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Diagnostic yield of push-enteroscopy in small bowel pathologies not presented with G.I. bleeding
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55 ROLE OF ENWSCOPIC IJLaTRASONOGRAPHY TN THE STAGING OF RECTAL CANCER. A RETROSPECTIVE ANALYSIS OF 71 CASES. Mario de Belhs, Pi&o Marone, Giovanni Batttsta Rossi, *Frrmco Cremona, ‘Gianmario Guidetti, Franca Petrolio and Alfonso Tempesta. Servizio di Endoscopia, ‘Oncologia Chirurgica “c”. Istituto Nazionale per lo Studio e la Cum dei Tumori Fondazione Giovanni Pascale, Napoli. Background and aim Endoscopic ultrasonography (EUS) is an imaging technique which combtnes endoscopy and ultrasonography and is highly accurate for the locoregional staging of gastrointestinal honors. In rectal cancer EUS, allows to evaluate the tumor penetration depth into the rectal wall and detect lymph nodes metastases. The aim of the present study was to evalttate retrospectively the accuracy of EUS in the preoperative staging of patients with rectal cancer at our Institution. Material and Method% From January 1994 to December 1999, 71 patients with rectal cancer were hospitalized and underwent surgery at our Institution During the preoperative staging, all patients underwent EUS which was performed in all cases using an echo-colonoscope Olympus Q CF UM 20, wth a 7.5 MHz radial scanner, without need of Sedation. There were 4 1 men, and 3 1 women with a mean age of 60 years (range 42-80). The results of the EUS preoperative staging were compared with the results of pathologic examination of the surgical specimens, because pathology was considered the gold standard for TNM stagmg Results: EUS showed an overall accuracy of 83% for the T stage (including nontraversable stenotic tumors). The accuracy of EUS for the T stage increased from 83 to 94% when we excluded those cases with nontraversable stenotic cancers from the analysis. When the T stages were analyzed separately, EUS showed an accuracy of 75% for Tl, 80% for T2, 86% for T3 and 80% for T4 stage, respectively. Six tumors (8 4%) were understaged, whtle another 6 cases (8.4%) were overstaged Finally, EUS was hi@y accurate (81%) in differentiating Tl from T2-4 tttmors. The endosonogmphic staging of lymph nodes completes the preoperative staging of rectal cancer In our series, EUS showed an overall accuracy of 70%, wth a sensitivity of 79% and a specificity of 68%, whch does not dtffer from the data reported by others authors. Conclusions: Our data shows that EUS is very accurate tn the locoregional staging of rectal cancer and confirms the role of this Imaging technique in the preoperative staging of patients wth rectal cancer
SUPPLEMENTATION OF MICROCRYSTALLME CELLULOSE TO A SOLID ivEAL CAUSES LESS SmOMS T”AN OTHER DIETARY FIBERS A ST”DY ON DIETARY PIBERS PHYSIOLOGICAL EFFECTSON HUMAN GUT BmnchiM. Lucheu P. Koch M. D’Ambmsio L, CapursnL Department of tiastrwntero&y ad Internal M&tine Aaenda Complessa OspedaheroSanFilippo Nen RomeItal) InfrodwtiOa Dwry tibers (DF) crms~ston carbohydratesthat resasthydrolyzesby human intest& enzymesbut are fermentedby mlonic micmflom DF have shorn mntroversi.4 efhts on gashic etn~ng, most studiesdealingwith a delayedgasmc empryinp while othemfailing to demmwate this efkzt. SolubleDF are fermaued to a large extent by a wide variety of anaerobicbacteria with prcduction of gases. SCFAs and other metabolicpmdwts that are b&wed to cause such symptomsas bloating. abdominal distention. flatulence. The insohthk fibers ax only partially fmmentedand they serve atmostexclus~wIy as butking agentsthat result m shottor transit time andincreasedfecal mass. Aim of the Itudy m to evahuts the effect of a supplementatmnof a single 5 gms doseof DF to a solid meal 011gastric emptying, omcecaItrruwt time (OCTI’). gas production and symptanr getis on h&y vdumeers. Three different DFs were tened two soluble(gum