- Email: [email protected]
P.12.6: Biopsy of Abdominal Focal Lesions Under Contrast-Enhanced Ultrasound Guidance. A Multicenter Italian Study
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
cleansing (Boston score >6) also determined a shorter WT. These differences became not significant in phase 2. In the phase 1 the MAP was 0.56 with the FUSE vs. 0.44 with the SE (p<0.01); in the phase 2 the MAP increases to 0.65 and 0.70, respectively (p=0.001). By optimizing the WT, the ADR increases from 29.9% to 34.8% with the SE and from 36.5% to 40.1% with the FUSE. The ADRs were essentially equivalent between FUSE with 291 sec WT and SE with 386 WT (35.5% vs. 34.8%). Conclusions: Unmonitored endoscopists have a sub-ottimal WT, which increases when they are aware to be monitored. Optimizing the WT resulted in a significant increase in the number of detected adenomas and a trend towards a better ADR. The FUSE scope allows the detection of a significant higher number of polyps when the WT is sub-optimal.
P.12.5 COMPARISON BETWEEN AN ASYMMETRIC (SMALL DOSE IN THE MORNING) AND A SYMMETRIC SPLIT-DOSE REGIMEN OF POLYETHYLENE GLYCOL PLUS BISACODYL FOR BOWEL PREPARATION FOR SCREENING COLONOSCOPY: A RANDOMIZED NON-INFERIORITY CLINICAL TRIAL G. De Nucci ∗ , C. Bezzio, P. Andreozzi, I. Arena, M. Devani, E. Mandelli, D. Morganti, B. Omazzi, R. Reati, D. Redaelli, S. Saibeni, G. Manes ASST Rhodense, Garbagnate Milanese and Rho, Italy Background and aim: An effective colon cleaning is essential to perform a good-quality screening colonoscopy. Split-dose regimens are presently considered the standard of care. However, the compliance of split regimens is poor because some patients do not want to wake-up very early in the morning to take the the second dose of preparation. We aimed to evaluate whether the reduction of the morning dose, maintaining the same total dose of preparation, may improve the compliance without negatively affecting the efficacy of colon cleaning. Material and methods: We prospectively enrolled consecutive outpatients undergoing screening colonoscopy. All subjects received a split-dose regimen of PEG-citrate-simethicone plus bisacodyl. Patients were randomly assigned to two groups: group A received an asymmetric split dose regimen (1.5 L of PEG the day before and 0.5 L the morning of colonoscopy); group B received a symmetric split dose regimen (1 L of PEG the day before and 1 L the morning of colonoscopy). Patients refusing split-preparation were free to take a typical preparation of 2 L PEG the day before colonoscopy. The primary endpoints were the rate of patients accepting split-dose regimen and the quality of bowel cleansing using the Boston Bowel Preparation Scale (BBPS). The threshold for statistical significance in this study was p=0.05 and a 10% margin was used to demonstrate non-inferiority of asymmetric vs. symmetric split-dose regimen. Results: 164 patients were enrolled (mean age 61±8 years, males 57%), 77 in group A and 87 in group B. Split-dose was taken by 66/77 and by 77/87 patients in group A and B, respectively (85.7% vs. 88.5%, p=0.381). Bowel cleansing was considered adequate (BBPS ≥2 in each segment of the colon) in 63/66 and 71/77 patients respectively in group A and B (95.5% vs. 92.2%, p=0.425); the total BBPS score and the scores of each colon segment were also similar in the two groups. The adenoma detection rate was also similar in the two groups (43.9% and 36.4%, respectively; p=0.394). Conclusions: This study shows that the morning administration of a lower amount of PEG was well accepted and as effective as a standard split-dose regimen. In addition, adenoma detection rate was similar in the two groups. A lower amount of preparation in the morning would allow to the patients to wake up later; this regimen could be thus preferred by patients undergoing colonoscopy early
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in the morning. Further study are needed to determine the smallest morning dose able to achieve an adequate colon cleansing.
