Blood-borne viral infections in patients with von Willebrand disease: Prevalence and clinical correlation

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63 HOW MUCH SAFE IS ENDOSCOPIC TREATMENT OF NON VARICEAL UPPER GASTROINTESTINAL BLEEDING 7 MA Bianco, R Marmo, G Rotondano, R Piscopo and L Cipolletta Gastroenterologia, A5L NA5, PO Maresca, Terre del Greco. Background and Aim The efficacy of endotherapy in upper nonvariceal GI bleeding is largely documented. Different procedures have different efficacies, but their safety has not been sistematically evaluated. For a treatment to be recommended we must know both its efficacy and safety. We therefore assessed the safety of the most popular (injection therapy with epinephrine) and that of the most effective (thermal therapy) endoscopic treatment. Methods: Medline as well as manual search of all RCTs on endoscopic treatment of non variceal bleeding with explicit reference to safety intended as presence / absence of bad outcomes induced by the procedure (bleeding, need for surgery, death) either m text or in tables was performed (January 90December 99). A total of 153 papers were found. Five papers could be entered m the meta-analysis wbth a total of 543 patients. Resuts: Induced bleeding was the most frequent and clinically relevant undesired event in patients treated with thermal therapy. All induced bleeding was not life-threatening and was managed conservatively. No perforation and/or death was induced by epinephrine ’ injection therapy, whereas these evenk were observed in 3 and 1 patients respectively with thermal therapy. cmINDUCED

ENOOSCOPIC TREATMENT THERMAL 1INlECnON p/o) , c”/) BLEEDING 7.3 I 5.9 SURGERY 1.1 I 0 DEATH 0.036 1 0 AM: absolute nkk redocbn; hWH: numk

/ A.R.R 1 N.N.H.

1.4 72 1.1 91 i 0.036 278 need to ham

1CL 95%

NON

BLEEDING RELATED GI DISEASES ARE MORE FREQUENT THAN BLEEDING RELATED IN ASYMPTOMATIC OUTPATIENTS WlTA IRON DEFlClENCY ANEMIA. G Caourso, E Lahner, G Mart&G. D’Ambra, C Grossi, A Chistolini*, B Monarca*, M Gentile*, G Delle Fave. B. Annibale Deot of Gastroenteroloev ‘Dent of Haematolow -1 Universiti deeli Stud1 “La Sapien& Roma, It& ’ Background: Iron defic!ency anemia @A) is the most wmmon form of anemia world-wide. Its standard care includes a complete evaluation of the GI tract to identify bleeding sites However, after a careful examination, a sizable portion (>30%) of patients remain without a diagnosis. IDA IS the resulf of an unbalance between iron loss and absorption, and can be due to diseases able to impair iron absorption in absence of bleeding Atrophic body gastritis (ABG), celiac disease (CD) and Helicobacfer pylorr chronic superlicial gastritis (HpCG), are able fo cause iron deficiency and IDA in absence of bleeding. Aim. to evaluate the prevalence of bleedmg and nonbhdmg-r&red GI diseases Patients: In a IO-month period 1202 outpatients were referred to our University Haematology Dept 668 (58IFi87M) of them had IDA. Among them those eligible to enter the study protocol were selected r&r an haematological visit including a detailed clinical questionnaire. Exclusion criteria were age 5 days. epistaxys. active GI haemorrage; chronic diseases, haematologrcal diseases and all malignancies, alcoholism, drug addiction, anorexia or iron-poor diet RI patients (60 F/21 M. median age 54. range 23.87) resulted eligible Methods: Upper GI endoscopy plus multiple gastric (3 antral and 3 body) and duodenal (n=2) biopsies and colonscopy Results: All patients were free from specific GI complaints 6 retiwd examinations, 4 underwent only gastroscopy 71 patients (20 Mi5 I F median age 56) were completely evaluated A GI finding likely to cause IDA was detected in 62 patients (87 3% of total) Bleeding-r&red diseases were found in 27 (38%) of patients including. colon cancer (n=lO), gastric cancer (n=2), peptic ulcer (n=7), h&al hernia with linear erosions (n=5), colonic vascular ectasla (n=3), colonic polyps (n=2), colonic dive&&r disease (n=3), Crohn’s disease (IFI) Non bleedmg-related disease were found in 36 (50 7%) patients, including 19 ABG, 4 CD and 13 HpCG 8 patients (I I 2%) had concomitant GI findings, including 3 with colon cancer Patients with non bleeding-related diseases were younger than those with bleeding (median 56 vs 70 years, p=O 0010) and included 60% of all the female patients vs only 30% of the males @=0.041) Haemoglobin levels and lenght of disease were not related with site and severity of disease Conclusions: GI nonblerdrng related dwaces account for the majority of patients with IDA and no gastrointestmal complaints, expecially young womea Evaluation of patients with IDA should always include gastric and duodenal biopsies to rule out these pathologies This approach reduces the rate of patients with diagnosis of “occult bleeding” and no detectable cause of IDA

1

18tom 43 to m 88 to m

Conclusion: effectiveness of thermal therapy should always be weighed against the not infrequently induced bad outcomes and the costs related to the management of such complications.

