- Email: [email protected]
P.09.8 ENDOSCOPIC MANAGEMENT OF FOREIGN BODIES INGESTION IN UPPER GASTROINTESTINAL TRACT: A COMPARISON OF TWO DIFFERENT PERIODS
S84
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144
with precancerous lesions or early gastric cancer larger than 15 mm were studied. The ESD was performed by two expert endoscopists. ESD was done with the Mucosectom or the IT Knife-2. Results: Twenty lesions were resected en bloc: ten with Mucosectom and ten with IT Knife-2. Procedure time was significantly shorter (p<0.05) with Mucosectom ESD than IT Knife-2. Delayed bleeding occurred in four patients (20%): two in each group, all treated by hemoclips placement. A delayed perforation occurred in the Mucosectom group and one intraprocedural perforation occurred in IT Knife-2 group: all were treated conservative. There were no recurrences in either group in the six-month follow-up from the procedure. Conclusions: Both knives resulted effective and safe, simple and easy to learn but the Mucosectom needed a shorter procedure time. It is useful for expert endoscopists and would also help less skilled endoscopists in carring out ESD safely.
P.09.5 ENDOSCOPIC ABLATION OF DYSPLASTIC BARRETT’S ESOPHAGUS USING THE HALO BARXX® SYSTEM. OUTCOMES OF PROSPECTIVE SERIES OF 24 PATIENTS
(DFS) and incidence of peritoneal carcinosis (PC) in a cohort of 40 patients (mean age: 70.8 y, M/F: 23/17, 11 pts with perforation/29 pts without perforations) treated with a SEMS (Wallstent Enteral-Boston Scientific) for a colonic obstruction due to colorectal cancer between January 2004 and 2009 at our institution. All patients with perforation but one were asymptomatic, all patients underwent surgery with radical intent. Results: Mean follow-up time was 52 mo (2-99 mo, median: 53 mo). MS, DSF and incidence of PC did non not statistically differ between patients with perforation (group P) and patients without perforation (group NP) (MS group P 39±31 mo vs MS group NP 57±27 mo p=ns, DFS group P 33±33.9 mo vs DFS group NP 42±32 mo p=ns, PC incidence: 3 cases in both groups, p=ns). Conclusions: Although the difference observed between the two groups didn’t reach statistical significance, these data should be taken with caution because of the small sample size (β error). Waiting for further studies to assess the long-term oncologic outcomes of SEMS for colorectal cancer, we suggest that stenting be reserved for patients who are at increased risk for complications of emergency surgery.
P.09.7
F. Decembrino ∗ , L. Camellini, F. Azzolini, V. Iori, C. Tioli, G. Sereni, M. Cavina, R. Sassatelli
OVER THE SCOPE CLIP (OTSC) IN UPPER AND LOWER GASTROINTESTINAL PERFORATION, LEAK AND BLEEDING: CLINICAL EXPERIENCE
IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
B. Mangiavillano ∗ , M. Arena, E. Morandi, P. Viaggi, E. Masci
Background and aim: Barrett’s Esophagus, a condition of intestinal metaplasia of the Esophagus, is associated with an increased risk of esophageal adenocarcinoma. Endoscopic Radiofrequency Ablation (RFA) can eradicate dysplastic Barrett’s esophagus and decrease the rate of neoplastic progression. We evaluated the efficacy and safety of the RFA treatment using the Halo Barrx® System in patients with dysplastic Barrett’s esophagus. Material and methods: From November 2008 to September 2013 we have treated with circumferencial and focal radiofrequency ablation 24 patients with dysplastic Barrett’s esophagus, 18 males and 6 females, median age 64 years (range 44–79 years). Before treatment 83% of patients had low grade dysplasia (LGD), 17% had high grade dysplasia (HGD). In one patient we have removed small visible abnormality with endoscopic resection before the first treatment, and the histological examination was in situ-adenocarcinoma. Most of patients (63%) received 2 treatments, 25% 1 treatment and the remaining 12% 3 treatments. The median length of Barrett was 3 centimeters. Results: Overall, during a median follow-up period of thirty months CRdysplasia (CR-D) was 88%, CR-intestinal metaplasia (CR-IM) was 79%, while in 3 patients (12%) the response to treatment is not available because 3 patients have not yet completed a one-year follow-up. One of these had upper gastrointestinal bleeding resolved spontaneously. Conclusions: Radiofrequency ablation of dysplastic Barrett’s esophagus was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a low rate of complications.
