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P.17.1 RELATIONSHIP AMONG COLORECTAL CANCER, ADVANCED HISTOLOGY AND POLYP SIZE IN PATIENTS UNDERGOING SCREENING COLONOSCOPY IN A TERTIARY CENTRE IN NORTH-EAST ITALY
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220 Conclusions: Our study confirms the efficacy of IFX as an alternative to colectomy in pts refractory to i.v. steroids. After one year of maintenance tp with IFX, 85.7% of pts who showed a response to induction tp avoided colectomy. Both colectomies, in the pts with lack of clinical response, were performed on an elective regime.
P.16.23 SMALL BOWEL CAPSULE ENDOSCOPY FOR ASSESSING EARLY POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE: A PROSPECTIVE LONGITUDINAL STUDY G. Condino ∗ , E. Calabrese, S. Onali, E. Lolli, C. Petruzziello, M. Ascolani, F. Zorzi, G. Sica, F. Pallone, L. Biancone
S197
Material and methods: We review data on 1000 patients referred to screening colonoscopy in our centre from Oct 2008 to Dec 2010. Results: Between Oct 2008 to Dec 2010 43229 FIT kits dispatched had been returned by 41.2% of men and 39.1% of women invited. Of the 17810 returning tests 1157 had a positive test (6.5%). Responders to colonoscopy were 86.43% (1000 colonoscopies, 616 male, 384 female, medium age 60.9). Completion rate rate was 97.2% (caecal or terminal ileum intubation) impacted only by low bowel preparation quality and stenosing neoplasia. In 88.68% of subjects polyps were removed in the same session. Colorectal cancer (CRC) was diagnosed in 88 subjects (8.8%) of whom 3 with synchronous CRC (0.3%). On a total of 1834 polyps, 1 or more adenoma were present in 551 patients (55.1%) with a total of 1230 adenomas. Advanced adenomas (AA) were 515 in 366 patients (36.6%). Table 1 and 2 respectively show CRC and AA compared to polyp size.
Università Tor Vergata, Roma, Italy Background and aim: Ileocolonoscopy (IC) is the gold standard for assessing Crohn’s Disease (CD) recurrence. Small bowel capsule endoscopy (SBCE) and Small Intestine Contrast Ultrasonography (SICUS) may be useful for assessing CD recurrence. The role of SBCE for assessing early CD recurrence is undefined. In a prospective longitudinal study, we aimed to compare the usefulness of SBCE vs conventional techniques for assessing the early postoperative recurrence of CD. Whether SBCE may visualize upper GI lesions not detected by standard techniques and the interobserver agreement using SBCE for assessing CD recurrence was also investigated. Material and methods: From Feb to Oct 2011, all patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed every 3mths for 1yr. SBCE was performed in early after surgery (<6mths) in pts with no stenoses, according to IC and SICUS <4 wks before SBCE. Recurrence was assessed by IC (Rutgeerts’ score 0-4: recurrence=1) (GE 1990;99:956) SICUS (bowel wall thickness>3mm). SBCE was assessed by 2 independent observers and findings compatible with recurrence graded (Buchman et al. AJG 2004; 99: 2171) (score 0-3: recurrence=1). Results: During the study period, 11 pts (8M, median age 44, range 25-64) were enrolled. SBCE was not performed in 5 pts, due to strictures (n=2), low compliance to perform SBCE (n=1) or IC after SICUS (n=1) or large ileal “cul de sac” (n=1). Among the 11 pts, 6 were able to perform IC, SICUS and SBCE early after surgery. At 3mths, 5/6 pts were in remission (CDAI<150). Endoscopic recurrence was observed in 5/6 pts (grade 1: n=2; grade 2: n=1; grade 3: n=2). Findings compatible with recurrence were detected by SICUS in 4 pts (4 true positives, TP) and by SBCE in 5/6 pts (grade 3, as assessed by both observers in 5/6 pts; grade 0 in 1 pt; 5TP,1 true negative). In 2 pts, SBCE also showed multiple aphtoid ulcers in the upper GI tract not detected by standard techniques before and after surgery. No SBCE retention was observed. Conclusions: IC is the gold standard for assessing CD recurrence. However, in the early postoperative period SBCE visualizes superficial upper GI lesions not detected by standard techniques. Strictures contraindicating SBCE may develop early in the postoperative period.
Conclusions: Over the period reviewed, 1000 colonoscopies were performed with excellent completion rates. Significant pathology (cancer and adenoma)was found in over half of patients with positive FIT. The extremely high rate of cancer/adenoma detected can partly be explained by: initial BCSP in our local population, relative initial older age of the involved population (most of them older than 60 y.o.), the performance of FIT and the average good bowel preparation in almost all the subjects. The previous hypothesis, however, do not completely explain why in our cohort we found a so high percentage of malignant and AA in polyps less than 9 mm. In this case a further hypothesis could include an over reading of AA. To confirm these latest findings a second opinion from another pathologist could be advisable.
P.17.2 IS EARLY-ONSET COLORECTAL CANCER A VALID MARKER TO IDENTIFY LYNCH SYNDROME? L. Sanchez Mete ∗ , M. Diodoro, B. Casini, A. Martayan, M. Anti, V. Stigliano Regina Elena National Cancer Institute, Rome, Italy
P.17.1 RELATIONSHIP AMONG COLORECTAL CANCER, ADVANCED HISTOLOGY AND POLYP SIZE IN PATIENTS UNDERGOING SCREENING COLONOSCOPY IN A TERTIARY CENTRE IN NORTH-EAST ITALY M. Marino ∗ ,1 , D. Berretti 1 , M. Bulajic 2 , R. Maieron 1 , S. Pevere 1 , P. Rossitti 1 , G. Terrosu 1 , L. Zoratti 1 , E. Zucchi 1 , M. Zilli 1 1 Azienda
Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy; For Digestive Endoscopy, Cc D. Misovic-Dedinje - Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2 Center
Background and aim: The University Hospital of Udine began the Bowel Cancer Screening Program (BCSP) in 2008. Subjects aged 50-69 are being invited to complete one single immunochemical fecal test (FIT) test every 2 years. At the beginning of our program screening priority was given to subjects aged 60-69 (about 63% of all FIT invitations). Those positive were referred for colonoscopy. We report the preliminary experience of 1000 screening participants referred in our Centre following positive FIT.
Background and aim: The Lynch Syndrome (LS) is an autosomal dominant condition predisposing to early onset colorectal cancer (CRC) and other malignancies due to Microsatellite instability (MSI-H) caused by mismatch repair (MMR) genes defect. It can be suspected in patients with early-onset CRC and on the basis of family history of CRC and other tumours in the spectrum of the syndrome. MSI and immunohistochemical analysis (IHC) of MMR proteins performed on tumour specimen can be used as pre screening tool for LS. We performed a prospective study to evaluate the utility of a combined approach of both IHC and MSI for LS screening in patients affected with early-onset CRC without family history. Material and methods: From January 2007 to November 2011, 73 CRC patients aged between 18 and 50 were recruited into the study. All of them underwent MSI and IHC to investigate MMR genes deficiency (MLH1, MSH2, MSH6 and PMS2). Cases with a lack of MMR expression and/or MSI-H underwent genetic testing. Results: Mean age at diagnosis was 40+7,3 years; M/F distribution was 29/47. MSI analysis revealed MSI–H in 2/73 patients (2,7%): 1 had lack of PMS2 expression at IHC and 1 had normal expression of all the MMR genes. All
P.16.23 SMALL BOWEL CAPSULE ENDOSCOPY FOR ASSESSING EARLY POSTOPERATIVE RECURRENCE OF CROHN’S DISEASE: A PROSPECTIVE LONGITUDINAL STUDY G. Condino ∗ , E. Calabrese, S. Onali, E. Lolli, C. Petruzziello, M. Ascolani, F. Zorzi, G. Sica, F. Pallone, L. Biancone
S197
Material and methods: We review data on 1000 patients referred to screening colonoscopy in our centre from Oct 2008 to Dec 2010. Results: Between Oct 2008 to Dec 2010 43229 FIT kits dispatched had been returned by 41.2% of men and 39.1% of women invited. Of the 17810 returning tests 1157 had a positive test (6.5%). Responders to colonoscopy were 86.43% (1000 colonoscopies, 616 male, 384 female, medium age 60.9). Completion rate rate was 97.2% (caecal or terminal ileum intubation) impacted only by low bowel preparation quality and stenosing neoplasia. In 88.68% of subjects polyps were removed in the same session. Colorectal cancer (CRC) was diagnosed in 88 subjects (8.8%) of whom 3 with synchronous CRC (0.3%). On a total of 1834 polyps, 1 or more adenoma were present in 551 patients (55.1%) with a total of 1230 adenomas. Advanced adenomas (AA) were 515 in 366 patients (36.6%). Table 1 and 2 respectively show CRC and AA compared to polyp size.
