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Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

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World Journal of Gastrointestinal Endoscopy 2023年第4期15卷 248-258页

作者： Ludovico Alfarone Marco Spadaccini Gianluca Franchellucci Kareem Khalaf Davide Massimi Alessandro De Marco Silvia Ferretti Valeria Poletti Antonio Facciorusso Roberta Maselli Alessandro Fugazza Matteo Colombo Antonio Capogreco Silvia Carrara Cesare Hassan Alessandro Repici Department of Biomedical Sciences Humanitas UniversityRozzano 20089Italy Department of Gastroenterology Division of Gastroenterology and Digestive EndoscopyHumanitas Research HospitalIRCCSRozzano 20089MilanItaly Division of Gastroenterology St.Michael's HospitalUniversity of TorontoToronto M5B 1W8Canada Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaFoggia 71100Italy

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal ***,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly *** to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard *** having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be *** events are primarily caused by electrocautery-induced ***,ER techniques with a better safety profile are needed to overcome these *** snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal *** aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

关键词： Non-ampullary duodenal adenomas Endoscopic resection Cold snare polypectomy Hot snare polypectomy Safety Efficacy

Diagnostic performance of endoscopic ultrasound-guided tissue acquisition of splenic lesions:systematic review with pooled analysis

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Gastroenterology Report 2022年第1期10卷 356-362页

作者： Andrea Lisotti Stefano Francesco Crino` Benedetto Mangiavillano Anna Cominardi Andrew Ofosu Nicole Brighi Flavio Metelli Rocco Maurizio Zagari Antonio Facciorusso Pietro Fusaroli Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly Gastrointestinal Endoscopy Unit Humanitas—Mater Domini CastellanzaVareseItaly Gastroenterology and Hepatology Stanford UniversityStanfordCAUSA Department of Medical Oncology IRCSS Istituto Romagnolo per lo Studio dei Tumori(IRST)“Dino Amadori”MedolaItaly Department of Medical and Surgical Sciences—DIMEC University of BolognaBolognaItaly Department of Surgical and Medical Sciences Section of GastroenterologyUniversity of FoggiaFoggiaItaly

Background Focal splenic lesions are usually incidentally discovered on radiological *** percutaneous tissue acquisition(TA)under trans-abdominal ultrasound guidance is a well-established technique for obtaining cyto-histological diagnosis of focal splenic lesions,endoscopic ultrasound(EUS)-guided TA has been described in several studies,reporting different safety and *** aimwas to assess the pooled safety,adequacy,and accuracy of EUS-TA of splenic *** A comprehensive review of available evidence was conducted at the end of November *** studies including more than five patients and reporting about the safety,adequacy,and accuracy of EUS-TA of the spleen were *** Six studies(62 patients)were identified;all studies have been conducted using fine-needle aspiration(FNA)*** specimen adequacy and accuracy of EUS-TA for spleen characterization were 92.8%[95%confidence interval(CI),86.3%–99.3%]and 88.2%(95%CI,79.3%–97.1%),*** pooled incidence of adverse events(six studies,62 patients)was 4.7%(95%CI,0.4%–9.7%).Conclusion EUS-FNA of the spleen is a safe technique with high diagnostic adequacy and *** EUS-guided approach could be considered a valid alternative to the percutaneous approach for spleen TA.

关键词： biopsy cancer lymphoma metastasis leukemia

A rare case of epiploic appendagitis in a patient affected by ulcerative colitis on vedolizumab therapy

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Gastroenterology Report 2022年第1期10卷 661-664页

作者： Daniela Pugliese Giuseppe Privitera Luigi Larosa Valentin Calvez Diana Broglia Nicoletta de Matthaeis Alessandro Armuzzi CEMAD IBD UNITUnita Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario“A.Gemelli”IRCCSRomeItaly Dipartimento Universitario di Medicina e Chirurgia Traslazionale Universita Cattolica del Sacro CuoreRomeItaly Fondazione Policlinico Universitario A.Gemelli IRCCS UOC di Radiodiagnostica Presidio ColumbusDipartimento di Diagnostica per immaginiRadioterapia Oncologica ed EmatologiaLargo Francesco VitoRomeItaly Universita Cattolica del Sacro Cuore RomeItaly IBD Center IRCCS Humanitas Research HospitalRozzanoMilanItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleMilanItaly

