Pietro Familiari

Catholic University of the Sacred Heart , Milano, Lombardy, Italy

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Publications (127)244.12 Total impact

  • Ivo Boškoski, Pietro Familiari, Guido Costamagna
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    ABSTRACT: To highlight the most recent findings and results of new hemostatic agents for acute bleeding of the gastrointestinal tract of common and less common cause published in the past 12 months.
    Current opinion in gastroenterology. 07/2014;
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    ABSTRACT: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the real-time measurement of the diameter of the oesophago-gastric junction.
    Digestive and Liver Disease 04/2014; 2(2):77-83. · 3.16 Impact Factor
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    ABSTRACT: Background Removal of biliary Fully Covered Self Expandable Metal Stents can fail due to stent migration and/or hyperplastic ingrowth/overgrowth. Methods A case series of 5 patients with benign biliary strictures (2 post-cholecystectomy, 2 following liver transplantation and 1 related to chronic pancreatitis) is reported. The biliary stricture was treated by temporary insertion of Fully Covered Self Expandable Metal Stents. Stent removal failed due to proximal stent migration and/or overgrowth. Metal stent removal was attempted a few weeks after the insertion of another Fully Covered Metal Stent into the first one. Results The inner Fully Covered Self Expandable Metal Stent compressed the hyperplastic tissue, leading to the extraction of both the stents in all cases. Two complications were reported as a result of the attempt to stents removal (mild pancreatitis and self-limited haemobilia). Conclusion In the present series, the “SEMS in SEMS” technique revealed to be effective when difficulties are encountered during Fully Covered Self Expandable Metal Stents removal.
    Digestive and Liver Disease 01/2014; · 3.16 Impact Factor
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    ABSTRACT: Chronic pancreatitis (CP)-related common bile duct (CBD) strictures are more difficult to treat endoscopically compared with benign biliary strictures because of their nature, particularly in patients with calcific CP. Before any attempt at treatment, malignancy must be excluded. Single plastic stents can be used for immediate symptom relief and as "bridge to surgery and/or bridge to decision," but are not suitable for definitive treatment of CP-related CBD strictures because of long-term poor results. Temporary simultaneous placement of multiple plastic stents has a high technical success rate and provides good long-term results.
    Gastrointestinal endoscopy clinics of North America 10/2013; 23(4):833-845.
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    ABSTRACT: Peroral Endoscopic Myotomy (POEM) is a new endoscopic technique for the treatment of esophageal achalasia, with excellent results in adults. Three children with classic-type achalasia (mean age 9.6 years) underwent POEM in a single center. Mean basal LES pressure and Eckard score were 34.6 mmHg and 5.3, respectively. Mean length of myotomy was 10 cm. On average, POEM were completed in 60.6 minutes. No patients experienced postoperative complications or GERD. In the two patients who completed a 12-month follow-up, complete symptoms relief was documented (Eckard score =0), as well as a significant drop of the basal LES pressure.
    Journal of pediatric gastroenterology and nutrition 08/2013; · 2.18 Impact Factor
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    ABSTRACT: Gastrointestinal (GI) and neuroendocrine tumors (NETs) can be treated by mini-invasive endoscopic resection when localized in the superficial layers of the bowel wall and their size is <20 mm. Endoscopic diagnosis of NETs is usually incidental or suspected after clinical, laboratory or imaging findings. Endoscopic mucosal resection is the most commonly used technique for NET removal, endoscopic submucosal dissection is indicated in selected cases, while papillectomy is feasible for ampullary lesions. Histopathologic assessment of the resection margin (circumferential and deep) is important for staging. Incidence of endoscopic mucosal resection-/endoscopic submucosal dissection-related complications for removal of GI NETs are similar to those reported for other GI lesions. Endoscopic follow-up is based on histopathologic characteristics of the resected NETs and its site. NETs >20 mm in size, with penetration of the muscle layer and/or serosa are at high risk for metastases and surgical approach is recommended when feasible.
    Expert review of gastroenterology & hepatology 08/2013; 7(6):559-69.
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    ABSTRACT: Pancreaticoduodenectomy is the standard care for invasive ampullary adenocarcinomas. However, endoscopic snare papillectomy (ESP) might play a curative role in very selected patients. We studied a series of 15 patients with T1 ampullary adenocarcinoma who were treated by ESP alone and followed up for a mean of 29.6 ± 21.9 months (range 8 - 81 months). ESP was curative for eight patients (57.1 %). No tumor-related death was observed in patients with a cancer infiltration depth of ≤ 4 mm. According to this preliminary experience, we suggest that this measurable variable threshold should be considered as a possible basis for future large-scale studies.
