- Email: [email protected]
P.1.240: EUS ACCURACY IN RESTAGING RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY: A PRELIMINARY REPORT
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 treatment goal for patients with IBD. Moreover evidence has now accumulated to show that MH can alter the course of IBD, as it is associated with sustained clinical remission and reduced rates of hospitalization and surgical resection. Herein, we evaluate, in Crohn’s Disease (CD) and Ulcerative Colitis (UC), the effect of length of biologic therapy in inducing and maintaining MH. Material and methods: 40 consecutive patients with moderate-severe IBD (19 UC and 21 CD) who had a history of resistance or dependence to steroid therapy, were enrolled to the study and screened for biological therapy. Patients received infliximab 5-10mg/kg/bw i.v. or adalimumab 160/80 s.c. as a scheduled therapy for 24 months. In all patients endoscopic evaluations were done at baseline before treatments and repeated at 3rd, 6th, 12th and 24th month of therapy. Endoscopic evaluation was based on an endoscopic score of 0-2 (0=normal mucosa, i.e. complete-MH; 1=erithema or granularity, i.e. partial-MH; 2=granularity and bleeding with or without the addition of ulcerations; i.e. non-MH). Results: 1 patient dropped out at 6th month because of the appearance of a myocardial ischemic disease; 3 CD patients with a clinical improvement but without MH worsened and underwent surgery after 1-year-therapy; 10 patients (5 CD, 5 UC) have been re-evaluated at 24th month, the remaining 26 patients still stay on treatment and they will be re-evaluated at 24th month. In table we report percentage of patients with complete or partial MH and percentage of patients with non-MH at 3rd, 6th, 12th month of biologic therapy. Endoscopic evaluation (time) No. of patients Mucosal healing (grade)
3rd month 40 0 1 2
6th month 40 0 1 2
12th month 39 0 1 2
CD (% pts) UC (% pts)
19 24
43 25
64 71
48 47
33 29
38 50
19 25
29 29
7 0
Conclusions: Our data point out that: i) MH is a reparative process requiring different time in different patient, ii) the rate of complete-MH progressively increases during the first year of biologic treatment, iii) length of therapy significantly (p<0.001) reduces number of patients with non-MH, iv) one year therapy minimizes clinical relapse, hospitalization rate and colectomy in IBD patients. All patients with UC were healed at 12th month of treatment while 3 CD patients remained non-MH and developed local complications. Preliminary data of 10 patients at 24th month of biologic therapy show that MH is detected respectively in 100% of CD and 80% of UC patients.
P.1.238 DNA DAMAGE IN PERIPHERAL BLOOD LYMPHOCYTES OF PATIENTS WITH CIRRHOSIS RELATED TO VIRAL HEPATITIS OR ALCOHOL USE: CORRELATION WITH CHILD-PUGH SCORE G. Testino ∗ , F. Ansaldi, P. Borro, O.A. Ancarani, D. Barciocco, A. Sumberaz Azienda Ospedaliera Univesritaria San Martino, Genova, Italy Background and aim: Both alcohol use and hepatitis B or C (HBV, HCV) virus infection are implicated in the development of hepatocellular carcinoma (HCC). Considering that alcoholic liver disease and chronic virus hepatitis promote the generation of reactive oxygen species, we have investigated the occurrence of DNA fragmentation (Comet assay) in peripheral blood lymphocytes from patients with cirrhosis and analyzed the correlation with Child-Pugh score used to assess the degree of hepatic insufficiency. Material and methods: The study population consisted of two groups: group I involved 12 patients (2 females, mean age: 50.7±11.2) with alcoholic cirrhosis and group II involved 25 patients (9 females; mean age: 54.6±9.6) with HBV or HCV cirrhosis. The control group involved 20 healthy subjects (11 females; mean age: 48.5±14.1). DNA fragmentation was evaluated by the alkaline Comet assay as described by Singh et al. Extent of DNA damage was quantified by measuring the tail length (TL) and the tail moment (TM) with computerized image analysis (Sarin System, Florence, Italy). The TM was defined as the product of TL and the amount of DNA in the tail. Statistical analysis: Wilcoxon two-sample test. Regression analysis was used to examine whether a positive correlation exists between degree of DNA damage and Child-Pugh score. Results: Results of DNA fragmentation in Table 1. Smoking habit cannot be considered a confusing factor. There is a significant correlation among Child-
S227
Table 1 Alcoholic cirrhosis HBV/HCV cirrhosis Cirrhosis smokers Cirrhosis non smokers Controls
TL
TM
2.96±1.79* 2.81±0.94* 2.84±1.76* 2.35±0.96* 1.54±0.49
258±162* 233±83* 254±155* 202±79* 141±45
*p<0.001.
