Probiotics, prebiotics and symbiotics in inflammatory bowel diseases: state-of-the-art and new insights.

Inflammatory bowel disease (IBD) consists of two distinct clinical forms, ulcerative colitis (UC) and Crohn's disease (CD), with unknown aetiology, which nevertheless are considered to share almost identical pathophysiological backgrounds. Up to date, a full coherent mechanistic explanation for IBD is still lacking, but people start to realize that the pathogenesis of IBD involves four fundamental components: the environment, gut microbiota, the immune system and the genome. As a consequence, IBD development might be due to an altered immune response and a disrupted mechanism of host tolerance to the non-pathogenic resident microbiota, leading to an elevated inflammatory response. Considering the available data arising from the scientific literature, here reviewed, in CD, a benefit of probiotics remains unproven; in UC, a benefit of probiotics remains unproven, even if E. coli Nissle 1917 seems promising in maintaining remission and it could be considered an alternative in patients intolerant or resistant to 5-ASA preparations; in pouchitis, small controlled trials suggest a benefit from VSL no. 3 in the primary and secondary prevention of pouchitis; in IBD-associated conditions, a benefit of probiotics remains unproven. However, well-designed randomized control clinical trials are necessary to understand the undoubted role of these agents in the management of gut physiology in health and disease.

[Thoracentesis and pleurodesis in the treatment of pleural effusion. Personal experience]. / Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale.

AIM: The pleural effusion is a sign of pulmonary, pleural or extrapulmonary, benign or malignant pathology. Our aim is to bring our experience on the treatment of the malignant pleural effusion through thoracentesis and successive pleurodesis. PATIENTS AND METHODS: From January 2000 to January 2007 we performed 217 thoracentesis of which 123 (57%) in subjects with malignant pleural effusion. In 92 of 123 subjects (75%) we performed a drainage with small size thoracic tube to realize directly the pleurodesis with sterile des-asbestos talc. RESULTS: None complication was registered during and after thoracentesis and pleurodesis and no mortality was recorded. We usually used talc slurry technique. Relapse rate after first treatment was of 12.2%. CONCLUSIONS: The pleural effusion is a pathological condition that usually needs repeated operative procedures with serious danger for the patient, however without definitive results. On the basis of our experience and considering the characteristics of sclerosing agents, we conclude that the sure, effective and economic agent for the pleurodesis is the des-asbestos talc.

What to do when endoscopic retrograde cholangio-pancreatography fails? Personal experience.

BACKGROUND: Endoscopic retrograde cholangio pancreatography failure is a rare and some dramatic reality too for the management of bilio-pancreatic tract disorders and in these cases it needs to utilize others operative technique. PATIENTS AND METHODS: Over a 6-year period, a total of 757 ERCPs were performed. In seventeen of these ERCPs the standard endoscopic technique failed and we employed alternative techniques such as interventional radiology or surgical management or double endoscopic approach. RESULTS: In all 17 failed ERCPs the alternative procedures allowed us to success in bilio-pancreatic disease. CONCLUSION: ERCP is an operator-dependent procedure. Even in expert hands failure occurs in 3% to 10% of cases. ERCP failure doesn't be considerated a dramatic situation in the management of the bilio-pancreatic disease for a multidisciplinary team (endoscopist, surgeon and interventional radiologist) whose cooperation allows to success.

Juxtapapillary duodenal diverticular bezor as an exceptional cause of biliary stent obstruction. Case report.

INTRODUCTION: we describe the first case in literature of biliary stent obstruction by bezoar impaction in a iuxtapapillary duodenal diverticulum. CASE REPORT: this case illustrates an juxtapapillary duodenal diverticulum and bezoar in it causing obstructive jaundice in subject with two biliary stents for cholangiocarcinoma (Klatskin's tumor) in the absence of bile duct stones. RESULT: successful treatment with endoscopic stent removal and diverticulum toilette. Obstructive jaundice was cured after endoscopic removal of the bezoar and stent substitution. DISCUSSION: the presence of a bezoar and its possible contribution to the pathogenesis of pancreatitis in the presence of periampullary extraluminal duodenal diverticula makes endoscopic intervention for removal of the bezoar necessary and effective. CONCLUSIONS: biliary bezoar is a very rare but treatable cause of stents obstruction in patients with juxtapapillary duodenal diverticula. Endoscopic retrograde cholangiopancreatografhy is helpful in making diagnosis and for resolutive treatment.

