Author: "Familiari, Pietro (ORCID:0000-0002-5181-2928)" - Searchworks@Jio Institute Digital Library Search Results

62 results on '"Familiari, Pietro (ORCID:0000-0002-5181-2928)"'

1. Diagnostic accuracy and interobserver agreement of cholangioscopy for indeterminate biliary strictures: A single-center experience

Author: Milluzzo, Sebastian Manuel, Landi, Rosario, Perri, Vincenzo, Familiari, Pietro, Boskoski, Ivo, Pafundi, Pia Clara, Farina, Annarita, Ricci, Riccardo, Spada, Cristiano, Costamagna, Guido, Tringali, Andrea, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Ricci, Riccardo (ORCID:0000-0002-9089-5084), Spada, Cristiano (ORCID:0000-0002-5692-0960), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea (ORCID:0000-0002-9614-3449), Milluzzo, Sebastian Manuel, Landi, Rosario, Perri, Vincenzo, Familiari, Pietro, Boskoski, Ivo, Pafundi, Pia Clara, Farina, Annarita, Ricci, Riccardo, Spada, Cristiano, Costamagna, Guido, Tringali, Andrea, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Ricci, Riccardo (ORCID:0000-0002-9089-5084), Spada, Cristiano (ORCID:0000-0002-5692-0960), Costamagna, Guido (ORCID:0000-0002-8100-2731), and Tringali, Andrea (ORCID:0000-0002-9614-3449)
Abstract: Background and study aims: Characterization of indeterminate biliary strictures (IDBS) still represents a major challenge. Digital single-operator cholangioscopy (DSOC) could potentially overcome limits of conventional biopsy and brush sampling. The aim of this study was to compare diagnostic accuracy of visual evaluation and DSOC-guided biopsies to conventional trans-papillary sampling techniques and to evaluate the inter-observer agreement (IOA) on visual diagnosis. Patients and methods: All consecutive patients undergoing DSOC-guided biopsy after conventional sampling techniques for IDBS during a six-year period were retrospectively evaluated. Final diagnosis was based on histological evaluation of the surgical specimen if available or a clinical follow-up of at least 6 months. For IOA, 20-second DSOC clips were retrospectively reviewed by 6 experts and 6 trainees and classified according to the Monaco Classification. Results: Thirty-five patients underwent DSOC for IDBS in the study period; 14 patients (F = 9) with a median age of 64 years (range 53-76) met the study aim. After DSOC, strictures location was changed in three patients (additional yield of 21.4 %). Intraductal DSOC-guided biopsy were technically successful in all cases, with an adequacy of 92.8 %. No adverse events were recorded. Final diagnosis was benign disease in five cases and cholangiocarcinoma in the others. For IOA, 29 videos were evaluated with almost perfect agreement for final diagnosis (kappa 0.871; agreement 93.1, p <0.001), although overall accuracy of DSOC visual finding was 73.6 % and 64.4 % for experts and trainees, respectively. Conclusions: DSOC could improve diagnostic accuracy for IDBS, since it showed high sensitivity for visual finding and high specificity for DSOC guided-biopsy. Visual diagnosis seems reliable for diagnosis using the Monaco Classification.
Published: 2023

2. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Author: Adisa, Adewale, Bahrami-Hessari, Michael, Bhangu, Aneel, George, Christina, Ghosh, Dhruv, Glasbey, Jame, Haque, Parvez, Ingabire, J C Allen, Kamarajah, Sivesh Kathir, Kudrna, Laura, Ledda, Virginia, Li, Elizabeth, Lillywhite, Robert, Mittal, Rohin, Nepogodiev, Dmitri, Ntirenganya, Faustin, Picciochi, Maria, Simões, Joana Filipa Ferreira, Booth, L, Elliot, R, Kennerton, A S, Pettigrove, K L, Pinney, L, Richard, H, Tottman, R, Wheatstone, P, Wolfenden, John W D, Smith, Jenovia Amisti, Sayed, A Emad, Goswami, Aakansha Giri, Malik, Aamer, Mclean, Aaron Lawson, Hassan, Abba, Nazimi, Abd Jabar, Aladna, Abdallah, Abdelgawad, Abdalrahman, Saed, Abdel, Abdelmageed, Abdelfatah, Ghannam, Abdelilah, Taha, Abdelrahman Mahmoud Ahmed Abdelsamad, Alvi, Abdul, Ismail, Abdulaziz, Adesunkanmi, Abdulhafiz, Ebrahim, Abdulla, Al-Mallah, Abdullah, Alqallaf, Abdullah, Durrani, Abdullah, Gabr, Abdullah, Kirfi, Abdullahi Musa, Altaf, Abdulmalik, Almutairi, Abdulmjeed, Sabbagh, Abdulrahman J, Ajiya, Abdulrazak, Haddud, Abdurrahman, Alnsour, Abed Alfattah Mahmoud, Singh, Abhinav, Mittal, Abhishek, Semple, Abigail, Adeniran, Abiodun, Negussie, Abraham, Oladimeji, Abraham, Muhammad, Abubakar Bala, Yassin, Abubaker, Gungor, Abuzer, Tarsitano, Achille, Soibiharry, Adaiah, Dyas, Adam, Frankel, Adam, Peckham-Cooper, Adam, Truss, Adam, Issaka, Adamu, Ads, Adel Mohamed, Aderogba, Adeleke Akeem, Adeyeye, Ademola, Ademuyiwa, Adesoji, Sleem, Adham, Papa, Adrian, Cordova, Adriana, Appiah-Kubi, Adu, Meead, Adullah, Nacion, Aeris Jane D, Michael, Afieharo, Forneris, Agustin Albani, Duro, Agustin, Gonzalez, Agustin Rodriguez, Altouny, Ahmad, Ghazal, Ahmad, Khalifa, Ahmad, Ozair, Ahmad, Quzli, Ahmad, Haddad, Ahmad, Othman, Ahmad Faidzal, Yahaya, Ahmad Shuib, Elsherbiny, Ahmed, Nazer, Ahmed, Hammad, Ahmed Tarek, Abu-Zaid, Ahmed, Al-Nusairi, Ahmed, Azab, Ahmed, Elagili, Ahmed, Elkazaz, Ahmed, Kedwany, Ahmed, Nuhu, Ahmed Mohammed, Sakr, Ahmed, Shehta, Ahmed, Shirazi, Ahmed, Mohamed, Ahmed Mohamed Ibrahim, Sherif, Ahmed Elshawadfy, Awad, Ahmed K, Abbas, Ahmed M, Abdelrahman, Ahmed Saber, Ammar, Ahmed Siddique, Azzam, Ahmed Y, Ciftci, Ahmet Burak, Dural, Ahmet Cem, Sanli, Ahmet Necati, Rahy-Martín, Aida Cristina, Tantri, Aida Rosita, Khan, Aimal, Al-Touny, Aiman, Tariq, Aiman, Gmati, Aimen, Costas-Chavarri, Ainhoa, Auerkari, Aino, Landaluce-Olavarria, Aitor, Puri, Ajay, Radhakrishnan, Ajay, Ubom, Akaninyene Eseme, Pradhan, Akhilesh, Turna, Akif, Adepiti, Akinfolarin, Kuriyama, Akira, Kassam, Al-Faraaz, Hassouneh, Ala, El-Hussuna, Alaa, Habeebullah, Alaa, Ads, Alaa Mohamed, Mousli, Alaa, Biloslavo, Alan, Hoang, Alan, Kirk, Alan, Santini, Alasdair, Melero, Alba Vazquez, Calvache, Albaro José Nieto, Baduell, Albert, Chan, Albert, Abrate, Alberto, Balduzzi, Alberto, Sánchez, Alberto Cabañero, Navarrete-Peón, Alberto, Porcu, Alberto, Brolese, Alberto, Barranquero, Alberto G, Saibene, Alberto Maria, Adam, Albushra Altayeb, Vagge, Aldo, Maquilón, Alejandra Jara, Leon-Andrino, 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Ahmad, Aline, Kent, Alistair J, Khamees, Almu'Atasim, Ugwu, Aloy Okechukwu, Turan, Alparslan, Mohammed, Alsnosy Abdullah Khalefa, Navarro-Barrios, Alvaro, Yebes, Alvaro, De Sousa, Álvaro Francisco Lope, Moreno, Amabelle, Sethi, Aman, Dawson, Amanda Caroline, Othman, Amani Alsayd Abdulsalam, Kaur, Amanjot, Wolde, Amanuel, Antonelli, Amedeo, Scifo, Amedeo, Alhamad, Ameen, Davis, Amelia, Alderazi, Amer, Harky, Amer, Mohammed-Durosinlorun, Amina, Seguya, Amina, Okhakhu, Amina, Chamakhi, Amine, Sebai, Amine, Souadka, Amine, Asla, Amir, Agrawal, Amit, Persad, Amit, Gupta, Amit, Elgazar, Amr, Kulkarni, Amruta, Coates, Amy, Bellés, Ana Ciscar, Hadzibegovic, Ana Danic, Jotic, Ana, Kowark, Ana, Martins, Ana, Pineda, Ana Mejía, Peral, Ana, Gollarte, Ana Sánchez, Senent-Boza, Ana, Camarena, Ana Isabel Avellaneda, Castaño-Leon, Ana M, Bravo, Ana Maria Minaya, Moro, Ana María Gimeno, Musina, Ana-Maria, Tapia-Herrero, Ana-María, Kothari, Anai, Gupta, Anand, Raja, Anand, Aljaiuossi, Ana, Taha, 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Asad, Jayawardane, Asanka, Gupta, Ashish, Ramasamy, Ashok, Mitul, Ashrarur Rahman, Bawa, Ashvind, Nugur, Ashwani, Rammohan, Ashwin, Sachdeva, Ashwin, Mehraj, Asif, Yildirim, Asif, Alqaseer, Asma, Radwan, Asmaa, Sallam, Asser, Syllaios, Athanasio, Tampakis, Athanasio, Alwael, Athari, Samara, Athina, Eroglu, Atilla, Rahman, Atiqur, Ulkucu, Attila, Zaránd, Attila, Dulskas, Audriu, Tawiah, Augustine, Zani, Augusto, Vas, Aurelia, Lukosiute-Urboniene, Ausra, Adamu, Auwal, Aujayeb, Avinash, Malik, Awais Amjad, İplikçi, Ayberk, Mahmud, Ayesha, Cil, Aylin Pelin, Makanjuola, Ayomide, Akwaisah, Ayoub, Galandarova, Aysuna, Saracoglu, Ayten, Regan, Azel, Barlas, Aziz Mutlu, Alhassan, Baba Alhaji Bin, Mostafa, Badr, Hamida, Baha Ben, Torun, Bahar Canbay, Abdullah, Bahiyah, Balagobi, Balasingam, Banky, Balaz, Singh, Baljit, Alegbeleye, Bamidele, Yigit, Banu, Hajjaj, Baraa Nabil, Burgos-Blasco, Barbara, Seeliger, Barbara, Alayande, Barnaba, Alhazmi, Barrag, Enodien, Bassey, Torre, Beatrice, Pérez, 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Berselli, Bruno, Martinez-Leo, Bruno, Sensi, Bruno, Nardo, Bruno, Celik, Burak, Giray, Burak, Abud, Burçin, Almiqlash, Bushray, Pramesh, C S, Taskiran, Cagatay, De Campos Prado, Caio Antonio, Cipolla, Calogero, Kumar, Calvin, English, Camilla, Riccetti, Camilla, Vanni, Camilla, Brasset, Camille, Downey, Candice, Duffy, Caoimhe, Chwat, Carina, Cutmore, Carina, Sars, Carl, Ratto, Carlo, Pacilio, Carlo Alberto, De La Infiesta García, Carlo, Moreno, Carlos Guijarro, Magalhães, Carlo, Prada, Carlo, Zapata, Carlos Shiraishi, Senni, Carlotta, Flumignan, Carolina Dutra Queiroz, Martinez-Perez, Carolina, Duarte, Carolina Lugo, Garcia, Carolina Soledad Romero, Anderson, Caroline, Hing, Caroline, Cullinane, Carolyn, Cina, Caterina, Zabkiewicz, Catheriner, Sohrabi, Catrin, Guldogan, Cem Emir, Ciubotaru, Cezar, Desai, Chaitya, Raut, Chandrajit, Demetriou, Chari, Handford, Charle, Okpani, Charle, Paranjape, Charudutt, Koh, Cherry, Khatri, Chetan, Parmar, Chetan, Mok, Chi Wei, Caricato, Chiara, Marafante, Chiara, Echieh, Chidiebere Peter, Tan, Chih Ying, Ong, Chon Sum, Conso, Christel, Jardinez, Christiaan, Konrads, Christian, Warner, Christian, Makwe, Christian Chigozie, Henein, Christin, Fleming, Christina, Roland, Christina L, Maurus, Christine, Nitschke, Christine, Mittermair, Christof, Mallmann, Christoph, Andro, Christophe, Harmston, Christopher, Kuppler, Christopher, Lotz, Christopher, Nahm, Christopher, Rowe, Christopher, Ryalino, Christopher, Wallis, Christopher, Millward, Christopher Paul, Anthoulakis, Christo, Apostolou, Christo, Chouliaras, Christo, Kalfountzos, Christo, Kaselas, Christo, Vosinakis, Christo, Okereke, Chukwuma, Chean, Chung Shen, Barlow, Ciaran, Tatar, Cihad, Clancy, Cillian, Forde, Cillian, Sharpin, Claire, Mccarthy, Claire, Nestor, Claire, Warden, Claire, Ávila, Clara Castro, Massaguer, Clara, Fang, Clarissa Ern Hui, Martins, Claudia Pinto, Guerci, Claudio, Mauriello, Claudio, Holzmeister, Clemen, Miller, Clemen, Weber, Clemen, Wiesinger, Clemens Georg, Kenington, Cleo, Noel, Colin, Sue-Chue-Lam, Colin, Adumah, Collin, Neary, Colm, Sen, Comert, Fitzgerald, Conall, Ezeme, Constantine, Nastos, Constantino, Mesina, Cristian, Bombardini, Cristina, Torregrosa, Cristina, Valdespino, Cristina Puente, Don, Cristine Pathirannehalage, Wickramasinghe, Dakshitha, Milanesi, Damiano, Armijos, Daniel, Asiimwe, Daniel, Beswick, Daniel, Clerc, Daniel, Cox, Daniel, Doherty, Daniel, Martínez, Daniel Fernández, Lechuga, Daniel Garay, Gero, Daniel, Gil-Sala, Daniel, Lindegger, Daniel, Reim, Daniel, Shaerf, Daniel, Shmukler, Daniel, Branzan, Daniela, Filipescu, Daniela, Rega, Daniela, Bernardi, Daniele, Bissacco, Daniele, Fusario, Daniele, Morezzi, Daniele, Sabella, Danielle, Zimak, Danijela Mrazovac, Vinci, Danilo, Sale, Danjuma, Khan, Danyal Zaman, Thereska, Dariel, Andreotti, Dario, Tartaglia, Dario, Abdulai, Darling Ramatu, Mukherjee, Dattatreya, Verdi, Daunia, Idowu, David, John, David, Johnson, David, Moro-Valdezate, David, Naumann, David, Omar, David, Proud, David, Roberts, David, Guzmán, David Santo, Watson, David, Bergkvist, David Julià, Lumenta, David Benjamin, Ferrari, Davide, Rizzo, Davide, Degarege, Dawit, Castillo, Dayan Fanery Campino, Douglas, Deborah, Wright, Deborah, Nanjiani, Deedar, Bratus, Dejan, Altun, Demet, Sievers, Denise, Vaysburg, Denni, Katechia, Devvrat, Ghosh, Dhruva, Azize, Diallo Abdoul, Rodrigues, Diana, Pachajoa, Diana Alejandra Pantoja, Hayne, Dickon, Mutter, Didier, Raimondo, Diego, Eskinazi, Diego, Sasia, Diego, Corallino, Diletta, Muduly, Dillip, Grewal, Dilraj, Hadzhiev, Dimitar, Peristeri, Dimitra, Pournaras, Dimitri, Raptis, Dimitri Aristotle, Angelou, Dimitrio, Haidopoulos, Dimitrio, Magouliotis, Dimitrio, Moris, Dimitrio, Schizas, Dimitrio, Symeonidis, Dimitrio, Tsironis, Dimitrio, Korkolis, Dimitrio, Tatsis, Dimitri, Thekkinkattil, Dinesh, Bulian, Dirk Rolf, Pandey, Diwakar, Vatansever, Dogan, Parker, Dominic, Wiedemann, Dominik, Borselle, Dominika, Pedini, Domiziana, Schweitzer, Donald, Venskutonis, Donata, Otokwala, Job, Adamu, Kabir Musa, Pk, Parvathy, Garod, Mebanshanbor, Ellafi, Amera Ali Dakheel, Zivkovic, Dragana, Jelovac, Drago, Wijeysundera, Duminda, Mcpherson, Duncan, Ryan, Éanna, Ugwu, Ebere, Baidoo, Ebikela Ivie, Shaddad, Ebrahim, Memişoğlu, Ecem, Naranjo, Eddy P Lincango, Brodkin, Edgar, Segalini, Edoardo, Viglietta, Edoardo, Hendriks, Eduard, Bonci, Eduard-Alexandru, Sá-Marta, Eduarda, Ortega, Eduardo Nieto, Gomez, Eduardo Garcia-Loarte, Joviliano, Edwaldo Edner, Clune, Edward, Horwell, Edward, Mains, Edward, Vasarhelyi, Edward, Caruana, Edward J, Nevins, Edward J, Yenli, Edwin Mwintiereh Ta-Ang, Baili, Efstratia, Lostoridis, Eftychio, Morgan, Eghosa, Shiban, Ehab, Latif, Ejaz, Tampaki, Ekaterini Christina, Ezenwa, Ekene, Irune, Ekpemi, Borg, Elaine, Eisa, Elamin, Gialamas, Eleftherio, Parvez, Elena, Theophilidou, Elena, Toma, Elena Adelina, Arnaoutoglou, Eleni, Samadov, Elgun, Kantor, Elie, Ulman, Elif Akba, Colak, Elif, Cassinotti, Elisa, Bannone, Elisa, Sarjanoja, Elise, Yates, Elizabeth, Vincent, Elizabeth, Lun, Elizabeth Weng Yan, Cerovac, Elmedina, Dif, Elmes Saoussene, Alkhalifa, Elmustafa, Daketsey, Elorm, Fayad, Elsayed A, Sheikh, Eman, Pontecorvi, Emanuele, Cammarata, Emanuele, La Corte, Emanuele, Rausa, Emanuele, Odai, Emeka Danielson, Guasch, Emilia, Cano-Trigueros, Emiliano, Uldry, Emilie, Ros, Emilio Peña, Matthews, Emily, Donmez, Emin Erhan, Giorgakis, Emmanouil, Kapetanakis, Emmanouil, Stamatakis, Emmanouil, Bua, Emmanuel, Schneck, Emmanuel, Nachelleh, Emmanuel Aadereyir, Ofori, Emmanuel Owusu, Akin, Emrah, Gönüllü, Emre, Kirkan, Emre Furkan, Çelik, Ene, Wong, Enoch, Capozzi, Enrico, Pinotti, Enrico, Colás-Ruiz, Enrique, González, Enrique, Fekaj, Enver, Ohazurike, Ephraim, Kebede, Ephrem, Erginöz, Ergin, Duran, Erik Efrain Sosa, Scott, Erin, Aytac, Erman, Albanese, Erminia, Castro, Ernes John, Albayadi, Eslam, Kriem, Eslam, Siddig, Esra, Otify, Esraa, El Tayeb, Essam Eldien Abuobaida Banaga Hag, Hong, Estelle How, Saguil, Esther, Belzile, Etienne, Tuyishime, Eugene, Panieri, Eugenio, Martínez, Eunate Ganuza, Myriokefalitaki, Eva, Wong, Evan G, Samara, Evangelia, Agbeno, Evans Kofi, Drozdov, Evgeniy, Tokidis, Evripidi, Shah, Faaiz Ali, Barra, Fabio, Carbone, Fabio, Ferreli, Fabio, Marino, Fabio, Martinelli, Fabio, D'Acapito, Fabrizio, Masciello, Fabrizio, Bàmbina, Fabrizio, Issa, Fadi, Salameh, Fadi-Tama, Kethy, Fagnon, Mahmood, Fahad, Gareb, Fahed, Idrees, Farah, Karimian, Faramarz, Ashraf, Fariha, Haji, Farnaz, Inayat, Farwa, Begum, Farzana, Nabil, Fatma, Rosa, Fausto, Haider, Fayza, Parray, Fazl, Calculli, Federica, Ferracci, Federica, Saraceno, Federica, Coppola, Federico, Coccolini, Federico, Fusini, Federico, Migliorelli, Federico, Pecoraro, Felice, Alconchel, Felipe, Coimbra, Felipe José Fernandez, Trivik-Barrientos, Felipe, Naegele, Felix, Almarshad, Felwa, Agresta, Ferdinando, Fleming, Fergal, Mendoza-Moreno, Fernando, Brzeszczyński, Filip, 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Gabriel, Wagner, Gabriela, Bellio, Gabriele, Giarratano, Gabriella, Capolupo, Gabriella Teresa, Budd, Gabrielle, Marom, Gad, Poillucci, Gaetano, Thiruchandran, Gajendiran, Nicholson, Gary, Groot, Gary, Hoey, Gary, Bass, Gary Alan, Sachdev, Gaurav, Agarwal, Gaurav, Aggarwal, Gaurav, Cormio, Gennaro, Mazzarella, Gennaro, Perrone, Gennaro, Osterhoff, Georg, Singer, Georg, Dejeu, George, Fowler, George, Garas, George, Gradinariu, George, Theodoropoulos, George, Tzimas, George, Babis, George, Wong, George Kwok Chu, Cross, George W V, Micha, Georgia, Chrysovitsiotis, Georgio, Koukoulis, Georgio, Peros, Georgio, Tsoulfas, Georgio, Kapetanios, Georgio, Karagiannidis, Georgio, Verras, Georgios-Ioanni, Ekwen, Gerald, Perrotta, Gerardo, Petruzzi, Gerardo, Bertelli, Giacomo, Calini, Giacomo, Fiacchini, Giacomo, Pirola, Giacomo Maria, Dolci, Giampiero, Mendiola, Gian, Baiocchi, Gian Luca, Palini, Gian Marco, Prucher, Gian Marco, D'Andrea, Giancarlo, Maggiore, Giandomenico, Cassese, Gianluca, 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Coates, Amy, Bellés, Ana Ciscar, Hadzibegovic, Ana Danic, Jotic, Ana, Kowark, Ana, Martins, Ana, Pineda, Ana Mejía, Peral, Ana, Gollarte, Ana Sánchez, Senent-Boza, Ana, Camarena, Ana Isabel Avellaneda, Castaño-Leon, Ana M, Bravo, Ana Maria Minaya, Moro, Ana María Gimeno, Musina, Ana-Maria, Tapia-Herrero, Ana-María, Kothari, Anai, Gupta, Anand, Raja, Anand, Aljaiuossi, Ana, Taha, Ana, Majbar, Anass Mohammed, Prodromidou, Anastasia, Kanatas, Anastasio, Gupte, Anaya, Zakaria, Andee Dzulkarnaen, Balla, Andrea, Barberis, Andrea, Bondurri, Andrea, Bottari, Andrea, Costantino, Andrea, Figus, Andrea, Lauretta, Andrea, Mingoli, Andrea, Romanzi, Andrea, Sagnotta, Andrea, Scacchi, Andrea, Picchetto, Andrea, Valadez, Andrea Estefania Cueto, Luzzi, Andrea-Pierre, Älgå, Andrea, Fontalis, Andrea, Hecker, Andrea, Demetriades, Andreas K, Serban, Andreea-Madalina, Văcărașu, Andrei Bogdan, Cokan, Andrej, Isaza-Restrepo, Andre, Beamish, Andrew, Schache, Andrew, Stevenson, Andrew, Yiu, Andrew, 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Abdelmawgoud, Sherif, Shehata, Sherif, Sharma, Shilpa, Ahmed, Shima, Al-Touny, Shimaa A, Ramzanali, Shireen, Nah, Shireen Anne, Jansen, Shirley, Rajan, Shiv, Dindyal, Shiva, Amin, Shivang, Ahmad, Shoaib, Shoukrie, Shoukrie I M, Karar, Shoura, Patkar, Shraddha, Abdulsalam, Shuaib, Lin, Shuxun, Hegde, Siddhi, Fiorelli, Silvia, Quaresima, Silvia, Redondo, Silvia Villacé, Palmisano, Silvia, Ruggiero, Silvia, Balogun, Simon, Cais, Simon, Cole, Simon, Federer, Simon, Le Roux, Simon, Ippoliti, Simona, Meneghini, Simona, Viola, Simona, Manfredelli, Simone, Novello, Simone, Gananadha, Sivakumar, Mesli, Smain Nabil, Kale, Smruti, Tani, Sobhana Iftekhar, Malik, Sobia, Anastasiadou, Sofia, Boligo, Sofia, Esposito, Sofia, Valanci, Sofia, Xenaki, Sofia, Pejkova, Sofija, Bandyopadhyay, Soham, Trungu, Sokol, Basu, Sompraka, Alkhatib, Sondo, Pérez-Bertólez, Sonia, Flores, Sonia Lopez, Donoghue, Sophie, Lunca, Sorinel, Orsoo, Soyombo, Potamianos, Spyridon, Devarakonda, Sreekar, Suresh, Sreelakshmi, Croghan, Stefanie M, Turi, Stefano, Capella, Stefano, Lucchini, Stefano, Magnone, Stefano, Salizzoni, Stefano, Scabini, Stefano, Scaringi, Stefano, Cioffi, Stefano Piero Bernardo, Seyfried, Steffen, Degener, Stephan, Potten, Stephanie, Taha-Mehlitz, Stephanie, Ali, Stephen, Angamuthu, Stephen, Mcaleer, Stephen, Knight, Stephen Richard, White, Stuart, Mantziari, Styliani, Kykalos, Styliano, Goh, Su Kah, Chowdhury, Subhadip Pal, Ibrahim, Sufyan, Elzwai, Suha, Bansal, Sujesh, Tripathy, Sujit, Amrayev, Sultan, Anwar, Sumadi Lukman, Banerjee, Sumit, Thakar, Sumit, Saeed, Summaya, Venkatappa, Sunil Kumar, Das, Sunit, Techapongsatorn, Suphakarn, Dube, Surya Kumar, Lee, Susan, González-Suárez, Susana, Henriques, Susana, Konjevoda, Suzana, Gisbertz, Suzanne, Bravo, Sybil Lizanne, Mannan, Syed, Bukhari, Syed Imran, Zafar, Syed Nabeel, Batista, Sylvia, Chin, Synn Lynn, Arif, Tahera, Lawal, Taiwo Akeem, Aktokmakyan, Talar Vartanoglu, Osborn, Tamara, Szakmany, Tama, Sztipits, Tamá, Triantafyllou, Tania, Valadez, Tania Abigail Cueto, Singh, Tanveer, Khaliq, Tanwir, Patel, Tapan, Fadalla, Tarig, Jichi, Tarik, Sammour, Tarik, Al-Shaiji, Tariq, Naggs, Taryn, Barišić, Tatjana, Nikolouzakis, Taxiarchi, Bisgin, Tayfun, Perra, Teresa, Uprak, Tevfik Kıvılcım, Dagklis, Themistokli, Liakakos, Theodore, Sidiropoulos, Theodoro, Adjeso, Theophilus Justus Kofi, Dölker, Theresa, Oung, Thida, Aherne, Thoma, Diehl, Thoma, Pinkney, Thoma, Raymond, Thoma, Rhomberg, Thoma, Schmitz-Rixen, Thoma, Madhuri, Thumuluru Kavitha, Lohmann, Tibor Karl, Yeoh, Tien, Zaimis, Tilemacho, Bright, Tim, Vilz, Tim O, Glowka, Tim R, Board, Timothy, Hardcastle, Timothy, Cohnert, Tina, Mahečić, Tina Tomić, William, Tinka George, Klatte, Tobia, Abbott, Tom, Watcyn-Jones, Tom, Mendes, Tome, Kulis, Tomislav, Sečan, Tomislav, Campagnaro, Tommaso, Frisoni, Tommaso, Simoncini, Tommaso, Violante, Tommaso, Safranovs, Toms Jani, Risteski, Toni, Pang, Tony, Akinyemi, Tosin, Yotsov, Tsanko, Laeke, Tsegazeab, Kochiyama, Tsukasa, Sholadoye, Tunde T, Alekberli, Tural, Ezomike, Uchechukwu, Giustizieri, Ugo, Grossi, Ugo, Köksoy, Ülkü Ceren, Bork, Ulrich, Kisser, Ulrich, Ronellenfitsch, Ulrich, Saeed, Umar, Bracale, Umberto, Jayarajah, Umesh, Rauf, Umme Habiba Abdul, Bumbasirevic, Uro, Ferrer, Ursula María Jariod, Ahmed, Usama, Bello, Usman Mohammed, Jogiat, Uzair, Sadia, Uzma, Galandarov, Vagif, Narayanan, Vairavan, Calu, Valentin, Bianchi, Valentina, Ciniero, Valeria, Tonini, Valeria, Silvestri, Vania, Vijay, Vardhini, Dewan, Varun, Lohsiriwat, Varut, Thuduvage, Vasanthika, Mousafeiris, Vasileio, Dragisic, Vedran, Sasireka, Veerasamy, Santric, Veljko, Kusuma, Venkata Ramana Murthy, Kolli, Venkata Satish, Alonso, Veronica, De Simone, Veronica, Picotti, Veronica, Martínez, Verónica Martín, Panduro-Correa, Vicky, Kakotkin, Victor, Angulo, Victor Pinto, Turrado-Rodriguez, Victor, Krishnamoorthy, Vijay, Ban, Vin Shen, Shah, Vinay, Maiola, Vincenza, Giordano, Vincenzo, La Vaccara, Vincenzo, Lizzi, Vincenzo, Papagni, Vincenzo, Schiavone, Vincenzo, Satchithanantham, Vinojan, Garcia-Virto, Virginia, Jimenez, Virginia, Kumar, Vishal, Shelat, Vishal, Bhat, Vivek, Sodhai, Vivek, Graziadei, Vivien, Kutuzov, Vladislav, Stoyanov, Vladislav, Oktseloglou, Vlasio, Flis, Vojko, Elhassan, Wael Atif Fadl, Yang, Wah, Soon, Wai Cheong, Tashkandi, Wail, Al-Khyatt, Waleed, Mabood, Waleed, Bijou, Walid, Wijenayake, Wasantha, D, Wasim, Krawczyk, Wiktor, Atkins, William, Bolton, William, White, William, Ceelen, Wim, Vagena, Xanthoula, Gozal, Yaacov, Baba, Yabasin Iddrisu, Subramani, Yamini, Jansen, Yanina, Mittal, Yash, Kara, Yasi̇n, Zwain, Yasir, Noureldin, Yasser, Alawneh, Yazan, Aydin, Yener, Lam, Yick Ho, Tang, Yita, Lim, Yizhe, Dean, Yomna, Tanas, Yousef, Su, Yu-Xiong, Fujimoto, Yuki, Altinel, Yuksel, Frolova, Yulia, Oshodi, Yusuf, Fadel, Zahir T, Zahid, Zahra, Elahi, Zain, Djama, Zakarya, Zaheen, Zakia, Jawad, Zaynab, Demetrashvili, Zaza, Gebremeskel, Zersenay, Gudisa, Zewdie, Alyami, Ziyad, Garoufalia, Zoe, Li, Zoe, Zimak, Zoran, Radin, Zorana, Balogh, Zsolt J, Smith, A, Mahmoud, Abdelrahman, Tarek, Ahmed, Moro, Alessandro (ORCID:0000-0002-6708-171X), Marra, Angelo Alessandro (ORCID:0000-0001-8384-5081), Ratto, Carlo (ORCID:0000-0002-0556-0037), D'acapito, Fabrizio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Bussu, Francesco (ORCID:0000-0001-6261-2772), Colombo, Francesco, Franceschini, Gianluca (ORCID:0000-0002-2950-3395), Gasparini, Giulio (ORCID:0000-0001-5091-5178), Bianco, Giuseppe (ORCID:0000-0001-7451-4002), Brisinda, Giuseppe (ORCID:0000-0001-8820-9471), Marano, Luigi (ORCID:0000-0002-9833-8055), Fransvea, Pietro (ORCID:0000-0003-4969-3373), and Familiari, Pietro (ORCID:0000-0002-5181-2928)
Abstract: Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
Published: 2023

