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5 results on '"Fabio Cipolletta"'

1. Endoscopic ultrasound-guided biliary drainage of malignant stenosis, not treatable with endoscopic retrograde cholangiopancreatography: a single-center, prospective observational study

Author

Ilaria Tarantino, Marco Peralta, Dario Ligresti, Michele Amata, Luca Barresi, Fabio Cipolletta, Granata Antonio, and Mario Traina

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and study aims The therapeutic role of endoscopic ultrasound (EUS) evolved in recent decade,s opening a new chapter in the field of endoscopic biliary drainage (BD). EUS-BD has emerged as a new mini-invasive technique for neoplastic jaundice not amenable to endoscopic retrograde cholangiopancreatography (ERCP). The primary study aims were to assess the clinical efficacy of EUS-BD using an electrocautery-enhanced lumen apposing metal stent (ECE-LAMS) in patients with malignant biliary obstruction with failed\unfeasible ERCP and the adverse event (AE) rate. The secondary aims were to evaluate the technical success and incidence of jaundice recurrence. Patients and methods Data from All patients referred to our tertiary-care Institute with obstructive jaundice due to unresectable malignant distal biliary stricture and unfeasible\failed ERCP, were prospectively recorded from January 2015 to February 2018. The procedures were performed by a single-step ECE-LAMS (AXIOS-EC, Boston Scientific) placement, from the upper gut lumen to the biliary tree, for definitive biliary decompression. Results Twenty-one patients were consecutively enrolled. Mean pre-procedure common bile duct diameter was 16 mm and the bilirubin level was 13.9 mg/dL (range 3.8–29.5). LAMS was positioned from the duodenal bulb (n = 19) to gastric antrum (n = 2). We registered a 100 % of technical and clinical success. No AEs occurred. We observed a single case of delayed AE consisting of a buried LAMS, which was successfully resolved endoscopically. Conclusions Despite the limits of being non-comparative, our study shows outcomes in a homogeneous population in terms of indications and technique. EUS-BD with dedicated ECE-LAMS is associated with extremely good clinical efficacy and safety and can be considered as an alternative in cases of failed/unfeasible ERCP.

Published
2021
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2. Malignant Gastric Outlet Obstruction Caused by Duodenal Cervix Metastasis in a Young Woman: Rendezvous Technique

Author

Ester Marra, Pasquale Quassone, Pasquale Tammaro, Cinzia Cardalesi, Raffaele D’Avino, Fabio Cipolletta, Anna Del Prete, Angela Travaglino, Stefania Tamburrini, Giovanni Ferrandino, Giuseppe Sarti, Michele Iannuzzi, Pietro Maida, and Gianpaolo Santini

Subjects
duodenal obstruction, SEMSs, rendezvous procedure, Medicine (General), R5-920
Abstract

Background: Malignant gastric outlet obstruction (MGOD) is an extremely rare expression of advanced extra-gastrointestinal cancer, such as squamous cell carcinoma (SCC) of the cervix, and only sixcases are described in the literature.Because of the short life expectancyand the high surgical risk involving these patients, less invasive approaches have been developed over time, such asthe use of an enteral stent or less invasive surgical techniques (i.e., laparoscopic gastrojejunostomy). However, MGOD could make it difficult to perform an endoscopic retrograde cholangio-pancreatography (ERCP) for standard endoscopic drainage, so in this case a combined endoscopic-percutaneous technique may be performed. This article, therefore, aims to highlight the presence in the doctor’s armamentarium of the “rendezvous technique”, few case reports of whichare described in the literature, and, moreover, this article aims to underline the technique’sfeasibility. Case Presentation: The case is that of a 38-year-old woman who presented with MGOD three years after the diagnosis of SCC of the cervix, who successfully underwent the rendezvous technique with the resolution of duodenal obstruction. Endoscopic enteral stenting treatment with the placement of a metal stent (SEMSs) represents the mainstay of MGOD treatment compared withsurgery due to its lower morbidity, mortality, shorter hospitalization and earlier symptom relief. However, in patients with both duodenal and biliary obstruction, a combined endoscopic–percutaneous approach may be necessary because of the difficulty in passing the duodenal stricture or in accessing the papilla through the mesh of the duodenal SEMS. Conclusion: The rendezvous procedure is a technicallyfeasible and minimally invasive approach to the double stenting of biliary and duodenal strictures. It achieves the desired therapeutic result while avoiding the need to perform more invasive procedures that could have a negative impact on the patient’sprognosis.

Published
2021
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4. Definition of a hospital volume threshold to optimize outcomes after drainage of pancreatic fluid collections with lumen-apposing metal stents: a nationwide cohort study

Author

Antonio Facciorusso, Arnaldo Amato, Stefano Francesco Crinò, Emanuele Sinagra, Marcello Maida, Alessandro Fugazza, Cecilia Binda, Chiara Coluccio, Alessandro Repici, Andrea Anderloni, Ilaria Tarantino, Carlo Fabbri, Daryl Ramai, Massimiliano Mutignani, Edoardo Forti, Paolo Giorgio Arcidiacono, Maria Chiara Petrone, Elisabetta Conte, Roberto Di Mitri, Debora Berretti, Germana De Nucci, Raffaele Macchiarelli, Mauro Lovera, Fabia Attili, Mario Luciano Brancaccio, Alessandro Redaelli, Enrico Tasini, Marco Ballarè, Franco Coppola, Nicola Leone, Luigi Cugia, Roberto Grassia, Monica Sbrancia, Thomas Togliani, Andrea Lisotti, Pietro Fusaroli, Claudio De Angelis, Fabio Cipolletta, Mauro Manno, Roberta Badas, Valeria Pollino, Lorenzo Camellini, and Laura Bernardoni