Unusual acute onset of pedunculated extragastric leiomyosarcoma. Case report.

INTRODUCTION: A case report of 25 yrs-old man with pedunculated exogastric leiomyosarcoma (with acute onset) surgically treated is presented. CASE REPORT: The patient was operated after clinical, instrumental and blood sample tests. We performed a 5 cm wedge resection of the stomach in continuity with the omentum. Careful inspection revealed neither adenopathy nor metastases. RESULTS: Actual complete remission of pathology. Negative 1 year follow up by endoscopy and CT. DISCUSSION: Information on gastric leiomyosarcoma (LM), such as prognostic factors, patterns of disease recurrence, and optimal methods of treatment, are derived from limited clinical experience. Although about 25% of the gastric mesenchymal tumors present an exogastric growth, pedunculated exogastric leiomyosarcomas are extremely rare. Lymphatic spread of gastric LM is uncommon, therefore a formal lymph node dissection is not standard surgical management. At present, there is no evidence of intraperitoneal seeding from exogastric leiomyosarcomas. Consequently, a local resection with an adequate margin is sufficient when no invasion to the adjacent structures is observed. Neither the addition of lymphadenectomy nor the wider tumor-free margins of a radical gastrectomy seemed superior to the more conservative local excision. CONCLUSIONS: Further studies are called for to elucidate if exogastric tumours lead to peritoneal seeding and, thereby, affect tumour survival.

[Bowel preparation before colonoscopy: personal experience and brief literature review]. / La preparazione intestinale alla colonscopia. Esperienza personale e breve review della letteraura.

INTRODUCTION: Colonoscopy is the most commonly used technique for inspection of the colonic mucosa. The safety and effectiveness of colonoscopy in identifying important colonic pathology is directly impacted by the operator experience and by the quality of the bowel preparation performed in anticipation of the procedure. PATIENTS AND METHODS: From December 2000 to June 2006, we performed 8328 total colonoscopy (M:F ratio =1:1.8, mean age 54.7 years, range 16-93). All the patients were submitted to routinary bowel preparation with polyethylenglycol (PEG) the evening before the exam, with fibres diet restriction 5 days before the exam. RESULTS: On 8328 colonoscopy, 1243 were not actable for worst/absent intestinal toilette. 423 colonoscopy were completed after visceral washing with saline solution during the exam. On 1243 colonoscopy repeated, 852 were in subjects affected by diabetes (p < 0.05); in these patients we prescribed 5 litres solution of PEG one day before the endoscopy, diet without fibers 7 days before the exam and the use of 250 ml solution of PEG (bid): with these method, all the patients were submitted successfully to colonoscopy and retrograde ileoscopy. DISCUSSION: Physicians favor preparations associated with the best patient compliance to achieve the best results. Patients favour preparations that are low in volume, palatable, have easy to complete regimens, and are reimbursed by health insurance or are inexpensive. Both patients and physicians favor preparations that are safe to administer in light of existing comorbid conditions and those that will not interact with previously prescribed medications. CONCLUSIONS: Today doesn't exist the "gold standard" for bowel preparation before colonoscopy. Basing on our experience, the 4 litres PEG solution mentioned above is well tolerated and effective. In patients with severe comorbidity (diabetes, renal failure, high blood pressure) only little modifications are required to optimize the colon cleansing.

[Pull percutaneous endoscopic gastrostomy: personal experience]. / La gastrostomia percutanea endoscopica (PEG) metodo pull: nostra esperienza.