Pugh score, TL and TM: TL R=0.7574 (p<0.001); TM R=0.7414 (p<0.001). Conclusions: The data of this experience confirm how alcohol and viral hepatitis could be involved in the development of HCC throught both direct (genotoxic) and indirect mechanism (severity of liver cirrhosis).
P.1.239 EMPLOYMENT OF TRANSGASTRIC-JEJUNAL INFUSION TUBE FOR INTRADUODENAL ADMINISTRATION OF LEVODOPA S. Carmagnola ∗ , M. Balzarini, A. Anderloni, M. Orsello, M. Pagliarulo, M. Ballarè, R. Tari, M. Sartori, M. Del Piano Scdo di Gastroenterologia Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy Background and aim: Motor complications are a common problem in the long-term management of Parkinson’s disease (PD). A stable suspension of levodopa and carbidopa (Duodopa® ) has been proposed to reduce on-off fluctuations. Positioning of duodenal catheter throught a percutaneous endoscopic gastrostomy (PEG) was used to administer the drug. We reported a single tertiary gastroenterology unit experience concerning technique, safety and efficacy of the procedure. Material and methods: Between February 2010 and November 2011 we positioned five duodenal devices for infusion of levodopa (Duodopa® ) in four patients (58-68 years, 3 male) affected by severe PD with motor fluctuations. All the patients were admitted in a neurology or gastroenterology unit and received upper gastrointestinal endoscopy apart one patient with pharyngolaryngeal obstruction who already had PEG for nutrition. The transgastricjejunal infusion tube were from Kymberly Clark or Boston Scientific. Results: Two patients received a common 20-French PEG through which the 10 F-French duodenal tube was replaced over pylorus at the ligament of Treitz dragging by a forceps under endoscopic and radiologic view. One female patient with history of gastroresection received a direct percutaneous endoscopic jejunostomy (D-PEJ). One man with pharyngo-laryngeal obstruction and a 14-French PEG was treated with dilation of gastrostomy to 22-French and a XP Olympus 4.9 mm endoscope was passed through the duodenal tube was replaced using a hydrofilic guide wire. In all the patients the procedure was efficacious and intraduodenal levodopa infusion was administered with neurological benefit; the mean time of hospitalization was four days. In one patient admitted in the neurology unit we observed infectious complications of gastrostomy and in one case the duodenal tube was replaced after nine months because of a knot. Conclusions: In our experience positioning of transgastric-jejunal infusion tube seems to be a safe and efficacious procedure for intraduodenal administration of levodopa in severe PD with motor complications. In these patients oral feeding and small size of the duodenal catheter may promote the dislocation of duodenal tube: a larger population study and a longer follow-up are advisable to assess the real clinical effectiveness.
