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1. Infection Control Practices and Outcomes of Endoscopy Units in the Lombardy Region of Italy A Survey From the Italian Society of Digestive Endoscopy During COVID-19 Spread

Author

Capurso, G., Archibugi, L., Vanella, G., Testoni, S. G. G., Petrone, M. C., Fanti, Lucrezia, Greco, Sara, Cavenati, S., Gaffuri, N., Lella, F., Pace, F., Cengia, G., Spada, Cristiano, Lovera, Mauro, Missale, G., Rosato, S., Radaelli, F., Buscarini, E., Parente, F., Pilati, S., Luigiano, C., Passoni, G. R., Salerno, R., Bargiggia, S., Penagini, R., Cantu, P., Fregoni, F., Giannetti, A., Devani, M., Manes, G., Fiori, G., Fontana, Paolo, Gambitta, P., Masci, E., Mutignani, Massimiliano, Gatti, M., Canani, M. B., Vailati, C., Dinelli, M. E., Marzo, V., Alvisi, C., Caramia, V., Di Sabatino, A., Mauro, A., De Grazia, F., Balzarini, M., Segato, S., Nella, G. A., Giannini, P., Leoni, Paola, Testoni, P. A., Mariani, A., Arcidiacono, P. G., Fanti L. (ORCID:0000-0003-2457-6373), Greco S., Spada C. (ORCID:0000-0002-5692-0960), Lovera M., Fontana P., Mutignani M. (ORCID:0000-0002-1272-4888), Leoni P., Capurso, G., Archibugi, L., Vanella, G., Testoni, S. G. G., Petrone, M. C., Fanti, Lucrezia, Greco, Sara, Cavenati, S., Gaffuri, N., Lella, F., Pace, F., Cengia, G., Spada, Cristiano, Lovera, Mauro, Missale, G., Rosato, S., Radaelli, F., Buscarini, E., Parente, F., Pilati, S., Luigiano, C., Passoni, G. R., Salerno, R., Bargiggia, S., Penagini, R., Cantu, P., Fregoni, F., Giannetti, A., Devani, M., Manes, G., Fiori, G., Fontana, Paolo, Gambitta, P., Masci, E., Mutignani, Massimiliano, Gatti, M., Canani, M. B., Vailati, C., Dinelli, M. E., Marzo, V., Alvisi, C., Caramia, V., Di Sabatino, A., Mauro, A., De Grazia, F., Balzarini, M., Segato, S., Nella, G. A., Giannini, P., Leoni, Paola, Testoni, P. A., Mariani, A., Arcidiacono, P. G., Fanti L. (ORCID:0000-0003-2457-6373), Greco S., Spada C. (ORCID:0000-0002-5692-0960), Lovera M., Fontana P., Mutignani M. (ORCID:0000-0002-1272-4888), and Leoni P.

Abstract

Goals: The present survey from the Italian Society of Digestive Endoscopy (SIED-Società Italiana di Endoscopia Digestiva) was aimed at reporting infection control practice and outcomes at Digestive Endoscopy Units in a high-incidence area. Background: Lombardy was the Italian region with the highest coronavirus disease-2019 (COVID-19) prevalence, at the end of March 2020 accounting for 20% of all worldwide deaths. Joint Gastro-Intestinal societies released recommendations for Endoscopy Units to reduce the risk of the contagion. However, there are few data from high-prevalence areas on adherence to these recommendations and on their efficacy. Methods: A survey was designed by the Lombardy section of SIED to analyze (a) changes in activity and organization, (b) adherence to recommendations, (c) rate of health care professionals' (HCP) infection during the COVID-19 outbreak. Results: In total, 35/61 invited centers (57.4%) participated; most modified activities were according to recommendations and had filtering face piece 2/filtering face piece 3 and water-repellent gowns available, but few had negative-pressure rooms or provided telephonic follow-up; 15% of HCPs called in sick and 6% had confirmed COVID-19. There was a trend (P = 0.07) toward different confirmed COVID-19 rates among endoscopists (7.9%), nurses (6.6%), intermediate-care technicians (3.4%), and administrative personnel (2.2%). There was no correlation between the rate of sick HCPs and COVID-19 incidence in the provinces and personal protective equipment availability and use, whereas an inverse correlation with hospital volume was found. Conclusions: Adherence to recommendations was rather good, though a minority were able to follow all recommendations. Confirmed COVID-19 seemed higher among endoscopists and nurses, suggesting that activities in the endoscopy rooms are at considerable viral spread risk.

