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P.08.10 ESOPHAGOGASTRIC JUNCTION MORPHOLOGY ASSESSMENT BY HIGH RESOLUTION MANOMETRY IN OBESE PATIENTS CANDIDATE TO BARIATRIC SURGERY
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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
was performed during therapy whereas ENT examination and nasal cytology were performed at the end of treatment. Results: Of the 20 patients with NARNE, 14 (70%) resulted to have pathological basal pH-Impedance values and 6 (30%) resulted to have normal basal values. PH-impedance performed during PPI treatment showed the normalization of the number of refluxes (< 48) and pH values (< 4.2) in nine (64.3%) out of the 14 patients with positive pH-Impedance at enrollment. Ph-Impedance during treatment continued to be pathological in 3 (21.4%) patients with a pathological number of refluxes (2 with acid pH, 1 with normal pH values). Two (14,3%) subjects experienced improvement in symptoms and showed the normalization of nasal cytology but refused to repeat the pH-Impedance during therapy. Seven (77.8%) out of 9 patients with normal ph-Impedance values under treatment showed the simultaneous normalization of nasal cytology whereas two (22,2%) subjects did not show any significant improvement at nasal cytology. Conclusions: Our study showed a possible causal effect association between GERD and NARNE. Treatment with high dose of oral PPI for 8 weeks seemed to be effective in improving symptoms and in reducing nasal inflammation in a significant number of patients with NARNE. Larger studies are needed to confirm our data.
P.08.9 CORRELATION BETWEEN HIGH RESOLUTION MANOMETRY PARAMETERS AND SYMPTOMS IN TREATED ACHALASIA PATIENTS Pesce M.*, Esposito D., Maione F., Gennarelli N., Cargiolli M., De Palma G.D., Cuomo R., Sarnelli G. Federico II University, Naples, Italy Background and aim: HRM is the gold standard study to follow up achalasia patients after treatment However, discrepancies between residual achalasia-related symptoms and HRM parameters may occur, thus drifting therapeutic choices in subsets of achalasia patients. Being more physiologic, it has been claimed that a HRM in the upright position may better reflect the clinical condition of these patients. We aimed to examine the effects of body position on HRM parameters and whether they are related to symptoms’ persistence. Material and methods: 40 achalasia patients (20 M, mean age 41 ± 12 ys) were treated with pneumatic dilation according to standardized protocol. In all patients a standardized questionnaire assessing the frequency and the intensity of achalasia-related symptoms (dysphagia for solids and liquids graded from 0: absent to 9: at each meal and precluding daily activities) was administered before and 6 months after pneumatic dilation. A HRM study was performed at the same time points, both in supine and sitting position with at least 10 single 5-mL swallows performed for each series. Results: In all patients, a significant improvement of dysphagia severity for both solids and liquids was achieved after dilation (1±1.5 vs 6.7±2.2 and 0.6±1.1 vs 5.2±3.2 respectively; all p<0,001). A significant reduction in terms of LES pressure, IRP4 and bolus clearance rate was observed in the sitting as compared to the supine position (32±13 vs 25,4±17 mmHg; 19,8±9,5 vs 14,8±10 and 67,5±36 vs 47,8±43%; respectively, all p<0.05). However, none of the examined values showed a significant correlation with the persistence of dysphagia for solids or liquids both in the upright and supine position. Conclusions: Here we showed that, despite body position significantly affects HRM parameters, none of these appears to significantly correlate with symptoms’ persistence in treated achalasia patients. HRM study, per se, may not predict the clinical outcome of these patients and a number of variables (namely achalasia subtypes, age, sex, presence of megaesophagus) may account for residual symptoms in treated achalasia patients.