P.1.240 EUS ACCURACY IN RESTAGING RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY: A PRELIMINARY REPORT A. Caruso ∗ , M. Cretella, M. Cossignani, M. Coppola, E. Mannisi, P. Sileri, V. Formica, I. Portarena, M. Roselli, F. Pallone, G. Del Vecchio Blanco Policlinico Tor Vergata, Roma, Italy Background and aim: Colorectal cancer (CRC) is the second most frequent
S228
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
cause of cancer-related death in Western countries: one third of CRC is represented by rectal cancer (RC). Good staging of RC is requested to give patients (pts) best cares referring to stage: Endoscopic Ultrasonography (EUS) is actually best choice for this. Neoadjuvant therapy help clinicians downstaging and downsizing RC in stage II and III, just providing less invasive surgery, but no diagnostic method, such as EUS and MRI, showed to be able to restage RC after chemoradiotherapy (CRT). the aim of this study was to test neoadjuvant CRT efficacy and EUS accuracy in restaging RC after CRT and before surgery. Material and methods: We prospectively signed up consecutive pts affected by RC in stage II and III who underwent EUS and MRI or CT or PET as staging tests. Then they underwent CRT (chemotherapy: CDDP, FOLFOX or FUFA; radiotherapy 45 cGy in 25 days); after CRT pts underwent restaging of RC with EUS and MRI or CT or PET, then underwent surgery. Results: Seventeen pts signed up, 13 male, median age 65 yrs (range 56-74), median distance from the anus 5 cm, 9 in stage II and 8 in stage III. Twelve underwent CDDP, 2 FOLFOX, 2 FUFA; all of them underwent radiotherapy with no complication. At second EUS all but one RC had a reduction >30% of diameter following RECIST criteria. Sixteen pts underwent TME and 1 Miles resection. Histopathology showed 3 pts at stage 0, 3 pts at stage I, 4 at stage II, 6 at stage III, 1 at stage IV. EUS post-RCT made correct T stage in 12/17 pts (3 T0, 3 T2, 6 T3), while overstaged 3 pts T2, 1 pt T1 and 1 pt T0. EUS post-RCT N stage accuracy was 79%; accuracy to discriminate a T0-T1 from T2-T3 was 100%; accuracy to discriminate muscolaris infiltration was 100%. 9/17 pts had downstaging at histopatology, 15/17 pts had a significant reduction in diameter. Conclusions: Neoadjuvant CRT is a usefull tool able to downstage and downsize RC. In our study, EUS showed its ability to restage RC after neoadjuvant CRT with an higher accuracy then that reported in literature.
P.1.241 A NEW ENDOSCOPIC MICROWAVE HEMOSTATIC DEVICE: AN EXPERIMENTAL STUDY OF SAFETY AND HEMOSTATIC EFFICACY IN A PORCINE MODEL M. Balzarini ∗ ,1 , E. Grossini 2 , C. Molinari 2 , F. Uberti 2 , G. Valente 2 , G. Vacca 2 , M. Del Piano 1 , M. Orsello 1 , S. Carmagnola 1 , A. Anderloni 1 , M. Ballarè 1 , L. Cipolletta 3 , L. Ficano 4 1 Scdo Gastroenterologiia Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy; 2 Laboratorio di Fisiologia, Dipartimento di Scienze Mediche, Facoltà di Medicina e Chirurgia, Università Del Piemonte Orientale A Avogadro, Novara, Italy; 3 Gastroenterologia P.O. “A. Maresca” Torre Del Greco (NA), Napoli, Italy; 4 Dipartimento di Oncologia, Divisione di Chirurgia Generale Ed Oncologica Università di Palermo, Palermo, Italy
Background and aim: Precedent study evaluated the effectiveness and safety of endoscopic microwave coagulation (MC) in achieving hemostasis. A new microwave deliver system was built and safety was evaluated. Endoscopic and histologic evaluation have been performed in order to establish the optimal time-course/power relation of MC application. Material and methods: The experiment has been performed in two pigs anesthetized according with national guidelines. Using a magnetron, 10-76 W were generated from the tip of a flexible coaxial cable for different period of time. The safety of the device was evaluated keeping tip in contact with endoscopic normal gastric mucosa and applying light pressure. We evaluated the safety of the device in achieving hemostasis in two bleeding ulcers made resecting with a cold snare a iatrogenic pseudopolyp overlying submucosal vessel. Also in this setting contact method was used. Results: The two pigs were sacrificed at the end of the procedure, stomach has been removed and processed for hematoxylin/eosin staining and TUNEL. All treatments lasted from 5 to 20 seconds with a power setting ranging from 10 to 76 W. Parameters evaluated included depth of injury and efficacy of hemostasis. In depth of injury study on normal mucosa there was no perforation or external muscle layer damage and also when MC was used at 70-76 W for 20 seconds, ulcerations were surrounded by necrosis, congestions and neutrophil inflammation never exceeding the submucosal layer. Hemostasis was achieved in 100% in the two endoscopically induced bleeding gastric ulcer using high power (60 W); histological analysis revealed the presence of muscolar layer damage in one case. TUNEL analysis evidenced 1-2 apoptotic nuclei for each
field when microwave was used at 10 W for 5 s, whereas microwave use at 76 W for 20 s caused an increase of apoptotic nuclei to 5-6 for each field. Conclusions: Microwave energy may be applied endoscopically and this new device is promising to produce hemostasis. Shorter time of application can be obtained modifying the generator to reach the peak power time in less time Further study are required in particular regarding safety in producing hemostasis.
