Cesare Hassan

Istituto Clinico Humanitas IRCCS, Rozzano, Lombardy, Italy

Are you Cesare Hassan?

Claim your profile

Publications (268)1122.12 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Colon capsule endoscopy (CCE) is a minimally invasive technique specifically designed to explore the colon without sedation and air insufflation. CCE may overcome some of the limitations of colonoscopy. Second-generation CCE (CCE-2) was proved accurate in detecting colonic neoplastic lesions when used in average-risk individuals. The evidence to date supports the use of CCE-2 in cases of colonoscopy failure, in patients unwilling to undergo colonoscopy, and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease, require clarification. Copyright © 2015 Elsevier Inc. All rights reserved.
    Gastrointestinal endoscopy clinics of North America 04/2015; 25(2):387-401. DOI:10.1016/j.giec.2014.11.007
  • [Show abstract] [Hide abstract]
    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule prior to capsule endoscopy in these patients (strong recommendation, low quality evidence). In the presence of obstructive symptoms or known stenosis, ESGE recommends that dedicated small bowel cross-sectional imaging modalities such as magnetic resonance enterography/enteroclysis or computed tomography enterography/enteroclysis should be used first (strong recommendation, low quality evidence). 6 In patients with established Crohn's disease, based on ileocolonoscopy findings, ESGE recommends dedicated cross-sectional imaging for small-bowel evaluation since this has the potential to assess extent and location of any Crohn's disease lesions, to identify strictures, and to assess for extraluminal disease (strong recommendation, low quality evidence). In patients with unremarkable or nondiagnostic findings from such cross-sectional imaging of the small bowel, ESGE recommends small-bowel capsule endoscopy as a subsequent investigation, if deemed to influence patient management (strong recommendation, low quality evidence). When capsule endoscopy is indicated, ESGE recommends use of the PillCam patency capsule to confirm functional patency of the small bowel (strong recommendation, low quality evidence). 7 ESGE strongly recommends against the use of small-bowel capsule endoscopy for suspected coeliac disease but suggests that capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy (strong recommendation, low quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 04/2015; 47(4):352-386. DOI:10.1055/s-0034-1391855 · 5.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with history of colonic resection for cancer have an increased risk of the development of metachronous malignant and premalignant lesions. Scanty data are reported on detection rates of premalignant lesions during colonoscopy surveillance in this setting. To assess the risk of metachronous precancerous lesions developing in patients with previous colonic surgery for cancer according to the resection type. Retrospective study. Two academic centers in Italy. A total of 441 patients; 256 with previous left-sided colectomy (LCR) (LCR group) and 185 with previous right-sided colectomy (RCR) (RCR group). Second surveillance colonoscopy. Polyp and adenoma detection rates. At least 1 adenoma was diagnosed in 76 of 256 patients (30% adenoma detection rate) and in 35 of 185 patients (19% adenoma detection rate) in the LCR and RCR groups, respectively (P = .014), yielding an odds ratio of 1.83 (95% confidence interval, 1.16-2.89). Corresponding figures for the polyp detection rate were 39% and 25%, respectively (P = .002; odds ratio 1.97; 95% confidence interval, 1.30-3.00). Retrospective study with colonoscopy baseline information missing. Patients who have undergone LCR are at higher risk of the development of adenomas than those who have undergone RCR. If this result is confirmed by large prospective studies, surveillance programs could be targeted according to the type of colonic resection, with longer intervals for patients with previous RCR compared with LCR. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal endoscopy 03/2015; DOI:10.1016/j.gie.2014.12.057 · 4.90 Impact Factor
  • Cesare Hassan, Alessandro Repici
    Nature Reviews Gastroenterology &#38 Hepatology 03/2015; DOI:10.1038/nrgastro.2015.38 · 10.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.
    Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates 03/2015; 38(2):107-10. DOI:10.1097/SGA.0000000000000096 · 0.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endo-sponge treatment is a novel approach to manage selected patients with anastomotic leakage following colorectal surgery. However, the available data are still scanty. To evaluate the efficacy and safety of the endo-sponge therapy in a large series, and to perform a review of the current evidence concerning such a treatment. Consecutive patients diagnosed with partial colonic anastomotic leakage managed with endo-sponge placement were enrolled. The endo-sponge system was changed every 48-72h as outpatient, until to cavity closure. Literature review was performed for pooled-data analysis. Twenty-five patients were enrolled, including 13 (52%) with diverting ileostomy. Following endo-sponge applications (median sessions: 9, range: 1-39; median treatment duration: 4 weeks, range: 1-32), a complete healing was achieved in 22 (88%) patients. Three (12%) patients developed a major complication (1 uretheric fistula, 1 ileal fistula, and 1 pararectal abscess), all successfully treated by surgery. Ileostomy closure was achieved in 11 (84.6%) patients. No mortality related to the procedure was observed. Overall, 174 patients treated with endo-sponge were reported in literature. By considering data of the larger 7 studies, a complete healing of presacral cavity was achieved in 131 (94.3%) out of 149 patients. Our relatively large series of patients confirmed the efficacy, tolerability, and an acceptably low complication rate of endo-sponge therapy for colorectal anastomosis leakage treatment. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the efficacy and safety of endoscopic resection of large colorectal polyps. Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I(2) statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I(2)=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I(2)=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Gut 02/2015; DOI:10.1136/gutjnl-2014-308481 · 13.32 Impact Factor
