Admission to a gastroenterology unit for adverse drug reactions

Abstracts nutritional risk and, furthermore, to test sensitivity of three different scores. Material and methods: All patients consecutively admitted from 1st April and 30th May in 5 divisions of Gastroenterology in Campania (Italy) were recruited. Three questionnaire to assess nutritional risk, Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA) and Malnutrition Universal Screening Tool (MUSn were administered at admission and at dimission. MNA was positive if the score was greater than 14; SGA was positive if rate was different from A; MUST was positive if the score was greater than 1. Results: Two hundred-thirty-one patients (M:F=136:94, median age 59, range 15-89) were recruited (cirrhosis and HCC-cirrhosis 24.4% cirrhosis and HCC-cirrhosis, 16.7% chronic hepatitis, 15,5% IBD, 13.8% neoplasms, 8,9% biliary diseases, 7.1% pancreatic diseases, 13.6% other disease). Nine patients was excluded because their BMI « 18,5) iudicated clear maluutrition. At admission the rates of malnutrition risk were 38.5% by MNA, 23,5% by SGA and 32% by MUST. At dimission the ratrse were 36.5% by MNA, 19% by SGA and 29.2% by MUST. A prevalence ofmalnutrition risk were higher in Difference were not statistically significative. Conclusions: These data, although not statistically significant for smallness of sample and rarity of disease, show that EUS is the most useful individual imaging technique to identify CDDW. Probably CDDW is underestimated, because not searched by most sensitive technique or not searched at all. All patient, male over all, with a positive anamnesis for abusive alcohol intake and a clinical suspicion of chronic pancreatitis should be undergone to EUS to evaluate pancreas parenchyma and duodenal wall. Furthermore when CDDW is present, associated pancreatitis seems to be more severe; therefore EUS assessment is important in the choice of therapeutic option, medical or surgical, that in these cases should be more aggressive.

PO.155 CLEANING AND DISINFECTION PRACTICES IN DIGESTIVE ENDOSCOPY IN LOMBARDIA: INTERIM RESULTS OF A REGIONAL SURVEY R. Fasoli .,1, G. Centenaro 1 , G. Spinzi 2 1Servizio di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Abbiategrasso, Milano 2Unitii Operativa di Gastroenterologia, Ospedale VaUiuce, COrM

Background and aim: Information about disinfection and reprocessing techniques are, in our country, rather scanty and, since 1997, when a national questionnaire on disinfection procedures was carried out, few data have become available. We therefore decided to carry out a survey iu Lombardia to verify everyday practice as regards a uumber of features connected to cleaning and disinfection. Material and methods: An anonymous questionnaire, consisting of 32 items, has been e-mailed to all endoscopic centers registered 1U Lombardia. Results: A total of 63 centers responded so far to the questionnaire (60% of the total). Yearly endoscopic procedures were classified in the following way: in twenty units less than 3000, in 22 3000-5000; in 21 more than 5000. All except three centers declared to follow written established disinfection guidelines. Appropriate manual cleaning is performed by 100% of respondants; in all centers except 5 an automatic washing machine is operating daily. An enzymatic solution to clean instruments is employed by 47 centers (74.6%), while 16 (25.4%) reported to use a detergent. Glutaraldehyde is the most widely used chemical disinfectant (71.4%), with peracetic acid and electrolysed acid water used by 14 (22.2%) and 4 (6.4%) centers, respectively. The application of special reprocessing procedures for endoscopes used in patients with known infectious diseases, including HIV and slow-viruses, was reported by all centers: 40 (63.5%) reported to perform endoscopy at the end of the day-list, 21 (33.3%) to

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increase disinfection time, and two (3.2%) to use dedicated instruments. Disposable materials were reported to never be re-used by 38 (60.3%) centers; 6 (9.5%) and 19 (30.2) centers occasionally and on a routine base, respectively, re-utilize disposable devices. Only 9 (14.3%) centers reported to rely on some method to retrace the endoscopes. Conclusions: Our preliminary data suggest that nowadays there is in our region a good compliance with standard guidelines. We feel nevertheless - necessary to emphasize that some centers need to improve aspects regarding eqnipment and quality control tests to verify the efficacy of disinfection practices.

