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P.06.13: Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy Using a 19-Gauge Flex Needle in Pancreatic Cystic Lesions
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
is able to reach a very good procurement yield and diagnostic accuracy. The 22G-size needle showed superior core procurement and diagnostic capabilities. However, large prospective studies on their performances are warranted to further evaluate the use of these novel types of needles.
P.06.11 HISTOLOGICAL DIAGNOSTIC YIELD OF 3 DIFFERENT NEEDLES FOR EUS-FNB: BIGGER SIZE NOT ALWAYS MAKES THE DIFFERENCE! F. Attili ∗ , C. Spada, D. Pagliari, F. Inzani, G. Rindi, A. Larghi, G. Costamagna Catholic University of Rome, Rome, Italy Background and aim: EUS-guided biopsy sampling using fine needle aspiration (EUS-FNA) and, more recently, fine-needle biopsy (FNB) needles has been reported with discrepant diagnostic accuracy, in part due to differences in methodology and type of needles adopted. To date, FNB is performed using large bore needles (i.e. 19 Gauge). Although, theoretically, a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle biopsy (EUS-FNB), its advantage over smaller needles is unclear. Aim of the present study was to compare the histological diagnostic accuracy of the standard 19G needle (Cook Medical, Ireland) with the smaller 22G and 25G Shark-core (Medtronic-Covidien, Ireland). Material and methods: This is a single Centre, single operator (FA) retrospective evaluation of 213 patients (107 female, mean age 60 years old, range 18–87) who were referred over the last 10 months period to our Unit for EUS-FNB. All the procedures were performed using a GF-UCT 180 linear endoscope (Olympus, Japan). For all included patients, 3±1 EUS-guided passes were made in each lesion. In all the passes, a syringe suction method was done. EUS was performed with patients under conscious sedation. Results: The indications for EUS-FNB were pancreatic mass (n=151), lymphnodes (n=36), submucosal lesions (n=26). In 51 patients a 19G (Cook Medical, Ireland) needle was used (29 pancreatic mass, 12 lymphnodes, 10 submucosal lesions); in 127 patients a 22G Shark-core (Medtronic-Covidien, Ireland) needle was used (93 pancreatic mass, 21 lymphnodes, 13 submucosal lesions); and in the remaining 35 patients a 25G Shark-core (Medtronic-Covidien, Ireland) needle was used (29 pancreatic mass, 3 lymphnodes, 3 submucosal lesions). The procurement yield was 100%. In 201 out of 213 patients EUS-FNB was diagnostic with an overall diagnostic yield of 94.4%. When considering the different needles, the diagnostic yield was 94.1%, 94.5% and 94.3% for 19G, 22G and 25G respectively (p=0.99). No severe adverse events were reported. One mild duodenal bleeding that spontaneously resolved was observed in a patient who underwent a 22G EUS-FNB. Conclusions: Twenty-two G and 25G Shark-core needles were not inferior to the standard 19G needle for tissue sampling. All the 3 needles achieved high overall diagnostic yields and similar performance and safety characteristics for histological diagnosis.
P.06.12 ENDOSCOPIC TREATMENT OF NON AMPULLARY SPORADIC DUODENAL ADENOMAS (NASDA): LONG TERM RESULTS G. Valerii ∗,2 , V. Bove 2 , A. Tringali 2 , P. Familiari 2 , I. Boškoski 2 , R. Landi 2 , V. Perri 2 , G. Costamagna 1 1 Digestive
Endoscopy Unit, Catholic University of Rome, Rome, Italy; Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy 2 Digestive
Background and aim: Non ampullary sporadic duodenal adenomas
e169
(NASDA) are usually asymptomatic and the diagnosis is incidental. Results of Endoscopic Mucosal Resection (EMR) of NASDA is evaluated in a large series with long-term follow-up. Material and methods: Consecutive patients that underwent EMR of NASDA between May 2002 and April 2016 were identified from an electronic database. The following data were retrospectively recorded: size, site, pre- and post-endoscopic resection histology, complications (bleeding, perforation), local recurrence rate and survival. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, and then yearly for the following 5 years. Results: EMR of 72 NASDA was performed in 65 patients (7 had 2 adenomas; piece meal, 52.8%; en bloc, 47.2%). Mean NASDA size was 22 mm (range 5–80) and 86.1% were located in the second duodenum. Histopatological findings are summarized in table 1. Pre-EMR biopsy resulted in 21.5% (14/65) dowstaging rate. Perforation occurred in 4.1% (3/72) of the cases (2 treated by surgery, 1 by percutaneous drainage of a retroperitoneal collection); delayed bleeding in 8.3% (6/72) managed by endoscopy (n=5) or embolization (n=1). Mortality was absent. 50 patients are alive after a 50.3 months mean follow-up (range 1–147); 11 were lost to follow-up, 3 died due to unrelated disease and 1 refused to provide informations. Local recurrence rate was 8/50 (22.8%); recurrences (4 LGD, 4 HGD) were diagnosed during the first 2 year of follow-up and were successfully retreated endoscopically.
