Silvia Gaia

Publications (15)74.42 Total impact

• Article: Duodenoscope entrapped by over-the-scope clip: Paradoxical image.

  Franco Coppola, Silvia Gaia, Serafino Recchia, Emanuela Rolle
  Digestive and Liver Disease 09/2012; · 3.05 Impact Factor
• Article: ERCP after Fag Kan Roux-en-Y-hepatojejunostomy in Caroli's syndrome.

  Franco Coppola, Roberto Bini, Silvia Gaia, Maurizio Cosimato, Serafino Recchia
  Gastrointestinal endoscopy 07/2011; 74(1):235-6. · 6.71 Impact Factor
• Article: Enteroscope without overtube for cecal intubation after an incomplete colonoscopy.

  Franco Coppola, Silvia Gaia, Maurizio Cosimato, Serafino Recchia
  [show abstract] [hide abstract]
  ABSTRACT: Cecal intubation is one of the targets of colon endoscopic evaluation, however even under experienced hands 5-10% of colonoscopies are incomplete. The aim of the study is to evaluate the usefulness of single balloon enteroscope (SBE) without employing overtube-balloon equipment in patients with incomplete colonoscopy. Between January 2009 and July 2010, patients with an incomplete standard colonscopy were prospectively enrolled to perform a colonoscopy with a single balloon enteroscope. Examinations were performed by the same expert operator during the same session. Enteroscopy was performed on 79 patients, cecal intubation were obtained in 93.6% of the cases (74/79). It provided a new diagnosis in 43% of cases (34/79). Procedure was safe and well tolerated. Overall the additional use of single balloon enteroscope allowed to obtain the cecal intubation in up to 99.2% cases (898/905). The use of the enteroscope without overtube-balloon equipment may be an effective method to increase the cecal intubation rate after failure of a standard colonoscopy.
  Digestive and Liver Disease 02/2011; 43(6):475-7. · 3.05 Impact Factor
• Article: Reply to comments on "Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis"

  Silvia Gaia
  Journal of Hepatology 01/2011; · 9.26 Impact Factor
• Article: Endoscopic treatment of postgastrectomy duodenal fistula with an over-the-scope clip.

  Roberto Bini, Franco Coppola, Serafino Recchia, Marcella Fusca, Silvia Gaia, Renzo Leli
  [show abstract] [hide abstract]
  ABSTRACT: Bleeding peptic ulcer is a life threatening condition with high mortality rate but often treatable by endoscopy. Surgical indications in case of gastroduodenal ulcers are confined to endoscopic and radiological failures in bleeding control. Duodenal fistula (DF) is a rare complication of gastric resection and even if a rare event it may be a life threatening condition. Surgical and medical options could not solve the DF. Herein we report a case of an old patient underwent emergency gastrectomy for ulcer's bleeding who developed DF associated to sepsis, malnutrition and, hydro-electrolyte disorders not responding to surgical and medical attempts. We demonstrated, for the first time, the efficacy of over the scope clips (OTSC®) in the treatment of postoperative duodenal fistulas not responding to surgical and medical treatment in high risk patient.
  Surgical Innovation 01/2011; 18(1):102-4. · 2.13 Impact Factor
• Article: Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis.

  Silvia Gaia, Silvia Carenzi, Angela L Barilli, Elisabetta Bugianesi, Antonina Smedile, Franco Brunello, Alfredo Marzano, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: Transient elastography (TE) is validated in chronic hepatitis C (CHC) to evaluate hepatic fibrosis; however, limited data are available in chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD). This prospective study is aimed to assess the accuracy and the efficacy of TE for the detection of fibrosis in patients with chronic liver disease of different etiology and to evaluate the effect of steatosis on the liver stiffness measurement (LSM). TE was performed in 219 consecutive patients with chronic liver disease (35% CHC, 32% CHB, and 33% NAFLD) within 6 months of the liver biopsy. LSM was related to the fibrosis stage in each group (CHC: p = 0.596, p < 0.001; CHB: p = 0.418, p < 0.001; NAFLD: p = 0.573, p < 0.001), but the correlation was less strong in CHB and NAFLD than in CHC patients. In CHB patients with histological cirrhosis (F4), the median stiffness value was almost two times lower than in patients with severe fibrosis (F3). In NAFLD patients with advanced fibrosis (F3) and severe steatosis (> 33%), the LSM values were lower than expected and were similar to those of patients with initial fibrosis (F1) and fat < 33%. TE underestimated the stage of fibrosis in 75% of patients with F3 and steatosis > 33%. At multiple logistic regression analysis, in CHC and CHB patients, LSM was the only predictive variable of severe fibrosis/cirrhosis (OR = 1.42, p = 0.003 and OR = 1.354, p = 0.003, respectively), while in NAFLD subjects BMI and AST (OR = 1.433, p = 0.002 and OR = 1.053, p = 0.020, respectively) but not LSM were independently related with advanced fibrosis and cirrhosis. This study confirms that TE can be considered a valid support to detect fibrosis in chronic liver disease related to HCV but it should be interpreted cautiously in CHB and NAFLD patients, where host or disease-related factors may modify its accuracy.
  Journal of Hepatology 08/2010; 54(1):64-71. · 9.26 Impact Factor
• Article: Lamivudine-resistant chronic hepatitis B: an observational study on adefovir in monotherapy or in combination with lamivudine.

