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P.1.199: “CLIP AND LOOP” TECHNIQUE FOR ENDOSCOPIC RESECTION OF LARGE PEDUNCULATED POLYPS
S214
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
P.1.198 BOWEL PREPARATION BEFORE COLONOSCOPY: SPLIT VERSUS NON SPLIT-DOSAGE REGIMEN O. Ignomirelli, M. Ciuffi, F. Tremolaterra ∗ Irccs - Centro di Riferimento Oncologico della Basilicata (Crob), Rionero In Vulture (PZ), Italy Background and aim: Inadequate bowel preparation is a known factor associated with low-quality colonoscopy. The aims of our study were to compare the degree of bowel cleansing achieved by split-dosage intake of 4 L polyethylene glycol (PEG) preparation versus non spilt-dosage regimen and the influence on the cecal intubation and polyp detection rates. Material and methods: A total of 438 outpatients, undergoing colonoscopy in our Endoscopy Unit, (196 split-dosage group/242 non split-dosage group) were consecutively studied over an 4-month period. The time at which colonoscopy was performed and the interval between the last dose of PEG and the start of colonoscopy were recorded. The quality of the preparation was graded using a 4-point scale (4=excellent, 3=good, 2=fair, 1=poor). Cecal intubation rate and polyp detection rate were recorded. Results: Patients in the split-dosage group had significantly higher preparation quality score (3 or 4 score) when compared with the non split-dosage group (80.1% vs 54.9%, p<0.001). Further the patients whose preparations were graded as excellent and good had a significantly shorter interval between the time of the last PEG dose and the start of the colonoscopy (p≤0.001). The cecal intubation rate was 93.3% in the split-dosage group and 91.6% in the non split-dosage group (p=0.52) while the polyp detection rate was significantly higher in the split-dosage group than non split-dosage group (22.4% vs 14.8%, p=0.04). Conclusions: The split-dosage regimen, as it decreases the interval between the last dose of the preparation agent and the start of colonoscopy, is more effective, on the bowel cleasing, than non split schedule and positively affects cecal intubation and polyp detection rates.
P.1.199 “CLIP AND LOOP” TECHNIQUE FOR ENDOSCOPIC RESECTION OF LARGE PEDUNCULATED POLYPS P. Fusaroli ∗ ,1 , S. Ferri 2 , S. Fiorentini 2 , F. Serotti 2 , M. Tattini 2 , R. Callegari 2 , G. Caletti 1 1
University of Bologna/ausl of Imola, Imola; 2 Ausl of Imola, Imola, Italy
Background and aim: Colonoscopic polypectomy of large pedunculated polyps may be associated with complications such as bleeding. Use of a detachable snare (endoloop) may reduce the risk of bleeding but its application may be cumbersome due to entrapment in the head of the polyp and risk of slipping off immediately after polypectomy. The latter is particularly frequent there is not enough room for endoloop application due to a short polyp stalk. We report about the use of a simple and safe method combining the use of clips and endoloop. Material and methods: Patients with large pedunculated polyps (>3 cm) were included. We used a prototype therapeutic sigmoidoscope (Olympus, Tokyo, Japan), 80 cm long, equipped with two working channels (2.8 mm and 3.7 mm, respectively). One working channel has an up/down elevator. Using a “two-handed” approach, 2 clips were initially placed at the base of the stalk, on two opposite sides. In order to fix it securely, the endoloop was then placed at the base of the stalk below the two clips. To facilitate the procedure the endoloop was opened through one channel, the polyp was grabbed through the other channel by a tripod and then pulled inside the endoloop. Thus, the endoloop was subsequently firmly secured at the base of the stalk. If necessary, the same procedure was repeated to capture the polyp within the diathermic snare for resection. The procedures were performed under conscious sedation using meperidine and midazolam. Results: Twenty-five pedunculated polyps in 24 patients (13 F, 11 M; median age 59) were resected with the “clip and loop” technique. It was possible to place an endoloop successfully below the clips at the basis of the stalk and perform a resection in all cases. No major complication occurred. Particularly,
in no case the endoloop fell off after resection. In comparison to the previous cases performed with the endoloop only, the success rate in terms of correct and durable endoloop placement was higher (100% vs. 84%). Conclusions: Application of endoloop below the clips is feasible and safe and prevents slipping off of the endoloop after polypectomy. Use of a combination of clips and endoloop is an effective prophylactic measure to prevent bleeding after polypectomy of large pedunculated polyps, also when the stalk is short.
