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Pancreatic Neoplasms: HELP
Articles by Alessandro Repici
Based on 19 articles published since 2010
(Why 19 articles?)
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Between 2010 and 2020, A. Repici wrote the following 19 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? 2019

Anderloni, Andrea / Troncone, Edoardo / Fugazza, Alessandro / Cappello, Annalisa / Blanco, Giovanna Del Vecchio / Monteleone, Giovanni / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy. andrea.anderloni@humanitas.it. · Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy. ·World J Gastroenterol · Pubmed #31413524.

ABSTRACT: In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (

2 Review Endoscopy-guided ablation of pancreatic lesions: Technical possibilities and clinical outlook. 2017

Signoretti, Marianna / Valente, Roberto / Repici, Alessandro / Delle Fave, Gianfranco / Capurso, Gabriele / Carrara, Silvia. ·Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Gabriele Capurso, Digestive and Liver Disease Unit, S.Andrea Hospital, University Sapienza, 00199 Rome, Italy. ·World J Gastrointest Endosc · Pubmed #28250896.

ABSTRACT: Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting. Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches, and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.

3 Review Role of endoscopy in the management of gastroenteropancreatic neuroendocrine tumours. 2011

De Angelis, C / Pellicano, R / Rizzetto, M / Repici, A. ·Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy. eusdeang@hotmail.com ·Minerva Gastroenterol Dietol · Pubmed #21587152.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) represent in clinical practice a diagnostic dilemma because they are often very small, located deeply within the retroperitoneum or in an extramucosal site in the gastrointestinal (GI) tract and, lastly, because they may be multi-sited. Modern digestive endoscopy offers a myriad of techniques, useful for localization, diagnosis and treatment (therapeutic endoscopy). The available tools include upper digestive endoscopy (esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography), lower digestive endoscopy (ileo-colonoscopy), enteroscopy (push-type, intra-operative, capsule, double or single balloon), for examining the small intestine, diagnostic and interventional echo-endoscopy (EUS), with radial, linear and miniprobe equipment. This narrative review offers scientific support to affirm that endoscopy and EUS give imaging and diagnostic possibilities that are unbeatable in the localization of GEP-NETs both of the GI tract and the pancreas. Endoscopy is useful for localization, bioptic diagnosis and curative resection of small neuroendocrine lesions of the stomach, duodenum, colon-rectum and more recently of the jejuno-ileum. EUS associated with dedicated instruments, particularly high frequency miniprobes, is a valuable procedure in locoregional staging of lesions of the GI wall and can supply information which has a clinical impact on therapeutic options and prognostic value. EUS is still today the sole technique in a certain number of cases which provides a definitive diagnosis of pancreatic insulinoma and to detect and follow subcentimetric lesions of the pancreas in patients with MEN-1 syndrome. It should be used in all those cases where results from radiographic imaging or nuclear medicine techniques show negative or dubious.

4 Article Malignant gastric outlet obstruction: Which is the best therapeutic option? 2020

Troncone, Edoardo / Fugazza, Alessandro / Cappello, Annalisa / Blanco, Giovanna Del Vecchio / Monteleone, Giovanni / Repici, Alessandro / Teoh, Anthony Yuen Bun / Anderloni, Andrea. ·Department of Systems Medicine, University of Rome "Tor Vergata", Napoli 80129, Italy. · Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy. · Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong 999077, China. · Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy. andrea.anderloni@humanitas.it. ·World J Gastroenterol · Pubmed #32390697.

ABSTRACT: Malignant gastric outlet obstruction (MGOO) is a clinical condition characterized by the mechanical obstruction of the pylorus or the duodenum due to tumor compression/infiltration, with consequent reduction or impossibility of an adequate oral intake. MGOO is mainly secondary to advanced pancreatic or gastric cancers, and significantly impacts on patients' survival and quality of life. Patients suffering from this condition often present with intractable vomiting and severe malnutrition, which further compromise therapeutic chances. Currently, palliative strategies are based primarily on surgical gastrojejunostomy and endoscopic enteral stenting with self-expanding metal stents. Several studies have shown that surgical approach has the advantage of a more durable relief of symptoms and the need of fewer re-interventions, at the cost of higher procedure-related risks and longer hospital stay. On the other hand, enteral stenting provides rapid clinical improvement, but have the limit of higher stent dysfunction rate due to tumor ingrowth and a subsequent need of frequent re-interventions. Recently, a third way has come from interventional endoscopic ultrasound, through the development of endoscopic ultrasound-guided gastroenterostomy technique with lumen-apposing metal stent. This new technique may ideally encompass the minimal invasiveness of an endoscopic procedure and the long-lasting effect of the surgical gastrojejunostomy, and brought encouraging results so far, even if prospective comparative trial are still lacking. In this Review, we described technical aspects and clinical outcomes of the above-cited therapeutic approaches, and discussed the open questions about the current management of MGOO.

