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ARTIFICIAL NEURAL NETWORK (ANN) VS. ROCKALL SCORE FOR PREDICTION OF MORTALITY IN PATIENTS WITH NON VARICEAL UPPER GI BLEEDING (UGIB)
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Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
CS.2.6 ARTIFICIAL NEURAL NETWORK (ANN) VS. ROCKALL SCORE FOR PREDICTION OF MORTALITY IN PATIENTS WITH NON VARICEAL UPPER GI BLEEDING (UGIB) R. Marmo ∗ ,1 , G. Rotondano 1 , L. Cipolletta 1 , M. Koch 1 , L. Capurso 1 , P.M. Buscema 2 , M. Intraligi 2 , E. Grossi 3 1 Aigo - Sied, on behalf of Progetto Nazionale Emorragia Digestiva, Italy; 2 Semeion Research Center of Sciences of Communication, Roma; 3 Bracco S.P.A., Milano
Background and aim: Early risk stratification is essential for timely and adequate clinical governance in patients with non variceal UGIB. Different predictive models have been developed with conventional statistical procedures to identify predictors of mortality in this setting. Rockall’s score is currently the most validated and used tool to predict the risk of death from UGIB. Artificial neural networks are software tools with the capacity to learn the relation between input and the output variable (death) After this learning or “training” period the ANN can “predict” the output on inputs of further unknown cases.This capability is called generalisation. The aim of this study is to evaluate whether the use the use of artificial neural network provides any previsional gain over the Rockall score in the prediction of mortality from non variceal UGIB Material and methods: The analysis included certified outcomes of 2432 patients with nonvariceal UGIB (1601 males) whose data set was extrapolated from a structured database as a part of multicenter prospective study carried out in 21 hospitals in Italy. The mortality was considered “bleeding-related” if occurred within 30 days from the index bleeding episode. A total of 68 independent variables were analysed, mostly pre-endoscopic clinico-anamnestic variables. Rockall score was compared with ANNs (Twist® system-Semeion) adopting the same result validation protocol with random allocation of the sample in training and testing subsets and subsequent cross-over. Ability to identify deceased patients was defined as sensitivity of the model. Ability to identifiy survivors was defined specificity. Diagnostic accuracy was also calculated. Of the 68 variables initially analysed, 21 were selected and used by the ANNs. Results: Overall, death occurred in 114 cases (4.7%), whereas 2318 survived (95.3%). In predicting the ultimate outcome, sensitivity of ANNs was 84.0% vs. 71.4% of Rockall score. The sensitivity, specificity, accuracy and areas under receiver-operating characteristic (ROC) curves was significantly higher with ANN (see table) Table 1. Mean diagnostic yield of best predictive models Models Rockall score Neural networks (Twist system) P
Sensitivity Specificity Accuracy 71.4 84.0 <0.01
52.0 97,5 <0.001
61.7 90.6 <0.001
Area Under Curve 0.60 0.95 <0.001
Conclusions: In patients with acute nonvariceal UGIB, artificial neural network provide a significant prognostic gain predicting the risk of death vs the Rockall score. # R. Therapeutic endoscopy 1. GI bleeding
CS.2.7 ENDOCLIP-ASSISTED VERSUS ENDOLOOP-ASSISTED RESECTION OF LARGE PEDUNCULATED COLORECTAL POLYPS C. Luigiano ∗ ,1 , F. Ferrara 1 , S. Ghersi 1 , V. Cennamo 2 , P. Billi 1 , C. Fabbri 1 , A.M. Polifemo 1 , P. Landi 1 , M. Bassi 1 , N. D’Imperio 1 1 Presidio
Ospedaliero Bellaria-Maggiore, Bologna; 2 Policlinico S. Orsola-Malpighi, Bologna Background and aim: Bleeding is the most frequent complication of
endoscopic polypectomy, specially in the presence of a large artery in the stalk of pedunculated polyps. Aim of this prospective study was to evaluate the outcomes of endoclipassisted polypectomy in patients with large pedunculated colorectal polyps, in comparison with an historical control of patients treated with endoloop-assisted resection Material and methods: In our institution Between January 2007 and December 2007, 32 patients with 32 large pedunculated polyps (=15mm) were treated with endoclip-assisted resection technique (Group A). Between January 2006 and December 2006 a total of 35 large pedunculated polyps in 35 patients were resected, 33 with endoloop-assisted polypectomy (control, Group B), the remaining 2 cases (very large polyps) were resected with endoclips and needle knife and included in the group A for the analysis. Statistical analysis was performed with NPC, Log-Likelihood and Spearman test. Results: Mean patient age was 68.3±10.2 years (range 45-85) in group A and 65.5±10.1 years (range 46-81) in group B. The mean (± SD) polyps head size was 26.8±8.1 mm (range 15-50) in group A and 22.3±4.1 mm (range 15-30) in group B (P=0.004) and the large diameter of the polyp’s