Arnaldo Amato - Academia.edu (original) (raw)

Papers by Arnaldo Amato

Research paper thumbnail of Easy ultrasound detection of retained video endoscopy capsule

Journal of Gastroenterology and Hepatology, 2004

Research paper thumbnail of An unusual double-balloon enteroscopy finding: duodenal perforation by an inferior vena cava filter

Gastrointestinal Endoscopy, 2013

Research paper thumbnail of Efficacy and acceptability of sodium picosulphate/magnesium citrate versus low-volume PEG-ascorbic acid for colon cleansing: a randomized controlled trial

Colorectal Disease, 2013

The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium c... more The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium citrate preparation with that of polyethylene glycol plus ascorbic acid (PEG + ASC) in a randomized clinical trial (RCT).

Research paper thumbnail of Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial

Digestive and Liver Disease, 2015

Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal ... more Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal cancer, but is not complication-free. To evaluate the incidence of early and delayed polypectomy complications and factors associated with their occurrence in a community setting. Web-database collection of patients' and polyp's features in consecutive colonic polypectomies during a 3-month period in 18 endoscopy centres. Data on 5178 polypectomies in 2692 patients (54.3% males, mean age 59 years) were collected. The majority of the polyps were <10mm (83.5%). Antithrombotic agents were taken by 22.7% of patients, 57.3% of which withheld them before the procedure. Overall, 5 patients experienced perforations (0.2%) and 114 had bleeding (4.2%); the overall complication rate was 4.4%. Early complications were observed in 87 (3.2%); delayed complications (all major bleedings) occurred in 32 (1.2%). At multivariate analysis polyp size (size >10mm: OR 4.35, 95% CI 5.53-7.48) and, inversely, right-sided location (OR 0.58, 95% CI 0.36-0.94) were correlated with bleeding events. The use of antithrombotics was associated with 5-fold increased risk of delayed bleeding. In the community setting, polypectomy was associated with a 1.4% risk of major complications. Polyp size and, inversely, right-sided location were associated with early bleeding; the use of antithrombotics increased the risk of delayed events.

Research paper thumbnail of Tu1487 Unsedated Colonoscopy: Probably for Some, but Not for All

Data Revues 00165107 V73i4ss S0016510711011989, Apr 1, 2011

detecting any kind of neoplasia, whereas the endoscopy center was not, except for the category 'a... more detecting any kind of neoplasia, whereas the endoscopy center was not, except for the category 'at least 2 adenomas' (pϽ0.005). The ranges of adjusted detection rates for each of the quoted neoplasia categories were 33.1-43.1%, 11.1-21.6%, 3.6-8.1%, 16.3-23.6% and 8.3-12.6%, respectively. Patients' age and gender remained significant predictors in the "per endoscopist" analyses, and again the endoscopy center was not, except for one, in the single category 'at least one adenoma'. The repeated-measures of variance analysis did not show any significant influence of the endoscopy center on neoplasia detection rates. Conclusion: In this population-based study, interendoscopist performance variations do not seem to be linked to procedure environment.

Research paper thumbnail of Modified Rendezvous Technique For Biliary Stents Placement When Papilla Is Inaccessible

Research paper thumbnail of Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy, 2015

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ES... more 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).

Research paper thumbnail of Narrow-band imaging in the prediction of surveillance intervals after polypectomy in community practice

