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P.1.71: PROSPECTIVE MULTICENTER STUDY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND (IEUS) COMPLICATIONS
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Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
examination (OR 2.62, 1.58-4.34 95%CI) and no previous colonoscopy (OR 1.74, 1.15-2.66 95%CI). Fear of procedure-related pain was inversely associated to acceptance (OR 0.29, 0.18-0.46 95%CI). No influence was disclosed for gender, age, level of education, indication to the procedure, history of irritable bowel syndrome, pain as main symptom, chronic use of sedative medications, and endoscopist offering the procedure. Colonoscopy was completed without sedation in 440 subjects (82.1%), with a cecal intubation rate of 97.2%. Conclusions: Acceptance rate of unsedated colonoscopy is clinically relevant and the procedure can be completed without medications in the majority of subjects. Subject-related factors may help to identify people willing to attempt unsedated procedures. Although patient acceptance can be positively influenced by a good relationship with the physician, the individual physician is not a key-factor affecting patient choice.
P.1.71 PROSPECTIVE MULTICENTER STUDY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND (IEUS) COMPLICATIONS I. Tarantino ∗ ,1 , C. Fabbri 2 , N. Muscatiello 3 , N. Pagano 4 , R. Di Mitri 5 , L. Barresi 1 , F. Mocciaro 1 , M. Traina 1 1 Ismett,
Palermo, Italy; 2 Ospedale Bellaria, Bologna, Italy; 3 Ospedale di Foggia, Foggia, Italy; 4 Humanitas, Milano, Italy; 5 Ospedale Civivo, Palermo, Italy Background and aim: Like FNA, the close proximity of the tip of the echoendoscope to the target organ permits therapeutic procedures. Procedures like celiac plexus neurolysis (CPN), pseudocyst/abscesses drainage, and pancreatic and biliary ductal system drainages have been introduced into clinical practice. Nevertheless, complications related to interventional EUS have not been assessed in prospective studies.To assess in a prospective, multicenter study the complication rates of interventional EUS (FNA and therapeutic procedures performed under EUS guidance). We report preliminary data through 9 months. Material and methods: Data between Jan 2010 and Oct 2010 were collected from four referral centers, searching for all complications related to interventional EUS (EUS FNA, pseudocyst/abscess drainage, biliary-pancreatic drainage, CPN). All patients signed an informed consent. Demographics, comorbidities, drug history, and laboratory tests were collected. Vital signs were monitored during procedures. The procedures were performed under deep sedation or general anesthesia by experienced endosonographers. Antibiotic prophylaxis was performed when indicated. Early and late complications (mild, moderate, severe, fatal) were recorded during follow-up. Results: Three hundred fifteen (315) interventional EUS were performed over 10 months (mean follow-up 164.4 days) in 173 males/142 females (mean age 63.4±13.9): 293 EUS-FNA, 14 CPN, 7 pseudocyst/abscess drainage, and 1 biliary drainage. The overall complication rate was 3.5%. Complications were: 2 diarrhea (post-CPN), 1 epigastric pain (post-FNA), 2 intra-cystic hemorrhages, and 1 gastric bleeding (post-FNA), 5 fever (4 post-FNA, 1 postpseudocyst drainage). FNA was associated with a lower risk of complications (p=0.007, OR 0.18, 95% CI 0.4-0.7). Nevertheless, FNA on cystic lesions was associated with a higher risk of complications than that on solid ones (p<0.001, OR 15.2, 95% CI 2.9-77.6). All events occurred within 10 days, and all but one (moderate) were mild and resolved with medical therapy. No deaths occurred. Conclusions: Our preliminary results show that EUS-FNA is safer than other procedures, even if all interventional procedures are associated with a low rate of complications. We aim to collect more than 1,000 cases, and to analyze the potential associated risk factors.
