Outcomes of Radiofrequency Ablation for Dysplastic Barrett’s Esophagus: A Comprehensive Review

Barrett's esophagus is a condition in which the normal squamous lining of the esophagus has been replaced by columnar epithelium containing intestinal metaplasia induced by recurrent mucosal injury related to gastroesophageal reflux disease. Barrett's esophagus is a premalignant condition that can progress through a dysplasia-carcinoma sequence to esophageal adenocarcinoma. Multiple endoscopic ablative techniques have been developed with the goal of eradicating Barrett's esophagus and preventing neoplastic progression to esophageal adenocarcinoma. For patients with high-grade dysplasia or intramucosal neoplasia, radiofrequency ablation with or without endoscopic resection for visible lesions is currently the most effective and safe treatment available. Recent data demonstrate that, in patients with Barrett's esophagus and low-grade dysplasia confirmed by a second pathologist, ablative therapy results in a statistically significant reduction in progression to high-grade dysplasia and esophageal adenocarcinoma. Treatment of dysplastic Barrett's esophagus with radiofrequency ablation results in complete eradication of both dysplasia and of intestinal metaplasia in a high proportion of patients with a low incidence of adverse events. A high proportion of treated patients maintain the neosquamous epithelium after successful treatment without recurrence of intestinal metaplasia. Following successful endoscopic treatment, endoscopic surveillance should be continued to detect any recurrent intestinal metaplasia and/or dysplasia. This paper reviews all relevant publications on the endoscopic management of Barrett's esophagus using radiofrequency ablation

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions

Endoscopic ultrasound core needle for diagnosing of solid pancreatic lesions: is rapid on-site evaluation really necessary?

INTRODUCTION: Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) has a crucial role in the diagnosis of solid pancreatic lesions and rapid on-site evaluation (ROSE) can increase its diagnostic yield. Rapid on-site evaluation is not always available and after EUS-FNA provides a cytology specimen with scant cellularity. Fine needle biopsy (FNB) specimens containing core tissue may theoretically overcome the limitations of EUS-FNA sampling. It could be hypothesized that EUS-FNB without ROSE could achieve the same adequacy and accuracy of EUS-FNB with ROSE. The aim of this review is to evaluate the evidence on the role of ROSE in the setting of EUS-guided tissue acquisition with core needles in patients with solid pancreatic lesions.EVIDENCE ACQUISITION: All relevant articles were extracted up to February 2017 based on the results of searches in PubMed, Scopus and Google Scholar.EVIDENCE SYNTHESIS: A total of 21 pertinent articles were finally included. Among the included studies, 11 were performed without ROSE, 8 with ROSE, and 2 were performed both with and without ROSE. In the ROSE group we found a sensitivity, specificity, overall diagnostic adequacy and overall diagnostic accuracy of 96%, 100%, 86.5%, 85.5%, respectively, while in the no-ROSE group 86.6%, 100%, 89.5%, 86.1% were found, respectively. Mild pancreatitis (mean rates, 3.43%) and abdominal pain (mean rates, 3.6%) were reported as most frequent adverse events.CONCLUSIONS: Endoscopic ultrasound guided-FNB without ROSE offers similar results in terms of adequacy and accuracy as in the presence of an on-site cytopathologist

The endoscopic overtube is a safe device for removing a fistulizing esophageal metal stent: A literature review

INTRODUCTION: Self-expandable metal stents are the gold standard for palliation of malignant dysphagia. Stent-associated esophagealrespiratory fistulas developed in 4% of patients causing a potentially life threatening emergency. When a fistula occurs, stent removal can be very challenging and related to increased risk for further complications. The aim of this paper was to perform a literature review on previous overtube-assisted reports for difficult esophageal stent removal. We also describe a safe method to remove a fully covered self-expandable metal stent prolapsing into the tracheal lumen by using a new type of overtube to reduce the risk of major injury. EVIDENCE ACQUISITION: All relevant articles were extracted up to December 2017 based on the results of searches in PubMed, Scopus and Google Scholar. EVIDENCE SYNTHESIS: A total of 6 case reports and 2 case series were included, for a total of 14 patients. The most frequent indications to stent placement were malignant strictures due to esophageal cancer or cardiac gastric cancer. The complications for which it was necessary to remove the stent were: occlusion, migration, strangulation, tissue overgrowth or ingrowth, embeeding, and epidural abscess and diskitis. In all cases at the time of stent removal no procedure related complications occurred. CONCLUSIONS: Using an overtube during removal of the stent increased patients safety during the procedure, reducing the risk of trauma and protecting the oesophageal wall

Endoscopic management of bile duct injury after hepatobiliary tract surgery: a comprehensive review

