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Biomedical subjects

Pier Alberto Testoni

Publications and source records attributed to Pier Alberto Testoni.

17 recordsLinked to original sources
PubMed2007

Endoscopic stenting in benign pancreatic diseases.

The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present, most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

Optical coherence tomography to detect epithelial lesions of the main pancreatic duct: an Ex Vivo study.

BACKGROUND: Optical coherence tomography (OCT) permits high-resolution, real-time, infrared-generated imaging of tissue microstructures by a probe inserted through the endoscope operative channel. Resolution is approximately 10 microm and the penetration depth of the near-focus probe is about 1 mm. The probe can be inserted into the main pancreatic duct (MPD) through a standard endoscopic retrograde cholangiopancreatography catheter. AIMS AND METHODS: To assess the ability of OCT to identify the structure of the MPD, to distinguish normal and malignant MPD epithelium, and to assess intra- and interobserver reproducibility of OCT images. Multiple sections of neoplastic and non-neoplastic segments of 10 consecutive surgical pancreatic specimens were obtained from patients with pancreatic head adenocarcinoma who had undergone Whipple resection, and repeated OCT radial and longitudinal scanning was done within 1 h of resection and before pathological examination. We compared 249 good-quality images with 100 histopathological sections. RESULTS: OCT recognized a definite, different pattern in 82.9% of tumor-free and in 97.6% of tumor-involved specimens; sensitivity and specificity for discrimination between adenocarcinoma and normal tissue were 78.6% and 88.9%, respectively. Inflammatory and dysplastic changes of the MPD showed an OCT pattern similar to that of the normal tissue in 53.3% of images. Overall, intraobserver reproducibility ranged from 85.1% to 100% and interobserver reproducibility ranged from 69.9% to 100% and from 89.7% to 100% for tumor-free and tumor-involved segments, respectively. CONCLUSIONS: OCT identified the neoplastic and non-neoplastic MPD layer structure and appeared to be a reproducible technique. In non-neoplastic conditions, OCT appeared unable to differentiate between normal and abnormal tissues in about half of the cases.

Adenocarcinoma↗
PubMed2004

Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP.

BACKGROUND: A target-controlled infusion system automatically adjusts the rate of infusion of propofol to maintain a desired (target) concentration. The aim of this study was to determine whether administration of propofol with a target-controlled infusion system could improve the sedation of patients undergoing ERCP. METHODS: A total of 205 consecutive patients undergoing ERCP were sedated by using a propofol target-controlled infusion system by an anesthesiologist. The target plasma concentration of propofol ranged from 2 to 5 microg/mL. A bolus dose of fentanyl (50-100 mcg) was administered if signs of insufficient analgesia were observed at the maximum target concentration of propofol allowed. The technical difficulty of ERCP was graded on a scale from 1 (least difficult) to 5 (most difficult). RESULTS: The mean dosages of propofol and fentanyl administered were 465 (245) mg and 59 (23) mcg, respectively. The total dose of propofol administered and the mean duration of ERCP were related to the degree of difficulty of the procedure. No severe complication was observed; mean time to discharge was 31 (12) minutes. Time to discharge was not influenced by the difficulty of ERCP or by the total dose of propofol administered. CONCLUSIONS: A target-controlled infusion system for administration of propofol provides safe and effective sedation during ERCP. Further studies are needed to determine the cost-effectiveness and the safety profile for infusion of propofol with a target-controlled infusion system by a nonanesthesiologist during ERCP.

Adult↗
PubMed2003

Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis.

BACKGROUND: Sphincter of Oddi dysfunction plays an important etiologic role in idiopathic acute recurrent pancreatitis. Sphincter of Oddi manometry is the most accurate test of sphincter of Oddi function, but it is associated with an increased risk of post-procedure pancreatitis and is non-diagnostic in about a third of cases. Secretin MRCP has a diagnostic efficacy comparable to ERCP, but data on its sensitivity with regard to sphincter of Oddi function are lacking. The aim of this study was to compare secretin MRCP and pancreatic sphincter of Oddi manometry for evaluation of sphincter of Oddi function in patients with idiopathic acute recurrent pancreatitis. METHODS: Eighteen consecutive patients with idiopathic acute recurrent pancreatitis underwent secretin MRCP and pancreatic sphincter of Oddi manometry/ERCP. Data from 15 patients were suitable for analysis. Fifteen subjects with asymptomatic, non-pancreatic hyperamylasemia matched for age and gender underwent secretin MRCP and served as a control group. RESULTS: Sphincter of Oddi manometry documented sphincter dysfunction in 6/15 patients (40%) and secretin MRCP, in 4/15 patients (26.7%). Sphincter of Oddi manometry confirmed the presence of elevated basal sphincter of Oddi pressure in two of the 4 patients with abnormal and other forms of sphincter of Oddi dyskinesia in the other two. None of the control subjects had an abnormal secretin MRCP. Secretin MRCP and sphincter of Oddi manometry were concordant in 13/15 patients (86.7%); positive and negative diagnoses for sphincter of Oddi dysfunction agreed in, respectively, 81.8% and 100% (kappa value 0.706). CONCLUSIONS: Secretin MRCP seems to be a useful noninvasive procedure for investigation of pancreatic sphincter of Oddi function, but evaluation in larger series is needed.