gum and ispaghula) and one rnsaluble( micmcrytihne CellUloSe) Melhad. atler a 24 hours low fibre diet IO healty sub- ( 3 male, 7 female)had B nd mnslsted of 100ym oi white bread and one 70 Smses whose yoLk was dopedwth 100mg of ‘C onnaoic .wid and fried. Subjectswere allowed 10drmk 3W ml oi tap water whde eating Every 15 mm&s for faw hears breathsamples werecollectedior “CO* nwawements wtb a massspeamphotometerand excretion curve (?laS, TI12) evaluationaccording to Gbms Funher breath samples were collectedevery 30 minutesfor eigth hours and a&v& \nth a gas chmmamgrapher for the evaluationof Hz and C& prcdxti~n Each evaluationhas been repeated addmg to basal meal . diluted in 300 ml of tap water, respectwely’ a 5 gms mycrwristaIline celluIase.gear gum or ispaghulasingledme Subjectswere askedto repmt all symp+cmts complainedhorn thetime of mealingestiontrhough 24 hoursand to evaluatewith an snaIc@c tie ranging from one to ten the symptoms intemity They werealso r&ed to repwt the muabersof flatuspassingthmugh theanus RewIts. all DF showeda eon signitjcatve reductionofTlag, and 0Cl-I versushsal meal. Subjats complained more symptomswhenate mea1supplementedwith gear (p=oolvsbaalmeal)andispaghuIa (p=o03vsbsalmeaI)PmkxbIyduetoa greater production of gases than caused by hasal mea1( p-0 06) and by meal supplementedwith micmaystalline cellulose@=&06). There was a good oarr&wn hehveengas pmdwtion and symptomsand behveengas pmduction and numbersOf flatuspasang anus (14.53 p=OGO09and 4.67 p=o.Om) Cmch,uaiaar:This study shcws no evidenceof a delayedgasvlc emptymg andof a shorter OCTT dueto suppkmentirm to a solidmeal &different DP. MiaxaystaIIine cclbktoJecauSeSless synptorna than @aI gum due to lowerm pKsiucoon.MC also cal!sesless SymptornE than lspaghuI*that scamsnot due to a Iowr gasplcducuon but pr&abIy caw+emx of the mwtuble nature and the part&s dimensionof this mmonmd celluIosc.
thmgh
54 DIAGNOSTIC YIELD OF PUSH-ENTEROSCOPY IN SMALL BOWEL PATHOLOGlES NOT PRESENTED WITH G I BLEEDING
Does gallbladder motility relate to biliary symptom frequency in cholesterol gallstone patients ? A.Colecchia, *A.Primavers, *M.Mazzocchetti, , A.Larocca, L Sandri, *S.Capodicasa, *A.Bonitantibus,OP.Portincasa G.Mazzella E.Roda, *D.Festi. Bologna, * Med. and Dpt.Gastroenterology,IJniversity D@ Aging,Univ.Chieti.“Dpt.Int. Med.Univ. Bari, Italy Gallbladder rnotility(GM) plays a role in cholesterol gallstone pathogenesis;however its role in biliary symptoms development is still debated Aims of this study were to evaluate:a)GM in symptomatic(S) and asymptomatic GS and b) to verify whether GM is different in relation to biliary symptom frequency .Methods: 120 consecutive GS were enrolled and subdivided in 4 groups according to the frequency of biliary symptoms (defined as pain in right hypocondriumkpigastrium): A)59 ASGS(M:30,F:29;age range 30-80 yrs); B)30 S-GS with history of biliary symptoms in the last year(M:9,F:21, age range: 19-77 yrs); C)19 S-GS with recurrent biliary symptoms in the last 5 years(M:4, F: 15, age range:3 l-75 yrs);D)lP S-GS only with history of symptoms(M:4, F:8,age range 26-71 yrs).GM was evaluated by ultrasound technique(EUipsoid method) after a standard meal(375 Kcal, 17 gr of fat) and expressed as: fasting volume(FV,ml);residual volume( RV,ml);% Emptying(% E).Resolts:in SGS(B,C,and D groups) a progressive reduction in %E was observed:(B:69,4~2.7%);(C:59,8~4,5%,D:5S~6~.~~,p~O,OOl B vs C;p
