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OC.10.7: SPLEEN STIFFNESS MEASUREMENT: A NEW NON INVASIVE PREDICTOR OF PORTAL HYPERTENSION AND ESOPHAGEAL VARICES IN VIRAL CHRONIC LIVER DISEASE
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Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
to international guidelines. Moreover the effectiveness of AASLD guidelines application has never been prospectively addressed. This is a prospective survey on a large cohort of newly diagnosed HCC observed in the last 2 years. Material and methods: From September 2008 to September 2010, 710 consecutive patients with HCC referring to 30 non-tertiary referral Hospitals were included. Inclusion criteria were newly detected HCC and cirrhosis. Patients were classified according to Child-Pugh and Meld score and BCLC stage. No prefixed protocols on diagnosis and treatment of HCC were operative. Statistical analysis is based on the first 536 cases. Results: Mean age was 70±4.7 yrs (71% M). Comorbidities were present in 322 patients (76%). Prevalent etiology was HCV (56%). Cirrhosis was Child A in 266 (63%), B in 125 (29%) and mean MELD score was 9.5±5.3. The mean size of nodules was 3.8±2.3 cm, monofocal in 57% and paucifocal in 23% cases. Age > 70 yrs and moderate/severe comorbidities were equally distributed among different BCLC stages. Regular follow-up was recorded in 289 cases (54%). Early HCC was more frequently observed in patients on regular follow-up (71% vs 39%). The most frequently employed imaging technique for diagnosis of HCC was TC (93%) followed by CEUS (62%); MRI was utilized in 17% of cases. Adherence to the non-invasive diagnostic criteria was 59% in nodules = 2 cm and 97% in larger nodules. The overall adherence to BCLC treatment algorithm was 52%. Ratio between ideal and real treatment offered was: OLT 42/9, resection 78/36, ablation 160/152, TACE 129/159, Sorafenib 67/21, palliative 60/134. In 25 cases combination therapy was performed. In particular 119 (40%) patients in BCLC stage A did not receive curative therapies. Conclusions: This translational study showed that adherence to either diagnostic and therapeutic AASLD 2005 algorithms was low particularly in early HCC stages. These discrepancies are mainly due to: 1) the difficulty in applying the algorithms in routine clinical practice and 2) the high prevalence of patients > 70 yrs with relevant comorbidities. The effectiveness of AASLD guidelines application remains to be verified.
OC.10.7 SPLEEN STIFFNESS MEASUREMENT: A NEW NON INVASIVE PREDICTOR OF PORTAL HYPERTENSION AND ESOPHAGEAL VARICES IN VIRAL CHRONIC LIVER DISEASE A. Colecchia ∗ ,1 , L. Montrone 1 , E. Scaioli 1 , M.L. Bacchi-Reggiani 1 , R. Schiumerini 1 , L. Turco 1 , A.R. Di Biase 2 , G. Mazzella 1 , D. Festi 1 1 S. Orsola Hospital, Bologna, Italy; 2 Department of Pediatrics, University of Modena, Modena, Italy
Background and aim: The spleen plays an important role in the portal hypertension (PH) pathophysiology; furthermore it shows fibrotic change during PH worsening as does the liver. Since there are no available data regarding the spleen stiffness measurement (SSM) by Fibroscan and its meaning in PH, the aim of the present study was to verify whether SSM represents a non-invasive parameter of PH and esophageal variceal (EV) presence; its contribution to the overall non invasive PH diagnostic work-up was also evaluated. Material and methods: In 87 patients with viral chronic liver disease, liver stiffness measurement (LSM) and SSM by Fibroscan, hepatic vein pressure gradient (HVPG), upper endoscopy and non invasive scores (LSPS: LSMspleen diameter to platelet ratio score; PLT/Spleen: platelet count to spleen diameter ratio) for PH and EV were assessed. Results: The cut-off values to predict EV of LSM, SSM, LSPS and plt/spleen were 20 Kpa, 38 Kpa, 1.81 and 979 respectively; their AUROC curves were 0.86 for LSM, 0.95 for SSM, 0.88 for LSPS, 0.84 for plt/spleen. The cut-off values to predict HVPG >10 mmHg of LSM, SSM, LSPS and plt/spleen were 14.4 Kpa, 36.8 Kpa, 1.81 and 979 respectively. AUROC curves for clinically significant portal hypertension (CSPH) were 0.93 for LSM; 0.96 for SSM; 0.87 for LSPS; 0.78 for plt/spleen respectively. The SSM was significantly correlated with both the LSM (p=0.0001) and the spleen diameter (p=0.0001). The area under ROC curve of the SSM was significantly higher than LSM (p=0.04) to predict EV, while it was higher but significantly to predict CSPH. The sequential use of the LSM plus the SSM was more accurate than each single method in identifying pre-clinical PH and CSPH. At multivariate analysis SSM resulted the only associated factor to both EV (OR=88.24; p=0.002) and CSPH (OR=20.5; p=0.01).
