Search Results (13)

In the management of cholangiocarcinoma, effective biliary drainage and accurate diagnosis are vital to allow further treatment. Confirmation of tissue diagnosis and molecular characterization is also required to guide future treatment options including surgery and chemotherapy as well as the possible use of personalized treatments that target specific mutations present within individual tumours. Initial CT or MRI scans may be followed by endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) to obtain tissue samples. However, these methods often fall short due to difficulty in accessing entire bile duct strictures. SpyGlass cholangioscopy can improve diagnosis, yet may fail to provide sufficient tissue for molecular characterization. Here we present a perspective on the development of snake-like agile robots with integrated optical imaging and Raman spectroscopy. These robots could improve the mapping of the biliary tree and the precision of biopsy collection and allow tissue analysis in situ, as well as facilitating stenting to restore the flow of bile. A multidisciplinary approach that brings together clinicians, pathologists, and engineers is required to develop these new robotic technologies and improve patient outcomes. Full article

Background: Pancreatic stents (PSs) play a crucial role in the management of pancreatic duct obstructions, particularly in the context of endoscopic retrograde cholangiopancreatography (ERCP). However, stent migration remains a significant complication, leading to risks such as pancreatitis, pancreatic duct stenosis, and abscess formation. This study aims to evaluate the efficacy of various endoscopic techniques for retrieving proximally migrated or broken pancreatic stents, highlighting optimal strategies for improving patient outcomes. Methods: A retrospective multicenter review was conducted across six hospitals from 2016 to 2024. Patients with proximally migrated or broken pancreatic stents referred for endoscopic retrieval after failed attempts at other facilities were included. Demographic data, stent characteristics, and retrieval techniques were analyzed. Endoscopic methods included SpyGlass forceps, SpyGlass baskets, Soehendra retriever stents, balloon sweeps, flower baskets, and extension pancreatic sphincterotomy. Procedural success, retrieval times, and post-procedural outcomes were assessed. Results: Twelve patients underwent endoscopic retrieval, including two with broken stents. All procedures were successful, with retrieval times averaging 30 to 45 min. Two patients developed pancreatic duct narrowing, requiring balloon dilation. All patients had new stents placed to maintain duct patency, and no major complications were observed. Follow-up evaluations confirmed complete resolution of migration-related issues, with all stents removed. Conclusions: Endoscopic retrieval of migrated pancreatic stents is highly effective, with specialized techniques ensuring a 100% success rate in this study. Early intervention and the selection of appropriate retrieval methods are critical in minimizing complications. Further research is needed to refine retrieval strategies and standardize protocols to enhance clinical outcomes. Full article

Background/Objectives: The management of refractory pancreatic duct (PD) and cystic duct leaks may represent an endoscopic challenge. Standard endoscopic therapy involves pancreatic/biliary sphincterotomy and stenting during endoscopic retrograde cholangiopancreatography (ERCP). After conservative (fasting, parenteral nutrition, and use of somatostatin analogs) or conventional endoscopic treatments fail, a surgical approach is usually required, leading to higher mortality due to several technical complications. Previous evidence of the endoscopic use of N-butyl-2-cyanoacylate (NBCA) for treating pancreaticobiliary leaks is reported, although the evidence is scarce. Methods: Six patients with pancreaticobiliary leaks (three IT pancreatic leaks and three Class A sec. Strasberg post-cholecystectomy biliary leaks) refractory to previous treatment were treated with the endoscopic topical application of NBCA. All our patients gave informed consent. The procedures were all performed between December 2017 and February 2025 at a tertiary referral center for biliopancreatic endoscopy. Results: Therapeutic success, as shown both endoscopically and radiologically, was 100%, and no procedural complication was reported. In one patient with biliary leak, standard cannulation of the cystic duct stump with the guidewire was unsuccessful, requiring a peroral cholangioscopy (SpyGlass System DSII) to directly visualize the leakage site, allowing a precise closure of the wall defect with NBCA. Conclusions: NBCA injection could represent a safe and effective endoscopic option in refractory PD of the tail of the pancreas and cystic duct leaks. Larger and further studies are necessary to confirm these results. Full article

Background/Objectives: the aim of this study was to evaluate the safety and efficacy of percutaneous transhepatic lithotripsy using the SpyGlassDSTM cholangioscopy system for the treatment of difficult stones. Methods: Retrospectively, all patients treated with percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy system were analyzed. As primary outcome measures, the following data were assessed: the presence of a previous history of the hepatobiliary disease, location of stones, reasons for the choice of the procedure, previous balloon bilioplasty, type of pre-procedural imaging, procedural time, technical success, clinical success, and post-procedural complications (according to CIRSE classification). Clinical success was considered “primary” when achieved with a single treatment, and “secondary” if more than one treatment was required in the duration of follow-up. Results: 10 patients (6 males and 4 females, mean age = 64 years, SD = 22), all with cholangitis due to gallstones, underwent 11 PTL procedures using SpyGlassDSTM. Technical and clinical successes were achieved in all patients (100%). Primary success was observed in 4/10 (40%) patients, while the remaining 6/10 (60%) patients undergoing re-treatment, and all showed secondary success (100%). No periprocedural complications were observed. In 10/11 procedures (90%), no relevant adverse events were recorded within the first thirty days of follow-up. In 1/11 case (9%), mild complications (grade I according to CIRSE classification) were registered in the following days after the procedure (<30 days). Conclusions: in conclusion, the treatment of percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy of difficult stones has been demonstrated as efficient and safe treatment. Full article

