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Efficacy and safety of therapeutic ERCP in elderly
Abstracts The M2A Patency Capsnle (M2A PC) consists of an ingestible, timecontrolled, dissolvable capsnle with the same size as Pillcam. It is composed of a dissolving lactnlose body snrronnding a radio freqnency identification tag, that can be relieved by a radio freqnency scanner. Pnrpose of the stndy is to asses the ability and the safety of M2A PC in detecting intestinal strictnres in pts with snspected small bowel CD before nndergoing Pillcam. Material and methods: A total of 15 pts (8 Male and 7 Female, mean age 37 yrs) with suspected CD was studied: 10 pts with clinical pattern of recurrent cramping abdominal pain and/or abdominal mass and 5 pts with clinical pattern of diarrhoea. All pts were first investigated with a small bowel follow-throngh (BFT) and snbsequently with ingested M2A PC.The presence of M2A PC was assessed with scanner after 36 hours and, if still present, after 48 and 72 hours. If M2A PC was detected after 72 h or disintegrated in the stool, the test was considered "pathological" and the occnrrence of a stricture was snggested. Results: In 9/15 pts (8 pts with clinical pattern of recnrrent cramping abdominal pain and/or abdominal mass and 1 pts with clinical pattern of diarrhoea) M2A PC test was "pathological". Two of them complained abdominal pain and nausea, probably due to the blockage of M2A PC, quickly improved probably for capsule dissolving. In 6/10 pts with clinical pattern of recurrent cramping abdominal pain and/or abdominal mass BFT showed no rednction of small bowel lumen. Pillcam was nneventfully performed in 6 pts with normal M2A PC test, 2 of them with BFT-positive for small bowel stricture; in 5/6 pts Pillcame disclosed lesions indicative for CD. Conclusions: Our preliminary results indicate M2A PC as a simple and safe test. M2A PC shonld be nsed before nndergoing Pillcam in pts with snspected small bowel CD and in particularly those clinically suspected for stenosis.Moreover M2A PC seems to be a diagnostic tool more sensitive then BFT to detect small bowel functional strictures.
PA.269 ENDOSCOPIC TREATMENT FOR BILIARY COMPLICATIONS AFTER LIVER TRANSPLANT
1. Tarantino', M. Traina, L. Barresi, M. DiPisa, R. Volpes, B. Gridelli IsMeIT, Palenno Background and aim: Biliary complications are the most freqnent problems after liver transplant (8-30%). These include: strictures, leaks, stones, debris, cast, oddities and sphincter dysfnnctions. Early recognition and treatment are crucialAim of the study was the assessment of the efficacy of endoscopic treatments on patients underwent OLTx or LRLTx. Material and methods: Longitudinal stndy on transplanted patients with biliary complications in our Istitution Separate data bases were done for OLTx and LRLTx recipients. Etiology, type of complication, time of onset, endoscopic treatment, number of procedures, recoverytime, other treatment, surgery, OLT, final outcome were recorded. Diagnosis was based on liver function test and MRCP. Results: Since Sep99 to Sep05, 224 adnIts were transplanted, 192 OLTx and 32 LRLTx. Dnct-to-Dnct where done in all LRLT and 117 OLT recipients, 75 OLT were hepatico-jejeuno anastomosis. In the OLTx group 57patients had biliary complications (21 hepatico-jejeunostomy had PTC and 36 D-to-D had ERCP), 14 in the LRLT group. If we consider both group with D-to-D anastomosis, 82% of complications occurred during the first 6 months. Leaks occurred in 5 patients, 4 LRLT and 1 OLTx, all treated with sphinterotomy and stent placement required one treatment. 39 patients had anastomotic stenosis, 30 OLTx and 9 LRLT. The m
S15l
placement and 6 sphinterotomy only. The mean of ERCP was 2. In OLT group we observed 4 patients with normal cholagiography, in 2 the sphinterotomy resolved the jaundice. 1 patient with oddities in the LRLT group recovered post sphinterotomy. 1 patient with stone solved with sphinterotomy. None major complications were recorded.At the final analysis 7 (14%) patients reqnired other treatment: 3 PTC, 2 surgery, 2 OLT. Conclusions: In our series the complications are more frequent on LRLT then OLT recipients, the majority is early complications, the most frequent is the anastomotic stricture. The endoscopic treatment resolves the complications in the majority of cases.