P.12.6 BIOPSY OF ABDOMINAL FOCAL LESIONS UNDER CONTRASTENHANCED ULTRASOUND GUIDANCE. A MULTICENTER ITALIAN STUDY G. Francica ∗,1 , I. De Sio 2 , F. Terracciano 3 , M. Pompili 4 , M.F. Meloni 6 , E. Caturelli 5 1 Pineta Grande Hopsital, Castel Volturno (CE), Italy; 2 Unita Operativa Complessa di Epatogastroenterologia 2 Universita Napoli, Napoli, Italy; 3 UOC Gastroenterologia, IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; 4 Dipartimento di Medicina Interna e Gastroenterologia Università Cattolica del Sacro Cuore, Roma, Italy; 5 Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy; 6 Servizio di Ecointerventistica, Casa di Cura Igea, Milano, Italy
Background and aim: Guidelines recently issued by the European Federation of Ultrasound Societes advice the use of ContrastEnhanced Ultrasound (CEUS) guided biopsy in deep abdominal organs (mainly liver) to avoid necrotic areas or improve targeting of undetectable or not conspicuous lesion targets on B-mode US. However, no data are available on routine use of this technique. Aim of this study was to quantify the use of CEUS as guidance technique for biopsy of Abdominal Focal Lesions (AFL) in field practice of six Italian centers with high volume of ultrasound interventional activity. Material and methods: The six participating centers retrospectively selected all patients in whom biopsy needles were positioned into AFL during CEUS with Sonovue. The rate of CEUS-guided biopsies was calculated on the whole bioptic activity of each center between 2005 and 2015. In addition, contrast media consumption, procedure indications, diagnostic yield and complications were evaluated. Results: CEUS-guided biopsy of AFL was carried out in 93 patients (58 M/35 F, median age 68.5 yrs, range 31–89) with 82 liver focal lesions (median size 24.5 mm; range 8–78) and 12 extra-hepatic abdominal masses (median size 31.5 mm; range 8–130) by using cutting needles (18–20g) in 86 cases (91.4%). A single needle pass was recorded in 72 AFL (76.6%) and a single standard dose of Sonovue (2.4 ml) was used in 54 AFL (57.4%). Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (25.5%), improvement of conspicuity of the target (34.1%), choice of nonnecrotic area inside the target (40.4%). 26 out of 93 patients (28%) had a previous non-diagnostic cyto-histological exam performed under B-mode US guide. Bioptic samples yielded a specific diagnosis in 88 cases (93.6): 77 AFL proved to be malignant (82%), mostly primary or secondary liver tumors (65 out of 77). No complications ensued either needle insertion or infusion of contrast medium. CEUS-guided biopsy guidance represented 2.4% (range 0.8–7.6%) of 3857 biopsies on AFL carried out at the participating centers.
Conclusions: To the best of our knowledge, it is the first time that
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the use of CEUS as guidance technique for abdominal biopsy has been quantified. In experienced hands such a procedure seems to have limited indication (2.4% of 3857 biopsies), but represents a powerful tool to cope with challenging scenarios such as poorly visualized or invisible lesions sampling of non-necrotic areas in the target lesions andrepeat biopsy after unsuccessful sampling performed using the standard unenhanced technique.
cases but 50% of patients on aspirin. After endoscopic treatment all patients recovered uneventfully. Overall, perforation occurred in 0.7% of patients; 75% of them were successfully managed endoscopically. Conclusions: The management of resection of LCLs varies widely. The incidence of intra-procedural complication is not negligible but the endoscopic management is successful in most of the cases, even in a real life setting.