PO.156 APPLICATION OF "DAY SERVICE" IN GASTROINTESTINAL DISEASE: MULTIPLE ACCESS TO CLINICAL, LABORATORY AND INSTRUMENTAL EXAMINATIONS BEYOND DAY HOSPITAL G.L. Milandri " G. Nicolini

AUSLdi Cesena, Cesena Background and aim: the choice to treat as in or out-patient depend on type, grade and clinical needs of gastrointestinal disease. Identification of staff, procedures, structures, and management of specific gastrointestinal diseases will reduce patient time and paths in health services. With the "Day Service" was established fixed access paths to clinical, laboratory and instrumental exams for gastrointestinal (Gl) or hepatobiliary (HB) diseases Material and methods: data comparison of GI-patients' treatments supplied from Jan. 2004 to Oct 2005 in two different care regimes: Day service (DS) and Day Hospital (DH). Patients with IBD, chronic epatic diseases, suspected gastrointestinal or hepatobiliary neoplasms, complicated coeliac diseases and malabsorption were evaluated in DS. Patients. Who required invasive diagnostic or therapeutics procedures (liver biopsies, paracentesis, PEl) or therapies or any maneuver only ensured for inpatient, were admitted to DH Results: 169 patients enter DS, 102 DH. DS gastrointestinal diseases were: IBD 48 pts (28,4%), CLD 35 pts (20,7%), suspected gastrointestinal neoplasms 57 pts (33,7%), complicated coeliac diseases 24 pts (14,2%) and malabsorption 5 pts (2,9%). DH gastrointestinal diseases were represented respectively: 10 (9,8%), 27 (26,5%), 37 (36,3%), o (0,0)%, 5 (4,9%); others gastrointestinal diseases account for 23 (22,5%). DS patients underwent: lab. Analysis 83 (49,5%), clinical evaluations 95 (56,2%), endoscopy 75 (44,4%), and ultrasound or Rx exams 127 (75,1 %). DH patients underwent: lab. Analysis 102 (100%), clinical evaluations 6 (5,9%), operative endoscopy 45 (44,1%), and ultrasound or Rx exams 56 (54,9%), liver biopsy or paracentesis or PEl 32 (31,4%) and endovenous therapy 36 (35,3%). 8 (4,7%) DS patients was enrolled in DH and 6 (5,9%) DH patients in DS. Respectively for DS and DH 2 (1,2%) and 5 (4,9%) patients required ordinary hospitalization. Number of access mean was 4.0 for DS and 11,7 for DH Conclusions: well designed procedures and selection of patients with GI or HB disease enrolled in Day Service allow snpplying adequate care, redncing nnmber of accesses versus simple outpatient care or reducing costs versus ordinary or DH admission especially for diseases that require a number of ultrasound and radiologic exams and specialist evaluation

PO.157 ADMISSION TO A GASTROENTEROLOGY UNIT FOR ADVERSE DRUG REACTIONS M. Baronio', G. Actis, L. Todros, A. Bianco, A. Gasco, M. Rizzetto

Ospedale San Giovanni Battista, Torino Background and aim: There are several studies on the impact of

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Abstracts

adverse drug reactions (ADRs) on the rate of hospitalisation, but none of them has been conducted at a gastrointestinal (Ol) unit, despite gut and liver playa central role in drug disposal. Material and methods: There were a total of 3584 admissions in a 45-month interval to our GI unit. We conventionally defined type A reactions as direct toxicity, and type B reactions as idiosyncratic. We looked at the rates of occurrence of type A and type B reactions among the admissions cited above, and recorded patients' demographics, active treatment on admission, length of stay and discharge prescriptions. Results: 60/3584 admissions were classified as due to ADRs (1.6%) with A reactions being 44 (1.2%) and B reactions 16 (0.44%). Hallmarks of type A reactions: Mostly involved drugs: NSAIDs - Anticoagulants - Corticoids. With 11 and 7 events, ASA and warfarin ranked first and second respectively; 93% of the A reactions were represented by a bleeding ulcer. The length of hospital stay increased with age, from 5 days at 30 years, to 7 at 40-50 years. Also among older patients anticoagulant therapy and back pain were mostly frequent. Gender effect: duodenal ulcer as an adverse effect was mostly frequent in males, as opposed to gastric ulcer in females. The cumulative length of hospital stay was 394 days. Hallmarks of type B reactions: mesalamine products, interferons, antidepressants, antiaggregants, and purine analogues mostly involved. 44% of cases due to cholestasis, pancreatitis ranking to 25%. More than 20 days of stay at all age; cumulative stay of 376 days. Conclusions: Of some 4000 admissions to our GI unit, 1.6% are due to ADRs, either direct -A- or idiosyncratic -B-. 90% of the A reactions are bleeding ulcers related to NSAIDs; the length of stay may be 5 days only but increases with patient's age. A drug array causes type B toxicity, primarily cholestasis and pancreatitis. In such cases the length of stay exceeds 20 days. The cumulative stay of 700 days in this study constitutes a serious socio-economic issue.

