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P.12.19 PRELIMINARY RESULTS OF A COLORECTAL CANCER SCREENING PROGRAM IN ASL 5 LA SPEZIA, ITALY
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220 diet group a not significant decrease by 24% was obtained after 3 and 6 mos (p=0.13). Abdominal bloating decreased significantly in the Flortec© group by 36% after 3 mos (p=0.01) and by 30% after 6 mos (p=0.03), while in the high-fibre diet group after 6 mos a decrease by only 14.3% (p=0.5) was observed. With regard to VAS of abdominal pain <24 hours and bloating, a significant reduction was observed in both groups after 6 mos, while VAS of abdominal pain >24 hours was signficantly reduced after 6 mos in the Flortec© group only, but not in the high-dietary fibre group. Conclusions: In symptomatic uncomplicated diverticular disease, Lactobacillus paracasei B21060 in association with high-fibre diet is effective in relief of abdominal symptoms, is superior compared with high-fibre diet in relieving abdominal pain >24 hours and abdominal bloating, and acts more rapidly in reducing abdominal pain <24 hours. This formuulation could thus be a promising treatment option in these patients.
P.12.19 PRELIMINARY RESULTS OF A COLORECTAL CANCER SCREENING PROGRAM IN ASL 5 LA SPEZIA, ITALY F. Praiano’ ∗ , M.V. Cristoni, G. Russo, P. Arpe, R. Briglia Ospedale Sant’Andrea, La Spezia, Italy Background and aim: Preliminary results evaluation of a colorectal cancer screening program. Material and methods: Period of study 1.12.2011-31.12.2011. Study population: healthy subjects, 50-69 years old (exclusion criteria: previous diagnosis of colorectal cancer, previous polipectomy, colonoscopy in the previous two years, diagnosis of IBD). Recruitment:sent to the residence kits, containing a letter of invitation, a questionary, a tube for fecal occult blood test (FIT) and a pre-pay envelope for FIT sending. Comunication of FIT positivity with registered A/R letter and cross telephone contact by dedicated staff of S.C Gastroenterology. Colonoscopy scheduling prior telephone conversation with the nursing staff or interview with specialist. Colonoscopies were planned in the afternoon, outside of our customer service, after PEG intake in the morning and performed by endoscopists with annual volume greater than 700 colonoscopies, with Olympus 180 endoscopes, with or without sedation. Results: 59764 subjects invited to October 31.21410 (36%) included. 929 (4,3%) with FIT positivity. 611 subjects (65,7%) performed colonoscopy in our clinics, 44 elsewhere. 592 complete colonoscopy was performed (cecal intubation 96,9%), 303 (49,2%) with sedation. 19 subjects did not complete colonoscopy (4 malignant stricture, 1 benign stricture, 2 poor clearing colon, 12 intolerance). For non-malignant stenosis has been proposed to perform barium enema X-ray or virtual CT. 333 subjects received a diagnosis of neoplastic lesions (54.5%) (data reported below refer to the number of subjects with specific diagnoses, the statistic was conducted considering the most serious injury for each subject). 281 subjects received diagnosis of adenoma: See table 1.These patients underwent endoscopic treatment and placed in a follow-up program, according to current guidelines. 52 cancers diagnosed (23 in the right colon, 17 in left colon and 12 in the rectum), with this staging: Stage I 27, stage II 13, Stage III 5, stage IV 1.14 patients underwent only endoscopic therapy, in 2 patients endoscopic therapy was followed by surgery. 36 surgically treated lesions (6 of these dealt with elsewhere). Table 1 Adenoma Ip Is II HGD Total
<10 mm
>10 mm
56 40 22 IIa 2 IIb 7 (6 Ip – 1 Is) 120
98 27 36 50 (32 Ip – 11 Is – 7LST) 161
Conclusions: Adhesion to the screening and diagnostic findings are in agreement with available literature data. It is desirable to have a better adhesion to the SOF and colonoscopy in positive subjects.
