Marco Emilio Dinelli - Academia.edu (original) (raw)

Papers by Marco Emilio Dinelli

Research paper thumbnail of Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

World Journal of Gastroenterology, 2022

Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it... more Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either qualitative or quantitative techniques. Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases, together with other imaging tests and clinical data. Elastography can be informative, especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions. However, further studies are necessary to standardize the method, increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses. Moreover, even if promising, elastography still provides little information in the evaluation of benign conditions.

Research paper thumbnail of Case Report: Hypomorphic Function and Somatic Reversion in DOCK8 Deficiency in One Patient With Two Novel Variants and Sclerosing Cholangitis

Frontiers in Immunology, 2021

DOCK8 deficiency is a combined immunodeficiency due to biallelic variants in dedicator of cytokin... more DOCK8 deficiency is a combined immunodeficiency due to biallelic variants in dedicator of cytokinesis 8 (DOCK8) gene. The disease has a wide clinical spectrum encompassing recurrent infections (candidiasis, viral and bacterial infections), virally driven malignancies and immune dysregulatory features, including autoimmune (cytopenia and vasculitis) as well as allergic disorders (eczema, asthma, and food allergy). Hypomorphic function and somatic reversion of DOCK8 has been reported to result in incomplete phenotype without IgE overproduction. Here we describe a case of DOCK8 deficiency in a 8-year-old Caucasian girl. The patient’s disease was initially classified as autoimmune thrombocytopenia, which then evolved toward a combined immunodeficiency phenotype with recurrent infections, persistent EBV infection and lymphoproliferation. Two novel variants (one deletion and one premature stop codon) were characterized, resulting in markedly reduced, but not absent, DOCK8 expression. Soma...

Research paper thumbnail of COVID-19 in Patients With Inflammatory Bowel Disease: A Single-center Observational Study in Northern Italy

Inflammatory Bowel Diseases, 2020

Research paper thumbnail of Infection Control Practices and Outcomes of Endoscopy Units in the Lombardy Region of Italy

Journal of Clinical Gastroenterology, 2020

Research paper thumbnail of Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy

Clinical Gastroenterology and Hepatology, 2020

This article has an accompanying continuing medical education activity, also eligible for MOC cre... more This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e122. Learning Objective-Upon completion of this activity, successful learners will be able to list the most common upper endoscopic findings in patients infected with 2019 novel coronavirus (SARS-Cov-2), list the most common lower endoscopic findings in patients infected with SARS-Cov-2; list appropriate PPE for health care providers performing endoscopic evaluation in patients positive or at high risk of SARS-Cov-2; and realize prioritization of endoscopic evaluation of GI bleeding in high-risk patients should be determined by clinical factors and not SARS-Cov-2 status.

Research paper thumbnail of First clinical experiences with a novel endoscopic over-the-scope clip system

Endoscopy international open, 2017

We describe our experience with a new over-the-scope clip (OTSC) system (Padlock Clip?) in the tr... more We describe our experience with a new over-the-scope clip (OTSC) system (Padlock Clip?) in the treatment of 14 patients. Eight of the 14 patients were treated for closure of gastrointestinal fistulas (n?=?4), iatrogenic gastrointestinal perforations (n?=?2), or hemostasis of post-polypectomy bleeding (n?=?2). The site of clipping was the lower gastrointestinal tract in five patients and the upper gastrointestinal tract in three patients. The clip was successfully delivered in seven out of the eight patients and clinical success was achieved in all patients. Endoscopic full thickness resection (EFTR) was performed to treat six patients: four with recurrent adenoma (n?=?4), one with ulcerated nodules at ileorectal anastomosis, and one with a neuro-endocrine tumor of the rectum. A complete intestinal wall resection was achieved in three of the six patients (50?%) and an R0 resection in five of the six patients (83.3?%). No complications related to the procedure and no recurrence at end...

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

Digestive and Liver Disease, 2016

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 behalf of the KRASTENT Study Group 1

Digestive and Liver Disease j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o... more Digestive and Liver Disease j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d l d Oncology Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: A retrospective multicentre study a b s t r a c t Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer. Methods: This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011. Results: K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemother-apy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P = 0.9). K-ras wild-type patients were not less l...

