- Email: [email protected]
P.08.16: Early Onset Colorectal Cancer vs Sporadic Colorectal Cancer: A Clinicopathological and Molecular Comparison
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
observed accrding to the colonic sites of placement or indications (BTS vs. palliative). Conclusions: The procedure for placing SEMS is efficacious and safe with an acceptable rate of complications when used either as a bridge to surgery or with palliative intent and both for right and left-side colonic stenosis.
P.08.15 STENTING IN MALIGNANT ESOPHAGEAL STRICTURES: OUTCOMES AND ADVERSE EVENTS IN OUR EXPERIENCE L. Gargiulo ∗ , P. Ciamarra, O. Labianca, G. Napoli, M. Napoli, A. Maurano AOIU San Giovanni di Dio e Ruggi d’Aragona, Gaetano Fucito Hospital, Digestive Endoscopy Unit, Mercato San Severino (Salerno), Italy Background and aim: Esophageal stenting has a high clinical impact, with a widely accepted role in obstructive benign and malignant conditions. Several different kind of stents have been developed, including self-expanding plastic and metal stents, available as uncovered, partially covered, and fully covered as well as biodegradable stents. Knowing that the management of patients with malignant esophageal strictures it requires a multidisciplinary approach, the aim of this study is to evaluate the outcomes and safety in palliative treatment of esophageal strictures and fistula, with different kind of stents, in our Unit of Digestive Endoscopy. Material and methods: A descriptive, retrospective study from august 2014 to august 2016 on the placement of 18 esophageal self-expanfing metal stents (SEMS) was conducted. Patients were 16 males and 2 females, mean age was 72.5 years (range 44–86 years). All patients were suffering from worsening dysphagia, and were subjected to chest and abdomen CT-scan. It was 12 patients with esophageal cancer, 4 patients with lung cancer and 2 patients with tracheo-esophageal fistula. We used 6 partially covered SEMS (Hanarostent, M.I. Tech. Co. Ltd. South Korea), and 6 uncovered SEMS (Boston Scientific Co. Natick, USA) in patients with esophageal cancer; 4 partially covered SEMS (3 Hanarostent, M.I. Tech. Co. Ltd. South Korea, and 1 Taewoong Medical Co. Ltd South Korea) in patients with lung cancer; 2 fully covered SEMS (Hanarostent, M.I. Tech. Co. Ltd. South Korea) in patients with tracheo-esophageal fistula. All the stents were “over the wire” (OTW system) and were positioned under fluoroscopy. Results: We had no major complications such as perforation or bleeding. All but two patients (88.9%) were able to be orally feeded with a significant relief of dysphagia. We had persistent dysphagia in one patient with esophageal cancer (5.5%), treated with an uncovered SEMS. We had one dislocation in the stomach (5.5%) in a patient with lung neoplasia treated with a partially covered SEMS. After SEMS’s placement, almost all the patients needed FANS treatment, due to medium to severe chest pain for an average of 4–5 days. Partially covered SEMS were more tolerated than uncovered. Conclusions: In our experience, the placement of SEMS is an appropriate palliative option of dysphagia in malignant esophageal strictures and safely treatment of fistulas. Currently there is no evidence scientific those that demonstrate a superiority of a particular type of stent among those in the trade, therefore the choice of a specific stent is often based on the endoscopist’s experience.