Published
2021

2. The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study

Author

Tursi A., Brandimarte G., Di Mario F., Lanas A., Scarpignato C., Bafutto M., Barbara G., Bassotti G., Binda G. A., Biondi A., Biondo S., Cassieri C., Crucitti A., Dumitrascu D. L., Elisei W., Escalante R., Herszenyi L., Kruis W., Kupcinskas J., Lahat A., Lecca P. G., Maconi G., Malfertheiner P., Mazzarri A., Mearin F., Milosavljevic T., Nardone G., de Oliveira E. C., Papa A., Papagrigoriadis S., Pera M., Persiani R., Picchio M., Regula J., Stimac D., Stollman N., Strate L. L., Walker M. M. D., Allegretta L., Altavilla N., Amaro P., Annunziata M. L., Barberio F., Basile G., Bedogni G., Belfiori V., Benvenuti S., Bertolami C., Bisello M., El Dammak M. B., Bozzi R., Buono M., Cambie G., Capezzuto E., Casamassima C., Chavoushian A., Ciofani R., Citarella C., Compare D., Cotruta B., D'amico F., Dulk M. D., Dyrda B. E., Festa V., Gallina S., Grasso R., Hanzel J., Taieb J. M., Lai M. A., Latella G., Lisi D., Lodi L., Marangi S., Mardegan A., Marlicz W., Maurano A., Milazzo G., Militaru V., Miraglia S., Monica F., Moskalev A., Natale A., Nicolas C., Pancetti A., Penna A., Pepe A. S., Pisano M., Pontone S., Prati M., Prisco A., Rando L., Hernandez E. R., Rosati O., Rossi G., Passoni G. R., Papa V., Nesme N. S., Schiffino L., Schillaci D., Selvaggi G., Taborchi F., Tornar A., Trebuna F., Triggiani C., Testai F. V., Vassallo R., Violi A., Tursi, A., Brandimarte, G., Di Mario, F., Lanas, A., Scarpignato, C., Bafutto, M., Barbara, G., Bassotti, G., Binda, G. A., Biondi, A., Biondo, S., Cassieri, C., Crucitti, A., Dumitrascu, D. L., Elisei, W., Escalante, R., Herszenyi, L., Kruis, W., Kupcinskas, J., Lahat, A., Lecca, P. G., Maconi, G., Malfertheiner, P., Mazzarri, A., Mearin, F., Milosavljevic, T., Nardone, G., de Oliveira, E. C., Papa, A., Papagrigoriadis, S., Pera, M., Persiani, R., Picchio, M., Regula, J., Stimac, D., Stollman, N., Strate, L. L., Walker, M. M. D., Allegretta, L., Altavilla, N., Amaro, P., Annunziata, M. L., Barberio, F., Basile, G., Bedogni, G., Belfiori, V., Benvenuti, S., Bertolami, C., Bisello, M., El Dammak, M. B., Bozzi, R., Buono, M., Cambie, G., Capezzuto, E., Casamassima, C., Chavoushian, A., Ciofani, R., Citarella, C., Compare, D., Cotruta, B., D'Amico, F., Dulk, M. D., Dyrda, B. E., Festa, V., Gallina, S., Grasso, R., Hanzel, J., Taieb, J. M., Lai, M. A., Latella, G., Lisi, D., Lodi, L., Marangi, S., Mardegan, A., Marlicz, W., Maurano, A., Milazzo, G., Militaru, V., Miraglia, S., Monica, F., Moskalev, A., Natale, A., Nicolas, C., Pancetti, A., Penna, A., Pepe, A. S., Pisano, M., Pontone, S., Prati, M., Prisco, A., Rando, L., Hernandez, E. R., Rosati, O., Rossi, G., Passoni, G. R., Papa, V., Nesme, N. S., Schiffino, L., Schillaci, D., Selvaggi, G., Taborchi, F., Tornar, A., Trebuna, F., Triggiani, C., Testai, F. V., Vassallo, R., Violi, A., Tursi A., Brandimarte G., Di Mario F., Lanas A., Scarpignato C., Bafutto M., Barbara G., Bassotti G., Binda G.A., Biondi A., Biondo S., Cassieri C., Crucitti A., Dumitrascu D.L., Elisei W., Escalante R., Herszenyi L., Kruis W., Kupcinskas J., Lahat A., Lecca P.G., Maconi G., Malfertheiner P., Mazzari A., Mearin F., Milosavljevic T., Nardone G., Chavez De Oliveira E., Papa A., Papagrigoriadis S., Pera M., Persiani R., Picchio M., Regula J., Stimac D., Stollman N., Strate L.L., and Walker M.M.