Bile duct injuries (BDIs) are the most serious complications after hepatobiliary surgery and are associated with high morbidity and mortality. The incidence of iatrogenic injuries of bile ducts has increased after the advent of laparoscopic cholecystectomy. BDIs present with biliary leak or biliary obstruction or a combination of both. Successful treatment of these complications requires a multidisciplinary team that includes biliary endoscopists, interventional radiologists and hepatobiliary surgeons. Endoscopic treatment is the main option for biliary leak. Depending on colangiographic appearance of the biliary damage, several endoscopic techniques (naso-biliary drainage, biliary sphincterotomy, placement of prosthesis) are used, allowing to achieve the leak sealing in most cases. In complex biliary fistulas the use of covered self-expandable metal stents is another therapeutic option with high success rates. The most common endoscopic therapy for biliary strictures involves balloon dilation and placement of multiple plastic stents followed by the periodic exchange of the stents. This is usually performed every three months by placing an increasing number of stents each time, until complete resolution of the stricture. Self-expandable metal stents have a larger diameter compared to plastic stents and therefore, higher patency rate. Covered self-expandable stents are an alternative option with the advantage of providing better permeability, preventing occlusion, and reducing the number of the required procedures. The aim of this paper was to review the endoscopic management of patients with bile duct injuries after hepatobiliary surgery

Negative Emotions in Irritable Bowel Sindrome: which differences among IBS Subtypes?

There are conflicting data on peculiar negative emotional patterns in Irritable Bowel Syndrome subtypes.  Our study was aimed to determine possible differences in depression, anxiety and anger in patients suffering from Irritable Bowel Syndromeconstipation, diarrhoea and mixed subtypes. The sample underwent a psychometric examination for the assessment of depression (Hamilton Rating Scale Depression), anxiety (Hamilton Rating Scale Anxiety), and anger (State-Trait Anger Expression Scale 2). Differences among groups were assessed using the Analysis of variance with Bonferroni post hoc comparisons, or the χ²-test if requested. 111 subjects (diarrhoea subtype =37; constipation subtype=34; mixed subtype=40) were included in the study. The severity of depressive symptoms was “moderate” in patients with constipationsubtype and “mild” in patients with diarrhoea and mixed subtypes (17.15±6.7 vs 14.24±6.6 vs 12.50±4.9); no statistically significant differences were documented among subtypes. Severity of anxiety symptoms was “mild to moderate” in patients with constipation subtype (mean = 18.53 ± 7.7), and mild in patients with diarrhoea (mean = 13.35 ± 7.1) and mixed subtypes (mean = 13.25 ± 4.7); statistically significant differences among subgroups were found (Constipation vs Diarrhoea: p=0.004; Constipation vs Mixed: p=0.003). Regarding anger, significant differences among subgroups emerged at State Anger Feeling Angry and Anger In variables, both higher in constipation subtype group than in mixedsubtype group (State Anger Feeling Angry: p=0.002; Anger In: p=0.001). Patients with constipation subtypeconstitute a subgroup characterized by a discrete burden of negative emotions, mainly anxiety and anger

Performance of the Over The Scope Clip system in the endoscopic closure of iatrogenic gastrointestinal perforations and post surgical leaks and fistulas

The increased invasiveness of endoscopic procedures and complex surgical interventions has resulted in an increased number of gastrointestinal iatrogenic defects, such as perforations, leak and fistulas. The conventional treatment for these gastrointestinal defects is surgery, with considerable risks especially in emergency situations and in patients with comorbidities. The Ovesco over-the- scope clip (OTSC) system (Ovesco Endoscopy AG, T\ufcbingen, Germany) and more recently, the Padlock ClipTM (Aponos Medical, Kingston, NH, United States) have shown promising results in the treatment of gastrointestinal defects. Several case reports and case series have demonstrated the efficacy of the OTSC system for the closure of full-thickness defects. Clinical success is best achieved in patients undergoing closure of a perforation or a leak. Closure of fistulas remains a clinical challenge since fibrosis or necrotic and inflamed tissue surrounding lesions may cause clip failure. Over-the-scope clips are a less invasive endoscopic option for managing patients with gastrointestinal defects before a more invasive surgical approach is attempted. Moreover, a failed attempt of OTSC deployment does not preclude subsequent surgical treatment

Pancreatic necrosectomy: an evidence-based systematic review of the levels of evidence and a comparison of endoscopic versus non-endoscopic techniques

Endoscopic necrosectomy is now becoming common worldwide as a minimally-invasive treatment alternative to surgical necrosectomy. The aims of this systematic review are to record the entire body of the literature accumulated over the past 15 years on endoscopic necrosectomy techniques and to compare the outcomes of endoscopic versus non-endoscopic techniques