Conclusions: The SSM, among the evaluated non invasive methods, gives the best results in predicting esophageal varices; the SSM plus the LSM together in a sequential algorithm are highly accurate in identifying portal hypertension classes. SSM could thus be proposed as a new non invasive tool useful in optimizing the diagnostic work-up in patients with liver cirrhosis.
OC.11.1 EUS-GUIDED TRANSMURAL DRAINAGE OF SYMPTOMATIC PANCREATIC FLUID COLLECTIONS WITH PLACEMENT OF COVERED SELF-EXPANDABLE METAL STENTS: A PROSPECTIVE STUDY AT TWO ITALIAN CENTERS C. Fabbri ∗ ,1 , I. Tarantino 2 , C. Luigiano 1 , A.M. Polifemo 1 , V. Cennamo 3 , L. Barresi 2 , M. Traina 2 , N. D’Imperio 1 1 Gastroenterologia
Ed Endoscopia Digestiva Ospedale Bellaria-Maggiore, Bologna, Italy; 2 Unità di Endoscopia Ismett/upmc, Palermo, Italy; 3 Dipartimento di Medicina Interna e Gastroenterologia Università di Bologna, Bologna, Italy Background and aim: Endoscopic ultrasonography-guided transmural drainage (EUS-GTD) has become the standard procedure for treating symptomatic pancreatic fluid collections (PFCs). Previous reports have shown that when plastic stents are used, especially in the case of debris or pus inside the collection, multiple stents, naso-cystic catheter placement and/or multiple sessions are required. The aim of this study was to evaluate the efficacy and safety of covered (C) self-expandable metal stent (SEMS) placement, instead of multiple plastic stents, for the treatment of symptomatic PFCs. Material and methods: From January 2007 to December 2009, all patients presenting with symptomatic PFCs, at two Italian centers (Bellaria-Maggiore Hospital, Bologna and ISMETT/UPMC, Palermo) were enrolled in the study. All patients underwent EUS examination and EUS-GTD with placement of a CSEMS in the same session. Results: Twenty-two patients (18M and 4F; mean age 56.9) were enrolled. All PFCs were confirmed at radiologic examination (MRI/CT). The mean size of the PFCs was 13.2 cm. The procedure was technically feasible in 20 patients (91%). One patient developed a fever which was resolved with antibiotics. One patient experienced stent migration and fever, and was managed surgically. Clinical success was achieved without additional intervention in the remaining 19 patients after a mean of 25.7±3.1 days. The SEMSs were removed without difficulty in 18 cases. In one patient stent removal failed due to inflammatory tissue ingrowth and it was removed during surgery performed for renal cancer. Only one symptomatic recurrence was observed during a mean follow-up of 212 days. Conclusions: EUS-GTD with CSEMS appears easy, fast, and safe for treatment of PFCs.
