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ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR REFRACTORY RECTAL POLYPS: RESULTS AFTER ONE YEAR OF FOLLOW UP
S96
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
P.56 PREDICTIVE VALUE OF SEROLOGICAL MARKERS OF DEGREE OF HISTOLOGICAL DAMAGE IN ACUTE UNCOMPLICATED COLONIC DIVERTICULITIS W. Elisei ∗ ,1 , G. Brandimarte 1 , G.M. Giorgetti 2 , P.G. Lecca 1 , F. Aiello 3 , A. Tursi 4 1 Department
of Internal Medicine, Division of Gastroenterology, “Cristo Re” Hospital, Roma; 2 Clinical Nutrition Unit, “S. Eugenio” Hospital, Roma; 3 Department of Statistical and Mathematic Sciences, University of Palermo, Palermo; 4 Division of Gastroenterology, “S. Nicola Pellegrino” Hospital, Trani (BA) Background and aim: Acute uncomplicated diverticulitis (AUD) may show histological and serological signs of inflammation. Our aim was to assess whether serological markers of inflammation may be predictive of abnormal histology in AUD. Material and methods: 21 consecutive patients affected by AUD were studied (15 Males, 6 Females, mean age 66.19 years, range 43-85 years). Diagnosis of AUD was based on specific endoscopic and CT scan patterns. Several serological markers were assessed (White blood cells [WBC], Erytro-sedimentation Rate [ESR], C-reactive protein [CRP], fibrinogen, a1-acid glycoprotein). Neutrophilic and lymphocytic inflammatory infiltrate was also scored. Results: WBC was increased in 4/21 pts (19.4%), ESR in 12/21 pts (57.14%), CRP in 13/21 pts (61.9%), fibrinogen in 5/21 pts (23.8%), and a1-acid glycoprotein in 6/21 pts (28.57%). All serological markers were related with the degree of histological damage. In patients scoring 3 in neutrophilic infiltrate (severe active inflammation), all markers showed a statistical significant relation (ranging from p=0.004 for WBC to p=0.00001 for fibrinogen). On the contrary, CRP was the most sensitive marker of mild-moderate histological damage, since it was increased in 4/10 (40%) patients scoring 0 or 1 in neutrophilic infiltrate (absence of mild active inflammation) (p=0.005). Conclusions: Serological markers showed a strict relation with the degree of histological damage in AUD. Moreover, CRP is the most sensitive marker of mild-moderate histological damage. # D. Colorectal diseases 1. Diverticular disease
P.57 LATERAL SPREADING TUMORS (LST): ENDOSCOPIC TREATMENT AND OUTCOME V. Lunedei ∗ , A. Casadei, E. Cavargini, E. De Vergori, S. Maltoni, C. Cortini, I. Manzi, A. Simone, E. Ricci Ospedale Morgagni-Pierantoni, Forlì Background and aim: LST are defined as lesions greater than 10 mm in diameter with low vertical axis that extend laterally along the colon wall. LST are distinct in granular (G-LST), flat (F-type), and mixed type (GNG). Endoscopic mucosal resection (EMR) is an alternative to surgery for removing LST; this study assessed the clinical outcome of EMR. Material and methods: Between February 2003 and November 2008, 103 LST (37 G, 56 NG, 10 G-NG) were diagnosed in 90 patients (48 women and 42 men, age range: 44-80 yr, median age: 62 yr). Lesions were located 57 in right colon, 16 transverse colon, 30 left colon (diameter 10 mm-65 mm; median size: 37.5 mm). All lesions underwent chromoscopy using indigo carmine stain before EMR during colonoscopy. After EMR patients were followed up at 3, 6, 9, 12 months and then after 1 and 3 years (follow-up range: 3-65 months, median value: 34 months). 92 LST underwent EMR, 60 with piecemeal resection (range 27 -65 mm) and 32 en bloc (21-24 mm). Results: 11 LST were referred for surgical treatment (9 no lifting-sign, 1 involved the ileal ostium, 1 fibrosis related to partial resection in other institute). Histological findings of this series were 4 adenocarcinomas, 5 HGD and 2 LGD.