Research paper thumbnail of Update on Helicobacter pylori research. Dyspepsia

European Journal of Gastroenterology & Hepatology

Research paper thumbnail of Area under pH 4: a more sensitive parameter for the quantitative analysis of esophageal acid exposure in adults

The American Journal of Gastroenterology, 1999

Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH o... more Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH of reflux episodes. Area under pH 4 (AU4) is a recently introduced parameter that describes the acid exposure rate through both duration and depth of pH falls. In Study A, we enrolled 20 healthy controls and 42 patients (18 without esophagitis, 24 with Savary I-III esophagitis) in a study evaluating reference values for 24-h reflux time at pH <4 (RT) and 24-h AU4 by means of receiver operating characteristic (ROC) discriminant analysis. For Study B, we next prospectively applied the resulting cutoffs to 16 healthy controls and to 110 gastroesophageal reflux (GERD) patients (55 with esophagitis) to adjust sensitivity, specificity, and predictive values of both RT and AU4. In Study A, the best cutoff values were 5.1% for RT (Area Index +/- SE, 0.899 +/- 0.038; 95% confidence interval [C.I.], 0.796 +/- 0.961) and 36.1 pH x min for AU4 (Area Index +/- SE, 0.935 +/- 0.03; 95% C.I., 0.842 +/- 0.981); AU4 gave the best performance (p = 0.038 vs RT) in discriminating controls and GERD patients. In Study B, RT was abnormal in three controls and 79 patients; AU4 identified all the controls and patients with abnormal RT and also 10/31 patients (32.3%) with so-called "normal" acid exposure (according to RT). In the whole GERD group of patients, AU4 and RT specificity was 81.2%, whereas sensitivity was 71.8% for RT and 80.9% for AU4 (chi2, 61.831; DF, 1; p < 0.005); PPV/NPV were 96.3%/29.5% for RT, and 96.7%/38.2% for AU4. AU4 appears to be a simple and sensitive quantitative parameter to measure the esophageal acid exposure in adults submitted to 24-h pH monitoring, and it could be an useful clinical aid in evaluating normal RT tests where, from a clinical point of view, a reflux disease is highly likely.

Research paper thumbnail of Is Esophageal pH Monitoring Used Appropriately in an Open-Access System? A Prospective Multicenter Study

The American Journal of Gastroenterology, 2004

To evaluate the referral patterns and indications for esophageal pH monitoring in an open-access ... more To evaluate the referral patterns and indications for esophageal pH monitoring in an open-access system and to determine whether these indications conform to practice guidelines of the American Gastroenterological Association (AGA). A total of 851 consecutive patients referred for ambulatory pH monitoring to nine open-access gastrointestinal units over a 12-month period received a structured interview. The indication for the examination was decided by the physician performing the procedure, on the basis of the patient's clinical history and main complaint. Three hundred and twenty-three (38%) examinations were for indications in accordance with the guidelines. The proportion of appropriate requests in each center ranged from 34% to 47%. This figure was not significantly different in larger gastrointestinal units (more than 150 examinations per year) and smaller ones (35% and 40%; p= 0.14). The proportion of appropriate requests was 45% for gastroenterologists, 38% for surgeons, 32% for other specialists, and 24% for primary care physicians (PCPs) (p < 0.001). The percentage of appropriateness was significantly different between gastrointestinal specialists and PCPs (p < 0.001 vs gastroenterologists, p= 0.015 vs GI surgeons), and between gastroenterologists and other specialists (p= 0.006). The underuse of an empirical trial of acid-suppression therapy in patients with suspected reflux disease and the overuse of this test to confirm a diagnosis in patients with erosive esophagitis and in endoscopy-negative cases with typical symptoms responding completely to antisecretory therapy accounted for most of the referrals, which was not in accordance with the guidelines. In an open-access system, a high proportion of esophageal pH studies are done for indications not consistent with published guidelines, particularly among the examinations not requested by gastrointestinal specialists. Further education is still needed on the appropriate use of esophageal pH monitoring and management of gastroesophageal reflux disease (GERD).

Research paper thumbnail of Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study

Surgical Endoscopy, 2013

Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldw... more Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79). The study showed that EMR can be performed also in LVC.

