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Esophageal testing: What we have so far

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World Journal of Gastrointestinal Pathophysiology 2016年第1期7卷 72-85页

作者： Nicola de Bortoli Irene Martinucci Lorenzo Bertani salvatore Russo Riccardo Franchi Manuele Furnari salvatore tolone Giorgia Bodini Valeria Bolognesi Massimo Bellini Vincenzo Savarino Santino Marchi Edoardo Vincenzo Savarino Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Gastroenterology Unit Department of Internal MedicineUniversity of Genoa Surgery Unit Department of SurgerySecond University of Naples Gastroenterology Unit Department SurgeryOncology and GastroenterologyUniversity of Padua

Gastroesophageal reflux disease(GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry(HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h p H-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and p H monitoring can detect acid and non-acid reflux events. Endo FLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal p H-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

关键词： Gastroesophageal reflux disease Highresolution manometry Multichannel impedance and pH BRAVO EndoFLIP PEP-test Restech

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

Recent trends in endoscopic management of achalasia

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World Journal of Gastrointestinal Endoscopy 2014年第9期6卷 407-414页

作者： salvatore tolone Paolo Limongelli Gianmattia del Genio Luigi Brusciano Antonio Russo Lorenzo Cipriano Marco Terribile Giovanni Docimo Roberto Ruggiero Ludovico Docimo XI Division of General and Obesity Surgery Second University of Naples

Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter(LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar mediumterm efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes.

关键词： Achalasia Endoscopy Pneumatic dilation Botulinum toxin injection Per oral endoscopic myotomy High resolution manometry Dysphagia

Esophageal papilloma: Flexible endoscopic ablation by radiofrequency

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World Journal of Gastrointestinal Endoscopy 2015年第3期7卷 290-294页

作者： Gianmattia del Genio Federica del Genio Pietro Schettino Paolo Limongelli salvatore tolone Luigi Brusciano Manuela Avellino Chiara Vitiello Giovanni Docimo Angelo Pezzullo Ludovico Docimo XI Division of General and Bariatric Surgery Department of Surgery Second University of Naples Center of Esophago-gastric and Bariatric Surgery (E.G.O.) Clinica C.G. Ruesch 80122 Naples Italy Surgical Endoscopy Department of Surgery Second University of Naples

Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation(RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for BarrxTM RFA in patients with esophageal papilloma.

关键词： Esophageal papilloma Endoscopic ablation Radiofrequency Minimally invasive Natural orificetransluminal endoscopic surgery