Introduction Epiploic appendagitis(EA)is an acute inflammation of the pedunculated mesenteric fat attached to the colonic surface,distinguished into two forms:primary EA,seemingly elicited by local ischaemic factors;and secondary EA(SEA),elicited by the inflammation of the adjacent organs,with diverticulitis being the most common trigger[1].Few case series have described the association between SEA and inflammatory bowel disease(IBD);however,information about clinical,laboratory and imaging findings,outcomes,and the impact of IBD-specific therapy were not *** first report the case of a woman affected by ulcerative colitis(UC)who developed a SEA during vedolizumab therapy(Figure 1A).

关键词： inflammation organs acute

Immunological treatment of liver tumors

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World Journal of Gastroenterology 2005年第42期11卷 6571-6576页

作者： Maurizio Chiriva-Internati Fabio Grizzi Cynthia A Jumper Everardo Cobos Paul L Hermonat Eldo E Frezza Department of Microbiology and Immunology Texas Tech university Health Sciences Center and Southwest Cancer Treatment and Research Center Lubbock TX 79430 United States Scientific Direction Istituto Clinico humanitas 20089 Rozzanoand Foundation "M.Rodriguez" - Institute for Quantitative Measures in Medicine 20100 Milan Italy Department of Internal Medicine Texas Tech university Health Sciences Center and Southwest Cancer Treatment and Research Center Lubbock TX 79430 United States Department of Internal Medicine university of Arkansas for Medical Sciences Little Rock Arkansas 72205 United States Department of Surgery Texas Tech university Health Sciences Center and Southwest Cancer Treatment and Research Center Lubbock TX 79430 United States

Although multiple options for the treatment of liver tumors have often been described in the past, including liver resection, radiofrequency ablation with or without hepatic pump insertion, laparoscopic liver resection and the use of chemotherapy, the potential of immunotherapy and gene manipulation is still largely *** therapy by gene manipulation is based on the interaction between virus-based gene delivery systems and dendritic cells. Using viruses as vectors, it is possible to transduce dendritic cells with genes encoding tumor-associated antigens, thus inducing strong humoral and cellular immunity against the antigens *** chemotherapy and radiation therapy have the disadvantage of destroying healthy cells, thus causing severe side-effects. We need more precisely targeted therapies capable of killing cancer cells while sparing healthy cells. Our goal is to establish a new treatment for solid liver tumors based on the concept of cytoreduction,and propose an innovative algorithm.

关键词： Liver Tumors Surgery Dendritic cell Cytoreduction Immunotherapy Gene manipulation

Management of residual penile curvature after penile prosthesis placement

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Asian Journal of Andrology 2021年第2期23卷 129-134页

作者： Denis V Krakhotkin David J Ralph Gideon A Blecher Volodymyr A Chernylovskyi Francesco Greco Evgeny E Bakurov Ruslan A Bugaev Central District Hospital Outpatient DepartmentKamenolomniRostov Region 346480Russia university College London St Peter’s Andrology Centre and university College London Hospitals London W1G 6BJUnited Kingdom Monash university Department of SurgeryMelbourne 3168Australia The Alfred Hospital Department of UrologyMelbourne 3004Australia Department of Urology 1 City Clinical Hospital No.4Dnipro 49102Ukraine Department of Urology Humanitas GavazzeniBergamo 24125Italy Department of Surgery No.1 Rostov Regional Hospital ROKB 1Rostov-on-Don 344015Russia

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s ***,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English *** this article,we provide a review of the techniques and the outcomes,according to the published literature.

