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

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

Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met?

Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark. Patients and methods A dedicated per-center semiquantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures. Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014–2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5%, 10.9%, 31.1%, 67.7%, 53.4%, and 32.2% of centers, respectively. Conclusions The present survey shows significant variability across SBCE centers; only four (4/10: 40 %) SBCE procedural minimum standards were met by a relevant proportion of the centers ( ≥ 80 %). Our data should help in identifying target areas for quality improvement programs in SBCE

Intelligenza artificiale e sicurezza: opportunità, rischi e raccomandazioni

L'IA (o intelligenza artificiale) è una disciplina in forte espansione negli ultimi anni e lo sarà sempre più nel prossimo futuro: tuttavia è dal 1956 che l’IA studia l’emulazione dell’intelligenza da parte delle macchine, intese come software e in certi casi hardware. L’IA è nata dall’idea di costruire macchine che - ispirandosi ai processi legati all’intelligenza umana - siano in grado di risolvere problemi complessi, per i quali solitamente si ritiene che sia necessario un qualche tipo di ragionamento intelligente. La principale area di ricerca e applicazione attuale dell’IA è il machine learning (algoritmi che imparano e si adattano in base ai dati che ricevono), che negli ultimi anni ha trovato ampie applicazioni grazie alle reti neurali (modelli matematici composti da neuroni artificiali) che a loro volta hanno consentito la nascita del deep learning (reti neurali di maggiore complessità). Appartengono al mondo dell’IA anche i sistemi esperti, la visione artificiale, il riconoscimento vocale, l’elaborazione del linguaggio naturale, la robotica avanzata e alcune soluzioni di cybersecurity. Quando si parla di IA c'è chi ne è entusiasta pensando alle opportunità, altri sono preoccupati poiché temono tecnologie futuristiche di un mondo in cui i robot sostituiranno l'uomo, gli toglieranno il lavoro e decideranno al suo posto. In realtà l'IA è ampiamente utilizzata già oggi in molti campi, ad esempio nei cellulari, negli oggetti smart (IoT), nelle industry 4.0, per le smart city, nei sistemi di sicurezza informatica, nei sistemi di guida autonoma (drive o parking assistant), nei chat bot di vari siti web; questi sono solo alcuni esempi basati tutti su algoritmi tipici dell’intelligenza artificiale. Grazie all'IA le aziende possono avere svariati vantaggi nel fornire servizi avanzati, personalizzati, prevedere trend, anticipare le scelte degli utenti, ecc. Ma non è tutto oro quel che luccica: ci sono talvolta problemi tecnici, interrogativi etici, rischi di sicurezza, norme e legislazioni non del tutto chiare. Le organizzazioni che già adottano soluzioni basate sull’IA, o quelle che intendono farlo, potrebbero beneficiare di questa pubblicazione per approfondirne le opportunità, i rischi e le relative contromisure. La Community for Security del Clusit si augura che questa pubblicazione possa fornire ai lettori un utile quadro d’insieme di una realtà, come l’intelligenza artificiale, che ci accompagnerà sempre più nella vita personale, sociale e lavorativa.AI (or artificial intelligence) is a booming discipline in recent years and will be increasingly so in the near future.However, it is since 1956 that AI has been studying the emulation of intelligence by machines, understood as software and in some cases hardware. AI arose from the idea of building machines that-inspired by processes related to human intelligence-are able to solve complex problems, for which it is usually believed that some kind of intelligent reasoning is required. The main current area of AI research and application is machine learning (algorithms that learn and adapt based on the data they receive), which has found wide applications in recent years thanks to neural networks (mathematical models composed of artificial neurons), which in turn have enabled the emergence of deep learning (neural networks of greater complexity). Also belonging to the AI world are expert systems, computer vision, speech recognition, natural language processing, advanced robotics and some cybersecurity solutions. When it comes to AI there are those who are enthusiastic about it thinking of the opportunities, others are concerned as they fear futuristic technologies of a world where robots will replace humans, take away their jobs and make decisions for them. In reality, AI is already widely used in many fields, for example, in cell phones, smart objects (IoT), industries 4.0, for smart cities, cybersecurity systems, autonomous driving systems (drive or parking assistant), chat bots on various websites; these are just a few examples all based on typical artificial intelligence algorithms. Thanks to AI, companies can have a variety of advantages in providing advanced, personalized services, predicting trends, anticipating user choices, etc. But not all that glitters is gold: there are sometimes technical problems, ethical questions, security risks, and standards and legislation that are not entirely clear. Organizations already adopting AI-based solutions, or those planning to do so, could benefit from this publication to learn more about the opportunities, risks, and related countermeasures. Clusit's Community for Security hopes that this publication will provide readers with a useful overview of a reality, such as artificial intelligence, that will increasingly accompany us in our personal, social and working lives

