Publications by authors named "Mario Traina"

138 Publications

Erratum: Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review.

Endosc Int Open 2020 Sep 16;8(9):C4. Epub 2021 Jun 16.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT Palermo, Italy.

[This corrects the article DOI: 10.1055/a-1198-4357.].
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http://dx.doi.org/10.1055/a-1527-7164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208834PMC
September 2020

Gastrointestinal exposed endoscopic full-thickness resection in the era of endoscopic suturing: a retrospective single-center case series.

Wideochir Inne Tech Maloinwazyjne 2021 Jun 15;16(2):321-328. Epub 2021 Mar 15.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

Introduction: Exposed endoscopic full thickness resection (EFTR) is a minimally invasive technique that has shown promising efficacy and safety in the removal of both gastrointestinal (GI) submucosal tumors (SMTs) arising from the muscularis propria (MP) and select epithelial tumors (ETs) unsuitable for conventional resection techniques. Given the chance of realizing endosurgical full-thickness suturing, the Endoscopic Suturing System (ESS) can be used to close wall defects in this setting. However, data concerning its use in EFTR are still limited.

Aim: This study was conducted to evaluate the safety and efficacy of exposed EFTR with defect closure using the ESS for the removal of both GI SMTs and select ETs unsuitable for conventional resection techniques.

Material And Methods: This was a retrospective, single-center, observational cohort study of patients who underwent GI exposed EFTR.

Results: Seven patients (M : F 6 : 1) with a mean age of 56 ±14.5 years were identified. The indications were MP-originating SMTs of the stomach (n = 2) and duodenum (n = 2), and from submucosa of the rectum (n = 1), and 2 ETs of the rectum. Exposed EFTR and defect closure were successfully performed in 6/7 patients. One case was converted to laparoscopic gastric wedge resection due to technical unfeasibility. We performed an R0 resection in all cases, with the exception of 1 case of rectal EFTR. No macroscopic recurrence was detected at 6-month endoscopic follow-up.

Conclusions: GI exposed EFTR with defect closure by the ESS appears to be feasible, effective, and safe in referral centers. Further studies are necessary to clarify the role of the ESS for post-EFTR wall defect closure.
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http://dx.doi.org/10.5114/wiitm.2021.104496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193753PMC
June 2021

Management of intra-abdominal hypertension during ECMO: Total water-assisted colonoscopy as a step-up minimally invasive treatment, and a literature review.

Endosc Int Open 2021 Jun 27;9(6):E848-E852. Epub 2021 May 27.

Endoscopy Service, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) Palermo, Italy.

During extracorporeal membrane oxygenation (ECMO), intra-abdominal hypertension (IAH) can impair ECMO venous drainage, reducing its ability to provide an adequate oxygenated blood flow. When medical therapy is ineffective in managing IAH, guidelines recommend a decompressive laparotomy (DL), though the procedure is associated with several complications and poor outcomes. This was a case series of IAH in patients affected with acute respiratory distress syndrome (ARDS) on veno-venous (V-V) ECMO, in whom we performed total water-assisted colonoscopy (t-WAC) to treat IAH. In three patients who underwent t-WAC, we report a real-time intra-procedural reduction of IAH, normalization of ECMO blood flow, and a reduction of vasopressors and lactates. t-WAC was performed in the context of evident abdominal compartment syndrome with multiorgan failure, and in one case was performed because of IAH and ECMO impairment. One patient was discharged alive, while the other two died of multiorgan failure, although the cause of death was apparently not secondary to IAH. During ECMO, in select cases,T-WAC may represent a first-line non-invasive approach.
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http://dx.doi.org/10.1055/a-1399-8209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159594PMC
June 2021

A novel 1-L PEG + ascorbate versus high-volume PEG regimen for colonoscopy cleansing: a multicenter, randomized, phase IV study.

Gastrointest Endosc 2021 Apr 30. Epub 2021 Apr 30.

Digestive Endoscopy Unit, Carpi-Mirandola Hospitals, Azienda USL Modena.