Histopathological evaluation of endoscopic retrieved tissue showed: 77 (83%) LGD, 13 (14%) HGD, 2 (2%) adenocarcinoma pTis. One LST of the caecum had presented wall burn syndrome treated with medical therapy. Five cases had delayed bleeding (three after 24 hour and two after 7 and 9 days), while 2 procedural bleeding occurred in the right colon, all treated with endoscopical haemostasis. In the piece-meal group, recurrent/residual adenomatous disease was diagnosed in 16 cases (13 after 3 months, 7 after 6 months, 5 after 9 months, 3 after 12 months), treated by further biopsy resections and APC; no recurrence in en-bloc group. Conclusions: EMR is a safe and effective treatment for LST, providing a high cure rate (recurrence rate 17%) and low risk of complications, with no difference between right (6%) and left colon (12%). # D. Colorectal diseases 2. Pre-cancerous lesions
P.58 MTHFR C677T AND A1298C POLYMORPHISMS AND SPORADIC COLORECTAL CARCINOMA RISK IN A COHORT OF ITALIAN PATIENTS G. Actis, P. Pazienza, A. Parziale, M. Cicilano, G. Tappero, E. Tarabra, S. Chiaramello, M. Ayoubi, L. Framarin, A. Biava, E. Borghesio, P. De Paolis, A. Comandone, F. Castellino, F. Rosina ∗ Presidio Sanitario Gradenigo, Torino Background and aim: Colorectal cancer (CRC) is a major health problem. Colonoscopic CRC screening is cumbersome and expensive. Identification of genetic risk of CRC may help to select the subjects who could benefit from colonoscopy. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism reduce the catalytic activity of MTHFR protein, which affects methionine synthesis and DNA methylation, possibly affecting the carcinogenetic pathway. The aim of this study was to determine whether MTHFR C677T and A1298C polymorphisms represent a risk factor for CRC in a Northern Italy caucasian population. Material and methods: The study cohort consisted of 465 subjects who underwent colonoscopy at our Centre between may 2006 and January 2008 divided into two groups: non familiar CRC patients (168 patients, M/F 77/91, mean age 66±11 years) and healthy controls matched for age, gender, hypertension, smoking, and drinking habits (297 patients, M/F 129/168, mean age 63±10 years). DNA was extracted from peripheral blood, MTHFR exon 5 was amplified by using specific primers, and C677T and A1298C polymorphisms were analysed by High-resolution melting of PCR amplicons. Results: Data are in Hardy-Weinberg Equilibrium. No statistically significant differences were observed between the genotype distribution among CRC patients and controls (p > 0,05) and in the CRC group among right and left sided CRC (p > 0,05). Conclusions: No significant correlation was detected between MTHFR c.677 C/T polymorphism and the risk of colorectal neoplasm among North Italian Caucasian patients. # D. Colorectal diseases 2. Pre-cancerous lesions
P.59 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR REFRACTORY RECTAL POLYPS: RESULTS AFTER ONE YEAR OF FOLLOW UP F. Azzolini ∗ , R. Sassatelli, L. Camellini, F. Decembrino, V. Iori, F. Biolchini, M. Cavina, G. Sereni, C. Tioli, G. Bedogni Endoscopia Digestiva Arcispedale S.Maria Nuova, Reggio Emilia Background and aim: Aim of this study was to evaluate the results of ESD in refractory adenomas after endoscopic follow up Material and methods: Eight patients (see Table 1) with large rectal
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
S97
Abstract P.59 – Table 1. History of patients before ESD Patient
Sex Age
Diameter of Morphology Time from first treatment Sessions the lesion (cm) to ESD (months) before ESD (No)*
Technique employed
Complete polypectomy
M.A. F 33 4.5 LST 22 3 (5) Piecemeal ERM + Cap + APC Yes B.S. F 34 6 LST 24 5(7) Piecemeal polypectomy + APC No P.G. M 69 6 LST 22 5 (7) Piecemeal ERM + Cap + APC Yes M.M.L. F 49 8 Nodal 2 3 (2) Piecemeal ERM No B.D. M 74 7.5 LST 128 7 (16) Piecemeal polypectomy + APC Yes B.M.O. M 56 4 LST 10 3 (5) Piecemeal polypectomy + APC No F.C. F 71 6 LST 15 3 (4) Piecemeal polypectomy + APC Yes C.S. F 85 14 LST 9 3(4) Piecemeal polypectomy + APC No *Number of polypectomy sessions before ESD. In brackets all endoscopic examinations during follow up, including polypectomy sessions.
