Cesare Hassan

Ospedale Nuovo Regina Margherita, Roma, Latium, Italy

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Publications (333)1650.41 Total impact

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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal tract in adults. Recommendations Nonendoscopic measures 1 ESGE recommends diagnostic evaluation based on the patient's history and symptoms. ESGE recommends a physical examination focused on the patient's general condition and to assess signs of any complications (strong recommendation, low quality evidence). 2 ESGE does not recommend radiological evaluation for patients with nonbony food bolus impaction without complications. We recommend plain radiography to assess the presence, location, size, configuration, and number of ingested foreign bodies if ingestion of radiopaque objects is suspected or type of object is unknown (strong recommendation, low quality evidence). 3 ESGE recommends computed tomography (CT) scan in all patients with suspected perforation or other complication that may require surgery (strong recommendation, low quality evidence). 4 ESGE does not recommend barium swallow, because of the risk of aspiration and worsening of the endoscopic visualization (strong recommendation, low quality evidence). 5 ESGE recommends clinical observation without the need for endoscopic removal for management of asymptomatic patients with ingestion of blunt and small objects (except batteries and magnets). If feasible, outpatient management is appropriate (strong recommendation, low quality evidence). 6 ESGE recommends close observation in asymptomatic individuals who have concealed packets of drugs by swallowing ("body packing"). We recommend against endoscopic retrieval. We recommend surgical referral in cases of suspected packet rupture, failure of packets to progress, or intestinal obstruction (strong recommendation, low quality evidence). Endoscopic measures 7 ESGE recommends emergent (preferably within 2 hours, but at the latest within 6 hours) therapeutic esophagogastroduodenoscopy for foreign bodies inducing complete esophageal obstruction, and for sharp-pointed objects or batteries in the esophagus. We recommend urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for other esophageal foreign bodies without complete obstruction (strong recommendation, low quality evidence). 8 ESGE suggests treatment of food bolus impaction in the esophagus by gently pushing the bolus into the stomach. If this procedure is not successful, retrieval should be considered (weak recommendation, low quality evidence). The effectiveness of medical treatment of esophageal food bolus impaction is debated. It is therefore recommended, that medical treatment should not delay endoscopy (strong recommendation, low quality evidence). 9 In cases of food bolus impaction, ESGE recommends a diagnostic work-up for potential underlying disease, including histological evaluation, in addition to therapeutic endoscopy (strong recommendation, low quality evidence). 10 ESGE recommends urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for foreign bodies in the stomach such as sharp-pointed objects, magnets, batteries and large/long objects. We suggest nonurgent (within 72 hours) therapeutic esophagogastroduodenoscopy for medium-sized blunt foreign bodies in the stomach (strong recommendation, low quality evidence). 11 ESGE recommends the use of a protective device in order to avoid esophagogastric/pharyngeal damage and aspiration during endoscopic extraction of sharp-pointed foreign bodies. Endotracheal intubation should be considered in the case of high risk of aspiration (strong recommendation, low quality evidence). 12 ESGE suggests the use of suitable extraction devices according to the type and location of the ingested foreign body (weak recommendation, low quality evidence). 13 After successful and uncomplicated endoscopic removal of ingested foreign bodies, ESGE suggests that the patient may be discharged. If foreign bodies are not or cannot be removed, a case-by-case approach depending on the size and type of the foreign body is suggested (weak recommendation, low quality evidence).
    No preview · Article · Feb 2016 · Endoscopy
