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Pancreatic Neoplasms: HELP
Articles by Silvia Carrara
Based on 22 articles published since 2008
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Between 2008 and 2019, S. Carrara wrote the following 22 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. 2017

Polkowski, Marcin / Jenssen, Christian / Kaye, Philip / Carrara, Silvia / Deprez, Pierre / Gines, Angels / Fernández-Esparrach, Gloria / Eisendrath, Pierre / Aithal, Guruprasad P / Arcidiacono, Paolo / Barthet, Marc / Bastos, Pedro / Fornelli, Adele / Napoleon, Bertrand / Iglesias-Garcia, Julio / Seicean, Andrada / Larghi, Alberto / Hassan, Cesare / van Hooft, Jeanin E / Dumonceau, Jean-Marc. ·Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland. · Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland. · Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany. · Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy. · Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. · Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain. · Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium. · Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy. · Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France. · Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal. · Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy. · Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France. · Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #28898917.

ABSTRACT: For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

2 Review Celiac plexus block for pancreatic cancer pain in adults. 2011

Arcidiacono, Paolo G / Calori, Giliola / Carrara, Silvia / McNicol, Ewan D / Testoni, Pier A. ·Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Institute, Via Olgettina 60, Milano, Lombardia, Italy, 21032. ·Cochrane Database Syst Rev · Pubmed #21412903.

ABSTRACT: BACKGROUND: Pancreatic cancer causes severe pain in 50 to 70% of patients and is often difficult to treat. Celiac plexus block (CPB) is thought to be a safe and effective technique for reducing the severity of pain. OBJECTIVES: To determine the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain, and to identify adverse effects and differences in efficacy between the different techniques. SEARCH STRATEGY: We searched Cochrane CENTRAL, MEDLINE, GATEWAY and EMBASE from 1990 to December 2010. SELECTION CRITERIA: Randomised controlled trials (RCTs) of CPB by the percutaneous approach or endoscopic ultrasonography (EUS)-guided neurolysis in adults with pancreatic cancer at any stage, with a minimum of four weeks follow-up. DATA COLLECTION AND ANALYSIS: We recorded details of study design, participants, disease, setting, outcome assessors, pain intensity (visual analogue scale (VAS)) and methods of calculation. MAIN RESULTS: The search identified 102 potentially eligible studies. Judged from the information in the title and abstract six of these concerning the percutaneous block, involving 358 participants, fulfilled the inclusion criteria and were included in the review. All were RCTs in which the participants were followed for at least four weeks. We excluded studies published only as abstracts. We identified one RCT comparing EUS-guided or computed tomography (CT) -guided CPB but its aim was to assess efficacy in controlling chronic abdominal pain associated with chronic pancreatitis rather than pancreatic cancer, so it was excluded.For pain (VAS) at four weeks the mean difference was -0.42 in favour of CPB (95% confidence interval (CI) -0.70 to - 0.13, P = 0.004, fixed-effect model). At eight weeks the mean difference was -0.44 (95% CI -0.89 to - 0.01, random-effects model). At eight weeks there was significant heterogeneity (I(2) = 89%).Opioid consumption was significantly lower in the CPB group than the control group (P < 0.00001).  AUTHORS' CONCLUSIONS: Although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients. Further studies and RCTs are recommended to demonstrate the potential efficacy of a less invasive technique under EUS guidance.

3 Clinical Trial Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. 2012

Arcidiacono, Paolo Giorgio / Carrara, Silvia / Reni, Michele / Petrone, Maria Chiara / Cappio, Stefano / Balzano, Gianpaolo / Boemo, Cinzia / Cereda, Stefano / Nicoletti, Roberto / Enderle, Markus Dominik / Neugebauer, Alexander / von Renteln, Daniel / Eickhoff, Axel / Testoni, Pier Alberto. ·Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University-Scientific Institute San Raffaele, Milan, Italy. arcidiacono.paologiorgio@hsr.it ·Gastrointest Endosc · Pubmed #23021160.