  • Cesare Hassan, Ian M. Gralnek
    [Show abstract] [Hide abstract]
    ABSTRACT: Compared to standard forward viewing colonoscopy, we aimed to assess the cost-effectiveness of full spectrum endoscopy colonoscopy in a population-based colorectal cancer screening and surveillance program. A Markov model was constructed to simulate the occurrence of colorectal neoplasia in a cohort of 100,000 subjects aged 50-100 years. The cost-effectiveness of full spectrum endoscopy was compared with that of standard forwarding viewing colonoscopy. Sensitivity for adenomatous and hyperplastic polyps <5mm, 6-9mm, and high-risk polyps were derived from the recent randomized tandem Fuse colonoscopy study. The significantly higher sensitivity of full spectrum endoscopy in detecting additional adenomas resulted in an increase in cancer prevention from 58% to 74%, corresponding to a gain of 9 days per person. This 14% increase led to an absolute reduction in the cost of cancer care from $90 million to $57 million. This cost savings was only minimally impacted by the higher cost of more frequent post-polypectomy colonoscopy surveillance rates, leading to full spectrum endoscopy being associated with a savings of $145 per person. Thus, standard colonoscopy appeared to be "dominated" by the full spectrum endoscopy. Compared to standard colonoscopy, full spectrum endoscopy appears to be more cost-effective for colon cancer screening and surveillance. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Serrated lesions have been recently implicated in colorectal carcinogenesis. Adenoma detection rate has been related with the risk of interval cancer. The correlation between adenoma detection rate and the serrated lesion detection rate is unclear.
    Digestive and Liver Disease 01/2015; 79(5). DOI:10.1016/j.dld.2015.01.003 · 2.89 Impact Factor
  • Cesare Hassan, Jean-Marc Dumonceau
    Endoscopy 01/2015; 47(1):88. DOI:10.1055/s-0034-1378099 · 5.20 Impact Factor
  • European Radiology 01/2015; DOI:10.1007/s00330-014-3435-z · 4.34 Impact Factor
  • Journal of Clinical Gastroenterology 01/2015; 49(1):88-89. DOI:10.1097/MCG.0000000000000139 · 3.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and study aim: Poorly differentiated/high grade pancreatic ductal adenocarcinoma (PDAC) is associated with an early unfavorable outcome, and patients with these tumors may be candidates for neo-adjuvant treatment. Endoscopic ultrasound-guided pancreatic fine-needle biopsy (EUS-FNB) may, in theory, allow preoperative assessment of PDAC histological grading. The aim of the current study was to assess the interobserver agreement and accuracy of preoperative PDAC grading from EUS-FNB specimens. Methods: Data from 42 postsurgical PDAC patients who had undergone preoperative EUS-FNB were retrieved. Four experienced pathologists independently reviewed the EUS-FNB slides and reported tumor grading (well, moderately, or poorly differentiated). Agreement among pathologists for grading of preoperative EUS-FNB samples was expressed by using Cohen's or Fleiss' kappa statistic, as appropriate. Postsurgical PDAC grading was used as the gold standard to assess the cumulative accuracy of EUS-FNB for the preoperative prediction of PDAC grading. Results: The kappa values for PDAC grading on EUS-FNB specimens ranged from 0.09 to 0.41. The total agreement among the four pathologists was only fair (κ = 0.27; 95 % confidence interval [CI] 0.14 - 0.38). When tumor grades were grouped as well or moderately differentiated vs. poorly differentiated, kappa values ranged from 0.19 to 0.50, with only a fair overall agreement (κ = 0.27; 95 %CI 0.21 - 0.49). The accuracy of preoperative grading from EUS-FNB was 56 % (75/134 readings; 95 %CI 40 % - 65 %), with mean sensitivity and specificity to detect a high grade, poorly differentiated tumor of 41 % (95 %CI 19 % - 54 %) and 78 % (53/68 readings; 95 %CI 60 % - 99 %), respectively. Conclusions: Preoperative EUS-FNB-based histological grading of PDAC is unreliable, and current results do not support the use of this information in clinical practice. This appears to be due to suboptimal interobserver agreement among pathologists and an overall low accuracy in predicting postsurgical grading. © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 12/2014; DOI:10.1055/s-0034-1390912 · 5.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colonoscopy is usually perceived as an invasive and potentially painful procedure, being also affected by a small, but definite, risk of major complications (cardiopulmonary complications, perforation, hemorrhage) and even mortality. To improve both acceptability and safety, PillCam Colon Capsule Endoscopy (CCE) (Given Imaging Ltd, Yoqneam, Israel) has been developed. CCE represents a non-invasive technique that is able to explore the colon without sedation and air insufflation. The Second Generation of Colon Capsule Endoscopy (PillCam Colon 2) (CCE-2) was proven to be an accurate tool to detect colonic neoplastic lesions when used in average risk individuals. To date, the evidence supports the use of CCE-2 in case of colonoscopy failure, in patients unwilling to perform colonoscopy and when colonoscopy is contraindicated. Other potential applications, such as colorectal cancer screening or diagnostic surveillance of inflammatory bowel disease need to be clarified. In this paper, the current "state of the art", potential application of CCE and future needs are evaluated.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. ESGE guidelines represent a consensus of best practice based on the available evidence at the time of preparation. They may not apply in all situations and should be interpreted in the light of specific clinical situations and resource availability. Further controlled clinical studies may be needed to clarify aspects of these statements, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations. ESGE guidelines are intended to be an educational device to provide information that may assist endoscopists in providing care to patients. They are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment.
