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| 1 | Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasoundguided gastroentero-anastomosis显示文摘Gastric outlet obstruction(GOO)is a clinical syndrome characterized by postprandial vomiting,abdominal pain,bloating and,in advanced cases,by weight loss secondary to inadequate oral intake.This clinical entity may be caused by mechanical obstruction,either benign or malignant,or by motility disorders.In this review we will focus on malignant GOO and on its endoscopic ultrasound(EUS)-guided palliative treatment.The most frequent malignant causes of this syndrome are gastric and locally advanced pancreatic carcinomas;other causes include duodenal or ampullary neoplasms,gastric lymphomas,retroperitoneal lymphadenopathies and,more infrequently,gallbladder and bile duct cancers.Surgery represents the treatment of choice when radical and curative resection is potentially feasible;if the malignant cause is not likely to be completely resected,palliative treatments should be proposed.Palliative treatments for malignant GOO are primarily based on surgical gastro-jejunostomy and endoscopic placement of an enteral self-expanding metal stent.Both treatments are effective;however,endoscopic stent placement is less invasive and it is associated with good short-term results,while surgery provides longer-lasting effects with a lower frequency of reintervention.In the last few years,EUS-guided gastroenterostomy(GE)has been proposed as palliative treatment for malignant GOO.This novel technique consists of the creation of an anastomosis between the gastric lumen and a small bowel loop distal to the malignant obstruction,through the deployment of a lumen-apposing metal stent under EUS-view.EUS-GE has the advantage of being as minimally invasive as enteral stent placement,and of guaranteeing long-term results similar to those of surgery. | Anna Cominardi Giacomo Tamanini Nicole Brighi Pietro Fusaroli Andrea Lisotti | 2021 | World Journal of Gastrointestinal Oncology2021，13，9： | 1 |
| 2 | 电刀辅助切除(KAP)治疗小直肠神经内分泌瘤显示文摘Rectal neuroendocrine neoplasia(rNEN)are usually small(<10mm),well-differentiated(G1/2)lesions arising from the interface between mucosal and submucosal layers;therefore,polypectomy and standard endoscopic mucosal resection(EMR)techniques are usually not curative due to the presence of neoplastic cells on the resection margin,leading to possible tumor recurrence[1].Ligation-assisted EMR and endoscopic submucosal dissection(ESD)have been proposed as treatment of choice in case of lesions<10mm without muscolaris propria involvement[1-3].However,in real practice,most of these lesions undergo standard EMR and are then refereed to tertiary centers in case of incomplete resections[2,3].Pagano et al.[4]recently demonstrated that,in those cases,ESD was indicated for lesions>3mm because of the risk of residual neoplasia. | Andrea Lisotti Sinan Sadalla Anna Cominardi Nicole Brighi Pietro Fusaroli | 2020 | Gastroenterology Report2020，8，6： | 1 |
| 3 | Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages:A systematic review focusing on issues and rescue management显示文摘BACKGROUND The introduction of lumen-apposing metal stents(LAMS)for endoscopic ultrasound(EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings.Nevertheless,the procedure may conceal unexpected pitfalls.LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences.Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure.To date,no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment.AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy(EUS-CDS),gallbladder drainage(EUS-GBD)and pancreatic fluid collections drainage(EUS-PFC)and to describe the endoscopic rescue strategies adopted under the circumstance.METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022.The search was carried out using the exploded medical subject heading terms“lumen apposing metal stent”,“LAMS”,“endoscopic ultrasound”and“choledochoduodenostomy”or“gallbladder”or“pancreatic fluid collections”.We included in the review on-label EUS-guided procedures namely EUS-CDS,EUS-GBD and EUS-PFC.Only those publications reporting EUS-guided LAMS positioning were considered.The studies reporting a technical success rate of 100%and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment,while studies not reporting the causes of technical failure were excluded.Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques.The following data were collected from each study:Author,year of publication,study design,study population,clinical indication,technical success,reported number of misdeployment,stent type and size,flange misdeployed and type of rescue strategy.RESULTS The overall technical success rate of EUS-CDS,EUS-GBD and EUS-PFC was 93.7%,96.1%,and 98.1%respectively.Significant rates of LAMS misdeployment have been reported for EUS-CDS,EUS-GBD and EUS-PFC drainage,respectively 5.8%,3.4%,and 2.0%.Endoscopic rescue treatment was feasible in 86.8%,80%,and 96.8%of cases.Non endoscopic rescue strategies were required only in 10.3%,16%and 3.2%for EUS-CDS,EUS-GBD,and EUS-PFC.The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%,8%and 64.5%and stent-in-stent in 23.5%,60%,and 12.9%,respectively for EUSCDS,EUS-GBD,and EUS-PFC.Further therapeutic option were endoscopic rendezvous in 11.8%of EUS-CDS and repeated procedure of EUS-guided drainage in 16.1%of EUS-PFC.CONCLUSION LAMS misdeployment is a relatively common adverse event in EUS-guided drainages.There is no consensus on the best rescue approach in these cases and the choice is often made by the endoscopist relying upon the clinical scenario,anatomical characteristics,and local expertise.In this review,we investigated the misdeployment of LAMS for each of the on-label indications focusing on the rescue therapies used,with the aim of providing useful data for endoscopists and to improve patient outcomes. | Elia Armellini Flavio Metelli Andrea Anderloni Anna Cominardi Giovanni Aragona Michele Marini FabioPace | 2023 | World Journal of Gastroenterology2023，29，21： | 0 |