P.1.200 PROSPECTIVE SINGLE-CENTER STUDY FOR THE LONG-TERM CLINICAL EFFICACY OF FLEXIBLE ENDOSCOPIC DIVERTICULOSCOPE-ASSISTED ZENKER’S DIVERTICULOTOMY F. Iacopini ∗ ,1 , A. Bizzotto 2 , A. Bella 3 , A. Tringali 2 , M. Marchese 2 , V. Perri 2 , M. Mutignani 2 , G. Costamagna 2 1 Gastroenterology
and Endoscopy Unit, Ospedale S. Giuseppe, Albano L; Roma, Italy; 2 Surgical Endoscopy Unit,university La Cattolica, Roma, Italy; 3 Istituto Superiore di Sanità, Roma, Italy Background and aim: Flexible endoscopic diverticulotomy is the less invasive but still evolving option for myotomy of Zenker’s diverticulum (ZD). Aim: To prospectively assess the clinical efficacy of flexible endoscopic diverticuloscope-assisted myotomy of ZD after a follow-up >12 months. Material and methods: March 2005 - February 2009: 35 consecutive pts (19 F, median 70 yrs) with ZD (depth 4 cm, range 2-11) were enrolled. The intervention was performed in a single endoscopic session. Dysphagia, regurgitation, daytime respiratory and nightly symptoms were recorded pre-treatment, at 1, 6 and 12 months postoperatively, and between July and Sept 2010 (end of follow-up: mean 39±14 months). Symptoms were scored according to frequency: 0 = absent; 1 = occasional (=2/week); 2 = frequent (>2/week); and 3 = daily (at each meal). Clinical success: absence of all symptoms or occasionall persistance of ≤ 2 symptoms. Results: Operative time: 15 min (range 8-20); complication rate: 3%. Prevalence of grades 2&3 of each symptom significantly reduced (P<0.0001) from pre-treatment to the end of F-U: dysphagia (91% vs. 34%); regurgitation (89% vs. 26%); daytime respiratory (97% vs. 9%) and nightly symptoms (94% vs. 9%). Clinical success was 86% after 1 month but significantly decreased at the end of F-U (49%; P=0.001), due to 7 early and 6 late failures. Early failures (<6 months) were characterized by grade 2&3 dysphagia and/or regurgitation, while late recurrences (>12 months) by a cluster of grade 1 symptoms. Incidence of ab ingestiis pneumonia decreased from 20% pre-treatment to 0% at the end of F-U (P=0.011). Univariate analysis showed that diverticula of pts with early clinical success (median 3 cm, range 2-7) were significantly less deep that that of pts with early failure (median 6, range 3-11; P=0.001). Conclusions: This is the first prospective long-term study demonstrating that flexible endoscopic diverticuloscope-assisted myotomy for ZD: definitively resolves dysphagia and regurgitation in almost 50% of pts, and respiratory and nightly symptoms in more than 90%; decreases the risk of ab ingestiis pneumonia. This mini-invasive approach can be the initial option in the therapeutic algorithm.
