8 P Biofeedback therapy in idiopathic slow transit constipation

5oc

7P COI.OP.ECTALCANCERSCREENINGTEE ExPERlENCEOF A MIDDLE AREA OF THE CENTERITALY

u 0 Gastroenterologll.Bldoaopia, Oncolagla Sincemarch2001the rcreetig of coloreall cater by faecaloccultbloodtea (FOBT) has bee” s&r&d in theprovinceof Areuo The screeningis basedonthe reliefof FOBT with immonochemical test,8”thegeneral populationaged X-70 yews, repeatedevery two years In the orgamzationof thescre&“g the *eneralpractitionerhasbee” involved,directly provideingthe clcsnnngup ofthe listsof hispatie”+ distributingthekit for FOBT, and, tinally, searing the repetitionof FOBT every two years TheMWWCT of thet&, wixn positive,is direaly com”“micaed to thegeneralpractitionerwttb the datefor thewood levelexamin*tion(i e colonoaeopy) Cmnpliamewith screeningwas46%(2726patiens,out of 5971recroited,attendedthe

In conclusion,wewant tn underlinethe imprmxe ofthe collaborationof thegeneral practittonerfor performingthecalorectalcancerscreening,mostof all to guarantethe continuityof thescreeningitself We alsounderlinetheimpcrtanccofthe Di~reno Socio Sanitmiotn organizethescreeningdeliveryof theinvitationsto thepoptitior, withdrawal of the bxologiealmaterialfor the wual labarafory,receiptof theanswerswith contan rvltb thegeneralpractitionerand,finally,storeandanalysisoftbe rendts

O”TCOME

ANALYS,S

OF ,031 COLONOSCOPIC

POLYPECTOMES

PEP.FOF.MED

WIT” AN .=.“TOMATlCALL.Y CONTROLLED (ENDOCUT MODE ) HF GENERATOR L Permldello O,A Gabbrielli‘, A Zambelli ii, F De Grazia 4. M Pa”dolfi ‘, C London1#. G Lupinacciff, P D’Alessto‘, GCostamagna8 ‘Campus&o-Medico Roma, lOsped& Civde - Crema,pU”iversitACattobcadel SacroCuor? ROma Backgroundandaim complicatro” rateof cndoscopicpolypectomyhasnot substanttally decreasedfrom the ’70s Accordingto literaturedata.perforationconoccor m 0 04% lo 2 I% ofcases, andthebleedingfrom 0 3% to 6 1% I” recentyearsa newHF generatordth a” automaticallycontrolledcut system(Endout) hasbeendevelopedThis device showed goodradts m endoscopicbiliuy spbincferotomy,wtb reducedbleedingincidenceThe urn ofthts study ISto assessthe eRective”essandsafetyofthe Endowt systemin endoscope colonicpolypectomy Materialsandmethods From January ‘97 to August2000, 103I consecutivepolypectomies were performedin 652patxents(I4 413,F 245,meanage66 I, ‘~“ge 6 -96 years) with the HF surgq unit ErbotomICC ZW (!3brbe, Tubtnge”,Germany) The unit wasset for Endonrt,effect 3 (outputlimit 120w) Polypswore swile “=7X (70 7%) pedoncolated 0=302(29 3%). Theh,stotology was.tubular adenoma“=S 18,villausadenoma“=X0, admocarunomaI” SW “=IS, invasive adenocarcinoma “=I& hyperplwic “=161, others (mtlammatory,pvende polyps, bpomar)“=35, “at retrieved“=42 The mea” diameterwas 9.34mm (range2-70mm), onehundred -thirty five polyps (13 1%) were > 2 cm Rewlts There hasbee” no mortality One perforation(0 09%) occurred afterremovalof a sesde pdyp 60 mm diameter(adenocarcinomain siti) This patlentunderwentsurgery and the ,,ontopaativeperiodwas u”evemfol One post-polypectomycoagulationsyndrome (0 09%) wasobserved Overall bleedingrate was2 33% (“=M) The onsetofthe bleeding was mmxdiate I” 23cases(92%) anddelayedin two (8%) I” onepatientadelayedbleedtng occurred a&r a” immediatebleedxngAll bleedingscould betreatedwith endoscopictherapy epinephrineand/orAPC “=20, regraspingwith snareandAK “=I, epinepbrlne+ endoloop + APC n-1, cbps II=;3 ConclusionsEndocotsystemshowedto be assafeandas effectweI” thepreventionof post-polypectomybleedingcomparedto otherconventionalHF Units Nonetheless,thanks to the delivery modeoftbe HF current,the oseofdus device~a” reducethe risk ofthermal damageto the bowel wall, as shownby the low-inadenceofperforations(0 09%) experiencedin OUTstudy

