Marco Soncini - Academia.edu (original) (raw)
Papers by Marco Soncini
Giornale italiano di cardiologia, 2020
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and ... more Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Indeed, pharmacodynamic and pharmacokinetic studies suggested an interaction through CYP2C19 between PPIs and clopidogrel, which could translate into clinical inefficacy, leading to higher rates of cardiovascular events. The Food and Drug Administration and the European Medicines Agency sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. In addition, whether the use of PPIs may affe...
Gut, 2020
ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGI... more ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in both UGIB and LGIB.Design and settingInternational cohort study. Patients presenting to hospital with UGIB at six international centres were used to develop a risk score for predicting mortality using regression analyses. The score’s performance in UGIB and LGIB was externally validated and compared with existing scores using four international datasets. We calculated areas under receiver operating characteristics curves (AUROCs), sensitivities, specificities and outcome among patients classified as low risk and high risk.Participants and resultsWe included 3012 UGIB patients in the development cohort, and 4019 UGIB and 2336 LGIB patients in the validation cohorts. Age, Blood tests and Comorbidities (ABC) score was closer associated with mortality in UGIB and LGIB (AUROCs:...
The Journal of Immunology, 2021
The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory ... more The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19). In this study, COVID-19 ARDS patients admitted to the Azienda Socio Sanitaria Territoriale of Lecco, Italy, between March 5th to April 15th, 2020, and who had received anakinra off-label were retrospectively evaluated and compared with a cohort of matched controls who did not receive immunomodulatory treatment. The primary end point was survival at day 28. The population consisted of 112 patients (56 treated with anakinra and 56 controls). Survival at day 28 was obtained in 69 patients (61.6%) and was significantly higher in anakinra-treated patients than in the controls (75.0 versus 48.2%, p = 0.007). When stratified by continuous positive airway pressure support at baseline, anakinra-treated patients’ survival was also significant compared with the controls (p = 0.008). Univariate analysis identified anakinra...
Digestive and Liver Disease, 2021
ESGE Days, 2020
Background/Aim: The indiscriminate use of high-dose, proton pump inhibitor (PPI) infusion in nonv... more Background/Aim: The indiscriminate use of high-dose, proton pump inhibitor (PPI) infusion in nonvariceal upper gastrointestinal bleeding (UGIB) patients to reduce the rate of peptic ulcers with high-risk stigmata (HRS) has been questioned. We evaluated the prevalence of HRS on peptic ulcer and non-ulcer lesions in patients receiving or not receiving pre-endoscopic PPI therapy. Methods: Data of consecutive UGIB patients observed in 50 Italian centres were analysed. The prevalence of both HRS on peptic ulcers and active bleeding on non-ulcer lesions between patients treated or not treated with PPI were compared. Multivariate analysis was performed. Results: A total of 1,792 (69.8%) out of 2,566 patients received PPI therapy. Prevalence of HRS on ulcers was 51.8% and 53.4% (P = 0.58) in treated and not treated patients, respectively, and the rate of endoscopic therapy did not differ between groups. Prevalence of non-ulcer bleeding lesions was higher in patients treated than in those not treated with PPI (18.7% vs 10.6%; P = 0.023). At multivariate analysis, PPI therapy (OR: 1.16, 95% CI = 0.82-1.64; P = 0.4) was not an independent factor affecting HRS prevalence, which was inversely correlated with timing to endoscopy (OR: 0.85, 95% CI = 0.76-0.95; P = 0.005). Conclusions: Our data failed to detect a significant role of pre-endoscopic PPI therapy in decreasing prevalence of HRS and need for endoscopic treatment in bleeding patients with either peptic ulcer or non-ulcer lesions.
American Journal of Gastroenterology, 2006
Digestive and Liver Disease, 2019
Background: Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure use... more Background: Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure used to provide nutritional support. Aim: To prospectively evaluate the mortality and complication incidences after PEG insertion or replacement.
