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Dilation assisted stone extraction for complex biliary lithiasis:Technical aspects and practical principles

World Journal of Gastrointestinal endoscopy 2021年第2期13卷 33-44页

作者： Giuseppe Grande Silvia Cocca Helga Bertani Angelo Caruso Flavia Pigo' Santi Mangiafico Salvatore Russo Marinella Lupo Graziella Masciangelo Paolo Cantu' Raffaele Manta Rita Conigliaro Gastroenterology and Digestive endoscopy Unit Azienda Ospedaliero Universitaria di ModenaModena 41126Italy Gastroenterology and endoscopy Unit Department of Pathophysiology and TransplantationFondazione IRCCS Ca’GrandaOspedale Maggiore Policlinico and Universitàdegli Studi di MilanoMilano 20122Italy Gastroenterology and Digestive endoscopy Unit General Hospital of PerugiaPerugia 06129Italy

Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde *** sphincterotomy(EST)has been used for the removal of bile duct stones for the past 40 years,providing a wide opening to allow *** to 15%of patients present with complicated *** this context,additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy,intraductal or extracorporeal lithotripsy,or endoscopic papillary large balloon dilation(EPLBD).EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in *** without EST was introduced as a simplified technique in ***-assisted stone extraction(DASE)is the combination of two techniques:EPLBD and sub-maximal *** studies have reported this technique as safe and effective in patients with large bile duct stones,without any increased risk of adverse events such as pancreatitis,bleeding,or ***,it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between *** purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE,based on current literature and daily clinical experience in biliary referral centers.

关键词： Dilation-assisted stone extraction Endoscopic papillary large balloon dilation Macrolithiasis Difficult choledochiolithiasis Stone treatment Common bile duct stones Endoscopic retrograde cholangiopancreatography

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Cholangiocarcinoma and malignant bile duct obstruction: A review of last decades advances in therapeutic endoscopy

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World Journal of Gastrointestinal endoscopy 2015年第6期7卷 582-592页

作者： Helga Bertani Marzio Frazzoni Santi Mangiafico Angelo Caruso Mauro Manno Vincenzo Giorgio Mirante Flavia Pigò Carmelo Barbera Raffaele Manta Rita Conigliaro Digestive endoscopy Unit Baggiovara Hospital Digestive Pathophysiology Unit Baggiovara Hospital

In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. endoscopy allows successful biliary drainage and stenting in more than 90% of patients with malignant bile duct obstruction, and allows rapid reduction of jaundice decreasing the risk of biliary sepsis. When biliary drainage and stenting cannot be achieved with endoscopy alone, endoscopic ultrasound-guided biliary drainage represents an effective alternative method affording successful biliary drainage in more than 80% of cases. The purpose of this review is to focus on the currently available endoscopic management options in patients with cholangiocarcinoma.

关键词： Cholangiocarcinoma Malignant bile ductobstruction Interventional endoscopy Endoscopictherapy Self-expandable metal stent

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Differential diagnosis in inflammatory bowel disease colitis:State of the art and future perspectives

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World Journal of Gastroenterology 2015年第1期21卷 21-46页

作者： Gian Eugenio Tontini Maurizio Vecchi Luca Pastorelli Markus F Neurath Helmut Neumann Gastroenterology and Digestive endoscopy Unit IRCCS Policlinico San Donato20097 San Donato MilaneseItaly Department of Medicine I University of Erlangen-Nuremberg91054 ErlangenGermany Department of Biomedical Sciences for Health University of Milan20122 MilanoItaly

Distinction between Crohn's disease of the colonrectum and ulcerative colitis or inflammatory bowel disease(IBD) type unclassified can be of pivotal importance for a tailored clinical management,as each entity often involves specific therapeutic strategies and ***,no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated ***,we have performed a literature search to address the problem of differential diagnosis in IBD colitis,revised current and emerging diagnostic tools and refined disease classification ***,the differential diagnosis is an untangled issue,and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD *** topic is receiving emerging attention,as medical therapies,surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD *** optimization of standard diagnostic approaches based on clinical features,biomarkers,radiology,endoscopy and histopathology appears to provide only marginal ***,emerging diagnostic techniques in the field of gastrointestinal endoscopy,molecular pathology,genetics,epigenetics,metabolomics and proteomics have already shown promising *** advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD,better reflecting diverse disease behaviors based on specific pathogenic pathways.

