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Endoscopic techniques for diagnosis and treatment of gastroentero-pancreatic neuroendocrine neoplasms:Where we are

World Journal of Gastroenterology 2022年第26期28卷 3258-3273页

作者： roberta Elisa rossi Alessandra Elvevi Camilla Gallo Andrea Palermo Pietro Invernizzi Sara Massironi HPB Surgery Hepatology and Liver TransplantationENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)Milan 20133Italy Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy

BACKGROUND The correct localization of the primary tumor site and a complete histological diagnosis represent the milestones for the proper management of gastro-enteropancreatic neuroendocrine neoplasms(GEP-NENs).AIM To analyze current evidence on the role of endoscopy in the diagnosis/treatment of *** An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 15 years,using both medical subject heading(MeSH)terms and free-language keywords:gastro-enteropancreatic neuroendocrine neoplasms;endoscopy;ultrasound endoscopy;capsule endoscopy;double-balloon enteroscopy;diagnosis;therapy;*** In the diagnostic setting,endoscopic ultrasonography(EUS)represents the diagnostic gold standard for pancreatic NENs and the technique of choice for the locoregional staging of gastric,duodenal and rectal *** diagnosis of small bowel NENs(sbNENs)has been improved with the advent of video capsule endoscopy and double-balloon enteroscopy,which allow for direct visualization of the entire small bowel;however,data regarding the efficacy/safety of these techniques in the detection of sbNENs are scanty and often *** a therapeutic point of view,endoscopic removal is the treatment of choice for the majority of gastric NENs(type 1/2),for well-differentiated localized nonmetastatic duodenal NENs<1 cm,confined to the submucosa layer and for<10 mm,stage T1–T2,rectal ***-guided pancreatic locoregional ablative treatments have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected *** Standard axial endoscopy and EUS still play a pivotal role in several *** techniques for increasing the rate of R0 resection should be reserved for high-volume referral centers.

关键词： Gastro-entero-pancreatic neuroendocrine neoplasms Endoscopy Ultrasound endoscopy Capsule endoscopy Double-balloon enteroscopy Diagnosis Therapy Staging

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Intraductal papillary neoplasm of the bile duct:The new frontier of biliary pathology

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World Journal of Gastroenterology 2023年第38期29卷 5361-5373页

作者： Federico Mocchegiani Paolo Vincenzi Grazia Conte Daniele Nicolini roberta rossi Andrea Benedetti Cacciaguerra Marco Vivarelli Department of Experimental and Clinical Medicine Polytechnic University of MarcheAncona 60126Italy Department of Gastroenterology and Transplant United Hospital of MarcheAncona 60126Italy

Intraductal papillary neoplasms of the bile duct(IPNBs)represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct *** their first description in 2001,several classifications have been proposed,mainly based on histopathological,radiological and clinical features,although no specific guidelines addressing their management have been *** duct neoplasms generally develop through a multistep process,involving different precursor pathways,ranging from the initial lesion,detectable only microscopically,*** intraepithelial neoplasia,to the distinctive grades of IPNB until the final stage represented by invasive *** and advanced investigations,mainly relying on magnetic resonance imaging(MRI)and cholangioscopy,are required to reach a correct diagnosis and to define an adequate bile duct mapping,which supports proper *** recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB,as well as their natural evolution with a particular focus on prognosis and *** surgical resection,including hepatectomy,pancreaticoduodenectomy or both,represents the treatment of choice,yielding optimal results in terms of survival,although several endoscopic approaches have been *** are newly recognized preinvasive neoplasms of the bile duct with high malignant *** novel subclassification of types 1 and 2 defines the histological and clinical aspects,prognosis and *** is mainly based on MRI and *** resection represents the mainstay of treatment,although endoscopic resection is currently applied to nonsurgically fit *** frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB,to identify targeted therapies.

关键词： Intraductal neoplasm of the bile duct Bile duct neoplasms Cholangiocarcinoma Intraductal papilloma Classification Treatment

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Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis:Insights into mechanisms,pathophysiology,and treatment options

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World Journal of Gastroenterology 2023年第23期29卷 3733-3747页

作者： roberta Elisa rossi Alessandra Elvevi Valentina Sciola Francesco Vito Mandarino Silvio Danese Pietro Invernizzi Sara Massironi Gastroenterology and Endoscopy Unit IRCCS Humanitas Research HospitalRozzano 20089MilanItaly Gastroenterology Unit Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy and Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilano 20100Italy Department of Gastroenterology and Endoscopy IRCCS Ospedale San RaffaeleMilan 20132Italy School of Medicine Vita-Salute San Raffaele UniversityMilan 20132Italy

