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Prospective evaluation of outcomes of ERCP procedures in a tertiary referral centre
Abstracts
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9 THE RATE OF GALLBLADDER BBJARY CHOLESTBROL ABSORPTION IS RELATED TO ANIONIC POLYPEPTIDE FRACTION CONTENT CHANGES IN GALLBLADDER BILE S Gimnni Conadini, F Liguori, N Domingo”, P Lcch8nede la Porte”, A Eramo,C Ripti, H Lafont^. Dip MedicinaClinica Div GastmentemlogiaUniversity “La Sapienza”Rome,Italy, and “Unit& 476 INSERM Marseille, France. UniV Back~ud : the human gallbladdermucosaabso& significant amountsof cholesterol (Ch) from bile andthis pmcess is impaired in Ch gallstonedisease(Gastmentemlogy 2ooO,118:912-920). Aim: to investigatethe relationshipbetweenthe anionicpolypeptidefraction (APF), which is the third abundantprotein in bile andis known to bmd biliay lipids, andthe rate of biliary Ch absorbed by the gallbladder.Methods: pig gallbladdersof comparablesize were isolatedand in vitro perfused via the cystic atcry with 300 ml of pig plasmain are-circulating system. At thebeginning of the experiments,the cystic duct was catmulatedand 13ml of naturalpig gallbladderbile or, of the same pig bile enrichedwith cholestemlto increasetherate of Ch absorption,were instilled in the gallbladderlumen after mdiolabellingwith[HJ]-Ch. The Ch removal from bile induced by mucoral absorptionwas measuredafler 180minutes.The total protein (BCA method) andAPF (ELlSA with a specific polyclcmal at&body) concentrationsin bile andplasmawere measuredat time 0 andafter 180minutes. Results:APF recoveries at the end of the experiments, comparedto the amount presentat the beginningof the experiments,were 119.5+7.2 and 102.2iS.4 % (meatts+SE)in bile andplasma,respectively. As shown in the figure, the amountof Ch removed from bile at the end ofthe experimentswas inversely correlated(r-0.9016; &KOo.OOl; n=lO) with the amountof APF presentin bile at the endof the experimentsminus the amountpresentat the beginning [TISO-TO]. No correlationwas found betweenthe amountof Ch wnoved t&n bile at the endof the experimentsandthe amountof total proteins presentin bile at the endof the experimentsminus the mount presentat the beginning. Conclusions: the gallbladdersecretesAPF into bile. Our results indirectly suggestthat APF could be IO-absorbedby the gallbladdertnucosa togetherwith biliary Ch.
PROSPECTIVEEVALUATION OF OUTCOMES OF ERCP PROCEDURES IN A TERTIARY REFERRAL CENTRE FoscbiaF, Pattdolfi M, SK Shah,Mutignti M, Petri V, CostamagnaG Digestive EndoscopyUnit, Catholic University, Rome, Italy Osp.PoliclitticoGemelb Backgmundand Aims: Endoscopictechniqueshave expandedenormously over the last 20 years. The needfor objective evalutationof interventionalproceduresis recognizedmcmasin81y.We prospectively evaluatedthe outcmmesof ERCP and its ability to modify the pre-pmccdure diagnosis.Patientsand methods:SinceDecember 1999,500~~nsccuti~epatientsi.MlF1.1,mean age66, range1l-95) undergoingERCP were evaluatedpmspextively. Pre ERCP, patientswere evaluatedby US SU??,CT 23%, MRCP 9.2%. Secretin-MRCP6%. Aim of ERCP was defined beforecommencingthe examination. ERCP outcomes were evaluatedaccordingto Cottons criteria (GastmintestEndosc; 40:514-18,1994). Patientswere followed for late complications. Results:Primary failure occurred in 11.8%(failed 2.4%-incomplete9.4%), 87% ofthese procedures were Z&51619; grade415according to technical difficulty grading scale(Schuts, Gastmintes Endosc;51: 535.39,2OOO).In previously failed BRCP from other hospitals, successwas 90%. Procedurerelatedcomplicationsccamed in 23.4% patients(minimal 13.4%,mild 5.4%, moderate 4.4%, severe0.2%, fatal O%), non specific complications0.4%, szquelae11.4%, sewnday failure 0.2%. ERCP modify diagnosispreviously suspectedby conventionalimaging techniquesin 72% patientswith biliary beni@ strictures, 64% of ampullary tumors, 55% ofbilc duct stones, 43% of bile duct tutnon, 37% of gallbladdertumors, 28% ofmetastatic.sbicmres and 19% ofpancreatic ttmors. Sequelaecould always bc retreatedby endoscopy.Conclusions: ERCP in a terttary referral center is safe andeffective both on a diagnosticand therapeuticaspect evenwhen prospectively evaluated.
