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Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

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World Journal of Gastroenterology 2024年第1期30卷 70-78页

作者： Alessandro Fugazza Kareem Khalaf Katarzyna M Pawlak Marco Spadaccini Matteo Colombo Marta Andreozzi Marco Giacchetto Silvia Carrara Chiara Ferrari Cecilia Binda Benedetto Mangiavillano Andrea Anderloni Alessandro Repici Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly Division of Gastroenterology St.Michael’s HospitalUniversity of TorontoToronto M5B 1W8ONCanada Department of Anesthesia Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsRomagna 47121Italy Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanza 21100Italy Gastroenterology and Digestive Endoscopy Unit Fondazione IRCCS Policlinico San MatteoPavia 27100Italy

This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage(EUS-GBD)as a salvage approach in cases of unsuccessful conventional ***-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of *** procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events,making it a safe and effective option for appropriate ***,EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary ***,patient selection is critical for the success of EUS-GBD,and proper patient selection and risk assessment are important to ensure the safety and efficacy of the *** the field continues to evolve and mature,ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD,ultimately leading to improved outcomes for patients.

关键词： Endoscopic ultrasound-guided gallbladder drainage Gallbladder drainage Acute cholecystitis Malignant obstruction Interventional endoscopic ultrasound Lumen-apposing metal stents

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Gastric endoscopic submucosal dissection in Western countries:Indications,applications,efficacy and training perspective

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1180-1189页

作者： Luca De Luca Massimiliano Di Berardino Benedetto Mangiavillano Alessandro Repici Gastroenterology and Digestive Endoscopy Unit Riuniti Marche North HospitalPesaro 61121Italy Gastrointestinal Endoscopy Unit Humanitas-Mater DominiCastellanza 21053Italy Digestive Endoscopy Unit Humanitas Clinical and Research CenterHumanitas UniversityRozzano 20089Italy

Endoscopic submucosal dissection was introduced in Japan for the mini-invasive treatment of early gastric cancer,as part of national screening program considering high prevalence of disease in these *** technique allows en-bloc curative oncological excision and to obtain in a single step R0-resection,characterization,histological staging and potential cure of the tumor with a very high cost-benefit *** the years,Western endoscopists have adopted endoscopic submucosal dissection,achieving good rates of efficacy,long-term improved outcomes and safety,with low risk of local recurrence comparable to those obtained in Asian ***,according to some authors,the excellent outcomes from East country could not be representative of the Western *** epidemiological differences of early gastric cancer,scant volume data and limitations in training opportunities between Western and Eastern countries,European Society of Gastrointestinal Endoscopy have adopted Japanese guidelines and developed a European core curriculum for endoscopic submucosal dissection *** should be able to estimate the probability of performing a curative resection by considering the benefit/risk relationship case-by-case in order to implement a correct decision-making process.

关键词： Endoscopic submucosal dissection Western experience Early gastric cancer Curative oncological excision Long-term outcome Training perspective

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Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence

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World Journal of Gastroenterology 2022年第29期28卷 3814-3824页

作者： Marco Spadaccini Glenn Koleth James Emmanuel Kareem Khalaf Antonio Facciorusso Fabio Grizzi Cesare Hassan Matteo Colombo Benedetto Mangiavillano Alessandro Fugazza Andrea Anderloni Silvia Carrara Alessandro Repici Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research Hospital and UniversityMilan 20800Italy Department of Gastroenterology and Hepatology Queen ElizabethKota Kinabalu 88200SabahMalaysia Section of Gastroenterology Department of Medical SciencesUniversity of FoggiaFoggia 71122Italy Department of Immunology and Inflammation Humanitas Clinical and Research HospitalRozzano 20089Italy Digestive Endoscopy Unit Division of GasteroenterologyHumanitas Mater DominiCastellanza 21053Italy

Early detection of pancreatic cancer has long eluded clinicians because of its insidious nature and *** metastatic or locally invasive when symptomatic,most patients are deemed *** those who are symptomatic,multi-modal imaging modalities evaluate and confirm pancreatic ductal *** asymptomatic patients,detected pancreatic lesions can be either solid or *** clinical implications of identifying small asymptomatic solid pancreatic lesions(SPLs)of<2 cm are tantamount to a better *** accurate detection of SPLs undoubtedly promotes higher life expectancy when resected early,driving the development of existing imaging tools while promoting more comprehensive screening *** imaging tool that has matured in its reiterations and received many image-enhancing adjuncts is endoscopic ultrasound(EUS).It carries significant importance when risk stratifying cystic lesions and has substantial diagnostic value when combined with fine needle aspiration/biopsy(FNA/FNB).Adjuncts to EUS imaging include contrast-enhanced harmonic EUS and EUS-elastography,both having improved the specificity of FNA and *** review intends to compile all existing enhancement modalities and explore ongoing research around the most promising of all adjuncts in the field of EUS imaging,artificial intelligence.