P.12.7 MANAGEMENT OF RESECTION AND INTRA-PROCEDURAL COMPLICATIONS OF LARGE COLONIC LESIONS IN A REAL-LIFE SETTING: THE SCALP STUDY A. Amato ∗,1 , F. Radaelli 1 , V. Cennamo 2 , E. Di Giulio 3 , L. Fuccio 4 , G. Manes 5 , O. Tarantino 6 , G. Fiori 7 , M. De Bellis 8 , A. Buda 9 , F. Pigò 10 , P. Cesaro 11 , G. Feliciangeli 12 , P. Dulbecco 13 , A. Musso 14 , G. Gullotti 15 , M. Giardini 16 , B. Mangiavillano 17 , C. Hassan 18 , A. Repici 19 1 Ospedale
2 Ospedale
Valduce, Como, Italy; Bellaria, Bologna, Italy; Sant’Andrea, Roma, Italy; 4 Policlinico Sant’Orsola, Bologna, Italy; 5 Ospedale Salvini, Garbagnate, Italy; 6 Ospedale San Giuseppe, Empoli, Italy; 7 Istituto Europeo Oncologico, Milano, Italy; 8 Istituto Nazionale Tumori, Napoli, Italy; 9 Ospedale Santa Maria del Prato, Feltre, Italy; 10 Ospedale Civile, Modena, Italy; 11 Fondazione Poliambulanza, Brescia, Italy; 12 Ospedale di Macerata, Macerata, Italy; 13 Università degli Studi, Genova, Italy; 14 Città della Salute e della Scienza, Torino, Italy; 15 Policlinico G. Martino, Messina, Italy; 16 Ospedale di Urbino, Urbino, Italy; 17 Humanitas Mater Domini, Castellanza, Italy; 18 Ospedale Nuovo Regina Margherita, Roma, Italy; 19 Humanitas University, Milano, Italy 3 Ospedale
Background and aim: Endoscopic resection of large colonic lesions (LCLs, >20mm) is effective and it is associated with an acceptable incidence of incomplete resection and complications when performed by appropriately trained endoscopists in resourced endoscopy centers. There are scanty data on the management of these lesions out of referral centers. Aim of the study is to evaluate the management of endoscopic resection of LCLs and intra-procedural complications in a real-life setting. Material and methods: In a prospective, multicenter, observational studies conducted in 20 centers, data from consecutive endoscopic resections of LCLs performed over a 6-months period were collected through a web database. All patients undergoing LCLs resection were enrolled at procedure-time and followed-up at 15 days for adverse events and at 6 months for endoscopic and histological recurrence. Results: 1076 LCLs (mean size 30.5 mm, SD 12.3; 41.2% lateral spreading tumor, 28.4% sessile, and 30.4% pedunculated) removed in 979 patients (59% males, mean age 66±11.7 years) were analyzed. Preliminary data on pre-procedure management and intra-procedural complications are presented. A piecemeal endoscopic mucosal resection (EMR) was performed in 37.5%, en-bloc EMR in 20.5%, snare polypectomy in 34.6%, underwater EMR in 1.1% and endoscopic submucosal dissection in 6.3% of the lesions. The resection of the LCLs was not performed at diagnosis-time in 50.2% of the cases. Reasons for deferral were time constrains (38.4%), limited endoscopist expertise (22.8%), concomitant antithrombotic therapy (ATT) (9.1%) and endoscopist’s preference for hospitalization (29.7%). Of patients with LCLs, 19.6% were on ATT (62.3% aspirin, 12.3% thienopyridines, 4.9% dual antiplatelet, 15.4% vitamin K antagonists [VKAs], 5.1% direct oral anticoagulants [DOACs]). Aspirin and/or thienopyridines were withhold before resection by 53.6% and 91.7% of patients, respectively. Overall, intra-procedural bleeding requiring endoscopic therapy occurred in 9.2% of patients of whom 28.2% were on ATT, which had been withheld in all the
P.12.8 META-ANALYSIS: ASPIRIN EXPOSURE AND CLINICALLY SIGNIFICANT DELAYED BLEEDING AFTER COLORECTAL POLYPECTOMY F. Pigò ∗ , H. Bertani, G. Grande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy Background and aim: To assess the risk of clinically significant delayed bleeding in patients who underwent to colorectal polypectomy in relation to aspirin exposure. Material and methods: Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966– 2016. Studies in which aspirin exposure and bleeding rate were specified were included in the study. Risk of post-polypectomy bleeding, also in relation to dimension of the polyp was extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models (Fig. 1, see p. e215). I2 statistic was used to describe the variation across studies due to heterogeneity. Results: 11 studies (4 prospective and 7 retrospective) including 9307 patients were comprised in the analyses. Overall, 344 patients (pooled OR 1.7, 95% CI 1.1% to 2.7%, I2 = 51.3%) experienced rectal bleeding after polypectomy with ongoing aspirin. Subgroup analysis (1 prospective and 1 retrospective studies with lesions ≤2cm) exposed the safeness of polypectomy and the aspirin not withheld for lesions ≤20 mm (OR 0.8, 95% CI 0.4% to 1.7%, I2 = 50.9%). Conclusions: Colorectal polyectomy is safe under aspirin for polyp ≤2 cm.