Adolescent↗
PubMed2003

A pilot trial of Saccharomyces boulardii in ulcerative colitis.

OBJECTIVES: Probiotics can be useful in the treatment of inflammatory bowel disease. In a previous report, the non-pathogenic yeast Saccharomyces boulardii was found to be beneficial in the maintenance treatment of Crohn's disease. The aim of this study was to assess the efficacy of S. boulardii in ulcerative colitis patients. METHODS: A group of 25 patients with a mild to moderate clinical flare-up of ulcerative colitis received additional treatment with S. boulardii 250 mg three times a day for 4 weeks during maintenance treatment with mesalazine. These patients were unsuitable for steroid therapy. Before and after treatment, Rachmilewitz's clinical activity index was calculated. The probiotic treatment was considered a therapeutic success only when the final score was lower than 6. RESULTS: Of the 24 patients who completed the study, 17 attained clinical remission; this was confirmed endoscopically. CONCLUSIONS: Our preliminary results suggest that S. boulardii can be effective in the treatment of ulcerative colitis. Controlled studies with this probiotic agent are warranted.

Adult↗
PubMed2003

Electroacupuncture analgesia for colonoscopy. a prospective, randomized, placebo-controlled study.

OBJECTIVE: A study was undertaken to compare the effectiveness of acupuncture in reducing patient's discomfort and anxiety during colonoscopy with a standard sedation protocol. METHODS: Thirty patients scheduled to undergo colonoscopy were randomly assigned to receive acupuncture, sham, or no acupuncture. A verbal rating scale was used to measure patient's pain when the endoscope reached four scheduled positions. Midazolam was administered at baseline and again anytime patients complained of "severe" pain. The amount of midazolam administered was recorded. A verbal rating scale was used to assess patient's satisfaction with the level of sedation achieved. RESULTS: Pain level was lower, although not significantly, in the acupuncture group. Midazolam boluses were required in three patients with acupuncture (30%), eight in the sham group (80%), and nine in the control group (90%) (p = 0.01). Six patients in the acupuncture group (60%) reported optimum acceptance of colonoscopy compared with only one in the sham group (10%) and none in the control group (0%) (p = 0.016). Satisfaction scores, assessed 24-72 h after colonoscopy, were extremely high (median score 90 of 100) in the three groups. CONCLUSIONS: Acupuncture may decrease the demand for sedative drugs during colonoscopy by reducing discomfort and anxiety of the patient and the well-known adverse effects of pharmacologic sedation.

Acupuncture Analgesia↗
PubMed2003

Comparison of two dosing regimens of gabexate in the prophylaxis of post-ERCP pancreatitis.

OBJECTIVES: A continuous 13-h infusion of gabexate starting 30-90 min before endoscopic cholangiopancreatography (ERCP) can reduce postprocedural pancreatitis, the onset of which is generally observed within the first 6 h after ERCP. This study was designed to verify whether a 6.5-h infusion of gabexate was as effective as a 13-h infusion, at the same concentration, for reducing the incidence of post-ERCP pancreatitis (primary endpoint) and pancreatic hyperenzymemia and pain (secondary endpoints). METHODS: A total of 434 patients (201 male and 233 female; mean age 63.9 yr, range 18-96 yr) scheduled for ERCP were prospectively recruited in 25 Italian centers. Patients were randomized double-blind to two treatment groups. All subjects enrolled were first treated with a 500-mg continuous intravenous infusion of gabexate, starting 30 min before the endoscopic maneuvers and continuing up to 6.5 h after it. Over the next 6.5 h, 214 patients (group I) continued the infusion of gabexate (for a total of 1 g over 13 h) and 220 patients (group II) were given placebo (saline solution). RESULTS: The overall incidence of acute pancreatitis was 1.8% (eight patients), which included 1.4% in group I (three of 214 patients) and 2.2% in group II (five of 220 patients). Serum amylase and lipase values over time, peak levels of the two enzymes, pancreatic pain, and need for analgesics did not significantly differ in the two groups. CONCLUSIONS: These results suggest that a 6.5-h infusion of gabexate (for a total of 500 mg) is not less effective than a 13 h infusion, with evident savings.

