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TRANSARTERIAL CHEMOEMBOLIZATION AND RISK FACTORS FOR ITS OCCURRENCE
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 at diagnosis but not tumor size or grading was associated to worse prognosis (HR 3.74, 95% CI: 2.4–5.82, p=0.0001) as well as albuminemia <3 g/dl (HR 1.78, 95% CI: 1.05–3.03, p=0.03), platelets <140.000 10.e3/Ul (HR 2.14, 95% CI: 1.20–3.80, p=0.009) and a NLR >5 (HR 1.91, 95% CI: 1.15–3.16, p=0.01). At multivariate only distant metastasis (HR 3.68, 95% CI: 2.26–5.98, p=0.0001) and N/L ratio >5 (HR 1.73, 95% CI: 1.01–2.95, p=0.0044) resulted to be significant and independent risk factors for mortality, whereas the significance of hypoalbuminemia was barely missed (HR 1.66, 95% CI: 0.96–2.87, p=0.06). Increased NLR (HR 1.18, 95% CI: 1.06–1.31, p=0.0023) and decreased albuminemia (HR 0.48, 95% CI: 0.25–0.93, p=0.03) resulted associated with mortality at univariate only in subgroup of patients with metastasis. Conclusions: We observed a slight association between nutritional impairment and PDAC prognosis, while elevated N/L ratio resulted to be significant risk factors for mortality in these patients regardless the stage of disease. These factors seem to modify in particular the prognosis of subgroup with distant metastasis, maybe worsening performance status and avoiding possible treatments.
P.18.6 INCIDENCE OF ACUTE PANCREATITIS AFTER LIVER EMBOLIZATION/TRANSARTERIAL CHEMOEMBOLIZATION AND RISK FACTORS FOR ITS OCCURRENCE R. Valente ∗ , M. Piciucchi, G. Zerboni, M. Signoretti, M. Marignani, M. Rossi, G. Delle Fave, G. Capurso Sant’Andrea Hospital, Roma, Italy Background and aim: Transarterial chemoembolization (TACE) or liver embolization (LE) are palliative treatment options in patients with primary and secondary liver tumors who can’t undergo a curative surgical resection. Acute pancreatitis (AP) is a possible complication of TACE/LE. Whether reported to be rare, little is known about the exact rate of such a complication and factors influencing it. The aims of this study are to investigate the incidence of AP in patients who underwent (chemo) embolization and to analyze risk for its occurrence. Material and methods: 39 patients (median age 68) underwent at least one procedure for primary 84.1% (n=53) or secondary 15.8% (n=10) liver lesions for a total of 63 procedures. All patients were clinically monitored, and pancreatic enzymes were routinely assessed after procedure. AP was defined according with the Atlanta criteria. Results: 2 patients (3.1% of procedures) developed AP, both had a severe form, one of them died. None of the two patients had vascular anatomical variants. Both the AP occurred after TACE with doxorubicin which was performed in 13 of the 63 procedures (20.6%). Thus 15.3% of TACE procedures with doxorubicin led to AP compared to 0% without doxorubicin (P=0.03). The incidence of AP was not different amongst TACE vs LE alone, or amongst procedures with or without the use of DC Bead microspheres, nor the age of patients and their liver disease predicted AP. A slight increase in amylase or lipase levels was recorded respectively in other 12 (19%) and 9 (14%), albeit without criteria for a diagnosis of AP. Conclusions: We observed a 3.1% rate of AP, with severe outcome and high mortality rate in subjects undergoing TACE. The use of doxorubicin seems to be risk factor for the development of post TACE AP. A routine clinical assessment with measurement of amylase and lipase after TACE is important to recognise early the occurrence of AP, which might mimic a post-embolization syndrome.