Giornale italiano di cardiologia, 1995
In the medical literature reports are accumulating a number of case reports suggesting the potent... more In the medical literature reports are accumulating a number of case reports suggesting the potential efficacy and safety of the combination of low-dose aspirin and warfarin to improve the efficacy of antithrombotic therapy in several clinical conditions, ranging from unstable angina to myocardial infarction. The advantages deriving from such a combination have to be considered together with its hemorrhagic risk. Thus the efficacy of such a treatment has to be proved by large clinical trials before the use of this potentially dangerous therapy can be transferred into common clinical practice.
Gastrointestinal Endoscopy, 2014
In small-bowel capsule endoscopy (SBCE), differentiating masses (ie, lesions of higher probabilit... more In small-bowel capsule endoscopy (SBCE), differentiating masses (ie, lesions of higher probability for neoplasia) requiring more aggressive intervention from bulges (essentially, false-positive findings) is a challenging task; recently, software that enables 3-dimensional (3D) reconstruction has become available. To evaluate whether "coupling" 3D reconstructed video clips with the standard 2-dimensional (s2D) counterparts helps in distinguishing masses from bulges. Three expert and 3 novice SBCE readers, blind to others and in a random order, reviewed the s2D video clips and subsequently the s2D clips coupled with their 3D reconstruction (2D+3D). Multicenter study in 3 community hospitals in Italy and a university hospital in Scotland. Thirty-two deidentified 5-minute video clips, containing mucosal bulging (19) or masses (13). 3D reconstruction of s2D SBCE video clips. Differentiation of masses from bulges with s2D and 2D+3D video clips, estimated by the area under the receiver operating characteristic curve (AUC); interobserver agreement. AUC for experts and novices for s2D video clips was .74 and .5, respectively (P = .0053). AUC for experts and novices with 2D+3D was .70 (compared with s2D: P = .245) and .57 (compared s2D: P = .049), respectively. AUC for experts and novices with 2D+3D was similar (P = .1846). The interobserver agreement was good for both experts and novices with the s2D (k = .71 and .54, respectively) and the 2D+3D video clips (k = .58 in both groups). Few, short video clips; fixed angle of 3D reconstruction. The adjunction of a 3D reconstruction to the s2D video reading platform does not improve the performance of expert SBCE readers, although it significantly increases the performance of novices in distinguishing masses from bulging.
Digestive and Liver Disease, 2010
Background: Although capsule endoscopy is the cornerstone for the evaluation of the small bowel i... more Background: Although capsule endoscopy is the cornerstone for the evaluation of the small bowel in patients with obscure GI bleeding data about costs are lacking. Aim: To evaluate, from a third party payer point of view, whether performing capsule endoscopy as an outpatient instead of an inpatient procedure can reduce costs. Materials and methods: The data source is a multicentre survey collecting data for 2921 patients; 1486 of them underwent capsule endoscopy for obscure GI bleeding or chronic unexplained iron-deficiency anaemia as inpatients (814 with positive, 211 with inconclusive and 461 with negative result). We estimated costs of inpatient procedures based on the diagnosis related groups (DRG) system, while those of outpatient procedures on reimbursement provided in five Italian regions. Results: We estimated that the cost for each inpatient undergoing capsule endoscopy is about D 1775.90. Assuming that all these patients had undergone the same procedure as outpatients, D 175.00-741.00 per patient (depending on the reimbursement and/or on diagnosis related group codes applied) would have been saved. Conclusions: Our estimate suggests that, from the third party payer's perspective and using the diagnosis related group reimbursement system, shifting capsule endoscopy from inpatient to outpatient procedure, would be potentially cost saving at least for patients referred for obscure GI bleeding or chronic unexplained anaemia.
