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A randomized prospective trial comparing the double layer™ stent and polyethylene stent for malignant biliary strictures: Preliminary results
25 Forceps biopsy versus brush andbile-cytology in proximal malignant biliwy strictures Macti G, Giardini M, Piergallini S, Marini F andAntonio Benedetti Departmentof Gastroentemlogy, University of Anwna, ltlly Torrette Objective: aim ofthe study was to evaluatesensitivity andspecificity of endoductalforceps biopsy versus blush-cvtolwv andbile-cvtologv durillp. endoswpie retnxmde cholangiopancreatonaphy (ERCP), in pr&i&i malignant bili&strict&s. M&h& we &mined 12&&ecutive patients with proximal or middle common bile duct stricture at cholangiogmpbicfilm, obstructive jaundice, abs&ce of hepaticand pamxeatic focal lesionsat imaging tectmiquesand absenceof papillary lesionsat dwdenoscopy. All patientsunderwentthe three abovementioned procedures during the sameendoscopicsession after performing spbinctemtamy. Gold-standard were consideredthe clinical and radiological course at six months of follow-up. Results: histology ham out to havethe samesensitivitv of brush-cvioloav (25%). whereas all bile-wtoloe, examinationsmissedto diagnosemali&ces as &es&~ f&w-up (deathof the $ti&i or spreadout of decease). Histologic sampleswere inadequatein 3 out of 9 false negativebiopsies.The specificity was 100% for all metbods~Concltions: aithougb no major ccmplications occumd, histoiogx samplingof proximal biliaty strictures showed to have low sensitivity in diagnosingmalignawes. This was likely due to the inadequacyof standardforceps in endoductaltissue sampling. Therefore further and larger studies, as well as new bioptic devices, are needed.
27 CAP-ASSISTED ENDOSCOPIC MLJCOSAL RESECTION FOR NEOPLASTIC LESIONS OF THE GASTROINTESTINAL TRACT A. Repici, C. De Angelis, C. Barletti, A. Musso, W. Debemardl,N. Pagan%M. Rizetto and G. SaraCCO. Dept of Gastmenterology,Molinette Hospital, Torino MOLINETTE Backgroundand Ann: Endoscopicmuwsal resectionof flat lesionsofthe gastrointestinaltract has beenproposedby JapaneseAuthors. Severalvariations of the techniqueof endoscopicmucosal resectionhew beenpmpoxd in the last ten years. Aim of this videotapeis to show the techniqueof thecap-assistedEMR wing the Olympus kit K-0002 for the resectionof lesions of the entire gastrointestinaltract. PatientsandMethods: the videotapeshows three cases of flat lesionsof the esooharms.stomach andcolon removed usinnthe technioueof cao-assistedEMR. Afler ide%.a&n of the lesionsand theuse of ch;omoadoscbpy to better define the edgesof the lesions,largevolume of saline(20 to 40 ml) is ini&ed in the submuwsa with intent to lift up the targetlesion andto createa c&ion betv& tbemucosal-submucosaand the muscular layer: TImeafter the fitted Innsparent cap along with the pm-loopedsnareare positionedabovethe lesion. The lesionis centrally suctionedandthe snare is then usedto decapitatethe tumor. If the technique is correctly accomplishedthe muscular layer will becamevisible in the floor of the scar. Results: In our sties 2 tmtientswith eswhed lesions,3 with aastric and 7 with flat colonic lesionshave been treated(en-bloc in 7 pie&, piece&l in 5) with this teetique. No complicationswere observedwith the exceptionof a case of bleedingafter the removal of a gastric lesion. The bleeding was easily controlled by placing severalhemocl~ps.The lesionswere &sidaed by the pathologists completelyremoved in 10 casesandpartially removedin 2 cases.High gradedysplasiawas diagnosedin I patientwith esophageal,I with gastric and2 with cokmic lesions.Conclusions:The useofthe cap-fitted submueosalsalineinjection techniqueappearsto be safe andeffective for the resectionof large prenwplastic lesionsandintramucosalcancer of the gastrointestinaltract.