P.09.6 LONG-TERM OUTCOME OF PATIENTS WITH PERFORATION AFTER STENT INSERTION FOR OBSTRUCTING COLORECTAL CANCER A. Buzzi ∗ , E. Petroncini, T. Casetti, O. Triossi Gastroenterologia ed Endoscopia Digestiva Ospedale Santa Maria delle Croci, Ravenna, Italy Background and aim: Self expandable metal stents (SEMS) for acute malignant colorectal obstruction are an option for patients with obstructing colorectal cancer who require decompression in order to permit elective surgical intervention. However, some recent studies suggest increased morbidity compared with surgery, in particular a high prevalence of silent perforation was reported and this could hamper the long-term outcome. Aim of our study was to assess the long-term outcome of patients with perforation after stent insertion compared with patients without perforation. Material and methods: We assess mean survival (MS), disease free survival
Azienda Ospedaliera San Paolo, Milano, Italy Background and aim: Gastro-intestinal acute perforation and bleeding are potentially life-threatening emergencies and could be treated endoscopically by using metallic clips. However clips have limits with regard to compression of tissue, especially in scarred and hardened tissue or inflammatory mucosa. Recently, a novel clip device, the over-the-scope clip (OTSC) (OVESCO® ) system has been developed to treat these patients. Clinical experiences in case series with the OTSC clip is however actually limited. Aim of our study is to retrospectively evaluate the usefulness of OTSC clip in the upper and lower GI acute perforation, leaks and bleeding. Material and methods: OTSC is a self-retracting clip made of nitinol, installed on a silicon straight cap that can be mounted on the tip of endoscope. The OTSC has two jaws that move separately to approximate the edges of the GI wall, to close the defect or stopping the bleeding. It can be released by turning a handle that is attached to the biopsy channel of the endoscope, similarly to endoscopic variceal ligation. Accessories used to close the defect are the “twin-grasper” and the “anchor”. To stop haemorrage only aspiration is usually needed. Seventeen patients were retrospectively evaluated. There were 7 leaks, 4 acute iatrogenic perforation and 6 bleedings. Results: All of the 7 leakage had good clinical course obtaining the complete sealing. Three of the 4 acute perforations had good clinical course with immediate closure of the wall defect, only one patient underwent surgical intervention. All of the 6 patients had stop bleeding after OTSC placement and no re-bleeding were observed. Conclusions: In our experience, including leak, iatrogenic acute perforation and bleeding, OTSC was a successful technique in the 94.1% of the cases. The major advantage of OTSC clips seems to be their ability to grasp more tissue compared to the standard clips and their strong grip on the lesions margins, because of their teeth. It could be create an advantage in the operative endoscopic techniques for the treatment of different cases that otherwise required surgery.
