Vincenzo Bove

EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy

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 mm2 (±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 mm2 (±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 technology after POEM remains controversial.

Endoscopic resection for gastrointestinal neuroendocrine tumors.

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.

New methods of teaching the axis in ERCP: Can I write my name?

ERCP is among the most difficult procedures in gastrointestinal endoscopy. In fact, as testified by P. B. Cotton in the 1960s to the 1970s, ERCP was “difficult to overstate,” and it still is today. Learning ERCP demands patience, skills, and an understanding of cholangiopancreatographic anatomy and imaging interpretation, as well as the ability to gain the cannulation axis and choose the adequate accessories. Most of all, knowing how to deal with ERCP-related adverse events is probably the key to “standing alone.” ERCP training in patients can be very risky. Simulators allow the practicing of invasive endoscopic procedures in

A novel triple-anchoring technique for hybrid endoscopic mucosal resection

Superficial colorectal lesions smaller than 20mm in size can be safely removed en bloc by endoscopic mucosal resection (EMR). Bigger lesions (≥20mm) usually require piecemeal EMR, which is associated with a lower curative rate [1] and a higher risk of recurrence [2]. Endoscopic submucosal dissection (ESD) was developed to allow en bloc resection of early stage gastrointestinal lesions. ESD is a technically difficult procedure, which requires specialized training, a longer procedure time, and is associated with a higher risk of perforation compared with EMR [3, 4]. ESD and EMR are not mutually exclusive and a hybrid technique may be a reasonable compromise that makes EMR more reliable by enabling the resection of larger polyp specimens, obtaining clear lateral margins, and reducing procedure times [5]. Here we report a new hybrid EMR technique that is aimed at facilitating mucosal resection of colonic and rectal lesions between 20mm and 30mm in size. After the submucosal injection has been performed, small incisions are made on the top and on the lateral margins of the lesion using the tip of the snare (25-mm SnareMaster; Olympus, Tokyo, Japan), which must be protruding 2mm out of the catheter. The small incision on the top of the lesion allows the snare to be anchored as it is opened, while the lateral incisions allow the lesion to be grasped as the snare is being closed, thereby avoiding slippage during the resection (▶Fig. 1; ▶Video1). Before cutting is E-Videos

Endotherapy of chronic calcified pancreatitis by ESWL+ERCP: Preliminary long-term results

CLASSIFICATIONS OF AN ITALIAN SERIES OF AUTOIMMUNE PANCREATITIS BY INTERNATIONAL CONSENSUS DIAGNOSTIC CRITERIA (ICDC) A. Amodio ∗ ,3, T. Ikeura2 , R. Manfredi 1 , G. Zamboni 4, P. Capelli 4 , R. Negrelli 1 , A. Calio4 , A. Gabbrielli 3 , L. Benini 3, K. Okazaki 2, L. Frulloni 3 1Department of Radiology, University of Verona, Verona, Italy; 2Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan; 3Department of Medicine, University of Verona, Verona, Italy; 4Department of Pathology, University of Verona, Verona, Italy