10 AN INDIRECT MEASURE OF THE ACCURACY OF COLONSCOPY IN A DIGESTIVE ENM)SCOPY UNIT Guatti-Zuliani C ‘, SassatelliR, Bedogni G Setvizio di EndoscopiaDigestiva, ArcispedaleS. Maria Nuova, Reggio Emil@ * Cattedmdi Gastnentemlogia, Universit& degli Studi di Pamn Amispedale S. Maria Nuovs, ; Colonos~ov is not infallible. Determining the accuracy of colonscopy is not possiblebecausethere is no sup&r method by which to reliabl~assessits results. An indirect nteastueof the accuracy and efficacy of colonoscopy may be to determinethe percentageof patients in whom colorectal cmca is dinenosedsoon after an aooaretttl~neaativewlonoscaw. These ASGE statements representthe-back8mudof the pm&t stud;. t&HODS: In thdperiod October 2000~Jamw~y2001 we retms~~~tively evaluatedthe fraction of missedcancer andmajor polyps (>lcm) in our Unit of Digestiv~!Zndos&py (total colonoscopia’year 2OCQn 3200). Completenessof wkmoswpy was also recorded, as it representsa limiting factor for accuracy. We consideredonly casesin which a dxectd cancer (or maim r&v) was detectedatIer a ‘her&e” total colonoscopy performed less than 5 years bef& (3 y&s’fo;~‘major polyp) at our c-z&: thesewere deemedmissed cancer (0~ DO~YLI). RESULTS A total of 1032colonoswpies were consider& total ~lonoscopy was possible in thk97.3 % of cases (stricture and insufficient cleanin excluded). A total of 84 major polyps and 41 cancerswere detected(total 125lesions in 125patients).Nineteenof these 125 patients(15.2%) had a prior colotmscopy at our center. In 11 cases (10 polyps and 1 cancer) the definition of “missing” was met. A negativeprevious wlonoscopy had beenperformed in 281 out of 821 negativecases (34.2 %). Tlus 11 missing have beenidentified out of 300patients in whom a colomscopy hadbeen alreadyperformed (3.6%). CONCLUSIONS: A 3.6 % of”missing” plypsIm~ seemsto be satscceptablerate. So, accordingto mu experience,this is a good indirect measll~eof accuracy of colonoscopy andcould be extensively usedby the Digestive Endoscopy Units in which the referal population remains stable.
