Combined Endoscopic Stent-In-Stent Placement by Lumen-Apposing Metal Stents Through Self-Expanding Metal Stents for Simultaneous Malignant Biliary and Duodenal Obstruction

The palliation of simultaneous biliary and duodenal obstruction in patients with advanced pancreatic cancer is a clinically and technically challenging scenario. Endoscopic procedures are a valid alternative to surgical or percutaneous transhepatic biliary drainage. The availability of self-expanding metal stents (SEMSs) and lumen-apposing metal stents (LAMS) have expanded therapeutic options. We describe a case in which biliary and duodenal obstructions were treated successfully with the combined use of SEMS and LAMS devices. Endoscopic ultrasound-guided biliary drainage with the use of new LAMS and a duodenal SEMS can be a valid option in expert hands as a palliative and minimally invasive treatment for gastric outlet and biliary obstruction

Hepatosplenic T-Cell Lymphoma Mimicking Acute Onset of Cholestatic Hepatitis in a Young Immunocompetent Man: A Case Report

We herein report a case of hepatosplenic T-cell lymphoma (HSTCL) incidentally found in a 30-year-old man who came to the emergency department after an ankle trauma. At admission, laboratory tests revealed abnormal liver enzymes and pancytopenia, and imaging showed mild hepatosplenomegaly. During hospitalization, the patient’s clinical condition worsened rapidly, with a concomitant increase in cholestatic enzymes, severe jaundice, and the worsening of pancytopenia. Causes of liver injury, including many infectious diseases, were explored until the diagnosis of HSTCL was made by liver and bone marrow biopsies. Subsequently, the patient underwent six cycles of chemotherapy with a CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone or prednisolone) regimen and one with Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) but, despite this aggressive treatment, died due to disease progression 2 months after diagnosis. This rare disease should be considered in the diagnostic workup of acute cholestatic hepatitis presenting with concomitant hepatosplenomegaly and cytopenia

Hepatocellular Cancer

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults, and currently it still remains third leading cause of cancer death. HCC affects patients’ chronic liver inflammation or cirrhosis, and it is most strictly associated to chronic viral hepatitis infection (such as hepatitis B or C) or exposure to alcohol or aflatoxin. Actually, metabolic syndrome and NASH are also increasingly recognized as risk factors for HCC. Treatment and prognosis of HCC vary depending on the particulars of tumor size, number of hepatic lesions, and metastatization, even if patient Child-Pugh classification can change the treatment and especially the prognosis. Localized and locally advanced settings are still based on resection, liver transplantation, ablation, and transcatheter arterial chemoembolization. Several improvements have been achieved in advanced and metastatic setting. Even if for the last 10 years, sorafenib was the only therapeutic strategy, nowadays new tyrosine kinase inhibitors and immune checkpoint inhibitors improved the survival of HCC patients

Emerging role of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma

Hepatocellular carcinoma is the most common primary liver cancer and the fourth leading cause of cancer death worldwide. A total of 70-80% of patients are diagnosed at an advanced stage with a dismal prognosis. Sorafenib had been the standardcare for almost a decade until 2018 when the Food and Drug Administration approved an alternative first-line agent namely lenvatinib. Cabozantinib, regorafenib, and ramucirumab also displayed promising results in second line settings. FOLFOX4, however, results inan alternative first-line treatment for the Chineseclinical oncology guidelines. Moreover,nivolumab and pembrolizumab,two therapeutics against the Programmed death (PD)-ligand 1 (PD-L1)/PD1 axis have been recently approvedfor subsequent-line therapy. However, similar to other solid tumors, the response rate of single agent targeting PD-L1/PD1 axis is low. Therefore, a lot of combinatory approaches are under investigation, including the combination of different immune checkpoint inhibitors (ICIs), the addition of ICIs after resection or during loco-regional therapy, ICIs in addition to kinase inhibitors, anti-angiogenic therapeutics, and others. This review focuses on the use of ICIs for the hepatocellular carcinoma with a careful assessmentof new ICIs-based combinatory approaches

Enabling adaptive analytics at the edge with the Bi-Rex Big Data platform

Zero Defect Manufacturing (ZDM) is an emergent and disruptive paradigm that aims to optimize industrial process efficiency and sustainability by leveraging innovative and sophisticated data-driven approaches. It is a technology intensive concept that has the ambition of achieving and maintaining ``first-time-right'' quality goals in spite of varying processes and input material. As a result, developing ZDM applications might become overwhelming for small enterprises due to the multitude of diverse platform, the lack of know-how, and the need to adapt general purpose solutions to meet their needs. The Big Data Innovation and Research Excellence (Bi-Rex) is an Italian consortium that aims to accelerate the industrial innovation process of small enterprises. Within this consortium we developed a Big Data platform that enables adaptive analytics at the IT/OT boundary by leveraging innovative solutions for the safe and automatic deployment of data-driven apps, using MLOps and DevOps techniques and technologies, and evaluated it in real use cases provided by the world leading industrial partners involved in the project

Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study

Background: Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy in patients aged over 80 years. Methods: In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥80 years (group A) and 99 patients aged 40-60 years (control group B) were retrospectively selected. Results: Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (p<0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. Conclusions: Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients