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P.17.18 PANCREATIC FNA
S126
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144
mortality. Intradialytic parenteral nutrition (IDPN) is widely employed to treat malnourished HD patients, although there is insufficient evidence to support its benefits. The aim of our work was to analyse IDPN effects on malnourished HD patients. Material and methods: Twenty-one severely malnourished (MUST score > 2), ESRD patients (14 M, 7 F, mean age 67±16 years, dry weight 57±13 kg, BMI 20±4 kg/m2 ) received personalized IDPN bags during each dialysis session (three times per week) for at least 4 months. The composition of bags was as follows: volume 600–1000 ml, glucides 70–130 g, proteins 40–50 g, lipids 20–40 g, kcal 600–1000. Patients also received a personalized nutritional counseling with an expert dietitian throughout the observation period. They were also asked to express their subjective well-being and any perceived benefit since the beginning of the treatment. Before/after we evaluated: dry-weight, BMI, nutritional blood test (proteins, albumin, phosphates), energy and nutrients intakes in the whole group which was then subdivided in subgroups according to 1 weight obtained with the treatment (group 1: >+1 kg, group 2: ±1 kg, group 3: <−1 kg). Results: The mean patients’ dry body weight (1 = +0.1±3 kg) and BMI (1 = +0.03±1.04 kg/m2 ) were maintained or did not worsen. Five patients (24%) increased their dry weight (+4.1±3.2 kg), 7 (33%) did not change weight while 9 patients (43%) lost a mean of −1.9±1.4 kg. Blood nutritional tests (total proteins, albumin, phosphates) slightly improved. The mean energy and protein intakes significantly improved (energy intake: +488±508 kcal, protein intake: +21±22 g/day, p<0.001), especially in group 1, but also in group 3, although in the latter group the nutritional goals were not fulfilled. Conclusions: Patients reported a decrease in anorexia and asthenia with an increase in food/nutritional intakes. Dry body weight/serum albumin did not worsen. IDPN seems to have a positive effect on subjective well-being and anorexia. More studies are however needed on larger groups.
P.17.17 SERUM CONCENTRATION OF 49 PROTEINS IN PATIENTS WITH CHRONIC GASTRITIS BY MULTIPLEX BIOMETRIC IMMUNOASSAY G. Rossetti 1 , A. Federico ∗,1 , G. De Simini 1 , D. Sgambato 1 , M. Dallio 1 , C. De Sio 1 , E. Ferrante 1 , R. Meucci 1 , M. Romano 1 , S. Costantini 2 , G. Colonna 3 , C. Loguercio 1 1 Hepato-Gastroenterology
Division, Second University of Naples, Naples, Italy; 2 Cancer Research Center of Mercogliano, Mercogliano, Italy; 3 Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy Background and aim: Helicobacter pylori is a gastric pathogen that may cause chronic gastritis, peptic ulcers, and gastric cancer. The infection is accompanied by a local inflammatory response and by a different expression of cytokines and other molecules. Aim of the study is to evaluate serum levels of 49 proteins in patients with chronic gastritis. Material and methods: A multiplex biometric ELISA-based immunoassay has been used to evaluate the serum concentration of 49 proteins by three different Cytokine Plex Panel in 20 patients with chronic gastritis (10 with or 10 without H. pylori infection). Results: MIF levels have been found significantly increased in H. pylori positive patients (p=0.031 vs H. pylori negative patients). HER-2 concentrations, instead, have decreased in the same group of patients (p=0.038 vs H. pylori negative patients). In addition, also serum concentration of two proteins, ghrelin and GIP, have been found lower in patients infected by H. pylori (p=0.015 and p=0.007 vs H. pylori negative patients, respectively). Conclusions: According to the role of the protein in the inflammatory response MIF levels have been found increased in H. pylori positive patients. HER-2 over-expression is a negative prognostic factor, in patients with intestinal phenotype, related to cancer malignancy and to lower efficacy of therapy and the HER-2 serum can be already evaluated in patients with chronic gastritis. Ghrelin is a peptide hormone, secreted primarily by P/D1 cells lining the fundus of the human stomach, that has been implicated in the stimulation of fat storage and food intake. During chronic inflammation, such as append in patients whit H. pylori infection, there is often a significant loss of body
mass and appetite. This can be explain by the reduction of ghrelin’s levels, suggesting the presence of a link between the immune and neuroendocrine systems. GIP can neutralize stomach acid and protect the small intestine from acid damage. It is also able to reduce the rate at which food is transferred through the stomach, and to inhibit the motility of the gastrointestinal tract and the secretion of acid. For these reasons, lower levels of this hormone can facilitate mucosal injury, caused by H. pylori induced inflammatory response.