ltslo Sorrentini, Add&rats Marasco and Gaetano Iaquinto Gastroentemlogy Service, “S G Moati” Hospital, Avelhno, Italy Bnckgmund and Aim. Push-enteroscopy (P-E) is a valuable method to evaluate part of the dtmdenum and the jejunum Althou& its main mdicatmn is diagnosis and management of occult GI bleeding, other settings are emer&g such as small bowel radiological abnormalities and unexplamed diarrhea We retrospectively assessed the diagnostic yield of P-E in pts whose entry diagnosis was not unexplained GI bleeding Patients. We selected 31 out of 83 consecutive ots underaorte P-E (37%) (males 22, mean age 47_+17, range 19-77) According ti iodicatidn we made five groups The P-E result was classed as useless, us&II or not necessary, depending on its diagnostic weight Results. In our ties the overall diagnostic rate w?.s 23/3 I (74%), while the real diagnostic yield (i e only usefull examinations) was 16/3l (52%) Groups and diagnosm were A) Chronrc dumbma and ~p’~e hb syndrome (IO pts) including low grade lymphoma (I), ulcerative jejunitis in a coeliac disease resistant to diet (I), undiagnosai coeliac dise& (I), eosinophil gastroenteritis (3), nodular lvmohoid hvoerolasia (NLHl in Common Variable Immunodef&ncy (&I)’ (3), no l&ions (1) 8) Rnrlrologrcal abnormalrnes (7 prsJ. two ahnortnalities on Computed Tomography revealed to be leiomyoma (1) and jejunal stenosing adenocarcinoma (I), m 5 abnomtalities on small bowel follow through we found stenoxs for recurrent lymphoma (I), small bowel dilation without other abnormalities (I), negative examination (3) C) Fmnrltal poryposi (4 pts). No lesions were found in three pts and the fourth, affected with Peutz-leghers syndrome, had 4 polyps endoscapically removed D) Surgrcoi rndrcaoonr (4 p&j: two pts with symptoms of proximal small bowel obstruction had a dingwsis of carcinoma of the Treitz corner (I) and a negative result (I), in the other two we mniirtned ‘d laparotomic suspicion of jjtmal Crohn’s Disease (I) and a jejutml leiomyoma (I) E) Mrscel/aneons (6~1s). In 2 pts wtth CVlD without G I symptoms we found a modest NLH (1) and a negative result (I), no lesions were found in a case of unexplained abdominal pain, in two cases of unexplained hypergammaglobulinemia and in a case of suspected jejunal Crohn’s Disease ConcIusieos. As far as the advantages over other methods are considered (ie simple performance, biopsy, polypectomy, treatment), we think that P-E us&l for diagnosing unexplained cases of chronic diarrbaea, for betta defining small bowel radiological abnormalities and in the surveillance and treatment ofthe upper G I tract involvement in FAP
A110
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55 ROLE OF ENWSCOPIC IJLaTRASONOGRAPHY TN THE STAGING OF RECTAL CANCER. A RETROSPECTIVE ANALYSIS OF 71 CASES. Mario de Belhs, Pi&o Marone, Giovanni Batttsta Rossi, *Frrmco Cremona, ‘Gianmario Guidetti, Franca Petrolio and Alfonso Tempesta. Servizio di Endoscopia, ‘Oncologia Chirurgica “c”. Istituto Nazionale per lo Studio e la Cum dei Tumori Fondazione Giovanni Pascale, Napoli. Background and aim Endoscopic ultrasonography (EUS) is an imaging technique which combtnes endoscopy and ultrasonography and is highly accurate for the locoregional staging of gastrointestinal honors. In rectal cancer EUS, allows to evaluate the tumor penetration depth into the rectal wall and detect lymph nodes metastases. The aim of the present study was to evalttate retrospectively the accuracy of EUS in the preoperative staging of patients with rectal cancer at our Institution. Material and Method% From January 1994 to December 1999, 71 patients with rectal cancer were hospitalized and underwent surgery at our Institution During the preoperative staging, all patients underwent EUS which was performed in all cases using an echo-colonoscope Olympus Q CF UM 20, wth a 7.5 MHz radial scanner, without need of Sedation. There were 4 1 men, and 3 1 women with a mean age of 60 years (range 42-80). The results of the EUS preoperative staging were compared with the results of pathologic examination of the surgical specimens, because pathology was considered the gold standard for TNM stagmg Results: EUS showed an overall accuracy of 83% for the T stage (including nontraversable stenotic tumors). The accuracy of EUS for the T stage increased from 83 to 94% when we excluded those cases with nontraversable