OBJECTIVE: To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). DESIGN: Retrospective review of patients referred for PEG placement from 2003 to 2005. SETTING: Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. PATIENTS AND METHODS: A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. RESULTS: 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. CONCLUSIONS: Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

[Endoscopic treatment of pancreatic pseudocysts]. / Il trattamento endoscopico delle pseudocisti pancreatiche.

AIM: the Authors report their experience about the endoscopic treatment of pancreatic pseudocysts (PP). PATIENTS AND METHODS: report of 10 cases; evaluation of effectiveness, morbidity and mortality of treatment. SETTING: Section of General and Thoracic Surgery, AOUP ?Paolo Giaccone?, University of Palermo. PROCEDURE: endoscopic drainage was performed in all 10 patients, with 2 cysto-gastrostomy, 5 cysto-duodenostomy and 3 trans-papillary cystic drainage. RESULTS: 100% successful; one case of bleeding post-procedure (10%), one case of sepsis (10%) and one case of stricture of fistula between PP and duodenum. CONCLUSION: endoscopic drainage of PP is a safe and simple treatment, with high rates of success and low rate of complication procedure-related, complementary to surgery.

[Severe rectal bleeding after transrectal US-guided prostate biopsy. Case report]. / Rettoraggia severa dopo biopsia prostatica transrettale ecoguidata. Case report.

CASE: The Authors report their experience about a case of severe rectal bleeding after transrectal ultrasound-guided prostate biopsy. INTERVENTION: After correct and sure diagnosis, the patient was submitted to resolutive endoscopic haemostatic treatment (failure of haemostatic mechanical manoeuvres, emergency colonscopy, haemostasis with sclerotherapy, heat bipolar probe and Argon Plasma Coagulation). RESULTS: Complete recovery (immediate stop bleeding). Follow-up (1 year) negative. CONCLUSIONS: Rectal bleeding after prostate biopsy is a important but rare complication of prostate cancer screening, potentially lethal. Best knowledge of causes and risk factors may improve the diagnosis and standardize the treatment. The prostatic biopsy is surely the best procedure for the screening of prostate cancer in the population, associated with PSA dosage.

[Prevention of complications in thyroid surgery recurrent laryngeal nerve injury personal experience on 313 cases]. / Prevenzione delle complicanze in chirurgia tiroidea: la lesione del nervo laringeo ricorrente. Esperienza personale su 313 casi.

INTRODUCTION: Thyroidectomy poses many challenges for the surgeon who undertakes endocrine surgery and iatrogenic injury of inferior laryngeal nerve (ILN) is one of the most serious (0-20%). We report our personal experience of a series of 313 thyroidectomy with intraoperative identification of ILN. METHODS: 313 patients (253 females, 60 males, whose age was between 17 and 86 years, mean 41 years) had undergone thyroidectomy in our Operative Unit from January 2000 to January 2004. Among them, 259 patients underwent total extracapsular thyroidectomy, 38 subtotal thyroidectomy, 5 isthmo-lobectomy and 11 were completions of thyroidectomy in patients who had previously undergone a first thyroid surgical intervention. RESULTS: We identified 588 ILN (in all cases), in the left or in the right side only in case of isthmo-lobectomy or completion of thyroidectomy. In two cases (0.63%) we noticed on the right side a non recurrent laryngeal nerve. Concerning the postoperative results we noticed only one case (0.38%) of ILN injury with monolateral vocal cord hypomotility and temporary dysphonia, actually on phoniatric therapy at follow-up. CONCLUSION: A strong knowledge of the anatomy and embryology of the thyroid region, a commitment to meticulous attention to detail, the awareness of the extremely varying course of the ILN and the inferior thyroid artery and their relations, and adequate experience are all required to maintain a level of expertise and avoid ILN. Thyroid carcinoma, recurrent goitre, total thyroidectomy operation, duration of the operation are factors which increase the risk of postoperative ILN injury.

Heterotopic gastric mucosa in the gallbladder: case report and literature review.