关键词： Crohn’s disease Ulcerative colitis Inflammatory bo

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SARS-CoV-2 in inflammatory bowel disease population:Antibodies,disease and correlation with therapy

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World Journal of Gastrointestinal endoscopy 2022年第3期14卷 153-162页

作者： Clara Benedetta Conti Elsa Mainardi Sara Soro Sophie Testa Annalisa De Silvestri Andrea Drago Fabrizio Cereatti Roberto Grassia Department of Gastroenterology and Digestive endoscopy ASST CremonaCremona 26100Italy Department of Laboratory Medicine Haemostasis and Thrombosis CenterASST CremonaCremona 26100Italy Department of Clinic Epidemiology and Biometric Scientific DirectionFondazione IRCCS Policlinico San MatteoPavia 27100Italy

BACKGROUND Guidelines recommend to cease inflammatory bowel disease(IBD)biologic therapy during coronavirus disease 2019(COVID-19).AIM To investigate severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)antibody positivity in an IBD cohort,COVID-19 disease severity and to evaluate the correlation with clinical/therapeutic *** Prospective observational cohort *** patients were tested for SARS-CoV-2 *** on COVID-19 disease,demographics/therapeutics and clinical features of the IBD population were ***≥7 was set for SARS-CoV-2 antibody *** swab was performed in cases of IgG *** between antibody positivity or COVID-19 symptoms and therapeutic/clinical data were *** In total,103 IBD patients were *** them,18.4%had IgG≥*** analysis of antibody positivity correlated only with IBD *** IgG≥7,the odds ratio was 1.44 and 0.16 for azathioprine and mesalazine,respectively,vs biologic drugs(P=0.0157 between them).COVID-19 related symptoms were reported in 63%of patients with IgG *** but one patient with COVID-19 symptoms did not require ceasing IBD treatment or hospitalization. IBDtreatment and body mass index correlated with COVID-19 disease development with *** IBD population does not have a higher risk of severe COVID-19. The relative risk of havingSARS-CoV-2 antibodies and symptoms was higher for patients taking azathioprine, then biologictherapy and lastly mesalazine. None of the patients under biologic therapy developed severeCOVID-19.

关键词： Inflammatory bowel disease SARS-CoV-2 COVID-19 Biologic treatment SARS-CoV-2 antibody Inflammatory bowel disease therapy

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结肠镜诊断阑尾黏液囊肿

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世界核心医学期刊文摘（胃肠病学分册） 2006年第1期2卷 35-36页

作者： Zanati S.A. Martin J.A. Baker J.P. N.E. Marcon 尹勇 centre for therapeutic endoscopy and Endoscopic Oncology 16-062 Cardinal Carter Wing St. Michael’s Hospital 30 Bond St Toronto Ont. M5B 1W8 Canada Dr.

Background: Appendiceal mucoceles are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus. There have been no reported series of colonoscopically diagnosed mucoceles with clinicopathologic correlation. Methods: A retrospective review of colonoscopies performed at our institution over the past 14 years was undertaken with patient demographics, clinical data, surgical outcomes, and histopathology obtained from hospital records. Observations: Seven patients (6 women) with mucocele of the appendix were identified at colonoscopy. Three had complained of right lower quadrant pain. All 7 patients underwent surgical resection. Histopathology demonstrated mucinous cystadenoma in all. No cases revealed carcinoma, and there have been no deaths related to the mucocele. Conclusions: Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Surgery is recommended in all cases given the risk of malignancy or perforation with resultant pseudomyxoma peritonei.

关键词：阑尾黏液囊肿结肠镜检查阑尾腔黏液囊腺瘤囊性肿瘤腹膜假性黏液瘤手术预后人口统计学文献报

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Subcapsular Hepatic Hematoma after ERCP:A Case Report and Revision of Literature

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Case Reports in Clinical Medicine 2014年第3期3卷 161-166页

作者： Katerina Klímová Camilo Padilla Suárez Cecilia González Asanza Ana Matilla Pena Enrique Cos Arregui Ana Hernando Alonso Department of Hepatogastroenterology and endoscopy Hospital General Universitario Gregorio MaranónMa-dridSpain

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.

关键词： Subcapsular Hepatic Hematoma Endoscopic Retrograde Cholangiopancreatography Arterial Embolization Percutaneous Drainage Surgery

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Do available data support the widespread adoption of pancreatoscopy guided-lithotripsy?

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World Journal of Gastrointestinal endoscopy 2020年第9期12卷 317-319页

作者： Luca De Luca Gastroenterology and Digestive endoscopy Unit Ospedali Riuniti Marche NordPesaro 61121Italy

Peroral pancreatoscopy(POPS)is a demanding endoscopic procedure that can be used to perform intracanal lithotripsy in obstructing pancreatic stones but the experience is *** stones can be removed successfully by endoscopic retrograde cholangio-pancreatography but patients with large stones require advanced therapeutic approaches,such as extracorporeal shock wave lithotripsy(alone or followed by endoscopic retrograde cholangio-pancreatography),currently the mainstay of ***,in about 10%of cases,extracorporeal shock wave lithotripsy can fail;moreover,it is not be available in many *** this subgroup of patients,POPS guided-lithotripsy can play a role and have *** most consistent study concerns a retrospective multicenter analysis that enrolled few patients per *** the epidemiological scenario and the scant volume of skilled endoscopists,POPS must be developed in very few high-volume referral centers with standardized pathways and capable of performing multi-modality *** addition,we could reasonably assume that POPS-guided-lithotripsy should be used as rescue therapy in special situations,identifying the ideal candidate who can achieve the maximum clinical result,and carefully balancing risk/benefits ratio.