Conclusions: EMR for NASDA is effective with favorable longterm outcomes. Complications are rare and a multidisciplinary approach to perforations is needed. Local recurrence rate is high but can be retreated endoscopically. A recall system and the patient compliance to the endoscopic follow-up are mandatory to detect recurrences and its prompt treatment.
P.06.13 ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION AND BIOPSY USING A 19-GAUGE FLEX NEEDLE IN PANCREATIC CYSTIC LESIONS C. Fabbri 1 , S. Giovanelli 1 , G. Gibiino ∗,2 , A. Fornelli 1 , D. De Biase 1 , E. Jovine 1 , A. Larghi 2 , A. Gasbarrini 2 , V. Cennamo 1 1 Ospedale
Maggiore, Bologna, Italy; 2 Ospedale Gemelli, Roma, Italy
Background and aim: Cytological diagnosis by endoscopic ultrasoundguided fine needle aspiration in pancreatic cystic lesions is associated with low sensitivity and adequacy. Well-known limits by using 22-gauge needle are linked to fluid consistency, since viscous content does not allow a rapid drainage. Attempts with 19-gauge needle are usual but inadequacy in reaching several sites is commonly underlined, as well. The new 19-gauge Flex needle, combining both a good diameter and manageability, seems to emerge as a promising device in this field. The aim of this study is to define feasibility, safety, and diagnostic
e170
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
yield of the 19-gauge Flex needle for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. Material and methods: 54 patients with pancreatic cystic lesions were consecutively referred for endoscopic ultrasound guided-fine needle aspiration. They were enrolled in a prospective, single center study and underwent fine needle aspiration and biopsy with the 19-gauge Flex needle. Results: In 54 patients (M 25, median age 69 years), pancreatic cystic lesions were rapidly reached. Technical success indeed was 100%, with 27 transbulbar and 27 transgastric route and safety achieved was 100%, as well. Considering the different sites, 27 (50%) lesions were in the pancreatic head/uncinate, 23 (42.6%) in the body and 4 (7.40%) in the tail. Median dimensions were 36 mm. Malignancy was detected with adequate samples in 11 cases including 6 adenocarcinoma and 5 high grade dysplasia and 2 cases standed out as cytological sampling failure. Definitive diagnosis included 7 serous lesions, 31 IPMN type I and type II with 3 cases of degeneration, 5 pseudocysts, 9 mucinous cystic neoplasms and 2 neuroendocrine tumours. Further evaluation on the cystic content was performed by dosing oncomarkers, with high level of CA 19.9 in 11 and CEA in 38 cases, respectively and increased amylase and lipase both in 34 lesions. K-ras gene was even detected in 28 lesions, with wild type expression in 17 ones. There was only 1 minor complication represented by 1 case of mild infection. Conclusions: Fine needle aspiration and biopsy with the 19-gauge Flex needle is feasible, particularly in pancreatic cystic lesions with solid component or malignancy, with a high diagnostic yield and with no increase in complication rate. Furthermore, the use of 19- gauge Flex needle for aspiration in pancreatic cystic lesions will allow the use of new devices, like microforceps and optical biopsy, improving the future management of these lesions.