Worst histology Severe dysplasia Moderate dysplasia Moderate dysplasia Severe dysplasia Moderate dysplasia Adenocarcinoma Severe dysplasia Low grade dysplasia
Abstract P.59 – Table 2. Lesions treated by one session of ESD and results Patient
Diameter Morphology (cm)
Pit “En bloc” Complete * pattern Resection Resection*
Histology
Free margins
M.A. B.S.
5 4
IIa IIa + IIc
IV III L
No No
Yes Yes
Moderate dysplasia Moderate dysplasia
Yes Yes
No No
P.G.
4
IIa
III L
No
Yes
Moderate dysplasia
Yes
No
4,5 3 2
Is IIa IIa
IV IV VI
Yes No No
Yes Yes No
Yes Yes No
4
Is
VI
Yes
Yes
Severe dysplasia Moderate dysplasia Adenocarcinoma with deep submucosal invasion Adenocarcinoma with submucosal invasion (1500 μm) Low grade dysplasia
Yes
M.M.L. B.D. B.M.O. F.C. C.S.
12
Is
IV
No
No
Complications
Deep Lateral
†
No
Fu Recurrence Fu 12 12
No No
12
No
Yes No No
None Perforation (severe diffuse subcutaneous emphysema) Perforation (mild localized subcutaneous emphysema) None None None
12 16
No No
†
†
Yes
None
12
No
None
§
§
No
§
*Resection of the dissected area were complete by snare; operation was performed; further treatment was not applied for relevant comorbidities (respiratory and hearth disfunction).
polyps (mean diameter 4,8 cm; range 2-12 cm), recurrent after endoscopic polypectomy (mean 4 sessions, range 2-12), or refractory to eradication after at least two attempts with standard techniques were approached by ESD. Mean time from first treatment and ESD session was 29 months (range 2-128 months). In all patients first standard treatment was applied (endoscopic mucosal resection), with or without further treatment of margins by argon plasma coagulation. In all patients a recurrence was diagnosed and ESD was performed. The ESD procedure was carried out using a single channel upper gastrointestinal endoscope with a water-jet system (Fujinon EG-450 CT 5 and Olympus GIF 1T-160). A transparent cap (ST-HOOD, DH-16CR, Fujinon) was attached to the tip of the endoscope. A standard needle knife was used for incision and dissection. Results: The average time required for ESD was 144 minutes (range 15-190 minutes). Complete resection was possible in 7/8 cases. Resection with ESD was not complete in a 12 cm laterally spreading tumor. In this case further treatment was not applied because the patient, a 85 year woman, with a low-grade dysplasia lesion, was affected by relevant comorbidities (respiratory and hearth disfunction). One patient with invasive adenocarcinoma with deep submucosal invasion was operated. All the other six patient were eradicated after a mean time of follow up of 12,8 month (range 12-16). The postoperative course was uneventful for 5 patients. Two patients presented subcutaneous emphysema. All complications were treated conservatively. Conclusions: ESD technique allows the resection of polyps unresectable after common endoscopic treatments. Thanks to ESD, in 6/7 patients major surgery was avoided. After a reasonable follow up (median 12,8 months) we could consider as healed all the 6 patients in which ESD was possible. ESD represents an interesting endoscopic “rescue therapy” for residual-recurrent rectal polyps scar-embedded and no recurrence was observed after the first year of follow up. # D. Colorectal diseases 2. Pre-cancerous lesions