Subjects
BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences, Diverticular Disease, Endoscopic classification, Video Recording, Colonoscopy, Gastroenterology, Severity of Illness Index, endoscopic classification, Diverticulum, classification, complications, Diverticular diseases, Endoscopy, methods, Colonic Diseases, 0302 clinical medicine, Community Health Services, Community Health Service, Observer Variation, 0303 health sciences, medicine.diagnostic_test, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti, agreement − colonoscopy − community setting − diverticular disease of the colon− endoscopic classification, 3. Good health, Diverticulosis, Malalties del còlon, Diverticular disease of the colon, Diverticular disease, 616.344-007.64 [udc], Community setting, 030211 gastroenterology & hepatology, Human, medicine.medical_specialty, Scoring system, Colonic Disease, Settore MED/12 - GASTROENTEROLOGIA, Reproducibility of Result, agreement, colonoscopy, community setting, diverticular disease of the colon, Agreement, 03 medical and health sciences, Internal medicine, Severity of illness, medicine, Diverticulosis, Colonic, Humans, Colonic diseases, 030304 developmental biology, Diverticular Diseases, business.industry, Colonoscòpia, Reproducibility of Results, medicine.disease, Inter-rater reliability, business, Kappa
Abstract

Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

Published
2019

3. A prospective comparison of endorectal ultrasound and pelvic magnetic resonance in the preoperative staging of rectal cancer

Author

paolo pietro bianchi, Ceriani, C., Palmisano, A., Pompili, G., Passoni, G. R., Rottoli, M., Cappellani, A., Montorsi, M., Bianchi, Paolo, Ceriani, Chiara, Palmisano, Angela, Pompili, Giovanni, Passoni, Giovanni Rubi, Rottoli, Matteo, Cappellani, Andrea, and Montorsi, Marco

Subjects
Adult, Aged, 80 and over, Male, Rectal Neoplasm, Rectal Neoplasms, Endorectal ultrasound, Predictive Value of Test, Middle Aged, Magnetic Resonance Imaging, Endosonography, Prospective Studie, Predictive Value of Tests, Preoperative Care, Humans, Female, Prospective Studies, Magnetic Resonance, Rectal cancer, Aged, Human, Neoplasm Staging
Abstract

