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OC1.07.5 SEDATION FOR EUS: A RANDOMISED PROSPECTIVE TRIAL COMPARING LOW-DOSE PROPOFOL+ REMIFENTANIL, MIDAZOLAM+MEPERIDINE AND STANDARD-DOSE OF PROPOFOL
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Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
expression in distal colon cultures. Our preliminary data suggest a potential pro-apoptotic effect for commensal and probiotic bacteria in the colon mucosa. Further studies are needed to test the possible role for the flora manipulation in colon cancer prevention. # J. GI Oncology 1. Basic science
OC1.07.5 SEDATION FOR EUS: A RANDOMISED PROSPECTIVE TRIAL COMPARING LOW-DOSE PROPOFOL+ REMIFENTANIL, MIDAZOLAM+MEPERIDINE AND STANDARD-DOSE OF PROPOFOL F. Di Matteo 1 , R. Rea 1 , M. Pandolfi 1 , M. Martino 1 , M. Carassiti 2 , F. Agrò 2 , G. Costamagna 3 , A. Gabbrielli 1 Endoscopy Unit, Campus “Bio-Medico”, Roma; 2 Anesthesiology Unit, Campus “Bio-Medico”, Roma; 3 Surgical Endoscopy Unit, “A.Gemelli”, Roma
1 GI
Background and aim: Recently iv Propofol (P) (Diprivan, AstraZeneca, Sweden), a short acting hypnotic agent, has gained popularity in order to achieve deep sedation during endoscopy. The Remifantanil (R) (Ultiva, GlaxoSmithKline, UK) is a newer, ultra-short acting µopioid iv drug used to achieve analgesia and sedation. Iv R+P has been shown to produce a potent synergistic action in blunting response to noxious stimuli. This prospective randomised study was in order to determine whether the use of the combination of low-dose propofol+remifentanil (group RP,37 pts) provides any advantage over deep sedation obtained with propofol (group P,37 pts) or standard midazolam+meperedine (group MP, 37 pts) sedation, in terms of safety, efficacy (patient/endoscopist satisfaction) and recovery time. Material and methods: 111 consecutive patients, 59 male, 52 female, mean age 56.7 (18-87 y), ASAI-II referred to a tertiary center for EUS from Jan.06 to Apr.06 were included. Sedation in the group RP was achieved by infusion of R with a syringe pump (Terufusion TE312, Terumo, Japan) at a starting dose of 0.2 µg/kg/min, plus P at a starting dose of 0.5 mg/kg, followed by boluses of 10 mg, to maintain conscious sedation (Ramsay score III). The dose of R was adjusted by changing the rate of infusion or adding a single boluses of the drug (20-30 µg). Anesthesia was achieved in the group P by iv administration of a single dose of P at a starting dose of 0.5 mg/kg, followed by boluses of 10 mg. The dose of M and P were 0.05 mg/kg+0.5–1mg/kg in the group MP. All EUS were performed by the same experienced endoscopist with an echoendoscopes (EG3830UT, PentaxCorp, Japan). Results: On the monovariate analysis the three groups were omogeneous about gender, age and patient’s experience of previous endoscopy or sedation, duration of the examination and operative or diagnostic EUS. Patients satisfaction wasn’t statistically different. The recovery time was: groupP 23.6±7.8, group RP 12.6±11.1 (95% CI -17.1, -6.9) and group MP 26.7 ±12.9 (p-value<0.01). The amnesia was: group P 99%, group RP 63.9%, group MP 56.7% (p-value<0.0001). Conclusions: This study shows that RP during EUS is a good alternative to the conventional sedation in terms of safety and efficacy, with an advantage on recovery time. This could suggest a quicker discharge of the patient with a chance of increasing number of procedures. # Q. Diagnostic endoscopy 4. Endoscopic US
OC1.07.6 PSYCHOLOGICAL SCREENING IN GASTROENTEROLOGY AMBULATORY PATIENTS G. Nicolini ∗ , F. Vaienti, B. Gorini, M. Rossi, R. Bocchini, R. Scagliarini, P. Pazzi Ospedale “M. Bufalini”, Cesena Background and aim: Gastrointestinal disorders (GID) have a significant impact on patient quality of life (QOL),on disease management,as well as on patient adherence to medical treatment.Psychological factors are reported to be of importance in a number of GID,but the perception of psychological problems (PP) by doctor and patient is substantially different,and they are difficult to objectify. Aims of the study were: – quantify distress and QOL with standardized psychological tests; – compare PP perception by patient and doctor; – identify an accurate and easy PP screening tool in patients attending a first level GI-ambulatory. Material and methods: We submitted 257 consecutive ambulatory patients (106 men,151 women,mean age 52.1) to different questionnaires: GHQ (General Health Quest), HADS (Hospital Anxiety and Depression Scale), PSQ (Perceived Stress Quest).They were self administrated