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Cosimo CALLARI


Roma, Italy
MD
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Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Surgical intervention
7 years ago
2005 views
9 likes
0 comments
04:38
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Surgical intervention
7 years ago
1291 views
9 likes
0 comments
02:14
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Endoscopic removal of accidentally swallowed dentures
Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.
Surgical intervention
8 years ago
1592 views
4 likes
0 comments
02:39
Endoscopic removal of accidentally swallowed dentures
Foreign body ingestion occurs more commonly in children with a peak incidence in the age group of 6 months to 3 years. In adults, it occurs mostly in edentulous patients, prisoners and psychiatric patients.
80-90% of the foreign bodies that reach the gastrointestinal tract will pass spontaneously; 10-20 % will have to be removed endoscopically and unfortunately, 1% requires surgery.
The decision and timing of endoscopic intervention depends on the patient’s age, clinical condition, size, shape and classification of ingested material, anatomical location, risk of aspiration and/or perforation and technical abilities of the endoscopist.
Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract, such as perforation that needs surgical intervention.
In this video, we present the endoscopic removal of a fixed four-dental prosthesis accidentally swallowed and blocked in the prepyloric zone.

Reference:
Management of foreign bodies of the upper gastrointestinal tract: update. William A. Webb Gastrointestinal Endoscopy, Vol 41, No.1, 1995.
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Surgical intervention
9 years ago
1322 views
19 likes
0 comments
05:08
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Emergency endoscopic removal of intragastric balloon for hematemesis and melena
The BioEnterics® Intragastric Balloon (BIB®) System has been developed as a temporary aid to achieve weight loss in obese people that are 40% or more above their optimal weight, in patients who have had unsatisfactory results in their treatment of morbid obesity despite being cared for by a multidisciplinary team, and in superobese patients for whom surgery is often associated with high risks. The BIB® reduces the volume of the stomach and leads to a premature feeling of satiety. The placement and removal of the BIB® is an interventional endoscopic procedure and the balloon is designed to float freely inside the stomach; its size can be changed during the placement.
The technique has absolute contraindications such as voluminous hiatus hernia, abnormalities of the pharynx and esophagus, esophageal varicose veins, use of anti-inflammatory or anti-coagulant drugs, pregnancy and psychiatric disorders. Relative contraindications are esophagitis, ulceration and acute lesions of the gastric mucous membrane. The complications of the BIB® are related to the endoscopic method itself, to sedation and perforation, to its prolonged contact with the mucous membrane and its migration, which may result in esophageal or intestinal obstruction (1). The patients must be clinically supervised during the BIB® placement. Complications and symptoms, such as esophageal injury and vomiting due to BIB® slippage must be described to the patient, along with the possibility that the BIB® may require early endoscopic removal. Since the BIB® works as an artificial bezoar, the patients usually show a maximal reduction in ingestion around the fourth week, and return to normal after 12 weeks.

(1) Mathus-Vliegen EMH. Efficacy of bioenterics intragastric balloon treatment in a prospective 2 years follow-up study. Presented at the Eighth European Congress on Obesity; 1997 Aug. Dublin, Ireland: European Congress on Obesity, 1997.
Surgical intervention
9 years ago
2644 views
14 likes
0 comments
03:36
Emergency endoscopic removal of intragastric balloon for hematemesis and melena
The BioEnterics® Intragastric Balloon (BIB®) System has been developed as a temporary aid to achieve weight loss in obese people that are 40% or more above their optimal weight, in patients who have had unsatisfactory results in their treatment of morbid obesity despite being cared for by a multidisciplinary team, and in superobese patients for whom surgery is often associated with high risks. The BIB® reduces the volume of the stomach and leads to a premature feeling of satiety. The placement and removal of the BIB® is an interventional endoscopic procedure and the balloon is designed to float freely inside the stomach; its size can be changed during the placement.
The technique has absolute contraindications such as voluminous hiatus hernia, abnormalities of the pharynx and esophagus, esophageal varicose veins, use of anti-inflammatory or anti-coagulant drugs, pregnancy and psychiatric disorders. Relative contraindications are esophagitis, ulceration and acute lesions of the gastric mucous membrane. The complications of the BIB® are related to the endoscopic method itself, to sedation and perforation, to its prolonged contact with the mucous membrane and its migration, which may result in esophageal or intestinal obstruction (1). The patients must be clinically supervised during the BIB® placement. Complications and symptoms, such as esophageal injury and vomiting due to BIB® slippage must be described to the patient, along with the possibility that the BIB® may require early endoscopic removal. Since the BIB® works as an artificial bezoar, the patients usually show a maximal reduction in ingestion around the fourth week, and return to normal after 12 weeks.

(1) Mathus-Vliegen EMH. Efficacy of bioenterics intragastric balloon treatment in a prospective 2 years follow-up study. Presented at the Eighth European Congress on Obesity; 1997 Aug. Dublin, Ireland: European Congress on Obesity, 1997.