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ABSTRACT: One of the most frequent complications of endoscopic sphincterotomy (ES) is bleeding. When post-ES bleeding does not respond to the use of typical endoscopic therapy, the only alternative is angiography or surgery. A 82-year-old female was admitted for jaundice. A RMN-cholangiography revealed multiple stones in the common bile duct (CBD). She underwent endoscopic retrograde cholangiopancreatography (ERCP). The papilla major was located between two large periampullary diverticula. During the ES, a severe bleeding was observed from the upper part of the biliary cut. Several methods of hemostasis (injection of adrenaline, thermal methods and balloon tamponate) were performed without efficacy. A partially covered metallic stent was placed across the biliary orifice, in order to compress mechanically the bleeding site achiving the hemostasis. Clin Ter 2013; 164(1):e27-29. doi: 10.7417/CT.2013.1517.
La Clinica terapeutica 01/2013; 164(1):e27-9. · 0.27 Impact Factor
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ABSTRACT: Argon plasma coagulation (APC) is a non-contact thermal method of hemostasis that has generated much attention in recent years. This endoscopic procedure is used primarily to control bleeding from lesions in the gastrointestinal tract, and also sometimes to debulk tumours in the case of patients for whom surgery is not recommended. APC involves the use of a jet of ionized argon gas (plasma) that is directed through a probe passed through the endoscope. The probe is placed at some distance from the lesion, and tissue damage is limited to superficial layers. The depth of coagulation is usually only a few millimetres. Theoretical advantages of APC include facility application, speedy treatment of multiple lesions in the case of angiodysplasias or wide areas (the base of resected polyps or tumor bleeding), safety due to reduced depth of penetration, and lower cost compared to laser. Clin Ter 2012; 163(6):e435-440.
La Clinica terapeutica 11/2012; 163(6):e435-e440. · 0.27 Impact Factor
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ABSTRACT: The gastrointestinal tract, particularly the stomach, is the most common site of mucosa-associated lymphoid tissue lymphoma (MALToma). Many studies describe primary MALT lymphoma arising from the gastric mucosa, especially in association with Helicobacter pylori infection. On the contrary, primary MALT duodenal lymphoma is a very rare neoplasm. We report a case of a patient with gastrointestinal bleeding in whom primary gastric and duodenal MALT lymphoma were occurred simultaneously. Clin Ter 2012; 163(4):e165-167.
La Clinica terapeutica 07/2012; 163(4):e165-7. · 0.27 Impact Factor
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ABSTRACT: A 46-year-old man was referred to our Unit for hematemesis. The medical history of the patient revealed an HCV-related cirrhosis, a human immunodeficiency virus (HIV) infection and recent and persistent episodes of emesis. An urgent gastroscopy disclosed evidence of active bleeding from varices of the lower third of the esophagus and a concomitant laceration of the esophageal wall due to the emesis. These two conditions have been endoscopically diagnosed and successfully treated by sclerotherapy and endoscopic clipping.
European review for medical and pharmacological sciences 05/2012; 16(5):704-6. · 1.04 Impact Factor
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ABSTRACT: Leptospirosis is a spirochetal zoonosis with a worldwide distribution affecting both animals and humans. These are infected only occasionally by direct contact with infected animals or through contaminated water and soil. Generally, this disease is commonly found in tropical regions. Infected patients usually present with non-specific features. In fact, the clinical manifestations of leptospirosis are variable, ranging from occult infection to Weil's disease with fatal complications. Often the disease remains underdiagnosed due to the broad spectrum of signs and symptoms. Here we are reporting a case of a woman with an ictero-haemorraghic leptospirosis complicated by acute renal failure and pulmonary involvement that received intensive care unit support including intubation and ventilation and promptly resolved with appropriate therapy. Clin Ter 2012; 163(3):e129-131.
La Clinica terapeutica 05/2012; 163(3):e129-31. · 0.27 Impact Factor
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ABSTRACT: Colorectal post anastomotic benign strictures are not uncommon. The purpose of this study was to investigate the results of endoscopic balloon dilatation of anastomotic strictures.
The study was on a retrospective survey. Records of 14 consecutive patients with anastomotic strictures (5 F, 9 M; median age 64 years; range: 50-87 years), attending our GI Unit from February 1st 2008 to December 31st 2009, were analyzed. All patients had been operated for colon carcinoma. All of them were treated with balloon dilatation.