P.1.242 CLINICAL SIGNIFICANCE OF ISOLATED DIMINUTIVE COLONIC POLYPS V. Peri ∗ ,1 , M. Marino 1 , G. Gatto 1 , M.L. Uzzo 2 1 Az.Osp.
Oo.Rr. Villa Sofia-Cervello, Palermo, Italy; 2 Bionec Histology Section University of Palermo, Palermo, Italy Background and aim: Several reports have assessed clinical significance of diminutive (1-5 mm) polyps; here we report on the prevalence of advanced histology in patient with “isolated” diminutive polyps, i.e. without associated polyps of larger size. Material and methods: Retrospective examination of endoscopy records and of histopathology records of patients with polyps of any size. Advanced histology was defined as the presence of high grade dysplasia (HGD) or in situ carcinoma. Polyps were categorized into three groups: diminutive (1-5 mm); small (6-10 mm) and large (11 mm or more). Results: Data on 2176 consecutive colonoscopies were evaluated; biopsies were performed in 895 (41%); 555 (61%) biopsies evaluated polyps of various size; 315 patients (61%) showed “isolated” diminutive polyps, 89 (16%) patients had small polyps and 67 (12%) had large polyps. Advanced carcinoma was present in 84 (15%) patients. Mean age and prevalence of high grade dysplasia are shown in the table.
Number Male (%) Mean age % HGD
Diminutive
Small
Large
Advanced Carcinoma
315 205 (62) 62.0 0.9
89 57 (64) 67.2 11.2
67 46 (68) 68.7 32.8
84 52 (62) 70.1 Not appropriated
Conclusions: “Isolated” diminutive polyps are at very low risk of advanced histology; small polyps carry a significant risk of advanced histological features. Difference in mean age between groups at different risk of HGD and with patients with advanced carcinoma suggests that progression from diminutive polyps to polyps of larger size and with significant HGD risk might need several (5 or 6) years.
P.1.243 NEEDLE KNIFE SPHINTEROTOMY (NKS) STENT GUIDED IN PATIENTS WITH BILLROTH II (B-II) GASTROJEJUNOSTOMY: 10 YEARS OF EXPERIENCE G. Frosini ∗ , M. Marini, R. Macchiarelli, R. Chieca, S. Rentini Gastroenterology And Gastrointestinal Endoscopy Unit University Hospital of Siena, Siena, Italy Background and aim: The success rate of therapeutic ERCP is almost 100% in patients with normal gastrointestinal anatomy but is between 60% and 91% in patients with Billroth II gastroenterostomy (B II GE) with or without Braun anastomosis (BA). Also rate of complications change: in patients with intact gastrointestinal anatomy is referred: pancreatitis, 5–6%; hemorrhage, 1–2%; perforation, 0.5–1%. In BII patients perforation related with ERCP is reported to be between 0.6% and 11%. NK-S guided by prior placement of a biliary stout has been shown to helpful. Aim: To review experience with the use of NK-S in B-II patients over a 10 year period. Material and methods: 2655 ERCP’s were performed at our institution over the last decade.
3rd month 40 0 1 2
6th month 40 0 1 2
12th month 39 0 1 2
CD (% pts) UC (% pts)
19 24
43 25
64 71
48 47
33 29
38 50
19 25
29 29
7 0
Conclusions: Our data point out that: i) MH is a reparative process requiring different time in different patient, ii) the rate of complete-MH progressively increases during the first year of biologic treatment, iii) length of therapy significantly (p<0.001) reduces number of patients with non-MH, iv) one year therapy minimizes clinical relapse, hospitalization rate and colectomy in IBD patients. All patients with UC were healed at 12th month of treatment while 3 CD patients remained non-MH and developed local complications. Preliminary data of 10 patients at 24th month of biologic therapy show that MH is detected respectively in 100% of CD and 80% of UC patients.