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P.08.16 EARLY ONSET COLORECTAL CANCER VS SPORADIC COLORECTAL CANCER: A CLINICOPATHOLOGICAL AND MOLECULAR COMPARISON L.H. Eusebi ∗,1 , C. Ceccarelli 2 , M.L. Artesiani 1 , L. Montanaro 3 , M. Derenzini 3 , F. Dall’Olio 4 , A. Ardizzoni 4 , G. Biasco 4 , D. Adua 4 , F. Bazzoli 1 , L. Ricciardiello 1 1 Department
of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy; 2 Pathology Unit, Sant’Orsola University Hospital, Bologna, Italy; 3 Department of Experimental, Diagnostic and Specialty Medicine, Bologna University, Bologna, Italy; 4 Medical Oncology Unit, Sant’Orsola University Hospital, Bologna, Italy Background and aim: Early Onset Colorectal cancers (EOCRCs) develop before the age of 50, with no evidence of familial predisposition or belonging to hereditary syndromes. Little is known about their predisposing factors and the molecular pathways that promote the early onset of these tumours. Our aim was to evaluate if EOCRCs may be defined as a distinct entity by comparing their clinicopathological, histological and molecular features to a consecutive series of sporadic CRCs developed in patients over 50 years of age. Material and methods: A series of 94 EOCRC identified from prospectively maintained databases of oncological surgeries was compared to a consecutive series of 192 sporadic CRCs from patients older than 50 years (from the same hospital). For all included cases, data was extracted on patients demographics, clinical features, and tumours histological and molecular data, including MLH1 and MSH2 protein levels, as well as p53 and Thymidylate synthase (TS) protein levels. Results: The mean age of EOCRCs and controls was 43 and 67 years. Regarding cancer location, 57% of the control CRCs were located in the left colon, whereas the most common site of EOCRCs was the rectum (p=0.16). Stage II lesions were the most frequent in the controls (47% of the cases – no stage 0 or stage I cancers were present in this group) whereas the advanced stages III and IV were present in 40% and 13% of the cases, respectively. Similarly, in the EOCRCs group stage III and IV lesions represented 50% of patients, although stage IV cancers seem to occur more often (16%). Histologically, EOCRCs showed a tendency of higher incidence of poorly differentiated tumours compared to control CRCs (20% vs. 15%) (p=0.29). Mucinous histology and signet-ring cell tumours were present in 15% and 0% of controls compared to 21% and 2% in the EOCRC cohort. Regarding the molecular features, 7.2% and 0% in the EOCRC and 9.9% and 4.7% lacked MLH1 and MSH2 expression, respectively. In both groups, immunohistochemistry analysis showed similar low p53 levels in 36% of cases and high TS levels (21% in both groups).
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Conclusions: The genetic basis in the majority of early onset colorectal carcinomas remains unknown, However, most EOCRCs appear to arise through the same pathways as sporadic CRCs, such as the classical adenoma-carcinoma sequence. EOCRCs appear more frequently as aggressive cancers, related to the advanced stage of disease and the delayed diagnosis since patients with less than 50 years of age are not included in screening programs.
P.08.17 CONCOMITANT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS AND NEUROENDOCRINE TUMORS OF THE PANCREAS: MORE THAN JUST A COINCIDENCE? L. Venezia ∗ , P. Cortegoso Valdivia, C.G. De Angelis Azienda Ospedaliera San Giovanni Battista, Presidio Molinette, Turin, Italy Background and aim: Intraductal papillary mucinous neoplasms (IPMNs) and neuroendocrine tumors (NETs) of the pancreas are rare tumors. Up to now 14 patients with association of endocrine and exocrine neoplasms of the pancreas have been reported in the literature, but this association is not expected to be frequent. The aim of this study is to describe a series of six patients with IPMN and concomitant NET of the pancreas followed in our center and to look for any common findings between them that could help early recognition and further comprehension of this association. Material and methods: Among all the patients who were followed in our clinic for IPMN or NET, we identified 6 with both diseases, diagnosed on imaging or after biopsies requested for uncertain results of previous investigations. We collected data about the patients (age, sex, symptoms, past and current medical history, blood chemistry, type of imaging) and about the lesions (classification, dimension, localization, imaging features, fine-needle aspiration (FNA) biopsies results and histology). Results: All patients (3 men and 3 women) were asymptomatic. Average age at diagnosis is 52 years. All IPMN were branch duct, localized in the head (n=4) and in body-tail (n=2), with a medium diameter of the duct of 12mm (minimum 8 and maximum 16 mm). All NET underwent endoscopic ultrasound examination with FNA; all were non functional G1 with a Ki67 of 1%, positive for Chromogranine A and Neuronospecific Enolase staining. Among NET, four were in the body and two in the head, with a medium diameter of 11mm (minimum 6 and maximum 15mm). In 3 patients, the first diagnosis was IPMN, followed by identification of NET with second level imaging. In 3 patients, who underwent magnetic resonance imaging for NET, a concomitant IPMN was found. Conclusions: Our study describes six cases of endocrine-exocrine pancreatic neoplasms association. Up to now both IPMN and NET in all patients had an indolent behaviour. We found neither sex or age predisposition, nor predominant localization or common pathologic background in the patients. No other concomitant neoplastic diseases were found. Altough the frequency of association between NET and IPMN is not too large and no diagnostic hallmark were found, it is still to be proven that this association is fortuitous. Further studies in the future are required.