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    ABSTRACT: Background and aims: Anastomotic biliary stricture (ABS) is the most common biliary complication after orthotopic liver transplantation (OLT) and can be successfully managed endoscopically. The long-term results of a protocol using placement of multiple plastic stents to treat ABS following OLT were analyzed. Methods: All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for OLT-related biliary complications at our Endoscopy Unit between July 1994 and March 2012 were retrospectively identified from the ERCP database. Patients with an ABS treated with an increasing number of plastic stents were included in the study. Follow-up after stent removal was obtained by telephone contact with the patient and/or referring physician and by liver function tests (LFTs) evaluation. Results: 56 patients, treated with an increasing number of plastic stents until resolution of the stricture, were included. Five patients were then excluded (unrelated death during treatment, n = 3; incomplete treatment because of poor compliance, n = 2), and 51/56 patients reached study end points and were included in the analysis. Resolution of ABS was obtained in 50/51 patients; 1 patient required hepaticojejunostomy because of failure to pass the stricture with the guidewire (per protocol resolution, 98 %). Mean duration of endoscopic treatment was 11.5 months, with a median 4 ERCPs per patient. Immediate ERCP-related adverse events occurred in 3/56 patients (5.4 %). After a median follow-up of 5.8 years from stent removal, 3/50 patients (6 %) had recurrence of ABS. These 3 patients were successfully treated again endoscopically and are asymptomatic after a further median follow-up of 5.6 years. Conclusions: At long-term follow-up, endoscopic treatment with multiple plastic stents of ABS following OLT appeared to be effective in most patients. Stricture recurrence is rare and can be successfully treated again endoscopically.
    No preview · Article · Feb 2016 · Endoscopy
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    ABSTRACT: Background and aims: Natural history of refractory benign esophageal strictures (RBES) is unclear, and surgery or PEG may be the only viable long-term option. The aim of the present study was to assess the long-term outcomes of patients with RBES. Methods: Clinical data of consecutive RBES-patients treated in the last 15 years in 2 tertiary referral academic centers with specialized interest in esophageal stricture management were retrospectively analyzed. RBES was defined as the persistence/recurrence of dysphagia despite at least 5 dilation sessions/cycles with at least dilation to 14 mm. Use of dilation, stents, and the dysphagia-free period between subsequent interventions and adverse events were collected. Clinical success was defined as no need for endoscopic interventions for at least 6 months; unfavorable outcomes were defined as need for endoscopic treatment at the end of follow-up, surgery, or PEG. Predictors of unfavorable outcomes were assessed by multivariate analysis. A linear mixed-effect model was also used to measure dysphagia-free period changes over time. Results: Overall, 70 RBES patients (46 male; mean age 60 years) were followed-up for a mean of 43.9 months (range 3.7-157). Caustic, post-radiotherapy, surgical, mixed, and post-inflammatory etiology accounted for 10%, 14.3%, 31.4%, 40% and 4.3%, respectively. All patients underwent sequential sessions of pneumatic or bougie dilation with a median of 15.5 dilation sessions per patient. Self-expandable metal stents (SEMSs) and biodegradable stents were placed in 18 (25.7%) and 14 (20%), patients, respectively. RBES resolution was achieved in only 22 out of 70 (31.4%). Two deaths (3%) were related to RBES. The success rate was lower in those who were also treated with endoprosthetics (OR, 3.7; 95% CI, 1.01 - 18.0). The mean dysphagia free period was 3.3 months (95% CI, 2.4 - 4.1) for patients treated with dilation and 2.4 months (95% CI, 1.2 - 3.6) for those stented (P=0.062). Over time, the total dysphagia-free period increased at a rate of 4.1 (95% CI, 1.7 - 6.4) days per dilation. There was no difference in the rate of change across groups defined by sex (P=0.976), age (P=0.633), or endoscopic treatment (P=0.267). Conclusions: Our multicenter series showed a disappointing long-term outcome for RBES, with only 1 out of 3 achieving clinical resolution. The dysphagia-free period was relatively short, affecting the quality of life. Endoprosthetics did not appear to affect the natural history of RBES.
    No preview · Article · Jan 2016 · Gastrointestinal endoscopy

