Publications (33)121.08 Total impact
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Article: Endoscopic retrieval of a duodenal perforating teaspoon.
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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. -
Article: Prospective evaluation of the partially covered nitinol "ComVi" stent for malignant non hilar biliary obstruction.
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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; · 3.05 Impact Factor -
Article: Peroral endoscopic myotomy (POEM) for oesophageal achalasia: Preliminary results in humans.
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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. · 3.05 Impact Factor -
Article: Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting: a prospective study with 2 years of follow-up.
Gastrointestinal endoscopy 03/2012; 75(6):1271-7. · 6.71 Impact Factor -
Article: "Doctor, I have a long, sausage-shaped lump in my abdomen".
Gastrointestinal endoscopy 02/2012; 75(5):1100-1; discussion 1102. · 6.71 Impact Factor -
Article: Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome.
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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 -
Article: Endoscopic treatment of obesity.
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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. -
Article: Plastic biliary stents for benign biliary diseases.
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ABSTRACT: Biliary plastic stenting plays a key role in the endoscopic management of benign biliary diseases. Complications following surgery of the biliary tract and liver transplantation are amenable to endoscopic treatment by plastic stenting. Insertion of an increasing number of plastic stents is currently the method of choice to treat postoperative biliary strictures. Benign biliary strictures secondary to chronic pancreatitis or primary sclerosing cholangitis may benefit from plastic stenting in select cases. There is a role for plastic stent placement in nonoperative candidates with acute cholecystitis and in patients with irretrievable bile duct stones.Gastrointestinal endoscopy clinics of North America 07/2011; 21(3):405-33, viii. -
Article: Successful off-label use of enteral stents in uncommon complicated biliary tract diseases.
Gastrointestinal endoscopy 04/2011; 73(4):828-32. · 6.71 Impact Factor -
Article: An unusual post-ERCP pneumoperitoneum.
Digestive and Liver Disease 03/2011; 43(7):579. · 3.05 Impact Factor -
Chapter: The Role of Interventional Endoscopy
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ABSTRACT: Interventional endoscopy has a key role in the palliation of pancreatic cancer. Biliary obstruction leading to jaundice and hitching can be safely resolved by endoscopic plastic or metal stenting. Metal stents have a longer patency than plastic, and are cost-effective in patients with 4-6 months life expectancy. Endoscopic palliation of jaundice improves the quality of life, is mini-invasive, safe and effective and is preferred to surgery or interventional radiology. The main problem of biliary stents is cholangitis recurrence due to stent clogging: the development of new drug-eluting stent maybe will improve stent patency in the near future. Also pain in pancreatic cancer can be reduced by endoscopic pancreatic stenting or EUS-guided celiac plexus block/neurolysis in selected cases. A late complication of pancreatic cancer is the developmant of a duodenal stricture and Gastric Outlet Obstruction Symptoms. This complication, which usually occurs in end-stage and fragile patients, can be resolved by endoscopic insertion of a duodenal metal stents. Duodenal stenting is preferred to surgery due to its lower morbidity and mortality, shorter hospitalization and earlier symptoms relief. ERCP and EUS are also a tool for intraluminal brachytherapy and delivery of cytotoxic agents directly into the pancreatic tumor. This latest possibility can represent a future approach to pancreatic and other tumors.01/2011: pages 147-165; -
Article: Update in biliary endoscopy.
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ABSTRACT: Biliary endoscopy has seen the development of several new techniques in the last few years. Its current role includes direct diagnostic imaging, tissue sampling, early diagnosis and palliation of biliary tumors. Relatively new methods for biliary stones management are electrohydraulic lithotripsy combined with choledochoscope guidance and laser lithotripsy. Intraductal ultrasound, confocal laser endomicroscopy and optical coherence tomography are emerging, purely diagnostic endoscopic tools in biliary endoscopy. Cytological examinations such as digital imaging analysis and fluorescence in situ hybridization have the potential of becoming very important in the early diagnosis of biliary tumors. Direct visualization of the biliary mucosa and tissue sampling can be done with the last generation of cholangioscopes. All these tools are promising, especially for the 'undetermined biliary strictures'. Improvements in quality of life, survival and biliary drainage in patients with non-operable cholangiocarcinoma have been reported after the application of both photodynamic therapy and high-dose rate intraluminal brachytherapy. Drug-eluting stents with incorporated anti-tumor agents designed to improve patency and reduce the risk of tumor ingrowth have already been tested, and other stents are under investigation as well.Digestive Diseases 01/2011; 29 Suppl 1:3-8. · 2.37 Impact Factor -
Article: Self-expandable metallic stents for malignant gastric outlet obstruction.
