Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e193
Background and aim: Colorectal cancer (CRC) in West Countries
is the third cause for incidence and mortality of malignant tumors
in the man after lung and prostate tumors and the second cause
in the women after breast tumors. The CRC screening is now
recommended in the general population. The aim of our study is
to assess the patients’ cumulative survival in CRC lesions diagnosed
during routine colonoscopies (RC) and in those found during the
colorectal cancer screening colonoscopies (SC).
Material and methods: We retrospectively reviewed the files
of 17587 colonscopies (8343 RC and 9244 SC) performed in our
Endoscopy Unit from July 2009 to January 2015 and extracted all the
CRC. Statistical analysis were assessed using SPSS software: student
T test for unpaired data, Pearson C2 test, Breslow test (generalized
Wilcoxon) for cumulative survival.
Results: In 65 months CRC was diagnosed in 605 pt, 329 (54%)
during SC and 276 (46%) during RC. The median follow up was 38
months. CRC prevalence was 329/9244 in SC (3,5%) and 276/8343
(3,3%) in RC (Pearson C2= 0,83, p=0,362). Mean±SD patients age at
CRC diagnosis, desease free survival and days of hospitalization after
surgery were respectively: 62,5±5,6 yr for SC group and 63,4±32,9
yr for Rc group (p=0,673), 34,3±18,6 days for SC group and 24,1±21,5
days for RC group (p<0,0001), 10,2±5,7 days in SC group and 14,2±8,5
in RC group (p<0,0001). CRC prevalence in the right colon was
significantly higher in RC 28,6% vs 16,5% of SC (p<0,001), there was
no differece in the other colon tracts between the two groups. In SC
CRC group untill 1st january 2015 314/329 pt (95,4%) were still alive
vs 162/242 pt (67%) of RC CRC group, the survival curves showed
a significatve difference between the two groups (p<0,0001).
Kaplan-Meier curves were then performed selecting only patients
aged between 50 and 70 yr, 220 pt in SC CRC group and 52 pt in
RC CRC group, and the survival estimate was respectively 98% and
81% maintainig the statistical significance (p<0,001). Cumulative
survival for male and female were respectively 97% in SC CRC group
vs 82% in RC CRC group (p<0,001) and 100% in SC CRC group vs 79%
in RC CRC group (p<0,001).
Conclusions: Data from controlled retrospective and prospective
studies have generally shown that sigmoidoscopy and colonoscopy
are associated with a significant reduction in CRC incidence and CRC
mortality. Instead the data on their impact on cumulative survival are
muchmore limited, with most studies unable to report a reduction in
cumulative survival. Although our study is a retrospective analysis,
we were able to demonstrate the effectiveness of SC in modifying
CRC patients cumulative survival comparing them with CRCs
diagnosed during routine endoscopies, with a dramatic advantage in
terms of mortality, disease free survival and time of hospitalization
after surgery.
P.13.12
OMEGA-3 SUPPLEMENTS FOR RECTAL PATIENTS IN
NEOADJUVANT CHEMORADIOTHERAPY
Pastore Silva J.*, Silva M., Aguiar S.
A.C. Camargo Cancer Center, São Paulo, Brazil
Background and aim: Clinical studies have reported beneficial
effects of Fish oil (FO) rich in Eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) in patients undergoing chemotherapy
and/or radiotherapy on different outcomes. The aim of our study is
to assess the effects on nutritional and inflammatory parameters in
specific rectal cancer population.
Material and methods: We conduct a randomized controlled
clinical trial comparing the administration of 2,2g DHA and EPA
with standard of care (SOC; no intervention) on rectal cancer. All
patients with a diagnosis of rectal cancer clinically staged as cT3-4
and/or N(+) treated on AC Camargo Cancer Center with neoadjuvant
chemoradiation followed by radical surgery are eligible. The sample
size calculated is 76 patients, to be recruited by December, 2016.