before medical examination,with the help of a psychologist.Doctor and patient independently indicated the presence of PP through an ad hoc questionnaire.Agreement between questionnaires was evaluated by chi-square test. Psychological interview was indicated in presence of PP in at least 2 of the 3 evaluations (by doctor, patient or standardized questionnaires). Results: PP were detected in 39.8% of patients by questionnaires GHQ and HADS (33.5% and 46.1%, respectively). No significant correlation between different GID and PP prevalence was found. PP were found in 67.3% of cases by patients (at least 1 among anxiety, depression or high stress) and in 58.2% by doctor (at least 1 among anxiety, depression, difficulties of disease acceptance or no compliance).The patient felt psychological support necessary in 42.5% of cases, the doctor in 23.9%, and the psychologist in 58.6%.The agreement between HADS and GHQ was 70.9%, between HADS and PSQ 68.1%, and 61.8% between GHQ and PSQ (p <0.05).Concordance between doctor and questionnaires to identify any PP was 41.1% (doctor-GHQ), and 56.9% (doctor-HADS). Doctor accuracy in PP detection was 56.2% (doctor-GHQ), 62.1% (doctor-HADS), and 59.1% (doctor- GHQ + HADS). Conclusions: PP prevalence is high in patients attending a first level GI-ambulatory. Doctors tend to overestimate PP presence and believe indicated psychological evaluation in about 1/4 of patients. Accuracy of gastroenterologist evaluation versus questionnaires in PP detection is low, therefore gastroenterology evaluation does not seem an adequate psychological screening tool. # Z. Health policy, quality assurance and ethics
OC1.08.1 THE ATYPICAL CHEMOKINE RECEPTOR D6 CONTROLS INTESTINAL INFLAMMATION AND INFLAMMATION-ASSOCIATED COLON CANCER S. Vetrano 1 , C. Correale 1 , E. Borroni 1 , R. Bonecchi 1 , V. Arena 2 , M. Fantini 3 , A. Malesci 1 , A. Vecchi 1 , A. Mantovani 1 , M. Locati 1 , S. Danese ∗ ,1 1 Istituto
Clinico Humanitas, IRCCS in Gastroenterologia, Rozzano, Milano; 2 Dipartimento di Patologia Generale, Policlinico Gemelli, Roma; 3 Dipartimento di Gastroenterologia, Università Tor Vergata, Roma Background and aim: D6 is a chemokine receptor that plays an important role in the control of inflammation by acting as a decoy and scavenger receptor for inflammatory chemokines. The chronic mucosal inflammation that occurs in inflammatory bowel disease (IBD) which is
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
expression in distal colon cultures. Our preliminary data suggest a potential pro-apoptotic effect for commensal and probiotic bacteria in the colon mucosa. Further studies are needed to test the possible role for the flora manipulation in colon cancer prevention. # J. GI Oncology 1. Basic science
OC1.07.5 SEDATION FOR EUS: A RANDOMISED PROSPECTIVE TRIAL COMPARING LOW-DOSE PROPOFOL+ REMIFENTANIL, MIDAZOLAM+MEPERIDINE AND STANDARD-DOSE OF PROPOFOL F. Di Matteo 1 , R. Rea 1 , M. Pandolfi 1 , M. Martino 1 , M. Carassiti 2 , F. Agrò 2 , G. Costamagna 3 , A. Gabbrielli 1 Endoscopy Unit, Campus “Bio-Medico”, Roma; 2 Anesthesiology Unit, Campus “Bio-Medico”, Roma; 3 Surgical Endoscopy Unit, “A.Gemelli”, Roma
1 GI
Background and aim: Recently iv Propofol (P) (Diprivan, AstraZeneca, Sweden), a short acting hypnotic agent, has gained popularity in order to achieve deep sedation during endoscopy. The Remifantanil (R) (Ultiva, GlaxoSmithKline, UK) is a newer, ultra-short acting µopioid iv drug used to achieve analgesia and sedation. Iv R+P has been shown to produce a potent synergistic action in blunting response to noxious stimuli. This prospective randomised study was in order to determine whether the use of the combination of low-dose propofol+remifentanil (group RP,37 pts) provides any advantage over deep sedation obtained with propofol (group P,37 pts) or standard midazolam+meperedine (group MP, 37 pts) sedation, in terms of safety, efficacy (patient/endoscopist satisfaction) and recovery time. Material and methods: 111 consecutive patients, 59 male, 52 female, mean age 56.7 (18-87 y), ASAI-II referred to a tertiary center for EUS from Jan.06 to Apr.06 were included. Sedation in the group RP was achieved by infusion of R with a syringe pump (Terufusion TE312, Terumo, Japan) at a starting dose of 0.2 µg/kg/min, plus P at a starting dose of 0.5 mg/kg, followed by boluses of 10 mg, to maintain conscious sedation (Ramsay score III). The dose of R was adjusted by changing the rate of infusion or adding a single boluses of the drug (20-30 µg). Anesthesia was achieved in the group