5 Article EUS-guided core biopsies of pancreatic solid masses using a new fork-tip needle: A multicenter prospective study. 2019

Di Leo, Milena / Crinò, Stefano Francesco / Bernardoni, Laura / Rahal, Daoud / Auriemma, Francesco / Correale, Loredana / Donato, Giulio / Massidda, Marco / Anderloni, Andrea / Manfrin, Erminia / Armellini, Elia / Poliani, Laura / Fugazza, Alessandro / Semeraro, Rossella / Occhipinti, Pietro / Repici, Alessandro / Carrara, Silvia. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy. · Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, G. B. Rossi University Hospital, Verona, Italy. · Pathological Department, Humanitas Research Hospital, Milan, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Centro di Prevenzione Oncologica, Turin, Italy. · Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy. · Department of Diagnostics and Public Health, G. B. Rossi University Hospital, Verona, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. Electronic address: silvia.carrara@humanitas.it. ·Dig Liver Dis · Pubmed #31010744.

ABSTRACT: BACKGROUND AND AIM: Endoscopic ultrasound-guided sampling (EUS sampling) is a safe and effective technique. The study aim was to evaluate the presence of a histological core from pancreatic lesions using a new 25G fork-tip needle. METHODS: Observational multicenter prospective and analytical study, including consecutive patients with solid pancreatic masses referred for EUS-guided sampling. At each needle pass, the endoscopist performed macroscopic on-site evaluation (MOSE). The primary outcome was the histological core procurement rates. Secondary outcomes were the evaluation of interobserver agreement between endoscopists and pathologists, adequacy of EUS samples for the diagnosis and post-procedure adverse events. RESULTS: 100 patients were enrolled in 3 centers. The mean size of the lesions was 28.5 mm (SD 11.7). Final diagnoses were adenocarcinoma (68%), neuroendocrine tumor (21%), inflammatory mass/benign lesions (8.0%), and pancreatic metastasis (3.0%). The pathologists described the presence of a core in 67 samples (67.0% of patients), with poor agreement with MOSE (kappa, 0. 12; 95% CI: 0.03-0.28). The diagnostic accuracy was 93%. We observed 6% of mild adverse events. CONCLUSION: The new 25-gauge core needle showed good overall adequacy and a good rate of histological specimens during EUS sampling of solid pancreatic masses, with a minimum number of passes and no major complications. Clinicaltrial.gov number, NCT02946840.

6 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.

7 Article Rescue management of recurrent duodenal and biliary obstruction due to lumen-apposing metal stent distal migration and duodenal stent ingrowth. 2019

Attardo, Simona / Auriemma, Francesco / Fugazza, Alessandro / Maselli, Roberta / Carrara, Silvia / Anderloni, Andrea / Repici, Alessandro. ·Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milano, Italy. · Humanitas University, Department of Biomedical Sciences, Rozzano, Milano, Italy. ·Endoscopy · Pubmed #30836383.

ABSTRACT: -- No abstract --

8 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.

9 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 --

10 Article Cautery-Tipped Lumen Apposing Metal Stent Placement Through the Mesh of an Indwelling Duodenal Self-Expanding Metal Stent. 2018

Anderloni, Andrea / Fugazza, Alessandro / Auriemma, Francesco / Maia, Luís / Maselli, Roberta / Troncone, Edoardo / DʼAmico, Ferdinando / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. Gastroenterology Department, Porto University Hospital Center, Porto, Portugal. Humanitas University, Milan, Italy. ·Am J Gastroenterol · Pubmed #29681628.

ABSTRACT: -- No abstract --

11 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.).

12 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 --

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 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%.