ABSTRACT: BACKGROUND: New therapies are needed for pancreatic cancer. OBJECTIVE: To determine the feasibility and safety of a new endoscopic treatment. Secondary endpoints were to determine effects on tumor growth measured with CT scan and to find the overall survival. DESIGN: A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance. SETTING: San Raffaele Hospital, Milan, Italy; University Medical Center, Hamburg-Eppendorf, Germany. PATIENTS: A total of 22 patients (male/female 11/11; mean age 61.9 years) were enrolled from September 2009 to May 2011. INTERVENTION: Radiofrequency heating: 18 W; pressure for cooling: 650 psi (Pounds per Square Inch); application time: depending on tumor size. MAIN OUTCOME MEASUREMENTS: Feasibility was evaluated during the procedure. A clinical and radiologic follow-up was planned. RESULTS: The CTP was successfully applied in 16 patients (72.8%); in 6 it was not possible because of stiffness of the GI wall and of the tumor. Amylase arose in 3 of 16 patients; none had clinical signs of pancreatitis. Late complications arose in 4 cases: 3 were mostly related to tumor progression. Median postablation survival time was 6 months. A CT scan was performed in all patients, but only in 6 of 16 was it possible to clearly define the tumor margins after ablation. In these patients, the tumor appeared smaller compared with the initial mass (P = .07). LIMITATIONS: Small sample of patients, difficulty of objectifying the size of the ablated zone by CT scan. CONCLUSION: EUS-guided CTP ablation is feasible and safe. Further investigations are needed to demonstrate progression-free survival and local control.

4 Clinical Trial Does cytotechnician training influence the accuracy of EUS-guided fine-needle aspiration of pancreatic masses? 2012

Petrone, Maria Chiara / Arcidiacono, Paolo Giorgio / Carrara, Silvia / Mezzi, Gianni / Doglioni, Claudio / Testoni, Pier Alberto. ·Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy. petrone.mariachiara@hsr.it ·Dig Liver Dis · Pubmed #22226546.

ABSTRACT: BACKGROUND/AIM: The presence of on-site cytopathologists improves the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic masses; however, on-site cytopathologists are not available to all endoscopic units. We hypothesized that experienced cytotechnicians can accurately assess whether an on-site pancreatic mass fine needle aspiration specimen is adequate. The aim of this study was to evaluate the effect of formal cytotechnician training on the diagnostic accuracy of EUS-FNA of pancreatic masses. METHODS: Single-centre, prospective study. The cytotechnician made an on-site assessment of specimen adequacy with immediate evaluation of smears over a 12-month period (pre-training period) then over another 12-month period (post-training period), with a year's intermediate training when the cytopathologist and the cytotechnician worked together in the room. The gold standard used to establish the final diagnosis was based on a non-equivocal fine needle aspiration biopsy reviewed by the same expert cytopathologist. The main outcome measurements were the cytotechnician diagnostic accuracy before and after the training period. RESULTS: A total of 107 patients were enrolled in the pre-training period. Cytotechnician in-room adequacy was 68.2% (73/107). The diagnostic accuracy was 74.8%. The adequacy for the blind-review pathologist was 93.4% (100/107), significantly higher (p=0.008) than the cytotechnician's results. During the post-training period, 95 EUS-FNA were performed and reviewed. Cytotechnician in-room adequacy was 87.4% (83/95). The diagnostic accuracy was 90.5%. The adequacy for the blinded pathologist was 95.8% (91/95), not significantly different from the cytotechnician (p=0.23). CONCLUSIONS: An adequate training period with an expert pathologist significantly improves the cytotechnician skill in terms of judging adequacy and diagnostic accuracy.

5 Article Pancreatic Neuroendocrine Tumours: The Role of Endoscopic Ultrasound Biopsy in Diagnosis and Grading Based on the WHO 2017 Classification. 2019

Di Leo, Milena / Poliani, Laura / Rahal, Daoud / Auriemma, Francesco / Anderloni, Andrea / Ridolfi, Cristina / Spaggiari, Paola / Capretti, Giovanni / Di Tommaso, Luca / Preatoni, Paoletta / Zerbi, Alessandro / Carnaghi, Carlo / Lania, Andrea / Malesci, Alberto / Repici, Alessandro / Carrara, Silvia. ·Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy, milena.di_leo@hunimed.eu. · Humanitas University, Department of Biomedical Sciences, Milan, Italy, milena.di_leo@hunimed.eu. · Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy. · Department of Pathology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy. · Humanitas Clinical and Research Center, IRCCS, Pancreatic Surgery Unit, Milan, Italy. · Humanitas University, Department of Biomedical Sciences, Milan, Italy. · Humanitas Clinical and Research Center, IRCCS, Division of Gastroenterology, Milan, Italy. · Humanitas Clinical and Research Center, IRCCS, Division of Oncology, Milan, Italy. · Humanitas Clinical and Research Center, IRCCS, Division of Endocrinology, Milan, Italy. ·Dig Dis · Pubmed #30897588.

