An algorithm to generate 2D bathymetry of an Alpine river for habitat suitability assessment.

Here we present an original approach to generate 2D high detail riverbed based on a drone photogrammetric survey, and RTK bathymetry measurements for Mera river in the Italian Alps. The aim is to better represent macro-roughness and riverbed structure of the river, also extending it to an ungauged area. Specifically, we apply a step-by-step approach. I) Depth and average slope of the riverbed were calculated from bathymetry data. II) Thus, a trapezoidal channel with constant slope and variable width was defined using the drone images. III) Riffle-pool sequence was assessed as a function of river width and applied to the generated channel. IV) Finally, the semi-random Perlin Noise was added to recreate riverbed irregularities in the natural stream. HEC-RAS 2D hydraulic software was then implemented to assess spatialized water depth and velocity. The proposed methodology could be quite relevant in river hydraulics to decouple roughness coefficient from water submergence, and in Physical Habitat Simulation Model (PHABSIM), where the dependency of the output is not linear with hydraulic parameters (i.e. water depth and velocity). Indeed, we apply PHABSIM for a case study of a stretch of the river and results are compared with a previous environmental study for Mera river.

Retrospective comparison of long-term ten-day/month rifaximin or mesalazine in prevention of relapse in acute diverticulitis.

OBJECTIVE: Diverticular disease (DD) of the colon has an increasing burden on health services. The effectiveness of rifaximin for the treatment of DD, is not yet established. The aim of this study is to assess the impact of long-term treatment with rifaximin or mesalazine in a 10-day schedule for the prevention of recurrent diverticulitis. PATIENTS AND METHODS: This is a retrospective study. We identified all consecutive patients with DD and previous acute diverticulitis (AD) in our outpatients' database; 124 patients, were included. The recommended therapy consisted of a ten-day/month treatment with either rifaximin (400 mg bid), or mesalazine (2.4 g/daily). Primary end point was AD recurrence. RESULTS: Between 2010 and 2014, 72 patients were treated with rifaximin and 52 with mesalazine. During a median follow-up of 15 months (range 1-50), we observed 21 episodes of AD among users of either rifaximin (n=7; 0.54 per 100 person-months), or mesalazine group (n=14; 1.46 per 100 person-months). Kaplan-Meier survival estimates of recurrent AD significantly differed between rifaximin and mesalazine groups (p=0.015). The multivariate Cox regression analysis showed that AD recurrence was significantly associated with therapy (rifaximin vs. mesalazine, adjusted HR 0.27; 95% CI: 0.10 to 0.72), age and gender. CONCLUSIONS: Long-term treatment with rifaximin in a 10-day schedule appears more effective than mesalazine in preventing recurrent AD.

Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with Periampullary duodenal diverticula (PAD).

BACKGROUND AND AIM: Periampullary diverticula (PAD) are found in 9-32% of patients who undergo endoscopic retrograde cholangiopancreatography (ERCP). PAD are acquired lesions which are rare in patients <40 years, but increasing with age. Several endoscopic studies have revealed an association between PAD and common bile duct (CBD) stones. The presence of a papilla located in the diverticula is also frequent (6.8-54.9%) and represents a restrictive factor for successful cannulation. MATERIALS AND METHODS: A retrospective analysis has been made of data related to the patients with PAD treated at our GI Unit (small center with low case volume), who underwent ERCP in the period 1st January 2010 to 31st March 2014. For each patient were analyzed data regarding sex, age at diagnosis, indication to ERCP, cannulation rate, endoscopic treatment and complications. PAD were classified in 3 different types according to the position of the major papilla. RESULTS: A total of 647 ERCPs have been performed of which 77 (16.5%) in pts with PAD (48 F, 29 M, mean age: 78.3 years; range: 48-95). PAD type I (inside the diverticulum) were found in 22 pts (28.6 %), Type II (in the margin of the diverticulum or between two PADs) in 36 pts (46.7 %) of which 12 cases between two PADs, type III (near the diverticulm) in 19 pts (24.7 %). The indication for ERCP were: 72 CBD stones (93.5%), 3 cholangiocarcinoma (3.9%) and 2 pancreatic head cancer (2.6%). In cases of difficult cannulation, precut was performed in 12 pts (15.6%). Deep CBD cannulation and endoscopic sphincterotomy (ES) was achieved in 70 cases (90.9%). The other 7 case of failure were all in patients with CBD stones. Complete clearance of CBD stones was achieved in 57 patients (87.7%) (57/65 ERCP/ES). Stent placement was necessary in 8 cases (12.3%) (8/65 ERCP/ES), due to multiple large stones. The adverse events related to ERCP/ES included 4 intraprocedural bleeding (5.7%) (4/70 ERCP/ES) and 1 mild pancreatitis (1.4%) (1/70 ERCP/ES), all managed conservatively. CONCLUSIONS: Our data show that ERCP is a safe procedure also in patients with PAD, with a good success rate and low complications.