  • No preview · Article · Jan 2016 · Endoscopy
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    ABSTRACT: Background and study aims: Barrett's esophagus is a common condition that is widely encountered in clinical practice. This European Society of Gastrointestinal Endoscopy (ESGE) survey aimed to determine practice patterns amongst European clinicians with regard to the diagnosis and management of Barrett's esophagus. Methods: Clinicians attending the ESGE learning area at the United European Gastroenterology Week in 2014 were invited to complete a 10-question survey. This survey was programed on to two Apple iPads. Information was gathered with regard to demographics, practice settings, and diagnosis and management strategies for Barrett's esophagus. Results: In total, 163 responses were obtained. Over half of respondents (61 %) were based in university hospitals, the majority (78 %) were aged 30 - 50 and half had more than 10 years' experience; 66 % had attended courses on Barrett's esophagus and more than half (60 %) used the Prague C & M classification. Advanced imaging was used by 73 % of clinicians and 72 % of respondents stated that their group practiced ablation therapy. Most (76 %) practiced surveillance for non-dysplastic Barrett's, 6 % offered ablation therapy in some situations, and 18 % offered no intervention. For low grade dysplasia, 56 % practiced surveillance, 19 % ablated some cases and 15 % ablated all cases. In total, 32 % of clinicians referred high grade dysplasia to expert centers, with 20 % referring directly for surgery and 46 % using ablation therapy in certain cases. Endoscopic mucosal resection was the most commonly used ablation technique (44 %). Conclusions: There has been reasonable uptake of the Prague C & M classification for describing Barrett's esophagus, and ablation is widely practiced. However, practice patterns for Barrett's esophagus vary widely between clinicians with clear guidance and quality standards required.
    No preview · Article · Jan 2016
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    ABSTRACT: Background and aims: Flexible endoscopic septum division (FESD) is a rapidly evolving technique for the treatment of Zenker's diverticulum (ZD). To perform a systematic review and meta-analysis of literature focusing on FESD for ZD, including an in depth evaluation of its efficacy, safety and limitations. Methods: A comprehensive literature search was completed, identifying papers that examined the efficacy and safety of FESD for ZD. Demographic, clinical and technical information was retrieved. Main outcomes were extracted, pooled and analyzed. Heterogeneity amongst studies was assessed using the I(2) statistic. A random effect model was used as the pooling method in case of high heterogeneity; otherwise the fixed effect model was applied. Meta-regression was also performed. Main outcomes such as rates of success, adverse events and recurrences evaluated. Results: 20 studies with a total of 813 patients were selected. The pooled success, adverse events and recurrence rates were 91% [95% CI, 86%-94%; I(2)=69.4%], 11.6% [95% CI, 8%-18%; I(2)=64%], and 11% (95% CI, 9%-15%; I(2)=38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I(2) =25.6%; P=0.154]. Adverse event rates decreased with larger samples (coefficient, -0.0123; 95% CI, -0.03 to -0.003; p = 0.017), whereas recurrence rates increased (coefficient, 0.006; 95% CI,-0.0010 to 0.0125; P=0.093). Year of publication was negatively associated with success rate, whereas the opposite pattern was found for recurrence rates. Conclusions: FESD is a feasible, safe and effective treatment of symptomatic ZD, with low adverse event and recurrence rates.
    No preview · Article · Jan 2016 · Gastrointestinal endoscopy
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    ABSTRACT: Background The association between diverticulosis and colonic neoplastic lesions has been suggested, but data in literature are conflicting. This study aimed to investigate such a relationship in patients participating in a colorectal cancer screening program who underwent high-quality colonoscopy.
    Preview · Article · Jan 2016 · United European Gastroenterology Journal
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    ABSTRACT: The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.
    Preview · Article · Dec 2015 · Endoscopy
  • Alberto Murino · Cesare Hassan · Alessandro Repici
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    ABSTRACT: Purpose of review: Diminutive polyps, measuring between 1 and 5 mm, represent the vast majority of colorectal polyps encountered during screening colonoscopy. Although the chance of harboring advanced adenoma or neoplastic cells is low, ensuring a complete polyp resection with clear margins is crucial to reduce the risk of interval colorectal cancer. The purpose of this review was to evaluate the different methods applied for polypectomy of diminutive polyps and clarify whether a diminutive polyp should be retrieved or left in place. Recent findings: Cold biopsy polypectomy is indicated for resection of polyps measuring 1-3 mm and removal of 4-5 mm polyps should be ensured by cold snare polypectomy. Over the last decade, hot biopsy polypectomy has been gradually abandoned because of an increased risk of diathermic injury. The resect and discard strategy and the diagnose and disregard strategy should be performed only by expert endoscopists, who should use validated scales and document the polyp features by storing several endoscopic images. Summary: Nowadays, complete resection of diminutive polyps, following the most appropriate technique, is recommended in clinical practice. The resect and discard strategy and the diagnose and disregard strategy should be reserved to expert endoscopists.
    No preview · Article · Nov 2015 · Current opinion in gastroenterology
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    ABSTRACT: Background The safety and diagnostic accuracy of colonoscopy depend on the quality of colon cleansing. The adenoma detection rate is usually used as a quality measurement score.
    Full-text · Article · Nov 2015 · United European Gastroenterology Journal
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    ABSTRACT: Background and aims: The management of refractory benign esophageal strictures (RBESs) is challenging. Stent placement has been proposed as a possible rescue strategy. We performed a systematic review and meta-analysis to examine the efficacy of this strategy in the long-term resolution of dysphagia. Methods: PubMed, SCOPUS, and Google Scholar were searched (up to January 2015). Studies recruiting adults with RBES treated with stent placement were eligible. The success, adverse event, and migration rates were pooled by means of a random-effect model to obtain odds with a 95 % confidence interval (CI). Results: Eighteen studies (444 patients) were eligible for inclusion. The pooled clinical success rate was 40.5 % (95 %CI 31.5 % - 49.5 %), yielding odds of 0.68 (95 %CI 0.46 - 0.98) with high heterogeneity (I(2) = 65.0 %). The meta-regression analysis showed stricture etiology as the only influencing factor. Treatment with self-expanding plastic (SEPSs) and metal stents (SEMSs) did not result in significantly higher success rates than treatment with biodegradable stents (BDSs) (46.2 % vs. 40.1 % vs. 32.9 %, respectively). The migration rate was 28.6 % (95 %CI 21.9 % - 37.1 %), yielding odds of 0.40 (95 %CI 0.28 - 0.59), with migration rates for SEPSs and SEMSs reported as being not significantly higher than BDSs (33.3 % vs. 31.5 % vs. 15.3 %, respectively). The adverse event rate was 20.6 % (95 %CI 15.3 % - 28.1 %), yielding odds of 0.26 (95 %CI 0.18 - 0.39) with no significant difference between stent types (19.4 % vs. 21.9 % vs. 21.9 %, respectively). Conclusions: Stent placement in patients with RBES is effective in about 40 % of cases. Further studies should investigate whether the clinical success rate varies according to the stricture etiology.(PROSPERO registration number: CRD42015019017.).
    No preview · Article · Nov 2015 · Endoscopy
  • Alessandro Repici · Cesare Hassan