P.1.201 CAN WE ESTIMATE ORO-CECAL TRANSIT TIME USING MRI? A COMPARISON WITH HYDROGEN BREATH TEST (H2-BT) IN HEALTHY VOLUNTEERS E. Savarino, L. Sconfienza ∗ , L. Gemignani, E. Marabotto, G. Sammito, M. Furnari, C. Mansi, V. Savarino Division Of Gastroenterology, Department Of Internal Medicine, University Of Genoa, Genoa, Italy Background and aim: Magnetic Resonance Imaging (MRI) is a widely known imaging modality in the evaluation of small bowel, both in basal condition and with MR-enterography technique. Lactulose H2-BT represents the more common non-invasive method used to assess oro-cecal transit time
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
P.1.198 BOWEL PREPARATION BEFORE COLONOSCOPY: SPLIT VERSUS NON SPLIT-DOSAGE REGIMEN O. Ignomirelli, M. Ciuffi, F. Tremolaterra ∗ Irccs - Centro di Riferimento Oncologico della Basilicata (Crob), Rionero In Vulture (PZ), Italy Background and aim: Inadequate bowel preparation is a known factor associated with low-quality colonoscopy. The aims of our study were to compare the degree of bowel cleansing achieved by split-dosage intake of 4 L polyethylene glycol (PEG) preparation versus non spilt-dosage regimen and the influence on the cecal intubation and polyp detection rates. Material and methods: A total of 438 outpatients, undergoing colonoscopy in our Endoscopy Unit, (196 split-dosage group/242 non split-dosage group) were consecutively studied over an 4-month period. The time at which colonoscopy was performed and the interval between the last dose of PEG and the start of colonoscopy were recorded. The quality of the preparation was graded using a 4-point scale (4=excellent, 3=good, 2=fair, 1=poor). Cecal intubation rate and polyp detection rate were recorded. Results: Patients in the split-dosage group had significantly higher preparation quality score (3 or 4 score) when compared with the non split-dosage group (80.1% vs 54.9%, p<0.001). Further the patients whose preparations were graded as excellent and good had a significantly shorter interval between the time of the last PEG dose and the start of the colonoscopy (p≤0.001). The cecal intubation rate was 93.3% in the split-dosage group and 91.6% in the non split-dosage group (p=0.52) while the polyp detection rate was significantly higher in the split-dosage group than non split-dosage group (22.4% vs 14.8%, p=0.04). Conclusions: The split-dosage regimen, as it decreases the interval between the last dose of the preparation agent and the start of colonoscopy, is more effective, on the bowel cleasing, than non split schedule and positively affects cecal intubation and polyp detection rates.
P.1.199 “CLIP AND LOOP” TECHNIQUE FOR ENDOSCOPIC RESECTION OF LARGE PEDUNCULATED POLYPS P. Fusaroli ∗ ,1 , S. Ferri 2 , S. Fiorentini 2 , F. Serotti 2 , M. Tattini 2 , R. Callegari 2 , G. Caletti 1 1
University of Bologna/ausl of Imola, Imola; 2 Ausl of Imola, Imola, Italy
Background and aim: Colonoscopic polypectomy of large pedunculated polyps may be associated with complications such as bleeding. Use of a detachable snare (endoloop) may reduce the risk of bleeding but its application may be cumbersome due to entrapment in the head of the polyp and risk of slipping off immediately after polypectomy. The latter is particularly frequent there is not enough room for endoloop application due to a short polyp stalk. We report about the use of a simple and safe method combining the use of clips and endoloop. Material and methods: Patients with large pedunculated polyps (>3 cm) were included. We used a prototype therapeutic sigmoidoscope (Olympus, Tokyo, Japan), 80 cm long, equipped with two working channels (2.8 mm and 3.7 mm, respectively). One working channel has an up/down elevator. Using a “two-handed” approach, 2 clips were initially placed at the base of the stalk, on two opposite sides. In order to fix it securely, the endoloop was then placed at the base of the stalk below the two clips. To facilitate the procedure the endoloop was opened through one channel, the polyp was grabbed through the other channel by a tripod and then pulled inside the endoloop. Thus, the endoloop was subsequently firmly secured at the base of the stalk. If necessary, the same procedure was repeated to capture the polyp within the diathermic snare for resection. The procedures were performed under conscious sedation using meperidine and midazolam. Results: Twenty-five pedunculated polyps in 24 patients (13 F, 11 M; median age 59) were resected with the “clip and loop” technique. It was possible to place an endoloop successfully below the clips at the basis of the stalk and perform a resection in all cases. No major complication occurred. Particularly,
in no case the endoloop fell off after resection. In comparison to the previous cases performed with the endoloop only, the success rate in terms of correct and durable endoloop placement was higher (100% vs. 84%). Conclusions: Application of endoloop below the clips is feasible and safe and prevents slipping off of the endoloop after polypectomy. Use of a combination of clips and endoloop is an effective prophylactic measure to prevent bleeding after polypectomy of large pedunculated polyps, also when the stalk is short.