关键词： Pancreatic ductal adenocarcinoma Pancreatic cancer Endoscopic ultrasound Contrast-enhanced endoscopic ultrasound Endoscopic ultrasound contrast agents Endoscopic ultrasound elastography Artificial intelligence Fractal analysis Endoscopy Imaging

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Radiofrequency and malignant biliary strictures:An update

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World Journal of Gastrointestinal Endoscopy 2019年第2期11卷 95-102页

作者： Francesco Auriemma Luca De Luca Mario Bianchetti Alessandro Repici Benedetto Mangiavillano Gastrointestinal Endoscopy Unit Humanitas Mater Domini Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital humanitas Huniversity

Malignant biliary strictures are usually linked to different types of tumors,mainly cholangiocarcinoma, pancreatic and hepatocellular carcinomas. Palliative measures are usually adopted in patients with nonresectable or borderline resectable biliary disease. Stent placement is a well-known and established treatment in patients with unresectable malignancy. Intraductal radiofrequency ablation(RFA) represents a procedure that involves the use of a biliary catheter device, via an endoscopic approach. Indications for biliary RFA described in literature are: Palliative treatment of malignant biliary strictures, avoiding stent occlusion, ablating ingrowth of blocked metal stents, prolonging stent patency,ablating residual adenomatous tissue after endoscopic ampullectomy. In this mini-review we addressed focus on technical success defined as deployment of the RF catheter, virtually succeeded in all patients included in the studies. About efficacy, three main outcome measures have been contemplated: Biliary decompression and stent patency, survival. Existing studies suggest a beneficial effect on survival and stent patency with RFA, but current impression is limited because most of studies have been performed using a retrospective design, on diminutive and dissimilar cohorts of patients.

关键词： Radiofrequency Ablation Endoscopic retrograde colangiopancreatography Malignant biliary strictures

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Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 53-61页

作者： Benedetto Mangiavillano Mouen A Khashab Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici Gastrointestinal Endoscopy Unit humanitas-mater domini humanitas Huniversity Division of Gastroenterology and Hepatology Johns Hopkins Hospital Gastroenterology and Endoscopy Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center IRCCS Digestive Endoscopy Unit Istituto Clinico Humanitas Research Hospital Unit of Gastroenterology Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography(EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP). The advent of lumen-apposing metal stents(LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

关键词： Malignant biliary strictures Malignant duodenal stenosis Bilio-duodenal stenosis Biliary self-expandable metal stent Duodenal self-expandable metal stent Lumen-apposing metal stents Gastro-jejunostomy

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Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation： long-term outcomes

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Asian Journal of Andrology 2018年第6期20卷 572-575页

作者： Antonio Luigi Pastore Giovanni Palleschi Andrea Fuschi Yazan AI Salhi Alessandro Zucchi Giorgio Bozzini Ester IUiano Elisabetta Costantini Antonio Carbone Uroiogy Unit Department of Medico-Surgical Sciences and Biotechnologies ICOT Faculty of Pharmacy and Medicine 'Sapienza' University of Rome Latina (LT) 04100 Italy Uroresearch Nonprofit Association for Research in Urology Latina 04100 Italy Department of Urology and Andrology University of Perugia Perugia 05156 Italy Department of Urology MATER DOMINI Humanitas Castellanza (VA) 21053 Italy

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and the self-report Premature Ejaculation Diagnostic Tool （PEDT） as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT 〈60 s and PEDT score 〉11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT （P 〈 0.0001）. Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory eiaculation control at 24 and 36 months oostintervention, respectively.

关键词： biofeedback electrostimulation intravaginal ejaculatory latency time pelvic floor rehabilitation premature ejaculation premature ejaculation diagnostic tool

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Evidence for accuracy of pain assessment and painkillers utilization in neuropsychiatric symptoms of dementia in Calabria region,Italy

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Neural Regeneration Research 2018年第9期13卷 1619-1621页

作者： Damiana Scuteri Maria Roberta Garreffa Stefania Esposito Giacinto Bagetta Maria Diana Naturale Maria Tiziana Corasaniti Preclinical and Translational Pharmacology Department of Pharmacy Health Science and NutritionUniversity of Calabria Pharmacy Unit "Mater Domini" University Hospital Department of Health Sciences University "Magna Graecia" of Catanzaro

During the clinical course of dementia,beside cognitive impairment and memory loss,a very complex challenge is posed by the neuropsychiatric symptoms（NPSs）.Accurate evaluation and treatment of pain impacts positively the agitation of demented patients aged ≥ 65 *** gather information on the utilization of pain killers in demented patients a preliminary survey has been conducted in collaboration with the Calabrian Pharmacovigilance Territorial Service of the health district of Catanzaro（Italy）.The study has taken into consideration the prescriptions of acetylcholinesterase inhibitors and memantine during the period ranging from July 2015 to June 2016 and the percentage of patients treated against pain with non steroidal antinflammatory drugs,opioids,and anticonvulsants have been *** latter have been evaluated statistically for difference between the treatment before（pre） and after（post） the settlement of acetylcholinesterase inhibitors（ACh EI） or memantine *** results do support accuracy in painkillers utilization in the course of dementia in the regional population of Calabria（Italy）.