INTRODUCTION: we report on a case of heterotopic gastric mucosa in the neck of the gallbladder and we also review 95 other reports of HGM in the gallbladder in the international medical literature from 1977. AIM: to evaluate the gold standard treatment in heterotopic gastric mucosa of the gallbladder by the analysis of literature, compared with our anecdotal experience. PATIENT AND METHOD: a 43-year-old man, who was recently symptomatic, visited our hospital to submit to laparoscopic cholecistectomy for cholelithiasis. Ultrasonography revealed a broad-based polypoid lesion in the gallbladder (2.5 cm in diameter in the neck of the gallbladder), with multiple gallstones. RESULTS: standard laparoscopic cholecystectomy was performed. The specimen revealed a 2.5 x 1.7 x 0.5 cm polypoid lesion with deep in the body, with many gallstones in the gallbladder. Histologically, the polypoid lesion consisted of gastric fundic glands located only in the mucosa of the gallbladder. The surrounding mucosa consisted of almost normal epithelium without any metaplastic changes. Postoperative technetium 99m-pertechnetate scintigraphy demonstrated no evidence of gastric heterotopia elsewhere in the body. Actually the patient is in long-time follow-up, asymptomatic. CONCLUSIONS: for its extreme difficult to make a conclusive diagnosis and thereby rule out the possibility of cancer, it appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.

[Non recurrent laryngeal nerve. Personal experience]. / Il nervo ricorrente che non ricorre. Esperienza personale.

PURPOSE: Damage to the recurrent laryngeal nerve (RLN) during thyroid or parathyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the RLNs and meticulous surgical technique can significantly decrease the incidence of this complication. Nonrecurrent RLNs (NRRLNs) are exceedingly rare. Surgeons need to be aware of their position to avoid injuries. PATIENT AND METHODS: A retrospective review of 263 right RLN exposures (and 251 left RNL) over a 5-year period was performed. RESULTS: Two NRRLNs were encountered, for an incidence of 0.39% (0.76% only for right dissection), without anatomic anomalies on the left side. The nerve anomaly was never preoperatively diagnosed. CONCLUSION: NRRLNs are rare and is associated with a right subclavian artery arising from distal aortic arch. Awareness of their existence and correct surgical technique will prevent the surgeon from accidentally lesion of NRRLN one if it is encountered during thyroid or parathyroid surgery.

[Intestinal endometriosis: an obscure cause of cyclic rectal bleeding]. / Endometriosi intestinale: una causa oscura di rettorragia ciclica.

OBJECTIVE: Authors report their experience about a case of intestinal endometriosis that lead cyclic and recurrent rectal bleeding in a fertile-age woman. DESIGN: Report of 1 case with multidisciplinary approach and surgical treatment. Surgical effectiveness evaluation and 2 years follow-up. Brief review on the recent literature and the diagnostic and therapeutic implications. SETTING: Section of General and Thoracic Surgery, Department of General Surgery, Emergency and Organ Transplantation, Policlinico "Paolo Giaccone", Palermo. INTERVENTION: After correct and sure diagnosis, the patient was submitted to sigmoid segmental resection with radical and curative intention. RESULTS: Complete recovery. Follow-up (24 months) negative. CONCLUSIONS: Diagnosis of endometriosis should be considered in women with recurrent monthly abdominal pain and bowel symptoms, especially if accompanied by gynaecologic complaints, even because the significant symptoms overlap with the irritable bowel syndrome (IBS) and makes the differentiation extremely difficult. Treatment of GI endometriosis is best approached in collaboration between gynaecologist experienced and intestinal surgeon. The high accuracy and low complications suggested that EUS-FNA was effective for the correct histologic diagnosis of intestinal endometriosis.

[Regression of primary low-grade gastric mucosa-associated lymphoma by eradication of Helicobacter pylori infection: case report]. / Regressione di un maltoma gastrico primitivo attraverso l'eradicazione della infezione da HP: report di un caso.