head was related to the old age of patients (P=0.007). In group A 6 polyps had a mean (± SD) head size of 40.8±5.8 mm (range 35-50) and were resected with clips and needle knife. The most frequent location of the polyps was the sigmoid colon in both groups, 22 (64.8%) in group A and 21 (63.7%) in group B. In group A bleeding occurred in 2 cases (5.9%), associated to the presence of cancer in polyps (P=0.006) and managed applying new clips. No bleeding occurred in patients of the group B and no perforation and post-polypectomy syndrome occurred in both groups. The most frequent histological type was villous adenoma in group A (35.3%) and tubular adenoma in group B (42.4%). There were also 3 (8.8%) adenomas containing cancer in group A and 1/33 (3%) in group B. Clip application was possible in all patients while in two cases loop placement was impossible. En-bloc resection of polyps was possible in both groups. Conclusions: In our experience endoclip-assisted resection is an efficacious and safe procedure to recommend as an alternative to endoloop for a safe resection of large pedunculated colorectal polyps when endoloop ligation is difficult or impossible. # S. Endoscopy complications
CS.3.1 HLA DQ2 AND DQ8 HOMOZYGOSITY IN PATIENTS WITH POTENTIAL COELIAC DISEASE F. Biagi 1 , P.I. Bianchi ∗ ,1 , C. Vattiato 1 , A. Marchese 1 , L. Trotta 1 , C. Badulli 2 , M. Martinetti 2 , A. De Silvestri 3 , G.R. Corazza 1 1 Coeliac Centre/first Dept. of Internal Medicine, University of Pavia, Pavia; 2 Immunohematology and Transfusion Centre, Fondazione IRCCS Policlinico San Matteo, Pavia; 3 Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia
Background and aim: Coeliac disease (CD) is a gluten-sensitive enteropathy associated with HLA-DQ2 and DQ8. It was shown that DQ2 homozygosity was more common in patients with complicated CD than uncomplicated CD [1], and that was associated with severe intestinal lesions [2]. To study DQ2 and DQ8 homozigosity in patients with potential CD, the most preserved histological end of the pathological coeliac spectrum. Material and methods: Molecular HLA-DQ typing was performed on 13 potential CD, 170 uncomplicated CD, 27 complicated CD patients, and 224 healthy blood donors. DNA was isolated from blood specimens using a DNA purification kit. Gene polymorphisms were analyzed using PCR-SSP commercial kits. Results: HLA-DQ2 was present in 85% of potential CD, 95% of uncomplicated CD, 93% of complicated CD patients, and 31% of controls. DQ2 homozygosity was present in 8% of potential CD, 37% of un-
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
CS.2.6 ARTIFICIAL NEURAL NETWORK (ANN) VS. ROCKALL SCORE FOR PREDICTION OF MORTALITY IN PATIENTS WITH NON VARICEAL UPPER GI BLEEDING (UGIB) R. Marmo ∗ ,1 , G. Rotondano 1 , L. Cipolletta 1 , M. Koch 1 , L. Capurso 1 , P.M. Buscema 2 , M. Intraligi 2 , E. Grossi 3 1 Aigo - Sied, on behalf of Progetto Nazionale Emorragia Digestiva, Italy; 2 Semeion Research Center of Sciences of Communication, Roma; 3 Bracco S.P.A., Milano
Background and aim: Early risk stratification is essential for timely and adequate clinical governance in patients with non variceal UGIB. Different predictive models have been developed with conventional statistical procedures to identify predictors of mortality in this setting. Rockall’s score is currently the most validated and used tool to predict the risk of death from UGIB. Artificial neural networks are software tools with the capacity to learn the relation between input and the output variable (death) After this learning or “training” period the ANN can “predict” the output on inputs of further unknown cases.This capability is called generalisation. The aim of this study is to evaluate whether the use the use of artificial neural network provides any previsional gain over the Rockall score in the prediction of mortality from non variceal UGIB Material and methods: The analysis included certified outcomes of 2432 patients with nonvariceal UGIB (1601 males) whose data set was extrapolated from a structured database as a part of multicenter prospective study carried out in 21 hospitals in Italy. The mortality was considered “bleeding-related” if occurred within 30 days from the index bleeding episode. A total of 68 independent variables were analysed, mostly pre-endoscopic clinico-anamnestic variables. Rockall score was compared with ANNs (Twist® system-Semeion) adopting the same result validation protocol with random allocation of the sample in training and testing subsets and subsequent cross-over. Ability to identify deceased patients was defined as sensitivity of the model. Ability to identifiy survivors was defined specificity. Diagnostic accuracy was also calculated. Of the 68 variables initially analysed, 21 were selected and used by the ANNs. Results: Overall, death occurred in 114 cases (4.7%), whereas 2318 survived (95.3%). In predicting the ultimate outcome, sensitivity of ANNs was 84.0% vs. 71.4% of Rockall score. The sensitivity, specificity, accuracy and areas under receiver-operating characteristic (ROC) curves was significantly higher with ANN (see table) Table 1. Mean diagnostic yield of best predictive models Models Rockall score Neural networks (Twist system) P