P.09.8 ENDOSCOPIC MANAGEMENT OF FOREIGN BODIES INGESTION IN UPPER GASTROINTESTINAL TRACT: A COMPARISON OF TWO DIFFERENT PERIODS G. Lombardi ∗ , E. Riccio, L. Orsini, S. Picascia, F. Cipolletta, L. Cipolletta Ospedale A.Cardarelli, Napoli, Italy Background and aim: The ingestion of foreign bodies (FB) is a frequent indication for urgent endoscopy. Few studies report the experience in a tertiary
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 referral center with a comparison between two periods away between them over 15 years. Material and methods: We have previously published our case series of patients admitted for referred impact of food bolus or ingestion of FB in the years 1995–1999 (55 months) and we have revised our series most recently until September 2013 (27 months) for a comparison between these two experiences.Since 2000 in our hospital there is an endoscopist for emergency over the entire 24-hour period Results: In the first period, were admitted 414 patients (F 181/M 233; m.a. 40.6) (7.5/m) while in recent months the number of patients was 345 (9% related to pediatric patients) (F 153/M 192; m.a. 46;1-96) (12.7/m) with an increase of 60% of cases. In the first period the indication for endoscopic examination accounted for about 4% of all urgent endoscopy of the upper digestive tract while in the most recent period we found a significant increase in cases, that had risen to 13.7%. In the previous series 114 out of 414 FB (34%) have not been found while in the most recent series only 82 FB (23.7%) have not been found, with a decrease of over 30%. The esophagus is the most frequent site of impact (>75% in both periods) followed by the stomach (16.5% and 14% respectively)and the pharynx (6.4% and 8.4% respectively). The impact of the food bolus is the most frequent reason for access to the emergency room (∼70%), followed by the ingestion of animal bone, coins, batteries, dentures and metal objects. All except three EC have been removed endoscopically in the first series while only one in the recent series with no major complications. Conclusions: The urgent endoscopy for the removal of boluses or foreign bodies is increasingly common in tertiary centers located in large urban areas and in our observation period has more than tripled from 4% to 13.7% of all the urgencies of UPGI. The significant reduction in the percentage of foreign bodies not found at the endoscopic examination is probably due to the ready availability of the endoscopist in recent years than in the past for the removal of the foreign body before it reaches the stomach filled with food. Reference: [1] S. Mosca et al. Endoscopy 2001;33(8):692–6.
P.09.9 SELF-EXPANDING METAL STENTS FOR BENIGN ESOPHAGEAL CONDITIONS: A SINGLE CENTER EXPERIENCE A. Anderloni ∗ , C. Genco, M. Massidda, E. Carlani, A. Carlino, S. Carrara, M. Jovani, E.C. Ferrara, G. Strangio, A. Malesci, A. Repici UO Endoscopia Digestiva, Istituto Clinico Humanitas, Rozzano, Italy Background and aim: Esophageal leaks, fistulae, and stenosis represent lifethreatening conditions with high morbidity and mortality. Over the last several years endoscopic esophageal stenting with Partially Covered Self Expanding Metal Stents (PCSEMS) or Fully Covered SEMS (FCSEMS) has been used as an alternative to surgery to treat these benign conditions. Our purpose was to evaluate the early and long-term outcome of PCSEMS and FCSEMS in patients with benign esophageal diseases. Material and methods: Data were extracted from a prospectively maintained register of all patients who underwent SEMS placement for benign esophageal conditions between January 2008 and September 2013 in our center. Patients’ demographics, locations and type of lesions, stents placement and removal, clinical success, and adverse events were analyzed. Results: A total of 68 patients (age 61.9±14.5 years; M/F: 53/15) received 121 SEMS (84 PCSEMS and 37 FCSEMS) for leaks (21 pts; 37 stents), fistulae (36 pts; 52 stents) and stenosis (11 pts; 54 stents). Technical success was achieved in all patients (100%) and therapeutic success (defined as permanent closure of leak/fistula or resolution of stenosis) was achieved in 22 pts (32.3%): 16 fistulae (13 PCSEMS, 3 FCSEMS), 5 leaks (4 PCSEMS, 1 FCSEMS), 1 stenosis (1 FCSEMS). Four pts (5.9%) experienced early adverse events (<1 week): 3 stents migration (2 PCSEMS, 1 FCSEMS) and 1 pneumomediastinum (1 FCSEMS). Stents removal was performed after a mean of 23.4 days (range 1–126±21.2) with 3 cases of major complications (esophageal mucosal stripping, 2 with PCSEMS and 1 with FCSEMS), which were successfully treated with second stent placement in one case and conservative therapy in the remaining. Long term complications (>1 week) were observed in 35 pts (51.5%): 8 stent migration (5 PCSEMS, 3 FCSEMS), 15 fistula persistence
S85
(12 PCSEMS, 3 FCSEMS), 8 stenosis persistence (5 PCSEMS, 3 FCSEMS), 4 tissue ingrowth (2 PCSEMS, 2 FCSEMS). Conclusions: The use of PCSEMS and FCSEMS for benign esophageal conditions is feasible although still associated with significant rates of complications and therapeutic failures. Better outcomes were observed in the subgroup of pts with fistulae. However further studies are needed in order to evaluate predictive factors related to successful outcome.
