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OC.20.2 IMPACT OF OPTICAL BIOPSY ON MANAGEMENT OF PATIENTS WITH BILIARY STRICTURES: INTERIM RESULTS OF A MULTICENTER STUDY
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 OC.20.2 IMPACT OF OPTICAL BIOPSY ON MANAGEMENT OF PATIENTS WITH BILIARY STRICTURES: INTERIM RESULTS OF A MULTICENTER STUDY P. Cesaro ∗,1 , A. Slivka 2 , S. Gan 3 , M. Giovannini 4 , F. Caillol 4 , M. Kahaleh 5 , P. Jamidar 7 , G. Costamagna 6 1 Fondazione
Poliambulanza, Brescia, Italy; 2 University of Pittsburgh Physicians, Pittsburgh, United States; 3 Virginia Mason Medical Center, Seattle, United States; 4 Paoli-Calmettes Institute, Marsiglia, France; 5 Weill Cornell Medical College, New York, United States; 6 Università Cattolica del Sacro Cuore, Roma, Italy; 7 Yale-New Haven Hospital, New Haven, United States Background and aim: Accurate differential diagnosis of indeterminate biliary stricture presents a clinical problem owing to the low sensitivity of tissue sampling. Probe based confocal laser endomicroscopy (pCLE) has been shown to accurately differentiate benign from malignant strictures in real time during ongoing ERCP procedure, with a sensitivity of 98%. This study presents the interim analysis of an ongoing international multicentric trial (FOCUS, NCT01392274) aimed at evaluating the impact of pCLE on the management of patients with indeterminate biliary stricture. Initial performance and impact on the subsequent patient workup will be presented. Material and methods: Patients presenting with indeterminate biliary strictures are currently enrolled in 6 international centers (2 european, 4 US) and undergoing pCLE procedure during standard ERCP. For each patient, the following information is collected prospectively and evaluated in a sequential fashion: #1: clinical history + ERCP impression;#2: pCLE information, #3: histology/cytology results. At each stage the investigator is asked to provide a presumptive diagnosis as well as a patient management recommendation. Results: 36 cases with a final diagnosis have been accumulated at this time 34 malignant proven by surgery or positive tissue sampling; 2 benign proven by surgery) 32 patients (31 malignant, 1 benign) were accurately diagnosed based on the clinical information and ERCP impression, pCLE accurately diagnosed the same 32 patients, whereas tissue sampling (combination of brush cytology and biopsy) would have missed 5 malignant patients. In 100% of the cases where physicians felt confident to immediately proceed with patient management, patient management based on clinical history and ERCP impression (n=7) and pCLE impression (n=10) were identical to decision making once tissue sample returned. Conclusions: This is the first study evaluating the impact of pCLE on management of patients with biliary strictures. A high preponderance of cancer is expected in this interim analysis based on study design. Clinical impression and pCLE outperform tissue sampling and optical biopsy has the potential to improve clinical decision making for difficult cases by reducing the work-up algorithm.