Biomedicine & Pharmacotherapy, 1997
Minerva medica, 1997
We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalv... more We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalvular atrial fibrillation (AF). Patients were also stratified according to a history of prior stroke. The generation of thrombin was investigated by means of the molecular markers prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), because AF patients may have a hypercoagulable state. There was only a trend toward higher values of TAT and F1 + 2 for AF patients, while subjects with previous stroke (irrespective of AF) had increased levels of the markers of thrombin generation (TAT stroke+ 18.95 +/- 5.15 vs TAT stroke- 8.34 +/- 2.41; F1 + 2 stroke+ 2.22 +/- 0.29 vs F1 + 2 stroke- 1.32 +/- 0.12). The presence of spontaneous echo contrast (SEC) within left atrium was also investigated in 32 AF patients by transesophageal echocardiography. TAT were significantly higher in subjects (n = 11) with SEC (TAT sec+ 37.5 +/- 13.41 vs TAT sec- 8.7 +/- 2.51, p = 0.008). Fin...
Digestive and Liver Disease, Oct 1, 2020
Digestive and Liver Disease, Oct 1, 2020
Digestive and Liver Disease, Mar 1, 2018
vaginal history (40%) were statistically associated with FI (p≤0.05). Normal manometric parameter... more vaginal history (40%) were statistically associated with FI (p≤0.05). Normal manometric parameters were found in 16 patients (4%). Manometric alterations were found in 342 pts: 228 internal anal sphincter (IAS) dysfunction (64%); 274 isolated external anal sphincter (EAS) dysfunction (76%); 198 combined sphincter dysfunction IAS and EAS (55%); 100 isolated dyssynergic defecation (28%); 130 rectal hypersensitivity (36%). Conclusions: In our study, we observed a female prevalence in FI. FI is significantly associated with UI. This may be explained by risk factors in common with these clinical conditions. FI is significantly associated with previous proctological/pelvic surgery and anal/vaginal traumaduring delivery. Furthermore, patients with FI reported also difficult evacuating stools. In these patients with dyssynergic-type constipation and FI, encopresis must be excluded first. Moreover we observed these prevalent manometric findings: combined dysfunction IAS and EAS, and rectal hypersensitivity. The manometric assessment could help physicians to identify patients appropriated for a biofeedback therapy.
Digestive and Liver Disease, Sep 1, 2021
BACKGROUND the lack of standardized pathways for patients with gastrointestinal bleeding may have... more BACKGROUND the lack of standardized pathways for patients with gastrointestinal bleeding may have led to differences in their management and inequity to medical care access. The "Hub & Spoke" model was adopted to fill this gap in many disciplines, but, to our knowledge, no data exist on its efficacy on mortality in GI bleeding. We aimed to evaluate if the "Hub & Spoke" organizational model has an impact on mortality risk from UGIB. METHODS from January 2014 to December 2015, 3324 consecutive patients admitted for UGIB in 50 Italian hospitals were enrolled (1977 patients in hospitals within the "Hub & Spoke" network for digestive hemorrhagic emergency and 1347 in hospitals outside the "Hub & Spoke" network). Clinical, endoscopic and organizational data were recorded. RESULTS we observed no differences in mortality between patients admitted to hospitals included or not included in the "Hub & Spoke" network (5.2% vs 6.1%, p = 0.3). On multivariate analysis, admission in gastroenterology wards (OR 0.61, p = 0.001) or an academic hospital (OR 0.65, p < 0.056) were independent protective factors while being in "Hub & Spoke" organization system did not affect mortality (OR 1.09, p = 0.57). CONCLUSION the "Hub & Spoke" model per sé does not impact on mortality while being treated in academic hospital or gastroenterology wards improved survival.
Endoscopy International Open, 2021
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issu... more Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark.Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures.Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014–2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for f...
Digestive and Liver Disease, 2019
Digestive and Liver Disease, 2019
et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical is... more et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical issues with the aim to support gastroenterologists in their clinical practice when dealing with patients with anaemia.