All the patients presented symptoms of obstruction. The total number of dilatation sessions was 37 and the median number of sessions by patient was 1,5 (range: 1-7). After the procedures, all patients had an improvement of symptoms. No complications were observed.
Our experience underlines that endoscopic ballon dilatation, in patients with post anastomotic benign strictures, is a safe technique with a low rate of complications.
La Clinica terapeutica 01/2011; 162(6):539-42. · 0.27 Impact Factor
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ABSTRACT: Magnetic resonance cholangio-pancreatography (MRCP) is a valuable method for the evaluation of biliary and pancreatic diseases and a valuable alternative to endoscopic retrograde cholangiopancreatography (ERCP). It is noninvasive and does not require the use of contrast material or ionizing radiation. Since its introduction in 1991, this technique has significantly improved in spatial resolution, now allowing the accurate assessment of the major bilio-pancreatic diseases.
MRCP is commonly performed with heavily T2-weighted sequences in order to highlight static fluids, as those contained in dilated pancreatic and biliary ducts. Newest MR equipments allow to perform MRCP within 10-15 minutes, due to the availability of ultra-fast sequences. Currently, MRCP is widely performed as a primary imaging modality for the assessment of obstructive jaundice and other benign or malignant bilio-pancreatic ducts abnormalities. The primary MRCP application is the evaluation of biliary obstructions due to choledocholithiasis, iatrogenic strictures, cholangiocarcinoma or pancreatic carcinoma. Other MRCP applications include the assessment of the exocrine pancreatic function, following secretin stimulation. Whenever needed, the MRCP may be completed with a conventional contrast-enhanced magnetic resonance imaging (MRI) of the upper abdomen and functional studies as well, thus providing an all-in-one mophological and functional study of the pancreas and biliary system. More recent applications include the possibility of 3D reconstructions and the use of hepato-biliary contrast agents, that provide a higher definition of the biliary tree, both in pathologic and normal conditions. The introduction of 3Tesla magnets could provide higher anatomic detail.
In the next years the role of MRCP will further expand, due to the availability of faster sequences, 3D imaging and functional studies.
European review for medical and pharmacological sciences 08/2010; 14(8):721-5. · 1.04 Impact Factor
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ABSTRACT: The prevalence of sexually transmitted diseases (STD) has risen in recent years [Brown AE, Sadler KE, Tomkins SE, McGarrigle CA, LaMontagne DS, Goldberg D, et al. Recent trends in HIV and other STIs in the United Kindom: data to the end of 2002. Sex Transm Infect 2004;80:159-66]. Homosexually active men have frequent intestinal and rectal symptoms due to sexually acquired gastrointestinal infections [Surawicz CM, Goodell SE, Quinn TC, Roberts PL, Corey L, Holmes KK, et al. Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms. Gastroenterology 1986;91:651-9]. The number of reported cases of primary syphilis is increasing especially among this group of people [Goh BT. Syphilis in adults. Sex Transm Infect 2005;81:448-52 ]. We herein describe a case of a young man with a primary syphilitic rectal localization mimicking rectal cancer.
Digestive and Liver Disease 08/2008; 40(7):579-81. · 3.05 Impact Factor
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ABSTRACT: Recurrent abdominal pain (RAP), surely one of the most frequent causes of medical intervention, is frequently present in many gastrointestinal disease. Usually no structural and/or biochemical alterations can be demonstrated. This condition is, therefore, considered to be due to functional disorders such as irritable bowel syndrome (IBS) or functional dyspepsia. Previous observations suggest the presence of a rare alteration of celiac vessels among the possible causes of RAP. This pathological condition was known as Dunbar syndrome. We report 2 cases of chronic abdominal pain. The former reported weight loss and the latter anemia with iron deficiency. It is remarkable that patients with initial diagnosis of IBS can be affected by celiac disease (CD), which is the cause of their abdominal pain. Our patients were tested for CD; the former was negative and IBS was diagnosed, the latter was positive and a gluten free diet was prescribed. The presence of an epigastric bruit, accentuated during expiration, suggested a possible vascular alteration known as tripod celiac artery compression syndrome. Duplex Doppler sonography suggests the diagnosis of celiac arterial constriction due the diaphragmatic ligament. These cases show that tripod celiac artery compression syndrome might be a cause of RAP and that it may be evaluated and investigated when the clinical examination discloses an abdominal systolic bruit.
