Role of Endoscopy in Tracheo-esophageal Prosthesis Phonation. Technical and Psychological Aspects. Our Institutional Experience

In our study, we have analyzed the use of flexible video endoscopy in patients undergoing total laryngectomy and candidates for the placement of a voice prosthesis, with the creation of a tracheo-esophageal fistula in which the prosthesis is positioned, which acts as a valve one-way, which allows the passage of air from the trachea to the oesophagus and prevents the passage of liquids in the opposite direction, allowing the pulmonary air to vibrate a segment of the cervical oesophagus. The use of flexible video endoscopy for the positioning of the prosthesis can be both primary and secondary to the intervention of total laryngectomy. Endoscopy has also been used in the ontological follow-up for the assessment of the hypo pharyngeal-oesophageal-gastric district in the search for relapses or secondary tumors, which may develop in this district in more than 10% of patients with pathological neoplasia. Higher aero-digestiv

Rubber band ligation (RBL) for haemorrhoids. The experience of three surgical units

Haemorrhoids are the most common proctological disorder with a high incidence per year and a prevalence up to 39% in the general population 1 . This condition often leads to disruption in an individual’s personal and working life. Management has considerable cost implications, and therefore, economic consequences 2 . Due to the fear of SARS-COVID infection the most of patients actually regret hospitalization for surgery and choose to delay the time of treatment. RBL can be proposed as successful procedure to patients with II-III grade with a short stay in the hospital. Treatment consists initially of conservative measures such as lifestyle advice, diet and toilet behaviour. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: rubber band ligation, injection sclerotherapy, cryotherapy, manual dilation of the anus infrared photocoagulation, bipolar diathermy 3 , direct current electrocoagulation 4 . Rubber band ligation (RBL) was established as one of the most important, cost-effective and commonly used treatments for first- to third-degree internal hemorrhoids. It is a very effective non-surgical treatment for internal hemorrhoids. causing fibrosis, retraction, and fixation of the hemorrhoidal cushions. Rubber band ligation is also more effective than sclerotherapy and infra-red coagulation, but more painful. Overall complications occur in less than 10%. A retrospective study of 186 patients outpatients who underwent RBL with a minimum follow-up of 12 months is reported. Results confirmed it is effective until 1 year with a low rate of complications and could be offered as conservative treatment for I to III grade hemorrhoids

Tailored treatment of intestinal angiodysplasia in elderly

Background: Angiodysplasia of the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and severe anemia in elderly. Different treatments exist for this kind of pathology. Methods: The aim of this work was to study 40 patients treated for intestinal angiodysplasia with two different kind of endoscopic treatments: argon plasma coagulation (APC) and bipolar electrocoagulation (BEC). Results: Age of patients was similar in both groups (76,2 ± 10.8 years vs 74,8 ± 8,7 years, P = 0,005). Angiodysplasia treated were located in small bowel, right colon, left colon, transverse colon and cecum. We analysed number of treatment, recurrence, hospital discharge, needs of blood transfusions before and after endoscopic treatment. Number of treatment was the same in both groups (1,2 ± 0,2 vs 1,1 ± 0,1, P < 0,001). We had more recurrence in patients treated with BEC (4/20 vs 2/20, P < 0,001). Hospital discharge was comparable in both groups (5,3 ± 3,1 days vs 5,4 ± 2,8 years, P < 0.001) Conclusions: Treatment of angiodysplasia in elderly is not easy. Different kinds of treatment could be adopted. APC and BEC are both safe and effective. The choice of a treatment should consider several factors: age, comorbidity, source of bleeding. In conclusion we think that treatment of bleeding for angiodysplasia in elder population should be a tailored treatment. © 2015 Rita Compagna et al., published by De Gruyter Open

Role of narrow band imaging (NBI), in the treatment of non-polypoid colorectal lesions, with endoscopic mucosal resection (EMR). A single-center experience

BACKGROUND: In this study, the authors evaluated the role of narrow band imaging endoscopy in the early detection of infiltration of the colon wall by flat and depressed lesions, highlighted during colonoscopy, to confirm the possibility of removal with Endoscopic Mucosal Resection (EMR). METHODS: 67 patients (37 males and 30 females) with non-polypoid colorectal lesions were included in this study. The location of the lesions, the size and possible infiltration of the colon wall were performed with a colonoscopy with NBI. Lesions without massive invasion were treated with an EMR. RESULTS: NBI was found to be a sensitive, specific, and accurate technique in assessing any infiltration of the colon wall. Endoscopic resection of the mucous membrane was successfully performed in 62 patients, it was not possible to perform it in 5 patients, due to the lack of dissection, and they underwent surgery. CONCLUSIONS: Non-polypoid colorectal lesions and early tumors can be treated with EMR. Certainly, early detection with Narrow Band Imaging endoscopy and subsequent endoscopic resection can reduce colorectal cancer mortality. Many studies have confirmed that these two methods have achieved important results comparable with surgical procedures. KEY WORDS: Endoscopic Mucosal Resection, Narrow Band Imaging, Therapy

gender and quality of life in laryngectomized patients

Background: the aim of this study was to investigate possible correlations between the perception of postoperative quality of life and gender. Methods: the questionnaires “the Brief illness Perception Questionnaire” (B-iPQ) and “Voice handicap index” (Vhi) were administered to 94 patients divided into two groups according to gender group a: 73 men, group B: 21 women. RESULTS: The results showed that gender should be considered a factor influencing perceived quality of life in laryngectomized patients. Specifically, women showed greater concern towards the disease, its evolution, and the consequences on their lives, compared to men. CONCLUSIONS: the care of the laryngectomized woman should consider the impact that loss of voice has on the perception of her femininity, and the physical, functional, and above all emotional issues that such surgeries may lead to for women

Post-operative oncological and psychological evaluation of patients with colostomy for colorectal cancer.