P.08.18 ENDOSCOPIC RESECTION OF SMALL DUODENAL NEUROENDOCRINE TUMORS: REPORT OF THREE CASES A. Fantin 1 , I. Barbuscio ∗,1 , C. Martini 2 , G.C. Sturniolo 1 1 Gastroenterology
Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova, Italy; 2 Third
Medical Unit, Department of Medicine, University Hospital of Padua, Padua, Italy Background and aim: Duodenal neuroendocrine tumors (d-NETs) are rare, representing 1%–3% of all gastrointestinal (GI) NETs. Most duodenal NETs are asymptomatic and generally diagnosed during upper gastrointestinal endoscopy for unrelated symptoms. Small d-NENs (<1 cm) can be locally resected by endoscopy according to the European Neuroendocrine Tumor Society (ENETS) consensus guidelines. Material and methods: We report here three cases of small duodenal NETs diagnosed and managed endoscopically. Results: Case 1: A 68-year-old man was admitted for EGD due to dyspeptic symptoms. He was incidentally found to have a submucosal lesion less than 1 cm in size in the apex of duodenal bulb. Endoscopic ultrasonography study shows that the lesion was 9 mm and that has no signs of invasion of the muscularis propria. An endoscopic snare resection was carried out and the lesion was completely removed macroscopically. The histological examination shows neuroendocrine tumor with well/moderate differentiation (G2 sec WHO 2010) with free margin. Case 2: A 62-year-old man was admitted for EGD due to symptoms suggesting gastroesophageal reflux. In the duodenal bulb we found a small submucosal polyp less than 1 cm in size. The endoscopic ultrasonography study shows no signs of invasion and the polyp were subsequently completely removed by an endoscopic snare resection. The histology report established that the lesion was a duodenal NET (G1 sec WHO 2010) and that the resection had been radical. Case 3: a 67-year-old man with incidentally discovered small duodenal submucosal lesion at EGD due to dyspeptic symptoms. Subsequent ultrasonography study shows that the lesion was 5 mm, limited to the submucosa and the polyp were resected with an endoscopic snare. The histological examination confirmed that neuroendocrine tumor (G1 sec WHO) were interely resected. No complications occurred during the procedures. Conclusions: Small d-NETs (<1 cm) are usually diagnosed by EGDS performed for aspecific symptoms. According to the European Neuroendocrine Tumor Society (ENETS) consensus guidelines small d-NENs (<1 cm), well-differentiated, that are limited to the mucosa or submucosa can be locally resected by endoscopy.
P.09 Liver
P.09.1 A CASE REPORT OF USTEKINUMAB-INDUCED ACUTE LIVER INJURY R. Lovero ∗ , G. Losurdo, N.M. Castellaneta, A. Mongelli, A. Iannone, M. Barone, M. Principi, E. Ierardi, A. Di Leo UOC Gastroenterologia Universitaria Policlinico di Bari, Bari, Italy Background and aim: Ustekinumab is a fully human monoclonal antibody which binds interleukin IL-12/23 receptor. It is indicated for the treatment of moderate-severe psoriasis and for active psoriatic arthritis. A Spanish, observational, retrospective study investigated the incidence of drug-induced liver injury in patients treated with ustekinumab in daily clinical practice over a period of about two years: mild elevation of the transaminases was observed in only 14% of patients and no cases of severe hypertransaminasemia were observed. Material and methods: We describe a case of severe acute liver damage induced by ustekinumab.
observed accrding to the colonic sites of placement or indications (BTS vs. palliative). Conclusions: The procedure for placing SEMS is efficacious and safe with an acceptable rate of complications when used either as a bridge to surgery or with palliative intent and both for right and left-side colonic stenosis.