Acute Disease↗
PubMed2003

Preventing post-ERCP pancreatitis: where are we?

Acute pancreatitis still represents the most common complication after procedures involving Vater's papilla; the reported incidence of this complication varies from less than 1% up to 40%. Attempts at preventing post-ERCP pancreatitis have been carried out using technical measures, pharmacological prophylaxis, or patient selection. Balloon sphincter of Oddi dilatation, difficult papillary cannulation, pancreatic sphincterotomy and multiple pancreatic duct injections have been found to be risk factors for postprocedure pancreatitis. Therefore, technique-related prevention of post-ERCP pancreatitis includes careful pancreatic duct injection, avoiding cannulation trauma, and maintaining adequate pancreatic drainage after the ERCP procedure. Pancreatic stent placement has been shown to be the most effective technique-related prevention of postprocedure pancreatitis. Apart from technique-related risk factors, operator experience also seems to be a potential risk-factor for post-ERCP/ES complications. The experience of the endoscopist rather than other patient- or technique-related conditions could probably constitute the major risk factor for postprocedure pancreatitis. Pharmacological prevention of pancreatitis after ERCP or sphincterotomy has been the topic of several investigations in recent years but still remains a debated question. Pharmacological prevention has been mainly aimed at either reducing the amount of intrapancreatic enzymes, preventing intra-cellular co-localization of enzymes and lysosomal hydrolases or blocking some steps of the enzyme-activated inflammatory cascade. Somatostatin, octreotide, gabexate mesilate and, more recently, recombinant interleukin-10 have been the most investigated drugs. Somatostatin, gabexate mesilate and recombinant interleukin-10, but not octreotide, have been found to be able to prevent post-ERCP pancreatitis in non-selected cases; however, a strategy of routine pharmacological prophylaxis in all patients is not likely to be cost-effective. A strategy of pharmacological prevention only in high-risk cases is cost-effective, but, up to now, only recombinant interleukin-10 has been proven effective. The "on demand" postprocedure treatment should also be of paramount importance, but no data are at present available regarding the potential efficacy of some drugs; on the basis of the mechanism of action, we can argue that recombinant interleukin-10 could be the only drug candidate for such a strategy. Post-ERCP pancreatitis can also be prevented by patient selection. Patient-related risk factors are now well-known, so an increased risk of developing pancreatitis is predictable "a priori" in these subjects, independently of the type of endoscopic procedure performed. Furthermore, the risk of pancreatitis escalates when multiple risk factors occur in the same patient or some technique-related risk factor comes up during the procedure. In these patients diagnostic ERCP should be avoided in routine practice and magnetic resonance cholangio-pancreatography should be used as the first diagnostic step. When either diagnostic or therapeutic ERCP is indicated, these high-risk patients should be informed about their own specific risk of postprocedure pancreatitis.

Animals↗
PubMed2002

In diffuse atrophic gastritis, routine histology underestimates Helicobacter pylori infection.

BACKGROUND: histologic detection of shows high diagnostic accuracy in chronic nonatrophic gastritis. However, when atrophy occurs, the sensitivity of bacterial detection varies. This study assessed the routine histologic sensitivity for current infection in patients with atrophic gastritis, with and without intestinal metaplasia. STUDY: five hundred and ten consecutive patients with diffuse chronic atrophic gastritis, with (174 cases) and without (336 cases) intestinal metaplasia, were investigated following the Sydney System recommendations. In cases with negative tissue staining for Helicobacter-like organisms, serum immunoglobulin G (IgG) antibodies to were assayed. RESULTS: the overall rate of positive staining for Helicobacter-like organisms was 51.8% (264 of 510 cases), 62.8% and 30.4% in cases without and with intestinal metaplasia, respectively. Serum IgG antibody determination was consistent with current infection in 180 (73.2%) of the 246 cases with negative histology. detection rate was significantly lower ( < 0.01) in Grade 3 than in Grade 1 atrophy. When intestinal metaplasia was present, histologic bacterial detection progressively decreased, from 46.3% to 20%, depending on severity. infection was found by histology in 42.2% and in 56.2% of cases with inactive and active disease, respectively. Overall, the diagnostic accuracy of histology was significantly lower ( <0.001) than that of histology combined with serology. CONCLUSIONS: most (87.1%) diffuse chronic atrophic gastritis patients showed serum antibody IgG levels consistent with current infection, although histology was positive in only 59.5% of cases. Gastritis activity and current infection did not ever correlate in the presence of mucosal atrophy and/or intestinal metaplasia. Routine biopsy sampling, hematoxylin and eosin staining, and Giemsa staining therefore underestimated the true prevalence of infection.