INHERITED THROMBOPHUIC FACTORS IN THE PATHWBNESIS OF PORTAL VEIN THROMBOSIS DEVELOPING AFTER ENWSCOPIC SCLEROTHERAPY L. Amitrano, M.A. Guardascione,R. M&no, V. Bmncaccio, L. Iatmawne, M. Margaglione,M. Sacm, A. Balzano Gasttwntemlogy Unit, CoagutationUnit an Radiology DepartementeAORN ’ A. Cardarelli”, Naples,Atbercclemsis and Thrombosis Unit, IRCCS “&a sollievo della Sofferenza”,S. Giovanni RotondoItaly A.C&lli BACKGROUND Poti vein tbmmbosis (FVT) is arare event in patientswith liver cirrhosis in absemeof a relatedhepatocellti carcinoma.Endoswpic sclemtherapy(ES) of oemphagenl vatices hasbeenanecdotily associatedwith the developmentof p&al vein thmmbasis. Pmzntly, thmmb~pbilicfactors either congenitalor acquiredhave beenidentified to have arole in PVT of cirrhotic and non cinhntic patientsAIM We investigatedtheprsscnce of inheritedthmmbaphiiic facton in patientswith liver cirrhosis who developedPVT after ES for bleedingcesophageal vatices. PATIENTS AND METHODS From June 1998to December 1999all cirrhotic patients adminedto our hospitalbecauseofbleeding oesophagealvariccs andwdergcdng multiple sessions of ES were considered.Critetia of exclusion were: hepatoeelluiarcarcinoma,previous panoCavalor intrahepaticshunts,pxexisting PVT, patientswho did not completedES program. Doppler dhasotmd of the portal vein was perfomxd before sclemtbempyand evety tbrez months thereafter. Factor V Leiden (NL) mutation,pmtbmmbin mutation G202lOA (PTHRA20210) andmutation TT677 of methylenetetr&ydmfoIate reductasc(TT677MTHFR) were evaluatedin all patients. RESULTSSixty-one patientswho achievedcompletevat&al eradication were included.PVT developedin IO/61 (16%) of thepatients after a mean follow-up of 7.4mooths (2-11). A genetic causefor thrombosis was found in 7/10 (7p/o) PVT patients(5 pts PTHP.A202IO,2 pts TT6777MTHFR) but only in 4 (8%) of 51 nott PVT (NPVT) patients(1 pt FVL, 1pt PTHRA202IO,2 pts TT677MTHFR). The developmentof PVT was not associatedwith acute clinical eventy rehleedingsrelatedto portalhypatension were more frequentin PVT patients(60% YS14%). CONCLUSIONS The developmentof PVT after ES of oesophagealvatices may indicate a coexisting inheritedtbmmbopblicfactor. Our study hypothesizesthat ES may trigger PVT only in patientswith inheritedthmmbopbilic stigmata.
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9 THE RATE OF GALLBLADDER BBJARY CHOLESTBROL ABSORPTION IS RELATED TO ANIONIC POLYPEPTIDE FRACTION CONTENT CHANGES IN GALLBLADDER BILE S Gimnni Conadini, F Liguori, N Domingo”, P Lcch8nede la Porte”, A Eramo,C Ripti, H Lafont^. Dip MedicinaClinica Div GastmentemlogiaUniversity “La Sapienza”Rome,Italy, and “Unit& 476 INSERM Marseille, France. UniV Back~ud : the human gallbladdermucosaabso& significant amountsof cholesterol (Ch) from bile andthis pmcess is impaired in Ch gallstonedisease(Gastmentemlogy 2ooO,118:912-920). Aim: to investigatethe relationshipbetweenthe anionicpolypeptidefraction (APF), which is the third abundantprotein in bile andis known to bmd biliay lipids, andthe rate of biliary Ch absorbed by the gallbladder.Methods: pig gallbladdersof comparablesize were isolatedand in vitro perfused via the cystic atcry with 300 ml of pig plasmain are-circulating system. At thebeginning of the experiments,the cystic duct was catmulatedand 13ml of naturalpig gallbladderbile or, of the same pig bile enrichedwith cholestemlto increasetherate of Ch absorption,were instilled in the gallbladderlumen after mdiolabellingwith[HJ]-Ch. The Ch removal from bile induced by mucoral absorptionwas measuredafler 180minutes.The total protein (BCA method) andAPF (ELlSA with a specific polyclcmal at&body) concentrationsin bile andplasmawere measuredat time 0 andafter 180minutes. Results:APF recoveries at the end of the experiments, comparedto the amount presentat the beginningof the experiments,were 119.5+7.2 and 102.2iS.4 % (meatts+SE)in bile andplasma,respectively. As shown in the figure, the amountof Ch removed from bile at the end ofthe experimentswas inversely correlated(r-0.9016; &KOo.OOl; n=lO) with the amountof APF presentin bile at the endof the experimentsminus the amountpresentat the beginning [TISO-TO]. No correlationwas found betweenthe amountof Ch wnoved t&n bile at the endof the experimentsandthe amountof total proteins presentin bile at the endof the experimentsminus the mount presentat the beginning. Conclusions: the gallbladdersecretesAPF into bile. Our results indirectly suggestthat APF could be IO-absorbedby the gallbladdertnucosa togetherwith biliary Ch.
