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

142 / 172

Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e203
An intraprocedure bleeding after EMP occurred in 3 patients and
was successfully treated with adrenalin injection or endoclip. No
pancreatitis or bleeding occurred.
Conclusions: Our minor papilla approach, guide wire assisted
without contrast injection, is safe, and effective when the procedure
is performed in a high-volume referral center by experienced
endoscopists.
P.15.6
THE ACCURACY OF ACETIC ACID CHROMOENDOSCOPY (AAC)
FOR THE DIAGNOSIS OF SPECIALIZED INTESTINAL METAPLASIA
(SIM) AND EARLY NEOPLASIA (EN) IN PATIENTS WITH BARRETT’S
OESOPHAGUS (BO). SYSTEMATIC REVIEW AND META-ANALYSIS
Coletta M.*1 , Sarmed S.2, Fraquelli M.1, Casazza G.3, Conte D.1,
Ragunath K.2
1Gastroenterology Unit, Department of pathophysiology and
transplantation, ; Fondazione IRCCS Ca’ Granda - Ospedale Maggiore
Policlinico and Università degli Studi di Milano, Milan, Italy,
2Nottingham Digestive Diseases Centre, NIHR Biomedical Research
Unit; Queens Medical Centre; University of Nottingham, Nottingham,
United Kingdom, 3Dipartimento di Scienze Biomediche e Cliniche L.
Sacco, Università degli Studi di Milano, Milan, Italy
Background and aim: Barrett’s Oesophagus (BO) surveillance with a
random biopsy protocol has many limitations. It is time consuming,
invasive, and can lead to sampling error. Chromoendoscopy with
acetic acid (AAC) and targeted biopsies has been proposed as an
effective alternative to address these limitations. The aim of this
study was to assess the diagnostic accuracy of AAC for the detection
of SIM and EN (High Grade Dysplasia and Early Cancer) in patients
with BO.
Material and methods: We performed a meta-analysis of all
primary studies which compared AAC-based diagnosis (index
test) with histopathology as the reference standard. The data were
extracted both on a “per patient” and “per area” and “per procedure”
basis wherever available.
Results: Thirteen studies met the inclusion criteria. For diagnosis EN,
the pooled sensitivity and specificity for all included studies were
0.92 (95% CI 0.83-0.97) and 0.96 (95% CI 0.85-0.99), respectively.
The positive and negative likelihood ratios (LR’s) were 24.97 (95% CI
5.92-105.3) and 0.08 (95% CI 0.04-0.18) respectively. No statistically
significant different results were obtained considering only studies
with a per-patient analysis. For the characterization of SIM, the
pooled sensitivity and specificity for all the included studies were
0.96 (95% CI 0.83-0.99) and 0.67 (95% CI 0.51-0.79), respectively. The
positive and negative LR’s were 2.9 (95% CI 1.9-4.4) and 0.06 (95% CI
0.02-0.28), respectively.
Conclusions: AAC has a high diagnostic accuracy for diagnosing
early neoplasia in patients with BO. AAC has high sensitivity but
poor specificity for characterizing SIM, suggesting that histological
confirmation is mandatory when AAC is positive.
P.15.7
GUIDELINES ON THE MANAGEMENT OF ANTITHROMBOTIC
THERAPY (ATT) FOR ENDOSCOPIC PROCEDURES AND CLINICAL
PRACTICE: PRELIMINARY REPORT
Dalla Libera M.*, Parodi A., Oppezzi M., Romagnoli P., Allegretti A.,
Coccia G.
Ospedale Galliera, Genova, Italy
Background and aim: Perioperative management of ATT occurs
frequently and requires considerations of the patients (pts), the
procedures, and the antithrombotic agents. ATT with antiplatelet
agents is widespread and is indicated for the management of
primary and secondary prevention of atherosclorotic thrombotic
disease. The most frequently used agents (aspirin and clopidogrel)
need to be withheld (7-10 days before) or not depending on the risk
of bleeding of the procedures and the thromboembolic risk of the
pts according to the guidelines recommendations.
