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Ciulla A.,General Hospital Paolo Giaccone | Cremona F.,General Hospital Paolo Giaccone | Genova G.,General Hospital Paolo Giaccone | Maiorana A.M.,General Hospital Paolo Giaccone
Minerva Gastroenterologica e Dietologica | Year: 2013

Aim. Achalasia, also known as Esophageal achalasia, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus (inability of smooth muscle to move food down the esophagus) in the absence of other explanations like cancer or fibrosis. In our experience, the echo-guided injection technique is the first procedure to implement to cure patients. After endoscopic-echo-guided injection technique, in patients presenting with refractory symptoms, the authors believe in surgical technique (extramucosal myotomy) as a good alternative technique to be implemented. Methods. From 1999 to 2010, the authors have treated 36 patients (Group A), 24 male and 12 female (age 26-78) with diagnosis of esophageal achalasia. Patients underwent botulinum toxin injection during echo-guided identification of the lower esophageal sphincter. Results were compared with 32 patients (Group B) (age 36-78) who underwent blind treatment. Results. Patients of Group A presented complete relief of obstruction, patients of Group B had an obstruction remission in the 86% of the cases. Results were confirmed by manometric assessments in the early months after endoscopic treatment. Conclusion. The authors emphasize the importance of the injection of botulinum toxin into the thicker area of the muscle layer of the lower esophageal sphincter. Patients undergoing echo-guided injection technique presented complete relief of obstruction, confirmed by manometric assessments in the early months after treatment. Source

Cremona F.,General Hospital Paolo Giaccone | Maiorana A.,General Hospital Paolo Giaccone | La Barbera C.,General Hospital Paolo Giaccone | Genova P.,General Hospital Paolo Giaccone | And 2 more authors.
Gazzetta Medica Italiana Archivio per le Scienze Mediche | Year: 2013

Aim: Gastrointestinal stromal tumor is not frequently type of sarcoma found in the digestive system, often arise in the wall of the stomach or stromal cells of the intestinal wall. They are peculiar to extreme cellular variability and uncertain malignancy (heterogeneous group of mesenchymal cells, non epithelial tumors, of the gastrointestinal tract). In our experience, the surgical treatment is the only procedure to the cure of the patient. Methods: The authors report two cases of recent observation of Gastrointestinal Stromal T\imor (GIST) arising from the wall of the small intestine, and discuss on the biological behaviour of these tumors. Till now they are object of discussion about their origin, diagnostic standards, prognostic factors, histopathological classification. Results: Our patients had a good response to surgery, with almost complete resolution of their symptoms. Conclusion: The authors believe in the surgical treatment as the first and only procedure to the cure of the patient. A long-term followup observation is needed for the cases. Source

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