Giuseppe Galloro | Università degli Studi di Napoli "Federico II" (original) (raw)

Papers by Giuseppe Galloro

PubMed, Jul 1, 1997

Mucosal and vascular changes in the lower gastrointestinal tract occur commonly in patients with ... more Mucosal and vascular changes in the lower gastrointestinal tract occur commonly in patients with portal hypertension. Portal enteropathy, however, is usually asymptomatic, though occasionally clinically significant for chronic gastrointestinal bleeding. Massive hemorrhage has only rarely been described and its management is controversial. Even though more effective non-operative treatments are now available, an emergency porta-systemic shunt procedure remains an important option for selected patients. We report on two cases of massive lower gastrointestinal bleeding from portal hypertensive enteropathy secondary to post-viral cirrhosis.

BACKGROUND Cryotherapy (also known as cryoablation or cryosurgery) involves freezing to destroy u... more BACKGROUND Cryotherapy (also known as cryoablation or cryosurgery) involves freezing to destroy unwanted tissues in situ. It has been used for a variety of neoplastic diseases, including solid organ cancers (prostate, 1,2 kidney, 3-5 liver 6-8), cervical neoplasia, 9,10 and endobronchial tumors. 11 Thermal injury or destruction involving freezing is quite different from ablation using high-energy heat, which results in immediate coagulation necrosis. Cryotherapy results in both immediate and delayed tissue injury and necrosis. The proposed mechanisms for cryotherapy effects begin with rapid intracellular and extracellular freezing, resulting in cell necrosis. 12,13 The direct freezing results in cell membrane interruption and protein denaturation. Vascular flow is also compromised, leading to the complete

Digestive and Liver Disease, Mar 1, 2018

All the pts reported satiety after 1 month, which was confirmed by 56.1% (n=23/41) of pts after 6... more All the pts reported satiety after 1 month, which was confirmed by 56.1% (n=23/41) of pts after 6 months and by 40% (n=10/25) after 12 months of f-up. In addition, over 50% of the study population had an improvement quality of life in terms of physical activity, relationships and dietary habits.

Journal of Clinical Medicine, Mar 9, 2020

Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, incl... more Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no need for surgical treatment) for EGC. The incidence of complications, the one-month mortality, and the recurrence rate at one-year follow-up were computed. A total of 296 patients with 299 gastric lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5% (58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were treated with radiological embolization (1 case) or surgery (1 case). No procedure-related deaths at one-month follow-up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and 10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low and amenable at endoscopy.

European Journal of Gastroenterology & Hepatology, Jul 1, 2018

United European gastroenterology journal, Feb 1, 2016

Background and aims: This systematic review and meta-analysis compares the safety and effectivene... more Background and aims: This systematic review and meta-analysis compares the safety and effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the treatment of flat and sessile colorectal lesions >20 mm preoperatively assessed as noninvasive. Methods: We reviewed the literature published between January 2000 and March 2014. Pooled estimates of the proportion of patients with en bloc, R0 resection, complications, recurrence, and need for further treatment were compared in a metaanalysis using fixed and random effects. Results: A total of 11 studies and 4678 patients were included. The en bloc resection rate was 89.9% for ESD vs 34.9% for EMR patients (RR 1.93 p < 0.001). The R0 resection rate was 79.6% for ESD vs 36.2% for EMR patients (RR 2.01 p < 0.001). The rate of perforation was 4.9% for the ESD group and 0.9% for EMR (RR 3.19, p < 0.001), while the rate of bleeding was 1.9% for ESD and 2.9% for EMR (RR 0.68, p ¼ 0.070). Therefore, the overall need for further surgery, including surgery for oncologic reasons and surgery for complications, was 7.8% for ESD and 3.0% for EMR (RR 2.40, p < 0.001). Conclusions: ESD achieves a higher rate of en bloc and R0 resection compared to EMR, at the cost of a higher risk of complications. This, added to an increased need for surgery for oncologic reasons for a plausible tendency to extend indication for endoscopic excision, increases the risk of further surgery after ESD.

International Journal of Surgery, Apr 1, 2016

Severe obesity leads to a high incidence of complications and a decrease in life expectancy, espe... more Severe obesity leads to a high incidence of complications and a decrease in life expectancy, especially among younger adults. Laparoscopic sleeve gastrectomy (LSG) first intended as the first step of biliopancreatic diversion with duodenal switch is gaining a per-se procedure role because of its effectiveness on weight loss and comorbidity resolution. Different techniques have been described for specimen extraction in LSG. In this article we report the technique adopted in 275 LSGs performed in our department. In the first 120 LSGs performed from 2007, the specimen was extracted through a mini laparotomy. In the following 155 cases the technique has been simplified: the grasped specimen has been withdrawn through the 15 mm trocar site. We registered in the fist group six cases of wound infection (5%), ten cases of hematoma (8.3%) and four cases of port site hernia (3.3%). In the second group only one case of hematoma (0.6%, p = 0.01) but no cases of wound infection (p = 0.01) or port site hernia, (p = 0.03) although we registered a specimen perforation during retrieval in 16 patients, were reported. The technique described in the 155 cases of the control group has shown to be more effective than the technique we used in the case group, allowing significantly lower operative time (112.9 ± 1.0 vs 74.9 ± 9.1 p &amp;amp;amp;amp;amp;lt; 0.001) and complications, and providing unchanged costs.