P.1.72 DIAGNOSTIC EFFICACY AND OUTCOME OF DBE IN OGIB S. Benvenuti ∗ , A. De Guelmi, L. Zancanella, S. Ierace, F. Chilovi Ospedale Centrale, Bolzano, Italy Background and aim: To evaluate the diagnostic efficacy and therapeutic
impact of DBE in patients presenting to our care with manifest or occult OGIB. Material and methods: The study was conducted on 76 patients with OGIB (21 manifest and 55 occult) who underwent oral or anal DBE. Both approaches were used in 27 cases. In 72 patients it was possible to perform a CE beforehand which helped in determining the DBE antegrade or retrograde approach. Results: In 48 (71%) of 67 patients CE and DBE provided concordant diagnoses. The main discrepancies regarded neoplasias (4/9 not seen at CE) and Meckel’s diverticula (3/3 not diagnosed at CE). In 58 patients (76%) of 76, a lesion felt to be the bleeding source was identified, although in two cases the lesions were located in a site reacheable by EGDscopy and Colonoscopy. AVM (22/58) were the most common lesions encountered, followed by erosions/ulcers (18/58) and neoplasias (10/58). In 46 patients (79%) of 58 it was possible to employ some form of treatment that was endoscopic in 33 cases (56%), surgical in 11 (19%), and medical in 2 (3.4%). In 5 patients DBE was incomplete and a comparison with CE is therefore not possible. During follow-up (1-29 months) the bleeding recurred in 2 patients with AVM and they were successfully retreated with DBE. No complications were encountered during the more than 100 endoscopic procedures performed, aside from mild, postprocedural, abdominal discomfort. No patient died because of bleeding. Conclusions: DBE represents a safe and sound endoscopic tool in the diagnosis and treatment of bleeding lesions of the small intestine. The rate of concordance between CE and DBE is high but not absolute, and the possibility to perform DBE in patients with negative CE should be taken into consideration.
P.1.73 GASTRITIS AND GASTRIC EPITHELIAL HYPERPLASIA ARE SPECIFICALLY INDUCED BY INTERLEUKIN-33 EXOGENOUS ADMINISTRATION L. Pastorelli ∗ ,1 , R.R. Garg 2 , C. De Salvo 2 , B. Mattioli 2 , D. Corridoni 2 , J.B. Meddings 3 , M. Vecchi 4 , T.T. Pizarro 2 1 Universitá
degli Studi di Milano, Milano, Italy; 2 Case Western Reserve University, Cleveland, United States; 3 University of Calgary, Calgary, Canada; 4 Irccs Policlinico San Donato, San Donato Milanese, Italy
Background and aim: Gastric inflammation is associated with the development of gastric adenocarcinoma; cytokines play a major role during this process, in fact, overexpression of interleukin (IL)-1 family members has been linked to gastritis and gastric cancer. IL-33 is a novel IL-1 family member known to promote Th2 immune responses and induce epithelial hyperplasia in the gut. The aim of this study was to evaluate the potential role of IL-33 in the development of gastritis and the pathological changes associated with gastric inflammation that may be involved in the predisposition to gastric cancer. Material and methods: Mouse recombinant IL-33 or vehicle control was administered i.p. daily to 4 and 12 wk-old AKR mice for one wk (N=6/exp grp), and in vivo gastric permeability measured by fractional excretion (FE) of sucrose using an establish assay, prior to, and after, IL-33 treatment. BrdU was administered i.p. to mice 2 hr before sacrifice in order to assess active cell proliferation. Upon sacrifice, stomachs were collected and evaluated histologically. IHC and qRT-PCR were performed for BrdU and ST2 (IL-33 receptor) localization, as well as tight junction protein expression, respectively. Results: IL-33 treatment induced gastritis and increased epithelial hyperplasia in 4 and 12 wk-old mice vs. vehicle controls, as long as macroscopic changes in the gastric mucosa, consisting of hypertrophic longitudinal folds. Actively proliferating cells, identified by BrdU staining, were increased in IL-33 treated mice and co-localized with ST2 to gastric epithelial cells, suggesting a direct effect of IL-33 on these cells. Increased gastric epithelial permeability was also detected in IL-33 treated mice (FE=0.0042±0.0011 vs. 0.0010±0.0002; P<0.05), which corresponded to an increased trend in claudin-2 and a reduction in occludin, ZO-1, claudin-3 and -4 mRNA expression compared to controls. Conclusions: Taken together, IL-33 is able to specifically induce gastric inflammation and gastric epithelial changes, leading to epithelial proliferation
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
examination (OR 2.62, 1.58-4.34 95%CI) and no previous colonoscopy (OR 1.74, 1.15-2.66 95%CI). Fear of procedure-related pain was inversely associated to acceptance (OR 0.29, 0.18-0.46 95%CI). No influence was disclosed for gender, age, level of education, indication to the procedure, history of irritable bowel syndrome, pain as main symptom, chronic use of sedative medications, and endoscopist offering the procedure. Colonoscopy was completed without sedation in 440 subjects (82.1%), with a cecal intubation rate of 97.2%. Conclusions: Acceptance rate of unsedated colonoscopy is clinically relevant and the procedure can be completed without medications in the majority of subjects. Subject-related factors may help to identify people willing to attempt unsedated procedures. Although patient acceptance can be positively influenced by a good relationship with the physician, the individual physician is not a key-factor affecting patient choice.