Research paper thumbnail of A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia

Gut, 2000

Background-Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment fo... more Background-Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment for oesophageal achalasia. However, the predictors of response and optimal dose remain unclear. Aims-To compare the eVect of diVerent doses of Botx and to identify predictors of response. Patients/methods-A total of 118 achalasic patients were randomised to receive one of three doses of Botx in a single injection: 50 U (n=40), 100 U (n=38), and 200 U (n=40). Of those who received 100 U, responsive patients were reinjected with an identical dose after 30 days. Clinical and manometric assessments were performed at baseline, 30 days after the initial injection of botulinum toxin, and at the end of follow up (mean 12 months; range 7-24 months). Results-Thirty days after the initial injection, 82% of patients were considered responders without a clear dose related eVect. At the end of follow up however, relapse of symptoms was evident in 19% of patients who received two injections of 100 U compared with 47% and 43% in the 50 U and 200 U groups, respectively. Using Kaplan-Meier analysis, patients in the 100×2 U group were more likely to remain in remission at any time (p<0.04), with 68% (95% CI 59-83) still in remission at 24 months. In a multiple adjusted model, response to Botx was independently predicted by the occurrence of vigorous achalasia (odds ratio 3.3) and the 100×2 U regimen (odds ratio 3.2). Conclusions-Two injections of 100 U of Botx 30 days apart appeared to be the most eVective therapeutic schedule. The presence of vigorous achalasia was the principal determinant of the response to Botx.

Research paper thumbnail of Tu1436 K-RAS Mutation Status and Anti-Tumoral Therapies Do Not Influence the Risk of Adverse Events in Patients With Obstructive Colorectal Cancer Palliated by Self-Expandable Metallic Stents

Gastrointestinal Endoscopy, 2014

Patients undergoing Surgery after EMR (n[9) Resection En Bloc Resection 18% 33.3% Complete micros... more Patients undergoing Surgery after EMR (n[9) Resection En Bloc Resection 18% 33.3% Complete microscopic resection after EMR 33% (2 of 6 patients) 40% (2 of 5 patients) Residual Cancer 0 [mean follow up 6.8 months, SD 9,nZ9] 2 cases in colectomy specimens

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

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1549 Endoscopic Resection for Sessile and Flat Colorectal Lesions Between High-Volume and Low Volumes Centers in the North of Italy. A Prospective Multicenter Study

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of Multicentre, dose-finding study of botulinum toxin for the therapy of esophageal achalasia

Research paper thumbnail of Appropriate use of oesophageal pH recording in an open access system

Research paper thumbnail of The Use of Double Lasso, Fully Covered Self-Expandable Metal Stents with New “Anchoring Flap” System in the Treatment of Benign Biliary Diseases

Digestive Diseases and Sciences, 2014

Background Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable ... more Background Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable metal stents (FCSEMS) but stent migration occurs in up to 35.7 %. The aim of this study was to prospectively assess the rate of, safety and effectiveness and stent migration of a new biliary FCSEMS with an anti-migration flap (FCSEMS-AF) in patients with BBD. Patients and Methods This was a prospective study from four Italian referral endoscopy centers of 32 consecutive patients (10 females and 22 males; mean age: 60.1 ± 14.8 years; range: 32-84 years) with BBD who were offered endoscopic placement of a FCSEMS-AF as first-line therapy. Results Were 24 strictures and 8 leaks. Stent placement was technically successful in 32/32 patients (100 %). Immediate clinical improvement was seen in all 32 patients (100 %). One late stent migration occurred (3.3 %). FCSEMS-AF were removed from 30 of the 32 patients (93.7 %) at a mean (±SD) of 124.4 ± 84.2 days (range: 10-386 days) after placement. All patients remained clinically and biochemically well at 1-and 3-month follow-up. One patient (3.3 %) with a post-laparoscopic cholecystectomy stricture developed distal stent migration at 125 days. Conclusion This new FCSEMS with anti-migration flap seems to be a safe and effective first-line treatment option for patients with BBD.

Research paper thumbnail of Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: A retrospective multicentre study

Digestive and Liver Disease, 2014

Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatm... more Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer. Methods: This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011. Results: K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemotherapy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P = 0.9). K-ras wild-type patients were not less likely to develop adverse events than K-ras mutant patients (OR, 0.99; 95% CI: 0.4-2.7). Overall mean time to complication was 167.6 days (range 4-720 days), with no difference between the two groups (141 vs. 197 days; P = 0.5). Chemotherapy did not influence the risk of complications (OR, 0.56; 95% CI: 0.14-2.9), and there was no evidence that patients treated with chemotherapy and cetuximab were more likely to experience stent-related complications than patients treated with chemotherapy alone, or untreated (OR, 1.2; 95% CI: 0.2-5.9). Although perforation rates were higher with bevacizumab-based treatment (11.8% vs. 7%), this result was not statistically significant (P = 0.69). Conclusions: K-ras mutation status, chemotherapy, and biological treatments should not influence colorectal stent-related complication rates.