P.10.1 EFFECT OF ACID-SUPPRESSIVE THERAPY ON BASELINE IMPEDANCE IN NERD PATIENTS F.P. Zito ∗ , P. Andreozzi, M. Della Coletta, M.I. Arnone, C. Buonfantino, R. Civitelli, G. Sarnelli, R. Cuomo Federico II University, Naples, Italy Background and aim: Patients with non-erosive reflux disease (NERD) have a lower impedance baseline than healthy subjects, probably due to an impaired oesophageal mucosal integrity. Proton pump inhibitors (PPIs) improve mucosal damage in erosive reflux disease (ERD) but the effects on mucosal integrity in NERD patients is still unclear. Our aim is to investigate whether PPI therapy affects impedance baseline in NERD patients. Material and methods: 24patients (13 M - mean age 45±9) with typical GERD-symptoms (heartburn and regurgitation) and with an endoscopically proven diagnosis of NERD and pathologic 24h ph-impedance monitoring were consecutively enrolled; 16 and 8 patients underwent toesophageal 24h pH-impedance monitoring while on therapy and off-therapy, respectively. For each patient, esophageal baseline impedance (BI) was calculated during the first period of 30 seconds without an impedance event (swallow or reflux) every two hours. Impedance baseline at 17, 15 and 9 cm from the lower esophageal sphincter (LES) was considered as proximal BI while impedance measurements at 7, 5 and 3 cm from LES were used in order to calculate distal BI. Results: Patients on therapy showed a significantly higher distal baseline impedance than off-therapy patients (2965,5±363,1 vs 2363,6±179,6; p<0.01). On the contrary, proximal baseline impedance was similar in the two groups (2687,2±357,7vs 2582,7±312,0; p>0.05). Conclusions: Our results indicate that acid suppressive therapy is able to influence distal baseline impedance in NERD patients, but it remains unclear if this reflects an improvement in mucosal integrity. In addition, although no significantly effects were observed on proximal baseline impedance, further studies on patients with pathological proximal reflux extent are needed.
P.10.2 THE PROGNOSTIC IMPACT OF ISOLATED TUMOR CELLS (ITC) IN LYMPH NODES OF PN0 ESOPHAGEAL CANCER L. Albertoni ∗,1 , L. Stefanizzi 1 , A. Ruol 1 , C. Castoro 2 , L. Giacomelli 1 , C. Mescoli 1 , G. Zaninotto 1 , M. Rugge 1 1 Azienda
Ospedaliera, Policlinico Universitario, Padova, Italy; 2 Istituto Oncologico Veneto, IOV – IRCCS, Padova, Italy Background and aim: Esophageal cancer is the sixth leading cause of cancer-related mortality and its overall five-year survival ranges from 15% to 25%. Metastasis in regional nodes is the most important prognostic factor. Among pN0 cancers (routine histology; H&E-stain), 30%-40% patients develop recurrent disease within five years. Isolated tumor cells (ITC) in regional lymph nodes may (at least partially) explain cancer recurrence. In the largest series ever published, this study assessed the prognostic impact of ITC-status (ITC+ve versus ITC-ve) in regional nodes of 281 consecutive pN0 esophageal cancers. Material and methods: Ninety-five esophageal adenocarcinoma (AdC; 23/95 undergone neo-adjuvant therapy) and 186 esophageal squamous cell carcinoma (SCC; 95/186 undergone neo-adjuvant therapy) were included. In total, 4767 lymph nodes (mean number of nodes/patient: 17; range: 1–58) were considered. ITC-status was assessed by immunohistochemistry (MNF116 antibody for cytokeratines; Dako). In all cases, Lymph node ratio ([LN-ratio]
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144
with precancerous lesions or early gastric cancer larger than 15 mm were studied. The ESD was performed by two expert endoscopists. ESD was done with the Mucosectom or the IT Knife-2. Results: Twenty lesions were resected en bloc: ten with Mucosectom and ten with IT Knife-2. Procedure time was significantly shorter (p<0.05) with Mucosectom ESD than IT Knife-2. Delayed bleeding occurred in four patients (20%): two in each group, all treated by hemoclips placement. A delayed perforation occurred in the Mucosectom group and one intraprocedural perforation occurred in IT Knife-2 group: all were treated conservative. There were no recurrences in either group in the six-month follow-up from the procedure. Conclusions: Both knives resulted effective and safe, simple and easy to learn but the Mucosectom needed a shorter procedure time. It is useful for expert endoscopists and would also help less skilled endoscopists in carring out ESD safely.