3. Long-term Outcomes of Transoral Outlet Reduction (TORe) for Dumping Syndrome and Weight Regain After Roux-en-Y Gastric Bypass

Author: Pontecorvi, Valerio, Matteo, Maria Valeria, Bove, Vincenzo, De Siena, Martina, Giannetti, Giulia, Carlino, Giorgio, Polidori, Giulia, Vinti, Laila, Angelini, Giulia, Iaconelli, Amerigo, Familiari, Pietro, Raffaelli, Marco, Costamagna, Guido, Boskoski, Ivo, Familiari, Pietro (ORCID:0000-0002-5181-2928), Raffaelli, Marco (ORCID:0000-0002-1259-2491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Pontecorvi, Valerio, Matteo, Maria Valeria, Bove, Vincenzo, De Siena, Martina, Giannetti, Giulia, Carlino, Giorgio, Polidori, Giulia, Vinti, Laila, Angelini, Giulia, Iaconelli, Amerigo, Familiari, Pietro, Raffaelli, Marco, Costamagna, Guido, Boskoski, Ivo, Familiari, Pietro (ORCID:0000-0002-5181-2928), Raffaelli, Marco (ORCID:0000-0002-1259-2491), Costamagna, Guido (ORCID:0000-0002-8100-2731), and Boskoski, Ivo (ORCID:0000-0001-8194-2670)
Abstract: Background Both weight regain and dumping syndrome (DS) after Roux-en-Y gastric bypass (RYGB) have been related to the dilation of gastro-jejunal anastomosis. The aim of this study is to assess the safety and long-term efficacy of endoscopic transoral outlet reduction (TORe) for DS and/or weight regain after RYBG.Materials and Methods A retrospective analysis was performed on a prospective database. Sigstad's score, early and late Arts Dumping Score (ADS) questionnaires, absolute weight loss (AWL), percentage of total body weight loss (%TBWL), and percentage of excess weight loss (%EWL) were assessed at baseline and at 6, 12, and 24 months after TORe.Results Eighty-seven patients (median age 46 years, 79% female) underwent TORe. The median baseline BMI was 36.2 kg/m(2). Out of 87 patients, 58 were classified as "dumpers " due to Sigstad's score & GE; 7. The resolution rate of DS (Sigstad's score < 7) was 68.9%, 66.7%, and 57.2% at 6, 12, and 24 months after TORe, respectively. A significant decrease in Sigstad's score as well as in early and late ADS questionnaires was observed (p < 0.001). The median Sigstad's score dropped from 15 (11-8.5) pre-operatively to 2 (0-12) at 24 months. The %TBWL was 10.5%, 9.9%, and 8.1% at 6, 12, and 24 months, respectively. Further, "dumpers " with resolution of DS showed better weight loss results compared with those with persistent DS (p < 0.001). The only adverse event observed was a perigastric fluid collection successfully managed conservatively.Conclusion TORe is a minimally invasive treatment for DS and/or weight regain after RYGB, with evidence of long-term efficacy.
Published: 2023

4. Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority randomised controlled trial