Our aim was to show the diagnostic performance of the Institution of a unit combining the opportunity of performing both EUS and EBUS-FNA for hilar-mediastinal district. Material and methods: In September 2015, a combined unit, composed by a digestive and a thoracic endoscopist, have been constituted in our department. This allowed us to choose the best diagnostic approach (EUS and/or EBUS-FNA) according to the lymph node stations involved. When both EUS and EBUS were technically faceable, the endoscopic approach has been chosen due to the lower risk of side effects. A surgical diagnostic lymphadenectomy or an oncological follow up have been performed in all FNA-negative patients. Clinical and histological data of patients undergone to EUS/EBUSFNA in a period of 6-months were collected and analyzed. Results: During the period of analysis (September 2015–February 2016), 91 EUS/EBUS FNA (50 EUS-FNA, 37 EBUS-FNA, 2 EUS/EBUSFNA and 2 EUS-B-FNA) of hilar-mediastinal and/or para-mediastinal mass were performed in 85 patients. Among them, 54 histological diagnosis of non-small cell lung cancer, 5 of small cell lung cancer, 9 of lymph node metastasis from other tumors, 2 of sarcoidosis and 2 of hamartoma were obtained. No complications related to the procedures occurred. In 5 of the 9 patients FNA-negative at this endoscopic approach a surgical staging lymphadenectomy was performed and the presence of lymph node disease has been documented in 4 patients. In the 10 FNA-negative patients undergone to follow up, no further suspicion of neoplasia raised. The combined approach resulted accurate (95%) and sensitive (95%). Conclusions: The institution of an endoscopic ultrasound unit with the opportunity of a combined endoscopic and/or endobronchial ultrasonographic approach for the mini-invasive hilar-mediastinal diagnosis improves the diagnostic performance in this setting and, thanks to that, the spectrum of patients which may avoid the surgical approach is broader.
P.06.16 P.06.14 Abstract withdrawn
THE ROLE OF WIRELESS CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF SMALL BOWEL TUMORS: A SINGLE CENTRE EXPERIENCE
P.06.15
G. Scarpulla, S. Camilleri, G.M.G. La Ferrera, M. Manganaro, M.F. Maida, S.M.R. Garufi ∗
THE INSTITUTION OF AN ENDOSCOPIC ULTRASOUND UNIT WITH THE OPPORTUNITY OF A COMBINED ENDOSCOPIC AND ENDOBRONCHIAL ULTRASONOGRAPHIC APPROACH FOR THE MINI-INVASIVE HILAR MEDIASTINAL DIAGNOSIS IMPROVES THE DIAGNOSTIC PERFORMANCE IN THIS SETTING D. Assisi ∗,1 , C. Lucidi 1 , D. Forcella 2 , F. Pieconti 4 , P. Visca 3 , F. Facciolo 2 , M. Anti 1 1 Unità
Operativa di Gastroenterologia ed Endoscopia Digestiva, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 2 Unità Operativa Complessa di Chirurgia Toracica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 3 Unità Operativa Complessa di Anatomia Patologica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 4 Unità Operativa Complessa di Anestesia e Rianimazione, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy Background and aim: The efficacy of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) as minimally invasive technique in the differential diagnosis of hilar-mediastinal lymphadenopathies is now widely recognized. The use of EUS has allowed to easily reach some of the hilarmediastinal lymph nodes stations without obtaining a complete study. This evaluation may be integrated by endobronchial ultrasound (EBUS) with FNA.
U.O.C. Gastroenterologia, P.O. “M. Raimondi”, San Cataldo (Cl), Italy Background and aim: Most small bowel (SB) tumors are detected during work-up for obscure gastrointestinal bleeding (OGIB) and they represent less than 6% of digestive tumors. The clinical manifestations of SB tumor tend to be nonspecific and this can delay the diagnosis, especially in the early stage. Wireless capsule endoscopy (WCE) is preferred by both patients and physicians mainly because of its non-invasiveness and is widely used as the first-line diagnostic modality for OGIB. Its use is recommended when traditional esophagogastroduodenoscopy and colonoscopy with ileoscopy resulted negative for disease. The aim of this study is to assess the clinical applicability and diagnostic yeld of WCE in neoplasm’s diagnosis in a large group of patients with OGIB in a single Italian centre. Material and methods: Between June 2003 and September 2016, 568 patients (pts) (324 males, 244 females; mean age 68.5 years; range 20–92 years) underwent WCE for OGIB (358 for OGIB occult and 210 for OGIB overt). A very careful selection of the pts has been carried: all subjects had a previous complete diagnostic work-up. The day before the WCE the patients followed a liquid and no fiber diet; the videocapsule was swallowed after an overnight fasting. In 13 cases, WCE were not diagnostic: 5 due prolonged permanence of the videocapsules in the stomach and 8 due to insufficient bowel cleaning. In 89% of patients we obtained a visualization of the entire
is able to reach a very good procurement yield and diagnostic accuracy. The 22G-size needle showed superior core procurement and diagnostic capabilities. However, large prospective studies on their performances are warranted to further evaluate the use of these novel types of needles.