OC.11.2 RISK FACTORS FOR INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN) OF THE PANCREAS: PRELIMINARY RESULTS OF A PROSPECTIVE ITALIAN MULTICENTRE CASE-CONTROL STUDY G. Capurso ∗ ,1 , A. Larghi 2 , S. Boccia 3 , R. Salvia 4 , M. Del Chiaro 5 , M. Piciucchi 1 , A. Carnuccio 2 , S. Carrara 6 , R. Manta 7 , C. Fabbri 8 , E. De Feo 3 , G. Leonardi 9 , P.G. Arcidiacono 6 , U. Boggi 5 , G. Costamagna 2 , G. Delle Fave 1 , C. Bassi 4 1 Gastroenterology, II Medical School of Sapienza University of Rome, Rome, Italy; 2 Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; 3 Epidemiology, Catholic University of Rome, Rome, Italy; 4 Surgery, University of Verona, Verona, Italy; 5 Surgery, University of Pisa, Pisa, Italy; 6 Gastroenterology & Gastrointestinal Endoscopy, San Raffaele Hospital, Milano, Italy; 7 Gastroenterology, S. Agostino Hospital of Modenma, Modena, Italy; 8 Gastroenetrology, Bellaria Maggiore Hospital, Bellaria, Italy; 9 Gastroenterology Unit, University of Pisa, Pisa, Italy
Background and aim: IPMN are increasingly diagnosed. They are frequent findings during screening of kindreds with “familiar pancreatic cancer”, and
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
to international guidelines. Moreover the effectiveness of AASLD guidelines application has never been prospectively addressed. This is a prospective survey on a large cohort of newly diagnosed HCC observed in the last 2 years. Material and methods: From September 2008 to September 2010, 710 consecutive patients with HCC referring to 30 non-tertiary referral Hospitals were included. Inclusion criteria were newly detected HCC and cirrhosis. Patients were classified according to Child-Pugh and Meld score and BCLC stage. No prefixed protocols on diagnosis and treatment of HCC were operative. Statistical analysis is based on the first 536 cases. Results: Mean age was 70±4.7 yrs (71% M). Comorbidities were present in 322 patients (76%). Prevalent etiology was HCV (56%). Cirrhosis was Child A in 266 (63%), B in 125 (29%) and mean MELD score was 9.5±5.3. The mean size of nodules was 3.8±2.3 cm, monofocal in 57% and paucifocal in 23% cases. Age > 70 yrs and moderate/severe comorbidities were equally distributed among different BCLC stages. Regular follow-up was recorded in 289 cases (54%). Early HCC was more frequently observed in patients on regular follow-up (71% vs 39%). The most frequently employed imaging technique for diagnosis of HCC was TC (93%) followed by CEUS (62%); MRI was utilized in 17% of cases. Adherence to the non-invasive diagnostic criteria was 59% in nodules = 2 cm and 97% in larger nodules. The overall adherence to BCLC treatment algorithm was 52%. Ratio between ideal and real treatment offered was: OLT 42/9, resection 78/36, ablation 160/152, TACE 129/159, Sorafenib 67/21, palliative 60/134. In 25 cases combination therapy was performed. In particular 119 (40%) patients in BCLC stage A did not receive curative therapies. Conclusions: This translational study showed that adherence to either diagnostic and therapeutic AASLD 2005 algorithms was low particularly in early HCC stages. These discrepancies are mainly due to: 1) the difficulty in applying the algorithms in routine clinical practice and 2) the high prevalence of patients > 70 yrs with relevant comorbidities. The effectiveness of AASLD guidelines application remains to be verified.
OC.10.7 SPLEEN STIFFNESS MEASUREMENT: A NEW NON INVASIVE PREDICTOR OF PORTAL HYPERTENSION AND ESOPHAGEAL VARICES IN VIRAL CHRONIC LIVER DISEASE A. Colecchia ∗ ,1 , L. Montrone 1 , E. Scaioli 1 , M.L. Bacchi-Reggiani 1 , R. Schiumerini 1 , L. Turco 1 , A.R. Di Biase 2 , G. Mazzella 1 , D. Festi 1 1 S. Orsola Hospital, Bologna, Italy; 2 Department of Pediatrics, University of Modena, Modena, Italy
Background and aim: The spleen plays an important role in the portal hypertension (PH) pathophysiology; furthermore it shows fibrotic change during PH worsening as does the liver. Since there are no available data regarding the spleen stiffness measurement (SSM) by Fibroscan and its meaning in PH, the aim of the present study was to verify whether SSM represents a non-invasive parameter of PH and esophageal variceal (EV) presence; its contribution to the overall non invasive PH diagnostic work-up was also evaluated. Material and methods: In 87 patients with viral chronic liver disease, liver stiffness measurement (LSM) and SSM by Fibroscan, hepatic vein pressure gradient (HVPG), upper endoscopy and non invasive scores (LSPS: LSMspleen diameter to platelet ratio score; PLT/Spleen: platelet count to spleen diameter ratio) for PH and EV were assessed. Results: The cut-off values to predict EV of LSM, SSM, LSPS and plt/spleen were 20 Kpa, 38 Kpa, 1.81 and 979 respectively; their AUROC curves were 0.86 for LSM, 0.95 for SSM, 0.88 for LSPS, 0.84 for plt/spleen. The cut-off values to predict HVPG >10 mmHg of LSM, SSM, LSPS and plt/spleen were 14.4 Kpa, 36.8 Kpa, 1.81 and 979 respectively. AUROC curves for clinically significant portal hypertension (CSPH) were 0.93 for LSM; 0.96 for SSM; 0.87 for LSPS; 0.78 for plt/spleen respectively. The SSM was significantly correlated with both the LSM (p=0.0001) and the spleen diameter (p=0.0001). The area under ROC curve of the SSM was significantly higher than LSM (p=0.04) to predict EV, while it was higher but significantly to predict CSPH. The sequential use of the LSM plus the SSM was more accurate than each single method in identifying pre-clinical PH and CSPH. At multivariate analysis SSM resulted the only associated factor to both EV (OR=88.24; p=0.002) and CSPH (OR=20.5; p=0.01).