Author: Familiari, Pietro, Borrelli De Andreis, Federica, Landi, Rosario, Mangiola, Francesca, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Borrelli de Andreis, Federica, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Borrelli De Andreis, Federica, Landi, Rosario, Mangiola, Francesca, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Borrelli de Andreis, Federica, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Objective: Peroral endoscopic myotomy (POEM) has become standard treatment for achalasia with comparable efficacy to surgery. In most of published series, the length of myotomy is 12-13 cm. Shorter cuts could have the advantage of shorter procedure time and possibly reduced gastro-oesophageal reflux disease (GORD) rate. Design: This single-centre, patient-blinded, randomised, non-inferiority clinical trial included 200 patients, who were randomly allocated, to receive either a long-POEM (13 cm; 101 patients) or a short-POEM (8 cm; 99 patients). Primary outcome was defined as an Eckardt symptom score of ≤3 at 24 months after the procedure; a non-inferiority design was chosen with an accepted success range of 6% between the two treatments. Secondary outcomes included operating time, complication rate, postoperative manometry, GORD rate and quality of life. Results: In the intention-to-treat analysis, clinical success rates were 89.1% in the long-POEM and 98.0% in the short-POEM group, resulting in an absolute between-group difference of -8.9% (90% CI -14.5 to -3.3).Procedure time was significantly reduced in the short-POEM as compared with the long-POEM group (40 vs 50 min, p<0.0001). Severe adverse events occurred in one patient in both groups.No differences were observed in postoperative GORD: acid exposure >6% on pH monitoring study at 6 months was seen in 34.3% (long-POEM) vs 31.1% (short-POEM), while endoscopic oesophagitis was diagnosed in 37.6% vs 51.5% at 6 months and in 21% vs 24.5% at 24 months. Regular proton pump inhibitor use was not different either (36.8% vs 37.5%). Conclusions: Our study demonstrates non-inferiority of a shorter cut length of POEM as compared with the standard treatment, which saved some procedural time. GORD rate was not reduced by reducing cutting length. Trial registration number: NCT03450928.
Published: 2023

5. The efficacy of peroral endoscopic myotomy vs. pneumatic dilation as treatment for patients with achalasia suffering from persistent or recurrent symptoms after laparoscopic Heller myotomy. A RANDOMIZED CLINICAL TRIAL

Author: Saleh, Caroline M G, Familiari, Pietro, Bastiaansen, Barbara A J, Fockens, Paul, Tack, Jan, Boeckxstaens, Guy, Bisschops, Raf, Lei, Aaltje, Schijven, Marlies P, Costamagna, Jan Guido, Bredenoord, Albert J, Familiari, Pietro (ORCID:0000-0002-5181-2928), Saleh, Caroline M G, Familiari, Pietro, Bastiaansen, Barbara A J, Fockens, Paul, Tack, Jan, Boeckxstaens, Guy, Bisschops, Raf, Lei, Aaltje, Schijven, Marlies P, Costamagna, Jan Guido, Bredenoord, Albert J, and Familiari, Pietro (ORCID:0000-0002-5181-2928)
Abstract: Background & aims: For achalasia patients with persistent or recurrent symptoms after laparoscopic Heller myotomy (LHM), pneumatic dilation (PD) is the most frequently used treatment. Per-oral endoscopic myotomy (POEM) is increasingly being investigated as rescue therapy. This study aimed to determine the efficacy of POEM versus PD for patients with persistent or recurrent symptoms after LHM. Methods: This randomized multicenter controlled trial included patients after LHM with an Eckardt score >3 and significant stasis (≥2 cm) on timed barium esophagogram, randomized to POEM or PD. The primary outcome was treatment success, defined as an Eckardt score of ≤3, without unscheduled retreatment. Secondary outcomes included the presence of reflux esophagitis, HRM, and timed barium esophagogram findings. Follow-up duration was 1 year after initial treatment. Results: Ninety patients were included. POEM had a higher success rate (28 of 45 patients [62.2%]) than PD (12 of 45 patients [26.7%] (absolute difference, 35.6% [95%CI, 16.4%-54.7%]; [p=0.001); OR, 0.22 [95%CI, 0.09-0.54]; RR for success 2.33 [95%CI, 1.37-3.99]. Reflux esophagitis was not significantly different between POEM (12 of 35 [34.3%]) and PD (6 of 40 [15%]). Basal LES pressure and IRP-4 were significantly lower in the POEM group [p=0.034; p=0.002]. Barium column height after 2 and 5 minutes was significantly less in patients treated with POEM [p=0.005; p=0.015]. Conclusion: Among achalasia patients with persistent or recurrent symptoms after LHM, POEM resulted in a significantly higher success rate than PD, with a numerically higher incidence of grade A-B reflux esophagitis.
Published: 2023

6. Durability of per-oral endoscopic myotomy beyond 6 years

Author: Abimansour, Jad P, Ichkhanian, Yervant, Minami, Hitomi, Familiari, Pietro, Landi, Rosario, Costamagna, Guido, Seewald, Stefan, Callahan, Zachary M, Ujiki, Michael B, Pioche, Mathieu, Ponchon, Thierry, Roman, Sabine, Cho, Joo Young, Yoo, In Kyung, Sippey, Megan, Marks, Jeffrey M, Eleftheriadis, Nikola, Khumbari, Vivek, Gutierrez, Olaya I Brewer, Khashab, Mouen A, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Abimansour, Jad P, Ichkhanian, Yervant, Minami, Hitomi, Familiari, Pietro, Landi, Rosario, Costamagna, Guido, Seewald, Stefan, Callahan, Zachary M, Ujiki, Michael B, Pioche, Mathieu, Ponchon, Thierry, Roman, Sabine, Cho, Joo Young, Yoo, In Kyung, Sippey, Megan, Marks, Jeffrey M, Eleftheriadis, Nikola, Khumbari, Vivek, Gutierrez, Olaya I Brewer, Khashab, Mouen A, Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia.Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) <= 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS >3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated.Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89% (65/73) at 6-years. Mean ESS decreased from 7.1 +/- 2.3 pre-procedure to 1.1 +/- 1.1 at 6 years (P<0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5%). Type I achalasia (OR 10.8, P=0.04) was found to be associated with clinical failure on logistic regression analysis.Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastro-esophageal reflux post-procedure which persist at long-term follow-up.
Published: 2021

7. The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?

Author: Kahaleh, Michel, Tyberg, Amy, Suresh, Supriya, Lambroza, Arnon, Casas, Fernando Rodriguez, Rey, Mario, Nieto, Jose, Martínez, Guadalupe Ma, Zamarripa, Felipe, Arantes, Vitor, Porfilio, Maria G, Gaidhane, Monica, Familiari, Pietro, Carames, Juan Carlo, Vargas-Rubio, Romulo, Canadas, Raul, Hani, Albi, Munoz, Guillermo, Castillo, Bismarck, Moura, Eduardo T, Galileu, Farias F, Lukashok, Hannah P, Robles-Medranda, Carlo, Moura, Eduardo G de, Familiari, Pietro (ORCID:0000-0002-5181-2928), Kahaleh, Michel, Tyberg, Amy, Suresh, Supriya, Lambroza, Arnon, Casas, Fernando Rodriguez, Rey, Mario, Nieto, Jose, Martínez, Guadalupe Ma, Zamarripa, Felipe, Arantes, Vitor, Porfilio, Maria G, Gaidhane, Monica, Familiari, Pietro, Carames, Juan Carlo, Vargas-Rubio, Romulo, Canadas, Raul, Hani, Albi, Munoz, Guillermo, Castillo, Bismarck, Moura, Eduardo T, Galileu, Farias F, Lukashok, Hannah P, Robles-Medranda, Carlo, Moura, Eduardo G de, and Familiari, Pietro (ORCID:0000-0002-5181-2928)
Abstract: Background/Aims: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.Methods: Patients undergoing POEM in Latin America with a single operator were included from a prospective registr y over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results: A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressi v e l y decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). Conclusions: Mastering POEM in Latin America requires approxima t e l y 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.
Published: 2021

8. Manometric pattern progression in esophageal achalasia in the era of high-resolution manometry

Author: Salvador, Renato, Costantini, Mario, Tolone, Salvatore, Familiari, Pietro, Galliani, Ermenegildo, Germanà, Bastianello, Savarino, Edoardo, Merigliano, Stefano, Valmasoni, Michele, Familiari, Pietro (ORCID:0000-0002-5181-2928), Salvador, Renato, Costantini, Mario, Tolone, Salvatore, Familiari, Pietro, Galliani, Ermenegildo, Germanà, Bastianello, Savarino, Edoardo, Merigliano, Stefano, Valmasoni, Michele, and Familiari, Pietro (ORCID:0000-0002-5181-2928)
Abstract: Esophageal manometry represents the gold standard technique for the diagnosis of esophageal achalasia because it can detect both the lack of lower esophageal sphincter (LES) relaxation and abnormal peristalsis. From the manometric standpoint, cases of achalasia can be segregated on the grounds of three clinically relevant patterns according to the Chicago Classification v3.0. It is currently unclear whether they represent distinct entities or are part of a disease continuum with the possibility of transition from a pattern to another one. The four cases described in the present report could provide further insights on this topic because the manometric pattern changed from type III to type II in all patients-without any invasive treatment. The cases described here support the hypothesis that the different manometric patterns of achalasia represent different stages in the evolution of the same disease, type III being the early stage, type II an intermediate stage, and type I probably the end stage of achalasia.
Published: 2021

9. Endoscopic treatment of intramural fistula and mucosal tear after peroral endoscopic myotomy

Author: Familiari, Pietro, Landi, Rosario, Mangiola, Francesca, Vita, Camilla, Boskoski, Ivo, Tringali, Andrea, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Landi, Rosario, Mangiola, Francesca, Vita, Camilla, Boskoski, Ivo, Tringali, Andrea, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Peroral endoscopic myotomy (POEM) is a safe procedure, with few reported adverse events. The integrity of the mucosal flap at the end of the procedure is crucial to prevent leakages and infections. We report on a rare complication after POEM.
Published: 2021

10. Blind-eye cannulation as a new method for ERCP training: Can we do more than merely teach?

Author: Boskoski, Ivo, Webster, George, Tringali, Andrea, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo, Webster, George, Tringali, Andrea, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) requires extensive hands-on training. Currently in ERCP training there are two very important problems that need attention: lack of standardized commands for communication, and misunderstanding between the trainee and the trainer. Methods A method of "blind-eye" cannulation was developed with two paired trainees using the Boskoski-Costamagna ERCP Trainer. The trainee who was holding the duodenoscope was blind-folded and the other trainee gave instructions on what maneuvers were necessary to achieve cannulation, under the supervision of a trainer. Before starting cannulation, a standard list of commands was agreed by the operators. Results The blind-eye method of cannulation teaches the operator trainee to listen and the assistant trainee to teach. Trainees use standardized commands. During the training session the two trainees swapped roles. Conclusions Currently, we do not have proof that this type of training is useful, therefore, scientific studies are needed for confirmation. However, we believe that this ERCP model may provide an entirely safe means of improving communication and technical proficiency.
Published: 2020

11. Endoscopic treatment of GERD: is there still a chance?

Author: Familiari, Pietro, Mangiola, Francesca, Landi, Rosario, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Mangiola, Francesca, Landi, Rosario, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: N/A
Published: 2019

12. Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis

Author: Tringali, Andrea, Bove, Vincenzo, Vadalà di Prampero, Salvatore F, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Bove, Vincenzo, Vadalà di Prampero, Salvatore F, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: BACKGROUND: Dominant pancreatic duct strictures in chronic pancreatitis are often managed by endoscopic placement of a single plastic stent. Insertion of multiple plastic stents (MPS) has been proven to be effective in managing refractory strictures, but data are still limited. The aim of this study was to investigate the efficacy and long-term results of MPS to dilate pancreatic duct strictures in chronic pancreatitis. METHODS: 48 patients (34 men; mean age 44 years) with chronic pancreatitis and a single pancreatic stent through a refractory stricture in the pancreatic head underwent the following protocol: 1) removal of the single pancreatic stent; 2) balloon dilation of the stricture; 3) insertion of the maximum number of stents; 4) stent removal after 6 - 12 months. RESULTS: The median number of pancreatic plastic stents placed was 3 (diameter 7 - 11.5 Fr, length 3 - 7 cm). Five patients (10.4 %) had persistent strictures after MPS removal. During a mean follow-up of 9.5 years (0.3 - 15.5 years) after stent removal, 74.4 % (32/43) of the patients were asymptomatic, and 25.6 % (11/43) experienced pancreatitis recurrence or pancreatic type pain after a mean time of 26.4 months (8/43, 18.6 % underwent plug extraction without evidence of stricture recurrence; 3/43, 7.0 % had stricture recurrence). No major complications were recorded. CONCLUSION: Endoscopic multiple plastic stenting of chronic pancreatitis-related pancreatic duct strictures showed satisfactory long-term results, with the option of re-treatment. This procedure can be considered an important therapeutic alternative for painful pancreatic duct strictures located in the head of the pancreas in the setting of chronic pancreatitis.
Published: 2019

13. Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents: long-term results in a large cohort of patients

Author: Costamagna, Guido, Tringali, Andrea, Perri, Vincenzo, Familiari, Pietro, Boskoski, Ivo, Barbaro, Federico, Landi, Rosario, Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Costamagna, Guido, Tringali, Andrea, Perri, Vincenzo, Familiari, Pietro, Boskoski, Ivo, Barbaro, Federico, Landi, Rosario, Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), and Boškoski, Ivo (ORCID:0000-0001-8194-2670)
Abstract: BACKGROUND AND AIMS: Endoscopic therapy of benign biliary strictures (BBSs) with multiple plastic stent (MPS) placement has shown satisfactory results. However, literature describes various BBS etiologies. Aim of this study was to evaluate long-term MPS results in patients with postcholecystectomy biliary strictures (PCBSs). METHODS: PCBS patients without complete bile duct transection were included. ERCP consisted of placing an increasing plastic stent number over time, exchanged at regular intervals (3-4 months), until complete morphologic stricture disappearance. After stent removal, patient follow-up comprised liver function tests (LFTs) and clinical assessment. RESULTS: One hundred fifty-four patients (43.5% males; mean age 53 years) were enrolled; in 43% of the cases, PCBSs were involved or were close to the main hepatic confluence. PCBS resolution rate was 96.7% (n=149). A mean maximum number of 4.3 ± 1.6 stents were placed side-by-side; a mean of 4.2 ± 1.5 ERCPs per patient was needed to obtain PCBS resolution during a mean treatment period of 11.8 ± 6.4 months. Unscheduled stent exchange due to cholangitis, jaundice or pain occurred in 7.4% of cases. Procedure-related mortality was absent. Follow-up data were available in 85.2% of cases. After a mean follow-up of 11.1 ± 4.9 years, stricture recurrence rate was 9.4% (n=12). Subsequent to re-treatment, 83.3% (n=10) of patients were asymptomatic after a mean time of 9 years, whereas 2 patients underwent hepaticojejunostomy due to failed re-treatment. Statistical analysis revealed no risk factors for PCBS recurrence after MPS. CONCLUSIONS: Endoscopic therapy of PCBSs with MPSs is safe and effective at long-term follow-up. PCBSs involving or being close to the main hepatic confluence were successfully treated with MPSs. PCBS recurrence rate is low and can be successful endoscopically retreated without precluding possible surgical treatment.
Published: 2019

14. A 17 years retrospective study on multiple metal stents for complex malignant hilar biliary strictures: Survival, stents patency and outcomes of re-interventions for occluded metal stents

Author: Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Bove, Vincenzo, Landi, Rosario, Attili, Fabia, Perri, Vincenzo, Onder, Graziano, Mutignani, Massimiliano, Costamagna, Guido, Boškoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Bove, Vincenzo, Landi, Rosario, Attili, Fabia, Perri, Vincenzo, Onder, Graziano, Mutignani, Massimiliano, Costamagna, Guido, Boškoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background: Endoscopic placement of SEMSs for malignant hilar biliary strictures (MHBS) is well-established palliative treatment for inoperable patients. Objectives of this study were evaluation of survival and stents patency after placement of multiple SEMS for palliation of complex MHBS. Methods: Retrospective review of patients with MHBS that underwent ERCP with insertion of multiple SEMSs for palliation. Survival-associated factors and stents patency were analyzed by Cox multivariate analysis. Results: Between January 1998 and January 2015, 740 patients with nonoperable MHBS that underwent ERCP were identified and only 18.2% of these received multiple SEMSs. Complications were observed in 7.5% of the patients with no procedure-related mortality. Palliative therapies (chemotherapy, external beam radiotherapy and high dose rate brachytherapy) were done in some patients, and outcomes were evaluated. Overall mean survival of the 134 patients was 323 days. Of these, 59% did not had stents malfunction while 41% patients had episodes of SEMSs malfunction and mean survival after re-interventions was 502.9 days. Survival was not influenced by type of tumor, sex or age. Conclusions: Endoscopic multiple SEMSs placement is safe and effective in patients with complex MHBS. Survival is independent from the type and complexity of MHBS while is prolonged in patients undergoing HDR brachytherapy. Prompt recognition of SEMSs malfunction is fundamental for survival.
Published: 2019

15. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study

Author: Tringali, Andrea, Vadalà di Prampero, Salvatore Francesco, Landi, Rosario, Bove, Vincenzo, Familiari, Pietro, Hamanaka, Jun, Attili, Fabia, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Vadalà di Prampero, Salvatore Francesco, Landi, Rosario, Bove, Vincenzo, Familiari, Pietro, Hamanaka, Jun, Attili, Fabia, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background and Aims: Symptomatic main pancreatic duct (MPD) strictures secondary to chronic pancreatitis (CP) may benefit from endoscopic insertion of single or multiple plastic stents. MPD stricture resolution after single plastic stent removal is uncommon. The use of removable fully covered, self-expandable metal stents (FC-SEMSs) to dilate MPD strictures secondary to CP was evaluated. Methods: Patients with CP and symptomatic MPD stricture located in the head of the pancreas persisting for 3 months or more after placement of a single plastic stent were enrolled in a prospective single-arm trial. A nitinol FC-SEMS was inserted and removed after 6 months. The FC-SEMS diameter and length were chosen according to the stricture anatomy and MPD diameter above the stricture. Our primary objective was FC-SEMS removability. Secondary outcomes were MPD stricture resolution rate and adverse events. Results: Between December 2012 and October 2014, 15 patients (10 male, mean age 60 years) were enrolled. Pancreatic calcifications were present in 6 (40%) patients. Four patients (27%) had a history of alcohol abuse. In 10 patients, the FC-SEMS was inserted through the major papilla, whereas 5 patients (3 pancreas divisum, 2 dominant dorsal duct) received the stent through the minor papilla. One patient developed cholangitis after 24 hours due to occlusion of the biliary sphincterotomy from the FC-SEMS; cholangitis resolved after insertion of a plastic biliary stent. Complete distal migration of the FC-SEMS was reported in 7 patients (47%) (5 asymptomatic, 2 symptomatic with recurrence of pancreatitis). All migrations occurred with the 3-cm-long FC-SEMS. Four patients (27%) developed de novo stricture induced by the FC-SEMS at the level of the flared end and were excluded from the follow-up; 1 patient with FC-SEMS migration had failed stricture resolution. One patient was lost to follow-up. Finally, 9 patients with MPD stricture resolution had a mean follow-up of 38.9 months (ran
Published: 2018

16. Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up

Author: Valerii, Giorgio, Tringali, Andrea, Landi, Rosario, Boškoski, Ivo, Familiari, Pietro, Bizzotto, Alessandra, Perri, Vincenzo, Petruzziello, Lucio, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Valerii, Giorgio, Tringali, Andrea, Landi, Rosario, Boškoski, Ivo, Familiari, Pietro, Bizzotto, Alessandra, Perri, Vincenzo, Petruzziello, Lucio, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Objective: We investigate the efficiency of endoscopic mucosal resection (EMR) of non-ampullary sporadic duodenal adenomas (NASDA) in a retrospective analysis with long-term follow-up. Methods: Consecutive patients undergoing EMR of NASDA between May 2002 and December 2016 were retrospectively identified from an electronic database. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly for up to five years. Results: EMR of 75 NASDA was performed in 68 patients (56% en-bloc, 44% piecemeal). Retroperitoneal perforations occurred in 3/68 (4.4%) patients, were treated by surgical (nâ=â2) or percutaneous (nâ=â1) drainage; delayed bleeding was reported in 13/75 (17.3%) resections and was successfully managed by endoscopy (nâ=â12) or radiologic embolization (nâ=â1). There was no procedure-related mortality. Follow-up was available in 61/68 patients (89.7%) after a median time of 59 months from resection. Residual and recurrent adenoma were diagnosed in 9 (14.5%) and 6 (10.9%) cases, respectively; all but one were successfully retreated endoscopically. Conclusions: EMR for NASDA is effective with a favorable long-term outcome. Local recurrences can be retreated endoscopically. A recall system, patientâs compliance to endoscopic follow-up are mandatory to detect recurrences and their prompt treatment.
Published: 2018

17. Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent

Author: Tringali, Andrea, Bove, Vincenzo, Perri, Vincenzo, Landi, Rosario, Familiari, Pietro, Boskoski, Ivo, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Bove, Vincenzo, Perri, Vincenzo, Landi, Rosario, Familiari, Pietro, Boskoski, Ivo, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background and study aim Leakage of the surgical suture is the main complication of laparoscopic sleeve gastrectomy (LSG) and is amenable to endoscopic therapy. The aim of this study was to evaluate the efficacy of a specifically designed self-expandable metal stent (SEMS) to seal the leakage. Patients and methods Over a 2-year period, patients referred for the treatment of post-LSG fistulas underwent placement of a fully covered esophagogastric SEMS with a specific design. Results A total of 10 patients were treated after a mean time of 50.9 days from the diagnosis of post-LSG leakage. A total of 11 SEMSs were placed. After stent removal, the leakage was seen to have healed in eight patients. Two patients who were treated with an SEMS with different mesh design, experienced stent migration, which required alternative endoscopic treatment such as the insertion of double-pigtail stents. After a mean follow-up period of 13.4 months, all patients were asymptomatic. Conclusions: Placement of a specifically designed SEMS for the treatment of post-LSG fistulas seems a promising first-line therapy according to this small series.
Published: 2017

18. Gastroesophageal reflux disease after peroral endoscopic myotomy: Analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis

Author: Familiari, Pietro, Greco, S, Gigante, Giovanni, Cali', Anna, Boškoski, I, Onder, Graziano, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, I (ORCID:0000-0001-8194-2670), Onder, Graziano (ORCID:0000-0003-3400-4491), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Greco, S, Gigante, Giovanni, Cali', Anna, Boškoski, I, Onder, Graziano, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, I (ORCID:0000-0001-8194-2670), Onder, Graziano (ORCID:0000-0003-3400-4491), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Peroral endoscopic myotomy (POEM) does not include any antireflux procedure, resulting in a certain risk of iatrogenic gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the incidence of iatrogenic GERD after POEM and identify preoperative, perioperative and postoperative factors associated with GERD.
Published: 2016

19. Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Author: Tringali, Andrea, Barbaro, Federico, Pizzicannella, Margherita, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Gigante, Giovanni, Onder, Graziano, Hassan, Cesare, Lionetti, Raffaella, Ettorre, Giuseppe Maria, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Barbaro, Federico, Pizzicannella, Margherita, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Gigante, Giovanni, Onder, Graziano, Hassan, Cesare, Lionetti, Raffaella, Ettorre, Giuseppe Maria, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background and aims: Anastomotic biliary stricture (ABS) is the most common biliary complication after orthotopic liver transplantation (OLT) and can be successfully managed endoscopically. The long-term results of a protocol using placement of multiple plastic stents to treat ABS following OLT were analyzed. Methods: All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for OLT-related biliary complications at our Endoscopy Unit between July 1994 and March 2012 were retrospectively identified from the ERCP database. Patients with an ABS treated with an increasing number of plastic stents were included in the study. Follow-up after stent removal was obtained by telephone contact with the patient and/or referring physician and by liver function tests (LFTs) evaluation. Results: 56 patients, treated with an increasing number of plastic stents until resolution of the stricture, were included. Five patients were then excluded (unrelated death during treatment, n = 3; incomplete treatment because of poor compliance, n = 2), and 51/56 patients reached study end points and were included in the analysis. Resolution of ABS was obtained in 50/51 patients; 1 patient required hepaticojejunostomy because of failure to pass the stricture with the guidewire (per protocol resolution, 98 %). Mean duration of endoscopic treatment was 11.5 months, with a median 4 ERCPs per patient. Immediate ERCP-related adverse events occurred in 3/56 patients (5.4 %). After a median follow-up of 5.8 years from stent removal, 3/50 patients (6 %) had recurrence of ABS. These 3 patients were successfully treated again endoscopically and are asymptomatic after a further median follow-up of 5.6 years. Conclusions: At long-term follow-up, endoscopic treatment with multiple plastic stents of ABS following OLT appeared to be effective in most patients. Stricture recurrence is rare and can be successfully treated again endoscopically.
Published: 2016