ABSTRACT: BACKGROUND: One of the controversial issues in the diagnosis of pancreatic neuroendocrine tumours (pNETs) is the accurate prediction of their clinical behaviour. OBJECTIVES: The aim of the study was to evaluate the role of endoscopic ultrasound (EUS) biopsy in the diagnosis and grading of pNETs in a certified ENETS Center. METHODS: A prospectively maintained database of EUS biopsy procedures was retrospectively reviewed to identify all consecutive patients referred to a certified ENETS Center with a suspicion of pNET between June 2014 and April 2017. The cytological and/or histological specimens were stained and the Ki-67 labeling index was evaluated. In patients undergoing surgery, the grade obtained with EUS-guided biopsy was compared with the final histological grade. The grade was evaluated according to the 2017 WHO classifications and grading. RESULTS: The study population included 59 patients. EUS biopsy material reached an adequacy of 98.3% and was adequate for Ki-67 evaluation in 84.7% of cases. Twenty-nine patients (49.2%) underwent surgery. Of these, 25 patients had Ki-67 evaluated on EUS biopsy: the agreement between EUS biopsy grading and surgical specimen grading was 84%. CONCLUSION: EUS biopsy is an accurate method for the diagnosis and grading of pNETs based on the WHO 2017 Ki-67 labelling scheme.

6 Article Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. 2019

Anderloni, Andrea / Fugazza, Alessandro / Troncone, Edoardo / Auriemma, Francesco / Carrara, Silvia / Semeraro, Rossella / Maselli, Roberta / Di Leo, Milena / D'Amico, Ferdinando / Sethi, Amrita / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Pancreaticobiliary Endoscopy Services, Division of Digestive and Liver Disease, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy; Humanitas University, Rozzano, Milan, Italy. ·Gastrointest Endosc · Pubmed #30189198.

ABSTRACT: BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. METHODS: This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. RESULTS: Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). CONCLUSIONS: EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.

7 Article Direct per-oral pancreatoscopy as a diagnostic tool for intraductal papillary mucinous neoplasm. 2018

Anderloni, Andrea / Fugazza, Alessandro / Troncone, Edoardo / Carrara, Silvia / Rovati, Andrea / Spaggiari, Paola / Repici, Alessandro. ·Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan,Italy. andrea.anderloni@humanitas.it. · Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan,Italy. · Oncology Unit, Ospedale Maggiore di Lodi, Lodi,Italy. · Department of Pathology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan;Humanitas University, Rozzano, Milan, Italy. ·J Gastrointestin Liver Dis · Pubmed #30240462.

ABSTRACT: -- No abstract --

8 Article Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A multicenter study. 2018

Barresi, Luca / Crinò, Stefano F / Fabbri, Carlo / Attili, Fabia / Poley, Jan W / Carrara, Silvia / Tarantino, Ilaria / Bernardoni, Laura / Giovanelli, Silvia / Di Leo, Milena / Manfrin, Erminia / Tacelli, Matteo / Bruno, Marco J / Traina, Mario / Larghi, Alberto. ·Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy. · Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Gastroenterology and Surgical Sciences, Bellaria-Maggiore Hospital, AUSL Bologna, University of Bologna, Bologna, Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy. ·Dig Endosc · Pubmed #29808529.

ABSTRACT: BACKGROUND AND AIM: Tissue acquisition in pancreatic cystic lesions (PCL) is the ideal method for diagnosis and risk stratification for malignancy of these lesions. Direct sampling from the walls of PCL with different devices has shown better results than cytology from cystic fluid. We carried out a retrospective, multicenter study to evaluate the feasibility, safety, and diagnostic yield of a micro-forceps, specifically designed to be used through a 19-gauge needle after endoscopic ultrasonography (EUS)-guided puncture of PCL. METHODS: We retrospectively collected data from patients who underwent EUS-through-the-needle biopsy (EUS-TTNB) in PCL at six referral centers. RESULTS: The sampling procedure was carried out in 56 patients (mean age 57.5 ± 13.1 years, M:F 17:39), and was technically successful in all of them (100%; 95% confidence interval [CI], 94-100%). Adverse events occurred in 9/56 (16.1%; 95% CI, 8-28%) patients, with self-limited intracystic hemorrhage the most common (7/56, 12.5%; 95% CI, 5-24%). All adverse events were mild, and resolved without any specific intervention. Specimens were considered adequate for histological diagnosis in 47/56 (83.9%; 95% CI, 72-92%). In two of these patients, despite the histological adequacy, a diagnosis could not be reached. In two other cases, a specimen sufficient for a cytological diagnosis was obtained. Overall diagnostic yield by combining cytological and histological samples was 47/56 (83.9%; 95% CI, 72-92%). CONCLUSION: EUS-TTNB with micro-forceps in PCL is feasible, safe, and has a high diagnostic yield. Future prospective studies are needed to better assess the clinical impact of EUS-TTNB on the management of PCL.