Research paper thumbnail of Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

World Journal of Gastroenterology, 2022

Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it... more Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either qualitative or quantitative techniques. Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases, together with other imaging tests and clinical data. Elastography can be informative, especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions. However, further studies are necessary to standardize the method, increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses. Moreover, even if promising, elastography still provides little information in the evaluation of benign conditions.

Research paper thumbnail of Case Report: Hypomorphic Function and Somatic Reversion in DOCK8 Deficiency in One Patient With Two Novel Variants and Sclerosing Cholangitis

Frontiers in Immunology, 2021

DOCK8 deficiency is a combined immunodeficiency due to biallelic variants in dedicator of cytokin... more DOCK8 deficiency is a combined immunodeficiency due to biallelic variants in dedicator of cytokinesis 8 (DOCK8) gene. The disease has a wide clinical spectrum encompassing recurrent infections (candidiasis, viral and bacterial infections), virally driven malignancies and immune dysregulatory features, including autoimmune (cytopenia and vasculitis) as well as allergic disorders (eczema, asthma, and food allergy). Hypomorphic function and somatic reversion of DOCK8 has been reported to result in incomplete phenotype without IgE overproduction. Here we describe a case of DOCK8 deficiency in a 8-year-old Caucasian girl. The patient’s disease was initially classified as autoimmune thrombocytopenia, which then evolved toward a combined immunodeficiency phenotype with recurrent infections, persistent EBV infection and lymphoproliferation. Two novel variants (one deletion and one premature stop codon) were characterized, resulting in markedly reduced, but not absent, DOCK8 expression. Soma...

Research paper thumbnail of COVID-19 in Patients With Inflammatory Bowel Disease: A Single-center Observational Study in Northern Italy

Inflammatory Bowel Diseases, 2020

Research paper thumbnail of Infection Control Practices and Outcomes of Endoscopy Units in the Lombardy Region of Italy

Journal of Clinical Gastroenterology, 2020

Research paper thumbnail of Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy

Clinical Gastroenterology and Hepatology, 2020

This article has an accompanying continuing medical education activity, also eligible for MOC cre... more This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e122. Learning Objective-Upon completion of this activity, successful learners will be able to list the most common upper endoscopic findings in patients infected with 2019 novel coronavirus (SARS-Cov-2), list the most common lower endoscopic findings in patients infected with SARS-Cov-2; list appropriate PPE for health care providers performing endoscopic evaluation in patients positive or at high risk of SARS-Cov-2; and realize prioritization of endoscopic evaluation of GI bleeding in high-risk patients should be determined by clinical factors and not SARS-Cov-2 status.

Research paper thumbnail of First clinical experiences with a novel endoscopic over-the-scope clip system

Endoscopy international open, 2017

We describe our experience with a new over-the-scope clip (OTSC) system (Padlock Clip?) in the tr... more We describe our experience with a new over-the-scope clip (OTSC) system (Padlock Clip?) in the treatment of 14 patients. Eight of the 14 patients were treated for closure of gastrointestinal fistulas (n?=?4), iatrogenic gastrointestinal perforations (n?=?2), or hemostasis of post-polypectomy bleeding (n?=?2). The site of clipping was the lower gastrointestinal tract in five patients and the upper gastrointestinal tract in three patients. The clip was successfully delivered in seven out of the eight patients and clinical success was achieved in all patients. Endoscopic full thickness resection (EFTR) was performed to treat six patients: four with recurrent adenoma (n?=?4), one with ulcerated nodules at ileorectal anastomosis, and one with a neuro-endocrine tumor of the rectum. A complete intestinal wall resection was achieved in three of the six patients (50?%) and an R0 resection in five of the six patients (83.3?%). No complications related to the procedure and no recurrence at end...

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

Digestive and Liver Disease, 2016

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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and polyp&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;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 behalf of the KRASTENT Study Group 1

Digestive and Liver Disease j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o... more Digestive and Liver Disease j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d l d Oncology Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: A retrospective multicentre study a b s t r a c t Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer. Methods: This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011. Results: K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemother-apy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P = 0.9). K-ras wild-type patients were not less l...

