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P.1.302: ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN THE TREATMENT OF NEOPLASTIC GASTRIC LESIONS
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Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
after endoscopy, independently of the totalized score with a clinical observation (blood pressure, heart beat, oxygen saturation). For the second cohort we discharged the patients when 2 successive registrations had reached the PADSS (Post Anaesthetic Discharge Scoring System) score equal or higher than 9 each registration. We have carried out a telephonic follow-up 24 hours after the discharge. Results: The first cohort consisted of 103 patients (46M-57F, mean age 58.4 ys); 40 patients were in A.S.A. I, 63 in A.S.A. II. The mean discharge time was 95.8 minutes (nobody was discharged before than 60 minutes); 2 patients had minor complications at home but they didn’t need for hospital care. The second cohort consisted of 104 patients (46 M, 58 F, mean age 57.2 ys)? 41 patients were in A.S.A. I and 63 in ASA II. The mean discharge time was 58.7 minutes (39 were discharged before than 60 minutes). 1 patient had minor complications but he didn’t need for hospital care. We found a statistically significant difference between the discharge time of the 2 cohorts (the group to which the PADSS score has been applied showed the shortest time) without any increase of complications at home. PADSS 20’ 40’ 60’ 80’ 100’ 120’ 140’ (Post Anaesthetic Discharge Scoring System) Vital Signs 0 = ± 40% 1 = ± 20-40% 2 = ± 20% Activity 0 = not able to walk 1 = need assistance to walk 2 = able to walk without assistance, not presenting vertigo Nausea and Vomiting 0 = severe (ineffective therapy) 1 = mild (effective therapy) 2 = slight (therapy not needed) Pain 0 = severe (NRS = 7-10) 1 = mild (NRS = 4-6) 2 = slight (NRS = 0-3) Bleeding 0 = severe 1 = mild 2 = slight (treatments not needed) TOTAL (a score ≥ 9 is needed for the discharge)
Conclusions: This form represents a simple and objective guide for patient’s evaluation in post sedation. It allows an early and equally safe discharge from the hospital and improves the service efficiency of the sedation room. The achievement of the discharge time score is an objective parameter that can be considered fundamental as also the nurses are delegated to monitor and discharge patients.
P.1.301 COLONIC RESECTION AFFECTS COLONIC CLEASING? M. Ciuffi, F. Tremolaterra ∗ , O. Ignomirelli Irccs, Centro di Riferimento Oncologico della Basilicata (Crob), Rionero In Vulture (PZ), Italy Background and aim: Quality of bowel cleansing is crucial to an effective and safe colonoscopy. No data, to our knowledge, has reported about preparation quality in patients undergoing colonic resection for colon cancer. We aimed to determine how segmental resection affects the colonic preparation quality and whether there are differences in bowel preparation between the patients undergoing right or left colonic resection. Material and methods: We studied 86 patients (72% men; mean age 71.3 years) undergoing colonic resection for colon cancer (42% right colonic resection) afferent to our Endoscopy Unit over an 5-month period. They were compared with each other and with 86 patients (70% men; mean age 70.4 years) without colonic resection matched for age and sex. All patients took 4 L polyethylene glycol (PEG) preparation the day before the examination as all colonoscopies were performed in the morning. The quality of colonic
preparation was graded using a 4-point scale (4 = excellent, 3 = good, 2 = fair, 1 = poor). Results: No difference was found regarding the preparation quality score between the patients with and without colonic resection (p=0.78). Interesting in the resected colonic group the patients with right resection had a lower preparation quality score (2 or 1 score) than patients with left resection (35.3% vs 24.1%, p=0.04). Conclusions: Colonic resection may affect the quality of bowel cleasing. The right resection may worsen the degree of preparation requiring a more thorough schedule.