9 Article EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions. 2018

Carrara, Silvia / Di Leo, Milena / Grizzi, Fabio / Correale, Loredana / Rahal, Daoud / Anderloni, Andrea / Auriemma, Francesco / Fugazza, Alessandro / Preatoni, Paoletta / Maselli, Roberta / Hassan, Cesare / Finati, Elena / Mangiavillano, Benedetto / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy. · Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Milan, Italy. · Centro di Prevenzione Oncologica, Turin, Italy. · Department of Pathology, Humanitas Clinical and Research Center, Milan, Italy. · Endoscopic Unit, Nuovo Regina Margherita Hospital, Rome, Italy. · Digestive Endoscopy Unit, Humanitas Mater Domini, Varese, Italy. ·Gastrointest Endosc · Pubmed #29329992.

ABSTRACT: BACKGROUND AND AIMS: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis-based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. METHODS: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. RESULTS: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001). CONCLUSIONS: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.).

10 Article Rectal metastases from malignant mucinous cystic neoplasm of the pancreas mimicking a rectal carcinoma. 2018

Carrara, Silvia / Di Leo, Milena / Spaggiari, Paola / Bagnoli, Pietro Francesco / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Department of Biomedical Sciences, Humanitas University, Milan, Italy. · Department of Pathology, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy. · Department of Cancer Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy. ·Gastrointest Endosc · Pubmed #28673644.

ABSTRACT: -- No abstract --

11 Article International Intraductal Papillary Mucinous Neoplasms Registry: Long-Term Results Based on the New Guidelines. 2017

Moris, Maria / Raimondo, Massimo / Woodward, Timothy A / Skinner, Verna J / Arcidiacono, Paolo G / Petrone, Maria C / De Angelis, Claudio / Manfrè, Selene / Carrara, Silvia / Jovani, Manol / Fusaroli, Pietro / Wallace, Michael B. ·From the *Department of Gastroenterology and †Clinical Studies Unit, Mayo Clinic, Jacksonville, FL; ‡Department of Gastroenterology, San Raffaele Scientific Institute, Milan; §Department of Gastroenterology, Azienda Universitario-Ospedaliera San Giovanni Battista, Turin; ∥Department of Gastroenterology, Humanitas Research Hospital, Milan; and ¶Department of Gastroenterology, University of Bologna/Hospital of Imola, Italy. ·Pancreas · Pubmed #28099263.

ABSTRACT: OBJECTIVE: The aim of this study was to analyze the outcomes of a long-term intraductal papillary mucinous neoplasm (IPMN) registry and evaluate new guidelines. METHODS: A prospectively maintained IPMN registry involving 6 centers in Europe and the United States was used to collect the data. Patients with more than 1-year follow-up and no malignancy diagnosed within the first 3 months of surveillance were included. RESULTS: From 1999 to 2014, 620 patients were included. The median follow-up time was 3 years. Thirty-seven (6%) patients developed malignancy with a median time from IPMN diagnosis to malignancy of 10.3 months. The 1-, 5-, and 10-year actuarial rates of disease-free survival were 97%, 93%, and 92% respectively. Four hundred thirty-one patients met criteria for low-risk branch duct IPMN consisting of cyst size less than 3 cm, with no solid component or main duct dilation. Eight malignancies were diagnosed in this subgroup, all of them within the first 5 years. From this subcohort, 112 patients had a follow-up time of more than 5 years, and no malignancy was diagnosed. CONCLUSIONS: In IPMN lesions with low-risk features at baseline, the risk of progression to malignancy after the first 5 years of follow-up was minimal. Furthermore, the main cyst characteristics remained unchanged during their surveillance.