P.12.9 COST ANALYSIS AND OUTCOME OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL LESIONS IN OUTPATIENTS VERSUS INPATIENTS R. Maselli ∗ , P.A. Galtieri, A. Fugazza, G. Lollo, L. Poliani, R. Semeraro, F. Auriemma, G. Amvrosiadis, M. Di Leo, E.C. Ferrara, S. Carrara, A. Anderloni, A. Repici Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic submucosal dissection (ESD) is worldwide accepted as a minimally invasive treatment for early gastrointestinal (GI) cancer but it is still considered a challenging and risky procedure in the colorectum. In both Eastern and Western settings published studies indicate that the vast majority of patients undergoing ESD are hospitalized because of the expected high risk of complications. Aim of this study is to compare costs in the endoscopic management of colorectal ESD in outpatients and inpatients and investigate the safety and efficacy of procedure performed in outpatient setting, in a tertiary level center. Material and methods: This is a retrospective observational study which included included 126 patients consecutively treated by ESD at Humanitas Research Hospital, Italy from May 2014 to March 2016. Patients were divided into 2 groups: outpatients (group A), discharged in 1 d and inpatients (group B) that were admitted in
cleansing (Boston score >6) also determined a shorter WT. These differences became not significant in phase 2. In the phase 1 the MAP was 0.56 with the FUSE vs. 0.44 with the SE (p<0.01); in the phase 2 the MAP increases to 0.65 and 0.70, respectively (p=0.001). By optimizing the WT, the ADR increases from 29.9% to 34.8% with the SE and from 36.5% to 40.1% with the FUSE. The ADRs were essentially equivalent between FUSE with 291 sec WT and SE with 386 WT (35.5% vs. 34.8%). Conclusions: Unmonitored endoscopists have a sub-ottimal WT, which increases when they are aware to be monitored. Optimizing the WT resulted in a significant increase in the number of detected adenomas and a trend towards a better ADR. The FUSE scope allows the detection of a significant higher number of polyps when the WT is sub-optimal.