20. Peroral Endoscopic Myotomy for Esophageal Achalasia: Outcomes of the First 100 Patients With Short-term Follow-up

Author: Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: OBJECTIVE: Aim of this study is to report the mid-term outcomes of a large series of patients treated with peroral endoscopic myotomy (POEM) in a single European center. BACKGROUND: POEM is a recently developed treatment of achalasia, which combines the efficacy of surgical myotomy, with the benefits of an endoscopic procedure. Previous studies, including few patients with a short-term follow-up, showed excellent results on dysphagia relief. METHODS: The first 100 adult patients treated in a single tertiary referral center were retrospectively identified and included in this study (41 men, mean age 48.4 years). Patients were treated according to a standard technique. Follow-up data, including clinical evaluation, and results of esophagogastroduodenoscopy (EGD), manometry, and pH monitoring were collected and analyzed. RESULTS: POEM was completed in 94% of patients. Mean operative time was 83 minutes (49-140 minutes). No complications occurred. Patients were fed after a median of 2 days (1-4 days). A mean follow-up of 11 months (3-24 months) was available for 92 patients. Clinical success was documented in 94.5% of patients. Twenty-four-hour pH monitoring documented Gastro-Esophageal Reflux Disease (GERD) in 53.4% of patients. However, only a minority of patients had heartburn (24.3%) or esophagitis (27.4%), and these patients were successfully treated with proton-pump inhibitors. CONCLUSIONS: Our results confirm the efficacy of POEM in a large series of patients, with a mean follow-up of 11 months. Should our results be confirmed by long-term follow-up studies, POEM may become one of the first-line therapies of achalasia in the next future.
Published: 2016

21. Treatment of esophageal achalasia in children: Today and tomorrow

Author: Caldaro, T, Familiari, Pietro, Romeo, Ef, Gigante, Giovanni, Marchese, Michele, Contini, Aci, Federici Di Abriola, G, Cucchiara, S, De Angelis, Paola, Torroni, F, Dall'Oglio, Luigi, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Caldaro, T, Familiari, Pietro, Romeo, Ef, Gigante, Giovanni, Marchese, Michele, Contini, Aci, Federici Di Abriola, G, Cucchiara, S, De Angelis, Paola, Torroni, F, Dall'Oglio, Luigi, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Esophageal achalasia (EA) is a rare esophageal motility disorder in children. Laparoscopic Heller myotomy (LHM) represents the treatment of choice in young patients. Peroral endoscopic myotomy (POEM) is becoming an alternative to LHM. The aim of this study is to evaluate the effectiveness, safety, and outcomes of POEM vs LHM in treatment of children with EA.
Published: 2015

22. Achalasia: current treatment options

Author: Familiari, Pietro, Greco, Santi, Volkanovska, A, Gigante, Giovanni, Cali, A, Boskoski, Ivo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, I (ORCID:0000-0001-8194-2670), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Greco, Santi, Volkanovska, A, Gigante, Giovanni, Cali, A, Boskoski, Ivo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, I (ORCID:0000-0001-8194-2670), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Achalasia is a rare esophageal motility disorder, characterized by impaired swallow-induced, lower esophageal sphincter (LES) relaxation and defective esophageal peristalsis. Unfortunately, there are no etiological therapies for achalasia. Patients present with dysphagia, chest pain and regurgitation of undigested food, often leading to weight loss. The currently available treatments have the common aim of relieving symptoms by decreasing the pressure of the LES. This can be achieved with some medications, by inhibiting the cholinergic innervation (botulinum toxin), by stretching (endoscopic dilation) or cutting (surgery) the LES. Recently, other therapeutic options, including per-oral endoscopic myotomy have been developed and are gaining international consensus. The authors report on the benefits and weaknesses of the different therapies and provide an updated approach to the management of achalasia.
Published: 2015

23. EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

Author: Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Bove, Vincenzo, Tringali, Andrea, Perri, Vincenzo, Onder, Graziano, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Bove, Vincenzo, Tringali, Andrea, Perri, Vincenzo, Onder, Graziano, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: BACKGROUND: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the real-time measurement of the diameter of the oesophago-gastric junction. OBJECTIVE: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. METHODS: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. RESULTS: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (±17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (±1.8) and 32.9 mm(2) (±23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (±1.7 SD) and 102.38 mm(2) (±28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median post-operative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. CONCLUSIONS: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technolog
Published: 2014

24. New and emerging endoscopic therapies for gastrointestinal bleeding

Author: Boškoski, I, Familiari, Pietro, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boškoski, I, Familiari, Pietro, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: To highlight the most recent findings and results of new hemostatic agents for acute bleeding of the gastrointestinal tract of common and less common cause published in the past 12 months.
Published: 2014

25. Peroral Endoscopic Myotomy for Esophageal Achalasia: Outcomes of the First 100 Patients With Short-term Follow-up

Author: Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: OBJECTIVE:: Aim of this study is to report the mid-term outcomes of a large series of patients treated with peroral endoscopic myotomy (POEM) in a single European center. BACKGROUND:: POEM is a recently developed treatment of achalasia, which combines the efficacy of surgical myotomy, with the benefits of an endoscopic procedure. Previous studies, including few patients with a short-term follow-up, showed excellent results on dysphagia relief. METHODS:: The first 100 adult patients treated in a single tertiary referral center were retrospectively identified and included in this study (41 men, mean age 48.4 years). Patients were treated according to a standard technique. Follow-up data, including clinical evaluation, and results of esophagogastroduodenoscopy (EGD), manometry, and pH monitoring were collected and analyzed. RESULTS:: POEM was completed in 94% of patients. Mean operative time was 83 minutes (49-140 minutes). No complications occurred. Patients were fed after a median of 2 days (1-4 days). A mean follow-up of 11 months (3-24 months) was available for 92 patients. Clinical success was documented in 94.5% of patients. Twenty-four-hour pH monitoring documented Gastro-Esophageal Reflux Disease (GERD) in 53.4% of patients. However, only a minority of patients had heartburn (24.3%) or esophagitis (27.4%), and these patients were successfully treated with proton-pump inhibitors. CONCLUSIONS:: Our results confirm the efficacy of POEM in a large series of patients, with a mean follow-up of 11 months. Should our results be confirmed by long-term follow-up studies, POEM may become one of the first-line therapies of achalasia in the next future.
Published: 2014

26. EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

Author: Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Bove, Vincenzo, Tringali, Andrea, Perri, Vincenzo, Onder, Graziano, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Gigante, Giovanni, Marchese, Michele, Boskoski, Ivo, Bove, Vincenzo, Tringali, Andrea, Perri, Vincenzo, Onder, Graziano, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Onder, Graziano (ORCID:0000-0003-3400-4491), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: BACKGROUND: Peroral endoscopic myotomy (POEM) has been recently introduced in clinical practice for the treatment of achalasia. The endoluminal functional lumen imaging probe (EndoFLIP) system) uses impedance planimetry for the real-time measurement of the diameter of the oesophago-gastric junction. OBJECTIVE: The aim of this study is to prospectively evaluate the effect of POEM on the oesophago-gastric junction using EndoFLIP. METHODS: All the patients who underwent POEM in a single centre between April and July 2013 were enrolled in the study. EndoFLIP was used intraoperatively, immediately before and after POEM. During follow-up patients underwent oesophagogastroduodenoscopy, oesophageal pH monitoring and manometry. Clinical outcomes were compared with the diameter of the oesophago-gastric junction after POEM. RESULTS: In total, 23 patients (12 males, mean age 51.7 years) were enrolled, and 21 underwent POEM successfully. Preoperative mean basal lower oesophageal sphincter pressure was 42.1 mmHg (±17.6). Before POEM, the mean oesophago-gastric junction diameter and cross-sectional area were 6.3 mm (±1.8) and 32.9 mm(2) (±23.1), respectively. After treatment, the mean diameter and cross-sectional area of the oesophago-gastric junction were 11.3 mm (±1.7 SD) and 102.38 mm(2) (±28.2 SD), respectively. No complications occurred during a mean follow-up of 5 months. Median post-operative Eckardt score was 1. Three patients (14.3%) referred heartburn. Follow-up studies revealed gastro-oesophageal reflux disease (GORD) in 57.1% of patients and oesophagitis in 33.3%. No correlations were observed between the diameter of oesophago-gastric junction after POEM and symptoms relief, GORD incidence and lower oesophageal sphincter pressure. CONCLUSIONS: The diameter of oesophago-gastric junction substantially increases after POEM. EndoFLIP is a reliable method for the intraoperative evaluation of oesophago-gastric junction diameter. However, the real usefulness of this technolog
Published: 2014

27. Difficult removal of fully covered Self Expandable Metal Stents (SEMS) for benign biliary strictures: The “SEMS in SEMS” technique

Author: Tringali, Andrea, Blero, Daniel, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Devière, Jacque, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Blero, Daniel, Boskoski, Ivo, Familiari, Pietro, Perri, Vincenzo, Devière, Jacque, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: BACKGROUND: Removal of biliary Fully Covered Self Expandable Metal Stents can fail due to stent migration and/or hyperplastic ingrowth/overgrowth. METHODS: A case series of 5 patients with benign biliary strictures (2 post-cholecystectomy, 2 following liver transplantation and 1 related to chronic pancreatitis) is reported. The biliary stricture was treated by temporary insertion of Fully Covered Self Expandable Metal Stents. Stent removal failed due to proximal stent migration and/or overgrowth. Metal stent removal was attempted a few weeks after the insertion of another Fully Covered Metal Stent into the first one. RESULTS: The inner Fully Covered Self Expandable Metal Stent compressed the hyperplastic tissue, leading to the extraction of both the stents in all cases. Two complications were reported as a result of the attempt to stents removal (mild pancreatitis and self-limited haemobilia). CONCLUSION: In the present series, the "SEMS in SEMS" technique revealed to be effective when difficulties are encountered during Fully Covered Self Expandable Metal Stents removal.
Published: 2014

28. Peroral Endoscopic Myotomy for the Treatment of Achalasia in Children

Author: Familiari, Pietro, Marchese, Michele, Gigante, Giovanni, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Marchese, Michele, Gigante, Giovanni, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Peroral endoscopic myotomy (POEM) is a new endoscopic technique for the treatment of esophageal achalasia, with excellent results in adults. Three children with classic-type achalasia (mean age 9.6 years) underwent POEM in a single center. Mean basal lower esophageal sphincter pressure and Eckard score were 34.6 mmHg and 5.3, respectively. Mean length of myotomy was 10 cm. On average, POEM was completed in 60.6 minutes. No patients experienced postoperative complications or gastroesophageal reflux disease. In the 2 patients who completed a 12-month follow-up, complete symptoms relief was documented (Eckard score 0), as well as a significant drop of the basal lower esophageal sphincter pressure
Published: 2013

29. Endoscopic snare papillectomy: a possible radical treatment for a subgroup of T1 ampullary adenocarcinomas

Author: Petrone, G, Ricci, Riccardo, Familiari, Pietro, Inzani, F, Matsuoka, M, Mutignani, M, Delle Fave, G, Costamagna, Guido, Rindi, Guido, Ricci, Riccardo (ORCID:0000-0002-9089-5084), Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Rindi, Guido (ORCID:0000-0003-2996-4404), Petrone, G, Ricci, Riccardo, Familiari, Pietro, Inzani, F, Matsuoka, M, Mutignani, M, Delle Fave, G, Costamagna, Guido, Rindi, Guido, Ricci, Riccardo (ORCID:0000-0002-9089-5084), Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), and Rindi, Guido (ORCID:0000-0003-2996-4404)
Abstract: Pancreaticoduodenectomy is the standard care for invasive ampullary adenocarcinomas. However, endoscopic snare papillectomy (ESP) might play a curative role in very selected patients. We studied a series of 15 patients with T1 ampullary adenocarcinoma who were treated by ESP alone and followed up for a mean of 29.6 ± 21.9 months (range 8 - 81 months). ESP was curative for eight patients (57.1 %). No tumor-related death was observed in patients with a cancer infiltration depth of ≤ 4 mm. According to this preliminary experience, we suggest that this measurable variable threshold should be considered as a possible basis for future large-scale studies.
Published: 2013

