51 research outputs found
Self-Expandable Metal Stenting of Refractory Upper Gut Corrosive Strictures: A New Role for Endoscopy?
Caustic strictures of the gastrointestinal tract are often difficult to treat, since relapses are frequent after medical or endoscopic treatment. Thus, novel approaches are needed. We report here our experience with self-expandable metallic stents (SEMS) as a new endoscopic approach in three patients with corrosive strictures of the upper gastrointestinal tract
Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions. An Italian, Multicenter Study
Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric
mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries
are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients
who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and
the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no
need for surgical treatment) for EGC. The incidence of complications, the one‐month mortality, and
the recurrence rate at one‐year follow‐up were computed. A total of 296 patients with 299 gastric
lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was
achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5%
(58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment
was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were
treated with radiological embolization (1 case) or surgery (1 case). No procedure‐related deaths at
one‐month follow‐up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and
10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in
Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low
and amenable at endoscopy
Rescue Therapies for H. pylori Infection in Italy
Curing Helicobacter pylori infection remains challenging for clinicians,
as no proposed first-line therapy achieves bacterial eradication in all treated patients so that several
patients need two or more consecutive treatments. Bacterial culture with antibiotics susceptibility
testing is largely unachievable in Italy, and empiric second-line and rescue therapies are generally
used. This study aimed to identify what eradication regimens perform better in Italy, following
first-line therapy failure. Methods: We performed a literature search on PubMed for studies on
standard therapy regimens used as second-line or rescue treatments performed in adult patients.
Studies including modified drug combinations were not considered. Both intention-to-treat and perprotocol
analyses were computed for each therapy subgroup. Results: Data from 35 studies with
a total of 4830 patients were eventually considered. As a second-line therapy, Pylera® (90.6%) and
a sequential regimen (89.8%) achieved eradication rates significantly higher than other therapies.
For third-line therapy, a levofloxacin-based regimen and Pylera® achieved comparable eradication
rates (88.2% vs. 84.7%; p = 0.2). Among therapies used as fourth (or more) attempts, Pylera® and
a rifabutin-based therapy achieved 77.4% and 66.4% cure rates, respectively (p = 0.013). A therapy
sequence based on the type of first-line therapy used was proposed. Conclusions: Data obtained
through our review indicate that standard therapies for H. pylori eradication can be used when
following an appropriate sequence, allowing clinicians to improve the cure rate without resorting to
bacterial culture
Unusual Paraneoplastic Syndrome Accompanies Neuroendocrine Tumours of the Pancreas
Neuroendocrine tumours comprise a small percentage of pancreatic neoplasia (10%) (1). Diagnosis of neuroendocrine tumours is difficult, especially if the tumours are small and nonfunctional. CT scans, MRI, and nuclear scans are sufficiently sensitive assessment tools for tumours with diameters of at least 2 cm; otherwise, the sensitivity and specificity of these techniques is less than 50% (2). Myasthenia gravis (MG) is a heterogeneous neuromuscular junction disorder that is primarily caused when antibodies form against the acetylcholine receptors (Ab-AchR). MG can develop in conjunction with neoplasia, making MG a paraneoplastic disease. In those cases, MG is most commonly associated with thymomas and less frequently associated with extrathymic malignancies. The mechanism underlying this paraneoplastic syndrome has been hypothesized to involve an autoimmune response against the tumour cells (3). No published reports have linked malignant pancreatic diseases with MG. Here, we report the case of a young woman, negative for Ab-AchR, with a neuroendocrine tumour in the pancreatic head, who experienced a complete resolution of her MG-like syndrome after surgical enucleation of the tumour
A Challenging Diagnosis of Jejunal Adenocarcinoma in a Celiac Patient: Case Report and Systematic Review of the Literature
Celiac disease (CD) is a common and chronic disorder requiring a long-life gluten-free diet. There is evidence that asymptomatic or subclinical presentation of CD has increased in the last decades, so that several cases are diagnosed during adulthood or even in the elderly. Celiac disease patients are at an increased risk of developing malignancies, particularly when the disease is diagnosed in the elderly. We describe a case of a challenging diagnosis of small bowel adenocarcinoma which developed in a patient with CD discovered only in the elderly. We also performed a systematic review of the literature. A tailored follow-up in a sub-group of CD patients at an increased risk of developing intestinal adenocarcinoma could be implemented.Abbreviations: CD: Celiac disease; GP: General Practitioner; FOBT: faecal occult blood test; EMA: anti-endomysial antibodies; tTG: anti-tissue transglutaminase antibodies; Hgb: hemoglobin; VCE: videocapsule endoscopy
Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series
Background: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. Methods: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient’s status. Results: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. Conclusions: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention
Bismuth-based quadruple therapy following H. Pylori eradication failures: A multicenter study in clinical practice
Background & Aims: Helicobacter pylori (H. pylori) eradication in patients who failed one or more therapeutic
attempts remains challenging. This study aimed to assess the efficacy of three-in-one capsules bismuth-based
quadruple therapy (Pylera®) in these patients managed in clinical practice.