OBJECTIVE: The Authors report their experience in diagnosis and treatment of one case of primary low-grade gastric lymphoma of mucosa associated lymphoid tissue (MALT); recent international literature review. EXPERIMENTAL DESIGN: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of eradication therapy and short follow-up. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Treatment of H. Pylori infection (lansoprazole, amoxicillin and metronidazole twice a day for 14 days; after that, lansoprazole for another 4 weeks), according to international guide-lines. RESULTS: H. Pylori was completed eradicated. Disappearance and total regression of the lymphomatous tissue was observed. No relapse were recorded at short follow-up. CONCLUSIONS: Our reports confirm the recent anecdotal reports on regression of gastric MALT lymphoma after eradication of H. Pylori and indicates that the growth of these extranodal lymphomas may depend on H. Pylori.

[Gastric foreign body: bezoars. Apropos of two cases]. / Corpi estranei gastrici: i bezoari. A proposito di due casi.

OBJECTIVE: The authors report their experience about the treatment of two cases of gastric bezoar, treated in curative mode, the first endoscopically and the second with surgical intervention. SETTING: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation, Policlinico, University of Palermo. INTERVENTION: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical fragmentation of phytobezoar and fragments extraction via-overtube), the second with surgical gastrotomy (stamp trichobezoar). There were no procedure-related complications. RESULTS: The two patients were curative and radically treated. Negative 2 years follow-up. CONCLUSIONS: There is no standardized method for the treatment of gastric bezoars. Endoscopic removal of gastric bezoars after fragmentation and using overtube is effective and safe. Surgical intervention, equally safe, is reserved to huge, stamp, impacted or complicated bezoars.

[Aberrant pancreas: a rare cause of epigastralgia]. / Pancreas aberrante: una causa rara di epigastralgia.

OBJECTIVE: The Authors report their experience about a case of aberrant pancreas that lead epigastralgia. DESIGN: Report of 1 case and endoscopic treatment (upper endoscopy + EUS + endoscopic polypectomy + endoscopic biopsy of the base. Surgical effectiveness evaluation. SETTING: Section of General and Thoracic Surgery, Department of General Surgery, Emergency and Organ Transplantation, Policlinico "Paolo Giaccone", Palermo. INTERVENTION: After correct and sure diagnosis, the patient was submitted to endoscopic polypectomy with radical and curative intention. RESULTS: Complete recovery. Hematochemical and endoscopic follow-up (1 months) negative. CONCLUSIONS: Diagnosis of aberrant pancreas is very hard and always post-resection. Symptoms are poor and makes the clinical diagnosis extremely difficult, except when the mass attains big dimension (>5 cm). The best treatment of aberrant pancreas is based on correct diagnosis (upper endoscopy + EUS + FNAB) and on a radical treatment that, if the lesion is mucosal, is totally endoscopic (endoscopic polipectomy), without specific risk.

Treatment of complications of hepatic hydatid disease by ERCP: our experience.

BACKGROUND: The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy and positioning of naso-biliary drain or biliary endoprosthesis for preoperative and postoperative complications of hepatic hydatid disease (fistuias, compressioni cholestasis, rupture in biliary tree). METHODS: During the period 1994-2003, 22 patients (12 male and 10 female, mean age 55.4 years, range 16-65 yrs) underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in ali, associated with acute cholangitis in 4 (80%) and acute pancreatitis in 1 (20%). In 17 patients treated after surgery (Group B), the indication was acute cholangitis in 6 (36%), obstructive jaundice 3 (17%), and persistent external drainage in 8 patients (47%). OBSERVATIONS: In group A, ERCP detected hydatid vesicies within the bile duct in all patients. Ali patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 8 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 25 days (in 4 patients with low-flow fistula was positioned nasobiliary drain to repeat cholangiogram) or in 4-6 weeks (in 4 patients with high-flow fistula was positioned biliary endoprosthesis). In 2 of 8 patients (25%) with postoperative external biliary fistulas was observed choledocholitiasis (resolution with ERCP). Ali the 9 patients with postoperative obstructive jaundice or acute cholangitis, had cyst remnants obstructing the bile duct. Surgical reintervention was avoided in all patients in group B: all underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients remained asymptomatic. CONCLUSION: Endoscopic sphincterotomy with positioning of naso-biliary drain or biliary endoprosthesis is a safe and effective treatment for preoperative and postoperative biliary complications of hepatic hydatid disease.