Background And Aims: An adequate bowel cleansing is critical to assure quality and safety of colonoscopy. A novel 1L-PEG plus ascorbate(PEG+ASC) regimen was previously validated against low-volume regimens, but it was never compared with high-volume regimens.

Methods: In a Phase IV study, patients undergoing colonoscopy were randomized 1:1 to receive split-dose 1L PEG+ASC or a split-dose 4L PEG-based regimen in 5 Italian centers. Preparation was assessed with the Boston Bowel Preparation Scale (BBPS) by the local endoscopists and centralized reading, both blinded to the randomization arm. Primary endpoint was noninferiority of 1L PEG+ASC in colon cleansing. Secondary endpoints were superiority of 1L PEG+ASC, patient compliance, segmental colon cleansing, adenoma detection rate (ADR), tolerability and safety.

Results: A total of 388 patients (59.8 years) were randomized between January 2019 and October 2019: 195 to 1L PEG+ASC and 193 to 4L-PEG. Noninferiority of 1L PEG+ASC was demonstrated for cleansing in both the whole colon (BBPS>6: 97.9% vs 93%; RR, 1.03; 95% CI, 1.001-1.04; p-superiority=0.027) and in the right colon segment (98.4% vs 96.0%; RR, 1.02; 95% CI, 0.99-1.02; p noninferiority=0.013). Compliance was higher with 1L PEG+ASC than 4L-PEG (178/192, 92.7% vs 154/190 patients, 81.1%; RR, 1.10; 95% CI, 1.05-1.12), whereas no difference was found regarding safety (moderate/severe side-effects: 20.8% vs 25.8%; p=0.253). No difference in ADR (38.8% vs 43.0%) was found.

Conclusion: 1L PEG+ASC showed noninferiority compared with 4L-PEG in achieving adequate colon cleansing, as well as a higher patient compliance. No differences in tolerability and safety were detected.
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http://dx.doi.org/10.1016/j.gie.2021.04.020DOI Listing
April 2021

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

Endosc Int Open 2021 Feb 25;9(2):E110-E115. Epub 2021 Jan 25.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

The therapeutic role of endoscopic ultrasound (EUS) evolved in recent decade,s opening a new chapter in the field of endoscopic biliary drainage (BD). EUS-BD has emerged as a new mini-invasive technique for neoplastic jaundice not amenable to endoscopic retrograde cholangiopancreatography (ERCP). The primary study aims were to assess the clinical efficacy of EUS-BD using an electrocautery-enhanced lumen apposing metal stent (ECE-LAMS) in patients with malignant biliary obstruction with failed\unfeasible ERCP and the adverse event (AE) rate. The secondary aims were to evaluate the technical success and incidence of jaundice recurrence. Data from All patients referred to our tertiary-care Institute with obstructive jaundice due to unresectable malignant distal biliary stricture and unfeasible\failed ERCP, were prospectively recorded from January 2015 to February 2018. The procedures were performed by a single-step ECE-LAMS (AXIOS-EC, Boston Scientific) placement, from the upper gut lumen to the biliary tree, for definitive biliary decompression. Twenty-one patients were consecutively enrolled. Mean pre-procedure common bile duct diameter was 16 mm and the bilirubin level was 13.9 mg/dL (range 3.8-29.5). LAMS was positioned from the duodenal bulb (n = 19) to gastric antrum (n = 2). We registered a 100 % of technical and clinical success. No AEs occurred. We observed a single case of delayed AE consisting of a buried LAMS, which was successfully resolved endoscopically. Despite the limits of being non-comparative, our study shows outcomes in a homogeneous population in terms of indications and technique. EUS-BD with dedicated ECE-LAMS is associated with extremely good clinical efficacy and safety and can be considered as an alternative in cases of failed/unfeasible ERCP.
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http://dx.doi.org/10.1055/a-1313-6850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834702PMC
February 2021

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review.

Endosc Int Open 2020 Sep 31;8(9):E1173-E1182. Epub 2020 Aug 31.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT Palermo, Italy.

Exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery (NOTES) technique that has shown promising efficacy and safety in resection of gastric submucosal tumors (G-SMTs) arising from muscularis propria (MP). However, data on the efficacy and safety of gastric Eo-EFTR mostly come from relatively small retrospective studies and concern regarding its use still exists. The aim of our systematic review was to assess the efficacy and safety of gastric Eo-EFTR without laparoscopic assistance. A detailed MEDLINE and EMBASE search was performed for papers published from January 1998 to November 2019 and reporting on gastric Eo-EFTR without laparoscopic assistance. The search strategy used the terms "endoscopic full thickness resection" and "gastric" or "stomach". The primary outcomes were complete resection and surgical conversion rates. The secondary outcomes were overall major adverse events, delayed bleeding, delayed perforation, peritonitis, abdominal abscess and/or abdominal infection and successful Eo-EFTR. Fifteen Asian studies were included in our final review, providing data on 750 Eo-EFTR-treated G-SMTs. The per-lesion rate of complete resection and surgical conversion were 98.8 %\0.8 %, respectively. The per-lesion rate of major adverse events, delayed bleeding, delayed perforation and peritonitis, abdominal abscess and/or abdominal infection was 1.6 %\0.5 %\0.1 %\0.9 %, respectively. The per-lesion rate of successful Eo-EFTR (i. e. complete tumor resection and effective endoscopic defect closure) was 98.3 %. Eo-EFTR without laparoscopic assistance appears to be highly effective and safe NOTES for removing deep G-SMTs, particularly those arising from MP layer.
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http://dx.doi.org/10.1055/a-1198-4357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458762PMC
September 2020

The C-Cube: an endoscopic solution in the time of COVID-19.

Endoscopy 2020 09 19;52(9):E351-E352. Epub 2020 Jun 19.

Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.

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http://dx.doi.org/10.1055/a-1190-3462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516370PMC
September 2020

Endoscopic drainage in patients with malignant extrahepatic biliary obstruction: when and how.

Eur J Gastroenterol Hepatol 2020 10;32(10):1279-1283

Humanitas University; Pieve Emanuele (MI); Italy.

The question of when and how to drain a malignant biliary obstruction (MBO), both intrinsic or extrinsic, remains a controversial point among endoscopists. An important factor that influences the decision to drain an MBO or not is if the patient is a surgical candidate or not and, in the former case, if the patients must undergo neoadiuvant chemotherapy or not. Other questions arising during biliary drainage in MBO patients is which type of stent should be chosen, plastic or metal, and if endoscopic biliary sphincterotomy must be performed or not when a stent is placed. The present review attempts to answer these questions and summarizes the optimal approach toward patients with MBO based on the available evidence.
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http://dx.doi.org/10.1097/MEG.0000000000001752DOI Listing
October 2020

Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency.

United European Gastroenterol J 2020 07 12;8(6):705-715. Epub 2020 May 12.

Pancreas Unit, Department of Gastroenterology, Sant'Orsola Polyclinic, Bologna, Italy.

Background: Autoimmune pancreatitis (AIP) is a rare, and relatively new, form of chronic pancreatitis. The management of AIP can vary considerably among different centres in daily clinical practice.

Objectives: The aim of this study is to present a picture of epidemiological, clinical characteristics, outcomes, and the real-life practice in terms of management in several academic and non-academic centres in Italy.

Methods: Data on the clinical presentation, diagnostic work-up, treatments, frequency of relapses, and long-term outcomes were retrospectively collected in a cohort of AIP patients diagnosed at 14 centres in Italy.