26 THE USE OF AN ALTERNATING MAGNETIC FIELD TO CONTROL THE METAL STEN’I INGROWTH AND OVERGROWTH: A THEORETICAL STUDY Del Piano M, Montino F, Occhipinti P, O&lo M, Ball&M, G&lo E. Gastmentemlogia, Azienda Ospcdaliera‘%&g&m della Cariti”, Novam. Osp. Maggioredella Caritl Introduction. Metal stating is probably the most efficacious palIiation for many gastroenteric obstructing cancer (i.e. cancer of esophagus,duodenum,jejuttum, biliary tree and colon). However, self-xuandinz metal stents are ofmn obstructed by the mmvtb of the neo&stic and gmmdmnatow t&e be&n the prosthesis meshesOTat it~pro&al anddistal e&s. It is possible to obviateto the ingmti using coatedstents.but they aremore difficult to build and to intmduce, mm expensiveand displacementoccurs easilv.The aal shouldalso be obtained con’a-ollinelocal tumor &Wh by incorp&ating chemotherape&c age;t in the aten,coating,developingnew-&t meterielthat matee enelectmmagneticfield inhibiting the tumor growth or using hyperibemda. Aim of this theoretical study is to use non-covered metal stents trying to inhibit the ingmwtb and overpwth by hypetthemtia.This techniqueis txd in the oncological treatmentsince a long time; it hasa direct cytotoxic effect andcan also increasethe neoplasticcell sensibility to the radio and chemotherapy.The hyperthenniacould bc generatedin themetallic stentby an outsidealternating megwtic field. The thermal increaseis dueto: a) thehysteresis cycles: when inaeacd in an alternat& mamtetic field with Iieauencv f andamolitudc HO. a fenomaeneticmaterial petswarm in result oftbe&wa PIST dissipaieditbe hy8&is cycles’and thatis-&al to (& B as themagnetic induction vector): PIST = f6HdB; b) the inducedcuren% a spiral with resistanceR crossed by a magneticflow F, getswarm in rest& of the Jouleeffect, d&i&ng a power PIND equalto: PIND = (dF/dt)ZiR. The stent shouldbe made of an alloy (like FPP& Ni-Cu or Ni-Si) with a Curie point between50 and 60 C in order to reach P stent temperawe of 45.47 C capableof destroyingthe nmplastic tissuewithout damagingthe adjacentorgans.The Curie point can be made different by altering the nm.w&action of the diluent (e.g. Cu, Si, Pd in alloys of Ni). Conclusions. This new, non invasive metiwd would pennit a relative control of local tumor emvnb andthe use of uncoveredmetal stentsthat m-eI) sin& to build 2) more difficult to displace3) chqcr 4) more flexible 5) of smaller diameter(requiring minor pre-dilatationand TTS compatible) and 6) easw to introduce.
A RANDOMIZED PROSPECTIVE TRIAL COMPARING THE DOUBLE LAYERTM STENT AND POLYETHYLENE STENT FOR MALIGNANT BILIARY STRICTUREs: PRELIMINARY RESULTS. Trinaali A, Mutignani M, Perri V, Petruzziello L*, Gabbrielli A’, Shah SK, CostemagnaG. Digestive Endoscopy Unit Catholic University: Endoscopy Unit, LUCBM’; Rome,Italy. Baekgmund and aim Endoscopic biliuy stenting is an establishedtreatment for malignant obstructive jaundice. Stentclogging remainsa major problem of plastic stats. Stem clogging dependsPorn bacterial depositionand also from stat shape;sidehoks may cause local turbulence with resultant eddy currents, enhancingbacterialencrustation and sludgedeposition. Aim of this study is to prospectively compare two stats of different material and shape:the Double LsyerTM Olympus (Perfluoro Alkoxy, without sideholes) and standard Polyefhylene stem (with sideholes). Patients and methods Fitly-three patients (23 M, mean age 71 years, range 40-88) with jaundice due to malignant strictures of the middle-distal third of the common bile duct (45 pancreatic cancer, 3 lymph&e meastases. 2 bile duct cancer, 2 gallbladder cancer), were randomly assigned to receive Double Laye? (n=26) or Polyethylene (n=26) IO Fr, length 5-7 cm biliary stems. Patients with cholangitis, haemobilia, previous biliary drainage, hilar snicmre and ampullary cancer were excluded.Rnafh: t Duoble Lavar 1Poivethvlene
Conclusions: These preliminary data show a longer patency of the Double Lay@’ Olympus biliary stem respect than Polyethylenestem.
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27 CAP-ASSISTED ENDOSCOPIC MLJCOSAL RESECTION FOR NEOPLASTIC LESIONS OF THE GASTROINTESTINAL TRACT A. Repici, C. De Angelis, C. Barletti, A. Musso, W. Debemardl,N. Pagan%M. Rizetto and G. SaraCCO. Dept of Gastmenterology,Molinette Hospital, Torino MOLINETTE Backgroundand Ann: Endoscopicmuwsal resectionof flat lesionsofthe gastrointestinaltract has beenproposedby JapaneseAuthors. Severalvariations of the techniqueof endoscopicmucosal resectionhew beenpmpoxd in the last ten years. Aim of this videotapeis to show the techniqueof thecap-assistedEMR wing the Olympus kit K-0002 for the resectionof lesions of the entire gastrointestinaltract. PatientsandMethods: the videotapeshows three cases of flat lesionsof the esooharms.stomach andcolon removed usinnthe technioueof cao-assistedEMR. Afler ide%.a&n of the lesionsand theuse of ch;omoadoscbpy to better define the edgesof the lesions,largevolume of saline(20 to 40 ml) is ini&ed in the submuwsa with intent to lift up the targetlesion andto createa c&ion betv& tbemucosal-submucosaand the muscular layer: TImeafter the fitted Innsparent cap along with the pm-loopedsnareare positionedabovethe lesion. The lesionis centrally suctionedandthe snare is then usedto decapitatethe tumor. If the technique is correctly accomplishedthe muscular layer will becamevisible in the floor of the scar. Results: In our sties 2 tmtientswith eswhed lesions,3 with aastric and 7 with flat colonic lesionshave been treated(en-bloc in 7 pie&, piece&l in 5) with this teetique. No complicationswere observedwith the exceptionof a case of bleedingafter the removal of a gastric lesion. The bleeding was easily controlled by placing severalhemocl~ps.The lesionswere &sidaed by the pathologists completelyremoved in 10 casesandpartially removedin 2 cases.High gradedysplasiawas diagnosedin I patientwith esophageal,I with gastric and2 with cokmic lesions.Conclusions:The useofthe cap-fitted submueosalsalineinjection techniqueappearsto be safe andeffective for the resectionof large prenwplastic lesionsandintramucosalcancer of the gastrointestinaltract.