P.1.238 DNA DAMAGE IN PERIPHERAL BLOOD LYMPHOCYTES OF PATIENTS WITH CIRRHOSIS RELATED TO VIRAL HEPATITIS OR ALCOHOL USE: CORRELATION WITH CHILD-PUGH SCORE G. Testino ∗ , F. Ansaldi, P. Borro, O.A. Ancarani, D. Barciocco, A. Sumberaz Azienda Ospedaliera Univesritaria San Martino, Genova, Italy Background and aim: Both alcohol use and hepatitis B or C (HBV, HCV) virus infection are implicated in the development of hepatocellular carcinoma (HCC). Considering that alcoholic liver disease and chronic virus hepatitis promote the generation of reactive oxygen species, we have investigated the occurrence of DNA fragmentation (Comet assay) in peripheral blood lymphocytes from patients with cirrhosis and analyzed the correlation with Child-Pugh score used to assess the degree of hepatic insufficiency. Material and methods: The study population consisted of two groups: group I involved 12 patients (2 females, mean age: 50.7±11.2) with alcoholic cirrhosis and group II involved 25 patients (9 females; mean age: 54.6±9.6) with HBV or HCV cirrhosis. The control group involved 20 healthy subjects (11 females; mean age: 48.5±14.1). DNA fragmentation was evaluated by the alkaline Comet assay as described by Singh et al. Extent of DNA damage was quantified by measuring the tail length (TL) and the tail moment (TM) with computerized image analysis (Sarin System, Florence, Italy). The TM was defined as the product of TL and the amount of DNA in the tail. Statistical analysis: Wilcoxon two-sample test. Regression analysis was used to examine whether a positive correlation exists between degree of DNA damage and Child-Pugh score. Results: Results of DNA fragmentation in Table 1. Smoking habit cannot be considered a confusing factor. There is a significant correlation among Child-
S227
Table 1 Alcoholic cirrhosis HBV/HCV cirrhosis Cirrhosis smokers Cirrhosis non smokers Controls
TL
TM
2.96±1.79* 2.81±0.94* 2.84±1.76* 2.35±0.96* 1.54±0.49
258±162* 233±83* 254±155* 202±79* 141±45
*p<0.001.
Pugh score, TL and TM: TL R=0.7574 (p<0.001); TM R=0.7414 (p<0.001). Conclusions: The data of this experience confirm how alcohol and viral hepatitis could be involved in the development of HCC throught both direct (genotoxic) and indirect mechanism (severity of liver cirrhosis).
P.1.239 EMPLOYMENT OF TRANSGASTRIC-JEJUNAL INFUSION TUBE FOR INTRADUODENAL ADMINISTRATION OF LEVODOPA S. Carmagnola ∗ , M. Balzarini, A. Anderloni, M. Orsello, M. Pagliarulo, M. Ballarè, R. Tari, M. Sartori, M. Del Piano Scdo di Gastroenterologia Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy Background and aim: Motor complications are a common problem in the long-term management of Parkinson’s disease (PD). A stable suspension of levodopa and carbidopa (Duodopa® ) has been proposed to reduce on-off fluctuations. Positioning of duodenal catheter throught a percutaneous endoscopic gastrostomy (PEG) was used to administer the drug. We reported a single tertiary gastroenterology unit experience concerning technique, safety and efficacy of the procedure. Material and methods: Between February 2010 and November 2011 we positioned five duodenal devices for infusion of levodopa (Duodopa® ) in four patients (58-68 years, 3 male) affected by severe PD with motor fluctuations. All the patients were admitted in a neurology or gastroenterology unit and received upper gastrointestinal endoscopy apart one patient with pharyngolaryngeal obstruction who already had PEG for nutrition. The transgastricjejunal infusion tube were from Kymberly Clark or Boston Scientific. Results: Two patients received a common 20-French PEG through which the 10 F-French duodenal tube was replaced over pylorus at the ligament of Treitz dragging by a forceps under endoscopic and radiologic view. One female patient with history of gastroresection received a direct percutaneous endoscopic jejunostomy (D-PEJ). One man with pharyngo-laryngeal obstruction and a 14-French PEG was treated with dilation of gastrostomy to 22-French and a XP Olympus 4.9 mm endoscope was passed through the duodenal tube was replaced using a hydrofilic guide wire. In all the patients the procedure was efficacious and intraduodenal levodopa infusion was administered with neurological benefit; the mean time of hospitalization was four days. In one patient admitted in the neurology unit we observed infectious complications of gastrostomy and in one case the duodenal tube was replaced after nine months because of a knot. Conclusions: In our experience positioning of transgastric-jejunal infusion tube seems to be a safe and efficacious procedure for intraduodenal administration of levodopa in severe PD with motor complications. In these patients oral feeding and small size of the duodenal catheter may promote the dislocation of duodenal tube: a larger population study and a longer follow-up are advisable to assess the real clinical effectiveness.