  Silvia Gaia, Valeria Barbon, Antonina Smedile, Antonella Olivero, Silvia Carenzi, Marco Lagget, Carlo Alessandria, Mario Rizzetto, Alfredo Marzano
  [show abstract] [hide abstract]
  ABSTRACT: In lamivudine-resistant patients with chronic hepatitis B (CHB), we compared efficacy, predictive response factors and changes in viral mutants in two antiviral approaches with adefovir. A prospective cohort study on therapy with adefovir alone (29 patients) or combined with ongoing lamivudine (23 patients) was performed. A virological response was achieved in 55% of patients treated with adefovir and in 83% of those treated with the combination (p>0.05). This response was directly related to the basal viral load (p<0.0001) and obtained in 10 patients with basal HBV-DNA<17,200 IU/ml using both strategies. In patients with a higher basal viral load, the virological response was more frequent when treated with the combination (p<0.05). Mutation at locus rt181 predicted HBV-DNA persistence during therapy. A virological rebound was observed in 18% of non-responders while on adefovir monotherapy. To achieve a complete virological response and reduce the risk of adefovir-resistant mutants in lamivudine-resistant patients, rescue therapy is preferable at early evidence of genotypic resistance. However, in subjects with a significant viral load, combination therapy is more effective. The presence of the rt181 mutation is associated with incomplete response.
  Journal of Hepatology 04/2008; 48(4):540-7. · 9.26 Impact Factor
• Article: Epithelial microchimerism: consistent finding in human liver transplants.

  Silvia Gaia, Susanna Cappia, Antonina Smedile, Elisa Bacillo, Ezio Gaia, Luciano Gubetta, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: Eleven liver biopsies from six male patients who received a liver transplant (LT) from female donors were examined in order to determine whether male host-derived hepatic cells were present in female grafts that exhibited minimal or important inflammatory damage. Immunohistochemistry for epithelial cell type differentiation (anticytokeratin monoclonal antibody) and fluorescence in situ hybridization for XY chromosomes identification were performed on each slide. Host-derived hepatic cells were found in all except one transplant, with a frequency ranging from 2.3 to 25 per thousand of the total hepatocytes in the biopsy specimen. They were usually found as isolated cells scattered throughout the hepatic lobule; in one patient they were grouped into little clusters. Host-derived hepatic cells persisted throughout the histological follow up (up to 535 days after LT). Polyploidy for XY chromosome was observed. Hepatocytes derived from extra-hepatic stem cells are frequently found in small numbers in human liver grafts and persist over time.
  Journal of Gastroenterology and Hepatology 01/2007; 21(12):1801-6. · 2.87 Impact Factor
• Article: Feasibility and safety of G-CSF administration to induce bone marrow-derived cells mobilization in patients with end stage liver disease.

