- Email: [email protected]
Predicting variables of successful total colonoscopy
Abstracts non variceal upper GI bleeding. Endoscopic hemostasis is achieved in the majority of ulcers with HRS but recurrent hemorrhage occurs in 10-30%. Data of Randomized Trials (RTs) suggest that combination of 2 endoscopic techniques can significantly reduce further bleeding, hospital stay and emergency surgery. Information is lacking about patients non included in RTs whose outcome could be affected by different therapeutic choices. To assess the outcome of patients with HRS ulcers submitted to emergency endotherapy and admitted to a gastroenterology care unit aside from a RT, evaluating if indicators such as length of hospital stay (LOS), rebleeding and mortality can be related to the choice of different endoscopic techniques and their combinations. Material and methods: A retrospective study was performed of all patients with HRS bleeding peptic ulcer referred to our endoscopic unit from Jan 2003 to Sept 2005, not included in a RT. The patients were submitted to emergency endoscopy, treated according to the clinical decision of the endoscopist, classified according to the Rockall scoring system and hospitalized in our gastroenterology care unit if referred by the Emergency Room. Patients in whom endoscopic hemostasis failed were admitted to a surgery unit and excluded from the study. All patients had i.v. PPI therapy and blood transfusions if necessary. The different endoscopic therapies were: Epinephrine 1: 10000 injection alone (E), hemo-clips alone (C), argon plasma coagulation alone (AP), E+C, E+AP, C+AP. Results: 141 patients submitted to emergency endoscopy for upper GI hemorrhage had a HRS bleeding ulcer: 37 returned to the referring unit after endoscopic treatment, 10 were admitted to a surgical unit, 94 were admitted to our gastroenterology unit and included in the study.All patients were classified as intermediate or high risk Rockall score, 43 were males, 51 females, mean age 72 yrs (range 33-90). Table 1 summarizes the figures of the different endoscopic therapies and their relationship with the outcome indicators. Table 1 Endotherapy E AP C E+C E+AP C+AP
No. Pts 25 1 14 50 3
LOS'S 4
LOS 0> 5
days
days
14
11 1
8 28 2
1
Rebleeding
Death Total Bleeding
5 1 1 5
11
6
22 1 1
21
Conclusions: No definite statement can be done about mortality data. The study suggests that, aside from a RT, LOS is not affected by the choice of endotherapy, while rebleeding rates seem to be reduced by about 50% using combination therapy, whatever the technique or the combination.
PO.12S PREDICTING VARIABLES OF SUCCESSFUL TOTAL COLONOSCOPY
F. Malfatti *, H. Martines, A. Grasso, G. Menardo
Ospedale San Paolo, Savona Background and aim: The potential of colonoscopy can be realised if the procedure is completed safely with good visualisation of the mucosa. Aim: To identify which variables are able to predict a successful total colonoscopy. Material and methods: Demographic, clinical, and colonoscopyrelated data were retrospectively recorded. A total of 1000 patients (510 men and 490 women; mean age ± SD: 65 years ± 14) who underwent colonoscopy were evaluated. Results: Fifty-five percent of patients required narcosis. No adverse effects occurred. Total colonoscopy was achieved in 146 patients (33%) without narcosis and in 338 patients (61%) with narcosis (P
S209
Main reasons for failing complete colonoscopy included poor bowel cleaning (23.6%), discomfort (18.4%) and looping (18.2%). A normal colonoscopy was reported in 48% of patients. The most common diagnosis was diverticular disease (22%) followed by polyps (18%). Inflammmatory bowel disesase and carcinoma were recorded in 6% respectively. Multivariate logistic regression analysis showed that female sex (OR 0.7; 95% CI, 0.54 to 0.89) and older age (OR 0.98; 95% CI, 0.97 to 0.99) were independently associated with a significantly lower rate of having a complete colonoscopy. Conversely, obtaining a total colonoscopy was strongly associated with the narcosis procedure independently from sex and age (OR 3.4; 95% CI, 2.6 to 4.4). Conclusions: Male sex, younger age and narcosis are predictive factors for successful pancolonoscopy.
PO.126 ERCP IN PATIENTS WITH BILLROTH II GASTRECTOMY: A SINGLE CENTRE EXPERIENCE G. Iodice *,1, M. Delle Cave 1, A. Iodice 1 , G. Sarrantonio 1, G. Francica 2, F. De Marino 2, F. Scarano 2 1 U. O. di Gastroenterologia ed Endoscopia Digestiva - Presidio Ospedaliero S.Maria della Piem, Casoria (NA) 2 U. O. di Ecografia ed Ecointevententistica - Presidio Ospedaliero S.Maria della Piem, Casoria (NA)
Background and aim: ERCP can be challenging in patients with altered surgical anatomy, e.g. Billroth II gastrectomy. A major limitation in accomplishing the endoscopic procedure in these patients is due to difficulties in both reaching the papilla via the afferent loop and correctly aligning with the axis ofthe ducts. We report the ERCP experience of our endoscopic centre. Material and methods: From January 1999 to June 2005, twenty four patients with Billroth II gastrectomy were selected for ERCP (19 male, mean age 66.2 ys, range 53-83 ys; 5 female, mean age 75.4 ys, range 57-92 ys). Main indication to ERCP were: common bile duct lithiasis, malignant biliary strictures, acute cholangitis, biliary fistula. The procedure was always performed with a side viewing endoscope with the patient on left side/prone decubitus, under conscious sedation. Endoscopic sphincterotomy was usually carried out with a needle knife papillotome after placement of a 10 Fr, 6 cm long, biliary plastic stent. Results: The papilla was reached and incannulated in twenty one cases at first attempt (success rate 87.5%). In one patient a rendez-vous approach was used (transpapillary guidewire passed laparoscopically via the cystic duct during laparoscopic cholecistectomy). Precut sphincterotomy was performed only in three pateints. Six plastic biliary stents were inserted in five patients (1 ampulloma, 1 pancreatic cancer, 2 hilar strictures, type 1, II, and 1 stricture distal CBD). A naso-biliary drainage was positioned in a patient with a biliary fistula of a peripheral duct (VIII hepatic segment following to hepatic surgery). In the remaining 15 patients common bile duct stones were removed. Procedure failures (12.5%) were due to a too long afferent loop preventing duodenal intubation in 2 cases and to an intradiverticular papilla in 1 case. One major complication occurred: perforation of an afferent loop was repaired surgically with an uneventful outcome. There were no cases of bleeding, pancreatitis, cholangitis or death in these series. Conclusions: ERCP in patients with Billroth II gastrectomy can be safe and successful in the majority of cases provided the procedure is carried out by a skilled and expert endoscopist.