OC.20.3 DIMINUTIVE COLORECTAL POLYPS: THE LEARNING CURVE OF YOUNG ENDOSCOPISTS FOR THE CHARACTERIZATION OF LESIONS WITH I-SCAN TECHNOLOGY A. Maimone ∗,1 , G. Bersani 2 , A. Guida 1 , C. Amella 2 , R. Arena 1 , A. Frascari 1 , G. Ricci 1 , A. Rossi 2 , V. Alvisi 1 1 Postgraduate
School of Gastroenterology, University of Ferrara, Ferrara, Italy; 2 Digestive Endoscopy Service, Malatesta Novello, Cesena, Italy Background and aim: Recently, Neumann et al.examine the learning curve of I-Scan technique for the prediction of hyperplastic and adenomatous colorectal lesion. However, there are limited data on interpretation of diminutive polyps (≤5 mm) by using i-Scan images. The diminutive polyps, as for as the majority of lesions detected during colonscopy, constitue the theme of the “predict, resect and discard” strategy. Given the size, they are the most difficult to interpret. The aim of this study was to evaluate the performance of young endoscopists for interpretation of hyperplastic and adenomatous diminutive colorectal polyps by using I-Scan images. Material and methods: Three young endoscopists with different practice experience and interpretation on i-scan images (0-1000 colonscopies performed)
S43
partecipated. At study entry, they underwent a teaching presentation of 25 pictures on pits and vascular patterns analysis of colorectal lesions visualized with i-scan technology. It followed a review of 90 images of diminutive polyps, divided into 2 sessions of 45 pictures each. All lesions were evaluated using iScan1 (SE5), iScan3 (SE4TEcCE2) and SE4TEp settings. At the end of the first module, the images were reviewed and histopathological diagnosis was known. The performance of young endoscopists was separately analyzed for each session and was calculated by using sensibility, specificity, LR+ and LR-. Results: Of the 90 lesions included, 47 polyps (52%) were <3 mm (median 3.6 mm, min/max 2/5 mm). The distribution for anatomic lesions was: rectum (n=25), left colon (n=24) and right colon (n=31). Forty-four polyps were hyperplastic and 46 adenomatous. After first session of 45 I-Scan images, the overall sensitivity, specificity, LR+ and LR- were 73%, 63%, 1.98 and 0.42, respectively. At the second module, the sensitivity, specificity, LR+ increases (80%, 73%, 2.96 respectively) and LR - decreases at 0.28. Conclusions: The young and less experienced endoscopists in I-Scan technologies can achieve an improvement for diminutive polyps characterization after reviewing cases previously analyzed. It is necessary to perform an adequate training period before reaching the results of skilled operators for the interpretation of polyps.
OC.20.4 CORRELATION BETWEEN CHRONIC STRESS AND UPPER GI PATHOLOGY G. Fiorini 1 , V. Castelli ∗,1 , I. Saracino 1 , C. Zaccaro 1 , C. Ricci 2 , D. Boschiero 3 , D. Vaira 1 1 Ospedale
S Orsola Malpighi, Bologna, Italy; 2 Università di Brescia, Brescia, Italy; 3 Biotekna, Marcon, Italy Background and aim: Stressful events are related to the onset or worsening of gastrointestinal symptoms. When stress duration goes beyond the adaptive responses of the individual it becomes “chronic stress” that can lead to changes in body composition and appearance of symptoms and gastrointestinal pathologies. Aim: To analyze the correlation between modificated body composition and presence of gastrointestinal and general symptoms (Medically unexplained Symptoms, MUS) and to evaluate correlations between total body potassium, extracellular potassium, extracellular water and skeletal muscle free fat mass. Material and methods: A total of 309 consecutive patients (median age 50 years, range 21–82) underwent endoscopy with biopsies for histological examination. Questionnaires were fulfilled according to dietary habits and symptoms. Analysis of differential body composition was assessed by BIAACC (BioTekna medical device) to scan through the spectrum analysis of bio impedance using molecular and functional quantitative and qualitative composition of the body: 1) Total Body Water, representing the electrolyte imbalance; 2) extracellular water, representing the inflammatory status; 3) TBK and ECK representing the systemic cellular excitability; 4) the skeletal muscle mass as an indicator of overall health and aging; 5) FFM, total fat mass. Results: Gastrointestinal symptoms were assessed in 8 out of 20 patients (45%) who declared two or less MUS, whereas symptoms as tiredness, anxiety and gastrointestinal disorders were present in 50 patients declaring more than 2 MUS, among 70 patients with ECK in range. In 239 patients with ECK out of range: 11 out of 29 patients (38%) who declared two or less MUS, manifested gastrointestinal symptoms. Whereas main symptoms as tiredness, anxiety, heartbeat alterations and gastrointestinal disorders were present in 210 patients declaring more than 2 MUS. Conclusions: We observed that ECK% increasing and TBK depletion correlates with worsening of inflammatory state and gastrointestinal and systemic stress-related symptoms. These observations can be explained with electrolytic alterations. Low skeletal muscle FFM correlated with TBK and ECK levels out of range: patients with a good muscle mass were able to maintain electrolytic balance and showed few symptoms and a low inflammatory state compared with patients with low muscular mass FFM.