Results: One hundred and six patients were classified as type 1 AIP, 48 as type 2 AIP, and 19 as not otherwise specified. Epidemiological, clinical, radiological, and serological characteristics, and relapses were similar to those previously reported for different types of AIP. Endoscopic cytohistology was available in 46.2% of cases, and diagnostic for AIP in only 35.2%. Steroid trial to aid diagnosis was administered in 43.3% cases, and effective in 93.3%. Steroid therapy was used in 70.5% of cases, and effective in 92.6% of patients. Maintenance therapy with low dose of steroid (MST) was prescribed in 25.4% of cases at a mean dose of 5 (±1.4) mg/die, and median time of MST was 60 days. Immunosuppressive drugs were rarely used (10.9%), and rituximab in 1.7%. Faecal elastase-1 was evaluated in only 31.2% of patients, and was pathological in 59.2%.

Conclusions: In this cohort of AIP patients, diagnosis and classification for subtype was frequently possible, confirming the different characteristics of AIP1 and AIP2 previously reported. Nevertheless, we observed a low use of histology and steroid trial for a diagnosis of AIP. Steroid treatment was the most used therapy in our cohort. Immunosuppressants and rituximab were rarely used. The evaluation of exocrine pancreatic insufficiency is underemployed considering its high prevalence.
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http://dx.doi.org/10.1177/2050640620924302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437084PMC
July 2020

Single-step EUS-guided jejunojejunostomy with a lumen-apposing metal stent as treatment for malignant afferent limb syndrome.

VideoGIE 2020 Apr 6;5(4):154-156. Epub 2020 Feb 6.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy.

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http://dx.doi.org/10.1016/j.vgie.2019.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125391PMC
April 2020

The role of endoscopy as non-invasive procedure to manage gastrointestinal complications during extracorporeal membrane oxygenation.

Perfusion 2020 11 10;35(8):786-794. Epub 2020 Mar 10.

Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

Introduction: Gastrointestinal bleeding is a life-threatening complication in patients undergoing extracorporeal membrane oxygenation support. Despite data on increased mortality due to gastrointestinal bleeding, there is little data on the treatment of such conditions under extracorporeal membrane oxygenation, and on the possibilities of advanced endoscopic therapy to non-invasively solve these bleeding complications. No clear treatment in the case of extracorporeal membrane oxygenation support is recommended in the guidelines.

Methods: Retrospective observational cohort study including 134 veno-venous extracorporeal membrane oxygenation patients for acute respiratory failure from 2009 to 2018 at IRCCS-ISMETT (Italy). Patients were divided into two groups according to gastrointestinal bleeding episodes and reviewed for type of endoscopic therapy. Gastrointestinal bleeding group was characterized for pre-extracorporeal membrane oxygenation characteristics, management variables-including amount of transfusions and clinical outcomes.

Results: Fourteen (14) patients (10.4%) experienced upper (n = 13) or lower (n = 1) gastrointestinal bleeding. Gastrointestinal bleeding and no-gastrointestinal bleeding group had similar characteristics apart from higher creatinine in the gastrointestinal bleeding group (1.9 mg/dL (1.3-4.9) vs 1.2 mg/dL (0.7-1.8), p = 0.03). In 3 of the 14 patients (21%), endoscopy showed no signs of active bleeding (nasogastric or feeding tube decubitus), and no specific intervention was performed. Active bleeding was recognized in 11 of the 14 patients (79 %). No patients died of fatal bleeding in the gastrointestinal bleeding group. Endoscopic therapy was feasible, with a complete bleeding control in all the cases: five Hemospray, two fibrin glue, two metallic clips, one combined approach metallic clips with epinephrine, and one cyanoacrylate. The extracorporeal membrane oxygenation course was significantly longer in the gastrointestinal bleeding group: 19.5 (15-36) days vs 13.5 (8-25) days, p = 0.01. No significant differences in mortality were found between the two groups (all p values > 0.05).

Conclusion: Advanced endoscopic therapy during veno-venous extracorporeal membrane oxygenation may contribute to reducing the negative effects on mortality for gastrointestinal bleeding episodes.
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http://dx.doi.org/10.1177/0267659120909669DOI Listing
November 2020

Correction: Pure cystic groove pancreatitis: endosonographic appearance.