Adult↗
PubMed2002

Direct detection of Helicobacter pylori mutations associated with macrolide resistance in gastric biopsy material taken from human immunodeficiency virus-infected subjects.

One hundred forty gastric biopsies were tested by microbiological methods and by amplifying a sequence of 23S rRNA and identifying mutations associated to clarithromycin resistance. Seventy-six specimens were positive for Helicobacter pylori. Mutational analysis revealed alterations in 18 (39.1%) of 46 and 2 (8.7%) of 23 samples from human immunodeficiency virus-seropositive and -seronegative persons, respectively. The results of the mutational analysis fully correlated with those of the susceptibility tests.

Anti-Bacterial Agents↗
PubMed2002

Distal ulcerative colitis refractory to rectal mesalamine: role of transdermal nicotine versus oral mesalamine.

BACKGROUND: Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined. AIM: To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine. PATIENTS AND METHODS: Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800 mg tid for four weeks. Clinical remission was evaluated by Rachmilewitz's activity index and confirmed by sigmoidoscopy. RESULTS: Remission was observed in 12 of 15 patients receiving additional treatment with nicotine and in five of 15 patients receiving additional treatment with oral mesalamine (P=0.027). CONCLUSIONS: The addition of transdermal nicotine to treatment with mesalamine enemas is significantly superior to combined therapy with oral and rectal mesalamine in patients with distal ulcerative colitis refractory to rectal mesalamine alone.

Administration, Cutaneous↗
PubMed2002

Unresolved issues about post-ERCP pancreatitis: an overview.

Pancreatitis represents the most common and feared complication after endoscopic retrograde cholangio-pancreatography. Since the introduction of ERCP into clinical practice, many attempts have been made to identify the mechanisms and conditions that can place patients at risk of developing post-procedure pancreatitis, with conflicting and in most cases unsatisfactory results. The following questions about post-ERCP pancreatitis still remain unanswered: the knowledge of the mechanisms involved in the onset of pancreatitis, procedural factors that can induce pancreatic damage, patient conditions that can increase the risk of developing pancreatitis in the post-procedure period, criteria for predicting the occurrence of pancreatitis, and possible methods of preventing the complication. Moreover, the criteria used to define post-ERCP pancreatitis differ in various studies and, consequently, there is a wide variation in the literature of the incidence of this complication and it is still not clear what its real incidence is. In the last six years, a significant advance in knowledge has been achieved in most of the above-mentioned fields. Four large prospective multicentre trials seemed to definitely identify patient- and technique-related risk factors that can place patients at risk of developing post-ERCP pancreatitis; clinical conditions, procedure- and patient-related factors, and laboratory tests able to predict the occurrence of post-ERCP pancreatitis in the early phase have been identified. An attempt to identify criteria for defining post-ERCP pancreatitis has also been carried out, although these proposed criteria have not been widely adopted by all Authors.

Biomarkers↗
PubMed2002

Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication.

The reported incidence of post-ERCP/sphincterotomy pancreatitis ranges between 1.3 and 24.4% in non-selected series. This varying incidence likely reflects on the one hand difference in patient populations, indications and endoscopic expertise and, on the other hand, different definitions of pancreatitis and methods of data collection. Among a number of patient-related factors recognized at risk for post-ERCP pancreatitis in four recent large prospective studies, the combination of female gender, normal serum bilirubin levels and recurrent abdominal pain suggesting sphincter of Oddi dysfunction and previous post-ERCP pancreatitis placed patients at an increasingly higher risk of pancreatitis. Among the technique-related risk factors for post-ERCP pancreatitis, biliary sphincter balloon dilation, difficult cannulation, sphincter of Oddi manometry and pancreatic sphincterotomy have also been recognized as significant risk factors. However, since the case mix in non-selected series does not significantly differ in the different studies, it is logical to assume that the different criteria adopted for defining the post-ERCP pancreatitis play a key role in the reported wide variation of incidence reported for this complication. The occurrence and duration of pain and the amplitude of serum amylase after ERCP are critical points in the definition of post-ERCP pancreatitis. Although a consensus conference identified 24-hour persisting pain associated with hyperamylasemia greater than 3 times the upper reference limit as an indicator of pancreatitis, these two parameters are however considered in a different manner in the studies available up to now. In a prospective study where we calculated the incidence of post-ERCP pancreatitis by using the most widely used criteria, for both occurrence and duration of pancreatic pain and serum amylase amplitude, the incidence of post-procedure pancreatitis ranged from 1.9 to 11.7% depending on the criteria adopted.

Cholangiopancreatography, Endoscopic Retrograde↗