12 Article The Golden Compass to the Depths. 2016

Carrara, Silvia / Di Leo, Milena / Zerbi, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano Milan, Italy. · Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano Milan, Italy. ·Gastroenterology · Pubmed #27713050.

ABSTRACT: -- No abstract --

13 Article Single-session double-stent placement in concomitant malignant biliary and duodenal obstruction with a cautery-tipped lumen apposing metal stent. 2016

Anderloni, Andrea / Buda, Andrea / Carrara, Silvia / Di Leo, Milena / Fugazza, Alessandro / Maselli, Roberta / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, "S. Maria del Prato" Hospital, Feltre, Italy. ·Endoscopy · Pubmed #27706541.

ABSTRACT: -- No abstract --

14 Article A Bone in the Pancreas. 2016

Carrara, Silvia / Spaggiari, Paola / Zerbi, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano Milan, Italy. · Department of Pathology, Humanitas Research Hospital, Rozzano Milan, Italy. · Pancreatic Surgery Unit, Humanitas Research Hospital, Rozzano Milan, Italy. ·Gastroenterology · Pubmed #26718169.

ABSTRACT: -- No abstract --

15 Article A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses. 2016

Carrara, Silvia / Anderloni, Andrea / Jovani, Manol / Di Tommaso, Luca / Rahal, Daoud / Hassan, Cesare / Ridola, Lorenzo / Federico, Davide / Loriga, Alessandra / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: silvia.carrara@humanitas.it. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Department of Pathology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. ·Dig Liver Dis · Pubmed #26607829.

ABSTRACT: BACKGROUND: A new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes. AIMS: To prospectively compare the efficacy of the new 25-G needles and 22-G needles for obtaining an adequate aspirate of solid masses. METHODS: Randomized controlled trial of 144 patients referred for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses, intraparietal tumours, or lymph-nodes, randomized to the 25-G or 22-G needle arms. RESULTS: An adequate specimen was obtained from 74.3% of cases. The sample tended to be more adequate in the 25-G compared to the 22-G group (81% vs. 68%; p=0.09). Crossover was required in 14 (19%) and 12 (17%) cases in the 22-G and in the 25-G groups, respectively (p=0.7). The overall rate of adequacy improved from 74% before crossover to 90% after crossover (p<0.01). When comparing the two groups after crossover, the rate of obtaining adequate samples was significantly higher in the 25-G arm than in the 22-G arm (95.8% vs. 86.1%; p=0.03). CONCLUSIONS: The 25-G needle was superior to the 22-G needle for endoscopic ultrasound-guided fine-needle aspiration biopsy. The adequacy and diagnostic accuracy improved after crossover, reaching 90%.

16 Article Cyst fluid biomarkers for intraductal papillary mucinous neoplasms of the pancreas: a critical review from the international expert meeting on pancreatic branch-duct-intraductal papillary mucinous neoplasms. 2015

Maker, Ajay V / Carrara, Silvia / Jamieson, Nigel B / Pelaez-Luna, Mario / Lennon, Anne Marie / Dal Molin, Marco / Scarpa, Aldo / Frulloni, Luca / Brugge, William R. ·Department of Surgery, Division of Surgical Oncology; University of Illinois at Chicago, Chicago, IL. Electronic address: amaker@uic.edu. · Digestive Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy. · Department of Surgery, University of Glasgow, Scotland. · Department of Gastroenterology; Instituto Nacional de Ciencias Medicas y Nutrición - School of Medicine - Universidad Nacional Autonoma de Mexico, Mexico City, Mexico. · Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD. · Department of Pathology, Johns Hopkins University, Baltimore, MD. · Department of Pathology and Diagnostics, University of Verona; Verona, Italy. · Department of Medicine, Section of Gastroenterology, University of Verona; Verona, Italy. · Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA. ·J Am Coll Surg · Pubmed #25592469.

ABSTRACT: -- No abstract --

17 Article Mucin expression pattern in pancreatic diseases: findings from EUS-guided fine-needle aspiration biopsies. 2011

Carrara, Silvia / Cangi, Maria Giulia / Arcidiacono, Paolo Giorgio / Perri, Francesco / Petrone, Maria Chiara / Mezzi, Gianni / Boemo, Cinzia / Talarico, Anna / Cin, Elena Dal / Grassini, Greta / Doglioni, Claudio / Testoni, Pier Alberto. ·Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. carrara.silvia@hsr.it ·Am J Gastroenterol · Pubmed #21647207.