    Gastrointestinal Endoscopy 11/2014; 80(5):747–761.e75. DOI:10.1016/j.gie.2014.09.018 · 4.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The European Society of Gastrointestinal Endoscopy (ESGE) is dedicated to improving the quality of gastrointestinal endoscopy through educational activities such as live endoscopy events (LEEs). The primary utility of LEEs is the educational value for the audience, and patients should not expect additional benefit from being treated during a LEE compared to a routine setting. Although there is no evidence that LEEs entail additional risks for patients, neither can possible unknown risks be excluded as the evidence available is limited. Therefore, necessary measures should be taken to assure patient safety. Patients must be adequately informed that the standard of care will be assured and that their identity will not be revealed. ESGE recommends that an endoscopist not belonging to the hosting unit is named as patient advocate. Clinical indications for the LEE procedures and the educational outputs must be clear and agreed between host and demonstrator teams. ESGE will ensure that in all ESGE-organized LEEs the indications, procedural descriptions, and adverse events will be registered, and that organizers requesting ESGE endorsement can demonstrate such a registry.
    Endoscopy 10/2014; 47(1). DOI:10.1055/s-0034-1390705 · 5.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.
    Endoscopy 09/2014; 25(2). DOI:10.1055/s-0034-1378092 · 5.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective single-centre study aims to evaluate a new diagnostic algorithm using capsule endoscopy, colon capsule endoscopy and single-balloon enteroscopy in the work-up of obscure gastrointestinal bleeding in children.
    Digestive and Liver Disease 09/2014; 47(2). DOI:10.1016/j.dld.2014.09.001 · 2.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The majority of currently available oesophageal metal stents are partially covered to reduce migration risk. Preliminary experiences with fully covered stents seem to indicate an increased risk of migration in patients treated for malignant dysphagia. The aim of our study was to determine, in this setting, the safety and efficacy of a new, recently introduced stent with anti-migration proprieties. Methods: We designed a prospective, multicentre, non-randomized, follow-up study in nine tertiary referral centres. Eighty-two patients with dysphagia due to inoperable or metastatic oesophageal cancer were included. In all of them the fully covered WallFlex (R) stent was placed. Main outcome measurements included functional outcome, recurrent dysphagia, complications, and mortality. Results: Dysphagia score improved from a median of 3, before stenting, to 1 at 4 weeks after stent placement (P < 0.001). Perforation occurred in 1 patient after 39 days, while bleeding was reported in 3. In total, 19 patients (23.1%) developed recurrent dysphagia because of stent migration (N = 10, 12.2%), tissue overgrowth (N = 7; 8.5%), and food impaction (N = 2; 2.4%). Conclusions: Placement of the fully covered WallFlex (R) stent resulted in safe and effective palliation of malignant dysphagia, with migration and tissue overgrowth rates comparable to previously reported data on partially covered stents.
    Digestive and Liver Disease 09/2014; 46(12). DOI:10.1016/j.dld.2014.08.037 · 2.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Prevalence of gastroduodenal lesions is changing in the last decades. Prevalence of Helicobacter pylori infection, non-steroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitor (PPI) therapy may be involved in such a phenomenon. We assessed gastroduodenal lesions prevalence in a nationwide study. Materials and methods: Consecutive patients who underwent upper endoscopy for the first time in 24 Italian centres between January 2012 and 31 March 2012 were enrolled. Prevalence of gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenal erosions (DE), gastric polyp (GP), Barrett's oesophagus (BE), and neoplasia was assessed. Results: Overall, 1054 (M/F: 388/666; Mean age: 57.5 +/- 5 years) patients were enrolled. H. pylori infection was detected in 356 (33.9%) patients, 358 (34%) were taking NSAIDs, and 532 (50.5%) PPIs. PPI therapy was associated with a significantly lower H. pylori detection rate (27.8% vs 39.8%; OR: 0.6, 95% CI 0.45-0.77; P < 0.001). GU, DU, GE, DE, GP and BE were detected in 17 (1.6%), 13 (1.2%), 150 (14.2%), 50 (4.7%), 51 (4.8%) and 17 (1.6%), respectively. Moreover, 3 (0.3%) distal gastric cancers were observed. H. pylori infection remained the most prevalent factor for all gastroduodenal lesions, but gastric polyp. One third of patients with GU and GE were taking only NSAIDs therapy. Conclusions: The prevalence of peptic ulcer was very low(<3%), with a similar rate between DU and GU. As many as half patients were on ongoing PPI therapy. Such a therapy could affect both the detection rate of H. pylori infection and the real prevalence of gastroduodenal lesions.
    European Journal of Internal Medicine 09/2014; 25(8). DOI:10.1016/j.ejim.2014.08.010 · 2.30 Impact Factor