30. Prospective evaluation of the partially covered nitinol 'ComVi' stent for malignant non hilar biliary obstruction

Author: Perri, Vincenzo, Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Marchese, Michele, Lee, Dk, Jang, Si, Han, J, Kim, Hg, Mutignani, Massimiliano, Onder, Graziano, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Onder, Graziano (ORCID:0000-0003-3400-4491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo, Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Marchese, Michele, Lee, Dk, Jang, Si, Han, J, Kim, Hg, Mutignani, Massimiliano, Onder, Graziano, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Onder, Graziano (ORCID:0000-0003-3400-4491), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Biliary partially covered self-expandable metal stents (PC-SEMS) offer prolonged relief of symptoms of biliary obstruction but may induce complications including pancreatitis, cholecystitis and migration.
Published: 2013

31. Endoscopic snare papillectomy: a possible radical treatment for a subgroup of T1 ampullary adenocarcinomas

Author: Petrone, G, Ricci, R, Familiari, Pietro, Inzani, F, Matsuoka, M, Mutignani, Massimiliano, Delle Fave, G, Costamagna, Guido, Rindi, G., Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Costamagna, Guido (ORCID:0000-0002-8100-2731), Petrone, G, Ricci, R, Familiari, Pietro, Inzani, F, Matsuoka, M, Mutignani, Massimiliano, Delle Fave, G, Costamagna, Guido, Rindi, G., Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Pancreaticoduodenectomy is the standard care for invasive ampullary adenocarcinomas. However, endoscopic snare papillectomy (ESP) might play a curative role in very selected patients. We studied a series of 15 patients with T1 ampullary adenocarcinoma who were treated by ESP alone and followed up for a mean of 29.6 ± 21.9 months (range 8 - 81 months). ESP was curative for eight patients (57.1 %). No tumor-related death was observed in patients with a cancer infiltration depth of ≤ 4 mm. According to this preliminary experience, we suggest that this measurable variable threshold should be considered as a possible basis for future large-scale studies.
Published: 2013

32. Effects of transoral gastroplasty on glucose homeostasis in obese subjects

Author: Leccesi, L, Panunzi, S, De Gaetano, A, Familiari, Pietro, Iaconelli, A, Guidone, C, Mazzarella, A, Costamagna, Guido, Mingrone, Geltrude, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Mingrone, G. (ORCID:0000-0003-2021-528X), Leccesi, L, Panunzi, S, De Gaetano, A, Familiari, Pietro, Iaconelli, A, Guidone, C, Mazzarella, A, Costamagna, Guido, Mingrone, Geltrude, Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), and Mingrone, G. (ORCID:0000-0003-2021-528X)
Abstract: Transoral gastroplasty (TOGA) is a safe and less invasive procedure than traditional bariatric surgery. We studied the effects of TOGA on the risk of progression from prediabetes to overt type 2 diabetes mellitus (T2DM) or on regression from diabetes or prediabetes to a lower risk category.
Published: 2013

33. ERCP for biliary strictures associated with chronic pancreatitis

Author: Familiari, Pietro, Boskoski, Ivo, Bove, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Boskoski, Ivo, Bove, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Chronic pancreatitis (CP)-related common bile duct (CBD) strictures are more difficult to treat endoscopically compared with benign biliary strictures because of their nature, particularly in patients with calcific CP. Before any attempt at treatment, malignancy must be excluded. Single plastic stents can be used for immediate symptom relief and as "bridge to surgery and/or bridge to decision," but are not suitable for definitive treatment of CP-related CBD strictures because of long-term poor results. Temporary simultaneous placement of multiple plastic stents has a high technical success rate and provides good long-term results.
Published: 2013

34. Endoscopic resection for gastrointestinal neuroendocrine tumors

Author: Boskoski, Ivo, Volkanovska, A, Tringali, Andrea, Bove, Vincenzo, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo, Volkanovska, A, Tringali, Andrea, Bove, Vincenzo, Familiari, Pietro, Perri, Vincenzo, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Gastrointestinal (GI) and neuroendocrine tumors (NETs) can be treated by mini-invasive endoscopic resection when localized in the superficial layers of the bowel wall and their size is <20 mm. Endoscopic diagnosis of NETs is usually incidental or suspected after clinical, laboratory or imaging findings. Endoscopic mucosal resection is the most commonly used technique for NET removal, endoscopic submucosal dissection is indicated in selected cases, while papillectomy is feasible for ampullary lesions. Histopathologic assessment of the resection margin (circumferential and deep) is important for staging. Incidence of endoscopic mucosal resection-/endoscopic submucosal dissection-related complications for removal of GI NETs are similar to those reported for other GI lesions. Endoscopic follow-up is based on histopathologic characteristics of the resected NETs and its site. NETs >20 mm in size, with penetration of the muscle layer and/or serosa are at high risk for metastases and surgical approach is recommended when feasible.
Published: 2013

35. Endoscopic retrieval of a duodenal perforating teaspoon

Author: Boskoski, Ivo, Tringali, Andrea, Landi, Rosario, Familiari, Pietro, Contini, Aci, Pintus, C, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo, Tringali, Andrea, Landi, Rosario, Familiari, Pietro, Contini, Aci, Pintus, C, Costamagna, Guido, Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.
Published: 2013

36. Peroral endoscopic myotomy for the treatment of achalasia in children

Author: Familiari, Pietro, Marchese, Michele, Gigante, Giovanni, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Marchese, Michele, Gigante, Giovanni, Boskoski, Ivo, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Peroral endoscopic myotomy (POEM) is a new endoscopic technique for the treatment of esophageal achalasia, with excellent results in adults. Three children with classic-type achalasia (mean age 9.6 years) underwent POEM in a single center. Mean basal lower esophageal sphincter pressure and Eckard score were 34.6 mmHg and 5.3, respectively. Mean length of myotomy was 10 cm. On average, POEM was completed in 60.6 minutes. No patients experienced postoperative complications or gastroesophageal reflux disease. In the 2 patients who completed a 12-month follow-up, complete symptoms relief was documented (Eckard score 0), as well as a significant drop of the basal lower esophageal sphincter pressure.
Published: 2013

37. Prospective evaluation of the partially covered nitinol “ComVi” stent for malignant non hilar biliary obstruction

Author: Perri, Vincenzo, Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Marchese, Michele, Dong Ki, Lee, Sung Il, Jang, Jimin, Han, Ho Gak, Kim, Mutignani, Massimiliano, Onder, Graziano, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Onder, Graziano (ORCID:0000-0003-3400-4491), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo, Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Marchese, Michele, Dong Ki, Lee, Sung Il, Jang, Jimin, Han, Ho Gak, Kim, Mutignani, Massimiliano, Onder, Graziano, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Onder, Graziano (ORCID:0000-0003-3400-4491), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Background: Biliary partially covered self-expandable metal stents (PC-SEMS) offer prolonged relief of symptoms of biliary obstruction but may induce complications including pancreatitis, cholecystitis and migration. Aims: To assess efficacy and safety of the ComVi partially covered self-expandable metal stents as primary palliative treatment of distal malignant biliary obstruction. Methods: Seventy patients (mean age 69.2 years) with distal malignant biliary strictures were prospectively included and underwent endoscopic retrograde cholangio-pancreatography and partially covered self-expandable metal stents placement. Follow-up was done for 12 months. self-expandable metal stents patency, survival and complication-rate after partially covered self-expandable metal stents placement were evaluated. Results: Overall median survival time was 190 days (30–856). Forty-four patients (62.8%) died after median 175.5 days (30–614) without signs of stent dysfunction; 37 patients (52.8%) were alive after 6 months without signs of self-expandable metal stents occlusion. Survival rapidly dropped between 8 and 12 months after treatment. Survival was not influenced by sex (P = 0.1) or type of neoplasia (P = 0.178). Median survival was longer (254 days [44–836]) in patients who underwent chemotherapy (P < 0.0001). Partially covered self-expandable metal stents occlusion had 24 (35.7%) patients 154 days (35–485) after treatment. Median survival after re-treatment was 66 days (13–597). Cholecystitis occurred in one patient (1.7%). Conclusions: The ComVi partially covered self-expandable metal stents is effective for palliation of biliary obstruction secondary to distal malignant biliary strictures. Self-expandable metal stents patency during follow-up is satisfactory without significant complications.
Published: 2013

38. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion

Author: Nanni, Giuseppe, Familiari, Pietro, Mor, Alessandro, Iaconelli, Amerigo, Perri, Vincenzo, Rubino, Francesco, Boldrini, Giuseppe, Salerno, Maria Paola, Leccesi, Laura, Iesari, S, Sollazzi, Liliana, Perilli, Valter, Castagneto, Marco, Mingrone, Geltrude, Costamagna, Guido, Nanni, Giuseppe (ORCID:0000-0001-9290-0695), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boldrini, Giuseppe (ORCID:0000-0003-1729-2508), Sollazzi, Liliana (ORCID:0000-0002-2973-6236), Perilli, Valter (ORCID:0000-0001-9655-4267), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), Costamagna, Guido (ORCID:0000-0002-8100-2731), Nanni, Giuseppe, Familiari, Pietro, Mor, Alessandro, Iaconelli, Amerigo, Perri, Vincenzo, Rubino, Francesco, Boldrini, Giuseppe, Salerno, Maria Paola, Leccesi, Laura, Iesari, S, Sollazzi, Liliana, Perilli, Valter, Castagneto, Marco, Mingrone, Geltrude, Costamagna, Guido, Nanni, Giuseppe (ORCID:0000-0001-9290-0695), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boldrini, Giuseppe (ORCID:0000-0003-1729-2508), Sollazzi, Liliana (ORCID:0000-0002-2973-6236), Perilli, Valter (ORCID:0000-0001-9655-4267), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: BACKGROUND: The effectiveness of restrictive procedures has been inferior to that of malabsorbitive ones. Recent variants of restrictive procedures, i.e., gastric banding and sleeve gastrectomy, confirm the strive for more efficacious solutions with less complications. We investigated the balance between effectiveness and complications for a new restrictive procedure, a Transoral Endoscopic Vertical Gastroplasty (TOGa®) METHODS: Seventy-nine morbidly obese patients were submitted to one out of three surgical procedures: TOGa® (29 patients), laparoscopic gastric bypass (LRYGBP; 20 patients), and biliopancreatic diversion (BPD; 30 patients). Mean BMI were 41.7 (35.4-46.6), 44.8 (36.4-54), and 47.5 (41-60.3), respectively. All the patients reached a 2-year follow-up. RESULTS: In TOGa® group BMI, respectively at 12 and 24 months, was 34.5 and 35.5, with 44 and 48.3% of patients with BMI lower than 35. In LRYGBP group, BMI was 30.7 and 29.2 kg/m(2), with 80 and 85% of patients with BMI < 35. In BPD group, BMI was 30 and 29.6 kg/m(2), with 100 and 93.3% of patients with BMI < 35. In TOGa® group, 59% of patients with an initial BMI < 45 reached a BMI < 35, in comparison to 48% recorded in the whole group and to 14.3% in patients with initial BMI ≥ 45. CONCLUSIONS: In selected patients, TOGa®, was associated with good results after two years in terms of weight loss, even in comparison with LRYGBP and BPD. Minimal trauma, absence of complications, and short hospital stay justify this procedure for patients with low BMI.
Published: 2012

39. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion

Author: Nanni, Giuseppe, Familiari, Pietro, Mor, Alessandro, Iaconelli, Amerigo, Perri, Vincenzo, Rubino, Francesco, Boldrini, Giuseppe, Salerno, Maria Paola, Leccesi, Laura, Iesari, S, Sollazzi, Liliana, Perilli, Valter, Castagneto, Marco, Mingrone, Geltrude, Costamagna, Guido, Nanni, Giuseppe (ORCID:0000-0001-9290-0695), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boldrini, Giuseppe (ORCID:0000-0003-1729-2508), Sollazzi, Liliana (ORCID:0000-0002-2973-6236), Perilli, Valter (ORCID:0000-0001-9655-4267), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), Costamagna, Guido (ORCID:0000-0002-8100-2731), Nanni, Giuseppe, Familiari, Pietro, Mor, Alessandro, Iaconelli, Amerigo, Perri, Vincenzo, Rubino, Francesco, Boldrini, Giuseppe, Salerno, Maria Paola, Leccesi, Laura, Iesari, S, Sollazzi, Liliana, Perilli, Valter, Castagneto, Marco, Mingrone, Geltrude, Costamagna, Guido, Nanni, Giuseppe (ORCID:0000-0001-9290-0695), Familiari, Pietro (ORCID:0000-0002-5181-2928), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boldrini, Giuseppe (ORCID:0000-0003-1729-2508), Sollazzi, Liliana (ORCID:0000-0002-2973-6236), Perilli, Valter (ORCID:0000-0001-9655-4267), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: The effectiveness of restrictive procedures has been inferior to that of malabsorbitive ones. Recent variants of restrictive procedures, i.e., gastric banding and sleeve gastrectomy, confirm the strive for more efficacious solutions with less complications. We investigated the balance between effectiveness and complications for a new restrictive procedure, a Transoral Endoscopic Vertical Gastroplasty (TOGa®)
Published: 2012

40. 'Doctor, I have a long, sausage-shaped lump in my abdomen'

Author: Familiari, Pietro, Hervoso, C, Boskoski, Ivo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Hervoso, C, Boskoski, Ivo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: N/A
Published: 2012

41. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: Preliminary results in humans

Author: Costamagna, Guido, Marchese, Michele, Familiari, Pietro, Tringali, Andrea, Inoue, H, Perri, Vincenzo, Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido, Marchese, Michele, Familiari, Pietro, Tringali, Andrea, Inoue, H, Perri, Vincenzo, Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), and Perri, Vincenzo (ORCID:0000-0002-0551-0873)
Abstract: BACKGROUND: Peroral endoscopic myotomy has been developed to provide a less invasive treatment for oesophageal achalasia compared to surgical cardiomyotomy. AIMS: To report our initial experience on feasibility, safety and clinical efficacy of peroral endoscopic myotomy. METHODS: Eleven patients (eight women, mean age 32, range 24-58) underwent an attempt at peroral endoscopic myotomy under general anaesthesia. After submucosal injection, a mucosal entry into the oesophageal submucosa, and a tunnel extending to the oesophagogastric junction and beyond into the stomach were created (total mean length: 15±1.7cm). Myotomy of the circular oesophageal and gastric muscle bundles was then achieved under direct vision (total mean length: 10.2±2.8cm). Haemostatic clips were used to close the mucosal entry. The Eckardt Score and manometry were used to evaluate the results. RESULTS: Peroral endoscopic myotomy could be completed in 10 out of 11 patients (91%). Mean procedure time was 100.7min (range 75-140min). No major complication occurred. Clinical success was achieved in all patients at 1-month follow-up (Eckardt Score 7.1 vs. 1.1, p=0). Lower oesophageal sphincter pressure decreased from 45.1 to 16.9mmHg (p=0). CONCLUSIONS: This initial experience with peroral endoscopic myotomy shows its safety and efficacy in the treatment of achalasia. Further studies are warranted to assess the long-term efficacy and to compare peroral endoscopic myotomy with other treatment modalities.
Published: 2012

42. Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting: a prospective study with 2 years of follow-up

Author: Perri, Vincenzo, Boškoski, I, Tringali, Andrea, Familiari, Pietro, Mutignani, Massimiliano, Marmo, R, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boškoski, I (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo, Boškoski, I, Tringali, Andrea, Familiari, Pietro, Mutignani, Massimiliano, Marmo, R, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boškoski, I (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Parenchymal fibrosis in chronic pancreatitis (CP) may induce stricturing of the common bile duct. The prevalence of CP-related benign biliary stricture (BBS) ranges between 3% and 46%.1 A durable drainage is needed if the stricture results in persistent increase in liver function test (LFT) results, jaundice, and cholangitis.2 If left untreated, symptomatic BBS can lead to secondary biliary cirrhosis.3 Biliodigestive anastomosis (hepaticojejunostomy) is the treatment of choice for persistent CP-related BBS.1,4 However, surgery may be difficult because of local complications of CP, mainly portal hypertension, and limited by other comorbidities or patient refusal. Endoscopic biliary stenting may be an alternative to surgery, being minimally invasive and having a lower short-term complication rate and a shorter hospital stay.5-8 Furthermore, endoscopic biliary drainage does not preclude subsequent surgery when necessary.9 Endoscopic treatment of BBS includes the placement of plastic stents or self-expandable metal stents (SEMSs). Long-term results of the placement of plastic stents are disappointing.10-13 Biliary SEMSs are uncovered or partially covered (PC) with a plastic coating. More recently, fully covered (FC) SEMSs have been developed and, being removable, are proposed also for benign indications. Uncovered and PC biliary SEMSs may clog because of tissue ingrowth through the uncovered meshes.14,15 Removable FC SEMSs are an attractive option for CP-related BBS, but limited data are available. We conducted a prospective, single-center trial to investigate the durability of CP-related BBS resolution after temporary insertion of FCSEMSs with unflared ends (UEs) and flared ends (FEs).
Published: 2012

43. Plastic biliary stents for benign biliary diseases

Author: Perri, Vincenzo, Familiari, Pietro, Tringali, Andrea, Boskoski, Ivo, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo, Familiari, Pietro, Tringali, Andrea, Boskoski, Ivo, Costamagna, Guido, Perri, Vincenzo (ORCID:0000-0002-0551-0873), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Biliary plastic stenting plays a key role in the endoscopic management of benign biliary diseases. Complications following surgery of the biliary tract and liver transplantation are amenable to endoscopic treatment by plastic stenting. Insertion of an increasing number of plastic stents is currently the method of choice to treat postoperative biliary strictures. Benign biliary strictures secondary to chronic pancreatitis or primary sclerosing cholangitis may benefit from plastic stenting in select cases. There is a role for plastic stent placement in nonoperative candidates with acute cholecystitis and in patients with irretrievable bile duct stones.
Published: 2011

44. Update in biliary endoscopy

Author: Costamagna, Guido, Boskoski, Ivo, Familiari, Pietro, Tringali, Andrea, Cesaro, Paola, Perri, Vincenzo, Costamagna, Guido (ORCID:0000-0002-8100-2731), Boškoski, I (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido, Boskoski, Ivo, Familiari, Pietro, Tringali, Andrea, Cesaro, Paola, Perri, Vincenzo, Costamagna, Guido (ORCID:0000-0002-8100-2731), Boškoski, I (ORCID:0000-0001-8194-2670), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), and Perri, Vincenzo (ORCID:0000-0002-0551-0873)
Abstract: Biliary endoscopy has seen the development of several new techniques in the last few years. Its current role includes direct diagnostic imaging, tissue sampling, early diagnosis and palliation of biliary tumors. Relatively new methods for biliary stones management are electrohydraulic lithotripsy combined with choledochoscope guidance and laser lithotripsy. Intraductal ultrasound, confocal laser endomicroscopy and optical coherence tomography are emerging, purely diagnostic endoscopic tools in biliary endoscopy. Cytological examinations such as digital imaging analysis and fluorescence in situ hybridization have the potential of becoming very important in the early diagnosis of biliary tumors. Direct visualization of the biliary mucosa and tissue sampling can be done with the last generation of cholangioscopes. All these tools are promising, especially for the 'undetermined biliary strictures'. Improvements in quality of life, survival and biliary drainage in patients with non-operable cholangiocarcinoma have been reported after the application of both photodynamic therapy and high-dose rate intraluminal brachytherapy. Drug-eluting stents with incorporated anti-tumor agents designed to improve patency and reduce the risk of tumor ingrowth have already been tested, and other stents are under investigation as well.
Published: 2011

45. An unusual post-ERCP pneumoperitoneum

Author: Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Costamagna, Guido, Boškoski, I (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Boskoski, Ivo, Tringali, Andrea, Familiari, Pietro, Costamagna, Guido, Boškoski, I (ORCID:0000-0001-8194-2670), Tringali, Andrea (ORCID:0000-0002-9614-3449), Familiari, Pietro (ORCID:0000-0002-5181-2928), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: A case of peritoneum secondary to a rupture of an hepatic ascess communicating with the bile ducts
Published: 2011

46. Successful off-label use of enteral stents in uncommon complicated biliary tract diseases

Author: Mutignani, Massimiliano, Lim, Ll, Seerden, T, Familiari, Pietro, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Mutignani, Massimiliano, Lim, Ll, Seerden, T, Familiari, Pietro, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: not available
Published: 2011

47. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome

Author: Familiari, Pietro, Costamagna, Guido, Bléro, D, Le Moine, O, Perri, Vincenzo, Boskoski, Ivo, Coppens, E, Barea, M, Iaconelli, Amerigo, Mingrone, Geltrude, Moreno, C, Devière, J., Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), Familiari, Pietro, Costamagna, Guido, Bléro, D, Le Moine, O, Perri, Vincenzo, Boskoski, Ivo, Coppens, E, Barea, M, Iaconelli, Amerigo, Mingrone, Geltrude, Moreno, C, Devière, J., Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Mingrone, Geltrude (ORCID:0000-0003-2021-528X)
Abstract: Bariatric surgery is associated with specific complications and mortality. Transoral gastroplasty (TOGA) is a transoral restrictive bariatric procedure that might offer the benefits of surgery with a reduced complication rate.
Published: 2011

48. Successful off-label use of enteral stents in uncommon complicated biliary tract diseases

Author: Mutignani, Massimiliano, Lim, Ll, Seerden, T, Familiari, Pietro, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Mutignani, Massimiliano, Lim, Ll, Seerden, T, Familiari, Pietro, Tringali, Andrea, Perri, Vincenzo, Costamagna, Guido, Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Familiari, Pietro (ORCID:0000-0002-5181-2928), Tringali, Andrea (ORCID:0000-0002-9614-3449), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: NA
Published: 2011

49. Endoscopic treatment of obesity

Author: Familiari, Pietro, Boskoski, Ivo, Marchese, Michele, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Familiari, Pietro, Boskoski, Ivo, Marchese, Michele, Perri, Vincenzo, Costamagna, Guido, Familiari, Pietro (ORCID:0000-0002-5181-2928), Boškoski, Ivo (ORCID:0000-0001-8194-2670), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)
Abstract: Obesity is a worldwide epidemic, complex metabolic disease associated with a variety of severe comorbidities. Bariatric surgery provides the patients with the benefits of sustained weight loss and improves obesity-related comorbidities, but can result in potentially life-threatening complications. Gastrointestinal endoscopy has recently been proposed as a scarless and noninvasive approach to obesity. Most of the current endoluminal devices and techniques are comparable to restrictive surgery. A variety of medical devices and procedures have been evaluated in recent years; however, with the exception of the intragastric balloon, evaluation of all the other endoluminal procedures is limited by the numbers of patients treated, the short follow-up and especially by the study design. Today, only a few devices have been evaluated in randomized controlled trials. The preliminary results of the first studies are extremely promising, but definitive statements cannot be drawn yet.
Published: 2011

50. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome

Author: Familiari, Pietro, Costamagna, Guido, Bléro, D, Le Moine, O, Perri, Vincenzo, Boskoski, Ivo, Coppens, E, Barea, M, Iaconelli, Amerigo, Mingrone, Geltrude, Moreno, C, Devière, J., Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), Mingrone, Geltrude (ORCID:0000-0003-2021-528X), Familiari, Pietro, Costamagna, Guido, Bléro, D, Le Moine, O, Perri, Vincenzo, Boskoski, Ivo, Coppens, E, Barea, M, Iaconelli, Amerigo, Mingrone, Geltrude, Moreno, C, Devière, J., Familiari, Pietro (ORCID:0000-0002-5181-2928), Costamagna, Guido (ORCID:0000-0002-8100-2731), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Boskoski, Ivo (ORCID:0000-0001-8194-2670), and Mingrone, Geltrude (ORCID:0000-0003-2021-528X)
Abstract: Bariatric surgery is associated with specific complications and mortality. Transoral gastroplasty (TOGA) is a transoral restrictive bariatric procedure that might offer the benefits of surgery with a reduced complication rate.
Published: 2011

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