    No preview · Article · Oct 2015 · Endoscopy
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    ABSTRACT: A new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes.
    No preview · Article · Oct 2015
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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH).
    Full-text · Article · Oct 2015 · Endoscopy
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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 - 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.
    Full-text · Article · Sep 2015 · Endoscopy
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    ABSTRACT: Objectives: To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). Design: 74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013. Results: 49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05). Conclusions: In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.
    No preview · Article · Aug 2015 · Gut
  • Cristiano Spada · Cesare Hassan · Guido Costamagna

    No preview · Article · Aug 2015 · Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association
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    ABSTRACT: Scanty data on the performance of the new 25-gauge Procore™ biopsy needle are available. Consecutive patients who underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using the 25G Procore™ were retrospectively retrieved. All samples were independently reviewed by 3 pathologists for the following: histological, cytological or no specimen, neoplasia, diagnostic or non-diagnostic. Diagnostic accuracy and inter-rater concordance among pathologists were calculated. 94 patients underwent EUS-FNB of 101 sites (69 solid masses, 25 lymph nodes, 5 wall thickening). Forty-one biopsies (40.5%) were classified as histological samples by at least two pathologists, 29 as cytological (28.7%), 31 had no sample (30.7%). Good and almost perfect agreements among pathologists in defining cytological vs. histological samples (k 0.82; 95% CI: 0.74-0.90), diagnostic vs. non-diagnostic (k 0.95; 95% CI: 0.85-1.00) and neoplastic vs. non-neoplastic (k 0.94; 95% CI: 0.83-1.00). According to consensus rating, 61 cases were diagnostic samples (60.4%). Histological samples were more likely to lead to a correct diagnosis (OR, 4.1; 95% P=0.027), while neoplastic lesions were less likely to be correctly classified than benign (OR, 0.11; P=0.04). EUS-FNB with the Procore™ 25G needle provided samples for histological examination in only 40% of the cases, with 31% of inadequate specimens, despite excellent results in term of inter-observer variability. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Digestive and Liver Disease
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    ABSTRACT: Low-volume preparations are gaining attention for higher acceptability but have been never evaluated in IBD. We compare the efficacy, safety, and tolerability of a 2-L PEG with a 4-L PEG solution in patients with ulcerative colitis. This is a multicenter, randomized, single-blind study. Adult outpatients with ulcerative colitis undergoing colonoscopy received either 2-L PEG plus bisacodyl or 4-L PEG. Bowel cleansing was assessed using the Ottawa Scale and rated as adequate if the score was ≤2 in each colon segment. Patient acceptance, satisfaction, and related symptoms were recorded. Preparation was adequate in 80% of the 211 patients without any differences between groups. Mean Ottawa scores for whole and right colon were similar in the 2 groups. As concern tolerability, 83% patients in 2-L PEG arm and 44.8% in 4-L PEG arm reported no or mild discomfort (P < 0.0001) and 94.3% and 61.9% expressed their willingness to repeat the preparation (P < 0.001). Palatability was better with 2-L PEG, whereas related symptoms occurred more frequently with 4-L PEG. Regardless of preparation, split dosage was associated with better cleansing. Further predictors of poor cleansing were moderate/severe discomfort during preparation and more than 6 hours between end of preparation and colonoscopy. Extension and severity of colitis did not influence quality of preparation. Low-volume PEG is not inferior to 4-L PEG for bowel cleansing in ulcerative colitis, but it is better tolerated and accepted. The time interval from solution intake and colonoscopy is the most important factor affecting quality of cleansing in ulcerative colitis.
    Full-text · Article · Jul 2015 · Inflammatory Bowel Diseases
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    ABSTRACT: This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging.The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes.The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation.As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy.Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging.The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures) Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures. © Georg Thieme Verlag KG Stuttgart · New York.
    Full-text · Article · Jul 2015 · Endoscopy