P.09.5 ENDOSCOPIC ABLATION OF DYSPLASTIC BARRETT’S ESOPHAGUS USING THE HALO BARXX® SYSTEM. OUTCOMES OF PROSPECTIVE SERIES OF 24 PATIENTS
(DFS) and incidence of peritoneal carcinosis (PC) in a cohort of 40 patients (mean age: 70.8 y, M/F: 23/17, 11 pts with perforation/29 pts without perforations) treated with a SEMS (Wallstent Enteral-Boston Scientific) for a colonic obstruction due to colorectal cancer between January 2004 and 2009 at our institution. All patients with perforation but one were asymptomatic, all patients underwent surgery with radical intent. Results: Mean follow-up time was 52 mo (2-99 mo, median: 53 mo). MS, DSF and incidence of PC did non not statistically differ between patients with perforation (group P) and patients without perforation (group NP) (MS group P 39±31 mo vs MS group NP 57±27 mo p=ns, DFS group P 33±33.9 mo vs DFS group NP 42±32 mo p=ns, PC incidence: 3 cases in both groups, p=ns). Conclusions: Although the difference observed between the two groups didn’t reach statistical significance, these data should be taken with caution because of the small sample size (β error). Waiting for further studies to assess the long-term oncologic outcomes of SEMS for colorectal cancer, we suggest that stenting be reserved for patients who are at increased risk for complications of emergency surgery.
P.09.7
F. Decembrino ∗ , L. Camellini, F. Azzolini, V. Iori, C. Tioli, G. Sereni, M. Cavina, R. Sassatelli
OVER THE SCOPE CLIP (OTSC) IN UPPER AND LOWER GASTROINTESTINAL PERFORATION, LEAK AND BLEEDING: CLINICAL EXPERIENCE
IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
B. Mangiavillano ∗ , M. Arena, E. Morandi, P. Viaggi, E. Masci
Background and aim: Barrett’s Esophagus, a condition of intestinal metaplasia of the Esophagus, is associated with an increased risk of esophageal adenocarcinoma. Endoscopic Radiofrequency Ablation (RFA) can eradicate dysplastic Barrett’s esophagus and decrease the rate of neoplastic progression. We evaluated the efficacy and safety of the RFA treatment using the Halo Barrx® System in patients with dysplastic Barrett’s esophagus. Material and methods: From November 2008 to September 2013 we have treated with circumferencial and focal radiofrequency ablation 24 patients with dysplastic Barrett’s esophagus, 18 males and 6 females, median age 64 years (range 44–79 years). Before treatment 83% of patients had low grade dysplasia (LGD), 17% had high grade dysplasia (HGD). In one patient we have removed small visible abnormality with endoscopic resection before the first treatment, and the histological examination was in situ-adenocarcinoma. Most of patients (63%) received 2 treatments, 25% 1 treatment and the remaining 12% 3 treatments. The median length of Barrett was 3 centimeters. Results: Overall, during a median follow-up period of thirty months CRdysplasia (CR-D) was 88%, CR-intestinal metaplasia (CR-IM) was 79%, while in 3 patients (12%) the response to treatment is not available because 3 patients have not yet completed a one-year follow-up. One of these had upper gastrointestinal bleeding resolved spontaneously. Conclusions: Radiofrequency ablation of dysplastic Barrett’s esophagus was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a low rate of complications.