BACKGROUND Autoimmune gastritis(AIG)is a progressive,chronic,immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity and loss of intrinsic *** symptoms such as dyspepsia and early satiety are very common,being second in terms of frequency only to anemia,which is the most typical feature of *** To address both well-established and more innovative information and knowledge about this challenging *** An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 10 *** A total of 125 records were reviewed and 80 were defined as fulfilling the *** AIG can cause a range of clinical manifestations,including *** pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion,gastric motility,hormone signaling,and gut microbiota,among other *** dyspeptic symptoms of AIG is challenging and there are no specific therapies targeting dyspepsia in *** proton pump inhibitors are commonly used to treat dyspepsia and gastroesophageal reflux disease,they may not be appropriate for *** agents,antidepressant drugs,and non-pharmacological treatments may be of help,even if not adequately evidence-based supported.A multidisciplinary approach for the management of dyspepsia in AIG is recommended,and further research is needed to develop and validate more effective therapies for dyspepsia.

关键词： Dyspepsia Dyspeptic symptoms Gastro-intestinal symptoms Autoimmune gastritis Chronic autoimmune atrophic gastritis Treatment

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Rectal neuroendocrine tumors:Current advances in management,treatment,and surveillance

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World Journal of Gastroenterology 2022年第11期28卷 1123-1138页

作者： Camilla Gallo roberta Elisa rossi Federica Cavalcoli Federico Barbaro Ivo Boškoski Pietro Invernizzi Sara Massironi Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaEuropean Reference Network on Hepatological DiseasesSan Gerardo HospitalMonza 20900Italy Division of HPB Surgery Hepatology and Liver TransplantationDepartment of Pathophysiology and TransplantationUniversity of MilanENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)Milan 20133Italy Diagnostic and Therapeutic Endoscopy Unit Fondazione IRCCS Istituto Nazionale TumoriMilan 20133Italy Digestive Endoscopy Unit UniversitàCattolica del Sacro Cuore di RomaCenter for Endoscopic Research Therapeutics and TrainingFondazione Policlinico Universitario Agostino Gemelli IRCSSRome 00168Italy

Rectal neuroendocrine neoplasms(r-NENs)are considered among the most frequent digestive NENs,together with small bowel *** incidence has increased over the past few years,and this is probably due to the widespread use of endoscopic screening for colorectal cancer and the advanced endoscopic procedures available *** to the current European Neuroendocrine Tumor Society(ENETS)guidelines,well-differentiated r-NENs smaller than 10 mm should be endoscopically removed in view of their low risk of local and distant invasion.R-NENs larger than 20 mm are candidates for surgical resection because of their high risk of distant spreading and the involvement of the muscularis *** is an area of uncertainty regarding tumors between 10 and 20 mm,in which the metastatic risk is intermediate and the endoscopic treatment can be *** removed,the indications for surveillance are scarce and poorly codified by international guidelines,therefore in this paper,a possible algorithm is proposed.

关键词： Rectal neuroendocrine tumors Endoscopy Endoscopic submucosal dissection Resectable advanced disease Systemic therapy

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Neuroendocrine liver metastases treatment strategies: a viewpoint

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Hepatobiliary Surgery and Nutrition 2021年第4期10卷 561-563页

作者： roberta Elisa rossi Department of Hepatology Hepato Pancreatic BiliarySurgery and Liver TransplantationENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)MilanItaly Department of Pathophysiology and Transplantation University of MilanMilanItaly

I read with great interest the article“Neuroendocrine liver metastases:a contemporary review of treatment strategies”(1)published in Hepatobiliary Surgery and Nutrition as it is focused on a debate *** majority of gastro-entero-pancreatic neuroendocrine neoplasms(GEP-NENs)metastasize to the liver,being the presence of liver metastases(NELM)a negative prognostic *** is still controversy regarding the optimal management of patients with NELM.

关键词： neoplasms Surgery liver treatment

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Gastrinoma and Zollinger Ellison syndrome:A roadmap for the management between new and old therapies

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World Journal of Gastroenterology 2021年第35期27卷 5890-5907页

作者： roberta Elisa rossi Alessandra Elvevi Davide Citterio Jorgelina Coppa Pietro Invernizzi Vincenzo Mazzaferro Sara Massironi HPB Surgery Hepatology and Liver TransplantationENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)Milan 20133Italy Department of Pathophysiology and Transplantation University of MilanMilan 20122Italy Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy European Reference Network on Hepatological Diseases(ERN RARE-LIVER) San Gerardo HospitalMonza 20033Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20122Italy