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IMPACT OF PLENARY DISCUSSION AMONG REFERRING PHYSICIANS ON THE PREVALENCE OF INAPPROPRIATE ENDOSCOPY IN INPATIENTS OF AN ACADEMIC HOSPITAL B. Marino *, E. De Marco, P. Cantu, L. Piodi, R. Penagini Cattedra di Gastroenterologia dell'Universitii degli Studi, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli Regina Elena, Milano

Background and aim: High rate of inappropriate referral is reported in open-access endoscopy. Limited data focused on inpatients have yielded similar results. Strategies to decrease the rate of inappropriateness, aiming at reducing costs of hospitalization, are welcome. Our aim was to prospectively evaluate the impact of a plenary discussion among the referring physicians on the prevalence of inappropriate endoscopies performed in inpatients of an academic Italian hospital. Material and methods: Appropriateness of referral to upper endoscopy, colonoscopy and ERCP during a 3- months period of consecutive hospitalized patients was first evaluated. Results have been presented and discussed with the hospital medical staff. Appropriateness was measured again during the subsequent 3-months period. Endoscopies were defined as inappropriate if indications were outside those of ASGE and additionally if they were within ASGE indications, but the endoscopy was not related to the reason of the patient's admission to hospital (i.e. colorectal cancer screening). Results: Before plenary discussion upper endoscopy was inappropriately used in 371180 pts (21%) and colonoscopy in 27/146 pts (18%). The main reasons of upper endoscopy' inappropriateness were incorrect investigation of anemia (n=8) and a recent negative upper endoscopy in a clinically stable patient (n=8) whereas main reasons of colonoscopy' inappropriateness were a recent negative colonoscopy in a clinically stable patient (n=5) and colorectal cancer screening (n= 7). Plenary discussion decreased frequency of inappropriate upper gastrointestinal

endoscopy to 241170 (14% of pts, p=O.l vs pre-discussion, by Fisher's exact test) whereas it did not decrease the number of inappropriate colonoscopies 281138 (20% of pts), which still included 10 colorectal cancer screening examinations. 3/52 ERCPs before and 1157 after discussion were inappropriate. Conclusions: 1) in inpatients of an academic hospital, upper endoscopy and colonoscopy are frequently used inappropriately, whereas ERCP is not, 2) plenary discussion has a positive impact on appropriate referral to upper endoscopy, but not to colonoscopy, which is incorrectly used also to screen for colorectal cancer. Better strategies to change referring physicians' behaviour are needed in order to decrease costs of hospitalization.

PO.159 DO DRG REIMBURSEMENTES REALLY REFLECT THE COSTS OF HOSPITAL STAY? A COST ANALYSIS IN A LOMBARDIAN GASTROENTEROLOGY DEPARTMENT G. Meucci *, G. Minoli Ospedale Valduce, Como

Background and aim: Aim if this study was to evaluate standard costs of hospital stay relative to patients discharged with the following DRGs: 202 (cirrhosis and alcoholic hepatitis); 207 (diseases of the biliary tract with complications); 208 (diseases of the biliary tract without complications) Material and methods: Medical records of all patients discharged during 2004 from our Unit with one of the above mentioned DRGs were retrieved. Costs of drug therapy and of diagnostic and therapeutic procedures were determined by manually looking up all records. All the remaining direct, indirect and structural costs were estimated by means of a standard procedure Results: For patients discharged with DRG 202 (reimbursement € 3.224,91) the mean cost per admission was €2,578.50. However, costs were higher than reimbursement for cirrhotic patients admitted for gastrointestinal bleeding (mean cost per admission € 3,676.08). Mean cost per admission was €2837.88 for DRG 207 (reimbursement €2647.09) and €20l5.74for DRG 208 (reimbursement € 1050.49). For both DRGs, a striking difference in costs was found between patients undergoing ERCP (€ 3029,33 and € 2429,67 for DRG 207 and 208, respectively) and patients not undergoing ERCP (€2443,71 and € 1291,37 for DRG 207 and 208, respectively). About 35% of patients discharged with DRG 207 had been admitted forless than three nights: the m
PO.160 EFFECTIVENESS OF COLONOSCOPY: QUALITY INDICATORS G. Meucci *,1, F. Radaelli 1, G. Bartesaghi 2, G. Minoli 1, AIG0 3 10spedale Valduce, Como 2S0FAR s.p.a., Trezzano Rosa 3 on behnlf ofAssociazione Italiana Gastroenterologi Ospedalieri

Background and aim: To evaluate the effectiveness of colonoscopy in Italian Endoscopy Units.