Research paper thumbnail of Update on Helicobacter pylori research. Dyspepsia

European Journal of Gastroenterology & Hepatology

Research paper thumbnail of Area under pH 4: a more sensitive parameter for the quantitative analysis of esophageal acid exposure in adults

The American Journal of Gastroenterology, 1999

Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH o... more Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH of reflux episodes. Area under pH 4 (AU4) is a recently introduced parameter that describes the acid exposure rate through both duration and depth of pH falls. In Study A, we enrolled 20 healthy controls and 42 patients (18 without esophagitis, 24 with Savary I-III esophagitis) in a study evaluating reference values for 24-h reflux time at pH &lt;4 (RT) and 24-h AU4 by means of receiver operating characteristic (ROC) discriminant analysis. For Study B, we next prospectively applied the resulting cutoffs to 16 healthy controls and to 110 gastroesophageal reflux (GERD) patients (55 with esophagitis) to adjust sensitivity, specificity, and predictive values of both RT and AU4. In Study A, the best cutoff values were 5.1% for RT (Area Index +/- SE, 0.899 +/- 0.038; 95% confidence interval [C.I.], 0.796 +/- 0.961) and 36.1 pH x min for AU4 (Area Index +/- SE, 0.935 +/- 0.03; 95% C.I., 0.842 +/- 0.981); AU4 gave the best performance (p = 0.038 vs RT) in discriminating controls and GERD patients. In Study B, RT was abnormal in three controls and 79 patients; AU4 identified all the controls and patients with abnormal RT and also 10/31 patients (32.3%) with so-called &quot;normal&quot; acid exposure (according to RT). In the whole GERD group of patients, AU4 and RT specificity was 81.2%, whereas sensitivity was 71.8% for RT and 80.9% for AU4 (chi2, 61.831; DF, 1; p &lt; 0.005); PPV/NPV were 96.3%/29.5% for RT, and 96.7%/38.2% for AU4. AU4 appears to be a simple and sensitive quantitative parameter to measure the esophageal acid exposure in adults submitted to 24-h pH monitoring, and it could be an useful clinical aid in evaluating normal RT tests where, from a clinical point of view, a reflux disease is highly likely.

Research paper thumbnail of Is Esophageal pH Monitoring Used Appropriately in an Open-Access System? A Prospective Multicenter Study

The American Journal of Gastroenterology, 2004

To evaluate the referral patterns and indications for esophageal pH monitoring in an open-access ... more To evaluate the referral patterns and indications for esophageal pH monitoring in an open-access system and to determine whether these indications conform to practice guidelines of the American Gastroenterological Association (AGA). A total of 851 consecutive patients referred for ambulatory pH monitoring to nine open-access gastrointestinal units over a 12-month period received a structured interview. The indication for the examination was decided by the physician performing the procedure, on the basis of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical history and main complaint. Three hundred and twenty-three (38%) examinations were for indications in accordance with the guidelines. The proportion of appropriate requests in each center ranged from 34% to 47%. This figure was not significantly different in larger gastrointestinal units (more than 150 examinations per year) and smaller ones (35% and 40%; p= 0.14). The proportion of appropriate requests was 45% for gastroenterologists, 38% for surgeons, 32% for other specialists, and 24% for primary care physicians (PCPs) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The percentage of appropriateness was significantly different between gastrointestinal specialists and PCPs (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 vs gastroenterologists, p= 0.015 vs GI surgeons), and between gastroenterologists and other specialists (p= 0.006). The underuse of an empirical trial of acid-suppression therapy in patients with suspected reflux disease and the overuse of this test to confirm a diagnosis in patients with erosive esophagitis and in endoscopy-negative cases with typical symptoms responding completely to antisecretory therapy accounted for most of the referrals, which was not in accordance with the guidelines. In an open-access system, a high proportion of esophageal pH studies are done for indications not consistent with published guidelines, particularly among the examinations not requested by gastrointestinal specialists. Further education is still needed on the appropriate use of esophageal pH monitoring and management of gastroesophageal reflux disease (GERD).

Research paper thumbnail of Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study

Surgical Endoscopy, 2013

Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldw... more Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79). The study showed that EMR can be performed also in LVC.

