Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bili...Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fullycovered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents.展开更多
The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel pre...The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel preparation(BP).In this review,we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy.Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’acceptability.The role of the diet before colonoscopy was also changed,as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’tolerance and/or quality of BP.The review also described BP in special situations,as lower gastrointestinal bleeding,elderly people,patients with chronic kidney disease,patients with inflammatory bowel disease,patients with congestive heart failure,inpatient,patient with previous bowel resection,pregnant/lactating patients.The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales.Finally,the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota.Moreover,the study underlined several points needed to further investigations.展开更多
The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy ...The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy is both diagnostic and interventional and in the last years the techniques have undergone a rapid expansion with the advent of different and novel endoscopic modalities, with consequent improvement of investigation and treatment of these patients. The choice of best therapeutic strategy depends on many factors: baseline disease, patient's clinical performance and the timing when it is done if in emergency or a prophylactic approaches. In this review we evaluate the endoscopic management of patients with the gastrointestinal complications of portal hypertension.展开更多
Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare tumors derived from the neuroendocrine cell system,which that have increased in incidence and prevalence in recent years.Despite improvements in radiol...Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare tumors derived from the neuroendocrine cell system,which that have increased in incidence and prevalence in recent years.Despite improvements in radiological and metabolic imaging,endoscopy still plays a pivotal role in the number of GEPNENs.Tumor detection,characterization,and staging are essential in management and treatment planning.Upper and lower gastrointestinal(GI)endoscopy is essential for correct localization of the primary tumor site of GI NENs.Endoscopic ultrasonography(EUS)has an important role in the imaging and tissue acquisition of pancreatic NENs and locoregional staging of GI neuroendocrine tumors.Correct staging and histological diagnosis have important prognostic implications.Endoscopic operating techniques allow the removal of small GI NENs in the early stage of mucosal or submucosal invasion of the intestinal wall.Preoperative EUS-guided techniques may help the surgeon locate small and deep tumors,thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery.Finally,locoregional ablative treatments have been proposed in recent studies with promising results in selected patients.展开更多
文摘Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fullycovered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents.
文摘The incidence of colorectal cancer(CRC)is characterized by rapid declines in the wake of widespread screening.Colonoscopy is the gold standard for CRC screening,but its accuracy is related to high quality of bowel preparation(BP).In this review,we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy.Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’acceptability.The role of the diet before colonoscopy was also changed,as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’tolerance and/or quality of BP.The review also described BP in special situations,as lower gastrointestinal bleeding,elderly people,patients with chronic kidney disease,patients with inflammatory bowel disease,patients with congestive heart failure,inpatient,patient with previous bowel resection,pregnant/lactating patients.The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales.Finally,the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota.Moreover,the study underlined several points needed to further investigations.
文摘The management of patients with gastrointestinal complications of portal hypertension is often complex and challenging. The endoscopy plays an important role in the management of these patients. The role of endoscopy is both diagnostic and interventional and in the last years the techniques have undergone a rapid expansion with the advent of different and novel endoscopic modalities, with consequent improvement of investigation and treatment of these patients. The choice of best therapeutic strategy depends on many factors: baseline disease, patient's clinical performance and the timing when it is done if in emergency or a prophylactic approaches. In this review we evaluate the endoscopic management of patients with the gastrointestinal complications of portal hypertension.
文摘Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)are rare tumors derived from the neuroendocrine cell system,which that have increased in incidence and prevalence in recent years.Despite improvements in radiological and metabolic imaging,endoscopy still plays a pivotal role in the number of GEPNENs.Tumor detection,characterization,and staging are essential in management and treatment planning.Upper and lower gastrointestinal(GI)endoscopy is essential for correct localization of the primary tumor site of GI NENs.Endoscopic ultrasonography(EUS)has an important role in the imaging and tissue acquisition of pancreatic NENs and locoregional staging of GI neuroendocrine tumors.Correct staging and histological diagnosis have important prognostic implications.Endoscopic operating techniques allow the removal of small GI NENs in the early stage of mucosal or submucosal invasion of the intestinal wall.Preoperative EUS-guided techniques may help the surgeon locate small and deep tumors,thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery.Finally,locoregional ablative treatments have been proposed in recent studies with promising results in selected patients.