P.60 RELATIONSHIP BETWEEN C/T_13910 POLYMORPHISM INVOLVED IN THE ADULT LACTASE PERSISTENCE AND RISK OF COLORECTAL CANCER IN THE ITALIAN POPULATION E. Tarabra, P. Pazienza, E. Borghesio, A. Biava, G. Tappero, L. Framarin, G. Actis, F. Castellino, N. Leone, P. De Paolis, A. Comandone, F. Rosina ∗ , M. Ayoubi Presidio Sanitario Gradenigo, Torino Background and aim: Colorectal cancer (CRC) is the most common cause of death in Europe. Absorption of lactose, the main sugar of milk, is regulated by the activity of the lactase enzyme (LCT) in the intestinal wall. The activity of LCT is genetically regulated and associated with a C/T single polymorphism located on 13910 bp upstream from the LCT-encoding gene. The three genotypes are perfectly related with the level of LCT activity: the CC genotype defines lactose malabsorbers, the CT and TT genotypes define lactose absorbers. A recent study showed a significative association with the CC genotype and an elevated risk of CRC in Finnish population but there was no evidence in the Italian subjects. In this study we have evaluated if CC genotype could be a risk factor of CRC or polyps in the Italian population. Material and methods: We enrolled a total of 762 subjects (252 with CRC, 178 with polyps and 332 control subjects). The C/T_13910 variant was genotyped by TaqMan real time PCR on PBMC from blood. Results: No statistically significant variation in genotype distribution of C/T_13910 variant was observed between control subjects and CRC (CC vs CT+TT genotype: OR: 1.201: Cl 95%: 0.858-1.682; p=0.285) or polyps (CC vs CT+TT genotype: OR:0.992; Cl 95%: 0.679-1.449; p=0.966) in the Italian population. Conclusions: In conclusion, genetic polymorphism involved in adulttype hypolactasia, do not play a significative role in modulating the CRC development in the Italian population. # D. Colorectal diseases 2. Pre-cancerous lesions
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
P.56 PREDICTIVE VALUE OF SEROLOGICAL MARKERS OF DEGREE OF HISTOLOGICAL DAMAGE IN ACUTE UNCOMPLICATED COLONIC DIVERTICULITIS W. Elisei ∗ ,1 , G. Brandimarte 1 , G.M. Giorgetti 2 , P.G. Lecca 1 , F. Aiello 3 , A. Tursi 4 1 Department
of Internal Medicine, Division of Gastroenterology, “Cristo Re” Hospital, Roma; 2 Clinical Nutrition Unit, “S. Eugenio” Hospital, Roma; 3 Department of Statistical and Mathematic Sciences, University of Palermo, Palermo; 4 Division of Gastroenterology, “S. Nicola Pellegrino” Hospital, Trani (BA) Background and aim: Acute uncomplicated diverticulitis (AUD) may show histological and serological signs of inflammation. Our aim was to assess whether serological markers of inflammation may be predictive of abnormal histology in AUD. Material and methods: 21 consecutive patients affected by AUD were studied (15 Males, 6 Females, mean age 66.19 years, range 43-85 years). Diagnosis of AUD was based on specific endoscopic and CT scan patterns. Several serological markers were assessed (White blood cells [WBC], Erytro-sedimentation Rate [ESR], C-reactive protein [CRP], fibrinogen, a1-acid glycoprotein). Neutrophilic and lymphocytic inflammatory infiltrate was also scored. Results: WBC was increased in 4/21 pts (19.4%), ESR in 12/21 pts (57.14%), CRP in 13/21 pts (61.9%), fibrinogen in 5/21 pts (23.8%), and a1-acid glycoprotein in 6/21 pts (28.57%). All serological markers were related with the degree of histological damage. In patients scoring 3 in neutrophilic infiltrate (severe active inflammation), all markers showed a statistical significant relation (ranging from p=0.004 for WBC to p=0.00001 for fibrinogen). On the contrary, CRP was the most sensitive marker of mild-moderate histological damage, since it was increased in 4/10 (40%) patients scoring 0 or 1 in neutrophilic infiltrate (absence of mild active inflammation) (p=0.005). Conclusions: Serological markers showed a strict relation with the degree of histological damage in AUD. Moreover, CRP is the most sensitive marker of mild-moderate histological damage. # D. Colorectal diseases 1. Diverticular disease
