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Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer:The puzzle of eCura C1

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World Journal of Gastrointestinal Endoscopy 2024年第8期16卷 439-444页

作者： Giulio Calabrese Guido Manfredi Marcello F Maida Francesco V Mandarino Endrit Shahini Francesco Pugliese paolo cecinato Liboria Laterza Emanuele Sinagra Sandro Sferrazza Department of Gastroenterology and Endoscopy ARNAS Civico–Di Cristina–BenfratelliPalermo 90127SiciliaItaly Department of Gastroenterology and Digestive Endoscopy Ospedale MaggioreCrema 26013Italy Department of Medicine and Surgery University of Enna"Kore"Enna 94100SiciliaItaly Department of Gastroenterology and Digestive Endoscopy IRCCS Ospedale San RaffaeleMilan 20132LombardyItaly Department of Gastroenterology National Institute of Gastroenterology-IRCCS“Saverio de Bellis”Castellana GrotteBari 70013Italy Department of Digestive and Interventional Endoscopy Niguarda HospitalASST NiguardaMilan 20162LombardyItaly Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero-Universitaria di BolognaPoliclinico Sant’OrsolaBologna 40138Emilia-RomagnaItaly Department of Gastroenterology and Endoscopy Fondazione Instituto San Raffaele GiglioCefalù90015PalermoItaly

In this editorial,we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection(ESD),starting from the consideration recently made by Zhu et ***,we evaluate the management of eCura C1 lesions,where decisions regarding further interventions are pivotal yet *** among endoscopists,surgeons,and pathologists is underscored to refine risk assessment and personalize therapeutic *** advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 ***,despite needing further clinical validation,molecular biomarkers have emerged as promising tools for enhancing *** manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options,ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

关键词： Early gastric cancer Endoscopic submucosal dissection eCura Non-curative resection Multidisciplinary approach

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ESWL for difficult bile duct stones:A 15-year single centre experience

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World Journal of Gastroenterology 2010年第33期16卷 4159-4163页

作者： Rosangela Muratori Francesco Azzaroli Federica Buonfiglioli Flavio Alessandrelli paolo cecinato Giuseppe Mazzella Enrico Roda Department of Digestive Diseases and Internal Medicine S.Orsola-Malpighi HospitalUniversity of Bologna

AIM:To evaluate the efficacy of extracorporeal shock wave lithotripsy(ESWL)for the management of refractory bile duct cholelithiasis in a third level referral ***:The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus,SIEMENS)from October 1990 to April 2005 were *** patients were monitored during the procedure and antibiotics were administered in case of ***χ 2 test and logistic regression analysis were performed as ***:Two hundred and fourteen patients(102 males,112 females;mean age 74.8±0.84 years-single stone 97,multiple stones 117)underwent *** mean number of sessions and shock waves were 3.5 ±0.13 and 3477.06±66.17,*** maximum stone size was 5 *** stone clearance was achieved in 192(89.7%)*** the remain-ing patients 15 required surgery,2 a palliative stent and in 5 patients stone fragmentation led to effective bile drainage with clinical resolution despite incomplete ***,sex and stone characteristics were not related to treatment *** complications occurred in two patients(haemobilia and rectal bleeding) and minor complications in 25(3 vomiting,22 arrhythmias).No procedure-related deaths ***:ESWL is a safe and effective technique for clearance of refractory bile duct stones.

关键词： Difficult bile duct stones Extracorporeal shock wave lithotripsy

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G-CSF in Peg-IFN induced neutropenia in liver transplanted patients with HCV recurrence

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World Journal of Gastroenterology 2009年第43期15卷 5449-5454页

作者： Francesca Lodato Francesco Azzaroli Maria Rosa Tamè Maria Di Girolamo Federica Buonfiglioli Natalia Mazzella paolo cecinato Enrico Roda Giuseppe Mazzella Department of Digestive Diseases and Internal Medicine University of BolognaBologna 40138Italy

AIM:To evaluate the efficacy of granulocyte colony stimulating factors(G-CSF)in liver transplanted patients with hepatitis C(HCV)recurrence and Pegylated-IFN α-2b induced neutropenia,and to evaluate the impact of G-CSF administration on virological response. METHODS:Sixty-eight patients undergoing antiviral treatment for post-liver transplantation(OLT)HCV recurrence were *** patients developing neutropenia received G-CSF. RESULTS:Twenty three(34%)received *** neutrophil count at the onset of neutropenia was 700/mmc(range 400-750/mmc);after 1 mo of G-CSF it increased to 1210/mmc(range 300-5590/mmc) (P<0.0001).Three patients did not respond to G-CSF. Treatment duration was similar in neutropenic and non-neutropenic *** differences in the rate of discontinuation,infections or virological response were observed between the two groups.G-CSF was protective for the onset of de novo autoimmune hepatitis(P<0.003). CONCLUSION:G-CSF administration is effective in the case of Peg-IFN induced neutropenia increasingneutrophil count,prolonging treatment and leading to sustained virological response(SVR)rates comparable to non-neutropenic *** prevents the occurrence of de novo autoimmune hepatitis.

