Publications by authors named "Maselli Roberta"
Introduction: Inflammatory bowel disease (IBD) patients have an increased risk of developing colorectal cancer. High-risk colorectal colitis-associated neoplasia (HR-CAN) can be difficult to treat using traditional endoscopic resection methods. Aim of the study is to evaluate the outcomes of endoscopic submucosal dissection (ESD) on IBD patients with HR-CANs.
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- The study focuses on developing guidelines for the safe use of fluoroscopy in gastrointestinal endoscopy, balancing its benefits with concerns about radiation exposure to patients and healthcare workers.
- A modified Delphi method was used, involving three rounds of surveys with 46 experts, resulting in 43 proposed statements, of which 31 achieved consensus and were prioritized across various categories such as Patient Safety and Staff Safety.
- The final consensus statements highlight the importance of education and safety measures, with a significant majority rated as high priority, aiming to enhance safety culture in healthcare settings while utilizing fluoroscopy.
Article Synopsis
- - The study evaluated the safety and effectiveness of PuraStat, a topical hemostatic agent, for treating active gastrointestinal bleeding and preventing bleeding in patients undergoing endoscopic procedures.
- - Data from 401 patients across ten Italian centers showed PuraStat achieved hemostasis in nearly all cases of active bleeding (98.9%) and had a low follow-up bleeding rate (3.9%) for preventive uses.
- - No adverse events related to PuraStat were reported, indicating it is a safe option that could be used for broader applications than currently recommended.
: Subepithelial lesions (SELs) of the gastrointestinal (GI) tract present a diagnostic challenge due to their heterogeneous nature and varied clinical manifestations. Usually, SELs are small and asymptomatic; generally discovered during routine endoscopy or radiological examinations. Currently, endoscopic ultrasound (EUS) is the best tool to characterize gastric SELs.
View Article and Find Full Text PDFThe endoscopic resection of gastrointestinal tract lesions embraces different types of techniques, ranging from conventional polypectomy/endoscopic mucosal resection (EMR) to the field of third-space endoscopy, including endoscopic submucosal dissection (ESD), full-thickness resection and peroral endoscopic myotomy (POEM). Parallelly, the advent of underwater techniques has served as an add-on for both basic and advanced procedures, since its first report in 2012. We aimed to provide a comprehensive update on the state of the art about the feasibility of underwater basic and advanced techniques for GI endoscopy.
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- The study explores the use of computer-aided diagnosis (CADx) in the resect-and-discard strategy for the optical diagnosis of diminutive polyps during colonoscopy, aiming to improve diagnosis and reduce unnecessary pathology assessments.
- It involved a systematic review of existing research to analyze the effectiveness of CADx systems compared to traditional histology for small polyps (≤5 mm), including comparisons of CADx-assisted and unassisted methods.
- The meta-analysis included 11 studies with a total of 7400 polyps examined, highlighting the potential benefits and harms of using CADx in terms of accurate diagnosis and avoidance of false positives/negatives.
Per oral endoscopic myotomy for achalasia.
Best Pract Res Clin Gastroenterol
August 2024
Achalasia, characterized by impaired lower esophageal sphincter (LES) relaxation and failed peristalsis, stands out as the most widely recognized primary esophageal motility disorder. It manifests with dysphagia to solid and liquid foods, chest pain, regurgitation, and weight loss, leading to significant morbidity and healthcare burden. Traditionally, surgical Heller myotomy and pneumatic dilation were the primary therapeutic approaches for achalasia.
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- - The study investigates how the location of colorectal polyps (proximal vs. distal colon) affects the performance of computer-aided diagnosis (CADx) in identifying neoplastic and non-neoplastic polyps during colonoscopies for polyps sized 5 mm or smaller.
- - It analyzes data from 11 studies involving 7,782 polyps, showing that CADx has lower specificity and accuracy in the proximal colon compared to the distal colon, while sensitivity is similar between both locations.