P.09.6 LONG-TERM OUTCOME OF PATIENTS WITH PERFORATION AFTER STENT INSERTION FOR OBSTRUCTING COLORECTAL CANCER A. Buzzi ∗ , E. Petroncini, T. Casetti, O. Triossi Gastroenterologia ed Endoscopia Digestiva Ospedale Santa Maria delle Croci, Ravenna, Italy Background and aim: Self expandable metal stents (SEMS) for acute malignant colorectal obstruction are an option for patients with obstructing colorectal cancer who require decompression in order to permit elective surgical intervention. However, some recent studies suggest increased morbidity compared with surgery, in particular a high prevalence of silent perforation was reported and this could hamper the long-term outcome. Aim of our study was to assess the long-term outcome of patients with perforation after stent insertion compared with patients without perforation. Material and methods: We assess mean survival (MS), disease free survival
Azienda Ospedaliera San Paolo, Milano, Italy Background and aim: Gastro-intestinal acute perforation and bleeding are potentially life-threatening emergencies and could be treated endoscopically by using metallic clips. However clips have limits with regard to compression of tissue, especially in scarred and hardened tissue or inflammatory mucosa. Recently, a novel clip device, the over-the-scope clip (OTSC) (OVESCO® ) system has been developed to treat these patients. Clinical experiences in case series with the OTSC clip is however actually limited. Aim of our study is to retrospectively evaluate the usefulness of OTSC clip in the upper and lower GI acute perforation, leaks and bleeding. Material and methods: OTSC is a self-retracting clip made of nitinol, installed on a silicon straight cap that can be mounted on the tip of endoscope. The OTSC has two jaws that move separately to approximate the edges of the GI wall, to close the defect or stopping the bleeding. It can be released by turning a handle that is attached to the biopsy channel of the endoscope, similarly to endoscopic variceal ligation. Accessories used to close the defect are the “twin-grasper” and the “anchor”. To stop haemorrage only aspiration is usually needed. Seventeen patients were retrospectively evaluated. There were 7 leaks, 4 acute iatrogenic perforation and 6 bleedings. Results: All of the 7 leakage had good clinical course obtaining the complete sealing. Three of the 4 acute perforations had good clinical course with immediate closure of the wall defect, only one patient underwent surgical intervention. All of the 6 patients had stop bleeding after OTSC placement and no re-bleeding were observed. Conclusions: In our experience, including leak, iatrogenic acute perforation and bleeding, OTSC was a successful technique in the 94.1% of the cases. The major advantage of OTSC clips seems to be their ability to grasp more tissue compared to the standard clips and their strong grip on the lesions margins, because of their teeth. It could be create an advantage in the operative endoscopic techniques for the treatment of different cases that otherwise required surgery.