Minerva gastroenterologica e dietologica 07/2007; 53(2):209-13.
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ABSTRACT: Malignant obstruction of the gastric outlet and duodenum is frequently due to extrinsic involvement by tumors from contiguous organs, in particular from pancreas and gallbladder. The treatment of malignant gastroduodenal stenoses is difficult. Many patients have advanced malignant disease and are too ill to undergo surgical approach. Surgical gastrojejunostomy has been considered the palliative treatment of choice. Metallic stents can be useful in this condition with adequate palliation obtained in most cases. We report a case in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum due to a colon cancer.
Digestive and Liver Disease 09/2006; 38(8):612-4. · 3.05 Impact Factor
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ABSTRACT: A small but significant excess of deaths for tumors of the digestive system has been described in Crohn's disease. In a study analyzing all cancers of the small intestine within a defined population, Crohn's disease was the major underlying factor for cancer of the small intestine. Areas of the small intestine containing strictures are unusually prone to malignant transformation. We report the rare case of a patient in whom surgery for intestinal occlusion disclosed Crohn's disease of the distal ileum complicated by two adenocarcinomas arising within distinct areas of the inflamed bowel.
International Journal of Colorectal Disease 06/2006; 21(4):388-91. · 2.38 Impact Factor
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Endoscopy 02/2006; 38 Suppl 2:E5-6. · 5.21 Impact Factor
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ABSTRACT: The introduction and rapid diffusion of biological agents in the treatment of inflammatory bowel disease had led us to believe that the old immunosuppressive drugs were destined to disappear. However, despite a decade of clinical experience in the use of biological agents, the old immunosuppressive drugs continue to play a pivotal role in the management of inflammatory bowel disease. Various factors may account for this change of view. Aim of the present review was to summarise key information currently available regarding the use of immunosuppressive drugs in the treatment of inflammatory bowel disease.
Digestive and Liver Disease 12/2004; 36(11):766-80. · 3.05 Impact Factor
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Digestive Diseases and Sciences 03/2004; 49(2):304-7. · 2.12 Impact Factor
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ABSTRACT: The continuous demand for sanitary care from the imprisoned patients to the general public hospitals has carried to the creation of dedicated structures like the Complex Protected Medicine Structure (SCMP) at the Hospital Sandro Pertini of Rome. Aim of this study was to present the preliminary epidemiologic-clinical data gathered from July 26th 2006 to March 1st, 2006 in our SCMP.
This study is based on an observational retrospective protocol. Patients characteristics included sex, age, alcohol, smoke and drug abuse, serology for viral hepatitis and AIDS, and treatment with benzodiazepine.
The records of 200 consecutive patients (18 F, 182 M; median age 46 years; range: 20-84 years), attending our Unit were analyzed retrospectively. Out of these patients, 40 (20%) were foreigners, 43 (21.5%) alcohol abusers, and 141 (70.5%) smokers. Forty-eight patients (24%) had a recent or last history of drug addiction (heroin and/or cocaine). The HIV antibodies have been assayed only on 28 patients, turning out positive in 10 (35.71%). Twenty-five patients were positive for HBsAg (12.5%) and 57 (28.5%) for HCV. A consumption of benzodiazepine (BZD) was present in 71 (35.5%) of the patients.
The essential elements of medical attendance of our structure are described in the article. We present the initial report of our working experience. The present data are in keeping with previous studies of the literature. We hope that our experience coul be extended to all italian Countries.
La Clinica terapeutica 158(2):135-7. · 0.27 Impact Factor
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ABSTRACT: Adequate sedation is fundamental for the execution of the endoscopic retrograde cholangiopancreatography (ERCP). Propofol is widely used for gastrointestinal endoscopy because of its rapid recovery profile. The aim of this study was to determine, retrospectively, whether the administration of propofol was safe in patients undergoing ERCP, both diagnostic and therapeutic.
In our GI Unit, from 1st February 2006 to 23 November 2006, we performed 100 ERCP. All the patients were sedated by using midazolam e.v., as pre-anaesthetic agent, and propofol e.v. During the procedure, vital signs were continuously monitored (oxygen saturation, blood pressure, heart rate). Patients were also divided into two groups: less than 80 years of age (group I) and 80 years of age and older (group II). Cardiorespiratory complications were recorded.