stenotic cancers from the analysis. When the T stages were analyzed separately, EUS showed an accuracy of 75% for Tl, 80% for T2, 86% for T3 and 80% for T4 stage, respectively. Six tumors (8 4%) were understaged, whtle another 6 cases (8.4%) were overstaged Finally, EUS was hi@y accurate (81%) in differentiating Tl from T2-4 tttmors. The endosonogmphic staging of lymph nodes completes the preoperative staging of rectal cancer In our series, EUS showed an overall accuracy of 70%, wth a sensitivity of 79% and a specificity of 68%, whch does not dtffer from the data reported by others authors. Conclusions: Our data shows that EUS is very accurate tn the locoregional staging of rectal cancer and confirms the role of this Imaging technique in the preoperative staging of patients wth rectal cancer
SUPPLEMENTATION OF MICROCRYSTALLME CELLULOSE TO A SOLID ivEAL CAUSES LESS SmOMS T”AN OTHER DIETARY FIBERS A ST”DY ON DIETARY PIBERS PHYSIOLOGICAL EFFECTSON HUMAN GUT BmnchiM. Lucheu P. Koch M. D’Ambmsio L, CapursnL Department of tiastrwntero&y ad Internal M&tine Aaenda Complessa OspedaheroSanFilippo Nen RomeItal) InfrodwtiOa Dwry tibers (DF) crms~ston carbohydratesthat resasthydrolyzesby human intest& enzymesbut are fermentedby mlonic micmflom DF have shorn mntroversi.4 efhts on gashic etn~ng, most studiesdealingwith a delayedgasmc empryinp while othemfailing to demmwate this efkzt. SolubleDF are fermaued to a large extent by a wide variety of anaerobicbacteria with prcduction of gases. SCFAs and other metabolicpmdwts that are b&wed to cause such symptomsas bloating. abdominal distention. flatulence. The insohthk fibers ax only partially fmmentedand they serve atmostexclus~wIy as butking agentsthat result m shottor transit time andincreasedfecal mass. Aim of the Itudy m to evahuts the effect of a supplementatmnof a single 5 gms doseof DF to a solid meal 011gastric emptying, omcecaItrruwt time (OCTI’). gas production and symptanr getis on h&y vdumeers. Three different DFs were tened two soluble(gum gum and ispaghula) and one rnsaluble( micmcrytihne CellUloSe) Melhad. atler a 24 hours low fibre diet IO healty sub- ( 3 male, 7 female)had B nd mnslsted of 100ym oi white bread and one 70 Smses whose yoLk was dopedwth 100mg of ‘C onnaoic .wid and fried. Subjectswere allowed 10drmk 3W ml oi tap water whde eating Every 15 mm&s for faw hears breathsamples werecollectedior “CO* nwawements wtb a massspeamphotometerand excretion curve (?laS, TI12) evaluationaccording to Gbms Funher breath samples were collectedevery 30 minutesfor eigth hours and a&v& \nth a gas chmmamgrapher for the evaluationof Hz and C& prcdxti~n Each evaluationhas been repeated addmg to basal meal . diluted in 300 ml of tap water, respectwely’ a 5 gms mycrwristaIline celluIase.gear gum or ispaghulasingledme Subjectswere askedto repmt all symp+cmts complainedhorn thetime of mealingestiontrhough 24 hoursand to evaluatewith an snaIc@c tie ranging from one to ten the symptoms intemity They werealso r&ed to repwt the muabersof flatuspassingthmugh theanus RewIts. all DF showeda eon signitjcatve reductionofTlag, and 0Cl-I versushsal meal. Subjats complained more symptomswhenate mea1supplementedwith gear (p=oolvsbaalmeal)andispaghuIa (p=o03vsbsalmeaI)PmkxbIyduetoa greater production of gases than caused by hasal mea1( p-0 06) and by meal supplementedwith micmaystalline cellulose@=&06). There was a good oarr&wn hehveengas pmdwtion and symptomsand behveengas pmduction and numbersOf flatuspasang anus (14.53 p=OGO09and 4.67 p=o.Om) Cmch,uaiaar:This study shcws no evidenceof a delayedgasvlc emptymg andof a shorter OCTT dueto suppkmentirm to a solidmeal &different DP. MiaxaystaIIine cclbktoJecauSeSless synptorna than @aI gum due to lowerm pKsiucoon.MC also cal!sesless SymptornE than lspaghuI*that scamsnot due to a Iowr gasplcducuon but pr&abIy caw+emx of the mwtuble nature and the part&s dimensionof this mmonmd celluIosc.