P.12.5 COMPARISON BETWEEN AN ASYMMETRIC (SMALL DOSE IN THE MORNING) AND A SYMMETRIC SPLIT-DOSE REGIMEN OF POLYETHYLENE GLYCOL PLUS BISACODYL FOR BOWEL PREPARATION FOR SCREENING COLONOSCOPY: A RANDOMIZED NON-INFERIORITY CLINICAL TRIAL G. De Nucci ∗ , C. Bezzio, P. Andreozzi, I. Arena, M. Devani, E. Mandelli, D. Morganti, B. Omazzi, R. Reati, D. Redaelli, S. Saibeni, G. Manes ASST Rhodense, Garbagnate Milanese and Rho, Italy Background and aim: An effective colon cleaning is essential to perform a good-quality screening colonoscopy. Split-dose regimens are presently considered the standard of care. However, the compliance of split regimens is poor because some patients do not want to wake-up very early in the morning to take the the second dose of preparation. We aimed to evaluate whether the reduction of the morning dose, maintaining the same total dose of preparation, may improve the compliance without negatively affecting the efficacy of colon cleaning. Material and methods: We prospectively enrolled consecutive outpatients undergoing screening colonoscopy. All subjects received a split-dose regimen of PEG-citrate-simethicone plus bisacodyl. Patients were randomly assigned to two groups: group A received an asymmetric split dose regimen (1.5 L of PEG the day before and 0.5 L the morning of colonoscopy); group B received a symmetric split dose regimen (1 L of PEG the day before and 1 L the morning of colonoscopy). Patients refusing split-preparation were free to take a typical preparation of 2 L PEG the day before colonoscopy. The primary endpoints were the rate of patients accepting split-dose regimen and the quality of bowel cleansing using the Boston Bowel Preparation Scale (BBPS). The threshold for statistical significance in this study was p=0.05 and a 10% margin was used to demonstrate non-inferiority of asymmetric vs. symmetric split-dose regimen. Results: 164 patients were enrolled (mean age 61±8 years, males 57%), 77 in group A and 87 in group B. Split-dose was taken by 66/77 and by 77/87 patients in group A and B, respectively (85.7% vs. 88.5%, p=0.381). Bowel cleansing was considered adequate (BBPS ≥2 in each segment of the colon) in 63/66 and 71/77 patients respectively in group A and B (95.5% vs. 92.2%, p=0.425); the total BBPS score and the scores of each colon segment were also similar in the two groups. The adenoma detection rate was also similar in the two groups (43.9% and 36.4%, respectively; p=0.394). Conclusions: This study shows that the morning administration of a lower amount of PEG was well accepted and as effective as a standard split-dose regimen. In addition, adenoma detection rate was similar in the two groups. A lower amount of preparation in the morning would allow to the patients to wake up later; this regimen could be thus preferred by patients undergoing colonoscopy early
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in the morning. Further study are needed to determine the smallest morning dose able to achieve an adequate colon cleansing.
P.12.6 BIOPSY OF ABDOMINAL FOCAL LESIONS UNDER CONTRASTENHANCED ULTRASOUND GUIDANCE. A MULTICENTER ITALIAN STUDY G. Francica ∗,1 , I. De Sio 2 , F. Terracciano 3 , M. Pompili 4 , M.F. Meloni 6 , E. Caturelli 5 1 Pineta Grande Hopsital, Castel Volturno (CE), Italy; 2 Unita Operativa Complessa di Epatogastroenterologia 2 Universita Napoli, Napoli, Italy; 3 UOC Gastroenterologia, IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; 4 Dipartimento di Medicina Interna e Gastroenterologia Università Cattolica del Sacro Cuore, Roma, Italy; 5 Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy; 6 Servizio di Ecointerventistica, Casa di Cura Igea, Milano, Italy
Background and aim: Guidelines recently issued by the European Federation of Ultrasound Societes advice the use of ContrastEnhanced Ultrasound (CEUS) guided biopsy in deep abdominal organs (mainly liver) to avoid necrotic areas or improve targeting of undetectable or not conspicuous lesion targets on B-mode US. However, no data are available on routine use of this technique. Aim of this study was to quantify the use of CEUS as guidance technique for biopsy of Abdominal Focal Lesions (AFL) in field practice of six Italian centers with high volume of ultrasound interventional activity. Material and methods: The six participating centers retrospectively selected all patients in whom biopsy needles were positioned into AFL during CEUS with Sonovue. The rate of CEUS-guided biopsies was calculated on the whole bioptic activity of each center between 2005 and 2015. In addition, contrast media consumption, procedure indications, diagnostic yield and complications were evaluated. Results: CEUS-guided biopsy of AFL was carried out in 93 patients (58 M/35 F, median age 68.5 yrs, range 31–89) with 82 liver focal lesions (median size 24.5 mm; range 8–78) and 12 extra-hepatic abdominal masses (median size 31.5 mm; range 8–130) by using cutting needles (18–20g) in 86 cases (91.4%). A single needle pass was recorded in 72 AFL (76.6%) and a single standard dose of Sonovue (2.4 ml) was used in 54 AFL (57.4%). Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (25.5%), improvement of conspicuity of the target (34.1%), choice of nonnecrotic area inside the target (40.4%). 26 out of 93 patients (28%) had a previous non-diagnostic cyto-histological exam performed under B-mode US guide. Bioptic samples yielded a specific diagnosis in 88 cases (93.6): 77 AFL proved to be malignant (82%), mostly primary or secondary liver tumors (65 out of 77). No complications ensued either needle insertion or infusion of contrast medium. CEUS-guided biopsy guidance represented 2.4% (range 0.8–7.6%) of 3857 biopsies on AFL carried out at the participating centers.