P.08.15 STENTING IN MALIGNANT ESOPHAGEAL STRICTURES: OUTCOMES AND ADVERSE EVENTS IN OUR EXPERIENCE L. Gargiulo ∗ , P. Ciamarra, O. Labianca, G. Napoli, M. Napoli, A. Maurano AOIU San Giovanni di Dio e Ruggi d’Aragona, Gaetano Fucito Hospital, Digestive Endoscopy Unit, Mercato San Severino (Salerno), Italy Background and aim: Esophageal stenting has a high clinical impact, with a widely accepted role in obstructive benign and malignant conditions. Several different kind of stents have been developed, including self-expanding plastic and metal stents, available as uncovered, partially covered, and fully covered as well as biodegradable stents. Knowing that the management of patients with malignant esophageal strictures it requires a multidisciplinary approach, the aim of this study is to evaluate the outcomes and safety in palliative treatment of esophageal strictures and fistula, with different kind of stents, in our Unit of Digestive Endoscopy. Material and methods: A descriptive, retrospective study from august 2014 to august 2016 on the placement of 18 esophageal self-expanfing metal stents (SEMS) was conducted. Patients were 16 males and 2 females, mean age was 72.5 years (range 44–86 years). All patients were suffering from worsening dysphagia, and were subjected to chest and abdomen CT-scan. It was 12 patients with esophageal cancer, 4 patients with lung cancer and 2 patients with tracheo-esophageal fistula. We used 6 partially covered SEMS (Hanarostent, M.I. Tech. Co. Ltd. South Korea), and 6 uncovered SEMS (Boston Scientific Co. Natick, USA) in patients with esophageal cancer; 4 partially covered SEMS (3 Hanarostent, M.I. Tech. Co. Ltd. South Korea, and 1 Taewoong Medical Co. Ltd South Korea) in patients with lung cancer; 2 fully covered SEMS (Hanarostent, M.I. Tech. Co. Ltd. South Korea) in patients with tracheo-esophageal fistula. All the stents were “over the wire” (OTW system) and were positioned under fluoroscopy. Results: We had no major complications such as perforation or bleeding. All but two patients (88.9%) were able to be orally feeded with a significant relief of dysphagia. We had persistent dysphagia in one patient with esophageal cancer (5.5%), treated with an uncovered SEMS. We had one dislocation in the stomach (5.5%) in a patient with lung neoplasia treated with a partially covered SEMS. After SEMS’s placement, almost all the patients needed FANS treatment, due to medium to severe chest pain for an average of 4–5 days. Partially covered SEMS were more tolerated than uncovered. Conclusions: In our experience, the placement of SEMS is an appropriate palliative option of dysphagia in malignant esophageal strictures and safely treatment of fistulas. Currently there is no evidence scientific those that demonstrate a superiority of a particular type of stent among those in the trade, therefore the choice of a specific stent is often based on the endoscopist’s experience.