ABSTRACT: OBJECTIVES: Alterations in mucin (MUC) glycosylation and expression have been described in cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can provide material for molecular biology analysis. This study assessed the feasibility of evaluating MUC expression from material obtained by EUS-FNA and studied the profile of MUC expression in benign and malignant pancreatic lesions. METHODS: A total of 90 patients with solid or cystic pancreatic lesions underwent FNA. The aspirated material was used for cytological analysis and RNA extraction to assess the expression pattern of MUCs by reverse transcription-PCR with primers specific for the MUC1, MUC2, MUC3, MUC4, MUC5A, MUC5B, MUC6, and MUC7 genes. RESULTS: RNA extraction was successful in 81% of the biopsies. The prevalences of MUC1, MUC2, MUC4, and MUC7 in ductal adenocarcinoma were 57.7, 51.4, 18.9, and 73.0%, respectively. Fifty percent of benign lesions and neuroendocrine tumors (NETs), and 63% of intraductal papillary mucinous neoplasms (IPMNs) were positive for MUC1. Twenty-five percent of benign lesions, 86% of NETs, and 47% of IPMNs were positive for MUC2. Of NETs, 50% were positive for MUC1, and 14% were positive for MUC7. None of the benign lesions or NETs expressed MUC4. MUC7 expression was highly significant for adenocarcinoma (P=0.007) and borderline for IPMN (P=0.05). MUC7 was expressed in 37.5% of chronic pancreatitis cases. CONCLUSIONS: RNA can be extracted from samples obtained under EUS-FNA. MUC7 could serve as a potential biological marker to identify malignant lesions, especially pancreatic adenocarcinoma.

18 Article US-guided application of a new hybrid probe in human pancreatic adenocarcinoma: an ex vivo study. 2010

Petrone, Maria Chiara / Arcidiacono, Paolo Giorgio / Carrara, Silvia / Albarello, Luca / Enderle, Markus D / Neugebauer, Alexander / Boemo, Cinzia / Doglioni, Claudio / Testoni, Pier Alberto. ·Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy. ·Gastrointest Endosc · Pubmed #20598256.

ABSTRACT: BACKGROUND: Ablative therapies such as radiofrequency and cryotechnology are widely used in oncological intervention but not in the pancreatic field because of their high operative risks. A new flexible bipolar ablation device (Cryotherm probe [CTP]) was developed combining radiofrequency and cryotechnology. OBJECTIVE: To evaluate the efficacy of the CTP in destroying neoplastic tissue of explanted pancreatic tumors of patients with pancreatic adenocarcinoma. DESIGN: Ex vivo clinical study. SETTING: Inpatient hospital setting. PATIENTS: This study involved 16 explanted pancreatic tumors from 16 patients. INTERVENTIONS: CTP application was performed on explanted pancreatic tumors. Anatomic specimens were divided into 4 groups; each group received a predefined application time of 120 to 600 seconds. MAIN OUTCOME MEASUREMENTS: The coagulation diameter (short axis) perpendicular to the device's longitudinal axis was used as the primary outcome measure. RESULTS: All pancreatic specimens showed histological signs of coagulative necrosis. There was a positive correlation between the short axis of the obtained necrosis and duration of application (r = 0.74). LIMITATIONS: This study was an ex vivo study with all limitations typical of this kind of study. CONCLUSIONS: The CTP is effective in destroying neoplastic pancreatic tissue, creating an ablation zone, the extent of which is related to the duration of application.

19 Article Pancreatic endoscopic ultrasound-guided fine needle aspiration: complication rate and clinical course in a single centre. 2010

Carrara, Silvia / Arcidiacono, Paolo Giorgio / Mezzi, Gianni / Petrone, Maria Chiara / Boemo, Cinzia / Testoni, Pier Alberto. ·Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. carrara.silvia@hsr.it ·Dig Liver Dis · Pubmed #19955025.