Conclusions: To the best of our knowledge, it is the first time that
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
the use of CEUS as guidance technique for abdominal biopsy has been quantified. In experienced hands such a procedure seems to have limited indication (2.4% of 3857 biopsies), but represents a powerful tool to cope with challenging scenarios such as poorly visualized or invisible lesions sampling of non-necrotic areas in the target lesions andrepeat biopsy after unsuccessful sampling performed using the standard unenhanced technique.
cases but 50% of patients on aspirin. After endoscopic treatment all patients recovered uneventfully. Overall, perforation occurred in 0.7% of patients; 75% of them were successfully managed endoscopically. Conclusions: The management of resection of LCLs varies widely. The incidence of intra-procedural complication is not negligible but the endoscopic management is successful in most of the cases, even in a real life setting.
P.12.7 MANAGEMENT OF RESECTION AND INTRA-PROCEDURAL COMPLICATIONS OF LARGE COLONIC LESIONS IN A REAL-LIFE SETTING: THE SCALP STUDY A. Amato ∗,1 , F. Radaelli 1 , V. Cennamo 2 , E. Di Giulio 3 , L. Fuccio 4 , G. Manes 5 , O. Tarantino 6 , G. Fiori 7 , M. De Bellis 8 , A. Buda 9 , F. Pigò 10 , P. Cesaro 11 , G. Feliciangeli 12 , P. Dulbecco 13 , A. Musso 14 , G. Gullotti 15 , M. Giardini 16 , B. Mangiavillano 17 , C. Hassan 18 , A. Repici 19 1 Ospedale
2 Ospedale
Valduce, Como, Italy; Bellaria, Bologna, Italy; Sant’Andrea, Roma, Italy; 4 Policlinico Sant’Orsola, Bologna, Italy; 5 Ospedale Salvini, Garbagnate, Italy; 6 Ospedale San Giuseppe, Empoli, Italy; 7 Istituto Europeo Oncologico, Milano, Italy; 8 Istituto Nazionale Tumori, Napoli, Italy; 9 Ospedale Santa Maria del Prato, Feltre, Italy; 10 Ospedale Civile, Modena, Italy; 11 Fondazione Poliambulanza, Brescia, Italy; 12 Ospedale di Macerata, Macerata, Italy; 13 Università degli Studi, Genova, Italy; 14 Città della Salute e della Scienza, Torino, Italy; 15 Policlinico G. Martino, Messina, Italy; 16 Ospedale di Urbino, Urbino, Italy; 17 Humanitas Mater Domini, Castellanza, Italy; 18 Ospedale Nuovo Regina Margherita, Roma, Italy; 19 Humanitas University, Milano, Italy 3 Ospedale
Background and aim: Endoscopic resection of large colonic lesions (LCLs, >20mm) is effective and it is associated with an acceptable incidence of incomplete resection and complications when performed by appropriately trained endoscopists in resourced endoscopy centers. There are scanty data on the management of these lesions out of referral centers. Aim of the study is to evaluate the management of endoscopic resection of LCLs and intra-procedural complications in a real-life setting. Material and methods: In a prospective, multicenter, observational studies conducted in 20 centers, data from consecutive endoscopic resections of LCLs performed over a 6-months period were collected through a web database. All patients undergoing LCLs resection were enrolled at procedure-time and followed-up at 15 days for adverse events and at 6 months for endoscopic and histological recurrence. Results: 1076 LCLs (mean size 30.5 mm, SD 12.3; 41.2% lateral spreading tumor, 28.4% sessile, and 30.4% pedunculated) removed in 979 patients (59% males, mean age 66±11.7 years) were analyzed. Preliminary data on pre-procedure management and intra-procedural complications are presented. A piecemeal endoscopic mucosal resection (EMR) was performed in 