P.08.10 ESOPHAGOGASTRIC JUNCTION MORPHOLOGY ASSESSMENT BY HIGH RESOLUTION MANOMETRY IN OBESE PATIENTS CANDIDATE TO BARIATRIC SURGERY Tolone S.*1, Savarino E.2, De Bortoli N.3, Frazzoni M.4, Furnari M.5, Bosco A.1, Pirozzi R.1, Parisi S.1, Bondanese M.1, Jannelli G.1, Carlea N.1, Ferrara F.1, Savarino V.5, Docimo L.1 Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy, 2Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, 3Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy, 4Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy, 5Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy 1
Background and aim: Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and hiatal hernia development. Pure restrictive bariatric surgery should not be indicated in case of hiatal hernia and GERD. However it is unclear what is the real incidence of disruption of esophagogastric junction (EGJ) in patients candidate to bariatric surgery. Actually, high resolution manometry (HRM) can provide accurate information about EGJ morphology. Aim of this study was to describe the EGJ morphology determined by HRM in obese patients candidate to bariatric surgery and to verify if different EGJ morphologies are associated to GERD-related symptoms presence. Material and methods: All patients underwent a standardized questionnaire for symptom presence and severity, upper endoscopy, high resolution manometry (HRM). EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, >2 cm separation. Results: One hundred thirty-eight obese (BMI>35) subjects were studied. Ninety-eight obese patients referred at least one GERDrelated symptom, whereas 40 subjects were symptom-free. According to HRM features, EGJ Type I morphology was documented in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%). EGJ Type III subjects were more frequently associated to Symptoms than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p<0.001). Conclusions: Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obese patients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obese patients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.
P.08.11 THE POSITION WITHIN THE OESOPHAGEAL CIRCUMFERENCE PREDICTS DYSPLASIA IN SHORT SEGMENT BARRETT’S ESOPHAGUS: A 7-YEAR RETROSPECTIVE SERIES OF 341 LESIONS Bibbò S.1, Ianiro G.*1, Arciuolo D.3, Ricci R.3, Petruzziello L.2, Spada C.2, Riccioni M.E.2, Larghi A.2, Dibitetto F.1, Monelli E.1, Gasbarrini A.1, Costamagna G.2, Cammarota G.1 Internal Medicine, Gastroenterology and Liver Unit - Catholic University of Rome, Rome, Italy, 2Endoscopy Unit - Catholic University of Rome, Rome, Italy, 3Histopathology Unit - Catholic University of Rome, Rome, Italy
1
Background and aim: A careful endoscopic surveillance of Barrett’s esophagus (BE) is essential to prevent esophageal cancer. The aim of this study is to identify the preferred location of short BE and its associated dysplasia within the esophageal circumference. Material and methods: We retrospectively reviewed a prospectively maintained database of patients with non-circumferential, short-
Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
was performed during therapy whereas ENT examination and nasal cytology were performed at the end of treatment. Results: Of the 20 patients with NARNE, 14 (70%) resulted to have pathological basal pH-Impedance values and 6 (30%) resulted to have normal basal values. PH-impedance performed during PPI treatment showed the normalization of the number of refluxes (< 48) and pH values (< 4.2) in nine (64.3%) out of the 14 patients with positive pH-Impedance at enrollment. Ph-Impedance during treatment continued to be pathological in 3 (21.4%) patients with a pathological number of refluxes (2 with acid pH, 1 with normal pH values). Two (14,3%) subjects experienced improvement in symptoms and showed the normalization of nasal cytology but refused to repeat the pH-Impedance during therapy. Seven (77.8%) out of 9 patients with normal ph-Impedance values under treatment showed the simultaneous normalization of nasal cytology whereas two (22,2%) subjects did not show any significant improvement at nasal cytology. Conclusions: Our study showed a possible causal effect association between GERD and NARNE. Treatment with high dose of oral PPI for 8 weeks seemed to be effective in improving symptoms and in reducing nasal inflammation in a significant number of patients with NARNE. Larger studies are needed to confirm our data.