PA.270 EFFICACY AND SAFETY OF THERAPHEUTIC ERCP IN ELDERLY A. Rispo .,1, A. Cozzolino 1, E. Di Girolamo 1, G. Bevilacqua 2, L. Caserta 1, L.MA.T. Hamma 1, R. Tortora 3, L. Pasquale 1 1Presidio
Gspedaliero, Gastroenterologia, Ariano Irpino Gspedaliero, Chirurgia Generale, Ariano Irpino 3Gastroenterologia, Universitii "Federico IT', Napoli 2 Presidio
Background and aim: Therapeutic ERCP has a pivotal role in the management of janndice due to a variety of pancreatic and biliary diseases. Both safety and efficacy ofthe procedure are well documented in general population while focused data about its performance in elderly subjects are scanty. Aim: To evaluate the efficacy and safety of therapeutic ERCP in the elderly people when compared to the younger population Material and methods: ERCP under general anaesthesia. We divided the patients in 2 groups: Group A (#28): patients > 75 years (median age 82 years; range 75-93 years); Group B (#25): patients <75 years (median age 57 years; range 29-72 years). Indication for ERCP was: choledocholithiasis (62%), pancreatic cancer (32%), ampulloma (6%) in Gronp A; choledocholithiasis (80%), pancreatic cancer (16%), cholangiocarcinoma (4%) in Gronp B. Nine patients in Group A and 5 patients in Gronp B needed a biliary stenting. The ontcomes of the procedure in the two groups were compared in terms of efficacy (jaundice resolution, successful biliary stenting) and safety (mortality, complications, need for surgery). The presence of comorbidity in the two groups was also recorded. Statistics was performed by using MedCalc software calcnlating Pearson's 2 Results: ERCP was effective for jaundice resolntion in 26 patients in Gronp A and 24 patients in Group B (93% vs 96%; p=ns). Biliary stenting was successfully performed in 8 out of the 9 patients in Group A and in all 5 patients in group B (89% vs 100%; p=ns). About safety, 2 patients in Group A (1 bleeding; 1 transient acute respiratory failure) and 1 patient in Gronp B (mild pancreatitis) presented a complication (7% vs 4%; p=ns). A varions comorbidity was present in 19 patients in Gronp A and in 9 patients in Gronp B (67% vs 36%; p=0.02). Conclusions: Therapeutic ERCP is safe and effective in elderly patients in spite of their significantly higher comorbidity.
PA.271 BURIED BUMPER SYNDROME: TWO CASES OF ENDOSCOPIC MANAGEMENT USING A GUIDEWIRE E. Limido', L. Furlan, F. Barzaghi, F. Rocca
A.G. Gspedale di Circolo di Busto Arsizio, Busto Arsizio Background and aim: Buried bumper is a complication of PEG that occurs in 2% to 6.1 % of patients, maybe for excessive external traction that leads to erosion of the internal bumper into the gastric wall. Someone suggested that alteration in the physical characteristic of the bumper cansed by gastric acid might facilitate pressnre necrosis of the
PA.269 ENDOSCOPIC TREATMENT FOR BILIARY COMPLICATIONS AFTER LIVER TRANSPLANT
1. Tarantino', M. Traina, L. Barresi, M. DiPisa, R. Volpes, B. Gridelli IsMeIT, Palenno Background and aim: Biliary complications are the most freqnent problems after liver transplant (8-30%). These include: strictures, leaks, stones, debris, cast, oddities and sphincter dysfnnctions. Early recognition and treatment are crucialAim of the study was the assessment of the efficacy of endoscopic treatments on patients underwent OLTx or LRLTx. Material and methods: Longitudinal stndy on transplanted patients with biliary complications in our Istitution Separate data bases were done for OLTx and LRLTx recipients. Etiology, type of complication, time of onset, endoscopic treatment, number of procedures, recoverytime, other treatment, surgery, OLT, final outcome were recorded. Diagnosis was based on liver function test and MRCP. Results: Since Sep99 to Sep05, 224 adnIts were transplanted, 192 OLTx and 32 LRLTx. Dnct-to-Dnct where done in all LRLT and 117 OLT recipients, 75 OLT were hepatico-jejeuno anastomosis. In the OLTx group 57patients had biliary complications (21 hepatico-jejeunostomy had PTC and 36 D-to-D had ERCP), 14 in the LRLT group. If we consider both group with D-to-D anastomosis, 82% of complications occurred during the first 6 months. Leaks occurred in 5 patients, 4 LRLT and 1 OLTx, all treated with sphinterotomy and stent placement required one treatment. 39 patients had anastomotic stenosis, 30 OLTx and 9 LRLT. The m
S15l
placement and 6 sphinterotomy only. The mean of ERCP was 2. In OLT group we observed 4 patients with normal cholagiography, in 2 the sphinterotomy resolved the jaundice. 1 patient with oddities in the LRLT group recovered post sphinterotomy. 1 patient with stone solved with sphinterotomy. None major complications were recorded.At the final analysis 7 (14%) patients reqnired other treatment: 3 PTC, 2 surgery, 2 OLT. Conclusions: In our series the complications are more frequent on LRLT then OLT recipients, the majority is early complications, the most frequent is the anastomotic stricture. The endoscopic treatment resolves the complications in the majority of cases.