关键词： grafting modeling penile curvature penile implant penile prosthesis Peyronie’s disease tunical plication

Management of cancer patients during the COVID-19 pandemic:A narrative review

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临床与病理杂志 2021年第8期41卷 1723-1727页

作者： Alfredo Tartarone Marina Tartarone Department of Onco-Hematology Division of Medical OncologyIRCCS-CROB Referral Cancer Center of BasilicataRionero in Vulture(PZ)Italy Med student at humanitas university Rozzano(MI)Italy

Objective:We wrote this review with the objective of helping the physicians to manage patients with cancer during the COVID-19 ***:In the absence of specific curative treatments,COVID-19 exerted worldwide a dramatic impact on public health and socio-economic *** with cancer represent a vulnerable population when suffering from COVID-19 infection since they usually present a series of risk factors such as immunosuppressed state,older age,comorbidities(e.g.,cardiovascular diseases,chronic lung disease,diabetes)and need for frequent hospitalizations and visits.A series of observational studies demonstrated that cancer patients infected with COVID-19,particularly with lung cancer,have a high rate of morbidity and ***:We conducted a review of several observational studies and guidelines regarding the management of cancer patients in the context of COVID-19 ***:The oncologists,according to the main available recommendations,should carefully weigh risks/benefits when planning therapies and follow-up *** should defeat the“distraction effect”of the pandemic,which is represented by the risk of shifting attention away from standard therapeutic approach to COVID-19 *** addition,health authorities should prioritize COVID-19 vaccinations for cancer patients with the aim of limiting the consequences of the pandemic in this particularly frail population.

关键词： COVID-19 pandemic guidelines cancer patients

Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: an international expert consensus

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Hepatobiliary Surgery and Nutrition 2018年第5期7卷 353-371页

作者： Tianfu Wen Chen Jin Antonio Facciorusso Matteo Donadon Ho-Seong Han Yilei Mao Chaoliu Dai Shuqun Cheng Bixiang Zhang Baogang Peng Shunda Du Changjun Jia Feng Xu Jie Shi Juxian Sun Peng Zhu Satoshi Nara JMichael Millis Qiu Li Weixia Chen Wusheng Lu Hong Tang Lvnan Yan Yong Zeng Bo Li Jiayin Yang Wentao Wang Hong Wu Mingqing Xu Zheyu Chen Changli Lu Chuan Li Wei Peng Xiaoyun Zhang Department of Liver Surgery and Liver Transplantation Center West China HospitalSichuan UniversityChengdu 610041China Department of Medical and Surgical Sciences University of FoggiaFoggiaItaly Department of Hepatobiliary&General Surgery Humanitas UniversityHumanitas Clinical and Research CenterMilanItaly Seoul National university Bundang Hospital Seoul National University College of MedicineSeoulKorea Department of Liver Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Hepatobiliary and Splenic Surgery Shengjing HospitalChina Medical UniversityShenyang 110000China Department of Hepatic Surgery VI Eastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityShanghai 200433China Hepatic Surgery Center Tongji HospitalHuazhong University of Science and TechnologyWuhan 430030China Department of Liver Surgery the First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080China Hepatobiliary and Pancreatic Surgery Division National Cancer Center HospitalTokyoJapan Department of Surgery University of ChicagoChicagoILUSA MDT of West China Hospital Department of Medical Oncology Cancer CenterState Key Laboratory of BiotherapyWest China HospitalSichuan UniversityChengdu 610041China Department of Radiology West China HospitalSichuan UniversityChengdu 610041China Center of Infectious Diseases West China HospitalSichuan UniversityChengdu 610041China

Hepatocellular carcinoma (HCC) is the sixth-most common cancer and the third leading cause of cancer-related death in the world. However, 40–70% patients eventually suffer from postoperative recurrence within 5 years. HCC recurrence after surgery severely affects prognosis of the patients. Nevertheless, there is an opportunity to improve patients' prognosis if doctors and researchers can recognize the importance of a standardized perioperative management and study it in clinical and pre-clinical settings. Hence, based on our own experience and published studies from other researchers, we develop this consensus regarding multidisciplinary management of locally recurrent and metastatic hepatocellular carcinoma after resection. This consensus consists of the entire course of recurrent hepatocellular carcinoma (RHCC) management, including prediction of recurrence, prevention, diagnosis, treatment and surveillance of RHCC. Consensus recommendations are presented with grades of evidences (Ia, Ib, IIa, IIb, III and IV), and strength ofrecommendations (A, B, C, D and E). We also develop a decision-making path for RHCC treatment, which can intuitively demonstrate the management for RHCC. It is hoped that we may make some effort to standardize the management of RHCC and ultimately understand how to improve outcomes.