PROSPECTIVEEVALUATION OF OUTCOMES OF ERCP PROCEDURES IN A TERTIARY REFERRAL CENTRE FoscbiaF, Pattdolfi M, SK Shah,Mutignti M, Petri V, CostamagnaG Digestive EndoscopyUnit, Catholic University, Rome, Italy Osp.PoliclitticoGemelb Backgmundand Aims: Endoscopictechniqueshave expandedenormously over the last 20 years. The needfor objective evalutationof interventionalproceduresis recognizedmcmasin81y.We prospectively evaluatedthe outcmmesof ERCP and its ability to modify the pre-pmccdure diagnosis.Patientsand methods:SinceDecember 1999,500~~nsccuti~epatientsi.MlF1.1,mean age66, range1l-95) undergoingERCP were evaluatedpmspextively. Pre ERCP, patientswere evaluatedby US SU??,CT 23%, MRCP 9.2%. Secretin-MRCP6%. Aim of ERCP was defined beforecommencingthe examination. ERCP outcomes were evaluatedaccordingto Cottons criteria (GastmintestEndosc; 40:514-18,1994). Patientswere followed for late complications. Results:Primary failure occurred in 11.8%(failed 2.4%-incomplete9.4%), 87% ofthese procedures were Z&51619; grade415according to technical difficulty grading scale(Schuts, Gastmintes Endosc;51: 535.39,2OOO).In previously failed BRCP from other hospitals, successwas 90%. Procedurerelatedcomplicationsccamed in 23.4% patients(minimal 13.4%,mild 5.4%, moderate 4.4%, severe0.2%, fatal O%), non specific complications0.4%, szquelae11.4%, sewnday failure 0.2%. ERCP modify diagnosispreviously suspectedby conventionalimaging techniquesin 72% patientswith biliary beni@ strictures, 64% of ampullary tumors, 55% ofbilc duct stones, 43% of bile duct tutnon, 37% of gallbladdertumors, 28% ofmetastatic.sbicmres and 19% ofpancreatic ttmors. Sequelaecould always bc retreatedby endoscopy.Conclusions: ERCP in a terttary referral center is safe andeffective both on a diagnosticand therapeuticaspect evenwhen prospectively evaluated.
10 AN INDIRECT MEASURE OF THE ACCURACY OF COLONSCOPY IN A DIGESTIVE ENM)SCOPY UNIT Guatti-Zuliani C ‘, SassatelliR, Bedogni G Setvizio di EndoscopiaDigestiva, ArcispedaleS. Maria Nuova, Reggio Emil@ * Cattedmdi Gastnentemlogia, Universit& degli Studi di Pamn Amispedale S. Maria Nuovs, ; Colonos~ov is not infallible. Determining the accuracy of colonscopy is not possiblebecausethere is no sup&r method by which to reliabl~assessits results. An indirect nteastueof the accuracy and efficacy of colonoscopy may be to determinethe percentageof patients in whom colorectal cmca is dinenosedsoon after an aooaretttl~neaativewlonoscaw. These ASGE statements representthe-back8mudof the pm&t stud;. t&HODS: In thdperiod October 2000~Jamw~y2001 we retms~~~tively evaluatedthe fraction of missedcancer andmajor polyps (>lcm) in our Unit of Digestiv~!Zndos&py (total colonoscopia’year 2OCQn 3200). Completenessof wkmoswpy was also recorded, as it representsa limiting factor for accuracy. We consideredonly casesin which a dxectd cancer (or maim r&v) was detectedatIer a ‘her&e” total colonoscopy performed less than 5 years bef& (3 y&s’fo;~‘major polyp) at our c-z&: thesewere deemedmissed cancer (0~ DO~YLI). RESULTS A total of 1032colonoswpies were consider& total ~lonoscopy was possible in thk97.3 % of cases (stricture and insufficient cleanin excluded). A total of 84 major polyps and 41 cancerswere detected(total 125lesions in 125patients).Nineteenof these 125 patients(15.2%) had a prior colotmscopy at our center. In 11 cases (10 polyps and 1 cancer) the definition of “missing” was met. A negativeprevious wlonoscopy had beenperformed in 281 out of 821 negativecases (34.2 %). Tlus 11 missing have beenidentified out of 300patients in whom a colomscopy hadbeen alreadyperformed (3.6%). CONCLUSIONS: A 3.6 % of”missing” plypsIm~ seemsto be satscceptablerate. So, accordingto mu experience,this is a good indirect measll~eof accuracy of colonoscopy andcould be extensively usedby the Digestive Endoscopy Units in which the referal population remains stable.
