Matteo Antonino

Serum ferritin as a new prognostic factor in hepatocellular carcinoma patients treated with radiofrequency ablation

Hepatic iron accumulation is considered to be a cofactor that influences liver injury and hepatocarcinogenesis. Aim of this study is to determine whether serum ferritin (SF) levels relate to overall survival (OS) and time to recurrence (TTR) in hepatocellular carcinoma (HCC) patients treated with percutaneous radiofrequency ablation (RFA).

Non-polypoid colorectal neoplasms: Classification, therapy and follow-up

In the last years, an increasing interest has been raised on non-polypoid colorectal tumors (NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally, called laterally spreading tumors (LST). LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection. According to the Paris classification, NPTs are distinguished in slightly elevated (0-IIa, less than 2.5 mm), flat (0-IIb) or slightly depressed (0-IIc). NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions, cell proliferation growth progresses in depth in the colonic wall, thus leading to an increased risk of submucosal invasion (SMI) even for smaller neoplasms. NPTs may be frequently missed by inexperienced endoscopists, thus a careful training and precise assessment of all suspected mucosal areas should be performed. Chromoendoscopy or, if possible, narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs, and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and, therefore, to guide the therapeutic decision. Lesions suitable to endoscopic resection are those confined to the mucosa (or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible. Endoscopic mucosal resection (EMR, piecemeal for LSTs > 20 mm, en bloc for smaller neoplasms) remains the first-line therapy for NPTs, whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR. After piecemeal EMR, follow-up colonoscopy should be performed at 3 mo to assess resection completeness. In case of en bloc resection, surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions ≥ 1 cm, or in presence of villous features or high-grade dysplasia patients (regardless of the size), while less intensive surveillance (colonoscopy at 5-10 years) is needed in case of single (or two) NPT < 1 cm presenting tubular features or low-grade dysplasia at histology.

Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation

BACKGROUND Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation. METHODS Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68-82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases. RESULTS A total of 103 patients were included (82.5% male; median age 70 years, range 39-86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54-78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16-35). Child-Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival. CONCLUSIONS In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.

Conditional survival analysis of hepatocellular carcinoma patients treated with radiofrequency ablation

Survival estimates are commonly reported as survival from the first observation, but future survival probability changes based on the survival time already accumulated after therapy, otherwise known as conditional survival (CS). The aim of the study was to describe CS according to different prognostic variables in hepatocellular carcinoma (HCC) patients treated with radiofrequency ablation (RFA).

Role of vaptans in the management of hydroelectrolytic imbalance in liver cirrhosis

Ascites and hyponatremia are the most common complications in patients with liver cirrhosis and develop as a consequence of a severe impairment of liver function and portal hypertension. Increasing evidences support the central role of renal function alterations in the pathogenesis of hydroelectrolytic imbalances in cirrhotic patients, thus implying a dense cross-talk between liver and kidney in the systemic and splanchnic vascular homeostasis in such subjects. Since Arginin Vasopressin (AVP) hyperincretion occurs at late stage of cirrhosis and plays an important role in the development of refractory ascites, dilutional hyponatremia and finally hepato-renal syndrome, selective antagonists of AVP receptors V2 (vaptans) have been recently introduced in the therapeutic algorithm of advanced cirrhotic patients. Despite the promising results of earlier phase-two studies, randomized controlled trials failed to find significant results in terms of efficacy of such drugs both in refractory ascites and hyponatremia. Moreover, concerns on their safety profile arise, due to the number of potentially severe side effects of vaptans in the clinical setting, such as hypernatremia, dehydration, renal impairment, and osmotic demyelination syndrome. More robust data from randomized controlled trials are needed in order to confirm the potential role of vaptans in the management of advanced cirrhotic patients.

Management of Complications After Endoscopic Polypectomy

Polypectomy is associated with complications such as bleeding, perforation, and post-polypectomy coagulation syndrome. Moreover, nearly 30% of patients experience gastrointestinal symptoms including abdominal pain, diarrhea, bloating, and nausea that usually resolve within 24–48 h.

P.04.16 ENDOSCOPIC POST FUNDOPLICATIO: IS IT NECESSARY?

Background and aim: GERD is a chronic, relapsing disease, with complications (EB). The pharmacological and surgical treatments antireflux are effective in controlling the symptoms of reflux. The laparoscopic fundoplicatio is effective in the prevention of pathological reflux acids and non-acids. The aim of our study is to evaluate the effectiveness of endoscopy after fundoplicatio. Material and methods: From February 2011 to October 2012 we performed endoscopy in 15 patients who underwent laparoscopic fundoplicatio for gastroesophageal reflux. The indication to perform endoscopy was a continuation or recurrence of reflux-related symptoms or onset of new symptoms, dysphagia. 12 patients had 15–18 weeks after complaining dyspeptic symptoms (postprandial bloating and heaviness, regurgitation, etc.), 3 patients had dysphagia to solids after 8–12 weeks after surgery. All patients were subjected to EGDS and has been evaluated the morphology of the gastroesophageal junction sec the classification of Hill skinfold mucosa along the lesser curve with endoscope in retroversion. Results: 8 patients was grade I sec. Classification Hill (prominent fold mucosa), 4 patients were grade II sec. Classification Hill (fold mucosa present with the opening and closing), 3 patients were grade III sec. Classification Hill. Patients with dysphagia had the fold mucosa not prominent and therefore fell within the grade III. Conclusions: EGDS after fundoplicatio is a simple procedure that allows to verify the effectiveness of surgical treatment, gastroesophageal continence and the possible presence of recurrent hernia. Must be made if patients have symptoms or persistent symptoms of new onset.