P.57 LATERAL SPREADING TUMORS (LST): ENDOSCOPIC TREATMENT AND OUTCOME V. Lunedei ∗ , A. Casadei, E. Cavargini, E. De Vergori, S. Maltoni, C. Cortini, I. Manzi, A. Simone, E. Ricci Ospedale Morgagni-Pierantoni, Forlì Background and aim: LST are defined as lesions greater than 10 mm in diameter with low vertical axis that extend laterally along the colon wall. LST are distinct in granular (G-LST), flat (F-type), and mixed type (GNG). Endoscopic mucosal resection (EMR) is an alternative to surgery for removing LST; this study assessed the clinical outcome of EMR. Material and methods: Between February 2003 and November 2008, 103 LST (37 G, 56 NG, 10 G-NG) were diagnosed in 90 patients (48 women and 42 men, age range: 44-80 yr, median age: 62 yr). Lesions were located 57 in right colon, 16 transverse colon, 30 left colon (diameter 10 mm-65 mm; median size: 37.5 mm). All lesions underwent chromoscopy using indigo carmine stain before EMR during colonoscopy. After EMR patients were followed up at 3, 6, 9, 12 months and then after 1 and 3 years (follow-up range: 3-65 months, median value: 34 months). 92 LST underwent EMR, 60 with piecemeal resection (range 27 -65 mm) and 32 en bloc (21-24 mm). Results: 11 LST were referred for surgical treatment (9 no lifting-sign, 1 involved the ileal ostium, 1 fibrosis related to partial resection in other institute). Histological findings of this series were 4 adenocarcinomas, 5 HGD and 2 LGD.
Histopathological evaluation of endoscopic retrieved tissue showed: 77 (83%) LGD, 13 (14%) HGD, 2 (2%) adenocarcinoma pTis. One LST of the caecum had presented wall burn syndrome treated with medical therapy. Five cases had delayed bleeding (three after 24 hour and two after 7 and 9 days), while 2 procedural bleeding occurred in the right colon, all treated with endoscopical haemostasis. In the piece-meal group, recurrent/residual adenomatous disease was diagnosed in 16 cases (13 after 3 months, 7 after 6 months, 5 after 9 months, 3 after 12 months), treated by further biopsy resections and APC; no recurrence in en-bloc group. Conclusions: EMR is a safe and effective treatment for LST, providing a high cure rate (recurrence rate 17%) and low risk of complications, with no difference between right (6%) and left colon (12%). # D. Colorectal diseases 2. Pre-cancerous lesions
P.58 MTHFR C677T AND A1298C POLYMORPHISMS AND SPORADIC COLORECTAL CARCINOMA RISK IN A COHORT OF ITALIAN PATIENTS G. Actis, P. Pazienza, A. Parziale, M. Cicilano, G. Tappero, E. Tarabra, S. Chiaramello, M. Ayoubi, L. Framarin, A. Biava, E. Borghesio, P. De Paolis, A. Comandone, F. Castellino, F. Rosina ∗ Presidio Sanitario Gradenigo, Torino Background and aim: Colorectal cancer (CRC) is a major health problem. Colonoscopic CRC screening is cumbersome and expensive. Identification of genetic risk of CRC may help to select the subjects who could benefit from colonoscopy. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism reduce the catalytic activity of MTHFR protein, which affects methionine synthesis and DNA methylation, possibly affecting the carcinogenetic pathway. The aim of this study was to determine whether MTHFR C677T and A1298C polymorphisms represent a risk factor for CRC in a Northern Italy caucasian population. Material and methods: The study cohort consisted of 465 subjects who underwent colonoscopy at our Centre between may 2006 and January 2008 divided into two groups: non familiar CRC patients (168 patients, M/F 77/91, mean age 66±11 years) and healthy controls matched for age, gender, hypertension, smoking, and drinking habits (297 patients, M/F 129/168, mean age 63±10 years). DNA was extracted from peripheral blood, MTHFR exon 5 was amplified by using specific primers, and C677T and A1298C polymorphisms were analysed by High-resolution melting of PCR amplicons. Results: Data are in Hardy-Weinberg Equilibrium. No statistically significant differences were observed between the genotype distribution among CRC patients and controls (p > 0,05) and in the CRC group among right and left sided CRC (p > 0,05). Conclusions: No significant correlation was detected between MTHFR c.677 C/T polymorphism and the risk of colorectal neoplasm among North Italian Caucasian patients. # D. Colorectal diseases 2. Pre-cancerous lesions
P.59 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) FOR REFRACTORY RECTAL POLYPS: RESULTS AFTER ONE YEAR OF FOLLOW UP F. Azzolini ∗ , R. Sassatelli, L. Camellini, F. Decembrino, V. Iori, F. Biolchini, M. Cavina, G. Sereni, C. Tioli, G. Bedogni Endoscopia Digestiva Arcispedale S.Maria Nuova, Reggio Emilia Background and aim: Aim of this study was to evaluate the results of ESD in refractory adenomas after endoscopic follow up Material and methods: Eight patients (see Table 1) with large rectal
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
S97
Abstract P.59 – Table 1. History of patients before ESD Patient
Sex Age
Diameter of Morphology Time from first treatment Sessions the lesion (cm) to ESD (months) before ESD (No)*
Technique employed
Complete polypectomy
M.A. F 33 4.5 LST 22 3 (5) Piecemeal ERM + Cap + APC Yes B.S. F 34 6 LST 24 5(7) Piecemeal polypectomy + APC No P.G. M 69 6 LST 22 5 (7) Piecemeal ERM + Cap + APC Yes M.M.L. F 49 8 Nodal 2 3 (2) Piecemeal ERM No B.D. M 74 7.5 LST 128 7 (16) Piecemeal polypectomy + APC Yes B.M.O. M 56 4 LST 10 3 (5) Piecemeal polypectomy + APC No F.C. F 71 6 LST 15 3 (4) Piecemeal polypectomy + APC Yes C.S. F 85 14 LST 9 3(4) Piecemeal polypectomy + APC No *Number of polypectomy sessions before ESD. In brackets all endoscopic examinations during follow up, including polypectomy sessions.
Worst histology Severe dysplasia Moderate dysplasia Moderate dysplasia Severe dysplasia Moderate dysplasia Adenocarcinoma Severe dysplasia Low grade dysplasia
Abstract P.59 – Table 2. Lesions treated by one session of ESD and results Patient
Diameter Morphology (cm)
Pit “En bloc” Complete * pattern Resection Resection*
Histology
Free margins
M.A. B.S.
5 4
IIa IIa + IIc
IV III L
No No
Yes Yes
Moderate dysplasia Moderate dysplasia
Yes Yes
No No
P.G.
4
IIa
III L
No
Yes
Moderate dysplasia
Yes
No
4,5 3 2
Is IIa IIa
IV IV VI
Yes No No
Yes Yes No
Yes Yes No
4
Is
VI
Yes
Yes
Severe dysplasia Moderate dysplasia Adenocarcinoma with deep submucosal invasion Adenocarcinoma with submucosal invasion (1500 μm) Low grade dysplasia
Yes
M.M.L. B.D. B.M.O. F.C. C.S.