6P OUTCOME OF POLYPECTOMYIN LARGE COLORECTAL ADENOMAS

BIOFEEDBACKTHERAPY IN D,OPATHIC SLOW TRANSIT CONSTlPATlON G Chiarioni‘, L Salandnnt #. W Whitebead*

Divisionedi Endoropia lstituto Europeodi Oncologia BACKGROUM) Largecolorecfalpolypsarelesionslargeror equalto 2 an in diameter, they udly containvillas tissuewith Dhigh maligrantpotmid andtendto recur after resection Aim oftbis study wls lo evaluatethe outmmeof endowpie plipectomy for

DD~vtsio”edi RiabilitanoneGastroenterologxca. C 0 C Valeggios/M, Anenda Ospedaheradl Verona,#Oivisionedi Gastroenterologia,C 0 C Valeggtos/M, AziendaOrpedalieradi Verona.‘UNC Centerfor FunctionalGI andMotility Disorders,Divism” of Dtgertlve Dmases, ChapelHill. University ofNolfh Carolma,USA BiofeedbackISdesignedto correct owletdysfunctionconstipatm”,but it hasalso bee” reportedto be effectivein slow transitconstipatro” Am oftLs stodywas to detenmne whethersuccessfulbiofeedbacktherapyis hmnedto patientswith outletdysfinctlon (I e paradox4 co”tractio” of theextnoal anal splxncterwhen strainingor tnabilityto defecatea 50.ml water-filledballoon)Methods 75 consecotwepatientswrth refractory constipation werescrewed for 30days a” 20 g/dayfiber andno morethan2 laxativesiweekendingwth a Sazmarkstudy oftransnttime Excludedwere5 patientsfor noncomplianceduringscreening and 18who hadnormaltrans” times( >go%of markers evacuatedat 120hours), leaving52 patients(49 womehaverageage35years) to receive5 weeklybiofeedbacksessionsdirected at xmprovingthe useofabdominalmusclesto strait relaxnngtheexternalanal sphincter duringstraining,andpracticewith defecatinga W-ml w&r filled balloon Patnentswere reevaluated6 monthslaterby questlonnalre,anorectalmanometry,balloondefecationand Smmark wdy Subjectivesuccesswasdefinedasa self-reponof majorimprovementor completerecovery Results A) 54%were sujectiw socce~ses,50%(26/52) achievednormal transittimes,andall ofthese reportedsubjectivesuccess,two otherpatient,bothofwhom evacuated70%oftbe markersat follow-up, alsoreportedsuccess,EJ)89%(25128)who reportedsubjective~occessat 6 monthswere tnitially dyssynergic,comparedto 54%of unwuccesstilpatientsNo successfulpatientwasdyssynergicat theendoftreatment,C) 92% (26128)of successeswere unableto pars Bwater-filledballoonatbaselinecomparedto 50% ofunsuccessfulpatnentsAll succersfolpatientscouldpasstheballoonat follow-up,D) 69% ofthonewith dyssynergiaat baselinehadsuccessfuloutcomesVI 19%ofthov wthout dyssynergia,E) 68%ofthose whowere unable10passa watt- filled balloonat baselineweresuccessfulvs 14%ofthose who could passthe balloon I” ConclusioR biofeedbacktreatmentis effective in about50%of patientswth refractory slowfrans” constipationThe successof biofeedbackdirectedat teachingpelvic floor relaxatno”IS htgbly relatedto thepresenceof outletdysfunction

A37