Role of endoscopic sphincterotomy of the minor papilla in pancreas divisum.

BACKGROUND: Pancreas divisum (PD) is a common anatomical variant of the pancreatic duct system. Only a little percentage of patients with this altered anatomy develop symptoms: acute recurrent pancreatitis (ARP), chronic pancreatitis (CP) and pancreatic-type pain alone. These have been supposed to arise from an obstruction to outflow of the pancreatic dorsal duct due to a stenosis of the minor papilla. Endoscopic sphincterotomy of the minor papilla (MiES) can be considered an effective treatment for patients with PD and ARP supported by stenosis or obstruction of the minor papilla. On the other hand, the access through the minor papilla is essential for therapeutic pancreatic endoscopy in patients with PD and CP, but the effectiveness of MiES in these patients is extremely controversial. MATERIALS AND METHODS: Aim of this brief review has been to evaluate the short and long-term effects of endoscopic pancreatic interventions in patients affected by symptomatic PD who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic sphincterotomy of the minor papilla (MiES). The main literature database was Medline (1966-2013). RESULTS: Data come from a personal overview of articles emerging from the same search strategy. CONCLUSIONS: Nowadays, when endoscopic pancreatic drainage is indicated in patient with symptomatic PD, access through the minor papilla (MiP) is required. Therapeutic endoscopic interventions provide less invasive alternatives to the surgical approach.

Benign pneumoperitoneum after percutaneous endoscopic gastrostomy (PEG) feeding tube placement: do not be afraid!

In order to ensure enteral feeding, placement of a percutaneous endoscopic gastrostomy (PEG) is considered a standard care for patients with oropharyngeal malignancies. Benign pneumoperitoneum is a complication of PEG feeding tube placement and it is usually an incidental finding that arises, generally, immediately following the procedure. We report a case of a benign pneumoperitoneum, developed 48 hours after the procedure, which was treated conservatively.

Comparison of endoscopic retrograde cholangiopancreatography between elderly and younger patients for common bile duct stones.

BACKGROUND: Choledocholithiasis is increasing in elderly subjects. The introduction of endoscopic retrograde cholangiopancreatography with biliary sphincterotomy has almost replaced surgery in the treatment of this condition. The aim of the present study was to evaluate the rates of successful clearance of common bile duct stones and the endoscopic techniques used in a population aged 75 years or older compared with those in a younger age group. MATERIALS AND METHODS: A retrospective analysis was made of data related patients who underwent endoscopic retrograde cholangiopancreatography for choledocolithiasis in the period 2010-2011. For all patients, factors such as sex, age at diagnosis, endoscopic treatment (stone extraction using baskets and balloon, mechanical lithotripsy and balloon dilatation of the ampulla, placement of a stent or a naso-biliary tube) and need of surgery were analysed. Two groups of patients were identified: patients aged <75 years (Group A) and patients aged ≥75 years (Group B). For the statistical analysis Mann-Whitney test and Fischer's Exact test were used. RESULTS: A total of 234 patients were enrolled in the study (94 in Group A, 140 in Group B). No statistically significant differences were observed as far concerns sex, previous cholecystectomy, gallbladder stones and periampullary diverticula, but only for common bile duct dilatation. Complete clearance of common bile duct stones was achieved in 230 patients (97.5%). CONCLUSIONS: The present data are in keeping with those presented in the literature, which confirm that endoscopic retrograde cholangiopancreatography is a safe and effective procedure also in older patients.

Self-expandable metal stent placement for treatment of severe sphincterotomy bleeding.

One of the most frequent complications of endoscopic sphincterotomy (ES) is bleeding. When post-ES bleeding does not respond to the use of typical endoscopic therapy, the only alternative is angiography or surgery. A 82-year-old female was admitted for jaundice. A RMN-cholangiography revealed multiple stones in the common bile duct (CBD). She underwent endoscopic retrograde cholangiopancreatography (ERCP). The papilla major was located between two large periampullary diverticula. During the ES, a severe bleeding was observed from the upper part of the biliary cut. Several methods of hemostasis (injection of adrenaline, thermal methods and balloon tamponate) were performed without efficacy. A partially covered metallic stent was placed across the biliary orifice, in order to compress mechanically the bleeding site archiving the hemostasis.

Gastric Dieulafoy's lesion successfully treated by "adjuvant" arterial embolization and endoscopic clipping.

While it is well recognized that peptic ulcer disease is the most common cause of nonvariceal upper gastrointestinal bleeding, other lesions cause of haemorrhage, even if rare, may potentially life-threatening. These include arteriovenous malformations such as Dieulafoy's lesion, defined as caliber-persistent submucosal vessel. The endoscopy with its hemostatic techniques is usually the treatment of choice for such patients. In those cases, in which these techniques fail due to the difficult in the correct localization, angiography with embolization may be a good alternative. The use of microcatheters and new embolic agents have improved this procedure. In fact, transcatheter arterial embolization represents a minimally invasive alternative to surgery when endoscopic treatment fails to control gastrointestinal bleeding, especially for the upper tract. This technique proved to be safe, fast and effective. According to our knowledge, only one case of a Dieulafoy's lesion of the duodenum treated with "adjuvant" embolization followed by laser coagulation has been reported in literature. Herein, we report a case of a Dieulafoy's lesion of the stomach, in which "adjuvant" transcatheter arterial embolization has permitted a more easier endoscopic diagnosis and treatment.

Hematemesis from esophageal varices associated with esophageal perforation: sclerotherapy and endoscopic clipping.

A 46-year-old man was referred to our Unit for hematemesis. The medical history of the patient revealed an HCV-related cirrhosis, a human immunodeficiency virus (HIV) infection and recent and persistent episodes of emesis. An urgent gastroscopy disclosed evidence of active bleeding from varices of the lower third of the esophagus and a concomitant laceration of the esophageal wall due to the emesis. These two conditions have been endoscopically diagnosed and successfully treated by sclerotherapy and endoscopic clipping.

[Use of argon plasma coagulation in digestive endoscopy: a concise review]. / Utilizzo della coagulazione con argon plasma in endoscopia digestiva: revisione della letteratura.

Argon plasma coagulation (APC) is a non-contact thermal method of hemostasis that has generated much attention in recent years. This endoscopic procedure is used primarily to control bleeding from lesions in the gastrointestinal tract, and also sometimes to debulk tumours in the case of patients for whom surgery is not recommended. APC involves the use of a jet of ionized argon gas (plasma) that is directed through a probe passed through the endoscope. The probe is placed at some distance from the lesion, and tissue damage is limited to superficial layers. The depth of coagulation is usually only a few millimetres. Theoretical advantages of APC include facility application, speedy treatment of multiple lesions in the case of angiodysplasias or wide areas (the base of resected polyps or tumor bleeding), safety due to reduced depth of penetration, and lower cost compared to laser.

[Endoscopic therapy with balloon dilatation in patients with colonic post anastomotic strictures. Personal experience]. / Trattamento endoscopico con dilatazione pneumatica nei pazienti affetti da stenosi coliche post-anastomotiche. Esperienza personale.

BACKGROUND AND AIM: Colorectal post anastomotic benign strictures are not uncommon. The purpose of this study was to investigate the results of endoscopic balloon dilatation of anastomotic strictures. MATERIALS AND METHODS: The study was on a retrospective survey. Records of 14 consecutive patients with anastomotic strictures (5 F, 9 M; median age 64 years; range: 50-87 years), attending our GI Unit from February 1st 2008 to December 31st 2009, were analyzed. All patients had been operated for colon carcinoma. All of them were treated with balloon dilatation. RESULTS: All the patients presented symptoms of obstruction. The total number of dilatation sessions was 37 and the median number of sessions by patient was 1,5 (range: 1-7). After the procedures, all patients had an improvement of symptoms. No complications were observed. CONCLUSIONS: Our experience underlines that endoscopic ballon dilatation, in patients with post anastomotic benign strictures, is a safe technique with a low rate of complications.

Percutaneous endoscopic gastrostomy (PEG) in critically ill patients performed at bed in Intensive Care Unit: report of our experience.

