Self-expandable metal stents for malignant colonic obstruction: data from a retrospective regional SIED-AIGO study.

Background: Self-expandable metal stents are a non-surgical option for the treatment of symptomatic malignant colorectal obstruction as palliative treatment or as a bridge to surgery.

Aims: To report data from a regional study on self-expandable metal stent (SEMS) placement for malignant colorectal obstruction.

Methods: Two hundred and four patients (male 54.

Oldest biliary endoprosthesis in situ.

The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing "irretrievable stones" include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting.

The importance of disease prevalence in assessing the diagnostic value of a test: endoscopic markers in celiac disease.

Background/aims: We evaluated the diagnostic variability and reproducibility of endoscopic signs in two populations with a different pretest likelihood of celiac disease (CD).

Methods: We recruited 289 CD patients (both adults and children) in a multicenter prospective study. Group 1 (high risk) included 111 patients referred for positive serology.

Upper GI endoscopy in elderly patients: predictive factors of relevant endoscopic findings.

Elderly patients are at increased risk for peptic ulcer and cancer. Predictive factors of relevant endoscopic findings at upper endoscopy in the elderly are unknown. This was a post hoc analysis of a nationwide, endoscopic study.

Endoscopic resection as a safe and effective technique for treatment of pedunculated and non-pedunculated benign-appearing colorectal neoplasms measuring 40 mm or more in size.

Aim: The aim of this paper was to evaluate the outcome of endoscopic resection (ER) for pedunculated and non-pedunculated colorectal neoplasms exceeding 4 cm in size.

Methods: All patients with a colorectal neoplasms measuring 4 cm or more, who underwent ER at our institution between January 1996 and December 2008 were included in the study.

Results: In the study period, 67 ERs were carried out in 67 patients with a mean (±SD) age of 72±11 years.

Massive bleeding from a Dieulafoy's lesion of the duodenum successfully treated with "adjuvant" transarterial embolization and endoscopic laser coagulation.

Dieulafoy's lesions, very rare in the duodenum, are considered uncommon causes of gastrointestinal bleeding and occur from pinpoint non-ulcerated arterial lesions. We report a case of Dieulafoy's lesion of the duodenum, in which a first diagnostic approach by using endoscopy and angiography was not successful; then, due to a high operative risk, we performed an "adjuvant" embolization of the gastroduodenal artery with the aim of reduce the flow through the artery, allowing the endoscopic localization of the site of bleeding and subsequent effective treatment. To our knowledge, this is the first case reported in the literature, in which, without aetiological diagnosis, an "adjuvant" embolization of the gastroduodenal artery was performed with the aim of reduce the blood flow in the duodenal wall, permitting an easier endoscopic diagnosis of Dieulafoy's duodenal lesion and successful treatment with laser coagulation.

Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study.

Objectives: Prospective studies have identified a number of patient- and procedure-related independent risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, with different conclusions, so various questions are still open. The endoscopist's expertise, case volume, and case mix can all significantly influence the outcome of ERCP procedures, but have been investigated little to date.

Methods: We identified patient- and procedure-related risk factors for post-ERCP pancreatitis and the impact of the endoscopist's experience and the center's case volume, using univariate and multivariate analysis, in a multicenter, prospective study involving low- and high-volume centers, over a 6-month period.

How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

Background: Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres.

Methods: A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed.

Depression, anxiety and anger in subtypes of irritable bowel syndrome patients.

The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of non-psychiatric IBS patients, starting from the hypothesis that IBS subtypes may have different symptomatic expressions of negative emotions with different outcomes on quality of life measures. Forty-two constipation-predominant IBS (C-IBS) subjects and 44 diarrhea-predominant IBS (D-IBS) subjects, after an examination by a gastroenterologist and a total colonoscopy, underwent a clinical interview and psychometric examination for the assessment of depression, anxiety, anger and quality of life. IBS subtypes showed different symptomatic profiles in depression, anxiety and anger, with C-IBS patients more psychologically distressed than D-IBS subjects.

Appropriateness guidelines and predictive rules to select patients for upper endoscopy: a nationwide multicenter study.

Objectives: Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models.

Methods: A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled.

Magnetic resonance cholangio-pancreatography versus endoscopic retrograde cholangio-pancreatography in the diagnosis of common bile duct stones: a prospective comparative study.

Aim: As it is a non-invasive method, magnetic resonance cholangiography (MRCP) has almost completely replaced endoscopic retrograde cholangiography (ERCP) in the diagnosis of pancreato-biliary diseases. The aim of this study was to evaluate sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in diagnosis of choledocholithiasis using ERCP/endoscopic sphincterotomy (ES) as gold standard.

Methods: For this study 140 individuals, suspected for lithiasis of the common bile duct (CBD), were enrolled.

Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up.

Background And Study Aims: This study examines efficacy, outcome, and complications of endoscopic mucosal resection (EMR) for large (> or = 20 mm) and giant (> or = 40 mm) sessile and flat colorectal polyps.