    Endoscopy 05/2013; 45(5):401-4. · 5.74 Impact Factor
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    ABSTRACT: The inflammatory fibroid polyp (IFP) is a benign lesion occurring in the digestive tract, mostly in the stomach and small bowel, composed of fibrovascular tissue infiltrated by inflammatory cells including eosinophils and mastocytes. Its pathogenesis has been controversial (reactive versus neoplastic). The recent finding of mutations in platelet-derived growth factor receptor α (PDGFRA) in most gastric and small intestinal IFPs supported their neoplastic etiology, moreover helping in their differential diagnosis. In the only gallbladder IFP reported so far, the diagnosis was based on morphologic and immunohistochemical grounds, which in current standards would probably be considered not fully conclusive. Conversely, the gallbladder IFP we report shows typical pathologic features supported by a PDGFRA mutation, similar to its usual gastric and small intestinal counterparts, constituting the first report of an unequivocal IFP at gallbladder level. Thus, IFPs must be considered in the differential diagnosis of gallbladder mesenchymal masses, and genetic analysis of PDGFRA is a helpful tool for this purpose.
    Archives of pathology & laboratory medicine 05/2013; 137(5):721-4. · 2.78 Impact Factor
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    ABSTRACT: Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.
    World journal of gastrointestinal endoscopy. 04/2013; 5(4):186-8.
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    ABSTRACT: Context and Objective:Transoral gastroplasty (TOGA) is a safe and less invasive procedure than traditional bariatric surgery. We studied the effects of TOGA on the risk of progression from prediabetes to overt type 2 diabetes mellitus (T2DM) or on regression from diabetes or prediabetes to a lower risk category.Design and Setting:Prospective, observational study (October 2008 to October 2010) performed at Catholic University, Rome, Italy. Fifty consecutive subjects 18-60 years old, 35 ≥ body mass index < 55 kg/m(2), were enrolled. Glucose tolerance, insulin sensitivity, and secretion were studied at baseline and 1 week and 1, 6, and 12 months after TOGA. Plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and ghrelin levels were measured.Results:Forty-three patients (86%) completed the 1-year postoperative follow-up. Patients lost 16.90% of baseline weight (P level × factor time <0.001). Body mass index decreased from 42.24 ± 3.43 to 34.65 ± 4.58 kg/m(2) (P < .001). Twenty-three patients (53.5%) were diagnosed as normal glucose tolerance (NGT) before treatment, 2 (4.6%) were impaired fasting glucose (IFG), 12 (27.9%) were impaired glucose tolerance (IGT), 1 (2.3%) had both IFG and IGT, and 5 (11.6%) had T2DM. At 1-year posttreatment, the percentages changed to 86.0% NGT, 2.3% IFG, 11.6% IGT, 0% IFG plus IGT, and 0% T2DM, respectively. Peripheral insulin resistance and homeostasis model of assessment-insulin resistance improved significantly. Fasting glucose-dependent insulinotropic peptide and ghrelin decreased from 316.9 ± 143.1 to 156.2 ± 68.2 pg/mL (P < .001) and from 630.6 ± 52.1 to 456.7 ± 73.1 pg/mL (P < .001), respectively, whereas GLP-1 increased from 16.2 ± 4.9 to 23.7 ± 9.5 pg/mL (P < .001).Conclusions:TOGA induced glucose disposal improvement with regression of diabetes to NGT or IGT and regression of IGT and IFG to NGT in half of the cases. Regressors showed a much larger increase of GLP-1 levels than progressors.
    The Journal of Clinical Endocrinology and Metabolism 03/2013; · 6.31 Impact Factor
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    ABSTRACT: The safety profile of a therapeutic procedure is almost more important than its efficacy. This concept is particularly true for those developing procedures, like Peroral Endoscopic Myotomy (POEM), which are supposed to mimic and reproduce what is usually done by a surgical operation that is recognized as the therapeutic gold standard. The first human POEM was performed in 2008 in Japan. Since then, few groups of investigators have begun to perform POEM and have published their preliminary experiences. The published results are encouraging, demonstrating good results of safety and efficacy. Pneumoperitoneum, pneumomediastinum, small perforations of the mucosal flap, and mild bleeding are very frequent events during POEM, but should not be considered as significant complications, because they are self-limited or can be managed during the procedure, and do not substantially alter the postoperative course. Few significant complications have been reported in the literature including aspiration pneumonia, mediastinal hematoma, delayed hemorrhage, pneumothorax, esophageal perforation, peritonitis, and dehiscence of the esophageal closure. No mortality has been reported to date. Analysis of the published series confirms the excellent safety profile of the POEM procedure. Some clinical points appear to be of significant importance, in terms of safety, especially the use of carbon dioxide instead of room air for insufflation and meticulous hemostasis during the procedure. Thorough cleaning of the esophagus and antibiotic prophylaxis may play significant roles in the prevention of infections.