Zollinger-Ellison syndrome(ZES)associated with pancreatic or duodenal gastrinoma is characterized by gastric acid hypersecretion,which typically leads to gastroesophageal reflux disease,recurrent peptic ulcers,and chronic *** symptoms of ZES are nonspecific and overlap with other gastrointestinal disorders,the diagnosis is often delayed with an average time between the onset of symptoms and final diagnosis longer than 5 *** critical step for the diagnosis of ZES is represented by the initial clinical *** is the hallmark of ZES;however,hypergastrinemia might recognize several causes,which should be ruled out in order to make a final *** levels>1000 pg/mL and a gastric pH below 2 are considered to be diagnostic for gastrinoma;some specific tests,including esophageal pH-recording and secretin test,might be useful in selected cases,although they are not widely *** ultrasound is very useful for the diagnosis and the local staging of the primary tumor in patients with ZES,particularly in the setting of multiple endocrine neoplasia type *** controversies about the management of these tumors also *** the localized stage,the combination of proton pump inhibitory therapy,which usually resolves symptoms,and surgery,whenever feasible,with curative intent represents the hallmark of gastrinoma *** high expression of somatostatin receptors in gastrinomas makes them highly responsive to somatostatin analogs,supporting their use as anti-proliferative agents in patients not amenable to surgical *** medical options for advanced disease are super-imposable to other neuroendocrine neoplasms,and studies specifically focused on gastrinomas only are scant and often limited to case reports or small retrospective *** multidisciplinary approach remains the cornerstone for the proper management of this composite ***,we reviewed available literature about gastrinoma-associated ZES wit

关键词： Gastrinoma Zollinger-Ellison syndrome Neuroendocrine neoplasms Pancreatic neuroendocrine neoplasm Duodenal neuroendocrine neoplasm Diagnosis Therapy

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Anti-tumour necrosis factor agent and liver injury:literature review,recommendations for management

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World Journal of Gastroenterology 2014年第46期20卷 17352-17359页

作者： roberta Elisa rossi Ioanna Parisi Edward John Despott Andrew Kenneth Burroughs James O'Beirne Dario Conte Mark Ian Hamilton Charles Daniel Murray Centre for Gastroenterology Royal Free HospitalLondon NW3 2QGUnited Kingdom Department of Pathophysiology and Organ Transplant Universita’ degli Studi di Milano20122 MilanoItaly Division of Gastroenterology and Endoscopy Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico20122 MilanoItaly Sheila Sherlock Liver Centre Royal Free Hospital and Institute of Liver and Digestive HealthLondon NW3 2PFUnited Kingdom

Abnormalities in liver function tests,including transient and self-limiting hypertransaminasemia,cholestatic disease and hepatitis,can develop during treatment with anti-tumour-necrosis-factor(TNF)*** optimal management of liver injury related to antiTNF therapy is still a matter of *** some authors recommend discontinuing treatment in case of both a rise of alanine aminotransferase more than5 times the upper limit of normal,or the occurrence of jaundice,there are no standard guidelines for the management of anti-TNF-related liver *** searches were performed in Pub Med,using the following key words:inflammatory bowel disease(IBD);TNF inhibitors;hypertransaminasemia;drugrelated liver injury;*** to published data,elevation of transaminases in patients with IBD treated with anti-TNF is a common finding,but resolution appears to be the usual ***-TNF agents seem to be safe with a low risk of causing severe drugrelated liver *** to our centre experience,we found that hypertransaminasemia was a common,mainly self-limiting finding in our IBD cohort and was not correlated to infliximab treatment on both univariate and multivariate *** algorithm for the management of liver impairment occurring during antiTNF treatment is also proposed and this highlights the need of a multidisciplinary approach and suggests liver biopsy as a key-point in the management decision in case of severe rise of ***,hepatic injury is generally self-limiting and drug withdrawal seems to be an exception.

关键词： Inflammatory bowel disease Tumour necrosis factor

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Altered molecular pattern of mucosal healing in Crohn's disease fibrotic stenosis

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World Journal of Gastrointestinal Pathophysiology 2013年第3期4卷 53-58页

作者： Enzo Ierardi Floriana Giorgio Domenico Piscitelli Mariabeatrice Principi Santina Cantatore Maria Grazia Fiore roberta rossi Michele Barone Alfredo Di Leo Carmine Panella Gastroenterology Department of Medical and Surgical Sciences University of Foggia 71100 Foggia Italy Gastroenterology Department of Emergency and Organ Transplantation University of Bari 70124 Bari Italy