ABSTRACT: BACKGROUND: Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) is effective for obtaining biopsy specimens from pancreatic lesions. AIM: To determine the frequency and severity of complications after EUS-FNA of solid and cystic pancreatic lesions in a single centre large series of patients. PATIENTS AND METHODS: From January 2005 to December 2008, information on all patients referred to our unit for pancreatic EUS was systematically entered in a computer database including clinical and morphologic data. Records were reviewed to evaluate whether complications such as haemorrhage, acute pancreatitis, intestinal perforation, or others occurred after EUS-FNA of the pancreas. RESULTS: A total of 3296 pancreatic EUS were done in four years. In the 1034 pancreatic EUS-FNA, we observed 10 (0.96%) haemorrhages (7 intracystic, 2 in the pancreatic duct, and 1 in a small carcinoma), 2 (0.19%) acute severe pancreatitis and 1 (0.09%) duodenal perforation followed by complicated post-surgical hospitalization and death. The haemorrhages were all self-limiting. Overall, major complications (pancreatitis and perforation) arose in 0.29% of these examinations. CONCLUSIONS: EUS-FNA is safe, with a low risk of severe haemorrhage. Although rare, acute pancreatitis is generally mild or severe, requiring prolonged hospitalization. One fatal complication occurred after duodenal perforation in a patient with duodenal neuroendocrine tumour and pancreatic infiltration.

20 Article Ascaris lumbricoides-induced acute pancreatitis: diagnosis during EUS for a suspected small pancreatic tumor. 2009

Mangiavillano, Benedetto / Carrara, Silvia / Petrone, Maria Chiara / Arcidiacono, Paolo Giorgio / Testoni, Pier Alberto. ·Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. mangiavillano.benedetto@hsr.it ·JOP · Pubmed #19734641.

ABSTRACT: CONTEXT: Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. CASE REPORT: We describe the case of a 37-year-old man, with a history of travelling in Eastern countries who presented with Ascaris lumbricoides-induced acute pancreatitis mimicking a small pancreatic cancer, diagnosed during an upper EUS. The endoscopy revealeda roundworm floating in the duodenum; its endoultrasonographic appearance showed a diffuse inhomogeneous pattern, with hypoechoic echotexture, such as in acute pancreatitis. Microbiological examination of the worm revealed a 20 cm long Ascaris lumbricoides. CONCLUSION: In non endemic countries, acute pancreatitis induced by Ascaris lumbricoides is an unusual diagnosis, and should be suspected especially in patients with history of traveling in endemic areas.

21 Article Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction: a pilot in vivo study. 2009

Testoni, P A / Mangiavillano, B / Mariani, A / Carrara, S / Notaristefano, C / Arcidiacono, P G. ·Division of Gastroenterology & Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy. testoni.pieralberto@hsr.it ·Dig Liver Dis · Pubmed #19403347.

ABSTRACT: BACKGROUND: Type 1 sphincter of Oddi dysfunction is a clinical entity characterised by biliary-type pain, elevated liver biochemical tests, and common bile duct dilation. Sphincter fibrosis is a common finding in this type of dysfunction and may require in some cases a differential diagnosis with a malignant intra-papillary disease. Optical coherence tomography permits high-resolution, real-time imaging of the sphincter of Oddi microstructure by a probe inserted into the common bile duct through an ERCP catheter. No data exist on the evaluation of sphincter of Oddi fibrosis by optical coherence tomography during ERCP in vivo. OBJECTIVE: To assess the feasibility of optical coherence tomography investigation of the sphincter of Oddi structure and assess its potential for diagnosing type 1 sphincter of Oddi dysfunction. PATIENTS: Ten consecutive patients, five with biliary-type 1 sphincter of Oddi dysfunction and five with pancreatic head/mid-body adenocarcinoma not involving the papillary region, who underwent both endoscopic ultrasound and therapeutic ERCP, were investigated by optical coherence tomography immediately before biliary sphincterotomy or stenting. RESULTS: In all sphincter of Oddi dysfunction patients optical coherence tomography recognised a hyper-reflective intermediate, fibro-muscular layer, significantly thicker than in patients with non-pathological sphincter of Oddi (p<0.0001). CONCLUSIONS: Optical coherence tomography imaging recognised an increased thickness and reflectance of the fibro-muscular layer of the sphincter of Oddi, very likely determined by fibrosis, and was not time-consuming; it can be safely used during ERCP to confirm the diagnosis in difficult cases. Its use in clinical practice has one important limitation since it requires magnification in the post-procedure computer analysis to obtain images useful for diagnosis.

22 Minor Acute hemorrhage with retroperitoneal hematoma after endoscopic ultrasound-guided fine-needle aspiration of an intraductal papillary mucinous neoplasm of the pancreas. 2009

Carrara, Silvia / Arcidiacono, Paolo Giorgio / Giussani, Antonella / Testoni, Pier Alberto. · ·Am J Gastroenterol · Pubmed #19491887.

ABSTRACT: -- No abstract --