PA.270 EFFICACY AND SAFETY OF THERAPHEUTIC ERCP IN ELDERLY A. Rispo .,1, A. Cozzolino 1, E. Di Girolamo 1, G. Bevilacqua 2, L. Caserta 1, L.MA.T. Hamma 1, R. Tortora 3, L. Pasquale 1 1Presidio
Gspedaliero, Gastroenterologia, Ariano Irpino Gspedaliero, Chirurgia Generale, Ariano Irpino 3Gastroenterologia, Universitii "Federico IT', Napoli 2 Presidio
Background and aim: Therapeutic ERCP has a pivotal role in the management of janndice due to a variety of pancreatic and biliary diseases. Both safety and efficacy ofthe procedure are well documented in general population while focused data about its performance in elderly subjects are scanty. Aim: To evaluate the efficacy and safety of therapeutic ERCP in the elderly people when compared to the younger population Material and methods: ERCP under general anaesthesia. We divided the patients in 2 groups: Group A (#28): patients > 75 years (median age 82 years; range 75-93 years); Group B (#25): patients <75 years (median age 57 years; range 29-72 years). Indication for ERCP was: choledocholithiasis (62%), pancreatic cancer (32%), ampulloma (6%) in Gronp A; choledocholithiasis (80%), pancreatic cancer (16%), cholangiocarcinoma (4%) in Gronp B. Nine patients in Group A and 5 patients in Gronp B needed a biliary stenting. The ontcomes of the procedure in the two groups were compared in terms of efficacy (jaundice resolution, successful biliary stenting) and safety (mortality, complications, need for surgery). The presence of comorbidity in the two groups was also recorded. Statistics was performed by using MedCalc software calcnlating Pearson's 2 Results: ERCP was effective for jaundice resolntion in 26 patients in Gronp A and 24 patients in Group B (93% vs 96%; p=ns). Biliary stenting was successfully performed in 8 out of the 9 patients in Group A and in all 5 patients in group B (89% vs 100%; p=ns). About safety, 2 patients in Group A (1 bleeding; 1 transient acute respiratory failure) and 1 patient in Gronp B (mild pancreatitis) presented a complication (7% vs 4%; p=ns). A varions comorbidity was present in 19 patients in Gronp A and in 9 patients in Gronp B (67% vs 36%; p=0.02). Conclusions: Therapeutic ERCP is safe and effective in elderly patients in spite of their significantly higher comorbidity.
PA.271 BURIED BUMPER SYNDROME: TWO CASES OF ENDOSCOPIC MANAGEMENT USING A GUIDEWIRE E. Limido', L. Furlan, F. Barzaghi, F. Rocca
A.G. Gspedale di Circolo di Busto Arsizio, Busto Arsizio Background and aim: Buried bumper is a complication of PEG that occurs in 2% to 6.1 % of patients, maybe for excessive external traction that leads to erosion of the internal bumper into the gastric wall. Someone suggested that alteration in the physical characteristic of the bumper cansed by gastric acid might facilitate pressnre necrosis of the