Research paper thumbnail of A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia

Gut, 2000

Background-Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment fo... more Background-Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment for oesophageal achalasia. However, the predictors of response and optimal dose remain unclear. Aims-To compare the eVect of diVerent doses of Botx and to identify predictors of response. Patients/methods-A total of 118 achalasic patients were randomised to receive one of three doses of Botx in a single injection: 50 U (n=40), 100 U (n=38), and 200 U (n=40). Of those who received 100 U, responsive patients were reinjected with an identical dose after 30 days. Clinical and manometric assessments were performed at baseline, 30 days after the initial injection of botulinum toxin, and at the end of follow up (mean 12 months; range 7-24 months). Results-Thirty days after the initial injection, 82% of patients were considered responders without a clear dose related eVect. At the end of follow up however, relapse of symptoms was evident in 19% of patients who received two injections of 100 U compared with 47% and 43% in the 50 U and 200 U groups, respectively. Using Kaplan-Meier analysis, patients in the 100×2 U group were more likely to remain in remission at any time (p<0.04), with 68% (95% CI 59-83) still in remission at 24 months. In a multiple adjusted model, response to Botx was independently predicted by the occurrence of vigorous achalasia (odds ratio 3.3) and the 100×2 U regimen (odds ratio 3.2). Conclusions-Two injections of 100 U of Botx 30 days apart appeared to be the most eVective therapeutic schedule. The presence of vigorous achalasia was the principal determinant of the response to Botx.

Research paper thumbnail of Tu1436 K-RAS Mutation Status and Anti-Tumoral Therapies Do Not Influence the Risk of Adverse Events in Patients With Obstructive Colorectal Cancer Palliated by Self-Expandable Metallic Stents

Gastrointestinal Endoscopy, 2014

Patients undergoing Surgery after EMR (n[9) Resection En Bloc Resection 18% 33.3% Complete micros... more Patients undergoing Surgery after EMR (n[9) Resection En Bloc Resection 18% 33.3% Complete microscopic resection after EMR 33% (2 of 6 patients) 40% (2 of 5 patients) Residual Cancer 0 [mean follow up 6.8 months, SD 9,nZ9] 2 cases in colectomy specimens

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

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Su1549 Endoscopic Resection for Sessile and Flat Colorectal Lesions Between High-Volume and Low Volumes Centers in the North of Italy. A Prospective Multicenter Study

Gastrointestinal Endoscopy, 2011

Research paper thumbnail of Multicentre, dose-finding study of botulinum toxin for the therapy of esophageal achalasia

Research paper thumbnail of Appropriate use of oesophageal pH recording in an open access system

Research paper thumbnail of The Use of Double Lasso, Fully Covered Self-Expandable Metal Stents with New “Anchoring Flap” System in the Treatment of Benign Biliary Diseases

Digestive Diseases and Sciences, 2014

Background Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable ... more Background Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable metal stents (FCSEMS) but stent migration occurs in up to 35.7 %. The aim of this study was to prospectively assess the rate of, safety and effectiveness and stent migration of a new biliary FCSEMS with an anti-migration flap (FCSEMS-AF) in patients with BBD. Patients and Methods This was a prospective study from four Italian referral endoscopy centers of 32 consecutive patients (10 females and 22 males; mean age: 60.1 ± 14.8 years; range: 32-84 years) with BBD who were offered endoscopic placement of a FCSEMS-AF as first-line therapy. Results Were 24 strictures and 8 leaks. Stent placement was technically successful in 32/32 patients (100 %). Immediate clinical improvement was seen in all 32 patients (100 %). One late stent migration occurred (3.3 %). FCSEMS-AF were removed from 30 of the 32 patients (93.7 %) at a mean (±SD) of 124.4 ± 84.2 days (range: 10-386 days) after placement. All patients remained clinically and biochemically well at 1-and 3-month follow-up. One patient (3.3 %) with a post-laparoscopic cholecystectomy stricture developed distal stent migration at 125 days. Conclusion This new FCSEMS with anti-migration flap seems to be a safe and effective first-line treatment option for patients with BBD.

Research paper thumbnail of Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: A retrospective multicentre study

Digestive and Liver Disease, 2014

Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatm... more Background: This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer. Methods: This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011. Results: K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemotherapy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P = 0.9). K-ras wild-type patients were not less likely to develop adverse events than K-ras mutant patients (OR, 0.99; 95% CI: 0.4-2.7). Overall mean time to complication was 167.6 days (range 4-720 days), with no difference between the two groups (141 vs. 197 days; P = 0.5). Chemotherapy did not influence the risk of complications (OR, 0.56; 95% CI: 0.14-2.9), and there was no evidence that patients treated with chemotherapy and cetuximab were more likely to experience stent-related complications than patients treated with chemotherapy alone, or untreated (OR, 1.2; 95% CI: 0.2-5.9). Although perforation rates were higher with bevacizumab-based treatment (11.8% vs. 7%), this result was not statistically significant (P = 0.69). Conclusions: K-ras mutation status, chemotherapy, and biological treatments should not influence colorectal stent-related complication rates.