  Silvia Gaia, Antonina Smedile, Paola Omedè, Antonella Olivero, Fiorella Sanavio, Federico Balzola, Antonio Ottobrelli, Maria Lorena Abate, Alfredo Marzano, Mario Rizzetto, Corrado Tarella
  [show abstract] [hide abstract]
  ABSTRACT: To evaluate feasibility, safety and pattern of bone marrow-derived cells (BMC) mobilization in patients with end stage liver cirrhosis following granulocyte-colony stimulating factor (G-CSF) administration. Eight patients with severe liver cirrhosis (Child-Pugh score B-C, spleen diameter less than 170 mm) were included. They were treated with G-CSF (5 microg/kg b.i.d for three consecutive days) to mobilize BMC, evaluated as circulating CD34+ve cells (flow cytometry) and myeloid CFU-GM progenitors (in vitro colony growth assay). Co-expression in CD34+ve cells markers of differentiation (Thy1, CD133, CXCR4, c1qRp) were investigated on CD34+ve cells by double direct immunofluorescence. Data from 40 healthy haematopoietic stem cell donors were used as controls. Mobilization of CD34+ve cells occurred in all patients. It was paralleled by expansion of circulating CFU-GM progenitors. Circulating CD34+ve cells co-expressed epithelial and stem cell markers in both cirrhotics and volunteer stem cell donors. G-CSF was well tolerated, no adverse event occurred, a significant reversible increase of splenic longitudinal diameter was observed. (i) G-CSF mobilization of BMC co-expressing epithelial and stem markers occurred in all cirrhotic patients; (ii) splenomegaly up to 170 mm does not prevent safe BMC mobilization following G-CSF in patients with end stage liver disease; (iii) mobilized BMC may represent an easy immature cell source potentially useful for novel approaches for liver regeneration.
  Journal of Hepatology 08/2006; 45(1):13-9. · 9.26 Impact Factor
• Article: Inactive hepatitis B virus carriers: a favourable clinical condition.

  Silvia Gaia, Alfredo Marzano, Antonella Olivero, Marilena Abate, Mario Rizzetto, Antonina Smedile
  European Journal of Gastroenterology & Hepatology 01/2006; 17(12):1435-6. · 1.76 Impact Factor
• Article: Viral load at the time of liver transplantation and risk of hepatitis B virus recurrence.

  Alfredo Marzano, Silvia Gaia, Valeria Ghisetti, Silvia Carenzi, Alberto Premoli, Wilma Debernardi-Venon, Carlo Alessandria, Alessandro Franchello, Mauro Salizzoni, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: Hepatitis B virus (HBV) recurrence after liver transplantation is significantly reduced by prophylaxis with hepatitis B immune globulins (HBIG) or antiviral drugs in nonreplicating patients and by the combination of both drugs in replicating patients. However, the load of HBV DNA, which defines replicating status in patients undergoing liver transplantation, remains unclear. This study analyzes the correlation between the viral load, tested with a single amplified assay, at the time of liver transplantation, and the risk of hepatitis B recurrence in 177 HBV carriers who underwent transplantation in a single center from 1990 to 2002. Overall, HBV relapsed after surgery in 15 patients (8.5%) with a 5- and 8-year actuarial rate of recurrence of 8% and 21%, respectively. After liver transplantation hepatitis B recurred in 9% of 98 selected subjects treated only with immune globulins and in 8% of 79 viremic patients who received immune globulins and lamivudine (P = NS). A linear correlation was observed between recurrence and viral load at the time of surgery. In transplant patients with HBV DNA higher than 100,000 copies/mL, 200-99,999 copies/mL, and DNA undetectable by amplified assay, hepatitis B recurred in 50%, 7.5%, and 0% of patients, respectively. Overall, a viral load higher than 100,000 copies/mL at the time of liver transplantation was significantly associated with hepatitis B recurrence (P = .0003). In conclusion, spontaneous or antiviral-induced HBV DNA viral load at the time of surgery classifies the risk of HBV recurrence after liver transplantation and indicates the best prophylaxis strategy.
  Liver Transplantation 05/2005; 11(4):402-9. · 3.39 Impact Factor
• Article: Prompt relapse of viremia after lamivudine discontinuation in e-minus chronic hepatitis B patients completely responders during 5 years of therapy.

  Valeria Barbon, Silvia Gaia, Alfredo Marzano, Marco Lagget, Mario Rizzetto
  Journal of Hepatology 10/2004; 41(3):500-1. · 9.26 Impact Factor
• Article: Application of the model for end-stage liver disease score for transjugular intrahepatic portosystemic shunt in cirrhotic patients with refractory ascites and renal impairment.