Università Tor Vergata, Roma, Italy Background and aim: Ileocolonoscopy (IC) is the gold standard for assessing Crohn’s Disease (CD) recurrence. Small bowel capsule endoscopy (SBCE) and Small Intestine Contrast Ultrasonography (SICUS) may be useful for assessing CD recurrence. The role of SBCE for assessing early CD recurrence is undefined. In a prospective longitudinal study, we aimed to compare the usefulness of SBCE vs conventional techniques for assessing the early postoperative recurrence of CD. Whether SBCE may visualize upper GI lesions not detected by standard techniques and the interobserver agreement using SBCE for assessing CD recurrence was also investigated. Material and methods: From Feb to Oct 2011, all patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed every 3mths for 1yr. SBCE was performed in early after surgery (<6mths) in pts with no stenoses, according to IC and SICUS <4 wks before SBCE. Recurrence was assessed by IC (Rutgeerts’ score 0-4: recurrence=1) (GE 1990;99:956) SICUS (bowel wall thickness>3mm). SBCE was assessed by 2 independent observers and findings compatible with recurrence graded (Buchman et al. AJG 2004; 99: 2171) (score 0-3: recurrence=1). Results: During the study period, 11 pts (8M, median age 44, range 25-64) were enrolled. SBCE was not performed in 5 pts, due to strictures (n=2), low compliance to perform SBCE (n=1) or IC after SICUS (n=1) or large ileal “cul de sac” (n=1). Among the 11 pts, 6 were able to perform IC, SICUS and SBCE early after surgery. At 3mths, 5/6 pts were in remission (CDAI<150). Endoscopic recurrence was observed in 5/6 pts (grade 1: n=2; grade 2: n=1; grade 3: n=2). Findings compatible with recurrence were detected by SICUS in 4 pts (4 true positives, TP) and by SBCE in 5/6 pts (grade 3, as assessed by both observers in 5/6 pts; grade 0 in 1 pt; 5TP,1 true negative). In 2 pts, SBCE also showed multiple aphtoid ulcers in the upper GI tract not detected by standard techniques before and after surgery. No SBCE retention was observed. Conclusions: IC is the gold standard for assessing CD recurrence. However, in the early postoperative period SBCE visualizes superficial upper GI lesions not detected by standard techniques. Strictures contraindicating SBCE may develop early in the postoperative period.
Conclusions: Over the period reviewed, 1000 colonoscopies were performed with excellent completion rates. Significant pathology (cancer and adenoma)was found in over half of patients with positive FIT. The extremely high rate of cancer/adenoma detected can partly be explained by: initial BCSP in our local population, relative initial older age of the involved population (most of them older than 60 y.o.), the performance of FIT and the average good bowel preparation in almost all the subjects. The previous hypothesis, however, do not completely explain why in our cohort we found a so high percentage of malignant and AA in polyps less than 9 mm. In this case a further hypothesis could include an over reading of AA. To confirm these latest findings a second opinion from another pathologist could be advisable.
P.17.2 IS EARLY-ONSET COLORECTAL CANCER A VALID MARKER TO IDENTIFY LYNCH SYNDROME? L. Sanchez Mete ∗ , M. Diodoro, B. Casini, A. Martayan, M. Anti, V. Stigliano Regina Elena National Cancer Institute, Rome, Italy
P.17.1 RELATIONSHIP AMONG COLORECTAL CANCER, ADVANCED HISTOLOGY AND POLYP SIZE IN PATIENTS UNDERGOING SCREENING COLONOSCOPY IN A TERTIARY CENTRE IN NORTH-EAST ITALY M. Marino ∗ ,1 , D. Berretti 1 , M. Bulajic 2 , R. Maieron 1 , S. Pevere 1 , P. Rossitti 1 , G. Terrosu 1 , L. Zoratti 1 , E. Zucchi 1 , M. Zilli 1 1 Azienda
Ospedaliero-Universitaria S. M. della Misericordia, Udine, Italy; For Digestive Endoscopy, Cc D. Misovic-Dedinje - Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2 Center
Background and aim: The University Hospital of Udine began the Bowel Cancer Screening Program (BCSP) in 2008. Subjects aged 50-69 are being invited to complete one single immunochemical fecal test (FIT) test every 2 years. At the beginning of our program screening priority was given to subjects aged 60-69 (about 63% of all FIT invitations). Those positive were referred for colonoscopy. We report the preliminary experience of 1000 screening participants referred in our Centre following positive FIT.
Background and aim: The Lynch Syndrome (LS) is an autosomal dominant condition predisposing to early onset colorectal cancer (CRC) and other malignancies due to Microsatellite instability (MSI-H) caused by mismatch repair (MMR) genes defect. It can be suspected in patients with early-onset CRC and on the basis of family history of CRC and other tumours in the spectrum of the syndrome. MSI and immunohistochemical analysis (IHC) of MMR proteins performed on tumour specimen can be used as pre screening tool for LS. We performed a prospective study to evaluate the utility of a combined approach of both IHC and MSI for LS screening in patients affected with early-onset CRC without family history. Material and methods: From January 2007 to November 2011, 73 CRC patients aged between 18 and 50 were recruited into the study. All of them underwent MSI and IHC to investigate MMR genes deficiency (MLH1, MSH2, MSH6 and PMS2). Cases with a lack of MMR expression and/or MSI-H underwent genetic testing. Results: Mean age at diagnosis was 40+7,3 years; M/F distribution was 29/47. MSI analysis revealed MSI–H in 2/73 patients (2,7%): 1 had lack of PMS2 expression at IHC and 1 had normal expression of all the MMR genes. All