P.17.18 PANCREATIC FNA T. Togliani ∗ , N. Mantovani, A. Savioli, E. Vitetta, S. Pilati Azienda Ospedaliera Carlo Poma, Mantova, Italy Background and aim: FNA has not been completely standardized yet; the best shape and size of the needle, the technique of execution (use of stylet, need of syringe suction, number of needle passes), the proper way to process the sample (smear cytology, liquid-based cell block cytology), the role of contrast-enhanced EUS or EUS elastography before FNA, the need of ROSE, are still under evaluation. Aim of this retrospective single center study was to verify the adequacy of FNA-smear cytology on pancreatic solid lesions according to the size and the number of passes of a standard needle, without using the recent expensive or time-consuming devices and techniques. Material and methods: We retrospectively evaluated 306 consecutive FNA performed since 2006; all the procedures have been carried out under conscious sedation with an Olympus GF UCT140 probe. We included in the study only FNA done with standard 22G or 25G needles on solid pancreatic lesions. Each pass of the needle consisted of 10 to 15 to-and-from movements in the target lesion without stylet and without syringe suction (unless no material was present in the first pass); at the end of each pass the needle was emptied on a smear injecting 10 ml of air; the glass slide was smeared and fixed in 94% ethylic alcohol. Depending on patient’s tolerance and the anatomical difficulty a total of one to five passes were done; no more than one needle and five smears were used for each patient. Pathological reports were assessed for the presence of diagnostic material and were matched with the size and the number of passes that were carried out with the needle. Results: A total of 145 FNA were included in the study. FNA with the 25G needle was adequate in 5/10 = 50% with 1–2 passes, in 32/39 = 82% with 3 passes, in 6/7 = 86% with 4–5 passes. FNA with the 22G needle was adequate in 20/32 = 63% with 1–2 passes, in 43/44 = 98% with 3 passes, in 13/13 = 100% with 4–5 passes. No complications occurred. Conclusions: FNA with standard needles and smear cytology reaches a good (90%) adequacy if at least 3 passes are carried out. The 22G needle seems better than the 25G, but the difference is not statistically significant (85% vs 77%; p=0.2). The addition of other new ancillary techniques could be helpful, but it is unclear if advantages balance the costs.