AIM: To investigate tumor necrosis factor-α (TNF-α), syndecan 1 and basic fibroblast growth factor (bFGF) balance in Crohn's disease (CD) strictures. METHODS: Our study was performed on 24 surgical specimens of CD fibrotic stenosis. Ten histological normal surgical samples were retrieved for both the large and small bowel from patients with benign conditions and healthy tissue represented control collection. Sex and age in controls did not differ from CD group. Three endoscopic biopsy specimens taken after informed consent in subjects with normal colon were also used as negative controls. TNF-α, syndecan 1 and bFGF were detected by both reverse transcriptase reverse transcriptase polymerase chain reaction after mRNA extraction (results expressed as fold-change) and ***: TNF-α did not show any significant difference between CD and control specimens (1.54 ± 1.19; P > 0.05). Very high levels of bFGF were observed in CD (11.76 ± 4.65; P syndecan 1 > TNF-α = control. Immunoreactivity for bFGF was observed in epithelial, stromal, endothelial cells and even in the muscular layer, whilst in normal tissue it was almost unexpressed. Syndecan 1 and TNF-α staining was confined to mucosal epithelial and stromal cells, while in controls syndecan 1 was found in its normal site, i.e. , basolateral area of the crypts and TNF-α very poorly expressed. CONCLUSION: Fibrotic stenosis of CD may be the final result of an irreversible transformation of different cells into fibrogenic phenotype no longer inhibited by posttranscriptional regulation.

关键词： Crohn’s disease Fibrotic stenosis Tumor necrosis factor-α Syndecan 1 Basic fibroblast growth factor

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The Remote Testing in Abbiategrasso (RTA) Study Protocol: A Counter-Balanced Crossover Trial to Assess the Feasibility of Direct-to-Home-Neuropsychology with Older People

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Health 2022年第5期14卷 586-598页

作者： roberta Vaccaro Virginia Aglieri Elena Rolandi Michele rossi Laura Pettinato Arcangelo Ceretti Mauro Colombo Antonio Guaita Golgi Cenci Foundation Abbiategrasso Milan Italy Department of Brain and Behavioral Sciences University of Pavia Pavia Italy Camillo Golgi Geriatric Institute Abbiategrasso Milan Italy

Background: The Sars-Cov-2 pandemic has accelerated the spreading of telemedicine, including TeleNeuroPsychology (TNP). Also in a non-pandemic scenario, TNP gives the advantage of reaching older subjects, which often have mobility or transportation limitations. Previous studies on the feasibility, acceptability and reliability of TNP provide promising indications. However, it remains unclear how elderly populations in Italy welcome this practice, in particular when carried out “direct-to-home” (DTH neuropsychology—DTH-NP), hence without assistance in setting up, i.e., the videoconference, and which tests validated in Italian populations show good comparability between remote (either by voice phone call or videoconference) and face-to-face administration. Aims: Here we present a study protocol aimed at assessing: 1) the recruitment rate in a study on DTH neuropsychological assessment through voice calls or videoconference, 2) the feasibility and acceptability of a DTH neuropsychological assessment, 3) the comparability between DTH and face-to-face neuropsychological assessments. Methods: Fifty-eight older adults (65 - 85 years) were recruited among donors of the Abbiategrasso Brain Bank and will undergo both a face-to-face and a DTH neuropsychological assessment in a counterbalanced cross-over design (Group 1: remote session first;Group 2: face-to-face session first). Recruitment rate will be first evaluated. Then, the responses to an acceptability questionnaire will be compared between the two administration modalities. Finally, the DTH-face-to-face comparability will be evaluated as good reliability of a DTH neuropsychological assessment and agreement between scores obtained in the two modalities. Discussion and Conclusion: This study protocol aims at describing the procedures allowing a more reliable implementation of DTH-NP in the Italian clinical and research contexts. The inclusion of both phone-call and videoconference DTH neuropsychological assessment will gi

关键词： Telehealth Neuropsychological Assessment Feasibility Study Counterbalanced Cross-Over Design

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Use of artificial intelligence in improving adenoma detection rate during colonoscopy:Might both endoscopists and pathologists be further helped

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World Journal of Gastroenterology 2020年第39期26卷 5911-5918页

作者： Emanuele Sinagra Matteo Badalamenti Marcello Maida Marco Spadaccini roberta Maselli Francesca rossi Giuseppe Conoscenti Dario Raimondo Socrate Pallio Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Fondazione Istituto San Raffaele GiglioCefalù90015Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Clinical and Research Center IRCCSRozzano 20089Italy Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Endoscopy Unit AOUP Policlinico G.MartinoMessina 98125Italy

Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or precancerous lesions and the capacity to remove them *** detection and diagnosis(CAD),thanks to the brand new developed innovations of artificial intelligence,and especially deep-learning techniques,leads to a promising solution to human biases in performance by guarantying decision support during *** application of CAD on real-time colonoscopy helps increasing the adenoma detection rate,and therefore contributes to reduce the incidence of interval cancers improving the effectiveness of colonoscopy screening on critical outcome such as colorectal cancer related ***,a significant reduction in costs is also *** addition,the assistance of the machine will lead to a reduction of the examination time and therefore an optimization of the endoscopic *** aim of this opinion review is to analyze the clinical applications of CAD and artificial intelligence in colonoscopy,as it is reported in literature,addressing evidence,limitations,and future prospects.

关键词： Colonoscopy Artificial intelligence Adenoma detection rate Pathology Endoscopy Computer-aided detection and diagnosis

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