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Milano, Italy

Filiberti R.,Clinical Epidemiology | Fontana V.,Clinical Epidemiology | De Ceglie A.,Digestive Endoscopy | Blanchi S.,Gastroenterology | And 11 more authors.
Cancer Causes and Control | Year: 2015

Purpose: To evaluate the role of smoking in Barrett’s esophagus (BE) and erosive esophagitis (E) compared to endoscopic controls with no BE or E. Smoking is considered a cause of both BE and E, but results on this topic are quite controversial. Methods: Patients with BE (339), E (462) and controls (619: 280 with GERD (gastroesophageal reflux disease)-negative and 339 with GERD-positive anamnesis) were recruited in 12 Italian endoscopy units. Data were obtained from structured questionnaires. Results: Among former smokers, a remarkable upward linear trend was found in BE for all smoking-related predictors. In particular, having smoked for more than 32 years increased the risk more than two times (OR 2.44, 95 % CL 1.33–4.45). When the analysis was performed in the subgroup of subjects with GERD-negative anamnesis, the risk of late quitters (<9 years) passed from OR 2.11 (95 % CL 1.19–3.72) to OR 4.42 (95 % CL 1.52–12.8). A noticeably positive dose–response relationship with duration was seen also among current smokers. As regards E, no straightforward evidence of association was detected, but for an increased risk of late quitters (OR 1.84, 95 % CL 1.14–2.98) in former smokers and for early age at starting (OR 3.63, 95 % CL 1.19–11.1) in GERD-negative current smokers. Conclusions: Smoking seems to be an independent determinant of BE and, to a lesser degree, of E. The elevation in risk is independent from GERD and is already present in light cigarette smokers. Smoking cessation may reduce, but not remove this risk. © 2014, Springer International Publishing Switzerland. Source

Mangiavillano B.,University of Milan | Manes G.,Digestive Endoscopy | Baron T.H.,Gastrointestinal Endosocpy | Frego R.,Endoscopy Unit | And 7 more authors.
Digestive Diseases and Sciences | Year: 2014

Background: Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable metal stents (FCSEMS) but stent migration occurs in up to 35.7 %. The aim of this study was to prospectively assess the rate of, safety and effectiveness and stent migration of a new biliary FCSEMS with an anti-migration flap (FCSEMS-AF) in patients with BBD. Patients and Methods: This was a prospective study from four Italian referral endoscopy centers of 32 consecutive patients (10 females and 22 males; mean age: 60.1 ± 14.8 years; range: 32–84 years) with BBD who were offered endoscopic placement of a FCSEMS-AF as first-line therapy. Results: Were 24 strictures and 8 leaks. Stent placement was technically successful in 32/32 patients (100 %). Immediate clinical improvement was seen in all 32 patients (100 %). One late stent migration occurred (3.3 %). FCSEMS-AF were removed from 30 of the 32 patients (93.7 %) at a mean (±SD) of 124.4 ± 84.2 days (range: 10–386 days) after placement. All patients remained clinically and biochemically well at 1- and 3-month follow-up. One patient (3.3 %) with a post-laparoscopic cholecystectomy stricture developed distal stent migration at 125 days. Conclusion: This new FCSEMS with anti-migration flap seems to be a safe and effective first-line treatment option for patients with BBD. © 2014, Springer Science+Business Media New York. Source

Tammaro L.,Gastroenterology and Digestive Endoscopy | Buda A.,University of Padua | Di Paolo M.C.,Gastroenterology and Digestive Endoscopy | Zullo A.,Gastroenterology and Digestive Endoscopy | And 58 more authors.
Digestive and Liver Disease | Year: 2014

Background: Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. Aims: To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. Methods: In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Results: Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p=0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p=0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p=0.3). Conclusions: The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy. © 2014 Editrice Gastroenterologica Italiana S.r.l. Source

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