Emanuele Tesauro’s Il cannocchiale aristotelico (The Spyglass of Aristotle) is widely considered a masterpiece of the Baroque, mainly because of his theory of metaphor as a cognitive tool. But this work is much more than that. Tesauro presents his volume as the ultimate interpretation of Aristotle’s rhetorical art, which is clearly not the case. Indeed, his work is a polycentric discourse on a revolutionary theory of rhetoric that goes beyond any previous treatise written on the subject, including Aristotle’s Rhetoric. Despite his relevance in the history of rhetorical theories, Tesauro’s work is still waiting for a comprehensive study of its own as well as investigations of some of its specific aspects. Furthermore, the majority of the existing studies of Tesauro are in Italian (with only very few in English), which makes it difficult for this text to reach an international public. This essay explores what seems to be a specific aspect that has so far been almost completely neglected: the role played by the ancient sophists in the Cannocchiale aristotelico and in the history of rhetoric that Tesauro redesigns. Tesauro proclaims his fidelity to Aristotle but actually contradicts Aristotle’s anti-sophistic approach. During this analysis, we will discover even more about Tesauro’s pro-sophistic attitude: he grounds the climax of Latin rhetorical tradition in Greek sophistry. This positive assessment of the ancient sophists, especially Thrasymachus and Gorgias of Leontini, coexists with a critique of Socrates. Except for Sperone Speroni, no other early modern Italian author—or European author—has proposed this radical inversion of the canon established by Plato. This reversal makes Tesauro a relevant case study in the on-going exploration of the legacy of ancient sophists in Western literature. Full article

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques. Full article

Background: The recent improvement of peroral cholangioscopy (POCS) maneuverability has enabled the precise, targeted biopsy of bile duct lesions under direct cholangioscopic vision. However, as only small-cup biopsy forceps can pass through the scope channel, the resulting small sample size may limit the pathological diagnosis of biopsy specimens. This study compared the diagnostic abilities of POCS-guided biopsy and conventional fluoroscopy-guided biopsy for bile duct cancer. Method: This multicenter, retrospective cohort study included patients exhibiting bile duct stricture with suspected cholangiocarcinoma in whom POCS-guided and fluoroscopy-guided biopsies were performed in the same session. The primary endpoint was the diagnostic sensitivity for malignancy. The size and quality of the biopsy specimens were also compared. Result: A total of 59 patients were enrolled. The sensitivity of POCS-guided biopsy was similar to that of fluoroscopy-guided biopsy (54.0% and 64.0%, respectively). However, when the modalities were combined, the sensitivity increased to 80.0%. The mean specimen size from POCS-guided biopsy was significantly smaller than that from fluoroscopy-guided biopsy. The specimen quality using fluoroscopy-guided biopsy was also better than that using POCS-guided biopsy. Conclusions: The diagnostic sensitivity of POCS-guided biopsy is still insufficient, mainly because of the limited specimen quantity and quality. Therefore, conventional fluoroscopy-guided biopsy would be helpful to improve diagnostic sensitivity. Full article

The research is focused on the design and development of woven textile-based structural hollow composites. E-Glass and high tenacity polyester multifilament yarns were used to produce various woven constructions. Yarn produced from cotton shoddy (fibers extracted from waste textiles) was used to develop hybrid preforms. In this study, unidirectional (UD), two-dimensional (2D), and three-dimensional (3D) fabric preforms were designed and developed. Further, 3D woven spacer fabric preforms with single-layer woven cross-links having four different geometrical shapes were produced. The performance of the woven cross-linked spacer structure was compared with the sandwich structure connected with the core pile yarns (SPY). Furthermore, three different types of cotton shoddy yarn-based fabric structures were developed. The first is unidirectional (UD), the second is 2D all-waste cotton fabric, and the third is a 2D hybrid fabric with waste cotton yarn in the warp and glass multifilament yarn in the weft. The UD, 2D, and 3D woven fabric-reinforced composites were produced using the vacuum-assisted resin infusion technique. The spacer woven structures were converted to composites by inserting wooden blocks with an appropriate size and wrapped with a Teflon sheet into the hollow space before resin application. A vacuum-assisted resin infusion technique was used to produce spacer woven composites. While changing the reinforcement from chopped fibers to 3D fabric, its modulus and ductility increase substantially. It was established that the number of crossover points in the weave structures offered excellent association with the impact energy absorption and formability behavior, which are important for many applications including automobiles, wind energy, marine and aerospace. Mechanical characterization of honeycomb composites with different cell sizes, opening angles and wall lengths revealed that the specific compression energy is higher for regular honeycomb structures with smaller cell sizes and a higher number of layers, keeping constant thickness. Full article