P.06.11 HISTOLOGICAL DIAGNOSTIC YIELD OF 3 DIFFERENT NEEDLES FOR EUS-FNB: BIGGER SIZE NOT ALWAYS MAKES THE DIFFERENCE! F. Attili ∗ , C. Spada, D. Pagliari, F. Inzani, G. Rindi, A. Larghi, G. Costamagna Catholic University of Rome, Rome, Italy Background and aim: EUS-guided biopsy sampling using fine needle aspiration (EUS-FNA) and, more recently, fine-needle biopsy (FNB) needles has been reported with discrepant diagnostic accuracy, in part due to differences in methodology and type of needles adopted. To date, FNB is performed using large bore needles (i.e. 19 Gauge). Although, theoretically, a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle biopsy (EUS-FNB), its advantage over smaller needles is unclear. Aim of the present study was to compare the histological diagnostic accuracy of the standard 19G needle (Cook Medical, Ireland) with the smaller 22G and 25G Shark-core (Medtronic-Covidien, Ireland). Material and methods: This is a single Centre, single operator (FA) retrospective evaluation of 213 patients (107 female, mean age 60 years old, range 18–87) who were referred over the last 10 months period to our Unit for EUS-FNB. All the procedures were performed using a GF-UCT 180 linear endoscope (Olympus, Japan). For all included patients, 3±1 EUS-guided passes were made in each lesion. In all the passes, a syringe suction method was done. EUS was performed with patients under conscious sedation. Results: The indications for EUS-FNB were pancreatic mass (n=151), lymphnodes (n=36), submucosal lesions (n=26). In 51 patients a 19G (Cook Medical, Ireland) needle was used (29 pancreatic mass, 12 lymphnodes, 10 submucosal lesions); in 127 patients a 22G Shark-core (Medtronic-Covidien, Ireland) needle was used (93 pancreatic mass, 21 lymphnodes, 13 submucosal lesions); and in the remaining 35 patients a 25G Shark-core (Medtronic-Covidien, Ireland) needle was used (29 pancreatic mass, 3 lymphnodes, 3 submucosal lesions). The procurement yield was 100%. In 201 out of 213 patients EUS-FNB was diagnostic with an overall diagnostic yield of 94.4%. When considering the different needles, the diagnostic yield was 94.1%, 94.5% and 94.3% for 19G, 22G and 25G respectively (p=0.99). No severe adverse events were reported. One mild duodenal bleeding that spontaneously resolved was observed in a patient who underwent a 22G EUS-FNB. Conclusions: Twenty-two G and 25G Shark-core needles were not inferior to the standard 19G needle for tissue sampling. All the 3 needles achieved high overall diagnostic yields and similar performance and safety characteristics for histological diagnosis.
P.06.12 ENDOSCOPIC TREATMENT OF NON AMPULLARY SPORADIC DUODENAL ADENOMAS (NASDA): LONG TERM RESULTS G. Valerii ∗,2 , V. Bove 2 , A. Tringali 2 , P. Familiari 2 , I. Boškoski 2 , R. Landi 2 , V. Perri 2 , G. Costamagna 1 1 Digestive
Endoscopy Unit, Catholic University of Rome, Rome, Italy; Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy 2 Digestive
Background and aim: Non ampullary sporadic duodenal adenomas
e169
(NASDA) are usually asymptomatic and the diagnosis is incidental. Results of Endoscopic Mucosal Resection (EMR) of NASDA is evaluated in a large series with long-term follow-up. Material and methods: Consecutive patients that underwent EMR of NASDA between May 2002 and April 2016 were identified from an electronic database. The following data were retrospectively recorded: size, site, pre- and post-endoscopic resection histology, complications (bleeding, perforation), local recurrence rate and survival. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, and then yearly for the following 5 years. Results: EMR of 72 NASDA was performed in 65 patients (7 had 2 adenomas; piece meal, 52.8%; en bloc, 47.2%). Mean NASDA size was 22 mm (range 5–80) and 86.1% were located in the second duodenum. Histopatological findings are summarized in table 1. Pre-EMR biopsy resulted in 21.5% (14/65) dowstaging rate. Perforation occurred in 4.1% (3/72) of the cases (2 treated by surgery, 1 by percutaneous drainage of a retroperitoneal collection); delayed bleeding in 8.3% (6/72) managed by endoscopy (n=5) or embolization (n=1). Mortality was absent. 50 patients are alive after a 50.3 months mean follow-up (range 1–147); 11 were lost to follow-up, 3 died due to unrelated disease and 1 refused to provide informations. Local recurrence rate was 8/50 (22.8%); recurrences (4 LGD, 4 HGD) were diagnosed during the first 2 year of follow-up and were successfully retreated endoscopically.