Endoscopy, 2015

Background and study aims: It has been proposed that the use of narrow-band imaging (NBI) for rea... more Background and study aims: It has been proposed that the use of narrow-band imaging (NBI) for real-time histological assessment to determine postpolypectomy surveillance intervals is a cost-effective approach to the management of diminutive polyps. However, significant discrepancies in NBI performance have been observed among endoscopists; hence, professional societies recommend training, monitoring, and auditing. The aim of the present study was to evaluate the performance of real-time optical diagnosis for diminutive polyps after the inclusion of this approach in an internal quality assurance program, in order to assess its applicability in clinical practice Patients and methods: Four endoscopists attended periodic training sessions on NBI assessment of polyp histology before and during the study. Performance was audited and periodic feedback was provided. The accuracy of high-confidence NBI evaluation for polyps ≤ 5 mm in predicting surveillance intervals according to the European and US guidelines, and the negative predictive value (NPV) for adenoma in the rectosigmoid were calculated and compared with recommended thresholds (90 % agreement and 90 % NPV, respectively). Results: Overall, 284 outpatients (mean age 61.3 ± 18.2 years; 63 % males) were enrolled. A total of 656 polyps were detected, 465 of which (70.9 %) were diminutive (70.5 % adenomas). Sensitivity, specificity, positive and negative predictive values, and accuracy of high-confidence NBI predictions for adenoma in diminutive lesions were 95.3 %, 83.5 %, 93.5 %, 87.6 %, and 91.9 %, respectively. High-confidence characterization of diminutive polyps predicted the correct surveillance interval in 95.8 % and 93.3 % of cases according to European and American guidelines, respectively. NPV for adenoma in the rectosigmoid was 91.3 % Conclusions: For community settings in which endoscopists are adequately trained and performance is periodically audited, real-time optical diagnosis for diminutive polyps is sufficiently accurate to avoid postpolypectomy histological examination of resected lesions, or to leave rectosigmoid hyperplastic polyps in place. Trial registered at ClinicalTrials.gov (NCT02196402).

Research paper thumbnail of Response

Gastrointestinal endoscopy

Research paper thumbnail of nbi

Research paper thumbnail of Su1529 Factors Influencing Patients' Choice of Split Dose Bowel Cleansing Regimen for Colonoscopy in Clinical Practice

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of The impact of hyoscine-N-butylbromide on adenoma detection during colonoscopy: meta-analysis of randomized, controlled studies

Gastrointestinal endoscopy, 2014

Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth m... more Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth muscle activity, which improves mucosal visualization. Whether this affects polyp detection is controversial. To evaluate whether HBB, administered during colonoscopy, improves polyp and adenoma detection. We performed a comprehensive search in MEDLINE and EMBASE databases to identify randomized, placebo-controlled trials (RCTs) in which HBB was administered during colonoscopy and which also reported the detection rate for polyps and/or adenomas (PDR and/or ADR, respectively). Meta-analysis of 5 RCTs. A total of 1998 patients (1006 receiving HBB) were included in the study. Intravenous administration of 20 mg (2 mL) HBB or 2 mL saline solution at the time of cecal intubation. The PDR was the primary outcome variable. Secondary outcomes included the ADR, the advanced adenoma detection rate (adv-ADR), and the mean number of polyps and adenomas per patient (PPP and APP, respectively). The PD...

Research paper thumbnail of Unsedated colonoscopy: A neverending story

World journal of gastrointestinal endoscopy, Jan 16, 2012

Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in W... more Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.

Research paper thumbnail of Half Doses of PEG-ES and Senna vs. High-Dose Senna for Bowel Cleansing Before Colonoscopy: A Randomized, Investigator-Blinded Trial

The American Journal of Gastroenterology, 2009

Patients ' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution... more Patients ' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution (PEG-ES) have prompted continuous investigation with alternative forms of cleansing. Highdose senna is superior to PEG-ES for the quality of bowel cleansing, patient compliance, and tolerance, but its acceptance may be infl uenced by the incidence of abdominal pain. We hypothesized that a combination of half doses of PEG-ES and senna could minimize the incidence of abdominal pain without affecting the quality of bowel preparation.

Research paper thumbnail of P475 Granulocyte and Monocyte Apheresis (GMA) – Adacolumn® in mild to moderate ulcerative colitis patients with steroid resistance or dependence and azathioprine intolerance or resistance: a prospective multicenter study (preliminary data)

Journal of Crohn's and Colitis, 2014

Research paper thumbnail of 687 Narrow Band Imaging in the Prediction of Surveillance Intervals After Polypectomy in Community Practice: Ready for (a European) Prime Time

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1535 Do New Generation Narrow Band Imaging Colonoscopes Improve the Prediction of Histology for Diminutive Polyps? Preliminary Results of an Observational Prospective Study

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of 836 Prospective Study on Polypectomy Complications: Spoc

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1496 Is It Really so Easy to Learn Histologic Characterization of Diminutive Polyps by Narrow Band Imaging? Preliminary Results of Endoscopists' and Nurses' Performances

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1276 Water Exchange May Be Superior to Water Immersion - Minimizes Colonoscopy Discomfort and Increases Adenoma Detection Rate (ADR) - Review of Recent Randomized Controlled Trials (RCT)