P.18.7 DOSE- AND TIME-DEPENDENT ERADICATION OF SMALL INTESTINE BACTERIAL OVERGROWTH (SIBO) WITH RIFAXIMIN: A META-ANALYTIC APPROACH L. Gatta ∗,1 , C. Scarpignato 2 1 Gastroenterology
& Digestive Endoscopy Unit, Versilia Hospital, Lido di Camaiore (Lucca), Italy; 2 Clinical Pharmacology & Digestive
S129
Pathophysiology Unit, Department of Clinical & Experimental Medicine, University of Parma, Parma, Italy Background and aim: SIBO is a condition caused by an increased number and/or abnormal type of bacteria in the small bowel. Eradication of SIBO relies on antibiotic therapy that must cover both aerobic and anaerobic enteric bacteria. Rifaximin is a poorly absorbable antibiotic, with a broad spectrum of antibacterial activity, covering Gram-positive and Gram-negative microorganisms, both aerobes and anaerobes. The aim of this study was to evaluate whether the well-known effect of rifaximin on SIBO is dose and/or time dependent, a systematic review and meta-analysis of the available studies was performed. Material and methods: MEDLINE, EMBASE, the CCRCT as well as abstract from the major American, European and Asiatic gastroenterology meeting were searched up to November 2012. Case series, open label studies, cross-over and RCTs in adult patients with proven SIBO, treated with rifaximin, were eligible. The proportion of individuals eradicated was combined from all studies to give a pooled eradication rate using a random effects model in order to provide a more conservative estimate. Results: Twenty-four studies were included in the analysis, which gave a pooled eradication rate of 67.0% (95% CI: 59.1 to 69.8). Only two trials, where SIBO was diagnosed via the Glucose Hydrogen Breath Test (GHBT), allowed the evaluation of the dose-response effect of rifaximin: a linear relationship (p<0.05) between the dose and the eradication rate was found, with the maximum effect (i.e. 80%) achieved at the dose of 1600 mg daily. The evaluation of the effect of treatment duration with rifaximin on SIBO eradication was only possible with studies where the regimen of 1200 mg daily was used. For the sake of uniformity with the analysis of the doseresponse curve, only studies where GHBT was adopted to diagnose SIBO were selected. A global evaluation of these studies showed a significant trend towards a duration-dependent effect (p<0.05) of rifaximin, with the highest figures (i.e. 88.6%) obtained after 14 days of therapy. Conclusions: Rifaximin is effective for treating SIBO, with an efficacy that appears to be dose and time-dependent. However, large and well-performed RCTs are needed to substantiate these findings and establish the optimal regimen (daily dose and duration) of therapy.
P.18.8 IS SMALL BOWEL CAPSULE ENDOSCOPY INDICATED IN PATIENTS WITH SPORADIC NON-AMPULLARY DUODENAL ADENOMA? D. Moneghini ∗ , G. Missale, R. Cestari Endoscopia Digestiva Spedali Civili Università degli Studi, Brescia, Italy Background and aim: Sporadic non-ampullary duodenal adenomas (SNADA) are an uncommon finding, with a prevalence of 1–3 cases per 1000 in patients non affected by genetic intestinal polyposis. Usually these lesions are asymptomatic and discovered incidentally during upper endoscopy. Some studies described a significant association between SN-ADA and colorectal adenomas and cancer; however there is currently no agreement about the surveillance of these patients. Moreover, the incidence of synchronous small bowel polyps has been investigated only in a single study: small bowel polyps were found in 8 of 14 (57,1%) patients with SN-ADA. The aim of this series is to assess the incidence of small bowel polyps in patients with SN-ADA in order to clarify a potential role of capsule endoscopy in this field. Material and methods: Between July 2009 and February 2013 7 consecutive patients with SN-ADA were prospectively studied by using the Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel). The day before the exam bowel preparation with 2L of polyethylene glycol solution was administered. Capsule ingestion was performed in the morning after a overnight fast. All the patients had colonoscopy in order to exclude the occurrence of an intestinal polyposis. All the patients gave their written informed consent. Results: Four patients were females (57,1%). The mean age was 59,1 years (range 43–71 years). Clinical data of patients are reported in the following table. Capsule reached ileo-cecal valve in all except one case (85,7%), without complications. No patients complained symptoms related to capsule transit. In
P.18.6 INCIDENCE OF ACUTE PANCREATITIS AFTER LIVER EMBOLIZATION/TRANSARTERIAL CHEMOEMBOLIZATION AND RISK FACTORS FOR ITS OCCURRENCE R. Valente ∗ , M. Piciucchi, G. Zerboni, M. Signoretti, M. Marignani, M. Rossi, G. Delle Fave, G. Capurso Sant’Andrea Hospital, Roma, Italy Background and aim: Transarterial chemoembolization (TACE) or liver embolization (LE) are palliative treatment options in patients with primary and secondary liver tumors who can’t undergo a curative surgical resection. Acute pancreatitis (AP) is a possible complication of TACE/LE. Whether reported to be rare, little is known about the exact rate of such a complication and factors influencing it. The aims of this study are to investigate the incidence of AP in patients who underwent (chemo) embolization and to analyze risk for its occurrence. Material and methods: 39 patients (median age 68) underwent at least one procedure for primary 84.1% (n=53) or secondary 15.8% (n=10) liver lesions for a total of 63 procedures. All patients were clinically monitored, and pancreatic enzymes were routinely assessed after procedure. AP was defined according with the Atlanta criteria. Results: 2 patients (3.1% of procedures) developed AP, both had a severe form, one of them died. None of the two patients had vascular anatomical variants. Both the AP occurred after TACE with doxorubicin which was performed in 13 of the 63 procedures (20.6%). Thus 15.3% of TACE procedures with doxorubicin led to AP compared to 0% without doxorubicin (P=0.03). The incidence of AP was not different amongst TACE vs LE alone, or amongst procedures with or without the use of DC Bead microspheres, nor the age of patients and their liver disease predicted AP. A slight increase in amylase or lipase levels was recorded respectively in other 12 (19%) and 9 (14%), albeit without criteria for a diagnosis of AP. Conclusions: We observed a 3.1% rate of AP, with severe outcome and high mortality rate in subjects undergoing TACE. The use of doxorubicin seems to be risk factor for the development of post TACE AP. A routine clinical assessment with measurement of amylase and lipase after TACE is important to recognise early the occurrence of AP, which might mimic a post-embolization syndrome.