BACKGROUND: The development of new surgical modalities (local excision, coloanal-anastomosis) and the diffusion of preoperative neoadjuvant therapy, has increased the importance of an accurate preoperative staging in patients with rectal cancer. The aim of this study was to compare the accuracy of endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) in the local preoperative staging of rectal carcinoma; moreover the two methods were assessed with a concordance K test. METHODS: Twenty-nine patients with rectal carcinoma were staged with EUS and body coil MRI and then underwent radical surgery. The preoperative staging was compared with the histologic findings of the operative specimen. RESULTS: EUS was more accurate (79.3%), with better sensibility (90%), positive predictive value (PPI9 (85.7%) and negative predictive value (NPV) (25%) than MRI in the evaluation of T parameter. MRI was more accurate (72.4%), with better specificity (81.2%), PPV (72.7%) and NPV (68.4%) than EUS in the evaluation of N parameter. The concordance test obtained a K value of 19.8% for the T parameter and 34.2% for the N parameter. CONCLUSIONS: EUS and MRI are complementary methods in the preoperative staging of rectal cancer. EUS is more accurate in determining bowel wall penetration of the tumor, while MRI is more accurate in the evaluation of lymph node involvement. The low value of the K index confirms the complementarity of the two examinations. Further studies with new imaging techniques such as endocoil MRI, external phase-arrayed coil MRI and three dimensional ultrasound are needed to identify the most effective single examination in the preoperative staging of rectal cancer.

Published
2006

4. Chicken bone as swallowed foreign body.

Author

Rossi UG, Passoni GR, and Cariati M

Subjects
Adult, Animals, Chickens, Endoscopy, Endoscopy, Gastrointestinal, Female, Foreign Bodies therapy, Humans, Bone and Bones, Foreign Bodies diagnostic imaging
Published
2016
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5. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.

Author

Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, and Testoni PA

Subjects
Acute Disease, Cholangiopancreatography, Endoscopic Retrograde statistics & numerical data, Cholangitis etiology, Common Bile Duct Diseases etiology, Hemorrhage etiology, Humans, Multivariate Analysis, Pancreatitis etiology, Prospective Studies, Risk Factors, Sphincter of Oddi physiopathology, Cholangiopancreatography, Endoscopic Retrograde adverse effects
Abstract

Objectives: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study., Methods: One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists., Results: Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater., Conclusions: The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.

Published
2001
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6. Original technique for small colorectal tumor localization during laparoscopic surgery.

Author

Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni GR, and Cosentino F

Subjects
Colon diagnostic imaging, Colon surgery, Colonic Neoplasms diagnostic imaging, Colonic Polyps diagnostic imaging, Colonoscopy, Female, Humans, Intraoperative Care, Male, Rectal Neoplasms diagnostic imaging, Surgical Instruments, Ultrasonography, Colonic Neoplasms surgery, Colonic Polyps surgery, Laparoscopy methods, Rectal Neoplasms surgery
Abstract

Introduction: Small colonic tumor localization and correct extension of colonic resection is critical in laparoscopic surgery. Currently used techniques are sometimes inconclusive and may carry some morbidity. We describe an original method of small tumor localization during laparoscopic colorectal operations through the use of preoperative clip applications by colonoscopy and intraoperative ultrasound of the colon., Methods: Eight patients with small colonic lesions necessitating preoperative marking were included into this study. A two-step technique was used. Before the operation two metal clips were endoscopically applied proximally and distally to the lesion site. At surgery an intraoperative ultrasound examination of the colon or rectum surface was performed to localize the clips. Subsequent laparoscopic colon resection was performed., Results: Endoscopic metallic clips were easily applied around the lesion in all cases without complications. No dislodgement of clips was documented. At surgery laparoscopic ultrasound visualized the clips in all cases. The examination took between 5 and 17 minutes with no specific morbidity. The lesions with the surrounding clips were always found in the resected specimen., Conclusions: Endoscopic metal clipping and intraoperative laparoscopic ultrasound proved to be an easy, safe, and accurate technique in locating small colonic tumors.

Published
1999
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7. Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding. First stage of a randomized, controlled trial.

Author

Spina GP, Santambrogio R, Opocher E, Cosentino F, Zambelli A, Passoni GR, Cucchiaro G, Macrì M, Morandi E, and Bruno S

Subjects
Adult, Aged, Data Interpretation, Statistical, Electroencephalography, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices surgery, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Humans, Hypertension, Portal therapy, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Randomized Controlled Trials as Topic, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage prevention & control, Sclerotherapy, Splenorenal Shunt, Surgical
Abstract

In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy; four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.

Published
1990
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