    Techniques in Gastrointestinal Endoscopy 01/2013;
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    ABSTRACT: Endoscopic placement of esophageal Self-Expandable Metal Stents (SEMS) is a therapeutic option for post-surgical esophageal leaks. Partially covered SEMS are mainly designed for malignant esophageal strictures, but are used off-label to close post-surgical leaks due to their lower migration rate than fully covered SEMS, and better adherence to the esophageal wall. Partially covered esophageal SEMS can achieve post-surgical fistula healing, but their removal is difficult due to tissue ingrowth through the uncovered part. A challenging case of a difficult removal of a partially covered esophageal SEMS (remove the indefinite article) is (bellow) presented.
    Digestive and Liver Disease. 01/2013; 44:S85.
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    ABSTRACT: BACKGROUND: Biliary partially covered self-expandable metal stents (PC-SEMS) offer prolonged relief of symptoms of biliary obstruction but may induce complications including pancreatitis, cholecystitis and migration. AIMS: To assess efficacy and safety of the ComVi partially covered self-expandable metal stents as primary palliative treatment of distal malignant biliary obstruction. METHODS: Seventy patients (mean age 69.2 years) with distal malignant biliary strictures were prospectively included and underwent endoscopic retrograde cholangio-pancreatography and partially covered self-expandable metal stents placement. Follow-up was done for 12 months. self-expandable metal stents patency, survival and complication-rate after partially covered self-expandable metal stents placement were evaluated. RESULTS: Overall median survival time was 190 days (30-856). Forty-four patients (62.8%) died after median 175.5 days (30-614) without signs of stent dysfunction; 37 patients (52.8%) were alive after 6 months without signs of self-expandable metal stents occlusion. Survival rapidly dropped between 8 and 12 months after treatment. Survival was not influenced by sex (P=0.1) or type of neoplasia (P=0.178). Median survival was longer (254 days [44-836]) in patients who underwent chemotherapy (P<0.0001). Partially covered self-expandable metal stents occlusion had 24 (35.7%) patients 154 days (35-485) after treatment. Median survival after re-treatment was 66 days (13-597). Cholecystitis occurred in one patient (1.7%). CONCLUSIONS: The ComVi partially covered self-expandable metal stents is effective for palliation of biliary obstruction secondary to distal malignant biliary strictures. Self-expandable metal stents patency during follow-up is satisfactory without significant complications.
    Digestive and Liver Disease 12/2012; · 3.16 Impact Factor
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    ABSTRACT: Background The effectiveness of restrictive procedures has been inferior to that of malabsorbitive ones. Recent variants of restrictive procedures, i.e., gastric banding and sleeve gastrectomy, confirm the strive for more efficacious solutions with less complications. We investigated the balance between effectiveness and complications for a new restrictive procedure, a Transoral Endoscopic Vertical Gastroplasty (TOGa®) Methods Seventy-nine morbidly obese patients were submitted to one out of three surgical procedures: TOGa® (29 patients), laparoscopic gastric bypass (LRYGBP; 20 patients), and biliopancreatic diversion (BPD; 30 patients). Mean BMI were 41.7 (35.4–46.6), 44.8 (36.4–54), and 47.5 (41–60.3), respectively. All the patients reached a 2-year follow-up. Results In TOGa® group BMI, respectively at 12 and 24 months, was 34.5 and 35.5, with 44 and 48.3 % of patients with BMI lower than 35. In LRYGBP group, BMI was 30.7 and 29.2 kg/m2, with 80 and 85 % of patients with BMI < 35. In BPD group, BMI was 30 and 29.6 kg/m2, with 100 and 93.3 % of patients with BMI < 35. In TOGa® group, 59 % of patients with an initial BMI < 45 reached a BMI < 35, in comparison to 48 % recorded in the whole group and to 14.3 % in patients with initial BMI ≥ 45. Conclusions In selected patients, TOGa®, was associated with good results after two years in terms of weight loss, even in comparison with LRYGBP and BPD. Minimal trauma, absence of complications, and short hospital stay justify this procedure for patients with low BMI.