BACKGROUND AND AIM: Patients with severe brain injures and severe neurological diseases frequently require prolonged nutritional support during their hospitalization as well as during their rehabilitation period. Since 1980, the percutaneous endoscopic gastrostomy (PEG) has become the method of choice for long term feeding. The aim of the present study was to present our experience concerning the placement of PEG in critically ill patients, recovered in Intensive Care Unit (ICU). MATERIALS AND METHODS: From 3-05-2001 to 28-09-2005, 36 patients (13 female, 23 male) with a median age of 63 years [range: 18-86 years], recovered in ICU of the Sandro Pertini Hospital, underwent PEG. These patients were retrospectively evaluated in terms of complications, indications to the procedures, durability of gastrostomy and mortality. Intravenous antibiotic prophylaxis was administered 1 h before the procedure (ceftriaxone 2gr). The entire PEG was placed in ICU at patient's bed, with the assistance of the anaesthetist. Propofol was used e.v. for sedation and fentanest for analgesia while lidocaine was used for local anesthesia. A 16-Fr or 20-Fr tube was inserted by the "pull method", after a complete upper gastroduodenoscopy. RESULTS: PEG was performed mainly for neurological disorders including cerebrovascular accidents (13), SLA (8), post-traumatic coma (7), post-cardiac arrest coma (7) and dementia (1). Procedure related mortality was 0%. The tube was changed in 4 patients due to clogging. The durability of the tube was a median of 2 months (range: 1-12 months). In 23 patients the placement of the PEG was definitive. CONCLUSIONS: Our experience underlines that PEG, in selected critically ill patients, is a safe technique easy to perform even in ICU.

Bouveret's syndrome: description of a case.

Bouveret's syndrome is a rare condition usually caused by a single large stone impacted in the duodenum. This is a cause of gastric outlet. Even if endoscopy is the mainstay of diagnosis, the radiographic examinations are also important too. Generally, the stones are too large to be removed endoscopically. Conservative endoscopic treatment should be attempted initially, and if it fails, surgical approach should be performed.

[Diagnosis and treatment of bleeding peptic ulcer: our experience]. / Diagnosi e trattamento dell'ulcera peptica emorragica. Nostra esperienza.

BACKGROUND: Bleeding peptic ulcer (PU) is the commonest cause of an acute upper gastrointestinal bleed. Aim of this study was to present our data regard the management of acute bleeding from PU during urgent endoscopy (examination performed in 2-6 h by the call). MATERIALS AND METHODS: This study is based on an observational retrospective protocol. Records of 259 consecutive patients with PU (92 F, 167 M; median age 71.5 years; range: 19-100 years), attending our GI Unit from February 1st 2004 to July 31st 2007, were analyzed. RESULTS: Out of 259 patients with PU, 170 (65.6%) were treated with endoscopic hemostasis followed by medical therapy (PPI 80 mg bolus within 12 h of endoscopy followed by 8 mg/for 72 h and then an oral PPI , 40 mg once daily for 30 days), while 89 (34.4%) patients received only medical therapy (PPI, 40 mg once daily for 30 days). All ulcerative lesions with endoscopic stigmata of acute bleeding, visible vessels or adherent clot (Forrest Ia-IIb) were treated during the gastroscopy. The endoscopic procedures used were: injection of 1:10000 adrenaline (about 10 mL) around the bleeding lesion in 93 cases (55%); injection therapy and thermal method (argon plasma coagulation) in 53 cases (31%); injection therapy and mechanical method (metallic clips) in 20 cases (12%); only mechanical method (metallic clips) in 4 cases (2%). Endoscopic hemostasis was achieved in 251 pts (97%), while 17 pts (6.5%) required second endoscopy for rebleeding. Three patients (1.16%) required immediate surgery for failure of primary endoscopic hemostasis. The mortality within 30 days from the bleeding episode was 3.9% (10 pts). CONCLUSIONS: The treatment of this condition has made important progress since the introduction of emergency endoscopy and endoscopic techniques for hemostasis. The application of specific protocols, significantly decreases rebleeding and the need for surgery, whereas mortality is still high. Our data are in keeping with previous studies of the literature.

[Sedation with propofol in endoscopic retrograde cholangiopancreatography: personal experience]. / La sedazione profonda con propofol in corso di colangiopancreatografia retrograda endoscopica: esperienza personale.