关键词： Pancreatic stones Pancreatoscopy guided-lithotripsy Rescue therapy Extracorporeal shock wave lithotripsy Endoscopic retrograde cholangio-pancreatography Referral centers

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Bio-feedback treatment of fecal incontinence: Where are we, and where are we going?

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World Journal of Gastroenterology 2005年第31期11卷 4771-4775页

作者： Giuseppe Chiarioni Barbara Ferri Antonio Morelli Guido Iantorno Gabrio Bassotti Gastroenterological Rehabilitation Division of the University of Verona Gastroenterology and Digestive endoscopy Institute Gastroenterology and Hepatology Section Digestive Motility Unit

Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedback techniques for the treatment of this disorder. Overall, the literature data claim a success rate in more than 70% of cases in the short term. However, recent controlled trials have not confirmed this optimistic view, thus emphasizing the role of standard care. Nonetheless, many authors believe that this should be the first therapeutic approach for fecal incontinence due to the efficacy, lack of side-effects,and scarce invasiveness. Well-designed randomized,controlled trial are eagerly awaited to solve this therapeutic dilemma.

关键词：排泄失禁肛门疾病信息反馈心理因素治疗方法

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Clinical management of inflammatory bowel disease in the organ recipient

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World Journal of Gastroenterology 2014年第13期20卷 3525-3533页

作者： Amedeo Indriolo Paolo Ravelli Digestive endoscopy Unit Department of GastroenterologyPapa Giovanni XXIII Hospital24127 BergamoItaly

There was estimated a higher incidence of de novo inflammatory bowel disease(IBD)after solid organ transplantation than in the general *** onset of IBD in the organ transplant recipient population is an important clinical situation which is associated to higher morbidity and difficulty in the medical therapeutic management because of possible interaction between anti-reject therapy and IBD *** course after liver transplantation(LT)is variable,but about one third of patients may worsen,needing an increase in medical therapy or a *** IBD at the time of LT,discontinuation of 5-aminosalicylic acid or azathioprine at the time of LT and use of tacrolimusbased immunosuppression may be associated with an unfavorable outcome of IBD after ***-tumor necrosis factor alpha(TNFα)therapy for refractory IBD may be an effective and safe therapeutic option after *** little experience of the use of biological therapy in transplanted patients,with concomitant anti-rejection therapy,suggests there be a higher more careful surveillance regarding the risk of infectious diseases,autoimmune diseases,and *** increased risk of colorectal cancer(CRC)is present also after LT in IBD patients with primary sclerosing cholangitis(PSC).Anannual program of endoscopic surveillance with serial biopsies for CRC is recommended.A prophylactic colectomy in selected IBD/PSC patients with CRC risk factors could be a good management strategy in the CRC prevention,but it is used infrequently in the majority of LT *** 30%of patients develop multiple IBD recurrence and 20%of patients require a colectomy after renal *** in the liver transplantation,anti-TNFαtherapy could be an effective treatment in IBD patients with conventional refractory therapy after renal or heart transplantation.A large number of patients are needed to confirm the preliminary *** the higher clinical complexity of this subgroup of IBD patients,a clo

关键词： Inflammatory bowel disease Ulcerative coli-tis Cro

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Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis

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World Journal of Gastroenterology 2008年第7期14卷 1016-1022页

作者： Maria Chiara Petrone Paolo G Arcidiacono Pier Alberto Testoni Division of Gastroenterology & Gastrointestinal endoscopy Vita-Salute San Raffaele University Scientific Institute San RaffaeleMillanItaly

Acute recurrent pancreatitis (ARP) is still a complex diagnostic and therapeutic challenge in clinical practice. In up to 30% of cases of ARP, it is not possible to establish the etiology of the disease. In the other 70%, many factors play an etiological role in ARP: microlithiasis, sphincter of Oddi dysfunction (SOD), pancreas divisum, hereditary pancreatitis, cystic fibrosis, a choledochocele, annular pancreas, an anomalous pancreatobiliary junction, pancreatic tumors or chronic pancreatitis are diagnosed. EUS should be useful in ARP as it is sensitive for diagnosing bile duct stones, gallbladder sludge, pancreatic lesions, ductal abnormalities and chronic pancreatitis. Endoscopic ultrasound (EUS) appears to be diagnostic in the majority of patients with previously unexplained pancreatitis, and offers an alternative to endoscopic retrograde cholangiopancreatography (ERCP) as the initial diagnostic test in patients with ARP.

关键词：内窥镜检查超声检查胰腺炎治疗方法

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