BACKGROUND: The therapeutic arsenal for colorectal cancer is largely made up of surgery. In digestive tumors, ostomy devices induce loss of function and control. This medical device generates changes that affect all aspects of patients’ lives. This study evaluates the postoperative follow-up from the oncological point of view and the psychological impact of colosto- my on the quality of life of patients with colorectal cancer, analyzing any complications or relapses, and the high risk of self-concept disorder and social isolation. METHODS: The aim of the work was to identify all the surgeries for colorectal cancer performed in the Federico II University Hospital of Naples, from 2018 to 2021, and among them how many had been packaged a colostomy. We then analyzed how many patients had been evaluated 12 months after surgery, with a transanal endoscopy or transto- my, and the percentage of any complications or relapses. The same patients who underwent endoscopic control were also evaluated psychologically, to analyze how they lived the packaging of the ostomy and how it had affected the quality of life. READ-ONLY COP RESULTS: At endoscopic control, diversion colitis phenomena and few cases of stoma stenosis and stomatitis were detect- PRINTING PROHIBITED ed. No case of neoplastic recurrence. From the psychological point of view, the problems detected were in particular the alteration of body image, the loss of sphincter control, embarrassment and shame for the bad smell, impairment of sex- uality and difficulties in the couple relationship and social contacts, anxiety, depression and loneliness. CONCLUSIONS: The post-operative evaluation of the ostomy patient following colorectal cancer requires endoscopic control to suddenly detect recurrences and complications and psychological support that improves their quality of life

[The role of endoscopy in gastroenteropancreatic neuroendocrine tumors].

[The role of endoscopy in gastroenteropancreatic neuroendocrine tumors]. [Article in Italian] Magno L, Sivero L, Napolitano V, Ruggiero S, Fontanarosa G, Massa S. Source Dipartmento di Chirurgia Generale, Geriatrica ed Endoscopia Diagnostica ed Geriatrica, Universitá degli Studi, Federico II di Napoli. Abstract Versione italiana Riassunto: Il ruolo dell'endoscopia nei tumori neuroendocrini gastroenteropancreatici. L. Magno, L. Sivero, V. Napolitano, S. Ruggiero, G. Fontanarosa, S. Massa I tumori neuroendocrini (NET) gastro-entero-pancreatici (GEP) sono neoplasie rare che originano dalle cellule neuroendocrine del tubo digerente e del pancreas. L'endoscopia digestiva e l'ecoendoscopia rivestono un ruolo importante nella diagnosi, stadiazione e sorveglianza dei pazienti con NET. Inoltre, in casi selezionati, le tecniche endoscopiche operative consentono il trattamento di queste neoplasie in fase precoce. English version Summary: The role of endoscopy in gastroenteropancreatic neuroendocrine tumors. L. Magno, L. Sivero, V. Napolitano, S. Ruggiero, G. Fontanarosa, S. Massa Gastroenteropancreatic (GEP) neuroendocrine tumors (NET) are rare neoplasia arisen from neuroendocrine cells present in the gut mucosa and pancreas. Digestive endoscopy and endoscopic ultrasonography play a relevant role in NET diagnosis, stadiation and surveillance. Moreover, in selected patients, surgical endoscopy allows the tratment of these cancers at an early stage

Percutaneous endoscopic jejunostomy (PEJ) in patients with dumping syndrome: Evaluation of our center on a series of clinical cases

Background: The Dumping syndrome occurs in a variable percentage of subjects undergoing surgery involving the esophageal and gastric district. The treatment makes use of the introduction of dietary measures and arti!cial nutrition, especially the internal one. This study evaluates the experience of a single center regarding the use of percutaneous endoscopic jejunostomy (PEJ) in patients developing the dumping syndrome. Methods: We evaluated the case history of our department, of all patients operated on at the level of the upper gastrointestinal tract, who had manifested symptoms referable to the Dumping syndrome in the postoperative period.We have identi!ed 3, which we have carried out further investigations to con!rm the presence of an accelerated gastric emptying, and given the poor results obtained with dietary modi!cations and drug therapy, we have implemented a feeding through enteral nutrition, through a jejunal probe. PEG/J positioned by Pull technique, and subsequently replaced after 8 months. Results: Clinically, patients did not develop short- or long-term complications, symptoms were signi!cantly reduced, and they gained weight. Psychologically, the anxiety disorders related to nutrition have improved. Conclusions: By means of percutaneous endoscopic jejunostomy, the symptoms related to hypoglycemic crises following the hyperinsulinemic response to the ingestion of carbohydrates in patients with Dumping were attenuated and the anxiety of eating was lessened. Although limited to a few cases, we believe this form of nutrition is the best for patients with dumping

Obstructing left sided colorectal cancer. A retrospective single center study.

Background: In recent years, with population aging, there has been an increased number of colorectal cancer cases in elderly patients with severe occlusion symptoms. About 75% of obstructions due to malignant colorectal cancer (10-30%) occur distal to splenic flexure. Methods: The authors evaluated the best surgical therapeutic strategy to be used in cases of left-sided colorectal carcinoma in patients over 65 years old, especially considering the emergency condition, age of patients and efficacy in terms of postoperative morbidity, mortality and 5 years survival rate. Results: The management of left-sided obstructing colorectal carcinoma is controversial. Hartmann’s procedure is the best therapeutic choice in elderly patients. However, resection with intraoperative colonic wash-out and primary anastomosis has favorable outcome in low risk patients. Conclusions: A review of the literature reveals that primary resection and anastomosis for left-sided obstructing CRC is the correct therapeutic strategy in low risk patients with localized, resectable carcinoma, without peritonitis; Hartmann’s procedure should be adopted in doubtful cases and in high risk patients