P.1.240 EUS ACCURACY IN RESTAGING RECTAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY: A PRELIMINARY REPORT A. Caruso ∗ , M. Cretella, M. Cossignani, M. Coppola, E. Mannisi, P. Sileri, V. Formica, I. Portarena, M. Roselli, F. Pallone, G. Del Vecchio Blanco Policlinico Tor Vergata, Roma, Italy Background and aim: Colorectal cancer (CRC) is the second most frequent
S228
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
cause of cancer-related death in Western countries: one third of CRC is represented by rectal cancer (RC). Good staging of RC is requested to give patients (pts) best cares referring to stage: Endoscopic Ultrasonography (EUS) is actually best choice for this. Neoadjuvant therapy help clinicians downstaging and downsizing RC in stage II and III, just providing less invasive surgery, but no diagnostic method, such as EUS and MRI, showed to be able to restage RC after chemoradiotherapy (CRT). the aim of this study was to test neoadjuvant CRT efficacy and EUS accuracy in restaging RC after CRT and before surgery. Material and methods: We prospectively signed up consecutive pts affected by RC in stage II and III who underwent EUS and MRI or CT or PET as staging tests. Then they underwent CRT (chemotherapy: CDDP, FOLFOX or FUFA; radiotherapy 45 cGy in 25 days); after CRT pts underwent restaging of RC with EUS and MRI or CT or PET, then underwent surgery. Results: Seventeen pts signed up, 13 male, median age 65 yrs (range 56-74), median distance from the anus 5 cm, 9 in stage II and 8 in stage III. Twelve underwent CDDP, 2 FOLFOX, 2 FUFA; all of them underwent radiotherapy with no complication. At second EUS all but one RC had a reduction >30% of diameter following RECIST criteria. Sixteen pts underwent TME and 1 Miles resection. Histopathology showed 3 pts at stage 0, 3 pts at stage I, 4 at stage II, 6 at stage III, 1 at stage IV. EUS post-RCT made correct T stage in 12/17 pts (3 T0, 3 T2, 6 T3), while overstaged 3 pts T2, 1 pt T1 and 1 pt T0. EUS post-RCT N stage accuracy was 79%; accuracy to discriminate a T0-T1 from T2-T3 was 100%; accuracy to discriminate muscolaris infiltration was 100%. 9/17 pts had downstaging at histopatology, 15/17 pts had a significant reduction in diameter. Conclusions: Neoadjuvant CRT is a usefull tool able to downstage and downsize RC. In our study, EUS showed its ability to restage RC after neoadjuvant CRT with an higher accuracy then that reported in literature.
P.1.241 A NEW ENDOSCOPIC MICROWAVE HEMOSTATIC DEVICE: AN EXPERIMENTAL STUDY OF SAFETY AND HEMOSTATIC EFFICACY IN A PORCINE MODEL M. Balzarini ∗ ,1 , E. Grossini 2 , C. Molinari 2 , F. Uberti 2 , G. Valente 2 , G. Vacca 2 , M. Del Piano 1 , M. Orsello 1 , S. Carmagnola 1 , A. Anderloni 1 , M. Ballarè 1 , L. Cipolletta 3 , L. Ficano 4 1 Scdo Gastroenterologiia Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy; 2 Laboratorio di Fisiologia, Dipartimento di Scienze Mediche, Facoltà di Medicina e Chirurgia, Università Del Piemonte Orientale A Avogadro, Novara, Italy; 3 Gastroenterologia P.O. “A. Maresca” Torre Del Greco (NA), Napoli, Italy; 4 Dipartimento di Oncologia, Divisione di Chirurgia Generale Ed Oncologica Università di Palermo, Palermo, Italy
Background and aim: Precedent study evaluated the effectiveness and safety of endoscopic microwave coagulation (MC) in achieving hemostasis. A new microwave deliver system was built and safety was evaluated. Endoscopic and histologic evaluation have been performed in order to establish the optimal time-course/power relation of MC application. Material and methods: The experiment has been performed in two pigs anesthetized according with national guidelines. Using a magnetron, 10-76 W were generated from the tip of a flexible coaxial cable for different period of time. The safety of the device was evaluated keeping tip in contact with endoscopic normal gastric mucosa and applying light pressure. We evaluated the safety of the device in achieving hemostasis in two bleeding ulcers made resecting with a cold snare a iatrogenic pseudopolyp overlying submucosal vessel. Also in this setting contact method was used. Results: The two pigs were sacrificed at the end of the procedure, stomach has been removed and processed for hematoxylin/eosin staining and TUNEL. All treatments lasted from 5 to 20 seconds with a power setting ranging from 10 to 76 W. Parameters evaluated included depth of injury and efficacy of hemostasis. In depth of injury study on normal mucosa there was no perforation or external muscle layer damage and also when MC was used at 70-76 W for 20 seconds, ulcerations were surrounded by necrosis, congestions and neutrophil inflammation never exceeding the submucosal layer. Hemostasis was achieved in 100% in the two endoscopically induced bleeding gastric ulcer using high power (60 W); histological analysis revealed the presence of muscolar layer damage in one case. TUNEL analysis evidenced 1-2 apoptotic nuclei for each
field when microwave was used at 10 W for 5 s, whereas microwave use at 76 W for 20 s caused an increase of apoptotic nuclei to 5-6 for each field. Conclusions: Microwave energy may be applied endoscopically and this new device is promising to produce hemostasis. Shorter time of application can be obtained modifying the generator to reach the peak power time in less time Further study are required in particular regarding safety in producing hemostasis.
