WHAT WE DO

Annually more than 1,200 ERCP are performed treating either biliary disease (biliary lithiasis, benign and malignant strictures of the common bile duct and the hepatic hilum, post-surgical biliary fistulas) or pancreatic diseases (chronic pancreatitis, pancreatic fistulas post-surgical). One of the most complex ERCP procedures is the endoscopic papillectomy (nearly 10-15 procedures per year) for the treatment of Vater papilla adenomas in alternative to complex and invasive surgeries.
During an ERCP advanced diagnostic procedures of biliary strictures are also carried out, whose typing is now an open debate. In this field new technologies such as cholangioscopy (30 cases per year) and confocal microscopy (30 cases year) represent a pivotal point for the diagnosis and treatment of indeterminate biliary stenosis.

In addition, integration of Extracorporeal Shock Wave Lithotripsy (ESWL) (50-60 procedures per year) allows the endoscopic approach and treatment of cholelithiasis complex (megalitiasi and intrahepatic lithiasis) and calcified intraductal pancreatic lithiasis.

The X-Ray Room used for ERCP is also the "theatre" of other interventional endoscopic procedures on the digestive system such as:

• Treatment of benign and malignant esophageal strictures by dilatation and/or stent placement
• Treatment of esophageal-gastric post-surgical fistulas
• Palliation of malignant gastric and duodenal ulcers with metal stents
• Palliation or "bridge to surgery" of malignant colon in selected cases

Overall we perform approximately 1,400-1,500 ERCP advanced biliary-pancreatic endoscopy procedures and surgical replacement and expansion of the digestive system per year.

Approximately 450 Enteroscopies have been performed since 2007 at our Digestive Endoscopy Unit with an average of 70-80 procedures per year, with an increasing demand in the last two/three years. The diagnosis and treatment of small bowel diseases are available only in a few centres in Italy. This is the reason why many patients come to our group, often after a long and inconclusive diagnostic process. In two thirds of the cases the diseases under investigation and/or treated are acute or chronic gastrointestinal bleedings with the source located in the small bowel (after the stomach before the colon), followed by inflammatory bowel diseases ( Crohn's disease), malabsorption syndromes, hereditary polyposis, enteritis caused by anti-inflammatory drugs and tumors.

Approximately 500 procedures per year are performed by our medical staff:
- High-resolution manometry - 24-Hour Esophageal - Wireless Capsule for Esophageal pH (Bravo™ reflux testing system) - 24-Hour pH Impedance

Approximately 4,500 colonoscopies per year are performed at the Digestive Endoscopy Unit of the Policlinico Gemelli Hospital, with a rate of achievement of the caecum of nearly 98%.

In addition to the diagnosis and treatment of many large intestine benign diseases, Colonoscopy also allows the identification, definition and treatment of most superficial colon neoplastic lesions due to numerous endoscopic resection techniques such as Polypectomy (approx. 1,500 cases per year), EMR Endoscopy (approx. 500 cases per year) and Endoscopic Submucosa Dissection (30-35 procedures per year). The Colonoscopy Dilation with balloon probes (approx. 60 cases per year) and palliation of malignant strictures through the placement of metallic stents (approx. 10-15 cases per year) during Colonoscopies also allows the treatment of large intestine benign stenosis.

About 1,100 Videocapsule Enteroscopies have been carried out in our Endoscopy Unit since 2002 (nearly 100 tests per year). In two thirds of cases the test was carried out for unknown bleeding. The remaining third of tests were for the diagnosis and/or follow-up of patients with Crohn's disease, patients with hereditary polyposis, suspected neoplastic diseases, malabsorption syndromes and enteropathies from drugs. Since inception, we have been involved in feasibility and validation studies of this new method.

Our Centre has coordinated and organized the first International Consensus Conference during which ESGE recommendations and guidelines were prepared. We are also involved in the organization of National and International Meetings. Recently our Unit was listed as worldwide colon capsule "Centre of Excellence" and in this context it organizes Training Courses in collaboration with the EETC. We performed approximately 500 procedures, mostly in the field of clinical trials.

In 2016, approximately 1,350 procedures (about 60% operational or surgical) were performed, with an increase of about 30% over the last 3 years. The exams are performed with linear therapeutic type instruments with an operator channel of 3.7mm, used for either diagnostic or surgical cases. Sampling for typing of solid lesions is performed with needles of different gauges to obtain histological examination samples, rather than for cytological examination. The interventional procedures that we carry out daily at our center include drainage of pancreatic pseudocysts with plastic and metal stents, gall bladder and bile duct drainage (after CPRE failure), positioning of fiducials, HCC alcoholizzation and RFA of small pancreatic NET’s.

The Digestive Endoscopy Unit has been pioneers in Europe of this technique. The first Esophageal Transoral Myotomy in Italy (and among the first in Europe) was in fact carried out at the Policlinico Gemelli in May 2011. Esophageal Transoral Myotomy was successfully performed on over 462 patients until February 2013.