thmgh
54 DIAGNOSTIC YIELD OF PUSH-ENTEROSCOPY IN SMALL BOWEL PATHOLOGlES NOT PRESENTED WITH G I BLEEDING
Does gallbladder motility relate to biliary symptom frequency in cholesterol gallstone patients ? A.Colecchia, *A.Primavers, *M.Mazzocchetti, , A.Larocca, L Sandri, *S.Capodicasa, *A.Bonitantibus,OP.Portincasa G.Mazzella E.Roda, *D.Festi. Bologna, * Med. and Dpt.Gastroenterology,IJniversity D@ Aging,Univ.Chieti.“Dpt.Int. Med.Univ. Bari, Italy Gallbladder rnotility(GM) plays a role in cholesterol gallstone pathogenesis;however its role in biliary symptoms development is still debated Aims of this study were to evaluate:a)GM in symptomatic(S) and asymptomatic GS and b) to verify whether GM is different in relation to biliary symptom frequency .Methods: 120 consecutive GS were enrolled and subdivided in 4 groups according to the frequency of biliary symptoms (defined as pain in right hypocondriumkpigastrium): A)59 ASGS(M:30,F:29;age range 30-80 yrs); B)30 S-GS with history of biliary symptoms in the last year(M:9,F:21, age range: 19-77 yrs); C)19 S-GS with recurrent biliary symptoms in the last 5 years(M:4, F: 15, age range:3 l-75 yrs);D)lP S-GS only with history of symptoms(M:4, F:8,age range 26-71 yrs).GM was evaluated by ultrasound technique(EUipsoid method) after a standard meal(375 Kcal, 17 gr of fat) and expressed as: fasting volume(FV,ml);residual volume( RV,ml);% Emptying(% E).Resolts:in SGS(B,C,and D groups) a progressive reduction in %E was observed:(B:69,4~2.7%);(C:59,8~4,5%,D:5S~6~.~~,p~O,OOl B vs C;p
ltslo Sorrentini, Add&rats Marasco and Gaetano Iaquinto Gastroentemlogy Service, “S G Moati” Hospital, Avelhno, Italy Bnckgmund and Aim. Push-enteroscopy (P-E) is a valuable method to evaluate part of the dtmdenum and the jejunum Althou& its main mdicatmn is diagnosis and management of occult GI bleeding, other settings are emer&g such as small bowel radiological abnormalities and unexplamed diarrhea We retrospectively assessed the diagnostic yield of P-E in pts whose entry diagnosis was not unexplained GI bleeding Patients. We selected 31 out of 83 consecutive ots underaorte P-E (37%) (males 22, mean age 47_+17, range 19-77) According ti iodicatidn we made five groups The P-E result was classed as useless, us&II or not necessary, depending on its diagnostic weight Results. In our ties the overall diagnostic rate w?.s 23/3 I (74%), while the real diagnostic yield (i e only usefull examinations) was 16/3l (52%) Groups and diagnosm were A) Chronrc dumbma and ~p’~e hb syndrome (IO pts) including low grade lymphoma (I), ulcerative jejunitis in a coeliac disease resistant to diet (I), undiagnosai coeliac dise& (I), eosinophil gastroenteritis (3), nodular lvmohoid hvoerolasia (NLHl in Common Variable Immunodef&ncy (&I)’ (3), no l&ions (1) 8) Rnrlrologrcal abnormalrnes (7 prsJ. two ahnortnalities on Computed Tomography revealed to be leiomyoma (1) and jejunal stenosing adenocarcinoma (I), m 5 abnomtalities on small bowel follow through we found stenoxs for recurrent lymphoma (I), small bowel dilation without other abnormalities (I), negative examination (3) C) Fmnrltal poryposi (4 pts). No lesions were found in three pts and the fourth, affected with Peutz-leghers syndrome, had 4 polyps endoscapically removed D) Surgrcoi rndrcaoonr (4 p&j: two pts with symptoms of proximal small bowel obstruction had a dingwsis of carcinoma of the Treitz corner (I) and a negative result (I), in the other two we mniirtned ‘d laparotomic suspicion of jjtmal Crohn’s Disease (I) and a jejutml leiomyoma (I) E) Mrscel/aneons (6~1s). In 2 pts wtth CVlD without G I symptoms we found a modest NLH (1) and a negative result (I), no lesions were found in a case of unexplained abdominal pain, in two cases of unexplained hypergammaglobulinemia and in a case of suspected jejunal Crohn’s Disease ConcIusieos. As far as the advantages over other methods are considered (ie simple performance, biopsy, polypectomy, treatment), we think that P-E us&l for diagnosing unexplained cases of chronic diarrbaea, for betta defining small bowel radiological abnormalities and in the surveillance and treatment ofthe upper G I tract involvement in FAP
A110
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