Poliambulanza, Brescia, Italy; 2 University of Pittsburgh Physicians, Pittsburgh, United States; 3 Virginia Mason Medical Center, Seattle, United States; 4 Paoli-Calmettes Institute, Marsiglia, France; 5 Weill Cornell Medical College, New York, United States; 6 Università Cattolica del Sacro Cuore, Roma, Italy; 7 Yale-New Haven Hospital, New Haven, United States Background and aim: Accurate differential diagnosis of indeterminate biliary stricture presents a clinical problem owing to the low sensitivity of tissue sampling. Probe based confocal laser endomicroscopy (pCLE) has been shown to accurately differentiate benign from malignant strictures in real time during ongoing ERCP procedure, with a sensitivity of 98%. This study presents the interim analysis of an ongoing international multicentric trial (FOCUS, NCT01392274) aimed at evaluating the impact of pCLE on the management of patients with indeterminate biliary stricture. Initial performance and impact on the subsequent patient workup will be presented. Material and methods: Patients presenting with indeterminate biliary strictures are currently enrolled in 6 international centers (2 european, 4 US) and undergoing pCLE procedure during standard ERCP. For each patient, the following information is collected prospectively and evaluated in a sequential fashion: #1: clinical history + ERCP impression;#2: pCLE information, #3: histology/cytology results. At each stage the investigator is asked to provide a presumptive diagnosis as well as a patient management recommendation. Results: 36 cases with a final diagnosis have been accumulated at this time 34 malignant proven by surgery or positive tissue sampling; 2 benign proven by surgery) 32 patients (31 malignant, 1 benign) were accurately diagnosed based on the clinical information and ERCP impression, pCLE accurately diagnosed the same 32 patients, whereas tissue sampling (combination of brush cytology and biopsy) would have missed 5 malignant patients. In 100% of the cases where physicians felt confident to immediately proceed with patient management, patient management based on clinical history and ERCP impression (n=7) and pCLE impression (n=10) were identical to decision making once tissue sample returned. Conclusions: This is the first study evaluating the impact of pCLE on management of patients with biliary strictures. A high preponderance of cancer is expected in this interim analysis based on study design. Clinical impression and pCLE outperform tissue sampling and optical biopsy has the potential to improve clinical decision making for difficult cases by reducing the work-up algorithm.
OC.20.3 DIMINUTIVE COLORECTAL POLYPS: THE LEARNING CURVE OF YOUNG ENDOSCOPISTS FOR THE CHARACTERIZATION OF LESIONS WITH I-SCAN TECHNOLOGY A. Maimone ∗,1 , G. Bersani 2 , A. Guida 1 , C. Amella 2 , R. Arena 1 , A. Frascari 1 , G. Ricci 1 , A. Rossi 2 , V. Alvisi 1 1 Postgraduate
School of Gastroenterology, University of Ferrara, Ferrara, Italy; 2 Digestive Endoscopy Service, Malatesta Novello, Cesena, Italy Background and aim: Recently, Neumann et al.examine the learning curve of I-Scan technique for the prediction of hyperplastic and adenomatous colorectal lesion. However, there are limited data on interpretation of diminutive polyps (≤5 mm) by using i-Scan images. The diminutive polyps, as for as the majority of lesions detected during colonscopy, constitue the theme of the “predict, resect and discard” strategy. Given the size, they are the most difficult to interpret. The aim of this study was to evaluate the performance of young endoscopists for interpretation of hyperplastic and adenomatous diminutive colorectal polyps by using I-Scan images. Material and methods: Three young endoscopists with different practice experience and interpretation on i-scan images (0-1000 colonscopies performed)
S43