P.1.200 PROSPECTIVE SINGLE-CENTER STUDY FOR THE LONG-TERM CLINICAL EFFICACY OF FLEXIBLE ENDOSCOPIC DIVERTICULOSCOPE-ASSISTED ZENKER’S DIVERTICULOTOMY F. Iacopini ∗ ,1 , A. Bizzotto 2 , A. Bella 3 , A. Tringali 2 , M. Marchese 2 , V. Perri 2 , M. Mutignani 2 , G. Costamagna 2 1 Gastroenterology
and Endoscopy Unit, Ospedale S. Giuseppe, Albano L; Roma, Italy; 2 Surgical Endoscopy Unit,university La Cattolica, Roma, Italy; 3 Istituto Superiore di Sanità, Roma, Italy Background and aim: Flexible endoscopic diverticulotomy is the less invasive but still evolving option for myotomy of Zenker’s diverticulum (ZD). Aim: To prospectively assess the clinical efficacy of flexible endoscopic diverticuloscope-assisted myotomy of ZD after a follow-up >12 months. Material and methods: March 2005 - February 2009: 35 consecutive pts (19 F, median 70 yrs) with ZD (depth 4 cm, range 2-11) were enrolled. The intervention was performed in a single endoscopic session. Dysphagia, regurgitation, daytime respiratory and nightly symptoms were recorded pre-treatment, at 1, 6 and 12 months postoperatively, and between July and Sept 2010 (end of follow-up: mean 39±14 months). Symptoms were scored according to frequency: 0 = absent; 1 = occasional (=2/week); 2 = frequent (>2/week); and 3 = daily (at each meal). Clinical success: absence of all symptoms or occasionall persistance of ≤ 2 symptoms. Results: Operative time: 15 min (range 8-20); complication rate: 3%. Prevalence of grades 2&3 of each symptom significantly reduced (P<0.0001) from pre-treatment to the end of F-U: dysphagia (91% vs. 34%); regurgitation (89% vs. 26%); daytime respiratory (97% vs. 9%) and nightly symptoms (94% vs. 9%). Clinical success was 86% after 1 month but significantly decreased at the end of F-U (49%; P=0.001), due to 7 early and 6 late failures. Early failures (<6 months) were characterized by grade 2&3 dysphagia and/or regurgitation, while late recurrences (>12 months) by a cluster of grade 1 symptoms. Incidence of ab ingestiis pneumonia decreased from 20% pre-treatment to 0% at the end of F-U (P=0.011). Univariate analysis showed that diverticula of pts with early clinical success (median 3 cm, range 2-7) were significantly less deep that that of pts with early failure (median 6, range 3-11; P=0.001). Conclusions: This is the first prospective long-term study demonstrating that flexible endoscopic diverticuloscope-assisted myotomy for ZD: definitively resolves dysphagia and regurgitation in almost 50% of pts, and respiratory and nightly symptoms in more than 90%; decreases the risk of ab ingestiis pneumonia. This mini-invasive approach can be the initial option in the therapeutic algorithm.
P.1.201 CAN WE ESTIMATE ORO-CECAL TRANSIT TIME USING MRI? A COMPARISON WITH HYDROGEN BREATH TEST (H2-BT) IN HEALTHY VOLUNTEERS E. Savarino, L. Sconfienza ∗ , L. Gemignani, E. Marabotto, G. Sammito, M. Furnari, C. Mansi, V. Savarino Division Of Gastroenterology, Department Of Internal Medicine, University Of Genoa, Genoa, Italy Background and aim: Magnetic Resonance Imaging (MRI) is a widely known imaging modality in the evaluation of small bowel, both in basal condition and with MR-enterography technique. Lactulose H2-BT represents the more common non-invasive method used to assess oro-cecal transit time