P.08.9 CORRELATION BETWEEN HIGH RESOLUTION MANOMETRY PARAMETERS AND SYMPTOMS IN TREATED ACHALASIA PATIENTS Pesce M.*, Esposito D., Maione F., Gennarelli N., Cargiolli M., De Palma G.D., Cuomo R., Sarnelli G. Federico II University, Naples, Italy Background and aim: HRM is the gold standard study to follow up achalasia patients after treatment However, discrepancies between residual achalasia-related symptoms and HRM parameters may occur, thus drifting therapeutic choices in subsets of achalasia patients. Being more physiologic, it has been claimed that a HRM in the upright position may better reflect the clinical condition of these patients. We aimed to examine the effects of body position on HRM parameters and whether they are related to symptoms’ persistence. Material and methods: 40 achalasia patients (20 M, mean age 41 ± 12 ys) were treated with pneumatic dilation according to standardized protocol. In all patients a standardized questionnaire assessing the frequency and the intensity of achalasia-related symptoms (dysphagia for solids and liquids graded from 0: absent to 9: at each meal and precluding daily activities) was administered before and 6 months after pneumatic dilation. A HRM study was performed at the same time points, both in supine and sitting position with at least 10 single 5-mL swallows performed for each series. Results: In all patients, a significant improvement of dysphagia severity for both solids and liquids was achieved after dilation (1±1.5 vs 6.7±2.2 and 0.6±1.1 vs 5.2±3.2 respectively; all p<0,001). A significant reduction in terms of LES pressure, IRP4 and bolus clearance rate was observed in the sitting as compared to the supine position (32±13 vs 25,4±17 mmHg; 19,8±9,5 vs 14,8±10 and 67,5±36 vs 47,8±43%; respectively, all p<0.05). However, none of the examined values showed a significant correlation with the persistence of dysphagia for solids or liquids both in the upright and supine position. Conclusions: Here we showed that, despite body position significantly affects HRM parameters, none of these appears to significantly correlate with symptoms’ persistence in treated achalasia patients. HRM study, per se, may not predict the clinical outcome of these patients and a number of variables (namely achalasia subtypes, age, sex, presence of megaesophagus) may account for residual symptoms in treated achalasia patients.
P.08.10 ESOPHAGOGASTRIC JUNCTION MORPHOLOGY ASSESSMENT BY HIGH RESOLUTION MANOMETRY IN OBESE PATIENTS CANDIDATE TO BARIATRIC SURGERY Tolone S.*1, Savarino E.2, De Bortoli N.3, Frazzoni M.4, Furnari M.5, Bosco A.1, Pirozzi R.1, Parisi S.1, Bondanese M.1, Jannelli G.1, Carlea N.1, Ferrara F.1, Savarino V.5, Docimo L.1 Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy, 2Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy, 3Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy, 4Digestive Pathophysiology Unit and Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy, 5Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy 1
Background and aim: Obesity is a strong independent risk factor of gastroesophageal reflux disease (GERD) symptoms and hiatal hernia development. Pure restrictive bariatric surgery should not be indicated in case of hiatal hernia and GERD. However it is unclear what is the real incidence of disruption of esophagogastric junction (EGJ) in patients candidate to bariatric surgery. Actually, high resolution manometry (HRM) can provide accurate information about EGJ morphology. Aim of this study was to describe the EGJ morphology determined by HRM in obese patients candidate to bariatric surgery and to verify if different EGJ morphologies are associated to GERD-related symptoms presence. Material and methods: All patients underwent a standardized questionnaire for symptom presence and severity, upper endoscopy, high resolution manometry (HRM). EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, >2 cm separation. Results: One hundred thirty-eight obese (BMI>35) subjects were studied. Ninety-eight obese patients referred at least one GERDrelated symptom, whereas 40 subjects were symptom-free. According to HRM features, EGJ Type I morphology was documented in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%). EGJ Type III subjects were more frequently associated to Symptoms than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p<0.001). Conclusions: Obese subjects candidate to bariatric surgery have a high risk of disruption of EGJ morphology. In particular, obese patients with hiatal hernia often refer pre-operative presence of GERD symptoms. Testing obese patients with HRM before undergoing bariatric surgery, especially for restrictive procedures, can be useful for assessing presence of hiatal hernia.
P.08.11 THE POSITION WITHIN THE OESOPHAGEAL CIRCUMFERENCE PREDICTS DYSPLASIA IN SHORT SEGMENT BARRETT’S ESOPHAGUS: A 7-YEAR RETROSPECTIVE SERIES OF 341 LESIONS Bibbò S.1, Ianiro G.*1, Arciuolo D.3, Ricci R.3, Petruzziello L.2, Spada C.2, Riccioni M.E.2, Larghi A.2, Dibitetto F.1, Monelli E.1, Gasbarrini A.1, Costamagna G.2, Cammarota G.1 Internal Medicine, Gastroenterology and Liver Unit - Catholic University of Rome, Rome, Italy, 2Endoscopy Unit - Catholic University of Rome, Rome, Italy, 3Histopathology Unit - Catholic University of Rome, Rome, Italy
1
Background and aim: A careful endoscopic surveillance of Barrett’s esophagus (BE) is essential to prevent esophageal cancer. The aim of this study is to identify the preferred location of short BE and its associated dysplasia within the esophageal circumference. Material and methods: We retrospectively reviewed a prospectively maintained database of patients with non-circumferential, short-