12
Is
IV
No
No
Complications
Deep Lateral
†
No
Fu Recurrence Fu 12 12
No No
12
No
Yes No No
None Perforation (severe diffuse subcutaneous emphysema) Perforation (mild localized subcutaneous emphysema) None None None
12 16
No No
†
†
Yes
None
12
No
None
§
§
No
§
*Resection of the dissected area were complete by snare; operation was performed; further treatment was not applied for relevant comorbidities (respiratory and hearth disfunction).
polyps (mean diameter 4,8 cm; range 2-12 cm), recurrent after endoscopic polypectomy (mean 4 sessions, range 2-12), or refractory to eradication after at least two attempts with standard techniques were approached by ESD. Mean time from first treatment and ESD session was 29 months (range 2-128 months). In all patients first standard treatment was applied (endoscopic mucosal resection), with or without further treatment of margins by argon plasma coagulation. In all patients a recurrence was diagnosed and ESD was performed. The ESD procedure was carried out using a single channel upper gastrointestinal endoscope with a water-jet system (Fujinon EG-450 CT 5 and Olympus GIF 1T-160). A transparent cap (ST-HOOD, DH-16CR, Fujinon) was attached to the tip of the endoscope. A standard needle knife was used for incision and dissection. Results: The average time required for ESD was 144 minutes (range 15-190 minutes). Complete resection was possible in 7/8 cases. Resection with ESD was not complete in a 12 cm laterally spreading tumor. In this case further treatment was not applied because the patient, a 85 year woman, with a low-grade dysplasia lesion, was affected by relevant comorbidities (respiratory and hearth disfunction). One patient with invasive adenocarcinoma with deep submucosal invasion was operated. All the other six patient were eradicated after a mean time of follow up of 12,8 month (range 12-16). The postoperative course was uneventful for 5 patients. Two patients presented subcutaneous emphysema. All complications were treated conservatively. Conclusions: ESD technique allows the resection of polyps unresectable after common endoscopic treatments. Thanks to ESD, in 6/7 patients major surgery was avoided. After a reasonable follow up (median 12,8 months) we could consider as healed all the 6 patients in which ESD was possible. ESD represents an interesting endoscopic “rescue therapy” for residual-recurrent rectal polyps scar-embedded and no recurrence was observed after the first year of follow up. # D. Colorectal diseases 2. Pre-cancerous lesions
P.60 RELATIONSHIP BETWEEN C/T_13910 POLYMORPHISM INVOLVED IN THE ADULT LACTASE PERSISTENCE AND RISK OF COLORECTAL CANCER IN THE ITALIAN POPULATION E. Tarabra, P. Pazienza, E. Borghesio, A. Biava, G. Tappero, L. Framarin, G. Actis, F. Castellino, N. Leone, P. De Paolis, A. Comandone, F. Rosina ∗ , M. Ayoubi Presidio Sanitario Gradenigo, Torino Background and aim: Colorectal cancer (CRC) is the most common cause of death in Europe. Absorption of lactose, the main sugar of milk, is regulated by the activity of the lactase enzyme (LCT) in the intestinal wall. The activity of LCT is genetically regulated and associated with a C/T single polymorphism located on 13910 bp upstream from the LCT-encoding gene. The three genotypes are perfectly related with the level of LCT activity: the CC genotype defines lactose malabsorbers, the CT and TT genotypes define lactose absorbers. A recent study showed a significative association with the CC genotype and an elevated risk of CRC in Finnish population but there was no evidence in the Italian subjects. In this study we have evaluated if CC genotype could be a risk factor of CRC or polyps in the Italian population. Material and methods: We enrolled a total of 762 subjects (252 with CRC, 178 with polyps and 332 control subjects). The C/T_13910 variant was genotyped by TaqMan real time PCR on PBMC from blood. Results: No statistically significant variation in genotype distribution of C/T_13910 variant was observed between control subjects and CRC (CC vs CT+TT genotype: OR: 1.201: Cl 95%: 0.858-1.682; p=0.285) or polyps (CC vs CT+TT genotype: OR:0.992; Cl 95%: 0.679-1.449; p=0.966) in the Italian population. Conclusions: In conclusion, genetic polymorphism involved in adulttype hypolactasia, do not play a significative role in modulating the CRC development in the Italian population. # D. Colorectal diseases 2. Pre-cancerous lesions