S167
P.12.20 CLOSTRIDIUM DIFFICILE INFECTION SURVEY IN NHS HOSPITALS OF BOLOGNA P. Pozzato ∗ ,1 , M. Ventrucci 1 , P. Farruggia 2 , M. Panico 2 , C. Descovich 2 1 Dept. of Internal Medicine and Gastroenterology, Bologna, Italy; 2 Dept. of Clinical Governance Ausl Bologna, Infection Control Team, Bologna, Italy
Background and aim: Clostridium difficile infection (CDI) as a comorbidity is the most important cause of in-hospital diarrhoea worldwide. Its prevention depends on hygiene policy and antimicrobial stewardship. We studied risk factors for CDI in inpatients seen in 2010 in 9 NHS hospitals in Bologna. Material and methods: After having tested positive for CD toxin in the stool, 148 patients (62 males and 86 females, median age 83 yrs, 2.5-97.5 percentile range 63-97) were referred to the Infection Control Team. Results: The incidence of CDI in 2010 was 0.25%, higher than that of 2009 (0.21%) and 2008 (0.17%). We have currently analysed the records of 30 out of the 145 patients for risk factors. The origin of patients was the home in 20, nursing homes in 8, and hospitals in 2. The main diagnoses were heart failure in 6, cerebrovascular disease in 7, bone diseases in 2, pneumonia in 2, other acute diseases in 10 and other chronic diseases in 3. Chronic renal failure was present in 7. Prior to the study, PPIs and antibiotics had been administered in 8 and in 7cases, respectively. Four patients had private bathrooms, bedpan cleaners were available in 18, and macerators in 12. Conclusions: Preliminary results suggest the following risk factors for CDI: age and poor adherence to hygienic rules. The role of previous PPI and antibiotic therapy in CDI is still questionable.
P.12.21 OUTCOME OF ENDOSCOPICALLY TREATED LARGE POLYPS EN BLOC OR PIECEMEAL TECHNIQUE: COMPLICATIONS AND RECURRENCE RATE FROM A SINGLE CENTRE EXPERIENCE G. Margagnoni ∗ , R. Rocco, V.D. Corleto, M. Ruggeri, G. D’Ambra, F. Cipolletta, G. Delle Fave, S. Angeletti, E. Di Giulio Azienda Ospedaliera S. Andrea-Università La Sapienza, Roma, Italy Background and aim: Large >2 cm and giant >3 cm colon lesions may have aggressive behaviour with faster growth,earlier recurrence (0-55%) and high risk for malignant development. Lesions size, proximal location, age >60 years, histological type, male gender are factors of increased risk recurrence. Aim of the study was to assess outcome of endoscopic mucosal resection (EMR) of large colorectal polyps and to evaluate risk factors of local recurrence using en bloc or piecemeal technique in a single centre cohort of patients. Material and methods: All EMRs for large colorectal lesions, performed over 3 years at our institution with regular follow up were included. The rate of en bloc and piecemeal resection, complications and local recurrence were analyzed. Results: 143 EMRs were carried out in 130 patients with large lesions [mean age 68 years (23-92); 84/46 M/F]. 88 (61.5%) were large and 55 giant lesions (38.5%). 55 (38.5%) were peduncolated, 54 (37.8%) sessile, 9 (6.3%) elevated superficial, 17 (11.8%) LST and 8 (5.6%) semipeduncolated. 