- - The conclusion highlights that while CADx works well for distal polyps, its inadequate performance in the proximal colon means it should not currently be used for those lesions until improved systems are created.
Endoscopic submucosal dissection (ESD) is an advanced technique that can become more challenging in the presence of submucosal fibrosis. Predicting the grade of fibrosis is important in order to identify technically difficult ESD. Our study aimed to derive and validate a prediction model to determine the preoperative degree of submucosal fibrosis in colorectal tumours undergoing ESD.
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- The study aimed to develop and validate an AI prediction system for assessing the risk of lymph node metastasis (LNM) in patients with T2 colorectal cancer (CRC), as traditional surgical approaches struggle with risk stratification.!* -
- Data from over 700 patients was analyzed, revealing that the AI model had a moderate prediction performance with a sensitivity of 97.8% but a low specificity of 15.6%, indicating many false positives in LNM predictions.!* -
- While the AI model shows promise for predicting LNM using basic clinical and pathologic data, improvements in accuracy could be achieved by training it with a larger and more diverse patient population from both Eastern and Western medical centers.!*
Background And Aim: Guidelines suggest endoscopic resection for rectal neuroendocrine tumors (rNETs) < 10 mm, but the most appropriate resection technique is unclear. In real-life clinical practice, the endoscopic removal of unrecognized rNETs can take place with "simple" techniques and without preliminary staging. The aim of the current study is to report our own experience at a referral center for both neuroendocrine neoplasms and endoscopy.
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- Endoscopic submucosal dissection (ESD) is a minimally invasive method for removing superficial gastrointestinal lesions, with reported variations in quality between East and West.
- This study analyzed the effectiveness and safety of ESD in a cohort of 111 patients at an Italian center, focusing on outcomes like technical success and resection rates.
- Results showed high technical success and R0 resection rates, indicating that ESD is a viable option for treating superficial GI lesions in Western patients, although some major adverse events were noted.
Article Synopsis
- - Significant advances in managing large laterally spreading tumors (LSTs) in colorectal polyps exist, but management practices vary globally, prompting the need for an international consensus.
- - A Delphi study involving 43 experts from 18 countries led to 42 statements reaching consensus regarding training, evaluation, resection techniques, and post-resection care for LSTs.
- - The resulting expert consensus aims to standardize practices and provide clear guidance for evaluating, resecting, and following up on LSTs worldwide.
Article Synopsis
- Endoscopic submucosal dissection (ESD) is an advanced technique for removing early tumors, initially used for gastric lesions, now expanding to more complex areas like the colorectum.
- The review discusses the growing variety of devices available for colorectal ESD, focusing on their indications and which tools are best suited for specific situations.
- While some devices may offer distinct advantages, the choice often depends on personal preference and experience, making it crucial for endoscopists to understand the tools and their functions to provide optimal patient care.
Management of perforations during endoscopic resection.
Best Pract Res Clin Gastroenterol
March 2024
Article Synopsis
- Perforation is a serious risk during therapeutic endoscopy, presenting significant challenges and potential complications for patients.
- Endoscopists need to be adept at recognizing and managing these perforations immediately, as timely endoscopic closure can prevent the need for surgery and reduce hospitalization duration.
- The review focuses on various endoscopic closure techniques—traditional and innovative—while highlighting the limited existing literature on the subject and aiming to enhance understanding of the pros and cons of each method.
Article Synopsis
- - This guideline from ASGE and ESGE outlines evidence-based recommendations about endoscopic bariatric and metabolic therapies (EBMTs) for managing obesity, focusing on their efficacy and safety.
- - It uses the GRADE framework to assess EBMT devices and procedures that have received CE mark or FDA approval, including those approved within the last five years.
- - The guidelines recommend EBMTs combined with lifestyle changes for patients with a BMI of ≥30 kg/m² or between 27.0-29.9 kg/m² with at least one obesity-related health issue, specifically suggesting intragastric balloons and endoscopic gastric remodeling devices.
This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development.
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