    Obesity Surgery 09/2012; 22(12). · 3.10 Impact Factor
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    ABSTRACT: Peroral endoscopic myotomy has been developed to provide a less invasive treatment for oesophageal achalasia compared to surgical cardiomyotomy. To report our initial experience on feasibility, safety and clinical efficacy of peroral endoscopic myotomy. Eleven patients (eight women, mean age 32, range 24-58) underwent an attempt at peroral endoscopic myotomy under general anaesthesia. After submucosal injection, a mucosal entry into the oesophageal submucosa, and a tunnel extending to the oesophagogastric junction and beyond into the stomach were created (total mean length: 15±1.7cm). Myotomy of the circular oesophageal and gastric muscle bundles was then achieved under direct vision (total mean length: 10.2±2.8cm). Haemostatic clips were used to close the mucosal entry. The Eckardt Score and manometry were used to evaluate the results. Peroral endoscopic myotomy could be completed in 10 out of 11 patients (91%). Mean procedure time was 100.7min (range 75-140min). No major complication occurred. Clinical success was achieved in all patients at 1-month follow-up (Eckardt Score 7.1 vs. 1.1, p=0). Lower oesophageal sphincter pressure decreased from 45.1 to 16.9mmHg (p=0). This initial experience with peroral endoscopic myotomy shows its safety and efficacy in the treatment of achalasia. Further studies are warranted to assess the long-term efficacy and to compare peroral endoscopic myotomy with other treatment modalities.
    Digestive and Liver Disease 05/2012; 44(10):827-32. · 3.16 Impact Factor
  • Gastrointestinal Endoscopy 04/2012; 44:S75. · 5.21 Impact Factor
  • Gastrointestinal endoscopy 03/2012; 75(6):1271-7. · 6.71 Impact Factor
  • Gastrointestinal endoscopy 02/2012; 75(5):1100-1; discussion 1102. · 6.71 Impact Factor
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    ABSTRACT: Bariatric surgery is associated with specific complications and mortality. Transoral gastroplasty (TOGA) is a transoral restrictive bariatric procedure that might offer the benefits of surgery with a reduced complication rate. To evaluate the safety and efficacy of TOGA at 12-month follow-up. Prospective, multicenter, single-arm trial. Two tertiary-care referral medical centers. This study involved 67 patients (average age 41.0 years, 47 women, baseline body mass index [BMI] 41.5 kg/m(2); 20 patients with BMI <40). The TOGA procedures were performed by using 2 stapling devices that were used to create a small, restrictive pouch along the lesser gastric curvature. The pouch is designed to give the patient a sustained feeling of satiety after small meals. Excess weight loss, excess BMI loss, safety, and improvements in quality of life, obesity-related comorbidities, and medication use. Fifty-three patients were available at the 12-month follow-up. Excess BMI loss was 33.9%, 42.6%, and 44.8% at 3, 6, and 12 months, respectively. At 12 months, excess BMI loss was 52.2% for patients with a baseline BMI of <40.0 and 41.3% for patients with a baseline BMI of ≥ 40.0 (P < .05). At 12 months, hemoglobin A(1c) levels decreased from 7.0% at baseline to 5.7% (P = .01); triglyceride levels decreased from 142.9 mg/dL to 98 mg/dL (P < .0001); high-density lipoprotein levels increased from 47.0 mg/dL to 57.5 mg/dL (P < .0001). Two complications occurred: a case of respiratory insufficiency and an asymptomatic pneumoperitoneum treated conservatively. Small number of patients. Short-term follow-up. Twenty-one percent of patients were not available for the 12-month follow-up. The TOGA procedure allowed a substantial weight loss 1 year after the operation without severe complications. A long-term evaluation is needed before definitive conclusions can be drawn.
    Gastrointestinal endoscopy 12/2011; 74(6):1248-58. · 6.71 Impact Factor
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    ABSTRACT: Obesity is a worldwide epidemic, complex metabolic disease associated with a variety of severe comorbidities. Bariatric surgery provides the patients with the benefits of sustained weight loss and improves obesity-related comorbidities, but can result in potentially life-threatening complications. Gastrointestinal endoscopy has recently been proposed as a scarless and noninvasive approach to obesity. Most of the current endoluminal devices and techniques are comparable to restrictive surgery. A variety of medical devices and procedures have been evaluated in recent years; however, with the exception of the intragastric balloon, evaluation of all the other endoluminal procedures is limited by the numbers of patients treated, the short follow-up and especially by the study design. Today, only a few devices have been evaluated in randomized controlled trials. The preliminary results of the first studies are extremely promising, but definitive statements cannot be drawn yet.
    Expert review of gastroenterology & hepatology 12/2011; 5(6):689-701.

Publication Stats

496 Citations
244.12 Total Impact Points


  • 2006–2014
    • Catholic University of the Sacred Heart
      • Digestive Endoscopy Unit
      Milano, Lombardy, Italy
    • Policlinico Universitario Agostino Gemelli
      Roma, Latium, Italy
  • 2004–2014
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2005–2007
    • Columbus-Gemelli University Hospital
      Roma, Latium, Italy