P.1.302 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN THE TREATMENT OF NEOPLASTIC GASTRIC LESIONS A. Casadei, A. Simone ∗ , E. Cavargini, E. De Vergori, E. Ricci Ospedale Morgagni Pierantoni, Forli, Italy Background and aim: ESD has the advantage over conventional EMR to permit removal en bloc of the lesions, but long term clinical outcomes remain unknown. We have evaluated endoscopic treatment and outcome of ESD for gastric dysplasia and EGC. Material and methods: Between January 2008 and November 2010 we treated and followed up 22 patients with gastric lesions (12 m and 10 f, mean age 67.7 years, range 54-81). The lesions were located in antrum (20), gastric stump (1) and corpus (1), presented a mean diameter of 22.5 mm (range 7-60 mm) and were subdivided on the basis of Paris classification: IIa (17) and IIa-IIc (5). Results: Histologically in 8 patients we found tubular adenomas (4 with MGD, 2 with HGD and 1 with EGC) while in the remaining 14 we observed MGD (2), HGD (8) and EGC (4). ESD was performed in deep sedaztion, after chromoscopy with Indaco carminio, FICE set 2 (415-445-500), magnification and injection of saline solution 0.9% in submucosa. The endoscopic devices used were triangle knife in 19 cases, IT knife + Flex knife in 1 and IT knife and snare at the end of the treatment in 2. Lesion was resected en-bloc in 21 patients and piece-meal in 1. In 86% the borders of the resected specimen were lesion free at histological evaluation. 2 patients showed complications: the first hematemesis after 12 hours treated with injection of epinephrine in saline solution 0.9% (IIa, 60×30 mm, AT + MGD) and the second perforation after 36 hours with air free in abdomen (IIa, 18 mm, EGC Sm1; at surgical laparotomy was not recognized a real perforation and the patient was treated only with drainages position). Endoscopic follow up were performe every three months for the first year with a median of 457 days (79-1305). In the 10 controls at 3 months 3 patients showed recurrence of the lesion (2 of these cases presented borders lesion free in the moment of the resection): 1 EGC submitted to APC treatment and then, on the basis of histology, treated with surgery, 1 MGD removed with biopsy and APC and 1 adenoma with MGD treated with APC and resulted negative at 6 and 9 months. In the endoscopic controls at 6, 9 and 12 months the patients were respectively 4, 3 and 2; in no one there was recurrence of neoplastic lesions. Conclusions: ESD with successful en-bloc resection con treat gastric neoplastic lesions and reduce local recurrence.
P.1.303 HIGH DOSE AMOXICILLIN-BASED FIRST LINE REGIMEN IS EQUIVALENT TO SEQUENTIAL THERAPY IN THE ERADICATION OF H. PYLORI INFECTION F. Franceschi ∗ ,1 , M. Campanale 2 , R. Finizio 2 , F. Barbaro 2 , A. Tortora 2 , G. Gigante 2 , V. Cesario 2 , S. Calcinaro 1 , D. Marsiliani 1 , A. Carroccia 1 , N. Gentiloni Silveri 1 , D. Currò 1 , G. Cammarota 2 , G. Gasbarrini 3 , G. Bombardieri 2 , A. Gasbarrini 2 1 Emegrency
Medicine, Catholic University of Rome, Rome, Italy; 2 Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy; 3 Fondazione Ricerca In Medicina, Bologna, Italy Background and aim: Helicobacter pylori eradication rates with standard
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
after endoscopy, independently of the totalized score with a clinical observation (blood pressure, heart beat, oxygen saturation). For the second cohort we discharged the patients when 2 successive registrations had reached the PADSS (Post Anaesthetic Discharge Scoring System) score equal or higher than 9 each registration. We have carried out a telephonic follow-up 24 hours after the discharge. Results: The first cohort consisted of 103 patients (46M-57F, mean age 58.4 ys); 40 patients were in A.S.A. I, 63 in A.S.A. II. The mean discharge time was 95.8 minutes (nobody was discharged before than 60 minutes); 2 patients had minor complications at home but they didn’t need for hospital care. The second cohort consisted of 104 patients (46 M, 58 F, mean age 57.2 ys)? 41 patients were in A.S.A. I and 63 in ASA II. The mean discharge time was 58.7 minutes (39 were discharged before than 60 minutes). 1 patient had minor complications but he didn’t need for hospital care. We found a statistically significant difference between the discharge time of the 2 cohorts (the group to which the PADSS score has been applied showed the shortest time) without any increase of complications at home. PADSS 20’ 40’ 60’ 80’ 100’ 120’ 140’ (Post Anaesthetic Discharge Scoring System) Vital Signs 0 = ± 40% 1 = ± 20-40% 2 = ± 20% Activity 0 = not able to walk 1 = need assistance to walk 2 = able to walk without assistance, not presenting vertigo Nausea and Vomiting 0 = severe (ineffective therapy) 1 = mild (effective therapy) 2 = slight (therapy not needed) Pain 0 = severe (NRS = 7-10) 1 = mild (NRS = 4-6) 2 = slight (NRS = 0-3) Bleeding 0 = severe 1 = mild 2 = slight (treatments not needed) TOTAL (a score ≥ 9 is needed for the discharge)
Conclusions: This form represents a simple and objective guide for patient’s evaluation in post sedation. It allows an early and equally safe discharge from the hospital and improves the service efficiency of the sedation room. The achievement of the discharge time score is an objective parameter that can be considered fundamental as also the nurses are delegated to monitor and discharge patients.