Gastrointestinal Endoscopy, 2012

Research paper thumbnail of Easy ultrasound detection of retained video endoscopy capsule

Journal of Gastroenterology and Hepatology, 2004

Research paper thumbnail of An unusual double-balloon enteroscopy finding: duodenal perforation by an inferior vena cava filter

Gastrointestinal Endoscopy, 2013

Research paper thumbnail of Efficacy and acceptability of sodium picosulphate/magnesium citrate versus low-volume PEG-ascorbic acid for colon cleansing: a randomized controlled trial

Colorectal Disease, 2013

The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium c... more The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium citrate preparation with that of polyethylene glycol plus ascorbic acid (PEG + ASC) in a randomized clinical trial (RCT).

Research paper thumbnail of Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial

Digestive and Liver Disease, 2015

Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal ... more Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal cancer, but is not complication-free. To evaluate the incidence of early and delayed polypectomy complications and factors associated with their occurrence in a community setting. Web-database collection of patients' and polyp's features in consecutive colonic polypectomies during a 3-month period in 18 endoscopy centres. Data on 5178 polypectomies in 2692 patients (54.3% males, mean age 59 years) were collected. The majority of the polyps were <10mm (83.5%). Antithrombotic agents were taken by 22.7% of patients, 57.3% of which withheld them before the procedure. Overall, 5 patients experienced perforations (0.2%) and 114 had bleeding (4.2%); the overall complication rate was 4.4%. Early complications were observed in 87 (3.2%); delayed complications (all major bleedings) occurred in 32 (1.2%). At multivariate analysis polyp size (size >10mm: OR 4.35, 95% CI 5.53-7.48) and, inversely, right-sided location (OR 0.58, 95% CI 0.36-0.94) were correlated with bleeding events. The use of antithrombotics was associated with 5-fold increased risk of delayed bleeding. In the community setting, polypectomy was associated with a 1.4% risk of major complications. Polyp size and, inversely, right-sided location were associated with early bleeding; the use of antithrombotics increased the risk of delayed events.

Research paper thumbnail of Tu1487 Unsedated Colonoscopy: Probably for Some, but Not for All

Data Revues 00165107 V73i4ss S0016510711011989, Apr 1, 2011

detecting any kind of neoplasia, whereas the endoscopy center was not, except for the category 'a... more detecting any kind of neoplasia, whereas the endoscopy center was not, except for the category 'at least 2 adenomas' (pϽ0.005). The ranges of adjusted detection rates for each of the quoted neoplasia categories were 33.1-43.1%, 11.1-21.6%, 3.6-8.1%, 16.3-23.6% and 8.3-12.6%, respectively. Patients' age and gender remained significant predictors in the "per endoscopist" analyses, and again the endoscopy center was not, except for one, in the single category 'at least one adenoma'. The repeated-measures of variance analysis did not show any significant influence of the endoscopy center on neoplasia detection rates. Conclusion: In this population-based study, interendoscopist performance variations do not seem to be linked to procedure environment.

Research paper thumbnail of Modified Rendezvous Technique For Biliary Stents Placement When Papilla Is Inaccessible

Research paper thumbnail of Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy, 2015

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ES... more 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).

Research paper thumbnail of Narrow-band imaging in the prediction of surveillance intervals after polypectomy in community practice

