Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques.

INTRODUCTION AND IMPORTANCE: Gastric Antral Vascular Ectasia is a rare disorder that causes up to 4 % of severe acute gastrointestinal bleeding. It affects elderly females with iron deficiency anemia due to chronic blood loss as a common presenting sign. CASE PRESENTATION: We report the case of a 70-year-old man admitted to the Urgency Department for severe asthenia associated with abdominal pain and severe anemia. An urgent upper endoscopic examination showed antral hyperemic streaks and vascular ectasias extending from the pyloric ring to the gastric body as well as signs of recent bleeding. Histological results demonstrated the pathognomonic features of GAVE. CLINICAL DISCUSSION: The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness. In current literature, other therapies and different types of endoscopic treatments have been proposed, such as EBL, RFA and Yag: laser. To date, there is no specific recommendation that privileges one method over another in the treatment of GAVE, although APC has proven effective and even better in terms of complications and costs than the other techniques. CONCLUSION: In our experience, endoscopic coagulation with APC probes is a relatively easy-to-use technique with low cost, minimal invasiveness and provides immediate results. On the other hand, a standardized algorithm is also required concerning to the different subtypes to give the best treatment in every case.

[Splenic artery pseudoaneurysm: a rare case of gastrointestinal haemorrhage in a patient with chronic pancreatitis]. / Pseudoaneurisma dell'arteria splenica: insolito caso di emorragia gastrointestinale in paziente con pancreatite cronica.

A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. This diagnosis may be very difficult and the optimal treatment remains controversial. We report the case of 80 years old female with calcific pancreatitis and severe intestinal bleeding due to a pseudoaneurysm of the splenic artery treated with interventional radiographic embolization.

[Laparoscopic versus open resection for colorectal cancer: meta-analysis of the chief trials]. / Laparoscopia vs. laparotomia nelle resezioni per cancro colorettale. Metanalisi dei principali trial.

BACKGROUND: The objective of this study is in the critical analysis of the results of the lap and open surgery in the colorectal carcinoma, through the meta-analysis of the principal trials. PATIENTS AND METHODS: A systematic search of the comparative studies has been made among lap and open surgery in the colorectal carcinoma, using PubMed and Cochrane Library. Among these, have been selected perspective studies containing the description of the surgical techniques, the perioperative results and the oncological long term results. Statistic analysis has been performed with the program NCSS (Kaysville 2006, Utah). RESULTS: From the revision of the literature, 7 perspective studies have checked fit to a meta-analysis, for a total of 3580 patients. Among the operative outcomes, has been observed, with statistically significant, a reduction of the blood loss and of the morbidity, an earlier resumption to passing flatus and to normal diet, a reduction of the postoperative hospitalization for the lap; shorter operative time is releaved for the open surgery. Statistically significant differences have emerged neither on the other surgical outcomes (included mortality) nor on relapset of illness (regional or metastasis), crab-correlated mortality, long term survival. CONCLUSIONS: The laparoscopic can be considered a valid alternative to the traditional open surgery in the therapy of the colorectal carcinoma: the advantages consist in smaller trauma and reduction of morbidity and postoperative stay. The oncological results are the same of the open surgery.

[Intestinal schwannoma: case report and literature review]. / Schwannoma intestinale: case report e revisione della letteratura.

Digestive Tract Schwannomas (DTS) are benign mesenchymal tumours, usually affecting female between 20 and 70 years old. They are most commonly found in the stomach but they can arise anywhere from the digestive tract. DTS are usually asymptomatic but can present with different symptoms. Definitive diagnosis can only be made with immunohistochemistry because endoscopy and computed tomography can't distinguish them from other non epithelial neoplasms. Surgical resection is the treatment of choice.

Efficacy and safety of full-thickness resection device based on over-the-scope clip system for resecting of gastric lesions in selected patients. Case series from a referral center for gastrointestinal diseases treatment and literature overview.

Since gastroduodenal FTRD system is commercially available, several data have been reported in Literature concerning duodenal full-thickness resections, whereas few cases of gastric full-thickness resections has been described. In this case series We report three patients treated with this innovative tool for resecting lesions of the gastric wall. The indications ranged notably: a neuroendocrine tumor in a difficult to treat environment in the first case, a recurrent adenocarcinoma in a poorly surgical candidate patient in the second case and a pre-pyloric lesion for the third patient. In the third patient, a complete pyloric stenosis due to the clip deployment occurred. Clinical success rate was 100%. Even if current Literature is still poor of articles dealing with gastric full-thickness resection device based on over-the-scope-clip system. Our case series show how this novel tool might be take into consideration for whenever both surgery and standard endoscopic resection techniques are poorly feasible.

Porto-spleno-mesenteric venous thrombosis.

Porto-spleno-mesenteric (PSM) venous thrombosis is a rare clinical condition that, while being mostly unrecognized, is nonetheless often severe with a high morbidity and mortality. PSM venous thrombosis is the cause of as many as 5-10% of all abdominal ischemic events, and it presents with a highly variable and non-specific pattern of abdominal symptoms. Such complex and non-specific presentation can delay diagnosis, determining the poor clinical outcome of this condition. This review article discusses the information available on the pathogenesis, clinical presentation, diagnosis and general management of PSM venous thrombosis, with a focus on a number of some clinical issues that remain unaddressed. In particular, the current understanding of the predisposing factors and the heterogeneous clinical manifestations of this condition are described in detail. The recent advances in imaging techniques, which are leading to an improved diagnostic accuracy and facilitate an early diagnosis are also presented. Further, the indications and limits of both pharmacological and surgical treatment options are discussed.