Patients were 51 females and 49 males, with a median age of 74 years (range: 23-94 years). Group I was composed by 72 patients (35 F, 37 M) and Group II by 28 patients (16 F, 12 M). There were no episodes of hemodynamic instability or airway obstruction. New ECG changes (1 ischemia, 3 arrhythmias) and 1 significant oxygen desaturation episode (SpO2<90%) occurred in 5% of procedures. If we considered the two groups, the rates of cardiopulmonary complications were 4.1% and 7.1%, respectively in group I and in group II.
Propofol seems to be safe and effective sedation for ERCP, with a low complication rate, also in patients aged 80 years or older.
La Clinica terapeutica 159(1):19-22. · 0.27 Impact Factor
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ABSTRACT: While, several studies indicate that there is an association between proximal and distal colorectal adenomas, no agreement seems to be between the presence of distal hyperplastic polyps and proximal neoplasia. The aim of this study was to investigate, retrospectively, the possible correlation between the distal hyperplastic polyps and proximal colorectal neoplasia.
In our GI Unit, from 1st February 2006 to 24 November 2006, we performed 142 polypectomy. Patients were 36 females and 80 males, with a median age of 66 years [range: 38-87 years]. All of the polpys were resected during colonoscopy and sent for histological study. Chi-square test was used for statistical analysis. A probability value of P< or =0.05 was considered to be statistically significant.
Histological study showed the following results: 33 hyperplastic polyps (8 F, 21 M; median age 63 years), 100 adenomas (26 F, 61 M; median age 67 years) and 2 inflammatory polpys (2 F, 0 M; median age 71 years). The rectal localization was associated with a significantly higher frequency of hyperplastic polyps (63.6% vs 23.5%), OR: 5.688 (95% C.I. 2.445-13.230) (p<0.0001). Five hyperplastic polyps of the rectum were associated with 5 adenomas located 1 in the rectum, 2 in the sigmoid colon, and 1 in the descendens colon and 1 in the ascendens colon. While, 5 adenomas were associated with 5 adenocarcinoma.
Guidelines from the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy do not recommend colonoscopy for patients with distal hyperplastic polyps. Also our study is in keeping with the data of the literature and it confirmed that rectal localization is associated with a higher prevalence of hyperplastic polyps.
La Clinica terapeutica 158(5):421-4. · 0.27 Impact Factor
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ABSTRACT: Foreign bodies ingestion is a potentially serious problem. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. In the present work, we report our experience in the management of ingested foreign bodies.
The study was observational and retrospective. We included in the study the foreign bodies ingestions occurred during urgent endoscopy (examination performed from 1 to 6 h by the call).
Records of 696 consecutive EGDS performed in urgency at the Unit of Gastroenterology and Digestive Endoscopy of the Hospital Sandro Pertini of Rome, from 01-02-'04 to 18-01-2006, were analyzed retrospectively. Out of these procedures, 21 (3.01%) were performed for suspected foreign bodies ingestion.
We present the initial report of our working experience. Objects that have passed the duodenum should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical approach is indicated when significant symptoms develop or if the object fails to progress through the gastrointestinal tract. The present data are in keeping with previous studies of the literature.
La Clinica terapeutica 158(4):291-5. · 0.27 Impact Factor
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ABSTRACT: Hydatid cyst disease still is a serious public-health problem in endemic areas. It is a tissue infestation caused by the larval stage of a parasite, Echinococcus granulosus. Although liver and lung are the most commonly involved organs, hydatid disease can occur in all viscera and soft tissues. In 10% of cases, hydatid disease arises in the viscera: mainly in the spleen (0.9-8%), but also in kidney, bone, heart and peritoneal cavity (0.5-5%). Other rare locations such as muscles have been described in less than 1% of cases of hydatid disease. We report magnetic resonance imaging findings of a case of diffuse abdominal hydatidosis.
La Clinica terapeutica 158(3):231-3. · 0.27 Impact Factor
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ABSTRACT: Gastroduodenal obstruction is a preterminal event in patients with advanced malignancies of the stomach, pancreas and duodenum. Surgical gastrojejunostomy has been considered the traditional palliative treatment. The use of metallic stents is intended not to be curative but to provide nonsurgical palliation for the symptoms of obstruction. The advantages of this technique are the minor invasivity, the decrease in morbidity and mortality respect the surgical approach, the patient that can be discharged the day of or the day after the procedure and the better life expectation.
La Clinica terapeutica 158(3):249-51. · 0.27 Impact Factor
