Gastroenterology and Gastrointestinal Endoscopy

The Unit of Gastroenterology and Gastrointestinal Endoscopy at San Raffaele Scientific Institute is well known and has as its main strength in the development and clinical use of new and advanced technologies for endoscopic diagnosis and therapy, endoluminal surgery, investigation and treatment of motility disorders of the gastrointestinal tract. The Unit includes also a section of personalized medicine for genetic testing and prediction of cancer risk by applying a personalized based approach and identifying risk factors for the most important and frequent tumors of the digestive system (gastric, colorectal, and pancreatic cancer).

The strict and continuous relationship between the gastroenterologists of the Division and basic researchers creates a tight network of experts that permits to develop and bring in the clinical practice to our patients new and exceptional treatments faster than in other Institutions. The Division includes four main clinical sections: clinical gastroenterology and hepatology, gastrointestinal and pancreatico-biliary diagnostic and therapeutic endoscopy, ultrasound endoscopy (EUS), and gastrointestinal motility. Endoscopy and ultrasound endoscopy sections use high-definition endoscopes and are ranked among the top in Europe as regards diagnostic techniques, endoluminal surgery, management of pancreatico-biliary diseases, and clinical research. Every year, approximately 15.000 endoscopic procedures and motility testing investigations are carried out by physicians working in the Division.

Main conditions treated

Pancreatico-biliary diseases:

  • bile stone disease
  • primary sclerosing cholangitis and biliary tree strictures
  • biliary, pancreatic (either esocrine and endocrine), and ampullary tumors and precancerous conditions
  • chronic pancreatitis
  • acute recurrent pancreatitis and complications of acute and chronic pancreatitis
  • cystic tumors of the pancreas and of the pancreatic duct
  • post-surgical complications

Gastrointestinal diseases:

  • motility disorders of esophagus, stomach and colon-rectum, including acalasia, gastroparesis and constipation
  • gastro-esophageal reflux disease, Barrett’s esophagus and esophageal cancer
  • chronic atrophic gastritis, gastric cancer and pre-cancerous conditions of the stomach
  • celiac disease
  • irritable bowel syndrome and food intolerance
  • chronic inflammatory bowel diseases
  • colo-rectal cancer, polyps and other precancerous conditions

Advanced endoluminal surgery and diagnosis:

  • mucosal resection and submucosal dissection for polyps and submucosal lesions of the gastrointestinal tract
  • trans-oral fundoplication for gastro-esophageal reflux disease
  • radiofrequency ablation of Barrett’s esophagus
  • EUS-guided cryothermal ablation of locally advanced pancreatic cancer
  • EUS-guided drainage of pancreatitc fluid collections and debridement of necrotic tissue in walled-off necrotic pancreatic lesions
  • EUS-guided endoluminal bilio-pancreatic and gastro-enteric anastomosis
  • biliary and pancreatic endosurgery
  • by-pass of strictures of the gastrointestinal tract by self-expandable metal/absorbable stenting
  • capsule video endoscopy
  • treatment of obesity by intra-gastric Aspire system and balloon placement
  • confocal endomicroscopy for early diagnosis of gastrointestinal and pancreatico-biliary tumors

Research

Clinical research is addressed to:

  • EUS Unit is carrying out the first randomized controlled trial worldwide on EUS-guided cryothermal treatment of locally advanced and borderline resectable pancreatic cancer. This innovative treatment is able to reduce the tumor mass and this study is designed to show a possible benefit in terms of progression free survival, resection rate and overall survival in these patients who have a dismal prognosis at the the time of the diagnosis.
  • development of new technologies and devices for endoscopy and EUS for gastrointestinal and pancreatico-biliary interventions and advanced diagnosis
  • management of idiopathic acute recurrent pancreatitis, pre-cancerous conditions and cystic tumours of the pancreas, cancer of the pancreas, and prevention of post-ERCP pancreatitis
  • management of Barrett’s esophagus and gastrointestinal pre-cancerous conditions, identification of early predictors of cancer
  • management of gastro-esophageal reflux disease

Basic research is addressed to:

  • relationship between intestinal microbiota, colon cancer and autoimmune pancreatitis
  • identifications of biological predictors of cancer risk of the gastrointestinal and pancreatic cancer
  • role of small bowel mucosa in the occurrence of childhood diabetes and neurological disorders

Research results are published in the most prestigious international journals; approximately 20 original articles are published every year. Books on operative endoscopy and pancreatic diseases have also been published in the last years. The Division organizes every year an international live course and several other monothematic courses addressed to specialists, every two years the congress of European Society of Endoscopic Ultrasound (EURO-EUS) The Endoscopy and EUS Units are currently involved or coordinate several national and international multicenter trials.

Educational activity

  • The Unit, affiliated with the Vita-Salute San Raffaele University of Medicine, organizes every year:
  • 2nd level Master courses in ERCP, therapeutic gastrointestinal endoscopy, and EUS
  • hands-on activity and stages for ERCP, therapeutic gastrointestinal endoscopy, and EUS within a network of European Centers of Excellence for gastrointestinal endoscopy.
  • The University-affiliated medical staff members have the responsibility of three integrated course of Gastroenterology within the undergraduate school of medicine, one of the in the English M.D. program, and post-graduate fellowship program.

Technology

Endoscopy is performed with the most technologically advanced endoscopes and ultrasound endoscopes, with full high definition capability and electronic contrast imaging. Operative procedures are performed using CO2 insufflation to reduce patient’s discomfort and risk in cases of intra-procedural complications and under deep sedation, carried out every day by two to three anesthesiologists. In the Division there is an x-Ray room for pancreatico-biliary procedures and stent placement. Technologically advanced devices are currently used in routine practice to perform trans-oral fundoplication for treatment of gastro-esophageal reflux, ablation of tissue in Barrett’s esophagus, intraductal imaging of the biliary and pancreatic ductal system, resection of mucosal and submucosal lesions in the gastrointestinal tract, and treat obesity. Motility disorders are investigated by most advanced technologies: pH-impedance, high resolution manometry, and Restech technology for proximal gastro-esophageal reflux.

Staff

It is composed by 13 physicians, 18 nurse members, 1 research–dedicated nurse, and 6 fellows. Medical staff members are:

  • Pier Alberto Testoni, head of the Unit and professor of Gastroenterology at Vita-Salute San Raffaele University of Medicine, Fellow of the American Society of Gastrointestinal Endoscopy (ASGE)
  • Mario Guslandi, head of Clinical gastroenterology and hepatology Unit, Fellow of the American College of Gastroenterology (FACG)
  • Sandro Passaretti, head of Motility disorders Unit
  • Maria Chiara Petrone, head of Ultrasound endoscopy Unit
  • Giulia Martina Cavestro, PhD, assistant professor of Gastroenterology at Vita-Salute San Raffaele University of Medicine, head of the personalized and preventive medicine program
  • Lorella Fanti, senior physician, head of sedation and analgesia for endoscopy program
  • Alberto Mariani, senior physician, head of pancreatic diseases section
  • Edi Viale, senior physician, head of gastrointestinal cancer and precancerous conditions section
  • Emanuele Dabizzi, junior physician, head of advanced pancreatico-biliary imaging program
  • Roberta Maselli, consultant for operative gastrointestinal endoscopy
  • Chiara Notaristefano, consultant for operative gastrointestinal endoscopy and videocapsule endoscopy
  • Elisa Radice, consultant for inflammatory bowel diseases and trans-abdominal ultrasound