P.09.8 ENDOSCOPIC MANAGEMENT OF FOREIGN BODIES INGESTION IN UPPER GASTROINTESTINAL TRACT: A COMPARISON OF TWO DIFFERENT PERIODS G. Lombardi ∗ , E. Riccio, L. Orsini, S. Picascia, F. Cipolletta, L. Cipolletta Ospedale A.Cardarelli, Napoli, Italy Background and aim: The ingestion of foreign bodies (FB) is a frequent indication for urgent endoscopy. Few studies report the experience in a tertiary
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 referral center with a comparison between two periods away between them over 15 years. Material and methods: We have previously published our case series of patients admitted for referred impact of food bolus or ingestion of FB in the years 1995–1999 (55 months) and we have revised our series most recently until September 2013 (27 months) for a comparison between these two experiences.Since 2000 in our hospital there is an endoscopist for emergency over the entire 24-hour period Results: In the first period, were admitted 414 patients (F 181/M 233; m.a. 40.6) (7.5/m) while in recent months the number of patients was 345 (9% related to pediatric patients) (F 153/M 192; m.a. 46;1-96) (12.7/m) with an increase of 60% of cases. In the first period the indication for endoscopic examination accounted for about 4% of all urgent endoscopy of the upper digestive tract while in the most recent period we found a significant increase in cases, that had risen to 13.7%. In the previous series 114 out of 414 FB (34%) have not been found while in the most recent series only 82 FB (23.7%) have not been found, with a decrease of over 30%. The esophagus is the most frequent site of impact (>75% in both periods) followed by the stomach (16.5% and 14% respectively)and the pharynx (6.4% and 8.4% respectively). The impact of the food bolus is the most frequent reason for access to the emergency room (∼70%), followed by the ingestion of animal bone, coins, batteries, dentures and metal objects. All except three EC have been removed endoscopically in the first series while only one in the recent series with no major complications. Conclusions: The urgent endoscopy for the removal of boluses or foreign bodies is increasingly common in tertiary centers located in large urban areas and in our observation period has more than tripled from 4% to 13.7% of all the urgencies of UPGI. The significant reduction in the percentage of foreign bodies not found at the endoscopic examination is probably due to the ready availability of the endoscopist in recent years than in the past for the removal of the foreign body before it reaches the stomach filled with food. Reference: [1] S. Mosca et al. Endoscopy 2001;33(8):692–6.
P.09.9 SELF-EXPANDING METAL STENTS FOR BENIGN ESOPHAGEAL CONDITIONS: A SINGLE CENTER EXPERIENCE A. Anderloni ∗ , C. Genco, M. Massidda, E. Carlani, A. Carlino, S. Carrara, M. Jovani, E.C. Ferrara, G. Strangio, A. Malesci, A. Repici UO Endoscopia Digestiva, Istituto Clinico Humanitas, Rozzano, Italy Background and aim: Esophageal leaks, fistulae, and stenosis represent lifethreatening conditions with high morbidity and mortality. Over the last several years endoscopic esophageal stenting with Partially Covered Self Expanding Metal Stents (PCSEMS) or Fully Covered SEMS (FCSEMS) has been used as an alternative to surgery to treat these benign conditions. Our purpose was to evaluate the early and long-term outcome of PCSEMS and FCSEMS in patients with benign esophageal diseases. Material and methods: Data were extracted from a prospectively maintained register of all patients who underwent SEMS placement for benign esophageal conditions between January 2008 and September 2013 in our center. Patients’ demographics, locations and type of lesions, stents placement and removal, clinical success, and adverse events were analyzed. Results: A total of 68 patients (age 61.9±14.5 years; M/F: 53/15) received 121 SEMS (84 PCSEMS and 37 FCSEMS) for leaks (21 pts; 37 stents), fistulae (36 pts; 52 stents) and stenosis (11 pts; 54 stents). Technical success was achieved in all patients (100%) and therapeutic success (defined as permanent closure of leak/fistula or resolution of stenosis) was achieved in 22 pts (32.3%): 16 fistulae (13 PCSEMS, 3 FCSEMS), 5 leaks (4 PCSEMS, 1 FCSEMS), 1 stenosis (1 FCSEMS). Four pts (5.9%) experienced early adverse events (<1 week): 3 stents migration (2 PCSEMS, 1 FCSEMS) and 1 pneumomediastinum (1 FCSEMS). Stents removal was performed after a mean of 23.4 days (range 1–126±21.2) with 3 cases of major complications (esophageal mucosal stripping, 2 with PCSEMS and 1 with FCSEMS), which were successfully treated with second stent placement in one case and conservative therapy in the remaining. Long term complications (>1 week) were observed in 35 pts (51.5%): 8 stent migration (5 PCSEMS, 3 FCSEMS), 15 fistula persistence
S85
(12 PCSEMS, 3 FCSEMS), 8 stenosis persistence (5 PCSEMS, 3 FCSEMS), 4 tissue ingrowth (2 PCSEMS, 2 FCSEMS). Conclusions: The use of PCSEMS and FCSEMS for benign esophageal conditions is feasible although still associated with significant rates of complications and therapeutic failures. Better outcomes were observed in the subgroup of pts with fistulae. However further studies are needed in order to evaluate predictive factors related to successful outcome.