Same-day regimen as an alternative to split preparation for colonoscopy: A systematic review with meta-analysis

Background. Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies. Aim. To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen. Results. A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens. Conclusion. Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients’ needs

An Integrated Cheese Whey Valorization Process

Cheese whey results as by product of cheese or casein production in large amounts. Depending on the ceesemaking process, the amount can rise to more than 6 times, on a weight basis, the cheese produced. Cheese whey has considerable nutritional value and a strong organic and saline content, such to pose serious disposal problems. The Chemical Oxygen Demand (COD) can be as high as 100 kg m-3, a value so high to make impossible the direct disposal in superficial water and to make critical any biological treatment without previous dilution. Many cheese whey components have significant value in the light of their direct use (proteins, lactose), or as a feedstock to obtain building blocks or chemicals (lactose fermentation to ethanol, lactic acid ecc.). In this paper a conceptual process for the valorisation of whey through the recovery of added value components is presented. The process includes lipids recovery via thermocalcic precipitation, protein recovery via ultrafiltration and lactose valorisation through biological processes to obtain polyhydroxyalcanoates (PHA) and/or Lactic Acid (LA). In this work many of the unit operation of the process were developed and optimized at a lab scale. Ultrafiltration with 10 kDa membranes allowed to obtain a stream having protein concentration of more than 80 g/l, permeate fermentation led to obtain a biomass concentration of more than 1,5 g/l with a PHA content ranging between 50-60%. A first attempt of a mass flow balance of the entire process can be drawn

Injection and Cautery Methods for Nonvariceal Bleeding Control

Upper gastrointestinal bleeding remains one of the most common challenges faced by gastroenterologists and endoscopists in daily clinical practice. Endoscopic management of nonvariceal bleeding has been shown to improve clinical outcomes, with significant reduction of recurrent bleeding, need for surgery, and mortality. Early upper gastrointestinal endoscopy is recommended in all patients presenting with upper gastrointestinal bleeding within 24 hours of presentation, although appropriate resuscitation, stabilization of hemodynamic parameters, and optimization of comorbidity before endoscopy are essential

The role of diet in counteracting gastroparesis

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common symptoms associated with gastroparesis are early satiety, postprandial fullness, nausea and vomiting, but also abdominal discomfort and bloating. The most frequent causes of gastroparesis include diabetes (29 %), post-surgical issues (13 %), and idiopathic-related factors (36 %). Gastroparesis has been associated with abnormalities of: impaired gastric accommodation, antral hypomotility, pylorospasm, duodenal dysmotily, autonomic dysfunction and visceral hypersensitivity. Ingestion of nutrients induces changes in motility, secretion, and release of hormones, that coordinate the digestive process and depend on the nature and composition of the ingested nutrients. The emptying speed of a meal is inversely correlated with its caloric content and also depends on the acidity, osmolarity, and viscosity of the meal. The presence of lipids induces sensations of satiety at low concentrations, and occurrence of nausea at higher concentrations; liquid form is better. The general principles for treating symptomatic gastroparesis are to: 1) reduce symptoms, 2) correct and prevent fluid, electrolyte and nutritional deficiencies; 3) identify and treat the concomitant comorbidities. The gastroparesis severity classification can facilitate the selection of patients that can be treated as outpatients. Mild gastroparesis is characterized by intermittent, is treated with dietary modification and avoidance of medications that slow emptying. Compensated gastroparesis is characterized by moderately severe symptoms with infrequent hospitalizations that are treated with combined prokinetic and antiemetic agents. Gastric failure gastroparesis patients are medication-unresponsive, cannot maintain nutrition or hydration, and require frequent emergency department or inpatient care. Reduction in meal size and volume are a relevant factor in the dietary management, by using the gravity effect, after the meal, sitting upright for 1 to 2 hours or by even going for a gentle walk could play a role in helping patients to reduce their symptoms; the next step is to introduce a more liquid-pureed-based meal or have alternate days with some solid food and then consume more liquid-type meals as the symptoms progress and the feeling of fullness increases. The administration of a low wine dose increase gastric emptying and intestinal motility; ethanol has also been seen to cause pyloric relaxation, which may facilitate gastric emptying. Foods responsible for symptoms worsening include orange juice, fried chicken, cabbage, oranges, sausage, pizza, peppers, onions, tomato juice, lettuce, coffee, salsa, broccoli, bacon, and roast beef. Foods able to elicit symptoms are generally fatty, acidic, spicy, and roughage-based. Foods not provoking symptoms are generally bland, sweet, salty, and starchy. A pilot study on soy germ pasta containing isoflavones provided evidence that nutraceutical could be a potential treatment for diabetic gastroparesis