关键词： Recurrent hepatocellular carcinoma (RHCC) multidisciplinary management consensus

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

Combination of squamous cell carcinoma antigen immunocomplex and alpha-fetoprotein in mid-and long-term prediction of hepatocellular carcinoma among cirrhotic patients

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World Journal of Gastroenterology 2021年第48期27卷 8343-8356页

作者： Antonio Gil-Gómez Ángela Rojas Chang-Hai Liu Rocio Gallego-Duran Rocio Muñoz-Hernandez Giorgio Fassina Patrizia Pontisso Javier Ampuero Manuel Romero-Gómez SeLiver Group Institute of Biomedicine of SevilleSeville 41013Spain CIBERehd Instituto de Salud Carlos IIIMadrid 28029Spain Mucosal Immunity Lab IRCCS Humanitas Research HospitalMilan 20089Italy Center of Infectious Diseases West China Hospital of Sichuan UniversityChengdu 610017Sichuan ProvinceChina State Key Laboratory of Biotherapy and Center of Infectious Diseases West China HospitalChengdu 610017Sichuan ProvinceChina Life Biotechnology Padua UniversityVenice 30175Italy Department of Clinical and Experimental Medicine University of PadovaPadova 35123Italy UCM Digestive Diseases Virgen del Rocío University HospitalSeville 41014Spain

BACKGROUND The combination of alpha-fetoprotein(AFP)and squamous cell carcinoma antigen immunocomplex(SCCA-IgM)have been proposed for its use in the screening of hepatocellular carcinoma(HCC).Current screening programs for all cirrhotic patients are controversial and a personalized screening is an unmet need in the precision medicine *** To determine the role of the combination of SCCA-IgM and AFP in predicting mid-and long-term appearance of *** Two-hundred and three cirrhotic patients(Child A 74.9%,B 21.2%,C 3.9%)were followed-up prospectively every six months to screen HCC by ultrasound and AFP according to European Association for the Study of the Liver *** estimation cohort was recruited in Italy(30.5%;62/203)and validation cohort from Spain(69.5%;141/203).Patients underwent to evaluate SCCA-IgM by enzyme-linked immunosorbent assay(Hepa-IC,Xeptagen,Italy)and AFP levels at *** were followed-up for 60 mo,being censored at the time of the appearance of *** There were 10.8%and 23.1%of HCC development at two-and five-years *** with HCC showed higher levels of SCCA-IgM than those without it(425.72±568.33 AU/mL vs 195.93±188.40 AU/mL,P=0.009)during the fiveyear *** multivariate analysis,after adjusting by age,sex,aspartate transaminase and Child-Pugh,the following factors were independently associated with HCC:SCCA-IgM[Hazard ratio(HR)=1.001,95%CI:1.000-1.002;P=0.003],AFP(HR=1.028,95%CI:1.009-1.046;P=0.003)and creatinine(HR=1.56495%CI:1.151-2.124;P=0.004).The log-rank test of the combination resulted in 7.488(P=0.024)in estimation cohort and 11.061(P=0.004)in the validation cohort,and a 100%of correctly classified rate identifying a low-risk group in both cohorts in the two-year *** We have constructed a predictive model based on the combination of SCCA-IgM and AFP that provides a new HCC screening method,which could be followed by tailored HCC surveillance for individual patients,esp

关键词： Squamous cell carcinoma antigen Hepatocellular carcinoma prediction Precision medicine Stratification of cirrhotic patient