Positive aspects of self-expandable metallic stent endoscopic placement for malignant colorectal obstruction during the COVID-19 pandemic

Lo studio sottolinea l'importanza e l'utilità di stents posizionati per via endoscopica in caso di occlusione acuta-subacuta per tumore del colon retto, nel periodo della pandemia da COVID 1

Self-expandable metal stents for left sided colon obstruction from diverticulitis. A single center retrospective series

Background and Objectives: The incidence of diverticulitis is increasing in western countries. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Colonic symptomatic strictures are often treated with segmental colectomy. The aim of our study is to report our experience with Self Expandable Metal Stents (SEMS) placement to relieve sigmoid obstruction secondary to diverticulitis, either as a permanent solution or as a bridge to elective colectomy. Material and Methods: From January 2016 to December 2018, 21 patients underwent SEMS placement for sigmoid obstruction secondary to diverticulitis at our institution. In four patients with poor general conditions, SEMS was considered the definitive form of treatment. In 17 patients, the stent was placed as bridge to elective colectomy. Data were prospectively collected and retrospectively analyzed. Primary outcomes were postoperative mortality and morbidity after SEMS and subsequent elective colectomy. Results: There was no mortality or major morbidity after SEMS placement or subsequent elective colectomy. No stoma was performed. Conclusions: Placement of Colorectal Self Expandable Stent represents a useful tool to relieve obstruction in patients with left-sided colonic diverticulitis. SEMS placement makes it possible to transform an emergency clinical condition into an elective condition, giving time to resolve the inflammation and the infection inevitably associated with complicated diverticulitis

Self-expandable metal stents for refractory complete rectal obstruction in patients with Crohn disease

Information regarding the efficacy of self-expanding metal stent (SEMS) placement in the treatment of strictures in CD is limited. Placement of a stent in contact with inflamed tissue may trigger worsening of the inflammatory reaction with complications including perforation, failure to solve the problem, and migration of the stent

Exploring pathogenicity and tumorigenic potential of the nematode Anisakis using human intestinal organoids and extracellular vesicles

Anisakiasis is an extremely underestimated accidental zoonosis both epidemiologically and medically. Its chronic form can potentially lead to erosive ulcers, granuloma formation and chronic inflammation at the human gastro-intestinal tract; features potentially involved in the onset of a carcinogenic microenvironment. In this regard, case reports of gastric or intestinal tumors in co-occurrence with anisakiasis are increasing from endemic countries. Giving that, investigations on tumorigenic potential of anisakiasis and its zoonotic agent Anisakis need to be exploited. Our work centers on the study of Anisakis-human interactions through a comparative transcriptomic approach using: i) the human intestinal organoids (HIO), a bi or three-dimensional cutting-edge model capable of self-organization, self-renewal, and exhibiting the architecture and functionality of the organ of origin, in this case the intestine; and ii) a newly discovered Anisakis messenger of pathogenicity, the extracellular vesiscles (EVs). EVs are nano-scale particles of 100-1000 nm involved in cell-cell and inter-species communication, having a new role in host-pathogen interface. EVs content is characterized by key elements such as lipids, nucleic acids, proteins and miRNAs, which are able to affect pivotal host pathways, being involved in a complex regulatory network and modulating host’s genes expression. Analysis of data revealed top 100 abundant transcripts in the HIO and 7 differentially expressed genes in HIO treated with Anisakis EVs, among them, transcripts showing potential link to cancer processes have been detected. In particular, a downregulation of EPHB2 and a upregulation of NUPR1 emerged and, interestingly, these alterations have been associated to colorectal cancer. In addition, qRT-PCR carried out on inflammatory products (Il33, Il8, Il1β) showed a decreasing trend in Il33 gene expression, an increasing trend in Il1β and no alteration in Il8, a dynamic that were previous described as involved in helminth infection chronicity. This project represent the first attempt aimed to investigate Anisakis tumorigenic potential using HIO and EVs, revealing interesting outcomes that we hope will open new ways for the study of anisakiasis and its potential consequences in humans, a field to be explored

Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study

Background: The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication use, while a minority have implemented objective functional measurements. Objective: To better comprehend the pathophysiological mechanisms involved in the genesis of GERD after SG. Setting: University Hospital, Italy. Methods: A total of 21 patients affected by morbid obesity and eligible for SG were prospectively enrolled in the present study. Patients were evaluated by means of endoscopy, high-resolution manometry (HRM), 24-hour pH monitoring, and the Gastroesophageal Reflux Disease Health- Related Quality of Life questionnaire. Results: Follow-up was completed at least 1 year post operation (mean follow-up, 14.3 6 2.1 mo) by 19 patients. Body mass index decreased from 41.2 6 .9 to 26.8 6 .8 kg/m2 (P , .001). Distal con- tractile integral significantly decreased from 2772.8 6 399.9 mm Hg/s/cm to 2060.4 6 338.9 mm Hg/ s/cm (P 5 .01). The 24-hour pH monitoring showed an overall reduction tendency of acid reflux, although this was not statistically significant. All analyzed endoscopic findings withstood substantial pejorative modifications after SG (P , .01). Distal contractile integral values at baseline predicted postoperative Z-line upward migration; HRM, distal latency, and DeMeester score at baseline pre- dicted the development of erosive esophagitis at follow-up, by bootstrap estimates of a logistic regression. Conclusions: Postoperative GERD-related esophageal sequelae should be carefully considered after SG. Our results demonstrate how acid reflux does not seem to play a relevant role in the pathophys- iology of post-SG GERD. Baseline HRM can help stratify the risk of developing erosive esophagitis and Z-line upward migration after SG, while postoperative endoscopic surveillance should be encouraged regardless of the presence or absence of symptoms

Genetic diversity, phylogroup distribution and virulence gene profile of pks positive Escherichia coli colonizing human intestinal polyps

Some Escherichia coli strains of phylogroup B2 harbor a (pks) pathogenicity island that encodes a polyketide-peptide genotoxin called colibactin. It causes DNA double-strand breaks and megalocytosis in eukaryotic cellsand it may contribute to cancer development. Study of bacterial community that colonizes the adenomatouspolyp lesion, defined as precancerous lesions, could be helpful to assess if such pathogenic bacteria possess a rolein the polyp progression to cancer. In this cross-sectional study, a total of 1500 E. coli isolates were obtained frombiopsies of patients presenting adenomatous colon polyps, the normal tissues adjacent to the polyp lesion andpatients presenting normal mucosa. pks island frequency, phylogenetic grouping, fingerprint genotyping, andvirulence gene features of pks positive (pks+) E. coli isolates were performed. We found pks+E. coli stronglycolonize two patients presenting polypoid lesions and none were identified in patients presenting normal mu-cosa. Predominant phylogroups among pks+E. coli isolates were B2, followed by D. Clustering based on frag-ment profiles of composite analysis, typed the pks+isolates into 5 major clusters (I–V) and 17 sub-clusters,demonstrating a high level of genetic diversity among them. The most prevalent virulence genes were fimH andfyuA (100%), followed by vat (92%), hra and papA (69%), ibeA (28%), and hlyA (25%). Our results revealed thatpks+E. coli can colonize the precancerous lesions, with a high distribution in both the polyp lesions and innormal tissues adjacent to the lesion. The high differences in fingerprinting patterns obtained indicate that pks+E. coli strains were genetically diverse, possibly allowing them to more easily adapt to environmental variations