Digestive and Liver Disease, 2017
non-variceal in 2764 (83.1%) and variceal in 560. Outpatients (2646) were driven to the First Aid... more non-variceal in 2764 (83.1%) and variceal in 560. Outpatients (2646) were driven to the First Aid Department in an ambulance 118: Northern Italy (55.6%), Central Italy (61.5%) and Southern Italy (40.5%) (p<0.0001). In the Northern Regions 64% of emergency endoscopy was performed after a direct request from the First Aid Department, 53.9% in the Centre and 27.7% in the South (p<0.0001). 81% of GI emergency endoscopy was performed in the daytime (8am-8pm) with significant differences among the several geographical areas. Endoscopy was averagely performed within 11 hours in the North, 12 hours in the Centre and 15 hours in the South (p<0.05). Mortality overall result (variceal and non-variceal) was 223 patients, equal to 6.7% but significant difference was present:6.6% in the North, 4.7% in the Centre and 8.1% in the South (p<0.02). No significant differences emerged among the regions with an active network of GI haemorrhage 6.2% (84/1347) versus those without it 7.0% (139/1977) (p=0.367). Overall mortality, evaluated according to the seriousness of the clinical case, resulted lower in University Hospitals (OR 0.60 [95% Cl: 0.35 to 1.02]). Mortality rate is lower when endoscopy is performed in the endoscopy room: 6.2% versus 9.2% when performed elsewhere (p<0.0001). Overall 8.4% patients are sent back home directly from the First Aid Department after undergoing endoscopy, but significant differences emerged among the several geographical areas: 12.1% in the North, 10.0% in the Centre and 1.7% in the South (p<0.0001). Conclusions: The mortality due to UGIB significantly differs among North, Centre and South Italy as well as the patients managed as outpatients. The presence of a well-organized network of gastrointestinal bleeding does not reduce the mortality. Organisational and health care course are different among the several geographical areas and provide different outcomes.
Giornale italiano di cardiologia, 2020
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and ... more Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular and cerebrovascular diseases. Gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed. However, potential increased risk of cardiovascular events has been suggested for PPIs, and, in recent years, it has been discussed whether these drugs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel. Indeed, pharmacodynamic and pharmacokinetic studies suggested an interaction through CYP2C19 between PPIs and clopidogrel, which could translate into clinical inefficacy, leading to higher rates of cardiovascular events. The Food and Drug Administration and the European Medicines Agency sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. In addition, whether the use of PPIs may affe...
Gut, 2020
ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGI... more ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in both UGIB and LGIB.Design and settingInternational cohort study. Patients presenting to hospital with UGIB at six international centres were used to develop a risk score for predicting mortality using regression analyses. The score’s performance in UGIB and LGIB was externally validated and compared with existing scores using four international datasets. We calculated areas under receiver operating characteristics curves (AUROCs), sensitivities, specificities and outcome among patients classified as low risk and high risk.Participants and resultsWe included 3012 UGIB patients in the development cohort, and 4019 UGIB and 2336 LGIB patients in the validation cohorts. Age, Blood tests and Comorbidities (ABC) score was closer associated with mortality in UGIB and LGIB (AUROCs:...
The Journal of Immunology, 2021
The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory ... more The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19). In this study, COVID-19 ARDS patients admitted to the Azienda Socio Sanitaria Territoriale of Lecco, Italy, between March 5th to April 15th, 2020, and who had received anakinra off-label were retrospectively evaluated and compared with a cohort of matched controls who did not receive immunomodulatory treatment. The primary end point was survival at day 28. The population consisted of 112 patients (56 treated with anakinra and 56 controls). Survival at day 28 was obtained in 69 patients (61.6%) and was significantly higher in anakinra-treated patients than in the controls (75.0 versus 48.2%, p = 0.007). When stratified by continuous positive airway pressure support at baseline, anakinra-treated patients’ survival was also significant compared with the controls (p = 0.008). Univariate analysis identified anakinra...