Patients And Methods: All EMRs carried out at our institution over a 9-year period, for large and giant sessile and flat colorectal polyps with an intensive and regular follow-up were evaluated. The rate of en bloc and piecemeal resection, complications, and recurrence were analyzed.

Cyanoacrylate glue in the management of gastric varices.

Gastric varices (GV) are less common than esophageal varices, but their management represents a particular challenge. When bleeding occurs is usually severe, requiring immediate supportive intensive care and has a high mortality rate. The best management of GV is supposed to be with a multidisciplinary approach and close cooperation between gastroenterologists, interventional radiologists and the surgical team.

Clinical practice in the management of ulcerative colitis--an Italian survey.

Objectives: To investigate the concordance of medical care of ulcerative colitis (UC) patients in Italy.

Methods: Interviews with responsible physicians in referral centres for inflammatory bowel disease (IBD) regarding the management (e.g.

Optical coherence tomography in inflammatory bowel disease: prospective evaluation of 35 patients.

Purpose: Optical coherence tomography is a technique using infrared light in tissues of the gastrointestinal tract and human colon affected by inflammatory diseases. We evaluated whether there are specific patterns of optical coherence tomography for inflammatory bowel disease and compared the technique performance to the histology.

Methods: Optical coherence tomography was performed in 35 patients (18 men; 31 ulcerative colitis, 4 Crohn's disease).

Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center.

Aim: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions.

Methods: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten-year period. One hundred and sixty of these were performed for large polyps, those measuring > or = 20 mm.

Optical coherence tomography evaluation of ulcerative colitis: the patterns and the comparison with histology.

Hypothesis: The optical coherence tomography (OCT) is an imaging modality based on infrared light backscattering properties of tissues. OCT studies documented the disappearance of crypts and the alteration in light backscattering as features of ulcerative colitis (UC) in human colon. This technique should be more and more able to identify tissue microstructures with a resolution that is nearly that of histology (optical biopsy).

[Endoscopic prosthetic treatment of the esophagojejunal leaks after total gastrectomy: clinical experience].

The Authors, on the basis of their experience on the use of self-expanding prostheses in abdominal surgery, report on the use of these prostheses in two patients who, having undergone a gastrectomy for cancer, developed a fistula of the esophago-jejunal anastomosis. Given recent data from literature, using a prosthesis for an anastomotic fistula may be a valid alternative to a second operation, which, apart from obvious difficulties, has a high mortality rate in patients in weakened general health conditions. In these cases, after the application of a stent, excellent results can be obtained and, after some days, the patients can begin a semi-liquid diet, then proceeding to a semi-solid diet, improving quality of life; in addition, within a reasonable time span, after the healing of the fistula, the prosthesis can easily be removed by endoscopy.

Colon and gastric metastases from a primary signet-ring cell carcinoma of the urinary bladder.

Signet-ring cell carcinoma is a relatively rare neoplasm that rarely occurs in the urinary bladder. We report a case of a 60-year-old man who presented with gross haematuria. Cystoscopy revealed a white sessile tumour of the anterior bladder wall.

Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome.

Background: Irritable bowel syndrome is commonly accepted as a disorder closely influenced by affective factors, which can either trigger the symptoms or contribute to their persistence, independently from their aetiology. It has been previously documented that irritable bowel syndrome patients respond to a variety of emotional states (anger, fear and anxiety) with an increase in colonic motility.

Aims: The aim of this study was to evaluate the experience and the expression of anger and the prevalent ego-defence mechanisms in a group of non-psychiatric patients with irritable bowel syndrome.

Endoscopic treatment of Barrett's epithelium with Argon Plasma Coagulation. Long-term follow-up.

Background: Barrett's esophagus (BE) is a premalignant condition for the development of esophageal adenocarcinoma. Recently, many endoscopic therapies based on thermal or photobiologic ablation of BE have been provided, with positive short-term results in 60-100% of cases, but long-term results are still lacking. The aim of this study is to evaluate long-term results of BE endoscopic ablation with Argon-Plasma Coagulation (APC).

[Caroli's disease: literature review and characteristics of a clinical case].

The Author's report the case of the simple form of Caroli's disease, a rare malformation, and review literature pointing out the difficulty of an early diagnosis, because disease can be silent for a long time too and it is identified for complication. Today, imaging, endoscopy and interventionist radiology are the most valid tools for a correct diagnosis and treatment, above all in a case of emergency, when other therapeutic solutions are not possible.

Ischemic colitis following colonoscopy in a systemic lupus erythematosus patient: report of a case.

Background: Ischemic colitis is an uncommon complication in patients with systemic lupus erythematosus but may be precipitated by colonoscopy.

Case Report: A 43-year-old female with systemic lupus erythematosus under treatment with immunosuppressive drugs and prednisone was submitted to colonoscopy because of a change in bowel habit. Apart from the presence of a small metaplastic polyp, colonoscopy showed only a few erythematosus areas in the sigma and left colon.