INHERITED THROMBOPHUIC FACTORS IN THE PATHWBNESIS OF PORTAL VEIN THROMBOSIS DEVELOPING AFTER ENWSCOPIC SCLEROTHERAPY L. Amitrano, M.A. Guardascione,R. M&no, V. Bmncaccio, L. Iatmawne, M. Margaglione,M. Sacm, A. Balzano Gasttwntemlogy Unit, CoagutationUnit an Radiology DepartementeAORN ’ A. Cardarelli”, Naples,Atbercclemsis and Thrombosis Unit, IRCCS “&a sollievo della Sofferenza”,S. Giovanni RotondoItaly A.C&lli BACKGROUND Poti vein tbmmbosis (FVT) is arare event in patientswith liver cirrhosis in absemeof a relatedhepatocellti carcinoma.Endoswpic sclemtherapy(ES) of oemphagenl vatices hasbeenanecdotily associatedwith the developmentof p&al vein thmmbasis. Pmzntly, thmmb~pbilicfactors either congenitalor acquiredhave beenidentified to have arole in PVT of cirrhotic and non cinhntic patientsAIM We investigatedtheprsscnce of inheritedthmmbaphiiic facton in patientswith liver cirrhosis who developedPVT after ES for bleedingcesophageal vatices. PATIENTS AND METHODS From June 1998to December 1999all cirrhotic patients adminedto our hospitalbecauseofbleeding oesophagealvariccs andwdergcdng multiple sessions of ES were considered.Critetia of exclusion were: hepatoeelluiarcarcinoma,previous panoCavalor intrahepaticshunts,pxexisting PVT, patientswho did not completedES program. Doppler dhasotmd of the portal vein was perfomxd before sclemtbempyand evety tbrez months thereafter. Factor V Leiden (NL) mutation,pmtbmmbin mutation G202lOA (PTHRA20210) andmutation TT677 of methylenetetr&ydmfoIate reductasc(TT677MTHFR) were evaluatedin all patients. RESULTSSixty-one patientswho achievedcompletevat&al eradication were included.PVT developedin IO/61 (16%) of thepatients after a mean follow-up of 7.4mooths (2-11). A genetic causefor thrombosis was found in 7/10 (7p/o) PVT patients(5 pts PTHP.A202IO,2 pts TT6777MTHFR) but only in 4 (8%) of 51 nott PVT (NPVT) patients(1 pt FVL, 1pt PTHRA202IO,2 pts TT677MTHFR). The developmentof PVT was not associatedwith acute clinical eventy rehleedingsrelatedto portalhypatension were more frequentin PVT patients(60% YS14%). CONCLUSIONS The developmentof PVT after ES of oesophagealvatices may indicate a coexisting inheritedtbmmbopblicfactor. Our study hypothesizesthat ES may trigger PVT only in patientswith inheritedthmmbopbilic stigmata.
A3