Methods: This was a prospective, open-label, multicenter study enrolling consecutive, adult patients with
persistent H. pylori infection following at least one standard therapy. All patients received a rescue quadruple
therapy with Pylera (3 capsules four times daily) and esomeprazole 20 mg (1 tablet twice daily) for 10 days.
H. pylori eradication was assessed by using Urea Breath Test 4-6 weeks following therapy ending. H. pylori
eradication rates, compliance, and side-effects were calculated.
Results: A total of 208 patients in the 9 participating centres were enrolled. Overall, 180 patients were
successfully cured from the infection, accounting for 86.5% (95% CI 81.9-91.2) and 92.3% (95% CI 88.6-96.1)
eradication rates at intention-to-treat analysis and at per protocol analysis, respectively. Cure rates were similar
across patients who failed one to three previous therapy attempts, but the success rate fell to 67% after 4 or
more therapy failures. Compliance to therapy was good in 198 (95.2%) patients, whilst in 7 (5.3%) cases the
therapy was interrupted within 5 days due to side effects. A total of 97 (46.6%) patients complained of at least
one side effect; nausea, diarrhea and vomiting were the most frequently reported.
Conclusions: Our study found that this bismuth-based quadruple therapy is highly effective as second-line
and rescue therapy for H. pylori eradication in clinical practic
Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series
Background: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. Methods: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient’s status. Results: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. Conclusions: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention
Bismuth-based quadruple therapy following H. Pylori eradication failures: A multicenter study in clinical practice
Background & Aims: Helicobacter pylori (H. pylori) eradication in patients who failed one or more therapeutic
attempts remains challenging. This study aimed to assess the efficacy of three-in-one capsules bismuth-based
quadruple therapy (Pylera®) in these patients managed in clinical practice.
Methods: This was a prospective, open-label, multicenter study enrolling consecutive, adult patients with
persistent H. pylori infection following at least one standard therapy. All patients received a rescue quadruple
therapy with Pylera (3 capsules four times daily) and esomeprazole 20 mg (1 tablet twice daily) for 10 days.
H. pylori eradication was assessed by using Urea Breath Test 4-6 weeks following therapy ending. H. pylori
eradication rates, compliance, and side-effects were calculated.
Results: A total of 208 patients in the 9 participating centres were enrolled. Overall, 180 patients were
successfully cured from the infection, accounting for 86.5% (95% CI 81.9-91.2) and 92.3% (95% CI 88.6-96.1)
eradication rates at intention-to-treat analysis and at per protocol analysis, respectively. Cure rates were similar
across patients who failed one to three previous therapy attempts, but the success rate fell to 67% after 4 or
more therapy failures. Compliance to therapy was good in 198 (95.2%) patients, whilst in 7 (5.3%) cases the
therapy was interrupted within 5 days due to side effects. A total of 97 (46.6%) patients complained of at least
one side effect; nausea, diarrhea and vomiting were the most frequently reported.
Conclusions: Our study found that this bismuth-based quadruple therapy is highly effective as second-line
and rescue therapy for H. pylori eradication in clinical practic
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