e185
P.08.16 EARLY ONSET COLORECTAL CANCER VS SPORADIC COLORECTAL CANCER: A CLINICOPATHOLOGICAL AND MOLECULAR COMPARISON L.H. Eusebi ∗,1 , C. Ceccarelli 2 , M.L. Artesiani 1 , L. Montanaro 3 , M. Derenzini 3 , F. Dall’Olio 4 , A. Ardizzoni 4 , G. Biasco 4 , D. Adua 4 , F. Bazzoli 1 , L. Ricciardiello 1 1 Department
of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy; 2 Pathology Unit, Sant’Orsola University Hospital, Bologna, Italy; 3 Department of Experimental, Diagnostic and Specialty Medicine, Bologna University, Bologna, Italy; 4 Medical Oncology Unit, Sant’Orsola University Hospital, Bologna, Italy Background and aim: Early Onset Colorectal cancers (EOCRCs) develop before the age of 50, with no evidence of familial predisposition or belonging to hereditary syndromes. Little is known about their predisposing factors and the molecular pathways that promote the early onset of these tumours. Our aim was to evaluate if EOCRCs may be defined as a distinct entity by comparing their clinicopathological, histological and molecular features to a consecutive series of sporadic CRCs developed in patients over 50 years of age. Material and methods: A series of 94 EOCRC identified from prospectively maintained databases of oncological surgeries was compared to a consecutive series of 192 sporadic CRCs from patients older than 50 years (from the same hospital). For all included cases, data was extracted on patients demographics, clinical features, and tumours histological and molecular data, including MLH1 and MSH2 protein levels, as well as p53 and Thymidylate synthase (TS) protein levels. Results: The mean age of EOCRCs and controls was 43 and 67 years. Regarding cancer location, 57% of the control CRCs were located in the left colon, whereas the most common site of EOCRCs was the rectum (p=0.16). Stage II lesions were the most frequent in the controls (47% of the cases – no stage 0 or stage I cancers were present in this group) whereas the advanced stages III and IV were present in 40% and 13% of the cases, respectively. Similarly, in the EOCRCs group stage III and IV lesions represented 50% of patients, although stage IV cancers seem to occur more often (16%). Histologically, EOCRCs showed a tendency of higher incidence of poorly differentiated tumours compared to control CRCs (20% vs. 15%) (p=0.29). Mucinous histology and signet-ring cell tumours were present in 15% and 0% of controls compared to 21% and 2% in the EOCRC cohort. Regarding the molecular features, 7.2% and 0% in the EOCRC and 9.9% and 4.7% lacked MLH1 and MSH2 expression, respectively. In both groups, immunohistochemistry analysis showed similar low p53 levels in 36% of cases and high TS levels (21% in both groups).
e186
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
Conclusions: The genetic basis in the majority of early onset colorectal carcinomas remains unknown, However, most EOCRCs appear to arise through the same pathways as sporadic CRCs, such as the classical adenoma-carcinoma sequence. EOCRCs appear more frequently as aggressive cancers, related to the advanced stage of disease and the delayed diagnosis since patients with less than 50 years of age are not included in screening programs.
P.08.17 CONCOMITANT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS AND NEUROENDOCRINE TUMORS OF THE PANCREAS: MORE THAN JUST A COINCIDENCE? L. Venezia ∗ , P. Cortegoso Valdivia, C.G. De Angelis Azienda Ospedaliera San Giovanni Battista, Presidio Molinette, Turin, Italy Background and aim: Intraductal papillary mucinous neoplasms (IPMNs) and neuroendocrine tumors (NETs) of the pancreas are rare tumors. Up to now 14 patients with association of endocrine and exocrine neoplasms of the pancreas have been reported in the literature, but this association is not expected to be frequent. The aim of this study is to describe a series of six patients with IPMN and concomitant NET of the pancreas followed in our center and to look for any common findings between them that could help early recognition and further comprehension of this association. Material and methods: Among all the patients who were followed in our clinic for IPMN or NET, we identified 6 with both diseases, diagnosed on imaging or after biopsies requested for uncertain results of previous investigations. We collected data about the patients (age, sex, symptoms, past and current medical history, blood chemistry, type of imaging) and about the lesions (classification, dimension, localization, imaging features, fine-needle aspiration (FNA) biopsies results and histology). Results: All patients (3 men and 3 women) were asymptomatic. Average age at diagnosis is 52 years. All IPMN were branch duct, localized in the head (n=4) and in body-tail (n=2), with a medium diameter of the duct of 12mm (minimum 8 and maximum 16 mm). All NET underwent endoscopic ultrasound examination with FNA; all were non functional G1 with a Ki67 of 1%, positive for Chromogranine A and Neuronospecific Enolase staining. Among NET, four were in the body and two in the head, with a medium diameter of 11mm (minimum 6 and maximum 15mm). In 3 patients, the first diagnosis was IPMN, followed by identification of NET with second level imaging. In 3 patients, who underwent magnetic resonance imaging for NET, a concomitant IPMN was found. Conclusions: Our study describes six cases of endocrine-exocrine pancreatic neoplasms association. Up to now both IPMN and NET in all patients had an indolent behaviour. We found neither sex or age predisposition, nor predominant localization or common pathologic background in the patients. No other concomitant neoplastic diseases were found. Altough the frequency of association between NET and IPMN is not too large and no diagnostic hallmark were found, it is still to be proven that this association is fortuitous. Further studies in the future are required.