Endoscopy 2019 Aug 28;51(8):C7. Epub 2020 Feb 28.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

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http://dx.doi.org/10.1055/a-1126-5092DOI Listing
August 2019

Solid pseudopapillary pancreatic tumor: improbable is not impossible.

Gastrointest Endosc 2020 07 25;92(1):218-220. Epub 2020 Feb 25.

Radiology Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, Palermo, Italy.

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http://dx.doi.org/10.1016/j.gie.2020.02.024DOI Listing
July 2020

Full-thickness gastric plication with Overstitch endoscopic suturing device for postsurgical chronic gastroparesis.

Endoscopy 2020 07 22;52(7):E235-E236. Epub 2020 Jan 22.

IRCCS - ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

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http://dx.doi.org/10.1055/a-1076-0652DOI Listing
July 2020

Thyroid ectopia of the liver: An unusual diagnosis with contrast-enhanced EUS (with video).

Endosc Ultrasound 2019 Nov-Dec;8(6):430-431

Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy.

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http://dx.doi.org/10.4103/eus.eus_71_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927141PMC
December 2019

Conversion to laparoscopy in gastric endoscopic full-thickness resection: adverse event or routine step-up approach?

Endoscopy 2020 04 25;52(4):E130-E131. Epub 2019 Oct 25.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

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http://dx.doi.org/10.1055/a-1024-3664DOI Listing
April 2020

Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience.

Surg Endosc 2020 09 3;34(9):3805-3817. Epub 2019 Oct 3.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy.

Background And Aims: Post-GI surgical wall defects are frequent and life-threatening complications, with limited literature regarding current treatment. This case series aims to assess the safety, feasibility, and outcomes of endoluminal therapy with the overstitch endoscopic suturing system (Apollo Endosurgery Inc, Austin).

Materials And Methods: All patients who underwent endoscopic suturing for post-surgical wall defect management at IRCCS-ISMETT Palermo from October 2017 until January 2019 were retrospectively enrolled. Stratification therapy was applied according to the clinical scenario, time from surgery to endoscopic intervention, and structural condition of the wall defect layers (tissue status and suture feasibility). The therapeutic endoscopic strategy was divided into three groups (A: pure endoscopic direct suture; B: combined therapy with endoscopic direct suture + FC-SEMS placement + anchoring; C: FC-SEMS placement + anchoring). Success was considered the resolution of symptoms and the presence of a regular intestinal transit after a period of 4-6 weeks.

Results: Twenty (20) patients (male/female 7/13; mean age 54 ± 13.43 years) were included in the study (group A: 9 patients, group B: 7 patients, group C: 4 patients). The types of operative procedures were bariatric (9/20), post-tracheostomy (3/20), post-operative GI surgery (8/20). The post-surgical defects were predominantly intermediate and chronic (24-72 h: 1/20; 3-30 days: 13/20; > 30 days: 6/20). The overall clinical success was 80% (17/20 patients), with a success of 94% (16/17 patients) when excluding the three cases of tracheo-esophageal fistula. No evidence of migration was detected. The only complication was short stenosis of the distal esophagus, present in 4 patients (19%) and successfully treated with a novel lumen-apposing metal stent.

Conclusions: In our experience, considering the absence of clear guidelines, the endoluminal approach with the overstich endoscopic suturing system is a valid alternative to conventional therapy, offering mini-invasiveness, and presenting promising opportunities in terms of technical feasibility and clinical efficacy.
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http://dx.doi.org/10.1007/s00464-019-07145-7DOI Listing
September 2020

Sequential multistenting protocol in biliary stenosis after liver transplantation: a prospective analysis.

Endoscopy 2019 12 2;51(12):1130-1135. Epub 2019 Aug 2.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

Background: Biliary complications are a serious source of morbidity after orthotopic and living-related liver transplantation. Endoscopic retrograde cholangiography (ERC) is the gold standard for patients with duct-to-duct anastomosis because it allows a direct approach for interventional procedures. A retrospective study showed results of a sequential multistenting protocol, without stent removal/exchange, with promising results. We conducted a prospective analysis to assess the clinical success, recurrence rate, and adverse event rate related to this protocol.