| 4 | Single-use duodenoscopes for the prevention of endoscopic retrograde cholangiopancreatography -related cross-infection – from bench studies to clinical evidence显示文摘BACKGROUND Several strategies have been implemented to reduce or abolish the life-threatening risk of endoscopic retrograde cholangiopancreatography(ERCP)-related multidrug-resistant infections due to duodenoscopes contaminations;among those strategies,serial microbiologic tests,thorough reprocessing schedules,and use of removable scope cap have been adopted,but the potential cross-infection risk was not eliminated.AIM To review available evidence in the field of single-use duodenoscopes(SUD)use for ERCP.METHODS An overview on ongoing clinical studies was also performed to delineate which data will become available in the next future.RESULTS One bench comparative study and four clinical trials performed with EXALT model-D(Boston Scientific Corp.,United States)have been identified.Of them,one is a randomized controlled trial,while the other three studies are prospective single-arm,cross-over studies.Pooled technical success rate(4 studies,368 patients)was 92.9%[95%confidence interval(CI):89.9-95.5;I2:11.8%].Pooled serious adverse event(4 studies,381 patients)rate was 5.9%[3.7%-8.5%;I2:0.0%].CONCLUSION Although few clinical trials are available,evidence is concordant in identifying an absolute feasibility and safety and feasibility for SUD use for ERCP.The expertise and quality of evidence in this field are going to be improved by further large clinical trials;data on cost-effectiveness and environmental impact will be needed for a worldwide spread of SUD use for ERCP. | Andrea Lisotti Pietro Fusaroli Bertrand Napoleon Anna Cominardi Rocco Maurizio Zagari | 2022 | World Journal of Methodology2022，12，3： | 0 |
| 5 | Diagnostic performance of endoscopic ultrasound-guided tissue acquisition of splenic lesions:systematic review with pooled analysis显示文摘Background Focal splenic lesions are usually incidentally discovered on radiological assessments.Although percutaneous tissue acquisition(TA)under trans-abdominal ultrasound guidance is a well-established technique for obtaining cyto-histological diagnosis of focal splenic lesions,endoscopic ultrasound(EUS)-guided TA has been described in several studies,reporting different safety and outcomes.The aimwas to assess the pooled safety,adequacy,and accuracy of EUS-TA of splenic lesions.Methods A comprehensive review of available evidence was conducted at the end of November 2021.All studies including more than five patients and reporting about the safety,adequacy,and accuracy of EUS-TA of the spleen were included.Results Six studies(62 patients)were identified;all studies have been conducted using fine-needle aspiration(FNA)needles.Pooled specimen adequacy and accuracy of EUS-TA for spleen characterization were 92.8%[95%confidence interval(CI),86.3%–99.3%]and 88.2%(95%CI,79.3%–97.1%),respectively.The pooled incidence of adverse events(six studies,62 patients)was 4.7%(95%CI,0.4%–9.7%).Conclusion EUS-FNA of the spleen is a safe technique with high diagnostic adequacy and accuracy.The EUS-guided approach could be considered a valid alternative to the percutaneous approach for spleen TA. | Andrea Lisotti Stefano Francesco Crino` Benedetto Mangiavillano Anna Cominardi Andrew Ofosu Nicole Brighi Flavio Metelli Rocco Maurizio Zagari Antonio Facciorusso Pietro Fusaroli | 2022 | Gastroenterology Report2022，10，1： | 0 |
| 6 | Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes显示文摘The differential diagnosis between benign and malignant lymph nodes(LNs)has a fundamental role in the characterization and staging of malignant conditions,as well as in subsequent patients’management.All imaging modalities(i.e.computed tomography and magnetic resonance imaging)rely mainly on size;endoscopic ultrasound(EUS)criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature.The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs,to identify which suspicious LN should require pathological characterization and,finally,to target tissue acquisition.EUS-guided tissue acquisition(EUS-TA)is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’subsequent management and when no superficial LN is accessible.Since target therapy are currently available(i.e.lung cancer,breast cancer),EUS-TA of malignant LNs could be required to identify tumor biology.In this field,both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity.We finally propose a diagnostic algorithm based on most recent,high-level evidence for the diagnostic approach to suspected LNs assessment. | Giacomo Tamanini Anna Cominardi Nicole Brighi Pietro Fusaroli Andrea Lisotti | 2021 | World Journal of Gastrointestinal Oncology2021，13，10： | 0 |
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