partecipated. At study entry, they underwent a teaching presentation of 25 pictures on pits and vascular patterns analysis of colorectal lesions visualized with i-scan technology. It followed a review of 90 images of diminutive polyps, divided into 2 sessions of 45 pictures each. All lesions were evaluated using iScan1 (SE5), iScan3 (SE4TEcCE2) and SE4TEp settings. At the end of the first module, the images were reviewed and histopathological diagnosis was known. The performance of young endoscopists was separately analyzed for each session and was calculated by using sensibility, specificity, LR+ and LR-. Results: Of the 90 lesions included, 47 polyps (52%) were <3 mm (median 3.6 mm, min/max 2/5 mm). The distribution for anatomic lesions was: rectum (n=25), left colon (n=24) and right colon (n=31). Forty-four polyps were hyperplastic and 46 adenomatous. After first session of 45 I-Scan images, the overall sensitivity, specificity, LR+ and LR- were 73%, 63%, 1.98 and 0.42, respectively. At the second module, the sensitivity, specificity, LR+ increases (80%, 73%, 2.96 respectively) and LR - decreases at 0.28. Conclusions: The young and less experienced endoscopists in I-Scan technologies can achieve an improvement for diminutive polyps characterization after reviewing cases previously analyzed. It is necessary to perform an adequate training period before reaching the results of skilled operators for the interpretation of polyps.
OC.20.4 CORRELATION BETWEEN CHRONIC STRESS AND UPPER GI PATHOLOGY G. Fiorini 1 , V. Castelli ∗,1 , I. Saracino 1 , C. Zaccaro 1 , C. Ricci 2 , D. Boschiero 3 , D. Vaira 1 1 Ospedale
S Orsola Malpighi, Bologna, Italy; 2 Università di Brescia, Brescia, Italy; 3 Biotekna, Marcon, Italy Background and aim: Stressful events are related to the onset or worsening of gastrointestinal symptoms. When stress duration goes beyond the adaptive responses of the individual it becomes “chronic stress” that can lead to changes in body composition and appearance of symptoms and gastrointestinal pathologies. Aim: To analyze the correlation between modificated body composition and presence of gastrointestinal and general symptoms (Medically unexplained Symptoms, MUS) and to evaluate correlations between total body potassium, extracellular potassium, extracellular water and skeletal muscle free fat mass. Material and methods: A total of 309 consecutive patients (median age 50 years, range 21–82) underwent endoscopy with biopsies for histological examination. Questionnaires were fulfilled according to dietary habits and symptoms. Analysis of differential body composition was assessed by BIAACC (BioTekna medical device) to scan through the spectrum analysis of bio impedance using molecular and functional quantitative and qualitative composition of the body: 1) Total Body Water, representing the electrolyte imbalance; 2) extracellular water, representing the inflammatory status; 3) TBK and ECK representing the systemic cellular excitability; 4) the skeletal muscle mass as an indicator of overall health and aging; 5) FFM, total fat mass. Results: Gastrointestinal symptoms were assessed in 8 out of 20 patients (45%) who declared two or less MUS, whereas symptoms as tiredness, anxiety and gastrointestinal disorders were present in 50 patients declaring more than 2 MUS, among 70 patients with ECK in range. In 239 patients with ECK out of range: 11 out of 29 patients (38%) who declared two or less MUS, manifested gastrointestinal symptoms. Whereas main symptoms as tiredness, anxiety, heartbeat alterations and gastrointestinal disorders were present in 210 patients declaring more than 2 MUS. Conclusions: We observed that ECK% increasing and TBK depletion correlates with worsening of inflammatory state and gastrointestinal and systemic stress-related symptoms. These observations can be explained with electrolytic alterations. Low skeletal muscle FFM correlated with TBK and ECK levels out of range: patients with a good muscle mass were able to maintain electrolytic balance and showed few symptoms and a low inflammatory state compared with patients with low muscular mass FFM.