recurrence of benign lesions occurs in up to 20% of patients and depends on tumor size, final histology, presence of intraductal tumor, coexisting familial adenomatous polyposis (FAP), and the expertise of the endoscopist. Recurrent lesions are usually benign and most can be retreated endoscopically.

关键词： Endoscopic papillectomy Papillary neoplasms Major duodenal papilla Endoscopic retrograde cholangiopancreatography Endoscopic sphincterotomy

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

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World Journal of Gastroenterology 2018年第21期24卷 2247-2260页

作者： Antonio Sciuto Giovanni Merola Giovanni D de palma maurizio Sodo Felice Pirozzi Umberto M Bracale Umberto Bracale department of Abdominal Surgery Casa Sollievo della Sofferenza Research Hospital department of General Surgery Casa di Cura Villa Berica department of Gastroenterology Endocrinology and Endoscopic SurgeryUniversity Hospital of Naples Federico Ⅱ department of Public Health University of Naples Federico Ⅱ

Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.

关键词： Laparoscopic colorectal surgery Colorectal surgery Anastomotic leakage Laparoscopy Risk factor Rectal cancer Diverting stoma

Role of endoscopy in the bariatric surgery of patients

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World Journal of Gastroenterology 2014年第24期20卷 7777-7784页

作者： Giovanni D de palma Pietro Forestieri Center of Excellence for Technical Innovation in Surgery Department of Clinical Medicine and SurgeryUniversity of Naples Federico ⅡSchool of Medicine80131 NaplesItaly department of Clinical Medicine and Surgery University of Naples Federico ⅡSchool of Medicine80131 NaplesItaly

Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett’s esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.

关键词： Morbid obesity Obesity surgery Endoscopy Complications Endoscopic therapy

Confocal laser endomicroscopy in inflammatory bowel diseases:Dream or reality?

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World Journal of Gastroenterology 2013年第34期19卷 5593-5597页

作者： Giovanni Domenico de palma Antonio Rispo Giovanni Domenico de palma Antonio RispoCenter of Excellence for Technical Innovation in SurgeryDepartment of Clinical Medicine and SurgeryUniversity "FedericoⅡ" of NaplesSchool of Medicine

Confocal laser endomicroscopy(CLE)is a newly introduced procedure that provide real-time,high-resolution imaging of the gastrointestinal mucosa during endoscopy,allowing the visualization of the pathology of the mucosal epithelium with its cellular and subcellular ***,the use of CLE was reported in the study of colonic mucosa in patients with inflammatory bowel diseases and in particular in patients affected by ulcerative *** has the potential to have an important role in management of inflammatory bowel diseases(IBD)patients as it can be used to assess the grading of colitis and in detection of microscopic colitis in endoscopically silent ***,CLE can be used in surveillance programs especially in highrisk ***,CLE has been effectively used in diagnosing a biliary dysplasia/neoplasia in patients with primary sclerosing cholangitis,a pathological condition frequently associated with IBD,with a coexisting bile duct stricture.

关键词： Inflammatory bowel diseases Endoscopy Confocal laser endomicroscopy Colon cancer Dysplasia

A Novel guide extension assisted stenting technique for coronary bifurcation lesions

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World Journal of Cardiology 2021年第6期13卷 155-162页

作者： Shams Y-Hassan Rodney de palma Coronary Artery Disease Area Heart and Vascular ThemeKarolinska Institutet and Karolinska University HospitalStockholm S-14186Sweden Buckinghamshire Healthcare NHS Trust Buckinghamshire HP112TTUnited Kingdom

A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL)is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation *** is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation *** aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter(GuideLiner).With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina,a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary *** implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative *** technique facilitates side-branch only stenting in side-branch mono-ostial(medina 0,0,1)CBL or only the distal main segment in distal mono-ostial(medina 0,1,0)CBL without compromising the other two remaining segments when using the onestent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions(tri-ostial or medina 1,1,1).Consequently,through optimizing stent deployment,the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent *** most appropriate lesions suitable for the technique,and some other practical tips are also described.

关键词： Coronary bifurcation lesion GuideLiner stenting Percutaneous coronary intervention One-or two-stenting technique Novel descriptive,intelligible and ordered

Actively bleeding Dieulafoy's lesion of the small bowel identified by capsule endoscopy and treated by push enteroscopy

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World Journal of Gastroenterology 2006年第24期12卷 3936-3937页

作者： Giovanni D de palma Francesco Patrone Maria Rega Immacolata Simeoli Stefania Masone Giovanni Persico Centro per l'Innovazione Tecnologica in Chirurgia-Dipartimento di Chirurgia Generale Oncologica e Tecnologie Avanzate Universita degli Studi di Napoli Federico Ⅱ Facoltà di Medicina e ChirurgiaNapoliItaly

Dieulafoy＇s lesion is an unusual cause of recurrent GI bleeding. This report describes a case of actively bleeding Dieulafoy＇s lesion of the small bowel in which the diagnosis was made by capsule endoscopy, followed by treatment with the use of push enteroscopy. The case illustrates that capsule endoscopy and enteroscopy are highly complementary in patients with small bowel diseases.

关键词： Dieulafoy's lesion GI hemorrhage Smallbowel Capsule endoscopy Push enteroscopy

Heavy metals adsorption by banana peels micro-powder: Equilibrium modeling by non-linear models

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Chinese Journal of Chemical Engineering 2018年第3期26卷 455-464页

作者： Giorgio Vilardi Luca Di palma Nicola Verdone Sapienza University of Rome Department of Chemical Engineering Materials Environment

In this study the copper and lead adsorption efficiency onto banana peels powder was investigated. The agroindustrial waste recovery represents one of the Circular Economy pillars. In the view of the synthesis of an environmentally friendly adsorbent material, the powder was used without any preliminary chemical or thermal activation, but only after simple washing, drying and grinding. The bio-adsorbent was characterized by the FTIR technique and tested in batch mode on synthetic aqueous solutions containing Pb and Cu in the range 10–90 mg·L^(-1). A selection of two(Langmuir, Freundlich) and three(Sips, Redlich–Peterson, Koble–Corrigan) parameter isotherm models was chosen to fit adsorption equilibrium data by non-linear regression procedure. The best fit isotherm model was selected relying on the error function with the lowest average percentage error(APE) value, among those characterized by the highest R^2 values. As expected, the three-parameter models are found to better represent both metals bio-adsorption, with APE and R^2 values always lower and higher, respectively, than the corresponding values obtained for the two-parameter models.

关键词： Banana peel Heavy metals Bio-adsorbent Non-linear model FIIR