Conclusions: The SSM, among the evaluated non invasive methods, gives the best results in predicting esophageal varices; the SSM plus the LSM together in a sequential algorithm are highly accurate in identifying portal hypertension classes. SSM could thus be proposed as a new non invasive tool useful in optimizing the diagnostic work-up in patients with liver cirrhosis.
OC.11.1 EUS-GUIDED TRANSMURAL DRAINAGE OF SYMPTOMATIC PANCREATIC FLUID COLLECTIONS WITH PLACEMENT OF COVERED SELF-EXPANDABLE METAL STENTS: A PROSPECTIVE STUDY AT TWO ITALIAN CENTERS C. Fabbri ∗ ,1 , I. Tarantino 2 , C. Luigiano 1 , A.M. Polifemo 1 , V. Cennamo 3 , L. Barresi 2 , M. Traina 2 , N. D’Imperio 1 1 Gastroenterologia
Ed Endoscopia Digestiva Ospedale Bellaria-Maggiore, Bologna, Italy; 2 Unità di Endoscopia Ismett/upmc, Palermo, Italy; 3 Dipartimento di Medicina Interna e Gastroenterologia Università di Bologna, Bologna, Italy Background and aim: Endoscopic ultrasonography-guided transmural drainage (EUS-GTD) has become the standard procedure for treating symptomatic pancreatic fluid collections (PFCs). Previous reports have shown that when plastic stents are used, especially in the case of debris or pus inside the collection, multiple stents, naso-cystic catheter placement and/or multiple sessions are required. The aim of this study was to evaluate the efficacy and safety of covered (C) self-expandable metal stent (SEMS) placement, instead of multiple plastic stents, for the treatment of symptomatic PFCs. Material and methods: From January 2007 to December 2009, all patients presenting with symptomatic PFCs, at two Italian centers (Bellaria-Maggiore Hospital, Bologna and ISMETT/UPMC, Palermo) were enrolled in the study. All patients underwent EUS examination and EUS-GTD with placement of a CSEMS in the same session. Results: Twenty-two patients (18M and 4F; mean age 56.9) were enrolled. All PFCs were confirmed at radiologic examination (MRI/CT). The mean size of the PFCs was 13.2 cm. The procedure was technically feasible in 20 patients (91%). One patient developed a fever which was resolved with antibiotics. One patient experienced stent migration and fever, and was managed surgically. Clinical success was achieved without additional intervention in the remaining 19 patients after a mean of 25.7±3.1 days. The SEMSs were removed without difficulty in 18 cases. In one patient stent removal failed due to inflammatory tissue ingrowth and it was removed during surgery performed for renal cancer. Only one symptomatic recurrence was observed during a mean follow-up of 212 days. Conclusions: EUS-GTD with CSEMS appears easy, fast, and safe for treatment of PFCs.
OC.11.2 RISK FACTORS FOR INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN) OF THE PANCREAS: PRELIMINARY RESULTS OF A PROSPECTIVE ITALIAN MULTICENTRE CASE-CONTROL STUDY G. Capurso ∗ ,1 , A. Larghi 2 , S. Boccia 3 , R. Salvia 4 , M. Del Chiaro 5 , M. Piciucchi 1 , A. Carnuccio 2 , S. Carrara 6 , R. Manta 7 , C. Fabbri 8 , E. De Feo 3 , G. Leonardi 9 , P.G. Arcidiacono 6 , U. Boggi 5 , G. Costamagna 2 , G. Delle Fave 1 , C. Bassi 4 1 Gastroenterology, II Medical School of Sapienza University of Rome, Rome, Italy; 2 Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; 3 Epidemiology, Catholic University of Rome, Rome, Italy; 4 Surgery, University of Verona, Verona, Italy; 5 Surgery, University of Pisa, Pisa, Italy; 6 Gastroenterology & Gastrointestinal Endoscopy, San Raffaele Hospital, Milano, Italy; 7 Gastroenterology, S. Agostino Hospital of Modenma, Modena, Italy; 8 Gastroenetrology, Bellaria Maggiore Hospital, Bellaria, Italy; 9 Gastroenterology Unit, University of Pisa, Pisa, Italy
Background and aim: IPMN are increasingly diagnosed. They are frequent findings during screening of kindreds with “familiar pancreatic cancer”, and