15 Article A case of primary pancreatic non-Hodgkin B-cell lymphoma mimicking autoimmune pancreatitis. 2015

Anderloni, Andrea / Genco, Chiara / Ballarè, Marco / Carmagnola, Stefania / Battista, Serena / Repici, Alessandro. ·Department of Gastroenterology, Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy. andrea.anderloni@humanitas.it. · Division of Endoscopy, Istituto Europeo Oncologico, Milan, Italy. · Gastrointestinal and Digestive Endoscopy Unit, AOU Maggiore della Carità, Novara, Italy. · Gastrointestinal and Digestive Endoscopy Unit, AOU Luigi Sacco, Milan, Italy. · Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy. · Department of Gastroenterology, Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy. ·J Gastrointestin Liver Dis · Pubmed #26114186.

ABSTRACT: Non Hodgkin lymphoma frequently involves the gastrointestinal tract, in particular the stomach and the small bowel. Rarely, it can also be a cause of pancreatic masses. Clinical presentation is often non-specific and may overlap with other pancreatic conditions such as carcinoma, neuroendocrine tumours and autoimmune pancreatitis. We report a case of primary pancreatic lymphoma in a young woman with jaundice, fever and abdominal pain mimicking autoimmune pancreatitis. Clinical evaluation included the abdominal Computed Tomography scan, Magnetic Resonance Imaging and an upper gastrointestinal endoscopy that revealed a large duodenal mass. Endoscopic biopsies were performed and eventually histological examination was coherent with a diagnosis of primary pancreatic lymphoma.

16 Article Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. 2014

Tarantino, Ilaria / Di Mitri, Roberto / Fabbri, Carlo / Pagano, Nico / Barresi, Luca / Granata, Antonino / Liotta, Rosa / Mocciaro, Filippo / Maimone, Antonella / Baccarini, Paola / Fabio, Tuzzolino / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milano, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Pathology Unit, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. · Pathology Unit, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Office of Research, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. ·Dig Liver Dis · Pubmed #24704290.

ABSTRACT: BACKGROUND: Endoscopic ultrasound fine needle aspiration has a central role in the diagnostic algorithm of solid pancreatic masses. Data comparing the fine needle aspiration performed with different aspiration volume and without aspiration are lacking. We compared endoscopic ultrasound fine needle aspiration performed with the 22 gauge needle with different aspiration volumes (10, 20 and 0 ml), for adequacy, diagnostic accuracy and complications. METHODS: Prospective clinical study at four referral centres. Endoscopic ultrasound fine needle aspiration was performed with a 22G needle with both volume aspiration (10 and 20 cc) and without syringe, in randomly assigned sequence. The cyto-pathologist was blinded as to which aspiration was used for each specimen. RESULTS: 100 patients met the inclusion criteria, 88 completed the study. The masses had a mean size of 32.21±11.24 mm. Sample adequacy evaluated on site was 87.5% with 20 ml aspiration vs. 76.1% with 10 ml (p=0.051), and 45.4% without aspiration (20 ml vs. 0 ml p<0.001; 10 ml vs. 0 ml p<0.001). The diagnostic accuracy was significantly better with 20 ml than with 10 ml and 0 ml (86.2% vs. 69.0% vs. 49.4% p<0.001). CONCLUSIONS: A significantly higher adequacy and accuracy were observed with the 20 ml aspiration puncture, therefore performing all passes with this volume aspiration may improve the diagnostic power of fine needle aspiration.

17 Article Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. 2014

Tarantino, Ilaria / Fabbri, Carlo / Di Mitri, Roberto / Pagano, Nico / Barresi, Luca / Mocciaro, Filippo / Maimone, Antonella / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milan, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. ·Dig Liver Dis · Pubmed #24054767.

ABSTRACT: BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been reported to have a higher complication rate than that of solid lesions, but the real complication rate is unknown. Aim of the study was to identify the complication rate of endoscopic ultrasound-guided fine needle aspiration and related risk factors. METHODS: Prospective multicenter study at four referral centres. Data were collected from January 2010 to July 2012, searching for all adverse events related to guided fine needle aspiration. All complications occurring up to day 90 were recorded. RESULTS: 298 patients (43.9% male, mean age 63.2 ± 15.4 years) underwent endoscopic ultrasound-guided needle aspiration of pancreatic cystic lesions. Mean size was 34.1 ± 9 mm. Adverse events occurred in 18 patients (6%): mild complications in 12/18 (66.6%), and moderate complications in 6/18 (33.3%). Seven were immediate, 6 early, and 5 late. All resolved with medical therapy. CONCLUSIONS: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been found to be associated with a higher complication rate than for solid lesions; however, the risk rate is acceptable considering the complication grade and the important diagnostic role of the technique in the management of pancreatic cystic lesions.