37.5%, en-bloc EMR in 20.5%, snare polypectomy in 34.6%, underwater EMR in 1.1% and endoscopic submucosal dissection in 6.3% of the lesions. The resection of the LCLs was not performed at diagnosis-time in 50.2% of the cases. Reasons for deferral were time constrains (38.4%), limited endoscopist expertise (22.8%), concomitant antithrombotic therapy (ATT) (9.1%) and endoscopist’s preference for hospitalization (29.7%). Of patients with LCLs, 19.6% were on ATT (62.3% aspirin, 12.3% thienopyridines, 4.9% dual antiplatelet, 15.4% vitamin K antagonists [VKAs], 5.1% direct oral anticoagulants [DOACs]). Aspirin and/or thienopyridines were withhold before resection by 53.6% and 91.7% of patients, respectively. Overall, intra-procedural bleeding requiring endoscopic therapy occurred in 9.2% of patients of whom 28.2% were on ATT, which had been withheld in all the
P.12.8 META-ANALYSIS: ASPIRIN EXPOSURE AND CLINICALLY SIGNIFICANT DELAYED BLEEDING AFTER COLORECTAL POLYPECTOMY F. Pigò ∗ , H. Bertani, G. Grande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy Background and aim: To assess the risk of clinically significant delayed bleeding in patients who underwent to colorectal polypectomy in relation to aspirin exposure. Material and methods: Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966– 2016. Studies in which aspirin exposure and bleeding rate were specified were included in the study. Risk of post-polypectomy bleeding, also in relation to dimension of the polyp was extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models (Fig. 1, see p. e215). I2 statistic was used to describe the variation across studies due to heterogeneity. Results: 11 studies (4 prospective and 7 retrospective) including 9307 patients were comprised in the analyses. Overall, 344 patients (pooled OR 1.7, 95% CI 1.1% to 2.7%, I2 = 51.3%) experienced rectal bleeding after polypectomy with ongoing aspirin. Subgroup analysis (1 prospective and 1 retrospective studies with lesions ≤2cm) exposed the safeness of polypectomy and the aspirin not withheld for lesions ≤20 mm (OR 0.8, 95% CI 0.4% to 1.7%, I2 = 50.9%). Conclusions: Colorectal polyectomy is safe under aspirin for polyp ≤2 cm.
P.12.9 COST ANALYSIS AND OUTCOME OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL LESIONS IN OUTPATIENTS VERSUS INPATIENTS R. Maselli ∗ , P.A. Galtieri, A. Fugazza, G. Lollo, L. Poliani, R. Semeraro, F. Auriemma, G. Amvrosiadis, M. Di Leo, E.C. Ferrara, S. Carrara, A. Anderloni, A. Repici Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic submucosal dissection (ESD) is worldwide accepted as a minimally invasive treatment for early gastrointestinal (GI) cancer but it is still considered a challenging and risky procedure in the colorectum. In both Eastern and Western settings published studies indicate that the vast majority of patients undergoing ESD are hospitalized because of the expected high risk of complications. Aim of this study is to compare costs in the endoscopic management of colorectal ESD in outpatients and inpatients and investigate the safety and efficacy of procedure performed in outpatient setting, in a tertiary level center. Material and methods: This is a retrospective observational study which included included 126 patients consecutively treated by ESD at Humanitas Research Hospital, Italy from May 2014 to March 2016. Patients were divided into 2 groups: outpatients (group A), discharged in 1 d and inpatients (group B) that were admitted in