Methods: From May 2012 to April 2018, all consecutive patients with a diagnosis of anastomotic stenosis following liver transplantation were enrolled in the study, and were followed for a period of at least 6 months after the last ERC. During the first ERC, a maximum number of plastic stents (10 Fr) were placed. In subsequent ERCs, scheduled every 3 months up to a maximum of 1 year, additional stents were inserted, as many as possible, without removing the previously placed stents.

Results: From May 2012 to May 2018, 87 patients were included in the study and treated with a sequential multistenting protocol. The mean number of stents placed was 3.7 (SD 1.0). Clinical success (stricture resolution and normalization of cholestasis) was achieved in 86 patients (98.9 %). Seven patients (8.0 %) developed complications. Recurrence was recorded in seven patients (8.0 %) after a mean of 992.7 days (SD 622.1).

Conclusions: This study represents the first prospective demonstration of the efficacy and safety of a sequential multistenting protocol. A key limitation of the study is the lack of a comparative group treated according to the traditional stent exchange approach.
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http://dx.doi.org/10.1055/a-0977-3158DOI Listing
December 2019

Endoscopic closure of gastrocolocutaneous fistula following percutaneous endoscopic gastrostomy, by OverStitch Endoscopic Suturing System.

Endoscopy 2019 12 5;51(12):E384-E385. Epub 2019 Jul 5.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

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http://dx.doi.org/10.1055/a-0956-6792DOI Listing
December 2019

Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials.

Ann Gastroenterol 2019 Jul-Aug;32(4):407-415. Epub 2019 Apr 13.

Division of Gastroenterology & Hepatology University of Utah, Salt Lake City, Utah, USA (Douglas G. Adler).

Background: Anastomotic biliary strictures (ABS) following liver transplantation (LT) are one of the most common complications, occurring in 4.5-32% of patients. Multiple plastic stenting (MPS) requires multiple sessions, with the associated risk, cost and patient discomfort. Fully covered self-expandable metal stents (FC-SEMS) have increasingly been used in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs), comparing the role of FC-SEMS and MPS in the treatment of ABS post-LT.

Methods: We conducted a bibliographic search using PubMed and EMBASE, aimed at identifying available RCTs that compared MPS to FC-SEMS in patients with ABS post LT from January 2000 to October 2017. Primary outcomes were ABS resolution and recurrence, while secondary outcomes were adverse events and number of procedures performed. Pooled estimates were calculated using random-effects models.

Results: Four RCTs (205 patients) were included. ABS resolution and recurrence did not differ significantly between the groups (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.43-2.56, P=0.92; and OR 2.37, 95%CI 0.54-10.38, P=0.25). The same was true for adverse events (OR 0.91, 95%CI 0.84-3.48, P=0.86) and migration rate (OR 1.31, 95%CI 0.46-3.71, P=0.61). The mean number of endoscopic retrograde cholangiopancreatography procedures was lower for FC-SEMS (mean difference [MD] -2.08).

Conclusions: FC-SEMS and MPS had equal ABS resolution and recurrence, although there was a trend towards a higher recurrence rate in FC-SEMS that disappeared when trials with a shorter stent indwelling time were excluding. No difference was found in overall adverse events or migration rate.
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http://dx.doi.org/10.20524/aog.2019.0376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595920PMC
April 2019

Iatrogenic perforation during colonoscopy in the endoscopic suturing era: surgical emergency or endoscopic clinical practice?

Endoscopy 2019 12 1;51(12):E366-E367. Epub 2019 Jul 1.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

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http://dx.doi.org/10.1055/a-0948-3960DOI Listing
December 2019

The lumen-apposing metal stent (LAMS)-in-LAMS technique as an intraprocedural rescue treatment during endoscopic ultrasound-guided gastroenterostomy.

Endoscopy 2019 11 4;51(11):E331-E332. Epub 2019 Jun 4.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

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http://dx.doi.org/10.1055/a-0924-5408DOI Listing
November 2019

Mini-invasive treatment of sump syndrome: OverStitch choledochoduodenostomy revision.