Publication Stats

3k Citations
1,122.12 Total Impact Points


  • 2011–2015
    • Istituto Clinico Humanitas IRCCS
      • Department of Gastroenterology
      Rozzano, Lombardy, Italy
    • Indiana University-Purdue University Indianapolis
      Indianapolis, Indiana, United States
  • 2010–2015
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 1970–2015
    • Ospedale Nuovo Regina Margherita
      Roma, Latium, Italy
  • 2014
    • American Society for Gastrointestinal Endoscopy
      Society Hill, New Jersey, United States
  • 2010–2014
    • Catholic University of the Sacred Heart
      • Digestive Endoscopy Unit
      Milano, Lombardy, Italy
    • Sapienza University of Rome
      • Department of Radiological, Oncological and Pathological Sciences
      Roma, Latium, Italy
  • 2010–2012
    • Università degli studi di Foggia
      • Department of Medical and Surgical Sciences
      Foggia, Apulia, Italy
  • 2005–2012
    • Sant'Andrea Medical Hospital
      Spezia, Liguria, Italy
  • 2009–2010
    • University of Wisconsin–Madison
      • Department of Radiology
      Madison, Wisconsin, United States
    • Sant´Andrea Hospital
      Roma, Latium, Italy
  • 2007
    • Università degli Studi di Palermo
      Palermo, Sicily, Italy
    • University of Bologna
      • Department of Medical and Surgical Sciences DIMEC
      Bolonia, Emilia-Romagna, Italy