P.1.71 PROSPECTIVE MULTICENTER STUDY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND (IEUS) COMPLICATIONS I. Tarantino ∗ ,1 , C. Fabbri 2 , N. Muscatiello 3 , N. Pagano 4 , R. Di Mitri 5 , L. Barresi 1 , F. Mocciaro 1 , M. Traina 1 1 Ismett,
Palermo, Italy; 2 Ospedale Bellaria, Bologna, Italy; 3 Ospedale di Foggia, Foggia, Italy; 4 Humanitas, Milano, Italy; 5 Ospedale Civivo, Palermo, Italy Background and aim: Like FNA, the close proximity of the tip of the echoendoscope to the target organ permits therapeutic procedures. Procedures like celiac plexus neurolysis (CPN), pseudocyst/abscesses drainage, and pancreatic and biliary ductal system drainages have been introduced into clinical practice. Nevertheless, complications related to interventional EUS have not been assessed in prospective studies.To assess in a prospective, multicenter study the complication rates of interventional EUS (FNA and therapeutic procedures performed under EUS guidance). We report preliminary data through 9 months. Material and methods: Data between Jan 2010 and Oct 2010 were collected from four referral centers, searching for all complications related to interventional EUS (EUS FNA, pseudocyst/abscess drainage, biliary-pancreatic drainage, CPN). All patients signed an informed consent. Demographics, comorbidities, drug history, and laboratory tests were collected. Vital signs were monitored during procedures. The procedures were performed under deep sedation or general anesthesia by experienced endosonographers. Antibiotic prophylaxis was performed when indicated. Early and late complications (mild, moderate, severe, fatal) were recorded during follow-up. Results: Three hundred fifteen (315) interventional EUS were performed over 10 months (mean follow-up 164.4 days) in 173 males/142 females (mean age 63.4±13.9): 293 EUS-FNA, 14 CPN, 7 pseudocyst/abscess drainage, and 1 biliary drainage. The overall complication rate was 3.5%. Complications were: 2 diarrhea (post-CPN), 1 epigastric pain (post-FNA), 2 intra-cystic hemorrhages, and 1 gastric bleeding (post-FNA), 5 fever (4 post-FNA, 1 postpseudocyst drainage). FNA was associated with a lower risk of complications (p=0.007, OR 0.18, 95% CI 0.4-0.7). Nevertheless, FNA on cystic lesions was associated with a higher risk of complications than that on solid ones (p<0.001, OR 15.2, 95% CI 2.9-77.6). All events occurred within 10 days, and all but one (moderate) were mild and resolved with medical therapy. No deaths occurred. Conclusions: Our preliminary results show that EUS-FNA is safer than other procedures, even if all interventional procedures are associated with a low rate of complications. We aim to collect more than 1,000 cases, and to analyze the potential associated risk factors.