P.1.242 CLINICAL SIGNIFICANCE OF ISOLATED DIMINUTIVE COLONIC POLYPS V. Peri ∗ ,1 , M. Marino 1 , G. Gatto 1 , M.L. Uzzo 2 1 Az.Osp.
Oo.Rr. Villa Sofia-Cervello, Palermo, Italy; 2 Bionec Histology Section University of Palermo, Palermo, Italy Background and aim: Several reports have assessed clinical significance of diminutive (1-5 mm) polyps; here we report on the prevalence of advanced histology in patient with “isolated” diminutive polyps, i.e. without associated polyps of larger size. Material and methods: Retrospective examination of endoscopy records and of histopathology records of patients with polyps of any size. Advanced histology was defined as the presence of high grade dysplasia (HGD) or in situ carcinoma. Polyps were categorized into three groups: diminutive (1-5 mm); small (6-10 mm) and large (11 mm or more). Results: Data on 2176 consecutive colonoscopies were evaluated; biopsies were performed in 895 (41%); 555 (61%) biopsies evaluated polyps of various size; 315 patients (61%) showed “isolated” diminutive polyps, 89 (16%) patients had small polyps and 67 (12%) had large polyps. Advanced carcinoma was present in 84 (15%) patients. Mean age and prevalence of high grade dysplasia are shown in the table.
Number Male (%) Mean age % HGD
Diminutive
Small
Large
Advanced Carcinoma
315 205 (62) 62.0 0.9
89 57 (64) 67.2 11.2
67 46 (68) 68.7 32.8
84 52 (62) 70.1 Not appropriated
Conclusions: “Isolated” diminutive polyps are at very low risk of advanced histology; small polyps carry a significant risk of advanced histological features. Difference in mean age between groups at different risk of HGD and with patients with advanced carcinoma suggests that progression from diminutive polyps to polyps of larger size and with significant HGD risk might need several (5 or 6) years.
P.1.243 NEEDLE KNIFE SPHINTEROTOMY (NKS) STENT GUIDED IN PATIENTS WITH BILLROTH II (B-II) GASTROJEJUNOSTOMY: 10 YEARS OF EXPERIENCE G. Frosini ∗ , M. Marini, R. Macchiarelli, R. Chieca, S. Rentini Gastroenterology And Gastrointestinal Endoscopy Unit University Hospital of Siena, Siena, Italy Background and aim: The success rate of therapeutic ERCP is almost 100% in patients with normal gastrointestinal anatomy but is between 60% and 91% in patients with Billroth II gastroenterostomy (B II GE) with or without Braun anastomosis (BA). Also rate of complications change: in patients with intact gastrointestinal anatomy is referred: pancreatitis, 5–6%; hemorrhage, 1–2%; perforation, 0.5–1%. In BII patients perforation related with ERCP is reported to be between 0.6% and 11%. NK-S guided by prior placement of a biliary stout has been shown to helpful. Aim: To review experience with the use of NK-S in B-II patients over a 10 year period. Material and methods: 2655 ERCP’s were performed at our institution over the last decade.