P.1.301 COLONIC RESECTION AFFECTS COLONIC CLEASING? M. Ciuffi, F. Tremolaterra ∗ , O. Ignomirelli Irccs, Centro di Riferimento Oncologico della Basilicata (Crob), Rionero In Vulture (PZ), Italy Background and aim: Quality of bowel cleansing is crucial to an effective and safe colonoscopy. No data, to our knowledge, has reported about preparation quality in patients undergoing colonic resection for colon cancer. We aimed to determine how segmental resection affects the colonic preparation quality and whether there are differences in bowel preparation between the patients undergoing right or left colonic resection. Material and methods: We studied 86 patients (72% men; mean age 71.3 years) undergoing colonic resection for colon cancer (42% right colonic resection) afferent to our Endoscopy Unit over an 5-month period. They were compared with each other and with 86 patients (70% men; mean age 70.4 years) without colonic resection matched for age and sex. All patients took 4 L polyethylene glycol (PEG) preparation the day before the examination as all colonoscopies were performed in the morning. The quality of colonic
preparation was graded using a 4-point scale (4 = excellent, 3 = good, 2 = fair, 1 = poor). Results: No difference was found regarding the preparation quality score between the patients with and without colonic resection (p=0.78). Interesting in the resected colonic group the patients with right resection had a lower preparation quality score (2 or 1 score) than patients with left resection (35.3% vs 24.1%, p=0.04). Conclusions: Colonic resection may affect the quality of bowel cleasing. The right resection may worsen the degree of preparation requiring a more thorough schedule.
P.1.302 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN THE TREATMENT OF NEOPLASTIC GASTRIC LESIONS A. Casadei, A. Simone ∗ , E. Cavargini, E. De Vergori, E. Ricci Ospedale Morgagni Pierantoni, Forli, Italy Background and aim: ESD has the advantage over conventional EMR to permit removal en bloc of the lesions, but long term clinical outcomes remain unknown. We have evaluated endoscopic treatment and outcome of ESD for gastric dysplasia and EGC. Material and methods: Between January 2008 and November 2010 we treated and followed up 22 patients with gastric lesions (12 m and 10 f, mean age 67.7 years, range 54-81). The lesions were located in antrum (20), gastric stump (1) and corpus (1), presented a mean diameter of 22.5 mm (range 7-60 mm) and were subdivided on the basis of Paris classification: IIa (17) and IIa-IIc (5). Results: Histologically in 8 patients we found tubular adenomas (4 with MGD, 2 with HGD and 1 with EGC) while in the remaining 14 we observed MGD (2), HGD (8) and EGC (4). ESD was performed in deep sedaztion, after chromoscopy with Indaco carminio, FICE set 2 (415-445-500), magnification and injection of saline solution 0.9% in submucosa. The endoscopic devices used were triangle knife in 19 cases, IT knife + Flex knife in 1 and IT knife and snare at the end of the treatment in 2. Lesion was resected en-bloc in 21 patients and piece-meal in 1. In 86% the borders of the resected specimen were lesion free at histological evaluation. 2 patients showed complications: the first hematemesis after 12 hours treated with injection of epinephrine in saline solution 0.9% (IIa, 60×30 mm, AT + MGD) and the second perforation after 36 hours with air free in abdomen (IIa, 18 mm, EGC Sm1; at surgical laparotomy was not recognized a real perforation and the patient was treated only with drainages position). Endoscopic follow up were performe every three months for the first year with a median of 457 days (79-1305). In the 10 controls at 3 months 3 patients showed recurrence of the lesion (2 of these cases presented borders lesion free in the moment of the resection): 1 EGC submitted to APC treatment and then, on the basis of histology, treated with surgery, 1 MGD removed with biopsy and APC and 1 adenoma with MGD treated with APC and resulted negative at 6 and 9 months. In the endoscopic controls at 6, 9 and 12 months the patients were respectively 4, 3 and 2; in no one there was recurrence of neoplastic lesions. Conclusions: ESD with successful en-bloc resection con treat gastric neoplastic lesions and reduce local recurrence.
P.1.303 HIGH DOSE AMOXICILLIN-BASED FIRST LINE REGIMEN IS EQUIVALENT TO SEQUENTIAL THERAPY IN THE ERADICATION OF H. PYLORI INFECTION F. Franceschi ∗ ,1 , M. Campanale 2 , R. Finizio 2 , F. Barbaro 2 , A. Tortora 2 , G. Gigante 2 , V. Cesario 2 , S. Calcinaro 1 , D. Marsiliani 1 , A. Carroccia 1 , N. Gentiloni Silveri 1 , D. Currò 1 , G. Cammarota 2 , G. Gasbarrini 3 , G. Bombardieri 2 , A. Gasbarrini 2 1 Emegrency
Medicine, Catholic University of Rome, Rome, Italy; 2 Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy; 3 Fondazione Ricerca In Medicina, Bologna, Italy Background and aim: Helicobacter pylori eradication rates with standard