We are presenting an interim analysis. From January to October,
2015, twenty patients concluded neoadjuvant chemoradiation
until this date and had biochemical (inflammatory, hematological)
and nutritional (anthropometric, subjective global assessment,
bioelectrical impedance, handgrip strength) measured in baseline
(pretreatment antineoplastic, M1) and post-chemoradiation (M2).
Results: Were tested variables general, clinical, nutritional and
inflammatory. There is no difference in all variables between the
SOC and FO group at baseline (p>0.05). Patient Generate Subjective
Global Assessment (PG-SGA) shows that chemoradiation implicate
in nutritional deterioration: in M1 40,1% of individual was well-
nourished (PG-SGA-A) and M2 only 5%; no was difference in SOC and
FO group. FO group presents average caloric intake and right hand
grip strength greater than the SOC inM2 (p<0.05). The cachexia inM1
was present in 15% of patients and in 30% in M2; none of these with
caquexia in M2 was supplemented with FO during chemoradiation.
When Delta values (final less initial) was analyzed, a significant
increase of fat mass (Kg) in the FO group vs. decrease in SOC group
was observed (2,83 vs. -2,66; p=0,014); concerning inflammation,
Delta C-reactive protein decreased in FO group and increase in SOC
(-4,26 vs. 13,98; p=0,046). There wasn’t difference about FO and SOC
group for muscle mass (kg), muscle mass index (Kg/m2), body mass
index (Kg/m2), albumin (g/dL).
Conclusions: These preliminary results show the anti-inflammatory
action of omega-3 fish oil (EPA and DHA) and ability to prevent the
development of cachexia during chemoradiation. Was observed
preservation of muscle strength by FO even without difference in
muscle quantity.
P.13.13
DYNAMIC TRANSPERINEAL ULTRASOUND FOR THE EVALUATION
OF PELVIC FLOOR DISORDERS: WHICH IS THE BEST POSITION?
Ricchiuti A.*1, Gambaccini D.1, Bolognesi V.1, Costa F.1, Mumolo M.G.1,
Ricco G.1, Bertani L.1, Giusti P.2, De Bortoli N.1, Marchi S.1, Bellini M.1
1U.O. Gastroenterologia Universitaria, AOUP Pisa, Italy, 2U.O.
Radiodiagnostica 1 Universitaria, AOUP Pisa, Italy
Background and aim: Dynamic transperineal ultrasound
(DTPUS) is gaining increasing interest for the study of pelvic
floor pathophysiology. It is very useful to evaluate pelvic floor
dynamics and morphological changes. Unlike defecography, it is
usually performed in a left lateral position, an unnatural position
for straining and squeezing maneuvers. This study was aimed at
evaluating if body position affects the assessment of puborectalis
muscle length (PRL) and anorectal angle (ARA).
Material and methods: Twenty eight consecutive females (mean
age: 50.6±16.6 yrs) referred for the presence of chronic non organic
constipation were enrolled. According to the Rome III criteria
they were separated into functional constipation (FC) (14 pts) and
functional defecatory disorder (FDD) (14 pts) by using anorectal
manometry, Rx defecography and the balloon expulsion test.
Control subjects were 12 asymptomatic non-constipated females
(mean age 49.7±11.9 yrs). Transperineal images were obtained using
a 3.5-6 MHZ convex probe by the same operator in three different
positions: left lateral (LL), supine (SP) and sitting (ST). For each
position, the ARA and the distance between the symphysis pubis
and the posterior limit of anorectal junction (expressing the PRL) at
rest and during push straining and squeezing were evaluated. The
emptying of the rectal ampulla was assessed after filling the rectum
with 120 cc of ultrasound gel.
Results: Tab. 1 shows mean basal values of ARA and PRL in the
different positions. Tab. 2 and 3 show mean changes of ARA and PRL
during push straining and squeezing, respectively. n basal conditions
PRL values in HV were significantly different in ST in comparison