Aim of the study is to verify the adherence to the guidelines on
the management of the ATT pts for endoscopic procedures in our
endoscopic unit.
Material and methods: 117 consecutive outpatients (56 male, 61
female) taking ATT for the prevention of atherosclerotic thrombotic
disease and referred to our endoscopic unit for gastroscopy (48/120)
or colonscopy (72/120) from january 2015 to march 2015.
The endoscopists were blinded about the ongoing study and decided
autonomosly to performe or not bioptic specimens. Nurses collected
data after endoscopy.
Results: 20/117pts hade the discontinuationof theATT (16/20 aspirin,
2/20 ticlopidine, 2/20 clopidogrel) from the general practitioner
(GP) before endoscopy (4/20 egdscopy, 16/20 colonoscopy) ranging
from 1 day to 15 days. 93/117 pts did not stoped the treatment before
endoscopy. 30/95 pts had endoscopic indication for biopsy (23/30
colonoscopy, 7/30 egdscopy). Biopsies were performed during
endoscopy in 8/30 pts taking aspirin (6/8 colonscopy, 2/8 egdscopy).
The other pts were surprisingly asked to sospend ATT 7-10 days
before to repeating the procedure. No complications were reported
in biopsed pts.
Conclusions: Our preliminary data show that clinical practice is
very far from the clinical guidelines with few differences between
GP and specialists. The final aim of this observational study is to
improve the knowledge in GP and gastroenterologists for the best
management of the ATT pts and reduce risks of periprocedural
bleeding and thromboembolic complications.
P.15.8
POOR OUTCOME FROM ACUTE UPPER GASTROINTESTINAL
BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS: A PROSPECTIVE
MULTICENTER OBSERVATIONAL STUDY
Marmo R., Soncini M., Cipolletta L., Parente F., Paterlini A., Orsini L.,
Guardascione M., Amitrano L., Bargiggia S., Cesaro P., Bizzotto A.,
Dell’Era A.*, Germanà B., Cavallaro L.G., Riccioni M.E., Marmo C.,
Tortora A., Segato S., Parravicini M., Purita L., Chirico A., Spinzi G.,
Imperiali G., Maringhi A., Boarino V., Bresci G., Metrangolo S.,
Bucci C., Baldassarre G., Gasparini P., Franceschi M., Soncini M.,
Nucci A., De Nigris F., Masci E., Marin R., Antoniazzi S., Ferraris L.,
Repici A., Andreloni A., Bianco M.A., Rotondano G., De Matthaeis M.,
Lauri A., De Fanis C., Borgheresi P., De Stefano S., Lamanda R.,
Furio L., Russo A., Maringhini A., Politi F., Di Giorgio P., Pumpo R.,
Martorano M., Triossi O., Coccia G., Montalbano L.M., Zagari R.M.,
Balzano A., Buscarini E., Conte D., D’Amico G., Di Giulio E.,
De Franchis R.
Gruppo Italiano Studio Emorragia Digestiva, Rome, Italy
Background and aim: Acute upper GI bleeding (AUGIB) frequently
occurs in patients with liver cirrhosis, the main source usually
being esophago-gastric varices or portal hypertensive gastropathy.
However, the epidemiology of UGIB in cirrhotic patients appears to
be changing, with a decrease in the incidence of variceal bleeding.
On the other hand, data on cirrhotic patients with a non-variceal
source of bleeding are scarce and mainly retrospective. Aim of the
study was to assess the rebleeding, surgery and death risk in cirrhotic
patients with AUGIB from a variceal or a non-variceal source.
Material and methods: Data on patients admitted for AUGIB were
collected from January 2014 to September 2015. Primary outcomes
were 45-day mortality, recurrent bleeding, need for surgery, use of
transjugular intrahepatic portosystemic shunt (TIPS), and length of