61.5% of lesions were located in the left and 38.5% in the right colon. En bloc resection was performed in 88 cases (62%) and piecemeal in 55 (38%). Overall, procedural bleeding occurred in 29 (20.2%) EMRs, mostly with en bloc technique 22/29 (76%) (p<0.003), and perforation in one case. Tubular or tubulovillous accounted for 75% of the adenomas, with 50% low, 40% high grade dysplasia and 10% invasive cancer. A complete endoscopic resection was achieved in 134 lesions (93.7%), 87 (65%) with en bloc, 47 (35%) with piecemeal. At one year follow-up 76 (53,2%) large lesions were evaluated. Recurrence was observed in 19.7%, mainly in giant lesions (60%), in lesions treated with piecemeal technique (73%) and in lesions with lateral margins not evaluable. In the giants lesions recurrence rate was 21.8% for piecemeal and 8.6% for en bloc. At one year follow up the cumulative probability to be free of recurrence is significantly higher for lesion resected with en bloc compared to piecemeal resection (OR 4.8, 95% CI 1.6-13.8, p=0.0036). Conclusions: A complete resection can be performed in the majority of large
P.12.19 PRELIMINARY RESULTS OF A COLORECTAL CANCER SCREENING PROGRAM IN ASL 5 LA SPEZIA, ITALY F. Praiano’ ∗ , M.V. Cristoni, G. Russo, P. Arpe, R. Briglia Ospedale Sant’Andrea, La Spezia, Italy Background and aim: Preliminary results evaluation of a colorectal cancer screening program. Material and methods: Period of study 1.12.2011-31.12.2011. Study population: healthy subjects, 50-69 years old (exclusion criteria: previous diagnosis of colorectal cancer, previous polipectomy, colonoscopy in the previous two years, diagnosis of IBD). Recruitment:sent to the residence kits, containing a letter of invitation, a questionary, a tube for fecal occult blood test (FIT) and a pre-pay envelope for FIT sending. Comunication of FIT positivity with registered A/R letter and cross telephone contact by dedicated staff of S.C Gastroenterology. Colonoscopy scheduling prior telephone conversation with the nursing staff or interview with specialist. Colonoscopies were planned in the afternoon, outside of our customer service, after PEG intake in the morning and performed by endoscopists with annual volume greater than 700 colonoscopies, with Olympus 180 endoscopes, with or without sedation. Results: 59764 subjects invited to October 31.21410 (36%) included. 929 (4,3%) with FIT positivity. 611 subjects (65,7%) performed colonoscopy in our clinics, 44 elsewhere. 592 complete colonoscopy was performed (cecal intubation 96,9%), 303 (49,2%) with sedation. 19 subjects did not complete colonoscopy (4 malignant stricture, 1 benign stricture, 2 poor clearing colon, 12 intolerance). For non-malignant stenosis has been proposed to perform barium enema X-ray or virtual CT. 333 subjects received a diagnosis of neoplastic lesions (54.5%) (data reported below refer to the number of subjects with specific diagnoses, the statistic was conducted considering the most serious injury for each subject). 281 subjects received diagnosis of adenoma: See table 1.These patients underwent endoscopic treatment and placed in a follow-up program, according to current guidelines. 52 cancers diagnosed (23 in the right colon, 17 in left colon and 12 in the rectum), with this staging: Stage I 27, stage II 13, Stage III 5, stage IV 1.14 patients underwent only endoscopic therapy, in 2 patients endoscopic therapy was followed by surgery. 36 surgically treated lesions (6 of these dealt with elsewhere). Table 1 Adenoma Ip Is II HGD Total
<10 mm
>10 mm
56 40 22 IIa 2 IIb 7 (6 Ip – 1 Is) 120
98 27 36 50 (32 Ip – 11 Is – 7LST) 161
Conclusions: Adhesion to the screening and diagnostic findings are in agreement with available literature data. It is desirable to have a better adhesion to the SOF and colonoscopy in positive subjects.