AIM: Adequate sedation is fundamental for the execution of the endoscopic retrograde cholangiopancreatography (ERCP). Propofol is widely used for gastrointestinal endoscopy because of its rapid recovery profile. The aim of this study was to determine, retrospectively, whether the administration of propofol was safe in patients undergoing ERCP, both diagnostic and therapeutic. MATERIALS AND METHODS: In our GI Unit, from 1st February 2006 to 23 November 2006, we performed 100 ERCP. All the patients were sedated by using midazolam e.v., as pre-anaesthetic agent, and propofol e.v. During the procedure, vital signs were continuously monitored (oxygen saturation, blood pressure, heart rate). Patients were also divided into two groups: less than 80 years of age (group I) and 80 years of age and older (group II). Cardiorespiratory complications were recorded. RESULTS: Patients were 51 females and 49 males, with a median age of 74 years (range: 23-94 years). Group I was composed by 72 patients (35 F, 37 M) and Group II by 28 patients (16 F, 12 M). There were no episodes of hemodynamic instability or airway obstruction. New ECG changes (1 ischemia, 3 arrhythmias) and 1 significant oxygen desaturation episode (SpO2<90%) occurred in 5% of procedures. If we considered the two groups, the rates of cardiopulmonary complications were 4.1% and 7.1%, respectively in group I and in group II. CONCLUSIONS: Propofol seems to be safe and effective sedation for ERCP, with a low complication rate, also in patients aged 80 years or older.

[Distal hyperplastic polyps as a marker for advanced neoplasm of the proximal colon. Our experience]. / Il polipo iperplastico distale come marcatore di neoplasia colica avanzata prossimale. La nostra esperienza.

BACKGROUND AND AIM: While, several studies indicate that there is an association between proximal and distal colorectal adenomas, no agreement seems to be between the presence of distal hyperplastic polyps and proximal neoplasia. The aim of this study was to investigate, retrospectively, the possible correlation between the distal hyperplastic polyps and proximal colorectal neoplasia. MATERIALS AND METHODS: In our GI Unit, from 1st February 2006 to 24 November 2006, we performed 142 polypectomy. Patients were 36 females and 80 males, with a median age of 66 years [range: 38-87 years]. All of the polpys were resected during colonoscopy and sent for histological study. Chi-square test was used for statistical analysis. A probability value of P< or =0.05 was considered to be statistically significant. RESULTS: Histological study showed the following results: 33 hyperplastic polyps (8 F, 21 M; median age 63 years), 100 adenomas (26 F, 61 M; median age 67 years) and 2 inflammatory polpys (2 F, 0 M; median age 71 years). The rectal localization was associated with a significantly higher frequency of hyperplastic polyps (63.6% vs 23.5%), OR: 5.688 (95% C.I. 2.445-13.230) (p<0.0001). Five hyperplastic polyps of the rectum were associated with 5 adenomas located 1 in the rectum, 2 in the sigmoid colon, and 1 in the descendens colon and 1 in the ascendens colon. While, 5 adenomas were associated with 5 adenocarcinoma. CONCLUSIONS: Guidelines from the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy do not recommend colonoscopy for patients with distal hyperplastic polyps. Also our study is in keeping with the data of the literature and it confirmed that rectal localization is associated with a higher prevalence of hyperplastic polyps.

[Foreign bodies in the upper gastrointestinal tract. Personal experience]. / Corpi estranei del tratto digestivo superiore. Esperienza personale.

OBJECTIVE: Foreign bodies ingestion is a potentially serious problem. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. In the present work, we report our experience in the management of ingested foreign bodies. MATERIALS AND METHODS: The study was observational and retrospective. We included in the study the foreign bodies ingestions occurred during urgent endoscopy (examination performed from 1 to 6 h by the call). RESULTS: Records of 696 consecutive EGDS performed in urgency at the Unit of Gastroenterology and Digestive Endoscopy of the Hospital Sandro Pertini of Rome, from 01-02-'04 to 18-01-2006, were analyzed retrospectively. Out of these procedures, 21 (3.01%) were performed for suspected foreign bodies ingestion. CONCLUSIONS: We present the initial report of our working experience. Objects that have passed the duodenum should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical approach is indicated when significant symptoms develop or if the object fails to progress through the gastrointestinal tract. The present data are in keeping with previous studies of the literature.