26 THE USE OF AN ALTERNATING MAGNETIC FIELD TO CONTROL THE METAL STEN’I INGROWTH AND OVERGROWTH: A THEORETICAL STUDY Del Piano M, Montino F, Occhipinti P, O&lo M, Ball&M, G&lo E. Gastmentemlogia, Azienda Ospcdaliera‘%&g&m della Cariti”, Novam. Osp. Maggioredella Caritl Introduction. Metal stating is probably the most efficacious palIiation for many gastroenteric obstructing cancer (i.e. cancer of esophagus,duodenum,jejuttum, biliary tree and colon). However, self-xuandinz metal stents are ofmn obstructed by the mmvtb of the neo&stic and gmmdmnatow t&e be&n the prosthesis meshesOTat it~pro&al anddistal e&s. It is possible to obviateto the ingmti using coatedstents.but they aremore difficult to build and to intmduce, mm expensiveand displacementoccurs easilv.The aal shouldalso be obtained con’a-ollinelocal tumor &Wh by incorp&ating chemotherape&c age;t in the aten,coating,developingnew-&t meterielthat matee enelectmmagneticfield inhibiting the tumor growth or using hyperibemda. Aim of this theoretical study is to use non-covered metal stents trying to inhibit the ingmwtb and overpwth by hypetthemtia.This techniqueis txd in the oncological treatmentsince a long time; it hasa direct cytotoxic effect andcan also increasethe neoplasticcell sensibility to the radio and chemotherapy.The hyperthenniacould bc generatedin themetallic stentby an outsidealternating megwtic field. The thermal increaseis dueto: a) thehysteresis cycles: when inaeacd in an alternat& mamtetic field with Iieauencv f andamolitudc HO. a fenomaeneticmaterial petswarm in result oftbe&wa PIST dissipaieditbe hy8&is cycles’and thatis-&al to (& B as themagnetic induction vector): PIST = f6HdB; b) the inducedcuren% a spiral with resistanceR crossed by a magneticflow F, getswarm in rest& of the Jouleeffect, d&i&ng a power PIND equalto: PIND = (dF/dt)ZiR. The stent shouldbe made of an alloy (like FPP& Ni-Cu or Ni-Si) with a Curie point between50 and 60 C in order to reach P stent temperawe of 45.47 C capableof destroyingthe nmplastic tissuewithout damagingthe adjacentorgans.The Curie point can be made different by altering the nm.w&action of the diluent (e.g. Cu, Si, Pd in alloys of Ni). Conclusions. This new, non invasive metiwd would pennit a relative control of local tumor emvnb andthe use of uncoveredmetal stentsthat m-eI) sin& to build 2) more difficult to displace3) chqcr 4) more flexible 5) of smaller diameter(requiring minor pre-dilatationand TTS compatible) and 6) easw to introduce.
A RANDOMIZED PROSPECTIVE TRIAL COMPARING THE DOUBLE LAYERTM STENT AND POLYETHYLENE STENT FOR MALIGNANT BILIARY STRICTUREs: PRELIMINARY RESULTS. Trinaali A, Mutignani M, Perri V, Petruzziello L*, Gabbrielli A’, Shah SK, CostemagnaG. Digestive Endoscopy Unit Catholic University: Endoscopy Unit, LUCBM’; Rome,Italy. Baekgmund and aim Endoscopic biliuy stenting is an establishedtreatment for malignant obstructive jaundice. Stentclogging remainsa major problem of plastic stats. Stem clogging dependsPorn bacterial depositionand also from stat shape;sidehoks may cause local turbulence with resultant eddy currents, enhancingbacterialencrustation and sludgedeposition. Aim of this study is to prospectively compare two stats of different material and shape:the Double LsyerTM Olympus (Perfluoro Alkoxy, without sideholes) and standard Polyefhylene stem (with sideholes). Patients and methods Fitly-three patients (23 M, mean age 71 years, range 40-88) with jaundice due to malignant strictures of the middle-distal third of the common bile duct (45 pancreatic cancer, 3 lymph&e meastases. 2 bile duct cancer, 2 gallbladder cancer), were randomly assigned to receive Double Laye? (n=26) or Polyethylene (n=26) IO Fr, length 5-7 cm biliary stems. Patients with cholangitis, haemobilia, previous biliary drainage, hilar snicmre and ampullary cancer were excluded.Rnafh: t Duoble Lavar 1Poivethvlene
Conclusions: These preliminary data show a longer patency of the Double Lay@’ Olympus biliary stem respect than Polyethylenestem.
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