Conclusions: EMR for NASDA is effective with favorable longterm outcomes. Complications are rare and a multidisciplinary approach to perforations is needed. Local recurrence rate is high but can be retreated endoscopically. A recall system and the patient compliance to the endoscopic follow-up are mandatory to detect recurrences and its prompt treatment.
P.06.13 ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION AND BIOPSY USING A 19-GAUGE FLEX NEEDLE IN PANCREATIC CYSTIC LESIONS C. Fabbri 1 , S. Giovanelli 1 , G. Gibiino ∗,2 , A. Fornelli 1 , D. De Biase 1 , E. Jovine 1 , A. Larghi 2 , A. Gasbarrini 2 , V. Cennamo 1 1 Ospedale
Maggiore, Bologna, Italy; 2 Ospedale Gemelli, Roma, Italy
Background and aim: Cytological diagnosis by endoscopic ultrasoundguided fine needle aspiration in pancreatic cystic lesions is associated with low sensitivity and adequacy. Well-known limits by using 22-gauge needle are linked to fluid consistency, since viscous content does not allow a rapid drainage. Attempts with 19-gauge needle are usual but inadequacy in reaching several sites is commonly underlined, as well. The new 19-gauge Flex needle, combining both a good diameter and manageability, seems to emerge as a promising device in this field. The aim of this study is to define feasibility, safety, and diagnostic
e170
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
yield of the 19-gauge Flex needle for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. Material and methods: 54 patients with pancreatic cystic lesions were consecutively referred for endoscopic ultrasound guided-fine needle aspiration. They were enrolled in a prospective, single center study and underwent fine needle aspiration and biopsy with the 19-gauge Flex needle. Results: In 54 patients (M 25, median age 69 years), pancreatic cystic lesions were rapidly reached. Technical success indeed was 100%, with 27 transbulbar and 27 transgastric route and safety achieved was 100%, as well. Considering the different sites, 27 (50%) lesions were in the pancreatic head/uncinate, 23 (42.6%) in the body and 4 (7.40%) in the tail. Median dimensions were 36 mm. Malignancy was detected with adequate samples in 11 cases including 6 adenocarcinoma and 5 high grade dysplasia and 2 cases standed out as cytological sampling failure. Definitive diagnosis included 7 serous lesions, 31 IPMN type I and type II with 3 cases of degeneration, 5 pseudocysts, 9 mucinous cystic neoplasms and 2 neuroendocrine tumours. Further evaluation on the cystic content was performed by dosing oncomarkers, with high level of CA 19.9 in 11 and CEA in 38 cases, respectively and increased amylase and lipase both in 34 lesions. K-ras gene was even detected in 28 lesions, with wild type expression in 17 ones. There was only 1 minor complication represented by 1 case of mild infection. Conclusions: Fine needle aspiration and biopsy with the 19-gauge Flex needle is feasible, particularly in pancreatic cystic lesions with solid component or malignancy, with a high diagnostic yield and with no increase in complication rate. Furthermore, the use of 19- gauge Flex needle for aspiration in pancreatic cystic lesions will allow the use of new devices, like microforceps and optical biopsy, improving the future management of these lesions.