Digestive and Liver Disease, 2021
ESGE Days, 2020
Background/Aim: The indiscriminate use of high-dose, proton pump inhibitor (PPI) infusion in nonv... more Background/Aim: The indiscriminate use of high-dose, proton pump inhibitor (PPI) infusion in nonvariceal upper gastrointestinal bleeding (UGIB) patients to reduce the rate of peptic ulcers with high-risk stigmata (HRS) has been questioned. We evaluated the prevalence of HRS on peptic ulcer and non-ulcer lesions in patients receiving or not receiving pre-endoscopic PPI therapy. Methods: Data of consecutive UGIB patients observed in 50 Italian centres were analysed. The prevalence of both HRS on peptic ulcers and active bleeding on non-ulcer lesions between patients treated or not treated with PPI were compared. Multivariate analysis was performed. Results: A total of 1,792 (69.8%) out of 2,566 patients received PPI therapy. Prevalence of HRS on ulcers was 51.8% and 53.4% (P = 0.58) in treated and not treated patients, respectively, and the rate of endoscopic therapy did not differ between groups. Prevalence of non-ulcer bleeding lesions was higher in patients treated than in those not treated with PPI (18.7% vs 10.6%; P = 0.023). At multivariate analysis, PPI therapy (OR: 1.16, 95% CI = 0.82-1.64; P = 0.4) was not an independent factor affecting HRS prevalence, which was inversely correlated with timing to endoscopy (OR: 0.85, 95% CI = 0.76-0.95; P = 0.005). Conclusions: Our data failed to detect a significant role of pre-endoscopic PPI therapy in decreasing prevalence of HRS and need for endoscopic treatment in bleeding patients with either peptic ulcer or non-ulcer lesions.
American Journal of Gastroenterology, 2006
Digestive and Liver Disease, 2019
Background: Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure use... more Background: Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure used to provide nutritional support. Aim: To prospectively evaluate the mortality and complication incidences after PEG insertion or replacement.
Giornale italiano di cardiologia, 1995
In the medical literature reports are accumulating a number of case reports suggesting the potent... more In the medical literature reports are accumulating a number of case reports suggesting the potential efficacy and safety of the combination of low-dose aspirin and warfarin to improve the efficacy of antithrombotic therapy in several clinical conditions, ranging from unstable angina to myocardial infarction. The advantages deriving from such a combination have to be considered together with its hemorrhagic risk. Thus the efficacy of such a treatment has to be proved by large clinical trials before the use of this potentially dangerous therapy can be transferred into common clinical practice.
Gastrointestinal Endoscopy, 2014
In small-bowel capsule endoscopy (SBCE), differentiating masses (ie, lesions of higher probabilit... more In small-bowel capsule endoscopy (SBCE), differentiating masses (ie, lesions of higher probability for neoplasia) requiring more aggressive intervention from bulges (essentially, false-positive findings) is a challenging task; recently, software that enables 3-dimensional (3D) reconstruction has become available. To evaluate whether &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;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;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;quot;coupling&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;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;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;quot; 3D reconstructed video clips with the standard 2-dimensional (s2D) counterparts helps in distinguishing masses from bulges. Three expert and 3 novice SBCE readers, blind to others and in a random order, reviewed the s2D video clips and subsequently the s2D clips coupled with their 3D reconstruction (2D+3D). Multicenter study in 3 community hospitals in Italy and a university hospital in Scotland. Thirty-two deidentified 5-minute video clips, containing mucosal bulging (19) or masses (13). 3D reconstruction of s2D SBCE video clips. Differentiation of masses from bulges with s2D and 2D+3D video clips, estimated by the area under the receiver operating characteristic curve (AUC); interobserver agreement. AUC for experts and novices for s2D video clips was .74 and .5, respectively (P = .0053). AUC for experts and novices with 2D+3D was .70 (compared with s2D: P = .245) and .57 (compared s2D: P = .049), respectively. AUC for experts and novices with 2D+3D was similar (P = .1846). The interobserver agreement was good for both experts and novices with the s2D (k = .71 and .54, respectively) and the 2D+3D video clips (k = .58 in both groups). Few, short video clips; fixed angle of 3D reconstruction. The adjunction of a 3D reconstruction to the s2D video reading platform does not improve the performance of expert SBCE readers, although it significantly increases the performance of novices in distinguishing masses from bulging.