P.08.18 ENDOSCOPIC RESECTION OF SMALL DUODENAL NEUROENDOCRINE TUMORS: REPORT OF THREE CASES A. Fantin 1 , I. Barbuscio ∗,1 , C. Martini 2 , G.C. Sturniolo 1 1 Gastroenterology
Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova, Italy; 2 Third
Medical Unit, Department of Medicine, University Hospital of Padua, Padua, Italy Background and aim: Duodenal neuroendocrine tumors (d-NETs) are rare, representing 1%–3% of all gastrointestinal (GI) NETs. Most duodenal NETs are asymptomatic and generally diagnosed during upper gastrointestinal endoscopy for unrelated symptoms. Small d-NENs (<1 cm) can be locally resected by endoscopy according to the European Neuroendocrine Tumor Society (ENETS) consensus guidelines. Material and methods: We report here three cases of small duodenal NETs diagnosed and managed endoscopically. Results: Case 1: A 68-year-old man was admitted for EGD due to dyspeptic symptoms. He was incidentally found to have a submucosal lesion less than 1 cm in size in the apex of duodenal bulb. Endoscopic ultrasonography study shows that the lesion was 9 mm and that has no signs of invasion of the muscularis propria. An endoscopic snare resection was carried out and the lesion was completely removed macroscopically. The histological examination shows neuroendocrine tumor with well/moderate differentiation (G2 sec WHO 2010) with free margin. Case 2: A 62-year-old man was admitted for EGD due to symptoms suggesting gastroesophageal reflux. In the duodenal bulb we found a small submucosal polyp less than 1 cm in size. The endoscopic ultrasonography study shows no signs of invasion and the polyp were subsequently completely removed by an endoscopic snare resection. The histology report established that the lesion was a duodenal NET (G1 sec WHO 2010) and that the resection had been radical. Case 3: a 67-year-old man with incidentally discovered small duodenal submucosal lesion at EGD due to dyspeptic symptoms. Subsequent ultrasonography study shows that the lesion was 5 mm, limited to the submucosa and the polyp were resected with an endoscopic snare. The histological examination confirmed that neuroendocrine tumor (G1 sec WHO) were interely resected. No complications occurred during the procedures. Conclusions: Small d-NETs (<1 cm) are usually diagnosed by EGDS performed for aspecific symptoms. According to the European Neuroendocrine Tumor Society (ENETS) consensus guidelines small d-NENs (<1 cm), well-differentiated, that are limited to the mucosa or submucosa can be locally resected by endoscopy.
P.09 Liver
P.09.1 A CASE REPORT OF USTEKINUMAB-INDUCED ACUTE LIVER INJURY R. Lovero ∗ , G. Losurdo, N.M. Castellaneta, A. Mongelli, A. Iannone, M. Barone, M. Principi, E. Ierardi, A. Di Leo UOC Gastroenterologia Universitaria Policlinico di Bari, Bari, Italy Background and aim: Ustekinumab is a fully human monoclonal antibody which binds interleukin IL-12/23 receptor. It is indicated for the treatment of moderate-severe psoriasis and for active psoriatic arthritis. A Spanish, observational, retrospective study investigated the incidence of drug-induced liver injury in patients treated with ustekinumab in daily clinical practice over a period of about two years: mild elevation of the transaminases was observed in only 14% of patients and no cases of severe hypertransaminasemia were observed. Material and methods: We describe a case of severe acute liver damage induced by ustekinumab.