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62 A new acrylic glue to endoscopic treatment of esophageal rod varices. ( Uaa nuova colla acrilicn per il trattamento dek es&go-gastriche) T.Morbin,

G. Battaglin, A.Cnrta,

F.Coppa,

gastric varici

S. Rampado

Clinica Chirurgicn 4” Universitr’ di Padova In Europe the gold standard technique of the sclerotherapy of gastric varices is that proposed in 1984 by Gotlib and after by far used by Soehndra, an adhesive glue, n-butyl-Z-cyanoacrylate (Histoawyl), injected intra-varices that polimerizes within3-10 s of coming into contact with blood. We prefer to diluite yhe adhesive with LipiodolQ I:1 Since June I@ 1998we have had change because all medical and Surgical materials must have the CE marking and the only CE marked product for iv. injection (specifically indicated for the tratment of EV and GV) is Glubran 20. Our studies Jirst in vitro and after in viva, have demonstrated that the polymerization time of Glubran2 in pure form or diluited with Lipiodol is 6 s , Histoacryl in pure form 3 s , Histoacyl diluited with Lipiodol 15 s GASTRIC V.&RICES SCLEROTHERAF’Y: 3 patients with hemorrhage from GV ( ‘I treated before with Glubran for hemorrhage from VE), mean age 63 years (52-72), 1 Child A, lB, 1C. Vial cirrhosis 2 (‘), alcoholic 1. Site and De= (personal classification ): 3 F2 of Iimdus and 1 F2 tie-like under cardia (‘) Indication : emergency in 2 patients , elective in 1 None early hemorragic recurrence.. Mean follow-up 4,67 months,lOO% of survival eradication non assessable. ESOPHAGEAL VARICES SCLEROTHERAPY 4 patients with hemorrhage from EV uncontrollable with Polidocanol alone , mean age 63 years (57-72); 4 Child -Risk C; viral cirrhosis in 2, biliary cirrhosis 1, cirrosi alcoholic+ponal throbosis I; Site and Degree : F3 blue CRS+ in 2, F2 blue CRS+ in 2 Indication emergency in 4. 1 early hemorrhagic recurrence from EV retreated with stop of hemorrhage. Mean follow-up 4,25 months, 50% of survival , 2 patients dead for epatic failure. CONCLUSION:Our studies in vitro and in viva have demonstrated that Glubran is corresponds exactly to Histoacryl blu and presents a greater manageability also in pure form without change the polymerization time The less temperature of polymerization could reduce the necrotic-ulcerous complication when the ijection is casually extra -vasal The initial experience is small but the early results are satisfyng

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BLOOD-BORNE VIRAL INFECTIONS IN PATIENTS WITH vo” WILLEBRAND DISEASE PREVALENCE AND CLINICAL CORRELATION MG Rumi, AB Federici, R Soflredini, F De Flliwi, M Colombo and PM MWlll”Wi Ctr for Liver Disease “A M & A. Migliavacca”, and “A. Bianchi Bonomi” Thrombosis and Haemostasis Ctr., Dept Internal Medicine, University of Milan, IRCCS Ma&are Hospital, Milan, Italy Van W&brand (VW) patients are an interesting model for studying the natural history of transfusion related virus Infections, because I) they had been treated with blood products from single donor (fresh frozen plasma and/or cryoprecipitate) till the 90’s 2) hepatitis virus-inactivated FVIWvWF concentrates have been available in the clinical practice only in the lafe 80’s Aim of this study was to assess the prevalence of HIV and blood borne hepatitis viruses (HBV, HCV and HGV) and the impact of virus infections on liver disease in B cohort of 112 patients with VW disease Methods: HBsAg, anti-HEls, anti-HIV, anti-HCV and anti-HGV were tested with immunoenzymatic assays Serum HCV-RNA and HGV-RNA were detected by HCV was germtyped by LiPA and quantified by bDNA 2 0 &&!Zs 73 patients (28 males,mean age 44 yrs) were infused with plasma, whole blood and/or Factor VIWvW (63 before 1987, 7 between 1987 and 1991, and 3 al?er 1991). They were affected by VW diseaseof type I in 32, type 2 in 25 and type 3 in 16 Thirty-nine patients (20 males, mean age 37 yrs, VW disease type I in 30 and type 2 in 9) never treated served as controls Follow-up was ZO+lO yrs from 1” mfusion ReSUltS none of the 39 untreated patients was HCV or HIV infected, while 2 (5%) were HBsAg positive and I showed active HGV infection Among the 73 treated patients, 1 was HIV infected, IHBV infected, while anti-HCV was present in 43 (59%) patients (35 HCV-RNA positive) and HGV-RNA in 8 (I 1%) None of the 3 patients treated after 1991 was infected with any virus. The genotype distribution in the 35 HCV-RNA positive patients was type la in 9 (26%). type lb in 9 (26%). type 2dc in 8 (23%), 3a in 5 (14%) and ofher types in the remaining 4, the median value of viremia WBS 1.8 Meq/ml (range ~0.2 lo 36 MEq/ml). 21 patients had persistently high ALT levels, all but one showed active HCV infection 16 (76%) with HCV alone, 3 (14%) with co-infection with HGV and I with HBV replication Canclusmns at variance with multitrans&sed hemophiliacs, VW patients showed low risk of HIV infection es a consequence of low exposure to clotting factor concenfrates HCV infection was a common complication of transfusion therapy in front of a 19% of spontaneous virus clearance, 81% of the Infected population had remained HCV-RNA positive HCV was the mayor cause of liver diseasein the cohon of uatienfs investigated

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