No. Pts 25 1 14 50 3
LOS'S 4
LOS 0> 5
days
days
14
11 1
8 28 2
1
Rebleeding
Death Total Bleeding
5 1 1 5
11
6
22 1 1
21
Conclusions: No definite statement can be done about mortality data. The study suggests that, aside from a RT, LOS is not affected by the choice of endotherapy, while rebleeding rates seem to be reduced by about 50% using combination therapy, whatever the technique or the combination.
PO.12S PREDICTING VARIABLES OF SUCCESSFUL TOTAL COLONOSCOPY
F. Malfatti *, H. Martines, A. Grasso, G. Menardo
Ospedale San Paolo, Savona Background and aim: The potential of colonoscopy can be realised if the procedure is completed safely with good visualisation of the mucosa. Aim: To identify which variables are able to predict a successful total colonoscopy. Material and methods: Demographic, clinical, and colonoscopyrelated data were retrospectively recorded. A total of 1000 patients (510 men and 490 women; mean age ± SD: 65 years ± 14) who underwent colonoscopy were evaluated. Results: Fifty-five percent of patients required narcosis. No adverse effects occurred. Total colonoscopy was achieved in 146 patients (33%) without narcosis and in 338 patients (61%) with narcosis (P
S209
Main reasons for failing complete colonoscopy included poor bowel cleaning (23.6%), discomfort (18.4%) and looping (18.2%). A normal colonoscopy was reported in 48% of patients. The most common diagnosis was diverticular disease (22%) followed by polyps (18%). Inflammmatory bowel disesase and carcinoma were recorded in 6% respectively. Multivariate logistic regression analysis showed that female sex (OR 0.7; 95% CI, 0.54 to 0.89) and older age (OR 0.98; 95% CI, 0.97 to 0.99) were independently associated with a significantly lower rate of having a complete colonoscopy. Conversely, obtaining a total colonoscopy was strongly associated with the narcosis procedure independently from sex and age (OR 3.4; 95% CI, 2.6 to 4.4). Conclusions: Male sex, younger age and narcosis are predictive factors for successful pancolonoscopy.
PO.126 ERCP IN PATIENTS WITH BILLROTH II GASTRECTOMY: A SINGLE CENTRE EXPERIENCE G. Iodice *,1, M. Delle Cave 1, A. Iodice 1 , G. Sarrantonio 1, G. Francica 2, F. De Marino 2, F. Scarano 2 1 U. O. di Gastroenterologia ed Endoscopia Digestiva - Presidio Ospedaliero S.Maria della Piem, Casoria (NA) 2 U. O. di Ecografia ed Ecointevententistica - Presidio Ospedaliero S.Maria della Piem, Casoria (NA)
Background and aim: ERCP can be challenging in patients with altered surgical anatomy, e.g. Billroth II gastrectomy. A major limitation in accomplishing the endoscopic procedure in these patients is due to difficulties in both reaching the papilla via the afferent loop and correctly aligning with the axis ofthe ducts. We report the ERCP experience of our endoscopic centre. Material and methods: From January 1999 to June 2005, twenty four patients with Billroth II gastrectomy were selected for ERCP (19 male, mean age 66.2 ys, range 53-83 ys; 5 female, mean age 75.4 ys, range 57-92 ys). Main indication to ERCP were: common bile duct lithiasis, malignant biliary strictures, acute cholangitis, biliary fistula. The procedure was always performed with a side viewing endoscope with the patient on left side/prone decubitus, under conscious sedation. Endoscopic sphincterotomy was usually carried out with a needle knife papillotome after placement of a 10 Fr, 6 cm long, biliary plastic stent. Results: The papilla was reached and incannulated in twenty one cases at first attempt (success rate 87.5%). In one patient a rendez-vous approach was used (transpapillary guidewire passed laparoscopically via the cystic duct during laparoscopic cholecistectomy). Precut sphincterotomy was performed only in three pateints. Six plastic biliary stents were inserted in five patients (1 ampulloma, 1 pancreatic cancer, 2 hilar strictures, type 1, II, and 1 stricture distal CBD). A naso-biliary drainage was positioned in a patient with a biliary fistula of a peripheral duct (VIII hepatic segment following to hepatic surgery). In the remaining 15 patients common bile duct stones were removed. Procedure failures (12.5%) were due to a too long afferent loop preventing duodenal intubation in 2 cases and to an intradiverticular papilla in 1 case. One major complication occurred: perforation of an afferent loop was repaired surgically with an uneventful outcome. There were no cases of bleeding, pancreatitis, cholangitis or death in these series. Conclusions: ERCP in patients with Billroth II gastrectomy can be safe and successful in the majority of cases provided the procedure is carried out by a skilled and expert endoscopist.