Digestive and Liver Disease, 2010
Background: Although capsule endoscopy is the cornerstone for the evaluation of the small bowel i... more Background: Although capsule endoscopy is the cornerstone for the evaluation of the small bowel in patients with obscure GI bleeding data about costs are lacking. Aim: To evaluate, from a third party payer point of view, whether performing capsule endoscopy as an outpatient instead of an inpatient procedure can reduce costs. Materials and methods: The data source is a multicentre survey collecting data for 2921 patients; 1486 of them underwent capsule endoscopy for obscure GI bleeding or chronic unexplained iron-deficiency anaemia as inpatients (814 with positive, 211 with inconclusive and 461 with negative result). We estimated costs of inpatient procedures based on the diagnosis related groups (DRG) system, while those of outpatient procedures on reimbursement provided in five Italian regions. Results: We estimated that the cost for each inpatient undergoing capsule endoscopy is about D 1775.90. Assuming that all these patients had undergone the same procedure as outpatients, D 175.00-741.00 per patient (depending on the reimbursement and/or on diagnosis related group codes applied) would have been saved. Conclusions: Our estimate suggests that, from the third party payer's perspective and using the diagnosis related group reimbursement system, shifting capsule endoscopy from inpatient to outpatient procedure, would be potentially cost saving at least for patients referred for obscure GI bleeding or chronic unexplained anaemia.
Biomedicine & Pharmacotherapy, 1997
Minerva medica, 1997
We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalv... more We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalvular atrial fibrillation (AF). Patients were also stratified according to a history of prior stroke. The generation of thrombin was investigated by means of the molecular markers prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), because AF patients may have a hypercoagulable state. There was only a trend toward higher values of TAT and F1 + 2 for AF patients, while subjects with previous stroke (irrespective of AF) had increased levels of the markers of thrombin generation (TAT stroke+ 18.95 +/- 5.15 vs TAT stroke- 8.34 +/- 2.41; F1 + 2 stroke+ 2.22 +/- 0.29 vs F1 + 2 stroke- 1.32 +/- 0.12). The presence of spontaneous echo contrast (SEC) within left atrium was also investigated in 32 AF patients by transesophageal echocardiography. TAT were significantly higher in subjects (n = 11) with SEC (TAT sec+ 37.5 +/- 13.41 vs TAT sec- 8.7 +/- 2.51, p = 0.008). Fin...
Digestive and Liver Disease, Oct 1, 2020
Digestive and Liver Disease, Oct 1, 2020
Digestive and Liver Disease, Mar 1, 2018
vaginal history (40%) were statistically associated with FI (p≤0.05). Normal manometric parameter... more vaginal history (40%) were statistically associated with FI (p≤0.05). Normal manometric parameters were found in 16 patients (4%). Manometric alterations were found in 342 pts: 228 internal anal sphincter (IAS) dysfunction (64%); 274 isolated external anal sphincter (EAS) dysfunction (76%); 198 combined sphincter dysfunction IAS and EAS (55%); 100 isolated dyssynergic defecation (28%); 130 rectal hypersensitivity (36%). Conclusions: In our study, we observed a female prevalence in FI. FI is significantly associated with UI. This may be explained by risk factors in common with these clinical conditions. FI is significantly associated with previous proctological/pelvic surgery and anal/vaginal traumaduring delivery. Furthermore, patients with FI reported also difficult evacuating stools. In these patients with dyssynergic-type constipation and FI, encopresis must be excluded first. Moreover we observed these prevalent manometric findings: combined dysfunction IAS and EAS, and rectal hypersensitivity. The manometric assessment could help physicians to identify patients appropriated for a biofeedback therapy.