S167
P.12.20 CLOSTRIDIUM DIFFICILE INFECTION SURVEY IN NHS HOSPITALS OF BOLOGNA P. Pozzato ∗ ,1 , M. Ventrucci 1 , P. Farruggia 2 , M. Panico 2 , C. Descovich 2 1 Dept. of Internal Medicine and Gastroenterology, Bologna, Italy; 2 Dept. of Clinical Governance Ausl Bologna, Infection Control Team, Bologna, Italy
Background and aim: Clostridium difficile infection (CDI) as a comorbidity is the most important cause of in-hospital diarrhoea worldwide. Its prevention depends on hygiene policy and antimicrobial stewardship. We studied risk factors for CDI in inpatients seen in 2010 in 9 NHS hospitals in Bologna. Material and methods: After having tested positive for CD toxin in the stool, 148 patients (62 males and 86 females, median age 83 yrs, 2.5-97.5 percentile range 63-97) were referred to the Infection Control Team. Results: The incidence of CDI in 2010 was 0.25%, higher than that of 2009 (0.21%) and 2008 (0.17%). We have currently analysed the records of 30 out of the 145 patients for risk factors. The origin of patients was the home in 20, nursing homes in 8, and hospitals in 2. The main diagnoses were heart failure in 6, cerebrovascular disease in 7, bone diseases in 2, pneumonia in 2, other acute diseases in 10 and other chronic diseases in 3. Chronic renal failure was present in 7. Prior to the study, PPIs and antibiotics had been administered in 8 and in 7cases, respectively. Four patients had private bathrooms, bedpan cleaners were available in 18, and macerators in 12. Conclusions: Preliminary results suggest the following risk factors for CDI: age and poor adherence to hygienic rules. The role of previous PPI and antibiotic therapy in CDI is still questionable.
P.12.21 OUTCOME OF ENDOSCOPICALLY TREATED LARGE POLYPS EN BLOC OR PIECEMEAL TECHNIQUE: COMPLICATIONS AND RECURRENCE RATE FROM A SINGLE CENTRE EXPERIENCE G. Margagnoni ∗ , R. Rocco, V.D. Corleto, M. Ruggeri, G. D’Ambra, F. Cipolletta, G. Delle Fave, S. Angeletti, E. Di Giulio Azienda Ospedaliera S. Andrea-Università La Sapienza, Roma, Italy Background and aim: Large >2 cm and giant >3 cm colon lesions may have aggressive behaviour with faster growth,earlier recurrence (0-55%) and high risk for malignant development. Lesions size, proximal location, age >60 years, histological type, male gender are factors of increased risk recurrence. Aim of the study was to assess outcome of endoscopic mucosal resection (EMR) of large colorectal polyps and to evaluate risk factors of local recurrence using en bloc or piecemeal technique in a single centre cohort of patients. Material and methods: All EMRs for large colorectal lesions, performed over 3 years at our institution with regular follow up were included. The rate of en bloc and piecemeal resection, complications and local recurrence were analyzed. Results: 143 EMRs were carried out in 130 patients with large lesions [mean age 68 years (23-92); 84/46 M/F]. 88 (61.5%) were large and 55 giant lesions (38.5%). 55 (38.5%) were peduncolated, 54 (37.8%) sessile, 9 (6.3%) elevated superficial, 17 (11.8%) LST and 8 (5.6%) semipeduncolated. 61.5% of lesions were located in the left and 38.5% in the right colon. En bloc resection was performed in 88 cases (62%) and piecemeal in 55 (38%). Overall, procedural bleeding occurred in 29 (20.2%) EMRs, mostly with en bloc technique 22/29 (76%) (p<0.003), and perforation in one case. Tubular or tubulovillous accounted for 75% of the adenomas, with 50% low, 40% high grade dysplasia and 10% invasive cancer. A complete endoscopic resection was achieved in 134 lesions (93.7%), 87 (65%) with en bloc, 47 (35%) with piecemeal. At one year follow-up 76 (53,2%) large lesions were evaluated. Recurrence was observed in 19.7%, mainly in giant lesions (60%), in lesions treated with piecemeal technique (73%) and in lesions with lateral margins not evaluable. In the giants lesions recurrence rate was 21.8% for piecemeal and 8.6% for en bloc. At one year follow up the cumulative probability to be free of recurrence is significantly higher for lesion resected with en bloc compared to piecemeal resection (OR 4.8, 95% CI 1.6-13.8, p=0.0036). Conclusions: A complete resection can be performed in the majority of large