P.1.72 DIAGNOSTIC EFFICACY AND OUTCOME OF DBE IN OGIB S. Benvenuti ∗ , A. De Guelmi, L. Zancanella, S. Ierace, F. Chilovi Ospedale Centrale, Bolzano, Italy Background and aim: To evaluate the diagnostic efficacy and therapeutic
impact of DBE in patients presenting to our care with manifest or occult OGIB. Material and methods: The study was conducted on 76 patients with OGIB (21 manifest and 55 occult) who underwent oral or anal DBE. Both approaches were used in 27 cases. In 72 patients it was possible to perform a CE beforehand which helped in determining the DBE antegrade or retrograde approach. Results: In 48 (71%) of 67 patients CE and DBE provided concordant diagnoses. The main discrepancies regarded neoplasias (4/9 not seen at CE) and Meckel’s diverticula (3/3 not diagnosed at CE). In 58 patients (76%) of 76, a lesion felt to be the bleeding source was identified, although in two cases the lesions were located in a site reacheable by EGDscopy and Colonoscopy. AVM (22/58) were the most common lesions encountered, followed by erosions/ulcers (18/58) and neoplasias (10/58). In 46 patients (79%) of 58 it was possible to employ some form of treatment that was endoscopic in 33 cases (56%), surgical in 11 (19%), and medical in 2 (3.4%). In 5 patients DBE was incomplete and a comparison with CE is therefore not possible. During follow-up (1-29 months) the bleeding recurred in 2 patients with AVM and they were successfully retreated with DBE. No complications were encountered during the more than 100 endoscopic procedures performed, aside from mild, postprocedural, abdominal discomfort. No patient died because of bleeding. Conclusions: DBE represents a safe and sound endoscopic tool in the diagnosis and treatment of bleeding lesions of the small intestine. The rate of concordance between CE and DBE is high but not absolute, and the possibility to perform DBE in patients with negative CE should be taken into consideration.
P.1.73 GASTRITIS AND GASTRIC EPITHELIAL HYPERPLASIA ARE SPECIFICALLY INDUCED BY INTERLEUKIN-33 EXOGENOUS ADMINISTRATION L. Pastorelli ∗ ,1 , R.R. Garg 2 , C. De Salvo 2 , B. Mattioli 2 , D. Corridoni 2 , J.B. Meddings 3 , M. Vecchi 4 , T.T. Pizarro 2 1 Universitá
degli Studi di Milano, Milano, Italy; 2 Case Western Reserve University, Cleveland, United States; 3 University of Calgary, Calgary, Canada; 4 Irccs Policlinico San Donato, San Donato Milanese, Italy
Background and aim: Gastric inflammation is associated with the development of gastric adenocarcinoma; cytokines play a major role during this process, in fact, overexpression of interleukin (IL)-1 family members has been linked to gastritis and gastric cancer. IL-33 is a novel IL-1 family member known to promote Th2 immune responses and induce epithelial hyperplasia in the gut. The aim of this study was to evaluate the potential role of IL-33 in the development of gastritis and the pathological changes associated with gastric inflammation that may be involved in the predisposition to gastric cancer. Material and methods: Mouse recombinant IL-33 or vehicle control was administered i.p. daily to 4 and 12 wk-old AKR mice for one wk (N=6/exp grp), and in vivo gastric permeability measured by fractional excretion (FE) of sucrose using an establish assay, prior to, and after, IL-33 treatment. BrdU was administered i.p. to mice 2 hr before sacrifice in order to assess active cell proliferation. Upon sacrifice, stomachs were collected and evaluated histologically. IHC and qRT-PCR were performed for BrdU and ST2 (IL-33 receptor) localization, as well as tight junction protein expression, respectively. Results: IL-33 treatment induced gastritis and increased epithelial hyperplasia in 4 and 12 wk-old mice vs. vehicle controls, as long as macroscopic changes in the gastric mucosa, consisting of hypertrophic longitudinal folds. Actively proliferating cells, identified by BrdU staining, were increased in IL-33 treated mice and co-localized with ST2 to gastric epithelial cells, suggesting a direct effect of IL-33 on these cells. Increased gastric epithelial permeability was also detected in IL-33 treated mice (FE=0.0042±0.0011 vs. 0.0010±0.0002; P<0.05), which corresponded to an increased trend in claudin-2 and a reduction in occludin, ZO-1, claudin-3 and -4 mRNA expression compared to controls. Conclusions: Taken together, IL-33 is able to specifically induce gastric inflammation and gastric epithelial changes, leading to epithelial proliferation