Our aim was to show the diagnostic performance of the Institution of a unit combining the opportunity of performing both EUS and EBUS-FNA for hilar-mediastinal district. Material and methods: In September 2015, a combined unit, composed by a digestive and a thoracic endoscopist, have been constituted in our department. This allowed us to choose the best diagnostic approach (EUS and/or EBUS-FNA) according to the lymph node stations involved. When both EUS and EBUS were technically faceable, the endoscopic approach has been chosen due to the lower risk of side effects. A surgical diagnostic lymphadenectomy or an oncological follow up have been performed in all FNA-negative patients. Clinical and histological data of patients undergone to EUS/EBUSFNA in a period of 6-months were collected and analyzed. Results: During the period of analysis (September 2015–February 2016), 91 EUS/EBUS FNA (50 EUS-FNA, 37 EBUS-FNA, 2 EUS/EBUSFNA and 2 EUS-B-FNA) of hilar-mediastinal and/or para-mediastinal mass were performed in 85 patients. Among them, 54 histological diagnosis of non-small cell lung cancer, 5 of small cell lung cancer, 9 of lymph node metastasis from other tumors, 2 of sarcoidosis and 2 of hamartoma were obtained. No complications related to the procedures occurred. In 5 of the 9 patients FNA-negative at this endoscopic approach a surgical staging lymphadenectomy was performed and the presence of lymph node disease has been documented in 4 patients. In the 10 FNA-negative patients undergone to follow up, no further suspicion of neoplasia raised. The combined approach resulted accurate (95%) and sensitive (95%). Conclusions: The institution of an endoscopic ultrasound unit with the opportunity of a combined endoscopic and/or endobronchial ultrasonographic approach for the mini-invasive hilar-mediastinal diagnosis improves the diagnostic performance in this setting and, thanks to that, the spectrum of patients which may avoid the surgical approach is broader.
P.06.16 P.06.14 Abstract withdrawn
THE ROLE OF WIRELESS CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF SMALL BOWEL TUMORS: A SINGLE CENTRE EXPERIENCE
P.06.15
G. Scarpulla, S. Camilleri, G.M.G. La Ferrera, M. Manganaro, M.F. Maida, S.M.R. Garufi ∗
THE INSTITUTION OF AN ENDOSCOPIC ULTRASOUND UNIT WITH THE OPPORTUNITY OF A COMBINED ENDOSCOPIC AND ENDOBRONCHIAL ULTRASONOGRAPHIC APPROACH FOR THE MINI-INVASIVE HILAR MEDIASTINAL DIAGNOSIS IMPROVES THE DIAGNOSTIC PERFORMANCE IN THIS SETTING D. Assisi ∗,1 , C. Lucidi 1 , D. Forcella 2 , F. Pieconti 4 , P. Visca 3 , F. Facciolo 2 , M. Anti 1 1 Unità
Operativa di Gastroenterologia ed Endoscopia Digestiva, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 2 Unità Operativa Complessa di Chirurgia Toracica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 3 Unità Operativa Complessa di Anatomia Patologica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 4 Unità Operativa Complessa di Anestesia e Rianimazione, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy Background and aim: The efficacy of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) as minimally invasive technique in the differential diagnosis of hilar-mediastinal lymphadenopathies is now widely recognized. The use of EUS has allowed to easily reach some of the hilarmediastinal lymph nodes stations without obtaining a complete study. This evaluation may be integrated by endobronchial ultrasound (EBUS) with FNA.
U.O.C. Gastroenterologia, P.O. “M. Raimondi”, San Cataldo (Cl), Italy Background and aim: Most small bowel (SB) tumors are detected during work-up for obscure gastrointestinal bleeding (OGIB) and they represent less than 6% of digestive tumors. The clinical manifestations of SB tumor tend to be nonspecific and this can delay the diagnosis, especially in the early stage. Wireless capsule endoscopy (WCE) is preferred by both patients and physicians mainly because of its non-invasiveness and is widely used as the first-line diagnostic modality for OGIB. Its use is recommended when traditional esophagogastroduodenoscopy and colonoscopy with ileoscopy resulted negative for disease. The aim of this study is to assess the clinical applicability and diagnostic yeld of WCE in neoplasm’s diagnosis in a large group of patients with OGIB in a single Italian centre. Material and methods: Between June 2003 and September 2016, 568 patients (pts) (324 males, 244 females; mean age 68.5 years; range 20–92 years) underwent WCE for OGIB (358 for OGIB occult and 210 for OGIB overt). A very careful selection of the pts has been carried: all subjects had a previous complete diagnostic work-up. The day before the WCE the patients followed a liquid and no fiber diet; the videocapsule was swallowed after an overnight fasting. In 13 cases, WCE were not diagnostic: 5 due prolonged permanence of the videocapsules in the stomach and 8 due to insufficient bowel cleaning. In 89% of patients we obtained a visualization of the entire