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ABSTRACT: Duodenal self-expandable metal stents (SEMS) are designed for palliation and prompt relief of malignant gastric outlet obstruction (GOO). This mini-invasive endoscopic treatment is preferable to surgery due to its lower morbidity and mortality, shorter hospitalization, and earlier symptoms relief; furthermore endoscopic enteral stenting can be performed under conscious sedation, reducing the risk of general anesthesia in these already fragile patients. The stent placement technique is well established and should be performed in referral centers with adequate materials and equipment. Duodenal stents can be covered and uncovered. Nitinol stents have almost replaced other materials, being more flexible with a satisfactory axial and radial force. Common duodenal SEMS-related complications are recurrence of GOO symptoms due to stent clogging (tissue ingrowth/overgrowth and food impaction) and stent migration. These complications can be usually managed endoscopically. Perforation and bleeding are the most severe, but rare, complications. After stent placement, malignant GOO patients usually have improvement of the GOO symptoms with good resumption of fluids and solids. Choosing the most appropriate type of stent is arduous and should be done mainly in relation to the morphological aspects of the stricture. Endoscopic duodenal SEMS placement is indicated in symptomatic GOO patients suffering from unresectable malignancy or those inoperable due to advanced age or comorbidities. The absence of peritoneal carcinomatosis and multiple small bowel strictures is a key point for the clinical success of duodenal SEMS. Almost all symptomatic malignant GOO patients are candidates for the duodenal SEMS procedure; resolution of GOO, avoiding the need for a permanent naso-gastric or percutaneous endoscopic gastrostomy tube, significantly improves the patients' quality of life and dignity, even if life expectancy is short. Endoscopic duodenal SEMS insertion, after an adequate training, is a reproducible, simple, safe, and cost-effective procedure.Advances in Therapy 10/2010; 27(10):691-703. · 2.11 Impact Factor -
Article: EUS-guided therapeutic interventions for uncommon benign pancreaticobiliary disorders by using a newly developed forward-viewing echoendoscope (with videos).
Gastrointestinal endoscopy 03/2010; 72(1):213-5. · 6.71 Impact Factor -
Article: Endoscopic treatment of a recalcitrant esophageal fistula with new tools: stents, Surgisis, and nitinol staples (with video).
Gastrointestinal endoscopy 03/2010; 72(3):647-50. · 6.71 Impact Factor -
Article: Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training.
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ABSTRACT: The Olympus colonoscopy simulator provides a high-fidelity training platform designed to develop knowledge and skills in colonoscopy. It has the potential to shorten the learning process to competency. To investigate the efficacy of the simulator in training novices in colonoscopy by comparing training outcomes from simulator training with those of standard patient-based training. Multinational, multicenter, single-blind, randomized, controlled trial. Four academic endoscopy centers in the United Kingdom, Italy, and The Netherlands. This study included 36 novice colonoscopists who were randomized to 16 hours of simulator training (subjects) or patient-based training (controls). Participants completed 3 simulator cases before and after training. Three live cases were assessed after training by blinded experts. Automatically recorded performance metrics for the simulator cases and blinded expert assessment of live cases using Direct Observation of Procedural Skills and Global Score sheets. Simulator training significantly improved performance on simulated cases compared with patient-based training. Subjects had higher completion rates (P=.001) and shorter completion times (P < .001) and demonstrated superior technical skill (reduced simulated pain scores, correct use of abdominal pressure, and loop management). On live colonoscopy, there were no significant differences between the 2 groups. Assessment tools for live colonoscopies may lack sensitivity to discriminate between the skills of relative novices. Performance of novices trained on the colonoscopy simulator matched the performance of those with standard patient-based colonoscopy training, and novices in the simulator group demonstrated superior technical skills on simulated cases. The simulator should be considered as a tool for developing knowledge and skills prior to clinical practice.Gastrointestinal endoscopy 11/2009; 71(2):298-307. · 6.71 Impact Factor -
Article: EUS-guided drainage of a pericardial cyst: closer to the heart (with video).