P.10.1 EFFECT OF ACID-SUPPRESSIVE THERAPY ON BASELINE IMPEDANCE IN NERD PATIENTS F.P. Zito ∗ , P. Andreozzi, M. Della Coletta, M.I. Arnone, C. Buonfantino, R. Civitelli, G. Sarnelli, R. Cuomo Federico II University, Naples, Italy Background and aim: Patients with non-erosive reflux disease (NERD) have a lower impedance baseline than healthy subjects, probably due to an impaired oesophageal mucosal integrity. Proton pump inhibitors (PPIs) improve mucosal damage in erosive reflux disease (ERD) but the effects on mucosal integrity in NERD patients is still unclear. Our aim is to investigate whether PPI therapy affects impedance baseline in NERD patients. Material and methods: 24patients (13 M - mean age 45±9) with typical GERD-symptoms (heartburn and regurgitation) and with an endoscopically proven diagnosis of NERD and pathologic 24h ph-impedance monitoring were consecutively enrolled; 16 and 8 patients underwent toesophageal 24h pH-impedance monitoring while on therapy and off-therapy, respectively. For each patient, esophageal baseline impedance (BI) was calculated during the first period of 30 seconds without an impedance event (swallow or reflux) every two hours. Impedance baseline at 17, 15 and 9 cm from the lower esophageal sphincter (LES) was considered as proximal BI while impedance measurements at 7, 5 and 3 cm from LES were used in order to calculate distal BI. Results: Patients on therapy showed a significantly higher distal baseline impedance than off-therapy patients (2965,5±363,1 vs 2363,6±179,6; p<0.01). On the contrary, proximal baseline impedance was similar in the two groups (2687,2±357,7vs 2582,7±312,0; p>0.05). Conclusions: Our results indicate that acid suppressive therapy is able to influence distal baseline impedance in NERD patients, but it remains unclear if this reflects an improvement in mucosal integrity. In addition, although no significantly effects were observed on proximal baseline impedance, further studies on patients with pathological proximal reflux extent are needed.
P.10.2 THE PROGNOSTIC IMPACT OF ISOLATED TUMOR CELLS (ITC) IN LYMPH NODES OF PN0 ESOPHAGEAL CANCER L. Albertoni ∗,1 , L. Stefanizzi 1 , A. Ruol 1 , C. Castoro 2 , L. Giacomelli 1 , C. Mescoli 1 , G. Zaninotto 1 , M. Rugge 1 1 Azienda
Ospedaliera, Policlinico Universitario, Padova, Italy; 2 Istituto Oncologico Veneto, IOV – IRCCS, Padova, Italy Background and aim: Esophageal cancer is the sixth leading cause of cancer-related mortality and its overall five-year survival ranges from 15% to 25%. Metastasis in regional nodes is the most important prognostic factor. Among pN0 cancers (routine histology; H&E-stain), 30%-40% patients develop recurrent disease within five years. Isolated tumor cells (ITC) in regional lymph nodes may (at least partially) explain cancer recurrence. In the largest series ever published, this study assessed the prognostic impact of ITC-status (ITC+ve versus ITC-ve) in regional nodes of 281 consecutive pN0 esophageal cancers. Material and methods: Ninety-five esophageal adenocarcinoma (AdC; 23/95 undergone neo-adjuvant therapy) and 186 esophageal squamous cell carcinoma (SCC; 95/186 undergone neo-adjuvant therapy) were included. In total, 4767 lymph nodes (mean number of nodes/patient: 17; range: 1–58) were considered. ITC-status was assessed by immunohistochemistry (MNF116 antibody for cytokeratines; Dako). In all cases, Lymph node ratio ([LN-ratio]