Subjects
Cohort Studies, Treatment Outcome, Gastroenterology, Drainage, Humans, Pancreatic Diseases, Radiology, Nuclear Medicine and imaging, Stents, Hospitals, Endosonography, Retrospective Studies
Abstract

There is increasing interest in expanding the use of lumen-apposing metal stents (LAMSs) in patients with pancreatic fluid collections (PFCs). The aim of this study was to determine whether there is a hospital volume threshold for which patient outcomes could be optimized.Data from a large multicenter series of patients with PFCs treated with LAMSs were retrieved. Rate of adverse events (AEs) was the primary outcome. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting hospital volume against the log odds ratio (OR) of AE rate. Propensity score matching was applied to obtain 2 well-balanced groups according to hospital volume, and univariate/multivariate logistic regression analysis was performed to identify significant predictors of AEs.Overall, 516 patients were included. Increasing hospital volume was associated with a reduced AE rate (P = .03), and the likelihood of experiencing an AE declined as hospital volume increased up to 15 cases. After propensity score matching, 175 patients in the high-volume (15 cases) and 132 in the low-volume hospital group were compared. Overall, 41 AEs were observed (13.3%), of which 14 (8%) and 27 (20.4%) occurred at high-volume and low-volume centers, respectively (P = .001). Severe and fatal events were observed more frequently in low-volume centers (6% vs 1.7% and 2.2% vs 0%, respectively; P = .05). In multivariate analysis, main pancreatic duct injury (OR, 2.62; 95% confidence interval [CI], 1.26-4.67; P = .02), presence of abnormal vessels (OR, 2.93; 95% CI, 1.41-5.02; P = .006), and institutional experience (OR, 2.95; 95% CI, 1.48-5.90; P = .002) were significant predictors of AEs.With 15 procedures representing the minimum number of cases associated with the lowest risk for postprocedural AEs, hospital volume is associated with improved outcomes. (Clinical trial registration number: NCT03903523.).

Published
2021

5. Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn's disease

Author

M. Diaferia, Giovanni Domenico De Palma, Luigi Camera, Antonio Rispo, Giuseppe Pesce, Luigi Bucci, Anna Testa, Fabiana Castiglione, Fabio Cipolletta, Castiglione, Fabiana, Bucci, Luigi, Pesce, G., DE PALMA, GIOVANNI DOMENICO, Camera, Luigi, Cipolletta, F., Testa, A., Diaferia, M., and Rispo, A.

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Contrast Media, Sensitivity and Specificity, Gastroenterology, Endoscopy, Gastrointestinal, Postoperative Complications, Crohn Disease, Recurrence, Internal medicine, Positive predicative value, medicine, Humans, Immunology and Allergy, Cutoff, contrast-enhanced, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, Ultrasonography, sonography, Crohn's disease, Sicus, Receiver operating characteristic, medicine.diagnostic_test, biology, business.industry, Bowel resection, Middle Aged, medicine.disease, biology.organism_classification, Endoscopy, postsurgical recurrence, Female, Radiology, business
Abstract

Background: Postsurgical recurrence (PSR) is very common in patients with Crohn's disease (CD) and previous surgery. Endoscopy is crucial for the diagnosis of PSR, also showing high prognostic value. Bowel sonography (BS) with or without oral contrast enhancement (OCBS) is accurate for CD diagnosis but its role in PSR detection and grading is poorly investigated. The aim was to evaluate the diagnostic accuracy of BS and OCBS for PSR compared to the endoscopical Rutgeerts's grading system. Methods: We prospectively performed endoscopy, BS, and OCBS in 40 CD patients with previous bowel resection to provide evidence of possible PSR. Endoscopy, BS, and OCBS were executed 1 year after surgery, with PSR diagnosis and grading made in accordance with Rutgeerts. BS and OCBS were considered suggestive for PSR in the presence of bowel wall thickness (BWT) >3 mm. OCBS was performed after ingestion of 750 mL of polyethylene glycol (PEG). Also, a receiver operating characteristic (ROC) curve was constructed in order to define the best cutoff of BWT to discriminate mild from severe PSR (grade 0–2 versus 3–4 of Rutgeerts) for both BS and OCBS. Results: In all, 22 out of the 40 CD showed an endoscopic evidence of PSR (55%). A severe PSR was present in 14 patients (64%). Sensitivity, specificity, and positive and negative predictive values were 77%, 94%, 93%, and 80% for BS, and 82%, 94%, 93%, and 84% for OCBS. On the ROC curve a BWT >5 mm showed sensitivity, specificity, and positive and negative predictive values of 93%, 96%, 88%, and 97% for the diagnosis of severe PSR at BS, while a BWT >4 mm was the best cutoff differentiating the mild from the severe CD recurrence for OCBS, with a sensitivity, specificity, and positive and negative predictive values of 86%, 96%, 97%, and 79%, respectively. Conclusions: Both BS and OCBS show good sensitivity and high specificity for the diagnosis of PSR in CD, with a BWT >5 mm for BS and BWT >4 mm for OCBS strongly indicative of severe endoscopic PSR. Accordingly, these techniques could replace endoscopy for the diagnosis and grading of PSR in many cases. (Inflamm Bowel Dis 2008)

Published
2008

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