•Family members of healthcare workers are extremely exposed to SARS-COV-2 infection.•Family members are less protected than healthcare workers.•Family members of healthcare workers experienced higher ...SARS-COV-2 contagion rate than healthcare workers themselves.•Healthcare workers were not the main source of SARS-COV-2 transmission for their families.
Many publications have considered the exposure risk to COVID-19 of the general population and healthcare workers. However, no available papers have discussed the risk of exposure by family members of health care workers.
The present study collected data on SARS-COV-2 positive family members (FM) of health care workers (HW) using serological rapid IgM/IgG tests (SRT), compared to positive HWs on SRT and serological quantitative IgG tests (SQT).
The study was conducted from May 2 to 31, 2020. Thirty-eight HWs were tested by both SRT and SQT; 81 FMs were screened using SRT. Descriptive statistical analyses were used to summarize the data.
Of the 38 HWs, two (5,3%) showed an IgG line on SRT, confirmed by SQT. Thirty-two HWs decided on self-isolation from the family during the SARS-COV-2 spread. Out of 81 FMs, 26 (32,1%) were found IgG positive on SRT. Eleven (42%) of them had symptoms typical for COVID-19, during the study period. In two families, the HWs were the only negative cases.
The general population's exposure to COVID-19 is less controlled than that of HWs. HWs experienced a lower infection rate than their families and did not represent a main transmission risk for relatives.
Background and aim
Clinically relevant pancreatic leaks of jejunal-pancreatic anastomosis after pancreato-duodenectomy (PD) occur in 9–15% of cases. Endoscopic strategies for management of pancreatic ...fistula, may allow to avoid reoperation and shorten times for fistula closure, but are still understudied and not widely performed. Aim of the present paper is to describe different endoscopic techniques used to treat such conditions.
Methods
It was a retrospective, single centre, study. All patients who underwent endoscopic treatment for pancreatic leaks following PD between 1st January 2013 and 31th May 2019 at our Centre were reviewed. Depending on the morphology and severity of the leak, four main endoscopic techniques were performed: (1) trans-anastomotic intraductal pancreatic stent insertion; (2) lumen-apposing metal stent between the jejunal loop and the retroperitoneum toward the pancreatic stump insertion (“yoyo-stent”); (3) large calibre nose-to-retroperitoneum drain insertion; (4) when a wide damage of the jejunal wall or a coexistent biliary-jejunal leak were observed, triple metal stent insertion was performed as follow in order to close the defect: enteral fully-covered SEMS in the jejunal stump, a pancreatic metal stent into the Wirsung duct and a fully-covered SEMS across the bilio-digestive anastomosis, through the meshes of the enteral stent. In all cases, surgical drain was simultaneously retracted.
Results
We identified 13 patients who underwent endoscopic treatment for POPF after PD. In total, 5 patients underwent “Yoyo stent insertion”, 3 with nose-to-collection drain placement and four patients were treated with triple-stent insertion; in only one patient intrapancreatic SEMS insertion was performed. Technical success was 100% and clinical success was 83.3%. Mean time for leak closure was 4.8 days (range 2–10). During the follow-up interval, no leak recurrences were observed.
Conclusions
Our experience confirms efficacy and safety of endoscopic management of POPF following pancreatoduodenectomy management. Endoscopy should play a central role in this clinical scenario.
Pure endoscopic treatment of combined cholelithiasis and choledocholithiasis is possible due to the chance to use together both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ...ultrasound (EUS) approaches. This endotherapy permits to treat biliary stones in the main bile duct by standard ERCP and gallbladder stones by EUS-guided cholecystoduodenostomy eventually associated to intracorporeal lithotripsy to achieve optimal results.
Abstract
Background and study aims
Since 2014, we have been using a new endoscopic approach to improve management of biliary adverse events (BAEs) after bilio-digestive anastomosis. We provide an ...update about our experience at 7 years.
Patients and methods
Patients with BAEs on hepatico-jejunostomy underwent entero-enteral endoscopic by-pass (EEEB) creation between the duodenal/gastric wall and the biliary jejunal loop. Evaluation of results during our seven-year experience was performed.
Results
Eighty consecutive patients (32 patients from Jan 2014 to Dec 2017 and 48 patients from Jan 2018 to Jan 2021) underwent EEEB, which was successful in all but one patient. The cumulative AEs rate was 32 %. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Cumulative disease recurrence was 3.8 % (three patients) and was retreated through the EEEB.
Conclusions
The update of our experience with EEEB confirmed that in patients with BAEs after bilio-digestive anastomosis, EEEB allows successful long-term treatment of different BAEs in a tertiary referral center with an acceptable rate of related AEs.
Inflammation and immunity are linked to intestinal adenoma (IA) and colorectal cancer (CRC) development. The gut microbiota is associated with CRC risk. Epithelial barrier dysfunction can occur, ...possibly leading to increased intestinal permeability in CRC patients. We conducted a case-control study including 100 incident histologically confirmed CRC cases, and 100 IA and 100 healthy subjects, matched to cases by center, sex and age. We performed 16S rRNA gene analysis of blood and applied conditional logistic regression. Further analyses were based on negative binomial distribution normalization and Random Forest algorithm. We found an overrepresentation of blood 16S rRNA gene copies in colon cancer as compared to tumor-free controls. For high levels of gene copies, community diversity was higher in colon cancer cases than controls. Bacterial taxa and operational taxonomic unit abundances were different between groups and were able to predict CRC with an accuracy of 0.70. Our data support the hypothesis of a higher passage of bacteria from gastrointestinal tract to bloodstream in colon cancer. This result can be applied on non-invasive diagnostic tests for colon cancer control.
Cricopharyngeal myotomy with flexible endoscope is a well-known and safe treatment for Zenker’s diverticulum. We describe hereafter how we perform this flexible endotherapy. From January 2011 to ...January 2017, we treated 28 patients with this endotherapy. Our technique is described step-by-step in the paper: the main principle is to perform an endoscopic cut of the diverticular septum and cricopharyngeal muscle’s fibers (see the video). We describe an objective measurement of the cutting length and depth of the myotomy. Technical success was achieved in all the patients. As to clinical success, 76.2% of patients showed a significant improvement and relevant disappearance of preoperative dysphagia. The present follow-up ranges from 6 months to 5 years. This flexible endoscopic technique can overcome some limitations of rigid endoscopic technique (i.e., upper teeth protrusion, inadequate jaw opening, or limited neck mobility). The main indication was based on clinical presentation and referred to the diverticular dimensions between 2 and 5 cm. Tips for the technique are described in the paper. This variant of cricopharyngeal myotomy with flexible endoscopy is feasible and effective for the treatment of Zenker’s diverticulum in selected patients.
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