P.18.7 DOSE- AND TIME-DEPENDENT ERADICATION OF SMALL INTESTINE BACTERIAL OVERGROWTH (SIBO) WITH RIFAXIMIN: A META-ANALYTIC APPROACH L. Gatta ∗,1 , C. Scarpignato 2 1 Gastroenterology
& Digestive Endoscopy Unit, Versilia Hospital, Lido di Camaiore (Lucca), Italy; 2 Clinical Pharmacology & Digestive
S129
Pathophysiology Unit, Department of Clinical & Experimental Medicine, University of Parma, Parma, Italy Background and aim: SIBO is a condition caused by an increased number and/or abnormal type of bacteria in the small bowel. Eradication of SIBO relies on antibiotic therapy that must cover both aerobic and anaerobic enteric bacteria. Rifaximin is a poorly absorbable antibiotic, with a broad spectrum of antibacterial activity, covering Gram-positive and Gram-negative microorganisms, both aerobes and anaerobes. The aim of this study was to evaluate whether the well-known effect of rifaximin on SIBO is dose and/or time dependent, a systematic review and meta-analysis of the available studies was performed. Material and methods: MEDLINE, EMBASE, the CCRCT as well as abstract from the major American, European and Asiatic gastroenterology meeting were searched up to November 2012. Case series, open label studies, cross-over and RCTs in adult patients with proven SIBO, treated with rifaximin, were eligible. The proportion of individuals eradicated was combined from all studies to give a pooled eradication rate using a random effects model in order to provide a more conservative estimate. Results: Twenty-four studies were included in the analysis, which gave a pooled eradication rate of 67.0% (95% CI: 59.1 to 69.8). Only two trials, where SIBO was diagnosed via the Glucose Hydrogen Breath Test (GHBT), allowed the evaluation of the dose-response effect of rifaximin: a linear relationship (p<0.05) between the dose and the eradication rate was found, with the maximum effect (i.e. 80%) achieved at the dose of 1600 mg daily. The evaluation of the effect of treatment duration with rifaximin on SIBO eradication was only possible with studies where the regimen of 1200 mg daily was used. For the sake of uniformity with the analysis of the doseresponse curve, only studies where GHBT was adopted to diagnose SIBO were selected. A global evaluation of these studies showed a significant trend towards a duration-dependent effect (p<0.05) of rifaximin, with the highest figures (i.e. 88.6%) obtained after 14 days of therapy. Conclusions: Rifaximin is effective for treating SIBO, with an efficacy that appears to be dose and time-dependent. However, large and well-performed RCTs are needed to substantiate these findings and establish the optimal regimen (daily dose and duration) of therapy.
P.18.8 IS SMALL BOWEL CAPSULE ENDOSCOPY INDICATED IN PATIENTS WITH SPORADIC NON-AMPULLARY DUODENAL ADENOMA? D. Moneghini ∗ , G. Missale, R. Cestari Endoscopia Digestiva Spedali Civili Università degli Studi, Brescia, Italy Background and aim: Sporadic non-ampullary duodenal adenomas (SNADA) are an uncommon finding, with a prevalence of 1–3 cases per 1000 in patients non affected by genetic intestinal polyposis. Usually these lesions are asymptomatic and discovered incidentally during upper endoscopy. Some studies described a significant association between SN-ADA and colorectal adenomas and cancer; however there is currently no agreement about the surveillance of these patients. Moreover, the incidence of synchronous small bowel polyps has been investigated only in a single study: small bowel polyps were found in 8 of 14 (57,1%) patients with SN-ADA. The aim of this series is to assess the incidence of small bowel polyps in patients with SN-ADA in order to clarify a potential role of capsule endoscopy in this field. Material and methods: Between July 2009 and February 2013 7 consecutive patients with SN-ADA were prospectively studied by using the Given M2A video capsule system (Pillcam; Given Imaging Ltd, Yoqneam, Israel). The day before the exam bowel preparation with 2L of polyethylene glycol solution was administered. Capsule ingestion was performed in the morning after a overnight fast. All the patients had colonoscopy in order to exclude the occurrence of an intestinal polyposis. All the patients gave their written informed consent. Results: Four patients were females (57,1%). The mean age was 59,1 years (range 43–71 years). Clinical data of patients are reported in the following table. Capsule reached ileo-cecal valve in all except one case (85,7%), without complications. No patients complained symptoms related to capsule transit. In