Digestive and Liver Disease, Sep 1, 2021
BACKGROUND the lack of standardized pathways for patients with gastrointestinal bleeding may have... more BACKGROUND the lack of standardized pathways for patients with gastrointestinal bleeding may have led to differences in their management and inequity to medical care access. The "Hub & Spoke" model was adopted to fill this gap in many disciplines, but, to our knowledge, no data exist on its efficacy on mortality in GI bleeding. We aimed to evaluate if the "Hub & Spoke" organizational model has an impact on mortality risk from UGIB. METHODS from January 2014 to December 2015, 3324 consecutive patients admitted for UGIB in 50 Italian hospitals were enrolled (1977 patients in hospitals within the "Hub & Spoke" network for digestive hemorrhagic emergency and 1347 in hospitals outside the "Hub & Spoke" network). Clinical, endoscopic and organizational data were recorded. RESULTS we observed no differences in mortality between patients admitted to hospitals included or not included in the "Hub & Spoke" network (5.2% vs 6.1%, p = 0.3). On multivariate analysis, admission in gastroenterology wards (OR 0.61, p = 0.001) or an academic hospital (OR 0.65, p < 0.056) were independent protective factors while being in "Hub & Spoke" organization system did not affect mortality (OR 1.09, p = 0.57). CONCLUSION the "Hub & Spoke" model per sé does not impact on mortality while being treated in academic hospital or gastroenterology wards improved survival.
Endoscopy International Open, 2021
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issu... more Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark.Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures.Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014–2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for f...
Digestive and Liver Disease, 2019
Digestive and Liver Disease, 2019
et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical is... more et al. / Digestive and Liver Disease xxx (2019) xxx-xxx paid particular attention to practical issues with the aim to support gastroenterologists in their clinical practice when dealing with patients with anaemia.
Digestive and Liver Disease, 2017
non-variceal in 2764 (83.1%) and variceal in 560. Outpatients (2646) were driven to the First Aid... more non-variceal in 2764 (83.1%) and variceal in 560. Outpatients (2646) were driven to the First Aid Department in an ambulance 118: Northern Italy (55.6%), Central Italy (61.5%) and Southern Italy (40.5%) (p<0.0001). In the Northern Regions 64% of emergency endoscopy was performed after a direct request from the First Aid Department, 53.9% in the Centre and 27.7% in the South (p<0.0001). 81% of GI emergency endoscopy was performed in the daytime (8am-8pm) with significant differences among the several geographical areas. Endoscopy was averagely performed within 11 hours in the North, 12 hours in the Centre and 15 hours in the South (p<0.05). Mortality overall result (variceal and non-variceal) was 223 patients, equal to 6.7% but significant difference was present:6.6% in the North, 4.7% in the Centre and 8.1% in the South (p<0.02). No significant differences emerged among the regions with an active network of GI haemorrhage 6.2% (84/1347) versus those without it 7.0% (139/1977) (p=0.367). Overall mortality, evaluated according to the seriousness of the clinical case, resulted lower in University Hospitals (OR 0.60 [95% Cl: 0.35 to 1.02]). Mortality rate is lower when endoscopy is performed in the endoscopy room: 6.2% versus 9.2% when performed elsewhere (p<0.0001). Overall 8.4% patients are sent back home directly from the First Aid Department after undergoing endoscopy, but significant differences emerged among the several geographical areas: 12.1% in the North, 10.0% in the Centre and 1.7% in the South (p<0.0001). Conclusions: The mortality due to UGIB significantly differs among North, Centre and South Italy as well as the patients managed as outpatients. The presence of a well-organized network of gastrointestinal bleeding does not reduce the mortality. Organisational and health care course are different among the several geographical areas and provide different outcomes.