P.17.19 CYSTIC PANCREATIC NEUROENDOCRINE TUMORS: REPORT OF TWO CASES O. Messina ∗ , A. Fantin, L. Bernardoni, A. Castagnini, L. Benini, A. Gabbrielli Policlinico GB Rossi-Gastroenterologia ed Endoscopia digestiva, Verona, Italy Background and aim: Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas that account for less than 2% of all pancreatic tumors. Usually PNETs are solid but about 10% of neuroendocrine tumors are cystic. Different diagnostic methods that could be of value in the differentiation of pancreatic cystic lesions include radiologic imaging techniques such as CT, MR, and endosonography. Material and methods: We report here two cases of cystic pancreatic neuroendocrine tumor. Case 1: A 70 year-old man with previous Billroth II resection for peptic disease presented with chronic diarrhea and 10 kg of weight loss in 5 months. An abdominal CT shows in the pancreatic head a vascularized lesion, 9
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144
mortality. Intradialytic parenteral nutrition (IDPN) is widely employed to treat malnourished HD patients, although there is insufficient evidence to support its benefits. The aim of our work was to analyse IDPN effects on malnourished HD patients. Material and methods: Twenty-one severely malnourished (MUST score > 2), ESRD patients (14 M, 7 F, mean age 67±16 years, dry weight 57±13 kg, BMI 20±4 kg/m2 ) received personalized IDPN bags during each dialysis session (three times per week) for at least 4 months. The composition of bags was as follows: volume 600–1000 ml, glucides 70–130 g, proteins 40–50 g, lipids 20–40 g, kcal 600–1000. Patients also received a personalized nutritional counseling with an expert dietitian throughout the observation period. They were also asked to express their subjective well-being and any perceived benefit since the beginning of the treatment. Before/after we evaluated: dry-weight, BMI, nutritional blood test (proteins, albumin, phosphates), energy and nutrients intakes in the whole group which was then subdivided in subgroups according to 1 weight obtained with the treatment (group 1: >+1 kg, group 2: ±1 kg, group 3: <−1 kg). Results: The mean patients’ dry body weight (1 = +0.1±3 kg) and BMI (1 = +0.03±1.04 kg/m2 ) were maintained or did not worsen. Five patients (24%) increased their dry weight (+4.1±3.2 kg), 7 (33%) did not change weight while 9 patients (43%) lost a mean of −1.9±1.4 kg. Blood nutritional tests (total proteins, albumin, phosphates) slightly improved. The mean energy and protein intakes significantly improved (energy intake: +488±508 kcal, protein intake: +21±22 g/day, p<0.001), especially in group 1, but also in group 3, although in the latter group the nutritional goals were not fulfilled. Conclusions: Patients reported a decrease in anorexia and asthenia with an increase in food/nutritional intakes. Dry body weight/serum albumin did not worsen. IDPN seems to have a positive effect on subjective well-being and anorexia. More studies are however needed on larger groups.
P.17.17 SERUM CONCENTRATION OF 49 PROTEINS IN PATIENTS WITH CHRONIC GASTRITIS BY MULTIPLEX BIOMETRIC IMMUNOASSAY G. Rossetti 1 , A. Federico ∗,1 , G. De Simini 1 , D. Sgambato 1 , M. Dallio 1 , C. De Sio 1 , E. Ferrante 1 , R. Meucci 1 , M. Romano 1 , S. Costantini 2 , G. Colonna 3 , C. Loguercio 1 1 Hepato-Gastroenterology
Division, Second University of Naples, Naples, Italy; 2 Cancer Research Center of Mercogliano, Mercogliano, Italy; 3 Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy Background and aim: Helicobacter pylori is a gastric pathogen that may cause chronic gastritis, peptic ulcers, and gastric cancer. The infection is accompanied by a local inflammatory response and by a different expression of cytokines and other molecules. Aim of the study is to evaluate serum levels of 49 proteins in patients with chronic gastritis. Material and methods: A multiplex biometric ELISA-based immunoassay has been used to evaluate the serum concentration of 49 proteins by three different Cytokine Plex Panel in 20 patients with chronic gastritis (10 with or 10 without H. pylori infection). Results: MIF levels have been found significantly increased in H. pylori positive patients (p=0.031 vs H. pylori negative patients). HER-2 concentrations, instead, have decreased in the same group of patients (p=0.038 vs H. pylori negative patients). In addition, also serum concentration of two proteins, ghrelin and GIP, have been found lower in patients infected by H. pylori (p=0.015 and p=0.007 vs H. pylori negative patients, respectively). Conclusions: According to the role of the protein in the inflammatory response MIF levels have been found increased in H. pylori positive patients. HER-2 over-expression is a negative prognostic factor, in patients with intestinal phenotype, related to cancer malignancy and to lower efficacy of therapy and the HER-2 serum can be already evaluated in patients with chronic gastritis. Ghrelin is a peptide hormone, secreted primarily by P/D1 cells lining the fundus of the human stomach, that has been implicated in the stimulation of fat storage and food intake. During chronic inflammation, such as append in patients whit H. pylori infection, there is often a significant loss of body
mass and appetite. This can be explain by the reduction of ghrelin’s levels, suggesting the presence of a link between the immune and neuroendocrine systems. GIP can neutralize stomach acid and protect the small intestine from acid damage. It is also able to reduce the rate at which food is transferred through the stomach, and to inhibit the motility of the gastrointestinal tract and the secretion of acid. For these reasons, lower levels of this hormone can facilitate mucosal injury, caused by H. pylori induced inflammatory response.