关键词：丙型肝炎病毒中性粒细胞干扰素α 聚乙二醇 CSF 肝移植粒细胞集落刺激因子患者

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Proton pump inhibitors in cirrhosis:Tradition or evidence based practice?

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World Journal of Gastroenterology 2008年第19期14卷 2980-2985页

作者： Francesca Lodato Francesco Azzaroli Maria Di Girolamo Valentina Feletti paolo cecinato Andrea Lisotti Davide Festi Enrico Roda Giuseppe Mazzella Department of Internal Medicine and Gastroenterology Gastroenterology UnitUniversity of Bologna

Proton Pump Inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence- based eventually leading to an increase in health costs.

关键词：质子泵抑制物肝硬化幽门胃溃疡 CYP P450

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Severe immune thrombocytopenia after peg-interferonalpha2a, ribavirin and telaprevir treatment completion: a case report and systematic review of literature

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World Journal of Hepatology 2015年第12期7卷 1718-1722页

作者： Rosario Arena paolo cecinato Andrea Lisotti Federica Buonfiglioli Claudio Calvanese Giuseppe Grande Marco Montagnani Francesco Azzaroli Giuseppe Mazzella Department of Medical and Surgical Science-DIMEC University of Bologna S.Orsola-Malpighi Hospital

Mild to moderate autoimmune thrombocytopenia(AITP) is a common finding in patients receiving interferonbased antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus(HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferonbased antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment(i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferonbased treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but alsoafter discontinuation.

关键词： Autoimmune thrombocytopenia Pegylatedinterferon Chronic hepatitis C Viral hepatitis Antiplateletantibody

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Long-term leukocyte natural α-interferon and ribavirin treatment in hepatitis C virus recurrence after liver transplantation

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World Journal of Gastroenterology 2013年第32期19卷 5278-5285页

作者： Mariarosa Tamè Federica Buonfiglioli Massimo Del Gaudio Andrea Lisotti paolo cecinato Antonio Colecchia Francesco Azzaroli Antonietta D’Errico Rosario Arena Claudio Calvanese Chiara Quarneti Giorgio Ballardini Antonio Daniele Pinna Giuseppe Mazzella Department of Digestive Diseases and Internal Medicine S. Orsola-Malpighi HospitalUniversity of Bologna Department of Liver and Multiorgan Transplant Unit S. Orsola-Malpighi HospitalUniversity of Bologna Department of Hematology Oncology and Laboratory MedicineS. Orsola-Malpighi HospitalUniversity of Bologna

AIM:To evaluate the effect of long-term treatment with leukocyte natural-interferon(ln-α-IFN)plus ribavirin(RBV).METHODS:Forty-six patients with hepatitis C virus(HCV)recurrence received 3 MU three times a week of ln-α-IFN plus RBV for 1 mo;then,patients with good tolerability(n=30)were switched to daily IFN administration,while the remaining were treated with the same *** have been treated for 12 mo after viral clearance while non-responders(NR)entered in the longterm treatment *** biopsies were planned at baseline,1 year after sustained virological response(SVR)and at 36 mo after start of therapy in *** software package was used for statistical ***:About 16.7%of genotype 1-4 and 70%of genotype 2-3 patients achieved *** patients withdrew therapy because of non-tolerance or noncompliance.A significant improvement in serum biochemistry and histological activity was observed in all SVR patients and long-term treated;100%of patients with SVR achieved a histological response(fibrosis stabilization or improvement)with a significant reduction in mean staging value(from 2.1 to 1.0;P=0.0031);histological response was observed in 84%of long-term treated patients compared to 57%of *** patients died during the entire study period(follow-up 40.6±7.7 mo);of them,5 presented with severe HCV recurrence on ***(OR=0.38,95%CI:0.08-0.59,P=0.01),leukopenia(OR=0.54,95%CI:0.03-0.57,P=0.03)and severe HCV recurrence(OR=0.51,95%CI:0.25-0.69,P=0.0003)were variables associated to ***-term treatment was well tolerated;no patients developed rejection or autoimmune ***:Long-term treatment improves histology in SVR patients and slows disease progression also in NR,leading to a reduction in liver decompensation,graft failure and liver-related death.

关键词： Hepatitis C virus Hepatitis C recurrence Interferon Ribavirin Liver transplantation

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