Journal of Gastrointestinal and Liver Diseases, Apr 1, 2023

Background & Aims: Although endoscopic ultrasound (EUS) is generally safe, duodenal perforation m... more Background & Aims: Although endoscopic ultrasound (EUS) is generally safe, duodenal perforation may occur during the procedure. When the iatrogenic break is wide, endoscopic positioning of a covered selfexpandable metal stent is indicated to avoid a more invasive surgical approach. We evaluated the efficacy of the 'over-the-scope stenting' (OTSS) technique to treat iatrogenic duodenal perforations occurred during EUS. Methods: Data of patients with large iatrogenic duodenal perforations treated with OTSS procedure were collected in 5 centers. Technical success was defined as a correct stent placement on the perforation site, and clinical success as complete healing of the duodenal leak at stent removal 3 weeks later. Results: A total of 15 (7 males; median age: 78 years, range 47-91) patients were included in this series. A correct stent positioning was achieved in all cases (technical success: 100%), and the perforation was healed in all, apart from one patient at stent removal (clinical success: 93%). This patient was successfully treated with a novel stent placement. No immediate post-procedural adverse events occurred, and no need for emergency surgery was recorded. In one (6.7%) patient, stent migration occurred 10 days after positioning, and it was spontaneously expulsed with stool movement without complications two days later. Conclusions: Our data showed that the OTTS technique for partially covered self-expandable metal stent placement is feasible, safe and effective to tread large iatrogenic duodenal perforation occuring during EUS.

GE Portuguese Journal of Gastroenterology, Sep 6, 2022

Background/Aims: Endoscopic submucosal dissection (ESD) has been proposed for removal of gastroin... more Background/Aims: Endoscopic submucosal dissection (ESD) has been proposed for removal of gastrointestinal subepithelial tumors (GI-SETs), but data are still scanty. This study aimed to report a case series from a western country. Patients and Methods: Data of patients with upper GI-SETs suitable for ESD removal observed in 4 centers were retrospectively reviewed. Before endoscopic procedure, the lesion was characterized by endosonographic evaluation, histology, and CT scan. The en bloc resection and the R0 resection rates were calculated, as well as incidence of complications, and the 1-year follow-up was reported. Results: Data of 84 patients with esophageal (N = 13), gastric (N = 61), and duodenal (N = 10) GI-SETs were collected. The mean diameter of lesions was 26 mm (range: 12-110 mm). There were 17 gastrointestinal stromal tumors, 12 neuroendocrine tumors, 35 leiomyomas, 18 lipomas, and 2 hamartomas. En bloc and R0 resection were achieved in 83 (98.8%) and in 80 (95.2%) patients, respectively. Overall, a complication occurred in 11 (13.1%) patients, including bleeding (N = 7) and perforation (N = 4). Endoscopic approach was successful in all bleedings, but 1 patient who required radiological embolization, and in 2 perforations, while surgery was performed in the other patients. Overall, a surgical approach was eventually needed in 5 (5.9%), including 3 in whom R0 resection failed and 2 with perforation. Conclusions: Our study found that ESD may be an effective and safe alternative to surgical intervention for both benign and localized malignant GI-SETs.

La Duodenocefalopancreatectomia \ue8 indicata nel trattamento dei tumori ampollari, del terzo inf... more La Duodenocefalopancreatectomia \ue8 indicata nel trattamento dei tumori ampollari, del terzo inferiore del coledoco, della testa del pancreas e del duodeno. Questa metodica trova altre indicazioni nel trattamento della pancreatite cronica calcificante, allorch\ue9 le lesioni siano prevalentemente situate nella testa del pancreas. A questa anastomosi \ue8 legata l'importanza dell'intervento giacch\ue9 nel 20% dei casi, soprattutto se si interviene per neoplasia, si ha la sua deiscenza e la comparsa di una fistola pancreatica mista alla quale si collegano molte delle complicanze del postoperatorio; infatti essa risulta letale in un terzo dei casi e giustifica oltre la met\ue0 delle morti dell\u2019intervento2 \ub7 6. A tal fine abbiamo sviluppato le tecniche di chiusura del moncone. In questo lavoro presentiamo i dati concernenti l\u2019esperienza di due anni con le tecniche di trattamento del moncone pancreatico senza anastomosi pancreaticodigiunale in corso di DPC per cancro (18 pazienti, 13 maschi e 5 femmine, et\ue0 media 56 anni). Gli Autori riportano una serie di 18 pazienti, affetti da cancro del pancreas e sottoposti a duodeno-cefalopancreasectomia con metodi alternativi alle anastomosi pancreatico-digiunali (drenaggio esterno del moncone, occlusione del dotto con prolamina alcolica e sutura meccanica del moncone, legatura del dotto e sutura del moncone in vycril, occlusione del dotto con prolamina e sutura in vycril del dotto) nell'intervallo 5/1986- 5/1988. Mortalit\ue0 operatoria nulla. I dati metabolici a distanza (diabete) risultano correlati all'evento presenza/assenza di fistola pancreatica postoperatoria. In conclusione la tecnica di chiusura del moncone aumenta l'incidenza di f\uecstola pancreatica (11:1 8 = 61,1 %) , genera insuff\ueccienza esocrina nel 100% dei casi e diabete nei pazienti il cui decorso post-operatorio sia stato complicato da f\uecstola. La chiusura del moncone pancreatico \ue8 accettabile dopo DCP laddove un\u2019anastomosi pancreaticodigiunale sarebbe troppo rischiosa in presenza di un pancreas friabile

Digestive and Liver Disease, 2021

Digestive and Liver Disease, 2020