Sensitivity Specificity Accuracy 71.4 84.0 <0.01
52.0 97,5 <0.001
61.7 90.6 <0.001
Area Under Curve 0.60 0.95 <0.001
Conclusions: In patients with acute nonvariceal UGIB, artificial neural network provide a significant prognostic gain predicting the risk of death vs the Rockall score. # R. Therapeutic endoscopy 1. GI bleeding
CS.2.7 ENDOCLIP-ASSISTED VERSUS ENDOLOOP-ASSISTED RESECTION OF LARGE PEDUNCULATED COLORECTAL POLYPS C. Luigiano ∗ ,1 , F. Ferrara 1 , S. Ghersi 1 , V. Cennamo 2 , P. Billi 1 , C. Fabbri 1 , A.M. Polifemo 1 , P. Landi 1 , M. Bassi 1 , N. D’Imperio 1 1 Presidio
Ospedaliero Bellaria-Maggiore, Bologna; 2 Policlinico S. Orsola-Malpighi, Bologna Background and aim: Bleeding is the most frequent complication of
endoscopic polypectomy, specially in the presence of a large artery in the stalk of pedunculated polyps. Aim of this prospective study was to evaluate the outcomes of endoclipassisted polypectomy in patients with large pedunculated colorectal polyps, in comparison with an historical control of patients treated with endoloop-assisted resection Material and methods: In our institution Between January 2007 and December 2007, 32 patients with 32 large pedunculated polyps (=15mm) were treated with endoclip-assisted resection technique (Group A). Between January 2006 and December 2006 a total of 35 large pedunculated polyps in 35 patients were resected, 33 with endoloop-assisted polypectomy (control, Group B), the remaining 2 cases (very large polyps) were resected with endoclips and needle knife and included in the group A for the analysis. Statistical analysis was performed with NPC, Log-Likelihood and Spearman test. Results: Mean patient age was 68.3±10.2 years (range 45-85) in group A and 65.5±10.1 years (range 46-81) in group B. The mean (± SD) polyps head size was 26.8±8.1 mm (range 15-50) in group A and 22.3±4.1 mm (range 15-30) in group B (P=0.004) and the large diameter of the polyp’s head was related to the old age of patients (P=0.007). In group A 6 polyps had a mean (± SD) head size of 40.8±5.8 mm (range 35-50) and were resected with clips and needle knife. The most frequent location of the polyps was the sigmoid colon in both groups, 22 (64.8%) in group A and 21 (63.7%) in group B. In group A bleeding occurred in 2 cases (5.9%), associated to the presence of cancer in polyps (P=0.006) and managed applying new clips. No bleeding occurred in patients of the group B and no perforation and post-polypectomy syndrome occurred in both groups. The most frequent histological type was villous adenoma in group A (35.3%) and tubular adenoma in group B (42.4%). There were also 3 (8.8%) adenomas containing cancer in group A and 1/33 (3%) in group B. Clip application was possible in all patients while in two cases loop placement was impossible. En-bloc resection of polyps was possible in both groups. Conclusions: In our experience endoclip-assisted resection is an efficacious and safe procedure to recommend as an alternative to endoloop for a safe resection of large pedunculated colorectal polyps when endoloop ligation is difficult or impossible. # S. Endoscopy complications
CS.3.1 HLA DQ2 AND DQ8 HOMOZYGOSITY IN PATIENTS WITH POTENTIAL COELIAC DISEASE F. Biagi 1 , P.I. Bianchi ∗ ,1 , C. Vattiato 1 , A. Marchese 1 , L. Trotta 1 , C. Badulli 2 , M. Martinetti 2 , A. De Silvestri 3 , G.R. Corazza 1 1 Coeliac Centre/first Dept. of Internal Medicine, University of Pavia, Pavia; 2 Immunohematology and Transfusion Centre, Fondazione IRCCS Policlinico San Matteo, Pavia; 3 Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia
Background and aim: Coeliac disease (CD) is a gluten-sensitive enteropathy associated with HLA-DQ2 and DQ8. It was shown that DQ2 homozygosity was more common in patients with complicated CD than uncomplicated CD [1], and that was associated with severe intestinal lesions [2]. To study DQ2 and DQ8 homozigosity in patients with potential CD, the most preserved histological end of the pathological coeliac spectrum. Material and methods: Molecular HLA-DQ typing was performed on 13 potential CD, 170 uncomplicated CD, 27 complicated CD patients, and 224 healthy blood donors. DNA was isolated from blood specimens using a DNA purification kit. Gene polymorphisms were analyzed using PCR-SSP commercial kits. Results: HLA-DQ2 was present in 85% of potential CD, 95% of uncomplicated CD, 93% of complicated CD patients, and 31% of controls. DQ2 homozygosity was present in 8% of potential CD, 37% of un-