  Carlo Alessandria, Silvia Gaia, Alfredo Marzano, Wilma Debernardi Venon, Maurizio Fadda, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: Transjugular intrahepatic portosystemic shunt (TIPS) can manage severe complications of portal hypertension. The Mayo Clinic group proposed a so-called model for end-stage liver disease (MELD) to predict survival in cirrhotic patients. High creatinine levels determine a decrease in calculated survival chances with MELD but functional renal disease can be reversed by TIPS. The aim of this study was to evaluate the efficacy of MELD in predicting survival after TIPS, particularly in patients with refractory ascites associated with functional renal failure. This retrospective analysis examines 68 cirrhotic patients who underwent elective TIPS: 48 patients had refractory ascites and 20 patients had recurrent variceal bleeding. Multivariate analysis was used to establish predictive parameters of survival after TIPS. Kaplan-Meier and log-rank tests were used to compare survival rates observed in our patients with those evaluated with the MELD score. The age of patients was the only variable shown to have an independent value in predicting survival after TIPS. In patients undergoing shunting for refractory ascites, the survival rates at 6, 12 and 24 months after the procedure were significantly higher than expected with the MELD score. The MELD scale may underestimate the efficacy of TIPS in end-stage cirrhotic patients with refractory ascites and functional kidney dysfunction. Further studies are needed to confirm this finding and ultimately to assess a correction factor to better predict survival after TIPS in patients with functional renal impairment.
  European Journal of Gastroenterology & Hepatology 07/2004; 16(6):607-12. · 1.76 Impact Factor
• Article: Occult hepatitis B virus infection in HBsAg negative patients undergoing liver transplantation: clinical significance.

  Valeria Ghisetti, Alfredo Marzano, Fausto Zamboni, Anna Barbui, Alessandro Franchello, Silvia Gaia, Giovanna Marchiaro, Mauro Salizzoni, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: Occult Hepatitis B virus (o-HBV) infection has been reported in HB surface antigen (HBsAg)-negative liver donors whose risk of transmitting HBV justifies a specific prophylaxis in liver recipients. The clinical significance of o-HBV infection in HBsAg-negative recipients and their need for prophylaxis is unknown. Liver samples collected during surgery from 23 HBsAg-negative patients (9 liver donors and 14 recipients) and 20 HBsAg-positive recipients (controls) were studied by polymerase chain reaction with an independent set of primers mapping the core and surface HBV genes. Intrahepatic HBV DNA was detected as core and surface genes in all the HBsAg-positive recipients, in none of the HBsAg-negative donors and in 9/14 (64%) of the HBsAg-negative recipients (2 HCV negative, 7 HCV positive). The intrahepatic amount of HBV was significantly lower in HBsAg-negative than in HBsAg-positive livers (median values 1.36 Log(10)/microg DNA vs. 3.66 Logs, p<0.0001, core gene, and 1.13 vs. 6.21 Logs p<0.0001, surface gene). No HBV DNA was detected in plasma from o-HBV recipients; one of them tested positive in lymphocytes. No correlation was found between o-HBV and serologic markers of previous HBV exposure, response to vaccination, acute rejection, hepatitis D and G virus-infections. None of o-HBV carriers experienced a de novo hepatitis B after transplantation (median follow-up: 477 days). Occult HBV is frequent in HBsAg-negative liver recipients. It is not associated with increased episodes of acute rejection, coinfection with hepatotropic viruses, different responses to HBV vaccination, or the development of de-novo hepatitis B. In o-HBV infection a particular virus-host interaction can explain the low intrahepatic HBV content and the lack of extrahepatic HBV replication, thus justifying the low risk of hepatitis B reactivation, in absence of specific prophylaxis, once the recipient liver is removed.
  Liver Transplantation 04/2004; 10(3):356-62. · 3.39 Impact Factor
• Article: 3D cholangio-Magnetic Resonance Imaging in Caroli disease

  Silvia Gaia, Andrea Marengo, Anna Morgando, Francesca Barisone, Jochen Maass, Franco Brunello, Mario Rizzetto
  [show abstract] [hide abstract]
  ABSTRACT: It is presented an impressive image of a cholangio-Magnetic Resonance Imaging in a bilateral Caroli disease. The innovative technique of 3D imaging elaboration allowed to perfectly build up the anomalies of the biliary tract.
  European Journal of Radiology Extra 79(2).