Publication Stats

4k Citations
1,650.41 Total Impact Points

Institutions

  • 1970-2016
    • Ospedale Nuovo Regina Margherita
      Roma, Latium, Italy
  • 2015
    • Policlinico Universitario Agostino Gemelli
      Roma, Latium, Italy
  • 2011-2015
    • Catholic University of the Sacred Heart
      • Digestive Endoscopy Unit
      Milano, Lombardy, Italy
    • Istituto Clinico Humanitas IRCCS
      • Department of Gastroenterology
      Rozzano, Lombardy, Italy
    • Indiana University-Purdue University Indianapolis
      • Division of Gastroenterology/Hepatology
      Indianapolis, Indiana, United States
  • 2010-2015
    • The Catholic University of America
      Washington, Washington, D.C., United States
    • Università Cattolica del Sacro Cuore
      Milano, Lombardy, Italy
  • 2014
    • The University of Calgary
      • Department of Medicine
      Calgary, Alberta, Canada
    • American Society for Gastrointestinal Endoscopy
      Society Hill, New Jersey, United States
    • Cardarelli Hospital
      Napoli, Campania, Italy
  • 2009-2014
    • Sapienza University of Rome
      • Department of Radiological, Oncological and Pathological Sciences
      Roma, Latium, Italy
  • 2011-2012
    • Università degli studi di Foggia
      • Department of Medical and Surgical Sciences
      Foggia, Apulia, Italy
  • 2002
    • Guy's and St Thomas' NHS Foundation Trust
      • Department of Gastroenterology
      Londinium, England, United Kingdom