Aims ERCP is performed with reusable duodenoscopes after manual and automated reprocessing. Recently, multidrug-resistant infection outbreaks associated with infected duodenoscopes have been reported. Our aim was to investigate the current Italian experience with duodenoscope-related infections and assess the criticality of the risk.
Abstract A comparative food ethnobotanical study was carried out in twenty-one local communities in Italy, fourteen of which were located in Northern Italy, one in Central Italy, one in Sardinia, and four in Southern Italy. 549 informants were asked to name and describe food uses of wild botanicals they currently gather and consume. Data showed that gathering, processing and consuming wild food plants are still important activities in all the selected areas. A few botanicals were quoted and cited in multiple areas, demonstrating that there are ethnobotanical contact points among the various Italian regions ( Asparagus acutifolius, Reichardia picroides, Cichorium intybus, Foeniculum vulgare, Sambucus nigra, Silene vulgaris, Taraxacum officinale, Urtica dioica, Sonchus and Valerianella spp.). One taxon ( Borago officinalis ) in particular was found to be among the most quoted taxa in both the Southern and the Northern Italian sites. However, when we took into account data regarding the fifteen most quoted taxa in each site and compared and statistically analysed these, we observed that there were a few differences in the gathering and consumption of wild food plants between Northern and Southern Italy. In the North, Rosaceae species prevailed, whereas in the South, taxa belonging to the Asteraceae, Brassicaceae, and Liliaceae s.l. families were most frequently cited. We proposed the hypothesis that these differences may be due to the likelihood that in Southern Italy the erosion of TK on wild vegetables is taking place more slowly, and also to the likelihood that Southern Italians' have a higher appreciation of wild vegetables that have a strong and bitter taste. A correspondence analysis confirmed that the differences in the frequencies of quotation of wild plants within the Northern and the Southern Italian sites could be ascribed only partially to ethnic/cultural issues. An additional factor could be recent socio-economic shifts, which may be having a continued effort on people's knowledge of wild food plants and the way they use them. Finally, after having compared the collected data with the most important international and national food ethnobotanical databases that focus on wild edible plants, we pointed out a few uncommon plant food uses (e.g. Celtis aetnensis fruits, Cicerbita alpine shoots, Helichrysum italicum leaves, Lonicera caprifolium fruits, Symphytum officinale leaves), which are new, or have thus far been recorded only rarely.
The paper studies the combined radiologic and endoscopic approach (rendez-vous technique) to the treatment of the biliary complications following liver transplant. The "rendez-vous" technique was used with an electrokinetic lithotripter, in the treatment of a biliary anastomotic stricture with multiple biliary stones in a patient who underwent orthotopic liver transplant. In this patient, endoscopic or percutaneous transhepatic management of the biliary complication failed. The combined approach, percutaneous transhepatic and endoscopic treatment (rendez-vous technique) with the use of an electrokinetic lithotritor, was used to solve the biliary stenosis and to remove the stones. Technical success, defined as disappearance of the biliary stenosis and stone removal, was obtained in just one session, which definitively solved the complications. The combined approach of percutaneous transhepatic and endoscopic (rendez-vous technique) treatment, in association with an electrokinetic lithotritor, is a safe and feasible alternative treatment, especially after the failure of endoscopic and/or percutaneous trans-hepatic isolated procedures.
A 77-year-old man with a 3-cm slightly elevated, nongranular type, laterally spreading tumor (LST-NG 0-IIa) of the sigmoid colon was referred to our institute for endoscopic resection ([Fig. 1]). Piecemeal underwater endoscopic mucosal resection (UEMR) was carried out with a high definition narrow band endoscope (CF-H190L; Olympus Europa SE, Hamburg, Germany). After UEMR, the margins were ablated using argon plasma coagulation. Histology revealed an adenomatous polyp with high grade dysplasia and free deep resection margins. Because of the patient's need to resume antiplatelet therapy with clopidogrel, prophylactic closure of the resection site was carried out.
A 67-year-old man with a pancreatic head lesion was referred for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) diagnosis and staging. EUS revealed a 35-mm, hypoechoic, irregular lesion of the pancreatic head. The lesion had no cleavage plane with the portal vein, and it had clearly invaded the bile duct and duodenal wall. The gastroduodenal artery was interfering with the EUS-FNA, so it was necessary to puncture the marginal area of the lesion adjoining the bile duct ([Fig. 1 a]).
Exposed endoscopic full-thickness resection (EFTR), with or without laparoscopic assistance, is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria (MP), especially of the gastric wall. To date, evidence concerning duodenal exposed EFTR is lacking, mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure. However, given the non-negligible morbidity and mortality associated with duodenal surgery, the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers. The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.