Although Spy DS (SpyGlass DS Direct Visualization System) is considered to be useful for the diagnosis of bile duct strictures and the treatment of bile duct stones, there is limited data to date validating its efficacy. We hence retrospectively evaluated the clinical outcomes of the use of Spy DS in a large number of patients. A total of 183 patients who underwent Spy DS-guided procedures for indeterminate bile duct strictures (n = 93) and bile duct stones (n = 90) were analyzed retrospectively. All patients (93/93) with bile duct strictures successfully underwent visual observation, and 95.7% (89/93) of these patients successfully underwent direct biopsy. The sensitivity, specificity, and overall accuracy were 94.7%, 83.3%, and 90.3%, respectively, for visual impression; 80.9%, 100%, and 89.2%, respectively, for histopathological analysis of a direct biopsy; and 96.5%, 91.7%, and 94.6%, respectively, for visual impression combined with biopsy. Successful visualization of the stones was achieved in 98.9% (89/90) of the patients, and complete stone removal was achieved in 92.2% (83/90) of the patients, with an average of 3.3 procedures. The adverse events rate was 17.5% (32/183; cholangitis in 15 patients, fever the following day in 25, pancreatitis in 1, hemorrhage in 1, and gastrointestinal perforation in 1). No administration of antibiotics before the procedure was found to be a statistically significant risk factor for the development of fever after the procedure (p < 0.01). Spy DS-guided procedures are effective for the diagnosis and treatment of bile duct lesions and can be performed with a low risk of serious adverse events. Full article

Objectives: To evaluate the efficacy and safety of percutaneous transhepatic lithotripsy (PTL) using an electro-hydraulic (EH) system for difficult bile stones. Methods: We retrospectively evaluated two patients with recurrent cholangitis, jaundice and fever for the presence of difficult bile stones, inaccessible by an endoscopic approach, treated with PTL. Both procedures were conducted using the same protocol, with two different accesses. The treatments were performed using a 10 Fr flexible choledoscopy SpyGlass DS^TM for visualization and an EH system for lithotripsy. Results: Technical success, clinical success and complications were evaluated. The two procedures were successfully concluded in both patients without any residual stones in the biliary tree. For both patients, a short follow-up period of six months was available, during which they remained asymptomatic. Neither major nor minor complications were registered. Conclusion: PTL was determined to be an effective and safe technique. This procedure allows a direct visualization of the stone, reducing fluoroscopy time and permitting a less invasive and less traumatic method for the percutaneous management of difficult bile stones. Advances in knowledge: The direct visualization, the high quality of the digital view, the adequate length of the device and the less traumatic approach of EH systems represent advantages compared with other available technologies. Full article

Background: Biliary strictures are frequently encountered in clinical practice. The determination of their nature is often difficult. This study aims to systematically evaluate the efficacy and safety of the second generation of digital single-operator cholangioscopy (SpyGlass DS, DSOC) in indeterminate biliary strictures (IBDS) through biopsies. Methods: All relative studies published in Medline, the Cochrane Library, Web of Science, and EMBASE were included. The diagnostic tests for IBDS were compared to the surgical histology, autopsy, or long-term clinical follow-up. The methodological quality of the included studies was evaluated by the Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS-2). Results: A total of 11 studies, which involved 356 patients diagnosed through biopsies, were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.74 (95% CI: 0.67–0.80), 0.98 (95% CI: 0.95–1.00), 10.52 (95% CI: 5.45–20.32), 0.31 (95% CI: 0.23–0.41), and 65.18 (95% CI: 26.79–158.61), respectively. The area under the curve (AUC) was 0.9479, and the pooled adverse event rate was 7%. The sensitivity and specificity in the heterogeneity analysis were I² = 48.1% and I² = 25.4%, respectively. Conclusion: SpyGlass DS is a safe and effective technique for IBDS. However, future randomized trials are needed to determine optimal number of biopsies. Full article

Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques. Full article

In two recent papers we introduced a generalization of Boltzmann’s assumption of molecular chaos based on a criterion of maximum entropy, which allowed setting up a bilocal version of Boltzmann’s kinetic equation. The present paper aims to investigate how the essentially non-local character of turbulent flows can be addressed through this bilocal kinetic description, instead of the more standard approach through the local Euler/Navier–Stokes equation. Balance equations appropriate to this kinetic scheme are derived and closed so as to provide bilocal hydrodynamical equations at the non-viscous order. These equations essentially consist of two copies of the usual local equations, but coupled through a bilocal pressure tensor. Interestingly, our formalism automatically produces a closed transport equation for this coupling term. Full article