Gastrointestinal endoscopy 08/2009; 70(6):1273-4. · 6.71 Impact Factor -
Article: Isotretinoin-associated pan-enteritis.
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ABSTRACT: A 22-year-old man has been recently admitted to our Department with a 10-day history of melena. Because of nodular acne, the patient had been treated with Isotretinoin, a 13-cis-retinoic acid (20-mg twice daily, for 15 d). Upper gastrointestinal endoscopy revealed edema and hyperemia of the gastric mucosa of the body and antrum. Flexible sigmoidoscopy revealed edema and hyperemia of the mucosa of the rectum and sigmoid colon with numerous erosions. To exclude the possibility of small bowel involvement the patient underwent video capsule endoscopy that showed a diffuse and extensive intestinal inflammation with multiple linear, irregular-shaped jejunal ulcerations, and apthae. Isotretinoin was discontinued and the patient improved with complete resolution of symptoms.Journal of clinical gastroenterology 09/2008; 42(8):923-5. · 2.21 Impact Factor -
Article: Endoscopic biliopancreatic investigations and therapy.
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ABSTRACT: The management of most biliopancreatic diseases benefits from endoscopic treatment. Forty years after the first endoscopic cannulation of the ampulla of Vater, the overall effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) can be evaluated using the quality assurance programs that have recently been developed for gastrointestinal endoscopy, including ERCP. Such evaluation does not mean simply reporting therapeutic success and complication rates; rather, it involves a complex analysis of the entire gastrointestinal unit, of the medical practises, and of patient satisfaction. The overall quality of ERCP has been analysed and many quality deficits identified, even in referral centres. Training for such a specialised procedure is difficult and expensive. Competence in ERCP requires as many as 200 ERCP procedures. Quality assurance programs can help to improve the overall quality of endoscopic practise, including training of young endoscopists.Baillière' s Best Practice and Research in Clinical Gastroenterology 02/2008; 22(5):865-81. · 2.46 Impact Factor -
Article: Video capsule endoscopy in small-bowel tumours: a single centre experience.
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ABSTRACT: Early diagnosis of small-bowel tumours is crucial for curative surgery. Although videocapsule endoscopy (VCE) has improved the diagnosis of small-bowel diseases, there are few data about the role of this examination in small-bowel malignancies. The aim of this study was to evaluate the diagnostic yield of VCE in small-bowel malignancies. From March 2001 to July 2006, 380 patients were studied by VCE in our centre. Data on 13 consecutive patients (3.4%) affected by small-bowel malignancy were retrospectively assessed from a prospectively collected database. Indications for VCE were: obscure gastrointestinal bleeding in 9 patients (70%), abdominal pain, coeliac disease, long-lasting fever and hepatic metastasis in the other 4 patients, respectively, (7.5%). Before VCE, patients had undergone 65 procedures, including oesophagogastroduodenoscopy, colonoscopy, push-enteroscopy, small-bowel radiographies, abdominal CT scanning, nuclear medicine bleeding-scan, positron emission tomography and octreoscan. VCE detected jejunal polyps in 6 patients (46.2%), ulcerated stricture in 3 (23%), and erosions, stricture with ileal inflammation, submucosal nodule and active bleeding in 4 patients, respectively. The diagnosis was confirmed after surgery in 11 cases. One patient died of ischaemic myocardial infarction 3 days after VCE, before surgery. Histological examination showed lymphoma (n=3), small-bowel metastasis from colonic carcinoma (n=3), carcinoid tumour (n=3), gastrointestinal stromal tumour (GIST) (n=2), metastatic melanoma (n=1) and primary small-bowel adenocarcinoma (n=1). VCE had an influence on the diagnosis or management of 10/13 patients. VCE is the diagnostic test with the highest yield for small-bowel malignancies, since it can detect small-bowel tumours that are often missed by traditional examinations.Scandinavian journal of gastroenterology 02/2008; 43(4):497-505. · 2.08 Impact Factor
Top co-authors
Top Journals
Institutions
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2006–2012
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Università Cattolica del Sacro Cuore
- Digestive Endoscopy Unit
Roma, Latium, Italy
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2005–2010
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The Catholic University of America
Washington, D. C., DC, USA
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2007
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Columbus-Gemelli University Hospital
Roma, Latium, Italy
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