["Rendez-vous" technique for palliation of neoplastic jaundice: personal experience]. / La tecnica del rendez-vous nel trattamento palliativo degli itteri neoplastici: nostra esperienza.

INTRODUCTION: "Rendez-vous" technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation ("not fit for surgery"). MATERIALS AND METHODS: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV. RESULTS: 11/14 (79%) RV were successful (successful stent insertion was defined as passage of the stent across the stricture) and 3 failure (21%) occurred in close biliary malignant obstruction even to percutaneous transhepatic approach. Only in 28% were registered minor complications (2 post-procedure fever, 1 papillary bleeding post PTE, 1 case mild acute pancreatitis). No mortality procedure related was registered and was not necessary to recur to surgery. CONCLUSIONS: RV is very useful in case of difficult cannulation of biliary tree and after failure of pre-cut. US-guided PTC is easy to perform, with low incidence of complications. Every well experienced team who works on bilio-pancreatic pathologies may recurs to this technique: even if not much utilized, RV can solves complex cases of biliary stricture.

[Paraesophageal hiatal hernia. Clinical considerations and report of a case]. / Ernia jatale paraesofagea. Considerazioni cliniche e report di un caso.

OBJECTIVE: The authors report their experience about the treatment about a case of paraesophageal hernia and they redefine nosography. DESIGN: Report of 1 case; evaluation of effectiveness of surgical treatment. 1-year follow up. Review of its clinical presentation. SETTING: Operative Unit of General and Thoracic Surgery. Department of General Surgery, Emergency and Transplantation. Polyclinc, University of Palermo. INTERVENTION: The patient was submitted to surgery with radical and curative intention. RESULTS: Complete resolution of the pathology. Follow-up (1 year) negative. CONCLUSION: Management of patients affected by paraesophageal hernia is difficult, because the physiopathology, anatomic basis and clinical presentation are not yet clear. The aim of surgical treatment is to reduce the hernia, to repair the hiatal gap and to make a correct antireflux procedure. According to us, the open surgical approach is very safe and useful because allows more safe surgical dissection, even if there is a big scar on the abdomen, the postoperative staying in hospital is longer. Finally, we emphasise the role of follow-up in these patients: it's the only way to prevent complications.

[Gastric antral vascular ectasia (GAVE) or watermelon stomach syndrome: report of 3 cases and clinical and therapeutic indications]. / Ectasia vascolare gastrica antrale (GAVE) o "Watermelon stomach syndrome": report di 3 casi ed indicazioni cliniche e terapeutiche.

OBJECTIVE: The authors report their experience in diagnosis, treatment and ambulatorial follow up of 3 cases of obscure upper gastrointestinal bleeding by gastric antral vascular ectasia (GAVE). EXPERIMENTAL DESIGN: Complete clinical report of 3 cases. Clinical and endoscopic indication, evaluation of effectiveness of endoscopic treatment with bipolar electrocoagulation and follow-up. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Endoscopic treatment by multiple session with bipolar electrocoagulation. No complications were registered. RESULTS: Complete recovery with "restitutio ad integrum". No relapse were recorded at follow up. CONCLUSIONS: The objective of the treatment is to recognize the site of obscure bleeding and then stop it. The choice between pharmacological, endoscopic and surgical treatment is individual for each patient. According to us, the endoscopic treatment is the first step in a gradual clinical approach, to detect the site of the lesion, to treat with bipolar electrocoagulation or with Argon Plasma Coagulator (lower wall penetration and minimal risk of perforation).