Endoscopy 2019 11 4;51(11):E337-E338. Epub 2019 Jun 4.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.

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http://dx.doi.org/10.1055/a-0919-4318DOI Listing
November 2019

High diagnostic adequacy and accuracy of the new 20G procore needle for EUS-guided tissue acquisition: Results of a large multicentre retrospective study.

Endosc Ultrasound 2019 Jul-Aug;8(4):261-268

Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy.

Background And Objective: EUS-guided fine-needle biopsy has become the standard for tissue sampling. A new 20G ProCore™ (PC) needle has been developed to overcome the limitations of tissue acquisition of the smaller needles (22G, 25G) and the rigidity of the larger one (19G). The aim of this study is to assess the performance of the 20G PC needle.

Materials And Methods: Patients who underwent EUS-guided tissue acquisition with the 20G PC needle of pancreatic and extra-pancreatic mass lesions were retrospectively identified at three Italian centers (Bologna, Fermo, and Palermo). Diagnostic adequacy, accuracy, and tissue core acquisition were the outcome measures. All the cases were performed without rapid on-site evaluation.

Results: A total of 384 patients with pancreatic (62.2%) and extra-pancreatic lesions were included in the study. For pancreatic lesions, adequacy, accuracy, sensitivity, and specificity were 92.4%, 91.5%, 90.8%, and 100%, respectively, with a number needed to misdiagnose (NNM) of 11.8. The tissue core was obtained in 72% of cases. Transduodenal approach was performed in 150 pancreatic lesions; adequacy, accuracy, and tissue core acquisition were 88.7%, 90%, and 66%, respectively (NNM 10). For extrapancreatic lesions, adequacy, accuracy, sensitivity, specificity, and tissue core sampling were 95.3%, 95.3%, 92.6%, 100%, and 84.5% (NNM 21.3).

Conclusions: The 20G PC needle showed high diagnostic adequacy and accuracy, regardless the access route.
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http://dx.doi.org/10.4103/eus.eus_14_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714486PMC
May 2019

Pure cystic groove pancreatitis: endosonographic appearance.

Endoscopy 2019 08 2;51(8):E235-E236. Epub 2019 May 2.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

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http://dx.doi.org/10.1055/a-0889-7569DOI Listing
August 2019

Underwater full-thickness resection of a duodenal bulb gastrointestinal stromal tumor with OverStitch defect repair.

Endoscopy 2019 08 2;51(8):E207-E208. Epub 2019 May 2.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.

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http://dx.doi.org/10.1055/a-0881-2702DOI Listing
August 2019

An unusual case of postcholecystectomy syndrome.

Gastrointest Endosc 2019 07 19;90(1):162-164. Epub 2019 Mar 19.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy.

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http://dx.doi.org/10.1016/j.gie.2019.03.008DOI Listing
July 2019

Erratum: Endoscopist's occupational dose evaluation related to correct wearing of dosimeter during X-ray-guided procedures.

Endosc Int Open 2019 03 20;7(3):C1. Epub 2019 Mar 20.

IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy - Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

[This corrects the article DOI: 10.1055/a-0841-3350.].
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http://dx.doi.org/10.1055/a-0876-6448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426725PMC
March 2019

Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature.

World J Gastrointest Surg 2019 Feb;11(2):53-61

Humanitas Huniversity, Hunimed, Pieve Emanuele, Milano 20090, Italy.

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography (EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). The advent of lumen-apposing metal stents (LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.
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http://dx.doi.org/10.4240/wjgs.v11.i2.53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397798PMC
February 2019

Endoscopist's occupational dose evaluation related to correct wearing of dosimeter during X-ray-guided procedures.

Endosc Int Open 2019 Mar 28;7(3):E367-E371. Epub 2019 Feb 28.

RCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy - Radiology Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

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http://dx.doi.org/10.1055/a-0841-3350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395086PMC
March 2019
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