18 Article The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: a meta-analysis of prospective studies. 2013

Fuccio, Lorenzo / Hassan, Cesare / Laterza, Liboria / Correale, Loredana / Pagano, Nico / Bocus, Paolo / Fabbri, Carlo / Maimone, Antonella / Cennamo, Vincenzo / Repici, Alessandro / Costamagna, Guido / Bazzoli, Franco / Larghi, Alberto. ·Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. ·Gastrointest Endosc · Pubmed #23660563.

ABSTRACT: BACKGROUND: Differential diagnosis of pancreatic solid masses with EUS-guided FNA (EUS-FNA) is still challenging in about 15% of cases. Mutation of the K-ras gene is present in over 75% of pancreatic adenocarcinomas (PADC). OBJECTIVE: To assess the accuracy of K-ras gene mutation analysis for diagnosing PADC. DESIGN: We systematically searched the electronic databases for relevant studies published. Data from selected studies underwent meta-analysis by use of a bivariate model providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve. SETTING: Meta-analysis of 8 prospective studies. PATIENTS: Total of 931 patients undergoing EUS-FNA for diagnosis of pancreatic solid masses. INTERVENTION: K-ras mutation analysis. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of K-ras mutation analysis and of combined diagnostic strategy by using EUS-FNA and K-ras mutation analysis in the diagnosis of PADC. RESULTS: The pooled sensitivity of EUS-FNA for the differential diagnosis of PADC was 80.6%, and the specificity was 97%. Estimated sensitivity and specificity were 76.8% and 93.3% for K-ras gene analysis, respectively, and 88.7% and 92% for combined EUS-FNA plus K-ras mutation analysis. Overall, K-ras mutation testing applied to cases that were inconclusive by EUS-FNA reduced the false-negative rate by 55.6%, with a false-positive rate of 10.7%. Not repeating EUS-FNA in cases in which mutation testing of the K-ras gene is inconclusive would reduce the repeat-biopsy rate from 12.5% to 6.8%. LIMITATIONS: Small number of studies and between-study heterogeneity. CONCLUSION: K-ras mutation analysis can be useful in the diagnostic work-up of pancreatic masses, in particular when tissue obtained by EUS-FNA is insufficient, and the diagnosis inconclusive.

19 Article Negative predictive value of endoscopic ultrasound in patients referred for fine-needle aspiration. 2011

Bruno, M / Carucci, P / Repici, A / Pellicano, R / Mezzabotta, L / Goss, M / Fagoonee, S / Allegranza, P / Reggio, D / Rizzetto, M / De Angelis, C. ·Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy. ·Panminerva Med · Pubmed #21775944.

ABSTRACT: AIM: Endoscopic ultrasound (EUS) is a valuable diagnostic tool in pancreatic diseases and its high negative predictive value (NPV) in excluding malignancies is universally recognized. Moreover, EUS with fine-needle aspiration (EUS-FNA) can significantly impact on diagnosis and management of many clinical conditions. However, there are circumstances in which EUS-FNA cannot or should not be performed. We evaluated the factors that prevented us from performing or induced us not to perform FNA. METHODS: The study was conducted in a tertiary university hospital. A total of 211 patients suspected of having solid pancreatic malignancy on the basis of clinical presentation and computed tomography and/or magnetic resonance imaging was included. When FNA was withheld because not deemed necessary by the operator, the NPV of EUS was calculated. RESULTS: In 9 patients (4.3% of the procedures), FNA was withheld because of contraindications that should have been foreseen by the referring physician. In 30 subjects, FNA was not accomplished as no lesions requiring biopsy were actually found at EUS exploration. In this group, EUS reached a NPV of 96.7% in excluding malignancy, but it reached 100% in patients without chronic pancreatitis. CONCLUSION: In a cohort of patients with high pre-test probability of malignancy, the high NPV of EUS was confirmed. False negative results should be expected in patients with chronic pancreatitis and they need a strict follow-up.