关键词： Alzheimer's disease dementia neuropsychiatric symptoms pain appropriate prescriptions aromatherapy opioids α2δ-1 ligands

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Pancreatoscopy: An update

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 22-30页

作者： Luca De Luca Alessandro Repici Adea Ko?ollari Francesco Auriemma Mario Bianchetti Benedetto Mangiavillano Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital humanitas University Gastroenterology Unit University Medical Center "Mother Theresa" Hospital Gastrointestinal Endoscopy Unit Humanitas Mater Domini

Per-oral pancreatoscopy(POPS) is an endoscopic procedure to visualize the main pancreatic duct. POPS specifically has the advantage of direct visualization of the pancreatic duct, allowing tissue acquisition and directed therapies such as stones lithotripsy. The aim of this review is to analyze and summarize the literature around pancreatoscopy. Pancreatoscopy consists of the classic technique of the mother-baby method in which a mini-endoscope is passed through the accessory channel of the therapeutic duodenoscope. Pancreatoscopy has two primary indications for diagnostic purpose. First, it is used for visualization and histological diagnosis of intraductal papillary mucinous neoplasms. In these cases, POPS is very useful to assess the extent of malignancy and for the study of the intraductal papillary mucinous neoplasm in order to guide the surgery resection margins. Second, it is used to determine pancreatic duct strictures,particularly important in cases of chronic pancreatitis, which is associated with both benign and malignant strictures. Therefore POPS allows differentiation between benign and malignant disease and allows mapping the extent of the tumor prior to surgical resection. Also tissue sampling is possible, but it can be technically difficult because of the limited maneuverability of the biopsy forceps in the pancreatic ducts. Pancreatoscopy can also be used for therapeutic purposes, such as pancreatoscopy-guided lithotripsy in chronic painful pancreatitis with pancreatic duct stones. The available data for the moment suggests that, in selected patients, pancreatoscopy has an important and promising role to play in the diagnosis of indeterminate pancreatic duct strictures and the mapping of main pancreatic duct intraductal papillary mucinous neoplasms. However, further studies are necessary to elucidate and validate the pancreatoscopy role in the therapeutic algorithm of chronic pancreatitis.

关键词： Pancreatoscopy Per-oral pancreatoscopy Endoscopic retrograde cholangiopancreatography SpyGlass

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From advanced diagnosis to advanced resection in early neoplastic colorectal lesions:Never-ending and trending topics in the 2020s

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World Journal of Gastrointestinal Surgery 2022年第7期14卷 632-655页

作者： Francesco Auriemma Sandro Sferrazza Mario Bianchetti Maria Flavia Savarese Laura Lamonaca Danilo Paduano Nicole Piazza Enrica Giuffrida Lupe Sanchez Mete Alessandra Tucci Sebastian Manuel Milluzzo Chiara Iannelli Alessandro Repici Benedetto Mangiavillano Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanza 21053Italy Gastroenterology and Endoscopy Unit Santa Chiara HospitalTrento 38014Italy Digestive Endoscopy Unit San Giuseppe Hospital-MultimedicaMilan 20123Italy Department of Gastroenterology and Gastrointestinal Endoscopy General HospitalSanremo 18038Italy Gastroenterology Unit IRCCS Policlinico San DonatoSan Donato MilaneseDepartment of Biomedical Sciences for HealthUniversity of MilanMilan 20122Italy Gastroenterology and Hepatology Unit A.O.U.Policlinico"G.Giaccone"Palermo 90127Italy Department of Gastroenterology and Digestive Endoscopy IRCCS Regina Elena National Cancer InstituteRome 00144Italy Department of Gastroenterology Molinette HospitalCittàdella salute e della Scienza di TorinoTurin 10126Italy Digestive Endoscopy Unit and Gastroenterology Fondazione PoliambulanzaBrescia 25100Italy Department of Health Sciences Magna Graecia UniversityCatanzaro 88100Italy Digestive Endoscopy Unit and Gastroenterology Humanitas Clinical and Research Center and Humanitas UniversityRozzano 20089Italy Biomedical Science HunimedPieve Emanuele 20090Italy Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanzaVarese 21053Italy

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer *** the world there are different approaches to the topic of colorectal cancer prevention and screening:different starting ages(45-50 years);different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests;recto-sigmoidoscopy;and *** key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination,experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination,knowledge in the field of resection of these lesions(from cold-snaring,through endoscopic mucosal resection and endoscopic submucosal dissection,up to advanced tools),and management of complications.

关键词： Colorectal lesions Colorectal tumor Endoscopic submucosal dissection Endoscopic mucosal resection Cold-endoscopic mucosal resection FTRD® Complications Adverse events Polypectomy

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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

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