Endoscopy, 2015

Background and study aims: It has been proposed that the use of narrow-band imaging (NBI) for rea... more Background and study aims: It has been proposed that the use of narrow-band imaging (NBI) for real-time histological assessment to determine postpolypectomy surveillance intervals is a cost-effective approach to the management of diminutive polyps. However, significant discrepancies in NBI performance have been observed among endoscopists; hence, professional societies recommend training, monitoring, and auditing. The aim of the present study was to evaluate the performance of real-time optical diagnosis for diminutive polyps after the inclusion of this approach in an internal quality assurance program, in order to assess its applicability in clinical practice Patients and methods: Four endoscopists attended periodic training sessions on NBI assessment of polyp histology before and during the study. Performance was audited and periodic feedback was provided. The accuracy of high-confidence NBI evaluation for polyps ≤ 5 mm in predicting surveillance intervals according to the European and US guidelines, and the negative predictive value (NPV) for adenoma in the rectosigmoid were calculated and compared with recommended thresholds (90 % agreement and 90 % NPV, respectively). Results: Overall, 284 outpatients (mean age 61.3 ± 18.2 years; 63 % males) were enrolled. A total of 656 polyps were detected, 465 of which (70.9 %) were diminutive (70.5 % adenomas). Sensitivity, specificity, positive and negative predictive values, and accuracy of high-confidence NBI predictions for adenoma in diminutive lesions were 95.3 %, 83.5 %, 93.5 %, 87.6 %, and 91.9 %, respectively. High-confidence characterization of diminutive polyps predicted the correct surveillance interval in 95.8 % and 93.3 % of cases according to European and American guidelines, respectively. NPV for adenoma in the rectosigmoid was 91.3 % Conclusions: For community settings in which endoscopists are adequately trained and performance is periodically audited, real-time optical diagnosis for diminutive polyps is sufficiently accurate to avoid postpolypectomy histological examination of resected lesions, or to leave rectosigmoid hyperplastic polyps in place. Trial registered at ClinicalTrials.gov (NCT02196402).

Research paper thumbnail of Response

Gastrointestinal endoscopy

Research paper thumbnail of nbi

Research paper thumbnail of Su1529 Factors Influencing Patients' Choice of Split Dose Bowel Cleansing Regimen for Colonoscopy in Clinical Practice

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of The impact of hyoscine-N-butylbromide on adenoma detection during colonoscopy: meta-analysis of randomized, controlled studies

Gastrointestinal endoscopy, 2014

Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth m... more Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth muscle activity, which improves mucosal visualization. Whether this affects polyp detection is controversial. To evaluate whether HBB, administered during colonoscopy, improves polyp and adenoma detection. We performed a comprehensive search in MEDLINE and EMBASE databases to identify randomized, placebo-controlled trials (RCTs) in which HBB was administered during colonoscopy and which also reported the detection rate for polyps and/or adenomas (PDR and/or ADR, respectively). Meta-analysis of 5 RCTs. A total of 1998 patients (1006 receiving HBB) were included in the study. Intravenous administration of 20 mg (2 mL) HBB or 2 mL saline solution at the time of cecal intubation. The PDR was the primary outcome variable. Secondary outcomes included the ADR, the advanced adenoma detection rate (adv-ADR), and the mean number of polyps and adenomas per patient (PPP and APP, respectively). The PD...

Research paper thumbnail of Unsedated colonoscopy: A neverending story

World journal of gastrointestinal endoscopy, Jan 16, 2012

Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in W... more Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.

Research paper thumbnail of Half Doses of PEG-ES and Senna vs. High-Dose Senna for Bowel Cleansing Before Colonoscopy: A Randomized, Investigator-Blinded Trial

The American Journal of Gastroenterology, 2009

Patients ' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution... more Patients ' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution (PEG-ES) have prompted continuous investigation with alternative forms of cleansing. Highdose senna is superior to PEG-ES for the quality of bowel cleansing, patient compliance, and tolerance, but its acceptance may be infl uenced by the incidence of abdominal pain. We hypothesized that a combination of half doses of PEG-ES and senna could minimize the incidence of abdominal pain without affecting the quality of bowel preparation.

Research paper thumbnail of P475 Granulocyte and Monocyte Apheresis (GMA) – Adacolumn® in mild to moderate ulcerative colitis patients with steroid resistance or dependence and azathioprine intolerance or resistance: a prospective multicenter study (preliminary data)

Journal of Crohn's and Colitis, 2014

Research paper thumbnail of 687 Narrow Band Imaging in the Prediction of Surveillance Intervals After Polypectomy in Community Practice: Ready for (a European) Prime Time

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1535 Do New Generation Narrow Band Imaging Colonoscopes Improve the Prediction of Histology for Diminutive Polyps? Preliminary Results of an Observational Prospective Study

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of 836 Prospective Study on Polypectomy Complications: Spoc

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Mo1496 Is It Really so Easy to Learn Histologic Characterization of Diminutive Polyps by Narrow Band Imaging? Preliminary Results of Endoscopists' and Nurses' Performances

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1276 Water Exchange May Be Superior to Water Immersion - Minimizes Colonoscopy Discomfort and Increases Adenoma Detection Rate (ADR) - Review of Recent Randomized Controlled Trials (RCT)

Gastrointestinal Endoscopy, 2012