P.17.18 PANCREATIC FNA T. Togliani ∗ , N. Mantovani, A. Savioli, E. Vitetta, S. Pilati Azienda Ospedaliera Carlo Poma, Mantova, Italy Background and aim: FNA has not been completely standardized yet; the best shape and size of the needle, the technique of execution (use of stylet, need of syringe suction, number of needle passes), the proper way to process the sample (smear cytology, liquid-based cell block cytology), the role of contrast-enhanced EUS or EUS elastography before FNA, the need of ROSE, are still under evaluation. Aim of this retrospective single center study was to verify the adequacy of FNA-smear cytology on pancreatic solid lesions according to the size and the number of passes of a standard needle, without using the recent expensive or time-consuming devices and techniques. Material and methods: We retrospectively evaluated 306 consecutive FNA performed since 2006; all the procedures have been carried out under conscious sedation with an Olympus GF UCT140 probe. We included in the study only FNA done with standard 22G or 25G needles on solid pancreatic lesions. Each pass of the needle consisted of 10 to 15 to-and-from movements in the target lesion without stylet and without syringe suction (unless no material was present in the first pass); at the end of each pass the needle was emptied on a smear injecting 10 ml of air; the glass slide was smeared and fixed in 94% ethylic alcohol. Depending on patient’s tolerance and the anatomical difficulty a total of one to five passes were done; no more than one needle and five smears were used for each patient. Pathological reports were assessed for the presence of diagnostic material and were matched with the size and the number of passes that were carried out with the needle. Results: A total of 145 FNA were included in the study. FNA with the 25G needle was adequate in 5/10 = 50% with 1–2 passes, in 32/39 = 82% with 3 passes, in 6/7 = 86% with 4–5 passes. FNA with the 22G needle was adequate in 20/32 = 63% with 1–2 passes, in 43/44 = 98% with 3 passes, in 13/13 = 100% with 4–5 passes. No complications occurred. Conclusions: FNA with standard needles and smear cytology reaches a good (90%) adequacy if at least 3 passes are carried out. The 22G needle seems better than the 25G, but the difference is not statistically significant (85% vs 77%; p=0.2). The addition of other new ancillary techniques could be helpful, but it is unclear if advantages balance the costs.
P.17.19 CYSTIC PANCREATIC NEUROENDOCRINE TUMORS: REPORT OF TWO CASES O. Messina ∗ , A. Fantin, L. Bernardoni, A. Castagnini, L. Benini, A. Gabbrielli Policlinico GB Rossi-Gastroenterologia ed Endoscopia digestiva, Verona, Italy Background and aim: Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas that account for less than 2% of all pancreatic tumors. Usually PNETs are solid but about 10% of neuroendocrine tumors are cystic. Different diagnostic methods that could be of value in the differentiation of pancreatic cystic lesions include radiologic imaging techniques such as CT, MR, and endosonography. Material and methods: We report here two cases of cystic pancreatic neuroendocrine tumor. Case 1: A 70 year-old man with previous Billroth II resection for peptic disease presented with chronic diarrhea and 10 kg of weight loss in 5 months. An abdominal CT shows in the pancreatic head a vascularized lesion, 9