P by iv administration of a single dose of P at a starting dose of 0.5 mg/kg, followed by boluses of 10 mg. The dose of M and P were 0.05 mg/kg+0.5–1mg/kg in the group MP. All EUS were performed by the same experienced endoscopist with an echoendoscopes (EG3830UT, PentaxCorp, Japan). Results: On the monovariate analysis the three groups were omogeneous about gender, age and patient’s experience of previous endoscopy or sedation, duration of the examination and operative or diagnostic EUS. Patients satisfaction wasn’t statistically different. The recovery time was: groupP 23.6±7.8, group RP 12.6±11.1 (95% CI -17.1, -6.9) and group MP 26.7 ±12.9 (p-value<0.01). The amnesia was: group P 99%, group RP 63.9%, group MP 56.7% (p-value<0.0001). Conclusions: This study shows that RP during EUS is a good alternative to the conventional sedation in terms of safety and efficacy, with an advantage on recovery time. This could suggest a quicker discharge of the patient with a chance of increasing number of procedures. # Q. Diagnostic endoscopy 4. Endoscopic US
OC1.07.6 PSYCHOLOGICAL SCREENING IN GASTROENTEROLOGY AMBULATORY PATIENTS G. Nicolini ∗ , F. Vaienti, B. Gorini, M. Rossi, R. Bocchini, R. Scagliarini, P. Pazzi Ospedale “M. Bufalini”, Cesena Background and aim: Gastrointestinal disorders (GID) have a significant impact on patient quality of life (QOL),on disease management,as well as on patient adherence to medical treatment.Psychological factors are reported to be of importance in a number of GID,but the perception of psychological problems (PP) by doctor and patient is substantially different,and they are difficult to objectify. Aims of the study were: – quantify distress and QOL with standardized psychological tests; – compare PP perception by patient and doctor; – identify an accurate and easy PP screening tool in patients attending a first level GI-ambulatory. Material and methods: We submitted 257 consecutive ambulatory patients (106 men,151 women,mean age 52.1) to different questionnaires: GHQ (General Health Quest), HADS (Hospital Anxiety and Depression Scale), PSQ (Perceived Stress Quest).They were self administrated before medical examination,with the help of a psychologist.Doctor and patient independently indicated the presence of PP through an ad hoc questionnaire.Agreement between questionnaires was evaluated by chi-square test. Psychological interview was indicated in presence of PP in at least 2 of the 3 evaluations (by doctor, patient or standardized questionnaires). Results: PP were detected in 39.8% of patients by questionnaires GHQ and HADS (33.5% and 46.1%, respectively). No significant correlation between different GID and PP prevalence was found. PP were found in 67.3% of cases by patients (at least 1 among anxiety, depression or high stress) and in 58.2% by doctor (at least 1 among anxiety, depression, difficulties of disease acceptance or no compliance).The patient felt psychological support necessary in 42.5% of cases, the doctor in 23.9%, and the psychologist in 58.6%.The agreement between HADS and GHQ was 70.9%, between HADS and PSQ 68.1%, and 61.8% between GHQ and PSQ (p <0.05).Concordance between doctor and questionnaires to identify any PP was 41.1% (doctor-GHQ), and 56.9% (doctor-HADS). Doctor accuracy in PP detection was 56.2% (doctor-GHQ), 62.1% (doctor-HADS), and 59.1% (doctor- GHQ + HADS). Conclusions: PP prevalence is high in patients attending a first level GI-ambulatory. Doctors tend to overestimate PP presence and believe indicated psychological evaluation in about 1/4 of patients. Accuracy of gastroenterologist evaluation versus questionnaires in PP detection is low, therefore gastroenterology evaluation does not seem an adequate psychological screening tool. # Z. Health policy, quality assurance and ethics
OC1.08.1 THE ATYPICAL CHEMOKINE RECEPTOR D6 CONTROLS INTESTINAL INFLAMMATION AND INFLAMMATION-ASSOCIATED COLON CANCER S. Vetrano 1 , C. Correale 1 , E. Borroni 1 , R. Bonecchi 1 , V. Arena 2 , M. Fantini 3 , A. Malesci 1 , A. Vecchi 1 , A. Mantovani 1 , M. Locati 1 , S. Danese ∗ ,1 1 Istituto
Clinico Humanitas, IRCCS in Gastroenterologia, Rozzano, Milano; 2 Dipartimento di Patologia Generale, Policlinico Gemelli, Roma; 3 Dipartimento di Gastroenterologia, Università Tor Vergata, Roma Background and aim: D6 is a chemokine receptor that plays an important role in the control of inflammation by acting as a decoy and scavenger receptor for inflammatory chemokines. The chronic mucosal inflammation that occurs in inflammatory bowel disease (IBD) which is